HDC STRX Flashcards
1
Q
What muscle does the parotid duct pierce on its way to the oral cavity?
A
Buccinator
2
Q
What vessels are embedded in the parotid gland?
A
Parotid plexus of facial n
Retromandibular vein
External Carotid Artery
3
Q
What nerves innervate the parotid sheath and overlying skin?
A
Auriculotemporal n (CNV3) and Great auricular n (C2-3)
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
5
Q
What structure divides the Maxillary artery into three parts?
A
Lateral pterygoid m
6
Q
What nerve supplies motor fiber to muscles of mastication?
A
CNV3
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
8
Q
What can occur as a direct result of obstruct lymphatics flow?
A
Edema
9
Q
What are the four stages of lymphedema?
A
- Asymptomatic
- Swelling
- Permanent swelling that cannot be relieved through elevation
- Lymphostatic elephantiasis
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
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
12
Q
Describe Danger Space #3
A
Retropharyngeal space between the alar fascia and the buccopharyngeal fascia
Continuous with the lateral pharyngeal space
13
Q
Describe Danger Space #4
A
Posterior to the alar fascia, superior to the prevertebral fascia
Continuous with posterior mediastinum
14
Q
What is the name of this foramen and the strcuture that passes through it?
A
Incivisve canal - greater palatine artery
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)
16
Q
PRNP is a gene that encodes for
A
Prion proteins
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
18
Q
How long is the incubation period of prion disease?
A
Anwhere from 1-30 years!
19
Q
What are the three diseases caused by germline PrP gene mutations
A
Familial CJD
Gerstmann-Strussler-Scheinker disease
Fatal familial insomnia
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
21
Q
How is a diagnosis for prion disease made?
A
Clinical grounds
Elevated protein markers in CSF
Sometimes western blot
22
Q
What key features in the brain are characteristic of prion disease?
A
Sponge-like lesions in the brain tissue
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
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
25
Which type of Xray is best for walkie talkie pts?
Which is best for pts who can't stand or hold their breath?
PA
AP
26
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
All branching from external carotid:
(a) Inferior Alveolar
(b) Posterior Superior Alveolar
(c) Sphenopalatine
(d) Infra-orbital
(e) Middle Meninges
27
What vein(s) drain the infratemporal fossa?
Pterygoid plexus
28
What is the association with infection in the face?
Veins don't have valves so there can be back flow of blood and spread of infection upwards into the head
29
What vein runs with the Superficial Temporal V?
Retromandibular v
30
N to myelohyoid is a branch of
Inferior alveolar n from CNV3
31
What fiber types does the Auriculotemporal n carry?
Somatic afferent (V3) - sensory
Visceral efferent (IX) - parasympathetic
32
What fiber types does the Inferior Alveolar n carry?
Somatic afferent (V3) - sensory
Somatic efferent (V3) - motor
Visceral efferent (IX) - parasympathetic
33
What fiber types does the Lingual n carry?
Somatic efferent (V3) - sensory
Visceral efferent - after merging with Chordatympani and before branching to submandibular ganglion
Special sense afferent (VII) - after merging with chordatympani
34
What fiber types does the Chordatympani n carry?
Visceral efferent - secretomotor of submandibular and sublingual glands
Special sense afferent - taste for anterior 2/3 tongue
35
Which muscles protract the jaw and which is the prime mover?
Prime: Lateral pterygoid
Others: medial pterygoid, masseter
36
Which muscles retract the jaw?
Temporalis
37
Which mucles elevate (close) the jaw?
Medial pterygoid, masseter, temporalis
38
Which muscles depress (open) the jaw?
Lateral pterygoid + gravity
and supra/infrahyoid muscles
39
What are the contents formed from the 1st Pharyngeal Arch?
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*
40
What are the contents formed from the 2nd Pharyngeal Arch?
Artery: *Stapedius a.*
Nerve: **CN VII**
Muscles: **muscles of facial expression**, stylohyoid, digatric anterior belly, *stapedius*
Bones: Hyoid bone, *Stapes*
41
What are the contents formed from the 3rd Pharyngeal Arch?
Artery: Internal Carotid a.
Nerve: CN IX
Muscles: stylopharyngeus m
Bones: Hyoid bone, stylohyoid ligament
42
What are the contents formed from the 4th Pharyngeal Arch?
Artery: R - Right Subclavian, L - Arotic arch
Nerve: CNX - Superior pharyngeal
Muscle: Cricothyroid, pharyngeal muscles
Bones: Epiglottic and thyroid cartilages
43
What are the contents formed from the 6th Pharyngeal Arch?
