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FA17 HEENT > Mouth and Throat Dz > Flashcards

Mouth and Throat Dz Flashcards

1
Q

Stomatitis

etiologies (5)

A

nutritional deficiencies

chemotherapy

nicotine

systemic autoimmune disease

infection

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2
Q

thrush (def. and common pathogen)

A

infection of buccal mucosa by candidiasis

commonly C. albicans

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3
Q

populations with thrush

A

infants and neonates

abx or steroids (inhalation)

endocrine disorders

underlying immune dysfunction

denture wears w/poor oral hygiene

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4
Q

clinical appearance of thrush

A

shedding of epithelial cells

lumpy/bumpy white

pseudomembranous easily peeled but leaves red erosion

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5
Q

thrush treatment

A

topical nystatin

pral fluconazole

HIV can’t be missed here

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6
Q

systemic diseases associated with aphthous ulcers (6)

A

HIV

Behcet syndrome

Celiac disease

SLE

IBD

Neutropenia

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7
Q

aphthous ulcers

A

aka canker sores

last 7-10 days

usually less than 5 mm

small, red, round/oval spots, prodromal tingling/burning

pain usually dissipates 3-4 days later

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8
Q

possible etiologies of aphthous ulcers (6)

A

genetics

medications

nutrient deficiencies

stress

allergy/sensitivity

trauma

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9
Q

aphthous ulcers treatment

A

avoid spicy food, citrus, hot foods, smoking and EtOH

topical analgesic can be used

antimicrobial mouthwashes

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10
Q

workup indicated if aphthous ulcers don’t heal

A 
CBC 
ESR 
serum iron studies 
B6
B12 
folate
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11
Q

transmission of herpes labials

A

primarily caused by HSV-1

non sexual contact in childhood

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12
Q

herpes labials lesions

A

vesicular lesions that rapidly rupture and ulcerate

acquire virus without clinical illness

buccal mucosa first, then disease is usually on the lips in keratinized skin

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13
Q

herpes labials treatment

A

acyclovir or famciclovir

most effective early in course of illness to shorten duration of illness and infectivity

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14
Q

herpes labials outbreak onset

A

stress, illness, trauma, menses or other irritants can provoke it

prodromal burning/tingling

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15
Q

leukoplakia

A

pre malignant condition that is the result of inflammation

hyperplasia of epithelium

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16
Q

leukoplakia occurs where

A

areas of trauma or in areas of significant carcinogen/chemical exposure

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17
Q

leukoplakia more common in which population

A

smokeless tobacco users

associated with HPV

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18
Q

most significant prognostic indicator of leukoplakia

A

degree of dysplasia

send pt to ENT physician

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19
Q

erythroplakia

A

red patches adjacent to normal mucosa

clinical term but not dx

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20
Q

appearance of atrophic glossitis

A

tongue appears smooth, glossy and with the loss of papillae

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21
Q

etiologies of atrophic glossitis

A

nutritional deficiencies (B12 or iron)

sick and Sjogren’s syndrome

celiac disease

oral candiaisis

PCM

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22
Q

black tongue appearance

A

hyperpigmentation of tongue and oral mucosa

commonly seen in darker skin individuals

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23
Q

black tongue causes

A

drugs (tetracyclines, line solid, antidepressants, proton pump) and addison’s disease

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24
Q

black hairy tongue

A

condition caused by antibiotics, candida infection, or poor oral hygiene

elongated filiform papillae and yellowish white to brown dorsal tongue surface

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25
Q

black hairy tongue treatment

A

brush area of the tongue with a soft bristle toothbrush and toothpaste two to three times per day

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26
Q

head and neck cancers include tumors where? (5)

A

oral cavity

pharynx

larynx

nasal cavity and paranasal sinuses

major and minor salivary glands

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27
Q

risk factors for CA of head and neck

A

tobacco use
alcohol use
HPV

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28
Q

pathogenesis of Head and Neck CA

A

mostly squamous cell origin

multiple genetic mutations

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29
Q

field carcinogenesis

A

exposure everywhere when exposing head and neck to cancer causing agents

reminds us that cancer in this area can develop a second PRIMARY tumor (2, genetically different cancers)

