Head & Neck - Nasal Cavity & Ears

Question 1

infectious rhinitis

• effects what part of the respiratory tract
• is caused by what agents?
• can turn into what?

Answer 1

• the nasal cavity
• viruses: common cold agents -> adeno, echo, rhino
• can become:
• pharyngotonsillitis (by extension)
• secondary bacterial infection
• nasal polyps

Question 2

allergic rhinitis

• effects what part of the respiratory tract?
• is cause by what agents?
• can become what?

Answer 2

• nasal cavity
• allergens - plan pollens, fungi, dust mites:
• –> IgE mediated reaction

- can cause nasal polyps

Question 3

what is the diagnostic difference between infectious and allergic rhinitis?

Answer 3

in a nasal smear of allergic rhinitis, you would see eiosinophils (vs infectious, where you’d see more lmphocytes )

Question 4

how long does infectious rhinitis last if treated?

Answer 4

1 week

Question 5

nasal polyps

• have what cause/pathogenesis?
• have what gross/microscopic appearance?
• are particularly common in what population?

Answer 5

• typically follow recurrent attacks of rhinitis (infectious or allergic), after which buildup of inflammation/inflammatory cells make –> focal protrusions of mucosa (3-4 cm)
• gross:
• shimmering, shining bump
• microscopic:
• respiratory (ciliated pseudostratified columnar) epithelial lining
• edematous, loose stroma (white color)
  
  • contain inflammatory cells
  • +/- hyperplastic/cystic mucous glands
• common in in children with cystic fibrosis*

Question 6

chronic rhinitis

• has what cause/pathogenesis?
• is exacerbated by what other issues?

Answer 6

• seqel to repeated acute rhinitis (allergic or infectious) attacks
• with eventual development of sumperimposed bacterial infection. inflammation creates “petri dish” for bacteria to fester
  • a deviated septum or nasal polyp increase the likelihood of said infection

Question 7

acute sinsusitis

• what is it?
• what is it cause/pathogenesis?
• what can it lead to?

Answer 7

• infection of the sinuses
• causes:
  
  • most often, due to rhinitis (either chronic or acute)
  • less often, arises by extension of a periapical (dental) infection thru the bony floor of sinus - i.e., maxillary sinusitis
• repeated bouts –> chronic sinusitis

Question 8

chronic sinusitis

• cause/pathogenesis
• subtypes of chronic sinusitis?
• complications

Answer 8

• cause: repeated bouts of acute sinusitis that are
  
  • typically due to inhabitants of the oral cavity - develops into –> chronic
    
    • typically involves some kind of outflow obstruction (mucosal inflammation, polyps) that inhibits purging of infection
• subtypes:
  
  • allergic fungal sinusitis (asperilligus)
  • severe chronic sinusitis (invasive fungi)
• complications:
  
  • empyma (mucocele)
  • osteomyelitis
  • septic thromophlebitis or dural venous sinus

Question 9

what are the complications of chronic sinusitis?

Answer 9

• empyma (mucocele) - suppurative exudate formed mostly by blockage of the frontal (or sometimes ant. ethmoid) sinuses
• osteomyelitis - of surrouding bone
• septic thromophlebitis of the dural venous sinus

Question 10

allergic fungal sinusitis

• acute/chronic?
• due to what fungal agent?
• has what microscopic presentation?
• is prevalent in what populations?

Answer 10

• type of chronic sinusitis
• agent: asperilligus
• histology: “allergic mucin”
• sloughed epithelial cells
• charot-layden crystals
• eisonophils
• funal hyphae
• seen in immunocompetent (healthy) populations

Question 11

severe chronic sinusitis

• chronic/acute?
• caused by what etiological agents?
• is seen in what populations?

Answer 11

• chronic sinutiis
• due to invasive fungi - ex: mucormyocosis

- seen mostly in diabetes patients

Question 12

what is Kartagener synrome?

• etiology?
• inheritence pattern?
• complications?

Answer 12

• a rare cause of chronic sinusitis
• primary ciliary dyskinesa - causes dynein arm absence/anormalities
• autosomal recessive
• can lead to:
  
  • situs inversus
  • bronchiectasis
  • infertility

Question 13

what is shown in this picture?

what cause it?

Answer 13

• a mucocelce (empyema)
  
  • a complication of severe chronic sinusitis (mucormycosis)
  • due to an accumulation of suppurative exudative likely from blockage of the frontal/ant. ethnmoid sinuses

Question 14

what three diseases are the major causes of necrotizing lesions of the nose/upperairways?

Answer 14

mucormycosis

graunlomatosus with polyangitis

extranodal NK/T-cell lymphoma

Question 15

mucormycosis

• can cause what disease(s)?
• is most likely to effect what populations?
• has what presentation?

Answer 15

• can cause
  
  • severe fungal chronic sinusitis
  • necrotizing lesions (in nose/upper airway)
• mostly effects diabetic & immunocompromised patients

Question 16

granulomatosis with polyangitis (Wegner’s)

• has what cause/pathognesis?
• can lead to what disease(s)?
• is diagnosed how?

