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Question 1

Characteristics of infective rhinitis

Answer 1

• Viral necrosis of surface epithelial cells → exudation (inflammatory response) of fluid and mucus from the damaged surface
• Submucosal edema produces swelling and nasal obstruction

Viral infection of the URT can spread to LRT, and can also predispose the patient to secondary bacterial infection

Question 2

Complications of sinusitis

Answer 2

Due to impaired drainage of secretions → predisposition to secondary bacterial infection

In severe cases, infection may spread to the meninges (since the brain and sinus is only separated by a thin layer of bone)

Question 3

What is tuberculosis

Answer 3

1. Chronic pneumonia which is communicable, granulomatous and caused by Mycobacterium tuberculosis
2. Initial infection is usually inhaled (spread by respiratory droplets)
3. Usually infects lungs, but can infect other organs and tissues

Question 4

What are the disease states which increase the risk of TB infection

Answer 4

1. Diabetes
2. Chronic lung diseases
3. Alcoholism
4. HIV infection

Question 5

Pathophysiology of pulmonary edema

Answer 5

Main cause: Pulmonary capillary congestion due to LH failure

Extracellular fluid leaks into the lungs → increased fluid in alveolar wall (interstitium) eventually leads to fluid in alveolar spaces

Capillary rupture → leakage of red cells into interstitium → haemoglobin phagocytosed by alveolar macrophages (heart failure cells, contains haemosiderin)

Patients with acute PE may present: Frothy & red phlegm

Question 6

CXR findings for pulmonary edema

Answer 6

Patches of airspace abnormality

Septal lines present due to interstitial edema throughout both lungs

Question 7

What are the causes of pulmonary (arterial) hypertension

Answer 7

1. Secondary to LH disease (especially mitral valve disease) where pressure is transmitted to the entire pulmonary system
2. Shunts from LH to RH (Eg septal defect)
3. Chronic lung disease, where there is a combination of loss of normal capillaries and hypoxic vasoconstriction of arterioles
4. Sequelae of pulmomary emboli
5. Unknown cause (idiopathic)

Question 8

Effects of pulmonary hypertension on lungs

Answer 8

Sustained increased pulmonary pressure → irreversible structural changes in pulmonary arteries (medial hypertrophy in muscular arteries and intimal proliferation) → narrowing & occlusion → reduced cross-sectional area → further increased pressure

Question 9

What is cor pulmonale

Answer 9

Heart failure secondary to lung disease

Question 10

Pathophysiology of cor pulmonale

Answer 10

Long term need for heart to pump at higher pressures → RH failure

Question 11

what is a juvenile angiofibroma

Answer 11

benign tumour in nasal cavity

usually occurs in male adolescents

grows quickly during puberty as it is hormone sensitive

frequently ulcerates and presents with bleeing

Question 12

Characteristics of nasopharynx

Answer 12

Lined by respiratory columnar epithelium

Contains associated mucosa-associated lymphoid tissue (part of waldeyer’s ring)

Question 13

What are the histological characteristics of sinonasal papillomas

Answer 13

1. Tends to grow outward beyond the surface epithelium from which it originates
2. (May be ‘fungiform’/exophytic or inverted)
3. May be covered by non-keratinising squamous epithelium, ciliated columnar epithelium or transitional epithelium (squamous → glandular)
4. May have mucus secreting cells
5. Epithelium may appear oncocytic (abundant mitochondria)

Question 14

Complications of allergic rhinitis

Answer 14

If antigenic stimulus persists, mucosa becomes swollen and polypoid, with formation of nasal polyps