Chapter 16-upper Airways, Ears, And Neck Flashcards
1
Q
What is another name for infectious rhinitis
A
Common cold
2
Q
What causes infectious rhinitis
A
Adenovirus, echovirus, and rhinovirus
3
Q
Exam signs of infectious rhinitis
A
Thick, edematous , red nasal mucosa with catarrhal discharge (runny nose from goblet cells)
Narrowed nasal cavities
Enlarged turbinates
4
Q
Infectious rhinitis can lead to ____
A
Pharyngotonsillites
5
Q
If have infectious rhinitis A ___ ___ __ enhances inflammatory reaction leading to mucopurulent/suppurative exudate
A
Secondary bacterial infection
6
Q
“In a week if treated, or seven days if ignored” with common cold
A
Treating doesn’t really help
7
Q
What is another name for allergic rhinitis
A
Hay fever
8
Q
What is allergic rhinitis
A
IfE mediated hypersensitivity reaction
9
Q
Early phase allergic rhinitis
A
Marked mucosal edema, redness, and mucus secretion
10
Q
Late phase allergic rhinitis
A
Leukocytic infiltration with prominent eosinophils
11
Q
What percentage of Americans are effected by allergic rhinitis
A
20
12
Q
What are some common allergens that cause hay fever
A
Plant pollen, fungi, animal allergens, dust mites
13
Q
What causes nasal polyps
A
Occur with recurrent rhinitis (either type)
14
Q
Histology of nasal polyps
A
Edematous mucosa with loose stroke, hyperplastic mucus glands and infiltrated by neutrophils, eosinophils and plasma cells
Likely to ave goblet cells inthe outer respiratory mucosal layer
15
Q
Most people with nasal polyps are not ___; only .5% of __ patients develop polyps
A
Atopic
16
Q
What if polyps are large or multiple
A
Can obstruct airway impairing sinus drainage
17
Q
Chronic polyps
A
The costal covering of the polyps may become ulcerated or infected
18
Q
Chronic rhinitis
A
Sequela to acute microbial or allergic rhinitis with the eventual development of superimposed bacterial infection
19
Q
Histology chronic rhinitis
A
Superficial mucosal desquamation or ulceration with inflammatory infiltrates extending into the air sinuses
20
Q
What can predispose someone to microbial invasion/chronic rhinitis
A
Deviated septum or nasal polyps
21
Q
What is acute sinusitis preceded by
A
Acute or chronic rhinitis (edema impairs sinus drainage)
22
Q
What causes acute sinusitis
A
Oral commensals (almost always bacterial
23
Q
How treat acute sinusitis
A
Amoxicillin
24
Q
What causes acute sinusitis in diabetics
A
Fungal
Mucormycosis
25
If there is a complete sinus drainage block with acute sinusitis it may lead to what
Epyema of the sinus where the suppurative exudate becomes impounded
26
With acute sinusitis, obstruction of outflow is most common from the ___ ___ leading to accumulation of the mucous secretions, called ____
Frontal sinus (not anterior ethmoid sinuses)
Mucocele
27
Is acute sinusitis serious
Uncomfortable nut not serious unless the infection spreads into the orbit or cranial vault (septic thrombophlebitis of a dural venous sinus) or penetrates the bone causing ostemyelitis
28
What bad things can happen from an acute sinusitis
Septic thrombophlebitis of a dural venous sinus or penetrates the bone causing osteomyelitis
29
Maxillary sinusitis why get
An extension of a periapical tooth infection
30
Kartagener syndrome triad
Sinusitis, bronchiectasis and situs inversus
31
