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mouth/throat Flashcards

1
Q

types of oral lesions

A 
squamous cell carcinoma
oral leukoplakia
candidiasis
herpes simplex virus
aphthous ulcers
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2
Q

causes of squamous cell carcinoma

A

dental changes/ ill fitting dentures
tongue/lip cancers- painful exophylic or ulcerative lesions
persistant papules, plaques, erosions, ulcers
smoking/alcohol
hpv infx

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3
Q

path SCC

A

leukoplakia, erythroplakia, leukoerythroplakia all progress to invasive cancer

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4
Q

pt presents w nonhealing mucosal ulcers, sore throat, referred otalgia, hoarseness, dysphagia, chronic cough, and neck mass

A

SCC

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5
Q

precancerous lesion presents as white patches/plaques of oral mucosa (cheek/tongue) that doesn’t scrape off

A

oral leukoplakia- progress to become SCC

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6
Q

white plaques that can be scraped off

A

pseudomembranous form oral candidiasis

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7
Q

erythema without plaques

A

atrophic form oral candidiasis

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8
Q

beefy red tongue w soreness

A

candidiasis

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9
Q

local infx seen in infants, denture wearers, diabetics, tx w abx/chemo,radiation, and immunocomp

A

oral candidiasis

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10
Q

tx candidiasis

A

nystatin suspension/ troche

clotrimazole troche

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11
Q

mc manifestation of primary herpes simplex infx in childhood caused by herpes simplex virus type 1

A

herpetic gingivostomatitis

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12
Q

multiple intraoral vesicular lesions and erosions bordered by inflam, eryth base

A

herpes simplex virus

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13
Q

what is herpes simplex virus brought on by

A

sunlight
trauma
emotional/physiologic stress

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14
Q

young kid with fever, lymphadenopathy, drooling, and dec po intake

A

herpes

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15
Q

where can a ruptured vesicle leave area of ulceration or erosion with herpes

A

bone bearing tissues or keratinized mucosa

palate, attached gingival, dorsal surface tongue

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16
Q

dx herpes

A

multi nucleated giant cells on tzanck smear
direct immunofluorescence smear
viral culture

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17
Q

tx herpes

A

acyclovir
fluids
ice/popsicles/oral sinuses
magic mouthwash, diphenhydramine, carafate, viscous lidocaine

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18
Q

painful oral lesions that appear as localized, shallow, round to oval ulcers w grayish base

A

aphthous ulcer- canker sore

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19
Q

presents round, clearly defined, small, painful ulcers that heal within 10-14d no scarring

A

aphthous ulcer

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20
Q

where does aphthous ulcers occur

A

soft, movable tissues that are non keratinized

labial/buccal mucosa, ventral surface tongue, floor mouth

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21
Q

tx aphthous ulcer

A

topical anesthetics- or abase w triamcinolone
magic mouthwash
silver nitrate/cautery

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22
Q

viral causes pharyngitis

A 
influenza
parainfluenza
adenovirus
enterovirus
rsv
hsv
ebv
cmv
hiv
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23
Q

bacterial causes pharyngitis

A

group a strep- incubate 2-4d, resolves 3-4d

mycoplasma

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24
Q

noninfectious causes pharyngitis

A

allergies

post nasal drip

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25
Q

group a strep (GAS) pharyngitis complications

A

acute rheumatic fever/scarlet fever
glomerulonephritis
peritonsillar abscess
toxic shock syndrome

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26
Q

pt sore throat worse when swallows, fever, ha, malaise, lymphadenopathy, uri

A

pharyngitis

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27
Q

what will see physical exam pharyngitis

A

doesn’t dist viral from bacterial
pharyngeal erythema
tonsillar swelling/exudates= kissing tonsils
lymphadenopathy

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28
Q

centor criteria for clinical indications for potential GAS

A 
tonsillar exudates
tender anterior cervical adenopathy
fever
absence of cough
(
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29
Q

dx GAS

A

rapid antigen detection test “rapid strep”- specific

throat cx is GS

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30
Q

tx viral pharyngitis

A

fever control
fluids
magic mouthwash or topical spray (chloraseptic )
cough drops/ lozenges

