OMFS Flashcards
IE manifestations/features x8+ how to mx
“FROM JANE:”
Fever,
Roth spots-eye,
Osler nodes-palms, Murmur,
Janeway lesions-sole/palms petechiae,
Anemia,
Nail bed SPLINTER hemorrhage, and
Emboli-> [neuro] seizure/dyspnea=SOB [respi].
mx: referral; they would do blood culture before empirical IV Abx-> switch to targetted Abx therapy with Blood culture results
LA with epiNEphrine - dosage and duration of action
Lidocaine [90-200mins] + Mepivacaine[120-240mins] 4.4mg/kg
bupivacaine [180mins-600mins] 1.3mg/kg
articaine is 7mg/kg [60-240mins]
Tachyphylaxis is the appearance of progressive
decrease in response to a given dose after repetitive administration
LN swollen in neck- 6 things to note
1) pain - benign/inflammatory causes, if non tender - suspect malignancy/mycobacterial cause
2) consistency -soft [benign/infl]; hard [breast cancer metastasis]/ rubbery is Hodgkin lymphoma
3) fixation -mobile [benign/infl]; fixed [malig/TB]
4) location- anterior to SCM [benign/infl]; dorsal to Sternocleidomastoid muscle [M/TB]
5) progression [acute -benign/inf]; slow progression [m/tb]
6) size ->1cm -infection
painful Generalized lymphadenopathy (enlargement of ≥ 2 noncontiguous lymph node groups)
Viral infections
CMV
HIV
Mumps, measles, rubella
VZV
Bacterial infections
Syphilis
Parasitic infections
Malaria
Toxoplasmosis
painless Generalized lymphadenopathy (enlargement of ≥ 2 noncontiguous lymph node groups)
Malignancy
Malignant lymphoma (NHL, Hodgkin lymphoma)
Leukemia
Autoimmune
Circulating immune complexes (due to medication or allergies)
Sjogren syndrome
Others
Hyperthyroidism
Tuberculosis
Amyloidosis
Sarcoidosis
Painful localised lymphadenopathy
Oral/genital herpes
Chancroid
Kawasaki disease (usually unilateral cervical lymphadenopathy)
Mononucleosis (bilateral cervical lymphadenopathy)
Rubella (especially postauricular nodes), mumps
Painless localised lymphadenopathy 3x
Tuberculosis
Metastases
Residual lymph nodes after overcoming an infection
What is Ludwig angina?Characteristics/symptoms?
Ludwig’s Angina is a rapidly progressing cellulitis affecting the sublingual, submandibular, and submental spaces on bilaterally/ may be a “bull neck” appearance.
This condition is characterized by significant neck swelling, possibly extending to the clavicles, and can raise + protrude- the tongue[WOODY tongue], posing a risk to the airway.
Symptoms include fever, malaise, neck pain, limited neck movement, difficulty swallowing (dysphagia), voice changes (dysphonia), slurred speech (dysarthria), drooling, and sore throat,
L. angina possibly spread from sub mand. space to–>
Mx: 7x
Submd space can
extend to the lateral pharyngeal space->retropharyngeal space and potentially to the mediastinum, leading to serious complications.
1 Hospital Admission for severe infections for IV antibiotics, airway mx, and possible incision and drainage.
2. Empirical Antibiotics: Initiate with amoxicillin-clavulanate [Clavulanic acid inactivates some beta-lactamase enzymes that are produced by bacteria, therefore preventing enzymatic destruction of amoxicillin] and metronidazole [Aerobic+Anaerobic]; Analgesia -NSAID/OPOID-tramadol
3.Extraction if non-restorable or consider pulpectomy +Periodontal Debridement
4 OHI: Use CHX mouth rinses to reduce bacterial load.
5 Hydration and Nutrition: Ensure hydration and maintain nutritional intake with a soft or liquid diet if needed.
6 Continued targetted ABX after results out.
7 f/up+ monitor
complications of L. Angina
Complications may include respiratory obstruction due to lateral pharyngeal space involvement, leading to rapid breathing (tachypnea), shortness of breath (dyspnea), fast heart rate (tachycardia), noisy breathing (stridor), and restlessness.
Patients may experience systemic symptoms like fever, chills, a high white blood cell count (leukocytosis), and elevated sedimentation rate.
