Mouth & Throat Disorders

Question 1

What is the main objective when diagnosing Acute Pharyngitis?

Answer 1

Whether to rule out GABHS- 5-15%

Question 2

Criterion Center for Stept Throat?

Answer 2

1. Fever
2. Absence of Cough
3. Exudates
4. Cervical adenitis

Question 3

Criteria needed to perform a RADT or throat culture

Answer 3

3 or more symptoms

Question 4

Main antibiotic for Acute Pharyngitis?

Answer 4

Penicillin V 500 mg or Amoxicillin 500 mg

If allergic to Penicillin:
-Give macrolides (erythromycin, clarithromycin, azithromycin)

Question 5

What are complications that are associated with GABHS?

Answer 5

Acute rheumatic fever

Acute Glomerulonephritis

Question 6

Paradise Criteria for Tonillectomy?

How long should these guidelines be observed

Answer 6

1. At least 7 episodes in the last year
   OR at least 5 episodes in 2 years
   OR 3 episodes in the last 3 years

• 12 month observation period

Question 7

Who does Peritonsillar Abscess mostly occur in?

Answer 7

1. Most common deep neck infection in children or adolescents

Question 8

Predominant species for Peritonsillar Abscess?

Answer 8

GABHS (Steptococcus pyogenes)

Question 9

Common symptoms with Peritonsillar Abscess?

Answer 9

1. Severe sore throat
2. Fever
3. “Hot potato” or muffled voice
4. Drooling “painful to swallow”
5. Trismus “lock jaw”
6. Ipsilateral ear pain

Question 10

Physical exam findings for Peritonsillar abscess

Answer 10

1. Swollen, fluctuate tonsils
2. Deviation of uvula
3. Bulding of the posterior soft palate

Question 11

Imaging preferred for Peritonsillar Abscess?

Answer 11

CT with IV contrast

Question 12

Treatment for Peritonsillar Abscess

Answer 12

1. Clear airway obstruction
2. Drainage (needle aspiration)
3. Antimicrobial Therapy
   
   • Parenteral: ampicillin-sulbactam or clindamycin
   • Oral: amoxicillin-cluvulanate or clindamycin x 14 days

Question 13

For a Tonsillectomy what does an episode of Acute pharyngitis consists of?

Answer 13

1. Sore throat + Fever
2. OR tonsillar exudate
3. OR Anterior cervical adenopathy
4. Culture confirmed GABHS

Question 14

What are the infectious causes of Laryngitis

Answer 14

1. Respiratory Viral

2. Low chance of Bacterial

Question 15

Labs for Peritonsillar Abscess

Answer 15

CBC
Electrolytes
Throat culture
Culture of abscess fluid

Question 16

How is Laryngitis clinically presented?

Answer 16

1. Hoarseness
2. URI symptoms
   - Rhinorrhea, nasal congestion, cough, sore throat

Question 17

Non infections causes of Laryngitis

Answer 17

Vocal abuse

GERD and more

Question 18

Treatment for Laryngitis

Answer 18

1. Treat underlying cause (virus)
2. Humidification
3. Voice rest (no whispering)
4. Hydration
5. Avoid smoking

Usually resolves in 1-3 weeks. Anything beyond that refer to ENT for possible cancer

Question 19

Ddx for Laryngitis

Answer 19

slide 27

Question 20

Etiology for Epiglottitis

Who is most at risk?

Answer 20

Viral or BACTERIAL
- Most common is H. Influenza

Risk: Non vaccinated, Immunodeficiency

Question 21

Clinical presentations for Epiglottis?

Answer 21

3 D’s

Dyphagia
Drooling
Distress

Along with Tripod position

Question 22

What is a common sign seen in imaging for Epiglottitis?

Answer 22

Lateral “thumb sign”

Question 23

Treatment for Epiglottitis?

Answer 23

1. Airway protection
2. Hopsitalization/ER
3. IV antibiotics
4. Educate on Prevention/Immunization

Question 24

Presentation for Oral herpes simplex or Herpetic gingivostomatitis

Answer 24

Sudden onset Painful vesicular lesions lasting between 10-14 days

Question 25

Treatment for Herpetic gingivostomatitis

Answer 25

Antivirals analgesics Fluids

Question 26

Etiology of Oral candidiasis

Answer 26

Candida albicans

Question 27

Signs of Oral candidiasis

Answer 27

1. Painful, creamy-white curd-like patches 2. Easily scraped off "thrush will brush" 3. Cotton mouth 4. Loss of taste

Question 28

How do you diagnose Oral candidiasis?

Answer 28

1. Clinical 2. KOH wet prep under a microscope - budding yeast with or w/o pseudophyphe

Question 29

Treatment for Oral candidiasis

Answer 29

Antifungal treatments

Question 30

3 Causes of Head and Neck cancers?

Answer 30

1. HPV 16, 18, 31, = Squamous Cell carcinomas 2. Nasopharyngeal Carcinomas 3. P53 Tumor suppressor gene

Question 31

How does Squamous cell carcinomas appear? What are the risk factors associated?

Answer 31

Oral cavity cancers with ulcers or masses that DO NOT heal

Question 32

What is the preferred way to diagnose Squamous Cell carcinoma

Answer 32

ENT referral for biopsy

Question 33

Infection that arises from tooth roots and within the neck

Answer 33

Ludwigs angina

Question 34

What are the preventions of Ludwig's angina

Answer 34

1. Swelling of the neck 2. Air way compression 2. Fever

Question 35

What are the treatments for Ludwig's angina?

Answer 35

1. Secure & monitor airway 2. Hospitalize 3. IV antibiotics

Question 36

- Acute infection of the parotid gland | - Firm, erythematous swelling or pre and post auricular areas down to the mandible

Answer 36

Suppurative Parotitis

Question 37

What will lab studies show in someone with Suppurative Parotitis

Answer 37

Elevated amylase

Question 38

Stone and inflammation in the salivary glands or ducts?

Answer 38

Silolithiasis - most stones occur in Wharton duct