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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
4 Causes of peripheral vertigo
1. benign paroxysmal 1. vestibular neuritis 1. meniere's diz 1. otosclerosis
26
3 causes of central vertigo
1. vestibular migraine 1. cerebrovascular diz 1. cerebellopontine angle & posterior fossa meningioma
27
define vertigo
patient feels as though they are moving when they are not
28
full neurologic exam is recommended for which patients w/C/C of dizziness?
orthostatic dizziness w/no hypotension
29
positive head-impulse
* head thrust 10 degrees right, then left, patient gaze at your nose * saccades = **peripheral** * no movemnt of eyes = **central**
30
How can nystagmus differentiate peripheral or central vertigo?
* peripheral: worse in the direction of gaze * central: spontaneous w/horizontal or torsional movemnt
31
positive Dix-Hallpike
transient upbeat-torsional nystagmus during maneuver (positive for benign paroxysmal positional vertigo)
32
4 structures involved in peripheral vertigo?
1. semicircular canals 1. saccule 1. utricle 1. vestibular nerve
33
population affected by vestibular neuritis
30-50 yo M=F
34
vestibulr neuritis is typically caused by
viral infection
35
4 sx of vestibular neuritis
1. oscillopsia (obj moving in visual field) 1. nausea 1. horizontal rotating spontaneous nystagmus (on non-affected side) 1. abnomral gait (falls)
36
Vertigo Rx classes (3)
1. antiemetic 1. antihistamine 1. benzodiazepines (antiemetics & antihistamin for <4 days)
37
Meniere's diz sx (3)
1. N/V 1. loss of balance 1. hearing loss (**worse during attack**)
38
Structures involved in central vertigo (central vestibular system)
1. vestibular nuclei 1. cerebellum 1. brainstem 1. spinal cord 1. vestibular cortex
39
central vertigo sx
1. disequilibrium 1. ataxia
40
why must central vertigo be treated urgently?
impending cerebrovascular event (w/o focal neuro signs)
41
What is the most highly sensitive & specific test in identifying stroke in patients w/acute vestibular syndrome?
HINTS examination (superior to MRI in r/o stroke)
42
HINTS exam
* **h**ead-impulse * **n**ystagmus * **t**est of **s**kew
43
MC cause of episodic vertigo in children
vestibular migraine
44
dx criteria: vestibular migraine
5 episodes that last 3 days hx of migraines migraine + 50% vestibular signs
45
occlusions of which arteries to which structures can cause vertebrobasilar ischemia?
1. brainstem 1. cerebellum 1. inner ear
46
Vertebrobasilar ischemia (vertigo) sx (4)
1. clumsiness 1. diplopia 1. dysarthria 1. weakness
47
bell palsy secondary causes (5) (primary = idopathic)
1. trauma 1. infection 1. tumor 1. DM 1. sarcoidosis
48
MC location for branchial cysts
anterolateral neck
49
Why is a branchial cyst is aka lymphoepithelial cyst?
Lined w/squamous epithelium, surrounded by lymphoid tissue
50
compare the cellularity of branchial and thyroglossal cysts
branchial: squamous + lymphoid tissue (top image) thyroglossal: squamous + repiratory epithelium + thyroid follicle
51
Branchial cysts arise from which embryologic structure?
second branchial pouch

Pulmonology - OMS 2 (28 decks)

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