Exam I, sinonasal tract, Gomez Flashcards
(120 cards)
1
Q
What are the basic structures in the sinonasal tract
A
nasal cavity, rhinosinuses
2
Q
what are the basic structures of the pharynx
A
nasopharynx
oropharynx
hypopharynx
3
Q
what are the major funcitons of upper airway
A
conduit air to and from lungs heat/humidify air particle removal immune surveillance smell and speech
4
Q
What are the 3 types of epithelial cells in sinonasal resp mucosA
A
ciliated psudeostratified columnar cells
mucin-containing goblet cells
basal (reserve) cells
5
Q
what are the 2 characteristics of lamina propria
A
prominent vascularity
subepithelial seromucous glands
6
Q
what is acute infectious thinitis
A
common cold- coryza
7
Q
How is common cold trasmitted
A
conatc with contaminated sin, contaminated environmental surface, aerosolization
8
Q
What can acute rhinitis progress to
A
pharyngitis, sinusitis, otitits media
9
Q
up to 40% adult colds are due to what viruses
A
rhino (picorna, ss-RNA, genus enterovirus)
10
Q
what are the other cold causing viruses that are not rhino
A
adeno, echo, corona, parainfluenza, respiratory syncytial
11
Q
What are signs of allergic rhinitis
A
watery rhinorrhea, sneeing, nasal congestion and itching
12
Q
what are the classifications for allergic rhinitis
A
seasonal: symptoms typically occur at a particular time of the year
perennial: occur year round
episodic: bouts of Sx occur at irregular intervals
13
Q
What are the early spring pollens
A
tree pollens, oak, maples, elms, birches
14
Q
what are the spring pollens
A
grass: ryegrass, bluegrass, bermuda grass
15
Q
What type HS is allergic rhinitis
A
type I
IgE mediated
16
Q
describe type I HS reaction
A
allergens timulates TH2 responses and IgE prodcution
IgE binds to Fc R on mast cells and then continuous exposure to allergin will activate mast cells to release histamine and other mediators
17
Q
What is definition of chronic rhinitis
A
> 1 mo Sx:
sneezing, rhinorrhea, nasal congestions, postnasal drainage
18
Q
What is major distinction of chronic rhinitis thatn alergic
A
onset after age 20
19
Q
What is a problem with nasal polyps
A
recurrent attachs of rhinitis, most patients are not atopic
multiple
may acuse bostruction or become secondarily infected
20
Q
What are types of sinusitis
A
acute- less than 4 weeks
empyema of sinue
subacute 4-12 weeks
chronic greater than 4 weeks
21
Q
what is a mucocele of sinue
A
mucus accumulation no bacterial involvement
22
Q
what are major findings of sinusitis
A
facial pain/pressure nasal obstruction/blockage nasal discharge/discolored postnasal drip hyposmia/anosmia facial congestion/fullness purulence in nasal cavity fever
23
Q
what are the minor findings in sinusitis
A
HA, halitosis, fatigue, dental pain, cough, ear pain, pressure, fullness, fever
24
Q
what are serious complications of sinusitis
A
spread to orbit
osteomyelitis
cranial vault extension
septic thromboplebitis of dural venous sinus
25
What is ARS
acute infectiou sinusitis
26
what is presentation of acute sinusitis
purulent rhinorrhea, nasal congestion and/or facial pain
27
what is AVRS
acute viral sinusitis assoc withc ommon cold and cleras in 7 days or less
28
what can cause AVRS
rhinoviruses, influenzavirus, parainfluenza
29
what is ABRS
acute bacterial sinusistis
30
what are causes of ABRS
strep pneumoniae
Haem influenzae
morazella catarrhalis
31
What are signs of ABRS
Sx for more than 7 days
Sx initially improve and then worsen
sinusitis associated with dental disease
32
what are anatomic predisposing factors to chronic obstructive sinusitis
deviated septum, trauma, foreign body, sinonasal mass/neoplasm
previous sinus surgery
33
what are the fenetic medical predisposing factors to chronic obstructive sinusitis
```
ASA triad
immunodeficiency
immotile cilia cyndrome
cystic fibrosis
DM
intensive care unit
```
34
What is the ASA triad
aspirin induced chronic rhinosinusitis, nasal polyps, severe bronchial asthma
35
what is kartagener syndrome
defective ciliary action and situs inversus
36
what are the environmental predisposing factors to chronic obstructive sinusitis
allergic rhinitis, nonallergic rhinitis microorganisms
sick building syndrome
smoking, pollutants, dry indoor heating
37
majority of chronic sinusitis is:
reccurent acute
obstructive
fungal sinus disorders?
