miscellaneous diseases of the head and neck

Question 1

lymphadenopathy

Answer 1

-signal infection, illness or tumor

can be unilateral or bilateral

Question 2

unilateral tonsillar enlargement causes

Answer 2

infection
chronic inflammatory response
neoplasm

Question 3

peritonsillar abscess

Answer 3

• abscess forms in the tissue near tonsil
• unilateral
• caused from tonsillitis that spread to the tissue (STREP)
• uvula may be midline
• lymph node swelling unilateral
• fever, chills, ear pain, difficulty to swallow and talk (potato voice)

Question 4

priorities with peritonsillar abcess

Answer 4

airway, hydration and able to swallow

Question 5

treatment of peritonsillar abcess

Answer 5

abx, steriods and rare but sometimes I&D

close follow up & daily checks 2-3 days

Question 6

tonsillitis can be

Answer 6

acute/chronic
unilateral/bilateral
bacterial/viral

Question 7

common causes of tonsillitis

Answer 7

streptococcus, influenza, parainfluenza, adenoviruses, epstein-barr, herpes simplex or enteroviruses

Question 8

unilateral tonsillar enlargement

Answer 8

1) neoplasm such as
- lymphomas
- squamous cell carcinomas
- rare: extramedullary plasmacytomas, hodgkins, leukemia and metastatic neoplasms

Question 9

remember STI’s

Answer 9

sore throat or red eye can always be an STI

herpes 1&2, gonorrhea, chlamydia, syphilis

Question 10

skin cancer of head and face - order of commonality

Answer 10

basal cell carcinoma
squamous cell carcinoma
melanoma

Question 11

know the ABCDE’s of dermatology

Answer 11

assemetry- one 1/2 of the mole doesn't match the other
border irregularity 
color
diameter greater than 6 mm 
evolving -size, shape or color

Question 12

basal cell carcinoma

Answer 12

common neoplasm caused by sun exposure

• rarely metastasizes
• most common type of skin cancer
  tx: excision

Question 13

basal cell carcinoma description

Answer 13

shiny, pearly, raised nodule +/- vascularity +/- ulceration

Question 14

squamous cell carcinoma

Answer 14

2nd most common

appearance: ulcerated lesion with hard raised edges that bleeds intermittently

Question 15

melanoma

Answer 15

3rd most common 
classic appearance- mole or small lesion 
-increase in size
-ABCDE's 
emergent dermatology referral

Question 16

squamous cell on the tongue

Answer 16

common in men over 50
smokers/tobacco chew and alcohol use
usually on the side or base of the tongue
*any persistent nodule is suspect

Question 17

txtment of carcinoma of the tongue

Answer 17

removal and possible radiation

Question 18

oral pharyngeal cancers

Answer 18

90% squamous cells

sx: sore throat, dysphagia, weight loss, neck mass and trismus

Question 19

oral pharyngeal cancers txtment

Answer 19

surgery chemotherapy, radiation and monoclonal antibodies based on staging

Question 20

oral pharyngeal cancers is usually in

Answer 20

an advanced stage by the time the patient is symptomatic

Question 21

The American Joint Committee on Cancer recommend for the dx of oral pharyngeal cancer

Answer 21

CT scan of the head & neck with contrast followed by triple endoscopy (nasopharygeal, esophageal, and bronchoscopy) under general anesthesia to complete the staging process.

Question 22

causes of salivary gland tumors

Answer 22

infections
other cancers
dehydration
sarcoidosis

Question 23

salivary gland tumors

Answer 23

• rare

- abnormal cells growing in the gland or in the tubes (duct) that drain the salivary glands

Question 24

sx of salivary gland tumors

Answer 24

firm
usually painless swelling in one of the salivary glands
the swelling gradually increases over months-years
facial nerve palsy-almost always correlates with malignancy (but salivary gland tumors should be considered)

Question 25

gold standard for salivary gland test

Answer 25

U/S CT MRI

Question 26

treatment for salivary gland

Answer 26

surgery radiation therapy chemotherapy

Question 27

oral leukoplakia

Answer 27

dx of exclusion of oral lesions -white plaques of questionable risk that WILL NOT SCRAP OFF

Question 28

85% of erythroplakia are ...

Answer 28

(velvety red plaques) | but are frank malignancy or severe epithelial dysplasia

Question 29

nonleukoplakia -white lesions

Answer 29

``` infection caused by candidiasis EBV (hairy leukoplakia) HPV (warts) syphilis measles (koplik spots) ``` mucocutaneous disease lichen planus lupus erythematosus

Question 30

benign tongue lesions ddx

Answer 30

oral hairy leukoplakia (hairy tongue) mucosal candidiasis contact stomatitis (geographic tongue)

Question 31

myasthenia gravis sx hallmark

Answer 31

fluctuating weakness worsened with exercise and improved with rest usually weakness involves proximal muscles diaphragm and neck extensors

Question 32

weakness in myasthenia gravis

Answer 32

is confined to eyelids and extraocular muscles in ~ 15% of patients

Question 33

other common symptoms of myasthenia gravis

Answer 33

ptosis, diplopia, dysarthria and dysphagia

Question 34

myasthenia gravis pathology

Answer 34

autoimmune affects postsynaptic neuromuscular transmission by blocking them: A resultant weakness occurs from the blocked receptors Can originate from a thymoma

Question 35

myasthenia gravis blood test

Answer 35

AchR-AB acetylcholine receptor antibodies test and refer to rhumatology

Question 36

reactive arthritis

Answer 36

reiters syndrome | -cant see, cant pee, cant climb a tree

Question 37

reiters syndrome is strongly affiliated with

Answer 37

Strong affiliation with HLA-B27

Question 38

sx of reiters syndrome

Answer 38

``` Arthritis of large joints e.g. hips, knees, and ankles Uveitis or conjunctivitis Urethritis -Usually follows an infection -typically men 20-40 years old ```

Question 39

head to toe eval or reiters syndrome sx

Answer 39

- Urethritis - Uveitis or conjunctivitis; uveitis can progress to blindness without treatment - Keratoderma blennorrhagicum, circinate balanitis - Hyperkeratotic lesions on soles of the feet, toes, penis, hands - Aortic regurgitation similar to ankylosing spondylitis

Question 40

reactive arthritis genetic test

Answer 40

HLA-B27 but not a diagnostic tool because can be on or off

Question 41

reactive arthritis

Answer 41

``` Ankylosing spondylitis Psoriatic arthritis Rheumatoid arthritis Gonococcal arthritis-tenosynovitis Rheumatic fever ```

Question 42

granulomatosis with polyangiitis (GPA) presentation

Answer 42

epistaxis, hemoptysis, nasal discharge or polyarticular complaints

Question 43

GPA renal

Answer 43

The classic renal lesion is “pauci-immune glomerulonephritis.” This is, by definition, rapidly progressive -> likely to have severe and rapid (<3 month) loss of kidney function, severe hematuria, proteinuria, hypertension and edema (variable depending on other factors)