Term
| demographics for candidiasis: |
|
Definition
young
old
immunocompromised |
|
|
Term
|
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
|
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
|
Definition
- leukoplakia
- lichen planus
- apthous stomatitis
- fordyce spots
- denture abrasions
- herpetic lesions
- immunocompromise |
|
|
Term
|
Definition
- KOH
- culture
- gram stain |
|
|
Term
|
Definition
looks part of
lacy white reticular pattern |
|
|
Term
| fordyce spots are _ __ __. |
|
Definition
|
|
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
|
|
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
|
Definition
Contagious!
Autoinoculation
Encourage fluids
Cool compresses
Cold foods
Self-limited |
|
|
Term
| Apthous ulcers aka __ __. |
|
Definition
|
|
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
|
|
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
|
|
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
|
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
|
|
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
|
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
|
|
Term
|
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
|
|
Term
| Pharyngitis is 40-60% __, 5-40% ___. |
|
Definition
|
|
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
|
|
Term
| 1 in 400 cases of group A strep will progress to __ _. |
|
Definition
|
|
Term
|
Definition
|
|
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
|
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
|
Definition
- Non-GAS
- Deptheria
- HHV
- Herpetic RAU
- Mononucleosis
- Gonococcal pharyngitis |
|
|
Term
|
Definition
| Can scrape the membrane off. Child can aspirate and choke on it. Reportable illness. |
|
|
Term
|
Definition
Rapid strep/TC
Throat culture
CBC
ASO
Monospot
Other cultures based on Hx or PE
Lateral ST neck XR |
|
|
Term
|
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 |
|
|
