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23 General Pathology > 10 - Head and Neck > Flashcards

10 - Head and Neck Flashcards

1
Q

what are the inflammatory/reactive lesions

A
  1. apthous ulcers
  2. fibroma (coal fibrous hyperplasia)
  3. pyogenic granuloma
  4. peripheral ossifying fibroma
  5. peripheral giant cell granuloma
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2
Q

are apthous ulcers recurrent and painful?

A

yes

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3
Q

cause of apthous ulcers? what percent of population affected

A

unknown cause - affect 40% of population

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4
Q

what age are apthous ulcers frequent

A

first two decades

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5
Q

what tends to be clusetered within some families and may be associated with immunlogical disorders including celiac, IBS, and bethchet syndrome

A

apthous ulcer

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6
Q

what lesion:

Lesion may be single or multiple, shallow, mucosal ulcerations covered by a thin exudate and rimmed by a narrow zone of erythema

A

apthous ulcer

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7
Q

when do apthous ulcers resolve

A

spontaneously in 7-10 days but sometimes persist for weeks, particularly in immunocompromised patients

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8
Q

what is a submucosal nodular mass of fibrous CT stroma

A

fibroma (focal fibrous hyperplasia)

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9
Q

where does fibroma (focal fibrous hyperplasia) present

A

> on buccal mucosa alone bite line or gingiva

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10
Q

is fibroma (focal fibrous hyperplasia) a reactive process induced by repetitive trauma

A

yes

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11
Q

treatment of fibroma (focal fibrous hyperplasia)

A

surgical excision

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12
Q

what is an exophytic inflammatory lesion that presents on gingiva of children, young adults and pregnant women

A

pyogenic granuloma

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13
Q

what does pyogenic granuloma look like

A

red to purple in color and frequently ulcerated

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14
Q

are rapid growth granulomas elicit concern of malignancy

A

yes

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15
Q

histologically, what are highly vascularized proliferation of organizing granulation tissue

A

pyogenic granuloma

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16
Q

what is capable of regressing, mature into dense fibrous masses or develop into peripheral ossifying fibroma

A

pyogenic granuloma

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17
Q

how to treat pyogenic granuloma

A

complete surgical excision

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18
Q

is pyogenic granuloma a misnomer? why?

A

yes - because it is not a pus forming bacteria

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19
Q

what has a reactive growth that occurs exclusively on the gingiva, and is greatest in younger females (10-19 years of age)

A

peripheral ossifying fibroma

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20
Q

what can arise in long-standing PG while others develop de novo from cells of PDL

A

peripheral ossifying fibroma

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21
Q

POF apperance

A

red, ulcerated, nodular lesion

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22
Q

treatment of peripheral ossifying fibroma? recurrence?

A

complete surgical excision down to the periosteum

recurrence rate of 8% to 16%

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23
Q

what has a reactive growth, occurs exclusively on gingiva or edentulous alveolar ridge; 2 cm in diameter, and its mean age is 31-46 years, where 55% cases seen in females (>mandible anterior or posterior)

A

peripheral giant cell granuloma

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24
Q

what can cause a cupping resorption of undelrying bone

A

peripheral giant cell grnauloma

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25
Q

histologically, PGCG looks like what

A

Histologically, PGCG contain aggregates of multinucleated,
foreign body-like giant cells separated by a fibrous stroma and
blood vessels

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26
Q

treatment and recurrence rate of peripheral giant cell granuloma

A

surgical excision;10-18%

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27
Q

what are infections of the oral cavity

A
  1. primary herpes simplex virus
  2. latent herpes simplex virus
  3. recurrent herpes simplex virus
  4. oral candidiasis (thrush)
  5. deep fungal infections
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28
Q

how do oral herpes present in children? in adults?

A

children = gingivostomatitis
adults = pharyngotonsillitis

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29
Q

where are oral herpes present

A

loose and bound down mucosa

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30
Q

most orofacial herpetic infections are caused by what virus

A

HSV 1

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31
Q

children with gingivostomatitis can be accompainied with what symptoms

A

lymphadenopathy, fever, and anorexiaadu

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32
Q

in adults, is acute herpes pharyngitis common and may recur?

