10 - Head and Neck Flashcards
(155 cards)
1
Q
what are the inflammatory/reactive lesions
A
- apthous ulcers
- fibroma (coal fibrous hyperplasia)
- pyogenic granuloma
- peripheral ossifying fibroma
- peripheral giant cell granuloma
2
Q
are apthous ulcers recurrent and painful?
A
yes
3
Q
cause of apthous ulcers? what percent of population affected
A
unknown cause - affect 40% of population
4
Q
what age are apthous ulcers frequent
A
first two decades
5
Q
what tends to be clusetered within some families and may be associated with immunlogical disorders including celiac, IBS, and bethchet syndrome
A
apthous ulcer
6
Q
what lesion:
Lesion may be single or multiple, shallow, mucosal ulcerations covered by a thin exudate and rimmed by a narrow zone of erythema
A
apthous ulcer
7
Q
when do apthous ulcers resolve
A
spontaneously in 7-10 days but sometimes persist for weeks, particularly in immunocompromised patients
8
Q
what is a submucosal nodular mass of fibrous CT stroma
A
fibroma (focal fibrous hyperplasia)
9
Q
where does fibroma (focal fibrous hyperplasia) present
A
> on buccal mucosa alone bite line or gingiva
10
Q
is fibroma (focal fibrous hyperplasia) a reactive process induced by repetitive trauma
A
yes
11
Q
treatment of fibroma (focal fibrous hyperplasia)
A
surgical excision
12
Q
what is an exophytic inflammatory lesion that presents on gingiva of children, young adults and pregnant women
A
pyogenic granuloma
13
Q
what does pyogenic granuloma look like
A
red to purple in color and frequently ulcerated
14
Q
are rapid growth granulomas elicit concern of malignancy
A
yes
15
Q
histologically, what are highly vascularized proliferation of organizing granulation tissue
A
pyogenic granuloma
16
Q
what is capable of regressing, mature into dense fibrous masses or develop into peripheral ossifying fibroma
A
pyogenic granuloma
17
Q
how to treat pyogenic granuloma
A
complete surgical excision
18
Q
is pyogenic granuloma a misnomer? why?
A
yes - because it is not a pus forming bacteria
19
Q
what has a reactive growth that occurs exclusively on the gingiva, and is greatest in younger females (10-19 years of age)
A
peripheral ossifying fibroma
20
Q
what can arise in long-standing PG while others develop de novo from cells of PDL
A
peripheral ossifying fibroma
21
Q
POF apperance
A
red, ulcerated, nodular lesion
22
Q
treatment of peripheral ossifying fibroma? recurrence?
A
complete surgical excision down to the periosteum
recurrence rate of 8% to 16%
23
Q
what has a reactive growth, occurs exclusively on gingiva or edentulous alveolar ridge; 2 cm in diameter, and its mean age is 31-46 years, where 55% cases seen in females (>mandible anterior or posterior)
A
peripheral giant cell granuloma
24
Q
what can cause a cupping resorption of undelrying bone
A
peripheral giant cell grnauloma
25
histologically, PGCG looks like what
Histologically, PGCG contain aggregates of multinucleated,
foreign body-like giant cells separated by a fibrous stroma and
blood vessels
26
treatment and recurrence rate of peripheral giant cell granuloma
surgical excision;10-18%
27
what are infections of the oral cavity
1. primary herpes simplex virus
2. latent herpes simplex virus
3. recurrent herpes simplex virus
4. oral candidiasis (thrush)
5. deep fungal infections
28
how do oral herpes present in children? in adults?
children = gingivostomatitis
adults = pharyngotonsillitis
29
where are oral herpes present
loose and bound down mucosa
30
most orofacial herpetic infections are caused by what virus
HSV 1
31
children with gingivostomatitis can be accompainied with what symptoms
lymphadenopathy, fever, and anorexiaadu
32
in adults, is acute herpes pharyngitis common and may recur?
