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PANCE 2.0 > EENT #8 (Nose/Sinus) > Flashcards

EENT #8 (Nose/Sinus) Flashcards

1
Q

Strep Pharyngitis (Strep Throat) has the highest incidence of ______ if untreated in children 5-15 years of age

A

Rheumatic fever

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2
Q

Cause of Strep Pharyngitis

A

Group A Strep (Strep Pyogenes)

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3
Q

Symptoms of Strep Pharyngitis

A
  • Dysphagia (pain with swallowing)
  • Fever
  • No symptoms of viral infections: cough, hoarseness, coryza, diarrhea
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4
Q

What is usually seen on exam of a patient with Strep Pharyngitis?

A
  • Fever
  • Absent Cough
  • Anterior Cervical LAD
  • Tonsillar Exudate/Petechiae

CENTOR CRITERIA

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5
Q

Best initial test for strep pharyngitis

A

-Rapid antigen detection test (if negative, throat cultures should be obtained especially in children 5-15 years old)

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6
Q

Definitive diagnostic for Strep Pharyngitis

A

Throat culture

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7
Q

First-line treatment for Strep Pharyngitis

A

-Penicillin (Pen G or VK, Amoxicillin)

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8
Q

If the patient has a penicillin allergy, what medications should be given for Strep Pharyngitis?

A

Macrolides (Erythromycin, Azithromycin)
Clindamycin
Cephalosporins

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9
Q

What are some complications of Strep Pharyngitis?

A

Rheumatic Fever
Acute glomerulonephritis
Peritonsillar Abscess

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10
Q

MC etiology of laryngitis

A

Viral upper respiratory tract infection: Adenovirus, Rhinovirus, Influenza, RSV, Parainfluenza

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11
Q

What are other causes of laryngitis?

A

Vocal strain
Irritants (GERD, acid)
Polyps
Laryngeal cancer

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12
Q

Symptoms of laryngitis

A
  • Hoarseness (hallmark)
  • Aphonia (inability to speak)
  • Dry or scratchy throat
  • May have viral URI symptoms
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13
Q

Treatment for laryngitis

A

-Supportive care mainstay: hydration, humidification, vocal rest, warm saline gargles, lozenges

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14
Q

A peritonsillar abscess (Quinsy) is a complication of tonsillitis or pharyngitis. This condition is often polymicrobial, but often the predominant species is

A

Group A Strep (Strep Pyogenes)

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15
Q

Symptoms of a peritonsillar abscess

A
  • Dysphagia
  • Severe unilateral pharyngitis
  • High fever
  • Muffled “hot potato voice”
  • Difficulty handling oral secretions (drooling)
  • Trismus (lockjaw)
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16
Q

What is on physical exam in a peritonsillar abscess?

A

Swollen or fluctuant tonsil causing uvula deviation to contralateral side
Bulging of soft palate
Anterior Cervical LAD

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17
Q

What is the imaging study of choice for peritonsillar abscess

A

CT scan

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18
Q

Management for peritonsillar abscess

A
  • Drainage (aspiration or I&D) + ABX
  • -Oral (Clindamycin or Amoxicillin-Clavulanic Acid)
  • -Parenteral (Ampicillin-Sulbactam, Clindamycin)
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19
Q

When should a tonsillectomy be considered for a peritonsillar abscess?

A

Patients who fail to respond to drainage
Abscess with complications
Prior episodes of abscess
Recurrent severe pharyngitis

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20
Q

How can you prevent Peritonsillar Abscess

A

Prompt Treatment of Streptococcal infections

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21
Q

A retropharyngeal abscess, although common in children ages 2-4, can occur in adults as a result of

A

Penetrating trauma (chicken bones, instrumentation, dental procedures)

22
Q

Etiologies of Retropharyngeal Abscess

A

-Often polymicrobial (Group A Strep is MC)

23
Q

Symptoms of Retropharyngeal abscess

A
  • Torticollis (unwilling to move neck due to pain)
  • Neck stiffness with extension
  • Fever, drooling, dysphagia, chest pain, trismus, hot potato voice
  • Midline or unilateral posterior pharyngeal wall edema (MC)
  • Anterior cervical LAD
  • Lateral neck mass and swelling
24
Q

If suspicion is high, what is the preferred imaging method for retropharyngeal abscess

