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My ENT > Pathology > Flashcards

Pathology Flashcards

1
Q

What are the most important parts of history taking for the ear?

A
  • Hearing loss
  • Tinnitus
  • Vertigo
  • Otalgia
  • Ear discharge
  • Facial weakness
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2
Q

What are the signs of ear disease?

A
  • External scars
  • Abnormalities of the canal:discharge, swelling, bleeding or masses
  • Abnormalities in ear drum
  • Swelling over mastoid
  • Facial weakness
  • Hearing loss
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3
Q

What are the causes of conductive hearing loss?

A
  • otitis externa
  • acute otitis media
  • glue ear
  • perforation
  • cholesteatoma
  • otosclerosis
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4
Q

What are the causes of sensorineural hearing loss?

A
  • presbycusis
  • noise-induced hearing loss
  • drug-induced hearing loss
  • vestibular schwannoma
  • merniere’s disease
  • trauma
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5
Q

What does chronic otitis media include?

A
  • otitis media with effusion (glue ear)
  • cholesteatoma (eardrum pulled inwards where there is a pocket of keratin which becomes infected)
  • perforation
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6
Q

What is a blepharoplasty?

A

surgery on the eye lids

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7
Q

What does dizziness include?

A

vertigo, pre-syncope and disequilibrium

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8
Q

What is vertigo?

A

a sensation of movement which is usually spinning

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9
Q

What are the cardiac symptoms of vertigo?

A

lightheadedness
syncope
palpitation

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10
Q

What are the neurological symptoms of vertigo?

A 
blackouts
visual disturbance
paresthesia
weakness
speech
swallow problems
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11
Q

What are the vestibular symptoms of vertigo?

A

vertigo with sense of spinning, falling or being pushed

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12
Q

What do the different durations of vertigo suggest about the diagnosis?

A
  • seconds: BPPV
  • hours: Meniere’s
  • days: vestibular neuritis
  • variable: migraine associated vertigo
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13
Q

What is the diagnosis for dizzy rolling over in bed?

A

BPPV

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14
Q

What is the diagnosis for first attack severe for hours with nausea and vomiting?

A

Vestibular neuritis

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15
Q

What is the diagnosis for light-sensitive during dizzy spells?

A

Vestibular migraine

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16
Q

What is the diagnosis for one ear feeling full or a change to the hearing around the dizzy spell?

A

Meniere’s disease

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17
Q

What are the types of nystagmus?

A
  • spontaneous
  • bidirectional
  • vertical
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18
Q

What does looking in the direction of a nystagmus do to it?

A

magnifies it

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19
Q

What does dizziness all the time suggest?

A

side effect from medication

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20
Q

What is the function of the tonsils?

A
  • helps immune system develop
  • expose bacteria and viruses to the immune system
  • antibodies can be produced
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21
Q

When do the tonsils develop?

A

after 2 years

they shrink after teenage years

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22
Q

What are the components of Waldeyer’s ring?

A
  • adenoids
  • tubal tonsils
  • palatine tonsils
  • lingual tonsils
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23
Q

What is the histology of the tonsils?

A
  • specialised squamous epithelium
  • deep crypts
  • lymphoid follicles
  • posterior capsule
  • plane behind where they are removed from
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24
Q

What is the histology of the adenoids?

A
  • respiratory epithelium
  • deep folds
  • transitional to stratified squamous
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25
Q

What are the key places for different types of epithelium?

A
  • upper aerodigestive = respiratory/squamous
  • where food goes = squamous
  • where air goes = columnar
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26
Q

What are the symptoms of obstructive hyperplasia?

A
  • adenoid: mouth-breathing, hypo nasal voice, snoring and AOM/OME
  • tonsil: muffled voice, snoring
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27
Q

What are the causes of unilateral tonsil enlargement?

A
  • the way that they sit in the mouth

- neoplasm (there will be bleeding and pain)

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28
Q

What cancer can EBV cause?

A
  • nasopharynx
  • causes glue ear as the cancer is in the Eustachian tube
  • esp in China
  • will present with a lymph node in the posterior triangle
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29
Q

What is common in young who have lymphadenopathy, night sweats and tiredness?

A

lymphoma

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30
Q

What is a pleomorphic adenoma?

A

a benign slow-growing tumour of the parotid gland

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31
Q

What are adjuvant analgesics?

A

painkillers which are primarily used for something other than pain

  • Anticonvulsants: gabapentin, pregabalin
  • Antidepressants: amitriptyline
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32
Q

What happens in type 1 hypersensitivity in the nose?

A

allergen causes mast cells to produce histamine and leukotrienes

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33
Q

What are the main treatments used for stuffy nose?

