ENT path Flashcards
sinonasal respiratory mucosa epi
3 types:
ciliated pseudostratified columnar
mucin-containing goblet cells
basal (reserve cells)
sinonasal respiratory mucosa lamina propria
prominant vascularity
subepi seromucosous glands
coryza
common cold
profuse catarrhal discharge
most common cause of common cold
rhinoviruses
picornaviruses, enteroviruses
other causes of cold
adenovirus echoovirus cornavirus parainfluenza respiratory synctial
chronic rhinits
> 1month
usually older then 20
may have anatomical abnormalities
bacterial infection may be superimposed
nasal plyps
can be caused by recurrent attacks of rhinitis
sugests allergies
most patients are not atopic
usually 3-4
complications of nasal polyps
obstruction
secondary bacterial infection
empyema of sinus
pus collection
mucocele of sinus
mucus accumulation, no bacterial involvement
acute rhinosinuitis
<4wks
subacute rhinosinuitis
4-12wks
chronic rhinosinuitis
> 12wks
recurrent acute: 5-10%
obstructive 70-80%
fungal 10-15%
serious complications of sinuitis
spread to orbit
osteomyelitis
cranial vault extension
septic thrombophlebitis of dural venous sinus
ARS
acute sinusitis
AVRS
acute viral sinusitis
associated w/common clod <7days
ABRS
acute bacterial sinusitis complicated .5-2% of AVRS strep pneumoniae H. influenza morzxella catarrhalis (kids)
ARBS suggested by
presence of symptoms for seven or more days
symptoms initially improve then worsen
sinusitis associated w//dental disease
chronic obstructive sinusitis anatomic risk factors
deviated septum trauma foreign body sinonasal mass/neoplasm previous sinus surgery
chronic obstructive sinusitis medical/genetic risk factors
ASA triad immunodeficiency immotile cilia snydrome cystic fibrosis DM ICU
chronic obstructive sinusitis enviromental/allergic risk factors
allergic rhinitis nonallergic rhinitis microorganisms sick building syndrome smoking/pollutants dry indoor heating
ASA triad
aspirin induced chronic rhinosinusitis, nasal polyps, and severe bronchial asthma
immotile cilia snydrome
kartagener syndrome
defective ciliary action
situs inversus
chronic obstructive sinusitis bacterial etiology
staph aureus 50% gram neg rods 20% H. influenza group A strep strep pneumoniae cornebacterium diptheriae
allergic mucus
clinical- recurrent sinusitis, nasal polyps
histo- Eos, charcot leyden crystals
Tx- surgical debridement, steroids
allergic fungal sinusitis
clinical- recurrent sinusitis, nasal polyps
histo- Eos, charcot leyden crystals with fungi
Tx- surgical debridement, steroids
fungus ball
aka mycetoma
clinical- mass lesion by x-ray
histo- fungal organisms scant mucous, little inflammation
Tx- surgical debridement
invasive fungal sinusitis
clinical- severe sinusitis, neuro deficits
histo- fungal organisms invading tissues and vessels
Tx- surgical debridement, anti-fungals
vascular necrotizing lesions
granulomatosis w/polyangitis (wegners)
churg-strauss syndrome
cocaine
infectious necrotizing lesions
rhinocerebral mucormycosis
hasen disease
malignant necrotizing lesions
squamous cell carcinoma
adenocarcinoma
lymphomas
misc. necrotizing lesions
sarcoidosis
relapsing polychondritis
idiopathic midline destructive disease
rhinocerebral mucromycosis
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
nasopharyngeal angiofibroma (NA) epidemiology
rare, <1% of head and neck tumors
young males
10-20yrs
symptoms of NA
unilateral nasal obstuction and epistaxis
can have swelling of face, eye, cheek
clinical behavior of NA
posterolateral wall fibromuscular stroma origin benign, but 10-20% locally agressive 9% fatal have androgen Rs and may resolve w/age
NA Tx
surgery
hemorrhagic complications not uncommon
