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GENERAL OTOLARYNGOLOGY > CHAPTER 11: Laryngeal and Tracheal Manifestations of Systemic Disease > Flashcards

CHAPTER 11: Laryngeal and Tracheal Manifestations of Systemic Disease Flashcards

1
Q

A multisystem inflammatory disease characterized by necrotizing granulomatosis and necrotizing vasculitis of small arteries, arterioles, capillaries, and venules

A

Granulomatosis with polyangitis (GPA)/ Wegener granulomatosis (WG)

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2
Q

Areas affected in GPA

A
  1. Upper and lower respiratory tracts
  2. Larynx
  3. Trachea
  4. Kidneys
  5. Oral cavity
  6. Skin
  7. Joints
  8. Orbit
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3
Q

Parts of airway commonly affected in GPA

A
  1. Subglottis

2. Trachea

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4
Q

TRUE or FALSE
Most patients with GPA have a positive antineutrophil cytoplasmic antibody (ANCA) test result, with cytoplasmic ANCA proteinase 3 staining being positive with greater frequency than perinuclear ANCA myeloperoxidase staining

A

TRUE

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5
Q

First line treatment of GPA

A

Steriods + cyclophosphamide

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6
Q

Treatment of airway obstruction in GPA

A
  1. Tracheostomy
  2. Dilation
  3. Carbon dioxide laser
  4. Resection and reanastomosis (mature stenoses and inactive disease)
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7
Q

A rare inflammatory disease of unknown etiology that causes episodic inflammation of cartilaginous structures throughout the body

A

Relapsing polychondritis

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8
Q

Commonly affected areas in relapsing polychondritis

A
  1. Ears
  2. Nose
  3. Eyes
  4. Larynx
  5. Bronchi
  6. Costal cartilages
  7. Articular joints
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9
Q

Peak onset of RP

A

4th to 5th decade

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10
Q

Most common finding in RP

A

Bilateral auricle chondritis

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11
Q

Respiratory distress in RP may occur by either of 2 mechanisms:

A
  1. Collapse of the central airway from destruction and fibrosis of the laryngeal and tracheal rings
  2. Peripheral airway narrowing from inflammation and cicatricial fibrosis
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12
Q

CT findings in RP

A
  1. Subglottic stenosis
  2. Tracheobronchial luminal narrowing
  3. Dense calcification and thickening of tracheal cartilages
  4. Peripheral bronchial narrowing
  5. Bronchiectasis
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13
Q

Most common CT finding in RP

A

Increased attenuation and smooth thickening of the airway walls

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14
Q

Histologic examination in RP

A

Chondritis with a mixed inflammatory cell infiltrate composed of polymorphonuclear leukocytes, lymphocytes, plasma cells, and eosinophils

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15
Q

Maintenance therapy in RP

A
  1. Methotrexate

2. Low-dose corticosteroid

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16
Q

TRUE or FALSE

In addition to surgical measures, RP is managed with high-dose corticosteroids

A

TRUE

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17
Q

Used in refractory cases of RP

A
  1. Azathioprine
  2. Cyclophosphamide
  3. Cyclosporine
  4. Dapsone
  5. Infliximab (TNF-alpha)
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18
Q

Is a chronic granulomatous disease of unknown etiology, characterized by noncaseating granuloma formation with clusters of tubercles in the same stage of developement, and it can affect any organ system within the body

A

Sarcoidosis

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19
Q

TRUE or FALSE

Although rare, laryngeal sarcoidosis can be the only manifestation of the disease

A

TRUE

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20
Q

Progression of RP…

A

Slow and is characterized by many relapses and remissions

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21
Q

TRUE or FALSE

The supraglottic larynx is affected most often, followed by the subglottis

A

TRUE

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22
Q

TRUE or FALSE

In RP, the epiglottis is the most common subsite, followed by the arytenoids, aryepiglottic folds, and false vocal folds

A

TRUE

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23
Q

Classic appearance of the larynx affected by sarcoidosis

A

“Turbanlike thickening”

