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2020 CPR II Pulm Exam 2 > Pulm Path 6: Upper Airways, Ear and Neck (Singh) > Flashcards

Pulm Path 6: Upper Airways, Ear and Neck (Singh) Flashcards

1
Q

Which 3 viruses are the major cause of infectious rhinitis?

A
  • Adenoviruses
  • Rhinoviruses
  • Echoviruses
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2
Q

The upper airways (i.e., nose, nasopharynx and sinuses) are lined by what type of epithelium?

A

Respiratory-type epithelium

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3
Q

Allergic rhinitis is an example of what type of hypersensitivity rxn?

A

Type 1 - immediate

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4
Q

Which 2 bacteria are most likely to be superimposed on infectious rhinitis?

A
  • S. pneumoniae
  • H. influenzae
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5
Q

How does the nasal discharge differ grossly if rhinitis purely viral or has a superimposed bacterial infection?

A
  • Viral will have clear nasal discharge
  • Bacteria will cause thick, purulent, sometimes suppurative discharge
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6
Q

Rhinitis/sinusitis characterized by marked mucosal edema, redness, and mucus secretion accompanied by a leukocytic infiltrate with prominent eosinophils describes what?

A

Allergic rhinitis

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7
Q

Edematous nasal mucosa w/ loose stroma, often harboring hyperplastic or cystic mucous glands w/ a variety of infiltrates including neutrophils, eosinophils, plasma cells, and occasional cluster of lymphocytes is characteristic of what?

A

Nasal polyps

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8
Q

What is the cause of nasal polyps?

A

Recurrent attacks of rhinitis

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9
Q

Maxillary sinusitis occasionally arises from extension of an infection from where?

A

Periapical infection through bony floor of the sinus (oral flora)

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10
Q

Obstruction and impairment of sinus drainage in sinusitis may lead to what 2 gross findings?

A
  • Empyema = impounded suppurative exudate
  • Mucocele = accumulation of mucus secretions
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11
Q

Which patients are at higher risk for particularly severe forms of chronic sinusitis and by which type of organisms?

A
  • Diabetics
  • Fungi (i.e., Mucormycosis)
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12
Q

Kartagener Syndrome is characterized by what triad and the sx’s are all caused by what?

A
  • Bronchiectasis
  • Situs inversus
  • Sinusitis (less common)
  • All sx’s due to defective ciliary action
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13
Q

What are 2 possible complications which may arise due to spread of infection associated with chronic sinusitis?

A
  • Speading into the orbit or penetrating surrounding bone –> osteomyelitis
  • Spreading into cranial vault –> septic thrombophlebitis of a dural venous sinus
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14
Q

What are 3 frequent complications which may arise from chronic sinusitis of the ethmoid sinus?

A
  • Preseptal cellulitis
  • Orbital cellulitis
  • Subperiosteal abscess
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15
Q

What are 3 conditions which can produce necrotizing ulcerating lesions of the nose and upper respiratory tract?

A
  • Acute fungal infections (i.e., Mucormycosis)
  • Granulomatosis w/ polyangiitis (Wegener)
  • Extranodal NK/T-cell lymphoma, nasal-type
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16
Q

Which sex, ethnicities, and age group is most frequently affected by extranodal NK/T-cell lymphomas?

A
  • Males in the 5th-6th decade
  • Most common in those of Asian or Latin American descent
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17
Q

Extranodal NK/T-cell lymphomas are related to which virus?

A

EBV

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18
Q

What are 3 systemic signs/sx’s related to lymphomas?

A
  • Fever
  • Night sweats
  • Weight loss
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19
Q

Acute invasive sinusitis requires what prompt treatment?

A

Emergent IV antifungal therapy to prevent extension into brain or sepsis

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20
Q

Which bacteria are most commonly found superimposed on pharyngitis/tonsilitis of viral origin?

A
  • β-hemolytic strep = most common
  • S. aureus
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21
Q

How are the hyphae formed by Mucormycetes distinct from Aspergillus hyphae?

A

Form nonseptate hyphae of variable width w/ frequent right-angle branching

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22
Q

Involvement of which other organ system may develop in pt with rhinocerebral mucormycosis and what is seen?

A
  • Lungs
  • Lesions of combined hemorrhagic pneumonia w/ vascular thrombi and distal infarctions
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23
Q

Which sinus is most often involved in obstruction of outflow in sinusitis leading to a mucocele?

A

Frontal sinus

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24
Q

Proliferating masses of hyphae due to Aspergillus frequently form what?

