Pathology

Question 1

Cholesteatoma

Answer 1

Collection of dead skin cells which become stuck in the ear, release enzymes which break down bone.

Question 2

What usually happens to the ear drum preceding cholesteatoma?

Answer 2

Retraction of the ear drum creating pockets in which the dead skin cells can collect.

Question 3

What nerve is affected in vestibular schwannoma ?

Answer 3

Vestibulocochlear nerve CN VIII within the temporal bone

Question 4

What symptoms does someone present with in vestibular schwannoma?

Answer 4

Hearing loss
Tinitus
Dizziness

Question 5

What should be considered if a young patient presents with bilateral vestibular schwannoma?

Answer 5

Neurofibromatosis type 2

Question 6

What is neurofibromatosis type 2?

Answer 6

Autosomal dominant sporadic mutation

Encodes for the merlin protein

Question 7

Where does the mutation occur in neurofibromatosis type 2?

Answer 7

Ch22q12

Question 8

What clinical signs are present in neurofibromatosis type 2?

Answer 8

Cafe au lait spots

Cataracts

Question 9

What are the causes of nasal polyps?

Answer 9

Allergic
Infection
Asthma
Nickel exposure

Question 10

If a young patient <20 presents with nasal polyps what is the risk?

Answer 10

Cystic fibrosis

Question 11

What is glomerulonephritis with polyangitis?

Answer 11

Small vessel vasculitis with necrosis (ulceration)

Question 12

What is the clinical presentation of someone with glomerulonephritis and polyangitis?

Answer 12

SOB, wheeze, cough, Rhinorrhea, septal ulcers
Glomerulonephritis, Haematuria
Increased BP

Question 13

Glomerulonephritis is pANCA +ve. T/F?

Answer 13

False

cANCA +VE

Question 14

Why are most malignant tumours of the nose squamous cell carcinoma?

Answer 14

Irritation of the respiratory epithelium and subsequent metaplasia as squamous cells are more resistant to irritation.

Question 15

Who are usually affected by sinonasal papillomas?

Answer 15

Over 50 male

Question 16

What three types of sinonasal papillomas are there?

Answer 16

Inverted
Exophytic
Oncocytic

Question 17

What factors increase the risk of sinonasal polyps?

Answer 17

HPV
Smoking
Organic solvents
Welding

Question 18

What is primary presenting complaint of someone with sinonasal polyps?

Answer 18

Blocked nose

Question 19

What is the risk of malignant change in sinonasal polyps?

Answer 19

Very low they very rarely undergo malignant change.

Question 20

What has a strong causative link to nasopharyngeal carcinomas?

Answer 20

Ebsteinn barr virus

Volatile nitrosamines

Question 21

What are risk factors for developing nasopharyngeal carcinomas?

Answer 21

Occupational exposure to hard wood dust, formaldehyde
Family history
Smoking
Alcohol
HPV

Question 22

What is the prognosis for someone with nasopharyngeal carcinomas?

Answer 22

Highly malignant locally invasive with early lymphatic spread.

Question 23

What cancer is Ebsteinn Barr virus linked to?

Answer 23

Hodgkins lymphoma

Excessive B cell proliferation due to T helper cells being hijacked by the virus.

Question 24

What are laryngeal polyps?

Answer 24

A reactive change secondary to vocal abuse or infection

Question 25

What endocrine condition can rarely present with laryngeal polyps?

Answer 25

Hypothyroidism

Question 26

What two age groups are affected by squamous papillomas?

Answer 26

<5 years | 20-40 years

Question 27

How are children affected by squamous papilloma?

Answer 27

Usually a more aggressive disease profile but regresses during puberty Risk of malignancy

Question 28

What are some risk factors for childhood squamous papillomas?

Answer 28

vaginal delivery

Question 29

In adults how do squamous papillomas present?

Answer 29

Often solitary papillomas.

Question 30

How do squamous papillomas present histologically?

Answer 30

Finger like projections with a fibrovascular core and squamous cover.

Question 31

What are paragangliomas?

Answer 31

Clusters of neuroendocrine cells

Question 32

What do sympathetic paragangliomas do and where are they generally located?

Answer 32

Secrete catelchoamines | Paravertebral sites

Question 33

Where are parasympathetic paragangliomas generally found?

Answer 33

Related to the great vessels of the head and neck.

Question 34

How common are paragangliomas and what condition are they linked to?

Answer 34

Very rare, if present they are often part of a MEN2

Question 35

What do paragangliomas look like histologically?

Answer 35

Nest of round neuroendocrine cells surrounded by a delicate vascular septum.

Question 36

If a patient presents with a squamous cell carcinoma of the oropharynx what is the most likely cause?

Answer 36

HPV type 16

Question 37

What is the prognosis of someone with a HPV type 16 related squamous cell carcinoma of the oropharynx?

Answer 37

Very good as it responds to therapy very well

Question 38

What risk factors for squamous cell carcinomas are there?

Answer 38

Smoking and alcohol

Question 39

What is a sialolithiasis ?

Answer 39

Stones within the salivary glands

Question 40

If a young patient presents with a unilaterally painful salivary gland what do you think?

Answer 40

Consider a tumour, parotid is the most common tumour

Question 41

Who is generally affected by a pleomorphic adenoma?

Answer 41

Women between 30-70 who have had a past exposure to radiation.

Question 42

What is the risk associated with pleomorphic adenomas?

Answer 42

Very difficult to excise due to risk of recurence | Longstanding risk of malignant transformation

Question 43

How do pleomorphic adenomas present histologically?

Answer 43

Well circumscribed partially encapsulated | Epithelial/ myoepithelia cells

Question 44

Who is generally affected with worthing tumours?

Answer 44

Male over 50

Question 45

How do Worthings tumours present?

Answer 45

Linked to the parotids, bilateral multi centric | Well circumscribed but can be cystic

Question 46

How do mucoepidermidoid carcinomas present?

Answer 46

Well circumscribed often infiltrative Varied squamous or mucous cells Cystic or solid

Question 47

How do adenoid cystic carcinomas present?

Answer 47

Grey white infiltrative mass Skip lesions Cribiform punched out appearance

Question 48

What 4 types of tumours affect the salivary glands?

Answer 48

Pleomorphic adenoma Worthings tumour Mucoepidermidoid carcinoma Adenoid cystic carcinoma