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(PA school) CAM I > ENT 3 > Flashcards

ENT 3 Flashcards

1
Q

1) Define chronic rhinosinusitis
2) What does diagnosis require?
3) Describe the onset and average age at diagnosis

A

1) Inflammatory condition involving paranasal sinuses & linings of the nasal passages lasting >12 weeks
2) Objective evidence of mucosal inflammation
3) Abrupt onset or slow/insidious onset (months-years)
-Affects 5-12% of general population (children & adults); mean age at diagnosis 39

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2
Q

List risk factors for chronic rhinosinusitis

A

Allergic rhinitis
Asthma
Aspirin-exacerbated respiratory disease (AERD)
Depression
Smoking
Irritants & pollutants
Immunodeficiency
Defects in mucociliary clearance (i.e., CF)
Viral infections
Systemic illnesses
Dental infections
Anatomic abnormalities
Indoor dampness & mold exposure

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3
Q

What are the four (4) cardinal signs & symptoms of chronic rhinosinusitis in adults? How does it differ in children?

A

1) Mucopurulent drainage (opaque white or light yellow)
2) Nasal obstruction/nasal blockage/congestion (bilateral)
3) Facial pain, pressure, and/or fullness (headache)
4) Reduction or loss of sense of smell **
-**In children, the 4th cardinal symptom is cough (instead of loss of smell)

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4
Q

For a pt with chronic rhinosinusitis, what Sx are suggestive of other conditions or complications requiring immediate evaluation?

A

High fever
Double (or reduced) vision
Proptosis
Dramatic periorbital edema
Ophthalmoplegia
Other focal neurologic signs
Severe headache
Meningeal signs
Significant or recurrent epistaxis

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5
Q

What are the 4 components of chronic rhinosinusitis evaluation?

A

1) Clinical Hx
2) Objective documentation of mucosal disease
3) Allergy evaluation
4) Consideration of immunologic defects & infectious complications

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6
Q

Describe how to gather clinical Hx and objective documentation of mucosal disease for chronic rhinosinusitis

A

1) 4 cardinal symptoms, duration, risk/causative factors, previous Tx & imaging, previous surgeries, exposures
2) Anterior rhinoscopy, nasal endoscopy, and/or CT w/o contrast (purulent mucus or edema, polyps, imaging showing mucosal thickening or partial or complete opacification of the paranasal sinuses)

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7
Q

Describe how to evaluate allergies and consider immunologic defects & infectious complications for chronic rhinosinusitis

A

1) Allergy evaluation (optional testing; mainly perennial allergens)
2) Pts with recurrent episodes of acute purulent sinusitis; consider if h/o pulmonary infections or recurrent otitis media; labs and/or imaging for systemic diseases

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8
Q

What are the criteria for diagnosing chronic rhinosinusitis?

A

Based on presence of suggestive symptoms + objective evidence of mucosal inflammation:
1) Must have at least 2 of the 4 cardinal signs & symptoms
2) Must be present for > 12 weeks
3) Must have 1 or more findings on nasal endoscopy or CT:
-Purulent (not clear) mucus or edema in the middle meatus or ethmoid regions
-Polyps in the nasal cavity or the middle meatus
-Radiographic imaging demonstrating mucosal thickening or partial or complete opacification of the paranasal sinuses

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9
Q

List the three (3) distinct clinical syndromes/subtypes of chronic rhinosinusitis, and the frequencies of each.

How are they differentiated, and why is this important?

A

1) CRS with nasal polyposis (20-33%)
2) Allergic fungal rhinosinusitis (AFRS)(<5%)
3) CRS without nasal polyposis (60-65%)
-Differentiated by CT findings & tissue biopsy; therapies differ based on subtypes

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10
Q

Can you treat chronic rhinosinusitis as a PCP?

A

Primary care level management, but ENT & allergy specialists frequently required (especially for refractory CRS & AFRS)

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11
Q

List ways to manage chronic rhinosinusitis

A

1) Intranasal saline (irrigation and/or sprays)
2) Intranasal corticosteroids (i.e., fluticasone, budesonide)
3) Oral corticosteroids (severe/refractory mucosal edema, reduce polyp size, minimize inflammation of AFRS; 10-15 days)
4) Antibiotics (only to manage acute exacerbations, not long term)
5) Antileukotriene agents (adjunct in pts with allergic rhinitis, nasal polyps)
6) Endoscopic sinus surgery (for medical polypectomy & insufficient results)
7) Biologic agents

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12
Q

Invasive fungal rhinosinusitis:
1) Define this condition
2) How long is its course?
3) Who are most cases in?
4) What are its two types?
5) What can cause it?

