EENT #4 (Throat) Flashcards
Oral Hairy Leukoplakia
-What virus causes it?
-Risk Factors (there’s a big one)
-Symptoms
-Management
-Mucocutaneous manifestation of the Epstein-Barr virus (Human herpesvirus 4)
-RF: Almost exclusively in HIV infection, immunocompromised states
-Painless, white smooth or corrugated “hairy” plaque along the lateral tongue borders that cannot be scraped off.
-No specific treatment required
Oral Leukoplakia
-What is it?
-Risk Factors
-Symptoms
-Diagnostics (to rule out…)
-Management
-Oral potentially malignant disorder characterized by hyperkeratosis due to chronic irritation. Up to 6% are SCC.
-RF: Chronic irritation due to tobacco, smoking, alcohol, dentures, HPV infections.
-Most asymptomatic. Painless white patchy lesions that cannot be scraped off (unlike candida which CAN be scraped off).
-Diagnostics: Biopsy to rule out SCC
-Management
–Cessation of irritants, cryotherapy, laser ablation
Erythroplakia
-What is it?
-90% are either _____ or _______
-Risk Factors
-Symptoms
-Diagnostics (to rule out…)
-Management
-Uncommon oral lesion with high risk of malignancy
-90% either dysplastic or evident SCC
-RF: chronic irritation (like oral leukoplakia)
-Most asymptomatic. Painless, erythematous soft velvety patch in oral cavity MC on mouth floor.
-Biopsy to rule out SCC
-Complete excision if SCC
Laryngitis
-Etiologies
-Symptoms
-Diagnostics
-Treatment
-Viral URI MC (Adenovirus, Rhinovirus, RSV, etc.), Bacterial causes, viral strain, irritants (GERD, acid), laryngeal cancer.
-Hoarseness is hallmark. Aphonia, dry/scratchy throat, URI symptoms.
-Clinical diagnosis.
-Supportive care: hydration, humidification, vocal rest, warm saline gargles, reassurance.
Acute Pharyngitis/Tonsillitis
-Etiologies (MC Viral Vs MC Bacterial)
-Symptoms
-Diagnostics
-Management
-Etiologies: Viral MC overall, Bacterial (Group A Strep/Strep Pyogenes MC bacterial cause)
-Sore throat, pain with swallowing, viral symptoms
-Clinical. Rapid strep to rule out bacterial cause.
-Symptomatic mainstay of treatment
Streptococcal Pharyngitis (Strep Throat)
-Cause
-Symptoms
-Exam Findings
-Diagnostics (initial, definitive)
-Management
-Complications
-Group A Strep (Strep Pyogenes)
-Dysphagia, fever. No hoarseness, cough, conjunctivitis, diarrhea.
-Pharyngeal edema or exudate, anterior cervical LAD
-Rapid antigen detection test (initial). If negative, get throat culture especially in kids 5-15 years old.
-Throat culture = definitive diagnostic.
-Penicillin (first line) = PCN G or VK, Amoxicillin
-PCN Allergy: Macrolides (Azithromycin, etc.)
-Complications
–Rheumatic Fever
–Acute glomerulonephritis
–Peritonsillar Abscess
What is the CENTOR Criteria regarding Strep Throat? (FAAT)
-Fever
-Absence of Cough
-Anterior Cervical LAD
-Tonsillar Exudates
Peritonsillar Abscess (Quinsy)
-What is it?
-Etiologies
-Symptoms
-Exam Findings
-Diagnostics
-Management
-Abscess between palatine tonsil and pharyngeal muscles from complication of tonsillitis or pharyngitis. MC in kids and young adults.
-Often polymicrobial. GAS is the main cause though.
-Dysphagia, severe unilateral pharyngitis, fever, muffled hot potato voice, difficulty handling oral secretions, drooling, trismus (lockjaw).
-Exam: swollen or fluctuant tonsil causing uvula deviation to the contralateral side**, anterior cervical LAD
-Clinical most times. CT scan if needed to differentiate between cellulitis and abscess.
-Treatment
–Needle aspiration drainage or incision and drainage + oral Augmentin, Clindamycin.
–Tonsillectomy if no response to above treatment.
Retropharyngeal Abscess
-What is it?
-Etiology
-Symptoms
-Exam Findings
-Diagnostics
-Management
-Deep neck space infection. MC in kids 2-4 years (due to penetrating trauma from chicken bones, dental procedures, etc.)
-Polymicrobial, but GAS is the predominant cause.
