ENT Pathology 5 - Nasopharyngeal Ca, Bell's palsy, Ramsay hunt, Croup, Epiglottis, laryngitis

Question 1

What are two common viral causes of nasopahryngeal carcinoma?

Answer 1

HPV (human papilloma virus) and EBV (Epsteinn Barr virus)

Question 2

What is the most common site of origin for nasopharyngeal carcinoma?

Answer 2

Fossa of rosenmuller - pharyngeal recess (located posterior to the eustachian tube opening

Question 3

What are risk factors for NPC?

Answer 3

Smoking and alcohol

Question 4

How many weeks of hoarseness is a red flag for NPC?

Answer 4

Hoarseness for greater than 6weeks

Question 5

Local spread may involve CN’s via jugular foramen in nasopharyngeal carcinoma (NPC) What is the mainstay of treatment?

Answer 5

Radiotherpy

Question 6

What is the most common type of carcinoma? (Of the head and neck)

Answer 6

Squamous cell carcinoma

Question 7

• Often advanced at presentation • M>F • Most are squamous • Usually older patient who is a smoker This is an orophraryngeal carcinoma What is the main treatment in oropharngeal carcinoma?

Answer 7

usually radiotherapy

Question 8

Where can the pain in oropharngeal carcinoma arise?

Answer 8

The pain can arise in the in the ear due to referred pain

Question 9

What innervates the eustachian tube with sensory innervation therefore can have referred pain?

Answer 9

CN IX - glossopharyngeal nerve

Question 10

Is a stridor suggestive of an upper or lower respiratory tract pathology?

Answer 10

Suggest of an upper respiratory tract pathology -eg in croup (laryngeotracheobronchitis) - you can have a stridor

Question 11

Patient presents with a stridor, hoarseness of voice, dysphagia and haemoptysis What do you think?

Answer 11

Laryngeal carcinoma

Question 12

What is the cause of unilateral facial nerve palsy causing facial weakness unilaterally?

Answer 12

Bell’s palsy

Question 13

What is the most probable cause of Bell’s palsy causing the unilateral facial paralysis?

Answer 13

Most likely to be of viral aetiology

Question 14

Describe the features of Bell’s palsy?

Answer 14

Can present with a variety of features due to the muscles of facial expression supplied by the facial nerve Can have - drooling, dry eyes, loss of taste on anterior 2/3rds of the tongue Drooping eyelid

Question 15

What is the sensory and motor innervation of the lacrimal gland?

Answer 15

Sesnory - lacrimal nerve branch of opthalmic nerve (CN V1) Motor - greater petrosal nerve branch of the facial nerve (CN VII) - therefore decreased tear production and dry eyes

Question 16

Which muscle moves the tears across the eyes due to the closure of the eyelids? Which muscle prevents drooling? What nerve supplies taste to the anterior 2.3rds of the tongue? (what fissure does it exit the skull via)

Answer 16

Closure of the eylids - orbicularis oculi muscle Prevents drooling - orbicularis oris muscle Taste to anterior 2/3rds of tongue - chorda tympani branch of the facial nerve - exits via the petrotympanic fissure Glossopharyngeal supplies the posterior 1/3rd of the tongue with sensory innervation

Question 17

What is the name for dry eyes in Bell’s palsy?

Answer 17

Keratoconjunctivitis sicca - just means dry eyes

Question 18

What is the first line treatment used in all cases of Bell’s palsy?

Answer 18

Corticosteroid - prednisolone and eye protection eg eye drops

Question 19

What may be given if there is severe paralysis of the facial muscles?

Answer 19

An antiviral such as aciclovir - refer to specialist help for consideration

Question 20

How is bell’s palsy differentiated from ramsay hunt syndrome?

Answer 20

Bell’s palsy is unilateral facial palsy (can have pain) Ramsay hunt syndrome presents with unilateral facial palsy with vesicles in auditory canal or face/tongue/hard palate

Question 21

How is ramsay hunt syndrome treated?

Answer 21

Treated with antivirals (acyclovir) + steroids (prednisolone)

Question 22

• Leading cause of stridor (high pitched inspiratory noise) with a barking cough What is this?

Answer 22

Croup (laryngeotracheobronchitis) - cough and no drooling is usually croup

Question 23

What is the cause of croup?

Answer 23

usually caused by parainfluenza virus

Question 24

What may be the sign on xray for croup and what is the usual treatment?

Answer 24

Sign is a steeple sign on xray usually NICE recommend giving a single dose of oral dexamethasone (0.15mg/kg) to all children regardless of severity

Question 25

What is not a common symptom to have in epiglottitis?

Answer 25

a cough

Question 26

How does epiglottitis present in children?

Answer 26

Difficulty breathing A severe sore throat Fever and dysphagia Drooling

Question 27

How is epiglottitis treated?

Answer 27

Make sure they are on oxygen for breathing IV ceftriaxone is given (also can give prednisolone as an adjunct)

Question 28

What organism is the usual cause of epiglottitis? How do you swab the tongue for organism?

Answer 28

Usually caused by H.influenza DO NOT TOUCH THE Epiglottis as it may close the whole airway

Question 29

What is the sign on xray seen in epiglottitis?

Answer 29

Thumbprint sign on xray

Question 30

hoarseness difficulty speaking sore throat mild fever irritating cough Usually self limiting What is this?

Answer 30

Laryngitiis

Question 31

If the laryngitits is caused by a bacteria eg strep pyogenes What is the treatment?

Answer 31

Pencillin V