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HEENT > Oral Cavity - Exam 4 > Flashcards

Oral Cavity - Exam 4 Flashcards

1
Q

What is the scientific name for a canker sore? What is the cause? What virus is it associated with?

A

Aphthous Stomatitis

cause is unknown
stress is a major factor!!, trauma, hormones, immunodeficiency, emotional stress, celiac dz, IBD, maybe B12 def

herpes virus 6

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2
Q

Apthous stomatitis is found on ____ and ____ mucosa. Describe the sore. When is it supposed to heal

A

buccal or labial

**yellow-gray center surrounded by red halos

1-3 weeks pain lasts for 7-10 days

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3
Q

What is the tx for aphthous stomatitis? What if it is severe?

A

no tx!! supportive care

can do viscous lidocaine, magic mouthwash, topical cortiosteroids

____

One week tapering course of prednisone if severe
40-60 mg/day, then taper

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4
Q

What do you do if apthous ulcer is very large or persistant?

A

If diagnosis not clear – incisional biopsy

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5
Q

What is Behcet’s disease?

A

is a rare disorder that causes blood vessel inflammation throughout your body. Including mouth sores, eye inflammation, skin rashes and lesions, genital sores

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6
Q

What are precipitating factors for Herpes Gingivostomatitis?

A

Oral trauma
Sunburn
Stress
Febrile illness

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7
Q

How does herpes gingivostomatitis present before the sore come out? What virus is it associated with? May have ______ present.

A

generally didn’t feel well 2-3 days before the sore appear, initial burning b4 cold core erupts

90% HSV 1, 10% HSV 2

cervical adenopathy

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8
Q

How is herpes gingivostomatitis dx?

A

clinical

PCR or culture

tzank smears

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9
Q

Which dx tool for herpes is more specific/sensitive? What will the Tzanck smear show if it is herpes?

A

PCR is more sensitive/specific than Tzank smear

Multinucleated giant cells

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10
Q

What is the tx for herpes gingivostomatitis? How soon do you need to start tx?

A

acyclovir or valacyclovir

must start within 24-48 hours

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11
Q

What organisms is oral candidiasis? What are some risk factors?

A

Candida albicans

young infants
dentures
DM
Immunocompromised pts (HIV!!!!)
chemo/radiation pts
abx
steroids

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12
Q

Painful, burning tongue
Creamy-white curd like patches overlying erythematous mucosa
Beefy red tongue
Can be scraped off the mucosal surface with tongue depressor

What am I?
How do you dx? What will it show?

A

Oral Candidiasis

clincial
**wet prep with KOH
budding yeasts with or without pseudohyphae

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13
Q

What is the tx for oral candidiasis? Pt is the important pt education point?

A

Nystatin swish and swallow
Flyconazole
Magic mouthwash

Continue use for 48 hours once symptoms resolve

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14
Q

Inflammatory lesion of the corner of the lips
Characterized by scaling and fissuring
dryness, itching, burning
Maceration is the usual predisposing factor

What am I?
What organism commonly invades the area?

A

Angular Cheilitis

Candida albicans

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15
Q

What is the tx for angular cheilitis? What is the prevention?

A

Clotrimazole or Miconazole

Advise to stop licking lips
Recommend protective lip balm
If denture wearer – make sure dentures are properly fitted to prevent drooling

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16
Q

______ Inflammation of the tongue and loss of _____ results in a red, smooth surfaced tongue. Is it painful?

A

glossitis

filiform papillae

rarely painful

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17
Q

What is glossitis caused by? What is the tx?

A

Nutritional deficiencies
Iron, riboflavin, niacin, vitamin E
Drug reactions
Dehydration
Irritants
Foods and liquids
Possibly autoimmune reactions
Psoriasis

nutritional replacement

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18
Q

What is the cause of “burning mouth syndrome”? BMS without glossitis is MC in _____

A

no known cause

postmenopausal women

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19
Q

Burning Mouth Syndrome with glossitis is common in (name 5 conditions)

A

DM
Drugs
Diuretics
Tobacco use
Xerostomia
Candidiasis

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20
Q

What is the tx of Burning Mouth Syndrome?

A

No specific treatment (underlying cause)

clonazepam: works on GABA receptors, have on tongue
TCA’s
Behavioral therapy

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21
Q

Hyperkeratosis occurring in response to chronic irritation
Dentures, tobacco, lichen planus, etc.
Presents as a white patchy lesion that cannot be scraped off the mucosal surface

What am I?
Is it normally cancerous?
What should you do if you see it?

A

Leukoplakia

2-6% is dysplasic

bx to check for cancer in all pts with a hx of tobacco use

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22
Q

What is the tx for leukoplakia?

A

No known treatment to date that will reverse leukoplakia

surgically removal

advise pts to eliminate contributing factors: tobacco and alcohol

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23
Q

Fiery red, sharply demarcated patch most commonly located on the floor of mouth, ventral tongue, or soft palate
generally found in older patients who consume tobacco and alcohol

What am I?
What am I at a high risk for?

