Mouth & Throat Mspa 2017 Adult Med

Front 1

Pt presents with creamy, white, curd-like patches over erythematous mucosa. The rub off the mucosa easily. What is your Dx and how do you Tx?

Back 1

Dx: Oral Candidiasis aka Thrush

Tx: Antifungals (azoles), improve hygiene, rinse with chlorhexidine or 50/50 H2O2 + H2O

Front 2

Why might a Pt have this Dz?

Back 2

• Poor oral hygiene
• Immunosuppression
• Denture wearer
• DM
• Inhaled (powder) corticosteroid use
  

Front 3

What is this and what is it called?

Back 3

Variation of Candidiasis - Erythematous Form

(angular chelitis of the mouth)

Front 4

What is this a Sx of?

Back 4

Erythematous Form of Candidiasis

Front 5

What Dx tests will you run on this Pt?

Back 5

• Wet prep culture (KOH)
• Biopsy by ENT/Dentist (if Tx fails)
• HIV testing if nothing else explains the Dx
  

Front 6

What is this and what is it called?

Back 6

Leukoplakia: premalignant, hyperkeratotic, white patch/plaque (doesn't rub off)

Front 7

What is this and what is it called?

Back 7

Erythroplakia: premalignant, hyperkeratotic,

erythematous patch/plaque (doesn't rub off)

Front 8

Pt presents with these lesions in mouth that have been there for 3 weeks. Pt is a pack a day smoker. What is your next step and what is at the top of your Diff Dx?

Back 8

Leukoplakia that may lead to Oral SCC

Refer to Dentist, Oral Surgeon, ENT for biopsy

Front 9

What is this and what is it called?

Back 9

Squamous Cell Carcinoma of the mouth: malignant neoplasm of the stratified squamous epithelium that is capable of local, invasive destruction and distant metastasis.

Front 10

What statistics surround Oral SCC?

Back 10

• 90% of mouth malignancies are SCC
• 60% are found only after they are advanced
  

Front 11

Who is at risk for this?

Back 11

People who smoke tobacco (nicotine is carcinogenic) and people who drink alcohol.

Front 12

What is the Px and Tx for this Pt?

Back 12

SCC lesions <4 mm have a low metastasis rate

SCC lesions <2 cm can be resected surgically

Front 13

What is a good oral exam necessary?

Back 13

To catch lesions before they become malignant

Front 14

What is this and what is it called?

Back 14

Aphthous Ulcer or Ulcerative Stomatits

Front 15

What are the 3 different types of Stomatitis and how are they differentiated?

Back 15

1. Minor: most common - < 1cm, shallow
2. Major: > 1cm, deep
3. Herpetiform: caused by HSV infxn
   

Front 16

Pt comes in with a yellow/grey, painful ulcer with a white fibrinoid center with a red halo around it. What is it called?

Back 16

Aphthous Stomatitis

Front 17

What is this Pt's Px?

Back 17

Minor Stomatitis - heal in 10-14 days without a scar

Front 18

What is this Pt's Px?

Back 18

Major Stomatitis - heal in 14+ days and will leave a scar

Front 19

Pt presents with oral ulcers, Hx of fever, burning sensation in mouth, and vesicles that have ruptured and scabbed over. What is the Dx and why?

Back 19

Herpetic Stomatitis: Vesicles, scabbed ulcers, Hx of fever & burning sensation are all Dx criteria for HSV infxn.

Front 20

How would you Tx this Pt?

Back 20

Antiviral meds and education about infxn and what triggers outbreaks (stress, other infxn or reduced immune response)

Front 21

What causes this?

Back 21

HSV 1 infxn

Front 22

How is this Pt different than someone with oral vesicular ulcers?

Back 22

Pt still has an HSV 1 infxn but it has manifested on the vermillion border of the lip - called

Herpes Labialis

Front 23

Pt presents with sore, inflamed, scratchy throat. What is the likely Dx?

Back 23

Pharyngitis

Front 24

What can cause this?

Back 24

• Bacterial Infxn - Strep Throat
• Viral Infxn
  
• Irritants - smoke, postnasal drip
  

Front 25

Pt presents with:

Fever > 38 C

Tender anterior cervical adenopathy

Pharyngotonsillar exudate

NO Cough

Dx and why?

