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Head and Neck Flashcards

1
Q

What is fluoroapatite?

A
  • Component of tooth enamel
  • Made from fluoride
  • Cavity resistant!
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2
Q

Gingivitis

  • Definition
  • Cause
A
  • Gingivitis
    • Inflammation of mucosa surrounding teeth
  • Cause
    • Plaque mineralizes into a calculus beneath gum line
    • Plaque composition
      • bacteria
      • salivary proteins
      • desquamated epithelial cells
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3
Q

What are the symptoms of Chronic Gingivitis?

A
  • Red, swollen gums
  • Gums pull away from the teeth
  • Bleeding
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4
Q

What population most commonly has gingivitis?

A

Adolescents

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5
Q

Periodontitis

  • Definition
  • Cause
A
  • Definition
    • Inflammation of periodontal ligaments, alveolar bone, cementum
    • teeth may loosen and fall out
  • Cause
    • Unknown
    • Associated with change in bacterial
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6
Q

Periodontitis

  • Associated Health Conditions
  • Systemic effects
A
  • Associated health conditions
    • Depressed immune system:
      • AIDS
      • Leukemia
      • DIabetes
    • Crohn’s
    • Down’s syndrome
  • Systemic effects
    • Infective endocarditis
    • Pulmonary abscess
    • Brain abscess
    • Complications of pregnancy
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7
Q

Aphthous Ulcers (Canker Sores)

  • Symptoms
  • Location
  • Stimulating factors
A
  • Symptoms
    • Painful
    • Recur
  • Location
    • Inside of lips
    • Never on vermillion! (herpes)
  • Stimulating factors
    • Stress
    • Fever
    • Certain foods
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8
Q

Aphthous Ulcers are associated with what disease states?

A
  1. IBD
  2. Celiac
  3. Behcet’s sydrome
    • Recurrent oral and genital ulcers
    • Eye inflammation
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9
Q

What inflammatory infiltrate indicates a secondary bacterial infection with Aphthous Ulcers?

A

Neutrophilic infiltrate

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10
Q

Irritation Fibroma

  • Definition
  • Location
  • Cause
  • Treatment
A
  • Definition
    • Fibrous mass
    • Benign
  • Location
    • Along buccal bite line
    • Gingivodental margin
  • Cause
    • Repetitive trauma
  • Treatment
    • Complete excision
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11
Q

Pyogenic Granuloma

  • Definition
  • Location
  • Population
  • Treatment
A
  • Definition
    • Vascular (red / purple) polypoid lesion
    • Benign
  • Location
    • Gingiva
  • Population
    • Children
    • Young adults
    • Pregnant women
  • Treatment
    • Excision
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12
Q

Peripheral Ossifying Fibroma

  • Definition
  • Location
  • Cause
  • Treatment
A
  • Definition
    • Red growth of gingiva
    • Includes bone
  • Location
    • Gingiva
  • Cause
    • Arise from pyogenic granuloma
    • De novo
  • Treatment
    • Complete excision down to periosteum
    • (high recurrence rate)
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13
Q

Peripheral Giant Cell Granuloma

  • Definition
  • Location
  • Treatment
A
  • Definition
    • Bluish / purple nodule
    • Multinucleated foreign body giant cells separated by fibrous tissue
  • Location
    • Soft tissue of gingiva
    • (Central giant cell granuloma is found in bone)
  • Treatment
    • Excision
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14
Q

How is Peripheral Giant Cell Granuloma differentiated from the following?

  • Central Giant Cell Granuloma
  • Brown Tumor
A
  • CGCG
    • occurs in bone
    • (peripheral in soft tissue)
  • Brown Tumor
    • background of hyperparathyroidism
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15
Q

What defense mechanisms prevent infection of the oral cavity?

A
  • Indigenous flora
  • Secretory IgA
  • Collections of lymphocytes
  • Antibacterial components of saliva
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16
Q

What are the manifestations of primary HSV of the mouth?

