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Pathology Term 2 > Week 1 - HEAD & NECK > Flashcards

Week 1 - HEAD & NECK Flashcards

URTIs, Oral Lesions, Influenza, Salivary Glands, Others

1
Q

What is the most common oral lesion and describe it?

A

Aphthous Ulcers (Canker Sores)

  • common, young age (<20)
  • self-limited
  • painful, superficial ulcers of unknown etiology
  • covered by thin exudate
  • surrounded by hyperemia
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2
Q

What is a fibroma?

A
  • firm nodular swelling of fibrous/scar tissue (healing tissue)
  • chronic irritation –> common on buccal mucosa along bite lines
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3
Q

What is the commonest oral cancer?

A

Squamous cell carcinoma

-95%

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4
Q

What are the common locations and etiologies of oral cancers?

A

Location:
-lips, tongue, floor, oropharynx (HPV)

Etiology:
-tobacco, alcohol, sunlight (lips), HPV

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5
Q

What is the pathogenesis of oral cancers?

A

-from precursor lesions (leukoplakia/erythroplakia)
-injury due to tobacco, alcohol, HPV, sunlight, etc.
-hyperplasia
metaplasia
-dysplasia (leukoplakia/erythroplakia)
-carcinoma in situ –> CARCINOMA

  • HPV 16 –> loss of E1/E2 tumour suppressor genes
  • spread to cervical lymph nodes –> distant organs
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6
Q

Compare leukoplakia vs. erythroplakia

A

Leukoplakia:

  • asymptomatic, chronic, white
  • tobacco, irritation, infection (EBV, HIV, HPV)
  • thick keratinised epidermis
  • less vascular submucosa
  • micro: –> 10% dysplastic cells
  • decreased risk of malignancy

Erythroplakia:

  • asymptomatic, chronic, red
  • tobacco, alcohol (inflammation)
  • thin, dysplastic epidermis
  • more vascular submucosa
  • micro: –> 90% dysplastic cells
  • increased risk of malignancy
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7
Q

What are the microscopic features of oral squamous cell carcinoma?

A
  • pleomorphic pink cells forming irregular clusters
  • keratin pearls and keratinisation of cells
  • increased inflammatory infiltrate
  • haemorrhage
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8
Q

What is verrucous carcinoma?

A
  • warty, exophytic white lesion (“cauliflower-like”)
  • hard, keratin-producing tumour
  • low grade/well-differentiated
  • buccal mucosa, vestibule, gingiva
  • marked continual keratosis WITHOUT infiltration
  • -> papillary hyperkaratosis over dysplastic epithelial growth
  • no/rare metastases –> wide excision –> good prognosis
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9
Q

What is hairy leukoplakia?

A
  • irregular, rough-surfaced leukoplakia-like patch
  • white patches of fluffy, hairy hyperkeratotic thickenings
  • lateral side of tongue
  • some times with candidiasis too
  • increase in EBV/immunocompromised (AIDS) pts.
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10
Q

What is the microscopy of hairy leukoplakia?

A
  • acanthosis

- balloon cells (loaded with EBV)

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11
Q

What are balloon cells?

A

Cells loaded with EBV on microscopy of hairy leukoplakia

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12
Q

What is EBV?

  • symptoms?
  • IP?
  • transmission?
A

AKA infectious mononucleosis/glandular fever
IP = 1-2 months; self-limited after 4-6wks
Transmission = spread in youth, close contacts, saliva (“kissing disease”)
Symptoms:
-URTI Sx.
-lymphadenopathy
-splenomegaly
-hepatitis
-(pneumonitis, meningitis, encephalitis)

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13
Q

What is the pathogenesis of EBV?

A
  • EBV infects epithelium + B lymphocytes

- EBV-specific CD8 T cells –> defense (destroy cells containing EBV

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14
Q

What are complications of EBV?

A
  • hepatitis
  • spleen rupture due to splenomegaly –> youth death
  • organ failure
  • meningitis
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15
Q

How is coxsackie virus transmitted and what do each of its 2 types cause?

A

-faeco-oral transmission

Coxsackie A = herpangina, HFM disease
Coxsackie B = myocarditis, pericarditis

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16
Q

What is herpangina?

A
  • fever
  • sore throat
  • oral tiny papulovesicles –> ulcers
  • caused by coxsackie virus (A)
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17
Q

What are the risk factors for URTIs and which is the most important?

