Pathology Flashcards
The external acoustic meatus and auditory canal are lined by ________ and contains which two types of glands?
Epidermis and contains ceruminous and sebaceous glands
The middle ear is lined by __________ and contains which bones?
Columnar epithelium and contains the ossicles; the malleus/incus and stapes.
The inner ear contains the _____ and ____
Cochlea and vestibular apparatus
The nasal vestibule (most anterior part of the nasal cavity) is lined by ______
Squamous epithelium
The nose and sinuses are lined by ________
Schneiderin epithelium - pseudo stratified, ciliated columnar epithelium with seromucinous glands (same as respiratory mucosa)
What lines the throat?
Respiratory or squamous epithelium depending on where exactly
The salivary glands are exocrine/endocrine glands
Exocrine
The glands have an _______ part and a _______ part.
Acinar
Ductular
Serous cells are darkly/lightly staining and mucous cells stain a ______
Darkly staining serous cells and clear grey staining mucous cells
The glands contain _____ cells which are often flat of cuboidal with clear cytoplasm
Myoepithelium cells
Myoepithelial cells ______
have some contractile ability to aid secretion of products
What is acute otitis media?
Inflammation of the middle ear - usually viral
In a bacterial AOM name the most common organism(s)
Strep pneumonia
h. influenzae
moxarella catarhallis
What infecting organism should you consider if there is a chronic bacterial otitis media?
pseudomonas aeruginosa
Cholesteatoma is a cholesterol filled tumour - true/false
False - it is nothing to do with a tumour or cholesterol.
Cholesteatoma is a locally expansive and destructive growth which is not officially cancer - true/false
true
is a cholesteatoma common? Is it common in any particular age group?
it is common and can occur in any age group
Where is a cholesteatoma most prevalent?
Superoposterior middle ear
petrous apex
What two things are quite often involved with the pathogenesis of a cholesteatoma?
Chronic otitis media
Acquired perforated tympanic membrane
The normal lining of the middle ear is _______ and cholesteatoma occurs when ____________
Cuboidal/columnar epithelium
Abnormally situated squamous epithelium with a high cell turnover and abundant keratin production occurs in the middle ear - associated inflammation.
Vestibular schwannoma is a tumour of _____
the vestibular portion of vestibulocochlear
Vestibular schwannoma occurs most commonly within the occipital bone - true/false
False - temporal bone
Vestibular schwannoma accounts for _____% of ______ tumours
Vestibular schwannoma accounts for 80-90% of cerebellopontine angle tumours
95% of vestibular schwannoma are sporadic and bilateral - true/false
False - most are sporadic and unilateral
There is a higher incidence of vestibular schwannoma in males than females - true/false
False - equal gender distribution
If there is a bilateral presentation of vestibular schwannoma in a young person what disease should you consider?
Neurofibromatosis type 2
Neurofibromatosis type 1 has an incidence of ______
1:3000
Neurofibromatosis type 1 is autosomal/x-linked dominant/recessive
Autosomal dominant
NF1 is characterised by _____
Widespread neurofibromas Bony defects cafe au last spots axillary freckling Lisch nodes
NF2 is more common than NF1 - true/false
False
NF2 is autosomal dominant - true/false
True - but is actually more common as a sporadic mutation
NF2 has an incidence of ______
1:40,000
What protein is encoded by the NF2 gene?
Merlin protein
What does NF2 cause?
Bilateral vestibular schwannomma
Multiple meningiomas
Gliomas
Cafe au lait patches
What type of hypersensitivity is allergic rhinitis/sinusitis?
IgE mediated type I hypersensitivity e.g. hay fever
What non-allergic causes are there of rhinitis/sinusitis?
Infection e.g. common cold
nasal olyps are common in both children and adults - true/false
False - common in adults not kids
There is an equal incidence of nasal polyps in men and women - true/false
true
There are a number of aetiologies of polyps including
Allergy infection Asthma Aspirin sensitivity Nickel exposure
Due to its rare incidence, nasal polyps in children should give a very high clinical suspicion of _____
Cystic Fibrosis
What is Wegener’s granulomatosis?
An autoimmune disorder characterised by small vessel vasculitis
Give the cause of Wegener’s Granulomatosis
No-one knows
Where does Wegener’s effect?
