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HEENT > Chap 5 Throat MDT > Flashcards

Chap 5 Throat MDT Flashcards

1
Q

Predisposing factors for:

Epiglottitis

A

Diabetes

Contact with group A-B-hemolytic Streptococci

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2
Q

Symptoms and physical exam:

Rapidly developing sore throat or odynophagia is out of proportion to minimal oropharyngeal findings

Laryngoscopy may demonstrate swollen, erythematous epiglottis

A

Epiglottitis

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3
Q

Labs/Studies:

Epiglottitis

A

Lateral plain radiography may demonstrate enlarged epiglottis (thumb sign)

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4
Q

Treatment for:

Epiglottitis

A

IV Antibiotics

  • Ceftizoxime 2g x 8-12 hours
  • Levofloxacin 750mg IV q 24 + Clindamycin 900mg IV q6-8 hours

IV Corticosteroid
-Dexamethasone

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5
Q

White lesion that cannot be removed by rubbing the mucosal surface

Hyperkeratosis usually in response to a physical or chemical irritant

A

Leukoplakia

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6
Q

Most common oral precancer

2-4% show dysplastic changes

Most common site is buccal mucosa

A

Leukoplakia

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7
Q

Leukoplakia lesions of the floor of the mouth, tongue, and vermilion border are most likely associated with:

A

Malignancy

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8
Q

Predisposing factors for:

Leukoplakia

A

Alcohol

Tabacco

Dentures that don’t fit

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9
Q

Symptoms and physical exam:

  • White painless lesion that cannot be scraped or removed
  • Small to several cm in diameter
  • Usually superficial but may have submucosal depth upon palpation
  • May have wrinkled “wet finger” appearance
  • May have redness or dysplasia
A

Leukoplakia

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10
Q

Labs/studies:

Leukoplakia

A

Refer to biopsy to rule out dysplasia

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11
Q

Treatment for:

Leukoplakia

A

None

Remove irritants and educate patient

Measure and document for malignancy

Refer if redness or submucosal depth

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12
Q

Follow-up for:

Leukoplakia

A

Refer if malignancy pathology suspected

If not, re-evaluate annually

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13
Q

A collection of purulent material between the tonsillar capsule and the superior constrictor and palatopharyngeal muscles

A

Peritonsillar abscess

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14
Q

Predisposing factors for:

Peritonsillar abscess

A

Chronic tonsillitis

Multiple trials of oral antibiotics

Previous peritonsillar abscess

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15
Q

Symptoms and physical exam:

  • Severe sore throat
  • Odynophagia
  • Muffled (hot potato) voice
  • Trismus
  • Inferior and medial displacement of infected tonsil
  • Moist and translucent
  • Palatal edema
  • Tender cervical lymphadenopathy
  • Drooling
  • Dehydration
  • Color ranging from nearly none to deep erythema
A

Peritonsillar abscess

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16
Q

Labs/studies:

Peritonsillar abscess

A

Ultrasound

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17
Q

Treatment for:

Peritonsillar Abscess

A

Ceftriaxone 2g IV QD & Metronidazole 500mg IV q6h

-PCN Allergy: Clindamycin 600mg IV q8h

MEDEVAC for I&D

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18
Q

If you had to I&D a peritonsillar abscess, how would you?

A

19-21 gauge needle

Medial to the molar

No deeper than 1 cm because the carotid artery is there

19
Q

Accounts for 10% of office visits for primary care

50% of outpatient antibiotic use

A

Tonsillitis and pharyngitis

20
Q

Main concern for pharyngitis/tonsillitis, as this could pose a threat for complications such as rheumatic fever and glomerular nephritis

A

Determining who has group A-B hemolytic streptococcal infection (GABHS)

21
Q

More than what percentage of primary infections of HIV are associated with acute pharyngitis

A

70%

22
Q

Fungal pharyngitis

A

Candida albicans

23
Q

Symptoms and physical exam:

