HEENT Flashcards
1
Q
Which type of cells line the air tract?
A
Columnar (pseudostratified)
2
Q
Which type of cells line the food tract?
A
Stratified squamous
3
Q
What occurs when columnar cells become damaged?
A
Metaplasia- they become squamous
4
Q
When can you expect deciduous teeth to erupt?
A
6m to 2yrs of age
5
Q
How many permanent teeth does a human have?
A
32
6
Q
Which tissue is the most mineralized in the body?
A
Enamel
7
Q
What is enamel synthesized by?
A
ameloblasts
8
Q
What does dentin contain?
A
dentinal tubules
9
Q
What is destroyed by caries?
A
Enamal and Odontoblasts which produce dentin
10
Q
The pulp is rich in…
A
Nerve bundles, lymphatics, and capillaries
11
Q
What does the Periodontal ligament do?
A
connects cementum to alveolar bone
12
Q
What does Periodontal DZ cause?
A
tooth loss
13
Q
What does S. mutans metabolize?
A
Sucrose to lactic acid
14
Q
What does Lactobacilli metabolize
A
lactose to lactic acid
15
Q
What is Bifidobacteria and what can result from it?
A
gram + bacteria used in probiotics. May increase risk for caries.
16
Q
What does flouride do?
A
incorporates into enamel structure and becomes resistant to degradation by bacterial acids.
17
Q
what does fluorosis cause?
A
Hypomineralization causing brown pitted enamel and weak(bowed) bones. Occurs with flouide intake >0.05mg/kg/day
18
Q
What is plaque made from?
A
bacteria, proteins, and desquamated epithelial cells forming a “bacterial bioflim”
19
Q
What is Calculus?
A
mineralized plaque AKA tartar.
20
Q
What causes gingivitis?
A
Lack of proper oral hygiene leading to dental plaque and calculus.
21
Q
Is gingivitis reversible?
A
Yes
22
Q
What is periodontitis?
A
Inflammation of supporting structures (periodontal lig., alveolar bone, and cementum)
23
Q
Is periodontitis only caused from gingivitis?
A
No, it can also be an independent DZ or present with other systemic DZs
24
Q
Which bacteria cause periodontitis?
A
Actinobacillus, Porphyromanas, Prevotella
25
What are the manifestations of Periodontitis?
loosening or loss of teeth
26
What criteria are used for periodontitis diagnosis?
Main=attachment loss, 2nd= Probing depth,3rd= Radiographic alveolar bone loss
27
Periodontitis Tx?
Includes debridement, scaling and root planing of subgingival biofilm and calculus by a periodontist, general dentist or dental hygienist. Topical or systemic antibiotics can be used in adjunct.
28
What are the 4 types of
| Fibrous proliferative lesions of the oral cavity
Fibroma (61%), peripheral ossifying fibroma(22%), Pyogenic granuloma (12%), peripheral giant cell granuloma (5%)
29
Where do most oral fibromas occur?
Buccal mucosa along bite line
30
oral fibroma Tx?
surgical excision if bothersome. Cannot aspirate bc it is fibrolytic with few inflammation cells.
31
How do you recognize a pyogenic granuloma?
They occur in gingiva and are red to purple due to it being highly vascularized
32
Pyogenic granuloma Tx?
regress spontaneously or surgical excision
33
Which type of lesion can occur in the oral cavity with pregnancy?
Pyogenic granuloma- no need for treatment
34
peripheral ossifying fibroma Tx?
surgical excision down to periosteum
35
What are peripheral giant cell granulomas made from?
Made of aggregation of multinucleate foreign body like giant cells separated by fibroangiomatous stroma
36
Peripheral giant cell granuloma Tx?
refer to ENT or Oral Surgery
37
What 2 diseases can Aphthous ulcers be associated with?
Celiac, IBD
38
What is Plummer-Vinson or Paterson-Kelly syndrome?
Combination of iron deficiency anemia, glossitis and esophageal dysphagia
39
What is glossitis associated with?
