Diseases of the oral cavity Flashcards
What is the general progression of the exudate seen with pharyngitis?
Serous to mucous to dryness
What causes the hyperemia with pharyngitis?
Pharyngeal wall blood vessels become dilated
What happens to the follicles in pharyngitis?
Small, white, yellow, or gray plugs form in the follicles of lymphoid tissue
What are the major JONEs criteria for rheumatic fever?
- Polyarteritis (joints)
- Carditis (heart)
- Nodules
- Erythema marginatum
- Sydenham’s chorea
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.
What are the four major gram positive rods?
- Clostridium
- Listeria
- Bacillus
- Mycobacterium
What are the alpha hemolytic streps, and how do you differentiate?
Pneumoniae = optochin sensitive and bile soluble
Viridans = optochin resistant and bile insoluble
Gram + cocci that is catalase negative, alpha hemolytic, optochin sensitive, and bile soluble = ?
Strep pneumo
Gram + cocci that is catalase negative, alpha hemolytic, optochin resistant, and bile insoluble = ?
Strep viridans
Gram + cocci that is catalase negative, beta hemolytic, and bacitracin sensitive = ?
Strep pyogenes
Gram + cocci that is catalase negative, beta hemolytic, and bacitracin resistant = ?
GBS (agalactiae)
Gram + cocci that is catalase negative, gamma hemolytic, and grows in bile AND 6.5% NaCl = ?
Enterococcus
Gram + cocci that is catalase negative, gamma hemolytic, and grows in bile but NOT in 6.5% NaCl = ?
Strep bovis
What are the beta hemolytic streps, and how do you differentiate them?
S. pyogenes = bacitracin sensitive
GBS = bacitracin resistant
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
How do you differentiate between staph epidermidis and saprophyticus?
Novobiocin sensitive = epidermidis
Novobiocin resistant = Saprophyticus
Gram + cocci that is catalase positive, coagulase negative, and novobiocin sensitive = ?
S. epidermidis
Gram + cocci that is catalase positive, coagulase negative, and novobiocin resistant = ?
S. Saprohpyticus
What are the four most common diseases caused by strep pneumo?
Meningitis
OM
Pneumonia
Sinusitis
Which strep bacteria predisposes to colon cancer?
Strep bovis
“bovis in the blood = cancer in the colon”
What are the encapsulated bacteria?
“SHiNE SKiS”
- strep pneumo
- HiB
- Neisseria Meningitidis
- E. coli
- Salmonella
- Klebsiella
- GBS
What are the catalase positive organisms?
PLACESS for your cats
- Pseudomonas
- Listeria
- Aspergillus
- Candida
- E.Coli
- S. Aureus
- Serratia
What causes the fetid breath with pharyngitis?
Crypts fill with bacterial debris
What are the obligate aerobes?
Nagging pests must breathe
- Nocardia
- Pseudomonas
- Mycobacterium TB
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