requires pre-op arteriogram w/presurgical emolization
NA Px
excellent after removal, recurrence 5-25%
sinonasal papillomas
aka schneiderian papillomas
benign neoplasm
derived from embryologic schneiderian memebrane
sinonasal papillomas Symptoms
epistaxis, nasal obstruction, asymptomatic mass, located in sinonasal tract
types of sinonasal papillomas
exophytic 50-60%
inverted 40-50%
oncocytic (5-10%)
squamous papilloma
arises in squamous mucosa
more common then sinonasal mucosa tumors
exophytic sinonasal papilloma aka
septal
squamous
fungiform
exophytic sinonasal papilloma
on septal nasal wall >90% 20-50yr;4-10M:1F HPV in 60% recurrence 25% rarely develops invasive carcinoma
inverted sinonasal papilloma
lat nasal wall near middle turnbinate or sinus
40-70yrs
2-5M:1F
recurrence 15%
5-10% develop invasive carcinoma w.in 5 yrs
oncocytic sinonasal papilloma aka
cylindrical, columnar
oncocytic sinonasal papilloma
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
olfactory neuroblastoma aka
esthesioneuroblastoma
olfactory neuroblastoma
arises from neuroendocrine cells in olfactory mucosa neurosectreotry membrane bound granules numerous IHC markers average age 15 and 50 small blue cell tumors
olfactory neuroblastoma IHC markers
NSE- neuron specific enylase (not specific)
SY- synaptophysin
CgA
CD56(NCAM)
olfactory neuroblastoma symptoms
extensive polypoid mass obstruction epistaxis anosmia visual disturbances
olfactory neuroblastoma Tx
surgery
radiation
chemo
olfactory neuroblastoma survival
40-90%
nasopharynx
60% NK squamous
40% respiratory epi
orapharynx and laryngopharynx
100% NK squamous
secondary disorders to lymphoid hyperplasia
obstruction sleep apnea recurrent otitis media difficult to arouse daytime sleepiness poor attention span poor school performance snoring
pertusis
aka whooping cough
extremely small gram neg cocoobacilli
spread vis resp droplets
attaches to pharyngeal and tracheal surfaces
pertusis vaccine
DTaP
aP- acellular pertusis
pertusis Dx
nasopharyngeal swab for culture and PCR or serology
pertusis stage 1
catarrhal phase
indistuinguishable from common cold
most infectious here
pertusis stage 2
paroxysmal phase
paroxysms of intense cough
posttussive vomiting and turning red
infants <6months no characteristic whoop, but may have apneic episodes
pertusis stage 3
convalenscent phase
chronic cough which may last for wks
nasopharyngeal carcinoma Histo types
keratinizing- squamous cell carcinoma
nonkeratinizing- squamous cell carcinoma
undifferentiated- carcinoma, w/lymphoid component
EBV-related nasopharyngeal carcinoma
ususally undifferentiated type
africa- children
s. china- adults
US-rare
environment-related nasopharyngeal carcinoma
diet- nitrosamines
smoking
nasopharyngeal carcinoma survival
70% metastasized at diagnosis
60% survival rate after radiation
NUT Midline carcinoma
mostly mediastinum
highly aggressive (survival 7mo)
appearance of similar nasopharyngeal and squamous cell carcinoma
BRD4/3-NUT fusion gene
acute pharyngitis
'beefy red' usually due to: adenovirus HSV EBV CMV some bacterial- strep
Group A Strep stats
10-20% of 5-15 yr olds
rare in adults
winter-early spring
GAS symptoms
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
fuso bacterium necrophorum
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
lemierre syndrome
jugular v w/thrombophlebitis accompanying abscess
C. diptheriae
humans only known reservoir
non-spore forming gram + rod
only strains w/Tox gene cause diptheriae
gene encoded w/in lysogenic bacteriophage
diptheriae clinical
sudden onset of exudative pharyngitis that rapidly worsens
production of pseudomembrane
vaccinated w/DTaP, rare
rhinoviruses
indirect pharyngitis
