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MED234 Respiratory > Resp Path 1 - Upper Airway, Nose/Nasopharynx, Larynx, Lungs, ARDS - Galbraith > Flashcards

Resp Path 1 - Upper Airway, Nose/Nasopharynx, Larynx, Lungs, ARDS - Galbraith Flashcards

1
Q

What is this?
Nasal mucosa becomes edematous and hyperemic with catarrhal secretions. May become mucopurulent exudates induced by bacterial superinfection.

A

Infectious rhinitis.

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2
Q

What is infectious rhinitis mainly caused by and what is the tx?

A
  • Usually viral - “the common cold”.
    • Adenovirus, rhinovirus, echovirus.
  • Self limiting.
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3
Q

What is classified as an IgE-mediated hypersensitivity reaction with clinical manifestations that can be similar to infectious rhinitis?

A

Allergic rhinitis

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4
Q

What are the prominent contents of edematous protrusions in nasal polyps?

A

Lymphocytes, plasma cells, neuts, and sometimes eosinophils.

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5
Q

When do nasal polyps occur?

A
  • Occur with RECURRENT rhinitis (NOT atopy/allergy).
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6
Q

Name the rhinitis:

1) “hay fever”, IgE
2) “Common cold”, adeno/echo/rhinovirus

A

1) Allergic rhinitis

2) Infectious rhinitis

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7
Q

When do nasal polyps clinically become a problem? Tx?

A
  • Become a problem when they reach 3-4 cm in size, causing obstruction.
  • Tx is surgical removal.
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8
Q

What is the sequela to chronic acute rhinitis?

A

Chronic rhinitis - superficial mucosal ulceration with variable inflammatory infiltrates that can extend into the sinuses.

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9
Q

What is sinusitis commonly preceeded by?

Bugs from where cause it?

A

Acute or chronic rhinitis with edema that impairs sinus drainage.
- Bugs from the oral cavity cause it.

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10
Q

What is the Kartagener Syndrome triad?

A
  1. Sinusitis
  2. Bronchiectasis
  3. Situs inversus
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11
Q

The dominant effect of sinusitis and a potential dangerous complication.

A
  • DM/immunocomp
  • Dominant effect is discomfort/malaise.
  • Can potentially spread to orbit or surrounding bone to cause osteomyelitis or dural venous sinus thrombophlebitis.
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12
Q

Two frequent concomitants of viral upper respiratory infections.

A

Pharyngitis and tonsillitis.

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13
Q

What are pharyngitis and tonsillitis primarily caused by?

A

1) Most commonly caused by VIRUSES (adeno, echo, rhino)
2) Bacteria
- beta-hemolytic strep
- S. aureus

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14
Q

What would you see in tonsillitis or pharyngitis caused by bacterial infection?

A

Whitish exudative material overlying reddened, swollen tonsils.

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15
Q

What are three causes of necrotizing lesions of the upper respiratory tract?

A

1) Acute fungal infection (mucormycosis in DM)
2) Granulomatosis with polyangiitis
3) **Extranodal NK/T cell lymphoma, nasal type

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16
Q

Extranodal NK/T cell lymphoma, nasal type:

  • What type of lymphoma is it
  • Associated with what
  • Demographic
  • Aggressive or benign
A
  • A lymphoma of NK cells infected with EBV.
  • Male, 40-50s, Asian and Latin American.
  • EXTREMELY AGGRESSIVE into cranial vault or necrotic/septic.
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17
Q

What is a highly vascularized tumor that occurs in adolescent males with red hair and fair skin?

A

Nasopharyngeal angiofibroma.

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18
Q

Where do nasopharyngeal angiofibromas arise?

A

In the posterolateral roof of the nasal cavity.

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19
Q

Are nasopharyngeal angiofibromas aggressive or benign? Tx?

A
  • Classified as benign, but may be LOCALLY AGGRESSIVE into the cranial vault.
  • Tx is surgical excision
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20
Q

A male, 30-60yo has a benign neoplasm arising from squamous or respiratory or columnar epithelium. What is it?

A

Sinonasal (Schneiderian) Papilloma.

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21
Q

What are the three subtypes of this type of Sinonasal (Schneiderian) Papilloma?