Vitamin B12 deficiencyDeficiency of: riboflavin, niacin, or pyridoxineSprue and iron deficiency anemiaBact or viral infectionIrritants= tobacco, ETOH, spices
40
Which type of Herpes is most common for oral infections?
HSV type1
41
What is herpetic gingivostomatitis?
abrupt onset of vesicle and ulcerations in oral cavity
42
Oral HSV Tx?
Symptomatic Tx-acyclovir (within 72 to 96hrs)
43
Which form of oral candidiasis is Thrush?
Pseudo membranous form. It can be scrapped off
44
Which form of oral candidiasis cannot be scrapped off?
Hyperplasitic
45
What is important to remember with oral disorders?
Many occur from systemic Dzs. Its important to look at the big picture.
46
What are premalignant lesions of the oral cavity?
Leukoplakias, erythroplakia, oral lichen planus
47
What are malignant lesions of the oral cavity?
squamous cell carcinoma(HPV is a major cause)
48
What causes oral lichen planus?
chronic inflammatory autoimmune disorder with many phenotypes
49
What does hypermethylation of the p16 gene cause?
Inactivation of p16( a inhibitor of cyclin-dependent kinase) = hyperplasia
50
What does a mutation of p53 cause
dysplasia (size, shape, organization)
51
95% of cancers of the head and neck are SCC. What are the remaining?
adenocacinomas (salivary gland in origin)
52
What size would indicate Head and neck squamous cell carcinomas(HNSCC) having a low chance of metastasis?
less than 4mm in depth
53
how are HNSCC lesions less than 2cm in diameter treated?
often cured by local resection
54
What are the pathogenesis of HNSCC
Often multifactoral from...SmokingAlcoholActinic radiation(sunlight)HPV
55
Where does HNSCC often metastasize to?
submandibular, superficial and deep cervial lymph nodes. A majority of those who die from HNSCC have a distant site.
56
What is a dentigerous cyst
Cyst around crown of unerupted tooth. Often associated with impacted third molar.
57
What can incomplete excision of a dentigerous cyst cause?
Recurrence,Neoplastic transformation (ameloblastoma)
58
What viruses often cause infectious rhinitis?
adenovirus, echoviruses, rhinoviruses
59
What are signs of infectious rhinitis
nasal mucosa thickened, edematous and red, nasal cavities narrowed, turbinates enlarged
60
What are nasal polyps often related to ?
Allergies- contains inflammatory cells
61
What is recurrent acute rhinosinusitis?
4 or more episodes of ARS per year with interim symptom resolution. Usually results from drainage problem in sinuses.
62
What can impaired sinusitis drainage with a suppurative exudate lead to?
Empyema (collection of pus)
63
What is "saddle nose" associated with?
wegener granulomatosis
64
Nasopharyngeal Angiofibroma Tx?
May respond to estrogen therapy
65
What is sinonasal (Schneiderian) papilloma associated with?
HPV types 6 and 11
66
what are the 3 types of Sinonasal papilloma?
1)Everted- origin on nasal septum2) Inverted- origin on lateral nasal or sinus wall3)cylindrical or oncocytic
67
Where do olfactory neuroblastomas arise from?
olfacoty mucosa (neuroendocranial cells) covering superior third of nasal septum
68
What is the geographical distribution of nasopharyngeal carcinoma?
African children, Chinese adults w/ HLA-A2
69
What the factors contribute to development of nasopharyngeal carcinoma?
Heredity, age, and EBV
70
What therapy is nasopharyngeal carcinoma most sensitive to?
Radiation
71
Where does nasopharyngeal carcinoma commonly metastasize to?
Cervical lymph nodes
72
What causes laryngoepiglottitis?
respiratory syncytial virus, H. flu or beta hemolytic strep
73
What is laryngotracheobronchitis?
Croup- narrowing produces inspiratory stridor
74
Of singers nodules and polyps, which are unilateral and which are bilateral?
singer nodules are usually bilateral, polyps are unilateral
75
Are singers nodules or polyps malignant?
