Easy Points: Medicine - HEENT - Mouth Pharynx Neck

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Easy Points: Medicine - HEENT - Mouth Pharynx Neck
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2013-12-10 06:07:51
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HEENT mouth pharynx neck olfu2016
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Medicine: HEENT - Mouth, Pharynx, Neck
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  1. starts with softening of the skin at the angles of the mouth,followed by fissuring. It may be due to nutritional deficiency or, more commonly,to overclosure of the mouth, seen in people with no teeth or with ill-fittingdentures. Saliva wets and macerates the infolded skin, often leading to secondaryinfection with Candida,
    Angular cheilitis
  2. results from excessive exposure to sunlight and affects primarilythe lower lip. Fair-skinned men who work outdoors are most often affected. Thelip loses its normal redness and may become scaly, somewhat thickened, andslightly everted. Because solar damage predisposes to carcinoma of the lip,examine such skin lesions carefully.
    Actinic cheilitis
  3. produces recurrent and painful vesiculareruptions of the lips and surrounding skin. A small cluster of vesicles firstdevelops. As these break, yellow-brown crusts form. Healing takes 10 to 14 days.Both new and erupted vesicles are visible here.
    Herpes Simplex (Cold sore, fever blister)
  4. localized subcutaneous or submucosal swelling caused byleakage of intravascular fluid into interstitial tissue. Two types are common.When vascular permeability is triggered by mast cells in allergic and NSAIDreactions, look for associated urticaria and pruritus. These are uncommon inangioedema from bradykinin and complement-derived mediators, the mechanismin ACE-inhibitor reactions.
    Angioedema
  5. usually benign and resolves within24 to 48 hours. It can be life threatening when it involves the larynx, tongue, orupper airway or develops into anaphylaxis.
    Angioedema
  6. Multiple small red spots on the lips strongly suggest hereditary hemorrhagictelangiectasia, an autosomal dominant endothelial disorder causing vascularfragility and arteriovascular malformations (AVMs).
    Hereditary Hemorrhagic Telangiectasia(Osler-Weber-Rendu syndrome)
  7. alsovisible on the oral mucosa and fingertips. Nosebleeds, gastrointestinal bleeding,and iron deficiency anemia are common. AVMs in the lungs and brain can causelife-threatening hemorrhage and embolic disease.
    Hereditary Hemorrhagic Telangiectasia(Osler-Weber-Rendu syndrome)
  8. prominent small brown pigmented spots in the dermal layer of the lips,buccal mucosa, and perioral area. These spots may also appear on the hands andfeet. In this autosomal dominant syndrome, these characteristic skin changesaccompany numerous intestinal polyps. The risk of gastrointestinal and othercancers ranges from 40% to 90%. Note that these spots rarely appear around thenose and mouth.
    Peutz-Jeghers Syndrome
  9. ulcerated papule with an indurated edge usually appears after 3 to 6 weeksof incubating infection from the spirochete Treponema pallidum. These lesionsmay resemble a carcinoma or crusted cold sore. Similar primary lesions arecommon in the pharynx, anus, and vagina but may escape detection since theyare painless, nonsuppurative, and usually heal spontaneously in 3 to 6 weeks.
    Chancre of Primary Syphilis
  10. usually affects the lower lip. It mayappear as a scaly plaque, as an ulcer with or without a crust, or as a nodularlesion, illustrated here. Fair skin and prolonged exposure to the sun are commonrisk factors.
    Carcinoma of the lip
  11. Normal tonsils may be large without being infected, especially in children. Theymay protrude medially beyond the pillars and even to the midline. Here theytouch the sides of the uvula and obscure the pharynx. Their color is pink. Thewhite marks are light reflections, not exudate.
    Large normal tonsils
  12. This red throat has a white exudate on the tonsils. This, together with fever andenlarged cervical nodes, increases the probability of group A streptococcal infectionor infectious mononucleosis. Anterior cervical lymph nodes are usually enlarged inthe former, posterior nodes in the latter.
    Exudative tonsillitis
  13. redness and vascularity of the pillars and uvula are mild to moderate; redness is diffuse and intense. Each patient would probably complain of asore throat, or at least a scratchy one. Causes are both viral and bacterial. If thepatient has no fever, exudate, or enlargement of cervical lymph nodes, thechances of infection by either of two common causes—group A streptococci andEpstein-Barr virus (infectious mononucleosis)—are small.
