Mouth and Throat Dz Flashcards
1
Q
Stomatitis
etiologies (5)
A
nutritional deficiencies
chemotherapy
nicotine
systemic autoimmune disease
infection
2
Q
thrush (def. and common pathogen)
A
infection of buccal mucosa by candidiasis
commonly C. albicans
3
Q
populations with thrush
A
infants and neonates
abx or steroids (inhalation)
endocrine disorders
underlying immune dysfunction
denture wears w/poor oral hygiene
4
Q
clinical appearance of thrush
A
shedding of epithelial cells
lumpy/bumpy white
pseudomembranous easily peeled but leaves red erosion
5
Q
thrush treatment
A
topical nystatin
pral fluconazole
HIV can’t be missed here
6
Q
systemic diseases associated with aphthous ulcers (6)
A
HIV
Behcet syndrome
Celiac disease
SLE
IBD
Neutropenia
7
Q
aphthous ulcers
A
aka canker sores
last 7-10 days
usually less than 5 mm
small, red, round/oval spots, prodromal tingling/burning
pain usually dissipates 3-4 days later
8
Q
possible etiologies of aphthous ulcers (6)
A
genetics
medications
nutrient deficiencies
stress
allergy/sensitivity
trauma
9
Q
aphthous ulcers treatment
A
avoid spicy food, citrus, hot foods, smoking and EtOH
topical analgesic can be used
antimicrobial mouthwashes
10
Q
workup indicated if aphthous ulcers don’t heal
A
CBC ESR serum iron studies B6 B12 folate
11
Q
transmission of herpes labials
A
primarily caused by HSV-1
non sexual contact in childhood
12
Q
herpes labials lesions
A
vesicular lesions that rapidly rupture and ulcerate
acquire virus without clinical illness
buccal mucosa first, then disease is usually on the lips in keratinized skin
13
Q
herpes labials treatment
A
acyclovir or famciclovir
most effective early in course of illness to shorten duration of illness and infectivity
14
Q
herpes labials outbreak onset
A
stress, illness, trauma, menses or other irritants can provoke it
prodromal burning/tingling
15
Q
leukoplakia
A
pre malignant condition that is the result of inflammation
hyperplasia of epithelium
16
Q
leukoplakia occurs where
A
areas of trauma or in areas of significant carcinogen/chemical exposure
17
Q
leukoplakia more common in which population
A
smokeless tobacco users
associated with HPV
18
Q
most significant prognostic indicator of leukoplakia
A
degree of dysplasia
send pt to ENT physician
19
Q
erythroplakia
A
red patches adjacent to normal mucosa
clinical term but not dx
20
Q
appearance of atrophic glossitis
A
tongue appears smooth, glossy and with the loss of papillae
21
Q
etiologies of atrophic glossitis
A
nutritional deficiencies (B12 or iron)
sick and Sjogren’s syndrome
celiac disease
oral candiaisis
PCM
22
Q
black tongue appearance
A
hyperpigmentation of tongue and oral mucosa
commonly seen in darker skin individuals
23
Q
black tongue causes
A
drugs (tetracyclines, line solid, antidepressants, proton pump) and addison’s disease
24
Q
black hairy tongue
A
condition caused by antibiotics, candida infection, or poor oral hygiene
elongated filiform papillae and yellowish white to brown dorsal tongue surface
25
black hairy tongue treatment
brush area of the tongue with a soft bristle toothbrush and toothpaste two to three times per day
26
head and neck cancers include tumors where? (5)
oral cavity
pharynx
larynx
nasal cavity and paranasal sinuses
major and minor salivary glands
27
risk factors for CA of head and neck
tobacco use
alcohol use
HPV
28
pathogenesis of Head and Neck CA
mostly squamous cell origin
multiple genetic mutations
29
field carcinogenesis
exposure everywhere when exposing head and neck to cancer causing agents
reminds us that cancer in this area can develop a second PRIMARY tumor (2, genetically different cancers)
30
common symptoms of head and neck cancers
pain
sores that won't heal
hoarseness/voice change
cough
dysphagia
neck mass
31
endoscopic visualization
used to evaluate cancers of deeper tissues
32
image studies used to diagnose head and neck CA
CT scan w/wo IV contrast
MRI scan w/wo IV contrast
PET scan
33
local invasion
CA remains at site of primary tumor
grows out of organ to invade neighboring tissue
