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Pathology Flashcards

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1
Q

What lines the auditory meatus and external canal

A

Epidermis - skin

Contains sebaceous and ceruminous glands

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2
Q

What lines the middle ear

A

Columnar lined mucosa

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3
Q

What is found in the middle ear

A

Ossicles - malleus, incus and stapes
Eustachian tube opening
Mastoid cavity

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4
Q

Where are the hair cells found in the cochlea

A

Basilar membrane

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5
Q

What lines the nose

A

Outer part is squamous epithelium

Inner nose is respiratory epithelium with seromucinous glands

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6
Q

What cell types are found in a salivary duct

A

Serous cells - dark staining
Mucinous components
Peripheral myoepithelial cells

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7
Q

What is otitis media and what causes it

A

Inflammation of the middle ear
Usually viral
Bacteria: strep pneumoniae, H. influenzae or Moraxella

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8
Q

What is cholesteatoma

A

Abnormally situated squamous epithelium in the middle ear
High cell turnover and abundant keratin
Associated inflammation

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9
Q

Describe a vestibular schwannoma

A

Tumour associated with vestibular part of CNVIII
Occurs in temporal bone
Can cause headaches and compress parts of the brain
Well circumscribed
Seen in NF type 2

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10
Q

What can cause rhinitis and sinusitis

A

Viral or bacterial infection

Allergy - hayfever

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11
Q

What can cause nasal polyps

A 
Allergy 
Infection 
Asthma 
Aspirin reaction 
CF in young children
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12
Q

How does granulomatosis with polyangiitis present

A

Pulmonary or renal disease - small vessel vasculitis affects these areas
Nasal congestion
Septal perforation

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13
Q

What is the most common cancer to affect the nose

A

squamous cell carcinoma

less commonly get adenocarcinoma, nasopharyngeal carcinoma

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14
Q

Which cancers are associated with EBV

A

Lymphoma

Nasopharyngeal carcinoma

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15
Q

What causes laryngeal polyps

A 
Change is laryngeal mucosa in response to trigger: 
Vocal abuse 
Infection 
Smoking 
Hypothyroidism
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16
Q

What can lead to contact ulcers in the throat

A 
Injury to the throat 
Chronic throat clearing 
Voice abuse 
GORD 
intubation
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17
Q

What causes squamous papilloma

A

HPV exposure - type 6 and 11

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18
Q

What is a paraganglioma

A

Tumours arising in clusters of neuroendocrine cells dispersed throughout the body
Can affect sympathetic nerves, carotid and aortic bodies and ENT system
Common in MEN2

