ENT Flashcards
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?
Thyroglossal duct cyst
Treatment of thyroglossal duct cyst
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
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
Branchial cleft cyst
Tx of branchial cleft cyst
Elective surgical removal
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?
Cystic hygroma
- should order CT scan to see how deep it goes
Tx of cystic hygroma
Surgical removal
What should you do if a patient presents to you with an enlarged LN?
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
What should you think of when you have an enlarged LN in the supraclavicular area?
Malignant mets from a primary tumor ex. Stomach, lung, colon, pancreas, kidney
What are some common presentations of squamous cell carcinoma?
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
What should you do if you suspect a mass in the neck to be squamous cell carcinoma?
Do not biopsy
- order triple endoscopy (panendoscopy)
- follow with CTscan
What does a unilateral version of common ENT problem (such as hearing loss) suggest in an adult?
Malignancy
- ex hearing loss: think acoustic neuroma
What does slow progressive, unilateral nerve paralysis suggest?
Malignancy
- vs sudden onset as in Bell’s palsy
Order MRI
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?
Pleomorphic adenoma of parotid gland
What should you do in a pt with a pleomorphic adenoma of parotid gland?
Never do open biopsy - refer to head and neck surgeon
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?
Parotid gland cancer
Unilateral versions of common bilateral ENT conditions in toddlers suggest….
Foreign body
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?
Ludwig angina - abscess on floor of mouth
Management of Ludwig angina
Need to maintain airway
- incision and drainage of abscess
- intubation or tracheostomy may be needed
Tx. Of sudden onset Bells Palsy
Antivirals (valacyclovir) and steroids (oral prednisone)
- usually resolves on its own
Pt is in a multiple trauma car accident; the next day he has facial paralysis - dx?
Likely from edema - will resolve on it’s own
A pt being treated for sinusitis calls you and tells you she is now seeing double - what do you do? Dx?
She likely has cavernous sinus thrombosis or orbital cellulitis
- emergency! Send her to hospital
Tx. Of cavernous sinus thrombosis/orbital cellulitis
High dose IV antibiotic treatment
Surgical drainage of paranasal sinuses or orbit
10 yo old girl has epistaxis; her mother says that she often picks her nose
Bleeding from anterior nasal septum
Management of epistaxis in children
Local pressure, phenylephrine spray
- anterior nasal packing if bleeding severe and others didn’t work
18 yo boy has epistaxis and the pt denies picking nose; no source of anterior bleeding can be seen - what can this be?
Septal perforation from cocaine abuse
Posterior juvenile nasopharygneal angiofibroma
Tx of septal perforation due to cocaine abuse
Posterior nasal packing
Tx. Of juvenile nasopharygneal angiofibroma
Surgical removal - benign but it is locally invasive
72 yo old man with BP of 220/115 comes in with a copious nosebleed and is swallowing blood- dx? Management?
Epistaxis secondary to HTN
- medical tx of BP
- posterior packing needed
- emergency arterial ligation may be required
If a patient is complaining of dizziness and a feeling of being UNSTEADY…
Think neurological (vascular occlusive)
If a patient complains of dizziness and explains that the room spins around him…
Due to inner ear problem (vestibular apparatus)
- sx treatment with meclizine, phenergan, diazepam
- ENT work up
