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ENT > Pathology > Flashcards

Pathology Flashcards

1
Q

What is Otitis Media and what usually causes it?

A

Inflammation of the middle ear
Usually viral
Strep. Penumoniae, H. INfluenzae, moxarella Catarrhalis
Chronic - pseudomonas aeruginosa

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2
Q

What is cholesteatoma?

A

Abnormally sited squamous epithelium in the middle ear

Becomes inflamed and reactive

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3
Q

What is the pathogenesis of cholesteatoma?

A 
chronic otitis media 
or 
perforated tympanic membrane 
or 
congenital (5% of children)
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4
Q

What is a vestibular schwannoma?

A

Benign primary intracrania tumour of the myelin forming cells (Schwann cells) of the vestibulocochlear nerve (CN8)

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5
Q

Are vestibular schwannomas normally associated with a condition or sporadic?

A

95% are sporadic and unilateral

If bilateral and young consider neurofibromatosis type 2

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6
Q

How is neurofibromatosis inherited?

A

Autosomal dominant or sporadic mutation

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7
Q

Describe how a vestibular schwannoma appears on x-ray?

A

Round and encapsulated
Relatively homogenous
Non-infiltrative

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8
Q

List the complications of cholesteatoma.

A

Infection spreads to inner ear - Labyrinthitis
Infection spread to sphenoid sinud - plebitis of cranial cavity
Erodes facial canal - facial nerve paralysis

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9
Q

What is the number 1 imaging used for cholesteatoma?

A

MRI

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10
Q

Describe a nasal polyp.

A

Polyploid, covered in respiratory epithelium with dense oedema. May be packed with eosinophils if allergic component.

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11
Q

What are the aetiologies of nasal polyps?

A 
Allergy 
Infection 
Asthma 
Aspirin sensitivity 
Nickel exposure
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12
Q

What is Wegner’s granuomatosis?

A

Autimmune disorder of unknown aetiology characterised by a small vessel vasculitis limited to the respiratory tract and kidneys.

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13
Q

Are tumours of the nose common?

A

No - rare

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14
Q

What is the most common malignant tumour of the nose?

A

Squamous cell carcinoma

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15
Q

Name the benign tumours that may arise in the nose?

A

Squamus papillomas
“Schneiderian” papillomas
angiofibromas

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16
Q

What are the other malignant cancers that may affect the nose excluding the most common squamous cell carcinoma?

A

Primary adenocarcioma
Nasopharyngeal carcinoma
Neuroblastoma
Lymphoma

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17
Q

Nasopharyngeal carcinoma has a strong association with what?

A

EBV and volatile nitrosamines in food

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18
Q

Laryngeal/ vocal cord polyps are caused by what?

A

Vocal abuse
Infection
Smoking
Ocassionally in hypothyriodism

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19
Q

Who are “nodules” most commonly seen in?

A

young wommen and are bilateral on middle 1/3rd to posterior 1/3rd

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20
Q

Vocal cord “polyps” specifically refers to what?

A

Unilateral and pedunculated

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21
Q

Describe polyps/ nodules?

A

Polyploid in shape
squamous epithellium border
vascular
scarring and fibrosis can be seen

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22
Q

What are contact ulcers?

A

Benign response to injury

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23
Q

What injuries may cause contact ulcers?

A

Chronic throat/ voice abuse

GORD

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24
Q

Why do contact ulcers need to be checked?

A

They commonly break down and bleed so need to check they are not SCC

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25
Q

Squamous papillomas/ papillomatosis are related to what types of HPV infection?

A

Types 6 and 11

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26
Q

What are the two peaks of incidences of Squamous papillomas?

A

< 5 years - aggressive disease, get lots of papillomas

20-40 years - often solitary lesion

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27
Q

Risk factors for squamous cell carcinomas of the head and neck?

A

Smoking
Alcohol
HPV type 16 or 18

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28
Q

Where in the ENT tract are commonly affected by SCC?

A

Tongue base and tonsils

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29
Q

Mets of SCC commonly presents where?

A

Neck

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30
Q

To grade a tumour means what?

A

How like a normal cell is it?

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31
Q

To stage a tumour means what?

A

How far has the tumour gone?

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32
Q

What is a parganglioma?

A

Tumours arising in clusters of neuroendocrine cells dispersed throughout the body.

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33
Q

What is the most common malignant tumour of the salivary glands?

A

Adenoid cystc carcinoma

34
Q

What is the term for salivary gland stones?

A

Sialolithiasis

35
Q

What virus is mumps caused by and what pathology does it create?

A

Paramyxovirus

Bilateral parotitis - inflammation of the parotid glands

36
Q

Which slaivary gland is most commonly affected by a tumour?

A

Parotids

37
Q

If a patient is young and the mass of the salivary gand is painful what should you be thinking?

A

Malignancy

38
Q

Is a pleomorphic adenoma malignant?

A

No but it has maligannt potential

39
Q

Describe the cell basis of pleomorphic adenoma?

A

neoplastic proliferation od parenchymatous glandular cells along with myoepithelial components
mixed epithelial and mesenchymal components

40
Q

How do pleomorphic adenomas present?

A

solitary, slow growing, painless and firm single nodular mass
it is mobile

41
Q

Can pleomorphic adeomas recurr after resection?

