Nasal Cavity & Ear Flashcards
What is the difference between rhinitis & allergic rhinitis?
allergic rhinitis will have more eosinophils
What cell is shown in the provided image?
It suggests what type of diagnosis?
eosinophil
allergic reaction
What pathology can appear after recurrent attacks of rhinitis?
inflammatory polyps
(including “allergic” polyps)
What are nasal polyps?
What types of cells are commonly located within the polyps?
- Focal protrusionso f the respiratory mucosa
- 3-4 cm
- edematous stroma
- mixed inflammatory infiltrate
- neutrophils, eosinophils, lymphocytes, plasma cells
- can become fibrotic over time
What secondary problem can be caused by nasal polyps?
can provide a barrier that makes it difficult for mucus to drain out of sinuses & nose
What are risk factors in kids for nasal polyps?
cystic fibrosis
aspirin sensitivitvity (& asthma)
What pathology is shown in the provided image?
nasal polyp
What featurs of the dissected polyp ar important for identification?
- ulcerated & hemorrhagic on the surface
- shimmery & shiny
- edema fluid that undermines the mucosa
What pathology is shown in the provided microscopic image?
What features helped you to identify it?
- respiratory-type epithelium
- ciliated columnar cells
- inflammatory edematous infiltrate in the stroma
- edematous b/c looks white
What is the cause of chronic rhinitis?
Risk factors?
sequel to repeated attackes of acute rhinitis with superimposed bacterial infection - obstruction providing optimal location for bacterial growth
deviated nasal septum or nasal polyps
What are the two most common causes of sinusitis?
preceded by acute or chronit rhinitis
direct extension of dental infection into maxillary sinus
What are the most common causes of chronic sinusitis?
Most common etiology of each?
- repeated acute sinusitis
- generally accompanied by outflow obstruction by mucosal inflammation
- oral cavity inhabitants
- allergic fungal sinusitis
- Aspergillus
What are the contents of the allergic mucin produced by allergic fungal sinusitis?
sloughed epithelial cells
eosinophils
Charcot-Leyden crystals (breakdown products of eosinophils)
perhaps some fungal hyphae (septate that branch at 45 degrees)
What condition predisposes individuals to sinusitis?
Describe this condition.
kartageners syndrome (primary ciliary dyskinesia)
autosomal recessive
dynein arm absent/abnormal
What conditions are associatd wtih Kartagener syndrome?
sinusitis
bronchietasis
infertility
situs invertis
What complications can result from sinusitis?
- empyema/mucocele
- abscess with bugs/mucus inside sinuses
- osteomyelitis
- when bugs crawl into the bones
- septic thrombophlebitis or dural venous sinus
- bugs & inflammation that make a thrombus in dural venous sinus
What pathology is shown in the provided image?
frontal sinus mucocele
What are the 3 major necrotizing lesions of the nose & upper airways?
- mucormycosis
- granulomatosus with polyangitis
- extranodal Nk/T-cell lymphoma
What patients are particularly susceptible to mucormycosis?
Diabetics & immunocompromised
What is granulomatosus with polyangitis?
(Wegeners granulomatosis)
T-cell hypersensitivity reaction to inhaled antigens causing nectorizing granulomas in the respiratory tract
vasculitis small & medium vessels
glomerulonephritis
Extranodal NK/T-cell lymphoma is driven by what virus?
Most commonly affected demographic?
Epstein Barr Virus driven
Males, 5th-6th decade, asian & latin
What pathology is shown in the provided image?
How can you identify the causitive agent?
How is it treated?
Mucormycosis
big, fat hyphae typically aseptate & branch at 90 degrees
Treated surgically b/c fast growth
What pathology is shown in the provided image?
Granulomatosis with polyangitis (Wegeners granulomatosis)
necrotizing granulomatous inflammation & vasculitis in small/medium vessels
histiocytes (monocyte) in the microscopic image (multinuceated)
How is granulomatosis with polyangitis (Wegeners granulomatosis) diagnosed?
cytoplasmic antineutrophil cytoplasmic antibody (c-ANCA) directed agains PR3 or MPO
What are the 3 diseases driven by Epstein Barr Virus?
