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Unit 5- Semester 2 > ENT 2 > Flashcards

ENT 2 Flashcards

1
Q

Leukoplakia

A

A white lesion that, unlike oral candidiasis, cannot be removed by rubbing the mucosal surfaces
Hairy Leukoplakia is caused by active Epstein Barr virus (EBV) replication – only observed in HIV patients – on tongue.

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2
Q

A white oral lesion that can be removed by rubbing mucosal surface

A

candidiasis

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3
Q

Hairy leukoplakia

A

Hairy Leukoplakia is caused by active Epstein Barr virus (EBV) replication – only observed in HIV patients – on tongue.

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4
Q

Similar to leukoplakia except that it has a definite erythematous component (red)

A

erythroplakia

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5
Q

OLP (Oral lichen planus)

A

Most commonly present as lacy leukoplakia but may be erosive; definitive diagnosis requires biopsy – OLP is a chronic inflammatory disease of unknown etiology.

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6
Q

Early lesions appear as leukoplakia or erythroplakia; more advanced lesions will be larger, with invasion into tongue such that a mass lesion is palpable.( +/- ulceration)

A

Oral cancer

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7
Q

Leukoplakia and Erythroplakia may be associated with

A

Dysplasia or squamous cell carcinoma (90% of erythroplasia are either dysplasia or carcinoma).

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8
Q

Causative agents of peritonsillar or retropharyngeal abscesses

A

Viruses: none
Bacteria: Group A Streptococcus (most common) , oral anaerobes (Fusarium spp), S. aureus, H. influenza (usually in infants)

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9
Q

the most common causative agents of peritonsillar or retropharyngeal abscesses:

A

GAS

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10
Q

Common varieties of OLP and the conditions they mimic:

A

Reticular (mimicking candidiasis or hyperkeratosis)

Erosive (mimicking squamous cell carcinoma)

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11
Q

Painful, creamy white curd-like patches overlying the erythematous mucosa ( can be rubbed off)

A

Candidiasis – Oral Thrush

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12
Q

Candidiasis predisposing conditions

A 
Oral denture use
Chronic debilitated disease association
Diabetes melitus
Severe chronic anemia
Cemohterapy or radiation therapy recipients
Prolonged coricosteroid use
Prolonged antibiotic use
HIV infection – most often an AIDS-defining illness.
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13
Q

Yeast endogenous to our mucous membranes and normal flora
Forms germ tubes at 37.0°C in serum
Forms pseudo-hyphae and true hyphae when it invades tissues

A

Candida albicans

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14
Q

Candidiasis
Diagnosis
Treatment

A 
Diagnosis is often made clinically
Diagnosis involves yeast identification: 
Non-septate
hyphae
Pseudo hyphae (photo)
Germ tube

1- Local antifungals
Nystatin mouth rinses; held in mouth before swallowing- 3 times daily, Hydrogen peroxide mouth rinse may provide local relief

2- Systemic antifungals

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15
Q

HIV associated oral lesions

A

Thrush/Candida
Hairy Leukoplakia (EBV)
Kaposi’s Sarcoma (KSHV/HHV-8)

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16
Q

Acute Necrotizing Ulcerative Gingivitis (ANUG) or Trench Mouth is characterized by

A 
Characterized by: 
Painful gingival inflammation and necrosis
Bleeding
Halitosis
Fever
Cervical lymphadenopathy
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17
Q

Trench mouth (ANUG) causative agents:

A

Synergistic infection – spirochetes (oral spirochete of Treponema genus; T. denticola) and anaerobic bacteria (Fusobacterium)

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18
Q

Fusobacterium

Id.,, Path., Tx

A

anaerobic gram negative rodGram negative rods, non-spore forming, anaerobes

Resides in mouth and intestine as normal flora

An opportunistic pathogen

Elongated rods with tapered ends

Pathogenesis
is mediated by LPS

Treatment:
Antibiotics

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19
Q

ANUG epid

A

Occurs at any age group (poor mouth care), especially with stress, malnutrition, or immunodeficiency

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20
Q

Bacteria responsible for the overwhelming majority of localized abscesses in cranium, thorax, peritoneum, liver and female genital tract

A

Fusobacterium, peptostreptococcus and bacteroides alone or together with other facultative or obligate anaerobes

