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CSI > sore throat > Flashcards

sore throat Flashcards

1
Q

most common signs of GABHS

A 
fever
anterior cervical (posterior is viral)
lymphadenopathy
lack of cough (don't rely on)
exudates (+ erythema)
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2
Q

causes of bac. pharyngitis

A 
1. GABHS
Strep pneumonia
H. flu
Bordetella Pertussis
Neisseria Gonorrhea
(viral is more common than bac)
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3
Q

leukoplakia

A

white lesions
DO NOT scratch off
defined border

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4
Q

erythroplakia

A

enlarging area of leukoplakia

-submucosal depth

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5
Q

other oral lesions

A

SqCC
irregular base/border, change in color
can be tender

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6
Q

oral candidiasis

A

painful, creamy-white patches, CAN be rubbed off, will bleed

more diffuse

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7
Q

ulcerative lesions: aphthous ulcer

A

assoc. w/ HHV 6

painful, round, small ulcerations

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8
Q

EBV

A 
hepatosplenomegaly
marked lymphadenopathy
purplish exudates
lymphocytosis
want to rule out GABHS
tx: erythromycin (risk of confection) steroids
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9
Q

(uncomp viral infection): mono tx

A

observation w. limited physical activity

do not give antiviral

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10
Q

Ludwig angina

A

cellulitis of sublingual and submaxillary spaces
-seems like epiglottitis but not
diff to swallow

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11
Q

deep neck abcesses w/

A

marked pain and swelling

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12
Q

tx GABHS

A

IM PCN (1x dose)

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13
Q

sore throat red flags

A
  • can’t handle secretions

- “hot potato” voice

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14
Q

trismus

A

cannot open mouth all the way

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15
Q

unilateral deviation of uvula, spitting into cup

A

peritonsilar abcess

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16
Q

stomatitis

A

inflammation of mouth, lesion

diff. eating/drinking/swallowing
etiology: infections, vit. def, chemo
danger: dehydration
tx: supportive, lidocaine/mylanta- “magic” mouthwash

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17
Q

thrush

A

candida spp., oral mucosa inf. white, cheesy coating, able to scrape off! -dx
risks: infants, abx tx, steroids, leukopenia, DM, immuncomps (HIV) diaper rash, endocarditis in IVDA (all ICs)

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18
Q

thrush tx

A

clotrimazole, nystatin (topical azoles)
systemic and esophageal: fluconazole, caspofungin, amphotericin
be aware of esophagitis! : HIV pt

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19
Q

thrush: you see this on KOH prep

A

yeast + pseudohyphae and budding yeast

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20
Q

see thrush (besides mouth)

A

under breasts of obese females

keep dry + anti fungal powder +/- oral anti fungals

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21
Q

HSV

A

prec. 24-48 hrs by fever, ha, malaise
swollen/eryth. lesions–>vsicular–>rupture–>ulcerated lesions
painful! (vs. syphilis, not painful)

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22
Q

HSV tx

A

antivirals dec. duration/sev/recurrence
acyclovir, famciclovir, valacyclovir (guanosine analog): inhib. viral DNA polymerase by chain termination (don’t get rid of virus)

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23
Q

acyclovir converted to

A

antiviral-monophosphate via viral thymidine kinase

  • ->antiviral triphosphate (host cell kinases)
  • ->inactivates DNA polymerases (prev. viral DNA syn.)
  • resistance occurs w/ mutated thymadine kinase
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24
Q

HSV autoinoculation

A

herpetic keratitis: leading cause of blindness in industrial world

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25
Q

HSV dx

A

Wright or giemsa stain (tzanck prep), intranuclear inclusions and multinuc. giant cells

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26
Q

HSV 1

A

mostly oral, gingivostomatitis, herpes, labialis-lip (some genital)
-assoc. ww/ facial nerve palsy (LMN lesion)
viral encephalitis affecting temp. lobe and keratoconjunctivitis
transmitted: resp. sec., saliva

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27
Q

HSV 2

A

typ. genital (some oral)
genitals, neonatal, transmitted:
sexual contact and perinatal

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28
Q

sore throat dx red flags

A

stridor (harsh vibratory noise w/ breathing)
trismus
unable to handle sec
palpable mass
*normal looking throat? (cannot see abcess in retropharyngeal area (abscess), epiglottitis (epiglottitis), something further down–>can be v. severe)
voice change
sx>7 days (abcess or such)

