Head And Neck Surgery Flashcards
(245 cards)
1
Q
Mutations in RET oncogene are responsible for what three inheritable syndromes associated with mtc?
A
Men 2a, men 2b, familial mtc
2
Q
What are the components of men 2a?
A
Mtc
Pheochromocytoma
Primary parathyroidism as a result of parathyroid adenomas
3
Q
What are the components of men 2b?
A
Mtc Pheochromocytoma Marfanoid habitus Mucosal neuromas if the lips and tongue Ganglioneuromas of the git
4
Q
What are the components of familial mtc?
A
Variant if men 2a without pheochromocytoma or primary parathyroidism
5
Q
Useful markers for long term surveillance in addition to routine neck utz and body imaging in mtc?
A
Calcitonin and cea
6
Q
What is more aggressive, men 2b or men 2a?
A
Men 2b thus need to perform central neck dissection.
7
Q
What type of tumor is ewings sarcoma?
This primarily affects?
A
Peripheral primitive neuroectodermal tumor. Affects long bones and pelvis
8
Q
Characteristic microscopic appearance of ppnt?
A
Small round blue cell tumor with characteristic fibrovascular cores. Ppnet will demonstrate pseudorosettes and mitosis.
9
Q
Current standard of therapy for ES treatment?
A
Neoadjuvant chemotherapy followed by resection with negative margins
10
Q
Most common extracerebral solid tumor of infancy and childhood?
A
Neuroblastoma
11
Q
Origin of neuroblastoma?
A
Arise from primitive neuroectodermal cells of neural crest origin as embryonal tumors of the sns
12
Q
Most unusual aspect of neuroblastoma?
A
Frequent occurence of spontaneous regression.
13
Q
Most common site of origin of neuroblastoma?
A
Adrenal medulla or adjacent retroperitoneum, but 2-5% develop in head and neck region
14
Q
What does en sablier tumors refer to?
A
Paraspinal neuroblastoma that extends through adjacent intervertebral foramina into spinal cord to produce paraplegia. Most commonly associated with mediastinal and retroperitoneal tumors
15
Q
What may be used to screen for neuroblastoma?
A
Catecholamines and their metabolites (vma, homovanillic acid, dopamine), elevated in 90-95% of patients
16
Q
Treatment of stage 1 neuroblastoma?
A
Surgical removal. In intermediate and high risk patients, chemotherapy is the main modality
17
Q
Histopathology of neuroblastoma?
A
Small uniform cells 7 to 10mm in diameter with dense hyperchromatic nuclei and minimal perinuclear cytoplasm
18
Q
Most common etiology of salivary gland lesions in children?
A
Inflammatory
19
Q
After how many weeks of completion of chemotherapy may a second surgical procedure be done for neuroblastoma?
A
12-24weeks after completion of chemotherapy
20
Q
Most frequently encountered benign tumors in the parotid area?
A
Hemangioma
21
Q
Most common benign intrinsic parotid tumor?
A
Pleomorphic adenoma
22
Q
Solid, firm, fixed salivary mass that persists for more than ____ usually an indication for open surgical biopsy and/or excision.
A
4-6 weeks.
23
Q
What is a minimally invasive and effective tool for the diagnosis of salivary gland ductal pathology?
A
Sialoendoscopy
24
Q
What separates the parotid gland from the submandibular gland?
A
Stylomandibular ligament. Both glands are covered by the superficial portion of the deep cervical fascia.
25
All salivary glands are derivatives of ______.
Ectoderm
26
Largest salivary gland and first to develop in utero?
Parotid gland
27
Detached accessory salivary glands in _____ of cadaver specimens?
21%
28
Length of stensen duct and diameter?
4-7cm and diameter between 0.5mm and 1.4mm
29
Description of whartons duct?
5cm long, mean diameter of 0.5 and 1.5mm, opens in the floor if the mouth through a papilla lateral to the tongue frenulum
30
What is the percentage of stones in the submandibular and parotid duct which are radiolucent?
20%, 80%
31
Ultrasound can detect up to what percentage of stones greater than 2mm in diameter?
90%
32
Another name for human herpesvirus 4?
Epstein barr virus
33
IP of ebv?
30-50days
34
Percentage of children with hiv who present with head and neck masses?
