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Otolaryngology > Adenotonsillar disease and malignancy > Flashcards

Adenotonsillar disease and malignancy Flashcards

1
Q

What is the most common cause of sleep apnoea in children?

A

Obstructive adenotonsillar hypertrophy

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2
Q

Describe the growth of tonsils after birth

A

Tonsils and adenoids continue to grow from birth to 12 years of age, with the greatest increase in size during the ages of 2 and 8

During this period of time, the disproportionate growth of the adenoids and tonsils compared to the skeletal boundaries results in a relatively narrower upper airway

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3
Q

Describe the growth of tonsils after birth in adenotonsillar hyperplasia

A

During this period of time, the disproportionate growth of the adenoids and tonsils compared to the skeletal boundaries results in a relatively narrower upper airway

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4
Q

How will adenoid hyperplasia present?

A
  • Obligate mouth breathing
  • Hyponasal voice
  • Snoring and other signs of sleep disturbance
  • AOM/OME
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5
Q

How will tonsillar hyperplasia present?

A
  • Snoring and other signs of sleep disturbance
  • Muffled voice
  • Visibly enlarged tonsils without symptoms means nothing
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6
Q

How will adenotonsillar hyperplasia managed?

A

Removal of the tonsils and adenoids is indicated if there is recurrent or persistent obstructive or infectious symptoms related to adenoid hypertrophy

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7
Q

What is meant by apparent tonsillar enlargement?

A

Tonsil is displacement medially by PTA or parapharyngeal space mass

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8
Q

What are some non-neoplastic causes of true unilateral tonsillar enlargement?

A
  • Acute or chronic infective
  • Hypertrophy
  • Congenital
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9
Q

What are some neoplastic causes of unilateral tonsillar enlargement?

A

Benign papillomas
Lymphoma
Squamous cell carcinoma

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10
Q

What are some chronic infective causes of unilateral tonsillar enlargement?

A
  • Tubercular tonsillitis
  • Actinomycosis
  • Congenital syphilis
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11
Q

What are some congenital causes of unilateral tonsillar enlargement?

A
  • Teratoma
  • Hemangioma
  • Lymphangioma
  • Cystic hygroma
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12
Q

How is unilateral tonsillar enlargement investigated?

A

Rule out malignancy - CT, PET scan

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13
Q

What are some cancers affecting the head and neck?

A

Squamous cell carcinoma
Nasopharyngeal carcinoma
Laryngeal carcinoma
Oropharyngeal carcinoma
Oral cavity carcinoma

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14
Q

What are some risk factors for developing squamous cell carcinoma?

A
  • Smoking
  • Alcohol
  • HPV type 16
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15
Q

How does HPV type 16 cause squamous cell carcinoma?

A

Produces proteins E6 and E7 which disrupt p53 and RB pathways respectively, leading to cellular immorality

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16
Q

What are some associations with nasopharyngeal carcinoma?

A

South China
EBV

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17
Q

What are some associations with laryngeal carcinoma?

A

Cigarettes
Alcohol

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18
Q

What are some associations with oropharyngeal carcinoma?

A

HPV (In the West)

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19
Q

What are some associations with oral cavity carcinoma?

A

South Asia
Chewing tobacco

20
Q

Describe the histology of SCC

A
  • Depends on grading of tumour
  • Well differentiated - epithelial cells with keratinisation and prickle cells
  • Poorly differentiated - lacks these characteristics
21
Q

Where do supra-glottic tumours drain to?

A

Superior deep cervical nodes

22
Q

Where do glottic tumours drain to?

A

95% stay on the cords

23
Q

How do glottic tumours (On cords) present?

A

voice changes/airway obstruction

24
Q

Where do sub-glottic tumours drain?

A

Paratracheal nodes

25
Q

What are some symptoms of head and neck cancer?

A
  • Dysphonia
  • Dysphagia
  • Odynophagia
  • Unilateral otalgia
  • Neck lump
  • Stridor and obstruction
26
Q

How is head and neck cancer diagnosed?

A
  • US + FNA
  • Confirm with panendoscopy and biopsy under general anaethesic (Direct laryngoscopy, tracheoscopy, oesophagoscopy)
27
Q

What are soem staging investigations required in head and neck cancer?

A
  • CT neck - lymph nodes, larynx
  • CT chest - staging e.g. looking for metastasis or second primary tumour
  • MRI - nasopharynx and tongue base
  • PET - metastases
28
Q

What are some symptom control strategies in head and neck cancer?

A

Pain management
Rehydrate
Improve oral intake if necessary (may need admission)

29
Q

How is early (T1/T2) stage laryngeal cancer managed?

A
  • Transoral laser surgery
  • Radiotherapy
  • 90% 5-year survival
30
Q

How is advances (T3/T4) stage laryngeal cancer managed?

A
  • Partial or total laryngectomy - often curative
  • Chemo and radiotherapy
31
Q

How is lymph node metastasis managed in laryngeal cancer?

A

In both cases will need treatment, either chemo/radiotherapy or surgery

32
Q

How is early (T1/T2) stage oropharyngeal cancer managed?

A
  • Transoral laser surgery
  • Radiotherapy
  • 90% 5-year survival
33
Q

How is advanced (T3/T4) stage oropharyngeal cancer managed?

A

Chemo and radiotherapy

34
Q

How is lymph node metastasis in oropharyngeal cancer managed?

A

Chemo/radiotherapy or surgery

35
Q

How is nasopharyngeal cancer managed?

A

Treatment is with (chemo) radiotherapy

36
Q

What is the prognosis for nasopharyngeal cancer?

A

stage 1 is 100%, stage 4a is 67% = 5-year survival

37
Q

What is a paraganglioma?

A

Tumours arising in clusters of neuroendocrine cells dispersed throughout the body

38
Q

What are some genetic syndromes that can cause paragangliomas?

A

MEN2, von Hippel-Lindau syndrome, neurofibromatosis type 1

39
Q

Where do paragangliomas of the sympathetic system affect?

A

Generally arise in paraganglia below the level of the neck

Paravertebral - organ of Zuckerkandl, rarely bladder

40
Q

Where do paragangliomas of the parasympathetic system affect?

A

Related to great vessels of the head and neck

Carotid bodies, aortic bodies, jugulotypanic ganglia, ganglia nodosum of vagus and clusters around oral cavity, nose, nasopharynx, larynx and orbit

41
Q

Describe the histology of paragangliomas

A

Nests of round/oval cells surrounded by delicate vascular septae

42
Q

How sympathetic paragangliomas present?

A

Features of catecholamine excess e.g. such as headaches, palpitations, diaphoresis and hypertension

43
Q

How do parasympathetic paragangliomas present?

A

Present more commonly with mass effects such as cranial nerve palsies, a neck mass or tinnitus

44
Q

What are some investigations required in paraganglioma?

A

CT, MRI, MIBG, PET

45
Q

How are paragangliomas managed?

A

Surgical resection or radiotherapy

46
Q
A

Otolaryngology (23 decks)

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