Mouth & Throat Disorders

Question 1

What causes acute pharyngitis/tonsilitis?

Answer 1

Viral MC: Adenovirus, rhinovirus, enterovirus, EBV, RSV, influenza A & B, HZV

Bacterial: GABHS

Question 2

What are s/s of pharyngitis/tonsilitis?

Answer 2

Sore throat

Pain w/ swallowing or w/ phonation

Question 3

How do you treat pharyngitis/tonsilitis?

Answer 3

Sx: Fluids, warm gargles, anesthetics, lozenges, NSAIDs

Abx if S.pyogenes: PCN, Amox
If PCN allergic –> macrolides

Question 4

What causes aphthous ulcers (canker sores)?

Answer 4

May be a/w HHV6

Question 5

What are s/s of aphthous ulcers (canker sores)?

Answer 5

Small, round/oval painful ulcers (yellow, white, or grey centers) w/ erythematous halos

MC on buccal or labial mucosa

Question 6

How do you treat aphthous ulcers?

Answer 6

Topical analgesics

Topical PO steroids (triamcinolone, fluocinonide), vit B&C

If recurrent –> cimetidine

Question 7

What causes laryngitis?

Answer 7

Viral infection MC - adenovirus, rhinovirus, influenza, RSV, parainfluenza

Bacterial: M. catarrhalis & mycoplasma pneumo

Trauma

Question 8

What are the s/s of laryngitis?

Answer 8

Hoarseness = hallmark*

Aphonia*

Pharyngitis, rhinitis, cough

Question 9

How do you treat laryngitis?

Answer 9

vocal rest, warm gargles, anesthetics, lozenges, fluids

Question 10

What causes oral candidiasis?

Answer 10

Candida albicans

Question 11

What are the s/s of oral candidiasis?

Answer 11

Mouth or throat pain

Question 12

How do you diagnose oral candidiasis?

Answer 12

Clinical: white curd-like plaques (+/- leave behind erythema/bleeds if scraped)

KOH smear: budding yeast/pseudohyphae

Question 13

How do you treat oral candidiasis?

Answer 13

Nystatin liquid = tx of choice

Clotrimazole troches, oral fluconazole

Question 14

What is oral leukoplakia?

Answer 14

PreCA hyperkeratosis due to chronic irritation (tobacco, cigarettes, Etoh, dentures)

6% show dysplasia or SCC

Question 15

What are s/s of oral leukoplakia?

Answer 15

Painless white patchy lesion that cannot be scraped off

Question 16

How do you treat oral leukoplakia?

Answer 16

Cryotherapy, laser ablation

Biopsy to assess from CA risk

Question 17

What is sialadenitis?

Answer 17

Bacterial inf of parotid or submandibular salivary glands

Question 18

What causes sialadenitis?

Answer 18

S. aureus MC

Dehydration, chronic illness

Question 19

What are s/s of sialadenitis?

Answer 19

1. pain, swelling, erythema near gland (esp. w/ meals)
2. tenderness at the duct opening (+/- pus when massaged)
3. pain, dysphagia, trismus –> fever, chills (if severe)

Question 20

How do you diagnose sialadenitis?

Answer 20

CT

Question 21

How do you treat sialadenitis?

Answer 21

Sialogogues (tart candy, lemon drops)

Antistaphylococcus (dicloxacillin or nafcillin) + metronidazole or clinda if severe

Question 22

What causes oral herpes?

Answer 22

HSV1

MC btwn 6mos-5yo

Question 23

What are s/s of oral herpes?

Answer 23

Sudden onset fever
Anorexia
Gingivitis
Grey/yellow vesicles on mucosa, tongue, lips

Question 24

How do you treat oral herpes?

Answer 24

Self-limiting

Acyclovir if severe

Question 25

What causes epiglottitis?

Answer 25

H. influenzae type B MC

MC in 3mos-6yo. Males. DM is a risk factor

Question 26

What are s/s of epiglottitis?

Answer 26

3 Ds: dysphagia, drooling, distress

Odynophagia, inspiratory stridor

Tripoding

Question 27

How do you diagnose epiglottitis?

Answer 27

Laryngoscopy = definitive

Lateral cervical radiograph: Thumb sign

Question 28

How do you treat epiglottitis?

Answer 28

Dexamethasone to reduce edema

Tracheal intubation in severe cases

2nd/3rd gen ceph: ceftriaxone or cefotaxime