50%
35
Pathognomonic for hiv infection if the salivary (parotid) glands?
Bilateral cystic and painless enlargement
36
Majority of cases of hiv infected parotid glands represent?
Other 7% represent?
Reactive lymphadenopathy
Benign lymphoepithelial cysts
Underlying infection
Underlying neoplasm including pleomorphic adenoma, lymphoma, Kaposi sarcoma
37
Slow-growing atypical mycobacterium species which require a few weeks to grow on culture which can affect parotid gland? (3)
Fast growing? (3)
M. Avium
M. Marinum
M. Kansasii
M. fortuitum
M. chelonae
M. abscessus
38
Most common manifestation of Nontuberculous mycobacteria?
Cervicofacial lymphadenopathy which usually involves submandibular and parotid areas
39
How to diagnose cat-scratch disease?
B. henselae antibody titers, positive warthin-starry stain, pcr analysis of tissue
40
Treatment for CSD?
5 day course of azithromycin 10mg/kg on day 1 (maximum 500mg) and 5 mg/kg the subsequent 4days (max 250 mg)
41
What are the components of uveoparotid fever or Heerfordt syndrome?
Anterior uveitis, parotid gland enlargement, facial palsy, fever
42
Systemic autoimmune disease characterized by infiltration of glandular tissue by predominantly CD4 T lymphocytes. There is also evidence of B cell activation with autoantibody production.
Sjogren syndrome
43
Mc rheumatic condition associated with sjogren syndrome?
Rheumatoid arthritis
44
Mc presenting clinical manifestation of sjogren syndrome in children?
Recurrent swelling of the salivary glands
45
What are the glands affected in sialolithiasis?
80-90% submandibular gland
6-20% parotid gland
1-2% sublingual gland
46
What are the components of salivary stones?
Calcium phosphate
| Hydroxyapatite
47
Sialolithiasis stones this diameter may pass spontaneously?
Less than 2mm
48
Most commonly involved in necrotizing sialometaplasia, which is a benign, self-limited inflammatory salivary gland lesion that can occur in adolescents and adults and mimic malignancy?
Mucus secreting minor salivary glands
49
Mc presentation necrotizing sialometaplasia?
Painless ulcerated lesion or a nodular swelling at junction of hard and soft palate which resolves in 2-3months
50
What are type 1 branchial anomalies?
Duplications of the membranous external auditory canal and are composed of ectoderm, course lateral to the facial nerve, and end in a cul-de-sac on a bony plate near the mesotympanum
51
What are Type 2 brachial anomalies?
Duplications of the membranous EAC and pinna and are composed of ectoderm and mesoderm and may contain cartilage; pass medial to facial nerve and present as swellings inferior to angle of the mandible
52
Pathology of pre tragal cysts or sinuses?
From failure of auricular hillocks to fuse
53
Salivary gland tumors constitute ____ of pediatric head and neck tumors and are the 4th most frequent after nasopharynx, skin and thyroid
8%
54
Most common salivary masses identified in children
Vascular tumors
55
Most common vascular tumors in children?
Infantile hemangioma
56
Mc non epithelial tumors?
Hemangioma
57
Percentage of hemangiomas present at birth?
30%, the rest arise within the first 6 weeks of life
58
Distinct pattern of development for hemangioma?
Proliferate rapidly during the first 1-2mos of life, second growth spurt between 4-6mos of life
59
Pattern of involution for hemangioma?
50% have complete involution by age 5
70% by age 7
90% by age 9
60
Pattern of occurence of hemangioma?
80% parotid gland
18% submandibular gland
2% minor salivary gland
61
2 types of hemangiomas?
Capillary form - present at birth, rapid growth, involution by age 1 year
Cavernous form - tendency to bleed and cause deformity
62
A highly selective and diagnostically useful marker for infantile hemangiomas?
GLUT-1 immunoreactivity
63
2nd most common vascular anomaly that affects salivary structures after hemangioma?
Lymphatic malformations (previously called cystic hygroma or lymphangioma)
64
Pattern of appearance of lymphatic malformation?
Present in perinatal period, 50-60% within first year of life, 90% by 2nd year of life
65
Lymphatic malformations can be divided into 3 categories on the basis of the size of their lymphatic channels?
