Inflammatory Flashcards by Reza Nouraei

What is the ATA classification system for eye involvement in Graves’ disease?

Class I-Lid lag and the appearance of a stare.
Class II-Conjunctival chemosis, epiphora, periorbital edema, and photophobia.
Class III-Proptosis.
Class IV-Decreased ocular mobility and diplopia.
Class V-Corneal ulceration.
Class VI-Optic nerve involvement.

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According to AAO-HNS, what are the criteria for “definite” Meniere’s disease?

Two or more episodes of spontaneous rotational vertigo lasting 20 minutes or longer.
Audiometrically documented hearing loss on at least one occasion.

3•Tinnitus or aural fullness in the affected ear.

4•Exclusion of other causes.

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What are the criteria for “certain” Meniere’s disease?

Two or more episodes of spontaneous rotational vertigo lasting 20 minutes or longer.
Audiometrically documented hearing loss on at least one occasion.

3•Tinnitus or aural fullness in the affected ear.

4•Exclusion of other causes.

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What percent of patients undergoing surgery for chronic rhinosinusitis have Sampter’s triad?

10%.

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What percent of patients with Meniere’s disease do not respond adequately to salt restriction and diuretics?

10%.

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What is the incidence of latex allergy?

1-6% among the general population; 5-17% among health care workers; 20-60% among those with spina bifida

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What percent of patients with AIED will also have a systemic autoimmune disease?

28%.

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What percent of patients with dysthyroid ophthalmopathy suffer from visual disturbances severe enough to warrant surgical intervention?

5%.

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What percent of patients with autoimmune inner ear disease - AIED have bilateral hearing loss?

79%.

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What percent of infants with GERD will spontaneously resolve by 18 months?

85%.

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What infectious diseases can cause chronic thyroiditis?

Actinomycosis, tuberculosis, and syphilis.

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What percent of patients have bilateral Meniere’s disease?

After 2 years, 15% of patients; after 10 years, 25-35%; and after 20 years, 40-60%.

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What antibodies are specific for Hashimoto’s thyroiditis?

Antimicrosomal and antithyroglobulin antibodies.

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What is the late-phase allergic response?

Approximately so% of allergic patients will have a late-phase response 3-12 hours after the early-phase response. Mediators released from mast cells cause infiltration of eosinophils and neutrophils to the exposure site. Nasal congestion is the primary symptom. Nasal mucosa becomes more sensitive to subsequent allergen exposure (priming) and to nonspecific environmental stimuli (nonspecific hyperresponsiveness).

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What is Sampter’s triad?

Aspirin sensitivity, nasal polyposis, and asthma.

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Where are vocal nodules most commonly located?

At the junction of the anterior one-third and posterior two-thirds of the vocal fold.

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What are the different manifestations of fixed food allergies?

Atopic dermatitis, asthma, allergic rhinitis, urticaria, angioedema, oral allergy syndrome, gastrointestinal distress, or severe anaphylaxis.

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What disease is characterized by recurrent aphthous ulcers, ocular inflammation, cutaneous vasculitis, and SNHL?

Bechet’s disease.

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What is the most likely etiology of vertigo? Positional vertigo,lasting seconds,associated with rotatory nystagmus ?

BPPV

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What is the most likely etiology of vertigo? Constant,progressive dizziness,Brun’s nystagmus,SNHL

Cerebellopontine angle tumor

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How do patients with EAC cholesteatoma present?

Chronic dull pain, usually unilaterally, with otorrhea and normal hearing.

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What other factors can predispose an infant to aspirate?

CNS disease, prematurity, mechanical barriers (nasogastric tube, endotracheal tube, tracheostomy), anatomic barriers (esophageal atresia/stricture, vascular rings, tracheoesophageal fistula), scoliosis.

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What are the criteria for “possible” Meniere’s disease?

Cochlear or vestibular variants of Meniere’s disease for which other causes have been excluded.

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What syndrome is characterized by vestibuloauditory symptoms in association with nonsyphilitic interstitial keratitis, mostly in young adults?

Cogan’s syndrome.

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Why are infants more prone to aspiration than adults?

Compared with adults, infants have a relatively lax epiglottis, large arytenoids, and wide aryepiglottic folds.

How do patients with keratosis obturans usually present?

Conductive hearing loss, acute severe otalgia, usually bilaterally; otorrhea is rare.

What are the most common lgE-mediated food allergens in infants with atopic dermatitis?

Cow's milk, fish, and eggs.

What is the most common complication of GERD in infants?

Distal esophagitis.

What is the mainstay of treatment for Meniere's disease?

Diuretics and dietary salt restriction.

What are the most common clinical manifestations of laryngopharyngeal reflux in adults?

