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ENT COPY > ENT pathology > Flashcards

ENT pathology Flashcards

1
Q

What lines the auricle and the external acoustic meatus?

A
  • The auricle and the external acoustic meatus have an by an epidermis, therefore, contain sebaceous and ceruminous glands which secrete cerumen (earwax).
  • The epidermis is made of stratified squamous epithelium.
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2
Q

What are the 4 main pathologies that affect the ear?

A
  1. Otitis media
  2. Cholesteatoma
  3. Tumours
  4. Vestibular Schwannoma
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3
Q

What does Otitis Media mean?

A

Ottitis media refers to any inflammation of the middle ear

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4
Q

What is the most common cause of otitis media?

A

Whilst viral upper respiratory tract infections (URTIs) typically precede otitis media, most infections are secondary to bacteria, particularly:

  1. Streptococcus Pneumonaie
  2. Haemophilus Influenzae
  3. Moraxella Catarrhalis.
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5
Q

If a patient presents with chronic Otitis Media what is the most likely causative organism?

A

Chronic Otitis Media is most likely to be caused by Pseudomonas Aerguinosa.

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6
Q

What is a cholesteatoma?

A

A cholesteatoma is a non-cancerous growth of keratinising squamous epithelium that is ‘trapped’ within the middle ear.

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7
Q

What is the normal lining of the middle ear supposed to be?

A

The normal lining of the middle ear is supposed to be cuboidal or columnar glandular epithelium.

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8
Q

Why is the abnormal keratinising squamous epithelium in the middle ear problematic?

A

The keratinising squamous epithelium exhibits independent growth which leads to expansion and resorption of the underlying bone.

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9
Q

How does a cholesteatoma present?

A

A cholesteatoma initially will present with a foul-smelling, painless, non-resolving discharge, and a conductive hearing loss.

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10
Q

What are the complications of a cholesteatoma?

A

Cholesteatomas can rarely cause sigmoid sinus thrombosis and epidural abscess meningitis.

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11
Q

What is seen on otoscopy for cholesteatomas and what is the treatment?

A

On otoscopy, an attic crust is seen in patients with cholesteatomas and surgical excision is the treatment.

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12
Q

What is a schwannoma?

A

A schwannoma is a benign tumour of the peripheral nervous system derived from Schwann cells.

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13
Q

What is a vestibular schwannoma and where does it occur?

A
  • A vestibular schwannoma is a schwannoma of the vestibular portion of the vestibulo-cochlear nerve.
  • Vestibular Schwannomas occur within the temporal bone and account for 90% of cerebellopontine angle tumours.
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14
Q

What is seen on histology for all schwannomas?

A

VEROCAY BODY

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15
Q

Are Vestibular Schwannomas unilateral or bilateral?

A

Vestibular Schwannomas in 95% of cases are unilateral and occur sporadically, HOWEVER, if you see a bilateral vestibular schwannoma think NEUROFIBROMATOSIS TYPE 2 (ESP IN CHILD)

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16
Q

What is Neurofibromatosis Type 2 and how does it present?

A
  • Neurofibromatosis Type 2 is an autosomal dominant condition which is caused by a mutation of the NF2 gene on chromosome 22q11.2
  • It presents with bilateral vestibular schwannomas, neurofibromas, meningiomas and gliomas.
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17
Q

What pathologies affect the nose?

A

Rhinitis

Sinusitis

Nasal Polyps

Granulomatosis with Polyangitis (Previously known as Wegner’s)

Nasopharyngeal carcinoma

Neuroblastomas

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18
Q

rhinitis

A

inflammation of the lining of the nose

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19
Q

rhinitis can be

A

allergic (IgE meatiated) or non-allergic

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20
Q

symptoms of rhinitis

A

runny nose, sneezing, post-nasal drip

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21
Q

sinusitis

A

inflammation of one or more of the paranasal sinuses

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22
Q

which sinus is most commonly affected

A

the maxillary sinus (antrum)

