ENT Flashcards
most common mouth cancer
oral keratosis (cancer on the side of the tongue)
dental caries/acute pulpitis
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)
vincent’s angina (trench mouth)
sign/sx- halitosis
tx- pcn + metroniadazole or clindamycin alone
Ludwig’s angina
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)
most common oral ulceration in north america
recurrent aphthous stomatitis
50% due to CMV
what is most important factor in flavor
smell or aroma of food
hypogeusia
diminished taste to 1 or more tastants
ageusea
absent taste func
dysgeusia
persistent sweet, sour, salty, bitter or metallic taste
allegeusia
unpleasant taste of food or drink that is usually pleasant
phantogeusia
unpleasant taste produced indigenously due to gustatory hallucination
can get before migraine and other neurological stuff
etiology and tx of halitosis
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
odynophagia
pain produced from swallowing
mouth pain
stomatitis
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
stomatitis tx
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
xerostomia
dry mouth causes: diuretics Drugs w/ anticholinergic effects (antihistamine, tricyclic antidepressant) autoimmune (sicca and sjogrens) normal aging
xerostomia presentation and tx
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
laryngitis
hoarsness and dysphonia
freq seen w/ URI
inflammation of vocal fold mucosa and larynx
actue sx3 weeks
most common cause of laryngitis
VIRAL
can be bacterial, vocal trauma, gerd, autoimmune, environmental factors, use of asthma inhalers
what is most important management for laryngitis
vocal cord rest
indications for indirect laryngoscopy
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)
Polypoid corditis (Reinke’s edema)
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 etiologyvocal nodules
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)
vocal polyps
Usual cause: smoking, reflux, muscle tension dysphonia, vocal abuse
More common in men
Unilateral
Sessile or pedunculated lesion on the vocal fold
Tx: excision
how to tell difference between polyps and nodules
nodules are bilateral
polyps are unilateral
what is the primary laryngeal cancer
squamous cell
most common cause of pharyngitis
viral
Over treatment of acute pharyngitis represents one of the major causes of antibiotic abuse.
complications of strep
rheumatic fever
post strep glomerular nephritis
PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections (group A strep)
fxs of GABHS
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
Gold standard test for strep
throat culture
tx for GABHS
DOC- oral pcn for 10 days
if allergic to pcn- z pack
what does tonsillitis usually cause
bacterial infxn: (usually children 6-15)
GABHS
viral infxn (usually children less then 6)
indications for tonsillectomy
> 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
vincent’s agngina (trench mouth)
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
ludwig angina
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