What causes kartagener syndrome
Congenitally defective ciliary action
32
Necrotizing lesions of the nose/upper airway causes
Acute fungal infections, espicially mucormycosis in diabetic and immunocompromised patients
Granulomatosis with polyangiitis (wegener granulomatosis)*
Extranodal NK/T cell lymphoma-nasal type, harboring EBV
33
Who gets extranodal NK.T cell lymphoma-nasal type, harboring EBV
Asian/Latin American males in 5-6 decade
34
What is extranodal NK.T cell lymphoma complicated by
Ulceration and bacterial superinfection
35
How treat extranodal NK.T cell Lymphoms
Radiotherapy controls localized disease
36
How can extranodal NK/T cell lymphoma be fatal
Spread to cranial vault or necrosis with infection and sepsis
37
Relapse and recurrences of extranodal NK/T cell lymphoma is associated with a __ outcome
Poor
38
URI
Pharyngitis and tonsillitis
39
Common causes of pharyngitis and tonsillitis
Rhinovirus, echovirus, adenovirus> influenza, respiratory syncytial virus
40
Histology pharyngitis and tonsillitis
Mucosal edema+erythema+reactive lymphoid hyperplasia in lymph nodes and tonsils
Exudative membrane may cover nasopharyngeal mucosa and tonsils (pseudomembrane)
41
Secondary ____ or ____ bacteria infections exacerbate pharyngitis and tonsillitis
B hemolytic strep or staph aureus (beware or sequelae_
42
Rheumatic fever is associated with what
Mitral valve prolapse
43
Post streptococcal glomerulonephritis is associated with what
Tea colored using
44
Follicular tonsillitis
Redden, enlarged tonsils (due to reactive lymphoid hyperplasia) with pinpoints of exudate emanating fromt he tonsillar crypts
45
What is a nasopharyngeal angiofibroma
Highly vascularized benign tumor that has a very bland look
46
Who gets nasopharyngeal angiofibroma
Red head, fair skinned adolescent males
Or/and
Associated with familial adematous polyps (FAP)-Germaine APC mutation
47
Where are nasopharyngeal angiofibroma
In stroma of posterolateral wall oft he roof of the nasal cavity
48
Treat nasopharyngeal angiofibroma
Surgery
49
Prognosis nasopharyngeal angiofibroma
Locally aggressive and intracranial extension =20% recurrence
9% fatal due to hemorrhage or intracranial extension
50
Sinonasal (scheiderian_ papilloma benign or malignant
Benign
51
Where are sinonasal (scheiderian_ papilloma
From the respiratory or schneiderian mucosa lining the nasal cavity and paranasal sinuses
52
What are the three forms of sinonasal papilloma
Exophytic (most common)
Endophytic (inverted, most biologically important)
Cylindrical
53
What is the only form of sinonasal papilloma that is aggressive
Endophytic
54
Who gets sinonasal papilloma
Males thirty to sixty
55
What virus is sinonasal papilloma associated with
HPV 6, 11
56
Sinonasal papilloma have ___ ___ cores
Fibrovascular
| Stromal
57
Endophytic sinonasal papilloma
Benign, but locally aggressive neoplasm of the squamous epithelium of the nasal cavity or paranasal sinuses
58
How does an endophytic sinonasal papilloma grow
Papillary way but invaginates into the underlying stroma
59
Malignant transformation fo endophytic sinonasal papilloma is seen in what percent of cases
Ten
60
Complete excision fo an endophytic sinonasal papilloma may prevent recurrence with potential invasion into the orbit or cranial vault. What is not all excised?
