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ENT > Pathology of ENT > Flashcards

Pathology of ENT Flashcards

1
Q

What is the normal histology of the auditory meatus and external canal?

A

Epidermis - stratified squamous epithelium

Contain sebaceous glands and ceruminous glands

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2
Q

What is the epithelium of the middle ear?

A

Columnar lined mucosa

Eustachian tube is respiratory epithelium

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3
Q

What type of cells are contained within the salivary gland?

A 
Acinar 
Ductal
Serous cells - contain amylase
Mucinous 
Peripheral myoepithelial cells
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4
Q

What bacteria can cause otitis media?

A 
Strep pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Pseudomonas 
Staph aureus
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5
Q

What is a cholesteatoma?

A

Chronic otitis media and perforated tympanic membrane leads to abnormally situated squamous epithelium in the middle ear (normal is cuboidal or columnar glandular) causing an abundance of keratin production with associated inflammation

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6
Q

What is a vestibular schwannoma - also called an acoustic neuroma?

A

Associated with the vestibular portion of CN 8

Occurs with temporal bone at the cerebellopontine angle

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7
Q

What should be considered in a bilateral vestibular schwannoma in a young patient?

A

Neurofibromatosis type 2

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8
Q

What will neurofibromatosis present as?

A 
Neurofibromas
Bilateral vestibular schwannoma
Multiple meningiomas
Gliomas 
Cafe au lait spots
Cataracts
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9
Q

What is the inheritance of neurofibromatosis type 2?

A

AD

Tumour suppressor gene - merlin protein on chromosome 22

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10
Q

What can cause a nasal polyp?

A 
Allergy
Infection
Asthma
Aspirin sensitivity
Nickel exposure
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11
Q

What should be considered in a nasal polyp in a child under 5?

A

CF (AR CFTR gene on chromosome 7)

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12
Q

What mucosa should a nasal polyp be covered with?

A

Respiratory epithelium - squamous epithelium is a metaplastic change

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13
Q

What will GPA present with?

A

Pulmonary - SOB, wheeze, chest pain
Renal - haematuria, glomerulonephritis, hypertension
Nasal symptoms - congestion, septal perforation - saddle nose

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14
Q

What antibody test can be used to diagnose GPA?

A

cANCA

Anti-PR3

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15
Q

What antibody test is used for microscopic polyangiitis?

A

pANCA

Anti-MPO

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16
Q

What benign lesions commonly affect the nose?

A

Squamous papilloma
Schneiderian papilloma
Angiofibroma

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17
Q

What malignant lesions commonly affect the nose?

A 
Squamous cell carcinoma (men, smoking and a previous schneiderian papilloma) 
Primary adenocarcinoma
Nasopharyngeal carcinoma
Neuroblastoma
Lymphoma
18
Q

What are the different types of schneiderian papilloma?

A

Inverted, exophytic or oncocytic

Inverted most common - found on the lateral wall and paranasal sinus

19
Q

What increases the risk of schneiderian papilloma?

A 
Over 50
Male
HPV
Smoking
Organic solvents
Welding
20
Q

What will a schneiderian papilloma present with?

A

Blocked nose

Sinusitis

21
Q

What does a nasopharyngeal carcinoma have an association with?

A

EBV
Volatile nitrosamines in food
Occupation, family history

22
Q

What cancers does EBV have an association with?

A

Burkitt’s lymphoma
B-cell lymphoma
Hodgkin’s lymphoma
Nasopharyngeal carcinoma

23
Q

How does EBV cause cancer?

A

Hi-jacks and mimics CD4+ T cells leading to proliferation and survival of B cells
EBV encodes a protein to activate cyclin D, promoting cell transition from G0 to G1

24
Q

What can cause a laryngeal polyp?

A

Vocal abuse
Infection
Smoking
Hypothyroidism

25
Q

What is the difference between a nodule and a polyp?

A

Nodule - young women, will be bilateral on middle 1/3rd to posterior 1/3rd on vocal cord
Polyps are unilateral and pedunculated

26
Q

What is a contact ulcer?

A

Benign response to injury
Posterior vocal cord
Caused by chronic throat clearing, voice abuse, GORD or intubation

27
Q

What is squamous papilloma related to?

A

HPV exposure - types 6 and 11
Children - aggressive disease
Adults - often solitary and possible not related to HPV 6&11

28
Q

What is a paraganglioma?

A

Tumour arising in clusters of neuroendocrine cells dispersed throughout the body

29
Q

What is a chromaffin positive paraganglioma?

A

Sympathetic nervous system and can secrete catecholamines

Usually adrenal medulla or paravertebral - organ of zuckerkandl (bifurcation of aorta)

30
Q

What is a non-chromaffin paraganglioma?

A

Carotid body
Aortic body
Jugulotympanic ganglia
Ganglia nodosum of vagus with clusters around oral cavity, nose, nasopharynx, larynx and orbit

31
Q

What will occur with MEN2?

A

Pheochromocytoma
Thyroid medullary carcinoma
Parathyroid lesion

32
Q

Where can a squamous cell carcinoma arise in the H&N?

A 
Nose
Sinus
Pharynx
Larynx
Oral cavity
33
Q

What are risk factors for SCC?

A

Smoking and alcohol

HPV - common in oropharynx

34
Q

How will HPV cause cancer?

A

Produces proteins E6 and E7 which disrupt p53 and RB pathways (tumour suppressors) leading to cellular mortality

35
Q

What is sialolithiasis?

A

Stones in the salivary glands leading to pain, swelling and bacterial infections

36
Q

What infections can infect the salivary glands?

A

Paramyxovirus - mumps causing bilateral parotitis. Associated with orchitis, pancreatitis and secondary meningitis

37
Q

What are the general rules for salivary gland tumours?

A

Parotid most common site
Tumours in the smaller glands are likely to be malignant
If young and painfull mass = MALIGNANCY

38
Q

What is a pleomorphic adenoma?

A

Most common tumour of the parotid gland
Usually females int he 4th-6th decade
If longstanding can transform into carcinoma ex pleomorphic adenoma

39
Q

What is warthin’s tumour?

A 
Second most common benign tumour
Males over 50
Rare outwith parotid
Strong assoc with smoking
Bilateral and multicentric
40
Q

What is the most common salivary tumour worldwide and in the uk?

A

Worldwide: mucoepidermoid carcinoma
UK: adenoid cystic carcinoma

41
Q

Why is the survival rate of an adenoid cystic tumour so low (5 year 35%)?

A

Frequent perineural invasion - assoc pain or LOF

ENT (20 decks)

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