yes
33
when does primary herpes simplex virus resolve
mild cases: 5-7 days
severe cases: 2 weeks
34
human herpes virus is what type of DNA virus
double stranded DNA virus
35
what is HHV1
herpes simplex virus 1 (above waist)
36
what is HHV 2
herpes simplex virus 2 (below waist)
37
what is HHV3
varicella-zoster virus (chicken pox and shingles)
38
what is HHV4
Epsetin Barr virus
39
what is HHV5
cytomegalovirus
40
what is HHV6 and HHV7
generally in children and are closely related
41
what is HHV 8
Kaposi sarcoma associated virus
42
what are the only know reservoirs for HHV
humans! endemic worldwide
43
After primary infection is established, the herpes simplex virus is taken up by the sensory nerve and transported to the ___ or less frequently, ___ where the virus remains in latent stage
associated sensory;autonomic ganglia
44
most common site for latent HSV1
trigeminal ganglion
45
does latent herpes simplex virus use axons of sensory neurons to travel back and forth to the skin and mucosa
yes
46
where do recurrent herpes simplex virus infections occur
May occur at site of primary inoculation or in adjacent areas of surface
epithelium supplied by the involved ganglion
47
what is the most common clinical pattern of recurent herpes simplex virus
herpes labialis (cold sore or fever blister)
48
what are prodromal signs and symptoms that arise 6-24 hours before recurrent herpes lesions appear
pain, burning, itching, tingling, localized warmth, erythema
49
what are multiple small, erythematous paupules that develop and form clusters of fluid-filled vesicles. It happens in BOUND DOWN MUCOSA (palate or gingiva)
recurrent herpes simplex virus
50
when to recurent herpes simplex virus rupture and crust? how long does healing take?
rupture and crust within 2 days
healing occur in 7-10 days
51
when is pain most severe in recurrent herpes simplex virus
first 8 hours and usually resolves in 4-5 days
52
does viral shedding occur in recurrent herpes simplex when vesicle ruptures
YES
53
when is recurrent herpes simplex most viral
within 48-72 hours
54
when should medicaiton be administered to shorten recurrent herpes simplex virus
prodrome phase (early stage and symptoms of any condition)
55
what is the most common fungal infection of oral cavity
oral candidasis (thrush)
56
oral candidasis is also called what
thrush
57
what are the factors that influence infectino of thrush
1. strain of C. albicans
2. oral microbiome composition
3. individuals immune status
58
how can oral candidiasis present
1. pseudomembranous (membrane covering, it can rub off)
2. erythematous (redness of oral mucosa)
3. hyperplastic
59
what cna be used to eliminate or alter bacteria flora of mouth that promotes thrush
brad spectrum antibiotics
60
what are examples of deep funcal infections
1. histoplasmosis
2. blastomycosis
3. zygomycosis
4. aspergillosis
61
The incidence of oral fungal infections has grown along with increasing numbers ___ as a result of disease such as AIDS, therapies for cancers, and organ transplant
immunocompromised patients
62
what are examples of oral manifestations of systemic diseases
1. oral hairy leukoplakia
2. scarlet fever
3. measles
4. infectious mononucleosis
5. diphteria
6. HIV
63
what is a distinctive oral lesion on lateral border of tongue caused by EBV (HHV4) that usually occurs in immunocompromised patients
oral hairy leukoplakia
64
in patients infected with HIV, what may be a warning of development of AIDS
OHL
65
OHL are seen in patients who are
immunocomporised for other reasons including:
1. cancer therapy
2. transplant associated immunosuppression
3. old age
66
what are white linear lines of hyperkeratotic thickenings seen on lateral border of tongue and CANNOT be scraped off
oral hairy leukoplakia
67
what disease presents with fiery red tongue with prominent papillae (raspberry tongue); white coated tongue through which hyperemic papillae project (strawberry tongue)
scarlet fever (group A strep)
68
what disease presents spotty enanthema in the oral cavity often proceeds the skin rash;
ulcerations on the buccal mucosa; Koplik spots
measles (single stranded RNA virus of paramyxoviridae family)
69
what disease presents acute pharyngitis and tonsilitis that may cause coating with a grey-white exudative membrane; enlargement of lymph nodes the neck; palatal petechiae
infectious mononucleosis (EBV aka HHV-4)
70
what disease presents Characteristic dirty white, fibrinosuppurative, tough, inflammatory membrane over the tonsil and retropharynx
diptheria (c. diptheriae)
71
what disease presents predisposition to opportunistic oral infections, particularly herpes virus, candida, and other fungi; oral lesions of Kaposi sarcoma and oral hairy leukoplakia
HIV
72
how long can infectious mono last? what is painful?