1. Microcystic lesions - small cysts that are less than 2 cm
2. Macrocystic lesions - made of channels larger than 2 cm
3. Mixed lesions contain both microcysts and macrocyst
66
Mc epithelial tumor of salivary glands in pediatric population, found mainly in pubertal age?
Pleomorphic adenoma
67
Cell of origin of pleomorphic adenoma?
Intercalated duct reserve cell
68
Recurrence rate of BMT with enucleation?
40%
69
Warthins tumor accounts for ___ of benign salivary gland tumors?
___ bilateral?
2%
10%
70
Mc radiation induced tumor in children?
Mucoepidermoid carcinoma
71
2nd mc salivary malignancy in children?
Acinic cell ca
72
Age when sialorrhea decreases in children?
By 18mos
73
2 types of sialorrhea?
Anterior (drooling)
| Posterior - spill over tongue into supraglottic and laryngeal area
74
Anterior sialorrhea pathologic beyond what age?
4 years old
75
What botulinum toxin may be used for sialorrhea?
A - widest pharmaceutical use. Prevents presynaptic release of ach by secretory parasympathetic nerve terminal fibers through inactivation of SNAP-25 (25-kDa synaptosome-associated protein), which is essential for the fusion and release of ach-containing vesicles at the cell membrane.
76
When does botulinum toxin take effect?
2-3 days after injection
| Lasts average 3-9mos
77
Blood supply of parotid gland? (Arterial)
ECA courses medial to parotid gland into
1. Maxillary aa
2. Superficial temporal aa
Superficial temporal aa -> transverse facial aa
78
Venous drainage of parotid gland?
Maxillary and superficial temporal vein —-> retromandibular vein ——-> posterior facial vein ——-> external jugular vein
79
Stensens duct opens into oral cavity:
Adjacent to 2nd molar
80
GAN arises from?
C2 ans C3 cervical branches
81
Anatomic landmarks to identify the facial nerve? (5)
Pt. TAPR
- Tragal pointer
- tympanomastoid suture line
- stylomastoid artery
- posterior belly of digastric mm
- retrograde tracing from peripheral branch of facial nerve
82
Autonomic nerve supply of parotid gland?
Sympathetic: superior cervical ganglion
Parasympathetic: cn 9
83
```
Parapharyngeal space boundaries?
Base?
Medial boundary?
Lateral boundary?
Posterior boundary?
Anterior boundary?
```
- Petrous bone of the skull base
- lateral pharyngeal wall
- medial pterygoid muscle
- carotid sheath and vertebral bodies
- pterygomandibular raphe
84
Arterial anatomy of the SMG?
Facial aa. Deep to posterior belly of digastric mm
Facial vein lateral to the gland
*whartons duct opens in the floor of the mouth and crosses deep to the lingual nerve
85
What nerves innervate the SMG?
1. Facial nerve via chorda tympani - secretomotor innervation to SMG and SL glands
2. Lingual nerve - sensory nerve. Deep to floor of mouth and attaches to deep superior surface of SMG via submandibular ganglion
3. Hypoglossal nerve - motor fxn to tongue. Medial to digastric muscle and SMG
86
Where do sublingual glands drain?
```
Rivinus ducts (floor of mouth) or
Bartholins duct (submandibular duct)
```
87
Minor salivary glands are concentrated on hard palate and number?
600-1000
88
AOG parotid gland develops?
7th week
89
Dominant ANS stimulation of parotid gland?
Parasympathetic cholinergic stimulation - acetylcholine to activate phospholipase C -> activates 2nd messenger Ca
90
Electrolyes secreted into the acinar cell lumen?
Na, Cl, HCO3
91
Saliva is ______ water.
99.5%
92
Humans secrete ____ of saliva in 1 day.
1 liter
93
Electrolyte which is concentrated twice as high in the smg.
Calcium
94
Submandibular gland saliva has high content if?
Mucin
95
Most abundant protein in saliva?
Alpha-amylase. 40% of body amylase produced by salivary glands
96
Starts digestion of starch.
Amylase.
97
Saliva buffers with _______.
HCO3
98
Antibacterial proteins in saliva?
