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113 Cards in this Set
- Front
- Back
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What's an example of an iatrogenic cause of oral disease?
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Irradiation often = xerostomia, cavities, and gum disease
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What would you suspect if you saw a superficial grey/white matted plaque in the mouth
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Candidiasis
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How does one develop candidiasis?
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Overgrowth of yeast due to immunosuppression (yeast is often part of normal mouth flora)
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What's the microscopic appearance of candidiasis?
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yeast enmeshed in fibropurulent exudates
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Who gets oral candidiasis?
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Immunosuppressed -- young kids, HIV+, DM, immunodef, pts on antibiotics, steroids, cancer tx, etc
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What's an aphthous ulcer?
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A canker sore = small, white, painful ulceration of nonkeratinized mucosa
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What triggers aphthous ulcers?
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stress, fever, certain foods, or IBD (cause unknown - possibly autoimmune)
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How can you tell the difference between an aphthous ulcer and a cold sore?
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canker sores are flat and are NOT caused by herpes virus versus cold sores which are fluid filled vesicles with Herpes
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What is the presentation of oral herpes?
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Ranges from asx primary infection to single fluid filled vesicle (cold sore/fever blister) to raging mucositis where the MM's covered with sores
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What common virus does Milad have a strain of in his genitals that 2/3 of adults have been infected with?
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HSV-1 (Milad has a nasty case of HSV-2)
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What triggers an attack of oral HSV?
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stress, fever, sun/cold, respiratory tract infection, or trauma.
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How can you dx oral herpes?
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Tzank smear - scrape base of freshly ruptured lesion and look for multinucleated cells with acidophilic intranuclear inclusions
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Name the 5 oral lesions seen in HIV+ patients.
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candidiasis
Herpes Other microbials Kaposi's spots Hairy leukoplakia |
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What oral lesion is pretty much pathomnemonic for HIV?
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Hairy leukoplakia
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What would you think if you saw subtle red/brown spots in the mouth?
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Kaposi's angiosarcoma (then think AIDs)
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Would you be worried about cancer if you saw white confluent patches with "hairy" surfaces in the mouth?
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No - hairy leukoplakia is not pre-malignant
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What causes hairy leukoplakia?
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epithelial hyperplasia due to an EBV infection
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What is leukoplakia?
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Epithelial hyperplasia (thickening) or hyperkeratosis with unknown cause = white, well defined mucosal plaque
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What must you rule out if you see leukoplakia? Why?
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Hairy leukoplakia (HIV+) and erthythroplasia (50% turn malignant)
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Are leukoplakia's pre-malignant?
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Yes, 3-6% progress to squamous cell carcinoma.
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What is leukoplakia associated with?
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Anything that causes oral irritation - tobacco, alcohol, and chronic friction (ie dentures or Milad's genitalia)
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Would you be worried if you saw a red, velvety area in the oral cavity?
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Yes, it's probably an erythroplasia with marked dysplasia - 50% progress to malignancies
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What type of cancer makes up 95% of the oral cavity malignancies? What's it's overall incidence in the US?
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Squamous cell carcinoma
3% of all cancer in the US are oral squamous cell. |
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What do HPV 6+11 cause in the mouth? (describe the lesion)
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Papillomas = benign finger-like lesion covered with squamous epithelium
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What are common locations for oral squamous cell carcinomas?
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vermillion border of lower lip
floor of mouth lateral borders of tongue |
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What's the effect of location for the 5 year survival rates of oral squamous cell ca?
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Significant: Lip lesions have 95% 5 years survival where as other oral lesions only have 30%
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What is the progression of oral squamous cell ca?
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hyperplasia (leukoplakia/ erythroplasia) to severe dysplasia (raised/warty plaque) to frank invasion (exophytic +/- ulcerations)
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What are the risk factors for oral squamous cell ca?
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Strongest = tobacco
Also alcohol and HPV 16/18/33 Weakly assoc with constant irritation (like dentures) |
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At what age do patients develop oral squamous cell ca?
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50-70 y/o
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What's of concern when you see a poorly differentiated oral squamous cell ca?
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It normally has more local invasion and earlier metastases
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Where do oral squamous cell carcinomas met to?
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Normally local cervical nodes. Remote mets are rare.
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What conditions are associated with geographic tongue? (4)
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Reiter's, atopy, subhorretic dermatitis, and psoriasis
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What's a common cause of glossitis?
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Nutritional deficiencies - b complex or pernicious anemia (tongue = overly smooth and red)
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What's sialorrhea and when do you see it?
