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3) Human Disease (Q&A) > 25: Head & Neck > Flashcards

25: Head & Neck Flashcards

1
Q

Herpes labialis (cold sores, fever blisters) and herpetic stomatitis are caused by?

A

Herpes virus type 1

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2
Q

What disease starts with painful inflammation of the affected mucosa, followed shortly by the formation of vesicles?

A

Herpes labialis (Herpes virus type 1)

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3
Q

After the vesicles in herpes labialis rupture, what forms?

A

Shallow, painful ulcers

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4
Q

Microscopically, the herpetic vesicle of Herpes labialis (Herpes virus type 1) forms as a result of “balooning degeneration” of what type of cells?

A

Epithelial cells

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5
Q

At the edge of the ulcer in Herpes labialis (Herpes virus type 1) are large, 1. _______ epithelial cells with “ground glass” homoginized nuclei, often exhibiting nuclear molding. The ulcers heal spontaneously without scar formation.

A

multinucleated

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6
Q

Thrush or candidaisis (also called moniliasis), is caused by a yeast-like fungus called?

A

Candida albicans

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7
Q

Candida albicans is a common surface inhabitant of what 3 areas?

A
  1. oral cavity
  2. GI tract
  3. vagina
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8
Q

Oral candidaisis is common in what 3 patient types?

A
  1. immunocomprimised patients
  2. diabetics
  3. AIDS
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9
Q

White oral lesions that appear slightly elevated with soft patches that consist of mainly fungal hyphae occur in which disease?

A

Candidaisis causes by Candida albicans

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10
Q

What disease is a rapidly spreading cellulitis or phlegmon, which originates in the submaxillary or sublingual space but extends locally to involve both the submaxillary & sublingual space ?

A

Ludwig angina

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11
Q

The bacteria responsible for the infection in Ludwig Angina, which is uncommon in developed countries, originate from what location?

A

Originate from the oral flora;

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12
Q

Describe the pathogenisis of Ludwig’s angina.

A

After extraction of a tooth, hairline fractures may occur in the lingual cortex of the mandible, providing microorganisms access to the submaxillary space. By following the fascial planes, the infection may dissect into the parapharyngeal space, and from there, into the carotid sheath.

NOTE: The carotid sheath is an anatomical term for the fibrous connective tissue that surrounds the vascular compartment of the neck.

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13
Q

Does acute necrotizing ulcerative gingivitis or Vincent angina extend into the neck?

A

No

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14
Q

What disease is a chonic inflammatory disease of the salivary and lacrimal glands, which may be resticted to these sites or may be associated with a systemic collagen vascular disease?

A

Sjogren syndrome

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15
Q

What are the two main findings in Sjogren syndrome?

A

Involvement of the salivary glands leads to dry mouth = xerostomia

Disease of the lacrimal glands gives dry eyes = keratoconjunctivitis sicca

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16
Q

What happens to the salivary and lacrimal glands in the later progression of Sjogren syndrome?

A

Late in the course of the disease the salivary and lacrimal glands become atrophic, with fibrosis and fatty infiltration of the parenchyma.

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17
Q

During development, what gland descends from the base of the tongue to its final position in the neck?

A

Thyroid gland

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18
Q

Heterotropic functioning thyroid tissue or a developmental cyst (thyroglossal duct cyst) may occur anywhere along the path of decent of the thyroid. The most common location of this thyroid tissue is at?

A

The foramen cecum of the tongue

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19
Q

What are the three main symtoms that become evident during adolesence and pregnancy that a patient whi has heterotropic functioning thyroid suffer from?

A

Dysphonia (difficulty speaking)

Awareness of a mass in the throat

Sore throat

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20
Q

Branched cleft cysts that originate from remnants of the branchial arches occur in what two anatomical locations?

A

Lateral anterior aspect of the neck

or

In the parotid gland.

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21
Q

What is the common disease that is characterized by painful, recurrent, solitary or multiple, small ulcers of the oral mucosa? What is the causitive agent?

A

Apthous stomatitis; unknown

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22
Q

Describe microscopic lesions of Apthous stomatitis.

