HEENT: Nose and paranasal sinuses
About this set
Created by:
pie3217 on April 22, 2012
Classes:
Seton Hill Physician Assistant Class of 2014
Log in to favorite or report as inappropriate.
Order by
179 terms
Terms | Definitions |
|---|---|
 respiration, conduction, purifying, olfaction | Nose provides for functions of _____, _____ and _____ inspired air and _____ |
| t | t/f: Nasal and sinus related disorders are among the most common reason patients now visit physicians in the United States. These may be sources of discomfort and cause lifestyle interruptions |
| anatomy of the nose | Nares, Turbinates, Meatus, Septum, Sinuses (frontal, maxillary, ethmoid, sphenoid), Kiesselbach plexus, Eustachian tube |
| f | t/f: Many disorders can be diagnosed by H & P but need lab testing for diagnosis |
| major sx of nasal or paranasal disorder | obstruction (congestion), drainage, facial pain or headache, epistaxis, change in smell or taste |
| nasal obstruction | Can be caused by deviated nasal septum, turbinate enlargement, polyps, or mass lesions. It is a common symptom. Assess whether unilateral, bilateral, or alternating and if constant or intermittent |
| nasal obstruction | Constant or fixed could be anatomic problems (septum, polyps, mass). Intermittent or alternating relate to variations in turbinate size. Bilateral; polyps, allergy, complex deviation of septum. Unilateral; fixed lesion, polyp, mass, deviated septum, foreign body |
| nasal drainage | Rhinorrhea can be unilateral or bilateral, clear or discolored, watery, mucoid, color, tenacious (sticky or clumps). Unilateral means localized; unilateral sinusitis, CSF leak. Bilateral means systemic, sinusitis. Clear; vasomotor, nonallergic or allergic rhinitis. Thick and discolored suggests infection. Post Nasal drainage is more bothersome if the consistency is thicker. There is a sense of mucus in the throat, hoarseness, chronic throat clearing |
| facial pain and HA | May not be useful in differentiating disorders because many disorders have these symptoms: TMJ, migraines, tension headaches, dental caries |
| sinusitis | Severe facial pain with swelling over sinuses and purulent drainage usually related to _____ |
| allergic conditions | _____ _____ may cause patient complaints of intermittent facial pressure associated with changes in weather, humidity, or other environmental factors |
| malignant tumors | Persistent unilateral facial pain without purulent rhinorrhea consider _____ _____ |
| anosmia | complete loss of olfaction |
| hyposmia | decrease in sense of smell |
| parosmia/dysosmia | altered sense of smell |
| cacosmia | sensation of unpleasant smell (sinusitis) |
| phantosmia | hallucination of smells |
| presbyosmia | decrease is sense of smell in aging |
| nasal polyps; chronic sinusitis | Alterations in smell is common with _____ _____ and _____ _____ |
| anosmia | can occur in any condition that affects nasal air flow to the region of the cribiform plate bilaterally |
| anosmia | without nasal obstruction can be caused by viral URI or severe head trauma. Bilateral causes of constriction consider chronic sinusitis, polyps. _____ and hyposmia can be from formaldehyde, lead poisoning, vitamin A deficiency, tobacco use, radiation therapy. rare cases are caused by are anterior cranial fossa meningioma, diabetes, hypothyroidism, pernicious anemia |
| anosmia | tx: Directed at cause, counsel with regards to smoke detectors, avoid excess perfume or cologne, control of body odors, attention to expiration dates of food |
| allergic symptoms | Sneezing, nasal or ocular pruritus, bilateral clear watery or mucoid nasal drainage, nasal congestion, pruritus of upper palate and ears, dry scratchy erythematous conjunctiva |
| dust; mite | _____ or _____ allergies are usually more symptomatic in morning and with exposure to upholstered furniture, mattresses, pillows, carpeting |
| mold | _____ allergies vary throughout the year. |
| dust; mold | _____ and _____ allergies may occur with congestion and nasal drainage without sneezing or pruritus |
| tree pollen | spring allergies are associated with _____ _____ |
| grass | midsummer allergies are associated with _____ |
| weed pollen | fall allergies are associated with _____ _____ |
| tobacco smoke | _____ _____ causes congestion of turbinates, destruction of cilia, and alteration in mucous secretion cells of the nasal mucosa |
| smokers | _____ have increased symptoms of nasal congestion and thick Post Nasal Drainage. (May be predisposed to sinusitis) |
| phenylephrine | _____ can cause rebound affect (rhinitis medicamentosa): Causes swelling of the nasal turbinates |
| diuretics | _____ cause thickened, more tenacious secretions |
| hypertrophy | Beta blockers, reserpine, exogenous estrogen cause turbinate _____. can become irreversible if used long-term |