A

“Fungus balls” = mycetoma

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25
Q

Describe the presentation of granulomatosis with polyangiitis in the sinus tract.

A
  • Necrotizing granulomas of the upper or lower respiratory tract or both
  • Necrotizing or granulomatous vasculitis affecting small-to-medium sized vessels
  • Can lead to ulceration, necrosis, or perforation of the septum
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26
Q

Enlarged, reddened tonsils (due to reactive lymphoid hyperplasia) dotted by pinpoints of exudate emanting from tonsillar crypts is known as what?

A

Follicular tonsillitis

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27
Q

Nasopharyngeal angiofibroma is a benign tumor found almost exclusively in whom?

Also associated with what GI disorder?

A

- Adolescent males who are most often fair-skinned and red headed

- Association w/ FAP

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28
Q

Nasopharyngeal angiofibroma arises from which layer of tissue and in which location?

A

Fibrovascular stroma of the posterolateral wall of the ROOF of the nasal cavity

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29
Q

What is the treatment of choice for nasopharyngeal angiofibroma?

A

Surgical removal

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30
Q

Sinonasal (Schneiderian) Papilloma most often occurs in which sex and age group?

A

Adult males between the ages 30-60 yo

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31
Q

What are the 3 forms the lesions of Sinonasal (Schneiderian) Papilloma occur as; which is most common?

A
  • Exophytic = most common
  • Endophytic (inverted)
  • Cylindrical
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32
Q

Which form of Sinonasal (Schneiderian) Papilloma is uniquely aggressive and in a minority of cases may progress to malignancy?

A

Endophytic (Inverted) form

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33
Q

The exophytic and endophytic forms of Sinonasal (Schneiderian) Papilloma are associated with what virus?

A

HPV (types 6 and 11)

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34
Q

What 2 locations are endophytic sinonasal papillomas found in?

A
  • Nose
  • Paranasal sinuses
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35
Q

What are the 2 benign (but potentially locally aggressive) tumors of the nose, sinuses, and nasopharynx?

A
  • Nasopharyngeal angiogibroma
  • Sinonasal (Schneiderian) papilloma
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36
Q

What are potential serious complications which may arise from a Sinonasal (Schneiderian) Papilloma?

A
  • Invasion of the orbit or cranial vault
  • Malignant transformation
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37
Q

Olfactory neuroblastomas arise from which cells and in which location?

A

Neuroectodermal olfactory cells present within the mucosa, particularly the superior aspect of the nasal cavity

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38
Q

What is the characteristic histology of Olfactory Neuroblastomas?

A
  • Small, blue, round cell neoplasms
  • Nests and lobules of well-circumscribed cells separated by fibrovascular stroma
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39
Q

What specific immunohistochemical markers are expressed by Olfactory Neuroblastomas?

A
  • Neuron-specific enolase
  • Synaptophysin
  • CD56
  • Chromogranin
40
Q

What is unique about the age distribution of Olfactory Neuroblastomas; patients present with what signs/sx’s?

A
  • Bimodal distribution = peaks at 15 yo and 50 yo
  • Present w/ nasal obstruction and/or epistaxis
41
Q

Olfactory neuroblastomas may penetrate through the cribriform plate and produce what characteristic appearance on imaging?

A

“Dumb-bell” shaped

42
Q

Where to NUT (midline) carcinomas occur?

A
  • Nasopharynx
  • Salivary gland
  • Midline structures in thorax or abdomen
43
Q

NUT (midline) carcinomas are often mistaken for what malignany?

A

SCC

44
Q

What is the typical course and prognosis of NUT (midline) carcinoma?

A
  • Extremely aggressive
  • Most patients survive for <1 year following dx
45
Q

NUT (midline) carcinomas are associated with translocations involving what 2 proteins?

A

NUT and BRD4

46
Q

What are the 3 patterns of Nasopharyngeal Carcinoma which may be seen?

A
  1. Keratinizing SCC’s
  2. Nonkeratinizing SCC’s
  3. Undifferentiated/basaloid carcinomas w/ abundant lymphocytic infiltrate (formerly lymphoepithelioma)
47
Q

What are the 3 factors which influence the origin of Nasopharyngeal Carcinomas?

A
  1. Age
  2. Hereditary
  3. Infection with EBV
48
Q

Nasopharyngeal carcinoma is the most frequent childhood cancer where?

A

Africa

49
Q

Nasopharyngeal carcinoma is very common in adults where?

A

SE China

50
Q

Which dietary and enviornemental factors are associated with Nasopharyngeal Carcinoma?

