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RESP II Exam 1 > ENT > Flashcards

ENT Flashcards

1
Q

Major functions of upper airway structures

A 
Allow air to and from lungs
Heat and humidify air
Remove particles
Immune surveillance
Smell
Speech
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2
Q

Schneiderian mucosa

A

Mucosa lining nasal cavity and rhinonasal sinuses

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3
Q

Three types of epithelial cells

A

Ciliated pseudostratified columnar cells
Goblet cells that produce mucin
Basal cells that replenish layers

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4
Q

Characteristics of lamina propria

A

Lots of vasculature

Subepithelial seromucous glands

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5
Q

Coryza

A

Common cold

Profuse catarrhal discharge

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6
Q

Rhinorrhea

A

Runny nose

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7
Q

Transmission of acute rhinitis

A

Direct contact:
Infected skin or environmental surface
Aerosolization

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8
Q

Acute rhinitis can induce and produce

A

Pharyngitis
Sinusitis
Otitis media

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9
Q

Acute Rhinitis

A

Self limited disease
Can include conjunctivitis
Not effected by treatment

Runny nose, HA, fever, anorexia, tired, muscle aches

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10
Q

Causes of acute rhinitis

A

40% rhinoviruses (picornaviruses, ss-RNA, **genus-enterovirus)

Adenoviruses
Echoviruses
Coronaviruses 
Parainfluenza
Respiratory syncytial (RSV)
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11
Q

Allergic rhinitis

A 
Hay fever
Children, young adults, 30-40s (continues throughout life)
Watery rhinorrhea (with sneezing, itching, congestion)
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12
Q

Seasonal rhinitis

A

Occurs a particular time of year

Tree, grass, weed pollen

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13
Q

Perennial rhinitis

A

Occurs year round
Fungi, household items
Occupational

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14
Q

Episodic rhinitis

A

Symptoms occur at irregular intervals

Could be anything

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15
Q

Allergic rhinitis pathophysiology

A

Type I hypersensitivity
Allergen stimulate Th2 -> IgE
IgE binds Fc on mast cells
Subsequent exposure activates mast cells

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16
Q

Immediate phase of hypersensitivity reaction

A

Vasodilation, congestion, edema

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17
Q

Late phase of hypersensitivity reaction

A

Eosinophils, neutrophils, and T cells infiltrate

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18
Q

Chronic rhinitis

A

**More than 1 month: sneezing, rhinorrhea, nasal congestion, and postnasal drainage

Follows acute rhinitis
May be due to altered anatomy (polyps, septum)
May have superimposed bacterial infection

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19
Q

Chronic rhinitis vs recurrent allergic rhinitis

A

Onset after age 20

Aeroallergen cannot be identified

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20
Q

Nasal polyps

A

Seen with recurrent rhinitis but patients **not atopic
Multiple, 3-4 cm
May cause obstruction or get infected

Edematous loose stroma with mixed inflammatory infiltrate
Lots of eosinophils

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21
Q

Mucocele of sinus

A

Accumulation of mucus but no bacterial involvement

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22
Q

Sinusitis can rarely occur from

A

Oral lesions: periapical infection, periodontal disease, or perforation of the antral floor and antral mucosa at the time of dental extraction

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23
Q

Major findings of sinusitis

A 
Facial pain and pressure
Nasal obstruction
Nasal discharge
Reduced ability to smell
Congestion
Purulence in nasal cavity
Fever (acute only)
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24
Q

Minor factors

A 
HA
Halitosis
Fatigue
Dental pain
Cough
Ear symptoms
Fever (non acute)
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25
Q

Serious complications of sinusitis

A

Spread to orbit -> orbital cellulitis
Osteomyelitis
Cranial vault extension
Septic thrombophlebitis of dural venous sinus

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26
Q

Acute sinusitis

A

Empyema of sinus
Less than 4 weeks
Purulent rhinorrhea, nasal congestion, facial pain
Can be viral or bacterial

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27
Q

Acute viral sinusitis

A

AVRS
Associated with common cold, clears in 7 days
Rhinoviruses, influenzavirus, parainfluenzavirus

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28
Q

Acute bacterial sinusitis

A

ABRS
Can be complication of AVRS
Streptococcus pneumoniae, haemophilus influenzae, moraxella catarrhalis (mainly children)

Presence of symptoms for seven or more days
Symptoms initially improve and then worsen
Sinusitis associated with dental disease

