Week 2 Flashcards
1
Q
8-10% of 5-7 yo have ____ when diagnosed with ___
A
sinusitis, URI
2
Q
Which is more common, more severe: Viral or Bacterial sinusitis?
A
Viral - more common
Bacterial - more severe
3
Q
What are the three types of rhinosinusitis?
A
Viral, Bacterial, Fungal
4
Q
What are predisposing factors for rhinosinusitis?
A
decongestants, fatigue, dental problems, food sensitivities, GI issues, septal deviation, large adeonoids, foreign bodies
5
Q
What are the distinguishing features between acute and chronic rhinosinusitis?
A
duration of symptoms (3 wks is cut-off), aggressive symptoms (fever, facial pain) not as apparent in chronic cases
6
Q
What is purulent discharge?
A
discharge filled with pus, yellowish color
7
Q
What are the two most important complications possible with rhinosinusitis?
A
orbital/periorbital cellulitis, cavernous sinus thrombosis
8
Q
What are symptoms of cavernous sinus thrombosis?
A
high fever, chills, prostrated, comatose, change in mental status
9
Q
What are the early signs of cavernous sinus thrombosis?
A
deep eye pain, ocular palsy (III, IV, VI), diplopia
10
Q
What are the late signs of cavernous sinus thrombosis?
A
both eyes involved, edema, death within 2-3 days
11
Q
What is a common, non-dangerous sequellae to rhinosinusitis?
A
Upper Airway Cough Syndrome (UACS, post-nasal drip)
12
Q
What might you find on a PE for UACS?
A
tonsilloliths, cobblestoning of oropharyngeal mucosa, tenderness of sinuses
13
Q
What symptoms are never seen in patient with allergic?
A
fever, ms pain
14
Q
What symptom is common to URI, allergy, and influenza?
A
nasal discharge
15
Q
What condition is commonly found underneath the tongue?
A
squamous cell carcinoma
16
Q
What condition is commonly found at the back/root of the tongue?
A
tongue cancer
17
Q
Important things to ask for history for oral cavity/throat/neck
A
date of last dental exam, diet, hygiene habits, history of smoking/alcohol/drug use, history of x-ray of head/neck
18
Q
What does the oral exam entail?
A
inspection (tongue blade + light source), palpation if indicated (gloves)
19
Q
What condition can fetor oris be associated with?
A
appendicitis
20
Q
What symptom is very common in URIs?
A
sore throat
21
Q
Fever: URI, allergy, influenza
A
URI: low grade possible, allergy: never, influenza: very common (100-102)
22
Q
Headache is rare for (URI, allergy, influenza)?
A
URI
23
Q
Headache: URI, allergy, influenza
A
URI: rare, allergy: uncommon, influenza: common
24
Q
Cough: URI, allergy, influenza
A
URI: common, allergy: sometimes, influenza: common dry cough
25
MS Pain: URI, allergy, influenza
URI: slight, allergy: never, influenza: very common
26
Malaise: URI, allergy, influenza
URI: sometimes, allergy: sometimes, influenza: very common
27
Sore Throat: URI, allergy, influenza
URI: very common, allergy: sometimes, influenza: sometimes
28
Sneezing: URI, allergy, influenza
URI: common, allergy: common, influenza: sometimes
29
Lacrimation: URI, allergy, influenza
URI: rare (conjunctivitis), allergy: common, influenza: soreness behind eyes
30
Is lacrimation common in URI?
rare, conjunctivitis
31
Sweet breath can be indicative of ___.
diabetic ketoacidosis
32
Faintly sulfurous breath can be indicative of ____.
liver failure
33
Ammonia breath can be indicative of ____.
renal failure
34
What are possible causes of xerostomia?
mouth breathing, dehydration, diuretics, salivary disease, sialoliths, sjogren's syndrome
35
Deviation of uvula is always indicative of cranial nerve dysfunction (T/F)
False, uvula deviation can be normal. Focus on symmetrical elevation of soft palate.
36
Abnormal deviation is related to cranial nerve ___.
