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Pathology > Chapter 16- Head And Neck > Flashcards

Chapter 16- Head And Neck Flashcards

1
Q

What causes oral caries?

A

Demineralization of tooth structure due to acidic metabolites of fermenting sugars from bacteria

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2
Q

What is another name for caries?

A

Cavities

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3
Q

What is gingivitis?

A

Inflammation of the oral mucosa surrounding teeth

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4
Q

What is periodontitis?

A

Inflammation that affects the supporting structures of the teeth, alveolar bone and cementum

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5
Q

What is periodontitis associated with?

A

Shifts in bacteria types and poor oral hygiene

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6
Q

Periodontitis can be the origin of what important systemic diseases?

A

Infective endocarditis

Pulmonary and brain abscesses

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7
Q

What inflammatory/reactive lesions are common in the oral cavity?

A

Apthous ulcer/canker sore

Irritation/traumatic fibroma

Pyogenic granuloma

Peripheral ossifying fibromas

Glossitis

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8
Q

What kind of lesion is a canker sore?

A

Superficial oral ulceration

Hyperaemic, thin exudate layer, zone of erythema

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9
Q

What do irritation fibromas occur?

A

Along the bite line

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10
Q

What patients are pyogenic granulomas commonly found in?

A

Pregnant women and children

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11
Q

What can peripheral ossifying fibromas arise from?

A

Pyogenic granulomas

Cells of the periodontal ligament

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12
Q

Why are infections in the oral cavity normally resisted?

A

Normal oral flora outcompetes pathogens

High IgA levels

Saliva

Dilution (food and drink)

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13
Q

What infections are seen in the oral cavity?

A

Herpes simplex virus

Oral candidiasis

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14
Q

What form of herpes simplex is most common found in the oral cavity?

A

HSV-1

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15
Q

What are the characteristics of oral HSV infections?

A

Vesicle with serious fluid that rupture causing shallow ulcerations

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16
Q

What test is performed to diagnose HSV-1?

A

Tzanck test (look for multinucleate polykaryons)

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17
Q

What is another name for oral candidiasis?

A

Thrush

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18
Q

What patients does thrush affect?

A

Immunocompromised

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19
Q

What is the most common form of thrush and what are the characteristics?

A

Pseudomembranous

Superficial, grey-white membrane composed of suppurative exudates (contain fungus)

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20
Q

What are the three forms of oral candidiasis?

A
  1. Membranous
  2. Erythematous
  3. Hyperplastic
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21
Q

What systemic diseases show early oral manifestations and what are they?

A

EBV- hairy leukoplakia (lateral tongue lesion with white hyperkeratotic thickenings)

Scarlet fever- red or white tongue with papillae

Measles- spotty enanthema, ulcerations cause Koplik spots

Mono- acute pharyngitis and tonsillitis, grey-white membrane

Diphtheria- inflammatory membrane over tonsils and retropharynx

HIV- oral infections, Kaposi lesions, hairy leukoplakia

Lichen planus- keratotic lesions

Pemphigus- hyperaemic erosions from ruptured vesicles

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22
Q

What precancerous lesions are seen in the oral cavity?

A

Leukoplakia- white plaque

Erythroplakia- red, velvety, flat lesion

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23
Q

Which precancerous lesion shows a higher risk of transformation in the oral mucosa?

A

Erythroplakia

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24
Q

What cancer makes up 95% of head and neck cancers?

A

Squamous cell carcinoma

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25
Q

What increases the risk of developing SCC in the oral cavity?

A

Smoking

Alcohol

Betel nut and paan chewing

Sunlight

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26
Q

Half of all SCCs in the oral cavity harbour what infection?

A

HPV 16

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27
Q

What are the characteristics of early and late SCC in the oral cavity?

A

Early- raised, firm, pearly plaques or irregular, roughened/verrucous areas

Late- ulcerated and protruding masses with irregular and indurated borders

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28
Q

Where are odontogenic cysts found?

A

In the mandible and maxilla

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29
Q

What are odontogenic cysts derived from?

A

Odontogenic remnants

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30
Q

What forms of odontogenic cysts are there? What are their locations? What type of epithelium lines them?

A

Dentigerous- near crowns of unerupted teeth, stratified squamous epithelium

Odontogenic keratocysts- posterior mandible males), parakeratinized stratified squamous epithelium

Periapical- at tooth apices from long standing pulpitis

31
Q

What type of odontogenic cyst is potentially aggressive?

A

Odontogenic keratocysts

32
Q

What are the two forms of odontogenic tumours?

A
  1. Ameloblastoma

2. Odontoma

33
Q

What type of odontogenic tumour is most common?

A

Odontoma

34
Q

What disorders are associated with the nose?

A

Infectious rhinitis

Allergic rhinitis

Nasal polyps

Chronic rhinitis

Sinusitis

Necrotizing lesions

35
Q

What type of immune reaction causes allergic rhinitis?

A

IgE mediated (type I hypersensitivity)

36
Q

What are the characteristics of nasal polyps?

A

Seen with recurrent rhinitis

Edematous mucosa infiltrated by neutrophils, eosinophils and plasma cells

37
Q

What are the common causes of sinusitis?

A

Preceded by rhinitis

Extension of a periapical tooth infection

38
Q

What can nasal necrotizing lesions be caused by?

