mouth, nose, throat Flashcards
(214 cards)
1
Q
what is rhinitis?
A
Rhinitis is an inflammation of the mucous membrane within the nasal cavity.
2
Q
what are the symptoms of rhinitis?
A
It’s commonly characterized by symptoms such as sneezing, rhinorrhea (which can be anterior or posterior, meaning it can drip out the nose or down the throat), nasal congestion, and itching in the nose and eyes.
3
Q
what type of rhinitis is triggered by allergens such as pollen, dust, and pet dander. It can be seasonal (occurring at specific times of the year, like hay fever) or perennial (occurring year-round)?
A
allergic rhinitis
Allergic rhinitis is a common condition characterized by an allergic response to airborne allergens, which affects both adults and children.
4
Q
what form of rhinitis is not caused by allergens and can be triggered by irritants like smoke, changes in weather, or strong odors?
A
non-allergic rhinitis
5
Q
what type of rhinitis is Also known as rebound rhinitis, this occurs due to the overuse of topical decongestants. When these medications are used for more than a few days, they can cause a rebound effect, leading to increased congestion when the medication is stopped?
A
rhinitis medicamentosa
6
Q
what symptom is exhibited when rhinitis becomes rhinosinusitis?
A
symptoms such as posterior nasal drainage (which may be purulent), facial pressure or pain, headaches, and sometimes a reduced sense of smell.
7
Q
what are some infectious causes of rhinitis?
A
rhinitis can be viral, such as the common cold; bacterial, often leading to sinusitis; or less commonly, fungal, which can lead to fungal sinusitis, especially in immunocompromised individuals.
8
Q
what symptom is the hallmark of allergic rhinitis which also helps differentiate it from non-allergic rhinitis?
A
nasal itching
nasal mucosa is often pale due to swelling and the allergic response, as opposed to being red, which is more common in infections.
9
Q
what color is nasal mucosa in allergic rhinitis vs infectious rhinitis?
A
nasal mucosa is often pale due to swelling and the allergic response, as opposed to being red, which is more common in infections.
10
Q
what is a rhinitis that happens year round called?
A
perennial allergic rhinitis
11
Q
what are some seasonal allergens?
A
Include tree, grass, and weed pollens, as well as molds found outdoors.
12
Q
what are some indoor allergens?
A
Perennial allergens often found indoors include house dust mites, cockroaches, pets, rodents, and fungi.
13
Q
what type of conditions do people with allergic rhinitis also tend to struggle with?
A
People with allergic rhinitis may also suffer from bronchospasm (which can be part of conditions like asthma), atopic dermatitis (eczema), and chronic cough.
14
Q
what gender is more commonly affected by allergic rhinitis?
A
males
15
Q
what are some risk factors for allergic rhinitis?
A
The condition is more commonly seen in males and those with a family history of atopy, indicating a genetic predisposition to allergic diseases.
16
Q
what other factors increases chance of developing allergic rhinitis?
A
Factors that may increase the likelihood of developing allergic rhinitis include being born during the pollen season, being the firstborn child, early use of antibiotics, exposure to tobacco smoke, and early or high exposure to allergens.
17
Q
what is another name for allergic rhinitis?
A
hay fever
18
Q
what is the process behind how allergic rhinitis develop?
A
- genetically predisposed individuals, exposure to specific allergens (like pollen, dust mites, animal dander, or mold) leads to the production of specific IgE antibodies against these allergens.
- The IgE antibodies bind to mast cells and basophils present in the nasal mucosa. Upon subsequent exposure to the same allergens, these cells degranulate, releasing a variety of inflammatory mediators.
- Preformed mediators like histamine and serotonin are released, causing symptoms such as sneezing, itching, and increased mucus production.
Newly generated mediators such as leukotrienes and prostaglandins contribute to the inflammation, causing symptoms like congestion and swelling. - As a part of the immune response, other cells like neutrophils, eosinophils, macrophages, and lymphocytes are recruited to the site of inflammation, releasing their own mediators and perpetuating the response.
- Late phase Occurs 4-6 hours after the initial allergen exposure and involves the continued recruitment of inflammatory cells to the nasal mucosa.
The symptoms are similar to the early-phase response but typically with less sneezing and itching and more congestion and mucus production.
19
Q
how does the mediators released in allergic rhinitis cause congestion and pressure?
A
The mediators released cause increased vascular permeability, leading to plasma exudation and vasodilation, which result in congestion and pressure.
20
Q
how do the mediators released in allergic rhinitis cause the sneezing and itching?
A
Stimulation of sensory nerves causes sneezing and itching.
21
Q
how does the mediators released in allergic rhinitis cause increased secretions?
A
Mucous glands are stimulated, leading to increased secretions.
22
Q
what are dark circles under the eyes that are often blue, gray, or purple. They occur due to congestion of the nasal passages, which can lead to venous pooling under the eyes?
A
allergic shiners
23
Q
what describes a set of facial features that can develop in children with chronic mouth breathing, often due to enlarged adenoids. These features can include:
A long, narrow face and high-arched palate
A narrow, upturned nose due to constant upward rubbing (the “allergic salute”)
A short upper lip and a longer distance between the nose and the upper lip
Exposed upper incisors and an open-mouth posture
A recessed lower jaw, which may also be due to the mouth always being open
Forward head posture, which can be a compensatory mechanism to keep the airway open for easier breathing
A
adenoid facies
24
Q
what is a horizontal line or crease across the lower part of the bridge of the nose. It can result from the frequent upward rubbing of the nose, a gesture often seen in children with itchy, runny noses, known as the “allergic salute.” ?
A
nasal crease
25
what is A narrow, upturned nose due to constant upward rubbing?
allergic salute
26
what is the main symptom of non-allergic rhinitis?
The main symptoms include nasal congestion and postnasal drip.
Nonallergic rhinitis is a medical condition characterized by inflammation of the nasal mucosa, similar to allergic rhinitis but without the allergic cause. It typically manifests later in life, and unlike allergic rhinitis, it does not usually include symptoms like nasal and eye itching or sneezing, although these can sometimes be present. The main symptoms include nasal congestion and postnasal drip. These symptoms can be constant (perennial) or they can come and go (sporadic).
27
which type of non-allergic rhinitis involves nasal congestion and/or a watery nasal discharge. People with this condition often have an exaggerated response to non-specific irritants, such as air pollution or changes in temperature?
vasomotor non-allergic rhinitis
28
which type of non-allergic rhinitis is an episodic form of rhinitis, usually triggered by eating hot or spicy foods. It is associated with a prominent watery discharge from the nose (watery rhinorrhea) and is thought to be caused by a reflex that is mediated by the vagus nerve?
Gustatory non-allergic rhinitis
29
which type of nonallergic rhinitis is caused by vagus nerve reflex?
gustatory nonallergic rhinitis
30
what are the 2 groups of nonallergic rhinitis based only on symptoms?
Wet Group: Characterized by nasal obstruction and significant watery nasal discharge, which is sometimes referred to as "runners."
Dry Group: Characterized by nasal obstruction with minimal nasal discharge (rhinorrhea).
