Medex Objectives Fall 2002
MEDEX Northwest Physician Assistant Objectives Home: http://faculty.washington.edu/alexbert/MEDEX/
Last updated 7 Dec 2003
HEENT Pathology
1. Define chalazion. Distinguish between hordeolums (styes) and chalazions.
Unlike a stye, a chalazion points inside the lid rather then on the lid margin.
Stye- A painful tender red infection around a hair follicle. A stye looks like a pimple or boil on the lid margin.
Anonymous
A “Chalazion” is an chronic inflammation lesion involving a Meibomian gland, (a gland in the eyelid that secrete a substance that keeps the eyelids from adhering to each other). It is a beady nodule in an otherwise normal eyelid, and is usually painless. Occasionally a chalazion becomes inflammed but, unlike a sty, it usually points inside the eyelid rather than on the eyelid margin. Bates; pg 214
Anonymous
Hordeolum (stye) is a localized, purulent, inflammatory staphylococcal infection of a sebaceous gland in the eyelid. It looks like a pimple or boil pointing on the lid margin. A chalazion is a chronic inflammatory lesion involving a meibomian gland. A beady nodule in an otherwise normal lid, it is usually painless. Occasionally a chalazion becomes acutely inflamed but, unlike a sty, usually points inside the lid rather than on the lid margin.Bates, p214 or McCance and Huether p443
Vince B
Chalazion- firm swelling of eyelid from blockage and inflammation of meibomian gland. At first red and tender, but later are firm nodules in the lid. Most resolve with local antibiotics, but some need curettage. Pg 440,484.
Zen Seeker Internet
Hordeolum
A stye or hordeolum is a localized redness, swelling, and tenderness of the upper or lower lid margin (similar to a pimple). Hordeolums are usually caused by a bacterial infection (staphylococcal) of the Meibomian (oil) glands around the lashes. These infections are treated with hot compresses to the affected area several times a day (for 20 - 30 minutes 4 -5 times a day) to increase circulation and promote drainage. Antibiotics can also be used to treat infection.
Chalazion
This is a lump or mass of the eyelid that results from chronic inflammation of a Meibomian gland. Chalazions in early stages are indistinguishable from hordeola, but when they heal they often form a hard non-tender lump within the eyelid. In early stages hot compresses are helpful, but bothersome residual lumps may require surgical removal by an ophthalmologist.
Fig 22.6 page 484 S&L
A chalazoin (meibomian cyst) develops from blockage and inflammation of a meibomian gland. At first, lesions are red and tender, but later form firm nodules in the lid. Most resolve with local antibiotic ointment but some require curettage (removal of tissue or growths from a body cavity, such as the uterus, by scraping with a curette).
Anonymous
Hordeolum (stye) is a localized, purulent, inflammatory staphylococcal infection of a sebaceous gland in the eyelid. It looks like a pimple or boil pointing on the lid margin. A chalazion is a chronic inflammatory lesion involving a meibomian gland. A beady nodule in an otherwise normal lid, it is usually painless. Occasionally a chalazion becomes acutely inflamed but, unlike a sty, usually points inside the lid rather than on the lid margin.
Michelle S&L pgs.- 476-477, Tabers 18th edition pg. 1851
Chalazion- a firm swelling in the eyelid, which bulges under the palpebral conjuctiva.
these are also known as internal styes which invovle meibomian glands.
-See figure 22.6a pg 484
Hordeolums- are superficial and external affecting the Zeis’ galnds.
Sung K, Stevens & Lowe, p.476 and Swartz, p.215
A chalazion is a firm swelling in the eyelid, which bulges under the palpebral (eyelid) conjunctiva and is caused by rupture or blockage and infection of a meibomian gland. A hordeolum is a localized abscess containing pus in an eyelash follicle and is caused by a staphylococcal infection.
2. Name three common causes of conjunctivitis.
Jenny Stevens & Lowe p. 476
Adenovirus types 3&7 cause follicular conjunctivitis. Adenovirus 8&19 cause epidemic keratoconjunctivitis. Allergies cause allergic conjunctivitis. Haemophilus causes bacterial conjunctivitis. Sarcoidosis & TB cause granulomatous conjunctivitis.
Anonymous
Conjunctivitis is usually classified as noninfectious or infectious. Noninfectious causes are mostly allergic and include allergin rhinoconjunctivitis, vernal, atopic, giant papillary, and contact allergy. Infectious causes are bacterial (mucopurulent, purulent-acute and chronic), viral (adenovirus, acute hemorrhagic, herpes simplex/zoster, molluscum contagiosum), fungal (candidal), and chlamydial.
Anonymous
Allergic conjunctivits- associated with a variety of antigens, and pollens. Ocular itching associated with photophobia, burning, and grity sensations in the eye. McCance and Huether p443
Acute bacterial conjunctivites (pinkeye)- highly contagious and often is caused by gram -positive organisms. On set is acute, characterized by mucopurulent drainage from one or both eyes. Hand washing and not using same towel can prevent spread. Antibiotic eye drops as treatment. McCance and Huether p443
Viral conjunctivitis- caused by an adenovirus. Symptoms from mild to severe. Contagious, with watering, redness and photophobia. McCance and Huether p443
Vince B
Conjunctivitis- causes- allergy to pollens, adenovirus type 3,7-follicular conjunctivitis; type 8,19-karoconjunctivitis; bacterial conjunctivitis. Pg 476
Zen Seeker S&L 476
Adenovirus types 3 and 7 cause follicular conjunctivitis
Adenovirus types 8 and 19 cause epidemic keratoconjunctivitis
Allergic conjunctivitis is common in association with allergy to pollens
Bacterial conjunctivitis may also occur due to Haemophilus or, uncommonly, there may be neonatal infection with gonococcus
Granulomatous inflammation of the conjunctiva may be caused by several diseases, particularly sarcoidosis and TB
Michelle Swartz pg. 203
The three most common causes of conjunctivitis are viral, bacterial or allergic.
-See table 9-2 pg. 203
Sung K, Stevens & Lowe, p.476
a. Adenovirus types 3 and 7 cause follicular conjunctivitis and types 8 and 19 cause keratoconjunctivitis
b. Allergy to pollen or other substances can cause allergic conjunctivitis
c. Bacterial conjunctivitis may occur due to Haemophilus or, uncommonly, there may be neonatal infection with gonococcus
d. Several diseases such as sarcoidosis and TB
3. Define pinguecula and pterygium.
Jenny, Stevens & Lowe p. 476
Pinguecula- small areas of yellow thickening of the bulbar conjunctiva. Caused by damaging environmental stimuli I.E. sun. A similar area encroaching over the limbus into the cornea are termed Ptergia.
Anonymous
Pinguecula are elevated, fleshy conjunctival masses located in the interpalpebral region, most commonly on the nasal side. They are yellow or light brown. Pterygium is also fibrovascular tissue that begins on the epibulbar conjunctiva; but in contradistinction to pinguecula, it grows slowly onto the cornea and can eventually affect the vision. Both conditions appear to be related to ultraviolet exposure, repeated trauma, and dry and windy conditions. Bates, 214,216.
Vince B
Pingueculas - proliferation of sub-epithelial support tissues. Small areas of yellow thickening of bulbar conjunctiva. Caused by cumulative exposure to sun, wind, and dust.
Pterygium- similar areas that encroach over the limbus onto cornea.
