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Clinical Medicine I > Throat/Mouth > Flashcards

Throat/Mouth Flashcards

1
Q

What is the health status of the oral cavity linked to?

A

Cardiovascular disease
Diabetes
Systemic Illnesses

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2
Q

What should you assume head and neck infections or swelling to?

A

Odontogenic in origin

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3
Q

What is a dental carie?

A

Infection that is bacterial in origin and causes demineralization and destruction of the hard tissues of the teeth

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4
Q

What can cause a dental carie?

A

A dry mouth

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5
Q

What mouth disease remains one of the most common diseases throughout the world?

A

Dental carie

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6
Q

What are risk factors for dental infection?

A 
Low socioeconomic status/ poor access to care
Poor oral hygiene
Poor nutrition
Inadequate fluoride 
Decreased saliva flow
Use of anticholinergic medications
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7
Q

How do we prevent dental problems?

A 
Flossing
Brushing with fluoride toothpaste 
Biannual cleaning
Avoid smoking
Good control of systemic diseases
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8
Q

What pathogen causes dental infections?

A

Streptococcus mutants

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9
Q

What dental diseases are common in pregnant women?

A

Pregnancy gingivitis caused by hormonal changes which promote pathogen growth

Pyogenic granuloma

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10
Q

What disease is a systemic risk factor for periodontal disease?

A

Diabetes

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11
Q

What are the two main clinical presentations of periodontal disease?

A

Sensitivity to hot or cold stimuli

Pain on biting

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12
Q

If a child < 4 comes in with a stiff neck, sore throat, and dysphagia, what should they be worked up for?

A

Retropharyngeal abscess secondary to molar infection

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13
Q

What labs might you obtain if a patient has periodontal disease and when is the only time you would obtain these?

A

If the patient looks extremely ill —>

CBC with differential
Culture and sensitivity to test for aerobic and anaerobic pathogens

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14
Q

What might you use a CT scan for with periodontal disease?

A

TO determine the extent and density of swelling, as well as, the location of an abscess within soft tissue or bone

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15
Q

What differential diagnoses might you consider with periodontal disease?

A

Sinusitis

Jaw pain is an angina equivalent in postmenopausal women or long-term diabetic patients

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16
Q

What is the first line treatment for dental infection?

A

Penicillin VK

Loading dose of 1000mg followed by 500mg QID for 7-10 days

IN kids its 40-60 mg/kg/day divided four times a day

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17
Q

What is the second line treatment for dental infection and when should you use it?

A

If there is a longstanding infection or previously treated infection that does not respond to first line; or PCN allergy

Oral Clindamycin 300mg TID for 7-10 days

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18
Q

If a patient has a severe dental infection, what should the treatment be?

A

Loading dose of CLINDAMYCIN 600mg or 900mg IV, then 300mg every 6 hours

COnsider double coverage with metronidazole

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19
Q

What must be obtained before a patient with a dental infection can be released from the hospital?

A

Dental consult and follow up dental care appointment scheduled

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20
Q

What anti inflammatory agents should be used in dental infection?

A

Aspirin or NSAIDS

Careful with opioids

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21
Q

What is the criteria for admission to the hospital for patient with dental infection?

A 
Swelling involving deep spaces (pre-fascial planes) of neck
Unstable vital signs
Fever
Chills
Confusion or delirium 
Evidence of invasvie infection
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22
Q

If a patient has an I&D for their dental infection, what is the treatment?

A

Warm salt water rinses several times a day to encourage drainage

Chlorhexidine gluconate twice a day

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23
Q

When can you discharge a patient from the hospital after they are admitted for a dental infection?

A

If airway is not compromised

If abscess and sepsis are eliminated

If the patient is able to take PO and ambulate

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24
Q

What should be avoided in young children in order to prevent dental caries?

A

Sleeping with a bottle

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25
Q

What are potential complications of dental infections?

A

Ludwig angina
Vincent’s angina
Retropharyngeal abscess/infection
Mediastinal infection

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26
Q

What is ludwig angina?

A

sublingual cellulitis with or without tracking abscess inferiorly

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27
Q

What is Vincent’s angina?

