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Unit 3 HDC > HDC STRX > Flashcards

HDC STRX Flashcards

1
Q

What muscle does the parotid duct pierce on its way to the oral cavity?

A

Buccinator

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2
Q

What vessels are embedded in the parotid gland?

A

Parotid plexus of facial n
Retromandibular vein
External Carotid Artery

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3
Q

What nerves innervate the parotid sheath and overlying skin?

A

Auriculotemporal n (CNV3) and Great auricular n (C2-3)

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4
Q

What nerves provide sympathetic and parasympathetic innervation to the parotid gland?

A

Sympathetic: cervical ganglia through external carotid nerve plexus

Parasympathetic: Glossopharyngeal n carries presynaptic fibers to otic ganglion –> postsynaptic fibers carried by auriculotemporal n

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5
Q

What structure divides the Maxillary artery into three parts?

A

Lateral pterygoid m

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6
Q

What nerve supplies motor fiber to muscles of mastication?

A

CNV3

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7
Q

What is the cutaneous innervation of CNV3?

A

Ear, lower face and jaw, lower lip, anterior 2/3 of the tongue, lower teeth

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8
Q

What can occur as a direct result of obstruct lymphatics flow?

A

Edema

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9
Q

What are the four stages of lymphedema?

A
  1. Asymptomatic
  2. Swelling
  3. Permanent swelling that cannot be relieved through elevation
  4. Lymphostatic elephantiasis
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10
Q

Outline the lymphatic drainage of the face

A

Parotid nodes, Posterior auricular nodes, occipital nodes –> Superficial Cervical Nodes –> Deep cervical nodes –> R lymphatic duct/ thoracic duct

Submandibular nodes, submental nodes –> deep cervical nodes –> R lymphatic duct/ thoracic duct

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11
Q

What are the boundaries of the retrovisceral space?

A

Buccopharyngeal fascia - anteriorly
Prevertbral fascia - posteriorly
Carotid sheath - laterally
Base of skull - superiorly
Root of neck - inferiorly

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12
Q

Describe Danger Space #3

A

Retropharyngeal space between the alar fascia and the buccopharyngeal fascia
Continuous with the lateral pharyngeal space

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13
Q

Describe Danger Space #4

A

Posterior to the alar fascia, superior to the prevertebral fascia
Continuous with posterior mediastinum

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14
Q

What is the name of this foramen and the strcuture that passes through it?

A

Incivisve canal - greater palatine artery

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15
Q

Explain why you get a runny nose when you cry

A

Fluid flows from the lacrimal glands –> lacrimal ducts –> lacrimal canal –> nasolacrimal duct –> naris (nostril)

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16
Q

PRNP is a gene that encodes for

A

Prion proteins

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17
Q

Explain the etiology of prion disease

A

PrPsc (abnormal) prion prtein contacts PrPc (normal) protein –> PrPsc induces conformational change in PrPc –> PrPc converted into prion –> prions form fibrils thought to lead to disease

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18
Q

How long is the incubation period of prion disease?

A

Anwhere from 1-30 years!

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19
Q

What are the three diseases caused by germline PrP gene mutations

A

Familial CJD
Gerstmann-Strussler-Scheinker disease
Fatal familial insomnia

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20
Q

The gene mutation in prion disease is substitution of Asp to Asn at [ ]

If the disease is fCJD, the next allele is [ ]

If the disease is FFA, the next allele is [ ]

A

178
VAL @ 129
MET @129

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21
Q

How is a diagnosis for prion disease made?

A

Clinical grounds

Elevated protein markers in CSF
Sometimes western blot

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22
Q

What key features in the brain are characteristic of prion disease?

A

Sponge-like lesions in the brain tissue

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23
Q

Esmeralda Jones, a previously healthy 20 y/o woman, comes to your primary care office reporting a one-month history of cough, fever, and unexplained weight loss.

After history and physical, you decide an imaging test is indicated. What do you order first and why?

A

Pregnancy test - female of childbearing age

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24
Q

What Xray orientation is best for detecting pneumonia and why?

A

Less magnification of the heart, done in a standardized way so good for progression comparison

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25
Q

Which type of Xray is best for walkie talkie pts?

Which is best for pts who can’t stand or hold their breath?