A

1) Rare aggressive fungal infection of sinuses
2) Days to weeks
3) Immunosuppressed (DM, HIV, organ transplant)
4) Acute (profound immunosuppression) & chronic
5) Aspergillus, Mucor species

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13
Q

List the symptoms of acute invasive fungal rhinosinusitis (hint: similar to ABRS)

A

1) Fever
2) Facial pain (facial numbness with CN involvement)
3) Nasal congestion
4) Possible visual & mental status changes (diplopia)

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14
Q

1) How is invasive fungal rhinosinusitis diagnosed?
2) How is it treated?

A

1) Diagnosis: CT and/or MRI, but confirmed with tissue biopsy
2) Medical & surgical emergency:
Hospital admission and ENT referral
-IV antifungal therapy (voriconazole or amphotericin B)
-Prompt wide surgical debridement

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15
Q

1) Who are nasal foreign bodies common in?
2) What types of materials can they be?
3) Why are they more difficult to remove with time?
4) What two things require immediate attention due to risk of septal perforation?

A

1) Common in children and developmentally disabled
2) Inorganic materials (beads, pebbles, etc.) or organic materials (beans, peas)
3) Swelling
4) Button batteries and magnets

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16
Q

1) What are two signs of nasal foreign bodies?
2) How can FBs be managed?

A

1) Unilateral foul-smelling discharge, nasal obstruction
2) Patient can blow nose or trial of insufflation, if that does not work:
1) Pretreat with nasal decongestant & topical anesthetic
2) Conscious sedation if needed - Protect airway
3) Use Katz extractor, foley catheter, or forceps

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17
Q

What are the referral criteria for nasal FBs?

A

-Foreign body refractory to removal attempts
-Chronic foreign body with localized reaction
-Young or developmentally delayed patients requiring conscious sedation
-Significant trauma on attempted removal
-Sharp, penetrating or hooked foreign body

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18
Q

Jobson-Horne probe, hook, & alligator forceps can be used for what?

A

Nasal FBs

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19
Q

1) What is the most fractured bone in the body?
2) What are the signs/ Sx?
3) How do you evaluate for it?

A

1) Nasal pyramid
2) Epistaxis, pain, soft tissue hematomas (periorbital hematoma/“black eye”)
3) Full HEENT (intranasal exam to r/o septal hematoma): crepitus, palpable & mobile bony segments, step-off of infraorbital rim (zygomatic complex fracture)
+ x-rays
-Assess for facial, spine, pulmonary, & intracranial injuries (based on MOI)

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20
Q

1) What is the goal of treating a nasal fracture?
2) How can this be done?

A

1) Maintain long-term nasal airway patency & cosmesis
2) Closed reduction of fracture (local or general anesthesia)

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21
Q

1) When does a nasal fracture require an urgent ENT referral?
2) How is this treated?

A

1) Septal hematomas
2) Bilateral I&D + fluid cultures
-Nasal packing 3-5 days (prevents re-formation of hematoma)
-Anti-Staph antibiotics (i.e., cephalexin, clindamycin) 3-5 days (or duration of packing) reduces risk of TSS

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22
Q

1) What is the most common neoplasm found in sinuses & nasopharynx?
2) What are 4 other less common neoplasms?
3) What the early Sx of malignant neoplasms similar to?
4) What are the common Sx of malignant neoplasms?
5) List cancer-related nasal Sx
6) Are malignant nasopharyngeal & paranasal sinus neoplasms usually caught early? How are they treated? What’s the prognosis for advanced tumors?

A

1) Squamous cell carcinoma (SCC)
2) Adenocarcinoma, mucosal melanomas, sarcomas, & non-Hodgkin lymphomas less common
3) Rhinosinusitis
4) Unilateral nasal obstruction & discharge, otitis media
5) Pain & recurrent hemorrhage
6) Advanced at presentation & treated with chemoradiation therapy
-Poor prognosis for advanced tumors

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23
Q

Benign nasopharyngeal neoplasms- nasal polyps:
1) What do they look like?
2) What are they commonly associated with?
3) What can they lead to?
4) What improves QOL?

