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Respiratory Medicine > Pathology 1st Slide Set > Flashcards

Pathology 1st Slide Set Flashcards

1
Q

What type of reaction is allergic rhinitis?

A

Type 1 hypersensitivity

IgE mediated

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2
Q

What is noncardiogenic pulmonary edema due to?

A

Injury to the alveolar septa

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3
Q

if there is death from nasopharyngeal angiofibroma then what causes it?

A

hemorrhage and intracranial extension

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4
Q

Describe the characteristic for resolution of infectious rhinitis?

A

Self limiting

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5
Q

Treatment for nasopharyngeal angiofibroma

A

surgical removal

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6
Q

Acute sinusitis is commonly preceded by what?

A

Acute or chronic rhinitis

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7
Q

What are the offending agents in sinusitis?

A

Oral cavity microbes or may be allergic (NOT viruses)

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8
Q

either incomplete expansion of the lungs or collapse of previously inflated lung

A

atelectasis

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9
Q

Exophytic and inverted subtypes of sinonasal (schneiderian) papilloma are associated with what?

A

HPV subtype 6 and 11

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10
Q

The most common form of laryngitis in adults is encountered in what people

A

heavy smokers

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11
Q

What is the histological manifestation of ALI and ARDS?

A

Diffuse alveolar damage (DAD)

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12
Q

Recurrent attacks of rhinitis may eventually lead to what?

A

Focal protrusion of mucosa producing so called nasal polyps (up to 3 to 4 cm in length)

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13
Q

Treatment for a nasopharyngeal carcinoma

A

Radiation

-undifferentiated is more sensitive but also most aggressive

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14
Q

What are the 4 steps in the pathogenesis of ALI/ARDS?

A
  • endothelial activation
  • Adhesion and extravasated of neutrophils
  • Accumulation of intraalveolar fluid and formation of HYALINE MEMBRANES
  • Resolution
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15
Q

sequestration most commonly come to attention in INFANTS as mass lesions and are external to the lung

A

extralobar

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16
Q

Tumor with association with familial adenomatous polyps

A

Nasopharyngeal angiofibroma

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17
Q

What contributes to the likelihood of microbial invasion in chronic rhinitis?

A

A deviated septum or nasal polyps with impaired drainage of secretions

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18
Q

Are nasal polyps linked to Atopy?

A

No

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19
Q

Enlarged, redened tonsils (due to reactive lymphoid hyperplasia) dotted by pinpoints of exudate emanating from the tonsillar crypts

A

follicular tonsillitis

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20
Q

When large or multiple what may nasal polyps encroach upon?

A

Airway and impair sinus drainage

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21
Q

sequestration that usually presents in OLDER CHILDREN often due to recurrent localized infection or bronchiectasis and occurs within the lung

A

intralobar

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22
Q

Laryngitis in adult heavy smokers predisposes to what

A

squamous epithelial metaplasia and sometimes overt carcinoma

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23
Q

Where can an inverted sinonasal papilloma extend?

A

orbit or cranial vault

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24
Q

What are the main viruses that cause infectious Rhinitis?

A
  • adenovirus
  • Rhinovirus
  • Echovirus
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25
Q

Focal or generalized pulmonary or plueral fibrosis causes what type of ateletasis?

A

contraction

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26
Q

In ALI the lungs have UNEVEN functional abnormalities. Areas of infiltration and consolidation are poorly aerated creating what?

A

Ventilation-perfusion mismatch

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27
Q

What does a patient with an olfactory neuroblastoma usually present with?

A

nasal obstruction and/or epistaxis

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28
Q

if pulmonary hypoplasia is bilateral what is the likely cause?

unilateral?

A

Oligohydramnios

Diaphragmatic hernia

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29
Q

What causes a severe form of of chronic sinusitis and in what kind of patients?

A
  • fungi (mucormycosis or aspergillus)

- diabetes and immunocompromised

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30
Q

This arises from abnormal detachments of primitive foregut and are most often located in he hilum or middle mediastinum

A

foregut cyst

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31
Q

what are causes of compression atelectasis

A
  • transudate, exudates, blood
  • tumor
  • air (pneumothorax
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32
Q

Allergic rhinitis is characterized by what clinically

A
  • mucosal edema
  • redness
  • mucus secretion
  • accompanied by a leukocytic infiltration in which eosinophils are prominent
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33
Q

Benign tumor arising from the respiratory mucosa of nasal cavity and paranasal sinuses

A

Sinonasal (Schneiderian) Papilloma

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34
Q

Abrupt onset of significant hypoxemia and bilateral pulmonary infiltrates in the absence of cardiac failure

A

Acute lung injury (noncardiogenic pulmonary edema)

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35
Q

What does the wall of a bronchogenic foregut cyst contain?

