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Pathophysiology- HEENT > pathophys_20130210190424 > Flashcards

pathophys_20130210190424 Flashcards

1
Q

Which type of cells line the air tract?

A

Columnar (pseudostratified)

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2
Q

Which type of cells line the food tract?

A

Stratified squamous

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3
Q

What occurs when columnar cells become damaged?

A

Metaplasia- they become squamous

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4
Q

When can you expect deciduous teeth to erupt?

A

6m to 2yrs of age

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5
Q

How many permanent teeth does a human have?

A

32

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6
Q

Which tissue is the most mineralized in the body?

A

Enamel

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7
Q

What is enamel synthesized by?

A

ameloblasts

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8
Q

What does dentin contain?

A

dentinal tubules

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9
Q

What is destroyed by caries?

A

Enamal and Odontoblasts which produce dentin

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10
Q

The pulp is rich in…

A

Nerve bundles, lymphatics, and capillaries

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11
Q

What does the Periodontal ligament do?

A

connects cementum to alveolar bone

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12
Q

What does Periodontal DZ cause?

A

tooth loss

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13
Q

What does S. mutans metabolize?

A

Sucrose to lactic acid

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14
Q

What does Lactobacilli metabolize

A

lactose to lactic acid

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15
Q

What is Bifidobacteria and what can result from it?

A

gram + bacteria used in probiotics. May increase risk for caries.

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16
Q

What does flouride do?

A

incorporates into enamel structure and becomes resistant to degradation by bacterial acids.

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17
Q

what does fluorosis cause?

A

Hypomineralization causing brown pitted enamel and weak(bowed) bones. Occurs with flouide intake >0.05mg/kg/day

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18
Q

What is plaque made from?

A

bacteria, proteins, and desquamated epithelial cells forming a “bacterial bioflim”

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19
Q

What is Calculus?

A

mineralized plaque AKA tartar.

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20
Q

What causes gingivitis?

A

Lack of proper oral hygiene leading to dental plaque and calculus.

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21
Q

Is gingivitis reversible?

A

Yes

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22
Q

What is periodontitis?

A

Inflammation of supporting structures (periodontal lig., alveolar bone, and cementum)

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23
Q

Is periodontitis only caused from gingivitis?

A

No, it can also be an independent DZ or present with other systemic DZs

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24
Q

Which bacteria cause periodontitis?

A

Actinobacillus, Porphyromanas, Prevotella

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25
Q

What are the manifestations of Periodontitis?

A

loosening or loss of teeth

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26
Q

What criteria are used for periodontitis diagnosis?

A

Main=attachment loss, 2nd= Probing depth,3rd= Radiographic alveolar bone loss

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27
Q

Periodontitis Tx?

A

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.

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28
Q

What are Fibrous proliferative lesions of the oral cavity

A

Fibroma (61%), peripheral ossifying fibroma(22%), Pyogenic granuloma (12%), peripheral giant cell granuloma (5%)

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29
Q

Where do most oral fibromas occur?

A

Buccal mucosa along bite line

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30
Q

oral fibroma Tx?

A

surgical excision if bothersome. Cannot aspirate bc it is fibrolytic with few inflammation cells.

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31
Q

How do you recognize a pyogenic granuloma?

A

They occur in gingiva and are red to purple due to it being highly vascularized

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32
Q

Pyogenic granuloma Tx?

A

regress spontaneously or surgical excision

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33
Q

Which type of lesion can occur in the oral cavity with pregnancy?

A

Pyogenic granuloma- no need for treatment

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34
Q

peripheral ossifying fibroma Tx?

A

surgical excision down to periosteum

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35
Q

What are peripheral giant cell granulomas made from?

A

Made of aggregation of multinucleate foreign body like giant cells separated by fibroangiomatous stroma

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36
Q

Peripheral giant cell granuloma Tx?

A

refer to ENT or Oral Surgery

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37
Q

What 2 diseases can Aphthous ulcers be associated with?

A

Celiac, IBD

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38
Q

What is Plummer-Vinson or Paterson-Kelly syndrome?

A

Combination of iron deficiency anemia, glossitis and esophageal dysphagia

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39
Q

What is glossitis associated with?

A

Vitamin B12 deficiencyDeficiency of: riboflavin, niacin, or pyridoxineSprue and iron deficiency anemiaBact or viral infectionIrritants= tobacco, ETOH, spices

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40
Q

Which type of Herpes is most common for oral infections?