A

Yes

42
Q

Adenoid cystic cancers occur in whom and where?

A

Wide age range and wide range of sites

43
Q

The most common malignant tumour of the palate is what?

A

Adenoid cystic carcinoma

44
Q

Adenoid cystic cancers are associated with what and why?

A

Associated with pain and/or loss of function

due to frequent perineural invasion

45
Q

What are the symptoms of Meniere’s disease+

A

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

46
Q

What supportive treatments can be given during episodes of Menieres?

A

Prochlorperazine and cyclone

47
Q

What is vertigo?

A

A sensation of movement usually spinning

48
Q

What does the vestibulo-occular reflex allow you to do?

A

Allows you to track something as your head movesb

49
Q

What other management options are available for Menieres?

A 
Tinnitus therapy
Hearing aids 
Prevention - salt restriction, betahistamines, caffeine and alcohol decrease and stress decrease
Grommet insertion 
Intratympanic gentamicin/steroids 
Surgery
50
Q

What does BPPV stand for?

A

Benign proximal positional vertigo

51
Q

What can trigger BPPV?

A 
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
52
Q

What are the symptoms of BPPV?

A

Brief (seconds) episodes of vertigo
No tinnitus
No hearing loss
No aural fullness

53
Q

What causes BPPV?

A

Otoliths break off from gel and move in to semicircular canals affecting the flow of endolymph

54
Q

What movements are used to diagnose and treat BPPV?

A

Diagnose - Hallpikes test

Treat - Epley manoeuvre

55
Q

What is vestibular neuronitis?

A

Prolonged vertigo (days)
No associated tinnitus or hearing loss
Viral astrology
May be viral prodromal symptoms

56
Q

How long can vestibular neuronitis take before the patient is feeling better?

A

Up to 3 weeks

57
Q

What is labyrinthitis?

A

Prolonged vertigo (days)
Associated tinnitus and/or hearing loss
Viral aetiology
May be viral prodromal symptoms

58
Q

What are the Tx mechanisms for vestibular neuronitis and labyrinthitis?

A

Vestibular sedatives - cyclizine, cinnarizine, bucostile
Generally self limiting
If prolonged or atypical may require further Ix
Rehabilitation exercises if prolonged

59
Q

What symptoms can occur in migraines vertigo?

A

Spontaneous attacks of vertigo and ataxia
Photophobia
Fluctuating hearing loss - small %
Acute permanent hearing loss - small %

60
Q

Why are nasal and pinna heamatomas considered medical emergencies?

A

Perichondrium is lifted off nasal septum or ear cartilage and AVN may occur as the csrtilages require the Perichondrium for blood supply

61
Q

In nasal fractures why does the nose tend to deviate to the right?

A

Most people are right handed so when they punch someone nose deviates to the right

62
Q

Complications of a nasal fracture.

A

Epistaxis
CSF leak
Anosmia
Cribriform plate fracture

63
Q

What treatment is required for a pinna heamatomas?

A

Aspirated or incision or drainage or pressure dressing

64
Q

In blunt trauma what aspect of management is very important before surgery?

A

Debridement

65
Q

What are the two types of temporal bone fractures? Which is most common?

A

Longitudinal fracture - 80%

Transverse fracture - 20%

66
Q

Do transverse and longitudinal fractures of the temporal bone lead to the same kind of deafness?

A

No
Longitudinal - conductive deafness from ossicular chain disruption
Transverse - SNHL due to CN8 damage

67
Q

In neck trauma, if the plasma muscle is not damaged then is anything else damaged?

A

No

68
Q

What method of injury can cause maxillary fractures?

A

High energy blunt force injury to the facial skeleton

69
Q

Le Fort fracture 3 is also known as ..?

A

Craniofacial dysjunction

70
Q

In facial trauma what is the imaging of choice?

A

CT

71
Q

On CT the “tear drop” sign indicates what?

A

Orbital contents have prolapsed

72
Q

A blow outlet fracture involves what walls of the orbit?

A

Medial wall and floor

73
Q

What are the 5 Ss of nose symptoms?

A 
Stuffy 
Snot 
Smell 
Sore 
Sneezing
74
Q

What are the 7 Ds of ear symptoms?

A 
Din din 
Deafness 
Discharge 
Discomfort (pain) 
Dizziness 
Destruction by disease (cholesteatoma)
Defective movement of face
75
Q

Nasal polyps are often associated with what?

A

Non-allergic asthma

76
Q

What classifies intermittent allergic rhinitis?

A

<4 weeks/year

77
Q

What classifies persistent allergic rhinitis?

A

> 1 month per year and >4 days per week

78
Q

What is the treatment of nasal polyps?

A

Oral then topical steroids

Surgery if no better

79
Q

Acute infective rhinosinusitis is characterised by what?

A

Facial pain
Nasal discharge
Nasal blockage
98% are viral

80
Q

When are broad spectrum antibiotics given in acute infective rhinosinusitis?

A

If persisting/ worsening after analgesics and decongestants given

81
Q

Is unilateral or bilateral discharge more worrying and why?

A

Unilateral
Child - foreign body
Adult - nasal or Parnassus tumour
Needs referred urgently!

ENT (4 decks)

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