A

Acute Herpetic Gingivostomatosis

  • Vesicles
  • Painful ulceration
  • Lymphadenopathy
  • Fever
  • May occur on the vermillion
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17
Q

What are the manifestations of secondary HSV oral infection? What is the cause?

A

Cold sores / Herpes labialis

  • Vesicles around mucosal orifice
  • Cause:
    • Activation of dormant virus in trigeminal ganglia
    • Activation caused by:
      • resp infxn
      • Fever
      • Exposure to sun / cold
      • Pregnancy
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18
Q

What is the microscopic appearance of HSV? What is used to visualize it?

A
  • Microscopic appearance
    • Acantholysis
    • Ground glass viral inclusion
    • Giant cells
  • Visualize:
    • Tzanck prep smears
      • shows giant cells
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19
Q

How is Acute Herpetic Gingivostomatitis differentiated from Aphthous Ulcers?

A
  • AHG
    • Has systemic symptoms
    • Occurs on the vermillion
  • Aphthous Ulcers
    • No systemic symptoms
    • Never on vermillion
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20
Q

What is the most common fungal infection of the oral cavity?

A

Candidiasis (Thrush)

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21
Q

Oral Candidiasis

  • Appearance
  • Cause
A
  • Appearance
    • Gray-white membrane over red mucosa
    • Can be scraped off (unlike hairy leukoplakia)
    • May ulcerate
  • Cause
    • Disturbance of oral flora
      • antibiotics
      • diabetes
      • immune-compromise
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22
Q

What is causing the increased incidence of deep fungal infections of the head, neck, and oral cavity?

A
  • AIDS
  • Cancer therapy
  • Organ transplants

***Immune compromise***

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23
Q

Hairy Leukoplakia

  • Gross Appearance
  • Micro
  • Cause
A
  • Appearance
    • White, confluent fluffy patches
    • Lateral border of tonue
    • Cannot be scraped off
  • Micro
    • Hyperkeratosis
    • Balloon cells
    • Acanthosis
  • Cause
    • EBV
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24
Q

Hairy Leukoplakia occurs in what populations?

A
  • HIV
  • Cancer patients
  • Transplant patients
  • Advanced age
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25
Q

Erythroplakia

  • Gross Appearance
  • Micro Appearance
  • Cause
A
  • Appearance
    • Red velvety area
    • May erode
  • Micro
    • atypia
      • Pre-malignant (CIS)
      • Malignant
    • Dysplasia w/o hyperkeratosis
  • Cause
    • assoc. w/ tobacco use
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26
Q

What is the most common cancer of the head and neck?

A

Squamous Cell Carcinoma

(95%)

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27
Q

What is the long-term survival of SCC of the head and neck? What is the most common cause of death in five year survivors?

A
  • Survival: 50%
  • Cause of death: second primary tumor
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28
Q

What are the risk factors for the following types of SCC?

  • Head and Neck (in general)
  • Lower lip
  • Oropharynx
A
  • Head and Neck (in general)
    • Alcohol and Tobacco use
  • Lower lip
    • Actinic exposure
    • Pipe smoking
  • Oropharynx
    • HPV
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29
Q

Alterations in which genes is associated with Classic SCC of the Head and Neck?

A
  • p53
  • p63
  • NOTCH1
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30
Q

Alterations in which genes is associated with HPV SCC of the Head and Neck?

A
  • p53
  • p16
  • Rb pathway
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31
Q

Where does SCC metastasize first? What are the locations of distant metastasis?

A
  • First
    • Cervical Nodes
  • Distant
    • Mediastinal nodes
    • Lung
    • Liver
    • Bone
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32
Q

Mutation in which gene causes progression from hyperplasia / hyperkeratosis to moderate dysplasia of the mouth (progression to SCC)?

A

p16

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33
Q

Mutation in which gene causes progression from moderate dysplasia to Severe displasia / CIS of the mouth (progression to SCC)?

A

p53

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34
Q

Mutation in which gene causes progression from Severe displasia / CIS to SCC of the mouth?

