ENT Flashcards
8 y/o boy. hoarseness but otherwise well. Mirror examination of larynx = two pedunculate swellings on the vocal cords
laryngeal papilloma
viral lesions
remove with caution as may spread - need laser treatment
normally disappear at puberty
May become large enough to obstruct airway - present with stridor
60 year old man
smokes 20 cigs a day
hoarseness of several weeks duration
mirror examination - left vocal cord is lying near midline and does not move
Carcinoma of bronchus
- spread to invade recurrent laryngeal nerve
- consider in all presenting with hoarseness and CXR should be ordered
4 year old child.
history of rapidly increasing stridor.
was well 6 hours previously but developed a sore throat, followed by vomiting and stridor.
Dyspnoeic, pale, anxious, high fever
Acute epiglottitis
Commonly - haem influenza type B
- responds to broad spectrum antibiotics
Take to operating theatre and anasthetise on operating table
- may need tracheostomy
red epiglottis and swollen, protrudes above tongue (rising sun sign)
- never examine to see this as can precipitate complete respiratory obstruction
rare nowadays due to HIB vaccine
20 year old woman
asymptomatic, painless lump in midline just beneath her chin. Lump is smooth, spherical, approximately 2cm in diameter, non-tender and fluctuant to palpation. Lump moves on swallowing and on protrusion of the tongue.
Thyroglossal cyst
forms from a remnant of thyroglossal duct left patent after migratory development of thyroid gland.
In/ very near to midline
cystic nature - fluctuant
moves upwards on tongue protrusion
80 year old man
history of recurrent sore throats, halitosis, regurgitation.
seen by GP for chronic cough, difficulty swallowing.
5-10cm indistinct mass behind sternocleidomastoid muscle, below thyroid cartilage.
Lump is soft, smooth and compressible on palpation.
Pharyngeal pouch = pulsion diverticulum of pharynx
regurgitation at night - causes chronic respiratory symptoms
suffers from dysphagia as a result of compression of oesophagus by the filling pouch.
25 year old woman - painless swelling in upper lateral part of left side of neck. 7cm, ovoid, smooth, non-tender, fluctuant swelling is palpable lying deep to and protruding anteriorly from the upper third of the sternomastoid muscle
Branchial cyst
remnant of second branchial cleft.
may be complicated by infection and inflammation of wall - may cause attacks of pain when increase in size.
most commonly in 15-25 age group as painless swellings
42 year old woman.
smooth swelling just in front of right ear.
USS - mass arising from right parotid gland.
surgery - mass is found to be encapsulated and have a lobulated, rather gelatinous cut surface.
histology- benign mixed tumor with both epithelial and connective tissue elements
Pleomorphic adenoma
2/3 of all salivary gland tumors.
More common in parotid than in other salivary glands.
Varied histological appearance - mixture of stroll and epithelial elements.
benign but has tendency to recur
65 year old man, lifelong heavy smoker, presents with slowly growing painful ulcer in floor of mouth.
Mucosa around ulcer is thickened and white.
Cytology - scrapings from lesion shows malignant cells with focal keratinisation
SCC
95% malignant tumors of oral cavity
often arises within area of leukoplakia
RF: tobacco, alcohol, chewing betel nut
often present late with poor prognosis
53 year old woman presents with tinnitus and increasing deafness in left ear.
CT - well-circumscribed 2.5cm mass at left cerebellopontine angle.
Histology - benign tumor of neural origin
Acoustic neuroma
originate in nerve sheath of the 8th (vestibulocochlear) CN, most commonly cerebellopontine angle.
Symptoms - due to compression of nerve - esp vestibular branch
arise from Schwann cells - so also known as acoustic schwannomas
Benign but prone to recur is excision is incomplete
34 year old Chinese man with left nasal obstruction and hearing loss in left ear.
Exam - enlarged lymph node in left side of neck.
CT- mass in left nasopharynx.
Biopsy - undifferentiated malignant tumor with heavy lymphocytic infiltrate.
Tumor cells express EBV-related antigens.
Intranasal undifferentiated malignant tumour = either nasopharyngeal carcinoma or olfactory neuroblastoma
Nasopharyngeal - chinese, prominent lymphocytic infiltrate, EBV infection
Tend to grow silently
