Exam 2- Upper airway, nasal, sinuses, neck & ear

Question 1

what are 3 pathologies that can occur in the neck?

Answer 1

• brachial cyst
• thyroglossal cyst
• paraganglioma (carotid body tumor)

Question 2

what are 2 types of cyst and a rare tumor we care about?

Answer 2

• inflammatory cyst (radicular most common)
• developmental cysts (dentigerous most common developmental cyst & surgical specimen)
• malignant tumors of odontogenic origin (rare)

Question 3

what are the two etiologies of cysts? where do they come from?

Answer 3

-developmental (abnormal development)
-inflammatory
both arise from remnants of odontogenic epithelium

Question 4

what can a dentigerous cyst give rise to?

Answer 4

ameloblastoma (malignant)

Question 5

what are the “tumors” of the nose/sinus/nasopharynx?

Answer 5

• polyps (not really a tumor, VAST MAJORITY)
• angiofibroma
• papilloma
• plasmacytoma
• neuroblastoma
• nasopharyngeal carcinoma

Question 6

what causes rhinitis and sinusitis?

Answer 6

• very often allergic (swab & find eosinophils) or URI (viral in general)
• any organism can cause it though

Question 7

what causes allergic rhinitis? what Ig? sxs?

Answer 7

• sensitivity rxns
• plants, pollens, fungi, animal allergens & dust mites
• IgE mediated/type I hypersensitivity
• mucosal edema, redness, thick mucus secretions and pale turbinates
• leukocytic infiltration (eosinophils)

Question 8

what causes infectious rhinitis? sxs? what can ensue? where can it go to?

Answer 8

• usu viral: adenoviruses, echoviruses & rhinoviruses
• acute: edematous, thickened nasal mucosa, enlarged turbinates & narrowed nasal cavities
• secondary bacterial infxn can ensue
• changes may extend into pharynx producing concomitant pharyngotonsilitis

Question 9

what causes chronic rhinitis? what immune cells are present?

Answer 9

• repeated acute rhinitis: allergic or infectious followed by secondary or superimposed microbial infxn
• inflammatory infiltrates with PMNs, plasma cells & lymphocytes

Question 10

what can predispose one to chronic rhinitis? causes?

Answer 10

• deviated nasal septum or nasal polyps predispose

- recurrent rhinitis or spontaneously occur

Question 11

what are nasal polyps?

Answer 11

-edematous mucous w/loose stroma often w/cystic or hyperplastic mucous glands

Question 12

what should be ruled out in a young caucasian with large polyps?

Answer 12

cystic fibrosis

Question 13

are most pts with polyps atopic?

Answer 13

no most with polyps are not atopic, though there is allergic etiology it is not atopically associated

Question 14

what is Samter triad or ASA triad?

Answer 14

aspirin intolerance + bronchial asthma + ethmoid polypi

*salicylates can provoke life-threatening status asthmaticus in these pts

Question 15

what usu causes infectious sinusitis?

Answer 15

viruses! but can be bac or fungal too and sometimes an extension of periapical dental infxn

Question 16

complete obstruction of sinuses can lead to what?

Answer 16

empyema or if w/o infxn can lead to mucocele

Question 17

what are the 3 categories sinusitis can be subdivided into?

Answer 17

1. acute: sxs <4 wks
2. subacute: sxs 4-12 wks in duration
3. chronic: sxs present for 12 or more wks

Question 18

what would make you think a sinusitis is bacterial?

Answer 18

• sxs persist beyond 7 to 14 d
• increase in severity, esp after period of convalescence
• when fever has been present (but absence of fever doesn’t rule out bac cause)

Question 19

what causes chronic sinusitis?

Answer 19

• recurrent acute sinusitis
• abn sinus drainage
• mixed microbial of oral cavity

Question 20

fungal sinusitis caused by mucormycosis occurs in who?

Answer 20

more common in immunocompromised including diabetics

Question 21

what are complications of sinusitis?

Answer 21

may spread to adjacent tissue: eye, soft tissues around eye, facial bone, cranial vault as well as septic thrombophlebitis of dural venous system

Question 22

what is kartagener syndrome?

Answer 22

• genetic ciliary dyskinesia
• autosomal recessive
• chronic sinusitis
• bronchiectasis
• situs inversus

Question 23

what are two very serious (potentially and often fatal aggressive) granulomatous proliferations of the upper airway?

Answer 23

• Wegener granulomatosis
• Lethal midline granuloma (thought to be malignant tumor of NK cells)
• often hard to distinguish from one another

Question 24

what are 3 necrotizing lesions of the upper airways?

