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FNP2- test 1 > Oropharyngeal Problems > Flashcards

Oropharyngeal Problems Flashcards

1
Q

Infection of the oropharynx and tonsils

A

Strep Pharyngitis

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2
Q

sore throat, painful swallowing, fever (greater than 101.3), chills, HA, n/v, abd pain.

A

Bacterial (Strep) Pharyngitis

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3
Q

sudden onset sore throat, fever, malaise, COUGH, RHINORRHEA, HA, myalgia, fatigue.

A

Viral Pharyngitis

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4
Q

(late winter/early spring) marked erythema of throat and tonsils
Patchy, discrete, white or yellowish exudate
Pharyngeal petechiae
Tender anterior cervical adenopathy
Pressure on tonsils produce purulent drainage
Edematous uvula
NO nasal sx
Might see “strawberry tongue”

A

Bacterial Pharyngitis

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5
Q

Strep Pharyngitis

Diagnostics

A

•Rapid antigen detection test (RADT)
•“Send off” throat culture
•Centor criteria
- tonsillar exudate, tender or swollen anterior cervical lymph nodes, Fever, absence of cough

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6
Q

Centor criteria

A

tonsillar exudate, tender or swollen anterior cervical lymph nodes, Fever, absence of cough

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7
Q

Strep Pharyngitis
Treatment:
1st line Antibiotic …

If allergic to PCN?

A

Bacterial: PCN or amoxicillin if GAS. If non-GAS symptomatic tx.
If PCN allergy: cephalexin

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8
Q

Strep Pharyngitis

Education

A
  • After 24 hours on antibiotic and afebrile, not considered contagious anymore and can return to work/school
  • Buy a new toothbrush
  • Clean orthodontic appliances (retainers)
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9
Q

what makes up early childhood caries?

A

Flora, the teeth, substrate (substance that bacteria eats to grow and multiply)

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10
Q

• Infected conjunctiva, watery discharge
(not purulent)
• Inflamed nasal turbinates with boggy
mucosa
• Pharynx may or may not be injected, can have a cobblestone appearance
• Generally no lymphadenopathy; lungs clear

A

allergies/PND

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11
Q

Patient presentation
• Complaints of irritated throat
• Hoarseness
• Clearing throat frequently
• Burning sensation in throat (also may feel in stomach or esophagus “heartburn”)
• Dry cough
• Worse after eating, especially a large meal, or lying down

A

GERD

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12
Q 
Patient presentation 
• Complaints of long lasting sore throat
• Difficulty swallowing; “lump” in the throat
• Earaches
• Hoarseness
• Lymphadenopathy
• Possibly painless lump on side of throat
• Ulcerations/sores that do not heal
A

oral cancers

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13
Q

common causes of oral cancers

A

Squamous cell and HPV16

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14
Q

Physical examination for oral cancers

A

• Depends upon the type of cancer and the progression; early oral cancer can be
asymptomatic and difficult to notice
• Look for ulcerated lesions that do not heal
• Can be indurated as well
• Discoloration of the oral mucosa
• Leukoplakia

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15
Q

Inflammation of the vocal cords, can be acute or chronic

Causes
•Viral infection, GERD, vocal cord trauma, malignancy, bacterial infections (syphilis, tuberculosis)

A

Laryngitis

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16
Q

Patient presentation
•Complaints of hoarseness
•Possible cough
•Possible sore throat

Physical exam
•Noticeable loss of voice/hoarseness
•Erythematous post pharynx usually
•Overall, the physical exam depends upon the cause

A

Laryngitis

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17
Q

how to dx Laryngitis

A
  • Mostly diagnosed by symptoms and presentation
  • Can perform throat culture if bacterial infection is suspected or to rule out bacterial causes
  • Can view vocal cords with laryngoscopy (usually performed by ENT)
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18
Q

Inflammation of one or both of the parotid glands

What causes it?
•Viral infections (usually paramyxovirus/mumps, can be HIV)
•Bacterial infections (staph, tuberculosis)
•Salivary stones (sialoliths)
•Dry mouth/possible side effect of medication
•Fungal infections
•Malignancies

A

Parotitis

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19
Q 
Patient presentation
•Pain and swelling on affected side (or bilaterally if both sides affected: mumps is usually bilateral)
•Difficulty/painful chewing
•May complain of fever
•May complain of pain into the ear
A

Parotitis

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20
Q

How to dx parotitis

A
  • Can do CBC, titers to determine cause
  • Culture any pus noted
  • May use ultrasound to identify salivary stones or inflammation
  • CT for suspected malignancy Treatment (dependent upon cause)
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21
Q

how to tx parotitis if bacterial infection

A

If bacterial infection, treat appropriately (may need hospitalization/IV antibiotics and fluids); outpatient can use amox/clav, dicloxacillin, clindamycin, and metronidazole

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22
Q

how to tx parotitis if viral infection

A

If virus (most likely mumps) suspected, treat symptomatically and monitor

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23
Q

Inflammation of the epiglottis; can spread to nearby structures called “supraglottitis”
•Can cause laryngospasms and death

A

Epiglottitis

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24
Q

Primary cause of epiglottitis in kids?

