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EENT > Throat > Flashcards

Throat Flashcards

1
Q

leukoplakia

A
  • White lesion not removable by rubbing mucosal surface
  • Varying sizes
  • Hyperkeratoses resulting from chronic irritation
  • Dentures, tobacco, ETOH
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2
Q

treatment of leukoplakia

A
  • Discontinue aggravating source
  • Surgical
  • Prevent Cancer - Monitoring
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3
Q

hairy leukoplakia

A

Occurs on lateral border of tongue or inside of cheek
Usually bilateral, Not removable by rubbing mucosa
Develops quickly
Appears as a slightly raised, shaggy area with a corrugated or “hairy” surface

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4
Q

what is hairy leukoplakia caused by?

A

EBV-grayish

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5
Q

is hairy leukoplakia a common finding in HIV?

A

yes

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6
Q

T/F: malignancy potential with hairy leukoplakia

A

false

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7
Q

treatment of hairy leukoplakia

A

Antiviral therapy - Acyclovir, Zidovudine

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8
Q

erythroplakia

A

a red, raised patch, unilateral with a higher likelihood of malignancy

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9
Q

T/F: erythroplakia always requires tissue biopsy and excisional surgery

A

TRUE

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10
Q

oral lichen planus

A

Chronic inflammatory autoimmune condition
Numerous clinical subtypes which leads to difficulty in diagnosis
Most commonly looks like a “lacy” leukoplakia

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11
Q

work up of oral lichen planus

A

Exfoliative cytology
Or incisional/excisional biopsy
Ruling out malignancy

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12
Q

treatment of oral lichen planus

A

Systemic and topical corticosteroids
Cyclosporine and retinoid

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13
Q

6 P’s

A
  1. planar [flat-topped]
  2. Purple
  3. Polygonal
  4. Pruritic
  5. Papules
  6. plaques
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14
Q

what is lichen planus

A

Chronic, Inflammatory, Autoimmune response – unknown cause

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15
Q

what is squamous cell carcinoma

A

90% of all oral cancers

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16
Q

risk factors of squamous cell carcinoma

A

Tobacco
Alcohol
Male gender
Advanced age

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17
Q

signs and symptoms squamous cell carcinoma

A

Non-healing lesions
+/- pain
Weight loss

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18
Q

treatment of squamous cell carcinoma

A
  • Early stage
  • < 2cm in diameter is often 100% curative with local excision
  • < 4mm in depth have low rate of metastasis
  • Late stage
    Combination therapy
  • Resection, head/neck dissection, and radiation
  • Often requires reconstructive surgery
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19
Q

prognosis of squamous cell carcinoma

A

5 year survival

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20
Q

necrotizing ulcerative gingivitis

A

Gingival infection caused by spirochetes and fusiform bacteria of the oral cavity (“Trench Mouth”)

Commonly seen in patients with poor oral hygiene or underlying systemic disorder

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21
Q

signs and symptoms of necrotizing ulcerative gingivitis

A
  • Painful gingival inflammation
  • Halitosis
  • Bleeding
  • Fever
  • +/- cervical lymphadenopathy
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22
Q

treatment of necrotizing ulcerative gingivitis

A

Topical peroxide rinses
Penicillin VK 250mg TID x 10 days
May need surgical debridement

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23
Q

meth mouth

A

drug abuse!

Tooth decay
Gum disease
Meth is acidic
breaks down enamel
Poor hygiene

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24
Q

Recurrent Aphthous Stomatitis

A

also called canker sores

most common cause of mouth ulcers

similar lesions can be associated with chronic diseases

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25
Q

cause of recurrent aphthous stomatitis

A

multifactorial: trauma, foods, genetic, etc

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26
Q

recurrent aphthous stomatitis morphology

A

Discrete, painful, located on non-masticatory mucosal surfaces
Round ulcerations with yellow-gray fibrinoid center on erythematous base
Found on buccal and labial mucosa
Can be single or multiple

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27
Q

how long does recurrent aphthous stomatitis

A

Several episodes per year
Last up to 14 days

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28
Q

treatment recurrent aphthous stomatitis

A
  • Pain relief
  • Oral Hygiene
  • Avoid Exacerbating Factors
  • Topical Corticosteroids