A

trench mouth

acute necrotizing ulcerative gingivitis

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28
Q

What are the two clinical pearls of dental infections?

A

Do not ignore toothache pain

Treat patients with facial swelling aggressively, as infections can quickly spread

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29
Q

What is tonsillitis?

A

inflammation of palatine tonsil glands

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30
Q

What is pharyngitis?

A

Inflammation of any structure of the pharynx, including adenoids and lingual tonsils

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31
Q

When is tonsillitis and pharyngitis usually seen?

A

winter and early spring

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32
Q

What virus typically causes tonsillitis or pharyngitis?

A

Rhinovirus

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33
Q

What bacteria typically causes tonsillitis or pharyngitis?

A

GABHS:

Strep pyogenes or GAS

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34
Q

What are the clinical manifestations of viral tonsillitis/pharyngitis?

A

Chronic sore throat and symptoms of common cold

Coryza
Cough
Malaise
Fatigue
Hoarseness
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35
Q

What symptoms are associated with viral tonsillitis/pharyngitis caused by mono?

A

Viral symptoms
Posterior LAD
Kissing tonsils
Hepatosplenomegaly

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36
Q

What are the clinical manifestations of Bacterial tonsillits/pharyngitis?

A

Lack of cough, coryza, or other URI symptoms

Sudden onset of sore throat
Anterior LAD
Fever
Petechiae of soft palate

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37
Q

What can bacterial tonsillits/pharyngitis lead to in children?

A

Scarlett fever (GABHS Pharyngitis)

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38
Q

What are the clinical manifestations of Scarlett fever?

A

strawberry tongue

Sandpaper rash on trunk and armpits

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39
Q

What are the general symptoms of Tonsillitis/pharyngitis?

A 
Dysphagia
Odynophagia
Sore throat
Fever
LAD
Exudate
Headache
N/V
Abdominal pain
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40
Q

What do we use to diagnose GABHS pharyngitis/tonsillitis?

A

Centor Criteria

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41
Q

What is the centor criteria?

A

Fever
Anterior LAD
Tonsillar exudate
Absence of cough

1 symptom = likelihood low for strep
2-3 symptoms = confirm via rapid strep test
4 symptoms = treat for strep pharyngitis

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42
Q

What do we treat Adult bacterial pharyngitis with?

A

Pen VK 500MG twice a day for 10 days

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43
Q

What do we treat child bacterial pharyngitis with?

A

Amoxicillin 50mg/kg PO every day for 10 days

or

24 mg/kg PO twice a day for 10 days

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44
Q

What is the secondline treatment for bacterial pharyngitis if the patient has a penicillin allergy?

A

Cephalexin or Macrolide

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45
Q

What is the treatment for viral pharyngitis?

A 
Gargle with warm water
Antipyretics
Analgesis for bad cases of mono
Rest
Decadron single dose if tonsils are really enlarged
IVF if dehydrated
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46
Q

What are the complications of strep pharyngitis/tonsillitis?

A

Peritonsilar abscess
Rheumatic fever
Glomerulonephritis

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47
Q

What is the most common complication seen with strep pharyngitis/tonsillitis?

A

Peritonsilar abscess

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48
Q

What is a peritonsilar abscess?

A

Collection of pus located between the capsule of palatine tonsil and pharyngeal muscles

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49
Q

What are the causative steps of peritonsilar abscess?

A

Tonsillitis/pharyngitis –> cellulitis –> abscess

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50
Q

What is considered the most common deep space infection of the head and neck?

A

peritonsilar abscess

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51
Q

What is a peritonsilar abscess caused by?

A

GABHS

Others:
S. aureus
Neisseria
Corynebacterium

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52
Q

What are the clinical manifestations of peritonsilar abscess?

A

Severe sore throat that is unilateral

Muffled/”hot potato voice”

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53
Q

What are other symptoms of peritonsilar abscess?

A 
Fever
Ipsilateral ear pain 
Fatigue
Irritability 
Decreased PO intake
Trismus
Neck pain with movement
Unilateral, swollen, and fluctuant tonsil with contralateral deviation of uvula
Pooling of saliva/drooling
Neck swelling
Rancid or fetor breath
Erythema or exudate of the tonsil
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54
Q

What are differential diagnoses of peritonsilar abscess?

