Mouth & Throat

Question 1

What is Recurrent Herpes Labialis and what is its prodrome?

Answer 1

Cold sore from HSV-1 most commonly; itching, burning, tingling for 12-36 hours followed by eruption of clustered vesicles

Question 2

What’s the most common cancer of the lips and what does it look like?

Answer 2

Squamous cell carcinoma; painless, clearly demarcated, elevated, indurated (hardened) border with ulcerated (atrophy of tissue) base

Question 3

What is a mucocele?

Answer 3

A soft cyst that’s mucin-filled, common under tongue near lip, clear or blue bubble that may enlarge, break, or shrink. Usually doesn’t go away unless surgically removed

Question 4

What is cheilitis?

Answer 4

Chapped lips

Question 5

What is angular cheilitis?

Answer 5

Deep cracks at labial commissure (corner of mouth) from irritation; can get infected by Candida albicans or Streptococcus aureus

Question 6

What are lesions?

Answer 6

Ulcerations, Lesions include ulcerations, cysts, firm nodules, hemorrhagic lesions, papules, vesicles,
bullae, and erythematous lesions.

Question 7

What is oral lichen planus?

Answer 7

A non-erosive lesion that’s usually painless, looks like lace-like white streaks on buccal mucosa

Erosive on gingival margin or erupt into violet papules on genitalia, lower back, ankles, anterior lower legs

Question 8

What is leukoplakia?

Answer 8

White plaque on oral mucosa that is precancerous of squamous epithelium; cannot be wiped off with gauze

Question 9

What is erythroplakia?

Answer 9

Red plaque with well-demarcated edges on the floor of mouth, tongue, and palate that is precancerous of epithelium

Question 10

Oral SCC

Answer 10

Present as leukoplakia or erythroplakia on floor of mouth of lateral and ventral tongue; HPV-16 infection

Question 11

Melanoma

Answer 11

Lesions breaking ABCD rules; will not blanch (turn white)

Question 12

Fordyce’s spots

Answer 12

Benign neoplasm from sebaceous glands

Asymptomatic, multiple, white to yellow, 1-2 mm papules, often occurring confluent cluster

Most common on the vermillion/buccal mucosal border. Also on the inner surface of the

lips, the retromolar region, tongue, gingiva, frenulum linguae or palate

Question 13

Stomatitis

Answer 13

Overall inflammation of oral tissue from a variety of infections: strep, Candida, TB, Varicella-zoster virus, fungus

Question 14

Oral Candidiasis

Answer 14

“Thrush”; soft white lesions that look like milk curds and can be easily wiped away, causing bleeding; caused by inhaled glucocorticoids (inhalers) or HIV

Question 15

Recurrent aphthous stomatitis

Answer 15

Necrotizing ulcerations of oral mucosa due to trauma; “canker sores”

Question 16

Herpetic gingivostomatitis

Answer 16

“Cold sore” from HSV-1; self-limited 1-2 weeks; lymphadenopathy (chronically swollen lymph nodes) in children

Question 17

Oral erythema multiforme

Answer 17

Hypersensitivity rxn to HSV; SSx: Painful stomatitis, sudden onset of diffuse hemorrhagic vesicles and bullae with erythematous base, on lips/mucosa

bullae rupture leaving raw, painful, friable surfaces, then form crusts

Other areas of body – maculopapular erythematous lesions (target lesions) form symmetrically on the hands, arms, feet, legs, face, and neck and, possibly, in the eyes and on the genitalia

Question 18

Chancre

Answer 18

Painless ulcerations from primary stages of syphilis (Treponema pallidum), these ulcers usually form on or around the lips, tongue, also anus, penis, and vagina, lasting 2 wks to 3 mos w/o tx.

