ENT Pathology

Question 1

what is contained within the external auditory meatus?

Answer 1

sebaceous glands
ceruminous glands
hair follicle
lined with skin

Question 2

what is contained within the middle ear?

Answer 2

columnar lined mucosa
ossicles
opening of eustachian tube
mastoid cavity

Question 3

what is contained within the inner ear?

Answer 3

the cochlea

vestibular apparatus

Question 4

what lines the nasal vestibule?

Answer 4

stratified squamous

Question 5

what lines the nose and sinuses etc?

Answer 5

resp epithelium

sero-mucinous glands

Question 6

what lines the throat?

Answer 6

resp and squamous epithelium depending on site

Question 7

describe the salivary gland

Answer 7

exocrine
major and minor
acinar and ductular component
serous cells (contain digestive enzymes including amylase)
mucinous component (clear grey staining)
peripheral myoepithelial cells (flat/cuboidal with clear cytoplasm, have contractile properties)

Question 8

what is otitis media and what usually causes it?

Answer 8

inflammation of middle ear
usually viral, occasionally bacterial
if chronic - pseudomaonas aerginosa, stph aureus, fungal

Question 9

what is cholesteatoma?

Answer 9

noncancerous, abnormal skin growth within the middle ear
not a tumour and doesn’t contain cholesterol
can arise as a result of chronic otitis media and perforated tympanic membrane

Question 10

describe the underlying pathology in cholesteatoma

Answer 10

normal lining of the middle ear is cuboidal or columnar glandular epithelium
abnormally situated squamous epithelium high cell turnover and abundant keratin production
associated inflammation

Question 11

what is a vestibular schwannoma?

Answer 11

benign primary intracranial tumour of the myelin-forming cells of the vestibulocochlear nerve(schwann cells)
associated with the vestibular portion of CN VIII
occur within temporal bone

Question 12

how does vestibular schwannoma present?

Answer 12

95% are sporadic and unilateral

gross - circumscribed tan/white/yellow mass

Question 13

what can cause bilateral vestibular schwannoma in young people?

Answer 13

neurofibromatosis type 2

Question 14

give 7 features of neurofibromatosis type 2?

Answer 14

autosomal dominant
neurofibromas
bilateral vestibular schwannoma
multiple meningiomas
gliomas
café au lait
cataracts

Question 15

causes of rhinitis and sinusitis?

Answer 15

infectious - common cold

allergic - hay fever, type 1 hypersensitivity

Question 16

causes of nasal polyps?

Answer 16

allergy
infection
asthma
aspirin sensitivity
nickel exposure
if young - consider CF

Question 17

what is GPA and how will it present?

Answer 17

granulomatosis with polyangiitis
autoimmune disorder of small vessel vasculitis and necrosis usually limited to the resp tract and kidneys
presents with pulmonary, renal or nasal symptoms
- nose bleeds
- bridge collapse
- deafness
- etc

Question 18

GPA antibodies?

Answer 18

cANCA

PR3

Question 19

causes of benign nasal tumours?

Answer 19

squamous papillomas
Schneiderian papillomas
angiofibromas

Question 20

causes of malignant nose tumours?

Answer 20

most commonly squamous cell carcinoma
primary adenocarcinoma
nasopharyngeal carcinoma
neuroblastoma
lymphoma

Question 21

features of Schneiderian papilloma?

Answer 21

inverted and oncocytic on lateral walls and paranasal sinuses
exophytic on nasal septum
causes a blocked nose

Question 22

Schneiderian papilloma risk factors?

Answer 22

over 50s
males
HPV
smoking
organic solvents
welding

Question 23

risk factors for nasopharyngeal carcinoma?

Answer 23

mals > females

associated with Epstein barr virus and volatile nitrosamines in food

Question 24

histology of nasopharyngeal carcinoma?

Answer 24

keratinising SCC

or non-keratinising

Question 25

how is EBV involved in carcinogenesis?

