25: Head & Neck

Question 1

Herpes labialis (cold sores, fever blisters) and herpetic stomatitis are caused by?

Answer 1

Herpes virus type 1

Question 2

What disease starts with painful inflammation of the affected mucosa, followed shortly by the formation of vesicles?

Answer 2

Herpes labialis (Herpes virus type 1)

Question 3

After the vesicles in herpes labialis rupture, what forms?

Answer 3

Shallow, painful ulcers

Question 4

Microscopically, the herpetic vesicle of Herpes labialis (Herpes virus type 1) forms as a result of “balooning degeneration” of what type of cells?

Answer 4

Epithelial cells

Question 5

At the edge of the ulcer in Herpes labialis (Herpes virus type 1) are large, 1. _______ epithelial cells with “ground glass” homoginized nuclei, often exhibiting nuclear molding. The ulcers heal spontaneously without scar formation.

Answer 5

multinucleated

Question 6

Thrush or candidaisis (also called moniliasis), is caused by a yeast-like fungus called?

Answer 6

Candida albicans

Question 7

Candida albicans is a common surface inhabitant of what 3 areas?

Answer 7

1. oral cavity
2. GI tract
3. vagina

Question 8

Oral candidaisis is common in what 3 patient types?

Answer 8

1. immunocomprimised patients
2. diabetics
3. AIDS

Question 9

White oral lesions that appear slightly elevated with soft patches that consist of mainly fungal hyphae occur in which disease?

Answer 9

Candidaisis causes by Candida albicans

Question 10

What disease is a rapidly spreading cellulitis or phlegmon, which originates in the submaxillary or sublingual space but extends locally to involve both the submaxillary & sublingual space ?

Answer 10

Ludwig angina

Question 11

The bacteria responsible for the infection in Ludwig Angina, which is uncommon in developed countries, originate from what location?

Answer 11

Originate from the oral flora;

Question 12

Describe the pathogenisis of Ludwig’s angina.

Answer 12

After extraction of a tooth, hairline fractures may occur in the lingual cortex of the mandible, providing microorganisms access to the submaxillary space. By following the fascial planes, the infection may dissect into the parapharyngeal space, and from there, into the carotid sheath.

NOTE: The carotid sheath is an anatomical term for the fibrous connective tissue that surrounds the vascular compartment of the neck.

Question 13

Does acute necrotizing ulcerative gingivitis or Vincent angina extend into the neck?

Answer 13

No

Question 14

What disease is a chonic inflammatory disease of the salivary and lacrimal glands, which may be resticted to these sites or may be associated with a systemic collagen vascular disease?

Answer 14

Sjogren syndrome

Question 15

What are the two main findings in Sjogren syndrome?

Answer 15

Involvement of the salivary glands leads to dry mouth = xerostomia

Disease of the lacrimal glands gives dry eyes = keratoconjunctivitis sicca

Question 16

What happens to the salivary and lacrimal glands in the later progression of Sjogren syndrome?

Answer 16

Late in the course of the disease the salivary and lacrimal glands become atrophic, with fibrosis and fatty infiltration of the parenchyma.

Question 17

During development, what gland descends from the base of the tongue to its final position in the neck?

Answer 17

Thyroid gland

Question 18

Heterotropic functioning thyroid tissue or a developmental cyst (thyroglossal duct cyst) may occur anywhere along the path of decent of the thyroid. The most common location of this thyroid tissue is at?

Answer 18

The foramen cecum of the tongue

Question 19

What are the three main symtoms that become evident during adolesence and pregnancy that a patient whi has heterotropic functioning thyroid suffer from?

Answer 19

Dysphonia (difficulty speaking)

Awareness of a mass in the throat

Sore throat

Question 20

Branched cleft cysts that originate from remnants of the branchial arches occur in what two anatomical locations?

Answer 20

Lateral anterior aspect of the neck

or

In the parotid gland.

Question 21

What is the common disease that is characterized by painful, recurrent, solitary or multiple, small ulcers of the oral mucosa? What is the causitive agent?

Answer 21

Apthous stomatitis; unknown

Question 22

Describe microscopic lesions of Apthous stomatitis.

Answer 22

The lesion consist of a shallow ulcer covered by a finbrinopurulent exudate.