A
  • bronchial glands
  • cartilage
  • smooth muscle
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36
Q

Occasionally arises by extension of a periapical infections through the bony floor of the sinus

A

Maxillary sinusitis

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37
Q

Which nasopharyngeal carcinoma is composed of large epithelial cells with oval or round vesicular nuclei, prominent necleoli, and indistinct cell borders disposed in a syncytium like array

A

undifferentiated basaloid variant

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38
Q

papillomas are caused by what virus

A

HPV 6 and 11

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39
Q

What is seen in serum by PCR with undifferentiated basaloid variant pharyngeal carcinoma

A

EBV genomes and EBV encodes RNAs such as EBER-1 and LMP-1

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40
Q

alveolar capillaries are engorged, and an intra-alveolar transudate appears as finely granular pale pink material

A

hemodynamic pulmonary edema

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41
Q

if multiple papillomas occur in a child they are referred to as what?

A

juvenile laryngeal papillomatosis

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42
Q

Patient presents with acute respiratory failure often following an illness of less than 3 weeks duration that resembles and upper respiratory tract infection. Age 59. Death within 1 to 2 months

A

Acute interstitial pneumonia or idiopathic ALI-DAD

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43
Q

Decreased pulmonary weight, volume, and acini for body weight and gestational age

A

pulmonary hypoplasia

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44
Q

Histology for olfactory neuroblastoma

A
  • “small, round blue cell tumor”
  • nests and lobules of well-circumscribed cells that are separated by a fibrovascular stroma
  • Many have fibrillary matrix that ultrastrucutally corresponds to tangles of neuronal cell processes
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45
Q

Explain the changes when a bacterial infection is super imposed on infectious rhinitis

A

-mucopurulent and sometimes frankly suppurative exudate

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46
Q

epidemiology for sinonasal (schneiderian) papilloma

A
  • M>F

- 30-60

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47
Q

Associations with Extranodal NK/T cell lymphoma nasal type

A
  • EBV
  • Male, 40s-50s, Asian and Latin American
  • Aggressive
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48
Q

Early in the course of ALI the lungs become stiff due to what?

A

Loss of functional surfactant

49
Q

in which form of nasopharyngeal carcinoma do most patients have anti-EBV antibodies against early antigens or viral capsid antigens

A

Nonkeratinizing form

50
Q

Carcinoma of the larynx often manifests clinically as what?

A

persistent hoarseness, dysphagia, and dysphonia

51
Q

consequences of hemodynamics pulmonary edema

A

decrease in O2 and increase risk of infection

52
Q

Frequently there is superficial desquamation or ulceration of mucosal epithelium and a variable inflammatory infiltrate of neutrophils, lymphocytes, and plasma cells subjacent to the epithelium

A

Chronic rhinitis

53
Q

Nasopharyngeal carcinoma geographic distribution

A
  • African children

- Chinese adults

54
Q

The main predisposing factors to ALI or ARDS?

A
  • Shock
  • oxygen therapy
  • SEPSIS
  • diffuse pulmonary infection
  • gastric aspiration
  • Trauma
55
Q

Describe the time frame and clinical presentation for primary pharyngeal carcinomas

A

clinically occult for long periods and present with nasal obstruction, epistaxis, and often metastases to cervical lymph nodes

56
Q

papillomatous growth of SQUAMOUS cell-lined fronds downward from mucosal surface into the underlying stromal tissue

A

inverted sinonasal papilloma

57
Q

what are foregut cysts lined by microscopically?

A

ciliated pseudostratified columnar epithelium

58
Q

What is the clinical significance of chronic sinusitis?