If Associated with Chronic Dz
Refer to ENT for treatment

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29
Q

herpetic stomatitis

A

herpes simplex I infection, can also be II

clinically very similar to canker sores

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30
Q

signs and symptoms herpetic stomatitis

A
  • Burning painful vesicles that rupture and form scabs
  • Found on attached gingiva and mucocutaneous junction of lip, tongue, and soft palate
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31
Q

treatment of herpetic stomatitis

A

Acyclovir 800mg 5x/day
7-14 days
Educate pt – very contagious

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32
Q

causes of oral candidiasis

A
  • Antibiotics
  • Dentures
  • Debilitated
  • Poor oral hygiene
  • Infants (milk)
  • Diabetes Mellitus
  • Anemia
  • Immunosuppression
    HIV / AIDS
    Steroid use
    Cancer pt
    Transplant pt
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33
Q

signs and symptoms of oral candidiasis

A
  • Odynophagia – pain with swallowing
  • Dysgeusia – distortion of taste
  • Thick, white plaque that can be removed to reveal an erythematous base
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34
Q

tests of oral candidiasis

A

Clinical
KOH wet prep (hyphae and spores)

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35
Q

treatment of oral candidiasis

A
  • Fluconazole
  • Topical oral therapy
    Nystatin
    Clotrimazole
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36
Q

ludwig’s angina

A

submandibular space infection

usually otogenic

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37
Q

signs and symptoms of ludwig’s angina

A
  • fever, chills, and malaise
  • mouth pain
  • stiff neck, and drooling
  • dysphagia
  • muffled voice
  • Woody induration
  • Elevated tongue
    ***AIRWAY
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38
Q

epiglottis is also called

A

supraglottitis

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39
Q

associated pathogens with epiglottitis

A

H.influenza, S.pneumonia, S.aureus, MRSA

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40
Q

signs and symptoms of epiglottitis

A
  • Rapidly developing sore throat
  • Odynophagia
  • Fever
  • Dyspnea
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41
Q

physical examination of epiglottitis

A
  • Tripod position – RESPIRATORY DISTRESS
    Upright, hands on knees, leaning forward
  • Drooling
  • APPEARS ILL
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42
Q

imaging of epiglottitis

A

thumb print sign

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43
Q

T/F: you can do a direct laryngoscopy on adults and children

A

FALSE: only adults

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44
Q

treatment of epiglottitis

A

AIRWAY CONTROL
Hospitalization
IV antibiotics
Ceftriaxone
Cefuroxime
IV dexamethasone
+/- intubation
This is an Emergency
Dec. Occurrence w/ Immunization (Hib Vaccine)(type b)

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45
Q

retropharyngeal abscess

A

infectious behind posterior pharyngeal wall

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46
Q

T/F: any URI can cause retropharyngeal abscess

A

TRUE

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47
Q

signs and symptoms of retropharyngeal abscess

A

Stiff neck
Fever
Malaise
Trismus
Dysphagia

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48
Q

population affected retropharyngeal abscess

A

uncommon

seen in young children

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49
Q

exam of retropharyngeal abscess

A

unremarkable

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50
Q

imaging of retropharyngeal abscess

A

Lateral Neck X-ray / CT and ENT Eval
Abx
Abx and Surgery

51
Q

best test for retropharyngeal abscess

A

CT

52
Q

peritonsillar abscess

A

Caused by tonsillar infection penetrating the tonsillar capsule and spreading to the surrounding tissues

53
Q

pathogen of peritonsillar abscess

A

β-hemolytic streptococcus is most common

54
Q

signs and symptoms of peritonsillar abscess

A
  • High fever, medially bulging tonsil, anterior tonsillar pillar
  • Uvular displacement to the unaffected side
  • Drooling, ear pain, dysphagia may be present in severe infection
  • severe unilateral sore throat
  • muffled voice
  • trismus - inability to open jaw
  • odynophagia - painful swallowing
55
Q

physical exam peritonsillar abscess

A

Unilateral palatal swelling
erythema
Deviated uvula

56
Q

imagine of peritonsillar abscess

A

CT neck with contrast

57
Q

treatment of peritonsillar abscess

A
  • medical (amoxicillin, augmentin, clindamycin)
  • surgical (needle vs I&D)
58
Q

complications of diphtheria

A

myocarditis

polyneuritis of palatal and pharyngeal nerves

life threatening due to exotoxin

59
Q

signs and symptoms of diphtheria

A
  • Sore throat, fever, malaise
  • Gray pseudomembrane over tonsils and pharynx
  • Marked Cervical lymphadenopathy
60
Q

diphtheria

A

Acute infection of the upper respiratory tract

61
Q

how does exotoxin impact the body

A

producing gram positive bacteria

Causes epithelial destruction and superficial inflammation

62
Q

diphtheria treatment

A

prevention! TDAP immunization

Antitoxin (Within 48 hours of infection)
Antibiotics (Erythromycin)
Hospitalization

63
Q

pharyngitis

A

viral - most common

bacterial

64
Q

viral pharyngitis

A

Respiratory Viruses
Herpes (HSV)
Infectious Mononucleosis (EBV)

65
Q

bacterial pharyngitis

A
  • Streptococcal Pharyngitis (Group A Strep)
  • N. Gonorrhea
  • Anaerobic (Lemierre’s Synd)
66
Q

infectious mononucleosis (EBV)

A
  • Fever, exudative tonsillitis, gray-white exudate, posterior cervical lymphadenopathy
  • Extreme Fatigue
  • +/- axillary lymphadenopathy or palpable spleen
  • Contagious – kissing disease
67
Q

treatment of mono

A

if symptomatic, no contact sports

68
Q

T/F: If EBV is suspected in a young patient with negative Monospot, the presence of IgM antibodies to EBV viral capsid antigen (VCA) is diagnostic.

