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GI II - Week 1 > DSA Ch. 16 (Dobson) > Flashcards

DSA Ch. 16 (Dobson) Flashcards

1
Q

What are the diseases of teeth and supporting structures that are discussed?

A
    • Caries
    • Gingivitis
    • Periodontitis
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2
Q

These are one of the most common diseases worldwide and a major cause of tooth loss before age 35.

A

Caries (cavity)

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3
Q

What is the main reasons for the production of caries?

A

– Poor oral hygiene

– High-sugar diet (trying to breakdown that much sugar will cause damage to enamel)

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4
Q

What is the bacteria that causes glucan production along with biofilm, resulting in caries?

A

S. mutans

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5
Q

What are other problems that caries can cause?

A

– Pain to the extent it affects activities of daily life

– Weight loss/Nutrition problems because they can’t eat

– Loss of self confidence/esteem

– Potential life-threatening infections due to bacteria getting into bloodstream

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6
Q

This is a sticky, colorless, biofilm that collects between and on the surface of the teeth. It forms as a result of poor oral hygiene.

A

Dental Plaque

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7
Q

In what age group is gingivitis the most prevalent and severe?

A

Adolescence (ranging from 40-60%)

***Also partly due to access to healthcare!

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8
Q

A ________ forms when certain microorganisms (ie, some types of bacteria) adhere to the surface of some object in a moist environment and begin to reproduce. The microorganisms form an attachment to the surface of the object by secreting a slimy, glue-like substance.

A

Biofilm

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9
Q

Explain the cycle of biofilm development, and why it is so dangerous in developing infections.

A

1) Bacteria adhere to the surface (teeth in this case)
2) Formation of monolayer and production of “slime”
3) Microcolony formation, with multi-layering cells
4) Mature biofilm with characteristic “mushroom” formed of polysaccharide
5) Cells start to detach, reverting to individual bacteria.

***Dangerous because these detached bacteria can get into blood vessels and spread to other places of the body, causing infection!

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10
Q

This is an inflammatory process that affects the supporting structures of the teeth (periodontal ligaments) alveolar bone, and cementum.

A

Periodontitis

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11
Q

What are believed to be important in the pathogenesis of periodontitis?

A

Poor oral hygiene with resultant change in oral flora

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12
Q

T/F. Gingivitis and periodontitis cannot be cured, they can only be managed once diagnosed.

A

False. These are reversible diseases!

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13
Q

What are some systemic diseases that periodontitis can present in?

A
    • AIDS
    • Leukemia
    • Crohn Disease
    • Diabetes
    • Down syndrome
    • Sarcoidosis
    • Syndromes associated with defects in neutrophil

***Periodontitis could be primary issue and these systemic diseases can be found as the underlying issue, or it is something else to treat along with the disease.

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14
Q

What are the 3 sources that a brain abscess can develop from?

A

1) Spread of infection from pericranial contiguous focus in 25-50% of cases (such as sinuses, middle ear, or dental infection)
2) Dental infections, ethmoid or frontal sinusitis (usually spreads to frontal lobe)
3) Subacute or chronic otitis media, or mastoiditis (preferentially spreads to the inferior temporal lobe and cerebellum)

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15
Q

This is a very common and often recurrent, exceedingly painful, superficial oral mucosal ulceration of unknown etiology. Especially occurs in <20 yo. Associated with immunologic disorders including celiac disease, IBD, and Behcet disease. Resolve spontaneously in 7-10 days.

A

Aphthous Ulcers (Canker Sores)

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16
Q

What are the fibrous proliferations that are discussed?

A

1) Traumatic fibroma/Irritation fibroma
2) Pyogenic granuloma (pregnancy tumor)
3) Peripheral ossifying fibroma

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17
Q

This fibrous proliferation is a raised mass on the inner buccal mucosa. Often due to things like chewing the inside of the mouth. It is sessile (flat and broad based).

