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Infectious Disease and HEENT > HEENT Exam 2 Cards > Flashcards

HEENT Exam 2 Cards Flashcards

1
Q

Anatomy of the ear canal

A

Medial two thirds contain thin skin overlying the osseous canal and is easily traumatized
Outer third is cartilaginous with hair follicles, sebaceous, and ceruminous glands

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2
Q

MCC of diffuse otitis externa

A

Pseudomonas

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3
Q

Clinical presentation of diffuse acute otitis externa

A

Fullness, Conductive hearing loss, Pain with tragus and auricle palpation, swollen canal with moist debris

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4
Q

4 topical antibiotics for diffuse otitis externa

A

Ofloxacin, Ciprofloxacin (can be systemic), Polymixin B, Neomycin

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5
Q

Ear wick

A

Placed in swollen ear canal to help distribute medicine and keep it in the canal

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6
Q

Furnunculosis

A

Acute otitis externa that effects hair follicles in the lateral 1/3 of the canal

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7
Q

MCC of furnunculosis

A

S. aureus

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8
Q

Treatment for furnunculosis

A

Oral Dicloxacillin or Cephalexin (Keflex) with I&D if needed

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9
Q

Otomycosis

A

Chronic otitis externa caused by aspergillosis or candadiasis

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10
Q

Clinical presentation of otomycosis

A

Ear itching and foreign body sensation in ear, can arise from abx or humidity - visualized mold in ear

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11
Q

Treatment for otomycosis

A

Clean the canal and give cotrimazole BID for 10-14 days

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12
Q

3 causes of non-infective otitis externa

A

Seborrheic dermatitis, psoriasis, Contact dermatitis

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13
Q

Clinical presentation of non-infective otitis externa

A

Red, scaly, dry canal

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14
Q

Treatment for non-infective chronic otitis externa

A

Topical hydrocortisone cream or otic drops

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15
Q

Malignant/Necrotizing Chronic Otitis Externa

A

Life threatening non-cancer infection that spreads from the skin to the bone and marrow of the skull - MCC pseudomonas

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16
Q

3 populations in which Malignant/Necrotizing otitis externa is most common

A

Elderly, Diabetic, and Immune compromised patients

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17
Q

3 clinical presentations of malignant/necrotizing chronic otitis externa

A

Deep seated otalgia, Granulation tissue at bony-cartilaginous junction of ear floor, foul smelling and prurulent

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18
Q

Neurologic and other red flag signs of malignant/necrotizing otitis externa

A

Cranial nerve palsy, meningitis, thrombosis of sigmoid sinus

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19
Q

Workup and treatment for malignant/necrotizing Chronic otitis externa

A

CT to determine extent
Glucose control
IV and oral ciprofloxacin is the treatment of choice for 6-8 weeks! - may need debreidment

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20
Q

Presentation of Herpes Zoster Oticus

A

Unilateral facial nerve palsy with facial vesicular eruption

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21
Q

Treatment for Herpes Zoster Oticus

A

Prednisone and Famciclovir or Valacyclovir

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22
Q

Another name for Herpes Zoster Oticus facial paralysis

A

Ramsey-Hunt syndrome

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23
Q

Cause of cerumen impaction

A

Usually self induced - recommended to only clean ear canal opening with washcloth over index finger

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24
Q

3 symptoms of cerumen impaction

A

Ear pain, fullness, Decreased conductive hearing loss

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25
Q

5 contraindications for cerumen impaction removal

A

Presence or hx or perforated TM, Previous pain on irrigation, Mastoidectomy or middle ear surgery, Uncooperative patient, Very hard cerumen

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26
Q

4 techniques for cerumen removal

A

Irrigation - water and steam followed by drying
Mechanical/Microsuction
AT HOME
Hydrogen peroxide
Detergent ear drops

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27
Q

Contraindication for otic foreign body removal via irrigation

A

Anything organic that might expand

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28
Q

Extra step for removal of live insects from the ear

A

Immobilize with lidocaine before using alligator forceps

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29
Q

Auricle hematoma

A

“Cauliflower ear”
Collection of blood under the perichondria of the ear

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30
Q

Treatment of auricle hematoma

A

Refer if more than 7 days old
Lidocaine auricular block
I&D
Irrigate
Compression dressing for 7 days

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31
Q

Lidocaine auricular block procedure

A

2 injections diagonal from the top, 2 diagonal from the bottom - can do with 2 needles

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32
Q

2 goals for an auricular laceration

A

Cover exposed cartilage
Minimize wound hematoma

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33
Q

4 Exams for auricular laceration

A

TM and Auditory Canal
Facial nerve
Basilar skull fracture
Hearing deficit

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34
Q

Prophylaxis for auricular laceration

A

Tetanus or Antibiotics if indicated

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35
Q

Technique for auricular laceration surgery

A

Anesthetize, Debride, Irrigate, Suture, Pack, Compress, Check after 24 hours

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36
Q

Amount of tissue loss that should be referred to plastic surgery for an auricular laceration

