2-Nose and sinus Flashcards
What causes acute pharyngitis
mostly VIRAL
but can be due to GABHS
What are symptoms of acute pharyngitis
sore throat fever HA malaise adenopathy URI
What are physical exam findings of acute pharyngitis
erythema tonsillar hypertrophy purulent exudate tender ant/ nodes palatal petechiae
What must you exclude when diagnosing acute pharyngitis
GABHS, because it can lead to glomerulonephritis or RF
How do you treat acute pharyngitis
Supportive! and reassess in 5-7 days
What is the Centor criteria for diagnosing GABHS tonsillopharyngitis
Tonsillar exudate
Fever >38
No cough
tender anterior nodes
What is the center diagnostic criteria
0-2 Sx: probably not GABHS
3+ Sx: probably GABHS
Tx: 0-1, dont test
2-3, test to assess for GABHS
4, dont test, treat empirically
What do you do with RADT results
If +, patient has GABHS
If -, need to do a culture to actually rule out
What are complications of GABHS
Rheumatic fever glomerulonephritis scarlet fever peritonsillar abscess OM
How do you treat GABHS
1st: Penicillin V x 10 days
(or Amoxicillin x 10 days)
If allergic to penicillin, Macrolides (Erythromycin)
What is the criteria for a tonsillectomy
7 episodes in the last year
5 episodes in the last 2 years
3 episodes in the last 3 years
What is an “episode” for tonsillectomy criteria
ST and fever >100.9, Tonsillar exudate , anterior cervical adenopathy, culture confirmed
–All with correct Abx therapy
What causes peritonsillar abscesses
They are polymicrobial, but mostly GABHS inside
What are symptoms of peritonsillar abscess
Severe ST
hot potato voice
drooling
ipsilateral ear pain
What will you see on peritonsillar abscess PE
uvula deviation of midline
soft palate bulging
swollen tonsils
cervical LAD
How do you diagnose peritonsillar abscess
Clinical Dx
can get CBC, culture, or electrolytes
Can get CT if concerned about info spreading
How do you treat peritonsillar abscess
Supportive care
Monitor airway obstruction
(may need Needle aspiration/I&D
Abx)
What abx can you give for peritonsillar abscess
IV ampicillin sulbactam/ clindamycin
PO Augmentin/clindamycin x 14 days
–If patient has high rate of MRSA, Vanco
What causes acute laryngitis
mostly VIRAL (rhinovirus, influenza) rarely bacterial (if so, strep, Moraxella, H. influenza) Non-infectious (vocal abuse, GERD, trauma, toxins)
What are symptoms of acute laryngitis
Hoarseness URI Sx (rhinorrhea, congestion, cough, ST)
What is the treatment for acute laryngitis
humidification
voice rest (no whispering)
smoking cessation
How long until acute laryngitis resolves
1-3 weeks
What are RF for epiglottis
incomplete/non-vaccination
immunodeficiency
What causes epiglottis
**H. Influenza/S. Aureus
streptococcus
(viral or bacterial)
What are symptoms of epiglottis
Drooling, Dysphagia, Distress
Tripod position
fever, stridor, odynophagia out of proportion to PE
When should you NOT examine the epiglottis
If the patient is anxious, you don’t want to obstruct the airway!
What does an epiglottitis PE look like
usually normal
What diagnostics should you get for epiglottitis
Labs (once airway secured)
Imaging (thumb’s sign)
direct laryngoscopy
How do you treat epiglottitis
emergently protect the airway IV abx (3rd generation cephalosporin/vanco) +/- dexamethasone
How can you PREVENT epiglottitis
immunization!
