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MS2 Unit 3 > Goljy: tha other shit (17, 18, 24 selected pages) > Flashcards

Goljy: tha other shit (17, 18, 24 selected pages) Flashcards

1
Q

Choanal atresia

A
  • MC congenital anomaly of the nose
  • A unilateral or bilateral bony (MC) or membranous septum between the nose and pharynx
  • Newborn turns cyanotic when breast feeding, crying causes child to “pink up” again
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2
Q

Nasal polyps

A
  • Non neoplastic tumefactions that develop as a response to chronic inflammation
  • Allergic polyps MC, esp in adults w/ hx of IgE- mediated allergies. Nasal smear shows eosinophils.
  • Often a/w cystic fibrosis –> seat test to rule out CF whenever a child has nasal polyp
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3
Q

Obstructive sleep apnea

A
  • Excessive snoring with intervals of breath cessation
  • Causes:
    1) Obesity (MC) - pharyngeal muscles collapse under weight
    2) Tonsillar hypertrophy, nasal septum deviation, hypothyroidism, or acromegaly
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4
Q

Obstructive sleep apnea pathogenesis

A

Airway obstruction causes CO2 retention (respiratory acidosis) –> hypoxemia (decreased PaO2)

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5
Q

Clinical and lab findings in obstructive sleep apnea

A

Clinical findings: excessive snoring w/ episodes of apnea
- daytime somnolence often simulating narcolepsy

Lab findings: Decreased PaO2 and O2sat + Increased PaCO2 during apneic episodes

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6
Q

Complications from obstructive sleep apnea

A

1) Pulmonary hypertension occurs followed by right ventricular hypertrophy
2) Secondary polycythemia

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7
Q

Dx and Tx of obstructive sleep apnea

A

Dx: Nocturnal polysomnography

Tx: CPAP or surgical correction + weight loss

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8
Q

Sinusitis

A
  • Inflammation of the mucous membranes lining one or more of the paranasal sinuses
  • In adults, MC in maxillary sinus. In children, MC in ethmoid sinus.
  • Caused by URI, deviated septum, allergic rhinitis, barotrauma, or cigs
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9
Q

Pathogens involved in sinusitis

A

MC is strep pneumoniae.

Others: H. influenzae, moraxella catarrhalis, rhinovirus, staph aureus, systemic fungi (Mucor)

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10
Q

Pathogenesis of sinusitis

A

Blockage of sinus drainage into the nasal cavity

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11
Q

Clinical findings in sinusitis

A

Fever, nasal congestion with or without purulent discharge, pain over sinuses, painful teeth, cough from postnasal drip, periorbital cellulitis

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12
Q

Dx and Tx of sinusitis

A

Dx: 4-view sinus radiographs, CT is most sensitive

Tx: Decongestants, antimicrobial therapy

Recommendation is NO antibiotics b/c most are viral. If it doesn’t resolve, use amoxicillin (MC), erythromycin, TMP-SMX.

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13
Q

Nasopharyngeal carcinoma

A
  • MC malignant tumor of nasopharynx
  • MC in males, Chinese (adults), Africans (kids)
  • Causal relationship with EBV
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14
Q

Pathologic findings in nasopharyngeal carcinoma

A
  • SCC, nonkeratinizing squamous carcinoma, or undifferentiated cancer
  • Metastasizes to cervical lymph nodes
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15
Q

Tx of nasopharyngeal carcinoma

A
  • Radiotherapy, 60% 3 yr survival rate
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16
Q

Laryngeal carcinoma

A
  • Risk factors: cigarettes, alcohol, squamous papillomas and papillomatosis (HPV 6, 11)
  • Majority are keratinizing SCCs
  • Sx: persistent hoarseness w/ cervical lymphadenopathy
  • Tx: surgery
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17
Q

Cleft lip and palate

A
  • MC congenital disorder of oral cavity
  • Can be cleft lip and palate, cleft lip alone (males usually), cleft palate alone (females usually)
  • Presence in subsequent siblings, MC in whites than blacks
  • Caused by failure of fusion of facial processes
  • Tx: surgery
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18
Q

