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Clin Med I > Mouth, throat, head and neck > Flashcards

Mouth, throat, head and neck Flashcards

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1
Q

aphthous stomatitis

A
  • aka cancer sore
  • most common acute oral lesion
  • often recurrent
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2
Q

classification of aphthous stomatitis

A
  • simple- 1 to several episodes lasting 14 days in oral mucosa
  • complex-oral and genital lesions, more numerous and last 4-6 weeks
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3
Q

risk factors for aphthous stomatitis

A
  • smoking
  • genetics
  • trauma
  • hormones
  • stress
  • food/ drug hypersensitivity
  • immunodeficiency or other GI disorders
  • vit b12, folic acid, or Fe deficiency
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4
Q

clinical presentation of aphthous stomatitis

A
  • round, oval, clearly defined ulcers
  • erythematous rim with yellow center
  • usually small
  • painful
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5
Q

management of aphthous stomatitis

A
  • oral hygiene
  • no alcohol mouthwash, soft tooth brush
  • pain control- viscous lidocaine
  • swish and spit steroids
  • for complex cases can have intralesional steroids, colchisine, dapsone, immunomodulators
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6
Q

oral leukoplakia

A
  • benign
  • white gray lesions that cant be scraped off
  • clinical significance depends on degree/presence of dysplasia
  • associated with HPV
  • common in smokeless tobacco users and pure inflammatory conditions
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7
Q

clinical manifestations of oral leukoplakia

A
  • white gray lesions
  • in trauma prone regions
  • thin areas show more dysplasia
  • not painful
  • flat and not well defined
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8
Q

diagnosis of oral leukoplakia

A
  • history and PE

- if indurated should be biopsied

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9
Q

management of oral leukoplakia

A
  • doesnt require tx
  • can surgically remove
  • cryoprobe
  • chemoprevention
  • oral retinoids
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10
Q

Herpes

A
  • more common in women
  • usually transmitted by people who dont know they have it
  • recurrent infection common
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11
Q

Herpes primary infection

A
  • highly variable
  • usually severe with systemic sx
  • Fever, LAD, drooling, decreased PO intake
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12
Q

Herpes recurrent infections

A
  • usually less severe

- more localized

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13
Q

clinical manifestations of herpes

A
  • affects gingiva
  • multiple oral vesicular lesions on erythematous base
  • herpetic gingivastomatitis most common
  • prodrome of burning, tingling, pain
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14
Q

management of herpes

A
  • systemic antivirals
  • swish and spit miracle mouthwash
  • supportive
  • popsicles
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15
Q

oral candida

A
  • aka thrush

- involves mucous membranes- oropharyngeal and esophageal

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16
Q

what is the most common cause of oral candida

A
  • candida albicans
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17
Q

what are the types of oral candida

A
  • pseudomembranous- most common, forms white plaques

- atrophic- aka denture stomatitis, erythema without plaques

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18
Q

epidemiology of oral candida

A
  • young infants
  • older adults who wear dentures
  • abx or chemo
  • radiation to head and neck
  • immunodeficiency
  • inhaled steroids
  • xerostomia
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19
Q

clinical manifestations of oral candida

A
  • dry mouth, loss of taste
  • white plaques
  • erythema without plaques if denture wearer
  • pain with swallowing or eating if esophageal
  • beefy red tongue with dentures
  • painful fissuring on sides of mouth
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20
Q

diagnosis of oral candida

A
  • clinical
  • white plaques removable
  • KOH
  • if refractory test for HIV
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21
Q

management of oral candida in health patients

A
  • local therapy
  • nystatin swish and swallow
  • clomitrazole troches
  • miconazole buccal tabs
  • PO diflucan
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22
Q

what type of cancer is mainly found in the head and neck?

A
  • squamous cell carcinomas
  • arise from mucosal surfaces
  • generally have good prognosis if detected early
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23
Q