Zen Seeker S&L 476
Pingueculas - small areas of yellow thickening of the bulbar conjunctiva
Pterygia - similar areas that encroach over the limbus onto the cornea
Internet
Pterygia and pingueculas are among the most commonly encountered eye conditions treated by Ophthalmologists. It is a fleshy appearing growth of conjunctival tissue. The conjunctiva is the clear membrane which covers the white portion or sclera of the eye. The growth usually begins in the corner of the eye closest to the nose. A pinguecula is sometimes a precursor to a pterygium. If the pinguecula continues to proliferate onto the cornea (the clear outer layer of the front of the eye) it is known as a pterygium. When this happens, vision loss may occur.
Anonymous
Pinguecula are elevated, fleshy conjunctival masses located in the interpalpebral region, most commonly on the nasal side. They are yellow or light brown. Pterygium is also fibrovascular tissue that begins on the epibulbar conjunctiva; but in contradistinction to pinguecula, it grows slowly onto the cornea and can eventually affect the vision. Both conditions appear to be related to ultraviolet exposure, repeated trauma, and dry and windy conditions.
Michelle S&L pg.-476
Pingueculas are small areas of yellow thickening of the bulbar conjunctiva. Caused by cumulative exposure to damaging enviromental stimli such as sun, wind, and dust, they will increase in incidence with age.
Similar ares that encroach over the limbus onto the cornea are termed Pterygia.
Sung K, Swartz, p.216
Pinguecula - a benign, whitish-yellow, triangular, nodular growth on the bulbar conjunctiva adjacent to the corneal-scleral junction (limbus); it does not cross onto the cornea; caused by cumulative exposure to damaging environmental stimuli such as sun, wind, and dust
Pterygium - a more vascular growth on the bulbar conjunctiva that begins at the medial canthus (angle of eye) and extends beyond the corneal-scleral junction to the cornea. The cause is unknown but its frequency is higher among people living near the equator.
4. Identify basal cell carcinoma as the most common neoplasm of the lower eyelid, and describe its typical clinical behavior.
Jenny, Stevens & Lowe p.477
Basal cell carcinoma of the lower eyelid are locally invasive and the most common neoplasm arising from the skin of the eyelid.
Anonymous
A basal cell carcinoma, though malignant, grows slowly and seldom metastasizes. It is most common in fair-skinned adults over age 40, and usually appears on the face. An initial translucent nodule 5mm across, spreads, leaving a depressed center and a firm, elevated border. Telangiectatic vessels are often visible. McCance and Huether, p1544-1545
Vince B
Basal cell carcinoma is a common tumor involving the skin of eyelid up to lid margin. Locally invasive and identical to those in other sites.
Zen Seeker S&L 477
Common tumors that involve the skin of the eyelid up to the lid margin (see Fig 22.6c). They are locally invasive and identical to those arising in other sites.
Anonymous
A basal cell carcinoma, though malignant, grows slowly and seldom metastasizes. It is most common in fair-skinned adults over age 40, and usually appears on the face. An initial translucent nodule spreads, leaving a depressed center and a firm, elevated border. Telangiectatic vessels are often visible.
Michelle Swartz pg. 477
Basal cell carcinomas are common tumors that involve the skin of the eyelid up to lid margin. They are locally invasive and identical to those arising in other sites.
-See figure 22.6c pg. 484
Sung K, Griffith’s, p.124 and Stevens & Lowe, p.477
Common tumors that involve the skin of the eyelid up to the lid margin. They are locally invasive and identical to those arising in other sites. May begin as a small, smooth surfaced, well-defined nodule. Color is pink to red with a pearly translucent border. May have varying degree of melanin pigment. As nodule enlarges, central ulceration and crusting occurs.
5. Define keratitis. Identify common infectious causes and potential consequences.
Jenny, Stevens & Lowe p. 477-478
Keratitis- inflammation of the cornea. Infective or inflammatory disorders of the cornea. Infection is most commonly due to viruses (herpes simplex) and bacteria (Chlamydia).
Anonymous
Infection of the cornea that can be caused by bacteria or viruses. Bacterial infection cause corneal ulceration and require intensive antibiotic treatment. Type I herpes simplex virus can involve both the cornea and conjunctiva. Symtoms are, photophobia, pain, and lacrimation. McCance and Huether p443
Vince B
Karatitis- infective or inflammatory disorders of the cornea. Infection is most commonly caused by viruses and bacteria.
Zen Seeker S&L 477-478
Infective or inflammatory disorders of the cornea, which are collectively termed keratitis, can result in scarring leading to opacification. Infection is most common due to viruses (herpes simplex), Chlamydia trachomatis (causing trachoma) and bacteria.
Michelle Swartz pg.477-478
Keratitis- infective of inflammatory disorders of the cornes. Can result in scarring leading to opacification. Most common causes are viruses (herpes Simplex), Chalamydia Trachomatis (causuing trachoma) and bacteria.
Sung K, Stevens & Lowe, p.477-8
Keratitis - inflammation of the cornea. It is generally caused by viruses (herpes simplex), Chlamydia trachomatis (causing trachoma) and bacteria. This condition can result in scarring leading to opacification.
6. Describe the process of cataract formation, and identify common predisposing causes.
Vince B
Cataracts- in cataracts formation, there is degeneration of lens crystallions, which become opaque. Degeneration lens material may gain access to the aqueous where it is phagocytes by macrophages and may cause blockage of orbicular meshwork, leading to secondary open-angle glaucoma. Several predisposing factors include aging (senile cataracts), trauma, Diabetes Mellitus, corticosteroid therapy, inflammation in globe, glaucoma.
Zen Seeker S&L 479
The normal lens is composed of a capsule, lens epithelial cells, and a central mass of tightly packed cells that have lost their nuclei and contain highly stable transparent proteins termed ‘crystallins’. In cataract formation, there is degeneration of lens crystallins, which become opaque. Structural changes in the lens occur with hyaline globules, liquefaction, and focal calcification. Degenerate lens material may gain access to the aqueous, where it is phagocytosed by macrophages and may cause blockage of the trabecular meshwork, leading to secondary open-angle glaucoma.
The main cause of cataracts is thought to be metabolic derangement in lens nutrition, which is derived from diffusion from the aqueous. There are several predisposing factors for development. The most common cataracts are those that develop in aging (senile cataracts). Predisposing conditions for cataract formation include trauma, diabetes mellitus, corticosteroid therapy, inflammation in the globe, glaucoma, and irradiation of the eye. Congenital cataracts may develop after rubella infection in utero.
Tim B Stevens&Lowe
The
formation of cataracts is caused by the degeneration of lens crystallins, which
are highly stable proteins located in central cells of the lens. Structural
changes in the lens occur with hyaline globules, liquefaction and focal
calcification. Common predisposing factors include trauma, diabetes mellitus,
corticosteroid therapy, inflammation of the globe, glaucoma and irradiation of
the eye, all contribute to what is thought to be the main cause of cataracts
which is metabolic derangement in lens nutrition derived from diffusion from
the aqueous. Stevens&Lowe
7. Identify age-related macular degeneration as a common cause of severe vision loss in the elderly.
Vince B
Age related macular degeneration (ARMS) is one of the most common causes of severe loss of vision in the elderly. Pathogenesis appears to involve disturbance in the normal mechanisms of photoreceptor turnover and renewal.
