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(OMS2) CPR II Exam 2 > (18.1) Pulmonary Path IV (Singh) > Flashcards

(18.1) Pulmonary Path IV (Singh) Flashcards

1
Q

Why do we include the nose, nasopharynx and paranasal sinuses in pulmonary path?

A

All these structures are lined by respiratory epithelium

They are vulnerable to the same enviornmental factors

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2
Q

What are the normal histologic features of the nose, nasopharynx and paranasal sinuses?

A

Respiratory epithelium

Mucous glands

Lymphoid aggregates

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3
Q

What are the common causes of viral rhinitis/sinusitis?

A

Rhinovirus

Coronavirus

Adenovirus

Echovirus

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4
Q

Symptom of viral rhinitis/sinusitis?

A

Clear rhinorrhea

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5
Q

What typically causes bacterial rhinitis/sinusitis?

A

Superimposed infection of streptococcus pneumoniae or haemophilus influenzae

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6
Q

Symptom of bacterial rhinitis/sinusitis?

A

Thick, purulent nasal secretions

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7
Q

What is a common manifestation of chronic rhinitis/sinusitis?

A

Inflammatory sinonasal polyps

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8
Q

What are the histologic hallmarks of inflammatory sinonasal polyps?

A

Edema in the stroma

w/ Eosinophilic infiltrates

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9
Q

What is an example of a consequence from chronic obstruction of a sinus?

A

Mucocele

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10
Q

What is a dental consideration with sinusitis?

A

The pathway of infection to the sinuses!

Normal oral flora may enter the maxillary sinus by tracking along periapical tissues (oral flora)

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11
Q

What are the 4 major sinuses, and where are they located anatomically?

A

Frontal sinus

Ethmoidal sinus

Maxillary sinus

Sphenoidal sinus

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12
Q

What causes allergic fungal sinusitis?

A

Occurs as a result of hypersensitivity of fungal organisms (eg aspergillus) that have colonized the sinus tract

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13
Q

What are the histologic features of allergic fungal sinusitis?

A

Allergic mucin

May see fungal hyphae

+/- mycetoma (fungal ball)

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14
Q

What typically causes acute invasive sinusitis?

A

Zygomycosis species (mucor)

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15
Q

What population does acute invasive sinusitis target?

A

Diabetic

or

Immunosuppressed

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16
Q

What is the severity of acute invasive sinusitis?

A

VERY emergent situation

Requires IV antifungal therapy to prevent extension into brain or sepsis

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17
Q

Granulomatosis with polyangiitis (GPA) typically affects?

A

Middle aged adults

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18
Q

Where can GPA affect anatomically?

A

Nasal passages/sinuses

Lungs

Kidney

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19
Q

What is the unique histology associated with GPA?

A

Granulomatous inflammation/vasculitis

Classic “necrobiotic” necrosis

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20
Q

What are the benign tumors of the nose, sinuses and nasopharynx?

A

Nasopharyngeal angiofibroma

Sinonasal (Schneiderian) papilloma

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21
Q

What are the malignant tumors of the nose, sinuses and nasopharynx?

A

Olfactory neuroblastoma

NUT midline carcinomas

EBV related malignancies (nasopharyngeal carcinoma and extranodal NK/T cell lympoma)

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22
Q

Nasopharyngeal angiofibroma

What is it?

Demographic?

A

Nasopharyngeal polypoid mass

Young men

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23
Q

What are the unique histologic features of nasopharyngeal angiofibroma?

A

Vascular fibrous core lined by benign epithelium

SIMILAR TO spongiosum of erectile tissue

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24
Q

What is the MAJOR association of nasopharyngeal angiofibroma?

A

Familial adenomatous polyposis (FAP)

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25
Q

What is familial adenomatous polyposis (FAP)?

A

Caused by a mutation in APC gene

Typically inherited

Characterized as numerous colon polyps that develop in childhood and adolescence

***Inevitable progression to carcinoma by middle age

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26
Q

Why does it matter that familial adenomatous polyposis (FAP) is HIGHLY associated with nasopharyngeal angiofibroma?

A

Because patients that have NO family hx. of FAP may have had a sporadic mutation in APC gene that would predispose them to colon cancer

If the physician observes nasopharyngeal angiofibroma, should look into genetic testing and performing a colon biopsy to evaluate risk of colon cancer

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27
Q

What are the three types of sinonasal (Schneiderian) papillomas?

A

Exophytic

Endophytic

Oncocytic

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28
Q

What is a common name for olfactory neuroblastoma?

Is it benign or malignant?

A

“Small round blue cell tumor”

Malignant

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29
Q

What is the origin of olfactory neuroblastoma?

A

Neuroectoderm in the superior nasal passage

(Neuroendocrine tumor)

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30
Q

What are the 2 age peaks for olfactory neuroblastoma?

A

Adolescence

Middle age

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31
Q

What is the classic radiographic presentation of olfactory neuroblastoma?

A

“Dumb-bell” shaped tumor

(penetrates through cribiform plate)

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32
Q

What is the most important clinical presentation of nasopharyngeal carcinoma?

A

Majority of cases present in the neck as cervical lymph node metastasis

*This is stange because the origin of nasopharyngeal carcinomas occur in the nasopharynx

(Double arrow=cervical lymph node metastasis, Single arrow=origin of nasopharyngeal carcinoma)

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33
Q

What are the risk factors for nasopharyngeal carcinoma?

A

Age

EBV

Chinese/Southeast asian adults

Young african children

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34
Q

Extranodal NK/T cell lymphoma

Associated with?

Demographic?

