Throat Flashcards
leukoplakia
- White lesion not removable by rubbing mucosal surface
- Varying sizes
- Hyperkeratoses resulting from chronic irritation
- Dentures, tobacco, ETOH
treatment of leukoplakia
- Discontinue aggravating source
- Surgical
- Prevent Cancer - Monitoring
hairy leukoplakia
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
what is hairy leukoplakia caused by?
EBV-grayish
is hairy leukoplakia a common finding in HIV?
yes
T/F: malignancy potential with hairy leukoplakia
false
treatment of hairy leukoplakia
Antiviral therapy - Acyclovir, Zidovudine
erythroplakia
a red, raised patch, unilateral with a higher likelihood of malignancy
T/F: erythroplakia always requires tissue biopsy and excisional surgery
TRUE
oral lichen planus
Chronic inflammatory autoimmune condition
Numerous clinical subtypes which leads to difficulty in diagnosis
Most commonly looks like a “lacy” leukoplakia
work up of oral lichen planus
Exfoliative cytology
Or incisional/excisional biopsy
Ruling out malignancy
treatment of oral lichen planus
Systemic and topical corticosteroids
Cyclosporine and retinoid
6 P’s
- planar [flat-topped]
- Purple
- Polygonal
- Pruritic
- Papules
- plaques
what is lichen planus
Chronic, Inflammatory, Autoimmune response – unknown cause
what is squamous cell carcinoma
90% of all oral cancers
risk factors of squamous cell carcinoma
Tobacco
Alcohol
Male gender
Advanced age
signs and symptoms squamous cell carcinoma
Non-healing lesions
+/- pain
Weight loss
treatment of squamous cell carcinoma
- 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
prognosis of squamous cell carcinoma
5 year survival
necrotizing ulcerative gingivitis
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
signs and symptoms of necrotizing ulcerative gingivitis
- Painful gingival inflammation
- Halitosis
- Bleeding
- Fever
- +/- cervical lymphadenopathy
treatment of necrotizing ulcerative gingivitis
Topical peroxide rinses
Penicillin VK 250mg TID x 10 days
May need surgical debridement
meth mouth
drug abuse!
Tooth decay
Gum disease
Meth is acidic
breaks down enamel
Poor hygiene
Recurrent Aphthous Stomatitis
also called canker sores
most common cause of mouth ulcers
similar lesions can be associated with chronic diseases
cause of recurrent aphthous stomatitis
multifactorial: trauma, foods, genetic, etc
recurrent aphthous stomatitis morphology
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
how long does recurrent aphthous stomatitis
Several episodes per year
Last up to 14 days
treatment recurrent aphthous stomatitis
- Pain relief
- Oral Hygiene
- Avoid Exacerbating Factors
- Topical Corticosteroids
If Associated with Chronic Dz
Refer to ENT for treatment
herpetic stomatitis
herpes simplex I infection, can also be II
clinically very similar to canker sores
signs and symptoms herpetic stomatitis
- Burning painful vesicles that rupture and form scabs
- Found on attached gingiva and mucocutaneous junction of lip, tongue, and soft palate
treatment of herpetic stomatitis
Acyclovir 800mg 5x/day
7-14 days
Educate pt – very contagious
causes of oral candidiasis
- Antibiotics
- Dentures
- Debilitated
- Poor oral hygiene
- Infants (milk)
- Diabetes Mellitus
- Anemia
- Immunosuppression
HIV / AIDS
Steroid use
Cancer pt
Transplant pt
signs and symptoms of oral candidiasis
- Odynophagia – pain with swallowing
- Dysgeusia – distortion of taste
- Thick, white plaque that can be removed to reveal an erythematous base
tests of oral candidiasis
Clinical
KOH wet prep (hyphae and spores)
treatment of oral candidiasis
- Fluconazole
- Topical oral therapy
Nystatin
Clotrimazole
ludwig’s angina
submandibular space infection
usually otogenic
signs and symptoms of ludwig’s angina
- fever, chills, and malaise
- mouth pain
- stiff neck, and drooling
- dysphagia
- muffled voice
- Woody induration
- Elevated tongue
***AIRWAY
epiglottis is also called
supraglottitis
associated pathogens with epiglottitis