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29
Q

streptococcal pharyngitis

A

GABHS? “rapid strep” (many false negs–>do culture (25% turn pos) or full Cx (anything))
fever, exudates, no cough, tender cervical LN (strep not viral)
-rheumatic fever if untx

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30
Q

streptococcal pharyngitis tx

A

PCN

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31
Q

streptococcal pharyngitis often presents w/

A 
abdominal pain
(also assoc. Scarlet fever)
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32
Q

This detects recent S. pyogenes infection

A

ASO titer

33
Q

strep presentation

A

exudates on tonsils

34
Q

Mono

A

everyone can get
EBV (CMV w/ neg monospot)
fever, hepatosplenomegaly, pharyngitis, lymphadenopathy (post. cerv)*
risk of traumatic rupture of spleen (no sports)

35
Q

Mono tx

A

amoxicillin–>WILL GET A RASH (basically dx)

36
Q

mono dx

A

atypical lymphocytes on blood smear, not inf. B cells but reactive CTLs
dx: *heterophile Abs–> + monospot test

37
Q

mono transmitted

A

resp. sec., saliva (kissing disease: teens, young adults)

38
Q

mono infects

A

B cells via CD 21

39
Q

unimmunized children: pharyngitis w/ gray* oropharyngeal exudated (pseudomembranes* may obstruct airway), sore throat

A

Corynebacterium diptheriae

40
Q

epiglotitis

A

stridor (scarier*) (upper airway: throat vs wheeze: lower airway), normal throat, fever, trismus, diff. handling sec, toxic, cherry red epiglottis, swollen (also CO poisoning-mucosal surfaces), dysphagia
-mouth open, sitting, leaning forward

41
Q

thumbprint sign

A

epiglottitis, lateral soft tissue XRneck,

also: CT, indirect laryngoscopy (tough to do, easily inflammed)

42
Q

number one concern in epiglottitis

A

protect airway (intubate, ENT, GENSX, or anesthesia present (in case need cric, trach)

43
Q

epiglottitis tx

A

abx (br. spec)

dec. inflammation w/ steroids (decadron)

44
Q

epiglottis organism

A

H. influenzae (Hib)

vaccine for this (now seeing more in adults, vaccine wears off)

45
Q

peritonsillar abcess

A

fever, sore throat, trismus, diff. hand sec, diff speaking

  • unilat swelling of peritonsillar area
  • deviation of uvula AWAY from affected side**
46
Q

peritonsillar abcess tx

A

I&D (numb then drain w/ 18G needle, dangerous b/c arterial plexus behind!!–>will bleed), abx
no need to pack, just gauze
complication is nonsig. bleeding

47
Q

Ludwig’s angina

A

cellulitis or phlegm on floor of mouth (floor will be resistant to pressure) infection of sub (mand/mental/lingual) spaces
-typ. recent dental work or untreated tooth inf.
tongue pushed upward to roof of mouth
firm induration of neck and submand. space
can get cellulitis on abcess

48
Q

this is vital in Ludwig’s angina

A

airway protection!
absolute disaster
(anesthesia will go in nasally)

49
Q

tx of Ludwig’s angina

A

abx, surgery (multiple incisions in abcess w/ drains)

50
Q

angular cheilitis

A 
AKA angular stomatitis
cracking and fissures (inflamm. lesions) at mouth corners, smtms bleeds
sometimes B/L 
painful to open mouth
crusts, shallow ulcer
(often mistaken for Herpes!)
51
Q

if you drain an abcess properly, you don’t need

A

abx!

  • drain early
  • needs abx if surrounding cellulitis
52
Q

angular cheilitis(stomatitis) tx

A

antifungal (OTC miconazole) or topical abx

53
Q

angular cheilitis etiology

A

candida* (most common), bacterial, vit. def (B12, iron, zinc)
-manifestations of anorex/bulimia
cold weather (“chapped lips”)
accutane

54
Q

torus palatinus

A

hard lump protruding on hard palate, midline*
covered w. normal mucous mem
*Females >30
most common bony maxillofacial exostosis
Middle eastern more predisposed
*must R/O cancer!
tx: surgery/excision if needed (dentures, etc)

55
Q

strawberry tongue dx

A

-scarlet fever
ALSO DO NOT MISS
-Kawasaki dis (fever>5 days, desqu. of hands/feet, injection)
-TSS

56
Q

scarlet fever

A
  • sandpaper red rash, fever, streph throat
  • school kids, late fall/early spring
  • desquamation of hands and feet
57
Q