A

5mm of tissue or more

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37
Q

Three things that can cause auricular cellulitis

A

Minor trauma, Insect bite, or ear piercing

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38
Q

2 most common pathogens for auricular cellulitis

A

Staph aureus and Strep. spp

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39
Q

4 antibiotics for auricualr cellulitis

A

Cephalexin
Bactrim (MRSA)
Clinda (MRSA)
IV Vanc - if fever, rapid spread and tachycardia

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40
Q

Perichondrium

A

Infection of the perichondrium (where blood pools in cauliflower ear) due to local trauma surgery or burns

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41
Q

Area usually involved in perichondritis`

A

Top of ear, usually not the lobule

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42
Q

Clinical presentation of perichondritis

A

Swollen, red, tender ear

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43
Q

2 most common causes of perichondritis

A

Pseudomonas and Staph aureus

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44
Q

Treatment for perichondritis

A

Start within 5 days
Oral or IV ciprofloxacin
I&D

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45
Q

Normal TM color

A

Pearly gray

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46
Q

Middle ear infusion

A

Fluid in the middle ear

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47
Q

Acute otitis media

A

Acute infection of middle ear fluid

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48
Q

Otitis media with effusion

A

Middle ear fluid that is NOT infected also called “serous OM”

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49
Q

3 potential antecedent events to otitis media

A

Upper respiratory tract infection
Eustachian tube dysfunction with mucosal infection
Negative pressure followed by an increse in middle ear secretions

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50
Q

3 signs of acute otitis media

A

Bulging, erythema, white discoloration

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51
Q

3 main causes of OM

A

S. pneumo - MCC
H. flu
M. cat

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52
Q

E. coli OM

A

first months of life

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53
Q

Pseudomonas OM

A

Chronic, Supperative OM

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54
Q

Common OM cause in children with tympanostomy tubes

A

Staph

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55
Q

4 clinical findings that point to otitis media

A

Ear pain, Bulging TM, Poor mobility of TM, May have fever

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56
Q

Additional diagnostic tool for OM

A

Tympanometry - look for absent mobility

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57
Q

4 initial therapies for OM

A

Amoxicillin
Cefdinir
Cefuroxime
Azithromycin (not effective for H. flu)

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58
Q

4 secondary therapies for resistant OM

A

Augmentin
Cefdinir
Ceftriaxone
Clindamycin

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59
Q

When should secondary OM treatments be used

A

If they have had antibiotics in the past 30 days or treatment failure after 72 hours

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60
Q

Recommendation to penicillin allergic OM patients

A

Cephalosporin for non-anaphylaxis
Z-max or Doxy for patients w/ anaphylaxis

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61
Q

Length of OM antibiotic treatment

A

10 days under 6 yrs
5-7 days over 6 yrs

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62
Q

3 ways to qualify for tympanostomy tube placement

A

3 AOM in 6 months
4 AOM in 12 months
Unresponsive to pharmacology

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63
Q

3 complications of acute otitis media

A

Hearing loss
Mastoiditis
Meningitis

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64
Q

3 ways to prevent AOM

A

Breast feed or upright bottle feed
Avoid passive smoke exposure
Avoid pacifier use after 10 months

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65
Q

AOM with bullae present

A

Bullous Myringitis

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66
Q

Clinical presentation of bullous myringitis

A

More painful than AOM with bullae

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67
Q

Treatment for bullous maryngitis

A

Same as AOM but may need to cover for atypicals with zithromax

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68
Q

Clinical presentation of a tympanic membrane rupture

A

Sudden decrease in pain followed by otorrhea

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69
Q

Two topical antibiotics for ruptured TM

A

Ofloxacin and Ciprodex

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70
Q

Treatment for TM rupture

A

Oral and Topical abx, Audiogram now and in 3 months, Earplugs while swimming or in bath

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71
Q

Resolution of TM rupture

A

Spontaneous resolution takes weeks to months
Tympanoplasty if no resolution

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72
Q

3 descriptors for TM rupture documentation

A

Location (clock face)
Size
Signs of infection (ie. erythema)

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73
Q

Scar on the TM

A

Tympanosclerosis

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74
Q

Chronic suppurative OM

A

Perforated TM with chronic purulent drainage for 6+ weeks

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75
Q

Clinical presentation of chronic suppurative OM

A

Otorrhea, Painless, conductive hearing loss
Refer to otolaryngology

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76
Q

4 causes of chronic OM

A

Pseudomonas, Proteus, Staph, Anaerobes

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77
Q

Topical treatment for chronic OM

A

Ofloxacin or Cipro with dexamethasone for exacerbation

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78
Q

Oral treatment for chronic OM

A

Cipro for 1-6 weeks

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79
Q

Definitive treatment for chronic OM

A

Surgical in most cases

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80
Q

Cholesteatoma

A

Abnormal growth of squamous epithelium that may destroy the ossicles and cause chronic negative pressure
Often a result of eustachian tube dysfunction

