ENT Pathology 3 - Carcinoma, rhinitis, nasal polyps, diptheria, candidia, sinusitis, Herpes, Flashcards
What is the main type of cancer in ENT?
Squamous cell carcinoma
What are two major risk factors for squamous cell carcinoma of the head and neck? (eg tonsilar carcinoma)
Alcohol and smoking Also increasing age is a risk factor
What is the new cause of head and neck cancers in the young who have never smoke or drank?
HPV associated cancer
What are the three types of non-opoid analgesics?
NSAIDs Anti-convulsants - gabapentin Anti-depressants - amitriptyline
What is the primary treatment of head and neck cancers if not metastasised?
Give surgery + the painkillers
What is the most common cause of rhinitis?
Viral cause is the most common
What is the management pathway of allergic rhinitis?
- Antihistamines
- Topical steroids
- Antihistamines + topical steroids
- Immunotherapy for selected patients with IgE mediated disease is final line
Always remember allergen avoidance throughout
Are leukotriene receptor antagnoist eg montelukast or cromoglycate given in allergic rhinitis?
Leukotrienes can be given, never give cromoglycat as not proven to have effect
What is samter’s triad?
Nasal polyps Salicytate sensitivity (aspirin) And asthma
What should be suspected if a young child presents with nasal polyps?
Suspect cystic fibrosis
What is the treatment of nasal polyps?
If mild to moderate - then intranasal topical corticosteroids If severe then oral followe by intranasal steroids
Which bacteria causes diptheria? What type of vaccine is diptheria vaccine?
Corneybacterium diptheriae It is a toxoid vaccine
What ages are the diptheria vaccine given?
Give at 8 weeks 12 weeks 16 week Do not give at 1year Give again at 3years 4 months Then again at 14 years
What is the membrane colour oroduced across the pharynx in diptheria?
Grey white membrane across pharynx in diptheria - can cause airway obstruction
What is the treatment of diptheria?
Antibiotic therapy - penicillin (erythromycin if en allergic) Also give toxoid vaccine
• White patches on red, raw mucous membranes in throat/ mouth What is this?
Candida - oral thrush
Which bacteria causes this? What in asthmatics can cause this?
Candidia albicans In asthmatics, improper use of inhaler technique can cause this
What is the treatment of oral candidiasis? What medication is recommended if the patient is on meds that could interact with the normally prescribed antifungals?
1st line - miconazole 2nd line - fluconazole Give nystatin as 1st line if any concerns with interactions with fluconazole or miconazole ie warfarin interaction
What sinuses is mostly predisposed to infection causing sinusitis?
The maxillary sinuses as the cilia have to beat against gravity
Most causes of sinusiitis are viral and resolve within 14 days When are antibiotics recommended in acute sinusitis? When are intranasal corticosteroids recommended?
Antibiotics recommended for potential bacterial causes which could be in immunocompromised or causing severe illness NICE CKS recommend that intranasal corticosteroids may be considered if the symptoms have been present for more than 10 days
What is the first line antibiotic for sinusitis? What is the treatment if allergic?
1st line - penicillin V 2nd line (pen allergic) - doxycycline
When is doxcycline not used? What is a known side effect of doxycycline?
Not used in children under 12 as it can cause permanent tooth disclouration Also causes photosensitivity
Young child presents with painful mouth ulcer, swollen and tender lips What is this thought to be? What virus causes it?
Primary gingivostomatitis - caused by herpes simplex virus (HSV)
How is the diagnosis of primary gingivostomatitis confirmed?
Swab of lesion in virus transport medium to lab - viral DNA detected by PCR
