sore throat Flashcards
most common signs of GABHS
fever anterior cervical (posterior is viral) lymphadenopathy lack of cough (don't rely on) exudates (+ erythema)
causes of bac. pharyngitis
1. GABHS Strep pneumonia H. flu Bordetella Pertussis Neisseria Gonorrhea (viral is more common than bac)
leukoplakia
white lesions
DO NOT scratch off
defined border
erythroplakia
enlarging area of leukoplakia
-submucosal depth
other oral lesions
SqCC
irregular base/border, change in color
can be tender
oral candidiasis
painful, creamy-white patches, CAN be rubbed off, will bleed
more diffuse
ulcerative lesions: aphthous ulcer
assoc. w/ HHV 6
painful, round, small ulcerations
EBV
hepatosplenomegaly marked lymphadenopathy purplish exudates lymphocytosis want to rule out GABHS tx: erythromycin (risk of confection) steroids
(uncomp viral infection): mono tx
observation w. limited physical activity
do not give antiviral
Ludwig angina
cellulitis of sublingual and submaxillary spaces
-seems like epiglottitis but not
diff to swallow
deep neck abcesses w/
marked pain and swelling
tx GABHS
IM PCN (1x dose)
sore throat red flags
- can’t handle secretions
- “hot potato” voice
trismus
cannot open mouth all the way
unilateral deviation of uvula, spitting into cup
peritonsilar abcess
stomatitis
inflammation of mouth, lesion
diff. eating/drinking/swallowing
etiology: infections, vit. def, chemo
danger: dehydration
tx: supportive, lidocaine/mylanta- “magic” mouthwash
thrush
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)
thrush tx
clotrimazole, nystatin (topical azoles)
systemic and esophageal: fluconazole, caspofungin, amphotericin
be aware of esophagitis! : HIV pt
thrush: you see this on KOH prep
yeast + pseudohyphae and budding yeast
see thrush (besides mouth)
under breasts of obese females
keep dry + anti fungal powder +/- oral anti fungals
HSV
prec. 24-48 hrs by fever, ha, malaise
swollen/eryth. lesions–>vsicular–>rupture–>ulcerated lesions
painful! (vs. syphilis, not painful)
HSV tx
antivirals dec. duration/sev/recurrence
acyclovir, famciclovir, valacyclovir (guanosine analog): inhib. viral DNA polymerase by chain termination (don’t get rid of virus)
acyclovir converted to
antiviral-monophosphate via viral thymidine kinase
- ->antiviral triphosphate (host cell kinases)
- ->inactivates DNA polymerases (prev. viral DNA syn.)
- resistance occurs w/ mutated thymadine kinase
HSV autoinoculation
herpetic keratitis: leading cause of blindness in industrial world
HSV dx
Wright or giemsa stain (tzanck prep), intranuclear inclusions and multinuc. giant cells
HSV 1
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
HSV 2
typ. genital (some oral)
genitals, neonatal, transmitted:
sexual contact and perinatal
sore throat dx red flags
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)
streptococcal pharyngitis
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
streptococcal pharyngitis tx
PCN
streptococcal pharyngitis often presents w/
abdominal pain (also assoc. Scarlet fever)
This detects recent S. pyogenes infection
ASO titer
strep presentation
exudates on tonsils
Mono
everyone can get
EBV (CMV w/ neg monospot)
fever, hepatosplenomegaly, pharyngitis, lymphadenopathy (post. cerv)*
risk of traumatic rupture of spleen (no sports)
Mono tx
amoxicillin–>WILL GET A RASH (basically dx)
mono dx
atypical lymphocytes on blood smear, not inf. B cells but reactive CTLs
dx: *heterophile Abs–> + monospot test
mono transmitted
resp. sec., saliva (kissing disease: teens, young adults)
mono infects
B cells via CD 21
unimmunized children: pharyngitis w/ gray* oropharyngeal exudated (pseudomembranes* may obstruct airway), sore throat
Corynebacterium diptheriae
epiglotitis
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
thumbprint sign
epiglottitis, lateral soft tissue XRneck,
also: CT, indirect laryngoscopy (tough to do, easily inflammed)
number one concern in epiglottitis
protect airway (intubate, ENT, GENSX, or anesthesia present (in case need cric, trach)
epiglottitis tx
abx (br. spec)
dec. inflammation w/ steroids (decadron)
epiglottis organism
H. influenzae (Hib)
vaccine for this (now seeing more in adults, vaccine wears off)
peritonsillar abcess
fever, sore throat, trismus, diff. hand sec, diff speaking
- unilat swelling of peritonsillar area
- deviation of uvula AWAY from affected side**
peritonsillar abcess tx
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
Ludwig’s angina
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
this is vital in Ludwig’s angina
airway protection!
