Path Test 3: ENT

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Path Test 3: ENT
2012-12-20 07:32:49

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  1. Dorma HSV-1 resides in
    sensory ganglia
  2. 2 things caused by HSV-1
    • Fever blisters/cold sores
    • Acute Herpetic Gingivostomatitis (peds or immunocompromised)
  3. Pt:  Child 2-4 years
    Sx:  Drooling and refusal to eat
    PE:  Fiery red oral mucosa w/ vesicles and ulcers
    Duration: 7-14 days
    Acute Herpetic Gingivostomatitis (HSV-1)
  4. What test confirms Herpes?
    Tzanck test
  5. What do you see on positive Tzanck test?
    • Multinucleated giant cells
    • Nuclei molding to one another (w/ intracellular inclusions, margination of chromatin --> ground glass appearance)

    Confirms HSV-1
  6. Drug given to immunosuppressed HSV-1 pts?
    Acyclovir (normal people tx is symptomatic)
  7. Marked increase in oral lesion in the last decade.  Tranmission of this virus has been documented to occur in the absence of visible lesions.
    HSV-II (genital herpes)
  8. Shallow, idiopathic oral ulcers that are painful, lasting a week to several weeks
    Aphthous ulcers (HSV-II)
  9. Mucosal changes that are associated with squamous dysplasia, a precursor to squamous cell carcinoma.
    Luekoplakia, erythroplakia
  10. White plaque on a mucosal surface; histologically, hyperkeratosis and squamous hyperplasia are seen, with or without dysplasia.
  11. Red, velvety mucosal lesion that usually show significant dysplasia or carcinoma in situ.  More likely to progres to invasive squamous cell carcinoma.
  12. More likely to progress to invasive squamous cell carcinoma in oral cavity:  Leukoplakia or Erythroplakia

    Although both may contain foci of invasive carcinoma at the time of presentation.
  13. Squamous cell carcinoma is most common where:  oral cavity, lip, or tongue
    lower lip (sun hits it), more common in men because wearing lipstick is protective for women
  14. 4 risk factors for intraoral squamous carcinoma
    • Tobacco
    • Alcohol
    • Oral-genital
    • Oral-Oral
  15. T or F:  HPV genetic material is increasingly identified in oral squamous cancers
    True  (especially those in tonsils and base of the tongue)

    Over 70% of newly diagnosed oropharyngeal cancers harbor oncogenic strains of HPV- esp. type 16 [90% of HPV related oropharyngeal carcinomas])
  16. _______show a greater tendence for early lymph node metasteses, bt are paradoxically associated w/ a better prognosis.
    HPV-related cancers
  17. E6 binds and degrades
    p53 protein
  18. E7 inhibits
    Rb protin --> accumulation of p16 protein
  19. Which carcinomas have the best prognosis?  oral cavity, lip, tongue
    Lip = best prognosis

