Endocrine, Head, and Neck Flashcards
Which vein CROSSES THE MIDLINE overlying the proximal trachea and is at risk in a tracheotomy?
anterior jugular vein
What is the innervation of the lower lip?
The cervical branch of the facial nerve through the marginal mandibular branch. Ipsilateral dysfunction (since no cross innervation)
Where is the phrenic nerve–the only part of the cervical plexus not sacrificed in radical nerve dissection–located?
superficial to the anterior scalene. Phrenic nerve can be damaged in this procedure
Trumpet player complains of sudden onset nonproductive cough and hoarseness of voice:
prolapse of mucosa overlying the true vocal cords (ventricle of Morgagni)=supraglottic prolapse. Treatment is surgical excision of the tissue via direct laryngoscopy. Occurs in people who routinely elevate the pressure in their pharynx and chest.
What may cause sudden onset hoarseness of voice in a person who strains their voice (lecturers etc)?
spasmodic dysphonia. ***Fluctuation with normal speech can occur. Temporary improvement with botox
Difficulty breathing after being held in chokehold:
unilateral vocal cord paralysis due to compression of the recurrent laryngeal nerve with compression of the cricothyoid joint
Dysphagia and aspiration can occur following injury to the ___________ nerve, which provides sensory innervation to the larynx.
internal branch of the superior laryngeal
What is Warthin’s tumor?
papillary cystadenoma lymphomatosum. Epithelial component interspersed with lymphoid tissue showing germinal centers. More common in men. Benign (?); second most common tumor of the parotid gland (following pleiomorphic adenomas)
What is the most common cause of primary mediastinal tumors?
neurogenic tumors (followed, in frequency, by thymoma, congenital cysts, lymphoma)
The thymus gland arises from which branchial arches?
3rd and 4th
It is the (absence/presence) of calcium that is more indicative of malignancy.
absence! <–really
What is a bronchopulmonary sequestration? Where in the lung would you think about it?
A pulmonary sequestration (also known as a bronchopulmonary sequestration or cystic lung lesion), is a piece of tissue that ultimately develops into lung tissue that is not attached to the pulmonary arterial blood supply. Remains sequestered and does not contribute to breathing. It has a separate arterial supply
Posterior aspect of inferior lobe of lung
What are the structures most likely to be affected initially when an apical tumor penetrates out of the thoracic inlet?
The first thoracic nerve and the lower trunk of the brachial plexus
When a lung tumor has expanded to the chest wall or has metastasized, how is it treated?
Radiotherapy first, before resection.
In small cell, combo chemo, THEN radiotherapy, then resection.
Patients with an FEV < _____ or a FVC < ______ are unlikely to tolerate a pneumonectomy well.
Neither are patients with maximal voluntary ventilation under ___%
FEV <50%
Metastatic lung cancer tends to be in the (upper/lower) lungs.
Lower
The presence of multiple lesions on CXR should alert the physician to which diagnoses?
1) AV fistulas
2) metastatic lung cancer
What is the treatment for a single AV fistula? For multiple AV fistulas?
single: resection
multiple: therapeutic embolization
Treatment of ARDS features PEEP and the smallest FiO2 to keep oxygen over 60 along with what kind of tidal volumes?
smaller (5-7) to avoid volutrauma
Where are bronchogenic cysts most commonly located?
behind the carina
There are three major openings of structures that penetrate the diaphragm at different levels. What are they?
T8: IVC (to right of midline)
T10: esophagus (to left of midline)
T12: aorta (midline)
How is tracheal stenosis treated? (for example, following intubation)
resected
The presence of subperiosteal resorption of bone of the phalanges and lamina dura of the teeth are fairly diagnostic of:
hyperparathyroidism –> osteitis fibrosa cystica
Chondromas account for 20% of benign tumors of the rib and occur where?
costochondral junction
What is essential to perform in an unexplained lung abscess?
Bronchoscopy to rule out foreign body or malignancy that may be causing bronchial obstruction
________ may become evident after an URI and present as a mass anterior to the SCM
Branchial cleft cysts
These are usually found in the posterior triangle of the neck but can be found in the mediastinum, axilla, or groin _______ What is their origin? WHat is a useful sign to diagnose them?
Cystic hygromas! Represent persistent primary lymphatic buds. Transillumination
c b? e a ?
T/F: Lip SCC usually occurs beyond the vermillion border.
true
What is ameloblastoma and how is it treated?
Benign tumor occurring at the junction of the body and ramus of the mandible. Will recur if not adequately excised; radioresistant. Odontogenic epithelium seen in connective tissue stroma with extensive areas of cystic degeneration.
Injury to the submandibular gland may injure which nerves?
Lingual nerve (from the mandibular division of the trigeminal nerve); mandibular branch of the facial nerve
Carcinoma of the posterior third of the tongue carries a (better/worse) prognosis
worse. Lymph gland spread is often encountered.
Malignant hard palate tumors are usually what kind of cancers?
adenocarcinomas (arise from salivary glands)
What is the first cranial nerve to be affected in nasopharyngeal carcinoma? What does it indicate?
abducens nerve (causing lateral rectus palsy); indicates cranial extension
________ is a low grade malignancy seen more frequently in the soutehrn part of the US and found most commonly on the gingival-buccal junction in tobacco chewers.
Verrucous carcinoma
A neck gland tumor is more likely to be (metastatic/primary)
metastatic (and most from structures above the clavicle)
Which structures are in the classic complete neck dissection for palpable adenopathy in the posterior triangle of the neck?
SCM, external and internal jugular veins, spinal accessory nerve, submandibular gland, lymphatic tissue of the lateral compartment of the neck
What is the chorda tympani?
a branch of the facial nerve that supplies the anterior 2/3 of the tongue with taste and which contains the secretory parasympathetic fibers to the submandibular and sublingual glands
What is the origin of the thymus?
3rd and 4th branchial arches
What is the most common source of epistaxis?
Kisselbach’s vascular plexus on the anterior nasal septum
The carotid bodies detect changes in (blood volume/PO2).
PO2
Bell’s palsy is attributed to an inflammatory condition of the facial nerve at what site?
where it exits the stylomastoid foramen
What is the most common complication of thyroid and parathyroid surgery?
iatrogenic injury to the recurrent laryngeal nerve
How can an NGT lead to sinusitis?
NGT causes swelling and irritation of the nasal mucosa, which may occlude drainage of the sinus into the meatus
This appears as a black crusting in the nose and sinuses of diabetics and can spread rapidly to involve the cerebrum. Biopsy reveals nonseptate hyphae.
Mucor –> opportunistic mold causing mucormycosis
Which nerve is responsible for tensing the vocal cords?
the external laryngeal nerve (a division of the superior laryngeal nerve)
If the thyroid gland is missing from the neck, where might it be?
the lingual position at the foramen cecum. Excision of this lesion from the tongue will require thyroid hormone replacement.
The tip of the tongue drains into which lymph nodes? The side of the tongue?
tip: submental
side: submandibular
What type of tumor develops along lines of embryological fusion, in the floor of the mouth and in the neck causing a “double chin” appearance?
dermoid cyst
What is the major contraindication to pneumonectomy?
uncorrected hypercarbia (PCO2 > 60)
