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Senior - ENT > 7 - Neck > Flashcards

7 - Neck Flashcards

1
Q

Neck triangles?

A

Slide 4

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2
Q

Normal lymph node size in neck?

A

<1cm in length

> 1.5cm “enlarged”

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3
Q

Neck mass is usually? (Broken down by age)

A

> 40 = cancer
<30, >70 = lymphoma

Kids and young adults
- usually benign

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4
Q

Neck mass rule of 7’s?

A

7 days - inflammatory
7 weeks - 7 months - neoplastic
7 yrs - congenital

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5
Q

Neck abscesses?

A

Emergency

- can compromise airway

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6
Q

MC neck space infection

A

Ludwig’s angina

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7
Q

What is ludwig’s angina?

A

ENT emergency

  • bilateral infectio of submandibular space
  • tongue pushes up and blocks airway
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8
Q

Ludwig’s angina is often caused by?

A

Dental infection

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9
Q

MCC of deep neck abscess?

A

Odontogenic infections (dental)

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10
Q

Lemierre syndrome?

A

Rare cause of ludwig’s angina or deep neck abscess

  • thrombophlebitis of internal jugular vein 2/2 orophangeal inflammation
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11
Q

Typical pt for lemierre syndrome?

A

ICU pts w prolonged internal jugular central venous catheter

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12
Q

S/s of lemierre syndrome?

A

Severe HA

Pulmonary infiltrates

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13
Q

Causes of ludwig’s angina and deep neck abscesses?

A
  • Dental infection
  • Lemierre syndrome
  • Suppurative lymphadenitis
  • Pharyngeal infection
  • Penetrating trauma
  • Pharyngoesophageal foreign bodies
  • Cervical osteomyelitis
  • Intravenous injection of internal jugular vein
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14
Q

Recurrent deep neck infection suggests?

A

Underlying congeintal lesion

- brachial cleft cyst

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15
Q

Suppurative lymphadenopaty in middle-aged pt with tobacco and ETOH hx is?

A

Metastatic SCC until proven otherwise

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16
Q

PE for deep neck abscess?

A

Edema
Erythemia
Pain in neck/chin/floor of mouth
Displaced tongue (2/2 cellulitis and pus)

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17
Q

MC cause of deep neck abscess?

A

Streptococci
Staphylococci
Bacteroides
Fusobacterum

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18
Q

Studies for deep neck abscess?

A

Contrast CT

CT/MIR can id lemierre syndrome

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19
Q

Tx for Ludwig’s angina?

A

PCN + metronidazole
Ampicillin-sulbactam
Clinamycin
Cephalosporins

Dental consult

I/D of external abscess

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20
Q

Deep neck abscess tx?

A

Secure airway
- intubate/tracheotomy
IV abx
I/D

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21
Q

Lemierre syndrome tx?

A

Antibiotics for fusobacterium necrophorum + airway pathogens

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22
Q

MCC of neck masses of all ages?

A

Reactive cervical lymphadenopathy (LAD)

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23
Q

What is reactive cervical lymphadenopathy?

A

Painful enlargement of normal lymph nodes in response to infection/inflammation

  • infection of pharynx, salivary glands, scalp
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24
Q

Reactive cervical lymphadenopathy prognosis?

A

Self-limiting and resolves spontaneously over weeks

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25
Q

Tx for reactive cervical lymphadenoapathy

A 
Abx
FNA if
- >1.5 cm
- hx of tobacco/etoh/ca
- persistent
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26
Q

Common causes of reactive cervical lymphadenopathy (LAD)

A

Tumor:

  • scc
  • lymphoma
  • mets

Infection:

  • virus
  • mycobacteria
  • cat scratch disease
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27
Q

Clinical presentation of reactive cervical lymphadenopathy (LAD)

A

Firm, mobile, tender
Rapid increase in size (rule 7’s)
- nodes can become necrotic and abscess

R/o cancer of >40

28
Q

Ddx of infectious lymphadenopathy?

A

Typical mycobacterial infection
- single non-painful lesion

Atypical (non-tb) mycobacterial infection

  • kids, no TB hx
  • leads to chronic fistula

Cat scratch disease
- bartonella henselae

Toxoplasmosis
- single node in posterior triangle

Mono
- acute pharyngitis

Syphilis
- should always be in ddx

29
Q

i say spirochete borrelia burgodorferi, you say?

A

Lyme disease from the ixodes tick

30
Q

Lyme HEENT symptoms?

A

75% of pts have HEENT symptoms

  • Facial paralysis
  • Dysesthesias (distorted touch)
  • Dysgeusia (distorted taste)
  • Cranial neruopathies
  • HA
  • Neck pain
  • Cervical LAD
31
Q

OSA vs snoring?

A

Snoring = noise

OSA = disruption of sleep (clinical eval)

32
Q

Prevalence of snoring/OSA?

A

OSA
Males - 20-30%
Females - 10-15%

33
Q

Snoring/OSA are attributed to?

A

Narrowing of the upper aerodigestive tract during sleep due to changes in:

  • position
  • muscle tone
  • soft tissue hypertrophy
  • laxity
34
Q

S/s of snoring/OSA?