| cocaine | _____ can cause large septal perforations with bleeding |
| asbestos | Wood dust and _____ exposure can cause irritant effects |
| transillumination | _____ of the frontal sinuses occurs with normal or slightly thickened mucosa |
| 2-3 | Otoscope will view the anterior nares, the first _____cm |
| ENT physical exam | Nasal speculum with light; Anterior rhinoscopy: Visualization of the septum, inferior and middle turbinates. Portions of the nasopharynx and limited view into the middle meatus. Posterior rhinoscopy with a tongue blade, nasopharyngeal mirror and headlight can view the posterior choana, nasopharynx, eustachian tubes, posterior edge of the septum and inferior turbinates |
| f (before and after) | t/f: Perform an ENT exam only after topical decongestants are given |
| nasal smears | _____ _____ can help differentiate sinusitis from allergic or nonallergic by determining type of white cells present. eosinophils - allergic cause. neutrophils - infection. CBC is sometimes helpful in bacterial (neutrophil) vs viral (lymphocytes). Immunologic studies: Elevated IgE; allergic. Sinus Films - CT most useful for paranasal sinuses. Allergy testing helpful. Allergen-specific IgE test. Scratch test. |
| common disorders | Epistaxis, Common cold Trauma, Acute and Chronic sinusitis, Deviated septum, Turbinate hypertrophy, Nasal vestibulitis, Nasal polyposis, Allergic, nonallergic, vasomotor rhinitis |
| epistaxis | May accompany almost any pathology of nose, nasopharynx, or paranasal sinuses. Most common cause is break in prominent capillary vessels along the anterior septum (Kiesselbach's Plexus or Little's Area). Most common site of bleeding is Kiesselbach Plexus. Usually with local trauma (Digital Extraction, nose blowing, sneezing, Foreign Body, infection, allergic rhinitis). If the scab dislodges, bleeding may recur. Systemic causes (anticoagulation, coagulopathies) |
| epistaxis | tx: Inspect and evacuate clots by suction. Patient seated upright apply firm pressure to the nares for 10-15 mins. Identify the site of bleeding and anesthetize with lidocaine. Cauterize w/ a silver nitrate stick. Place packing and leave in for 24 hours. Topical vasoconstrictive agents oxymetazoline - 2 sprays every 12 hours for 3 days can be helpful if persistent. Improve humidity. Petroleum jelly. Nasal saline sprays and water based lotion can prevent recurrences. education important |
| posterior epistaxis | Woodruff's plexus. Uncommon and significant. The bleed cannot be visualized by anterior rhinoscopy. More common in adults. Cause: Acute trauma and bleeding. Generally arterial. Presentation: Blood may be seen in the posterior pharynx. May cause airway compromise |
| posterior epistaxis | tx: Often requires ENT consult. Posterior packing placed. Monitor for Toxic Shock Syndrome from retained packing. Often admitted, placed on supplemental oxygen and monitored for hypoxemia. Antibiotic often used. Last resort is ligation of the internal maxillary and ethmoidal arteries |
| recurrent | _____ epistaxis: humidify air, saline spray, vaseline petroleum jelly, antibiotic ointment |
| deviated septum | _____ _____ may cause bleeding along the defected portion of the septum |
| sinusitis | Blood with purulent drainage suggests acute _____ |
| t | t/f: Tumors are a rare cause of nasal bleeding |
| juvenile nasopharyngeal angiofibroma | Adolescent male with profuse bleeding consider _____ _____ _____ |
| acute viral rhinosinusitis | aka the common cold. inflammation of all mucosa of nose and paranasal sinuses. Cause: Rhinovirus, coronavirus, respiratory syncytial virus (RSV), additional viral causes. Rhinoviruses cause at least ½ of all common cold illnesses |
| acute viral rhinosinusitis (the common cold) | Sx: Malaise, fatigue, occasionally a low grade fever possible (>38C suggests influenza or bacterial infection), chills, cough, sore throat. Nasal sx: obstruction, clear rhinorrhea, pressure over sinuses, blocked ears, stuffy nose. In children a fever for the first 2-3 days is not unusual. Anterior cervical lymph node enlargement can occur. Cold may last 10-14 days in infants and children |
| acute viral rhinosinusitis (the common cold) | Labs: WBC predominance of lymphocytes Tx: Management is supportive. Antipyretics, analgesics, oral decongestants/adrenergic agents (pseudoephedrine), antihistamine 1st generation, rehydration, symptoms resolve 5-8 days. Nasal saline spray or short term use of nasal decongestant. Ipatropium bromide nasal spray (Atrovent) anticholinergic |
| f | t/f: abx are effective in the treatment of the common cold |
| 5-8 | common cold: tx of sx. sx generally clear in _____ days |
| influenza | Viral infection involving the respiratory system. sx: Fever, Headache, Severe achiness, exhaustion, fatigue, weakness, chest discomfort and cough. Less common: stuffy nose, sneezing, sore throat. in 2011-12, 42,000 US residents hospitalized and 2,125 died. Prevention is key through vaccination |
