Mouth Flashcards
1
Q
chorda tympani
A
branch of the facial nerve that innervates 2/3 of the tongue for taste
2
Q
Deciduous Teeth
A
- baby teeth or milk teeth
- 20 teeth
- emerge between 6-24 months
3
Q
Succedaneous Teeth
A
- Permanent/adult teeth teeth
- 32 teeth
- ages 6-12 years except for 3rd molar (17-25 years)
- central incisor, lateral incisor, canine, 1st premolar, 2nd premolar, 1st-3rd molar
- innervated by CN V
4
Q
Nerves involved in Mastication
A
- Facial muscles (CN VII)
- Jaw muscles (CN V3)
- Tongue movement (CN XII- hypoglossal)
5
Q
Salivary Glands and their Ducts plus innervations
A
- Innervated by CN VII and CV IX (parotid)
- Locations:
- Parotid duct = Stenson’s duct
- Submandibular duct = Wharton’s duct
6
Q
Function and Location of the Tonsils
A
- Function: contain lymphocytes that destroy and remove pathogens that enter through air and food
- Tonsils:
- pharyngeal tonsils: posterior wall of the nasopharynx
- palatine tonsils: boundary between the soft palate and pharynx
- lingual tonsil: base of tongue
7
Q
Voluntary Phase of Deglutition
A
- Oropharyngeal phase of Swallowing (skeletal muscle)
- tongue propels the food bolues into the pharynx
- respiratory passages are closed off by the uvula, upper esophageal sphincter and epiglottis
- bolus moves from pharynx to esophagus
8
Q
Involuntary Phase of Deglutition
A
- pharyngoesophageal phase of swallowing
- bolus moves from esophagys to stomach through cardiac sphincter via peristalsis waves
- respiratory passages can reopen
9
Q
Gag Reflex physiology and cranial nerves
A
- Contraction of the soft palate and protrustion of the tongue when the upper pharynx is stimulated
- closes airway and expels substance
- CN IX: sensation of the soft palate and pharynx
- CN X: contraction of the pharynx and soft palate
- CN XII: protrustion of the tongue
- CN V3: open jaw
10
Q
Taste receptors, innervation of, and pathway of taste
A
- CN VII: anterior 2/3 of tongue
- CN IX: posterior 1/3 of the tongue
- CN X: palate, epiglottis
- signals travel from CN to medulla oblongata then to the thalamus, then to the gustatory cortex
- taste buds (3 types):
- have about 40 gustatory receptors
- live for aout 10-12 days
- have about 40 gustatory receptors
- 5 tastes: sweet, sour, salty, bitter, umami
11
Q
Cranial Nerves involved in Taste sensation
A
CN VII, IX, and X
12
Q
Cranial nerves involved in swallowing and gag reflex
A
CN IX, X, and XII
13
Q
Function of the Larynx
A
- produces sound and prevents food from entering the trachea
- muscles that move the larynx and control the vocal cord also contribute to swallowing and respiration and prevent aspiration into the trachea
14
Q
Cartilage of the Larynx
A
epiglottis, thyroid cartilage, cricoid cartilage, arytenoid cartilage, corniculate cartilage, cuneiform cartilage
15
Q
Vocal Cords
A
- found in the larynx
-
vestibular folds (false vocal cords): mucosal fold located superior to true vocal cords
- will provoke coughing reflex if anything touches them to eject whatever touched it
-
True vocal cords: elastic ligaments attached to the artenoid and thyroid cartilages
- vibrate and produce sound as air is expelled form the lungs
- Rima glotidis: opening between vocal cords
16
Q
Laryngeal Muscles and CN X
A
- intrinsic muscles of the larynx are responsible for adducting, abducting, tensing, and relaxing the vocal apparatus
- innervated by CN X
- external laryngeal nerve
- recurrent laryngeal nerve
- **TRAVELS UNDER THE AORTA → hoarse voice during aortic dissection ***
17
Q
Muscles of the Anterior Neck
A
- Suprahyoid muscles
- Infrahyoid muscles
- Sternocleidomastoid
- Scalene muscles
18
Q
Location of Trachea
A
- anterior to esophagus
- extends from larynx to ~T5
19
Q
Cough Reflex
A
- mechanical and chemical irritant receptors in the larynx, trachea, and bronchi
- sensed by CN X
- stimulates cough reflex to expel irritants