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30
Q

common symptoms of head and neck cancers

A

pain

sores that won’t heal

hoarseness/voice change

cough

dysphagia

neck mass

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31
Q

endoscopic visualization

A

used to evaluate cancers of deeper tissues

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32
Q

image studies used to diagnose head and neck CA

A

CT scan w/wo IV contrast

MRI scan w/wo IV contrast

PET scan

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33
Q

local invasion

A

CA remains at site of primary tumor

grows out of organ to invade neighboring tissue

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34
Q

lymph node involvement

A

lymphatic drainage can follow spread

gives easy access

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35
Q

distant mets

A

far away from site

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36
Q

second primary cancer

A

totally genetically different cancer found in the same spot

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37
Q

cancer can’t be confirmed until

A

tissue dx is obtained

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38
Q

sequence of events in evaluating head and neck CA

A

H and P –> imaging –> tx

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39
Q

most common sites of head and neck CA metastasis

A

lungs, liver bone

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40
Q

most common second primaries in head and neck CA

A

head and neck CA
lung CA
esophageal CA

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41
Q

treating early head and neck CA

A

early head and neck cancer

treated surgically or with definitive radiation therapy

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42
Q

follow up with patients in head and neck CA

A

surveillance for recurrence for next 5 years at least

most recurrences occur within first 2-4 yrs

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43
Q

patients with recurrent head and neck CA treatment

A

pallative care, support

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44
Q

components of salivary system

A

2 parotid glands
2 submandibular glands
hundreds of minor salivary glands

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45
Q

acute sialadenitis

A

aka parotitis

infection of the salivary gland

may be bacterial or viral

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46
Q

sialolithiasis

A

stones in the salivary duct resulting in obstruction

stone formation

47
Q

bacterial sialadenitis s/s

A

unilateral parotid glands

  1. unilateral swelling of the gland
  2. exquisite localized pain
  3. dysphagia or trismus (lockjaw)
  4. systemic symptoms
48
Q

bacterial sialadenitis pathophysiology

A

stasis of saliva in the duct

therefore oral bacteria spread into the gland

49
Q

bacterial sialadenitis

salivary stasis is facilitated by

A

obstruction (stone, tumor, growth)

decreased salivary flow (dehydration)

medication (anticholinergics, diuretics, opioids)

50
Q

bacterial sialadenitis

bactieral culture suspected

A

polymicrobial (gram positive and anaerobes) – esp staph aureus

if hospitalized - gram neg. (klebsiella, enterobacter)

culture material from the duct (not just swob) but typically just empirically treat

51
Q

bacterial sialadenitis

diagnostic working

A

Ultrasound *** detects abscess (I&D)

Contrast ct is best to distinguish cellulitis from abscess

elevated serum amylase w/o concurrent pancreatitis

52
Q

bacterial sialadenitis

treatment

A

hydration

promotion of salivary flow (lemon drops or other mints)

IV ABx (vancomycin + metronidazole) 10-14 days

if abscess - I & D

53
Q

bacterial sialadenitis

complications

A

massive swelling of neck = air way obstruction

osteomyelitis

septic phlebitis (jugular)

sepsis

54
Q

sialithiasis s/s

A

pain and swelling over gland before or during eating

may be possible to feel stone or milk it (duct may be tender)

55
Q

sialithiasis

dx

A

NON contrast CT of face

56
Q

sialithiasis

tx (conservative)

A

moist heat

sialogogues

good hydration ‘

milking duct

NSAIDS for pain

57
Q

sialithiasis

tx (procedural)

A

lithotripsy

wire basket retrieval via endoscopy

surgery

58
Q

untreated/chronic sialithiasis

A

saliva production ceases and gland then becomes firm

59
Q

infection/irritation of pharynx or tonsils

A

pharyngitis/tonsillitis

60
Q

pharyngitis/tonsillitis

etiologies

A

infectious (typically viral)

trauma, toxins, allergy, neoplasm

61
Q

infectious pharyngitis/tonsillitis

A

if bacterial: typically caused by GAS (group A strep)

but most often viral

62
Q

symptoms associated with bacterial pharyngitis/tonsillitis

A 
fever ( <102) 
white spots (pus) 
cervical LAD 
sudden, systemic illness 
sick contact

