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Pulmonology - OMS 2 > ENT Pathology > Flashcards

ENT Pathology Flashcards

1
Q

What is the difference between leukoplakia, hairy leukoplakia and erythroplakia?

A
  1. hairy leukoplakia: not pre-malignant
  2. leukoplakia: pre-cancerous
  3. erythroplakia: highly pre-cancerous
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2
Q

causes of hairy leukoplakia

A
  1. EBV
  2. HIV
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3
Q

MC location for largyngeal carcinoma (small cell)

A

floor of mouth

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4
Q

MC esophogeal cancer worldwide

A

small cell carcinoma

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5
Q

Define thyroglossal duct cyst

A

cystic dilation of thyroglossal duct remnant anterior neck

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6
Q

Thyroglossal duct cyst physical exam findings

A

anterior neck mass

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7
Q

Vestibular schwannoma (aka acoustic neuroma) is a rare, benign tumor originating from what structure?

A

Schwann cells in the vestibular portion of the eighth cranial nerve in the inner ear

unilateral

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8
Q

vestibular schwannoma (aka acoustic neuroma) sx (5)

A
  1. Hearing loss
  2. tinnitus
  3. vertigo
  4. facial numbness
  5. weakness, or paralysis on ipsilateral side of tumor
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9
Q

Vestibular schwannoma (acoustic neuroma) Dx

A

audiometric testing
MRI: brain and internal auditory canal

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10
Q

vestibular schwannoma/acoustic neuroma tx (non-pharmacologic)

A
  1. microsurgical resection
  2. stereotactic radiosurgery or radiotherapy
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11
Q

Pharmacologic tx: vestibular schwannoma (2)

A
  1. bevacizumab: vascular endothelial growth factor inhibitor
  2. Lapatinib: tyrosinase kinase inhibitor
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12
Q

5 complications of acoustic neuroma/vestibular schwannoma

A
  1. Permanent hearing loss
  2. tinnitus
  3. balance disturbances
  4. facial weakness
  5. headaches
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13
Q

there are grading systems for 2 of the sx of vestibular schwannoma, what are they?

A
  1. tinnitis
  2. dizziness
    (scale I-IV: none, intermittent, persistent moderate, persistent severe)
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14
Q

3 physical exam findings for vestibular schwannoma/acoustic neuroma

A
  1. absent corneal reflex
  2. sensorineural hearing loss (weber & Rinne)
  3. Hitzellberger sign (light touch to back of ear hurts)
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15
Q

vestibular schwannoma/acoustic neuroma typically affects which 2 populations?

A
  1. 65-75
  2. NF2 is bilateral: adolescence
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16
Q

3 DDx: vestibular schwannoma

A
  1. meningioma
  2. epidermoid tumor or inclusion cyst
  3. schwannoma: facial or trigeminal nerve
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17
Q

Which chromosome is NF2 found on?

A

22

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18
Q

What are the key histologic features of vestibular schanomma

A

Antoni A & B areas: dense and loose areas, respectively

(these come together in intersecting fascicles)

Antoni A left, Antoni B right

hyalinized blood vessels also present
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19
Q

Dx? Why?

A

Verocay bodies: palisading of nuclei between “nuclear-free zones” of the vestibular schwanomma

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20
Q

How can cholesteoatomas (1-4 cm) be acquired?

A

ruptured TM –> inflammation & ingrowth of squamous epithelium
(chronic inflammation around keratinous cyst)

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21
Q

What is the main difference between peripheral vs. central vertigo treatment?

A

peripheral = benign
central = urgent treatment req

22
Q

vertigo associated w/unilateral hearing loss suggests which condition?

A

meniere’s diz

(tx: low salt diet + diuretic)

23
Q

When is lab testing & imaging recommended for vertigo?

A

neurological abnormality on phyisical exam

24
Q

tx for vestibular neuritis

A
  1. vestibular rehab
  2. meds
25
Q

4 Causes of peripheral vertigo

A
  1. benign paroxysmal
  2. vestibular neuritis
  3. meniere’s diz
  4. otosclerosis
26
Q

3 causes of central vertigo

A
  1. vestibular migraine
  2. cerebrovascular diz
  3. cerebellopontine angle & posterior fossa meningioma
27
Q

define vertigo

A

patient feels as though they are moving when they are not

28
Q

full neurologic exam is recommended for which patients w/C/C of dizziness?

A

orthostatic dizziness w/no hypotension

29
Q

positive head-impulse

A
  • head thrust 10 degrees right, then left, patient gaze at your nose
  • saccades = peripheral
  • no movemnt of eyes = central
30
Q

How can nystagmus differentiate peripheral or central vertigo?

A
  • peripheral: worse in the direction of gaze
  • central: spontaneous w/horizontal or torsional movemnt
31
Q

positive Dix-Hallpike

A

transient upbeat-torsional nystagmus during maneuver

(positive for benign paroxysmal positional vertigo)

32
Q

4 structures involved in peripheral vertigo?

A
  1. semicircular canals
  2. saccule
  3. utricle
  4. vestibular nerve
33
Q

population affected by vestibular neuritis

A

30-50 yo M=F

34
Q

vestibulr neuritis is typically caused by

A

viral infection

35
Q

4 sx of vestibular neuritis

A
  1. oscillopsia (obj moving in visual field)
  2. nausea
  3. horizontal rotating spontaneous nystagmus (on non-affected side)
  4. abnomral gait (falls)
36
Q

Vertigo Rx classes (3)

A
  1. antiemetic
  2. antihistamine
  3. benzodiazepines

(antiemetics & antihistamin for <4 days)

37
Q

Meniere’s diz sx (3)

A
  1. N/V
  2. loss of balance
  3. hearing loss (worse during attack)
38
Q

Structures involved in central vertigo

(central vestibular system)

A
  1. vestibular nuclei
  2. cerebellum
  3. brainstem
  4. spinal cord
  5. vestibular cortex
39
Q

central vertigo sx

A
  1. disequilibrium
  2. ataxia
40
Q

why must central vertigo be treated urgently?

A

impending cerebrovascular event
(w/o focal neuro signs)

41
Q

What is the most highly sensitive & specific test in identifying stroke in patients w/acute vestibular syndrome?

A

HINTS examination
(superior to MRI in r/o stroke)

42
Q

HINTS exam

A
  • head-impulse
  • nystagmus
  • test of skew
43
Q

MC cause of episodic vertigo in children

A

vestibular migraine

44
Q

dx criteria: vestibular migraine

A

5 episodes that last 3 days
hx of migraines
migraine + 50% vestibular signs

45
Q

occlusions of which arteries to which structures can cause vertebrobasilar ischemia?

A
  1. brainstem
  2. cerebellum
  3. inner ear
46
Q

Vertebrobasilar ischemia (vertigo) sx (4)

A
  1. clumsiness
  2. diplopia
  3. dysarthria
  4. weakness
47
Q

bell palsy secondary causes (5)

(primary = idopathic)

A
  1. trauma
  2. infection
  3. tumor
  4. DM
  5. sarcoidosis
48
Q

MC location for branchial cysts

A

anterolateral neck

49
Q

Why is a branchial cyst is aka lymphoepithelial cyst?

A

Lined w/squamous epithelium, surrounded by lymphoid tissue

50
Q

compare the cellularity of branchial and thyroglossal cysts

A

branchial: squamous + lymphoid tissue (top image)
thyroglossal: squamous + repiratory epithelium + thyroid follicle

51
Q

Branchial cysts arise from which embryologic structure?

A

second branchial pouch

Pulmonology - OMS 2 (28 decks)

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