Exam 2- Upper airway, nasal, sinuses, neck & ear Flashcards
what are 3 pathologies that can occur in the neck?
- brachial cyst
- thyroglossal cyst
- paraganglioma (carotid body tumor)
what are 2 types of cyst and a rare tumor we care about?
- inflammatory cyst (radicular most common)
- developmental cysts (dentigerous most common developmental cyst & surgical specimen)
- malignant tumors of odontogenic origin (rare)
what are the two etiologies of cysts? where do they come from?
-developmental (abnormal development)
-inflammatory
both arise from remnants of odontogenic epithelium
what can a dentigerous cyst give rise to?
ameloblastoma (malignant)
what are the “tumors” of the nose/sinus/nasopharynx?
- polyps (not really a tumor, VAST MAJORITY)
- angiofibroma
- papilloma
- plasmacytoma
- neuroblastoma
- nasopharyngeal carcinoma
what causes rhinitis and sinusitis?
- very often allergic (swab & find eosinophils) or URI (viral in general)
- any organism can cause it though
what causes allergic rhinitis? what Ig? sxs?
- sensitivity rxns
- plants, pollens, fungi, animal allergens & dust mites
- IgE mediated/type I hypersensitivity
- mucosal edema, redness, thick mucus secretions and pale turbinates
- leukocytic infiltration (eosinophils)
what causes infectious rhinitis? sxs? what can ensue? where can it go to?
- usu viral: adenoviruses, echoviruses & rhinoviruses
- acute: edematous, thickened nasal mucosa, enlarged turbinates & narrowed nasal cavities
- secondary bacterial infxn can ensue
- changes may extend into pharynx producing concomitant pharyngotonsilitis
what causes chronic rhinitis? what immune cells are present?
- repeated acute rhinitis: allergic or infectious followed by secondary or superimposed microbial infxn
- inflammatory infiltrates with PMNs, plasma cells & lymphocytes
what can predispose one to chronic rhinitis? causes?
- deviated nasal septum or nasal polyps predispose
- recurrent rhinitis or spontaneously occur
what are nasal polyps?
-edematous mucous w/loose stroma often w/cystic or hyperplastic mucous glands
what should be ruled out in a young caucasian with large polyps?
cystic fibrosis
are most pts with polyps atopic?
no most with polyps are not atopic, though there is allergic etiology it is not atopically associated
what is Samter triad or ASA triad?
aspirin intolerance + bronchial asthma + ethmoid polypi
*salicylates can provoke life-threatening status asthmaticus in these pts
what usu causes infectious sinusitis?
viruses! but can be bac or fungal too and sometimes an extension of periapical dental infxn
complete obstruction of sinuses can lead to what?
empyema or if w/o infxn can lead to mucocele
what are the 3 categories sinusitis can be subdivided into?
- acute: sxs <4 wks
- subacute: sxs 4-12 wks in duration
- chronic: sxs present for 12 or more wks
what would make you think a sinusitis is bacterial?
- sxs persist beyond 7 to 14 d
- increase in severity, esp after period of convalescence
- when fever has been present (but absence of fever doesn’t rule out bac cause)
what causes chronic sinusitis?
- recurrent acute sinusitis
- abn sinus drainage
- mixed microbial of oral cavity
fungal sinusitis caused by mucormycosis occurs in who?
more common in immunocompromised including diabetics
what are complications of sinusitis?
may spread to adjacent tissue: eye, soft tissues around eye, facial bone, cranial vault as well as septic thrombophlebitis of dural venous system
what is kartagener syndrome?
- genetic ciliary dyskinesia
- autosomal recessive
- chronic sinusitis
- bronchiectasis
- situs inversus
what are two very serious (potentially and often fatal aggressive) granulomatous proliferations of the upper airway?
- Wegener granulomatosis
- Lethal midline granuloma (thought to be malignant tumor of NK cells)
- often hard to distinguish from one another
what are 3 necrotizing lesions of the upper airways?