| influenza | three types: A, B, C. is a respiratory illness but GI sx are often present in children or cases of H1N1. Testing can determine the presence of virus |
| 48 | Antiviral medications can help decrease duration of symptoms if started within _____ hours of symptom onset |
| trauma | Nasal bone most frequently fx facial bone. Presentation: Often with epistaxis from intranasal mucosal tears. Bruising is common. Tenderness with palpation. Displacement upon palpation. Radiographic tests - Lateral x-rays confirm |
| trauma | Supportive tx; septal hematoma refer ENT emergently. (septal widening may indicate septal hematoma. Refer to prevent saddle nose deformity). Cold compresses. Reduction of the fx is done 4-8 days after the injury to allow swelling to decrease. Repair is needed if obstruction of the airway |
| sinusitis | Inflammation of the sinus cavities. Can be acute or chronic. Usually occurs after an upper respiratory infection (URI). Risk factors include: Recent URI, chronic sinusitis, smoking, history or trauma or foreign body |
| sinusitis | Causes: Strep pneumoniae, H. flu, M. catarrhalis, S. aureus. It could also be due to a dental infection. Foreign bodies. Viruses: rhinovirus, influenza/parainfluenza, RSV, adenovirus, coronavirus, enterovirus. Viral more common than Bacterial |
| acute sinusitis | Presentation: HA, facial pain (can increase with leaning forward), discolored drainage, purulent drainage, fever, malaise, Tender to palpation, opacification of the sinus with transillumination. Bacterial infection, unilateral or bilateral nasal obstruction, purulent rhinorrhea, facial pain/pressure, congestion in the turbinates. Toothache. 2 major factors or one major factor and 2 minor factors, or purulence (cecil's) |
| acute sinusitis | Sinus films are not generally useful. CT scan - may show opacification. Referral: More than 3 cases of sinusitis per year. Severe infection that fails to be treated by abx. Persistent infection despite a few adequate trials of abx |
| uncomplicated | Sinusitis: _____ <7 days is symptomatic treatment. Saline nasal spray. Hot packs, steam. Topical decongestant for a 2-3 day period and monitor. Oral decongestant. Antipyretic |
| bacterial | Acute Sinusitis : _____ >7 days/purulent, facial pain, tooth pain. Symptomatic treatment and abx. Antibiotics: amoxicillin 500mg TID for 10 days, F/u to ensure resolution. Second line tx: Augmentin 875mg TID or clindamycin 300mg TID for anaerobe coverage. Macrolides, cephalosporin, fluroquinolones |
| focal | Acute _____ Sinusitis: any duration. Toxic appearance, severe facial pain, toothache, unilateral redness/edema, temp >38 C. Antibiotic treatment and consultation to ENT |
| acute sinusitis | Complications: Osteomyelitis, cavernous sinus thrombosis, orbital cellulitis, meningitis, brain abscess |
| chronic sinusitis | Often with multiple organisms including: M. catarrhalis, H. flu, S. pneumoniae, S. aureus, variety of anaerobes. Chronic viral, bacterial, allergen, fungal organisms. Osteomeatal complex obstruction. Persistent infection with mucosal thickening. Factors: smoking (alters mucosal transport less cilia), nasal polyps |
| chronic sinusitis | presentation: Represents persistent low grade infection. Persistent nasal obstruction, drainage thick and discolored and copious in morning, thins in the evening. Persistent mucosal thickening. Intermittent or constant facial pressure. Pain usually absent |
| chronic sinusitis | CT will confirm diagnosis. Allergy testing may be needed to rule out chronic allergic rhinitis |
| chronic sinusitis | Antibiotics alone not good enough. Decongestants and intranasal steroids, treat 3-4 weeks. Topical steroid sprays. Antibiotics: 3-4 weeks. Augmentin, cephalosporins, macrolides, clindamycin. Refer for surgery after 1-2 months of treatment. widespread destruction of sinus walls to create open chamber to nasal cavity |
| mucocele | dilation of chamber w/ mucus retention |
| potts puffy tumor | complication of frontal sinusitis with swelling in forehead due to osteomyelitis in frontal bone |
| fungal/mycotic sinusitis | Almost exclusively in immunocompromised or diabetic patients. More common in warm, humid climates. Consider if typical treatment fails. Causes: Aspergillus is most common, Coccidiomycosis, histoplasmosis, sporotrichosis, cryptococcosis, and others Tx: Surgical Drainage is the treatment of choice |
| invasive mycoses | Rapidly progressive and destructive process can cause necrosis of nose and facial soft tissue. Apergillosis and mucormycoses. Fever, facial pain, bloody nasal drainage, facial swelling. Necrotic tissue of the skin or septum. ENT referral and I&D. Debridement of necrotic tissue and systemic antifungal |
