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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
Erythroplakia * Gross Appearance * Micro Appearance * Cause
* Appearance * Red velvety area * May erode * Micro * atypia * Pre-malignant (CIS) * Malignant * Dysplasia w/o hyperkeratosis * Cause * assoc. w/ tobacco use
26
What is the most common cancer of the head and neck?
Squamous Cell Carcinoma | (95%)
27
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?
* Survival: 50% * Cause of death: second primary tumor
28
What are the risk factors for the following types of SCC? * Head and Neck (in general) * Lower lip * Oropharynx
* Head and Neck (in general) * Alcohol and Tobacco use * Lower lip * Actinic exposure * Pipe smoking * Oropharynx * HPV
29
Alterations in which genes is associated with Classic SCC of the Head and Neck?
* p53 * p63 * NOTCH1
30
Alterations in which genes is associated with HPV SCC of the Head and Neck?
* p53 * p16 * Rb pathway
31
Where does SCC metastasize first? What are the locations of distant metastasis?
* First * Cervical Nodes * Distant * Mediastinal nodes * Lung * Liver * Bone
32
Mutation in which gene causes progression from hyperplasia / hyperkeratosis to moderate dysplasia of the mouth (progression to SCC)?
p16
33
Mutation in which gene causes progression from moderate dysplasia to Severe displasia / CIS of the mouth (progression to SCC)?
p53
34
Mutation in which gene causes progression from Severe displasia / CIS to SCC of the mouth?
Rb pathway Cyclin D
35
Dentigerous cysts * Appearance * Location * Treatment
* Appearance * Unilocular cyst * Location * around crown of unerupted tooth * usually wisdom tooth * Treatment * Removal
36
Odontogenic Keratocysts * Appearance * Location * Treatment
* Appearance * Uni- or Multilocular cyst * Corrugated surface * Location * post. mandible * Treatment * Aggressive excision * (60% recurrence rate)
37
What is Gorlin Syndrome?
Nevoid Basal Cell Carcinoma Syndrome Has multiple odontogenic keratocysts
38
Periapical cysts * Appearance * Location * Cause * Treatment
* Appearance * Periapical abscess * Location * Around apex of teeth * Cause * Pulpitis * Treatment * Removal of infected material * May extract tooth
39
Ameloblastoma * Appearance * Origin * Treatment
* Appearance * cystic lesion * Locally invasive tumor * Origin * Odontogenic epithelium * Treatment * Wide resection to prevent recurrence
40
Odontoma * Definition * Composition * Treatment
* Definition * Odontogenic tumor * Most common tumor of this type * Composition * Enamel * Dentin * Treatment * Local Excision
41
Infectious Rhinitis * Symptoms * Most common causes
* Symptoms * Thickened, red mucosa * Enlarged turbinates * Profuse discharge * purulent w/ secondary bacterial infection * Most common causes * Adenovirus * Echovirus * Rhinovirus * "AER"
42
What type of hypersensitivity is Allergic Rhinitis? What is the most prominent cell type seen?
* Type I (IgE) Hypersensitivity * Cell: Eosinophils
43
Nasal polyps * Cause * Most abundant cell type
* Cause * Recurrent Rhinitis * Cell: * Eosinophils
44
Chronic Rhinitis * Cause * Associated conditions * Result
* Cause * Repeated Acute Rhinitis + superimposed bacterial infxn * Associated conditions * Deviated septum * Nasal polyps * (impaired drainage) * Result * Ulceration * Suppuration * Extention into sinuses
45
What complications can arise from sinusitis (suppurative)?
* Osteomyelitis * Intracranial infxn * Dural sinus thrombophlebitis
46
What fungal infection is commonly seen in sinusitis with concurrent diabetic acidosis?
Mucormycoses
47
What are the symptoms of Kartagener's syndrome?
* Chronic sinusitis * Bronchiectasis * Situs inversus Cause; defective ciliary action
48
What 3 disorders cause Necrotizing Sinusitis?
