Throat

Question 1

Pharyngitis

Answer 1

Viral Causes: rhinovirus, coronavirus, adenovirus, ebstein barr (mono

Bacterial: GABHS, mycoplasma, H. Flu Type B., diptheria, GC, chlamydia

Question 2

Strep Pharyngitis

Answer 2

GABHS criteria: sore throat with erythema and exudates, fever, cervical lymphadenopathy and the ABSENCE of coryza
Rapid antigen test or throat culture, CBC
Scarlatiniform rash
Complications: Rheumatic fever, post streptococcal glomerulonephritis, peritonsillar abcess
Treat with PCN VK or EMycin 500 mg bid for 10 days

Question 3

Mononucleosis

Answer 3

Pharyngitis, bilateral white plaster like, exudates, diffuse lymphadenopathy (including splenomegaly in 50%), malaise, fever, and fatigue.
Most common in young adults, toxic appearing
Most of the adult population presents with clinically inapparent disease
May have jaundice, icterus, rash
Confirm with Monospot, CBC (atypical leukocytosis), LFT’s
Treatment is supportive
Restrict contact sports to protect spleen
Restrict activities (work, school)
Recheck in 1-2 weeks. Resolves in 2-4 weeks

Question 4

Tonsillar Abscess

Answer 4

Develops between the tonsil and the superior constrictor muscle.
With an abscess, the affected tonsil will often protrude beyond the midline
Severe, worsening sore throat
Patients often speak in a muffled voice and may not be able to swallow saliva.
Risk of airway obstruction. Refer immediately for drainage, antibiotics

Question 5

Epiglotittis

Answer 5

Rare but life-threatening inflammation of epiglotitis caused by bacterial infection
Incidence increasing in adults, decreasing in children due to vaccine (HIB)
Suspect it when swallowing is extremely painful (causing drooling), when speech is muffled and when breathing becomes difficult.
Emergency room referral ASAP maintain airway, antibiotics, steroids
Maintain upright position, quiet environment, humidified oxygen

Question 6

Tumors of the Oropharynx

Answer 6

Tumors of the throat, tongue, and larynx A/W long time use of tobacco and alcohol.
C/O difficulty swallowing, sometimes with pain radiating to the ear
Sore throat or hoarseness > 2 weeks
C/O a lump in the neck
Unexplained weight loss
Spitting up blood in the saliva or phlegm.
Cervical lymphadenopathy
Refer to ENT for exam

Question 7

Perleche (oral lesion)

Answer 7

angular cheilitis
Erythematous, scaly eruption at the corners of the mouth. Increase saliva secondary Candida infection
Correct cause; topical clotrimezole and hydrocortisone

Question 8

Apthous stomatitis (oral lesion)

Answer 8

canker sore
Superficial ulcer causing burning discomfort
Last 5-7 days
Kenalog in Orabase or Benadryl with Kaopectate

Question 9

Leukoplakia (oral lesion)

Answer 9

white patch
Slightly raised, white, translucent dense, opaque
10% are premalignant

Question 10

Erythroplasia (oral lesion)

Answer 10

red patch
Red, hyperplastic area
High suspicious of premalignancy

Question 11

Periodontal Disease

Answer 11

Bacterial inflammation of the gums
Secondary to poor dental hygiene
Primary cause of tooth loss in adults
Risk for bacterial heart disease
Attacks root of the tooth
Gums recede and become infected, bleed
Check all patients for plaque, swelling, encourage use of floss and dental referrals. 
Public clinics offer sliding scale and or free care.

Question 12

Temporomandibular Joint Disease

Answer 12

Unilateral jaw/facial pain, can radiate to head, neck, ears
R/T bruxism, jaw clenching, dental manipulation, degenerative arthritis (RA, OA)
Pain with jaw movement, clicking, locking, limited movement
R/O OM, dental problem, temporal arteritis
Treatment: rest, heat/cold, massage, analgesics, muscle relaxants, jaw guard
Refer to oral surgeon, ENT