ENT

Question 0

Causes of congenital neck masses?

Answer 0

#Thyroglossal duct cyst
#Branchial cleft cyst
#Cystic hygroma

Question 1

General causes of neck masses?

Answer 1

#Congenital
#Inflammatory
#Neoplastic

Question 2

Baby presents with mass located at the midline of level of hyoid bone. Pulling at the tongue retracts the mass – suspected diagnosis? Management?

Answer 2

Thyroglossal duct cyst; surgical removal of cyst, middle segment of hyoid bone, and tract that leads to base of tongue

Question 3

Baby presents with mass along anterior edge of SCM. Suspected diagnosis?

Answer 3

Branchial cleft cyst

Question 4

Baby presents with ill-defined large mass occupying supraclavicular area – suspected diagnosis? When surgery?

Answer 4

Cystic hygroma; CT scan to assess depth before surgical removal

Question 5

Patient presents with enlarged lymph nodes on neck – Next step?

Answer 5

Follow up in 3-4 weeks. If masses still there, do full work up

Question 7

Young patient presents with multiple enlarged nodes in the neck, low-grade fever, night sweats. Suspected diagnosis? Confirm diagnosis with? Treatment?

Answer 7

Lymphoma; possibly afternoon, but usually lymph node removal for histology

Chemotherapy

Question 8

Old male patient with history of drinking and poor dentate presents with mass on deck – suspected diagnosis? Also associated with what illness? First manifestation usually is?

Other symptoms include?

Answer 8

Squamous cell carcinoma of the mucosa; AIDS; metastatic
In the neck on the jugular chain

Persistent hoarseness, persistent painless ulcer on the floor of mouth, persistent unilateral earache

Question 8

Differential diagnosis for persistent mass in neck?

Answer 8

#Lymphoma
#Metastatic tumor
#Squamous cell carcinoma of mucosa

Question 9

Ideal work up/treatment for squamous cell carcinoma of the mucosa?

Answer 9

#Triple endoscopy for primary tumor
#Biopsy of PRIMARY tumor for diagnosis (Never biopsy neck mass – Will interfere with surgery for tumor)
#CT scan for extent
#Resection, radial neck dissection
#Radiotherapy and platinum chemotherapy

Question 10

Adult presents with sensory hearing loss in one ear. Suspected diagnosis? Best test?

Answer 10

Acoustic nerve neuroma; MRI

Question 11

Toddler presents with unilateral earache, lateral rhinorrhea, or unilateral wheezing – most likely diagnosis? Management?

Answer 11

Foreign body (toys); endoscopy under anesthesia

Question 12

Adult patient presents with gradual unilateral facial nerve paralysis affecting forehead and lower face – suspected diagnosis? Best test?

If patient had sudden unilateral facial paralysis – suspected diagnosis?

Answer 12

Facial nerve tumor; gadolinium-enhanced MRI

Bell’s palsy

Question 13

Patient presents with painless the palpable mass between ear and angle of mandible – suspected diagnosis? Diagnose with? Absolutely contraindicated?

Treatment option? Insufficient treatment?

Answer 13

Parotid tumor; FNA; open biopsy contraindicated

#if benign, Formal superficial parotidectomy (+ deep if tumor is deep to facial nerve)
#if malignant, sacrifice nerve and do a graft

Question 14

ENT emergencies?

Answer 14

#Ludwig angina
#Cavernous sinus thrombosis

Question 15

Patient presents with abscess on the floor of the mouth – suspected diagnosis? Usual cause? Management?

Answer 15

Ludwig angina; bad tooth infection

#I&D
#Intubation/tracheostomy may be needed if affecting airway

Question 16

Treatment for Bell’s palsy?

Answer 16

Antivirals and steroids

Question 17

Difference between facial nerve injury that begins immediately after trauma versus later?

Answer 17

Actual nerve injury versus swelling that will resolve spontaneously

Question 18

Patient presents with diplopia, paralysis of extrinsic eye muscles. Suspected diagnosis? Likely cause? Surgery went?

Answer 18

Cavernous sinus thrombosis; frontal or ethmoid sinusitis

Drainage AFTER, IV antibiotics, CT scan,

Question 19

Patient presents with dizziness.

Difference between spinning sensation versus unsteadiness? Management of each?

Answer 19

Inner ear versus brain

Meclizine, Phenergan, diazepam versus neurologic workup