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ENTJaz > ENT pathology > Flashcards

ENT pathology Flashcards

1
Q

auditory meatus and external canal are lined with ___ with __+__ glands
therefore

A

epidermis
sebaceous and ceruminous
can get skin conditions here too

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2
Q

mucosa in the middle ear =

A

columnar

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3
Q

____ epithelium in the paranasal sinuses is identical to ____ epithelium but instead of being endoderm derived it is ____ derived

A

Schneiderian
respiratory (pseudostratified ciliated columnar with glands)
ectoderm

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4
Q

usual causative agents of otitis media =

A

viral

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5
Q

causes a chronic otitis media with a purulent smell

A

pseudomonas aeruginosa

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6
Q

bacteria that can cause otitis media

A

Strep. pneumoniae
H. influenzae
Moxarella Catarrhalis

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7
Q

cholesteatoma =

A

abnormally situated squamous epithelium in the middle ear - high cell turnover and abundant keratin production.
associated inflammation causes a cheesy discharge

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8
Q

pathogenesis of cholesteatoma

A

chronic otitis media and a perforated tympanic membrane

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9
Q

common site for cholesteatoma

A

superior posterior middle ear +/ petrous apex

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10
Q

80-90% of cerebellopontine angle tumours =

A

vestibular schwannoma

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11
Q

site of a vestibular schwannoma

A

affects the vestibular part of CNVIII

temporal bone

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12
Q

vestibular schwannoma is benign/malignant

A

benign

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13
Q

if bilateral vestibular schwannoma in a young patient consider

A

NF2

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14
Q

NF2 mutation location and protein

A

Ch22q12 location on NF2 gene which encodes merlin protein

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15
Q

NF1 encodes ___ at ___

A

neurofibroma

17q11.2

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16
Q

describe a nasal polyp

A

non-tender

painless bag of jelly

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17
Q

if young with nasal polyps suspect

A

CF

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18
Q

causes of nasal polyps

A 
allergies
CF
infection
NSAID asthma
aspirin sensitivity
nickel sensitivity
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19
Q

in nasal polyps you get ____ often due to ___ inflammation - there is also scattered stromal atypia

A

lamina propria oedema

eosinophilic

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20
Q

cANCA associated with

A

GPA

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21
Q

pANCA associated with

A

microscopic polyangiitis

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22
Q

GPA present with ++_ congestion and ____ perforation

A

pulmonary
renal
nasal
septal

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23
Q

benign tumours of the nose (3)

A

squamous
Schneiderian papillomas
angiofibromas

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24
Q

malignant tumours of the nose (5)

