Oropharyngeal Disorders

What is the primary bacterial organism responsible for the production of organic acids that lead to tooth decay?

Streptococcus mutans

 A patient presents with a brown spot on a molar but reports no pain. What is the likely extent of the caries?

No pulp involvement

A patient presents with severe, throbbing tooth pain. What does this clinical finding suggest regarding the pathology?

Irreversible pulpitis or necrosis

According to USPSTF recommendations, at what age should oral fluoride supplementation begin for children with deficient water supplies?

6 months

What is the primary cause of a periapical abscess?

Untreated pulpitis

A patient reports tooth pain that radiates to the jaw and ear, along with a fever and halitosis. What is the likely diagnosis?

Periapical abscess

What is the first-line antibiotic therapy typically prescribed for a dental abscess?

Augmentin (Amoxicillin-clavulanate)

 If a clinician suspects a dental abscess has led to Ludwig’s Angina, which imaging should be ordered?

CT scan

Periodontal disease is an infection/inflammation of the ______ (gingivitis) or ______ (periodontitis).

Gums / Bone

How do dentists definitively differentiate between gingivitis and periodontitis?

X-ray

What mechanical treatment involves cleaning below the gum line to remove tartar and bacteria?

Planing

Clinical evidence has established a definitive causal relationship between oral health and cardiovascular health.

False

Aphthous ulcers, also known as canker sores, typically present as painful ulcerations with a ______ center.

Yellow

How are "minor" aphthae distinguished from "major" aphthae in terms of size and resolution?

Minor are <1cm and resolve in 10 days

What is a common topical pharmacological option for managing the pain of aphthous ulcers?

Topical corticosteroids (paste) or anesthetics

If a patient has recurrent aphthous ulcers, what systemic autoimmune conditions should be in the differential?

• Lupus

• Celiac

• IBD

• Behcet's

 What is the causative organism of oral candidiasis (thrush)?

Candida albicans

What unique physical exam finding allows a clinician to differentiate thrush from other white oral lesions?

Patches can be wiped off

What is the first-line topical treatment for a mild case of oral candidiasis?

• Nystatin

• Clotrimazole

• Miconazole

In an adult with new-onset thrush and no obvious risk factors (like steroid use), what diagnostic test should be considered?

HIV testing

 Oral Lichen Planus is a ______ mediated autoimmune disease.

T-cell mediated

What is the name of the lacy, white, reticular lesions classic for oral lichen planus?

Wickham striae

Why is a biopsy often necessary for oral or genital lichen planus?

Rule out Squamous Cell Cancer

What is the first-line management for symptomatic oral lichen planus?

High-potency topical corticosteroid ointment

What is the #1 medication class associated with non-histamine mediated angioedema?

ACE-inhibitors

 A patient presents with acute swelling of the tongue and hives after a bee sting. Symptoms started 30 minutes ago. What is the priority?

Airway and Epinephrine

Why will Epinephrine, antihistamines, and steroids fail in ACE-inhibitor-related angioedema?

It is its own "special thing" (Bradykinin-mediated)

What is the most critical management instruction for a patient who has experienced ACE-inhibitor angioedema?

Never take an ACE-inhibitor again

What is the most common cause of inflammation of the vocal cords?

Viral URI

What is the hallmark clinical sign of laryngitis?

Dysphonia (hoarseness)

What is the mainstay of treatment for viral or overuse-related laryngitis?

Supportive care (vocal rest)

At what point should a patient with hoarseness be referred to ENT to rule out serious causes like cancer?

Symptoms > 3 weeks

Croup, or acute tracheolaryngitis, is characterized by a classic ______ cough.

"Barking" cough

What is the classic radiologic feature seen on an A-P neck X-ray in a child with croup?

"Steeple sign"

 What is the first-line pharmacological treatment for croup?

Dexamethasone (Steroids)

What are the primary items in the differential diagnosis for a child presenting with stridor?

• Foreign body

• Epiglottitis

• Asthma

Which vaccine has greatly reduced the incidence of epiglottitis by targeting its primary bacterial cause?

Hib (Haemophilus influenzae type B)

Children with epiglottitis often present with the "Three D's." What are they?

• Dysphagia

• Drooling

• Distress

What is the characteristic finding on a lateral neck X-ray for epiglottitis?

"Thumb sign"

What is an absolute contraindication during the physical exam of a child suspected of having epiglottitis?

Do NOT use a tongue depressor

What is the most common overall cause of pharyngitis?

Respiratory viruses

Which clinical signs are suggestive of a bacterial (Strep) etiology over a viral one?

• Exudates

• Fever

• Tender LAD

What clinical tool is used to determine whether to test or treat for Strep pharyngitis?

Centor score

A Centor score of 0-1 requires ________.

no test/treat

A Centor score of 2-3 requires ________.

a rapid strep test or culture

A Centor score of 4-5 requires ________.

 culture and consideration of empiric treatment

What is the gold standard empiric antibiotic for Strep pharyngitis?

Penicillin (oral PCN-V) or Amoxicillin

Why should clinicians avoid testing for Strep if the Centor score is very low?

5–20% of people are asymptomatic carriers

Which two serious complications of GAS pharyngitis are immune-mediated and occur weeks after the infection?

Rheumatic Fever and PSGN

Mononucleosis is primarily caused by which virus?

Epstein-Barr virus (EBV)

What is the "classic triad" of symptoms for Mononucleosis?

• Fever

• Exudative pharyngitis

• LAD

What laboratory finding on a CBC with differential is highly suggestive of Mononucleosis?

Atypical lymphocytes

Why must patients with Mononucleosis avoid contact or collision sports for at least 4 weeks?

Risk of splenic rupture

Peritonsillar abscess (Quinsy) is characterized by muffled voice and deviation of the ______ to the opposite side.

Uvula

What is the definitive management for a peritonsillar abscess?

Needle aspiration or I&D

Ludwig’s Angina is a deep neck infection usually originating from ______.

Infected mandibular teeth

What is a hallmark physical exam finding of Ludwig's Angina?

Upward tongue displacement

What is the most critical management priority in any patient with a deep neck infection?

Airway management

A patient presents "toxic appearing" with high fever, neck pain, and drooling. CT shows a collection in the retropharyngeal space. This is a(n) ______.

Retropharyngeal abscess

Diphtheria is characterized by an adherent, ______ pseudomembranous coating in the pharynx.

Gray

What is the required pharmacological treatment for suspected Diphtheria?

IV diphtheria antitoxin and penicillin

Where do the majority of obstructive salivary duct stones (sialoliths) occur?

Wharton’s duct

What is a classic clinical history for a patient with a salivary stone?

Recurrent pain/swelling with meals

What are "sialagogues" used for in the management of salivary stones?

Stimulate salivary flow

What is the most common causative bacterial agent of sialadenitis?

Staphylococcus aureus

What is the treatment for acute bacterial sialadenitis?

IV or PO antibiotics targeting S. aureus

Stensen’s duct drains the ______ gland and is located near the second maxillary molar.

Parotid