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81
Q

4 clinical features of a cholesteatoma

A

White mass behind TM
Chronic infections
Ear drainage for 2 weeks despite treatment
Focal granulation at the TM periphery

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82
Q

Treatment for cholesteatoma

A

Refer to surgery

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83
Q

Clinical features of mastoiditis

A

Pain, swelling, and proptosis of the mastoid process

Look for one ear that sticks out WAY more than the other

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84
Q

Complications of mastoiditis

A

Subperiosteal abcess
Deep neck abcess
Septic thrombosis of lateral sinus

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85
Q

Diagnostic for mastoiditis

A

CT scan - compare with other mastoid

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86
Q

Treatment for mastoiditis

A

IV Rocephin or Ancef for 7-10 days
PO Augmentin or cefdinir
Myringotomy (I&D)

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87
Q

2 things that open the eustachian tube

A

Yawning or swallowing

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88
Q

3 causes of eustacian tube dysfunction

A

Viral URI - MCC
Allergies
Edema of tubal lining

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89
Q

3 symptoms and one sign of eustachian tube dysfunction

A

Ear fullness
Mild/moderate hearing impairment
Popping or crackling sound with yawning/swallowing
TM retraction with decreased mobility

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90
Q

4 treatments for eustachian tube dysfunction

A

Decongestants
Autoinflation
Steroids for allergies
Avoid air travel and diving

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91
Q

How barotrauma happens

A

Negative middle ear pressure tends to collapse and lock the auditory tube - can be painful

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92
Q

Treatment and Prevention for barotrauma

A

Decongestants can help, VT tubes, autoinflation and myringotomy can also be useful treatments

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93
Q

When should decongestants be used on a flight to prevent barotrauma

A

1 hour before arrival for topical
Several hours for oral

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94
Q

Perilympatic fistula

A

Rupture of oval or round window leading to vertigo, hearing loss, and emesis

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95
Q

2 conditions you should not dive with

A

URI or perforated TM

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96
Q

Common presentation of diving related barotrauma

A

Hemotympanum

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97
Q

Exosteses/Osteomas

A

Bony overgrowth of ear canal d/t benign tumors

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98
Q

Significance of osteomas

A

Usually not significant if solitary, multiple can be from cold water exposure and may require surgery

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99
Q

2 ear canal neoplasias

A

Squamous cell - more aggressive can be life threatening if it goes lymphatic
Adenomatous - ceruminous glands - more indolent

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100
Q

Rhinorrhea

A

Runny nose

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101
Q

Coryza

A

Describes cold symptoms such as mucous membrane inflammation

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102
Q

Rhinitis

A

Symptomatic disorder of the nose characterized by itching, nasal discharge, sneezing, and nasal airway obstruction

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103
Q

Rhinosinusitis

A

Symptomatic inflammation of the nasal cavity and paranasal sinuses

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104
Q

MCC of the common cold

A

Rhinoviruses

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105
Q

Upper respiratory tract infection

A

Usually refers to the common cold

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106
Q

URI transmission

A

Hands, droplets, fomites

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107
Q

Usual clinical course of URIs

A

10-14 days
3 weeks in kids
Peak viral shedding on days 2 and 3 but may persist

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108
Q

Three most common features of a URI

A

Rhinitis, Nasal congestion, Rhinorrhea

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109
Q

3 complications from a URI

A

Rhinosinusitis, Otitis media, Pneumonia

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110
Q

Sinuses present at 1 year old

A

Maxillary and Ethmoid

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111
Q

Sinus that develops after 2

A

Sphenoid sinus

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112
Q

Treatment for URI

A

NO ANTIBIOTICS
NSAIDs, Fluids, decongestants, irrigation

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113
Q

Sinus that develops after 12

A

Frontal sinus (develops with frontal lobe??)