  • Incubation period of 2-5 days a sudden onset of sore throat, painful swallowing, chills, fever, headache, nausea, and vomiting
  • Erythema of the tonsils, tonsillar pillars and edematous uvula

CENTOR criteria:

1) Fever over 38 degrees C
2) Tender anterior cervical lymph nodes
3) Lack of cough
4) Pharyngotonsillar exudates

A

A-B-Hemolytic streptococcal (GABHS) infection Pharyngitis/Tonsillitis

24
Q

Symptoms and physical exam:

Marked lymphadenopathy with shaggy white-purple exudates that often extends into the nasopharynx

A

Mononucleosis

25
Q

Symptoms and physical exam:

Vesicular and petechial pattern on the soft palate and tonsils with rhinorrhea, no tonsillar exudates or cervical lymphadenopathy

A

Viral pharyngitis/tonsillitis

26
Q

Symptoms and physical exam:

White, cheesy exudates that can be scraped off an erythematous base

A

Fungal pharyngitis/tonsillitis

27
Q

Labs/studies:

Pharygitis/tonsillitis

A

Rapid strep

Mono spot

Throat culture

HIV

28
Q

Treatment for:

GABHS pharyngitis/tonsillitis

A

Penicillin or macrolides

Acetaminophen and NSAIDS

Warm saltwater gargles

Lozenges

29
Q

Treatment for:

Viral pharyngitis/tonsillitis

A

Acetaminophen and NSAIDS

Warm saltwater gargles

Lozenges

30
Q

Pharyngitis/Tonsillitis:

Refer for tonsillectomy if:

A

Three or more episodes in each of three years (3:3)

Five or more episodes in each of two years (5:2)

Seven or more episodes in one year (7:1)

31
Q

Complications of:

Pharyngitis/tonsillitis

A

Scarlet fever

Glomerulonephritis

Rheumatic myocarditis

Local abscess

Rheumatic valve disease

32
Q

Acute bacterial, commonly affects either the parotid or submandibular glands

Ductal obstruction, often by an inspissated mucous plug or a stone, is followed by salivary stasis and secondary infection

A

Sialadenitis

33
Q

More common organism recovered from purulent draining saliva from sialadenitis

A

Staph aureus

34
Q

Predisposing factors of:

Sialadenitis

A

Dehydration

Chronic illness

Sjogren syndrome

Chronic periodontitis

35
Q

Symptoms and physical exam:

  • Acute swelling of the salivary gland
  • Increased pain and swelling with meals
  • Tenderness and erythema of duct opening
  • Pus can often be massaged from the duct
A

Sialadenitis

36
Q

Labs/studies:

Sialadenitis

A

Ultrasound

CT scan

37
Q

Treatment for:

Sialadenitis

A

IV antibiotics
-Nafcillin, Oxacillin

PO antibiotics (if stable)
-Clindamycin PLUS ciprofloxacin

Increase salivary flow (warm compresses, massage, Fluids)

MEDEVAC

38
Q

Soft aggregates of bacterial and cellular debris that form in the tonsillar crypts, the crevices of tonsils

Occur mostly in palatine tonsils

Usually not harmful

Can cause bad breath

A

Tonsilloliths (Tonsil stones)

39
Q

Predisposing factors:

Tonsilloliths

A

Chronic or repeated tonsillitis

Post-nasal drip

40
Q

Larger tonsilloliths may cause multiple symptoms, including:

A
  • Halitosis
  • Sore throat
  • White debris
  • Bad taste (metallic) in back of throat
  • Dysphasia
  • Ear ache
  • Tonsillitis
41
Q

Labs/studies:

Tonsilloliths

A

X-ray

CT scan

42
Q

Treatment for:

Tonsilloliths

A

None if asymptomatic

Irrigation

Curettage of larger stones

43
Q

What may be indicated if bad breath continues due to tonsillar stones, persists despite other measures?

A

Tonsillectomy

44
Q

Initial care/Follow-up:

Tonsilloliths

A

Instruct patient to gargle saltwater as a prophylaxis

HEENT (6 decks)

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