Diseases of the oral cavity Flashcards by tcarlso 3

What is the general progression of the exudate seen with pharyngitis?

Serous to mucous to dryness

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What causes the hyperemia with pharyngitis?

Pharyngeal wall blood vessels become dilated

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What happens to the follicles in pharyngitis?

Small, white, yellow, or gray plugs form in the follicles of lymphoid tissue

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What are the major JONEs criteria for rheumatic fever?

Polyarteritis (joints)
Carditis (heart)
Nodules
Erythema marginatum
Sydenham’s chorea

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What is erythema marginatum seen with rheumatic fever? How does it spread? What classically makes it worse?

A long-lasting reddish rash that begins on the trunk or arms as macules, which spread outward and clear in the middle to form rings, which continue to spread and coalesce with other rings, ultimately taking on a snake-like appearance. This rash typically spares the face and is made worse with heat.

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What are the four major gram positive rods?

Clostridium
Listeria
Bacillus
Mycobacterium

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What are the alpha hemolytic streps, and how do you differentiate?

Pneumoniae = optochin sensitive and bile soluble

Viridans = optochin resistant and bile insoluble

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Gram + cocci that is catalase negative, alpha hemolytic, optochin sensitive, and bile soluble = ?

Strep pneumo

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Gram + cocci that is catalase negative, alpha hemolytic, optochin resistant, and bile insoluble = ?

Strep viridans

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Gram + cocci that is catalase negative, beta hemolytic, and bacitracin sensitive = ?

Strep pyogenes

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Gram + cocci that is catalase negative, beta hemolytic, and bacitracin resistant = ?

GBS (agalactiae)

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Gram + cocci that is catalase negative, gamma hemolytic, and grows in bile AND 6.5% NaCl = ?

Enterococcus

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Gram + cocci that is catalase negative, gamma hemolytic, and grows in bile but NOT in 6.5% NaCl = ?

Strep bovis

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What are the beta hemolytic streps, and how do you differentiate them?

S. pyogenes = bacitracin sensitive

GBS = bacitracin resistant

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What are the gamma hemolytic streps, and how do you differentiate them?

Enterococcus = grows in bile, and NaCl

Non Enterococcus = grows in bile, NOT NaCl

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How do you differentiate between staph epidermidis and saprophyticus?

Novobiocin sensitive = epidermidis

Novobiocin resistant = Saprophyticus

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Gram + cocci that is catalase positive, coagulase negative, and novobiocin sensitive = ?

S. epidermidis

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Gram + cocci that is catalase positive, coagulase negative, and novobiocin resistant = ?

S. Saprohpyticus

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What are the four most common diseases caused by strep pneumo?

Meningitis
OM
Pneumonia
Sinusitis

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Which strep bacteria predisposes to colon cancer?

Strep bovis

“bovis in the blood = cancer in the colon”

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What are the encapsulated bacteria?

“SHiNE SKiS”

strep pneumo
HiB
Neisseria Meningitidis
E. coli
Salmonella
Klebsiella
GBS

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What are the catalase positive organisms?

PLACESS for your cats

Pseudomonas
Listeria
Aspergillus
Candida
E.Coli
S. Aureus
Serratia

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What causes the fetid breath with pharyngitis?

Crypts fill with bacterial debris

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What are the obligate aerobes?

Nagging pests must breathe

Nocardia
Pseudomonas
Mycobacterium TB

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What are the obligate anaerobes?

Can't breathe Air Clostridium Bacteroides Actinomyces

What are the two obligate intracellular organisms?

Rickettsia Chlamydia "stay inside when it's Really Cold"

What are the facultative intracellular organisms?

Some Nasty bugs may live facultativeLY - Salmonella - Neisseria - Brucella - mycobacterium - Listeria - Francisella - Legionella - Yersinia pestis

What are the organisms that stain positive with a giemsa stain?

Certain Bugs Really Try my Patience - Chlamydia - borrelia - Rickettsiae - Trypanosomes - Plasmodium

What is trench mouth?

Acute necrotizing ulcerative gingivitis (ANUG; colloquially known as trench mouth) is a common, non-contagious infection of the gums with sudden onset. The main features are painful, bleeding gums, and ulceration of inter-dental papillae

What is the abx of choice for pharyngitis? Duration of treatment?

PCN--5-10 days

What is the most common infectious agent that causes adenotonsillitis?

GAS Staph aureus Hi

True or false: the tonsil weight is directly proportional to the bacterial load with tonsillitis

True

What are the classical findings of EBV?

- Marked LAD and splenomegaly - Macular rash that increases with PCN administration - Exanthem of the palate

What is the treatment for severe obstructive symptoms with EBV?

Prednisone

What is the virus that can cause Guillain barre syndrome?

EBV

What is a major sequelae of untreated tonsillitis?

Infections of the tonsils proceed to diffuse cellulitis that could lead to a peritonsillar abscess

What are the s/sx of peritonsillar abscesses? (4)

- Marked dysphagia / trismus - Otalgia unilaterally - Increased salivation - Uvula deviation

Where does the suppurative infiltration most commonly occur with tonsillitis?

