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Respiratory Medicine Exam I > Upper Airway & Lung Pathology > Flashcards

Upper Airway & Lung Pathology Flashcards

1
Q

Viral causes of infectious rhinitis/sinusitis

A

Rhinovirus
Coronavirus

Less commonly adenovirus and echovirus

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2
Q

Primary clinical manifestation of infectious rhinitis in viral vs. bacterial etiology

A

Viral = clear rhinorrhea

Bacterial = thick, purulent nasal secretions

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3
Q

Bacterial rhinitis/sinusitis is typically due to a superimposed infection following a viral illness. What are some common bacterial etiologies?

A

Streptococcus pneumoniae

Haemophilus influenzae

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4
Q

Allergic rhinitis/sinusitis can be from a variety of allergens that are inhaled - typically pollens, mold, or animal dander. What type of hypersensitivity reaction is it and what are some clinical features?

A

Type I hypersensitivity reaction — inflammatory infiltrate with eosinophils

Clinical features: edema, rhinorrhea (differentiate from viral illness based on history and exposures)

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5
Q

Chronic rhinitis/sinusitis may lead to inflammatory sinonasal _____

A

Polyps

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6
Q

Inflammatory sinonasal polyps are characterized by _____ in the stroma, with ______ infiltrates

A

Edema; eosinophilic

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7
Q

Sinusitis may lead to obstruction due to _____, which is a collection of inflammatory fluid, or ______ which is a respiratory epithelium-lined cyst that is closed off from the rest of the respiratory tract and can eventually erode bone around the sinus

A

Empyema; mucocele

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8
Q

Pathways of infection leading to sinusitis

A

Typically due to inhalation of bacteria

Can also enter maxillary sinus by tracking along periapical tissues (oral flora)

Advanced sinusitis can secondarily spread based on anatomic relationships with surrounding structures

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9
Q

Maxillary sinusitis is associated with what complications?

A

Osteomyelitis

Mucocele

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10
Q

Ethmoid sinusitis is associated with what complications?

A 
Mucocele
Preseptal cellulitis
Orbital cellulitis
Subperiosteal abscess
Orbital abscess
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11
Q

Frontal sinusitis is associated with what complications?

A 
Osteomyelitis
Mucocele
Meningitis
Epidural abscess
Orbital cellulitis (more common with ethmoid)
Subdural abscess
Brain abscess
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12
Q

Sphenoid sinusitis is associated with what complication?

A

Mucocele

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13
Q

Allergic fungal sinusitis occurs as a result of hypersensitivity to fungal organisms like _____ that have colonized the sinus tract. Histologic features include allergic mucin which forms an aggregate composed of ______ on a background of mucus; there may also be a ______ which is a fungal ball of hyphae

A

Aspergillus; eosinophils; mycetoma

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14
Q

Acute invasive fungal sinusitis typically occurs in ____ or _____ patients, and is often due to _____ species. It is an emergent situation requiring IV amphotericin to prevent extension into the brain or sepsis.

A

Diabetic; immunosuppressed; zygomycosis (mucor)

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15
Q

Granulomatosis with Polyangiitis (Wegener granulomatosis) can affect the nasal passages, sinuses, lungs, and kidneys. What age group is typically affected, and what are the typical manifestations affecting the nasal passages and sinuses?

A

Typically middle aged adults

Nasal passages and sinuses: ulceration, necrosis, possible perforation of septum

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16
Q

Histologic findings with Granulomatosis with polyangiitis

A

Granulomatous inflammation/vasculitis

Classic “necrobiotic” necrosis — evidence of severe destruction!

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17
Q

2 types of benign (although potentially aggressive) tumors of the nose, sinuses, and nasopharynx

A

Nasopharyngeal angiofibroma

Sinonasal (schneiderian) papilloma

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18
Q

4 types of malignant tumors of the nose, sinuses, and nasopharynx

A

Olfactory neuroblastoma

NUT midline carcinomas

EBV-related: Nasopharyngeal carcinoma, extranodal NK/T cell lymphoma

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19
Q

Describe nasopharyngeal angiofibroma in terms of age/gender affected, histologic findings, and major clinical association

A

Nasopharyngeal polypoid mass occurring in young men

Histologically: vascular fibrous core lined by benign epithelium

Associated with familial adenomatous polyposis (FAP)

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20
Q

Describe sinonasal (shneiderian) papilloma in terms of age/gender affected and different types

A

Middle aged, men > women

3 types:
Exophytic
Endophytic
Oncocytic

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21
Q

What subtype of sinonasal (schneiderian) papilloma has highest rate of recurrence and the minority (10%) of cases may progress to malignancy?