A

PA

AP

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26
Q

Which arteries supply:
(a) Mandibular tooth row
(b) Maxillary tooth row
(c) Nasal cavity
(d) Maxillary sinus
(e) Pterion and meninges in the pterion region

A

All branching from external carotid:
(a) Inferior Alveolar
(b) Posterior Superior Alveolar
(c) Sphenopalatine
(d) Infra-orbital
(e) Middle Meninges

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27
Q

What vein(s) drain the infratemporal fossa?

A

Pterygoid plexus

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28
Q

What is the association with infection in the face?

A

Veins don’t have valves so there can be back flow of blood and spread of infection upwards into the head

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29
Q

What vein runs with the Superficial Temporal V?

A

Retromandibular v

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30
Q

N to myelohyoid is a branch of

A

Inferior alveolar n from CNV3

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31
Q

What fiber types does the Auriculotemporal n carry?

A

Somatic afferent (V3) - sensory
Visceral efferent (IX) - parasympathetic

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32
Q

What fiber types does the Inferior Alveolar n carry?

A

Somatic afferent (V3) - sensory
Somatic efferent (V3) - motor
Visceral efferent (IX) - parasympathetic

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33
Q

What fiber types does the Lingual n carry?

A

Somatic efferent (V3) - sensory
Visceral efferent - after merging with Chordatympani and before branching to submandibular ganglion
Special sense afferent (VII) - after merging with chordatympani

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34
Q

What fiber types does the Chordatympani n carry?

A

Visceral efferent - secretomotor of submandibular and sublingual glands
Special sense afferent - taste for anterior 2/3 tongue

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35
Q

Which muscles protract the jaw and which is the prime mover?

A

Prime: Lateral pterygoid
Others: medial pterygoid, masseter

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36
Q

Which muscles retract the jaw?

A

Temporalis

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37
Q

Which mucles elevate (close) the jaw?

A

Medial pterygoid, masseter, temporalis

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38
Q

Which muscles depress (open) the jaw?

A

Lateral pterygoid + gravity
and supra/infrahyoid muscles

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39
Q

What are the contents formed from the 1st Pharyngeal Arch?

A

Artery: Maxillary a.
Nerve: CNV
Muscles: muscles of mastication, mylohyoid, digastric posterior belly, tensor veli palatini
Bones: Maxilla, zygomatic, mandible, temporal bone, Malleus and Incus

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40
Q

What are the contents formed from the 2nd Pharyngeal Arch?

A

Artery: Stapedius a.
Nerve: CN VII
Muscles: muscles of facial expression, stylohyoid, digatric anterior belly, stapedius
Bones: Hyoid bone, Stapes

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41
Q

What are the contents formed from the 3rd Pharyngeal Arch?

A

Artery: Internal Carotid a.
Nerve: CN IX
Muscles: stylopharyngeus m
Bones: Hyoid bone, stylohyoid ligament

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42
Q

What are the contents formed from the 4th Pharyngeal Arch?

A

Artery: R - Right Subclavian, L - Arotic arch
Nerve: CNX - Superior pharyngeal
Muscle: Cricothyroid, pharyngeal muscles
Bones: Epiglottic and thyroid cartilages

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43
Q

What are the contents formed from the 6th Pharyngeal Arch?

A

Artery: R - Pulmonary a, L - L Pulmonary a
Nerve: CNX - Recurrent laryngeal
Bones: Arytenoid cartilage

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44
Q

What contents are formed from the Pharyngeal grooves, and what germ layer are they derived from?

A

Germ layer: Ectoderm

PG1 - Exterior auditory meatus

PG 3 - Cervical sinus

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45
Q

What contents are formed from the Pharyngeal pouches, and what germ layer are they derived from?

A

Germ layer: Endoderm

PP1 - Middle ear, PT tube
PP2 - Palatine tonsils
PP3 - Thymus, inferior parathyroid
PP4 - superior parathyroid, C cells

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46
Q

What is the pathogenesis and pathophysiology of DiGeorge syndrome?

A

22q11 microdeletion
TBX1, HIRA, UFDIL defects

3rd/4th pharyngeal arch defect - no thymus, no parathyroid glands, aortic arch issues, heart issues

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47
Q

What is the pathogenesis and pathophysiology of Treacher Collins syndrome?

A

TCOF1 - treacle ribosomal biogenesis factor 1 defect

1st pharyngeal arch deformity - zygomatic bones, lower eyelids, auricle and middle ear abnormalities

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48
Q

What is the pathogenesis and pathophysiology of Pierre Robin syndrome?

