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CPR Exam 1 > Chapter 16 > Flashcards

Chapter 16 Flashcards

1
Q

What is rhinitis?

A

Inflammation and swelling of mucous membranes of the nose, causing runny nose and stuffiness.

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2
Q

______ is also called the common cold.

A

Infectious rhinitis

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3
Q

Is rhinitis infectious or allergic?

If recurrent, what happens?

A
  • Either
  • Can cause chronic rhinitis, sinusitus and nasal polyps
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4
Q

Pharyngitis and tonsillitis are URT ____ infections caused by what?

A
  • VIRAL
  • Rhinovirus, echovirus and adenovirus
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5
Q

Nasopharyngeal carcinoma is most often caused by _____ and is most common in who?

A
  • EBV
  • children in Africa (EBV related) and Asian adults (eat smoked fish with nitrosasmine)
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6
Q

Bacterial rhinitis is most likely caused by what?

A

A superimposed infection by Strep. pneumo or H. influenzae of a viral infection

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7
Q

Allergic rhinitis produces what symptoms?

A
    1. Inflammatory infiltrate with EOSINOPHILS
    1. Edema in nasal/airways
    1. Clear mucus (rhinorrhea)
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8
Q

Recurrent rhinitis can lead to nasal polyps.

What are nasal polps?

A

Edematous nasal mucosa in stroma filled with eosinophils, neutrophils and plasma cells and lined by normal respiratory epithelium

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9
Q

Obstruction of sinus drainage in sinusitis may lead to what 2 gross findings?

A

Obstruction, creating a

    1. Empyema in pleural cavity
    1. Mucocele: cysts lined by respiratory epithelium that secretes mucus
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10
Q

What is the pathway of infection of sinusitis?

A
  1. Sinuses can secondarily receive bacteria: Infection can enter the maxillary sinus via periapical tissue of the mouth
  2. Advanced sinutis can secondarily spread bacteria to adjacent tissue.
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11
Q

What are 3 frequent complications which may arise from chronic sinusitis of the ethmoid sinus?

A

Infection spread to eye and causes: -

  1. Preseptal cellulitis
  2. - Orbital cellulitis
  3. - Subperiosteal abscess
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12
Q

What are 3 frequent complications which may arise from chronic sinusitis of the frontal sinus?

A

Go to meninges and brain

  • 1. Meningits
  • 2. Epidural abcess
  • 3. Osteomyolitis
  • 4. Mucocele
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13
Q

What are 3 frequent complications which may arise from chronic sinusitis of the maxillary sinus and sphenoid?

A
  • Maxillary: mucocele* and osteomyolitis
  • Sphenoid: mucocele
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14
Q

Maxillary sinusitis occasionally arises from extension of an infection from where?

A

Periapical infection from the mouth

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15
Q

Kartagener Syndrome is characterized by what triad and the sx’s are all caused by what?

A

- Bronchiectasis

- Situs inversus

- Sinusitis (less common)

- All sx’s due to defective ciliary action

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16
Q

What is allergic fungal sinusitis?

What do you see on histology?

A

Type 1 hypersensitivity reaction to the fungus asperigillus in the sinus tract, producing a thick compact mmucus with eosinphils and Charcot Leyden Crystals on histology. Fungal hypae are also sometimes seen.

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17
Q

What happens if a patient has allergic fungal sinusitis and alot of aspergillus accumulates?

A

Form a aspergillus mycetoma (fungal ball) in nasal cavity

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18
Q

What is a_cute invasive sinusitis?_

Who does it occur in most often?

How do we treat?

A
  • Occurs when fungal hypae (often Zygomycosis species/Mucor) invade and go into brain, bloodsream or both.
  • DB patients and immunocompromised
  • Immediate IV antifungal therapy to prevent spread and sepsis
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19
Q

Which patients are at higher risk for particularly severe forms of chronic sinusitis and by which type of organisms?

A

DB

Fungi (murcomycosis)

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20
Q

What are 3 conditions which can produce necrotizing ulcerating lesions of the nose and upper respiratory tract?

A
  1. - Acute fungal infections (i.e., Mucormycosis)
  2. - Granulomatosis w/ polyangiitis (Wegener)
  3. - Extranodal NK/T-cell lymphoma, nasal-type
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21
Q

Describe the presentation of granulomatosis with polyangiitis in the sinus tract.