A

CONTACT = most important
-crowding, school, kindergarten, travel, congregations

Others:

  • immunity
  • nutrition
  • age
  • smoking
  • carrier states (e.g. GAS)
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18
Q

What are the common pathogens for URTIs in:

  • nasopharynx?
  • oropharynx?
  • epiglottitis?
  • larynx –> tachea?
  • bronchi?
A 
Nasopharynx --> rhinoviruses 
Oropharynx --> GAS
Epiglottitis --> H. influnzae (rare)
Larynx - Trachea --> parainflunza, S. aureus
Bronchi --> S. pnuemoniae, H. influenzae
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19
Q

What is the commonest URTI and its most common cause?

A

Rhinitis –> “The Common Cold”

  • rhinovirus
  • other causes = influenza, parainfluenza, SARS, adenovirus, RSV
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20
Q

True or False?

Secondary bacterial infections are uncommon in rhinitis

A

False

-v. common

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21
Q

Describe transmission of rhinitis

A

Highly contagious

-droplets spread by sneezing, coughing, or hand contact with nose, eyes or face

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22
Q

What is the incubation period and symptoms of rhinitis?

A
  • IP = 2-4 days
  • sneezing, coughing and malaise for 3-6 days
  • recovery after approx. 7 days w/without Tx. (VIRAL)
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23
Q

What is meant by rhinitis being catarrhal inflammation?

A

-excess mucous production

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24
Q

What are complications of rhinitis?

