Oncology: Nasopharyngeal Biopsy Techniques

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Questions and Answers

What is the primary purpose of a CT scan or MRI when diagnosing nasopharyngeal carcinoma?

To assess the extent of the tumour (correct)

To treat the tumour more effectively

To perform a biopsy of the lesion

To confirm the presence of nasopharyngeal carcinoma

Which treatment modality is primarily used for nasopharyngeal carcinoma?

Targeted therapy

Chemotherapy

Radiotherapy (correct)

Surgery

What is a potential advantage of using Cobalt 60 and megavoltage linear accelerators in radiotherapy?

They improve treatment outcomes while reducing complications (correct)

They can increase the risk of complications

They are less precise than traditional radiotherapy

They require longer treatment durations to be effective

What action should be prioritized if a patient is in hypovolaemic shock due to bleeding?

Engage in emergency resuscitation Signup and view all the answers

Why is it beneficial to assess the nose without vasoconstriction initially?

It helps in stopping the bleeding Signup and view all the answers

Why might surgery be performed before radiotherapy in patients with massive lymphadenopathy?

To reduce hypoxia in the centre of the lesion, making radiotherapy more effective Signup and view all the answers

What role does immuno-cytochemistry play in the assessment of nasopharyngeal carcinoma?

It determines the origin of the cancer. Signup and view all the answers

Which local anaesthetic is frequently used due to its vasoconstrictive properties?

Cocaine Signup and view all the answers

What is the maximum dose of cocaine that should be administered to a patient based on their weight?

1.5 mg/kg Signup and view all the answers

What is the main purpose of using strong suction during the examination of a patient with epistaxis?

To remove clots for better visibility Signup and view all the answers

Prior to nasal packing, what step should be taken to manage a patient with anterior epistaxis?

Tamponade the nasal vessels Signup and view all the answers

Which condition must be reported in the patient's history when assessing bleeding risks?

History of bleeding diathesis Signup and view all the answers

In which position should a stable patient be examined to assess for epistaxis?

Semi-recumbent Signup and view all the answers

What is a common indication for the use of sedation during treatment for epistaxis?

To manage anxiety Signup and view all the answers

What is considered an effective treatment for anterior epistaxis?

Surgical ligation of blood vessels Signup and view all the answers

Which of the following is emphasized as an important skill for the student to develop during the ORL rotation?

Professionalism and interaction with patients. Signup and view all the answers

What should a medical student constantly reflect upon when interacting with patients?

What they would want if they were the patient. Signup and view all the answers

In the context of ENT management, what must a student be able to recognize?

Potentially dangerous problems needing referral. Signup and view all the answers

What is the significance of reading materials such as the otorhinolaryngology handbook for students?

They assist in understanding patient conditions. Signup and view all the answers

Which term refers to the mass of lymphoid tissue located in the pharyngeal region that is significant in ENT?

Waldeyer’s Ring Signup and view all the answers

What is a key disadvantage of nasal balloons compared to traditional nasal packs in managing epistaxis?

They do not adapt well to the irregularities of the lateral nasal wall. Signup and view all the answers

For how long should anterior nasal packs typically be left in place?

24-48 hours Signup and view all the answers

What is a primary role of nasal endoscopy in managing epistaxis?

To identify the bleeding point more effectively. Signup and view all the answers

What initial management step is suggested for heavy posterior epistaxis?

Insertion of a double-lumen balloon for tamponade. Signup and view all the answers

Why is it helpful to perform an initial nasal examination without vasoconstriction?

It can lead to better identification of the bleeding point. Signup and view all the answers

What procedure may need to be performed to facilitate access to a bleeding point when treating epistaxis?

Septoplasty Signup and view all the answers

What is the typical purpose of using topical anaesthesia in managing posterior epistaxis?

To reduce discomfort during examination. Signup and view all the answers

What is a common treatment approach immediately after identifying a bleeding point during nasal examination?

Use of chemical cautery at the site. Signup and view all the answers

What is the effect of using antibiotics on patients with anterior nasal packs in place?

They are used to prevent secondary infections. Signup and view all the answers

What type of endoscopic scopes are especially useful for detecting posterior bleeding points?

