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CLIN MED 3 - HEENT > Mouth and throat Conditions > Flashcards

Mouth and throat Conditions Flashcards

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1
Q

What is a Stomatitis

A

inflammation of the mouth with or without ulceration

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2
Q

what are the oral causes of stomatitis

A

poor hygiene
poor fitting dentures
trauma (hot foods, chemical)
ingested toxins

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3
Q

what are systemic causes of stomatitis

A

infection (viral, fungal, bacterial)
drug reactions
allergic reactions
chemotherapy/radiation
nutritional deficiencies

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4
Q

what are gingivostomatitis

A

when inflammation also affects the gingiva

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5
Q

what are mucositis

A

not to be used interchangeably as this refers to systemic mucosal pathology often as a result of chemo/RT (mouth and gut)

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6
Q

What is benign inflammatory glossitis

A

aka geographic tongue
benign condition exacerbated by stress, nutritional deficiency or heredity
the pattern changes
no treatment needed

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7
Q

what is “black” hairy tongue

A

treated with vigorous brushing with abrasive toothpaste

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8
Q

what is “white” hairy tongue

A

abnormal elongation of filiform papillae secondary to increased keratin deposits
M>F

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9
Q

what are recurrent aphthous ulcers

A

aka canker sores
last 10-30 days on average
vary in size and shape

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10
Q

what are triggers for aphthous ulcers

A

decrease in mucosal barrier: trauma, pernicious anemia
increased antigenic exposure: foods, flavoring agents
primary immunosuppression/dysfunction: dehcet’s, crohns, celiac, cyclic neutropenia, HIV/AIDS, STRESS

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11
Q

what is the workup for recurrent aphthous ulcers

A

CBC
ESR/CRP
iron studies
B12
SS-A(Ro)/SS-B (La)
glucose
thyroid
HSV titers
HIV

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12
Q

what is the treatment for Aphthous ulcers

A

topical steroids: either rinse or cream/gel
systemic steroid: good for multiple lesions or if in oropharynx
Dexamethasone elixr 0.5mg/5ml

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13
Q

what is the presentation of aphthous ulcers

A

prodrome: sometimes
duration: 10-14 days
Location: non-keratinized tissue- buccal mucosa, ventral tongue, soft palate

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14
Q

what is the presentation of HSV

A

prodrome: usually
duration: 10-14 days
location: keratinized tissue - gingiva, lip, hard palate

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15
Q

what is primary herpetic gingivostomatitis

A

Herpes (HSV1)- primary lesion: highly infectious
primary infection lasts up to 2 weeks
patients are very sick
after initial infection - virus goes into latency

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16
Q

how do you differentate from HSV1 from oral Zoster

A

oral herpes zoster: unilateral with mandibular or maxillary distribution and HAS a prodrome

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17
Q

how do you treat primary HSV1 for adults

A

acyclovir or famvir

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18
Q

how do you treat primary HSV1 in kids

A

oral acyclovir 200mg/5ml suspension

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19
Q

how do you treat recurrent HSV infection

A

topical: acyclovir or pencyclovir
systemic: vanlacyclovir, famiclovir, acyclovir

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20
Q

What is oral candidiasis

A

“thrush”
opportunistic organism
m/c w/ dentures, diabetics, infants, elderly, pregnancy, nutritional deficiencies, HIV and other immunosuppressed states

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21
Q

What can cause persistent candidiasis

A

anemia
poorly controlled/undiagnosed DM
thyroid disease
immunosuppression, chronic steroid or abx use
xerostomia

