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Flashcards in sore throat Deck (79):
1

most common signs of GABHS

fever
anterior cervical (posterior is viral)
lymphadenopathy
lack of cough (don't rely on)
exudates (+ erythema)

2

causes of bac. pharyngitis

1. GABHS
Strep pneumonia
H. flu
Bordetella Pertussis
Neisseria Gonorrhea
(viral is more common than bac)

3

leukoplakia

white lesions
DO NOT scratch off
defined border

4

erythroplakia

enlarging area of leukoplakia
-submucosal depth

5

other oral lesions

SqCC
irregular base/border, change in color
can be tender

6

oral candidiasis

painful, creamy-white patches, CAN be rubbed off, will bleed
more diffuse

7

ulcerative lesions: aphthous ulcer

assoc. w/ HHV 6
painful, round, small ulcerations

8

EBV

hepatosplenomegaly
marked lymphadenopathy
purplish exudates
lymphocytosis
want to rule out GABHS
tx: erythromycin (risk of confection) steroids

9

(uncomp viral infection): mono tx

observation w. limited physical activity
do not give antiviral

10

Ludwig angina

cellulitis of sublingual and submaxillary spaces
-seems like epiglottitis but not
diff to swallow

11

deep neck abcesses w/

marked pain and swelling

12

tx GABHS

IM PCN (1x dose)

13

sore throat red flags

-can't handle secretions
-"hot potato" voice

14

trismus

cannot open mouth all the way

15

unilateral deviation of uvula, spitting into cup

peritonsilar abcess

16

stomatitis

inflammation of mouth, lesion
diff. eating/drinking/swallowing
etiology: infections, vit. def, chemo
danger: dehydration
tx: supportive, lidocaine/mylanta- "magic" mouthwash

17

thrush

candida spp., oral mucosa inf. *white, cheesy coating, able to scrape off!* -dx
risks: infants, abx tx, steroids, leukopenia, DM, immuncomps (HIV) diaper rash, endocarditis in IVDA (all ICs)

18

thrush tx

clotrimazole, nystatin (topical azoles)
systemic and esophageal: fluconazole, caspofungin, amphotericin
be aware of esophagitis! : HIV pt

19

thrush: you see this on KOH prep

yeast + pseudohyphae and budding yeast

20

see thrush (besides mouth)

under breasts of obese females
*keep dry* + anti fungal powder +/- oral anti fungals

21

HSV

prec. 24-48 hrs by fever, ha, malaise
swollen/eryth. lesions-->vsicular-->rupture-->ulcerated lesions
painful! (vs. syphilis, not painful)

22

HSV tx

antivirals dec. duration/sev/recurrence
acyclovir, famciclovir, valacyclovir (guanosine analog): inhib. viral DNA polymerase by chain termination (don't get rid of virus)

23

acyclovir converted to

antiviral-monophosphate via viral thymidine kinase
-->antiviral triphosphate (host cell kinases)
-->inactivates DNA polymerases (prev. viral DNA syn.)
*resistance occurs w/ mutated thymadine kinase

24

HSV autoinoculation

herpetic keratitis: leading cause of blindness in industrial world

25

HSV dx

Wright or giemsa stain (tzanck prep), intranuclear inclusions and multinuc. giant cells

26

HSV 1

mostly oral, gingivostomatitis, herpes, labialis-lip (some genital)
-assoc. ww/ facial nerve palsy (LMN lesion)
viral encephalitis affecting temp. lobe and keratoconjunctivitis
transmitted: resp. sec., saliva

27

HSV 2

typ. genital (some oral)
genitals, neonatal, transmitted:
sexual contact and perinatal

28

sore throat dx red flags

stridor (harsh vibratory noise w/ breathing)
trismus
unable to handle sec
palpable mass
*normal looking throat? (cannot see abcess in retropharyngeal area (abscess), epiglottitis (epiglottitis), something further down-->can be v. severe)
voice change
sx>7 days (abcess or such)

29

streptococcal pharyngitis

GABHS? "rapid strep" (many false negs-->do culture (25% turn pos) or full Cx (anything))
fever, exudates, no cough, tender cervical LN (strep not viral)
-rheumatic fever if untx

