Goljy: tha other shit (17, 18, 24 selected pages) Flashcards
Choanal atresia
- 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
Nasal polyps
- 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
Obstructive sleep apnea
- 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
Obstructive sleep apnea pathogenesis
Airway obstruction causes CO2 retention (respiratory acidosis) –> hypoxemia (decreased PaO2)
Clinical and lab findings in obstructive sleep apnea
Clinical findings: excessive snoring w/ episodes of apnea
- daytime somnolence often simulating narcolepsy
Lab findings: Decreased PaO2 and O2sat + Increased PaCO2 during apneic episodes
Complications from obstructive sleep apnea
1) Pulmonary hypertension occurs followed by right ventricular hypertrophy
2) Secondary polycythemia
Dx and Tx of obstructive sleep apnea
Dx: Nocturnal polysomnography
Tx: CPAP or surgical correction + weight loss
Sinusitis
- 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
Pathogens involved in sinusitis
MC is strep pneumoniae.
Others: H. influenzae, moraxella catarrhalis, rhinovirus, staph aureus, systemic fungi (Mucor)
Pathogenesis of sinusitis
Blockage of sinus drainage into the nasal cavity
Clinical findings in sinusitis
Fever, nasal congestion with or without purulent discharge, pain over sinuses, painful teeth, cough from postnasal drip, periorbital cellulitis
Dx and Tx of sinusitis
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.
Nasopharyngeal carcinoma
- MC malignant tumor of nasopharynx
- MC in males, Chinese (adults), Africans (kids)
- Causal relationship with EBV
Pathologic findings in nasopharyngeal carcinoma
- SCC, nonkeratinizing squamous carcinoma, or undifferentiated cancer
- Metastasizes to cervical lymph nodes
Tx of nasopharyngeal carcinoma
- Radiotherapy, 60% 3 yr survival rate
Laryngeal carcinoma
- Risk factors: cigarettes, alcohol, squamous papillomas and papillomatosis (HPV 6, 11)
- Majority are keratinizing SCCs
- Sx: persistent hoarseness w/ cervical lymphadenopathy
- Tx: surgery
Cleft lip and palate
- 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
Complications of cleft lip and palate
- Malocclusion
- Eustachian tube dysfunction –> chronic otitis media
- Speech problems
Oral problems inHIV
- Candidiasis
- Apthous ulcers
- Hairy leukoplakia d/t EBV
- Kaposi sarcoma d/t HHV 8 (hard palate)
Dental caries
- 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)
Exudative tonsillitis
- MC viral
- Culture necessary to differentiate bacterial vs viral
Hairy leukoplakia
- Caused by EBV
- Glossitis a/w bilateral white excrescences on lateral border of tongue
- Pre-AIDS-defining lesion
Herpes labialis
- 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.
Mumps
- Caused by paramyxovirus
- Bilateral parotitis w/ increased serum amylase
- Complications: meningoencephalitis, unilateral orchitis or oophoritis, pancreatitis
Herpangina
- 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
Hand foot and mouth disease
- Caused by coxsackievirus
- Occurs in young children
- Vesicles in mouth and distal extremities (shocker)
Cervicofacial actinomycosis
- 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
Diptheria
- Caused by Coynebacterium diphtheriae
- Toxin produces shaggy gray pseudomembrane in posterior pharynx and upper airways
- Tx: erythromycin
Peritonsillar abscess
- 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
Ludwig angina
- 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
Pharyngitis
- S. pyogenes
- A/w tonsillitis
- Potential for acute rheumatic fever and glomerulonephritis
- Tx: penicillin V
Scarlet fever
- 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
Sialadenitis
- 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
Congenital syphilis
- T. pallidum
- Abnormalities involving incisors (notched and tapered like a peg) and molar teeth (resemble mulberries)
- looks gross af
- Tx: aqueous crystalline penicillin G
Acute necrotizing gingivitis
- 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
Oral thrush
- Candida albicans
- May occur in neonates, immunocompromised patients (pre-AIDS- defining), DM, following antibiotics
- Tx: fluconazole, itraconazole
Erythema multiforme
- Hypersensitivity reaction against Mycoplasma or drugs
- Called Stevens-Johnson syndrome when it involves the mouth
Behcet syndrome
- Recurrent apthous ulcers, genital ulcerations
- Uveitis, erythema nodosum
- Attacks last 1 to 4 weeks
Behcet syndrome epidemiology
- Combo of environmental + genetic factors: HLA-B51, HLA-B27
- May be precipitated by HSV or parvovirus
- High incidence in Turkey and eastern Mediterranean
Tx of Behcet syndrom
- antiinflammatories
- corticosteroids
- colchicine, thalidomide
Peutz-Jeghers syndrome
Melanin pigmentation of the lips and oral mucosa
Addison disease
- Increased ACTH stimulates melanocytes
- Melanin pigmentation is present on the buccal mucosa
Lead poisoning
Lead deposits along the gingival margins in adults with gingivitis
Tetracycline effect on teeth
Discolors newly formed teeth –> not recommended in children under 12
Excess fluoride
Mottled, chalky white discoloration
Congenital erythropoietic porphyria effect on teeth
- Porphyrin deposits on teeth
- Reddish-brown discoloration
