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Nayla Foundations > 2-Nose and sinus > Flashcards

2-Nose and sinus Flashcards

1
Q

What causes acute pharyngitis

A

mostly VIRAL

but can be due to GABHS

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2
Q

What are symptoms of acute pharyngitis

A 
sore throat
fever
HA
malaise
adenopathy
URI
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3
Q

What are physical exam findings of acute pharyngitis

A 
erythema
tonsillar hypertrophy 
purulent exudate 
tender ant/ nodes
palatal petechiae
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4
Q

What must you exclude when diagnosing acute pharyngitis

A

GABHS, because it can lead to glomerulonephritis or RF

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5
Q

How do you treat acute pharyngitis

A

Supportive! and reassess in 5-7 days

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6
Q

What is the Centor criteria for diagnosing GABHS tonsillopharyngitis

A

Tonsillar exudate
Fever >38
No cough
tender anterior nodes

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7
Q

What is the center diagnostic criteria

A

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

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8
Q

What do you do with RADT results

A

If +, patient has GABHS

If -, need to do a culture to actually rule out

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9
Q

What are complications of GABHS

A 
Rheumatic fever 
glomerulonephritis 
scarlet fever 
peritonsillar abscess
OM
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10
Q

How do you treat GABHS

A

1st: Penicillin V x 10 days
(or Amoxicillin x 10 days)
If allergic to penicillin, Macrolides (Erythromycin)

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11
Q

What is the criteria for a tonsillectomy

A

7 episodes in the last year
5 episodes in the last 2 years
3 episodes in the last 3 years

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12
Q

What is an “episode” for tonsillectomy criteria

A

ST and fever >100.9, Tonsillar exudate , anterior cervical adenopathy, culture confirmed
–All with correct Abx therapy

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13
Q

What causes peritonsillar abscesses

A

They are polymicrobial, but mostly GABHS inside

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14
Q

What are symptoms of peritonsillar abscess

A

Severe ST
hot potato voice
drooling
ipsilateral ear pain

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15
Q

What will you see on peritonsillar abscess PE

A

uvula deviation of midline
soft palate bulging
swollen tonsils
cervical LAD

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16
Q

How do you diagnose peritonsillar abscess

A

Clinical Dx
can get CBC, culture, or electrolytes
Can get CT if concerned about info spreading

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17
Q

How do you treat peritonsillar abscess

A

Supportive care
Monitor airway obstruction
(may need Needle aspiration/I&D
Abx)

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18
Q

What abx can you give for peritonsillar abscess

A

IV ampicillin sulbactam/ clindamycin
PO Augmentin/clindamycin x 14 days
–If patient has high rate of MRSA, Vanco

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19
Q

What causes acute laryngitis

A 
mostly VIRAL (rhinovirus, influenza) 
rarely bacterial (if so, strep, Moraxella, H. influenza)
Non-infectious (vocal abuse, GERD, trauma, toxins)
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20
Q

What are symptoms of acute laryngitis

A 
Hoarseness 
URI Sx (rhinorrhea, congestion, cough, ST)
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21
Q

What is the treatment for acute laryngitis

A

humidification
voice rest (no whispering)
smoking cessation

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22
Q

How long until acute laryngitis resolves

A

1-3 weeks

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23
Q

What are RF for epiglottis

A

incomplete/non-vaccination

immunodeficiency

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24
Q

What causes epiglottis

A

**H. Influenza/S. Aureus
streptococcus
(viral or bacterial)

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25
Q

What are symptoms of epiglottis

A

Drooling, Dysphagia, Distress
Tripod position
fever, stridor, odynophagia out of proportion to PE

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26
Q

When should you NOT examine the epiglottis

A

If the patient is anxious, you don’t want to obstruct the airway!

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27
Q

What does an epiglottitis PE look like

A

usually normal

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28
Q

What diagnostics should you get for epiglottitis

A

Labs (once airway secured)
Imaging (thumb’s sign)
direct laryngoscopy

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29
Q

How do you treat epiglottitis

A 
emergently protect the airway 
IV abx (3rd generation cephalosporin/vanco) +/- dexamethasone
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30
Q

How can you PREVENT epiglottitis

A

immunization!

