Mouth and Throat 2.27.18 Flashcards
Name the 5 centor criteria
For RADT - strept throat
- Sudden onset
- Tonsillar exudate
- Tender lymph nodes
- Fever
- NO COUGH
What is the treatment for bacterial tonsillitis?
Penicillin V 500mg BID-TID for 10 days
or Amoxicillin
If PCN allergic: Macrolides: Azithromycin, erythromycin, clarithromycin
Name 4 complications of strep throat
- Acute rheumatic fever*
- Acute glomerulonephritis*
- Mastoiditis
- Bacteremia
How many times does someone need to have tonsillitis to have tosillectomy
7 in a year
5 a year, for 2 consecutive years
3 a year for 3 consecutive years
What constitutes an episode of strept throat?
- Strept throat
- Fever >100.9
- Tonsillar exudate
- Anterior cervical adenopathy
- Confirmed GABHS culture
Most common cause of acute pharyngitis?
Viral
Most common bacterial cause of acute pharyngitis?
Group A strept
What organism most common causes peritonsillar abcess?
streptococcus pyogenes (GABHS)
Name 5 symptoms of peritonsillar abcess
- hot potato voice
- drooling
- Trismus (lock jaw)
- fever
- exudate
Best imaging for Peritonsillar abcess
CT with IV constrast
Peritonsillar abcess: treatment
Ampicillin-sulbactam IV (or clindamycin)
-or-
Amoxicillin-clavaulanate for 14 days (or clindamycin)
After when do you become concerned about laryngitis?
If it hasn’t resolved by 3 weeks they need to see ENT and have imaging
Epiglottitis: cause
Haemophilus influenzae type B (bacterial)
What are the 3 D’s of epiglottitis?
Dysphagia - “pain out of proportion”’
Distress - anxiety, can’t breathe well
Drooling - too painful to swallow
What is thumb sign?
inflammed epiglottis on lateral radiograph
What is the treatment (ABO) for epiglottitis?
3rd generation cephalosporin + Vancomycin IV
+/- Dexamethasone
What virus causes oral herpes?
Herpes Simplex Virus type 1
What causes Hand, Foot, Mouth disease?
coxsackie A16
What is the difference in lesions between oral herpes and coxsackie?
herpes: painful vesicles on erythematous base
coxsackie: papules on erythematous base
Compare and contrast fever and location of papules: Herpangia and Hand, Foot, Mouth
HFM:
- lower fever
- papules on tongue and hard palate (more anterior)
Herpangia:
- HIGHER fever
- lesions on soft palate (more posterior)
What virus causes apthous ulcers?
Herpes-virus 6
Treatment for apthous ulcers?
steroids + analgesics
Bechet’s Dx criteria
recurrent oral ulcers more than 3 times/year + 2 of the following [recurrent genital ulcers, eye lesions, skin lesions]
What other labs need to be considered with a patient with thrush?
- HIV
2. blood glucose
What disease is characterized by reticular white/ hyperkeratotic plaques?
Oral lichen planus
Lichen planus: treatment
- pain management
- steroids
- cyclosporine
- retinoids
- tacrolimus
What disease is a hyperplasia of squamous epithelium from chronic irritation?
Oral leukoplakia
*precancerous
Erythroplakia treatment
This is malignant - ALL MUST BE BIOPSIED*****
Hairy Leukoplakia: infectious agent
Epstein-barr virus
*almost exclusive with HIV
Black hairy tongue is associated with what treatment?
ABO
Which organism causes dental caries?
strept mutans
Most common location for sialolithiasis
wharton duct
Imaging for sialolithaisis?
US or CT
What lab would you expect to see elevated in suppurative parotitis?
Elevated Amylase**
Imaging for suppurative parotitis?
- US
- CT
- MR sialography**
Treatment for suppurative parotitis?
- IV ABO
- Hydration
- Surgery (if no improvement in 48 hours)
3 complications of suppurative parotitis
- Massive neck swelling
- septicemia
- osteomyelitis
Oral cancer cell type
squamous cell carcinoma
*oral cancer is most common head and neck cancer
Which HPVs (3) are associated with cancers of mouth, pharynx, larynx?
16
18
31
What is the tumor suppression gene most commonly associated with head and neck tumors?
p53
What is the cause associated with nasopharyngeal cancers?
Epstein-barr virus
