Conditions of the Head and Neck Flashcards
What are the risk factors for laryngeal cancer?
Tobacco use, alcohol use, HPV infection, more common in males
What is the most common type of laryngeal cancer?
Squamous cell carcinoma
What are the classic symptoms associated with laryngeal cancer?
Hoarseness for longer than 14 days, dyspnea, dysphagia, persistent cough or sore throat
How us laryngeal cancer diagnosed?
Biopsy during laryngoscopy
Given the symptom of chronic hoarseness, what would be in the ddx fro laryngeal cancer?
Laryngitis, vocal cord polyps, vocal cord nodules, GERD, TB or fungal infections of the larynx, thyroid disorders
What is the most common cause of oral cancer?
Squamous cell carcinoma associated with tobacco and alcohol use
Where are the oral cancers most commonly found?
Lip or lateral part of the tongue
What disease is associated with gingival hyperplasia?
Acute myeloblastic leukemia (AML)
What else can cause gingival hyperlasia?
Drug induced: Usually phenytoin, Cyclosporine, Nifedipine and Amlodipine
Does gingival hyperplasia go away with treatment of AML or discontinuation of the offending drugs?
Yes, it will regress
What people are most susceptible to clinically significant CMV infections?
Immunocompromised
Patients on immunosuppresive drugs
What are the common signs and symptoms of CMV?
Acute febrile illness: fever, fatigue, LAO
Hepatitis
Atypical lymphocytosis
Rash
Heptosplenomegaly
What are some other clinical findings CMV?
Retinitis: blurred vision, progressive blindness
Esophagitis: Pain, dysphagia, ulcers
Colitis: fever, diarrhea, abdominal pain, weight loss
How is CMV diagnosed?
Immunofluorescence: Direct demonstration of CMV in body fluids or tissues
PCR
Serologic testing
What drug has been used to treat CMV infection?
Acyclovir, newer generation are more commonly used now: Valacylovir, Ganciclovir
What is the hallmark presentation of diphtheria?
Gray to black fibrous coating on the posterior oropharynx, which can lead to airway obstruction
How is diphtheria spread?
Respiratory Droplets
What is a possible complication of severe acute OM?
Mastoiditis
What bacterial infection usually causes mastoiditis?
Strep pneumoniae, Strep pyogens, Haemophilius
What are the signs and symptoms of mastoiditis?
1) Usually associated with OM
2) Otalgia, *otorrhea with possible perforation of the TM
3) *Swelling and pain over mastoid process
4) Fever, may be high and unrelenting
5) External ear displacement
6) Progressive hearing loss
7) *Retroauricular swelling with protruding ear
How is mastoiditis usually diagnosed?
CT scan, culture discharge
What are the signs and symptoms of infectious mononucleosis?
Fatigue
Fever
Pharyngitis
Cervical LAO
Myalgia
What organ is enlarged in 50% of mono cases?
The spleen
How is infectious mononucleosis diagnosed?
1) Presence of atypical lymphocytes ( Downy cells) on a CBC
2) Positive Heterophile antibody (Monospot) test
3) (+) EBV specific antibodies: VCA IgM, VCA IgG, EB-NA antibodies
What would be in the DDx for mononucleosis?
CMV
Group A Beta hemolytic step (pharyngitis)
Adenovirus
Toxoplasmosis
Viral Hepatitis
HIV
Leukemia
How is mononucleosis transmitted?
1) Contact with oral secretions
2) Blood transfusion
At what time do antibodies for infectious mononucleosis appear in the serum?
6-10 days post infection
What might make you suspicious that your patient has acute closed angle glaucoma?
Periorbital pain with ipsilateral headache and vision changes changes
Closed - ocular emergency
Rare (5%)
Acute onset
Painful red eye
Very elevated IOP
Hazy cornea
Mid-dilated pupil un-reactive to light
N/V, abdominal pain
Halos around light
What is blepharitis?