| deviated septum | Deviation from midline from trauma or disproportionate growth between the facial skeleton and nasal septum. Trauma or development. May lead to ostial obstruction or sinusitis |
| deviated septum | Unilateral or bilateral obstruction with symptoms. Diagnosis made by history and physical. Anterior deviations with worse symptoms than posterior. Treatment: only required if there is obstruction present. Septal deformity is a minor elective surgical procedure under local anesthesia. External nasal deformity may undergo rhinoplasty |
| turbinate hyperplasia | Caused by allergic rhinitis, nonallergic rhinitis, septal deviation, exposure to tobacco smoke, irritants, and pollutants; certain drugs (B-blockers, reserpine, hormones). Frequent cocaine use similar to rebound effect of topical decongestants |
| turbinate hyperplasia | Diagnosis based on history of chronic nasal obstruction associated with turbinate hypertrophy. Failure to respond to decongestants, antihistamines, or intranasal steroids leads to different surgeries to correct |
| nasal vestibulitis | Staph aureus infection around hair follicle in nasal vestibule; associated with excessive nose blowing or digital manipulation. Scabbing around the hair follicle. Management is limiting digitally induced nasal trauma, antibiotic ointment (bactroban) and/or antibiotics. DM, immune deficiency or progressive infection may need to use IV antibiotics to prevent spread of infection to cavernous sinus |
| nasal polyps | Inflammatory disorder of unknown etiology. Possibly due to chronic inflammation. Histamine may play a role. Often seen with allergic rhinitis. May be single or multiple. Originate from sinus mucosa, appearing gray translucent pedunculated masses. Symptoms are obstruction, hyposmia, anosmia, congestion, infections. Nasal phonations and complain of constant congestion |
| nasal polyps | Dx: Made by rhinoscopy or nasal endoscopy. Bx to r/o malignancy if there is a unilateral or solitary mass. Tx: Management aim is control of symptoms; topical/oral steroids. Surgery where indicated. Frequently recur. ENT for surgery |
| Samter's Triad | nasal polyps, asthma, ASA sensitivity and is difficult to treat. Caused by aspirin allergy that begins midlife. Treat asthma, polypectomy, avoid aspirin. Related to upregulation of leukotrienes caused by prostaglandin blockade |
| rhinitis | inflammation of the nasal mucosa |
| allergic rhinitis | Cause: Immunoglobulin E-mediated reactivity to airborne antigens (pollen, mold, dander, dust). Common in patients with a history of atopy. Presentation: Includes intermittent obstruction, clear rhinnorrhea or post nasal drainage, sneezing, watery eyes, pruritus of nose, eyes, palate. Sx similar to the common cold. Often seasonal. Allergic shiners, scratchy/itchy/watery eyes, sneezing, nasal congestion, dry cough, pale, boggy mucosa Increased IgE levels. Eosinophils on nasal smear |
| allergic rhinitis | Tx: Avoid allergens: tree pollens in spring; grasses in midsummer; weeds in fall, Animal danders, dust mites, mold-perennial symptoms with less pruritus. Responds to antihistamines. Cromolyn sodium (Crolom) mast cell stabilizer. Leukotriene receptor antagonist: Montelukast (Singulair). Nasal Steroids Fluticasone propionate (Flonase), Nasacort, Nasonex. Systemic corticosteroids. Nasal saline spray. Nasal antihistamine: Azelastine (Astelin). Nasal anticholinergics: Atrovent Nasal Spray |
| nonallergic rhinitis | Same symptoms as allergic rhinitis but allergy testing is negative. No eosinophils on nasal smear. Tx with decongestants |
| vasomotor rhinitis | Increased secretion of mucus from the nasal mucosa. May be from changes in temperature or humidity, odors, alcohol, or from a neurovascular imbalance. Bogginess of the nasal mucosa with complaints of stuffiness and rhinorrhea Symptoms can clear quickly. tx: Avoid the irritant. Decongestants |
| rhinitis medicamentosa | Overuse of decongestant drops or sprays (phenylephrine and oxymetazoline). Rebound congestion prompts increased use of the agent which creates a vicious cycle. Presentation: Severe congestion and pain. Minimal discharge. Tx: Discontinue the irritant. Consider topical steroids during the withdrawal period |
| turbinate engorgement | elevations in estrogen during pregnancy causes this |
| sarcoidosis | noncaseating septal nodules on bx. tx is systemic steroids |
| wegener's granulomatosis | septal ulcers, turbinate hypertrophy, vasculitis. tx is cyclophosphamide |
| tuberculosis | beefy, red mucosa w/ ulcerations and exudates. + ppd, caseating granulomas. tx is isoniazid, rifampid, ethambutol |
| nasopharyngeal | _____ tumors may present as neck masses, hearing loss, OM, diplopia, other visual disturbance, epistaxis, nasal obstruction |
