Pathology Lab-Eyes, Ears & PNS Flashcards
A 40 year-old woman presents with nasal congestion accompanied with postnasal drainage that has been worsening over the past week. She has seasonal allergies. Occasional smoker. Older sibling also experiences seasonal allergies. Patient reports recent increase in headaches and sinus pain, she also has begun to lose her sense of smell and taste. Anterior rhinoscopy shows presence of semi-transparent lesion in the nasal mucosa. Peripheral eosinophilic count of 1500 cells/microliter. What is the etiology of the lesion seen in the nasal mucosa?
She has an inflammatory nasal polyp. Underlying inflammatory conditions can cause a Th2-induced inflammatory condition in the nasal cavity. Rarely patients get atopic nasal polyps.
A fifty-five-year-old male commercial airline pilot comes to your clinic seeking an ophthalmologic referral. He states that his eyesight has progressively worsened over the last few months. Prior to this experience, his eyesight had always been great and he had never required glasses. Now, he needs a magnifying glass to read his paper and has difficultly driving. Fluorescein angiogram reveals focal subfoveal neovascularization. What do you expect to see on fundoscopic exam of this patient when the degenerative process first began? What would you see when he presents today?
Dry macular degeneration begins with drusen (deposits beneath the macula in Bruch’s membrane). These deposits eventually destroy the overlying photoreceptors and the choroid. Choroidal destruction stimulates VEGF and new blood vessel proliferation causing wet macular degeneration. The new blood vessels can cause hemorrhage and retinal detachment.
A 75-year-old man presents to your office because yesterday, he went totally blind in his left eye.. His vision got progressively worse over the past six months;, and he attributed it to old age, but yesterday, he went totally blind in his left eye. Upon examination, you find the patient is jaundiced and hypertensive. Ophthalmoscope examination reveals a mushroom shaped growth and extensive hemorrhage in the left eye. What caused him to sudden lose all of his vision?
Retinal detachment or hemorrhage into the vitreous.
This 18 month old male was noted by his mother to have ”whiteness” in his left pupil. Usual vaccinations, and has had no previous eye abnormalities. No family history of eye disease. An older brother had a left leg osteosarcoma treated with radiation and excision. Obvious white reflex visible through the left pupil. With pupillary dilation, the white reflex is seen to be a mass apparently in or beneath the retina and pushing the retina forward. What would you expect histological analysis of the mass to look like?
He has retinoblastoma. This is a rapidly growing blue cell neural crest tumor with lots of mitosis, density around blood vessels, Wintersteiner rosettes and necrosis away from the blood vessels.
A 35-year-old male physician with a six-month history of gradual left side hearing loss and tinnitus. What would you expect to see on biopsy of the mass found in his internal ear canal?
Antoni A (hyperdense), Antoni B (hypodense) and Verocay bodies in the Antoni A areas.
A 2-year-old infant was irritable and had a fever of 102° degrees. He was observed pulling on his left ear by his parents and did not want to eat. Temperature 102 ° degrees -the tympanic membrane is tense, reddened and bulges outward. What likely preceded this condition?
Upper respiratory infection. Inflammation from viral infection of the upper airway can block the eustacian tube which creates fluid blockade and secondary bacterial infection.
Why do patients with nasal polyps often present with sinus pain?
Obstruction of sinus outflow.
Injection of a monoclonal antibody for what molecule would help eliminate nasal polyps?
IL-5. In patients with nasal polyps, Th2 response causes IgE secretion. IgE cross-linking causes type I hypersensitivity, with a late phase secretion of IL-5. IL-5 is what causes peripheral eosinophilia.
Conditions associated with eosinophilia
Parasites, drugs, allergies and Hodkin’s lymphoma (Reid-Sternberg cells secrete IL-5), non-Hodgkin’s lymphoma, leukemia and ovarian cancer.
Why do you see squamous cells in the nasal cavity when patients have nasal polyps?
Metaplasia from inflammation.
Retinitis pigmentosa
Group of conditions that lead to apoptosis of rods and cones, causing blindness.
A patient presents with the vision complaint below, what is it?
Scotoma
How do you slow the progression of dry macular degeneration? Wet?
You don’t. You can treat wet macular degeneration with anti-VEGF and lasers.
Risk factors for developing macular degeneration.
Smoking (causes widespread inflammation), obesity (metabolic syndrome), age, hereditary and genetics (CFH, inflammatory mediator).
Vitamin that decreases risk for macular degeneration
Vitamin D in women
Where would this neoplasm have primary spread to if it were found on the conjunctiva?
Melanomas of the conjunctive spread to the lymphatics. When located within the eye it spreads hematogenously to the liver.
What things give a patient the worst prognosis if they have an intra-ocular melanoma?
Elderly, penetration of the sclera, epitheliod histology, metastasis, monosomy 3, trisomy 8 or arises from the ciliary body.
Where in the brain are acoustic schwannomas typically found?
The cerebra-pontine angle. This is where CN VIII begins to acquire Schwann cells.
Acute otitis media in kids
Strep pneumo, Hib and Moraxella
Chronic otitis media
Pseudomonas and staph aureus
What is a serious potential complication of bacteria otitis media?
Meningitis, brain abscess or mastoiditis.