They rarely transform to malignancy
76
What are squamous papilloma?
benign neoplasms on true vocal cords.
77
What can cause multiple recurring papilloma of the vocal cords?
HPV 6 and 11
78
What is the difference between intrinsic and extrinsic laryngeal carcinoma?
Intrinsic is confined within larynx. Extrinsic arises or extends outside larynx.
79
What is the most common manifestation of laryngeal carcinoma?
Hoarseness
80
What type of cells compose the the outer surface of the TM?
squamous epithelium
81
What type of cells compose the inner surface of the TM?
cuboidal epithelium
82
What type of cells compose the middle layer of the TM?
dense fibrous epithelium
83
What causes relapsing polychondritis?
Antibodies to type 2 collegen and chrondroitin sulfate
84
relapsing polychondritis Tx?
steroids
85
What causes malignant OE?
pseudomonas aeruginosa
86
What can occur with chronic serous OM
goblet cell metaplasia
87
Can otosclerosis be genetic?
Yes, autosomial dominant
88
Where are branchial cleft cysts located?
lateral part of the neck
89
What causes branchial cysts?
failure of obliteration of the second branchial cleft in embryonic development causing excess fluid buildup
90
What causes thyroglossal duct cyst?
Same etiology as branchial cleft cyst. Remnants of thyroid follicles in cyst.
91
What are the locations of thyroglossal duct cysts?
Intralingual-2%suprahyoid-24%thyrohyoid-61%suprasternal-13%
92
Are thyroglossal duct cysts malignant?
Potentially, thyroid cancer present in 1-2% of cysts
93
Thyroglossal duct cyst Tx?
Sistrunk operation- excision of cyst as well as the tract which passes through the central portion of the hyoid bone to the base of the tongue.
94
What is a paraganglioma?
Carotid body tumor- develops within the adventitia of the medial aspect of the carotid bifurcation.
95
What are the different types of carotid body tumors?
Familial, Sporadic, Hyperplastic
96
What is characteristic about the rate of growth in paragangliomas?
slow-growing tumor- 7 yr doubling time
97
Paraganglioma presentation?
Typically asymptomatic palpable neck mass in the anterior triangle of the neck. 10% involve cranial nerve palsy.
98
What is Xerostomia?
"dry mouth" due to a decrease in production of saliva. Associated with Sjogren syndrome.
99
What is Sjogren Syndrome?
autoimmune against salivary and lacrimal glands. Decreases tear and saliva production.
100
What can be caused by blockage or rupture of salivary gland ducts?
Mucoceles
101
What are benign tumors of the facial lymphatics?
pleomorphic adenoma, warthin tumor(papillary cystadenoma lymphomatosum)
102
What are malignant tumors of facial lymphatics?
mucoepidermoid carcinoma, adenoid cystic carcinoma
103
What is the basic anatomy of the sclera?
Thick, white, transparent at the cornea
104
What is the basic anatomy of the choroid?
Deeply pigmented, contains blood vessels, and the Iris is part of the choroid
105
What is the basic anatomy of the Retina?
Has rods and cones, converts light energy into nerve impulses
106
What is present at the Fovea centralis?
Only cones. This is where the greatest visual acuity occurs.
107
Which bones make up the orbit?
ZygomaticSphenoidFrontalEthmoidLacrimalPalatineMaxillary
108
Which bone making up the orbit is the thinnest and what can result from this?
Ethmoid- orbital cellulitis can result if infection erodes through from the sinus
109
What is the origin of the occular muscles?
Annulus of Zinn
110
What does the annulus of zinn encircle?
optic n.
111
What is characteristic of the lower canaliculus in children?
It's smaller= inc risk for infection.Massage can keep the duct open.
112
What is the mechanism for thyroid-related orbitopathy(Graves Dz)?
T cells secrete cytokines(TNF, interferon) which stimulates fibroblast proliferation. Fibroblasts synthesize extracellular matrix proteins to 1)inc hydrophilic glycosaminogycans (Hyaluronic acid) and 2) inc osmotic pressure= fluid accumulation.