A

BMPR1B - bone morphogeneic protein receptor 1B defect

1st pharyngeal arch deformity - micrognathia (hypoplasia of mandible), bilateral cleft palate

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49
Q

What structures are formed from the frontonasal prominence?

A

Forehead, bridge of nose, medial and lateral nasal prominences

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50
Q

What structures are formed from the maxillary prominence?

A

Cheeks, lateral portion of upper lip

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51
Q

What structures are formed from the medial nasal prominence?

A

Philtrum of upper lip, crest, tip of nose

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52
Q

What structures are formed from the lateral nasal prominence?

A

Alae of nose

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53
Q

What are the contents of the carotid sheath?

A

Medial –> Lateral

CCA
Vagus
Internal Jugular

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54
Q

What are the contents of the submandibular triangle?

A

Subman gland
Subman LN
Hypoglossal n
Mylohyoid n
Facial v and a

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55
Q

Discuss the location, function and innervation of the carotid sinus

A

Carotid sinus is a dilation of the proximal part of the Internal Carotid Artery

Its a barareceptor and detects arterial BP

Innervated by glossopharyngeal n and vagus n

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56
Q

Discuss the location, function and innervation of the carotid body

A

Small ovoid mass of tissue that lies on the medial side of bifurcation of CCA

Chemoreceptor - detects changes in oxygen saturation

Innervated by glossopharyngeal and vagus n

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57
Q

What are the basic funcitons of naso-, oro-, and laryngopharynx?

A

Nasopharynx - respiratory
Oropharynx - digestive
Laryngopharynx - passageway

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58
Q

What is the border that separates the superior laryngeal constrictor from the middle constrictor?

A

Stylopharyngeus m.

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59
Q

Explain the process of deglutition

A
  1. bolus of food squeezes to back of mouth by tongue
  2. Nasopharynx sealed off, larynx is elevated to enlarge pharynx to recieve food
  3. Pharyngeal sphincters contract to squeeze food into esophagus, epiglottis deflects bolus from trachea
  4. Bolus of food moves down esophagus by peristaltic contractions
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60
Q

Characterize Horner Syndrome and describe what causes it

A

Caused by a lesion of the cervical sympathetic trunk - sympathetic disturbance on ipsilateral side of head.

Miosis (contraction of pupil)
Ptosis (drooping of eyelid)
Enophthalmos (sinking in of eye)
Anhydrosis (vasodialtion and absence of sweating in face and neck)

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61
Q

Cranial nerves running near pharynx

A

Medial superior - glossopharyngeal n (overlaying stylopharyngeus)
Medial inferior - Superior laryngeal (internal + external)
Middle - Vagus
Lateral superior - spinal accessory (swooping out toward trap)
Lateral inferior - hypoglossal (diving toward base of tongue)

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62
Q

Sensory innervation for the naso-, oro-, and laryngopharynx are provided by what nerve(s)?

A

Nasopharynx - CNV2
Oropharynx - Glossopharyngeal n
Laryngopharynx - Vagus

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63
Q

Label the structures of the external ear A-E

A

A - Lobule
B - Anti tragus
C - Tragus
D - Antihelix
E - Helix

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63
Q

What is the relationship of the chorda tympani to the malleus and incus?

What does it innervate?

A

Passes between malleus and incus

Carries special sense taste fibers for anterior 2/3 of tongue
Carries secretomotor fibers for submandibular and sublingual salivary glands

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64
Q

What is the arterial supply of the inner ear

A

Labyrinthe artery

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65
Q

What is the most likely location of food getting stuck in the throat?

What structures are at risk of injury if the food is sharp (bone), and what are the consequences?

A

Piriform recess

Internal laryngeal and recurrent laryngeal nerves
Difficulty speaking/swallowing

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66
Q

What are the three layers of the tympanic membrane?

A

Cuticle layer (external) - thin layer of skin
Fibrous layer - type I and II collagen
Mucus layer (internal) - cuboidal cells

67
Q

Outline the flow of endolymph from the membranous labyrinth

A

Flows from within ML –> endolymphatic sac –> sigmoid sinus –> internal jugular vein

68
Q

What cell type do you find in respiratory epithelium vs olfactory epithelium

A

Resp -
1. ciliated
2. goblet
3. stem
4. brush
5. neuroendocrine

Olfactory -
1. stem
2. supporing
3. olfactory epithelial

69
Q

Characterize the difference in epithelium in the nasopharynx vs oropharynx

A

Nasopharynx - pseudostratified columnar epithelium with cilia and goblet cells

Oropharynx - Stratified squamous epithelial cells

70
Q

What is the contrast agent used in MRI?

