Pathoma 9 and 10.

Question 1

Rhinitis

Answer 1

inflammation of nasal mucosa - MCC rhinovirus (adenovirus)

Question 2

How does rhinitis present?

Answer 2

sneezing, congestion, runny nose (common cold)

Question 3

Allergic rhinitis - characterized by?

Answer 3

type I hypersensitivity reaction - eosinophils and associated with asthma and eczema

Question 4

Nasal polyp

Answer 4

protrusion of edematous, inflamed nasal mucosa - secondary to repeated bouts of rhinitis

Question 5

What are associations with nasal polyp?

Answer 5

cystic fibrosis in a child and aspirin-intolerant asthma

Question 6

What triad is associated with aspirin-intolerant asthma?

Answer 6

asthma, aspirin-induced bronchospasms, nasal polyps

Question 7

angiofibroma

Answer 7

benign tumor of nasal mucosa composed of large blood vessels and fibrous tissue - adolescent males

Question 8

how does angiofibroma typically present?

Answer 8

profuse epistaxis (nose bleeds)

Question 9

nasopharyngeal carcinoma

Answer 9

malignant tumor of nasopharyngeal epithelium

Question 10

What is nasopharyngeal carcinoma associated with?

Answer 10

EBV - seen in african children and chinese adults

Question 11

What does biopsy of nasopharyngeal carcinoma show?

Answer 11

pleomorphic keratin-positive epithelial cells in a background of lymphocytes

Question 12

what often presents with nasopharyngeal carcinoma?

Answer 12

involvement of cervical lymph nodes

Question 13

acute epiglottitis

Answer 13

inflammation of epiglottis

Question 14

what is the MCC of acute epiglottitis?

Answer 14

h influenzae type b - esp in nonimmunized children

Question 15

how does acute epiglottitis present?

Answer 15

high fever, sore throat, drooling with dysphagia, muffled voice, inspiratory stridor, risk for airway obstruction

Question 16

laryngotracheobronchitis (croup)

Answer 16

inflammation of upper airway

Question 17

MCC laryngotracheobronchitis

Answer 17

parainfluenza virus

Question 18

how does laryngotracheobronchitis present

Answer 18

hoarse, “barking” cough and inspiratory stridor

Question 19

vocal cord nodule due to?

Answer 19

excessive use of vocal cords, usually bilateral - resolves with resting voice

Question 20

what is a vocal cord nodule composed of?

Answer 20

degenerative (myxoid) connective tissue

Question 21

laryngeal papilloma - what is it due to?

Answer 21

benign papillary tumor of the vocal cord - due to HPV 6 and 11

Question 22

how do laryngeal papillomas differ in appearance between children and adults

Answer 22

adults = single; children = multiple

Question 23

how does laryngeal papilloma present?

Answer 23

hoarseness

Question 24

laryngeal carcinoma

Answer 24

squamous cell carcinoma arising from epithelial lining of vocal cord

Question 25

risk factors for laryngeal carcinoma

Answer 25

alcohol and tobacco; rarely can arise from laryngeal papilloma (HPV 6 and 11)

Question 26

how does laryngeal carcinoma present

Answer 26

hoarseness, cough, stridor

Question 27

cleft lip and palate

Answer 27

failure of facial prominences to fuse - full-thickness defect of lip or palate

Question 28

aphthous ulcer

Answer 28

painful, superficial ulceration of the oral mucosa - arises in relation to stress and resolves spontaneously

Question 29

What is an aphthous ulcer characterized by?

Answer 29

grayish base surrounded by erythema

Question 30

behcet syndrome

Answer 30

recurrent aphthous ulcers, genital ulcers, uveitis

Question 31

what is behcet syndrome due to?

Answer 31

immune complex vasculitis involving small vessels

Question 32

oral herpes

Answer 32

vesicles involving oral muscosa that rupture resulting in shallow, painful red ulcers due to HSV-1

Question 33

where does oral herpes remain dormant

Answer 33

ganglia of the trigeminal nerve

Question 34

what causes reactivation of HSV-1?

Answer 34

stress and sunlight - arises on lips - cold sore

Question 35

squamous cell carcinoma

Answer 35

malignant neoplasm of squamous cells lining the oral mucosa

Question 36

what are major risk factors for squamous cell carcinoma?

Answer 36

tobacco and alcohol

Question 37

MC location of squamous cell carcinoma?

Answer 37

floor of mouth

Question 38

what are precursor lesions to squamous cell carcinoma

Answer 38

oral leukoplakia and erythroplakia

Question 39

leukoplakia

Answer 39

white plaque that cannot be scraped away - represents squamous cell dysplasia

Question 40

oral candidiasis

Answer 40

white deposit on the tongue - easily scraped away (immunocompromised)

Question 41

hairy leukoplakia

Answer 41

white, rough “hairy” patch that arises on the lateral tongue due to EBV induced squamous cell hyperplasia (immunocompromised - not pre-malignant)

Question 42

erythroplakia

Answer 42

red plaque - vascularized leukoplakia - highly suggestive of squamous cell dysplasia

Question 43

What are the major salivary glands? minor?

Answer 43

major: parotid, submandibular, sublingual. minor: hundreds of microscopic ones

Question 44

mumps

Answer 44

virus - bilateral inflamed parotid glands

Question 45

what else can also be present with mumps?

Answer 45

orchitis (testicles), pancreatitis, aseptic meningitis

Question 46

sialadenitis

Answer 46

inflammation of the salivary gland

Question 47

what is sialadenitis MC due to?

Answer 47

obstructing stone (sialoithiasis) leading to staph aureus infection - usually unilateral

Question 48

pleomorphic adenoma

Answer 48

benign tumor composed ot stromal and epithelial tissue - MC tumor of salivary gland

Question 49

where does pleomorphic adenoma usually arise? how does it present?

Answer 49

parotid - presents as mobile, painless, circumscribed mass at angle of jaw

Question 50

why is there a high rate of recurrence with pleomorphic adenoma?

Answer 50

irregular margins makes it difficult to completely resect

Question 51

how does carcinoma from pleomorphic adenoma present?

Answer 51

signs of facial nerve damage (palsy)

Question 52

warthin tumor

Answer 52

benign cystic tumor with abundant lymphocytes and germinal centers (lymph node-like stroma) - usually in parotid

Question 53

mucoepidermoid carcinoma

Answer 53

malignant tumor compsoed of mutinous and squamous cells - usually parotid

Question 54

MC malignant tumor of the salivary gland

Answer 54

mucoepidermoid carcinoma