**Can’t differentiate from viral initially

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29
Q

Chronic bacterial sinusitis

A

More than 12 weeks
Recurrent acute attacks
Fungal sinus disorders
**Obstructive

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30
Q

Anatomic predisposing factors for chronic sinusitis

A

Deviated septum, trauma, foreign body, mass/neoplasm, previous surgery

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31
Q

Genetic/medical predisposing factors for chronic sinusitis

A

ASA triad, immunodeficiency, immotile cilia syndrome, cystic fibrosis, DM, ICU

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32
Q

Environmental/allergic predisposing factors for chronic sinusitis

A

Allergic and nonallergic rhinitis, microorganisms, sick building syndrome, smoking/pollution, dry indoor heating

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33
Q

ASA triad

A

Aspirin induced chronic rhinosinusitis, nasal polyps, and severe bronchial asthma

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34
Q

Immotile cilia syndrome

A

Kartagener syndrome

Cilia don’t work and patient has situs inversus

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35
Q

Sick building syndrome

A

No specific illness or cause can be identified

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36
Q

Ostiomeatal complex

A

Needs to be patent for normal ventilation and drainage

Sphenoethmoid recess and nasolacrimal duct most important

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37
Q

Chronic obstructive sinusitis

A

Facial pain, pressure, fullness
Nasal obstruction/congestion
Nasal drainage/postnasal drip
Decreased sense of smell

Opacity can be seen on CT

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38
Q

Non-infected obstructive sinusitis

A

Mucocele

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39
Q

Infected obstructive sinusitis

A

Empyema

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40
Q

Obstructive sinusitis bacteriology

A

**Staph aureus
Gram negative rods
H. flu, Group A strep, strep p, diptheriae

**Increasing mixed infections with anaerobes

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41
Q

Allergic mucus

A

Eosinophilic mucus with Charcot-Leyden crystals but no fungi
Recurrent symptoms, polyps
May need debridement or steroids

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42
Q

Allergic fungal sinusitis

A

Eosinophilic mucus with Charcot-Leyden crystals WITH fungi
Recurrent symptoms, polyps
May need debridement or steroids

43
Q

Fungus ball

A

Myecytoma
Can see mass lesion on xray
Fungal organisms with little mucus or inflammation
Surgical debridement

44
Q

Invasive fungal sinusitis

A

Severe sinusitis with possible neuro deficit
Fungal organisms invade tissue and vessels
Aggressive surgical debridement and anti-fungal drugs

45
Q

Vascular necrotizing lesions of upper airways

A

Granulomatosis with polyangitis
Cocaine
Vasospasm

46
Q

Infectious necrotizing lesions of upper airways

A

**Rhinocerebral mucormycosis/Rhinocerebral zygomycosis
**Hansen disease/lepromatous leprosy
Several fungi
Syphilis

47
Q

Malignant necrotizing lesions of upper airways

A

**Extranodal NK/T cell lymphoma - lethal midline granuloma
Blocks blood flow -> ischemia
Squamous cell
Adenocarcinoma

48
Q

Rhinocerebral Mucormycosis

A

Saprophytic mold fungi (Mucoromycotina)
Irregular hyphae with no septa
**Usually in uncontrolled DM ketoacidosis - mucor loves iron

Can invade oral, brain, and eye areas

49
Q

Nasopharyngeal angiofibroma

A

RARE
Almost all young males age 10-20
**Epistaxis, unilateral blockage, swelling

Posterolateral wall origin, usually benign but can be aggressive
Have androgen receptors, very vascular

Surgically remove - prognosis depends on resectability

50
Q

Schneiderian benign neoplasms

A

Derived from epithelium of embryonic membrane, benign
Epistaxis, nasal obstruction, asymptomatic mass
3 types:
Exophytic
Inverted
Oncocytic

51
Q

Squamous papilloma

A

Verruca vulgaris or wart
More common than schneiderian benign neoplasms
Squamous mucosa - towards nares

52
Q

Exophytic sinonasal papilloma

A 
**Septal, squamous, fungiform
Often HPV
Rarely becomes carcinoma
Looks like little fingers
More men than women
53
Q

Inverted sinonasal papilloma

A

Lateral wall
Associated with HPV
5-10% develop invasive carcinoma within 5 years
Cells grow downward and inward -> inverted
Looks much more rounded
More difficult to get rid of
More men than women

