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Aging- Phys > Foundations-Mouth and Throat > Flashcards

Foundations-Mouth and Throat Flashcards

1
Q

What percentage of acute pharyngitis is caused by bacteria?

A

5-15%

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2
Q

What bacteria causes acute pharyngitis?

A

Group A beta-hemolytic Streptococcus

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3
Q

Acute pharyngitis PE findings

A 
Pharyngeal erythema
Tonsillar hypertrophy
Purulent exudate
Tender and/or enlarged anterior cervical lymph nodes
Palatal petechiae
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4
Q

Center criteria for GABHS

A
  1. Tonsillar exudate
  2. Fever
  3. Tender cervical adenines
  4. Absence of cough
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5
Q

Who gets strep testing (rapid antigen detection testing)?

A

2-3 centor criteria

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6
Q

What age group do you add a point to determine rapid antigen detection testing?

A

Ages 3-14 y.o.

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7
Q

What age group do you subtract a point to determine rapid antigen detection testing?

A

Age >45 y.o.

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8
Q

What is the RADT sensitivity for GABHS?

A

70-90%;

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9
Q

What is the RADT specificity for GABHS?

A

90-100%:

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10
Q

How long do results take to get back for RADT?

A

15 minutes

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11
Q

What is the throat culture Sensitivity for GABHS?

A

90-95%

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12
Q

How long does it take to get a throat culture back?

A

24-48 hrs

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13
Q

What is your treatment of choice in GABHS?

A

Penicillin V 500 mg PO BID – TID x 10 days OR

Amoxicillin 500 mg BID x 10 days

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14
Q

If you have a PCN allergy, what would you prescribe in GABHS?

A

Macrolides: erythromycin, clarithromycin, azithromycin

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15
Q

Complications of GABHS?

A

Acute rheumatic fever

Acute glomerulonephritis

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16
Q

Paradise criteria for tonsillectomy

A
  1. 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
  2. Episode = ST + fever >100.9 OR tonsillar exudate OR anterior cervical adenopathy OR culture confirmed GABHS
  3. Appropriate antibiotic treatment for strept episodes
  4. Recommend 12 month observation period
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17
Q

What is the most common deep neck infection in children and adolescents?

A

Peritonsillar abscess

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18
Q

Etiology of peritonsilar abscess

A

Streptococcus pyogenes (GABHS)

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19
Q

What are the 3-5 main sx’s of a peritonsilar abscess

A
  1. Severe sore throat
  2. Fever
  3. “hot potato” or muffled voice
  4. Trismus
  5. Drooling
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20
Q

PE findings in a peritonsilar abscess

A
  1. Swollen, fluctuant tonsil with deviation of uvula to the opposite side
  2. Bulging of posterior soft palate
  3. Cervical LAD
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21
Q

Abx therapy for peritonsilar abscess

A

Parenteral: Ampicillin-sulbactam OR Clindamycin
Oral: Amoxicillin-clavulanate OR Clindamycin X 14 days

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22
Q

What is the most common cause of laryngitis

A

Respiratory viruses

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23
Q

What is the most common noninfectious causes of laryngitis?

A

Vocal abuse

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24
Q

What is the main clinical presentation in laryngitis?

A

Hoarseness

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25
Q

What is a common chronic cause in laryngitis?

A

GERD

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26
Q

What is most common cause of epiglottitis?

A

Haemophilus influenzae type B (HiB)

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27
Q

What are the clinical presentations in epiglottitis?

A 
3 D's:
1. Dysphagia
2. Distress
3. Drooling
\+ "Tripod" or "sniffing" position"
-Trunk leaning forward
-Mouth open
-Neck and chin extended
28
Q

What would you expect to find on an lateral plain x-ray in a pt with epiglottitis?

A

“Thumb sign”

29
Q

Antibiotic treatment in epiglottitis?

A

3rd generation cephalosporin & antistaphylococcal (vancomycin)
+/- Dexamethasone

30
Q

What causes oral herpes simplex, “cold sores”?