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114
Q

Most common sinus infected in bacterial rhinosinusitis

A

Maxillary sinus

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115
Q

4 precursors to bacterial rhinosinusitis

A

Viral URI, Allergic Rhinitis, NG-Tube, Dental infections

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116
Q

2 most common pathogens that cause bacterial rhinosinusitis

A

Strep pneumo
H. flu

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117
Q

Pathophysiology of bacterial rhinosinusitis

A

Pathway is obstructed from edema leading to buildup of muscous that becomes infected

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118
Q

Maxillary sinus pain

A

Unilateral facial fullness with pressure and tenderness over the cheek

119
Q

Ethmoid sinus pain

A

Usually referred to the orbits

120
Q

Sphenoid sinus pain

A

associated with pansinusitis (all cavities on ONE side) refers to vertex (top) of the head

121
Q

Frontal sinus pain

A

Pain on the forehead and on palpation below the medial end of the eyebrow

122
Q

Location of sphenoid sinus

A

Behind the bottom of the nose

123
Q

Diagnostic criteria for acute bacterial rhinosinusitis

A

s/s of acute rhinitis lasting 10+ days
OR
Onset of high fever with purulent discharge and facial pain 3-4 days
OR
Symptoms of viral URI that slowly improve but than worsen to more severe after 5-6 days

124
Q

Diagnostics for acute bacterial rhinosinusitis

A

Clinical
CT can be done but not necessary for routine cases
Nasal culture NOT useful

125
Q

Treatment for acute bacterial rhinosinusitis

A

Observation for 7-10 days
Can use oxymetazoline spray for symptomatic relief or flonase

126
Q

Rhinitis medicamentosa

A

rebound congestion with ABRS when Afarin is administered

127
Q

Treatment for ABRS that lasts more than 10 days

A

Augmentin is first line
Macrolides, Bactrim, and Ceph not recommended
Treatment for 7-10 days

128
Q

Antibiotics for penicillin allergic pts

A

FQ or Zmax if the patient cannot tolerate a cephalosporin

Clindamycin and cefixime or cefpodoxime if the patient CAN tolerate a cephalosporin

129
Q

Treatment for orbital cellulitis

A

CT
I&D
Vanc and Ceftriaxone

130
Q

Treatment for subperiosteal abcess (Pott’s puffy tumor)

A

Tender doughy swelling over forehead
I&D
6 weeks of antibiotics depending on sensitivity

131
Q

Intracranial complications that can result from ABRS

A

Cavernous sinus thrombosis
Meningitis

132
Q

Invasive fungal sinusitis

A

Invasive opportunistic infection of the sinuses caused by saprophytic fungi in the immune compromised - can be life-threatening

133
Q

Clinical findings of invasive fungal sinusitis

A

Severe facial pain
Black eschar on middle turbinate - necrosis
Orbital cellulitis

134
Q

Diagnosis and treatment of invasive fungal sinusitis

A

Nasal endoscopy with biopsy to diagnose
IV amphotericin B for 3-6 months
Switch to oral itraconazole

135
Q

Chronic sinusitis

A

Sinusitis that persists for more than 12 weeks
Diagnose with CT and refer for culture guided antibiotics

136
Q

Indication for sinus surgery

A

When antibiotics fail to clear infection - open up the passageway

137
Q

Chronic fungal sinusitis

A

Non invasive, more insidius aspergillis infection of the sinuses, biopsy to diagnose
IV amphotericin followed itraconazole to treat
Poor prognosis

138
Q

Chronic fungal sinusitis

A

Allergy induced, treated with surgery to remove drainage and debris

139
Q

Wegners granulomatosis

A

Condition that causes inflammation of the blood vessels and reduced blood flow to the nose- sinus pain. cough fever, hematuria, and hearing loss

140
Q

Clinical presentation of wegners granulomatosis

A

Smell disturbances, Nasal crusting Saddle nose defomity, Purulent/bloody discharge

141
Q

Diagnosis and treatment of wegner’s granulomatosis

A

Rheumatologic work-up
Imaging and biopsy
Treat with steroids and immunosuppressants

142
Q

Cause of perennial vs. seasonal allergic rhinitis

A

Perennial = Chronic (ie. household)
Seasonal = Pollens
Tree to grass to weeds
Fungi full growing season

143
Q

Immunoglobulin that mediates allergic responses

A

IgE

144
Q

Clinical presentation of allergic rhinitis

A

Similar to viral but with persistent and seasonal variation, pruritis

145
Q

3 phisical signs of allergic rhinitis

A

Shiners under eyes, Salute and crease, Allergic faces, pharyngeal cobblestoning, boggy nasal mucosa

146
Q

Diagnosis of allergic rhinitis

A

Accurate hx
Allergy skin testing
Eosinophils in nasal discharge

147
Q

Prick puncture method of allergy testing

A

Intrademal - must be off antihistamines for 5 days

148
Q

Allergen specific IgE serum testing

A

No antihistamine cessation necessary, just as good as prick puncture

149
Q

4 symptoms that qualify allergic rhinitis as severe

A

Sleep disturbance
Impairment of daily activities
Impairment of school or work
Troublesome symptoms

Only need 1

150
Q

Persistent allergic rhinitis

A

More than four days a week for more than four weeks

151
Q

Treatment for allergic rhinitis

A

Clean nose if crusted
IN Glucocorticoids for persistent and moderate-severe
Flucatisone, mometasone, beclomethasone