A

1) Pale, edematous, mucosal-covered masses
2) Common association with allergic rhinitis
3) Possible chronic nasal obstruction & dysosmia
4) Topical intranasal steroids improves QOL (1-3 months for small polyps)

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24
Q

1) How can nasal polyps be treated?
2) When should you consider surgery for them?

A

1) Short course oral steroids
2) Massive polyps or failed medical therapy

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25
Q

Benign nasopharyngeal neoplasms- Inverted papillomas
1) Where are they usually located?
2) What causes them?
3) How do they present?
4) Can they be malignant?
5) What’s the recommended Tx?

A

1) Lateral nasal wall
2) HPV
3) Unilateral nasal obstruction & occasional hemorrhage
4) Malignant potential; SCC seen in ~10% cases
5) Complete excision

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26
Q

What do oropharyngeal diseases include?

A

-Diseases of the teeth & gums
-Infectious & inflammatory disorders
-Salivary disorders
-Others

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27
Q

1) Necrotizing ulcerative gingivitis is also called what?
2) What often causes it?
3) Who is it typically seen in?

A

1) “Vincent’s Angina, Trench Mouth”
2) Infection with spirochetes & fusiform bacilli
3) Young adults under stress

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28
Q

1) True or false: Underlying systemic diseases are possible with necrotizing ulcerative gingivitis
2) How does it typically present?
3) What are the other Sx?

A

1) True
2) Painful, acute gingival inflammation & necrosis
3) Possible bleeding, halitosis, fever, cervical lymphadenopathy

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29
Q

How is Necrotizing ulcerative gingivitis treated?

A

1) Warm ½ strength peroxide rinses
2) Metronidazole 500 mg PO q8h for 7 days (or until lesions healed)
-Dental gingival curettage may be required

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30
Q

1) Apthous stomatitis is also called what? How common are they?
2) What is the etiology?
3) What part of the mouth does it affect?
4) What does this condition look like?

A

1) Canker sores; 5-21%
2) Exact etiology unknown (possible association with HHV6)
3) Affects buccal & labial mucosa (not palate or gingiva)
4) Recurring, painful, solitary or multiple ulcers typically covered by a white-to-yellow pseudomembrane & surrounded by an erythematous halo (last 7-14 days)

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31
Q

1) What are some DDx for Apthous stomatitis?
2) What should you do if diagnosis is unclear?

A

1) Erythema multiforme or drug allergies
Acute herpes simplex
Pemphigus
Pemphigoid
Bullous lichen planus
Behçet disease
IBD
SCC
2) Incisional biopsy

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32
Q

How do you treat canker sores? Why is it challenging?

A

1) Good oral hygiene and avoidance of exacerbating factors/foods is key
2) Medical treatment is challenging as there is no single effective therapy:
-Pain control (viscous lidocaine 2% or benzocaine 10%)
-1 week tapering course prednisone (40-60 mg)
-Topical corticosteroids (fluocinonide gel): symptomatic relief
-Medicated mouthwash

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33
Q

1) What is oral candidiasis?
2) What are some risk factors in immunocompetent people?
3) What abt in immunocompromised ppl?
4) What may immunocompromised ppl with this also have?

A

1) Infection of oral mucosa usually caused by Candida albicans; aka “thrush”
2) Dentures, xerostomia, antibiotic and/or steroid use, DM, anemia
3) HIV/AIDS, hematologic malignancies, transplant recipients, chemotherapy, steroids, head & neck RT
4) Immunocompromised patients may also have Candida esophagitis or laryngeal candidiasis

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34
Q

Oral candidiasis/ thrush:
1) Signs/ Sx
2) What is a Sx of this that can be described as white plaques on buccal mucosa, palate, tongue, & oropharynx that can be scraped off?

A

1) May be asymptomatic; cotton feeling in mouth, loss of taste, painful eating & swallowing
2) Pseudomembranous

35
Q

Oral candidiasis/ thrush:
1) Define Atrophic (aka denture stomatitis)
2) Define angular cheilitis

A

1) Older adults who wear dentures; erythema beneath upper dentures without plaques
-Erythematous macular lesions
2) Erythematous fissures bilaterally at angles of mouth

36
Q

Oral candidiasis/ thrush:
1) How do you Dx?
2) How do you test for it?
3) How do you treat it? Who may need longer Tx?