A

yes

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33
Q

when does primary herpes simplex virus resolve

A

mild cases: 5-7 days
severe cases: 2 weeks

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34
Q

human herpes virus is what type of DNA virus

A

double stranded DNA virus

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35
Q

what is HHV1

A

herpes simplex virus 1 (above waist)

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36
Q

what is HHV 2

A

herpes simplex virus 2 (below waist)

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37
Q

what is HHV3

A

varicella-zoster virus (chicken pox and shingles)

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38
Q

what is HHV4

A

Epsetin Barr virus

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39
Q

what is HHV5

A

cytomegalovirus

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40
Q

what is HHV6 and HHV7

A

generally in children and are closely related

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41
Q

what is HHV 8

A

Kaposi sarcoma associated virus

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42
Q

what are the only know reservoirs for HHV

A

humans! endemic worldwide

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43
Q

After primary infection is established, the herpes simplex virus is taken up by the sensory nerve and transported to the ___ or less frequently, ___ where the virus remains in latent stage

A

associated sensory;autonomic ganglia

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44
Q

most common site for latent HSV1

A

trigeminal ganglion

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45
Q

does latent herpes simplex virus use axons of sensory neurons to travel back and forth to the skin and mucosa

A

yes

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46
Q

where do recurrent herpes simplex virus infections occur

A

May occur at site of primary inoculation or in adjacent areas of surface
epithelium supplied by the involved ganglion

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47
Q

what is the most common clinical pattern of recurent herpes simplex virus

A

herpes labialis (cold sore or fever blister)

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48
Q

what are prodromal signs and symptoms that arise 6-24 hours before recurrent herpes lesions appear

A

pain, burning, itching, tingling, localized warmth, erythema

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49
Q

what are multiple small, erythematous paupules that develop and form clusters of fluid-filled vesicles. It happens in BOUND DOWN MUCOSA (palate or gingiva)

A

recurrent herpes simplex virus

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50
Q

when to recurent herpes simplex virus rupture and crust? how long does healing take?

A

rupture and crust within 2 days
healing occur in 7-10 days

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51
Q

when is pain most severe in recurrent herpes simplex virus

A

first 8 hours and usually resolves in 4-5 days

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52
Q

does viral shedding occur in recurrent herpes simplex when vesicle ruptures

A

YES

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53
Q

when is recurrent herpes simplex most viral

A

within 48-72 hours

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54
Q

when should medicaiton be administered to shorten recurrent herpes simplex virus

A

prodrome phase (early stage and symptoms of any condition)

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55
Q

what is the most common fungal infection of oral cavity

A

oral candidasis (thrush)

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56
Q

oral candidasis is also called what

A

thrush

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57
Q

what are the factors that influence infectino of thrush

A
  1. strain of C. albicans
  2. oral microbiome composition
  3. individuals immune status
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58
Q

how can oral candidiasis present

A
  1. pseudomembranous (membrane covering, it can rub off)
  2. erythematous (redness of oral mucosa)
  3. hyperplastic
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59
Q

what cna be used to eliminate or alter bacteria flora of mouth that promotes thrush

A

brad spectrum antibiotics

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60
Q

what are examples of deep funcal infections

A
  1. histoplasmosis
  2. blastomycosis
  3. zygomycosis
  4. aspergillosis
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61
Q

The incidence of oral fungal infections has grown along with increasing numbers ___ as a result of disease such as AIDS, therapies for cancers, and organ transplant

A

immunocompromised patients

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62
Q

what are examples of oral manifestations of systemic diseases

A
  1. oral hairy leukoplakia
  2. scarlet fever
  3. measles
  4. infectious mononucleosis
  5. diphteria
  6. HIV
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63
Q

what is a distinctive oral lesion on lateral border of tongue caused by EBV (HHV4) that usually occurs in immunocompromised patients

A

oral hairy leukoplakia

64
Q

in patients infected with HIV, what may be a warning of development of AIDS

A

OHL

65
Q

OHL are seen in patients who are

A

immunocomporised for other reasons including:
1. cancer therapy
2. transplant associated immunosuppression
3. old age

66
Q

what are white linear lines of hyperkeratotic thickenings seen on lateral border of tongue and CANNOT be scraped off

A

oral hairy leukoplakia

67
Q

what disease presents with fiery red tongue with prominent papillae (raspberry tongue); white coated tongue through which hyperemic papillae project (strawberry tongue)

A

scarlet fever (group A strep)

68
Q

what disease presents spotty enanthema in the oral cavity often proceeds the skin rash;
ulcerations on the buccal mucosa; Koplik spots

A

measles (single stranded RNA virus of paramyxoviridae family)

69
Q

what disease presents acute pharyngitis and tonsilitis that may cause coating with a grey-white exudative membrane; enlargement of lymph nodes the neck; palatal petechiae

A

infectious mononucleosis (EBV aka HHV-4)

70
Q

what disease presents Characteristic dirty white, fibrinosuppurative, tough, inflammatory membrane over the tonsil and retropharynx

A

diptheria (c. diptheriae)

71
Q

what disease presents predisposition to opportunistic oral infections, particularly herpes virus, candida, and other fungi; oral lesions of Kaposi sarcoma and oral hairy leukoplakia

A

HIV

72
Q

how long can infectious mono last? what is painful?

