Exam 1 Flashcards
Aphthous Stomatitis
S. Recurring, painful, solitary or multiple ulcers; covered by white/yellow pseudomembrane; surrounded by erythematous halo
O. “
A. Diagnosis from history and PE; biopsy only useful in eliminating other differential diagnoses
P. Topical corticosteroids to tx symptoms
Minor Aphthous Stomatitis
Usually well-circumscribed; <5; small
Common on labial mucosa, buccal mucosa, ventral side of tongue
Heal without scarring in 10-14 days
Majority do not require tx
Major Aphthous Stomatits
Larger lesions; 1-10 lesions; onset after puberty
Common on labial mucosa, soft palate, tonsillar fossas
Heal with scarring in 2-6 weeks
Herpetiform Aphthous Stomatitis
Small, multiple ulcerations that may coalesce
Onset in adulthood
May affect any oral surface
Typically heal in 7-10 days
Oral Herpes Simplex Virus
S. prodromal symptoms of pain, burning, itching may occur 6-24 hours before lesions
O. Multiple, small erythematous papules which progress to clusters of vesicles
A. PE or culture
P. Antiviral agents (acyclovir, etc)
Heals within 7-10 days
Acute Herpetic Gingivostomatitis
6months - 5 yo
S. Painful gingiva; oral lesions; often accompanied by cervical lymphandenopathy, fever, chills, nausea, anorexia, irritability
O. Initial pinhead vesicles rapidly enlarge and develop central ulcerations with erythematous bases; gingiva is enlarge and erythematous
A. H & PE; viral culture if vesicles are intact; cytologic smear; serologic tests for HSV; biopsy if chronic ulcers
P. Antivirals; symptomatic relief with lidocaine or oral NSAIDs
Self inoculation; mild cases resolve in 5-7d; severe cases 1-2wk
Oral Candidiasis
S. oral white plaques
O. white plaque that can be removed
A. KOH prep, PE
P. Polyene agents (Nystatin - swish&swallow); imidazole agents; triazoles
Oral Candidiasis - Pseudomembranous Candidiasis
“Thrush”
Removable white plaques on buccal mucosa, palate, dorsal tongue
May be associated with burning sensation or foul taste
Oral Candidiasis - Erythematous Candidiasis
Lacks white component; red macular areas due to loss of filiform papillae on hard palate, buccal mucosa, dorsal tongue
Usually presents with burning sensation
More frequent in patients with xerostomia
Oral Candidiasis - Angular Cheilitis
Scaling erythematous fissures at corners of mouth
Lesions may be co-infected with Staph aureus
Common with dentures or iron or vit B deficiency
Hairy Tongue
S. Brown/black or yellow discoloration; halitosis or metallic taste
O. Inadequate desquamation or increased keratinization of papillae; elongation and hypertrophy of filiform papillae on dorsal surface of tongue
A. Hx & PE - more common with heavy smokers and pts with poor oral hygiene
P. Self improve
Leukoplakia
S. white, non-removable plaque on lip vermilion, buccal mucosa, gingiva
O. Hyperkeratosis of the surface epithelium
A. Biopsy
P. Excision
~4% transform into squamous cell carcinoma (especially proliferative verrucous leukoplakia)
Erythroplakia
S. Often asymptomatic
O. Well-demarcated erythematous macule or plaque with soft, velvety texture on floor of mouth, tongue, soft palate
A. Biopsy
P. Depends on degree; long-term follow-up required
Higher prevalence in older population; more likely than leukoplakia to be malignant
Oral Squamous Cell Carcinoma
S. Oral lesion that doesn’t heal within 14 days; pain in mouth; lump or thickening in the cheek; difficulty swallowing/chewing; ear pain; difficulty moving jaw or tongue; voice changes; numbness; swelling of oral cavity; bleeding; red or white lesions; persistant halitosis
O.