| sinus | _____ tumors may present as sinusitis, epistaxis, toothache, proptosis, cheek swelling, facial pain/numbness/tingling |
| parotid gland | largest salivary gland, opening into the oral cavity via Stenson's Duct (parotid duct) which penetrates the buccinator muscle (opens bilaterally at the area of the second upper molar) |
| submandibular gland | located in submandibular triangle, opening in floor of mouth (Wharton's Duct) |
| sublingual gland | smallest salivary gland, lies above mylohyoid muscle |
| hard palate | separates oral cavity from nasal cavity and is a bony plate covered with mucous membrane |
| soft palate | (part of oropharynx) muscular tissue covered with mucous membrane, plays a role in swallowing and vocal resonance |
| oropharynx | includes soft palate, anterior & posterior tonsillar pillars, tonsils, base of tongue, posterior pharyngeal wall |
| tongue | helps form floor of mouth; divided into anterior 2/3 and posterior 1/3 at the V-shaped sulcus terminalis. Muscle, nerve, vessels enter through the base |
| t | t/f: Most oral cavity conditions diagnosed from H & P. Dentures should be removed |
| 200 | _____ primary oral cavity lesions/dz. also secondary abnormalities can occur |
| disease processes affecting the oral cavity | Herpangina, Aphthous stomatitis, Aphthous ulcer, Herpes Zoster, Herpes simplex, Cheilitis sicca, Angular Cheilitis, Hand-foot-mouth disease, Candidiasis, Acute tonsillitis, Peritonsillar abscess, Torus palatinus or mandibularis, Infectious mononucleosis, Tonsillar hypertrophy, Acute pharyngitis, Papilloma, Basal cell carcinoma lip, Squamous cell carcinoma, Sjogren's syndrome, Fissured tongue, Geographic tongue, Tongue carcinoma, Leukoplakia, Erythroplakia |
| torus palatinus | bump on palate |
| torus mandibularis | bump on mandible |
| ankyloglossia | tongue tie (tight frenulum) |
| torus palatinus | Exostosis or outgrowth of bone. Incidental finding upon examination. Hard bony growth with intact mucosa. Palatinus: 20-25%. Mandibularis: 6-8%. No tx |
| hemangiomas | Vascular tumor that appears at birth. Grows until puberty and spontaneously resolves. Consider steroid injection or surgical removal if obstructive or cosmetic problem |
| ranula | Small painless mucocele that forms at outlet of sublingual glands. Soft compressible blue mass overlying vein on floor of mouth. Treat by making a pouch. Marsupialization |
| phenytoin (dilantin) | drug induced condition with gingival hyperplasia is caused by |
| tetracycline (sumycin) | drug induced condition with yellow discoloration of the teeth if given before about 8 years old is caused by |
| chemotherapy | drug induced stomatitis or mucositis is caused by |
| steven johnson syndrome | drug induced condition with oral involvement |
| vitamin c deficiency | bleeding gums and gingivitis. scurvy. is caused by |
| vitamin b2 deficiency | atrophic glossitis, angular chelitis and gingivostomatosis is caused by |
| vitamin b3 (niacin) deficiency | pellegra. beefy tongue w/ ulcerations and loss of papillae is caused by |
| vitamin b12 deficiency | pernicious anemia. smooth, beefy red tongue w/ pale mucosa and loss of papillae +/- ulcers is caused by |
| iron deficiency | smooth, red tongue with loss of papillae, angular cheilitis and pale/grey colored oral mucosa is caused by |
| acromegaly | macroglossia with wide spaced teeth is caused by |
| amyloidosis | macroglossia with yellow nodules on dorsal and lateral surfaces is caused by |
| menopause | atrophic mucosa and gingivostomatitis is caused by |
| papilloma | caused by hpv. nonpainful mass. single or multiple raspberry-like masses. predilection for mucocutaneous junctions. excisional bx w/ histologic examination |
| vincent's disease/angina | Trench mouth. Polymicrobial infection of gums leading to inflammation, bleeding, deep ulceration and necrotic gums. Overpopulation of oral bacteria and poor hygiene, smoking, poor diet or lifestyle. Spirochetes, Bacteroides. Presents with pain, fever, halitosis. Tx: oral hygiene, antibiotic |
| herpangina | Cause: Coxsackievirus A; Fall and Summer. Presentation: Severe sore throat, odynophagia, sudden high fever, malaise, dysphagia, vomiting, anorexia. Child is irritable due to pain. Primarily children less than 5 years old. Oropharynx has numerous small vesicles that are gray/white with red halos, then become flat. Linear arrangement on the palate, uvula, tonsillar pillars. Diffuse pharyngeal hyperemia. Oropharynx! Usually less than one week. Acute onset. tx: Self-limiting; supportive and symptomatic treatment with antipyretics, fluids |
| aphthous ulcer | aka canker sore. idiopathic. possible associate w/ viral causes. presentation: Buccal mucosa, single, multiple. Painful round ulcer with red halo. Covered by yellowish exudate. Typically recurrent. Older children and adults. Most common nontraumatic ulceration of the oral mucosa. Pain is often disproportionate to their size. Minor ulcers often resolve in 7-10 days |
