Pathology Flashcards
What is Otitis Media and what usually causes it?
Inflammation of the middle ear
Usually viral
Strep. Penumoniae, H. INfluenzae, moxarella Catarrhalis
Chronic - pseudomonas aeruginosa
What is cholesteatoma?
Abnormally sited squamous epithelium in the middle ear
Becomes inflamed and reactive
What is the pathogenesis of cholesteatoma?
chronic otitis media or perforated tympanic membrane or congenital (5% of children)
What is a vestibular schwannoma?
Benign primary intracrania tumour of the myelin forming cells (Schwann cells) of the vestibulocochlear nerve (CN8)
Are vestibular schwannomas normally associated with a condition or sporadic?
95% are sporadic and unilateral
If bilateral and young consider neurofibromatosis type 2
How is neurofibromatosis inherited?
Autosomal dominant or sporadic mutation
Describe how a vestibular schwannoma appears on x-ray?
Round and encapsulated
Relatively homogenous
Non-infiltrative
List the complications of cholesteatoma.
Infection spreads to inner ear - Labyrinthitis
Infection spread to sphenoid sinud - plebitis of cranial cavity
Erodes facial canal - facial nerve paralysis
What is the number 1 imaging used for cholesteatoma?
MRI
Describe a nasal polyp.
Polyploid, covered in respiratory epithelium with dense oedema. May be packed with eosinophils if allergic component.
What are the aetiologies of nasal polyps?
Allergy Infection Asthma Aspirin sensitivity Nickel exposure
What is Wegner’s granuomatosis?
Autimmune disorder of unknown aetiology characterised by a small vessel vasculitis limited to the respiratory tract and kidneys.
Are tumours of the nose common?
No - rare
What is the most common malignant tumour of the nose?
Squamous cell carcinoma
Name the benign tumours that may arise in the nose?
Squamus papillomas
“Schneiderian” papillomas
angiofibromas
What are the other malignant cancers that may affect the nose excluding the most common squamous cell carcinoma?
Primary adenocarcioma
Nasopharyngeal carcinoma
Neuroblastoma
Lymphoma
Nasopharyngeal carcinoma has a strong association with what?
EBV and volatile nitrosamines in food
Laryngeal/ vocal cord polyps are caused by what?
Vocal abuse
Infection
Smoking
Ocassionally in hypothyriodism
Who are “nodules” most commonly seen in?
young wommen and are bilateral on middle 1/3rd to posterior 1/3rd
Vocal cord “polyps” specifically refers to what?
Unilateral and pedunculated
Describe polyps/ nodules?
Polyploid in shape
squamous epithellium border
vascular
scarring and fibrosis can be seen
What are contact ulcers?
Benign response to injury
What injuries may cause contact ulcers?
Chronic throat/ voice abuse
GORD
Why do contact ulcers need to be checked?
They commonly break down and bleed so need to check they are not SCC
Squamous papillomas/ papillomatosis are related to what types of HPV infection?
Types 6 and 11
What are the two peaks of incidences of Squamous papillomas?
< 5 years - aggressive disease, get lots of papillomas
20-40 years - often solitary lesion
Risk factors for squamous cell carcinomas of the head and neck?
Smoking
Alcohol
HPV type 16 or 18
Where in the ENT tract are commonly affected by SCC?
Tongue base and tonsils
Mets of SCC commonly presents where?
Neck
To grade a tumour means what?
How like a normal cell is it?
To stage a tumour means what?
How far has the tumour gone?
What is a parganglioma?
Tumours arising in clusters of neuroendocrine cells dispersed throughout the body.
What is the most common malignant tumour of the salivary glands?
Adenoid cystc carcinoma
What is the term for salivary gland stones?
Sialolithiasis
What virus is mumps caused by and what pathology does it create?
Paramyxovirus
Bilateral parotitis - inflammation of the parotid glands
Which slaivary gland is most commonly affected by a tumour?
Parotids
If a patient is young and the mass of the salivary gand is painful what should you be thinking?
Malignancy
Is a pleomorphic adenoma malignant?
No but it has maligannt potential
Describe the cell basis of pleomorphic adenoma?
neoplastic proliferation od parenchymatous glandular cells along with myoepithelial components
mixed epithelial and mesenchymal components
How do pleomorphic adenomas present?
solitary, slow growing, painless and firm single nodular mass
it is mobile
Can pleomorphic adeomas recurr after resection?
Yes
Adenoid cystic cancers occur in whom and where?
Wide age range and wide range of sites
The most common malignant tumour of the palate is what?