31
how do you differentiate wet group from dry group of nonallergic rhinitis?
Wet Group: Characterized by nasal obstruction and significant watery nasal discharge, which is sometimes referred to as "runners."
Dry Group: Characterized by nasal obstruction with minimal nasal discharge (rhinorrhea).
32
which group of nonallergic rhinitis is referred to as runners?
wet group
33
what stimulates wet (runners) non-allergic rhinitis?
Increased cholinergic glandular secretory activity leads to excessive mucus production. This is sometimes referred to as "runner's nose" and can occur in response to exercise.
34
what stimulates dry non-allergic rhinitis irritation?
Heightened sensitivity of nociceptive neurons to stimuli that are usually not problematic can result in symptoms like a dry, irritated nose.
35
what are some causes of nonallergic rhinitis?
Other causes:
Nasal decongestant sprays (rhinitis medicamentosa): Overuse of these sprays can lead to rebound congestion, where the nasal passages become swollen, leading to a cycle of continuous use and worsening symptoms.
Intranasal cocaine use: Cocaine and other substances taken intranasally can lead to chronic irritation and inflammation of the nasal mucosa.
Systemic medications: Some medications like oral contraceptives, Viagra, and NSAIDs can have side effects that include symptoms of rhinitis.
Structural abnormalities: Physical abnormalities within the nasal cavity, such as enlarged adenoids, foreign bodies, or a deviated septum, can lead to chronic symptoms.
Rhinitis of pregnancy: Hormonal changes during pregnancy can lead to swelling of the nasal passages and increased mucus production.
Systemic diseases: Diseases like Granulomatosis with Polyangiitis (formerly known as Wegener’s Granulomatosis) and cystic fibrosis can cause chronic inflammation of the nasal passages.
36
Which agent causing occupational rhinitis would you most likely be exposed to in a supermarket?
Detergents and perfumes are agents causing occupational rhinitis that you would most likely be exposed to in a supermarket.
37
Name an immunologic agent that could affect nurses and cause occupational rhinitis.
Nurses may be exposed to latex, which is an immunologic agent that can cause occupational rhinitis.
38
Which type of occupational rhinitis might a chemical plant worker be at risk of developing and due to what agent?
A chemical plant worker might be at risk of developing corrosive occupational rhinitis due to exposure to ammonia.
39
what is epistaxis?
Epistaxis, commonly known as a nosebleed, is a condition where bleeding occurs from the nasal cavity.
40
what are the 2 forms of epistaxis?
anterior and posterior
41
which type of epistaxis is the most common type of nosebleed.
These bleeds are typically self-limited, which means they stop on their own without the need for extensive medical intervention.
anterior epistaxis
42
what are the causes of anterior epistaxis?
The causes (etiologies) of anterior epistaxis include local trauma (such as nose picking or the insertion of foreign bodies), irritation, or nasal dryness.
43
which plexus causes anterior epistaxis?
Around 90% of anterior bleeds originate from Kiesselbach's plexus, also known as Little’s area, which is a vascular-rich region in the anterior part of the nasal septum.
44
which type of epistaxis is less common but can be more severe and often requires medical treatment.
posterior epistaxis
45
what blood vessels cause posterior epistaxis?
The source of the bleeding is usually the branches of the sphenopalatine artery, but it can also come from the carotid artery.
46
which type of epistaxis can lead to significant hemorrhage and are more likely to require medical intervention, such as packing the nose or cauterizing the bleeding vessel?
posterior epistaxis
47
what are some causes of posterior epistaxis?
The causes of posterior epistaxis include the use of anticoagulant medications, bleeding disorders such as hemophilia and von Willebrand disease, aneurysms, and the presence of nasal neoplasms (tumors), which can also cause anterior epistaxis.
48
what are nasal polyps?
Nasal polyps are non-cancerous growths that occur on the lining of the nasal passages or sinuses. They're often associated with chronic inflammation and can result from a variety of conditions.
Benign: They are not malignant, meaning they are not cancerous.
Semitransparent: They have a somewhat see-through appearance.
Arising from mucosa: They develop from the mucous membranes that line the nasal cavity or paranasal sinuses.
49
how does polyps develop?
Chronic inflammation: Long-term inflammation in the nasal passages or sinuses can lead to the growth of polyps. This inflammation can be caused by conditions such as cystic fibrosis, asthma, chronic rhinitis or rhinosinusitis, and certain forms of vasculitis, such as Churg-Strauss syndrome.
50
which conditions increase risk of developing nasal polyps?
Cystic fibrosis: This genetic disorder is known to be associated with a higher prevalence of nasal polyps. As the statistics suggest, nearly half of the children with cystic fibrosis develop nasal polyps.
Asthma: Chronic respiratory conditions like asthma can also contribute to the development of nasal polyps due to ongoing inflammation.
Chronic rhinitis or rhinosinusitis: Inflammation of the nasal lining or sinuses, whether due to allergy or infection, can result in polyp formation.
Vasculitis: Diseases causing inflammation of blood vessels, such as Churg-Strauss syndrome, can be associated with nasal polyps.
51
what percentage of children with cystic fibrosis develop nasal polyps?
48%
52
is nasal polyp more common in adults or children?
adults
53
what are the adenoids?
Lymphoid tissue located in the back of the nose (not seen in regular physical exam)
54
what is the Waldeyer's ring and what 3 things make it up?
ring of lymphoid tissue known as Waldeyer's ring. This ring also includes the palatine tonsils, which are located on either side at the back of the mouth, and the lingual tonsils, which are found at the base of the tongue. This ring of tissue forms part of the body's immune system, acting as a first line of defense by trapping pathogens that are inhaled or ingested.
55
what is the function of waldeyer's ring?
This ring of tissue forms part of the body's immune system, acting as a first line of defense by trapping pathogens that are inhaled or ingested.
56
what condition can infected adenoids lead to?
Infected adenoids can lead to conditions such as adenoiditis, which can cause symptoms of nasal obstruction, snoring, and respiratory infection. Chronic enlargement of the adenoids can lead to chronic mouth breathing, snoring, and even sleep apnea.
57
what are symptoms of infected adenoids?
nasal obstruction, snoring, and respiratory infection
58
what are symptoms of chronic enlargement of adenoids?
chronic mouth breathing, snoring, and even sleep apnea.
59
what are symptoms of infected tonsils?
infected tonsils (tonsillitis) may cause a sore throat, difficulty swallowing, fever, and swollen lymph nodes. Tonsillitis is often due to bacterial or viral infections and can sometimes lead to the formation of pus-filled pockets (peritonsillar abscess).
60
what is peritonsillar abscess?
pus-filled pockets at the back of the mouth near tonsils.
61
which 2 lymphoid organs have Same structure and function, but diseases associated with them differ?
adenoids and tonsils
62
what type of conditions do enlarged adenoids contribute to?
recurrent sinusitis, chronic persistent or recurrent ear disease (can harbor a chronic infection), and to chronic airway obstruction.
Pathogenesis of Enlarged Adenoids:
When adenoids are enlarged, they can obstruct the airways, which contributes to chronic airway obstruction. This can lead to difficulty breathing, especially during sleep, resulting in conditions such as sleep apnea.
