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51 Cards in this Set
- Front
- Back
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Neck Swellings
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Inflammatory/Infectious - Furuncle, MRSA
Benign neoplastic - Dermoid cyst, lipoma Malignant neoplastic - Carcinoma, Adenexal tumor |
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Inflammatory Neck swellings
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Most common - 50%
Viral - CMV, Mono Bacterial - Parotid sialadenitis, Odontogenic infections Parasitic - Toxiplasmosis Granulomatous - Sarcoidosis, Scrofula Acute or Chronic Lmphadenitis |
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Neoplastic Neck swellings
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Second most common - 40%
Tumors of Parotid Lymphoma Metastatic lesions |
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Developmental neck swellings
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Third most common
- Branchial cleft cyst - Epidermoid cyst - Dermoid cyst - Thyroglossal duct cyst |
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Pediatric neck masses
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Lymphoma
- 50%. Half hodgkin's Half NHL - Thyroid cancer - Neuroblastoma - Nasopharyngeal carcinoma - Alveolar soft part sarcoma |
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Rule of 80
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Applies to 40yrs or older
- 80% neck masses are neoplastic - 80% of neoplastic are malignant - 80% malignant are secondary - 80% secondary are from above the clavicle |
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Rule of 7
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7 days - Inflammatory
7 months - Neoplastic 7 years - Developmental |
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Biopsy of Neck Masses
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Fine needle
- Aspiration of liquid of present - Aspiration of solid tumor for cytological specimen Lymph node/Mass surgical biopsy - Surgical specimen |
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Common location for parotid gland tumors
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Lie on or behind angle of mandible and grow slowly over months or years
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Oral Cancer statistics
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30,000 new cases yearly
8000 Deaths yearly. More than melanoma and Cervical cancer combined - 5 year survival rate is 50% - Mortality unchanged for 50 yrs |
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Brush Biopsy technique
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- Moisten brush with water
- Flat or cylindrical edge of brush placed against surface of lesion - Apply firm pressure against surface of lesion and rotate 5-10 times - Pink tissue or microbleeding indicates adequate depth penetration - Spread material immediately onglass slide - Saturate cellular material with fixative agent - Let dry for 15-20min and ship slide |
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Brush Biopsy technique
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- Moisten brush with water
- Flat or cylindrical edge of brush placed against surface of lesion - Apply firm pressure against surface of lesion and rotate 5-10 times - Pink tissue or microbleeding indicates adequate depth penetration - Spread material immediately onglass slide - Saturate cellular material with fixative agent - Let dry for 15-20min and ship slide |
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Velscope vs Vizilite
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Velscope - Normal pale, SCCa dark green or black
Vizilite - With Tblue630 - Abnormal tissue appears white |
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Culprits of Sialadenitis
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Bacteria - Most common Staph A
- May be Strep Viridians, Haemophilus, Strep Pyogenes, E.Coli Viruses - Mumps, HIV, Coxsackievirus, Parainfluenza |
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First Line agent in Dental infection
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Pen VK
- Used for abscess, Cellulitis, Suppurative pulpitis, and Pericoronitis - Food decreases drug absorption - Do not use for prophylaxis 500mg QID x 7days Pedo - 15-30mg/kg/day Divided into QID x 7days |
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Amoxicillin
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2g PO 1hr prior to procedure
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Penicillin Allergy Cross-reactivity
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May have allergy to Cephalosporins
- 1% chance when allergic reaction is delayed - 10-20% if theres a history of immediate reaction to penicillin |
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Macrolide side effects
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- Altered cardiac conduction
- Hepatic impairment - Myasthenia Gravis - Major inhibitor of CYP3A4 |
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Treatment for Anaerobic infections
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Clindamycin above
Flagyl below |
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Quinolones
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- Inhibits DNA topoisomerase
- Should not be used in pediatric patients or pregnant patients - May have tendon inflammation and rupture even after discontinuation |
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Tetracycline
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Should be given on empty stomach
- Given to pediatric to treat malaria - Can cause phototoicity and Pseudotumor Cerebri |
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Cobalt -60
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Doesn't directly damage DNA or RNA, but forms free radicals that does
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Typical treatment for SCCa and Lymphoma
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200cGy 5 days a week for 6-9wks
- Total of 5000-7600cGy - Lymphoma tx 3000-4500cGy |
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Brachytherapy
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Implant radioactive seeds of Iridium
- More damaging to tumor |
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Cellular Succeptibility
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Most - Germinal Lymphoreticular