Due to the pale, pink, diffuse induration and swelling of the supraglottis

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24
Q

Pathologic findings in RP

A

Lymphocytic infiltration and noncaseating epitheliod granulomas

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25
Q

Treatment of the laryngeal manifestations of sarcoidosis

A

Systemic corticosteroid

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26
Q

An idiopathic disorder characterized by extracellular deposition of insoluble fibrillar proteins

A

Amyloidosis

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27
Q

The deposits in amyloidosis were initially described by…

A

Rokitansky in1873

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28
Q

TRUE or FALSE

Laryngeal amyloidosis is usually localized and associated with immunoglobulin localized light-chain amyyloidosis (LLA) and rarely found in association with an underlying disorder, such as multiple myeloma

A

TRUE

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29
Q

Amyloidosis is classified on the basis of 3 parameters:

A
  1. Fibrillar protein making up the deposits
  2. Precursor protein from which the amyloid protein was derived
  3. Clinical description of the associated disease process
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30
Q

Most common location of deposits within the larynx

A

True and false vocal folds and the ventricles

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31
Q

Amyloidosis: light microscopy

A

Acellular, amorphous, homogenous, eosinophilic appearance after H&E staining

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32
Q

Amyloidosis: Congo red

A

Bright green birefringence under polarizing light microscopy

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33
Q

Treatment of amyloidosis

A

Maintaining airway patency, improving hoarseness and/or pain while minimizing the effects on voice quality

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34
Q

Amyloidosis treatment: symptomatic

A

Excision (suspension microlaryngoscopy)

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35
Q

Treatment: Recurrence of airway in amyloidosis

A

Reexcision and/or radiation therapy

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36
Q

A common autoimmune disease that involves inflammation of the synovial tissue

A

Rheumatoid arthritis

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37
Q

Commonly involved area in RA

A

Larynx (25 to 30%)

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38
Q

RA affects the larynx in 2 forms

A
  1. Active form

2. Chronic form

39
Q

RA: larynx is acute with tenderness and erythema

A

Active form

40
Q

Laryngoscopic examination in RA active form

A

Red, swollen arytenoids

41
Q

RA: cricorytenoid joint involvement with ankylosis

A

Chronic form

42
Q

A rare autoimmune disease that affects the skin and mucous membranes

A

Pemphigus

43
Q

Loosening of the epidermal-dermal junction leads to the characteristic formation of blebs

A

Pemphigus

44
Q

TRUE or FALSE

Pemphigus may be isolated to the larynx, but this is unusual

A

TRUE

45
Q

Most common laryngeal presentation in pemphigus

A

Hoarseness

46
Q

Fiberoptic exam: Pemphigus

A

Tan, fibrinous base with halo of erythema

47
Q

Most common site of pemphigus in the head and neck

A

Oral cavity mucosa

48
Q

TRUE or FALSE

In pemphigus, scarring can be prevalent and can lead to supraglottic narrowing

A

TRUE

49
Q

Histologic finding in pemphigus

A

Intraepithelial acantholysis

50
Q

Direct immunofluorescence in pemphigus

A

Intracellular pattern

51
Q

Indirect immunofluorescence in pemphigus

A

Can measure the amount of circulating antibodies and correlates with disease severity

52
Q

Treatment of pemphigus

A

Oral corticosteroids

53
Q

Maintenance medications for pemphigus

A
  1. Azathioprine
  2. Cyclophosphamide
  3. Cyclosporine
54
Q

Etiologic agent of whooping cough

A

Bordetella pertussis

55
Q

Treatment of whooping cough

A

Erythromycin

56
Q

TRUE or FALSE

Laryngeal TB is the result of hematogenous or lymphatic spread

A

TRUE

57
Q

Most common location of laryngeal TB

A
  1. Posterior glottis
  2. Aryepiglottic folds
  3. Ventricular
  4. Vocal
58
Q

TRUE of FALSE

The lesions of laryngeal TB may be nodular, exophytic or ulcerative, sometimes mistaken for SCCA

