Mouth and throat Flashcards
(116 cards)
1
Q
2 types of HSV
A
HSV1
HSV2
2
Q
Which type of HSV does not cause oral lesions? What lesion does it cause instead?
A
HSV2
It causes genital lesions
3
Q
What is the hallmark feature of all herpes viruses
A
They can establish latent infections that can be reactivated and persist for the life of the individual
4
Q
Primary HSV presentation
A
Primary gingivostomatis - painful ulcers on lips, hard palate, buccal mucosa (inner lining of cheeks)
Fever
Local lymphadenopathy
5
Q
Where does HSV1 establish a latent infection
A
Trigeminal ganglia
6
Q
What triggers the reactivation of latent HSV1 in trigeminal ganglia
A
Stress
Trauma
Febrile illnesses
UV radiation
7
Q
Presentation of latent HSV
A
Herpes labials - cold sores
8
Q
What is herpetic whitlow
A
HSV infection of the finger
9
Q
How to prevent herpetic whitlow from spreading
A
Use of gloves
10
Q
What is herpes simplex encephalitis
A
Inflammation of the brain due to HSV1
11
Q
Symptoms of herpes simplex encephalitis
A
Fever
Headache
Seizures
Impaired consciousness
Sudden behavioural change
12
Q
Investigations for HSV
A
Swab of lesion
13
Q
Management for HSV
A
Aciclovir
14
Q
HSV can cause which condition in a patient with atopic dermatitis
A
Eczema herpeticum
15
Q
Management of eczema herpeticum
A
IV acyclovir
16
Q
What is hand, foot and mouth disease
A
Oral enanthum + macular/vesicular/maculopapular rash of the hands and feet
17
Q
Most common cause of hand, foot and mouth disease in children
A
Coxsackie virus A16
18
Q
Hand, foot and mouth disease is usually preceded by
A
One day history of fever and lethargy
19
Q
Management of hand, foot and mouth disease
A
Self-limiting - usually resolves within 10 days
Does not need to be isolated
20
Q
Is hand, foot and mouth disease contagious
A
yes, most contagious in the first 5 days
Avoid sharing towels / items
Keep off school until the child is feeling better, no need to wait for the blisters to heal
21
Q
What is aphthous ulcer
A
Recurrent ulcer in the mouth such as inside the lips / underneath the tongue / inside cheeks
22
Q
Difference between aphthous ulcer and cold sores
A
Aphthous ulcers are not contagious
Aphthous ulcers do not occur on surface of lips
Aphthous ulcers are not caused by viruses
23
Q
Management of aphthous ulcer
A
Self-limiting - resolves in less than 3 weeks
24
Q
What is the causative pathogen of oral candidiasis
A
Candida albicans - fungus
25
Risk factors of oral candidiasis
Post antibiotics
Immunosuppresed
Smokers
Inhaled steroids
26
Management of oral candidiasis
Nystatin
Fluconazole
27
What is Behçet's disease
Multi-organ disease caused by systemic vasculitis
28
What is the most common symptom presented in Behçet's disease
Recurrent oral ulcers
29
Symptoms of Behçet's disease
Recurrent oral ulcers
Recurrent genital ulcers
Uveitis
Erythema nodosum
30
Behect's disease is common in which part of the world
Middle East
Asia
31
Which GI disease can cause recurrent aphthous ulcers
Coeliac
IBD
32
Which skin conditions can cause oral ulcers
Pemphigus vulgaris (almost always causes oral ulcers)
Lichen planus
33
Which age groups do squamous cell papilloma of the mouth affect
<5 years old
20-40 years old
34
Which disease is squamous cell papilloma of the mouth related to
HPV
35
Presentation of squamous cell papilloma of the mouth
Painless lesion in mouth
36
Where does squamous cell papilloma of the mouth usually affect
Soft palate
Hard palate
Tongue
Lips
Tonsils
Oesophagus
37
Management of squamous cell papilloma of the mouth
most do not need treatment
cryotherapy
Topical salicylic acid
Surgical excision
38
Which salivary gland is the most common site for tumours
Parotid gland
39
Are most of the parotid gland tumours malignant
No - 60% are benign
Tumours at smaller salivary glands are more likely to be malignant
40
What are the types of benign tumours of the salivary gland
Pleomorphic adenoma
Warthin's tumour
41