A 
Squamous cell carcinoma
primary adenocarcinoma
neuroblastoma
lymphoma
nasopharyngeal carcinoma
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25
most common malignant tumour of the nose
Squamous cell carcinoma
26
malignancy of the nose that carpenters get
primary adenocarcinoma
27
nasal malignancy that has a high incidence in the Far East eg. Japan M>F associated with which virus? and ___ in food histological appearance
nasopharyngeal carcinoma EBV volatile nitrosamines large mass of cells and lymphocytes
28
cancers associated with EBV
Burkitt's lymphoma B cell lymphoma Hodgkin's lymphoma
29
EBV encodes ___ which activates ___ => ___ this is why it is associated with certain lymphoma It hijacks and mimics ___ causing proliferation and survival of ___ - mediated largely by ___
``` EBNA-2 cyclin-D G0 to G1 Th's response B cells LMP-1 ```
30
causes of laryngeal polyps
vocal abuse infection smoking hypothyroidism
31
laryngeal ___ is unilateral and pedunculated
polyp
32
laryngeal ___ is bilateral, young F, on ____ of vocal cord
nodule | middle posterior 1/3
33
causes of contact ulcer in the throat = | pathological appearance =
benign response to GORD / voice abuse / smoking / infection / hypothyroid similar to polyps but ulceration and granulation tissue with fibrin on top
34
pathological appearance of laryngeal polyps
prominent stromal expansion and possibly oedema/myxoid change/hyaline/fibrosis/haemorrhage
35
papillomatosis in kids is due to ___ it is an ___ form which causes few/many
HPV 6+11 aggressive 100s
36
2 peaks for squamous papilloma/papillomatosis in the throat
under 5yo | 20-40yo
37
koilocytosis indicates which disease
HPV
38
pathological appearance of squamous papilloma
koilocytosis, binucleated cells, dyskeratotic (crinkly) cells
39
chromaffin +ve paraganglioma secrete __ and examples are_+__
catecholamines | adrenal medulla + paravertebral - organ of Zuckerkandl
40
non-chrommafin paraganglioma (9)
``` carotid and aortic bodies jugulotympanic ganglia ganglia nodosum of vagus around oral cavity nose nasopharynx larynx orbit ```
41
HPV squamous cell carcinoma are usually found in the ___ by type __ produce _+_ disrupting _+_ pathways Rx =
``` oropharynx 16 E6 E7 RB + p53 chemo and radio responsive = good prognosis ```
42
staging squamous cell carcinoma of the larynx: T1a
1 vocal cord
43
staging squamous cell carcinoma of the larynx: T1b
both vocal cords
44
staging squamous cell carcinoma of the larynx: T2
supra/subglottis spread from vocal cords
45
staging squamous cell carcinoma of the larynx: T3
cord fixation/paraglottic space | minor thyroid cartilage involvement
46
staging squamous cell carcinoma of the larynx: T4
thyroid and carilage, oesophagus, tongue muscles involved
47
staging squamous cell carcinoma of the larynx: T5
mediastinal spread
48
mumps = inflammation of the ___
parotid glands
49
``` salivary gland pleomorphic adenoma usually benign/malignant which gland usually? F:M pathological appearance ```
benign - small risk of malig change parotid F>M epithelial and myoepithelial cells in chondromyxoid stroma, poorly circumscribed
50
Warthins tumour = associated with __+__+__ pathological appearance
2nd most common benign salivary gland tumour - usually parotid gland smoking in older men multifocal usually - mixture of oncocytic epithelium with dense lymphoid infiltrate
51
Most common malignancy of salivary glands = | describe =
mucepidermoid carcinoma | mixture of squamous, mucinous and intermediate epithelium
52
salivary gland tumour that presents with PAIN (due to __) and loss of function =
adenoid cystic | frequent perineural invasion
53
most common malignancy of the palate =
adenoid cystic
54
How to conduct a Rinne test and what it shows
tuning fork next to mastoid then when can no longer hear it move 1-2cm from ear canal normal = air>bone conduction shows conductive loss
55
Weber test = how to conduct one detects ___ hearing loss
tuning fork in midline of forehead and should hear equally in both ears sensorineural/conductive loss
56
____ is used to look at external and middle ear
otoendoscope
57
D principle of s+s of ear disease =
``` deafness discomfort discharge dizziness din din defective movement of face ```
58
4 types of deafness =
sensorineural conductive mixed central
59
what nerves can cause earache =
``` CN V VII IX (sore throat) X C2+3 ```
60
ear discharge medical term =
otorrhea
61
tinnitus = | Rx =
sound of silence masking device CBT hearing aid
62
otitis externa is common in people who __/___ | for relief =
swim use steroidal antibiotic drops simple suction clearance
63
infection causing acute OM causes a ___
transudate
64
Glue ear aka | =
otitis media with effusion | presence of fluid behind intact eardrum wo infection
65
causes of glue ear in kids = | is usually bilateral/unilateral in kids
