Path: ENT

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1

what is considered the "realm" of ENT

nose, nasal cavvity, nasopharynx, oral cavity, oropharynx, larynx,laryngopharynx and the structures within them like four pairs of nasal sinuses, auditory tubes, ears, nasolacrimal duct, tonsils, salivary glands

2

what are the main categories of diseases

DEGENERATIVE
INFLAMMTORY
NEOPLASTIC

deviations of normal anatomy and histology

3

what are the four main components of disease

etiology
pathogenesis
morphology
clinical manifestations

4

what type of mucosa does anything that touches food have in head/neck

squamous

5

what type of mucosa does an area that touches air have in the head/neck

columnar

6

how would PCCE in the head and neck become squamous if exposed to injurious stimuli?

squamous metaplasia

7

what are the common pathologic conditions of the oral cavity

teeth/gingivae/alveolar bone

inflammatory/reactive lsions

infections

leukoplakia/"hairy" leukoplakia

squamous tumors

odontogenic cysts/tumors

8

what is leukoplakia

white plaque

9

what are considered "upper" airway areas

nose
nasopharynx
paranasal sinuses
larynx

10

what types of problems can arise in any of the upper airway areas

inflammation and tumors

11

what physical structure separates upper and lower airway

trachea

12

what are the possible disease types of the ears

degeneration (otosclerosis)
inflammation
neoplasms

13

what is otosclerosis common in

conduction defect common in old people

14

what are the commmon pathologic conditions in the neck

branchial cyst
thyroglossal cyst
paraganglioma

15

what is characteristic of branchial cysts

painless cysts in neck below parotid glands

16

where would you look for thyroglossal cytss

midline

17

what is the paraganglioma a tumor of

carotid body

18

what is the role of the carotid body

monitors O2 and CO2

19

what is the degenerative disease of the salivary glands

xerostomia

20

what are the benign neoplasms of the salivary glands

pleomorphic adenoma (mixed tumor)
warthin tumor

21

what are the malignant neoplasms of the salivary glands

mucoepidermoid
adenoid cystic
adenocarcinoma

22

what types of salivary glands have both serous and mucinous parts

submandibular

23

what type of salivary gland is all serous

parotid

24

what salivary gland is all mucinous

sublingual

25

do we get new enamel after we are born

no

26

why is sugar bad for your teeth

because it feeds bacteria

27

what leads to tooth decay

processed carbs (sugars) providing food for bacteria

28

what types of bacteria contribute to acidic erosion of enamel

strep mutans,lactobacilli

29

what is the progression of tooth decay

tartar to plaque to calculus

30

what is caries

cavity (enamel erosion)

31

what is th emain predecessory to peridontal disease

gingivitis

32

what is gingivitis caused by largeley

actinobacilli, porphyromonas, prevotella species

33

how many types of bacteria are commonly in the mouth

300

34

what bacteria cause periodontal disease

actinobacillus
porphyromonas
prevotella

35

what areas can periodontal disease attack

soft tissue of the mouth (gingiva) then to periodontal ligaments, bone, and cementum

36
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what is this

irritation fibroma

37

what types of people get irritation fibromas

people with dentures

38

is an irritation fibroma a true fibroma

no

39
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what is this

irritation fibroma

40

what does pyogenic granuloma look like grossly

normal granulation tissue

41
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what is this

pyogenic granuloma

42

will a pyogenic granuloma or irritation fibroma be more likely to blanch

pyogenic granuloma

43

where do pyogenic granulomas originate

gingiva

44
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what is this

pyogenic granuloma

45

what is another name for an aphthous ulcer

canker sore

46

how many people get canker sores

40%

47

what is the etiology of canker sores

very obscure, painful, inflammatory cells at the base

48

is a canker sore a leukoplakia

NO

ulcer or lack of mucosa is more accurate

49

what can cause glossitis

bacterial/viral infections (like oral herpes simplex)

mechanical irritation or injury from burns, rough edges of teeth, or dental appliances