A

HSV type1

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41
Q

What is herpetic gingivostomatitis?

A

abrupt onset of vesicle and ulcerations in oral cavity

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42
Q

Oral HSV Tx?

A

Symptomatic Tx-acyclovir (within 72 to 96hrs)

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43
Q

Which form of oral candidiasis is Thrush?

A

Pseudo membranous form. It can be scrapped off

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44
Q

Which form of oral candidiasis cannot be scrapped off?

A

Hyperplasitic

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45
Q

What is important to remember with oral disorders?

A

Many occur from systemic Dzs. Its important to look at the big picture.

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46
Q

What are premalignant lesions of the oral cavity?

A

Leukoplakias, erythroplakia, oral lichen planus

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47
Q

What are malignant lesions of the oral cavity?

A

squamous cell carcinoma(HPV is a major cause)

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48
Q

What causes oral lichen planus?

A

chronic inflammatory autoimmune disorder with many phenotypes

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49
Q

What does hypermethylation of the p16 gene cause?

A

Inactivation of p16( a inhibitor of cyclin-dependent kinase) = hyperplasia

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50
Q

What does a mutation of p53 cause

A

dysplasia (size, shape, organization)

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51
Q

95% of cancers of the head and neck are SCC. What are the remaining?

A

adenocacinomas (salivary gland in origin)

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52
Q

What size would indicate Head and neck squamous cell carcinomas(HNSCC) having a low chance of metastasis?

A

less than 4mm in depth

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53
Q

how are HNSCC lesions less than 2cm in diameter treated?

A

often cured by local resection

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54
Q

What are the pathogenesis of HNSCC

A

Often multifactoral from…SmokingAlcoholActinic radiation(sunlight)HPV

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55
Q

Where does HNSCC often metastasize to?

A

submandibular, superficial and deep cervial lymph nodes. A majority of those who die from HNSCC have a distant site.

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56
Q

What is a dentigerous cyst

A

Cyst around crown of unerupted tooth. Often associated with impacted third molar.

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57
Q

What can incomplete excision of a dentigerous cyst cause?

A

Recurrence,Neoplastic transformation (ameloblastoma)

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58
Q

What viruses often cause infectious rhinitis?

A

adenovirus, echoviruses, rhinoviruses

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59
Q

What are signs of infectious rhinitis

A

nasal mucosa thickened, edematous and red, nasal cavities narrowed, turbinates enlarged

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60
Q

What are nasal polyps often related to ?

A

Allergies- contains inflammatory cells

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61
Q

What is recurrent acute rhinosinusitis?

A

4 or more episodes of ARS per year with interim symptom resolution. Usually results from drainage problem in sinuses.

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62
Q

What can impaired sinusitis drainage with a suppurative exudate lead to?

A

Empyema (collection of pus)

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63
Q

What is “saddle nose” associated with?

A

wegener granulomatosis

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64
Q

Nasopharyngeal Angiofibroma Tx?

A

May respond to estrogen therapy

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65
Q

What is sinonasal (Schneiderian) papilloma associated with?

A

HPV types 6 and 11

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66
Q

what are the 3 types of Sinonasal papilloma?

A

1)Everted- origin on nasal septum2) Inverted- origin on lateral nasal or sinus wall3)cylindrical or oncocytic

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67
Q

Where do olfactory neuroblastomas arise from?

A

olfacoty mucosa (neuroendocranial cells) covering superior third of nasal septum

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68
Q

What is the geographical distribution of nasopharyngeal carcinoma?

A

African children, Chinese adults w/ HLA-A2

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69
Q

What the factors contribute to development of nasopharyngeal carcinoma?

A

Heredity, age, and EBV

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70
Q

What therapy is nasopharyngeal carcinoma most sensitive to?

A

Radiation

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71
Q

Where does nasopharyngeal carcinoma commonly metastasize to?

A

Cervical lymph nodes

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72
Q

What causes laryngoepiglottitis?

A

respiratory syncytial virus, H. flu or beta hemolytic strep

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73
Q

What is laryngotracheobronchitis?

A

Croup- narrowing produces inspiratory stridor

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74
Q

Of singers nodules and polyps, which are unilateral and which are bilateral?

