Sinonasal & Upper Aerodigestive Tract Flashcards
paranasal sinuses
1 right frontal sinus 2 left frontal sinus 3 ethmoidal cells 4 sphenoidal sinus 5 maxillary sinus
pharynx
1 nasopharynx
2 oropharynx
3 hypopharynx
internal pharynx
1 palatine glands 2 pharyngeal tonsil 3 tubal tonsils 4 palatine tonsil 5 lingual follicles of lingual tonsil
UV on skin of the nose
1 solar (Actinic) keratosis
2 basal cell carcinoma
3 squamous cell carcinoma
Inflammation on skin of nose
1 rosacea= chronic vascular follicular dilation of the nose and cheeks; telangiectasias
2 rhinophyma= form of rosacea, hypertrophy, follicular dilation, hyperplasia of sebaceous glands, fibrosis; increased vascularity
3 lupus erythematosus
nasal Polyps
1 Nasal Polyps Rhinitis (“runny, blocked”) precedes
2 smooth surfaced
3 creamy, semi-translucent
4 ovoid masses
5 histology: immense edema, scattered CICI (mainly plasma cells but if allergic the many eosinophils)
Epistaxis
nosebleeds
Etiology of nosebleeds
1 trauma 2 H.H.T (hereditary Hemorrhagic Telangiectasia) 3 Hypertension 4 THombocytopenia 5 Nasopharyngeal angiofibroma 6 Sarcoidosis 7 Wegener's Granulomatosis 8 Hemangioma
Acute Maxillary Sinusitis
1 Thickened, acutely inflamed sinus membranes
2 Blockage of sinus drainage at ostia
3 persistent stasis of maxillary secretions
4 secondary bacteria infections
5 retained maxillary fluid becomes purulent
6 severe infections: ehtmoid and frontal sinuses; meninges of the brain
Factors of chronic maxillary sinusitis
1 cigarette smoke or allergies
2 deviated nasal septum
3 presence of nasal polyps
squamous papilloma (benign tumor of nose and paranasal sinus)
1 nasal vestibule
2 surface epithelium
3 warty nature
nasopharyngeal angiofibroma (benign tumors of nose and paranasal sinuses)
1 adolescent and young adult males
2 epistaxis
3 may mimic malignancy
Paranasal sinuses
squamous cell carcinoma: causes erosion and maxillary sinus most often
Malignant tumor of the nasopharynx
1 MALToma (Mucosa Associated Lymphoid Tissue) type of lymphoma
2 * Nasopharyngeal Carcinoma
3 Squamous cell carcinoma
Nasopharyngeal carcinoma
1 Epstein-Barr virus origin
2 poorly differentiated
3 prevalent in China, Southeast Asia, and East Africa
4 Early metastasis, late detection
5 Obstruction-secretory otitis media, hearing loss, and tinnitus
6 Diplopia, nasal obstruction, epistaxis, serous nasal discharge
Waldeyer’s ring in the oropharynx
1 palatine tonsils
2 nasopharyngeal tonsils (Adenoids)
3 lingual tonsils
4 tubal tonsils
beta-hemolytic streptococcal pharyngitis (pathology of the oropharynx) is a possible precursor of
1 acute rheumatic fever
2 acute post-streptococcal glomerulonephritis
what is the most common cause of tonsillar enlargement?
reactive lymphoid hyperplasia
What is “Quinsy” (Abscess) or Ludwig’s angina (submandibular space)
acute tonsillitis
Tenacious Pseudomembrane produced results in
obstructive asphyxia
Production of exotoxin
affects heart and nerves
Tympanic membrane of the middle ear
eardrum
what are keloids
-reactive response to injury (acquired diseases of the pinna)
Where is the etiology of conductive deafness most often located?
in ear wax
otitis media with effusion (OME/EAR GLUE)
1 thick mucoid, gray/brown fluid
2 sterile, sticky, glue like
3 accumulates in middle ear of children following blocked Eustachian tube
4 Associated with conductive deafness with intermittent earache
5 Predisposes to acute suppurative otitis media
6 Tympanosclerosis: hyaline degernation of the eardrum mucosa associated with OME
What is the etiology of chronic suppurative otitis media?
persistent non-healing perforation of the tympanic membrane
What are the clinical manifestations of chronic suppurative otitis media?