4-7 y.o., vomiting and HA, petechiae

63
Q

symptoms viral pharyngitis/tonsillitis

A

SUB ACUTE onset

hoarseness, coryza, myalgia
cough, conjunctivitis, rhionrrhea

64
Q

unreliable pharyngitis/tonsillitis symptoms that don’t help us distinguish b/t viral and bacterial

A

fever (or lack of)

tonsillar or pharyngeal exudates

65
Q

Centor criteria (list)

A
  1. fever to 101
  2. anterior cervical lymphadenopathy
  3. tonsillar exudate
  4. absence of cough
66
Q

centor criteria interpretation

A

if 4 present - high likelihood of GAS, give aBX

if 2-3: preform rapid strep test

if 1: probably viral, symptomatic management

67
Q

tests used to diagnose step

A

rapid strep testing

throat culture (takes longer but sure that it is strep)

68
Q

what is our biggest concern in missing a GAS pharyngitis/tonsillitis diagnosis?

A

rheumatic fever

but we shouldn’t be concerned bc the strains that cause it are not in America

69
Q

viral pharyngitis treatment

A

symptomatically

NSAIDs/tylenol, salt water, hot showers/steam inhalation, lozenges

70
Q

GAS pharyngitis/tonsillitis treatment

A

self limited

s/s can resolve spontaneously 3-4 days

71
Q

empiric ABX treatment of GAS pharyngitis/tonsillitis

A

penicillin (first line)

can give amoxicillin in young kids

erythromycin if PCN allergy

72
Q

severe complications of strep

A
  1. scarlet fever
  2. rheumatic fever
  3. strep glomerulonephritis
73
Q

scarlet fever

epidemiology

A

occurs in < 10% of strep throat cases

typically follows untreated/poorly treated strep

74
Q

pathophysiology of scarlet fever

A

TOXIN produced by strep causes pathognomonic rash and other s/s

75
Q

scarlet fever

rash

A

orange/red coarse sandpaper textured rash

  • starts on head/center and moves out and down
  • blanches may be puritic
  • intensifies on flexor creases and facial flushing
  • 12-48 hrs following fever

desquamation of skin 7-10 days later

76
Q

scarlet fever

other s/s

A

rash +

strawberry tongue (white coating and red papillae, until white peels away)

high fever (103,104)

abdominal pain

77
Q

scarlet fever management

A

HIGHLY contagious

PCN still drug of choice

78
Q

rheumatic fever

pathophys

A

autoimmune inflammatory response

molecular mimicry causes inflammatory tissue injury persisting beyond acute GAS infection

body can’t distinguish b/t strep and self

inflammatory lesions of joints, heart, subcutaneous tissue, central nervous system

79
Q

s/s of rheumatic fever

A

Arthritis (75%) - SYMMETRIC lg joints (knees, shoulder)

Carditis (30-60) pericarditis, valvular injury, myocarditis- esp. younger

sydenham chorea (little girls, near and psych features)

fever

abdominal pain

erythema marginatum (non-puritic, painless, serpiginous eruption) - RARE

80
Q

Jones criteria of rheumatic fever

A

pancarditis (CV issues)

polyarthritis

syndham chorea

subcutaneous nodules

erythema marginatium

81
Q

rheumatic fever

treatment

A

PCN and anti inflammatories

following diagnosis patients are placed on long term PCN to prevent recurrence

82
Q

rheumatic valvular disease

A

causes mitral valve stenosis

more common in women `

increased risk for clotting issues, dental problems, procedures and fluid adminstarion

83
Q

streptococcal glomerulonephritis

A

occurs 1-2 weeks after strep (throat or impetigo)

urinary (hematuria, oliguria or anuria) 
edema (face, arms, eyes, feet, ankles) 
hypertension 
abdominal pain 
back pain
84
Q

deep neck infections

A

infections of the deep fascial layers of the neck

bad bc they can cause airway obstruction

85
Q

deep neck infections

bacterial etiologies

A

typically polymicrobial (Gram pos. + anaerobes_)

