HEENT mouth Flashcards
Common causes of pharyngitis are
infectious,
immune
xerostomia
dehydration
GERD
degenerative
trauma
congenital
vitamin - zinc
neoplastic
most common cause of pharyngitis ..
viral
T/F, 40 % of children and 20 % of adults are affected by GABHS, streptoccus pyogenes
True
cause of pharyngitis
which viruses causes viral pharyngitis
EBV (mono), rhinovirus, HSV-1 and 2, CMV, and coxsackie virus
Pt has a history of sore throat, odynophagia, rhinitis, acute onset, what does this pt have?
viral pharyngitis
upon a PE for viral pharyngitis, you see..
erythema of the tonsils and posterior oropharynx without exudate
+/- fever
+/- adenopathy
*rapid strep screen + culture
treatment : supportive bc its viral
what is the clinical presentation for GABHS strep pharyngotonsillitis
fever
anterior cervical adenopathy
posterior oropharyngeal exudate
lack of cough, common cold symptoms
diagnostic test and antibiotic Rx for GABSH is
strep and cultural strep
PEN VK 50 mg/kg/pediatric X 10 days
PEN VK 1 - 2 grams/day/adults x 10days
allergic to PEN VK: cephalosporin and erythromycin
which criteria do you use to diagnose GABHS strep? and what are you looking for
centor
absence of cough
tonsillar exudates
history of fever
tender anterior cervical adenopathy
age under 15 = +1
age over 44 = - 1
pt has a 2-3 centor score, you do the following:
supportive care, rapid strep test, abx is positive, if not, culture, if positive,
infectious mononucleosis is caused by which virus, affects who, and how it is contracted
EBV
young adults
oral contact
for IM (infectious mononucleosis), you see the following on PE exams
lymph node enlargement: posterior triangle neck
hepatosplenomegaly (possible)
diagnosis for infectious mononucleosis will be
monospot to check for heterophile Ige (prior)/ Igm (Acute) (delayed)
lymphocytosis on WBC differential
increase in monocytes
atypical lymphocytes
treatment for mononucleosis
supportive, hydration
no contact sports within 6 weeks
check liver and spleen for hypertrophy
steroids
antibiotics for secondary bacterial infection
DO not give amoxicillin and ampicillin = rash with mono
how to gonococcal pharyngitis acquired, which bacteria, and what are the symptoms
oral sex
N. gonorrhoeae
mostly asymptomatic, but can have sore throat, pharyngeal exudate, cervical lymphadenitis
diagnosis and treatment for gonococcal pharyngitis
diagnosis: NAAT of a pharyngeal swab (faster)/ culture
treatment: single 500 mg IM dose of ceftiaxone or
1g if over 300 lbs
reasons to treat pharyngitis is so you can prevent the following complications
peritonsillar abscess
retropharygneal abscess
rheumatic fever
post-strep acute glomerular nephritis
Ludwig’s angina
supportive care - fluids, lozenges, analgesics
when do you refer pt to ENT for pharyngitis
- peritonsillar abscess
- deep neck and retropharyngeal abscess
- recurrent tonsillitis
- tonsillar hyperthropy/ asymmetry/ lesion
what is the difference between peritonsillar abscess and cellulitis.