Flexible fibreoptic scopes. Signup and view all the answers

What is a possible cause of intrinsic obstruction of the eustachian tube related to upper respiratory infections?

Lymphatic drainage obstruction due to peritubal inflammation Signup and view all the answers

How can adenoidal hyperplasia affect the eustachian tube?

It compresses and obstructs the eustachian tube. Signup and view all the answers

What is a common organism found in cultures from middle ear effusions associated with otitis media?

Streptococcus pneumoniae Signup and view all the answers

In children under 7 years old, what anatomical characteristic contributes to eustachian tube obstruction?

Relative reduction in cartilage stiffness Signup and view all the answers

What consequence arises from the gradual absorption of air in the middle ear due to eustachian tube obstruction?

Transudation of fluid from the mucosa to the tympanic cavity Signup and view all the answers

Why is it suggested that otitis media with effusion and acute suppurative otitis media are manifestations of a similar spectrum?

They can have overlapping symptoms and causes involving tube obstruction and inflammation. Signup and view all the answers

What role do the adenoids primarily play in relation to eustachian tube function?

Being a source of sepsis Signup and view all the answers

Which craniofacial abnormalities are associated with a disproportion of adenoid size to the nasopharyngeal space?

Down's, Hunter's, and Hurler's syndromes Signup and view all the answers

What is the primary effect of ascending infection along the eustachian tube?

Oedema and exudate production resulting in obstruction Signup and view all the answers

What aspect complicates the understanding of eustachian tube obstruction and its resulting conditions?

The significant role of infection in conjunction with obstruction Signup and view all the answers

Which of the following factors is NOT associated with an increased risk of laryngeal carcinoma?

Vitamin D deficiency Signup and view all the answers

What is the primary histological type of laryngeal carcinoma that is reported in 95% of cases?

Squamous cell carcinoma Signup and view all the answers

Which demographic is reported to have the highest incidence of laryngeal cancer?

Urban men Signup and view all the answers

Which of the following conditions related to hoarseness is caused by dysfunction at the neuromuscular junction?

Myasthenia gravis Signup and view all the answers

What is a significant factor influencing the higher incidence of supraglottic cancers in wine-producing countries?

Increased alcohol consumption Signup and view all the answers

Which of the following procedures requires the student to perform an examination of the ear?

Otoscopic Examination of the ear Signup and view all the answers

What is the purpose of conducting pure tone audiometry?

To interpret the auditory thresholds of hearing Signup and view all the answers

Which examination is specifically listed for observing a condition of the upper respiratory tract?

Fibreoptic laryngoscopy Signup and view all the answers

Which procedure falls under the category of student observations rather than performance?

Examination of balance Signup and view all the answers

Which of the following skills is emphasized for students attending seminars and presentations?

Joint radiology collaboration Signup and view all the answers

In the context of attending clinical sessions, which meeting is specified for all students to participate in?

Morbidity/mortality conference Signup and view all the answers

What type of clinical procedure is described by the term 'impedance tympanometry'?

Measurement of ear canal pressure Signup and view all the answers

Which procedure requires local anaesthesia as part of the examination process?

Endoscopy of the nasopharynx Signup and view all the answers

What should be done first before attempting cautery on the bleeding site in case of anterior epistaxis?

Cauterize the immediate area around the source of bleeding Signup and view all the answers

Which statement accurately describes the effectiveness of electrocautery compared to chemical cautery?

Electrocautery is generally more effective during active bleeding Signup and view all the answers

What is the most common site for epistaxis?

The antero-inferior nasal septum Signup and view all the answers

In what situation would nasal packs be required during the management of epistaxis?

In cases of profuse anterior epistaxis or unidentified bleeding Signup and view all the answers

What is the primary risk associated with unilateral cautery if performed excessively?

Septal perforation as a potential complication Signup and view all the answers

What type of packing is commonly used and is noted for better tolerance in patients, especially children?

Merocel sponges Signup and view all the answers

When can patients who have not experienced major bleeds typically be discharged after observation?

After 20-30 minutes of observation Signup and view all the answers

What is a significant disadvantage of performing bilateral cautery on the nasal septum?

It has a high incidence of septal perforations Signup and view all the answers

What type of cautery is generally preferred for its effectiveness during active bleeding?