change of ear flora adenoid cyst closes eustachian tube opening bilateral
66
glue ear in adults is usually uni/bilateral | caused by
unilateral | eustachian tumour
67
if perforation in AOM doesnt heal it leads to ___ | this can result in a ___ loss
Chronic otitis media | 60Hz hearing loss
68
Rx for cholesteatoma
Sx and check up because it recurs
69
Sade I-IV is used to grade ____ | IV =
level of retraction of eardrum | the worst - everything is stuck and immobile
70
congenital cholesteatoma is caused by ___ | criteria =
epithelium behind an intact eardrum that should have regressed at wk28 Derlacki
71
for recurring cholesteatoma Ix =
diffusion weighted MRI is replacing MRI and CT (shows its density)
72
tonsil definition =
lymphoid aggregate in subepithelium of oro and nasopharynx
73
point of attachment between palatine and lingual tonsil = | cut during ___
plica triangularis | tonsillectomy
74
space lateral to adenoid and posteromedial to eustachian tube = ____ in its lip goes into eustachian tube
fossa of Rosenmuller | Gerlach's tonsil
75
Passavant's ridge =
inferior edge of adenoid where meets superior constrictor
76
palatine tonsil histology
specialised squamous epithelium deep crypts lymphoid follicles posterior capsule
77
adenoid histology =
ciliated pseudostratified columnar > stratified squamous > transitional layer deep folds
78
___ layer in adenoid thickens with chronic infection
stratified squamous
79
the function of the transitional epithelium layer in adenoid
antigen processing
80
tonsillitis is usually caused by a ___
virus
81
viral causes of tonsillitis
``` EBX rhinovirus influenza parainfluenza enterovirus adenovirus ```
82
5-30% of tonsillitis are bacterial in orgin organisms = 39% are __
``` H. influenza strep pyogenes S. aureus Strep pneumoniae 39% = beta lactamase producing ```
83
symptoms of viral tonsillitis
``` malaise sore throat temperature unable to undertake near normal activity possibly lymphadenopathy lasts 3-4 days ```
84
symptoms of bacterial tonsillitis
``` systemic upset fever odynophagia halitosis unable to work lymphadenopathy lasts 1 wk ```
85
centor criteria for tonsillitis= 0-1 - 2/3 - 4/5 -
``` Hx of fever tonsillar exudates ender anterior cervical lymphadenopathy no cough <15yo/>44yo (minus a point) 0/1 = no Abx 2/3 - Abx if symptoms progress 4/5 - Abx ```
86
Abx given if bacterial tonsillitis
penicillin 500mg qds 10 days | clarithromycin if allergic
87
classic Hx and examination of a peritonsillar abscess (quinsy)
``` unilateral throat pain odynophagia trismus 3-7 days of preceding acute tonsillitis exam = medial displacement of tonsil and uvula, concavity of palate lost ```
88
treatment for a peritonsillar abscess (quinsy)
aspiration and Abx
89
signs of infective mononucleosis
``` gross tonsillar enlargement with membranous exudate marked cervical lymphadenopathy palatal petechial haemorrhages general lymphadenopathy hepatosplenomegaly ```
90
CRP in mono =
<100 - low
91
s+s of chronic tonsillitis
``` chronic sore throat halitosis tonsilliths peritonsilar erythema persistent tender lymphadenopathy ```
92
Rx for chronic tonsillitis
gargle warm salty water
93
s+s of obstructive hyperplasia of the adenoid
obligate mouth breathing hyponasal voice snoring AOM/OME
94
s+s of obstructive hyperplasia of palatine tonsil
snoring muffled voice maybe dysphagia
95
apparent unilateral tonsillar enlargement is due to
one lying more medially that the other and so appears bigger
96
causes of unilateral tonsillar enlargement
hypertrophy congenital neoplastic (benign papilloma, lymphoma, squamous cell ca) infection (chronic = tb, syphilis, actinomycosis)
97
risk factors for glue ear =
``` M>F smoking household day care older siblings recurrent URTI ```
98
aetiologies of glue ear =
recurrent URTI/AOM premature craniofacial abnormality immunodeficiency
99
glue ear doesn't usually cause ___
otalgia
100
Ix for glue ear =
``` otoscopy tuning fork (if >6yo), audiometry, tympanometry (aka an age appropriate hearing test) ```
101
signs of OME
TM retraction, decreased mobility and altered colour visible ME fluid/BUBBLES conductive hearing loss on tuning fork test
102
treatment for OME
90% resolve at 3months 1st line if >3months = grommet if recurs/nasal symptoms = grommet and adenoidectomy
103
symptoms of OME
deafness poor school performance/behaviour speech delay
104
causes of otalgia originating at the pinna/ear canal
``` folliculitis cellulitis perichondritis sebaceuous cyst candidiasis HZ/S ```
105
tympanic membrane causes of otalgia
myringitis - Ramsay hunt syndrome myringitis bullosa inflam 2ndry to OM
106
middle ear causes of otalgia
cholesteatoma OM effusion
107
otalgia caused by CNV3 referred pain =
``` lower mandible pathology (dental abscesses) TMJ lesions (Costen's syndrome) inflam ant 2/3 tongue grind teeth salivary gland pathology ```
108
otalgia caused by CN VII referred pain