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31
Q

What is oral herpes simplex

A

cold sores! caused by HSV1

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32
Q

How do oral herpes simplex present on first exposure

A

herpetic gingivostomatitis

Prodrome for 14 days (sudden onset painful vesicles on red base)

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33
Q

What about herpes simplex going forward

A

prodrome only lasts about 5 days

34
Q

What triggers recurrence of oral herpes simplex

A 
sun
fever
menstruation
stres
trauma
35
Q

How do you diagnose oral herpes simplex

A

clinically

also w/ culture, serology, immunofluorescence

36
Q

How can you manage oral herpes symptoms

A

antivirals
analgesics
fluid management

37
Q

What does Coxsackie A16 cause

A

hand foot and mouth disease (mostly in kids)

38
Q

What is the prodrome of Coxsackie virus

A

low grade fever
malaise
abdominal pain
URI

39
Q

What does the coxsackie virus rash look like

A

papules on a red base to hard palate and tongue

Lesions over hands, feet, mouth, and buttocks

40
Q

What is herpangia

A

Disease commonly mistaken for Coxsackie virus BUT it has HIGH fever and POSTERIOR lesions of SOFT palate

41
Q

How do you diagnose and treat Coxsackie virus

A

clinical Dx

supportive treatment with 2-3 day resolution

42
Q

What is an aphthous ulcer

A

Canker sore triggered by stress

43
Q

What causes aphthous ulcers

A

not fully known, but probably HHV6

44
Q

What diseases are concomitant with aphthous ulcers

A

Celiac
IBD
HIV

45
Q

Where are aphthous ulcers mostly found

A 
gums
tongue
lips
palate
buccal mucosa
46
Q

What do aphthous ulcers look like

A

single, recurrent, painful ulcers with grey base and surrounding red halo

47
Q

How do you treat aphthous ulcers

A

topical corticosteroids

topical analgesics

48
Q

What is Bechet’s

A

inflammatory disorder with lesions that recur more than aphthous ulcers

49
Q

What causes Bechet’s

A

autoimmune diseases

50
Q

What are symptoms of Bechet’s

A

recurrent oral and genital aphthae, often at multiple sites

51
Q

What is diagnostic criteria for Bechet’s

A

recurrent ulcers, 3+/yr and 2+ other findings

52
Q

Who do you refer Bechet’s patients to

A

rheumatologists

53
Q

What is a characteristic finding of oral candidiasis

A

thrush (burning, creamy white patches over erythematous mucosa that is EASILY scraped)

54
Q

What are risk factors for candidiasis

A 
Pt with dentures
poor oral hygiene
infants 
DM
anemia
HIV
chemo
55
Q

How do you diagnose candidiasis

A

clinically

-can support Dx with KOH wet prep

56
Q

How do you treat candidiasis

A

anti-fungals (Nystatin mouth rinse)

57
Q

What is oral lichen planus

A

chronic inflammatory AI disease of the mouth

58
Q

What are symptoms of oral lichen planus

A

reticular white plaque
mucosal erythema
ulcerations

59
Q

How can you diagnose oral lichen planus

A

Exfoliative cytology/biopsy

difficult to dx

60
Q

How do you treat oral lichen plants

A

manage pain w/ corticosteroids

61
Q

What is oral leukoplakia

A

precancerous hyperplasia of squamous epithelium

62
Q

What causes oral leukoplakia

A

chronic irritation (dentures, tobacco, lichen planus)

63
Q

How can you tell the difference between oral lichen plants and oral leukoplakia

A

Oral leukoplakia lesions do NOT remove by brush

64
Q

How can you treat oral leukoplakia

A

consider biopsy or exfoliative cytologic exam

65
Q

What referral should you consider for oral leukoplakia

A

ENT
head/neck surgeon
radiation oncology

66
Q

Who’s is erythroplakia most common in

A

smokers and alcohol users

67
Q

What causes erythroplakia

A

malignant change in epithelium

68
Q

What does erythroplakia look like

A

red, velvety, plaque-like lesion

69
Q

What MUST you do with every suspected erythroplakia patient

A

BIOPSY!

then refer to ENT

70
Q

What is hairy leukoplakia seen with and what cases it

A

HIV (even though it is NOT pre-malignant)

caused by EBV

71
Q

What is characteristic of erythroplakia lesion

A

it is on LATERAL tongue with painless plaque that can’t be brushed

72
Q

How do you treat hairy leukoplakia

A

antivirals are possible but not necessary

73
Q

What are mucoceles

A

fluid filled cavities w/ mucus glands lining the epithelium

74
Q

When are mucoceles usually seen

A

after mild oral trauma

75
Q

How do you treat mucoceles

A

they can rupture spontaneously

remove mucocele with cryotherapy or cyst excision

76
Q

What is an amalgam tattoo

A

benign black finding adjacent to filling that can look like melanoma

77
Q

What is Torus palatinus

A

benign, bony lesion usually on hard palate, ALWAYS midline

78
Q

When is a torus palatinus dangerous

A

if with rapid onset

79
Q

What are dental caries caused by

A

Strep mutans (metabolize sugar into acid, ruining enamel, causing cavity

80
Q

What are symptoms of dental caries

A

heat/cold intolerance

Visually disturbing

81
Q

What can dental caries lead to

A

intraoral abscess
cellulitis
brain abscess

Nayla Foundations (18 decks)

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