A

1) Clinical based H&P
2) Scrape lesions for Gram stain and/or KOH prep (budding yeasts with/without hyphae)
3) Antifungals (fluconazole, ketoconazole, clotrimazole troches, nystatin mouth rinses)
-HIV/AIDS patients may need longer duration of therapy

37
Q

Deep neck infection- Ludwig’s angina:
1) What is it?
2) Describe the signs/ Sx

A

1) Cellulitis of the submandibular space (often from infection of the mandibular dentition)
-Most commonly-encountered neck space infection
2) Edema & erythema of upper neck & floor of mouth
-Tongue may be displaced upward & backward; may occlude airway (emergency)
-May have pus in floor of mouth

38
Q

Deep neck infection- Ludwig’s angina:
1) How’s it Dx’d?
2) How’s it Tx’d?

A

1) Clinical, augmented with CT with contrast
2) Hospital admission, IV ceftriaxone + metronidazole, Cx/Sens., dental consult/ENT consult, + drains

39
Q

Deep neck infection- deep neck abscess
1) What usually causes it?
2) What are some other causes?
3) What are its Sx?

A

1) Usually caused by odontogenic infections
2) Suppurative lymphadenitis, direct spread of pharyngeal infection, penetrating trauma, pharyngoesophageal FB, cervical osteomyelitis, IV drug injection into internal jugular vein
3) Marked neck pain & edema, +/ fever

40
Q

Deep neck infection- deep neck abscess
1) Untreated or inadequately treated may spread to _____________ or cause _______________
2) How is it Dx’d?
3) How is it Tx’d?

A

1) mediastinum or cause sepsis
2) Clinical, augmented with CT with contrast
3) Secure airway, IV antibiotics, I&D; may required intubation or tracheotomy

41
Q

Epiglottitis:
1) Define this condition
2) What usually causes it? What’s the most common?
3) What’s its usual presentation?
4) Who’s it most common in?
5) What are some clinical features?

A

1) Inflammation of epiglottis & supraglottic structures
2) Viral or bacterial infection (also caustic ingestion, thermal injury, & trauma)
-MC bacterial =H. influenza type B (Hib)
3) Rapidly developing severe sore throat or odynophagia out of proportion to minimal oropharyngeal findings on exam
4) More common in diabetics and those who have not gotten routine vaccinations
5) Severe sore throat, dysphagia, odynophagia, drooling, fever, muffled or hoarse voice, stridor, dyspnea, mostly normal OP exam, minimal respiratory distress

42
Q

Describe an epiglottitis exam (including in children) and treatment

A

1) Indirect laryngoscopy (not in children) revealing edematous & erythematous epiglottis
-Not necessarily needed for diagnosis
-Children may be in “tripod” position to increase airway patency
2) Safer than direct visualization
-X-Ray: enlarged epiglottitis “thumb print sign”
-CT scan
-Imaging should not delay airway management

43
Q

How is epiglottitis treated? Is it an emergency?

A

Emergency airway management and evaluation
-Keep the patient calm
-Avoid agitating the patient (especially in children)
-Avoid sedation (unless needed for intubation), inhalers, or racemic epinephrine
1) Hospitalization for IV antibiotics (ceftriaxone or amoxicillin/clavulanate)
2) IV dexamethasone
3) Analgesic/antipyretic
4) Supplemental humidified oxygen

44
Q

1) What is herpes labialis?
2) Is it common? What triggers it?

A

1) “Fever blister”, ”cold sore”; reactivation of HSV-1 oral vesicles along the vermilion border
2) Common, 15-45% of US population
-Immunodeficiency, stress, exposure to sunlight, fever, trauma, dental procedures

45
Q

Herpes labialis:
1) Symptoms & signs
2) What medications are involved in Tx?

A

1) Prodrome (pain, burning, tingling, pruritis)
-Eruption of clustered vesicles (7-14 days)
2) Local anesthetics (i.e., topical lidocaine)
-Oral antiviral (i.e., acyclovir, famciclovir, valacyclovir)
-Topical antiviral (acyclovir) less effective than oral antivirals

46
Q

Herpes labialis: what are the 3 treatment options? How do you pick one?

A

1) No treatment (mild symptoms, no prodrome)
2) Episodic therapy (mild-moderate symptoms with prodrome)
3) Chronic suppressive therapy (severe disease)
-Frequent recurrences (especially if no prodrome)
-Recurrences that are very bothersome
-Recurrences associated with serious systemic complications (i.e., erythema multiforme)

47
Q

Acute laryngitis:
1) What is it a common cause of? When does it often happen?
2) What are the signs/ Sx?
3) How’s it treated?
4) What are some complications?