A

Traumatic fibroma/Irritation fibroma

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18
Q

Are traumatic fibromas benign or malignant? Why?

A

Benign, because histologically they are very well circumscribed (characteristic of being benign).

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19
Q

This fibrous proliferation is an inflammatory lesion typically found on the gingiva of children, young adults, and pregnant women. It is red because it’s a vascular lesion, and is soft and spongy.

A

Pyogenic granuloma (pregnancy tumor)

***There is nothing actually pyogenic or granulomatous about it, so the name is bad!

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20
Q

This fibrous proliferation appears as red, ulcerated, and/or nodular lesions of the gingiva. Peak incidence is in young and teenage females. It is hard and bony.

A

Peripheral ossifying fibroma

***Looks just like pregnancy tumor but is hard! Remember the pregnancy tumors are soft.

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21
Q

What is the treatment for peripheral ossifying fibromas?

A

Complete surgical excision down to the periosteum

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22
Q

All fibrous proliferations are (BENIGN/MALIGNANT).

A

Benign

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23
Q

Bony outgrowths, or _________, are incidental findings on routine oral examinations. They are varied in clinical appearance and there are many reasons for the development of them, including genetic and environmental causes. They are generally asymptomatic.

A

Exostoses

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24
Q

Exostoses are localized, benign bony protrusions. The most common oral exostoses are _______ _______ and _______ _______, which do not have cartilage involvement, owing to their anatomical location.

A

Torus palatinus

Torus mandibularis

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25
Q

Microbes can enter the host by breaching epithelial surfaces, inhalation, ingestion, or sexual transmission. In general, respiratory, GI, and GU tract infections in otherwise healthy persons are caused by virulent microorganisms with the ability to damage or penetrate the ________ or ________ epithelium.

A

Epidermis

Mucosal

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26
Q

What are the infections of the oral cavity discussed?

A
    • HSV 1 and 2
    • Candida
    • Deep fungal infections
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27
Q

Most orofacial herpetic infections are caused by _______ but oral _______ (genital herpes) infections do occur.

A

HSV-1

HSV-2

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28
Q

In what age groups do HSV infections primarily occur?

A

Children 2-4 yo (often asymptomatic)

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29
Q

In ______, the vesicles range from lesions of a few millimeters to large bullae and are at first filled with a clear, serous fluid, but rapidly rupture to yield painful, red-rimmed, shallow ulcerations. The vesicles and shallow ulcers usually spontaneously clear within 3-4 weeks.

A

HSV

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30
Q

This test is used to test for HSV. Optimally, fluid from intact vesicle is smeared thinly on a microscope slide, dried, and stained with either Wright or Giemsa stain. Positive if acantholytic keratinocytes or multinucleated giant acantholytic keratinocytes are detected.

A

Tzanck Test

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31
Q

T/F. Tzanck Test for HSV does NOT specify for which type of HSV it is. It only tells you if you have HSV or not.

A

True

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32
Q

This is the most common fungal infection of the oral cavity, and the most frequent cause of human fungal infections. It is a normal component in 50% of the population.

A

Candidiasis

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33
Q

What are the factors that influence clinical infection of Candidiasis?

A
    • Strain of C. albicans
    • Composition of individual oral flora
    • Immune status of the patient
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34
Q

What cell types are important for the protection against Candida infection?

A
    • Neutrophils
    • Macrophages
    • Th17 Cells
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35
Q

This type of oral infection is characterized by a superficial, gray to white inflammatory membrane composed of matted organisms enmeshed in a fibrinosuppurative exudate that can be readily scraped off to reveal an underlying erythematous inflammatory base.

A

Candidiasis

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36
Q

When observing Candida albicans histologically for diagnosis, the presence of __________ is an important diagnostic clue. These are a chain of budding yeast cells joined end to end at constrictions.

