L25 Sinonasal and Upper Airways

Question 1

Types of Inflammation of the Upper Airways

Answer 1

• Infectious rhinitis

– Viral – adeno / echo / rhino / viruses: catarrhal clear

– Bacterial superinfection: mucopurulent-yellow/green

– Extension-pharyngotonsillitis

• Allergic rhinitis– Type I hypersensitivity
• Nasal polyps:
• Nonneoplastic
• Response to chronic inflammation
• Arise from lateral nasal wall or ethmoid recess
• Oedematous mucosa
• Allergic nasal polyp asc. w/ eosinophils
• Sinusitis: Blockage of drainage. Risk of spread to orbit or dura (brain)

Question 2

___________________________:

• Medium and small-vessel necrotizing VASCULITIS
  
  • Arterioles, venules, capillaries, and occasionally small arteries
• Characterized by Necrotizing Granulomatous inflammation involving:
  
  • Respiratory epithelium - ear, nose sinus thorat
  • Small and medium vasculitis in lings (conscionably cavitation)
• ASSOCIATED WITH COCAINE USE
• Detection?

Answer 2

Granulomatosis with PolyAngiitis - GPA- (previously known as Wegener’s)

• Medium and small-vessel necrotizing VASCULITIS
• Arterioles, venules, capillaries, and occasionally small arteries
• Characterized by Necrotizing Granulomatous inflammation involving:
  
  • Respiratory epithelium - ear, nose sinus thorat
  • Small and medium vasculitis in lings (conscionably cavitation)
    
    • ASSOCIATED WITH COCAINE USE
• Detected with Serum: Anti-Neutrophil Cytoplasmic Antibodies

Question 3

‘Lethal midline granuloma’ – _________________________ often with superimposed bacterial infection

• Often Asian or Hispanic Descent
• Highly associated with Epstein Bar Virus
• Perforated nasal septum, perforated palate, erosion of antral bone/akin over nose

Answer 3

‘Lethal midline granuloma’ – a Non Hodgkin’s Lymphoma (NK type cells) (often with superimposed bacterial infection)

• Often Asian or Hispanic Descent
• Highly associated with Epstein Bar Virus
  
  • Perforated nasal septum, perforated palate, erosion of antral bone/akin over nose

Question 4

____________________________:

Benign

Bleeds Profusely

Adolescent males exclusively: Fair-skinned and Red-Headed

Answer 4

Nasopharyngeal Angiofibroma

Benign

Bleeds Profusely

Adolescent males exclusively: Fair-skinned and Red-Headed

Question 5

Who Classification of Nasopharyngeal Carcinoma?

Answer 5

1. Keratoinizing squamous cell carcinoma (WHO type I): linked to previous inverted papiloma/HPV
2. Non-Keratinizing carcinoma-differentiated (WHO Type II)- Squamous cell carcinoma w/o keratinization
3. Non-Keratinizing carcinoma- UNdifferentiated (WHO Type III): = Lymphoepithelioma
   
   1. Typically arise from EBV Infection
   2. large nuclei
      
      1. reactive T cells in stroma

Question 6

Answer 6

Sinonasal Papilomas:

Benign neoplasms

Unilateral

Mushroom shaped

HPV Type 6/11

Question 7

Answer 7

Question 8

Answer 8

Question 9

Answer 9

Question 10

________________ trivial accompaniment to URTI

______________ in children is a medical emergency

Answer 10

LARYNGITIS trivial accompaniment to URTI

LARYNGOEPIGLOTTITIS in children is a medical emergency

Question 11

Benign vocal chord nodules?

Answer 11

Singer’s Nodule: Bilateral

Polyps: Unilateral

Question 12

Laryngeal papillomas are characterized by _____________ andcaused by HPV __ and __

Manifestations in Juveniles vs. Adults?

Answer 12

Laryngeal papillomas are characterized by multiple, slender finger-like projections and caused by HPV 6 and 11

Juveniles: Multiple, recurant, respiratory distress

Adults: solitary, less recurrant

Question 13

_______________________:

Caused by HPV

2. 2% of all cancers
   7: 1 Male to Female. Smoking, alcohol, radiation exposure increase risk

Present with persistent hoarseness, usually presents in vocal chords

Precusors?

Answer 13

Invasive Carcinoma of the Larynx:

Caused by HPV

2. 2% of all cancers
   7: 1 Male to Female. Smoking, alcohol, radiation exposure increase risk

Present with persistent hoarseness usually presents in vocal cords