H.influenza, S.pneumonia, S.aureus, MRSA
signs and symptoms of epiglottitis
- Rapidly developing sore throat
- Odynophagia
- Fever
- Dyspnea
physical examination of epiglottitis
- Tripod position – RESPIRATORY DISTRESS
Upright, hands on knees, leaning forward - Drooling
- APPEARS ILL
imaging of epiglottitis
thumb print sign
T/F: you can do a direct laryngoscopy on adults and children
FALSE: only adults
treatment of epiglottitis
AIRWAY CONTROL
Hospitalization
IV antibiotics
Ceftriaxone
Cefuroxime
IV dexamethasone
+/- intubation
This is an Emergency
Dec. Occurrence w/ Immunization (Hib Vaccine)(type b)
retropharyngeal abscess
infectious behind posterior pharyngeal wall
T/F: any URI can cause retropharyngeal abscess
TRUE
signs and symptoms of retropharyngeal abscess
Stiff neck
Fever
Malaise
Trismus
Dysphagia
population affected retropharyngeal abscess
uncommon
seen in young children
exam of retropharyngeal abscess
unremarkable
imaging of retropharyngeal abscess
Lateral Neck X-ray / CT and ENT Eval
Abx
Abx and Surgery
best test for retropharyngeal abscess
CT
peritonsillar abscess
Caused by tonsillar infection penetrating the tonsillar capsule and spreading to the surrounding tissues
pathogen of peritonsillar abscess
β-hemolytic streptococcus is most common
signs and symptoms of peritonsillar abscess
- 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
physical exam peritonsillar abscess
Unilateral palatal swelling
erythema
Deviated uvula
imagine of peritonsillar abscess
CT neck with contrast
treatment of peritonsillar abscess
- medical (amoxicillin, augmentin, clindamycin)
- surgical (needle vs I&D)
complications of diphtheria
myocarditis
polyneuritis of palatal and pharyngeal nerves
life threatening due to exotoxin
signs and symptoms of diphtheria
- Sore throat, fever, malaise
- Gray pseudomembrane over tonsils and pharynx
- Marked Cervical lymphadenopathy
diphtheria
Acute infection of the upper respiratory tract
how does exotoxin impact the body
producing gram positive bacteria
Causes epithelial destruction and superficial inflammation
diphtheria treatment
prevention! TDAP immunization
Antitoxin (Within 48 hours of infection)
Antibiotics (Erythromycin)
Hospitalization
pharyngitis
viral - most common
bacterial
viral pharyngitis
Respiratory Viruses
Herpes (HSV)
Infectious Mononucleosis (EBV)
bacterial pharyngitis
- Streptococcal Pharyngitis (Group A Strep)
- N. Gonorrhea
- Anaerobic (Lemierre’s Synd)
infectious mononucleosis (EBV)
- Fever, exudative tonsillitis, gray-white exudate, posterior cervical lymphadenopathy
- Extreme Fatigue
- +/- axillary lymphadenopathy or palpable spleen
- Contagious – kissing disease
treatment of mono
if symptomatic, no contact sports
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.
TRUE
Do you prescribe Augmentin for mono?
If Augmentin was used and illness worsens, think mono
Do you prescribe Augmentin for mono?
If Augmentin was used and illness worsens, think mono
signs and symptoms of Herpangina (coxsackie A)
- Abrupt, high fever
- Anorexia
- Sore throat
Exam of Herpangina (coxsackie A)
- Papulovesicular lesions
- Yellow/greyish-white
- Rim of erythema
- Ant. Tonsillar pillars, soft palate, tonsils, uvula
signs and symptoms of Hand, Foot, & Mouth (Enterovirus)
- Mouth and/or Throat Pain
- Anorexia
- Fever
Exam of Hand, Foot, & Mouth (Enterovirus)
- 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
treatment for herpangina and hand, foot and mouth
supportive for both illnesses
herpangina lasts 2-4 days with rash resolving in 5-6 days
HFMD lasts 7-10 days
common cause of Bacterial Pharyngitis / Tonsillitis
Group A Beta Hemolytic Strep
signs and symptoms of Bacterial Pharyngitis / Tonsillitis
- Abrupt onset
- Sore throat
- Fever, HA, Abd Pain, N/V
- Symptoms resolve in 3-5 days without treatment
Exam Bacterial Pharyngitis / Tonsillitis
- Exudative Tonsillopharyngitis
- **Enlarged, erythematous Tonsils
- **Enlarged, tender, anterior cervical lymphad.
