ENT

Question 1

15 yo pt with cystic mass in midline of neck at level of hyoid bone; when you pull on tongue, there is a connection between the two -dx?

Answer 1

Thyroglossal duct cyst

Question 2

Treatment of thyroglossal duct cyst

Answer 2

Sistrunk operation

• removal of mass and the track to the base of the tongue along with medial segment of hyoid bone
• should ascertain the location of the normal thyroid first with radioisotope scanning

Question 3

18 yo old has a fluctuant round mass on her lateral neck in front of the sternomastoid; CT scan shows the mass to be cystic

Answer 3

Branchial cleft cyst

Question 4

Tx of branchial cleft cyst

Answer 4

Elective surgical removal

Question 5

6 yo has mushy, fluid filled mass at base of neck; occupies most of supraclavicular area and on physical appears to go deeper into the neck and chest - dx? Test?

Answer 5

Cystic hygroma

- should order CT scan to see how deep it goes

Question 6

Tx of cystic hygroma

Answer 6

Surgical removal

Question 7

What should you do if a patient presents to you with an enlarged LN?

Answer 7

Ask pt to come back in 3 weeks and recheck

• if it went away, it was likely inflammatory
• if still present, it is likely neoplastic

Question 8

What should you think of when you have an enlarged LN in the supraclavicular area?

Answer 8

Malignant mets from a primary tumor ex. Stomach, lung, colon, pancreas, kidney

Question 9

What are some common presentations of squamous cell carcinoma?

Answer 9

An old man who smokes and drinks and has rotten teeth
An AIDS pt
Pt with persistent hoarseness
Pt with persistent ulcer on floor of mouth
Pt with persistent unilateral earache

Question 10

What should you do if you suspect a mass in the neck to be squamous cell carcinoma?

Answer 10

Do not biopsy

• order triple endoscopy (panendoscopy)
• follow with CTscan

Question 11

What does a unilateral version of common ENT problem (such as hearing loss) suggest in an adult?

Answer 11

Malignancy

- ex hearing loss: think acoustic neuroma

Question 12

What does slow progressive, unilateral nerve paralysis suggest?

Answer 12

Malignancy
- vs sudden onset as in Bell’s palsy
Order MRI

Question 13

45 yo man presents with a firm mass in front of the left ear which has been present for 4 months. The mass is deep to the skin and it is painless; pt has normal function of facial nerve -dx?

Answer 13

Pleomorphic adenoma of parotid gland

Question 14

What should you do in a pt with a pleomorphic adenoma of parotid gland?

Answer 14

Never do open biopsy - refer to head and neck surgeon

Question 15

If pt has mass in parotid area that is gradually growing, is painful and he is experiencing gradual progression of facial nerve paralysis; he also has rock hard LN in the left neck - what are you thinking?

Answer 15

Parotid gland cancer

Question 16

Unilateral versions of common bilateral ENT conditions in toddlers suggest….

Answer 16

Foreign body

Question 17

45 yo woman with history of recent tooth infection shows up with a huge, hot, red, tender, fluctuant mass on left lower side of face and upper neck; the mass pushes up the floor of the mouth on that side and she is febrile - dx?

Answer 17

Ludwig angina - abscess on floor of mouth

Question 18

Management of Ludwig angina

Answer 18

Need to maintain airway

• incision and drainage of abscess
• intubation or tracheostomy may be needed

Question 19

Tx. Of sudden onset Bells Palsy

Answer 19

Antivirals (valacyclovir) and steroids (oral prednisone)

- usually resolves on its own

Question 20

Pt is in a multiple trauma car accident; the next day he has facial paralysis - dx?

Answer 20

Likely from edema - will resolve on it’s own

Question 21

A pt being treated for sinusitis calls you and tells you she is now seeing double - what do you do? Dx?

Answer 21

She likely has cavernous sinus thrombosis or orbital cellulitis
- emergency! Send her to hospital

Question 22

Tx. Of cavernous sinus thrombosis/orbital cellulitis

Answer 22

High dose IV antibiotic treatment

Surgical drainage of paranasal sinuses or orbit

Question 23

10 yo old girl has epistaxis; her mother says that she often picks her nose

Answer 23

Bleeding from anterior nasal septum

Question 24

Management of epistaxis in children

Answer 24

Local pressure, phenylephrine spray

- anterior nasal packing if bleeding severe and others didn’t work

Question 25

18 yo boy has epistaxis and the pt denies picking nose; no source of anterior bleeding can be seen - what can this be?

Answer 25

Septal perforation from cocaine abuse

Posterior juvenile nasopharygneal angiofibroma

Question 26

Tx of septal perforation due to cocaine abuse

Answer 26

Posterior nasal packing

Question 27

Tx. Of juvenile nasopharygneal angiofibroma

Answer 27

Surgical removal - benign but it is locally invasive

Question 28

72 yo old man with BP of 220/115 comes in with a copious nosebleed and is swallowing blood- dx? Management?

Answer 28

Epistaxis secondary to HTN

• medical tx of BP
• posterior packing needed
• emergency arterial ligation may be required

Question 29

If a patient is complaining of dizziness and a feeling of being UNSTEADY…

Answer 29

Think neurological (vascular occlusive)

Question 30

If a patient complains of dizziness and explains that the room spins around him…

Answer 30

Due to inner ear problem (vestibular apparatus)

• sx treatment with meclizine, phenergan, diazepam
• ENT work up