Mouth & Throat

Question 1

Pharyngitis Etiology, PE, Dx, Tx

Answer 1

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

Question 2

Peritonsilar abscess Etiology, PE, Ddx, Dx, Tx

Answer 2

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

Question 3

Laryngitis Etiology, PE, Ddx, Dx, Tx

Answer 3

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

Question 4

Epiglottitis Etiology, PE, Dx, Tx

Answer 4

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

Question 5

Oral Herpes simplex & herpes labialis Etiology, PE, Triggers, Dx, Tx

Answer 5

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.

Question 6

Herpetic gingivostomatitis Etiology, PE, Dx, Tx

Answer 6

primary HSV infection (mouth, skin, tongue)

PE: Ulcerative lesions on gingiva and mouth with vesicles, Fever.

Question 7

Coxasckie Etiology, PE, Dx, Tx

Answer 7

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

Question 8

Candidiasis Etiology, PE, Dx, Tx

Answer 8

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

Question 9

Criteria for tonsillectomy of GABHS

Answer 9

7 per last year
5 over 2 years
3 over 3 years
observation for 12 months

Question 10

GABHS Tx

Answer 10

PCN v 500mg PO BID-TIP x 10 days, or Amoxicillin

Question 11

Coxsackie A16 vs Herpangina

Answer 11

Cox: low fever, papules on tongue and hard palate (hands and feet).

Herpangina: high fever, lesions on soft palate (only mouth)

Question 12

Aphthous ulcers Etiology, PE, Dx, Tx

Answer 12

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

Question 13

Bechet’s disease

Answer 13

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

Question 14

Oral Lichen Planus Etiology, PE, Dx, Tx

Answer 14

Chronic inflammation, autoimmune. Not Cancer
PE: reticular white plaques, erosion (SCC), hyperkeratotic plaques. Painful
Dx: exfoliate biopsy.

Question 15

Leukoplakia Etiology, PE, Dx, Tx

Answer 15

Hyperplasia SCC. Chronic irritation.
Etiology: Lichen planus, tobacco, Dentures, HPV..
PE: white lesion, cant scrap (not candida).
Tx: Refer, Biopsy, SCC patient education.

Question 16

Erythroplakia Etiology, PE, Dx, Tx

Answer 16

Red plague lesion (90% SCC)
Etiology: Tobacco, alcohol.
Dx: clinical + Biopsy All,
Tx: refer

Question 17

Hairy Leukoplakis Etiology PE, Dx, Tx

Answer 17

Epstein Barr (mono)
Epi: HIV
PE: Lateral tongue, white painless plagues, cant scrap.
Tx: antiviral

Question 18

Mucoceles Etiology, Dx, Tx

Answer 18

Fluid filled cavity of mucus, self resolving.
Dx: clinical
Tx: rupure, excision

Question 19

Ludwig’s Etiology PE, Dx, Tx

Answer 19

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

Question 20

other tongue conditions

Answer 20

Fissure - normal
Black - normal, medication
Black hairy - medication
Geography - normal

Question 21

Torus palatinus

Answer 21

benign boney lesion, normal on hard palate & Midline

Question 22

Teeth and gum - dental caries Etiology PE, Dx, Tx, Complication

Answer 22

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

Question 23

Sialolithiasis/ Sialadenitis Etiology risk factors. PE.

Answer 23

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.

Question 24

Sialolithiasis/ Sialadenitis PE, Dx, Tx, Complication.

Answer 24

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

Question 25

Suppurative Parotitis Etiology PE, Dx, Tx, Complications

Answer 25

Acute viral/bact parotid gland infection.
Salivary retrograde flow = infection backflow.
PE: sudden onset, pre &post auricular swelling, severe pain, trismus, dysphagia, fevers, chills.
Dx: clinical, amylase elevated, US, CT, MRI assess obstruction.
Tx: IV antibiotics, hydration, I&D.
Complications: massive neck swelling, septicemia, osteomyelitis.

Question 26

Amalgam tattoo

Answer 26

benign, adjacent to filling.

Question 27

Fibroma and Cheek bite

Answer 27

benign where you bite alot

Question 28

Oral cancer facts

Answer 28

90% SCC, 8,000 die this year.

Question 29

SCC PE, Dx, Tx, P53

Answer 29

Ulcers masses dont heal after 6 weeks. 80& tobacco use, HPV 16,18,31
PE: Papules, plaques, erosion. Unexplained lump = cancer until R/O
Dx: ENT referral
Tx: biopsy, stage
P53 = tumor suppressor gene (genetic), smoking and alcohol (environ)

Question 30

When to refer

Answer 30

Mass on neck, Otalgia, odynophagia, dysphagia, Hoarse > 2 weeks, lump pre/post auricular, persistent ulcer, unilateral serous otitis.

Question 31

GABHS TX if allergic to PCN

Answer 31

Macrolides ( erythromycin, Axithromycin)

Question 32

GABHS complications

Answer 32

acute rheumatic fever, Acute globularnephritis, Peritonsillar abscess, scarlet fever

Question 33

GABHS clinical presentation

Answer 33

Tonsilar exudate, tender cervical adenitis, fever, No Cough. Culture positive