ENT, Neurosurgery, Transplant

Question 1

Thyroglossal duct cyst patient presentation?

Answer 1

Midline cyst at the level of the hyoid bone, connected to tongue so moves.

Question 2

How to treat thyroglossal duct cyst?

Answer 2

Surgery to remove cyst, medial portion of hyoid bone, and thyroglossal tract.

Question 3

Branchial cleft cyst patient presentation

Answer 3

Blind pouch on the anterior border of the sternocleidomastoid muscle.

Question 4

Cystic hygroma patient presentation

Answer 4

Mushy ill-defined mass that occupies supraclavicular area. Some can extend deep into chest.

Question 5

How to diagnose cystic hygroma? Why does this need to be done?

Answer 5

CT scan because cystic hygroma can extend deep into mediastinum

Question 6

How to treat cystic hygroma?

Answer 6

Surgery to remove it.

Question 7

Differential for neck mass?

Answer 7

Reactive LN vs lymphoma. If first presentation is not super suspicious, have patient come back in 3-4 weeks. If patient has persistently large LN, cancer must be ruled out.

Question 8

How do patients with lymphoma present?

Answer 8

Enlarged LN in young patient with fever and night sweats.

Question 9

How to diagnose lymphoma from LN?

Answer 9

Excisional biopsy.

Question 10

How to distinguish cancers metastatic to LN from primary lymphoma?

Answer 10

Cancers from below the neck (GI/breast/lung) usually metastasize to supraclavicular nodes. Very firm.

Question 11

Which patients get squamous cell carcinoma of head and neck?

Answer 11

Old men who smoke and drink with bad teeth. Or patients with AIDS. usually manifests as neck node.

Question 12

How to diagnose squamous cell carcinoma?

Answer 12

Triple endoscopy to find primary, then biopsy primary. Use CT to assess extent.

Question 13

How to work up neck mass from squamous cell?

Answer 13

DO NOT open biopsy. Will interfere with surgery to actually treat tumor.

Question 14

How to treat squamous cell carcinoma of head/neck?

Answer 14

Resect, radical neck dissection, platinum based chemotherapy, and radiation.

Question 15

Other presentations of squamous cell carcinoma?

Answer 15

Persistent hoarseness, persistent mouth ulcer, unilateral headache.

Question 16

Acoustic neuroma presentation and diagnosis?

Answer 16

Patient presents with sensory hearing loss in one ear. Diagnose with MRI.

Question 17

Facial nerve tumor patient presentation

Answer 17

Presents as gradual facial nerve paralysis of both forehead and face.

Question 18

How to diagnose facial nerve tumor?

Answer 18

Gadolinium enhanced MRI

Question 19

How to distinguish facial nerve tumor from bell’s palsy?

Answer 19

Bell’s onsets immediately. Facial nerve tumor is gradual.

Question 20

Most common parotid tumor?

Answer 20

Pleomorphic adenoma, benign but can degenerate into malignancy.

Question 21

How to parotid tumors present

Answer 21

Hard mass in front of ear and at angle of manible. Painful, can sometimes cause facial paralysis.

Question 22

How to diagnose parotid tumor?

Answer 22

FNA the mass, DO NOT open biopsy.

Question 23

How to treat parotid tumor

Answer 23

Formal superficial parotidectomy. Can’t just do enucleation because that may lead to recurrence.

Question 24

Toddler presenting with unilateral earache, wheezing, or rhinorrhea? How to treat?

Answer 24

Probably foreign body. Treat with endoscopy under anesthesia.

Question 25

Ludwig angina

Answer 25

Abscess at the floor of the mouth due to tooth infection. Can lead to airway obstruction, so protect airway!

Question 26

Bell's Palsy

Answer 26

Sudden paralysis of facial nerve. Treat with antivirals or steroids.

Question 27

Presentation of cavernous sinus thrombosis?

Answer 27

Patient with ethmoid or frontal sinusitis has fever and diplopia due to eye muscle paralysis. VI is the first to go.

Question 28

How to treat cavernous sinus thrombosis?

Answer 28

This is an emergency. Hospitalize the patient, give IV antibiotics, CT scan, drain

Question 29

Most common causes of epistaxis?

Answer 29

Nosepicking, cocaine, pharygneal angiofibroma.

Question 30

How to treat pharygneal angiofibroma

Answer 30

Treat with surgery.

Question 31

Foster-Kennedy Syndrome

Answer 31

Tumor at the base of the forebrain causes anosmia, inappropriate behavior, optic nerve atrophy, papilledema on contralateral side.

Question 32

Craniopharyngoma?

Answer 32

Young patient with short stature and bitemporal hemianopsia. Calcified lesion from rathke's pouch.

Question 33

Presentation of prolactinoma

Answer 33

Amenorrhea and galactorrhea. Need to rule out hypothroidism.

Question 34

How to diagnose prolactinoma

Answer 34

MRI

Question 35

How to treat prolactinoma

Answer 35

Bromocriptine, surgery if patient fails to respond.

Question 36

What is reflex sympathetic dystrophy (causalgia)?

Answer 36

Pain after a crush injury, made worse by any stimulation. Extremity is cold, cyanotic, and moist.

Question 37

How to treat causalgia?

Answer 37

Surgical sympathectomy.

Question 38

Only absolute contraindication to organ donation?

Answer 38

HIV + patients

Question 39

Hyperacute rejection

Answer 39

Vascular thrombosis within minutes of revascularization of organ. Not seen clinically because it is prevented with ABo matching and lymphocytotoxic crossmatch.

Question 40

What causes hyperacute rejection?

Answer 40

Preformed antibodies

Question 41

Acute rejection

Answer 41

Happens 5 days to 3 months after organ transplantation, even if patient is on immunosuppressants. Signs of organ dysfunction occur, biopsy confirms diagnosis.

Question 42

Acute rejection presentation in liver and diagnostic test?

Answer 42

Increasing liver damage enzymes, GGT, alkphos, bili. Need to rule out thrombosis and biliary issues so rule out with ultrasound and doppler.

Question 43

Acute rejection presentation in heart?

Answer 43

Signs of acute rejection show up too late so ventricular biopsies need to be done at standardized intervals.

Question 44

How to treat acute rejection?

Answer 44

Steroid boluses, if unsuccessful, antilymphocyte agents or antithymocyte serum.

Question 45

Chronic rejection and diagnosis?

Answer 45

Seen years after transplant as organ function steadily declines. Biopsy just in case it is acute because chronic has no treatment.

Question 46

Graft vs host disease presentation

Answer 46

Hepatitis, dermatitis, gastroenteritis.