A

More uncomfortable than disabling but have potential of spreading into the orbit or of penetrating into surrounding bone to give rise to osteomyelitis or spreading into cranial vault, causing septic thrombophlebitis of a dural venous sinus

59
Q

uniformly associated with translocations that create fusion genes encoding chimeric proteins comprised of most of NUT, a chomatin regulator, and a portion of a “chromatin reader” usually BRD4

A

NUT midline carcinoma

60
Q

Vascular tumor, almost always in adolescent males especially red-haired and fair-skinned

A

Nasopharyngeal angiofibroma

61
Q

3 subtypes of sinonasal (Schneiderian) papilloma in decreasing order of prevalence

A
  • Exophytic (fungating)
  • Inverted (endophytic)
  • Cylindrical (oncocytic)
62
Q

epidemiology for squamous cell carcinoma of larynx

A

chronic male smokers in 50s

63
Q

Describe the histology of a nasal polyp

A

Edematous mucosa having loose stroma, often harbor into hyperplastic or cystic mucous glands, infiltrated with a variety of inflammatory cells, including neutrophils, EOSINOPHILS, and plasma cells with occasional clusters of lymphocytes

64
Q

describe the malignancy of an inverted sinonasal papilloma?

A

10% malignant transformation

65
Q

Because olfactory neuroblastomas are of neuroendocrine origin, the tumor cells contains what on electron microscopy and express what b IHC?

A
  • membrane bound secretory granules

- neuron-specific enolase, synaptophysin, CD56, and chromogranin

66
Q

Describe the mucosal covering of a nasal polyp with chronicity

A

May become ulcerated or infected

67
Q

Major importance of strep throat?

A

possible development of late sequelae such as rheumatic fever and glomerulonephritis

68
Q

Describe the mucosal covering of a polyp in the absence of a bacterial infection

A

Intact

69
Q

Describe the initial acute stages of infectious Rhinitis

A
  • nasal mucosa thickened, edematous, and red
  • nasal cavities narrowed
  • turbinates enlarged
70
Q

describe the resolution of papillomas

A

often spontaneously regress at puberty

71
Q

A discrete area of lung tissue that lacks any connection to the airway system and has an abnormal blood supply arising from the aorta or its brances

A

pulmonary sequestration

72
Q

Reactive nodules are smooth round small protrusions on the true vocal cords arising in what people

A
  • Singers (bilateral)

- Smokers - polyps - (unilateral)

73
Q

Kartagener syndrome is secondary to defective what?

A

Ciliary action (dyenin)

74
Q

What are the bacteria that cause super infections on top of viral pharyngitis and tonsillitis?

A
  • beta-hemolytic strep (strep throat)

- S. aureus (occasionally)

75
Q

3 forms of nasopharyngeal carcinoma

A
  • Keratinizing squamous cell carcinoma
  • Nonkeratinizing squamous cell carcinoma
  • undifferentiated basaloid carcinoma that have an abundant non-neoplastic, lymphocytic infiltrate
76
Q

describe the progression to carcinoma of the larynx

A

squamous hyperspasia to dysplasion to carcinoma

77
Q

What are the three ways to get a necrotizing ulcerating lesion of the upper respiratory tract?

A
  • Acute fungal infection
  • Granulomatosis with polyangiitis
  • Extranodal NK/T cell lymphoma nasal type
78
Q

Soggy lungs become firm and brown from fibrosis and thickening of the alveolar walls (brown induration), hemosiderin-laden macrophages are abundant

A

Long standing hemodynamic pulmonary congestion as seen in mitral stenosis

79
Q

What syndrome?

Sinusitis
Bronchiectasis
Situs inversus

A

Karagener syndrome

80
Q

What is admixed with the epithelial cells of undifferentiated basaloid variant pharyngeal carcinoma

A

abundant mature, normal appearing lymphocytes, which are predominantly T cells

81
Q

What environmental factors have been linked to nasopharyngeal carcinoma?

A
  • diets high in nitrosamines such as fermented foods and salted fish
  • smoking
  • chemical fumes
82
Q

Three classifications of a foregut cyts depending on wall structure

A
  • bronchogenic (most common)
  • esophageal
  • enteric
83
Q

how do you distinguish brochioles from bronchi

A

lack of cartilage and lack of submucosal glands within their walls

84
Q

papillomas are usually _____ in adults but are often _____ in children

A

single

multiple

85
Q

Where do nasopharyngeal angiofibromas arise and what are the characteristics

A
  • with fibrovascular stroma of posterolateral roof of nasal cavity
  • classified as benign
  • may be locally aggressive and extend intracranially
86
Q

Where do the suppurative infections of chronic rhinitis often extend

A

Air sinuses

87
Q

Benign neoplasms usually located on the true vocal cords that form soft respberry-like proliferations rarely more than 1 cm in diameter

A

Laryngeal squamous papillomas

88
Q

Do papillomas become malignant?