A

Pseudohyphae

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37
Q

This type of slide preparation shows pseudohyphae, budding yeast, and human epithelial cells and is the simplest and most rapid diagnostic test in aiding presumptive identification of Candida species.

A

Direct wet mount prepared from white vaginal discharge

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38
Q

What are some conditions associated with a compromised immune state that may predispose a person to Candida infection?

A
    • HIV
    • Diabetes mellitus
    • Broad spectrum antibiotics or steroid inhalers
    • Vaginal yeast infection in a pregnant woman
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39
Q

Certain fungi have a predilection for the oral cavity and head and neck region. The key predisposing factor is…

A

Immunosuppression

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40
Q

What are the fungi discussed that cause oral deep fungal infections?

A
    • Aspergillosis
    • Cryptococcosis
    • Zygomycetes (Mucor, Absidia, Rhizopus)
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41
Q

This type of fungi looks long, thin, and branches. Has segments stuck together (kind of look like individual cardiac muscle with intercalated discs to me).

A

Aspergillus fumigatus

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42
Q

This infectious disease has a fiery red tongue with prominent papillae (raspberry tongue) OR a white-coated tongue through which hyperemic papillae project (strawberry tongue).

A

Scarlet Fever

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43
Q

This infectious disease has spotty enanthema in the oral cavity that often precedes a skin rash. There are ulcerations on the buccal mucosa by the Stensen duct that produces Koplik spots.

A

Measles

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44
Q

This infectious disease consists of acute pharyngitis and tonsillitis that may cause coating with a gray-white exudative membrane. There is also enlargement of LNs in the neck and palatal petechiae.

A

Infectious mononucleosis

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45
Q

This infectious disease has a characteristic dirty white, fibrinosuppurative, tough, inflammatory membrane over the tonsils and retropharynx.

A

Diphtheria

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46
Q

This infectious disease causes a predisposition to opportunistic oral infections, particularly HSV, Candida, and other fungi. There are oral lesions of Kaposi sarcoma and hairy leukoplakia.

A

HIV

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47
Q

This is a distinctive oral lesion on the lateral border of the tongue that is usually seen in immunocompromised patients (common in HIV).

A

Hairy Leukoplakia

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48
Q

What virus causes Hairy Leukoplakia?

A

EBV

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49
Q

Hairy leukoplakia takes the form of white, confluent patches of fluffy (“hairy”), hyperkeratotic thickenings, almost always situated on the lateral border of the tongue that (CAN/CANNOT) be wiped off.

A

Cannot

***Remember, Candida CAN be wiped off!

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50
Q

What can sometimes be superimposed on the surface of the hairy leukoplakia lesions? This adds to the “hairiness.”

A

Candida

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51
Q

In hairy leukoplakia, the distinctive microscopic appearance consists of hyperkeratosis and acanthosis with “________ ________” in the upper spinous layer.

A

Balloon cells

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52
Q

Oral manifestations can occur in this type of systemic disease. It presents as maculopapular, vesiculobullous eruption that sometimes follows an infection elsewhere, ingestion of drugs, development of cancer, or a collagen vascular disease.

A

Erythema multiforme

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53
Q

Erythema multiforme is an acute, self-limited, and sometimes recurring skin condition that is considered to be a type ______ hypersensitivity reaction associated with certain infections, medications, and other various triggers.

A

IV

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54
Q

Erythema multiforme (MAJOR/MINOR) contains typical targets or raised, edematous papule distributed acrally.

A

Minor

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55
Q

Erythema multiforme (MAJOR/MINOR) contains typical targets or raised, edematous papule distributed acrally with involvement of one or more mucous membranes. Epidermal detachment involves less than 10% of total body surface area.

A

Major

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56
Q

Erythema multiforme can develop this disease when there are widespread blisters predominant on the trunk and face, presenting with erythematous or pruritic macules and one or more mucous membrane erosions. Epidermal detachment is <10% or up to 30% or more TBSA.

