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Clinical Medicine 1 > Oral/Oropharnyx Diseases > Flashcards

Oral/Oropharnyx Diseases Flashcards

1
Q

This disease presents purulence and pain in a tooth, also commonly referred to as “an abscessed tooth”

A

Acute periapical periodontitis

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2
Q

How would you treat a patient with an acute periapical periodontitis?

A

Abx and referral

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3
Q

What unique physical examination finding might you see on a patient with an acute periapical periodontitis?

A

Fistula

in the gums - these can come and go, and are created by an increase in pressure

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4
Q

You may likely see biphosphonate osteonecrosis in patient who wear what?

A

Dentures

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5
Q

These are white patchy calluses also commonly referred to as Leukoplakia

A

Hyperkeratosis

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6
Q

T/F: Hyperkeratosis (Leukoplakia) can be rubbed or scraped off?

A

False

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7
Q

This disease is more worrisome than typical leukoplakia and is typically caused by chemicals (ie. alcohol, tobacco)

A

Epithelial Dysplasia

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8
Q

_____ _______ is typically caused by irritation from smoking and presents as thick luekoplakia on the surface of the tongue?

A

Hairy Tongue

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9
Q

Another common source of hairy tongue is what virus?

A

EBV

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10
Q

This disease presents as a lacy “rash” on the buccal mucosa, it can become ulcerated.

A

Oral Lichen Planus

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11
Q

Oral Lichen Planus is more present in what age range?

Is it more common in men or women?

A

> 50 y.o.

Women > Men

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12
Q

Why should Oral Luchen Planus be referred to a dental specialist?

A

Because 1% can become Small Cell Carcinoma

Need to r/o cancer

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13
Q

Which are typically more ominous, erythroplakia or leukoplakia?

A

Erythroplakia

90% are dysplasia or carcinoma

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14
Q

Erythroplakia on physical examination of the mouth is typically a sign of what?

A

Small Cell Carcinoma

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15
Q

Why would erythroplakia and an atrophic tongue raise concern for cancer?

A

The tongue being atrophic is a sign of malnourishment, which may indicate the presence of cancer “commandeering” nutrients that would typically go to the tongue.

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16
Q

Other than tobacco/alcohol use, what is the 2nd most common risk factor for oral cancer?

A

HPV (16, 18)

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17
Q

What is the most common oral cancer?

Where is it located?

A

Squamous cell carcinoma

EVERYWHERE

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18
Q

On physical examination, SCCa typically can be what?

A

Erythematous
Ulcerated
Indurated
Shifted Teeth

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19
Q

Why is it important to refer a patient with SCCa to a dentist who has experience dealing with chemotherapy patients?

A

To help manage the severe side effects of chemotherapy

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20
Q

This will often develop after chemotherapy, resulting in a dry mouth, and imminent tooth lose.

A

Xerostomia

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21
Q

This is bone death due to radiation/

A

OsteoRadioNecrosis

(Radiation causes the vessels in the bones to shrink down, cutting off ‘nutrient & healing’ supplies, resulting in bone death)

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22
Q

How is oral pseudomembranous candidiasis clinically diagnosed?

A

Presence of ‘white curds’ on an erythematous base that can be easily rubbed/scraped off

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23
Q

What are three risk factors for oral candidiasis?

A
  1. Immunocomprimised
  2. DM
  3. ABx usage
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24
Q

This form of oral candidiasis does not easily rub off, is associated with smoking, and can commonly appear similar to Hairy Tongue or Oral Lichen Planus?

A

Hyperplastic Candidiasis

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25
Q

This form of candidiasis presents with erythroplakia, stomatitis, and is often associated with a mucosal allergy

A

Erythematous Candidiasis

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26
Q

This disease presents with white plaque on the lips and is typically seen in patients exposed to sunlight (ie. farmers)

A

Angular cheilitis

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27
Q

T/F: Should you use “magic mouthwash” in patients with oral candidiasis?

A

False

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28
Q

T/F: Treatment for oral candidiasis is anti-fungals?

A

True

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29
Q

This disease occurs when there are patches of no papillae growth on the tongue, t often travels around, and is harmless requiring no treatment

A

Geographic tongue

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30
Q

This form of glossitis is typically related to B12, Vit E, or iron deficiencies.

A

Atrophic glossitis

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31
Q

This disease is continuous neuropathic pain without any clinical signs, is typically bilateral, and most common in women >50 y.o.

A

Glossodynia (Burning Mouth Syndrome)

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32
Q

This disease is also referred to as trench mouth and is tpically seen in stressed young adults.

A

Aucte Necrotizing Ulcerative Ginigivitis (ANUG)

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33
Q

What are some common clinical signs of ANUG?

A
  1. BAD Smell
  2. Red, necrotic papillae
  3. erythematous gums, bleed easily
  4. Lymphadenopathy
  5. Fever
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34
Q

Which type of bacteria typically cause ANUG?

A

Spirochetes

Fusiform Bacteria

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35
Q

What is the Tx for ANUG?