30

streptococcal pharyngitis tx

PCN

31

streptococcal pharyngitis often presents w/

abdominal pain
(also assoc. Scarlet fever)

32

This detects recent S. pyogenes infection

ASO titer

33

strep presentation

exudates on tonsils

34

Mono

everyone can get
EBV (CMV w/ neg monospot)
fever, hepatosplenomegaly, pharyngitis, lymphadenopathy **(post. cerv)***
risk of traumatic rupture of spleen (no sports)

35

Mono tx

amoxicillin-->WILL GET A RASH (basically dx)

36

mono dx

atypical lymphocytes on blood smear, not inf. B cells but reactive CTLs
dx: *heterophile Abs--> + monospot test

37

mono transmitted

resp. sec., saliva (kissing disease: teens, young adults)

38

mono infects

B cells via CD 21

39

unimmunized children: pharyngitis w/ gray* oropharyngeal exudated (pseudomembranes* may obstruct airway), sore throat

Corynebacterium diptheriae

40

epiglotitis

stridor (scarier*) (upper airway: throat vs wheeze: lower airway), normal throat, fever, trismus, diff. handling sec, toxic, **cherry red epiglottis**, swollen (also CO poisoning-mucosal surfaces), dysphagia
-mouth open, sitting, leaning forward

41

thumbprint sign

epiglottitis, lateral soft tissue XRneck,
also: CT, indirect laryngoscopy (tough to do, easily inflammed)

42

number one concern in epiglottitis

protect airway (intubate, ENT, GENSX, or anesthesia present (in case need cric, trach)

43

epiglottitis tx

abx (br. spec)
dec. inflammation w/ steroids (decadron)

44

epiglottis organism

H. influenzae (Hib)
vaccine for this (now seeing more in adults, vaccine wears off)

45

peritonsillar abcess

fever, sore throat, trismus, diff. hand sec, diff speaking
-unilat swelling of peritonsillar area
*deviation of uvula AWAY from affected side**

46

peritonsillar abcess tx

I&D (numb then drain w/ 18G needle, dangerous b/c arterial plexus behind!!-->will bleed), abx
no need to pack, just gauze
complication is nonsig. bleeding

47

Ludwig's angina

cellulitis or phlegm on floor of mouth (floor will be resistant to pressure) infection of sub (mand/mental/lingual) spaces
-typ. **recent dental work or untreated tooth inf.**
tongue pushed upward to roof of mouth
firm induration of neck and submand. space
can get cellulitis on abcess

48

this is vital in Ludwig's angina

airway protection!
absolute disaster
(anesthesia will go in nasally)

49

tx of Ludwig's angina

abx, surgery (multiple incisions in abcess w/ drains)

50

angular cheilitis

AKA angular stomatitis
cracking and fissures (inflamm. lesions) at mouth corners, smtms bleeds
sometimes B/L
painful to open mouth
crusts, shallow ulcer
(often mistaken for Herpes!)

51

if you drain an abcess properly, you don't need

abx!
-drain early
-needs abx if surrounding cellulitis

52

angular cheilitis(stomatitis) tx

antifungal (OTC miconazole) or topical abx

53

angular cheilitis etiology

candida* (most common), bacterial, vit. def (B12, iron, zinc)
-manifestations of anorex/bulimia
cold weather ("chapped lips")
accutane

54

torus palatinus

hard lump protruding on hard palate, midline*
covered w. normal mucous mem
*Females >30
most common bony maxillofacial exostosis
Middle eastern more predisposed
*must R/O cancer!
tx: surgery/excision if needed (dentures, etc)

55

strawberry tongue dx

-scarlet fever
ALSO DO NOT MISS
-Kawasaki dis (fever>5 days, desqu. of hands/feet, injection)
-TSS

56

scarlet fever

-sandpaper red rash, fever, streph throat
-school kids, late fall/early spring
-desquamation of hands and feet

57

Scarlet fever sandpaper rash cause

pyrogenic A-C and erythrogenic exotoxins produ. by GAS
(chest and back)

