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Resp II > ENT path > Flashcards

ENT path Flashcards

1
Q

sinonasal respiratory mucosa epi

A

3 types:
ciliated pseudostratified columnar
mucin-containing goblet cells
basal (reserve cells)

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2
Q

sinonasal respiratory mucosa lamina propria

A

prominant vascularity

subepi seromucosous glands

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3
Q

coryza

A

common cold

profuse catarrhal discharge

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4
Q

most common cause of common cold

A

rhinoviruses

picornaviruses, enteroviruses

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5
Q

other causes of cold

A 
adenovirus
echoovirus
cornavirus
parainfluenza
respiratory synctial
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6
Q

chronic rhinits

A

> 1month
usually older then 20
may have anatomical abnormalities
bacterial infection may be superimposed

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7
Q

nasal plyps

A

can be caused by recurrent attacks of rhinitis
sugests allergies
most patients are not atopic
usually 3-4

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8
Q

complications of nasal polyps

A

obstruction

secondary bacterial infection

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9
Q

empyema of sinus

A

pus collection

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10
Q

mucocele of sinus

A

mucus accumulation, no bacterial involvement

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11
Q

acute rhinosinuitis

A

<4wks

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12
Q

subacute rhinosinuitis

A

4-12wks

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13
Q

chronic rhinosinuitis

A

> 12wks
recurrent acute: 5-10%
obstructive 70-80%
fungal 10-15%

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14
Q

serious complications of sinuitis

A

spread to orbit
osteomyelitis
cranial vault extension
septic thrombophlebitis of dural venous sinus

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15
Q

ARS

A

acute sinusitis

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16
Q

AVRS

A

acute viral sinusitis

associated w/common clod <7days

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17
Q

ABRS

A 
acute bacterial sinusitis
complicated .5-2% of AVRS
strep pneumoniae
H. influenza
morzxella catarrhalis (kids)
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18
Q

ARBS suggested by

A

presence of symptoms for seven or more days
symptoms initially improve then worsen
sinusitis associated w//dental disease

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19
Q

chronic obstructive sinusitis anatomic risk factors

A 
deviated septum
trauma
foreign body
sinonasal mass/neoplasm
previous sinus surgery
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20
Q

chronic obstructive sinusitis medical/genetic risk factors

A 
ASA triad
immunodeficiency
immotile cilia snydrome
cystic fibrosis
DM
ICU
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21
Q

chronic obstructive sinusitis enviromental/allergic risk factors

A 
allergic rhinitis
nonallergic rhinitis
microorganisms
sick building syndrome
smoking/pollutants
dry indoor heating
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22
Q

ASA triad

A

aspirin induced chronic rhinosinusitis, nasal polyps, and severe bronchial asthma

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23
Q

immotile cilia snydrome

A

kartagener syndrome
defective ciliary action
situs inversus

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24
Q

chronic obstructive sinusitis bacterial etiology

A 
staph aureus 50%
gram neg rods 20%
H. influenza
group A strep
strep pneumoniae
cornebacterium diptheriae
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25
Q

allergic mucus

A

clinical- recurrent sinusitis, nasal polyps
histo- Eos, charcot leyden crystals
Tx- surgical debridement, steroids

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26
Q

allergic fungal sinusitis

A

clinical- recurrent sinusitis, nasal polyps
histo- Eos, charcot leyden crystals with fungi
Tx- surgical debridement, steroids

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27
Q

fungus ball

A

aka mycetoma
clinical- mass lesion by x-ray
histo- fungal organisms scant mucous, little inflammation
Tx- surgical debridement

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28
Q

invasive fungal sinusitis

A

clinical- severe sinusitis, neuro deficits
histo- fungal organisms invading tissues and vessels
Tx- surgical debridement, anti-fungals

