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Senior - ENT > 5 - Otolaryngology > Flashcards

5 - Otolaryngology Flashcards

1
Q

The 3 Pharynges

A

Nasopharynx
Oropharynx
Hypopharynx

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2
Q

Mouth disease list

A 
Leukoplakia
Erythoplakia
Oral lichen planus
Oral cancer
Oral herpes
Candidiasis
Glossitis
Intraoral lesions
Disease of teeth/gums
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3
Q

Throat diseases list

A

Pharyngitis and tonsilitits
Peritonsillar abscess and cellulitis
Tonsillectomy

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4
Q

Diseases of the salivary glands list

A

Sialandenitis

Parotitis

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5
Q

Key to success for diagnosing oral lesions?

A

Form an appropriate differential diagnosis based on H/P

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6
Q

Even longer list of oral cavity lesions?

A

Slide 8

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7
Q

What is the problem with precancer and early oral cancer?

A

They are subtle and often asymptomatic

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8
Q

Presentation of early and precancer?

A

White/red patch

  • Progresses to ulceration
  • Becomes endophytic or exophytic mass (SCC)
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9
Q

Endophytic vs exophytic?

A

Endophytic - grows inward from superficial lesion

Exophytic - grows outward from the lesion

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10
Q

Best known precancerous oral lesion?

A

Leukoplakia - precancer

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11
Q

What is leukoplakia?

A

Precancer

white patches or plaques
- non-removal

Represents hyperplasia of the squamous epithelium

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12
Q

Transformation of leukoplakia?

A

Hyperplasia -> dysplasia -> carcinoma in situ -> invasive malignant tumor

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13
Q

Leukoplakia progression to cancer?

A

1-20% become cancer in 10 yrs

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14
Q

What (non-cancer) causes leukoplakia?

A

Inflammatory conditions

- hyperkeratosis from chronic irritation (dentures, tobacco etc)

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15
Q

What is erythroplakia?

A

Similar to leukoplakia except red (erythematous for your smart people)

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16
Q

Problem with erythroplakia?

A

More likely than leukoplakia to exhibit dysplasia or carcinoma microscopically
- 90% are dysplasia/SCC

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17
Q

Exam for leuko/erythroplakia?

A

Through oral exam

Palpation of neck for lymphadenopathy

Biopsy everything

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18
Q

When should you give an ENT referral for leuko/erythro?

A

Early
- precancer needs to be removed

  • cryotherapy and lasers are used sometimes but not preferred
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19
Q

MC oral cancer?

A

Squamous cell carcinoma SCC

-90% of oral cancer

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20
Q

Describe SCC

A

Ulcers or masses that dont heal

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21
Q

Any persistent lesions in mouth need?

A

Biopsy and ENT referral

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22
Q

Risk factors for SCC?

A

Tobacco/ETOH
- accounts for 80%

Combine them and they are even more effective

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23
Q

Common locations of SCC?

A

Ventral surface of tongue
Hard palate
Tip of tongue
Mouth hole

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24
Q

5 yr survival SCC?

A

5 yr = 50-55%

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25
Q

ABCDE of melanoma?

A 
A - assymetry
B - Boarders (irregular)
C - color (variable)
D - Diameter (increased)
E - elevation
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26
Q

DDX for melanoma?

A

Melanosis - symmetric spots on dark skin ppl
Oral melanotic macules - symmetric w sharp boarders
Amalgam tattoos - leeching of dental fillings

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27
Q

What are fordyce spots?

A

Benign neoplams of sebaceous gland etiology

  • isolated/scattered
  • white/yellow,
  • 1-2mm discrete papules

Prominent on vermillion/buccal mucosal boarder

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28
Q

What are mucoceles?

A

Fluid filled caveties in mucous glands

- after mild oral trauma

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29
Q

Mucoceles MCC?

A

MCC - lower lip biting

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30
Q

Tx for mucoceles?

A

Symptomatic - cryotherpathy/excision

Aspiration may relieve symptoms but usually come back

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31
Q

Oral linchen planus are?

A

Chronic waxing and waning inflammatory condition

Maybe immune mediated

Usually pts >40yo

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32
Q

Forms of oral lichen planus?

A

2 clinical forms

Reticular

  • white, lacy striations (wickham’s striae) or papules on buccal mucosa
  • painless

Erosive
- zones of tender erythema and painful ulcers surrounded by white radiating straie

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33
Q

Thrush?

A

Oral candidiasis

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34
Q

What is candidiasis?

A

Fluctuating mouth or throat discomfort caused by fungus

- seen in young and AIDS

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35
Q

Describe thrush

A

Erythema of oral cavity
Creamy-white curd-like patches
Angular chelitis

Resolves rapidly w tx

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36
Q

Causes of etiology?

A

MC - candida albicans

Less common

  • C glabrata
  • C. Krusei
  • C. Tropicalis
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37
Q

Forms of oral candidiasis?