Zen Seeker S&L 479
Age related macular degeneration (ARMS) is one of the most common causes of severe loss of vision in the elderly. Pathogenesis appears to involve disturbance in the normal mechanisms of photoreceptor turnover and renewal.
Tim B
ARMD is one of the most common causes of severe loss of vision in the elderly. The pathogenesis of this condition is not completely understood but appears to involve disturbance in the normal mechanisms for photoreceptor turnover and renewal. Histologically, the affected area shows atrophy of the photoreceptor cell layer with loss of cells from the outer nuclear layer with gliotic scarring. Lipohyaline material may accumulate beneath the pigment epithelium.
8. Identify hypertension and diabetes mellitus as the two most common predisposing causes of vascular disease of the retina.
Vince B
The main predisposing factors for vascular disease are hypertension and DM. Benign HT associated with development of hyaline thickening in retinal vessels. In accelerated phase, flame hemorrhage, exudates, and areas of retinal ischemia develop causing micro infarcts termed cotton-wool spots. Diabetic retinal disease causes thickening of basement membrane of capillaries and hyaline arteriolosclerosis
Zen Seeker S&L 479 - 480
Vascular disorders are a major cause of eye disease, having their main impact on the retina. The main predisposing factors for vascular disease are hypertension and diabetes mellitus. Retinal complications of diabetes mellitus are now one of the most common causes of blindness in western countries.
Among the main vascular diseases is benign hypertension, which is associated with development of hyaline thickening in retinal vessels. In accelerated-phase hypertension, flame hemorrhages, exudates, and areas of retinal ischemia develop, causing microinfarcts termed cotton-wool spots.
Diabetic retinal disease causes thickening of the basement membrane of capillaries and hyaline arteriolosclerosis. Microaneurysms occur as dilations of arterioles and capillaries with abnormally fragile and permeable walls. Exudates develop, with ‘blot hemorrhages’ from leaking capillary vessels. Areas of ischemia cause cotton-wool spots. Retinal ischemia causes secretion of angiogenesis factors, inducing formation of new vessels (proliferative retinopathy).
Tim B
Vascular disorders are a major cause of the eye disease, having their main impact on the retina. The main predisposing factors for vascular disease are hypertension and diabetes mellitus which is now one of the leading causes of blindness in western countries.
Hypertension is associated with development of hyaline
thickening in retinal vessels, which in accelerated phase hypertension can
cause flame hemorrhages, exudates, and areas of retinal ischemia that cause
microinfarcts called cottonwool spots. Diabetes is discussed in #9. Stevens&Lowe
9. Describe the mechanisms and progressive changes of diabetic retinopathy.
Zen Seeker S&L 480
Diabetic retinal disease causes thickening of the basement membrane of capillaries and hyaline arteriolosclerosis. Microaneurysms occur as dilations of arterioles and capillaries with abnormally fragile and permeable walls. Exudates develop, with ‘blot hemorrhages’ from leaking capillary vessels. Areas of ischemia cause cotton-wool spots. Retinal ischemia causes secretion of angiogenesis factors, inducing formation of new vessels (proliferative retinopathy).
Tim B Stevens&Lowe
Diabetic retinal disease causes thickening of the basement membrane of capillaries and hyaline arteriosclerosis which can lead to the following changes;
Microaneurysms occur as dilatations of arterioles and capillaries with abnormally fragile and permeable walls. Exudates develop, with blot hemorrhages from leaking capillary vessels. Retinal ischemia causes cotton wool spots and secretion of angiogenesis factor, which induces formation of new vessels (proliferative retinopathy)
Neovascularization is the term used to describe the formation of new vessels on the inner surface of the retina (leading to hemorrhages) and the anterior surface of the iris (leading to secondary closed-angle glaucoma).
Retinal artery occlusion occurs with blockage of the central retinal artery as a result of embolism or, less commonly, from vasculitis such as giant cell ateritis. The retina undergoes necrosis and there is loss of retinal ganglion cells leading to optic atrophy and proliferation of retinal glial cells (retinal gliosis).
Retinal vein occlusion is predisposed by
polycythemia and chronic glaucoma. Thrombosis leads to suffusion of the retina
with blood, resulting in widespread hemorrhage. If lysis of the thrombis
occurs, normal function is regained. However, persistent occlusion causes
development of neovascularization and glaucoma. (Stevens&Lowe
10. Identify retinoblastoma as a malignant intraocular childhood tumor. Describe the genetic aspect of the disease, and define leukokoria.
Vince B
Retinoblastoma is a very rare malignant tumor of the retina, occurring in children <5 Y/O, inherited in about 1/3. Molecular genetics have shown it to be predisposed by loss of specific tumor-suppressor gene termed RB. Lesions macroscopically appear as a mass of white tissue that arises in the retina and replaces the vitreous. Present with enlargement of the globe or with a white pupil due to tumor in the vitreous. Leukokoria
Zen Seeker S&L 480
Retinoblastoma is a very rare malignant tumor of the retina, occurring in children under the age of 5 years. Its importance lies in the fact that it is inherited in about a third of cases, and molecular genetics have shown it to be predisposed by loss of a specific tumor-suppressor gene termed RB. Patients with the heritable form have a high incidence of bilateral disease, whereas patients with sporadic disease tend to have unilateral tumor.
Composed of primitive neuroblast-like cells, lesions macroscopically appear as a mass of white tissue that arises in the retina and replaces the vitreous. Tumors behave aggressively, with spread to the orbit and along the optic nerve to the CNS. Children present with enlargement of the globe, or with a white pupil due to tumor in the vitreous.
internet
Leukokoria (White pupil reflex) (lack of normal red reflex in eye)
Requires urgent ophthalmology referral
Causes
Retinoblastoma (most important and urgent)
Hyphema or other anterior chamber fluid
Vitreous opacity
Retinal disease
Tim B
Retinoblastoma is a very rare malignant tumor of the retina, occurring in children under the age of 5. Its importance lies in the fact that it is inherited in about a third of cases, and molecular genetics have shown it to be predisposed by loss of a specific tumor-suppressor gene termed RB. Patients with the heritable form have a high incidence of bilateral disease, whereas patients with sporadic disease tend to have unilateral tumor.
Composed of primitive neuroblast-like cells, lesions macroscopically appear as a mass of white tissue that arises in the retina and replaces the vitreous. Tumors behave aggressively, with spread to the orbit and along the optic nerve to the CNS. Children present with enlargement of the globe, or with a white pupil due to tumor in the vitreous.
Leukokoria is white or abnormal papillary reflex. Usually
present in children and who have retinoblastoma, people who have cataracts,
retinal detachment and intraocular infection. Patients w/ white or absent
reflex should be referred. Stevens&Lowe
11. Define glaucoma. Identify the most common mechanism underlying most cases of glaucoma. Describe the effects and potential consequences of raised intraocular pressure.
Vince B
Glaucoma- A very common syndrome in which there is increased interlobular pressure caused by the abnormal secretion and removal of aqueous humor by the ciliary body and orbicular meshwork. if left untreated will cause blindness. Effects of raised interlobular pressure are cupping and trophy of optic disc and degeneration of retinal ganglion cells. Progressive peripheral visual field loss, leading to blindness.
Zen Seeker S&L 481-482
Glaucoma - A very common syndrome in which there is increased intraocular pressure, glaucoma affects 2% of the population over the age of 40 years. It is important in that if it remains untreated, blindness develops.
