Mostly diagnosed by symptoms and presentation Can perform throat culture if bacterial infection is suspected or to rule out bacterial causes Can view vocal cords with laryngoscopy (usually performed by ENT)

Can do CBC, titers to determine cause Culture any pus noted May use ultrasound to identify salivary stones or inflammation CT for suspected malignancy Treatment (dependent upon cause)

Oropharyngeal Problems Flashcards by katie gazda

Infection of the oropharynx and tonsils

Strep Pharyngitis

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sore throat, painful swallowing, fever (greater than 101.3), chills, HA, n/v, abd pain.

Bacterial (Strep) Pharyngitis

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sudden onset sore throat, fever, malaise, COUGH, RHINORRHEA, HA, myalgia, fatigue.

Viral Pharyngitis

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(late winter/early spring) marked erythema of throat and tonsils
Patchy, discrete, white or yellowish exudate
Pharyngeal petechiae
Tender anterior cervical adenopathy
Pressure on tonsils produce purulent drainage
Edematous uvula
NO nasal sx
Might see “strawberry tongue”

Bacterial Pharyngitis

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Strep Pharyngitis

Diagnostics

•Rapid antigen detection test (RADT)
•“Send off” throat culture
•Centor criteria
- tonsillar exudate, tender or swollen anterior cervical lymph nodes, Fever, absence of cough

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Centor criteria

tonsillar exudate, tender or swollen anterior cervical lymph nodes, Fever, absence of cough

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Strep Pharyngitis
Treatment:
1st line Antibiotic …

If allergic to PCN?

Bacterial: PCN or amoxicillin if GAS. If non-GAS symptomatic tx.
If PCN allergy: cephalexin

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Strep Pharyngitis

Education

After 24 hours on antibiotic and afebrile, not considered contagious anymore and can return to work/school
Buy a new toothbrush
Clean orthodontic appliances (retainers)

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what makes up early childhood caries?

Flora, the teeth, substrate (substance that bacteria eats to grow and multiply)

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• Infected conjunctiva, watery discharge
(not purulent)
• Inflamed nasal turbinates with boggy
mucosa
• Pharynx may or may not be injected, can have a cobblestone appearance
• Generally no lymphadenopathy; lungs clear

allergies/PND

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Patient presentation
• Complaints of irritated throat
• Hoarseness
• Clearing throat frequently
• Burning sensation in throat (also may feel in stomach or esophagus “heartburn”)
• Dry cough
• Worse after eating, especially a large meal, or lying down

GERD

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Patient presentation 
• Complaints of long lasting sore throat
• Difficulty swallowing; “lump” in the throat
• Earaches
• Hoarseness
• Lymphadenopathy
• Possibly painless lump on side of throat
• Ulcerations/sores that do not heal

oral cancers

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common causes of oral cancers

Squamous cell and HPV16

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Physical examination for oral cancers

• Depends upon the type of cancer and the progression; early oral cancer can be
asymptomatic and difficult to notice
• Look for ulcerated lesions that do not heal
• Can be indurated as well
• Discoloration of the oral mucosa
• Leukoplakia

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Inflammation of the vocal cords, can be acute or chronic

Causes
•Viral infection, GERD, vocal cord trauma, malignancy, bacterial infections (syphilis, tuberculosis)

Laryngitis

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Patient presentation
•Complaints of hoarseness
•Possible cough
•Possible sore throat

Physical exam
•Noticeable loss of voice/hoarseness
•Erythematous post pharynx usually
•Overall, the physical exam depends upon the cause

Laryngitis

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how to dx Laryngitis

Mostly diagnosed by symptoms and presentation
Can perform throat culture if bacterial infection is suspected or to rule out bacterial causes
Can view vocal cords with laryngoscopy (usually performed by ENT)

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Inflammation of one or both of the parotid glands

What causes it?
•Viral infections (usually paramyxovirus/mumps, can be HIV)
•Bacterial infections (staph, tuberculosis)
•Salivary stones (sialoliths)
•Dry mouth/possible side effect of medication
•Fungal infections
•Malignancies

Parotitis

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Patient presentation
•Pain and swelling on affected side (or bilaterally if both sides affected: mumps is usually bilateral)
•Difficulty/painful chewing
•May complain of fever
•May complain of pain into the ear

Parotitis

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How to dx parotitis

Can do CBC, titers to determine cause
Culture any pus noted
May use ultrasound to identify salivary stones or inflammation
CT for suspected malignancy Treatment (dependent upon cause)

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how to tx parotitis if bacterial infection

If bacterial infection, treat appropriately (may need hospitalization/IV antibiotics and fluids); outpatient can use amox/clav, dicloxacillin, clindamycin, and metronidazole

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how to tx parotitis if viral infection

If virus (most likely mumps) suspected, treat symptomatically and monitor

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Inflammation of the epiglottis; can spread to nearby structures called “supraglottitis”
•Can cause laryngospasms and death

Epiglottitis

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Primary cause of epiglottitis in kids?

