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Disease Processes > Iatrogenic > Flashcards

Iatrogenic Flashcards

1
Q

What is Cotton’s grading system for SGS?

A
  • Grade 1: Less than so% laryngeal lumen obstruction.
    <* Grade 2: 51-70% laryngeal lumen obstruction.
    <* Grade 3: 71-99% laryngeal lumen obstruction.
    <* Grade 4: Complete obstruction.
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2
Q

What are the three types of ORN?

A
  • Type I occurs soon after radiation therapy
  • Type II occurs long after radiation therapy and is induced by trauma
  • Type III occurs long after radiation therapy and occurs spontaneously.
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3
Q

How much time must elapse before starting radiation after dental extractions?

A

10 days.

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4
Q

What is the incidence of ORN after radiation to the head and neck?

A

10-15%.

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5
Q

What percent of premature infants develop subglottic stenosis (SGS)?

A

4%.

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6
Q

At what doses can radiation retinopathy or optic neuropathy occurs?

A

50-55 Gy.

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7
Q

Cataracts can occur after how much radiation therapy?

A

6 Gy.

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8
Q

What problems are seen more commonly in patients with vocal cord paralysis due to a brainstem disorder?

A

Breathiness; pitch changes; chronic aspiration; and velopharyngeal insufficiency.

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9
Q

What are the ocular complications of radiation therapy?

A

Cataracts, radiation retinopathy, optic nerve injury, lacrimal gland damage, and ectropion/entropion.

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10
Q

What are other etiologies of SGS?

A

Congenital anomalies, increased infant activity, autoimmune mechanisms (antibodies to type II collagen, antineutrophil cytoplasmic antibodies), infection, GERD, caustic injury, and high tracheostomy.

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11
Q

What is the pathogenesis behind transient radiation myelopathy?

A

Demyelination of the posterior columns.

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12
Q

What accounts for vocal fold bowing observed with vocal fold paralysis?

A

Denervation atrophy of the thyroarytenoid muscle.

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13
Q

What are the treatment options for SGS?

A

Dilation, steroid injection, lathyrogenic agents, cryotherapy, laser therapy, anterior cricoid split, one-stage laryngotracheoplasty, autogenous cartilage grafts, four-quadrant cartilage division, end-to-end tracheal anastomosis, and flaps.

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14
Q

What are the risk factors for development of ORN?

A

Dose of radiation (>70 Gy), size, and extent of primary, postradiation dental extraction.

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15
Q

What effects does radiation therapy have on the skin?

A

Dryness secondary to damaged sebaceous and sweat glands, thinning of the epidermis, and telangiectasias.

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16
Q

What is the principle dose-limiting factor of radiation therapy?

A

Fibrosis of the subcutaneous tissue and muscle.

17
Q

What is the most common cause of unilateral facial palsy in a newborn infant?

A

Forceps delivery.

18
Q

What is the most common hormonal deficiency after radiation therapy for nasopharyngeal carcinoma?

A

Growth hormone deficiency.

19
Q

What are the three most important factors leading to osteoradionecrosis (ORN)?

A

Hypovascularity, hypocellularity, and hypoxia (the “3Hs”).

20
Q

If the paralyzed vocal cord is in the paramedian position, why is aspiration less likely?

A

Indicates that the superior laryngeal nerve is intact, and hence laryngeal sensation is intact.

21
Q

What position will the vocal cord be in if the nerve is damaged at or above the nodose ganglion?

A

Lateral.

22
Q

In patients with unilateral vocal cord paralysis, which side is most commonly involved?

A

Left.

23
Q

What is the somnolence syndrome?

A

Lethargy, nausea, headache, cranial nerve palsies, and ataxia presenting 2-3 months after radiation therapy and lasting 2-4 weeks.

24
Q

What clinical factors increase the risk of radiation injury?

A

Male gender, extremes of age, higher doses and fractions, and comorbidities.

25
Q

Which bone in the head and neck is most commonly affected by ORN?

A

Mandible, as it has a relatively tenuous blood supply and is stress bearing.

26
Q

What are the disadvantages of serial bouginage?

A

Multiple treatment applications over a prolonged period of time, lack of stabilization if cartilaginous destruction or instability has occurred, generally requires a tracheotomy.

27
Q

What are the advantages of serial bouginage for the treatment of SGS?

A

Noninvasive growth may take care of the stenosis, avoids concerns regarding the potential for laryngeal growth inhibition with open procedures.

28
Q

What position will the vocal cord be in if the nerve is damaged below the nodose ganglion?

A

Paramedian, due to innervation from the superior laryngeal nerve.

29
Q

What is the biggest risk factor for acquired SGS?

A

Prolonged endotracheal intubation.

30
Q

What are the two most common causes of vocal cord paralysis in adults?

A

Surgical trauma (#1) and lung cancer (#2).

31
Q

What effects does radiation therapy have on the brain or spinal cord?

A

Transient radiation myelopathy, transverse myelitis.

32
Q

Which cranial nerve is most commonly damaged by radiation therapy to the head and neck?

A

XII.

Disease Processes (9 decks)

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