A

The lesion consist of a shallow ulcer covered by a finbrinopurulent exudate.

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23
Q

What disease is a reactive vascular lesion that occurs in the oral cavity due to minor trauma to the tissues, which permits invation of nonspecific microorganisms?

A

Pyogenic granuloma

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24
Q

In the oral cavity, pyogenic granulomas, ranging from a few millimeters to a centimeter, are most frequent on what structure?

A

The gingiva (gums)

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25
Q

Desribe the macroscopic appearance of pyogenic granulomas.

A

The lesion is seen as an elevated, red or purple, soft mass, with a smooth, lobulated, ulcerated surface.

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26
Q

Desribe the microscopic appearance of pyogenic granulomas.

A

Microscopically, the nodule consists of highly vascular granulation tissue that shows varying degrees of acute and chronic inflammation.

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27
Q

With time, pyogenic granuloma becomes less vascular and comes to resemble what?

A

A fibroma

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28
Q

Acute necrotizing ulcerative gingivitis or Vincent angina represents an infection by two organisms. Name the organism and the organism type.

A
  1. Fusiform bacillus

2. B. vincentii - a spirochete

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29
Q

Fusiform bacilli & the spirochete B. vincentii are found in the mouths of many healthy people which suggests that predisposing factors are important to the development of acute necrotizing gingivitis. What is the most important element?

A

Decreased resistance to infection due to inadequate nutrition, immunodeficiency, or poor oral hygeine (homeless).

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30
Q

Vincent infection is characterized by what type of erosions of the interdental papillae?

A

punched out erosions of the interdental papillae

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31
Q

In Vincent infection does the ulceration spread? What occurs as a result of spread or no spread?

A

The ulceration spreads, and eventually involves all gingival margins, which become covered by a necrotic pseudomembrane.

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32
Q

What is the most prevalent chronic disease of the calcified tissues of the teeth?

A

Caries

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33
Q

Describe the pathogenisis of caries?

A

Caries begin with the disintegration of the enamel prisms after decalcification of the interprismatic substance; this leads to the accumulation of debris and microorganisms.

34
Q

Dental carries produce a small pit or fissure in what tissue? What is the consequence?

A

The enamel;

When the process reaches the dentinoenamel junction, it spreads laterally and also penetrates the dentin along the dentinal tubules. A substantial cavity then forms in the dentin, producing a flask shaped lesion with a narrow orifice.

35
Q

If a carie progresses and invades the vascular pulp of the tooth, what is the inflammatory reaction called?

A

Pulpitis

36
Q

What is the most common sequel of pulpitis? Describe it.

A

Apical granuloma is the formation of chronically inflammed periapical granulation tissue.

37
Q

What is another result of pulpitis?

A

Periapical abscess.

38
Q

Define periodontitis.

A

Periodontitis is an inflammatory condition of the marginal gingiva.

39
Q

What condition is the most common cause of deafness among the postnatal viral infections?

A

Mumps

40
Q

Is the rapid hearing loss typical of mumps unilateral or bilateral?

A

Unilateral in 80% of cases

41
Q

What is a bilateral prenatal infectious cause of hearing loss?

A

Rubella has bilateral hearing loss, with permanent loss of cochlear and vestibular function.

42
Q

A number of viruses including influenza, parainfluenza, ebstein-barr, hepersvirus, and adenoviruses can cause what condition?

A

Labyrinthitis. Temporal bone specimens of these cases have damage to the organ of Corti, with almos total loss of both inner and outer hair cells.

43
Q

What is a Warthin tumor?

A

It is a benign neoplasm of the parotid gland composed of cystic glandular spaces embedded in dense lymphoid tissue.

44
Q

Warthin tumor is the most common ______ adenoma. Althought the neoplasm is benign, it can be _____ or multifocal within the same gland. It is more common in _____ than women.

A

monomorphic; bilateral; men

War = men so more common in men

45
Q

Pleomorphic adenoma has a biphasic appearance, which represents an admixture of _____ and _____ elements.

A

epithelial; stromal

46
Q

Adenoid cystic carcinoma is a slow-growing malignant neoplasm of the ______ gland, which invades locally and tends to _____ after surgery.