A

1) Hoarseness; often after a URI (viral or bacterial)
2) Hoarseness, +/- sore throat, congestion
3) Supportive (voice rest, PO hydration, humidified air)
-Antibiotics usually not necessary
4) Vocal fold hemorrhage, polyps, cysts

48
Q

1) What is the most common deep infection (polymicrobial) of the head and neck?
2) Where does it generally form?
3) Who does it occur most commonly in?
4) When?
5) What are the risk factors?

A

1) Peritonsillar abcess
2) Generally forms in the soft palate, just above the superior pole of the tonsil, in the location of Weber’s glands.
3) Mostly in young adults (20-40)
4) Nov-Dec, Apr-May
5) Periodontal disease & smoking

49
Q

What are the signs and Sx of a peritonsillar abscess?

A

1) Ill appearing, fever, malaise, severe sore throat, foul breath, dysphagia or otalgia
2) Trismus, odynophagia, drooling
3) Muffled voice “hot potato voice”

50
Q

What would you expect to see upon examination for a peritonsillar abscess?

A

1) Tense swelling & erythema of anterior tonsillar pillar & soft palate
2) Tonsil is usually displaced inferiorly & medially with contralateral deviation of the uvula
3) Tender cervical lymphadenopathy

51
Q

Peritonsillar abscess:
1) How’s it diagnosed? (3 ways)
2) Describe treatment for small and large abscesses

A

1) Needle aspiration, intraoral or submandibular US, CT or MRI (adjunct)
2) Small abscess (<1cm): observation and antibiotics
-Drainage of abscess larger than 1cm (needle aspiration, I&D, +/- tonsillectomy)
-Antibiotics (i.e., piperacillin-tazobactam IV; alternatives include IV metronidazole + ceftriaxone, or clindamycin)
-Hydration, analgesia, airway management

52
Q

What are some complications of peritonsillar abcess?

A

-Airway obstruction
-Aspiration pneumonitis
-Death secondary to hemorrhage
-Extension of infection into deep neck or mediastinum
-Poststreptococcal sequelae if caused by GABHS

53
Q

1) How common is pharyngitis?
2) When are the peak seasons?
3) What are the causes?
4) What are the Sx? What should you consider for acute cases?

A

1) Very common
2) Peak seasons: late winter, early spring
3) Mostly viral & bacterial; others include GERD, postnasal drip (rhinitis), persistent cough, thyroiditis, allergies, FB, smoking
4) Scratchy feeling, sore throat, difficulty swallowing
*Consider SARS-CoV-2 testing in patients with acute pharyngitis

54
Q

1) What is the most common cause of pharyngitis?
2) What are the Sx/ signs?
3) Describe how to conservatively treat it

A

1) Viral pharyngitis
2) Coryza, conjunctivitis, malaise, hoarseness, low-grade fever
3) Systemic PO analgesics (i.e., acetaminophen, NSAIDs, ASA)
Topicals (i.e., lozenges, sprays, beverages, foods
Breathing humidified air
Avoid tobaccos smoke

55
Q

Infectious mononucleosis:
1) Define
2) What is the cause? Who is it most common in?
3) Describe what you would see upon examination

A

1) Pharyngitis with significant fatigue
2) Epstein-Barr virus (EBV); ages 15-30
3) Pharyngeal injection with exudates (shaggy, white-purple)
-Posterior cervical & auricular lymphadenopathy
-Palatal petechiae
-Hepatosplenomegaly

56
Q

Infectious mononucleosis:
1) How is it diagnosed? (3 ways)
2) How’s it treated?

A

1) -Heterophile antibody test (i.e., Monospot) or EBV-specific antibody test to confirm
-CBC: lymphocytosis (absolute count >4500/microL)
-Peripheral smear: differential count >50% (or atypical lymphocytosis)
2) Supportive (fluids, rest, acetaminophen or NSAIDs, no contact sports for minimum 3-4 weeks)
-NO antibiotics

57
Q

GABHS pharyngitis:
1) Most common in?
2) Signs and Sx?
3) Supportive features?

A

1) Group A beta-hemolytic streptococcus (GABHS)
2) Ages 5-15
3) Acute-onset sore throat, fever, pharyngeal edema, patchy tonsillar exudates, & prominent, tender, anterior cervical lymphadenopathy
4) Palatal petechiae, scarlatiniform rash, & strawberry tongue

58
Q

What is the importance of an accurate diagnosis for GABHS pharyngitis?

