pathologies/ Diseases

Question 1

what is Choanal Atresia?
chonal- choncae of nose
atresia- abnormal absence of opening/narrowing of opening

Answer 1

in our noses we have 3 choanae.

The superior, middle and inferior. these choanae have Meatus.

Usually there is a membrane or a bone that bocks these choanae that disrupts or doesnt allow the air to pass through the nose.
most commonly unilateral (right side)
more common bony than membranous

if bilateral boi boi becuase infants are obligate nasal breathers and cannot breathe through their mouth.

congenital anomaly. failiure of recanalization during development

baby cry=some air goes in=baby pink
baby feeding=no air through nose and mouth=baby blue

Question 2

what is CHARGE syndrome?

Answer 2

if a congenital anomaly is present nd detected there are always other anomalies that will be seen.

if an infant have one anomaly, he wil have more tha that.

C  coloboma
H   heart defect
A    atresia choanae
R    retardation (mental or physical)
G    genital abnormalities
E   ear abnormalities/hearing loss

Question 3

Explain Epistaxis. (nosebleed)

Answer 3

Nosebleed can be of two types

1) anterior = more common due to nose picking or mucosal dryness. not significant and usually in younger patients
2) posterior = older patient, hypertensive diseases and more significant

Question 4

symtoms related to epistaxis?(lethal)

Answer 4

1) blood through nose
2) blood through lacrimal glands (nasolacrimal duct drains into inferior meatus of nose)
3) vomitting blood
4) blood in anus (you swallow blood , it hets digest and comes out)
the blood is dark as it is digested by stomach acid

Question 5

treatment for epistaxis?

Answer 5

if a foreign body in a kid = pressure and phenylephrine VC spray

if cocaine = perforated nose = nasal packing

if nasopharyngeal angiofibroma= resection.

elderly hypertension = BP control, vessel ligation and posterior packing

Question 6

if in exam a kid comes with nasal polyps its almost always cystic fibrosis. usually a caucasian kid. name the test for diagnosis

Answer 6

chloride sweat test (CFTR gene)

very thick secrections presnt so in this Kid bowel obstruction is also seen (Meconium Ileus) (No passing of the first stool)

in kid if nasal polyps are not due to allergy we should suspect CF

Question 7

polyps

Answer 7

usually bilateral. due to chronic inflammation or allergy. non cancerous. could be due to CF in kids. (not in adults)

Question 8

how to treat Cystic fibrosis?

Answer 8

1) oral pancreatic enzymes
2)Antibiotics
3)mucolytics
4)lavacaftor (CFTR potentiator)Potentiators are CFTR modulators that hold the gate open so chloride can
flow through the cell membrane

Question 9

Rhinoscleroma.

Answer 9

Chronic Granulomatous disease affecting the nose
main cell in this is Epitheliod Histiocytes (macrophages)
fuse together = multinucleated = langerhans

klebsiella

russell bodies are also seen

Question 10

explain russell bodies.

Answer 10

eosinophillic , large homogenous inclusions that are found in plasma cells . These inclusions contain Immunoglobins.

Eosinophillic means thee are basic granules stained By an Acidic dye.
(In normal histology the cytoplasm is stained Pink (acidophillic) as the protiens are basic in nature)

These are PAS positive(Periodic acid–Schiff (PAS) is a staining method used to detect polysaccharides such as glycogen, and mucosubstances such as glycoproteins, glycolipids and mucins in tissues.)

Question 11

What is collection of russel bodies called? Where are they seen in

Answer 11

Mott cell
seen in cases of Chronic inflammation
multiple myeloma (clonal malignancy of plasma cell)
and glioma in rats

Question 12

Explain Rhinosinusitis.

Answer 12

Inflammation of the epithelial wall surrounding the nasal sinuses.

Frontal, Ethmoid, maxillary and sphenoid :)

Obstruction of sinus drainage in the nasal cavity=stagnation=bacteria loves stagnation=Inflammation of the linning of paranasal sinus=pain :( (infection is painful)

it can be acute,subacute,chronic or recurret

usually occurs in maxilary as the drainage is against gravity=high chance of stagnation

Question 13

where do the paranasal sinus drains?

Answer 13

superior meatus- sphenoid and posterior ethmoid
middle= frontal maxillary and anterior ethmoid
inferior= drains the lacrimal duct

Question 14

causes of Rhinosinusitis?

Answer 14

viral= rhinovirus
Bacterial = usually superimposed infectin after the viral one,

the triad in order Stret. Pneumonia
haemo. influenxae influenzae
moraxella

non infectious causes= allergy air pollution barotrauma smoking anatomical problem

Question 15

how do you diffrentiate between a tooth ache and sinusitis?

Answer 15

sinusitis worsens while tilting head forward due to pressure

Question 16

where do sinusitis spread?

Answer 16

into eustacian tube (otitis media)

into ethmoidal vein=ethmoidal vien thrombophlebitis=eye socket= PERIORBITAL CELLULITIS= loss of vision

sinusitis=Facial bone=osteomyelitis (potts puffy tumor)

can also cause meningitis and brain abcess

Question 17

Explain Cavernous sinus Thrombosis.

Answer 17

Cavernous sinus thrombosis is a blood clot in the cavernous sinuses. It can be life-threatening. The cavernous sinuses are hollow spaces located under the brain, behind each eye socket. A major blood vessel called the jugular vein carries blood through the cavernous sinuses away from the brain

.The cavernous sinus is a relatively large venous channel formed by a splitting of the dura mater on each side of the body of the sphenoid bone.

symptoms
- sudden onset of periorbital (around the eye orbit) edema, headache, photophobia, proptosis (eye bulginf)

chemosis in extreme cases (swelling of conjuctiva)

Cavernous sinus contains the CN III IV and VI ( and also tha V1 and V2 of CN V) (opthalmic and maxillary branch of trigeminal nerve) (loss of sensation )

3rd nerve (occulomotor) = ptosis and mydriasis
6th (abducens) cannot abduct eye

drug of choice= amoxicillin/clavulanate

Question 18

What is granulomatosis with Polyangitis? (GWP)

wegners

Answer 18

Granulomatosis with polyangiitis is an uncommon disorder that causes inflammation of the blood vessels in your nose, sinuses, throat, lungs and kidneys.

formerly called Wegener’s granulomatosis, this condition is one of a group of blood vessel disorders called vasculitis

Strawberry Gingivitis is seen.

Question 19

Is wegners tha same as ANCA vasculitis?

Answer 19

no.
ANCA vasculitis is an autoimmune disease affecting small blood vessels in the body. It is caused by autoantibodies called ANCAs, or Anti-Neutrophilic Cytoplasmic Autoantibodies. ANCAs target and attack a certain kind of white blood cells called neutrophils.

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis comprises three different syndromes —
granulomatosis with polyangiitis (GWP, also known as –=Wegener’s granulomatosis);
=microscopic polyangiitis (MPA);
=eosinophilic granulomatosis with polyangiitis (EGPA, also known as Churg-Strauss syndrome)

Question 20

What is Ludwig Angina?

Answer 20

Ludwig angina is a type of bacterial infection that occurs in the floor of the mouth, under the tongue. It often develops after an infection of the roots of the teeth (such as tooth abscess) or a mouth injury