MOUF!

Question 1

White lesion in the mouth that cannot be removed with rubbing of the mucosa

Think

Answer 1

Leukoplakia

Question 2

What should be FNA in a pt with leukoplakia or erythroplakia ?

Answer 2

Cervical lymph nodes!

Question 3

What is oral lichen planus and what is the Tx for it

Answer 3

Autoimmun dz very similar to leukoplakia

Requires a Bx

Tx: analgesics
, +corticosteroids
+tacrolimus

Question 4

If a pt has RAISED, firm white lesions with ulcers at the base

In the mouth

Think

Answer 4

Oral CA

Get a Bx

If less than 2 cm local resection

If >2 cm then resection down to the neck AND radiation

Question 5

What does ABCDE mean for oral cancer

Answer 5

Asymmetry 
Borders 
Color 
Diameter 
Elevation

Question 6

What is the tx and Bx for candidiasis

Answer 6

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

Question 7

What is the 1st line Rx for uncomplicated Thursh pts

Answer 7

-any of the Azoles for 7 days

+ nystatin rinse daily

And chlorhexidine for pain

Question 8

What is the tx for HIV pts with thrush

Answer 8

Longer course of fluconazole
(2-3 weeks minimum)- first line

If refractory- Itraconazole 200 mg/day

Still resistant- Voriconazole

Question 9

What is the tx for glossitis

Answer 9

(Smooth tongue)

Treat underlying cause

Question 10

When should you get an MRI of the brain in a pt iwth glossodynia

Answer 10

MRI if unilateral, s/s are not associated with any medication
Or there are cranial neuropathies

Question 11

A pt presents with fever, halitosis, gingival bleeding and necrosis

Think

Answer 11

NUG!

Question 12

What is the tx approach for NUG

Answer 12

Peroxide rinse 3x a day .

May require dental curet

Question 13

A yellow gray ulceration with a red center..

think

Answer 13

Aphthous ulcer

Question 14

What are the risk fx for aphtous ulcers

Answer 14

Stress, Viral URI , or bed time after 2300

Question 15

What are the treatment options for recurrent apthous ulcers in HIV pts

Answer 15

Thalidomide

Question 16

What are the general treatments for aphtous ulcers

Answer 16

Corticosteroids

Diclofenac gel

Doxycycline-cyanocrylate

Amexanox oral paste

Prednisone tapers

Question 17

A pt presents with vessicles on a erythematous base, think?

Answer 17

Herpes!

Question 18

What is the most common cause of pharyngitis/ Tonilitis

Answer 18

VIRAL ! Rhino, flu, adenovirus

Bacterial causes are less : 
Group A Beta Strep 
Gonorrhea/ Chlamydia 
Diphtheria 
Or mono

Question 19

What is the CENTOR criteria used to identify GABHS ?

Answer 19

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

Question 20

CENTOR criteria of 1 =

Answer 20

No test, no treatmetn for GABHS

Question 21

CENTOR score of 2=

Answer 21

Rapid antigen test for GABHS

Question 22

When should you start to emperically treat fro GABHS

Answer 22

CENTOR score of 3 or more

Question 23

What is the tx approach to pharyngitis/ tonsillitis

Answer 23

Analgesics/ NSAIDs

Benzocaine lozenges

Salt water gargles

And Prednisone

Question 24

What is the tx approach to GABHS

Answer 24

Penicillin or cefuroxime is 1st line
(x 10 days) (PO)

If PCN allergy then Erythromycin!
AVOID CEPHALOSPORIN!

Question 25

When should you admit a pt with pharyngitis

Answer 25

In unable to swallow due to pain

Question 26

In a pt with rheumatic fever what is the tx approach

Answer 26

Continuous course of PCN or E-mycin for 5 years

Question 27

What is the agent of MONO

Answer 27

EBV

Question 28

A pt presents with marked lymphadenopathy Shaggy purple/ white exudates and hepatosplenomegaly In a young adult Think

Answer 28

MONO

Question 29

What is the most sensitive finding in mono

Answer 29

Lymphocyte to WBC ratio greater than 35% Or Monospot

Question 30

What is the tx approach to mono

Answer 30

Avoid amoxicillin and ampicillin (rash) Treat s/s and avoid contact sports

Question 31

An alcoholic pt presentes with gray psuedomembrane on exam with a low grade fever Think

Answer 31

Diphtheria

Question 32

What are the S/s of Peritonsillary abcesses

Answer 32

Severe sore throat Painful swallowing And trismus

Question 33

A pt presents with a hot potato voice, and medial deviation of the soft palate With a inferior and medially displaced uvula Think

Answer 33

Abcess

Question 34

What is the tx for a peritonsillar abcess

Answer 34

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 .

Question 35

What is the most common organism in saliva gland d/o

Answer 35

Staph aureus

Question 36

What is the tx for sialadenitis

Answer 36

Nafacillin X 10 days

Question 37

What is the tx approach to suppurative sialadenitis

Answer 37

Immediate referral and Nafacillin + clinda or metro If immuno comp - Vanc

Question 38

Where is the most common location for a salivary stone

Answer 38

Whartons duct

Question 39

What is the dif. Of a stone in whartons vs stensons duct

Answer 39

Wharton stones- large, radiopaque | Stensen stones- smaller, radiolucent

Question 40

A pt presents with a medially deviated soft palate With a CN palsy and a mass in the salivary gland Think

Answer 40

Get an MRI, CA UPO

Question 41

If a tumor is the most likey DX for a salivary gland d/o What is the tx

Answer 41

Resection of gland -In parotid tumor, dissect the facial nerve to preserve it FNA biopsy -Only if negative results will prevent surgery