Artery: R - Pulmonary a, L - L Pulmonary a
Nerve: CNX - Recurrent laryngeal
Bones: Arytenoid cartilage
44
What contents are formed from the Pharyngeal grooves, and what germ layer are they derived from?
Germ layer: Ectoderm
PG1 - Exterior auditory meatus
PG 3 - Cervical sinus
45
What contents are formed from the Pharyngeal pouches, and what germ layer are they derived from?
Germ layer: Endoderm
PP1 - Middle ear, PT tube
PP2 - Palatine tonsils
PP3 - Thymus, inferior parathyroid
PP4 - superior parathyroid, C cells
46
What is the pathogenesis and pathophysiology of DiGeorge syndrome?
22q11 microdeletion
TBX1, HIRA, UFDIL defects
3rd/4th pharyngeal arch defect - no thymus, no parathyroid glands, aortic arch issues, heart issues
47
What is the pathogenesis and pathophysiology of Treacher Collins syndrome?
TCOF1 - treacle ribosomal biogenesis factor 1 defect
1st pharyngeal arch deformity - zygomatic bones, lower eyelids, auricle and middle ear abnormalities
48
What is the pathogenesis and pathophysiology of Pierre Robin syndrome?
BMPR1B - bone morphogeneic protein receptor 1B defect
1st pharyngeal arch deformity - micrognathia (hypoplasia of mandible), bilateral cleft palate
49
What structures are formed from the frontonasal prominence?
Forehead, bridge of nose, medial and lateral nasal prominences
50
What structures are formed from the maxillary prominence?
Cheeks, lateral portion of upper lip
51
What structures are formed from the medial nasal prominence?
Philtrum of upper lip, crest, tip of nose
52
What structures are formed from the lateral nasal prominence?
Alae of nose
53
What are the contents of the carotid sheath?
Medial --> Lateral
CCA
Vagus
Internal Jugular
54
What are the contents of the submandibular triangle?
Subman gland
Subman LN
Hypoglossal n
Mylohyoid n
Facial v and a
55
Discuss the location, function and innervation of the carotid sinus
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
56
Discuss the location, function and innervation of the carotid body
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
57
What are the basic funcitons of naso-, oro-, and laryngopharynx?
Nasopharynx - respiratory
Oropharynx - digestive
Laryngopharynx - passageway
58
What is the border that separates the superior laryngeal constrictor from the middle constrictor?
Stylopharyngeus m.
59
Explain the process of deglutition
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
60
Characterize Horner Syndrome and describe what causes it
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)
61
Cranial nerves running near pharynx
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)
62
Sensory innervation for the naso-, oro-, and laryngopharynx are provided by what nerve(s)?
Nasopharynx - CNV2
Oropharynx - Glossopharyngeal n
Laryngopharynx - Vagus
63
Label the structures of the external ear A-E
A - Lobule
B - Anti tragus
C - Tragus
D - Antihelix
E - Helix
63
What is the relationship of the chorda tympani to the malleus and incus?
What does it innervate?
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
64
What is the arterial supply of the inner ear
Labyrinthe artery
65
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?
Piriform recess
Internal laryngeal and recurrent laryngeal nerves
Difficulty speaking/swallowing
66
What are the three layers of the tympanic membrane?
Cuticle layer (external) - thin layer of skin
Fibrous layer - type I and II collagen
Mucus layer (internal) - cuboidal cells
67
Outline the flow of endolymph from the membranous labyrinth
Flows from within ML --> endolymphatic sac --> sigmoid sinus --> internal jugular vein
68
What cell type do you find in respiratory epithelium vs olfactory epithelium
Resp -
1. ciliated
2. goblet
3. stem
4. brush
5. neuroendocrine
Olfactory -
1. stem
2. supporing
3. olfactory epithelial
69
Characterize the difference in epithelium in the nasopharynx vs oropharynx
Nasopharynx - pseudostratified columnar epithelium with cilia and goblet cells
Oropharynx - Stratified squamous epithelial cells
70
What is the contrast agent used in MRI?
Gadolinium chelate
71
What's the abnormality?
Epiglottitis
72
Identify the structures related to the vertebrae levels:
C3
Disc between C3/C4
C4 and C5
C6
C7
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
Identify the nerves
A - Greater auricular n
B - lesser occipital n
C - transverse cervical n
D - supraclavicular n
74
Identify the veins A-I
## Footnote
Bonus, what nerve runs with I?
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
What is the innervation of the submental triangle?
Nerve to mylohyoid
76
What is the innervation of the submandibular triangle?
Facial n
77
How does fluid behind the ear result in hearing loss?