Answer 16

• cause: autoimmune - inhaled antigens induce a T-cell mediated reaction
• can lead to:
• necrotizing granulomas (in nose / palate / pharnyx)
• necrotizing vasculitis of small/medium vessels –> alveolar hemorphage
• glomerulonephritis
• dx: c-ANCA against PR3 or MPO

Question 17

extranodal NK/T-cell lymphoma

• has what cause/pathogenesis?
• causes what disease(s)?
• effects what demographic

Answer 17

• caused by lymphoma tumor cells that harbor EBV
• leads to nasal type necrotizing lesions (nose/upper airways)
• demographics:
• men in 5th/6th decade
• asian/latin american descent

Question 18

pharyngitis & tonsillitis

• have what cause/etiology?
• present with what defining symptom?
• can lead to..?

Answer 18

• causes:
  
  • 1st: common cold viruses - adeno, echo, rhino
  • 2nd: bacterial - B-hemolytic strep (strep. pyo) > s. aurues
    
    • either superimposed or primary invader
• symptom:
  
  • sore throat
    
    • key sequela to be worried with this “sore throat” are
      
      • RHEUMATIC FEVER
      • GLOMERULONEPHRIIS

Question 19

nasopharyngeal angiofibroma

• benign/malignant?
• arises from what tissue?
• has what associations/characteristics?
• has what sequelae?
• seen predominantly in what population?
• is treated how?

Answer 19

• benign
• arises from fibrovascular stroma
• characteristics:
• highly vascular
• highly aggressive

- demographics: fair skinned, red headed adolescent males

- associations:

• associated w/ familial adenomatous polyps
• 75% express androgen receptors*
• sequelae: due to vascular/aggressive nature, these tumors can cause:
• SEVERE NOSE BLEEDS (EPITAXIS)
• INTRACRANIAL EXTENSION

-tx: surgical exicison (high recurrence rates)

Question 20

discuss the microsophic characteristics of nasopharyngeal angiofibroma

Answer 20

• presence of “ staghorn antlers“
• microscopically resembles erectile tissue

Question 21

sinonasal papillomas

• benign/malignant?
• arise from what tissue?
• has what characteristics/associations?
• is seen in what demograhics?

Answer 21

• benign
• arises from respiratory mucosa
• HPV DNA (types 6 and 11) are often isolated from the papillomas, especially exo and endophytic forms
• exophytic (most common)
• endophytic - can become malignant
• demographic: males 30-60

Question 22

olfactory neuroblastomas

• benign/malignant
• arises from what tissue?
• has what associations/characteristics?
• has what sequelae?
• effects what demographics?

Answer 22

• benign
• from neuroectodermal olfactory cells (esp superior aspect of nasal cavity mucosa)
• associations: express neuroendocrine markers (ex: chromagramin)
• sequelae:
• NOSE BLEEDS (EPISTAXIS)
• NASAL OBSTRUCTION
• demographic: bimodal peak at 15 & 50 yrs

Question 23

sinonasal undifferientiated carinoma

• benign/malignant?
• characteristics?
• sequelae?

Answer 23

• malignant:
• characteristics:
• found at base of skull
• stains + for CK

- sequelae: aggressive, 2 yr survival

Question 24

NUT midline carcinoma

• benign/malignant?
• characteritics?
• sequelae?

Answer 24

• malignant
• characteristic: occurs in the “midline” of the nasopharynx, salivary gland, thorax/abdomen
• sequelae: extremely agressive, < 1 yr prognosis
• may be treated by BRD4-NUT in the future

Question 25

nasopharyngeal carcinoma

• causes/pathognesis?
• sequelae
• microscopic presentation

Answer 25

• pathogenesis
  
  • causes
    
    • EBV
    • diets high in nitrosamines (fermented foods)
  • is clinically occult for long periods
• presentation:
  
  • EPISTAXIS
  • METASTASIS TO CERVICAL LYMPH NODES
• microscopic presentations (3):
  
  • squamous cell carcinoma -
    
    • keratinizing vs nonkeratinizing
  • undifferentiode basal cell carincoma

Question 26

what findings - independent of histology - is absoutely diagnostic for nasopharyngeal carcinoma

Answer 26

• is an epithelial malignancy
  
  • ​stains w/ cytokeratin stain
• is in the nasopharynx
• is + for EBV

Question 27

otiitis media

• most common demographic
• etiological agents
• sequelae

Answer 27

• most common demographic: infants and children
• etiological agents
  
  • usually viral
  • if bacterial: s. pneumonia, h. influenza, m. catarrhalis
  • in diabetic patients: psuedomonas can be highly aggresive – necrotizing
• sequelae:
  
  • cholesteatomas

Question 28

which variation of nasopharyngeal carcinoma is the most malignant?

Answer 28

keratinized squamous cell (vs NKSS & undifferentiated/cuboid)

Question 29

cholesteatoma

• cause/pathogenesis
• gross/histological presentation
• sequelae

Answer 29

• often associated with otitis media__​
• microscopic presentation:
  
  • 1-4 cm cystic lesions that are
    
    • lined with keratinizing squamous epithelium
    • filled with amorphous debris
• if they enlarge, they can errode the ossicles/labrynth

Question 30

what is otosclerosis

• cause
• sequelae

Answer 30

• cause: abnormal bone deposition in the middle ear - around rim of oval window
• sequelae: hearing loss in the early decades

Question 31

having a deviated nasal septum predisposes what condition?

Answer 31

chronic rhinitis (develops from acute rhinitis, presence of a nasal septum makes this progression more likely(