| aphthous ulcer | Self-limited. Supportive treatment with anti-inflammatories. Topical steroid rinse or topical steroids. Benadryl, Lidocaine, Maalox swish and spit Recurrence is common |
| aphthous stomatitis | Affects 20% of the population. Occur on all areas of the oral mucosa except the hard palate, gingiva, and vermilion which are keratinized. They are in 3 clinical forms: Minor, Major, and herpetiform. Failure to resolve should prompt incisional biopsy to exclude neoplasia |
| Primary Herpetic Gingivostomatitis | Herpes simplex virus type I most commonly. Presentation: painful oral lesions. Children most common. Most people are exposed during childhood. Many painful lesions on the buccal and gingival mucosa. Vesicles coalesce to form ulcers. May have fever, arthralgia, malaise, cervical lymphadenopathy. Fever and malaise, any oral mucosal site. Tx: Self-limited and Lasts 7-14 days. Treatment supportive and symptomatic. Early treatment with acyclovir suspension swish and swallow can shorten duration |
| hsv-1 | cold sores: secondary lesions. Recurrent, episodic eruptions of yellowish fluid filled vesicles on upper/lower lip, nose. Most common: lip. Less common on the keratinized mucosa of the gingiva or hard palate. Usually a prodrome of tingling, burning or itching occurs before the episode. Stress, immunosuppression, trauma, sunlight exposure. Topical acyclovir ointment can be affective for mucosal lesions. Systemic acyclovir within 72 hours of onset can help. Fluids, rest, analgesics, antipyretics. Avoid herpetic whitlow |
| herpes zoster | Varicella-zoster virus. Presentation: Extremely painful; burning; may have fever; malaise. Early adults with impaired host defenses. Unilateral vesicles on buccal mucosa, tongue, uvula, pharynx, larynx, erosions after eruptions. tx: Self-limited and Lasts 7-14 days. Antiviral drugs; symptomatic treatment |
| solar cheilitis | Exogenous damage by weather, drying, solar radiation. Presentation: Especially bottom lip. Atrophic, pale appearance. Slightly firm and swollen. Mainly white, fair individuals. Related to sun exposure. Dry, fissured, reddened or scaling lip mucosa. Can ulcerate. Tx: Symptomatic. Chapstick, Vaseline, sun-blocking lip balm. Consider biopsy and referral if severe |
| angular cheilitis | Infection: Often Candida or Staph. Thumb sucking. Sagging face and loss of teeth. Presentation: Dry, burning at the corners of mouth. Often associated with oral candidiasis. Macerated, deep fissures at the mouth corners. Tx: Identify and treat the cause. Clotrimazole 1% cream if the etiology is Candida |
| Hand-Foot-and-Mouth Disease | Viral: Coxsackievirus. Presentation: Sore mouth, low grade fever, coryza. Young children, 6 months to 5 years. Vesicular lesions of skin; small, multiple, vesicular and ulcerative oral lesions, also on the hands and feet. Tx: Self-limiting; usually 1-2 weeks. No specific treatment; local measures |
| mumps | Paramyxovirus. Presentation: Rare since vaccine. Bilateral salivary gland enlargement and salivary hypofunction. Mild temperature elevation, malaise, sudden distention and pain. Diffuse swelling over the parotid glands. Tx: Hydration, analgesics. Symptomatic treatment. Recurrent Parotitis of childhood. Unilateral or bilateral parotid enlargement. Salivary secretion may be reduced, but usually without prominent signs or symptoms |
| recurrent parotitis | _____ _____ of childhood. Unilateral or bilateral parotid enlargement. Salivary secretion may be reduced, but usually without prominent signs or symptoms |
| pharyngitis | a broad term. Sore throat. Many causes. Bacterial, viral and other origins |
| tonsillitis | enlargement of the tonsils and inflammation |
| peritonsillar abscess | Inflammatory infiltration and abscess formation. Presentation: Severe unilateral throat pain, fever, malaise, difficulty eating, drooling, fetid breath. Any age; peak times second to fourth decades. Erythema and bulging of peritonsillar area, uvula deviation, fluctuance of soft palate. Asymmetric and unilateral palatal swelling and uvular deviation. Tender cervical adenopathy. Usually has exudates. May appear as a sore throat, then symptom free, then worsening. Patient has a "hot potato voice" (voice sounds like they are talking with hot food in their mouth) |
| peritonsillar abscess | ENT referral for Needle aspiration, I&D, antibiotics: amoxicillin plus metronidazole. Often polymicrobial. May require tonsillectomy (infection started superficial and extends. May erode into internal carotid artery: Bleeding quinsy) |
