Exam 2- Neck& Throat pathology pt II

Question 1

what is the carotid body sensitive to?

Answer 1

-CO2, O2, pH & even temperature

Question 2

what is a paraganglioma? composed of? where do you find it?

Answer 2

• 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

Question 3

what %age of paragangliomas occur outside the adrenals & where do they occur?

Answer 3

70% occur outside adrenals occur in aorticopulmonary chain of head and neck

Question 4

how many paragangliomas does one usu get and at what age?

Answer 4

• typically singular

- 6th and 7th decades of life

Question 5

what syndrome can paragangliomas be part of? what happens after resection most the time?

Answer 5

• multiple endocrine neoplasia syndrome type 2 (MEN 2)

- frequently recur after resection & metastasize, about 50% fatal

Question 6

what is the sign of epiglottitis?

Answer 6

thumbprint sign

Question 7

what are the 4 D’s that go with epiglottitis?

Answer 7

• dyspnea
• respiratory distress
• drooling
• dysphagia

Question 8

what other symptoms go with epiglottitis?

Answer 8

• severe sore throat
• high fever
• hoarseness
• tachypnea
• inspiratory stridor
• tend to sit upright, neck lightly extended, motionless

Question 9

how common is epiglottitis? causes? age?

Answer 9

• 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

Question 10

what is laryngitis? causes?

Answer 10

• inflammation of vocal folds
• allergic, viral, bac, chemical (smoke, gastric acid, GERD, bulimia) or mechanical irritiants, vocal abuse
• often result of URI

Question 11

what are laryngeal polyps? how do they present? who gets them? what’s the difference b/w singer’s nodules & polyps?

Answer 11

• reactive nodules/polyps/singer’s nodules, hoarseness of throat
• common in smokers & those w/vocal strain
• singer’s nodules= bilateral
• polyps= unilateral

Question 12

what are laryngeal polyps made of? what can happen to them? malignant?

Answer 12

• myxoid CT covered by squamous epithelium
• sessile or pedunculated
• may ulcerate
• may become keratotic, fibrotic or dysplastic
• usu never transform to malignancies

Question 13

what is laryngotracheobronchitis?

Answer 13

• inflammation and edema of subglottic larynx & trachea

- reduced airway diameter= turbulent airflow= barky cough

Question 14

what is laryngotracheobronchitis also known as? causes? ages? sxs?

Answer 14

• croup!
• 6 mos- 3 yo
• viral infxns, parainfluenza viruses 1 & 2
• barking spasmodic cough & hoarseness
• minimal to no sxs during day
• typically self-limited

Question 15

what commonly causes pharyngitis & tonsilitis?

Answer 15

• viruses: adeno, rhino, parainfluenza, EBV, etc

- bac can be cause too: GABHS, n. gonorrhea, chlamydia pneumonia, mycoplasma p., corynebacterium diptheria

Question 16

resolution of viral pharyngitis? characteristics of adeno, rhino, parainfluenza and bacterial pharyngitis?

Answer 16

• 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

Question 17

causes of EBV? sxs? transmission?

Answer 17

• 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

Question 18

causes of bac pharyngitis?

Answer 18

• most clinically significant: s. pyogenes

- n. gonorrhea, chlamydia, mycoplasma, diphtheriae

Question 19

complications of bac pharyngitis?

Answer 19

• local suppurative infxns
• rheumatic fever, rheumatic heart dz
• acute glomerulonephritis

Question 20

what does diphtheria look like? possible negative outcome? prevalence in US?

Answer 20

• 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

Question 21

what is tonsillitis also known as?

Answer 21

• exudative tonsillitus
• follicular tonsillitis
• pharyngotonsillitis

Question 22

what is tonsillitis?

Answer 22

• infxn localized to tonsils
• similar to viral & bac etiology as pharyngitis
• possible local suppurative complications

Question 23

complications of bacterial pharyngitis?

Answer 23

• peritonsillar abscess (quinsy): hot potato voice, pain, palpable, tender mass
• strep, staph, bacteroides
• may lead to cellulitis airway obstruction

Question 24

where does a peritonsillar abscess form?

Answer 24

b/w palatine tonsil & capsule

Question 25

ssxs & PE of peritonsillar abscess?

Answer 25

• 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

Question 26

whats the difference b/w retro/parapharyngeal abscess and a peritonsillar abscess?

Answer 26

retro/parapharyngeal abscesses have similar ssxs but location of abscess is deeper in neck= greater potential for airway obstruction

Question 27

what is acute rheumatic fever?

Answer 27

-acute inflam complication of GAS infxn

Question 28

as opposed to ARF whcih causes immune-mediated syndrome (synovium, myocardium & heart valve involvement), what does GAS pharyngitis cause?

Answer 28

-strep skin infxns, scarlet fever, TSS

Question 29

worldwide ARF affects how many people? what age?

Answer 29

nearly 20 million worldwide, leading cause of cardiovascular related death in first five decades of life

Question 30

what is the pathophys of ARF? age?

Answer 30

• onset follows 2-4 weeks after GAS pharyngitis

- 5-15 yrs of age at 1st episode, rare before 3 yrs or after 21 yrs