What is the most common benign salivary gland tumour
Pleomorphic adenoma
42
Is there a risk of malignant transformation for pleomorphic adenoma
Yes, if the tumour has been there for a long time
43
Pleomorphic adenoma most commonly occurs in
Females
30-60 years old
44
Histological appearance for pleomorphic adenoma
Epithelial + myoepithelial cells
Chondromyxoid stroma
With an outer fibrous capsule
45
Warthin's tumour is most commonly seen in
Males
Over 50
Smokers - strongly associated with smoking
46
What are the malignant tumours of salivary gland
Mucoepidermoid carcinoma
Adenoid cyst carcinoma
47
Who should you suspect to have malignant tumour of salivary gland
Young patients
w Painful mass
48
Most common type of malignant salivary gland tumour worldwide
Mucoepidermoid carcinoma
49
most common type of malignant salivary gland in UK
Adenoid cystic carcinoma
50
Adenoid cystic carcinoma usually affects
Those over 40
51
Which structures can adenoid cystic carcinoma affect
Parotid gland
Palate
52
Malignant tumours of the salivary gland usually causes
Facial nerve palsy
53
Management of tumours of salivary glands
Resection of tumours - no matter benign or malignant
54
What structures may be damaged in parotidectomy
Facial nerve
External carotid artery
Retromandibular vein
55
Acute tonsillitis often occurs with
Pharyngitis
56
Most common cause of acute tonsillitis
Viral tonsillitis
57
What are the viral causes of acute tonsillitis
EBV
Rhinovirus
Influenza
Parainfluenza
Enterovirus
Adenovirus
58
What are the bacterial causes of acute tonsillitis
Strep pyogenes
Strep pneumoniae
H. influenza
59
Pharyngitis can be due to non-infectious causes as well. What are the non-infectious causes of pharyngitis
GORD
Chronic irritation from smoking
60
Symptoms of viral tonsillitis
Malaise
Sore throat
Cough
Able to undertake normal activity
Mild fever
61
Symptoms of bacterial tonsillitis
Fever >38
Odynophagia
Halitosis
Unable to work / school
Lymphadenopathy
62
How long does viral tonsillitis usually last
3-4 days
63
How long does bacterial tonsillitis usually last
1 week
64
How to differentiate between viral and bacterial tonsillitis
Bacterial
- NO COUGH
- Higher fever
- Tonsillar exudate
- presence of lymphadenopathy
65
Which criteria are used for tonsillitis that suggests a bacterial cause
CENTOR criteria
FeverPAIN
66
What are the factors in CENTOR criteria that suggests bacterial tonsillitis
1. Tonsillar exudate
2. Tender cervical lymphadenopathy
3. Fever >38
4. No cough
67
A score of 3-4 in CENTOR criteria suggests
32-56% likelihood of strep causing tonsillitis
68
What are the factors of FeverPAIN criteria that suggests bacterial tonsillitis
Fever
Purulence
Attend rapidly within 3 days (onset)
very Inflamed tonsils
No cough
69
Investigations for acute tonsillitis
History and clinical examination
CENTOR and FeverPAIN criteria
70
What are the scoring criteria used for in acute tonsillitis
To see who is more likely to benefit from antibiotics
71
What CENTOR score would indicate prescribing antibiotics
3/4
72
What FeverPAIN score would indicate prescribing antibiotics
4/5
2-3 suggests moderate association w strep hence consider delayed prescription for antibiotics
73
Management of acute tonsillitis
Eat and drink
Rest
Regular analgesia
Lozenges
Antibiotics if indicated by scoring system
74
Antibiotics used for acute tonsillitis
Penicillin or clarithromycin if allergic
75
When should you admit a patient with acute tonsillitis
If present with
- stridor
- breathing difficulty
- dehydration
- persistent sore throat that lasts for 3-4 weeks
- persistent sore throat with neck mass
- persistent lesions in oral / pharyngeal mucosa
76
Management of tonsillitis in hospital
IV fluids
IV antibiotics
Tonsillectomy for recurrent tonsillitis in adults
77
Complications of tonsillitis
Otitis media
Quincy - peritonsillar abscess
Parapharyngeal abscess
Rheumatic fever
Glomerulonephritis
78
