Mouth and Nose

Question 1

Pt presents with white plaque on tongue.

Upon examination, the plaque scrapes off.

Answer 1

Oral Candidiasis (Thrush).
Tx: Nyastatin or fluconazole

Question 2

Pt is currently going through a bar exam with a lot stress. Her brother currently has similar symptoms.
Upon examination, there is a small, oval, bump with a gray base near her lip of her mouth.

Answer 2

Aphthous ulcer (canker sore).
Tx: heals w/in 10-14 days - relieve pain symptoms

Question 3

Pt has clusters of lesions near mouth.

Answer 3

Herpetic Gingivostomatitis
d/t HSV 1
Tx: Acyclovir & magic mouthwash

Question 4

Pt presents with a clear tongue and noticed that the “bumps” on her tongue are gone. It is not painful.

Answer 4

Glossitis

Question 5

Pt presents with sore throat.

Upon examination, there are no abscess, no exudates but conjucitivits

Answer 5

Viral pharyngitis
d/t rhinovirus, coronavirus, inufluenza
Tx: supportive- ibuprofen and acetaminophen

Question 6

Pt presents with sore throat but not coughing.

Upon examination:

Answer 6

Group A Beta hemolytic strep
Upon examination, there are exudates, inflammation of the tongue, anterior cervical lymphnodes are swollen
Tx: clindomyacin, penicillin, azithromyocin, cephalosporin

Question 7

Pt presents with sore throat, fever, N&V, rashes, and maliase

Answer 7

Scarlett Fever

Question 8

Pt presets with sore throat with fever and cough.

Upon examination:

Answer 8

Acute Tonisilitis
Upon examination: white exudates, cervical lymph nodes are swollen, fever, vomiting
Tx: supportive - gargle w/ salt, ibuprofen and acetaminophen

Question 9

Pt presents with hot potato mouth and sore throat.

Upon examination:

Answer 9

Peritonsillar abscess
d/t complication of acute tonsilitis (s aurues, h influnezae)
Upon examination: exudates, swollen tonsil, fever, pooling of saliva, cerval lymph nodes.
Tx: I&D, IV abx, tonsillectomy

Question 10

Pt presents with pain in mouth that is exacerbated when salivating or swallowing. Feels that mouth is dry and dehydrated.
Upon examination: purulent discharge from affected area, stone is in the salivary gland

Answer 10

Salivary stone
d/t s aureus, s pneumoniae - underlying for sjogren syndrome
Tx: clinda, vanco, erythromycin
Rehydration, NSAID, improve oral hygiene

Question 11

Pt presents with drooling in mouth, muffled speech, and neck is hyperextended.
Upon examination:

Answer 11

Epiglottitis 
Upon examination: thumbs up sign 
Tx: keeping airway open is the priority
prednisolone for swelling
empiric therapy

Question 12

Pt has been to a football game w/ a cold and has been cheering for 4 hours. Her voice is hoarse and is having difficulty talking.

Answer 12

Laryngitis

Tx: supportive - do not drink/smoke and rest w/ humidification

Question 13

Pt presents with headache, earache, and fever.

Upon examination: parotid glands are swollen.

Answer 13

Parotitis
d/t mumps, coxsackie, or influenza
Tx: supportive

Question 14

Pt presents with snoring and has lost sense of smell. She complains of constant runny nose and post nasal drip at night.
Upon examination: grape like smooth yellow polyps

Answer 14

Nasal polypsaspirin triad (nasal polposis, aspirin, and asthma)
Tx: nasal steroids (oral if severe), surgery if unable to reduce (but will come back)

Question 15

Pt presents with cold w/ severe runny nose and nasal congestion.  She has a scratchy throat and has exacerbated pain when pressure is on the sinus. 
mild-moderate turbinate erymetha
yellow nasal d/c
no epistaxis
swollen lymph nodes

Answer 15

Acute viral rhinosinusitis
inflammation of nasal mucosa and paransal sinuses
d/t rhinovrrius, influenza
Tx: symptomatic: NSAIDs, saline irrigation, sudafed, antihistamines, guifensesin (expectorant)

Question 16

Pt must present with what major and minor symptoms before dx sinusitis

Answer 16

2 major or 1 major and 2 minor symptoms:

major: purulent (1) ant or (2) post nasal discharge (3) nasal congestion (4) facial congestion/fullness (5) anosima/hyposmia (cannot smell/eat) (6) fever
minor: (1) headache (2) ear pain/pressure (3) halitosis (bad breath) (4) dental pain (5) fever (6) fatigue

Question 17

Pt has history of acute rhinosinusitis but is not getting better after 12 wks. Pt presents with all major symptoms*.
Pt also has asthma and has been smoking for 2 years.

Answer 17

Chronic Rhinosinusitis.
three subtypes: (1) CRS w/out nasal polyposis (2) CRS w/ nasal polyposis (3) Allergic fungal rhinosinusitis in order to dx: subjective - failed tx of acute objective: documentation of objective findings
Tx: supportive - nasal saline internasal gluococrtioids (1) CRS w/out nasal polyposis - oral glucocorticodis and oral abx (2) CRS w/nasal polyposis - aspirin desenitization (3) AFRD tx - sinus surgery and oral corticosteroids

Question 18

Pt presents with bloody nose after picking nose.

Inspect:

Answer 18

Epistaxisd/t ant - nose picking, FB, low moisture post - anticoagulation/bleeding disorder
inspect: Kisselbach’s plexus and verify no FB
Tx: (1) blow nose (2) oxymetazoline (afrin) (3) clamp for 10 min

Question 19

Pt presents w/sneezing, rhinorrhea, nasal congestion, watery eyes, post nasal drip, mouth breathing, and dark puffy lids. 
Cobblestoning
Mucous is moist
Nasal creasing 
Hx:

Answer 19

Allergic Rhinitis
Hx: pt parents have allergic rhinitis as welld/t immunoglobin E I hypersensitivity
Tx: avoid allergen, olopatadine (patanol, patanase) triamcinolone (kenalog, nasacort)

Question 20

Allergic Rhinitis frequency of symptoms

Answer 20

Intermittent –> mild –> antihistamine –> INCS
Intermittent –> mod/severe –> INCS –> antihistamine
Persistent –> mild –> INCS –> anthistamine
Persistent –> mod/severe –> INCS –> immunotherapy

Question 21

Pt parent’s smell something awful from child’s nose

Answer 21

Nasal FB

Tx: attempt with alligator forceps, right-angle hooks, swab, magnet - if first attempt fails referral to otolaryngology

Question 22

Pt presents with swollen salivary glands (parotid and submanibular). Pt is dehydrated and poor oral hygiene.
Fever, purulent discharge.

Answer 22

Sialadenitis
Tx: clinda, vanco, erythromycin
Rehydration, NSAID, improve oral hygiene

Question 23

Pt had a cold and had the Sx for 10days without improvement, fever w/ pain for 3-4days, worsening after 5-6 days.

Answer 23

Acute Bacterial Rhinosinusitis

Tx: (1) amox clav - augmentin (2) allergic? - doxycycline