Back 25

Group A Beta-hemolytic Strep

The 4 Sxs are the Centor Criteria

Front 26

Pt presents with red, sandpaper like rash over entire body and has Hx of GABHS in the past week. What is the Dx and what is the

complication?

Back 26

Scarlatina Rash

Rheumatic Heart Dz

Front 27

What is the most likely Dx for this Pt?

Back 27

GABHS

Front 28

Pt presents with Fever, halitosis, Cervical LAD, Odynophagia and pharyngeal exam reveals this. What is the most likely Dx?

Back 28

Tonisillitis

Front 29

Pt presents with

tonisilitis. What do you need to do and why?

Back 29

Perform a throat culture to r/in or r/o GABHS or Mononucleosis.

Front 30

Labs come back and confirm a Dx of GABHS what is the Tx?

Back 30

Abx: Penicillin, Erythomycin, or Macrolides

Front 31

How does the Centor Criteria work?

Back 31

Rating scale on four criteria: fever > 38 C,

anterior cervical adenopathy, no cough, tonsillar exudate. If Pt has 1 Sx - no lab & no tx. If Pt has 2-3 Sxs run a lab and tx. If Pt has 4 Sxs no need to run a lab - just tx.

Front 32

Pt presents with Hx of exhaustion, marked cervical LAD, tonsils w/exudate that is hairy appearing. What is at the top of your Diff Dx list and what is your next step?

Back 32

Mononucleosis caused by Eppstein Barr virus. Run a monospot EBV titer. Although may only give positive result after 2-6 wks of infxn

Front 33

What Abx is contraindicated in Mono infxn and why?

Back 33

Penicillin - it causes a rash

Front 34

What is this and what is it called?

Back 34

Peritonsillar Abscess "Quinsy": Infection that invades tonsillar capsule and surrounding tissue, usually preceded by cellulitis

Front 35

Pt presents w/severe sore throat, odynophagia, trismus, medial deviation of soft palate and uvula, "hot potato" voice. What is the most likely Dx and what is the best Tx/management?

Back 35

Dx: Peritonsillar abscess/quinsy

Tx: Abx (parenteral if can't swallow oral), I&D (oral surgeon), Tonsillectomy, analgesics for pain, NSAIDs, salt water gargles

Front 36

What is this Pt at risk for?

Back 36

Airway obstruction & aspiration pneumonia

Front 37

Pt presents complaining of local swelling of the face, pain, tenderness, erythema on buccal

mucosa. What is the most likely Dx and how do you Tx?

Back 37

Sialadenitis

• Increase salivation (sour candy)
• IV Abx if severe
• I&D if cannot remove obstruction
  

Front 38

What may have caused this?

Back 38

Sialadenitis

• Dehydration
• Ductal Obstrxn
• Secondary Infxn
  

Front 39

How is hoarseness different from stridor?

Back 39

Hoarseness: abnormal vibration of the vocal cords that results in a breathy/raspy voice

Stridor: high pitched whistle on inspiration due to turburlent airflow through narrow/obstructed airway

Front 40

What causes laryngitis?

Back 40

• URI (viral or bacterial)
• Overuse of voice
• Smoking
• GERD
  

Front 41

What is the most common cause of hoarseness?

Back 41

Laryngitis

Front 42

When should you refer a Pt with stridor?

Back 42

ALWAYS and when there is a rapid onset it should be an EMERGENT referral

Front 43

Stridor is inspiratory when?

Back 43

the narrowing is above the vocal cords

Front 44

Stridor is expiratory when?

Back 44

the narrowing is below the vocal cords

Front 45

What are the Tx possibilities for a Pt with Laryngitis?

Back 45

• Abx to reduce severity
• Corticosteroids (oral or IM) AFTER Pt has been referred and had laryngoscopy

• Vocal rest
• Fluids
  

Front 46

Pt is a 26 yo female and presents with a SHx that indicates she is a professional singer. She has had hoarseness for 3 weeks. What is the most likely Dx & Tx?

Back 46

Dx: Vocal Cord Nodules

Tx: refer to specialist for voice modification/speech therapy & surgical removal

Front 47

Complications of Vocal Cord trauma include:

Back 47

• Cysts
• Hemorrhages
• Polyps
• Nodules
  

Front 48

Pt presents w/ dysphonia, hoarseness, odynophagia, otalgia. SHx reveals Pt does not smoke but PMHx indicates HSV 16 infxn. What is the most likely Dx and how would you confirm?

