Resp Path 1 - Upper Airway, Nose/Nasopharynx, Larynx, Lungs, ARDS - Galbraith Flashcards
What is this?
Nasal mucosa becomes edematous and hyperemic with catarrhal secretions. May become mucopurulent exudates induced by bacterial superinfection.
Infectious rhinitis.
What is infectious rhinitis mainly caused by and what is the tx?
- Usually viral - “the common cold”.
- Adenovirus, rhinovirus, echovirus.
- Self limiting.
What is classified as an IgE-mediated hypersensitivity reaction with clinical manifestations that can be similar to infectious rhinitis?
Allergic rhinitis
What are the prominent contents of edematous protrusions in nasal polyps?
Lymphocytes, plasma cells, neuts, and sometimes eosinophils.
When do nasal polyps occur?
- Occur with RECURRENT rhinitis (NOT atopy/allergy).
Name the rhinitis:
1) “hay fever”, IgE
2) “Common cold”, adeno/echo/rhinovirus
1) Allergic rhinitis
2) Infectious rhinitis
When do nasal polyps clinically become a problem? Tx?
- Become a problem when they reach 3-4 cm in size, causing obstruction.
- Tx is surgical removal.
What is the sequela to chronic acute rhinitis?
Chronic rhinitis - superficial mucosal ulceration with variable inflammatory infiltrates that can extend into the sinuses.
What is sinusitis commonly preceeded by?
Bugs from where cause it?
Acute or chronic rhinitis with edema that impairs sinus drainage.
- Bugs from the oral cavity cause it.
What is the Kartagener Syndrome triad?
- Sinusitis
- Bronchiectasis
- Situs inversus
The dominant effect of sinusitis and a potential dangerous complication.
- DM/immunocomp
- Dominant effect is discomfort/malaise.
- Can potentially spread to orbit or surrounding bone to cause osteomyelitis or dural venous sinus thrombophlebitis.
Two frequent concomitants of viral upper respiratory infections.
Pharyngitis and tonsillitis.
What are pharyngitis and tonsillitis primarily caused by?
1) Most commonly caused by VIRUSES (adeno, echo, rhino)
2) Bacteria
- beta-hemolytic strep
- S. aureus
What would you see in tonsillitis or pharyngitis caused by bacterial infection?
Whitish exudative material overlying reddened, swollen tonsils.
What are three causes of necrotizing lesions of the upper respiratory tract?
1) Acute fungal infection (mucormycosis in DM)
2) Granulomatosis with polyangiitis
3) **Extranodal NK/T cell lymphoma, nasal type
Extranodal NK/T cell lymphoma, nasal type:
- What type of lymphoma is it
- Associated with what
- Demographic
- Aggressive or benign
- A lymphoma of NK cells infected with EBV.
- Male, 40-50s, Asian and Latin American.
- EXTREMELY AGGRESSIVE into cranial vault or necrotic/septic.
What is a highly vascularized tumor that occurs in adolescent males with red hair and fair skin?
Nasopharyngeal angiofibroma.
Where do nasopharyngeal angiofibromas arise?
In the posterolateral roof of the nasal cavity.
Are nasopharyngeal angiofibromas aggressive or benign? Tx?
- Classified as benign, but may be LOCALLY AGGRESSIVE into the cranial vault.
- Tx is surgical excision
A male, 30-60yo has a benign neoplasm arising from squamous or respiratory or columnar epithelium. What is it?
Sinonasal (Schneiderian) Papilloma.
What are the three subtypes of this type of Sinonasal (Schneiderian) Papilloma?
1) **Exophytic (fungating)
2) **Inverted (endophytic)
3) Cylindrical (oncocytic)
HPV 6 and 11:
- What two subtypes of Sinonasal Papilloma are associated with this
- What type of papilloma is associated with it?
- Exophytic and inverted sinonasal papilloma
- Squamous papillomas
How is Inverted Sinonasal Papilloma different from non-inverted forms?
Tx?
- VERY LOCALLY AGGRESSIVE
- Tx is COMPLETE EXCISION required to prevent recurrence with potential invasion into the orbit for cranial vault.
What tumor is highly malignant and composed of neuroendocrine cells that arise from neuroectoderm in SUPERIOR NASAL CAVITY?
Olfactory neuroblastoma
What’s this?
Bimodal 15yo and 50yo.
To dx, see: enolase, synaptophysin, CD56, chromogranin
olfactory neuroblastoma
Is an olfactory neuroblastoma benign or malignant?
How is it physically described?
- Very malignant
- “small blue cell tumor”
What is the age/distinctive geographic distribution of nasopharyngeal carcinoma (3 locations)?
- EBV-related carcinoma.
- Africa = CHILDREN
- S. China = ADULTS
- USA = diet of fermented or salted fish (nitrosamines
Three forms that nasopharyngeal carcinomas? Which is most aggressive/sensitive to radiotherapy?
1) Keratinizing squamous cell (least aggressive, least sensitive).
