L38 - Common ENT Inflammatory Diseases Flashcards

1
Q

Classification of Rhinitis?

A

Classify by cause:

  • Infective
  • Allergic
  • Others
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2
Q

List the pathogens that cause infective rhinitis?

A

1) URTI Viruses

2) Bacteria – common ones in upper respiratory tract:
a) Haemophilus influenzae
b) Streptococcus pneumoniae
c) Staphylococcus aureus
d) Moraxella catarrhalis
e) Mycobacteria

3) Others: Fungi, Protozoa, Parasites

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3
Q

How to distinguish allergic or infective cause of rhinitis by P/E?

A

Infective = Cloudy, white discharge from swollen inferior turbinate not to be confused with nasal polyps

Allergic = Red, swollen inferior turbinate

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4
Q

Pathogenesis of chronic allergic rhinitis?

A

Type I hypersensitivity involving IgE

Allergen at nasal epithelium
> Mast cell degranulation
> release inflammatory mediators i.e. Histamine
causing sneezing, epistaxis
> Late-phase response involve cellular infiltration (i.e. eosinophils) to cause chronic nasal obstruction

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5
Q

List some causative agents of rhinitis apart from infective or allergic cause.

A

Others:

  • Occupational: intermittent, persistent
  • Drug-induced: aspirin, others
  • Hormonal (pregnancy)
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6
Q

List the paranasal air sinuses? Convergence point of all sinuses?

A

Sinuses (on both sides = 8 in total):

Maxillary
Ethmoid
Frontal
Sphenoid

All converge at middle meatus

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7
Q

Pathogenesis of sinusitis?

A

Functional / anatomical impairment of normal mucociliary clearance on the Respiratory epithelium

> > Swelling of osteomeatal complex

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8
Q

Investigations for sinusitis and typical findings?

A

1) Endoscopy = swollen, edematous tissue + purulent discharge
2) CT = opaque sinuses and air-fluid level present

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9
Q

Complications of sinusitis?

A

Orbital cellulitis
Orbital abscess
Cavernous sinus thrombosis

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10
Q

Which part of the ear is most commonly infected?

A

Outer ear = common

Middle ear = less common

Inner ear = rare

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11
Q

Describe the physiological protective mechanism against external ear infections?

A
Ear wax Inhibit growth of bacteria and fungi (waterproof, acidic): 
made of:
- Desquamated cells 
- Cerumen from ceruminous glands 
- Sebum 

Pars tensa epithelium migrates outwards to external ear canal&raquo_space; ear wax made at inner ear canal is constantly pushed out with no accumulation

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12
Q

Pathogenesis of otitis externa?

A

Inflammatory reaction in ear canal skin (e.g. pathogens, scratching)

> > swelling, blocking rapid cell turnover

> > more dead skin produced

> > Germs breed on moist dead skin, toxic pus fills ear canal

> > Increase inflammation, viscous cycle

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13
Q

Investigation and expected findings for otitis externa?

A

Direct endoscopy:
- Bacterial = red, edematous ear canal with abundant pus and dead skin

  • Fungal = black spores, edematous ear canal with lots of hyphae
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14
Q

2 forms of otitis media?

A

1) Acute Otitis media

2) Chronic Suppurative Otitis media = Residual perforation, can be active/ discharging or Inactive/ dry

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15
Q

Symptoms, pathogen and typical endoscopic finding of acute otitis media?

A

pain, fever, hearing loss, discharge

Viral / bacterial (Streptococcus pneumoniae, Haemophilus influenzae) (asso. with URTI)

Red, congested, engorged eardrum, bulging due to pus accumulation behind

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16
Q

Complications of acute otitis media? (5)

A

1) Tympanic membrane rupture with pus discharge from middle ear
2) Pus Into mastoid cavity = mastoid abscess (bulge behind ear)
3) Facial nerve palsy (affected side = drooping, no wrinkles, cannot close eyes)
4) CN VI palsy (lateral rectus) – cannot abduct eye
5) Brain abscess

17
Q

List the most common pathogens that cause tonsilitis?

A

Bacterial:

  • Streptococcus pyogenes
  • Staphylococci
  • Pneumococci
  • Haemophilus influenza
  • Syphilis (Treponema pallidum)
  • Corynebacterium diphtheriae)
  • Mycobacterium tuberculosis

Viral: rhinovirus, adenovirus, EBV

Others: Candida

18
Q

Clinical features of tonsilitis?

A
 Fever 
 Sore throat 
 Odynophagia (painful swallowing) 
 Trismus (jaw spasm/ pain)
 Otalgia (= pain referred to ear)
19
Q

Describe the normal appearance of tonsil in children and adults?

A

Children = Large tonsils

Adults = atrophied, not very visible
* large tonsils in adults is abnormal*

20
Q

Compare the appearance of tonsilitis caused by bacteria vs viral?

A

Bacterial: red swollen tonsils, throat redness, whitish spots, swollen uvula, gray furry tongue**

Viral: red swollen tonsils, throat redness (normal uvula, no white spots, normal tongue)

21
Q

Give one complication of tonsilitis? List symptoms?

A

Quinsy/ Peritonsillar abscess

Severe sore throat 
Low grade fever 
Dysphagia 
Inflammation of peritonsillar area with medial displacement of tonsil 
Bilateral airway obstruction → stridor 
Severe trismus 

Requires drainage of abscess

22
Q

Which region of the larynx is most commonly affected by croup?

A

Subglottis

23
Q

List common causative pathogens of Sialoadenitis?

A
Salivary gland infection: 
Viral: 
- Mumps 
- Coxsackievirus 
- HIV 
-  Echovirus 

Bacterial:

  • Staphylococcus
  • Mycobacterium tuberculosis
  • Syphilis (Treponema pallidum)

Noninfectious inflammatory: Sjogren’s (autoimmune)

24
Q

Pathogenesis of sialadenitis?

A

1) Ascending salivary duct infections: related to dehydration, debilitation
2) Secondary to salivary duct obstruction (submandibular gland more likely obstructed by stones than parotid gland)

25
Give one example of parotid gland infection.
Parotiditis e.g. viral: mumps
26
Presentation of secondary ductal obstruction of submandibular gland?
Blockage by stone >> Viscous saliva, more mucus
27
Lateral pharyngeal space infection is secondary to which infections?
Spread of infection from adjacent structures Odontitis, pharyngitis, tonsillitis, parotitis, otitis, mastoiditis
28
Submandibular space infection is secondary to which infections?
Dental root abscess 50-90%
29
Symptoms and primary infections causing retropharyngeal space infection?
Fever, sore throat, dysphagia, neck stiffness Odontitis, peritonsillar abscess, cervical vertebral osteomyelitis, perforated pharynx