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1
Q

Is infective rhinitis viral or bacterial in origin?

A

Viral

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2
Q

what is infective rhinitis also known as?

A

common cold

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3
Q

what is allergic rhinitis also known as?

A

hay fever

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4
Q

causes of acute and chronic sinusitis

A

Acute:
Extension of acute / chronic rhinitis

Chronic:
Sequel of acute sinusitis

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5
Q

complications of sinusitis

A

In severe cases, infection can spread to meninges to cause meningitis (roof of paranasal sinuses is directly in contact with base of brain)

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6
Q

what are the 3 types of nasopharyngeal carcinoma?

A

Non-keratinising carcinoma (95% of NPCs)
Keratinising squamous cell carcinoma
Basaloid squamous cell carcinoma

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7
Q

what is nasopharyngeal carcinoma also known as?

A

cantonese cancer

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8
Q

risk factors for nasopharyngeal carcinoma

A
  • EBV infection at young age
  • salt-preserved food
  • genetic factors

Smoking, alcohol - for keratinising squamous cell carcinoma

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9
Q

what percentage of NPCs are non-keratinising carcinomas?

A

95%

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10
Q

clinical features of NPC

A
  • Largely asymptomatic until it spreads out of the nasopharynx
    1. Obstruction of eustachian tube
    2. Secretory otitis media leading to hearing loss and tinnitus
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11
Q

screening tests for NPC

A
  • Screening test
    • Antibody against EBV viral capsid antigen
  • In Singapore
    • annual screening (EBV IgA antibody test & nasoendoscopy) is recommended for people with strong family history
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12
Q

what are Squamous/laryngeal papilloma caused by

A

Caused by HPV infections

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13
Q

what is the most common malignant neoplasm of larynx and what is the percentage

A

Squamous cell carcinoma (most common: 95%)

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14
Q

what is a strongly associated cause of Squamous cell carcinoma of the larynx

A

smoking

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15
Q

3 types of Squamous cell carcinoma of the larynx

A

glottic, supraglottic, subglottic

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16
Q

presentation and prognosis of glottic Squamous cell carcinoma of the larynx

A
  • Presents early with hoarseness, lower stage at presentation
  • slow to metastasise, good prognosis
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17
Q

type 1 vs type 2 respiratory failure

A

Type 1 Respiratory failure:
- Hypoxaemia without hypercapnia
- Inability to maintain oxygen levels but able to ventilate hence carbon dioxide levels are normal

Type 2 Respiratory failure:
- Hypoxaemia with hypercapnia
- Component of poor ventilation resulting in retention of CO2

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18
Q

main cause of pulmonary oedema

A

pulmonary capillary congestion

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19
Q

clinical features of pulmonary oedema

A
  • Frothy & pinkish phlegm
  • Haemosiderin-laden macrophages
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20
Q

causes of pulmonary arterial hypertension

A
  • Secondary to Left sided heart disease (most common)
  • Congenital left-to-right shunts
  • Chronic lungs disease
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21
Q

complication of pulmonary arterial hypertension

A

cor pulmonale - heart failure secondary to lung disease, esp. right heart failure

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22
Q

3 pathological classifications of pneumonia

A

lobar pneumonia, bronchopneumonia, atypical pneumonia

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23
Q

usual pathogens of lobar pneumonia

A

Streptococcus pneumoniae, Klebsiella

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24
Q

who is bronchopneumonia usually seen in?