    • (floor of mouth and base of tongue have the worst)
    • HPV genetic material present = better prognosis
  20. Most common human infection
    Infectious rhinitis
  21. 3 Types of viruses that cause infectious rhinitis
    Rhinovirus, Adenovirus, Echovirus
  22. Major cause of common cold
  23. Rhinovirus binding site
    is in a cleft that is no accessible to Ab (ICAM-1, CD54 molecule) on epithelial cells
  24. Inflammatory mediates (ie. bradykinin) in their response to rhinovirus cause
    increased mucus secretion and congestion
  25. Hypersensitivity rxn of Allergic Rhinitis
    Type I, IgE-mediated
  26. Reactive, non-neoplastic protrusions of edematous inflamed mucosa.  Surgically removed to improve air movement and drainage.
    Nasal Polyps
  27. Nasal polyps are esp. common in
    children w/ CF
  28. Usually secondary to bacterial rhinitis
    Acute sinusitis
  29. Fungi can colonize sinuses to form
    non-invasive "fungal balls" (similar to ones found in cavitary lesions of the lungs)
  30. Pt. is asthmatic w/ recurring sinusitis that is refractory to conventional therapy.  Sinuses are filled w/ "allergic mucin" (lamination, eosinophils, Charcot-Leyden crystals, hyphae)
    Allergic fungal sinusitis (Fungal organsims do NOT invade)
  31. Mucor affects
    Diabetic ketoacidosis and immunosuppressed (opportunistic fungi)
  32. In immunocompromised individuals, Mucor (fungus) is
    angioinvasive and spreads to cranial vault --> thromboses and cerebral infarcts (can be life-threatening)
  33. 3 things that invove upper airway lesiosn
    • Mucor fungus
    • Wegener's granulomatosis
    • Angiocentric non-Hodgkin's lymphoma
  34. Pharyngitis and tonsilitis have _____ etiology?
    • Viral
    • Grp A, Beta-hemolytic strep (rheumatic fever and post-infectious glomerulonephritis)
  35. Androgen-dependent vascular fibrous proliferation having teh appearance of erectile tissue arising in the nasopharynx.
    Nasopharyngeal angiofibroma (Males age 10-25)
  36. Benign epithelial neoplasm, but the ______ subtype recurs  and is associated w/ invasive carcinoma.
    Sinonasal papillomas, Inverted papilloma
  37. 5 year survival of Olfactory Neuroblastoma
  38. Soft mass/small blue cell tumor in the roof of the nasal fossa.  Arises from neuroepithelial elements in the olfactory membrane
    Olfactory Neuroblastoma
  39. Olfactory Neuroblastoma tx
    Surgery + radiation
  40. Squamous cell carcinoma associated w/ nickel refiners and woodworkers.  it has a very poor prognosis.
    Sinonasal carcinomas
  41. 3 histologic patterns of Nasopharyngeal Carcinoma (NPC)
    • 1)  Keratinizing SCC
    • 2)  Non-keratinizing SCC
    • 3)  Undifferentiated carcinoma
  42. Fluid-filled mass, occurs following trauma, leads to disruption of salivary gland

    (Mucus dissects into stroma to produce a cyst-like lesion
  43. Where is mucocele typically seen?
    Lip mucosa
  44. Pleomorphic adenoma:  Males or females
    More common in females (4th decade)
  45. Benign mixed tumor of salivary gland origin
    Pleomorphic adenoma
  46. Most common neoplasm of salivary glands (affects parotic most then submandibular)
    Pleomorphic adenoma (benign)
  47. Second most common salivary gland tumor.  Seen in
    • Wartin tumor
    • male smoker
  48. Warthin tumor affects, histology?
    • Parotid gland
    • Proliferating oncocytic cells an dense lymphoid stroma
  49. Most common MALIGNANT salivary gland tumor
    Mucoepidermoid carcinoma (parotid, minor salivary gland tumors)

    • Low grade = good prognosis
    • High grade = bad prognosis
  50. Types of cells in Mucoepidermoid carcinoma
    Squamous, mucous, intermediate
  51. Characteristically invades nerves and is a malignant salivary gland tumor
    Adenoid cystic carcinoma
  52. Neoplastic cells demonstrate serous acinar differentiation
    Acinic cell carcinoma (Parotid Gland)
  53. Bacteria that causes Acute Epiglottitis
    H. influenzae
  54. Pts. sit in sniffing dog position and have a huge cherry red epiglottis, intubation is required to maintain airway.
    Acute epiglottitis
  55. Pts. who stress their vocal cords.  Hoarseness.  Neither neoplastic or pre-neoplastic
    Reactive Laryngeal Nodules
  56. Reactive Laryngeal Nodule
    • Center:  connective tissue (myxoid, fibrous)
    • Covering:  Squamous epithelium
  57. Squamous laryngeal papilloma most commonly seen in middle-aged men
    Solitary Laryngeal Papilloma

    More likely to contain dysplasia
  58. Born to mothers who have genital HPV lesions, infants acquire virus as they travel through birth canal --> Laryngeal nodes
    Laryngeal papillomatosis
  59. Laryngeal Papillomatosis:
    Virus types?
    • 6, 11 (ones that progress to SCC are 11)
    • Laser tx
  60. SCC of the Larynx:
    Most commonly seen in?
    Good prognostic sign?
    • Cigarette smokers
    • Hoarseness due to CA on vocal cord, means it's in its early stages
  61. Neck
    Thyroglossal tract cysts:
    Branchial Cysts
    • TGTC:  Midline, must resect entire tract
    • Branchial Cysts:  Anterolateral neck, young adults, squamous or columnar epithelium (prominent lymphoid component)
  62. Extraadrenal pheochomocytomas
  63. Affects neuroendocrine cells (sometimes as part of AD MEN II Syndrome) and cells result in zellballen nesting pattern.  enolas, chromogranin, synaptophysin and S-100 protein positive.