EENT #9 (Nose/Sinus)

Question 1

Erythroplakia is an uncommon oral lesion with a high risk of malignant transformation. 90% is either dysplastic or shows evidence of

Answer 1

Squamous cell carcinoma

Question 2

Risk factors for erythroplakia

Answer 2

-Chronic irritation due to tobacco, smoking, age > 65

Question 3

Clinical manifestations of erythroplakia

Answer 3

Painless, erythematous soft velvety patch in the oral cavity on mouth floor, ventral aspect of tongue, and soft palate

Question 4

What diagnostic should be done on erythroplakia?

Answer 4

Biopsy to rule out SCC

Question 5

Management for erythroplakia

Answer 5

Complete excision depending on biopsy results

Question 6

Sialolithiasis (salivary gland stones) are MC in

Answer 6

Wharton’s duct (submandibular gland duct) and Stensen’s duct (parotid gland duct)

Question 7

Risk factors for salivary gland stones

Answer 7

-Decreased salivation (dehydration, anticholinergic medications, diuretics)

Question 8

Symptoms of sialolithiasis

Answer 8

• Sudden onset of salivary gland pain and swelling with eating or in anticipation of eating
• Stone may be palpated in salivary gland

Question 9

Management of sialolithiasis

Answer 9

• First line therapy: sialagogues (tart hard candies, lemon drops, Xylitol gum)
• Increase fluid intake
• Gland massage
• Moist heat to affected area
• Laser lithotripsy or surgery for refractory cases

Question 10

What is acute bacterial sialadenitis (suppurative sialadenitis)

Answer 10

-Bacterial infection of the parotid or submandibular salivary glands

Question 11

MC etiology of acute bacterial sialadenitis

Answer 11

-S. Aureus (MC)

Question 12

Risk factors for acute bacterial sialadenitis

Answer 12

-Salivary gland obstruction from a stone
Dehydration
Chronic illness

Question 13

Symptoms of acute bacterial sialadenitis

Answer 13

• Sudden onset of a very firm and tender gland swelling with purulent discharge (pus if the duct is massaged)
• Dysphagia
• Trismus (lockjaw, spasm of the muscles of mastication)
• Fever and chills

Question 14

What is the diagnostic of choice for acute bacterial sialadenitis

Answer 14

CT scan

Question 15

Treatment for acute bacterial sialadenitis

Answer 15

• Anti-Staph ABX + Sialagogues to increase salivary flow
• -Dicloxacillin or Nafcillin. Metronidazole can be added
• -Clindamycin

Question 16

What is oral hairy leukoplakia?

Answer 16

Mucocutaneous manifestation of EBV (HHV4)

Question 17

Oral hairy leukoplakia is almost exclusively seen with ______

Answer 17

HIV infection

But other immunocompromised states such as post-transplant, chemotherapy, chronic steroid use as well

Question 18

Symptoms of oral hairy leukoplakia

Answer 18

-Painless, white smooth or corrugated hairy plaque along lateral tongue borders that cannot be scraped off

Question 19

Management for oral hairy leukoplakia

Answer 19

No specific treatment required (may spontaneously resolve)

Antiretroviral therapy in patients with HIV

Question 20

What is acute herpetic pharyngotonsillitis?

Answer 20

Primary manifestation of HSV-1 in adults

Question 21

Symptoms of acute herpetic pharyngotonsillitis

Answer 21

-Vesicles that rupture, leading ulcerative lesions with grayish exudates in the posterior pharyngeal mucosa

Question 22

Treatment for acute herpetic pharyngotonsillitis

Answer 22

Oral hygiene - lesions usually resolve within 7-14 days

Question 23

What is acute herpetic gingivostomatitis?

Answer 23

Primary manifestation of HSV-1 in children (MC between 6 months and 5 years)

Question 24

Symptoms of acute herpetic gingivostomatitis

Answer 24

• Prodrome: sudden onset of fever, anorexia, malaise, oral lesions
• Gingivostomatitis: ulcerative lesions of gingiva (gum swelling and bleeding) and vesicles on mucous membranes with perioral vesicular lesions clustered on an erythematous base (dew drops on a rose petal)
• After rupture, vesicles become ulcerated, yellow, and surrounded by erythematous halo
• Regional LAD

Question 25

Treatment for acute herpetic gingivostomatitis

Answer 25

• Supportive care mainstay: hydration, oral hygiene, barrier cream to the lips
• Oral Acyclovir if within 72-96 hours of onset if they are unable to drink or painful
• IV Acyclovir if immunocompromised

Question 26

What are some ototoxic medications?

Answer 26

• Loop Diuretics: Furosemide, Ethacrynic acid (Most ototoxic)
• ABX: Vancomycin, Macrolides (erythromycin), Tetracyclines, Aminoglycosides (Gentamicin)
• Aspirin, NSAIDs
• Chloroquine, Hydroxychloroquine, Quinine