what exam do you do to tell the difference
peritonsillar abscess is collection of pus between the palatine tonsil capsule and pharyngeal mms
cellulities is a inflammatory reaction of the tissue between the palatine tonsil capsule and the pharyngeal mms . (no pus) (aka phlegmon)
needle aspiration/ CT neck
pt has a history of sore throat, and on PE, you hear a hot poato voice, displaced uvula, and fluctance
peritonsillar abscess
what is the management for peritonsillar abscess
clindamycin, oral steroids
incision and drainage
refer for tonsillectomy
Ludwig’s angina common area, cause, and PE
neck space infection
dental infection/ sublingual and submaxillary spaces infections
pe: edema and erythema of neck and floor of mouth / dysphagia, odynophagia, pain, and airway compromise
treatment for Ludwig’s angina
IV antibiotics, I & D, protect airway (tracheostomy)
source of infection for deep neck infections for kids is
tonsil, otitis media, and sinus
source of infection for deep neck infections for adults is
teeth/ salivary gland/ skin
signs and symptoms for deep neck space infections is
fever, pain, swelling (90)
dysphagia, trismus (18)
fluctuance - uncommon (27)
most common bacterial cause of deep neck infection is
staph and strep
but can also be
gram negative
anaerobic
mixed flora (40)
how to manage deep neck infection
secure airway
CT scan with contrast
* cellulitis vs abscess
* neck space involved
culture : blood and needle aspiration
IV antibiotics
incision and drainage
* obv abscess, abx not working, complications
retropharyngeal space expands from the base of skull to mediastinum. infection in this area can spread from …… and is most common under which age
lateral pharyngeal space infection
lymphatic spread from posterior sinus, adenoids, and nasopharynx
age 5
causes of retropharyngeal infection/ abscess is
adults: endoscopy or FB
kids: lollipop-stick perforation or URI in children
risk factors for retropharyngeal infection/ abscess is
oral hygiene
diabetes
immunocompromised
low socioeconomic status
pt is showing symptoms of fever, dysphagia, dyspnea, hot potato voice, and torticollis.
PE: posterior wall swelling
has…
retropharyngeal infection/ abscess
diagnosis and treatment for retropharyngeal infection/ abscess is
lateral neck x ray - screen
CT with contrast - definitive
IV antibiotics - strep, staph, anaerobes
incision and drainage
TM joint dysfunction
affects:
common S/S:
Cause:
women in childbearing age
jaw pain/ dysfunction …. earache…. headache… facial pain
direct trauma, indirect trauma (whiplash), and stress / grinding and clenching teeth (microtrauma)
diagnosis and treatment for TMJ dysfunction
imaging = malocclusion or intra-articular problems
treatment:
*education, self-care, cognitive behavior
*nonsteriodial-noninflammatory drugs and mm relaxants - INITAL
* benzo and antidepres - CHRONIC
Aphthous Ulcers
name:
cause:
found on:
canker sore, ulcerative stomatitis
Human herpes virus 6
buccal and labial mucosa
pt has cranker sore (aphthous ulcers), it is painful, shallow ulcers with red halos and recurrent. you give them which med?
lidocaine
topical steriod in orabase
oral herpes simplex virus
called:
PE:
cause:
fever blister or cold sores
fluid-filled blisters on lips, gums, hard palate
reactivated or primary HSV - active from stress, sunlight, hormones, trauma, fever
pt felt pain on their lips a few days before seeing lesions. pt said the lesions blisters ruptured within hours and became crusty. what does this pt has and how do you treat it
oral herpes simplex virus
topical or oral antivirals (zovirax, famvir, valtrex, denavir)
herpetic gingivostomatitis is caused by
common in:
S/S
treatment:
HSV - 1
young kids- first exposure to herpes
high grade fever, mm painful oral lesions
immunosuppressed / HIV pts: treat –> oral acyclovir, famciclovir, valacyclovir
oral candidiasis, thrush, risk factors and S/S includes
dentures, diabetes, anemia, recent chemo/ radiation, recent antibiotic/ steroids, immunocompromised
s/s: burning on tongue, cheek, or throat
pt has creamy curd like patches that can be scrapped off. the overlying mucosa is erythematous, raw, and friable. what treatment do you give
pt has oral candidiases
tx:
underlying cause
antifungals
* liquid
* troche - dissolve in mouth
* pills - diflucan
pt has painless white area on the tongue, inside of cheek, lower lips, and floor of mouth. you try to scrap it off but can not. you learn that the pt has etoh abuse, smokes, chhew tobacco and uses denture.
