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GI II > Oral Cavity and Salivary Glands > Flashcards

Oral Cavity and Salivary Glands Flashcards

1
Q

Pathology of dental caries

A

focal demineralization of tooth by acidic metabolites of sugars produced by bacteria

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2
Q

Main cause of tooth loss before age 35

A

dental caries

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3
Q

Possible sxs of dental caries

A

pain, weight loss/nutrition problems, loss of self confidence, life-threatening infections

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4
Q

Causes of dental caries

A

poor oral hygiene, food with large amounts of carbs

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5
Q

What is gingivitis?

A

inflammation of oral mucosa surrounding the teeth due to poor oral hygiene, leading to the build up of plaque and calculus

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6
Q

What age group is gingivitis most common in?

A

adolescents

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7
Q

What is periodontitis?

A

Inflammatory process that affects structures of teeth, alveolar bone, and cementum

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8
Q

Oral bacteria associated with periodontitis

A

G- anaerobic microaerophilic

A. actinomycetemcomitans, P. gingivalis, P. intermedia

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9
Q

Systemic diseases associated with periodontitis

A

AIDS/HIV, leukemia, Crohn disease, diabetes, Down syndrome, sarcoidosis, defects in neutrophil

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10
Q

Inflammatory process

A

local reaction that shows up by swelling, heat, pain, and redness often due to infection, foreign body, immune rxns, tissue necrosis

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11
Q

Reactive process

A

showing a response to a stimulus such as hypoxia, chemical agents or drugs, infectious agents, immunologic reactions, genetic abnormalities, etc.

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12
Q

Aphthous ulcer

A

painful, superficial oral mucosal ulceration of unknown etiology

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13
Q

Aphthous ulcers are associated with what immunologic disorders?

A

Celiac disease, inflammatory bowel disease, Behcet disease

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14
Q

How quickly do aphthous ulcers resolve?

A

7 to 10 days

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15
Q

Traumatic fibroma description

A

submucosal nodular mass of fibrous CT stroma

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16
Q

Location of traumatic fibromas

A

bucal mucosa/bite line

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17
Q

Treatment of traumatic fibroma

A

surgical excision

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18
Q

Pyogenic granuloma description

A

inflammatory lesion on gingiva of children, young adults, and pregnant women

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19
Q

Morphology of pyogenic granuloma

A

ulcerated, red to purple; highly vascular proliferation

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20
Q

Peripheral ossifying fibroma description

A

gingival growth that may arise from a pyogenic granuloma or de novo from cells of periodontal ligament

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21
Q

Morphology of peripheral ossifying fibroma

A

red, ulcerated, nodular lesion of gingiva

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22
Q

Peak incidence of peripheral ossifying fibroma

A

young and teenage females

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23
Q

Torus palatinus

A

bony outgrowths with varied clinical appearance

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24
Q

How can microbes enter the oral cavity?

A

breaching epithelial surfaces, inhalation, ingestion, sexual transmission

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25
Q

What HSV type is responsible for oral herpetic infections

A

Typically HSV-1, but HSV-2 infections can occur

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26
Q

Morphological appearance of HSV infections

A

lesions of a few mm to large bullae, first filled with a clear fluid but can rupture to yield painful, red-rimmed, shallow ulcerations

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27
Q

Primary HSV infections typically occur in what population?

A

children between 2-4

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28
Q

Positive Tzanck Smear

A

acantholytic keratinocytes or multinucleated giant acantholytic keratinocytes are detected

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29
Q

HSV-1 clinical presentation

A

lymphadenopathy, fever, anorexia, irritability, painful vesicles and ulcerations of oral mucosa

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30
Q

Where does HSV take residence in the body?