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21
Q

Aphthous ulcers

A

Canker sore, Ulcerative Stomatitis

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22
Q

aphthous ulcers

causative agent, manifestation

A

Cause remains uncertain; association with HHV6 has been suggested

Found on non-keratinized mucosa
Buccal and labial mucosa
Not on gingiva or palate

Characterized by single or multiple painful ulcers with irregular margin and yellow-grey fibrinoid center surrounded by red halo (2-10 mm)

Recur in relation to stress, menses, local trauma and other non-specific stimuli (similar to herpes)
May be confused with herpetic lesions

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23
Q

The oral location at which aphthous ulcers can NOT be found

A

Not on gingiva or palate

They are found on mucosa: non-keratinized, buccal and labial mucosa

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24
Q

Aphthous ulcer tx

A

Non-specific

Topical corticosteroids
Triamcinolone or fluocinonide ointment

Oral prednisolone- one week tapering course (starting 40-60mg/day)

Thalidomide
in recurrent aphthous ulcerations in HIV-positive patients

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25
Q

Noma/ cancrum oris

Sx, epid.

A

A severe gangrenous stomatitis progressing beyond the mucus membrane to involve soft tissue, skin, and sometimes bone

Seen in severely debilitated patients and people with poor oral hygiene; typical cases occur in children with protein-calorie malnutrition and other immunocompromised conditions

Measles sometimes precipitate noma

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26
Q

Noma/ Cancrum oris etiologic agents

A

Etiologic agents include Fusobacterium, Bacteroides, and P. aeruginosa

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27
Q 
Herpetic Stomatitis (HSV-1)
3 clinical forms of oral infection
A

Oral infection with herpes simplex virus occurs in three clinical forms:

Recurrent small blisters on the lips commonly referred to as fever blisters or secondary herpes labialis (most common type).

A generalized oral infection called primary herpetic stomatitis.

Small ulcers usually localized on palatal mucosa (rare variety).

28
Q

causative agent of recurrent small blisters on the lips commonly referred to as fever blisters or secondary herpes labialis (most common type).

A

HSV1

29
Q

Small ulcers usually localized on palatal mucosa are caused by

A

HSV-1

30
Q

Treatment fro Herpetic labialis (cold sores, fever blisters) and primary herpetic stomatitis

A

Acyclovir

31
Q

Causative agents of pharyngitis:

Viral and Bacterial

A

Pharyngitis is an acute infection of the pharyngeal mucosa caused by a variety of microorganisms:

Majority are viral
Rhinoviruses, Enteroviruses, Coronavirus, Adenovirus, Influenza viruses, and Epstein Barr virus (EBV)

Minority are bacterial –
Group A Streptococcus (GAS) is the most common cause.
Other bacterial causes:
Non-Group A Strep, C. diphtheriae, N. gonorrhoeae, Y. enterocolitica, and anaerobic bacterial species.

32
Q

Pharyngitis

Sx, O/E

A

Sore throat
Difficulty in swallowing/painful swallowing
Fever
Lymphadenopathy
Vesicles or ulcers (HSV and Enterovirus)
Respiratory distress- in severe form of pharyngitis; particularly when pharyngeal edema extends to the larynx

On examination:
Erythematous pharynx with or without exudates or cervical lymphadenopathy.

33
Q

Sx of HSV/Enterovirus caused pharyngitis in addition to:

Difficulty in swallowing/painful swallowing
Fever
Lymphadenopathy
Respiratory distress- in severe form of pharyngitis; particularly when pharyngeal edema extends to the larynx

A

Vesicles or ulcers (HSV and Enterovirus)

34
Q

Mild pharyngeal symptoms with rhinorrhea suggest a ——-etiology.

A

viral

35
Q

Exudative pharyngitis

causative ag.

A

Exudative pharyngitis - EBV, HIV

Need to also consider Group A Streptococcus (GAS)

36
Q

Pharyngeal symptoms with vesicular lesions and ulcers - often on hard palate
causative ag.