Chronic inflammation leading to flaky irritated and itchy eyelids
What are the common causes of blepharitis?
Staph infection, allergies, seborrheic dermatitis, eyelash mites or lice and rosacea
What are the 3 types of conjunctivitis?
Viral
Bacterial
Allergic or Irritative
What are some common causes of bacterial conjunctivitis?
Stap, Strep, Gonorrhea, Chlamydia, Haemophilius
What are the symptoms of allergic conjunctivitis?
Velvety projection on the underside of the lid
Intense itching, watery eyes
Mucoid white stringy discharge containing eosinophils
What are the causes of viral conjunctivitis?
Adenovirus (most common), varicella zoster or herpes simplex ( most severe)
Which lasts longer, viral or bacterial conjunctivitis?
Viral tends to last longer, up to 2-4 weeks
What are the symptoms of viral conjunctivitis?
Enlarged pre-auricular lymph nodes
Clear, thin and watery discharge
Corneal injection
Usually bilateral
Photophobia
What are symptoms of bacterial conjunctivitis?
Thick, purulent, copious discharge
Usually unilateral
Swollen lids
Corneal Injection
How would you diagnose conjunctivitis?
Usually diagnosed clinically, but in cases that do not respond to empiric treatment consider culture and sensitivity of discharge
What herbs are used for conjunctivitis?
Euphrasia officinalis
Ruta graveolens
Foeniculum vulgare
Hydrastis canadensis
Verbascum Thapsus
What homeopathic remedied are indicated fro conjunctivitis in a patient with acrid, burning, tears and bland nasal discharge?
Euphrasia
What are the causes of retinal detachment?
Trauma or blow to the head or ey
Post cataract surgery
Severe myopia
What are the classic symptoms of retinal detachment?
1) Painless, dark or irregular floaters, flashes of light, blurred vision
2) Curtain or veil in field of vision
3) Loss of visual fields
What is the difference between vitreous and retinal detachment?
Vitreous detachment rarely threaten vision
What are vitreous detachments commonly called?
Floaters
What are the common signs and symptoms of keratitis?
Eye redness
Eye pain
Excessive tearing or discharge
Blurred or decreased vision
Photophobia
Condition in which the eye’s cornea, the clear dome on the front surface of the eye, becomes inflamed
What are some causes of keratitis?
Corneal Injury, contaminated contact, lenses (gram-negative bacteria), Herpes virus, contaminated water
Viral, Bacterial, funga, Amoebic, Parasitic, Enviromental
What are common signs and symptoms of optic neuritis?
Inflammation of the optic nerve; occurs in individuals younger than 50 years old
Eye pain worsened by eye movement
Loss of Color vision
Flashing lights
Vision loss may be permanent
What conditions predispose to optic neuritis?
Multiple sclerosis ( most common), SLE, Sarcoidosis, Lyme Disease
What are the risk factors for developing orbital cellulitis?
Orbital cellulitis is an infection of the soft tissues of the orbit posterior to the orbital septum
History of sinusitis, trauma or dental infections
What are the symptoms of orbital cellulitis?
Sever eye and orbital pain with orbital erythema
Lid swelling and exopthalmos
Decreased vision
Pain on eye movements
Fever, malaise, headache
How would you approach a diagnosis orbital cellulitis?
Send to ER
CT with contrast, culture of any purulent material present
What is a pterygium?
A non-cancerous growth of the conjunctiva; Rapidly growing fibrovascular lesion that can distort the cornea causing a decrease in vision, possibly astigmatism (Triangular shaped of epithelia tissue into cornea)
What are the hallmark symptoms of diabetic retinopathy?
Initially asymptomatic, then develops floaters, visual distortion and/or blurred vision in the setting of elevated blood glucose
What do you see on PE in a patient with diabetic retinopathy?
Flame hemorrhages, hard exudates, cotton wool spots (soft exudates)
What are the two types of diabetic retinopathy and which has a worse diagnosis?