XII (hypoglossal nerve)
37
What does a CBC tell us?
count/quality of WBC, count/quality of RBC
38
What are symptoms of B12 deficiency seen in the tongue?
beefy red, enlarged, soreness
39
Classic presentation of recurrent herpes labialis?
prodromal sensations where lesion previously appeared, painful vesicle appears and erupts, ulcer remains, crusts over, heals
40
Characteristics of recurrent herpes labialis?
viral infection, high incidence, contagious, episodes of painful blisters on the lip
41
Type of herpes most commonly linked to herpes of the mouth?
HSV-1
42
Reactivation triggers: recurrent herpes labialis
UV light, fatigue, trauma, stress, menstruation
43
When should you be concerned with autoinnoculation (w/ herpes)?
when it spreads the eyes
44
Prodromal symptoms: herpes
itching, burning, tingling lasting approximately 12-36 hours
45
Etiology: Carcinoma of the lips
tobacco, alcohol, sunlight, poor oral hygiene, poorly fitting dentures
46
Characteristics of the lesions present with SCC?
painless, well-demarcated, elevated, indurated border with ulcerated base, verrucous/plaque-like
47
Prognosis: carcinoma of the lips
slow-growing, poor healing, bleeding probable, high risk of metastasis
48
Morphology: mucocele
soft cyst, mucin-fileld cavity, can appear red/purple, movable
49
Location: mucoceles
lips, under tongue
50
What is another name for mucoceles?
ranula
51
In what patient population are mucoceles most common?
< 20 years
52
Etiology: Chelitis
use of retinoids, wind-burn, allergies
53
What is chelitis?
erythema and scaling of the lips
54
What is angular chelitis?
inflammatory lesion at the labial commissure, often bilateral
55
What is an inflammatory lesion at the labial commissure that is often bilateral?
angular chelitis
56
What are the signs and symptoms of angular chelitis?
deep cracks, bleeding/splitting if severe, shallow ulcers
57
Angular chelitis lesion can become infected by ___
candida albicans, staph aureus
58
What are some conditions where secondary lesions can appear?
measles, scarlet fever, pellagra, scurvy, erythema multiforme, syphilis, uremia
59
Pellagra is a deficiency of ____
vitamin B3
60
A smooth fiery tongue and painful mouth can be symptoms of ____.
Pellagra
61
What conditions can present with painless lesions?
oral lichen planus, syphilis, mucocele, scc
62
Morphology: oral lichen planus
lace-white patches/papules/streaks on the buccal mucosa (Wickham striae), erosions on the gingival margin
63
Is oral lichen planus contagious?
No
64
Morphology: leukoplakia
white patches/plaque on oral mucosa, cannot be rubbed off; patches can be darker esp with heavy tobacco use; vary in thickness
65
What is a key difference between leukoplakia and candida?
candida can be rubbed off, leukoplakia cannot
66
Etiology: leukoplakia
AIDS, tobacco use, oral sepsis, alcoholism, vitamin deficiency, syphilis, dental galvanism, actinic radiation (w/ lip involvement), trauma, endocrine disturbance
67
Leukoplakia always signifies a malignancy (T/F).
false, leukoplakia is also seen in inflammatory conditions; only 20% of lesions progress to cancer in 10 years
68
Sex/Age: leukoplakia
M > F, ~90% > 40 yo
69
What PE should be done if leukoplakia is suspected?
lesion cannot be wiped away with gauze, cervical lymphadenopathy
70
What are concerning signs when palpating lymph nodes?
hard, immovable, painless, large/getting larger
71
Where are the most common locations for finding leukoplakia?
tongue, mandibular alveolar ridge, buccal mucosa in > 50% of cases
72
DDx: leukoplakia
candidiasis, aspirin burn, erythroplakia, dysplastic lesion
73
Morphology: erythroplakia
red macule, well-demarcated, soft texture
74
Common location: erythroplakia
floor of mouth, tongue, palate
75
What are risk factors for erythroplakia?
smoking, alcohol
76
What are risk factors for Oral SCC?
smoking (90% of pts w/ SCC), alcohol
77
Common locations (3): Oral SCC
Floor of mouth, lateral/ventral surface of tongue (40%), lower lip (38%), palate/tonsillar area (11%)
78
Is Oral SCC always painless?
