Mouth/Throat d/s

Laryngitis + S&S

inflammation of the larynx (voice box), with erythema and edema of the laryngeal mucous membranes.

Acute Laryngitis - Causes

Viral infection or vocal abuse

Acute Laryngitis - Treatment

resolves spontaneously with voice rest and humidification.

Chronic Laryngitis - Causes

Exposure to irritants (smoke, chemicals, etc.) or benign lesions on laryngeal structures.

Main Symptom of Laryngitis

Hoarseness of voice or a harsh, deep-pitched voice.

Diagnostic Tool for Laryngitis

Direct laryngoscopy.

Laryngoscopy Findings in Laryngitis

Diffuse laryngeal erythema, edema, and vascular engorgement of the vocal folds.

Types of Stridor in Laryngeal Disease

Above the vocal folds: Inspiratory stridor
Below the vocal folds: Expiratory or biphasic stridor

Laryngeal Disease - Common Symptoms

Dysphonia, hoarseness, and stridor.

Angioedema

Acute swelling of the deeper layers of the skin, often involving lips, eyelids, genitals, tongue, or larynx.

Precipitating Factors of Angioedema

Medications, food, insect bites

Symptoms of Angioedema

Itching, swelling, transitory light-colored edematous plaques.

Treatment for Mild Angioedema

Antihistamines and steroids.

Treatment for Severe Angioedema

severe angioedema with airway compromise treated w/ epinephrine (EPI).

key characteristics of Croup

Stridor, shortness of breath (SOB), and a seal-like barking cough.

How does Croup progress in severe cases?

Progressive shortness of breath can lead to severe respiratory distress.

Croup - Precipitating Factors

Antecedent upper respiratory infection (URI).

Croup - Common Lab Findings

Labs are nonspecific but may show signs of a viral illness, including increased WBCs.

What imaging sign is commonly seen on a plain film for Croup?

The steeple sign (subglottic narrowing)

Croup - Appearance

Nontoxic but restless, with fatigue, tachycardia, and tachypnea.

What type of cough is characteristic of Croup?

seal-like barking cough.

signs of worsening Croup or impending respiratory failure

Change in mental status, increased retractions, decreased breath sounds with stridor, pallor, or cyanosis.

Croup - Diagnosis

Croup is diagnosed clinically, based on symptoms and physical exam findings.

Croup - Treatment for Mild Cases

Reassurance, cool mist, oxygen, frequent monitoring, and hydration.

Croup - Treatment for Mild to Moderate Cases

Glucocorticoids like dexamethasone, prednisone

Croup - Treatment for Moderate to Severe Cases

Nebulized epinephrine, observe for 3-4 hours, discharge with steroids, and possibly antibiotics

most common site of swelling and upper airway obstruction in epiglottitis

The supraglottis.

Is Epiglottitis a Medical Emergency?

yes

most common pathogen causing epiglottitis

Haemophilus influenzae B (Hib), though cases have decreased due to the Hib vaccine.

prophylactic measure to prevent epiglottitis

Hib vaccine and rifampin for contacts without the vaccine or at high risk

Lab Findings in Epiglottitis

Elevated WBC , positive blood cultures for Hib , and positive epiglottis cultures (50%).

Key Symptoms - The 3 D’s of epiglottitis

Dysphagia, drooling, and distress.

Pediatric Symptoms of Epiglottitis

Drooling (80%), dysphagia, distress, fever, hot potato voice, stridor, sniffing position, hypoxia, cyanosis, and cough

Adult Symptoms of Epiglottitis

Preceding URI, rapidly developing sore throat (95%), muffled hot potato voice, odynophagia, severe pain on palpation of the larynx

What imaging sign is characteristic of epiglottitis on a lateral neck X-ray?

The thumbprint sign, which indicates a swollen epiglottis.

