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CPR Exam 1 > Chapter 16 > Flashcards

Chapter 16 Flashcards

1
Q

What is rhinitis?

A

Inflammation and swelling of mucous membranes of the nose, causing runny nose and stuffiness.

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2
Q

______ is also called the common cold.

A

Infectious rhinitis

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3
Q

Is rhinitis infectious or allergic?

If recurrent, what happens?

A
  • Either
  • Can cause chronic rhinitis, sinusitus and nasal polyps
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4
Q

Pharyngitis and tonsillitis are URT ____ infections caused by what?

A
  • VIRAL
  • Rhinovirus, echovirus and adenovirus
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5
Q

Nasopharyngeal carcinoma is most often caused by _____ and is most common in who?

A
  • EBV
  • children in Africa (EBV related) and Asian adults (eat smoked fish with nitrosasmine)
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6
Q

Bacterial rhinitis is most likely caused by what?

A

A superimposed infection by Strep. pneumo or H. influenzae of a viral infection

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7
Q

Allergic rhinitis produces what symptoms?

A
    1. Inflammatory infiltrate with EOSINOPHILS
    1. Edema in nasal/airways
    1. Clear mucus (rhinorrhea)
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8
Q

Recurrent rhinitis can lead to nasal polyps.

What are nasal polps?

A

Edematous nasal mucosa in stroma filled with eosinophils, neutrophils and plasma cells and lined by normal respiratory epithelium

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9
Q

Obstruction of sinus drainage in sinusitis may lead to what 2 gross findings?

A

Obstruction, creating a

    1. Empyema in pleural cavity
    1. Mucocele: cysts lined by respiratory epithelium that secretes mucus
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10
Q

What is the pathway of infection of sinusitis?

A
  1. Sinuses can secondarily receive bacteria: Infection can enter the maxillary sinus via periapical tissue of the mouth
  2. Advanced sinutis can secondarily spread bacteria to adjacent tissue.
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11
Q

What are 3 frequent complications which may arise from chronic sinusitis of the ethmoid sinus?

A

Infection spread to eye and causes: -

  1. Preseptal cellulitis
  2. - Orbital cellulitis
  3. - Subperiosteal abscess
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12
Q

What are 3 frequent complications which may arise from chronic sinusitis of the frontal sinus?

A

Go to meninges and brain

  • 1. Meningits
  • 2. Epidural abcess
  • 3. Osteomyolitis
  • 4. Mucocele
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13
Q

What are 3 frequent complications which may arise from chronic sinusitis of the maxillary sinus and sphenoid?

A
  • Maxillary: mucocele* and osteomyolitis
  • Sphenoid: mucocele
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14
Q

Maxillary sinusitis occasionally arises from extension of an infection from where?

A

Periapical infection from the mouth

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15
Q

Kartagener Syndrome is characterized by what triad and the sx’s are all caused by what?

A

- Bronchiectasis

- Situs inversus

- Sinusitis (less common)

- All sx’s due to defective ciliary action

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16
Q

What is allergic fungal sinusitis?

What do you see on histology?

A

Type 1 hypersensitivity reaction to the fungus asperigillus in the sinus tract, producing a thick compact mmucus with eosinphils and Charcot Leyden Crystals on histology. Fungal hypae are also sometimes seen.

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17
Q

What happens if a patient has allergic fungal sinusitis and alot of aspergillus accumulates?

A

Form a aspergillus mycetoma (fungal ball) in nasal cavity

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18
Q

What is a_cute invasive sinusitis?_

Who does it occur in most often?

How do we treat?

A
  • Occurs when fungal hypae (often Zygomycosis species/Mucor) invade and go into brain, bloodsream or both.
  • DB patients and immunocompromised
  • Immediate IV antifungal therapy to prevent spread and sepsis
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19
Q

Which patients are at higher risk for particularly severe forms of chronic sinusitis and by which type of organisms?

A

DB

Fungi (murcomycosis)

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20
Q

What are 3 conditions which can produce necrotizing ulcerating lesions of the nose and upper respiratory tract?

A
  1. - Acute fungal infections (i.e., Mucormycosis)
  2. - Granulomatosis w/ polyangiitis (Wegener)
  3. - Extranodal NK/T-cell lymphoma, nasal-type
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21
Q

Describe the presentation of granulomatosis with polyangiitis in the sinus tract.

