Pathology Flashcards
What is the external acoustic canal lined with and contain?
epidermis (skin) and contain sebaceous and ceruminous glands
What does this mean?
any dermatology condition can affect the outer ear
What is the middle ear lined with and contain?
columnar lined mucosa and contains ossicles (malleus, incus and stapes)
What is in the inner ear?
the cochlea and vestibular apparatus
What is the mucous like in the nose?
Squamous at tip, majority is respiratory (schneiderian) epithelium and olfactory mucosa at superoposterior aspect of nose.
What glands are in the nose?
Seromucinous glands
When does squamous epithelium become respiratory epithelium in the throat?
At the level of the true chords.
What are the salivary glands?
Exocrine glands with acinar and ductular components.
What are the 3 components of salivary glands?
serous cells (contain digestive enzymes) mucinous component (clear/grey staining) peripheral myoepithelial cells (squeeze everything along)
Identify these components
pale = mucinous component
light purple = serous cells
dark purple = peripheral myoepithelial cells
What is otitis media?
Inflammation of the middle ear
What usually causes otitis media?
Viral infection (sometime bacteria from strep pneumoniae, haemophilus influenzae)
What is the cause if it is chronic otitis media?
Pseudomonas aeruginosa
What agents can be used against psuedomonas?
Cephalosporins (ceftazidime)
Quinolone (ciprofloxacin) or penicillins
What is a cholesteatoma?
NOT a tumour or to do with cholesterol
Is when keratinising epithelium is found in the middle ear
How will a cholesteatoma present?
With discharge if perforated the tympanic membrane or a white surface seen on membrane.
Why is there a high keratin production in cholesteatoma?
Because squamous epithelium has a high cell turnover and abundant keratin production.
What is a vestibular schwannoma?
Benign tumour of the schwann cells on the vestibular portion of the vestibulocochlear nerve.
Are schwannomas only found in ENT region?
No as schwann cells are found all over the body
Where do most vestibular schwannomas occur?
80-90% occur at the cerebropontine angle (connection between the cerebellum and pons)
If someone presents with a bilateral schwannoma and is young what do you suspect?
Neurofibromatosis type 2
What is also associated with NF-2?
NF1
multiple meninhiomas
gliomas
cafe au lait macules
Are nasal polyps common in children?
no - if see this then suspect cystic fibrosis (should have other symptoms too)
What are causes of nasal polyps?
allergy, infection, asthma, aspirin sensitivity
What is the presentation of a nasal polyp?
Vascular dilation and oedema (results in large swelling) but not clinically painful.
What is rhinitis?
Inflammation of the mucous membrane of the nose
What is sinusitis?
Inflammation of the sinsuses
What are the causes of rhinitis and sinusitis?
Infection, allergic (IgE mediated)
What is granulomatosis with polyangitis?
autoimmune disease characterised by small vessel inflammation in the respiratory tract and kidneys
What will GPA present with?
pulmonary problems, renal disease, congestion, septal perforation
How would you diagnose GPA?
cANCA antibody, biopsy
What is the most common malignant tumour of the nose?
SCC
What is the nasopharyngeal carcinoma associated with?
Epstein-barr virus (causes glandular fever)
What is nasopharygeal carcinoma caused by epstein-barr virus ass with?
lymphomas
What causes laryngeal polyps?
Reactive change in mucosa secondary to vocal chord abus e.g. constant rubbing together of chrods, reflux of stomach acid, infection and smoking
What is a contact ulcer and what causes it?
benign response to injury and chronic throat and voice abuse
What causes a squamous papilloma and who is most affected?
HPV 6 and 11
<5 years and 20-40 years
What can be done to reduce the risk of a squamous papilloma?
HPV vaccine
What is histologically diagnostic of a papilloma?
A warty appearance with finger-like projections
What is a paraganglioma?
Tumours that arise in clusters of neuroendocrine cells dispersed through the body.
Where are paragangliomas common?
In the head and neck
What condition are paragangliomas associated with?
MEN 2 but can also be something more sinister so always refer.
Can HPC cause a SCC?
yes
What else can cause SCC in the head and neck?
smoking and alcohol
How does HPV cause cancers?
by releasing 2 toxins - E6 and E7 which attack p53 and RB (tumour suppressor proteins) and thus results in cell immortality.
Where will the primary SCC normally present?
base of the tongue
Where will the SCC spread to?
the lymphatics
Is SCC responsive to chemo and radiotherapy?
YES - very
Which salivary gland is most commonly affected by tumours?
Parotid
if there is a tumour in a smaller gland is it more likely to be malignant r benign?
Malignant
What does painful mass in the parotid gland usually indicate?
Indicates that the tumour has invaded the facial nerve (which passes through the parotid)
What is the most common tumour of the salivary gland?
pleomorphic adenoma
Pleomorphic adenomas has a high rate of recurrence - why?
They are difficult to excise
Can pleomorphic adenomas become malignant?
Yes they have the risk of malignant transformation but only if had for 20-30 years.
What is a Warthin’s tumour?
Second most common benign tumour within the parotid gland with a strong association with smoking
What is the common presentation of a warthin’s tumour?
Bilateral and multicentric
What is the most common malignant tumour in the world?
mucoepidermoid carcinoma
What is the most common malignant tumour in the UK?
adenoid cystic carcinoma
What is characteristic of an adenoid cystic tumour?
Nasty tumour that invades nerves early so can creep up to the brain. They are also often difficult to excise so recur often - ‘slow growing and sinster’
