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ENT Flashcards

1
Q

most common mouth cancer

A

oral keratosis (cancer on the side of the tongue)

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2
Q

dental caries/acute pulpitis

A

cause- strep mutans
pathophys- destroys hard tissue of teeth; progresses into dental pulp (acute pulpits)
sx- throbbing pain; hot and cold sensitivity
prevention- fluoride, brushing, flossing, routine cleanings
tx- simple caries-resotoration (fillings)
pulpitis- abx and NSAIDS; root canal may be needed
high risk pop- anything that causes spit to decrease and have a dry mouth (chemo, drugs, xerostomia secondary to other stuff)

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3
Q

vincent’s angina (trench mouth)

A

sign/sx- halitosis

tx- pcn + metroniadazole or clindamycin alone

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4
Q

Ludwig’s angina

A

MUST GET TO HOSPITAL/SURGEON
GRAPEFRUIT OF LOWER JAW
patho- spreading cellulitis of sublingual spaces
sign/sxs-febrile, drooling, trismus, edema in sublingal area spreading down neck
tx- pcn or unasyn plus metronidazole (Flagyl)

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5
Q

most common oral ulceration in north america

A

recurrent aphthous stomatitis

50% due to CMV

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6
Q

what is most important factor in flavor

A

smell or aroma of food

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7
Q

hypogeusia

A

diminished taste to 1 or more tastants

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8
Q

ageusea

A

absent taste func

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9
Q

dysgeusia

A

persistent sweet, sour, salty, bitter or metallic taste

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10
Q

allegeusia

A

unpleasant taste of food or drink that is usually pleasant

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11
Q

phantogeusia

A

unpleasant taste produced indigenously due to gustatory hallucination
can get before migraine and other neurological stuff

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12
Q

etiology and tx of halitosis

A 
80-90% in oral cavity
5-8% nasal passages
3% tonsils (tonsillioiths)
tx- tx underlying cause
clean posterior tongue
good dental hygiene
rinsing and DEEP gargling of mouth wash
chew gum
decrease alcohol and coffee intake
drink water
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13
Q

odynophagia

A

pain produced from swallowing

mouth pain

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14
Q

stomatitis

A

blanket term for inflammatory cone of mouth
Oral infections- HSV, VZV, HIV infection, Candida
Autoimmune- Bechets syndrome, Sicca syndrome
Recurrent aphthous stomatitis (RAS)–most common cause of mouth ulcers in North America
always r/o cancer for persistent or unusual lesions

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15
Q

stomatitis tx

A

Symptomatic relief:
Triamcinolone acetonide in Orabase gel (for inflammation)
Topical analgesics (OTC)
Oragel
Anbesol
Magic mouthwash
Antivirals- acyclovir (if a viral infxn)
Chemical cautery w/ silver nitrate or sulfuric acid
Severe: intralesional or oral cortisone

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16
Q

xerostomia

A 
dry mouth
causes:
  diuretics
  Drugs w/ anticholinergic effects (antihistamine, tricyclic antidepressant)
  autoimmune (sicca and sjogrens)
  normal aging
17
Q

xerostomia presentation and tx

A

pres: C/O oral dryness, burning of mouth, difficulty eating and swallowing, tongue irritation, painful ulcerations.
tx-Salivary stimulation with sugarless hard candies
Saliva substitutes
Sialogogues: pilocarpineorcevimeline
Meds that increase salivation

18
Q

laryngitis

A

hoarsness and dysphonia
freq seen w/ URI
inflammation of vocal fold mucosa and larynx
actue sx3 weeks

19
Q

most common cause of laryngitis

A

VIRAL

can be bacterial, vocal trauma, gerd, autoimmune, environmental factors, use of asthma inhalers

20
Q

what is most important management for laryngitis

A

vocal cord rest

21
Q

indications for indirect laryngoscopy

A 
Hoarseness > 2 weeks
Odynophagia
Voice change
Dysphagia
Hemoptysis
Foreign body sensation
Contraindications:
  Uncooperative pt, or one w/ a strong gag reflex
  Compromised airway (croup or epiglotitis)‏
22
Q

Polypoid corditis (Reinke’s edema)

A 
Isolated edema of the mucosal edge of the vocal fold
Etiology
  Usually due to smoking
  Maybe hormonal changes
     Menopause
     Hypothyroidism
  Allergy, vocal abuse or URI
Therapy
  Vocal rest
  Medical management of etiology
23
Q

vocal nodules

A

Thickened areas on the vocal cord, bilaterally occurring at the junction of the anterior and middle thirds (analogous to a callus)
Usual cause: smoking, reflux, muscle tension dysphonia, vocal abuse
Treatment:
Adults: excision
Children: monitor (these frequently regress in adolescence)

24
Q

vocal polyps

A

Usual cause: smoking, reflux, muscle tension dysphonia, vocal abuse
More common in men
Unilateral
Sessile or pedunculated lesion on the vocal fold
Tx: excision

25
Q

how to tell difference between polyps and nodules

A

nodules are bilateral

polyps are unilateral

26
Q

what is the primary laryngeal cancer

A

squamous cell

27
Q

most common cause of pharyngitis

A

viral

Over treatment of acute pharyngitis represents one of the major causes of antibiotic abuse.

28
Q

complications of strep

A

rheumatic fever
post strep glomerular nephritis
PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections (group A strep)

29
Q

fxs of GABHS

A

Unusual before 3 years of age and highest incidence of occurrence between 6-15 years of age (25-40% of pharyngitis cases)
More frequent in late winter and spring (Jan-Apr), uncommon in summer
Classic symptoms
Acute onset of discomfort/sore throat
Dysphagia- usually from odynophagia
Malaise
Headache
Absence of other URI symptoms (rhinorrhea, conjunctivitis, diarrhea or cough)
Occasionally abdominal pain and vomiting
Classic physical signs
Exudative pharyngeal erythema
Palatal petechiae
Tender anterior cervical adenopathy
Fever (>101F or 38.3C)
Absence of post-nasal drainage

30
Q

Gold standard test for strep

A

throat culture

31
Q

tx for GABHS

A

DOC- oral pcn for 10 days

if allergic to pcn- z pack

32
Q

what does tonsillitis usually cause

A

bacterial infxn: (usually children 6-15)
GABHS
viral infxn (usually children less then 6)

33
Q

indications for tonsillectomy

A

> 6 episodes culture-confirmed GABHS pharyngitis in 1 year

3 or more infections of tonsils and/or adenoids in 1 year despite adequate therapy

Chronic or recurrent tonsillitis associated with GABHS carrier state unresponsive to beta-lactamase resistant antibiotics

Chronic tonsillitis affecting work/school

Others

34
Q

vincent’s agngina (trench mouth)

A

Pathophysiology
Acute inflammation and necrotizing ulceration of the pharyngeal tonsils
Usually caused by mixed bacterial-spirochetal infection

Symptoms: Severe throat pain, often radiating to the ears, halitosis, bad taste
Signs: Tonsil is covered by pseudomembrane formed from necrosis of the superficial layer of the mucous membrane

Treatment
Oral/parenteral penicillin
Vigorous oral hygiene

35
Q

ludwig angina

A

grapefruit on side of neck
Acute cellulitis, usually of dental origin, extending into the submaxillary and sublingual space
Can cause airway compromise because of the swelling in the floor of the mouth and neck which makes it an emergency
10% mortality rate

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