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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
Q

However, if a lateral neck radiograph is performed, what is seen with a retropharyngeal abscess?

A

increased prevertbral space > 50% of width of adjacent vertebral body

26
Q

Treatment for retropharyngeal abscess

A
  • 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
Q

Oral Lichen Planus has increased incidence with

A

Hepatitis C infection

28
Q

Symptoms of oral lichen planus

A
  • Reticular: lacy reticular leukoplakia of oral mucosa (Wickham striae). Painless
  • Erythematous: red patches that may be painful
  • Erosive: erosions or ulcers. Painful.
29
Q

What is the MC type of oral lichen planus?

A

Reticular

30
Q

Although oral lichen planus is often a clinical diagnosis, what should be done in the erythematous and erosive types to rule out malignancy?

A

Biopsy

31
Q

Initial treatment of choice for oral lichen planus

A

Local glucocorticoids (Clobetasol, Betamethasone)

32
Q

However, second line treatment for oral lichen planus is

A

Topical (Tacrolimus, Cyclosporine), intralesional corticosteroid injections
-Systemic glucocorticoids if no response to topical therapy

33
Q

What is Ludwig’s Angina?

A

Rapidly spreading cellulitis of the floor of the mouth

34
Q

Risk factors for Ludwig’s Angina?

A
  • MC due to dental infections (second or third mandibular molars)
  • Diabetes
  • HIV
35
Q

Symptoms of Ludwig’s Angina

A
  • 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
Q

Initial diagnostic for Ludwig’s Angina

A

-CT scan

37
Q

Management of Ludwig’s Angina (normal person)

A
  • IV ABX: Ampicillin-Sulbactam OR Ceftriaxone + Metronidazole OR Clindamycin + Levofloxacin
  • Add Vancomycin if MRSA is suspected
38
Q

However, if the patient is immunocompromised and has Ludwig’s Angina, what is the treatment?

A

-IV ABX: Cefepime + Metronidazole
OR Imipinem
OR Meropenem
OR Piperacillin-Tazobactam

-Add Vancomycin if MRSA suspected

39
Q

Risk factors for oropharyngeal candidiasis

A
  • 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
Q

Symptoms and Exam findings of oral candidiasis (thrush)

A
  • 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
Q

What is the diagnostic that is done for oral thrush?

A

-Potassium Hydroxide: budding yeast and pseudohyphae (smear performed on scrapings)

42
Q

Management of Thrush

A

-Topical (first line): Nystatin liquid swish and swallow, Clotrimazole troches or Miconazole buccal tablets

43
Q

______ is usually reserved for refractory cases of Thrush

A

Oral Fluconazole

44
Q

Aphthous Ulcers (Ulcerative Stomatitis) are recurrently seen in patients with what conditions?

A 
IBD
HIV
Celiac disease
SLE
Methotrexate use
Neutropenia
45
Q

Symptoms of an aphthous ulcer

A

-Small, painful, shallow round or oval shallow ulcer (yellow, white or grey central exudate) with erythematous halo

46
Q

Treatment for aphthous ulcer

A
  • First line: Topical oral glucocorticoids: Clobetasol, Dexamethasone, Triamcinolone
  • Topical analgesics: 2% viscous lidocaine, aluminum hydroxide + magnesium hydroxide +simethicone
47
Q

What is oral leukoplakia characterized by?

A

Painless white patchy lesions that cannot be scraped off

48
Q

What diagnostic should be done for oral leukoplakia?

A

Biopsy to rule out squamous cell carcinoma

49
Q

Risk factors for oral leukoplakia

A
  • Chronic irritation due to tobacco
  • Alcohol
  • Dentures
  • HPV infections
50
Q

How do you manage oral leukoplakia?

A

Avoidance of irritants

-Cryotherapy, laser ablation, surgical excision if malignant

PANCE 2.0 (62 decks)

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