Head and Neck

Question 1

What is the underlying cause of dental caries?

Answer 1

Mineral dissolution, acids released by oral bacteria during sugar fermentation.

Demineralization > Reminineralization

Question 2

What is the mechanism by which fluoride protects against dental caries?

Answer 2

Fluoride replaces calcium producing fluorapatite which is more resistant to acids.

Question 3

Define gingivitis and clinical signs/symptoms of gingivitis.

Answer 3

Gingivitis: inflammation of oral mucosa surrounding teeth (gums).

Erythema, edema, bleeding, contour change, loss of soft tissue adaptation.

Question 4

Define dental plaque and how it can become tartar.

Answer 4

Dental plaque:
Sticky, colorless, biofilm that collects between surface of teeth

Unremoved plaque mineralizes to form calculus (tartar).

Question 5

Define periodontitis and its sequelae.

Answer 5

Inflammatory process affecting the periodontal ligaments, which could cause loosening teeth and eventually loss of teeth.

Question 6

What is the shift in oral flora associated with periodontitis?

Answer 6

Periodontitis-associated plaque contains anaerobic and microaerophilic Gram-negative flora (as opposed to facultative Gram-positive flora).

Question 7

Describe the clinical symptoms and appearance of aphthous ulcers.

Answer 7

Painful, shallow, hyperemic
ulcerations initially infiltrated by mononuclear inflammatory
cells; secondary bacterial infection recruits neutrophils.

Question 8

What infectious agents are associated with orofacial herpetic lesions?

Answer 8

Herpes simplex virus (HSV)

Question 9

Describe the clinical appearance of orofacial herpetic lesions.

Answer 9

Vesicles and ulcerations of the oral mucosa,

particularly the gingiva; accompanied by lymphadenopathy, fever, anorexia, and irritability.

Question 10

Define thrush and its most common etiologic agent.

Answer 10

A fungal infection of the oral cavity caused by candida albicans.

Question 11

Describe the clinical findings of thrush.

Answer 11

Pseudomembranous (white inflammatory membrane/patch that can be scraped off), erythmatous, hyperplastic.

Question 12

What are several clinical conditions that predispose to thrush?

Answer 12

Immunosuppressive conditions (AIDS, diabetes, organ/bone marrow transplant)
Broad-spectrum antibiotics.

Question 13

What are the characteristic lesion of hairy leuokplakia and what is its etiologic agent?

Answer 13

White patches of fluffy hyperkeratotic thickenings that CANNOT be scraped off; caused by Epstein-Barr Virus (EBV).

Question 14

Define leukoplakia. What is the “typical” patient with leukoplakia?

Answer 14

White patches that cannot be scraped off, usually tongue.

Ages 40-70; tobacco users.

Question 15

Describe the locations and appearances of this leukoplakia.

Answer 15

Usually on tongue; also vulva and penis.

White patches, often with demarcated borders.

Question 16

What are the common risk factors for the development of squamous cell carcinoma of head and neck?

Answer 16

Tobacco, alcohol
Human papillomavirus (HPV)
Actinic radiation (sun)

Question 17

What are the clinical signs and symptoms of rhinitis?

Answer 17

Infectious: thickened, edematous, red, narrow nasal cavities
Allergic: mucosal edema, redness
Chronic: ulcerations with inflammatory infiltrates

Question 18

Describe a nasal polyp and its potential sequelae.

Answer 18

Edematous mucosa infiltrated by neutrophils, eosinophils, and
plasma cells; most are not due to atopy.

Question 19

Describe underlying pathogenic mechanism of sinusitis.

Answer 19

Impairment of drainage by inflammatory edema. May impound suppurative exudate

Question 20

What are three characteristics of nasopharyngeal carcinoma and three factors that influence the origin of this disease process?

Answer 20

1. distinctive geographic distribution
2. close anatomic relationship to lymphoid tissue
3. association with EBV infection.
4. heredity
5. age
6. EBV infection

Question 21

What are the clinical findings most commonly seen with nasopharyngeal carcinoma?

Answer 21

Nasal obstruction, epistaxis, metastases to cervical lymph

Question 22

What are the common risk factors for development of reactive laryngeal nodules?

Answer 22

Heavy smokers and singers (great strain on vocal cords)

Question 23

Describe most common presenting symptoms and associated malignant potential of reactive laryngeal nodules.

Answer 23

Change in voice character and hoarseness; virtually never for malignant potential.

Question 24

What is/are the etiologic agent of laryngeal squamous papillomas?

Answer 24

HPV 6 and 11

Question 25

What are the clinical symptoms of laryngeal squamous papillomas?

Answer 25

Soft raspberry-like proliferation with finger-like projections.
Rarely malignant.

Question 26

What is the “typical” patient with carcinoma of the larynx?

Answer 26

Male chronic smokers

Question 27

What are the potential complications of chronic otitis media? What infectious agent is most commonly seen in diabetic persons with this disease process?

Answer 27

Complications: perforated eardrum, temporal cerebritis or abscess

Diabetes/Infectious agent:
Pseudomonas aeruginosa

Question 28

Define cholesteatoma and its association with otitis.

Answer 28

Non-neoplastic, cystic lesions lined by keratinized squamous epithelium or mucus-secreting epithelium, filled with amorphous debris

Associated with chronic otitis media.

Question 29

Define otosclerosis and note its bilaterality.

Answer 29

Abnormal bone deposition in the middle ear around the rim of the oval window. Usually bilateral.

Question 30

Describe the heritability and outcome of otosclerosis.

Answer 30

Autosomal dominant with variable penetrance.

Slowly progressive which leads to hearing loss.

Question 31

Describe the cellular origin of acoustic neuromas and list the common signs/symptoms.

Answer 31

Encapsulated benign tumors exhibiting Schwann cell differentiation arising from peripheral nerves.

Local compression of involved nerve can lead to tinnitus and hearing loss.

Question 32

Define xerostomia and any associated clinical conditions.

Answer 32

Dry mouth resulting from a decrease in the production of saliva.

Autoimmune disorder Sjögren syndrome. Side effects of certain medications.

Question 33

What are the complications of unmanaged xerostomia?

Answer 33

Increased rates of dental caries, candidiasis, difficulty in swallowing and speaking

Question 34

What is the difference between sialadenitis and sialolithiasis?

Answer 34

Sialadenitis:
Salivary glands; induced by trauma, viral/bacteria infection, and autoimmune disease; Sjögren syndrome

Sialolithiasis:
salivary glands; induced by obstruction of the orifices of the salivary glands; can lead to sialolithiasis.