- extranodal NK/T-cell lymphoma
- Nasopharyngeal carcinoma
- Oral Hairy Leukoplakia
What are the most common viral causes of pharyngitis & tonsilitis?
Rhino, Echo & Adeno
less common – respiratory syncytial viruses (RSV) & influenza virus
What are the most common bacterial causes of pharyngitis & tonsilitis?
B-hemolytic stroptococci (may manifest as late sequelae w/ rheumatic fever & glomerulonephritis)
sometimes– S. aureus
What is a nasopharyngeal angiofibroma?
Most commonly affected demographics?
Treatment?
Complications?
Benign tumor found in the posteriolateral roof of nasal cavity - bleed a lot
fair-skinned, red-headed adolescent-youn adults, biological males
Surgical removal (locally aggressive nature)
Can be fatal due to hemorrhage & intracranial extension
75% of nasopharyngea angiofibromas have what type of receptors?
androgen
What features of the provided photo indicate a nasopharyngeal angiofibroma?
asymmetry in the R & L maxillary sinus
posterior wall of L sinus is bowed inward by mass extending into nasocavity
What pathology is shown in the provided image?
How do you know?
nasopharyngeal angiofibroma
respiratory epithelium overlying numeorus blood vessels in a fibrous tissue
vessels are “staghorn” like – (antlers)
What is a sinonasal papilloma?
What are the 3 types & which is most dangerous?
Most commonly affected demographic?
benign neoplasm of the nasal cavity & paranasal sinuses
papillomatous proliferation of non-keratinizing squamous and/or columnar epithelium on fibrovascular stalk
- Endophytic - locally aggressive w/ change malignant transformation
- grow down into the stroma
- Exophytic
- Cylindrical
adult males 30 - 60 years
Sinonasal Papillomas are related to what virus?
HPV
type 6 and 11
What pathology is shown in the provided image?
Sinonasal papilloma
What pathology is shown in the provided image?
How do you know?
Papilloma
finger-like proliferation of epithelium on fibrovascular stalk
What is a olfactory neuroblastoma?
Most commonly affected demographic?
Symptoms?
Treatment?
small round blue cell tumor with neuroendocrine marker
arise from the neuroectodermal olfactory cells in the mucosa
15 & 50 year
Symptoms: nasal obstruction & epistaxis (nose bleed)
Combo surgery, radiation & chemotherapy
What is an example of a neuroendocrin marker?
chromogranin
What pathology is shown in the provided image?
How do you know?
Olfactory neuroblastoma
Respiratory epithelium with underlyign infiltrate of small blue cells
What 3 characteristics define a nasopharyngeal carcinoma?
Most commonly affected demographics?
Symptoms?
Epithelial malignancy arising in nasopharynx positive for Epstein Barr virus
children in africa
adults in southern china
adults & children in US
diets high in nitrosamines (fermented foods & salted fish), smoking & chemical fumes
Symptoms: nasal obstruction, epistaxis & lump in neck (cervical lymph nodes)
What type of nasopharyngeal carcinoma has the worst prognosis?
keratinizing squamous cell carcinoma
What is otits media & what are the most commonly affected demographics?
inflammation inner ear
infants & children
diabetic persons
Most common etiological causes of otitis media?
- usually viral
- Bacterial (supperative exudate)
- acite: Strep. pneumonae, influenzae, Moraxella catarrhalis
- chronic: Pseudomonas Aeruginosa, S. aureus, Fungus
- ear drum perforation, spread to mastoid process, temporal lob abscess
- Diabetic person
- Pseudomonas Aeruginosa
What is a cholesteatoma?
It can arise as a complication of what condition?
non-neoplastic squamous-lined cyst& filled with amorphous debris/cholesterol
can erode into the ossicles, the labrynth & the adjacent bone
complication of otitis media
What is the name for abnormal deposition of bone in the middle ear?
