Flashcards in Resp Path 1 - Upper Airway, Nose/Nasopharynx, Larynx, Lungs, ARDS - Galbraith Deck (60)
What is this?
Nasal mucosa becomes edematous and hyperemic with catarrhal secretions. May become mucopurulent exudates induced by bacterial superinfection.
What is infectious rhinitis mainly caused by and what is the tx?
- Usually viral - "the common cold".
- Adenovirus, rhinovirus, echovirus.
- Self limiting.
What is classified as an IgE-mediated hypersensitivity reaction with clinical manifestations that can be similar to infectious rhinitis?
What are the prominent contents of edematous protrusions in nasal polyps?
Lymphocytes, plasma cells, neuts, and sometimes eosinophils.
When do nasal polyps occur?
- Occur with RECURRENT rhinitis (NOT atopy/allergy).
Name the rhinitis:
1) "hay fever", IgE
2) "Common cold", adeno/echo/rhinovirus
1) Allergic rhinitis
2) Infectious rhinitis
When do nasal polyps clinically become a problem? Tx?
- Become a problem when they reach 3-4 cm in size, causing obstruction.
- Tx is surgical removal.
What is the sequela to chronic acute rhinitis?
Chronic rhinitis - superficial mucosal ulceration with variable inflammatory infiltrates that can extend into the sinuses.
What is sinusitis commonly preceeded by?
Bugs from where cause it?
Acute or chronic rhinitis with edema that impairs sinus drainage.
- Bugs from the oral cavity cause it.
What is the Kartagener Syndrome triad?
3. Situs inversus
The dominant effect of sinusitis and a potential dangerous complication.
- Dominant effect is discomfort/malaise.
- Can potentially spread to orbit or surrounding bone to cause osteomyelitis or dural venous sinus thrombophlebitis.
Two frequent concomitants of viral upper respiratory infections.
Pharyngitis and tonsillitis.
What are pharyngitis and tonsillitis primarily caused by?
1) Most commonly caused by VIRUSES (adeno, echo, rhino)
- beta-hemolytic strep
- S. aureus
What would you see in tonsillitis or pharyngitis caused by bacterial infection?
Whitish exudative material overlying reddened, swollen tonsils.
What are three causes of necrotizing lesions of the upper respiratory tract?
1) Acute fungal infection (mucormycosis in DM)
2) Granulomatosis with polyangiitis
3) **Extranodal NK/T cell lymphoma, nasal type
Extranodal NK/T cell lymphoma, nasal type:
- What type of lymphoma is it
- Associated with what
- Aggressive or benign
- A lymphoma of NK cells infected with **EBV**.
- Male, 40-50s, Asian and Latin American.
- EXTREMELY AGGRESSIVE into cranial vault or necrotic/septic.
What is a highly vascularized tumor that occurs in adolescent males with red hair and fair skin?
Where do nasopharyngeal angiofibromas arise?
In the posterolateral roof of the nasal cavity.
Are nasopharyngeal angiofibromas aggressive or benign? Tx?
- Classified as benign, but may be LOCALLY AGGRESSIVE into the cranial vault.
- Tx is surgical excision
A male, 30-60yo has a benign neoplasm arising from squamous or respiratory or columnar epithelium. What is it?
Sinonasal (Schneiderian) Papilloma.
What are the three subtypes of this type of Sinonasal (Schneiderian) Papilloma?
1) **Exophytic (fungating)
2) **Inverted (endophytic)
3) Cylindrical (oncocytic)
HPV 6 and 11:
- What two subtypes of Sinonasal Papilloma are associated with this
- What type of papilloma is associated with it?
- Exophytic and inverted sinonasal papilloma
- Squamous papillomas
How is Inverted Sinonasal Papilloma different from non-inverted forms?
- VERY LOCALLY AGGRESSIVE
- Tx is COMPLETE EXCISION required to prevent recurrence with potential invasion into the orbit for cranial vault.
What tumor is highly malignant and composed of neuroendocrine cells that arise from neuroectoderm in SUPERIOR NASAL CAVITY?
Bimodal 15yo and 50yo.
To dx, see: enolase, synaptophysin, CD56, chromogranin
Is an olfactory neuroblastoma benign or malignant?
How is it physically described?
- Very malignant
- "small blue cell tumor"
What is the age/distinctive geographic distribution of nasopharyngeal carcinoma (3 locations)?
- EBV-related carcinoma.
- Africa = CHILDREN
- S. China = ADULTS
- USA = diet of fermented or salted fish (nitrosamines
Three forms that nasopharyngeal carcinomas? Which is most aggressive/sensitive to radiotherapy?
1) Keratinizing squamous cell (**least aggressive, least sensitive**).
2) Nonkeratinizing squamous
3) Undifferentiated with abundant lymphocytic infiltrate (**most aggressive, most sensitive**).
What bug causes a life threatening type of laryngitis in children? What does it cause?
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).