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ENT II Flashcards

1
Q

How does otitis media occur?

A

Infection occurs post pharyngitis via the Eustachian tube

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2
Q

What pathogens causes otitis media?

A

Strep. pneumonia or H. Influenzae, also coinfection by viruses. Rarely caused by fungi or Pneumocyctis in HIV+ PTS

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3
Q

What are the clinical characteristics of otitis media?

A

Hyperaemc, opaque and bulging tympanic membrane with limited mobility, may have purulent otorhoea (discharge)

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4
Q

What happens in severe cases of otitis media?

A

Severe cases are associated with destruction of the ossicles

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5
Q

What is tympanosclerosis?

A

Dystrophic calcification of the tympanic membrane or middle ear associated with recurrent cases of otitis media

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6
Q

Explain the pathophysiology of otitis media

A

Viral URTI or allergy → results in Congestion of the respiratory mucosa of the nose, nasopharynx, and Eustachian tube →
Congestion of the mucosa in the Eustachian tube obstructs the isthmus.
Obstruction of the isthmus will cause negative pressure followed by accumulation of secretions secreted by the mucosa of the middle ear.
These secretions have no egress and accumulate in the middle ear space.
Viruses and bacteria that colonize the URT can reach the middle ear via aspiration, reflux or insufflation.
Microbial growth in the middle ear then causes suppuration.

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7
Q

Describe the clinical picture of otitis media

A

-Tubal occlusion: This produces early signs of otitis media. Discomfort, autophony (hearing your own sounds), retracted eardrum (opposite of bulging
-Mild deafness
-Tinnitus (ONLY IN CHILDREN)
-Suppurative infection of the middle ear: fever, severe earache, deafness, congestion and bulging eardrum (pus behind it)

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8
Q

Complications of otitis media (5)

A

Mastoditis
Labyrinthitis
meningitis
Abscess

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9
Q

What is chronic suppurative otitis media? (CSOM)

A

a perforated tympanic membrane and chronic drainage from the middle ear for 2-6 weeks. Chronic suppuration can occur with or without cholesteatoma

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10
Q

What is chronic serous otitis media?

A

Middle ear effusion without perforation that is reported persistent for more than 1-3 months

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11
Q

Gross description of otitis media?

A

Not a common specimen, but may have small fragments of soft/rubbery granulation tissue.

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12
Q

Microscopic/histologic description of otitis media

A
  1. Acute and Chronic inflammatory cells
  2. Haphazard glandular metaplasia with cilia, fibrosis, hemorrhage, foci of calcification (tympanosclerosis), cholesterol granulomas and reactive bone formation.
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13
Q

Explain what cholesterol granulomas are.

A

Foreign body granulomas in response to cholesterol crystals from rapture of red blood cells and breakdown of lipid bilayer in cell membrane, prominent cholesterol clefts

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14
Q

Cholesterol granulomas are associated with what?

A

associated with interference to drainage or ventilation of middle ear space

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15
Q

Cholesterol granulomas are not associated with____________

A

Cholesteatomas

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16
Q

What is the differential diagnosis of otitis media?

A

Middle ear adenoma: regular, not haphazard glands, no cilia

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17
Q

What is a cholesteatoma?

A

Benign, non-neoplastic destructive lesion in the middle ear or mastoid

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18
Q

what do cholesteatomas involve

A

May involve the medial external canal with potential destruction of the surrounding structures

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19
Q

What structures can be invaded by the cholesteatoma?

A

Bone, ossicular chain, erosion into the external ear canal, and cranial cavity

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20
Q

Cholesteatomas are usually bilateral T/F

A

F. They are usually unilateral

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21
Q

Describe cholesteatomas histologically

A

Accumulation of non-keratinizing squamous epithelium and keratinous debris, with stromal fibrosis and associated inflammatory reaction

-Leads to destruction of adjacent structures e.g bone

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22
Q

What are the complications of untreated cholesteatomas? (3)

A

infected
lead to conductive hearing loss
intracranial mass : complications

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23
Q

What is the aetiology of acquired cholesteatoma?

A

it is caused by recurrent otitis media, traumatic or iatrogenic tympanic membrane perforation

24
Q

Where does acquired cholesteatoma usually occur?