Who does it affect

Where else does it affect

A
  • Middle aged adults
  • Necrotic granulomas that lead to ulceration, necrosis or perforate the septum, nasal passages and sinuses.
  • Also affecting lungs and kidney
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22
Q

What are benign tumors (but locally aggressive) that occur in nose, sinus and nasopharynx?

A
  • 1. Nasopharyngeal angiofibroma
  • 2. Sinonasal (Schneiderian papilloma)
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23
Q

What are maligiant tumors (but locally aggressive) that occur in nose, sinus and nasopharynx?

A

1. Olfactory neuoblastoma

2. NUT midline carcinomas

3. EBV related cancers (nasopharyngeal carcinomas and extranodal NK/T cell lymphoma)

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24
Q

What are the 2 EBV related malignancies?

A
  • 1. Nasopharyngeal carcinomas
  • 2. Extranodal NK/T cell lymphoma
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25
Q

Nasopharyngeal angiofibroma is a benign tumor found almost exclusively in whom?

Also associated with what GI disorder?

A
  • Young males who are most often fair-skinned and red headed
  • Association w/ FAP
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26
Q

What is a nasopharyngeal angiofibroma?

What is its reccurence?

A
  • Polypoid benign mass with BV and fibrous tissue, surrounded with thick BENIGN epithelium
  • May recurr and bleed
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27
Q

What tumor looks like thick penile erectile tissue that grows in nose?

A

nasopharygeal angiofibroma

28
Q

What is FAP (familial adenomatous polypsis)?

Mutation:

Can it become cancer?

A
  • Precancerous colon polyps that occur most commonly in LI and develop in childhood/adolescence
  • Mutation in APC gene
  • Will become invasive colon cancer by middle age.
29
Q

Sinonasal (Schneiderian) Papilloma most often occurs in which sex and age group?

A

Adult males between the ages 30-60 yo

30
Q

What are the 3 forms the lesions of Sinonasal (Schneiderian) Papilloma occur as; which is most common?

A
  • Exophytic = most common
  • Endophytic (inverted)
  • Oncocytic (type of cell)
31
Q

Which form of Sinonasal (Schneiderian) Papilloma is uniquely aggressive and in a minority of cases may progress to malignancy?

A
  • Endophytic (Inverted), because even though benigin, it grows DOWN IN tissue.
32
Q

The exophytic and endophytic forms of Sinonasal (Schneiderian) Papilloma are associated with what virus?

A

HPV (types 6 and 11)

33
Q

Olfactory neuroblastomas (MALIGNANT) arise from which cells and in which location?

A

Neuroectodermal olfactory cells in the superior nasal cavity

34
Q

What is the characteristic histology of Olfactory Neuroblastomas?

A

- Small, round blue cell tumor

  • -Nests and lobules of well separtaed cells separated by fibrovascular stroma
35
Q

What is unique about the age distribution of Olfactory Neuroblastomas; patients present with what signs/sx’s?

A
  • Peaks at 15 yo and 50 yo (middle age)
  • Present w/ nasal obstruction and/or epistaxis
36
Q

Olfactory neuroblastomas may penetrate through the ______ and produce what characteristic appearance on imaging?

A

Cribiform plate

Dumb-bell shaped tumor

37
Q

What are the 3 patterns of Nasopharyngeal Carcinoma which may be seen?

A

1. Keratinizing SCC’s

  1. Nonkeratinizing SCC’s
  2. Basophilic with lymphoid tissue (formerly lymphoepithelioma)
38
Q

How do nasopharyngeal carcinomas typically present; most often metastases where?

A
  • Usually very small lesions that may obstruct nose and cause epistaxis.
  • However, they often do not come to ATN until they metastize to cervical LN in the neck.
39
Q

What are the 3 factors which influence the origin of Nasopharyngeal Carcinomas?

A
  1. Age
  2. Hereditary
  3. Infection with EBV
40
Q

Which dietary and enviornemental factors are associated with Nasopharyngeal Carcinoma?

A

smoked fish with nitrosamines + EBV

41
Q

What may be detected via in-situ hybridization or immunohistochemistry in the malignant cells of nasopharyngeal carcinoma?

A
  • EBV encoded RNA’s such as EBER-1
  • Proteins such as LMP-1
42
Q

Extranodal NK/T-cell lymphomas is a _____ related tumor with increased incidence ______ and occurs when?

A
  • EBV
  • in Asia and Latin American countries
  • at any age, but peaks in middle age
43
Q

What is this?