A

SJS (<10%)
SJS/TEN (10-30%)
TEN (>30%)

  • **SJS = Steven-Johnson Syndrome
  • **TEN = Toxic Epidermal Necrolysis
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57
Q

What is something we have to watch out for clinically with SJS/TEN?

A

Significant fluid loss

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58
Q

In this hematologic disorder, severe oral infections in the form of gingivitis, pharyngitis, and tonsillitis may appear. May extend to produce cellulitis of the neck (Ludwig angina).

A

Pancytopenia (agranulocytosis, aplastic anemia)

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59
Q

In this hematologic disorder, oral lesions may appear like in pancytopenia with the depletion of functioning neutrophils.

A

Leukemia

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60
Q

In this hematologic disorder, there is leukemic infiltration and enlargement of the gingivae, often with accompanying periodontitis.

A

Monocytic leukemia

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61
Q

The common feature of this heterogeneous group of neoplasms is an origin from hematopoietic progenitor cells.

A

Myeloid Neoplasms

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62
Q

Tumors with monocytic differentiation often infiltrate the skin (leukemia cutis) and the ________. This probably reflects the normal tendency of monocytes to extravasate into tissues.

A

Gingiva

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63
Q

This type of oral issue may appear in Addison disease, hemochromatosis, fibrous dysplasia of bone (Albright syndrome), and Peutz-Jeghers syndrome (GI polyposis).

A

Melanotic pigmentation

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64
Q

This presents as a striking fibrous enlargement of the gingivae.

A

Phenytoin (Dilantin) ingestion

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65
Q

This is a genetic disorder in which people develop polyps and dark-colored spots that appear on various parts of the body, and are at greater risk for some types of cancer. Can also present on the inside of the oral cavity.

A

Peutz-Jeghers Syndrome (PJS)

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66
Q

_______ _______ is an overgrowth of gum tissue around the teeth. There are a number of causes for this condition, but it’s often a symptom of poor oral hygiene or a side effect of using certain medications (ie, Dilantin).

A

Gingival hyperplasia

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67
Q

This disease is a rare autosomal dominant disorder that affects blood vessels throughout the body (causing vascular dysplasia) and results in a tendency for bleeding. Often appears with multiple congenital aneurysmal telangiectasias beneath mucosal surfaces of the oral cavity and lips.

A

Osler-Weber-Rendu Disease (OWRD)

***Also called Hereditary Hemorrhagic Telangiectasia (HHT)

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68
Q

OWRD can cause recurrent and severe ________ as the most common presentation. This frequently leads to severe anemia that necessitates transfusion. GI bleeding is also prevalent.

A

Epistaxis

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69
Q

Dental _______ is caused by focal demineralization of tooth structure (enamel and dentin) by acidic metabolites of fermenting sugars that are produced by bacteria.

A

Caries

70
Q

The rate of caries has markedly dropped in countries such as the United States, where improved oral hygiene has improved and _________ of the drinking water is widespread.

A

Fluoridation

71
Q

________ is incorporated into the crystalline structure of enamel, forming ________, which contributes to the resistance to degradation by bacterial acids.

A

Fluoride

Fluoroapatite

72
Q

What other clinical symptoms can present with HSV?

A

Lymphadenopathy
Fever
Anorexia
Irritability

73
Q

What are the 3 major clinical forms of oral candidiasis?

A

Pseudomembranous
Erythematous
Hyperplastic

74
Q

The _________ form of oral candidiasis is the most common and is also known as thrush.

A

Pseudomembranous

75
Q

Epithelial-lined cysts are quite common in the jaws. This is an important lesion that must be differentiated from other odontogenic cysts because of its aggressive behavior.

A

Multiocular Keratocystic Odontogenic Tumor (OKC)

76
Q

OKCs can be seen at any age but are most often diagnosed in patients between ages ______ and ______.

