Throat MDT

Question 1

What is epiglottitis?

Answer 1

Inflammation of epiglottis of viral or bacterial origin

Question 2

Who is predisposed to epiglottis?

Answer 2

• DM patients
• contact with group A-beta hemolytic streptococci

Question 3

Physical findings of epiglottitis

Answer 3

• rapidly developing sore throat or odynophagia out of proportion with findings
• laryngoscopy may find swollen erythematous epiglottis

Question 4

What would radiologic studies show in epiglottitis?

Answer 4

“Thumb sign”

Question 5

Treatment of epiglottitis

Answer 5

Antibiotics
- Ceftriaxone (rocephin)
Steroid
- Dexamethasone

Question 6

What is leukoplakia?

Answer 6

White lesions unable to be removed by rubbing of mucosal surface

Question 7

What is hyper keratosis?

Answer 7

Response to a physical or chemical irritant

Question 8

What percentage of leukoplakia show dysplastic changes?

Answer 8

2%-4%

Question 9

What predisposing factors can lead to leukoplakia?

Answer 9

• alcohol and tobacco use
• ill fitting dentures or ill contoured dental restoration

Question 10

Where is leukoplakia most common?

Answer 10

Buccal mucosa (cheeks)

Question 11

What locations of leukoplakia are associated with malignancy?

Answer 11

Floor of mouth, tongue and vermillion border

Question 12

Signs and sx of leukoplakia

Answer 12

• white or painless lesions that cannot be removed
• wet finger appearance

Question 13

What labs should be done for leukoplakia?

Answer 13

Refer for biopsy to r/o dysplasia

Question 14

What treatment is required for leukoplakia?

Answer 14

No treatment required

Question 15

What is peritonsillar abscess?

Answer 15

Infection penetrates tonsillar capsule and involves the surrounding tissues

Question 16

What predisposes a patient to peritonsillar abscess?

Answer 16

• chronic tonsillitis
• multiple trials of oral antibiotics
• hx of PTA

Question 17

Sx and findings of PTA

Answer 17

• hot potato voice
• cervical lymphadenopathy
• Uvula deflection

Question 18

Treatment of PTA

Answer 18

Ceftriaxone + Metronidazole
If PCN allergy:
Clindamycin

Question 19

What procedure must be done to treat PTA?

Answer 19

Needle aspiration with 19-21g needle

Question 20

How deep should needle aspiration be for PTA I&D?

Answer 20

No deeper than 1cm due to internal carotid artery

Question 21

Who should PTA be referred to?

Answer 21

ER, ENT or Gen surg for I&D

Question 22

What is pharyngitis?

Answer 22

Inflammation and infection of the pharynx

Question 23

What is tonsillitis?

Answer 23

Inflammation and infection of the tonsils

Question 24

What percentage of office visits are due to pharyngitis/tonsillitis?

Answer 24

10%

Question 25

What percentage of outpatient antibiotics are due to pharyngitis/tonsillitis?

Answer 25

50%

Question 26

What infection is most concerning for management of pharyngitis/tonsillitis?

Answer 26

Group A-B hemolytic streptococcal infection (GABHS)

Question 27

What complication can GABHS lead to?

Answer 27

Rheumatic fever

Question 28

What kind of pharyngitis is common after antibiotic treatment or if patient is immunocompromised?

Answer 28

Fungal Pharyngitis (candida albicans)

Question 29

How long is the incubation period of GABHS?

Answer 29

2-5 days

Question 30

What is the CENTOR criteria?

Answer 30

- Fever over 38C (100.4F) - Lymphadenopathy - Lack of a cough - Pharyngotonsillar exudates

Question 31

What is indicative of shaggy white-purple exudates that often extends into the nasopharynx?

Answer 31

Mononucleosis

Question 32

What is indicative of vesicular and petechial pattern on the soft palate?

Answer 32

Viral Pharyngitis/Laryngitis

Question 33

What is indicative of white, cheesy exudates?

Answer 33

Fungal Pharyngitis/Laryngitis

Question 34

What labs should be done when examining a patient with pharyngitis/laryngitis?

Answer 34

- Rapid Strep - Monospot - Throat Culture - HIV

Question 35

What medications should be given to patients with GABHS?

Answer 35

Benzathine PCN 1.2million units IM PCN VK 500mg PO BID/TID for 10 days Dicloxacillin 250-500mg PO QID Augmentin 500mg PO TID Azithromycin 500mg daily for 3 days

Question 36

What can a patient do that can also assist with viral laryngitis/pharyngitis?

Answer 36

Warm, salt water gargles

Question 37

What is paradise criteria?

Answer 37

Referral for tonsillectomy - 3 or more episodes in each of 3 years - 5 or more episodes in each of 2 years - 7 or more episodes in one year

Question 38

What is sialadentitis?

Answer 38

Dutcal obstruction often by mucus plug or stone followed by salvary stasis and secondary infection

Question 39

What glands does acute bacterial sialdentitis commonly affect?

Answer 39

Parotid or submandibular glands

Question 40

What is the most common organism from purulent discharge of sialadentitis?

Answer 40

S aureus

Question 41

What predisposes a patient to siladentitis?

Answer 41

- dehydration - chronic illness - chronic periodontitis

Question 42

Sx and physical findings of sialadentitis

Answer 42

- acute swelling of gland - pus can often be massaged from the duct - increased pain and swelling with meals

Question 43

Radiologic studies for sialadentitis

Answer 43

- Ultrasound - CT

Question 44

Medications for sialadentitis

Answer 44

Antibiotics - Nafcillin - Oxacillin PO Antibiotics if patient stable - Clindamycin - Cipro

Question 45

Conservative treatment of sialadentitis

Answer 45

- hydration - warm compress - sialogogues - massage gland

Question 46

What is tonsilloliths?

Answer 46

Tonsil stones, soft aggregates of bacterial and cellular debris that form in tonsillar crypts, crevices

Question 47

Signs and sx of tonsilloliths

Answer 47

- may be asymptomatic - Putrid breath - Metallic taste

Question 48

Treatment of tonsiloliths

Answer 48

- no treatment if asymptomatic - irrigation - tonsillectomy maybe indicated