obstructive
38
what are common Sx of chronic obstructive sinusitis
facial pain, pressure fullness
nasal obstruction/congestion
nasal drainage/postnasal drip
decreased sense of smell
39
what are the types of obstructive sinusitis
non-infected (mucocele)
| suppurative(empyema)
40
what are the common bacterial agents to cause chronic obstructive sinusitis
staph aureus, gram neg rods
41
describe allergic fungal sinusitis
recurrent sinusitis, possibly nasal polyps
| eosinophilic mucus charco-leyden cyrstals; with fungi
42
how do you Tx allergic fungal sinusitis
surgical debridment and possibly systemic steroids
43
describe fungus ball
mass lesion by X ray in one sinus cavity
| fungal organisms with scant mucus and little inflammation
44
what is Tx for fungus ball (mycetoma)
surgical debridement
45
desribe invasive fungal sinusisits
severe, sometimes neuro deficit
| the fungal organisms invade tissue vessels
46
what is Tx for invasive fungal sinusitis
aggressive surgical debridement; post-op anti-fungal drugs
47
What are vascular necrotizing lesions of upper airways
granulomatosis with polyangiitis
cocaine
churg strauss syndrome
48
what are infectious causes of necrotizing lesions of upper airways
rhinocerebral mucormycosis/ rhinocerebral zygomycosis
| hansen disease/leptromatous leprosy
49
what lymphoma can cause necrotizing lesions in upper airways
extranodal NK/T cell lymphoma
50
what causes rhinocerebral mucormycosis and what patients is it seen in
saprophytic mold fungi
| usually in uncontrolled DM with ketoacidosis
51
What population is affected by nasopharyngeal angiofibromas?
| Sx?
young males
onset 10-20 "juvenile NA"
Sx: unilateral nasal obstruction and epistaxis. can also cause swelling of face, eye and cheek
52
histo of nasopharyngeal angiofibroma
posterolateral wall fibromuscular stroma origin
| benign, 10-20% locally aggressive
53
What is Tx for nasopharyngeal angiofibroma
surgery, hemorrhagic complications no uncommon
| pre-op ateriogram with pre surgical embolization
54
prognosis of nasoparhyngeal angiofibroma depends on what
extent of resectability
55
What are schneiderian benign neoplasms derived from and 3 types
from embrologic schneiderian membran that coverys cavity and sinuses
Exophytic- septal and squamous
Inverted- lateral and squamous
oncocytic- lateral and cylindrical/columnar
56
what papilloma is more common thatn schneiderian mucosa tumors
squamous papilloma of nasal vestibule
| (verruca vulgaris or wart
57
Exophytic sinonasal papilloma occurs in what population
```
20-50 y.o
male more likkel ythan female
HPV 6/11 in 60%
recurrence
rarlery develops invasive carcinoma
```
58
inverted sinonasal papillma occurs in what pipulation
40-70 y.o
male more likely than female
HPV 6/11 in 40%
5-10% develop invasive carcinoma within 5 years
59
oncocytic sinonasal papilloma occurs in what population
>50 y/o
M:F 1:1
some may develop invasive carcinoma
oncocyte-abundant bright pink cytoplasm (mitochondria)
60
What is an esthesionneuroblastoma
olfacotry neuroblasotma that arises from neuroendocrine cell in olfactory mucosa
61
what is survival of esthesionneuroblastoma
5 yr survival is 40-90% with varying biologic activity
62
What are the 3 divisions of pharynx and coinciding mucosae
nasopharynx- 60% non-keratinizing(no cornified layer) squamous. 40% respiratory epithelium
oropharynx
laryngopharynx- 100% NK squamos
63
what are the upper airway lymph structures
diffuse submucosal lymphoid aggregates in nasal cavity
| tonsils
64
What are some disorders of pharynx that are secondary to lymphoid hyperplasia
obstructive sleep apnea
| recurrent otitis media(adenoids)
65
