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Path Flashcards

1
Q

external ear histology

A

Auditory meatus and external canal are lined by epidermis (skin – stratified squamous)

Dermis contains hair follicles, sebaceous and ceruminous glands (made by apocrine glands)
(superficial to deep)

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2
Q

middle ear histology

A

Columnar lined mucosa

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3
Q

nose histology

A

Nasal vestibule – squamous epithelium (skin)

Nose, sinus etc. – respiratory epithelium (pseudostratified ciliated columnar). Sero-mucinous gla

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4
Q

throat histology

A

squamous epithelium depending

resp epithelium under larynx in trachea

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5
Q

salivary glands types of cells

A

acinar and ductal

ducts lined by columnar/cuboidal epithelium

Serous cells – darkly staining. Contain digestive enzymes including amylase

Mucinous component – clear grey staining. Contain glycoproteins

Myoepithelial cells – often flat or cuboidal with clear cytoplasm. Have some contractile properties

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6
Q

Otitis Media

A

Inflammation of middle ear
children

usually viral/ bacterial – Strep. pnuemoniae, H. influenzae and Moxarella catarrhalis

chronic – Pseudomonas aeruginosa, Staph aureus, fungal

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7
Q

Otitis Media symptoms

A

pain
fever
irritability
anorexia
vomiting
often after a viral upper respiratory tract infection

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8
Q

acute otitis media symptoms

A

impaired hearing and fever
discharge when the tympanic membrane perforates with relief of pain.

bacterial

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9
Q

chronic otitis media

A

persistent pain lasting a couple of weeks after the initial episode

glue ear, cholesteatoma, perforation

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10
Q

Cholesteatoma

A

Acquired - chronic otitis media and perforated tympanic membrane

accumulation of skin, squamous epithelium/keratin within the middle eat cleft and mastoid air cells- dead skin in middle ear

goes backwards into mastoid and erodes bone

congenital- Proliferation of embryonic rest

Superior posterior middle ear/ petrous apex or anterior superior

Macro – pearly white mass in middle ear
Micro – squamous epithelium with abundant keratin production. Associated inflammation

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11
Q

Cholesteatoma symptoms

A

persistent foul smelling discharge, headache and otalgia

area of white in the attic behind the tympanic membrane

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12
Q

Cholesteatoma management

A

surgery

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13
Q

ear tumours

A

SSC- most common
or BCC

chronic inflammation or radiation

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14
Q

vestibular schwannoma

A

benign subarachnoid tumour causes pressure on vestibular portion of vestibulocochlear nerve (VIII)

in Internal Auditory Meatus

in temporal bone
cerebellopontine angle tumours

mostly sporadic and unilateral

may be due to exposure to loud noise

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15
Q

Vestibular Schwannoma symptoms

A

asymmetric or unilateral hearing loss and progressive ipsilateral tinnitus

dizzyness
headaches

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16
Q

Vestibular schwannoma investigations and management

A

MRI

40mm + surgery
under then 6 monthly MRI and surveillance

17
Q

rhinitis

A

Infectious rhinitis – common cold (viral)
Allergic rhinitis – hay fever. IgE mediated type 1 hypersensitivity reaction.

18
Q

Sinusitis

A

most commonly preceded by rhinitis, but can spread from dentition

19
Q

Nasal polyps causes

A
  • Occur with inflammation and oedema of the sinus nasal mucosa
  • This oedematous mucosa prolapses into the nasal caviity and can cause significant obstruction

common in adults ,If young – consider cystic fibrosis

causes -allergy, infection, asthma, aspirin sensitivity, nickel exposure

Micro – allergic aetiology associated with eosinophils.

20
Q

Nasal polyps histology

A

Lined by respiratory or squamous epithelium, oedematous stroma containing mixed inflammatory cells +/- eosinophils

21
Q

nasal polyps symptoms

A
  • Blocked nose
  • Runny nose
  • Reduced sense of taste or smell
22
Q

nasal polyps investigations and management

A

Nasoendoscopy

  • Treat with oral then topical steroids
  • If the polyps are large or unresponsive surgical removal is necessary
23
Q

otitis media treatment

A

if doesn’t resolve in 4 days then amoxicillin or erythromycin

ear drops- Neomycin, Gentamicin, Polymyxin B
Framycetin

fungal- Aspergillus niger
Candida albicans

24
Q

SCC symptoms

A
  • Firm, red nodules and sores on skin of the ear
  • Discomfort in the affected ear
  • Hearing problems
  • Tinnutus
  • Vertigo

mri?

25
Q

other possible ear tumours

A

Ceruminous adenoma/adenocarcinoma, meningioma, middle ear adenoma, aggressive papillary tumour

26
Q

rhinitis treatment

A

Nasal irrigation with saline
antihistamines

if no change then intranasal steroids

27
Q

sinusitis treatment

A

antibiotics for severe/deteriorating cases of >10 days duration, 1ST LINE phenoxymethylpenicillin, 2ND LINE doxycycline – NOT IN CHILDREN!!!

28
Q

sinusitis symtoms

A
  • nasal blockage or nasal discharge with facial pain/pressure (or headache) and/or reduction of the sense of smell
  • Severe pain and tenderness with purulent nasal discharge indicates secondary bacterial infection
29
Q

Granulomatosis with polyangiitis/ wegners

A

Rare autoimmune disorder characterized by inflammation of small- and medium-sized blood vessels (vasculitis)

40 +

cancer

30
Q

wegners symptoms

A

sinusitis, nasal crushing, epistaxis, mouth ulcers, sensorineural deafness, otitis media and deafness, ‘saddle nose’ (due to cartilage damage from ischaemia), subglottic inflammation

kidney necrosis

31
Q

wegners signs

A

ANCA positive
microscopic polyangiitis

32
Q

wegners managemnt

A

IV steroids and cyclophosphamide/chemo

33
Q

Eczematous Otitis Externa treatment

A

steroid without antibiotic is preferred.

Antibiotics, particularly neomycin and gentamicin, may cause local sensitivity

exposure to water

34
Q

Otitis Externa- what is it and causes

A

Inflammation of the skin of the ear canal
Almost always infective
bacterial/fungal

Common causes - water, cotton buds, skin conditions

35
Q

glue ear causes adults

A

blocked eustachian tube/obstruction

check back of nose-
Rhinosinusitis
Nasopharyngeal Carcinoma
Nasopharyngeal Lymphoma

36
Q

perforation of ear drum

A

Commonly due to Acute Otitis Media

usually heals by itself or wont due to infection - water/cotton bud

37
Q

Complications of Acute Otitis Media and Cholesteatoma

A

Medially-
Sensorineural Hearing Loss /Tinnitus / Vertigo / Facial Palsy

Superiorly-
Brain Abscess / Meningitis

Posteriorly-
Venous Sinus Thrombosis

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