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CPD > Week 2 > Flashcards

Week 2 Flashcards

1
Q

8-10% of 5-7 yo have ____ when diagnosed with ___

A

sinusitis, URI

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2
Q

Which is more common, more severe: Viral or Bacterial sinusitis?

A

Viral - more common

Bacterial - more severe

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3
Q

What are the three types of rhinosinusitis?

A

Viral, Bacterial, Fungal

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4
Q

What are predisposing factors for rhinosinusitis?

A

decongestants, fatigue, dental problems, food sensitivities, GI issues, septal deviation, large adeonoids, foreign bodies

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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

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6
Q

What is purulent discharge?

A

discharge filled with pus, yellowish color

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7
Q

What are the two most important complications possible with rhinosinusitis?

A

orbital/periorbital cellulitis, cavernous sinus thrombosis

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8
Q

What are symptoms of cavernous sinus thrombosis?

A

high fever, chills, prostrated, comatose, change in mental status

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9
Q

What are the early signs of cavernous sinus thrombosis?

A

deep eye pain, ocular palsy (III, IV, VI), diplopia

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10
Q

What are the late signs of cavernous sinus thrombosis?

A

both eyes involved, edema, death within 2-3 days

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11
Q

What is a common, non-dangerous sequellae to rhinosinusitis?

A

Upper Airway Cough Syndrome (UACS, post-nasal drip)

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12
Q

What might you find on a PE for UACS?

A

tonsilloliths, cobblestoning of oropharyngeal mucosa, tenderness of sinuses

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13
Q

What symptoms are never seen in patient with allergic?

A

fever, ms pain

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14
Q

What symptom is common to URI, allergy, and influenza?

A

nasal discharge

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15
Q

What condition is commonly found underneath the tongue?

A

squamous cell carcinoma

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16
Q

What condition is commonly found at the back/root of the tongue?

A

tongue cancer

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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

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18
Q

What does the oral exam entail?

A

inspection (tongue blade + light source), palpation if indicated (gloves)

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19
Q

What condition can fetor oris be associated with?

A

appendicitis

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20
Q

What symptom is very common in URIs?

A

sore throat

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21
Q

Fever: URI, allergy, influenza

A

URI: low grade possible, allergy: never, influenza: very common (100-102)

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22
Q

Headache is rare for (URI, allergy, influenza)?

A

URI

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23
Q

Headache: URI, allergy, influenza

A

URI: rare, allergy: uncommon, influenza: common

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24
Q

Cough: URI, allergy, influenza

A

URI: common, allergy: sometimes, influenza: common dry cough

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25
Q

MS Pain: URI, allergy, influenza

A

URI: slight, allergy: never, influenza: very common

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26
Q

Malaise: URI, allergy, influenza

A

URI: sometimes, allergy: sometimes, influenza: very common

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27
Q

Sore Throat: URI, allergy, influenza

A

URI: very common, allergy: sometimes, influenza: sometimes

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28
Q

Sneezing: URI, allergy, influenza

A

URI: common, allergy: common, influenza: sometimes

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29
Q

Lacrimation: URI, allergy, influenza

A

URI: rare (conjunctivitis), allergy: common, influenza: soreness behind eyes

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30
Q

Is lacrimation common in URI?

A

rare, conjunctivitis

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31
Q

Sweet breath can be indicative of ___.

A

diabetic ketoacidosis

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32
Q

Faintly sulfurous breath can be indicative of ____.

A

liver failure

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33
Q

Ammonia breath can be indicative of ____.

A

renal failure

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34
Q

What are possible causes of xerostomia?

A

mouth breathing, dehydration, diuretics, salivary disease, sialoliths, sjogren’s syndrome

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35
Q

Deviation of uvula is always indicative of cranial nerve dysfunction (T/F)

A

False, uvula deviation can be normal. Focus on symmetrical elevation of soft palate.

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36
Q

Abnormal deviation is related to cranial nerve ___.

A

XII (hypoglossal nerve)

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37
Q

What does a CBC tell us?

A

count/quality of WBC, count/quality of RBC

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38
Q

What are symptoms of B12 deficiency seen in the tongue?

A

beefy red, enlarged, soreness

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39
Q

Classic presentation of recurrent herpes labialis?

A

prodromal sensations where lesion previously appeared, painful vesicle appears and erupts, ulcer remains, crusts over, heals

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40
Q

Characteristics of recurrent herpes labialis?

