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CPD I > Mouth & Throat > Flashcards

Mouth & Throat Flashcards

1
Q

What is Recurrent Herpes Labialis and what is its prodrome?

A

Cold sore from HSV-1 most commonly; itching, burning, tingling for 12-36 hours followed by eruption of clustered vesicles

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2
Q

What’s the most common cancer of the lips and what does it look like?

A

Squamous cell carcinoma; painless, clearly demarcated, elevated, indurated (hardened) border with ulcerated (atrophy of tissue) base

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3
Q

What is a mucocele?

A

A soft cyst that’s mucin-filled, common under tongue near lip, clear or blue bubble that may enlarge, break, or shrink. Usually doesn’t go away unless surgically removed

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4
Q

What is cheilitis?

A

Chapped lips

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5
Q

What is angular cheilitis?

A

Deep cracks at labial commissure (corner of mouth) from irritation; can get infected by Candida albicans or Streptococcus aureus

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6
Q

What are lesions?

A

Ulcerations, Lesions include ulcerations, cysts, firm nodules, hemorrhagic lesions, papules, vesicles,
bullae, and erythematous lesions.

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7
Q

What is oral lichen planus?

A

A non-erosive lesion that’s usually painless, looks like lace-like white streaks on buccal mucosa

Erosive on gingival margin or erupt into violet papules on genitalia, lower back, ankles, anterior lower legs

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8
Q

What is leukoplakia?

A

White plaque on oral mucosa that is precancerous of squamous epithelium; cannot be wiped off with gauze

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9
Q

What is erythroplakia?

A

Red plaque with well-demarcated edges on the floor of mouth, tongue, and palate that is precancerous of epithelium

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10
Q

Oral SCC

A

Present as leukoplakia or erythroplakia on floor of mouth of lateral and ventral tongue; HPV-16 infection

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11
Q

Melanoma

A

Lesions breaking ABCD rules; will not blanch (turn white)

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12
Q

Fordyce’s spots

A

Benign neoplasm from sebaceous glands

Asymptomatic, multiple, white to yellow, 1-2 mm papules, often occurring confluent cluster

Most common on the vermillion/buccal mucosal border. Also on the inner surface of the

lips, the retromolar region, tongue, gingiva, frenulum linguae or palate

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13
Q

Stomatitis

A

Overall inflammation of oral tissue from a variety of infections: strep, Candida, TB, Varicella-zoster virus, fungus

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14
Q

Oral Candidiasis

A

“Thrush”; soft white lesions that look like milk curds and can be easily wiped away, causing bleeding; caused by inhaled glucocorticoids (inhalers) or HIV

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15
Q

Recurrent aphthous stomatitis

A

Necrotizing ulcerations of oral mucosa due to trauma; “canker sores”

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16
Q

Herpetic gingivostomatitis

A

“Cold sore” from HSV-1; self-limited 1-2 weeks; lymphadenopathy (chronically swollen lymph nodes) in children

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17
Q

Oral erythema multiforme

A

Hypersensitivity rxn to HSV; SSx: Painful stomatitis, sudden onset of diffuse hemorrhagic vesicles and bullae with erythematous base, on lips/mucosa

bullae rupture leaving raw, painful, friable surfaces, then form crusts

Other areas of body – maculopapular erythematous lesions (target lesions) form symmetrically on the hands, arms, feet, legs, face, and neck and, possibly, in the eyes and on the genitalia

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18
Q

Chancre

A

Painless ulcerations from primary stages of syphilis (Treponema pallidum), these ulcers usually form on or around the lips, tongue, also anus, penis, and vagina, lasting 2 wks to 3 mos w/o tx.

SSX Painless single ulcerated lesion, indurated border, no central necrotic tissue; tender cervical LA

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19
Q

Other causes of inflammation in the mouth

A

Many are denture-related: frictional hyperkeratosis, epulis fissura, denture sore spot or mouth, irritation fibroma

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20
Q

Angioedema

A

Acute swelling of the skin and mucosa (mouth, throat, tongue), and submucosa with rapid onset of minutes to hours; urticaria (itchy raised bumps) and hand swelling is common if due to allergy

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21
Q

Palatal or Mandibular Torus

A

Non-neoplastic, slowly growing nodular protuberance of bone. Of little clinical significance except with dentures

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22
Q

Hemangioma

A

Proliferation of blood vessels, will blanch when pressed down

Lesions are flat or raised, with a deep red or bluish-red color

Most common sites: lips, tongue, buccal mucosa and palate. Secondary infx common

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23
Q

Varicosities

A

Like varicose veins, dilated and tortuous veins in oral cavity from increased hydrostatic pressure and weak surrounding tissues, will blanch

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24
Q

Papilloma

A

Asymptomatic, well-circumscribed, usually pedunculated benign growths with numerous,small finger-like projections (papillary or verrucal)

Generally

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25
Q

Lipoma

A

Painless, benign, slow-growing mass of adipose tissue (on cheek, tongue)

Yellow, non-tender, rubbery or soft, mobile (if on cheek)

