Pathology Flashcards
What lines the auditory meatus and external canal
Epidermis - skin
Contains sebaceous and ceruminous glands
What lines the middle ear
Columnar lined mucosa
What is found in the middle ear
Ossicles - malleus, incus and stapes
Eustachian tube opening
Mastoid cavity
Where are the hair cells found in the cochlea
Basilar membrane
What lines the nose
Outer part is squamous epithelium
Inner nose is respiratory epithelium with seromucinous glands
What cell types are found in a salivary duct
Serous cells - dark staining
Mucinous components
Peripheral myoepithelial cells
What is otitis media and what causes it
Inflammation of the middle ear
Usually viral
Bacteria: strep pneumoniae, H. influenzae or Moraxella
What is cholesteatoma
Abnormally situated squamous epithelium in the middle ear
High cell turnover and abundant keratin
Associated inflammation
Describe a vestibular schwannoma
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
What can cause rhinitis and sinusitis
Viral or bacterial infection
Allergy - hayfever
What can cause nasal polyps
Allergy Infection Asthma Aspirin reaction CF in young children
How does granulomatosis with polyangiitis present
Pulmonary or renal disease - small vessel vasculitis affects these areas
Nasal congestion
Septal perforation
What is the most common cancer to affect the nose
squamous cell carcinoma
less commonly get adenocarcinoma, nasopharyngeal carcinoma
Which cancers are associated with EBV
Lymphoma
Nasopharyngeal carcinoma
What causes laryngeal polyps
Change is laryngeal mucosa in response to trigger: Vocal abuse Infection Smoking Hypothyroidism
What can lead to contact ulcers in the throat
Injury to the throat Chronic throat clearing Voice abuse GORD intubation
What causes squamous papilloma
HPV exposure - type 6 and 11
What is a paraganglioma
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
Which of the salivary gland is the most common site for tumours
Parotid
What is sialolithiasis
Stones in the salivary glands
Due to calcium deposits
What is Waldeyer’s ring
Ring of lymphoid tissue at the back of the mouth
Comprised of palatine tonsils, adenoids and lingual tonsils
Describe the histological structure of the tonsils
Specialised squamous epithelium with deep crypts and lymphoid follicles
Describe the histological structure of the adenoids
Ciliated pseudostratified columnar and
stratified squamous epithelium
List causes of acute tonsillitis
EBV Rhinovirus Influenzas Parainfluenza Adenovirus Group A strep
Oral candida infections are common in which people
Immunocompromised
Inhaler users
List symptoms of viral tonsillitis
Malaise Sore throat, mild analgesia requirement Temperature Able to undertake near normal activity Possible lymphadenopathy Lasts 3-4 days
List symptoms of bacterial tonsillitis
Systemic upset, Fever Odynophagia Halitosis Unable to work / school Lymphadenopathy Lasts around 1 week
What are the centor criteria for diagnosing bacterial tonsillitis
History of fever Tonsillar exudates Tender anterior cervical adenopathy Absence of cough All give one point Age <15 add 1 point Age > 44
How do you use the results of the centor criteria
0 or 1 points - no antibiotics, low bacterial risk
2 or 3 - give antibiotics of symtpoms get worse
4 or 5 - treat empirically
How do you treat tonsillitis
Supportive - rest, analgesia
Antibiotics - penicillin or clarithromycin
IV fluid, antibiotics and steroids if in hospital
What is a peritonsillar abscess
Complication of Acute tonsillitis
Bacteria between muscle and tonsil produce pus
How does a peritonsillar abscess present
Unilateral throat pain and odynophagia
3-7 days of preceding acute tonsillitis
Cannot open their mouth as wide
Medial displacement of tonsil and uvula
How do you treat a peritonsillar abscess
Aspiration and antibiotics
List signs of glandular fever
Gross tonsillar enlargement with membranous exudate Marked cervical lymphadenopathy Palatal petechial haemorrhages Generalised lymphadenopathy Hepatosplenomegaly
How do you diagnose glandular fever
Atypical lymphocytes in peripheral blood
+ve Monospot or Paul-Bunnell test
Low CRP (<100)
What drug should not be given to someone with glandular fever
Ampicillin
Will give a macular rash
How do you manage glandular fever
Symptomatic treatment Antibiotics Steroids Avoid alcohol for 6 weeks Avoid contact sports - risk of spleen rupture
List symptoms of chronic tonsillitis
chronic sore throat
malodorous breath
peritonsillar erythema
tender cervical lymohadenopthay
Which structures can lead to obstructive hyperplasia
Adenoids
Tonsils
List signs of obstructive hyperplasia caused by the adenoids
Obligate mouth breathing
Hyponasal voice
Snoring and other signs of sleep disturbance
AOM / OME
List signs of obstructive hyperplasia caused by the tonsils
Snoring and other symptoms of sleep disturbance
Muffled voice
Dysphagia
List the major nasal symptoms
Blockage
Loss of smell
Discharge - clear in allergy, infection is green/yellow
Facial pain
List causes of rhinitis
Viral UTRI - may get a superimposed bacteria linfection
Allergy - pollen, animals, dust mites
Vasomotor - caused by overstimulation of parasympathetic or polyps
List signs of allergic rhinitis
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
How do you treat allergic rhinitis
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
What condition are nasal polyps associated with
Non-allergic asthma
Rhinitis
How do you treat nasal polyps
Oral then topical steroids
Eventually surgery if it doesn’t resolve
What are the symptoms of infective rhinosinusitis
Facial pain
Discharge
Nasal blockage
Reduced sense of smell
How do you treat infective rhinosinusitis
Analgesic and decongestants
Most are viral
If it persists or gets worse, add antibiotics