A

salivary; recur

47
Q

Periodontal disease refers to acute and chronic disorders of the ______ tissues surrounding the teeth, which eventually lead to the loss of supporting _____. Chronic periodontal disease typically occurs in _____, especially in those with poor oral hygiene.

However, many ppl w awesome dental habits, but a strong ______ history of periodontal disease get it. Chronic periodontitis causes loss of ______ teeth in adults than does any other disease, including caries.

A

soft; bone; adults; family; more

48
Q

Periapical granuloma is the most common sequel to _____ and represents chronically inflamed periapical granulation tissue.

A

pulpitis

49
Q

What is Peripheral giant cell granuloma?

A

Peripheral giant cell granuloma is an unusual proliferative reaction to local injury that is seen as a mass on the gingiva or the alveolar process. It is denoted as peripheral, as opposed to the central giant cell granulomas that occur in the jawbone.

50
Q

What does Peripheral giant cell granuloma look like on microscopy?

A

On Microscopy many multinucleated giant cells are in a fibrous stroma that also contain ovoid or spindle-shaped mesenchymal cells. You see giant cells w a history of gingival lesions.

51
Q

What are sinonasal inflammatory polyps? What causes it?

A

Sinonasal inflammatory polyps are nonneoplastic lesions of the mucosa caused many things including chronic allergic rhinitis, allergy, cystic fibrosis, infections, diabetes mellitus and aspirin intolerance.

52
Q

Describe the anatomy and symptoms of sinonasal inflammatory polyps.

A

Most polyps arise from the lateral nasal wall or the ethmoid recess. They may be unilateral or bilateral and singe or multiple. Symptoms include nasal obstruction, rhinorrhea, and headaches.

53
Q

Describe the histology of sinonasal inflammatory polyps.

A

Microscopically, sinonasal allergic pollyps are lined externally by respiratory epithelium and contain mucous glands within a loose mucoid stroma, which is infiltrated by plasma cells, lymphocytes and numerous eosinophils.

54
Q

If you see a picture of a guy with a saddle nose deformity, what is the dx?

A

Wegener’s granulomatosis

55
Q

What is Wegener’s granulomatosis? What disease is it simmilar to?

A

A disease of unknown origin that shares some features with lethal midline granuloma. Both diseases are characterized by necrotizing, ulcerated, mucosal lesions.

56
Q

Lethal midline granuloma is a sign of underlying _____ malignancy, whereas Wegener granulomatosis is an ______ disease.

A

lymphoid; inflammatory

57
Q

Discuss the pathogenisis of Wegener’s granulomatosis. Autoantibodies in this disease are directed vs what?

A

Usually, lesions are not limited to the respiratory tract; they also involve the lungs and kidneys.

More than 90% of patients have antineutrophil antibodies and most of them are vs the cytoplasm of neutrophils, i.e., C-ANCAs.

58
Q

Papillomas are the most common tumors of the ____ cavity. HPV _ & _ cause papillomas, which may be histologically diagnosed as either squamous or inverted.

A

nasal; 6 & 11

59
Q

_____ infection is related to nasopharyngeal carcinoma.

A

EBV

60
Q

Acute tonsilitis may be caused by bacterial or viral infections; however, Streptococcus ______ is the most common cause of suppurative tonsilitis.

A

pyogenes

61
Q

Streptococcus pyogenes is group ___ & it is _____ hemolytic.

A

A; beta

62
Q

What is Osteosclerosis?

A

Osteosclerosis is the formation of new spongy bone about the stapes at the oval window, which results in progessive deafness.

63
Q

What is the etiology, genetics, and symptomatology of Osteosclerosis?

A

This condition is an autosomal dominant hereditary defect and is the most common cause of conductive hearing loss in young and middle aged adults in the USA. 90% of cases of Osteosclerosis is asymptomatic, except for the complaint of gradual hearing loss.

64
Q

What is a non-infectious cause of eustachian tube obstruction?

A

Obstruction of the eustachian tube may result from sudden changes in atmospheric pressure like in flying or deep sea diving.

65
Q

What is an infectious cause of eustachian tube obstruction?

