Ch 9.1-9.2, 18.4-18.5, 10.1-10.2 Pathoma; Resp, MSK, GI

Question 1

Name 4 pathologies seen in the nasopharynx

Answer 1

rhinitis, nasal polyps, angiofibroma, nasopharyngeal carcinoma

Question 2

Rhinitis is inflammation of the ___. ___ is the most common cause. It presents with ___, ___, and ___ (common cold).

Answer 2

nasal mucosa (respiratory epithelium); Rhinovirus (or adenovirus?); sneezing, congestion, runny nose

Question 3

Allergic rhinitis is a subtype of rhinitis due to type __ hypersensitivity (ex: rxn to ___). It is characterized by a ____ infiltrate with ___. It is associated with ___ and ____.

Answer 3

1; pollen; inflammatory; eosinophils; asthma; eczema

Question 4

____ is a protrusion of edematous, inflamed nasal mucosa, usually secondary to repeated bouts of ____.

Answer 4

Nasal polyp; rhinitis

Question 5

In addition to rhinitis, nasal polyps also occur in these two other situations.

Answer 5

Cystic fibrosis (if you have a child with nasal polyps, think CF); aspirin-intolerant asthma

Question 6

Aspirin intolerant asthma is characterized by this triad. It is seen in __% of asthmatic adults

Answer 6

asthma; aspirin-induced bronchospasms; nasal polyps; 10

Question 7

Angiofibroma is a malignant/benign tumor of nasal mucosa composed of ___ and ___. It is classically seen in ___. It presents with profuse ___.

Answer 7

benign; large blood vessels; fibrous tissue; adolescent males; epistaxis

Question 8

____ is a malignant tumor of nasopharyngeal epithelium. It is associated with ___, and classically seen in ___ and ___.

Answer 8

Nasopharyngeal carcinoma; EBV; Chinese adults; African children

Question 9

Nasopharyngeal carcinoma biopsy reveals pleomorphic ___+ ____ cells (poorly differentiated ____) in a background of ____. It presents with involvement of ____.

Answer 9

keratin; epithelial; squamous cell carcinoma; lymphocytes (keratin helps reveal there are epithelial cells); cervical lymph nodes

Question 10

Name 5 pathologies of the larynx

Answer 10

acute epiglottitis; laryngotracheobronchitis (croup); vocal cord nodule (singer’s nodule); laryngeal papilloma; laryngeal carcinoma

Question 11

Acute epiglottitis is ___ of the epiglottis. ___ is the most common cause in both immunized and especially non-immunized children.

Answer 11

inflammation; H influenza type b

Question 12

Acute epiglottitis presents with these 5 symptoms and has a risk of ___.

Answer 12

1) high fever; 2) sore throat; 3) drooling with dysphagia; 4) muffled voice; 5) inspiratory stridor; airway obstruction (medical emergency)

Question 13

Laryngotracheobronchitis (aka ___), is inflammation of the ___. ___ is the most common cause. It presents with a hoarse, “___” cough, and ____.

Answer 13

croup; upper airway; parainfluenza virus; barking; inspiratory stridor

Question 14

Vocal cord nodule (aka ___) is a nodule that arises on the true/false vocal cord. It is due to ___, and is usually unilateral/bilateral. It is composed of ____ tissue, and presents with ___. Resolves with resting of the voice.

Answer 14

Singer’s nodule; true; excessive use; bilateral; degenerative (myxoid) connective tissue; hoarseness

Question 15

Laryngeal papilloma is a malignant/benign papillary tumor of the ___. It is due to ___. Papillomas are usually single in adults/children and multiple in adults/children. It presents with ___.

Answer 15

benign; vocal cord; HPV 6 and 11; adults; children; hoarseness

Question 16

Laryngeal carcinoma is a ___ carcinoma arising from the ___ lining of the ___. It presents with ____. Other signs include __ and __.

Answer 16

squamous cell; epithelial; vocal cord; hoarseness; cough; stridor

Question 17

Name two big risk factors for laryngeal carcinoma. Name an additional.

Answer 17

alcohol and tobacoo; can rarely arise from a laryngeal papilloma

Question 18

Dermatomyositis is an inflammatory disorder of the __ and ___. The etiology is ___. Some cases are associated with ____ (ex: ___). Treatment is ____.

