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63 Cards in this Set
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Benign disorders of the oral cavity include cleft lip and palate (most common of oral cavity), viral, bacterial, and fungal infections, dental and gingival problems, systemic diseases, aphthous ulcers, and leukoplakia. Coxsackie A can cause what 2 viral diseases of the mouth? What are their manifestations?
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herpangina: C: mouth blisters, fever, and sore throat O: Lesions in back area of the mouth that progress from red macules, to vesicles, and lastly to ulcerations which can be 2 - 4 mm in size. The lesions heal in 7 – 10 days.
hand-foot-mouth disease: Begins with a fever, poor appetite, malaise, and a sore throat. Red macules, porgress to vesicles, and then ulcers, as with herpangina, but on the tongue, gums, and inside of the cheeks. Macules appear on hands, buttocks, and feet as well. |
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What virus causes herpangina?
What is the manifestation? |
Coxsackie A
C: mouth blisters, fever, and sore throat O: Lesions in back area of the mouth that progress from red macules, to vesicles, and lastly to ulcerations which can be 2 - 4 mm in size. The lesions heal in 7 – 10 days. |
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What virus causes hand-foot-mouth disease?
What is the manifestation? |
Coxsackie A
Begins with a fever, poor appetite, malaise, and a sore throat. Red macules, progress to vesicles, and then ulcers, as with herpangina, but on the tongue, gums, and inside of the cheeks. Macules appear on hands, buttocks, and feet as well. |
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What virus cases gingivostomatitis (fever, bad breath, malaise, sores on the inside of the cheeks or gums) and herpes labialis (fever blisters)?
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HSV I
cold sores, encephalitis (#1 cause in the US), keratitis of the eye (#1 in US) |
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What viruses cause mono?
What are the manifestations? |
EBV/HHV4 (also causes causation of Burkitt's lymphoma, hairy leukoplakia, Nasopharyngeal carcinoma, and chronic fatigue) in B lymphocytes invaded, virus makes circular EBV DNA - Downey Cells
CMV/HHV-5 Invades white cells, causes cytomegally (swelling), and syncitium. Dx of CMV: antibody culture of buffy coat or histology if WBCs w/inclusion bodies CMV has inclusion bodies in WBC’s, EBV has downy cells |
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What is hairy leukoplakia and what causes it?
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EBV/HHV-4
white lesion on ateral border of tongue in HIV positive patients. |
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Causes of exudative pharyngitis/tonsillitis?
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50% viral especially EBV
20-35% Strep. pyogens |
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A systemic disease that may involve the mouth is pemphigus vulgaris. What is it?
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circulating IgG-Ab of the basement membrane leads to major sores and infections of mouth.
40-60 y-o especially Ashkenazi Jews. Dx: biopsy Tx: steroids, IVIG, Rituximab (anti-CD20 Ab) |
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Systemic diseases and skin disorders my involve the mouth. An example is Erythema multiforme. If it involves the mouth it is called Stevens-Johnson Syndrome. What is it?
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hypersensitivity reaction to mycoplasma or sulfonimides. IgM to the superficial microvasculature of the skin and oral mucous membrane (in S-J syndrome). Therefore, the mucous membrane part of S-J syndrome is like pemphigus vulgaris.
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Hyperpigmentation of the buccal mucosa will cause you to suspect what disease?
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Addison's disease due to adrenal insufficiency.
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Macroglossia (big tongue) will lead you to consider what systemic problems?
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amyloidosis and hypothyroidism
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You discover Wickham's striae (fine, lacy white lines) on the mucosa of the mouth, what systemic disease will you consider?
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Lichen planus from stress, autoimmune, or drug reaction
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What are aphthous ulcers?
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canker sores
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What causes leukoplakia, erythroleukoplakia, and ertythroplakia?
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tobacco products, excessive ingestion of alcohol
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How do leukoplakia, erythroleukoplakia, and ertythroplakia present and how are they diagnosed?
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Lesions do not wipe off. predispose to sqamous cell cancer. biopsy to r/o squamous cell cancer.
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Most common cancer of mouth?
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Squamous cell carcinoma.
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What are predisposing factors of squamous cell carcinoma (#1 cancer of mouth)?
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same features that cause leukoplakia, erythroleukoplakia, and ertythroplakia: tobacco products and excessive alcohol intake.
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To where does squamous cell carcinoma usually metasticize?