Causes -
Primary glaucoma is caused by two main abnormalities in drainage of aqueous:
Closing-up of the trabecular meshwork, which normally leads to the
With age, some patients develop narrowing of the angle between the iris and the cornea, causing functional blockage to aqueous drainage. This may be predisposed by the normal reduction of the size of the eye with aging, and the normal increase in the size of the lens with age. An acute attack occurs particularly when the pupils is dilated, as the iris thickens with contraction. Acute attacks may therefore be precipitated by being in the dark. Because the drainage angle is abnormal, this is termed primary closed-angle glaucoma (fig 22.5b).
Secondary glaucoma is caused by diseases that obstruct the drainage of aqueous. For example, there may be adhesions between the iris and cornea that are caused by uveitis (inflammation of the uvea (constituting the iris, ciliary body, and choroid)) or are secondary to vascular proliferation due to retinal ischemia (secondary closed-angle glaucoma). Alternatively, there may be blockage of the trabecular meshwork by particulate material in the aqueous, especially degenerate lens material, pigment from melanocytic lesions, or macrophages accumulating in response to hemorrhage or inflammation (secondary open-angle glaucoma) (fig 22.5c)
Congenital glaucoma seen in childhood with enlargement of the globe is very rare. It is mainly due to developmental defects in the drainage of aqueous.
The effects of raised intraocular pressure are cupping and atrophy of the optic disc, detected on fundoscopy, and degeneration of retinal ganglion cells. Clinically, there is progressive peripheral visual-field loss, leading to blindness in untreated cases. In acute glaucoma there is breakdown of the endothelium, leading to edema of the cornea and formation of painful corneal bullas. In chronic glaucoma the sclera may stretch to form bulges termed staphylomas.
Janelisa Stevens 481 Glaucoma is a common syndrome in which the raised intraocular pressure can potentially damage the retina and optic nerve. The most common underlying mechanism is an abnormality in the filtration and removal of aqueous. The effects of the raised intraocular pressure are cupping and atrophy of the optic disc and degeneration of retinal ganglion cells. The potential consequences are progressive peripheral visual-field loss, leading to blindness if left untreated.
Steven L, Tabers Cyclopedic Med Dictionary
Glaucoma- a group of eye diseases characterized by an increase in intraocular pressure, which results in atrophy of the optic nerve and may result in blindness.
Swartz . pg, 223 Characteristic finding in all types of glaucoma is an increase intraocular pressure. Pathology. Pg, 481 … can potentially cause damage to the retina… Tabers again. Increased pressure causes depression of the head of the optis nerve and destruction of the nerve fibers. Effects include pain, halos, and poor vision.
12. Distinguish between acute and chronic glaucoma, and between primary and secondary glaucoma.
Vince B
Acute glaucoma is associated with rapid increase in pressure causing pain and redness (fig 22-6b) with rapid deterioration of visual function. Chronic glaucoma occurs with gradual increase in pressure leading to slow gradual deterioration in visual acuity. Primary glaucoma is caused by abnormalities in draining of aqueous. Closing of the trabecular meshwork as degenerative process (primary open-angle glaucoma). With age some patients develop narrowing of the angle between iris and cornea, causing functional blockage to aqueous drainage (primary closed-angle glaucoma. Secondary glaucoma- caused by diseases that obstruct the drainage of aqueous. Adhesions between iris and cornea caused by uveitis or as secondary to vascular proliferation due to retinal ischemia (secondary closed-angle glaucoma). Blockage of the orbicular meshwork by particulate material in the aqueous - degenerative lens material, pigment from melanocytic lesions, or macrophage accumulation to hemorrhage or inflammation (secondary open-angle glaucoma.
Zen Seeker S&L 481-482 See question11
In acute glaucoma there is breakdown of the endothelium, leading to edema of the cornea and formation of painful corneal bullas.
In chronic glaucoma the sclera may stretch to form bulges termed staphylomas.
Primary glaucoma is caused by two main abnormalities in drainage of aqueous:
Closing-up of the trabecular meshwork, which normally leads to the
With age, some patients develop narrowing of the angle between the iris and the cornea, causing functional blockage to aqueous drainage. This may be predisposed by the normal reduction of the size of the eye with aging, and the normal increase in the size of the lens with age. An acute attack occurs particularly when the pupils is dilated, as the iris thickens with contraction. Acute attacks may therefore be precipitated by being in the dark. Because the drainage angle is abnormal, this is termed primary closed-angle glaucoma ( fig 22.5b).
Secondary glaucoma is caused by diseases that obstruct the drainage of aqueous. For example, there may be adhesions between the iris and cornea that are caused by uveitis or are secondary to vascular proliferation due to retinal ischemia (secondary closed-angle glaucoma). Alternatively, there may be blockage of the trabecular meshwork by particulate material in the aqueous, especially degenerate lens material, pigment from melanocytic lesions, or macrophages accumulating in response to hemorrhage or inflammation (secondary open-angle glaucoma) (fig 22.5c)
Congenital glaucoma seen in childhood with enlargement of the globe, is very rare. It is mainly due to developmental defects in the drainage of aqueous.
Janelisa Stevens 481-482 Acute glaucoma is associated with
rapid increase in intraocular pressure which causes severe pain and redness in
the eye and rapid deterioration in visual function. There is breakdown of the
endothelium, leading to edema of the cornea and formation of painful corneal
bullas. Chronic glaucoma occurs with gradual increase in intraocular pressure
leading to slow, gradual deterioration in visual acuity. The sclera may stretch
to form bulges termed staphylomas. Primary glaucoma is caused by 2
abnormalities in drainage of aqueous. Primary open-angle occurs when the
trabecular meshwork, which leads to the
Stephen L, Path. Pg, 481. Acute glaucoma is associated with rapid increase in intraocular pressure, which causes severe pain and redness in the eye and rapid deterioration in visual function (this can be permanent if not urgently treated).
Chronic glaucoma occurs with gradual increase in intraocular pressure, leading to slow, gradual deterioration in visual acuity if untreated.
Primary glaucoma is caused two main abnormalities in drainage of aqueous:
a) Closing-up of the trabecular meshwork, which normally leads to the
b) Path. Pg, 481. With age, some patients develop narrowing of the angle between the iris and the cornea, causing functional blockage to aqueous drainage. This may be predisposed by the normal reduction in the size of 0the lens with age. An acute attack occurs particularly when the pupil is dilated, as the iris thickens with contraction. Acute attacks may therefore be precipitated by being in the dark. Because the drainage angle is abnormal, this is termed “primary closed-angle glaucoma.
Secondary glaucoma is caused by diseases that obstruct the drainage of aqueous. For example, there may be adhesions between the iris and cornea that are caused by uveitis or are secondary to vascular proliferation due to retinal ischemia (secondary closed-angle glaucoma). Alternately, there may be blockage of the trabecular meshwork by particulate material in the agueous, especially degenerate lens material, pigment from melanocytic lesions, or macrophages accumulating in response to hemorrhage or inflammation (secondary open-angle glaucoma).
13. Define proptosis and identify common potential causes.
Vince B
Proptosis- Displacement of the eye. Main causes include thyroid eye disease, vascular lesions, inflammatory diseases, and tumors.
Zen Seeker S&L 482
Proptosis - diseases of the orbit present with displacement of the eye.
The main causes for swelling in the orbit are gyroid eye disease, vascular lesions, inflammatory diseases, and tumors.