grow in nasal mucous membranes and causes swelling of membranes in area and pharynx
adenoviruses
grow in pharyngeal mucosa
can casue pharyngoconjunctival fever
EBV
infectious mononucleosis
mainly in 15-25
can develop lymphadenitis and hepatosplenomegaly
monospot test for heterophile Abs
HSV types 1 and 2
gingivitis, stomatitis, and pharyngitis, vesicles in pharyngeal mucosa
cause pain in nn endings -> spread to ganglia and into sensory and autonomic nn
influenza
pharyngitis component of the flu
CMV and HIV
mononucleosis type illness in acute infection
epiglotitis
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
acute larynx
<3wks
in children may lead to life threatening laryngoepiglottitis
acute laryngitis causes
viruses >90% (rhino, parainfluenza, RSV, adenoviruses) bacterial causes (H. influenza, s. pneumonia)
croup aka
laryngotracheitis
larygoracheobronchitis
croup
mainly affects larynx and trachea, occasionally bronchi 3m-5yr acute onset, usually march-april most common cause of inspiratory stridor seal-like bark
cause and Tx of croup
mainly parainfluenza
anti inflammatories
xray croup
steeple/bottle sign
reinke edema aka
polypoid corditis
reinke edema
middle aged females who are heavy smokers
can also occur w/heavy recurrent voice strain
develop husky low pitched voices
reversible
vocal cord nodules and polps
reaction to injury of vocal cord
hyperkeratosis
increased myxoid stroma
at jnx of ant and middle third of cord
nodules vs polyps
nodules- bilateral small
polyp unilateral larger
vocal cord papilloma
benign neoplasms located on true vocal cards
soft raspberry like exrcesceneces
single in adults, but can be recurrent
linked to HPVS
juvenile papilomatosis
multiple papillomas in children
rarely progress to malignanacy, usually regress at puberty
linked to HPV
squamous cell carcinoma of larynx
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
epidemiology of squamous cell carcinoma of larynx
unusually <50, peaks 65-74 5M:1F 2B:1W 90% smokers alcohol abuse irradiation, asbestos, HPV
premalignant changes and invasice carcinoma
hyperplasia -> hyperkeratosis -> dysplasia -> carcinoma in situ -> cancer
location of laryngeal carcinoma
glottic 50-60%
supraglottic 30-40% (discovered later)
subglottic
transglottic
laryngeal carcinoma sruvival
glottic- 5 yr 65%
supraglottic 5 yr 45%
otitis externa
7-12
swimmers ear
bacterial 90%
fungal 10%
otitis externa bacterial
pseudomonas
staphylococcus
gram-neg rods
otitis externa fungal
asprgillus
candida
middle ear histo
thin non keratinizing stratified squamous epi
cholesteatoma
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
complications of cholesteatoma
hearing loss facial n paralysis labrynthitis meningitis epidural or brain abscess
acute otitis media
acute onset, eustachian tube blocked
most frequent specific diagnosis of febrile children
acute otitis media bacteria
S. pneumonia
H. influenza
M. Catarrhalis
chronic otitis media bacteria
psuedomoas aeurginosa
s. aureus
chronic otitis media long term sequllae
perforated tympanic membrane scarring mastoiditis bone erosion cysts conductive hearing loss
middle ear cysts
.5-3cm
2 types:
squamous epithelium with large keratin production
metaplstic columnar epi- mucin secreting
otosclerosis
50% have FHx
autosomal dominant, variable penetrance
boney overgrowth
clinical course otosclerosis
begins u/l, 60-80% become b/l
hearing loss late adolescence/young adult
progresses to severe conductive hearing loss
carotid body tumor
parasympathetic tumor increase ventilatory rate slow growing, painless mass, pulsatile bruit mean age 40s, but rare 50% fatal
carotid body familial
5-10% multiple, b/l MEN type 2a and 2b vonHippel Lindau syndrome neurofibromatosis type 1
