Week 1 - E - Pathology of Ear, nose and throat

Question 1

What are the glands that produce ear wax in the ear canal?

Answer 1

Ceruminous glands

Question 2

What type of mucosa lines the external acoustic meatus and the ear canal?

Answer 2

Skin - keratinized stratified squamous epithelium

Question 3

Fun question, how many bones are in the human body? What part of the ear is lined with columnar mucosa?

Answer 3

206 bones Middle ear is columnar lined mucosa

Question 4

What is the nasal vestibule lined with?

Answer 4

The nasal vestibule is lined with stratified squamous epithelium changing from keratinized to non-keratinized

Question 5

Noses and sinuses are lined by respiratory epithelium What is this epithelium? What is respiratory epithelium in the nose also known as?

Answer 5

This pseudostratified ciliated columnar epithelium with goblet cells Respiratory epithelium is also known as Schneiderian epithelium

Question 6

Are salivary glands exocrine or endocrine and what are the two components?

Answer 6

They are exocrine Have a ductular and acinar component

Question 7

What is inflammation of the middle ear known as? Is otitis media usually viral r bacterial?

Answer 7

Known as otitis media It is usually a viral condition

Question 8

What bacteria can usually cause otitis media?

Answer 8

Strep. Pnuemoniae,

H. Influenzae and

moraxella catarrhalis

Question 9

What bacteria can cause chronic otitis media? It usually stinks

Answer 9

pseudomonas aeruginosa

Question 10

What is skin growth in the middle ear known as? Not cholesterol or a tumour

Answer 10

Cholesteatoma

Question 11

What can cause cholesteatoma?

Answer 11

Recurrent ear infections Perforated eardrum Eustachian tube dysfunction

Question 12

What can happen if the abnormally situated keratinized squamous epithelium is left to lie in the middle ear?

Answer 12

The cholesteatoma can grow and destroy the ossicles of the middle ear

Question 13

Associated with vestibular portion of vestibulocochlear nerve (VII). Occur within temporal bone and represent 80-90% of cerebellopontine angle tumours WHat is this?

Answer 13

Vestibular schwannoma (acoustic neuroma)

Question 14

95% of vestibular schwannoma are sporadic and unilateral What is the tumour a growth of? Which cranial nerve is not a true peripheral nervous system cranial nerve?

Answer 14

The tumour is a benign growth of the schwanna cells which produce the myelin sheath in the peripheral nervous system protecting the nerve and increasing the speed of nerve impulse conduction

The optic nerve (CN II)

Question 15

If a vestibular schwannoma is bilateral and in the young, what condition do you think of?

Answer 15

Neurofibromatosis type 2 - can see the tumour on MRI scan

Question 16

What gene is mutated in NF2 ad what does it code for? What are some other features of NF2 apart from vestibular schwannomas?

Answer 16

NF2 gene is mutated and it codes for merlin protein (aka schwannomin)

People with NF2 present with gluacoma which can cause damage to the optic nerve

Hearing loss Ringing in the ears Meningiomas Optic gliomas Juvenile cataracts

Question 17

Nasal polyps are common howver less common in children If a child presents with a nasal polyp, what should you suspect?

Answer 17

Think cystic fibrosis

Question 18

What is samter’s triad?

Answer 18

A triad that includes nasal polyps, salicytate (aspirin) sensitivity and asthma

Question 19

What can the nasal polyps in cystic fibrosis cause?

Answer 19

Makes patient more likely to have recurrent sinusitis

Question 20

Autoimmune disorder characterised by a small vessel vasculitis limited to respiratory tract and ENT (and kidneys) Present with pulmonary, renal disease or nasal symptoms of congestions, septal perforation etc. What is this disoder? How does this lead to septal perforation?

Answer 20

Granulomatosis with polyangitis (Wegener’s granulomatosis)

Since the small blood vessels become inflamed, this can cause necrosis therefore decreasing the blood supply to eg nasal septum cartilage and causing a perforation

Question 21

What type of antibodies are seen in Wegener’s granulomatosis?

Answer 21

People with thi are ANCA+ c-ANCA positive to be precise

Question 22

What ANCA antibodies are present in microscopic polyangiitis?

Answer 22

p-ANCA

Question 23

What is a squamous papilloma of the respiratory epithelium of the nose known as?

Answer 23

Schneiderian papilloma

Question 24

What are squamous papillomas associated with?

Answer 24

Associated with HPV types 6 and 11

Question 25

What are the major risk factors for squamous cell carcinoma of the oral mucosa?

Answer 25

Smoking Alcohol

Question 26

Which type of schneiderian papillloma should you be aware of?

Answer 26

Inverted schneiderian papilloma as they can go malignant

Question 27

What virus is associated with nasopharyngeal carcinoma?

Answer 27

EBV

Question 28

How can epsteinn bar virus lead to cancer? EBV is also associated with lymphomas (cancer of lymphatic system)

Answer 28

EBV hijacks and mimicks Thelper cell response leading to proliferation and survival of B cells

It also produces EBNA2 (epstein barr nuclear antibody 2) which causes Bcells to continue the cell cycle and divide out of control

Question 29

Chronic throat, voice abuse, gastrooesophageal reflux (GORD) can cause ulceration in the vocal cords What is this known as?

Answer 29

Contact granuloma or contact ulcer

Question 30

What syndrome is associated with dryness of the eyes and mouth (sicca symptoms) and massive parotid gland swelling?

Answer 30

Sjorgen’s syndrome

Question 31

What is the most common tumour seen in the parotid gland?

Answer 31

Pleomorphic adenoma

Question 32

What is the 2nd most common benign tumour of the parotid gland?

Answer 32

Warthin’s tumour - strongly associated with smoking