Respi - URT

Question 1

Rhinitis pathogenesis

Answer 1

infection (rhinovirus, influenza)
necrosis of surface epithelial cells
-> exudation of fluid and mucus

• allergic rhinitis: hypersensitivity

Question 2

rhinitis complication

Answer 2

• viral infection spread to lower RT
• > secondary bacterial infection
• formation of nasal polyps

Question 3

nasal polyps

Answer 3

involves nasal cavity and paranasal sinuses

inflammatory

Question 4

microscopy of nasal polyps

Answer 4

outgrowths of lamina propria: accumulation of edema fluid, inflammation and fibroblast proliferation
- inflammatory cells: neutrophils, eosinophils, lymphocytes, plasma cells

Question 5

sinusitis

Answer 5

inflammation of paranasal sinus

• > mucosal edema
• > impaired drainage of secretions - risk of secondary infection

complication: spread to meninges

Question 6

types of benign tumours of nose & paranasal sinuses

Answer 6

• squamous papilloma

- sinonasal papilloma

Question 7

sinonasal papilloma

Answer 7

covered by non-keratinising squamous/ ciliated columnar/ transitional epithelium - secrete mucus + appears oncocytic

• high recurrence rate
• potentially cause bone destruction

Question 8

types of malignant tumours of nose & paranasal sinuses

Answer 8

• squamous cell carcinoma
• transitional cell carcinoma
• adenocarcinoma
• malignant melanoma (mucosal)

Question 9

tumours at the nasopharynx

Answer 9

• juvenile angiofibroma

- nasopharyngeal carcinoma (NPC)

Question 10

juvenile angiofibroma

Answer 10

affects male adolescents
ulcerate -> bleeding
benign, but grows w/ puberty

Question 11

NPC (nasopharyngeal carcinoma)**

+ 3 histologic types

Answer 11

malignant
affects southern chinese

• non-keratinising: most common - poorly differentiated, w/ many lymphocytes
• keratinising squamous cell: associated w/ smoking & alcohol
• Undifferentiated carcinoma (has an abundant, non-neoplastic lymphocytic infiltrate surrounding nests of undifferentiated neoplastic cells)** more common in SEA

Question 12

NPC risk factors

Answer 12

• EBV infection - usually in childhood -> affects nasopharyngeal epithelium/ tonsils
• diet: salt preserved (salted fish) (Southern Chinese)
• family history (Chinese)

Question 13

screening for NPC

Answer 13

test for EBV viral antigens - IgA
+ endoscopy
- test those w/ strong family history also

Question 14

NPC symptoms

Answer 14

• nasal obstruction/ epistaxis (haemorrhage: nose bleed)/ nasal discharge
• diplopia: affects CN6
• potential metastasis to cervical lymph nodes

Question 15

2 URT related compulsory vaccinations

Answer 15

DTaP: Diphtheria (corynebacterium diphtheriae) -> causes necrosis of epithelium
HIB: haemophilus influenzae -> acute epiglottitis

Question 16

infection of larynx/pharynx

+ take note of special pts

Answer 16

• acute pharyngitis
• acute laryngitis
  caused by viral infection
  hoarseness, cough, tracheal soreness

*have to take special care of children!! - small airways that collapse easily -> stridor (heavy breathing sounds)

+ elderly/unconscious/debilitated - infected material cannot be coughed out -> travel downwards -> bronchopneumonia

Question 17

other laryngeal diseases (3) apart from acute laryngitis

Answer 17

• allergic pharyngolaryngeal edema
  type 1 hypersensitivity -> facial edema, bronchospasms
• acute toxic laryngitis (fires)
• chronic laryngitis
  heavy smokers: chronic irritation epithelium -> squamous metaplasia -> risk of dysplasia + squamous cell carcinoma

Question 18

lesions of larynx

Answer 18

benign

• singer’s nodules: nodular thickening of vocal chords (affects singers/chronic smokers)
• laryngeal papilloma/ squamous papilloma: cause by infection by HPV
  children: juvenile laryngeal papillomatosis - multiple persistent and recurrent soft papillomas

Question 19

laryngeal carcinomas

+ site

Answer 19

malignant
- mainly squamous cell carcinoma
- site: supraglottic/ glottic/ subglottic
(glottic usually lower stage at presentation cause of poor lymphatic supply)

Question 20

laryngeal carcinomas clinical presentation

Answer 20

polypoid/ ulcerative
locally invasive
spreads to regional lymph nodes

Question 21

how EBV causes NPC

Answer 21

EBV infection -> increase in antibody titres - correlated w/ tumour growth and recurrence
+ clonal expansion