    Pharyngitis
  14. acute infection caused by Corynebacterium diphtheriae, is now rarebut still important. Prompt diagnosis may lead to life-saving treatment. Thethroat is dull red, and a gray exudate (pseudomembrane) is present on the uvula,pharynx, and tongue. The airway may become obstructed.
    Diphtheria
  15. yeast infection from Candida species. Shown here on the palate,it may appear elsewhere in the mouth (see p. 289). Thick, white plaques aresomewhat adherent to the underlying mucosa. Predisposing factors include(1) prolonged treatment with antibiotics or corticosteroids and (2) AIDS.
    Thrush on the palate (Candidiasis)
  16. deep purple colored lesions, a low-gradevascular tumor associated with human herpesvirus 8. The lesions may be raised orflat.
    Kaposi's sarcoma in AIDS
  17. midline bony growth in the hard palate that is fairlycommon in adults. Its size and lobulation vary. Although alarming at first glance,it is harmless. In this example, an upper denture has been fitted around the torus.
    Torus palatinus
  18. normal sebaceous glands that appear as small yellowish spots inthe buccal mucosa or on the lips. Here they are seen best anterior to the tongueand lower jaw. These spots are usually not numerous
    Fordyce spots (Fordyce granules)
  19. early sign of measles (rubeola). Search for small white specksthat resemble grains of salt on a red background. They usually appear on thebuccal mucosa near the first and second molars.
    Koplik's spots
  20. small red spots caused by blood that escapes from capillaries into the tissues. In the buccal mucosa, they are often caused by accidentally biting the cheek. Oral petechiae may be due to infection or decreased platelets, aswell as traum
    Petechiae
  21. A thickened white patch may occur anywhere in the oral mucosa.The extensive example shown on this buccal mucosa resulted from frequentchewing of tobacco, a local irritant. This benign reactive process of the squamousepithelium may lead to cancer and should be biopsied. Another risk factor ishuman papillomavirus infection.
    leukoplakia
  22. common among teenagers and young adults. The gingivalmargins are reddened and swollen, and the interdental papillae are blunted,swollen, and red. Brushing the teeth often makes the gums bleed. Plaque—thesoft white film of salivary salts, protein, and bacteria that covers the teeth andleads to gingivitis—is not readily visible.
    Marginal gingivitis
  23. This uncommon form of gingivitis occurs suddenly in adolescents and youngadults and is accompanied by fever, malaise, and enlarged lymph nodes. Ulcersdevelop in the interdental papillae. Then the destructive (necrotizing) processspreads along the gum margins, where a grayish pseudomembrane develops. Thered, painful gums bleed easily; the breath is foul.
    Acute necrotizing ulcerative gingivitis
  24. Gums enlarged by hyperplasia are swollen into heaped-up masses that may evencover the teeth. The redness of inflammation may coexist, as in this example.Causes include phenytoin therapy (as in this case), puberty, pregnancy, andleukemia.
    Givingival hyperplasia
  25. Red purple papules of granulation tissue form in the gingival interdental papillae,and sometimes on the fingers. They are red, soft, painless, and usually bleedeasily. They occur in 1% to 5% of pregnancies and usually regress after delivery.Note the accompanying gingivitis.
    Pregnancy Tumor (also termed Pregnancy Epulis orPyogenic Granuloma)
  26. In many elderly people, the chewing surfaces of the teeth are worn down byrepetitive use so that the yellow-brown dentin becomes exposed; has exposed the rootsof the teeth, giving a “long in the tooth” appearance.
    Attrition of Teeth; Recession of Gums
  27. by chemical action. Note here the erosion of the enamelfrom the lingual surfaces of the upper incisors, exposing the yellow-browndentin. This results from recurrent regurgitation of stomach contents, as inbulimia.
    Erosion of teeth
  28. by recurrent trauma, such as holding nails or opening bobby pins between the teeth. Unlike Hutchinson’s teeth, the sides of these teeth show normal contours; size and spacing of the teeth are unaffected.
    Abrasion of teeth with notching
  29. smaller and more widely spaced than normal and arenotched on their biting surfaces. The sides of the teeth taper toward the bitingedges. The upper central incisors of the permanent (not the deciduous) teeth aremost often affected. These teeth are a sign of congenital syphilis.
    Hutchinson's teeth in congenital syphillis
  30. In this benign condition, the dorsumshows scattered smooth red areas denuded of papillae. Togetherwith the normal rough and coated areas, they give a maplikepattern that changes over time.