A

viral infection, high incidence, contagious, episodes of painful blisters on the lip

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41
Q

Type of herpes most commonly linked to herpes of the mouth?

A

HSV-1

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42
Q

Reactivation triggers: recurrent herpes labialis

A

UV light, fatigue, trauma, stress, menstruation

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43
Q

When should you be concerned with autoinnoculation (w/ herpes)?

A

when it spreads the eyes

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44
Q

Prodromal symptoms: herpes

A

itching, burning, tingling lasting approximately 12-36 hours

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45
Q

Etiology: Carcinoma of the lips

A

tobacco, alcohol, sunlight, poor oral hygiene, poorly fitting dentures

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46
Q

Characteristics of the lesions present with SCC?

A

painless, well-demarcated, elevated, indurated border with ulcerated base, verrucous/plaque-like

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47
Q

Prognosis: carcinoma of the lips

A

slow-growing, poor healing, bleeding probable, high risk of metastasis

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48
Q

Morphology: mucocele

A

soft cyst, mucin-fileld cavity, can appear red/purple, movable

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49
Q

Location: mucoceles

A

lips, under tongue

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50
Q

What is another name for mucoceles?

A

ranula

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51
Q

In what patient population are mucoceles most common?

A

< 20 years

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52
Q

Etiology: Chelitis

A

use of retinoids, wind-burn, allergies

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53
Q

What is chelitis?

A

erythema and scaling of the lips

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54
Q

What is angular chelitis?

A

inflammatory lesion at the labial commissure, often bilateral

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55
Q

What is an inflammatory lesion at the labial commissure that is often bilateral?

A

angular chelitis

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56
Q

What are the signs and symptoms of angular chelitis?

A

deep cracks, bleeding/splitting if severe, shallow ulcers

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57
Q

Angular chelitis lesion can become infected by ___

A

candida albicans, staph aureus

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58
Q

What are some conditions where secondary lesions can appear?

A

measles, scarlet fever, pellagra, scurvy, erythema multiforme, syphilis, uremia

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59
Q

Pellagra is a deficiency of ____

A

vitamin B3

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60
Q

A smooth fiery tongue and painful mouth can be symptoms of ____.

A

Pellagra

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61
Q

What conditions can present with painless lesions?

A

oral lichen planus, syphilis, mucocele, scc

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62
Q

Morphology: oral lichen planus

A

lace-white patches/papules/streaks on the buccal mucosa (Wickham striae), erosions on the gingival margin

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63
Q

Is oral lichen planus contagious?

A

No

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64
Q

Morphology: leukoplakia

A

white patches/plaque on oral mucosa, cannot be rubbed off; patches can be darker esp with heavy tobacco use; vary in thickness

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65
Q

What is a key difference between leukoplakia and candida?

A

candida can be rubbed off, leukoplakia cannot

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66
Q

Etiology: leukoplakia

A

AIDS, tobacco use, oral sepsis, alcoholism, vitamin deficiency, syphilis, dental galvanism, actinic radiation (w/ lip involvement), trauma, endocrine disturbance

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67
Q

Leukoplakia always signifies a malignancy (T/F).

A

false, leukoplakia is also seen in inflammatory conditions; only 20% of lesions progress to cancer in 10 years

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68
Q

Sex/Age: leukoplakia

A

M > F, ~90% > 40 yo

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69
Q

What PE should be done if leukoplakia is suspected?

A

lesion cannot be wiped away with gauze, cervical lymphadenopathy

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70
Q

What are concerning signs when palpating lymph nodes?

A

hard, immovable, painless, large/getting larger

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71
Q

Where are the most common locations for finding leukoplakia?

A

tongue, mandibular alveolar ridge, buccal mucosa in > 50% of cases

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72
Q

DDx: leukoplakia

A

candidiasis, aspirin burn, erythroplakia, dysplastic lesion

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73
Q

Morphology: erythroplakia

A

red macule, well-demarcated, soft texture

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74
Q

Common location: erythroplakia

A

floor of mouth, tongue, palate

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75
Q

What are risk factors for erythroplakia?

A

smoking, alcohol

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76
Q

What are risk factors for Oral SCC?

A

smoking (90% of pts w/ SCC), alcohol

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77
Q

Common locations (3): Oral SCC

A

Floor of mouth, lateral/ventral surface of tongue (40%), lower lip (38%), palate/tonsillar area (11%)

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78
Q

Is Oral SCC always painless?