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31
Q

tx GAS

A

penicillin VK- 1st line amoxicillin, ampicillin

  • (po amoxil tastes better)
  • cephalosporins, macrolides, clinda

penicillin G im injection

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32
Q

tx kissing tonsils

A

steroids

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33
Q

when can someone return school

A

after abx therapy, fever free 24h

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34
Q

infection between the capsule of the palatine tonsil and the pharyngeal muscles

A

peritonsillar cellulitis

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35
Q

collection of pus located between the capsule of the palatine tonsil and the pharyngeal muscles

A

peritonsillar abscess

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36
Q

deep cervical tissue infection

A

retropharyngeal cellulitis/abscess

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37
Q

path of peritonsillar abscess

A

peritonsillar infx- preceded by tonsillitis or pharyngitis and progresses from cellulitis to phlegm on to abscess

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38
Q

where does peritonsillar abscess occur

A

superior pole of tonsil

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39
Q

bacterial causes peritonsillar abscess

A

GAS, staph aureous, respiratory anaerobes

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40
Q

severe sore throat, fever, “hot potato”/muffled voice and may have drooling, trismus, ear pain

A

peritonsillar abscess

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41
Q

extremely swollen tonsil, uvula deviated to opposite side, building of posterior soft palate, fever, exudates

A

peritonsillar abscess

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42
Q

dx peritonsillar abscess

A

labs for baseline- cbc, bmp, throat cx/rapid strep, aso titer
imaging for extent- ct w contrast

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43
Q

tx peritonsillar abscess

A

consult ent
abscess- needle aspiration, iv clinda or ampicillin-sulbactam
cellulitis- 24h iv abx and reeval

44
Q

what must you match sure you do with peritonsillar abscess

A

monitor airway

45
Q

complications of peritonsillar abscess

A

airway compromise
sepsis
necrotizing fasciitis

46
Q

complication of GAS pharyngitis may be life threatening

A

retropharyngeal infx

47
Q

when to worry w retropharyngeal infx

A 
torticollis/pain neck movement
difficulty swallowing, drooling
changes in voice
neck swelling
trismus
48
Q

what should you do for retropharyngeal infx

A

airway protection

ct/ soft tissue X-ray of neck

49
Q

tx retropharyngeal infx

A

admit/stat ent consult
may need intubation/surgical airway
may need surgical evacuation of abscess
iv abx- clinda or ampicillin-sulbactam

50
Q

Inflammation of the epiglottis and adjacent supraglottic structures

A

epiglottitis

life threatening infx- airway obstruction

51
Q

Kids: Trouble breathing, fever, toxic appearing, Tripod position, neck extended / chin thrust forward, drooling, stridor

A

epiglottitis

52
Q

Adults: Sore throat, fever, muffled voice / hoarseness, stridor, trouble breathing, drooling

A

epiglottitis

53
Q

path of epiglottitis

A

Cellulitis of epiglottis and adjacent tissue
Posterior nasopharynx is the primary source of pathogens in epiglottitis
Once infection begins, swelling rapidly progresses to involve the entire supraglottic larynx

54
Q

bacterial causes epiglottitis in kids

A

Haemophilus influenzae type b (Hib) – most common! Also see H. flu (other types), Strep, Staph

55
Q

bacterial causes epiglottitis in adults

A

Hib is most common. Can be caused by viruses, bacteria, and fungal pathogens as well

56
Q

bacterial causes epiglottitis immunocomp

A

Pseudomonas and Candida

57
Q

what dec incidents of epiglottitits

A

hib vaccine

58
Q

rf epiglottitis kids

A

incomplete/lack immunizations, immune def

59
Q

rf epiglottitis adutls

A

htn, diabetes, substance abuse, immune def

60
Q

3 d’s in kids for epiglottitis and other symp

A

dysphagia, drooling, distress
fever, sore throat, toxic appearing, choking sensation, stridor, muffled voice, tripod position, neck extension/jaw forward