HAIL LiM
Histamine
Amylase
Ig A
Lysozyme
Lactoferrin
mucin
99
This disease condition results in abnormal chloride regulation with failure of reabsorption of nacl in the ductal cells resulting in more viscous saliva with decreased flow rates and sludging of saliva.
Cystic fibrosis
100
Most common source of xerostomia? (2)
Antihistamines
| Antidepressants
101
What salivary gland cells can modify the salivary gland composition? (2)
Intercalated and striated cells
102
What percentage of the smg is serous cells?
10%
103
What are serous minor salivary glands located posteriorly on the tongue?
Ebner glands
104
Where are sebaceous glands usually found if affecting the salivary gland? What are sebaceous cells in the oral mucosa?
Parotid gland.
Fordyce granules.
105
How to diagnose amyloidosis?
Positive congo red stain (apple green birefringence on polarized view)
106
In chronic sialedenitis px, how many will improve with conservative measures?
50%
107
Heavy lymphoid infiltrate in smg, may mimic neoplasm?
Kuttner tumor
108
Solid mass in parotid gland fir hiv px, percentage chance malignant?
40%
109
Treatment of actinomycosis (gram positive anaerobic actinomyces, sulfur granules)?
Penicillin G IV x 6 weeks, then PO erythromycin or clindamycin
110
Large polygonal thyroid follicular cells with abundant granular cytoplasm and numerous mitochondria?
Hürthle cell ca
110
Calcified laminated bodies called psammoma bodies; elongated, pale nuclei with a ground glass appearance (Orphan Annie eyes)?
Papillary thyroid ca
111
Nests of small, round cells; amyloid; dense, irregular areas of calcification?
Medullary thyroid ca
112
Cuboidal epithelial cells with large nuclei in a well-structured follicular pattern extending beyond the tumor's capsule?
Follicular thyroid ca
113
What is Ackerman's tumor?
Verrucous carcinoma, thought to be less radiosensitive and less likely to metastasize than SCCA.
114
Unencapsulated tumor that arises from within a nerve; 15% become malignant, when associated with von Recklinghausen's disease?
Neurofibroma
115
Arise from pericytes of Zimmerman and considered neither benign nor malignant?
Hemangiopericytoma
116
Most common tumor to metastasize to the sinonasal area?
Renal cell
117
Well-circumscribed, mobile, painless benign lesion most commonly found on the tongue that has malignant potential and histopathology shows polygonal cells with abundant eosinophils?
Granular cell tumor
118
Metastasizes to the brain more frequently than any other soft-tissue sarcoma?
Alveolar soft part sarcoma
119
From which part of the nasal cavity does JNA arise from?
Trifurcation of the palatine bone, horizontal ala of the vomer, and the root of the pterygoid process.
120
What are the high risk features in well-differentiated thyroid carcinoma?
Gross extrathyroidal extension
Incomplete tumor resection
Distant metastasis
Tumor lymph node >3cm
121
What are the intermediate risk features in well-differentiated thyroid carcinoma?
Aggressive histology
Minor extrathyroidal extension
Vascular invasion
>5 lymph nodes involved (0.2-3cm)
122
What are the low risk features in well-differentiated thyroid carcinoma?
Intrathyroidal DTC
| <=5 lymph nodes (0.2 cm)
123
What is the ATA classification for ocular involvement in Grave's disease?
Class I-Lid lag and the appearance of a stare
Class II-Conjunctival chemosis, epiphora, periorbital edema, and photophobia
Class III-Proptosis
Class IV-Decreased ocular mobility and diplopia
Class V-Corneal ulceration
Class VI-Optic nerve involvement.
124
What are the three most important factors leading to osteoradionecrosis?
Hypovascularity
hypocellularity
hypoxia (the "3Hs")
125
What are the three types of ORN?
Type I occurs soon after radiation therapy
Type II occurs long after radiation therapy and is induced by trauma
Type III occurs long after radiation therapy and occurs spontaneously.
126
What are the indications for parathyroid exploration in patients with asymptomatic or minimally symptomatic hyperparathyroidism?
Age less than 50
History of a life-threatening hypercalcemic episode
Kidney stones on abdominal X-rays
Serum calcium 1 mglmL above the upper limits of normal for the lab
Creatinine clearance reduced by 30% or more compared with age-matched normal persons
24-hour urinary calcium excretion >400 mg
T-score at lumbar spine, hip, or distal radius less than -2.5
Poor follow-up expected
Coexistent illness complicating conservative management.