A

No, ulcerated lesions can be painful

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79
Q

What can be the first symptom of oral SCC?

A

metastatic mass (non-tender) in the neck

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80
Q

Morphology: oral SCC

A

may appear as erythroplakia/leukoplakia, exophytic or ulcerated, rolled border

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81
Q

Morphology: melanoma

A

pigmented lesions, asymmetric, irregular borders, variable coloration, increasing diameter, doesn’t blanch

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82
Q

DDx: melanoma

A

melanosis (symmetric lesions in individuals with dark skin), oral melanotic macules (symmetric, stable, sharply delimited dark macules on lips/oral mucosa)

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83
Q

Morphology: Fordyce’s spots

A

multiple, white-to-yellow, 1-2 mm papules, often in a cluster opposite molars

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84
Q

Location: Fordyce’s spots

A

vermillion/buccal mucosal border, inner surface of lips, retromolar region, tongue, gingiva, frenulum linguae, palate

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85
Q

What are Fordyce’s spots?

A

asymptomatic, benign neoplasms from sebaceous glands

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86
Q

Sex/Age: Fordyce’s spots

A

M = F, 20-30 years

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87
Q

DDx: Fordyce’s spots

A

candida albicans (Fordyce’s spots do not rub off)

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88
Q

What is stomatitis?

A

inflammation of oral tissue from local/systemic disease that may be accompanied by foul breath/mucosal bleeding

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89
Q

Risk factors: oral candidiasis

A

dentures, diabetes, antibiotics, chemotherapy/radiation, HIV/AIDS, inhaled glucocorticoids

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90
Q

Oral candidiasis is common in ____

A

infants

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91
Q

Diagnosis of oral candidiasis can be confirmed with ____

A

KOH prep

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92
Q

Morphology: oral candidiasis

A

lesion, slightly raised, white plaques, hyperemic, soft-looking, easily wiped away, mouth appears dry

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93
Q

What is recurrent aphthous stomatitis?

A

“canker sores”, acute, painful, recurring, solitary/multiple necrotizing ulcerations of the oral mucosa

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94
Q

What is the most common trigger of recurrent aphthous stomatitis?

A

trauma

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95
Q

What are two conditions with similar prodromal symptoms (burning/tingling)?

A

herpes and canker sores

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96
Q

DDx: recurrent aphthous stomatitis

A

secondary herpetic ulceration, Crohn’s, neutropenia, sprue, trauma, pemphigus vulgaris, cicatricial pemphigoid

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97
Q

What is the medical term for cold sores and what is their main cause?

A

herpetic gingivostomatitis, HSV-1

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98
Q

What is a macule?

A

lesion within the dermis, < 1 cm

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99
Q

What is a patch?

A

lesion within the dermins, > 1 cm

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100
Q

What is a papule?

A

raised, solid lesion < 1 cm

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101
Q

What is a plaque?

A

raised, solid lesion > 1 cm

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102
Q

What is a vesicle?

A

superficial, palpable lesion filled with fluid, < 1 cm

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103
Q

What is a bulla(e)?

A

superficial, palpable lesion filled with fluid, > 1 cm

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104
Q

What are different ways to classify mouth lesions?

A

painful/painless, type of lesion, coloration, size, benign/cancerous/precancerous

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105
Q

What is the classic sign of erythema multiforme?

A

target lesions on the skin

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106
Q

Morphology: aphthous stomatitis

A

shallow, round/oval lesions with grayish base and red border

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107
Q

What is the classic sign of erythema multiforme?

A

target lesions on the skin

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108
Q

Sx: aphthous stomatitis

A

painful lesions, occasionally have prodromal burning/tingling

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109
Q

abbreviation: NT

A

non-tender

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110
Q

abbreviation: TTP

A

tender to palpation

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111
Q

Location: aphthous stomatitis

A

non-keratinized, moveable mucosa (buccal/labial mucosa, buccal/lingual sulci, ventral tongue, soft palate, floor of mouth)

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112
Q

DDx: aphthous stomatitis

A

secondary herpetic ulceration, pemphigus vulgaris, cicatricial pemphigoid, Crohn’s dz, neutropenia, sprue

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113
Q

Sx: herpetic gingivostomatitis

A

prodromal pain/burning/tingling, painful eruption of unmovable oral mucosa and vermilion border, fever, malaise, LA, painful eating