A

Acute fungal infections

Wegener granulomatosis (autoimmune blood vessel inflammation)

Lethal midline granuloma (lymphoma of NK cells infected with EBV)

39
Q

What is Wegener granulomatosis now called?

A

Granulomatosis with polyangitis (GPA)

40
Q

What are two common upper respiratory tract infections?

A
  1. Pharyngitis

2. Tonsillitis

41
Q

How does follicular tonsillitis differ from normal tonsillitis?

A

Normal- enlarged, covered by exudate

Follicular- dotted by pinpoints of exudate from crypts

42
Q

What are the most common tumours of the nose, sinuses and nasopharynx?

A

Nasopharyngeal angiofibroma- benign, vascularized, adolescent boys

Sinonasal (Schneiderian) papilloma- benign squamous or columnar epithelial

Olfactory neuroblastoma- highly malignant tumour of the neuroectodermal olfactory cells

Nasopharyngeal carcinoma- close relationship to lymphoid tissue and associated with EBV

43
Q

What form of sinonasal papilloma is locally aggressive?

A

Inverted papilloma

44
Q

What are the different types of nasopharyngeal carcinoma?

A

Keratinizing vs nonkeratinizing squamous cell

Undifferentiated with lymphocytic infiltrates

45
Q

What disorders are associated with the larynx?

A

Laryngitis

Reactive nodules

Squamous papilloma and papillomatosis

Carcinoma

46
Q

What bacterial infection can cause life threatening laryngitis?

A

H. influenzae

47
Q

How do reactive nodules differ between smokers and singers?

A

Smokers- unilateral due to transformation

Singers- bilateral

48
Q

What are the characteristics of squamous papilloma?

A

1cm benign squamous epithelial lined lesions on true vocal cords

49
Q

What is the difference between juvenile and adult squamous papilloma?

A

Juvenile- multiple lesions that can spontaneously regress

Adult- multiple recurring lesions caused by HPV 6 and 11

50
Q

What are the characteristics of laryngeal carcinoma?

A

Squamous cell carcinoma

On vocal cords primarily

Intrinsic- larynx proper

Extrinsic- extends/occurs outside the larynx

51
Q

What is otosclerosis?

A

Abnormal bone deposition in the middle ear about the rim of the oval window

52
Q

What are the most common aural disorders?

A

Otitis

Symptomatic otosclerosis

Polyps

Labrynthitis

Carcinomas

Paragangliomas

53
Q

What type of ear infection is cholesteatoma associated with?

A

Chronic otitis media

54
Q

What are the characteristics of branchia cysts?

A

Benign lesions with fibrous walls lined by stratified squamous or psuedostratified columnar epithelium with lymphocytic infiltrates

On anterolateralneck

55
Q

What are the characteristics of thyroglobulin cysts?

A

Lined by stratified squamous or pseudostratified columnar epithelium

Walls can have lymphoid or thyroid tissue

On midline

56
Q

What are the characteristics of paragangliomas?

A

Carotid body tumour

Nests of neuroendocrine cells enclosed by fibrous trabecular and elongated sustentacular cells

Bifurcation of the carotid

57
Q

What are the nests of neuroendocrine cells in paragangliomas called?

A

Zellballen

58
Q

What is the difference between sporadic and familial forms of paragangliomas?

A

Sporadic- single

MENII- multiple

59
Q

Here do 70% of extra-adrenal paragangliomas occur?

A

Head and neck

60
Q

What are the major salivary glands and what type of glands are they?

A

Parotid- serous

Submandibular- mucous

Sublingual- mucous

61
Q

What disorders affect salivary glands?

A

Xerostomia (dry mouth)

Sialadentitis (inflammation)

Mucocele (mucin cyst)

Sialolithiasis (stone formation)

Neoplasms

62
Q

Xerostomia is a common feature of what?

A

Autoimmune disorders

Drug side affect

63
Q

What is the most common salivary gland lesion?

A

Mucocele

64
Q

A ranula is a mucocele from which gland?

A

Salivary

65
Q

Risk of malignancy of salivary neoplasms increases as gland size increases or decreases?

A

Decreases

66
Q

What neoplasms occur in the salivary glands?

A

Pleomorphic adenoma

Warthin tumour

Mucoepidermoid carcinoma

Adenoid cystic carcinoma

Acinic cell carcinoma

67
Q

What are the characteristics of pleomorphic adenoma?

A

Benign

Epithelial and mesenchymal elements (epithelial nests in matrix)

10% undergo malignant transformation

60% of all parotid tumours

68
Q

What are the characteristics of Warthin tumours?

A

Almost exclusively parotid

Mutinous or serous cysts

Columnar cell’s with eosinophilic cytoplasm and lymphoid stroma

69
Q

What are the characteristics of mucoepidermoid carcinomas?

A

Mixture of squamous and mucous secreting cells

Infiltrative

70
Q

What stain can be used to visualize mucins in mucoepidermal carcinomas?

A

Mucicarmine

71
Q

What is the most common primary malignant tumour of salivary glands?

A

Mucoepidermoid carcinoma

72
Q

What are the characteristics of adenoid cystic carcinoma?

A

Small cells with scant cytoplasm in cribriform pattern

Secrete excess basement membrane

Perineural invasion

73
Q

What are the characteristics of acinic cell carcinoma?

A

Most common in parotid

Resemble serous acinar cells

Form sheets or microcystic, glandular, follicular or papillary patterns

Pathology (25 decks)

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