geniculate herpes/Ramsay hunt linked to Bell's palsy spenoid/ethmoid sinuses nasal pathology
109
otalgia caused by CNIX referred pain
tonsillitis carcinoma post 1/3 tongue neuralgia oropharyngeal carcinoma
110
otalgia caused by CNX
foreign body in piriform fossa piriform fossa/larynx/post-cricoid carcinoma piriform abscess
111
otalgia caused by C2/3 (great auricular nerve) referred pain
cervical neuritis | HZV
112
C3 that supplies the ear = ___ nerve
lesser occipital nerve
113
end if upper airway marked by
vocal cords
114
special airway features of neonates
``` large head small nares obligate nasal breathers large tongue small and soft larynx at C1 (higher) weak neck muscles narrow subglottis (3.5mm at cricoid) ```
115
air flow resistance is proportional to ___
1/r^4
116
stertor =
heavy snore/ gasp = low pitched sonorous sound from nasopharyngeal airway - sign of airway obstruction
117
sternal subcostal recession and tracheal tug are signs pf
airway obstruction
118
treatment for recurrent respiratory papillamatosis =
antivirals (HPV causes) and Sx
119
subglottic stenosis causes =
congenital (rare) | trauma/intubation/GPA/GORD/idiopathic
120
s+s of subglottic stenosis
decreased exercise tolerance noisy chronic breathing scar tissue usually present
121
Rx for subglottic stenosis
endoscopic dilatation
122
heliox = | purpose =
79%helium and 21%oxygen | makes are thinner and easier to breathe
123
general anaesthetics used for airway endoscopy =
gas - sevoflurane | IV - propofol, remifentanyl
124
Pierre-Robin syndrome features =
micrognathia retrognathia cleft-palate glossoptosis
125
why is septal haematoma an emergency?
cartilage is supplied by perichondrium layer around it if bleed under it then septum is avascularised and can become necrosed and form a septal abscess => intracranial infection
126
if nasal septum if boggy and moves =
haematoma
127
if nasal septum is rigid and doesn't move =
septal deviation
128
treatment for nasal #
MUA nose - local or general anaethetic within 2/3 days
129
complications of nasal #s
epistaxis recurring (esp if ant ethmoid artery as spasms) CSF leak, meningitis anosmia (cribriform plate #)
130
Rx epistaxis
stop flow - ice, P, lignocaine, adrenaline, co-phenylcaire remove clot cauterise - silver nitrate/diathermy
131
CSF leak usually resolve __ | Sx repair if last __
spontaneously | >10 days
132
cauliflower ear aka | Rx =
pinna haematoma aspirate incise and drain pressure dressing
133
Rx of ear laceration
debride close LA Abx if cartilage infection
134
battle sign =
bruising behind and around ear = temporal bone #s
135
80% of temporal bone #s are ___ | caused by __
longitudinal | lateral blows
136
20% of temporal bone #s are ___ | caused by
transverse | frontal blows
137
s+s of longitudinal temporal #s
``` usually spares otic capsule # line parallel to long axis of petrous pyramid bleeds from external canal may cause conductive hearing loss 20% = CNVII palsy CSF otorrhea ```
138
s+s of transverse temporal #s
usually involve otic capsule # at right angle to long axis of petrous pyramid can cross IAM => sensorineural hearing loss due to CNVIII damage 50% CNVII palsy vertigo
139
sensory causes of hearing loss are due to pathology affecting the ___
cochlea
140
neural cause of hearing loss is due to pathology affecting the __
CNVIII
141
causes of conductive hearing loss =
stapes fixation - otosclerosis effusion, blood CSF TM perforation ossicular disruption
142
if days after a temporal # a nerve palsy develops it is usually due to ___ and so will ___
swelling compression | resolve
143
zone 1 of the neck is the lowest/highest zone | contains =
lowest trachea, oeso, thoracic duct, thyroid brachiocephalic, subclavian, common carotid and thyrocervical arteries spinal cord
144
zone 2 of neck contains
``` larynx hypopharynx CN X,XI, XII carotids IJV spinal cord ```
145
zone 3 of neck contains
``` pharynx CNs carotids IJV spinal cord ```
146
can justclose neck direct trauma if it doesn't penetrate the ___
platysmus
147
Ix for neck trauma
``` FBC blood type AP/lateral neck XR CXR CT angiogram MRA ```
148
tear drop sign =
prolapse of infraorbital fat into maxillary sinus on CT | an orbital floor # sign
149
imaging of choice for Le fort fractures =
CT
150
vertigo =
sensation of movement - usually spinning and usually horizontal
151
systems that can cause balance problems
``` vestibular ocular heart joints brain drugs haematological/metabolic trauma anxiety ```
152
examination of balance problems =
``` otoscopy neuro exam bp lying and standing balance system audiometry ```
153
BPPV aka | signs =
benign postitional paroxysmal vertigo vertigo on movement eg. look up, turn in bed brief episodes wo associated tinnitus, hearing loss or aural fullness
154
pathophysiology of BPPV
otoliths from utricle are displaced into semicircular canal (usually the posterior one)