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114
Q

DDx: herpetic gingivostomatitis

A

aphthous stomatitis, erythema multiforme, drug eruptions, pemphigus

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115
Q

Prognosis: herpetic gingivostomatitis

A

self-limited to 1-2 weeks, recurrent infxs as virus goes into latency

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116
Q

Sx (kids): herpetic gingivostomatitis

A

fever, LA, drooling, pain, dehydration due to decreased oral intake

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117
Q

Labs: herpetic gingivostomatitis

A

Tzanck smear, direct immunofluorescence smear, viral culture

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118
Q

Differences (symptoms): aphthous stomatitis and herpetic gingivostomatitis

A

In addition to painful lesions, herpes lesions can also have accompanying symptoms (fever, malaise, LA)

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119
Q

Differences (location): aphthous stomatitis and herpetic gingivostomatitis

A

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)

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120
Q

Differences (morphology): aphthous stomatitis and herpetic gingivostomatitis

A

herpes lesions will often have crusting

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121
Q

DDx: oral erythema multiforme

A

aphthous stomatitis, allergic stomatitis, pemphigus, herpes

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122
Q

Similarities: aphthous stomatitis and herpetic gingivostomatitis

A

painful/recurrent lesions, prodromal sxs (burning/tingling), common triggers (stress/fatigue), often self-limited

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123
Q

Morphology: oral erythema multiforme

A

diffuse hemorrhagic vesicles and bullae, erythmatous base; bullae often rupture leaving raw, friable surface which then form crusts

124
Q

Location: oral erythema multiforme

A

lips and mucosa

125
Q

Sx: oral erythema multiforme

A

painful stomatitis; systemic: maculopapular erythematous lesions (target lesions) on the skin; sinusitis, rhinitis, high fever (may be prodromal)

126
Q

What is a chancre?

A

painless ulceration formed during primary stage of syphilis

127
Q

Location: chancre

A

on/around lips, tongue, anus, penis, vagina

128
Q

Morphology: chancre

A

single ulcerated lesion, indurated border, no central necrotic tissue

129
Q

What is important on the physical exam when a chancre is found?

A

examine for genital lesions as well

130
Q

Sx: chancre

A

painless lesion, tender cervical LA

131
Q

Prognosis: chancre

A

resolve in 2 wks to 3 mos without treatment

132
Q

Lab: chancre

A

PCR serology

133
Q

Etiology: oral erythema multiforme

A

hypersensitivity rxn to HSV, drugs, other organisms

134
Q

Morphology: frictional hyperkeratosis

A

hyperkeratotic white lesion leading to white line called linea alba if caused by biting

135
Q

If the cause of frictional hyperkeratosis is unknown, ____

A

consider the lesion an idiopathic leukoplakia and obtain a biopsy

136
Q

Etiology: frictional hyperkeratosis

A

chronic friction against oral mucosal surface

137
Q

Etiology: epulis fissura

A

chronically ill-fitting dentures

138
Q

Location: epulis fissura

A

vestibular or anterior maxillary mucosa

139
Q

SSx: acute suppurative rhinosinusitis

A

persistent cold nasal congestion, purulent drainage, facial pain with headache, dental pain, altered smell

140
Q

Persistent or worsening symptoms for a patient with acute suppurative rhinosinusitis may indicate ____

A

developing bacterial sinusitis

141
Q

For children with acute suppurative rhinosinusitis, complaints of ____ (2) are rare

A

facial pain, headache

142
Q

Sx (maxillary): acute suppurative rhinosinusitis

A

dull, throbbing pain in cheek; tender, painful maxillary teeth; tenderness over maxilla

143
Q

When there is tender, painful maxillary teeth and you suspect rhinosinusitis, rule out ____

A

infected tooth

144
Q

Sx (frontal): acute suppurative rhinosinusitis

A

tenderness over forehead area, swelling of eyelids, frontal headache

145
Q

Sx (ethmoid): acute suppurative rhinosinusitis

A

pain more medial to eye, feels deep in head or eye, splitting headache on one side, swelling of eyelids

146
Q

Sx (sphenoid): acute suppurative rhinosinusitis

A

pain behind eye or in occiput or vertex, deeper pain, not local tenderness

147
Q

PE: acute suppurative rhinosinusitis

A

purulent secretions in the middle meatus, facial tenderness, complete opacification of sinus on transillumination