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
How is conductive hearing loss different from sensorineural hearing loss?
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
Shorter, high pitch waves cause displacement of the basilar membrane [a] whereas longer, low pitch waves cause displacement [b]
a. near the oval window
b. more distant near the helicotrema at apex of cochlea
80
What action causes the neurotransmitter to be released, stimulating action potentials conveyed by cohclear nerve to the brain?
Movement of the basilcar membrane bending the hair cells of the spiral organ
81
Identify the cervical vertebrae that the vertebral nerve does not travel through
C7
82
What nerves supply superificial innervation of the neck
Lesser occipital n (C2)
Greater auricular n (C2/3)
Transverse cervical n (C2/3) - skin over ACT
Supraclavicular n (C3/4)
83
What two veins form the brachiocephalic vein?
Internal Jugular and Subclavian v
84
The external jugular vein courses obliquely on the [a] and drains into the [b] after piercing the [c].
a. SCM
b. subclavian vien
c. investing fascia
85
Outline the path of lymph flow from the formation of lymph to the return back into the blood stream
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
How can a sedentary lifestyle lead to lymphedema?
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
How does fluid move between the CV system and lymphatic system?
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
Explain how lymph propulsion works
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
How might lack of exercise and smoking effect lymphatic propulsion?
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
What are the triad of symptoms for infectious mononucleosis?
Lymphadenopathy, pharyngitis, fever
88
88
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?
Downy cells - atypical CD8+ T cells
Cytotoxic T cells reacting to EBV antigen in the space
89
Outline the pathogenesis of EBV and relate it to the clinical presentation
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
How can EBV infection lead to lymphoma/leukemia?
B cells infected with EBV --> proliferation --> EBNA, LMP1 --> uncontrolled proliferation of B cells --> immunosuppressed have no T cells to fight them off --> cancer
91
Explain the roles of EBNA and LMP in EBV virus
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
Provide a justification as to how EBV could impair net flow rate of lymph patient
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
Explain the etiology and pathogenesis of Milroy's disease
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
Ca2+, Calcineurin, NFAT and FOX2 are all necessary for what part of lymphatics?
Lymphatic maturation
95
Describe the directions of the spinous process of cervical, thoracic and lumbar vertebrae
Cervical - BUM - backwards, upward, medial
Thoracic - BUL - backwards, upward, lateral
Lumbar - BM - backwards, medial
96
What is the contrast material used for CT?
Iodine
97
What is the role of Hassall corpuscles and where are they located?
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
What is the Periarteriolar lymphoid sheath (PALS) and what is it's purpose?
PALS - houses T cells around the central artery of the spleen
99
Describe the open versus closed circulatory system, and how this involves the ‘stave’ cells.
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
What does the white pulp of the spleen contain?
B and T cells (white pulp = white blood cells)
101
Where do blood antigens enter the spleen?
Via the central artery and marginal sinus
102
What five components make up the red pulp?
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
What are the primary lymphoid organs?
Secondary?
Bone marrow and thymus
LN, white pulp, tonsils, BALT/GALT
104
Where are T cells housed in the LN?
Cortex/Paracortex
105
What is the hilum?
Location of efferent lymphatic vessels, artery, and vein of LN
106
What area of the cortex is B cell rich?
Outer/lymphoid follicle
107
Area of the cortex that contains helper T cells and HEVs
Inner cortex of the LN
108
What is an HEV?
Postcapillary venule with a simple cuboidal endothelium that allows 90% of lymphocytes to enter the LN
109
Where do B and T cell interactions take place?
Para-cortical zone
110
What does the primary lymphatic follicle house?
Naive T cells and dendritic cells
111
Which lymphatic follicle contains germinal centers, a mantle and marginal zones?
Secondary lymphatic follicles
112
Where are plasma cells housed?
Medullary cords/sinuses
113
What is the function of thymic cortical epithelial cells?
Clonal selection
114
What is the function of thymic medullary epithelial cells?
Clonal deletion of potential autoreactive T cells (negative selection)
115
Where are T cells found within the spleen of the white pulp?
PALS - periarticular lymphatic sheath
116
What are the indications for RBC tranfusion?
Increased cardiac output/ altered flow distribution
Increased plasma erythropoeitin
Increased RBC 2,3-DPG, decreased RB O2 affinity
117
What is the greatest identifiable risk factor for an anaphylactic transfusion reaction?
How is it preventable?
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
How do you prevent TA-GVHD transfusion reactions in immunocompromised patients?
