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CLIN MED 3 - HEENT > Mouth and throat Conditions > Flashcards

Mouth and throat Conditions Flashcards

1
Q

What is a Stomatitis

A

inflammation of the mouth with or without ulceration

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2
Q

what are the oral causes of stomatitis

A

poor hygiene
poor fitting dentures
trauma (hot foods, chemical)
ingested toxins

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3
Q

what are systemic causes of stomatitis

A

infection (viral, fungal, bacterial)
drug reactions
allergic reactions
chemotherapy/radiation
nutritional deficiencies

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4
Q

what are gingivostomatitis

A

when inflammation also affects the gingiva

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5
Q

what are mucositis

A

not to be used interchangeably as this refers to systemic mucosal pathology often as a result of chemo/RT (mouth and gut)

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6
Q

What is benign inflammatory glossitis

A

aka geographic tongue
benign condition exacerbated by stress, nutritional deficiency or heredity
the pattern changes
no treatment needed

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7
Q

what is “black” hairy tongue

A

treated with vigorous brushing with abrasive toothpaste

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8
Q

what is “white” hairy tongue

A

abnormal elongation of filiform papillae secondary to increased keratin deposits
M>F

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9
Q

what are recurrent aphthous ulcers

A

aka canker sores
last 10-30 days on average
vary in size and shape

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10
Q

what are triggers for aphthous ulcers

A

decrease in mucosal barrier: trauma, pernicious anemia
increased antigenic exposure: foods, flavoring agents
primary immunosuppression/dysfunction: dehcet’s, crohns, celiac, cyclic neutropenia, HIV/AIDS, STRESS

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11
Q

what is the workup for recurrent aphthous ulcers

A

CBC
ESR/CRP
iron studies
B12
SS-A(Ro)/SS-B (La)
glucose
thyroid
HSV titers
HIV

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12
Q

what is the treatment for Aphthous ulcers

A

topical steroids: either rinse or cream/gel
systemic steroid: good for multiple lesions or if in oropharynx
Dexamethasone elixr 0.5mg/5ml

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13
Q

what is the presentation of aphthous ulcers

A

prodrome: sometimes
duration: 10-14 days
Location: non-keratinized tissue- buccal mucosa, ventral tongue, soft palate

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14
Q

what is the presentation of HSV

A

prodrome: usually
duration: 10-14 days
location: keratinized tissue - gingiva, lip, hard palate

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15
Q

what is primary herpetic gingivostomatitis

A

Herpes (HSV1)- primary lesion: highly infectious
primary infection lasts up to 2 weeks
patients are very sick
after initial infection - virus goes into latency

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16
Q

how do you differentate from HSV1 from oral Zoster

A

oral herpes zoster: unilateral with mandibular or maxillary distribution and HAS a prodrome

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17
Q

how do you treat primary HSV1 for adults

A

acyclovir or famvir

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18
Q

how do you treat primary HSV1 in kids

A

oral acyclovir 200mg/5ml suspension

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19
Q

how do you treat recurrent HSV infection

A

topical: acyclovir or pencyclovir
systemic: vanlacyclovir, famiclovir, acyclovir

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20
Q

What is oral candidiasis

A

“thrush”
opportunistic organism
m/c w/ dentures, diabetics, infants, elderly, pregnancy, nutritional deficiencies, HIV and other immunosuppressed states

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21
Q

What can cause persistent candidiasis

A

anemia
poorly controlled/undiagnosed DM
thyroid disease
immunosuppression, chronic steroid or abx use
xerostomia

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22
Q

what labs are ordered with persistent candidiasis

A

CBC with diff
B12
glucose
thyroid funciton
HIV
nutritional workup

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23
Q

what are the treatments for oral candidiasis

A

Nystatin
Clortimazole
Fluconazole

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24
Q

what is the treatment of angular cheilitis

A

topical anti-fungal (nystatin)
fluconazole - single dose

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25
Q

what is pharyngitis and tonsillitis

A

infection and/or irritation of pharynx and/or tonsils
majority of cases are viral and self limited
bacterial cause is usually strepA (GAS)