Janelisa Stevens 482 Proptosis is displacement of the eye. Common potential causes are thyroid eye disease, vascular lesions, inflammatory diseases, and tumors.
Stephen L, Proptosis- Tabers. A downward displacement such as… the eyeball in exophthalmic goiter or in inflammatory conditions of the orbit.
Pathology. Pg, 482. The main causes for swelling in the orbit are thyroid eye disease, vascular lesions, inflammatory diseases, and tumors. Thyroid disease (Graves’ disease) may cause orbital swelling and proptosis due to accumulation of extracellulat matrix material in the orbital tissues.
14. Identify the causative pathogen in thrush, and predisposing factors in adult infection.
Vince B
Thrush- Infection of the mouth caused by Candida albicans seen most frequent in infants. White patches on palatal, buccal, and tongue surfaces. Patches composed of tangled fungal hyphae mixed with acute inflammatory cells and epithelium. In adults less common unless predisposing factors such as DM, immunosuppressive therapy, or HIV.
Zen Seeker S&L 124-125
Thrush - Candida albicans
Immunosuppressed individuals, systemic blood-borne infections can occur with small candidal abscesses in many organs. Intravenous drug abusers, and patients with long-standing intravenous lines are particularly at risk; sometimes candidal endocarditis, with large mitral and aortic valve vegetations, is the basis of the wide-spread blood dissemination.
Janelisa Stevens 224 Candida albicans is the causative agent for thrush. Predisposing factors in adult infection are diabetes mellitus, immunosuppressive therapy, or a natural immunosuppressed state as in advanced malignancy or HIV infection. Candida can also lodge under the denture plate causing denture stomatitis in adults with no other predisposing factors.
Stephen L, Path. Pg, 125. Candida albicans is the causative pathogen in thrush… The commonest sites for infection are the mouth (oral thrush).
Path. Pg, 224. In adults… there are predisposing factors such as diabetes mellitus, immunosuppressive therapy, or a natural immunosuppressed state, for example in advanced malignancy or with HIV infection.
15. Describe the clinical syndrome of acute pharyngitis and identify what proportion of cases are due to viruses vs. streptococci.
Zen Seeker S&L 242
The superglottic and glottic regions are frequently inflamed in acute pharyngitis. Viral and bacterial infections of the pharynx frequently involve the supraglottic and glottic regions, producing hoarseness and temporary voice loss. Infection usually extends into subglottic and tracheal regions, and perhaps down into bronchi, producing cough and tracheal soreness. This symptom complex, which is known as upper respiratory tract infection (URTI), is very common but usually transient and trivial. It can have serious consequences in young children and in the elderly or debilitated.
Internet
Most cases of pharyngitis and tonsillitis are viral: 90% of pharyngitis in adults and 60% to 75% in children are caused by viruses including influenza virus, adenovirus, and Epstein-Barr virus, many of which are associated with the common cold.
Janelisa Stevens 232 Pharyngitis presents with a red, inflamed, sore oropharynx and is usually due to a viral infection, also involving the nasopharynx and larynx. It is a common component in the common cold, influenza, and other viral upper respiratory tract infections. Bacterial pharyngitis is much less common, usually due to infection by beta hemolytic strep, and is often accompanied by acute tonsillitis - red, swollen tonsils, covered by creamy acute inflammatory exudate. (242) Viral and bacterial infections of the pharynx frequently involve the supraglottic and glottic regions, producing hoarseness and temporary voice loss. Infection usually extends into subglottic and tracheal regions, perhaps down into bronchi, producing cough and tracheal soreness. Ballweg 176 90% of cases are due to a viral cause, while the remaining 10% is due to streptococcal infection.
Stephen L, Brunner and Suddarth’s Textbook of Med/Surg Nursing. Pg, 446. Acute pharyngitis is a febrile inflammation of the throat that is caused by a viral organism 70% of the time. A group A Streptococcus is the most common bacterial organism.
Path. Pg, 242. The supraglottic and glottic regions are frequently inflamed in acute pharyngitis.
16. Identify the major complications of post-streptococcal pharyngitis, and of acute streptococcal pharyngitis and tonsillitis.
Zen Seeker S&L 233
Bacterial pharyngitis is usually due to infection by β-hemolytic streptococci; it is an important precursor of acute post-streptococcal glomerulonephritis and acute rheumatic fever
Greg R. Stevens pg. 233. Acute streptococcal pharyngitis and tonsillitis may be complicated by the development of a peri-tonsillar abscess (quinsy) or, rarely, by spreading cellulites in the neck (Ludwig’s angina) or retropharyngeal abscess formation. Post-streptococcal pharyngitis???
Deb B./Stevens & Lowe, pg.234 : Post strep pharyngitis= ??
Tonsillitis=peritonsillar abcess/ Acute strep pharyngitis=peritonsillar abcess , spreading cellulites in neck
17. Define rhinitis and distinguish between infective and allergic rhinitis.
Vince B
Rhinitis- runny, blocked, and sore nose usually due to infection or allergy. Infective rhinitis usually viral in origin,ie common cold, flu. Allergic rhinitis due to type I hypersensitivity reaction to inhaled material such as grass, pollen ect.
Zen Seeker S&L 235
Rhinitis - a runny, blocked and perhaps sore nose
Infective rhinitis - is usually viral in origin, e.g. common cold, influenza. Viral necrosis of surface epithelial cells is followed by exudation of fluid and mucus from the damaged surface (runny nose). Later submucosal edema produces swelling, which may lead to partial blockage of the narrow nasal airways.
Allergic rhinitis - a type I hypersensitivity reaction to inhaled materials such as grass and flower pollens produces a mixed serous-mucous exudates, and submucosal edema leads to nasal blockage. In allergic rhinitis, where the antigenic stimulus may persist for many weeks, the submucosal edema may persist and worsen. An irregular, swollen, polypoid mucosa can develop, in which one or more nasal poyps may develop, usually bilaterally.
Greg R. Stevens pg. 235. Rhinitis (a runny, blocked and perhaps sore nose) is usually due either to infection or to allergy. Infective rhinitis is usually viral in origin, e.g. common cold, influenza. Viral necrosis ofsurface epithelial cells is followed by exudation of fluid and mucus from the damaged surface (runny nose). Later submucosal edema produces swelling, which may lead to partial blockage of the narrow nasal airways. Allergic rhinitis a Type I hypersensitivity reaction to inhaled materials such as grass and flower pollens produces a mixed serous-mucous exudate, and submucosal edema leads to nasal blockage.
Deb B./Stevens & Lowe, pg. 235 :Rhinitis=runny, blocked and perhaps sore nose
Infective rhinitis=viral in origin (cold, flu), viral necrosis of surface epith. Cells followed by exudation of fluid
Allergic rhinitis=type 1 hypersensitivity reaction to inhaled materials
18. Describe the syndromes of acute and chronic sinusitis, including causes and potential consequences.
Vince B
Acute maxillary sinusitis- most important type of sinus inflammation, ethmoid and frontal sinusitis less significant. Prevents draining of maxillary sinus secretions into nasal cavity and predisposing to secondary bacterial infection. Severe cases may extend up to ethmoid and frontal sinuses and to meningis. Chronic maxillary sinusitis may follow acute sinusitis with a chronically thickened and inflamed mucosa (fig 12.26) due to failure of an acutely inflamed sinus to drain, severe deviated septum, nasal polyps.