what is it and whats the next step
oral leukoplakia
biopsy to rule out cancer
refer to ENT
sialadenitis/parotitis
is…
cause…
risk factors…
inflammation of the salivary gland - common the parotid gland
bacterial infection (staph aureus) or ductal obstruction
dehydration, chronic illness (sjogrens)
pt has sjogrens, a chronic illness. pt has pain and swelling, worsens with eating, and erythema of the parotid duct opening. you also notice pus and stone. what is it
sialadenitis/ parotitis
treatment for sialadenitis/ parotitis
conservative: hydration, warm compresses, local message, sialagogues
anti-staph antibiotic
sialolithiasis
is:
common in:
s/s:
treatment:
stone in the salivary duct
common in the wharton’s duct (drain submandibular gland)
post-prandial pain/ swelling
treat if infected, conservative treatment
refer to ENT
epiglottis
is
caused
common in
life threatening infection of epiglottis that can lead to airway obstruction
H. influenzae Type B
adults
pt is a kid and comes in with high fever, difficulty swallowing, sore throat, abrupt onset, drooling, tripod/sniffing position (only in kids) , what is it
epiglottitis
diagnosis for epiglottis is
lateral softer tissue neck x ray will show thumb sign
intubate
iv fluid and antibiotics, then oral antibiotics
prophylaxis with rifampin for unimmunized pts
breathy hoarseness is when
vocal cords do not close complete ( nodules, lesions, polyps)
raspy hoarseness is when
vocal cords are thickened from edema or inflammation
when there is decreased respiratory force (edlerly), you have … hoarsness
shaky
muffled hoarseness is when
airway obstruction (PTA, epiglttis)
harsh hoarseness is
largyngitis
stridor hoarseness is
narrowing above cords, high pitched
acute hoarseness can be due to 3 things
laryngitis - viral, allergy. vc abuse
laryngeal edema - hereditary angioneurotic edema ( c1 esterase inhibitor deficiency) , trauma, infection, cough, choking
epiglottis
laryngitis is typically
viral and little to no pain
laryngitis conservative treatment is
hydration, no yelling, whispering, voice rest, quit smoking, avoid spicy / acidic food
if laryngitis does not improve, refer to
laryngoscopy and videostroboscopy
chronic hoarseness is due to
tobacco, allergy, vc abuse, GERD, LPR,
VC polpys/nodules
chronic environmental exposure
MS
VC paralysis, CVA, neoplasm
myasthenia gravis
Parkinsons disease
presbyphonia
paradoxical VC motion - psych
associated symptoms of hoarseness is
sore throat, globus, dysphagia, mucus, cough
PMH of thyroid, neck, head, lung cancer can lead to
hoarsness
which PT exam and diagnosis will u do for hoarseness
HEENT
LUNG
neurological exam
nasopharyngolaryngoscopy
for hoarseness, you will do the following work up
labs: cbc, ESR, TFT (enlarged thyroid)
chest ct
neck ct, mri
videostroboscopy
barium swallow
treatment: treat underlying cause
* PPI for gerd, steriods, surgery, voice therapy
&hydration, voice rest, stop smoking
pt has hoarsness, cough, mucus in throat, globus, halitosis, dysphagia, sore throat. no heart burn. pt has
GERD
which diagnosis will do you for Gerd
HEENT exam
NPL
H. pylori test
barium swallow
transnala esophagoscopy (TNS)
upper endoscopy
treat: diet and life changes
PPI medication, H2 blocker
how will you diagnosis and treat VC polyps and nodules
microdirect laryngoscopy (MDL) with biopsy
speech therapy and stop smoking
how will you treat leukoplakia/erthyroplakia/lesion in the VC
MDL with Bx
for VC paralysis, you have to
diagnos the cause
rule out neoplasm
thyroplasty with VC medialization or injectables (radiesse)
video swallow to rule out apsiration
tracheostomy with bilateral VC paralysis
speech therapy
