Throat Flashcards
Little red and white spots on palate. Poor hygiene, smokers, protein deficiency, poorly fitted dentures, radiation therapy, allergies, iron efficiency, vitamin B deficiency.
Redness, swelling, occasional bleeding, halitosis; use Hx to diagnose
Stomatitis
Drug/referral and consider indications, contraindications, cost effectiveness; remove source or treat w/ medication in systemic or use topical anesthetic for pain (2% lidocaine)
Treatment stomatitis
Present as single or multiple painful, round ulcers with yellow-gray centers and red halos. They occur on nonkeratinized mucosa (buccal or labial) and are recurrent
Aphthous ulcer; ulcerative stomatitis
Non-specific; topical therapies like corticosteroids.
1-week prednisone taper, cimetidine can be used as maintenance therapy
Aphthous ulcer treatment
Infection more likely in patients who wear dentures or those w/ diabetes/immunocompromised states, chemo/radiation, corticosteroid or broad abx treatment.
Throat or mouth pain w/ creamy white patches that can be scraped off to reveal red erythematous mucosa
Wet prep or biopsy can be done
Oral candidiasis
Antifungals (ketoconazole or fluconazole, clotrimazole troches, nystatin liquid rinse)
Oral candidiasis treatment
Elders w/ poor fitting dentures, children
Bx infection (impetigo; honey-colored crusts and ulceration) or yeast; Yellow crusting sores on sides of mouth
Dx visual but can culture
Angular chelitis
Bacterial impetigo: Bactroban or topical ABX
Yeast: Clotrimazole (topical)
Barrier cream to stop irritation before it becomes infection
Angular chelitis treatment
Infection of mouth and lips by HSV1; herpes labials usually involves trigger
Prodromal period (tingling), pain, burning, or itching can occur at the site before the sore appears. The cluster or sores erupt into blisters, then quickly turn into shallow grey ulcers with a red base, become crusted or scabbed; May have palpable lymph nodes
Swab sore and send to lab, Tzanck smear test; antigen antibody studies (PCR) usually just Dx clinically
Herpes simplex/cold sores/ herpes gingivostomatitis
Tylenol or ibuprofen for pain; acyclovir, valtrex, famvir, and topical penciclovir. Mouth wash with lidocaine and benadryl.
Cold sore treatment
Sore throat. More commonly viral than bacterial Differentiate between GABHS to prevent complications as well as to limit unnecessary antibiotic use
Acute pharyngitis
Fever, tender anterior cervical nodes, lack of cough, pharygotonsillar exudate
Rapid strep test, if negative and still suspicious culture
GABHS if all four, only three likely, only one most likely not GABHS
Coryza, hoarsness, cough
Viral pharyngitis
IM Penicillin if patient non compliant
Oral penicillin or cefuroxime can be used. E-mycin or another macrolide can be substituted in cases of PCN allergy.
Complications = scarlet fever, glomerulonephritis, abscess formation
GABHS bacterial pharyngitis
Viral and follows URI. Bacteria can include M. Cattarhalis and H. Influenzae. Hoarseness hallmark symptom, cough can be present, pain is atypical.
Rx: Vocal rest; if bacterial E-mycin, cefuroxime, amox-Clav can decrease hoarsness/cough. Oral or IM corticosteroids can be used for performers but vocal fold evaluation first
Laryngitis
More frequent in diabetic patients, etiology can be viral or bacterial.
Quick developing sore throat or pain on swallowing with relatively benign oral examination. Fever, drooling, tripod or sniffling posture to improve air exchange.
Lateral tissue X-ray reveals “thumb sign”; can do laryngosopy but can cause airways spasm so do in controlled environment
Epiglottitis
IV abx (ceftrizoxime or cefuroxime) and IV corticosteroids
Can switch to oral forms upon improvement; complete 10 day steroid taper
Intubate if dyspnea or concern of airway closure
Patients should be closely monitored always with this condition (ICU)*
Epiglottitis treatment
White, oral lesion; painless and cannot be rubbed or scraped off. Linked with tobacco, alcohol, or denture use. 5% are dysplastic or squamous cell carcinomas.
If associated erythematous appearance, higher risk of dysplasia or cancer (90%)
Leukoplakia
Inflammation of one or both parotid glands.
PE: abnormal tastes, decreased ability to open mouth, dry mouth, fever, nausea, facial pain (along parotid gland), redness over side of face or upper neck, facial swelling esp. in front of ears
Stetson’s duct may be red or irritated; pus drainage into mouth
Sialadenitis (parotitis)
Radiology if suspected abscess; abx if pus or fever, aspiration of abscess, stop smoking, good oral hygiene, warm salt water rinses
Tylenol for symptomatic therapy; if spreads IV abx; clindamycin
Sialadenitis treatment
Pain and swelling of affected gland aggravated bye eating; stones in salivary duct
Tx: Stimulate saliva production
Sialolithiasis
Severe sore throat, muffled voice, truisms
Pus between palatine tonsil and pharyngeal muscles; Polymicrobial
Fluctulant tonsils deviation of uvula to opposite side
Peritonsillar abscess
Heat sensitivity, fever, gingival bleeding and swelling, erythema, decreased intake of food, fluid; fluctuant mass that extends inside of the mouth; gum boil, tooth mobility, trismus (can’t open mouth); neck swelling
Leukocytosis and neutrophil predominance; needle aspirate for cultures; Xray or CT
Dental abscess
ABX therapy depending on culture; analgesic and hydrate; drain abscess (administer abx before)
Dental abscess treatment
Gingivitis treatment
PCN and clindamycin
Prevention for dental caries
Fluoride
How should you handle a dental trauma?
REFER; put tooth in milk, spit, or inside mouth to preserve root
Dry mouth; can be side effect of meds; Sjorgen’s syndrom; depression, age, anxiety, vitamin deficiency, diabetes, AIDS, cancer
Dry mouth w/ cobblestone appearance, hard time talking, cracked lips, potential dental caries
Dx w/ blood test to rule out sjorgen’s; check salivary gland function
Xerostomia
Increase salivary secretions with pilocarpine
Xerostomia