Complications of cleft lip and palate

A
  1. Malocclusion
  2. Eustachian tube dysfunction –> chronic otitis media
  3. Speech problems
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19
Q

Oral problems inHIV

A
  1. Candidiasis
  2. Apthous ulcers
  3. Hairy leukoplakia d/t EBV
  4. Kaposi sarcoma d/t HHV 8 (hard palate)
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20
Q

Dental caries

A
  • S. mutans produces acid from sucrose fermentation –> acid erodes enamel and exposes underlying dentine
  • Fluoride prevents cavities, too much stains your teeth white (why is this bad)
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21
Q

Exudative tonsillitis

A
  • MC viral

- Culture necessary to differentiate bacterial vs viral

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22
Q

Hairy leukoplakia

A
  • Caused by EBV
  • Glossitis a/w bilateral white excrescences on lateral border of tongue
  • Pre-AIDS-defining lesion
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23
Q

Herpes labialis

A
  • Caused by HSV1
  • Recurrent vesicular lesions on lips
  • Virus remains dormant in cranial sensory ganglia
  • Reactivated by stress, sun, menses
  • Tx: acyclovir, valacyclovir, famciclovir, etc.
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24
Q

Mumps

A
  • Caused by paramyxovirus
  • Bilateral parotitis w/ increased serum amylase
  • Complications: meningoencephalitis, unilateral orchitis or oophoritis, pancreatitis
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25
Q

Herpangina

A
  • Caused by coxsackievirus
  • Occurs in kids, endemic in summer
  • Painful vesicles or small white papules on an erythematous base typicall at the junction of hard and soft palate
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26
Q

Hand foot and mouth disease

A
  • Caused by coxsackievirus
  • Occurs in young children
  • Vesicles in mouth and distal extremities (shocker)
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27
Q

Cervicofacial actinomycosis

A
  • Caused by Actinomyces israelii
  • Draining sinus tract from facial or cervical area
  • Sulfur granules in pus contain gram + branching filamentous anaerobic bacteria
  • Often follow abscessed tooth extraction
  • Tx: ampicillin, penicillin G
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28
Q

Diptheria

A
  • Caused by Coynebacterium diphtheriae
  • Toxin produces shaggy gray pseudomembrane in posterior pharynx and upper airways
  • Tx: erythromycin
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29
Q

Peritonsillar abscess

A
  • Caused by strep pyogenes
  • Uvula deviates to contralateral side, “hot potato” voice (what the fuck), foul smelling breath
  • Complication of tonsillitis
  • Tx: surgical drainage of pus, penicillin G or V, add clindamycin for serious invasive infection
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30
Q

Ludwig angina

A
  • Caused by aerobic/anaerobic Strep, Eikenella corrodens
  • Cellulitis involving submaxillary and sublingual space, follows fascial planes and may spread to pharynx, carotid sheath, superior mediastinum
  • Causes: dental extraction (MC), trauma to floor of mouth
  • Tx: surgical drainage, clindamycin + metronidazole
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31
Q

Pharyngitis

A
  • S. pyogenes
  • A/w tonsillitis
  • Potential for acute rheumatic fever and glomerulonephritis
  • Tx: penicillin V
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32
Q

Scarlet fever

A
  • S. pyogenes
  • Pharyngitis, glossitis, tonsillitis
  • Erythrogenic toxin produces rash on skin and tongue (initially white, turns strawberry red)
  • Increased risk for glomerulonephritis
  • Nephritogenic strains pose no risk for acute rheumatic fever
  • Tx: penicillin G or V
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33
Q

Sialadenitis

A
  • Staph aureus
  • Bacterial inflammation of major salivary gland
  • Secondary to a calculus, which obstructs the duct in postop patients
    Tx: oxacillin, nafcillin if methicillin susceptible; TMP-SMX if community-acquired methicillin resistant; vancomycin if methicillin resistant in hospital
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34
Q

Congenital syphilis

A
  • T. pallidum
  • Abnormalities involving incisors (notched and tapered like a peg) and molar teeth (resemble mulberries)
  • looks gross af
  • Tx: aqueous crystalline penicillin G
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35
Q