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26
Q

What is GAS

A

Group A Strep (GAS)
tends to occur in 5-15 year olds
dx: confirm using rapid antigen detection test and/or throat culture

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27
Q

what is the treatment of GAS pharyngitis

A

abx therapy (penicillin or amoxicillin)
cephalexin, azithromycin, erythromycin, clindamycin, cetriaxone

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28
Q

what are the complications of strep pharyngitis

A

Rheumatic fever/rheumatic heart disease
post-stretococcal glomerulonephritis

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29
Q

What is mononucleosis

A

EBV - pharyngitis is the most common complain/finding
highest incidence in 15-25 year olds

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30
Q

what is the biggest concern with mononucleosis

A

splenomegaly with rupture

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31
Q

what is the clinical presentation of mono

A

prodrome: fatigue, low-grade fever, malaise, myalgias over 1-2 weeks are common
pharyngeal and tonsil symptoms often severe and exudative
lymphadenopathy in almost all cases

32
Q

what medication should be avoided in exudative tonsilitis (mono)

A

amoxicillin - may cause a rash

33
Q

how do you diagnose mono

A

EBV titer vs monospot: CBC, LFTs
typically a clinical diagnosis

34
Q

what is the treatment of mono

A

supportive

35
Q

what is coxsackie virus

A

herpangina not caused by herpes virus
children <10 yo
common in summer and fall
“hand, foot and mouth disease” similar eruptions on hands or feet

36
Q

what is acute tonsillitis

A

rare in children <2yo
“strep” (bacterial) tonsillitis most common in ages 5-15
viral tonsillitis more common in younger kids

37
Q

how is chronic tonsillitis classified

A

7 episodes in 1 year
5 episodes /year x 2 years
3 episodes/year x 3 years
symptoms: chronic sore throat, halitosis, tonsilliths

38
Q

what is the indication for tonsillectomy

A

recurrent infections
multiple antibiotic allergies
hx of peritonsillar abscess (PTA)
periodic fever, aphthous stomatitis, pharyngitis, adenitis (PFAPA)
hypertrophy and sleep disordered breathing/OSA

39
Q

What is seen with PTA

A

fever, malaise, dysphagia, odynophagia, “hot potato” voice, trismus, bulging of superior tonsil pole and soft palate
DEVIATION OF THE UVULA

40
Q

what is the treatment for PTA

A

I&D, IM pen VK if not allergic, pain control and recheck 24 hours

41
Q

what is the difference between tonsillitis and PTA

A

uvula midline with tonsillitis and deviated with PTA

42
Q

What is the first choice medication for dental abscess

A

amoxicillin but if allergic - consider azythro, metronidazole or clindamycin

43
Q

What is Ludwigs angina

A

potentially life threatening cellulitis of the soft tissue of floor of the mouth and neck.
includes submandibular spaces of mouth, spreading to sublingual and submental spaces
often result of dental root infection or mouth injury

44
Q

what is the clinical presentation of Ludwig’s angina

A

breathing difficulty (tripod)
AMS/confusion
fever/chills
neck pain/stiffness
neck swelling (not lymphadenopathy)
redness of the neck
weakness, fatigue, excessive tiredness
difficulty swallowing, drooling, earache, trismus

45
Q

what is the treatment plan for Ludwig’s angina

A

secure airway - AIRWAY EMERGENCY
IV abx, broad spectrum including MRSA
IV steroids can help with swelling
surgical drainage

46
Q

what are predisposing factors of Ludwig’s angina

A

poor oral hygiene
dental caries, recent dental tx
diabetes
ETOH use d/o
malnutrition
immunosuppression

47
Q

What is Croup

A

laryngotracheobronchitis
most common cause of stridor in children
2nd year of life (6mo - 6 year, peak 12mo-2 yo)
parainfluenza type 1
barking cough
inspiratory high-pitched stridor

