Gomez - Intro to Resp Path/Rad

Question 1

What other name is nasal mucosa called by?

Answer 1

Schneiderian mucosa

Question 2

What does nasal histology look like?

Answer 2

Pseudostratified ciliated columnar epithelium with submucosal glands

Question 3

What are the nasal vestibules lined by?

Answer 3

Nonkeratinized squamous epithelium

Question 4

What causes acute infectious rhinitis?

Answer 4

Rhinoviruses are most common

many others can also cause it

Question 5

Describe the disease process of acute rhinitis

Answer 5

Run nose (rhinorrhea)

Transmission by contact

Can cause other conditions like pharyngitis, sinusitis, tonsillitis, otitis media

Self-limiting

Question 6

Describe allergic rhinitis

Answer 6

Type I hypersensitivity (IgE mediated)

Pt presents with runny nose and congestion

Associated with seasonal allergies

Tx: antihistamine

Question 7

Describe the pathway of Type I hypersensitivity rxns

Answer 7

Allergen stims T_H2 response and IgE production

IgE binds to Fc receptors on mast cells

Subsequent exposures to same allergen activate mast cells to degranulate, releasing histamine and other inflammatory mediators

Question 8

What is chronic rhinitis?

Answer 8

Caused by many different factors

Defined as persistence of cardinal sx for >1month

Sx: sneezing, rhinorrhea, congestion, postnasal drip

Appears to follow acute rhinitis

Question 9

Describe nasal polyps

Answer 9

Inflammatory polyp

often results from recurrent attacks of rhinitis

suggestive of allergies but most pts are not atopic

May cause obstruction

Question 10

What is the important anatomical relationship of all sinuses?

Answer 10

All communicate in some way with nasal cavity

Question 11

What are the three types of sinusitis?

Answer 11

Acute (w/ empyema)

Subacute

Chronic

Only differentiating factor is time

Question 12

What is a mucocele of the sinus?

Answer 12

Mucus accumulation that obstructs sinus

No bacterial involvement

Question 13

What are some serious complications of sinusitis?

Answer 13

Orbital cellulitis

Osteomyelitis

Cranial vault extension

Septic thrombophlebitis of dural venous sinus

Question 14

Describe acute (infectious) sinusitis

Answer 14

Can be viral or bacterial in nature

Anything that causes common cold or ear infections can cause this

Question 15

What is the ASA triad?

Answer 15

Chronic rhinosinustis

Nasal polyps

Severe bronchial asthma

Induced by taking aspirin

Can lead to chronic sinusitis

Question 16

What is immotile cilia syndrome?

Answer 16

During development, if cilia aren’t motile, can result in defective migration of cells to wrong side of body and may cause situs inversus in 50% with this abnormality

Question 17

What is Kartagener syndrome?

Answer 17

Defective ciliary action and situs inversus

Question 18

What is the most common bacterial cause of sinusitis?

Answer 18

Staph aureus

Question 19

What is a mycetoma?

Answer 19

Ball of fungus resulting in fungal sinusitis

Destructive lesion

Question 20

What is a complication of invasive fungal sinusitis?

Answer 20

Major destruction of surrounding tissues

Question 21

Discuss cocaine’s effect on upper airways

Answer 21

Cocaine is a potent vasoconstrictor, and can cause tissue destruction from ischemia

Question 22

What are two significant causes of infectious necrotizing lesions of upper airways?

Answer 22

Rhinocerebral mucormycosis

Hansen disease/lepromatous leprosy

Question 23

What is a major malignancy causing necrotizing lesions of the upper airway?

Answer 23

Extranodal NK/T cell lymphoma

Often localize to the midline

can be quite lethal

Question 24

Discuss rhinocerebral mucormycosis

Answer 24

Caused by sarophytic mold fungi

More prevalent in diabetics or immunocompromised individuals

Produce irregular-shaped hyphae w/ few to no septa

Very aggressive

Question 25

Where do a lot of lung cancers occur? What sequelae are important to recognize because of this?

Answer 25

Around the hilum Important because these cancers can invade esophagus, trachea, and aorta

Question 26

What structures are present in the trachea/bronchus?

Answer 26

Ciliated epithelium Goblet cells Seromucus glands Cartilage Histologically, differentiate trachea and bronchus based on size

Question 27

What structures are present in the bronchiolus?

Answer 27

Smooth muscle cells Clara cells Capillaries Basal membrane Surfactant No cartilage

Question 28

What structures are present in the alveoli?

Answer 28

Type I pneumocyte Type II pneumocyte Alveolar septum

Question 29

What is a major difference between Type I and Type II pneumocytes?

Answer 29

Type I are terminally differentiated Type II will regenerate if there is alveolar injury

Question 30

What are pores of Kohn?

Answer 30

Gaps in between alveoli Serve to equalize pressure between adjacent alveoli

Question 31

What is atelectasis?

Answer 31

Collapse of alveoli

Question 32

What is resorption of lung tissue?

Answer 32

Obstruction of an area leads to no air getting in, but air is diffusing into tissues, leading to collapse of that area Mediastinum will shift towards side of resorption Other lung will have compensatory hyperinflation

Question 33

What is compression of lung tissue?

Answer 33

External pressure on lung (incl. elevation of diaphragm) Mediastinal shifting away from affected lung

Question 34

What is contraction of lung tissue?

Answer 34

Secondary to fibrosis of lung or pleura Does not allow lung to expand properly Irreversible

Question 35

All atelectasis increases the risk for what?

Answer 35

Infection

Question 36

What are the two main types of pulmonary edema?

Answer 36

Hemodynamic Microvascular

Question 37

Describe hemodynamic pulmonary edema

Answer 37

Most common form Increased hydrostatic pressure from L heart failure Presence of "heart failure" cells If chronic, can lead to alveolar fibrosis (appearance of brown induration of lung)

Question 38

Describe microvascular injury resulting in pulmonary edema

Answer 38

Caused by increased permeability resulting from infection, toxic injury, etc. If diffuse, can lead to ARDS

Question 39

What are the criteria for acute lung injury?

Answer 39

Acute onset of dyspnea Hypoxemia Bilateral infiltrates Absence of primary L-sided heart failure

Question 40

Describe ARDS (aka diffuse alveolar damage)

Answer 40

Occurs in pts w/ severe disease Diffuse damage to alveolar capillary walls, leading to neutrophil migration Vascular injury and secondary loss of surfactant

Question 41

What are the main causes of ARDS?

Answer 41

Diffuse pulmonary infection (PNA, viral, etc) Gastric aspiration Mechanical trauma, incl. head inj.

Question 42

Describe Acute Interstitial Pneumonia

Answer 42

aka Hamman-Rich Syndrome Sx similar to ARDS No real causative disorder Acute respiratory failure following illness Pts get progressively worse High mortality rate