A

Pseudomembranous form: MC
- overall-white plaques on buccal mucosa, palate, tongue or oropharynx

Atrophic form (denture stomatitis):

  • MC in older adults
  • erythema w/o plaques
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38
Q

Diagnosis of candidiasis?

A

KOB - budding yeast

Aids test

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39
Q

Candidiasis tx in infants

A

Topical antifungal

  • nystatin suspension x 2 weeks
  • gentian violet/oral fluconazol if refractory

Sterilizing bottles/nipples

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40
Q

Candidiasis tx in older kids?

A

Mild: topical nystatin or clotrimazol

Severe:

  • fluconazole 6mg/kg once
  • followed by 3mg/kg q day x 7-14 days
41
Q

Adult candidiasis tx?

A

Fluconazole 100mg po x 7 days
Ketoconazole 200-400mg po x 7-14 days
Nystatin mouth rinse

HIV needs longer tx

42
Q

Cancer sore is aka?

A

Appthous ulcer

43
Q

Describe aphthous ulcer

A

Painful oral lesion
Small round ulcerations
Yellow-gray base w red halo

44
Q

MCC form of oral lesions?

A

RAS - recurrent aphtosus stomatitis

45
Q

Risk factors for RAS?

A 
Stress
Hormones
Food sensitivitis
celiac disease
IBD
Vitamin deficienes (B 1,2,6,12)(iron)(folate) (zinc)
46
Q

Presentation/course of RAS?>

A

Round clearly defined small painful ulcer

  • heals in 10-14 days
  • larger lesion (>1cm) last 6 weeks

2-4 times/yr or more

Usually resolves by age 30

47
Q

Tx fo RAS?

A

Usually nonsystemic

  • septra/fluocinonide (orobase)
  • diclofinac in hyaluronan
  • amlexanox (aphthasol) paste

Systemic
- Oral prednisone 1 wk taper (40-60mg q day)

48
Q

Herpetic gingivostomatitis is aka?

A

Herpes labialis

HSV 1

49
Q

S/s of herpetic gingivostomatitis?

A

You should know these by now but slide 41 has them

Picture dew drops on a rose petal but the rose is your mouth

50
Q

Dx for herpetic gingivostomatitis?

A

Multinucleated giant cells on tzank smear

Comes from a scraping

51
Q

Tx for herpetic gingivostomatitis?

A

Acyclovir PO 5per day x 7-14 days

Valcyclovier 1000mg PO BID

52
Q

Tx for herpes only works if?

A

You take it prophylacticl
or
W/in 24-48 hrs of prodromal symptoms

53
Q

Varicella-zoster virus

A

Yep it can be in the mouth

- so run the autism risk and get the vaccine

54
Q

Atrophic glossitis is?

A

Inflammatory d/o of tongue that leads to atrophy of papillae

55
Q

Causes of atrophic glossitis

A 
Nutritional deficiencies
Chronic dry mouth
Oral candidiasis
Protein-calorie malnutrition 
Celiac disease
56
Q

Sx of atrophic glossitis?

A

Burning sensation

Increases sensitivity to eating acidic or salty foods

57
Q

Tx of atrophic glossitis

A

Directed at cause

58
Q

Describe fissured tongue?

A

Deep grooves over tongue surface

Generally asymptomatic

Permanent

59
Q

Fissured tongue is associated w?

A

Downs - T21

60
Q

Black tongue

A

Hyperpigmentation common in dark-skinned individuals

61
Q

Less common cause of black tongue?

A 
Tetracyclines
Bismuth subsalicylate
Antidepressants
PPI
Interferon
62
Q

Tx for black tongue?

A

None unless med induced then stop the meds

63
Q

Geographic tongue?

A

Local loss of filiform papillae leads to ulcer-like lesions

Lesions cause change location, pattern and size w/in min/hours

64
Q

Tonsil size?

A 
0 - surgically removed
1 - tonsils hidden w/in pillars
2 - tonsils extending to pillars
3 - tonsils are beyond pillars
4 - tonsils extend to midline

Slide 54 pic

65
Q

Essentials of diagnosis

Strep

A

Sore throat
Fever
Anterior cervical adenopathy
Tonsillar exudate

Focus to tx group A b-hemolytic strep

66
Q

All sore throats are not strep throat but?

A

If its GAS you must treat w abx

67
Q

Centor criteria?

A

Suggest GAS
3/4 present 90% GAS

FACE
F - Fever (>100.4)
A - Anterior cervical LAD
C - Con-cough
E - exudate
68
Q

RADT?

A

Rapid antigen detection test

Rapid strep

Can also do culture

69
Q

Other pharygitis and tonsillitis that looks like strep?

A 
Mononucleosis (petichia)
- shaggy white-purple exudate 
Diphtheria 
- gray tonsillar pseudomembrane 
Virals agents (dont forget a z-pack)
- cough, rhinorrhea, no exudate
Neisseria, chlamydia
- culture/history
70
Q

Tx for GAS?