A

10 and 40

77
Q

OKCs occur most commonly in males within the…

A

Posterior mandible

78
Q

95% of head and neck cancers are…

A

SCCs

79
Q

Head and neck SCC (HNSCC) is the _______ most common neoplasm in the world (approximately 650k cases).

A

6th

80
Q

What are the 5 main causes of cancerous lesions of the oral cavity?

A

1) HPV (leading cause)
2) Tobacco and alcohol
3) Betel quid and paan (India/Asia)
4) Actinic radiation (sunlight)
5) Unknown cause

81
Q

Betel quid is a combination of betel leaf, areca nut, and slaked lime. In many countries, tobacco is also added, and the product is known as…

A

Gutka (ghutka or gutkha)

82
Q

What are known predisposing influences for cancer of the lower lip?

A
    • Actinic radiation (sunlight)

- - Pipe smoking

83
Q

The incidence of oral cavity SCC (particularly the tongue) in individuals younger than age ______, who have no known risk factors, has been on the rise. The pathogenesis in this group of patients, who are nonsmokers and not infected with HPV, is unknown.

A

40

84
Q

In the oropharynx, as many as 70% of SCCs, particularly those involving the tonsils, the base of the tongue, and the pharynx, harbor oncogenic variants of ______, particularly _______.

A

HPV

HPV-16

85
Q

What are the 2 types of HPV that are high-risk for oropharyngeal cancers?

A

HPV-16

HPV-18

86
Q

What category of people (ethnicity and age group) are at the most of risk of developing oropharyngeal SCC due to HPV?

A

White, non-smoking males age 35-55

87
Q

It is predicted that by the year 2020, the incidence of HPV-associated head and neck SCC will surpass that of ________ cancer.

A

Cervical

88
Q

In the head and neck, HPV demonstrates tropism for lymphoid-associated structure of the oropharynx, including the…

A

Palatine and Lingual Tonsils

89
Q

In the oropharynx, HPV gains access to basal keratinocyte progenitors through fenestrations in the reticulated epithelium of the…

A

Tonsillar crypts

90
Q

Infection of the ________ epithelium result aberrant basal cell differentiation, dysplasia, carcinoma in situ, and finally invasive carcinoma (due to HPV).

A

Tonsillar

91
Q

What are the steps to reach invasive carcinoma due to HPV?

A

1) Infection of tonsillar crypt epithelium
2) Aberrant basal stem cell differentiation
3) Dysplasia
4) Carcinoma in situ
5) Invasive carcinoma

92
Q

The oncogenic potential of HPV can largely be explained by the activities of the two viral genes encoding ______ and ______. This leads to inactivation of the ______ and ______ pathways.

A

E6
E7
p53
RB

93
Q

HPV E6 inhibits ______.

A

p53

94
Q

HPV E7 inhibits ______ and ______.

A

p21

RB-E2F

95
Q

Inhibition of p21 (due to HPV E7) leads to increased _______, which will also inhibit RB-E2F.

A

CDK4/Cyclin D

96
Q

T/F. In cancers, the HPV genome is integrated into the host genome, suggesting that integration of viral DNA is important for malignant transformation.

A

True

97
Q

This is a tumor suppressor protein encoded by CDKN2A gene.

A

p16

98
Q

Overexpression of ______, a cell cycle inhibitor, has been postulated as a surrogate marker for HR-HPV, since it is aberrantly over expressed in such lesions, especially in HR-HPV-positive OPSCC.

A

p16

99
Q

Patients with HPV-positive SCC have (LOWER/GREATER) long-term survival than those with HPV-negative tumors.

A

Greater

100
Q

What are some non-specific symptoms of HNSCC that a patient can present with?

A
    • Sore throat
    • Ear ache
    • Pain on swallowing (odynophagia)
    • Weight loss
101
Q

HNSCC can also present as a metastatic tumor in a…

A

Lymph node

102
Q

Deep sequencing of the classic SCC subset has revealed a large number of genetic alterations that bear a molecular signature consistent with ________ _______ induced cancers (DNA adducts).

