Cheil
Lips
Stom or stoma
Mouth
Actinic
Sun
Angular stomatitis/cheilitis
Cracks, fissures at corner of mouth
In older adults (or anyone actually), angular stomatitis/cheilitis is often due to? Name 3
- B vitamin deficiency
- Iron deficiency anemia
- Malnutrition
Blotchy, mottled, swollen lips due to damage from chronic sun exposure
Actinic cheilitis
Why keep an eye on sun damaged lips?
Potential for cancer
Cold sores are due to an infection with ____
Herpes simplex virus 1 (HSV1)
Small, painful, fluid-filled blisters near lips or around mouth
Cold sores
When are cold sores contagious?
When lesions are present (when you can see them!)
Stress, anxiety, sunlight, hormonal changes, exhaustion, infections in other parts of the body - are all triggers for this lip infection
HSV1 = cold sores
Name a few treatments for cold sores:
- OTC ointments: topical lidocaine, benzyl alcohol (Zilactin)
- Cold or warm compresses
Red, swollen tonsils, can have white patches. Sore throat, difficult/painful swallowing. Headache, fever/chills. ABDOMINAL PAIN in children.
Tonsillitis
Tonsillitis is most often due to ____ infection, but can be from ___ infection
Viral, bacterial
List two mouth/throat reasons to seek emergency care and why:
- Drooling
- Unable to swallow because of pain or swelling
(May indicate epiglottitis, which can lead to asphyxia)
Tests for tonsillitis (2):
- Throat swab (check for strep)
2. CBC
A tonsillectomy is elected for kids who have what criteria? (3)
- 7+ infections in a year
- 5+ infections each year for two straight years
- 3+ infections/year for 3 straight years
Self care for tonsillitis? (Remember, most are viral)
- Gargle with warm salt water
- Drink soothing liquids
- When necessary, take acetaminophen or ibuprofen for pain
Crevices in tonsils where food can become lodged, leading to infections
Tonsillar crypts
Sore, yellow-white, raised patches in mouth and throat due to proliferation of a fungus. Name fungus also
Oral thrush/candidiasis
—Candida albicans
Name a common cause of oral thrush/candidiasis. Hint: asthma
Inhaled corticosteroids (ICS)
In what two ways can someone reduce risk of thrush when using ICS’s?
- Use a spacer
2. Rinse mouth after using
Name an oral antifungal that can be used to treat thrush:
Nystatin
Another side effect of ICS’s is a change in the patient’s voice, and discomfort while talking. This is known as:
Dysphonia
A thickened, white plaque in the mouth, tongue, or gums. Usually not painful. Most are benign, but it IS the MC pre-cancerous growth in the mouth.
Leukoplakia
What is believed to cause most cases of leukoplakia?
Tobacco use (smoking or chewing)
Small yellow spots with red borders on soft tissues inside the mouth. Can be very painful. Not contagious. More common in women.
Canker sore
____ containing sodium lauryl sulfate (SLS) can cause aphthous ulcers
Toothpastes
What nutritional supplements may help treat canker sores? (4)
- B complex
- Zinc
- Vitamin C
- Probiotics
A _____ is due to incomplete fusion of the hard and/or soft palate
Cleft palate
A bony growth on the hard palate
Torus palatinus (plural=palatini)
Prevalence of torus palatinus is __-__% of the population. Also name more common populations.
30-35%
Asian, Inuit, females
A bony growth on the mandible, on surface nearest to tongue. 90% of cases are bilateral. Prevalence is 7-10% of pop.
Torus madibularis
Surgery to fix a short (or improperly attached) frenulum?
Frenulectomy
Laryngotracheobronchitis (LTB) is commonly called ____
Croup
Croup/LTB is a ____ infection of the sub-glottic area
Viral
Name 3 sx’s in children w/croup:
- Barking cough
- Stridor
- Hoarseness
Croup is most common in children ages __-__
3 months-5 y.o.
Croup causes a ____ of the airways/trachea
Narrowing
Several days of ___ sx precede croup sx
Cold
The chief DDX for croup?
Epiglottitis
An AP X-Ray of the trachea would show a classic ___ sign
Steeple
A child with an abrupt onset (2-4 hours) of fever, severe dysphagia, and drooling, with NO hx of recent cold sx’s would most likely have?
Epiglottitis
Epiglottitis can lead to sudden ____. Child needs to go to ER
Asphyxia
Home care for a child with croup? (2 options)
- Mist therapy (hot shower, close door, have child breath for 20 minutes)
- Cold air therapy (bundle child up, go outside in cold air, have child breath for 20 mins)
____ percussion (to open airways) can also help treat croup/LTB
Upper thoracic
Should you adjust a child if epiglottitis is suspected?
NO
Inflammation and/or mass in the laryngeal part of the main airway. Leads to hoarseness and loss of normal voice
Laryngitis
Chronic, persistent laryngitis is more common in what two groups of people?