Back 48

Early stage Laryngeal Cancer - SCC

Refer to Otolaryngology for biopsy, CT/MRI, and labs

Front 49

Pt presents w/hoarsness for 3 wks, no PMHx of URI, SHx reveals Pt is a smoker. What is at the top of your Diff Dx list and why?

Back 49

Laryngeal SCC

Smokers are at the greatest risk

Front 50

Pt presents w/dysphonia, weight loss, otalgia, LAD, stridor. Laryngoscopy reveals this. Dx & Tx?

Back 50

Dx: Later stage Laryngeal SCC

Tx: refer to Oncology/Otolaryngology who will attempt to cure, preserve swallowing fxn,

preserve useful voice, avoid permanent

tracheostomy

Front 51

A Pt comes in for a routine HEENT exam. When you examine the mouth you should also examine what? How?

Back 51

Teeth

Shape, alignment, defects, mobility, color, plaque, sensitivity to percussion

Front 52

Pt presents with obvious evidence of dental caries. How will you educate them?

Back 52

Educate Pt on prevention of oral Dz by:

• Brushing & flossing regularly for approx 2 mins
• Use fluoridated toothpaste
• Minimize sugar in diet
• Avoid alcohol/tobacco
• Routine dental care
• Be aware of medications that affect teeth
  

Front 53

During your oral exam, you discover pale, yellow, sticky deposits on the teeth. What do you tell your Pt and how do you educate them?

Back 53

Pt has dental plaque

Education:

• Plaque becomes tartar in 24 hrs
• Plaque causes decay and gum dz
• Brushing removes plaque
• Tartar needs to be removed with a dental pic
  

Front 54

Bacteria metabolize sugar into acidic products that breakdown tooth enamel resulting in

Back 54

Dental Caries

Front 55

Saliva and Fluoride do what for teeth?

Back 55

Saliva has antimicrobial properties

Fluoride helps remineralize teeth

Front 56

How do Dental Caries progress?

Back 56

Initial - involves enamel only and asymptomatic

Moderate - dentin invaded and Sxs include hot/cold/sweet sensitivity & pain with chewing/percussion

Severe - pulp involved and pain is severe and persisitent

Front 57

Pt's oral exam reveals this. Pt complains that gums bleed during flossing and that they are tender. Dx?

Back 57

Gingivitis (reversible with improved oral hygiene)

Front 58

Plaque buildup, infxn, hormonal changes, oral FB may all be causes of

Back 58

Gingivitis

Front 59

This Pt has poor oral hygiene and that has caused the periodontal dz. Correct or Incorrect & why?

Back 59

Incorrect - Pt has Necrotizing Gingivitis which is a local infxn and not related to oral hygiene

Front 60

This Pt has a fever, LAD, halitosis, and oral exam reveals this. What is the Dx and what is the Tx?

Back 60

Dx: Necrotizing Gingivitis

Tx: Oral Penicillin TID 10d + warm half-strength peroxide rinse

Front 61

A group of microorganism-induced inflammatory dzs that lead to the destruction of the supporting stxs of the teeth: alveolar bone,

periodontal ligament, adjacent soft tissues

Back 61

Periodontal Dz

Front 62

Periodontal dz starts with Gingivitis and then progresses to

Back 62

Periodontitis

Front 63

Gingival, Periodontal, Periapical are the 3 types of

Back 63

Dental Abscess

Front 64

What is this and what is it called?

Back 64

Gingival Abscess: Injury/Infxn of surface of the gum

Front 65

What is this and what is it called?

Back 65

Periodontal Abscess: Infxn deeper in the gum

Front 66

What is this and what is it called?

Back 66

Periapical Abscess: Infxn of the pulp

Front 67

Gingival & Periodontal Abscess will present with

Back 67

• Erythema of the affected area
• Edema of the affected area
• Tenderness of the affected area
• Enlarged mass below gumline
  

Front 68

Periapical Abscess will present with

Back 68

• Tooth pain & sensitivity
• Elevation of the tooth
• Otalgia (maybe)
  

Front 69

You suspect a dental abscess in your Pt. What do you do next?

Back 69

Refer to a dentist for:

• Xrays to identify what type of abscess
• Debridement of area
• I&D of area
• Abx
• Surgical extraction if apical abcess