A

Erythroplakia

~90% are either dysplasia or carcinoma

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24
Q

What is the tx for erythroplakia?

A

sx! surgical excision with clear margins

eliminate contributory factors: tobacco and alcohol

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25
Slightly raised leukoplakic areas with a “hairy” surface occurring on the lateral portion of the tongue Often develops quickly waxes and wanes What am I? What is the MC pt population? What is the tx?
hairy leukoplakia **lateral** portion of the tongue commonly associated with HIV no tx neccessary! need to adjust HAART therapy
26
oral lichen planus is caused by ??? Does it hurt?
Chronic inflammatory autoimmune disease definitive cause is unknown does NOT hurt
27
White lines, papules, or plaques Reticular or lacey pattern What am I? How do you definitively dx?
oral lichen planus bx
28
What is the tx for oral lichen planus? What is the tx for severe? What is the pt education?
no cure! tx: topical steroids: Clobetasol Triamcinolone topical 0.1% in Orabase ______________ **severe: oral steroids prednisone 30-60mg daily for 4-6 weeks, then taper Good oral hygiene Smoking cessation
29
Well demarcated red areas of the dorsal and lateral tongue with white scalloped borders (edge/border with repeating patterns) lesions can frequently change location, pattern and shape Usually asymptomatic, but may have some discomfort or burning What am I? What is the tx?
Geographic Tongue (Benign Migratory Glossitis) no tx is necessary!
29
Hyperpigmentation of the tongue and oral mucosa What am I? What drugs commonly cause it? What dz is it associated with?
black tongue drugs: Tetracycline, Linezolid (Zyvox), Pepto-Bismol, Antidepressants, PPIs dz: Addison's dz
30
Retention of keratin on tips of filiform papillae Seen on dorsal midline of tongue What am I? What are some common causes? What is the tx/
Hairy tongue smoking, coffee, tea, or poor oral hygiene tx: Improve oral hygiene Smoking cessation Tongue scrapers
31
What are the 3 salivary glands? What are the 3 salivary ducts?
Glands: Parotid sublingual submandibular Ducts: Wharton's duct Stensen's duct Sublingual duct
32
What duct drains the submandibular gland? What duct drains the parotid gland? Which duct is MC to get blocked?
Wharton's duct- MC Stensen's duct
33
What are some contributing factors to a sialolithiasis?
relative stagnation of salivary flow and elevated serum calcium concentration contributes (composed largely of calcium phosphate)
34
Postprandial Pain Swelling Spasm upon eating What am I? What is the diagnosis tool of choice? What is the tx?
Sialolithiasis CT Local heat Massage Hydration Small stone - salivary secretion first line Sialogogues (Salagen, Evoxac) Sour candy
35
What is the tx for a refractory sialolithiasis?
Incise duct remove stone Sialendoscopy Large stone – interventional removal of duct
36
_____ is inflammation of the parotid gland. **What is the MC organism of suppurative _____?
parotitis suppurative MC: Staph Aureus, anaerobes is second
37
What is the MC cause of non-suppurative parotitis?
viral causes MC: parainfluenza and EBV
38
What are some common pts who may present with suppurative parotitis?
Elderly postoperative patients who have been dehydrated or intubated Recent intensive teeth cleaning Medications that reduce salivary flow Malnutrition Ductal obstruction
39
Acute swelling Increased pain and swelling with meals Trismus and dysphagia Pus from opening of Stensen's duct with massage Fever and leukocytosis Usually unilateral What am I? What is a key factor?
Suppurative parotitis unilateral with pus from opening of Stensen's duct
40
How do you dx suppurative parotitis?
US, CT: looking for stone, abscess or tumor can also be made clinically Expression of purulent material from Stensen's duct with gram stain and culture Elevated serum amylase
41
What is the tx for suppurative parotitis?
**IV abx: Nafcillin or 1st generation Cephalosporin PLUS either Metronidazole or Clindamycin Vancomycin or Linezolid (Zyvox) if MRSA suspected can switch to oral abx when improvement Clindamycin plus Ciprofloxacin Or Amocicillin/Clavulanate Acid alone
42
What do you do for suppurative parotitis if no improvement after 48 hours of IV abx?
Surgical I&D
43
Why is suppurative parotitis important to treat asap?
can progress to other parts of the neck Swelling of the neck Respiratory obstruction Septicemia Osteomyelitis of adjacent facial bone Parapharyngeal space infection
44
Prodromal period followed by acute swelling Often bilateral resolves after 5-10 days What am I? What are the MC?
non-suppurative parotitis parainfluenza and EBV
45
What is Sialadenitis? What is the MC organism?
Submandibular Gland inflammation Staphylococcus Aureus
46
What is the dx TOC for sialadenitis? What is the tx?
CT **IV abx: Nafcillin or 1st generation Cephalosporin PLUS either Metronidazole or Clindamycin Vancomycin or Linezolid (Zyvox) if MRSA suspected can switch to oral abx when improvement Clindamycin plus Ciprofloxacin Or Amocicillin/Clavulanate Acid alone hydration warm compresses I&D if abscess formation or refractory
47