No, ulcerated lesions can be painful
79
What can be the first symptom of oral SCC?
metastatic mass (non-tender) in the neck
80
Morphology: oral SCC
may appear as erythroplakia/leukoplakia, exophytic or ulcerated, rolled border
81
Morphology: melanoma
pigmented lesions, asymmetric, irregular borders, variable coloration, increasing diameter, doesn't blanch
82
DDx: melanoma
melanosis (symmetric lesions in individuals with dark skin), oral melanotic macules (symmetric, stable, sharply delimited dark macules on lips/oral mucosa)
83
Morphology: Fordyce's spots
multiple, white-to-yellow, 1-2 mm papules, often in a cluster opposite molars
84
Location: Fordyce's spots
vermillion/buccal mucosal border, inner surface of lips, retromolar region, tongue, gingiva, frenulum linguae, palate
85
What are Fordyce's spots?
asymptomatic, benign neoplasms from sebaceous glands
86
Sex/Age: Fordyce's spots
M = F, 20-30 years
87
DDx: Fordyce's spots
candida albicans (Fordyce's spots do not rub off)
88
What is stomatitis?
inflammation of oral tissue from local/systemic disease that may be accompanied by foul breath/mucosal bleeding
89
Risk factors: oral candidiasis
dentures, diabetes, antibiotics, chemotherapy/radiation, HIV/AIDS, inhaled glucocorticoids
90
Oral candidiasis is common in ____
infants
91
Diagnosis of oral candidiasis can be confirmed with ____
KOH prep
92
Morphology: oral candidiasis
lesion, slightly raised, white plaques, hyperemic, soft-looking, easily wiped away, mouth appears dry
93
What is recurrent aphthous stomatitis?
"canker sores", acute, painful, recurring, solitary/multiple necrotizing ulcerations of the oral mucosa
94
What is the most common trigger of recurrent aphthous stomatitis?
trauma
95
What are two conditions with similar prodromal symptoms (burning/tingling)?
herpes and canker sores
96
DDx: recurrent aphthous stomatitis
secondary herpetic ulceration, Crohn's, neutropenia, sprue, trauma, pemphigus vulgaris, cicatricial pemphigoid
97
What is the medical term for cold sores and what is their main cause?
herpetic gingivostomatitis, HSV-1
98
What is a macule?
lesion within the dermis, < 1 cm
99
What is a patch?
lesion within the dermins, > 1 cm
100
What is a papule?
raised, solid lesion < 1 cm
101
What is a plaque?
raised, solid lesion > 1 cm
102
What is a vesicle?
superficial, palpable lesion filled with fluid, < 1 cm
103
What is a bulla(e)?
superficial, palpable lesion filled with fluid, > 1 cm
104
What are different ways to classify mouth lesions?
painful/painless, type of lesion, coloration, size, benign/cancerous/precancerous
105
What is the classic sign of erythema multiforme?
target lesions on the skin
106
Morphology: aphthous stomatitis
shallow, round/oval lesions with grayish base and red border
107
What is the classic sign of erythema multiforme?