SSX Painless single ulcerated lesion, indurated border, no central necrotic tissue; tender cervical LA

Question 19

Other causes of inflammation in the mouth

Answer 19

Many are denture-related: frictional hyperkeratosis, epulis fissura, denture sore spot or mouth, irritation fibroma

Question 20

Angioedema

Answer 20

Acute swelling of the skin and mucosa (mouth, throat, tongue), and submucosa with rapid onset of minutes to hours; urticaria (itchy raised bumps) and hand swelling is common if due to allergy

Question 21

Palatal or Mandibular Torus

Answer 21

Non-neoplastic, slowly growing nodular protuberance of bone. Of little clinical significance except with dentures

Question 22

Hemangioma

Answer 22

Proliferation of blood vessels, will blanch when pressed down

Lesions are flat or raised, with a deep red or bluish-red color

Most common sites: lips, tongue, buccal mucosa and palate. Secondary infx common

Question 23

Varicosities

Answer 23

Like varicose veins, dilated and tortuous veins in oral cavity from increased hydrostatic pressure and weak surrounding tissues, will blanch

Question 24

Papilloma

Answer 24

Asymptomatic, well-circumscribed, usually pedunculated benign growths with numerous,small finger-like projections (papillary or verrucal)

Generally

Question 25

Lipoma

Answer 25

Painless, benign, slow-growing mass of adipose tissue (on cheek, tongue) Yellow, non-tender, rubbery or soft, mobile (if on cheek) May affect speech if large

Question 26

Sialadenitis

Answer 26

Salivary glands: Benign swelling seen in many systemic diseases (eg hepatic cirrhosis, sarcoidosis, neoplasms, infections (mumps) Usually pain with mumps, malignancy and infection; others may be painless

Question 27

Sialolithiasis

Answer 27

Salivary duct stones, most common in the submandibular glands Pain and swelling associated with eating

Question 28

Sjögren’s syndrome

Answer 28

Systemic inflammation (autoimmune) associated with dry eyes, mouth and mucus membranes

Question 29

Xerostomia

Answer 29

Dry mouth; from drug use, mouth breathing

Question 30

Gingivitis

Answer 30

Inflammation of the gums with redness, swelling, changes in contours, pocket formation due to poor oral hygiene and food impaction

Question 31

Acute Necrotizing Ulcerative Gingivitis ANUG

Answer 31

Acute infection of the gingiva from bacteria Progressive painful infection with ulceration, swelling and sloughing off of dead tissue Ulcerated lesions of the interdental papillae; can affect all gum tissue, bad odor, bleeding

Question 32

Periodontitis

Answer 32

Progressive gingivitis infection of the periodontium from anaerobic organisms causing inflammation of the periodontal ligament, gingival, cementum and alveolar bone Tooth may be tender with percussion, bleeding easily with exudate from gums

Question 33

Dental caries

Answer 33

Tooth decay due to bacteria or meth users

Question 34

What are some serious concomitant symptoms with toothache and infection?

Answer 34

Headache, fever, swelling or tenderness on floor of mouth, CN abnormalities

Question 35

What are some serious causes of toothache that call for referral or emergency care?

Answer 35

Painful apical abscess in root of tooth Ludwig's angina - bacterial Strep or Staph cellulitis Cavernous sinus thrombosis - Strep or Staph in cavernous sinus leads to development of blood clot

Question 36

What does deviation of the tongue indicate in a PE?

Answer 36

Paralysis to hypoglossal nerve CN XII

Question 37

What are some causes to taste abnormalities?

Answer 37

Damaged papilla, B3 or zinc deficiency

Question 38

What are some causes to color changes to the tongue?

Answer 38

Geographic tongue from loss of papilla (erythematous patches with white borders) - consider Candida, Reiter's (reactive arthritis), SLE White or yellow - local irritation Red - B12 deficiency (pernicious anemia), celiac, scarlett fever Dark - drugs

Question 39

What is hairy tongue?

