mouth/throat Flashcards
1
Q
types of oral lesions
A
squamous cell carcinoma oral leukoplakia candidiasis herpes simplex virus aphthous ulcers
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
3
Q
path SCC
A
leukoplakia, erythroplakia, leukoerythroplakia all progress to invasive cancer
4
Q
pt presents w nonhealing mucosal ulcers, sore throat, referred otalgia, hoarseness, dysphagia, chronic cough, and neck mass
A
SCC
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
6
Q
white plaques that can be scraped off
A
pseudomembranous form oral candidiasis
7
Q
erythema without plaques
A
atrophic form oral candidiasis
8
Q
beefy red tongue w soreness
A
candidiasis
9
Q
local infx seen in infants, denture wearers, diabetics, tx w abx/chemo,radiation, and immunocomp
A
oral candidiasis
10
Q
tx candidiasis
A
nystatin suspension/ troche
clotrimazole troche
11
Q
mc manifestation of primary herpes simplex infx in childhood caused by herpes simplex virus type 1
A
herpetic gingivostomatitis
12
Q
multiple intraoral vesicular lesions and erosions bordered by inflam, eryth base
A
herpes simplex virus
13
Q
what is herpes simplex virus brought on by
A
sunlight
trauma
emotional/physiologic stress
14
Q
young kid with fever, lymphadenopathy, drooling, and dec po intake
A
herpes
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
16
Q
dx herpes
A
multi nucleated giant cells on tzanck smear
direct immunofluorescence smear
viral culture
17
Q
tx herpes
A
acyclovir
fluids
ice/popsicles/oral sinuses
magic mouthwash, diphenhydramine, carafate, viscous lidocaine
18
Q
painful oral lesions that appear as localized, shallow, round to oval ulcers w grayish base
A
aphthous ulcer- canker sore
19
Q
presents round, clearly defined, small, painful ulcers that heal within 10-14d no scarring
A
aphthous ulcer
20
Q
where does aphthous ulcers occur
A
soft, movable tissues that are non keratinized
labial/buccal mucosa, ventral surface tongue, floor mouth
21
Q
tx aphthous ulcer
A
topical anesthetics- or abase w triamcinolone
magic mouthwash
silver nitrate/cautery
22
Q
viral causes pharyngitis
A
influenza parainfluenza adenovirus enterovirus rsv hsv ebv cmv hiv
23
Q
bacterial causes pharyngitis
A
group a strep- incubate 2-4d, resolves 3-4d
mycoplasma
24
Q
noninfectious causes pharyngitis
A
allergies
post nasal drip
25
group a strep (GAS) pharyngitis complications
acute rheumatic fever/scarlet fever
glomerulonephritis
peritonsillar abscess
toxic shock syndrome
26
pt sore throat worse when swallows, fever, ha, malaise, lymphadenopathy, uri
pharyngitis
27
what will see physical exam pharyngitis
doesn't dist viral from bacterial
pharyngeal erythema
tonsillar swelling/exudates= kissing tonsils
lymphadenopathy
28
centor criteria for clinical indications for potential GAS
```
tonsillar exudates
tender anterior cervical adenopathy
fever
absence of cough
(
```
29
dx GAS
rapid antigen detection test "rapid strep"- specific
| throat cx is GS
30
tx viral pharyngitis
fever control
fluids
magic mouthwash or topical spray (chloraseptic )
cough drops/ lozenges
31
tx GAS
penicillin VK- 1st line amoxicillin, ampicillin
- (po amoxil tastes better)
- cephalosporins, macrolides, clinda
penicillin G im injection
32
tx kissing tonsils
steroids
33
when can someone return school
after abx therapy, fever free 24h
34
infection between the capsule of the palatine tonsil and the pharyngeal muscles
peritonsillar cellulitis
35
collection of pus located between the capsule of the palatine tonsil and the pharyngeal muscles
peritonsillar abscess
36
deep cervical tissue infection
retropharyngeal cellulitis/abscess
37
path of peritonsillar abscess
peritonsillar infx- preceded by tonsillitis or pharyngitis and progresses from cellulitis to phlegm on to abscess
38
where does peritonsillar abscess occur
superior pole of tonsil
39
bacterial causes peritonsillar abscess
GAS, staph aureous, respiratory anaerobes
40
severe sore throat, fever, "hot potato"/muffled voice and may have drooling, trismus, ear pain
peritonsillar abscess
41
extremely swollen tonsil, uvula deviated to opposite side, building of posterior soft palate, fever, exudates
peritonsillar abscess
42
dx peritonsillar abscess
labs for baseline- cbc, bmp, throat cx/rapid strep, aso titer
imaging for extent- ct w contrast
43
tx peritonsillar abscess
consult ent
abscess- needle aspiration, iv clinda or ampicillin-sulbactam
cellulitis- 24h iv abx and reeval
44
what must you match sure you do with peritonsillar abscess
monitor airway
45
complications of peritonsillar abscess
airway compromise
sepsis
necrotizing fasciitis
46
complication of GAS pharyngitis may be life threatening
retropharyngeal infx
47
when to worry w retropharyngeal infx
```
torticollis/pain neck movement
difficulty swallowing, drooling
changes in voice
neck swelling
trismus
```
48
what should you do for retropharyngeal infx
airway protection
| ct/ soft tissue X-ray of neck
49
tx retropharyngeal infx
admit/stat ent consult
may need intubation/surgical airway
may need surgical evacuation of abscess
iv abx- clinda or ampicillin-sulbactam
50
Inflammation of the epiglottis and adjacent supraglottic structures
epiglottitis
| life threatening infx- airway obstruction
51
Kids: Trouble breathing, fever, toxic appearing, Tripod position, neck extended / chin thrust forward, drooling, stridor