A

Gadolinium chelate

71
Q

What’s the abnormality?

A

Epiglottitis

72
Q

Identify the structures related to the vertebrae levels:
C3
Disc between C3/C4
C4 and C5
C6
C7

A

C3 - Hyoid bone
Disc btwn C3/4 - Bifurcation of CCA
C4/5 - Thyroid cartilage
C6 - cricoid cartilage, beginning of esophagus from larynx, beginning of trachea from pharynx, vertebral artery enters transverse foramen
C7 - Isthmus of thyroid gland, conenctions of thyroid glands, highest point of thoracic duct

73
Q

Identify the nerves

A

A - Greater auricular n
B - lesser occipital n
C - transverse cervical n
D - supraclavicular n

74
Q

Identify the veins A-I

Bonus, what nerve runs with I?

A

A - Maxillary
B - Retromadibular
C - Anterior division of Retromandibular
D - Fascial
E - Common fascial
F - Anterior Jugular
G - Posterior auricular
H - Posterior division of Retromandibular
I - External jugular (nerve: Greater Auricular)

75
Q

What is the innervation of the submental triangle?

A

Nerve to mylohyoid

76
Q

What is the innervation of the submandibular triangle?

A

Facial n

77
Q

How does fluid behind the ear result in hearing loss?

A

Conductive hearing loss

When fluid is present, the vibrations of the TM are not transmitted efficiently, and reduced movement of the ossicles lead to loss of sound energy

78
Q

How is conductive hearing loss different from sensorineural hearing loss?

A

Conductive - results from anythign in external or middle ear that interferes with conduction - can be improved with hearing aid

Sensorineural - results from defects in pathway from cochlea to brain - can be improved with cochlear implant to resore sound perception when hair cells of spiral organ have been damaged

79
Q

Shorter, high pitch waves cause displacement of the basilar membrane [a] whereas longer, low pitch waves cause displacement [b]

A

a. near the oval window
b. more distant near the helicotrema at apex of cochlea

80
Q

What action causes the neurotransmitter to be released, stimulating action potentials conveyed by cohclear nerve to the brain?

A

Movement of the basilcar membrane bending the hair cells of the spiral organ

81
Q

Identify the cervical vertebrae that the vertebral nerve does not travel through

A

C7

82
Q

What nerves supply superificial innervation of the neck

A

Lesser occipital n (C2)
Greater auricular n (C2/3)
Transverse cervical n (C2/3) - skin over ACT
Supraclavicular n (C3/4)

83
Q

What two veins form the brachiocephalic vein?

A

Internal Jugular and Subclavian v

84
Q

The external jugular vein courses obliquely on the [a] and drains into the [b] after piercing the [c].

A

a. SCM
b. subclavian vien
c. investing fascia

85
Q

Outline the path of lymph flow from the formation of lymph to the return back into the blood stream

A

Blood in arterioles –> capillaries –> plasma forced into interstitial space due to hydrostatic pressure gradients –> some gets reabsorbed, rest enters intial lymphatics –> forms lymph –> collecting lymphatics –> lymph nodes –> lymphatic trunks –> lymphatic/thoracic ducts –> right lymphatic duct –> right venous angle of subclavian/internal jugular veins

86
Q

How can a sedentary lifestyle lead to lymphedema?

A

Sedentary lifestyle –> not moving enough to force fluid up –> chronic static fluid can cause breakdown of ECM and anchoring filaments –> disrupt interstital-lymphatic interface –> lymph formation decreases –> chronic edema –> extra fluid puts pressure on filaments –> further breakdown of GAGs and ECM

87
Q

How does fluid move between the CV system and lymphatic system?

A

Higher hydrostatic pressure moving from arterioles to capillaries push fluid into interstitial space (filtration) –> hydrostatic pressure in interstitial space increases –> puts tension on anchoring filaments –> endothelial cells open –> fluid flows into lymphatics - remaining fluid flows back into lower hydrostatic pressure venuole (absorption)

87
Q

Explain how lymph propulsion works

A

Fluid within the lymphatic vessel increases the hydrostatic pressure which closes the endothelial junctions and opens the secondary valve –> fluid flows downstream into collecting lymphatics –> volume and pressure increase within collecting lymph stretching smooth muscle –> pressure and contraction open next valve –> fluid continues moving

88
Q

How might lack of exercise and smoking effect lymphatic propulsion?

