ENT Secrets Flashcards
What are the insertions and 5 layers of the true vocal cords?
The vocal cords extends from the anterior commissure of the thyroid cartilage to the vocal process of the arytenoid.
The layers from superficial to deep:
- Squamous epithelium (stratified, nonkeratinizing epithelium)
- Superficial lamina propria (fibrous matrix)
- Intermediate lamina propria (elastin)
- Deep lamina propria (dense collagen, and 3+4 makes up the vocal ligament
- Thyroarytenoid mussle complex (thyroarytenoid and vocalis muscle)
Where is the most common site for hypopharyngeal cancer to occur?
The pyriform sinus in 65-75% of the cases
What is tylosis?
An autosomal dominant disease with hyperkeratosis of the palms of hands and feet, leading to 95% chance of developing SCC by the age of 70
Since the PE of esophageal cancer is often unremarkable, which lab tests are useful to aid diagnosis? Other tests?
- Hematocrit and albumin to check for malnutrient secondary to dysphagia and odynophagia
- Alkaline phosphatase and bilirubin secondary to liver metastasis
- Ca secondary to bone metastasis
- Others: barium swallow, esophagoscopy, CT, MRI, PET etc
Which types of thyroid cancer require complete dissection of reurrent laryngeal nerve if it is involved?
Medullary and anaplastic carcinoma, which are unresponsive to radioactive 131I
What is the protocol for thyroid hormone replacement before 131I ablation therapy?
T3 should be used for hormone replacement due to its short half-life, so that when it is withdrawn, there will be a shorter period of hypothyroidism until TSH is above 30mU/L, and 131I is given
What is the origine of medullary thyroid cancer?
They come from calcitonin-secreting parafollicular C cells. They are associated with MEN II.
What are the cancers associated with different MEN types?
MEN I: Wermer’s syndrome:
Pituitary adenoma, parathyroid adenoma, pancreatic islet cell tumor, gastric carcinoid
MEN IIa: Sipple’s syndrome:
Parathyroid adenoma, medullary carcinoma, and pheochromocytoma
MEN IIb:
Mucosal neuroma, ganglioneuroma, marfanoid habitus, medullary carcinoma, pheochromocytoma
Which neoplasm conditions are associated with RET proto-oncogene mutation? Implication?
MEN IIa and IIb
Total thyroidectomy is recommended
Which markers are used to track thyroid cancer?
Thyroglobulin level is an indicator for well-differentiated thyroid cancer recurrence
Calcitonin is a marker for medullary thyroid cancer
Presenting Sx of primary hyperparathyroidism hypercalcemia?
Stones, bones, groans, psychiatric overtones.
Stones: kidney stones, cholelithiasis
**Bones: **bone pain, pathologic fractures, subperiosteal resorption
**Groans: **muscle pain, weakness, pancreatitis, gout, constipation
**Psychiatric overtones: **anorexia, anxiety, depression
**Others: **hypertension, polydipsia, polyuria, lethargy, weight loss, neck mass
What is the cell origin of paraganglioma?
Locations?
They are paraganglionic cells, derived from sympathogonia, which are neural crest cells. Some can produce catecholamine and therefore are chromaffin positive
Normally they are in the adrenal medulla, but in the H&N regions they are at the carotid bifurcation and glomus jugulare (jugular bulb in the temporal bone)
Compare the glomus tympanicum and glomus jugulare?
Both are paraganglioma tumors, and present with pulsatile tinnitus, conductive hearing loss, and a red/blue mass behind tympanic membrane
Glomus tympanicum: arise in the middle ear on the promontory of the cochlea; minimal risk with ressection
Glomus jugulare: arise on the jugular bulb (origin of the jugular vein); it can cause bone destruction and puts cranial nervse IX, X and XI at risk with ressection
What is the mechanism of (large) hemangioma-associated coagulopathy? Txt?
Platelet trapping leading to diseminated intravascular coagulation-like syndrome. Txt is by transfusion of clotting factors and platelets, and later on, resection of the hemangioma.
Describe Sturge-Weber syndrome?
A congenital syndrome associated with venous angioma of cerebral leptomeninges and port-wine nevi along V2 and V3 branches. Angiomas of mouth, nasal mucosa; calcification of occipital and posterior lobes; seizures, and ophthalmologic problems.