describe bordetella pertussis
whooping cough
small gram - coccobacilli taht spread in respiratory droplets
have Tdap
Dx with nasopharyngeal swab for culture and PCR or serology
66
what are the stages of whooping cough/pertussis
stage 1- catarrhal phase: indistinguishable from common URI, nasal congestion, rinorrhea and sneezing. most infectious stage
stage 2- paroxysmal intense coughing, vomiting
stage 3- covalescent phase
chronic cough which may last for weeks
67
how does whooping cough present in infants younger than 6 mo
apneic episodes instead od characteristic whoop
68
what are the 3 histopath types of nasopharyngeal carcinoma
keratinzing (squamous cell carcinoma)
nonkeratinizing- squmaous cell
undifferentiated carcinoma with lymphoid component
69
epidemiology of nasopharyngeal carcinoma
```
EBV related
associated with smoking
common in children in Africa
common in adults in S China
rare in USA
```
70
What is clinical course of nasopharyngeal carcinoma
unresectable at Dx (metastases in 70%)
treat with radiotherapy
5 yr survival is 60%
71
What is NUT midline carcinoma
appearance similar to nasopharyngeal and squamous cell carcinoma
mostly in mediastinum and is highly aggressive
assoc with BRD4-BRD3-NUT fusion gene
72
What are typical clinical features of Group A strep
```
age 5-15
peaks winter-early spring
sore throat with rapid onset fever
strawberry tongue
no cough, hoarseness of conjunctivitis
tender anterior cervical lymph nodes
enlarged tonsils with patchy exudate
```
73
what is the filamentou anaerobic gram - rod that can cause pharyngitis
fusobacgerium necrophorum
| >20% in recurring cases and inperitonsillar abscesses
74
what is the bacteria where humans are only known reservoir
corynebacterium diphtheriae
75
describe gene of diphtheriae
only strains with tox gene casue diphteria
| genes are encoded with lysogenic bacteriophage
76
what is clinical course of diphteriae
sudden onset exudative pharyngitis that gets worse over 3 days
produces a pseudomembrane
77
What are common viruses that cause pharyngitis
```
rhinoviruses
adeno- pharynogconjunctival fever
EBV- infecitous mononucelosis
HSV 1 and 2- gigivitis, stomatitis, pharyngitis
influenza- pharyngitis
parainfluenze and coronavirus
entero
CMV and HIV
```
78
what is Dx test for EBV
monospot test
79
What is the most common cause epiglottitis
H influenze type b
| Hib vaccine
80
What are Sx of acute laryngitis
hoarseness, decreased vocal volume, painful speech
81
what are common causes acute laryngitis
infections, vocal overuse: Acute- loud yelling
vocal overuse- subacute- lecturing
heavy smokin
direct trauma
82
describe clinical course acute laryngitis
abrubt onset, self limited, <3 week duration
| ages 3-5 yrs, 18-40 y/o
83
what viruses and bacteria cause acute laryngitis
viruses >90% cases: rhino, parainfluenza, RSV, adeno
| bacteria: H influenza, S pneumonia
84
what can acute laryngitis lead to in children
life-threatening laryngoepiglottisis
85
What is most common cause of inspiratory stridor in children and associated with seal-like barking
croup, laryngotracheitis
86
When is "Croup season"
3 mo- 5 yr
acute onset
MArch-April
87
what is cause of croup
parainfluenza that caues edema and inglammtion in subglottic layrnx and trachea around circoid cartiladge
edema of vocal cords can cause hoarseness
88
What is Tx fro Croup
supportive with short term steroids to reduce inflammation
89
What is the steeple sign
subglottic narrowing, seen in croup
90
What is reinke edema and population it affects
soft gelatninous translucent expansion of cord surfaces from edema
usually in middle aged females who are heavy smokers
