Chapter 6 - Granulomatous dz

Question 1

3 Hallmarks of Sarcoidosis

Answer 1

No-caseating
Hilar LAD
ACE

Question 2

Hallmarks of GPA

Answer 2

Necrotizing gloma
C-ANCA
Subglottic Stenosis (up to 16%)

Question 3

Hallmarks of Churg Strauss

Answer 3

Vasculitis
Eosinophils, Asthma, Sinonasal Dz
COD: Myocarditis, Coronary artery vasculitis

Question 4

Bacterial gloma dz nose

Answer 4

TB, Syphilis, Rhinoscleroma, Leprosy, Actinomyces

Question 5

Mucor vs Asperg hyphae

Answer 5

M: non-septate, wide
A: septate, 45 degree

Question 6

Sarcoid: Sx

Answer 6

10-15% H/N
Nasal crust, hyposmia, PND, epistaxis, infxn, obstruction, parotid enlarge, dry mouth, uveitis
Cough, hoarse, dyspnea

Question 7

Sarcoid: PE, Tx

Answer 7

Polyps, septal perf/saddle
Pearly nodules submucosal
High ACE, Urine Ca

Nasal irrigation, steroid (top/inj)
FESS
Sys Ster, MTX, Azathio, Cyclophos

Question 8

Heerfordt Syndrome

Answer 8

Parotid enlarge, uveitis, facial nerve palsy, fever (rare sarcoid presentation)

Question 9

GPA: Sx

Answer 9

Autoimmune
Nasal: pain, cong, bleed, crust, foul d/c
Perf/Saddle
Gingival hyperplasia, HL, NLDO, conjunctivitis
Glomerulonephritis
Worse SubGSten if child onset

Question 10

GPA: Dx, Tx

Answer 10

Bx
High CRP, ESR, cANCA pos
90% white

Steroids, Cyclophos, Azathio, MTX, Rituxin

Question 11

Churg Strauss: Sx, Tx

Answer 11

Early: Sinonasal (crust, runny, obst, polyp), asthma
Late: eosinophils, vasculitis, fever, WL, malaise, night sweats, GI
CRP, ESR, p-ANCA

Steroid, irrigate, polypectomy

Question 12

Sjogren: Complications, Dx, Tex

Answer 12

Non-Hodgkin lymphoma

> 50 lymphocytes in 4mm salivary gland

Humidifier, saliva, sialogogue, saline irr
Pilocarpine/Cevimeline

Question 13

Lupus H/N Sx

Answer 13

Oral ulcers
Malar rash
Perf
Glottic bamboo nodules (also in RA, Sjogren)

Question 14

Relapsing polychondritis

Answer 14

Episodic ear/nose swelling
Lobule-sparing erythema
Saddle nose/valve collapse

Question 15

Behcet Syndrome

Answer 15

Recurrent Oral apthous ulcer, genitalia ulcer, uveitis
CNs, Kidney, GI, Joints
Coronary a thrombosis, Pulm a aneurysm
Positive pathergy (papule after needle prick)

Question 16

Rhinoscleroma

Answer 16

Klebsiella
East Africa, C/S America, Central Europe, India

Catarrhal- foul d/c
Gloma- friable gloma, epistaxis, deform nose
Sclerosis
Mikulicz cells (large histiocytes, bacilli inside)

Question 17

H/N TB Sx

Answer 17

Scrofula
Larynx granulation
Refractory otorrhea
Nodular hypertrophy nose mucosa

Question 18

H/N Leprosy

Answer 18

Nodular thickening nose…obst/deformity

Tx dapsone, rifampin

Question 19

H/N Syphilis

Answer 19

Primary- painless chancre
Sec- weeks later, skin, mucosa, LN
Latent
Tertiary- gummata (may be nasal)
SNHL, larynx

Question 20

Blastomycosis

Answer 20

Eastern N America
Soil
Lung/Skin (hoarse)
Broad based budding (sputum)

Question 21

Histoplasmosis

Answer 21

Central US (OH River)
Bird/Bat drop
Respiratory Sx
Mucosal lesions look like CA
Silver stain, macrophage oval fungi

Question 22

Coccidiomycosis

Answer 22

San Joaquin River (SW US)

Spherules small endospores

Question 23

Aspergillosis

Answer 23

Non-invasive (sinus fungal ball)

Severe if low immune

Question 24

Rhinosporidiosis

Answer 24

Strawberry like friable polyp
Nose/larynx/conjunctiva
India

Question 25

Leishmaniasis

Answer 25

Sandfly, tropics
Red papules, skin plaque, ulcers
Septum

Tx: antimonials, AMP B, Miltefosine