A

Obstruction of the eustachian tube is severe in the presence of an upper respiratory tract in fection, an acute alleric reaction, or a viral or bacterial infection at the oriface of the eustachian tube. Inflammation of the eustachian tube may occer without bacterial invasion of the middle ear.

66
Q

More than half of the children in the USA have had at least one episode of _____ otitis media before their 3rd birthday.

Repeated bouts of otitis media in early childhood often contribute to unsuspected hearing _____, which is due to residual, usually sterile, fluid in the middle ear.

A

serous; loss

67
Q

Nasopharyngeal carcinoma is an epithelial cancer of the nasopharynx that is classified into ______ and _____ subtypes.

A

keratinizing; nonkeratinizing

68
Q

______ nasopharyngeal carcinoma is associated with an EBV infection. Most patients have anti-EBV ____ in their serum.

A

Nonkeratinizing; IgA

69
Q

Both differentiated and undifferentiated nonkeratinizing nasopharyngeal carcinomas are ummunoreactive with antibodies to ______.

A

cytokeratins

70
Q

What is Adenoid cystic carcinoma? What it is a tumor of?

A

Adenoid cystic carcinoma is a slowly growing malignant neoplasm of the salivary gland that is notorious for its tendency to invade locally and to recur after surgical resection.

71
Q

Describe the tumor cells in an Adenoid cystic carcinoma.

A

The tumor cells are small, have scant cytoplasm, and grow in solid sheets or as small groups, strands, or columns. Within these structures, the tumor cells interconnect to enclose cystic spaces, resulting in a solid, tubular or cribiform arrangement.

72
Q

What is a Cholesteatoma?

A

Cholesteatoma is a complication of chronic suppurative otitis and a rupture of the eardrum. Cholesteastoma is a mass of accumulated keratin and squamous mucosa that results from the growth of squamous epithelium from the external ear canal through the perforated eardrum into the middle ear.

73
Q

Describe the microscopic nature of a Cholesteatoma & how the mass can be involved in infection.

A

Microscopically choleasteatomas are identical to epidermal inclusion cysts and are surrounded by granulation tissue and fibrosis. The keratin mass often becomes infected and shields the bacteria from antibiotics.

74
Q

Ameloblastomas (adamantinomas) are tumors of epithelial _____ (teeth formation) origin and represent the most common clinically significant ______ tumor. They are slow growing, locally invasive tumors that follow a benigen clinical course.

A

odontogenic; odontogenic

75
Q

Describe the microscopic nature of Ameloblastomas. What organ do they resemble?

A

Microscopically, ameloblastoma resembles the enamel organ in its various stages of differentiation, and a single tumor may show various histologic patterns. The centers of these cell nests consist of loosley arranged, large polyhedral cells that resemble the stellate reticulum of the developing tooth.

76
Q

______ is a descriptive term for many reactive, preneoplastic, and neoplastic lesions of the oral mucosa. _______ lesions are not necissarily premalignant and demonstrate a spectrum of histopathological changes, ranging from increased surgace keratinization without dysplasia to invasive keratinizing squamous carcinoma.

A

Leukoplakia; Leukoplakic

77
Q

Candidaisis presents with whitish plaques but does not induce ______.

A

dysplasia

78
Q

There is a low risk of patients with leukoplakia developing a malignant transformation into ______ cell carcinoma.

Carcinogenic factors that lead to the induction of cancer usually affect more than one site in the oral mucosa, and the tumors may therefore be _____.

A

squamous; multiple

79
Q

What is the most common tumor of the salivary glands?

A

Pleoporphic adenoma

80
Q

What is a Pleoporphic adenoma? What is done to treat it? what are the complications?

A

A benign neoplasm characterized by a biphasic appearance which represents an admixture of epithelial and stromal elements.

At surgery, tumor projections can be missed if the tumor is not carefully dissected. Tumor implanted druting surgery or tumor nodules left behind continue to grow as recurrences in the scar tissue of the previous operation.

Recurrence of pleomorphic adenoma represents local groeth and does not reflect malignancy as malignant transformation is rare.

3) Human Disease (Q&A) (4 decks)

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