Answer 18

skin; skeletal muscle; unknown; carcinoma; gastric carcinoma; corticosteroids

Question 19

Name 3 clinical features of dermatomyositis

Answer 19

1) bilateral proximal muscle weakness (distal invlvmt late in dx); 2) rash of upper eyelids (heliotrope rash) and malar rash; 3) red papules on elbows, knuckles, and knees (Gottron papules)

Question 20

Name 3 lab findings and the bx finding in dermatomyositis

Answer 20

1) increased creatine kinase; 2) positive ANA; 3) positive anti-Jo-1 antibody; 1) perimysial inflammation (CD4+ T cells) with perifascicular atrophy on bx

Question 21

Which skeletal muscle inflammatory disorder involves the endomysium vs perimysium? Which T cells are involved in each?

Answer 21

Polymyositis: endomysium CD8+ t cells

Dermatomyositis: perimysium CD4+ t cells

Question 22

Polymyositis is an inflammatory disorder of ____. It resembles ____ clinically (___ muscle weakness), but ___ is not involved. ____ inflammation (CD__ t cells) with ___ muscle fibers is seen on biopsy

Answer 22

skeletal muscle; dermatomyositis; proximal; skin; endomysial; CD8+; necrotic

Question 23

Muscular dystrophy is a degernative disorder characterized by ___ and replacement of ___ by ___. Name the pattern of inheritance. It is due to defects of ___ gene, which is impt for ___ the muscle ___ to the___. Mutations are often ___, since the large gene size predisposes to high rates of mutation

Answer 23

muscle wasting; skeletal muscle; adipose tissue; x-linked recessive; dystrophin; anchoring; cytoskeleton; extracellular matrix; spontaneous

Question 24

Duchenne muscular dystrophy is due to a deletion/mutation of ____. It presents as proximal/distal muscle weakness at __ years of age. Progresses to involve ___ muscles. Death results from __ or __ failure. ___ is commonly involved.

Answer 24

deletion; dystrophin; proximal; 1; distal; respiratory; cardiac; myocardium

Question 25

Name 1 clinical characteristic finding of DMD, and 1 lab finding. Becker muscular dystrophy is due to ___. Clinically results in milder/more severe disease.

Answer 25

calf pseudohypertrophy (distal muscle that pt initially puts weight on, since proximal are first - causes hypertrophy, then it turns to fat); elevated serum creatine kinase; mutated dystrophin; milder

Question 26

Myasthenia gravis is due to ___ again the pre/post synaptic ___ receptor at the NMJ. It is more commonly seen in women/men. Symptoms improve with ___ agents.

Answer 26

autoantibodies; post; acetylcholine; women; anti-cholinesterase (acetylcholinesterase inhibitors)

Question 27

Myasthenia gravis presents with ___ that improves/worsens with use and improves/worsens with rest. It classically involves the ___, leading to __ and __. It is associated with ___ or ___, so a ___ improves symptoms.

Answer 27

muscle weakness; worsens; improves; eyes; ptosis; diplopia; thymic hyperplasia; thymoma; thymectomy

Question 28

Lambert-eaton syndrome is due to ___ against pre/post synaptic ____ of the NMJ. It arises as a ___ syndrome, most commonly due to ___. It leads to impaired ___ release, since firing of ___ is required for ___ release.

Answer 28

antibodies; pre; calcium channels; paraneoplastic; small cell carcinoma of the lung; acetylcholine; presynaptic calcium channels; acetylcholine

Question 29

Lambert-eaton syndrome symptoms do/do not improve with anti-cholinesterase agents. It resolves with ___. It causes proximal/distal muscle weakness that improves/worsens with use. ___ are usually spared.

Answer 29

do not; resection of the cancer; proximal; improves (more use creates a stronger calcium gradient to knock off the antibody); eyes

Question 30

Myasthenia gravis vs. lambert eaton syndrome: which gets better with use, and which responds to acetylcholinesterase inhibitors?

Answer 30

Lambert-eaton syndrome; myasthenia gravis

Question 31

Cleft lip and palate is a full/partial thickness defect of lip and palate. It is due to failure of ____ to ___ . They usually occur together/separately. During early/late pregnancy, ____ (one from superior, two from the sides and two from inferior) grow and ___ together to form the face.

Answer 31

full; facial prominences; fuse; together (isolated cleft lip or palate is less common); early; facial prominences; fuse

Question 32

An aphthous ulcer is a painless/painful, ____ ulceration of the ____. It arises in relation to ___ and resolves spontaneously, and never/sometimes/often recurs. It is characterized by a ___ base surrounded by ___.

Answer 32

painful; superficial; oral mucosa; stress; often; grayish (represents granulation tissue); erythema

Question 33

Behcet syndrome is recurrent ___, ___, and ___. It is due to ____ involving small ____. Can be seen after ___ infection, but etiology is ____.