1. Mucormycosis 2. Granulomatosis with polyangiitis 3. Extranodal NK / T-cell lymphoma
49
Extranodal NK / T-cell Lymphoma * Presentation * Viral association * Prognosis
* 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
What are the frequent viral causes of pharyngitis / tonsillitis?
AER * Adenovirus * Echovirus * Rhinovirus
51
What bacteria are often associated with pharyngitis / tonsillitis? What severe complications may result?
* Bacteria * beta-strep (most often) * S. aureus * Complications * Rheumatic fever * Glomerulonephritis
52
Nasopharyngeal angiofibroma * Population affected * Associated condition * Prognosis * Causes of fatality
* Population affected * Adolescent males * Associated condition * Familial Adenomatous Polyposis * Prognosis * Benign * Locally aggressive * Causes of fatality * Bleeding * Intracranial extension
53
Inverted papilloma * Associated with which virus? * Cell type * Prognosis
* Associated with which virus? * HPV 6 and 11 * Cell type * Squamous epithelium * Prognosis * Benign * Locally aggressive * may invade orbit or cranial vault
54
Olfactory neuroblastoma * Cell type * Cell markers * Mutation present * Treatment
* 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
NUT Midline Carcinoma * Associated with what other malignancy? * Location * Genetic mutation * Population * Prognosis
* 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
Plasmacytoma * Cell type * Frequency of progression to multiple myeloma
* Cell type * Malignant plasma cells * Progression to multiple myeloma * Rare
57
What are the three types of nasopharyngeal carcinomas? Which types are associated with EBV? Which is the least radiosensitive?
Squamous cell / basaloid carcinomas 1. Keratinizing (least radiosensitive) 2. Non-keratinizing (EBV) 3. Undifferentiated / lymphoepithelioma (EBV)
58
What populations are more commonly affected by nasopharyngeal carcinomas?
1. Adults in S. China 2. Children in Africa
59
Nasopharyngeal carcinomas spread to which lymph nodes? What are the sites of metastasis?
* Nodes * Cervical * Mets * Lungs * Pleural cavities * Liver
60
What environmental exposures are associated with nasopharyngeal carcinomas?
1. EBV 2. Nitrosamines 3. Fermented food 4. Salted fish 5. Smoking 6. Chemical fumes
61
Acute laryngoepiglottitis * Cause * Symptoms * Appearance on lateral CXR
* 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
Laryngotracheobronchitis * Symptoms * Prognosis
* Symptoms * Inspiratory stridor * Prognosis * Fine * No obstruction occurs
63
What are the benign tumors of the Larynx?
1. Chondromas 2. Leiomyomas 3. Polyps 4. Papillomas
64
What is the difference between laryngeal polyps and singer's nodules?
* Polyps: unilateral * Singer's nodules: bilateral
65
Laryngeal polyps * Cause * Symptoms * Location * Histo
* Cause * Overuse of vocal cords * Smoking * Symptoms * Hoarseness * Location * True vocal cords * Histo * Round nodule * Squamous epithelium * Underlying vascular myxomatous stroma
66
Papillomas * Cause * Symptoms * Location * Appearance / Histo
* 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
Carcinoma of the Larynx * Symptoms * Location * Appearance * Risk factors
* 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
What is the most common type of Laryngeal Carcinoma?
Squamous (95%)
69
Acute Otitis Media * Appearance * Cause
* Appearance * red, bulging tympanic membrane * (w/pain) * Cause: * Viral infxn w/ superimposed bacterial infxn * Strep. pneumonia * H. influenza * M. catarrhalis
70
Chronic Otitis Media * Cause * What symptoms differentiates from acute? * Complications
* Cause * S. aureus * P. auruginosa * Fungus * Symptom * drainage * Complications * TM perforation * Hearing impairment * cholesteatoma * granulation tissue around ossicles * Conductive hearing loss
71
What is the most likely cause of Chronic Otitis Media in Diabetic patients? What severe complications can result?
* Cause * Pseudomonas * Complications * meningitis * brain abscess * (aggressive)
72
What is the most common cause of hearing loss in young and middle aged adults?