A

Snoring
Daytime somnolence
HA
Wt gain

May or may not have demonstratable apnea or hypopnea on formal testing

35
Q

PE for snoring OSA?

A

Excessive oropharyngeal tissue
Retrognathia
Large neck circumference
Obesity

Epworth sleepiness scale (ESS)

36
Q

Diagnostics for OSA?

A

Polysmnography - an overnight test to eval sleep d/o

37
Q

Snoring/OSA tx?

A

Wt loss
PT

Non-surg

  • mandibular advancement appliances
  • CPA
  • BiPAP

Surgical

  • stiffen palate
  • UPPP
  • craniofacial procedure
  • hypoglossal nerve stimulation (implantable neurostimulator)
38
Q

uvulopaletopharyngoplasty (UPPP)

A

Throat and uvula trimmed, folded and sutured

- pic on 34

39
Q

Difference between crichothyrodotomy and tracheotomy?

A

You can smoke cigarettes through a tracheotomy

Seriously google it crazy…

Crichothyrotomy: acute emergency
- less risk (pneumothorax, hemorrhage)

Tracheotomy:

  • air way obstruction
  • respiratory failure w prolonged vent
40
Q

Why would you transition from intubation to tracheotomy?

A

Prevention of:

  • Subglotic stenosis
  • Aspiration pneumonia
  • sleep apnea
41
Q

MC congenital mass of the lateral neck?

A

Branchial cleft cyst

42
Q

What causes the branchial cleft cyst?

A

Remnants of the embryological development of the neck

43
Q

Presentation of branchial cleft cyst?

A

Soft, slow growing painless lesion anywhere along the sternocleomastoid
Typically appear on face near auricle

H/o infection
2nd/3rd decade of life

44
Q

Dx of branchial cleft cyst

A

CT: cystic mass medial to SCM

45
Q

Tx for branchial cleft cyst?

A

Excise completely along fistulous tracts
- recurrent infection/carcinoma possible but rare

Send to path

46
Q

MC congenital mass on central neck?

A

Thyroglossal duct cyst

47
Q

Thyroglossal duct cyst developes from?

A

Remnant occurring along the embryologic descent of thyroid

48
Q

Presentation of thyroglossal duct cyst?

A

< 20 yo
Thyroglossal duct cysts are midline
- often just below hyoid bone
- moves w swallowing and tongue protrusion

49
Q

Diagnosis for thyroglossal duct cyst?

A

TSH - indicates amount of thyroid tissue in neck

CT

50
Q

Tx for thyroglossal duct cyst?

A

Surgical removal
- preop US to confirm position of thyroid

Sistrunk procedure
- resection of the thyroglossal duct to the base of tongue w removal of the cyst and medial segment of they hyoid bone

51
Q

Lipomas, hemangiomas and neurofibromas are all?

A

Benign
Slow growing
No invasion

52
Q

Where in the neck does cancer like to mets to?

A

Lateral neck area

53
Q

Almost 95% of head and neck cancer is?

A

SCC

54
Q

Pt population who get SCC in the neck?

A

Middle-aged to elderly

  • upper aerodigestive tract carcinogen exposure
  • cigarette smoke
  • ethanol

So basically bikers (sorry “motorcycle enthusiasts”)

55
Q

Head and neck cancer gets a triple endoscopy. WTF is that?

A

Triple endoscopy

  • direct laryngoscopy
  • bronchoscopy
  • esophagoscopy

Conducted under anesthesia

56
Q

Why is SCC in the neck bad?

A

Its like a super highway mets to:

  • lymph nodes of neck
  • lung
  • liver
  • bone
  • brain
57
Q

What is the condition knowns as unknown primary?

A

When the primary tumor cannot be found

- about 10% of the time

58
Q

What type of endoscope is used for biopsy?

A

ENT surgeons use rigid endoscops b/c they are better for biopsy

But you can use both

59
Q

Adult pt with lump on neck and not good reason for it>?

A

Cancer until proven otherwise
Get complete HEENT exam
Get triple endoscopy

60
Q

SCC lesions need? (Diagnostic)

A

FNA of lymph node

- then find the primary cancer

61
Q

SCC presentation?

A 
Sore throat
Referred otalgia
Hoarseness
Airway obstruction
Fixed reactive LAD
Tender
Constitutional symptoms
62
Q

Thyroid Cancer type prevalence?

A 
Papillary carcinoma - 80%
- slow
Follicular carcinoma - 10%
- more aggressive
Medullary carcinoma - 5%
Anaplastic (undifferentiated) - <2%
- most aggressive
63
Q

Rule of 7’s

<7 weeks

A

Suspect infectious source

  • abx
  • f/u 2-4 wks
  • CXR, PPD
64
Q

Rule of 7’s

7 weeks - 7 months

A

Suspect neoplasm

  • CT w contrast and FNA
  • Endoscopy
  • Management based on histology and stage
65
Q

Rule of 7’s

> 7yrs

A

Suspect congenital anomaly

  • CT
  • excisional biopsy
66
Q

Neck tattoos used to mean “watch out motherfucker”

A

Now they mean “i’d like to read you poems about my vegan bicycle”

Senior - ENT (8 decks)

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