2nd Exam: Head and Neck Disease Flashcards
Abnormal positions of head:
kyphosis, torticollis
Kyphosis:
usually spine disease, forward bending of neck
Torticollis:
twisting, congenital, antipsychotics, infections in neck or pharynx, spastic - abnormal contration of cervical mm. (often neurologic d., muscle relaxant), can be oscilating, head continually moving
Most hearing problems involve:
middle ear, disease of oscicles
Middle ear issue related to the base/footplate of the stapes:
otosclerosis: fibrous ankylosis (stiffness/ fusion of joint) ossicles, calcification, deformity, dysfunction, often not severe loss, conductive, oft autosomal dominant, slow progression, usually middle age
2 types of hearing loss:
sensory (nerve deafness, inner ear) and conductive (bones, middle ear)
Common ear issue in kids:
Otitis media, preceding URI (i.e., cold), blocked eustachian tube
Eustachian tube communicates bw:
middle ear, oral cavity
Where does otitis media usually start?
mouth/ nose
Acute otitis media:
bacterial, middle ear fills w pus, pain from pressure and inflammation
treatment for otitis media:
Antibiotics, gone in a few days
Sinusitis:
usually bacterial, common, headache, fever, face pain (maybe teeth), thick, purulent nasal discharge, bad breath
Causes of acute sinusitis:
HIMSP: H influenze, Moraxella, strep pnemoniae
Suspect this is pt has tooth pain, headache, fever, and purulent discharge:
sinusitis, referred from sinus
Cause of halitosis in sinusitis:
bacteria, smell changes w bacteria type
Normal sinuses are lined by
pseudostratified ciliated columnar, w goblet cells
Resp epi is:
stratified epithelium
Pathology of sinusitis:
obstruction of ostia, URI, allergic rhinitis, oral infection, usually tooth
ostia:
opening at end of canal
Sinusitis sinus staining:
blue, viscous secretion that gets infected
Appearance of mucosal inflammation in sinusitis on slides:
lots of blue PMNs surrouned by white
Does the sinus mucosa make mucoid secretions?
yes
Nasal polyps:
assoc w chronic rhinitis, not allergic, reactive, non-neoplastic, bleeding, sneezing, difficulty breathing, tend to enlarge, edematous, gelatinous, tan-pink, inflamed
TF? Nasal polyps are caused by allergy.
F
What induces the reactive change in nasal polyps?
inflammation
Are nasal polyps typically singular or mulitple?
multiple
Nasal polyps may also affect:
paranasal sinus
What proliferates in nasal polyps?
stromal and epi cells
Type or proliferation nasal polyps are:
mucosal
Cellular components of nasal polyps:
stroma under, ct core, often inflammed, collagen, inflammatory cells, mesenchymal elements
Olfactory neuroblastoma:
malignant, from sup pos nasal cavity, origin: olfactory epi, primitive, undifferentiated, usually 55yo, nasal discharge, stuffiness, epitaxis (bleeding), obstruction, 75% 5 y survival rate, small, round blue (nuclie) cells, nests surrounded by fibrous stroma
Rx for olfactory neuroblastoma:
surgery + radiation
Olfactory neuroblastoma, benign or malignant?
malignant
Glands of olfactory epi:
Bowman’s glands
Olfactory n. fibers cross this before entering the olfactory epi:
lamina propria
Cells at the lamina propria surface of olfactory epi:
basal cells
Composition of olfactory neuroblastoma:
supporting tissue, mesenchymal tissue and collagen
Danger of olfactory neuroblastoma:
invasion of surrounding structures, brain
S100 protein is a protein marker for:
neural cells
Micro view of olfactory neuroblastoma:
Homer-Wright rosettes-tumor cells around central focus of fibrillary material
Nestles in images are characteristic of:
olfactory neuroblastoma
olfactory neuroblastoma can appear to be
lymphoma, S100 protein stain to rule out lymphoma
Tumor of neural origin:
olfactory neuroblastoma
Reasons for hoarse voice:
singer’s node, R/O laryngeal cancer, URI, benign reactive lesion, arise from vocal cords, usually singuar
Singer’s nodes are typically found here;
anterior vocal cord, few mm
Singer’s node:
polypoid lesion, hyperplastic epi, stroma with edema, prominent vessels and inflammation, reactive looking, similar to nasal polyps, project into larynx
Causes of coughing:
usually upper respiratory, often in bronchii, laryngitis, bronchitis, pneumonia
Causes of laryngitis:
tobacco smoke, acid reflux, singing, allergy, usually part of URI, viral, bacterial
2 types of acute bronchitits:
infection (usaully viral, bacterial), whooping cough
Examples of viral infetions that can cause acute bronchitis:
flu, adenovirus
Whooping cough;
pertusis, gram negative, ro, exotoxin, highly contageous, usually unvaccinated kids, -4wks, fever, rhinitis, sneezing prodrome, violent cough, vomiting due to GI iritation, dehydration
whooping cough can develop into:
acute bronchitis, exudate in lumen, can infect you
