Resp Path 1 - Upper Airway, Nose/Nasopharynx, Larynx, Lungs, ARDS - Galbraith

Question 1

What is this?
Nasal mucosa becomes edematous and hyperemic with catarrhal secretions. May become mucopurulent exudates induced by bacterial superinfection.

Answer 1

Infectious rhinitis.

Question 2

What is infectious rhinitis mainly caused by and what is the tx?

Answer 2

• Usually viral - “the common cold”.
  
  • Adenovirus, rhinovirus, echovirus.
• Self limiting.

Question 3

What is classified as an IgE-mediated hypersensitivity reaction with clinical manifestations that can be similar to infectious rhinitis?

Answer 3

Allergic rhinitis

Question 4

What are the prominent contents of edematous protrusions in nasal polyps?

Answer 4

Lymphocytes, plasma cells, neuts, and sometimes eosinophils.

Question 5

When do nasal polyps occur?

Answer 5

• Occur with RECURRENT rhinitis (NOT atopy/allergy).

Question 6

Name the rhinitis:

1) “hay fever”, IgE
2) “Common cold”, adeno/echo/rhinovirus

Answer 6

1) Allergic rhinitis

2) Infectious rhinitis

Question 7

When do nasal polyps clinically become a problem? Tx?

Answer 7

• Become a problem when they reach 3-4 cm in size, causing obstruction.
• Tx is surgical removal.

Question 8

What is the sequela to chronic acute rhinitis?

Answer 8

Chronic rhinitis - superficial mucosal ulceration with variable inflammatory infiltrates that can extend into the sinuses.

Question 9

What is sinusitis commonly preceeded by?

Bugs from where cause it?

Answer 9

Acute or chronic rhinitis with edema that impairs sinus drainage.
- Bugs from the oral cavity cause it.

Question 10

What is the Kartagener Syndrome triad?

Answer 10

1. Sinusitis
2. Bronchiectasis
3. Situs inversus

Question 11

The dominant effect of sinusitis and a potential dangerous complication.

Answer 11

• DM/immunocomp
• Dominant effect is discomfort/malaise.
• Can potentially spread to orbit or surrounding bone to cause osteomyelitis or dural venous sinus thrombophlebitis.

Question 12

Two frequent concomitants of viral upper respiratory infections.

Answer 12

Pharyngitis and tonsillitis.

Question 13

What are pharyngitis and tonsillitis primarily caused by?

Answer 13

1) Most commonly caused by VIRUSES (adeno, echo, rhino)
2) Bacteria
- beta-hemolytic strep
- S. aureus

Question 14

What would you see in tonsillitis or pharyngitis caused by bacterial infection?

Answer 14

Whitish exudative material overlying reddened, swollen tonsils.

Question 15

What are three causes of necrotizing lesions of the upper respiratory tract?

Answer 15

1) Acute fungal infection (mucormycosis in DM)
2) Granulomatosis with polyangiitis
3) **Extranodal NK/T cell lymphoma, nasal type

Question 16

Extranodal NK/T cell lymphoma, nasal type:

• What type of lymphoma is it
• Associated with what
• Demographic
• Aggressive or benign

Answer 16

• A lymphoma of NK cells infected with EBV.
• Male, 40-50s, Asian and Latin American.
• EXTREMELY AGGRESSIVE into cranial vault or necrotic/septic.

Question 17

What is a highly vascularized tumor that occurs in adolescent males with red hair and fair skin?

Answer 17

Nasopharyngeal angiofibroma.

Question 18

Where do nasopharyngeal angiofibromas arise?

Answer 18

In the posterolateral roof of the nasal cavity.

Question 19

Are nasopharyngeal angiofibromas aggressive or benign? Tx?

Answer 19

• Classified as benign, but may be LOCALLY AGGRESSIVE into the cranial vault.
• Tx is surgical excision

Question 20

A male, 30-60yo has a benign neoplasm arising from squamous or respiratory or columnar epithelium. What is it?

Answer 20

Sinonasal (Schneiderian) Papilloma.

Question 21

What are the three subtypes of this type of Sinonasal (Schneiderian) Papilloma?