2) Nonkeratinizing squamous
3) Undifferentiated with abundant lymphocytic infiltrate (most aggressive, most sensitive).
What bug causes a life threatening type of laryngitis in children? What does it cause?
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).
The most common form of laryngitis is encountered in people who are ____ and predisposes them to ____?
Heavy smoking»_space; predisposes to squamous epithelial metaplasia and overt carcinoma.
What are small, round protrusions on the vocal cord? What two groups of people do they occur in?
Called Reactive Nodules.
Arise due to repeated vocal cord strain (SINGERS) or HEAVY SMOKERS.
Benign, but lead to hoarseness.
What are recurring squamous lined frond(s) with fibrovascular cores on vocal cords? Pathogen? Prognosis?
Squamous papillomas (single or multiple)
HPV 6/11
BENIGN
What is the main type of laryngeal carcinoma and what demographic do you find it in?
Male smokers, 50s. Squamous cell carcinoma.
- Present with hoarseness, pain, dysphagia, hemoptysis.
How do you differentiate between squamous papillomas, reactive nodules, and laryngeal carcinoma on vocal cords?
- Squamous papillomas are smooth, nodular, bilateral.
- Papillomas are bumpier.
- Carcinoma = Bulky, fungating mass protruding from the laryngeal surface, often with ulceration.
Sequence of epithelial alteration seen in carcinoma of the larynx.
Hyperplasia»_space; atypical hyperplasia»_space; dysplasia»_space; carcinoma in situ»_space; invasive cancer
What is pulmonary hypoplasia and what is it caused by?
Diminished wt/vol/acinar # due to compression in utero.
- Unilateral small lungs (dt hernia)
- Bilateral small lungs (dt oligohydraminos)
What is a foregut cyst?
Abnormal detachment of primitive foregut - located in hilum and mediastinum.
1) Bronchogenic (most common) 2) esophageal 3) enteric
What is pulmonary sequestration
Lung tissue lacking connection to airway system.
Get blood supply from aorta instead of pulmonary artery.
What are the two types of pulmonary sequestration.
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)
What is atelectasis and what are the three types?
Incomplete lung expansion or collapse.
1) Resorption atelectasis
2) Compressive atelectasis
3) Contraction atelectasis
Resorption atelectasis
- Obstruction caused by what?
- What happens to the mediastinum?
- Reversible?
- COMPLETE obstruction of the airway»_space; mucus plug (astha, bronchitis, apiration pneumo)
- Mediastinum shifts TOWARD the affected lung.
- Reversible
Compression atelectasis
- Obstruction caused by what?
- What happens to the mediastinum?
- Reversible?
- Fluid (blood, transudate, exudate), tumor, or air (pneumothorax) accumulates within the pleural space - prevent normal expansion.
- Mediastinum shifts AWAY from the affected lung.
- Reversible
Contraction atelectasis
- Obstruction caused by what?
- What happens to the mediastinum?
- Reversible?
- Pulmonary or pleural FIBROSIS prevents normal expansion
- NOT REVERSIBLE
What type of atelectasis would effusions from HF/neoplasms, or a pneumothorax result in?
Compressive
What type of atelectasis would mucus plugs, foreign body aspiration, or bronchial neoplasms cause?
Resorption
Types of pulmonary edema
1) hemodynamic pulmonary edema
2) edema secondary to microvascular (alveolar) injury
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.
Hemodynamic pulmonary edema.
“pushing fluid out”
Decreased o2 in Hemodynamic pulmonary edema leads to increased chance of what?
Infection.
What is acute lung injury?
(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.
What 4 conditions are associated with development of ARDS in 50% of cases?
1) Sepsis
2) Diffuse pulmonary infection (mycoplasma, Pneumocytis, viral)
3) Gastric aspiration
4) Head trauma
Pathogenesis of ARDS - 4 steps.
1) endothelial activation
2) neut accumulation and activation
3) accumulation of intraalveolar and hyaline membranes
4) resolution of injury.
DAD is a histological manifestation for what?
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.
Combined endothelial and epithelial assault in ARDS culminates in what?
Increases vascular permeability and LOSS OF SURFACTANT»_space; alveoli stiff and resistant to expansion.
What clinical course is this describing:
Dyspnea, tachypnea, cyanosis, hypoxemia, respiratory failure refractory to oxygen therapy.
ALI/ARDS
What does follicular tonsillitis look like? What is it caused by?
Pinpoint exudate emanating from tonsillar crypts.
Caused by bacterial infection superimposed on viral infection.
Most important sequelae of streptococcal “sore throats”
Rheumatic Fever and Glomerulonephritis
What cancer is this?
BRD4-NUT, very aggressive, any age, nasopharynx, salivary gland, midline structures in thorax or abdomen
NUT Midline Carcinoma
What is pulmonary edema?
Leakage of excessive interstitial fluid which accumulates in alveolar spaces.
What is noncardiogenic pulmonary edema often due to?
Injury to the alveolar septa, causing INCREASED CAPILLARY PERMEABILITY.
What can alveolar edema cause?
ARDS