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23
Q

sinusitis can be

A

acute or chronic

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24
Q

acute sinusitis

A

develops over a fews days and lasts up to 30 day

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25
Q

chronic sinusitis

A

lasts for more than 12 weeks

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26
Q

rhino sinusitis

A

is nor the more preferred term because sinusitis rarely occurs without concurrent rhinitis

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27
Q

vast majority of rhinosinustiis are cased by

A

viral infections the most common being rhinovirus also caused by parainfluenza, influenza and adenovirus

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28
Q

nasal polyps

A

fleshy benign swelling that grow inside the nasal cavity or sinus

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29
Q

nasla polyps are very common except

A

in children where if they occur you must RULE OUT CYSTIC FIBROSIS

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30
Q

how many people with cystic fibrosis have nasal polyps

A

1 in 2

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31
Q

nasal polyps are usually

A

bilateral

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32
Q

aetiology of nasal polyps

A

allergy, infection, asthma, aspirin sensitivity, nickel exposure

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33
Q

granulomatosis with polyangitis

A

chronic autoimmune inflammatory disease of the small blood vessels associated with c-ANCA and PR3

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34
Q

GPA mostly affects

A

the skin, kidneys and respiratory tract

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35
Q

symptoms of GPA

A
  • chronic refractory sinusitis
  • saddle nose deformity due to destruction of the nasal septum
  • epistaxis
  • haemoptysis
  • sudden onset loss of hearing
  • non-blanching purpuric rash
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36
Q

in the kidneys GPA

A

causes micro- haematuria and proteinuria

37
Q

ocular involvement of GPA

A

keratitis, scleritis, episcelritis, conjunctivitis

38
Q

x-rays in GPA

A

show caveatting granuloma and CT scans show alveolar haemorrhage

39
Q

initial test for GPA

A

c- ANCA titre

40
Q

diagnostic test for GPA

A

renal biopsy

41
Q

treatment of GPA

A

IV steroids and IV cyclophosphamide fro 18 months and then methotrexate/ azathioprine to maintain remisssion

42
Q

tumours of the nose can be

A

benign or malignant

43
Q

benign tumours of the nose

A
  • squamous papillomas
  • schnedidderian papillomas
  • nasal angiofibroma
44
Q

shneidderian papillomas

A

are being they they commonly recur and are locally destructive they are associated with squamous cell carcinoma

45
Q

nasal angiofibroma

A

benign but locally aggressive vascular tumour

46
Q

malignant lesions of nose

A
  • most commonly is squamous cell carcinoma
  • other malignant lesions that can occur are primary adenocarcinoma, nasopharyngeal carcinomas and neuroblastoma and lymphoma
47
Q

primary nasal adenocarcinoma is associated with what

A

woods dust i.e. occurring in carpenters

48
Q

nasopharyngeal carcinomas are

A

extremely rare in the uk but very common in the far east and are strongly associated with eibstenn barr virus as well as volatile nitrosamines in food

49
Q

volatile nitrosamines in food are consumed

A

more frequently in far east hence the reason nasopharyngeal carcinomas are most common there

50
Q

EBV is seen in association with

A

burritos lymphoma, other B cell lymphomas, hodgkins lymphoma and nasopharyngeal carcinomas

51
Q

EBV infects

A

epithelial cells of the oropharynx and B cells

52
Q

most people

A

get infected with eibsten barr virus but it causes no symptoms while some get infective mononucleosis

53
Q

in carcinogenesis EBV

A

hi-jacks and mimis helper T cells response leading to the survival and proliferation of B cells

  • mediated largely by latent membrane protein 1
  • EBV encodes EBNA-2 activating cyclin D and promoting transition from G0 to G1
54
Q

throat true vocal cords are lined with

A

stratified squamous epithelium, everything else from paranasal sinuses and upper repsiratory tract is lined with pseudo-stratified columnar epithelium

55
Q

pathology of the throat

A
  • laryngeal polyps
  • ulcers
  • papillomas
  • dysplasia/ cancer
  • paraganglioma
56
Q

laryngeal polyps/ nodules

A

generally used interchangeably but technically

  • polyps are unilateral and pedunculatedd
  • nodules are bilateral on the middle third to posterior third of the vocal cord
57
Q

laryngeal polyps/ nodules are caused by

A

injury to the lamina propria of the true vocal cords caused by vocal abuse, smoking and can occur in hypothyroidism