A

-Prevent suppurative complications & acute rheumatic fever (ARF)
-Prevent transmission
-Reduce duration & severity of symptoms

59
Q

GABHS pharyngitis:
1) Which adults should you test?
2) What are some clinical features suspicious for GABHS in adults?

A

1) Patients with clinical features compatible with GABHS pharyngitis who lack symptoms of a respiratory viral syndrome
2) Sudden onset of sore throat, fever, pharyngotonsillar and/or uvular edema, patchy tonsillar exudates, cervical lymphadenopathy (often tender & anterior), scarlatiniform skin rash and/or strawberry tongue, history of GABHS exposure

60
Q

GABHS pharyngitis:
1) When the need for testing is unclear, use 4 Centor criteria to help guide decision to test, which are what?
2) Include the interpretation of these criteria

A

1) Pharyngotonsillar exudates, tender anterior cervical lymphadenopathy, fever, and absence of cough
(also Consider patient age (more likely in those 3-14 yrs old))
2) Interpretation:
> 3 criteria present: intermediate likelihood (test these patients)
< 3 criteria present: unlikely (no benefit with testing)

61
Q

GABHS pharyngitis:
Describe how you’d diagnose it and your next steps

A

For most patients with suspected GAS pharyngitis:
1) Test with a sensitive rapid antigen detection test (RADT)
-Follow-up throat culture not always needed
a) If positive RADT, treat with antibiotics
b) If negative RADT, additional testing not usually needed (only in some pts)

62
Q

You should reserve throat culture to confirm negative RADT for GABHS pharyngitis in what groups of patients?

A

-Children
-High-risk for severe infection or complications (i.e., h/o ARF or immunocompromised)
-Close contact with high-risk people (i.e., caring for infants, immunocompromised)
-Living in areas of high GAS prevalence (i.e., college dorms)
-Living in areas of ARF endemic or active epidemics
-High clinical suspicion for GAS despite negative RADT (i.e., exposure to persons with GAS, > 3 Centor criteria)

63
Q

GABHS pharyngitis: describe the Tx

A

1) Analgesic (i.e., NSAIDs, acetaminophen)
2) PO antibiotic preferred 1st line (i.e., penicillin VK, cefuroxime, cefpodoxime) x 10 days
-Can also use amoxicillin 500mg BID x 10 days
PO antibiotic for PCN allergy (i.e., erythromycin, azithromycin)
-Antibiotic for compliance problem or unable to take PO meds (i.e., benzathine PCN or procaine PCN as single IM injection)

64
Q

Complications of GABHS:
1) Is Acute rheumatic fever (ARF) rare? What labs would be elevated?
2) Which is associated with intrinsic renal failure? What are the Sx/ signs?

A

1) Acute rheumatic fever (ARF): Rare, 1 case per 100,000
-Joint swelling/pain, subcutaneous nodules, erythema marginatum, myocarditis, chorea
-Lab: elevated ESR/CRP
2) Poststreptococcal glomerulonephritis: Intrinsic renal failure
-Hematuria, edema

65
Q

GABHS pharyngitis complications:
1) Are peritonsillar abscesses a rare complication? What are the signs?
2) What are the signs/ Sx of scarlet fever?

A

1) Rare, <1%; toxic appearance
2) Punctate, erythematous, blanchable, sandpaper-like exanthem
-Neck, groin, axillae
-Accentuated in body folds and creases (Pastia’s lines)
-Strawberry tongue

66
Q

slide 68
List the Sx of GAHS pharyngitis

A

1) Sudden onset of sore throat
2) Fever
3) Tonsillopharyngeal and/ or uvular edema
4)

67
Q

slide 68

A
68
Q

What is diphtheria a type of?

A

Bacterial meningitis

69
Q

1) Who should you suspect Gonococcal pharyngitis in?
2) What are the signs/ Sx?
3) Tx? (hint: 2 things at once)

A

1) Sexually active patients
2) Fever, dysuria, greenish exudate
3) Ceftriaxone 250mg IM,
-AND Azithromycin 1 gm PO x 1 dose

70
Q

Diphtheria:
1) Signs/ Sx?
2) Tx?