A

Tobacco carcinogen

103
Q

The development of classic _______ is driven by the accumulation of mutations and epigenetic changes that alter the expression and function of oncogenes and tumor suppressor genes, leading to acquisition of cancer hallmarks such as resistance to cell death, increased proliferation, induction of angiogenesis, and the ability to invade and metastasize.

A

SCC

104
Q

Mutations that result in classic oral SCC frequently involve the _______ pathways as well as proteins responsible for the regulation of squamous differentiation, such as ______ and _______.

A

p53
p63
NOTCH1

105
Q

With loss of _______ function, DNA damage goes unrepaired, driver mutations accumulate in oncogenes and other cancer genes, and the cell marches blindly along a dangerous path leading to malignant transformation.

A

p53

106
Q

What is the possible location for classic oral SCC (not HPV)?

A
    • Ventral tongue
    • Floor of mouth
    • Lower lip
    • Soft palate
    • Gingiva
107
Q

Where is it especially important to check for classic oral SCC in elderly people?

A

Look under dentures!!!

if they have them obvi

108
Q

The “classic” malignancies are typically preceded by the presence of premalignant lesions that can be very heterogenous in presentation. Do HPV type SCC have similar premalignant lesions?

A

No, HPV type SCC do not have premalignant lesions.

109
Q

Survival is dependent on a number of factors including the specific etiology of SCC. The early detection of ________ ________ is critical for the long-term survival of these patients.

A

Premalignant lesions

110
Q

This is a white patch or plaque that cannot be scraped off and cannot be characterized clinically or pathologically with any other disease. 3% of the worlds population have these lesions, and up to 25% are precancerous!

A

Leukoplakia

111
Q

Until proven otherwise, leukoplakias must be considered…

A

Precancerous

112
Q

This is a red, velvety, possibly eroded area within the oral cavity that usually remains level with or may be slightly depressed in relation to the surrounding mucosa.

A

Erythroplakia

113
Q

Erythroplakia is less common (than leukoplakia) but is more ominous because it is almost always associated with severe…

A

Dysplasia/CIS

114
Q

What is common cause of leukoplakia and erythroplakia?

A

Tobacco use

115
Q

________ is a term that literally means “disordered growth”. It is encountered principally in epithelia and is characterized by a constellation of changes that include a loss in the uniformity of the individual cells as well as a loss in their architectural orientation.

A

Dysplasia

116
Q

SCCs range from well-differentiated keratinizing neoplasms to anaplastic, sometimes sarcomatoid, tumors, and from slowly to rapidly growing lesions. However, the degree of histologic differentiation, as determined by the relative degree of ________, is not correlated with behavior.

A

Keratinization

117
Q

95% of cancers of the head and neck are SCC, with the remainder consisting of…

A

Adenocarcinomas of salivary gland origin

118
Q

________ is a protein required for progression through the G1 phase of the cell cycle. During the G1 phase, it is synthesized rapidly and accumulates in the nucleus, and is degraded as the cell enters the S phase. It is a regulatory subunit of CDK4 and CDK6. Seen in higher amounts with SCC and leukoplakia.

A

Cyclin D1

119
Q

_______ gene provides instruction for making a protein called tumor protein ________. This protein functions as a transcription factor, which means it attaches to certain regions of DNA and controls the activity of particular genes. It is seen in high amounts 100% of the time in SCC and leukoplakia.

A

TP63

p63

120
Q

The 5-year survival rate of “classic” (smoking and alcohol related) early-stage SCC is approximately _______, while survival drops to _______ for late-stage disease.

A

80%

20%

121
Q

Frequent development of multiple ________ tumors markedly decreases survival.

A

Primary

122
Q

The rate of second primary tumors of the oral cavity has been reported to be _______ per year, which is higher than for any other malignancy.

A

3-7%

***Due to theory of field cancerization!

123
Q

What is the theory of field cancerization?

