Head And Neck Pathology

Question 1

This is a build up of atherosclerotic plaque in lumen of common carotid neat bifurcation into external/internal carotid

Answer 1

Carotidstenoisis

Question 2

What does carotid stenosis do to blood flow

Answer 2

Reduces it, but can be asymptomatic if mild

Question 3

What can carotid stenosis lead to

Answer 3

Thrombosis at stenotic site or formation of emboli which can occlude major arteries

Question 4

What arteries could thrombosis occur in if one has a carotid stenosis

Answer 4

MCA, ACA, opthalmic

Question 5

What ocular manifestation can a carotid stenosis lead to

Answer 5

Amaurosis fugax

Question 6

What is carotid stenosis accompanied with on physical exam

Answer 6

Bruit

Question 7

Severity of carotid stenosis deefeind by

Answer 7

Degree of narrowing of lumen

Question 8

Treatments fo carotid stenosis

Answer 8

Carotid endarterectomy, angioplasty, stenting

Question 9

Surgical removal of the atherosclerotic build up. Can be performed for asymptomatic patients but usually not done due to high risk:benefit ratio

Answer 9

Carotid endarterectomy

Question 10

Some patients may gradually develop complete filling occlusion of a Lon segment of the internal carotid, but are functional intact due to general compensation though collateral blood flow via circle of Willis. But thrombi can form at distal end of occlusion, which makes endarterectomy risky. Occurs in carotid stenosis

Answer 10

Carotid occlusion

Question 11

Trauma-induced tear in the intimal lining of the vessel, creating a flap of tissue protruding in the lumen that can occlude the vessel. Patient may have heard a popping sound at the time of the tear

Answer 11

Carotid/vertebral dissection

Question 12

Complications of carotid/vertebral dissection

Answer 12

Can trigger thrombosis along the dissection flap and then occlusion

Question 13

Presentation of carotid/vertebral dissection

Answer 13

Pain in distribution areas (orbital pain with carotid artery, neck/occipital pain for vertebral artery), signs of transient ischemic attacks or an infraction, horners syndrome ipsilaterslly

Question 14

Inflammatory disease in larger arteries involving the elastic laminate, can lead to ischemia distal to site of origin.

Answer 14

Vasculitis

Question 15

Relevant arteries for vasculitis

Answer 15

Vertebral, ophthalmic. Can also involve smaller vessels including the posterior ciliary. More common in extramural arteries

Question 16

Risk of temporal arteritis

Answer 16

Risk of secondary ischemia due to occlusion or significant narrowing

• can develop in CNS, especially in neuro-ophthalmic pathway (ischemic optic neuropathy)
• transient ongoing visual loss

Question 17

This is an emergency to prevent blindness

Answer 17

Temporal arteritis: experiencing transient or ongoing visual loss

Question 18

This can cause ischemic optic neuropathy

Answer 18

Temporal arteritis

Question 19

How is temporal arteritis treated

Answer 19

With glucocorticoids (anti-inflammatory)

Question 20

Presentation of temporal arteritis

Answer 20

• visible los of blood perfusion in the affected side of face
• fever, aches and pains in arterial distribution, scalp tenderness, HA
• jaw claudication (pain/tenderness while chewing)
• general, non-specific signs: weight loss, anemia
• can lead to-or be co-morbid with-peripheral neuropathic

Question 21

Retinal presentation with temporal arteritis

Answer 21

May be normal, or white swelling around optic disc

Question 22

Demographics of temporal arteritis

Answer 22

Rare in people under 50
Typically seen in people over 70
More common in women than men
More common Caucasian’s than AA

Question 23

DX appraoches for temporal arteritis

Answer 23

Biopsy of temporal artery

Angiogram

Question 24

Autoimmune pathology that is the most common origin for orbital disorders in adults. AB produced that target T-SHIRT receptor in thyroid gland.

Answer 24

Graves’ disease

Question 25

Most common origin for orbital disorder in adults

Answer 25

Graves’ disease

Question 26

What is the autoimmune problem for graves

Answer 26

AB generated that a target TSH receptor in thyroid gland

Question 27

Ab effect in Graves’ disease

Answer 27

Have a stimulators effect on TSH-R, activating T3 and T4 release

Question 28

How does Graves’ disease affect orbit

Answer 28

Lymphocytic infiltration syndrome in orbit, hence orbital sign.
Ab also induce excess production of glucoaminoglycans in orbital fat and EOMs

Question 29

Hyperthyroid presentation

Answer 29

• often palpable goiter over the thyroid gland
• tachycardia
• generalized symptoms: fatigue, weight loss, anxiety, Heat intolerance, sweating, increased appetite

Question 30

Thyroid associated ophthalmology

Answer 30

Periocular swelling
Lid retraction
Bulging eyes
Diplopia and dyscongucvgte gaze
Oculomotor deficits-varies but typically impaired and abduction.
Frequent complaints of foreign body sensation or pain during eye movements

Question 31

Craniopharyngeal carcinoma

Answer 31

More likely to invade intracranial if spreads to cranial sinuses, eg ethmoid sinuses

Question 32

Nasopharyngeal carcinoma

Answer 32

More likely to invade intracranially if spreads to cranial sinuses, ethmoid sinuses

Question 33

Laryngeal carcinoma

Answer 33

More common in smokers, presents with hoarseness, cervical lymphadenopathy
-less likely to invade CNS

Question 34

Salivary gland carcinoma

Answer 34

• most common form originates in parotid gland
• so can invade toward CNS along facial nerve
• less likely to lead to visual or oculomotor system disturbances

Question 35

Lymphoma

Answer 35

• CNS essentially lacks lymphatic vessels and nodes
• primary CNS lymphoma: very rare, develops from glial cells
• choleric lymphocytic lymphoma (B cell lymphoma): in lymph vessels and nodes, relatively benign, contained with very selective chemotherapeutic RX