Mouth & Throat Flashcards
Pharyngitis Etiology, PE, Dx, Tx
12 million. GABHS only 5-15%, over prescribt antibiotics. Mostly viral.
PE: sore throat, swollen glands, URI, Pharyngeal erythema, tonsilar hypertrophy, purulant exudate, tender cervical lymph nodes, Palatal Petechiea (bacterial).
Dx: RAPT. 15 mins, should get better in 5-7 days
Peritonsilar abscess Etiology, PE, Ddx, Dx, Tx
Most common deep neck infection in kids. Polymicrobial but mostly GABHS.
PE: Severe sore throat, fever, hot potato muffled voice, drooling, Ipsilateral ear pain. Deviated uvula.
Ddx: mono, lymphona
Dx: Clinical, CBC, Culture, CT
Tx: Airway monitor, I&D, IV ampicillin or clindamycin, Vanco MRSA
Laryngitis Etiology, PE, Ddx, Dx, Tx
Viral (rhino, adeno, coxsa, flu). Bact (HMSS)
Noninfectious: vocal abuse, trauma, GERD, SCC.
PE: Hoarseness, URI symptoms.
Ddx: croup, GERD, epiglottitis
Dx: Clinical
Tx: Viral, humidify, No speaking, avoid smoking
resolve in 1-3 weeks
Epiglottitis Etiology, PE, Dx, Tx
Hib, SS,
Risk due to non-vaccination, immuncomp.
PE: 3 Ds(distress, drool, dysphagia) Tripod, fever, odynophagia, muffled voice, stride. Causion with Visualization -> ED
Dx: CT “thumbs sign”, laryngoscopy
Tx: airway protect, IV 3rd gen cephalo, immunize
Oral Herpes simplex & herpes labialis Etiology, PE, Triggers, Dx, Tx
HSV
PE: sudden painful blisters on erythematous base (10-14 days initial) , 5days recurrent.
Trigger: sun, stress, menses, fever.
Dx: Clinical, culture
Tx: Antiviral, fluid management (dehydrated bc pain) analgesic.
Herpetic gingivostomatitis Etiology, PE, Dx, Tx
primary HSV infection (mouth, skin, tongue)
PE: Ulcerative lesions on gingiva and mouth with vesicles, Fever.
Coxasckie Etiology, PE, Dx, Tx
Hand foot mouth - kids Etioligy: Coxascie virus A16 PE: Low fever, abdominal pain, URI, Painful PAPULES on red base. Dx: Clinical Tx: 2-3 days resolve
Candidiasis Etiology, PE, Dx, Tx
Thrush will brush.
Epi Etiol: Kids, dentures, poor oral hygiene, diabetes, corticosteriod use, HIV, Antibiotic use.
PE: painful cream white patch over red mucosa, cotton mouth, no taste, pain eating.
Dx: Clinical, KOH wet prep, see budding, hyphae.
Tx: antifunal, clean corticosteriods
Criteria for tonsillectomy of GABHS
7 per last year
5 over 2 years
3 over 3 years
observation for 12 months
GABHS Tx
PCN v 500mg PO BID-TIP x 10 days, or Amoxicillin
Coxsackie A16 vs Herpangina
Cox: low fever, papules on tongue and hard palate (hands and feet).
Herpangina: high fever, lesions on soft palate (only mouth)
Aphthous ulcers Etiology, PE, Dx, Tx
Canker sores. Etiology: HHV6, celiacs, IBD, HIV.
PE: Single sore on lips, tongue, gums, palate. Recurrant, painful small.
Grey base with red halo.
Trigger: Stress
Tx: corticosteriod, analgesic
Bechet’s disease
Inflammation disorder
PE: recurrant genital (75%) and oral lesions on multiple sites.
Dx: Recurrent oral ulcers 3x per year & 2 clinical sites)
Tx: refer to rheumatologist
Oral Lichen Planus Etiology, PE, Dx, Tx
Chronic inflammation, autoimmune. Not Cancer
PE: reticular white plaques, erosion (SCC), hyperkeratotic plaques. Painful
Dx: exfoliate biopsy.
Leukoplakia Etiology, PE, Dx, Tx
Hyperplasia SCC. Chronic irritation.
Etiology: Lichen planus, tobacco, Dentures, HPV..
PE: white lesion, cant scrap (not candida).
Tx: Refer, Biopsy, SCC patient education.
Erythroplakia Etiology, PE, Dx, Tx
Red plague lesion (90% SCC)
Etiology: Tobacco, alcohol.
Dx: clinical + Biopsy All,
Tx: refer
Hairy Leukoplakis Etiology PE, Dx, Tx
Epstein Barr (mono)
Epi: HIV
PE: Lateral tongue, white painless plagues, cant scrap.
Tx: antiviral
Mucoceles Etiology, Dx, Tx
Fluid filled cavity of mucus, self resolving.
Dx: clinical
Tx: rupure, excision
Ludwig’s Etiology PE, Dx, Tx
Most common neck space infection. Sublingual and submaxillary cellulitis. Infection from tooth root.Induration of upper neck and mouth floor.
PE: fever, neck pain, dysphagia, tongue lelevated = block airway.
Dx: Clinical, CT
Tx: Secure airway, Tracheostomy, hospitalize with IV antibiotics
other tongue conditions
Fissure - normal
Black - normal, medication
Black hairy - medication
Geography - normal
Torus palatinus
benign boney lesion, normal on hard palate & Midline
Teeth and gum - dental caries Etiology PE, Dx, Tx, Complication
Etiology: Strep mutans - convert sugar to acid and burn enamel.
PE: heat/cold intolerance, visually disturbing.
Dx: clinical
Tx: densist
Complication: intraoral abscess, brain abscess
Sialolithiasis/ Sialadenitis Etiology risk factors. PE.
Stone +/- inflammation in salivary gland or duct.
PE: reduced salivary flow, localized infection.
Risk factors: dehydrated, diuretics, anticholinergics, trauma, gout, smoking, kidney stone hx, peridontal disease.
Most common = Wharton duct.
Sialolithiasis/ Sialadenitis PE, Dx, Tx, Complication.
PE: pain and acute swelling or gland or anticipating eating, fever, erythema.
Dx: clinical. Massage Pus from duct. CT or US of duct.
Tx: IV antibiotics, hydrate, heat massage, milk the duct, Sialagogues (suck to increase salivation), S.aureus, refer.
Complication: abscess, obstruction = US or CT
