Mouth/Throat disorders Flashcards

Question

# Peritonsillar abscess Dx

Answer 1

Diagnostic studies Ultrasound may be a useful adjunct to clinical suspicion, but imaging is not required for the diagnosis The existence of an abscess may be confirmed by aspirating pus from the peritonsillar fold just superior and medial to the upper pole of the tonsil

Answer 2

Treatment parenteral **amoxicillin (1 g), amoxicillin-sulbactam (3 g), or clindamycin (600–900 mg)** Less severe cases and patients who are able to tolerate oral intake may be treated for 7–10 days with oral antibiotics, including amoxicillin, 500 mg three times a day; amoxicillin-clavulanate, 875 mg twice a day; or clindamycin, 300 mg four times daily needle aspiration, incision and drainage, and tonsillectomy

Answer 3

Sialadentis: Salivary gland infection Swelling and tenderness that increase with eating/ anything that causes salivation Erythema of the duct opening Often happens after dehydration, with chronic illness, with Sjogren’s syndrome Usually S. aureus

Answer 4

Tx: IV abx (nafcillin), resolve dehydration, give lemon drops/ lemonheads, warm compresses When ready to send home, continue oral antibiotics for 10-day total of treatment Will occasionally not drain and will require surgical I&D

Answer 5

Sialolithiasis: Stone that blocks drainage of salivary gland Usually, Wharton duct in submandibular glands and Stensen duct in parotids Pain and swelling that increases with salivation, no erythema or “illness” like with infection If stone is small- treat with lemon candy If stone is large- refer for surgical removal which can be difficult If recurrent and frequent, sometimes the gland is just removed

Answer 6

80% are in parotids and 80% OF THESE are benign Tend to have more malignancies in submandibular tumors Parotids are usually slow growing but will eventually get large enough to push the soft palate medially MRI and CT are used to diagnose

Answer 7

Treatment: refer out for surgical excision, sometimes surgeon will do FNA biopsy first; radiation therapy for malignant tumors Misc: facial nerve involvement has high correlation with malignancy

Answer 8

any inflammatory process involving the larynx Nearly all major respiratory viruses have been implicated in acute viral laryngitis, including rhinovirus, influenza virus, parainfluenza virus, adenovirus, coxsackievirus, coronavirus, and RSV can also be associated with group A Streptococcus but less likely

Answer 9

Symptoms Hoarseness other symptoms and signs of URI, including rhinorrhea, nasal congestion, cough, and sore throat Exam hoarseness URI symptoms

Answer 10

Diagnostic Studies laryngoscopy often reveals diffuse laryngeal erythema and edema, along with vascular engorgement of the vocal folds

Answer 11

humidification and voice rest Antibiotics are not recommended except when group A Streptococcus is cultured, in which case penicillin is the drug of choice

Answer 12

persistent use of voice while infected may lead to the formation of traumatic vocal fold hemorrhage, polyps, and cysts

Answer 13

GERD acid will cause hoarseness after irritating the laryngeal tissue

Answer 14

Testing and Treatment: patients with chronic hoarseness just need to be referred out for scope with ENT (otolaryngologist) IF high suspicion for this, you can do a trial of GERD meds (PPI) for 3 months, but the tissue can take up to 6 months to improve

Answer 15

Growths where the ciliated tissue and throat epithelial tissue meet Usually caused by HPV (types 6 & 11) Cause hoarseness since they are close to laryngeal tissue Basically have to send to ENT to have laser or cryotherapy to excise them, over and over again Misc: Can sometimes cause airway compromise BUT you should avoid tracheotomy because it can cause the problem to worsen

Answer 16

Symptoms: Chronic hoarseness Chronic cough or throat clearing Esophageal spasm Sometimes asthma symptoms Usually have other GERD symptoms PE: nothing exciting unless you can scope and see the tissue; basically, a normal exam

Answer 17

Nodules/ polyps/ cysts can cause hoarseness Usually from “vocal abuse” Treat with modification of habits (AKA don’t talk), speech therapy and possibly even specialist for surgery if necessary Misc: this is what you hear about with singers that have “vocal cord surgery”

Answer 18

Etiology cellulitis of the epiglottis and adjacent structures that can cause potentially fatal airway obstruction H. Influenza and group A Streptococcus Misc Security of the airway is always of primary concern Disease is more severe/ acute in young children

Answer 19

Symptoms high fever severe sore throat drooling while sitting forward Patients come in with a look of distress Exam high fever severe sore throat tachycardia systemic toxicity drooling while sitting forward DO NOT USE TONGUE BLADE/DEPRESSOR moderate or severe respiratory distress with inspiratory stridor and retractions of the chest wall. These findings diminish as the disease progresses and the patient tires

Answer 20

Diagnostic Studies Neck radiographs typically reveal an enlarged edematous epiglottis (the “thumbprint sign”) specimens of blood and epiglottis tissue should be obtained for culture AFTER securing airway Laryngoscope but ONLY in the OR in case you need to do immediate procedure for airway (will have “cherry-red” epiglottis)

Answer 21

Treatment IV antibiotics cefotaxime, or ceftriaxone is given; clindamycin plus fluoroquinolone reserved for patients allergic to β-lactams. Antibiotic therapy should be continued for 7–10 days

Answer 22

“Thumb Print” sign on lateral neck x-ray