miscellaneous diseases of the head and neck Flashcards
lymphadenopathy
-signal infection, illness or tumor
can be unilateral or bilateral
unilateral tonsillar enlargement causes
infection
chronic inflammatory response
neoplasm
peritonsillar abscess
- 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)
priorities with peritonsillar abcess
airway, hydration and able to swallow
treatment of peritonsillar abcess
abx, steriods and rare but sometimes I&D
close follow up & daily checks 2-3 days
tonsillitis can be
acute/chronic
unilateral/bilateral
bacterial/viral
common causes of tonsillitis
streptococcus, influenza, parainfluenza, adenoviruses, epstein-barr, herpes simplex or enteroviruses
unilateral tonsillar enlargement
1) neoplasm such as
- lymphomas
- squamous cell carcinomas
- rare: extramedullary plasmacytomas, hodgkins, leukemia and metastatic neoplasms
remember STI’s
sore throat or red eye can always be an STI
herpes 1&2, gonorrhea, chlamydia, syphilis
skin cancer of head and face - order of commonality
basal cell carcinoma
squamous cell carcinoma
melanoma
know the ABCDE’s of dermatology
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
basal cell carcinoma
common neoplasm caused by sun exposure
- rarely metastasizes
- most common type of skin cancer
tx: excision
basal cell carcinoma description
shiny, pearly, raised nodule +/- vascularity +/- ulceration
squamous cell carcinoma
2nd most common
appearance: ulcerated lesion with hard raised edges that bleeds intermittently
melanoma
3rd most common classic appearance- mole or small lesion -increase in size -ABCDE's emergent dermatology referral
squamous cell on the tongue
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
txtment of carcinoma of the tongue
removal and possible radiation
oral pharyngeal cancers
90% squamous cells
sx: sore throat, dysphagia, weight loss, neck mass and trismus
oral pharyngeal cancers txtment
surgery chemotherapy, radiation and monoclonal antibodies based on staging
oral pharyngeal cancers is usually in
an advanced stage by the time the patient is symptomatic
The American Joint Committee on Cancer recommend for the dx of oral pharyngeal cancer
CT scan of the head & neck with contrast followed by triple endoscopy (nasopharygeal, esophageal, and bronchoscopy) under general anesthesia to complete the staging process.
causes of salivary gland tumors
infections
other cancers
dehydration
sarcoidosis
salivary gland tumors
- rare
- abnormal cells growing in the gland or in the tubes (duct) that drain the salivary glands
sx of salivary gland tumors
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)
gold standard for salivary gland test
U/S
CT
MRI
treatment for salivary gland
surgery
radiation therapy
chemotherapy
oral leukoplakia
dx of exclusion of oral lesions -white plaques of questionable risk
that WILL NOT SCRAP OFF
85% of erythroplakia are …
(velvety red plaques)
but are frank malignancy or severe epithelial dysplasia
nonleukoplakia -white lesions
infection caused by candidiasis EBV (hairy leukoplakia) HPV (warts) syphilis measles (koplik spots)
mucocutaneous disease
lichen planus
lupus erythematosus
benign tongue lesions ddx
oral hairy leukoplakia (hairy tongue)
mucosal candidiasis
contact stomatitis (geographic tongue)
myasthenia gravis sx hallmark
fluctuating weakness worsened with exercise and improved with rest
usually weakness involves proximal muscles diaphragm and neck extensors
weakness in myasthenia gravis
is confined to eyelids and extraocular muscles in ~ 15% of patients
other common symptoms of myasthenia gravis
ptosis, diplopia, dysarthria and dysphagia
myasthenia gravis pathology
autoimmune
affects postsynaptic neuromuscular transmission by blocking them:
A resultant weakness occursfrom the blocked receptors
Can originate from a thymoma
myasthenia gravis blood test
AchR-AB acetylcholine receptor antibodies test and refer to rhumatology
reactive arthritis
reiters syndrome
-cant see, cant pee, cant climb a tree
reiters syndrome is strongly affiliated with
Strong affiliation with HLA-B27
sx of reiters syndrome
Arthritis of large joints e.g. hips, knees, and ankles Uveitis or conjunctivitis Urethritis -Usually follows an infection -typically men 20-40 years old
head to toe eval or reiters syndrome sx
- 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
reactive arthritis genetic test
HLA-B27 but not a diagnostic tool because can be on or off
reactive arthritis
Ankylosing spondylitis Psoriatic arthritis Rheumatoid arthritis Gonococcal arthritis-tenosynovitis Rheumatic fever
granulomatosis with polyangiitis (GPA) presentation
epistaxis, hemoptysis, nasal discharge or polyarticular complaints
GPA renal
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)