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29
Q

vascular necrotizing lesions

A

granulomatosis w/polyangitis (wegners)
churg-strauss syndrome
cocaine

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30
Q

infectious necrotizing lesions

A

rhinocerebral mucormycosis

hasen disease

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31
Q

malignant necrotizing lesions

A

squamous cell carcinoma
adenocarcinoma
lymphomas

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32
Q

misc. necrotizing lesions

A

sarcoidosis
relapsing polychondritis
idiopathic midline destructive disease

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33
Q

rhinocerebral mucromycosis

A

doesn’t pick up on silver stain, can be missed, seen on H&E
saprophytic mold fungi mucor
irregular shaped hyphae that have few or no septa
usually uncontrolled DM due to high Fe

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34
Q

nasopharyngeal angiofibroma (NA) epidemiology

A

rare, <1% of head and neck tumors
young males
10-20yrs

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35
Q

symptoms of NA

A

unilateral nasal obstuction and epistaxis

can have swelling of face, eye, cheek

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36
Q

clinical behavior of NA

A 
posterolateral wall 
fibromuscular stroma origin
benign, but 10-20% locally agressive
9% fatal
have androgen Rs and may resolve w/age
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37
Q

NA Tx

A

surgery
hemorrhagic complications not uncommon
requires pre-op arteriogram w/presurgical emolization

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38
Q

NA Px

A

excellent after removal, recurrence 5-25%

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39
Q

sinonasal papillomas

A

aka schneiderian papillomas
benign neoplasm
derived from embryologic schneiderian memebrane

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40
Q

sinonasal papillomas Symptoms

A

epistaxis, nasal obstruction, asymptomatic mass, located in sinonasal tract

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41
Q

types of sinonasal papillomas

A

exophytic 50-60%
inverted 40-50%
oncocytic (5-10%)

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42
Q

squamous papilloma

A

arises in squamous mucosa

more common then sinonasal mucosa tumors

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43
Q

exophytic sinonasal papilloma aka

A

septal
squamous
fungiform

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44
Q

exophytic sinonasal papilloma

A 
on septal nasal wall >90%
20-50yr;4-10M:1F
HPV in 60%
recurrence 25% 
rarely develops invasive carcinoma
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45
Q

inverted sinonasal papilloma

A

lat nasal wall near middle turnbinate or sinus
40-70yrs
2-5M:1F
recurrence 15%
5-10% develop invasive carcinoma w.in 5 yrs

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46
Q

oncocytic sinonasal papilloma aka

A

cylindrical, columnar

47
Q

oncocytic sinonasal papilloma

A 
lat nasal wall near middle turbinate
>50 yr
1M:1F
recurrence 25-35%
some develop invasive carcinoma
onocoyte= abundent bright pink cyto due to mitochondria
48
Q

olfactory neuroblastoma aka

A

esthesioneuroblastoma

49
Q

olfactory neuroblastoma

A 
arises from neuroendocrine cells in olfactory mucosa
neurosectreotry membrane bound granules
numerous IHC markers
average age 15 and 50
small blue cell tumors
50
Q

olfactory neuroblastoma IHC markers

A

NSE- neuron specific enylase (not specific)
SY- synaptophysin
CgA
CD56(NCAM)

51
Q

olfactory neuroblastoma symptoms

A 
extensive polypoid mass
obstruction
epistaxis
anosmia
visual disturbances
52
Q

olfactory neuroblastoma Tx

A

surgery
radiation
chemo

53
Q

olfactory neuroblastoma survival

A

40-90%

54
Q

nasopharynx

A

60% NK squamous

40% respiratory epi

55
Q

orapharynx and laryngopharynx

A

100% NK squamous

56
Q

secondary disorders to lymphoid hyperplasia

A 
obstruction
sleep apnea
recurrent otitis media
difficult to arouse
daytime sleepiness
poor attention span
poor school performance
snoring
57
Q

pertusis

A

aka whooping cough
extremely small gram neg cocoobacilli
spread vis resp droplets
attaches to pharyngeal and tracheal surfaces