Answer 39

Distal dorsal third looks hairy (black or green) due to hyperplasia of filiform papillae - AIDS, or Candida or Aspergillus infx after antibiotics Benign condition, painless, pt may experience “gagging” sensation

Question 40

What are some causes of tongue pain?

Answer 40

Post-menopausal burning tongue syndrome DM Heavy metal poisoning

Question 41

What are some causes to tongue tremor?

Answer 41

Hyperthyroidism (fine tremor) | Lower motor neuron dz - ALS

Question 42

What are furrows in the tongue?

Answer 42

Deep groove in midline due to dehydration or syphilis

Question 43

What might dry tongue with and without furrows indicate?

Answer 43

Without furrows - Sjogren’s | With - dehydration

Question 44

What might cause the tongue to have a smooth appearance?

Answer 44

atrophy of the filiform papillae Sjogren's Syndrome B12, iron, folate, protein deficiency Oral candidiasis

Question 45

What might be some causes of enlarged tongue?

Answer 45

``` Acromegaly (person with bigger bones due to excess GH from pituitary gland) Down Syndrome Allergic rxn Pernicious anemia Strep infx ```

Question 46

What is glossitis?

Answer 46

Acute or chronic inflammation from bacterial or viral infx (oral herpes simplex); B12 or iron deficiency Tongue swelling and scalloping Tongue colors: usually dark red, pale=pernicious anemia, fiery red=B vit deficiency

Question 47

What's the measurement for tonsil size?

Answer 47

Grade 0-4 with 0 being really far apart (may be congenital)

Question 48

Acute pharyngitis

Answer 48

Inflammation from viral (90%) or bacterial infx, aphthous ulcers, herpes, fungus, trauma, neoplasm, or glossopharyngeal neuralgia

Question 49

Viral pharyngitis types

Answer 49

Adenovirus (most common) and infectious mononucleosis (EBV or CMV)

Question 50

Adenovirus

Answer 50

Normal looking throat but painful | Runny nose, stuffy nose and throat, sore throat within 24-48 hrs, lymph node enlargement modest

Question 51

Infectious mononucleosis

Answer 51

(EBV or CMV) - exudative tonsillitis with marked redness and swelling of the throat. “kissing tonsils” significant lymph gland; Herpes simplex virus, measles, or rhinovirus (80%) Other symptoms include splenomegaly, persistent fatigue, weight loss; possibly hepatitis

Question 52

Types of bacterial pharyngitis

Answer 52

Group A Strep (GAS) Non-group Strep Diphtheria

Question 53

Group A Strep (GAS)

Answer 53

Most common bacteria agent typically enlarged and tender lymph glands, with bright red inflamed and swollen throat, often unilateral, progresses May have a high temperature, headache, myalgia, arthralgia

Question 54

What is the Modified Centor Criteria used for?

Answer 54

GAS clinical probability to rule Strep OUT 1. Absence of cough 2. Tender anterior cervical adenopathy 3. Tonsillar exudate 4. History of fever

Question 55

What are some suppurative (pussing) and non- complications of GAS?

Answer 55

Suppurative - sinusitis, otitis media, meningitis | Non-suppurative - rheumatic fever, glomerulonephritis

Question 56

Non-group Strep

Answer 56

Not associated with rheumatic fever

Question 57

Diphtheria

Answer 57

Potentially life threatening URI caused by Corynebacterium diphtheriae toxin SSx: in 30% of cases--characteristic dirty gray, tough fibrous membrane in tonsillar area, may cause dyspnea or stridor. Membrane will bleed with scraping. mild sore throat, dysphagia, low grade fever, nausea, vomiting Check history of travel (endemic in Africa)

Question 58

Tonsillitis

Answer 58

Acute inflammation of palatine tonsils often seen alongside pharyngitis sudden onset, high fever, malaise, vomiting common enlarged hyperemic tonsils with purulent exudate may see membrane on tonsils fetid breath Acute - bacterial/viral infx Subacute - 3 wks to 3 mos Chronic - 3 mos+, typically bacterial

Question 59

Complications of tonsillitis

Answer 59

Peritonsillar abscess Tonsilloliths - whitish-yellow deposits produced by bacteria feeding on mucus which accumulates in crypts. These "tonsil stones" emit pungent odor from volatile sulphur compounds Hypertrophy of tonsils

Question 60

Peritonsillar abscess (PTA)

Answer 60

SERIOUS: worsening unilateral sore throat and pain during swallowing (dysphagia) from persistent tonsillitis causing abscess between tonsils and pharyngeal constrictor ms Fever can be >103 and inability to open mouth (trismus)

Question 61

Parapharyngeal abscess

Answer 61

SERIOUS: suppuration of the parapharyngeal lymph nodes. abscess is lateral to the superior constrictor muscle and close to the carotid sheath; markedly swollen anterior triangle in the neck Throat may appear normal

Question 62

Retropharyngeal abscess

Answer 62

MEDICAL EMERGENGY: infection in one of the deep spaces of the neck, potential for airway compromise and other catastrophic complications usually occurs in small children or infants (adults too) as complication of suppurative retropharyngeal (behind) lymph nodes. Infection spread from the nose, ears, sinuses or tonsils

Question 63

What can happen in chronic infection of the pharynx?

Answer 63

Inflammation leading to scarring and fibrosis

Question 64

What are some causes of chronic irritation of the pharynx?

Answer 64

Allergies Vocal abuse Chronic sinusitis Complication of nephritis (inflamm of kidneys), GERD, pregnancy Will cause cobblestoning of pharyngeal mucosa, hypertrophic lymph tissue

Question 65

Signs of malignancies in the pharynx

Answer 65