| acute viral pharyngitis | Pharyngitis is Primarily viral. May turn into a bacterial infection. Presentation: Children and adults. Gradual onset often with a cold. Usually lack exudate. Fever is low grade, lymphadenopathy occasionally present. Dry, red, thickened pharyngeal mucosa; exudate occasionally. Often tonsillar enlargement, halitosis, fever, dysphagia, odynophaghia |
| acute viral pharyngitis | tx: Culture can be done. Rapid strep or throat culture. Analgesics, local measures. Score <1 observe. 2-3culture and tx. >4tx |
| infectious mononucleosis | Epstein-Barr virus. Presentation: Severe sore throat, odynophagia, fever, malaise, Headache. Primarily adolescents and young adults. Bilateral posterior cervical lymph nodes, huge tonsils, exudate on tonsils, leukocytosis, atypical lymphocytes. Soft palate petechiae |
| infectious mononucleosis | Course Usually 10-21 days. Avoid contact sports for 6-8 weeks. Monospot test and CBC with differential |
| bacterial pharyngitis/tonsillitis | Group A B-hemolytic streptococci. M. catarrhalis, H. influenza, S. aureus. Presentation: Raw, dry, burning throat, adenopathy in children. Children (3-14 is common) and adults. Fever present. Dry, red, thickened pharyngeal mucosa; exudates. +/-Tonsillar swelling. |
| bacterial pharyngitis/tonsillitis | Dx: Rapid Strep. Throat culture. Tx: Cefuroxime 250mg BID for 5-10 days. Penicillin as PCN VK250mg TID or 500mg TID for 5-10 days. Analgesics |
| Group A Beta Hemolytic Strep | most important strep to tx. Presentation: Fever > 100.4 or 38 C, tender anterior cervical adenopathy, lack of cough and presence of pharyngo-tonsillar exudates. 3 out of 4 suggest Strep. 2 out of 4 indicate need to culture. Children and adults. Additional sx: Pharyngeal erythema with red palatine tonsils and arch; yellow exudate, painful adenopathy, chills, malaise, painful glands in neck; Sudden onset intense throat pain, odynophagia, cough +/- coryza, and rhinorrhea suggestive that is clear |
| Group A Beta Hemolytic Strep | Penicillin as PCN VK250mg TID or 500mg TID for 5-10 days. Cefuroxime 250mg BID for 5-10 days. Erythromycin |
| Group A Beta Hemolytic Strep | Complications: rheumatic fever, tonsillar abscess |
| tonsillar hypertrophy | Excessive reactive proliferation of tonsil tissue. Mouth breathing, eating difficulties, snoring, sleep disorder, change in speech resonance. Children and adults. Increase in volume of tonsils, cervical adenopathy; if unilateral refer to ENT. Progressive with worsening upper airway symptoms. Tx: Surgery if dental, facial abnormality, airway obstruction, dysphagia, sleep disorders |
| viral | The most common cause of pharyngitis is a _____ infection. Rapid strep or throat culture |
| glomerulonephritis | Treating strep throat is key to help decrease transmission to others. Also to prevent rheumatic fever and acute _____. Mono spot if suspect mono: fatigue, teenagers |
| penicillin | _____ abx used for strep pharyngitis. macrolides if allergic. consider tonsillectomy if tonsillitis recurs |
| fissured tongue | Normal variant in 11% of the population. Differential: Psoriasis, myxedema, acromegaly, Sjogren syndrome. Presentation: Usually painless, except if food debris in grooves lead to irritation. Numerous small furrows on dorsal and lateral tongue. Tx: No concern unless evaluation reveals other pathology. Hygiene; stretch/flatten fissures, clean surface with toothbrush |
| geographic tongue | Also known as benign migratory glossitis. Idiopathic. No specific cause. Possible link with psoriasis. 25% tenderness and burning. Discrete, irregular areas of desquamation, white to yellow in color, resembling a "map." Regression and recurrence. Well-defined areas of atrophied filiform papillae bordered by arcs of normal or hyperplastic filiform papillae. Tx: No specific treatment. Reassurance. Vit. B12 complex |
| oral candidiasis: thrush | Often in immunocompromised or with use of broad spectrum antibiotics. Burning pain of the tongue, inside cheeks, throat. Can be scraped off and the area underneath will be red, friable, raw. Tx: Nystatin (antifungal) swish and swallow. Clortrimazole, Fluconazole |
| black hairy tongue | Benign condition. Defective desquamation of filiform papillae resulting in hair-like projections on the dorsum of tongue. Elongation of the papillae. White, yellow, green, brown, or black. Associated with heavy tobacco use, systemic antibiotic therapy, poor oral hygiene, systemic steroids. Asymptomatic or gagging, altered taste. Tx: eliminate cause. Oral hygiene; |
| sialolithiasis | Calculi in salivary gland, principally submandibular gland (80%). Mainly middle aged males. Recurrent swelling and pain especially with eating. Reduces in size once done eating. Palpation may reveal calculus. X-ray may show location. May require surgical excision. Some pass spontaneously. Try to milk the stone out. May require analgesic, antibiotic |