A

Theory is that multiple independent primary tumors develop as the result of years of chronic exposure of the mucosa to carcinogens (ie, smoking).

124
Q

The 5-year survival rate for the first primary tumor is considerably better than 50%, but in such individuals, what are the most common cause of death?

A

Second primary tumors

125
Q

There are 3 major salivary glands, _______, _______, and _______, as well as innumerable minor salivary glands distributed throughout the mucosa of the oral cavity. Inflammatory or neoplastic disease may develop within any of these.

A

Parotid
Submandibular
Sublingual

126
Q

Parotid gland secretes what enzyme?

A

Salivary amylase

127
Q

Submucosa layer of the tongue secretes what enzyme?

A

Lingual lipase

128
Q

The major function of the salivary glands is the production of ________.

A

Saliva

129
Q

Lack of saliva causes “dry mouth” or ________.

A

Xerostomia

130
Q

Saliva plays a critical role in what things?

A
    • Digestion (ptyalin/salivary amylase)
    • Lubrication (mucus) for swallowing
    • Protection (IgA, lactoferrin, lysozyme)
131
Q

The incidence of Xerostomia is as high as 20% of patients at what age?

A

> 70 yo

132
Q

What are the most common etiologies of Xerostomia?

A
    • Most frequently due to medications
    • Major feature of Sjogren syndrome
    • Radiation therapy
133
Q

The presence of Xerostomia in _______ also suggests the disease may involve hypo functioning of the parasympathetic nervous system. Many OMT treatments target the PNS in order to normalize activity.

A

BMS (Burning Mouth Syndrome)

134
Q

This is the term for inflammation in the salivary gland.

A

Sialadenitis

135
Q

What are the most common etiologies of sialadenitis?

A

1) Trauma – mucocele and ranula
2) Autoimmune disease – Sjogren syndrome
3) Viral – mumps most common viral cause
4) Bacterial – Staph aureus/Strep viridans (secondary to stone)

136
Q

________ result from blockage or rupture of a salivary gland duct, with a consequent leakage of saliva into surrounding CT stroma. Most common type of inflammatory salivary gland lesion.

A

Mucocele

***Caused by trauma!

137
Q

_______ is a term reserved for epithelial-lined cysts that arise when the duct of the sublingual gland has been damaged. It may become so large that it develops into a “plunging _______”, a colorful description of a cyst that has dissected through the connective tissue stroma connecting the two bellies of the mylohyoid muscle.

A

Ranula
Ranula

***Caused by trauma!

138
Q

What is the term for a stone within a salivary gland?

A

Sialolithiasis

139
Q

Mucoceles can occur at all ages but are most common in…

A

Toddlers
Young Adults
Elderly (who are more prone to falling)

140
Q

What is the best treatment for mucoceles?

A

Complete excision

141
Q

This is a symptom of Sjogren syndrome that produces blurring of vision, burning, itching, and thick secretions that accumulate in the conjunctival sac.

A

Keratoconjunctivitis

142
Q

This is a symptom of Sjogren syndrome that results in difficulty in swallowing solid foods, a decrease in the ability to taste, cracks and fissures in the mouth, and dryness of the buccal mucosa.

A

Xerostomia

143
Q

In Sjogren syndrome, half the patients have enlargement of what gland?

A

Parotid gland

144
Q

In Sjogren syndrome, 1/3 of the patients manifest extragrandular diseases, including…

A
    • Synovitis
    • Diffuse pulmonary fibrosis
    • Peripheral neuropathy
145
Q

What is essential for the diagnosis of Sjogren syndrome?

A

Biopsy of the lip (to examine minor salivary glands)

146
Q

About 5% of Sjogren patients develop ________, an incidence that is 40-fold greater than normal.

