Oropharyngeal Disorders

Question 1

Laryngitis

Answer 1

• MC viral s/p URI, usually painless
• bact: M cat, H flu
• acute: PND, hypothyroid, recent intubation, vocal hemorrhage
• chronic: smoking, strain, GERD, CA, vocal nodules, polyps
• tx: rest, fluids, no smoke, do NOT use antihist/steroids, ENT ref if sx > 2 wks (need vocal fold eval b4 steroid tx)
• if bact: erythro, cefuroxime, augmentin

Question 2

Viral pharyngitis

Answer 2

• MC than bacterial
• adenovirus, parainfluenza, coxsackie, rhinovirus, coronavirus
• concurrent rhinorrhea, F, LAD, diffusely pink throat, cough
• tx sx

Question 3

Strep pharyngitis

Answer 3

• GAS
• uncommon in peds < 2-3 y.o.
• odynophagia, bright/beefy red, Centor criteria (tender cervical LAD, F > 100.4, no cough, tonsillar exudate), +/- abd pain/V in peds
• rapid strep (90-99% sens) +/- cx
• pen VK, cephalosporin, eythro (increasing resist tho)
• comps: scarlet F, GN, abscess

Question 4

Acute tonsillitis

Answer 4

• viral: mono, bact: GAS
• swollen w/ plaques
• rapid strep, monospot
• abx (amox, pcn, clarithromycin, clinda)

Question 5

Peritonsillar abscess

Answer 5

• can be s/p tonsillitis
• bulging, asymmetrical soft palate, “hot potato voice”, sev throat pain, dysphagia, trismus, deviated uvula, salivation, F, sev malaise
• urgent ENT ref for I&D

Question 6

Mononucleosis

Answer 6

• EBV, CMV
• fatigue, sore throat w/ tonsillar edema, shaggy white-purple tonsillar exudate, LAD, hepatospleomegaly (many have 2ndary strep tonsillitis)
• monospot (not + early on), CBC (atypical lymphocytes)
• supportive, splenic precautions, tx tonsillitis if present, NO ampicillin bc of rash rxn

Question 7

Fusobacterium pharyngitis

Answer 7

• adolescents, sev pharyngitis, cervical LAD, +/- F, HA, unilateral neck pain/swelling
• very high CRP, inc WBC w/ leukocytosis
• tx to avoid Lemierre’s synd (septic emboli in IJ) w/ PCN + clindamycin

Question 8

Aphthous ulcers (apthous stomatitis, canker sore)

Answer 8

• intermittent, non-contagious ulcers on mucus membranes of otherwise healthy pt
• triggers: nutrition def, trauma/stress, hormones/allergens
• minor if < 10 mm, major if > 10 mm
• herpetiform ulceration (looks like, but is not HSV)
• ddx: HSV, SLE, acute HIV, syphilis, reactive arthritis, IBD, SCC, drug rxn
• tx: topical barriers/analgesics, topical hydrocortisone + abx oint (large may take 20-30 days to heal)
• PO pred taper can help, cimetidine (antacid/hist) for maintenance if recurrent

Question 9

Dental caries

Answer 9

• start as white spot
• AAP recs ref to dentist a 1 y.o., Medicaid at 3 y.o.
• screen for plaque, white spots, cavities w/ 1st tooth
• stop pacifiers at 3, thumb sucking at 6

Question 10

Dental abscess

Answer 10

• in periodontal pocket
• pain, red, fluctuant, swelling, exudate w/ probing
• tx: warm saline rins, PO pcn or erythro for small, I&D for large

Question 11

Acute epiglottitis

Answer 11

• H. flu, S pneumo, S pyogenes, S aureus, trauma, more common in DM and adults (Hib vacc)
• abrupt onset, high F, stridor, tripoding, drooling, trismus
• lateral XR (“thumbprint sign”), laryngoscopy (risky)
• ddx: croup, peritonsillar abscess, FB, diptheria
• tx: stabilize airway, ED for inpt mgmt & IV abx (ceftizoxime, cefuroxime) and IV steroids (dexamethasone)

Question 12

Sialadenitis and Parotitis

Answer 12

• MC affects parotid or submandibular glands
• MC S aureus, can be polymicrobial
• RF: dec salivary flow, dehydration, poor hygiene
• s/s: painful swell/edema of cheek (esp w/ meals)
• cx Stensen’s duct d/c if present
• tx: abx x 10-14 days (IV if sev): clinda + cipro or augmentin, warm compress
• comps: abscess, Ludwig’s angina (submandibular, “bull neck”, cellulitis

Question 13

Oral leukoplakia

Answer 13

• RF: smoking, repeated trauma, EtOH, dentures
• assoc w/ HPV, can be malignant/inflammatory
• painless, cannot be scraped off
• 5% dysplastic/SCC. If erythroplakia w/ it, 90% risk
• area of trauma = less likely bad
• bx

Question 14

Candidiasis

Answer 14

• RF: DM, dentures, immunocomp’d, chemo/rad pts, corticosteroids, broad spec abx use
• can have throat/mouth pain, scrapes off
• dx = clinical, can do wet prep, bx
• tx: antifungal (keto/fluconazole PO, clotrimazole troches (lozenge), nystatin rinse)

Question 15

HSV 1

Answer 15

• oral, usually trans when kid, nonsexual
• acyclovir, valacyclovir, famciclovir PO for tx/ppx
• abreva for tx
• watch for herpetic whitlow (fingers)
• HSV 2 (genital), though 1 & 2 can be fluid

Question 16

Deep neck infections

Answer 16

• CT = img of choice
• MR for soft tissue involvement
• blood cx (then s/s rpt for abx choice)