Tieman CIS Flashcards
what do we need to worry about with swelling in the upper GI/ oral cavity?
airway!
Have a low threshold for intubation
What are people probably put on for tooth infection if they have penicillin allergies?
clindamycin
trismus
when people can’t open their mouth really wide
respiratory rate where we think of respiratory failure?
30
ace inhibitors are notorious for causing
angio-edema
other drugs that cause angio-edema
ARBs, direct thrombin inhibitors
guy with swelling in his lips and cheeks, what’s a differential?
anaphylaxis
drug-induced angio-edema
ludwig’s angina- subglottic abscess from tooth infection
hereditary angio-edema
allergic stuff would often involve what?
urticria
hives
etc.
what substance causes angio-edema in allergic?
histamine
what substance causes angio-edema in drug-induced?
bradykinin
in hereditary, bradykinin is built up due to deficiency in C1 esterase inhibitor
white spot in the mouth, what?
candida– with history of antibiotic use, esp.
leukoplakia– can’t scrape. Think of cancer.
dysplasia vs carcinoma
through the basement membrane is carcinoma
sore throat
think of viral pharyngitis, tonsillitis
mono (EBV)- difference is lymphadenopathy here
pus on tonsils- tonsillitis. Do a rapid strep test (group A beta-hemolytic strep usually causes strep, treat with a penicillin)
classification of tonsils
Class I- still behind tonsillar pillar
Class II- up to the pillar
Class III- beyond the pillar
Class IV- to the midline
criteria for tonsillectomy
chronic infections
7 in one year or 5/year for 2 years or 3/year for 3 years
Theory: most kids will outgrow the tonsillitis
we believe the tonsils have some immune function
mass near the angle of the mandible. What lives there?
parotid
lymph nodes
bone tumor
night sweats, weight loss
beta symptoms of lymphoma
indicate a more widespread disease
painful mass (at angle of mandible) indicates
could be infection
Stone (sialolithiasis)
invasion into the facial nerve
cutoff of size of head and neck tumors
2 cm is the difference between class 1 and 2
parotid tumors- prognosis?
85% are benign, mixed tumors
treat by excising
asthma and GERD
always think about the other when a pt presents with one (adult onset)
GERD and weight
obese people get it more often
GERD diagnosis
PE usually non-specific
lab usually not helpful
dx testing– usually trial of PPIs- 80% sensitivity and specificity for GERD if response in 2 weeks or less
EGD
Barium esophogram- should be done initiallly if “alarmm symptoms” present
esophageal pH monitoring and symptom recording,
esophageal motility studies
6 months later recurrence of epigastric pain and episodes of difficult and painful swallowing.
What do we do now?
EGD and barium swallow
usually do them both; they give you different information