Question 23

What disease is a reactive vascular lesion that occurs in the oral cavity due to minor trauma to the tissues, which permits invation of nonspecific microorganisms?

Answer 23

Pyogenic granuloma

Question 24

In the oral cavity, pyogenic granulomas, ranging from a few millimeters to a centimeter, are most frequent on what structure?

Answer 24

The gingiva (gums)

Question 25

Desribe the macroscopic appearance of pyogenic granulomas.

Answer 25

The lesion is seen as an elevated, red or purple, soft mass, with a smooth, lobulated, ulcerated surface.

Question 26

Desribe the microscopic appearance of pyogenic granulomas.

Answer 26

Microscopically, the nodule consists of highly vascular granulation tissue that shows varying degrees of acute and chronic inflammation.

Question 27

With time, pyogenic granuloma becomes less vascular and comes to resemble what?

Answer 27

A fibroma

Question 28

Acute necrotizing ulcerative gingivitis or Vincent angina represents an infection by two organisms. Name the organism and the organism type.

Answer 28

1. Fusiform bacillus | 2. B. vincentii - a spirochete

Question 29

Fusiform bacilli & the spirochete B. vincentii are found in the mouths of many healthy people which suggests that predisposing factors are important to the development of acute necrotizing gingivitis. What is the most important element?

Answer 29

Decreased resistance to infection due to inadequate nutrition, immunodeficiency, or poor oral hygeine (homeless).

Question 30

Vincent infection is characterized by what type of erosions of the interdental papillae?

Answer 30

punched out erosions of the interdental papillae

Question 31

In Vincent infection does the ulceration spread? What occurs as a result of spread or no spread?

Answer 31

The ulceration spreads, and eventually involves all gingival margins, which become covered by a necrotic pseudomembrane.

Question 32

What is the most prevalent chronic disease of the calcified tissues of the teeth?

Answer 32

Caries

Question 33

Describe the pathogenisis of caries?

Answer 33

Caries begin with the disintegration of the enamel prisms after decalcification of the interprismatic substance; this leads to the accumulation of debris and microorganisms.

Question 34

Dental carries produce a small pit or fissure in what tissue? What is the consequence?

Answer 34

The enamel; When the process reaches the dentinoenamel junction, it spreads laterally and also penetrates the dentin along the dentinal tubules. A substantial cavity then forms in the dentin, producing a flask shaped lesion with a narrow orifice.

Question 35

If a carie progresses and invades the vascular pulp of the tooth, what is the inflammatory reaction called?

Answer 35

Pulpitis

Question 36

What is the most common sequel of pulpitis? Describe it.

Answer 36

Apical granuloma is the formation of chronically inflammed periapical granulation tissue.

Question 37

What is another result of pulpitis?

Answer 37

Periapical abscess.

Question 38

Define periodontitis.

Answer 38

Periodontitis is an inflammatory condition of the marginal gingiva.

Question 39

What condition is the most common cause of deafness among the postnatal viral infections?

Answer 39

Mumps

Question 40

Is the rapid hearing loss typical of mumps unilateral or bilateral?

Answer 40

Unilateral in 80% of cases

Question 41

What is a bilateral prenatal infectious cause of hearing loss?

Answer 41

Rubella has bilateral hearing loss, with permanent loss of cochlear and vestibular function.

Question 42

A number of viruses including influenza, parainfluenza, ebstein-barr, hepersvirus, and adenoviruses can cause what condition?

Answer 42

Labyrinthitis. Temporal bone specimens of these cases have damage to the organ of Corti, with almos total loss of both inner and outer hair cells.

Question 43

What is a Warthin tumor?

Answer 43

It is a benign neoplasm of the parotid gland composed of cystic glandular spaces embedded in dense lymphoid tissue.

Question 44

Warthin tumor is the most common ______ adenoma. Althought the neoplasm is benign, it can be _____ or multifocal within the same gland. It is more common in _____ than women.

Answer 44

monomorphic; bilateral; men War = men so more common in men

Question 45

Pleomorphic adenoma has a biphasic appearance, which represents an admixture of _____ and _____ elements.

Answer 45

epithelial; stromal

Question 46

Adenoid cystic carcinoma is a slow-growing malignant neoplasm of the ______ gland, which invades locally and tends to _____ after surgery.