A

sensory ganglia, especially trigeminal

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31
Q

Most common fungal infection of the oral cavity

A

candidiasis

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32
Q

Factors that influence clinical infection of candidiasis

A

strain of C. albicans, composition of oral flora, immune status of the patient

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33
Q

Leukocytes important for protection against Candida infections

A

Neutrophils, macrophages, Th17 cells

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34
Q

Morphological appearance of pseudomembranous Candida infections

A

superficial, gray to white inflammatory membrane composed of matted organisms enmeshed in a fibrinosuppurative exudate

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35
Q

Histological appearance of Candida species

A

pseudohyphae, budding yeast

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36
Q

Immunocompromised states that may predispose pts to Candida infections

A

AIDs, Chemo pts, transplant pts, DM, broad spec abx or steroid inhalers, pregnancy

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37
Q

Fungi with a predilection for oral cavity/head and neck

A

histoplasmosis, blastomycosis, coccidioidomycosis, aspergillosis, cryptococcosis, zygomycetes

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38
Q

Associated oral changes of scarlet fever

A

fiery red tongue with prominent papillae; white-coated tongue through which hyperemic papillae project

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39
Q

Associated oral changes of measles

A

Koplik spots on buccal mucosa (ulcerations

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40
Q

Associated oral changes of mono

A

gray-white exudative membrane, enlarged LN and palatal petechiae

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41
Q

Associated oral changes of diphtheria

A

dirty white, fibrinosuppurative, tough, inflammatory membrane over tonsils

42
Q

Associated oral changes of HIV

A

predisposition to opportunistic infections; Kaposi sarcoma and leukoplakia

43
Q

Hairy leukoplakia is caused by…

A

Epstein-Barr virus

44
Q

Morphological description of hairy leukoplaxia

A

white, confluent patches of fluffy, hyperkeratotic thickenings typically situated on lateral border of tongue; cannot be wiped off, may have overlying candida infection that can be wiped off

45
Q

Microscopic description of hairy leukoplakia

A

hyperkeratosis and acanthosis with “balloon cells” in upper spinous layer

46
Q

Erythema multiforme

A

acute, self-limited condition associated with a type IV hypersensitivity rxn

47
Q

Clinical description erythema multiforme minor

A

targets or raised, edematous papules distributed acrally

48
Q

Clinical description erythema multiforme major

A

targets or raised, edematous papules distributed acrally with involvement of one or more mucous membranes; epidermal detachment involves <10% TBSA

49
Q

SJS/TEN

A

widespread blisters on trunk and face, presenting with erythematous or pruritic macules and one or more mucous membrane erosions

50
Q

Oral changes associated with pancytopenia and leukemia

A

severe oral infections, may extend to cellulitis of the neck

51
Q

Oral changes associated with monocytic leukemia

A

leukemic infiltration and enlargement of gingivae, accompanying periodontitis

52
Q

Oral changes associated with Peutz-Jeghers syndrome

A

polyps and dark-colored spots that appear on various parts of the body, increased risk for CA

53
Q

Oral changes associated with phenytoin (dilantin) ingestion

A

fibrous enlargement of gingivae

54
Q

Oral changes associated with Rendu-Osler-Weber syndrome

A

aneurysmal telangiectasias beneath mucosal surfaces of oral cavity and lips; autosomal dominant disorder that affects blood vessels and results in a tendency for bleeding

55
Q

Multilocular keratocystic odontogenic tumor

A

Epithelial-lined cysts common in jaws

56
Q

Population most commonly affected by keratocystic odontogenic tumors

A

males between ages of 10 and 40

57
Q

Most common type of head and neck cancers

A

squamous cell carcinomas

58
Q

5 Etiologies of SCC in head and neck

A

HPV, tobacco and alcohol, Betel quid and paan, actinic radiation and pipe smoking, and unknown causes without risk factors

59
Q

Common HPV variant of SCC involving tonsils, tongue, pharynx

A

HPV-16

60
Q

Population most common effected by HPV-associated cancers

A

white, non-smoking males 35-55

61
Q

Cells of tonsillar epithelium first infected by HPV

A

basal keratinocyte progenitors, deep in tonsillar crypts

62
Q

HPV viral genes associated with inactivation of P53 and RB pathways

A

E6 and E7

63
Q

What protein is over-expressed in HPV induced SCC?