148
Q

Purulent secretions in the middle meatus is highly predictive of ____

A

maxillary sinusitis

149
Q

Fever is (common/rare) in patients with acute suppurative rhinosinusitis

A

rare, < 2% of cases

150
Q

Etiology: chronic suppurative rhinosinusitis

A

S. pneumoniae, H. influenzae, M. catarrhalis (> 70% of cases)

151
Q

PE (eye exam): chronic suppurative rhinosinusitis

A

conjunctival congestion, lacrimation; check for extraocular muscle palsies and visual disturbances

152
Q

PE (nose exam): chronic suppurative rhinosinusitis

A

nasal mucosa erythema, edema, purulent secretions; check for nasal obstruction and polyps

153
Q

PE: chronic suppurative rhinosinusitis

A

pain/tenderness over frontal/maxillary sinuses, oropharyngeal erythema, purulent secretions; check for dental caries

154
Q

What are common viral etiologies for URIs?

A

rhinovirus, coronavirus, parainfluenza virus, adenovirus, respiratory syncytial virus

155
Q

What is the most common bacterial etiology for pharyngitis?

A

strep. pyogenes

156
Q

Etiology: mucocele

A

minor injury to ductal system of minor labial or sublingual salivary gland due to trauma

157
Q

Sx: mucocele

A

painless cyst

158
Q

Prognosis: mucocele

A

surgical removal, rarely goes away on its own

159
Q

What is a lab to conduct for angular chelitis?

A

KOH prep to check for Candida infx

160
Q

If oral lichen planus is chronic, it can increase the risk for ____

A

oral cancer

161
Q

8 conditions which present as white oral lesions that cannot be wiped away with gauze

A

oral lichen planus, SLE, white sponge nevus, SCC, leukoedema, frictional keratosis, leukoplakia, Fordyce’s spots

162
Q

When does leukoplakia become a concern?

A

when dysplasia or anaplasia are evident

163
Q

Erythroplakia is found to be cancerous in ___

A

40% of cases

164
Q

Melanoma is often diagnosed at ____

A

later stages

165
Q

Sx: epulis fissura

A

painless folds of fibrous CT, may be erythematous/ulcerated but usually not highly inflammed

166
Q

Morphology: denture sore spot

A

small ulcer with overlying grayish necrotic membrane and surrounding inflammatory halo

167
Q

Prognosis: denture sore spot

A

painful, but will usually heal quickly once dentures are removed

168
Q

____ are though to play a major role in 90% of denture sore mouth cases.

A

fungi

169
Q

What is denture stomatitis?

A

common condition where mucosa underneath denture becomes erythematous and swollen with sever burning sensation being common

170
Q

What is the most common benign oral soft tissue neoplasm?

A

irritation fibroma

171
Q

Age/Sex: irritation fibroma

A

M=F, usually ages 20-49

172
Q

Location: irration fibroma

A

buccal mucosa, lateral border of tongue, lower lip

173
Q

Morphology: irritation fibroma

A

sessile or pedunculated swelling, firm/resilient or soft/spongy, < 1 cm, color slightly lighter than surrounding mucosa

174
Q

Sx: irritation fibroma

A

painless lesion

175
Q

DDx (tongue): irritation fibroma

A

neurofibroma, neurolemmoma, granular cell tumor

176
Q

DDx (lower lip/buccal mucosa): irritation fibroma

A

lipoma, mucocele, salivary gland tumor

177
Q

What is angioedema?

A

acute swelling of the skin (esp hands), mucosa, and submucosal tissues

178
Q

Etiology: angioedema

A

allergy, infx, illness (autoimmune, leukemia)

179
Q

SSx: angioedema

A

painless, non-pruritic (if non-allergic), non-pitting, well circumscribed areas of edema

180
Q

When is angioedema dangerous?

A

when swelling obstructs the airway

181
Q

What is urticaria and its relation to angioedema?

A

itchy, raised bumps that can develop if angioedema is allergy-related

182
Q

What is hereditary angioedema?

A

rare, autosomal-dominant inheritance, presenting as edema in the face, airway passages, hand, feet

183
Q

85% of hereditary angioedema cases are deficiencies of ____

A

C1 esterase inhibitor

184
Q

What is the difference between angioedema and hereditary angioedema?

A

hereditary angioedema - painful edema (not pruritic b/c no allergy), recurrent attacks, concomitant symptoms - abdominal pain, vomiting, weakness, rash, and diarrhea

185
Q

What is a palatal or mandibular torus?

A

non-neoplastic, slow-growing nodular protuberance of bone.