- **forceful closure of glottis, contraction of diaphragm and abdominal muscles **
20
Q
When does hoarseness require a referral to ENT
A
- lasts more than 2 weeks
21
Q
Polypoid Corditis
A
- hoarseness associated with smoking –> middle aged woman who sounds husky
- aka Reinke’s Edema
22
Q
Apthous Ulcers
A
- Minor: <1cm
- Major >1cm → can involve malaise and fever, and scarring
- can have a genetic predisposition for recurrent apthous ulcers
- often caused by H. pylori
- diagnosis: punch biopsy, check vitamin levels of B1, B2, B6, B12, check serum zinc and folate, CBC with iron
- tx: minor: tend to heal within 1-2 weeks
- high potency topical steroid gels: fluocinonide gel, dexamethasone elixir → can’t eat within 30 min, can cause oral thrush so may also need to be on nystatin or fluconazole
23
Q
Oral Lichen Planus
A
- caused by a cell-mediated autoimmune response
- mostly affects buccal mucosa, tongue, and gingiva
- Wickham Striae: lacy, reticular bluish/white leukoplakia
- **Hepatitis C** →must check these patients for hepatitis C
- diagnosis: biopsy to rule out malignancy
- tx: corticosteroids, hydroxychloroquine (also used to treat lupus)
- high potency oral steroids → fluocinonide gel
24
Q
Oral Candidiasis
A
- result of chronic xerostomia, overgrowth of candida, DM, hormonal women,
- diagnosis: clinical, potassium hydroxide (KOH) wet mount, budding yeasts with pseudohyphae
- tx: Clotrimazole troche, Nystatin mouth wash
- HIV seropositive patients: fluconazole systemic treatment
25
Primary HSV-1 Infection
* dsDNA infection
* gingivostomatitis, fever, malaise, cervical adenopathy
* diagnosis: **Tzanck smear**, clinical diagnosis, antigen testing →from base of lesion
* tx: acyclovir, valacyclovir
26
Recurrent HSV-1 Infection
* herpes labialis, lives dormant in CN V
* prodromal symptoms, rarely systemic symptoms
* diagnosis**: Tzanck smear**, viral cx
* tx: prompt initiation of tx →within 72 hours, acyclovir, valacyclovir to reduce severity of symptoms
27
Peritonsillar Abscess
* \*\*most commonly caused by **GAS, S. aureus, strep anginosus, and respiratory anaerobes**\*\*
* unilateral pharyngitis, fever, hot potato voice, drooling due to odynophagia, uvula is not midline
* diagnosis: CT, needle aspiration
* tx: **Clindamycin** or **Vancomycin**
* if doubt \*\*Call an ENT, may require surgical drainage\*\*
28
Retropharyngeal Abscess
* difficulty swallowing, neck stiffness and swelling, fever,
* risk factors: more common in ages **2-4 years of age**
* diagnosis: neck films that see increased thickness of the prevertebral tissue, **prevertebral space is \>50%**
* complications**: acute necrotizing mediastinitis**
* tx: drainage and **clindamycin** or ceftriaxone
* causative organisms:
* GAS
* s. aureus (incl. MRSA)
* respiratory anaerobes (produce gas)
29
Epiglottitis
* \*\*most commonly caused by HIB, GAS, staph, or viral\*\*
* cherry red epiglottis
* 3 Ds: drooling, dysphagia, distress
* can present similarly to airway obstruction
* \*\*thumb sign\*\*
* tx: airway management, STAT ENT referral
* **ceftriaxone, cephalosporins** and **anti-staphylococcal**
30
Herpangina
* \*\*primarily caused by enteroviruses such as the COXSACKIE virus\*\*
* abrupt onset with HIGH fever (up to 104)
* papular-vesicular-ulcerative oral rash
* usually resolves on its own in 7-10 days
31
Hand, Foot and Mouth
* \*\*most common cause are enteroviruses such as COXSACKIEVIRUS\*\*
* oral rash and macular, papular, or vesicular rash on hands, feet, and around mouth
* should resolve on its own in 7-10 days
* \*\*BE AWARE OF POTENTIAL FOR DEHYDRATION\*\*
32
Acute Laryngitis
* common, self limiting infection of the vocal cords (usually lasts \<3 weeks)
* \*\*common bugs: **S. pneumoniae, HIB, Moraxella catarrhalis**\*\*
* associated with previous URI and vocal strain
* \*\*hoarseness
* Viral: supportive care
* Bacterial: **erythromycin, ceftriaxone, Augmentin**
33
Acute Laryngotracheitis