A

Endophytic subtypes

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22
Q

Which upper respiratory tumor is referred to as the “small round blue cell tumor (SRBCT)”?

A

Olfactory neuroblastoma

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23
Q

Olfactory neuroblastoma arises from _____ in the superior nasal passage. There is a bimodal distribution with a peak in incidence in ______, then another with _____ ____

A

Neuroectoderm; adolescence; middle age

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24
Q

What upper respiratory tumor may appear on histology with “rosettes” or characterized as “dumb-bell” shaped tumor due to penetration through the cribriform plate?

A

Olfactory neuroblastoma

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25
Q

Rare tumor that may occur at any age (median 22 years) and at any midline location, morphologically characterized as a small round blue cell tumor with squamous nests

A

NUT (midline) carcinoma

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26
Q

The NUT carcinoma is defined by rearrangement of the _____ gene and positive staining for the NUT protein. It is highly aggressive and most die within ______ from metastasis

A

NUTM1; 1 year

27
Q

3 types of nasopharyngeal carcinoma

A

Essentially a squamous carcinoma:

  1. Keratinizing
  2. Non-keratinizing
  3. Basophilic with lymphoid tissue (formerly lymphoepithelioma)
28
Q

Nasopharyngeal carcinoma arises in the nasopharynx, but the majority of cases present where?

A

In the neck - d/t lymph node metastasis

29
Q

Risk factors for nasopharyngeal carcinoma

A

Hereditary
Age
EBV

Chinese/Southeast Asian adults higher risk d/t ingestion of smoked fish with nitrosamines, EBV to lesser degree

Young African children higher risk, usually EBV-related

30
Q

EBV-related tumor with increased incidence in Asia and Latin America that may occur at any age, but peaks in incidence at middle age; can cause necrotic destruction of paranasal sinuses

A

Extranodal NK/T cell lymphoma

31
Q

Typical presentation of extranodal NK/T cell lymphoma

A

Typically does not present until systemic spread has begun - presents with constitutional sx like fever, night sweats, weight loss

[prognosis can be variable, depends on stage and symptoms]

32
Q

Describe pathology, gross appearance, and histology associated with vocal cord nodules

A

Expansions of soft tissue underlying the vocal fold (Rienke’s space)

Grossly: soft and translucent

Histology: edema and loose stroma underlying benign squamous epithelium

[NOT a neoplasm!!]

33
Q

Laryngeal squamous papilloma is a benign squamous neoplasm with papillary appearance. It has a strong association with _____________; it can be solitary or in assocation with _____________________

A

HPV types 6 and 11; recurrent respiratory papillomatosis

34
Q

Gross and histologic appearance of laryngeal squamous papilloma

A

Grossly: friable papillary masses

Histologically: benign or mildly atypical squamous epithelium with multiple papillae

35
Q

Who is typically affected by recurrent respiratory papillomatosis?

A

Typically children and adolescents

Associated with HPV 6 and 11, thought to be acquired during childbirth; risk factors include mothers <20, vaginal delivery, first-born

Can diffusely involve the lungs, causing obstruction

Malignant progression is rare (<1%)

36
Q

Laryngeal carcinoma is a squamous carcinoma. Who is most commonly affected by laryngeal carcinoma? What are 3 major risk factors?

A

Most commonly seen in men >60

Strong association with smoking, alcohol, and HPV infection

[alcohol and smoking are synergistic risk factors!]

37
Q

3 most common pathogens implicated in otitis media

A

Streptococcus pneumoniae

Moraxella catarrhalis

Haemophilus influenzae

38
Q

Chronic otitis media in diabetics is typically caused by what pathogen?

A

Pseudomonas aeruginosa

39
Q

Cystic lesion that arises in chronic otitis media, lined by benign squamous epithelium with trapped keratin debris; a reactive process that is NOT neoplastic but can enlarge and erode adjacent bone

A

Cholesteatoma

40
Q

Abnormal bony deposition, typically at stapedial footplate

A

Otosclerosis

41
Q

Primary complication of otosclerosis

A

Conductive hearing loss (surgically curable!)

