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Clin Med 1- HEENT > Mouth & Throat > Flashcards

Flashcards in Mouth & Throat Deck (80):
2

How does Leukoplakia present?

White patch or plaque that cannot be rubbed off

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What causes Leukoplakia?

often hyperkeratosies occurring in response to chronic irritation

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Leukoplakia treatment/plan

-Early referral (5% dysplasia/early invasive squamous cell carcinoma -Biopsy -stop tobacco -stop ETOH

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How does hairy leukoplakia present?

Slightly raised lekoplakic areas with a corrugated or “hairy surface” Filaform papilla on the tongue(lateral) will elongate and look like little hairs Common early finding in HIV infection Developes quickly

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How does Erythroplakia present?

Slow-growing, erythematous, velvety red lesion with well-defined margins, occurring on a mucous membrane, most often in the oral cavity. -Older males – 65-75yo  

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Where are the most common sites for Erythroplakia?

Lateral tongue Floor of mouth  Soft palate  Alveolar ridge

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How does Oral Lichen Planus present?

Lesions may appear as: -Lacy, white, raised patches of tissues -Red, swollen, tender patches of tissues -Open sore  

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What causes Oral Lichen Planus?

Chronic inflammatory autoimmune disease

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Oral Lichen Planus treatment?

O Managing pain and discomfort O Corticosteroids O Cyclosporines and retinoids O Low rate (1%) of SCC arising within lichen planus if correctly diagnosed

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What is the most common form of oral cancer?

Oral squamous cell carcinoma (OSCC O Accounts for more than 90% of all oral cancers

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What are the initial stages of oral cancer?

O Erytholeukoplastic area O Without symptoms

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What are the advanced stages of oral cancer?

O Ulcers and lumps with irregular margins, which are rigid to palpation

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oral cancer S/Sx?

O Ear pain O Chronic sore throat, hoarseness or change in voice O Remarkable weight loss O Unexplained bleeding in the mouth O Change in the way of fitting the teeth and dentures O Difficulty to chew, speak, swallow to move the jaw or tongue O Constant sores on the face, mouth or neck that bleed easily and do not heal within two weeks O A feeling that something is caught in the back of the throat O Presence of velvety red, white or speckled color of patched in the mouth O Unexplained numbness or loss of feeling O Pain and softness in any area of the mouth, neck or face O Thickness or swelling, crusts, rough sports and eroded areas on the gums, lips and other areas inside the mouth

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How do Apthous Ulcers present?

Recurrent small, round, or ovoid ulcers with circumscribed margins, erythematous haloes, and yellow or gray floors. O Restricted to the mouth O Typically starts in childhood or adolescence

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Are labs ordered for Apthous Ulcers?

Yes, but only if they are recurrent

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Apthous Ulcer treatment?

O Vitamin B12 used orally may have some effect O Topical corticosteroids (TCs) remain the mainstays of treatment O Topical tetracyclines may reduce the severity of ulceration, O Chlorhexidine gluconate mouth rinses O Anti-inflammatory agents

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How does Geographic Tongue present?

Patches on the tongue; Tongue - patchy; Benign migratory glossitis

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What causes Geographic Tongue?

O Unknown O May be caused O Vitamin B deficiency O Irritation from hot or spicy foods, or alcohol O The condition appears to be less common in smokers

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What are the S/Sx of Geographic Tongue?

O Map-like appearance to the surface of the tongue O Patches that move from day to day O Dunuded appearing O Soreness and burning pain (in some cases)

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What are the S/Sx of Oral Candidiasis?

O White patches in mouth or on tongue O Cottage or mild curds O Sore mouth and tongue and/or difficulty swallowing O Poor appetite O Burning feeling in mouth and throat (at start of a thrush infection) O Bad taste in mouth O Typically only mild pain  

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What other symptom can be caused by Oral Candidiasis in infants?

Diaper rash May develop because yeast may be in stool

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What is Oral Candidiasis also known as?

Thrush

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What is Candida albicans?

a fungus that causes Thrush

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Oral Candidiasis treatment?

Treat underlying cause O DM O HIV O Immunosuppresion O Antibiotic use O Steroid Inhalers Nystatin(antifungal), Gentian violet, Magic Mouthwash

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What is a irretation fibroma?

Slow-growing fibrous nod ules on the oral mucosa, resulting from irritation caused by cheek biting or objects such as dentures and fillings.

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What is Epulis Fissurata

Mucosal hyperplasia from low grade trauma ie. dentures.

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What are Fordyce’s Granules

Sebaceous glands found in the mouth O Small yellow dots in the oral mucous membrane O Misplaced sebaceous glands

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Fordyce's Granules treatment

 Once properly diagnosed, no treatment is necessary

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What is a Hemangioma

Abnormal build-up of blood vessels in the skin or internal organs

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What is a Papilloma?  

Benign epidermal tumor that grows out of the skin.

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What can cause Oral Herpes Simplex Virus

Stress, Chemothreapy, Infection

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Oral Herpes Simplex Virus treatment?

PO or topical antivirals

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What do salivary glands secrete?

amylase

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What increases risk for Sialadenitis

Dehydration, Radiation, Immunosuppression

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What bacteria cause Sailadenitis?

O Staphylococcus aureus – most common O Streptococcus viridans O Haemophilus influenzae O Streptococcus pyogenes O Escherichia coli

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Sialadenitis treatment?

Antibiotics, steroids, warmth

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What causes Parotitis?

Can be either bacterial or viral. S. aureus is the most common. Viral can be from mumps(paramyxovirus) or non-mumps.