Answer 33

aphthous ulcers; genital ulcers; uveitis; immune complex vasculitis (type 3 hypersens); vessels; viral; unknown

Question 34

Oral herpes are ___ involving oral ___ that rupture, resulting in shallow/deep, painless/painful, ___ ___. Usually due to ____. Primary infection occurs in ___. Lesion heal, but virus remains dormant in ____. ___ and ___ cause reactivation of the virus, leading to ___ that often arise on the lips (aka ___)

Answer 34

vesicles; mucosa; shallow, painful, red ulcers; HSV-1; childhood; ganglia of trigeminal nerve; stress; sunlight; vesicles; cold sores

Question 35

Squamous cell carcinoma of the oral mucosa is most commonly found in the ___. ___ and ___ are the major risk factors. ___ and ___ are common precursor lesions.

Answer 35

floor of the mouth; tobacco; alcohol; oral leukoplakia and erythroplakia

Question 36

Oral leukoplakia is a ___ that can/cannot be scraped away. It often represents ____. It can be mistaken for ___ and ___. It is often ___ to rule out carcinoma.

Answer 36

white plaque; cannot; squamous cell dysplasia; oral candidiasis; hairy leukoplakia; biopsied

Question 37

Oral erythroplakia is a ___ that represents ____ leukoplakia and is highly suggestive of ___. It is often ___ to rule out carcinoma.

Answer 37

red plaque; vascularized (angiogenesis due to dysplasia); squamous cell dysplasia; biopsied

Question 38

Is oral leukoplakia or erythroplakia more suggestive of squamous cell dysplasia?

Answer 38

erythroplakia (there is angiogenesis suggestive of dysplasia)

Question 39

Oral candidiasis is a ___ on the tongue, which can/cannot be scraped away. It is usually seen in ___ patients. Hairy leukoplakia is a ___, ___, ___ patch that arises on the __ tongue. It is usually seen in __ patients, and is due to ___-induced squamous cell ___. It is/is not pre-malignant.

Answer 39

white deposit (thrush); can (easily); immunocompromised; white, rough, hairy; lateral; immunocompromised; EBV; hyperplasia (no dysplasia); is not

Question 40

Salivary glands are ___ glands that secrete ___. They are divided into major (name 3) and minor glands (hundreds of microscopic glands distributed throughout the ___)

Answer 40

exocrine; saliva; parotid, submandibular, sublingual; oral mucosa

Question 41

Mumps infection (virus) can result in unilateral/bilateral inflamed ___ glands. These 3 other conditions may also be present. Serum amylase may be increased due to ___ or ___ involvement. ___ carries the risk of sterility, especially in children/teenagers/adults

Answer 41

bilateral; parotid; orchitis; pancreatitis; aseptic meningitis; salivary gland; pancreatic; orchitis; teenagers (less than 10 don’t get orchitis)

Question 42

____ is inflammation of the salivary gland. Most commonly due to a _____ (aka ____) leading to ___ infection. Usually unilateral/bilateral.

Answer 42

Sialadenitis; obstructing stone; sialolithiasis; staph aureus; unilateral

Question 43

Pleomorphic adenoma is a benign/malignant tumor composed of ___ and ___ tissue. Usually arises in ___ gland. Presents as mobile/non-mobile, painless/painful, ___ mass at the ____. There is a high/low rate of recurrence. Extension of small islands of tumor through tumor capsule often leads to ___. Salivary gland

Answer 43

benign; stromal (eg cartilage); epithelial; parotid; mobile, painless, circumscribed; angle of the jaw; high; incomplete resection

Most common salivary gland tumor

Question 44

What is the most common tumor of the salivary gland? What is the 2nd most common? What is the most common malignant tumor of the salivary gland?

Answer 44

pleomorphic adenoma; warthin tumor; mucoepidermoid carcinoma

Question 45

Pleomorphic adenoma often/sometimes/rarely/never transforms into carcinoma, which presents with signs of ___ damage, since the ___ runs through the ___ gland.

Answer 45

rarely; facial nerve; facial nerve; parotid

Question 46

Warthin tumor is a benign/malignant ___ tumor with abundant ___ and ____ (___-like stroma). It is the 2nd most common salivary gland tumor. It almost always arises in the ___ gland.

Answer 46

benign; cystic; lymphocytes; germinal centers; lymph node; parotid

cystic tumor w/LN tissue

Question 47

Name 3 tumors of the salivary gland and which ones are benign vs malignant

Answer 47

pleomorphic adenoma (benign); warthin tumor (benign); mucoepidermoid carcinoma (malignant)

Question 48

Mucoepidermoid carcinoma is a benign/malignant tumor composed of ___ and ___ cells. It is the most common malignant tumor of the salivary gland. Usually arises in the ____, and commonly involves the ___.

Answer 48

malignant; mucinous; squamous; parotid; facial nerve