Zen Seeker S&L 235
Acute maxillary sinusitis is the most important type of sinus inflammation, ethmoidal and frontal sinusitis being less significant. Swelling of the mucosa around the drainage foramen of the maxillary sinus may prevent drainage of maxillary sinus secretions into the nasal cavity, causing stasis. Stasis of maxillary secretions predisposes to secondary bacterial infection, with alteration of the retained maxillary fluid from seromucous to frankly purulent.
Chronic maxillary sinusitis may follow acute sinusitis, chronic imaginational insult, or nasal obstruction. Failure of an acutely inflamed sinus to drain, even after the resolution of the acute rhinititis that initiated it, leads to chronic maxillary sinusitis, with a chronically thickened and inflamed mucosa, and persistent fluid accumulation.
Chronic inhalation of irritant material is sometimes the result of industrial exposure, but mostly commonly involves cigarette smoke. Chronic rhinitis and maxillary sinusitis develop, initially as a toxic allergic reaction, but such cases are always liable to secondary bacterial infection, or exacerbation during a viral infection.
Obstruction to maxillary sinus drainage may result from a severely deviated nasal septum, or from the presence of nasal polyps.
Greg R. Stevens pg. 235. Acute maxillary sinusitis is the most important type of sinus inflammation, ethmoidal and frontal sinusitis being less significant. Swelling of the mucosa around the drainage foramen of the maxillary sinus may prevent drainage of maxillary sinus secretions into the nasal cavity, causing stasis. Stasis of maxillary secretions predisposes to secondary bacterial infection, with alteration of the retained maxillary fluid from seromucous to frankly purulent. In severe cases the infection may spread into the ethmoids and frontal sinuses, with the risk of spread of infection to the meninges. Chronic sinusitis-Failure of an acutely inflamed sinus to drain, even after the resolution of the acute rhinitis that initiated it, leads to chronic maxillary sinusitis, with a chronically thickened and inflamed mucosa, and persistent fluid accumulation (see fig. 12-23). Chronic inhalation of irritant material is sometimes the result of industrial exposure, but most commonly involves cigarette smoke. Chronic rhinitis and maxillary sinusitis develop, initially as a toxic allergic reaction, but such cases are always liable to secondary bacterial infection, or exacerbation during a viral infection. Obstruction to maxillary sinus drainage may result from a severely deviated nasal septum, or from the presence of nasal polyps
Deb B./Stevens & Lowe, pg. 235 :Acute sinusitis=swelling of mucosa, prevents drainage of maxillary sinus secretions into nasal cavity, leads to stasis, leads to bacterial infection/ Severe cases infection spreads to ethmoids and frontal sinuses with risk of spread to meninges. Chronic sinusitis=result of failure of acute to resolve, chronic thickened and inflamed mucosa and persist. Fluid accumulation/Comes from chronic inhalation of irritant material (industrial exposure, cigarette smoke)
19. Define otitis externa and list several common causes.
Vince B
Otis Externa- inflammation of the skin around the meatus. May be localized (boil, furnuncle), or may be diffuse (bacterial, fungal infection). Allergic otis externa due to response to topical ear drops.
Anonymous
a. Pain
b. Perforation of the tympanic membrane
c. Conductive hearing loss
d. Mastoiditis, leading to facial nerve paresis, or paralysis.
e. Progression of infection into the middle ear, and possibly:
f. Progression into the inner ear (lambyrinthitis) leading to:
g. Sensorineural hearing loss, vertigo, disequilibrium, facial nerve palsy, nausea, vomiting, and possibly meningitis.
Zen Seeker S&L 238
Otitis externa - inflammation of the external auditory meatus
Localized - due to a boil (furuncle) in the ear canal
Diffuse - usually due to either
bacterial or fungal infection (Aspergillus
Allergic otitis externa - usually a response to topical ear drops
Greg R. Stevens pg. 238.
Otitis externa is inflammation of the external auditory meatus.
Inflammation may be localized, due to a boil (furuncle) in the ear canal, or
diffuse, usually due to either bacterial or fungal infection (see fig. 12-30).
A common fungus is Aspergillus
Deb B./Stevens & Lowe, pg. 238 : Otitis externa=inflammation of external auditory meatus/ Causes=bacterial or fungal infection
20. Define otitis media and describe the anatomic factors that lead to otitis media, particularly in children.
Vince B
Otis Media- infection to the middle ear. Children are more prone due to their narrow Eustachian tube that can become obstructed by hyperplasic submucosal lymphoid tissue (adenoids). Acute complications include persistent perforation of the eardrum, tubotympanic chronic suppurative otits media, otitis media with effusion (OME) and acute mastoiditis.
Anonymous
Otitis media most commonly affects children between the ages of 6 months to 2 yrs old and 4yrs to 6yrs old. The eustachian tubes in children are nearly horizontal, allowing easy access of organisms to the middle ear.
Anonymous
Otitis media is an inflammation between the eardrum and inner ear (cochlea). The three most common causes are streptococcus pneumoniae, streptococcus pyogenes, and haemophilus influenzae.
Zen Seeker S&L 238
Otitis media - middle ear infection
Upper respiratory tract viral infections in children are frequently accompanied by the changes of acute inflammation in the lining of the middle ear, and in the inner lining of the tympanic membrane. Secondary bacterial infection may supervene, increasing the risk of a central perforation of the tympanic membrane. Children are particularly prone, probably because the narrow Eustachian tube can become obstructed by the hyperplastic submucosal lymphoid tissue at its lower end (adenoids).
Greg R. Stevens pg. 238 & 241. (Taber’s) Acute otitis media-inflammation/infection of the middle ear. Narrow Eustachian tubes and the prominent adenoid lymphoid tissue at its lower end predispose children to otitis media with effusion.
Deb B./Stevens & Lowe, pg. 238: Otitis media=acute inflammation in lining of middle ear and in inner lining of TM/ Kids prone to because of the narrow Eustachian tube can become obstructed by hyperplastic submucosal lymphoid tissue at its lower end (adnoids)
21. Distinguish between acute otitis media, chronic suppurative otitis media, and otitis media with effusion.
Anonymous
Acute
Chronic
Serous
Vince B
Acute otitis media- acute inflammation to the lining of the middle ear. Chronic suppurative otitis media- recurrent inflammation in the middle ear causing earache, deafness, and persistent discharge from external auditory meatus. Occurs in people with persistent, non-healing perforation of eardrum. Subdivided into Tubotympanic disease where the perforation is in the pars tensa of the eardrum. Mucosal lining becomes chronically inflamed with heavy infiltrate of lymphocyte and plasma cells; Atticoantral disease- perforation is located at attic region and associated with development of cholesteatoma. Otis media with effusion (OME)-Mucoid fluid accumulates in middle ear cavity because it is unable to drain through the child’s narrow Eustachian tube. Associated with lower tube blockage. Fluid is sterile often thick and tenacious, grayish-brown liquid resembling glue. Associated with conductive deafness.
Zen Seeker S&L 238-239
Otitis media - middle ear infection
Internet
Chronic suppurative otitis media - a perforated tympanic membrane with persistent drainage from the middle ear - as chronic otorrhea (otopyorrea) (ie, >6-12 wk) through a perforated tympanic membrane (TM).