Can a negative radiograph rule out epiglottitis?

no

most critical initial step in treating epiglottitis

Evaluate ABCs and secure the airway

Medications Used in Epiglottitis

IV antibiotics (ceftriaxone or cefuroxime), and dexamethasone

Should laryngoscopy be performed on children with epiglottitis?

No, never perform laryngoscopy on a child unless the provider is an expert in pediatric intubation.

Is hospitalization required for epiglottitis?

Yes, hospitalization is necessary, along with continuous monitoring, supplemental O2, NPO status, and IV treatments after securing the airway.

etiology of aphthous ulcers

unknown, but there may be a potential link to HHV-6.

Which type of mucosa is affected by aphthous ulcers?

NON-KERATINIZED MUCOSA

Are aphthous ulcers recurrent?

Yes, aphthous ulcers are recurrent.

What is the appearance of aphthous ulcers?

small round ulcerations with yellow/gray fibrinoid centers surrounded by red halos.

How long does it take for aphthous ulcers to resolve completely?

Complete resolution typically occurs in 1-3 weeks.

How long do aphthous ulcers typically cause pain?

7-10 d

What are the treatment options for aphthous ulcers?

Treatment is nonspecific but may include topical steroids and analgesics (magic mouthwash).

Oral Leukoplakia

predominant white lesion of the oral mucosa; diagnosis of exclusion and requires confirmation with a biopsy.

What is the most important risk factor for developing oral leukoplakia?

The most important risk factor is tobacco use.

Is lesion recurrence or progression to carcinoma common in oral leukoplakia?

yes

charcyerstics of oral leukoplakia

homo/hetero plaques, verrucous lesions, erthyroplakia( speckle leuokplakia)

treatment options for oral leukoplakia

discontinuing contributing factors (e.g., smoking), antifungal medications, corrective dental treatments, and in more aggressive cases, surgical excision.

Ludwig’s angina?

rapidly progressive, potentially fulminant cellulitis affecting the sublingual and submandibular spaces

Common Characteristics of ludwig’s angina

neck space infection.

Where does Ludwig’s angina usually originate?

from an infected or recently extracted tooth.

Why is Ludwig’s angina considered a severe medical emergency?

It is a severe medical emergency because it can lead to airway obstruction; the most common cause of death is asphyxiation.

What is the general treatment approach for Ludwig’s angina?

The treatment includes close monitoring of patients and prompt IV antibiotics.

What are the preferred IV antibiotic options for Ludwig’s angina?

• Ampicillin-sulbactam

• Penicillin G (PCN G) + metronidazole

• Clindamycin

What is Acute Necrotizing Gingivitis (ANUG)?

ANUG is an acute infection of the gingiva primarily caused by poor dental hygiene.

Complications of ANUG

increased destruction of affected tissues, which can be local or spread systemically, leading to conditions like coronary artery disease (CAD), cerebrovascular accident (CVA), and periodontal disease, especially in pregnant individuals (increased risk of preterm births).

Symptoms of ANUG

painful acute gingival inflammation and necrosis, often accompanied by bleeding, halitosis (bad breath), fever, and cervical lymphadenopathy

primary treatment approach for ANUG

debridement and IV antibiotics.

What antibiotics are commonly used to treat ANUG?

• Penicillin (PCN) + Metronidazole with Clindamycin

• Erythromycin (alone) can be used as an alternative.

What is oral candidiasis?

Oral candidiasis is a spectrum of opportunistic infectious diseases primarily caused by yeast, with C. albicans being the most common.

Where does oral candidiasis typically occur?

It involves the skin and/or mucous membranes.

In which populations is oral candidiasis most commonly seen?

A: It is most commonly seen at extreme ages, specifically in neonates and the elderly.

What are the main risk factors for developing oral candidiasis?

• Broad-spectrum antibiotics

• Chronic/improper use of inhaled corticosteroids

• Hormonal changes

• Diabetes

• Malignancy

  • HIV/AIDS

What are the common symptoms of oral candidiasis?