Irradiate the unit to kill off any lymphocytes, neutrophils, etc --> prevent donor lymphocytes from attacking host cells
119
What is the cause of febrile non-hemolytic tranfusion reactions and what are the clinical features?
Caused by proinflammatory cytokines in blood cells or by recipient antibodies directed against donor Ags
Chills, rigor, 1C increase in body temp
120
What is the cause of TRALI tranfusion reactions and what are the clinical features?
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
Differentiate between acute and delayed hemolytic transfusion reactions
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
What blood transfusion reaction involved the recipients antibodies attacking the donor WBC cells?
Febrile, non-hemolytic
123
What are the borders of the superior thoracic aperture?
1st rib, T1, manubrium
124
Describe the relationship between the subclavian a and v, and the scalene muscles
Anterior to posterior
Subclavian V
Anterior Scalene
Subclavian A
Brachial Plexus Roots
Middle Scalene
Posterior Scalene
125
Outline the branching of the subclavian artery
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
Describe the anatomic distribution, morphology and pathogenesis of pemphigus
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
What are the different variants of pemphigus?
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
Describe the anatomic distribution, morphology and pathogenesis of Bullous pemphigoid
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
Describe the anatomic distribution, morphology and pathogenesis of Dermatitis Herpetiformis
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
How would you be able to distinguish between pemphigus, bullous pemphigoid and dermatitis herpetiformis using immunoflorescence?
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
Describe the anatomic distribution, morphology, and pathogenesis of urticaria
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
Describe the anatomic distribution, morphology, and pathogenesis of Acute Eczematous Dermatitis
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
Describe the anatomic distribution, morphology, and pathogenesis of Erythema Multiforme
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
Contrast inflammatory vs non-inflammatory blistering disorders (epidermolysis bullosa)
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
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?
Torticollis
Fibrosis of SCM that develops before or shortly after birth
136
What two veins contribute to the EJV?
Posterior auricular and posterior retromandibular
137
What veins contribute to IJV?
Anterior retromandibular and Facial vein --> common facial vein --> IJV
138
Where does the superficial temporal vein drain into?
Maxillary v --> retromandibular v
139
Outline the order of lymphatic OMM techniques of the head and neck
Open thoracic inlet --> hyoid cartilage --> cervical chain drainage --> submandibular --> glabreath --> auricular --> altering nasal --> trigeminal stimulation --> effleurage
140
What is the name of this foramen and what structures pass through it?
Sphingopalatine foramen
Greater and lesser palatine nerves
141
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
Explain the drainage pattern of each of the sinuses
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
What vessels pierce the thyrohyoid membrane?
Superior laryngeal a
superior laryngeal n
144
The facial n exits the skull through the
stylomastoid foramen
145
Skin of the face is innervated by [a] except for the [b] which is innervated by [c]
a. Trigeminal n
b. angle of the mandible
c. greater auricular n
146
Differentiate between Le Fort I, II, and III fractures
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
What is the embryological basis of a cleft palate?
Failure of mesenchymal masses in lateral palatine processes to meet and fuse
148
Outline the pathway of the glossopharyngeal n to the parotid gland
Tympanic branch --> middle ear --> lesser petrosal n --> foramen ovale --> otic ganglion --> auriculotemporal n --> parotid gland
149
What nerve loops around the middle meningeal artery?
Auriculotemporal n
150
What are the somatic afferent nerves of V3
Auriculotemporal
Inferior alveolar
Lingual
151
What are the somatic efferent nerves of V3
Inferior alveolar --> n to mylohyoid
152
What are the visceral efferent (parasympathetic) nerves of V3
Auriculotemporal
Inferior alveolar
Lingual after merging with **chorda tympani** - secretomotor to subman and sublin glands
153
What are the special sense afferent nerves of V3
Lingual after merging with **Chorda tympani** - taste for anterior 2/3 tongue
154
What ligament of the TMJ serves as the fulcrum for swinging hinge
Sphenomandibular ligament
155
How does the ptyergoid plexus drain from the face?
Pterygoid plexus --> maxillary vein --> retomandibular vein
156
How could an infection in the parotid gland spread to the brain?
pterygoid plexus --> emissary veins, superior or inferior ophthalmic veins --> cavernous sinus
157
What kind of gland is in the external acoustic meatus?
Ceruminous gland - modified apocrine sweat gland
158
What structure secretes endolymph?
Stria vascularis
159
Seeing autoantibodes against Dsg1 and Dsg3 on immunofloresence leads you to [a] diagnosis, while only seeing them against Dsg1 leads you to [b]
a. pemphigus vulgaris
b. pemphigus foliaceus
160
Describe Frey's syndrome
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.