A

HSV, Coxackievirus

37
Q

causes pharyngeal symptoms with conjunctival inflammation

A

adenovirus

38
Q

Pharyngitis with generalized rash caused by

A

EBV, HIV

Streptococcal toxic shock from toxin-producing S. pyogenes strains)

39
Q

Pharyngitis

Serologic testing can establish the diagnosis of

A 
Serologic testing can establish the diagnosis of
EBV
HIV
CMV
Influenza
M. pneumoniae
C. pneumoniae
40
Q

Pharyngitis

Special culture media should be requested for

A

Special culture media should be requested for
N. gonorrhea
C. diphtheria

41
Q

Associate symptos of phartngitis

A

Myalgia
Fever
Rhinorhea and lymphadenopathy
Pharyngeal erythema with or without exudates or lymphadenopathy
Leukocytosis, rapid strep test and bacterial cultures or other serologies may provide the definitive microbiologic diagnosis

42
Q

Adenoviral pharyngitis

A 
This patient presented with 
Sore throat: Strep test negative
Cough
Fever
Red, inflamed conjunctiva
Lyphadenopathy involved  - anterior and other groups of LNs.
43
Q

Rapid Antigen Detection Test

A

All available RADTs involve the detection of the Lancefield group A carbohydrate, a GAS‐specific cell‐wall antigen

44
Q

S. Pyogenes

Colony morphology

A

Colony Morphology -
Culture
●Grow best in enriched media e.g. blood agar
● Small colonies (pinpoint-2mm), may have a surrounding zone of hemolysis
-B-hemolysis- a clear zone surrounding the colony (complete hemolysis)

They appear in chain like arrangements

45
Q

S. Pyogenes

Biochemistry

A 
Glucose fermentation test yield lactic acid 
Catalase negative (Staphylococcus: catalase positive)
46
Q

S. Pyogenes

Cell morphology

A

Gram-positive round cells growing in chains
non acid-fast
Nonmotile
May or may not have capsules

47
Q

Differentiation of GAS from other b- hemolytic pathogens

A

Group B Streptococci (GBS) also produce b-hemolysis (and a positive CAMP test)
Enterococci also produce b-hemolysis

Only GAS is bacitracin sensitive

48
Q

Gram + cocci that result in complete lysis of RBCs on Blood Agar

How to differentiate them

A

GAS (S. aureus), GBS ( S. agalactiae) and Staph aureus are all B-Hemolytic.

Staph aureus: Cat +, Coag +
GAS: Cat - , Bacitracin sensitive (-CAMP)
GBS: Cat -, Bacitracin Resistant ( + CAMP)

49
Q

Sore Throat

Clinical ft,

A

Symptoms are variable from individual to individual and some people may remain asymptomatic and serve as carriers

Soreness of throat and difficulty in swallowing
Fever, malaise and headache
Redness of throat
White patches of pus with hemorrhagic spots or yellowish white exudates
Enlarged and tender cervical lymph nodes
Abdominal pain (not always)

50
Q

S. Pyogenes

Immunity

A

Immunity
Type-specific IgA prevents adhesion and IgG against M-protein protects against invasion

Repeat infections due to the large number of GAS strains (over 80 serotypes**)

**Serotypes are performed using antibody against M protein

51
Q

Complications of Acute Streptococcal Pharyngitis

A

Scarlet fever rashes and strawberry tongue
Signs & Symptoms
● Fever, lethargy, sore throat, and a sand paper-like rash.

● The patient usually has a “strawberry tongue.”

● Finally, dark red lines (called Pastia’s lines) may appear in the creases of skin folds

52
Q

Scarlet fever

A

Scarlet fever is the result of infection with an S. pyogenes strain that is itself infected with a bacteriophage (T12)
Erythrogenic toxin enters blood stream and cause the rashes to appear
Children are commonly affected
Usually self-limiting but antibiotics are preferred to avoid additional complications
Penicillin is the drug of choice, but some resistance has been reported.