This can lead to what problems?
otosclerosis
slowly progressive hearly loss beginng in early decades
What pathology is shown in the provided image?
How do you know?
Basal cell carcinioma
nodule w/ injected blood vessels on the surface
eroded ulcer
nests of blue cells with peripheral palisating (tumor cells on outside are perpendicular to tumor cells on the inside of the nest)
What is the cause of tooth caries?
focal demineralization of tooth by acidic metabolites of fermenting surgars from bacteria
What is gingivitis?
What is the cause & what can be the result?
inflammation of the gums
poor oral hygeine & leads to plaque accumulation
What is periodontitis?
inflammatory process that affects the supporting structures of the teeth, alveolar bone & cememtum
What pathology is shown in the provided image?
aphthous ulcer (canker sore)
What are aphthous ulcers?
single/crops ulceration with a erythematous halo surrounding a yellowish fibropurulent membrane
What is shown in the provided image?
Irritation (traumatic) fibroma
smoooth pink exophytic nodule on the buccal mucosa
What pathology is shown in the provided image?
How do you know?
Most commonly affected demographic?
Complications?
Pyogenic granuloma
erythematous, hemorrhagic & extraphytic mass on gingival mucosa
higly vascular proliferation of organizing granulation tissue
most common in children, young adults & pregnant women
can lead to regression or develop into peripheral ossifyign fibroma
What pathology is shown in the provided image?
Peripheral ossifyign fibroma
What pathology is shown in the provided image?
How do you know?
Peripheral giant cell granuloma
aggregation of multinucleate, foreign body-like giant cells separated by a fibroangiomatous stroma
What pathology is shown in the provided image?
Herpes simplex virus infection (type 1 & less commonly type 2)
What are the symptoms of Herpes simplex virus infection?
can initially present as gingivostomatitis
abrupt onset of vesicles & the ulcers of the oral mucosa
3-4 weeks duration & the dormancy in trigeminal ganglia that results in recurrent stomatitis
What pathology is shown in the provided image?
gingivostomatitis
What type of cell is shown in the provided image?
It is indicative of what pathology?
Tzank cell
gigantic epithelial cells with multinucleation
Herpes Smplex virus
What pathology is shown in the provided image?
It is most common in what demographics?
oral candidiasis pseudo membrane - can be scraped off
(thrush)
immunocompromised, diabetics, steroid inhalers/asthma
What pathology is shown by the provided image?
What ar the othe associated symptoms with this illness?
Scarlet Fever (Group A Strep)
Raspberry & strawberry tongue (white coating that eventually goes away & leads to hypertrophied taste buds)
Rash that starts at the belt & moves up
What pathology is shown in the provided image?
Measles
Koplik spots (punctate ulcers on buccal mucosa)
What pathology is shown in the provided image?
Diptheria
Pseudomembrane that can extend all the way down into the trachea
What pathology is shown in the provided image?
Lichen Planus (typically cutaneous but can occur in oral mucosa)
hyperkeritosis w/ reticulate (lace-like) patter on buccal mucosa
What pathology is shown in the provided image?
pemphigus bulgaris
blistering cutaneous disorder that can occur in oral mucosa
Vesicles & bullae prone to rupture
What pathology is shown in the provided image?
Most commonly affected demographic?
Oral Hairy Leukoplakia
White, confluent pathces of fluffy hyperkerototic thickenings on lateral aspect of tongue
immunocompromised – caused by Epstein Barr Virus
How can you differentiate oral hairy leukoplakia from oral candidiasis?
the lesions in oral hairy CANNOT be scraped off
the CAN be scraped off with candidiasis
What pathology is shown in the provided image?
Leukoplakia
25% pre malignant (low-grade squamous dysplasia)
can only be diagnosed after primary causes have been excluded
Leukoplakia is associated with what risk factors?
smoking, chewing tobacco
What pathology is shown in the provided image?
Erythroplakia
Red, velvety
risk of malignant gransformation much higher than in leukoplakia (high-grade squamous dysplasia)