Answer 21

1) **Exophytic (fungating)
2) **Inverted (endophytic)
3) Cylindrical (oncocytic)

Question 22

HPV 6 and 11:

• What two subtypes of Sinonasal Papilloma are associated with this
• What type of papilloma is associated with it?

Answer 22

• Exophytic and inverted sinonasal papilloma

- Squamous papillomas

Question 23

How is Inverted Sinonasal Papilloma different from non-inverted forms?
Tx?

Answer 23

• VERY LOCALLY AGGRESSIVE

- Tx is COMPLETE EXCISION required to prevent recurrence with potential invasion into the orbit for cranial vault.

Question 24

What tumor is highly malignant and composed of neuroendocrine cells that arise from neuroectoderm in SUPERIOR NASAL CAVITY?

Answer 24

Olfactory neuroblastoma

Question 25

What's this? Bimodal 15yo and 50yo. To dx, see: enolase, synaptophysin, CD56, chromogranin

Answer 25

olfactory neuroblastoma

Question 26

Is an olfactory neuroblastoma benign or malignant? | How is it physically described?

Answer 26

- Very malignant | - "small blue cell tumor"

Question 27

What is the age/distinctive geographic distribution of nasopharyngeal carcinoma (3 locations)?

Answer 27

- EBV-related carcinoma. - Africa = CHILDREN - S. China = ADULTS - USA = diet of fermented or salted fish (nitrosamines

Question 28

Three forms that nasopharyngeal carcinomas? Which is most aggressive/sensitive to radiotherapy?

Answer 28

1) Keratinizing squamous cell (**least aggressive, least sensitive**). 2) Nonkeratinizing squamous 3) Undifferentiated with abundant lymphocytic infiltrate (**most aggressive, most sensitive**).

Question 29

What bug causes a life threatening type of laryngitis in children? What does it cause?

Answer 29

H. INFLUNEZA causes laryngoepiglottitis that can be life threatening due to airway obstruction from rapid onset mucosal edema. This is called CROUP. (Also: Respiratory Syncytial Virus, B-hemolytic strep).

Question 30

The most common form of laryngitis is encountered in people who are ____ and predisposes them to ____?

Answer 30

Heavy smoking >> predisposes to squamous epithelial metaplasia and overt carcinoma.

Question 31

What are small, round protrusions on the vocal cord? What two groups of people do they occur in?

Answer 31

Called Reactive Nodules. Arise due to repeated vocal cord strain (SINGERS) or HEAVY SMOKERS. Benign, but lead to hoarseness.

Question 32

What are recurring squamous lined frond(s) with fibrovascular cores on vocal cords? Pathogen? Prognosis?

Answer 32

Squamous papillomas (single or multiple) HPV 6/11 BENIGN

Question 33

What is the main type of laryngeal carcinoma and what demographic do you find it in?

Answer 33

Male smokers, 50s. Squamous cell carcinoma. | - Present with hoarseness, pain, dysphagia, hemoptysis.

Question 34

How do you differentiate between squamous papillomas, reactive nodules, and laryngeal carcinoma on vocal cords?

Answer 34

- Squamous papillomas are smooth, nodular, bilateral. - Papillomas are bumpier. - Carcinoma = Bulky, fungating mass protruding from the laryngeal surface, often with ulceration.

Question 35

Sequence of epithelial alteration seen in carcinoma of the larynx.

Answer 35

Hyperplasia >> atypical hyperplasia >> dysplasia >> carcinoma in situ >> invasive cancer

Question 36

What is pulmonary hypoplasia and what is it caused by?

Answer 36

Diminished wt/vol/acinar # due to compression in utero. - Unilateral small lungs (dt hernia) - Bilateral small lungs (dt oligohydraminos)

Question 37

What is a foregut cyst?

Answer 37

Abnormal detachment of primitive foregut - located in hilum and mediastinum. 1) Bronchogenic (most common) 2) esophageal 3) enteric

Question 38

What is pulmonary sequestration

Answer 38

Lung tissue lacking connection to airway system. | Get blood supply from aorta instead of pulmonary artery.

Question 39

What are the two types of pulmonary sequestration.

Answer 39

1) Extralobal - outside the lungs (dx in infancy, presents as a mass) 2) Intralobar - within lung parenchyma (dx in older children, presents as recurrent localized infection)

Question 40

What is atelectasis and what are the three types?