Acute necrotizing gingivitis

A
  • Anaerobes: Prevotella, Fusobacterium
  • Anaerobic bacterial infection of gingiva
  • Necrosis of interdental papilla with punched out lesions covered by a grayish pseudomembrane
  • Tx: penicillin or metronidazole
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36
Q

Oral thrush

A
  • Candida albicans
  • May occur in neonates, immunocompromised patients (pre-AIDS- defining), DM, following antibiotics
  • Tx: fluconazole, itraconazole
37
Q

Erythema multiforme

A
  • Hypersensitivity reaction against Mycoplasma or drugs

- Called Stevens-Johnson syndrome when it involves the mouth

38
Q

Behcet syndrome

A
  • Recurrent apthous ulcers, genital ulcerations
  • Uveitis, erythema nodosum
  • Attacks last 1 to 4 weeks
39
Q

Behcet syndrome epidemiology

A
  • Combo of environmental + genetic factors: HLA-B51, HLA-B27
  • May be precipitated by HSV or parvovirus
  • High incidence in Turkey and eastern Mediterranean
40
Q

Tx of Behcet syndrom

A
  • antiinflammatories
  • corticosteroids
  • colchicine, thalidomide
41
Q

Peutz-Jeghers syndrome

A

Melanin pigmentation of the lips and oral mucosa

42
Q

Addison disease

A
  • Increased ACTH stimulates melanocytes

- Melanin pigmentation is present on the buccal mucosa

43
Q

Lead poisoning

A

Lead deposits along the gingival margins in adults with gingivitis

44
Q

Tetracycline effect on teeth

A

Discolors newly formed teeth –> not recommended in children under 12

45
Q

Excess fluoride

A

Mottled, chalky white discoloration

46
Q

Congenital erythropoietic porphyria effect on teeth

A
  • Porphyrin deposits on teeth

- Reddish-brown discoloration

47
Q

Macroglossia association

A
  • Myxedema (severe primary hypothyroidism)
  • Down syndrome
  • Acromegaly
  • Systemic amyloidosis
  • Mucosal neuromas in MEN syndrome IIb
48
Q

Glossitis

A
  • sore, beefy red tongue w/ or w/o papillary atrophy
  • Causes:
  • long-standing iron deficiency
  • Vit B12 or folate deficiency
  • Scurvy
  • Pellagra (niacin deficiency)
  • Scarlet fever
  • EBV-associated hairy leukoplakia
49
Q

Leukoplakia and erythroplakia

A
  • Leukoplakia = white patch
  • Eryroplakia = red patch
  • Combination of both is called leukoerythroplakia
50
Q

Cell shit in leukoplakia and erythroplakia

A
  • initially show squamous hyperplasia of the epidermis

- may progress into squamous dysplasia or invasive SCC (leukoplakia

51
Q

Locations, causes of leukoplakia and erythroplakia

A

Locations: vermilion border of lower lip (MC), buccal mucosa, hard and soft palates, floor of mouth

Causes: chronic irritation, tobacco, alcohol, HPV

ALWAYS biopsy these shits cuz there’s a high risk of oral cancer

52
Q

Lichen planus

A
  • Often a/w Wickham striae on the buccal mucosa
  • Fine, white, lacy lesions
  • May be a/w SCC
53
Q

Dentigerous cyst

A
  • Derives from epithelial elements of dental origin
  • A/w the crown of the unerupted or impacted 3rd molar
  • A/w ameloblastomas in some cases
54
Q

Squamous papilloma

A
  • MC benign tumor in oral cavity
  • Exophytic tumor w/ fibrovascular core
  • May occur on the tongue, gingiva, palate, lips
55
Q

Ameloblastoma

A
  • Arise from enamel organ epithelium or a dentigerous cyst
  • Located in the mandible
  • Produces radiolucency in bone w/ “soap bubble” appearance
  • Locally invasive but does NOT metastasize
56
Q