Who does it affect

Where else does it affect

A
  • Middle aged adults
  • Necrotic granulomas that lead to ulceration, necrosis or perforate the septum, nasal passages and sinuses.
  • Also affecting lungs and kidney
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22
Q

What are benign tumors (but locally aggressive) that occur in nose, sinus and nasopharynx?

A
  • 1. Nasopharyngeal angiofibroma
  • 2. Sinonasal (Schneiderian papilloma)
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23
Q

What are maligiant tumors (but locally aggressive) that occur in nose, sinus and nasopharynx?

A

1. Olfactory neuoblastoma

2. NUT midline carcinomas

3. EBV related cancers (nasopharyngeal carcinomas and extranodal NK/T cell lymphoma)

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24
Q

What are the 2 EBV related malignancies?

A
  • 1. Nasopharyngeal carcinomas
  • 2. Extranodal NK/T cell lymphoma
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25
**Nasopharyngeal angiofibroma** is a **benign** tumor found almost exclusively in whom? Also associated with what GI disorder?
- **Young males** who are most often **fair-skinned** and **red headed** - Association w/ **FAP**
26
What is a nasopharyngeal angiofibroma? What is its reccurence?
* Polypoid benign mass with **BV** and **fibrous tissue**, surrounded with **thick BENIGN epithelium** * May recurr and bleed
27
What tumor looks like thick penile erectile tissue that grows in nose?
**nasopharygeal angiofibroma**
28
What is **FAP (familial adenomatous polypsis)**? Mutation: Can it become cancer?
* **Precancerous colon polyps** that occur most commonly in LI and **develop in childhood/adolescence** * Mutation in **APC** gene * Will become i**nvasive colon cancer** by middle age.
29
**Sinonasal (Schneiderian) Papilloma** most often occurs in which sex and age group?
**Adult males** between the ages 30-60 yo
30
What are the 3 forms the lesions of **Sinonasal (Schneiderian) Papillom**a occur as; which is most common?
- **Exophytic** = most common - **Endophytic** (inverted) - **Oncocytic (type of cell)**
31
Which form of Sinonasal (Schneiderian) Papilloma is uniquely aggressive and in a minority of cases may progress to malignancy?
* **Endophytic (Inverted),** because even though benigin, it grows DOWN IN tissue.
32
The exophytic and endophytic forms of **Sinonasal (Schneiderian) Papilloma** are associated with what virus?
HPV (types 6 and 11)
33
**Olfactory neuroblastomas (MALIGNANT)** arise from which cells and in which location?
**Neuroectodermal olfactory cells** in the **superior nasal cavity**
34
What is the characteristic histology of **Olfactory Neuroblastomas?**
**- Small, round blue cell tumor** * -Nests and lobules of well separtaed cells separated by fibrovascular stroma
35
What is unique about the age distribution of **Olfactory Neuroblastomas;** patients present with what signs/sx's?
- Peaks at 15 yo and 50 yo (middle age) - Present w/ n**asal obstruction** and/or **epistaxis**
36
**Olfactory neuroblastomas** may penetrate through the ______ and produce what characteristic appearance on imaging?
**Cribiform plate** **Dumb-bell shaped tumor**
37
What are the 3 patterns of **Nasopharyngeal Carcinoma** which may be seen?
**1. Keratinizing SCC's** 2. **Nonkeratinizing** SCC's 3. **Basophilic with lymphoid tissu**e (formerly lymphoepithelioma)
38
How do **nasopharyngeal carcinomas** typically present; most often metastases where?
* Usually v**ery small lesions** that may o**bstruct nose** and cause **epistaxis**. * However, they often do not come to ATN until they metastize to **cervical LN in the neck.**
39
What are the 3 factors which influence the origin of **Nasopharyngeal Carcinomas?**
1. **Age** 2. **Hereditary** 3. Infection with **EBV**
40
Which dietary and enviornemental factors are associated with N**asopharyngeal Carcinoma?**
**smoked fish with nitrosamines + EBV**
41
What may be detected via in-situ hybridization or immunohistochemistry in the malignant cells of **nasopharyngeal carcinoma?**
- EBV encoded RNA's such as **EBER-1** - Proteins such as **LMP-1**
42
**Extranodal NK/T-cell lymphomas** is a _____ related tumor with increased incidence ______ and occurs when?
* **EBV** * in **Asia** and **Latin American** countries * **at any age, but peaks in middle age**