A

1) **Exophytic (fungating)
2) **Inverted (endophytic)
3) Cylindrical (oncocytic)

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22
Q

HPV 6 and 11:

  • What two subtypes of Sinonasal Papilloma are associated with this
  • What type of papilloma is associated with it?
A
  • Exophytic and inverted sinonasal papilloma

- Squamous papillomas

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23
Q

How is Inverted Sinonasal Papilloma different from non-inverted forms?
Tx?

A
  • VERY LOCALLY AGGRESSIVE

- Tx is COMPLETE EXCISION required to prevent recurrence with potential invasion into the orbit for cranial vault.

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24
Q

What tumor is highly malignant and composed of neuroendocrine cells that arise from neuroectoderm in SUPERIOR NASAL CAVITY?

A

Olfactory neuroblastoma

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25
Q

What’s this?
Bimodal 15yo and 50yo.
To dx, see: enolase, synaptophysin, CD56, chromogranin

A

olfactory neuroblastoma

26
Q

Is an olfactory neuroblastoma benign or malignant?

How is it physically described?

A
  • Very malignant

- “small blue cell tumor”

27
Q

What is the age/distinctive geographic distribution of nasopharyngeal carcinoma (3 locations)?

A
  • EBV-related carcinoma.
  • Africa = CHILDREN
  • S. China = ADULTS
  • USA = diet of fermented or salted fish (nitrosamines
28
Q

Three forms that nasopharyngeal carcinomas? Which is most aggressive/sensitive to radiotherapy?

A

1) Keratinizing squamous cell (least aggressive, least sensitive).
2) Nonkeratinizing squamous
3) Undifferentiated with abundant lymphocytic infiltrate (most aggressive, most sensitive).

29
Q

What bug causes a life threatening type of laryngitis in children? What does it cause?

A

H. INFLUNEZA causes laryngoepiglottitis that can be life threatening due to airway obstruction from rapid onset mucosal edema. This is called CROUP.
(Also: Respiratory Syncytial Virus, B-hemolytic strep).

30
Q

The most common form of laryngitis is encountered in people who are ____ and predisposes them to ____?

A

Heavy smoking&raquo_space; predisposes to squamous epithelial metaplasia and overt carcinoma.

31
Q

What are small, round protrusions on the vocal cord? What two groups of people do they occur in?

A

Called Reactive Nodules.
Arise due to repeated vocal cord strain (SINGERS) or HEAVY SMOKERS.
Benign, but lead to hoarseness.

32
Q

What are recurring squamous lined frond(s) with fibrovascular cores on vocal cords? Pathogen? Prognosis?

A

Squamous papillomas (single or multiple)

HPV 6/11

BENIGN

33
Q

What is the main type of laryngeal carcinoma and what demographic do you find it in?

A

Male smokers, 50s. Squamous cell carcinoma.

- Present with hoarseness, pain, dysphagia, hemoptysis.

34
Q

How do you differentiate between squamous papillomas, reactive nodules, and laryngeal carcinoma on vocal cords?

A
  • Squamous papillomas are smooth, nodular, bilateral.
  • Papillomas are bumpier.
  • Carcinoma = Bulky, fungating mass protruding from the laryngeal surface, often with ulceration.
35
Q

Sequence of epithelial alteration seen in carcinoma of the larynx.

A

Hyperplasia&raquo_space; atypical hyperplasia&raquo_space; dysplasia&raquo_space; carcinoma in situ&raquo_space; invasive cancer

36
Q

What is pulmonary hypoplasia and what is it caused by?

A

Diminished wt/vol/acinar # due to compression in utero.

  • Unilateral small lungs (dt hernia)
  • Bilateral small lungs (dt oligohydraminos)
37
Q

What is a foregut cyst?

A

Abnormal detachment of primitive foregut - located in hilum and mediastinum.
1) Bronchogenic (most common) 2) esophageal 3) enteric

38
Q

What is pulmonary sequestration

A

Lung tissue lacking connection to airway system.

Get blood supply from aorta instead of pulmonary artery.

39
Q

What are the two types of pulmonary sequestration.

A

1) Extralobal - outside the lungs (dx in infancy, presents as a mass)
2) Intralobar - within lung parenchyma (dx in older children, presents as recurrent localized infection)

40
Q

What is atelectasis and what are the three types?

