URT pathology Flashcards by Harriet Agnew

What anatomy forms the URT?

Nose
Naso-pharynx
Larynx
Paranasal sinueses
Eustachian tube
Middle ear

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What defence mechanisms does the URT have?

filtration of 10-20,000L air per day 
Muco-cillary transport system 
Cough/sneeze/gag/swallow reflex 
Richly vascularised/erectile 
MALT (Waldeyer's ring)
White blood cells and IgA secretion

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What conditions have abnormal muco-ciliary transport system?

PCD
Kartagener’s syndrome
bronchiectasis
infertility

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What are the causes of acute rhinitis?

viruses, bacteria, allergens (season and perennial vasomotor rhinitis), occasionally fungi

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What are the effects of acute rhinitis (common cold)?

inflammation- congested, oedematous, rhinorrhoea - watery or mucoid or muco-purulent

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What happens in chronic rhinitis?

atrophy of mucous glands and surface epithelium, squamous metaplasia, fibrosis

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What is atopic or allergic rhinitis?

hayfever
- caused by allergens and mediated by type I and type III hypersensitivity reactions - may be associated with eczema and asthma

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What are nasal polyps?

result from either chronic infective or allergic inflammation
= polypoid oedematous masses of connective tissue infiltration by chronic inflammatory cells esp lymphocytes, plasma cells and eosinophil polymorphs
usually bilateral or inverted papilloma

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What are the causes and effects of acute sinusitis

Usually a complication of acute rhinitis with blocking of the ostium. Less commonly due to dental sepsis.
May get secondary bacterial infection.
same causes a rhinitis

effects: mucocoele or empyema, orbital cellulitis, osteomyelitis, meningitis, cerebral abscess

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What can chronic sinusitis cause?

nasal and naso-sinal polyps

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What are the acute causes of pharyngitis?

viruses
bacteria
e.g haemophilus, diphtheria, TB, gonnorhoea, fungi

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What are the effects of acute pharyngitis?

tonsilitis
retropharyngeal abscess
peritonisillar abscess
cervical adenitis
parapharyngeal abscess
ludwig's angina

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What is chronic sinusitis?

continuing irritation from another source

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What is granulomatosis with polyangiitis (GPA, wegener’s granulomatosis)?

cardinal triad

giant cell transformation
arteritis/phlebitis
zonal necrosis with karyorrhexis/leukocytoclasis

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What are the different organs/systems that GPA affects?

nose and paranasal sinuses
Lungs
kidneys (75%)
other organs - isolated or systemic

limited form = lungs only

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What are the signs and symptoms of GPA and who does it usually affect?

Symptoms = numerous and varied based on the fact its a multi system disease

Signs:
- ulcers, sores crusting in and around the nose, with destruction of nasal cartilage, rhinorrhoea, often bloody
subglottic stenosis (20%) causing hoarseness, stridor, dyspnoea or cough
chronic ear infections
haemoptysis
haematuria

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What investigations should be carried out for GPA?

FBC, ESR, U&amp;Es
Anti-neutrophil antibodies (C-ANCA, P-ANA (90%)) - low specificity
Urinanalysis- protein, blood, casts 
Nasal endoscopy 
Lung function tests 
CXR 
Biopsy

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What are the treatments for GPA?

Drugs
- steroids, cyclophosphamide, methotrexate, azothioprine, cyclosporin,TNF trials
Surgery

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What are the complications and prognosis of GPA?

Complications:

mechanical = nasal septum perforation/deformity, airway stenosis
Functional = respiratory failure, renal failure

Prognosis
- untreated: 50% mortality at 5 yrs
- treated: 90% will achieve long term remission
renal function determinant

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What is necrotising midline granuloma?

includes:
non-heating granuloma 
midline granuloma 
granuloma ganrenescens 
lethal granuloma = Rare condition with progressive destruction of nose, nasal sinuses and adjacent structures - encompasses a number of entities, some cases of which are non-Hodgkin’s lymphoma T cell type

What is an inverted papilloma and what are the causes and which people are susceptible?

transitional papilloma
ringertz tumour
schneiderian papilloma = nose and paranasal sinuses derived from ectoderm but description encompasses inverted cyclindric cells and exophytic histological patterns which behave differently

5:1 in males
40-70 year olds

cause is unknown - ? smoking, chemical pollutants, allergens, chronic sinusitis, HPV (6/11)

What are the differential diagnoses for inverted papilloma?

inflammatory nasal polyp 
fungiform/exophytic papilloma 
cyclindric cell/oncocytic papilloma 
verruca vulgaris 
carcinoma

What is the natural history of inverted papilloma?

recurrence rate = 40-60%
malignant change up to 53%
multicentric 
synchronous or metachornous 
pre-malignant potential - dysplasia, SCC, adenocarcinoma, MEC