target lesions on the skin
108
Sx: aphthous stomatitis
painful lesions, occasionally have prodromal burning/tingling
109
abbreviation: NT
non-tender
110
abbreviation: TTP
tender to palpation
111
Location: aphthous stomatitis
non-keratinized, moveable mucosa (buccal/labial mucosa, buccal/lingual sulci, ventral tongue, soft palate, floor of mouth)
112
DDx: aphthous stomatitis
secondary herpetic ulceration, pemphigus vulgaris, cicatricial pemphigoid, Crohn's dz, neutropenia, sprue
113
Sx: herpetic gingivostomatitis
prodromal pain/burning/tingling, painful eruption of unmovable oral mucosa and vermilion border, fever, malaise, LA, painful eating
114
DDx: herpetic gingivostomatitis
aphthous stomatitis, erythema multiforme, drug eruptions, pemphigus
115
Prognosis: herpetic gingivostomatitis
self-limited to 1-2 weeks, recurrent infxs as virus goes into latency
116
Sx (kids): herpetic gingivostomatitis
fever, LA, drooling, pain, dehydration due to decreased oral intake
117
Labs: herpetic gingivostomatitis
Tzanck smear, direct immunofluorescence smear, viral culture
118
Differences (symptoms): aphthous stomatitis and herpetic gingivostomatitis
In addition to painful lesions, herpes lesions can also have accompanying symptoms (fever, malaise, LA)
119
Differences (location): aphthous stomatitis and herpetic gingivostomatitis
herpes lesions can appear on the vermilion border and unmovable mucosa, while canker sores will always appear inside the oral cavity (unmovable and movable mucosa)
120
Differences (morphology): aphthous stomatitis and herpetic gingivostomatitis
herpes lesions will often have crusting
121
DDx: oral erythema multiforme
aphthous stomatitis, allergic stomatitis, pemphigus, herpes
122
Similarities: aphthous stomatitis and herpetic gingivostomatitis
painful/recurrent lesions, prodromal sxs (burning/tingling), common triggers (stress/fatigue), often self-limited
123
Morphology: oral erythema multiforme
diffuse hemorrhagic vesicles and bullae, erythmatous base; bullae often rupture leaving raw, friable surface which then form crusts
124
Location: oral erythema multiforme
lips and mucosa
125
Sx: oral erythema multiforme
painful stomatitis; systemic: maculopapular erythematous lesions (target lesions) on the skin; sinusitis, rhinitis, high fever (may be prodromal)
126
What is a chancre?
painless ulceration formed during primary stage of syphilis
127
Location: chancre
on/around lips, tongue, anus, penis, vagina
128
Morphology: chancre
single ulcerated lesion, indurated border, no central necrotic tissue
129
What is important on the physical exam when a chancre is found?
examine for genital lesions as well
130
Sx: chancre
painless lesion, tender cervical LA
131
Prognosis: chancre
resolve in 2 wks to 3 mos without treatment
132
Lab: chancre
PCR serology
133
Etiology: oral erythema multiforme
hypersensitivity rxn to HSV, drugs, other organisms
134
Morphology: frictional hyperkeratosis
hyperkeratotic white lesion leading to white line called linea alba if caused by biting
135
If the cause of frictional hyperkeratosis is unknown, ____
consider the lesion an idiopathic leukoplakia and obtain a biopsy
136
Etiology: frictional hyperkeratosis
chronic friction against oral mucosal surface
137
Etiology: epulis fissura
chronically ill-fitting dentures
138
Location: epulis fissura
vestibular or anterior maxillary mucosa
139
SSx: acute suppurative rhinosinusitis
persistent cold nasal congestion, purulent drainage, facial pain with headache, dental pain, altered smell
140
Persistent or worsening symptoms for a patient with acute suppurative rhinosinusitis may indicate ____
developing bacterial sinusitis
141
For children with acute suppurative rhinosinusitis, complaints of ____ (2) are rare
facial pain, headache
142
Sx (maxillary): acute suppurative rhinosinusitis
dull, throbbing pain in cheek; tender, painful maxillary teeth; tenderness over maxilla
143
When there is tender, painful maxillary teeth and you suspect rhinosinusitis, rule out ____
infected tooth
144
Sx (frontal): acute suppurative rhinosinusitis
tenderness over forehead area, swelling of eyelids, frontal headache
145
Sx (ethmoid): acute suppurative rhinosinusitis
pain more medial to eye, feels deep in head or eye, splitting headache on one side, swelling of eyelids
146
Sx (sphenoid): acute suppurative rhinosinusitis
pain behind eye or in occiput or vertex, deeper pain, not local tenderness
147
PE: acute suppurative rhinosinusitis
purulent secretions in the middle meatus, facial tenderness, complete opacification of sinus on transillumination
148
Purulent secretions in the middle meatus is highly predictive of ____
maxillary sinusitis
149
Fever is (common/rare) in patients with acute suppurative rhinosinusitis
rare, < 2% of cases
150
Etiology: chronic suppurative rhinosinusitis
S. pneumoniae, H. influenzae, M. catarrhalis (> 70% of cases)
151
PE (eye exam): chronic suppurative rhinosinusitis
conjunctival congestion, lacrimation; check for extraocular muscle palsies and visual disturbances
152
PE (nose exam): chronic suppurative rhinosinusitis
nasal mucosa erythema, edema, purulent secretions; check for nasal obstruction and polyps
153
PE: chronic suppurative rhinosinusitis
pain/tenderness over frontal/maxillary sinuses, oropharyngeal erythema, purulent secretions; check for dental caries
154
What are common viral etiologies for URIs?