113
What is the manifestation of thyroid related orbitopathy?
ProptosisStrabismus/muscle-restrictionExposure problemsCompressive optic neuropathy.
114
Thyroid related orbitopathy Tx?
SteroidsRadiation therapySurgical decompression (opening the orbital walls into the sinuses)
115
What are the most frequent primary tumors of the orbit?
Most are vascular in originCapillary hemangiomaCavernous hemangioma Lymphangioma
116
What are characteristics of capillary hemangiomas?
"spider", thinner
117
What are characteristics of cavernoushemangiomas?
more dense/dilated
118
What is the most common primary malignancy of the orbit in children?
rhabdomyosarcoma
119
What is the most common metastatic tumor in children?
neuroblastoma- 20% develop orbit metastasis
120
Where will the gaze likely be in orbital floor fx?
Restricted upgaze if there is muscle entrapement
121
How critical are orbital floor fx?
Typically require hospitalization
122
What are the tarsal glands AKA?
Meibomian glands
123
What are the malignant tumors of the eyelids?
Basal cell carcinoma – most common Sebaceous carcinomaSquamousMelanoma
124
What can occur if basal cell carcinoma is not completely removed?
inc risk of becoming squamous cell carcinoma
125
What causes a Chalazion?
chronic inflammatory lesion of the meibomian gland
126
What secretes the mucinous components of the tear film?
goblet cells
127
What causes conjunctivitis?
viral(adenovirus), bacterial, or allergic cause
128
What can result from chlamydial conjunctivitis?
scarring causing a dec in goblet cells leading to dec in mucin
129
Bacterial conjunctivitis Tx?
usually self limited in 10-14 days
130
Allergic conjunctivitis Tx?
antihistamines, vasoconstrictors, and steriods
131
What does conjunctiva intraepithelial neoplasia(CIN) often preceed?
Squamous cell tumor
132
What is the Limbus?
Border of the cornea and the sclera. The limbus is a common site for the occurrence of corneal epithelial neoplasm.
133
Where do lymphoidic conjunctiva tumors arise from?
mucosa-associated lymphoid tissue (MALT)
134
What are conjunctiva squamous papilloma and conjunctiva intraepithelial neoplasia(CIN) associated with?
HPV 16 and 18
135
Is the cornea vascularized?
No
136
What are the 5 layers of the Cornea?
EpitheliumBowmans MembraneStromaDescemet's membraneEndothelium
137
What is the anatomy of the Cornea epithelium?
Continuous with conj, richly innervated by CN-V1
138
What is the anatomy of the Corneal Stroma?
The thickest central portion (90%). Primarily made up of Type 1 Collagen in uniformly-spaced lamellar bundles.
139
Where does copper deposition occur in Wilsons disease (Kayser-Fleischer ring)?
Descemet's membrane layer of the cornea
140
What is the function of the endothelial layer of the cornea?
pumps the water out of the cornea and keeps it clear
141
Where does LASIK/Refractive surgery happens?
Corneal Stroma
142
What is Keratitis?
inflammation of the cornea
143
What is the most common cause of bacterial keratitis?
Pseudomonas
144
What is the most common cause of viral keratitis?
HSV
145
What are the signs of HSV Keratitis?
epithelial "dendritic" lesions
146
What are the signs of Bacterial Keratitis?
Hypopyon
147
What is Stromal dystrophy?
a heritable disorder resulting in abnormal tissue morphology, function, or abnormal depositions of material into the cornea.
148
What is ectasia?
progressive deformation of the cornea
149
What is the most common ectatic dystrophy?
Keratoconus
150
What can be a complication of refractive surgery?
Ectasia
151
ectasia Tx?
refer to ophthalmology
152
What composes the Uvea?
Iris, ciliary body, and the choroid
153
What is the function of the iris?
diaphragm for light
154
What is the function of the ciliary body
suspends and flexdes the lens, also makes the aqueous humor
155
What is the function of the choroid
nourishes the outer retina
156
where is the angle of the uvea?
where the iris meets the cornea
157
What is the function of the angle of the uvea?
regulates the outflow of aqueous humor through the canal of Schlem. This determines intraocular pressure.