Non-proliferative and proliferative. Proliferative with neovascularization has a worse prognosis.
What herb is indicated for diabetic retinopathy?
Vaccinium Myrtillus
What are the major signs and symptoms of hypertensive retinopathy?
1) Asymptomatic until late in the disease
2) Double, diminished or blurred vision
3) Headaches
4) Halos around objects or floaters
What might you see on PE in a patient with hypertensive retinopathy?
Cotton wool spots ( soft exudates), hard exudates, flame hemorrhages, AV nicking
Which systemic autoimmune diseases can have uveitis as a symptom?
Ankylosing spondylitis
Sexually-acquired reactive arthritis
Juvenile RA
Psoriatic arthritis
IBD
What infections can cause uveitis?
TB
Toxoplasmosis
CMV
HSV
What are the symptoms of anterior uveitis?
1) Usually unilateral with ocular or periocular pain
2) Miosis with poor pupillary response and decreased visual acuity
3) Photophobia
4) Ciliary and conjunctival injection
5) Excessive tearing
Whats in the DDx for uveitis?
1) Conjunctivitis
2) Episcleritis
3) Acute angle closure glaucoma
What are the 2 types of vertigo?
Central: Secondary to brainstem or cerebellar ishemia, patients are generally non ambulatory
Peripheral: patient are generally ambulatory: Meniere’s Disease, Benign Paroxysmal Positional Vertigo, Acute vestibular neuronitis
Whats in the DDx for vertigo?
Meinere’s disease
Benign Paroxysmal positional vertigo
Ototoxicity
Vestibular neuronitis
Labyrinithitis
Acoustic neuroma
Ostosclerosis
What are the usual presenting symptoms of cholesteatoma?
Conductive hearing loss
Otorrhea
An abnormal collection of skin cells deep inside your ear
What is the etiology of cholesteatoma?
Congenital or acquired (chronic otitis media)
What are the common signs and symptoms of Meniere’s disease?
Recurring, spontaneous episodic vertigo, hearing loss, aural fullness, and tinnitus lasting minutes to hours
1) Fluctuating, sensorineural hearing loss
2) Episodic vertigo- severe, may be accompanied by nausea and/or vomiting
3) Tinnitus
4) Aural Fullness
5) Nystagmus- horizontal or rotary usually away from involved ear
What conditions are associated with Meniere’s syndrome?
1) Meniere’s syndrome is when it is secondary to another disease process
2) Syphilis
3) Autoimmune thyroid disease
4) Autoimmune disease: SLE, RA
5) Food triggers and allergies
What are some lifestyle recommendations that would benefit a patient with Meniere’s Disease?
Avoid trigger substances: Chocolate, salt and caffeine, smoking cessation
What are some of the diagnostic test used to diagnose Meniere’s disease?
Serial audiography
MRI
Electronystagmography
What homeopathic remedy is indicated for Meniere’s disease if the person is very chilly and ameliorated by wrapping the head up warmly?
Silica
What is Otosclerosis?
Abnormal bone growth inside the ear. Fairly common cause of hearing loss in young adults
Who is likely to be affected with Otosclerosis?
Progressive conductive hearing loss that is first noticed during teenage years and early 20s
Adults > 30 years
More common in women
Family Hx: Autosomal Dominant Disorder
What are the findings in otosclerosis?
Progressive conductive hearing loss with normal TM, tinnitus, vertigo
What’s in the DDx for otosclerosis?
Cholesteatoma
Migraine
Labyrinthitis
Presbycusis
What the common signs and symptoms of benign paroxysmal positional vertigo BPPV?
1) Episodic vertigo induced flexing, extending or rotating head
2) Nausea and/or vomiting
3) Nystagmus during and provoking maneuver
4) Not accompanied by tinnitus or hearing loss
What test is used to diagnose BPPV?
Dix- Hallpike Maneuver
What predisposes one to getting labyrinthitis?