LA MOA
Benefits
LA-> temporarily block nerve conduction reversibly and thereby provide pain relief during procedures; without loss of consciousness and central control of vital functions such as respiration.
cellulitis mechanism of spread
Strep milleri->synthesise hyaluronidase; allows infective organisms to spread through CT
generates metabolic by-products=>
favourable envrionment for anaerobic growth
o Lowered pH too!
abcess how is it formed
Anaerobic bacteria predominate synthesise
collagenase->liquefactive necrosis of tissues.
Invading WBC lyse-> microabscesses
formation
microorganisms related to dry socket
Actinomyces viscous; Streptococcus mutans
=retard alveolar post-extraction healing
- Treponema Denticola->Fibrinolytic activity
Mx and meds used for Dry socket
Local measures:
oPlacement-medicaments/dressing externally
(i.e.Alvoygyl/BIPP Bismuth iodoform paraffin paste)
alvogyl-eugenol (analgesic, anti-inflammatory), butamben (anesthetic), and iodoform (antiseptic)
o Surgical/intervention
o Socket packing
o Review every few days
Cavernous Sinus Thrombophlebitis -what, symptoms
An infection and inflammation+ clot formation in the cavernous sinus.
Orodental infections are responsible for approximately 10% of the cases.
Clinical Presentation
Eye Symptoms:
Edematous Periorbital Enlargement: Involving the eyelids and conjunctiva.
Proptosis, Chemosis, and Ptosis
Pupil dilation, excessive tearing (lacrimation), sensitivity to light (photophobia), and potential loss of vision.
Nasal Area Symptoms:
Canine Space Involvement: Presents with swelling along the lateral border of the nose, potentially extending to the medial aspect of the eye and periorbital area.
Induration and Swelling: Noted on the adjacent forehead and nose, suggesting spread or severe localized inflammation.
Pain: Occurs over the eye and along the distribution of the ophthalmic and maxillary branches of the trigeminal nerve, =involvement of these sensory pathways due to the spreading infection.
Advanced Toxemia and Meningeal Involvement:
Meningitis: Inflammation of the meninges, characterized by symptoms such as stiffening of the neck, irregular breathing patterns, tachycardia (fast heart rate), and tachypnea (rapid breathing).
Neurological Deterioration: =experience deepening stupor and possibly delirium.
Severe Complications: progression of the infection might lead to the formation of brain abscesses.
diagnosis of candidiasis
clinical signs,with positive microscopic findings/culture, +ve response to anti-fungal therapy, necessary to confirm diagnosis
potassium hydroxide KOH TEST- smear preparation
* dx aid:-tissue culture of smears,cytology,
o Sabourand’s medium
oPeriodic acid schiff-see hyphae/Pseudohyphae
oral cancer diagnosis methods and TOOLs
1 gold standard -visual examination and palpation .
2. VELscope =direct fluorescence visualization device to detect high-grade oral PML and delineate the margin of the lesion.
2 1% Toluidine Blue (ORASCAN) stains nuclei acid [DNA]=Adjunct tools=> chemiluminescent light sources that use toluidine blue improves the brightness and sharpness of the lesion’s margin and assist in the identification of mucosal lesions that were not considered under the conventional visual examination.
orascan purpose x2
Purpose:
Used as a diagnostic tool in oral cancer screening.
Helps to establish the borders for biopsy procedures.
TNM classification
Clinical assessment of the anatomical extent of disease
Tumour
T 1 < 2 cm
T 2 < 2 – 4 cm
T 3 > 4 cm
T 4 Infiltrating deep structures
Nodes
N 1 Mobile palpable nodes < 3 cm on same side
N 2 Contra or bilateral mobile nodes 3 – 6 cm
N 3 Fixed node(s) > 6 cm
Metastases M 1 Distant metastases present
VZV + salicylate=>
reyes syndrome in children; rare but when viral infection alters the metabolism of salicylates and leads to accumulation of metabolites in the liver, which causes hepatic mitochondrial injury that prevents hepatic ATP production+ hepatic failure.
HSV-1 infection - mx of pain
Rest: Emphasized to support recovery.
Antipyretic: Used to manage fever.
Topical/systemic corticosteroids-oracort E
Topical Analgesics:
Benzydamine (NSAID): Available as a gel or mouthwash for pain relief.
Lignocaine/benzocaine Gel: Effective for pain relief, but use with caution in young children.
Salicylate: Not recommended due to potential risks, such as Reye’s syndrome.
Topical Antiseptic:
Chlorhexidine (CHX): Available in swab form or as a 0.2% mouthwash.