S&L 238-239
Otitis media with effusion (OME or glue ear) - Mucoid fluid accumulates in middle ear cavity because it is unable to drain through the child’s narrow Eustachian tube. This is possibly associated with lower tube blockage due to reactive hyperplasia of the adenoid lymphoid tissue. The fluid is sterile, and is often thick and tenacious, resembling grayish-brown liquid glue, hence the common term ‘glue ear’.
April T. Stevens p. 238-239. Acute otitis media- Viral infection causes inflammation in the middle ear, and in the inner lining of the TM. 2’ bacterial infection may supervene increasing the risk of a central perforation.
Chronic Suppurative Otitis media- Recurrent chronic inflammation of the middle ear. Causes chronic ear aches, deafness, and persistant discharge. Occurs usually in people with non-healing perforations. Divided into 2 groups. Tubotympanic disease I which the perforation is in the pars tensa and the discharge is copious. With lots of WBC and forming granulation tissue and sometimes polyps. Atticoantral disease- when lperforation is located at the attic region and is typically assoc. with cholesteatoma. Also assoc. with brain absecc and other intercranial infection.
Otitis Media with Effusion- mucoid fluid accumulation in the middle ear cavity because it is unable to drain. Anbe blocked by adenoid tissue.
EChing, Taber’s Med Dic 1536
Acute otitis media= the presence of fluid in the middle ear accompanied by signs & symptoms of intense local or systemic infection
Swartz 239
Chronic suppurative otitis media= recurrent chronic inflammation in the middle ear is an important cause of chronic earache, deafness & persistent discharge from the external auditory meatus.
Chronic suppurative otitis media is subdivided into 2 broad groups:
1) Tubotympanic disease, in which the perforation is in the pars tensa of the eardrum, & the discharge is typically copious & mucopurulent.
2) Atticoantral disease, in which the perforation is located in the eardrum at the attic region & is typically associated w/ the development of cholesteatoma.
Otitis media w/ effusion= mucoid fluid accumulates in the middle ear cavity because it is unable to drain through the child’s narrow Eustachian tube. The fluid is often thick & tenacious, resembling grayish-brown liquid glue, hence the common term ‘glue ear’.
22. List potential complications of the three forms of otitis media listed above.
Vince B
See parts of 21 above.
Zen Seeker S&L 238
Complications - Persistent perforation of the eardrum, tubotymphanic chronic suppurative otitis media, otitis media with effusion and acute mastoiditis
April T. Stevens p. 238. Persistant perforation of the ear drum, tubotympanic chronic suppurative ototis media, otitis media with effusion and mastoiditis.
EChing, Swartz, 238, 240
Acute otitis media: persistent perforation of the eardrum, tubotympanic chronic suppurative otitis media, otitis media w/ effusion (OME or ‘glue ear’), & acute mastoiditis, conductive hearing loss.
EChing, Swartz, 239
Chronic suppurative otitis media/tubotympanic disease: chronic inflammatory granulation polyps, cholesterol granuloma.
Chronic suppurative otitis media/atticoantral disease: higher risk of major complications, e.g. brain abscess & other intracranial infection.
Otitis media w/ effusion: associated w/ conductive deafness w/ intermittent earache, predisposition to acute supprative otitis media due to secondary bacterial infection.
23. Define cholesteatoma and describe how it forms and does damage.
Vince B
Cholesteatoma-is a form of epidermis cyst located in the epitympanic recess, often extends into the mastoid process. Pathogenesis is disputed, frequently associated with an atticoantral perforation of the eardrum. Area may be colonized by Gram-negative saprophytic bacteria stimulating keratin formation which can eventually erode bone and may destroy the labyrinth, mastoid air cells and facial nerve.
Anonymous
Cholesteatoma (keratoma) is the presence of normal squamous epithelium within the middle ear.
It may form as the result of squamous epithelial tissue migrating through a perforation of the tympanic membrane and slowly extend to form a large mass within the middle ear. This mass of cells is a great medium for bacterial growth, and ultimately causes local destruction of bone and the ossicles and may erode into the cranial cavity or inner ear producing meningitis and labyrinthitis symptomology.
Zen Seeker S&L 239
Cholesteatoma is a form of epidermoid cyst. Most commonly located in the epitympanic recess (attic) and mastoid antrum, it often extends into the mastoid process. Its precise pathogenesis is disputed, but it is frequently associated with an atticoantral perforation of the eardrum. It is a cystic structure lined by squamous epithelium which constantly produces keratin. This leads to expansion of the lesion, damaging the small structures in the cavity. The aria may become colonized by Gram-negative saprophytic bacteria, which probably stimulate continuing keratin formation. The enlarging keratinous mass, lined by stratified squamous epithelium, can eventually erode bone, and may destroy the labyrinth, mastoid air cells, and facial nerve. It may even erode through the skull forming the base of the middle cranial fossa. Although non-neoplasic, cholesteatomas have the same effects as a slow-growing benign tumor.
April T. Stevens p. 239. It is a form of epidermoid cyst. Located in the attic and mastoid antrum, can extend into mastoid process. Lined with squamous cell and produces keratin leading to expansion. Can be colonized with gram-neg. Can erode bone, and nerve. Acts like a slow growing benign tumor.
EChing, Swartz, 239
Cholesteatoma= a form of epidermoid cyst. Most commonly located in the epitympanic recess (attic) & mastoid antrum, it often extends into the mastoid process. It is frequently associated w/ an atticoantral perforation of the eardrum. It is a cystic structure lined by squamous epithelium, which constantly produce keratin. This leads to expansion of the lesion, damaging the small structures in the cavity. The areamay become colonized by Gram-negative saprophytic bacteria, which probably stimulate continuing keratin formation. The enlarging keratinous mass, lined by stratified squamous epithelium, can eventually erode bone & may destroy the labyrinth, mastoid air cells, & facial nerve. It may even erode through the skull forming the base of the middle cranial fossa.
24. Define otosclerosis and identify its potential outcome.
Vince B
Otosclorosis- the normal bone of the auditory ossicles is replaced and thickened by newly deposited woven bone. Usually bilat and eventually produces deafness. May spread to involve footplate and limbs of the stapes. Involvement of the stapes and cochlea leads to deafness.
Anonymous
Otosclerosis: hardening of the bony tissue of the labyrinth of the ear. Caused by formation of spongy bone around the oval window resulting in ankylosis (stiffening) of the staples bone. Resulting in chronic progressive deafness. Etiology: unknown (possibly familial) Treatment: surgical replacement of the staples bone with a synthetic substitute.
Zen Seeker S&L 240
Otosclerosis - the normal bone of the auditory ossicles is replaced and thickened by newly deposited woven bone (see page 511). The diseases, which is usually bilateral and eventually produces deafness, may be hereditary. There is an adult female preponderance.
A.T. Stevens p. 240. The normal bone of the auditory ossicle is replaced and thickened by newly deposited woven bone. Usually bilateral, produces deafness, poss, hereditary. Female predisposition, starts between the cochlea and the vestibule in the otic capsule and spreads to the footplate and the limbs of the stapes. Stapes and cochlea cause deafness.
EChing, Swartz, 240
In otosclerosis, the normal bone of the auditory ossicles is replaced & thickened by newly deposited woven bone. The disease, which is usually bilateral & eventually produces deafness, may be hereditary. The disease usually starts at the otic capsule between the cochlea & vestibule, & may spread to involve the foot plate & limbs of the stapes. It is the involvement of the stapes & of the cochlea that leads to deafness.