A

Incomplete lung expansion or collapse.

1) Resorption atelectasis
2) Compressive atelectasis
3) Contraction atelectasis

41
Q

Resorption atelectasis

  • Obstruction caused by what?
  • What happens to the mediastinum?
  • Reversible?
A
  • COMPLETE obstruction of the airway&raquo_space; mucus plug (astha, bronchitis, apiration pneumo)
  • Mediastinum shifts TOWARD the affected lung.
  • Reversible
42
Q

Compression atelectasis

  • Obstruction caused by what?
  • What happens to the mediastinum?
  • Reversible?
A
  • Fluid (blood, transudate, exudate), tumor, or air (pneumothorax) accumulates within the pleural space - prevent normal expansion.
  • Mediastinum shifts AWAY from the affected lung.
  • Reversible
43
Q

Contraction atelectasis

  • Obstruction caused by what?
  • What happens to the mediastinum?
  • Reversible?
A
  • Pulmonary or pleural FIBROSIS prevents normal expansion

- NOT REVERSIBLE

44
Q

What type of atelectasis would effusions from HF/neoplasms, or a pneumothorax result in?

A

Compressive

45
Q

What type of atelectasis would mucus plugs, foreign body aspiration, or bronchial neoplasms cause?

A

Resorption

46
Q

Types of pulmonary edema

A

1) hemodynamic pulmonary edema

2) edema secondary to microvascular (alveolar) injury

47
Q

What type of pulmonary edema is this describing:
Pink/granular intra alveolar transudate. Lungs wet+heavy w/basal fluid accumulation first. Lungs become brown and first due to interstitial fibrosis and hemosiderin laden macrophages.

A

Hemodynamic pulmonary edema.

“pushing fluid out”

48
Q

Decreased o2 in Hemodynamic pulmonary edema leads to increased chance of what?

A

Infection.

49
Q

What is acute lung injury?

A

(aka, noncardiogenic pulmonary edema)

  • Inflammation-induced vascular permeability, leading to diffuse pulmonary edema and rapid hypoxemia onset, in the ABSENCE of HF
  • ARDS is severe ALI.
50
Q

What 4 conditions are associated with development of ARDS in 50% of cases?

A

1) Sepsis
2) Diffuse pulmonary infection (mycoplasma, Pneumocytis, viral)
3) Gastric aspiration
4) Head trauma

51
Q

Pathogenesis of ARDS - 4 steps.

A

1) endothelial activation
2) neut accumulation and activation
3) accumulation of intraalveolar and hyaline membranes
4) resolution of injury.

52
Q

DAD is a histological manifestation for what?

A

ALI/ARDS (DAD=Diffuse Alveolar Damage).

  • Gross - heavy, wet, firm lung
  • Micro - congested, interstitial and intraalveolar edema, necrosis, hyaline membranes. Hyaline membrane presence. Collapse of some alveoli.
53
Q

Combined endothelial and epithelial assault in ARDS culminates in what?

A

Increases vascular permeability and LOSS OF SURFACTANT&raquo_space; alveoli stiff and resistant to expansion.

54
Q

What clinical course is this describing:

Dyspnea, tachypnea, cyanosis, hypoxemia, respiratory failure refractory to oxygen therapy.

A

ALI/ARDS

55
Q

What does follicular tonsillitis look like? What is it caused by?

A

Pinpoint exudate emanating from tonsillar crypts.

Caused by bacterial infection superimposed on viral infection.

56
Q

Most important sequelae of streptococcal “sore throats”

A

Rheumatic Fever and Glomerulonephritis

57
Q

What cancer is this?

BRD4-NUT, very aggressive, any age, nasopharynx, salivary gland, midline structures in thorax or abdomen

A

NUT Midline Carcinoma

58
Q

What is pulmonary edema?

A

Leakage of excessive interstitial fluid which accumulates in alveolar spaces.

59
Q

What is noncardiogenic pulmonary edema often due to?

A

Injury to the alveolar septa, causing INCREASED CAPILLARY PERMEABILITY.

60
Q

What can alveolar edema cause?

A

ARDS

MED234 Respiratory (15 decks)

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