Intermediate - Endothelial, Fibroblasts Most - Muscle and nerve cells |
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Three H tissue
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Hypocellular
Hypovascular Hypoxic |
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Three H tissue
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Hypocellular
Hypovascular Hypoxic |
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Osteoradionecrosis
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Wait 21 days after extractions to begin radiotherapy
- Less likely to need maxillary exos since blood supply is greater |
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Golden window
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3-4months after radiotherapy when acute damage has recovered and three-H tissue hasn't developed yet
- Will need hyperbaric oxygen later |
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Dental care for Chemo
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When patient feels up to it
- Usually 17-20 days after treatment - When granulocyte is >2000 cells/mm3 - Platelet >50,000 cells/mm3 |
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Chemo complications
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Neurotoxicity
- Especially with Vincristine and Vinblastine |
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Oral Burning vs Burning mouth syndrome
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Oral burning has underlying disease
Burning mouth syndrome has no clinical sign of disease |
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Oral Burning symptoms
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Vitamin B deficiency - Test for B12 or Folic acid
Diabetes mellitus GERD - Endoscopy Hypothyroid - T3, T4, TSH Estrogen deficiency AIDS Candidiasis |
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Burning mouth syndrome
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Predilection for peri/post menopausal women
- Anterior 3rd of tongue and inside of lower lips |
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Salivary hypofunction
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Unstimulated
Normal 0.3-0.4ml/min Abnormal <0.1ml/min Stimulated Normal: 1-2 Abnormal <0.5ml/min |
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Prediposing factors for Oral Manifestations
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CD4<200/mm3
Viral load > 3000copies/mm3 Xerostomia, Poor OH, Smoking |
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Significant Oral AIDs indicators
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Esophageal candidiasis
Kaposi sarcoma Lymphoma CMV HSV>1month Histoplasmosis Cryptococcus |
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HAART era
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Pre-HAART 50%
40% in HAART era - Decreased OHL, NUP - No change in Candida, oral ulcers, and KS - Increase in HPV lesions |
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Angular Cheilitis
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Vytone Cream 1%
Disp 15g tube Rub into corners of mouth QID |
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Oral candidiasis
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Mycelex Troches 10mg
Disp 70 troches Dissolve one slowly in mouth five times a day for 2 wks |
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HSV Diet Modifications
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- Eat more Seafood, Poultry, Eggs, Dairy, Organ meats, potatoes
- Avoid whole grains, legumes, seed containing foods chocolate, nuts Supplement - Beta-carotene, Zinc, Lysine |
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Bioterrorism Categories
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A
- Easily disseminated - High rates of mortality - Require special attention Category B - Moderately easy to disseminate - Moderate morbidity and lower mortality C - Emerging pathogens based on availability, ease of production and dissemination, and potential for high morbidity and mortality |
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Smallpox incubation
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7-17day incubation
- Fever and systemic complaints in 1-4 days before rash onset |
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Smallpox rash stages
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Macules
Papules Vesicles Pustules Crusts Scars |
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Smallpox rash distribution vs Chickenpox
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Smallpox
- More on extremeties and all in same stage Chickenpox - More on trunk and all in different stages |
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Differenial for Smallpox
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- Enteroviral infections especially HFM disease
- Disseminated HSV in immunocompromised - Scabies, insect bites - Molluscum contagiosum in immunocompromised |
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Oral Smallpox
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May be first sign of disease
- Large amounts of virus released into saliva - Highest Titer 1st week of illness |
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Anthrax Forms
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Cutaneous
- Papule, vesicle, ulcer - Edema, redness and necrosis - Most commonly encountered Inhalation - Prodromal viral like illness - Meningitis in 50% of patients - Extremely rare in US Gastrointestinal - Abdominal distress with bloody vomiting or diarrhea followed by fever and signs - Gastrointestinal illness - Develops after ingestion of poorly cooked meat |
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Oropharyngeal Ulcers of Anthrax
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Early - Edematous and congested
Week 1 - Central necrosis and whitish patch Week 2 - Pseudomembrane covering ulcers |
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DDx for Cutaneous anthrax
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Spider bite
Plague Staph or Strep cellulitis Ecthyma Gangrenosum |
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Anthrax Characteristics
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- Must be exposed to spores
- Can be prevented after exposure with antibiotics - Must enter skin, swallowed, or inhaled - NOT spread person to person |