May affect speech if large

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26
Q

Sialadenitis

A

Salivary glands: Benign swelling seen in many systemic diseases (eg hepatic cirrhosis, sarcoidosis, neoplasms, infections (mumps)

Usually pain with mumps, malignancy and infection; others may be painless

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27
Q

Sialolithiasis

A

Salivary duct stones, most common in the submandibular glands

Pain and swelling associated with eating

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28
Q

Sjögren’s syndrome

A

Systemic inflammation (autoimmune) associated with dry eyes, mouth and mucus membranes

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29
Q

Xerostomia

A

Dry mouth; from drug use, mouth breathing

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30
Q

Gingivitis

A

Inflammation of the gums with redness, swelling, changes in contours, pocket formation due to poor oral hygiene and food impaction

31
Q

Acute Necrotizing Ulcerative Gingivitis ANUG

A

Acute infection of the gingiva from bacteria

Progressive painful infection with ulceration, swelling and sloughing off of dead tissue

Ulcerated lesions of the interdental papillae; can affect all gum tissue, bad odor, bleeding

32
Q

Periodontitis

A

Progressive gingivitis infection of the periodontium from anaerobic organisms causing inflammation of the periodontal ligament, gingival, cementum and alveolar bone

Tooth may be tender with percussion, bleeding easily with exudate from gums

33
Q

Dental caries

A

Tooth decay due to bacteria or meth users

34
Q

What are some serious concomitant symptoms with toothache and infection?

A

Headache, fever, swelling or tenderness on floor of mouth, CN abnormalities

35
Q

What are some serious causes of toothache that call for referral or emergency care?

A

Painful apical abscess in root of tooth
Ludwig’s angina - bacterial Strep or Staph cellulitis
Cavernous sinus thrombosis - Strep or Staph in cavernous sinus leads to development of blood clot

36
Q

What does deviation of the tongue indicate in a PE?

A

Paralysis to hypoglossal nerve CN XII

37
Q

What are some causes to taste abnormalities?

A

Damaged papilla, B3 or zinc deficiency

38
Q

What are some causes to color changes to the tongue?

A

Geographic tongue from loss of papilla (erythematous patches with white borders) - consider Candida, Reiter’s (reactive arthritis), SLE
White or yellow - local irritation
Red - B12 deficiency (pernicious anemia), celiac, scarlett fever
Dark - drugs

39
Q

What is hairy tongue?

A

Distal dorsal third looks hairy (black or green) due to hyperplasia of filiform papillae - AIDS, or Candida or Aspergillus infx after antibiotics

Benign condition, painless, pt may experience “gagging” sensation

40
Q

What are some causes of tongue pain?

A

Post-menopausal burning tongue syndrome
DM
Heavy metal poisoning

41
Q

What are some causes to tongue tremor?

A

Hyperthyroidism (fine tremor)

Lower motor neuron dz - ALS

42
Q

What are furrows in the tongue?

A

Deep groove in midline due to dehydration or syphilis

43
Q

What might dry tongue with and without furrows indicate?

A

Without furrows - Sjogren’s

With - dehydration

44
Q

What might cause the tongue to have a smooth appearance?

A

atrophy of the filiform papillae
Sjogren’s Syndrome
B12, iron, folate, protein deficiency
Oral candidiasis

45
Q

What might be some causes of enlarged tongue?

A 
Acromegaly (person with bigger bones due to excess GH from pituitary gland)
Down Syndrome
Allergic rxn
Pernicious anemia
Strep infx
46
Q

What is glossitis?

A

Acute or chronic inflammation from bacterial or viral infx (oral herpes simplex); B12 or iron deficiency
Tongue swelling and scalloping
Tongue colors: usually dark red, pale=pernicious anemia, fiery red=B vit deficiency

47
Q

What’s the measurement for tonsil size?

A

Grade 0-4 with 0 being really far apart (may be congenital)

48
Q

Acute pharyngitis

A

Inflammation from viral (90%) or bacterial infx, aphthous ulcers, herpes, fungus, trauma, neoplasm, or glossopharyngeal neuralgia

49
Q

Viral pharyngitis types

A

Adenovirus (most common) and infectious mononucleosis (EBV or CMV)

50
Q

Adenovirus

A

Normal looking throat but painful

Runny nose, stuffy nose and throat, sore throat within 24-48 hrs, lymph node enlargement modest

51
Q

Infectious mononucleosis

A

(EBV or CMV) - exudative tonsillitis with marked redness and swelling of the throat. “kissing tonsils” significant lymph gland; Herpes simplex virus, measles, or rhinovirus (80%)

Other symptoms include splenomegaly, persistent fatigue, weight loss; possibly hepatitis

52
Q

Types of bacterial pharyngitis

A

Group A Strep (GAS)
Non-group Strep
Diphtheria

53
Q

Group A Strep (GAS)

A

Most common bacteria agent

typically enlarged and tender lymph glands, with bright red inflamed and swollen throat, often unilateral, progresses

May have a high temperature, headache, myalgia, arthralgia

54
Q

What is the Modified Centor Criteria used for?

