Lung I - Upper Respiratory Tract

Question 1

Whats Respiratory epithelium
Whats Lung interstitium
Whats Lung compliance - link to Factors of Elasticity, Surface Tension and Elastic Recoil

Answer 1

Ciliated pseudostratified columnar epithelium
PSC + Mucous glands;

Pulmonary interstitium is a collection of support tissues within the lung that includes the alveolar epithelium, pulmonary capillary endothelium, basement membrane, perivascular and perilymphatic tissues.

Compliance is a measure of the lung’s ability to stretch and expand

• high elasticity high C, high surface tension, low C;
• high elastic RECOIL, low C

Question 2

Factors affecting ventilation and their diseases

Answer 2

Alveoli open - Pneumothorax
Lung compliance - Pneumothorax, Fibrosis

Airway passage to move freely - Asthma, COPD

Diffusion of gases across thin barrier - Fibrosis
Sufficient diffusion area - Emphysema (emphysema, the air sacs in the lungs (alveoli) are damaged);

Question 3

Rhinitis Pathophysiology

Causes

Cx [2]

Answer 3

Inflammation of Nasal Mucosa - including Olfactory and Respiratory epithelium

• Necrosis, then EXUDATE, - submucosal edema
• Swelling, Obstruction,

Causes: Viral - Flu/ Rhinovirus, Allergies;

Cx: nasal polyps, Sinusitis (2nd bacterial)

Question 4

Nasal Polyps histo

Answer 4

Edematous
Inflammatory cells, Fibroblast
Lamina Propria outgrowths (note lamina propria is part of Mucosa under the epithelium and BM)

Question 5

HPV CPE [3]

vs

Reed Sternberg Cells [2]

Answer 5

Koliocytosis (kolio meaning empty - perinuclear halo)

• Enlarged nuclei,
• Hyperchromatic
• perinuclear halo

Reed Sternberg

• Multinucleated/ lobulated nuclei
• Eosinophilic, nucleolus inclusion

Question 6

Whats Oncocytic change?

Associations [2]

Answer 6

Oncocytic change is defined as

• arise from the follicular epithelium
• enlarged
• abundant eosinophilic granular cytoplasm as a result of the accumulation of altered mitochondria.
• Hürtle cell tumours of thyroid - can be benign/ malignant;
• associated with Hashimoto’s thyroiditis

Question 7

What if both squamous and glandular histologies are found in Nose samples

Answer 7

Transitional cell carcinoma

Question 8

Most impt nasopharynx neoplasm and subtypes

• risk factors [3]

Answer 8

NPC

• Keratinizing SCC - linked to alcohol and smoking (possible link to HPV, not linked to EBV)
• Non-keratinizing SCC - poorly differentiated (high link to EBV by WHO) - MOST COMMON

Risk factors:
Genetic (family), Salt-preserved Food (env)
EBV - infecting tonsillar B lymphocytes
- IgA EBV precedes cancer formation

Question 9

Childhood vaccines

Answer 9

DTaP - Corynebacterium diphtheria
HiB - Haemophilus Influenza
IPV - Inactivated Polio Vaccine

measles also given

Question 10

URT vs LRT

Answer 10

Nose all the way to larynx at vocal folds

Larynx after vocal folds to bronchioles

Question 11

Laryngitis causes

Answer 11

Allergy
Toxins - fires
Smoking - lead to squamous metaplasia

Question 12

Larynx Cancers benign + malignant

Causes

Answer 12

Benign: Papilloma - by HPV - Squamous Papilloma

HPV6 and HPV11 are common causes of genital warts and laryngeal papillomatosis

Malignant: SCC of larygnx

• Strong association w Smokers (HPV possible is possible)
• Common @ vocal folds - NKSS epithelium!!!
• rest is PSC epithelium

Question 13

Viral Cancers of Upper Respi Tract

- think epithelium @ locations

Answer 13

HPV Benign:

• HPV 6, 11 for Larygnx benign papilloma
• Larygnx NKSS for vocal folds

HPV Malignant - HPV 16, 18:

• Larygnx @ vocal folds, NKSS
• Oropharynx, NKSS epithelium

EBV Malignant

• think B cells, tonsils,
• NPC - PSC epithelium!!! hence not HPV
• Non-keratinising type SCC, poorly differentiated