42
Q

Otosclerosis appears to be familial, with a __________ inheritance pattern

A

Autosomal dominant

43
Q

Branchial cysts most often affect young adults. They most frequently arise from the _____ branchial arch. Histologically, they are simple cysts lined by ____ ____ or respiratory epithelium with surrounding fibrous tissue, +/- lymphoid tissue

A

2nd; stratified squamous

44
Q

If an infant, child, or adolescent presents with a cystic tumor of the neck, the most common diagnosis is _____________, but if it is an adult presenting similarly, the most common diagnosis is ___________

A

Thyroglossal duct cyst; metastatic cystic carcinoma

45
Q

Remnant nests of tissue from thyroid migration with cystic change [basically thyroid follicles with respiratory lining]

A

Thyroglossal duct cyst

46
Q

Carotid body tumors are tumors of _________ origin, arising from autonomic ______

A

Neural crest; paraganglia

[carotid body tumors = parasympathetic paragangliomas; can also get a paravertebral paraganglioma]

47
Q

Parasympathetic paragangliomas may arise sporadically, or may be associated with _____

A

Multiple endocrine neoplasia 2 (MEN2)

48
Q

Characteristic histology and prognosis of carotid body tumors

A

Nests of cells [balls of cells = “zellballen”] - demonstrated with S-100 stain highlighting supporting (sustentacular) cells

Prognosis: 15-40% will be malignant (note that histology cannot tell the difference); fatality may be linked to metastasis or local invasion

49
Q

What are the major requirements for normal fetal lung development?

A

Space in the thoracic cavity (lungs are soft and cannot push their way into adjacent structures to make room)

Ability to inhale: depends on ability of chest wall to move, as well as enough amniotic fluid present to inhale

50
Q

Normal alveolar structure consists of capillaries with associated endothelium, as well as basement membrane with interstitium. The alveolar epithelium consists of 2 cell types: what are the functions of the 2 major cell types?

A

Type 1 pneumocytes — facilitate gas exchange

Type 2 pneumocytes — produce surfactant and replace type 1 pneumocytes

51
Q

What part of normal alveolar structure allows bacteria/cells/exudate to travel between alveoli?

A

Alveolar pores (of Kohn)

52
Q

Congenital anomaly characterized by small, underdeveloped lungs

A

Pulmonary hypoplasia

53
Q

Congenital anomaly characterized by simple cysts typically derived from mediastinal elements

A

Foregut cysts

54
Q

Congenital anomaly characterized by intrapulmonary cystic malformation with connection to tracheobronchial airways and pulmonary vasculature

A

Congenital pulmonary adenomatoid malformation (CPAM/CCAM)

55
Q

Congenital anomaly characterized by intra- or extra-pulmonary lung tissue with NO connection to pulmonary vasculature or tracheobronchial tree

A

Pulmonary sequestration

56
Q

Potential causes and prognosis associated with pulmonary hypoplasia

A

Causes: reduced space in thoracic cavity (i.e., diaphragmatic hernia), impaired ability to inhale (i.e., oligohydramnios/renal agenesis, chest wall motion disorders)

High mortality (up to 95%); if lung weight is <40%, immediate death occurs in neonatal period

57
Q

Foregut cysts are detached outpouchings of foregut, typically seen along _____ and _______. They can be respiratory, esophageal, or gastroenteric. Often seen incidentally, and excision is curative

A

Hilum; mediastinum

58
Q

Complications of foregut cysts

A

Rupture
Infection
Airway compression

59
Q

CPAM or CCAM is caused by a halt in the development of pulmonary tissue with formation of intrapulmonary cystic masses. What are the 5 types?

A

5 types are designated based on stage of arrest

Type 0: tracheobronchial
Type 1: bronchial
Type 2: bronchiolar
Type 3: alveolar duct
Type 4: distal acinar
60
Q

Detection and prognosis of CPAM/CCAM

A

Can be detected on fetal US

Can be deadly due to hydrops or pulmonary hypoplasia; also can get infected later in life

61
Q

Pulmonary sequestrations are nonfunctioning lung tissue that forms as aberrant accessory lung bud, typically in the region of the ___________. They are characterized by lack of connection to the _________, and independent ________ supply.

They may be intralobar or extralobar based on whether the budding occurs before or after the ______ is established

A

Left lower lobe; tracheobronchial tree; arterial (systemic)

Pleura

62
Q

What type of sequestration may present in older children and adults and often results in infection and abscess formation due to lack of airway perfusion?

A

Intralobar pulmonary sequestration (ILS)

63
Q

What type of sequestration usually presents after birth with other congenital anomalies, may have airways and pleura, and often come to attention as mass lesions in chest or abdomen?

A

Extralobar pulmonary sequestration (ELS)

Respiratory Medicine Exam I (9 decks)

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