A

Pen VK - DOC
Amoxicillin - better for kids (taste like bubble gum)
IM benzathine pen G (honestly why would you give anything else)

71
Q

Ancillary tx for GABHS?

A

Aspirin/nsaid
Acetaminophen
Corticosteroids
Salt water gargle

72
Q

Tx for MONO

A

Same except no abx (its viral)

73
Q

With mono you need to watch for?

A

Splenomegaly

  • no sports
  • no bikes
  • no skateboarding (this is a rule of life not just for mono)
74
Q

Quinsy tonsil?

A

Peritonsillar cellulitis and abscess

75
Q

Peritonsillar cellulitis and abscess is?

A

Infection penetrates the tonsilar capsule and involves the surrounding tissurs

76
Q

Peritonsillar cellulitis and abscess sx?

A 
Severe sore throat
Odynophagia
Trismus
Medial deviation of soft palate/peritonsillar fold
Hot potato voice
77
Q

Dx for peritonsillar cellulitis and abscess?

A 
US/CT
Needle aspiration (pus)
78
Q

Complications for peritonsillar cellulitis and abscess?

A

Extension to the retropharyngeal, deep neck, and posterior mediastinal space

79
Q

Tx for peritonsillar cellulitis and abscess?

A

GET ENT INVOLVED

Cellulitis - good airway, no sepsis

  • empiric IV abx (GABHS, S. Aureus, resp anaerobes)
  • admit

PTA w good airway
- needle aspiration and admission

Tonsillectomy or I/D if they dont respond

80
Q

Indications for tonsillectomy?

A

Obstructions or infections

  • obstruction of naso or oropharyneal airway
  • sleep disordered breathing (SBD)
81
Q

Tonsillectomy in kids?

A

Kids w SDB might get better w/o tonsillectomy and s/e may be

  • growth delay
  • poor school performance
  • bedwetting
  • behavioral problems

Watchful waiting is best

82
Q

When to do tonsillectomy in kids?

A

<7 episodes/yr - dont do
<5 a yr in past 2 yrs or <3 in past 3 yrs

But if needed can reduce req of sever throat infections

83
Q

Concerns w tonsillectomy”

A

Bleeding - can lead to laryngospasm and airway obstruction

Pain - can be considerable

Protracted emesis/fever

Secondary bleeding 5-8 days later

84
Q

Important salivary glands?

A

Stenson - on top

Wharton duct - on bottom

85
Q

Drain pattern of salivary glands?

A

Parotid glands -> stenson duct

Submandibular -> wharton duct

Sublingual gland

86
Q

What is sialadenitis?

A

Ductal obstruction from mucous plug - salivary stais from secondary infection with:
- staph Aureus MC

Parotid or submandibular gland and duct infection

87
Q

Symptoms of sialadenitis?

A

Swelling of gland
Pain/swelling w meals
Tenderness/erythema of duct opening
Exudate w massage of duct

88
Q

Tx for sialadenitis?

A

Mild - hydrate, warm compress of gland

Less sever - PO abx for s aureus

Severe - IV abx (nafcillan) followed by PO abx

89
Q

Failed tx for sialadenitis?

A 
Failed tx - 
consider abscess, 
stricture, 
tumor
suppurative sialadenitis
90
Q

What is suppurative sialadenitis

A

Sever/life threatening form

  • Get US/CT
  • will need I/D
91
Q

What is suppurative parotitis?

A

Acute infection of parotid gland w bacteria or virus
- MC s. Aureus

Seen with dehydration or dirty mouth

92
Q

Presentation of suppurative parotitis?

A

Sudden onset
- firm, Erythematous swelling of pre and postauricualr areas that extends to angle of mandible

TTP w trismus and dysphagia
Fever/chills
Purulent material (maybe)

93
Q

Tx for parotitis?

A

Immediate referral
- may spread to deep neck spaces

Hydrate and IV abx

  • nafcillin + metrinidazol or clinda
  • vanc for aids pts

Prob needs an I/D

94
Q

Sialolithiasis?

A

Stone in ductu

  • usually wharton duct
  • maybe stenson duct

Palpated manually

95
Q

CT for sialolithiasis?

A

Wharton duct stones - large and radiopaque

Stensen duct - small and radiolucent

96
Q

Tx for sialothiasis

A

< 2cm from duct opening- sialangouges, warm fluids, massage, dilation or I/D

> 2cm from duct opening - sialendoscopy

Chronic
- sialoendoscopy - management of choice

97
Q

Salivary gland tumors a big deal?

A

80% are benign

- mostly asymptomatic

98
Q

When to worry about malignancy for salivary gland tumors?

A

If CN VII affected

Tumors in paraphyngeal space cause by medial deviation of soft palage

99
Q

Audience member:

“Why do you have such a small mouth?”

A

Comedian:

“To make dicks like yours seem big”

Senior - ENT (8 decks)

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