develop husky low pitched weak voices
91
where is classic location for vocal cord nodules and polyps
junction anterior and middle third of cord
92
What can lead to vocal cord nodules
heavy smoking
heavy recurrent voice strain (singers nodules)
HPV types 6/11
93
howlikely are nodules and polyps going to give rise to cacner
virtually never
94
how do vocal cord papillomas differ in adults and children
single in adults
| mutiple in children
95
what are clinical findings or squamous cell carcinoma of larynx
prolonged hoarseness, >6 weeks earliest, most consistent symptom
96
epidemiology of squamous cell carcinoma of larynx
50 pack years)
| ehtanol abuse.dependence
97
what is progression of squamous cell carcinoma of larynx
hyperplasia- hyperkeratosis- dysplasia- carcinoma in situ- cancer
98
What are the anatomic locations of laryngeal carincomas and which are most common
glottic(true vocal folds) 50-60%
supraglottic 30-40% when Dx usually already stage III or IV
subglottic
transglottic
99
what is best indicator for prognosis of cancer
stage
100
What are physical findings of otitis externa
marked tenderness after gentle traction of pinna
erythema, swelling, moist debris
peak age 7-12
101
What can cause otitis externa
```
traumatized ear canal
swimmers ear
bacterial 90%: pseudomonas Sp
Staph Ps
Gram - rods
Fungal: aspergillus, candida
```
102
what are neoplasms of the external ear
squamous and basal cell carcinoma
103
what is middle ear lined by
non-keratinizing stratified squamous epithelium
104
what is a cholesteatoma
squamous peithelium trapped within temporal bone (middle ear or mastoid)
105
what are sequalle of cholesteatoma
hearing loss, facial nerve paralysis, labrynthitis, meningitis, epidural or brain abscess
106
what is Tx for choesteatoma
surgical resection to prevent sequellae
107
What are the signs of acute otitis media
ear pain, fever, otorrhea(discharge), irritability vomiting and diarrhea
TM opacity, bulding, erythema, effusion and dec mobility
108
What are the most common bacterial caues of acute otitis media
S pneumoniae, H influenza, M catarrhalis
109
What are the common causes of chronic otitis media and long term sequellae
pseudomonas aeruginos, S aureus
| perforation TM, scarring, mastoiditis, bone erosion, cysts and conductive hearing loss common
110
what are the two types of cyst lining in middle ear
```
squamoud epithelium (cholesteatoma) large amounts keratin
metaplastic columnar epithelium
```
111
what is etiology of middle ear disorders like otosclerosis
>50% famility Hx
| auto dominant, variabl epenetrance
112
what is clinical course otosclerosis
begins unilaterally 60-80% become b/l
hearing loss begins late adolescence
progressive ankylosis leading to severe conductive hearing loss
113
Where does the bone thicken in otosclerosis
callus of bone accumulates at footplate of the stapes and rim of oval window
114
What are some branchial cleft defects
sinus tracts, fistulas, cysts
115
What is a thyroglossal duct cysts
cyst in midline
any age
portion of hyoid bone is removed along with cyst and tract
116
What is prototype of parasympathetic tumor
carotid body tumor
117
What are effects of carotid body tumor
releases NT that increase RR when hypoxic
118
what are Signs of a carotid body tumor
bruit on auscultation from obstruction and turbulence
119
What population is carotid body tumor more common in
40s
M=F
familial: MEN types 2a and 2b, vHL syndrome, Neurogibromatosis type 1 and 4 distinct paraganalgionic tumor syndromes
120
What is dangerious about carotid body tumors
may metastasize to lymph nodes and distant
| 50% fatal due to infiltrative growth