A

Herpes simplex virus type 1

31
Q

What areas of the body does coxsackie A16 virus infect?

A
  • Hand
  • Foot
  • Mouth
32
Q

What is the main difference between a herpes infection versus a coxsackie infection?

A

Coxsackie-PAPULAR lesions

Virus- VESICULAR lesions

33
Q

What is the main difference between a hand foot mouth (coxsackie) infection versus a Herpangia infection?

A

Herpangia-Higher fever +lesions more posterior

Coxsackie- Low grade fever + lesions more anterior

34
Q

What is Aphthous ulcers associated with (possible etiology)?

A

HHV-6

35
Q

What is the cause of Bechet’s?

A

inflammatory disorder

36
Q

Treatment for Bechet’s?

A

Refer to Rheumatologist

37
Q

What population does oral candidiasis most often effect?

A 
Infants
Older adults (dentures)
38
Q

Risk factors for oral candidiasis

A
  • Diabetes Mellitus
  • Steroid use
  • Antibiotics
  • HIV
39
Q

What would you see on a KOJ prep if a pt has oral candidiasis

A

Budding yeasts with or without pseudohyphae

40
Q

Etiology of oral lichen planus

A

Chronic, inflammatory autoimmune dz

41
Q

What can oral leukoplakia be associated with?

A

HPV

–>Considered a precancerous lesion

42
Q

How do you differentiate oral leukoplakia from candidia or lichen planus?

A

White lesions CANT be removed

43
Q

Etiology of erythroplakia?

A

Malignancy, >90%

44
Q

Diagnosis of erythroplakia?

A

Biopsy

45
Q

Etiology of hairy leukoplakia

A

Epstein-Barr virus

46
Q

What population do we see hairy leukoplakia in?

A

HIV pt’s

47
Q

Clinical presentation of hairy leukoplakia?

A
  • Lateral tongue

- White, painless plaque, cannot be scraped

48
Q

Etiology of Mucoceles

A

Mild oral trauma-lip chewers!

49
Q

Define amalgam tattoo

A

Benign black spot seen adjacent to amalgam fillings

50
Q

Define Torus palatines

A
  • Benign boney lesion on hard palate

- Always midline!!!

51
Q

Etiology of dental caries

A

Strep mutans

52
Q

Complications of dental caries

A

Intraoral abscess
Cellulitis
Brain abscess

53
Q

What gland does Sialolithiasis/Sialadenitis stones most often occur in ?

A

Wharton duct (submandibular duct)

54
Q

Treatment for What gland does Sialolithiasis/Sialadenitis

A

Sialagogues-Suck on candy

55
Q

What is the most common neck space infection?

A

Ludwig’s angina

56
Q

What is the biggest concern with Ludwig’s angina?

A

Airway compromise

57
Q

Define Ludwig’s angina

A

Cellulitis of sublingual and submaxillary spaces

58
Q

Risk factors for squamous cell carcinoma

A

Tobacco and alcohol

–>account for up to 80% of SCC of the head and neck

59
Q

Clinical presentation of squamous cell carcinoma

A

Papules, plaques, erosions, ulcers that DO NOT resolve

60
Q

Why is oropharyngeal cancers increasing in incidence?

A

HPV-mediated cancers

61
Q

How many weeks of hoarseness in adult is considered to be cancer of the larynx?

A

6 weeks

62
Q

What strains of HPV are associated with SCC of the tongue, tonsil & pharynx in 46% post mortem specimens

A

16, 18 & 31

63
Q

Etiology of Nasopharyngeal Carcinoma

A

Environmental Factor

–>Epstein-Barr virus

64
Q

What is the most common genetic abnormality in head and neck cancer?

A

P53 Tumor Suppressor Gene

65
Q

When do you refer to an ENT?

A
  1. Mass in the neck
  2. Otalgia
  3. Odynophagia
  4. Dysphagia
  5. Hoarse for > 3 weeks
  6. Lump below or in front of the ear
  7. Persistent oral ulcer
  8. Unilateral serous otitis

Aging- Phys (6 decks)

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