Respiratory Path 1 - Galbraith

Question 1

Infectious rhinitis - pathogens

Answer 1

• Usually viral (adeno, rhino, echo)

- Can get bacterial superinfection

Question 2

Infectious rhinitis - presentation (viral and bacterial)

Prognosis?

Answer 2

• Clear, watery catarrhal secretion (runny nose) = viral
• Mucopurulent (green, thicker) = bacterial superinfection
• Self-limited (resolves with time)

Question 3

Differentiating infectious rhinitis from ALLERGIC rhinitis

Answer 3

Allergic = IgE hypersensitivity reaction

- Similar presentation otherwise

Question 4

Edematous protrusions of nasal mucosa, with a myxoid spongy core of eosinophils, lymphocytes, plasma cells, and neutrophils

Common cause?
Complication?

Answer 4

Nasal polyps

• Secondary to repeated RHINITIS episodes (often)
• Can cause OBSTRUCTION

Question 5

Protrusions of nasal mucosa lined with sinonasal pseudostratified epithelium with interspersed goblet cells

Answer 5

Nasal polyps

Question 6

Sinusitis - culprits (2)

Caused by ______

Answer 6

• Oral bacteria or allergies

- Impaired drainage of sinuses (rhinitis, blockage (polyp))

Question 7

FUNGAL sinusitis…organisms? (2)

Think what?

Answer 7

• Mucormycosis, Aspergillus

- DIABETICS or immunocompromised

Question 8

Common symptoms of sinusitis

Answer 8

Discomfort, malaise

Question 9

Sinusitis - complication?

Thus?

Answer 9

Spread into underlying tissues (bone, orbit, cranium)

MUST BE TREATED

Question 10

Common start spot for a sinusitis infection

Answer 10

Tooth infection –> spreads upward into sinus

Question 11

Red, swollen tonsils with white exudate on top (organisms?)

Answer 11

Bacterial pharyngitis/tonsillitis (group A strep, S. aureus)

Question 12

Pharyngitis/tonsillitis…most common pathogens?

Interesting thing about these pathogens?

Answer 12

Adenovirus, Echovirus, Rhinovirus

SAME ONES as in rhinitis –> can move down and cause this too

Question 13

Necrotizing lesions of URT… 3 causes?

Answer 13

• Fungal infection
• Granulomatosis with polyangiitis
• NK/T cell lymphoma (EBV)

Question 14

Male, 40-60, asian or latin american, necrotizing ulceration lesion of the upper respiratory tract

Answer 14

Aggressive (EBV) NK/T cell lymphoma

Question 15

Adolescent male (red head, fair skin)
Benign vascular tumor with stromal background in the nasal cavity

Answer 15

Nasopharyngeal angiofibroma

Question 16

Common location of nasopharyngeal angiofibroma

Answer 16

Posterolateral roof of the nasal cavity

Question 17

“Benign” nature of a nasopharyngeal angiofibroma

Thus?

Answer 17

May be locally aggressive and extend into the cranium

MUST be excised completely

Question 18

Male, 30-60

Benign tumor of the RESPIRATORY or SQUAMOUS mucosa in nasal cavity and sinuses

Answer 18

Sinonasal (Schneiderian) papilloma

Question 19

3 types of sinonasal (Schneiderian) papilloma

Answer 19

• Exophytic (growing up off mucosal surface)
• Inverted (growing down into mucosa and tissue)
• Cylindrical

Question 20

Sinonasal (Schneiderian) papilloma - pathogens

Answer 20

HPV 6, 11 (Exophytic, Inverted)

Question 21

Squamous cell-lined fronds growing downward into stromal tissue from mucosal surface

Complications?

Treatment?

Answer 21

Inverted sinonasal papilloma

Malignant extension into orbit or cranial vault

EXCISION - to prevent recurrence

Question 22

Small round blue cell tumor in superior nasal cavity

Arises from what cell layer?

Answer 22

Olfactory neuroblastoma

Neuroendocrine/neuroectoderm

Question 23

Treatment for olfactory neuroblastoma

Answer 23

Removal + chemo

Question 24

3 forms of nasopharyngeal carcinoma

Answer 24

• Keratinizing squamous cell
• Nonkeratinizing squamous cell
• Undifferentiated basaloid carcinoma (w/ lymphocytes)

Question 25

Nasopharyngeal carcinoma - populations? (2)

Answer 25

- African children | - Chinese adults

Question 26

Nasopharyngeal carcinoma - pathogen

Answer 26

EBV

Question 27

Nasopharyngeal carcinoma - treatment

Answer 27

Radiation (especially undifferentiated type)

Question 28

Nasopharyngeal carcinoma - most common other finding?