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submental and jugular nodes
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Describe verrucous carcinoma?
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squamous carcinoma from smokeless tobacco. (all squamous cell carcinomas are low grade, well-differentiated)
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You suspect a patient has Mumps. What lab work will help with this diagnosis?
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elevated Amylase (therefore also may cause pancreatitis).
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What kind of virus causes mumps?
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Mumps virus of Paramyxoviridae family. RNA virus
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The majority of salivary glad tumors are benign. What is the most common tumor and where is it located?
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pleomorphic adenoma
parotid gland |
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What is the most common malignancy of the salivary glands?
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mucoepidermoid carcinoma (squamous and glandular component)
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What is pleomorphic adenoma and where is it located?
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usually the parotid gland, non-neoplastic tumor.
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Gastric Reflux and infectious esophagitis cause odynophagia. What is odynophagia?
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pain on swallowing
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What is the word for pain on swallowing?
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odynophagia
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What is the most common symptom/manifestation of esophageal disease?
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heartburn
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What is the most common congenital esophageal anomaly?
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tracheosophageal fistula
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What is Plummer-Vinson syndrome?
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iron deficiency,
esophageal web (dysphagia for solids) glossitis, leukoplakia, koilonychia (spoon nails), achlorhydria (interestingly might present like GERD) |
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A patient presents with iron deficiency,
esophageal web, glossitis, leukoplakia, koilonychia, achlorhydria. What might they have? |
Plummer-Vinson syndrome
might be genetic and/or dietary in origin...uncertain. Presents in middle aged women. Watch for squamous cell CA |
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What are unique about true diverticula?
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lined by mucosa, submucosa, muscularis propria, and adventitia
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What are unique about false (pulsion) diverticula?
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a hernation of mucosa, submucosa, and part of muscularis propria due to pressure
not all of muscularis propria and not adventitia...it isn't all 4 layers |
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Diverticula are analogous to _____ in the CVS and ____ respiratory tract.
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aneurysms and bronchietasis
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What is the most common pulsion/false diverticula of the esophagus?
Where is the defect? |
Zenker's diverticulum
cricopharyngeus muscle defect (Contraction of the lower pharyngeal constrictor is followed by relaxation of the cricopharyngeal muscle, allowing the bolus to pass into the esophagus.) http://images.google.com/imgres?imgurl=http://www.radiologyassistant.nl/images/thmb_44299de5ccc67pharyngeal1%2B2.jpg&imgrefurl=http://www.radiologyassistant.nl/en/440bca82f1b77&usg=__cQrtsbwod7keFKbd8CH1IsIkQ90=&h=205&w=370&sz=24&hl=en&start=7&sig2=2ab16Yy3tIpRtoQf9bSpsg&um=1&tbnid=XtdH_wPZMkUptM:&tbnh=68&tbnw=122&prev=/images%3Fq%3Dcricopharyngeus%26hl%3Den%26client%3Dsafari%26rls%3Den%26sa%3DN%26um%3D1&ei=LuxUS9ikL5PsNZmO-I8J |
http://images.google.com/imgres?imgurl=http://www.radiologyassistant.nl/images/thmb_44299de5ccc67pharyngeal1%2B2.jpg&imgrefurl=http://www.radiologyassistant.nl/en/440bca82f1b77&usg=__cQrtsbwod7keFKbd8CH1IsIkQ90=&h=205&w=370&sz=24&hl=en&start=7&sig2=2ab16Yy3tIpRtoQf9bSpsg&um=1&tbnid=XtdH_wPZMkUptM:&tbnh=68&tbnw=122&prev=/images%3Fq%3Dcricopharyngeus%26hl%3Den%26client%3Dsafari%26rls%3Den%26sa%3DN%26um%3D1&ei=LuxUS9ikL5PsNZmO-I8J
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What are Esophogeal Web's?
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ledge-like protrusions of mucosa
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What causes Esophogeal Web's?
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congenital
Secondary to long-term GERD, graft-v-host Dz, blistering Dz's, or Plummer-Vinson syndrome |
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What are Esophogeal Rings?
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circumfrential and thick (mucosa, submucosa, and sometimes muscularis) in the distal esophogus
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What is esophogeal stenosis?
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thickening and fibrous changes of the submucosa with atrophy of muscularis
Usually due to inflammatory scarring |
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There are 3 primary muscular disorders of the esophogus, Scleroderma, stenosis, and achalasia. What are the causes of achalasia?