A
  • sinusitis
  • pharyngitis
  • tonsillitis
  • otitis media
  • septicemia
  • nasal polyps –> inflammatory (allergy/hypersensitivity) –> inflamm. tissue occurs under mucosa
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25
What is the common cause of pharyngitis?
GAS
26
What is centor criteria
1. Fever 2. Tonsillar exudate 3. Anterior lymphadenopathy 4. NO cough * criteria used to diagnose pharyngitis * 0=unlikely, 4 = likely (^each Sx. = 1 point)
27
Why is epiglottitis not common nowadays?
- can be in children | - not common due to vaccine against Hib
28
What are the Sx. of epiglottitis?
- fever - dysphagia - drooling - hoarseness - stridor *complete obstruction = urgent endotracheal intubation
29
What is chronic rhinosinusitis?
Inflammation of paranasal/maxillary sinuses for >12 wks
30
What are the 3 types of sinusitis and what are the symptoms?
1. with polyps 2. without polyps 3. allergic Sx. --> fecer, pain, nasal discharge, hyposmia/anosmia
31
What is the causative organism of diptheria and why is it rare nowadays?
Corynebacterium diptheriae - gram + pleomorphic bacilli ('chinese letter pattern') - rare due to DPT vaccine
32
What are the Sx. of diptheria?
-high fever -SOB -sore throat, cough hoarseness -nausea and vomiting -marked neck lymphadenopathy ("Bull Neck") -pseudomembrane formation --> mucosal necrosis with fibropurulent exudate
33
What are complications of diptheria?
- aspiration of pseudomembrane + airway obstruction - spread of exotoxin --> myocarditis, heart failure/death, peripheral neuritis - cutaneous diptheria --> non-healing ulcer
34
What is the IP and mode of transmission of influenza?
- IP = 1-5 days | - person to person spread (crowd, school, aged-care, etc.)
35
What are clinical symptoms of influenza and how is it diagnosed?
Clinical: - mild URTI --> high fever - chills - headache/muscle aches - dry cough - abdo. pain + diarrhoea (esp. in children) Diagnosis: - nasopharyngeal swab for a rapig Ag test or PCR - serum Abs develop later
36
What are the 2 main surface Ags of influenza A?
500 surface molecules of hemagglutinin (H) 100 surface molecules of neuraminidase (N) * influenza = orthomyxovirus * types A, B, C
37
Which strain(s) of influenza is there a vaccine for? And what are the 2 available types of vaccines?
- type A + B - type C = rare (no vaccine) Vaccine = purified, inactivated Fluvac 1. Trivalent* --> commonest (2A + 1B) 2. Quadrivalent (2A + 2B)
38
How is Influenza B named?
according to LOCATION | -e.g. Influenza Brisbane
39
What is the most common influenza strain nationally?
Influenza A (H3N2)
40
Commonly prescribed trivalent vaccine in Australian Fluvac has this type?
B Phuket
41
What is SARS?
Severe Acute Respiratory Syndrome - severe pneumonia - high morbidity/mortality
42
What is atrophic rhinitis? | -symptoms + etiology?
- rhinitis sicca/dry nose - chronic atrophy of nasal mucosa + turbinates Sx. -nasal crusting, fetor, widening of space, ANOSMIA Etiology: - primary --> unknown - immune/hereditary? - secondary --> chronic sinusitis, trauma, surgery, granulomatous disease
43
What bacteria is commonly isolated from the greenish pus produced in atrophic rhinitis?
coccobacillus
44
What are the major and minor salivary glands and which type are each?
Major: 1. Parotid - serous (enzyme-rich) 2. Submandibular - mixed 3. Sublingual - mucinous (for lubrication) Minor: -hundreds of small widespread glands all over oral cavity
45
How are salivary glands linked to the pancreas?
- they have acini and ducts | - difference is that the salivary glands have mucinous acini as well
46
What are the functions of saliva?
- lubrication (mucous - digestion (enzymes) - mineralisation of teeth - speech
47
What is the commonest tumour of salivary glands?
Pleomorphic adenoma - benign - commonest carcinoma = mucoepidermoid carcinoma - Warthins tumour = #2
48
Which glands are commonly affected in sialadenitis and what is the pathogenesis?
- parotid + submandibular - parotid sialadenitis identified clinically by raising of earlobes Pathogenesis: - dry mouth (xerostomia) --> drying of secretions --> ductal block --> inflammation and infection - mumps --> bacterial infection of salivary glands - Sjogren's syndrome --> autoimmune sialadenitis (parotitis)
49
What is chronic sialadenitis?
- total atrophy/fibrosis of the gland - common in submandibular - drying up of secretions --> stone formation of ducts (sialolithiasis)
50
What is xerostomia? - causes? - clinical features? - complications?
-dry mouth --> "decreased saliva" Causes: - drugs, stress, fever, anticholinergics, antipsychotics, sedatives, antihistamines, Vit. C - autoimmune --> Sjogren + SICCA syndrome Clinical Features: -dry mouth, atrophy of papillae of tongue with fissuring, ulcerations Complications: -caries, candidiasis, dysphagia, speaking difficulty
51
What are the 2 types of Sjogren's syndrome?
AUTOIMMUNE SIALADENITIS 1. Primary (SICCA syndrome): (50%) - systemic - T cell mediated --> ducts 2. Secondary (with other disorders): 50% - RA, SLE, SS, etc
52
What are the clinical features of Sjogren's syndrome?
- dry eyes (conjunctivitis) - dry mouth (xerostomia) - caries - speech/taste abnormalities - dysphagia
53
What antibodies are involved in Sjogren's syndrome?
Anti-SS-A/SS-B (anti-Ro + La) *used to confirm diagnosis
54
What type of virus is Mumps and what is the 'good' thing about mumps?
- paramyxovirus | - single serotype --> therefore infects only ONCE with subsequent lifelong immunity
55
What are the clinical features of mumps and what other diseases can it cause?
Clinical features: - fever - swollen, painful parotids - orchitis Can cause: - aseptic meningitis - orchitis - acute pancreatitis
56
Why is there an increased likelihood of recurrence of pleomorphic adenomas?
- often involve extensions into surrounding tissue | - therefore difficult to excise adequately --> increase recurrence
57
What 2 tissues is pleomorphic adenomas comprised of?
- epithelial and connective tissues | - benign mixed tumour
58
What are the gross and microscopic features of pleomorphic adenoma?
Gross: - solid grey/white tumour - translucent blue areas of cartilage + myxoid tissue Micro: - epithelial + CT - cartilage common - glandular structures
59
From what do pleormphic adenomas typically arise from?
Myoepithelial cells | -of the salivary ducts
60
What is carcinoma ex pleomorphic adenoma?
- carcinoma that arises after many years in a pleomorphic adenoma - 10% at 10yrs - highly aggressive - mortality = 50% at 5yrs
61
What is Warthin's tumour?
- benign tumour due to the inclusion of lymphoid tissue into the gland - no damage/inflammation - ONLY in parotid glands - morphology = double layer of neoplastic epithelium folded around dense lymphoid tissue with cystic spaces
62
What salivary glands do adenoid cystic carcinomas affect?
Minor salivary glands | -palate, cheeks, lips
63
What are 2 key points for nasopharyngeal carcinomas?
1. common in Asian people | 2. strong link to EBV infection
64
What is the common CT element associated with pleomorphic adenomas?
Cartilage

Pathology Term 2 (6 decks)

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