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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
Q

most common malignant tumour of the nose

A

Squamous cell carcinoma

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26
Q

malignancy of the nose that carpenters get

A

primary adenocarcinoma

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27
Q

nasal malignancy that has a high incidence in the Far East eg. Japan M>F
associated with which virus? and ___ in food
histological appearance

A

nasopharyngeal carcinoma
EBV
volatile nitrosamines
large mass of cells and lymphocytes

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28
Q

cancers associated with EBV

A

Burkitt’s lymphoma
B cell lymphoma
Hodgkin’s lymphoma

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29
Q

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 ___

A 
EBNA-2
cyclin-D
G0 to G1
Th's response
B cells
LMP-1
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30
Q

causes of laryngeal polyps

A

vocal abuse
infection
smoking
hypothyroidism

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31
Q

laryngeal ___ is unilateral and pedunculated

A

polyp

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32
Q

laryngeal ___ is bilateral, young F, on ____ of vocal cord

A

nodule

middle posterior 1/3

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33
Q

causes of contact ulcer in the throat =

pathological appearance =

A

benign response to GORD / voice abuse / smoking / infection / hypothyroid
similar to polyps but ulceration and granulation tissue with fibrin on top

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34
Q

pathological appearance of laryngeal polyps

A

prominent stromal expansion and possibly oedema/myxoid change/hyaline/fibrosis/haemorrhage

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35
Q

papillomatosis in kids is due to ___ it is an ___ form which causes few/many

A

HPV 6+11
aggressive
100s

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36
Q

2 peaks for squamous papilloma/papillomatosis in the throat

A

under 5yo

20-40yo

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37
Q

koilocytosis indicates which disease

A

HPV

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38
Q

pathological appearance of squamous papilloma

A

koilocytosis, binucleated cells, dyskeratotic (crinkly) cells

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39
Q

chromaffin +ve paraganglioma secrete __ and examples are_+__

A

catecholamines

adrenal medulla + paravertebral - organ of Zuckerkandl

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40
Q

non-chrommafin paraganglioma (9)

A 
carotid and aortic bodies
jugulotympanic ganglia
ganglia nodosum of vagus
around oral cavity
nose
nasopharynx
larynx
orbit
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41
Q

HPV squamous cell carcinoma are usually found in the ___
by type __
produce + disrupting + pathways
Rx =

A 
oropharynx
16
E6 E7
RB + p53
chemo and radio responsive = good prognosis
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42
Q

staging squamous cell carcinoma of the larynx: T1a

A

1 vocal cord

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43
Q

staging squamous cell carcinoma of the larynx: T1b

A

both vocal cords

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44
Q

staging squamous cell carcinoma of the larynx: T2

A

supra/subglottis spread from vocal cords

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45
Q

staging squamous cell carcinoma of the larynx: T3

A

cord fixation/paraglottic space

minor thyroid cartilage involvement

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46
Q

staging squamous cell carcinoma of the larynx: T4

A

thyroid and carilage, oesophagus, tongue muscles involved

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47
Q

staging squamous cell carcinoma of the larynx: T5

A

mediastinal spread

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48
Q

mumps = inflammation of the ___

A

parotid glands

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49
Q 
salivary gland pleomorphic adenoma
usually benign/malignant
which gland usually?
F:M
pathological appearance
A

benign - small risk of malig change
parotid
F>M
epithelial and myoepithelial cells in chondromyxoid stroma, poorly circumscribed

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50
Q

Warthins tumour =
associated with __+__+__
pathological appearance

A

2nd most common benign salivary gland tumour - usually parotid gland
smoking in older men
multifocal usually - mixture of oncocytic epithelium with dense lymphoid infiltrate

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51
Q

Most common malignancy of salivary glands =

describe =

A

mucepidermoid carcinoma

mixture of squamous, mucinous and intermediate epithelium

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52
Q

salivary gland tumour that presents with PAIN (due to __) and loss of function =

A

adenoid cystic

frequent perineural invasion

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53
Q

most common malignancy of the palate =

A

adenoid cystic

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54
Q

How to conduct a Rinne test and what it shows

A

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

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55
Q

Weber test =
how to conduct one
detects ___ hearing loss

A

tuning fork in midline of forehead and should hear equally in both ears
sensorineural/conductive loss