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Excessive salivation
Acute inflammation, Parkinson's, rabies, nausea, pregnancy |
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Where do you normally get sialolithiaisis?
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Stones in your salivary ducts - normally in submandibular gland
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What's the most common cause of sialoadenitis?
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Paramyxovirus infection of the parotid duct (mumps)
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What's the difference between mumps in kids and mumps in adults?
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In kids it's usually self limiting with no residual issues but in adults it can = pancreatitis and orchitis (leading to infertility)
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What's the morphology of partoditis due to mumps?
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Enlargement with mononuclear infultrates, edema and possibly necrosis.
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What is Sjogren's syndrome?
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An autoimmune disorder that causes painless chronic inflam of the salivary and lacrimal glands
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What are the symptoms of sjogren's syndrome?
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Xerostomia
Keratoconjunctivitis sicca |
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What's secondary Sjogren's syndrome?
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When it's part of a systemic autoimmune disease like our favorites: SLE or RA
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What normally causes a bacterial sialoadenitis?
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Staph aureus infection secondary to obstruction from a stone
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What do you see with a bacterial sialoadenitis?
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Interstitial PMN inflammation with necrosis or abscess
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What's Mikulicz's syndrome?
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Painless salivary and lacrimal gland enlargement with xerostomia that isn't associated with an autoimmune disorder
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What 4 conditions are associated with Mikulicz's syndrome?
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Sarcoidosis*
Leukemia Lymphoma Idiopathic lymphoepithelial hyperplasia |
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What HEENT condition is associated with sarcoidosis?
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Mikulicz's syndrome
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What are the most common types of salivary tumors?
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Usually unilateral parotid masses
75% of all salivary tumors are benign |
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What percent of parotid gland tumors are benign? What about submandibular gland tumors?
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70-80% of parotid
50% of submadibular |
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What's the most common benign salivary gland tumor?
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Pleomorphadenomas
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Who gets Pleomorphadenomas?
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Middle aged females
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What does it mean to say that Pleomorphadenomas are often pseudoencapuslated?
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They often have focal extension beyond the capsule (important to know for resection so they don't recur)
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What morphologic types of things do you see in Pleomorphadenomas?
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Epithelial elements = ducts, acini, sheets, and strands
CT = mucoid, myxoid, or chondroid. |
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What's the prognosis of Pleomorphadenomas?
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Good - they're well circumscribed and slow growing. Only 2-3% progress to malignancy and that's only after 10-20 years
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Where do you see malignant mixed salivary gland tumors?
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40% are submandibular
15% parotid |
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What's the prognosis of malignant mixed salivary gland tumors?
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Poor - it's very aggressive and 5yr survival is 50-70%
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Who gets Warthin's tumors and where are they found?
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Males over the age of 30 (but it's uncommon)
Almost always in the parotid glands |
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What would you be thinking if you saw a small, encapsulated neoplasm with cysts or clefts in the parotid gland?
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Warthin's tumor
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Describe the microscopic appearance of Warthin's tumors?
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Eosinophilic epithelial cells in glands/cysts surrounded by dense lymphoid tissue with follicles/germinal centers
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What two cell types would you see if you did a fine need aspiration of a Warthin's tumor?
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Red, plump granular epithelial cells and background lymphocytes.
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Are Warthin's tumors always solitary?
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Nope - 10% are multifocal
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What should you do next if you dx a Warthin's tumor in a pts left parotid?
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Check the right parotid - 10% are bilateral.
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What's the prognosis of a Warthin's tumor?
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Depends on differentiation, 5 year survival rates range from 50-90%
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What is the most common malignant salivary gland tumor?
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Mucoepidermoid carcinoma
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What cell types do you see in a Mucoepidermoid carcinoma of the salivary glands?
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Mucous and squamous
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What are nasal polyps?
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Edematous mucosal overgrowth that protudes into the nasal cavity
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What causes nasal polyps?
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Allergy (see eosinophils) or
Chronic rhinitis/sinusitis |
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What's an epithelial neoplasia in the nose called? What's the prognosis?
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Papillomas - may recur after incomplete resection and eventually maybe lead to malignancy?
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What causes sinusitis?
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Incomplete drainage with persistent bacterial (or fungal) infection = accumulation of purulent material
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What types of problems can you get with hyperplasia of the nasopharyx?
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Obstruction (respiratory or of the eustachian tube) = otitis media, hearing problems, and sleep apnea
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When should you worry about a case of tonsillitis?
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When an adult has unilateral enlargement.
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What types of neoplasms do you see in the nasopharynx?
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Squamous - anaplastic or undifferentiated.