25. Define acoustic neuroma (aka: schwannoma of the vestibulocochlear nerve) and identify it as an important cause of unilateral, sensorineural hearing loss.
Vince B
Schwannoma of vestibulocochlear nerve is an important cause of unilateral hearing loss.
Anonymous
acoustic neuroma is a benign tumor arising from the eighth cranial nerve (acoustic nerve) in the brain. This tumor causes tinnitis, vertigo, and hearing loss.
Zen Seeker Internet
Acoustic neuromas (also known as vestibular schwannomas) are benign tumors that arise in the cerebellopontine angle as a result of the growth of the Schwann cells that surround and insulate the vestibulocochlear nerve. This nerve has two separate parts. The vestibular nerve sends balance information to the brain from the inner ear and the cochlear nerve transmits sound and the others. These pathways, along with the facial nerve, lie adjacent to each other as they pass through a bony canal called the internal auditory canal.
An acoustic neuroma is a benign tumor that develops in the acoustic or auditory nerve which is responsible for hearing. It starts from schwann cells which line the nerve and is therefore called a schwannoma. It is usually a slow growing tumor and does not spread from the original site.
A.T. Taber’s Dictionary- A benign tumor of the 8th cranial nerve. Causes hearing loss, loss of balance, pain, HA, tinnitus.
A.T. Stevens p. 240-241. Two types of hearing loss. Conductive- Temporary, often seen in family practice, caused by wax, acute otitis externa, acute and chronic otitis media and its complications, barotrauma (blast injury), perforation of the TM, otosclerosis. Sensorineural- Permanent, caused by prebyacucis (decreases in hair cells in the elderly), excessive noise, ototoxic meds (aspirin, aminoglycosides), postinfective (meningitis, rubella), acute neuroma and head injury.
EChing, Swartz, 241 can’t find much in the book or Taber’s med dic
Acoustic neuroma is an important cause of acquired sensorineural deafness in adults. Schwannoma of the vestibulocochlear nerve is an important cause of unilateral hearing loss.
26. Identify croup and epiglottitis as acute infectious causes of laryngeal obstruction, and distinguish between their causes (i.e., viral vs. bacterial).
Vince B
Croup- bacterial- small airway becomes obstructed by mucosal and submucosal swelling. Epiglottitis-viral- usually due to Haemorhilus influenzae produces fatal obstruction.
Zen Seeker S&L 242
In young children the small airway can become obstructed by mucosal and submucosal swelling (croup). Acute epiglottitis, usually due to Haemophilus influenzae (gram negative bacteria) infection, can produce fatal obstruction.
S&L 41
In acute epiglottitis, infection of the upper airway by Haemophilus bacteria causes acute inflammation. The extensive outpouring of exudates into the soft tissues of the laryngeal submucosa can lead to such severe narrowing of the airway that respiration is compromised. Ultimately, the acute inflammatory response to infection can result in death through asphyxia.
Internet
Viral croup
Causes: Croup is most commonly caused by para-influenza virus infection in the spring and autumn, but occasionally other viruses may cause croup.
Group affected: There is a male predominance and the peak age is between 1 to 2 years.
Clinical features: The condition is diagnosed clinically. It usually starts with a runny nose, followed by a mild fever and characteristic barking cough. As obstruction worsens, inspiratory stridor and then breathlessness develop. The epiglottis is unaffected. Inflammatory edema in the subglottic region is the main site of obstruction and /or stridor. However, inflammation is present throughout the respiratory tract and bronchial wheezing may sometimes be heard on auscultation of the chest. Obstruction is typically worse at night.
As previously mentioned, severity is assessed by the degree of increase in respiratory effort, and impairment of ventilation and gas exchange, and not by the stridor.
A.T. Swartz had the best reference p. 754 chart
Croup is viral, slow onset with cold symptom, fever <103, URI common, “seal bark”, s/s worsen at night. Epiglottis- Bacterial infection usually caused by H. Influenze, severe swelling of the epiglottis, fever >104, total airway obstruction can occur.
Paul, S&L pg 242: Croup: In young children, the small airway can become obstructed by mucosal and submucosal swelling. Viral infection.
Epiglottitis: usually due to bacterial Haemophilus influenzae infection and can produce fatal obstruction
27. Identify the connection between smoking and cancers of the nose, mouth, throat, and larynx.
Vince B
Dysplasic changes may occur in the basal layer, considered to be a predisposing factor in the eventual development of squamous carcinoma. Carcinoma of larynx is most common in male smokers over 40, sqamous carcinoma can occur in supraglottic region, false cords and ventricles; glottis region and subglottic region
Zen Seeker S&L 244
Carcinoma of the larynx is an important malignancy in cigarette smokers.
Paul, S&L pg 244 Carcinoma of the larynx is most common in male cigarette smokers over the age of 40 years. It is a squamous carcinoma and can occur in the supraglottic region (aryepiglottic folds, false cords, and ventricles); the glottic region (true vocal cords and anterior and posterior commissures); or subglottic region (arising below the true vocal cords and above the first tracheal ring. Mild dysplasia of the laryngeal epithelium is a common feature of smoker’s keratosis, hyperkeratotic laryngeal thickening that occurs in heavy smokers.
S&L pg 226 White thickening of the mucosa in the mouth is mainly seen in smokers and is an important physical sign in which pre-malignant epithelial dysplasia may present
28. Identify common causes of lymph node enlargement in the neck.
Vince B
Pg 244-246
Zen Seeker S&L 244
The lymph nodes in the neck, particularly those in the jugular region, respond to local inflammation and infection by reactive hyperplasia, which is either follicular or parafollicular in pattern. Common sources of primary infection include the tonsils, teeth, pharynx, sinuses and, occasionally, the ear. Reactive lymph node enlargement may also occur when there has been localized skin inflammation, e.g. in the scalp or behind the ear. Three important diseases may present with benign lymph node enlargement in the neck:
Infectious mononucleosis (glandular fever)
Cervical tuberculosis
Toxoplasmosis
Paul, S&L pg 244-245 Solid lumps can be divided into:
• Related to thyroid gland: multinodular goiter, solitary thyroid nodule, thyroid carcinoma
• Related to submandibular salivary gland: pleomorphic salivary adenoma, chronic sialadenitis
• Related to the cervical lymph node groups: these occur mainly in the jugular chain and in the supraclavicular region
• Related to mandible: mandibular cysts, abscesses and tumors of both dental and bone origin
• Related to carotid bifurcation: these are almost always neuroendocrine tumors derived from the carotid body, the chemodectoma
The lymph nodes in the neck, particularly those in the jugular region, respond to local inflammation and infection by reactive hyperplasia, which is either follicular or parafollicular in pattern. Common sources of primary infection include the tonsils, teeth, pharynx, sinuses and occasionally ear. Reactive lymph node enlargement may also occur when there has been localized skin inflammation in the scalp or behind the ear.
Three important diseases with benign lymph node enlargement of the neck:
Infectious mononucleosis (glandular fever): associated with severe inflammation of the tonsils.
Cervical tuberculosis: lymph nodes are often matted and inflamed
Toxoplasmosis: may have circulating atypical lymphocytes
The lymph nodes in the neck are a common site for metastatic tumor deposition. The jugular nodes are a common site for metastatic carcinoma deposits from sites such as the lip, tongue, mouth, nasopharynx, oropharynx, larynx, salivary glands, and thyroid.