A
  1. Rx for Metronidazole
  2. Rx for Pencillin
  3. Referral to DDS for debridement
  4. Improve oral hygiene
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36
Q

How would you distinguish between ANUG and Ginigivitis?

A

You would except a significant papillae lose in a patient with ANUG where as in Ginigivitis the papillae should still be intact with only areas of erythema

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37
Q

These type of ulcers are typically located on unattached tissues, can be singular or multiple, and usually have a RED Halo around them.

A

Aphthous Ulcers

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38
Q

T/F: Are Apthous Ulcers self-limiting?

A

Yes

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39
Q

This oral disease presents as unilateral vesicles on attached tissues and is often referred to as ‘cold sores’.

A

Oral Herpes Simplex

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40
Q

In what type of patient population may herpes simplex not be unilateral?

A

Immunocomprimised

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41
Q

What may children experience with oral HSV if it is their first exposure?

A

Herpangia (Fever, Red Soft Palate)

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42
Q

How should you treat and manage oral HSV?

A
  1. Topical Antivirals

2. Avoiding exposing others

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43
Q

What is the common prodrome to Oral HSV?

A

Tingling

Usually following stress

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44
Q

This disease is a life threatening emergency in which sublingual/submandibular swelling crosses the midline.

A

Ludwig’s Angina

45
Q

Other than submandibular/sublingual swelling, what symptoms might be present in Ludwig’s Angina?

A
  1. Raised Tongue
  2. Fever
  3. Dysphagia
46
Q

When would an I&D likely be indicated in a patient with Ludwig’s Angina?

A

When there is palpable fluctuance

47
Q

How do you treat Ludwig’s Angina

A
  1. Hospitalization for IV ABx
  2. Airway Management
  3. Possible I&D
48
Q

What would be concerning for any infection in the head or neck that is left untreated?

A

Abscesses in the brain

49
Q

What is the most common bacterial etiology of pharyngitis?

What is the most common viral etiology of pharyngitis?

A

Group A beta hemolytic streptococcus

Rhinovirus

50
Q

What are the symptoms of of pharyngitis?

A 
Sore throat
Dysphagia 
Fever
Exudate
Cervial Lymphadenopathy
51
Q

How is pharyngitis primarily diagnosed?

What additional diagnostic measure can be taken?

A

Clinically

Throat Cultrue

52
Q

What is the first line treatment for pharyngitis?

What would be second line if a patient had a penicillin allergy?

A

Penicillin

Erythromycin

53
Q

What is the primary complication of pharyngitis?

A

Scarlet Fever

54
Q

What are unique symptoms of staphylococcal pharyngitis?

A

Mucopurulent discharge in the posterior oropharynx

Edema and pustules

55
Q

This disease is commonly referred to as “whooping cough” and is vaccine preventable.

A

Bordatella Pertussis

56
Q

What are the three stages of pertussis?

A
  1. Catarrhal Stage
  2. Paroxysmal Stage
  3. Convalescent Stage
57
Q

Are Abx indicated to treat pertussis?

A

No, the disease is typically self-limited.

58
Q

This is the most common cause of epiglottitis in children ages 2-5 and is vaccine preventable.

A

Haemophilus Influenzae

59
Q

What Sx are associated with epiglottitis?

A

Sore throat, Fever, Dysphagia

4-10 hours after onset there can be drooling and airway compromise

60
Q

T/F: Epiglottitis is not an airway emergency

A

False, it is an airway emergency

61
Q

How is epiglottitis treated?

A

Airway management

ABx (Ampicillin, amoxicillin)

62
Q

What symptoms are unique to bacterial pharyngitis?

What symptoms are unique to viral pharyngitis?

A

Bacterial…

  1. mucopurulent discharge
  2. high fevers
  3. Longer

Viral……

  1. Myalgias
  2. Fatigue
  3. Negative Cx
63
Q

How is viral pharyngitis treated?

A

Self-limited

64
Q

Oral thrush is typically caused by what?

A

Candida albicans

65
Q

What may cause a proliferation of candida? (TWO)

A
  1. Immunocompromised

2. ABx use

66
Q

What Sx are associated with candida albicans?

A

Sore throat
Dysphagia
White “cheesy” plaque in the oral cavity/pharynx

67
Q

How is oral thrush treated?

A

Topical Nystatin

Sometimes systemic ketoconazole

68
Q

This occurs when there is an infection in the tonsillar fossa (b/w the muscle and the posterior pharynx)

A

Peritonsillar abscess

69
Q

T/F: Peritonsillar abscesses are a life-threatening, ENT emergency

A

True (it can progress to life threatening mass lesions)

70
Q

What would be concerning if a peritonsillar abscess became too large?

A
  1. Airway compromise
  2. Septic shock (abscess can break through the muscle and into the carotid/jugular)
  3. IJV thrombosis
  4. Carotid blowout
71
Q

What are the symptoms associated with a peritonsillar abscess?