Answer 40

Incomplete lung expansion or collapse. 1) Resorption atelectasis 2) Compressive atelectasis 3) Contraction atelectasis

Question 41

Resorption atelectasis - Obstruction caused by what? - What happens to the mediastinum? - Reversible?

Answer 41

- COMPLETE obstruction of the airway >> mucus plug (astha, bronchitis, apiration pneumo) - Mediastinum shifts TOWARD the affected lung. - Reversible

Question 42

Compression atelectasis - Obstruction caused by what? - What happens to the mediastinum? - Reversible?

Answer 42

- Fluid (blood, transudate, exudate), tumor, or air (pneumothorax) accumulates within the pleural space - prevent normal expansion. - Mediastinum shifts AWAY from the affected lung. - Reversible

Question 43

Contraction atelectasis - Obstruction caused by what? - What happens to the mediastinum? - Reversible?

Answer 43

- Pulmonary or pleural FIBROSIS prevents normal expansion | - NOT REVERSIBLE

Question 44

What type of atelectasis would effusions from HF/neoplasms, or a pneumothorax result in?

Answer 44

Compressive

Question 45

What type of atelectasis would mucus plugs, foreign body aspiration, or bronchial neoplasms cause?

Answer 45

Resorption

Question 46

Types of pulmonary edema

Answer 46

1) hemodynamic pulmonary edema | 2) edema secondary to microvascular (alveolar) injury

Question 47

What type of pulmonary edema is this describing: Pink/granular intra alveolar transudate. Lungs wet+heavy w/basal fluid accumulation first. Lungs become brown and first due to interstitial fibrosis and hemosiderin laden macrophages.

Answer 47

Hemodynamic pulmonary edema. | "pushing fluid out"

Question 48

Decreased o2 in Hemodynamic pulmonary edema leads to increased chance of what?

Answer 48

Infection.

Question 49

What is acute lung injury?

Answer 49

(aka, noncardiogenic pulmonary edema) - Inflammation-induced vascular permeability, leading to diffuse pulmonary edema and rapid hypoxemia onset, in the ABSENCE of HF - ARDS is severe ALI.

Question 50

What 4 conditions are associated with development of ARDS in 50% of cases?

Answer 50

1) Sepsis 2) Diffuse pulmonary infection (mycoplasma, Pneumocytis, viral) 3) Gastric aspiration 4) Head trauma

Question 51

Pathogenesis of ARDS - 4 steps.

Answer 51

1) endothelial activation 2) neut accumulation and activation 3) accumulation of intraalveolar and hyaline membranes 4) resolution of injury.

Question 52

DAD is a histological manifestation for what?

Answer 52

ALI/ARDS (DAD=Diffuse Alveolar Damage). - Gross - heavy, wet, firm lung - Micro - congested, interstitial and intraalveolar edema, necrosis, hyaline membranes. Hyaline membrane presence. Collapse of some alveoli.

Question 53

Combined endothelial and epithelial assault in ARDS culminates in what?

Answer 53

Increases vascular permeability and LOSS OF SURFACTANT >> alveoli stiff and resistant to expansion.

Question 54

What clinical course is this describing: | Dyspnea, tachypnea, cyanosis, hypoxemia, respiratory failure refractory to oxygen therapy.

Answer 54

ALI/ARDS

Question 55

What does follicular tonsillitis look like? What is it caused by?

Answer 55

Pinpoint exudate emanating from tonsillar crypts. | Caused by bacterial infection superimposed on viral infection.

Question 56

Most important sequelae of streptococcal "sore throats"

Answer 56

Rheumatic Fever and Glomerulonephritis

Question 57

What cancer is this? | BRD4-NUT, very aggressive, any age, nasopharynx, salivary gland, midline structures in thorax or abdomen

Answer 57

NUT Midline Carcinoma

Question 58

What is pulmonary edema?

Answer 58

Leakage of excessive interstitial fluid which accumulates in alveolar spaces.

Question 59

What is noncardiogenic pulmonary edema often due to?

Answer 59

Injury to the alveolar septa, causing INCREASED CAPILLARY PERMEABILITY.

Question 60

What can alveolar edema cause?

Answer 60

ARDS