152
Q

Topical nasal spray use

A

NOT PRN
Can cause local irritation and epistaxis
Tilt head forward pointing bottle to ipsillateral ear

153
Q

H1 antagonists

A

Antihistamines that antagonize the H1 receptor
Allergic rhinitis, conjunctivitis, Angioedema, Pruritis and uticaria

154
Q

1st generation antihistamines

A

Sedating can cause weight gain
Benadryl
Atarax
Vistaril

155
Q

2nd generation antihistamines

A

Preferred because they don’t have sedative properties
Zyrtec and Claritin
Allegram Carinex, Xyzall
Can rotate medication if tolerance occurs

156
Q

Decongestant use for Allergic rhinitis

A

Sudafed, zicam are options
Can cause insomnia and anti-cholinergic symptoms

157
Q

Other treatment options for allergic rhinitis

A

Cromolyn
Leukotriene antagonists
Ipratropium bromide (anticholinergic)
SQ allergy shots if very severe

158
Q

Vasomotor rhinitis

A

Non allergic sneezing rhinorrhea and post nasal drip
Worse with weather changes but no allergy symptoms
May be gustatory in response to eating

159
Q

Rhinitis medicamentosa

A

Nasal obstruction due to overuse of decongestants
Switch to steroids to treat

160
Q

Area where 95% of nosebleeds originate

A

Keisselbach’s plexus - anterior epistaxis

161
Q

Signs of posterior epistaxis

A

Source not visualized
Bleeding from BOTH nares
Blood in posterior pharynx

162
Q

4 perdisposing factors for epistaxis

A

Trauma (including picking), Deviated septum, Alcohol, Neoplasms

163
Q

Management for anterior epistaxis

A

pressure on sight for 15 minutes
Sit leaning forward
Phenyephrine for vasoconstriction or nasal congestants

164
Q

Management of anterior epistaxis if the bleeding will not stop

A

Topical 4% cocain, or lidocaine and epinephrine
Silver nitrate if ID on bleeding point
Nasal packing or baloon

165
Q

Management of posterior epistaxis

A

Associated with hypertension and atherosclerosis
ENT consultation for packing, narcotic analgesics, ligation

166
Q

Antibiotic prophylaxis for epistaxis w/packing and patient education

A

Augmentin, Clindamycin, Keflex w/ 48-72 hour follow up
Avoid intense exercise, spicy food, nasal trauma and lubricate

167
Q

Nasal polyps

A

Pale edematous mucosally covered masses
See with allergies due to prolonged irritation
May suggest cystic fibrosis in children

168
Q

Treatment for nasal polyps

A

Topical nasal steroids for 1-3 months with surgical removal if unsuccessful

169
Q

Clinical presentation of a nasal foreign body

A

Unilateral obstruction, foul smelling rhinorrhea, Persistent unilateral epistaxis

170
Q

Removal tools for nasal foreign body

A

Suction catheter, slligator forceps, positive pressure

171
Q

2 workup considerations for nasal fractures

A

Consider the airway and exclude cervical spinal injuries

172
Q

Septal hematoma

A

Widening of the nasal septum
Needs I&D and anti staph abx

173
Q

Cribriform plate fracture

A

Can cause CSF leakage - test

174
Q

Aphthous stomatitis

A

Canker sore - often caused by stress - may be associated with herpes 6 virus

175
Q

Treatment for Aphthous stomatitis

A

No definitive treatment
Can use viscous lidocaine or steroids for supportive care

176
Q

Herpes gingivostomatitis

A

HSV 1 cold sore triggered by stress, 2-3 day prodromal phase with fever following in initial infection

177
Q

Clinical presentation of gingivostomatitis

A

Initial burning followed by vescicle formation and crusting around the lips. May have cervical adenopathy

178
Q

Diagnosis for Herpes gingivostomatitis

A

PCR is definitive, Tzanck smear for multinucleated cells is less so

179
Q

Treatment for herpes gingivostomatitis

A

Antivirals started within 24-48 hours
Acyclovir or Valacyclovir
2% viscous lidocaine

180
Q

Oral candidiasis

A

Thrush, scrapes off with a tongue blade
Infants, dentures, diabetes, immune compromised

181
Q

Clinical findings of oral candidiasis

A

Painful burning tongue, beefy with white patches that can be scraped off

182
Q

Diagnosis for oral candidiasis

A

Wet KOH prep looking for budding yeasts with or without pseudohyphae

183
Q

Treatment for oral candidiasis

A

Nystatin, fluconazole, magic mouthwash
May need to sanitize bottles for babies and treat mothers breasts if breastfeeding

184
Q

Angular cheilitis

A

Inflammatory lesion of the corner of the lips, usually breakdown due to excessive moisture due to thumb sucking, etc. invaded by candida albicans