A

6-10 days -> swallowing is paindul

73
Q

HIV can cause what oral presentations

A
  1. kaposi sarcoma
  2. candidiasis
  3. oral hairy leukoplakia
74
Q

what disease presents reticulate, lacelike, white keratotic lesions (Wickham striae) that sometimes ulcerate and rarely form bullae; seen in more than 50% of patients with cutaneous ___

A

lichen planus (unknown autoimmune disease)

75
Q

what disease presents vesicles and bullae prone to rupture, leaving hyperemic erosions covered with exudates

A

pemphigus (unknown autoimmune disease)

76
Q

what disease presents oral lesion (mucous membrane pemphigoid) resemble those of pemphigus but can be differentiated histologically

A

bullous pemphigoid (unknown-autoimmune disease)

77
Q

what disease presents maculopapular,
vesiculobullous eruptions that sometimes follow an infection elsewhere, ingestion of drugs, development of cancer, or a collagen vascular disease; crusting of lips when there is widespread mucosal and skin involvement it is referred to as Stevens-Johnson syndrome

A

Erythema multiforme (autoimmune * may be associated with herpes simplex infection, mycoplasma pneumoniae or medications)

78
Q

radiating white lines are called what in lichen planus

A

Wickham striae

79
Q

what presents an intraepithelial split? what forms subepithelial split?

A

pemphigus: intraepithelial split to form vesicle or bullae
mucous membrane pemphigoid: subepithelial split

80
Q

what presents severe oral infections in the form of gingivitis, pharyngitis, tonsillitis; may extend to produce cellulitis of the neck (Ludwig angina)

A

pancytopenia (agranulocytosis, aplastic anemia)

81
Q

what presents with depletion of functioning neutrophils, oral lesions similar to those in pancytopenia may develop

A

leukemia

82
Q

what presents leukemic infiltration and enlargement of the gingivae, often with accompanying periodontitis

A

monocytic leukemia (one type of cell)

83
Q

what may appear in Addison disease, Hemochromatosis, fibrous dysplasias of bone (McCune Albright syndrome), and Peutz- Jegher syndrome (gastrointestinal polyposis)

A

melanotic pigmentation

84
Q

what is a striking fibrous enlargement of gingivae

A

phenytoin ingestion (antiseizure med)

85
Q

what causes a friable, red, pyogenic granuloma producing form the gingivae (Pregnancy tumor, PG)

A

pregnancy

86
Q

what is an AD disorder with multiple congenital aneurysmal telangiectasis beneath mucosal surfaces of the oral cavity and lips

A

Rendu-Osler-Weber syndrome (Hereditary hemorrhagic telangectasia)

87
Q

what is a rare chronic condition where adrenal glands don’t produce enough cortisol and aldosterone hormones

A

addison’s disease

88
Q

With adrenal insufficiency, not being able to increase the amount of cortisol made as a result of stress can lead to an ___

A

Addisonian crisis.

89
Q

what are part of McCune Albright syndrome

A
  1. cafe-au-lait lesions
  2. precocious puberty
  3. fibrous dysplasia
90
Q

what are precancerous and cancerous oral lesions

A
  1. leukoplakia
  2. erythroplakia
  3. squamous cell carcinoma
91
Q

Defined by WHO as “a white patch or plaque that cannot be scraped off and cannot be characterized clinically or pathologically as any other disease”

A

leukoplakia

92
Q

what is a term reserved for lesion present in oral cavity for no apparent reason

A

leukoplakia

93
Q

5%-25% of leukoplakia lesions are ___

A

premalignant

94
Q

who gets leukoplakia

A

> 40-70 year olds
2:1 male predilection

95
Q

where does leukoplakia occur in oral cavity

A

anywhere in oral cavity

96
Q

Defined by WHO as a red, velvety patch or eroded area that cannot be characterized clinically or pathologically as any other disease”

A

erythroplakia

97
Q

the epithelium in these lesions are markedly atypical; risk of malignant transformation is higher than leukoplakia

A

erytheroplakia

98
Q

Intermediate forms that have the characteristics of both eukoplakia and erythroplakia are termed ___

A

speckled leukoplakia

99
Q

who gets erythroplakia

A

> 40-70 year of age, 2:1 male predilection

100
Q

where does erythroplakia occur in oral cavity

A

anywhere in oral cavity

101
Q

what are most cancers of head and neck

A

sqamous cell carcinoma

102
Q

what is the 6th most common neoplasm in the world

A

SCC

103
Q

where is sqamous cell carcinoma present? what does it harbor?