    Geographic tongue
  31. Note the “hairy” yellowish to brown and blackelongated papillae on the tongue’s dorsum. This benign conditionis associated with antibiotic therapy, Candida infection, and poordental hygiene. It also may occur spontaneously
    Hairy tongue
  32. Fissures appear with increasing age,sometimes termed scrotal tongue. Food debris may accumulate inthe crevices and become irritating, but a fissured tongue isbenign.
    Fissured tongue
  33. A smooth and oftensore tongue that has lost its papillae suggests a deficiency inriboflavin, niacin, folic acid, vitamin B12, pyridoxine, or iron, ortreatment with chemotherapy.
    Smooth tongue, atrophic glossitis
  34. Note the thick white coating from Candida infection. The raw red surface is where the coat was scraped off.Infection may also occur without the white coating. It is seen inimmunosuppression from chemotherapy or prednisone therapy.
    Candidiasis
  35. These whitish raised areas with a feathery orcorrugated pattern most often affect the sides of the tongue.Unlike candidiasis, these areas cannot be scraped off. They areseen in HIV and AIDS infection
    Hairy leukoplakia
  36. Small purplish or blue-black round swellingsappear under the tongue with age. These dilatations of thelingual veins have no clinical significance
    Varicose veins
  37. A painful, round or oval ulcerthat is white or yellowish gray and surrounded by a halo ofreddened mucosa. It may be single or multiple. It heals in 7–10days, but may recur.
    Aphthous ulcer (Canker sore)
  38. This painless lesion of secondarysyphilis is highly infectious. It is slightly raised, oval, and coveredby a grayish membrane. It may be multiple and occur elsewherein the mouth.
    Mucous patch of syphillis
  39. With this persisting painless white patch in the oralmucosa, the undersurface of the tongue appears painted white.Patches of any size raise the possibility of squamous cell carcinomaand require biopsy.
    Leukoplakia
  40. Rounded bony growths on the innersurfaces of the mandible are typically bilateral, asymptomatic,and harmless.
    Tori mandibulares
  41. This ulcerated lesion is in acommon location for carcinoma. Medially, note the reddened areaof mucosa, called erythroplakia, also suspicious for malignancy
    Carcinoma, floor of the mouth
  42. Thyroid condition involving the following:
    Includes the isthmus and lateral lobes;there are no discretely palpable nodules. Causes include Graves’disease, Hashimoto’s thyroiditis, and endemic goiter
    Diffuse enlargement
  43. Thyroid condition involving the following:
    May be a cyst, a benign tumor, or one nodulewithin a multinodular gland. It raises the question of malignancy.Risk factors are prior irradiation, hardness, rapid growth, fixation tosurrounding tissues, enlarged cervical nodes, and occurrence in men.
    Single nodule
  44. Thyroid condition involving the following:
    An enlarged thyroid gland with two or more nodules suggests ametabolic rather than a neoplastic process. Positive family history and continuing nodularenlargement are additional risk factors for malignancy
    Multinodular goiter
  45. Symptoms of this thyroid dysfunction:
    NervousnessWeight loss despite increased appetiteExcessive sweating and heat intolerance
    hyperthyroidism
  46. Symptoms of this thyroid dysfunction:
    PalpitationsFrequent bowel movementsTremor and proximal muscle weakness
    hyperthyroidism
  47. Symptoms of this thyroid dysfunction:
    Fatigue, lethargy, Modest weight gain with anorexia, Dry, coarse skin and cold intoleranceSwelling of face, hands, and legs
    hypothyroidism
  48. Symptoms of this thyroid dysfunction:
    ConstipationWeakness, muscle cramps, arthralgias, paresthesias,impaired memory and hearing
    hypothyroidism
  49. Signs of this thyroid dysfunction:
    Warm, smooth, moist skinWith Graves’ disease, eye signs such as stare, lid lag, andexophthalmosIncreased systolic and decreased diastolic blood pressures
    hyperthyroidism
  50. Signs of this thyroid dysfunction:
    Tachycardia or atrial fibrillationHyperdynamic cardiac pulsations with an accentuated S1Tremor and proximal muscle weakness
    hyperthyroidism
  51. Signs of this thyroid dysfunction:
    Dry, coarse, cool skin, sometimes yellowish fromcarotene, with nonpitting edema and loss of hairPeriorbital puffinessDecreased systolic and increased diastolic blood pressures
    hypothyroidism
  52. Signs of this type of thyroid dysfunction: Bradycardia and, in late stages, hypothermiaSometimes decreased intensity of heart soundsImpaired memory, mixed hearing loss, somnolence,peripheral neuropathy, carpal tunnel syndrome
    hypothyroidism

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