Pathology Flashcards
What artery can cause a fatal bleed from trauma to the nose?
What is it a branch of?
Sphenopalatine artery (branch of maxillary) - Posterior segment of nostril
What type of cancers are head and neck cancer usually?
Squamous cell carcinoma
What are risk factors for Head and neck cancers?
- Tobacco
- Alcohol
- HPV-16 (oropharyngeal)
- EBV (nasopharyngeal)
What may nasopharyngeal carcinomas present with?
- Unilateral nasal obstruction
- Discharge
- Epistaxis
What arteries are in the Kiesselbach plexus?
Kiesselbach’s LEGS
- Labial artery
- anterior and posterior Ethmoidal arteries
- Greater palatine artery
- Sphenopalatine artery
What does the superior meatus drain?
Sphenoid and posterior ethmoid sinuses
What does the middle meatus drain?
- Frontal
- Maxillary
- Anterior ethmoid
What does the inferior meatus drain?
Nasolacrimal duct
What may paranasal sinus infections extend to?
- Orbits - orbital cellulitis
- Cavernous sinus - Cav sinus syndrome
- Brain - meningitis
What are causes of epistaxis?
- Foreign body
- Trauma
- Allergic rhinits
- Nasal angiofibromas
What sinuses are most commonly affected by rhinosinusitis?
Maxillary sinuses
What are the causes of an anterior mediastinal mass?
- Thyroid (substernal goiter)
- Thymic neoplasm
- Teratoma
- Terrible Lymphoma
What are the causes of a middle mediastinal mass?
- Esophageal carcinoma
- Metastases
- Hiatal hernia
- Bronchiogenic cysts
What are causes of a posterior mediastinal mass?
- Neurogenic tumour (neurofibroma)
- Multiple myeloma
What are causes of mediastinitis?
- Post-op complications of cardio-thoracic procedures (< 14 days)
- Esophageal perforation
- Contigous spread of odontogenic/retropharyngeal infection
What organism may cause mediastinitis?
Histoplasma capsulatum
How does mediastinitis occur?
Increased proliferation of connective tissue in mediastinum (aka Fibrosing mediastinitis)
What are the clinical features of mediastinitis?
- Fever
- Tachycardia
- Leukocytosis
- Chest pain
- Sternal wound drainage
What are the causes of pneumomediastinum?
- Spontaneous rupture of pulmonary bleb
Secondary causes
- Trauma
- Iatrogenic
- Boerhaave syndrome
What are complications of idiopathic pulmonary fibrosis?
- PAH
- Resp failure
- Lung cancer
- Arrhythmias
What are potential causes of idiopathic pulmonary fibrosis?
- Smoking
- Environmental pollutants
- Genetic defects
What type of hypersensitivity reaction is hypersensitivity pneumonitis?
III/IV
What are the acute symptoms of hypersensitivity pneumonitis?
- Dyspnea
- Cough
- Chest tightness
- Fever
- Headache
What does chronic hypersensitivity pneumonitis lead to (what are its features)?
- Irreversible fibrosis
- Noncaseating granuloma
- Alveolar septal thickening
- Traction bronchiectasis
What will serum and bronchioalveolar lavage fluid show specifically in Sarcoidosis, what will be elevated?
- Serum - Elevated ACE levels
- Bronchioalveolar fluid - Elevated CD4/CD8 ratio
What will CXR show in sarcoidosis?
- Bilateral adenopathy
- Coarse reticular opacities
What are possible signs / symptoms associated with sarcoidosis outside of the lungs?
- Bell palsy
- Uveitis
- Lupus pernio
- Erythema nodosum
- Rheumatoid arthritis-like arthropathy
- Hypercalcemia
What are the features of the granulomas in sarcoidosis?
- Noncaseating epitheloid
- Containing microscopic Schaumann and asteroid bodies
How does sarcoidosis cause hypercalcemia?
Increased 1alpha-hydroxylasee-mediated vit D activation in macrophages
What will bronchoscopy show in inhalation injury?
Edema, congestion of bronchus and possibly soot deposition
What is pneumoconiosis?
Interstitial lung diseases where inhalation of dust has caused interstitial fibrosis
Name 4 pneumoconioses
- Asbestos-related disease
- Berylliosis
- Coal workers’ pneumoconiosis
- Silicosis
What types of pneumoconioses affect the upper lobes and what types affect the lower?
Asbestos-related disease - lower
Upper lobes
- Berylliosis
- Coal workers’ pneumoconiosis
- Silicosis
What are 3 main asbestos-related diseases?
- Asbestosis - pulmonary fibrosis
- Pleural disease
- Malignancies - mesothelioma
What cancers can be due to absestos exposure?
- Bronchiogenic carcinoma
- Mesothelioma
What is Caplan syndrome?
- Rheumatoid arthritis
- Pneumoconiosis
- W. Intrapulmonary nodules
What do asbestos bodies look like on histology from alveolar sputum sample (often obtained by bronchoalveolar lavage)?
What stain is used?
- Golden-brown fusiform rods resembling dumbbells
- Visualized from Prussian-blue stain
What is berylliosis?
Beryllium exposure in aerospace and manufacturing industries
What will be seen on histology in berrylliosis?
Noncaseating granulomas
What are those with berylliosis at increased risk of?
- Cor pulmonare
- Cancer
What diseases may increase the risk of Caplan syndrome?
- Absestosis
- Coal-workers pneumoconiosis
- Silicosis
What will be seen on histology in Coal-workers pneumoconiosis?
Macrophages laden with carbon
-> Inflammation and fibrosis
What will be seen on imaging in Coal-workers pneumoconiosis?
Small, rounded nodular opacities seen
What is anthracosis?
Basically asymptomatic coal-workers pneumoconiosis
- Many urban dwellers exposed to sooty air
What is Silicosis associated with (what workers)/
- Sandblasting
- Foundries
- Mines
Describe the pathology of Silicosis?
Macrophages respond to silica and release fibrogenic factors, leading to fibrosis
- Silica may disrupt phagolysosomes and impair macrophages -> incr susceptibility to TB
What are those with Silicosis at increased risk of?
- Cancer
- Cor pulmonale
- Caplan syndrome
What will ne seen on CXR in Silicosis?
- Upper lobes affected
- Eggshell calcification of hilar lymph nodes
What will histology show with mesothelioma?
Psammoma bodies
What will EM show in mesothelioma?
Polygonal tumor cells with microvilli, desmosomes, tonofilaments
- Calretinin and cytokeratin 5/6 +ve in almost all and not in normal lung cancer
What is the pneumonic to remeber silicosis?
The silly egg sandwich is mine