Enlarged adenoids can block the normal drainage of fluid from the sinuses and the Eustachian tubes, which connect the middle ear to the nasopharynx. This blockage can lead to recurrent sinusitis (inflammation of the sinuses) and otitis media (middle ear infections), as the trapped fluid can serve as a breeding ground for infections.
Chronic infections in the adenoids can lead to a persistent infection in the ear if the pathogens spread from the adenoids to the middle ear through the Eustachian tubes.
63
what are some pathogens associated with enlarged adenoids?
Common Pathogens Associated with Enlarged Adenoids:
Haemophilus influenzae (H. influenzae)
Streptococcus pyogenes (S. pyogenes)
Staphylococcus aureus (S. aureus)
Moraxella catarrhalis (M. catarrhalis)
Streptococcus pneumoniae (S. pneumoniae)
These pathogens can infect the adenoids and lead to their enlargement, perpetuating the cycle of infection and inflammation.
64
what is the most effective treatment of enlarged adenoids for children older than 3 years old?
Adenoidectomy, which is the surgical removal of the adenoids, has been shown to improve the signs and symptoms of rhinosinusitis associated with enlarged adenoids.
The procedure has also been effective in reducing the recurrence of persistent middle ear infections, especially in children older than 3 years, by removing the blockage and allowing normal drainage and ventilation of the sinuses and middle ear.
65
what is acute pharyngitis?
Acute pharyngitis refers to the sudden onset of inflammation or infection of the pharynx, which is the part of the throat behind the mouth and nasal cavity, and sometimes includes the tonsils.
66
what is the most common cause of acute pharyngitis?
Infection: This is the most common cause of acute pharyngitis.
Viruses: The majority of pharyngitis cases are viral in origin. Common viruses include the common cold, influenza, adenovirus, and others.
Bacteria: Group A Streptococcus (GAS), also known as strep throat, is a well-known bacterial cause. Other bacteria can also be responsible, though less commonly.
67
what is the most common cause of acute pharyngitis between viral and bacterial?
viral
68
what is the most common virus and most common bacteria to cause acute pharyngitis?
Common viruses include the common cold, influenza, adenovirus, and others.
Bacteria: Group A Streptococcus (GAS)
69
what is another cause of acute pharyngitis besides infection?
Irritation: The pharynx can become irritated and inflamed due to non-infectious causes.
70
what are the forms of irritation that causes acute pharyngitis?
Allergy: Allergic reactions can cause symptoms similar to infections, such as swelling and sore throat.
Trauma: Physical injury to the throat, such as from intubation or a foreign object, can cause pharyngitis.
Toxins: Exposure to toxic substances, including cigarette smoke or industrial chemicals, can irritate the pharynx.
Neoplasia: Tumors or growths in the throat, whether benign or malignant, can cause inflammation or mimic the symptoms of pharyngitis.
71
what are some symptoms for acute pharyngitis?
Symptoms of acute pharyngitis can include a sore throat, pain when swallowing, fever, swollen lymph nodes, and redness of the pharynx.
72
which form of acute pharyngitis normally resolve on its own, viral or bacterial?
viral
73
what is the difference in symptoms between group A streptococcus pharyngitis and viral pharyngitis?
for group A strep there is pharyngeal exudate like pus/fluid, there is palatal petechiae, and no cough. confirm with rapid antigen test or culture for bacterium.
for viral, there is no pharyngeal exudate but there is a cough
Group A Strep: This is a bacterial cause of pharyngitis and is responsible for less than one-third of all pharyngitis cases.
Symptoms include fever, pharyngeal exudate (pus or other fluids on the throat), cervical adenopathy (swollen lymph nodes in the neck), palatal petechiae (small red spots on the roof of the mouth), and typically a lack of cough.
Diagnosis can be confirmed with a rapid antigen test or culture, which will be positive for this bacterium.
Viral Causes:
Viral pharyngitis is often distinguished from bacterial by the absence of pharyngeal exudate and the presence of a cough.
Diagnosis is supported by a negative bacterial culture, which means that no bacteria are found to be causing the infection, suggesting a viral etiology.
Infectious mononucleosis (caused by the Epstein-Barr virus) is often accompanied by significant lymphadenopathy (swollen lymph nodes) and splenomegaly (enlarged spleen).
74
what is the most common viral causes of acute pharyngitis?
Common viral causes include Epstein-Barr virus (which causes infectious mononucleosis), cytomegalovirus, herpes simplex virus, adenoviruses, enteroviruses, and influenza.
LESS COMMON CAUSES
Less commonly, acute pharyngitis can be caused by other infectious agents such as Neisseria gonorrhoeae (the bacterium that causes gonorrhea), Mycoplasma species, and Candida albicans (a fungus).
These causes may present with varying symptoms and typically require specific tests for accurate diagnosis.
75
what is mononucleosis?
Mononucleosis (mono/kissing disease) is a viral infection that causes a sore throat and fever. Cases often happen in teens and young adults. It goes away on its own after a few weeks of rest. Transferred by saliva.
76
what other sign is infectious mononucleosis accompanied with?
is often accompanied by significant lymphadenopathy (swollen lymph nodes) and splenomegaly (enlarged spleen).
77
which virus causes infectious mononucleosis?
Epstein-Barr virus
78
which age group is more commonly affected by group A strep pharyngitis?
age 4-7
79
what increases likelihood of getting group A strep pharyngitis?
A history of contact with others who have GAS infection or rheumatic fever increases the likelihood of GAS pharyngitis.
A personal or family history of rheumatic fever can be a risk factor for GAS infection.
80
why might Recent orogenital contact suggest pharyngitis?
gonococcal pharyngitis, which is caused by Neisseria gonorrhoeae.
81
what clinical features helps you identify group A streptococcal pharyngitis?
Features Consistent with GAS Infection:
Age Group: GAS pharyngitis is most common in children aged 4-7 years.
Onset: Sudden onset of symptoms is characteristic of GAS pharyngitis.
Symptoms: Pharyngitis that follows a cough or rhinorrhea (nasal discharge) is more likely to be viral rather than bacterial. GAS infection typically does not start with these symptoms.
Exposure: A history of contact with others who have GAS infection or rheumatic fever increases the likelihood of GAS pharyngitis.
Headache: The presence of a headache can be associated with GAS infection.
Cough: The absence of a cough is a clue that may point towards GAS rather than a viral infection.
Vomiting: While not exclusive to GAS, vomiting in the context of sore throat may suggest a GAS infection.
History: A personal or family history of rheumatic fever can be a risk factor for GAS infection.
Orogenital Contact: Recent orogenital contact might suggest gonococcal pharyngitis, which is caused by Neisseria gonorrhoeae.
82
what is candida pharyngitis?
Candida pharyngitis is an infection of the pharynx caused by Candida species, which are fungi commonly found in the normal flora of the mouth, gastrointestinal tract, and skin.
83
who is at risk of developing candida pharyngitis?
