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Respiratory Medicine Midterm > Respiratory System Pathology 1- Galbraith lecture > Flashcards

Respiratory System Pathology 1- Galbraith lecture Flashcards

1
Q

Infectious Rhinitis

A

usually viral, self limiting:
Adenovirus
Rhinovirus
Echovirus

Nasal mucosa edematous and hyperemic
-catarrhal secretion
May get bacterial superinfection –> mucopurulent secretion

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2
Q

Allergic rhinitis

A

Hypersensitivity reaction - IgE

Nasal mucosa edematous and hyperemic
-catarrhal secretion

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3
Q

Nasal polyps

A

Edematous protrusions of nasal mucosa

prominent eosinophils, lymphocytes, plasma cells, neutrophils

can be secondary to repeated episodes of rhinitis

no link to atopy

can cause obstruction (3-4 cm)

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4
Q

Sinusitis

A

Allergic or oral cavity microbial infection

Impaired drainage - mucosal edema of rhinitis or physical blockage

Severe chronic sinusitis - caused or complicated by fungi, seen in DM its or immunocompromised

  • Mucormycosis
  • Aspergillus

Discomfort, malaise
Can spread to bone, orbit, cranial vault

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5
Q

Pharyngitis and tonsilitis

A

most commonly viral:

  • Adenovirus
  • echovirus
  • rhinovirus

Bacterial causes primary or superinfection

  • usually beta-hemolytic streptococci
  • occasionally S. aureus
  • associated with whitish exudative material overlying reddened, swollen tonsils
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6
Q

Causes of necrotizing ulceration of upper respiratory tract

A

acute fungal infection

Granulomatosis with polyangiitis

Extra nodal EK/T cell lymphoma- nasal type

  • associated with EBV
  • male, 40-50s, Asian and Latin American
  • Aggressive
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7
Q

Nasopharyngeal angiofibroma

A

Vascular tumor
Adolescent males - red-haired, fair-skinned

Arises in posterolateral roof of the nasal cavity

  • benign
  • Locally aggressive
  • extend intracranially
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8
Q

Sinonasal (Schneiderian) papilloma

A

respiratory mucosa “benign” tumor
-nasal cavity and paranasal sinuses

M>F
30-60

Subtypes:

  • Exophytic (fungating)
  • Inverted (endophytic)
  • Cylindrical

Exophytic and inverted associated with HPV 6 and 11

Epithelium respiratory or squamous

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9
Q

Inverted sinonasal papilloma

A

papillomatous growth of squamous cell-lined fronds downward from mucosal surface into underlying stromal tissue

May recur if not completely excised

May extend into orbit or cranial vault

10% malignant transformation

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10
Q

Olfactory neuroblastoma

A

esthesioneuroblastoma

neuroectoderm in superior nasal cavity

Small, round blue cell tumor

peaks at ages 15 and 50

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11
Q

Nasopharyngeal carcinoma

A

EBV related
African children, Chinese adults

May take form of:

  • Keratinizing squamous cell carcinoma
  • Nonkeratinizing squamous cell carcinoma
  • undifferentiated basaloid carcinoma with numerous tumor-associated lymphocytes

Tx: radiation

  • Keratinized carcinoma least radiosensitive
  • Undifferentiated carcinoma most radiosensitive
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12
Q

Laryngitis

A

Secondary to infection, allergy, or environmental exposure (e.g. smoke)

may compromise airway in small children

Causes:

  • RSV
  • H. influenzae
  • Beta-hemolytic streptococci
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13
Q

Reactive nodules

A

Smooth round small protrusion on true vocal cords

repeated vocal cord strain (singer’s nodules) or heavy smokers

lead to hoarseness

Benign

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14
Q

Squamous papillomas

A

Squamous-lined fronds with fibrovascular cores

Single or multiple

Children or adults

HPV 6 and 11

Benign, may recur

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15
Q

Laryngeal carcinoma

A

squamous cell carcinoma

men, 50s, smoker

Squamous hyperplasia –> dysplasia –> carcinoma

Bulky, fungating mass protruding from laryngeal surface, often with ulceration

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16
Q

Pulmonary hypoplasia

A

congenital

decreased weight, volume and acini for age/body weight

compression of lung(s) in utero - diaphragmatic hernia

If severe - fatal shortly after birth

17
Q

Foregut cyst

A

Congenital

bronchogenic, esophageal, or enteric

18
Q

Pulmonary sequestration

A

congenital

Segment of lung tissue without connection to airway
with systemic circulatory supply (not pulmonary)

19
Q

Resorption atelectasis

A

complete obstruction of an airway (FB, secretions, tumor, anything that can physically block the airway)

air within dependent lung is resorbed –> collapse

Mediastinum shifts TOWARD the affected lung

20
Q

Compression atelectasis

A

Fluid, tumor, or air accumulate within the pleural space
-prevents expansion

Mediastinum shifts AWAY from affected lung

21
Q

Contraction atelectasis

A

pulmonary or pleural fibrosis preventing normal expansion

not reversible

Mediastinum shifts TOWARD the affected lung

22
Q

Hemodynamic pulmonary edema

A

Intra-alveolar fluid accumulation
-increased hydrostatic pressure in pulmonary circulation

Basally at first

Alveolar capillaries congested
Intra-alveolar transudate seen - pink and granular

Hemosiderin-laden macrophages within alveoli (“heart failure cells”) with chronic pulmonary edema
-lungs become brown and indurated

Decreased oxygenation
Increased chance of infection

23
Q

Pulmonary edema secondary to microvascular (alveolar) injury

A

Injury to and inflammation of alveolar vascular endothelium and/or respiratory epithelium

infectious or toxic insults

localized or diffuse

24
Q

Acute lung injury - general

A

Inflammation induced vascular permeability
–> diffuse pulmonary edema and rapid onset of hypoxemia

Severe form - acute respiratory distress syndrome (ARDS)

Predisposing:
infectious agents
physical injury
toxic substances
Hemodynamic disturbances

sepsis, diffuse pulmonary infection, gastric aspiration, head trauma account for >50% of cases

25
Q

Pathogenesis of acute lung injury

A

Endothelial activation

Neutrophil accumulation and activation

Accumulation of intraalveolar fluid and hyaline membranes

Resolution of injury

26
Q

Morphology of acute lung injury

A

Diffuse alveolar damage (DAD)

Grossly: heavy, firm, wet longs

Micro: congested, interstitial and idntraalveolar edema, necrosis of Type I and Type II pneumocytes, presence of hyaline membranes, collapse of some alveoli

Resolution: granulation tissue may form and resolve, reestablishing functional tissue
-occasional interstitial scarring

27
Q

Clinical course of acute lung injury

A

depends on underlying cause and severity of lung injury

Mortality ~40%

Respiratory Medicine Midterm (11 decks)

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