A
  • Topical corticosteroids eg beclometasone
  • Antihistamines eg cetirizine
  • Decongestants eg pseudoephedrine
  • Anticholinergics eg ipratropium
  • LTR blockers eg montelukast
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34
Q

What are the core nasal symptoms?

A

stuffy: blockage
smell: loss of smell
snot: discharge
sore: facial pain

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35
Q

What is the treatment for vasomotor rhinitis?

A

topical anticholinergic eg ipratropium

36
Q

What are the types of rhinitis?

A
  • non-infective= allergic (intermittent or persistent rhinitis) or non-allergic (vasomotor rhinitis or polyps)
  • infective= rhinosinusitis
37
Q

What are the most important things in nasal trauma?

A
  • top ⅓ of the nose is bone and the bottom ⅔ are cartilaginous
  • Wworry about septal haematoma as blood can’t get to the cartilage so it will die
  • mechanism of injury
38
Q

What are some rarer causes of stuffy nose?

A
  • Adenoid obstruction in children
  • Unilateral smelly discharge from nose of child is a foreign body
  • Mucocele when the sinuses fill up and get infected
  • Maxillary sinus tumour- present late as there is room to grow
  • Orbital cellulitis as a complication of acute sinusitis needs emergency referral
39
Q

What are the main differences in a neonatal ENT?

A
  • weak neck muscles
  • small nares
  • neonates are obligate nasal breathers
  • small and soft larynx
  • narrow subglottis
40
Q

What are the causes of airway obstruction?

A
  • Inflammatory/infective/allergy eg acute epiglottitis
  • Foreign bodies
  • Physical compression
  • Trauma
  • Neurological causes
  • Neoplasm
  • Burns
  • Congenital airway pathology
41
Q

What are the signs and symptoms of airway obstruction?

A
  • SOB
  • Cough
  • Choking
  • Stridor
  • Stertor
  • Sternal recession
  • Dysphagia
  • Dysphonia
  • Pyrexia
  • Cyanosis
42
Q

What is the difference between stridor and stertor?

A
  • Stridor (high pitched noise from airway obstructions)

- Stertor (low pitched sound arising from nasopharyngeal airway)

43
Q

What is subglottic stenosis?

A

narrowing of sub glottis due to scar tissue

44
Q

What is involved in the assessment of airway obstruction?

A
  • skin circulation
  • work of breathing
  • appearance
45
Q

What is a septal haematoma?

A

Bleeding underneath the perichondrium

Can lead to death of cartilage and collapses

46
Q

When do you see patients for nasal injuries?

A

on day 5

47
Q

What are the features of a CSF leak from the nose?

A
  • This is usually from the sphenoid sinus, fracture of cribriform plate
  • Infection can go up where the fluid is coming out
  • Most of these will settle spontaneously in 10 days but if not then go in and repair due to risk of meningitis
48
Q

What are the features of a pinna haematoma?

A
  • This is subperichondrial
  • Contact sports
  • The cartilage can die off
  • Incision or aspiration
  • Pressure dressing and no sport
49
Q

What is the treatment for ear lacerations?

A
  • decried and suture
  • ?reconstruction
  • under LA
50
Q

What to do if someone has sudden sensorineural hearing loss?

A
  • Weber test- if the sounds goes away form the affected ear
  • This is an emergency
  • High dose steroid and then refer for steroids into the ear
51
Q

How and when to remove foreign bodies from the ear?

A
  • Remove batteries immediately

- For animals, drown with oil and then remove the next day

52
Q

How to deal with penetrating trauma to the neck?

A
  • There is zone classification system
  • Do ABCDE
  • Inspect through platysma, if this is intact then there is no significant injury so suture
  • FBC, XR, CXR, CT angio depending on situation
53
Q

What are the features of a deep neck space infection?

A
  • This is from mouth or tonsil
  • There will be less movement of neck, sore throat and unwell
  • Admit, do bloods, give fluid, IV co-amoxiclav or clindamycin if allergic
  • Theatre to drain abscess
54
Q

What are orbital floor fractures usually from?

A
  • golf ball
  • squash ball
  • eye contents can prolapse
55
Q

What are the Le Fort fractures?

A

1 is through maxilla

2 is through midface but not orbits

3 is through all even orbits

56
Q

What are the drugs given for an airway obstruction?

A
  • Heliox is helium and oxygen so this is easier to breathe
  • Nebulised budesonide
  • Dexathansone
  • Nebulised adrenaline high dose
57
Q

What is the most common cause of Reinke’s oedema?

A

smoking

58
Q

What happens in left abductor palsy?

