Mouth and Nose Flashcards
Pt presents with white plaque on tongue.
Upon examination, the plaque scrapes off.
Oral Candidiasis (Thrush). Tx: Nyastatin or fluconazole
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.
Aphthous ulcer (canker sore). Tx: heals w/in 10-14 days - relieve pain symptoms
Pt has clusters of lesions near mouth.
Herpetic Gingivostomatitis
d/t HSV 1
Tx: Acyclovir & magic mouthwash
Pt presents with a clear tongue and noticed that the “bumps” on her tongue are gone. It is not painful.
Glossitis
Pt presents with sore throat.
Upon examination, there are no abscess, no exudates but conjucitivits
Viral pharyngitis
d/t rhinovirus, coronavirus, inufluenza
Tx: supportive- ibuprofen and acetaminophen
Pt presents with sore throat but not coughing.
Upon examination:
Group A Beta hemolytic strep
Upon examination, there are exudates, inflammation of the tongue, anterior cervical lymphnodes are swollen
Tx: clindomyacin, penicillin, azithromyocin, cephalosporin
Pt presents with sore throat, fever, N&V, rashes, and maliase
Scarlett Fever
Pt presets with sore throat with fever and cough.
Upon examination:
Acute Tonisilitis
Upon examination: white exudates, cervical lymph nodes are swollen, fever, vomiting
Tx: supportive - gargle w/ salt, ibuprofen and acetaminophen
Pt presents with hot potato mouth and sore throat.
Upon examination:
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
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
Salivary stone
d/t s aureus, s pneumoniae - underlying for sjogren syndrome
Tx: clinda, vanco, erythromycin
Rehydration, NSAID, improve oral hygiene
Pt presents with drooling in mouth, muffled speech, and neck is hyperextended.
Upon examination:
Epiglottitis Upon examination: thumbs up sign Tx: keeping airway open is the priority prednisolone for swelling empiric therapy
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.
Laryngitis
Tx: supportive - do not drink/smoke and rest w/ humidification
Pt presents with headache, earache, and fever.
Upon examination: parotid glands are swollen.
Parotitis
d/t mumps, coxsackie, or influenza
Tx: supportive
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
Nasal polypsaspirin triad (nasal polposis, aspirin, and asthma)
Tx: nasal steroids (oral if severe), surgery if unable to reduce (but will come back)
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
Acute viral rhinosinusitis
inflammation of nasal mucosa and paransal sinuses
d/t rhinovrrius, influenza
Tx: symptomatic: NSAIDs, saline irrigation, sudafed, antihistamines, guifensesin (expectorant)
Pt must present with what major and minor symptoms before dx sinusitis
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
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.
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
Pt presents with bloody nose after picking nose.
Inspect:
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
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:
Allergic Rhinitis
Hx: pt parents have allergic rhinitis as welld/t immunoglobin E I hypersensitivity
Tx: avoid allergen, olopatadine (patanol, patanase) triamcinolone (kenalog, nasacort)
Allergic Rhinitis frequency of symptoms
Intermittent –> mild –> antihistamine –> INCS
Intermittent –> mod/severe –> INCS –> antihistamine
Persistent –> mild –> INCS –> anthistamine
Persistent –> mod/severe –> INCS –> immunotherapy
Pt parent’s smell something awful from child’s nose
Nasal FB
Tx: attempt with alligator forceps, right-angle hooks, swab, magnet - if first attempt fails referral to otolaryngology
Pt presents with swollen salivary glands (parotid and submanibular). Pt is dehydrated and poor oral hygiene.
Fever, purulent discharge.
Sialadenitis
Tx: clinda, vanco, erythromycin
Rehydration, NSAID, improve oral hygiene
Pt had a cold and had the Sx for 10days without improvement, fever w/ pain for 3-4days, worsening after 5-6 days.
Acute Bacterial Rhinosinusitis
Tx: (1) amox clav - augmentin (2) allergic? - doxycycline