34
lymph node involvement
lymphatic drainage can follow spread
gives easy access
35
distant mets
far away from site
36
second primary cancer
totally genetically different cancer found in the same spot
37
cancer can't be confirmed until
tissue dx is obtained
38
sequence of events in evaluating head and neck CA
H and P --> imaging --> tx
39
most common sites of head and neck CA metastasis
lungs, liver bone
40
most common second primaries in head and neck CA
head and neck CA
lung CA
esophageal CA
41
treating early head and neck CA
early head and neck cancer
treated surgically or with definitive radiation therapy
42
follow up with patients in head and neck CA
surveillance for recurrence for next 5 years at least
most recurrences occur within first 2-4 yrs
43
patients with recurrent head and neck CA treatment
pallative care, support
44
components of salivary system
2 parotid glands
2 submandibular glands
hundreds of minor salivary glands
45
acute sialadenitis
aka parotitis
infection of the salivary gland
may be bacterial or viral
46
sialolithiasis
stones in the salivary duct resulting in obstruction
stone formation
47
bacterial sialadenitis s/s
unilateral parotid glands
1. unilateral swelling of the gland
2. exquisite localized pain
3. dysphagia or trismus (lockjaw)
4. systemic symptoms
48
bacterial sialadenitis pathophysiology
stasis of saliva in the duct
therefore oral bacteria spread into the gland
49
bacterial sialadenitis
salivary stasis is facilitated by
obstruction (stone, tumor, growth)
decreased salivary flow (dehydration)
medication (anticholinergics, diuretics, opioids)
50
bacterial sialadenitis
bactieral culture suspected
polymicrobial (gram positive and anaerobes) -- esp staph aureus
if hospitalized - gram neg. (klebsiella, enterobacter)
culture material from the duct (not just swob) but typically just empirically treat
51
bacterial sialadenitis
diagnostic working
Ultrasound *** detects abscess (I&D)
Contrast ct is best to distinguish cellulitis from abscess
elevated serum amylase w/o concurrent pancreatitis
52
bacterial sialadenitis
treatment
hydration
promotion of salivary flow (lemon drops or other mints)
IV ABx (vancomycin + metronidazole) 10-14 days
if abscess - I & D
53
bacterial sialadenitis
complications
massive swelling of neck = air way obstruction
osteomyelitis
septic phlebitis (jugular)
sepsis
54
sialithiasis s/s
pain and swelling over gland before or during eating
may be possible to feel stone or milk it (duct may be tender)
55
sialithiasis
dx
NON contrast CT of face
56
sialithiasis
tx (conservative)
moist heat
sialogogues
good hydration '
milking duct
NSAIDS for pain
57
sialithiasis
tx (procedural)
lithotripsy
wire basket retrieval via endoscopy
surgery
58
untreated/chronic sialithiasis
saliva production ceases and gland then becomes firm
59
infection/irritation of pharynx or tonsils
pharyngitis/tonsillitis
60
pharyngitis/tonsillitis
etiologies
infectious (typically viral)
trauma, toxins, allergy, neoplasm
61
infectious pharyngitis/tonsillitis
if bacterial: typically caused by GAS (group A strep)
but most often viral
62
symptoms associated with bacterial pharyngitis/tonsillitis
```
fever ( <102)
white spots (pus)
cervical LAD
sudden, systemic illness
sick contact
```
4-7 y.o., vomiting and HA, petechiae
63
symptoms viral pharyngitis/tonsillitis
SUB ACUTE onset
hoarseness, coryza, myalgia
cough, conjunctivitis, rhionrrhea
64
unreliable pharyngitis/tonsillitis symptoms that don't help us distinguish b/t viral and bacterial
fever (or lack of)
tonsillar or pharyngeal exudates
65
Centor criteria (list)
1. fever to 101
2. anterior cervical lymphadenopathy
3. tonsillar exudate
4. absence of cough
66
centor criteria interpretation
if 4 present - high likelihood of GAS, give aBX
if 2-3: preform rapid strep test
if 1: probably viral, symptomatic management
67
tests used to diagnose step
rapid strep testing
throat culture (takes longer but sure that it is strep)
68
what is our biggest concern in missing a GAS pharyngitis/tonsillitis diagnosis?