Malignant tumors in oral cavity

A
  • MC are well-differentiated SCC
  • Men > women
  • Risks: HPV, tobacco, alcohol, chronic irritation, lichen planus
  • Cancer sites in descending order: lower lip, floor of mouth, lateral border of tongue
  • Mets: tonsillar node
  • Tx: surgery, radiation, chemo
57
Q

Verrucous carcinoma

A

a/w smokeless tobacco

58
Q

Basal cell carcinoma

A

MC cancer of upper lip

- a/w exposure to UVB light

59
Q

Sjogren syndrome

A
  • Female dominant autoimmune disease a/w rheumatoid arthritis
  • Autoimmune destruction of minor salivary glands and lacrimal glands
60
Q

Salivary gland tumors locations

A
  • Parotid gland is MC site
  • major salivary gland tumors are more likely to be benign
  • Minor salivary gland tumors more likely to be malignant
61
Q

Pleomorphic adenoma

A
  • MC benign tumor of major and minor salivary glands
  • Parotid gland MC site
  • Female dominant
  • Painless, moveable mass at angle of jaw
  • Epithelial cells intermixed w/ myxomatous and cartilaginous stroma
  • Tumor projections through capsule –> increased risk of recurrence
  • May become malignant –> facial nerve involvement an indicator
62
Q

Warthin tumor

A
  • Benign parotid gland tumor
  • Male dominant, smokers
  • Heterotopic salivary gland tissue trapped in lymph node
  • Cystic glandular structures located within benign lymphoid tissue
63
Q

Mucoepidermoid carcinoma

A
  • MC malignant salivary gland tumor
  • MC located in parotid gland
  • Mixture of neoplastic squamous and mucus- secreting cells
64
Q

Type I muscle fibers

A
  • Slow twitch (red)
  • Slow contraction but repetitive
  • Do not fatigue easily
  • Rich in mitochondria, myoglobin, oxidative enzymes
  • Weak in ATPase enzymes
65
Q

Type II muscle fibers

A
  • Fast twitch (white)
  • Fast contraction but fatigue easily
  • Specialized for fine, skilled movement
  • Poor in mitochondria, myoglobin, oxidative enzymes
  • Rich in ATPase enzymes
66
Q

Causes of muscle weakness (3)

A
  1. abnormality in motor neuron pathways
  2. abnormality in neuromuscular synapse
  3. abnormality in muscle
67
Q

Neurogenic atrophy

A
  • Motor neuron or its axon degenerates

- Produces atrophy of type I and II fibers

68
Q

Trichinella spiralis transmission

A
  • Eating raw or poorly cooked pork containing encysted larvae in muscle
  • Common on pig farms where pigs are fed uncooked garbage
  • Bear and seal meat
  • Larva encyst and develop into adult worms within small intestine mucosa
  • Commonly undergo dystrophic calcification, visible on xray
69
Q

Trichinosis Sx, Dx, Tx

A

Sx: Muscle pain, periorbital edema, splinter hemorrhages in nails
Complications: myocarditis, encephalitis

Dx: eosinophilia, muscle biopsy

Tx: albendazole

70
Q

Types of group A strep invasive infections, Tx

A
  1. Necrotizing fasciitis
  2. Myositis
  3. Strep TSS

Tx: IV penicillin G + clindamycin

71
Q

Group A strep toxins

A
  • Pyrogenic exotoxin A (superantigen! a/w TSS)

- Exotoxin B –> protease that destroys tissue a/w necrotizing fasciitis

72
Q

Clostridium tetani

A
  • Gram + anaerobic rod that lives in soil
  • Spores in soil enter via closed wounds, skin-popping in IVDU, umbilical cord/circumcision
  • Germination of spores enhanced w/ necrosis, poor blood supply
73
Q

C. tetani proliferation

A
  • Releases tetanospasmin neurotoxin
  • No inflammatory exudate
  • Toxin carried intra-axonally retrograde to the CNS
  • Toxin binds to ganglioside receptors of spinal afferent fibers, inhibits release of inhibitory glycine and GABA in spinal cord
  • Causes sustained motor stimulation of all voluntary muscles
74
Q

