2-Nose and sinus Flashcards by Shea Green

What causes acute pharyngitis

mostly VIRAL

but can be due to GABHS

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What are symptoms of acute pharyngitis

sore throat
fever
HA
malaise
adenopathy
URI

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What are physical exam findings of acute pharyngitis

erythema
tonsillar hypertrophy 
purulent exudate 
tender ant/ nodes
palatal petechiae

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What must you exclude when diagnosing acute pharyngitis

GABHS, because it can lead to glomerulonephritis or RF

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How do you treat acute pharyngitis

Supportive! and reassess in 5-7 days

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What is the Centor criteria for diagnosing GABHS tonsillopharyngitis

Tonsillar exudate
Fever >38
No cough
tender anterior nodes

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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

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What do you do with RADT results

If +, patient has GABHS

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

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What are complications of GABHS

Rheumatic fever 
glomerulonephritis 
scarlet fever 
peritonsillar abscess
OM

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How do you treat GABHS

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

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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

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What is an “episode” for tonsillectomy criteria

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

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What causes peritonsillar abscesses

They are polymicrobial, but mostly GABHS inside

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What are symptoms of peritonsillar abscess

Severe ST
hot potato voice
drooling
ipsilateral ear pain

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What will you see on peritonsillar abscess PE

uvula deviation of midline
soft palate bulging
swollen tonsils
cervical LAD

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How do you diagnose peritonsillar abscess

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

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How do you treat peritonsillar abscess

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

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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

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What causes acute laryngitis

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

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What are symptoms of acute laryngitis

Hoarseness 
URI Sx (rhinorrhea, congestion, cough, ST)

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What is the treatment for acute laryngitis

humidification
voice rest (no whispering)
smoking cessation

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How long until acute laryngitis resolves

1-3 weeks

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What are RF for epiglottis

incomplete/non-vaccination

immunodeficiency

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What causes epiglottis

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

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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