High change of return
61
Olfactory neuroblastoma (esthesioneuroblastoma) is benign or malignant
HIGHLY MALIGNANT
62
Describe an olfactory neuroblastoma
Uncommon, highly malignant tumor arising from the neuroectodermal olfactory cells present within the mucosa within the superior aspect of the nasal cavity
63
What is the bio deal distribution of olfactory neuroblastoma
Peak incidence at 15 and 50 years
64
How do patients with olfactory neuroblastoma present
Nasal obstruction and epistaxis
65
Histology olfactory neuroblastoma
Small, BLUE, round cell neoplasm
Nests and lobules of well circumscribed cells separated with fibrovascular stroma
*memrane bound secretory granules and neuron specific markers neoplasm, synaptophysin, CD56 and chromogranin
66
What are the other small blu round cell neoplasms
Lymphoma, small cell carcinoma, Ewing sarcoma/peripheral neuroectodermal tumor, rhabomyosarcoma, melanoma, and sinonasal undifferentiated carcinoma
67
How treat olfactory neuroblastoma
Surgery, radio/chemotherapy
68
Prognosis olfactory neuroblastoma
5 year survival rate of 40-90%
69
NUT midline carcinoma
Uncommon, extremely aggresssive and resistant to therapy
70
Where do we get NUT midline carcinoma
Nasopharyngeal, salivary gland or other midline structures of thorax/abdomen
71
Genetics of NUT midline carcinoma
Translocation in fusion gene of NUT and BRD4
72
NUT
Chromatin regulator
73
BRD4
Chromatin reader
74
What happens if take drug that displace NUT-BRD4 from chromatin
Induce NUT midline carcinoma cells to terminally differentiate (no cure)
Unusual in epithelial cancers, although common ina cute Leukemias
75
Prognosis of NUT midline carcinoma
Survival less than a year -high mortality very lethal
76
Who gets NUT midline carcinoma
Any age group
77
Morphology NUT midline carcinoma
Like squamous cell carcinoma
78
Nasopharyngeal carcinoma who gets it
African kids and Chinese adults (south china)
79
Where are nasopharyngeal carcinoma
Close anatomic relationship to lymphoid tissue
80
What are nasopharyngeal carcinomas associated with
EBV infection, diets high in nitrosamines (fermented food, salted fish), smoking
81
What are the three types of nasopharyngeal carcinoma
Keratinize got squamous cell carcinoma
Non keratinize go squamous cell carcinoma
Undifferentiated/basaloid carcinomas (lymphoepithelioma)-may have abundant non neoplastic, lymphocytic infiltrate
82
Risk factors for nasopharyngeal carcinoma
Hereditary, age, EBV infection , diets high in nitrosamines (fermented foods and salted fish), smoking, chemical fumes
83
Squamous nasopharyngeal carcinoma morphology
Look like other squamous cell carcinomas in body
84
Undifferentiated/basaloid nasopharyngeal carcinoma morphology
Large epithelial cells with oval or round vesicular nuclei, prominent nucleoli and indistinct cell borders disposed in a syncytial like array
Mixed with lymphocytes, espicially mature T cells
May also detect EBR1 or LMP1
85
Clinical presentation nasopharyngeal carcinoma
Found secondary to nasal obstruction, epistaxis and metastasis to cervical lymph nodes
86
Treat nasopharyngeal carcinoma
Radiotherapy
87
What nasopharyngeal nasocarcinoma is most radiosensitive
Undifferentiated carcinoma
88
Prognosis nasopharyngeal carcinoma
Five year survival overall 60%
Non keratinize go 70-98%
Keratinize go 20% least radiosensitive
89
What are common laryngeal pathologies and uncommon
Common-inflammatory
Uncommon-tumors
90
What happens if remove laryngeal tumour
Loss of normal voice, larynx is the voice box
91
Laryngitis causes
Allergic, viral, bacterial, or chemical injury (GERD)
92
Treatment of laryngitis
Self limited
93
Why can laryngitis be serious in kids/infants
SMAll airway
94
Laryngoepiglottitis
Caused by haemophilus influenza (there is a vaccine), respiratory syncytial of B hemolytic strep may induce sudden swelling of the epiglottis and vocal cords that the airway is compromised (medical emergency