rhinovirus, coronavirus, parainfluenza virus, adenovirus, respiratory syncytial virus
155
What is the most common bacterial etiology for pharyngitis?
strep. pyogenes
156
Etiology: mucocele
minor injury to ductal system of minor labial or sublingual salivary gland due to trauma
157
Sx: mucocele
painless cyst
158
Prognosis: mucocele
surgical removal, rarely goes away on its own
159
What is a lab to conduct for angular chelitis?
KOH prep to check for Candida infx
160
If oral lichen planus is chronic, it can increase the risk for ____
oral cancer
161
8 conditions which present as white oral lesions that cannot be wiped away with gauze
oral lichen planus, SLE, white sponge nevus, SCC, leukoedema, frictional keratosis, leukoplakia, Fordyce's spots
162
When does leukoplakia become a concern?
when dysplasia or anaplasia are evident
163
Erythroplakia is found to be cancerous in ___
40% of cases
164
Melanoma is often diagnosed at ____
later stages
165
Sx: epulis fissura
painless folds of fibrous CT, may be erythematous/ulcerated but usually not highly inflammed
166
Morphology: denture sore spot
small ulcer with overlying grayish necrotic membrane and surrounding inflammatory halo
167
Prognosis: denture sore spot
painful, but will usually heal quickly once dentures are removed
168
____ are though to play a major role in 90% of denture sore mouth cases.
fungi
169
What is denture stomatitis?
common condition where mucosa underneath denture becomes erythematous and swollen with sever burning sensation being common
170
What is the most common benign oral soft tissue neoplasm?
irritation fibroma
171
Age/Sex: irritation fibroma
M=F, usually ages 20-49
172
Location: irration fibroma
buccal mucosa, lateral border of tongue, lower lip
173
Morphology: irritation fibroma
sessile or pedunculated swelling, firm/resilient or soft/spongy, < 1 cm, color slightly lighter than surrounding mucosa
174
Sx: irritation fibroma
painless lesion
175
DDx (tongue): irritation fibroma
neurofibroma, neurolemmoma, granular cell tumor
176
DDx (lower lip/buccal mucosa): irritation fibroma
lipoma, mucocele, salivary gland tumor
177
What is angioedema?
acute swelling of the skin (esp hands), mucosa, and submucosal tissues
178
Etiology: angioedema
allergy, infx, illness (autoimmune, leukemia)
179
SSx: angioedema
painless, non-pruritic (if non-allergic), non-pitting, well circumscribed areas of edema
180
When is angioedema dangerous?
when swelling obstructs the airway
181
What is urticaria and its relation to angioedema?
itchy, raised bumps that can develop if angioedema is allergy-related
182
What is hereditary angioedema?
rare, autosomal-dominant inheritance, presenting as edema in the face, airway passages, hand, feet
183
85% of hereditary angioedema cases are deficiencies of ____
C1 esterase inhibitor
184
What is the difference between angioedema and hereditary angioedema?
hereditary angioedema - painful edema (not pruritic b/c no allergy), recurrent attacks, concomitant symptoms - abdominal pain, vomiting, weakness, rash, and diarrhea
185
What is a palatal or mandibular torus?
non-neoplastic, slow-growing nodular protuberance of bone.