A

singer nodules are usually bilateral, polyps are unilateral

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75
Q

Are singers nodules or polyps malignant?

A

They rarely transform to malignancy

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76
Q

What are squamous papilloma?

A

benign neoplasms on true vocal cords.

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77
Q

What can cause multiple recurring papilloma of the vocal cords?

A

HPV 6 and 11

78
Q

What is the difference between intrinsic and extrinsic laryngeal carcinoma?

A

Intrinsic is confined within larynx. Extrinsic arises or extends outside larynx.

79
Q

What is the most common manifestation of laryngeal carcinoma?

A

Hoarseness

80
Q

What type of cells compose the the outer surface of the TM?

A

squamous epithelium

81
Q

What type of cells compose the inner surface of the TM?

A

cuboidal epithelium

82
Q

What type of cells compose the middle layer of the TM?

A

dense fibrous epithelium

83
Q

What causes relapsing polychondritis?

A

Antibodies to type 2 collegen and chrondroitin sulfate

84
Q

relapsing polychondritis Tx?

A

steroids

85
Q

What causes malignant OE?

A

pseudomonas aeruginosa

86
Q

What can occur with chronic serous OM

A

goblet cell metaplasia

87
Q

Can otosclerosis be genetic?

A

Yes, autosomial dominant

88
Q

Where are branchial cleft cysts located?

A

lateral part of the neck

89
Q

What causes branchial cysts?

A

failure of obliteration of the second branchial cleft in embryonic development causing excess fluid buildup

90
Q

What causes thyroglossal duct cyst?

A

Same etiology as branchial cleft cyst. Remnants of thyroid follicles in cyst.

91
Q

What are the locations of thyroglossal duct cysts?

A

Intralingual-2%suprahyoid-24%thyrohyoid-61%suprasternal-13%

92
Q

Are thyroglossal duct cysts malignant?

A

Potentially, thyroid cancer present in 1-2% of cysts

93
Q

Thyroglossal duct cyst Tx?

A

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
Q

What is a paraganglioma?

A

Carotid body tumor- develops within the adventitia of the medial aspect of the carotid bifurcation.

95
Q

What are the different types of carotid body tumors?

A

Familial, Sporadic, Hyperplastic

96
Q

What is characteristic about the rate of growth in paragangliomas?

A

slow-growing tumor- 7 yr doubling time

97
Q

Paraganglioma presentation?

A

Typically asymptomatic palpable neck mass in the anterior triangle of the neck. 10% involve cranial nerve palsy.

98
Q

What is Xerostomia?

A

“dry mouth” due to a decrease in production of saliva. Associated with Sjogren syndrome.

99
Q

What is Sjogren Syndrome?

A

autoimmune against salivary and lacrimal glands. Decreases tear and saliva production.

100
Q

What can be caused by blockage or rupture of salivary gland ducts?

A

Mucoceles

101
Q

What are benign tumors of the facial lymphatics?

A

pleomorphic adenoma, warthin tumor(papillary cystadenoma lymphomatosum)

102
Q

What are malignant tumors of facial lymphatics?

A

mucoepidermoid carcinoma, adenoid cystic carcinoma

103
Q

What is the basic anatomy of the sclera?

A

Thick, white, transparent at the cornea

104
Q

What is the basic anatomy of the choroid?

A

Deeply pigmented, contains blood vessels, and the Iris is part of the choroid

105
Q

What is the basic anatomy of the Retina?

A

Has rods and cones, converts light energy into nerve impulses

106
Q

What is present at the Fovea centralis?

A

Only cones. This is where the greatest visual acuity occurs.

107
Q

Which bones make up the orbit?

A

ZygomaticSphenoidFrontalEthmoidLacrimalPalatineMaxillary

108
Q

Which bone making up the orbit is the thinnest and what can result from this?

A

Ethmoid- orbital cellulitis can result if infection erodes through from the sinus

109
Q

What is the origin of the occular muscles?

A

Annulus of Zinn

110
Q

What does the annulus of zinn encircle?

A

optic n.

111
Q

What is characteristic of the lower canaliculus in children?

A

It’s smaller= inc risk for infection.Massage can keep the duct open.

112
Q

What is the mechanism for thyroid-related orbitopathy(Graves Dz)?

A

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
Q

What is the manifestation of thyroid related orbitopathy?