rheumatic fever
but we shouldn't be concerned bc the strains that cause it are not in America
69
viral pharyngitis treatment
symptomatically
NSAIDs/tylenol, salt water, hot showers/steam inhalation, lozenges
70
GAS pharyngitis/tonsillitis treatment
self limited
s/s can resolve spontaneously 3-4 days
71
empiric ABX treatment of GAS pharyngitis/tonsillitis
penicillin (first line)
can give amoxicillin in young kids
erythromycin if PCN allergy
72
severe complications of strep
1. scarlet fever
2. rheumatic fever
3. strep glomerulonephritis
73
scarlet fever
epidemiology
occurs in < 10% of strep throat cases
typically follows untreated/poorly treated strep
74
pathophysiology of scarlet fever
TOXIN produced by strep causes pathognomonic rash and other s/s
75
scarlet fever
rash
orange/red coarse sandpaper textured rash
- starts on head/center and moves out and down
- blanches may be puritic
- intensifies on flexor creases and facial flushing
- 12-48 hrs following fever
desquamation of skin 7-10 days later
76
scarlet fever
other s/s
rash +
strawberry tongue (white coating and red papillae, until white peels away)
high fever (103,104)
abdominal pain
77
scarlet fever management
HIGHLY contagious
PCN still drug of choice
78
rheumatic fever
pathophys
autoimmune inflammatory response
molecular mimicry causes inflammatory tissue injury persisting beyond acute GAS infection
body can't distinguish b/t strep and self
inflammatory lesions of joints, heart, subcutaneous tissue, central nervous system
79
s/s of rheumatic fever
Arthritis (75%) - SYMMETRIC lg joints (knees, shoulder)
Carditis (30-60) pericarditis, valvular injury, myocarditis- esp. younger
sydenham chorea (little girls, near and psych features)
fever
abdominal pain
erythema marginatum (non-puritic, painless, serpiginous eruption) - RARE
80
Jones criteria of rheumatic fever
pancarditis (CV issues)
polyarthritis
syndham chorea
subcutaneous nodules
erythema marginatium
81
rheumatic fever
| treatment
PCN and anti inflammatories
following diagnosis patients are placed on long term PCN to prevent recurrence
82
rheumatic valvular disease
causes mitral valve stenosis
more common in women `
increased risk for clotting issues, dental problems, procedures and fluid adminstarion
83
streptococcal glomerulonephritis
occurs 1-2 weeks after strep (throat or impetigo)
```
urinary (hematuria, oliguria or anuria)
edema (face, arms, eyes, feet, ankles)
hypertension
abdominal pain
back pain
```
84
deep neck infections
infections of the deep fascial layers of the neck
bad bc they can cause airway obstruction
85
deep neck infections
bacterial etiologies
typically polymicrobial (Gram pos. + anaerobes_)
86
deep neck infections
presenting s.s
may not have distinct fluctuant mass
dysphagia
swelling
trismus
pooling of saliva
87
deep neck infections
historial questions
likely source of infection
recent hospital or ECF
prior surgery
88
deep neck infections
imaging
CT scan of neck w/wo contrast
must be done quick bc of airway problems
89
deep neck infections
treatment options
vancomycin/zosyn
hospital admission
ENT + I and D consult
90
PTA/cellulitis
infection of tonsils that has extended into soft tissue of neck
not quite as deep but on way
result of contiguous spread (cellulitis -> phlegm -> abscess
91
pTA mc in which population
adolescents and young adults
92
PTA bacterial etiology
often poly microbial
GAS, MSSA/MRSA, respiratory anerobes
93
PTA symptoms
```
severe sore throat
muffled voice
drooling
trismus
systemic symptoms
```
94
PTA signs
enlarged, s wollen and fluctuant tonsil
bulging or fullness of soft palate
deviation of uvula
95
PTA work up
labs not great but imaging is diagnostic
CT scan of neck w/and w/o IV contrast
96
pta Differential
epiglottis
other deep neck infections
severe tonsillopharyntitis
97
PTA management
hospitalization
airway management
drainage
ABX (gram + and anaerobe cvg) - Unasyn, cleocin, vanco 14 days
typically full recovery
98
stridor
high pitched whistling produced from narrowed air way
above the cords = inspiratory, below cords = expiratory
99
why is PEEP important?
keeps a little bit of air inside the lungs so that alveolar cells are still open
decreases stress and allows easier gas exchange
100
epiglottitis bacterial causes
H. flu (we have vaccine now)
now it is mostly viral
must control bc airway compromise
101
epiglottitis s.s (young kids)
Abrupt onset of:
respiratory Distress
Dysphagia
Drooling
tripod or sniffling posture (CHIN thrust forward) to maximize airway
102
epiglottitis s/s (adults)
sore throat, fever, muggled voice, drooling
onset is more gradual and compromise is less common
not sniff posture bc airway is larger
103
epiglottitis exam
be careful in exam bc may provoke laryngospasm and constriction of air way
ENT consult and lateral neck radiographs
104
epiglottitis treatment
1. airway management
2. supplemental oxygen
3. monitoring in ICU, ent consult
+/- corticosteroids, bronchodilators
105
laryngitis
hoarseness persisting for one or more weeks
treatment is voice rest
106
abnormal adduction of vocal cords during respiratory cycle that produces air flow obstruction at larynx
vocal cord dysfunction (VCD)
107
vocal cord dysfunction (VCD)
epidemiology
can occur at any age
MC in females, 20-40
108
vocal cord dysfunction (VCD)
risk factors
GERD, occupational exposure, swimming, strenuous exertion, allergies, psychiatric
109
vocal cord dysfunction (VCD)
pathoneumonic finding
paradoxical vocal cord adduction with posterior glottic chink during inspiration
110
vocal cord dysfunction (VCD)
symptoms
```
sudden onset of dyspnea
cough
throat tightness
wheezing
stridor
```
111
exam findings in VCD
harsh stridor and may have radiation of wheezing into upper chest
patients are often dx and tx for asthma with no or little response
112
vcd v. asthma
both have wheezing, cough, dyspnea BUT VCD has
for response to inhaled beta agonists or ICS
absence of nocturnal awakening
absence hypoxemia
INSPIRATORY stridor and wheezing
113
vocal cord dysfunction (VCD) diagnosis
direct observation via laryngoscopy while symptomatic
114
vocal cord dysfunction (VCD)
treatment
speech therapy
| psychotherapy
