Neck diseases

Question 1

Paraganglioma (Carotid Body Tumor)

Answer 1

Slow growing & painless
Infrequent catecholamine release
Lesion: near bifurcation of carotid
Histology: nests of uniform chief cells w/ thin septa (Zellballen pattern)

Question 2

Idiopathic pulmonary fibrosis

Answer 2

Patchy, progressive bilateral interstitial fibrosis
Insidious gradual onset dyspnea & non-productive cough w/ relentless progression of fibrosis

Tx: ONLY treatment is transplant, poor response to immunosuppression

Question 3

Differentiate IPF from NSIP

Answer 3

vs IPF: lacks fibroblastic foci, temporal heterogeneity & honeycomb change

Question 4

Hypersensitivity Pneumonitis

Answer 4

Farmer’s Lung: thermophilic actinomycetes in moldy hay
Pigeon Breeder’s Lung: serum protein in pigeon droppings
Bagassosis: bagasse in sugar cane
Humidifier Lung: amoebae in humidifier water
Hot Tub Lung: MAC in contaminated hot tubs

Question 5

Hypersensitivity Pneumonitis dx and tx

Answer 5

CT: shows ground glass opacities & centrilobular nodules @ lung bases
High dose steroids

Question 6

What population has a high risk for sarcoidosis?

Answer 6

NON-smokers

Question 7

Pathogenesis of Sarcoidosis

Answer 7

Ag stimulus – alveolitis (macrophage & TH1 response)

Question 8

Skin tests and sarcoidosis

Answer 8

Delayed skin test responses in active disease – d/t dec peripheral T cells (TB skin test is -)

Question 9

Albumin and calcium in sarcoidosis

Answer 9

for every gram change in albumin conc’n, total Ca++ conc’n changes 0.8g/mL in the same direction

Question 10

SSx of hypercalcemia

Answer 10

SSx of Hypercalcemia: constipation, hyporeflexia

Question 11

Tx of Sarcoidosis

Answer 11

Pulmonary: corticosteroids and mycophenolate – only w/ active flare-ups
Muco-cutaneous: anti-malarial drugs Hydroxychloroquine, chloroquin
Systemic: corticosteroids w/ steroid sparing agents – methotrexate

Question 12

Histology of Cryptogenic Organizing Pneumonia

Answer 12

Light blue plugs of loose fibrous CT in air spaces w/ normal underlying lung architecture

Question 13

Anatomy of the EAC

Answer 13

Outer ⅓: Cartilaginous - skin thick and adherent, cerumen production
Inner ⅔: Bony - Skin thin, sensitive to palpation, susceptible to trauma

Question 14

Foreign body in the EAC

Answer 14

DO NOT IRRIGATE unless you know what it is

Question 15

Bacterial Acute Otitis Externa (AOE)

Answer 15

Diffuse (swimmer’s ear) - most common
Tx: ototopical agents
Furunculosis: abscess in lateral portion of EAC
Tx: systemic Abx
Necrotizing: diabetic/immunocompromised, can be fatal
Tx: referral to ENT