127
What is the most effective regimen for anaplastic thyroid carcinoma?
Doxorubicin with Valproic acid
128
Virchow's node located?
Level 4
129
How many days prior to surgery stop warfarin?
3 days or reverse 6 hours prior using vitamin k
130
How many weeks prior to surgery stop aspirin?
2 weeks prior to surgery
131
How many weeks stop smoking prior to surgery?
1 week
132
How to do lateral view of xray?
5 degree off the lateral plane to avoid superimposition of posterior wall of maxillary sinus
133
How to perform caldwell view?
Pa view with 15 degree caudal angulation of the beam
134
How to perform waters view?
Pa with 33 degree neck extension
135
How to perform smv view?
Ap with 90 degree neck extension
136
What is the view for lower cervical spine?
Swimmers aka twining view
137
How to obtain schullers view?
Lateral view of the mastoid with 30 deg cephalocaudal angulation
138
How to perform stenvers projection?
For petrous bone, head slihtly flexed, turned 45 degree to opposite side, beam at 15 deg angle
139
How to perform transorbital view?
Frontal projection of the mastoid and petrous bone
140
How many HU fat?
-80-100
141
HU bone?
100 - 400
142
Soft tissue window?
40 - 70, 250 - 400 HU width
143
Width of bone window? Window level?
2000 - 4000 HU, 0 - 400
144
A sinus ct gives ____ more radiation than a sinus series with 4 films.
4 - 6 times
145
How many MHz used in ultrasound?
5 - 10
146
Disadvantage of PET?
Lack of anatomic information
| Poor spatial recognition 5 - 6mm
147
Useful in salivary gland function in autoimmune and inflammatory disease. Can pathogmonically demonstrate Warthin's tumor and oncocytoma. Has spatial resolution of 1.5 cm.
Technetium - 99m pertechnetate
148
FDG - PET is deferred until how many months after treatment?
4 months
149
What is contained in the pre styloid parapharyngeal space? (5)
Fat, cn v3, internal maxillary aa, ascending pharyngeal aa, pteryoid venous plexus.
150
What is contained in the parotid space?
Parotid gland, lymph nodes, facial nerve, retromandibular vein, branches of the eca
151
Separates carotid space and parotid space?
Posterior belly of digastric
152
Which is usually bigger, the right or left ijv?
Right
153
Contents of masticator space?
Muscles of deglutition, cn v3, cn v, ima, pterygoid venous plexus, ramus and posterior body of mandible.
154
Retropharyngeal space extends?
Skull base to t3
155
What may have a "bowtie" appearance on axial imaging?
Infection/mass in the lateral portion of the infrahyoid rps on axial imaging.
156
Contained in the prevertebral space?
Prevertebral, scalene, paraspinal muscles, branchial plexus, phrenic nerve, vertebral artery and vein.
157
Contained in the sublingual space?
Anterior part of the hyoglossus, lingual nerve, chorda tympani, lingual artery and vein. Deep portion of the submandibular gland and duct, sublingual glands and ducts.
158
Common pseudomass in the infrahyoid rps?
Tortuous internal or common carotid artery in the elderly.
159
Posterior (lateral) cervical space corresponds to?
Posterior triangle, containing ijv, transverse cervical lymph nodes, cn 11, phrenic nerves
160
Corresponds to muscular triangle in neck?
Visceral space.
161
When does a lesion become transglottic?
Fat interface between the thyroarytenoid muscle (tvf) and paralaryngeal fat (fvf) is eliminated, indicating the tumor has crossed the laryngeal ventricle. The anterior commisure should be <1mm thick.
162
Gold standard for detecting and identifying LAD as benign or malignant?
CECT
163
Normal thickness of maxillary and frontal sinus mucosa?
1-3mm
164
Appearance of mucocoele in MRI?
Concentric rings of variable dessicated mucous, with the center being the most dessicated.
165
Superior in detecting recurrent tumors from muscular and vascular invasion?
MRI
166
What is the most critical cellular target in radiotherapy?
Nuclear dna. Other targets are mitochondria and cell membrane.
167
Why are larger tumors less radiosensitive?