43
**What is this?** **Describe**
**Extranodal NK/T-cell lymphoma:** an **EBV related cancer** that causes n**ecrotic destruction of paranasal sinuses.**
44
What are the signs of **Extranodal NK/T-cell lymphoma**s and prognosis?
**Fever, night sweat, weight loss** **Depends on stages and sx**
45
What can we use to dx Extranodal NK/T-cell lymphomas?
LOOK FOR **EBER**
46
What are the **3 squamous lesions** of the **larynx**?
**1. Singers node** **2. Papilloma** **3. Cancer on vocal cord**
47
**Reactive nodules** of the vocal cords are most often seen in whom?
- **Smokers** - Pts who impose great strain on their vocal cords (i.e., Singers)
48
Describe a **vocal cord nodule** What can be seen on hisoloy?
* Expansion of soft tissue under the vocal fold (Rienke space) that is soft and transulent. * Filled w edema and loose stroma trapped in a squamous epithelium (NOT A NEOPLASM)
49
How do singers nodules differ from polyps in terms of distribution?
**- Singers nodules** = bilateral - **Polyps** = unilateral
50
**Laryngeal squamous papillomas** are caused by what?
**HPV types 6 and 11**
51
La**ryngeal squamous papilloma**s are what
**Benign**, squamous epithelium-lined **NEOPLASMS on vocal cord** that look like papilla.
52
What is the prsentation of ## Footnote **Laryngeal squamous papillomas**
1. Can be **solitary** (easy to tx and do not progress to cancer) or assx with **2. Recurrent respiratory papillamatosis**
53
What is a bad complication of largeal papillomas?
Papilla spread to respiratory airways and creates a **cystic _lung_ disease** called **recurrent respiratory papillomatosis** that can lead to respiratory insuff or progress to cancer (\<1%)
54
**Recurrent respiratory papillomatosis** typically occurs in whom and is associated with what?
**- Children and adolescents** - Associated w/ **HPV 6 and 11;** thought to be **acquired** during **birth ( mom under 20, vaginal birth and first born)**
55
**Laryngeal carcinoma** is most often what type of carcinoma and seen in whom?
* **Squamous cell carcinoma (LOOK FOR KERATIN PEARL and CRATER IN CENTER OF LESION)** * **- Men \>60 yo** who s**moke, drink alochol, HPV infection**
56
What effect does alcohol and smoking on laryngeal carcinoma
**SYNERGISTIC**
57
3 most common bacteria responsible for **acute otitis media?**
**- Streptococcus pneumoniae** **- Moraxella catarrhalis** **- H. influenza** **\*SMH\***
58
**Otits media** in the *diabetic* pt is most often caused by which organism and what serious complication may arise?
**- P. aeruginosa** - Is especially **aggressive** and spreads widely, causing destructive necrotizing otitis media
59
What are **cholesteatomas**; and what are they associated with?
**- Non-neoplastic,** **CYSTIC lesions** lined by **squamous epithelium** w/ trapped **keratin** debris and **cholesterol** - Associated w/ c**hronic otitis media**
60
The reactive nature of cholesteatomas may lead to what complications?
- Enlarge and e**rode** into the **ossicles**, the labyringht, adjacent **bone**, or surrounding soft tissue - May produce visible neck masses
61
**Otosclerosis** is due to abnormal bony deposition where? What is the primary **complication** of Otosclerosis?
* **Stapedial footplate**, sticking it to the oval window * **Conductive hearing loss**
62
**Branchial cysts** are thought to arise from what remnant and are most commonly observed in whom?
**- 2nd branchial arch =\> occuring on upper lateral neck near SCM** - Young adults btw ages **20-40 yo**
63
What is the histology of **branchial cysts?**
Simple cyst lined by **stratified squamou**s or **respiratory epithelium** w/ surrounding fibrous tissue +/- lymphoidtissue
64
**Thyroglossal duct cysts** arise from what? what will you see on histo
- Remenant of tissue from thyroid migration that form a cyst. ## Footnote **thyroid follicles and respiratory lining**
65
What type of epithelium are thyroglossal duct cysts lined with when located near base of tongue vs. lower locations in anterior neck?
- Base of tongue --\> **stratified squamous epithelium** - Lower --\> **pseudostratified columnar epithelium**
66
What is the origin of **paragangliomas** **(carotid body tumors)?**
**Neural crest**
67

CPR Exam 1 (19 decks)

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