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ENT > week 1 pathology > Flashcards

week 1 pathology Flashcards

1
Q

what are the Auditory meatus and external canal are lined by?

A

sebaceous and ceruminous glands.

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2
Q

what is the middle ear lined by? what does the middle ear contain?

A

columnar lined mucosa.

Contains ossicles – malleus, incus and stapes

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3
Q

what is in the inner ear

A

the cochlea, vestibular apparatus

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4
Q

what lines the Nasal vestibule

A

stratified squamous, keratinized (skin)

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5
Q

what lines the nose/sinus etc?

A

Schneiderian epithelium

identical to respiratory mucosa – pseudostratified ciliated columnar with Sero-mucinous glands (glands give ‘bogeys’)

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6
Q

throat lined with what?

A

Respiratory and squamous epithelium depending on anatomical site (true cords = goal cords = squamous, underneath them = respiratory)

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7
Q

what kind of glands are salivary glands?

A

Exocrine gland

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8
Q

what are salivary glands made up of?

A

Acinar component and ductular component
Serous cells – darkly staining. Contain digestive enzymes including amylase
Mucinous component – clear grey staining
Peripheral myoepithelial cells – often flat or cuboidal with clear cytoplasm. Have some contractile properties

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9
Q

what pathology can occur concerning the ear

A

Otitis media
Cholesteatoma
Tumours
Vestibular Schwannoma

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10
Q

what is otitis media?

A

Inflammation of middle ear

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11
Q

cause of otitis media

A

Usually viral. Occasionally bacterial – Strep. Pnuemoniae, H. Influenzae and Moxarella Catarrhalis. If chronic – Pseudomonas Aeruginosa

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12
Q

what is a Cholesteatoma

A

Not a tumour and doesn’t contain cholesterol!!!

it is a destructive and expanding growth consisting of keratinizing squamous epithelium in the middle ear and/or mastoid process. due to tympanic rupture/hole

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13
Q

what is the normal lining of middle ear? what occurs in cholesteatoma?

A

cuboidal or columnar glandular epithelium

Abnormally situated squamous epithelium. High cell turnover and abundant keratin production. Associated inflammation

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14
Q

what is a vestibular schwannoma? buzzword on mircosope?

A

a peripheral nerve benign tumour associated with CNVIII

verocay bodies

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15
Q

Vestibular Schwannoma occurs where?

A

Occur within temporal bone and represent 80-90% of cerebellopontine angle tumours

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16
Q

how do Vestibular Schwannoma usually present? when to associate with another disease?

A

95% are sporadic and unilateral. Equal gender distribution

If bilateral and young – consider neurofibromatosis (NF) type 2

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17
Q

NF1 prevalence, genetics, description and signs?

A

1:3000. Autosomal dominant. Widespread neurofibromas. Bony defects, café au lait spots, axillary freckling, Lisch nodules

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18
Q

NF2 prevalence, genetics, description and signs?

A 
AD but usually sporadic mutation. 1:40000 incidence. NF-2 gene encodes merlin protein at Ch22q12
Bilateral vestibular schwannoma
Multiple meningiomas
Gliomas
Café au lait
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19
Q

pathology of the nose?

A 
Rhinitis
Sinusitis
Polyp
Wegeners
NPC
Neuroblastoma
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20
Q

who are nasal polyps common in? what to suspect if not in these people?

A

Common (not in children). Equal gender distribution.

if kids suspect CF

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21
Q

causes of nasal polyps?

A

Numerous aetiologies – allergy, infection, asthma, aspirin sensitivity, nickel exposure (NSAID exacerbation asthmatic get nasal polyps)

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22
Q

rhinitis and sinusitis cuases?

A

Infectious – common cold

Allergic – hay fever. IgE mediated type 1 hypersensitivity reaction.

23
Q

what is Wegener’s granulomatosis/ Granulomatosis with polyangiitis

A

Autoimmune disorder of unkown aetiology characterised by a small vessel vasculitis limited to respiratory tract and kidneys

24
Q

when does Wegener’s granulomatosis/ Granulomatosis with polyangiitis occur?

A

Rarely. Usually white patients and >40years old.

25
Q

PC of Rare. Wegener’s granulomatosis/ Granulomatosis with polyangiitis

A

Present with pulmonary, renal disease or nasal symptoms of congestion, septal perforation etc.

26
Q

commonest septal perforation?

A

cocaine

27
Q

how to determine if Wegener’s granulomatosis/ Granulomatosis with polyangiitis?

A

biopsy (nose bc lung is more difficult)

cANCA

28
Q

what tumours can occur in the nose?