A

Lymphoma

147
Q

Among all vaccines given to children, the 3 most often refused or requested on an alternate schedule are…

A
    • HPV
    • Influenza
    • MMR
148
Q

Last year, survey respondents identified the _______ vaccine (52%) as most often refused or given on an alternate schedule, compared with this year at 37%. This shows uptake has increased.

A

MMR

149
Q

Overall, salivary gland neoplasms are relatively uncommon and represent less than ______ of all tumors in humans.

A

2%

150
Q

Salivary gland tumors usually occur in adults, with a slight female predominance, but about ______ occur in children younger than age 16.

A

5%

151
Q

In salivary gland neoplasms, the benign tumors most often appear in the ______ to ______ decades of life. The malignant ones tend to appear somewhat later.

A

5th

7th

152
Q

What are the benign salivary gland neoplasms discussed?

A
    • Pleomorphic adenoma (50%)

- - Warthin tumor (5-10%)

153
Q

What are the malignant salivary gland neoplasms discussed?

A
    • Mucoepidermoid carcinoma (15%)

- - Adenoid cystic carcinoma

154
Q

The likelihood of a salivary gland tumor being malignant is more or less (DIRECTLY/INVERSELY) proportional to the size of the gland.

A

Inversely

***ie, parotid gland is large so it has lower chance of malignancy!

155
Q

In most benign and malignant neoplasms, all of the parenchymal cells closely resemble one another. Infrequently, however, divergent differentiation of a single neoplastic clone creates a _______ _______.

A

Mixed tumor

156
Q

This is a type of mixed tumor that consists of a mix of ductal (epithelial) cells and myoepithelial cells. It presents as well-demarcated masses of varying size and can recur if not completely excised.

A

Pleomorphic Adenoma

157
Q

Pleomorphic adenomas are benign, but malignancy can arise when?

A

The longer they remain untreated (aggressive tumors)

158
Q

What gene rearrangement causes transcription factor over expression, resulting in Pleomorphic Adenomas?

A

PLAG1

159
Q

This type of benign salivary tumor occurs almost exclusively in the parotid. More frequent in males than females.

A

Warthin Tumor (Papillary Cystadenoma Lymphomatosum)

160
Q

Warthin tumors are ______ multifocal, and ______ bilateral.

A

10%

10%

161
Q

What group of people have an 8x increased risk of getting a Warthin tumor?

A

Smokers

162
Q

This is the most common primary malignancy of all salivary glands, and occurs in 15% of all salivary gland tumors. There are variable mixtures of squamous cells, mucus-secreting cells, and intermediate cells.

A

Mucoepidermoid carcinoma

163
Q

Mucoepidermoid carcinoma occurs 60-70% in the ________ but also in minor salivary glands.

A

Parotid

164
Q

Mucoepidermoid carcinoma occurs due to a balanced chromosomal translocation _______, which produces a fusion gene product _________. This gene product perturbs NOTCH and cAMP signaling pathways.

A

11:19 (q21;p13)

MECT1 - MAML2

165
Q

Prognosis of Mucoepidermoid carcinoma is dependent on ________, which is a description of a tumor based on how abnormal the cancer cells and tissue look under a microscope and how quickly the cancer cells are likely t grow and spread.

A

Grade

166
Q

This is a type of salivary gland malignancy that is relatively uncommon (5%). It is slow growing but unpredictable.

A

Adenoid Cystic Carcinoma

167
Q

Adenoid Cystic Carcinoma occurs 50% in the minor salivary glands (palatine glands) which gives a (POOR/GOOD) prognosis.

A

Poor

168
Q

50% of Adenoid cystic carcinomas will disseminate to the bone, liver, brain, etc. decades after what?

A

Primary tumor removal

169
Q

Why are Adenoid Cystic Carcinomas often painful?

A

They often grow along nerves (perineural)

170
Q

This is the term for the inflammation of the oral mucosa surrounding the teeth, caused by accumulation of dental plaque and calculus due to poor oral hygiene.

A

Gingivitis

GI II - Week 1 (4 decks)

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