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
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
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
4
Q
Obstructive sleep apnea pathogenesis
A
Airway obstruction causes CO2 retention (respiratory acidosis) –> hypoxemia (decreased PaO2)
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
6
Q
Complications from obstructive sleep apnea
A
1) Pulmonary hypertension occurs followed by right ventricular hypertrophy
2) Secondary polycythemia
7
Q
Dx and Tx of obstructive sleep apnea
A
Dx: Nocturnal polysomnography
Tx: CPAP or surgical correction + weight loss
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
9
Q
Pathogens involved in sinusitis
A
MC is strep pneumoniae.
Others: H. influenzae, moraxella catarrhalis, rhinovirus, staph aureus, systemic fungi (Mucor)
10
Q
Pathogenesis of sinusitis
A
Blockage of sinus drainage into the nasal cavity
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
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.
13
Q
Nasopharyngeal carcinoma
A
- MC malignant tumor of nasopharynx
- MC in males, Chinese (adults), Africans (kids)
- Causal relationship with EBV
14
Q
Pathologic findings in nasopharyngeal carcinoma
A
- SCC, nonkeratinizing squamous carcinoma, or undifferentiated cancer
- Metastasizes to cervical lymph nodes
15
Q
Tx of nasopharyngeal carcinoma
A
- Radiotherapy, 60% 3 yr survival rate
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
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
18
Q
Complications of cleft lip and palate
A
- Malocclusion
- Eustachian tube dysfunction –> chronic otitis media
- Speech problems
19
Q
Oral problems inHIV
A
- Candidiasis
- Apthous ulcers
- Hairy leukoplakia d/t EBV
- Kaposi sarcoma d/t HHV 8 (hard palate)
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)
21
Q
Exudative tonsillitis
A
- MC viral
- Culture necessary to differentiate bacterial vs viral
22
Q
Hairy leukoplakia
A
- Caused by EBV
- Glossitis a/w bilateral white excrescences on lateral border of tongue
- Pre-AIDS-defining lesion
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.
24
Q
Mumps
A
- Caused by paramyxovirus
- Bilateral parotitis w/ increased serum amylase
- Complications: meningoencephalitis, unilateral orchitis or oophoritis, pancreatitis
25
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
26
Hand foot and mouth disease
- Caused by coxsackievirus
- Occurs in young children
- Vesicles in mouth and distal extremities (shocker)
27
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
28
Diptheria
- Caused by Coynebacterium diphtheriae
- Toxin produces shaggy gray pseudomembrane in posterior pharynx and upper airways
- Tx: erythromycin
29
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
30
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
31
Pharyngitis
- S. pyogenes
- A/w tonsillitis
- Potential for acute rheumatic fever and glomerulonephritis
- Tx: penicillin V
32
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
33
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
34
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
35
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
36
Oral thrush
- Candida albicans
- May occur in neonates, immunocompromised patients (pre-AIDS- defining), DM, following antibiotics
- Tx: fluconazole, itraconazole
37
Erythema multiforme
- Hypersensitivity reaction against Mycoplasma or drugs
| - Called Stevens-Johnson syndrome when it involves the mouth
38
Behcet syndrome
- Recurrent apthous ulcers, genital ulcerations
- Uveitis, erythema nodosum
- Attacks last 1 to 4 weeks
39
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
40
Tx of Behcet syndrom
- antiinflammatories
- corticosteroids
- colchicine, thalidomide
41
Peutz-Jeghers syndrome
Melanin pigmentation of the lips and oral mucosa
42
Addison disease
- Increased ACTH stimulates melanocytes
| - Melanin pigmentation is present on the buccal mucosa
43
Lead poisoning
Lead deposits along the gingival margins in adults with gingivitis
44
Tetracycline effect on teeth
Discolors newly formed teeth --> not recommended in children under 12
45
Excess fluoride
Mottled, chalky white discoloration
46
Congenital erythropoietic porphyria effect on teeth
- Porphyrin deposits on teeth
| - Reddish-brown discoloration
47
Macroglossia association
- Myxedema (severe primary hypothyroidism)
- Down syndrome
- Acromegaly
- Systemic amyloidosis
- Mucosal neuromas in MEN syndrome IIb
48
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
49
Leukoplakia and erythroplakia
- Leukoplakia = white patch
- Eryroplakia = red patch
- Combination of both is called leukoerythroplakia
50
Cell shit in leukoplakia and erythroplakia
- initially show squamous hyperplasia of the epidermis
| - may progress into squamous dysplasia or invasive SCC (leukoplakia
51
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
52
Lichen planus
- Often a/w Wickham striae on the buccal mucosa
- Fine, white, lacy lesions
- May be a/w SCC
53
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
54
Squamous papilloma
- MC benign tumor in oral cavity
- Exophytic tumor w/ fibrovascular core
- May occur on the tongue, gingiva, palate, lips
55
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
56
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
57
Verrucous carcinoma
a/w smokeless tobacco
58
Basal cell carcinoma
MC cancer of upper lip
| - a/w exposure to UVB light
59
Sjogren syndrome
- Female dominant autoimmune disease a/w rheumatoid arthritis
- Autoimmune destruction of minor salivary glands and lacrimal glands
60
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
61
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
62
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
63
Mucoepidermoid carcinoma
- MC malignant salivary gland tumor
- MC located in parotid gland
- Mixture of neoplastic squamous and mucus- secreting cells
64
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
65
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
66
Causes of muscle weakness (3)
1. abnormality in motor neuron pathways
2. abnormality in neuromuscular synapse
3. abnormality in muscle
67
Neurogenic atrophy
- Motor neuron or its axon degenerates
| - Produces atrophy of type I and II fibers
68
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
69
Trichinosis Sx, Dx, Tx
Sx: Muscle pain, periorbital edema, splinter hemorrhages in nails
Complications: myocarditis, encephalitis
Dx: eosinophilia, muscle biopsy
Tx: albendazole
70
Types of group A strep invasive infections, Tx
1. Necrotizing fasciitis
2. Myositis
3. Strep TSS
Tx: IV penicillin G + clindamycin
71
Group A strep toxins
- Pyrogenic exotoxin A (superantigen! a/w TSS)
| - Exotoxin B --> protease that destroys tissue a/w necrotizing fasciitis
72
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
73
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
74
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
75
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
76
C. perfringens
- Gram + anaerobic rod
- Virulence factor: a-toxin --> damages cell membranes
- Normal flora in vag and butt
77
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
78
Gas gangrene tx
- Debride wound
- Penicillin G +/- clindamycin
- Hyperbaric O2
79
Other C. perfringens infections
- Food poisoning (spores survive cooking), septicemia, intra-abdominal infections, PID, backroom abortion septic endometritis
80
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
81
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 :(
82
Lab findings in DMD
- Serum creatine kinase increased at birth, progressively declines as muscle degenerates over time
- Female carriers have increased levels of CK
83
Dx, Tx of DMD
Dx: Muscle biopsy, EMG, DNA testing
Tx: supportive
84
Myotonic dystrophy
- AD, MC adult muscular dystrophy
- CTG trinucleotide repeat disorder, encoded on chromosome 19
- Selective atrophy of type I fibers
85
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
86
Myotonic dystrophy Dx, Tx
Dx: EMG, muscle biopsy
Tx: none, muscle wasting and heart probs MCC death
87
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
88
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
89
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