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56
Q

____ is used to look at external and middle ear

A

otoendoscope

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57
Q

D principle of s+s of ear disease =

A 
deafness
discomfort
discharge
dizziness
din din
defective movement of face
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58
Q

4 types of deafness =

A

sensorineural
conductive
mixed
central

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59
Q

what nerves can cause earache =

A 
CN V
VII
IX (sore throat)
X
C2+3
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60
Q

ear discharge medical term =

A

otorrhea

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61
Q

tinnitus =

Rx =

A

sound of silence
masking device
CBT
hearing aid

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62
Q

otitis externa is common in people who __/___

for relief =

A

swim
use steroidal antibiotic drops
simple suction clearance

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63
Q

infection causing acute OM causes a ___

A

transudate

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64
Q

Glue ear aka

=

A

otitis media with effusion

presence of fluid behind intact eardrum wo infection

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65
Q

causes of glue ear in kids =

is usually bilateral/unilateral in kids

A

change of ear flora
adenoid cyst closes eustachian tube opening
bilateral

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66
Q

glue ear in adults is usually uni/bilateral

caused by

A

unilateral

eustachian tumour

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67
Q

if perforation in AOM doesnt heal it leads to ___

this can result in a ___ loss

A

Chronic otitis media

60Hz hearing loss

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68
Q

Rx for cholesteatoma

A

Sx and check up because it recurs

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69
Q

Sade I-IV is used to grade ____

IV =

A

level of retraction of eardrum

the worst - everything is stuck and immobile

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70
Q

congenital cholesteatoma is caused by ___

criteria =

A

epithelium behind an intact eardrum that should have regressed at wk28
Derlacki

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71
Q

for recurring cholesteatoma Ix =

A

diffusion weighted MRI is replacing MRI and CT (shows its density)

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72
Q

tonsil definition =

A

lymphoid aggregate in subepithelium of oro and nasopharynx

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73
Q

point of attachment between palatine and lingual tonsil =

cut during ___

A

plica triangularis

tonsillectomy

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74
Q

space lateral to adenoid and posteromedial to eustachian tube =
____ in its lip goes into eustachian tube

A

fossa of Rosenmuller

Gerlach’s tonsil

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75
Q

Passavant’s ridge =

A

inferior edge of adenoid where meets superior constrictor

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76
Q

palatine tonsil histology

A

specialised squamous epithelium
deep crypts
lymphoid follicles
posterior capsule

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77
Q

adenoid histology =

A

ciliated pseudostratified columnar > stratified squamous > transitional layer
deep folds

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78
Q

___ layer in adenoid thickens with chronic infection

A

stratified squamous

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79
Q

the function of the transitional epithelium layer in adenoid

A

antigen processing

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80
Q

tonsillitis is usually caused by a ___

A

virus

81
Q

viral causes of tonsillitis

A 
EBX
rhinovirus
influenza
parainfluenza
enterovirus
adenovirus
82
Q

5-30% of tonsillitis are bacterial in orgin
organisms =
39% are __

A 
H. influenza
strep pyogenes
S. aureus
Strep pneumoniae
39% = beta lactamase producing
83
Q

symptoms of viral tonsillitis

A 
malaise
sore throat
temperature
unable to undertake near normal activity
possibly lymphadenopathy
lasts 3-4 days
84
Q

symptoms of bacterial tonsillitis

A 
systemic upset
fever 
odynophagia
halitosis
unable to work
lymphadenopathy
lasts 1 wk
85
Q

centor criteria for tonsillitis=
0-1 -
2/3 -
4/5 -

A 
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
Q

Abx given if bacterial tonsillitis

A

penicillin 500mg qds 10 days

clarithromycin if allergic

87
Q

classic Hx and examination of a peritonsillar abscess (quinsy)

A 
unilateral throat pain
odynophagia
trismus
3-7 days of preceding acute tonsillitis
exam = medial displacement of tonsil and uvula, concavity of palate lost
88
Q

treatment for a peritonsillar abscess (quinsy)

A

aspiration and Abx

89
Q

signs of infective mononucleosis

A 
gross tonsillar enlargement with membranous exudate
marked cervical lymphadenopathy
palatal petechial haemorrhages
general lymphadenopathy
hepatosplenomegaly
90
Q