Scarlet fever sandpaper rash cause

A

pyrogenic A-C and erythrogenic exotoxins produ. by GAS

chest and back

58
Q

Scarlet fever Pastia’s lines

A

bright red color in creases of axilla and groin

59
Q

Forchheimer spots

A

small petechiae on soft palate

indicative of Rubella, measles, scarlet fever* (others are vaccinated)

60
Q

black hairy tongue

A

elongation and hypertrophy of filiform papillae and desquamation of papillae on dorsal tongue (as long as 12mm normal 1mm)

typ. asymptomatic
- higher in incarcerated, etOH/drug addicted pop
- males, inc. age

61
Q

black hairy tongue risk factors

A

smokers, poor oral hygiene, use oxidizing mouth wash, candida albicans, certain meds (broad spec abx)
debris between papillae–>halitosis
foods, tobacco, tea, coffee

62
Q

geographic tongue (benign migratory glossitis)

A

inflammatory, large well-delineated, shiny, smooth erythematous spots surrounded by white halo, typ. on ant 2/3s of dorsal tongue
histopathologic–>psoriasis (or sympt of Reiter’s syndrome)
-more females
waxes and wanes, days–>yrs
no symps ex burning w. spicy foods
if sympt. tx w/ topical steroids, zinc

63
Q

gingivitis vs periodontitis

A

gingivitis is rev, periodontitis is not, causes tooth loss

both by bac in dental plaque

64
Q

gingivitis

A

reversible, inflammation of gums
ANUG: (acute necrot. ulcerative ging) Vincent’s disease, (“trench mouth”)
a-hemolytic strep, anaerobic fusiform bac, nontreponemal? oral spirochetes

65
Q

periodontitis

A

chrn. inflamm disease
Gingivitis + loss of bone support for teeth
-damages alveolar bone and periodontal pigs–>tooth loss
-link w/ CAD, CVA, inc. in pre term births

66
Q

gingivitis/periodontitis tx

A

oral abx if ANUG

otherwise NSAIDS, avoid risk factors, good oral hygiene

67
Q

apthous ulcer

A

canker sore
minor vs major (1-3 cm) vs herpetiform (>3mm)
*DO NOT miss oral cancer

68
Q

DDX of apthous ulcer

A

herpes, candidiasis, oral Ca, erythema multiforme, erosive lichen planus, contact dermatitis, Bechet’s syndrome, HFM dis (babies, don’t give anything, Coxsackie)

69
Q

apthous ulcer tx

A

supportive
corticosteroids
(will go away, follow pt)

70
Q

leukoplakia

A

white plaque/patch, cannot be characterized clinically or path. as any other disease, CANNOT scratch off, gets worse
pre-cancer, unknown cause, smokers, chronic, non-painful, etOH
red or white*
needs to be biopsied to rule out cancer!!

71
Q

oral cancer

A

-9th most common
SCC
risks: low intake fruits/veggies, tobacco (chew), etOH (75%), lichen planus, HPV
-inc. age, AA males
-lesions are unique and can be anywhere in mouth, need to biopsy

72
Q

early childhood caries (ECC)

A
  • most common childhood disease (25% 2-5, 42% 2-15)
  • hispanic, AA, low soc-economic status
  • prevalence now slight increase (not sure why)
73
Q

ECC organisms

A

Strep mutans* and Strep sobrinus–>acid producing
-fermentable carbs (sucrose, glucose)
more plaque=more orgs.
communicable!: caregivers, siblings to infant, toddler

74
Q

ECC risks

A

freq. consumption of liquids
sippy cup use w/ sugary drinks, sleeping w/ bottle
nursing ad lib
caregiver w/ caries
consump. of sticky foods
drinking nonfluor. comm. water or bottle water
low SES
taking meds that have sugar or cause dryness
poor oral hygiene

75
Q

ECC, look for

A

white lesions

–>can develop into abcess–>facial swelling

76
Q

oncogenic microbe assoc. w/ nasopharyngeal carcinoma

A

EBV

77
Q

normal flora of dental plaque

A

S. Mutans

78
Q

gingivitis/periodontitis risk factors

A

poor oral hygiene, smoking, env. factors (crowded teeth, mouth breathing), weakened IS (HIV, steroids, DM), low income

79
Q

apthous ulcer risk factors

A 
certain foods (milk sensitivity), medications (NSAIDs), vitamin deficiencies (zinc, iron, B12, folate), environmental factors (trauma, stress), viruses (HSV, HIV), and systemic diseases (Celiac and Bechets)
Can be seen in Crohn dz and ulcerative colitis

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