Pathology Flashcards by Laura Barry

What is Otitis Media and what usually causes it?

Inflammation of the middle ear
Usually viral
Strep. Penumoniae, H. INfluenzae, moxarella Catarrhalis
Chronic - pseudomonas aeruginosa

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What is cholesteatoma?

Abnormally sited squamous epithelium in the middle ear

Becomes inflamed and reactive

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What is the pathogenesis of cholesteatoma?

chronic otitis media 
or 
perforated tympanic membrane 
or 
congenital (5% of children)

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What is a vestibular schwannoma?

Benign primary intracrania tumour of the myelin forming cells (Schwann cells) of the vestibulocochlear nerve (CN8)

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Are vestibular schwannomas normally associated with a condition or sporadic?

95% are sporadic and unilateral

If bilateral and young consider neurofibromatosis type 2

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How is neurofibromatosis inherited?

Autosomal dominant or sporadic mutation

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Describe how a vestibular schwannoma appears on x-ray?

Round and encapsulated
Relatively homogenous
Non-infiltrative

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List the complications of cholesteatoma.

Infection spreads to inner ear - Labyrinthitis
Infection spread to sphenoid sinud - plebitis of cranial cavity
Erodes facial canal - facial nerve paralysis

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What is the number 1 imaging used for cholesteatoma?

MRI

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Describe a nasal polyp.

Polyploid, covered in respiratory epithelium with dense oedema. May be packed with eosinophils if allergic component.

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What are the aetiologies of nasal polyps?

Allergy 
Infection 
Asthma 
Aspirin sensitivity 
Nickel exposure

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What is Wegner’s granuomatosis?

Autimmune disorder of unknown aetiology characterised by a small vessel vasculitis limited to the respiratory tract and kidneys.

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Are tumours of the nose common?

No - rare

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What is the most common malignant tumour of the nose?

Squamous cell carcinoma

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Name the benign tumours that may arise in the nose?

Squamus papillomas
“Schneiderian” papillomas
angiofibromas

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What are the other malignant cancers that may affect the nose excluding the most common squamous cell carcinoma?

Primary adenocarcioma
Nasopharyngeal carcinoma
Neuroblastoma
Lymphoma

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Nasopharyngeal carcinoma has a strong association with what?

EBV and volatile nitrosamines in food

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Laryngeal/ vocal cord polyps are caused by what?

Vocal abuse
Infection
Smoking
Ocassionally in hypothyriodism

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Who are “nodules” most commonly seen in?

young wommen and are bilateral on middle 1/3rd to posterior 1/3rd

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Vocal cord “polyps” specifically refers to what?

Unilateral and pedunculated

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Describe polyps/ nodules?

Polyploid in shape
squamous epithellium border
vascular
scarring and fibrosis can be seen

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What are contact ulcers?

Benign response to injury

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What injuries may cause contact ulcers?

Chronic throat/ voice abuse

GORD

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Why do contact ulcers need to be checked?

They commonly break down and bleed so need to check they are not SCC

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Squamous papillomas/ papillomatosis are related to what types of HPV infection?

Types 6 and 11

What are the two peaks of incidences of Squamous papillomas?

< 5 years - aggressive disease, get lots of papillomas | 20-40 years - often solitary lesion

Risk factors for squamous cell carcinomas of the head and neck?

Smoking Alcohol HPV type 16 or 18

Where in the ENT tract are commonly affected by SCC?

Tongue base and tonsils

Mets of SCC commonly presents where?

Neck

To grade a tumour means what?

How like a normal cell is it?

To stage a tumour means what?

How far has the tumour gone?

What is a parganglioma?

Tumours arising in clusters of neuroendocrine cells dispersed throughout the body.

What is the most common malignant tumour of the salivary glands?

Adenoid cystc carcinoma

What is the term for salivary gland stones?

Sialolithiasis

What virus is mumps caused by and what pathology does it create?

Paramyxovirus | Bilateral parotitis - inflammation of the parotid glands

Which slaivary gland is most commonly affected by a tumour?

Parotids

If a patient is young and the mass of the salivary gand is painful what should you be thinking?

Malignancy

Is a pleomorphic adenoma malignant?

No but it has maligannt potential

Describe the cell basis of pleomorphic adenoma?

neoplastic proliferation od parenchymatous glandular cells along with myoepithelial components mixed epithelial and mesenchymal components

How do pleomorphic adenomas present?

solitary, slow growing, painless and firm single nodular mass it is mobile

Can pleomorphic adeomas recurr after resection?

Yes

Adenoid cystic cancers occur in whom and where?

