Final Patho, Upper Resp

Question 1

Epistaxis, what are the arteries that supply the nose? Venous supply?

Answer 1

1. arterial supply to the nasal cavity - extensive anastomoses create Kiesselbach’s plexus (Little’s Area) in the medial wall of Septum. 90% of nose bleeds occur here
2. Internal carotid artery
   
   1. posterior and anterior ethmoid branch of the ophthalamic artery
3. External Carotid artery
   
   1. Sphenopalatine - “artery of epistaxis” - terminal branch of the maxillary artery via pterygopalatine fossa then sphenopalatine foramen.
   2. greater palatine - branch of maxillary a via pterygopalatine fossa through palatine canal and greater palatine foramen
   3. superior labial and facial a
   4. anterior ethmoidal a
4. Venous supply
   
   1. emissary veins are routes of infection intracranially.

Question 2

What is the difference between anterior and posterior bleeds? Which is harder to stop?

Answer 2

1. anterior bleeds: maxillary artery and branches. Sphenopalatine artery is the artery of epistaxis, kiesselbach’s plexus
2. posterior bleeds: From woodruff’s plexus, a venous plexus in the posterior portion of the inferior meatus. Much harder to stop.

Question 3

What is choanal (funnel) atresia

Answer 3

• Newborns are obigate nose breathers, meaning they prefer to breath through their nose.
• The septum between the nasal cavity and pharynx occurs, this is the most common congenital anomaly of the upper airway
• Often seen with other congenital anomalies
• Unilateral or bilateral
  
  • bony 90%, membranous 10%
  • Found in newborns, turn cyanotic during breast feeding. Pink up when crying.

Question 4

Why do nasal polyps occur?

Answer 4

• Non neoplastic swelling of nasal tissue secondayr to chronic inflammation
• Allergic polyps are most common.
  
  • nasal smears show numerous eosinophils
• associated with cystic fibrosis

Question 5

What is Obstructive sleep apnea? what causes it?

Answer 5

1. excessive snoring with intervals of breath cessation. Daytime somnolence
2. causes
   
   1. obesity is most common cause, pharyngeal muscles collapse due to weight of neck tissue
   2. upper pharyngeal airway collapse secondary to reduced pharyngeal airway dilator muscle activity.
   3. tonsillar hypertrophy
   4. nasal septal deviation
   5. hypothyroidism
   6. acromegaly
3. Airway obstruction causes CO2 retention and respiratory acidosis, leading to hypoxemia (decreased PaO2)
   
   1. get cycles of hypoxia/hypercapnia, sympathetic activation, and sleep fragmentation
4. This can cause smooth muscle cells in pulmonary vessels to constrict with resultant pulmonary htn followed by right ventricular hypertrophy
5. Secondary polycythemia secondary to hypoxemic stimulus of erthropoietin release

Question 6

How do you diagnose OSA? How do you treat it?

Answer 6

1. diagnose: nocturnal polysomnogrpahy
2. treatment -
   
   1. nasal continuous positive airway pressure (CPAP)
   2. surgical correction if necessary
   3. weight loss

Question 7

What is sinusitis? Most common? Causes? Pathogens?

Answer 7

1. In adults, most common is maxillary sinuses
2. in children, ethmoid sinuses
3. Causes
   
   1. URIs
   2. deviated nasal septum
   3. allergic rhinitis, barotrauma, smoking
4. Pathogens
   
   1. rhinovirus most common cause
   2. bacteria - strep pneumo (MC), H influenza, M catarrhalis
   3. staphylococcus in nosocomial infections
   4. systemic fungi in diabetics
5. Main cause of sinusitis is obstruction of the draining pathways of the sinuses
   
   1. clearing obstuction is done in surgery
6. drainage occurs in osteomeatal unit
   
   1. composed of frontal recess, middle turbinate, anterior ethmoid sinus, ethmoid bullae, uncinate process, maxillary infundibulum, hiatus semilunaris
   2. blockage of OM unit prevents mucociliary clearence, leading ot stagnation of clearence of mucus and acute and chronic sinusitis

Question 8

What is nasopharngeal carcinoma?

Answer 8

1. Although rare, most common malignant tumor of nasopharynx
2. Males mc, very common in east asia and africa (esp in children)
3. Pathogenesis: Causal relationship with EBV, and HPV 16
4. Squamos cell carcinoma, nonkeratinizinzg SC, or undifferentiated
5. metases to cervical nodes is common
   
   1. tx: radiation
   2. 60% survival

Question 9

laryngeal carcinoma

Answer 9

1. cancer of larynx,
2. caused
   
   1. by cigarettes, MCC
   2. alcohol
   3. squamous papilllomas and papillomatosis
      
      1. HPV types 6 and 11
3. persistant hoarseness often asscoaited with cervical lymphadenopathy
4. Tx: surgery and radiation