MOUF! Flashcards
White lesion in the mouth that cannot be removed with rubbing of the mucosa
Think
Leukoplakia
What should be FNA in a pt with leukoplakia or erythroplakia ?
Cervical lymph nodes!
What is oral lichen planus and what is the Tx for it
Autoimmun dz very similar to leukoplakia
Requires a Bx
Tx: analgesics
, +corticosteroids
+tacrolimus
If a pt has RAISED, firm white lesions with ulcers at the base
In the mouth
Think
Oral CA
Get a Bx
If less than 2 cm local resection
If >2 cm then resection down to the neck AND radiation
What does ABCDE mean for oral cancer
Asymmetry Borders Color Diameter Elevation
What is the tx and Bx for candidiasis
Testing not usually required
Wet prep with potassium hydroxide (KOH)
-Non-septate mycelia
Biopsy
-Intraepithelial pseudomycelia
Consider test for HIV
-Thrush can be first sign of HIV
What is the 1st line Rx for uncomplicated Thursh pts
-any of the Azoles for 7 days
+ nystatin rinse daily
And chlorhexidine for pain
What is the tx for HIV pts with thrush
Longer course of fluconazole
(2-3 weeks minimum)- first line
If refractory- Itraconazole 200 mg/day
Still resistant- Voriconazole
What is the tx for glossitis
(Smooth tongue)
Treat underlying cause
When should you get an MRI of the brain in a pt iwth glossodynia
MRI if unilateral, s/s are not associated with any medication
Or there are cranial neuropathies
A pt presents with fever, halitosis, gingival bleeding and necrosis
Think
NUG!
What is the tx approach for NUG
Peroxide rinse 3x a day .
May require dental curet
A yellow gray ulceration with a red center..
think
Aphthous ulcer
What are the risk fx for aphtous ulcers
Stress, Viral URI , or bed time after 2300
What are the treatment options for recurrent apthous ulcers in HIV pts
Thalidomide
What are the general treatments for aphtous ulcers
Corticosteroids
Diclofenac gel
Doxycycline-cyanocrylate
Amexanox oral paste
Prednisone tapers
A pt presents with vessicles on a erythematous base, think?
Herpes!
What is the most common cause of pharyngitis/ Tonilitis
VIRAL ! Rhino, flu, adenovirus
Bacterial causes are less : Group A Beta Strep Gonorrhea/ Chlamydia Diphtheria Or mono
What is the CENTOR criteria used to identify GABHS ?
1 point each for:
- Lack of cough
- Cervical Adenopathy
- Fever over 100.4 (38C)
- Tonsillar exudate
Modified Centor-
- Add 1 point if age <15
- Subtract 1 point if age >44
CENTOR criteria of 1 =
No test, no treatmetn for GABHS
CENTOR score of 2=
Rapid antigen test for GABHS
When should you start to emperically treat fro GABHS
CENTOR score of 3 or more
What is the tx approach to pharyngitis/ tonsillitis
Analgesics/ NSAIDs
Benzocaine lozenges
Salt water gargles
And Prednisone
What is the tx approach to GABHS
Penicillin or cefuroxime is 1st line
(x 10 days) (PO)
If PCN allergy then Erythromycin!
AVOID CEPHALOSPORIN!
When should you admit a pt with pharyngitis
In unable to swallow due to pain
In a pt with rheumatic fever what is the tx approach
Continuous course of PCN or E-mycin for 5 years
What is the agent of MONO
EBV
A pt presents with marked lymphadenopathy
Shaggy purple/ white exudates and hepatosplenomegaly
In a young adult
Think
MONO
What is the most sensitive finding in mono
Lymphocyte to WBC ratio greater than 35%
Or Monospot
What is the tx approach to mono
Avoid amoxicillin and ampicillin (rash)
Treat s/s and avoid contact sports
An alcoholic pt presentes with gray psuedomembrane on exam with a low grade fever
Think
Diphtheria
What are the S/s of Peritonsillary abcesses
Severe sore throat
Painful swallowing
And trismus
A pt presents with a hot potato voice, and medial deviation of the soft palate
With a inferior and medially displaced uvula
Think
Abcess
What is the tx for a peritonsillar abcess
S/s Tx with I/D and culutre
+ ABX :
Amoxicillin or clinda
I/D: 119-21 gauge needle, medial to the molar, only 1cm deep .
What is the most common organism in saliva gland d/o
Staph aureus
What is the tx for sialadenitis
Nafacillin
X 10 days
What is the tx approach to suppurative sialadenitis
Immediate referral and Nafacillin
+ clinda or metro
If immuno comp - Vanc
Where is the most common location for a salivary stone
Whartons duct
What is the dif. Of a stone in whartons vs stensons duct
Wharton stones- large, radiopaque
Stensen stones- smaller, radiolucent
A pt presents with a medially deviated soft palate
With a CN palsy and a mass in the salivary gland
Think
Get an MRI, CA UPO
If a tumor is the most likey DX for a salivary gland d/o
What is the tx
Resection of gland
-In parotid tumor, dissect the facial nerve to preserve it
FNA biopsy
-Only if negative results will prevent surgery