absolute disaster
(anesthesia will go in nasally)
tx of Ludwig’s angina
abx, surgery (multiple incisions in abcess w/ drains)
angular cheilitis
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!)
if you drain an abcess properly, you don’t need
abx!
- drain early
- needs abx if surrounding cellulitis
angular cheilitis(stomatitis) tx
antifungal (OTC miconazole) or topical abx
angular cheilitis etiology
candida* (most common), bacterial, vit. def (B12, iron, zinc)
-manifestations of anorex/bulimia
cold weather (“chapped lips”)
accutane
torus palatinus
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)
strawberry tongue dx
-scarlet fever
ALSO DO NOT MISS
-Kawasaki dis (fever>5 days, desqu. of hands/feet, injection)
-TSS
scarlet fever
- sandpaper red rash, fever, streph throat
- school kids, late fall/early spring
- desquamation of hands and feet
Scarlet fever sandpaper rash cause
pyrogenic A-C and erythrogenic exotoxins produ. by GAS
chest and back
Scarlet fever Pastia’s lines
bright red color in creases of axilla and groin
Forchheimer spots
small petechiae on soft palate
indicative of Rubella, measles, scarlet fever* (others are vaccinated)
black hairy tongue
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
black hairy tongue risk factors
smokers, poor oral hygiene, use oxidizing mouth wash, candida albicans, certain meds (broad spec abx)
debris between papillae–>halitosis
foods, tobacco, tea, coffee
geographic tongue (benign migratory glossitis)
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
gingivitis vs periodontitis
gingivitis is rev, periodontitis is not, causes tooth loss
both by bac in dental plaque
gingivitis
reversible, inflammation of gums
ANUG: (acute necrot. ulcerative ging) Vincent’s disease, (“trench mouth”)
a-hemolytic strep, anaerobic fusiform bac, nontreponemal? oral spirochetes
periodontitis
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
gingivitis/periodontitis tx
oral abx if ANUG
otherwise NSAIDS, avoid risk factors, good oral hygiene
apthous ulcer
canker sore
minor vs major (1-3 cm) vs herpetiform (>3mm)
*DO NOT miss oral cancer
DDX of apthous ulcer
herpes, candidiasis, oral Ca, erythema multiforme, erosive lichen planus, contact dermatitis, Bechet’s syndrome, HFM dis (babies, don’t give anything, Coxsackie)
apthous ulcer tx
supportive
corticosteroids
(will go away, follow pt)
leukoplakia
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!!
oral cancer
-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
early childhood caries (ECC)
- most common childhood disease (25% 2-5, 42% 2-15)
- hispanic, AA, low soc-economic status
- prevalence now slight increase (not sure why)
ECC organisms
Strep mutans* and Strep sobrinus–>acid producing
-fermentable carbs (sucrose, glucose)
more plaque=more orgs.
communicable!: caregivers, siblings to infant, toddler
ECC risks
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
ECC, look for
white lesions
–>can develop into abcess–>facial swelling
oncogenic microbe assoc. w/ nasopharyngeal carcinoma
EBV
normal flora of dental plaque
S. Mutans
gingivitis/periodontitis risk factors
poor oral hygiene, smoking, env. factors (crowded teeth, mouth breathing), weakened IS (HIV, steroids, DM), low income
apthous ulcer risk factors
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