| Acute Suppurative Sialoadenitis | Can affect parotid, submandibular, or sublingual. caused by any factor that reduces flow of saliva allowing for retrograde infection of salivary gland (age, poor hygiene, medication). Acute onset of pain, swelling often associated with fever, swollen gland with erythema. Fever. Swollen, tender gland with overlying erythema |
| Acute Suppurative Sialoadenitis | Obtain a culture. Empiric antibiotics like cloxacillin or dicloxacillin; improve salivary flow; volume repletion; milking gland. Moist heat. No improvement 2-3 days CT to Rule out abscess, mass lesion, or impacted sialolith requiring surgery |
| Acute Nonsuppurative Sialoadenitis | Typically viral infection most common cause mumps. EBV, coxsackievirus, HIV. Tx is supportive |
| Sjogren's Syndrome | Autoimmune; classic triad of xerostomia (oral dryness), dry eyes, connective tissue disorder (RA most common). Swelling of parotid/submandibular gland bilaterally, arthritis, laryngitis. May be tender or firm. More common in women, dry lips or mouth, viscous mucus when expressed from salivary ducts. Diminished salivary flow. Atrophy of tongue papillae |
| Sjogren's Syndrome | Biopsy of labial salivary gland. Antibody testing. AntiSSA (Ro) and anti-SSB (La). Course is Progressive; rheumatology evaluation. Local and symptomatic, humidification and hydration, Avoidance of anything that decreases salivary flow. Supportive Treatment |
| Xerostomia | dry mouth, many causes. may lead to pain, dysphagia, altered taste, and dental caries |
| ptyalism | Hypersalivation or drooling. Usually due to a secondary condition. Pregnancy, Graves disease, heavy metal poisoning, epilepsy, CVA. Treat the underlying condition |
| leukoplakia | white patches that cannot be removed |
| erythroplasia | ominous mucosal change, velvety red patch, floor of mouth, ventral tongue, soft palate, tonsil, high rate of dysplasia, always biopsy |
| verrucous carcinoma | low grade variant of SCC, found in oral cavity and larynx, resembles wart, non invasive cancer |
| leukoplakia | Denotes white patch or plaque on mucous membrane. Cause: Most common inciting agent is cigarette smoking. Tobacco smoked or smokeless. Alcohol use. Trauma. Iron deficiency anemia. Patient usually >40 years old. Usually males |
| leukoplakia | May be asymptomatic, hoarseness, voice changes. May be Isolated to vocal cords or larynx diffusely. Keratinization of the mucosa occurs. It may involve dysplastic epithelial changes. Painless white patch on the tongue, inside cheek, lower lip, floor of the mouth and it CANNOT be scraped off |
| leukoplakia | May be considered a premalignant lesion. Carcinoma develops in 2% to 6%. Erythroplakia has a 60% rate of changing to malignancy. Excisional biopsy both diagnostic and therapeutic, especially in those with a history of alcohol and tobacco use. Laryngoscopy to observe for recurrence or progression |
| erythroplakia | possible dysplastic lesion. velvety red patch, floor of mouth, ventral tongue, soft palate, tonsil, high rate of dysplasia. tx: bx to determine tx. referral to ENT |
| basal cell carcinoma of lips | prolonged exposure to sunlight. Lesions ulcerates, heals over, then breaks down again; history of ultraviolet light exposure. Crusting ulcer with heaped or rolled borders; induration. Untreated lesions enlarge, infiltrate adjacent and deeper tissues. Biopsy for diagnosis; each lesion considered separately when choosing therapy |
| squamous cell carcinoma | Lack specific etiology; tobacco , alcohol, poor oral hygiene, syphilis implicated. Usually painless ulcer unless nerves or periosteum involved; fetid breath. Ulcerated lesion with raised borders; palpation of mouth and tongue mandatory; if trismus (lock jaw: tonic contraction) noted suspect deep invasion. Comprise 95% of oral cancers. Biopsy for diagnosis; therapy depends on staging |
| tongue carcinoma | Associated with tobacco, alcohol use. Initial painless mass or ulcer becoming painful; difficulty with speech, eating; referred ear pain; weight loss. Ulcer or mass with induration and raised borders; fetid breath; firm tongue; neck mass. Metastasis common. Staging biopsy for diagnosis and treatment |
| Salivary Gland Carcinoma | Parotid gland is the most common site of involvement. Any age but most common between 55-65 years of age. Many tumors of the parotid are benign. The 3 most common types of malignant tumors of the salivary glands are; adenoid cystic carcinoma, mucoepidermoid cancer, adenocarcinoma. Adenoid cystic carcinoma can spread hematogenously, and along the nerves. Alcohol and tobacco are the main causes. Surgical removal and possibly radiation. Response rates of 20-35%, but some prolonged responses are occasionally seen |
First Time Here?
Welcome to Quizlet, a fun, free place to study. Try these flashcards, find others to study, or make your own.