A

GAS clinical probability to rule Strep OUT

  1. Absence of cough
  2. Tender anterior cervical adenopathy
  3. Tonsillar exudate
  4. History of fever
55
Q

What are some suppurative (pussing) and non- complications of GAS?

A

Suppurative - sinusitis, otitis media, meningitis

Non-suppurative - rheumatic fever, glomerulonephritis

56
Q

Non-group Strep

A

Not associated with rheumatic fever

57
Q

Diphtheria

A

Potentially life threatening URI caused by Corynebacterium diphtheriae toxin

SSx: in 30% of cases–characteristic dirty gray, tough fibrous membrane in tonsillar area, may cause dyspnea or stridor. Membrane will bleed with scraping.

mild sore throat, dysphagia, low grade fever, nausea, vomiting

Check history of travel (endemic in Africa)

58
Q

Tonsillitis

A

Acute inflammation of palatine tonsils often seen alongside pharyngitis

sudden onset, high fever, malaise, vomiting common
enlarged hyperemic tonsils with purulent exudate
may see membrane on tonsils
fetid breath

Acute - bacterial/viral infx
Subacute - 3 wks to 3 mos
Chronic - 3 mos+, typically bacterial

59
Q

Complications of tonsillitis

A

Peritonsillar abscess
Tonsilloliths - whitish-yellow deposits produced by bacteria feeding on mucus which accumulates in crypts. These “tonsil stones” emit pungent odor from volatile sulphur compounds
Hypertrophy of tonsils

60
Q

Peritonsillar abscess (PTA)

A

SERIOUS: worsening unilateral sore throat and pain during swallowing (dysphagia) from persistent tonsillitis causing abscess between tonsils and pharyngeal constrictor ms

Fever can be >103 and inability to open mouth (trismus)

61
Q

Parapharyngeal abscess

A

SERIOUS: suppuration of the parapharyngeal lymph nodes. abscess is lateral to the superior constrictor muscle and close to the carotid sheath; markedly swollen anterior triangle in the neck

Throat may appear normal

62
Q

Retropharyngeal abscess

A

MEDICAL EMERGENGY: infection in one of the deep spaces of the neck, potential for airway compromise and other catastrophic complications

usually occurs in small children or infants (adults too) as complication of suppurative

retropharyngeal (behind) lymph nodes. Infection spread from the nose, ears, sinuses or tonsils

63
Q

What can happen in chronic infection of the pharynx?

A

Inflammation leading to scarring and fibrosis

64
Q

What are some causes of chronic irritation of the pharynx?

A

Allergies
Vocal abuse
Chronic sinusitis
Complication of nephritis (inflamm of kidneys), GERD, pregnancy

Will cause cobblestoning of pharyngeal mucosa, hypertrophic lymph tissue

65
Q

Signs of malignancies in the pharynx

A 
Usually SCC
Lump in neck
Pain in throat
Tumor is red smooth mass
DDX: erythroplakia
66
Q

What causes hoarseness in the larynx?

A 
Structural changes in the vocal cords that impair their ability to vibrate due to:
allergies
vocal abuse
polyps
nerve impairment
general weakness of cords
TB
Hypothyroidism
Emotional causes
67
Q

Laryngitis

A

Hoarseness or complete loss of voice due to irritation from infection, inflammation, excessive coughing

68
Q

Epiglottitis

A

MEDICAL EMERGENCY: bacterial infection of the epiglottis, most often caused by Haemophilus influenzae type B; also Streptococcus pneumoniae or Streptococcus pyogenes.

Difficulty swallowing, stridor (high pitch upon inhale), head hung forward
May lead to asphyxiation and cyanosis

Most common 2-5 yo

DO NOT try to visualize throat
“Thumbprint sign” in lateral C-spine x-ray is positive

69
Q

Vocal cord polyp or nodule

A

Benign, often bilateral lesion from vocal abuse, irritants, allergies

Dx with indirect laryngoscopy

70
Q

Vocal cord contact ulcers

A

unilateral or bilateral ulcers on the mucus membrane over the the arytenoids cartilage

commonly from GERD

Prolonged ulceration leads to granulomas

71
Q

Laryngeal vocal cord SCC

A

Most common cancer in head and neck
Males > Females
Hoarseness

72
Q

General causes of swelling/masses in neck for adults and children

A

Adults: most are due to inflammatory or neoplastic conditions of the cervical lymph nodes

Kids: usually due to recurrent tonsillitis

Tuberculosis, brachial cysts.

73
Q

What are the types of swelling in the neck?

A
  1. Cervical LA, suspected with acute inflammation of the tonsils, pharynx. Tender, rubbery
  2. Neoplasm of the lymphatic chain: NT cervical LA, hard, immobile, large
    also from metastases from other areas
    confirm with biopsy
  3. Salivary gland swelling: may be inflammatory (mumps, bacteria) or the result of a stone in duct
  4. Medial neck swellings: from thyroid condition or spread of infection from other areas

CPD I (1 decks)

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