Oral Infections (Khaitan no slides)

Question 1

Patient presents with hoarse throat (pharyngitis), rapid heart rate, trouble breathing?

Answer 1

Lemierre’s Syndrome (EMERGENCY)

1) Cause: Fusobacterium spread into lungs
2) Definition: Septic thrombophlebitis of the Inferior Jugular Vein
3) Treatment: Ceftriaxone and Metronidazole (IV) 10-14 days

Question 2

Toddler, High fever, pain in throat, decreased appetite, with lesions on tongue, throat/palate:

Answer 2

Coxsackie virus “hand foot mouth”

1) Pathogenesis: fecal-oral and respiratory transmission
2) Presentation: ulcers on hard palate/posterior pharynx
3) Treatment: supportive → hydration
Self limiting, resolved in 3-7 days

Question 3

What medication for cocksackie virus?

Answer 3

NONE –> self-limiting, support with hydration. Resolves within 1 week

Question 4

Toddler with vesicular lesions, lymphadenopathy, crusted lesions on the face:

Answer 4

Primary Herpes (can be horrendous) HSV-1

1) Presentation: gingivostomatitis, primary can be severe, most cases are asymptomatic, and can reactivate over time

2) Diagnosis: swab & PCR

3) Treatment: acyclovir/valacyclovir, supportive care - pain management & Hydration

Question 5

3yom, fever, cheek swelling, and redness, large dental caries:

Answer 5

Cellulitis

1) Cheek swelling & large dental caries

2) Diagnostics:
Imaging & Culture (that’s why they ask for drainage)

3) Treatment:
Source control: incision & drainage, esp if >2-3cm

Antibiotics:
Amoxicillin-clavulanate OR Ampicillin-Sulbactam

If Severe: Ceftriaxone &
metronidazole

Question 6

Majority of Oral Flora at certain timepoints of life

Answer 6

Sterile at birth
Hours later → Strep species
Early childhood → G+
Adolescence → gram negatives
Old age → candida

Question 7

School-aged child, Fever, sore throat red tongue, lymphadenopathy, and palatal petechiae, lack of nasal symptoms:

Answer 7

Strep throat (bacterial)

1) Diagnosis:
Culture, PCR, Rapid antigen
2) Treatment:
Penicillin or Azithromycin

Question 8

Strep throat Symptoms:

Answer 8

Acute pharyngitis
Swollen, red tonsils
Lymphadenopathy
*Strawberry tongue *
Fever

Question 9

Mimicker of Group A Strep:

Answer 9

Arcanobacterium haemolyticum

No palatal petechiae or strawberry tongue
Lymphadenopathy, Swollen tonsils
Key: If not getting better with Amox, consider this
Optimal Treatment: Azithromycin

Question 10

What is unique about Group A Strep mimic (aka non resolving strep throat)

Answer 10

No palatal petechiae or strawberry tongue

If Strep Throat is not getting better with Amox, consider Azithromycin

Question 11

11yoF, exudate tonsil, lymphadenopathy:

Answer 11

EBV/mono

Age range: Either <5 or in teens

Diagnosis: EBV panel serology (IgG and IgM)

Treatment: supportive care

Question 12

Typical clinical findings in EBV/Mono

Answer 12

Fever
Sore throat
Abdominal pain

Question 13

Can you treat mono?

Answer 13

NOPE. Supportive care only.

Question 14

10yof, ulcers in mouth, recurrent episodes, painful, but no fever:

Answer 14

Apthous ulcers (non-infective)

Causes: Stress, diet, Rheumatological (Behcet), Inflammatory Disease

Diagnosis:
Clinical diagnosis, exclude infectious causes

Treatment:
Supportive care

Question 15

What causes apthous ulcers?

Answer 15

Non-infective

Causes: Stress, diet, Rheumatological (Behcet), Inflammatory Disease

Question 16

What situations DO NOT require SBE?

Answer 16

Pacemaker

Septal defect closure device after closure

VP Shunt

Question 17

Review PAVE indications for SBE:

Answer 17

Prosthetic Cardiac Valve
A history of infective endocarditis
Valve regurgitation in heart transplant
Endocardial (Congenital)Heart Defect considerations:
- Unrepaired Cyanotic CHD defect
- CHD Repaired with residual shunts or valve regurgitation