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ENT: throat pain
Throat pain ENT
65
Anatomy
Graduate
10/08/2011

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Term
demographics for candidiasis:
Definition
young
old
immunocompromised
Term
Causes of candidiasis:
Definition
- normal flora
- C. ALBICANS
- C. krusei
- C. glabrata
- C. dubliniesis
- C. inconspicua
Term
risk factors for oral candidiasis:
Definition
- immunocompromised
- xerstomia
- dentures
- smoking
- Diabetes
- steroid inhaler/nebulizer treatment
Term
what 3 things does fungus need to grow?
Definition
- darkness
- heat
- moisture
Term
Candidiasis symptoms:
Definition
- White patches: growing on, not part of, painless, bleeding
- Red mucosal patches: may be painful
- Cracking/fissuring: lips, chelitis

WHITE SCRAPES OFF TO REVEAL ERYTHEMATOUS BASE, DOES NOT HURT TO SCRAPE OFF
Term
Candidiasis ddx:
Definition
- leukoplakia
- lichen planus
- apthous stomatitis
- fordyce spots
- denture abrasions
- herpetic lesions
- immunocompromise
Term
Workup of candidiasis:
Definition
- KOH
- culture
- gram stain
Term
lichen planus:
Definition
looks part of
lacy white reticular pattern
Term
fordyce spots are _ __ __.
Definition
plugged oil glands
Term
Treatment for Oral Candidiasis:
Definition
- Topicals: azoles, Gentian violet, Nystatin
- Systemic: Fluconazole, Ketoconazole

Diflucan for infants with thrush that won't go away
Term
Herpetic Stomatitis demographics:
Definition
Human Herpes Virus (HHV) infects virtually everyone
Primary infection usually occurs in childhood
Recurrent herpetic infections occur throughout life but tend to decrease with age
Female = male
Term
Herpetic stomatitis: Primary infection ususally occurs in childhood. They will be sick 5-7 days. Subsequent infections won’t be as bad> later just cold sores.
Definition
Term
HSV type 1 is 80% ___. It peaks at __ to __.
Definition
- oral
- 6 months to 3 years
Term
HSV type 2 is 80% __ and peaks between ages __ and __ __.
Definition
- genital
- 18 and 25 years
Term
HSV spreads via __ and __. Common in household contacts and daycares. It has an incubation of __ to __ __. Rare under __ __ of age.
Definition
- contact and droplets
- one to three weeks
- rare under 6 months of age
Term
Signs and Symptoms of Herpes Stomatitis:
Definition
- abrupt onset
- painful
- red ulcers
- clustered vesicles on a red base
- usually multiple lesions
- difficulty eating
- possibly fever
Term
Intensely red punctate lesions surrounded by erythematous tissue.
Definition
Herpes stomatitis
Term
DDx of herpes stomatitis:
Definition
- apthous ulcers
- erythema multiforme
- trauma
- Behcet disease
- Reiter's syndrome
- Varicella
- Lupus
Term
Behcet disease: ulcers can be anywhere, from mouth to anus, they don’t go away (ulcers don’t go away)
Definition
Term
Evaluation of Herpes Stomatitis:
Definition
- usually none
- H/E stain
- Viral culture
- Tzanck prep
- IFA
- testing to r/o other causes
Term
Treatment of primary herpes stomatitis:
Definition
- supportive
- analgesia
- maybe antivirals
Term
HSV
Definition
Contagious!
Autoinoculation
Encourage fluids
Cool compresses
Cold foods
Self-limited
Term
Apthous ulcers aka __ __.
Definition
Canker sores
Term
Apthous stomatitis demographics:
Definition
- most common oral disease in North America affecting 20-50%
- Female> Male
- equal in all races
- peak incidence b/w 10-19 y/o
- frequency and severity decrease with age
Term
Most common oral disease affecting 20-50%:
Definition
Apthous Stomatitis
Term
3 variations of Recurrent Apthous Ulcers (RAU):
Definition
- RAU minor: 80-85%, childhood
- RAU major: 10-15%, puberty
- Herpetiform RAU: 5-10%, 20s
Term
Etiology of RAU is unlcear:
Definition
- FE, B12, FOLATE DEFICIENCY
- trauma
- stress
- intestinal disease
- HSV
- autoimmune
- strep
- gluten sensitivity
- H. pylori
- shampoo
Term
Fe, B12, or folate deficiencies may result in __ __.
Definition
apthous stomatitis
Term
Signs and Symptoms of RAU minor:
Definition
- prodrome of discomfort
- 1-5 ulcers less than 1 cm, appear 24-48 hr after prodrome
- pain for 3-4 days
- healing in 7-10 days
- no scaring
Term
RAU major:
Definition
- same prodrome
- 1-10 ulcers greater than 1 cm
- deeper ulcers, may coalesce
- heal slowly (up to 6 weeks)
- reoccur
- may scar
Term
Differences between RAU major and minor:
Definition
- major has bigger and deeper ulcers that are slower to heal and scar
Term
Herpetiform apthous ulcers:
Definition
- older female pts
- begins with vesiculation
- multiple tiny ulcer clusters
- may coalesce
- very painful
- reoccurs often
Term
what type of RAU is common in older female pts?
Definition
herpetiform RAU
Term
Coxsachi disease: hand foot mouth, can be confused with syphilis. EVERYONE WITH A PALMAR RASH> GET AN RPR TO RULE OUT SYPHILIS.
Definition
Term
DDx of RAU:
Definition
Behçet’s
HHV
Lupus
Dermatologic manifestation of other disease
Hand-foot-mouth disease
Syphilis
Term
clinical evaluation of RAU:
Definition
- clinical diagnosis
- rule out other causes
- CBC
- sed rate
- B12/folate/ Fe studies
- culture
Term
If you want to rule out lupus, do an ANA and sed rate. High sed rate is NOT seen with ulcers.
Definition
Term
Not sure if pt has lupus or RAU, but lab reveals a high sed rate. Whats the dx?
Definition
lupus
Term
Tmt of RAU:
Definition
Symptomatic
Steroids
Topical
Oral
Parenteral
Amlexanox (Aphthasol)
Mouthwash preparations
Kaopectate
Colchicine, AZT, cimetidine
Thalidomide
www.aafp.org/afp/20000701/149.html
Term
Topical steroids work well for apthous ulcers. Canaloge in Orabase> keeps steroid in ulcer. Tell them to put it one right before bed at night
Definition
Term
pharyngitis, tonsilitis,and peritonsilar abscess demographics:
Definition
male=female
Worldwide
All races equally affected
More common in children with peak incidence 4-7yo
Communal living situations (daycare, school, etc.)
Term
Pharyngitis is more common in __ ages __ to __ and in ___ living situations like __ and __.
Definition
- children ages 4-7
- communal
- daycare and school
Term
Pharyngitis is more common in the __ and is spread via __.
Definition
winter
droplets
Term
Pharyngitis is 40-60% __, 5-40% ___.
Definition
- viral
- bacterial
Term
15% of adult and 30% of child pharyngitis is __ __ __.
Definition
Group A streptococcus

