ENT Pathology 3 - Carcinoma, rhinitis, nasal polyps, diptheria, candidia, sinusitis, Herpes,

Question 1

What is the main type of cancer in ENT?

Answer 1

Squamous cell carcinoma

Question 2

What are two major risk factors for squamous cell carcinoma of the head and neck? (eg tonsilar carcinoma)

Answer 2

Alcohol and smoking Also increasing age is a risk factor

Question 3

What is the new cause of head and neck cancers in the young who have never smoke or drank?

Answer 3

HPV associated cancer

Question 4

What are the three types of non-opoid analgesics?

Answer 4

NSAIDs Anti-convulsants - gabapentin Anti-depressants - amitriptyline

Question 5

What is the primary treatment of head and neck cancers if not metastasised?

Answer 5

Give surgery + the painkillers

Question 6

What is the most common cause of rhinitis?

Answer 6

Viral cause is the most common

Question 7

What is the management pathway of allergic rhinitis?

Answer 7

• Antihistamines
• Topical steroids
• Antihistamines + topical steroids
• Immunotherapy for selected patients with IgE mediated disease is final line

Always remember allergen avoidance throughout

Question 8

Are leukotriene receptor antagnoist eg montelukast or cromoglycate given in allergic rhinitis?

Answer 8

Leukotrienes can be given, never give cromoglycat as not proven to have effect

Question 9

What is samter’s triad?

Answer 9

Nasal polyps Salicytate sensitivity (aspirin) And asthma

Question 10

What should be suspected if a young child presents with nasal polyps?

Answer 10

Suspect cystic fibrosis

Question 11

What is the treatment of nasal polyps?

Answer 11

If mild to moderate - then intranasal topical corticosteroids If severe then oral followe by intranasal steroids

Question 12

Which bacteria causes diptheria? What type of vaccine is diptheria vaccine?

Answer 12

Corneybacterium diptheriae It is a toxoid vaccine

Question 13

What ages are the diptheria vaccine given?

Answer 13

Give at 8 weeks 12 weeks 16 week Do not give at 1year Give again at 3years 4 months Then again at 14 years

Question 14

What is the membrane colour oroduced across the pharynx in diptheria?

Answer 14

Grey white membrane across pharynx in diptheria - can cause airway obstruction

Question 15

What is the treatment of diptheria?

Answer 15

Antibiotic therapy - penicillin (erythromycin if en allergic) Also give toxoid vaccine

Question 16

• White patches on red, raw mucous membranes in throat/ mouth What is this?

Answer 16

Candida - oral thrush

Question 17

Which bacteria causes this? What in asthmatics can cause this?

Answer 17

Candidia albicans In asthmatics, improper use of inhaler technique can cause this

Question 18

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?

Answer 18

1st line - miconazole 2nd line - fluconazole Give nystatin as 1st line if any concerns with interactions with fluconazole or miconazole ie warfarin interaction

Question 19

What sinuses is mostly predisposed to infection causing sinusitis?

Answer 19

The maxillary sinuses as the cilia have to beat against gravity

Question 20

Most causes of sinusiitis are viral and resolve within 14 days When are antibiotics recommended in acute sinusitis? When are intranasal corticosteroids recommended?

Answer 20

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

Question 21

What is the first line antibiotic for sinusitis? What is the treatment if allergic?

Answer 21

1st line - penicillin V 2nd line (pen allergic) - doxycycline

Question 22

When is doxcycline not used? What is a known side effect of doxycycline?

Answer 22

Not used in children under 12 as it can cause permanent tooth disclouration Also causes photosensitivity

Question 23

Young child presents with painful mouth ulcer, swollen and tender lips What is this thought to be? What virus causes it?

Answer 23

Primary gingivostomatitis - caused by herpes simplex virus (HSV)

Question 24

How is the diagnosis of primary gingivostomatitis confirmed?

Answer 24

Swab of lesion in virus transport medium to lab - viral DNA detected by PCR

Question 25

What is the treatment of primary gingivostomatitis?

Answer 25

Acicylovir

Question 26

Which human herpes virus causes cold sores?

Answer 26

Human herpes virus 1 - causes oral lesions

Question 27

What is the treatment of cold sores?

Answer 27

Aciclovir

Question 28

What is an abscess at the end of the finger caused by HSV and a risk for dentisits?

Answer 28

Herpes whitlow - treat with aciclovir

Question 29

What disease presents with vesicles/ulcers at the back of the mouth? Also has fever and can cause dysphagia due to the sore throat

Answer 29

Herpangina

Question 30

Which virus causes herpangina?

Answer 30

Caused by coksackie A virus family of enteroviruses

Question 31

What is the similar virus to herpangina however presents with blisters at the front of the mouth? Also found on hand and feet

Answer 31

Hand, foot and mouth disease

Question 32

What is the painless ulcer at the site of injury in syphilis known as?

Answer 32

A chancre

Question 33

What bacteria causes syphilis and what is the treatment?

Answer 33

Caused by treponema pallidum Treatment is penicillin (penicillin G to be specific)