Mouth & Throat Flashcards
How does Leukoplakia present?
White patch or plaque that cannot be rubbed off
What causes Leukoplakia?
oftenhyperkeratosiesoccurringinresponsetochronicirritation
Leukoplakia treatment/plan
-Early referral (5% dysplasia/early invasive squamous cell carcinoma -Biopsy -stop tobacco -stop ETOH
How does hairy leukoplakia present?
Slightly raised lekoplakic areas with a corrugated or “hairysurface” Filaform papilla on the tongue(lateral) will elongate and look likelittle hairs Common early finding in HIV infection Developes quickly
How does Erythroplakia present?
Slow-growing, erythematous, velvety red lesion with well-defined margins, occurring on a mucous membrane, most often in the oral cavity. -Older males – 65-75yo
Where are the most common sites for Erythroplakia?
Lateral tongue Floor of mouth Soft palate Alveolar ridge
How does Oral Lichen Planus present?
Lesions may appear as: -Lacy, white, raised patches of tissues -Red, swollen, tender patches of tissues -Open sore
What causes Oral Lichen Planus?
Chronic inflammatory autoimmune disease
Oral Lichen Planus treatment?
O Managing pain and discomfort O Corticosteroids O Cyclosporines and retinoids O Low rate (1%) of SCC arising within lichen planus if correctly diagnosed
What is the most common form of oral cancer?
Oral squamous cell carcinoma (OSCC O Accounts for more than 90% of all oral cancers
What are the initial stages of oral cancer?
O Erytholeukoplastic area O Without symptoms
What are the advanced stages of oral cancer?
O Ulcers and lumps with irregular margins, which are rigid topalpation
oral cancer S/Sx?
O Ear pain O Chronic sore throat, hoarseness or change in voice O Remarkable weight loss O Unexplained bleeding in the mouth O Change in the way of fitting the teeth and dentures O Difficulty to chew, speak, swallow to move the jaw or tongue O Constant sores on the face, mouth or neck that bleed easily and do not heal within two weeks O A feeling that something is caught in the back of the throat O Presence of velvety red, white or speckled color of patched in the mouth O Unexplained numbness or loss of feeling O Pain and softness in any area of the mouth, neck or face O Thickness or swelling, crusts, rough sports and eroded areas on the gums, lips and other areas inside the mouth
How do Apthous Ulcers present?
Recurrent small, round, or ovoid ulcers with circumscribedmargins, erythematous haloes, and yellow or gray floors. O Restricted to the mouth O Typically starts in childhood or adolescence
Are labs ordered for Apthous Ulcers?
Yes, but only if they are recurrent
Apthous Ulcer treatment?
O Vitamin B12 used orally may have some effect O Topical corticosteroids (TCs) remain the mainstays of treatment O Topical tetracyclines may reduce the severity of ulceration, O Chlorhexidine gluconate mouth rinses O Anti-inflammatory agents
How does Geographic Tongue present?
Patches on the tongue; Tongue - patchy; Benign migratoryglossitis
What causes Geographic Tongue?
O Unknown O May be caused O Vitamin B deficiency O Irritation from hot or spicy foods, or alcohol O The condition appears to be less common in smokers
What are the S/Sx of Geographic Tongue?
O Map-like appearance to the surface of the tongue O Patches that move from day to day O Dunuded appearing O Soreness and burning pain (in some cases)
What are the S/Sx of Oral Candidiasis?
O White patches in mouth or on tongue O Cottage or mild curds O Sore mouth and tongue and/or difficulty swallowing O Poor appetite O Burning feeling in mouth and throat (at start of a thrush infection) O Bad taste in mouth O Typically only mild pain
What other symptom can be caused by Oral Candidiasis in infants?
Diaper rash May develop because yeast may be in stool
What is Oral Candidiasis also known as?
Thrush
What is Candida albicans?
a fungus that causes Thrush
Oral Candidiasis treatment?
Treatunderlyingcause O DM O HIV O Immunosuppresion O Antibiotic use O SteroidInhalers Nystatin(antifungal), Gentian violet, Magic Mouthwash
What is a irretation fibroma?
Slow-growing fibrous nod ules on the oral mucosa, resulting from irritation caused by cheek biting or objects such as dentures and fillings.
What is Epulis Fissurata
Mucosal hyperplasia from low grade trauma ie. dentures.
What areFordyce’s Granules
Sebaceous glands found in the mouth O Small yellow dots in the oral mucous membrane O Misplaced sebaceous glands
Fordyce’s Granules treatment
Once properly diagnosed, no treatment is necessary
What is a Hemangioma
Abnormal build-up of blood vessels in the skin or internal organs
What is a Papilloma?
Benign epidermal tumor that grows out of the skin.
What can cause Oral Herpes Simplex Virus
Stress, Chemothreapy, Infection
Oral Herpes Simplex Virus treatment?
PO or topical antivirals
What do salivary glands secrete?
amylase
What increases risk for Sialadenitis
Dehydration, Radiation, Immunosuppression
What bacteria cause Sailadenitis?
O Staphylococcus aureus – most common O Streptococcus viridans O Haemophilus influenzae O Streptococcus pyogenes O Escherichia coli
Sialadenitis treatment?
Antibiotics, steroids, warmth
What causes Parotitis?
Can be either bacterial or viral. S. aureus is the most common. Viral can be from mumps(paramyxovirus) or non-mumps.