CRP in mono =

A

<100 - low

91
Q

s+s of chronic tonsillitis

A 
chronic sore throat
halitosis
tonsilliths
peritonsilar erythema
persistent tender lymphadenopathy
92
Q

Rx for chronic tonsillitis

A

gargle warm salty water

93
Q

s+s of obstructive hyperplasia of the adenoid

A

obligate mouth breathing
hyponasal voice
snoring
AOM/OME

94
Q

s+s of obstructive hyperplasia of palatine tonsil

A

snoring
muffled voice
maybe dysphagia

95
Q

apparent unilateral tonsillar enlargement is due to

A

one lying more medially that the other and so appears bigger

96
Q

causes of unilateral tonsillar enlargement

A

hypertrophy
congenital
neoplastic (benign papilloma, lymphoma, squamous cell ca)
infection (chronic = tb, syphilis, actinomycosis)

97
Q

risk factors for glue ear =

A 
M>F
smoking household
day care
older siblings
recurrent URTI
98
Q

aetiologies of glue ear =

A

recurrent URTI/AOM
premature
craniofacial abnormality
immunodeficiency

99
Q

glue ear doesn’t usually cause ___

A

otalgia

100
Q

Ix for glue ear =

A 
otoscopy
tuning fork (if >6yo), audiometry, tympanometry (aka an age appropriate hearing test)
101
Q

signs of OME

A

TM retraction, decreased mobility and altered colour
visible ME fluid/BUBBLES
conductive hearing loss on tuning fork test

102
Q

treatment for OME

A

90% resolve at 3months
1st line if >3months = grommet
if recurs/nasal symptoms = grommet and adenoidectomy

103
Q

symptoms of OME

A

deafness
poor school performance/behaviour
speech delay

104
Q

causes of otalgia originating at the pinna/ear canal

A 
folliculitis
cellulitis
perichondritis
sebaceuous cyst
candidiasis
HZ/S
105
Q

tympanic membrane causes of otalgia

A

myringitis - Ramsay hunt syndrome
myringitis bullosa
inflam 2ndry to OM

106
Q

middle ear causes of otalgia

A

cholesteatoma
OM
effusion

107
Q

otalgia caused by CNV3 referred pain =

A 
lower mandible pathology (dental abscesses)
TMJ lesions (Costen's syndrome)
inflam ant 2/3 tongue
grind teeth
salivary gland pathology
108
Q

otalgia caused by CN VII referred pain

A

geniculate herpes/Ramsay hunt linked to Bell’s palsy
spenoid/ethmoid sinuses
nasal pathology

109
Q

otalgia caused by CNIX referred pain

A

tonsillitis
carcinoma post 1/3 tongue
neuralgia
oropharyngeal carcinoma

110
Q

otalgia caused by CNX

A

foreign body in piriform fossa
piriform fossa/larynx/post-cricoid carcinoma
piriform abscess

111
Q

otalgia caused by C2/3 (great auricular nerve) referred pain

A

cervical neuritis

HZV

112
Q

C3 that supplies the ear = ___ nerve

A

lesser occipital nerve

113
Q

end if upper airway marked by

A

vocal cords

114
Q

special airway features of neonates

A 
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
Q

air flow resistance is proportional to ___

A

1/r^4

116
Q

stertor =

A

heavy snore/ gasp = low pitched sonorous sound from nasopharyngeal airway
- sign of airway obstruction

117
Q

sternal subcostal recession and tracheal tug are signs pf

A

airway obstruction

118
Q

treatment for recurrent respiratory papillamatosis =

A

antivirals (HPV causes) and Sx

119
Q

subglottic stenosis causes =

A

congenital (rare)

trauma/intubation/GPA/GORD/idiopathic

120
Q

s+s of subglottic stenosis

A

decreased exercise tolerance
noisy chronic breathing
scar tissue usually present

121
Q

Rx for subglottic stenosis

A

endoscopic dilatation

122
Q

heliox =

purpose =

A

79%helium and 21%oxygen

makes are thinner and easier to breathe

123
Q

general anaesthetics used for airway endoscopy =

A

gas - sevoflurane

IV - propofol, remifentanyl

124
Q

Pierre-Robin syndrome features =

A

micrognathia
retrognathia
cleft-palate
glossoptosis

125
Q

why is septal haematoma an emergency?

