ENT Exam Flashcards
All Diseases/Conditions
Leukplakia
= chronic irritation (dentures, tobacco, lichen planus) causing hyperkeratotic response and rare malignancy
S/S: white patch on oral mucosa that CANNOT BE REMOVED
ENT referral -> surgical excision tx
***incisional biopsy if enlarging, ulcerating, or depth on palpation
Erythroplakia
= fiery red sharply demarcated erythematous patch on oral mucosa
***90% dysplastic or carcinoma (older pts with tobacco or ETOH use)
PE: check lymph nodes!!!
HEENT referral -> all lesions require bx and SURGICAL excision with clear margins
Lichen Planus
Pruritic, planar, purple, polygonal papules
scalp, extremities, nails, and mucous membranes
Whickham’s striae
Autoimmune etiology… T cell mediated to epithelial cells…rarely beyond vermillion border
S/S: lacy leukoplakia erosive, reticular
DX: definitive requires biopsy
TX: topical corticosteroids 1st line!!
Oral Candidiasis
= immune suppression results in overgrowth of Candida albicans fungus
RF: dentures, poor oral hygiene, DM, anemia, chemo, steroids, abx
“thrush”
S/S: creamy-white curd-like plaques, erythematous oral cavity, fluctuating throat/mouth discomfort
***plaques easily removed with tongue depressor
DX: wet prep KOH PRN
TX: Nystatin swish and swallow 5mL OR Fluconazole 100mg po qd x 7d
Glossitis
= red, smooth surfaced tongue +/- glossodynia (burning/pain of tongue)
DX: clinical dx
TX: ID causative agent and tx underlying condition
Apthous Ulcers/Stomatitis
= “canker sore”, trauma/stress can predispose to viral eruption
buccal and tongue…NOT gingiva or palate
S/S: painful, small round ulcerations with yellow-gray fibrous center surrounded by red halo
HHV 6
self-linited…
Herpes Stomatitis
= HSV 1 -> mild initial burning -> small vesicles that rupture and form scabs -> lesions on lip junction
TX: self-limited, Acyclovir to decrease duration and risk of postherpetic pain
Sialadenitis
= MC bacterial etiology? S. aureus
dehydration or chronic illness predispose to ductal obstruction via mucus plug -> stasis -> secondary infection
**Usually Parotid and Submandibular glands
S/S: ACUTE GLAND SWELLING AND PAIN, tenderness and erythema of duct
DX: clinical
TX: IV/PO abx, swelling decreases in 2-3 weeks, increase salivary flow
Sialolithiasis
= unknown etiology but stagnation of salivary flow & elevated Ca levels contribute to calculus formation in salivary gland
S/S: postprandial pain and local swelling, may be able to see or palpate the stone
DX: clinical
TX: HEENT referraly, dilate/incise duct OR Sialoendoscopy (Distal/larger stones only)
Salivary Gland Tumors
RF: radiation, smoking, viral (EBV, HIV, HPV)
**Majority of in parotid gland and typically benign pleomorphic adenomas or warthin tumors
S/S: usually asx mass in superficial gland…careful if involves facial nerve!
DX: CT/MRI and FNA bx
TX: parotidectomy or submandibular gland excision
Sjogren Syndrome
= Dry eyes and dry mouth causing ocular sx and xerostomia
Ocular sx: burning, itching, FB sensation
Xerostomia: cotton mouth, difficulty swallowing dry foods, dental carries
+/- H/O RA or other connective tissue dz
DX: Rheum factor & ANA, Schirmer test (measures tears secreted), Lip bx (lymphoid foci on access. salivary glands)
TX: alleviate sx’s, artificial tears, cyclosporine, hydration, chewing gum
Mumps/Parotitis
= Paramyxovirus respiratory droplet spread -> 12-15 days post exposure -> onset
S/S: painful swollen salivary glands (parotid), +/- F/C, trismus, orchitis, parotid tenderness with overlying facial edema
DX: elevated IgM, Mild leukopenia
TX: sx management, vaccination ppx (MMR), isolation
Acute Viral Rhinosinusitis
= common cold MC d/t Rhinovirus/Adenovirus
spread via hand contact, small and large particle droplets
S/S: sore throat, nasal congestion, rhinorrhea, hyposmia (dec. sense of smell), malaise, HA, cough, conjunctivitis <10 days
PE: erythematous engorged nasal mucosa, watery dischargery w/o purulence
TX: supportive care (NSAID, sudafed, zinc, honey)
**NO ABX, ANTIHISTAMINES, ANTIVIRALS
Acute Bacterial Rhinosinusitis
= less common than viral…impaired mucociliary clearance -> nasal inflammation and obstruction
MC S. pneumoniae and H. flu
S/S:
