Final - Oropharynx

Question 1

With Herpes Labialis

• common symptoms prior to lesions appearing
• cause
• triggers

Answer 1

cold sore

• burning, tingling, itching
• HSV-1 causes episodes of vesicles eruption (usually recurrent)
• infection, emotional stress, fatigue

Question 2

What are we looking for with an oral exam of the lips?

Answer 2

Color (cyanosis or pallor)
Lesions
Congenital deformities (cleft lip and/or palate are common)

Question 3

What 5 areas do we check with an oropharynx exam of the mouth and throat?

Answer 3

Lips, mucosa, teeth, tongue, pharynx

Question 4

What is IMPORTANT TO KNOW about the treatment for Herpes Labialis (cold sores)

Answer 4

Not required

Vesicles typically rupture and crust over in ~1 week without treatment
(If not resolved within 1 week monitor for signs of secondary infection)

duration of symptoms is only shortened if topical or oral treatment is started within 24-48 hours of the onset of initial symptoms (pain, itching, burning)

Question 5

What are TREATMENT OPTIONS for Herpes Labialis (cold sores)

Answer 5

OTC topical creams
–> Example: docosanol 10% (Abreva) applied 5x/day

Ancedotal use of citrus or tea tree oils

Referral to PCP for oral antiviral prescription medication (Rx) is also an option
–> Example: Acyclovir orally 5x/day for 7–10 days

Question 6

With Angular Cheilitis what are

• symptoms
• causes

Answer 6

• Edentulous patient with figuring at the angles of the mouth

Symptoms

• excessive moisture from ill-fitting dentures/no teeth
• possibly nutrition deficiencies (iron, B2 [riboflavin])

Question 7

What is the treatment for angular cheilitis?

Answer 7

• Identify and treat underlying cause (can become secondarily infected > consider culture for candida or bacteria)
• refer to dentist for denture fitting
• recommend protective barrier: zinc oxide or Vaseline
• refer to PCP if bacterial/fungal treatment needed

Question 8

Ulcerated or crusted lesion

Answer 8

Squamous Cell Carcinoma (SCC)

Question 9

What is the management for SCC?

Answer 9

• refer to dermatologist for biopsy/resection if suspected

* early detection is KEY! Can usually be cured by local resection if treated when <2 cm

Question 10

What are you looking for when inspecting the oral mucosa?

Answer 10

Lesions or masses

*can see by all mucosa, opening of the parotid duct

Question 11

What is buccal mucosa

Answer 11

Inside of cheek

Question 12

What are three salivary glands

Answer 12

Parotid - drains to upper buccal mucosa

Submandibular and sublingual gland -

Question 13

Stone formation in a salivary gland or duct is known as ______ and is most common in the _____

What are the risk factors

Answer 13

Sialolithiasis
Submandibular

-dehydration, smoking

Question 14

Unilateral, painful, facial swelling from a stone in

duct. (Sometimes only swelling, sometimes only pain) worse when eating & swelling comes and goes.

Answer 14

Sialandenitis

Question 15

Conservative treatment for Sialolithiasis/Sialadenitis

4 things

Answer 15

1. Apply heat to the area
2. Massage gland/duct
3. Plentiful hydration
4. Tart hard candies (lemon drops) to promote salivary secretion > may flush out small stones

*consider referral to PCP or urgent care for antibiotic co-treatment

Question 16

Well-defined, soft nodule on the inner lip

filled with clear mucus. Caused by trauma of minor salivary gland

Answer 16

Mucocele

Question 17

What is the treatment for mucocele

Answer 17

• may resolve spontaneously

- may require surgical removal

Question 18

Painful 1-5mm round white superficial ulcer

surrounded by red border/halo

Answer 18

Aphthous ulcer (canker sore)

Question 19

What is the prevalence of aphthous ulcer (canker sore).

Prognosis?

Answer 19

Affects 20-25% of people at some point in time

Good - typically resolve on their own within 2 weeks
Bad - common to have recurrences

Question 20

Treatment for aphthous ulcer (canker core)

Answer 20

OTC symptomatic relief may be obtained with
• benzocaine (Orabase, Anbesol, Orajel) – avoid food and drink for 30 minutes after application

Naturopathic remedies
• Citrus oil/magnesium salt patches
• DGL (deglycyrrhizinated liquorice) mouthwash/chews

Refer to PCP for Rx options if severe:
– Steroids - topical paste or oral (pill form)
– Mouthwashes

Question 21

What is a Candida yeast infection that will scrape off

Answer 21

Thrush

• Can result from taking antibiotics or prescription
  steroids but may also indicate immunocompromised state

Question 22

What is the treatment for thrush?

Answer 22

Refer to PCP for antifungal

Question 23

What is a Thick white plaque that is potentially cancerous and Does NOT scrap off?

Answer 23

Leukoplakia

Question 24

What is the management for leukoplakia?

Answer 24

Must refer for biopsy if present for >2-3 weeks

Refer to oral surgeon or ENT

Question 25

red swollen gum margins caused by plaque

Answer 25

Gingivitis

Question 26

What is a puffy red spot in the mouth than can be cause by a cavity that traveled to the root? Can lead to swollen, painful face

Answer 26

Tooth abscess * Refer to PCP, urgent care, or dentist for antibiotics

Question 27

What is halitosis Where does it come from

Answer 27

Chronic, bad breath Most often comes from oral cavity or nasal passages – occasionally lung abscess or GI disorder

Question 28

What could a sweet or fruity breath odor be due to

Answer 28

Ketoacidosis of diabetes

Question 29

What could ammonia breath be due to

Answer 29

Kidney failure

Question 30

What could fishy or rotting breath odor be due to

Answer 30

Hepatic disease

Question 31

A lesion on the tongue lasting ___ is concerning

Answer 31

>2 weeks

Question 32

Chronic raised white lesion, firm, painless*

Answer 32

Carcinoma

Question 33

What are the risk factors for oral carcinoma

Answer 33

Tobacco, alcohol, human papilloma virus (HPV)

Question 34

Sides of tongue, white will NOT scrape off, | seen in HIV/AIDs (viral infection)

Answer 34

Hairy Leukoplakia of Tongue

Question 35

Benign bony growth(s) in the sublingual area

Answer 35

Torus Mandibularis (singular) aka Mandibular Tori (plural) *no management required)

Question 36

Benign bony growth on the hard palate

Answer 36

Torus palatinus

Question 37

If bilaterally enlarged tonsils are present with no ____, ___ or ____, it is probably not infected

Answer 37

Fever, sore throat, lymphadenopathy

Question 38

Tonsillitis with exudate is cause by ____

Answer 38

Viral URI or bacterial infection

Question 39

What are the 4 symptoms of strep throat?

Answer 39

CAFE - no cough - anterior cervical adenopathy - fever - tonsillar exudates *use total score to determine diagnostic testing and management plan (2-4 of sx needed to refer for rapid strep testing ad antibiotics)

Question 40

A strep score of O to 1 treatment

Answer 40

Provide symptomatic conservative care recommendations for assumed non-strep pharyngitis

Question 41

Strep score 2-4 treatment

Answer 41

Perform rapid antigen test - Antigen test positive: refer to PCP or urgent care for antibiotics - Antigen test negative: Send throat culture

Question 42

Non-strep pharyngitis conservative care

Answer 42

- Salt water gargles - Teas - Lozenges - OTC throat sprays - OTC analgesics (acetaminophen, ibuprofen, aspirin) —> Side