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19
Q

Which of the salivary gland is the most common site for tumours

A

Parotid

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20
Q

What is sialolithiasis

A

Stones in the salivary glands

Due to calcium deposits

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21
Q

What is Waldeyer’s ring

A

Ring of lymphoid tissue at the back of the mouth

Comprised of palatine tonsils, adenoids and lingual tonsils

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22
Q

Describe the histological structure of the tonsils

A

Specialised squamous epithelium with deep crypts and lymphoid follicles

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23
Q

Describe the histological structure of the adenoids

A

Ciliated pseudostratified columnar and

stratified squamous epithelium

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24
Q

List causes of acute tonsillitis

A 
EBV 
Rhinovirus 
Influenzas 
Parainfluenza 
Adenovirus 
Group A strep
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25
Oral candida infections are common in which people
Immunocompromised | Inhaler users
26
List symptoms of viral tonsillitis
``` Malaise Sore throat, mild analgesia requirement Temperature Able to undertake near normal activity Possible lymphadenopathy Lasts 3-4 days ```
27
List symptoms of bacterial tonsillitis
``` Systemic upset, Fever Odynophagia Halitosis Unable to work / school Lymphadenopathy Lasts around 1 week ```
28
What are the centor criteria for diagnosing bacterial tonsillitis
``` History of fever Tonsillar exudates Tender anterior cervical adenopathy Absence of cough All give one point Age <15 add 1 point Age > 44 ```
29
How do you use the results of the centor criteria
0 or 1 points - no antibiotics, low bacterial risk 2 or 3 - give antibiotics of symtpoms get worse 4 or 5 - treat empirically
30
How do you treat tonsillitis
Supportive - rest, analgesia Antibiotics - penicillin or clarithromycin IV fluid, antibiotics and steroids if in hospital
31
What is a peritonsillar abscess
Complication of Acute tonsillitis | Bacteria between muscle and tonsil produce pus
32
How does a peritonsillar abscess present
Unilateral throat pain and odynophagia 3-7 days of preceding acute tonsillitis Cannot open their mouth as wide Medial displacement of tonsil and uvula
33
How do you treat a peritonsillar abscess
Aspiration and antibiotics
34
List signs of glandular fever
``` Gross tonsillar enlargement with membranous exudate Marked cervical lymphadenopathy Palatal petechial haemorrhages Generalised lymphadenopathy Hepatosplenomegaly ```
35
How do you diagnose glandular fever
Atypical lymphocytes in peripheral blood +ve Monospot or Paul-Bunnell test Low CRP (<100)
36
What drug should not be given to someone with glandular fever
Ampicillin | Will give a macular rash
37
How do you manage glandular fever
``` Symptomatic treatment Antibiotics Steroids Avoid alcohol for 6 weeks Avoid contact sports - risk of spleen rupture ```
38
List symptoms of chronic tonsillitis
chronic sore throat malodorous breath peritonsillar erythema tender cervical lymohadenopthay
39
Which structures can lead to obstructive hyperplasia
Adenoids | Tonsils
40
List signs of obstructive hyperplasia caused by the adenoids
Obligate mouth breathing Hyponasal voice Snoring and other signs of sleep disturbance AOM / OME
41
List signs of obstructive hyperplasia caused by the tonsils
Snoring and other symptoms of sleep disturbance Muffled voice Dysphagia
42
List the major nasal symptoms
Blockage Loss of smell Discharge - clear in allergy, infection is green/yellow Facial pain
43
List causes of rhinitis
Viral UTRI - may get a superimposed bacteria linfection Allergy - pollen, animals, dust mites Vasomotor - caused by overstimulation of parasympathetic or polyps
44
List signs of allergic rhinitis
Crease on bridge of nose from pushing nose back and rubbing it lots Complain of itchy nose, eyes and soft palate Breathing through mouth a lot – potential blocked nose May struggle when eating Other allergic symptoms/conditions
45
How do you treat allergic rhinitis
``` Allergen avoidance Antihistamines Then try topical steroids - nasal spray Then use a combination Monoclonals becoming more popular Immunotherapy - not used in NHS but still works, antigen exposure ```
46
What condition are nasal polyps associated with
Non-allergic asthma | Rhinitis
47
How do you treat nasal polyps
Oral then topical steroids | Eventually surgery if it doesn't resolve
48
What are the symptoms of infective rhinosinusitis
Facial pain Discharge Nasal blockage Reduced sense of smell
49
How do you treat infective rhinosinusitis
Analgesic and decongestants Most are viral If it persists or gets worse, add antibiotics
50
List complications of rhinosinusitis
Pressure on the optic nerve can lead to reduced blood flow and blindness If it spreads to the frontal sinus it can enter the brain and be fatal Orbital cellulitis
51
What investigations are done for nasal/sinus problems
RAST IgE levels Skin prick tests Radiographs
52
How can you treat non-infective rhinitis
``` Allergen/irritant avoidance Stop drinking alcohol Topical nasal steroids Antihistamines Topical anticholinergic ```
53
How can you treat infective rhinitis
Nasal decongestant Analgesia Broad spectrum antibiotic
54
What is a septal haematoma
Blood clot under the perichondrium which blocks the blood supply to the cartilage Leads to cartilage collapse and eventual collapse of the nose
55
What are vocal nodules
Calcified nodules on the vocal cords caused by trauma | Common cause of dysphonia in kids
56
At what frequencies does audiology test hearing
Speech frequency | 125-8000Hz
57
What is masking in audiology
The process that allows you to isolate the test ear | Play white noise into other ear
58
If there is no difference between air and bone conduction on an audiogram, what type of hearing loss is it
Sensorineural
59
If there is a difference between air and bone conduction on an audiogram, what type of hearing loss is it
Conductive | AC will be less than BC
60
What does tympanometry measure
Middle ear and drum function Bounces sound off the drum and measures how much comes back Senses pressure in ear