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22
Q

what labs are ordered with persistent candidiasis

A

CBC with diff
B12
glucose
thyroid funciton
HIV
nutritional workup

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23
Q

what are the treatments for oral candidiasis

A

Nystatin
Clortimazole
Fluconazole

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24
Q

what is the treatment of angular cheilitis

A

topical anti-fungal (nystatin)
fluconazole - single dose

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25
what is pharyngitis and tonsillitis
infection and/or irritation of pharynx and/or tonsils majority of cases are viral and self limited bacterial cause is usually strepA (GAS)
26
What is GAS
Group A Strep (GAS) tends to occur in 5-15 year olds dx: confirm using rapid antigen detection test and/or throat culture
27
what is the treatment of GAS pharyngitis
abx therapy (penicillin or amoxicillin) cephalexin, azithromycin, erythromycin, clindamycin, cetriaxone
28
what are the complications of strep pharyngitis
Rheumatic fever/rheumatic heart disease post-stretococcal glomerulonephritis
29
What is mononucleosis
EBV - pharyngitis is the most common complain/finding highest incidence in 15-25 year olds
30
what is the biggest concern with mononucleosis
splenomegaly with rupture
31
what is the clinical presentation of mono
prodrome: fatigue, low-grade fever, malaise, myalgias over 1-2 weeks are common pharyngeal and tonsil symptoms often severe and exudative lymphadenopathy in almost all cases
32
what medication should be avoided in exudative tonsilitis (mono)
amoxicillin - may cause a rash
33
how do you diagnose mono
EBV titer vs monospot: CBC, LFTs typically a clinical diagnosis
34
what is the treatment of mono
supportive
35
what is coxsackie virus
herpangina not caused by herpes virus children <10 yo common in summer and fall "hand, foot and mouth disease" similar eruptions on hands or feet
36
what is acute tonsillitis
rare in children <2yo "strep" (bacterial) tonsillitis most common in ages 5-15 viral tonsillitis more common in younger kids
37
how is chronic tonsillitis classified
7 episodes in 1 year 5 episodes /year x 2 years 3 episodes/year x 3 years symptoms: chronic sore throat, halitosis, tonsilliths
38
what is the indication for tonsillectomy
recurrent infections multiple antibiotic allergies hx of peritonsillar abscess (PTA) periodic fever, aphthous stomatitis, pharyngitis, adenitis (PFAPA) hypertrophy and sleep disordered breathing/OSA
39
What is seen with PTA
fever, malaise, dysphagia, odynophagia, "hot potato" voice, trismus, bulging of superior tonsil pole and soft palate DEVIATION OF THE UVULA
40
what is the treatment for PTA
I&D, IM pen VK if not allergic, pain control and recheck 24 hours
41
what is the difference between tonsillitis and PTA
uvula midline with tonsillitis and deviated with PTA
42
What is the first choice medication for dental abscess
amoxicillin but if allergic - consider azythro, metronidazole or clindamycin
43
What is Ludwigs angina
potentially life threatening cellulitis of the soft tissue of floor of the mouth and neck. includes submandibular spaces of mouth, spreading to sublingual and submental spaces often result of dental root infection or mouth injury
44
what is the clinical presentation of Ludwig's angina
breathing difficulty (tripod) AMS/confusion fever/chills neck pain/stiffness neck swelling (not lymphadenopathy) redness of the neck weakness, fatigue, excessive tiredness difficulty swallowing, drooling, earache, trismus
45
what is the treatment plan for Ludwig's angina
secure airway - AIRWAY EMERGENCY IV abx, broad spectrum including MRSA IV steroids can help with swelling surgical drainage
46
what are predisposing factors of Ludwig's angina
poor oral hygiene dental caries, recent dental tx diabetes ETOH use d/o malnutrition immunosuppression
47
What is Croup
laryngotracheobronchitis most common cause of stridor in children 2nd year of life (6mo - 6 year, peak 12mo-2 yo) parainfluenza type 1 barking cough inspiratory high-pitched stridor
48
hat is the steeple sign
subglottic narrowing can be seen with croup
49
what is epiglottitis
H infleunzae type B (Hib vaccine) 1-5 yo - rapid progression sitting position head up and mouth open drooling "tripod"
50
what are the 4Ds of epiglottitis
drooling dysphagia dysphonia distressed respiratory efforts
51
what can be seen on x-ray with epiglottitis
"thumb print" sign
52
What is Leukoplakia
white patch or plaque biopsy malignant transformation ~10%
53
What is Erythroplakia
red dysplasia biopsy/refer ASAP high malignant transformation - 70%
54
what is lichen planus
lacy white mucosal change biopsy low chance of malignant transformation (unless erosive) chronic disease of skin and mucous membranes
55
what are the primary salivary glands
parotid (2) Submandibular (2) Sublingual (2) minor salivary glands (5,000)
56
What are the two salivary ducts that enter the oral cavity
Whartons ducts - from submandibular glands (side of tongue) Stensen's ducts - from parotid glands (across from second molar of upper jaw)
57
what are the three categories of problems with the salivary glands
altered saliva production painless swelling painful swellng
58
What is Sialadenosis
recurrent painless swelling (parotid gland)
59
what can cause Sialadenosis
endocrine disorders (DM) Malnutrition (protein, ETOH, vitamin) Autonomic dysfunction
60
what is the treatment for Sialdenosis
correct underlying causes reassurance
61
what is the treatment of acute Sialadenitis
B-lactam resistant penicillin or cephalosporins steroids fluid replacement Sialogogues (chewing gum or hard candy) analgesics manual massage topical heat
62
what is acute Sialdenitis
all possible glands but most commonly parotid rapid onset of pain, swelling and induration suppurative discharge from duct
63
what is recurrent Sialadenitis
mechanical obstruction is the most common factor
64
how do you work up recurrent Sialadenitis
Ct neck with contrast to rule out stones or intrinsic lesions or abscess
65
what are the treatment options for recurrent Sialadenitis
oral anaerobes dominate: clindamycin, augmentin, flagyl+cephalopsorin, avelox (fluoroquinalone) surgical excision of gland is the last resort
66
what is Sialolithiasis
formation of salivary stones M>F ages 30 - 60 submandicular > parotid > minor one of the most common cause of salivary dysfunction
67
what causes Sialolithiasis
enhanced if stasis of salivary flow genetic predisposition (kidney stones, gout) mineralization of mucoid gel
68
what is the clinical presentation of Sialolithiasis
asymptomatic recurrent swelling associated with eating spitting out stones sialadenitis (infection)
69
how do you manage Sialothiasis
hydration massage (posterior -> anterior) + heat anti-inflammatories abx if infected removal of stones sialendoscopy surgical excision of affected gland
70
what is the most common cause of acute non-suppurative sialadenitis in childhood
mumps
71
what is the most common cause of acute suppurative parotitis
S. aureus, ~strep species
72
what is the treatment for acute suppurative parotitis
initial empiric antibiotics covering aerobic and anaerobic bacterial surgical drainage may be indicated when pus has formed
73
what is laryngitis
inflammation of the larynx, usually viral and occasionally from reflux usually URI prodrome, then hoarsness
74
what is the treatment of laryngitis
supportive care, LOTS of fluids, voice rest
75
when is a laryngoscopic exam required with laryngitis
if dyspneic or hoarsness lasts longer than 1-2 weeks
76
what is a laryngeal polyp
results of hemorrhagic event: acute phono trauma 90% unilateral treatment: voice rest, ~excision + voice therapy

CLIN MED 3 - HEENT (8 decks)

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