Immunosuppressed individuals: People with weakened immune systems are more susceptible to infections, including fungal infections. This includes individuals with HIV/AIDS, those taking immunosuppressive drugs (such as after an organ transplant), and those with other conditions that impair the immune system.
84
what fungal inflammatory condition normally accompany Chemotherapy or irradiation treatment?
candida pharyngitis
Chemotherapy or irradiation: Treatments for oropharyngeal cancer, such as chemotherapy and radiation therapy, can weaken the immune system and disrupt normal mucosal barriers. This creates an opportunity for Candida to overgrow and infect the pharynx.
85
what is a characteristic feature for candida pharyngitis you will see on examination of oral cavity?
white patches resembling cottage cheese on the walls of the throat.
86
what infection normally develops as a complication of suppurative (pus producing) tonsilitis?
A peritonsillar abscess is a serious infection that often develops as a complication of tonsillitis, which is an inflammation of the tonsils.
87
what is peritonsillar abscess?
Localized Accumulation of Pus: The peritonsillar abscess is characterized by a collection of pus that forms in the tissues surrounding the tonsils (the peritonsillar area). This usually occurs in one of the potential spaces between the capsule of the palatine tonsil and the pharyngeal muscles.
88
what is the most common bacterial cause of peritonsillar abscess?
Group A Beta-hemolytic Streptococci most common
Other Bacterial Causes: While Group A beta-hemolytic streptococci are the most common cause, other bacteria can also cause peritonsillar abscesses. This includes staphylococci (which are common skin bacteria that can invade deeper tissues), pneumococci (which typically cause pneumonia but can also infect the throat), and Hemophilus (a group of bacteria that can cause various infections including those of the respiratory tract).
89
which bacteria normally causes strep throat?
Group A Beta-hemolytic Streptococci
90
which infection exhibits ipsilateral soar throat, ipsilateral inflammation of tonsils, swelling or fullness on one side of throat, ipsilateral ear pain, halitosis, hot potato voice, and trismus (difficulty opening mouth)?
peritonsillar abscess
91
what are some clinical presentations of peritonsillar abscess?
Acute Pharyngitis and Tonsillitis: Sore throat and inflammation of the tonsils, often severe and on one side, which can worsen rapidly.
Unilateral Pharyngeal Discomfort: Pain on one side of the throat that can worsen over time, usually more severe than a typical sore throat.
Malaise, Fatigue, and Headaches: General feeling of unwellness, tiredness, and headaches are common.
Fever and Asymmetric Throat Fullness: Fever accompanied by a sensation of swelling or "fullness" on one side of the throat, where the abscess is forming.
Halitosis: Foul-smelling breath due to the infection and presence of pus.
Odynophagia and Dysphagia: Painful swallowing (odynophagia) and difficulty swallowing (dysphagia), sometimes severe enough to cause drooling.
'Hot Potato' Voice: A muffled, altered voice that sounds as if the person is speaking with a hot potato in their mouth, which is due to swelling and the collection of pus.
Ipsilateral Referred Otalgia: Ear pain on the same side as the abscess, which occurs due to shared nerve pathways between the throat and the ear.
Trismus: Difficulty opening the mouth because of the inflammation and swelling in the area between the tonsils and the wall of the throat.
Neck Pain and Limited Neck Mobility: Swelling of the lymph nodes (lymphadenopathies) in the neck can cause pain and restrict movement.
92
what causes halitosis in peritonsillar abscess?
Halitosis: Foul-smelling breath due to the infection and presence of pus.
93
how does hot potato voice sound and what causes it in peritonsillar abscess?
'Hot Potato' Voice: A muffled, altered voice that sounds as if the person is speaking with a hot potato in their mouth, which is due to swelling and the collection of pus.
94
what cause ipsilateral referred ear pain in peritonsillar abscess?
Ipsilateral Referred Otalgia: Ear pain on the same side as the abscess, which occurs due to shared nerve pathways between the throat and the ear.
95
what causes trismus in peritonsillar abscess?
Trismus: Difficulty opening the mouth because of the inflammation and swelling in the area between the tonsils and the wall of the throat.
96
what causes neck pain in peritonsillar abscess?
Neck Pain and Limited Neck Mobility: Swelling of the lymph nodes (lymphadenopathies) in the neck can cause pain and restrict movement.
97
when compared to Epstein Barr Virus pharyngitis (aka infectious mononucleosis) how do you tell it's peritonsillar abscess?
the characteristic unilateral symptoms and severe sore throat with trismus usually point towards a peritonsillar abscess.
98
what is retropharyngeal abscess?
A retropharyngeal abscess is a collection of pus that forms in the tissues at the back of the throat behind the pharynx, usually due to a bacterial infection. It's a potentially serious condition that can affect the deep spaces of the head and neck.
99
as infection for retropharyngeal abscess gets worse where does it progress to?
As the infection worsens, it can spread to adjacent spaces, including the floor of the mouth (sublingual space), the parapharyngeal space (to the sides of the pharynx), and the prevertebral space (in front of the vertebral column).
100
why is extension of retropharyngeal abscess infection into the floor of the mouth worrisome and can potentially become a medical emergency?
Extension in the Floor of the Mouth: If the abscess extends into the floor of the mouth, it may cause swelling that can rapidly lead to airway obstruction, which is a medical emergency.
Airway Emergency: Due to the risk of airway compromise, any indication of a retropharyngeal abscess requires urgent medical attention. The swelling can progress to the point where the patient cannot breathe, which is potentially life-threatening.
101
what is a hallmark sign in blood for Mono?
atypical lymphocyte
102
what are other pathogens that causes mononucleosis like symptoms?
Mononucleosis-like Syndrome: There are other pathogens that can cause a similar clinical picture, often referred to as "mononucleosis-like syndrome." These include:
Human Herpes Virus 6 (HHV-6) and Cytomegalovirus (CMV), which are both members of the herpesvirus family, similar to EBV.
Herpes Simplex Virus-1 (HSV-1), which is more commonly known for causing cold sores, but can also produce a mononucleosis-like illness.
Rare Causes: There are a number of other, less common infectious agents that can mimic the symptoms of infectious mononucleosis, including:
Streptococcus pyogenes (S. pyogenes), which typically causes strep throat.
Toxoplasma gondii (T. gondii), a parasite that can cause toxoplasmosis.
Acute Human Immunodeficiency Virus type 1 (HIV-1) infection, which can present with a wide variety of symptoms, including those similar to mononucleosis.
Adenovirus, which can cause respiratory illnesses among other syndromes.
Corynebacterium diphtheriae (C. diphtheriae), the bacterium that causes diphtheria.
Francisella tularensis (F. tularensis), which causes tularemia.
Hepatitis A and B Viruses, which primarily affect the liver but can cause flu-like symptoms early on.
Rubella, a viral infection that typically presents with a rash.
Enteroviruses, which can cause a variety of symptoms, including those similar to mononucleosis.
103
which infection is normally Positive for Heterophile Antibodies detected by the Monospot test?
infectious mononucleosis
104
what are common symptoms of infectious mononucleosis?
Febrile Illness: Fever is a common symptom in infectious mononucleosis.