185
Q

Treatment and prevention for angular cheilitis

A

Clotrimazole or Miconazole BID topical
Stop licking lips, wear lip balm, ensure dentures fit properly to prevent drooling

186
Q

Glossitis

A

Inflammation of the tongue and loss of filiform papillae resulting in a red smooth surface - rarely painful

187
Q

Usual cause of glossitis

A

Nutritional deficiencies, Dehydration, drug reaction

188
Q

Treatment of glossitis

A

Treat primary cause or begin empiric nutritional replacement therapy

189
Q

Glossodynia

A

Intraoral burning sensation in the mouth
without glossitis in postmenopausal women
With glossitis in other causes

190
Q

Treatment Treatment for glossdynia

A

Treat underlying cause
Clonazepam, TCAs, Behavioral therapy help

191
Q

Oral leukoplakia

A

Hyperkeratosis in response to chronic irritation. White patchy lesion that cannot be scraped off the tongue

192
Q

Management and treatment for leukplakia

A

Always biopsy for carcinoma
Surgical removal with elimination of irritating factos
Follow up in 3 months

193
Q

Erythroplakia

A

Like leukoplakia but erythematous, sharply demarcated firey red patch - HIGH risk of malignancy

194
Q

Management of erythroplakia

A

Refer for biopsy
Surgical excision with clear margins
Eliminate contributory factors such as tobacco and alcohol

195
Q

Hairy leukoplakia

A

Raised, “hairy” surface occuring on the lateral portion of the tongue - usually in the immunocompromised
Usually no treatment is needed
HAART and antivirals can be used

196
Q

Oral lichen planus

A

Chronic inflammatory autoimmune disease of unknow etiology - reticular or lacy pattern on the tongue
Biopsy for definitive diagnosis and to differentiate from carcinoma

197
Q

Treatment for oral lichen planus

A

high potency topical corticosteroids
educate on oral hygiene and smoking cessation

198
Q

Geographic tongue

A

Looks like a map
Rapidly changing well demarcated red lesions with raised borders
May have discomfort or burning
Comes and goes
No treatment needed

199
Q

Black tongue

A

hyperpigmentation of the tongue and oral mucosa commonly seen in dark skinned individuals

200
Q

5 drugs that can cause black tongue

A

Tetracycline, Linezolid, Pepto-Bismol, Antidepressants, PPIs

201
Q

Hairy tongue

A

NOT the same as hairy leukoplakia
On dorsal midline of tongue, retention of keratin on tips of filliform papillae
Due to coffee, smoking, tea, or poor oral hygeine

202
Q

Wharton’s duct

A

Submandibular gland opening - flow against gravity

203
Q

Stensen’s duct

A

Drains the parotid gland

204
Q

Clinical presentation of sialolithiasis

A

Postprandial pain
Swelling
Spasm upon eating

205
Q

4 treatments for sialolithiasis

A

Local heat, Massage, Hydration, Sour candy or salagen/evoxac

206
Q

Tretment for sialolithiasis that is not improving

A

Inscise duct and remove stone

207
Q

Suppurative parotitis

A

MCC = Staph aureus
Can be anearobic bacteria

208
Q

Non-suppurative parotitis

A

Viral (mumps, flu, EBV, etc.) or non-infectious (CF, DM, Alcohol, gout)

209
Q

5 things that can lead to suppurative parotitis

A

Intubation, Intensive teeth cleaning, Anticholinergics, Malnutrition, Ductal onstruction

210
Q

Clinical presentation of suppurative parotitis

A

Glandular swelling
Fever
Dysphagia
Unilateral
Pus from duct when massaged

211
Q

3 DIfferentials for parotitis

A

Stone, Abcess, Tumor
US or CT to look at it
Clinical diagnosis

212
Q

Treatment for suppurative parotitis

A

IV antibiotics b/c can spread to neck tissue
Nafcillin or 1st gen cephalosporin PLUS Metronidazole or Clindamycin

Switch to oral clinda plus cipro

Vanc or Linezolid for MRA

Surgical I&D if no response within 48 hours of intiation

213
Q

Complications of suppurative parotitis

A

Progression of infection to bone marrow, neck, resp. tractr, blood
Fistula

214
Q

MCC of non-suppurative parotitis

A

Parainfluenza and Epstein Barr (was Mumps) resolves in 5-10 days

215
Q

Sialadentitis

A

Submandibular gland inflammation
Tenderness and erythema often caused by S. aureus
May need culture and CT

216
Q

Treatment for sialadenitis

A

Hydration
Warm compress
Same abx as parotitis
I&D if unresponsive

217
Q

MCC of bacterial dental decay

A

Strep Mutans - communicable plaques calcify if not removed

218
Q

Childhood risk factors for dental caries

A

Use of a sippy cup containing sugars
Sleeping with a bottle
Non fluoridated water
Dryness