Previous viral infection or meningitis
What are the symptoms of labyrinthitis?
Severe vertigo, nystagmus, total hearing loss, tinnitus
How is labyrinthitis diagnosed?
Clinically
What is vestibular neuronitis?
Abrupt attack of severe vertigo that is persistent and then paroxysmal
Acute, sustained dysfunction of the peripheral vestibular system causing nausea, vomiting, and vertigo/imbalance without hearing loss
What causes vestibular neuronitis?
Usually a viral infection; common cold
How long does an attack last? What are the symptoms?
1) 1st attack is usually the most severe-severe vestibular symptoms last 2-3 days, with milder symptoms lasting 7-10 days with persistent nystagmus
What are the signs and symptoms of allergic rhinitis?
Lacrimation
Rhinorrhea
Conjunctival Injection
Itching of mouth, nose, eyes, posterior pharynx
Sneezing, HA, swollen blue-red nasla mucosa
What herbs are used for allergic rhinitis?
Euphrasia officinalis
Sambucus nigra
Urtica dioica
What category of drugs indicated in allergic rhinitis?
Antihistamines
What are the most common causes of allergic rhinitis by season?
Spring: Tree pollen
Summer: grass and weed pollen
Fall : Weed pollens
Year round: Fungal spores, animal dander, dust, mold
What are the etiologies of nasal polyps?
Chronic allergic rhinitis
Chronic sinusitis
Nasal polyp seen in a child under age 10 is pathognomonic for what disease?
Cystic Fibrosis
What are the signs and symptoms of nasal polyps?
Nasal obstruction, reduced smell, postnasal drainage, snoring, rhinorrhea
What is the etiology of sinusitis?
Viral, bacterial, fungal, or allergic
What are the general symptoms of sinusitis?
1) Nasal congestion, reduce smell, postnasal drainage, snoring, rhinorrhea
2) Tenderness over the sinuses especially with percussion
3) Purulent yellow-green nasal discharge
What are the symptoms of maxillary sinusitis?
Toothache, maxillary pain, frontal HA
What are the symptoms of frontal sinusitis?
Frontal HA, eyelid pain
What are the symptoms of ethmoid sinusitis?
Splitting HA on one side, pain medical eye felt deep in heda
What are the symptoms of sphenoid sinusitis?
Diffuse face pain with pain behind eye, in vertex, deep pain, no local tenderness
What are the possible complications of sinusitis?
Orbital or periorbital cellulits
Cavernous sinus thrombosis
How is sinusitis diagnosed?
Clinical, if unresponsive to treatment then consider CT, x-ray, culture of discharge
What herbs are indicated for sinusitis?
Ephedra sinica
Euphrasia officinalis
Matricaria recutita
Sambucus nigra
What is the antibiotic of choice for bacterial sinusitis?
Amoxicillin
What physical therapy treatment is indicated in sinusitis?
Diathermy
What homeopathic remedy is indicated for sinusitis when the patient has pain and obstruction at the root of the nose?
Kali Bichromicum
What are some possible causes of white patches on the tongue?
Candidiasis, Leukoplakia, Lichen Planus
What disease are associated with hairy leukoplakia?
EBV, AIDS, HIV
What are they symptoms of hairy leukoplakia?
Swollen tongue with fixed white plagues on edges of tongue that may have hairy appearance
Whats in the DDX for hairy leukoplakia?
Candida, Squamous cell carcinoma, HIV
What causes oral leukoplakia?
Oral squamous cell carcinoma, tobacco smoking or chewing, alcohol use, candidiasis
What does ulceration with leukoplakia often mean?
Progression to squamous cell carcinoma
Who is the most at risk for oral candidiasis or thrush?
AIDs patients, immunocompromised, infants, post-antibiotic use
What does thrush look like?
White patches on an erythematous base especially on tongue that bleed when they are scraped off
What test can you order to evaluate oral candidiasis or thrush?