A

oropharynx - harbor oncogenic variants of HPV (specifically HPV 16)

104
Q

why is early detection of HPV associated head and neck SCC challenging

A

because of anatomical sites (tonsillar crypts, base of tongue, and oropharynx)

105
Q

is HPV associated SCC of the ORAL CAVITY common?

A

NO! oropharynx is the common one

106
Q

patient age, risk factors, location, clinical presentation, histology, distant metasis, clinical outcomes, and risk of second primary:

associated with HPV

A

age: younger
risk factors: number of oral sex partners
location: oropharynx/back of throat
clinical presentation: small primary lesion with bulky nodular disease
histology: nonkeratinizing SCC
distant metasasis: rare
clinical outcomes: good
risk of secondary primary (death): low

107
Q

patient age, risk factors, location, clinical presentation, histology, distant metasis, clinical outcomes, and risk of second primary:

not associated with HPV

A

age: older
risk factors: tobacco/alcohol
location: oral cavity
clinical presentation: large primary lesion with variable nodal disease
histology: keratinizing SCC
distant metasasis: common
clinical outcomes: poor
risk of secondary primary (death): high

108
Q

what are lesions of the nose

A
  1. inflammatory lesions (rhinitis, sinusitis)
  2. necrotizing lesions of nose and upper airways
109
Q

what are lesions of nasopharynx

A

inflammatory lesion (pharyngitis and tonsilits)

110
Q

what are tumors of the nose, sinuses, and nasopharynx

A
  1. nasopharyngeal angiofibroma
  2. sinonasal papilloma
  3. olfactory neuroblastoma
  4. nasopharyngeal carcinoma
111
Q

what is the infectious rhinitis also called

A

common cold

112
Q

what Is caused by one or more viruses; major offenders are adenovirus, echovirus, and rhinovirus

A

infectious rhinitis (common cold)

113
Q

during initial stages of ___ nasal mucosa is thickned, edematous and red; nasal cavities narrowed and tribunates are enlarged

A

infectious rhinitis

114
Q

can infectious rhinitis get seocndary bacterial infection

A

yes

115
Q

when does infectious rhinitis clear

A

rapidly in 7 days

116
Q

what is allergic rhinitis also called

A

hay fever

117
Q

what is Initiated by hypersensitivity to one of a large group of allergens and
dust mites; affects 20% of US population; IgE mediated reaction; characterized by mucosal edema, erythema, and secretions

A

allergic rhinitis

118
Q

Recurrent attacks of rhinitis may eventually lead to focal protrusion of the mucosa, producing what?

A

nasal polyps

119
Q

describe nasal polyps

A

3-4 cm in length
in absence of bacterial infection, mucosal surface is intact

120
Q

most cases of ___ are preceded by what

A

rhinitis

121
Q

what occasionally arises by extension of the periapical infection throughthe bony sinus floor

A

maxillary sinusitis

122
Q

what can cause severe chronic sinusitis (mucormycosis) especially in uncontrolled diabetic patients

A

fungi

123
Q

what can necrotizing lesions be produced by

A
  1. acute fungal infections
  2. granulomatosis with polyangiitis (Wagner granulomatosis)
  3. extranodal NK/Tcel lymphoma nasal type (tumor harbors EBV)
124
Q

what are the most common causes of pharyngitis and tonsilitis

A

Rhinovirus, echovirus, and adenovirus are the most common
causes; remaining cases are primarily due to various strains of
influenza or respiratory syncytial virus

125
Q

___ and ___ of the nasopharyngeal mucosa with ___ of nearby tonsils and lymph nodes are characteristic in pharyngitis and tonsilitis

A

erythema, edema, enlargement

126
Q

Bacterial infections may also cause the infections or may be secondarily superimposed on viral infection; ___ most frequent cause

A

Beta-hemolytic streptococcus aureus

127
Q

Major importance of streptococcal “sore throat” lies in the possible development of late sequelae such as ___

A

rheumatic fever and glomerulonephritis

128
Q

what is a benign, highly vascular tumor that occurs almost exclusively in adolescent males who are often fair-skinned and red-headed. Arises in the posterolateral wall of the roof of the nasal cavity; cause trouble breathing, nosebleeds, and runny nose that is consistence

A

nasopharyngeal angiofibroma

129
Q

how to treat nasopharyngeal angiofibroma

A

Surgical removal, often with preoperative embolization to
decrease bleeding, is the treatment of choice

