Exam 2- Neck& Throat pathology pt II Flashcards
what is the carotid body sensitive to?
-CO2, O2, pH & even temperature
what is a paraganglioma? composed of? where do you find it?
- carotid body tumor
- composed of neuroendocrine cells; nests of round chief cells, spindle-shaped stroma, ‘sustentacular cells’
- occur throughout the body: adrenal medulas= pheochromocytomas; paravertebral paragangial= produce catecholamines
what %age of paragangliomas occur outside the adrenals & where do they occur?
70% occur outside adrenals occur in aorticopulmonary chain of head and neck
how many paragangliomas does one usu get and at what age?
- typically singular
- 6th and 7th decades of life
what syndrome can paragangliomas be part of? what happens after resection most the time?
- multiple endocrine neoplasia syndrome type 2 (MEN 2)
- frequently recur after resection & metastasize, about 50% fatal
what is the sign of epiglottitis?
thumbprint sign
what are the 4 D’s that go with epiglottitis?
- dyspnea
- respiratory distress
- drooling
- dysphagia
what other symptoms go with epiglottitis?
- severe sore throat
- high fever
- hoarseness
- tachypnea
- inspiratory stridor
- tend to sit upright, neck lightly extended, motionless
how common is epiglottitis? causes? age?
- rare, severe, rapidly progressive infxn of epiglottis
- h.flu, h. paraflu, RSV, GABHS
- kids 2-5 used to be most susceptible, now seen in older kids and teens in ER
what is laryngitis? causes?
- inflammation of vocal folds
- allergic, viral, bac, chemical (smoke, gastric acid, GERD, bulimia) or mechanical irritiants, vocal abuse
- often result of URI
what are laryngeal polyps? how do they present? who gets them? what’s the difference b/w singer’s nodules & polyps?
- reactive nodules/polyps/singer’s nodules, hoarseness of throat
- common in smokers & those w/vocal strain
- singer’s nodules= bilateral
- polyps= unilateral
what are laryngeal polyps made of? what can happen to them? malignant?
- myxoid CT covered by squamous epithelium
- sessile or pedunculated
- may ulcerate
- may become keratotic, fibrotic or dysplastic
- usu never transform to malignancies
what is laryngotracheobronchitis?
- inflammation and edema of subglottic larynx & trachea
- reduced airway diameter= turbulent airflow= barky cough
what is laryngotracheobronchitis also known as? causes? ages? sxs?
- croup!
- 6 mos- 3 yo
- viral infxns, parainfluenza viruses 1 & 2
- barking spasmodic cough & hoarseness
- minimal to no sxs during day
- typically self-limited
what commonly causes pharyngitis & tonsilitis?
- viruses: adeno, rhino, parainfluenza, EBV, etc
- bac can be cause too: GABHS, n. gonorrhea, chlamydia pneumonia, mycoplasma p., corynebacterium diptheria
resolution of viral pharyngitis? characteristics of adeno, rhino, parainfluenza and bacterial pharyngitis?
- self resolving w/in 2 weeks
- adeno: most common, can cause conjunctivitis, respiratory infxn, gastroenteritis
- rhino: infects nasal respiratory epithelia w/optimal growth temp 91-95, mucosal swelling
- paraflu: HPIV 1 & 2 annual or biennial fall out breaks, HPIV 3 outbreaks in spring/summer
- bac super-infection possible
causes of EBV? sxs? transmission?
- usu EBV but possibly CMV
- sore throat 80% of the time, fever, fatigue, LAD, posterior cervical chain often involved (GABHS will involve anterior chain!)
- reactive atypical lymphocytes (downey cells)
- viral replication in oropharyngeal epithelium
- salivary transmission
- splenic enlargement common
causes of bac pharyngitis?
- most clinically significant: s. pyogenes
- n. gonorrhea, chlamydia, mycoplasma, diphtheriae
complications of bac pharyngitis?
- local suppurative infxns
- rheumatic fever, rheumatic heart dz
- acute glomerulonephritis
what does diphtheria look like? possible negative outcome? prevalence in US?
- gray fibrous membrane over tonsils, pharynx
- removal may cause bleeding
- exotoxin release may cause myocardial & neural tissue damage
- rare in US due to DPT vaccine
what is tonsillitis also known as?
- exudative tonsillitus
- follicular tonsillitis
- pharyngotonsillitis
what is tonsillitis?
- infxn localized to tonsils
- similar to viral & bac etiology as pharyngitis
- possible local suppurative complications
complications of bacterial pharyngitis?
- peritonsillar abscess (quinsy): hot potato voice, pain, palpable, tender mass
- strep, staph, bacteroides
- may lead to cellulitis airway obstruction
where does a peritonsillar abscess form?
b/w palatine tonsil & capsule
ssxs & PE of peritonsillar abscess?
- ssxs: sore throat, fever, h/a, drooling, hot potato voice, neck pain, stiffness, referred pain to ear, trismus
- PE: fever, dehydration, trismus, deviation of uvula, UL swelling of soft palate superior to tonsil, tonsillar hypertrophy, erythema, exudate, cervical LAD
whats the difference b/w retro/parapharyngeal abscess and a peritonsillar abscess?
retro/parapharyngeal abscesses have similar ssxs but location of abscess is deeper in neck= greater potential for airway obstruction
what is acute rheumatic fever?
-acute inflam complication of GAS infxn
as opposed to ARF whcih causes immune-mediated syndrome (synovium, myocardium & heart valve involvement), what does GAS pharyngitis cause?
-strep skin infxns, scarlet fever, TSS
worldwide ARF affects how many people? what age?
nearly 20 million worldwide, leading cause of cardiovascular related death in first five decades of life
what is the pathophys of ARF? age?
- onset follows 2-4 weeks after GAS pharyngitis
- 5-15 yrs of age at 1st episode, rare before 3 yrs or after 21 yrs