A

Rb pathway

Cyclin D

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35
Q

Dentigerous cysts

  • Appearance
  • Location
  • Treatment
A
  • Appearance
    • Unilocular cyst
  • Location
    • around crown of unerupted tooth
    • usually wisdom tooth
  • Treatment
    • Removal
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36
Q

Odontogenic Keratocysts

  • Appearance
  • Location
  • Treatment
A
  • Appearance
    • Uni- or Multilocular cyst
    • Corrugated surface
  • Location
    • post. mandible
  • Treatment
    • Aggressive excision
    • (60% recurrence rate)
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37
Q

What is Gorlin Syndrome?

A

Nevoid Basal Cell Carcinoma Syndrome

Has multiple odontogenic keratocysts

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38
Q

Periapical cysts

  • Appearance
  • Location
  • Cause
  • Treatment
A
  • Appearance
    • Periapical abscess
  • Location
    • Around apex of teeth
  • Cause
    • Pulpitis
  • Treatment
    • Removal of infected material
    • May extract tooth
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39
Q

Ameloblastoma

  • Appearance
  • Origin
  • Treatment
A
  • Appearance
    • cystic lesion
    • Locally invasive tumor
  • Origin
    • Odontogenic epithelium
  • Treatment
    • Wide resection to prevent recurrence
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40
Q

Odontoma

  • Definition
  • Composition
  • Treatment
A
  • Definition
    • Odontogenic tumor
      • Most common tumor of this type
  • Composition
    • Enamel
    • Dentin
  • Treatment
    • Local Excision
41
Q

Infectious Rhinitis

  • Symptoms
  • Most common causes
A
  • Symptoms
    • Thickened, red mucosa
    • Enlarged turbinates
    • Profuse discharge
      • purulent w/ secondary bacterial infection
  • Most common causes
    • Adenovirus
    • Echovirus
    • Rhinovirus
    • “AER”
42
Q

What type of hypersensitivity is Allergic Rhinitis? What is the most prominent cell type seen?

A
  • Type I (IgE) Hypersensitivity
  • Cell: Eosinophils
43
Q

Nasal polyps

  • Cause
  • Most abundant cell type
A
  • Cause
    • Recurrent Rhinitis
  • Cell:
    • Eosinophils
44
Q

Chronic Rhinitis

  • Cause
  • Associated conditions
  • Result
A
  • Cause
    • Repeated Acute Rhinitis + superimposed bacterial infxn
  • Associated conditions
    • Deviated septum
    • Nasal polyps
    • (impaired drainage)
  • Result
    • Ulceration
    • Suppuration
    • Extention into sinuses
45
Q

What complications can arise from sinusitis (suppurative)?

A
  • Osteomyelitis
  • Intracranial infxn
  • Dural sinus thrombophlebitis
46
Q

What fungal infection is commonly seen in sinusitis with concurrent diabetic acidosis?

A

Mucormycoses

47
Q

What are the symptoms of Kartagener’s syndrome?

A
  • Chronic sinusitis
  • Bronchiectasis
  • Situs inversus

Cause; defective ciliary action

48
Q

What 3 disorders cause Necrotizing Sinusitis?

A
  1. Mucormycosis
  2. Granulomatosis with polyangiitis
  3. Extranodal NK / T-cell lymphoma
49
Q

Extranodal NK / T-cell Lymphoma

  • Presentation
  • Viral association
  • Prognosis
A
  • Presentation
    • necrotizing sinusitis
    • Destruction of cartilage
    • Vascular thrombosis with lymphoid infiltrate
  • VIral association
    • EBV
  • Prognosis
    • Localized can be treated with radiation
    • Most Lethal
      • bacterial infxn
      • sepsis
      • tumor spread
50
Q

What are the frequent viral causes of pharyngitis / tonsillitis?

A

AER

  • Adenovirus
  • Echovirus
  • Rhinovirus
51
Q

What bacteria are often associated with pharyngitis / tonsillitis? What severe complications may result?