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Who gets neoplasias of the nasopharynx? (Why?)
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Chinese adults
African kids (closely associated with EBV infection) |
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What's a somewhat common presentation of squamous cell ca of the nasopharynx?
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An occult primary lesion with obvious cervical node metastases
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What's the micro appearance of squamous cell ca of the nasopharynx?
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Anaplastic squamous cells with benign mononuclear lymphocytes
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What's the prognosis of squamous cell ca of the nasopharynx?
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Bad - it's radiosensitive but it's often picked up late after it's metastasized
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Who normally gets otitis media and what causes it?
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young kids and infants
Normally viral with serous exudates |
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What are common complications of otitis media? (4)
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Bacterial superinfection
Spread to mastoid air spaces Tympanic membrane perforation Cholesteatoma |
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What's a Cholesteatoma?
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Cyst with cholesterol and amorphous debris caused by otitis media.
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What causes chronic otitis media?
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Recurrent infections or unresolved primary infection.
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What is otosclerosis?
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Bone disease at oval window bony rim with fibrous ankylosis
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What is a complication of otosclerosis?
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Bony ankylosis can spread to the stapes foot plate causing conductive hearing loss due to decreased bone movement
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How common is otosclerosis?
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minimal disease is common but severe disease with significant hearing loss is uncommon.
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What's the triad assoc with Meniere's disease?
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Tinnitus
Paroxysmal vertigo Unilateral deafness |
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What is the pathogenesis behind Meniere's disease?
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Unknown fluid build up that causes dilation of the cochlear duct and saccule. Can progress to the entire endolymphatic system and even cause rupture.
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What drugs can cause labrynthine toxicity?
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aminoglycosides and aspirin
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What's the pathogenesis of labrynthine toxicity?
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Drugs build up in the body of the labrynth causing hearing loss and dizziness
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What are two causes of labrynthitis that can eventually lead to hearing loss?
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Viral infection
Acoustic trauma (loud sounds) |
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Why's epiglottitis bad?
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It obstructs the airway.
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What's the most common cause of epiglottis and who gets it?
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H. influ B infection in young kids and infants
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What are the presenting sx of epiglottis?
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Inspiratory stridor and cyanosis
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How can the incidence of epiglottis caused by h.influ be reduced?
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Vaccinations
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What is juvenile papillomatosis?
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A carpet of papillomas (warts) on the airway that regress with puberty
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What's a potentially life-treatening condition in the airway of kid's that's often misdiagnosed as asthma?
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juvenile papillomatosis
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What causes papillomas in the larynx?
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HPV 6 or 11
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What causes singer's nodules?
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Overuse and damage of the larynx leads to hyperplasia
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How do you tx singer's nodules?
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rest the voice
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What type of cancer do you see in the larynx?
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Mostly squamous carcinoma
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What are the risk factors of squamous carcinoma of the larynx?
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Strong assoc with smoking
Also assoc with alcohol |
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How do squamous carcinoma of the larynx present?
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Initial hoarsness followed by hemoptysis and dysphagia
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What percent of squamous carcinoma of the larynx are intrinsic?
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60%
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Rank the types of squamous carcinoma of the larynx from good to bad.
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Glottic (best prog, slow to met)
Supraglottic Transglottic (mets to nodes) Infraglottic (worse prog) |
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What are you thinking when you find lumpy bumpys in the thyroid?
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Multinodular goiter
Solitary nodule/cancer |
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What are you thinking when you find lumpy bumpys in the submandibular gland?
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Pleomorphic adenoma
Chronic sialadenitis |
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What are you thinking when you find lumpy bumpys in the cervical nodes?
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reactive
primary ca/metastases |
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What are you thinking when you find lumpy bumpys in the mandible?
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Cyst
Abcesses Tumors (bone or teeth) |
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What are you thinking when you find lumpy bumpys in the carotid bifurcation?
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Neuroendocrine (almost always)
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What should you consider when evaluating neck lumpy bumpies?
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location and texture (solid v. cystic)
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What's a brachial cyst?
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Embryologic cystic remnants of the brachial arch
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Where's a brachial cyst located?
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lateral neck near the jaw
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What is the micro appearance of both a brachial and thyroglossal duct cyst?
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Cyst lined with squamous or pseudostratified columnar epithelium with surrounding lymphoid aggregates (thyroid may also have gland remnants)
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What is a thyroglossal duct cyst?
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remnant from the thyroid migration during embryologic development
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Who normally gets brachial and thyroglossal duct cysts?
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kids
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What's the most common midline cystic lesion in the neck?
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thyroglossal duct cyst
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