EXAM 4 Upper Airway Flashcards
Inflammation of the nasal mucosa results in
- Mucosal vasodilation (erythema)
- Mucous membrane edema (coryza)
- Mucous secretion (rhinorrhea)
- Mucosal tissue proliferation (polyps) with chronic inflammation (non-allergic)
Infectious rhinitis (common cold) caused by ______
Infectious rhinitis (common cold) caused by viruses
types of viruses causing infectious rhinitis
Adenoviruses, echoviruses, and rhinoviruses
Infection of _____ _____ cells in nasal mucosa (lose ability to clear mucous) results in _______ (swelling, erythema, increased local production of mucus and clear to purulent exudate)
Infection of ciliated epithelial cells in nasal mucosa (lose ability to clear mucous) results in inflammation (swelling, erythema, increased local production of mucus and clear to purulent exudate)
Initially the nasal mucosa is _____, edematous, and red; the nasal cavities are ______; and the turbinates are _______
Initially the nasal mucosa is thickened, edematous, and red; the nasal cavities are narrowed; and the turbinates are enlarged
enhances the inflammatory reaction and produces mucopurulent exudate, including increased risk for bacterial sinusitis
secondary bacterial infection
caused by hypersensitivity (allergy) to allergens
allergic rhinitis
Allergic rhinitis affects ~__% of the US population (common)
Affects ~20% of the US population (common)
An IgE–mediated immune reaction with early- and late-phase responses (Type I Hypersensitivity)
allergic rhinitis
Allergic rhinitis is characterized by marked mucosal edema (“_____”), redness, and mucus secretion, accompanied by a ______ infiltration in which _______ are prominent
Characterized by marked mucosal edema (“boggy”), redness, and mucus secretion, accompanied by a leukocytic infiltration in which eosinophils are prominent
focal hyperplastic protrusions of the mucosa
nasal polyps
Frequently related to recurrent rhinitis (perennial non-allergic rhinitis, asthma, intolerance of aspirin (acetylsalicylic acid) / NSAIDs, allergic fungal rhinosinusitis, cystic fibrosis, and primary ciliary dyskinesia – NOT IgE mediated allergic)
nasal polyps
Nasal polyps consist of _______ mucosa having a loose ____ with hyperplastic or cystic mucous glands, infiltrated with _____ and ______
Consist of edematous mucosa having a loose stroma with hyperplastic or cystic mucous glands, infiltrated with neutrophils and eosinophils
- May obstruct the airway and impair sinus drainage
- May be large or small
nasal polyps
- Frequently preceded by acute or chronic viral rhinitis
- Characterized by facial pain, nasal mucopurulent exudate
acute bacterial sinusitis
Usually caused by proliferation of oral cavity bacteria in sinuses (often trapped in sinuses by swelling, reducing diameter of sinus ostia)
acute bacterial sinusitis
May develop from acute sinusitis when there is interference with exudate drainage (e.g., polyps)
chronic bacterial sinusitis
Fungal forms may be very severe (consider immunosuppression)
chronic bacterial sinusitis
______ syndrome, caused by defective ____ action, can result in chronic sinusitis (among other problems)
Kartagener syndrome, caused by defective ciliary action, can result in chronic sinusitis (among other problems
inflammation and discomfort of the upper and posterior pharynx
pharyngitis
Frequently occurs with upper respiratory infections:
- Most commonly viral infections (rhinoviruses, echoviruses, adenoviruses, respiratory syncytial viruses, influenza virus)
- Bacterial infections (β-hemolytic streptococci or other pathogens)
pharyngitis
- (β-hemolytic streptococci or other pathogens)
- More likely to present with tonsillar exudates
bacterial pharyngitis
signs of pharyngitis
- Acute inflammatory response results in erythema and slight mucosal edema
- May produce mucopurulent to pseudo-membranous exudates
- Enlargement of the tonsils and cervical chain lymph nodes
enlargement and erythema of the tonsils (exudate may be produced from the tonsillar crypts)
tonsillitis
Risk of developing ______ abscess if you have tonsillitis
Risk of developing peritonsillar abscess if you have tonsillitis
the vocal folds become inflamed (edema, exudate)
laryngitis
- Causes include allergic, viral, bacterial, traumatic, or chemical irritation (stomach acid, smoke)
- Most infections are self-limited
laryngitis
In infancy or childhood, mucosal congestion, exudation, or edema may cause ______ obstruction
In infancy or childhood, mucosal congestion, exudation, or edema may cause laryngeal obstruction
caused by respiratory syncitial virus, Haemophilus influenzae, or β-hemolytic streptococci
Laryngoepiglottitis
inflammatory narrowing of the airway produces inspiratory stridor (parainfluenza virus)
Laryngotracheobronchitis (croup)
develop on the laryngeal folds in response to chemical irritation (e.g., heavy smoking) or chronic strain (e.g., singers nodules)
reactive nodules/polyps
Laryngeal folds covered by ______ epithelium, may become keratotic, ______, or even dysplastic, with a core of edematous ______ tissue
Laryngeal folds covered by squamous epithelium, may become keratotic, hyperplastic, or even dysplastic, with a core of edematous connective tissue
a few millimeters in size, located usually on the true vocal cords
Smooth, rounded, sessile or pedunculated lesions
Singers nodules are _____ lesions and polyps are ______
Singers nodules are bilateral lesions and polyps are unilateral
Usually cause progressive hoarseness
Rarely become cancerous
Reactive nodules/polyps
Laryngeal squamous papillomas are _____ neoplasms
Laryngeal squamous papillomas are benign neoplasms
Usually located on the true vocal cords
Laryngeal squamous papillomas
Laryngeal squamous papillomas: Soft, _____-like growths (usually < 1 cm) which may be caused by ____ (6, 11), other viruses
Laryngeal squamous papillomas: Soft, raspberry-like growths (usually < 1 cm) which may be caused by HPV (6, 11), other viruses
Central fibrovascular cores and covered by an orderly stratified squamous epithelium, may bleed when ulcerated
Laryngeal squamous papillomas
- Usually single, when multiple called papillomatosis, sometimes regress spontaneously
- Rarely become cancerous
Laryngeal squamous papillomas
range from hyperplasia, atypical hyperplasia, dysplasia, carcinoma in situ, to invasive carcinoma
laryngeal neoplasms
About __% of laryngeal cancers are ______ cell carcinomas
About 95% of laryngeal cancers are squamous cell carcinomas
- Usually develops directly on the vocal cords, but it may arise above or below
- Carcinoma of the larynx manifests itself clinically by persistent hoarseness
SCC
Larynx neoplasia: Risk factors include cigarette smoking and alcohol consumption, Caucasian and African ancestry, HPV infection
SCC
SCC larynx: At presentation, about __% are confined to the larynx
SCC larynx: At presentation, about 60% are confined to the larynx