``` Usually SCC Lump in neck Pain in throat Tumor is red smooth mass DDX: erythroplakia ```

Question 66

What causes hoarseness in the larynx?

Answer 66

``` Structural changes in the vocal cords that impair their ability to vibrate due to: allergies vocal abuse polyps nerve impairment general weakness of cords TB Hypothyroidism Emotional causes ```

Question 67

Laryngitis

Answer 67

Hoarseness or complete loss of voice due to irritation from infection, inflammation, excessive coughing

Question 68

Epiglottitis

Answer 68

MEDICAL EMERGENCY: bacterial infection of the epiglottis, most often caused by Haemophilus influenzae type B; also Streptococcus pneumoniae or Streptococcus pyogenes. Difficulty swallowing, stridor (high pitch upon inhale), head hung forward May lead to asphyxiation and cyanosis Most common 2-5 yo DO NOT try to visualize throat "Thumbprint sign" in lateral C-spine x-ray is positive

Question 69

Vocal cord polyp or nodule

Answer 69

Benign, often bilateral lesion from vocal abuse, irritants, allergies Dx with indirect laryngoscopy

Question 70

Vocal cord contact ulcers

Answer 70

unilateral or bilateral ulcers on the mucus membrane over the the arytenoids cartilage commonly from GERD Prolonged ulceration leads to granulomas

Question 71

Laryngeal vocal cord SCC

Answer 71

Most common cancer in head and neck Males > Females Hoarseness

Question 72

General causes of swelling/masses in neck for adults and children

Answer 72

Adults: most are due to inflammatory or neoplastic conditions of the cervical lymph nodes Kids: usually due to recurrent tonsillitis Tuberculosis, brachial cysts.

Question 73

What are the types of swelling in the neck?

Answer 73

1. Cervical LA, suspected with acute inflammation of the tonsils, pharynx. Tender, rubbery 2. Neoplasm of the lymphatic chain: NT cervical LA, hard, immobile, large also from metastases from other areas confirm with biopsy 3. Salivary gland swelling: may be inflammatory (mumps, bacteria) or the result of a stone in duct 4. Medial neck swellings: from thyroid condition or spread of infection from other areas