Large tumors overgrow their blood supply so are in a hypoxic state where radiation is not very effective.
168
What are the 4 rs of radiation?
Repair
Redistribution
Repopulation
Reoxygenation
169
What is the standard fractionation?
70 Gy, 2 Gy/Fx, 35 fx, 5d/week
170
How many hours does it take for normal tissue to repair after radiation damage?
4 - 6 hours
171
When and how to perform intraoprative rt?
Usually done in abdomen and pelvis, using 12.5 Gy
172
Mechanism of action for cell death for hyperthermia and radiation therapy?
1. Altered membrane permeability
2. Microtubule breakdown
3. Enhancement of antigen exprssion or antigen-antibody complexation
173
Most studied radioprotectant?
Amifostine
174
Survival time of patients with locally advanced of disseminatd recurrent scca?
6-8mos.
175
MOA of methotrexate?
Folic acid analogue, s-phase specific
176
Increases therapeutic index of methotrexate?
Leukovorin
177
Chemotherapeutic agent which is a metal coordination complex. Binds to dna to cause inter and intra strand cross linking?
Cisplatin.
178
Major toxic reaction to cisplatin?
Renal dysfunction. Others are ototoxicity and neurotoxicity.
179
Derivative of cisplatin. Dose limiting toxicity is myelosuppresion (primary leukopenia), thrombocytopenia. May be administered at the opd.
Carboplatin.
180
Inhibit microtubule polymerization, resulting in cell arrest at G2? Major toxicity is neutropenia.
Taxanes (ex. Paclitaxel).
181
Causes dna inter and intrastrand crosslinking. Dose limiting toxicity is hemorrhagic cystitis, thus administered with sodium mercaptothane sulfonate (mesna).
Ifosfamide.
182
Generates O2 radicals to break dna strands. Serious complication of pulmonary toxicity.
Bleomycin.
183
Inhibits formation of thymidine. Toxic reactions are myelosuppression.
5-fluororacil
184
Crosslinks DNA strands. Causes permanent infertility, fibrotic bladder.
Cyclophosphamide.
185
Interferes with nucleic acid synthesis. Cause limiting effect is cardiac toxicity.
Adriamycin.
186
Moa of vinca alkaloids?
Disrupt microtubular spindle formation.
187
Major side effects of vinblastine?
Myelosuppresion, alopecia, myalgia
188
Major side effect of vincristine?
Constipation (almost no myelosuppressive effect).
189
Inhibits dna synthesis. Major toxic response is neutropenia and thrombocytopenia.
Hydroxyurea
190
Most effective combinations for npca?
Cisplatin based regimens
191
Gold standard to which all new combinations should be compared?
Cisplatin + 5-FU
192
Another name for induction therapy (chemo before surgery or radiation?)
Neoadjuvant therapy
193
Standard of treatment in npca?
Cisplastin + radiotherapy then cisplatin + 5 FU.
194
In intraarterial chemotherapy, factors to consider in choosing the drug?
1. Drug concentration
2. Drug should be deactivated in the systemic circulation
3. Should be a high tissue extraction
4. Should not require deactivation in the liver
195
Best chemotherapeutic agents for adenoid cystic carcinoma?
Cisplatin, 5-FU, doxorubicin
196
Have been used to prevent malignant transformation of dysplastic leukoplakia lesions.
Retinoids and carotenoids
197
Thermoregulation is via?
Precapillary sphincters
198
What is a tissue supplied by a named artery?
Angiosome
199
What communicates adjacent angiosomes?
Choke vessels
200
Blood flow needed for nutritional support?
9ml/mg/100g of tissue
201
In maximal vasodilation, what is the blood flow?
20x normal
202
Theories of zone 2 (capillary circulation) autoregulation?
Myogenic theory-stretching of arteriolar muscle results in reflex contraction
Metabolic theory-excess of oxygen and nutrients results in arteriolar constriction
203
Loss of nutritive blood flow occurs in the prescence of an adequate vascular supply?
No reflow phenomenon
204
Dermis is ____ thicker than epidermis. Maximum ___ at back.
15-40x, 4mm
205
How nutrients are passed in zone 3?
Diffusion (passive) and convection (active).
206
Ultimate determinant of flap survival.