54
Q

Oncocytic sinonasal papilloma

A

Cylindrical, columnar
Later wall
NO association with HPV
**Bright pink cytoplasm

55
Q

Olfactory neuroblastoma

A 
Neuroendocrine cells
Neurosecretory granules
\+ IHC markers
Extensive polypoid mass, obstruction, epistaxis, anosmia, visual disturbance
Looks like blue cell tumor
5-year Survival 40-90%
56
Q

Nasopharynx mucosa

A

60% NK squamous

40% Respiratory epithelium

57
Q

Oropharynx and Laryngopharynx mucosa

A

100% NK squamous

58
Q

Upper airway lymphoid structures

A

Diffuse submucosal aggregates
Tonsils: palatine, lingual, adenoids, tubal

Lymphocytes in the lamina propria -> follicle

59
Q

Disorders secondary to lymphoid hyperplasia

A

Obstruction: sleep apnea and recurrent otitis media

Difficult to arouse 
Daytime sleepiness 
Poor attention span
Poor school performance        
Snoring	            
Observed episodes of sleep apnea
60
Q

Infectious and inflammatory conditions of nasopharynx

A

Same as nasal mucosa

61
Q

Pertussis (Whooping cough)

A 
Bordetella pertussis 
Gram neg coccobacilli
Spread via droplets
DTaP and Tdap vaccine
Attaches to pharygneal and tracheal surfaces
Diagnose with swab and PCR
62
Q

Catarrhal phase of pertussis

A

Most infectious this stage

Looks like any other URI

63
Q

Paroxysmal phase of pertussis

A

Bouts of intense coughing
Post cough vomiting and turning red is common
Coughing has characteristic whoop sound (not seen in under 6 mo old)

64
Q

Convalescent phase of pertussis

A

Chronic cough lasting for weeks

65
Q

Nasopharyngeal carcinoma

A 
Three types: K and NK SqCC, undifferentiated with lymphoid component
**EBV-related
Africa - common in children
Asia - common in adults
USA - rare
Often metastases
Associated with smoking and diet
Undifferentiated is most aggressive but has best prognosis
66
Q

NUT Midline Carcinoma

A

Mostly mediastinum
Highly aggressive (median survival 7 mo.)
Appearance similar to nasopharyngeal and squamous cell carcinoma
BRD4/BRD3-NUT fusion gene

67
Q

Acute pharyngitis

A 
"Beefy red"
**Adenovirus (ds-DNA)
HSV, EBV and CMV
Some bacterial (strep)
Same things that cause tonsilitis
68
Q

Group A Strep

A

Age 5-15
Winter and spring
Sore throat and fever
Absence of cough, coryza, hoarseness, conjunctivitis
Tender anterior cervical lymph nodes
Tonsils are enlarged, erythematous and have patchy exudate

69
Q

Symptoms suggestive of viral not bacterial sore throat

A

Cough, coryza, hoarseness, conjunctivitis

70
Q

Fusobacterium necrophorum

A

Common cause of bacterial pharyngitis
Part of normal flora
10% acute pharyngitis cases
>20% in recurring cases and in peritonsillar abscesses

Jugular vein with thrombophlebitis (Lemierre syndrome)
Thrombi break off and seed to different sites

71
Q

Diptheria

A

Corynebacterium diphtheriae
Strains carrying tox gene -> gene encoded within a lysogenic bacteriophage
Sudden pharyngitis that worsens over a few days
**Pseudomembrane
Vaccine

72
Q

Rhinovirus pharyngitis

A

Indirect infection -> grow in nasal mucosa

73
Q

Adenovirus pharyngitis

A

Pharyngoconjunctival fever (fever, sore throat, conjunctivitis)

74
Q

EBV pharyngitis

A

Infectious mononucleosis - can be chronically tired
Can develop lymphadenitis and hepatosplenomegaly
Monospot test

75
Q

HSV type 1 and 2 pharyngitis

A

Gingivitis, stomatitis and pharyngitis

Painful vesicles

76
Q

Pharyngitis common part of

A

Flu and common cold

77
Q

Enterovirus pharyngitis

A

Secondary to upper GI infection and then dissemination

78
Q

CMV and HIV pharyngitis

A

Mononucleosis-type illness with acute infection

HIV>CMV

79
Q

Reinke’s space

A

Space between vocal ligament and overlying mucosa

80
Q

Epiglottitis

A

Swelling of epiglottis secondary to **infections, chemical, and traumatic agents -> may lead to suffocation