Otosclerosis
73
Otosclerosis * Cause * Population * Path
* Cause * AD * Population * young and middle aged adults * Path * bone deposition around stapes * eventually anchors it to oval window * Conductive hearing loss
74
What benign tumors occur on the external ear?
1. Epidermal inclusion cysts 2. Aural polyps * Secondary to Chronic Otitis 3. Nevi 4. Squamous papilloma
75
What malignant tumors occur on the external ear? What is the biggest risk factor?
* Types 1. Basal cell * local invasion only 2. Squamous cell * Local invasion only 3. Melanoma * Risk factor * Sun exposure
76
What complications arise from SCC of the external ear canal?
* Invades cranial cavity * Mets to lymph nodes * Result: poor outcome
77
Acoustic Neuroma * Location * Associated condition * Outcome
* Location * on 8th cranial nerve * Cerebello-pontine angle * Associated condition * Neurofibromatosis Type II * Outcome * Neural hearing loss
78
Branchial Cyst * Location * Tissue of origin * Population
* Location * along the SCM mm * Tissue of origin * 2nd Branchial Cleft * Population * 20-40 y/o
79
Thyroglossal Duct Cyst * Location * Composition
* Location * Midline of the neck * (starting at the base of the tongue) * Commposition * lymphoid aggregates * Thyroid tissue
80
Paraganglioma * Cells of origin * Cell markers * Histo * Location
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
What genetic disease is associated with multiple paragangliomas?
MEN II | (Sipple syndrome)
82
What are the causes of xerostomia?
1. Radiation 2. Drugs * anticholinergics * antidepressant * anti-HTN * antihistamine 3. Sjogren syndrome
83
What side effects result from Xerostomia?
1. Atrophy of papillae 2. Fissuring 3. Ulceration 4. Increased dental caries 5. Candidiasis
84
What is a mucocele?
* Blockage of salivary duct * Cystic swelling on lwr lip
85
What is a mucocele in the sublingual gland area called?
Ranula
86
What are the causes of Sialadenitis?
* 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
What are the symptoms of sialolithiasis?
* Unilateral, painful enlargement * May or may not have purulent ductal discharge
88
Where do salivary tumors most commonly occur? How do they present?
* Location * Parotid most common * Presentation * non-painful * mobile mass (4-6 cm)
89
What is the rule of thumb regarding salivary gland tumors and malignancy? In which gland is malignancy most common?
* Rule: * The smaller the gland, the more likely it is malignant * Location of common malignancy? * Sublingual
90
What is the most common tumor of the parotid gland?
Pleomorphic Adenoma | (aka Mixed Tumor)
91
Pleomorphic Adenoma of Salivary Glands * Presentation * Genetic mutation * Risk of malignancy * Differentiating Primary vs Recurrent tumors
* 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
Carcinoma Ex Pleomorphic Adenoma * What needs to be present for diagnosis? * Prognosis
* Diagnosis * mixed tumor must be present * (aka malignant mixed tumor) * Prognosis * one of most aggressive salivary gland malignancy
93
Warthin Tumor * Risk factor * Location * Histo
aka Adenolymphoma * Risk factor * Smoking * Location * Parotid gland * Histo * cleft-like spaces * Columnar epithelium * Subepithelial lymphoid tissue
94
What is the most common primary tumor of the salivary glands?
Mucoepidermoid Carcinoma
95
Mucoepidermoid Carcinoma * Genetic mutation * Common location * Appearance
* Genetic mutation * MECT1-MAML2 fusion gene * Common location * Parotid * Appearance * Squamous and mucus-secreting cells * up to 8 cm * No capsule * Cystic configuration
96
Mucoepidermoid Carcinoma * Metastasis * Prognosis
* Metastasis * Bone * Brain * Lung * Regional nodes * Prognosis * Depends on grade
97
Adenoid Cystic Carcinoma * Appearance * Clinical relavance * Metastasis
* Salivary gland tumor * Appearance * small dark cells * Hyaline basement membrane * Tubular or cribiform pattern * Clinical * ​**Perineural** invasion * Metastasis * Mets to **lung** most common
98
Acinic Cell Tumor * Appearance * Location * Prognosis
* 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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