A

Skeletal muscle helps with the peristaltic nature of propulsion –> no contraction, less fluid movement –> static veins –> higher hydrostatic pressure –> more filtration into interstitial space –> edema

Smoking degrades and shrinks vasculature and lymph vessels

88
Q

What are the triad of symptoms for infectious mononucleosis?

A

Lymphadenopathy, pharyngitis, fever

88
Q
A
88
Q

A patient presents with LAD, sore throat and fever. You suspect infectious mononucleosis and find this on the PBS. What are these and what does this mean?

A

Downy cells - atypical CD8+ T cells
Cytotoxic T cells reacting to EBV antigen in the space

89
Q

Outline the pathogenesis of EBV and relate it to the clinical presentation

A

EBV in saliva –> enter B cells and epithelial cells of oropharynx –> sheds into saliva (–>pharyngitis), B cells proliferate –> T cell activation (atypical Downey cells; malaise from long term fight of infection) –> B cell proliferation and T cell activation in spleen (splenomegaly)

90
Q

How can EBV infection lead to lymphoma/leukemia?

A

B cells infected with EBV –> proliferation –> EBNA, LMP1 –> uncontrolled proliferation of B cells –> immunosuppressed have no T cells to fight them off –> cancer

91
Q

Explain the roles of EBNA and LMP in EBV virus

A

EBNA-1 is anti-apoptotic
LMP-1 mimics CD40 to activate NFkB, induces BCL for anti-apoptosis, activates Akt and promotes cell prliferation
LMP-2 blocks lytic cycle

92
Q

Provide a justification as to how EBV could impair net flow rate of lymph patient

A

Lymphadenopathy can cause blockage or closing of lymphatics of everything behind it - build up of pressure in collecting lymphatics –> dilation and retrograde flow of collecting lymph –> fluid builds up and causes lymphedema

93
Q

Explain the etiology and pathogenesis of Milroy’s disease

A

Mutation of the FTL4 gene q35.3 - defective vascular endothelial growth factor receptor (VEGFR-3)

No VEGFR –> no angiogenesis and sprouting of lymphatic capillaries –> no initial lymphatic vessels –> no lymph formation or pick up of fluid from interstitial space

94
Q

Ca2+, Calcineurin, NFAT and FOX2 are all necessary for what part of lymphatics?

A

Lymphatic maturation

95
Q

Describe the directions of the spinous process of cervical, thoracic and lumbar vertebrae

A

Cervical - BUM - backwards, upward, medial
Thoracic - BUL - backwards, upward, lateral
Lumbar - BM - backwards, medial

96
Q

What is the contrast material used for CT?

A

Iodine

97
Q

What is the role of Hassall corpuscles and where are they located?

A

Located in the medulla of the thymus

secrete lymphopoietin –> regulates differentiation and proliferation of dendritic cells, mast cells, basophils, B cells, T cells, NK cells, stimulates maturation of dendritic cells, and increases the ability of dendritic cells to convert naive thymocytes to a Foxp3+ regulatory T cell lineage

98
Q

What is the Periarteriolar lymphoid sheath (PALS) and what is it’s purpose?

A

PALS - houses T cells around the central artery of the spleen

99
Q

Describe the open versus closed circulatory system, and how this involves the ‘stave’ cells.

A

Stave cells are highly elongated, spindle-shaped endothelial cells on a discontinuous membrane that line splenic venous sinuses –> these sequester RBC back into the system

100
Q

What does the white pulp of the spleen contain?

A

B and T cells (white pulp = white blood cells)

101
Q

Where do blood antigens enter the spleen?

A

Via the central artery and marginal sinus

102
Q

What five components make up the red pulp?

A
  1. Splenic cords - cords of Billroth - contain different types of blood cells and macrophages
  2. Splenic sinusoids - wide vessels that drain blood from splenic cords into pulp veins - filter our defective or worn RBCs
  3. Pulp veins - collect blood and drain into trabecular veins
  4. Trabecular veins - extensions of capsule into spleen parenchyma
  5. Marginal zone - area between red and white pulp, contains specialized macrophages and lymphocytes that response to antigens
103
Q

What are the primary lymphoid organs?

