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September lectures yr 3 (2018) > URT pathology > Flashcards

URT pathology Flashcards

1
Q

What anatomy forms the URT?

A 
Nose
Naso-pharynx
Larynx
Paranasal sinueses
Eustachian tube
Middle ear
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2
Q

What defence mechanisms does the URT have?

A 
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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3
Q

What conditions have abnormal muco-ciliary transport system?

A

PCD
Kartagener’s syndrome
bronchiectasis
infertility

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4
Q

What are the causes of acute rhinitis?

A

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

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5
Q

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

A

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

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6
Q

What happens in chronic rhinitis?

A

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

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7
Q

What is atopic or allergic rhinitis?

A

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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8
Q

What are nasal polyps?

A

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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9
Q

What are the causes and effects of acute sinusitis

A

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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10
Q

What can chronic sinusitis cause?

A

nasal and naso-sinal polyps

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11
Q

What are the acute causes of pharyngitis?

A

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

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12
Q

What are the effects of acute pharyngitis?

A 
tonsilitis
retropharyngeal abscess
peritonisillar abscess
cervical adenitis
parapharyngeal abscess
ludwig's angina
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13
Q

What is chronic sinusitis?

A

continuing irritation from another source

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14
Q

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

A

cardinal triad

  • giant cell transformation
  • arteritis/phlebitis
  • zonal necrosis with karyorrhexis/leukocytoclasis
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15
Q

What are the different organs/systems that GPA affects?

A

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

limited form = lungs only

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16
Q

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

A

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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17
Q

What investigations should be carried out for GPA?

A 
FBC, ESR, U&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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18
Q

What are the treatments for GPA?

A

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

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19
Q

What are the complications and prognosis of GPA?

A

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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20
Q

What is necrotising midline granuloma?

A 
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
21
Q

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

A

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)

22
Q

What are the differential diagnoses for inverted papilloma?

A 
inflammatory nasal polyp 
fungiform/exophytic papilloma 
cyclindric cell/oncocytic papilloma 
verruca vulgaris 
carcinoma
23
Q

What is the natural history of inverted papilloma?

A 
recurrence rate = 40-60%
malignant change up to 53%
multicentric 
synchronous or metachornous 
pre-malignant potential - dysplasia, SCC, adenocarcinoma, MEC
24
Q

How is inverted papilloma treated?

A

surgery = endoscopic vs en bloc

continued long term surveillance

25
Q

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

A

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

26
Q

What are the signs and symptoms of SCC?

A 
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
27
Q

What investigations are for SCC?

A 
XR 
CT scan 
MRI scan 
Nasal endoscopy 
Biopsy
28
Q

What are the treatments for SCC?

A 
depends on: site, stage, grade general health 
Surgery (+/- reconstruction/prosthetics)
Radiotherapy 
occasionally chemo 
GF receptor antagonists 
cyclin kinase inhibitors 
photodynamic therapy 
oncolytic viruses 
vaccines
29
Q

What is the prognosis for SCC?

A

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

30
Q

What are the causes of adenocarcinoma?

A

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

31
Q

Who is susceptible to juvenille (nasal) angiofibroma?

A

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

always males

32
Q

What are the aetiologies of JNA?

A

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

33
Q

What are the signs and symptoms of JNA?

A

Nasal obstruction
epistaxis
headaches
facial swelling

nasal mass
orbital mass
proptosis

34
Q

What investigations are carried out for JNA?

A

XR
CT scan
MRI scan
Angiography

35
Q

What are the treatments for JNA?

A

Surgery

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

36
Q

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

A

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

37
Q

What are the symptoms and signs of NPC?

A 
Blocked nose
telecanthus
epistaxis
deafness
tinnitus 
lymphadenopathy
38
Q

What does the NPC do?

A

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

39
Q

What are the investigations for NPC?

A 
CXR
CT scan 
MRI scan 
Bone scan 
Nasal endoscopy 
Biopsy - ebv, lmp-1 in situ EBERs
40
Q

What is the treatment for NPC and prognosis?

A

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

dependent on stage and grade

41
Q

What are some other examples of nasopharyngeal tumours?

A 
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
42
Q

What are the causes and complications of diphtheria?

A

corynebacterium, diptheria, exotoxin formation

psuedomembrane coagulum of deadcells, fibrin, inflammatory cells and bacteria

death due to asphyxia or renal or cardiac failure

43
Q

What are the treatments for diphtheria?

A

antibiotics
antitoxin
vaccine - toxoid, DTP immunisation

44
Q

What are examples of acute inflammation of the URT?

A

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

45
Q

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

A

mycobacterium TB (acid alcohol fast bacilus)

differentials: other granulomatous conditions (equally rare) and carcinoma

46
Q

What investigations for TB should be carried out?

A 
CXR
sputum - microscopy and culture 
laryngoscopy 
biopsy 
tuberculin skin test 
interferon gamma release assays
47
Q

What are the treatments for tb?

A

antibiotics - anti-tuberculosis therapy regime

resistant strains

48
Q

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

A 
vocal cord abuse
cigarette smoking 
pharyngo-laryngeal reflux disease 
other pollutants 
nasal disease

site- unilateral or bilateral

49
Q

What are the treatments for vocal cord node or nodule?

A

surgery or laser cordectomy - may recur

contact (intubation) granuloma or ulcer voice abuse
pharyngo-laryngeal reflux
instrumentation

September lectures yr 3 (2018) (56 decks)

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