Difflam C Mouthwash: Used for its antiseptic properties.
HSV - OHI and dietary mx
Oral Hygiene
Soft-bristled Toothbrush: Should be discarded after illness to prevent reinfection.
Cotton Buds/Swabs with CHX: For gentle cleaning.
Moist Warm Cloth: For cleaning without causing irritation.
Toothpaste: May cause stinging pain and should be used cautiously.
Nutrition and Hydration
Soft, Bland Diet: Foods like pudding, yogurt, and porridge recommended.
Cool Foods/Drinks: Such as ice chips or shavings to soothe the throat.
Avoid Irritants: Such as alcohol, tobacco, citrus fruits, tomatoes, and carbonated drinks to prevent aggravation of symptoms.
hsv - medication mx
Targeted Therapy
Acyclovir: Used particularly for severe cases or immunocompromised patients if started within 72 hours of infection onset.
Dosage: 200mg 5x/day for 5 days for adults and >2yrs old.
Benefits: Decreases the duration of fever, pain, lesions, and viral shedding.
Limitations: Does not change the frequency or severity of recurrent herpes simplex infections (RHSI).
Additional Care Considerations
Fever and Pain Management: Aim to reduce both fever and pain effectively.
Prevent Secondary Infections: Critical to prevent complications.
Adequate Fluid Intake: Essential to prevent dehydration.
Isolation and Infection Control: Important to prevent spread during the contagious period.
progression of Progression of Symptoms
HSV
Progression of Symptoms
HSV
incubation:
Prodromal period
resolves by
Progression of Symptoms
Incubation: 5-7 days.
Prodrome: 1-2 days, with symptoms like fever, malaise, headache, nausea.
Active Infection: Characterized by vesiculation and ulceration, with fever typically decreasing by the third day and symptoms reducing by the sixth day.
Resolution: Symptoms generally resolve after 10-14 days.
Absolute CI of adrenaline in LA
- <6/12 MI
- <6 CVAccident
- <6/12 CABG
- uncontrolled HTN > 200mg/115mmHg
- unstAble Angina pectoris
- uncontrolled thyrotoxicosis
- Congestive heart failure
relative contraindications of ADRENALINE in LA- use only _ catridge , aspirate and avoid hemostat with epinephrine
- dm on hypoglycemics
- HTN -controlled
- cardiac arrythmia
- NON selective beta blockers [PROp/timolol] and digoxin for arrythmias
- hepatic or renal failure- metabolism of amide LA and excretion is affected
PT prothrombin time, duration, which pathway,+ which factors
PT 10-13 sec extrinsic pathway + common pathway [1,2,5,7, 10] I, II, VII and X
WBC
platelets; normal and what level what procedure can be done?
wbc 4500-10,000/mL
platelets 150k-450k/uL;
> 80k major surg
50k minor surg
30k-50k routine procedure
<30k defer all tx
transfused 1hr before procedure and regularly to maintain at least >30k-40k range until healing occurs
APartial thromboplastin time,duration, which pathway+ factor- used to monitor what?
25-35 sec
intrinsic + common pathway
xii
xi [hemophilia c-autosom dom.]
ix [hemophilia b- X-linked]
viii [hemophilia a- X-linked]
also monitor for heparin
TT-,duration, which pathway- measures ability to form initial … from…
9-13sec
common pathway
ability to form initial clot from fibrinogen
bleeding time
check the function of …
7-9mins - duration to arrest bleeding
platelets and blood vessels and primary hemostasis
INR- measures what/which pathway? pt on .. therapy stable range
0.8-1.2 normal
measure extrinsic pathway
RATIO OF pt PT to standard PT
for monitoring patients on warfarin therapy 2.0-3.0
hemophilia level of factor of VIII [%]
mild >5% -rarely bleed spontaneously
moderate 1-5%
severe <1% -bleed spontaneously into muscle and joints at young age
mx of hemophilia A
factor viii [ ]
prothrombin complex [ ]
cryoprecipitate if ddvap unavailable
desmopressin [ddvap]- mild hemophilia A
warfarin - MOA, used for
-block vit k epoxide reductase in liver
also (-) vit k dependent clotting factors like ii-thrombin, vii, ix, x ; C+S -> dec clotting ability
- use to tx/prevent
->DVT, Pulm embolism
-> atrial fib
-> post MI, cardiac valve replacement