Haemophilus influenzae

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Primary causes of epiglottitis in adults?

Streptococcus pneumoniae and Streptococcus pyogenes Can also be caused by traumatic injury or herpes virus

Patient presentation •Presentation can differ in adults and children •Children may present with difficulty breathing, stridor, drooling, look like they are in distress •Adults may complain of a progressive, severe sore throat, dysphagia, and vocal changes •Many adults do not have stridor but might complain of difficulty breathing; however, not common like in children

Epiglottitis

physical exam if epiglottitis suspected?

do not examine the patient’s throat with a tongue depressor!

What to do with epiglottitis?

Refer all cases of suspected epiglottitis to the ER for immediate treatment

inflammation and pain anywhere within the oral cavity ``` Causes • Medications • Infectious process • Immunosuppression • Side effect of head and neck radiation • Trauma • Tobacco exposure • Dehydration • Alcohol abuse • Poor dentition and hygiene • Dental prosthetics • Neoplasms and hematologic cancers • Allergic reactions ```

Stomatitis

Stomatitis Treatment

* Frequent assessment * Mouth hygiene and routine dental visits * Remove causative agent if possible * Antibiotics, antifungals, antivirals

Symptom relief for Stomatitis

• Coating agents such as bismuth salicylate, sucralfate, or other antacids • Water-soluble lubricants for mouth and lips • Topical analgesics, such as benzydamine • Topical anesthetics • Oral or parenteral analgesics • “Magic mouthwash" consists of various combinations of diphenhydramine, magnesia-alumina, Kaolin pectin, and/or viscous lidocaine

inflammation of the tongue | - causes : systemic, local, tongue

Glossitis

* Difficulty with mastication * Dysphasia * Dysphagia * Smooth tongue surface * Painful tongue * Tongue color changes * Tongue swelling * Missing papillae

Glossitis

Glossitis tx

* Reduce inflammation * Oral hygiene * Antibiotics, antifungal, and antiviral if appropriate * Treat and remove underlined cause * Encourage proper diet * Avoid irritants

Appears on the sides of the mouth “angular”- inflammation of one or both corners of the mouth (unilateral or bilateral) Painful Itchy Red- can be confused with impetigo

Angular cheilitis

Risk factors and management of Angular cheilitis

Risk Factors: Allergies- tooth paste, makeup, food, Infection, Fungus/ S.Aureus and it gets inside cracks Treat the underlying cause Barrier cream- vaseline for protective barrier Vitamin deficiencies - check their diet, vegans at high risk

“tongue tie” caused by a short lingual frenulum- hinders tongue movement Difficulty breastfeeding/latching (clicking sound), can affect speech later in life

Ankyloglossia

painful, shallow ulcers of oral mucosa Risk Factors: UC, Crohn’s, gluten sensitivity, vitamin deficiencies (B, iron, zinc), trauma, hormones

Aphthous ulcers- Kanker sore

Differentials and Mgmt of Aphthous ulcers- Kanker sore

Differentials: oral CA, HSV, autoimmune disorder (DM, Crohn’s, UC) Management: self-limited (7-14 days)

From mouth washes after getting wisdom teeth out; build up of dead skin cells where taste buds are - black, hairy Resolves after 1-2 weeks on its own

Black hairy tongue (mild/ temporary)

Risk Factors: Trauma in children Clinical Manifestations: Bleeding in nose/ears, dizzy, h/a-ER

Broken tooth/teeth

grinding the teeth or clench teeth

Bruxism

Risk Factors: Smoking Clinical Manifestations: Hyperpigmentation: red and white dental lesions

Common oral lesions | - Melanoma (oral CA) usually squamous cell carcinoma

A localized collection of pus surrounding the tooth. Strep. Anginosus

Dental Abscess

difficulty moving jaw

Trismus

how to manage and tx dental abscess?

Management: PCN, allergies-erythromycin Root canal I & D Treatment Abx: PCN or Clindamycin- 1st line, macrolides Resistance- Augmentin

Dental Caries risk factors for adults and kids?