A 
Retropharyngeal abscess
Ludwig angina
Dental infection
Peritonsilar cellulitis
Infectious mononucleosis
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55
Q

What typically occurs after patient has had viral pharyngitis?

A

peritonsilar cellulitis

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56
Q

What is the diagnostic tool used to diagnose a peritonsilar abscess?

A

CT neck with IV contrast

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57
Q

If you get an xray of the neck and see a positive thumb sign, what is diseased?

A

epiglottis

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58
Q

When would you get imaging for a peritonsilar abscess?

A

If you are uncertain about your diagnosis

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59
Q

How is a peritonsilar abscess treated?

A

Drainage
Empiric antibiotics –> Augmentin 875 mg twice a day for 14 days or Unasyn IV or clindamycin IV
Antipyretics
Analgesia

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60
Q

What is rheumatic fever?

A

Delayed, non-suppurative sequelae of GABHS pharyngitis involving lesions of joints, heart, subcutaneous tissue, and CNS

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61
Q

What is the concern with rheumatic fever?

A

lifelong complications and damage to cardiac valves

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62
Q

What are the clinical manifestations of rheumatic fever?

A 
Carditis/Valvulitis
Migratory arthritis
Erythema marginatum
Sydenhaum chorea
Subcutaneous nodules
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63
Q

What symptoms are assocaited with carditis/valvulitis in rheumatic fever?

A

Occurs mostly in kids and lasts long-term
30-60% of patients get this on first occurence
Effects pericardium, epicardium, myocardium, and valves
MITRAL VALVE IS MOST AFFECTED
Pericardial friction rub
New murmur
CHF symptoms

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64
Q

What are the symptoms associated with migratory arthritis?

A 
Lasts 4 weeks
Seen in older teens/adults
75% will get on first occurence
Asymmetric pattern
Large joints effected
Edema
Swollen joints
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65
Q

What are the symptoms associated with erythema marginatum?

A

lasts weeks to months
Seen in kids and rarely adults
10% will get on first attack
Non-pruritic, serpinginous erythematous eruption on the trunk
Effects trunk more than proximal extremities
Non-pruritic rash

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66
Q

What are the symptoms associated with sydenhaum chorea?

A 
Lasts 2-3 years
Seen in children and rarely in adults
Females are most likely to get this
25% will get on first occurence
Neurological and pyschological components
Abrupt rhythmic, purpseless movement
Emotionally labile
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67
Q

What are the symptoms associated with Subcutaneou nodules?

A 
Rare and assocaited with carditis
Persists for 1-2 weeks
Rare to get
Painless nodules over tendon sheaths
Occurs on elbows, wrist, ankles, and achilles
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68
Q

How do we diagnose Rheumatic fever?

A

Jones criteria

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69
Q

What is the Jones criteria?

A

Evidence of recent strep infection +

2 major

Or

1 major and 2 minor

Or

3 minor if recurrent

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70
Q

What are the major symptoms associated with Jones’ criteria?

A 
Migratory arthritis
Carditis/valvulitis
Sydenhaum chorea
Erythema marginatum
Subcutaneous nodules
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71
Q

What are the minor symptoms associated with Jones’ criteria?

A

Arthralgia
Fever
Elevated ESR or CRP
Prolonged PR interval

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72
Q

How are adults with rheumatic fever treated?

A

Pen VK 500mg twice a day for 10 days

Bed rest until fever is gone and labs/EKG normalize

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73
Q

How are children with rheumatic fever treated?

A

Pen VK 250 mg twice a day for 10 days

Bed rest until fever is gone and labs/EKG normalize

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74
Q

What is the secondary prophylaxis treatment for rheumatic fever?

A

PCN Benzathine G 1.2 million units IM every 4 weeks for

5 years without carditis or 10 years with carditis

75
Q

What is post-streptococcal glomerulonephritis?

A

Kidney injury caused by a strep infection from impetigo or sore throat that can cause nephritis

76
Q

What is nephritis syndrome?

A

inflammation of glomerulus

77
Q

Where is post-strep glomerulonephritis most common?