Answer 24

• acute fungal infxns: immunocompromised
• Wegener granulomatosis: necrotizing gingival ulcerations
• NK cell lymphoma: lethal midline granuloma/polymorphic reticulosis, NK cells infected w/EBV, rapidly fatal

Question 25

do tumors of the nose, sinuses & nasopharynx occur frequently or infrequently? what are the 5 types?

Answer 25

infrequently but can include entire category of mesenchymal & epithelial neoplasms - nasopharyngeal angiofibroma - sinonasal papillomas - plasmacytomas - olfactory neuroblastomas - nasopharyngeal carcinomas

Question 26

what are nasopharyngeal carcinomas characterized by?

Answer 26

- distinctive geographic distribution - close anatomic relationship to lymphoid tissue - association w/EBV infxn

Question 27

what are the 3 patterns of nose, sinus or nasopharyngeal tumors?

Answer 27

can present as... - keratinizing squamous cell carcinomas - nonkeratinizing squamous cell carcinomas - undifferentiated carcinomas that have an abundant non-neoplastic lymphocytic infiltrate

Question 28

what are nasopharyngeal angiofibromas? who is affected most?

Answer 28

- benign tumors that are highly vascularized (bleed profusely during resection) - almost exclusively in adolescent adult males

Question 29

what are sinonasal papillomas? associated with? which form is most common? most important? where can it invade? does it convert to carcinoma frequently?

Answer 29

- benign neoplasms of nose & paranasal sinuses - assoc w/HPV 6 & 11 - exophytic, inverted & cylindrical forms (exophytic most common, inverted are most important) - locally aggressive, high recurrence if incompletely excised - can invade orbit or cranial vault - rarely convert to carcinoma

Question 30

what are plasmacytomas? what is it histologically similar to? how often do they progress to multiple myelomas

Answer 30

- lymphoid structure tumors - polypoid growths up to several cms - usu intact overlying mucosa - similar to malignant plasma cell tumor - rarely progress to multiple myeloma

Question 31

what are neuroblastomas? does it metastasize? treatment?

Answer 31

- uncommon primary head and neck malignancy - small round cell resembling neuroblasts, from neuroendocrine cells - tend towards metastases - treated surgically, radio & chemotherapeutically - 5 yr survival 40-90%

Question 32

what are nasopharyngeal carcinomas distinguished by? what are the 3 patterns it generally presents in?

Answer 32

- distinctive geographic distribution - close anatomical relationship to lymphoid tissue - associated w/EBV infxn 1. keratinizing squamous cell carcinomas 2. nonkeratinizing squamous cell carcinomas 3. undifferentiated carcinomas that have abundant non-neoplastic lymphatic infiltrate

Question 33

what are the 4 cardinal signs of acute-itis?

Answer 33

1. heat 2. redness 3. swelling 4. pain

Question 34

what are 3 common proliferations? which is the most benign? the most malignant?

Answer 34

1. polyp (most benign) (singer's nodule) 2. papilloma 3. carcinoma

Question 35

what is the common appearance of carcinomas?

Answer 35

-ulcerated, indurated, irregular, invasive & destructive w/secondary necrosis

Question 36

what are the most common causes of AOMs?

Answer 36

-strep & H. flu in children <2 & moraxella

Question 37

is serous otitis media more chronic or acute?

Answer 37

-more chronic

Question 38

what is otosclerosis? when does it begin? UL or BL? causes?

Answer 38

abnormal bone deposition b/w footplate of stapes & oval window - one of most common forms of conductive hearing loss - begins in middle age, progressive, usu BL, often familial

Question 39

what are brachial cleft cysts? become malignant? spot it occurs?

Answer 39

- developmental remnants of brachial clefts, can become inflamed - do not become malignant most times - on the side of the neck

Question 40

what are thyroglossal duct cysts? what can you find in the wall of the cyst? spot it occurs?

Answer 40

- same etiology, appearance & behavior as brachial cleft cyst but it over thyroid - remmants of thyroid follicles in wall of cyst mb present (rare) - over the thyroid

Question 41

what are carotid body tumors?

Answer 41

- 'balls of cells' | - tumors of carotid body receptor cells, near the carotid sinus that are sensitive to pO2, pCO2, pH & temp

Question 42

what is epiglottitis? what are the 4 D's?

Answer 42

- swelling of epiglottis due to bac infxn - can be deadly in kids - 4 D's: dyspnea, respiratory distress, difficulty swallowing & drooling

Question 43

what is stridor? what are the 3 causes?

Answer 43

high-pitched musical breath sound caused by turbulent air flow in upper airway, can often hear w/o stethoscope -3 causes: airway swelling from croup, epiglottitis, lodged foreign bodies

Question 44

what is croup? what does it cause?

Answer 44

- viral infxn occuring in children - causes stridor as inflamed airway narrows - seal-like barking cough