Secondary?

A

Bone marrow and thymus

LN, white pulp, tonsils, BALT/GALT

104
Q

Where are T cells housed in the LN?

A

Cortex/Paracortex

105
Q

What is the hilum?

A

Location of efferent lymphatic vessels, artery, and vein of LN

106
Q

What area of the cortex is B cell rich?

A

Outer/lymphoid follicle

107
Q

Area of the cortex that contains helper T cells and HEVs

A

Inner cortex of the LN

108
Q

What is an HEV?

A

Postcapillary venule with a simple cuboidal endothelium that allows 90% of lymphocytes to enter the LN

109
Q

Where do B and T cell interactions take place?

A

Para-cortical zone

110
Q

What does the primary lymphatic follicle house?

A

Naive T cells and dendritic cells

111
Q

Which lymphatic follicle contains germinal centers, a mantle and marginal zones?

A

Secondary lymphatic follicles

112
Q

Where are plasma cells housed?

A

Medullary cords/sinuses

113
Q

What is the function of thymic cortical epithelial cells?

A

Clonal selection

114
Q

What is the function of thymic medullary epithelial cells?

A

Clonal deletion of potential autoreactive T cells (negative selection)

115
Q

Where are T cells found within the spleen of the white pulp?

A

PALS - periarticular lymphatic sheath

116
Q

What are the indications for RBC tranfusion?

A

Increased cardiac output/ altered flow distribution
Increased plasma erythropoeitin
Increased RBC 2,3-DPG, decreased RB O2 affinity

117
Q

What is the greatest identifiable risk factor for an anaphylactic transfusion reaction?

How is it preventable?

A

IgA deficiency - pts without IgA who receive plasma with IgA –> immune system develops IgE against IgA

Give IgA negative plasma, washed RBCs without plasma

118
Q

How do you prevent TA-GVHD transfusion reactions in immunocompromised patients?

A

Irradiate the unit to kill off any lymphocytes, neutrophils, etc –> prevent donor lymphocytes from attacking host cells

119
Q

What is the cause of febrile non-hemolytic tranfusion reactions and what are the clinical features?

A

Caused by proinflammatory cytokines in blood cells or by recipient antibodies directed against donor Ags

Chills, rigor, 1C increase in body temp

120
Q

What is the cause of TRALI tranfusion reactions and what are the clinical features?

A

Transfusion related acute lung injury - transufsion of donor plasma that contains high titer anti-HLA class II abs that bind recipient Ag

Worsening hypoxia, noncardiogenic pulmonary edema, interstitial infiltrates on CXR

121
Q

Differentiate between acute and delayed hemolytic transfusion reactions

A

Acute: donor RBC being destroyed by recipient Abs - hypotension, tachypnea, tachycardia, fever, chills

Delayed: undetected Abs in recipient response to donor cell antigens (IgG) - worsening anemia, depleted haptoglobin, hemoglobinuria

122
Q

What blood transfusion reaction involved the recipients antibodies attacking the donor WBC cells?

A

Febrile, non-hemolytic

123
Q

What are the borders of the superior thoracic aperture?

A

1st rib, T1, manubrium

124
Q

Describe the relationship between the subclavian a and v, and the scalene muscles

A

Anterior to posterior
Subclavian V
Anterior Scalene
Subclavian A
Brachial Plexus Roots
Middle Scalene
Posterior Scalene

125
Q

Outline the branching of the subclavian artery

A

1st part
1. Internal Thoracic A
2. Vertebral A
3. Thyrocervical trunk –> inf thyroid, suprascapular, transverse cervical

2nd part
1. Costocervical trunk –> deep cervical, supreme intercostal

3rd part
1. Suprascapular, dorsal scapular (maybe?)

126
Q

Describe the anatomic distribution, morphology and pathogenesis of pemphigus

A

Blistering disorder caused by autoantibodies that result in the dissolution of intercellular attachments within the epidermis and mucosal epithelium

IgG antibodies against desmogleins disrupt adhesions and result in blister formation - desmosomes fine, hemidesmosomes not - cells can hold onto the floor but not to each other

acantholysis of squamous epithelial cells. Cells lose their shape and become rounded

127
Q

What are the different variants of pemphigus?