186
Age: palatal/mandibular torus
shortly before 30
187
What is a hemangioma?
proliferation of blood vessels
188
Age/Sex: hemangioma
F > M, 85% of lesions develop by end of first year, often congenital
189
Morphology: hemangioma
flat or raised, deep red or bluish-red color
190
Location: hemangioma
lips, tongue, buccal mucosa and palate
191
DDx: hemangioma
arteriovenous fistula (more likely if history of trauma)
192
What is a papilloma?
papillary and verrucal growths, composed of benign epithelium and small amount of connective tissue
193
What does verrucous mean?
wart-like
194
Etiology: papilloma
HPV
195
Morphology: papilloma
well-circumscribed, usu pedunculated growths with numerous, finger-like projections, < 1 cm in diameter, usu solitary
196
Location: papilloma
intraoral mucosa and vermillion border of the lips, palates, uvula, tongue
197
Papillomas are most common where?
soft or hard palate
198
DDx: papilloma
verruciform xanthomas, warty dyskeratoma, condylomata acuminata
199
Difference between papilloma and verruciform xanthomas?
verruciform xantomas have a distinct predilection for gingiva and alveolar ridge
200
Difference between papilloma and warty dyskeratoma?
warty dyskeratoma tend to occur as multiple lesions
201
Difference between papilloma and condylomata acuminata?
condylomata acuminata are usually larger and multifocal with a broader base
202
What is a lipoma?
painless, benign, slow-growing mass of adipose tissue
203
Location: lipoma
cheek, tongue
204
Morphology: lipoma
yellow, NT, rubbery/soft, mobile
205
Etiology: lipoma
hereditary, trauma
206
Lipomas, if large, can affect ____
speech
207
What are varicosities?
dilated, tortuous veins in the oral cavity
208
Location: varicosities
ventral aspect of the tongue, upper/lower lips, buccal mucosa, buccal commissure
209
Etiology: varicosities
increased hydrostatic pressure and poor support by surrounding tissues
210
Morphology: varicosities
blue in color, blanch when compressed
211
Varicosities can occasionally be accompanied by ____
thrombosis
212
What is sialadenitis?
painless benign swelling of the salivary glands
213
Sialadenitis is seen in what conditions?
hepatic cirrhosis, sarcoidosis, neoplasms, infections, mumps
214
What is sialolisthesis?
salivary duct stones which cause pain/swelling associated with eating
215
Where is sialolisthesis commonly found?
submandibular gland
216
What is Sjogren's syndrome?
systemic inflammation associated with dry eyes, mouth and mucus membranes
217
What is gingivitis?
inflammation of the gums with redness, swelling, changes in contours, pocket formation, watery exudate, bleeding
218
Gingivitis is commonly seen in ____ (2)
puberty, pregnancy
219
Etiology: gingivitis
poor oral hygiene, malocclusion, dental calculi, food impaction, faulty dental restorations, mouth breathing
220
The most common cause of gingivitis is ____
poor oral hygiene
221
What drug is known for causing gingival hypertrophy?
dilantin
222
Morphology: gingivitis
swollen, bright-red/purple gums, receding gum line, bleeding easily, itching
223
Gingivitis can be the first sign of a systemic dz such as _____
DM, leucopenia, endocrine disorder
224
sesame oil, CoQ10, probiotics can be effective in preventing ____
gingivitis
225
What is Vincent's angina?
acute infection of the gingiva
226
Etiology: vincent's angina
fusiform bacteria and spirochetes, poor oral hygiene, stress, malnutrition, alcohol/tobacco use
227
Morphology: vincent's angina
"punched out" lesions with gray membrane, bleeding easily, ulcerated lesions of the interdental papillae
228
What is periodontitis?