A

TRUE

69
Q

Do you prescribe Augmentin for mono?

A

If Augmentin was used and illness worsens, think mono

69
Q

Do you prescribe Augmentin for mono?

A

If Augmentin was used and illness worsens, think mono

70
Q

signs and symptoms of Herpangina (coxsackie A)

A
  • Abrupt, high fever
  • Anorexia
  • Sore throat
71
Q

Exam of Herpangina (coxsackie A)

A
  • Papulovesicular lesions
  • Yellow/greyish-white
  • Rim of erythema
  • Ant. Tonsillar pillars, soft palate, tonsils, uvula
72
Q

signs and symptoms of Hand, Foot, & Mouth (Enterovirus)

A
  • Mouth and/or Throat Pain
  • Anorexia
  • Fever
73
Q

Exam of Hand, Foot, & Mouth (Enterovirus)

A
  • Oral ulcers – vesicles with thin erythematous halo
    • Ant. tonsillar pillars, on tongue, buccal mucosa
  • Skin ulcers – maculopapular and vesicular with thin erythematous halo
    • Begins on hands and feet
74
Q

treatment for herpangina and hand, foot and mouth

A

supportive for both illnesses

herpangina lasts 2-4 days with rash resolving in 5-6 days

HFMD lasts 7-10 days

75
Q

common cause of Bacterial Pharyngitis / Tonsillitis

A

Group A Beta Hemolytic Strep

76
Q

signs and symptoms of Bacterial Pharyngitis / Tonsillitis

A
  • Abrupt onset
  • Sore throat
  • Fever, HA, Abd Pain, N/V
  • Symptoms resolve in 3-5 days without treatment
77
Q

Exam Bacterial Pharyngitis / Tonsillitis

A
  • Exudative Tonsillopharyngitis
  • **Enlarged, erythematous Tonsils
  • **Enlarged, tender, anterior cervical lymphad.
  • **Palatal Petechiae
  • **Scarlatiniform rash
78
Q

Labs Pharyngitis / Tonsillitis

A
  • Blood work not helpful
  • Rapid Antigen Detection Test (RADT)
    • 1st line testing in most cases
    • 70% - 95% Sensitive
    • Cx required if negative
  • Throat culture
    • 90% - 95% sensitive
    • Can identify other causes of pharyngitis
    • Takes 24 – 48 hours
  • Molecular Assays – NAAT or PCR
    • High sensitivity > 97%
    • Expensive
    • Other pathogens not identified
79
Q

what is the main indications for ABO treatment for strep pharyngitis?

A

prevention of acute rheumatic fever

80
Q

acute rheumatic fever

A
  • Presents within 2-4 weeks of GAS infection
  • Modified Jones Criteria
81
Q

Post Streptococcal Glomerulonephritis

A
  • Red Cell Casts, Hematuria, Proteinuria, Edema
  • Treatment of GAS infection unclear if decreases occurrence – no definitive study
  • Treat symptoms, usually resolves on own.
  • Small % of population has long term kidney disease
82
Q

Treatment of Pharyngitis and Tonsillitis

A

Penicillin is the treatment of choice for GAS Pharyngitis

83
Q

indications of a tonsillectomy

A
  • Obstructive Sleep Apnea
    • Nighttime symptoms
    • Daytime symptoms
  • Enlarged tonsils
  • Recurrent DOCUMENTED bacterial pharyngitis
    • 7 episodes in 1 year
    • 5 per year for 2 years
    • 3 per year for 3 years
  • Surgery
84
Q

sialadenitis

A

Inflammation of salivary glands

85
Q

common pathogen in sialadenitis

A

S. aureus

86
Q

what is most commonly affected in sialadenitis

A

Parotid or Submandibular gland

can also be precipitated by stone

*usually multifactorial

87
Q

signs and symptoms sialadenitis

A

neck swelling

pain and swelling with meals

88
Q

physical exam of sialadenitis

A
  • Tenderness and erythema at duct opening
  • +/- purulent expression
89
Q

tests sialadenitis

A

CT and ultrasound

90
Q

treatment of sialadenitis

A
  • Antibiotics
  • Increase salivary flow
  • Surgery
91
Q

how do salivary gland tumors present

A

asymptomatic mass

nerve involvement strongly correlates with malignancy

92
Q

work up for salivary gland tumors

A

MRI or CT

93
Q

most common benign salivary gland tumor

A

pleomorphic adenoma

94
Q

pleomorphic adenoma

A
  • Onset begins in 4th-6th decade
  • 4:1 male: female ratio
  • Slow growing, painless mass
95
Q