• Sore throat

• Dysphagia (difficulty swallowing)

• Cheesy, raised white plaques that can be wiped off, revealing a raw, erythematous base (with possible bleeding)

  • Pain/discomfort while eating or drinking

How is oral candidiasis diagnosed?

A: Diagnosis is primarily clinical, but a wet mount is considered the definitive diagnostic test.

What are the treatment options for oral candidiasis?

A:

• Mild cases: Topical nystatin or clotrimazole

  • Systemic treatment flucanoazole or itracanazole sln

What antibody tests are used in the workup of mononucleosis?

IgM antibodies, Positive heterophile agglutination test (monospot)

Which virus is specifically tested for in mononucleosis cases?

Serology for Epstein-Barr virus (EBV) is performed.

What is the classic clinical triad of mononucleosis? other S&S

The classic triad includes:

• Lymphadenopathy

• Fever

• Sore throat (with or without exudates)

spleenomegaly

What is the primary treatment approach for mononucleosis?

Treatment is primarily supportive, including:

• Fever management

• Hydration

• Prednisone (in certain cases)

• Avoid contact sports

How does a retropharyngeal abscess present?

The presentation is dependent on the stage of illness and may be hard to distinguish from uncomplicated pharyngitis in early stages.

What are the common symptoms of a retropharyngeal abscess?

• Dysphagia (difficulty swallowing)

• Odynophagia (painful swallowing)

• Drooling with decreased oral intake

• Neck stiffness, swelling, or mass

• Lymphadenopathy

How is retropharyngeal abscess typically diagnosed?

Diagnosis is primarily clinical, supported by patient history and physical examination. Imaging may be used to confirm the diagnosis.

What is the primary treatment for retropharyngeal abscess?

• Incision and drainage (I&D) or needle aspiration (if the abscess can be visualized; caution is needed to avoid the internal carotid artery)

• Antibiotics (IV then PO; typically amoxicillin or penicillin derivatives)

• Close monitoring of the patient's condition

• Oral rehydration to maintain hydration

When might a tonsillectomy be indicated in cases of retropharyngeal abscess?

Tonsillectomy may be indicated in patients with a history of frequent previous infections.

What is a peritonsillar abscess commonly known as?

It is also known as "Quinsy." It typically develops from tonsillitis, leading to cellulitis and then abscess formation.

How does a peritonsillar abscess develop, and what is its onset period?

The abscess can form in 2-8 days and may occur without a prior history of tonsillitis. It involves one or both tonsils and leads to pus pocket formation.

What happens in the peritonsillar space during an abscess formation?

Fluid in the peritonsillar space pushes the tonsil medially, obscuring the definition of the anterior tonsillar pillar.

What are the key symptoms of a peritonsillar abscess?

• Unilateral, severe throat pain (+/-)

• Dysphagia (difficulty swallowing)

• Odynophagia (painful swallowing)

• Trismus (difficulty opening the mouth)

• Referred ear pain

• Drooling

• Muffled "hot potato" voice

• Fever

What signs are commonly observed in a patient with a peritonsillar abscess?

• Fever and severe dehydration (+/-)

• Distress, tonsillar hypertrophy, palatal edema

• Contralateral deflection of the swollen uvula

• Inferior and medial displacement of the infected tonsil

• Fluctuant peritonsillar fullness

• Tender cervical adenopathy

• Edema in the neck (due to infective lymphadenopathy)

• Rancid breath and inflamed oropharyngeal mucosa

• Brawny pitting of the ipsilateral neck (in advanced infection)

How is a peritonsillar abscess diagnosed?

Diagnosis is based on history and clinical examination. Additional tests may include:

• CBC with differential

• Blood cultures

• Monospot test

• Tonsillar swab (to rule out other infections)

What is the primary treatment for peritonsillar abscess?

• IV antibiotics:

  • Ampicillin/Sulbactam (Unasyn)

  • Clindamycin

  • PCN G + Metronidazole

• Incision and drainage (I&D)

• Tonsillectomy (indicated in certain cases)