A

Usually seen in infancy, old age & immunocompromised individuals

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25
usual pathogens of atypical pneumonia
Mycoplasma, Chlamydia, Rickettsia, some viruses
26
morphology of lobar pneumonia
- Gross - Consolidation of whole or part of a lobe, causing 'hepatisation' (firm, airless) - Histology - Red hepatisation - Massive confluent exudation with neutrophils, red cells & fibrin filling the alveolar spaces - Grey hepatisation - follows red hepatisation
27
morphology of bronchopneumonia
Gross: Patchy areas of consolidation that may become confluent
28
morphology of atypical pneumonia
Gross: No findings of consolidation Histology: No alveolar exudation/consolidation
29
5 clinical classifications of pneumonia and their causes
- Community-acquired pneumonia - Usually caused by Gram + bacteria - Streptococcus pneumoniae (most common) - Hospital acquired pneumonia - Usually caused by gram negative rods - Viral pneumonia - Aspiration pneumonia - Usually due to unconsciousness or impaired swallowing - Frequently leads to lung abscess - Opportunistic pneumonia - In immunocompromised patients
30
complications of pneumonia
Lung Abscess Bronchopneumonia: focal fibrosis Atypical pneumonia: interstitial fibrosis
31
lung abscess causes
- Aspiration pneumonia (most common cause) - Infection by Staphylococcus aureus
32
lung abscess clinical features
- Cough with foul-smelling purulent sputum - Clubbing
33
complications of lung abscess
- Rupture in pleural space, causing empyema and pneumothorax - Haemorrhage from erosion into a pulmonary vessel
34
what is the pathogen that causes pulmonary tuberculosis
mycobacterium tuberculosis
35
risk factors for pulmonary tb
- Poverty, crowded, endemic areas - immunocompromised: diabetes, HIV - Alcoholism - Chronic lung diseases
36
3 types of pulmonary TB
- Primary tuberculosis - Occurs in individuals not exposed to mycobacteria before (unsensitized) or in immunosuppressed - Secondary tuberculosis (post-primary tuberculosis) - Occurs in previously exposed, sensitised people - Main presentation in immunocompetent adults - Miliary TB - Occurs when the infection spreads through the bloodstream to other organs
37
important clinical features of tb
Cervical lymphadenopathy Fever Night sweats Weight loss Chronic cough
38
morphology of primary tb
formation of ghon focus
39
outcomes of primary tb
- Complete resolution via cell mediated immunity in 95% of cases - Latent tuberculosis - viable organisms may lie dormant in these foci for decades - Progressive primary tuberculosis (uncommon)
40
pattern of miliary tb
Distinctive pattern on chest X-ray with many tiny spots distributed throughout lung fields with appearance similar to millet seeds
41
morphology of secondary tb
apical lesion with formation of assman focus
42
outcome of secondary tb
Healing & Fibrocaseous TB - in adults with vigorous immune responses, healing of the apical lesion occurs results in fibrocaseous TB - May reactivate in later life if immune system is weakened, latent tuberculosis becomes a reactivated fibrocaseous TB
43
diagnostic tests for active tb
Microscopy: Ziehl-Neelsen stain (for confirmation) Auramine phenol fluorescence technique (for screening) Gold standard: Tb culture (more sensitive but takes 2 months)
44
diagnostic tests for latent tb
no gold standard diagnostic test for LTBI 2 imperfect tests: TST (tuberculin skin test) IGRA (Gamma Interferon (IFN-γ) Release Assay)
45
four first line drugs for Tb
Rifampicin Isoniazid Pyrazinamide Ethambutol
46
difference between obstructive and restrictive lung disease
obstructive: Normal total lung capacity, reduced expiratory flow rate FVC normal or slightly decreased, while FEV1 is greatly decreased leading to decreased FEV: FVC ratio restrictive: Reduced total lung capacity, normal expiratory flow rate
47
examples of obstructive and restrictive lung disease
obstructive: COPD, bronchiectasis, asthma restrictive: diffuse parenchymal lung disease
48
2 types of bronchial asthma
Allergic / atopic asthma: - Type I hypersensitivity reaction (IgE-mediated) - Triggered by allergens (e.g. certain food, drugs, animal allergens) Non-atopic asthma: - Hypersensitive airways can be triggered by irritants (e.g. URTI, strenuous exercise, air pollution, second hand smoke) - Occupational and environmental triggers are important to ask about
49
What is the main abnormality in the pulmonary function test in COPD?
FEV1/FVC < 0.7, where FEV1 is the forced expiratory volume in the first second, while FVC is the forced vital capacity.
50
causes of COPD and what they are
Emphysema: Permanent dilation of air spaces distal to the terminal bronchiole without fibrosis Chronic bronchitis: Clinically defined as persistent cough with sputum production for at least 3 months in at least 2 consecutive years
51
difference between the 2 types of patients pink puffers and blue bloaters
Pink puffers: - patient has pink complexion, obvious breathing effort - emphysema is primary underlying pathology - no CO2 retention and there is adequate oxygenation of haemoglobin hence patients are pink - patient compensates for less surface area for gaseous exchange by hyperventilating Blue bloaters: - chronic bronchitis is primary underlying pathology - marked ventilation/perfusion mismatch → good perfusion but poor ventilation - poor ventilation results in combined hypoxaemia & hypercapnia
52
morphology and histology of emphysema
Gross: - Blebs & bullae (air-filled spaces) Histological: - Dilation of alveolar spaces
53
What are the complications of COPD
- Cor pulmonale leading to right ventricular failure - Hypoxemia leading to respiratory failure - Rupture of bullae leading to pneumothorax
54
what are diffuse parenchymal lung diseases and their clinical features
Group of disorders characterised by widespread inflammation predominantly in the interstitium Clinical Features* - Reduced compliance of lungs - Oedema (in acute form) & Fibrosis (in chronic form) of alveolar walls
55
what is ARDS and its causes
Acute Respiratory Distress Syndrome (ARDS): Severe form of acute diffuse parenchymal lung disease Causes: - Systemic sepsis - Severe trauma/ burns - Inhalation of toxic fumes
56
what is the end stage of ALL interstitial lung disease and what is it known as
Chronic pulmonary fibrosis - known as honeycomb lung
57
what is the most common cause of cancer related deaths worldwide
lung cancer
58
routes of spread and metastases of lung cancer
- Local spread to adjacent lung parenchyma - Lymphatic spread to regional lymph nodes - Transcoelomic spread to pleural space, pericardium - Haematogenous spread to distant organs
59
classifications of lung cancer
non small cell lung carcinoma - squamous cell carcinoma (central) - adenocarcinoma (peripheral) small cell lung carcinoma (central)
60
associations and histology of squamous cell carcinoma
associations: - Commonest in males, often central - High association with a history of smoking histology: - Squamous differentiation with keratin pearls
61
associations and histology of adenocarcinoma
association: Not much association with smoking (equal incidence in smokers and non-smokers) histology: Bronchioalveolar carcinoma (BAC) - looks like a consolidation rather than mass on chest X-ray
62
associations and clinical features of small cell lung carcinoma
associations: strong relationship with smoking clinical features: - Poor prognosis - Tumour cells show neuroendocrine differentiation
63
prognosis of lung cancer and reasons for prognosis
All subtypes of lung cancer have a dismal prognosis: Majority diagnosed are stage IV Reasons for poor prognosis - No early symptoms - Only way to pick up small lesions are by CT scan - Metastatic spread is present in most (>50%) patients at presentation - Many patients present with symptoms caused by metastatic disease
64
transudate vs exudate in pleural effusion
- Transudate: Low protein fluid, due to high hydrostatic pressure, low oncotic pressure - cardiac failure, hypoalbuminemia - Exudate: High protein fluid, due to increased capillary permeability or inflammation - bacterial infections (pneumonia, tb) - carcinomas

Pathology (11 decks)

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