Adults: smokers, diabetes, cancer, Children/ adults: developmental delay, hypertension, autoimmune, HIV, sinus infection, HPV, frequent snacking, Children: juice at bedtime, sleeping w bottle

A chemical process that leads to irreversible acid demineralization of tooth structure Can be intrinsic: from stomach acid/ vomiting GERD Can be extrinsic: acidic drinks, meth, citrus foods, medications

Dental Erosion

Risk Factors: dry mouth, bulimia, GERD, asthma, medications Clinical Manifestations: complaints of hypersensitivity PE: smooth cupped out teeth on chewing surfaces

Dental Erosion

space between two neighboring teeth

Diastema

EMERGENCY= Inflammation of the epiglottis; can spread to nearby structures- supraglottis Can cause laryngospasms and death Pathogen: H. Influ b (Hib vaccination) Adults: Strep P. and strep pyogenes

Epiglottitis (cover trachea when we swallow)

fibrous enlargement of gingival tissue - ulcerations Risk Factors: phenytoin, cyclosporine, nifedipine, hormones, inflammation, leukemia, idiopathic tx with Oral hygiene, chlorhexidine

Gingival hyperplasia

``` Clinical Manifestations: Swelling Inflamed lymph nodes Not bilateral Pain, erythema Tooth partially out of socket Usually radiates on nerve upward or downward ```

dental abscess

Trismus

difficulty moving jaw

discomfort especially when eating hot/ spicy food PE: benign asymptomatic yellowish-white circular lesion with atrophic red centers appearing on anterior two thirds of the dorsum of the tongue

migrating glossitis

viral HSV 1 in children 6 mo - 5 yo tingling, pain, and burning PE:vesicles with erythematous base

Herpes stomatitis

how to manage / tx Herpes stomatitis?

heals in 7-14 days, remove from daycare during drooling, clean teeth with soft toothbrush, oral acyclovir can reduce symptoms if initiate within 3 days, topical antivirals ARE NOT effective

salivary gland lesion caused by a blockage of a salivary gland duct; usually caused by trauma or lip-biting fluid filled vesicle most often on the lower lip refer to oral sx for excision

Mucocele

partially erupted lower wisdom tooth with a tissue flap covering the crown→ food or foreign body gets under flap, causing an infection

Pericoronitis

cyst filled with mucin from a ruptured salivary gland. CM large, soft, mucous-containing cyst on floor of mouth. Refer to oral surgeon for excision.

Ranula

white verrucous (warty) lesions (individual or clusters) onlips, hard palate, or gingiva. Painless PE: pain, tingling, burning, with erythema spread through oral secretions

HPV oral infection

overgrowth of yeast Candida albicans- most common fungus in infect oral cavity Risk Factors: inhaled corticosteroids- rinse mouth after Decreased immunity; Crohn’s, Ulcerative Colitis, DM Long term use of ABX or corticosteroids Dentures→ Denture stomatitis

Candida or thrush (yeast)

how to tx Candida or thrush (yeast)

Nystatin- 4-5x/day for 5 days

inflammation of gingiva, bleeding with eating hard foods and tooth care minor manipulation of gingiva causes localized bleeding

Gingivitis

Inflammation of one or both of the parotid glands; viral infection (paramyxovirus/mumps, HIV) ``` Bacterial: staph, TB Salivary stones (Sialoliths) Dry mouth-meds (anticholinergics and antihistamines) Fungal infections Malignancies ``` Risk Factors: older adults, chronic illness, immunocompromised

Parotitis (Severe-IV abx)

``` Rapid onset Pain and swelling on affected side Painful chewing Fever, Pain into ear- close to ear If Both sides.. prob mumps ```

Parotitis

mild erythema with little to no exudate. Pharynx appears boggy, swollen, or pale NO painful/tender lymphadenopathy (unless infectious mononucleosis)

Viral Pharyngitis

Anterior cervical lymph nodes enlarged.... ____ If posterior cervical enlarged ____

anterior = prob group A hemolytic strep posterior = mumps

group A strep; formation of pus in peritonsillar tissue | Risk Factors: recent strep infection, recurrent tonsillitis, smokers, poor oral hygiene

Peritonsillar Abscess -> ER

Fever, chills, fatigue, malaise, halitosis, dysphagia, severe sore throat, otalgia, Pain radiating to ear of affected side, Hoarse (“hot potato”) voice, drooling Trismus (spasms of masticator muscles) Edema and erythema of peritonsillar tissue & soft palate; covered with exudate→ unilateral Uvula edematous and displaced to opposite side Tonsil displaced downward and medially

Peritonsillar Abscess -> ER

What to do with peritonsillar abscess?

MUST REFER IMMEDIATELY for surgical intervention (I&D, needle aspiration, or tonsillectomy)

pain (facial, neck, jaw) at least once/week; limited ability to open mouth wide; painful clicking, popping of jaw

TMJ soft diet, muscle relaxation, ice, analgesics and antiinflammatory meds. Bite block (plastic splint)

Oropharyngeal Problems Flashcards

(72 cards)