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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
What are the key places for different types of epithelium?
- upper aerodigestive = respiratory/squamous - where food goes = squamous - where air goes = columnar
26
What are the symptoms of obstructive hyperplasia?
- adenoid: mouth-breathing, hypo nasal voice, snoring and AOM/OME - tonsil: muffled voice, snoring
27
What are the causes of unilateral tonsil enlargement?
- the way that they sit in the mouth | - neoplasm (there will be bleeding and pain)
28
What cancer can EBV cause?
- 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
29
What is common in young who have lymphadenopathy, night sweats and tiredness?
lymphoma
30
What is a pleomorphic adenoma?
a benign slow-growing tumour of the parotid gland
31
What are adjuvant analgesics?
painkillers which are primarily used for something other than pain - Anticonvulsants: gabapentin, pregabalin - Antidepressants: amitriptyline
32
What happens in type 1 hypersensitivity in the nose?
allergen causes mast cells to produce histamine and leukotrienes
33
What are the main treatments used for stuffy nose?
- Topical corticosteroids eg beclometasone - Antihistamines eg cetirizine - Decongestants eg pseudoephedrine - Anticholinergics eg ipratropium - LTR blockers eg montelukast
34
What are the core nasal symptoms?
stuffy: blockage smell: loss of smell snot: discharge sore: facial pain
35
What is the treatment for vasomotor rhinitis?
topical anticholinergic eg ipratropium
36
What are the types of rhinitis?
- non-infective= allergic (intermittent or persistent rhinitis) or non-allergic (vasomotor rhinitis or polyps) - infective= rhinosinusitis
37
What are the most important things in nasal trauma?
- 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
What are some rarer causes of stuffy nose?
- 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
What are the main differences in a neonatal ENT?
- weak neck muscles - small nares - neonates are obligate nasal breathers - small and soft larynx - narrow subglottis
40
What are the causes of airway obstruction?
- Inflammatory/infective/allergy eg acute epiglottitis - Foreign bodies - Physical compression - Trauma - Neurological causes - Neoplasm - Burns - Congenital airway pathology
41
What are the signs and symptoms of airway obstruction?
- SOB - Cough - Choking - Stridor - Stertor - Sternal recession - Dysphagia - Dysphonia - Pyrexia - Cyanosis
42
What is the difference between stridor and stertor?
- Stridor (high pitched noise from airway obstructions) | - Stertor (low pitched sound arising from nasopharyngeal airway)
43
What is subglottic stenosis?
narrowing of sub glottis due to scar tissue
44
What is involved in the assessment of airway obstruction?
- skin circulation - work of breathing - appearance
45
What is a septal haematoma?
Bleeding underneath the perichondrium Can lead to death of cartilage and collapses
46
When do you see patients for nasal injuries?
on day 5
47
What are the features of a CSF leak from the nose?
- 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
What are the features of a pinna haematoma?
- This is subperichondrial - Contact sports - The cartilage can die off - Incision or aspiration - Pressure dressing and no sport
49
What is the treatment for ear lacerations?
- decried and suture - ?reconstruction - under LA
50
What to do if someone has sudden sensorineural hearing loss?
- 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
How and when to remove foreign bodies from the ear?
- Remove batteries immediately | - For animals, drown with oil and then remove the next day
52
How to deal with penetrating trauma to the neck?
- 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
What are the features of a deep neck space infection?
- 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
What are orbital floor fractures usually from?
- golf ball - squash ball - eye contents can prolapse
55
What are the Le Fort fractures?
1 is through maxilla 2 is through midface but not orbits 3 is through all even orbits
56
What are the drugs given for an airway obstruction?
- Heliox is helium and oxygen so this is easier to breathe - Nebulised budesonide - Dexathansone - Nebulised adrenaline high dose
57
What is the most common cause of Reinke's oedema?
smoking
58
What happens in left abductor palsy?
left vocal cord sits in the adducted position the patient can phonate but there is a stridor
59
What happens in left adductor palsy?
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
How do cochlear implants work?
- 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
What is PTA?
- Pure tone audiometry (PTA) is the first hearing test performed to assess hearing loss- this is with air and bone conduction assessment
62
What is tympanometry?
- 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
What is masking?
isolate one ear in order to test it by occupying the other ear
64
What are the features of sensorineural hearing loss?
- 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
What are the features of conductive hearing loss?
- 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
What are the features of mixed hearing loss?
- 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
What is the histology of the ear?
- auditory meatus to external canal is skin- stratified squamous epithelium - middle ear- simple columnar epithelium
68
What is the histology of the salivary gland?
- exocrine gland | - acinar component and a ductular component
69
What is the most common tumour of the ear?
squamous cell carcinoma (related to chronic inflammation and radiation)
70
What are the features of Neurofibromatosis Type 2?
``` sporadic neurofibromas meningiomas gliomas cafe au lait cataracts ```
71
What are the features of granulomatosis with polyangiitis?
- autoimmune - small vessel vasculitis and necrosis with granulomas - in respiratory tract and kidneys - rare - do cANCA levels
72
What are the features of nasal tumours in general?
rare | if malignant then squamous cell carcinoma
73
What are the features of Scheiderian/sinonasal papillomas?
- inverted - nose - over 50y man - caused by HPV, smoking, organic solvents - presents with blocked nose
74
What are the features of a nasopharyngeal carcinoma?
- very strong EBV link, working with formaldehyde or dust - family link - three types are keratinising, non-keratinising and baseloid - lymphocytes
75
What is EBV associated with?
- lymphoma and carcinoma - common - causes glandular fever - mimics Th cells
76
What are the features of laryngeal polyps?
- not common - secondary to vocal abuse, infection and smoking - can be caused by pretibial myxoedema
77
What are the features of contact ulcers in the throat?
- benign response to injury - posterior vocal cord - chronic throat clearing etc
78
What are the features of squamous cell papillomas in the throat?
- less than 5y and between 20-40 - HPV exposure - in children it is aggressive - in adults it is a solitary lesion
79
What are the features of paragangliomas?
- in clusters of neuroendocrine cells - can be either chromaffin or not - rare - associated with MEN2
80
What is the most common infection in the salivary gland?
paramyxovirus (causes mumps)
81
Where are most tumours if in a salivary gland?
the parotid gland
82
What are the features of the two benign salivary gland tumours?
- 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
What are the features of the most common malignant salivary gland tumours?
- Mucoepidermoid carcinoma: malignant, most in parotid | - Adenoid cystic carcinoma: most common, palate, over 40y
84
What pathologies cause referred pain to the ear from the auriculotemporal branch of CNV and C1 and C2?
- dental pain - temporomandibular joint dysfunction - upper cervical osteoarthritis
85
What pathologies cause referred pain to the ear from the facial nerve?
Ramsay-Hunt syndrome from varicella reactivation along the sensory division
86
What pathologies cause referred pain to the ear from the vagus nerve?
cancer of the larynx and pharynx

My ENT (5 decks)

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