A
  • Bacteria
    • beta-strep (most often)
    • S. aureus
  • Complications
    • Rheumatic fever
    • Glomerulonephritis
52
Q

Nasopharyngeal angiofibroma

  • Population affected
  • Associated condition
  • Prognosis
  • Causes of fatality
A
  • Population affected
    • Adolescent males
  • Associated condition
    • Familial Adenomatous Polyposis
  • Prognosis
    • Benign
    • Locally aggressive
  • Causes of fatality
    • Bleeding
    • Intracranial extension
53
Q

Inverted papilloma

  • Associated with which virus?
  • Cell type
  • Prognosis
A
  • Associated with which virus?
    • HPV 6 and 11
  • Cell type
    • Squamous epithelium
  • Prognosis
    • Benign
    • Locally aggressive
      • may invade orbit or cranial vault
54
Q

Olfactory neuroblastoma

  • Cell type
  • Cell markers
  • Mutation present
  • Treatment
A
  • Cell type
    • Neural crest cells
    • Small round blue cell
  • Cell markers
    • CD56, NSE, chromogranin, synaptophysin, S-100
  • Mutation present
    • Trisomy 8 (some)
  • Treatment
    • Combo of surgery, radiation, and chemo
55
Q

NUT Midline Carcinoma

  • Associated with what other malignancy?
  • Location
  • Genetic mutation
  • Population
  • Prognosis
A
  • Associated with what other malignancy?
    • Acute Leukemia
  • Location
    • Midline abdomen, thorax, head and neck
  • Genetic mutation
    • BRD4-NUT fusion gene
    • (nuclear protein in testes)
  • Population
    • age 17-30
  • Prognosis
    • Poor
    • 9 mo survival
56
Q

Plasmacytoma

  • Cell type
  • Frequency of progression to multiple myeloma
A
  • Cell type
    • Malignant plasma cells
  • Progression to multiple myeloma
    • Rare
57
Q

What are the three types of nasopharyngeal carcinomas? Which types are associated with EBV? Which is the least radiosensitive?

A

Squamous cell / basaloid carcinomas

  1. Keratinizing (least radiosensitive)
  2. Non-keratinizing (EBV)
  3. Undifferentiated / lymphoepithelioma (EBV)
58
Q

What populations are more commonly affected by nasopharyngeal carcinomas?

A
  1. Adults in S. China
  2. Children in Africa
59
Q

Nasopharyngeal carcinomas spread to which lymph nodes? What are the sites of metastasis?

A
  • Nodes
    • Cervical
  • Mets
    • Lungs
    • Pleural cavities
    • Liver
60
Q

What environmental exposures are associated with nasopharyngeal carcinomas?

A
  1. EBV
  2. Nitrosamines
  3. Fermented food
  4. Salted fish
  5. Smoking
  6. Chemical fumes
61
Q

Acute laryngoepiglottitis

  • Cause
  • Symptoms
  • Appearance on lateral CXR
A
  • Cause
    • Most often Haemophilus influenza group B
  • Symptoms
    • inspiratory stridor
    • cyanosis
    • Can cause laryngeal obstruction
    • Epiglottis looks like swollen red cherry
  • Appearance on lateral CXR
    • Thumb sign
62
Q

Laryngotracheobronchitis

  • Symptoms
  • Prognosis
A
  • Symptoms
    • Inspiratory stridor
  • Prognosis
    • Fine
    • No obstruction occurs
63
Q

What are the benign tumors of the Larynx?

A
  1. Chondromas
  2. Leiomyomas
  3. Polyps
  4. Papillomas
64
Q

What is the difference between laryngeal polyps and singer’s nodules?

A
  • Polyps: unilateral
  • Singer’s nodules: bilateral
65
Q

Laryngeal polyps

  • Cause
  • Symptoms
  • Location
  • Histo
A
  • Cause
    • Overuse of vocal cords
    • Smoking
  • Symptoms
    • Hoarseness
  • Location
    • True vocal cords
  • Histo
    • Round nodule
    • Squamous epithelium
    • Underlying vascular myxomatous stroma
66
Q

Papillomas

  • Cause
  • Symptoms
  • Location
  • Appearance / Histo
A
  • Cause
    • Juvenile form: HPV 6 and 11
  • Symptoms
    • Hoarseness
    • Hemoptysis
  • Location
    • True vocal cords
  • Appearance / Histo
    • Raspberry-like growth
    • finger - like growths w/ fibrous core
67
Q