58

Scarlet fever Pastia's lines

bright red color in creases of axilla and groin

59

Forchheimer spots

small petechiae on soft palate
indicative of Rubella, measles, scarlet fever* (others are vaccinated)

60

black hairy tongue

elongation and hypertrophy of filiform papillae and desquamation of papillae on dorsal tongue (as long as 12mm normal 1mm)
typ. asymptomatic
-higher in incarcerated, etOH/drug addicted pop
-males, inc. age

61

black hairy tongue risk factors

smokers, poor oral hygiene, use oxidizing mouth wash, candida albicans, certain meds (broad spec abx)
debris between papillae-->halitosis
foods, tobacco, tea, coffee

62

geographic tongue (benign migratory glossitis)

inflammatory, large well-delineated, shiny, smooth erythematous spots surrounded by white halo, typ. on ant 2/3s of dorsal tongue
histopathologic-->psoriasis (or sympt of Reiter's syndrome)
-more females
waxes and wanes, days-->yrs
no symps ex burning w. spicy foods
if sympt. tx w/ topical steroids, zinc

63

gingivitis vs periodontitis

gingivitis is rev, periodontitis is not, causes tooth loss
both by bac in dental plaque

64

gingivitis

reversible, inflammation of gums
ANUG: (acute necrot. ulcerative ging) Vincent's disease, ("trench mouth")
a-hemolytic strep, anaerobic fusiform bac, nontreponemal? oral spirochetes

65

periodontitis

chrn. inflamm disease
Gingivitis + loss of bone support for teeth
-damages alveolar bone and periodontal pigs-->tooth loss
-link w/ CAD, CVA, inc. in pre term births

66

gingivitis/periodontitis tx

oral abx if ANUG
otherwise NSAIDS, avoid risk factors, good oral hygiene

67

apthous ulcer

canker sore
minor vs major (1-3 cm) vs herpetiform (>3mm)
*DO NOT miss oral cancer

68

DDX of apthous ulcer

herpes, candidiasis, oral Ca, erythema multiforme, erosive lichen planus, contact dermatitis, Bechet's syndrome, HFM dis (babies, don't give anything, Coxsackie)

69

apthous ulcer tx

supportive
corticosteroids
(will go away, follow pt)

70

leukoplakia

white plaque/patch, cannot be characterized clinically or path. as any other disease, CANNOT scratch off, gets worse
*pre-cancer*, unknown cause, smokers, chronic, non-painful, etOH
red or white*
**needs to be biopsied to rule out cancer!!**

71

oral cancer

-9th most common
SCC
risks: low intake fruits/veggies, tobacco (chew), etOH (75%), lichen planus, HPV
-inc. age, AA males
-lesions are unique and can be anywhere in mouth, need to biopsy

72

early childhood caries (ECC)

-most common childhood disease (25% 2-5, 42% 2-15)
-hispanic, AA, low soc-economic status
-prevalence now slight increase (not sure why)

73

ECC organisms

Strep mutans* and Strep sobrinus-->acid producing
-fermentable carbs (sucrose, glucose)
more plaque=more orgs.
*communicable!*: caregivers, siblings to infant, toddler

74

ECC risks

freq. consumption of liquids
sippy cup use w/ sugary drinks, sleeping w/ bottle
nursing ad lib
caregiver w/ caries
consump. of sticky foods
drinking nonfluor. comm. water or bottle water
low SES
taking meds that have sugar or cause dryness
poor oral hygiene

75

ECC, look for

white lesions
-->can develop into abcess-->facial swelling

76

oncogenic microbe assoc. w/ nasopharyngeal carcinoma

EBV

77

normal flora of dental plaque

S. Mutans

78

gingivitis/periodontitis risk factors

poor oral hygiene, smoking, env. factors (crowded teeth, mouth breathing), weakened IS (HIV, steroids, DM), low income

79

apthous ulcer risk factors

certain foods (milk sensitivity), medications (NSAIDs), vitamin deficiencies (zinc, iron, B12, folate), environmental factors (trauma, stress), viruses (HSV, HIV), and systemic diseases (Celiac and Bechets)
Can be seen in Crohn dz and ulcerative colitis