Sore Throat: Often severe, the sore throat can be similar to that seen in streptococcal pharyngitis.
Enlarged Lymph Nodes: Swollen lymph nodes, especially in the neck, are a hallmark of the disease.
Atypical Lymphocytosis: A high number of atypical lymphocytes, a type of white blood cell, is typically seen on a blood smear.
Positive Heterophile Antibodies: These are detected by the Monospot test, which is usually positive in cases of infectious mononucleosis.
105
is infectious mono more severe in children?
no, milder
106
why are people still able to spread mono through their saliva even after the infection has been resolve and they no longer have symptoms?
After the acute phase of the infection has resolved, EBV remains in the body in a latent (dormant) state, typically without causing further symptoms. However, the virus can reactivate, usually without symptoms, and can be shed in saliva, potentially spreading to others.
107
how long can patients spread the EBV for in Mono?
6-15 months
108
which type of cells in the oropharynx or tonsils does the EBV infect in Mono?
The virus initially infects B cells in the oropharyngeal region, particularly the tonsils. EBV has an affinity for B cells because of the specific receptor (CD21) that it uses to enter the cells.
Circulating B cells then spread infection to liver, spleen, and peripheral lymph nodes, prompting humoral and cellular immune responses to the virus.
109
how does mono infection spread throughout body?
Circulating infected B cells then spread infection to liver, spleen, and peripheral lymph nodes, prompting humoral and cellular immune responses to the virus.
110
how is mono managed by the immune system?
B cells form antibodies against the EBV and these antibodies can be detected in blood and serology tests. Then T-cells resolve the infection and suppress primary EBV infection.
Immune Response: The body mounts both humoral (antibody-mediated) and cellular (T cell-mediated) immune responses to the virus.
Humoral Response: B cells produce antibodies against EBV structural proteins. These antibodies can be detected in the blood and are used for the serological diagnosis of EBV infection.
Cellular Response: T cells respond rapidly to infected B cells to control and suppress the primary infection. This T cell response is crucial for resolving the infection and is responsible for the characteristic symptoms of mono, such as swollen lymph nodes and an enlarged spleen.
111
which part of the immune system response is responsible for the characteristic symptoms of mono such as swollen lymph nodes and enlarged spleen?
Cellular Response: T cells respond rapidly to infected B cells to control and suppress the primary infection. This T cell response is crucial for resolving the infection and is responsible for the characteristic symptoms of mono, such as swollen lymph nodes and an enlarged spleen.
112
what is the classic triad of symptoms for mono?
Classic Triad: The typical presentation includes fever, pharyngitis (sore throat), and lymphadenopathy (swollen lymph nodes). Many patients, however, might be asymptomatic, particularly in the early stages of the disease.
113
why do people with mono often not recall being in contact with a sick person?
Incubation Period: EBV has a lengthy incubation period of 1-2 months, which means that patients often do not recall being in contact with someone who was sick, as the onset of symptoms occurs much later.
114
what are symptoms patients with mono will experience initially before sore throat, nausea, and anorexia?
Initial Symptoms: Patients commonly experience fatigue and a prolonged feeling of malaise, which precede the development of a sore throat, nausea (typically without vomiting), and anorexia (loss of appetite).
Additional Symptoms: Some may also suffer from a cough, ocular muscle pain (pain on moving the eyes), chest pain, and photophobia (increased sensitivity to light).
Less Common Symptoms: Low-grade fever, chills, muscle pain (myalgias), and joint pain (arthralgias) are less frequent.
115
what are some early finding in physical exam for Mono?
Early Physical Examination Signs: Early in the course of the disease, patients may have fever, lymphadenopathy, pharyngitis, a skin rash, and swelling around the eyes (periorbital edema). Bradycardia, or a slower than normal heart rate, may sometimes be observed.
116
what are some late fining on physical examination for Mono?
Late Findings: In the later stages, the disease may lead to hepatomegaly (enlarged liver), palatal petechiae (small red spots on the roof of the mouth), jaundice (yellowing of the skin and eyes, which is more common in the elderly), uvular edema (swelling of the uvula at the back of the throat), and splenomegaly (enlarged spleen). Very rarely, the disease can cause the spleen to rupture, which occurs in 1-2% of cases and requires emergency medical attention.
117
which symptom of late stage mono is more common in elderly?
jaundice (yellowing of the skin and eyes, which is more common in the elderly)
118
what is laryngitis?
Laryngitis is the inflammation of the larynx, which is the part of the throat that contains the vocal cords. This condition can lead to swelling of the vocal folds, known as edema, which can affect the quality of the voice or even cause loss of voice.
119
what can laryngitis lead to?
This condition can lead to swelling of the vocal folds, known as edema, which can affect the quality of the voice (lower vocal pitch) or even cause loss of voice.
120
what is the most common infectious cause of laryngitis?
URI
Infectious: It can be caused by a viral infection, most commonly following an upper respiratory infection (URI). Bacterial infections can also cause laryngitis but are less common.
121
what are the most common Noninfectious causes for laryngitis?
Noninfectious: Noninfectious causes include vocal strain from excessive talking, shouting, or singing; irritation from acid reflux (reflux laryngitis); and chronic irritative factors like smoking or exposure to polluted air.
122
what is the most typical symptom of laryngitis and what is it normally preceded by?
Hoarseness: This is the most typical symptom, and it usually develops after a viral URI. The condition is generally self-limiting and resolves within a week.
123
what are some symptoms of acute laryngitis?
Acute Laryngitis:
Hoarseness: This is the most typical symptom, and it usually develops after a viral URI. The condition is generally self-limiting and resolves within a week.
Airway Distress and Fever: If laryngitis is accompanied by significant airway distress or high fever, it might suggest a more severe infection or another condition.
Exudative Tonsillopharyngitis: The presence of pus on the tonsils or pharynx, along with fever and swollen lymph nodes in the neck (anterior cervical lymphadenitis), can indicate a bacterial infection rather than a viral one.
124
what might indicate a more serious form of laryngitis?
Airway Distress and Fever: If laryngitis is accompanied by significant airway distress or high fever, it might suggest a more severe infection or another condition.
125
what might indicate a bacterial infection instead of a viral infection regarding laryngitis?
Exudative Tonsillopharyngitis: The presence of pus on the tonsils or pharynx, along with fever and swollen lymph nodes in the neck (anterior cervical lymphadenitis), can indicate a bacterial infection rather than a viral one.
126
what symptom might indicate a more chronic form of laryngitis?
Persistent Hoarseness: If hoarseness lasts longer than three weeks, it is considered chronic and warrants further evaluation by a specialist, such as an otolaryngologist (ENT doctor), to rule out more serious conditions, including malignancy.
127
when should you refer a laryngitis patient to ENT?
Persistent Hoarseness: If hoarseness lasts longer than three weeks, it is considered chronic
128
which symptom of laryngitis is self limiting and resolves in <7 days?
hoarseness
129
why may laryngitis impact children greater than adults?
Special Considerations in Children:
Children have a smaller larynx, so any edema can more significantly impact their airway, potentially leading to compromise and breathing difficulties.