Dysphonia (71%), chronic cough (51%), globus (47%), chronic throat clearing (42%), and dysphagia (35%).

What are the indications for surgical treatment of Graves' disease?

Extremely large glands, the presence of a dominant nodule, failure of J131, massive enlargement with compressive symptoms, pregnant women intolerant to antithyroid drugs, women of childbearing age, and patients who are opposed to radioiodine.

What is Heerfordt's syndrome?

Facial nerve palsy with anterior uveitis, parotid gland enlargement, and fever.

What are other signs or complications of GERD in infants?

Failure to thrive, vomiting, recurrent aspiration pneumonia, and acute life-threatening events.

True/False: Thickening formula decreases the amount of reflux in children.

False: No studies have proven any benefit of this. It may decrease the amount of visible regurgitation, but it does not improve reflux.

True/False: Cyclic food allergy is not related to dose or frequency of allergen exposure.

False: Unlike fixed food allergy, cyclic food allergy is dose and frequency dependent.

How do patients with Hashimoto's thyroiditis present?

Firm, diffusely enlarged goiter and hypothyroidism.

What is the most common inflammatory disease of the thyroid?

Hashimoto's thyroiditis.

Which type of vocal cord granuloma has the worst prognosis?

Idiopathic.

What is oral allergy syndrome?

IgE-mediated reaction causing immediate swelling of the lips, tingling of the tongue and throat, and blistering of the oral mucosa. Symptoms are commonly associated with the ingestion of various fruits and vegetables that cross-react with their specific allergic rhinitis-inducing pollen.

What is the pathophysiology behind dysthyroid ophthalmopathy?

Infiltration of fluid and cells into the extraocular muscles and retrobulbar structures secondary to deposition of abnormal antibody-receptor complexes and glycosaminoglycans.

What is the early-phase allergic response?

Initial sensitization to an allergen results in cross-linking of IgE antibodies on mast cells upon subsequent exposure. Mast cells then degenerate and release chemical mediators like histamine. Histamine stimulates dilatation of the blood vessels in the nose, mucus glands to produce mucin, and leakage of plasma from capillaries and venules. Resulting symptoms include sneezing, itching, rhinorrhea, and nasal congestion.

What is the term for a keratin plug occluding the external auditory canal?

Keratosis obturans.

What are the physical findings in a patient with EAC cholesteatoma?

Localized erosion and periostitis of the posterior-inferior EAC associated with otorrhea.

What are the operative and pathologic findings of patients with pathologic sulcus vocalisjtype 3 sulcus?

Loss of superficial lamina propria and fixation of a thinned epithelium to underlying vocal ligament.

What is an early sign of relapse following treatment for AIED?

Loud tinnitus.

Which muscles are most commonly involved in dysthyroid ophthalmopathy?

Medial and inferior rectus muscles.

The triad of recurrent facial palsy, orofacial edema, and lingua plicata is classic for what disease?

Melkersson-Rosenthal syndrome (orofacial granulomatosis).

What is the most likely etiology of vertigo? *Acute,episodic vertigo lasting at least 20 minutes, low-frequency SNHL.*

Meniere's disease

What are the most common type of antigens causing delayed, immune complex or T-cell-mediated reactions?

Mold or food antigens.

Breathiness that progressively worsens as the day wears on is classic for which autoimmune disease?

Myasthenia gravis.

What are the surgical options for treatment of intractable aspiration?

Narrow-field laryngectomy, endolaryngeal stent, laryngeal closure, and tracheoesophageal diversion (TED) or laryngotracheal separation (LTS).

What condition is characterized by nasal eosinophils, rhinorrhea, normal lgE levels, and negative skin tests for allergens?

Nonallergic rhinitis with eosinophilia syndrome (NARES).

What is cyclic food allergy?

Non-IgE-mediated delayed sensitivity to food allergens, primarily the result of type III immune complex disease.

What proportion of patients with AIED will not have any vestibular symptoms?

One-third.

What are the criteria for "probable" Meniere's disease?

Only one episode of vertigo plus the other criteria for "definite" disease which are: 1. Two or more episodes of spontaneous rotational vertigo lasting 20 minutes or longer. 2. Audiometrically documented hearing loss on at least one occasion. 3•Tinnitus or aural fullness in the affected ear. 4•Exclusion of other causes.

What is the most likely etiology of vertigo? *Constant dizziness,high-frequency SNHL,oscillopsia, head-shaking nystagmus*

Ototoxicity

What is the best initial approach for management of mild GERD with no adverse clinical consequences in an infant?

Parental reassurance; reverse Trendelenburg; prone positioning after feeding.

What is intractable aspiration?

Persistent aspiration despite maximum medical management and minor surgery.

What are the typical symptoms of interstitial keratitis?

Photophobia, lacrimation, and pain.