H. flu used to be most common now group B strep
Now more common in adults
More of a problem in children

81
Q

Acute laryngitis

A

Hoarseness, decreased speech volume, painful speech

Infections, overuse, trauma, smoking

Allergic rxns and GERD are rare

82
Q

Infectious laryngitis

A

Abrupt and self-limited and 3-5 years of age
Progressive hoarseness with URI

Viruses > 90% cases: Rhinoviruses, Parainfluenza, RSV, Adenoviruses
Bacteria causes: H. influenzae, S. pneumonia

Viral better than bacterial

83
Q

Infectious laryngitis in children may lead to

A

life-threatening laryngoepiglottitis

84
Q

Croup/Laryngotracheitis/Laryngotracheobronchitis

A 
Inspiratory stridor
Seal-like barking
Mainly caused by parainfluenza
Treat with steroids
May see Steeple sign - subglottic narrowing
85
Q

Reinke edema

A

Polypod corditis

Usually occurs in middle-aged females who are heavy smokers
Can also occur with heavy, recurrent voice strain
Develop husky low-pitched weak voices
Can be reversed

86
Q

Vocal Cord Nodules and Polyps

A 
Reaction to injury of vocal cord
Usually at junction anterior and middle third of cord
Nodules - small and bilateral
Polyps - large and unilateral
Sustained injury: singing, smoking
Almost never give rise to cancer
87
Q

Vocal Cord Papilloma and Papillomatosis

A 
Benign neoplasms
Looks like a raspberry
Single in adults but can be recurrent
Multiple in children
HPV
88
Q

SqCC of larynx

A

**Prolonged hoarseness
Dysphagia, SOB, other evidence of obstruction
Enlarged cervical lymph nodes
90% have history of smoking and alcohol abuse

89
Q

SqCC progression

A

Hyperplasia -> hyperkeratosis -> dysplasia -> carcinoma in situ -> cancer

90
Q

Location of laryngeal carcinomas

A

Glottic, involving vocal cords - 50%
Supraglottic, higher stage at diagnosis - 30%
Subglottic - 5%
Transglottic

Glottic has better survival
Most are squamous

91
Q

Otitis Externa

A

Marked tenderness after gentle traction of pinna
Peak age between 7-12
Physical Findings: erythema, swelling, moist debris, pus

92
Q

Causes of otitis externa

A 
Trauma, contaminated water
90% bacterial: 
**pseudomonas
Staph
Gram - rods
10% fungal
93
Q

Neoplasms of external ear

A

Simple skin tumors:

Squamous and basil cell

94
Q

Cholesteatoma

A

Squamous epithelium trapped within the temporal bone
Usually secondary to injury
Can erode tissue in middle ear
Hearing loss, facial nerve paralysis, labrynthitis, meningitis, epidural or brain abscess
Requires surgery

95
Q

Acute otitis media

A

Eustachian tube blocked
Otalgia, fever, otorrhea, irritability, vomiting, diarrhea
Tympanic membrane opacity, bulging, erythema, effusion and decreased motility
Associated with bacterial conjunctivitis and concurrent URI

96
Q

Bacteria causing acute otitis media

A

S. pneumoniae, H. influenzae, and Moraxella catarrhalis

97
Q

Chronic otitis media

A

Recurrent otitis media with adenoid hypertrophy
**Conductive hearing loss
Perforation tympanic membrane, scarring, mastoiditis and bone erosion, cysts

98
Q

Bacteria causing chronic otitis media

A

Pseudomonas aeruginosa, S. aureus

99
Q

Middle ear cysts

A

Squamous epithelium: large amounts keratin produced

Metaplastic columnar epithelium: mucin-secreting

100
Q

Otosclerosis

A

Autosomal dominant
Begin unilateral, most become bilateral
Hearing loss begins late adolescence/young adults
Progressive ankylosis/immobilization over decades -> severe conductive hearing loss

Bone callus builds up on stapes

101
Q

Branchial cleft defects

A

Sinus tracts
Fistulas
Lymphoepithelial cyst: lateral neck, usually unilateral

Most arise from 2nd branchial cleft

102
Q

Thyroglossal duct cysts

A

Cyst in midline

Portion of hyoid bone is removed along with cyst and tract

103
Q

Carotid body tumor

A

Parasympathetic tumor
Bruit on auscultation
Neuroendocrine cells

Genetic factor if multiple or bilateral

RESP II Exam 1 (2 decks)

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