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Surgery Clerkship > ENT, Neurosurgery, Transplant > Flashcards

ENT, Neurosurgery, Transplant Flashcards

1
Q

Thyroglossal duct cyst patient presentation?

A

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

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2
Q

How to treat thyroglossal duct cyst?

A

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

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3
Q

Branchial cleft cyst patient presentation

A

Blind pouch on the anterior border of the sternocleidomastoid muscle.

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4
Q

Cystic hygroma patient presentation

A

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

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5
Q

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

A

CT scan because cystic hygroma can extend deep into mediastinum

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6
Q

How to treat cystic hygroma?

A

Surgery to remove it.

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7
Q

Differential for neck mass?

A

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.

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8
Q

How do patients with lymphoma present?

A

Enlarged LN in young patient with fever and night sweats.

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9
Q

How to diagnose lymphoma from LN?

A

Excisional biopsy.

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10
Q

How to distinguish cancers metastatic to LN from primary lymphoma?

A

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

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11
Q

Which patients get squamous cell carcinoma of head and neck?

A

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

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12
Q

How to diagnose squamous cell carcinoma?

A

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

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13
Q

How to work up neck mass from squamous cell?

A

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

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14
Q

How to treat squamous cell carcinoma of head/neck?

A

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

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15
Q

Other presentations of squamous cell carcinoma?

A

Persistent hoarseness, persistent mouth ulcer, unilateral headache.

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16
Q

Acoustic neuroma presentation and diagnosis?

A

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

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17
Q

Facial nerve tumor patient presentation

A

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

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18
Q

How to diagnose facial nerve tumor?

A

Gadolinium enhanced MRI

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19
Q

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

A

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

20
Q

Most common parotid tumor?

A

Pleomorphic adenoma, benign but can degenerate into malignancy.

21
Q

How to parotid tumors present

A

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

22
Q

How to diagnose parotid tumor?

A

FNA the mass, DO NOT open biopsy.

23
Q

How to treat parotid tumor

A

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

24
Q

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

A

Probably foreign body. Treat with endoscopy under anesthesia.

25
Q

Ludwig angina

A

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

26
Q

Bell’s Palsy

A

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

27
Q

Presentation of cavernous sinus thrombosis?

A

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

28
Q

How to treat cavernous sinus thrombosis?

A

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

29
Q

Most common causes of epistaxis?

A

Nosepicking, cocaine, pharygneal angiofibroma.

30
Q

How to treat pharygneal angiofibroma

A

Treat with surgery.

31
Q

Foster-Kennedy Syndrome

A

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

32
Q

Craniopharyngoma?

A

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

33
Q

Presentation of prolactinoma

A

Amenorrhea and galactorrhea. Need to rule out hypothroidism.

34
Q

How to diagnose prolactinoma

A

MRI

35
Q

How to treat prolactinoma

A

Bromocriptine, surgery if patient fails to respond.

36
Q

What is reflex sympathetic dystrophy (causalgia)?

A

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

37
Q

How to treat causalgia?

A

Surgical sympathectomy.

38
Q

Only absolute contraindication to organ donation?

A

HIV + patients

39
Q

Hyperacute rejection

A

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

40
Q

What causes hyperacute rejection?

A

Preformed antibodies

41
Q

Acute rejection

A

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

42
Q

Acute rejection presentation in liver and diagnostic test?

A

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

43
Q

Acute rejection presentation in heart?

A

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

44
Q

How to treat acute rejection?

A

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

45
Q

Chronic rejection and diagnosis?

A

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

46
Q

Graft vs host disease presentation

A

Hepatitis, dermatitis, gastroenteritis.

Surgery Clerkship (11 decks)

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