A

1) Sore throat, low-grade fever, adherent grayish membrane, tender cervical adenopathy
2) Antitoxin + Antibiotic
Erythromycin 500 mg IV QID OR PCN G 50,000 units/kg IV q12h

71
Q

Sialadenitis:
1) What is it in general?
2) What can it be seen with?
3) What is often the cause?
4) What are the signs/ Sx?

A

1) Acute swelling of the parotid or submandibular gland
2) Can also be seen with dehydration and chronic illness
Sjogren’s syndrome, chronic periodontitis
3) Often bacterial cause – S. aureus
4) Increased pain and swelling with meals

72
Q

Sialadenitis:
1) What should you expect upon PE?
2) How should you treat it?

A

1) Tenderness and erythema of the duct opening
Pus often massaged from the duct
2) Hydration, warm compresses
-Sialagogues – lemon drops
-Massage the gland
-IV antibiotics (PO for less severe cases)

73
Q

Suppurative parotitis:
1) What is it?
2) What typically causes it?
3) Who’s it most common in?
4) What should you consider in kids and young adults? What should you evaluate?

A

1) Acute infection of parotid gland (viruses & bacteria)
2) S. aureus & mixed oral aerobes & anaerobes
3) Debilitation, dehydration, & poor oral hygiene, particularly among elderly postoperative patients
4) Mumps in children & young adults; sarcoidoisis
-Testicles (epididymo-orchitis)

74
Q

Suppurative parotitis:
1) What are some signs/ Sx?
2) What are some systemic Sx?
3) What would you possibly see on PE?

A

1) Firm, erythematous swelling
-Pain & tenderness
-Possible trismus & dysphagia
2) Fever & chills
3) Purulence from Stenson’s duct

75
Q

Suppurative parotitis:
1) How’s it diagnosed?
2) Treated?

A

1) US (preferred initially), CT, MRI
-Elevated serum amylase in absence of pancreatitis
-Gram stain & culture discharge
2) Inpatient hydration & IV antibiotics (admission)
-Surgical I&D if no response in 48 hours

76
Q

Pre-cancer: Leukoplakia
1) What is it?
2) Risk factors?
3) How do you Dx?
4) Tx?

A

1) White adherent patch or plaque; premalignant lesion
2) Tobacco, dentures, lichen planus
-2-6% dysplasia or early SCC
3) Biopsy
4) Watchful waiting; +/- excision

77
Q

Oral hairy leukoplakia:
1) What does it look like? Where?
2) Who’s it prevalent with? What’s it associated with?
3) Is it premalignant?
4) How do you treat it?

A

1) White, corrugated & painless plaques usually on lateral tongue; plaques cannot be scraped off
2) HIV, organ transplant, malignancy, steroids (systemic or inhaled)
-Associated with EBV
3) No; not considered premalignant
4) Treatment usually not indicated; antivirals may provide temporary resolution

78
Q

True or false: oral cancer is an example of a neoplasm

A

True

79
Q

Oral cancer: SCC
1) Risk factors?
2) What would you see on PE?
3) How do you Dx?
4) Tx?

A

1) Risk factors: increasing age, tobacco use, alcohol use
2) Raised, firm, white lesions with ulcers at base
-Can lead to nodularity or ulceration
-Usually involves the lateral surface of the tongue
-Quite painful with gentle palpation
3) Biopsy
4) Surgery/radiation

80
Q

1) Upper airway FBs are most common in who?
2) Where are they most common?
3) How are they treated?

A

1) Young children
2) 52% in right main bronchus
3) Airway management

81
Q

What are the signs/ Sx of an upper airway FB?

A

1) Sudden episode of choking or coughing
2) Subsequent wheezing, coughing, or stridor
3) 1/3 of parents were unaware of the aspiration or remembered an event that occurred more than a week prior

82
Q

Esophageal FB:
1) What usually causes them? Do most pass spontaneously?
2) Who are they most common in? What is a concerning example of an esophageal FB?
3) What are some Sx of complete esophageal obstruction?
4) Tx?

A

1) Usually due to food bolus impaction; most will pass spontaneously (80%)
2) Peak incidence between 6 months & 6 years; small batteries (necrosis/perforation)
3) Drooling, inability to handle secretions
4) Flexible endoscope
-Glucagon 1.0 mg IV (relaxes the esophagus)
-Airway management

83
Q
A
84
Q

What two glands can sialadenitis affect? What else differentiates it from suppurative parotitis?

A

Parotid and submandibular; not always bacterial

(PA school) CAM I (16 decks)

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