219
Q

Clinical presentation of dental caries

A

Demineralized areas
Painless, opaque brown spots

220
Q

Management of dental caries

A

Refer to a dentist
Fluoride

221
Q

4 risk factors for adult dental caries

A

Sjogren’s syndrome
Medications that decrease saliva flow
Radiation of the head and neck
Existing restorations or appliances

222
Q

Clinical features of adult dental caries

A

Brownish discoloration, Diffuse pain with heat or cold exposure
Pain gets more severe with spread to pulp

223
Q

Treatment for adult dental caries

A

Refer to dentist
Fluoride mouth rinse
Treat xerostomia

224
Q

Dental abcess presentation

A

Toothache with blister at tooth base
Dicharge and thermal hypersensitivity

225
Q

Dental abcess treatment

A

SMALL:
PCN +/- metromidazole
Cinda if allergic
LARGE:
I&D
IV antibiotics
Dental referral

226
Q

Gingivitis

A

Inflammation of the gums - results from prolonged exposure to plaque, may result from steroid hormones
Clinical diagnosis

227
Q

3 medications that cause gingival hyperplasia

A

Calcium channel blockers. Phenytoin, Cyclosporine

228
Q

Acute necrotizing ulcerative gingivitis

A

Trench mouth
Poor oral hygeine, alcohol, and tobacco causing painful, friable gingiva
Halitosis
Fever
Lymphadenopathy

229
Q

Treatment for acute necrotizing ulcerative gingivitis

A

Debridement and Metro, Clinda, or Augmentin
Peroxide or chlorahexidine as adjunct

230
Q

Periodontitis

A

Chronic inflammatory disease which complicates from gingivitis
Damages alveolar bone and periodontal ligaments
Major cause of tooth loss

231
Q

Management and Risk factors of periodontitis

A

Poor oral hygeine, smoking, poverty
Educate and refer to a dentist

232
Q

Dry socket

A

2-3 days after tooth extraction displacement of a clot leads to exposure of the alveolar bone

233
Q

Management of Dry socket

A

Often from impacted 3rd molar extractions
PCN or Clinda

234
Q

MCC of acute pharyngitis

A

Usually viral

235
Q

Symptom that sets apart adenovirus pharyngitis

A

Conjunctivitis - use to differentiate from strep

236
Q

Etiologies of a sore throat with ulcers

A

Ulcers

237
Q

Mono rash

A

Happens when PCN given to pt with mono
Macular papular

238
Q

Classic lab finding for mono`

A

Atypical lymphocytosis

239
Q

When does tamiflu need to be started for influenza

A

within 24-48 hours

240
Q

Patient education for mono

A

Avoid contact sports -risk of splenic rupture

241
Q

Associated symptoms of strep pharyngitis

A

Scarlatinaform rash that fades in 2-5 days
Palatal petichiae
Strawberry tongue

242
Q

Thorough throat swab

A

Should cause a gag reflex, avoid gums/teeth

243
Q

4 centor criteria

A

Tonsilar exudate
Lymphadenopathy
No cough
Fever

244
Q

Treatment for strep throat

A

PCN
Keflex
Z-max
First line

CHange toothbrush

245
Q

Peritonsilar abcess

A

Infection penetrates tonsillar capsule
Strep pyogenes or Staph aureus
Unilateral

246
Q

SIgns of pertonsilar abcess

A

Hot potato voice
Didn’t finish strep treatment
Drooling
Very painful swallowing

247
Q

Imaging for peritonsilar abcess

A

CT with IV contrast

248
Q

Treatment of peritonsilar abcess

A

Maintain airway
I&D
Unasyn or CLinda - IV
May need vanc IV

249
Q

Retropharyngeal abcess

A

Abcess of deep neck structure that can be the result of a URI or forign body ingestion

250
Q

Clinical presentation of retropharyngeal abcess

A

BIG lump in back of throat - must be intubated very carefully
Odynophagia and irritability

251
Q

Diagnostic of retropharyngeal abcess

A

CT of neck with IV contrast
Labs not essential as with peritonsilar abcess
May want to culture any pus

252
Q

Management of retropharyngeal abcess

A

Maintain airway
Unisyn, Ceftriaxone and Metronidazole or Clinda and Levofloxacin
Drain with US
Surgery if not getting better
Switch to oral once they get better

253
Q

Tripod position

A

hands in front leaning forward - indicates difficulty breathing

254
Q

Laryngitis

A

Inflammation of the larynx causing hoarseness
Can be reflux, vocal strain, infectious

255
Q

Clinical presentation of laryngitis

A

Hoarseness
URI hx
Pharyngitis w/ fever points to infection
Strep, rhinovirus, candidiasis