Carcinoma of the Larynx

  • Symptoms
  • Location
  • Appearance
  • Risk factors
A
  • Symptoms
    • Progressive hoarseness
    • Pain
    • Difficulty swallowing
    • Hemoptysis
  • Location
    • Glottic: confined to larynx
      • better prognosis
    • Extrinsic: involved above / below larynx
      • aggressive
  • Appearance
    • Premalignant: white / red focal thickening
    • Malignant: rough, verrucous
  • Risk factors
    • Alcohol
    • Smoking
    • Asbestos exposure
    • Irradiation
    • HPV
68
Q

What is the most common type of Laryngeal Carcinoma?

A

Squamous (95%)

69
Q

Acute Otitis Media

  • Appearance
  • Cause
A
  • Appearance
    • red, bulging tympanic membrane
    • (w/pain)
  • Cause:
    • Viral infxn w/ superimposed bacterial infxn
      • Strep. pneumonia
      • H. influenza
      • M. catarrhalis
70
Q

Chronic Otitis Media

  • Cause
  • What symptoms differentiates from acute?
  • Complications
A
  • Cause
    • S. aureus
    • P. auruginosa
    • Fungus
  • Symptom
    • drainage
  • Complications
    • TM perforation
    • Hearing impairment
    • cholesteatoma
      • granulation tissue around ossicles
      • Conductive hearing loss
71
Q

What is the most likely cause of Chronic Otitis Media in Diabetic patients? What severe complications can result?

A
  • Cause
    • Pseudomonas
  • Complications
    • meningitis
    • brain abscess
    • (aggressive)
72
Q

What is the most common cause of hearing loss in young and middle aged adults?

A

Otosclerosis

73
Q

Otosclerosis

  • Cause
  • Population
  • Path
A
  • Cause
    • AD
  • Population
    • young and middle aged adults
  • Path
    • bone deposition around stapes
    • eventually anchors it to oval window
    • Conductive hearing loss
74
Q

What benign tumors occur on the external ear?

A
  1. Epidermal inclusion cysts
  2. Aural polyps
    • Secondary to Chronic Otitis
  3. Nevi
  4. Squamous papilloma
75
Q

What malignant tumors occur on the external ear? What is the biggest risk factor?

A
  • Types
  1. Basal cell
    • local invasion only
  2. Squamous cell
    • Local invasion only
  3. Melanoma
  • Risk factor
    • Sun exposure
76
Q

What complications arise from SCC of the external ear canal?

A
  • Invades cranial cavity
  • Mets to lymph nodes
  • Result: poor outcome
77
Q

Acoustic Neuroma

  • Location
  • Associated condition
  • Outcome
A
  • Location
    • on 8th cranial nerve
    • Cerebello-pontine angle
  • Associated condition
    • Neurofibromatosis Type II
  • Outcome
    • Neural hearing loss
78
Q

Branchial Cyst

  • Location
  • Tissue of origin
  • Population
A
  • Location
    • along the SCM mm
  • Tissue of origin
    • 2nd Branchial Cleft
  • Population
    • 20-40 y/o
79
Q

Thyroglossal Duct Cyst

  • Location
  • Composition
A
  • Location
    • Midline of the neck
    • (starting at the base of the tongue)
  • Commposition
    • lymphoid aggregates
    • Thyroid tissue
80
Q

Paraganglioma

  • Cells of origin
  • Cell markers
  • Histo
  • Location
A

aka Carotid Body Tumor

  • Cells of origin
    • Parasympathetic ganglia
    • Secretes ACh
  • Cell markers
    • NSE
    • Chromogranin
    • Synaptophysin
    • CD56 and CD57
  • Histo
    • Zellballen pattern: nests of plump ovoid cells
    • Red/brown
  • Location
    • Carotid bifurcation most common
81
Q

What genetic disease is associated with multiple paragangliomas?