A

no but frequently recur

89
Q

What type of organisms usually cause infectious rhinitis?

A

Virus

90
Q

What is the acinus composed of

A
  • respiratory bronchioles
  • alveolar ducts
  • alveolar sacs
91
Q

Histology of squamous papillomas

A

multiple slender, finger-like projections supported by central fibrovascular cores and covered by an orderly stratified squamous epithelium

92
Q

another name for undifferentiated basaloid carcinoma that have an abundant non-neoplastic lymphocytic infiltrate

A

lymphoepithelioma

93
Q

What is the characteristic clinically of Reactive Nodules on the vocal cords

A

change the character of the voice and often cause progressive hoarseness

94
Q

What are the most common allergens that cause allergic rhinitis

A

Plant pollens, fungi, animal allergens, dust mites

95
Q

When you have a bacterial super infection on top of viral pharyngitis and tonsillitis what do you find?

A

whitish exudative material overlying reddened, swollen tonsils (psuedomembrane)

96
Q

resorption atelectasis stems from what?

mediastinum goes where?

A

complete obstruction (excessive secretions; mucus plugs; aspiration; exudates of smaller bronchi)

towards

97
Q

A sequel to repeated attacks of acute rhinitis, either microbial or allergic in origin, with the eventual development of superimposed bacterial infection

A

Chronic rhinitis

98
Q

the epithelial alteration of carcinoma of the larynx are most often related to waht?

A

tobacco smoke . . with alcohol increases risk even more

99
Q

What does an olfactory (esthesioneuroblastoma) neuroblastoma arise from?

A

neuroectoderm in superior nasal cavity

100
Q

Impairment of drainage of sinus by inflammatory edema of mucosa that when complete, it impound the suppurative exudate

A

Empyema

101
Q

Severe Acute lung injury (ALI) is also called what?

A

Acute respiratory distress syndrome (ARDS)

102
Q

Which type of atelectasis is NOT reversible?

A

contraction

103
Q

uncommon tumor that may occur in nasopharynx, salivary gland, or other midline structure in thorax or abdomen

A

NUT midline Carcinoma

104
Q

Profound dyspnea and tachypnea followed by increasing cyanosis and hypoxemia, respiratory failure and appearance of DIFFUSE BILATERAL INFILTRATES

A

ALI

105
Q

Nature and description of NUT midline carcinoma

A
  • resembles squamous cell carcinoma’
  • extremely aggressive and resistant to conventional therapy
  • most paitents survive for less than a year
106
Q

When a papilloma is on the free edge of the vocal cord, trauma may lead to ulceration and be accompanied by what?

A

hemoptysis

107
Q

Age for olfactory neuroblastoma?

A

bimodal peaks at 15 and 50

108
Q

characterized by distinctive geographic distribution, a close anatomic relationship to lymphoid tissue, and an association with EBV infection

A

nasopharyngeal carcinoma

109
Q

Do reactive nodules give rise to cancers?

A

Virtually never

110
Q

if pulmonary hypoplasia is severe then what is the outcome?

A

fatal shortly after birth

111
Q

hemosiderin laden macrophages (“heart failure” cells) may be seen within alveoli

A

hemodynamic pulmonary edema

112
Q

Majority of death in an ALI patient are due to what?

A

Sepsis or multi organ failure and, in some cases, direct lung injury

113
Q

What is the term used to describe widespread ALI of unknown etiology associated with a rapidly progressive clinical course

A

Acute interstitial pneumonia or idiopathic ALI-DAD

114
Q

Pharyngitis and tonsillitis are most commonly caused by what agents?

A

Viruses

  • Adeno
  • echo
  • rhino
115
Q

Obstruction of what sinus most often leads to accumulation of mucous secretions . .. mucocele

A

Frontal

Less commonly anterior ethmoid

116
Q

What happens if inverted sinonasal papiloma is not completely excised?

A

may recur

117
Q

What agents in infants and young children with their small airways cause laryngoepiglottitis that may induce sudden swelling of the epiglottis and vocal cords as to constitute a medical emergency . . . croup

A
  • RSV
  • Haemophilus influenza
  • B-hemolytic strep
118
Q

defective development of both lungs (or one more than the other)

A

pulmonary hypoplasia

Respiratory Medicine (37 decks)

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