A

Vulgaris - scalp, face, axilla, groin, trunk, point of pressure

Vegetans - groin, axillae, fleural surfaces

Foliaceus - scalp, face, chest, back (only taking out desmoglein 1 - more superficial)

128
Q

Describe the anatomic distribution, morphology and pathogenesis of Bullous pemphigoid

A

Lesions are tense bullae filled with clear fluid - inner thighs, flexor surfaces of forearms, axillae, groin, lower abdomen

IgG antibodies that bind proteins required for adherence of basal keratinocytes to the basement membrane. - epidermis stays in tact but not in tact with basement membrane - cells still hold on to each other

Separation of bullous pemphigus from pemphigus - subepidermal, non-acantholytic blisters

129
Q

Describe the anatomic distribution, morphology and pathogenesis of Dermatitis Herpetiformis

A

bilateral, symmetric, groups on extensor surfaces, elbows, knees, upper back, buttocks

genetically predisposed individuals develop IgA antibodies to dietary gluten –> antibodies cross react with reticulin, component of anchoring fibrils that tether BM to superficial epithelium –> subepidermal blister

fibrin and neutrophils accumulate in dermal papillae; immuno shows granular deposits of IgA

130
Q

How would you be able to distinguish between pemphigus, bullous pemphigoid and dermatitis herpetiformis using immunoflorescence?

A

Pemphigus vulgaris - deposition of Ig along plasma membranes of keratinocytes in reticular or fishnet pattern (Fishnet pattern –> IgG attaching to cell-to-cell adhering proteins)
* Pemphigus foliaceus - Ig deposits more superficial

Bullous Pemphigoid - Linear deposition of Ig along dermoepidermal junction - basal portion of basal keratinocytes in association with hemidesmosomes

Dermatitis Herpetiformis - selective deposition of IgA autoantibodies at the tips of dermal papillae -

131
Q

Describe the anatomic distribution, morphology, and pathogenesis of urticaria

A

antigen-induced release of vasoactive mediators from mast cells - lesions range from small, pruritic papules to large, edematous plaques

Three different pathogenesis:
1. Mast cell-dependent, IgE-dependent - exposure to many antigens (allergens) –> localized immediate hypersensitivity reaction triggered by binding of IgE to mast cells
2. Mast cell-dependent, IgE-independent - complement substances that directly incite degranulation of mast cells (opiates, some antibiotics, contrast media)
3. Mast cell-independent, IgE-independent - triggered by local factors that increase vascular permeability - can be initiated by chemicals/drugs that inhibit COX and AA production

132
Q

Describe the anatomic distribution, morphology, and pathogenesis of Acute Eczematous Dermatitis

A

Allergic contact dermatitis, atopic dermatitis, drug-related dermatitis, photo eczematous dermatitis, primary irritant dermatitis

Substance and self-antigen create neoantigen –> neoantigens taken up by Langerhans cells –> migrate through dermal lymphatics to LN –> present antigens to naïve CD4+ T cells –> T cells activated and develop effector and memory cells –> antigen reexposure, memory T cells migrate to cutaneous site –> release of cytokines and chemokines –> recruit of inflammatory cells

Acanthosis, acantholysis, spongiosis

133
Q

Describe the anatomic distribution, morphology, and pathogenesis of Erythema Multiforme

A

Variety of distributions, direct involvement of extremities
Target-like lesions w/ central blister or zone of epidermal necrosis

Keratinocyte injury mediated by skin-homing CD8+ cytotoxic cells

Steven-Johnson syndrome - febrile form, mostly seen in children
Toxic epidermal necrolysis - diffuse necrosis and sloughing of cutaneous and mucosal epithelial surfaces

134
Q

Contrast inflammatory vs non-inflammatory blistering disorders (epidermolysis bullosa)

A

inherited defects in structural proteins that lead to mechanical instability of skin caused by mutation in genes coding keratin 14 or keratin 5

Type of blister is not helpful in differentiating (intraepiderminal vs subepidermal) between inflam vs noninflam, but is helpful in differentiating btwn inflam disorders

135
Q

A baby presented with stiff neck that pulls to the right but face turns to the left. Paplation of the neck reveals nontender mass on right anterior neck region. What is the most likely diagnosis and what is effected?

A

Torticollis

Fibrosis of SCM that develops before or shortly after birth

136
Q

What two veins contribute to the EJV?

A

Posterior auricular and posterior retromandibular

137
Q

What veins contribute to IJV?