86
Q

deep neck infections

presenting s.s

A

may not have distinct fluctuant mass

dysphagia
swelling
trismus
pooling of saliva

87
Q

deep neck infections

historial questions

A

likely source of infection

recent hospital or ECF

prior surgery

88
Q

deep neck infections

imaging

A

CT scan of neck w/wo contrast

must be done quick bc of airway problems

89
Q

deep neck infections

treatment options

A

vancomycin/zosyn

hospital admission

ENT + I and D consult

90
Q

PTA/cellulitis

A

infection of tonsils that has extended into soft tissue of neck

not quite as deep but on way

result of contiguous spread (cellulitis -> phlegm -> abscess

91
Q

pTA mc in which population

A

adolescents and young adults

92
Q

PTA bacterial etiology

A

often poly microbial

GAS, MSSA/MRSA, respiratory anerobes

93
Q

PTA symptoms

A 
severe sore throat 
muffled voice
drooling
trismus
systemic symptoms
94
Q

PTA signs

A

enlarged, s wollen and fluctuant tonsil

bulging or fullness of soft palate

deviation of uvula

95
Q

PTA work up

A

labs not great but imaging is diagnostic

CT scan of neck w/and w/o IV contrast

96
Q

pta Differential

A

epiglottis
other deep neck infections
severe tonsillopharyntitis

97
Q

PTA management

A

hospitalization

airway management
drainage
ABX (gram + and anaerobe cvg) - Unasyn, cleocin, vanco 14 days

typically full recovery

98
Q

stridor

A

high pitched whistling produced from narrowed air way

above the cords = inspiratory, below cords = expiratory

99
Q

why is PEEP important?

A

keeps a little bit of air inside the lungs so that alveolar cells are still open

decreases stress and allows easier gas exchange

100
Q

epiglottitis bacterial causes

A

H. flu (we have vaccine now)

now it is mostly viral

must control bc airway compromise

101
Q

epiglottitis s.s (young kids)

A

Abrupt onset of:
respiratory Distress
Dysphagia
Drooling

tripod or sniffling posture (CHIN thrust forward) to maximize airway

102
Q

epiglottitis s/s (adults)

A

sore throat, fever, muggled voice, drooling

onset is more gradual and compromise is less common

not sniff posture bc airway is larger

103
Q

epiglottitis exam

A

be careful in exam bc may provoke laryngospasm and constriction of air way

ENT consult and lateral neck radiographs

104
Q

epiglottitis treatment

A
  1. airway management
  2. supplemental oxygen
  3. monitoring in ICU, ent consult

+/- corticosteroids, bronchodilators

105
Q

laryngitis

A

hoarseness persisting for one or more weeks

treatment is voice rest

106
Q

abnormal adduction of vocal cords during respiratory cycle that produces air flow obstruction at larynx

A

vocal cord dysfunction (VCD)

107
Q

vocal cord dysfunction (VCD)

epidemiology

A

can occur at any age

MC in females, 20-40

108
Q

vocal cord dysfunction (VCD)

risk factors

A

GERD, occupational exposure, swimming, strenuous exertion, allergies, psychiatric

109
Q

vocal cord dysfunction (VCD)

pathoneumonic finding

A

paradoxical vocal cord adduction with posterior glottic chink during inspiration

110
Q

vocal cord dysfunction (VCD)

symptoms

A 
sudden onset of dyspnea 
cough 
throat tightness 
wheezing 
stridor
111
Q

exam findings in VCD

A

harsh stridor and may have radiation of wheezing into upper chest

patients are often dx and tx for asthma with no or little response

112
Q

vcd v. asthma

A

both have wheezing, cough, dyspnea BUT VCD has

for response to inhaled beta agonists or ICS
absence of nocturnal awakening
absence hypoxemia
INSPIRATORY stridor and wheezing

113
Q

vocal cord dysfunction (VCD) diagnosis

A

direct observation via laryngoscopy while symptomatic

114
Q

vocal cord dysfunction (VCD)

treatment

A

speech therapy

psychotherapy

FA17 HEENT (8 decks)

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