A

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
Q

if nasal septum if boggy and moves =

A

haematoma

127
Q

if nasal septum is rigid and doesn’t move =

A

septal deviation

128
Q

treatment for nasal #

A

MUA nose - local or general anaethetic within 2/3 days

129
Q

complications of nasal #s

A

epistaxis recurring (esp if ant ethmoid artery as spasms)
CSF leak, meningitis
anosmia (cribriform plate #)

130
Q

Rx epistaxis

A

stop flow - ice, P, lignocaine, adrenaline, co-phenylcaire
remove clot
cauterise - silver nitrate/diathermy

131
Q

CSF leak usually resolve __

Sx repair if last __

A

spontaneously

>10 days

132
Q

cauliflower ear aka

Rx =

A

pinna haematoma
aspirate
incise and drain
pressure dressing

133
Q

Rx of ear laceration

A

debride
close
LA
Abx if cartilage infection

134
Q

battle sign =

A

bruising behind and around ear = temporal bone #s

135
Q

80% of temporal bone #s are ___

caused by __

A

longitudinal

lateral blows

136
Q

20% of temporal bone #s are ___

caused by

A

transverse

frontal blows

137
Q

s+s of longitudinal temporal #s

A 
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
Q

s+s of transverse temporal #s

A

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
Q

sensory causes of hearing loss are due to pathology affecting the ___

A

cochlea

140
Q

neural cause of hearing loss is due to pathology affecting the __

A

CNVIII

141
Q

causes of conductive hearing loss =

A

stapes fixation - otosclerosis
effusion, blood CSF
TM perforation
ossicular disruption

142
Q

if days after a temporal # a nerve palsy develops it is usually due to ___ and so will ___

A

swelling compression

resolve

143
Q

zone 1 of the neck is the lowest/highest zone

contains =

A

lowest
trachea, oeso, thoracic duct, thyroid
brachiocephalic, subclavian, common carotid and thyrocervical arteries
spinal cord

144
Q

zone 2 of neck contains

A 
larynx
hypopharynx
CN X,XI, XII
carotids
IJV
spinal cord
145
Q

zone 3 of neck contains

A 
pharynx
CNs
carotids
IJV
spinal cord
146
Q

can justclose neck direct trauma if it doesn’t penetrate the ___

A

platysmus

147
Q

Ix for neck trauma

A 
FBC
blood type
AP/lateral neck XR
CXR
CT angiogram
MRA
148
Q

tear drop sign =

A

prolapse of infraorbital fat into maxillary sinus on CT

an orbital floor # sign

149
Q

imaging of choice for Le fort fractures =

A

CT

150
Q

vertigo =

A

sensation of movement - usually spinning and usually horizontal

151
Q

systems that can cause balance problems

A 
vestibular
ocular
heart
joints
brain
drugs
haematological/metabolic
trauma
anxiety
152
Q

examination of balance problems =

A 
otoscopy
neuro exam
bp lying and standing
balance system
audiometry
153
Q

BPPV aka

signs =

A

benign postitional paroxysmal vertigo
vertigo on movement eg. look up, turn in bed
brief episodes wo associated tinnitus, hearing loss or aural fullness

154
Q

pathophysiology of BPPV

A

otoliths from utricle are displaced into semicircular canal (usually the posterior one)

155
Q

causes of BPPV

A

usually idiopathic

maybe trauma or ear Sx

156
Q

VBI aka

s+s

A

vertebrobasilar insufficiency
vertigo on moving head back
visual disturbances, weakness, numbness ass with it

157
Q

Investigation of BPPV

describe it

A

Hallpike’s test -

sit on couch, lie back, turn head 45 degrees and hold for >=30s => tortional nystagmus

158
Q

treatment for BPPV

A

Epley manouevre
Semont manouevre
Brandt-Daroff exercises

159
Q

describe the Epley manouevre for BPPV

A

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
Q

describe Brandt-Daroff exercises for BPPV

A

turn head to left and sit on bed - fall to right - sit - turn head to right - fall to left -sit - repeat