Answer 46

salivary; recur

Question 47

Periodontal disease refers to acute and chronic disorders of the ______ tissues surrounding the teeth, which eventually lead to the loss of supporting _____. Chronic periodontal disease typically occurs in _____, especially in those with poor oral hygiene. However, many ppl w awesome dental habits, but a strong ______ history of periodontal disease get it. Chronic periodontitis causes loss of ______ teeth in adults than does any other disease, including caries.

Answer 47

soft; bone; adults; family; more

Question 48

Periapical granuloma is the most common sequel to _____ and represents chronically inflamed periapical granulation tissue.

Answer 48

pulpitis

Question 49

What is Peripheral giant cell granuloma?

Answer 49

Peripheral giant cell granuloma is an unusual proliferative reaction to local injury that is seen as a mass on the gingiva or the alveolar process. It is denoted as peripheral, as opposed to the central giant cell granulomas that occur in the jawbone.

Question 50

What does Peripheral giant cell granuloma look like on microscopy?

Answer 50

On Microscopy many multinucleated giant cells are in a fibrous stroma that also contain ovoid or spindle-shaped mesenchymal cells. You see giant cells w a history of gingival lesions.

Question 51

What are sinonasal inflammatory polyps? What causes it?

Answer 51

Sinonasal inflammatory polyps are nonneoplastic lesions of the mucosa caused many things including chronic allergic rhinitis, allergy, cystic fibrosis, infections, diabetes mellitus and aspirin intolerance.

Question 52

Describe the anatomy and symptoms of sinonasal inflammatory polyps.

Answer 52

Most polyps arise from the lateral nasal wall or the ethmoid recess. They may be unilateral or bilateral and singe or multiple. Symptoms include nasal obstruction, rhinorrhea, and headaches.

Question 53

Describe the histology of sinonasal inflammatory polyps.

Answer 53

Microscopically, sinonasal allergic pollyps are lined externally by respiratory epithelium and contain mucous glands within a loose mucoid stroma, which is infiltrated by plasma cells, lymphocytes and numerous eosinophils.

Question 54

If you see a picture of a guy with a saddle nose deformity, what is the dx?

Answer 54

Wegener's granulomatosis

Question 55

What is Wegener's granulomatosis? What disease is it simmilar to?

Answer 55

A disease of unknown origin that shares some features with lethal midline granuloma. Both diseases are characterized by necrotizing, ulcerated, mucosal lesions.

Question 56

Lethal midline granuloma is a sign of underlying _____ malignancy, whereas Wegener granulomatosis is an ______ disease.

Answer 56

lymphoid; inflammatory

Question 57

Discuss the pathogenisis of Wegener's granulomatosis. Autoantibodies in this disease are directed vs what?

Answer 57

Usually, lesions are not limited to the respiratory tract; they also involve the lungs and kidneys. More than 90% of patients have antineutrophil antibodies and most of them are vs the cytoplasm of neutrophils, i.e., C-ANCAs.

Question 58

Papillomas are the most common tumors of the ____ cavity. HPV _ & _ cause papillomas, which may be histologically diagnosed as either squamous or inverted.

Answer 58

nasal; 6 & 11

Question 59

_____ infection is related to nasopharyngeal carcinoma.

Answer 59

EBV

Question 60

Acute tonsilitis may be caused by bacterial or viral infections; however, Streptococcus ______ is the most common cause of suppurative tonsilitis.

Answer 60

pyogenes

Question 61

Streptococcus pyogenes is group ___ & it is _____ hemolytic.

Answer 61

A; beta

Question 62

What is Osteosclerosis?

Answer 62

Osteosclerosis is the formation of new spongy bone about the stapes at the oval window, which results in progessive deafness.

Question 63

What is the etiology, genetics, and symptomatology of Osteosclerosis?

Answer 63

This condition is an autosomal dominant hereditary defect and is the most common cause of conductive hearing loss in young and middle aged adults in the USA. 90% of cases of Osteosclerosis is asymptomatic, except for the complaint of gradual hearing loss.

Question 64

What is a non-infectious cause of eustachian tube obstruction?

Answer 64

Obstruction of the eustachian tube may result from sudden changes in atmospheric pressure like in flying or deep sea diving.