A

Relatively rare
Benign lesions – squamous papillomas, “Schneiderian” papillomas. Angiofibromas
Malignant lesions – Most commonly Squamous cell carcinoma
Also primary adenocarcinoma, nasopharyngeal carcinoma, neuroblastoma, lymphoma

29
Q

what two things are Nasopharyngeal carcinoma associated with?

A

Epstein Barr virus as well as volatile nitrosamines in food

30
Q

what does EBV cause? how?

A

many lymphomas, also Nasopharyngeal carcinoma

Infects epithelial cells of oropharynx and B-cells

31
Q

pathology of the throat?

A 
Laryngeal polyps
Ulcers
Papillomas
Dysplasia/cancer
paraganglioma
32
Q

what are Laryngeal polyps

due to?

A

Reactive change in laryngeal mucosa secondary to - vocal abuse, reflux, infection and smoking. Occ. in hypothyroidism.

33
Q

difference between Laryngeal polyps and nodules

A

Nodules and polyps are largely interchangeable terms. Nodules are usually seen in young women and are bilateral on middle 1/3 to posterior 1/3 on vocal cord. Polyps are unilateral and pedunculated

34
Q

what is a contact ulcer? causes of contact ulcer?

A

Benign response to injury

Chronic throat, voice abuse, gastrooesophageal reflux (GORD

35
Q

what is Squamous papilloma/ papillomatosis + Two peaks of incidence?

A

papiloma = projection/fingers/warts/benign

<5years and between 20-40 years

36
Q

Squamous papilloma/ papillomatosis due to?

A

Related to HPV exposure – types 6 and 11

37
Q

difference between Squamous papilloma/ papillomatosis in kids and adults?

A

Children – aggressive disease

Adults – often solitary and possibly not related to HPV 6 & 11.

38
Q

what is a Paraganglioma?

A

Tumours arrising in clusters of neuroendocrine cells dispersed throughout the body.

39
Q

two types of Paraganglioma? where are they found?

A

Chromaffin positive and negative (positive = below abdomen + can produce adrenaline and negative =above + rarely produce adrenaline)

40
Q

Paraganglioma usually occurs in who? what should be considered if Paraganglioma occurs in young and fit?

A

> 50s

genetic testing as maybe due to MEN2 + others

41
Q

commonest places of SCC

A

Common tumour in head and neck – nose, sinuses, pharynx, larynx and oral cavity

42
Q

causes of SCC in old? young?

A

smoking and alcohol

sex (HPV 16). Largely in the oropharynx.

43
Q

HPV SCC of head and neck PC and treatment

A

HPV type 16

Produces proteins E6 and E7 which disrupt p53 and RetinoBlastoma pathways respectively, leading to cellular immortality

Tumours have a distinct appearance and a greatly improved prognosis and sensitivity to radiochemotherapy.

44
Q

what are the Salivary Glands

A

Parotid
Submandibular
Sublingual
Minor salivary glands

45
Q

pathology of the salivary glands

A

Sialolithiasis – stones

Paramyxovirus – mumps, bilateral parotitis. Assoc orchitis. Risk of secondary meningitis

Tumours – general rules

46
Q

where is the commonest site for all tumours in the salivary glands? malinant tumours?

A

parotid

Tumours in smaller glands are more likely to be malignant

47
Q

what PC to watch out for in malignant salivary gland?

A

young and a painful mass (as facial nerve travels through parotid).

[note: usually malignant tumour is painless lump until end stage/bone mets]

48
Q

what is the most common tumour of the salivary glands?

A

Pleomorphic adenoma

49
Q

who does Pleomorphic adenoma occur in?

A

Usually females over 60 in parotid
with a long history. Can occur at any
age in any gland.

50
Q

treatment of Pleomorphic adenoma

A

Difficult to excise – recurrence

If longstanding risk of malignant transformation

51
Q

what is Warthin’s Tumour? who does it occur in?

A

2nd commonest BT

males over 50. Rare outwith the parotid. Strong association with smoking. Often bilateral and multicentric

52
Q

what is commonest and second commonest salivary gland tumours?

A

1-Pleomorphic adenoma

2-Warthin’s Tumour

53
Q

commonest malignant tumour of salivary gland worldwide? in UK?

A

Worldwide =mucoepidermoid carcioma

In the UK =adenoid cystic carcinoma

54
Q

adenoid cystic carcinoma occurs in who? survival rate? PC?

A

Usually over 40 and parotid but most common malignant tumour of the palate.

35% 5year survival (cancer creeps up nerve and slowly recurs and kills)

Frequent perineural invasion – assoc pain or loss of function.

ENT (19 decks)

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