A

Haemophilus influenzae

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25
Q

Primary causes of epiglottitis in adults?

A

Streptococcus pneumoniae and Streptococcus pyogenes

Can also be caused by traumatic injury or herpes virus

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26
Q

Patient presentation
•Presentation can differ in adults and children
•Children may present with difficulty breathing, stridor, drooling, look like they are in distress
•Adults may complain of a progressive, severe sore throat, dysphagia, and vocal changes
•Many adults do not have stridor but might complain of difficulty breathing; however, not common like in children

A

Epiglottitis

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27
Q

physical exam if epiglottitis suspected?

A

do not examine the patient’s throat with a tongue depressor!

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28
Q

What to do with epiglottitis?

A

Refer all cases of suspected epiglottitis to the ER for immediate treatment

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29
Q

inflammation and pain anywhere within the
oral cavity

Causes
• Medications
• Infectious process
• Immunosuppression
• Side effect of head and neck radiation
• Trauma
• Tobacco exposure
• Dehydration
• Alcohol abuse
• Poor dentition and hygiene
• Dental prosthetics
• Neoplasms and hematologic cancers
• Allergic reactions
A

Stomatitis

30
Q

Stomatitis Treatment

A
  • Frequent assessment
  • Mouth hygiene and routine dental visits
  • Remove causative agent if possible
  • Antibiotics, antifungals, antivirals
31
Q

Symptom relief for Stomatitis

A

• Coating agents such as bismuth salicylate, sucralfate, or other
antacids
• Water-soluble lubricants for mouth and lips
• Topical analgesics, such as benzydamine
• Topical anesthetics
• Oral or parenteral analgesics
• “Magic mouthwash” consists of various combinations of
diphenhydramine, magnesia-alumina, Kaolin pectin, and/or viscous
lidocaine

32
Q

inflammation of the tongue

- causes : systemic, local, tongue

A

Glossitis

33
Q
  • Difficulty with mastication
  • Dysphasia
  • Dysphagia
  • Smooth tongue surface
  • Painful tongue
  • Tongue color changes
  • Tongue swelling
  • Missing papillae
A

Glossitis

34
Q

Glossitis tx

A
  • Reduce inflammation
  • Oral hygiene
  • Antibiotics, antifungal, and antiviral if appropriate
  • Treat and remove underlined cause
  • Encourage proper diet
  • Avoid irritants
35
Q

Appears on the sides of the mouth “angular”- inflammation of one or both corners of the mouth (unilateral or bilateral)

Painful
Itchy
Red- can be confused with impetigo

A

Angular cheilitis

36
Q

Risk factors and management of Angular cheilitis

A

Risk Factors:
Allergies- tooth paste, makeup, food, Infection, Fungus/ S.Aureus and it gets inside cracks

Treat the underlying cause
Barrier cream- vaseline for protective barrier
Vitamin deficiencies - check their diet, vegans at high risk

37
Q

“tongue tie” caused by a short lingual frenulum- hinders tongue movement

Difficulty breastfeeding/latching (clicking sound), can affect speech later in life

A

Ankyloglossia

38
Q

painful, shallow ulcers of oral mucosa

Risk Factors: UC, Crohn’s, gluten sensitivity, vitamin deficiencies (B, iron, zinc), trauma, hormones

A

Aphthous ulcers- Kanker sore

39
Q

Differentials and Mgmt of Aphthous ulcers- Kanker sore

A

Differentials: oral CA, HSV, autoimmune disorder (DM, Crohn’s, UC)

Management: self-limited (7-14 days)

40
Q

From mouth washes after getting wisdom teeth out; build up of dead skin cells where taste buds are
- black, hairy
Resolves after 1-2 weeks on its own

A

Black hairy tongue (mild/ temporary)

41
Q

Risk Factors:
Trauma in children

Clinical Manifestations:
Bleeding in nose/ears, dizzy, h/a-ER

A

Broken tooth/teeth

42
Q

grinding the teeth or clench teeth

A

Bruxism

43
Q

Risk Factors: Smoking
Clinical Manifestations:
Hyperpigmentation: red and white dental lesions

A

Common oral lesions

- Melanoma (oral CA) usually squamous cell carcinoma

44
Q

A localized collection of pus surrounding the tooth. Strep. Anginosus

A

Dental Abscess

45
Q

difficulty moving jaw

A

Trismus

46
Q

how to manage and tx dental abscess?

A

Management:
PCN, allergies-erythromycin
Root canal
I & D

Treatment
Abx: PCN or Clindamycin- 1st line, macrolides
Resistance- Augmentin

47
Q

Dental Caries risk factors for adults and kids?