6-10 days -> swallowing is paindul
73
HIV can cause what oral presentations
1. kaposi sarcoma
2. candidiasis
3. oral hairy leukoplakia
74
what disease presents reticulate, lacelike, white keratotic lesions (Wickham striae) that sometimes ulcerate and rarely form bullae; seen in more than 50% of patients with cutaneous ___
lichen planus (unknown autoimmune disease)
75
what disease presents vesicles and bullae prone to rupture, leaving hyperemic erosions covered with exudates
pemphigus (unknown autoimmune disease)
76
what disease presents oral lesion (mucous membrane pemphigoid) resemble those of pemphigus but can be differentiated histologically
bullous pemphigoid (unknown-autoimmune disease)
77
what disease presents maculopapular,
vesiculobullous eruptions that sometimes follow an infection elsewhere, ingestion of drugs, development of cancer, or a collagen vascular disease; crusting of lips when there is widespread mucosal and skin involvement it is referred to as Stevens-Johnson syndrome
Erythema multiforme (autoimmune * may be associated with herpes simplex infection, mycoplasma pneumoniae or medications)
78
radiating white lines are called what in lichen planus
Wickham striae
79
what presents an intraepithelial split? what forms subepithelial split?
pemphigus: intraepithelial split to form vesicle or bullae
mucous membrane pemphigoid: subepithelial split
80
what presents severe oral infections in the form of gingivitis, pharyngitis, tonsillitis; may extend to produce cellulitis of the neck (Ludwig angina)
pancytopenia (agranulocytosis, aplastic anemia)
81
what presents with depletion of functioning neutrophils, oral lesions similar to those in pancytopenia may develop
leukemia
82
what presents leukemic infiltration and enlargement of the gingivae, often with accompanying periodontitis
monocytic leukemia (one type of cell)
83
what may appear in Addison disease, Hemochromatosis, fibrous dysplasias of bone (McCune Albright syndrome), and Peutz- Jegher syndrome (gastrointestinal polyposis)
melanotic pigmentation
84
what is a striking fibrous enlargement of gingivae
phenytoin ingestion (antiseizure med)
85
what causes a friable, red, pyogenic granuloma producing form the gingivae (Pregnancy tumor, PG)
pregnancy
86
what is an AD disorder with multiple congenital aneurysmal telangiectasis beneath mucosal surfaces of the oral cavity and lips
Rendu-Osler-Weber syndrome (Hereditary hemorrhagic telangectasia)
87
what is a rare chronic condition where adrenal glands don't produce enough cortisol and aldosterone hormones
addison's disease
88
With adrenal insufficiency, not being able to increase the amount of cortisol made as a result of stress can lead to an ___
Addisonian crisis.
89
what are part of McCune Albright syndrome
1. cafe-au-lait lesions
2. precocious puberty
3. fibrous dysplasia
90
what are precancerous and cancerous oral lesions
1. leukoplakia
2. erythroplakia
3. squamous cell carcinoma
91
Defined by WHO as "a white patch or plaque that cannot be scraped off and cannot be characterized clinically or pathologically as any other disease"
leukoplakia
92
what is a term reserved for lesion present in oral cavity for no apparent reason
leukoplakia
93
5%-25% of leukoplakia lesions are ___
premalignant
94
who gets leukoplakia
>40-70 year olds
2:1 male predilection
95
where does leukoplakia occur in oral cavity
anywhere in oral cavity
96
Defined by WHO as a red, velvety patch or eroded area that cannot be characterized clinically or pathologically as any other disease"
erythroplakia
97
the epithelium in these lesions are markedly atypical; risk of malignant transformation is higher than leukoplakia
erytheroplakia
98
Intermediate forms that have the characteristics of both eukoplakia and erythroplakia are termed ___
speckled leukoplakia
99
who gets erythroplakia
>40-70 year of age, 2:1 male predilection
100
where does erythroplakia occur in oral cavity
anywhere in oral cavity
101
what are most cancers of head and neck
sqamous cell carcinoma
102
what is the 6th most common neoplasm in the world
SCC
103
where is sqamous cell carcinoma present? what does it harbor?
oropharynx - harbor oncogenic variants of HPV (specifically HPV 16)
104
why is early detection of HPV associated head and neck SCC challenging
because of anatomical sites (tonsillar crypts, base of tongue, and oropharynx)
105
is HPV associated SCC of the ORAL CAVITY common?