Answer 25

seen in lymphomas
infects epithelial cells of oropharynx and B cells
hijacks and mimics helper T cell responses leading to proliferation and survival of B cells
mediated largely by latent membrane protein 1
EBV encodes EBNA-2 activating cyclin D and promoting transition from G0 to G1 (in cell cycle?)

Question 26

what causes laryngeal polyps?

Answer 26

reactive change in laryngeal mucosa secondary to vocal abuse, infection and smoking
(occasionally in hypothyroidism)

Question 27

laryngeal polyps vs nodules?

Answer 27

nodules = young women, bilateral on middle 1/3rd to posterior 1/3rd of vocal cord
polyps = unilateral and pedunculated

Question 28

what causes a contact ulcer in the throat?

Answer 28

benign response to injury
- chronic throat clearing
- voice abuse
- GORD
- intubation
usually occurs on posterior vocal cord

Question 29

aeitiology of squamous papilloma/papillomatosis?

Answer 29

peaks in <5 y/o and 20-40 y/o
related to HPV - types 6 and 11
aggressive in children
often solitary and not related to HPV in adults

Question 30

what is a paraganglioma?

Answer 30

tumour arising in culsters of neuroendocrine cells dispersed throughout the body

Question 31

2 types of paraganglioma?

Answer 31

chromaffin +ve 
- sympathetic CNS
- can secrete catecholamines 
- usually adrenal medulla or paravertebral - organ of Zuckerkandl
non-chromaffin 
- carotid bodies
- aortic bodies
- jugulotympanic ganglia
- ganglia nodosum of vagus
- clusters around oral cavity, nose, nasopharynx, larynx and orbit

Question 32

who does paraganglioma usually occur in?

Answer 32

usually >50
can be part of MEN2
- autosomal dominant

Question 33

risk factors for squamous cell carcinoma in throat?

Answer 33

smoking
alcohol
HPV virus

Question 34

where does SCC occur in the head and neck?

Answer 34

nose 
sinuses
pharynx
larynx
oral cavity

Question 35

how can HPC cause cancer?

Answer 35

usually due to type 16

produces proteins E6 and E7 which disrupt P53 and RB pathways leading to cellular immortality

Question 36

staging of SCC in the larynx?

Answer 36

T1a = one vocal cord
T1b = both vocal cords
T2 = extension into supra/subglottis
T3 = vocal cord fixation or extension into paraglottic space, minor thyroid cartilage involvement
T4a = thyroid cartilage, trachea, tongue muscles, strap muscles, thyroid, oesophagus
T4b = prevertebral space, mediastinal structures, carotid artery

Question 37

what are the 4 salivary glands?

Answer 37

parotid
submandibular
sublingual
minor salivary glands

Question 38

name 3 salivary gland pathologies

Answer 38

sialolithiasis - stones
infection - paramyxovirus (mumps, parotitis)
tumours

Question 39

where do tumours present in salivary glands?

Answer 39

usually parotid
tumours in smaller glands more likely to be malignant
if young and a painful mass - think malignant

Question 40

what is the most common salivary gland tumour?

Answer 40

pleomorphic adenoma

benign but risk of malignant transformation if longstanding (carcinoma ex pleomorphic adenoma)

Question 41

who does pleomorphic adenoma usually occur in?

Answer 41

females
4th-6th decade
can occur at any age in any gland

Question 42

second most common salivary gland tumour?

who does this occur in?

Answer 42

Warthin’s tumour
usually males >50
associated with smoking

Question 43

presentation of Warthin’s tumour?

Answer 43

usually in parotid

often bilateral and multicentric

Question 44

most common malignant salivary gland tumour?

Answer 44

worldwide = mucoepidermal carcinoma
UK = adenoid cystic carcinoma

Question 45

where does mucoepidermoid carcinoma usually occur?

Answer 45

majority in parotid but can be in any gland
wide age range
equal gender incidence

Question 46

who/where does adenoid cystic carcinoma usually occur in?

Answer 46

wide age range
usually over 40
usually in parotid
most common malignant tumour of the palate
frequent perineural invasion causing pain and loss of function