epiglottitis
52
Adults: Sore throat, fever, muffled voice / hoarseness, stridor, trouble breathing, drooling
epiglottitis
53
path of epiglottitis
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
bacterial causes epiglottitis in kids
Haemophilus influenzae type b (Hib) – most common! Also see H. flu (other types), Strep, Staph
55
bacterial causes epiglottitis in adults
Hib is most common. Can be caused by viruses, bacteria, and fungal pathogens as well
56
bacterial causes epiglottitis immunocomp
Pseudomonas and Candida
57
what dec incidents of epiglottitits
hib vaccine
58
rf epiglottitis kids
incomplete/lack immunizations, immune def
59
rf epiglottitis adutls
htn, diabetes, substance abuse, immune def
60
3 d's in kids for epiglottitis and other symp
dysphagia, drooling, distress
fever, sore throat, toxic appearing, choking sensation, stridor, muffled voice, tripod position, neck extension/jaw forward
61
adult presentation epiglottitis
sore throat, fever, muffled voice, drooling, stridor, respiratory distress
62
what will see on imaging for epiglottitis
later soft tissue film of necks shows enlarged protruding epiglottis
"thumb sign"
63
tx epiglottitis
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
“Hoarseness” - often used to describe any change invoice quality
laryngitis
65
causes of hoarseness in laryngitis
acute, chronic, benign vocal fold lesions, malignancy, neurologic dysfunction, non organic (functional) issues
66
common, self limited inflammation resulting in hoarseness that lasts
acute laryngitis
67
bacteria that causes laryngitis
m cat, h flu, strep pneumo
68
pt presents with runny nose, cough, and sore throat from screaming
acute laryngitis
69
hoarseness as result of irritants that leads to persistent inflam
chronic laryngitis
70
ex of causes of chronic laryngitis
inhaled fumes, gerd, chronic post nasal drip, etoh use, chronic vocal strain, smoking
71
gastric contents come to larynx and cause laryngitis
laryngopharyngeal reflux
72
psychological/neurologic disorder - excessive muscle tension - stain on vocal cords
muscle tension dysphonia
73
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”
polypoid corditis
| "reinke's edema"
74
results from chronic irritation- smoking, reflux, muscle tension
polyps/nodules
75
form following trauma, vocal abuse, coughing, and tend to be unilateral
polyps
76
form in singer/screamers b/l from overuse and abuse, mc w/k
nodules
77
what is most laryngeal cancer caused by
squamous cell carcinoma
78
what do early lesions of laryngeal cancer look like
white plaques
79
what do late lesions of laryngeal cancer look like
large, exophytic or deep ulcers
80
unilater or b/l cord paralysis of neuro dysfuntion laryngitis causes
```
trauma, iatrogenic, neuro ds
parkinsons
motor neuron ds
tremors
myasthenia gravis
```
81
impairment of voice production without an identifiable organic cause
functional dysphonia
82
impairment of voice related to a psychiatric condition
laryngeal conversion disorder
83
mistaken for asthma - cords move to close with inspiration (rather than open)
paradoxical vocal cord motion
84
tx acute laryngitis
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
tx chronic laryngitis
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
tx benign vocal cord lesions (corditis, polyps, nodes)
Polypod corditis - smoking cessation, reflux management, and voice therapy
Polyps - surgey
Nodes - correcting vocal strain and poor vocal habits - voice therapy
87
tx laryngeal cancer
refer ent
| 5y cure rate >90%, 25% if metastasis
88
tx vocal cord paralysis
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
acute inflam/infx of parotid glads usually in elders postoperative due to dehydration/intubation
parotitis
90
path parotitis
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
rf parotitis
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
bacterial causes parotitis
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
viruses that can cause parotitis
mumps, influenza, coxsackievirus, ebv, parainfluenza, hsv, cmv
94
why get imaging for parotitis
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
tx parotitis
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
complications of parotitis
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
stones (calculi) in salivary gland/duct in men 30-60
sialolithiasis
98
path of sialolithiasis
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
rf for sialolithiasis
dehydration, diuretics, anticholinergic meds, trauma, gout, smoking
100
pt presents w pain/swelling that is made worse w eating
sialolithiasis
101
typically presents with pain, swelling, and erythema in the area of the gland - purulent drainage can be noted from the duct, +/- fever/chills
sialadenitis
102
tx sialadenitis
abx for 7-10d (oral/outpt)
103
imaging for sialolithiasis
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
conservative tx sialolithiases
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
tx for sialolithiases w infx
cephalexin or dicloxacillin
106
ent tx sialolithiases
lithotripsy, wire basket retrieval, sialoendoscopy, surgical intervention for excision of stone
107
complications of sialolithiases
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