infection of the periodontium causing inflammation of the periodontal ligament, gingival, cementum and alveolar bone
229
Etiology: periodontitis
progressive gingivitis
230
Risk factors: periodontitis
DM, leukemia, Down's, Crohn's, poor hygiene
231
Periodontitis is painless unless ____
acute infection
232
Sx: periodontitis
pain with chewing, food impaction, tooth may be tender to percussion, visible plaque, red swollen gums, exudate, easily bleeding gums
233
What are caries?
tooth decay, enamel erosion
234
What are concomitant symptoms of dental caries?
headache, fever, swelling, tenderness in floor of mouth, cranial nerve abnormalities
235
What are conditions which can cause toothache?
caries, periodontitis, wisdom teeth, teething, sinusitis
236
What is an apical abscess?
infection into the root of a tooth
237
What is Ludwig's angina?
cellulitis of mouth floor
238
What is cavernous sinus thrombosis?
staph/strep infection in the cavernous sinus leading to development of a blood clot
239
Sx: Ludwig's angina
swelling, malaise, fever, dysphagia, stridor
240
Difficulty moving the tongue is most often caused by ____ (3)
nerve damage, nerve root disorder, cancer
241
What is ankyloglossia?
short frenulum
242
When CN ___ is damaged, the tongue will ___
XII, deviate to the paralyzed side
243
What is ageusia?
loss of taste
244
What is dysgeusia?
abnormal taste
245
What can cause taste dysfunction?
Bell's palsy, B3/Zn deficiency, MS, damage to facial nerve or glossopharyngeal nerve
246
What is hairy tongue?
benign, painless condition of the tongue where the distal third of the tongue appears hairy due to hyperplasia of papillae
247
Etiology: hairy tongue
AIDS, coffee, tobacco, oral hygiene, antibiotics, alcohol, prednisone, estrogen, mouthwashes, candida, aspergillis
248
What is burning tongue syndrome?
feeling experienced by some women after menopause
249
In addition to infections and irritations, what other 2 conditions can cause tongue pain?
glossitis and geographic tongue
250
Etiology: tongue tremor
hyperthyroidism, nervousness, alcoholism, paresis, drug dependence, debilitation, neurological dz, insecticides
251
When there is a dry tongue w/o furrows, consider ___.
Sjogren's syndrome
252
When there is a dry tongue w/ furrows, consider ____
dehydration
253
What is glossitis?
acute or chronic inflammation that can be primary or secondary
254
Etiology: glossitis
bacterial or viral infx, poor hydration, mechanic irritation, irritants, allergic rxn, dentures, iron deficiency, B-vitamin deficiency, erythema multiforme, pemphigus vulgaris, pernicious anemia, oral lichen planus, aphthous ulcer, syphilis
255
Sx: glossitis
tongue swelling, beefy red tongue, sore/tender tongue, difficulty chewing, swallowing, speaking
256
With chronic inflammation of the pharynx, consider ____
malignancies
257
What is the most common cause of acute pharyngitis?
viral infections (~90%)
258
What is the most common viral infx for acute pharyngitis?
adenovirus
259
Etiology: infectious mononucleosis
EBV, sometimes CMV
260
Sx: infectious viral mononucleosis
LA, exudative tonsillitis, redness/swelling of throat, splenomegaly, fatigue, weight loss, hepatitis
261
Lab findings (CBC): infectious mononucleosis
lymphocytosis, atypical lymphocytes, monospot
262
What is the most common cause of bacterial pharyngitis?
group a streptococcus (GAS)
263
Sx: infectious bacterial pharyngitis
LA, red/inflamed throat, unilateral, fever, headache, myalgia, arthralgia
264
What is the most significant difference between bacterial and viral pharyngitis?
bacterial pharyngitis progresses more rapidly than viral infections
265
What is the Modified Centor Criteria?
diagnostic test for GAS pharyngitis
266
In the modified centor criteria, a point is given for ____(4)
absence of cough, tender ant cervical adenopathy, tonsillar exudate, history of fever
267
If a patient scores > 3 on the modified centor criteria, ____
treat empirically with antibiotics
268
What are two diagnostic techniques for GAS pharyngitis?