- acute fungal infxns: immunocompromised
- Wegener granulomatosis: necrotizing gingival ulcerations
- NK cell lymphoma: lethal midline granuloma/polymorphic reticulosis, NK cells infected w/EBV, rapidly fatal
do tumors of the nose, sinuses & nasopharynx occur frequently or infrequently? what are the 5 types?
infrequently but can include entire category of mesenchymal & epithelial neoplasms
- nasopharyngeal angiofibroma
- sinonasal papillomas
- plasmacytomas
- olfactory neuroblastomas
- nasopharyngeal carcinomas
what are nasopharyngeal carcinomas characterized by?
- distinctive geographic distribution
- close anatomic relationship to lymphoid tissue
- association w/EBV infxn
what are the 3 patterns of nose, sinus or nasopharyngeal tumors?
can present as…
- keratinizing squamous cell carcinomas
- nonkeratinizing squamous cell carcinomas
- undifferentiated carcinomas that have an abundant non-neoplastic lymphocytic infiltrate
what are nasopharyngeal angiofibromas? who is affected most?
- benign tumors that are highly vascularized (bleed profusely during resection)
- almost exclusively in adolescent adult males
what are sinonasal papillomas? associated with? which form is most common? most important? where can it invade? does it convert to carcinoma frequently?
- benign neoplasms of nose & paranasal sinuses
- assoc w/HPV 6 & 11
- exophytic, inverted & cylindrical forms (exophytic most common, inverted are most important)
- locally aggressive, high recurrence if incompletely excised
- can invade orbit or cranial vault
- rarely convert to carcinoma
what are plasmacytomas? what is it histologically similar to? how often do they progress to multiple myelomas
- lymphoid structure tumors
- polypoid growths up to several cms
- usu intact overlying mucosa
- similar to malignant plasma cell tumor
- rarely progress to multiple myeloma
what are neuroblastomas? does it metastasize? treatment?
- uncommon primary head and neck malignancy
- small round cell resembling neuroblasts, from neuroendocrine cells
- tend towards metastases
- treated surgically, radio & chemotherapeutically
- 5 yr survival 40-90%
what are nasopharyngeal carcinomas distinguished by? what are the 3 patterns it generally presents in?
- distinctive geographic distribution
- close anatomical relationship to lymphoid tissue
- associated w/EBV infxn
1. keratinizing squamous cell carcinomas
2. nonkeratinizing squamous cell carcinomas
3. undifferentiated carcinomas that have abundant non-neoplastic lymphatic infiltrate
what are the 4 cardinal signs of acute-itis?
- heat
- redness
- swelling
- pain
what are 3 common proliferations? which is the most benign? the most malignant?
- polyp (most benign) (singer’s nodule)
- papilloma
- carcinoma
what is the common appearance of carcinomas?
-ulcerated, indurated, irregular, invasive & destructive w/secondary necrosis
what are the most common causes of AOMs?
-strep & H. flu in children <2 & moraxella
is serous otitis media more chronic or acute?
-more chronic
what is otosclerosis? when does it begin? UL or BL? causes?
abnormal bone deposition b/w footplate of stapes & oval window
- one of most common forms of conductive hearing loss
- begins in middle age, progressive, usu BL, often familial
what are brachial cleft cysts? become malignant? spot it occurs?
- developmental remnants of brachial clefts, can become inflamed
- do not become malignant most times
- on the side of the neck
what are thyroglossal duct cysts? what can you find in the wall of the cyst? spot it occurs?
- same etiology, appearance & behavior as brachial cleft cyst but it over thyroid
- remmants of thyroid follicles in wall of cyst mb present (rare)
- over the thyroid
what are carotid body tumors?
- ‘balls of cells’
- tumors of carotid body receptor cells, near the carotid sinus that are sensitive to pO2, pCO2, pH & temp
what is epiglottitis? what are the 4 D’s?
- swelling of epiglottis due to bac infxn
- can be deadly in kids
- 4 D’s: dyspnea, respiratory distress, difficulty swallowing & drooling
what is stridor? what are the 3 causes?
high-pitched musical breath sound caused by turbulent air flow in upper airway, can often hear w/o stethoscope
-3 causes: airway swelling from croup, epiglottitis, lodged foreign bodies
what is croup? what does it cause?
- viral infxn occuring in children
- causes stridor as inflamed airway narrows
- seal-like barking cough