Question 65

What is an infectious cause of eustachian tube obstruction?

Answer 65

Obstruction of the eustachian tube is severe in the presence of an upper respiratory tract in fection, an acute alleric reaction, or a viral or bacterial infection at the oriface of the eustachian tube. Inflammation of the eustachian tube may occer without bacterial invasion of the middle ear.

Question 66

More than half of the children in the USA have had at least one episode of _____ otitis media before their 3rd birthday. Repeated bouts of otitis media in early childhood often contribute to unsuspected hearing _____, which is due to residual, usually sterile, fluid in the middle ear.

Answer 66

serous; loss

Question 67

Nasopharyngeal carcinoma is an epithelial cancer of the nasopharynx that is classified into ______ and _____ subtypes.

Answer 67

keratinizing; nonkeratinizing

Question 68

______ nasopharyngeal carcinoma is associated with an EBV infection. Most patients have anti-EBV ____ in their serum.

Answer 68

Nonkeratinizing; IgA

Question 69

Both differentiated and undifferentiated nonkeratinizing nasopharyngeal carcinomas are ummunoreactive with antibodies to ______.

Answer 69

cytokeratins

Question 70

What is Adenoid cystic carcinoma? What it is a tumor of?

Answer 70

Adenoid cystic carcinoma is a slowly growing malignant neoplasm of the salivary gland that is notorious for its tendency to invade locally and to recur after surgical resection.

Question 71

Describe the tumor cells in an Adenoid cystic carcinoma.

Answer 71

The tumor cells are small, have scant cytoplasm, and grow in solid sheets or as small groups, strands, or columns. Within these structures, the tumor cells interconnect to enclose cystic spaces, resulting in a solid, tubular or cribiform arrangement.

Question 72

What is a Cholesteatoma?

Answer 72

Cholesteatoma is a complication of chronic suppurative otitis and a rupture of the eardrum. Cholesteastoma is a mass of accumulated keratin and squamous mucosa that results from the growth of squamous epithelium from the external ear canal through the perforated eardrum into the middle ear.

Question 73

Describe the microscopic nature of a Cholesteatoma & how the mass can be involved in infection.

Answer 73

Microscopically choleasteatomas are identical to epidermal inclusion cysts and are surrounded by granulation tissue and fibrosis. The keratin mass often becomes infected and shields the bacteria from antibiotics.

Question 74

Ameloblastomas (adamantinomas) are tumors of epithelial _____ (teeth formation) origin and represent the most common clinically significant ______ tumor. They are slow growing, locally invasive tumors that follow a benigen clinical course.

Answer 74

odontogenic; odontogenic

Question 75

Describe the microscopic nature of Ameloblastomas. What organ do they resemble?

Answer 75

Microscopically, ameloblastoma resembles the enamel organ in its various stages of differentiation, and a single tumor may show various histologic patterns. The centers of these cell nests consist of loosley arranged, large polyhedral cells that resemble the stellate reticulum of the developing tooth.

Question 76

______ is a descriptive term for many reactive, preneoplastic, and neoplastic lesions of the oral mucosa. _______ lesions are not necissarily premalignant and demonstrate a spectrum of histopathological changes, ranging from increased surgace keratinization without dysplasia to invasive keratinizing squamous carcinoma.

Answer 76

Leukoplakia; Leukoplakic

Question 77

Candidaisis presents with whitish plaques but does not induce ______.

Answer 77

dysplasia

Question 78

There is a low risk of patients with leukoplakia developing a malignant transformation into ______ cell carcinoma. Carcinogenic factors that lead to the induction of cancer usually affect more than one site in the oral mucosa, and the tumors may therefore be _____.

Answer 78

squamous; multiple

Question 79

What is the most common tumor of the salivary glands?

Answer 79

Pleoporphic adenoma

Question 80

What is a Pleoporphic adenoma? What is done to treat it? what are the complications?

Answer 80

A benign neoplasm characterized by a biphasic appearance which represents an admixture of epithelial and stromal elements. At surgery, tumor projections can be missed if the tumor is not carefully dissected. Tumor implanted druting surgery or tumor nodules left behind continue to grow as recurrences in the scar tissue of the previous operation. Recurrence of pleomorphic adenoma represents local groeth and does not reflect malignancy as malignant transformation is rare.