STRX Week 1 & 2 Flashcards
Which is more likely leukoplakia and which is erythroplakia?
Leukoplakia more likely the right bc leukoplakia is a plaque-like lesion so you would see hyperkeratinized tissue
Erythroplakia is more likely to be malignant so the left is more likely that due to its lack of structure and infiltration of leukocytes
a. HPV is the primary cause of SCC in what anatomical structure?
b. What are the primary causes of SCC in the related structures?
a. Oropharynx - commonly base of tongue and tonsil
b. Oral cavity HCC primary cause is tobacco and alcohol (betal quid in Asia/India)
Lower lip - UV radiation and pipe smoking
Fill in the characteristics of SCC
What are the common driver mutations of P16-negative (non-HPV) HCC?
p53, RB pathways, CDKN2A
Explain what field cancerization is
Because the entire oral cavity/ oropharynx has been exposed to the same carcinogens for the same amount of time, it’s likely that there are multiple mutations within the mucosal cells that could become cancerous at any time
Multiple tumors develop independently (not metastasis) - the second primary tumors often fatal
Differentiate the locations and risk factors of adenocarcinoma vs squamous cell carcinoma in esophageal cancers
Adenocarcinoma:
Lcoation - lower esophagus
Risk factors - Barret’s esophagus, GERD, radiation, tobacco
Squamous Cell Carcinoma
Location - oral cavity to upper esophagus
Risk factors - alcohol, tobacco, achalasia, Plummer Vinson, hot beverages, radiation
Why are SCC and adenocarcinoma of the oropharynx and esophagus so aggressive in terms of spreading quickly to regional lymph nodes?
SCC - in the upper esophagus/oral cavity - surrounded by lymph nodes (tonsillar, submandibular)
Adenocarcinoma - esophagus lacks serosa so it can access lymphatic plexus much more easily
What nerves carry sensory innervation for the upper and lower teeth?
Upper: anterior, middle, and posterior superior alveolar nerves
Lower: Inferior alveolar nerve
What are the differences between tunica adventitia and tunica serosa?
Adventitia is connective tissue contiguous with CT lining and other strctures.
Serosa consists of CT lined by mesothelium (cells that secrete serous fluid to reduce friction caused by movement)
What structures of the oral cavity have lining mucosa?
Vestibular fornix
Sublingual sulcus
Alveolar mucosa
Soft palate
Ventral surface of tongue
What structures of the oral cavity have masticatory mucosa?
Hard palate
Gingiva
What structures of the oral cavity have specialized mucosa?
Dorsum of tongue
Floor of mouth
How can you tell where the oral mucus membrane of the lip stops and the skin begins?
Lip has 3 layers, non-keratinized
Skin has 5 layers, keratinized
Vermilion zone
Presence of hair follicles on the skin
What is the major difference between hard and soft palate?
Presence of bone in hard palate
What type of gland is shown, and what type of excretion would you expect?
Tonsillar gland - mucus
What type of gland is shown, and what type of excretion would you expect?
Palatine gland - mucus
What type of gland is shown, and what type of excretion would you expect?
Lip/Buccal gland - seromucus
What type of gland is shown, and what type of excretion would you expect?
Glands of von Ebner - serous
What type of gland is shown, and what type of excretion would you expect?
Parotid gland - 100% serous
Abundant intercaclated, striated, and excretory ducts
What type of gland is shown, and what type of excretion would you expect?
Submandibular gland - 80% serous, 20% mucus
Rare interacalated ducts, abundant striated and excretory ducts
What type of gland is shown, and what type of excretion would you expect?
Sublingual gland - 40% serous, 60% mucous
No intercalated, rare striated, abundant excretory ducts
Identify the glands
What is the arcuate line?
The transition from bilaminar to a unilaminar sheath approx 2/3 of the way down the anterior wall
What is the order of layers you would encounter cutting into the medial abdomen?
Skin –> Camper’s fascia –> Scarpa fascia –> External oblique aponeuorosis –> internal oblique aponeurosis –> transversalis abdominis aponeurosis –> transversalis fascia –> extraperitoneal fat –> parietal peritoneum
What’s the difference between the layers of the rectus sheath above and below the arcuate line?
Above the arcuate line - the rectus sheath is bilaminar:
external and internal oblique aponeurosis contributing to the anterior lamina
internal oblique and** transversalis abdominis** aponeurosis contributing to posterior lamina
Below the arcuate line - rectus sheath is unilaminar:
Anterior lamina is made of all three muscle fascia (ext, int, transversalis)
Posterior lamina no longer exists and is simply transversalis fascia
What is the blood supply of the abdominal wall?
Superior epigastric a. from Internal Thoracic
Descending Aorta
Inferior Epigastric a and Deep Circumflex a from External Iliac
Superficial Epigastric a and Superficial Circumflex a from Femoral
What is the significance of portal veins that anastomose with caval veins?
When there is portal hypertension, blood can flow retrograde due to an absence of valves in the portal system –> back to the anastamoses with the caval veins to drain from there
This locations are the esophageal veins, superficial epigastric veins, and rectal veins
What nerve passes through the superficial ring and what level does it originate?
Ilioinguinal n from L1