A

ProptosisStrabismus/muscle-restrictionExposure problemsCompressive optic neuropathy.

114
Q

Thyroid related orbitopathy Tx?

A

SteroidsRadiation therapySurgical decompression (opening the orbital walls into the sinuses)

115
Q

What are the most frequent primary tumors of the orbit?

A

Most are vascular in originCapillary hemangiomaCavernous hemangioma Lymphangioma

116
Q

What are characteristics of capillary hemangiomas?

A

“spider”, thinner

117
Q

What are characteristics of cavernoushemangiomas?

A

more dense/dilated

118
Q

What is the most common primary malignancy of the orbit in children?

A

rhabdomyosarcoma

119
Q

What is the most common metastatic tumor in children?

A

neuroblastoma- 20% develop orbit metastasis

120
Q

Where will the gaze likely be in orbital floor fx?

A

Restricted upgaze if there is muscle entrapement

121
Q

How critical are orbital floor fx?

A

Typically require hospitalization

122
Q

What are the tarsal glands AKA?

A

Meibomian glands

123
Q

What are the malignant tumors of the eyelids?

A

Basal cell carcinoma – most common Sebaceous carcinomaSquamousMelanoma

124
Q

What can occur if basal cell carcinoma is not completely removed?

A

inc risk of becoming squamous cell carcinoma

125
Q

What causes a Chalazion?

A

chronic inflammatory lesion of the meibomian gland

126
Q

What secretes the mucinous components of the tear film?

A

goblet cells

127
Q

What causes conjunctivitis?

A

viral(adenovirus), bacterial, or allergic cause

128
Q

What can result from chlamydial conjunctivitis?

A

scarring causing a dec in goblet cells leading to dec in mucin

129
Q

Bacterial conjunctivitis Tx?

A

usually self limited in 10-14 days

130
Q

Allergic conjunctivitis Tx?

A

antihistamines, vasoconstrictors, and steriods

131
Q

What does conjunctiva intraepithelial neoplasia(CIN) often preceed?

A

Squamous cell tumor

132
Q

What is the Limbus?

A

Border of the cornea and the sclera. The limbus is a common site for the occurrence of corneal epithelial neoplasm.

133
Q

Where do lymphoidic conjunctiva tumors arise from?

A

mucosa-associated lymphoid tissue (MALT)

134
Q

What are conjunctiva squamous papilloma and conjunctiva intraepithelial neoplasia(CIN) associated with?

A

HPV 16 and 18

135
Q

Is the cornea vascularized?

A

No

136
Q

What are the 5 layers of the Cornea?

A

EpitheliumBowmans MembraneStromaDescemet’s membraneEndothelium

137
Q

What is the anatomy of the Cornea epithelium?

A

Continuous with conj, richly innervated by CN-V1

138
Q

What is the anatomy of the Corneal Stroma?

A

The thickest central portion (90%). Primarily made up of Type 1 Collagen in uniformly-spaced lamellar bundles.

139
Q

Where does copper deposition occur in Wilsons disease (Kayser-Fleischer ring)?

A

Descemet’s membrane layer of the cornea

140
Q

What is the function of the endothelial layer of the cornea?

A

pumps the water out of the cornea and keeps it clear

141
Q

Where does LASIK/Refractive surgery happens?

A

Corneal Stroma

142
Q

What is Keratitis?

A

inflammation of the cornea

143
Q

What is the most common cause of bacterial keratitis?

A

Pseudomonas

144
Q

What is the most common cause of viral keratitis?

A

HSV

145
Q

What are the signs of HSV Keratitis?

A

epithelial “dendritic” lesions

146
Q

What are the signs of Bacterial Keratitis?

A

Hypopyon

147
Q

What is Stromal dystrophy?

A

a heritable disorder resulting in abnormal tissue morphology, function, or abnormal depositions of material into the cornea.

148
Q

What is ectasia?

A

progressive deformation of the cornea

149
Q

What is the most common ectatic dystrophy?

A

Keratoconus

150
Q

What can be a complication of refractive surgery?

A

Ectasia

151
Q

ectasia Tx?

A

refer to ophthalmology

152
Q

What composes the Uvea?

A

Iris, ciliary body, and the choroid

153
Q

What is the function of the iris?

