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HEENT mouth Flashcards

1
Q

Common causes of pharyngitis are

A

infectious,

immune

xerostomia

dehydration

GERD

degenerative

trauma

congenital

vitamin - zinc

neoplastic

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2
Q

most common cause of pharyngitis ..

A

viral

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3
Q

T/F, 40 % of children and 20 % of adults are affected by GABHS, streptoccus pyogenes

A

True

cause of pharyngitis

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4
Q

which viruses causes viral pharyngitis

A

EBV (mono), rhinovirus, HSV-1 and 2, CMV, and coxsackie virus

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5
Q

Pt has a history of sore throat, odynophagia, rhinitis, acute onset, what does this pt have?

A

viral pharyngitis

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6
Q

upon a PE for viral pharyngitis, you see..

A

erythema of the tonsils and posterior oropharynx without exudate

+/- fever

+/- adenopathy

*rapid strep screen + culture

treatment : supportive bc its viral

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7
Q

what is the clinical presentation for GABHS strep pharyngotonsillitis

A

fever
anterior cervical adenopathy
posterior oropharyngeal exudate
lack of cough, common cold symptoms

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8
Q

diagnostic test and antibiotic Rx for GABSH is

A

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

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9
Q

which criteria do you use to diagnose GABHS strep? and what are you looking for

A

centor

absence of cough
tonsillar exudates
history of fever
tender anterior cervical adenopathy

age under 15 = +1
age over 44 = - 1

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10
Q

pt has a 2-3 centor score, you do the following:

A

supportive care, rapid strep test, abx is positive, if not, culture, if positive,

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11
Q

infectious mononucleosis is caused by which virus, affects who, and how it is contracted

A

EBV
young adults
oral contact

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12
Q

for IM (infectious mononucleosis), you see the following on PE exams

A

lymph node enlargement: posterior triangle neck

hepatosplenomegaly (possible)

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13
Q

diagnosis for infectious mononucleosis will be

A

monospot to check for heterophile Ige (prior)/ Igm (Acute) (delayed)

lymphocytosis on WBC differential
increase in monocytes
atypical lymphocytes

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14
Q

treatment for mononucleosis

A

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

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15
Q

how to gonococcal pharyngitis acquired, which bacteria, and what are the symptoms

A

oral sex

N. gonorrhoeae

mostly asymptomatic, but can have sore throat, pharyngeal exudate, cervical lymphadenitis

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16
Q

diagnosis and treatment for gonococcal pharyngitis

A

diagnosis: NAAT of a pharyngeal swab (faster)/ culture

treatment: single 500 mg IM dose of ceftiaxone or
1g if over 300 lbs

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17
Q

reasons to treat pharyngitis is so you can prevent the following complications

A

peritonsillar abscess

retropharygneal abscess

rheumatic fever

post-strep acute glomerular nephritis

Ludwig’s angina

supportive care - fluids, lozenges, analgesics

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18
Q

when do you refer pt to ENT for pharyngitis

A
  • peritonsillar abscess
  • deep neck and retropharyngeal abscess
  • recurrent tonsillitis
  • tonsillar hyperthropy/ asymmetry/ lesion
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19
Q

what is the difference between peritonsillar abscess and cellulitis.
what exam do you do to tell the difference

A

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

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20
Q

pt has a history of sore throat, and on PE, you hear a hot poato voice, displaced uvula, and fluctance

A

peritonsillar abscess

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21
Q

what is the management for peritonsillar abscess

A

clindamycin, oral steroids

incision and drainage

refer for tonsillectomy

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22
Q

Ludwig’s angina common area, cause, and PE

A

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

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23
Q

treatment for Ludwig’s angina

A

IV antibiotics, I & D, protect airway (tracheostomy)

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24
Q

source of infection for deep neck infections for kids is

A

tonsil, otitis media, and sinus

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25
source of infection for deep neck infections for adults is
teeth/ salivary gland/ skin
26
signs and symptoms for deep neck space infections is
fever, pain, swelling (90) dysphagia, trismus (18) fluctuance - uncommon (27)
27
most common bacterial cause of deep neck infection is
staph and strep but can also be gram negative anaerobic mixed flora (40)
28
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
29
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
30
causes of retropharyngeal infection/ abscess is
adults: endoscopy or FB kids: lollipop-stick perforation or URI in children
31
risk factors for retropharyngeal infection/ abscess is
oral hygiene diabetes immunocompromised low socioeconomic status
32
pt is showing symptoms of fever, dysphagia, dyspnea, hot potato voice, and torticollis. PE: posterior wall swelling has...
retropharyngeal infection/ abscess
33
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
34
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)
35
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
36
Aphthous Ulcers name: cause: found on:
canker sore, ulcerative stomatitis Human herpes virus 6 buccal and labial mucosa
37
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
38
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
39
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)
40
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
41
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
42
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
43
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
44
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)
45
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
46
treatment for sialadenitis/ parotitis
conservative: hydration, warm compresses, local message, sialagogues anti-staph antibiotic
47
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
48
epiglottis is caused common in
life threatening infection of epiglottis that can lead to airway obstruction H. influenzae Type B adults
49
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
50
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
51
breathy hoarseness is when
vocal cords do not close complete ( nodules, lesions, polyps)
52
raspy hoarseness is when
vocal cords are thickened from edema or inflammation
53
when there is decreased respiratory force (edlerly), you have ... hoarsness
shaky
54
muffled hoarseness is when
airway obstruction (PTA, epiglttis)
55
harsh hoarseness is
largyngitis
56
stridor hoarseness is
narrowing above cords, high pitched
57
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
58
laryngitis is typically
viral and little to no pain
59
laryngitis conservative treatment is
hydration, no yelling, whispering, voice rest, quit smoking, avoid spicy / acidic food
60
if laryngitis does not improve, refer to
laryngoscopy and videostroboscopy
61
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
62
associated symptoms of hoarseness is
sore throat, globus, dysphagia, mucus, cough
63
PMH of thyroid, neck, head, lung cancer can lead to
hoarsness
64
which PT exam and diagnosis will u do for hoarseness
HEENT LUNG neurological exam nasopharyngolaryngoscopy
65
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
66
pt has hoarsness, cough, mucus in throat, globus, halitosis, dysphagia, sore throat. no heart burn. pt has
GERD
67
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
68
how will you diagnosis and treat VC polyps and nodules
microdirect laryngoscopy (MDL) with biopsy speech therapy and stop smoking
69
how will you treat leukoplakia/erthyroplakia/lesion in the VC
MDL with Bx
70
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

Clinical med (6 decks)

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