Adenoid cystic carcinoma
Adenoid cystic cancers are associated with what and why?
Associated with pain and/or loss of function
due to frequent perineural invasion
What are the symptoms of Meniere’s disease+
Recurrent spontaneous rotational vertigo with at least 2 mins >20mins
Occurence/worsening of tinnitus on affected side
Aural fullness on affected side
SNHL
Need to fit all points
What supportive treatments can be given during episodes of Menieres?
Prochlorperazine and cyclone
What is vertigo?
A sensation of movement usually spinning
What does the vestibulo-occular reflex allow you to do?
Allows you to track something as your head movesb
What other management options are available for Menieres?
Tinnitus therapy Hearing aids Prevention - salt restriction, betahistamines, caffeine and alcohol decrease and stress decrease Grommet insertion Intratympanic gentamicin/steroids Surgery
What does BPPV stand for?
Benign proximal positional vertigo
What can trigger BPPV?
Looking up Turning in bed First lying down in bed at night First getting out of bed in morning Bending forward Rising from bending Moving head quickly
What are the symptoms of BPPV?
Brief (seconds) episodes of vertigo
No tinnitus
No hearing loss
No aural fullness
What causes BPPV?
Otoliths break off from gel and move in to semicircular canals affecting the flow of endolymph
What movements are used to diagnose and treat BPPV?
Diagnose - Hallpikes test
Treat - Epley manoeuvre
What is vestibular neuronitis?
Prolonged vertigo (days)
No associated tinnitus or hearing loss
Viral astrology
May be viral prodromal symptoms
How long can vestibular neuronitis take before the patient is feeling better?
Up to 3 weeks
What is labyrinthitis?
Prolonged vertigo (days)
Associated tinnitus and/or hearing loss
Viral aetiology
May be viral prodromal symptoms
What are the Tx mechanisms for vestibular neuronitis and labyrinthitis?
Vestibular sedatives - cyclizine, cinnarizine, bucostile
Generally self limiting
If prolonged or atypical may require further Ix
Rehabilitation exercises if prolonged
What symptoms can occur in migraines vertigo?
Spontaneous attacks of vertigo and ataxia
Photophobia
Fluctuating hearing loss - small %
Acute permanent hearing loss - small %
Why are nasal and pinna heamatomas considered medical emergencies?
Perichondrium is lifted off nasal septum or ear cartilage and AVN may occur as the csrtilages require the Perichondrium for blood supply
In nasal fractures why does the nose tend to deviate to the right?
Most people are right handed so when they punch someone nose deviates to the right
Complications of a nasal fracture.
Epistaxis
CSF leak
Anosmia
Cribriform plate fracture
What treatment is required for a pinna heamatomas?
Aspirated or incision or drainage or pressure dressing
In blunt trauma what aspect of management is very important before surgery?
Debridement
What are the two types of temporal bone fractures? Which is most common?
Longitudinal fracture - 80%
Transverse fracture - 20%
Do transverse and longitudinal fractures of the temporal bone lead to the same kind of deafness?
No
Longitudinal - conductive deafness from ossicular chain disruption
Transverse - SNHL due to CN8 damage
In neck trauma, if the plasma muscle is not damaged then is anything else damaged?
No
What method of injury can cause maxillary fractures?
High energy blunt force injury to the facial skeleton
Le Fort fracture 3 is also known as ..?
Craniofacial dysjunction
In facial trauma what is the imaging of choice?
CT
On CT the “tear drop” sign indicates what?
Orbital contents have prolapsed
A blow outlet fracture involves what walls of the orbit?
Medial wall and floor
What are the 5 Ss of nose symptoms?
Stuffy Snot Smell Sore Sneezing
What are the 7 Ds of ear symptoms?
Din din Deafness Discharge Discomfort (pain) Dizziness Destruction by disease (cholesteatoma) Defective movement of face
Nasal polyps are often associated with what?
Non-allergic asthma
What classifies intermittent allergic rhinitis?
<4 weeks/year
What classifies persistent allergic rhinitis?
> 1 month per year and >4 days per week
What is the treatment of nasal polyps?
Oral then topical steroids
Surgery if no better
Acute infective rhinosinusitis is characterised by what?
Facial pain
Nasal discharge
Nasal blockage
98% are viral
When are broad spectrum antibiotics given in acute infective rhinosinusitis?
If persisting/ worsening after analgesics and decongestants given
Is unilateral or bilateral discharge more worrying and why?
Unilateral
Child - foreign body
Adult - nasal or Parnassus tumour
Needs referred urgently!