A

diaphragm for light

154
Q

What is the function of the ciliary body

A

suspends and flexdes the lens, also makes the aqueous humor

155
Q

What is the function of the choroid

A

nourishes the outer retina

156
Q

where is the angle of the uvea?

A

where the iris meets the cornea

157
Q

What is the function of the angle of the uvea?

A

regulates the outflow of aqueous humor through the canal of Schlem. This determines intraocular pressure.

158
Q

What serious systemic Dzs can uveitis be associated with?

A

arthritis, IBD, vacuities, torch syndrome

159
Q

What is commonly seen in anterior uveitis?

A

WBC’s floating in aqueous humor

160
Q

What is seen in posterior uveitis?

A

active toxoplasmosis choroiditis, old scars

161
Q

Why is the choroid a potential target site for metastasis?

A

It is highly vascularized

162
Q

What has the highest protein content in the body and what is the significance of this?

A

Lens- creates a high refractive index

163
Q

What focuses light on the retina

A

The lens in concert with the cornea

164
Q

What happens the the central fibers of the lens with aging?

A

they become sclerotic and opaque making the lens flatten with time

165
Q

What are pathogenic factors of cataracts

A

UV light, steroids, and inflammation

166
Q

What type of cells are in the retina?

A

Photoreceptors-detect lightBipolars-transmit signal to ganglion cellsGanglion cells- send signal by long axon through optic n.

167
Q

Which side of the optic disc do retinal arteries and veins emerge from?

A

nasal side

168
Q

Which direction do arching retinal vessels go?

A

toward the temple

169
Q

which direction do radial retinal vessels go?

A

toward the nose

170
Q

Do retinal arteries contain a muscular coat?

A

No

171
Q

What do retinal arteries drain?

A

innner retina(retinal ganglion cells and their axons and the bipolar cells)

172
Q

What drains the outer retina(rods and cones)?

A

choroidal circulation

173
Q

Where does retinal detachment occur?

A

between the retinal pigment epithelium(RPE) and photoreceptor(neurosensory) segments

174
Q

What causes Macular degeneration?

A

Bruch’s membrane damaged by deposition of drusen, allowing leaky choroidal vessels to grow into retina (exudative type).

175
Q

What causes Drusen?

A

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
Q

What are the 2 types of retinal detachment?

A

Tear (most common), seperation

177
Q

What are characteristics of atrophic macular degeneration?

A

Discrete deposits in the Bruch membrane(drusen)

178
Q

What are characteristics of neovascular macular degeneration?

A

Presence of angiogenic vessels originate from choroid capillaries Penetrate Bruch membrane and may penetrate the RPE.Vessels may leak causing macular scars.

179
Q

Neovascular macular degeneration Tx?

A

VEGF antagonists(antibodies to growth factors)

180
Q

What is characteristic of hemorrhage form of macular degeneration?

A

sudden onset of painless, blurred, or warped vision called metamorphopsia.

181
Q

What can cause microvascular Dz in the retina?

A

Dm, Sickle cell, radiation

182
Q

What occurs in the preproliferative phase of diabetic retinopathy?

A

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
Q

What occurs in the proliferative phase of diabetic retinopathy?

A

retinal angiogenesis=retina becomes thicker

184
Q

Consequences of Diabetic Retinopathy?

A

Vitreous humor detachment “posterior vitreous detachment”May precipitate massive hemorrhageOrganization of retinal neovascular membrane may wrinkle the retinaTraction retinal detachment

185
Q

What is the best prevention of Diabetic Retinopathy?

A

blood glucose control

186
Q

Diabetic Retinopathhy Tx?

A

lasers can stop progression

187
Q

What are Roth spots

A

Cotton wool spots surrounded by hemorrhage

188
Q

If a person has chronic hypertension, what is likely to be seen on the optic disc?

A

AV nicking due to stiffened arteries

189
Q

What is the classic pediatric tumor of retina?

A

Retinoblastoma

190
Q

What causes Ischemic Neuropathy?

A

due to arteritic (Giant Cell Arteritis) or non-arteritic causes. Vessle walls become inflammed= dec diameter= dec blood supply to optic n.

191
Q

What causes Optic Neuritis?

A

Many causes, but demyelinating (Multiple Sclerosis) causes are most important

192
Q

What causes Papilledema?

A

swelling due to increased intracranial pressure

Pathophysiology- HEENT (2 decks)

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