head and neck -- upper airways, nasal, sinuses, neck

Question 1

What are the two types of odontogenic cysts and what do they come from?

Answer 1

Developmental (dentigerous most common subtype) and Inflammatory (radicular aka ‘periapical’ most common subtype).
Inflammatory is more common overall and both types of cysts come from odontogenic epithelium

Question 2

What is the name for a malignant tumor of odontogenic origin?

Answer 2

ameloblastoma

Question 3

What conditions lead to a tumor or bump in the nose/nasal cavity/nasal pharynx?

Answer 3

polyps (not really a tumor but most common)
angifibroma
papilloma
plasmacytoma
neuroblastoma
nasopharyngeal carcinoma

Question 4

Most nasal polyps generally result from what?

Answer 4

allergic rxn

Question 5

What is the best way to view the sinuses?

Answer 5

limited CT scan

Question 6

How is allergic rhinitis mediated?

Answer 6

IgE with lots of esinophils

Question 7

How does allergic rhinitis present?

Answer 7

mucosal erythema and edema. lots of mucus secretion.

turbinates pale.

Question 8

why does chronic allergic rhinitis sometimes get biopsied?

Answer 8

thickness of mucosa builds up such that it can be mistaken for a bacterial infx

Question 9

What is the most common cause of infectious rhinitis?

Answer 9

Virus…adenovirus most often. Also rhinovirus.

Question 10

How does infectious rhinitis present?

Answer 10

edematous, erythematous, thickened nasal mucosa. turbinates are enlarged.
also may see concomitant pharyngotonsilitis because viruses spread everywhere at once.

Question 11

What is the usual origin of chronic rhinitis?

Answer 11

repeat acute rhinitis (allergic or infectious) with secondary microbial infx.
deviated septum and nasal polyps predispose.

Question 12

how does chronic rhinitis often present?

Answer 12

grey hue to the mucosa and not nearly as much edema. often ulceration of the mucosa. risk of spreading suppurative infx to the sinuses.

Question 13

What are nasal polyps? What do they arise from? What is often present in their infiltrate? And what must be ruled out when they appear in a young caucasian?

Answer 13

edematous mucosa with loose stroma. come from recurrent rhinitis or an unknown origin. infiltrate has inflammatory eosinophils and PMNs. must rule out CF in a young caucasian.

Question 14

what cells are common in the infiltrate of chronic rhinitis and polyps?

Answer 14

inflammatory cells….PMNs, eosinophils

Question 15

What are the sxs of Samter’s triad?

Answer 15

chronic rhinosinusitis w/ polyps
severe asthma
salicylate sensitivity

reaction to aspirin but also can be NSAIDs

Question 16

what dzs are associated with nasal polyps?

Answer 16

• samter’s triad
• CF
• allergic fungal sinusitis
• kartagener’s syndrome
• young’s syndrome

Question 17

What are the top three problems leading to acute sinusitis?

Answer 17

• Drainage is uphill for maxillary sinus
• Sinuses are bony caves making it hard for Abx to even get in there
• Pseudmonas has figured out how to not get killed even if drugs reach it

Question 18

What are common precursors to acute rhinosinusitis?

Answer 18

acute or chronic rhinitis

Question 19

______ account for 90-95% on infectious sinusitis cases

Answer 19

viruses

Question 20

What are the three categories of sinusitis based on time?

Answer 20

Acute: sxs for less than 4 wks
Subacute: sxs for 4-12 wks
Chronic: sxs for 12+ wks

Question 21

__________ patients and those with ________ are more prone to a fungal sinusitis (mucormycosis).

Answer 21

immunocompromised;

diabetes (fungi love the high blood sugar)

Question 22

Where are some dangerous and nearby places sinus infxs like to spread?

Answer 22

the eye (opthalmitis)
soft tissue around the eye (periorbital cellulitis)
facial bone (osteomyelitis)
cranial vault (meningitis; encephalitis)

Question 23

What is Kartagener syndrome and how does it present?

Answer 23

autosomal recessive d/o where the cilia don’t move (ciliary dyskinesia).

presents as: chronic sinusitis, bronchiectasis, situs inversus

Question 24

What are the two ‘necrotizing’ upper airway lesions? How serious are they?

Answer 24

‘lethal’ midline granuloma: a tumor of NKT cells
‘wegener’ granulomatosis: causes necrotizing gingival ulcerations

both are potentially fatal as necrotization opens the way for bacterial infx.
NK cell lymphoma is radiosensitive but spreads everywhere and so you can’t radiate the whole body at once.

Question 25

What are the three most common laryngeal proliferations?

Answer 25

• polyp
• papilloma (a collection of polyps)
• carcinoma

Question 26

Are true and false vocal cords now called vocal folds and vestibular folds, respectively?

Answer 26

Yes

Question 27

What are the characteristics of a carcinoma?

Answer 27

ulcerated, irregular, indurated, invasive, and destructive, with secondary necrosis.

Question 28

By what are nasopharyngeal carcinomas characterized?

Answer 28

• distinctive geographic distribution
• anatomic relationship to lymphoid tissue
• association w/EBV infx

Question 29

What are the three histologic patters of nasopharyngeal carcinomas?

Answer 29

• Keratinizing squamous cell carcinomas
• Non-keratinizing squamous cell carcinomas
• Undifferentiated carcinomas that have an abundant non-neoplastic, lymphocytic infiltrate

Question 30

What is a nasopharyngeal fibroma? Who gets them the most?

Answer 30

Thick collagenous growth around blood vessels. Highly vascular tumors but benign. Trouble to cut surgically.

Adolescent males

Question 31

What is a sinonasal papilloma? With which virus(es) is it associated? What are the forms?

Answer 31

Benign neoplasm in the nose and sinuses. Associated with HPV 6 and 11.

Three forms:
exophytic - most common
cylindrical
inverted - most aggressive

Can be excised but a high recurrence if not fully removed. Can potentially invade orbit or cranial vault

Question 32

How do normal papillomas differ from inverted in terms of growth shape?

Answer 32

normal papilloma - fingers out

inverted - fingers in

Question 33

What are the four features of normal plasma cells (mature B cell)?

Answer 33

1. big
2. large nucleus
3. small amts cytoplasm
4. stain blue

Question 34

How do plasmacytomas lead to protein in the urine?

Answer 34

Normal plasma cells produce Ab, these cells only produce certain chains…when the Ab can’t be produced, excess protein goes to the urine.

Question 35

How many plasmacytomas will become multiple myelomas and express a monoclonal gammopathy?

Answer 35

many if not all given enough time

Question 36

What is an olfactory neuroblastoma?

Answer 36

head and neck malignancy arising from neuroendocrine cells which will secrete granules

neuroblastomas tend to metastasize

Question 37

What histologic pattern do most neuroblastomas have?

Answer 37

rosettes