95
Laryngotracheobronchitis in kids
Croup
Inflammatory narrowing of the airway produces inspiration stridor
96
What is the msot common form of laryngitis and what are the problems associated with it
In heavy smokers
| Predisposes to squamous epithelial metaplasia and sometimes overt carcinoma
97
Reactive nodules (polyps) of the vocal cords are __ in heavy smokers and __ in singers
Unilateral
| Bilateral
98
Morphology reactive nodules
Small, smooth, round, sessile or pedunculated excrescences (bumps) on the true vocal cords
Loose myxoid core, covered with squamous epithelium
May become keratotic, hyperplastic, or even slightly dysplastic
99
A polyp on the volca cord may __ if the nodules impinge each other
Ulcerate
100
Clinical reactive nodules
Progressive hoarseness
101
Malignant transformation of reactive nodules of the volca cords
Never gives rise to cancer
102
Squamous papilloma of larynxbenign or malignant
Benign
103
What is a squamous papilloma of the larynx
Small benign squamous epithelium lined lesions on the true vocal cords
104
Morphology squamous papilloma of larynx
Soft raspberry like proliferation’s
Multiple slender finger like projections supported by a central fibrovascular core and covered by an orderly stratified squamous epithelium
105
What happens if get trauma to squamous papilloma on the free edge of the true vocal cord
Ulceration and hemoptysis
106
Who gets squamous papilloma of larynx
Single adults HPV6 or 11 (non oncogenic) in which case they can be multiple and recur
Do not become malignant
Multiple in children (juvenile laryngeal papillomatosis) that may spontaneously regress at puberty
107
Squamous cell carcinoma 9malignant) of the larynx
Squamous cell carcinoma seen in male chronic smokers in 6th decade
108
Sequence of squamous cell carcinoma
Epithelial changes range from hyperplasia, atypical hyperplasia, dysplasia, and carcinoma in situation to invasive carcinoma
109
Likelihood of developing overt cancer from squamous cell carcinoma is proportional to __ seen at first diagnosis
Atypia
Orderly hyperplasia have almost no potential for malignant transformation
110
Risk factors for squamous cell carcinoma
Tobacco smoke, alcohol, asbestos, irradiation, HPV
Risk proportional to level of exposure,
Smoking cessation will cause the changes to regress
111
Morphology squamous cell carcinoma
Intrinsic if confined to the inside of the larynx, if extends outward then is called extrinsic
Begin as in situation lesion that later appear pearly grey wrinkled plaques on the mucosal surface that may ultimately become a funginating mass that ulcerated
Degree of anaplasia is variable
Sometimes massive tumor giant cells and bizarre mitosis figures are seen
Adjacent mucosa may be hyperplastic or dysplastic
112
Clinical squamous cell carcinoma
Persistent hoarseness* PERsistENT
Dysphagia, dysphonia, and hemoptysis
113
Treat squamous cell carcinoma
Surgery and radiation
Maybe even laryngectomy
114
Prognosis squamous cell carcinoma
Depends on clinical staging
115
Name the most common aural disorders (in descending order of frequency)
1. Acute and chronic otitis (middle ear and mastid_ sometimes leading to cholesteatoma
2. Symptomatic otosclerosis
3. Aural polyps
4. Labyrinthitis
5. Carcinomas, largely of the external ear
6. Paragangliomas
116
Otitis media (acute of chronic) has viral etiology...meaning?
Serious exudate (so transudate)
117
Otitis media may become ___ with superimposed bacterial infection
Suppurative
118
What bacteria may superimpose otitis media
Strep p.
| Non typeable haemophilus influenza and morazella catarrhalis
119
Clinical acute otitis media
Bulging opaque and hyperemic tympanic membrane with decreased movement on pneumatic otoscopy and a fever==strep p.