- **Palatal Petechiae
- **Scarlatiniform rash
Labs Pharyngitis / Tonsillitis
- 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
what is the main indications for ABO treatment for strep pharyngitis?
prevention of acute rheumatic fever
acute rheumatic fever
- Presents within 2-4 weeks of GAS infection
- Modified Jones Criteria
Post Streptococcal Glomerulonephritis
- 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
Treatment of Pharyngitis and Tonsillitis
Penicillin is the treatment of choice for GAS Pharyngitis
indications of a tonsillectomy
- 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
sialadenitis
Inflammation of salivary glands
common pathogen in sialadenitis
S. aureus
what is most commonly affected in sialadenitis
Parotid or Submandibular gland
can also be precipitated by stone
*usually multifactorial
signs and symptoms sialadenitis
neck swelling
pain and swelling with meals
physical exam of sialadenitis
- Tenderness and erythema at duct opening
- +/- purulent expression
tests sialadenitis
CT and ultrasound
treatment of sialadenitis
- Antibiotics
- Increase salivary flow
- Surgery
how do salivary gland tumors present
asymptomatic mass
nerve involvement strongly correlates with malignancy
work up for salivary gland tumors
MRI or CT
most common benign salivary gland tumor
pleomorphic adenoma
pleomorphic adenoma
- Onset begins in 4th-6th decade
- 4:1 male: female ratio
- Slow growing, painless mass
most common malignant salivary gland tumor
Mucoepidermoid Carcinoma
Mucoepidermoid Carcinoma
- Occurs 3rd-8th decade
- Peak incidence in 5th decade
- More common in females and Caucasians
- +/- pain depending on growth rate
treatment salivary gland tumor
- Surgical excision
- Parotidectomy
- Submandibular gland excision
- Wide local excision of minor salivary gland
larynx functions
- 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
Symptoms of laryngeal dysfunction
- 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
Etiologies of Acute Laryngitis
URI, vocal strain, nodules, LPR (Laryngopharyngeal Reflux)
treatment of Acute Laryngitis
Augmentin x 10 days, 3rd gen Cephalosporin, Clarithromycin
most common acute laryngitis
viral
respiratory papillomatosis
- Benign, symptomatic masses
Caused by HPV subtypes 6 and 11 - Slowly progressive course over months to years
T/F: More common in children than adults
TRUE
signs and symptoms of Respiratory Papillomatosis
Hoarseness, dyspnea, cough
diagnosis of Respiratory Papillomatosis
laryngoscopy
treatment of Respiratory Papillomatosis
laser vaporization
cold knife resection
Vocal fold nodules
- Smooth, paired lesions
- Spontaneous resolution with voice rest
Vocal fold nodules
- Unilateral masses as a result of hemorrhage within lamina propria
- Treatment with corticosteroids
- May require surgery if large and with voice alteration
signs and symptoms cancer of the larynx
- Change in voice is most common presenting complaint
- Throat or ear pain
- Hemoptysis
- Dysphagia
- Dyspnea
- Weight loss
physical exam of larynx cancer
Often benign
+/- cervical lymphadenopathy
imaging cancer of the larynx
CT or MRI for staging
what are the four goals for cancer treatment of the larynx?
- Cure
- Preservation of swallowing
- Preservation of voice
- Avoidance of traceostoma
early stage treatment of larynx cancer
radiation therapy
advanced stage treatment of larynx cancer
multimodal approach
vocal cord paralysis
Can result from lesion or damage to:
Vagus nerve
Recurrent laryngeal nerve
causes of vocal cord paralysis
- Iatrogenic
- Intubation
- Surgery
- Thyroid, neck, mediastinal, skull base
- Cancer
- Cricoarytenoid arthritis in RA
- Trauma
vocal cord paralysis signs and symptoms
Breathy dysphonia
Effortful voicing
vocal cord paralysis treatment
- Minimal symptoms
- May resolve spontaneously for up to a year
- Symptomatic
- Laryngoplasty
ankyloglossia
- 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
Torus Palatini
- Hard midline masses on the palate
- Bony protrusions that form at the suture line
- Most are asymptomatic and require no intervention
Cleft Lip and Palate
- 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