Describe

A

Extranodal NK/T-cell lymphoma: an EBV related cancer that causes necrotic destruction of paranasal sinuses.

44
Q

What are the signs of Extranodal NK/T-cell lymphomas and prognosis?

A

Fever, night sweat, weight loss

Depends on stages and sx

45
Q

What can we use to dx Extranodal NK/T-cell lymphomas?

A

LOOK FOR EBER

46
Q

What are the 3 squamous lesions of the larynx?

A

1. Singers node

2. Papilloma

3. Cancer on vocal cord

47
Q

Reactive nodules of the vocal cords are most often seen in whom?

A
  • Smokers
  • Pts who impose great strain on their vocal cords (i.e., Singers)
48
Q

Describe a vocal cord nodule

What can be seen on hisoloy?

A
  • Expansion of soft tissue under the vocal fold (Rienke space) that is soft and transulent.
  • Filled w edema and loose stroma trapped in a squamous epithelium (NOT A NEOPLASM)
49
Q

How do singers nodules differ from polyps in terms of distribution?

A

- Singers nodules = bilateral

  • Polyps = unilateral
50
Q

Laryngeal squamous papillomas are caused by what?

A

HPV types 6 and 11

51
Q

Laryngeal squamous papillomas are what

A

Benign, squamous epithelium-lined NEOPLASMS on vocal cord that look like papilla.

52
Q

What is the prsentation of

Laryngeal squamous papillomas

A
  1. Can be solitary (easy to tx and do not progress to cancer)

or assx with

2. Recurrent respiratory papillamatosis

53
Q

What is a bad complication of largeal papillomas?

A

Papilla spread to respiratory airways and creates a cystic lung disease called recurrent respiratory papillomatosis that can lead to respiratory insuff or progress to cancer (<1%)

54
Q

Recurrent respiratory papillomatosis typically occurs in whom and is associated with what?

A

- Children and adolescents

  • Associated w/ HPV 6 and 11; thought to be acquired during birth ( mom under 20, vaginal birth and first born)
55
Q

Laryngeal carcinoma is most often what type of carcinoma and seen in whom?

A
  • Squamous cell carcinoma (LOOK FOR KERATIN PEARL and CRATER IN CENTER OF LESION)
  • - Men >60 yo who smoke, drink alochol, HPV infection
56
Q

What effect does alcohol and smoking on laryngeal carcinoma

A

SYNERGISTIC

57
Q

3 most common bacteria responsible for acute otitis media?

A

- Streptococcus pneumoniae

- Moraxella catarrhalis

- H. influenza

*SMH*

58
Q

Otits media in the diabetic pt is most often caused by which organism and what serious complication may arise?

A

- P. aeruginosa

  • Is especially aggressive and spreads widely, causing destructive necrotizing otitis media
59
Q

What are cholesteatomas; and what are they associated with?

A

- Non-neoplastic, CYSTIC lesions lined by squamous epithelium w/ trapped keratin debris and cholesterol

  • Associated w/ chronic otitis media
60
Q

The reactive nature of cholesteatomas may lead to what complications?

A
  • Enlarge and erode into the ossicles, the labyringht, adjacent bone, or surrounding soft tissue
  • May produce visible neck masses
61
Q

Otosclerosis is due to abnormal bony deposition where?

What is the primary complication of Otosclerosis?

A
  • Stapedial footplate, sticking it to the oval window
  • Conductive hearing loss
62
Q

Branchial cysts are thought to arise from what remnant and are most commonly observed in whom?

A

- 2nd branchial arch => occuring on upper lateral neck near SCM

  • Young adults btw ages 20-40 yo
63
Q

What is the histology of branchial cysts?

A

Simple cyst lined by stratified squamous or respiratory epithelium w/ surrounding fibrous tissue +/- lymphoidtissue

64
Q

Thyroglossal duct cysts arise from what?

what will you see on histo

A
  • Remenant of tissue from thyroid migration that form a cyst.

thyroid follicles and respiratory lining

65
Q

What type of epithelium are thyroglossal duct cysts lined with when located near base of tongue vs. lower locations in anterior neck?

A
  • Base of tongue –> stratified squamous epithelium
  • Lower –> pseudostratified columnar epithelium
66
Q

What is the origin of paragangliomas (carotid body tumors)?

A

Neural crest

67
Q
A

CPR Exam 1 (19 decks)

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