ENT Pathology

Question 1

what is the external auditory meatus and external ear lined with

Answer 1

epidermis (skin)

has hair follicles, sebaceous glands and ceruminos glands

Question 2

what is the middle ear lines with

Answer 2

columnar lined mucosa

Question 3

what lines the nasal vestibule

Answer 3

squamous cell epithelium

Question 4

what lines the nose and sinuses

Answer 4

respiratory epithelium (pseudo stratified ciliated columnar)

Question 5

what lines the throat

Answer 5

respiratory and squamous epithelium depending on anatomical site

Question 6

what type of glands are salivary glands

Answer 6

exocrine glands

Question 7

what 2 components do salivary glands have

Answer 7

acinar component

ductular component

Question 8

what kinds of cells are sound in salivary glands

Answer 8

serous cells
mutinous cells
peripheral myoepithelial cells

Question 9

what are some common ear pathologies

Answer 9

otitis media
cholesteatoma
tumours
vestibular schwannoma

Question 10

what is Ottis media

Answer 10

inflammation of the middle ear usually due to a viral infection, but can occasionally be bacterial

Question 11

what is a cholesteatoma

Answer 11

a cysts/skin growth which develops in the middle ear secondary to chronic otitis media and a perforated tympanic membrane

has a high cell turnover and abundant keratin which leads to inflammation

Question 12

what cell lining changes are seen in cholesteatoma

Answer 12

normal lining of middle ear is cuboidal or columnar glandular epithelium

cholesteatoms causes abnormally situated squamous epithelium

Question 13

what is a vestibular schwannoma

Answer 13

a benign tumour of the myelin cells of the vestibular portion of the vestibulocochlear nerve

(tumour of Schwann cells)

Question 14

what do bilateral vestibular schwannomas in your people suggest

Answer 14

Neurofibromatosis type 2

Question 15

signs/symptoms of neurofibromatosis type 1

Answer 15

neurofibromas 
bilateral vestibular schwannoma 
multiple meningiomas 
gliomas 
cafe au lait
cataracts

Question 16

common nose pathologies

Answer 16

rhinitis 
sinusitis
polyps 
Granulomatosis with polyangitis
tumours

Question 17

what causes rhinitis and sinusitis

Answer 17

infections - common cold

allergies - hayfever, IgE mediated type 1 hypersensitivity reaction

Question 18

what are nasal polyps

Answer 18

painless soft growth inside the nose

Question 19

causes of nasal polyps

Answer 19

allergy 
infection 
asthma 
aspirin sensitivity 
nickel exposure 

if in young consider cystic fibrosis

Question 20

what is granulomatosis with polyangitis

Answer 20

autoimmune disorder causing small vessel vasculitis and necrosis

usually limited to the resp tract and kidneys

Question 21

how does granulomatosis with polyangitis present

Answer 21

pulmonary, renal disease or nasal symptoms of congestion

septal perforation

Question 22

what are some charactersistics of granulomatosis with polyangitis

Answer 22

high frequency of anti-neutrophil antibody levels (ANCA +ve)

cANCA (GPA) (C and G look kinda similar lol)

Question 23

what tumours affect the nose

Answer 23

benign lesions (squamous papillomas, angiofibromas, schneiderian papillomas)

malignancy lesions (SCC)

primary adenocarcinoma, nasopharyngeal carcinoma, neuroblastoma, lymphoma

Question 24

what are schneiderian papillomas

Answer 24

benign tumours however can be locally destructive

can be inverted, exophytic or oncoytic

Question 25

who gets chneiderian papillomas

Answer 25

most common in males >50 ``` risks HIV Smoking organic solvents welding ```

Question 26

what virus has a strong association with nasopharyngeal carcinomas

Answer 26

Epstein Barr virus

Question 27

who is most likely to get a nasopharyngeal carcinoma

Answer 27

males>females | more common in the Far East

Question 28

how can Epstein Barr predispose to carcinogens

Answer 28

it hi-jacks and mimics helper T cells somehow it leads to the promotion of cells from G0 to G1

Question 29

common throat pathologies

Answer 29

``` laryngeal polyps/nodules ulcers papillomas dysplasia/cancer paraganglioma ```

Question 30

what are laryngeal polyps

Answer 30

abnormal tissue growth secondary to vocal cause, infection and smoking

Question 31

what is a contact ulcer

Answer 31

a benign response to injury occurs posterior to local cord

Question 32

what can cause a contact ulcer

Answer 32

chronic throat clearing voice abuse gastrooesophageal reflux intubation

Question 33

what are squamous papillomas

Answer 33

common benign neoplasm of oral mucosa

Question 34

who gets squamous papillomas

Answer 34

two peaks of incidence >5 and 20-40 years related to HPV types 6 and 11 aggressive in children but often solitary in adults

Question 35

what are paragangliomas

Answer 35

tumours arising from clusters of neuroendocrine cells rare, can arise at any age but usually >50 can occur as part of MEN2

Question 36

what are squamous cell carcinomas

Answer 36

common tumour in head and neck (nose, sinuses, pharynx, larynx and oral cavity)

Question 37

risk factors for squamous cell carcinomas

Answer 37

smoking and alcohol HPV

Question 38

how can HPV16 cause squamous cell carcinomas

Answer 38

produces proteins which disrupt p53 and RB pathways stopping cell regulation

Question 39

management for squamous cell carcinomas

Answer 39

``` confirm diagnosis grade stage look at other prognostic factors (vascular invasion, perineurial invasion) ```

Question 40

what does T1a mean in SCC staging

Answer 40

affects one vocal cord

Question 41

T1b

Answer 41

affects both vocal cords

Question 42

T2

Answer 42

extension into supra/subglottis

Question 43

T3

Answer 43

vocal cord fixation or extension into paraglottic space minor thyroid cartilage involvement

Question 44

T4a

Answer 44

thyroid cartilage, trachea, muscles of tongue, strap muscles, thyroid, oesophagus

Question 45

T4b

Answer 45

prevertebral space, mediastinal structures, carotid artery

Question 46

what are the 4 main salivary glands

Answer 46

parotid submandibular sublingual minor salivary glands

Question 47

what are sialolithiasis

Answer 47

calcified mass/stone forms int h salivary gland

Question 48

what are some common infections of the salivary glands

Answer 48

paramyxovirus (mumps)

Question 49

what is the most common site for all salivary gland tumours

Answer 49

parotid gland

Question 50

what are tumours in smaller salivary glands likely to be

Answer 50

malignant

Question 51

what is a pleomorphic adenoma

Answer 51

most common salivary gland tumour (benign) usually seen in females 40-60 in the parotid gland often recurrent and difficult to excise

Question 52

what is warthog's tumour

Answer 52

2nd most common benign salivary gland tumour males >50 usually in parotid strong association with smoking

Question 53

what is the most common malignant salivary gland tumour

Answer 53

mucoepidermoid carcinoma (worldwide) in uk its adenoid cystic carcinoma

Question 54

who gets adenoid cystic carcinomas

Answer 54

usually >40 an din the parotid gland, but also most common tumour of the palate 35% 5 year survival