61
How do you manage vasomotor rhinitis
Ipratropium nasal spray which blocks parasympathetic and dries up the nose However, must avoid in those with glaucoma as can increase pressure slightly
62
What causes vasomotor rhinitis
Overstimulation of the parasympathetic system causes running of the nose More common in elderly as they are more likely to have autonomic dysfunction.
63
Allergic rhinitis is often seen alongside which condition
Overlap with other allergic conditions such as asthma, ezcema Linked to asthma as it the same mucosa and a similar immunological mechanism
64
Allergic rhinitis is most common in which parts of the world
Developed world - hygiene hypothesis? IgE initially designed to help deal with parasitic infection so as we don't have a lot of these in the western world the IgE instead becomes overreactive to other allergens
65
How do you diagnose allergic rhinitis
Typically a clinical diagnosis with a classic history 2 or more from rhinorrhoea, sneezing, nasal obstruction, itch, conjunctivitis Can do a IgE skin prick test or blood test to be 100% sure or find specific trigger (mainly done in hospitals not GP - they just treat)
66
How does allergic rhinitis present
``` Rhinorrhoea = runny nose, usually clear Sneezing - irritation of nose nerves Blocked nose = vasodilation Itch May have eye symptoms ```
67
How does rhinitis increase risk of lower respiratory tract infection
Breathing through the nose is actually protective - cleans, warms and humidifies air and forms part of innate immune system - mucus trapping, IgA, lysozymes Therefore, blocked nose such as allergic rhinitis increases risk of lower airway infection/inflammation by forcing us to mouth breathe
68
What is the definition of persistent allergic rhinitis
All year round In response to dogs, cats and dust mits typically Symptoms for > 4 days per week and more than 4 weeks per year
69
What is the definition of intermittent allergic rhinitis
Seasonal allergies In response to pollen (grass in summer, tree in spring) Symptoms < 4 days a weeks or <4 weeks a year
70
What is the definition of mild rhinitis
Normal sleep and no impairment of daily living, work and no troublesome symptoms
71
What is the definition of moderate to severe rhinitis
Abnormal sleep, impairment of daily livingm missing work or school and troublesome symptoms
72
List some non-pharmacological treatments for allergic rhinitis
Saline rinse of nose to get rid of allergen Allergen avoidance For dust mites cover mattress and pillow and wash regularly, wash them at 60C, damp dust and clean carpet
73
What part of the immune system are responsible for allergic rhinitis
IgE mediated immune response - Th2 driven response as they stimulate B cells to produce excess IgE Also in the nose the allergen binds to mast cells which then release inflammatory mediators such as histamine, cytokines and interleukins
74
List pharmacological treatments for rhinitis
Non-sedating antihistamine - cetirizine and loratadine Leukotriene receptor antagonist - Montelukast Omalizumab - binds to circulating IgE, given as injection Monoclonal antibodies Steroids - given as a nasal spray, topical Beclomethasone - cheap, bd Fluticasone
75
What treatment is best for the symptom of blocked nose in particular
Nasal steroid
76
A fixed blocked nose (i.e. same side all the time) is suggestive of what
Septal deviation or polyps
77
A variable blocked nose (i.e. sides change sides) is suggestive of what
More likely to be a mucosal problem such as rhinitis
78
What is the definition of hoarseness
A change in the voice or an abnormal voice (dysphonia)
79
What is the definition of aphonia
Aphonia is a complete loss of voice
80
Describe a wheeze
Expiratory breath sound Multi-phonic - lots of notes More associated with the lower respiratory tract and reversible causes of airway obstruction (asthma)
81
Describe stridor
High pitched and harsh Can be inspiratory or expiratory If present on inspiration it can be a sign of impending airway closure Reflects a narrowed/obstruction airway with turbulent airflow in the larynx, trachea or main bronchi
82
Describe stertor
Low pitched snoring sound Caused by the soft palate and pharynx or nasopharynx vibrating Airway obstruction above the larynx Seen in sleep apnoea
83
List causes of airway obstruction
``` Foreign body Tumour Infection - epiglottitis/supraglottitis Anaphylaxis Laryngeal inflammation of any kind - smoke/heat inhalation ```
84
How can lung cancer cause hoarseness
Apical lung tumours can cause hoarseness through compression of the recurrent laryngeal May also have signs of Horner's
85
How does tracheostomy increase infection risk
Cold dry air inhaled via the tracheastoma causes crusting and dries out the membranes, increasing risk of infection Therefore use humidifiers in the home, caps for the end of the stoma to reduce cold/dry air
86
A pulsatile neck lump is suggestive of what
A carotid body tumour
87
List causes of a neck lump in adults
``` Cancer - local or mets Reactive or infective lymphadenopathy Dermoid cysts Congenital masses - thyroglossal cyst, branchial cyst, lymphatic malformation Thyroid nodules or cysts inflammatory thyroiditis ```
88
List causes of salivary gland masses
Inflammatory Infection Stone blocking the ducts Parotid tumours Can be parotid, sublingual or submandibular
89
How does a dermoid cyst present
Midline neck lump Non-tender Mobile
90
How does a thyroglossal duct cyst present
Forms in a remnant of the duct that thyroid descends through Mass in the midline of the neck It moves up when they stick their tongue out
91
What is the most common cause of neck masses in children
Most are reactive lymphadenopathy in response to infection which settle with time If they then present severely unwell, consider a neck abscess from infection
92
Which blood vessels anastomose in Little’s area
Facial Artery Anterior Ethmoidal Artery Sphenopalatine Artery Greater Palatine Artery
93
How can you cauterise nasal vessles
Silver nitrate
94
List symptoms of an acute sinusitis attack
Facial pain Nasal discharge Pyrexia Foul taste
95
Smoking can make rhinitis worse - true or false
True

ENT (9 decks)

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