KNOW THIS
Term
Group A strep is uncommon before age __.
Definition
3
Term
1 in 400 cases of group A strep will progress to __ _.
Definition
renal failure
Term
Tmt of group A strep:
Definition
Amoxicillin
Term
Viral pharyngitis has a more __ onset with a prodrome of ___ symptoms.
Definition
- gradual
- URI
- cough
- congestion
- low grade fever
- possibly exudate
- possibly adenopathy
- often well appearing
- mild odynophagia, no dysphagia
- household contacts also affected
Term
With viral pharngitis there is __ __, with bacterial pharyngitis there is ___.
Definition
- viral> no dysphagia
- bacterial> dysphagia
Term
Bacterial pharyngitis has an __ onset. __ is uncommon but __ is common.
Definition
- abrupt
- cough
- exudate
- temperature, sometimes high
- adenopathy
- looks bad
- significant odynophagia and maybe dysphagia
- household contacts unaffected
Term
Centor Criteria needs 3 of the following 4 for dx of bacterial pharyngitis:
Definition
- Tonsillar exudates
- tender anterior cervical adenopathy
- absence of cough
- history of fever
Term
other etiologies of pharyngitis/tonsilitis:
Definition
- allergies
- chronic post nasal drip
- GERD
- dental erosions
- body habitus
Term
Peritonsilar abscess (PTA) usually starts as typical __ __. Looks like __ __ but the __ is not __ and there is ___.
Definition
- bacteria pharyngitis
- bacteria pharyngitis
- uvula is not midline
- trismus
Term
PTA presentation:
Definition
- looks like bacterial pharyngitis
- uvula not midline
- trismus
- prominent odynophagia and dysphagia
- possible obstructive symptoms
- enlargement of one tonsil or tonsillar fossa
Term
Sand paper rash of strep: you can feel it more than you can see it, run hand along back or arms and you can feel and they have sore throat> strep throat
Definition
Term
PE:
Chest
Heart exam
Pulmonary involvement
Abdomen
Organomegaly
Skin
rashes
Definition
Term
DDx of PTA:
Definition
- Non-GAS
- Deptheria
- HHV
- Herpetic RAU
- Mononucleosis
- Gonococcal pharyngitis
Term
Diptheria:
Definition
Can scrape the membrane off. Child can aspirate and choke on it. Reportable illness.
Term
Pharyngitis evaluation:
Definition
Rapid strep/TC
Throat culture
CBC
ASO
Monospot
Other cultures based on Hx or PE
Lateral ST neck XR
Term
pharyngitis treatment:
Definition
Viral:
Supportive care
Analgesics
Diet modification
Bacterial
As above PLUS
Antibiotics
PTA
All of the above PLUS
drainage
Term
Pharyngitis
Rapid strep
Positive: treat for GAS
Negative: get TC and offer supportive care
Throat culture positive
Already on ATB – notify and continue
Not on ATB – start on ATB if <10 days
Definition
Term
Antibiotics for bacterial pharyngitis:
Definition
- B-lactams: Penicillin, Cefalosporins
- Macrolides: Erythromycin, Azithromycin, Clarithromycin
- Lincosamides- Clindamycin
- Glycopeptides: Vancomycin
Term
If pt is pregnant with bacterial pharyngitis, would you use Azithromycin or Clarithromycin?
Definition
- Azithromycin b/c it is category B, but Clarithromycin is category C
Term
Complications of Strep infections:
Definition
- toxic shock syndrome
- peritonsilar abscess
- acute glomerulonephritis
- parapharyngeal abscess
- acute rheumatic fever
- scarlet fever
- airway compromise
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