Oral cavity & Pharynx

Question 1

precancerous oral lesion that appears as white patches/plaques/non-removable

Answer 1

Leukoplakia

Question 2

leukoplakia steps in formation

Answer 2

hyperplasia–>dysplasia–>carcinoma in situ–>invasive malignant tumor

Question 3

other conditions not associated w/malignancy associated w/ leukoplakia

Answer 3

hyperkeratosis from chronic irritation

eg, dentures, tobacco, etc.

Question 4

Tx of Precancerous lesions

Answer 4

should be surgically removed ;

cryotherapy & laser ablation have been used

Question 5

Most common oral cancer

Answer 5

Squamous Cell Carcinoma

Question 6

oral pigmented lesions

Answer 6

Melanoma

Question 7

fluid-filled cavities w/mucous glands lining epithelium after mild oral trauma on the lower lip

Answer 7

Mucoceles

Question 8

two forms of lichen planus

Answer 8

Reticular

Erosive

Question 9

white lacy striations (wickham’s striae) or papules on buccal mucosa (no pain)

Answer 9

Reticular :ichen PLanus

Question 10

Zones of tender erythema & painful ulcers surrounded by white, radiating striae

Answer 10

Erosive Lichen PLanus

Question 11

Tx of Asymptomatic Lichen Planus

Answer 11

regular follow-up

Question 12

Tx of Symptomatic Lichen Planus

Answer 12

manage pain & discomfort

topical + systemic corticosteroids, cyclosporines, retinoids

Question 13

erythema of oral cavity w/creamy-white, curd-like patches. Fluctuating mouth / throat discomfort

Answer 13

Oral Candidiasis

Question 14

Tx of Thrush on infants

Answer 14

cleans everything nipples, pacifiers

Nystatin suspension x 2wks until 2-3 days after resolution

refractory gentian violet or oral fluconazole

Question 15

Tx of mild thrush in older children

Answer 15

<50% mucosal involvement:
Topical nystatin QID or
Clotrimazole lozenges 10mg 5-6 x a day

Question 16

Tx of Severe Thrush in older children

Answer 16

> /= 50% oral mucosal &/or deep erosive / refractory

Fluconazole 6mg/kg po on 1st day, 3mg/kg x 7-14 days

Question 17

Tx of Thrush in Adults

Answer 17

fluconazole 100mg PO x 7 day
Ketoconazole 200-400mg PO 7-14 days
Nystatin mouth ring 5mg swish before swallow

HIV+ Tx’d for longer

Question 18

prodromal pain, burning, &/or tingling x 24 hrs, clusters of small vesicles on vermilion border which rupture/ulcerate/& crust in 24-48 hrs

Answer 18

Herpetic Gingivostomatitis

HSV-1

Question 19

Diagnosis of Herpetic Gingivostomatitis

Answer 19

multinucleated giant cells on Tzanck smear

Question 20

Tx of Herpetic Gingivostomatitis

Answer 20

Acyclovir200-800mg PO 5 x day for 7-10 days

Valacyclovit 1000mg PO BID 7-10 days

Question 21

Tx of Herpetic Gingivostomatitis only effective if initiated w/in

Answer 21

24-48 hrs of prodromal Sx’s

Question 22

Criteria suggesting Group A Streptococcus (GAS) “Strep Throat”

Answer 22

Fever (>100.4)
Anterior cervical LAD
No Cough
Tonsillar Exudate

Question 23

Most common cause of pharyngitis

Answer 23

Viral agent

Question 24

Cough, rhinorrhea &/or lack of exudate

Answer 24

Viral pharyngitis

Question 25

Marked cervical LAD, palatal petechiae & SHAGGY white-purple tonsilar exudate

Answer 25

Mononucleosis

Question 26

Pharyngitis, malaise & low grade fever - GRAY tonsillar PSEUDOMEMBRANE

Answer 26

Diptheria

Question 27

Tx of GAS strep throat

Answer 27

Pen VK DOC ADULTS- 500mg PO BID x 10days Children- PVK 250mg PO BID/TID x 10 days

Question 28

Sx of peritonsillar cellulitis & Abscess

Answer 28

Sever sore throat, odynophagia Trismus, medial deviation of soft palate/pertosillar fold ABnormal voice muffled

Question 29

Dx of peritonsillar cellulitis & Abscess

Answer 29

US or CT | needle aspiration in pus present

Question 30

Tx of peritonsillar cellulitis no evidence of airway compromise/septicemia/severe trismus

Answer 30

ENT Consult | Empiric IV ABX to cover GABHS, S. aureus, & respiratory anaerobes

Question 31

Tx of peritonsillar Abscess no airways Sx's does have fever, trimus, voice change, peritonsillar swelling, uvular deviation

Answer 31

Needle aspiration + admission w/o imaging x 24 hrs of hydration, ABX & analgesia Tonsillectomy or I&D reserved for those that dont respond to Tx

Question 32

affects parotid/submandibular gland/duct with dehydration/chronic illness w/ ductal obstruction mucous plugs-salivary stasis & 2ndary infection S. aureus MC

Answer 32

Sialadenitis

Question 33

Sx of Sialadenitis

Answer 33

gland swelling pain/swelling w/meals tenderness/erythema of duct opening exudate messaged from duct

Question 34

Tx of Mild Sialadenitis

Answer 34

increase salivary flow hydration, warm compress, message gland Sialagogues (lemon drops)

Question 35

Tx of less severe Sialadenitis

Answer 35

PO ABX to cover S. aureus

Question 36

Tx of severe Sialadenitis

Answer 36

IV ABX (Nafcillin 1gm IV q 4-6 hrs)followed by PO x 10days if no airway compromise

Question 37

Sialadenitis not responding to Tx

Answer 37

concern for suppurative Sialadenitis severe life-threatening get US or CT require I&D

Question 38

Tx of Parotitis

Answer 38

Immediate referral required Hydration & IV ABX Nafcillin & metronidazole or clinda Vanc for immunocompromised often dont respon need I&D to resolve