-Torticollis of the neck, neck stiffness with extension, fever, drooling, dysphagia, chest pain, hot potato voice, trismus.
-Exam: Midline or unilateral posterior pharyngeal wall edema (MC), anterior cervical LAD, lateral neck swelling or mass.
-Diagnostics
–Lateral neck radiographs: increased prevertebral space > 50% of width of adjacent vertebral body
–CT scan of neck with contrast: if suspicion high
-Treatment
–Surgical I&D with IV Ampicillin-Sulbactam or Clindamycin (like Peritonsillar abscess)
Oral Lichen Planus
-Increased incidence with ….
-Symptoms
-Diagnostics
-Treatment
-Hepatitis C infection
-Reticular: lacy reticular leukoplakia in oral mucosa (Wickham Striae). Painless. MC type.
-Diagnostics: Clinical. Biopsy to rule out malignancy.
-Treatment
–Local glucocorticoids (Clobetasol, Betamethasone)
–Topical second line, intralesional steroid injections
–Systemic if no response to topicals.
Ludwig’s Angina
-What is it?
-Risk Factors
-Symptoms
-Exam Findings
-Diagnostics
-Management
-Rapidly spreading cellulitis of the floor of the mouth
-RF: spread due to dental infections. DM, HIV.
-Fever, chills, malaise, dysphagia, drooling, muffled voice. Stridor if severe.
-Exam: Tender, symmetric swelling, woody induration and erythema of the upper chin and neck. Pus on floor of the mouth. Swelling of the tongue = airway compromise if severe.
-CT scan initial test of choice.
-Treatment
–IV Ampicillin-Sulbactam OR Ceftriaxone + Metronidazole OR Clindamycin + Levofloxacin
–Add Vanco if MRSA suspected
Oropharyngeal Candidiasis (Thrush)
-What is it?
-Risk Factors
-Symptoms
-Exam Findings
-Diagnostics
-Treatment
-Candida Albicans is normally part of the flora, but becomes pathogenic due to systemic or local immunosuppressed states.
-RF: Immunocompromised states, use of inhaled corticosteroids without a spacer, ABX use, denture use.
-Asymptomatic. Loss of taste or cotton feel in mouth. Pain with eating or swallowing.
-Exam: White curd-like plaques that can be easily scraped off (may leave behind erythema and friable mucosa if scraped)
-Diagnostics
–Clinical
–Potassium Hydroxide: budding yeast and pseudohyphae.
-Treatment
–Topical (first line): Nystatin liquid swish and swallow, Clotrimazole troches or Miconazole buccal tablets.
–Oral Fluconazole if refractory
Aphthous Ulcers (Canker Sore, Ulcerative Stomatitis)
-Recurrent disease seen in patients with what other conditions?
-Symptoms
-Management
-IBD, HIV, Celiac Disease, SLE, Methotrexate use
-Small, painful, shallow round or oval ulcer (yellow, white or grey with central exudate) with erythematous halo. MC on buccal or labial mucosa.
-Topical oral glucocorticoids (Clobetasol gel or ointment, Dexamethasone swish and spit)
-Topical analgesics: 2% viscous lidocaine, aluminum hydroxide + magnesium hydroxide + simethicone.
Sialolithiasis (Salivary Gland Stones)
-What is it?
-MC in what ducts?
-RF
-Symptoms
-Management
-Stones with the salivary glands or ducts (no inflammation)
-MC in Wharton’s duct (submandibular gland duct) or Stensen’s duct (parotid gland duct)
-RF: Decreased salivation (dehydration, anticholinergic meds, diuretics)
-Sudden onset of salivary gland pain and swelling with eating or anticipation of eating.
-Treatment
–Sialogogues to increase salivary flow (tart hard candies, lemon drops, Xylitol gum), increase fluid intake, gland massage, moist heat.
–Laser lithotripsy if needed
–Sialoadenectomy if recurrent or refractory
Acute Bacterial Sialadenitis (Suppurative Sialadenitis)
-What is it?
-MC Etiology
-RF
-Symptoms
-Diagnostics
-Management
-Bacterial infection of parotid or submandibular salivary glands.
-S. Aureus is the MC etiology
-RF: Salivary gland obstruction from a stone, dehydration, chronic illness.
-Sudden onset of firm and tender gland swelling with purulent discharge, pus comes out if massaged. Dysphagia, trismus, fever, chills.
-CT scan to rule out abscess.
-Anti-Staph ABX + Sialogogues (Dicloxacillin or Nafcillin), Clindamycin.