what type of head and neck cancers respond best to treatment

A
  • HPV associated cancer

- HPV cancers usually seen in younger patients

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24
Q

categories of oropharynx cancer

A
  • carcinoma of oral cavity proper
  • carcinoma of oropharynx
  • carcinoma of lip vermillion
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25
risk factors for oropharyngeal cancers
- smoking** - alcohol abuse ** - HPV infection** - EBV - diet - immune status - environmental/ occupational pollutants - genetics
26
anterior oral cavity cancers
- SCC - ulcerative - painful later in disease - may be mass with raised, rolled boarder - tongue is common site - often see lesions on floor of mouth as well
27
what is the biggest risk factor for anterior oral cancers
- alcohol abuse | - tobacco abuse
28
posterior oral cancers
- SCC - mostly associated with erythema rather than lesions - pt presents with neck mass, sore throat, dysphagia
29
what is the biggest risk factor for posterior oropharyngeal cancers
- HPV (16 and 18)
30
clinical presentation of oropharyngeal cancers
- leukoplakia or erythroplakia* - speckled erythroplakia - dentures that no longer fit properly* - most DONT have hx of premalignant lesions - pain - possible airway obstruction - loosening of teeth - LAD
31
what is the best imaging to dx oropharyngeal cancers?
- CT - need chest CT if there is distant metastasis - f/u with MRI or PET scan
32
treatment and prognosis of localized oropharyngeal cancers
- curative intent - surgery for smaller lesions - radiation preferred in laryngeal lesions - survival is good - if recurrence usually happens if first two years
33
treatment and prognosis of advanced oropharyngeal cancers
- curative intent - combo of surgery, radiation, and chemo - can do chemo and radiation at the same time
34
treatment and prognosis of recurrent/ metastatic oropharyngeal cancers
- usually palliative intent - poor prognosis - poor response to chemo
35
what is the most common cause of viral tonsillitis/ pharyngitis
- rhinovirus
36
clinical manifestations of viral tonsillitis/ pharyngitis
- sore throat - coryza* - cough* - N/V/ abdominal pain - malaise/ fever/ hoarseness - more erythematous
37
clinical manifestations of mono
- may appear similar to viral tonsillitis - inclused posterior LAD - kissing tonsils - hepatosplenomegaly
38
diagnosis of viral tonsillitis/ pharyngitis
- no tests | - rapid flu and rapid mono testing
39
treatment of viral tonsillitis/ pharyngitis
- supportive - warm water gargle - antipyretics and analgesia - +/- single dose steroids - +/- IV fluids - if mono- no contact sports - if flu- tamiflu
40
what is the most common cause of bacterial tonsillitis/ pharyngitis
- s. pyogenes
41
clinical manifestations of bacterial tonsillitis/ pharyngitis
- LACK of coryza, cough, or other URI sx - sudden onset sore throat* - anterior LAD - petechiae on soft palate - n/v/ abdominal pain - malaise, fever, hoarseness
42
what is the centor criteria used to diagnose
- strep throat
43
what are the components of the centor criteria
- fever - anterior LAD - tonsillar exudate - absence of cough
44
scores of centor criteria
- 0-1= likely not strep, no testing - 2-3= confirm with rapid strep test - 4= treat for strep
45
diagnosis of strep
- use centor criteria - rapid antigen detection testing - culture - may also want to r/o pharyngitis caused by diptheria, gonorrhea, and chlamydia
46
treatment of bacterial tonsillitis/ pharyngitis
- Pen VK 500 mg BID X 10 days | - if PCN allergy use cephalexin or macrolide
47
classic symptoms of scarlet fever
- strawberry tongue | - sandpaper like rash on trunk or armpits
48
peritonsillar abscess
- collection of pus between palatine tonsils and pharyngeal muscles - pharyngitis -> cellulitis -> abscess - usually unilateral
49
what is the most common cause of peritonsillar abscesses?
- s. pyogenes
50
clinical manifestations of peritonsillar abscesses
- severe unilateral sore throat* - ipsilateral ear pain* - muffled/ "hot potato voice" * - contralateral uvula deviation - trismus and decreased PO intake - neck pain with movement - drooling and blocked airway if severe - fowl breath - erythema/ exudate on tonsil
51
differential dx for peritonsillar abscess
- retropharyngeal abscess - ludwig angina - dental infection - peritonsillar cellulitis - mono
52
diagnosis of peritonsillar abscess
- almost always just clinical dx - can get CT or ENT consult if uncertain - intra-oral US - lateral soft tissue xray to r/u epiglottitis
53
treatment of peritonsillar abscess
- secure airway - drain via needle aspiration or I&D - empiric abx- augmentin - antipyretics - analgesia - +/- steroid
54
complications of peritonsillar abscess
- airway obstruction - internal jugular seeding of infection - septicemia
55
rheumatic fever
- sequelae of s. pyogenes pharyngitis - spreads to heart, joints, subq tissue - cardiac complications may be permanent
56
cardiac involvement in rheumatic fever
- more often in kids - mitral valve affected - can see new murmur, CHF sx, pericardial friction rub
57
migratory arthritis in rheumatic fever