most common malignant salivary gland tumor

A

Mucoepidermoid Carcinoma

96
Q

Mucoepidermoid Carcinoma

A
  • Occurs 3rd-8th decade
    • Peak incidence in 5th decade
  • More common in females and Caucasians
  • +/- pain depending on growth rate
97
Q

treatment salivary gland tumor

A
  • Surgical excision
    • Parotidectomy
    • Submandibular gland excision
    • Wide local excision of minor salivary gland
98
Q

larynx functions

A
  • Prevents aspiration
    • Epiglottis forms a cover over the opening of the larynx when we swallow so food goes in esophagus not trachea.
  • Allows for phonation – vocal cords
99
Q

Symptoms of laryngeal dysfunction

A
  • Hoarseness
    • Caused by abnormal vibration of the vocal cords
  • Stridor
    • EMERGENCY!!!
    • High-pitched sound as a result of turbulent airflow from a narrowed upper airway
      At or above vocal cords → inspiratory
      Below vocal cords → expiratory or biphasic
100
Q

Etiologies of Acute Laryngitis

A

URI, vocal strain, nodules, LPR (Laryngopharyngeal Reflux)

101
Q

treatment of Acute Laryngitis

A

Augmentin x 10 days, 3rd gen Cephalosporin, Clarithromycin

102
Q

most common acute laryngitis

A

viral

103
Q

respiratory papillomatosis

A
  • Benign, symptomatic masses
    Caused by HPV subtypes 6 and 11
  • Slowly progressive course over months to years
104
Q

T/F: More common in children than adults

A

TRUE

105
Q

signs and symptoms of Respiratory Papillomatosis

A

Hoarseness, dyspnea, cough

106
Q

diagnosis of Respiratory Papillomatosis

A

laryngoscopy

107
Q

treatment of Respiratory Papillomatosis

A

laser vaporization

cold knife resection

108
Q

Vocal fold nodules

A
  • Smooth, paired lesions
  • Spontaneous resolution with voice rest
109
Q

Vocal fold nodules

A
  • Unilateral masses as a result of hemorrhage within lamina propria
  • Treatment with corticosteroids
  • May require surgery if large and with voice alteration
110
Q

signs and symptoms cancer of the larynx

A
  • Change in voice is most common presenting complaint
  • Throat or ear pain
  • Hemoptysis
  • Dysphagia
  • Dyspnea
  • Weight loss
111
Q

physical exam of larynx cancer

A

Often benign
+/- cervical lymphadenopathy

112
Q

imaging cancer of the larynx

A

CT or MRI for staging

113
Q

what are the four goals for cancer treatment of the larynx?

A
  1. Cure
  2. Preservation of swallowing
  3. Preservation of voice
  4. Avoidance of traceostoma
114
Q

early stage treatment of larynx cancer

A

radiation therapy

115
Q

advanced stage treatment of larynx cancer

A

multimodal approach

116
Q

vocal cord paralysis

A

Can result from lesion or damage to:
Vagus nerve
Recurrent laryngeal nerve

117
Q

causes of vocal cord paralysis

A
  • Iatrogenic
    • Intubation
    • Surgery
      • Thyroid, neck, mediastinal, skull base
  • Cancer
  • Cricoarytenoid arthritis in RA
  • Trauma
118
Q

vocal cord paralysis signs and symptoms

A

Breathy dysphonia
Effortful voicing

119
Q

vocal cord paralysis treatment

A
  • Minimal symptoms
    • May resolve spontaneously for up to a year
  • Symptomatic
    • Laryngoplasty
120
Q

ankyloglossia

A
  • Tightness of the lingual frenulum
  • Hallmark is a puckering of the midline tongue
  • Can present as difficulty latching and feeding
  • May have speech and dental problems later
  • Often a frenulectomy is performed in the neonatal period
121
Q

Torus Palatini

A
  • Hard midline masses on the palate
    • Bony protrusions that form at the suture line
  • Most are asymptomatic and require no intervention
122
Q

Cleft Lip and Palate

A
  • Associated with specific genetic mutations and syndromes
  • Multiple variations
    • Lip vs Palate
    • Unilateral vs Bilateral
    • Incomplete vs Complete
  • Many developmental difficulties
  • Multidisciplinary approach to management and surgery is required

EENT (5 decks)

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