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ENT > Pathology > Flashcards

Pathology Flashcards

1
Q

What lines the auditory meatus and external canal

A

Epidermis - skin

Contains sebaceous and ceruminous glands

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2
Q

What lines the middle ear

A

Columnar lined mucosa

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3
Q

What is found in the middle ear

A

Ossicles - malleus, incus and stapes
Eustachian tube opening
Mastoid cavity

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4
Q

Where are the hair cells found in the cochlea

A

Basilar membrane

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5
Q

What lines the nose

A

Outer part is squamous epithelium

Inner nose is respiratory epithelium with seromucinous glands

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6
Q

What cell types are found in a salivary duct

A

Serous cells - dark staining
Mucinous components
Peripheral myoepithelial cells

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7
Q

What is otitis media and what causes it

A

Inflammation of the middle ear
Usually viral
Bacteria: strep pneumoniae, H. influenzae or Moraxella

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8
Q

What is cholesteatoma

A

Abnormally situated squamous epithelium in the middle ear
High cell turnover and abundant keratin
Associated inflammation

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9
Q

Describe a vestibular schwannoma

A

Tumour associated with vestibular part of CNVIII
Occurs in temporal bone
Can cause headaches and compress parts of the brain
Well circumscribed
Seen in NF type 2

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10
Q

What can cause rhinitis and sinusitis

A

Viral or bacterial infection

Allergy - hayfever

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11
Q

What can cause nasal polyps

A 
Allergy 
Infection 
Asthma 
Aspirin reaction 
CF in young children
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12
Q

How does granulomatosis with polyangiitis present

A

Pulmonary or renal disease - small vessel vasculitis affects these areas
Nasal congestion
Septal perforation

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13
Q

What is the most common cancer to affect the nose

A

squamous cell carcinoma

less commonly get adenocarcinoma, nasopharyngeal carcinoma

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14
Q

Which cancers are associated with EBV

A

Lymphoma

Nasopharyngeal carcinoma

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15
Q

What causes laryngeal polyps

A 
Change is laryngeal mucosa in response to trigger: 
Vocal abuse 
Infection 
Smoking 
Hypothyroidism
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16
Q

What can lead to contact ulcers in the throat

A 
Injury to the throat 
Chronic throat clearing 
Voice abuse 
GORD 
intubation
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17
Q

What causes squamous papilloma

A

HPV exposure - type 6 and 11

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18
Q

What is a paraganglioma

A

Tumours arising in clusters of neuroendocrine cells dispersed throughout the body
Can affect sympathetic nerves, carotid and aortic bodies and ENT system
Common in MEN2

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19
Q

Which of the salivary gland is the most common site for tumours

A

Parotid

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20
Q

What is sialolithiasis

A

Stones in the salivary glands

Due to calcium deposits

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21
Q

What is Waldeyer’s ring

A

Ring of lymphoid tissue at the back of the mouth

Comprised of palatine tonsils, adenoids and lingual tonsils

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22
Q

Describe the histological structure of the tonsils

A

Specialised squamous epithelium with deep crypts and lymphoid follicles

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23
Q

Describe the histological structure of the adenoids

A

Ciliated pseudostratified columnar and

stratified squamous epithelium

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24
Q

List causes of acute tonsillitis

A 
EBV 
Rhinovirus 
Influenzas 
Parainfluenza 
Adenovirus 
Group A strep
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25
Q

Oral candida infections are common in which people

A

Immunocompromised

Inhaler users

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26
Q

List symptoms of viral tonsillitis

A 
Malaise
Sore throat, mild analgesia requirement
Temperature
Able to undertake near normal activity
Possible lymphadenopathy
Lasts 3-4 days
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27
Q

List symptoms of bacterial tonsillitis

A 
Systemic upset,
Fever
Odynophagia
Halitosis
Unable to work / school
Lymphadenopathy
Lasts  around 1 week
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28
Q