Exposure to irritants like tobacco, alcohol, hot foods, or spices

allergic reaction to toothpaste, mouthwash,breath fresheners,dyes in candy, plastic in dentures or retainers, or certain BP medication (ACE inhibitors)

inherited (occasionally)

50

what type of disorders can cause glossitis

iron deficiency anemia

pernicious anemia

other B vitamin deficiencies

51

what types of infections can cause glossitis

oral lichen planus
erythema multiforme
aphthous ulcer
pemphigus vulgaris
syphillis

52
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what is this

glossitis

53

why is herpes called so

because herpetic vesicles "creep" over mucosal surfaces

54

what are the herpes viruses

CMV
VZV
HSV 1 and 2

55

what happens in the steps of herpes infection

vesicles first, then they are irritated, ulcerated, and inflamed

then they become pustulated

56

what is HSV 1 associated with

oral herpes (not as serious)

57

what is HSV 2 associated with

genital herpes (more aggresive)

58

do you lose the herpes virus once you get it

no, triggered off by random things

59

can you see the vesicled canker sores of herpes

not usually, normally ulcerated when you can see them

60
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what stage of herpes is this canker sore in

dried vesicle with inflammation

61
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what stage is this herpes canker sore in

dried vesicle with ulceration and secondary inflammation

62

what is the most likely bacteria to infect an ulcerated herpes sore

staph

63
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what type of test is this from

Tzanck smear

64

how do you do a Tzanck smear

scrape vesicle, smear it, stain it with anything, and look for squamous nuclei (larger than normal)

65

what type of Tzanck smear will you get with most vesicles caused by herpes family viruses

positive

66

why would a Tzanck smear be positive if someone has Herpes

because it causes intranuclear inclusions and enlarged nuclei

67

what color intranuclear inclusions will HSV have on H and E

red

68

what color intranuclear inclusions will CMV have on H and E

blue

69

what are synonyms for thrush mouth

monilla or candida

70

what will be present in thrush mouth

whitish oral film without underlying inflammation/redness

71

what is thrush mouth common in

babies, diabetics, immunocompromised people

72

what type of tissue does candida affect mostly

moist, nonkeratinized stratified squamous mucosa

73

what places on the body does candida usually affect

mouth
vagina
moist genital skin areas

(basically everyone has it lying around waiting ofr an immunocompromised condition to occur)

74
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what is this

candida (white filmy patches not firmly attached to the underlying moist nonkeratinized stratified squamous mucosa with minima redness)

75
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what type of stain is this and what will be stained red

PAS stain

yeast and pseudohyphae

76
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what is this

leukoplakia

77

is leukoplakia always premalignant

no, mostly not

remember that this is a clincal description, not a specific clinical or pathological entity, and can go from hyperkeratosis/inflammation to carcinoma

78

what is "hairy" leukoplakia a sign of

HIV

79
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waht is this

hairy leukoplakia, diagnostic of HIV

80

what are the steps of normal tissue to squamous cell carcinoma

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normal to hyperplasia/hyperkeratosis to mild/moderate dysplasia to severe dysplasia/CIS to SCC

81
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what is this a classic appearance of

infiltrating or infiltrative squamous cell carcinoma of the mouth

82

what are the levels of differentiation of squamous cell cancer

well
moderate
poor

83

what is apparent in well differentiated squamous cell cancer

pearls

84
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what level of differentiation of squamous cell cancer is this

well differentiated

85

what is usually visible in moderately differentiated squamous cell cancer

intercellular bridges (not pearls)

86

will squamous cells even look squamous in poorly differentiated SCC

no (squamous or immunochemical markers like cytokeratin markers to determine)

87
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what is this

well differentiated SCC (notice pearls)

88
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what is this

moderately differentiated SCC (tonofibrils and desmosomes apparent)

89
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what is this

poorly differentiated SCC (large mitoses)

90

what is more important in cancer diagnosis: staging or grading

staging (metastasis) more important than grading (cell type)

91

are odontogenic cysts normally malignant? what is the main question with them?

