Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_2611_Библиотеки_им_академика_М_И_Перельмана.pdf
226
type 16/18—is believed to be the cause of up to 70% of all
oropharyngeal squamous cell carcinoma. HPV-positive
CMDT 2025
CHAPTER 8
▲
Figure 8–8. Severe angular cheilitis in a man with
HIV with oral thrush. (Reproduced with permission from
Richard P. Usatine, MD, in Usatine RP, Smith MA, Mayeaux
EJ Jr, Chumley H. The Color Atlas of Family Medicine, 2nd ed.
McGraw-Hill, 2013.)
B. Diagnostic Studies
ORAL CANDIDIASIS
ESSENTIALS OF DIAGNOSIS
»
Fluctuating throat or mouth discomfort.
»
Associated with systemic or local immunosuppression, such as recent corticosteroid, chemotherapy, or antibiotic use.
»
Erythema of the oral cavity or oropharynx with
creamy-white, curd-like patches.
»
Rapid resolution of symptoms with appropriate
treatment.
» Clinical Findings
A. Symptoms and Signs
easily rubbed off (eg, by a tongue depressor)—unlike leuko-
Candidiasis is often the first manifestation of HIV infec-
tion, and HIV testing should be considered in patients with no
» Treatment
OTOLARYNGOLOGY DISORDERS
GLOSSITIS, GLOSSODYNIA, & BURNING
MOUTH SYNDROME
Glossodynia is burning and pain of the tongue,
mouth syndrome.” Glossodynia with glossitis has been
227
2. Aphthous Ulcer (Canker Sore,
Ulcerative Stomatitis)
INTRAORAL ULCERATIVE LESIONS
1. Necrotizing Ulcerative Gingivitis
(Trench Mouth, Vincent Angina)
3. Herpes Stomatitis
228
effective only when started within 24–48 hours of the onset of
initial symptoms (pain, itching, burning) and are not effective once vesicles have erupted. Differential diagnosis
CMDT 2025
CHAPTER 8
▲
Figure 8–9. Marked exudative pharyngitis and ton-
sillitis due to group A beta-hemolytic streptococci.
(Used, with permission, from Lawrence B. Stack, MD, in
Knoop KJ, Stack LB, Storrow AB, Thurman RJ. The Atlas of
Emergency Medicine, 5th ed. McGraw Hill, 2021.)
PHARYNGITIS & TONSILLITIS
ESSENTIALS OF DIAGNOSIS
»
Centor criteria for streptococcal pharyngitis:
exudate or swelling on tonsils, anterior cervical
adenopathy, fever, lack of cough.
»
Goal is to treat group A beta-hemolytic streptococcal infection to prevent subsequent rheumatic
fever (rash, arthralgias, myocarditis) and other
sequelae (glomerulonephritis, posterior pharyngeal abscess).
» General Considerations
Pharyngitis and tonsillitis account for over 10% of all office
visits to primary care clinicians and 50% of outpatient antibiotic use. The main concern is determining who is likely to
infection, since this can lead to subsequent complications,
» Clinical Findings
A. Symptoms and Signs
be avoided if mononucleosis is suspected because it induces
gonorrhoeae, Mycoplasma, and Chlamydia trachomatis.
ria, anaerobic streptococci, and Corynebacterium haemolyticum (which responds better to erythromycin than
B. Laboratory Findings
» Treatment
OTOLARYNGOLOGY DISORDERS
229
Chlamydia) is a reasonable alternative to penicillin in aller-
PERITONSILLAR ABSCESS & CELLULITIS
230
CMDT 2025
CHAPTER 8
» Clinical Findings
Fusobacterium. Patients with diabetes may have different
DEEP NECK INFECTIONS
ESSENTIALS OF DIAGNOSIS
»
Marked acute neck pain and swelling.
»
Abscesses are emergencies because rapid airway
compromise may occur.
»
May spread to the mediastinum or cause sepsis.
» General Considerations
Deep neck abscesses most commonly originate from
emergency as it may cause rapid upper airway compromise and necessitate creation of a surgical airway. Recur-
» Treatment
rophorum as well as the more usual upper airway pathogens.
OTOLARYNGOLOGY DISORDERS
SNORING
ESSENTIALS OF DIAGNOSIS
»
Noise produced on inspiration due to upper
aerodigestive tract blockage during sleep.
»
Snoring is associated with obstructive sleep apnea
(OSA) but may not alone disrupt sleep quality.
» General Considerations
231
» Treatment
While OSA occurs in 5–10% of Americans, clinically relevant
snoring may occur in as many as 59%. In general, sleep-
problem, and despite its prevalence and association with
» Clinical Findings
A. Symptoms and Signs
All patients who report snoring should be evaluated for OSA
B. Imaging and Diagnostic Testing
232
º
DISEASES OF THE SALIVARY GLANDS
CMDT 2025
CHAPTER 8
ACUTE INFLAMMATORY SALIVARY
GLAND DISORDERS
1. Sialadenitis
S aureus. Treatment consists of intravenous antibiotics,
CHRONIC INFLAMMATORY & INFILTRATIVE
DISORDERS OF THE SALIVARY GLANDS
2. Sialolithiasis
SALIVARY GLAND TUMORS
º
DISEASES OF THE LARYNX
OTOLARYNGOLOGY DISORDERS
COMMON LARYNGEAL DISORDERS
1. Acute Laryngitis
has failed to demonstrate any convincing evidence that antibiotics significantly alter the natural resolution of acute laryngitis. Erythromycin may speed improvement of hoarseness
233
HOARSENESS & STRIDOR
evaluated emergently.
has persisted beyond 2 weeks should be evaluated by an otolaryngologist with laryngoscopy. Especially when the patient
2. Laryngopharyngeal Reflux
ESSENTIALS OF DIAGNOSIS
»
Commonly associated with hoarseness, throat
irritation, heartburn, foreign body sensation, and
chronic cough.
»
Symptoms typically occur when upright, and
many patients do not experience classic
heartburn.
»
Laryngoscopy is critical to exclude other causes of
hoarseness.
»
Diagnosis is often made based on response to PPI
therapy.
»
Treatment failure with PPIs is common and suggests other etiologies.
234
ryngeal reflux, as it is now called, do not meet criteria for
GERD by pH probe testing and these entities must be con-
tion of the vocal folds to exclude other causes of hoarseness.
CMDT 2025
CHAPTER 8
3. Recurrent Respiratory Papillomatosis
4. Epiglottitis
OTOLARYNGOLOGY DISORDERS
MASSES OF THE LARYNX
1. Traumatic Lesions of the Vocal Folds
Vocal fold nodules are smooth, paired lesions that form at
235
granulomas. Both lesions form on the vocal processes of
Vocal fold polyps are unilateral masses that form
Vocal fold cysts are also considered traumatic lesions
Polypoid corditis is different from vocal fold polyps
2. Laryngeal Leukoplakia