- chronic earache and deafness
- persistent discharge from external auditory meatus
Most important primary disease of small bones of the middle ear
otosclerosis
meniere’s disease
1 marked distention of the cochlear duct by excess fluid
2 vestibular membrane (of Reissner) (VM) buldges into Scala vestibuli m membrane ruptures with two fluids mixing??? (Slide 47 confusing)
Hearing Loss
sounds waves NOT to inner ear
etiology of hearing loss
1 usually ear wax 2 otitis externa and otitis media 3 barotrauma 4 ear drum perforation 5 otosclerosis 6 congenital malformations
Sensorineural hearing loss
Damage to inner ear or nerve tracts to brain
Etiology of sensorineural hearing loss
1 usually presbyacusis -degernative changes in cochlea -very common in elderly 2 excessive noise 3 ototoxic drugs=ASA, Aminoglycosides, etc. 4 Post infective= Rubella, Cytomegalovirus, Toxoplasmosis, Meningitis 5 Acoustic neuroma 6 Head Injury
Ear disease in Children temporary hearing loss
acute otitis media or OME
Permanent hearing loss in children
usually sensorineural
Angioedema
allergic and toxic damage
1 type I hypersensitivity; may be life-threatening
Allergic and toxic damage of the larynx
1 angioedema
2 acute toxic laryngitis
3 chronic laryngitis
Singer’s nodules
1 Benign Thickenings, nodules, and polyps
2 smooth, round, minute fibrous nodules
3 junction of anterior one third and posterior two thirds of the vocal cord
Laryngeal Carcinoma usually occurs in
male, cigarette smokers, >40 yrs old
Sites of laryngeal Carcinoma
1 glottis= most common; best prognosis
2 Supraglottis= more often mets. since more lymphatics
3 subglottis= rarest; poor prognosis with late onset of symptoms
Some laryngeal carcinoma preceded by epithelial dysplasia
most are well-differentiated squamous cell carcinoma
Verrucous carcinoma variant
1 pathology of the larynx
2 affects one or both true vocal cords
3 locally destructive
4 metastasis is rare unless irradiation treatment
3 characteristic locations of esophageal diverticula
1 *Zenker Diverticulum = immediately above the upper esophageal spincter
2 near the midpoint of the esophagus
3 epiphrenic diverticulum= immediately above the lower esophageal spincter
What causes Achalasia?
loss of ganglion cells of the myenteric plexus (muscular)
Achalasia usually occurs in
middle aged adults
What is a lack of coordinated muscle contraction (peristalsis) and constant contraction of the loewr esophageal spincter. Dilation of the esophagus, difficult swallowing and retention of food bolus?
achalasia
Megaesophagus slowly evolves.
Predisposes to esophageal carcinoma
achalasia
What increases width of esophagus except distal spastic segment?
achalasia
Esophageal Varices
Esophageal submucosal venous channels enormously dilated secondary to portal hypertension (e.g. chronic liver disease, cirrhosis)
What can protrude into the esophagus’s lumen?
Esophageal varices
If this ruptures or overlying mucosa ulcerates, then torrential hemorrhage into esophagus and stomach with hematemesis leads to exanguination
esophageal varices
Mallory-Weiss Tear (laceration)
1 lower esophagus
2 following vomitting with full stomach- severe retching
3 typically seen in alcoholism
hiatal hernia
upper part of stomach moves through the diaphragmatic esophageal hiatus into the thoracic cavity
symptoms of hiatal hernia
reflux, esophagitis, peptic ulcers in intrathoracic stomach and lower esophagus
what is an important complication of hiatal hernia?
esophagitis
two types of hiatal hernia
sliding and paraesophageal (rolling)
Gastroesophageal reflux
most common clinical abnormality of the esophagus
What leads to substernal pain (heartburn)
reflux of gastric acid contents into esophagus
Predisposing factors of Gastroesophageal reflux
1 increase abdominal pressure (overeating, pregnancy, recumbent position)
2 lower esophageal spincter lax or incompetent
( hiatal hernia, excessive smoking, and alcohol ingestion , scleroderma)
3 complications of GERD
esophagitis, erosive esophagitis, esophageal stricture
Gastroesophageal reflux complications
1 reflux-acute inflammation (Esophagitis)
2 Peptic ulceration (Erosive): lower esophagus, small ulcers
3 stricture- lower esophagus, progressive fibrosis of ulceration
4 barrett esophagus
barrett esophagus
persistent reflux results in columnar metaplasia of the lower esophageal squamous epithelial mucosa to glandular tall columnar epithelium and epithelial dysplasia. Eventually, adenocarcinoma may (3-10%) develop so monitor patients with endoscopy and biopsy
What does Adenocarcinoma (malignant esophageal tumor) most often arise from?
aberrant (ectopic) gastric mucosa or Barrett Esophagus
Where does Adenocarcinoma arise most frequently?
lower one third of esophagus
Clinical Squamous Cell Carcinoma
1 alcohol and tobacco use 2 seen more in men 3 affects loewr and middle thirds 4 dysplastic epithelium may precede 5 dysphagia occurs when tumor becomes large
treatment of squamous sell carcinoma
surgery or irradiation
Prognosis of Squamous cell carcinoma?
regional lymph node involvemnet early and common
-survival rate is POOR with 5 yr. survival
Plummer Vinson Syndrome
1 severe iron deficiency anemia
2 middle aged and elderly women
3 more often Scandinavian origin
4 Squamous cell carcinoma at a rare esophageal site: posterior -cricoid area (upper 1/3)