What are the centor criteria for diagnosing bacterial tonsillitis

A 
History of fever
Tonsillar exudates
Tender anterior cervical adenopathy
Absence of cough
All give one point 
Age <15 add 1 point 
Age > 44
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29
Q

How do you use the results of the centor criteria

A

0 or 1 points - no antibiotics, low bacterial risk
2 or 3 - give antibiotics of symtpoms get worse
4 or 5 - treat empirically

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30
Q

How do you treat tonsillitis

A

Supportive - rest, analgesia
Antibiotics - penicillin or clarithromycin
IV fluid, antibiotics and steroids if in hospital

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31
Q

What is a peritonsillar abscess

A

Complication of Acute tonsillitis

Bacteria between muscle and tonsil produce pus

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32
Q

How does a peritonsillar abscess present

A

Unilateral throat pain and odynophagia
3-7 days of preceding acute tonsillitis
Cannot open their mouth as wide
Medial displacement of tonsil and uvula

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33
Q

How do you treat a peritonsillar abscess

A

Aspiration and antibiotics

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34
Q

List signs of glandular fever

A 
Gross tonsillar enlargement with membranous exudate
Marked cervical lymphadenopathy
Palatal petechial haemorrhages
Generalised lymphadenopathy
Hepatosplenomegaly
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35
Q

How do you diagnose glandular fever

A

Atypical lymphocytes in peripheral blood
+ve Monospot or Paul-Bunnell test
Low CRP (<100)

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36
Q

What drug should not be given to someone with glandular fever

A

Ampicillin

Will give a macular rash

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37
Q

How do you manage glandular fever

A 
Symptomatic treatment 
Antibiotics 
Steroids 
Avoid alcohol for 6 weeks
Avoid contact sports - risk of spleen rupture
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38
Q

List symptoms of chronic tonsillitis

A

chronic sore throat
malodorous breath
peritonsillar erythema
tender cervical lymohadenopthay

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39
Q

Which structures can lead to obstructive hyperplasia

A

Adenoids

Tonsils

40
Q

List signs of obstructive hyperplasia caused by the adenoids

A

Obligate mouth breathing
Hyponasal voice
Snoring and other signs of sleep disturbance
AOM / OME

41
Q

List signs of obstructive hyperplasia caused by the tonsils

A

Snoring and other symptoms of sleep disturbance
Muffled voice
Dysphagia

42
Q

List the major nasal symptoms

A

Blockage
Loss of smell
Discharge - clear in allergy, infection is green/yellow
Facial pain

43
Q

List causes of rhinitis

A

Viral UTRI - may get a superimposed bacteria linfection
Allergy - pollen, animals, dust mites
Vasomotor - caused by overstimulation of parasympathetic or polyps

44
Q

List signs of allergic rhinitis

A

Crease on bridge of nose from pushing nose back and rubbing it lots
Complain of itchy nose, eyes and soft palate
Breathing through mouth a lot – potential blocked nose
May struggle when eating
Other allergic symptoms/conditions

45
Q

How do you treat allergic rhinitis

A 
Allergen avoidance 
Antihistamines 
Then try topical steroids - nasal spray 
Then use a combination
Monoclonals becoming more popular   
Immunotherapy - not used in NHS but still works, antigen exposure
46
Q

What condition are nasal polyps associated with

A

Non-allergic asthma

Rhinitis

47
Q

How do you treat nasal polyps

A

Oral then topical steroids

Eventually surgery if it doesn’t resolve

48
Q

What are the symptoms of infective rhinosinusitis

A

Facial pain
Discharge
Nasal blockage
Reduced sense of smell

49
Q

How do you treat infective rhinosinusitis

A

Analgesic and decongestants
Most are viral
If it persists or gets worse, add antibiotics

50
Q

List complications of rhinosinusitis

A

Pressure on the optic nerve can lead to reduced blood flow and blindness
If it spreads to the frontal sinus it can enter the brain and be fatal
Orbital cellulitis