no, benign

question: developmental cyst or inflammatory cyst

92

what do both developmental and inflammatory cysts develop from

remnants of odontogenic epithelium (epithelium that gives rise to teeth)

93

what are the types of odontogenic cysts (general)

inflammatory cysts (radicular, periapical most common)

developmental cysts (dentigerous most common)

malignant tumors of odontogenic origin (ameloblastomas (rare))

94
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what type of cyst is this

dentigerous cyst (loose looking tissue around the tooth)

95

what type of epithelium lines the teeth

odontogenic

96

what are many rhinitis/sinusitises associated with

allergies and upper respiratory (viral) infections

97

what could prove that a rhinitis or sinusitis is allergic in origin

eosinophils

98

what are the types of nose/sinus/nasopharynx tumors

polyps (not relaly tumors)
angiofibroma
papilloma
plasmacytoma
neur

99

what are the vast majority of "tumors" in the nose, nasal cavity, or nasal pharynx

polyps/inflammatory polyps

100

what types of tissue would be included in an angiofibroma

BV and fibrous tissue

101

is an angiofibroma benign or malignant

benign

102

what does a plasmacytoma look like

plasma cell

103

how would you approach a plasmacytoma

do serum-protein electrophoresis to see if it were part of an overall plasma cell dysplasia

104

are most plasmacytomas associated with clonal proliferations in bone marrow?

no (this would be multiple myeloma)

105

what can many solitary plasmacytomas develop into

malignancies

106

what will be associated with neuroblastomas

rossettes

107

what will be present in nasopharyngeal carcinomas

lymphocytes

108

what type of carcinoma will nasopharyngeal carincoma be

SCC

109
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what is shown above

inflammatory polyps of the nasal cavity

110

what will inflammatory polyps be associated with

inflammaoion of their mucosa of origin and also will have inflammatory changes within those mucosae

111

what do inflammatory polyps look ilke

edematous, boggy swelling

112

where do most nasal polyps originate

internal nose

113
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what's going on with this guy

nasal polyps

114

what are two necrotizing upper airway lesions

wegener granulomatosis

lethal midline granuloma

115

are necrotizing upper airway lesions minor ailments

no, very serious, often fatal

116

what cells are lethal midline granulomas thought to be a malignant tumor of

natural killer cells

117
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what is shown here

necrotizing upper airway lesion

118

what are the two types of papillomas in the upper airway

papilloma and inverted papilloma

119

where is the only part of the body that harbors inverted papillomas

uppper airway

120

is a papilloma or inverted papilloma more likely to become a malignancy

inverted

121
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what is this here

inverted papilloma

122
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what is this

angiofibroma

123

how would you prove that an angiofibroma does have BVs involved

factor VIII stain (will stain endothelial cells that those BVs will have)

124
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what is this

plasmacytoma

125

what is a plasmacytoma

proliferation of plasma cells, which often look classically like normal plasma cells

126

what are the four features of normal plasma cells

...

127

what are two things that plasmacytomas wil ALL with time become and express

multiple myelomas and express monoclonal gammopathy

128
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what is this

rosette

129
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what is this

neuroblastoma/olfactory ethesioneuroblastoma

130

are esthesioneuroblastomas of the olfactory nerve common

no, very rare (may have rosettes, like any other neuroblastoma)

131
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what is this

nasopharyngeal carcinoma

132

what do nasopharyngeal carcinomas look like usually

half carcinoma and half lymphoma

133
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what is this

normal vocal cords

134

what types of tumors of the vocal cords exist

supraglottic and infraglottic tumors

135
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what do we have here

laryngitis

136

what are the four cardinal signs of acute inflammation grossly

red, swollen, edematous, ...?