A

CT scan of neck with contrast

25
However, if a lateral neck radiograph is performed, what is seen with a retropharyngeal abscess?
increased prevertbral space > 50% of width of adjacent vertebral body
26
Treatment for retropharyngeal abscess
- Surgical incision and drainage for large abscesses - If abscess < 2.5 cm, may be observed for 24-48 hours with ABX - ABX: IV Ampicillin-Sulbactam or Clindamycin
27
Oral Lichen Planus has increased incidence with
Hepatitis C infection
28
Symptoms of oral lichen planus
- Reticular: lacy reticular leukoplakia of oral mucosa (Wickham striae). Painless - Erythematous: red patches that may be painful - Erosive: erosions or ulcers. Painful.
29
What is the MC type of oral lichen planus?
Reticular
30
Although oral lichen planus is often a clinical diagnosis, what should be done in the erythematous and erosive types to rule out malignancy?
Biopsy
31
Initial treatment of choice for oral lichen planus
Local glucocorticoids (Clobetasol, Betamethasone)
32
However, second line treatment for oral lichen planus is
Topical (Tacrolimus, Cyclosporine), intralesional corticosteroid injections -Systemic glucocorticoids if no response to topical therapy
33
What is Ludwig's Angina?
Rapidly spreading cellulitis of the floor of the mouth
34
Risk factors for Ludwig's Angina?
- MC due to dental infections (second or third mandibular molars) - Diabetes - HIV
35
Symptoms of Ludwig's Angina
- Fever, chills, malaise, stridor - Tender, symmetric swelling - Woody induration and erythema of upper neck and chin - Pus on floor of mouth - Swelling of the tongue can lead to airway compromise
36
Initial diagnostic for Ludwig's Angina
-CT scan
37
Management of Ludwig's Angina (normal person)
- IV ABX: Ampicillin-Sulbactam OR Ceftriaxone + Metronidazole OR Clindamycin + Levofloxacin - Add Vancomycin if MRSA is suspected
38
However, if the patient is immunocompromised and has Ludwig's Angina, what is the treatment?
-IV ABX: Cefepime + Metronidazole OR Imipinem OR Meropenem OR Piperacillin-Tazobactam -Add Vancomycin if MRSA suspected
39
Risk factors for oropharyngeal candidiasis
- Immunocompromised states (HIV, chemotherapy, diabetes) - Use of inhaled corticosteroids without a spacer - Antibiotic use - Xerostomia (salivary glands don't make enough saliva to keep mouth wet) - Denture use
40
Symptoms and Exam findings of oral candidiasis (thrush)
- Loss of taste or cotton in mouth - Throat or mouth pain with eating and swallowing - White curd-like plaques on buccal mucosa that are easily scraped off (may leave behind erythema and friable mucosa if scraped)
41
What is the diagnostic that is done for oral thrush?
-Potassium Hydroxide: budding yeast and pseudohyphae (smear performed on scrapings)
42
Management of Thrush
-Topical (first line): Nystatin liquid swish and swallow, Clotrimazole troches or Miconazole buccal tablets
43
______ is usually reserved for refractory cases of Thrush
Oral Fluconazole
44
Aphthous Ulcers (Ulcerative Stomatitis) are recurrently seen in patients with what conditions?
``` IBD HIV Celiac disease SLE Methotrexate use Neutropenia ```
45
Symptoms of an aphthous ulcer
-Small, painful, shallow round or oval shallow ulcer (yellow, white or grey central exudate) with erythematous halo
46
Treatment for aphthous ulcer
- First line: Topical oral glucocorticoids: Clobetasol, Dexamethasone, Triamcinolone - Topical analgesics: 2% viscous lidocaine, aluminum hydroxide + magnesium hydroxide +simethicone
47
What is oral leukoplakia characterized by?
Painless white patchy lesions that cannot be scraped off
48
What diagnostic should be done for oral leukoplakia?
Biopsy to rule out squamous cell carcinoma
49
Risk factors for oral leukoplakia
- Chronic irritation due to tobacco - Alcohol - Dentures - HPV infections
50
How do you manage oral leukoplakia?
Avoidance of irritants | -Cryotherapy, laser ablation, surgical excision if malignant

PANCE 2.0 (62 decks)

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