NO! oropharynx is the common one
106
patient age, risk factors, location, clinical presentation, histology, distant metasis, clinical outcomes, and risk of second primary:
associated with HPV
age: younger
risk factors: number of oral sex partners
location: oropharynx/back of throat
clinical presentation: small primary lesion with bulky nodular disease
histology: nonkeratinizing SCC
distant metasasis: rare
clinical outcomes: good
risk of secondary primary (death): low
107
patient age, risk factors, location, clinical presentation, histology, distant metasis, clinical outcomes, and risk of second primary:
not associated with HPV
age: older
risk factors: tobacco/alcohol
location: oral cavity
clinical presentation: large primary lesion with variable nodal disease
histology: keratinizing SCC
distant metasasis: common
clinical outcomes: poor
risk of secondary primary (death): high
108
what are lesions of the nose
1. inflammatory lesions (rhinitis, sinusitis)
2. necrotizing lesions of nose and upper airways
109
what are lesions of nasopharynx
inflammatory lesion (pharyngitis and tonsilits)
110
what are tumors of the nose, sinuses, and nasopharynx
1. nasopharyngeal angiofibroma
2. sinonasal papilloma
3. olfactory neuroblastoma
4. nasopharyngeal carcinoma
111
what is the infectious rhinitis also called
common cold
112
what Is caused by one or more viruses; major offenders are adenovirus, echovirus, and rhinovirus
infectious rhinitis (common cold)
113
during initial stages of ___ nasal mucosa is thickned, edematous and red; nasal cavities narrowed and tribunates are enlarged
infectious rhinitis
114
can infectious rhinitis get seocndary bacterial infection
yes
115
when does infectious rhinitis clear
rapidly in 7 days
116
what is allergic rhinitis also called
hay fever
117
what is Initiated by hypersensitivity to one of a large group of allergens and
dust mites; affects 20% of US population; IgE mediated reaction; characterized by mucosal edema, erythema, and secretions
allergic rhinitis
118
Recurrent attacks of rhinitis may eventually lead to focal protrusion of the mucosa, producing what?
nasal polyps
119
describe nasal polyps
3-4 cm in length
in absence of bacterial infection, mucosal surface is intact
120
most cases of ___ are preceded by what
rhinitis
121
what occasionally arises by extension of the periapical infection throughthe bony sinus floor
maxillary sinusitis
122
what can cause severe chronic sinusitis (mucormycosis) especially in uncontrolled diabetic patients
fungi
123
what can necrotizing lesions be produced by
1. acute fungal infections
2. granulomatosis with polyangiitis (Wagner granulomatosis)
3. extranodal NK/Tcel lymphoma nasal type (tumor harbors EBV)
124
what are the most common causes of pharyngitis and tonsilitis
Rhinovirus, echovirus, and adenovirus are the most common
causes; remaining cases are primarily due to various strains of
influenza or respiratory syncytial virus
125
___ and ___ of the nasopharyngeal mucosa with ___ of nearby tonsils and lymph nodes are characteristic in pharyngitis and tonsilitis
erythema, edema, enlargement
126
Bacterial infections may also cause the infections or may be secondarily superimposed on viral infection; ___ most frequent cause
Beta-hemolytic streptococcus aureus
127
Major importance of streptococcal "sore throat" lies in the possible development of late sequelae such as ___
rheumatic fever and glomerulonephritis
128
what is a benign, highly vascular tumor that occurs almost exclusively in adolescent males who are often fair-skinned and red-headed. Arises in the posterolateral wall of the roof of the nasal cavity; cause trouble breathing, nosebleeds, and runny nose that is consistence
nasopharyngeal angiofibroma
129
how to treat nasopharyngeal angiofibroma
Surgical removal, often with preoperative embolization to
decrease bleeding, is the treatment of choice
130
Benign neoplasm arising from the respiratory or