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Primary: dysfxn of inhibitory neurons containing NO and vasoactive intestinal polypeptide in the distal esophagus (Analogous to hirschsprung's Dz)
Secondary to Chagas Dz which destroys myenteric plexus (occurs elsewhere in GI too) Idiopathic Achalsasia-like Dz (auntoimmune) from diabetes, sarcoidosis, or amyloidosis (actually causes relaxation, dilation, and lack of peristalsis) |
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Achalasia is analagous to Hirschsprung's Dz. What are they?
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Failure to relax, dilation, and absence of peristalsis.
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Progressive systemic Sclerosis (Scleroderma) often causes relaxation, dilation, and absence of peristalsis in what portion of the GI tract?
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lower esophagus
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How are the effects of scleroderma different?
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Scleroderma would cause relaxation, dilation, and absence of peristalsis.
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There are 3 primary muscular disorders of the esophogus, Scleroderma, stenosis, and achalasia. Where do each typically have their effect?
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Scleroderma = distal esophagus
Stenosis = anywhere achalasia = proximal |
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What is CREST syndrome?
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type of PSS (scleroderma), an acronym for the five main features:
Calcinosis Raynaud's syndrome Esophageal dysmotility Sclerodactyly Telangiectasia |
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What is a hiatal hernia?
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most common hernia. Protrusion of proximal stomach through diaphram (hiatus) that causes esophagitis (even as bad as Barrett's esophagus)
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What is Barrett's esophagus?
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glandular metaplasia ( squamous to columnar change) in distal esophagus.
Major risk for adenocarcinoma |
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What risk does Barrett's esophagus carry?
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adenocarcinoma
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How is Barrett's esophagus diagnosed?
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endoscopic evidence
hostologic evidence |
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What are the 3 prominent diverticula of the esophagus?
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Zenker, above UES
Traction, midpoint Epiphrenic, above LES |
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Where is Zenker diverticulum located?
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above the UES
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Where is Traction diverticulum located?
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midpoint in the esophagus
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Where is Epiphrenic diverticulum located?
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above the LES
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There are two types of lacerations, Mallory-Weiss and Boerhaave's. What are the differences?
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Mallory-Weiss is less severe, usually longitudinal, and usually heals on it's own.
Boerhaave's will often rupture, requiring surgery, and may include esophagus and/or proximal stomach. |
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What might cause either Mallory-Weiss syndrome or Boerhaave's syndrome?
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forceful vomiting/retching
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What are the histological changes associated with esophagitis?
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elongated lamina propria papillae (with capillaries) into top third of epithelial layer
eosinophils, PMN's and lymphocytes get out into that squam. layer And back at base camp, the basal zone has hyperplasia exeeding 20%. |
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What are the leading causes of esophagitis?
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GERD, Viruses (HSV-1, CMV, HIV) and Candida, Corosive agents
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A biopsy of distal esophagus is taken. It shows elongated lamina propria, hyperplasia of the basal layer, and inflammatory cells. What is the diagnosis?
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esophagitis (usually from GERD, virus/fungi, or corosive agents)
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A biopsy of distal esophagus is taken and shows columnar (perhaps pseudostratified) cells arranged in a glandular fashion. They have large nuclei and engrossed/hyperchromatic chromatin. There are also areas of intestinal epithelium with goblet cells. What is the diagnosis?
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mild dysplasia of Barrett Esophagus
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A biopsy of the distal esophagus reveals stratified collumnar epithelium with large nuclei, engrosed hyperchromatic chromatin and the loss of mucin producing cells. What is the diagnosis?
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Severe dysplasia of Barrett Esophagus
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On gross observation how are adenocarcinoma and squamous cell carcinoma different?
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Adeno usually has polyps or ulcers, not white like a squamous cell CA
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Hernias and Barrett's esophagus predisposes a patient to what CA?
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adenocarcinoma
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Alcohol, tobacco, and achalasia predisposes a patient for which CA?
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squamous cell CA
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Describe the transitional stages to adenocarcinoma of the esophagus.
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Normal -->
esophagitis (inflammation, basement thickening, and lamina propria growth) --> Barrett esophagus (transition to columnar epi) --> dysplasia (active cells with stratified columnar cells) --> CA of glandular tissue with dark (active) squeezed dysplastic cells |
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