Eent

Front 1

a general term describing inflammation of any salivary gland.

The three major salivary glands are the parotid, submandibular, and sublingual.

Back 1

sialoadenitis

Front 2

broad spectrum of causes, including acute and chronic infections; metabolic, systemic, and endocrine disorders; infiltrative processes; obstructions; allergic inflammation; and neoplastic diseases.

Key features in the history are the duration and course of the symptoms, complaints of pain, and unilateral or bilateral location.

Back 2

sialoadenitis

Front 3

Both viral and bacterial infections of the salivary gland can lead to enlarged, swollen, painful masses.

Viral sialoadenitis such as mumps parotitis, occurs with a concomitant viral illness and is usually _________, whereas bacterial infections are primarily __________.

Back 3

bilateral, unilateral

Front 4

Suppurative bacterial sialoadenitis is most commonly caused by ___________, and is found in patients who are elderly, diabetic, dehydrated, or have poor oral hygiene.

Back 4

staphylococcus aureus

Front 5

Purulent drainage may be expressed from the submandibular (Wharton’s) duct or from the parotid (Stensen’s) duct.

Back 5

Sialoadenitis

Front 6

The glands are very painful and tender to palpation

Back 6

Sialoadenitis

Front 7

Treatment of __________ requires antibiotics with staphylococcal coverage such as nafcillin, rehydration, proper oral hygiene, measures to increase salivary flow (warm compresses and massage), and occasionally surgical irrigation and drainage.

Back 7

suppurative sialoadenitis

Front 8

results from a stone or calculus in the salivary gland or duct, most commonly in the submandibular (Wharton’s) duct.

Back 8

Sialolithiasis or obstructive sialoadenitis

Front 9

The flow of saliva is obstructed, causing swelling, pain, and firmness.

Back 9

Sialolithiasis

Front 10

Patients note general xerostomia (dry mouth) and recurrent worsening of swelling and pain during and after mealtime.

Back 10

Sialolithiasis

Front 11

a paramyxoviral disease spread by respiratory droplets that usually produces inflammation of the salivary glands.

Back 11

Mumps parotitis

Front 12

Most patients are children, and the incidence is highest in the springtime.

The incubation period is 14 to 21 days.

Back 12

Mumps parotitis

Front 13

Parotid tenderness and overlying facial edema are the most common physical findings.

Back 13

Mumps parotitis

Front 14

Fever and malaise are variable and are often minimal in young children.

Back 14

Mumps parotitis

Front 15

the leading cause of pancreatitis in children

Back 15

Mumps parotitis

Front 16

Serum amylase is commonly elevated, with or without pancreatitis.

Back 16

Mumps parotitis

Front 17

The patient should be isolated until swelling subsides and kept at bed rest during the febrile period.

Treatment is symptomatic as needed.

Back 17

Mumps parotitis

Front 18

The two most common causes are infections and angioedema, although most causes are idiopathic (of unknown cause).

Regardless of the cause, most patients complain of sore throat, gagging sensation, or a foreign body sensation in the back of the mouth.

Back 18

uvulitis

Front 19

The infectious etiologies are bacterial, including Haemophilus influenzae and streptococci; fungal, such as Candida albicans; and viral.

Back 19

uvulitis

Front 20

With infectious ______, patients note fever, dysphagia, trismus, facial pain, hoarseness, neck pain, and headache.

Infections of are typically extensions from adjacent infections, such as epiglottitis, tonsillitis, peritonsillar abscess, and pharyngitis.

Back 20

uvulitis

Front 21

On examination, the uvula is red, firm, swollen, and very tender to palpation

Back 21

uvulitis

Front 22

In uvulitis, when associated with peritonsillar abscess, the uvula is displaced to the ____________ side of the mouth.

Back 22

contralateral (opposite)

Front 23

Angioedema of the uvula, also known as ________, can be hereditary, acquired, or idiopathic.

The uvula appears pale, boggy, and edematous, resembling a large white grape (uvular hydrops).

Back 23

Quincke’s disease

Front 24

many patients note pruritis, urticaria, and wheezing.

Most cases are benign and self-limited

Back 24

uvulitis

Front 25

This is treated with administration of steroids, antihistamines (both H1 and H2 blockers), and epinephrine.

Back 25

Angioedema of the uvula

Front 26

For infectious __________, antibiotic coverage is dictated by the primary source of infection.