256
Q

Treatment of laryngitis

A

Supportive care if viral
Oral steroids for actors/singers - main need vocal therapy
Surgery for polyps
PCN or erythromycin for bacterial
Treat GERD w/ PPI

257
Q

Laryngotracheobronchitis (Croup)

A

Barky seal cough with respiratory distress
MCC=Parainfluenza
COld air helps
Stridor
Steeple sign on X-ray

258
Q

Treatment of croup

A

Minimal handling
Supportive care and cool air
Fluids
Most can be managed at home
Bring in if stridor at rest or morethan a week
Dexamethasone shot for severe nebulized epinephrine - observe afterwards

259
Q

Epiglottitis

A

Airway emergency MCC=H flu can be vaccinated

260
Q

Clinical presentation of Epiglottitis

A

Tripod position
Drooling
Can’t breath
Inflamed epiglottis with laryngoscopy
Sore throat is too severe for what you can see in the back of the throat

261
Q

Treatment of epiglottitis

A

Intubate Emperic IV Ceftriaxone possible steroid use

262
Q

CLassic neck X-ray sign for epiglottitis

A

THumbprint sign

263
Q

2 nearves that cause hoarseness when damaged

A

Recurrent laryngeal nerve and CN X

264
Q

Ludwig’s angina

A

Bilateral neck space infection caused by a tooth
MCC=Strep viridans
Aggressive and fast spreading

265
Q

4 clinical signs of ludwigs angina

A

Woody cellulitis
Rapidly spreading w/o lymph node involvement
Sublingual and submaxillary spaces involves
Bilateral

266
Q

Complications of Ludwigs angina

A

airway obstruction
Bull neck
Drooling

267
Q

Treatment of ludwig’s angina

A

Empiric IV abx
Unasyn
Ceftriaxone metronidazole
Clinda and Levo for PCN allergy
I&D may be needed

268
Q

Vocal chord nodules

A

Usually benign - often from vocal abuse ie. performers

269
Q

Vocal chord polyps

A

Smoking or chemicals

270
Q

Squamous cell carcinoma of the larynx

A

Most common malignancy
Hoarseness
Trouble swallowing
Surgery (invasive) and chemo

271
Q

Vocal cord paralysis

A

VOcl cords naturally open -get paralyzed on one side - asymmetry on larygoscopy

272
Q

Cause of vocal cord paralysis

A

Damage to Recurrent Laryngeal nerve in surgery (thyroidectomy)

273
Q

Clinical presentation of VCP

A

Dyspnea, stridor is bilateral
Hoarsness if unilateral

274
Q

Grade 0 tonsils

A

TOnsils removed

275
Q

Grade 4 tonsils

A

Kissing at midline

276
Q

One thing to ask about when you see hypertrophic tonsils

A

Sleep apnea

277
Q

When to remove tonsils

A

Causing apnea/snoring
Recurrent throat infection (more than 3 episodes in 3 each in years, 5 each in in two, 7 each in in one)

278
Q

Treatment for tonsil stones

A

Irrigation -tonsilectomy if SEVERE

279
Q

Pain on dynamic loading

A

Hurts when biting a tongue depressor

280
Q

3 types of TMJ issues

A

Myofacial - Most common
Dislocation
Osteoarthritis - Degenration

More in females

281
Q

Cause of TMJ issues
and clinical presentation

A

Psych exacerbation or trauma
Teeth grinding
Clicks and crepitus
Tenderness
Jaw can lock
Headache
Ear fullness/pain

282
Q

Treatment for TMJ issues

A

Reduce stress
Rest Botos for muscles
Soft diet

283
Q

When to refer TMJ

A

Recurrent problems

284
Q

COmmon emerging cause of head and neck cancer

A

HPV in young populations

285
Q

Clinical red flags for neck cancer

A

Chronic sore throat
Change in speach
Lesions that don’t heal
Tobacco use
Change in tongue mobility

286
Q

3 neck mass categories

A

Infectous
Malignant
Non-malignant

287
Q

Size cutoff for cancer determination

A

1.5 cm or greater = cancer

288
Q

Lymph node

A

Tender and mobile

289
Q

Tumor

A

Firm and non painful
Bump that becomes a lesion

290
Q

Diagnostic study for suspected neck malignancy

A

FNA
Take whole mass if doing biopsy

291
Q

Where does HPV show up in the mouth

A

Base of tongue or tonsils
Can be asymptomatic
Can be spread by aerosol to healthcare workers!!

292
Q

Where does squamous cells cancer show up in the mouth

A

Oropharynx

293
Q

Treatment for SC carcinoma

A

Surgery if local
Radiation or chemo is lymph involved
Palliative if Mets

Infectious Disease and HEENT (4 decks)

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