51
Q

What investigations are done for nasal/sinus problems

A

RAST IgE levels
Skin prick tests
Radiographs

52
Q

How can you treat non-infective rhinitis

A 
Allergen/irritant avoidance
Stop drinking alcohol 
Topical nasal steroids 
Antihistamines 
Topical anticholinergic
53
Q

How can you treat infective rhinitis

A

Nasal decongestant
Analgesia
Broad spectrum antibiotic

54
Q

What is a septal haematoma

A

Blood clot under the perichondrium which blocks the blood supply to the cartilage
Leads to cartilage collapse and eventual collapse of the nose

55
Q

What are vocal nodules

A

Calcified nodules on the vocal cords caused by trauma

Common cause of dysphonia in kids

56
Q

At what frequencies does audiology test hearing

A

Speech frequency

125-8000Hz

57
Q

What is masking in audiology

A

The process that allows you to isolate the test ear

Play white noise into other ear

58
Q

If there is no difference between air and bone conduction on an audiogram, what type of hearing loss is it

A

Sensorineural

59
Q

If there is a difference between air and bone conduction on an audiogram, what type of hearing loss is it

A

Conductive

AC will be less than BC

60
Q

What does tympanometry measure

A

Middle ear and drum function
Bounces sound off the drum and measures how much comes back
Senses pressure in ear

61
Q

How do you manage vasomotor rhinitis

A

Ipratropium nasal spray which blocks parasympathetic and dries up the nose

However, must avoid in those with glaucoma as can increase pressure slightly

62
Q

What causes vasomotor rhinitis

A

Overstimulation of the parasympathetic system causes running of the nose
More common in elderly as they are more likely to have autonomic dysfunction.

63
Q

Allergic rhinitis is often seen alongside which condition

A

Overlap with other allergic conditions such as asthma, ezcema
Linked to asthma as it the same mucosa and a similar immunological mechanism

64
Q

Allergic rhinitis is most common in which parts of the world

A

Developed world - hygiene hypothesis?

IgE initially designed to help deal with parasitic infection so as we don’t have a lot of these in the western world the IgE instead becomes overreactive to other allergens

65
Q

How do you diagnose allergic rhinitis

A

Typically a clinical diagnosis with a classic history
2 or more from rhinorrhoea, sneezing, nasal obstruction, itch, conjunctivitis
Can do a IgE skin prick test or blood test to be 100% sure or find specific trigger (mainly done in hospitals not GP - they just treat)

66
Q

How does allergic rhinitis present

A 
Rhinorrhoea = runny nose, usually clear 
Sneezing - irritation of nose nerves 
Blocked nose = vasodilation 
Itch 
May have eye symptoms
67
Q

How does rhinitis increase risk of lower respiratory tract infection

A

Breathing through the nose is actually protective - cleans, warms and humidifies air and forms part of innate immune system - mucus trapping, IgA, lysozymes
Therefore, blocked nose such as allergic rhinitis increases risk of lower airway infection/inflammation by forcing us to mouth breathe

68
Q

What is the definition of persistent allergic rhinitis

A

All year round
In response to dogs, cats and dust mits typically
Symptoms for > 4 days per week and more than 4 weeks per year

69
Q

What is the definition of intermittent allergic rhinitis

A

Seasonal allergies
In response to pollen (grass in summer, tree in spring)
Symptoms < 4 days a weeks or <4 weeks a year

70
Q

What is the definition of mild rhinitis

A

Normal sleep and no impairment of daily living, work and no troublesome symptoms

71
Q

What is the definition of moderate to severe rhinitis

A

Abnormal sleep, impairment of daily livingm missing work or school and troublesome symptoms

72
Q

List some non-pharmacological treatments for allergic rhinitis

A

Saline rinse of nose to get rid of allergen
Allergen avoidance
For dust mites cover mattress and pillow and wash regularly, wash them at 60C, damp dust and clean carpet