_____ is the single MC chronic childhood dz? What is it caused by?
Dental caries Caused by demineralization of tooth enamel in the presence of sugar substrate and acid forming bacteria that are found in the soft gelatinous plaque
48
______ considered the primary strain causing dental caries
Streptococcus mutans
49
What are risk factors for dental caries in kids?
Repetitive use of a "sippy cup" containing sugars Consumption of sticky foods Sleeping with a bottle or nursing ad lib Drinking non-fluoridated community water or bottled water Low socioeconomic status Medications that contain sugar or cause dryness
50
Demineralized areas painless, opaque or brown spots What am I? Why is it need to be addressed?
dental caries Cavity forms that can spread to and through the dentin and pulp
51
What is the management for dental caries? When do they need to see a dentist?
Patient education Refer to dentist: By age 1 Prescribe fluoride as needed Fluoride varnish
52
______ is a strong preventative measure for dental caries? What forms does it come in?
fluoride Oral drops, chewable tablet, lozenges, gel, paste, oral rinse, fluoride varnish
53
What are some risk factors for adult dental caries?
Physical and medical disabilities Presence of existing restorations or oral appliances Patients with Sjogren's syndrome Medications that decrease saliva flow Illicit drug use such as methamphetamine and cocaine Radiation to the head and neck Gingival recession Low socioeconomic status
54
Brownish discoloration Non-localized pain upon exposure to heat or cold results from activity of dental bacterial plaque What am I? What is it called when it spreads and pain is severe and persistent?
adult dental caries pulpitis: infection spreads to the pulp
55
What is xerostomia?
Dry mouth resulting from reduced or absent saliva flow
56
Why are dental abscesses considered major?
possibility of spreading into deep neck structures causing airway obstruction
57
an acute lesion characterized by localization of pus in the structures that surround the teeth Dental pain Toothache Gingival Edema Gingival Erythema Discharge Thermal hypersensitivity Fluctuant mass Trismus What am I? **What is the MC organism?
dental abscess **polymicrobial: Bacteroides, fusobacterium, Streptococcus Viridans
58
What is the tx for small dental abscess?
PCN VK treatment of choice +/- Metronidazole If Penicillin allergic: Clindamycin Analgesics Chlorhexidine mouth rinses dental referral
59
What is the tx for large dental abcesses?
I&D +/- IV antibiotics dental referral
60
What is gingivitis caused by?
inflammatory process that occurs as the result of prolonged exposure of the gingival tissues to plaque also could be due to steroids, calcium channel blockers, phenytoin, cyclosporine
61
How is gingivitis dx? what is the tx?
clinically! Good oral hygiene practices Tooth brushing Flossing
62
What is the technical name for “Trench mouth” or “Vincent’s angina”? What is it caused by?
Acute Necrotizing Ulcerative Gingivitis Caused by oral anaerobic fusiform bacteria and spirochetes
63
What is the tx for Acute Necrotizing Ulcerative Gingivitis?
Debridement Metronidazole or Clindamycin or Augmentin Warm, ½ strength peroxide rinses or Chlorhexidine rinses as adjunct
64
Painful, inflamed gingiva with ulcerations that bleed easily Halitosis Fever, malaise Lymphadenopathy What am I? What are risk factors?
Acute Necrotizing Ulcerative Gingivitis Poor oral hygiene common in young adults under Stress Tobacco, alcohol
65
_____ is the chronic inflammatory disease which includes gingivitis along with loss of connective tissue and bone support for the teeth. _____ and ____ are damaged
Periodontitis alveolar bone and periodontal ligaments
66
______ is a major cause of tooth loss in adults and most common oral disease in adults
periodontitis
67
periodontitis and pregnancy increases your risk of _____. What pt population is at high risk?
preterm birth homeless population is at high risk
68
what is periodontitis caused by?
Bacteria in dental plaque that create an inflammatory response In gingival tissue In soft tissue and bone supporting teeth
69
What are risk factors for periodontitis? What is it MC caused by? What is the management?
Poor oral hygiene Smoking Environmental factors – crowded teeth, mouth breathing Comorbid conditions Low socioeconomic status ***Most common induced by plaque Patient education - good oral hygiene Refer to dentist
70
There is an association between poor oral health and ________
CV disease
71
______ usually occurs on the 2nd or 3rd post-op day. Severe oral pain. What is it caused by?
Dry Socket Post extraction Alveolar Osteitis Displacement of the clot or fibrinolytic dissolution of the clot results in exposure of the alveolar bone and initiates a localized osteomyelitis of the exposed bone
72
What are risk factors for a dry socket? What is the management?
Smoking Preexisting periodontal disease Traumatic extraction Prior history of alveolar osteitis HRT Refer to dentist!! Dental radiographs to exclude FB Local or topical anesthesia Irrigation of dental socket, suction, medicated packing Penicillin VK or clindamycin
73

HEENT (12 decks)

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