158
What serious systemic Dzs can uveitis be associated with?
arthritis, IBD, vacuities, torch syndrome
159
What is commonly seen in anterior uveitis?
WBC's floating in aqueous humor
160
What is seen in posterior uveitis?
active toxoplasmosis choroiditis, old scars
161
Why is the choroid a potential target site for metastasis?
It is highly vascularized
162
What has the highest protein content in the body and what is the significance of this?
Lens- creates a high refractive index
163
What focuses light on the retina
The lens in concert with the cornea
164
What happens the the central fibers of the lens with aging?
they become sclerotic and opaque making the lens flatten with time
165
What are pathogenic factors of cataracts
UV light, steroids, and inflammation
166
What type of cells are in the retina?
Photoreceptors-detect lightBipolars-transmit signal to ganglion cellsGanglion cells- send signal by long axon through optic n.
167
Which side of the optic disc do retinal arteries and veins emerge from?
nasal side
168
Which direction do arching retinal vessels go?
toward the temple
169
which direction do radial retinal vessels go?
toward the nose
170
Do retinal arteries contain a muscular coat?
No
171
What do retinal arteries drain?
innner retina(retinal ganglion cells and their axons and the bipolar cells)
172
What drains the outer retina(rods and cones)?
choroidal circulation
173
Where does retinal detachment occur?
between the retinal pigment epithelium(RPE) and photoreceptor(neurosensory) segments
174
What causes Macular degeneration?
Bruch’s membrane damaged by deposition of drusen, allowing leaky choroidal vessels to grow into retina (exudative type).
175
What causes Drusen?
mucoproteins and mucopolysaccarides that progressively calcify, leaving remnants of axonal transport system of degenerative retinal ganglion cells. Occurs in both wet and dry macular degeneration
176
What are the 2 types of retinal detachment?
Tear (most common), seperation
177
What are characteristics of atrophic macular degeneration?
Discrete deposits in the Bruch membrane(drusen)
178
What are characteristics of neovascular macular degeneration?
Presence of angiogenic vessels originate from choroid capillaries Penetrate Bruch membrane and may penetrate the RPE.Vessels may leak causing macular scars.
179
Neovascular macular degeneration Tx?
VEGF antagonists(antibodies to growth factors)
180
What is characteristic of hemorrhage form of macular degeneration?
sudden onset of painless, blurred, or warped vision called metamorphopsia.
181
What can cause microvascular Dz in the retina?
Dm, Sickle cell, radiation
182
What occurs in the preproliferative phase of diabetic retinopathy?
Glu and sorbitol levels are high=Retinal blood vessels thicken= 1)dec O2 perfusion=up regulation of VEGF and 2)vessles become flimsy=microaneurysusms occure
183
What occurs in the proliferative phase of diabetic retinopathy?
retinal angiogenesis=retina becomes thicker
184
Consequences of Diabetic Retinopathy?
Vitreous humor detachment “posterior vitreous detachment”May precipitate massive hemorrhageOrganization of retinal neovascular membrane may wrinkle the retinaTraction retinal detachment
185
What is the best prevention of Diabetic Retinopathy?
blood glucose control
186
Diabetic Retinopathhy Tx?
lasers can stop progression
187
What are Roth spots
Cotton wool spots surrounded by hemorrhage
188
If a person has chronic hypertension, what is likely to be seen on the optic disc?
AV nicking due to stiffened arteries
189
What is the classic pediatric tumor of retina?
Retinoblastoma
190
What causes Ischemic Neuropathy?
due to arteritic (Giant Cell Arteritis) or non-arteritic causes. Vessle walls become inflammed= dec diameter= dec blood supply to optic n.
191
What causes Optic Neuritis?
Many causes, but demyelinating (Multiple Sclerosis) causes are most important
192
What causes Papilledema?
swelling due to increased intracranial pressure
