Respi - URT Flashcards
Rhinitis pathogenesis
infection (rhinovirus, influenza)
necrosis of surface epithelial cells
-> exudation of fluid and mucus
- allergic rhinitis: hypersensitivity
rhinitis complication
- viral infection spread to lower RT
- > secondary bacterial infection
- formation of nasal polyps
nasal polyps
involves nasal cavity and paranasal sinuses
inflammatory
microscopy of nasal polyps
outgrowths of lamina propria: accumulation of edema fluid, inflammation and fibroblast proliferation
- inflammatory cells: neutrophils, eosinophils, lymphocytes, plasma cells
sinusitis
inflammation of paranasal sinus
- > mucosal edema
- > impaired drainage of secretions - risk of secondary infection
complication: spread to meninges
types of benign tumours of nose & paranasal sinuses
- squamous papilloma
- sinonasal papilloma
sinonasal papilloma
covered by non-keratinising squamous/ ciliated columnar/ transitional epithelium - secrete mucus + appears oncocytic
- high recurrence rate
- potentially cause bone destruction
types of malignant tumours of nose & paranasal sinuses
- squamous cell carcinoma
- transitional cell carcinoma
- adenocarcinoma
- malignant melanoma (mucosal)
tumours at the nasopharynx
- juvenile angiofibroma
- nasopharyngeal carcinoma (NPC)
juvenile angiofibroma
affects male adolescents
ulcerate -> bleeding
benign, but grows w/ puberty
NPC (nasopharyngeal carcinoma)**
+ 3 histologic types
malignant
affects southern chinese
- non-keratinising: most common - poorly differentiated, w/ many lymphocytes
- keratinising squamous cell: associated w/ smoking & alcohol
- Undifferentiated carcinoma (has an abundant, non-neoplastic lymphocytic infiltrate surrounding nests of undifferentiated neoplastic cells)** more common in SEA
NPC risk factors
- EBV infection - usually in childhood -> affects nasopharyngeal epithelium/ tonsils
- diet: salt preserved (salted fish) (Southern Chinese)
- family history (Chinese)
screening for NPC
test for EBV viral antigens - IgA
+ endoscopy
- test those w/ strong family history also
NPC symptoms
- nasal obstruction/ epistaxis (haemorrhage: nose bleed)/ nasal discharge
- diplopia: affects CN6
- potential metastasis to cervical lymph nodes
2 URT related compulsory vaccinations
DTaP: Diphtheria (corynebacterium diphtheriae) -> causes necrosis of epithelium
HIB: haemophilus influenzae -> acute epiglottitis
infection of larynx/pharynx
+ take note of special pts
- acute pharyngitis
- acute laryngitis
caused by viral infection
hoarseness, cough, tracheal soreness
*have to take special care of children!! - small airways that collapse easily -> stridor (heavy breathing sounds)
+ elderly/unconscious/debilitated - infected material cannot be coughed out -> travel downwards -> bronchopneumonia
other laryngeal diseases (3) apart from acute laryngitis
- allergic pharyngolaryngeal edema
type 1 hypersensitivity -> facial edema, bronchospasms - acute toxic laryngitis (fires)
- chronic laryngitis
heavy smokers: chronic irritation epithelium -> squamous metaplasia -> risk of dysplasia + squamous cell carcinoma
lesions of larynx
benign
- singer’s nodules: nodular thickening of vocal chords (affects singers/chronic smokers)
- laryngeal papilloma/ squamous papilloma: cause by infection by HPV
children: juvenile laryngeal papillomatosis - multiple persistent and recurrent soft papillomas
laryngeal carcinomas
+ site
malignant
- mainly squamous cell carcinoma
- site: supraglottic/ glottic/ subglottic
(glottic usually lower stage at presentation cause of poor lymphatic supply)
laryngeal carcinomas clinical presentation
polypoid/ ulcerative
locally invasive
spreads to regional lymph nodes
how EBV causes NPC
EBV infection -> increase in antibody titres - correlated w/ tumour growth and recurrence
+ clonal expansion