Electrocautery Signup and view all the answers

What type of nasal packing offers a significant discomfort during insertion and removal?

Nasal gauze strips Signup and view all the answers

Which congenital lesion is characterized by abnormal connections between the larynx and the surrounding tissues?

Laryngocoele Signup and view all the answers

What is the primary characteristic of myxoedema associated with hypothyroidism?

Non-pitting oedema with mucin deposits Signup and view all the answers

Which malignant tumor is most commonly associated with hoarseness due to invasion of the larynx?

Squamous cell carcinoma Signup and view all the answers

Which of the following is primarily a result of damage to the recurrent laryngeal nerve?

Vocal cord palsy Signup and view all the answers

What condition is associated with trauma to the larynx and typically features both haematoma and oedema?

Neck injury Signup and view all the answers

What is a characteristic feature of vocal cord nodules?

Chronic inflammatory changes Signup and view all the answers

Which type of laryngeal lesion can be attributed to both congenital malformations and acquired deformities?

Vocal cord webs Signup and view all the answers

Which viral infection is known to potentially affect the recurrent laryngeal nerve and cause hoarseness?

Cytomegalovirus Signup and view all the answers

What type of benign tumor is specifically linked to repetitive injury and irritation of the vocal cords?

Vocal cord nodules Signup and view all the answers

What common pathway can lead to a number of lesions affecting the larynx, such as trauma and laryngitis?

Infectious processes Signup and view all the answers

What is the recommended duration for keeping nasal balloons in situ during the management of epistaxis?

48 - 72 hrs Signup and view all the answers

What is a potential complication when using saline for inflating a Foley's catheter balloon?

Risk of aspiration Signup and view all the answers

When is it advisable to ligate the maxillary artery in the management of epistaxis?

At the time of first general anaesthesia if other methods fail Signup and view all the answers

What should be done if epistaxis persists despite using nasal balloons and undergoing an endoscopic examination?

Examine and cauterize any identified bleeding points Signup and view all the answers

What is the most common reason for the failure of embolization of the maxillary artery in controlling epistaxis?

Higher failure rate compared to ligation Signup and view all the answers

Which anatomical structure may need to be fractured to access the meati for identification of a bleeding point?

Turbinates Signup and view all the answers

What is a crucial aspect when managing a case of epistaxis in a male teenager?

Consideration of possible angiofibroma Signup and view all the answers

Which procedure is most effective for controlling recurring epistaxis after the removal of nasal packs?

Ligation of maxillary artery Signup and view all the answers

What is the primary alternative after failure of cautery and nasal packs for severe epistaxis?

Foley's catheter insertion with air inflation Signup and view all the answers

In the context of epistaxis, what clinical assessment should be prioritized to rule out serious conditions?

Radiologic studies to identify malignancy Signup and view all the answers

Study Notes

Introduction to Otorhinolaryngology (ORL) Rotation

Year 4, Semester schedule for medical students focusing on ENT disorders.
Emphasis on apprenticeship model; observe interactions with colleagues and patients.
Key traits: punctuality, professionalism, and effective communication with patients.
Aim to differentiate between urgent cases requiring specialist referral and manageable primary care issues.
Importance of daily reading to build a foundational understanding of ENT disorders.

Eustachian Tube Obstruction

Obstruction types: intrinsic (due to inflammation) and extrinsic (due to adenoidal hyperplasia/tumors).
Intrinsic obstruction often linked to upper respiratory infections, involving edema and secretions.
In children under 7, eustachian tube collapse can occur from cartilage stiffness.
Extrinsic causes include nasopharyngeal tumors and craniofacial abnormalities.
Consequence of obstruction: vacuum formation in the middle ear leading to serous fluid accumulation.

Otitis Media with Effusion

Frequent in children, particularly with submucous cleft palate.
Infection from the eustachian tube plays a significant role; organisms found include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
Delicate balance maintained in chronic infections; patients may have asymptomatic effusions.

Epistaxis (Nosebleeds)

Initial management dependent on cardiovascular stability; assess pulse and blood pressure.
Techniques for anterior epistaxis include nasal tamponade, cautery, packing, and surgery if necessary.
Use of topical vasoconstrictors (e.g., cocaine) aids examination and management.
Antibiotics recommended during nasal packing duration (24-48 hours).