For odontogenic infections, pharyngitis, or tonsillitis with uvulitis, penicillin, clindamycin (Cleocin), or amoxicillin with clavulanate (Augmentin) are effective.

Epiglottitis associated with uvulitis requires potent H. influenzae coverage, such as third generation cephalosporins.

Back 26

uvulitis

Front 27

The causes are bacterial, such as group A beta-hemolytic streptococci (GABHS), Mycoplasma pneumoniae, Corynebacterium diphtheriae, and Neisseria gonorrhoeae; viral; and Epstein-Barr virus (EBV).

Back 27

pharyngitis

Front 28

The overall manifestations include sore throat, difficulty in swallowing, fever, erythema of the tonsils and posterior pharynx, lymph node enlargement, rhinitis, and cough, all in varying degrees.

Back 28

pharyngitis

Front 29

Infections that penetrate the tonsillar capsule leads to cellulitis and peritonsillar abscess, a medical emergency

Back 29

pharyngitis

Front 30

With _________, the physical examination should not end at the neck.

Auscultation of the chest, palpation of the abdomen, and examination of the skin are also important.

______________ itself may be a prodrome for other pathologic conditions, such as measles, scarlet fever, and influenza.

Back 30

pharyngitis, pharyngitis

Front 31

General ancillary treatment includes analgesics and anti-inflammatory agents, such as acetaminophen or ibuprofen.

Some patients find that salt water gargle is soothing.

Anesthetic gargles and lozenges may provide additional symptomatic relief.

Systemic corticosteroids such as dexamethasone (Decadron) may be helpful to alleviate pain and edema in severe cases.

Back 31

pharyngitis/tonsillitis

Front 32

Occasionally, dysphagia is so intense that hospitalization for intravenous hydration and antibiotics is necessary

Back 32

pharyngitis

Front 33

the most common cause of pharyngitis, and account for 90% of all cases.

Back 33

viral pharyngitis

Front 34

presents with an insidious onset, often with coryza (rhinitis), usually lacking exudate.

The pharynx and tonsils are erythematous, may be edematous, and exudate may also be present.

Back 34

viral pharyngitis

Front 35

Fever is low grade, lymphadenopathy may or may not be present.

A throat culture should be obtained to rule out streptococcal infection.

Most cases are self-limited with spontaneous resolution in a matter of days.

Treatment is supportive in nature.

Back 35

viral pharyngitis

Front 36

caused by group A beta-hemolytic streptococcus (Streptococcus pyogenes).

Back 36

Streptococcal Pharyngitis

Front 37

It presents with an acute onset of the following: sore throat, fever, exudate in the posterior pharynx or on the tonsils, and anterior cervical adenopathy.

Frequently, there is also nausea, vomiting, malaise, headache, and abdominal cramping.

Back 37

Streptococcal Pharyngitis

Front 38

In children, it may present as abdominal pain secondary to adenopathy in the abdomen.

unusual in children under the age of 2 to 3 years.

Back 38

Streptococcal Pharyngitis

Front 39

On examination, patients may have a mild to moderate fever, an erythematous posterior pharynx and palatine tonsils (“beefy red”), tender cervical adenopathy, and palatal petechiae.

Back 39

Streptococcal Pharyngitis

Front 40

Classically, the tonsils have a white or yellow exudate with debris in the crypts; however, many patients may not have exudate on exam (up to 30%).

Back 40

Streptococcal Pharyngitis

Front 41

The tongue may be red with enlarged papillae (“strawberry tongue”).

Back 41

Streptococcal Pharyngitis

Front 42

What are these:
fever over 38˚ C (100.4˚ F),
tonsillar exudates,
cervical adenopathy,
and lack of viral symptoms (no cough, coryza, or congestion).

Back 42

four clinical predictors for streptococcal pharyngitis (the Centor criteria):

Front 43

Treatment is necessary to prevent the development of rheumatic fever, and treatment within 7 to 9 days of onset will prevent the disease.

Back 43

Streptococcal Pharyngitis

Front 44

The choice of treatment includes penicillin VK, 500 mg BID x 10 days (for children, 50 mg/kg PO BID x 10 days).

Back 44

Streptococcal Pharyngitis

Front 45

A single IM injection of benzathine penicillin or procaine penicillin is effective, and may be the best choice if compliance is an issue.