A

left vocal cord sits in the adducted position

the patient can phonate but there is a stridor

59
Q

What happens in left adductor palsy?

A

the left vocal cord sits in the abducted position

the patient has a breathy voice as there is a large gap in the glottis on phonation so air can escape

60
Q

How do cochlear implants work?

A
  • electrical stimulation of neural structures in the cochlea which is then passed onto the brain
  • this is for patients with severe to profound sensorineural hearing loss
61
Q

What is PTA?

A
  • Pure tone audiometry (PTA) is the first hearing test performed to assess hearing loss- this is with air and bone conduction assessment
62
Q

What is tympanometry?

A
  • Tympanometry tests the condition of the middle ear by creating variations of pressure in the ear canal-this distinguishes between sensorineural and conductive hearing loss
63
Q

What is masking?

A

isolate one ear in order to test it by occupying the other ear

64
Q

What are the features of sensorineural hearing loss?

A
  • No significant gap between air and bone conduction thresholds
  • Damage to the hair cells in the cochlea
  • Usually a steady line downwards on a graph
65
Q

What are the features of conductive hearing loss?

A
  • Significant gap between air and bone conduction with bone conduction in the normal range on the graph
  • Sound can’t pass freely to the inner ear
66
Q

What are the features of mixed hearing loss?

A
  • At parts there is gap between air and bone thresholds but bone thresholds are not all within normal limits
  • Damage to both the outer/middle ear and the inner ear
67
Q

What is the histology of the ear?

A
  • auditory meatus to external canal is skin- stratified squamous epithelium
  • middle ear- simple columnar epithelium
68
Q

What is the histology of the salivary gland?

A
  • exocrine gland

- acinar component and a ductular component

69
Q

What is the most common tumour of the ear?

A

squamous cell carcinoma (related to chronic inflammation and radiation)

70
Q

What are the features of Neurofibromatosis Type 2?

A 
sporadic 
neurofibromas
meningiomas
gliomas
cafe au lait
cataracts
71
Q

What are the features of granulomatosis with polyangiitis?

A
  • autoimmune
  • small vessel vasculitis and necrosis with granulomas
  • in respiratory tract and kidneys
  • rare
  • do cANCA levels
72
Q

What are the features of nasal tumours in general?

A

rare

if malignant then squamous cell carcinoma

73
Q

What are the features of Scheiderian/sinonasal papillomas?

A
  • inverted
  • nose
  • over 50y man
  • caused by HPV, smoking, organic solvents
  • presents with blocked nose
74
Q

What are the features of a nasopharyngeal carcinoma?

A
  • very strong EBV link, working with formaldehyde or dust
  • family link
  • three types are keratinising, non-keratinising and baseloid
  • lymphocytes
75
Q

What is EBV associated with?

A
  • lymphoma and carcinoma
  • common
  • causes glandular fever
  • mimics Th cells
76
Q

What are the features of laryngeal polyps?

A
  • not common
  • secondary to vocal abuse, infection and smoking
  • can be caused by pretibial myxoedema
77
Q

What are the features of contact ulcers in the throat?

A
  • benign response to injury
  • posterior vocal cord
  • chronic throat clearing etc
78
Q

What are the features of squamous cell papillomas in the throat?

A
  • less than 5y and between 20-40
  • HPV exposure
  • in children it is aggressive
  • in adults it is a solitary lesion
79
Q

What are the features of paragangliomas?

A
  • in clusters of neuroendocrine cells
  • can be either chromaffin or not
  • rare
  • associated with MEN2
80
Q

What is the most common infection in the salivary gland?

A

paramyxovirus (causes mumps)

81
Q

Where are most tumours if in a salivary gland?

A

the parotid gland

82
Q

What are the features of the two benign salivary gland tumours?

A
  • Pleomorphic adenoma: most common, mostly in parotid, slow-growing, benign, well-circumscribed, encapsulated, women, 40-60y
  • Warthin’s: smoking association, benign, males, 50y over
83
Q

What are the features of the most common malignant salivary gland tumours?

A
  • Mucoepidermoid carcinoma: malignant, most in parotid

- Adenoid cystic carcinoma: most common, palate, over 40y

84
Q

What pathologies cause referred pain to the ear from the auriculotemporal branch of CNV and C1 and C2?

A
  • dental pain
  • temporomandibular joint dysfunction
  • upper cervical osteoarthritis
85
Q

What pathologies cause referred pain to the ear from the facial nerve?

A

Ramsay-Hunt syndrome from varicella reactivation along the sensory division

86
Q

What pathologies cause referred pain to the ear from the vagus nerve?

A

cancer of the larynx and pharynx

My ENT (5 decks)

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