186
Q

Age: palatal/mandibular torus

A

shortly before 30

187
Q

What is a hemangioma?

A

proliferation of blood vessels

188
Q

Age/Sex: hemangioma

A

F > M, 85% of lesions develop by end of first year, often congenital

189
Q

Morphology: hemangioma

A

flat or raised, deep red or bluish-red color

190
Q

Location: hemangioma

A

lips, tongue, buccal mucosa and palate

191
Q

DDx: hemangioma

A

arteriovenous fistula (more likely if history of trauma)

192
Q

What is a papilloma?

A

papillary and verrucal growths, composed of benign epithelium and small amount of connective tissue

193
Q

What does verrucous mean?

A

wart-like

194
Q

Etiology: papilloma

A

HPV

195
Q

Morphology: papilloma

A

well-circumscribed, usu pedunculated growths with numerous, finger-like projections, < 1 cm in diameter, usu solitary

196
Q

Location: papilloma

A

intraoral mucosa and vermillion border of the lips, palates, uvula, tongue

197
Q

Papillomas are most common where?

A

soft or hard palate

198
Q

DDx: papilloma

A

verruciform xanthomas, warty dyskeratoma, condylomata acuminata

199
Q

Difference between papilloma and verruciform xanthomas?

A

verruciform xantomas have a distinct predilection for gingiva and alveolar ridge

200
Q

Difference between papilloma and warty dyskeratoma?

A

warty dyskeratoma tend to occur as multiple lesions

201
Q

Difference between papilloma and condylomata acuminata?

A

condylomata acuminata are usually larger and multifocal with a broader base

202
Q

What is a lipoma?

A

painless, benign, slow-growing mass of adipose tissue

203
Q

Location: lipoma

A

cheek, tongue

204
Q

Morphology: lipoma

A

yellow, NT, rubbery/soft, mobile

205
Q

Etiology: lipoma

A

hereditary, trauma

206
Q

Lipomas, if large, can affect ____

A

speech

207
Q

What are varicosities?

A

dilated, tortuous veins in the oral cavity

208
Q

Location: varicosities

A

ventral aspect of the tongue, upper/lower lips, buccal mucosa, buccal commissure

209
Q

Etiology: varicosities

A

increased hydrostatic pressure and poor support by surrounding tissues

210
Q

Morphology: varicosities

A

blue in color, blanch when compressed

211
Q

Varicosities can occasionally be accompanied by ____

A

thrombosis

212
Q

What is sialadenitis?

A

painless benign swelling of the salivary glands

213
Q

Sialadenitis is seen in what conditions?

A

hepatic cirrhosis, sarcoidosis, neoplasms, infections, mumps

214
Q

What is sialolisthesis?

A

salivary duct stones which cause pain/swelling associated with eating

215
Q

Where is sialolisthesis commonly found?

A

submandibular gland

216
Q

What is Sjogren’s syndrome?

A

systemic inflammation associated with dry eyes, mouth and mucus membranes

217
Q

What is gingivitis?

A

inflammation of the gums with redness, swelling, changes in contours, pocket formation, watery exudate, bleeding

218
Q

Gingivitis is commonly seen in ____ (2)

A

puberty, pregnancy

219
Q

Etiology: gingivitis

A

poor oral hygiene, malocclusion, dental calculi, food impaction, faulty dental restorations, mouth breathing

220
Q

The most common cause of gingivitis is ____

A

poor oral hygiene

221
Q

What drug is known for causing gingival hypertrophy?

A

dilantin

222
Q

Morphology: gingivitis

A

swollen, bright-red/purple gums, receding gum line, bleeding easily, itching

223
Q

Gingivitis can be the first sign of a systemic dz such as _____

A

DM, leucopenia, endocrine disorder

224
Q

sesame oil, CoQ10, probiotics can be effective in preventing ____

A

gingivitis

225
Q

What is Vincent’s angina?

A

acute infection of the gingiva

226
Q

Etiology: vincent’s angina

A

fusiform bacteria and spirochetes, poor oral hygiene, stress, malnutrition, alcohol/tobacco use

227
Q

Morphology: vincent’s angina

A

“punched out” lesions with gray membrane, bleeding easily, ulcerated lesions of the interdental papillae

228
Q

What is periodontitis?

