Head and Neck Pathology (2)- Gomez Flashcards

Question

Epiglottitis = Laryngoepiglottitis

Answer 1

Swelling of epiglottis secondary to infections (most common), chemical, and traumatic agents Complete blockage of the airway may occur (suffocation and death) Airflow resistance increases H. influenzae type b main cause prior to Hib vaccine where most patients were young (~2 yr) children Pleomorphic Gram negative coccobacilli that colonize upper airways (predominantly encapsulated variants) Also causes pneumonia, sinusitis, otitis media, meningitis, cellulitis Also caused by RSV & β-hemolytic strep Nowadays more common in adults (3M:1F), but pretty rare

Answer 2

Definition: Laryngitis < 3 weeks Symptoms Hoarseness (gradual onset, progressive) Decreased vocal volume Painful speech ``` Common Causes Infections Vocal overuse: Acute – loud yelling Vocal overuse: Subacute – lecturing Heavy smoking (acute) Direct trauma ``` Uncommon Causes Acute allergic reactions Acid reflux from the stomach (GERD)

Answer 3

Clinical Course: abrupt onset, self-limited, less than 3 wk duration Age of Onset: 3 – 5 yrs* & 18–40 yrs Symptoms: progressive hoarseness (aphonia) often concurrent upper respiratory tract infection (URI) Laryngoscopy: vocal cords swollen and red Etiology Viruses > 90% cases: Rhinoviruses, Parainfluenza, RSV, Adenoviruses Bacteria causes: H. influenzae, S. pneumonia *In children may lead to life-threatening laryngoepiglottitis!

Answer 4

inspiratory stridor seal-like barking mainly parainfluenza Steeple sign- subglottic narrowing, absent in about half the kids Pathogenesis Infection via aerosol into nasopharynx and spread to larynx and trachea Edema and inflammation in subglottic larynx and trachea around cricoid cartilage – airway narrowing. May have endothelial damage and loss of ciliary function. Fibrinous exudate may be formed and add to airway occlusion Edema of vocal cords can cause hoarseness Treatment Supportive with short term steroids to reduce inflammation

Answer 5

Usually occurs in middle-aged females who are heavy smokers Can also occur with heavy, recurrent voice strain Develop husky low-pitched weak voices Soft, gelatinous translucent expansion of cord surfaces caused by edema and expansion of Reinke space (lamina propria of vocal mucosa)

Answer 6

Pathogenesis: Reaction to injury of vocal cord Hyperkeratosis Increased myxoid stroma Classic location at*** junction anterior and middle third of cord*** Nodules *- bilateral, small (~2-3 mm) Polyp -* unilateral, larger (~4-8mm) Occurs following * sustained injury caused by Heavy smoking Heavy, recurrent voice strain (**singer’s nodules) “They virtually never give rise to cancers”

Answer 7

Papillomas: Benign neoplasms located on true vocal cords Usually single in adults, but can be recurrent Multiple in children (juvenile laryngeal papillomatosis) Caused by HPV types 6/11

Answer 8

``` Clinical Findings Prolonged hoarseness (> 6 wks) earliest, most consistent symptom ``` dysphagia, palpable cervical lymph nodes Epidemiology : most heavy smoking (> 50 pack years) Ethanol abuse/dependence

Answer 9

1. Glottic carcinoma: involves the true vocal folds 50-60% of laryngeal carcinomas 2. Supraglottic carcinoma: confined to the supraglottic area (free border of the laryngeal epiglottis, false vocal folds and laryngeal ventricles) 30-40% of laryngeal carcinomas Discovered later– early tumors do not cause hoarseness Higher stage tumors at diagnosis - 2/3 Stage III or IV 3. Subglottic carcinoma: extend or arise more than 10mm below the free margin of the true vocal fold up to the inferior border of the cricoid cartilage. less than 5% of laryngeal carcinomas 4. Transglottic carcinoma: cross the ventricle from the supraglottic area to involve the true and false vocal folds or involve the glottis and extend subglottically more than 10 mm or both. Glottic tumors: 5 yr survival ~65% Supraglottic tumors: 5 yr survival ~45%

Answer 10

Intrinsic - confined to larynx Extrinsic - beyond the larynx Transglottic carcinoma - the large, ulcerated, fungating lesion involving the vocal cord and pyriform sinus.

Answer 11

Marked tenderness after gentle traction of pinna Peak age between 7-12 Physical Findings: erythema, swelling, moist debris +/-pus Etiology: Traumatized ear canal excessive use cotton-tip swabs retained contaminated water “Swimmer’s Ear” Bacterial - 90% Pseudomonas Sp - many Fungal- 10% (aspergillus, candida)

Answer 12

Simply skin tumors; i.e. squamous and basal cell carcinoma

Answer 13

lined by thin “non-keratinizing” stratified squamous epithelium ossicles: malleus, incus, stapes

Answer 14

Tympanic membrane opacity, bulging , erythema, effusion and decreased motility

Answer 15

Bacterial agents: Pseudomonas aeruginosa, S. aureus Long-term sequellae: Perforation tympanic membrane, scarring, mastoiditis and bone erosion, cysts; conductive hearing loss common *** ear-o? Aer-o and aur-o

Answer 16

Two types of cyst lining ``` Squamous epithelium (cholesteatoma): large amounts keratin produced Metaplastic columnar epithelium: mucin-secreting ```

Answer 17

Squamous epithelium trapped within the temporal bone (middle ear or mastoid)

Answer 18

Autosomal dominant, variable penetrance Progressive ankylosis/immobilization over decades → severe conductive hearing loss Pathologic process Callus of bone accumulates at footplate of the stapes and rim of oval window

Answer 19

``` Sinus tracts Fistulas Cysts (lymphoepithelial cyst) Circumscribed ~2 - 5 cm 20-40 y.o. ``` *** Lateral neck Most arise from 2nd branchial cleft

Answer 20

Cyst in midline location usually lined by respiratory or squamous epithelium and usually has chronic inflammation and thyroid follicles in the wall

Answer 21

Prototype of parasympathetic tumor Bruit on auscultation *** Slow growing, painless mass, pulsatile May metastasize to lymph nodes and distant