ENT path Flashcards
(113 cards)
1
Q
sinonasal respiratory mucosa epi
A
3 types:
ciliated pseudostratified columnar
mucin-containing goblet cells
basal (reserve cells)
2
Q
sinonasal respiratory mucosa lamina propria
A
prominant vascularity
subepi seromucosous glands
3
Q
coryza
A
common cold
profuse catarrhal discharge
4
Q
most common cause of common cold
A
rhinoviruses
picornaviruses, enteroviruses
5
Q
other causes of cold
A
adenovirus echoovirus cornavirus parainfluenza respiratory synctial
6
Q
chronic rhinits
A
> 1month
usually older then 20
may have anatomical abnormalities
bacterial infection may be superimposed
7
Q
nasal plyps
A
can be caused by recurrent attacks of rhinitis
sugests allergies
most patients are not atopic
usually 3-4
8
Q
complications of nasal polyps
A
obstruction
secondary bacterial infection
9
Q
empyema of sinus
A
pus collection
10
Q
mucocele of sinus
A
mucus accumulation, no bacterial involvement
11
Q
acute rhinosinuitis
A
<4wks
12
Q
subacute rhinosinuitis
A
4-12wks
13
Q
chronic rhinosinuitis
A
> 12wks
recurrent acute: 5-10%
obstructive 70-80%
fungal 10-15%
14
Q
serious complications of sinuitis
A
spread to orbit
osteomyelitis
cranial vault extension
septic thrombophlebitis of dural venous sinus
15
Q
ARS
A
acute sinusitis
16
Q
AVRS
A
acute viral sinusitis
associated w/common clod <7days
17
Q
ABRS
A
acute bacterial sinusitis complicated .5-2% of AVRS strep pneumoniae H. influenza morzxella catarrhalis (kids)
18
Q
ARBS suggested by
A
presence of symptoms for seven or more days
symptoms initially improve then worsen
sinusitis associated w//dental disease
19
Q
chronic obstructive sinusitis anatomic risk factors
A
deviated septum trauma foreign body sinonasal mass/neoplasm previous sinus surgery
20
Q
chronic obstructive sinusitis medical/genetic risk factors
A
ASA triad immunodeficiency immotile cilia snydrome cystic fibrosis DM ICU
21
Q
chronic obstructive sinusitis enviromental/allergic risk factors
A
allergic rhinitis nonallergic rhinitis microorganisms sick building syndrome smoking/pollutants dry indoor heating
22
Q
ASA triad
A
aspirin induced chronic rhinosinusitis, nasal polyps, and severe bronchial asthma
23
Q
immotile cilia snydrome
A
kartagener syndrome
defective ciliary action
situs inversus
24
Q
chronic obstructive sinusitis bacterial etiology
A
staph aureus 50% gram neg rods 20% H. influenza group A strep strep pneumoniae cornebacterium diptheriae
25
allergic mucus
clinical- recurrent sinusitis, nasal polyps
histo- Eos, charcot leyden crystals
Tx- surgical debridement, steroids
26
allergic fungal sinusitis
clinical- recurrent sinusitis, nasal polyps
histo- Eos, charcot leyden crystals with fungi
Tx- surgical debridement, steroids
27
fungus ball
aka mycetoma
clinical- mass lesion by x-ray
histo- fungal organisms scant mucous, little inflammation
Tx- surgical debridement
28
invasive fungal sinusitis
clinical- severe sinusitis, neuro deficits
histo- fungal organisms invading tissues and vessels
Tx- surgical debridement, anti-fungals
29
vascular necrotizing lesions
granulomatosis w/polyangitis (wegners)
churg-strauss syndrome
cocaine
30
infectious necrotizing lesions
rhinocerebral mucormycosis
| hasen disease
31
malignant necrotizing lesions
squamous cell carcinoma
adenocarcinoma
lymphomas
32
misc. necrotizing lesions
sarcoidosis
relapsing polychondritis
idiopathic midline destructive disease
33
rhinocerebral mucromycosis
doesn't pick up on silver stain, can be missed, seen on H&E
saprophytic mold fungi mucor
irregular shaped hyphae that have few or no septa
usually uncontrolled DM due to high Fe
34
nasopharyngeal angiofibroma (NA) epidemiology
rare, <1% of head and neck tumors
young males
10-20yrs
35
symptoms of NA
unilateral nasal obstuction and epistaxis
| can have swelling of face, eye, cheek
36
clinical behavior of NA
```
posterolateral wall
fibromuscular stroma origin
benign, but 10-20% locally agressive
9% fatal
have androgen Rs and may resolve w/age
```
37
NA Tx
surgery
hemorrhagic complications not uncommon
requires pre-op arteriogram w/presurgical emolization
38
NA Px
excellent after removal, recurrence 5-25%
39
sinonasal papillomas
aka schneiderian papillomas
benign neoplasm