61
Q

adult presentation epiglottitis

A

sore throat, fever, muffled voice, drooling, stridor, respiratory distress

62
Q

what will see on imaging for epiglottitis

A

later soft tissue film of necks shows enlarged protruding epiglottis
“thumb sign”

63
Q

tx epiglottitis

A

Mild - treat and watch
Signs of distress / compromise - Prophylactic Intubation or Surgical Tracheostomy
ICU Admission
IV Antibiotics:
3rd Gen Cephalosporin (Cefriaxone or Cefotaxime) AND antistaph agent that covers MRSA (Vancomycin or Clindamycin)
Usually a 7-10 day course
IV Glucocorticoids - controversial - not recommended until days later

64
Q

“Hoarseness” - often used to describe any change invoice quality

A

laryngitis

65
Q

causes of hoarseness in laryngitis

A

acute, chronic, benign vocal fold lesions, malignancy, neurologic dysfunction, non organic (functional) issues

66
Q

common, self limited inflammation resulting in hoarseness that lasts

A

acute laryngitis

67
Q

bacteria that causes laryngitis

A

m cat, h flu, strep pneumo

68
Q

pt presents with runny nose, cough, and sore throat from screaming

A

acute laryngitis

69
Q

hoarseness as result of irritants that leads to persistent inflam

A

chronic laryngitis

70
Q

ex of causes of chronic laryngitis

A

inhaled fumes, gerd, chronic post nasal drip, etoh use, chronic vocal strain, smoking

71
Q

gastric contents come to larynx and cause laryngitis

A

laryngopharyngeal reflux

72
Q

psychological/neurologic disorder - excessive muscle tension - stain on vocal cords

A

muscle tension dysphonia

73
Q

Viscous material accumulates on true vocal cords - results from irritants like smoking
Vocal cords appear swollen/floppy - seen in women in 50s - husky, low-pitched voice. “Sound like a man”

A

polypoid corditis

“reinke’s edema”

74
Q

results from chronic irritation- smoking, reflux, muscle tension

A

polyps/nodules

75
Q

form following trauma, vocal abuse, coughing, and tend to be unilateral

A

polyps

76
Q

form in singer/screamers b/l from overuse and abuse, mc w/k

A

nodules

77
Q

what is most laryngeal cancer caused by

A

squamous cell carcinoma

78
Q

what do early lesions of laryngeal cancer look like

A

white plaques

79
Q

what do late lesions of laryngeal cancer look like

A

large, exophytic or deep ulcers

80
Q

unilater or b/l cord paralysis of neuro dysfuntion laryngitis causes

A 
trauma, iatrogenic, neuro ds
parkinsons
motor neuron ds
tremors
myasthenia gravis
81
Q

impairment of voice production without an identifiable organic cause

A

functional dysphonia

82
Q

impairment of voice related to a psychiatric condition

A

laryngeal conversion disorder

83
Q

mistaken for asthma - cords move to close with inspiration (rather than open)

A

paradoxical vocal cord motion

84
Q

tx acute laryngitis

A

should resolve on own
Hydration, humification, vocal rest
Antibiotics not indicated - unless there is strong evidence of a bacterial infection
Steroids - should be reserved for those who need used of their voice (i.e. professional speaking engagement / vocal performance)

85
Q

tx chronic laryngitis

A

Remove irritant and treat underling cause
Ex: GERD, smoking cessation
Muscle tension dysphonia - voice therapy is helpful
Education of vocal hygiene - stop screaming
Most recover well with removal of irritant

86
Q

tx benign vocal cord lesions (corditis, polyps, nodes)

A

Polypod corditis - smoking cessation, reflux management, and voice therapy
Polyps - surgey
Nodes - correcting vocal strain and poor vocal habits - voice therapy

87
Q

tx laryngeal cancer

A

refer ent

5y cure rate >90%, 25% if metastasis

88
Q

tx vocal cord paralysis

A

Damage to recurrent laryngeal nerve - likely is permanent - vocal therapy to help regain some speech
Unilateral - surgical procedures are available
Bilateral - various surgical procedures available - airway maintenance is a concern
Spasmotic dysphonia - voice therapy is not effective - botox injections have been helpful