58
Q

pertusis vaccine

A

DTaP

aP- acellular pertusis

59
Q

pertusis Dx

A

nasopharyngeal swab for culture and PCR or serology

60
Q

pertusis stage 1

A

catarrhal phase
indistuinguishable from common cold
most infectious here

61
Q

pertusis stage 2

A

paroxysmal phase
paroxysms of intense cough
posttussive vomiting and turning red
infants <6months no characteristic whoop, but may have apneic episodes

62
Q

pertusis stage 3

A

convalenscent phase

chronic cough which may last for wks

63
Q

nasopharyngeal carcinoma Histo types

A

keratinizing- squamous cell carcinoma
nonkeratinizing- squamous cell carcinoma
undifferentiated- carcinoma, w/lymphoid component

64
Q

EBV-related nasopharyngeal carcinoma

A

ususally undifferentiated type
africa- children
s. china- adults
US-rare

65
Q

environment-related nasopharyngeal carcinoma

A

diet- nitrosamines

smoking

66
Q

nasopharyngeal carcinoma survival

A

70% metastasized at diagnosis

60% survival rate after radiation

67
Q

NUT Midline carcinoma

A

mostly mediastinum
highly aggressive (survival 7mo)
appearance of similar nasopharyngeal and squamous cell carcinoma
BRD4/3-NUT fusion gene

68
Q

acute pharyngitis

A 
'beefy red'
usually due to:
adenovirus
HSV
EBV
CMV
some bacterial- strep
69
Q

Group A Strep stats

A

10-20% of 5-15 yr olds
rare in adults
winter-early spring

70
Q

GAS symptoms

A 
sore throat +fever
strawberry tounge
absence of cough, coryza, conjunctivitis
HA, nausea, vomiting, ab pain
tender ant cervical lymph nodes
tonsils enlarged, erythamatous, patchy exudate
71
Q

fuso bacterium necrophorum

A

filamentous, anaerobic, gram - rod
part of pharyngeal normal flora
potent endotoxin production turns it pathogenic
10% acute pharyngitis cases
>20% in recurring cases an peritonsilar abscesses
lemierre syndrome

72
Q

lemierre syndrome

A

jugular v w/thrombophlebitis accompanying abscess

73
Q

C. diptheriae

A

humans only known reservoir
non-spore forming gram + rod
only strains w/Tox gene cause diptheriae
gene encoded w/in lysogenic bacteriophage

74
Q

diptheriae clinical

A

sudden onset of exudative pharyngitis that rapidly worsens
production of pseudomembrane
vaccinated w/DTaP, rare

75
Q

rhinoviruses

A

indirect pharyngitis

grow in nasal mucous membranes and causes swelling of membranes in area and pharynx

76
Q

adenoviruses

A

grow in pharyngeal mucosa

can casue pharyngoconjunctival fever

77
Q

EBV

A

infectious mononucleosis
mainly in 15-25
can develop lymphadenitis and hepatosplenomegaly
monospot test for heterophile Abs

78
Q

HSV types 1 and 2

A

gingivitis, stomatitis, and pharyngitis, vesicles in pharyngeal mucosa
cause pain in nn endings -> spread to ganglia and into sensory and autonomic nn

79
Q

influenza

A

pharyngitis component of the flu

80
Q

CMV and HIV

A

mononucleosis type illness in acute infection

81
Q

epiglotitis

A

infection, trauma, chemical irritation
obstruction of airflow
used to be caused by H. influenza type b in kids, but vaccinations make rare
more common in adult males, but rare