List complications of rhinosinusitis
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
What investigations are done for nasal/sinus problems
RAST IgE levels
Skin prick tests
Radiographs
How can you treat non-infective rhinitis
Allergen/irritant avoidance Stop drinking alcohol Topical nasal steroids Antihistamines Topical anticholinergic
How can you treat infective rhinitis
Nasal decongestant
Analgesia
Broad spectrum antibiotic
What is a septal haematoma
Blood clot under the perichondrium which blocks the blood supply to the cartilage
Leads to cartilage collapse and eventual collapse of the nose
What are vocal nodules
Calcified nodules on the vocal cords caused by trauma
Common cause of dysphonia in kids
At what frequencies does audiology test hearing
Speech frequency
125-8000Hz
What is masking in audiology
The process that allows you to isolate the test ear
Play white noise into other ear
If there is no difference between air and bone conduction on an audiogram, what type of hearing loss is it
Sensorineural
If there is a difference between air and bone conduction on an audiogram, what type of hearing loss is it
Conductive
AC will be less than BC
What does tympanometry measure
Middle ear and drum function
Bounces sound off the drum and measures how much comes back
Senses pressure in ear
How do you manage vasomotor rhinitis
Ipratropium nasal spray which blocks parasympathetic and dries up the nose
However, must avoid in those with glaucoma as can increase pressure slightly
What causes vasomotor rhinitis
Overstimulation of the parasympathetic system causes running of the nose
More common in elderly as they are more likely to have autonomic dysfunction.
Allergic rhinitis is often seen alongside which condition
Overlap with other allergic conditions such as asthma, ezcema
Linked to asthma as it the same mucosa and a similar immunological mechanism
Allergic rhinitis is most common in which parts of the world
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
How do you diagnose allergic rhinitis
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)
How does allergic rhinitis present
Rhinorrhoea = runny nose, usually clear Sneezing - irritation of nose nerves Blocked nose = vasodilation Itch May have eye symptoms
How does rhinitis increase risk of lower respiratory tract infection
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
What is the definition of persistent allergic rhinitis
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
What is the definition of intermittent allergic rhinitis
Seasonal allergies
In response to pollen (grass in summer, tree in spring)
Symptoms < 4 days a weeks or <4 weeks a year
What is the definition of mild rhinitis
Normal sleep and no impairment of daily living, work and no troublesome symptoms
What is the definition of moderate to severe rhinitis
Abnormal sleep, impairment of daily livingm missing work or school and troublesome symptoms
List some non-pharmacological treatments for allergic rhinitis
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
What part of the immune system are responsible for allergic rhinitis
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
List pharmacological treatments for rhinitis
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
What treatment is best for the symptom of blocked nose in particular
Nasal steroid
A fixed blocked nose (i.e. same side all the time) is suggestive of what
Septal deviation or polyps
A variable blocked nose (i.e. sides change sides) is suggestive of what
More likely to be a mucosal problem such as rhinitis
What is the definition of hoarseness
A change in the voice or an abnormal voice (dysphonia)
What is the definition of aphonia
Aphonia is a complete loss of voice
Describe a wheeze
Expiratory breath sound
Multi-phonic - lots of notes
More associated with the lower respiratory tract and reversible causes of airway obstruction (asthma)
Describe stridor
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
Describe stertor
Low pitched snoring sound
Caused by the soft palate and pharynx or nasopharynx vibrating Airway obstruction above the larynx
Seen in sleep apnoea
List causes of airway obstruction
Foreign body Tumour Infection - epiglottitis/supraglottitis Anaphylaxis Laryngeal inflammation of any kind - smoke/heat inhalation
How can lung cancer cause hoarseness
Apical lung tumours can cause hoarseness through compression of the recurrent laryngeal
May also have signs of Horner’s
How does tracheostomy increase infection risk
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
A pulsatile neck lump is suggestive of what
A carotid body tumour
List causes of a neck lump in adults
Cancer - local or mets Reactive or infective lymphadenopathy Dermoid cysts Congenital masses - thyroglossal cyst, branchial cyst, lymphatic malformation Thyroid nodules or cysts inflammatory thyroiditis
List causes of salivary gland masses
Inflammatory
Infection
Stone blocking the ducts
Parotid tumours
Can be parotid, sublingual or submandibular
How does a dermoid cyst present
Midline neck lump
Non-tender
Mobile
How does a thyroglossal duct cyst present
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
What is the most common cause of neck masses in children
Most are reactive lymphadenopathy in response to infection which settle with time
If they then present severely unwell, consider a neck abscess from infection
Which blood vessels anastomose in Little’s area
Facial Artery
Anterior Ethmoidal Artery
Sphenopalatine Artery
Greater Palatine Artery
How can you cauterise nasal vessles
Silver nitrate
List symptoms of an acute sinusitis attack
Facial pain
Nasal discharge
Pyrexia
Foul taste
Smoking can make rhinitis worse - true or false
True