89
Q

acute inflam/infx of parotid glads usually in elders postoperative due to dehydration/intubation

A

parotitis

90
Q

path parotitis

A

These glands are located on side of face anterior to the external auditory canals, superior to angle of mandible, and inferior to zygomatic arch
Acute bacterial suppurative parotitis can occur when salivary status permits retrograde seeing of bacteria through Stensen’s duct - mixed oral flora
Ductal obstruction by calculi (sialolithiasis) can predispose to infection

91
Q

rf parotitis

A

recent intensive teeth cleaning, use of anticholinergic drugs or other meds that reduce salivary flow, malnutrition, salivary duct obstruction, and neoplasm of oral cavity

92
Q

bacterial causes parotitis

A

Variable - mixed oral flora
Staph aureus - most common, anaerobes are common, Gram-negatives are seen in hospitalized patients
Strep pneumo, Moraxella, Pseudomonas, Mycobacterium - all rare causes

93
Q

viruses that can cause parotitis

A

mumps, influenza, coxsackievirus, ebv, parainfluenza, hsv, cmv

94
Q

why get imaging for parotitis

A

Can be helpful in determining inflammation or duct obstruction from stone
Differentiate suppurative parotitis versus large abscess collection versus tumor
Ultrasound will show abscess and duct obstruction
CT is the most sensitive test for assessing suppurative infection vs. large abscess

95
Q

tx parotitis

A

This can spread and become a life-threatening infection
Admission - IV fluids / IV antibiotics
Antibiotics: Total course is 10-14 days (IV and Oral)
Immunocompetent: Nafcillin or Ancef + Mentronidazole or Clindamycin
Immunocompromised: Vancomycin +
Cefepime / metronidazole, or Imipenem, or Meropenem, or Piperacillin-tazobactam

96
Q

complications of parotitis

A

Progression of infection can lead to:
Massive neck swelling, airway compromise, sepsis, and osteomyelitis
Other complications: facial nerve palsy, fistula development, parapharyngeal space infection

97
Q

stones (calculi) in salivary gland/duct in men 30-60

A

sialolithiasis

98
Q

path of sialolithiasis

A

Believed to be secondary to stagnation of saliva - rich in calcium - in the setting of a particle obstruction
Stones composed primarily of calcium - also has magnesium, potassium, and ammonium
Inflammation of the gland (sialadenitis) can occur

99
Q

rf for sialolithiasis

A

dehydration, diuretics, anticholinergic meds, trauma, gout, smoking

100
Q

pt presents w pain/swelling that is made worse w eating

A

sialolithiasis

101
Q

typically presents with pain, swelling, and erythema in the area of the gland - purulent drainage can be noted from the duct, +/- fever/chills

A

sialadenitis

102
Q

tx sialadenitis

A

abx for 7-10d (oral/outpt)

103
Q

imaging for sialolithiasis

A

CT Scan - High resolution CT is the test of choice for salivary stones - typically do not need contrast
Plain films - good at detecting stones
Ultrasound - >90% effective at seeing stones > 2 mm
Sialography - cannulated duct and injected dye - this was replaced by CT scan
MRI - standard MRI cannot see stones

104
Q

conservative tx sialolithiases

A

Keep well hydrated, warm compresses to area, massage the gland, and “milk” the duct
Sour candy - increases saliva production and flow
Discontinue any anticholinergic meds - if possible
Pain meds - NSAIDS - might needs opiates

105
Q

tx for sialolithiases w infx

A

cephalexin or dicloxacillin

106
Q

ent tx sialolithiases

A

lithotripsy, wire basket retrieval, sialoendoscopy, surgical intervention for excision of stone

107
Q

complications of sialolithiases

A

Can lead to secondary infections - usually minor - can spread in to larger infections involving the surrounding tissues / structures
Could lead to airway compromise
Chronic obstruction - leads to dysfunctional gland - leads to drop in salivary flow rates
Increased risk of dental problems, eating issues, loss of taste

mouth/throat (1 decks)

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