A

infection of the periodontium causing inflammation of the periodontal ligament, gingival, cementum and alveolar bone

229
Q

Etiology: periodontitis

A

progressive gingivitis

230
Q

Risk factors: periodontitis

A

DM, leukemia, Down’s, Crohn’s, poor hygiene

231
Q

Periodontitis is painless unless ____

A

acute infection

232
Q

Sx: periodontitis

A

pain with chewing, food impaction, tooth may be tender to percussion, visible plaque, red swollen gums, exudate, easily bleeding gums

233
Q

What are caries?

A

tooth decay, enamel erosion

234
Q

What are concomitant symptoms of dental caries?

A

headache, fever, swelling, tenderness in floor of mouth, cranial nerve abnormalities

235
Q

What are conditions which can cause toothache?

A

caries, periodontitis, wisdom teeth, teething, sinusitis

236
Q

What is an apical abscess?

A

infection into the root of a tooth

237
Q

What is Ludwig’s angina?

A

cellulitis of mouth floor

238
Q

What is cavernous sinus thrombosis?

A

staph/strep infection in the cavernous sinus leading to development of a blood clot

239
Q

Sx: Ludwig’s angina

A

swelling, malaise, fever, dysphagia, stridor

240
Q

Difficulty moving the tongue is most often caused by ____ (3)

A

nerve damage, nerve root disorder, cancer

241
Q

What is ankyloglossia?

A

short frenulum

242
Q

When CN ___ is damaged, the tongue will ___

A

XII, deviate to the paralyzed side

243
Q

What is ageusia?

A

loss of taste

244
Q

What is dysgeusia?

A

abnormal taste

245
Q

What can cause taste dysfunction?

A

Bell’s palsy, B3/Zn deficiency, MS, damage to facial nerve or glossopharyngeal nerve

246
Q

What is hairy tongue?

A

benign, painless condition of the tongue where the distal third of the tongue appears hairy due to hyperplasia of papillae

247
Q

Etiology: hairy tongue

A

AIDS, coffee, tobacco, oral hygiene, antibiotics, alcohol, prednisone, estrogen, mouthwashes, candida, aspergillis

248
Q

What is burning tongue syndrome?

A

feeling experienced by some women after menopause

249
Q

In addition to infections and irritations, what other 2 conditions can cause tongue pain?

A

glossitis and geographic tongue

250
Q

Etiology: tongue tremor

A

hyperthyroidism, nervousness, alcoholism, paresis, drug dependence, debilitation, neurological dz, insecticides

251
Q

When there is a dry tongue w/o furrows, consider ___.

A

Sjogren’s syndrome

252
Q

When there is a dry tongue w/ furrows, consider ____

A

dehydration

253
Q

What is glossitis?

A

acute or chronic inflammation that can be primary or secondary

254
Q

Etiology: glossitis

A

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
Q

Sx: glossitis

A

tongue swelling, beefy red tongue, sore/tender tongue, difficulty chewing, swallowing, speaking

256
Q

With chronic inflammation of the pharynx, consider ____

A

malignancies

257
Q

What is the most common cause of acute pharyngitis?

A

viral infections (~90%)

258
Q

What is the most common viral infx for acute pharyngitis?

A

adenovirus

259
Q

Etiology: infectious mononucleosis

A

EBV, sometimes CMV

260
Q

Sx: infectious viral mononucleosis

A

LA, exudative tonsillitis, redness/swelling of throat, splenomegaly, fatigue, weight loss, hepatitis

261
Q

Lab findings (CBC): infectious mononucleosis

A

lymphocytosis, atypical lymphocytes, monospot

262
Q

What is the most common cause of bacterial pharyngitis?

A

group a streptococcus (GAS)

263
Q

Sx: infectious bacterial pharyngitis

A

LA, red/inflamed throat, unilateral, fever, headache, myalgia, arthralgia

264
Q

What is the most significant difference between bacterial and viral pharyngitis?

A

bacterial pharyngitis progresses more rapidly than viral infections

265
Q

What is the Modified Centor Criteria?

A

diagnostic test for GAS pharyngitis

266
Q

In the modified centor criteria, a point is given for ____(4)

A

absence of cough, tender ant cervical adenopathy, tonsillar exudate, history of fever

267
Q

If a patient scores > 3 on the modified centor criteria, ____

A

treat empirically with antibiotics

268
Q

What are two diagnostic techniques for GAS pharyngitis?