schneiderian mucosa lining the nasal cavity and
paranasal sinuses
Sinonasal (Schneiderian ) Papilloma
131
who gets Sinonasal (Schneiderian ) Papilloma
males between 30-60 years
132
what, alhough benign, it can exhibit locally aggressive behavior within both the nose and paranasal sinuses, including invasion into the orbit or cranial vault
Sinonasal (Schneiderian) Papilloma
133
does Sinonasal (Schneiderian ) Papilloma have high rate of recurrence if not adequately excised
yes
134
is Sinonasal (Schneiderian ) Papilloma capable of malignant transformation
yes in 10% of cases
135
what arises from the neuroectodermal olfactory cells within the mucosa, particularly in the superior aspect of the nasal cavity
Olfactory Neuroblastoma (Esthesioneuroblastoma)
136
what age do people get Olfactory Neuroblastoma (Esthesioneuroblastoma)
peaks at 15 and 50 years
137
what do patients with Olfactory Neuroblastoma (Esthesioneuroblastoma) present
nasal obstruction and/or epistaxis
138
how does Olfactory Neuroblastoma (Esthesioneuroblastoma) look histologically
small, round, blue cells
139
treatment of Olfactory Neuroblastoma (Esthesioneuroblastoma)? survival rate?
Treatment includes a combination of surgery, chemotherapy, and radiation therapy-depending upon the tumor stage
5 year SRs of 40%-90%
140
what is characterized by a distinct geographic distribution, a close anatomic relationship to lymphoid tissue, and an association with EBV
nasopharyngeal carcinoma
141
Beyond EBV, diets high in nitrosamines (found in fermented foods and salted fish, and environmental insults (smoking) and chemical fumes have been linked to what tumors
nasopharyngeal carcinoma
142
what does nasopharyngeal carcinoma cause? survival rate?
Cause nasal obstruction and/ or epistaxis; overall 5yr SR 60%
after treatment
143
what are tumors of neck
1. branchial cyst (cervical lymphoepithelial cyst)
2. thyroglossla duct cyst
3. paraganglioma
144
vast majority of branchial cyst (cervical lymphoepithelial cyst) are thought to arise from from
remnants of second branchial arch
145
Most commonly observed in young adults between 20 and 40 years of age; Usually appear as nontender, soft tissue mass on the upper lateral aspect of the neck along the sternocleidomastoid muscle
Branchial Cyst (Cervical
Lymphoepithelial Cystl
146
The slowly-enlarging cysts are well circumscribed, 2-5 cm in diameter, and usually lined by stratified squamous epithelium or pseudostratified columnar epithelium; fibrous cyst wall contains lymphoid tissue
Branchial Cyst (Cervical
Lymphoepithelial Cyst)
147
are Branchial Cyst (Cervical Lymphoepithelial Cyst) readily excised?
yes! do not undergo malignatn transformation
148
what cyst:
The thyroid anlage begins in the region of the foramen caecum, at the base of the tongue; as the gland develops, it descends to its definitive midline location in the anterior neck; Remnants of this developmental process may persist, resulting in 1-4 cm cysts
Thyroglossal Duct Cyst
149
They are lined by stratifies squamous epithelium when located near the base of the tongue and pseudostratified columnar epithelium in lower locations; the fibrous cyst wall contains thyroid remnants
thyroglossal duct cyst
150
treatment for thyroglossal duct cyst
surgical exicision (definitive tx)
151
what is paraganglioma also called
carotid body tumo
152
what arises from neuroectodermal cells associated with the sympathetic and parasympathetic nervous systems; occurs at many sites
paraganglioma (Carotid body tumor)
153
what is the most common paraganglioma
adernal medullary pheochromocytomas
154
who has a higher incidence of paraganglioma
people living in higher altitudes
155
describe paraganglioma
Slow-growing painless mass; rarely exceed 6 cm and arise close to the
bifurcation of the carotid artery
Arise in 5th -6th decades of life; they recur after incomplete resection
and may metastasize to regional LN and distant sites
Approx. 50% ultimately fatal due to infiltrative growth