Back 45

Streptococcal Pharyngitis

Front 46

Erythromycin is a reasonable alternative to penicillin in allergic patients.

Azithromycin (Zithromax), 500 mg PO QD x 3 days, has also been reported to be successful in shorter-duration regimens.

Back 46

Streptococcal Pharyngitis

Front 47

School-aged children should receive antibiotic treatment for one day before returning to school.

Prophylactic treatment of family contacts is not justified or necessary.

The patient should be instructed to replace his/her toothbrush.

Back 47

Streptococcal Pharyngitis

Front 48

Tonsillectomy is generally reserved for a child who has at least 7 documented throat infection episodes during the previous year that were characterized by fever, cervical adenopathy, exudate, or a positive culture for group A strep.

Back 48

Streptococcal Pharyngitis

Front 49

Complications of improper or incomplete treatment include scarlet fever, glomerulonephritis, rheumatic myocarditis, Ludwig’s angina, and peritonsillar abscess.

Back 49

Streptococcal Pharyngitis

Front 50

produces a toxin that results in the erythematous, fine, “sandpaper” rash of scarlet fever, involving the face and skin folds.

It is followed by desquamation of the affected epidermis

Back 50

Streptococcal Pharyngitis

Front 51

a rare cause of pharyngitis.

It is more commonly seen in immunocompromised patients.

Back 51

Gonococcal Pharyngitis

Front 52

should be considered in patients from high-risk populations such as homosexuals and prostitutes, patients with a history of orogenital contact, those with the presence of gram negative intracellular diplococci on pharyngeal Gram stain, or patients with other symptoms suggestive of genital infection.

Back 52

Gonococcal Pharyngitis

Front 53

This form of pharyngitis has an acute onset of severe sore throat.

Exudate is present with multiple ulcer-type lesions and tender cervical lymphadenopathy.

The patient may have a concurrent urethritis or cervicitis.

Back 53

Gonococcal Pharyngitis

Front 54

A throat culture on selective media (Thayer-Martin) should be used for a gonococcal culture.

Back 54

Gonococcal Pharyngitis

Front 55

Treatment is with ceftriaxone (Rocephin), erythromycin, or probenecid.

Back 55

Gonococcal Pharyngitis

Front 56

caused by the Epstein-Barr virus (EBV).

Back 56

Mononucleosis

Front 57

There is a prodromal phase of malaise and constitutional symptoms of at least one week’s duration

Back 57

Mononucleosis

Front 58

Physical exam reveals pharyngitis, a shaggy white-purple tonsillar exudate (often extending into the nasopharynx), and petechiae on the mucous membranes.

Back 58

Mononucleosis

Front 59

Posterior cervical adenopathy is common.

There is tender widespread adenopathy; and possibly splenomegaly, hepatomegaly, and jaundice.

A CBC with atypical lymphocytosis or a positive monospot test supports the diagnosis.

Back 59

Mononucleosis

Front 60

Monospot tests can be falsely positive if the patient has lymphoma, malaria, or is on anticonvulsant medication.

Back 60

Mononucleosis

Front 61

Treatment is supportive.

A short course of corticosteroids may be required to reduce the pharyngeal edema.

Back 61

Mononucleosis

Front 62

An antibiotic may be used to cover concomitant strep infection.

Ampicillin and amoxicillin should be avoided because they induce a rash when given in this setting.

If splenomegaly is present, contact sports should be avoided to prevent splenic rupture.

Back 62

Mononucleosis

Front 63

Is is a rare cause of pharyngitis, more prevalent among the alcoholic population.

It presents with low-grade fever and severe sore throat in a toxic appearing patient.

Back 63

diptheria

Front 64

Physical exam reveals a discrete white to gray pseudomembranous exudate on the tonsils or posterior pharynx that, if removed, bleeds easily.

There is also marked cervical adenopathy.

Back 64

diptheria

Front 65

Treatment is with antitoxin, penicillin, and quarantine

Back 65

diptheria

Front 66

is the most common deep neck infection.

Most abscesses develop as a complication of tonsillitis or pharyngitis, but they can also result from odontogenic spread, recent dental procedures, and local mucosal trauma.