161
Q

signs of vestibular neuritis

A

prolonged vertigo (days to wks)
vomit on waking
no associated tinnitus or hearing loss

162
Q

signs of labyrinthitis

A

prolonged vertigo
vomit on waking
may be associated with hearing loss/tinnitus

163
Q

treatment for vestibular neuritis and labyrinthitis

A

symptomatic = antiemetic eg. cyclizine

usually self limiting but if not further Ix

164
Q

suspected pathophysiology of Menieres

A

endolympthatic hydrops due to overproduction/impaired absorption

165
Q

s+s of Menieres

A

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
Q

classical audiogram of Menieres

A

1 normal ear and other with low pitched sensorineural hearing loss

167
Q

Rx for Menieres

A 
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
Q

__+__ occurs in 2/3 of those with migraines

A

motion sensitivity and sickness

169
Q

criteria for migrainous vertigo

A

> = 1 during at least 2 attacks =

migrainous sympts during vertigo, migraine-specific precipants of vertigo, response to anti-migrainous drugs

170
Q

most head and neck cancers are _

A

squamous cell carcinoma

171
Q

bags under eyes are caused by __

A

weakening of orbital septum and so fat comes through it

172
Q

Rx of Type 1 HS cause of stuffy nose:

A 
topical steroid - beclomethasone
antihistamine (H1) - cetirizine
decongestant short term (pseudoephedrine)
anticholinergic (ipratropium)
LTR blockers (montelukast)
173
Q

examination of nasal patency =

A

can see vapour on cold metal held below nose

174
Q

infective rhinosinusitis is usually __ and caused by __

A

self-limiting

Viral URTI

175
Q

allergic causes of intermittent rhinosinusitis

A

pollen

fungal spores

176
Q

allergic causes of persistent rhinosinusitis

A

house dust mite
cat
dog

177
Q

symptoms last ___ in intermittent allergic rhinosinusitis

A

<4 days/wk for < 4 wks

178
Q

symptoms last ___ in persistent allergic rhinosinusitis

A

> 4days/wk for >4wks

179
Q

stepwise Rx of allergic rhinosinusitis

A

antihistamine (H1)
topical steroid
both
if refractory = diathermy to decrease mucosal hypertrophy

180
Q

investigation for rhinosinusitis

A

skin prick test
RAST
dont do nasal/sinus XR

181
Q

signs of acute infective rhinosinusitis =

A

facial pain
discharge
blockage

182
Q

non-allergic causes of rhinosinusitis

A

infection (98% viral)
vasomotor (nose drips)
polyps

183
Q

unilateral nasal discharge that doesnt switch sides in kids is usually due to

A

foreign body

184
Q

unilateral discharge in adults that doesnt switch sides in adults is usually due to

A

nasal/paranasal cancer

185
Q

acute sinusitis complication that is an emergency

A

orbital cellulitis

186
Q

cacosmia =

usually caused by

A

purulent smell

fungal infection

187
Q

Rx for vasomotor rhinitis

it is triggered by

A

antimuscarinics (iprartopium)

cold, running, food

188
Q

mid facial segment pain =

Rx =

A

like a tension headache that is over other areas of the face with no other symptoms
treat like a tension headache

189
Q

weak and breathy hoarseness is due to

A

vocal cord palsy

190
Q

gruff and low hoarseness is due to

A

masses

191
Q

hoarseness in F smokers is due to

A

vocal cord/Rathke’s oedema

192
Q

refer if hoarse for ___

A

> 3 wks

193
Q

throat mass in kids is ___ until proven otherwise

A

viral

194
Q

sites of tongue cancers commonly

A

lateral or underside of tongue

195
Q

investigations for head and neck cancers

A 
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
Q

HPV cancer sites

A

tonsil and tongue base

197
Q

nasopharyngeal carcinoma is due to ___
common in ___+___
present with _+__

A

EBV
south China an North Africa
neck lump and hearing loss (eustachian tube blocked)

198
Q

hardwoods are a risk factor for ___ cancer

A

sinus

199
Q

metastases to the neck usually go to the ___

A

L supraclavicular fossa - thoracic duct

ENTJaz (6 decks)

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