What is oral herpes simplex
cold sores! caused by HSV1
How do oral herpes simplex present on first exposure
herpetic gingivostomatitis
Prodrome for 14 days (sudden onset painful vesicles on red base)
What about herpes simplex going forward
prodrome only lasts about 5 days
What triggers recurrence of oral herpes simplex
sun fever menstruation stres trauma
How do you diagnose oral herpes simplex
clinically
also w/ culture, serology, immunofluorescence
How can you manage oral herpes symptoms
antivirals
analgesics
fluid management
What does Coxsackie A16 cause
hand foot and mouth disease (mostly in kids)
What is the prodrome of Coxsackie virus
low grade fever
malaise
abdominal pain
URI
What does the coxsackie virus rash look like
papules on a red base to hard palate and tongue
Lesions over hands, feet, mouth, and buttocks
What is herpangia
Disease commonly mistaken for Coxsackie virus BUT it has HIGH fever and POSTERIOR lesions of SOFT palate
How do you diagnose and treat Coxsackie virus
clinical Dx
supportive treatment with 2-3 day resolution
What is an aphthous ulcer
Canker sore triggered by stress
What causes aphthous ulcers
not fully known, but probably HHV6
What diseases are concomitant with aphthous ulcers
Celiac
IBD
HIV
Where are aphthous ulcers mostly found
gums tongue lips palate buccal mucosa
What do aphthous ulcers look like
single, recurrent, painful ulcers with grey base and surrounding red halo
How do you treat aphthous ulcers
topical corticosteroids
topical analgesics
What is Bechet’s
inflammatory disorder with lesions that recur more than aphthous ulcers
What causes Bechet’s
autoimmune diseases
What are symptoms of Bechet’s
recurrent oral and genital aphthae, often at multiple sites
What is diagnostic criteria for Bechet’s
recurrent ulcers, 3+/yr and 2+ other findings
Who do you refer Bechet’s patients to
rheumatologists
What is a characteristic finding of oral candidiasis
thrush (burning, creamy white patches over erythematous mucosa that is EASILY scraped)
What are risk factors for candidiasis
Pt with dentures poor oral hygiene infants DM anemia HIV chemo
How do you diagnose candidiasis
clinically
-can support Dx with KOH wet prep
How do you treat candidiasis
anti-fungals (Nystatin mouth rinse)
What is oral lichen planus
chronic inflammatory AI disease of the mouth
What are symptoms of oral lichen planus
reticular white plaque
mucosal erythema
ulcerations
How can you diagnose oral lichen planus
Exfoliative cytology/biopsy
difficult to dx
How do you treat oral lichen plants
manage pain w/ corticosteroids
What is oral leukoplakia
precancerous hyperplasia of squamous epithelium
What causes oral leukoplakia
chronic irritation (dentures, tobacco, lichen planus)
How can you tell the difference between oral lichen plants and oral leukoplakia
Oral leukoplakia lesions do NOT remove by brush
How can you treat oral leukoplakia
consider biopsy or exfoliative cytologic exam
What referral should you consider for oral leukoplakia
ENT
head/neck surgeon
radiation oncology
Who’s is erythroplakia most common in
smokers and alcohol users
What causes erythroplakia
malignant change in epithelium
What does erythroplakia look like
red, velvety, plaque-like lesion
What MUST you do with every suspected erythroplakia patient
BIOPSY!
then refer to ENT
What is hairy leukoplakia seen with and what cases it
HIV (even though it is NOT pre-malignant)
caused by EBV
What is characteristic of erythroplakia lesion
it is on LATERAL tongue with painless plaque that can’t be brushed
How do you treat hairy leukoplakia
antivirals are possible but not necessary
What are mucoceles
fluid filled cavities w/ mucus glands lining the epithelium
When are mucoceles usually seen
after mild oral trauma
How do you treat mucoceles
they can rupture spontaneously
remove mucocele with cryotherapy or cyst excision
What is an amalgam tattoo
benign black finding adjacent to filling that can look like melanoma
What is Torus palatinus
benign, bony lesion usually on hard palate, ALWAYS midline
When is a torus palatinus dangerous
if with rapid onset
What are dental caries caused by
Strep mutans (metabolize sugar into acid, ruining enamel, causing cavity
What are symptoms of dental caries
heat/cold intolerance
Visually disturbing
What can dental caries lead to
intraoral abscess
cellulitis
brain abscess