Back 66

Peritonsillar abscess, or Quincy

Front 67

This results when infection penetrates the tonsillar capsule and involves the surrounding tissues

Back 67

peritonsillar cellulitis

Front 68

Following therapy, peritonsillar cellulitis usually either resolves over several days, or evolves into

Back 68

peritonsillar abscess

Front 69

It may be diagnosed with a CT scan of the neck with IV contrast, which will show the abscess as a hypodense lesion in the retropharyngeal space with peripheral ring enhancement.

Back 69

Peritonsillar Cellulitis & Abscess

Front 70

presents with severe sore throat, dysphagia, drooling, trismus, medial deviation of the soft palate and peritonsillar fold, ipsilateral ear pain, and an abnormal muffled (“hot potato”) voice.

During the early stages, the tonsil and anterior pillar are erythematous, appear full, and may be shifted medially.

Later, the uvula and soft palate are shifted to the contralateral side.

The tonsil may feel fluctuant and tender on palpation.

Back 70

Peritonsillar Cellulitis & Abscess

Front 71

The existence of an abscess may be confirmed by aspirating pus from the peritonsillar fold just superior and medial to the upper pole of the tonsil.

A 19 or 21 gauge needle should be passed no deeper than 1 cm, because the internal carotid artery passes posterior and deep to the tonsillar fossa.

There is controversy about the best way to treat

Some incise and drain the area and continue with parenteral antibiotics, while others aspirate only and follow as an outpatient.

Back 71

Peritonsillar Cellulitis & Abscess

Front 72

Patients who are immunocompromised, have airway involvement, appear toxic, or cannot tolerate oral intake require admission for rehydration, parenteral antibiotics, and specialty consultation.

Although penicillin alone is arguable a good first choice, penicillin and metronidazole (Flagyl), amoxicillin with clavulanate (Augmentin), clindamycin (Cleocin), or third generation cephalosporins are also suitable antibiotic choices.

Back 72

Peritonsillar Cellulitis & Abscess

Front 73

the most common cause of hoarseness

Back 73

laryngitis

Front 74

It may persist for a week or so after other symptoms of an upper respiratory infection have cleared.

It is usually caused by a virus.

There is little to no pain associated with the loss of voice.

Back 74

laryngitis

Front 75

The patient should be warned to avoid the vigorous use of the voice such as singing or shouting, since this may foster the formation of vocal cord nodules

Back 75

laryngitis

Front 76

Although thought to be usually viral in origin, both Moraxella catarrhalis and Haemophilus influenzae may be isolated from the nasopharynx.

Erythromycin may reduce the severity of hoarseness and cough.

Back 76

laryngitis

Front 77

Hoarseness, sore throat, or chronic pharyngitis that lasts more than two weeks must be referred for further evaluation to rule out possible neoplastic or neurologic causes, especially in patients over age 50 who have a smoking or chewing tobacco history.

Back 77

laryngitis

Front 78

_______________ of the larynx is the most common carcinoma of the larynx.

It presents with hoarseness, dyspnea, stridor, and severe pain.

Back 78

Squamous cell carcinoma

Front 79

a life-threatening infection of the epiglottis and surrounding tissues that leads to obstructive respiratory disease

Back 79

epiglottitis

Front 80

It is commonly caused by Haemophilus influenzae type B, group A beta-hemolytic streptococcus, Streptococcus pneumoniae, or Staphylococcus aureus.

It has become more common in adults than children, because most children have received the Hib vaccine.

Back 80

epiglottitis

Front 81

presents as an abrupt onset of high fever, difficulty swallowing, stridor, sore throat, drooling, and, in children, sitting in the “tripod position” (sitting upright with the neck extended, arms supporting the trunk, and the jaw thrust forward).

Back 81

Epiglottitis

Front 82

A lateral soft-tissue neck X-ray reveals a thickened epiglottis as a thumb-like projection (the classic “thumb sign”).

Back 82

Epiglottitis

Front 83

Airway management is paramount!

Anesthesiology and ENT should be consulted immediately, and controlled intubation should be performed.

Back 83

epiglottitis

Front 84

The mainstay of treatment is antibiotics.

Second and third generation parenteral cephalosporins or ampicillin with sulbactam (Unasyn) have proven efficacy .

Back 84

epiglottitis

Front 85

The patient also needs IV fluids.

Steroids or epinephrine (either nebulized or subcutaneous), may provide some improvement in edema.

All un-immunized close contacts should be given prophylaxis with rifampin.

Back 85

epiglottitis