throat culture, rapid strep
269
Non-group streptococcus is not associated with ____
rheumatic fever
270
Morphology: diphtheria
dirty gray, tough fibrous membrane in tonsillar area
271
Complications: diphtheria
myocarditis, nervous system toxicity
272
If diphtheria is diagnosed, ___
report to the health department
273
Compare prevalence: viral/bacterial/fungal pharyngitis
Viral, bacteria, fungal (most to least common)
274
Compare fever: viral/bacterial/fungal pharyngitis
Viral - low, bacterial - mid, fungal - none
275
Compare nodes: viral/bacterial/fungal pharyngitis
Viral - little change, bacterial - common LA, fungal - occasional LA
276
Compare pain: viral/bacterial/fungal pharyngitis
bacteria - most painful
277
Compare erythema: viral/bacterial/fungal pharyngitis
bacterial - most erythema
278
Chronic tonsillitis is almost always caused by ___
bacterial infection (GAS)
279
DDx: tonsillitis
diphtheria
280
Sx: tonsillitis
sudden onset, fever, malaise, vomiting, enlarged tonsils w/ purulent exudate, fetid breath, fibrotic in chronic cases
281
What are tonsilloliths?
whitish-yellow deposits produced by bacteria feeding on mucus; "tonsil stones"; pungent odor
282
Complications: tonsillitis
peritonsillar abscess, tonsilloliths, hypertrophy of the tonsils
283
Location: peritonsillar abscess
between tonsil and pharyngeal constrictor muscles
284
Sx: peritonsillar abscess
fever, malaise, headache, hot potato voice, dysphagia, LA, referred ear pain, breath odor, tonsillar edema, displaced uvula toward unaffected side
285
Location: parapharyngeal abscess
lateral to superior constrictor muscle, close to carotid sheath
286
Sx: parapharyngeal abscess
swollen ant triangle in the neck, throat may appear normal
287
Why is retropharyngeal abscesses emergencies?
airway obstruction
288
What is velopharyngeal insufficiency?
incomplete closure of the sphincter between the oropharynx and nasopharynx, resulting in impaired deglutition and speech
289
What is the most common type of cancer in the head and neck?
laryngeal squamous cell cancer
290
The most common site of laryngeal SCC is ____
true vocal chords
291
The most common cause of vocal chord contact ulcers is ____
gastric reflux
292
What is important when diagnosing epiglottis?
DO NOT try to visualize throat. Look for "thumbprint sign" on X-ray
293
DDx: epiglottitis
croup, peritonsillar abscess, retropharyngeal abscess
294
Epiglottitis is a ___ infection of the epiglottis most often caused by ____
bacterial, H. influenzae type B
295
What is epiglottitis an emergency?
symptoms are rapidly progressive and swelling can lead to cyanosis and asphyxiation
296
Epiglottitis typically affects ____
children, aged 2-5
297
Sx: epiglottitis
fever, dysphagia, drooling, stridor, shallow breathing
298
What is laryngitis?
hoarse voice or complete loss of voice due to irritation of vocal chords
299
Etiology: laryngitis
infx, inflammation, excessive coughing
300
Sx: laryngitis
voice change, hoarseness, aphonia, dsyphagia, dyspnea
301
Where are carcinomas of the lip lesions typically found?
mucocutaneous junction of the lips (esp. lower lip)
302
Etiology: stomatitis
strep, candida, corynebacterium, syphilis, TB, measles, HIV, coxsackie virus, HSV, VSV, fungus
303
If there is a recent onset of hoarseness, rule out ___
sinus and respiratory dz
304
In adults, hoarseness is commonly caused by ____
alcohol and tobacco use
305
Etiology (local): hoarseness
inflammation, polyps, hypothyroidism, fibrous nodes, leukoplakia, papilloma, CA
306
Etiology (neurological): hoarseness
nerve impairment, myasthenia gravis, Parkinson's, nerve paralysis
307
Etiology (systemic): hoarseness
aortic aneurysm, TB, syphilis, hypothyroidism