KOH prep of scraping showing budding yeast or hyphae
Toxicity of what vitamin may worsen candidiasis?
Biotin
What drugs are indicated in candidiasis?
Ketoconazole, Nystatin, Fluconazole
What are some of the side effects of Nystatin?
Nausea
GI Irritation
What are the signs and symptoms of gingivitis?
Gingival inflammation
Gingival bleeding from slight trauma
Halitosis
What are the causes of glossitis?
Food irritation
Allergic reaction
Poorly made denatures
Prenicious or iron deficiency anemia
B3, B12 deficiency
Oral candidiasis
What are the symptoms of glossitis?
Painful, enlarged tongue that may be scalloped or ulcerated
What causes a pale, smooth, enlarged tongue?
Iron deficiency, pernicious anemia
What is in the DDx for acute sore throat?
Tonsillitis
Strep throat
Viral Pharyngitis
Mononucleosis
Peritonsillar abscess
Diphtheria
What are the symptoms of laryngitis?
Hoarseness, aphonia, unusual tone in voice, raw or tickling feeling in throat, constant need to clear throat, dyspnea
What’s the DDx for laryngitis?
Croup
Strep Pharyngitis
Vocal nodules or polyps
Hypothyroidism
Diphtheria
GERD
What is an acute infection between the tonsils and superior pharyngeal constrictor muscle?
Peritonsillar abscess or quinsy
What is the cause of peritonsillar abscess or quinsy?
Usually due to Group A Beta- hemolytic strep
What are the signs and symptoms of peritonsillar abscess?
Unilateral, sever throat pain
Severe pain on swallowing, fever, very sick looking
Tonsil is displaced medially and uvula is pushed to the opposite side
Hot potato voice, drooling
When would you suspect a malignancy with pharyngitis?
Chronic hoarseness, weight loss and dysphagia
What are the 2 types of pharyngitis?
Viral and bacterial
What is the bacterial pharyngitis picture?
Purulent exudate on tonsils, inflammation and erythema of pharyngeal mucosa, cervical LAO
What do you do if a rapid strep test done in office is and negative and you still strongly suspect strep pharyngitis?
Run a strep culture
What are common symptoms of parotiditis?
Fever, facial pain and swelling, foul taste in mouth
A young child or infant has pain or swallowing, a fever, respiratory stridor, cervical LAO, dyspnea and neck stiffness. What is a possible diagnosis?
Retropharyngeal abscess, epiglottitis
What is a complication of retropharyngeal abscess?
Sepsis, mediastinal infection, pericarditis
What is sialolithiasis?
1) Blockage of salivary duct by salivary stone
2) Pain and swelling of affected duct
3) Worse when salivary flow is stimulated “mealtime syndrome)
What are the causes of aphthous uclers?
Psychological or physical stress
Vitamin and mineral deficiencies: Iron, folic acid, B6, B12
Crohn’s Disease
Immune Dysregulation
What are the signs and symptoms of aphthous uclers?
Painful shallow ulcers on non-keratinized oral mucosa in groups or alone
What’s in the DDx for aphthous ulcers?
Herpetic ulcers
Hand, Foot, and Mouth Disease
Pemphigus
Herpangina
Oral Cancer (if it doesn’t resolve within 3 weeks)
What are some causes of acute tonsillitis?
Strep, EBV, RSV, adenovirus, influenza or diphtheria
What are the signs and symptoms of tonsillitis?
Hyperemic tonsils with exudate, does not bleed when removed
Throat pain on swallowing, pain mau be referred to ears
Systemic: Fever, malaise, HA, vomiting
Cervical LAO
How is tonsillitis diagnosed?
Clinically, culture
What could be complications of tonsillitis?
Rheumatic fever, peritonsillar abscess, poststreptococcal glomerulponephritis
What herbs are indicated for tonsillitis?
Althea officinalis
Eucalyptus globulus
Baptisia tinctora
Berberis aquefolium
Echinancea ssp.
Galium aparine