A

in developing countries

78
Q

What are the clinical manifestations of post-strep glomerulonephritis?

A 
Edema
Hematuria
Hypertension
Oliguria
Proteinuria
79
Q

What are some nonspecific symptoms associated with post-strep glomerulonephritis?

A

General malaise
Weakness
Anorexia
N/V

80
Q

How do we diagnose post-strep glomerulonephritis?

A

Urine dip and microscopy to test for hematuria/proteinuria and RBC casts
Streptozyme test
Rapid strep/strep culture
Renal function for increased BUN/Creatinine which would signify AKI

81
Q

What antigens does the streptozyme test test for?

A 
Anti-Dnase B
Antinicotinamide-adenine dinucleotiase (Anti-NAD)
Antistreptokinase (ASKase)
Antihyaluronidase (Ahase)
Antistreptolysin (ASO)
82
Q

How would we treat post-strep glomerulonephritis?

A 
Treat the underlying condition
Symptomatic/supportive care:
Restrict water and salt intake
\+/- diuretics for edema
HTN control with diuretics, CCB, and ACE's
Limit activity
\+/- dialysis if needed
83
Q

What is laryngitis?

A

inflammation of vocal fold mucosa and larynx

84
Q

What is the funciton of the larynx?

A

Voice

Prevent aspiration of food

85
Q

What is acute laryngitis caused by?

A 
VIRUS
bacteria
GERD
Environmental 
Vocal trauma
86
Q

How long is acute laryngitis?

A

Resolves in 7-10 days

87
Q

How long is chronic laryngitis?

A

> 3 weeks

88
Q

What are the clinical manifestations of laryngitis?

A

Hoarseness (dysphonia)
Preceding or concurrent URI symptoms like cough and rhinitis
Odynophonia
Odynophagia

89
Q

What is the treatment for laryngitis?

A

VOICE REST

inhaled humidifier

90
Q

What is the most common virus that causes Non-suppurative sialadenitis?

A

MUMPS

91
Q

What bacteria typically causes suppurative sialadenitis?

A

Staph aureus

92
Q

Which salivary duct most commonly is inflammed?

A

parotid duct

93
Q

What are the clinical manifestations of bacterial suppurative sialadenitis?

A

Sudden onset of pain, fever, and chills
Unilateral
Firm and tender
Expression of pus

94
Q

How do we diagnose sialadenitis?

A

Physical exam
MUMPS titer -RT PCR or serology if indicated
HIV RNA if indicated

If unclear or unimproved:
Ultrasound
CT face/neck
Sialadenoscopy

95
Q

How do we treat bacterial sialadenitis?

A 
Paraenteral or oral antibiotics --> nafcillin, dicloxacillin, Augmentin
Massage of duct
Warm compresses
Sialagogues
Surgical drainage if abscess develops
96
Q

What is chronic or recurrent sialadenitis?

A

Caused by obstruction (stone or stricture of duct)
Repeated episodes of pain, swelling, and recurrent infections
Swollen or firm gland; imaging revels calculus of dilated ducts
Treat with hydration, gland massage, sialedonscopy, or surgery and antibiotic

97
Q

What is neoplasm sialadenitis?

A

Benign or malignant
Painless, firm, slow growing
Imaging; CT or MRI; FNA
Surgical removal of gland

98
Q

What is autoimmune sialadenitis?

A

Caused by Sjogren’s
Gradual onset swelling bilateral parotid or submandibular
Lab work specific to Sjogren’s
Supportive treatment

99
Q

What is parotitis?

A

Acute-onset of parotid swelling lasting about 2 days

Parmyxoviral disease spread by respiratory routes like saliva, droplets, and fomites

100
Q

What is parotitis caused by?

A

exposure to MUMPS about 2-3 weeks before symptom onset

101
Q

Who are most effeced by parotitis?

A

Children but college students are now being seen with it due to waning immunity to vaccines

102
Q

What are the clinical manifestations of parotitis?

A

Bilateral parotid gland edema
Flu like prodrome 48 hours before
Unilateral testicular swelling and tenderness

103
Q

What are the complications of parotitis?