derived from embryologic schneiderian memebrane
40
sinonasal papillomas Symptoms
epistaxis, nasal obstruction, asymptomatic mass, located in sinonasal tract
41
types of sinonasal papillomas
exophytic 50-60%
inverted 40-50%
oncocytic (5-10%)
42
squamous papilloma
arises in squamous mucosa
| more common then sinonasal mucosa tumors
43
exophytic sinonasal papilloma aka
septal
squamous
fungiform
44
exophytic sinonasal papilloma
```
on septal nasal wall >90%
20-50yr;4-10M:1F
HPV in 60%
recurrence 25%
rarely develops invasive carcinoma
```
45
inverted sinonasal papilloma
lat nasal wall near middle turnbinate or sinus
40-70yrs
2-5M:1F
recurrence 15%
5-10% develop invasive carcinoma w.in 5 yrs
46
oncocytic sinonasal papilloma aka
cylindrical, columnar
47
oncocytic sinonasal papilloma
```
lat nasal wall near middle turbinate
>50 yr
1M:1F
recurrence 25-35%
some develop invasive carcinoma
onocoyte= abundent bright pink cyto due to mitochondria
```
48
olfactory neuroblastoma aka
esthesioneuroblastoma
49
olfactory neuroblastoma
```
arises from neuroendocrine cells in olfactory mucosa
neurosectreotry membrane bound granules
numerous IHC markers
average age 15 and 50
small blue cell tumors
```
50
olfactory neuroblastoma IHC markers
NSE- neuron specific enylase (not specific)
SY- synaptophysin
CgA
CD56(NCAM)
51
olfactory neuroblastoma symptoms
```
extensive polypoid mass
obstruction
epistaxis
anosmia
visual disturbances
```
52
olfactory neuroblastoma Tx
surgery
radiation
chemo
53
olfactory neuroblastoma survival
40-90%
54
nasopharynx
60% NK squamous
| 40% respiratory epi
55
orapharynx and laryngopharynx
100% NK squamous
56
secondary disorders to lymphoid hyperplasia
```
obstruction
sleep apnea
recurrent otitis media
difficult to arouse
daytime sleepiness
poor attention span
poor school performance
snoring
```
57
pertusis
aka whooping cough
extremely small gram neg cocoobacilli
spread vis resp droplets
attaches to pharyngeal and tracheal surfaces
58
pertusis vaccine
DTaP
| aP- acellular pertusis
59
pertusis Dx
nasopharyngeal swab for culture and PCR or serology
60
pertusis stage 1
catarrhal phase
indistuinguishable from common cold
most infectious here
61
pertusis stage 2
paroxysmal phase
paroxysms of intense cough
posttussive vomiting and turning red
infants <6months no characteristic whoop, but may have apneic episodes
62
pertusis stage 3
convalenscent phase
| chronic cough which may last for wks
63
nasopharyngeal carcinoma Histo types
keratinizing- squamous cell carcinoma
nonkeratinizing- squamous cell carcinoma
undifferentiated- carcinoma, w/lymphoid component
64
EBV-related nasopharyngeal carcinoma
ususally undifferentiated type
africa- children
s. china- adults
US-rare
65
environment-related nasopharyngeal carcinoma
diet- nitrosamines
| smoking
66
nasopharyngeal carcinoma survival
70% metastasized at diagnosis
| 60% survival rate after radiation
67
NUT Midline carcinoma
mostly mediastinum
highly aggressive (survival 7mo)
appearance of similar nasopharyngeal and squamous cell carcinoma
BRD4/3-NUT fusion gene
68
acute pharyngitis
```
'beefy red'
usually due to:
adenovirus
HSV
EBV
CMV
some bacterial- strep
```
69
Group A Strep stats
10-20% of 5-15 yr olds
rare in adults
winter-early spring
70
GAS symptoms
```
sore throat +fever
strawberry tounge
absence of cough, coryza, conjunctivitis
HA, nausea, vomiting, ab pain
tender ant cervical lymph nodes
tonsils enlarged, erythamatous, patchy exudate
```
71
fuso bacterium necrophorum
filamentous, anaerobic, gram - rod
part of pharyngeal normal flora
potent endotoxin production turns it pathogenic
10% acute pharyngitis cases
>20% in recurring cases an peritonsilar abscesses
lemierre syndrome
72
lemierre syndrome
jugular v w/thrombophlebitis accompanying abscess
73
C. diptheriae
humans only known reservoir
non-spore forming gram + rod
only strains w/Tox gene cause diptheriae
gene encoded w/in lysogenic bacteriophage
74
diptheriae clinical
sudden onset of exudative pharyngitis that rapidly worsens
production of pseudomembrane
vaccinated w/DTaP, rare
75
rhinoviruses
indirect pharyngitis
| grow in nasal mucous membranes and causes swelling of membranes in area and pharynx
76
adenoviruses