48
Q

hat is the steeple sign

A

subglottic narrowing
can be seen with croup

49
Q

what is epiglottitis

A

H infleunzae type B (Hib vaccine)
1-5 yo - rapid progression
sitting position head up and mouth open drooling “tripod”

50
Q

what are the 4Ds of epiglottitis

A

drooling
dysphagia
dysphonia
distressed respiratory efforts

51
Q

what can be seen on x-ray with epiglottitis

A

“thumb print” sign

52
Q

What is Leukoplakia

A

white patch or plaque
biopsy
malignant transformation ~10%

53
Q

What is Erythroplakia

A

red dysplasia
biopsy/refer ASAP
high malignant transformation - 70%

54
Q

what is lichen planus

A

lacy white mucosal change
biopsy
low chance of malignant transformation (unless erosive)
chronic disease of skin and mucous membranes

55
Q

what are the primary salivary glands

A

parotid (2)
Submandibular (2)
Sublingual (2)
minor salivary glands (5,000)

56
Q

What are the two salivary ducts that enter the oral cavity

A

Whartons ducts - from submandibular glands (side of tongue)
Stensen’s ducts - from parotid glands (across from second molar of upper jaw)

57
Q

what are the three categories of problems with the salivary glands

A

altered saliva production
painless swelling
painful swellng

58
Q

What is Sialadenosis

A

recurrent painless swelling (parotid gland)

59
Q

what can cause Sialadenosis

A

endocrine disorders (DM)
Malnutrition (protein, ETOH, vitamin)
Autonomic dysfunction

60
Q

what is the treatment for Sialdenosis

A

correct underlying causes
reassurance

61
Q

what is the treatment of acute Sialadenitis

A

B-lactam resistant penicillin or cephalosporins
steroids
fluid replacement
Sialogogues (chewing gum or hard candy)
analgesics
manual massage
topical heat

62
Q

what is acute Sialdenitis

A

all possible glands but most commonly parotid
rapid onset of pain, swelling and induration
suppurative discharge from duct

63
Q

what is recurrent Sialadenitis

A

mechanical obstruction is the most common factor

64
Q

how do you work up recurrent Sialadenitis

A

Ct neck with contrast to rule out stones or intrinsic lesions or abscess

65
Q

what are the treatment options for recurrent Sialadenitis

A

oral anaerobes dominate: clindamycin, augmentin, flagyl+cephalopsorin, avelox (fluoroquinalone)

surgical excision of gland is the last resort

66
Q

what is Sialolithiasis

A

formation of salivary stones
M>F ages 30 - 60
submandicular > parotid > minor
one of the most common cause of salivary dysfunction

67
Q

what causes Sialolithiasis

A

enhanced if stasis of salivary flow
genetic predisposition (kidney stones, gout)
mineralization of mucoid gel

68
Q

what is the clinical presentation of Sialolithiasis

A

asymptomatic
recurrent swelling associated with eating
spitting out stones
sialadenitis (infection)

69
Q

how do you manage Sialothiasis

A

hydration
massage (posterior -> anterior) + heat
anti-inflammatories
abx if infected
removal of stones
sialendoscopy
surgical excision of affected gland

70
Q

what is the most common cause of acute non-suppurative sialadenitis in childhood

A

mumps

71
Q

what is the most common cause of acute suppurative parotitis

A

S. aureus, ~strep species

72
Q

what is the treatment for acute suppurative parotitis

A

initial empiric antibiotics covering aerobic and anaerobic bacterial
surgical drainage may be indicated when pus has formed

73
Q

what is laryngitis

A

inflammation of the larynx, usually viral and occasionally from reflux
usually URI prodrome, then hoarsness

74
Q

what is the treatment of laryngitis

A

supportive care, LOTS of fluids, voice rest

75
Q

when is a laryngoscopic exam required with laryngitis

A

if dyspneic or hoarsness lasts longer than 1-2 weeks

76
Q

what is a laryngeal polyp

A

results of hemorrhagic event: acute phono trauma
90% unilateral
treatment: voice rest, ~excision + voice therapy

CLIN MED 3 - HEENT (8 decks)

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