Nasal Examination Techniques

Nasal endoscopy preferred for locating bleeding points in epistaxis cases.
Rigid telescopes or flexible fiberoptic scopes are utilized for optimal visualization.
Posterior epistaxis requires careful assessment; management often includes balloon tamponade.

Tumor Assessment and Treatment

Diagnosis confirmed through histology; deep biopsies under anesthesia may be necessary.
CT scans essential for assessing tumor extent and planning treatment (radiotherapy).
Nasopharyngeal carcinoma primarily treated with radiotherapy—doses typically 65-70 Gy.
Surgery reserved for biopsies or radical neck dissections post-radiotherapy; may involve debulking in massive lymphadenopathy cases.

Pediatric Otolaryngology

Specific considerations for ENT disorders in children; different presentation and management strategies may be required.
Knowledge of developmental anatomy and physiology essential for understanding management choices.

General Recommendations

Student engagement in learning enhances knowledge and skills in ENT, improving patient care proficiency.
Continuous study and self-reflection are crucial for developing a strong foundation in Otorhinolaryngology.

ENT Procedures for Students

Focused ENT history is essential for diagnosis and management decisions.
Perform otoscopic examinations and balance assessments to evaluate ear health.
Nose, oral cavity, thyroid, and neck examinations are critical components of ENT assessments.
Pure tone audiometry and tympanometry interpretations help assess hearing function and middle ear status.
Endoscopy techniques include ear, laryngeal, and nasopharyngeal examinations.
Otoacoustic emission tests are vital for newborn hearing screenings.
Fine needle aspiration cytology aids in evaluating thyroid nodules and salivary gland masses.
Understanding soft tissue neck X-rays is important for diagnosing various head and neck conditions.
Ear syringing is a common procedure for wax removal.

Attendance Requirements

Regular participation in Thursday meeting presentations is mandatory.
Attendance at joint radiology and head & neck seminars is necessary.
Morbidity and mortality conferences require student attendance for learning from clinical outcomes.
All clerkship sessions must be adhered to as per the timetable.

Clinical Year Timetable Overview

Monday to Friday: ENT operations, clinic visits, and seminars are scheduled throughout the week at set times.
Group A and B rotations allow for comprehensive exposure to ENT procedures.

Management of Epistaxis

Effective tamponade techniques include direct pressure; failure may necessitate cauterization.
Little's area is the most common site for epistaxis; cauterization should be cautious to avoid perforation.
Bilateral cautery at equivalent sites increases the risk of septal perforation; perform unilaterally when possible.
Nasal packing options include petrolatum gauze, Merocel sponges, and nasal balloons, with different tolerability levels.
Persistent epistaxis post-treatment warrants detailed nasal examination and potential arterial ligation.

Causes and Types of Hoarseness

Common intrinsic laryngeal lesions include vocal cord nodules, polyps, and acute laryngitis.
Congenital anomalies can also contribute to vocal issues including webs and cysts.
External factors such as trauma, infections, and malignancies severely affect vocal cord function.
Neuromuscular disorders and surgical history involving the laryngeal nerve may lead to hoarseness.
Persistent hoarseness beyond two weeks necessitates vocal cord visualization.

Carcinoma of the Larynx

Typically appears in individuals aged 60-70, linked with smoking and alcohol consumption.
Carcinogenic substances from cigarettes directly damage DNA, elevating cancer risk.
Other risk factors include viral infections (HPV), occupation exposures, and previous radiation.
Incidence is higher in men (approx. 9 per 100,000) compared to women (1.5 per 100,000).
Geographical variations exist; urban pollutants may correlate with increased rates in specific populations.
Squamous cell carcinoma constitutes 95% of cases; glottic cancers present early with worsening hoarseness.

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Description

This quiz explores the critical aspects of diagnosing and assessing nasopharyngeal lesions through biopsy techniques. It emphasizes the necessity for deep biopsies, considerations for anesthesia, and the role of imaging studies like CT and MRI in tumor extent assessment. Test your knowledge on the histological diagnosis in oncology.