MDT Throat Flashcards by Draper Kauffman

_________ is a white lesion that cannot be removed by rubbing the mucosal surface.
It is hyperkeratosis usually in response to a physical or chemical irritant.

Leukoplakia

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what iis the most common oral precancer

Leukoplakia

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What would you suspect from this?
(1) White painless lesion that cannot be scraped or removed.
(2) Small to several centimeters in diameter.
(3) Usually superficial, but may have submucosal depth upon palpation.
(4) May have wrinkled “wet finger” appearance.
(5) May have underlying redness (erythroleukoplakia) or dysplasia.
(6) Cannot be attributed to another definable lesion.

Leukoplakia

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How would you treat Leukoplakia

(1) No treatment
(2) Remove irritants and educate patient.
(3) Measure and document for malignancy.
(4) Refer if associated with redness or submucosal depth.

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When would you REfer leukoplakia?

If malignant pathology suspected

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Complications of leukoplakia

Carcinoma

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DDx of Leukoplakia

(1) Oral Candidiasis
(2) Geographic tongue

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What would you suspect?
(1) Severe sore throat
(2) Odynophagia
(3) Muffled (hot potato) voice
(4) Trismus
(5) Inferior and medial displacement of the infected tonsil
(6) Contralateral deflection of the swollen uvula
(7) Moist and translucent
(8) Palatal edema
(9) Tender cervical lymphadenopathy
(10) Drooling
(11) Dehydration
(12) Color ranging from nearly none too deep erythema.

Peritonsillar Abscess

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Predisposing factors of Peritonsillar Abscess

(a) Chronic tonsillitis
(b) Multiple trials of oral antibiotics
(c) Previous peritonsillar abscess

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A collection of purulent material between the tonsillar capsule and the superior constrictor and palatopharyngeal muscles is a ___________

peritonsillar abscess

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DDx for Peritonsillar abscess

(1) Cellulitis
(2) Herpes simplex tonsillitis
(3) Mononucleosis
(4) Internal artery carotid aneurysm

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What studies should you do for peritonsillar abscess

Ultrasound

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Disposition for peritonsillar abscess

Patient needs to be MEDEVAC to MTF for needle aspiration or I&D

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What antibiotics would you give for peritonsillar abscess?

Ceftriaxone 2g IV QD + Metronidazole 500mg IV q6h

Penicillin allergy patient
Clindamycin 600mg IV q8h

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complications for Peritonsillar abscess

(1) Airway obstruction
(2) Rupture of abscess
(3) Epiglottitis
(4) Septicemia
(5) Endocarditis

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_____ is inflammation and infection of the pharynx

Pharyngitis

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_____ is inflammation and infection of the tonsils

Tonsillitis

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What accounts for over 10% of all office visits to primary care clinicians and 50% of outpatient antibiotic use?

Pharyngitis and Tonsillitis

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What is CENTOR Criteria

1) Fever over 38 degrees Celsius
2) Tender anterior cervical lymphadenopathy
3) Lack of a cough
4) Pharyngotonsillar exudates

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What is marked lymphadenopathy with shaggy white-purple exudates that often extends into the nasopharynx

Mononucleosis

Vesicular and petechial pattern on the soft palate and tonsils with rhinorrhea, no tonsillar exudates or cervical lymphadenopathy.

Viral

White, cheesy exudates that can be scraped off an erythematous base

Fungal infection

Pharyngitis/Tonsillitis ddx

(1) Peritonsillar abscess
(2) Laryngitis
(3) Epiglottitis
(4) HIV

Labs for Pharyngitis/Tonsillitis

(1) Rapid Strep
(2) Monospot
(3) Throat culture
(4) HIV

Treatment for GABHS

-Benzathine penicillin (Bicillin) Dose: 1.2 million units IM (only 1 dose) -Penicillin VK 500 mg PO twice or three times a day for 10 days -Augmentin 500mg PO TID -Azithronmycin 500mg once daily for three days Acetaminophen plus NSAIDS Warm salt water gargles Lozenges

True/False For intense odynophagia IV hydration and IV antibiotics may be necessary.

TRue

Viral Pharyngitis/Tonsillitis treatment

(a) Acetaminophen plus NSAIDS (b) Warm salt water gargles (c) Lozenges (d) Intense odynophagia IV hydration may be necessary

Initial Care of the Disease and Follow Up Pharyngitis/laryngitis:

Retain unless complications develop.

Refer for tonsillectomy if the patient falls within the paradise criteria:

(a) Three or more episodes in each of three years. (b) Five or more episodes in each of two years. (c) Seven or more episodes in one year.

Complication for Pharyngitis/Tonsillitis.

(1) Scarlet fever (2) Glomerulonephritis (3) Rheumatic myocarditis (4) Local abscess (5) Rheumatic valve disease

What is GABHS

group A B- hemolytic streptococcal infection

Acute bacterial sialadenitis most commonly affects either the ____ or the _____

parotid (Parotitis) or submandibular glands.

The most common organism recovered from purulent draining saliva is

S aureus

What would you suspect? (1) Acute swelling of the gland. (2) Increased pain and swelling with meals. (3) Tenderness and erythema of the duct opening. (4) Pus can often be massaged from the duct.

Sialadenitis

Differential Diagnosis: for Sialadenitis

(1) Sialolithiasis (2) Ranula (3) Ludwig Angina (4) Salivary gland tumor

Predisposing factors for Sialadenitis

(a) Dehydration (b) Chronic illness (c) Sjögren syndrome (d) Chronic periodontitis

DO you medivac Sialadenitis?

YES

What antibiotics for sialadenitis What if they are stable?

a) Nafcillin 2gm IV QD********* (b) Oxacillin 2gm IV QD PO Antibiotics can be given if patient stable (a) Clindamycin 450mg PO TID PLUS Ciprofloxacin 500mg BID

sialadenitis Measures to increase salivary flow.

(a) Hydration (b) Warm compress (c) Sialogogues (lemon drops, chewing gum) (d) Message of gland

Complications or Sialadenitis

(1) Retropharyngeal abscess leading to Ludwig’s angina (2) Abscess (3) Airway obstruction

________ also known as tonsil stones, are soft aggregates of bacterial and cellular debris that form in the tonsillar crypts, the crevices of the tonsils

Tonsilloliths

Tonsillitis occur mostly where?

palatine tonsils

While Tonsillitis may occur most commonly in the palatine tonsils, they can also happen where?

lingual tonsils

Theses are symptoms of what? (a) Halitosis (b) Sore throat (c) White debris (d) Bad taste (possibly metallic) in the back of throat (e) Dysphasia (f) Ear ache (g) Tonsillitis

Symptoms of larger tonsiliths

True/False Tonsilloliths may produce no symptoms, or they may be associated with bad breath, or produce pain when swallowing. Increased pain and swelling with meals.

True

DDx's for tonsiliths

(1) Foreign body (2) Calcified granuloma (3) Malignancy (4) Enlarged temporal styloid process (5) Displaced teeth

Treatment for tonsiliths

(1) No treatment if asymptomatic. (2) Irrigation to attempt to remove. (3) Curettage larger stones. (4) Tonsillectomy may be indicated if bad breath due to tonsillar stones persists despite other measures.

What can be used as a prophylaxis for tonsiliths

Instruct patient to gargle with salt water

What are the Medivac..able stuff from this section

Epiglottitis Peritonsillar Abscess Sialadenitis