A

EBV

Asia and Latin America; any age but peaks in middle age

35
Q

Extranodal NK/T cell lymphoma

Can cause…

A

Necrotic destruction of paranasal sinuses

36
Q

Extranodal NK/T cell lymphoma

What are the sx?

A

Fever

Night sweats

Weight loss

37
Q

Identify the squamous lesions of the larynx

38
Q

Vocal cord nodules… aka?

A

“Singer’s nodules”

39
Q

What are vocal cord nodules?

A

Expansion of the soft tissue underlying the vocal fold

40
Q

Laryngeal squamous papilloma

What is it?

Association?

A

Benign squamous neoplasm with papillary appearance

HPV 6/11

41
Q

What is a SIGNIFICANT complication associated with laryngeal squamous papilloma?

A

Recurrent respiratory papillomatosis

42
Q

Laryngeal carcinoma

What type of carcinoma?

Common demographic?

A

Squamous carcinoma

Men >60y/o

43
Q

Laryngeal carcinoma has a strong association with?

A

Smoking

Alcohol

HPV infection

44
Q

Describe what otitis media looks like

A

Opaque, buldging out

45
Q

What are the three major causes of otitis media?

A

S | Streptococcus pneumoniae

M | Moraxella catarrhalis

H | Haemophilus influenzae

46
Q

What is unique about chronic otitis media in diabetics?

A

Usually caused by pseudomonas aergunosa

This will drastically change how you treat it

47
Q

What is a major complication associated with chronic otitis media?

A

Cholesteatoma

48
Q

What is otosclerosis?

A

Abnormal bony deposition at the stapedial footplate

49
Q

What is the major symptom associated with otosclerosis?

A

Conductive hearing loss

50
Q

What is the inheritance pattern of otosclerosis?

A

Autosomal dominant

51
Q

What are the common neck cysts?

A

Branchial cyst

Thyroglossal duct cyst

52
Q

Branchial cyst

Demographic?

Mechanism?

A

Young adults

2nd branchial arch pinching off cyst

53
Q

Thyroglossal duct cyst

What is it?

What would you see histologically?

A

Remnant nests of tissue from thyroid migration with cystic change

You’ll see respiratory lining PLUS thyroid follicles

54
Q

Carotid body tumor

Origin?

Appearance?

Associated with?

A

Neural crest origin

See image

Sporadically or associated with MEN2

55
Q

What are the unique histologic hallmarks of carotid body tumors?

What stain do you use to highlight these?

A

Nests of cells called “zellballen”

S-100 stain

56
Q

NOW STARTING WITH PATHOLOGIC RADIOGRAPHIC CORRELATION CASES (52min into lecture)

57
Q

What is a major radiographic pattern of bronchopneumonia?

A

Tree-in-bud

58
Q

What is imporant to note with tree-in-bud pattern?

A

Sometimes the pattern is patchy or subtle

59
Q

What is this?

A

Lobar pneumonia

60
Q

What is this sign?

A

“Bulging fissure” sign

Typical sign associated with lobar pneumonia

61
Q

What are the distinct patterns for bronchopneumonia?

A

“Tree-in-bud”

62
Q

What are the take home points of lobar pneumonia?

A

Tend to follow anatomic lobar distribution

Usually S.pneumo, S.aureus, Gram negatives

More likely to ABSCESS

63
Q

This is an example of:

A

Bronchiectasis

64
Q

What is this?

A

Primary ciliary dyskinesia w/ dextrocardia

Kartagener syndrome

65
Q

What are the take home points for evaluating bronchiectasis on imaging?

A

Abnormal dilation and extension of airway spaces into peripheral fields

66
Q

What sign is this?

A

Batwing appearance

67
Q

What caues “bat-wing” infiltrates?

A

Pulmonary edema

Pneumonias

Hypersensitivity pneumonitis

Inhalation injury

***Anything favoring proximal vascular airway involvement

68
Q

What causes “reverse bat-wing” infiltrates?

A

Anything that favors peripheral involvement

FIBROSIS

Sarcoidosis

69
Q

What is this?

A

Hypersensitivity pneumonitis

–> Follows AIRWAYS

70
Q

What is this?

A

Sarcoidosis

—> Follows LYMPHATICS

71
Q

What is this radiographic sign?

What is the most common cause of this?

A

“White out”

Acute respiratory distress syndrome (ARDS)

72
Q

Take home points for:

Central process

Sign?

Involvement?

A

“Bat-wing”

Rely on initial involvement of proximal airways or vessels

73
Q

Take home points for:

Peripheral processes

Sign?

Involvement?

A

“Reverse bat-wing”

Almost always a fibrosing process

74
Q

Take home points for:

Diffuse processes

Sign?

Involvement?

A

“White out”

ARDS

75
Q

What are the ways to categorize nodules?

76
Q

What is a classic entity that will demonstrate a “popcorn” appearance as it calcifies?

77
Q

When would a lesion on a chest X-ray or CT scan be more worrisome for malignancy?

A

Irregular border

Size

Calcification

Rate of growth

78
Q

What are the fleischner guidelines?

A

A set of guidelines used to determine next steps following radiographic imaging

79
Q

Adenocarcinomas have a _____________ appearance

A

Ground glass

80
Q

What is a radiographic hallmark of invasive adenocarcinoma?

A

“Bubble lucencies”

81
Q

What are the hallmarks of squamous carcinoma?

A

Cavitation

82
Q

What is this?

A

Atelectasis

“Wedge shaped”

83
Q

What is an important consideration when taking a CXR of a suspected tension pneumothorax?

A

SHOULD BE EXPIRATORY!!!

Unable to observe mediastinal shift during inhalation

(OMS2) CPR II Exam 2 (19 decks)

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