How is inverted papilloma treated?

surgery = endoscopic vs en bloc

continued long term surveillance

Which people are more susceptible to SCC and what are the causes?

about 70 yrs- uncommon under 40 M:F = 1.5: 1 - 2:1 24% tumours of nose and paranasal sinuses more common in japan and south africa Cause: unknown - smoking, chemical pollutants, snuff, various occupations, HPV

What are the signs and symptoms of SCC?

``` Blocked nose and sinuses Epistaxis Pain behind nose or upper teeth swelling around the eyes numb cheeks, upper lip, uper teeth, side of node headache speech change diplopia/telecanthus ```

What investigations are for SCC?

``` XR CT scan MRI scan Nasal endoscopy Biopsy ```

What are the treatments for SCC?

``` depends on: site, stage, grade general health Surgery (+/- reconstruction/prosthetics) Radiotherapy occasionally chemo GF receptor antagonists cyclin kinase inhibitors photodynamic therapy oncolytic viruses vaccines ```

What is the prognosis for SCC?

Dependent on site, stage, and grade - further back the site the worse the prognosis carcinoma of nasal vestibule = 78% survival 5 years carcinoma of nasal cavity= 56% survival 5 years Carcinoma of paranasal sinuses = 24% survival at 5 years

What are the causes of adenocarcinoma?

wood workers, furniture makers, chromate exposure intestinalised pattern is indistinguishable morphologically and immunophenotypically from metastatic colo-rectal adenocarcinoma artificial distinction between surface mucosal versus minor SG origin

Who is susceptible to juvenille (nasal) angiofibroma?

pre-pubertal and adolescent periods - usually 7-19 rare after 25 yrs always males

What are the aetiologies of JNA?

Originates in close proximity to the posterior attachment of the middle turbinate near the superior border of the speno-palatine foramen hormonal therapy- increasing testosterone

What are the signs and symptoms of JNA?

Nasal obstruction epistaxis headaches facial swelling nasal mass orbital mass proptosis

What investigations are carried out for JNA?

XR CT scan MRI scan Angiography

What are the treatments for JNA?

Surgery | pre-operative embolisation - coils, pva, onyx, sclerosant

What are the causes of nasopharyngeal carcinoma and what are the causes?

age 50-60 M:F = 2:1 infrequent in EU and NA, common in china, malaysia, indonesia and east africa Aetiology: dietary factors e.g.nitrosamines, EBV, HLA A2

What are the symptoms and signs of NPC?

``` Blocked nose telecanthus epistaxis deafness tinnitus lymphadenopathy ```

What does the NPC do?

the neoplasm blocks the eustachian tube causing secretory otitis media or glue ear with conduction deafness

What are the investigations for NPC?

``` CXR CT scan MRI scan Bone scan Nasal endoscopy Biopsy - ebv, lmp-1 in situ EBERs ```

What is the treatment for NPC and prognosis?

depends on stage and grade radiotherapy - external and internal chemotherapy surgery - lymph nodes in neck recurrences dependent on stage and grade

What are some other examples of nasopharyngeal tumours?

``` rhabdomyosarcoma lymphoma (T cell and B cell NHL) sino-nasal undifferentiated carcinoma malignant adult teratoma olfactory neuroblastoma malignant melanoma peripheral neuroectodermal tumour small cell undifferentiated carcinoma midline NUT carcinoma ```

What are the causes and complications of diphtheria?

corynebacterium, diptheria, exotoxin formation psuedomembrane coagulum of deadcells, fibrin, inflammatory cells and bacteria death due to asphyxia or renal or cardiac failure

What are the treatments for diphtheria?

antibiotics antitoxin vaccine - toxoid, DTP immunisation

What are examples of acute inflammation of the URT?

Acute epiglottis acute laryngo-tracheobronchitis allergic laryngitis/angio-oedema diptheritic laryngitis

What are the causes of TB and what are the other differential diagnoses?

mycobacterium TB (acid alcohol fast bacilus) differentials: other granulomatous conditions (equally rare) and carcinoma

What investigations for TB should be carried out?

``` CXR sputum - microscopy and culture laryngoscopy biopsy tuberculin skin test interferon gamma release assays ```

What are the treatments for tb?

antibiotics - anti-tuberculosis therapy regime | resistant strains

What are the causes of vocal cord polyp/laryngeal nodule ?

``` vocal cord abuse cigarette smoking pharyngo-laryngeal reflux disease other pollutants nasal disease ``` site- unilateral or bilateral

What are the treatments for vocal cord node or nodule?

surgery or laser cordectomy - may recur contact (intubation) granuloma or ulcer voice abuse pharyngo-laryngeal reflux instrumentation