Macroglossia association
- Myxedema (severe primary hypothyroidism)
- Down syndrome
- Acromegaly
- Systemic amyloidosis
- Mucosal neuromas in MEN syndrome IIb
Glossitis
- 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
Leukoplakia and erythroplakia
- Leukoplakia = white patch
- Eryroplakia = red patch
- Combination of both is called leukoerythroplakia
Cell shit in leukoplakia and erythroplakia
- initially show squamous hyperplasia of the epidermis
- may progress into squamous dysplasia or invasive SCC (leukoplakia
Locations, causes of leukoplakia and erythroplakia
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
Lichen planus
- Often a/w Wickham striae on the buccal mucosa
- Fine, white, lacy lesions
- May be a/w SCC
Dentigerous cyst
- Derives from epithelial elements of dental origin
- A/w the crown of the unerupted or impacted 3rd molar
- A/w ameloblastomas in some cases
Squamous papilloma
- MC benign tumor in oral cavity
- Exophytic tumor w/ fibrovascular core
- May occur on the tongue, gingiva, palate, lips
Ameloblastoma
- 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
Malignant tumors in oral cavity
- 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
Verrucous carcinoma
a/w smokeless tobacco
Basal cell carcinoma
MC cancer of upper lip
- a/w exposure to UVB light
Sjogren syndrome
- Female dominant autoimmune disease a/w rheumatoid arthritis
- Autoimmune destruction of minor salivary glands and lacrimal glands
Salivary gland tumors locations
- Parotid gland is MC site
- major salivary gland tumors are more likely to be benign
- Minor salivary gland tumors more likely to be malignant
Pleomorphic adenoma
- 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
Warthin tumor
- Benign parotid gland tumor
- Male dominant, smokers
- Heterotopic salivary gland tissue trapped in lymph node
- Cystic glandular structures located within benign lymphoid tissue
Mucoepidermoid carcinoma
- MC malignant salivary gland tumor
- MC located in parotid gland
- Mixture of neoplastic squamous and mucus- secreting cells
Type I muscle fibers
- Slow twitch (red)
- Slow contraction but repetitive
- Do not fatigue easily
- Rich in mitochondria, myoglobin, oxidative enzymes
- Weak in ATPase enzymes
Type II muscle fibers
- Fast twitch (white)
- Fast contraction but fatigue easily
- Specialized for fine, skilled movement
- Poor in mitochondria, myoglobin, oxidative enzymes
- Rich in ATPase enzymes
Causes of muscle weakness (3)
- abnormality in motor neuron pathways
- abnormality in neuromuscular synapse
- abnormality in muscle
Neurogenic atrophy
- Motor neuron or its axon degenerates
- Produces atrophy of type I and II fibers
Trichinella spiralis transmission
- 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
Trichinosis Sx, Dx, Tx
Sx: Muscle pain, periorbital edema, splinter hemorrhages in nails
Complications: myocarditis, encephalitis
Dx: eosinophilia, muscle biopsy
Tx: albendazole
Types of group A strep invasive infections, Tx
- Necrotizing fasciitis
- Myositis
- Strep TSS
Tx: IV penicillin G + clindamycin
Group A strep toxins
- Pyrogenic exotoxin A (superantigen! a/w TSS)
- Exotoxin B –> protease that destroys tissue a/w necrotizing fasciitis
Clostridium tetani
- 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
C. tetani proliferation
- 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
Tetanus clinical findings
- Incubation period days-2months
- Begins w/ lockjaw, risus sardonicus
- Slightest stimulus causes generalized painful muscle contractions
- Contractions of back muscles –> opisthotonus
- Patients mentally alert
Tetanus Tx
- 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
C. perfringens
- Gram + anaerobic rod
- Virulence factor: a-toxin –> damages cell membranes
- Normal flora in vag and butt
Gas gangrene
- 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
Gas gangrene tx
- Debride wound
- Penicillin G +/- clindamycin
- Hyperbaric O2
Other C. perfringens infections
- Food poisoning (spores survive cooking), septicemia, intra-abdominal infections, PID, backroom abortion septic endometritis
Duchenne muscular dystrophy (DMD) pathogenesis
- 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
Clinical findings in DMD
- 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 :(
Lab findings in DMD
- Serum creatine kinase increased at birth, progressively declines as muscle degenerates over time
- Female carriers have increased levels of CK
Dx, Tx of DMD
Dx: Muscle biopsy, EMG, DNA testing
Tx: supportive
Myotonic dystrophy
- AD, MC adult muscular dystrophy
- CTG trinucleotide repeat disorder, encoded on chromosome 19
- Selective atrophy of type I fibers
Myotonic dystrophy clinical features
- 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
Myotonic dystrophy Dx, Tx
Dx: EMG, muscle biopsy
Tx: none, muscle wasting and heart probs MCC death
Myasthenia gravis
- 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
Clinical features of myasthenia gravis
- 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
Myasthenia gravis Dx, Tx
Dx: Tensilon test (inhibits AChE –> reverses muscle weakness), single-fiber electromyography
Tx: Avoid certain meds, Pyrostigmine (AChE inhibitor), Immunosuppressive drugs, plasmapheresis, thymectomy
