ENT

Question 1

Neck masses

Answer 1

Congen, inflamm, or neoplastic. Congen in young, present for years before sx. Inflamm timetable is measiured in days- resolves in a few weeks. Neoplastic = several weeks relentless growth

Question 2

Thyroglossal duct cyst

Answer 2

Midline @ level of hyoid, connected to tongue somehow. 1-2cm diameter, surgical removal of cyst, middle of hyoid bone and tract to base of tongue. Some check normal thryoid location by radionclide scan

Question 3

Branchial cleft cysts

Answer 3

Anterior edge of sternomastoid muscle, from front of tragus to base of neck. Several cm in diameter, maybe a little opening/blind tract in skin

Question 4

Cystic hygroma

Answer 4

Base of neck, large mushy ill-defined mass in whole supraclav area, extends deeper into chest. Can extend into mediastinum, do CT scan before surg removal

Question 5

Newly enlarged lymph node?

Answer 5

Probs benign. Do a full h& p and wait -4 weeks to see if its still there, then w/u

Question 6

Persistent enlarged lymph node?

Answer 6

Weeks to months? could still be inflamm, but gotta rule of cancer

Question 7

Lymphoma

Answer 7

Seen in young ppl, multiple enlarged lymph nodes (neck and elsewhere) + low-grade fever and night sweats. FNA or remove a node for pathologic study. Tx = chemo

Question 8

Mets to supraclav node

Answer 8

Comes from below clav (not head/neck). Usually from lung/abdominal tumor, node can be removed for dx

Question 9

Squamous cell carcinoma of mucosa

Answer 9

head/neck in old men smokers, drinkers, rotten teeth, pts with AIDS. Mets in neck (jugular chain), then do w/u of triple endoscopy to find rimary tumor(s). Biopsy primary for dx, do CT to demonstrate extent. FNA of node ok, but open biopsy of neck mass NEVER. Incision would just interfere w/ later surgery. Tx = resection, radical neck dissection, rads and platinum-based chemo. Also sx = persistent hoarseness, painless ulcer in floor of mouth, unilateral earache

Question 10

Acoustic nerve neruoma

Answer 10

Adult ww/ sensory hearing loss in one ear, w/ no sport shooting hx. MRI for dx

Question 11

Facial nerve tumors

Answer 11

Gradual unilat facial nerve paralysis affecting forehead/lowerface. (Suddent onset = bells palsy). Gadolinium enhanced MIR to dx

Question 12

Parotid tumor

Answer 12

Visible/palplable in front of ear or at mandible angle. Pleiomorphic benging adenoma w/ potential for malig. NO pain or facial nerve paralysis
Hard parotid painful paralytic mass = parotid cancer, do FNA but DONT DO open biopsy. Formal superficial parotidectomy (or deep if deep to facila nerve) is how to excise and biopsy tumor, prevent recurrences/spare faicla nerve. Enucleation alone => recurrences. If malig, sacrific nerve, do a graf

Question 13

Foreign bodies in toddlers

Answer 13

2-year old w/ unilat earache, rhinorrhea or wheezing has a little toy stuck up! Do endoscopy under anesthesia to extract

Question 14

Ludwig angina

Answer 14

Abscess in floor of mouth from bad tooth infec, find abscess, but potential airway threat. Do i&d but also maybe intubation/racheostomy

Question 15

Bell palsy

Answer 15

Sudden paralysis of facial nerve for no reason. Use antiviral meds w/ prompt and early admin, maybe helps

Question 16

Facial nerve injury

Answer 16

Paralysis immediately. If they have normal nerve function and get paralysis later, it’s just swelling that will resolve

Question 17

Cavernous sinus thrombosis

Answer 17

Dipolopia develops (paralysis of extrinsic eye muscles) in someone w/ frontal or ethmoid sinusitis. EMERGENCY- hospital, IV antibiotics, CT scan, drain sinuses

Question 18

Epistaxis

Answer 18

Kids from nosepicking- bleeding from anterior septum, phenylephrine spray _ local pressure control problem. In teens, think cocaine (septal perforation), or juvenile nasopharyngeal angiofibroma. Posterior packing for cocaine, surgical resection for benign tumor. In old/hypertensive, can be life-threatening bleed. Control HTN, pack posteriorly, maybe surgical ligation of vessels

Question 19

Dizziness

Answer 19

From inner ear or cerebral disease. Inner ear? Room spinning. Use meclizine, phenergan or diazepam. Brain? Unsteady pt but roomis stable. Do a neuro w/u