Foundations-Mouth and Throat Flashcards
What percentage of acute pharyngitis is caused by bacteria?
5-15%
What bacteria causes acute pharyngitis?
Group A beta-hemolytic Streptococcus
Acute pharyngitis PE findings
Pharyngeal erythema Tonsillar hypertrophy Purulent exudate Tender and/or enlarged anterior cervical lymph nodes Palatal petechiae
Center criteria for GABHS
- Tonsillar exudate
- Fever
- Tender cervical adenines
- Absence of cough
Who gets strep testing (rapid antigen detection testing)?
2-3 centor criteria
What age group do you add a point to determine rapid antigen detection testing?
Ages 3-14 y.o.
What age group do you subtract a point to determine rapid antigen detection testing?
Age >45 y.o.
What is the RADT sensitivity for GABHS?
70-90%;
What is the RADT specificity for GABHS?
90-100%:
How long do results take to get back for RADT?
15 minutes
What is the throat culture Sensitivity for GABHS?
90-95%
How long does it take to get a throat culture back?
24-48 hrs
What is your treatment of choice in GABHS?
Penicillin V 500 mg PO BID – TID x 10 days OR
Amoxicillin 500 mg BID x 10 days
If you have a PCN allergy, what would you prescribe in GABHS?
Macrolides: erythromycin, clarithromycin, azithromycin
Complications of GABHS?
Acute rheumatic fever
Acute glomerulonephritis
Paradise criteria for tonsillectomy
- At least 7 episodes in the last year OR at least 5 episodes in each of the past 2 years OR at least 3 episodes in each of the past 3 years
- Episode = ST + fever >100.9 OR tonsillar exudate OR anterior cervical adenopathy OR culture confirmed GABHS
- Appropriate antibiotic treatment for strept episodes
- Recommend 12 month observation period
What is the most common deep neck infection in children and adolescents?
Peritonsillar abscess
Etiology of peritonsilar abscess
Streptococcus pyogenes (GABHS)
What are the 3-5 main sx’s of a peritonsilar abscess
- Severe sore throat
- Fever
- “hot potato” or muffled voice
- Trismus
- Drooling
PE findings in a peritonsilar abscess
- Swollen, fluctuant tonsil with deviation of uvula to the opposite side
- Bulging of posterior soft palate
- Cervical LAD
Abx therapy for peritonsilar abscess
Parenteral: Ampicillin-sulbactam OR Clindamycin
Oral: Amoxicillin-clavulanate OR Clindamycin X 14 days
What is the most common cause of laryngitis
Respiratory viruses
What is the most common noninfectious causes of laryngitis?
Vocal abuse
What is the main clinical presentation in laryngitis?
Hoarseness
What is a common chronic cause in laryngitis?
GERD
What is most common cause of epiglottitis?
Haemophilus influenzae type B (HiB)
What are the clinical presentations in epiglottitis?
3 D's: 1. Dysphagia 2. Distress 3. Drooling \+ "Tripod" or "sniffing" position" -Trunk leaning forward -Mouth open -Neck and chin extended
What would you expect to find on an lateral plain x-ray in a pt with epiglottitis?
“Thumb sign”
Antibiotic treatment in epiglottitis?
3rd generation cephalosporin & antistaphylococcal (vancomycin)
+/- Dexamethasone
What causes oral herpes simplex, “cold sores”?
Herpes simplex virus type 1
What areas of the body does coxsackie A16 virus infect?
- Hand
- Foot
- Mouth
What is the main difference between a herpes infection versus a coxsackie infection?
Coxsackie-PAPULAR lesions
Virus- VESICULAR lesions
What is the main difference between a hand foot mouth (coxsackie) infection versus a Herpangia infection?
Herpangia-Higher fever +lesions more posterior
Coxsackie- Low grade fever + lesions more anterior
What is Aphthous ulcers associated with (possible etiology)?
HHV-6
What is the cause of Bechet’s?
inflammatory disorder
Treatment for Bechet’s?
Refer to Rheumatologist
What population does oral candidiasis most often effect?
Infants Older adults (dentures)
Risk factors for oral candidiasis
- Diabetes Mellitus
- Steroid use
- Antibiotics
- HIV
What would you see on a KOJ prep if a pt has oral candidiasis
Budding yeasts with or without pseudohyphae
Etiology of oral lichen planus
Chronic, inflammatory autoimmune dz
What can oral leukoplakia be associated with?
HPV
–>Considered a precancerous lesion
How do you differentiate oral leukoplakia from candidia or lichen planus?
White lesions CANT be removed
Etiology of erythroplakia?
Malignancy, >90%
Diagnosis of erythroplakia?
Biopsy
Etiology of hairy leukoplakia
Epstein-Barr virus
What population do we see hairy leukoplakia in?
HIV pt’s
Clinical presentation of hairy leukoplakia?
- Lateral tongue
- White, painless plaque, cannot be scraped
Etiology of Mucoceles
Mild oral trauma-lip chewers!
Define amalgam tattoo
Benign black spot seen adjacent to amalgam fillings
Define Torus palatines
- Benign boney lesion on hard palate
- Always midline!!!
Etiology of dental caries
Strep mutans
Complications of dental caries
Intraoral abscess
Cellulitis
Brain abscess
What gland does Sialolithiasis/Sialadenitis stones most often occur in ?
Wharton duct (submandibular duct)
Treatment for What gland does Sialolithiasis/Sialadenitis
Sialagogues-Suck on candy
What is the most common neck space infection?
Ludwig’s angina
What is the biggest concern with Ludwig’s angina?
Airway compromise
Define Ludwig’s angina
Cellulitis of sublingual and submaxillary spaces
Risk factors for squamous cell carcinoma
Tobacco and alcohol
–>account for up to 80% of SCC of the head and neck
Clinical presentation of squamous cell carcinoma
Papules, plaques, erosions, ulcers that DO NOT resolve
Why is oropharyngeal cancers increasing in incidence?
HPV-mediated cancers
How many weeks of hoarseness in adult is considered to be cancer of the larynx?
6 weeks
What strains of HPV are associated with SCC of the tongue, tonsil & pharynx in 46% post mortem specimens
16, 18 & 31
Etiology of Nasopharyngeal Carcinoma
Environmental Factor
–>Epstein-Barr virus
What is the most common genetic abnormality in head and neck cancer?
P53 Tumor Suppressor Gene
When do you refer to an ENT?
- Mass in the neck
- Otalgia
- Odynophagia
- Dysphagia
- Hoarse for > 3 weeks
- Lump below or in front of the ear
- Persistent oral ulcer
- Unilateral serous otitis