What disease is a necrotizing vasculitis of small- and medium-sized muscular arteries, most commonly involving the renal and visceral vessels, and is a potential cause of hearing loss?

Polyarteritis nodosa.

What pathologic changes occur in the larynx as a result of GERD?

Polypoid corditis (Reinke's edema), posterior glottic edema, and arytenoid edema/erythema.

Where are intracranial lesions that cause bilateral facial paralysis located?

Pons.

What is the commonest manifestation of GERD on the larynx?

Posterior glottic edema.

What distinguishes type 1or physiologic sulcus from pathologic sulcus?

Preservation of vocal cord vibratory activity on videostroboscopy, signifying intact superficial lamina propria.

What are the two types of aspiration?

Primary or direct from oral substances and secondary or indirect from gastric substances.

What is the usual presentation of autoimmune inner ear disease (AIED)?

Progressive sensorineural hearing loss over weeks to months in middle-aged women, occasionally with a serous middle ear effusion.

What is the treatment of choice for patients over 40 with Graves' disease?

Radioactive J131.

What is the most common sign of GERD in infants?

Regurgitation.

What thyroid disorder is characterized by replacement of the thyroid gland with fibrous tissue?

Riedel's struma (invasive fibrous thyroiditis, woody thyroiditis).

What is the most likely cause of bilateral facial palsy in a young adult?

Sarcoidosis.

What is the most common otologic manifestation of Wegener's granulomatosis?

Serous otitis media.

What are the most common lgE-mediated food allergens causing urticaria and angioedema?

Shellfish, fish, milk, nuts, beans, potatoes, celery, parsley, spices, peanuts, and soy.

What congenital disease is associated with a relatively high incidence of latex allergy?

Spina bifida.

Which area of the larynx is involved in Wegener's granulomatosis?

Subglottis.

Where is Reinke's edema located?

Superficial layer of the lamina propria.

Which area of the larynx is involved in sarcoidosis?

Supraglottis.

What impact does allergic rhinitis have on surgical outcomes in endoscopic sinus surgery?

The long-term success rate decreases from 90-93% (uncomplicated rhinosinusitis in otherwise healthy patients) to 78-85%.

Why do newborns and infants have an increased incidence of food allergy?

Their gut mucosa is highly permeable, increasing antigen uptake.

What are the physical findings in a patient with keratosis obturans?

Thickened tympanic membrane, widened EAC medially, and hyperemic canal skin with granulation tissue.

Why are vocal fold nodules most commonly located at the junction of the anterior one-third and posterior two-thirds of the vocal fold?

This is the point of maximum velocity of the vocal cords during forceful adduction.

What is the preferred treatment for patients with toxic multinodular goiter?

Thyroid resection (lobectomy to total thyroidectomy) because J131 treatment often requires repeated doses, does not reduce goiter size, and may even cause acute enlargement.

What is the most common cause of GERD in children?

Transient lower esophageal sphincter relaxation.

True/False: The concordance of allergy and chronic rhinosinusitis is higher in the pediatric population.

True.

True/False: Patients with a cyclic food allergy often crave a certain food, feeling better when regularly eating it.

True: This is known as "masked sensitization."

A 40-year-old professional singer comes in for hoarseness. Her vocal quality is notably rough and videostroboscopy shows a linear sulcus along the medial edge of the vocal fold with diminished vocal cord vibratory activity. What is the likely diagnosis?

Type 2 sulcus/sulcus vergeture.

What is a fixed food allergy?

Type I, IgE-mediated response occurring seconds to hours after contact with the allergen.

What is the most common form of immune reaction causing food hypersensitivity?

Type III reactions.

A patient develops erythematous, eczematous lesions on her arm 48 hours after having her blood drawn. This reaction is characteristic of which Gell and Coombs reaction?

Type IV, delayed hypersensitivity.

What is the most likely etiology of vertigo? *Transient,orthostatic dizziness with vertical nystagmus*

Vertebrobasilar insufficiency

What is the most likely etiology of vertigo? *Acute,nonprogressive,episodic vertigo lasting for hours to days;no hearing loss*

Vestibular neuritis

What are the risk factors for developing a vocal fold granuloma?

Vocal abuse, GERD, prolonged intubation, trauma, and surgery.

What are the clinical findings associated with pathologic sulcus vocalis?

Vocal fold stiffness, fullness, edema, and bowing; capillary ectasia; and vibratory disturbances.

What syndrome is characterized by vestibuloauditory symptoms in association with uveitis, depigmentation of periorbital hair and skin, loss of eyelashes, and aseptic meningitis?

Vogt-Koyanagi-Harada syndrome.

What disease is characterized by necrotizing granulomas with vasculitis in one or more organs and focal necrotizing glomerulonephritis?

Wegener's granulomatosis.