137

what are the tumors of the vocal cord

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polyps
papillomas
carcinomas

138

are singer's nodes tumors

not really

139

can the true neoplasms of the vocal cords be distinguished grossly

no, usually just histologically

140
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any guesses

polyp or singer's node

141
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what is this

papilloma (maybe cancer microscopically)

142

what do vocal cord carcinomas usually look like

card image

ulcerated, irregular, indureated, invasive, destructive, and with secondary necrosis

143
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what are the huge cells under the stratified squamous mucosa??

what is the black stuff and why is it used?

malignant, invasive, squamous cells

india ink; if surgical margins are not free of tumor cells, then the doctor didnt get it all

144
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whats going on here

otitis externa

145

what types of things infect the outer ear

anything that infects the skin

146
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what is this

tympanic membrane

147
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what's going on here

middle ear infection

148

what types of things infect the midle ear most commonly

strep
h. flu (under 2)
moraxella

149
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what is this

chronic serious otitis media

150
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what is gonig on here

cerumen impaction!

151

what is the most commmon cause of ear abnormality and/or cause of decreased hearing

cerumen impaction

152

what is otosclerosis

abnormal bone deposition between the footplate of the stapes and oval window

153

what is otosclerosis one of the most common forms of

conduction hearing loss

154

when does otosclerosis start

middle age, progresses bilaterally often

155
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what is this

branchial cleft cyst

156

do branchial cleft cysts become inflamed? malignant?

yes

no

157
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what is this

thyroglossal duct cyst

158
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what is this if you find it on the midline of someone, bulging outward

thyrogossal duct cyst

159

what regulates the blood pressure in the carotid artery

carotid sinus

160

what regulates the blood chemistry (O2 and CO2 and pH and temp) in the carotid artery

carotid body

161

what can the carotid body have

carotid body tumors

162
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what is this and what are they called

carotid body tumor

zellballen

163

if you have a salivary gland that looks like pancreatic tissue, but there are no islets, what do you ahve

parotid gland

164

if you have a 100% mucinous salivary gland, which is it

sublingual gland

165

if you have a salivary gland that is both serous and mucnous, what gland is it

submandibular gland

166
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what is this condition and how do you know

chronic sialadenitis (probably) due to the squamous metaplasia of an interlobular duct

167
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what is this

mucocele of an accessory salivary gland duct (big cyst filled with mucin and lined by mucinous columnar epithelium, often inflamed and/or squamous metaplastic

168

why would a mucocele of an accessory salivary gland duct get big

if it gets blocked off

169
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what is this

mucocele

170
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what is this

swollen parotid gland

171

what could have caused a swollen parotid gland (assumed until proven otherwise)

mumps

172
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what is this

seminiferous tubule infected by mumps (orchitis)

173

what is the main occupant of the submandibular triangle

submandibular gland

174

what are the most common benign salivary gland tumors

pleomorphic adenoma (mixed tumor)

warthin tumor (papillary cystadenoma lymphomatosum)

175

what are the most common malignant salivary gland tumors

mucoepidermoid carcinoma
adenoid cystic carcinoma

176

what type of tumor are all malignant salivary gland tumors

adenocarcinomas

177

why would a pleomorhpic adenoma be called mixed

it has CT and epithelial tissue

178

are any pleomorhpic adenomas malignant

no

179

what types of wartharin tumors exist

papillary form, cysts, many lymphocytes

180

where do adenoid cystic carcinomas grow

along nerve roots

181
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what type of tumor is thi

pleomorhpic adenoma (mixed tumor)

182

are mixed tumors generally benign or malignant

benign

183

what do pleomorhpic adenomas look like and feel like

round soft cartilage balls

184
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what are theses

papillary cystadenoma lymphomatosum/warthin tumor

185

why are papillary cystadenoma lymphomatosums good names for these tumors

lymphs inside papilla, cyst shown by white area

186
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what is this

mucoepidermoid carcinoma

187

why are mucoepidermioid carcinomas perfect names for the salivary gland malignancy

squamous with cystic spaces and also mucus-y

188

what is the number one malignancy of the salivary gland

mucoepidermoid carcinoma

189
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what is this

adenoid cystic carcinoma

190

where do adenoid cystic carcinomas grow

tumor cells grow along nerve spaces

191

how long do patients live after being diagnosed with adenoid cystic carcinoma

a long time wihtout any treatment, usually die from other causes