A

throat culture, rapid strep

269
Q

Non-group streptococcus is not associated with ____

A

rheumatic fever

270
Q

Morphology: diphtheria

A

dirty gray, tough fibrous membrane in tonsillar area

271
Q

Complications: diphtheria

A

myocarditis, nervous system toxicity

272
Q

If diphtheria is diagnosed, ___

A

report to the health department

273
Q

Compare prevalence: viral/bacterial/fungal pharyngitis

A

Viral, bacteria, fungal (most to least common)

274
Q

Compare fever: viral/bacterial/fungal pharyngitis

A

Viral - low, bacterial - mid, fungal - none

275
Q

Compare nodes: viral/bacterial/fungal pharyngitis

A

Viral - little change, bacterial - common LA, fungal - occasional LA

276
Q

Compare pain: viral/bacterial/fungal pharyngitis

A

bacteria - most painful

277
Q

Compare erythema: viral/bacterial/fungal pharyngitis

A

bacterial - most erythema

278
Q

Chronic tonsillitis is almost always caused by ___

A

bacterial infection (GAS)

279
Q

DDx: tonsillitis

A

diphtheria

280
Q

Sx: tonsillitis

A

sudden onset, fever, malaise, vomiting, enlarged tonsils w/ purulent exudate, fetid breath, fibrotic in chronic cases

281
Q

What are tonsilloliths?

A

whitish-yellow deposits produced by bacteria feeding on mucus; “tonsil stones”; pungent odor

282
Q

Complications: tonsillitis

A

peritonsillar abscess, tonsilloliths, hypertrophy of the tonsils

283
Q

Location: peritonsillar abscess

A

between tonsil and pharyngeal constrictor muscles

284
Q

Sx: peritonsillar abscess

A

fever, malaise, headache, hot potato voice, dysphagia, LA, referred ear pain, breath odor, tonsillar edema, displaced uvula toward unaffected side

285
Q

Location: parapharyngeal abscess

A

lateral to superior constrictor muscle, close to carotid sheath

286
Q

Sx: parapharyngeal abscess

A

swollen ant triangle in the neck, throat may appear normal

287
Q

Why is retropharyngeal abscesses emergencies?

A

airway obstruction

288
Q

What is velopharyngeal insufficiency?

A

incomplete closure of the sphincter between the oropharynx and nasopharynx, resulting in impaired deglutition and speech

289
Q

What is the most common type of cancer in the head and neck?

A

laryngeal squamous cell cancer

290
Q

The most common site of laryngeal SCC is ____

A

true vocal chords

291
Q

The most common cause of vocal chord contact ulcers is ____

A

gastric reflux

292
Q

What is important when diagnosing epiglottis?

A

DO NOT try to visualize throat. Look for “thumbprint sign” on X-ray

293
Q

DDx: epiglottitis

A

croup, peritonsillar abscess, retropharyngeal abscess

294
Q

Epiglottitis is a ___ infection of the epiglottis most often caused by ____

A

bacterial, H. influenzae type B

295
Q

What is epiglottitis an emergency?

A

symptoms are rapidly progressive and swelling can lead to cyanosis and asphyxiation

296
Q

Epiglottitis typically affects ____

A

children, aged 2-5

297
Q

Sx: epiglottitis

A

fever, dysphagia, drooling, stridor, shallow breathing

298
Q

What is laryngitis?

A

hoarse voice or complete loss of voice due to irritation of vocal chords

299
Q

Etiology: laryngitis

A

infx, inflammation, excessive coughing

300
Q

Sx: laryngitis

A

voice change, hoarseness, aphonia, dsyphagia, dyspnea

301
Q

Where are carcinomas of the lip lesions typically found?

A

mucocutaneous junction of the lips (esp. lower lip)

302
Q

Etiology: stomatitis

A

strep, candida, corynebacterium, syphilis, TB, measles, HIV, coxsackie virus, HSV, VSV, fungus

303
Q

If there is a recent onset of hoarseness, rule out ___

A

sinus and respiratory dz

304
Q

In adults, hoarseness is commonly caused by ____

A

alcohol and tobacco use

305
Q

Etiology (local): hoarseness

A

inflammation, polyps, hypothyroidism, fibrous nodes, leukoplakia, papilloma, CA

306
Q

Etiology (neurological): hoarseness

A

nerve impairment, myasthenia gravis, Parkinson’s, nerve paralysis

307
Q

Etiology (systemic): hoarseness

A

aortic aneurysm, TB, syphilis, hypothyroidism

CPD (8 decks)

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