A

p16, which is a tumor suppressor protein encoded by CDKN2A

64
Q

HPV-positive SCC prognosis

A

HPV-positive SCC has greater long-term survival than HPV-negative tumors

65
Q

Clinical presentation of HPV SCC

A

sore throat, ear ache, odynophagia, weight loss, metastatic tumor in LN

66
Q

Mutations in which pathways/proteins contribute to dysregulation of cell differentiation

A

p63, p53, and NOTCH1

67
Q

Common genetic mutation acquired in progression of severe dysplasia

A

17p13

68
Q

Percentage of leukoplakia cases that are precancerous

A

25%

69
Q

Erythroplakia

A

red, velvety, possibly eroded area within oral cavity that usually remains level but may be slightly depressed; associated with severe dysplasia

70
Q

Characteristics of dysplastic cells

A

loss of uniformity and orientation, pleomorphism, presence of mitotic figures

71
Q

Proteins overexpressed in leukoplakia

A

Cyclin D1 and p63

72
Q

5 year survival rate of early-stage SCC

A

80%

73
Q

5 year survival rate of late-stage SCC

A

20%

74
Q

Theory of field cancerization

A

multiple independent primary tumors develop as the result of years of chronic carcinogenic exposure

75
Q

Xerostomia

A

“dry mouth” due to lack of saliva

76
Q

Role of saliva

A

digestion, lubrication, protection

77
Q

Medications associated with xerostomia

A

anticholinergic, antidepressant/antipsychotic, diuretic, antihypertensive, sedative, muscle relaxant, analgesic, antihistamine

78
Q

Etiology of xerostomia

A

Sjögren syndrome, medications, radiation

79
Q

Complications of dry mouth

A

increased incidence of dental caries, candidiasis, difficulty swallowing and speaking

80
Q

Hypofunctioning of what portion of the nervous system may cause xerostomia?

A

parasympathetic nervous system

81
Q

Etiologies of sialadenitis

A

trauma, autoimmune disease, viral, bacterial

82
Q

Mucocele description

A

fluctuant fluid-filled lesion on lower lip subsequent to trauma causing rupture or blockage of salivary gland duct

83
Q

Most common lesion of salivary glands

A

mucocele

84
Q

Vaccines most often refused by parents

A

HPV, influenza, MMR

85
Q

Population most commonly affected by benign salivary neoplasms

A

adults in fifth to seventh decades of life, slight female predominance

86
Q

Population most commonly affected by malignant salivary neoplasms

A

adults in sixth to eighth decades of life, slight female predominance

87
Q

Most common benign salivary neoplasms

A

pleomorphic adenoma, warthin tumor

88
Q

Most common malignant salivary neoplasms

A

mucoepidermoid carcinoma, adenocarcinoma (NOS)

89
Q

Presentation of a pleomorphic adenoma

A

well demarcated, painless, mobile, discrete mass

90
Q

Malignancy potential of pleomorphic adenoma

A

can arise the longer they remain untreated

91
Q

Gene rearrangement associated with pleomorphic adenomas

A

PLAG1 gene rearrangement, upregulates expression of genes that increase cell growth

92
Q

Histologic features of pleomorphic adenomas

A

epithelial elements in ductal formations, acini, irregular tubules, strands, or sheets; mesenchymal foci of cartilage, bone, fat in myxoid stroma

93
Q

Populations most at risk for developing warthin tumor

A

smokers, increased incidence in males

94
Q

Histologic features of Warthin tumor

A

epithelial and lymphoid elements; cystic spaces separate lobules of neoplastic epithelial which consist of a double layer of eosinophilic epithelial cells based on a reactive lymphoid stroma

95
Q

Most common primary malignancy of salivary glands

A

mucoepidermoid carcinoma

96
Q

In what salivary glands do mucoepidermoid carcinomas most typically occur?

A

60-70% occur in the parotid glands

97
Q

Mucoepidermoid carcinoma genetic aberration

A

t(11;19)(q21;p13) ; produces fusion gene product MECT1-MAML2

98
Q

Mucoepidermoid carcinoma prognosis is dependent on…

A

grade of tumor, how abnormal cancer cells and tissues are

99
Q

Typical location of adenoid cystic carcinoma

A

50% occur in minor salivary glands

100
Q

Percentage of adenoid cystic carcinomas that disseminate

A

50%

101
Q

Histologic features of mucoepidermoid carcinoma

A

grows in nests composed of squamous cells and clear vacuolated cells containing mucin

102
Q

Histologic features of adenoid cystic carcinomas

A

cribriform pattern of tumor cells that enclose secretions; typically grow along nerves

GI II (8 decks)

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