A
  • Diets high in nitrosamines, such as fermented foods and salted fish
  • Smoking and chemical fumes
51
Q

What is seen histologically with the undifferentiated/basaloid type of nasopharyngeal carcinoma (i.e., cell types and characteristics)?

A
  • Large epithelial cells w/ oval or round vesicular nuclei

- Prominent nucleoli, and indistinct cell borders in a SYNCYTIUM-like array

  • Admixed w/ abundant lymphocytes (predominantly T cells)
52
Q

What may be detected via in-situ hybridization or immunohistochemistry in the malignant epithelial cells of nasopharyngeal carcinoma?

A
  • EBV encoded RNA’s such as EBER-1
  • Proteins such as LMP-1
53
Q

How do nasopharyngeal carcinomas typically present; most often metastases where?

A
  • Nasal obstruction
  • Epistaxis
  • Majority of cases present in the neck (cervical LN metastasis)
54
Q

What is the standard tx for nasopharyngeal carcinoma and which variant is the most/least sensitive to tx?

A
  • Radiotherapy is standard tx
  • Undifferentiated carcinoma is the most radiosensitive = best prognosis
  • Keratinizing SCC is the least radiosensitive = worse prognosis
55
Q

Laryngoepiglottitis in children is most often due to what 3 underlying organisms?

A
  • Respiratory syncytial virus
  • Haemophilus influenza
  • β-hemolytic streptococci
56
Q

Why is laryngoepiglottitis more serious in childre/infants?

A

Smaller airways; sudden swelling of epiglottis and vocal cords may cause obstruction –> medical emergency

57
Q

Laryngotracheobronchitis (aka croup) is often seen in whom and with what sign/sx?

A
  • Children
  • Inflammatory narrowing of airway –> inspiratory stridor
58
Q

Reactive nodules of the vocal cords are most often seen in whom?

A
  • Smokers
  • Pts who impose great strain on their vocal cords (i.e., Singers)
59
Q

How do singers nodules differ from polyps in terms of distribution?

A
  • Singers nodules = bilateral
  • Polyps = unilateral
60
Q

Reactive nodules (vocal cord nodules and polyps) are covered with what histologically and what is seen at their core?

A
  • Covered by squamous epithelium that may become kerotic, hyperplastic, or slightly dysplastic
  • Core composed of loose myxoid CT
61
Q

Reactive nodules of the vocal cords will present with what signs/sx’s?

Risk of malignancy?

A
  • Change in voice + hoarsness
  • Virtually never give rise to cancer
62
Q

What is seen on histologic examination of laryngeal squamous papillomas (i.e., morphology, cell types, and core)?

A
  • Multiple slender, finger-like projections
  • Supported by central fibrovascular core
  • Covered by stratified squamous epithelium
63
Q

Laryngeal squamous papillomas are caused by what?

A

HPV types 6 and 11

64
Q

Laryngeal squamous papillomas are usually single lesions in whom?

Multiple lesions in?

A
  • Single lesions in adults
  • Multiple lesions in children –> Juvenile laryngeal papillomatosis
65
Q

Chance of malignancy w/ laryngeal squamous papillomas and typical course?

A
  • Benign and do NOT become malignant
  • Often spontaneously regress at puberty, but some affect pt’s endure numerous surgeries before this occurs
66
Q

Recurrent respiratory papillomatosis typically occurs in whom and is associated with what?

A
  • Children and adolescents
  • Associated w/ HPV 6 and 11; thought to be acquired during birth
67
Q

Recurrent respiratory papillomatosis may diffusely involve what?

A

Lungs

68
Q

Laryngeal carcinoma is most often what type of carcinoma and seen in whom?

A
  • SCC
  • Men >60 yo who smoke
69
Q

What is the hyperplasia-dysplasia-carcinoma sequence seen in laryngeal carcinomas?

A

Hyperplasia –> atypical hyperplasia –> dysplasia –> carcinoma in situ –> invasive carcinoma

70
Q

The likelihood of the development of an overt laryngeal carcinoma is directly proportional to what?

A

Grade of dysplasia when the lesion is first seen

71
Q

What are the risk factors for laryngeal carcinoma?

A
  • Smoking
  • Alcohol
  • HPV infection
  • Asbestos
  • Irradiation
72
Q

Where may laryngeal carcinomas arise and how does this fit with the terms intrinsic and extrinsic?

A
  • Usually on the vocal cords
  • May also arise on epiglottis or aryepiglottic folds or in pyriform sinuses
  • Those confined in larynx proper = intrinsic; those arising or extending outside the larynx = extrinsic
73
Q

Laryngeal carcinomas begin as in situ lesions which later have what gross appearance on the mucosal surface?

