ENT - Adult neck masses Flashcards

1
Q

where do nasopharynx tumors metastasize?

A

upper jugular chain

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2
Q

where do nasopharynx / posterior scalp / ear / temporal bone / skull base tumors metastasize?

A

posterior triangle

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3
Q

where do thyroid / piriform sinus / upper esophagus tumors metastasize?

A

lower jugular chain

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4
Q

where do anterior 2/3 tongue / floor of mouth / gums / cheek mucosa tumors metastasize?

A

submandibular triangle

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5
Q

where do lip cancer tumors metastasize?

A

submental triangle

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6
Q

where do oral cavity (any location) / pharynx / larynx tumors metastasize?

A

midjugular chain

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7
Q

a tumor just behind the ear will be a metastasis from where?

A

nasopharynx

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8
Q

what should be the first step in addressing a neck mass / pain, especially with any inflammatory symptoms (redness, pain)?

A

2 week course of abx (prior to invasive treatment)

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9
Q

what is the standard diagnostic test for neck masses? what are the indications?

A

FNA

  • neck mass that is not an obvious abscess
  • persistence after 2 wk abx
  • progressive growth / supraclavicular / over 3 cm
  • B symptoms
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10
Q

what is radionucleotide scanning used for?

A
  • salivary and thyroid masses
  • location: glandular vs extra-glandular
  • functional information
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11
Q

80% of asymmetric neck masses are of what origin?

A

SCC

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12
Q

if there is unilateral otalgia with normal otoscopy, where should you suspect a neoplasm?

A

nasopharynx - tonsil, tongue base, supraglottis, hypopharynx

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13
Q

if there is unilateral serous otitis, where should you look?

A

nasopharynx (direct examination) - obstructing auditory tube

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14
Q

what is the nodal mass workup in the adult?

A
  • panendoscopy (FNA)
  • directed biopsy
  • synchronous primaries
  • open excisional biopsy (only if neg workup)
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15
Q

what is the most common anterior neck mass?

A

thyroid mass

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16
Q

what are the signs and symptoms of lymphoma?

A
  • lateral neck mass (discrete, rubbery, nontender)
  • fever
  • hepatosplenomegaly
  • diffuse adenopathy
17
Q

what diagnostic tests are done for lymphoma?

A
  • FNA (first line)
  • if suggestive for lymphoma: open biopsy
  • full workup: CT chest, abdomen, head neck, bone marrow
18
Q

does skin fixation indicate benign or malignant?

A

malignant

19
Q

what are the diagnostic tests for salivary gland tumors?

A
  • open excisional biopsy preferred
  • FNA
  • CT (deep lobe tumors, intra vs extra parotid)
20
Q

for salivary gland tumor resection, what should you be prepared to do?

A
  • total parotidectomy with possible facial nerve sacrifice
21
Q

how is lipoma diagnosis confirmed?

A

excision

22
Q

neurogenic tumors arise from what germ layer?

A

neural crest

23
Q

what is the most common neurogenic head and neck tumor?

A

schwannoma

24
Q

what are the neurogenic tumors?

A
  • schwannoma
  • neurofibroma
  • malignant peripheral nerve sheath tumor
25
Q

what are the s/sx of schwannoma?

A
  • medial tonsillar displacement
  • hoarseness
  • horners syndrome
26
Q

which branchial cleft has the highest incidence of cysts?

A

2nd

27
Q

WHEN do branchial cleft cysts most commonly present? what is the presentation?

A
  • post URI

- smooth fluctuant mass underyling SCM

28
Q

what is the treatment for branchial cleft cysts?

A
  • initial control of infection

- surgical excision, including tract

29
Q

do thyroglossal duct cysts move with swallowing?

A

yes (elevates on swallowing / protrusion of tongue)

30
Q

what is the treatment for lymphangiomas?

A

surgical excision if easily accessible

31
Q

what is the treatment for hemangiomas?

A

surgical excision for rapid growth in vital structures or thrombocytopenia

32
Q

what is required for equivocal or suspicious FNA in the pediatric nodal mass?

A

open excisional biopsy to rule out malignant or granulomatous disease