A

Adults: smokers, diabetes, cancer,
Children/ adults: developmental delay, hypertension, autoimmune, HIV, sinus infection, HPV, frequent snacking,
Children: juice at bedtime, sleeping w bottle

48
Q

A chemical process that leads to irreversible acid demineralization of tooth structure
Can be intrinsic: from stomach acid/ vomiting GERD
Can be extrinsic: acidic drinks, meth, citrus foods, medications

A

Dental Erosion

49
Q

Risk Factors: dry mouth, bulimia, GERD, asthma, medications
Clinical Manifestations: complaints of hypersensitivity
PE: smooth cupped out teeth on chewing surfaces

A

Dental Erosion

50
Q

space between two neighboring teeth

A

Diastema

51
Q

EMERGENCY= Inflammation of the epiglottis; can spread to nearby structures- supraglottis
Can cause laryngospasms and death
Pathogen: H. Influ b (Hib vaccination)
Adults: Strep P. and strep pyogenes

A

Epiglottitis (cover trachea when we swallow)

52
Q

fibrous enlargement of gingival tissue - ulcerations

Risk Factors: phenytoin, cyclosporine, nifedipine, hormones, inflammation, leukemia, idiopathic

tx with Oral hygiene, chlorhexidine

A

Gingival hyperplasia

53
Q 
Clinical Manifestations:
Swelling
Inflamed lymph nodes 
Not bilateral
Pain, erythema 
Tooth partially out of socket 
Usually radiates on nerve upward or downward
A

dental abscess

54
Q

Trismus

A

difficulty moving jaw

55
Q

discomfort especially when eating hot/ spicy food
PE: benign asymptomatic yellowish-white circular lesion with atrophic red centers appearing on anterior two thirds of the dorsum of the tongue

A

migrating glossitis

56
Q

viral HSV 1 in children 6 mo - 5 yo
tingling, pain, and burning
PE:vesicles with erythematous base

A

Herpes stomatitis

57
Q

how to manage / tx Herpes stomatitis?

A

heals in 7-14 days, remove from daycare during drooling, clean teeth with soft toothbrush, oral acyclovir can reduce symptoms if initiate within 3 days, topical antivirals ARE NOT effective

58
Q

salivary gland lesion caused by a blockage of a salivary gland duct; usually caused by trauma or lip-biting
fluid filled vesicle most often on the lower lip
refer to oral sx for excision

A

Mucocele

59
Q

partially erupted lower wisdom tooth with a tissue flap covering the crown→ food or foreign body gets under flap, causing an infection

A

Pericoronitis

60
Q

cyst filled with mucin from a ruptured salivary gland. CM large, soft, mucous-containing cyst on floor of mouth. Refer to oral surgeon for excision.

A

Ranula

61
Q

white verrucous (warty) lesions (individual or clusters) onlips, hard palate, or gingiva. Painless
PE: pain, tingling, burning, with erythema
spread through oral secretions

A

HPV oral infection

62
Q

overgrowth of yeast Candida albicans- most common fungus in infect oral cavity

Risk Factors:
inhaled corticosteroids- rinse mouth after
Decreased immunity; Crohn’s, Ulcerative Colitis, DM
Long term use of ABX or corticosteroids
Dentures→ Denture stomatitis

A

Candida or thrush (yeast)

63
Q

how to tx Candida or thrush (yeast)

A

Nystatin- 4-5x/day for 5 days

64
Q

inflammation of gingiva, bleeding with eating hard foods and tooth care
minor manipulation of gingiva causes localized bleeding

A

Gingivitis

65
Q

Inflammation of one or both of the parotid glands; viral infection (paramyxovirus/mumps, HIV)

Bacterial: staph, TB
Salivary stones (Sialoliths)
Dry mouth-meds (anticholinergics and antihistamines)
Fungal infections
Malignancies

Risk Factors: older adults, chronic illness, immunocompromised

A

Parotitis (Severe-IV abx)

66
Q 
Rapid onset
Pain and swelling on affected side
Painful chewing
Fever, 
Pain into ear- close to ear
If Both sides.. prob mumps
A

Parotitis

67
Q

mild erythema with little to no exudate. Pharynx appears boggy, swollen, or pale
NO painful/tender lymphadenopathy (unless infectious mononucleosis)

A

Viral Pharyngitis

68
Q

Anterior cervical lymph nodes enlarged…. ____

If posterior cervical enlarged ____

A

anterior = prob group A hemolytic strep

posterior = mumps

69
Q

group A strep; formation of pus in peritonsillar tissue

Risk Factors: recent strep infection, recurrent tonsillitis, smokers, poor oral hygiene

A

Peritonsillar Abscess -> ER

70
Q

Fever, chills, fatigue, malaise, halitosis, dysphagia, severe sore throat, otalgia,
Pain radiating to ear of affected side, Hoarse (“hot potato”) voice, drooling

Trismus (spasms of masticator muscles)
Edema and erythema of peritonsillar tissue & soft palate; covered with exudate→ unilateral
Uvula edematous and displaced to opposite side
Tonsil displaced downward and medially

A

Peritonsillar Abscess -> ER

71
Q

What to do with peritonsillar abscess?

A

MUST REFER IMMEDIATELY for surgical intervention (I&D, needle aspiration, or tonsillectomy)

72
Q

pain (facial, neck, jaw) at least once/week; limited ability to open mouth wide; painful clicking, popping of jaw

A

TMJ

soft diet, muscle relaxation, ice, analgesics and antiinflammatory meds. Bite block (plastic splint)

FNP2- test 1 (7 decks)

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