82
Q

acute larynx

A

<3wks

in children may lead to life threatening laryngoepiglottitis

83
Q

acute laryngitis causes

A 
viruses >90% (rhino, parainfluenza, RSV, adenoviruses)
bacterial causes (H. influenza, s. pneumonia)
84
Q

croup aka

A

laryngotracheitis

larygoracheobronchitis

85
Q

croup

A 
mainly affects larynx and trachea, occasionally bronchi
3m-5yr
acute onset, usually march-april
most common cause of inspiratory stridor
seal-like bark
86
Q

cause and Tx of croup

A

mainly parainfluenza

anti inflammatories

87
Q

xray croup

A

steeple/bottle sign

88
Q

reinke edema aka

A

polypoid corditis

89
Q

reinke edema

A

middle aged females who are heavy smokers
can also occur w/heavy recurrent voice strain
develop husky low pitched voices
reversible

90
Q

vocal cord nodules and polps

A

reaction to injury of vocal cord
hyperkeratosis
increased myxoid stroma
at jnx of ant and middle third of cord

91
Q

nodules vs polyps

A

nodules- bilateral small

polyp unilateral larger

92
Q

vocal cord papilloma

A

benign neoplasms located on true vocal cards
soft raspberry like exrcesceneces
single in adults, but can be recurrent
linked to HPVS

93
Q

juvenile papilomatosis

A

multiple papillomas in children
rarely progress to malignanacy, usually regress at puberty
linked to HPV

94
Q

squamous cell carcinoma of larynx

A

prolonged hoarseness >6wks, is earliest most consistent symptom
dysphagia shortness of breath and other evidence of airway obstruction
palpable cervical nodes 10-20% at the time

95
Q

epidemiology of squamous cell carcinoma of larynx

A 
unusually <50, peaks 65-74
5M:1F 2B:1W
90% smokers
alcohol abuse
irradiation, asbestos, HPV
96
Q

premalignant changes and invasice carcinoma

A

hyperplasia -> hyperkeratosis -> dysplasia -> carcinoma in situ -> cancer

97
Q

location of laryngeal carcinoma

A

glottic 50-60%
supraglottic 30-40% (discovered later)
subglottic
transglottic

98
Q

laryngeal carcinoma sruvival

A

glottic- 5 yr 65%

supraglottic 5 yr 45%

99
Q

otitis externa

A

7-12
swimmers ear
bacterial 90%
fungal 10%

100
Q

otitis externa bacterial

A

pseudomonas
staphylococcus
gram-neg rods

101
Q

otitis externa fungal

A

asprgillus

candida

102
Q

middle ear histo

A

thin non keratinizing stratified squamous epi

103
Q

cholesteatoma

A

squamous epi trapped w/in temporal bone
usually secondary from injury to tympanic membrane
may errode ear bones and soft tissue or from visible neck mass
must be surgically excised

104
Q

complications of cholesteatoma

A 
hearing loss
facial n paralysis
labrynthitis
meningitis
epidural or brain abscess
105
Q

acute otitis media

A

acute onset, eustachian tube blocked

most frequent specific diagnosis of febrile children

106
Q

acute otitis media bacteria

A

S. pneumonia
H. influenza
M. Catarrhalis

107
Q

chronic otitis media bacteria

A

psuedomoas aeurginosa

s. aureus

108
Q

chronic otitis media long term sequllae

A 
perforated tympanic membrane
scarring
mastoiditis
bone erosion
cysts 
conductive hearing loss
109
Q

middle ear cysts

A

.5-3cm
2 types:
squamous epithelium with large keratin production
metaplstic columnar epi- mucin secreting

110
Q

otosclerosis

A

50% have FHx
autosomal dominant, variable penetrance
boney overgrowth

111
Q

clinical course otosclerosis

A

begins u/l, 60-80% become b/l
hearing loss late adolescence/young adult
progresses to severe conductive hearing loss

112
Q

carotid body tumor

A 
parasympathetic tumor
increase ventilatory rate
slow growing, painless mass, pulsatile
bruit 
mean age 40s, but rare
50% fatal
113
Q

carotid body familial

A 
5-10%
multiple, b/l
MEN type 2a and 2b
vonHippel Lindau syndrome
neurofibromatosis type 1

Resp II (15 decks)

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