Throat

Question 1

Aphthous Ulcers (Canker Sores)
-Causes
-Symptoms
-Treatment

Answer 1

-IBD, HIV, Celiac, SLE
-Small painful round shallow ulcer with erythematous halo
-Topical oral glucocorticoids (Clobetasol, Dexamethasone)

Question 2

Oral Candidiasis (Thrush)
-RF
-Symptoms
-Testing
-Treatment

Answer 2

-Immunocompromised, no spacer use with inhaled corticosteroids, denture use, smoking
-Decreased taste, white curd like plaques that are friable and bleed easily
-KOH prep: budding yeast and pseudohyphae
-Nystatin Liquid, Clotrimazole Troches, Oral Fluconazole if severe

Question 3

Oral Leukoplakia
-Definition
-RF
-Symptoms
-Testing
-Treatment

Answer 3

-Hyperkeratosis due to chronic irritation
-Smoking, alcohol, dentures, HPV infection
-Painless, white patchy lesions that can’t be scraped off
-Increased risk of SCC –> Biopsy
-Stop irritants, cryotherapy/laser if high risk for SCC

Question 4

Oral Hairy Leukoplakia
-Mucosal manifestation of…
-Symptoms
-Almost always in…
-Treatment

Answer 4

-EBV (HHV4)
-Painless white, smooth, corrugated or hairy lesions that can’t be scraped off
-HIV
-Antiretrovirals if HIV related

Question 5

Erythroplakia
-Causes
-High risk of…
-Symptoms
-Testing and Treatment

Answer 5

-Chronic irritation, High risk of SCC
-Painless, erythematous soft velvety patch on mouth floor
-Biopsy
-Excision if SCC

Question 6

Oral Lichen Planus
-Related to an infection with…
-Symptoms
-Testing
-Treatment

Answer 6

-Hep C
-Lacy reticular leukoplakia (Wickham Striae)
-Biopsy
-Local glucocorticoids (Betamethasone, Clobetasol)

Question 7

Parotitis
-If bilateral =
-If unilateral =
-Treatment
-Prevention?

Answer 7

-Bilateral = Mumps
-Unilateral = Bacterial
-Sialogogues, IV ABX, Stone Removal
-MMR vaccine

Question 8

Acute Bacterial Sialadenitis (Suppurative)
-MCC
-RF Conditions
-Symptoms
-Testing
-Treatment

Answer 8

-Staph A
-Sjogren’s, Autoimmune, Dehydration, Stone
-Sudden onset of tender, swollen gland with pus
-Dysphagia, Trismus, Fever, Chills
-CT scan
-Sialogogues + Nafcillin/Dicloxacillin

Question 9

Sialolithiasis
-MC locations
-Symptoms
-Treatment

Answer 9

-Wharton’s Duct (submandibular bland) or Stensen’s Duct (parotid gland)
-sudden onset of salivary gland pain and swelling with eating or in anticipation of eating
-Sialogogues, increase fluids, moist heat, laser

Question 10

Epiglottitis
-MCC if no vaccines
-MCC if immunized
-Symptoms
-Testing
-DO NOT…
-Treatment
-Prophylaxis for close contacts

Answer 10

-H. Influenzae
-Strep (GABHS) if immunized
-Drooling, dysphagia, distress, inspiratory stridor, tripod position, hot potato voice
-Lateral Cervical XR: Thumbprint Sign
-Laryngoscopy: definitive: cherry red epiglottis with swelling
-Do not visualize with tongue depressor
-maintain airway, IVF, IV ABX (Ceftriaxone or Cefotaxime)
-Rifampin or get HiB vaccine

Question 11

Laryngitis
-Causes
-Symptoms
-Treatment

Answer 11

-Viral URI, vocal strain, irritation (GERD, Polyps)
-Hoarseness, aphonia, scratchy throat
-Supportive, vocal rest, fluids

Question 12

Peritonsillar Abscess (Quinsy)
-MCC
-Symptoms
-Testing
-Treatment

Answer 12

-Strep Pyogenes (GABHS)
-Dysphagia, Drooling, Trismus, Hot Potato Voice, swollen fluctuant tonsil, uvula deviation to contralateral side
-CT scan to differentiate from cellulitis
-Drainage or I&D and ABX (Oral Augmentin or Clinda)

Question 13

Strep Pharyngitis
-MCC
-Symptoms
-Testing
-Complication to Remember
-Treatment

Answer 13

-GABHS
-Fever, absence of cough, tonsillar exudates, anterior cervical LAD
-Rapid antigen detection (initial) and throat culture (Definitive)
-Rheumatic Fever
-Penicillin G or VK (first line), Macrolides if PCN allergic

Question 14

Ludwig’s Angina
-Definition
-RF
-Symptoms
-Testing
-Treatment

Answer 14

-Cellulitis of floor of mouth
-Dental infections, HIV, DM
-Fever, stiff neck, dysphagia, drooling, woody induration of chin and neck
-CT scan of neck
-IV Augmentin or Ceftriaxone + Metro
–Add Vanco if suspect MRSA

Question 15

Retropharyngeal Abscess
-Symptoms
-Testing
-Treatment

Answer 15

-Torticollis, Stiff neck with extension, fever, drooling, dysphagia
-Unilateral posterior pharyngeal wall edema
-Anterior cervical LAD

-Lateral neck XR: increased prevertebral space(<50%)
-CT with contrast is DOC

-I&D and IV ABX (Augmentin or Clinda)

Question 16

Respiratory Diphtheria
-Cause
-Symptoms
-Testing (even though clinical diagnosis)
-Treatment
-Prophylaxis for close contacts
-Droplet Precautions?

Answer 16

-Corynebacterium diphtheriae
-Laryngitis, Myocarditis
-Friable, gray to white membrane on pharynx that bleeds if scraped.
-Cervical LAD (Bull Neck)
-Culture (using Loffler medium or tellurite agar)
-Diphtheria Antitoxin (horse serum) + erythromycin or PCN x 2 weeks

-Prophylaxis: Erythromycin or Penicillin G x 1 dose
-Patient in respiratory droplet isolation until 2 cultures 24 hours apart are negative

Question 17

Nasopharyngeal Carcinoma
-MC type
-RF
-Symptoms
-Associated with…

Answer 17

-Squamous Cell Carcinoma
-EBV, hereditary, diet rich in salted fish
-Lump in neck, unilateral hearing loss, nasal obstruction, blood tinged nasal discharge, facial numbness, unintentional weight loss
-EBV Infection

Question 18

Mucocele
-Definition
-Symptoms
-Treatment

Answer 18

-Mucus filled cyst caused by trauma
-Obstructs salivary gland flow
-Located on lower lip. Painless swelling in oral cavity. Bluish color.
-Spontaneously resolve

Question 19

Oropharyngeal/Larynx Cancer
-MC type
-RF
-Symptoms
-Treatment

Answer 19

-SCC
-HPV, smoking, exposure to paint, asbestos, gas fumes, radiation
-Hoarseness, odynophagia, referred ear pain, weight loss, firm painless mass in neck, aspiration, airway compromise
-Surgical resection, chemo, radiation

Question 20

Torus Palatinus
-Definition
-Treatment

Answer 20

-Harmless, painless bony growth located on hard palate (roof of mouth)
-Refer to maxofacial surgeon if problematic. Observation for most.