A

MEN II

(Sipple syndrome)

82
Q

What are the causes of xerostomia?

A
  1. Radiation
  2. Drugs
    • anticholinergics
    • antidepressant
    • anti-HTN
    • antihistamine
  3. Sjogren syndrome
83
Q

What side effects result from Xerostomia?

A
  1. Atrophy of papillae
  2. Fissuring
  3. Ulceration
  4. Increased dental caries
  5. Candidiasis
84
Q

What is a mucocele?

A
  • Blockage of salivary duct
  • Cystic swelling on lwr lip
85
Q

What is a mucocele in the sublingual gland area called?

86
Q

What are the causes of Sialadenitis?

A
  • Bacterial infxn secondary to stone in major duct
    • S. aureus
    • S. viridians
  • Dehydration following long-term phenothiazine therapy
  • Major abdominal / thoracic surgery
    • bacterial or suppurative parotitis
    • more common in elderly
87
Q

What are the symptoms of sialolithiasis?

A
  • Unilateral, painful enlargement
  • May or may not have purulent ductal discharge
88
Q

Where do salivary tumors most commonly occur? How do they present?

A
  • Location
    • Parotid most common
  • Presentation
    • non-painful
    • mobile mass (4-6 cm)
89
Q

What is the rule of thumb regarding salivary gland tumors and malignancy? In which gland is malignancy most common?

A
  • Rule:
    • The smaller the gland, the more likely it is malignant
  • Location of common malignancy?
    • Sublingual
90
Q

What is the most common tumor of the parotid gland?

A

Pleomorphic Adenoma

(aka Mixed Tumor)

91
Q

Pleomorphic Adenoma of Salivary Glands

  • Presentation
  • Genetic mutation
  • Risk of malignancy
  • Differentiating Primary vs Recurrent tumors
A
  • Presentation
    • Slow-growing
    • Painless
    • Mobile
  • Genetic mutation
    • PLAG1 rearrangement
  • Risk of malignancy
    • increases with duration
  • Differentiating Primary vs Recurrent tumors
    • Primary
      • unifocal
      • Benign
    • Recurrent
      • Multifocal
92
Q

Carcinoma Ex Pleomorphic Adenoma

  • What needs to be present for diagnosis?
  • Prognosis
A
  • Diagnosis
    • mixed tumor must be present
    • (aka malignant mixed tumor)
  • Prognosis
    • one of most aggressive salivary gland malignancy
93
Q

Warthin Tumor

  • Risk factor
  • Location
  • Histo
A

aka Adenolymphoma

  • Risk factor
    • Smoking
  • Location
    • Parotid gland
  • Histo
    • cleft-like spaces
    • Columnar epithelium
    • Subepithelial lymphoid tissue
94
Q

What is the most common primary tumor of the salivary glands?

A

Mucoepidermoid Carcinoma

95
Q

Mucoepidermoid Carcinoma

  • Genetic mutation
  • Common location
  • Appearance
A
  • Genetic mutation
    • MECT1-MAML2 fusion gene
  • Common location
    • Parotid
  • Appearance
    • Squamous and mucus-secreting cells
    • up to 8 cm
    • No capsule
    • Cystic configuration
96
Q

Mucoepidermoid Carcinoma

  • Metastasis
  • Prognosis
A
  • Metastasis
    • Bone
    • Brain
    • Lung
    • Regional nodes
  • Prognosis
    • Depends on grade
97
Q

Adenoid Cystic Carcinoma

  • Appearance
  • Clinical relavance
  • Metastasis
A
  • Salivary gland tumor
  • Appearance
    • small dark cells
    • Hyaline basement membrane
    • Tubular or cribiform pattern
  • Clinical
    • ​Perineural invasion
  • Metastasis
    • Mets to lung most common
98
Q

Acinic Cell Tumor

  • Appearance
  • Location
  • Prognosis
A
  • Appearance
    • Cells resemble normal serous cells of salivary gland
    • Rounded polygonal
  • Location
    • Parotid (most common)
    • Submandibular
  • Prognosis
    • depends on level of pleomorphism

Pathology (27 decks)

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