What is bilateral Parotitis likely caused from?
Mumps
What is Sialolithiasis?
Salivary stones. They often block the salivary gland duct opening
What is Ranula
A mucocele on the floor of the mouth
What is Epulis?
A mucocele on the gums
Pharyngitis S/Sx?
O Sore throat O Dysphagia O Odynophagia O Fever O Headache O Abdominal pain O Nausea/vomiting
What symptoms suggest a viral pharyngitis?
Coryza, Conjunctivitis, Hoarseness
What can be complications of group A beta hemolytic streptococcal infection (GABHS)
1)Rheumatic Fever 2)Acute proliferative glomerulonephritis
What can Rheumatic Fever cause?
O Arrythmias O Damage to heart valves O Endocarditis O Heart failure O Pericarditis O Sydenham chorea
What is Acute proliferative glomerulonephritis?
Inflammation of the glomeruli in the kidney which can lead torenal failure and hypertensive enceophalopathy
What symptoms suggest GABHS pharyngitis?
O Fever >38°C O Tender anterior cervical adenopathy O Lack of cough O Pharyngotonsillar exudate O Sore throat – may be severe O Odynophagia O Palatal petechiae O Tender cervical adenopathy O Elevated WBC and left shift possible O Headache O Chills (rigors) O Flushed face
What are S/Sx of Scarlet Fever?
Sandpaper rash with onset 24 to 48hrs post strep throat symptoms Strawberry tongue
How is Strep transmitted?
direct person contact (saliva, nasal secretions) and may be transmitted with food preparation
How long is incubation for strep pharyngitis
2-5days
When can a child with strep return to school?
After 24 hours with no fever (usually 1-3 days)
What labs are ordered to confirm strep?
Streptococcal Rapid Antigen Test. If negative then a culture is done to confirm negative result.
What can be consequences if strep goes untreated?
O Acute rheumatic fever O Acute post streptococcal glomerulonephritisis O Peritonsillar abscesses.
Strep Treatment?
Symptomatic management First line Abx= Penicillin VK Second line= Augmentin
What is mono caused by?
Epstein-Barr virus infecting B cells
How long is mono incubation?
4-8 weeks
What are the S/Sx of mono
O Exudative pharyngitis(>97%) O Prominent cervical lymphadenopathy (>97%) O Posterior cervical: most common O Pharyngeal erythema and edema(85%) O Splenomegaly (75%) O Palatal petechiae (50%)
What labs test for mono?
O Throat Culture O Lymphocyte predominance O Lymphyocyte atypia – very specific O Heterophil antibody test (Monospot test)
What is involved in the management of mono?
O Rest O Non-caffeinated fluids for adequate hydration O NSAIDs O Avoid strenuous exercise or sport
How long does a person with mono need to avoid strenuous exercise?
Moderate training allowed after 3 weeks. Strenuous activity allowed after 4 weeks.
When would you use Abx with mono?
only indicated if coexisting strep (rash develpes in 90% of EBV pts on Abx)
Complications of Mono?
O Meningoencephalitis O Guillain-Barre Syndrome O Bell’s Palsy O Pneumonitis O Myocarditis
What is Quinsy?
Peritonsillar Abscess-Infection of the tonsil(s) that spreads to surrounding areas with a pocket of infected material.
What often causes a Peritonsillar abscess?
Group A strep
What are S/Sx of peritonsillar abscess?
Trismus(clenched teeth) Drooling Muffled voice Unilateral throat pain Uvula deviates to opposite side
What tests are ordered for a peritonsillar abscess?
O Labs to r/o mono & strep O I&D or aspiration w/ C&S O CT scan
peritonsillar abscess treatment?
O Antibiotics O I&D O Pain meds
Peritonsillar Abscess complications?
O Airway obstruction O Cellulitis O Endocarditis/pericarditis O Pneumonia
Symptoms of Retropharyngeal Abscess?
O Neck pain out of proportion to findings O Dysphagia O High fever
Retropharyngeal abscess tests?
Lateral neck Xray showing bulging of posterior pharyngeal wall
Retropharyngeal Abscess management?
O Hospitalize O Airway observation O IV Antibiotics O Early ENT consultation
Epiglottitis S/Sx
Shortness of breath Drooling “Sniffing Position”
what will a Xray show with Epiglottitis?
Thumbprint sign
Epiglottitis treatment
O Avoid tongue depressor or other oral instruments O Epiglottitis irritation may lead to obstruction O Keep patient calm O Airway management ASAP! O Do not attempt to intubate!! O Do not lay person down! O Hospitalization O Antibiotics O Anti-inflammatory meds (steroids)
What can cause Laryngitis?
O Viral infection (Most common cause of acute) O Bacterial infection O Gastroesophageal reflux disease (GERD) O Nerve damage, sores, polyps, nodules on the vocal cords
What is the most common cause of acute Laryngitis?
Viral infection
What is the most common cause of chronic laryngitis?
GERD
Laryngitis S/Sx
O Hoarseness O Aphonia (voice breaks intermittently) O Upper respiratory infection (URI) symptoms variably present O Leukocytosis, if bacterial
Laryngitis treatment
O Increased household humidity O Rest voice (including asking patient to not whisper) O Increase hydration O Analgesics O Treat underlying cause such asGERD
What indicates a ENT referral for Laryngitis?
Hoarseness persisting beyond 2 weeks