53
Q

Complications of bacterial pharyngitis

A

Peritonsillar or retropharyngeal abscesses
Jugular vein thromobosis and embolic complications (Lemeire’s syndrome) in Fusobacterium necrophorum infection
Rheumatic heart disease (GAS)
Post-streptococcal glomerulonephritis (GAS)
Acute airway obstruction (C. diphtheriae)
Myocarditis (C. diphtheriae)
Neuritis (C. diphtheriae)

54
Q

Complications of C. diphtheriae pharyngitis

A

Acute airway obstruction (C. diphtheriae)
Myocarditis (C. diphtheriae)
Neuritis (C. diphtheriae)

55
Q

Complications of GAS pharyngitis

A

Rheumatic heart disease (GAS)

Post-streptococcal glomerulonephritis (GAS)

56
Q

Complications of viral pharyngitis

A

Viral pharyngitis
Secondary bacterial infections of sinus
Secondary bacterial infections of lower respiratory tract

57
Q

Control of pharyngitis

A

Penicillin prophylaxis for patients with rheumatic heart disease

Acyclovir for recurrent HSV pharyngitis
Treatment of sexual partner in gonorrheal pharyngitis
Good hand washing, especially if there is an infected person in the family
Tonsillectomy in recurrent pharyngitis as appropriate
Active immunization for influenza A/B and diphtheria
Prophylactic measures

58
Q

Laryngitis

Causes (more and less)

A

Laryngitis: infection of the larynx that results in an inflammatory reaction and consequent symptoms and signs.
Most commonly, viral pathogens:
Rhinovirus, adenovirus, influenza virus, RSV or parainfluenza virus
Less commonly, bacterial pathogens:
S. pyogenes, Moraxella catarrhalis
Rare causes:
Mycobacterium tuberculosis, Treponema pallidum and fungal pathogens (Histoplasma, Blastomyces, Candida)

59
Q

Laryngitis

Sx and symp

A 
Hoarseness
Aphonia
Associated symptoms
Rhinitis, or pharyngitis
Features of respiratory obstruction

Hyperemic (increased blood flow), edematous, with or without ulcerations
Exudative in diphtheria, GAS, EBV laryngitis

60
Q

Laryngitis

Imaging

A

Lateral X-ray of neck would help exclude:

  • acute bacterial epiglottitis
  • bacterial tracheitis

When hoarseness persists longer than 2 weeks, direct laryngoscopy should be done.

A lateral neck X-ray should be done if the patient has associated symptoms of stridor* (harsh vibrating noice when breathing) or respiratory compromise to rule out laryngeal obstruction.

61
Q

Laryngitis differential dx

A 
Voice abuse
Tumor 
Paralysis of the vocal cord
Chemical irritants
Gastroesophageal reflux

Also, should be differentiated from acute bacterial epiglottitis and acute bacterial tracheitis (presents with more systemic manifestations)

62
Q

Laryngitis tx

A 
Viral laryngitis
Mostly supportive treatment including
Voice rest
Warm saline gargling
Increased humidity

Bacterial laryngitis
Specific antibiotic should be administered

63
Q

Laryngitis

Ess of Dx

A

Hoarseness or loss of voice (aphonia).
Associated symptoms of rhinitis, pharyngitis, or cough.
Children tend to develop airway obstruction.
Mostly viral, occasionally bacterial.
Persistent hoarseness lasting more than 10 days should prompt laryngoscopy to exclude other etiologies.

The larynx is hyperemic and edematous, with or without ulcerations.

64
Q

Croup (Acute Laryngotracheitis)

A

Croup is a clinical syndrome due to subglottic inflammation and edema caused by a viral or bacterial infection of the larynx, trachea, and bronchi.

This is the most common cause of upper respiratory tract obstruction in children between the ages of 6 months to 6 years, with peak occurrence at 2 years.

Mostly caused by viruses with occasional bacterial involvement.

65
Q

Frequent pathogens causing croup in Child a d Adults

A

Children:Parainfluenza virus
type I and II
Influenza A or B
RSV

Adults: HSV
Influenza A or B

66
Q

Croup Sx

A

Hoarsness of voice
Brassy cough
Stridor* (inspiratory or expiratory)

Fever
Rhinorrhea preceding the above complaints
Sore throat

On examination:
Lung sounds reveal ronchi, crepitations or wheezing*
Diminished breath sound due to upper airway obstruction

Stridor: harsh vibrating noise when inhaling or exhaling due to obstruction of larynx or trachea.
Ronchi: coarse rattling noise during respiration, most often caused by secretions in the bronchial airways.
Crepitations: crackling sounds in the lungs during respiration detected with a stethoscope, caused by lung inflammation.
Wheezing: a whistling or hissing chest noise during respiration due to obstruction of airways.

Unit 5- Semester 2 (2 decks)

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