120
Causadative agents of suppurative otitis media
Pseudomonas aeruginosa and staph aureus
121
Most common cause of URI is __ etiology
Viral
122
Otitis media in diabetic
When caused by pseudomonas aeruginosa is espicially aggressive and spreads widely, causing destructive necrotizing otitis media
123
Cholesteatoma
Non neoplastic, cystic lesion 1-4 cm in diameter lined by keratinize go squamous epithelium or metaplastic mucus-secreting epithelium and filled with amorphous debris derived largely form desquamated epithelium
Sometimes contain spicules of cholesterol
Associated with chronic otitis media
124
Otosclerosis
Abnormal deposition of bone in the middle ear about the rim of the oval window into which the footplate of the stapes fits
125
Otosclerosis unilateral or bilateral
Bilateral wnd slowly progressive to marked hearing loss
126
What causes otosclerosis
Familial AD with variable penetrate
127
Epithelial and mesenchymal tumors that arise in the ear are ___. Except for what
Rare
Basal cell or squamous cell carcinoma of the pinna
128
Who gets basal cell or squamous cell carcinoma of the pinna
Elderly men
129
What are basal cell or squamous carcinomas of the pinna associated with
Sun exposure
130
Spread of basal cell or squamous cell carcinoma of the pinna
Locally invasive but rarely spread/metasticize
131
Who gets squamous cell carcinoma of the canal
Middle age to elderly women
132
What are squamous cell carcinoma of canal associated with
Not sun
133
Morphology squamous cell carcinoma of canal
Resemble counterparts in other skin locations, beginning as populates that extend and eventually erode and invade locally
134
Spread squamous cell carcinoma of canal
Invade cranial cavity or metastisize to regional nodes
135
Prognosis squamous cell carcinoma of the canal
5 year mortality 50%
136
Branchial cyst (cervical lymphoepithelial cyst)
Remnant of the second arch
137
Who do we see branchial cyst in
Young adults between 20 and 40
138
Morphology branchial cyst
Benign, welll circumscribed 2-5 cm in diameter, with fibrous walls usually lined by stratified squamous or pseudostratified columnar epithelium
Cyst wall contains lymphoid tissue with prominent germinal centers
139
Where is the branchial cyst
Upper lateral aspect of the neck along the sternocleidomastoid muscle
140
Malignancy branchial cyst
Rare...readily excusable
141
Thyroglossal duct cyst
Thyroid analogue begin in the region of the foramen cecum at the base of the tongue
142
How get thyroglossal duct cyst
As thyroid develops it descende to its definitive midline location in the anterior neck
Remnants of this developing tract may persist and produce cysts 1-4 cm in diameter
143
Morphology thyroglossal duct cyst
Lined by stratified squamous epithelium when located near the base of the tongue
Lined by pseudostratified columnar epithelium when located in lower locations
144
Treat thyroglossal duct cyst
Excision
145
Malignancy thyroglossal duct cyst
Rare
146
Paraganglioma (carotid body tumor)
Paraganglia-clusters of neuroendocrine cells associated with the sympathetic and parasympathetic nervous systems
147
Most common location of paraganglioma (carotid tumor)
Adrenal medulla (pheochromocytoma)
70% extra-adrenal paragangliomas occur in the head and neck region
148
Genetics paraganglioma (carotid body tumor)
Loss of function mutations in genes encoding succinate dehydrogenasesubunits or cofactors, proteins, occur frequent in both hereditary and spontaneous paragangliomas
149
Paravertebral paraganglioma
```
Sympathetic connections
Chromatin positive (stsainthat detects catecholamines)
```
150
Aorticopulmonary chain paraganglioma (related to vessels of head and neck)
Carotid bodies (most common, prototype of a parasympathetic paraganglioma)
Aortic bodies
Jugulotympanic ganglia
Ganglion nodosum of the vagus nerve
Clusters located about the oral cavity, nose, nasopharyngeal, larynx and orbit
Parasympathetic connections
Chromaffin-negative bc they infrequently release catecholamines
151
Morphology paraganglioma
Composed of nests (Zellballen) of round to oval chief cells (neuroectodermal derivatives) that are surrounded by delicate vascular septae
Secrete catecholamines
Tumor cells contain abundant clear or granular eosinophilic cytoplasm and uniform round to ovoid sometimes vesicular nuclei
152
Chief cells stain strongly for what
Neuroendocrine markers (chromogranin, synaptophysin, neuron specific enclave, CD56, CD57)
153
Substentacular cells
Supporting network of spindle shaped stroma cells positive for s-100
154
Are paraganglioma common
No
155
When do people get paraganglioma
5-6th decade
156
Are paraganglioma single or multiple
Single
157
Are paraganglioma sporadic
Yup
| But may be familial (AD, MEN2, multiple and sometimes bilateral)
158
Are paraganglioma Benign
Look benign but may metasticize to regional lymph nodes and instant sites
159
Why are 50% of paraganglioma fatal
Infiltrating growth
160
It is almost impossible to predict the clinical course of a carotid body tumor
Incomplete resection -> recurrence