58
Q

laryngeal contact ulcer

A

unilateral or bilateral erosions of the mucous membrane over the vocal processes of the arytenoid cartilages

59
Q

cause of laryngeal contact ulcer

A

chronic throat and voice abuse or GORD

60
Q

if the ulceration goes beyond the basement membrane

A

then it will cause scarring

61
Q

squamous papilloma

A

has 2 peaks of incidence

  • less than 5 years
  • 20-40 years
62
Q

squamous papilloma

A

is associated with exposure to human papilloma virus types 6+11

63
Q

in adults squamous papillomas

A

tend to be solitaire but in children many occur

64
Q

a papilloma is anything with

A

a fibrovascular core

65
Q

paraganglioma

A

tumour which arises in clusters of neuroendocrine cells throughout the body

66
Q

2 main types of paragangliom

A

chromatin positive, chromaffine negative

67
Q

chromaffin positive paraganglioma

A

generally any paragangliom which occurs below the diaphragm it communicates with the pre-synaptic ganglia of the sympathetic nervous system and secreted catecholamines: noradrenaline and adrenaline

68
Q

chromatin positive paragnagliomas are usually

A

Tumours of the adrenal medullar or paravertebral (organ of zuckerandil)

69
Q

organ of zuckerandil

A

chromatin body derived from the neural crest located at the bifurcation of the aorta at the origin of the inferior mesenteric artery

70
Q

non-chromaffin paraganglioma

A

generally everything above the diaphragm: carotid and arotic bodies, clusters around oral cavity, nose, nasopharynx, larynx and orbit

71
Q

any paragnalgioma

A

is referred for genetic screening as they commonly occur as part of MEN2A AND MEN2B syndromes

72
Q

what is seen on histology of paragangliomas

A

ZELLBALLEN

73
Q

squamous cell carcinoma

A

common tumour of the head and neck: nose, sinuses pharynx, larynx and oral cavity

74
Q

most squamous cells carcinomas

A

are related to smoking and alcohol, but there is a type related to human papilloma virus which mostly occur in the oropharynx

75
Q

squamous cell carcinoma HPV type

A

vast majority associated with HPV type 16, produces protein E6 and E7 which disrupts the p53 and Rb pathways respectively leasing to cell immortality

76
Q

HPV type of squamous cells carcinomas have a

A

very good prognosis with chemoradiotherapy

77
Q

all squamous cell carcinomas are

A

graded according to the TNM criteria

78
Q

salivary glands are

A

exocrine glands which have an acinar and ductular component

- acinar component contains the secretory cells

79
Q

acinar component

A

serous cells: darkly staining and contain amylase

mucinous component: cleary grey staining

80
Q

pathologies of salivary glands

A
  • sialolithiasis= stones
  • paramyxomovirus= cases mumps which presents as a bilateral parotitis and causes an associated orchitis, risk of secondary meningitis
81
Q

tumours of salivary glands

A

nearly always occur at the parotid gland but if a tumour is affecting one of the smaller glands it is more likely too be malignant

82
Q

as a general rule

A

is young person has a painful salivary gland swelling it is malignant until proven otherise (weird because malignant is usually not painful)

83
Q

most common salivary gland tumour

A

pleomorphic adenoma which mostly occur in females over 60 and occurs in the parotid gland

84
Q

pleomorphic adenoma

A

commonly recurs but is benign but if it is long standing there is a risk of malignant tranformation

85
Q

2nd most common type of salivary gland tumour

A

warthins tumour which usually affects males over 50 and there is a very strong associated with smoking and it is often bilateral and multi-centric

86
Q

malignant tumours of salivary glands

A
  • most common world wide is mucoepidermoid carcinoma

- most common in the uk is adenoid cystic carcinoma

87
Q

adenoid cystic carcinoma

A

most common tumour of the palate but it actually most commonly affects the parotid gland

88
Q

adenoid cystic carcinomas are

A

very aggresive and frequently cause perineural invasion causing pain and loss of function

ENT COPY (12 decks)

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