130
what is epiglottitis?
Epiglottitis is a potentially life-threatening condition that involves inflammation and swelling of the epiglottis, which can lead to sudden and severe airway obstruction.
131
what can epiglottitis lead to?
can lead to sudden and severe airway obstruction.
132
what is another name for epiglottitis?
Supraglottitis
Cellulitis of Supraglottis: Epiglottitis was traditionally referred to as "supraglottitis," indicating inflammation of the supraglottic area, which includes the epiglottis and surrounding tissues. "Cellulitis" refers to the infection and inflammation of these tissues.
133
what are the symptoms of epiglottitis?
Symptoms: The disease typically presents with a rapid onset of high fever, sore throat, an inability to control secretions leading to drooling, difficulty breathing, and a distinct posture known as "tripod positioning," where a person sits leaning forward on their hands to open up the airway. Children may also be irritable due to discomfort and difficulty breathing. dysphagia (difficulty swallowing), decreased oral intake due to pain or difficulty swallowing, muffled or altered voice (as if talking with a hot potato in the mouth), and general irritability.
134
what is the tripod position?
a distinct posture known as "tripod positioning," where a person sits leaning forward on their hands to open up the airway.
135
what was the most common bacterial cause of epiglottitis?
Haemophilus influenzae type b (Hib)
Etiology: Historically, Haemophilus influenzae type b (Hib) was the most common cause of epiglottitis, but with the advent of the Hib vaccine, the incidence of Hib-related epiglottitis has decreased significantly. However, other bacteria like Streptococcus pneumoniae, Staphylococcus aureus, and methicillin-resistant Staphylococcus aureus (MRSA) can also cause the condition.
136
what are 2 key symptoms of epiglottitis?
drooling and tripod position
137
is you have a History of lack of vaccination with Hib vaccine what inflammatory condition are you at risk for?
epiglottitis
138
what signs will you see on physical exam for epiglottitis?
Physical Appearance and Signs: Patients with epiglottitis can appear very sick ("toxic appearance") and in acute distress, showing signs of respiratory difficulty such as stridor (a high-pitched wheezing sound), and adopting a tripod position to ease breathing.
139
what is toxic appearance in epiglottitis?
appearing very sick
140
what is strider as heard in epiglottitis?
a high-pitched wheezing sound. Stridor is a sign of significant airway obstruction and is often heard on inhalation. It indicates that the airway is compromised, and immediate medical attention is needed.
141
how does epiglottitis develop?
Inflammation: This is often caused by an infection, which leads to inflammation of the epiglottis and surrounding tissues.
Localized Edema: The inflammatory process results in the accumulation of fluid in the tissues (edema), leading to swelling.
Narrowing of Supraglottic Aperture: As the epiglottis swells, it leads to a narrowing of the opening above the vocal cords (the supraglottic aperture). This narrowing reduces the space through which air can flow into the trachea and lungs.
Increasing Airway Resistance: The narrowed aperture increases resistance to air flow. As air passes through the restricted space, it causes a turbulent flow that results in a characteristic high-pitched sound.
Stridor: This is the result of the turbulent air flow through the narrowed supraglottic region. Stridor is a sign of significant airway obstruction and is often heard on inhalation. It indicates that the airway is compromised, and immediate medical attention is needed.
142
which phase of expiration is stridor heard on, inspiration or expiration?
inspiration
143
what is the opening above the vocal cords called?
supraglottic aperture
144
what position is to maximize airway patency by physically pulling the structures of the neck, including the hyoid bone and the swollen epiglottis, forward. It requires immediate medical attention, often including securing the airway via intubation or a tracheostomy if necessary?
tripod position
145
what causes reflux laryngitis?
hydrochloric acid, pepsin, or bile which leads to chemical damage.
146
what is characterized by a white patch or plaque on the oral mucosa that cannot be rubbed off. It's considered a precancerous lesion, meaning it can potentially develop into cancer over time?
Leukoplakia
147
what is Similar to leukoplakia, but with a red (erythematous) component, indicating more blood vessels are present. Is less common than leukoplakia but has a higher risk of becoming cancerous?
erythroplakia
148
what is a chronic inflammatory condition that affects the mucous membranes of the mouth. It often presents as white, lacy patches on the mucosa, which may sometimes be erosive. A biopsy is usually required for a definitive diagnosis because the appearance can be similar to other conditions, including precancerous or cancerous lesions?
oral lichen planus
149
what cancer has early sign appearance of leukoplakia or erythroplakia. As the cancer progresses, the lesions can become larger, invade deeper tissues like the tongue, and a palpable mass may be felt. Ulceration, where the lesion becomes an open sore, may also occur?
oral cancer
150
what type of cancer affects the part of the throat directly behind the mouth (the oropharynx). Early signs may include unilateral (one-sided) throat masses, pain during swallowing (odynophagia), and non-specific symptoms such as weight loss?
Oropharyngeal Cancer
151
what are early signs of Oropharyngeal Cancer?
Early signs may include unilateral (one-sided) throat masses, pain during swallowing (odynophagia), and non-specific symptoms such as weight loss
152
what is odynophagia?
pain during swallowing
153
what is oral squamous cell carcinoma?
Oral squamous cell carcinoma (SCC) is a type of cancer that arises from the squamous cells lining the oral cavity.
Oral SCC can be challenging to distinguish from other noncancerous lesions in the mouth due to its varied appearance. It can mimic benign conditions, which may delay diagnosis and treatment.
154
what size and depth limit characterizes early detection of oral squamouse cell carcinoma?
Importance of Early Detection: Identifying oral SCC when it is smaller than 2cm in size and less than 4mm in depth is crucial.
Early-stage cancers have a higher chance of successful treatment with less extensive surgery and a better chance of preserving important functions such as speech and swallowing.
155
how does oral SCC lesions present?
Characteristic Appearance: Oral SCC often presents as raised, firm, white lesions with ulceration. The presence of an ulcer, especially one that is painful upon gentle palpation, is highly suspicious for SCC.
156
what may indicate high suspicion of SCC?
painful ulcer when gently palpated
157
what is the most common type of oral cancer?
90% oral cancer cases are Squamous Cell Carcinoma
158
what are the common locations for SCC lesions?
Common Locations: Oral SCC typically occurs on the lateral borders of the tongue, the oropharynx (the part of the throat at the back of the mouth), and the floor of the mouth.
159
is leukoplakia more common than erythoplakia?
yes
160
which type of patch in the mouth has an even higher risk of being cancerous than erythroplakia?
Mixed red and white lesions (erythroleukoplakia)
161
what when presented within any of these 3 plakia (erythroplakia, leukoplakia, or erythroleukoplakia) lesions, particularly if it does not heal over time, is a concerning sign that warrants further investigation?
Ulcer
162
how does oral squamous cell carcinoma develop?
1. Tobacco as a Risk Factor:
Tobacco contains numerous carcinogens that directly damage the DNA in the cells of the oral cavity.
Chewing tobacco or smoking exposes the oral mucosa to these carcinogens.
2. Oxidative Stress:
Cigarette smoke contains reactive oxygen species (ROS) and redox-active metals that can produce free radicals.