A

Deafness
Orchitis
Meningitis
Fetal congenital abnormalities

104
Q

How do we treat parotitis?

A 
Supprtive care:
Bed rest
Hydration
Sialagogues
Analgesia
warm or cold compresses on parotid
Testicular pain is treated with scrotal sling
105
Q

What are cancers of the oral cavity associated with?

A

Ulcers or masses that DO NOT HEAL

106
Q

What accounts for 80% of Squamous cell carcinoma of the head and neck?

A

Tobacco and Alcohol use

107
Q

What is aphthous stomatitis?

A

Canker sore

Painful oral lesion that often reoccurs

108
Q

What is the most common acute oral lesion?

A

Aphthous Stomatitis

109
Q

When do aphthous stomatitis usually develop?

A

First during adolescence and will wane with increasing age

110
Q

Where does aphthous stomatitis usually occur?

A

in middle east and south asia

111
Q

What type of aphthous stomatitis is most commoN?

A

simple aphthous

112
Q

What is simple aphthous (Mikulicz)?

A

Several episodes a year
May be 1 sore to several at a time
They can last up to 14 days
Limited only to oral mucosa

113
Q

What is a complex aphthous?

A 
Can be oral or genital
More numerous lesions will occur
Lesions are > 1 cm
Takes 4-6 weeks to resolve
So frequent that patients almost always have them
114
Q

What are aphthous stomatitis caused by?

A

Multifactorial causes that are often unknown

Immune dysregulation
Exaggerated proinflammatory process
Weak anti-inflammatory response
Possibel genetic predisposition
Certain foods can exacerbate them
May be seen in celiac disease, IBD, or Crohn’s
Conditions that cause decrease in mucosal thickening
Use of antimetabolites such as methotrexate for RA
Vitamin B12, folic acid, or iron deficiency
Neutropenia of any cause

115
Q

What are the risk factors of aphthous stomatitis?

A 
Smoking cessation
Familial tendency
Trauma like dental cleaning
Hormonal factors like progestin falling in luteal phase of menstrual cycle
Emotional stres
Food or drug hypersensitivity
Immunodeficiency
116
Q

What are the clinical manifestations of Aphthous stomatitis?

A 
1-5 can occur at one time
Round to oval shape
Clearly defined ulcers
Erythematous rim
Yellowish/whitish central space
Small, usually 1-3 cm
Painful
117
Q

How do we treat aphthous stomatitis?

A

Oral hygiene with non-alcohol mouthwash and soft toothbrush

Pain control–>
viscous lidocaine 2% applied directly or swish and spit
Diphenhydramine liquid swish and spit
Dyclonine lozenges

Topical steroids–>
Dexamethasone elixir swish and spit
Clobetasol gel
Triamcinolone paste

118
Q

How do we treat complex aphthous stomatitis?

A

Intralesional or oral glucocorticoids for recalcitrant lesions or severe disease:

Colchicine
Dapsone
Pentoxifylline as bronchodilator and immunomodulator
Thalidomide in HIV infected patients

119
Q

What is oral leukoplakia?

A

Benign reactive process

Clinical significance depends on degree of and presence of dysplasia

120
Q

What is the change that oral leukoplakia will progress to carcinoma in 10 years?

A

1-20%

121
Q

Who most commonly gets oral leukoplakia?

A

Men more than women
Those with HPV
Smokeless tobacco users

122
Q

What are the clinical manifestations of oral leukoplakia?

A

Leukplakic lesions that show up in trauma prone regions like the cheek and dorsum of tongue where mucosa is normally thicker

Thin areas of mucosa like ventral tongue or retromolar triangle show more dysplasia

Not painful

Whitish grey lesions

Flat

Not well defined

Can’t scrape off easily

123
Q

How do we treat oral leukoplakia?

A

Most won’t need treatment but if they do, surgery, cryoprobe, or chemoprevention

124
Q

What is oral hairy leukoplakia?

A

NOT premalignant
EBV associated
Occurs almost entirely in HIV affected patients

125
Q

Who is Herpes simplex virus (HSV-1) most common in?

A

women

126
Q

What are the characteristics of primary HSV-1 infection?

A

HIghly variable and usually severe and systemic

127
Q

What are the characteristics of recurrent HSV-1 infection?