A

It usually occurs in the posterior superior portion of the middle ear, in the posterior epitympanic (pars flaccida) , and in the posterior mesotympanic (posterior superior quadrant of the pars tensa)

25
What is the aetiology of congenital cholesteatoma?
Persistent epidermoid: The squamous epithelium of mucosa of the middle ear of the fetus fails to be reabsorbed after 15 weeks of gestation, which leads to the formation of congenital cholesteatomas
26
where can congenital cholesteatomas be found?
Superior anterior middle ear, possibly in the area of tensor tympani
27
Clinical presentation of cholesteatoma
-History of chronic otitis media is present in most include expansile pearly cyst within the middle ear or mastoid cavity -Pathophysiology is likely multifactorial and remains controversial -Treatment is surgical but may recur locally
28
Complications of untreated cholesteatoma:
infected lead to conductive hearing loss intracranial mass : complications
29
Anterior triangle differentials for swellings in the neck:
Enlarged lymph node Thyroglossal cyst Thyroid pathology Carotid body tumour Sternocleidomastoid tumour Submandibular salivary gland swelling Goiter Parathyroid gland masses
30
Posterior triangle differentials for swellings in the neck
Enlarged lymph nodes Cystic hygroma Zenker's diverticulum
31
List causes of cervical lymphadenopathy
Malignancy Infection (e.g TB) Autoimmune disease eg Sarcoidosis Iatrogenic e.g.e dye for sentinel lymph node Reactive hyperplasia
32
Explain malignancy as a cause of cervical lymphadenopathy
(e.g., lymphomas) Primary neoplasms of lymph nodes/metastatic. An enlarged supraclavicular lymph gland commonly indicates intra-abdominal or thoracic disease. This gland is called Virchow’s gland; its presence is Troisier’s sign. Children: enlarged supratrochlear LN Significant
33
what is a thyroglossal cyst?
Portion of the thyroglossal gland that remains patent
34
where is the thyroglossal duct found?
Between isthmus of the thyroid gland and hyoid bone, and just above the hyoid bone
35
How does a thyroglossal cyst present?
Presents as a midline swelling: Painless prominent lump. Common in females, no systemic symptoms
36
Describe the histological appearance of a thyroglossal cyst
contains an epithelial lining of squamous or pseudostratified ciliated columnar epithelium and ectopic thyroid gland tissue in the duct wall.
37
What malignancy is associated with thyroglossal cyst?
TGD-associated malignancy is rare, and the majority is papillary thyroid carcinoma (PTC).
38
What is a branchial cyst?
Remnant of the second and third branchial cleft
39
Where is a branchial cyst found?
Behind the anterior edge of the upper third of the sternomastoid muscle. between 5-10 cm long
40
How does a branchial cyst look like?
Filled with golden yellow fluid and shimmers with fat globules and cholesterol crystals
41
Age group commonly affected by branchial cyst
15-25 y/o
42
Define fistula and sinus tract
Fistula: An abnormal connection between two epithelium-lined surfaces. ● Sinus tract: an abnormal channel that originates or ends in one opening
43
histology of branchial cleft cyst
Lining of the cyst is usually a stratified squamous epithelium  or columnar ciliated epithelium Often there are marked inflammatory changes and the epithelium overlying the lymphoid tissue is attenuated/absent
44
What is a carotid body tumour?
Rare tumour of the chemoreceptor tissue in the carotid body
45
where is a chemodectoma found?
Lateral neck swelling: upper part of the anterior triangle of the neck, level with the hyoid bone and beneath the anterior edge of the sternomastoid muscle
46
describe a chomedectoma
Size : Vary from 2–3 cm to 10 cm in diameter. ● Solid and hard, dull to percussion and do not fluctuate, Sometimes they pulsate.
47
In a chemodectoma, what are important points that you can look out for during history taking? (3)
Between the ages of 40 and 60 years. Benign, painless and slow growing lump Symptoms of transient cerebral ischemia
48
What is a cystic hygroma?
Congenital collection of lymphatic cysts in underdeveloped lymphatic channels that contain clear, colourless lymph
49
What is a typical feature of cystic hygromas?
Translucence
50
Where are cystic hygromas normally found?
● Commonly occur near the root of the arm and the leg.
51
Describe iatrogenic cystic hygroma
Found around the base of the neck, usually in the posterior triangle. ● Diffuse swelling, not tender, not hot & normal skin.
52
What is a cervical rib?
It is an additional rib that is found from lower cervical vertebra and is adherent to the first rib by fibrous bands
53
What are the implications of a cervical rib?
narrowing of the thoracic outlet, compression : ○ Subclavian artery ○ Brachial plexus.
54
Pharyngeal pouch (Zenker's diverticulum)
‘Pulsion’ diverticulum of the pharynx between the cricopharyngeus muscle below and the lowermost fibres of the inferior constrictor muscle above.
55
Microscopic features of Zenker's diverticulum
Microscopic evaluation of the pouch usually shows a sac containing stratified squamous epithelium, and the submucosa lining often shows fibrous tissue. Rarely, ulcerations or evidence of cancer, squamous cell or carcinoma in situ, may be present.
56
Important history taking points for Zenker diverticulum
○ Long history of halitosis ○ regurgitation of froth and undigested food. ○ It can be compressed and sometimes emptied with gurgling sounds

ANATPATH (19 decks)

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