Wide age range and wide range of sites

The most common malignant tumour of the palate is what?

Adenoid cystic carcinoma

Adenoid cystic cancers are associated with what and why?

Associated with pain and/or loss of function | due to frequent perineural invasion

What are the symptoms of Meniere's disease+

Recurrent spontaneous rotational vertigo with at least 2 mins >20mins Occurence/worsening of tinnitus on affected side Aural fullness on affected side SNHL Need to fit all points

What supportive treatments can be given during episodes of Menieres?

Prochlorperazine and cyclone

What is vertigo?

A sensation of movement usually spinning

What does the vestibulo-occular reflex allow you to do?

Allows you to track something as your head movesb

What other management options are available for Menieres?

``` Tinnitus therapy Hearing aids Prevention - salt restriction, betahistamines, caffeine and alcohol decrease and stress decrease Grommet insertion Intratympanic gentamicin/steroids Surgery ```

What does BPPV stand for?

Benign proximal positional vertigo

What can trigger BPPV?

``` Looking up Turning in bed First lying down in bed at night First getting out of bed in morning Bending forward Rising from bending Moving head quickly ```

What are the symptoms of BPPV?

Brief (seconds) episodes of vertigo No tinnitus No hearing loss No aural fullness

What causes BPPV?

Otoliths break off from gel and move in to semicircular canals affecting the flow of endolymph

What movements are used to diagnose and treat BPPV?

Diagnose - Hallpikes test | Treat - Epley manoeuvre

What is vestibular neuronitis?

Prolonged vertigo (days) No associated tinnitus or hearing loss Viral astrology May be viral prodromal symptoms

How long can vestibular neuronitis take before the patient is feeling better?

Up to 3 weeks

What is labyrinthitis?

Prolonged vertigo (days) Associated tinnitus and/or hearing loss Viral aetiology May be viral prodromal symptoms

What are the Tx mechanisms for vestibular neuronitis and labyrinthitis?

Vestibular sedatives - cyclizine, cinnarizine, bucostile Generally self limiting If prolonged or atypical may require further Ix Rehabilitation exercises if prolonged

What symptoms can occur in migraines vertigo?

Spontaneous attacks of vertigo and ataxia Photophobia Fluctuating hearing loss - small % Acute permanent hearing loss - small %

Why are nasal and pinna heamatomas considered medical emergencies?

Perichondrium is lifted off nasal septum or ear cartilage and AVN may occur as the csrtilages require the Perichondrium for blood supply

In nasal fractures why does the nose tend to deviate to the right?

Most people are right handed so when they punch someone nose deviates to the right

Complications of a nasal fracture.

Epistaxis CSF leak Anosmia Cribriform plate fracture

What treatment is required for a pinna heamatomas?

Aspirated or incision or drainage or pressure dressing

In blunt trauma what aspect of management is very important before surgery?

Debridement

What are the two types of temporal bone fractures? Which is most common?

Longitudinal fracture - 80% Transverse fracture - 20%

Do transverse and longitudinal fractures of the temporal bone lead to the same kind of deafness?

No Longitudinal - conductive deafness from ossicular chain disruption Transverse - SNHL due to CN8 damage

In neck trauma, if the plasma muscle is not damaged then is anything else damaged?

What method of injury can cause maxillary fractures?

High energy blunt force injury to the facial skeleton

Le Fort fracture 3 is also known as ..?

Craniofacial dysjunction

In facial trauma what is the imaging of choice?

On CT the "tear drop" sign indicates what?

Orbital contents have prolapsed

A blow outlet fracture involves what walls of the orbit?

Medial wall and floor

What are the 5 Ss of nose symptoms?

``` Stuffy Snot Smell Sore Sneezing ```

What are the 7 Ds of ear symptoms?

``` Din din Deafness Discharge Discomfort (pain) Dizziness Destruction by disease (cholesteatoma) Defective movement of face ```

Nasal polyps are often associated with what?

Non-allergic asthma

What classifies intermittent allergic rhinitis?

<4 weeks/year

What classifies persistent allergic rhinitis?

>1 month per year and >4 days per week

What is the treatment of nasal polyps?

Oral then topical steroids | Surgery if no better

Acute infective rhinosinusitis is characterised by what?

Facial pain Nasal discharge Nasal blockage 98% are viral

When are broad spectrum antibiotics given in acute infective rhinosinusitis?

If persisting/ worsening after analgesics and decongestants given

Is unilateral or bilateral discharge more worrying and why?

Unilateral Child - foreign body Adult - nasal or Parnassus tumour Needs referred urgently!

Pathology Flashcards

(81 cards)