A

Common but typically less severe and more local

128
Q

What are the clinical manifestations of HSV-1?

A

Herpetic gingivostomatitis
Multiple oral vesicular lesions and erosions surrounded by erythematous base
Painful
Prodromal of signs and burning, tingling, and pain will occur 24 hours prior to outbreak

129
Q

Where do recurrent outbreaks of HSV-1 usually occur?

A

on lip borders

130
Q

What are the symptoms that young children infected with HSV-1 will have?

A

Fever
LAD
Drooling
Decreased oral intake

131
Q

Where will sores be located in primary herpetic gingivostomatitis?

A

Inside of mouth

132
Q

Where will sores be located in recurrent herpetic gingivostomatitis?

A

On outside of mouth

133
Q

What are the risk factors for HSV-1?

A

Sunlight exposure
Stress
Trauma

134
Q

What labs could you get to confirm HSV-1?

A

Tzanck smear, immunofluorescent smear or viral culture

135
Q

How do we treat HSV-1?

A

Systemic antiviral –> Acyclovir, valacyclovir, or Famciclovir
Swish and spit miracle mouthwash
Supportive care
Popsicles for kids

136
Q

What is oral candida?

A

Common local infection involving oropharyngeal and esophageal mucous membranes

137
Q

Who most commonly gets oral candida?

A 
Young infants
Older adults who wear dentures
Those on antibiotics
Those on chemotherapy
Those on radiation of head and neck
Those that are immunodeficient
Those that have inhaled corticosteroids
Those with xerostomia
138
Q

What is oral candida caused by?

A

Candida albicans

139
Q

What is pseudomembranous oral candida?

A

White plaques on buccal mucosa, palate, tongue, and oropharynx

140
Q

What is atrophic oral candida?

A

Found around upper dentures and appear as erythema without papules

141
Q

What are the clinical manifestations of oral candida?

A 
Asymptomatic
Dry mouth
Loss of taste
Pain with swallowing or eating
White plaques on buccal mucosa, palate, or tongue
Erythema without placques in denture wearers
Painful swallowing if esophageal
Beefy, red tongue with denture wearers
Angula chelitis 
Painful fissuring
142
Q

How do we treat oral candida in healthy patients?

A

Local therapy
Nystatin suspension swish and swallow
Clotimazole troches
Miconazole buccal tabs

143
Q

How do we treat oral candida in immunocompromised patients?

A

Diflucan PO

144
Q

What structures are in the oropharynx?

A

Posterior 1/3rd of tongue
Soft palate
Lateral and posterior walls of throat
Tonsils

145
Q

What are the regions of the throat?

A

Nasopharynx
Oral cavity
Oropharynx
Larynx

146
Q

What are malignant neoplasms of head and neck?

A

Epithelial carcinomas of head and neck that arise from mucosal surfaces and are overwhelmingly Squamous cell carcinomca

147
Q

What are anterior cancers of head and neck caused by?

A

Tobacco and alcohol

148
Q

What are posterior cancers of head and neck caused by?

A

HPV 16 and 18

149
Q

What are anterior cancers of head and neck associated with?

A

nonhealing ulcers or masses

Dental changes or poorly fitting dentures

150
Q

WHo have a 3-8X greater risk of developing oral cancer?

A

moderate to heavy drinkers

151
Q

Who has a 30X greater risk for oral cancers?

A

extremely heavy drinkers

152
Q

Who has a 100X greater risk for oral cancers?

A

Heavy smokers and heavy drinkers

153
Q

Who has a 5-9X greater risk for oral cancers?

A

Smokers

154
Q

Who has a 17X greater risk for oral cancers?

A

heavy smokers

155
Q

What are the risk factors for oral cancers?

A

Smoking
Alcohol abuse
HPV infection
EBV infection

156
Q

Who most commonly get oral cancers?

A

males

157
Q

Who do HPV related oral cancers occur in?

A

younger patients usually in their 40s

158
Q

What are the clinical manifestations of posterior tongue cancers?

A

HPV 16
Does not produce visible lesions/discolorations
There are no warning signs
There will be erythema but no ulcers

159
Q

What are the clinical manifestations of Oral cavity cancers?

