Pulmonary Pathology IV

Question 1

Infectious Rhinosinusitis Viral vs. Bacterial
Infectious Agents (4/2) and Secretions

Answer 1

Viral: 
Rhinorrea (clear secretions)
Rhinovirus
Coronarvirus
Adenovirus
Echovirus

Bacterial:
Thick, purulent secretions
Streptococcus pneumoniae
Haemophilus influenzae

Question 2

Allergic Rhinosinusitis

Etiology and Presentation (3)

Answer 2

Type I hypersensitivity reaction to inhaled allergens

Eosinophilia
Rhinorrhea
Edema

Question 3

Inflammatory Sinonasal Polyp

Cause, Histology and Appearance

Answer 3

Chronic rhinosinusitis

Eosinophilia

Ball of mucus surrounded by epithelium

Question 4

Sinusitis Unique Features

Obstructions (2) and Infection Pathways

Answer 4

Empyema: see purulent exudate
Mucocele: mucus cyst from chronic obstruction

Can enter cranial sinuses: maxillary, ethmoid, frontal and spehnoid

Question 5

Fungal Rhinosinusitis

Description, Histology (2), Complication

Answer 5

Hypersensitivity to aspergillus spores

Eosinophils
Charcot Leyden Crystals

Mycetoma: large collection of aspergillus

Question 6

Acute Invasive Fungal Sinusitis

Fungus, Risk Factors (2), Complications (2)

Answer 6

Zygomycosis species (mucor)

Diabetes
Immunocompromised

Untreated mucor infection can go to brain or blood
Emergency requiring IV antifungals

Question 7

Nasal Granulomatosis with Polyangitis

Presentation (3) and Histology

Answer 7

Ulceration
Necrosis
Perforated nasal septum

Necrobiotic necrosis (blue haze)

Question 8

Nasopharyngeal Angiofibroma

Association and Histology

Answer 8

Familial Adenomatous Polyposis (APC gene defect)

Polypoid lesion (looks like penile tissue)

Question 9

Sinonasal Schneiderian Papilloma

Types with Behaviors (2) and Complication

Answer 9

Exophtic: expands outward
Endophytic: Expands inward and down

Endophytic can become malignant if it loses basement membrane

Question 10

Olfactory Neuroblastoma

Histology, Radiology and Ages (2)

Answer 10

Small round blue cell tumor

Dumbbell shaped tumor
If penetrating the cribiform plate

Bimodal distribution of:
Adolescents
Middle aged

Question 11

Nasopharyngeal Carcinoma

Complication, Risky Populations (3) and Diagnosis

Answer 11

Metastasis to Cervical LN’s (often first sign)

EBV
Asian smoked meats
Young African Children

EBER-1 test

Question 12

Extranodal NK/T cell Lymphoma

Presentation (3), Risk Factor, Diagnosis

Answer 12

Fever
Night sweats
Weight loss

EBV

EBER-1 test

Question 13

Vocal Cord Nodules

Populations (2), Presentation (2), Prognosis

Answer 13

Singers
Heavy smokers

Voice changes
Progressive hoarseness

No metastasis but vocal damage from surgery

Question 14

Laryngeal Squamous Papilloma

Association, Complications (2)

Answer 14

HPV 6 and 11

Recurrent respiratory papillomatosis
Leads to cystic lung disease

Question 15

Laryngeal Carcinoma

Histology (2) and Risk Factors (3)

Answer 15

Cavitated center of lesion
Keratin pearls

Smoking
Alcohol abuse (smoking/EtOH are synergistic)
HPV infection

Question 16

Otitis Media
Infectious Agents (3) and Chronic OM Associations (2)

Answer 16

Streptococcus pneumoniae
Moraxella catarrhalis
Haemophilus influenzae

Chronic otitis media:
Pseudomonas aeruginosa (in diabetics)
Cholesteatoma
squamous cyst with keratin debris

Question 17

Otosclerosis

Pathogenesis (2), Presentation and Inheritance

Answer 17

Bony deposition on footplate of stapes
Immobilizes stapes on oval window

Conductive hearing loss

Autosomal dominant

Question 18

Branchial Cysts

Derivation and Histology (3)

Answer 18

2nd branchial arch

Stratified squamous or Pseudostratified columnar Epi.
Lymphoid tissue (germinal centers

Question 19

Thyroglossal Duct Cysts

Derivation and Histology (2)

Answer 19

Pouches of thyroid tissue left behind from thyroid gland migration

Respiratory epithelium
Thyroid follicles

Question 20

Carotid Body Tumor

Derivation (2), Histological Diagnosis, Prognosis

Answer 20

Paraganglioma from neural crest

Zellballen (cell nests) seen on S-100 stain

50% fatal from infiltrative growth