- usually in teens/ adults | - asymmetric involvement of knees, elbows, wrists
58
erythema marginatum in rheumatic fever
- usually in kids | - non-pruritic erythematous eruption on trunk
59
Jones criteria
- used to dx rheumatic fever in addition to evidence of recent strep infection - need 2 major sx OR - 1 major and 2 minor sx OR - 3 minor sx - also get rapid strep or throat culture if needed - imaging- EKG, chest XR, echo
60
major sx of jones criteria
- migratory arthritis - carditis/ valvitis - sydenham chorea - erythema marginatum - subq nodules
61
minor sx of jones criteria
- arthralgia - fever - elevated ESR or CRP - prolonged PR interval
62
treatment of rheumatic fever
- pen VK 500 mg BID X 10 days - aspirin for joint pain - +/- steroids - bed rest until fever is gone, labs and EKG normalize
63
secondary prophylaxis for rheumatic fever
- PCN IM q4 weeks - without carditis- for 5 years - with carditis- for 10 years
64
sx of post-streptococcal glomerulonephritis
- edema - hematuria - HTN - proteinuria - majority of pts have at least two of the sx - nonspecific malaise, weakness, anorexia, n/v
65
diagnosis of post-strep glomerulonephritis
- urine dip and microscopy* - streptozyme test - renal function tests* - renal biopsy- last resort
66
treatment of post-strep glomerulonephritis
- treat underlying cause - mostly supportive - restrict salt and water intake - +/- diuretics - HTN control - limited activity - dialysis if severe
67
laryngitis
- inflammation of vocal cords - typically resolves in 7-10 days - mostly viral cause
68
chronic laryngitis
- > 3 weeks
69
clinical manifestations of laryngitis
- preceding or concurrent URI - hoarseness - odynophonia - odynophagia
70
diagnosis of laryngitis
- clinical | - ENT may use fiber optic laryngoscope for chronic cases
71
treatment of laryngitis
- voice rest | - inhaled humidifier
72
sialadenitis
- usually viral- mumps - may be related to HIV infection - duration varies
73
parotitis
- secondary to mumps infection - acute parotid swelling - see more cases in college aged students d/t waning immunity to vaccine
74
clinical manifestations of mumps
- bilat parotid gland inflammation - flu like prodrome - unilateral testicular swelling and tenderness
75
complications of mumps
- deafness - orchitis - meningitis - fetal congenital abnormalities
76
treatment of mumps
- supportive - bed rest and hydration - sialagogues - scrotal sling for testicular pain - warm or cold compress - analgesia - live MMR vacine +/- booster
77
diagnosis of sialadenitis
- PE - mumps titer - HIV RNA detection if indicated - if unclear or unimproved get US, CT, or sialadenoscopy
78
other causes of sailadenitis
- stones - elderly, malnourished, or post op (dehydration in all) - s aureus - usually more unilateral involvement
79
what causes dental caries
- strep mutants | - demineralization exceeds saliva and remineralization -> progressive breakdown
80
what are the top four complaints of drug seekers
- HA/migraine - back pain - tooth ache - kidney stones
81
what should happen before you d/c a patient with an oral infection
- consult dentist | - definitive f/u care scheduled prior to d/c
82
risk factors for oral infectiosn
- low SES - poor access to care - poor oral hygiene and nutrition - prior trauma or many dental procedures - inadequate fluoride - decreased salivary flow - anticholinergic medications
83
how do you prevent oral infections
- prevent bacterial infection - regular floss, brushing with fluoride tooth paste, biannual cleaning - no smoking - control systemic diseaseS
84
what causes most oral infections
- usually strep mutans - often polymicrobial infections with anaerobes - caregivers can vertically transmit infections
85
periodontal disease and DM
- severe periodontal disease and DM increases risk of worsening glycemic control - DM is a risk factor for periodontal disease
86
pregnancy gingivitis
- d/t hormonal changes | - pyogenic granulomas can occur
87
si/sx of dental infections
- sensitivity to hot or cold stimuli* - pain on biting* - pain at site or refered to jaws, ears, cheeks, sinuses - bleeding or purulent d/c - if severe can have systemic sx
88
what should kids < 4 years old with stiff neck, sore throat, and dysphagia be worked up for
- retropharyngeal abscess
89
diagnosis of oral infections
- clinical - no labs unless acutely ill - can use xrays but not usually necessary - CT to determine extend and density of swelling, location of abscess
90
treatment for oral infections
- anti-inflammatories for pain*** - nerve block for severe pain - Pen VK (or amoxicillin) loading dose 1000 mg then 500 mg QID X 7-10 days - use clindamycin or erythromycin for PCN allergy - +/- IV fluids - admit if necessary - educate about good oral hygiene - warm salt water rinses
91
ludwig's angina
- sublingual cellulitis - +/- tracking abscess - potential for airway issue - possible complication of oral infections
92
vincent's angina
- acute necrotizing ulcerative gingivitis - aka trench mouth - possible complication of oral infections

Clin Med I (16 decks)

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