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50 Cards in this Set

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What's in Waldeyer's ring?
tonsils and adenoids
anatomic features of the upper respiratory tract include:
1 Oropharynx.
2 Waldeyer's ring: tonsils and adenoids.
3 Eustachian tube >> middle ear >>mastoid air >>meninges spaces
4 Epiglottis, aryepiglottic folds.
5 Fascial spaces:
a. retropharyngeal.
b. lateral pharyngeal.
6. Trachea and Bronchi.
7. Esophagus
8 Sinuses
Chronic loci for infection: (3)
a. middle ear and mastoids
b. sinuses
c . Waldeyer’s ring.
Strep pyogenes Attaches to epithelial cells by binding to ______
fibronectin
S. pyogenes: Two main patterns of disease
a. suppurative, spreading local infection.
b. non-suppurative post streptococcal hypersensitivity disease at distant sites.
c. (spread with secondary infections).
What disease?

a. punctate red rash that appear on the skin and mucous membranes (in some S. pyogenes infections, especially pharyngitis.
1) generally starts on the chest and spreads to the extremities.
"strawberry" tongue.
due to an erythogenic toxin produced by certain strains of S. pyogenes. :
+/-Scarlet fever(scarletina):
_____ criteria for diagnosis of acute rheumatic fever.
Jones
Benign, Self-limited Disease of the B-cells in Lymphoid Tissues Caused by the Epstein-Barr virus (EBV).
Infectious Mononucleosis
IM:
period in which the virus or virus-infected B-cell spread hematogenously infecting other lymphoid organs.
asymptomatic period
IM:
period in which infected B cells arc killed by killer T cells (typical lymphocytes). Although there are many antibodies produced, the protective host response is the cellular immunity as manifested by the atypical lymphocytes.
symptomatic period
Like other herpesviruses, EBV persists as a latent infection:
EBV genome is integrated into the DNA of __?-cells which in culture can reproduce indefinitely
B
Characteristics of infectious mononucleosis due to EBV
1) common (5O% of patients): fever lymphadenopathy pharyngitis malaise and fatigue
2) less common (>l0% of patients)
splenomegaly
palatal petechiae
hepatomegaly
complications of IM:
hemolytic anemia
thrombocytopenia
aplastic anemia
myocarditis
hepatitis
genital ulcers
splenic rupture
Rash
neurologic sequelae
laboratory findings of IM
leukocytosis with absolute increase in the number of peripheral mononuclear cells, atypical lymphocytes (T cells).
heterophile antibodies.
elevated serum aminotransferase levels.
Neoplasia assoc with EBV
nasopharygeal carcinoma.
Burkitt’s lymphoma.
Hodgkin's disease.
EBV problems assoc with HIV pts
oral hairy leukoplakia
non-Hodgkin's lymphoma
lymphoid interstitial pneumonia.
1 Gram-negative diplococcus.
2 Oxidase positive
3 Ferments:
a. maltose.
b. glucose.
Neisseria meningitidis
N. meningitidis attaches to nonciliated respiratory epithelium of upper respiratory tract by _____.
pili
invasion by Neisseria meningitidis is favored by
1) infection with a strain to which the individual has not developed antibodies. 2) preceding URI. 3) stressed or debilitated host.
characteristics of disseminated infection:
organ Tropism
Gram-negative endotoxin
vasculitis
Neisseria meningitidis:

Meningitis and meningoencephalitis. In 3% of childhood meningitis, homozygous C4 _____ found.
deficiency
Bilateral adrenal necrosis and hemorrhage secondary to vasculitis and thrombosis.
Waterhouse-Fridericksen syndrome
Recurrent meningococcal meningitis due to complement (C3)_______.
deficiency
Perforation of the nasal septum is seen in drug abuse (cocaine) and with _______ ______
multiple myeloma.
Sinusitis is usually due to obstruction of the orifices of the sinus. May also be rarely seen patients with ciliary defects (______'s Syndrome).
Kartagener
Bacterial infections usually follow orifice obstruction. Fungal sinusitis (Mucor) is sometimes seen and is more common in _____
diabetics
Squamous cell carcinoma
of the nasal cavity.
Three variants:
keratinizing, nonkeratinizing, undifferentiated.
_____ genome is found in virtually all nasopharyngeal carcinoma,
particularly the undifferentiated type.
EBV
______ type has a syncytial growth pattern with large epithelial cells
with indistinct cell borders
Undifferentiated
When the nasopharyngeal lesion is accompanied by large numbers of atypical lymphocytes
It has been called a _______
lymphoepthelioma
Lymphoepitheliomas really a misnomer;
it is actually a _____ carcinoma of the nasopharyx with an abundant non-malignant lymphocytic infiltrate
squamous cell
Histologically, Lymphoepitheliomas may look like a _____ lymphoma
Hodgkin’s
EBV virus is associated with this malignancy in Africa and SE Asia.
African patients tend to be children, Asian patients tend to be ______.
adults
Obstructive lesions of larynx
1. Foreign bodies-
2. Tracheostomies-
3. Infectious
4. Aneioneurotic edema due to allergy/anaphylaxis
Which infections cause Obstructive lesions of larynx
a. Diphtheria -pseudomembrane composed of organisms, fibrin, inflammatory cells and debris.
b. H. influenza or beta hemolytic streptococcus -Epiglottitis and Laryngeo-tracheobronchitis. This is especially dangerous in children.
Laryngeal papillomatosis is a recurrent lesion (polyps) caused by ____
HPV
HPV Virus is contracted during -________
passage through an infected birth canal.
Laryngeal papillomatosis AKA
Vocal cord polyps
Where are vocal cord polyps
Seen on true vocal cords
Papillomas are associated with HPV _____
6 and 11.
Laryngeal papillomatosis
Histologically consists of slender fibrovascular cores covered by stratified _____ epithelium.
squamous
Laryngeal papillomatosis:
Benign neoplasm soft, rasberry like excrescence less than 1cm, usually single in adults and multiple in ____.
kids
What problem?

Polypoid nodules and lesions caused by chronic irritation.
0.5 cm smooth round nodules on true vocal cords covered by stratified squamous epithelium; may ulcerate.
Also seen in heavy smokers
Singer's nodules
Constitutes 95% of laryngeal malignancies and is typically found on true or false vocal cords.
Squamous cell carcinoma
Squamous cell carcinoma :
Location matters: 90% of Glottic remain confined to larynx,1/3 of ______ tumors metastasizes to cervical LNs.
supraglottic


Subglottic remain quisescent until advanced disease.
What problem?

A common pediatric problem of middle ear.
Usually due to S. pneumonia, H. influenza. or beta hemolytic strep.
Complications include perforation of ear drum, mastoiditis. chronic effusion, cholesteatoma and hearing loss.
Otitis media (acute or chronic)
What problem?

A non-neoplastic tumor-like condition which is actually an inflammatory lesion.
Patient usually has a history of otitis media and on exam has a cystic mass (often 1 cm or larger) filled with cholesterol and keratin debris.
If left alone it will enlarge, erode hone and cause hearing loss.
Cholesteatoma
What problem?

An autosomal dominant condition with variable penetrance resulting in bilateral bone deposition and fusion of the stapes footplate
Otosclerosis
what carcinomas of external ear are associated with sun exposure?
Basal cell and squamous cell
What type of neuroma?

A schwannoma derived from the Schwann cells of cranial nerve VIII near the cerebella-pontine angle.
Causes deafness.
Acoustical neuroma