73
Q

What part of the immune system are responsible for allergic rhinitis

A

IgE mediated immune response - Th2 driven response as they stimulate B cells to produce excess IgE

Also in the nose the allergen binds to mast cells which then release inflammatory mediators such as histamine, cytokines and interleukins

74
Q

List pharmacological treatments for rhinitis

A

Non-sedating antihistamine - cetirizine and loratadine

Leukotriene receptor antagonist - Montelukast

Omalizumab - binds to circulating IgE, given as injection
Monoclonal antibodies

Steroids - given as a nasal spray, topical
Beclomethasone - cheap, bd
Fluticasone

75
Q

What treatment is best for the symptom of blocked nose in particular

A

Nasal steroid

76
Q

A fixed blocked nose (i.e. same side all the time) is suggestive of what

A

Septal deviation or polyps

77
Q

A variable blocked nose (i.e. sides change sides) is suggestive of what

A

More likely to be a mucosal problem such as rhinitis

78
Q

What is the definition of hoarseness

A

A change in the voice or an abnormal voice (dysphonia)

79
Q

What is the definition of aphonia

A

Aphonia is a complete loss of voice

80
Q

Describe a wheeze

A

Expiratory breath sound
Multi-phonic - lots of notes
More associated with the lower respiratory tract and reversible causes of airway obstruction (asthma)

81
Q

Describe stridor

A

High pitched and harsh
Can be inspiratory or expiratory
If present on inspiration it can be a sign of impending airway closure
Reflects a narrowed/obstruction airway with turbulent airflow in the larynx, trachea or main bronchi

82
Q

Describe stertor

A

Low pitched snoring sound
Caused by the soft palate and pharynx or nasopharynx vibrating Airway obstruction above the larynx
Seen in sleep apnoea

83
Q

List causes of airway obstruction

A 
Foreign body 
Tumour 
Infection - epiglottitis/supraglottitis 
Anaphylaxis 
Laryngeal inflammation of any kind - smoke/heat inhalation
84
Q

How can lung cancer cause hoarseness

A

Apical lung tumours can cause hoarseness through compression of the recurrent laryngeal
May also have signs of Horner’s

85
Q

How does tracheostomy increase infection risk

A

Cold dry air inhaled via the tracheastoma causes crusting and dries out the membranes, increasing risk of infection

Therefore use humidifiers in the home, caps for the end of the stoma to reduce cold/dry air

86
Q

A pulsatile neck lump is suggestive of what

A

A carotid body tumour

87
Q

List causes of a neck lump in adults

A 
Cancer - local or mets 
Reactive or infective lymphadenopathy 
Dermoid cysts
Congenital masses - thyroglossal cyst, branchial cyst, lymphatic malformation 
Thyroid  nodules or cysts 
inflammatory thyroiditis
88
Q

List causes of salivary gland masses

A

Inflammatory
Infection
Stone blocking the ducts
Parotid tumours

Can be parotid, sublingual or submandibular

89
Q

How does a dermoid cyst present

A

Midline neck lump
Non-tender
Mobile

90
Q

How does a thyroglossal duct cyst present

A

Forms in a remnant of the duct that thyroid descends through
Mass in the midline of the neck
It moves up when they stick their tongue out

91
Q

What is the most common cause of neck masses in children

A

Most are reactive lymphadenopathy in response to infection which settle with time
If they then present severely unwell, consider a neck abscess from infection

92
Q

Which blood vessels anastomose in Little’s area

A

Facial Artery
Anterior Ethmoidal Artery
Sphenopalatine Artery
Greater Palatine Artery

93
Q

How can you cauterise nasal vessles

A

Silver nitrate

94
Q

List symptoms of an acute sinusitis attack

A

Facial pain
Nasal discharge
Pyrexia
Foul taste

95
Q

Smoking can make rhinitis worse - true or false

A

True

ENT (9 decks)

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