Zone 4 (cellular systems)
207
Loss of energy substrate in cells (oxygen and subsequently atp) produces reversible swelling in ____ of insult, after which cell lysis and flap necrosis develop?
10 mins.
208
Mucosal Kaposi's sarcoma usually occurs?
Oral cavity
209
3 histologic forms of ks?
Spindle cell
Anaplastic
Mixed cell (most common in aids-ks)
210
Most common type of non aids defining tumor?
Hodgkin's lymphoma
211
30% occur in the head and neck in hiv infected persons compared to 85% in the general population?
Basal cell carcinoma
212
Three mechanisms that contribute to the high incidence of sinusitis in HIV infected persons?
Impaired systemic and local immunity
Decreased mucociliary clearance
Increased atopy
213
What are the principle components of the cell cycle?
```
G1 phase
S phase
G2
M phase
G0
```
214
Cell cycle state of rest?
G0
215
Cell cycle actual distribution of the duplicated DNA and physical division into daughter cells?
M phase
216
Cell cycle cell growth and duplication of cellular proteins and structures?
G2 phase
217
Cell cycle dna replication or synthesis?
S phase
218
Cell cycle enzymes, nucleic acids and other factors are produced?
G1 phase
219
What are the 3 basic tenets of tumor progression?
1. Cancer arises as a result of inactivation of tumor suppressor genes
2. There is a defined order of genetic events that lead to development of a malignant phenotype
3. Variations in the order of events can occur, and it is ultimately the net accumulation of genetic events that determines the phenotypic expression of malignancy.
220
Tobacco smoke contains how many mutagenic compounds?
55
221
Inactivation of both parenteral alleles of TSG leads to a malignant phenotype.
Knudson's hypothesis
222
What is the largest neuronal center outside the cranial cavity, for facial pain, headaches ang migraine?
Sphenopalatine ganglion.
223
Formed by the fusion of the inferior cervical ganglion to the first thoracic ganglion?
Stellate ganglion.
224
What are the 4 phases of migraine progression?
1st phase: prodromal phase, depressiom, irritability, and anorexia
2nd: aura phase, visual somatosensory, or motor/language deficit of neurologic origin
3rd: headache phase marked by unilateral throbbing pain of moderate to severe intensity that lasts for 4-72hours, sometimes with nausea
4th phase: resolution phase marked by fatigue
225
Only anticonvulsant approved for prophylaxis of migraine headache?
Sodium valproate
226
What is effective for acute therapy for migraine?
12.5 to 37.5mg of IV chlorpromazine, or 10mg IV prochlorpromazine
227
Cluster headache more common M>F?
6:1
228
Presentation of cluster headache?
Excruciating unilateral pain involving the eye, temple, or upper jaw, lasting 15mins to 2hrs, 1-4x/day.
229
Treatment of cluster headaches?
240-480mg
230
Acute therapy of cluster headache in the ER?
```
O2 8-10lpm for 10mins
Ergotamine
DHE-45
Triptans
Lidocaine
Sphenopalatine block
```
231
Maximal rate of salivary production?
1ml/min/gm of glandular tissue
232
Pathway for stimulation of parotid gland.
```
Pans
Inferior salivary nucleus
Cn 9
Jacobsons nerve
Otic ganglion
Cn 5
Auriculotemporal branch
Parotid gland
```
233
Pathway for stimulation of smg
```
Pans
Superior salivary nucleus
Nervus intermedius
Chorda tympani
Submandibular ganglion
Submandibular gland
```
234
Salivary gland sans stimulation?
Sans
Superior cervical ganglion
Smg and parotid gland
235
Salivary flow rate stabilizes at what age?
15yo
236
Unstimulated salivary flow?
0.1ml/min
237
Stimulated saliva flow?
0.2 ml/min
238
Maximum salivary flow rate
7 ml/min
239
Ave daily saliva secretion?
1000-1500 ml
240
Most stimulating taste?
Acid
241
Least stimulating taste
Sweet
242
Diurnal variation of salivary flow
Highest late afternoon
| Minimal night
243
What is referred to by salivary highways and byways?
Highest flow mandibular lingual area and lowest maxillary incisors and interproximals
244
Amylase present in parotid? Smg?
60-120 mg/100ml
| 25mg/100ml