Answer 28

Nodal metastases

Question 29

Laryngeal inflammation Causes?

Answer 29

Laryngitis - Infection (children most common) - Allergy - SMOKING (adults most common)

Question 30

Childhood laryngitis...pathogens? (3) Complication?

Answer 30

- Haemophilus influenza - Respiratory syncycial virus - Group A beta-hemolytic strep Can OCCLUDE AIRWAY

Question 31

Child, laryngeal infection --> inspiratory stridor

Answer 31

Croup

Question 32

Adult laryngeal infection...complications?

Answer 32

Smoking --> squamous metaplasia and carcinoma

Question 33

Smooth, round protrusions of vascular and connective tissue covered with squamous epithelium - on the vocal cords

Answer 33

Reactive nodules

Question 34

Unilateral vs. bilateral vocal cord nodules

Answer 34

``` U/L = smoker B/L = singer (repeated vocal cord strain) ```

Question 35

Reactive nodule - complication

Answer 35

Chronic hoarseness

Question 36

Recurring squamous-lined frond(s) with fibrovascular core - on vocal cords Pathogen? Prognosis?

Answer 36

Squamous papilloma HPV 6, 11 Benign

Question 37

Male, 50s, smoker | Dysplastic squamous epithelium protruding as a mass frm the laryngeal (vocal cord) surface

Answer 37

Laryngeal carcinoma

Question 38

Laryngeal carcinoma is almost exclusively caused by ___

Answer 38

SMOKING

Question 39

Laryngeal carcinoma - presentation

Answer 39

Hoarse, pain in throat, dysphagia, hemoptysis

Question 40

Newborn, decreased breathing, small lung(s)

Answer 40

Pulmonary hypoplasia

Question 41

Unilateral vs. bilateral pulmonary hypoplasia

Answer 41

``` U/L = via congenital diaphragmatic hernia B/L = via oligohydramnios ```

Question 42

Newborn, mass of fluid lined with epithelium and smooth muscle - in the mediastinum 3 types?

Answer 42

Foregut cyst Bronchogenic, Esophageal, Enteric

Question 43

Segment of lung without connection to airway, supplied by SYSTEMIC vasculature (oxygenated)

Answer 43

Pulmonary sequestration

Question 44

Resorption atelectasis - describe

Answer 44

- Airway obstruction - Air within lung section is resorbed - Lung section collapses - Mediastinum shifts TOWARD the bad lung

Question 45

Compression atelectasis - describe

Answer 45

- Fluid, tumor, or air accumulation in pleural space - Lung section cannot expand - Mediastinum shifts AWAY from bad lung

Question 46

Contraction atelectasis - describe

Answer 46

- Pulmonary/pleural FIBROSIS - Lung cannot expand - Lung completely shrinks over time (IRREVERSIBLE)

Question 47

Intra-alveolar accumulation of fluid Alveolar are pink and granular Alveoli contain brown-colored macrophages

Answer 47

Pulmonary edema

Question 48

2 main causes of pulmonary edema

Answer 48

- Increased hemodynamic pressure in pulmonary vasculature (heart failure, volume overload, etc.) - Microvascular (alveolar) injury (toxins, drugs, gases, infections, trauma, etc.)

Question 49

Inflammation-induced vascular permeability --> diffuse pulmonary edema and rapid hypoxemia

Answer 49

Acute lung injury

Question 50

Causes of the vascular inflammation in ALI

Answer 50

- Infections - Trauma - Toxins - Hemodynamic disturbances - Pancreatitis - Urema - Immune reactios

Question 51

The damage to the endothelium in ALI is called ____

Answer 51

Diffuse alveolar damage (DAD)

Question 52

Lungs are firm, heavy, boggy, and red...with edema, hyaline membranes, and inflammatory cells

Answer 52

Acute lung injury

Question 53

Granulation tissue within the alveolar endothelium, type 2 pneumocyte hyperplasia, fibrosis

Answer 53

Organizing ("resolving") ALI/ARDS

Question 54

Potential cause of collapsing alveoli in ALI

Answer 54

Loss of type 2 pneumocytes = loss of surfactant