ENT pathology

Question 1

WHAT TEAM?!

Answer 1

WILDCATS!

Question 2

what type of cells line the following/compnents:

• auditory meatus & auditory canal
• middle ear
• inner ear
• nasal vestibule
• nasal sinus
• throat
• vocal chords

Answer 2

• epidermis containing sebaceous & ceruminous glands
• columnar lined mucosa, contains ossicles
• cochlea and vestibular apperatus
• squamous

-schneiderian epithelium (resp mucosa)
columnar, seromucinous glands

• resp and squamous epithelium
• squamous

Question 3

Salivary glands

• type of gland
• cells present

Answer 3

-exocrine gland

-serous cells (contain digestive enzymes), mucinous cells,
peripheral myoepithelial cells- flat or cuboidal with clear cytoplasm

Question 4

Name the 4 major forms of pathology in the ear

Answer 4

Otitis media
Cholesteatoma
tumours
Shwannoma

Question 5

Otitis media

• what is it?
• caused by?
• onset?

Answer 5

• inflammation of the inner ear
• usually viral, occasionally bacterial- Strep Pneumoniae/H.influenzae
• can be acute or cronic

Question 6

Cholesteatoma

• what is it?
• occurs where
• associations
• appearance

Answer 6

• Abnormally situated squamous epithelium with increased cell turnover & keratin production causing inflammation
• superior posterior middle ear and petrous apex
• chronic OM and perforated tympanic membrane
• blackened with keratin flakes

Question 7

Vestibular shwannoma

• what is it?
• bilaterally in young then assoc with?

Answer 7

-tumour o the VIIICN sheath in the shwann cells within the temporal bone

-NF type 2
autosomal dominant neurofibromas
bony defects
Cafe au liât spots, axillary freckling, lisch nodules
meningiomas and gliomas

Question 8

6 main pathologies of the nose?

Answer 8

Rhinitis
sinusitis
polyps
Wegeners granulomatosis
NPC- nasal pharangeal carcinoma
neuroblastoma

Question 9

Nasal polyps

• causes?
• in children then…?
• appearance

Answer 9

• allergy, infection, asthma, aspirin sensitivity, nickel exposure
• consider CF
• fluid filled sacs with normal purple mucosa outline

Question 10

Rhinitis & sinusitis

• name the two types
• examples

Answer 10

-infectious e.g common cold

allergic e.g.hayfever

Question 11

Wegener’s granulomatosis

• also know as
• what is it?
• presentation
• antibody
• histology

Answer 11

• Granulomatosis with polyangitis
• auto-immmune disorder in the small vessels of the kidneys and resp tract

-pulmonary or renal disease OR nasal symptoms of congestion
+ septal perforation and ulcers

• c-ANCA
• intense inflammatory process with multinucleate giant cells

Question 12

Name the benign nasal tumours (3)

Answer 12

squamous papilloma
Shneiderian papillomas
angiofibromas

Question 13

Name the malignant nasal tumours (5)

-the virus associated with lymphoma?

Answer 13

most commonly squamous cell carcinoma
primary adenoma
nasopharangeal carcinoma
neuroblastoma
lymphoma

-EBV

Question 14

Name the 5 most common pathologies in the throat?

excluding infection

Answer 14

larangeal polyps
ulcers
papillomas
dysplasia/cancer
paragangliomas

Question 15

Larangeal polyps

• caused by what?
• difference between nodules and polyps
• appearance

Answer 15

-vocal abuse, infection, smoking, hypothyroidism

-nodules= bilateral
polyps= unilateral and pedunculated

-polopoid protrusion with oedema and infectious infiltrate

Question 16

Ulcer

• caused by what?
• appearance
• histology

Answer 16

-benign response to injury
chronic throat or voice abuse e.g. GORD

• see a break in the epithelium below the basement membrane
• granulation tissue and an influx of fibroblasts & inflammatory cells act as scaffold

Question 17

Papillomatosis

• assoc with which virus
• histology

Answer 17

• HPV 6&11m aggressive in children

- fibrovascular core with epithelium surrounding

Question 18

paraganglioma

• what are they & what do they arise from
• name the two types and where they arise from

Answer 18

-tumours arising from clusters of neuroendocrine cells

-chromaffin positive
sympathetic NS secretes catecholamines (adrenal medulla or paravertebral)

Non-chromaffin
carotid bodies, aortic bodies, jugulotympanic ganglia, clusters around the oral cavity, nose, nasopharynx, larynx and orbit

Question 19

SCC

• risk factors
• role of assoc virus
• location

Answer 19

• smoking, alcohol, HPV 16&18
• produce proteins E6 and E7 disrupting the P53 and RB pathway to cause cellular immortality
• tonsils, toungue base

Question 20

SSC staging in the larynx
T1a
T1b
T2
T3
T4a
T4b

Answer 20

• 1 vocal chord
• both vocal chords
• extension into the supra/subglottis
• vocal chord fixation/extension into the paraglottic space/minor thyroid cartilage
• thyroid cartilage/trachea/tongue muscles/strap muscles/thyroid/oesophagus
• prevertebral spine/ mediastinal structures/carotid artery

Question 21

Salivary gland pathology

• name the 4 different types of salivary gland
• name the 3 most common pathologies

Answer 21

-parotid, submandibular, sublingual, minor salivary glands

-sialolithiasis (stones)
paramyxovirus (mumps)
tumours

Question 22

name the two benign salivary gland tumours

-features and assoc

Answer 22

pleomorphic adenoma
males over 60 yrs
jelly centre and weak capsule
if longstanding risk of malignant transformation

Warthin’s tumour
assoc with smoking
bilateral and multicentric

Question 23

what is the most common malignant salivary gland tumour

• location
• invasion

Answer 23

adenoid cystic carcinoma

• parotid or palate gland
• frequent perineural invasion & assoc pain or loss of function