A

Anterior retromandibular and Facial vein –> common facial vein –> IJV

138
Q

Where does the superficial temporal vein drain into?

A

Maxillary v –> retromandibular v

139
Q

Outline the order of lymphatic OMM techniques of the head and neck

A

Open thoracic inlet –> hyoid cartilage –> cervical chain drainage –> submandibular –> glabreath –> auricular –> altering nasal –> trigeminal stimulation –> effleurage

140
Q

What is the name of this foramen and what structures pass through it?

A

Sphingopalatine foramen
Greater and lesser palatine nerves

141
Q
A

A - frontal sinus
B - superior nasal concha
C - middle nasal concha
D - inferior nasal concha
E - superior nasal meatus
F - middle nasal meatus
G - inferior nasal meatus
H - soft palate
I - Torus tubarius
J - Pharyngeal tonsil
K - sphenoidal sinus
L - opening to ET tube

142
Q

Explain the drainage pattern of each of the sinuses

A

Sphenoidal sinuses –> sphenoethmoidal recess

Posterior ethmoidal sinus –> superior meatus

Frontal, maxillary, and anterior and middle ethmoidal sinus –> middle meatus

Nasolacrimal duct –> inferior meatus (why you get a runny nose when you cry)

143
Q

What vessels pierce the thyrohyoid membrane?

A

Superior laryngeal a
superior laryngeal n

144
Q

The facial n exits the skull through the

A

stylomastoid foramen

145
Q

Skin of the face is innervated by [a] except for the [b] which is innervated by [c]

A

a. Trigeminal n
b. angle of the mandible
c. greater auricular n

146
Q

Differentiate between Le Fort I, II, and III fractures

A

Le Fort I: horizontal fracture of maxillae superior to maxillary alveolar process

Le Fort II: entire central part of face, including hard palate and alveolar process

Le Fort III: horizonal fracture superior to orbital fissues, including maxillae and zygomatic bones

147
Q

What is the embryological basis of a cleft palate?

A

Failure of mesenchymal masses in lateral palatine processes to meet and fuse

148
Q

Outline the pathway of the glossopharyngeal n to the parotid gland

A

Tympanic branch –> middle ear –> lesser petrosal n –> foramen ovale –> otic ganglion –> auriculotemporal n –> parotid gland

149
Q

What nerve loops around the middle meningeal artery?

A

Auriculotemporal n

150
Q

What are the somatic afferent nerves of V3

A

Auriculotemporal
Inferior alveolar
Lingual

151
Q

What are the somatic efferent nerves of V3

A

Inferior alveolar –> n to mylohyoid

152
Q

What are the visceral efferent (parasympathetic) nerves of V3

A

Auriculotemporal
Inferior alveolar
Lingual after merging with chorda tympani - secretomotor to subman and sublin glands

153
Q

What are the special sense afferent nerves of V3

A

Lingual after merging with Chorda tympani - taste for anterior 2/3 tongue

154
Q

What ligament of the TMJ serves as the fulcrum for swinging hinge

A

Sphenomandibular ligament

155
Q

How does the ptyergoid plexus drain from the face?

A

Pterygoid plexus –> maxillary vein –> retomandibular vein

156
Q

How could an infection in the parotid gland spread to the brain?

A

pterygoid plexus –> emissary veins, superior or inferior ophthalmic veins –> cavernous sinus

157
Q

What kind of gland is in the external acoustic meatus?

A

Ceruminous gland - modified apocrine sweat gland

158
Q

What structure secretes endolymph?

A

Stria vascularis

159
Q

Seeing autoantibodes against Dsg1 and Dsg3 on immunofloresence leads you to [a] diagnosis, while only seeing them against Dsg1 leads you to [b]

A

a. pemphigus vulgaris
b. pemphigus foliaceus

160
Q

Describe Frey’s syndrome

A

When the parotid gland is removed, the postsynaptic parasympathetic fibers in the auriculotemporal nerve are cut; however, the cell bodies of these postsynaptic fibers, located in the otic ganglion, were undamaged.

As a result, the** postsynaptic parasympathetic fibers** within the auriculotemporal nerve then grew peripherally, forming synapses with the sweat glands over the parotid region. Sweat glands are normally only innervated by the sympathetic nervous system. This phenomenon results in sweating and flushing of the skin over the region of the removed parotid gland in response to the thought, smell, or taste of food.

Unit 3 HDC (8 decks)

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