* aka Croup
* \*\*barking cough most commonly caused by **parainfluenzae virus**\*\*
* abrupt onset of symptoms
* \*\***Steeple Sign\*\***
* home treatment: symptomatic care maybe with some **dexamethasone**
* **Nebulized epi with IV/oral/IM dexamethasone**
* \*\*the WESLEY CROUP SCORE\*\* \>12 → send to the hospital
* mild = 2
* Moderate 3-7
* severe \>/= 8
* impending respiratory failure \>/=12
34
Acute Pharyngitis
* \*\*most common bugs: **adenovirus, coronavirus, rhinovirus** \*\*
* coryza (inflammation of mucus membrane of nose), *cough*, and hoarseness
*
35
Acute Bacterial Pharyngitis
* aka strep throat/ Scarlatina
* EXUDATE, fever, rarely cough, scarlatina form rash (\*\*sandpaper rash\*\*), and STRAWBERRY TONGUE
* tx: **Penicillin** is first choice but kids may not like it →**Amoxicillin ⇒ Augmentin** if you suspect resistance
* alernative abx: **Cephalosporins, macrolides, clindamycin**
36
Infectious Mononucleosis
* caused by Epstein Barr Virus \*\*dsDNA (HHSV-4)\*\* infects B cells of the lymphoid tissues
* fever, fatigue, pharyngitis, acute rupture of spleen due to trauma as after splenomegaly
* higher lympocyte than neutrophil count → indicative of viral infection
* Liver function test: higher number of aminotransferases ⇒ indicates that its mono not strep
* diagnosis: **heteroantibody test** is gold standard
* tx: supportive, maybe corticosteroids for throat and tonsillar swelling
* **can return to sports 4 weeks after onset of symptoms**
* ******Cold agglutination**
37
Sialolithiasis
* salivary stones, usually in Wharton's duct (submandibular gland duct) than Stenson's duct (Parotid gland duct)
* acute onset pain and swelling → can be provoked by eating or thinking about eating (salivation)
* diagnosis: palpating, ultrasound then CT or MRI if indicated
* tx: massage, sialagogues → saliva stimulants like lemon every 3-4 hours
* surgery if necessary
38
Sialadenitis
* viral or bacterial infection of salivary glands
* bacterial may have purulent discharge from the ducts
* sudden onset of very firm or tender swelling, +/- fever/chills
* \*\*most common cause: **Staph aureus, S. viridans, HIB**\*\*
* tx: anti-staphylococcal → **clindamycin** or **vancomycin** (if MRSA is suspected)
39
Leukoplakia vs. Oral Hairy Leukoplakia
* Leukoplakia: asymptomatic squamous cell carcinoma
* risk factors: smoking, excessive drinking, dentures, HPV infection
* tx: stop using irritants, cryotherapy, surgery with postop chemo/radiation
* Oral Hairy Leukoplakia
* result of the Epstein Barr Virus (dsDNA)
* \*\*INDICATIVE OF HIV INFECTION\*\*
* antivirals to treat underlying HIV infection
40
Sicca Syndrome
* often age related atrophy of exocrine glands that lead to decrease secretions
* more common than Sjogren's syndrome
* tx: cholinergic agonsts such as Cevimeline and Salagen
41
Sjogren's Syndrome
* chronic autoimmune inflammatory disorder that results in decreased lacrimation, salivation, and vaginal secretions
* diagnosis: +RF (rheumatoid factor), ANA (antinuclear antibodies that demonstrate autoimmune), tear test
* tx: **Pilocarpine, cevimeline** (cholinergic agonists)
42
Bacteria that cause acute laryngitis
* HIB, strep. pneumoniae, Moraxella
43
Most common bug that causes acute laryngotracheitis
* aka croup
* parainfluenza virus
44
Most common bugs causing acute viral pharyngitis
* adenovirus, rhinovirus, coronavirus
45
Most common bug causing Sialadenitis
* Staph aureus
46
Bugs associated with chronic bacterial rhinosinusitis
* no anaerobes
* Gram negative bacilli:
* pseudomonas aeruginosa, Klebsiella pneumonia, enterobacter, and E. coli
* Gram positive cocci:
* S. aureus (tends to be more acute) --\> MRSA
* tx: Single drug: **augmentin, clindamycin**
47
Bugs associated with Acute bacterial rhinosinusitis
strep pneumoniae, Haemophilus influenzae, Moraxella catarrhalis
48
Bug most commonly associated with dental caries
*Strepococcus mutans*