grow in pharyngeal mucosa
| can casue pharyngoconjunctival fever
77
EBV
infectious mononucleosis
mainly in 15-25
can develop lymphadenitis and hepatosplenomegaly
monospot test for heterophile Abs
78
HSV types 1 and 2
gingivitis, stomatitis, and pharyngitis, vesicles in pharyngeal mucosa
cause pain in nn endings -> spread to ganglia and into sensory and autonomic nn
79
influenza
pharyngitis component of the flu
80
CMV and HIV
mononucleosis type illness in acute infection
81
epiglotitis
infection, trauma, chemical irritation
obstruction of airflow
used to be caused by H. influenza type b in kids, but vaccinations make rare
more common in adult males, but rare
82
acute larynx
<3wks
| in children may lead to life threatening laryngoepiglottitis
83
acute laryngitis causes
```
viruses >90% (rhino, parainfluenza, RSV, adenoviruses)
bacterial causes (H. influenza, s. pneumonia)
```
84
croup aka
laryngotracheitis
| larygoracheobronchitis
85
croup
```
mainly affects larynx and trachea, occasionally bronchi
3m-5yr
acute onset, usually march-april
most common cause of inspiratory stridor
seal-like bark
```
86
cause and Tx of croup
mainly parainfluenza
| anti inflammatories
87
xray croup
steeple/bottle sign
88
reinke edema aka
polypoid corditis
89
reinke edema
middle aged females who are heavy smokers
can also occur w/heavy recurrent voice strain
develop husky low pitched voices
reversible
90
vocal cord nodules and polps
reaction to injury of vocal cord
hyperkeratosis
increased myxoid stroma
at jnx of ant and middle third of cord
91
nodules vs polyps
nodules- bilateral small
| polyp unilateral larger
92
vocal cord papilloma
benign neoplasms located on true vocal cards
soft raspberry like exrcesceneces
single in adults, but can be recurrent
linked to HPVS
93
juvenile papilomatosis
multiple papillomas in children
rarely progress to malignanacy, usually regress at puberty
linked to HPV
94
squamous cell carcinoma of larynx
prolonged hoarseness >6wks, is earliest most consistent symptom
dysphagia shortness of breath and other evidence of airway obstruction
palpable cervical nodes 10-20% at the time
95
epidemiology of squamous cell carcinoma of larynx
```
unusually <50, peaks 65-74
5M:1F 2B:1W
90% smokers
alcohol abuse
irradiation, asbestos, HPV
```
96
premalignant changes and invasice carcinoma
hyperplasia -> hyperkeratosis -> dysplasia -> carcinoma in situ -> cancer
97
location of laryngeal carcinoma
glottic 50-60%
supraglottic 30-40% (discovered later)
subglottic
transglottic
98
laryngeal carcinoma sruvival
glottic- 5 yr 65%
| supraglottic 5 yr 45%
99
otitis externa
7-12
swimmers ear
bacterial 90%
fungal 10%
100
otitis externa bacterial
pseudomonas
staphylococcus
gram-neg rods
101
otitis externa fungal
asprgillus
| candida
102
middle ear histo
thin non keratinizing stratified squamous epi
103
cholesteatoma
squamous epi trapped w/in temporal bone
usually secondary from injury to tympanic membrane
may errode ear bones and soft tissue or from visible neck mass
must be surgically excised
104
complications of cholesteatoma
```
hearing loss
facial n paralysis
labrynthitis
meningitis
epidural or brain abscess
```
105
acute otitis media
acute onset, eustachian tube blocked
| most frequent specific diagnosis of febrile children
106
acute otitis media bacteria
S. pneumonia
H. influenza
M. Catarrhalis
107
chronic otitis media bacteria
psuedomoas aeurginosa
| s. aureus
108
chronic otitis media long term sequllae
```
perforated tympanic membrane
scarring
mastoiditis
bone erosion
cysts
conductive hearing loss
```
109
middle ear cysts
.5-3cm
2 types:
squamous epithelium with large keratin production
metaplstic columnar epi- mucin secreting
110
otosclerosis
50% have FHx
autosomal dominant, variable penetrance
boney overgrowth
111
clinical course otosclerosis
begins u/l, 60-80% become b/l
hearing loss late adolescence/young adult
progresses to severe conductive hearing loss
112
carotid body tumor
```
parasympathetic tumor
increase ventilatory rate
slow growing, painless mass, pulsatile
bruit
mean age 40s, but rare
50% fatal
```
113
carotid body familial
```
5-10%
multiple, b/l
MEN type 2a and 2b
vonHippel Lindau syndrome
neurofibromatosis type 1
```