A 
Sore throat
Trismus
Dysphagia
Fever
Uvula deviation
Soft palate swelling
Drooling
“Hot Potato” voice
72
Q

How is a peritonsillar abscess treated?

A
  1. Drainage
  2. Fluid replacement
  3. Airway management
  4. Antibiotics (IV Ampicillin)
73
Q

If you had recurrent peritonsillar abscesses (more than 2) what would you recommend?

A

Tonsillectomy

74
Q

This is usually caused by a suppurative lymph node as well as by trauma in children <5 y.o.

A

Retropharyngeal Abscess

75
Q

What is the most concerning complication of a retropharyngeal abscess?

A

Infection spread to the mediastinum (~40%mortality rate)

76
Q

What are the symptoms of a retropharyngeal abscess?

A 
Fever
Neck swelling
Dysphagia
Respiratory distress
Nuchal rigidity
77
Q

What are some of the clinical findings of a retropharnygeal abscess?

A

Cervical lymphadenopathy
Bulging of posterior pharyngeal wall
Tilting of head to unaffected side

78
Q

How is a retropharyngeal abscess diagnosed?

A
  1. Clinically
  2. Lat. XRay soft tissue
  3. CT
79
Q

How is a retropharyngeal treated?

A
  1. Airway management
  2. IV Antibiotics (small abscess)
  3. I&D + ABx (Large Abscess)
80
Q

This is the most common indication for a tonsillectomy

A

Tonsillar hypertropy

81
Q

What are common symptoms/complications of tonsillar hypertrophy?

A
  1. Snoring
  2. Dysphagia
  3. Disturbed sleep patterns
  4. Nocturnal choking/coughing
  5. Failure to thrive
  6. Severe OSA
82
Q

If the symptoms were severe enough, how would you treat tonsillar hypertrophy?

83
Q

Why would asymetrical tonsils be concerning? (When not infectious)

A

It would be concerning for neoplasm which is concerning for cancer

84
Q

With this disease patients complain of “feeling like food is getting stuck” and typically is associated with bad breath and dysphagia.

A

Tonsilloliths

85
Q

How are tonsilloliths treated?

A
  1. Gargles and Rinses
  2. “Water Pik”
  3. Tonsillectomy
86
Q

Are ABX indicated to treat tonsilloliths?

87
Q

This is disease is an acutely inflamed mucosa in the mouth, often referred to as a soreness, and can be caused by dehydration, poor hygiene, and medications.

A

Stomatitis

88
Q

How is stomatitis treated?

A
  1. Stop “drying” medications
  2. Improve oral hygiene
  3. Increase moisture
89
Q

What type of ulcer is commonly seen with stomatitis?

A

Aphthous Ulcers

90
Q

This occurs when the corners of the mouth appear chapped.

A

Angular Cheilitis

91
Q

Is angular cheilitis usually fungal, viral, or bacterial?

92
Q

How is angular cheilitis treated?

A

Antifungals

93
Q

This is severe disorder presents with tongue and lip swelling often leading to airway obstruction

A

Oral angioedema

94
Q

How would an airway obstruction be handled in a patient with oral angioedema that could not be intubated?

A

Tracheostomy

95
Q

What medication is angioedema a side effect of?

What else can it occur from?

A

ACE Inhibitors for HTN

Allergies

96
Q

What are three types of Sialadenitis?

A

Parotid
Submandibular
Minor

97
Q

What is Sialadenitis?

A

Diffuse painful swelling of the salivary glands typically exacerbated with eating

98
Q

What typically causes sialadenitis?

A
  1. Dehydration from illness or medications

2. Trauma to the duct

99
Q

How is sialandenitis treated?

A
  1. Augmentin
  2. Steroid dose
  3. Sialagogues
100
Q

This disease is caused by similar organism as tonsillitis/pharyngitis and presents as a hoarseness in the patients voice as well as a cough

A

Laryngitis

101
Q

Is symptoms persist for more than 2-3 weeks what may be warranted?

A

Endoscopy (“take a look down”)

102
Q

What is another common cause of laryngitis other than viral/bacterial?

103
Q

This is typically caused by a dental abscess that spreads to the sublingual and submandibular spaces forcing the tongue backward

A

Ludwig’s Angina

104
Q

Is Ludwig’s Angina an ENT emergency?

What is the most concerning immediate complication?

A

YESSSSSS

Airway obstruction

105
Q

How is Ludwig’s Angina treated?

A
  1. Airway management (Tracheostomy, Intubation)
  2. I&D of dental abscess
  3. Tooth extraction
  4. IV Abx
106
Q

What virus is Hand, Foot, and Mouth disease commonly caused by?

107
Q

Is Hand, Foot, and Mouth disease more common in children or adults?

108
Q

What is a unique physical exam finding of Hand, Foot, and Mouth Disease

A

Characteristic blisters on the hands, feet, and ulcerative lesions in the mouth

(can also have diarrhea)

109
Q

How is Hand, Foot, and Mouth disease treated?

A

Conservative Management

Clinical Medicine 1 (6 decks)

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