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NRS 250: Exam 2 ENT and ID > Mouth > Flashcards

Mouth Flashcards

1
Q

chorda tympani

A

branch of the facial nerve that innervates 2/3 of the tongue for taste

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2
Q

Deciduous Teeth

A
  • baby teeth or milk teeth
  • 20 teeth
  • emerge between 6-24 months
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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
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4
Q

Nerves involved in Mastication

A
  • Facial muscles (CN VII)
  • Jaw muscles (CN V3)
  • Tongue movement (CN XII- hypoglossal)
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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
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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
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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
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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
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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
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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
  • 5 tastes: sweet, sour, salty, bitter, umami
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11
Q

Cranial Nerves involved in Taste sensation

A

CN VII, IX, and X

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12
Q

Cranial nerves involved in swallowing and gag reflex

A

CN IX, X, and XII

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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
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14
Q

Cartilage of the Larynx

A

epiglottis, thyroid cartilage, cricoid cartilage, arytenoid cartilage, corniculate cartilage, cuneiform cartilage

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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
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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 ***
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17
Q

Muscles of the Anterior Neck

A
  • Suprahyoid muscles
  • Infrahyoid muscles
  • Sternocleidomastoid
  • Scalene muscles
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18
Q

Location of Trachea

A
  • anterior to esophagus
  • extends from larynx to ~T5
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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 **
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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
Q

Primary HSV-1 Infection

A
  • dsDNA infection
  • gingivostomatitis, fever, malaise, cervical adenopathy
  • diagnosis: Tzanck smear, clinical diagnosis, antigen testing →from base of lesion
  • tx: acyclovir, valacyclovir
26
Q

Recurrent HSV-1 Infection

A
  • 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
Q

Peritonsillar Abscess

A
  • **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
Q

Retropharyngeal Abscess

A
  • 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
Q

Epiglottitis

A
  • **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
Q

Herpangina

A
  • **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
Q

Hand, Foot and Mouth

A
  • **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
Q

Acute Laryngitis

A
  • 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
Q

Acute Laryngotracheitis

A
  • 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
Q

Acute Pharyngitis

A
  • **most common bugs: adenovirus, coronavirus, rhinovirus **
  • coryza (inflammation of mucus membrane of nose), cough, and hoarseness
    *
35
Q

Acute Bacterial Pharyngitis

A
  • 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
Q

Infectious Mononucleosis

A
  • 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
Q

Sialolithiasis

A
  • 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
Q

Sialadenitis

A
  • 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
Q

Leukoplakia vs. Oral Hairy Leukoplakia

A
  • 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
Q

Sicca Syndrome

A
  • 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
Q

Sjogren’s Syndrome

A
  • 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
Q

Bacteria that cause acute laryngitis

A
  • HIB, strep. pneumoniae, Moraxella
43
Q

Most common bug that causes acute laryngotracheitis

A
  • aka croup
  • parainfluenza virus
44
Q

Most common bugs causing acute viral pharyngitis

A
  • adenovirus, rhinovirus, coronavirus
45
Q

Most common bug causing Sialadenitis

A
  • Staph aureus
46
Q

Bugs associated with chronic bacterial rhinosinusitis

A
  • 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
Q

Bugs associated with Acute bacterial rhinosinusitis

A

strep pneumoniae, Haemophilus influenzae, Moraxella catarrhalis

48
Q

Bug most commonly associated with dental caries

A

Strepococcus mutans

NRS 250: Exam 2 ENT and ID (9 decks)

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