Symptoms of rheumatic fever
fever
arthritis
pancarditis
3 weeks post strep pyogene infection
79
What is quinsy
When abscess forms between one of the tonsils and wall of throat due to spread of infection
80
When does quinsy usually occur
3-7 days after onset of tonsillitis
81
Presentation of quinsy
Displacement of tonsil and uvula
Loss of concavity of palate
82
Management of quinsy
Aspiration
IV antibiotics
83
What is considered as chronic tonsillitis
Infection of the tonsils that persist beyond 2 weeks
84
Presentation of chronic tonsillitis
Chronic sore throat
Very unpleasant breath
Tonsil stones
Persistent cervical lymphadenopathy
85
Management of chronic tonsillitis
Dental mouthwash
86
Neutropenia can be caused by
Severe sepsis
Bone marrow failure due to malignancy
Drugs
Felty's syndrome
Hypersplenism
87
Which drugs are associated as cause of neutropenia
Carbamazepine
Carbimazole / propythiouracil
Clozapine
DMARD - methotrexate, azathioprine, sulfasalazine, hydroxychloroquine
88
Diphtheria is caused by
Corynebacterium diphtheria
89
Presentation of diphtheria
Severe sore throat
Grey-white coating over pharynx / nose / tonsils (pseudomembrane)
90
What can happen to pseudomembrane in diphtheria if left untreated
Becomes very large and obstruct airway
91
Management of diphtheria
Penicillin or erythromycin
Diphtheria antitoxin if severe
92
What is glandular fever (infectious mononucleosis)
infection caused by EBV
93
Glandular fever most commonly affects which age group
young adults
94
Primary glandular fever present in different ages has different severity. At which age does glandular fever cause more severe infection
Teenagers > 10 years old
95
How does glandular fever spread
By saliva
96
What is the classic triad of glandular fever
Fever
Pharyngitis
Lymphadenopathy
97
Symptoms of glandular fever
Fever
Pharyngitis / sore throat / tonsillitis
Malaise
98
Signs of glandular fever
Tonsillar enlargement with membranous exudates
Cervical lymphadenopathy
Palatal petechial haemorrhage
Hepatomegaly
Splenomegaly
Jaundice
Rash
99
What are palatal petechial haemorrhage
Pinpoint red macule in oral cavity
100
Investigations for glandular fever
Bloods - low CRP
EBV serology
Deranged liver function tests
101
Management for glandular fever
Self limiting - paracetamol
Systemic steroids if severe
Avoid sports for 6 weeks
102
Complications of glandular fever
Anaemia
Thrombocytopenia
Splenic rupture
Upper airway obstruction
Increased risk of lymphoma
103
Cause of Acute epiglottitis
H influenza B (not common anymore due to vaccines)
Strep pneumoniae
Strep pyogenes
S aureus
104
Children can still present with acute epiglottitis if
Missed the vaccination
Born overseas with poor immunisation coverage
105
Symptoms of acute epiglottitis
Severe sore throat - cannot speak or swallow
Drooling saliva
High fever
Stridor
Breathing difficulty
Child sits immobile / upright with open mouth
106
What are the 4Ds that suggest acute epiglottitis
Dysphagia
Dysphonia
Drooling
Distress
107
Acute epiglottitis most commonly affects which age group
1-6 years olds
108
Investigations for acute epiglottitis
DO NOT EXAMINE the child without seniors / sufficient staff
Urgent referral to ENT
109
Why shouldn't you examine a child with acute epiglottitis without seniors around
High risk of laryngeal spasm causing total airway obstruction
110
Management of mild acute epiglottitis
Supportive
Oral antibiotics
Nebulisers
111
Management of severe acute epiglottitis
Secure airway via intubation
Take cultures and examine the throat
IV cefuroxime
112
What is Reinke's oedema
Swelling of vocal cords due to fluid collected in Reinke's space
113
Where is Reinke's space
The space right below the squamous epithelium of vocal cord
114
Most common cause of Reinke's oedema
Smoking
115
Symptoms of Reinke's oedema
Hoarse voice
Dysphonia
Throat discomfort
116
Management of Reinke's oedema
Smoking cessation
Voice therapy
Surgery