A

Lesions present as exophytic, ulcerative, and often painful

160
Q

What do 2/3rds of patients with primary tongue lesions also have?

A

nodal disease

161
Q

What is oral cavity squamous cell carcinoma usually proceeded by?

A

Leukplakia
Erythroplakia
Speckled Erythroplakia

162
Q

What is erythroplakia?

A

Red patch similar to leukoplakia except that is has erythematous components

163
Q

What is speckled erythroplakia?

A

Combination of red and white freatures
Fiery red patch taht cannot be identified clinically/pathologically as any other definable disease
Will show evidence of high grade dysplasia, carcinoma in situ, or invasive SCC
Lesions appear as red, velvety patho that is often demarcated
Some lesions may have rough, granular surface

164
Q

What are the clinical manifestations of oral cavity squamous cell carcinoma?

A

Painless
can appear as ulcer without adjacent mucosal change
Continued growth can result in a mass with raised, rolled borders
Pain/tenderness often will develop but later in the disease

165
Q

What is the most common site of oral squamous cell carcinoma?

A

Tongue

166
Q

What is the second most common site of oral cavity squamous cell carcinoma?

A

Floor of mouth

167
Q

Where do the vast majority of tongue lesions in OC-SCC occur?

A

lateral and ventrolateral aspects

168
Q

Where does oralpharyngeal squamous cell carcinoma develop?

A

Tonsillar region and base of tongue

169
Q

What are the clinical manifestations of oropharyngeal squamous cell carcinoma?

A

Appear as ulcerated mass, fullness, or irregular erythematous mucosal changes
Presents at more advanced stage as it grows undetected and has higher propensity for metastasis
Presene of neck mass
Sore throat
Dysphagia

170
Q

What are the clinical manifestations of SCC with leukoplakia?

A

Rough, papillary patch of leukoplakia seen in retromolar trigone and soft palate
Large size and nonhemogenous nature of lesions worrisome for malignancy
Biopsy shows invasive SCC

171
Q

What are symptoms of oral cavity cancers?

A 
pain that will occur in stage 3 or 4
Otalgia
Dysphagia
Odynophagia
Airway obstruction
Neuropathies
172
Q

What are the signs of oral cavity cancers?

A 
Cervical LAD
Cranial neuropathies
Decreased tongue mobility
Fistulas
Skin involvement
173
Q

Where can oral cancer occur in oral cavity?

A 
lips
tongue
floor of mouth
Maxillary alveolar ridge/hard palate
Mandibular alveolar ridge
Buccal vestibules
174
Q

Where can oral cancer occur in oropharynx?

A

Tongue base
Soft palate
Palatine tonsils
Posterior wall of pharynx

175
Q

Where can oral cancer occur in hypopharynx?

A

Piriform sinuses and postcricoid area leading into esophagus below

176
Q

Where can oral cancer occur in larynx?

A

Supraglottis (epiglottis and false vocal cords)

Cancers here will spread to lymph nodes early

177
Q

Where can oral cancer occur in glottis?

A

true vocal cords

Presents with hoarseness

178
Q

What are some later symptoms of oral cancer?

A 
Bleeding
Loosening of teeth
Difficult wearing dentures
Dysphagia
Dysarthria
Hoarseness
Development of a neck mass
179
Q

How do we figure the extent of oral cancers?

A

Contrast or noncontrast CT scan of neck and head

180
Q

What are the three clinical groups for treatment of oral cancers?

A

Localized disease
Locally or regionally advanced disease
Recurrent and/or metastatic disease

181
Q

How do we treat localized oral cancers?

A

Curative intent by either surgery or radiation

182
Q

How do we treat locally or regionally advanced disease?

A

Curative intent but with combined modality therapy using:
Surgery
Radiation therapy
chemotherapy

183
Q

How do we treat recurrent and/or metastatic oral cancer?

A

Treated with palliative care

THis can’t be cured so radiation and chemo just extend the patients life for a few months and relieve the pain

184
Q

Which oral cancer has the best overall 3 year survival rate?

A

Those caused by HPV

Clinical Medicine I (15 decks)

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