Restricted to resp and renal tracts
Wegener’s is common and normally presents in patient’s of all ages - true/false
False - it is uncommon and usually presents in white patient’s over 40
How does Wegener’s normally present?
Renal disease
Pulmonary disease
nasal symptoms of congestion/septal perf.
What antibodies are usually present in Wegener’s?
Anti-neutrophil antibodies
is Wegener’s ANCA positive?
Yes
cANCA indicates microscopic polyangitis which pANCA indicates Wegener’s - true/false
False - pANCA is microscopic polyangitis while cANCA is Wegener’s
- Tumours in general in the nose are common/rare
- Most tumours in the nose are malignant/benign
- the most common three tumours in the nose are:
Rare
Benign
Squamous papilloma/schneiderian papilloma/angiofibroma
Malignant lesions in the nose tend to be _______
Squamous cell carcinoma (most) Can also be : Adenocarcinoma Nasopharyngeal carcinoma neuroblastoma lymphoma
nasopharyngeal carcinoma has a low/high incidence in the UK but a low/high incidence in the middle east
Low incidence UK
High incidence ME
Nasopharyngeal carcinoma is more prevalent in males/females and has a strong/weak association with EBV/HPV
Males
Strong
EBV
laryngeal polyps occur in ___% of the population and are a _______
1% and are a reactive change in the laryngeal mucosa
name three things which cause laryngeal polyps
Vocal abuse
infection
Smoking
Occasionally laryngeal polyps can be a secondary effect of another disease - what is it?
hypothyroidism
Who is most likely to get laryngeal polyps?
Young women
Where in the larynx are polyps most common?
The middle 1/3 of the vocal cord to the posterior 1/3
laryngeal polyps tend to be uni/bilateral
Unilateral
Contact ulcer in the throat is malignant/benign response to _____
benign response to:
- Chronic throat infection
- vocal abuse
- GORD
Squamous papilloma of the throat is most common in two age groups - what are they?
less than 5 years and between 20 and 40 years
Squamous papilloma in children is strongly linked with HPV types ____
6 and 11
In children squamous papilloma is an aggressive/benign disease
Aggressive
In adults squamous papilloma is often solitary and not associated with HPV 6 & 11 - true/false
true
What is a common tumour in the head and neck?
Squamous cell carcinoma
Risk factors for squamous cell carcinoma include:
Smoking, alcohol and HPV type 16
How does HPV 16 cause cancer?
it produces E6 and E7 which disrupt the p53 and RB pathways respectively which leads to cellular immortality
HPV caused SCCs have a distinct appearance and much better/worse prognosis than those not caused by HPV
Better
Name the four types of salivary glands
parotid
Submandibular
Submental
minor glands
What is sialolithiasis?
Stones (similar to gallstones) formed from saliva in the salivary glands
Paramyxovirus causes what symptoms?
Mumps;
Bilateral parotitis and orchitis (inflammation of one or both testes)
What is there a risk of in paramyxovirus infection?
Secondary meningitis
What salivary gland is most likely to be affected by all tumours?
Parotid
Tumours in the minor glands are more likely to be malignant - true/false
True
What is a pleomorphic adenoma?
Most common benign tumour of the salivary gland (mostly parotid)
What group does a pleomorphic adenoma normally affect? Does it have a short or long history?
Women over 60 - long history
pleomorphic adenoma is a reasonably easy tumour to excise but has a high recurrence rate with a risk of malignant transformation if long standing- true/false
false and true;
They are difficult to excise
but do have a high recurrence rate and do have a risk of malignant transformation if long standing.
Warthin’s tumour is most/second most common benign/malignant tumour of the salivary glands
Second most common benign tumour of the salivary glands
Warthin’s tumour is most common in males under 50 - true/false
False - most common in males over 50
Warthin’s tumour has a strong association with _____ and is rare outside the ______ glands
Smoking
parotid
Worldwide the most common malignant tumour of the salivary glands is _______ while in the UK it is _____
Mucoepidermoid carcinoma
Adenoid cystic carcinoma
What age group and gland are mostly affected by an adenoid cystic carcinoma?
over 40
parotid
What is the most common malignancy of the palate?
Adenoid cystic carcinoma
What is the 5 year survival for an adenoid cystic carcinoma?
35%
What is commonly invaded by an adenoid cystic carcinoma? this will cause symptoms of:
There is normally peri-neural invasion
Symptoms of pain and loss of function