A. Biopsy; direct laryngoscopy, bronchoscopy and esophagoscopy to exclude a simultaneous second cancer;
head/neck/chest CTs
P. Surgical excision, radiation therapy
Metastatic spread usually to ipsilateral cervical lymph nodes
Lip Vermilion Carcinoma
Common to sun exposure or cigarette smoking
Crusted, nontender lesion with oozing ulceration
Slow growing with late matastasis
Intraoral Squamous Cell Carcinoma
Most commonly on the tongue; usually painless indurated mass or ulcer
Often arises from preexisting leukoplakia or erythroplakia
Exophytic or endophytic lesions normal/white/red in color
TM Perforation
Causes: trauma, infection, middle ear barotrauma
Symptoms: otorrhea
Signs: perforation; weber lateralizes to side of perforation (conductive hearing loss)
Mgmt: keep dry; ENT referral; sometimes abx
Middle Ear Hematoma
Cause: head trauma
Mgmt: careful observation; hearing should return in 6-8 wks; no abx unless signs of infection
Hematoma of the Pinna
Prompt drainage to avoid cauliflower ear!
Eustachian Tube Dysfunction
Failure of valve to open and/or close –> disrupts pressure regulation, protection of middle ear, mucociliary clearance
Causes: Failure of tubal dilatory action or valve incompetency leading to chronic patency (surgery!)
Barotrauma
Abrupt onset of pain, fullness in ear, conductive hearing loss, dizziness, tinnitus, vertigo, nausea/vomiting, transient facial paralysis, TM rupture
Causes: air travelers, scuba divers
Tx: open eustachian tube; antihistamines, decongestants, abx to prevent infection
Epistaxis
Have pt lean forward and blow nose; pinch nose below nasal bones for 5-10min; spray nares with oxymetazoline (nasal decongestant to shrink edema and vasoconstrict)
Otitis Externa - “Swimmer’s Ear”
Common bacteria: Pseudomonas aeruginosa (green discharge) & Staph aureus (yellow discharge); fungal
S. ear pain, pruritis, fullness, hearing loss, discharge
O. erythema & edema
A. culture discharge if severe or recurrent
P. keep clean, avoid water, relieve pain, topical abx; (vinegar sol for fungal)
Necrotizing (malignant) Otitis Externa
Seen in diabetics & immunocompromised
Pseudomonas infection that involves underlying bone
S. fever, deep-seated otalgia & discharge
O. foul-smelling discharge, cranial nerve palsies
A. CT scan
Acute Otitis Media
Strep pneumoniae, Haemophilus influenzae, Moraxella catarrhalis
Previous URI
S. irritable, fever, otalgia
O. bulging TM, decreased TM mobility
A.
P. abx for 6mo if severe or bilateral; amoxicillin x10d; NSAID and/or acetaminophen for pain and fever
Hearing loss may take up to 1 month to resolve
Chronic Otitis Media
> 3 episodes per 6 months; conductive hearing loss; TM perf with purulent discharge
Tx with myringotomy/tympanostomy tubes if persistant symptoms, hearling loss >40dB, speech delays, evidence of TM damage
Mastoiditis
Extension of OE or AOM into mastoid air cells
CT scan to look for bony destruction
IV abx, ENT consult
Serous Otitis Media with Effusion
Middle ear effusion secondary to inflammation or eustachian tub dysfunction; previous URI, AOM, allergic rhinitis
S. fullness, usually painless, afebrile
O. retraction of TM
A.
P. majority resolve within 12 wks; 10 day amoxicillin and/or oral steroids
Labyrinthitis (vestibular neuronitis or otitis interna)
Benign, acute inflammation or infection of vestibular system
Commonly associated with viral infections
Acute onset of vertigo, nystagmus, possible nausua/vomiting, no tinnitus/hearing loss/CNS deficits
Tx. bedres, hydration
Laryngitis
Inflammation around larynx causing hoarseness; usually viral URI
Peritonsillar Abscess
Generally post-URI; unilateral, worse than tonsillitis, drooling, difficulty swallowing, cervical adenopathy
ENT referral - has to be drained