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What is bilateral Parotitis likely caused from?

Mumps

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What is Sialolithiasis?

Salivary stones. They often block the salivary gland duct opening

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What is Ranula

A mucocele on the floor of the mouth

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What is Epulis?

A mucocele on the gums

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Pharyngitis S/Sx?

O Sore throat  O Dysphagia O Odynophagia O Fever O Headache O Abdominal pain O Nausea/vomiting  

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What symptoms suggest a viral pharyngitis?

Coryza, Conjunctivitis, Hoarseness

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What can be complications of group A beta hemolytic streptococcal infection (GABHS)

1)Rheumatic Fever 2)Acute proliferative glomerulonephritis

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What can Rheumatic Fever cause?

O Arrythmias O Damage to heart valves O Endocarditis O Heart failure O Pericarditis O Sydenham chorea

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What is Acute proliferative glomerulonephritis?

Inflammation of the glomeruli in the kidney which can lead to renal failure and hypertensive enceophalopathy

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What symptoms suggest GABHS pharyngitis?

O Fever >38°C O Tender anterior cervical adenopathy O Lack of cough O Pharyngotonsillar exudate O Sore throat – may be severe O Odynophagia O Palatal petechiae O Tender cervical adenopathy O Elevated WBC and left shift possible O Headache O Chills (rigors) O Flushed face

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What are S/Sx of Scarlet Fever?

Sandpaper rash with onset 24 to 48hrs post strep throat symptoms Strawberry tongue

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How is Strep transmitted?

direct person contact (saliva, nasal secretions) and may be transmitted with food preparation

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How long is incubation for strep pharyngitis

2-5days

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When can a child with strep return to school? 

After 24 hours with no fever (usually 1-3 days)

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What labs are ordered to confirm strep?

Streptococcal Rapid Antigen Test. If negative then a culture is done to confirm negative result.

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What can be consequences if strep goes untreated?

O Acute rheumatic fever O Acute post streptococcal glomerulonephritisis O Peritonsillar abscesses.

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Strep Treatment?

Symptomatic management First line Abx= Penicillin VK Second line= Augmentin

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What is mono caused by?

Epstein-Barr virus infecting B cells

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How long is mono incubation?

4-8 weeks

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What are the S/Sx of mono

O Exudative pharyngitis(>97%) O Prominent cervical lymphadenopathy (>97%) O Posterior cervical: most common O Pharyngeal erythema and edema(85%) O Splenomegaly (75%) O Palatal petechiae (50%)

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What labs test for mono?

O Throat Culture O Lymphocyte predominance O Lymphyocyte atypia – very specific O Heterophil antibody test (Monospot test)

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What is involved in the management of mono?

O Rest O Non-caffeinated fluids for adequate hydration O NSAIDs O Avoid strenuous exercise or sport  

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How long does a person with mono need to avoid strenuous exercise?

Moderate training allowed after 3 weeks. Strenuous activity allowed after 4 weeks.

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When would you use Abx with mono?

only indicated if coexisting strep (rash develpes in 90% of EBV pts on Abx)

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Complications of Mono?

O Meningoencephalitis O Guillain-Barre Syndrome O Bell’s Palsy O Pneumonitis O Myocarditis

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What is Quinsy?

Peritonsillar Abscess-Infection of the tonsil(s) that spreads to surrounding areas with a pocket of infected material.

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What often causes a Peritonsillar abscess?

Group A strep

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What are S/Sx of peritonsillar abscess?

Trismus(clenched teeth) Drooling Muffled voice Unilateral throat pain Uvula deviates to opposite side

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What tests are ordered for a peritonsillar abscess?

O Labs to r/o mono & strep O I&D or aspiration w/ C&S O CT scan

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peritonsillar abscess treatment?

O Antibiotics O I&D O Pain meds

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Peritonsillar Abscess complications?

O Airway obstruction O Cellulitis O Endocarditis/pericarditis O Pneumonia

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Symptoms of Retropharyngeal Abscess?

O Neck pain out of proportion to findings O Dysphagia O High fever

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Retropharyngeal abscess tests?

Lateral neck Xray showing bulging of posterior pharyngeal wall

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Retropharyngeal Abscess management?

O Hospitalize O Airway observation O IV Antibiotics O Early ENT consultation

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Epiglottitis S/Sx

Shortness of breath Drooling "Sniffing Position"

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what will a Xray show with Epiglottitis?

Thumbprint sign

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Epiglottitis treatment

O Avoid tongue depressor or other oral instruments O Epiglottitis irritation may lead to obstruction O Keep patient calm O Airway management ASAP! O Do not attempt to intubate!! O Do not lay person down! O Hospitalization O Antibiotics O Anti-inflammatory meds (steroids)

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What can cause Laryngitis?

O Viral infection (Most common cause of acute) O Bacterial infection O Gastroesophageal reflux disease (GERD) O Nerve damage, sores, polyps, nodules on the vocal cords

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What is the most common cause of acute Laryngitis?

Viral infection

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What is the most common cause of chronic laryngitis?

GERD

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Laryngitis S/Sx

O Hoarseness O Aphonia (voice breaks intermittently) O Upper respiratory infection (URI) symptoms variably present O Leukocytosis, if bacterial

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Laryngitis treatment

O Increased household humidity O Rest voice (including asking patient to not whisper) O Increase hydration O Analgesics O Treat underlying cause such as GERD

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What indicates a ENT referral for Laryngitis?

Hoarseness persisting beyond 2 weeks