A

TRUE

59
Q

Diagnosis of laryngeal TB

A
  1. Sputum culture
  2. Biopsy
  3. Chest X-ray
60
Q

Etiologic agent of Histoplasmosis

A

Dimorphic fungus Histoplasma capsulatum

61
Q

TRUE or FALSE
Histoplasmosis manifest as either an acute or chronic pulmonary infection or an acute or chronic disseminated infection with systemic symptoms

A

TRUE

62
Q

TRUE or FALSE

Acute disseminated histoplasmosis is almost always fatal

A

TRUE

63
Q

TRUE or FALSE

Chronic disseminated histoplasmosis manifest as focally destructive lesions

A

TRUE

64
Q

Histologic findings in histoplasmosis

A

Presence of poorly defined granulomas with macrophages and multinecleated giant cells

65
Q

Stains can show intracellular Histoplasma capsulatum

A
  1. Periodic acid-Schiff

2. Grocott-Gomori methenmaine-silver nitrate

66
Q

Treatment of histoplasmosis

A

IV amphotericin B

67
Q

Etiologic agent of Blatomycosis

A

Dimorphic fungus Blastomyces dermatitidis

68
Q

The primary portal of entry of Blastomyces dermatitidis

A

Lungs

69
Q

Most commonly affected system in Blastomycosis

A

Skin

70
Q

Most common subsite of larynx affected in Blastomycosis

A

True vocal cords with extension to the ventricular folds

71
Q

Histologic finding in Blastomycosis

A

Acute and chronic inflammation, microabscess, and giant cell formation

72
Q

Hallmark finding in Blastomycosis

A

Pseudoepitheliomatous hyperplasia

73
Q

Treatment for uncomplicated Blastomycosis

A
  1. Oral ketoconazole

2. Itraconazole

74
Q

Treatment of Blastomycosis with central nervous system involvement

A

Amphotericin B

75
Q

Etiologic agent of Cryptococcosis

A

Cryptococcus neoformans (yeast-like fungus with a thick polysaccharide capsule)

76
Q

Most commonly affected system in Cryptococcosis

A

Central nervous system

77
Q

Histologic finding in Cryptococcosis

A

Budding yeast

78
Q

Treatment of Cryptococcosis

A
  1. Amphotericin B

2. Fluconazole

79
Q

Etiologic agent of San Joaquin Valley fever

A

Coccidioides immitis

80
Q

Symptoms of laryngeal involvement of San Joaquin Valley fever

A

Hoarseness, pain, and odynophagia to airway involvement with stridor

81
Q

Treatment of Coccidioidomycosis

A

Amphotericin B

82
Q

A chronic suppurative infection characterized by the presence of purulent drainage from the chronic discharge of sinus tract that contain sulfur granules

A

Actinomycosis

83
Q

Etiologic agent of Actinomycosis

A

Actinomyces israelii (anaerobic or microaerophilic, non-acid-fast, gram-positive organism)

84
Q

These organism are endogenous to the oral cavity and can be found in carious teeth, plaque, and tonsillar crypts

A

Actinomyces israelii

85
Q

Treatment of actinomycosis

A

Prolonged antibiotic therapy

  1. Penicillin (mainstay)
  2. Clindamycin
86
Q

Lesion of candidiasis

A

White sessile plaques on an erythematous base, ulceration may be noted

87
Q

Therapy of candidiasis

A

Eliminating the causative agent

Antifungal: Fluconazole

88
Q

Amyloidosis is classified on the basis of three parameters

A
  1. Fibrillar protein making up the deposits
  2. Precursor protein from which the amyloid protein was derived
  3. Clinical description of the associated disease process
89
Q

The most common location of amyloid deposit in larynx

A

True and false vocal cords and ventricles

90
Q

Classic findings of amyloidosis under polarizing light microscopy

A

Bright green birefringence after staining with Congo red

91
Q

RA affects larynx in 2 forms

A
  1. Active form

2. Chronic form

92
Q

Involvement of the larynx is with tenderness and erythema

Laryngoscopy: red, swollen arytenoids

A

Active form of RA

93
Q

Causes cricoarytenoid joint involvement with ankylosis

A

Chronic form of RA

GENERAL OTOLARYNGOLOGY (12 decks)

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