A

Pearly gray, wrinkles plaques, ultimately ulcerating and fungating

74
Q

Laryngeal carcinoma most often manifests clinically with what signs/sx’s?

A
  • Persistent hoarsness
  • Dysphagia
  • Dysphonia
75
Q

3 most common bacteria responsible for acute otitis media?

A
  • Streptococcus pneumoniae
  • Moraxella catarrhalis
  • H. influenza

*SMH*

76
Q

What are the most common causative agents of chronic otitis media?

A
  • Pseudomona aeruginosa
  • Staphylococcus aureus
  • Some fungi
77
Q

Otits media in the diabetic pt is most often caused by which organism and what serious complication may arise?

A
  • P. aeruginosa
  • Is especially aggressive and spreads widely, causing destructive necrotizing otitis media
78
Q

What are cholesteatomas; and what are they associated with?

A
  • Non-neoplastic, CYSTIC lesions lined by benign squamous epithelium w/ trapped keratin debris and sometimes spicules of cholesterol
  • Associated w/ chronic otitis media
79
Q

The reactive nature of cholesteatomas may lead to what complications?

A
  • Erode into the ossicles, the labyringht, adjacent bone, or surrounding soft tissue
  • May produce visible neck masses
80
Q

What is the primary complication of Otosclerosis?

A

Conductive hearing loss

81
Q

Otosclerosis is due to abnormal bony deposition where?

A

Stapedial footplate anchoring it to the oval window

82
Q

What is the inheritance pattern of Otosclerosis?

A

Familial, autosomal dominant w/ variable penetrance

83
Q

Branchial cysts are thought to arise from what remnant and are most commonly observed in whom?

A
  • Second branchial arch
  • Young adults btw ages 20-40 yo
84
Q

Where are branchial cysts most often anatomically?

A

Upper lateral aspect of neck along the SCM

85
Q

What is the histology of branchial cysts?

A

Simple cyst lined by stratified squamous or respiratory epithelium w/ surrounding fibrous tissue +/- lymphoid tissue w/ prominent germinal centers

86
Q

Thyroglossal duct cysts arise from what?

A
  • Remenant nests of tissue from thyroid migration
  • Origin at base of tongue (foramen cecum) to its definitive midline location in anterior neck
87
Q

What type of epithelium are thyroglossal duct cysts lined with when located near base of tongue vs. lower locations in anterior neck?

A
  • Base of tongue –> stratified squamous epithelium
  • Lower –> pseudostratified columnar epithelium
88
Q

Paragangliomas (carotid body tumors) are most commonly found where and form what?

A
  • Adrenal medulla —> pheochromocytomas
  • Extra-adrenal occuring in the head and neck region
89
Q

What is the origin of paragangliomas (carotid body tumors)?

A

Neural crest

90
Q

Paragangliomas (carotid body tumors) typically develop in what 2 locations and differ how?

A
  • Paravertebral paraganglia –> sympathetic connections and are chromaffin-positive, stain for catecholamines
  • Paraganglia related to great vessels of the head and neck (i.e., carotid bodies) –> parasympathetic innervation and infrequently release catecholamines
91
Q

Carotid body tumors are chiefly composed of what histologically and are surrounded by?

A
  • Nests (zellballen) of round to oval chief cells (neuroectodermal in origin)
  • Surrounded by delicate VASCULAR septae
92
Q

Which 5 neuroendocrine cell markers do the chief cells of carotid body tumors stain strongly for?

A
  • Chromogranin
  • Synaptophysin
  • Neuro-specifc enolase
  • CD56
  • CD57
93
Q

What supporting network of cells is seen in carotid body tumors and what do they stain for?

A
  • Spindle-shaped stromal cells, called sustentacular cells
  • Positive for S-100
94
Q

What is the growth of carotid body tumors like and when are they most often seen?

A
  • Slow-growing and painless masses
  • Usually arising in the fifth and sixth decades
95
Q

Carotid body tumors may arise how and how does the pattern differ based on the underlying cause?

A
  • Sporadically
  • Autosomal dominant assoc. w/ MEN-2 –> often multiple and b/l
96
Q

How aggressive are carotid body tumors, where do they metastasize and what is the prognosis?

A
  • Frequently recur after incomplete resection
  • May metastasize to regional LN’s and distant sites
  • 50% are fatal due to infiltrative growth (histology CANNOT tell!)

2020 CPR II Pulm Exam 2 (28 decks)

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