Tetanus clinical findings

A
  • Incubation period days-2months
  • Begins w/ lockjaw, risus sardonicus
  • Slightest stimulus causes generalized painful muscle contractions
  • Contractions of back muscles –> opisthotonus
  • Patients mentally alert
75
Q

Tetanus Tx

A
  • Tetanus toxoid for immunization (active)
  • Hyperimmune tetanus immune globulin also given (passive) (must be before neurotoxin fixed in CNS)
  • Debriding wound is super important, removes necrotic tissue where bacteria breeds
  • Hyperbaric oxygen therapy
    • Metronidazole or penicillin G
  • Mortality d/t pneumonia and cardiac failure MC
  • No permanent sequelae if pt survives
  • Protective antibody titers not high enough to prevent disease in future
76
Q

C. perfringens

A
  • Gram + anaerobic rod
  • Virulence factor: a-toxin –> damages cell membranes
  • Normal flora in vag and butt
77
Q

Gas gangrene

A
  • Formation of gas bubbles in tissue (produced by organism’s anaerobic metabolism, noted on radiographs)
  • Pain, edema, cellulitis, smelly pus
  • Hemolytic anemia, jaundice, shock, DIC, renal failure
78
Q

Gas gangrene tx

A
  • Debride wound
  • Penicillin G +/- clindamycin
  • Hyperbaric O2
79
Q

Other C. perfringens infections

A
  • Food poisoning (spores survive cooking), septicemia, intra-abdominal infections, PID, backroom abortion septic endometritis
80
Q

Duchenne muscular dystrophy (DMD) pathogenesis

A
  • XR
  • Absence of dystrophin d/t frameshift mutation of dystrophin gene on X chromosome
  • MC childhood muscular dystrophy
  • Progressive degeneration of type I and II fibers
  • Fibrosis and infiltration of muscle tissue by fatty tissue –> pseudohypertrophy of calf muscles
81
Q

Clinical findings in DMD

A
  • Sx begin ages 2-5
  • Weakness and wasting of pelvic muscles (child puts hands on knees to stand, waddling gait)
  • cardiomyopathy –> heart failure, arrhythmias
  • Respiratory muscle weakness –> respiratory failure
  • Death by age 20 :(
82
Q

Lab findings in DMD

A
  • Serum creatine kinase increased at birth, progressively declines as muscle degenerates over time
  • Female carriers have increased levels of CK
83
Q

Dx, Tx of DMD

A

Dx: Muscle biopsy, EMG, DNA testing

Tx: supportive

84
Q

Myotonic dystrophy

A
  • AD, MC adult muscular dystrophy
  • CTG trinucleotide repeat disorder, encoded on chromosome 19
  • Selective atrophy of type I fibers
85
Q

Myotonic dystrophy clinical features

A
  • Facial muscle weakness (sagging face, cant close mouth)
  • Percussion and grip myotonia (inability to relax muscles)
  • Frontal balding
  • Testicular atrophy, glucose intolerance
  • Cardiac involvement
  • Elevated serum CK
86
Q

Myotonic dystrophy Dx, Tx

A

Dx: EMG, muscle biopsy
Tx: none, muscle wasting and heart probs MCC death

87
Q

Myasthenia gravis

A
  • Men in 6-7th decade of life, women 2-3rd decade
  • An autonomic disorder of postsynaptic neuromuscular transmission
  • Antibodies against ACh receptors (type II hypersensitivity)
  • Antibody synthesized in thymus –> thymic hyperplasia w/ germinal follicles
88
Q

Clinical features of myasthenia gravis

A
  • Fluctuating muscle weakness (worse w/ exercise, better w/ rest)
  • Ptosis MC initial finding
  • Weakness in proximal muscles, diaphragm, neck extension, flexion
  • Dysphagia
  • Normal reflexes, sensation, coordination
  • Increased risk of thymoma
89
Q

Myasthenia gravis Dx, Tx

A

Dx: Tensilon test (inhibits AChE –> reverses muscle weakness), single-fiber electromyography

Tx: Avoid certain meds, Pyrostigmine (AChE inhibitor), Immunosuppressive drugs, plasmapheresis, thymectomy

MS2 Unit 3 (21 decks)

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