Saliva normally contains antioxidants that neutralize harmful free radicals.
However, the interaction between the antioxidants in saliva and the substances in tobacco smoke can overwhelm the antioxidant capacity of the saliva.
3. Loss of Antioxidant Capacity:
Over time, the persistent exposure to tobacco smoke can cause saliva to lose its antioxidant capacity.
As a result, saliva becomes a pro-oxidant milieu, meaning it starts contributing to the oxidative stress instead of protecting against it.
4. DNA Damage and Mutations:
The pro-oxidative environment leads to DNA damage within the oral epithelial cells.
Specifically, it can cause mutations in crucial genes that regulate cell growth and death, such as p16 and p53.
The p16 protein is a tumor suppressor that helps regulate the cell cycle, and p53 plays a key role in DNA repair and apoptosis (programmed cell death).
5. Carcinogenesis:
The accumulation of such mutations disrupts normal cell cycle control and apoptosis.
This can lead to uncontrolled cell growth and the development of cancerous tumors.
6. Development of OSCC:
The continued exposure to tobacco carcinogens and the persistent oxidative stress can lead to the development of precancerous changes and eventually OSCC.
163
which gene is a tumor suppressor gene that regulates cell growth/cell cycle and is mutated by smoking in oral SCC?
p16
164
which gene is involve in DNA repair and apoptosis (programmed cell death) and is mutated by smoking in oral SCC?
p53
165
what is oral candidiasis (thrush)?
Oral candidiasis, also known as oral thrush, is a fungal infection of the mouth caused by the overgrowth of Candida species, usually Candida albicans.
166
what are risk factors for oral candidiasis?
Risk Factors:
Diabetes: High blood sugar levels can promote the growth of yeast.
Immunocompromised Status: A weakened immune system cannot control Candida growth effectively.
Broad-Spectrum Antibiotics: These medications can kill beneficial bacteria that normally keep Candida in check.
Corticosteroids: These can suppress the immune response and alter the oral environment.
Defective Dentures: They can harbor fungi and irritate oral tissues, creating an environment conducive to Candida overgrowth.
Poor Oral Hygiene: This can allow for the accumulation of fungi.
Anemia: Reduced red blood cells can affect the health of mucosal tissues.
Chemotherapy or Local Irradiation: These treatments can weaken the immune system and disrupt normal oral flora.
167
what candida species normally overgrow in thrush?
candida albicans
168
which Lesions are often painful and are described as creamy-white, curd-like patches on the erythematous (red and inflamed) mucosal surfaces. These patches are typically easy to rub off, revealing a red, raw area beneath that may bleed slightly?
oral candidiasis
169
what is angular cheilitis?
This is a condition where the corners of the mouth become inflamed and may crack, often associated with the same fungal infection (oral candidiasis). It can also be seen in nutritional deficiencies, like vitamin B2 (riboflavin) or iron deficiency.
170
which condition presents with angular cheilitis?
vitamin B2 (riboflavin) or iron deficiency and oral candidiasis
171
what is one of the first signs of HIV?
Oral candidiasis is often one of the first signs of HIV infection due to the compromised immune system associated with HIV, which allows opportunistic infections like candidiasis to occur more easily.
172
what is commonly known as canker sores, are small, shallow lesions that develop on the soft tissues in the mouth or at the base of the gums. They are not contagious?
aphthous ulcers
173
which type of aphthous ulcer account for about 85% of all aphthous ulcer cases.
The ulcers are typically small, less than 8mm in diameter, often between 2-3mm.
They occur on the floor of the mouth, lateral and ventral surfaces of the tongue, and pharynx.
They cause mild pain and generally heal within 7-10 days without leaving scars.
Patients may experience recurrences 3-4 times per year, which can be quite bothersome?
minor aphthous ulcer
174
which type of aphthous ulcer represent about 10% of cases.
These ulcers are larger, more than 1cm in diameter.
They often appear on the lips, soft palate, and throat.
Accompanying symptoms may include fever, difficulty swallowing (dysphagia), and malaise.
They are more painful and can take up to a month to heal, possibly leaving scars?
major aphthous ulcer
175
which types of aphthous ulcer is larger, more painful, and less common?
major aphthous ulcer
176
which type of ulcer is more common in women, painful, pinpoint ulcers that coalesce, and not related to herpes virus?
Herpetiform Ulcers
177
which ulcer Comprise 5% of aphthous ulcer cases.
Despite the name, they are not related to the herpes virus.
These ulcers are more common in females and are characterized by multiple small, pinpoint ulcers that can merge into larger ulcerated areas.
They typically heal in 10-14 days and are quite painful during the course?
Herpetiform Ulcers
178
what is the cause of aphthous ulcer?
Cause is uncertain (may be association with herpesvirus HHV 6 has been suggested).
179
what are some ways that aphthous ulcer develop?
Idiopathic Nature:
"Idiopathic" means the exact cause is unknown. While the precise triggering mechanism of aphthous ulcers is unclear, they are thought to result from a complex interaction of factors.
Immunological Factors:
They are associated with a cell-mediated immune response, particularly involving T-helper 1 (TH1) cells.
This suggests that the body’s immune system may mistakenly target the mucous membrane cells lining the mouth, leading to ulcer formation.
Genetic Predisposition:
There is evidence to suggest a genetic component, as aphthous ulcers can run in families.
Systemic Immune Disorders:
Aphthous ulcers can be associated with systemic conditions such as celiac disease, Crohn’s disease, and Behçet's disease.
These conditions should be ruled out if aphthous ulcers are frequent or severe.
HIV Infection and Nutritional Deficiencies:
People with HIV infection have a higher incidence of aphthous ulcers, likely due to their compromised immune system.
Nutritional deficiencies, including those of vitamin B12, iron, and folic acid, can also predispose individuals to develop these ulcers.
External Triggers:
Mechanical trauma, such as from poorly fitting dentures or accidentally biting the inside of the lip or cheek, can trigger the development of ulcers.
Other factors like hormonal changes, certain foods, and cessation of smoking may also trigger or worsen the condition.
Psychological Stress:
Stress and anxiety are known to be significant triggers for the development of aphthous ulcers in susceptible individuals.
Smoking Cessation:
Surprisingly, stopping smoking can precipitate the appearance of aphthous ulcers in some people, potentially due to the anxiety and stress associated with nicotine withdrawal.
180
which 3 systemic disease must be ruled out first when aphthous ulcer is present because they're often associated with it?
Aphthous ulcers can be associated with systemic conditions such as celiac disease, Crohn’s disease, and Behçet's disease.
These conditions should be ruled out if aphthous ulcers are frequent or severe.
181
people with HIV have a higher incidence of which ulcer?
aphthous ulcer
182
what nutritional deficits predisposes to aphthous ulcers?
Nutritional deficiencies, including those of vitamin B12, iron, and folic acid, can also predispose individuals to develop these ulcers.
183
smoking cessation and stress can lead to what type of ulcer?
aphthous ulcer
184
is aphthous ulcer sexually transmitted?
no
185
what is Behçet's disease (silk road disease)?