130
Q

Benign neoplasm arising from the respiratory or
schneiderian mucosa lining the nasal cavity and
paranasal sinuses

A

Sinonasal (Schneiderian ) Papilloma

131
Q

who gets Sinonasal (Schneiderian ) Papilloma

A

males between 30-60 years

132
Q

what, alhough benign, it can exhibit locally aggressive behavior within both the nose and paranasal sinuses, including invasion into the orbit or cranial vault

A

Sinonasal (Schneiderian) Papilloma

133
Q

does Sinonasal (Schneiderian ) Papilloma have high rate of recurrence if not adequately excised

A

yes

134
Q

is Sinonasal (Schneiderian ) Papilloma capable of malignant transformation

A

yes in 10% of cases

135
Q

what arises from the neuroectodermal olfactory cells within the mucosa, particularly in the superior aspect of the nasal cavity

A

Olfactory Neuroblastoma (Esthesioneuroblastoma)

136
Q

what age do people get Olfactory Neuroblastoma (Esthesioneuroblastoma)

A

peaks at 15 and 50 years

137
Q

what do patients with Olfactory Neuroblastoma (Esthesioneuroblastoma) present

A

nasal obstruction and/or epistaxis

138
Q

how does Olfactory Neuroblastoma (Esthesioneuroblastoma) look histologically

A

small, round, blue cells

139
Q

treatment of Olfactory Neuroblastoma (Esthesioneuroblastoma)? survival rate?

A

Treatment includes a combination of surgery, chemotherapy, and radiation therapy-depending upon the tumor stage
5 year SRs of 40%-90%

140
Q

what is characterized by a distinct geographic distribution, a close anatomic relationship to lymphoid tissue, and an association with EBV

A

nasopharyngeal carcinoma

141
Q

Beyond EBV, diets high in nitrosamines (found in fermented foods and salted fish, and environmental insults (smoking) and chemical fumes have been linked to what tumors

A

nasopharyngeal carcinoma

142
Q

what does nasopharyngeal carcinoma cause? survival rate?

A

Cause nasal obstruction and/ or epistaxis; overall 5yr SR 60%
after treatment

143
Q

what are tumors of neck

A
  1. branchial cyst (cervical lymphoepithelial cyst)
  2. thyroglossla duct cyst
  3. paraganglioma
144
Q

vast majority of branchial cyst (cervical lymphoepithelial cyst) are thought to arise from from

A

remnants of second branchial arch

145
Q

Most commonly observed in young adults between 20 and 40 years of age; Usually appear as nontender, soft tissue mass on the upper lateral aspect of the neck along the sternocleidomastoid muscle

A

Branchial Cyst (Cervical
Lymphoepithelial Cystl

146
Q

The slowly-enlarging cysts are well circumscribed, 2-5 cm in diameter, and usually lined by stratified squamous epithelium or pseudostratified columnar epithelium; fibrous cyst wall contains lymphoid tissue

A

Branchial Cyst (Cervical
Lymphoepithelial Cyst)

147
Q

are Branchial Cyst (Cervical Lymphoepithelial Cyst) readily excised?

A

yes! do not undergo malignatn transformation

148
Q

what cyst:

The thyroid anlage begins in the region of the foramen caecum, at the base of the tongue; as the gland develops, it descends to its definitive midline location in the anterior neck; Remnants of this developmental process may persist, resulting in 1-4 cm cysts

A

Thyroglossal Duct Cyst

149
Q

They are lined by stratifies squamous epithelium when located near the base of the tongue and pseudostratified columnar epithelium in lower locations; the fibrous cyst wall contains thyroid remnants

A

thyroglossal duct cyst

150
Q

treatment for thyroglossal duct cyst

A

surgical exicision (definitive tx)

151
Q

what is paraganglioma also called

A

carotid body tumo

152
Q

what arises from neuroectodermal cells associated with the sympathetic and parasympathetic nervous systems; occurs at many sites

A

paraganglioma (Carotid body tumor)

153
Q

what is the most common paraganglioma

A

adernal medullary pheochromocytomas

154
Q

who has a higher incidence of paraganglioma

A

people living in higher altitudes

155
Q

describe paraganglioma

A

Slow-growing painless mass; rarely exceed 6 cm and arise close to the
bifurcation of the carotid artery
Arise in 5th -6th decades of life; they recur after incomplete resection
and may metastasize to regional LN and distant sites
Approx. 50% ultimately fatal due to infiltrative growth

23 General Pathology (24 decks)

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