Supratonsillar fossa

What is the role of throat cultures with tonsillitis?

Not effective--need culture of the abscess

What bacteria usually causes peritonsillar abscesses?

Strep pyogenes

What is the treatment for a peritonsillar abscess?

I and D | Abx and warm saline irrigation

Where are retropharyngeal abscess located?

Buccopharyngeal fascia, running along the entire length of the neck

What is the anterior border of the retropharyngeal space?

Pharynx and esophagus

What is the posterior border of the retropharyngeal space?

Alar layer of deep fascia

What is the superior border of the retropharyngeal space?

Skull base

What is the inferior border of the retropharyngeal space?

Superior mediastinum

What are the general s/sx of retropharyngeal abscesses?

- Odynophagia/ dysphagia | - Fever

What are the breathing s/sx of retropharyngeal abscesses?(2)

Stridor | Noisy breathing

What are the neck findings of retropharyngeal abscesses? (3)

- Cervical LAD - torticollis - nuchal rigidity

What is the treatment for retropharyngeal abscesses? (3)

- Airway management - I and D - IV abx and steroids

Peritonsillar or retropharyngeal abscess symptom: trismus

Peritonsillar

Peritonsillar or retropharyngeal abscess symptom: torticullis

Retropharyngeal

Peritonsillar or retropharyngeal abscess symptom: common voice changes

Peritonsillar

Peritonsillar or retropharyngeal abscess symptom: fever

Both

Peritonsillar or retropharyngeal abscess symptom: LAD

Both

Peritonsillar or retropharyngeal abscess symptom: ear/throat/neck pain

Peritonsillar

Peritonsillar or retropharyngeal abscess symptom: nuchal rigidity

Retropharyngeal

Peritonsillar or retropharyngeal abscess symptom: airway s/sx?

Retropharyngeal

Peritonsillar or retropharyngeal abscess symptom: unilateral s/sx

Peritonsillar

What is the frequency criteria for a tonsillectomy?

3 or more episodes in a year

What are the indications for a tonsillectomy, beside the frequency?

- Hypertrophy causing obstruction - Halitosis - Peritonsillar abscess unresponsive to nonsurgical management

What two diseases predispose patient to alar ligament laxity?

Down syndrome and RA

Under what age should overnight observation be done post tonsillectomy?

Less than 3 years

What are the indications for overnight observation post tonsillectomy?

- Poor oral intake / emesis - Surgery for OSA or PTA - Poor f/u

If home is greater than how far away is an indication for overnight observation post tonsillectomy?

45 minutes

What is the issue with not hydrating enough post tonsillectomy?

Dry oral mucosa = cracking and bleeding

What is the most common post tonsillectomy complication?

Bleeding

What is velopharyngeal insufficiency? how does this relate to tonsillectomy?

Disorder resulting in the improper closing of the velopharyngeal sphincter (soft palate muscle in the mouth) during speech, allowing air to escape through the nose instead of the mouth. Complication of tonsillectomy

What are the nasopharyngeal complications 2/2 tonsillectomy?

- Stenosis d/t overuse of caudry | - Eustachian tube dysfunction

What are the indications for adenoidectomy?

- OSA - Dysphagia - Speech issues - Severe orofacial abnormalities

What is the frequency criteria for an adenoidectomy 2/2 infection?

3 or more episodes / year, OR recurrent OME

What is the classic triad of symptoms with adenoid disease?

- Hyponasality - Snoring - Mouth breathing

What happen to the face with adenoid disease?

Overbite Long face Crowded incisors

What is the concern with a bifid uvula?

- Submucous cleft | - Diastasis of muscles of the soft palate

What is the only indication for lateral plain films in the evaluation of adenoids?

If the PE and history are not in agreement

What is geographic tongue?

Idiopathic, benign overgrowth of the mucosa of the tongue

What is hairy tongue?

Elongation of the fusiform papillae of the tongue, 2/2 poor oral hygiene

What are tonsilliths? Treatment?

Debris accumulating in the mucosa crypts H2O2 rinse

What are the external mouth findings c/w candidiasis?

Angular cheilitis

What are mucous retention cysts of the oral mucosa?

Usually asymptomatic cyst caused by an obstruction of a duct, usually belonging to the parotid gland or a minor salivary gland

What are mucoceles of the lip?

Clinical term that refers to two related phenomena: - Mucus extravasation phenomenon - Mucus retention cyst The former is a swelling of connective tissue consisting of a collection of fluid called mucin. This occurs because of a ruptured salivary gland duct usually caused by local trauma, in the case of mucus extravasation phenomenon, and an obstructed or ruptured salivary duct (parotid duct) in the case of a mucus retention cyst. The mucocele has a bluish translucent color, and is more commonly found in children and young adults.

Angioedema is caused by a deficiency of what?

C1 esterase inhibitor

What is torus palatinus?

Benign, bony protrusion of the palate

What is torus mandibularis?

Benign, bony growth in the mandible along the surface nearest to the tongue