Behçet's disease is a rare, chronic, multisystemic disorder characterized by inflammation of the blood vessels ([systemic]vasculitis) and is known for causing recurrent mouth and genital ulcers.
186
what is the hallmark of Behçet's disease?
Oral and Genital Ulcers: A hallmark of the disease is the presence of recurrent, painful oral ulcers that are usually larger and more painful than common canker sores and can take weeks to heal. Genital ulcers, which may affect the anus, vulva, or scrotum, are also a common symptom.
187
which disease is commonly associated with individuals who have the HLA-B51 gene variant. There is also a noted presence of high levels of antibodies against Helicobacter pylori?
Behçet's disease
188
why are antibodies against helicobacter pylori present in people with Behçet's disease?
due to molecular mimicry; this means that the immune system may mistake body tissues for this bacterium and attack them, leading to inflammation.
189
what presents with Behcet's disease clinically?
Uveitis:
Anterior Uveitis: This can cause pain, decreased vision, redness, and hypopyon (accumulation of sterile pus in the anterior chamber of the eye).
Posterior Uveitis: This may present with a painless decrease in vision, floaters, and potential optic nerve damage.
Skin Conditions: There is an increased prevalence of skin conditions like folliculitis (inflammation of hair follicles) and erythema nodosum (tender nodules usually on the front of the legs).
Vascular Complications: The vasculitis in Behçet's disease can lead to serious complications such as the formation of aneurysms (abnormal bulges in blood vessel walls) and thromboembolism (blood clots that can travel through the bloodstream and cause blockages).
190
which skin condition is associated with behcet's disease due to pathergy?
Skin Conditions: There is an increased prevalence of skin conditions like folliculitis (inflammation of hair follicles) and erythema nodosum (tender nodules usually on the front of the legs).
190
what is hypopyon?
accumulation of sterile pus in the anterior chamber of the eye [lower portion]
191
which uveitis is painful, anterior or posterior?
anterior
192
what is pathergy?
an exaggerated skin injury [hyper-sensitive skin response] occurring after minor trauma such as bump, bruise, needle stick injury. often tested by pricking the skin with a small needle to see if a small red bump (papule) or pustule forms in response.
A more severe injury, such as a surgical procedure, can result in persistent ulceration in a patient with pathergy.
193
What are the common ocular manifestations of Behçet's disease?
Common Ocular Manifestations: Behçet's disease can lead to various eye problems, including anterior uveitis, relapsing hypopyon, vitritis, retinal infiltrates, retinal vasculitis, and retinal vascular occlusion.
194
Can Behçet's disease affect the gastrointestinal tract, and if so, how?
Gastrointestinal Tract Involvement: Yes, Behçet's disease can affect the entire GI tract, manifesting as aphthous ulcers, which can be similar in appearance to those found in the mouth but can occur anywhere along the gastrointestinal lining.
195
Describe the form of arthritis that is associated with Behçet's disease. How does it typically present?
Form of Arthritis in Behçet's Disease: Arthritis in Behçet's disease is usually non-obliterative, affecting large joints and typically not leading to permanent joint damage.
196
What are the potential complications of Behçet's disease in the genitourinary system?
Genitourinary Complications: In the genitourinary system, Behçet's disease can cause ulcers and may lead to epididymitis in males.
196
How can Behçet's disease impact the vascular system, specifically in terms of venous occlusions?
Vascular System Impact: Vascular involvement in Behçet's disease can lead to deep venous occlusions, which may result in complications like thrombosis and aneurysms.
197
Define "Neuro Behçet" and describe what it entails.
Neuro Behçet: This term refers to the neurological manifestations of Behçet's disease, which can include both central nervous system involvement, such as parenchymal disease, and vascular complications like cerebral sinus thrombosis.
198
What is "Angio Behçet," and which systems does it affect?
Angio Behçet: This is a term used to describe the vascular manifestations of Behçet's disease, including ischemic heart disease, involvement of cardiac structures, and aneurysms in pulmonary and peripheral vessels.
199
what are the most common risk factors for developing leukoplakia?
Association with Alcohol and Tobacco:
The most common risk factors for developing leukoplakia are chronic alcohol and tobacco use. The irritants in tobacco and alcohol can cause changes in the oral mucosa leading to the formation of leukoplakia.
Other Risk Factors:
Chronic irritation from other sources, such as ill-fitting dentures, can also lead to leukoplakia.
Lichen planus, a chronic inflammatory condition of the mucous membranes, and candidiasis, a fungal infection, are also associated with leukoplakia.
Nutritional deficiencies, particularly vitamins A and B, can contribute to its development.
200
what is one way leukoplakia differ from oral candidiasis?
it can't be wiped away>
Leukoplakia appears as bright white patches or plaques within the mouth. These are sharply defined and cannot be wiped away.
The surface of these patches is slightly raised above the level of the surrounding tissue.
201
what vitamin deficiency pus you at risk for leukoplakia?
Vitamin A and
202
what is the thickening of the outer layer of the skin or mucous membrane called that's normally in leukoplakia?
hyperkeratosis
203
what is the precancerous change in the cells that may be found upon biopsy of the leukoplakia called?
dysplasia
there may be early signs of squamous cell carcinoma (SCC).
204
what are some signs that calls for concern in leukoplakia?
Leukoplakia with a verrucous (wart-like) appearance, ulcerations, or nodules is particularly concerning.
Lesions located on the anterior floor of the mouth or the undersurface of the tongue are more likely to show dysplasia or early invasive SCC and require closer monitoring and more aggressive management.
205
Lesions located on the which area of the mouth or tongue are more likely to show dysplasia or early invasive SCC and require closer monitoring and more aggressive management?
Lesions located on the anterior floor of the mouth or the undersurface of the tongue
206
what is meant by verrucous?
wart-like
a low-grade variant of squamous cell carcinoma
207
why should any red patch in the oral cavity that cannot be attributed to a specific disease such as trauma, infection, or systemic disease should be biopsied?
to check for dysplasia or carcinoma Due to the high risk of malignancy associated with erythroplakia. Early detection and treatment are crucial for improving outcomes, as oral SCC can be aggressive and metastasize (spread to other parts of the body) if not treated promptly.
208
what is oral hairy leukoplakia?
Oral hairy leukoplakia is a condition characterized by a white patch or plaque that appears on the side of the tongue.
The condition manifests as white patches that are slightly raised above the surface of the tongue. They have a characteristic "hairy" or corrugated texture.
209
which virus is present in oral hairy leukoplakia?
epstein barr virus
210
which oral condition is considered an early sign of HIV
oral hairy leukoplakia
can also occur in other immunocompromised states, such as in patients who have had organ transplants and are on immunosuppressive therapy or in individuals who are on long-term systemic corticosteroid therapy.
211
what differentiates oral hairy leukoplakia from other oral white lesions that are more indolent?
The lesions typically develop quickly, distinguishing them from other white lesions in the mouth that may be more indolent.
212
which type of plaque is white, non-malignant, non-painful, asymptomatic, and appears and disappears spontaneously?
hairy oral leukoplakia