- Smokers
2. People w/allergies
Name 4 contributing factors of laryngitis:
- Dry air (winter)
- Smoke, dust, noxious gasses
- Allergies (hay fever)
- Use of ICS’s (asthma)
Non-smokers and people who talk or sing for a living may have a __ or __ on their larynx. People who smoke (or smoked) and have been hoarse for years may have ___ of the larynx
Cyst, nodule
Cancer
When suspecting laryngitis, what is the best question to ask your patients?
When was the last time you had your normal voice?
List some patient self-care options for laryngitis:
- Rest voice (do not whisper either)
- Hydrate, humidify air
- Vitamin C (250-500mg)
- Echinacea and Zinc
- Throat lozenges or cough drops
An acute inflammation of the mucosa of the pharynx
Pharyngitis (sore throat)
____ is one of the top 10 reasons for ER visits
Pharyngitis/sore throat
Pharyngitis is most often (70%) caused by ___ infection
Viral
The most important cause of sore throat to rule out is?
Group A beta-hemolytic streptococcus (GABHS)
Strep throat requires antibiotic treatment due to risk of what serious complication?
Rheumatic fever
Name a good confirmatory test for infectious mononucleosis (IM/Mono)
Monospot test
Patient presents with fever, fatigue, sore throat, swollen lymph nodes, HA, chills, possible anorexia. What is a top DDX?
Infectious mononucleosis
Taking 1 teaspoon of liquid antacid at bedtime (not long term) can help treat?
Sore throat from postnasal drip
Strep throat is most common in what season(s)?
Late winter, early spring
Name the top DDX. Fever, lymphadenopathy, red and swollen pharynx and tonsils, white tonsillar exudates, pain on swallowing, HA, nausea, vomiting, ABSENCE of cold symptoms.
Strep throat (GABHS pharyngitis)
Red cheeks, circumoral pallor, strawberry tongue are good signs of?
Scarlet fever
The __ test is most common for diagnosing strep now (takes 10-15 minutes)
Rapid strep
If rapid strep test is negative, a ___ is used to diagnose strep throat
Throat culture
Treatment for strep throat (antibiotics) is directed towards what?
Preventing rheumatic fever
These symptoms occur 1-4 weeks post strep: migrating polyarthritis, carditis (chest pain, SOB, palpitations)
Rheumatic fever
Carditis, which affects the heart valves, occurs in about __% of cases of rheumatic fever
50%
What antibiotic is usually used in the treatment of rheumatic fever?
Penicillin
A monthly penicillin shot is administered to patients with RF until the patient is at least __ y.o. (Usually)
20
An acute contagious disease characterized by an exotoxin that forms a pseudomembrane (usually on resp. Mucosa), causes myocardial and neural tissue damage.
Diphtheria
Bacteria that causes diphtheria?
Corynebacterium diphtheriae
Incubation period for patient with diphtheria?
1-7 days
Overwhelming fatigue
Prostration
What nerves are first involved in diphtheria infection?
Cranial
What is given early in all cases where diphtheria is suspected?
Diphtheria antitoxin (derived from horses)
A ____ test is given to determine a person’s susceptibility to diphtheria
Schick
An acute, highly contagious bacterial disease characterized by paroxysmal or spasmodic cough that usually ends in prolonged, high-pitched, crowing, inspiratory “whoop”
Pertussis
Name of the gram-negative coccobacillus that causes pertussis?
Bordetella (Hemophilus) pertussis
Patients with pertussis (whooping cough) are not usually contagious after the __ week of paroxysmal phase
3rd
__% of pertussis cases are in children less than 2 years of age
50%
Incubation period for patient with pertussis?
7-17 days
Symptoms of pertussis usually last about __ weeks and have __ stages
6, 3
Name the 3 stages of pertussis:
- Catarrhal (cold sx)
- Paroxysmal (coughing jags)
- Convalescent (healing)
Is fever common in patient’s with pertussis?
NO (if they have it, low-grade, which is uncommon for children w/bacterial infections)
“Emetic” means?
Induces vomiting
Vomiting is common during the coughing jags of pertussis because the ___ is emetic
Mucus
The paroxysmal stage of pertussis begins at about __-__ days, and last to about __ weeks
10-14, 4
What WBC is most elevated in pertussis? (70%)
Lymphocytes (which is odd because I thought viral infections cause an increase in lymphocytes…)
Pertussis (whooping cough) kind of looks like a ___, but doesn’t go away.
Cold
Most frequent complications of pertussis? (4)
- Asphyxia
- Pneumonia
- Cerebral hemorrhage
- Otitis media
____ are NOT helpful for pertussis and should be avoided
Cough suppressants
What vaccine is used to help prevent diphtheria and pertussis?
DTaP (Diphtheria, Tetanus, and Pertussis)
Tdap is used as a booster and for adults.
Fancy name for canker sores
Aphthous ulcer