155
causes of BPPV
usually idiopathic | maybe trauma or ear Sx
156
VBI aka | s+s
vertebrobasilar insufficiency vertigo on moving head back visual disturbances, weakness, numbness ass with it
157
Investigation of BPPV | describe it
Hallpike's test - | sit on couch, lie back, turn head 45 degrees and hold for >=30s => tortional nystagmus
158
treatment for BPPV
Epley manouevre Semont manouevre Brandt-Daroff exercises
159
describe the Epley manouevre for BPPV
if problem at right side then move head left, lie down the move head to right and turn to lie on right side then sit up (in each position for at least 30s)
160
describe Brandt-Daroff exercises for BPPV
turn head to left and sit on bed - fall to right - sit - turn head to right - fall to left -sit - repeat
161
signs of vestibular neuritis
prolonged vertigo (days to wks) vomit on waking no associated tinnitus or hearing loss
162
signs of labyrinthitis
prolonged vertigo vomit on waking may be associated with hearing loss/tinnitus
163
treatment for vestibular neuritis and labyrinthitis
symptomatic = antiemetic eg. cyclizine | usually self limiting but if not further Ix
164
suspected pathophysiology of Menieres
endolympthatic hydrops due to overproduction/impaired absorption
165
s+s of Menieres
recurrent spontaneous rotational vertigo with >=2 episodes longer than 20 mins tinnitus on affected side = warning sign aural fullness on affected side >= 1 occasion of sensorineural hearing loss
166
classical audiogram of Menieres
1 normal ear and other with low pitched sensorineural hearing loss
167
Rx for Menieres
``` prevention = salt restrict, diuretics to lose salt, betahistine, caffeine and alcohol and stress reduce intratympanic gentamicin (poison vestibular system)/ steroids Sx - rare = cut vestibular nerve ```
168
__+__ occurs in 2/3 of those with migraines
motion sensitivity and sickness
169
criteria for migrainous vertigo
>= 1 during at least 2 attacks = | migrainous sympts during vertigo, migraine-specific precipants of vertigo, response to anti-migrainous drugs
170
most head and neck cancers are _
squamous cell carcinoma
171
bags under eyes are caused by __
weakening of orbital septum and so fat comes through it
172
Rx of Type 1 HS cause of stuffy nose:
``` topical steroid - beclomethasone antihistamine (H1) - cetirizine decongestant short term (pseudoephedrine) anticholinergic (ipratropium) LTR blockers (montelukast) ```
173
examination of nasal patency =
can see vapour on cold metal held below nose
174
infective rhinosinusitis is usually __ and caused by __
self-limiting | Viral URTI
175
allergic causes of intermittent rhinosinusitis
pollen | fungal spores
176
allergic causes of persistent rhinosinusitis
house dust mite cat dog
177
symptoms last ___ in intermittent allergic rhinosinusitis
<4 days/wk for < 4 wks
178
symptoms last ___ in persistent allergic rhinosinusitis
>4days/wk for >4wks
179
stepwise Rx of allergic rhinosinusitis
antihistamine (H1) topical steroid both if refractory = diathermy to decrease mucosal hypertrophy
180
investigation for rhinosinusitis
skin prick test RAST dont do nasal/sinus XR
181
signs of acute infective rhinosinusitis =
facial pain discharge blockage
182
non-allergic causes of rhinosinusitis
infection (98% viral) vasomotor (nose drips) polyps
183
unilateral nasal discharge that doesnt switch sides in kids is usually due to
foreign body
184
unilateral discharge in adults that doesnt switch sides in adults is usually due to
nasal/paranasal cancer
185
acute sinusitis complication that is an emergency
orbital cellulitis
186
cacosmia = | usually caused by
purulent smell | fungal infection
187
Rx for vasomotor rhinitis | it is triggered by
antimuscarinics (iprartopium) | cold, running, food
188
mid facial segment pain = | Rx =
like a tension headache that is over other areas of the face with no other symptoms treat like a tension headache
189
weak and breathy hoarseness is due to
vocal cord palsy
190
gruff and low hoarseness is due to
masses
191
hoarseness in F smokers is due to
vocal cord/Rathke's oedema
192
refer if hoarse for ___
>3 wks
193
throat mass in kids is ___ until proven otherwise
viral
194
sites of tongue cancers commonly
lateral or underside of tongue
195
investigations for head and neck cancers
``` endoscopy FNA US guided MRI for tongue and soft tissues CT - sinus/jaw CT-PET if HPV tonsils /tongue base biopsy to confirm LA if mouth, GA if larynx/pharynx ```
196
HPV cancer sites
tonsil and tongue base
197
nasopharyngeal carcinoma is due to ___ common in ___+___ present with _+__
EBV south China an North Africa neck lump and hearing loss (eustachian tube blocked)
198
hardwoods are a risk factor for ___ cancer
sinus
199
metastases to the neck usually go to the ___
L supraclavicular fossa - thoracic duct

ENTJaz (6 decks)

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