Mouth and Throat Dz Flashcards

1
Q

Stomatitis

etiologies (5)

A

nutritional deficiencies

chemotherapy

nicotine

systemic autoimmune disease

infection

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2
Q

thrush (def. and common pathogen)

A

infection of buccal mucosa by candidiasis

commonly C. albicans

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3
Q

populations with thrush

A

infants and neonates

abx or steroids (inhalation)

endocrine disorders

underlying immune dysfunction

denture wears w/poor oral hygiene

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4
Q

clinical appearance of thrush

A

shedding of epithelial cells

lumpy/bumpy white

pseudomembranous easily peeled but leaves red erosion

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5
Q

thrush treatment

A

topical nystatin

pral fluconazole

HIV can’t be missed here

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6
Q

systemic diseases associated with aphthous ulcers (6)

A

HIV

Behcet syndrome

Celiac disease

SLE

IBD

Neutropenia

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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

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8
Q

possible etiologies of aphthous ulcers (6)

A

genetics

medications

nutrient deficiencies

stress

allergy/sensitivity

trauma

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9
Q

aphthous ulcers treatment

A

avoid spicy food, citrus, hot foods, smoking and EtOH

topical analgesic can be used

antimicrobial mouthwashes

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10
Q

workup indicated if aphthous ulcers don’t heal

A
CBC 
ESR 
serum iron studies 
B6
B12 
folate
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11
Q

transmission of herpes labials

A

primarily caused by HSV-1

non sexual contact in childhood

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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

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13
Q

herpes labials treatment

A

acyclovir or famciclovir

most effective early in course of illness to shorten duration of illness and infectivity

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14
Q

herpes labials outbreak onset

A

stress, illness, trauma, menses or other irritants can provoke it

prodromal burning/tingling

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15
Q

leukoplakia

A

pre malignant condition that is the result of inflammation

hyperplasia of epithelium

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16
Q

leukoplakia occurs where

A

areas of trauma or in areas of significant carcinogen/chemical exposure

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17
Q

leukoplakia more common in which population

A

smokeless tobacco users

associated with HPV

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18
Q

most significant prognostic indicator of leukoplakia

A

degree of dysplasia

send pt to ENT physician

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19
Q

erythroplakia

A

red patches adjacent to normal mucosa

clinical term but not dx

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20
Q

appearance of atrophic glossitis

A

tongue appears smooth, glossy and with the loss of papillae

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21
Q

etiologies of atrophic glossitis

A

nutritional deficiencies (B12 or iron)

sick and Sjogren’s syndrome

celiac disease

oral candiaisis

PCM

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22
Q

black tongue appearance

A

hyperpigmentation of tongue and oral mucosa

commonly seen in darker skin individuals

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23
Q

black tongue causes

A

drugs (tetracyclines, line solid, antidepressants, proton pump) and addison’s disease

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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

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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