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Clinical Medicine > ENT2 > Flashcards

ENT2 Flashcards

1
Q

what afferent pupillary defect look like

what does it mean

A

thee affected pupil doesn’t constrict symetrically when a light is moved from one eye to the other

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2
Q

what will the swinging flashlight test look like

A

the consensual pupillary reflex will be diminshed in the good eye when the light is shined in the affected eye

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3
Q

causes of afferent pupillary defect

A

retinal detachment (total)

optic nerve damage

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4
Q

causes of acute vision loss

A

macular disease

retinal detachments

vein occlusions

arterial onclusions

vitreous hemorrhage

optic nerve trauma

“functional vision loss”

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5
Q

SS macular degeneration

A

metamorphosia

central scotoma

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6
Q

metamorphosia

A

a symptom of macular degeneration where a grid of straightlines will appear wavy and some parts of the grid will look black

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7
Q

central scotoma

A

a symptom of macular degeneration where the middle part of the visual field looks black

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8
Q

why is afferent pupillary defect diagnostically valuable

A

because you can assess the function of the afferent and efferent nerves in both eyes from one

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9
Q

what would cause a bitempral visual field defect

A

lesion at the optic chiasma

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10
Q

how would a lesion in the optic tract behind the optic chiasm manifest

A

contralateral homogogenous hemianopsia (vision lost on the nasal ipsilateral and the temporal contralateral side)

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11
Q

T/F macular degeneration is painless

A

true

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12
Q

blood under the retina is indicative of what

A

macular degeneration

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13
Q

intact confrontational visual fields with poor vision is indicative of what

A

central scotoma from macular degeneration

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14
Q

VEGF inhibition

A

vascular enthothelial growth factor inhibition, treatment for macular degeneration

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15
Q

what causes macular degeneration

A

vascular overgrowth in the retinal pigmented epithelium precipitated by an defect

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16
Q

symptoms of retinal detachment

A

new floaters

flashing lights (photopsia)

visual field loss

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17
Q

what causes retinal detachment

A

tears that allow the vitreous humor to escape the posterior chamber and flow behind the retina

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18
Q

what is the goal of the scleral buckle

A

to fix retinal detachment by indenting the posterior eye to remove traction on the retina from the vitreous

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19
Q

vitrectomy

A

scope operation that fixes retinal detachment by draining the vitreous from behind the retina then putting an air bubble in the vitreous chamber to tamp down the retina

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20
Q

pneumatic retinopexy

A

repair of a retinal tear on the superior portion of the retina tha tuses are an air bubble in teh vitreous chamber to tamp down the tear why whe pigemented retinal cells pump out eh vitreous

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21
Q

branch retinal occulsion

A

ischemia in the retina related to HTN caused by a blockage int he retinal veins that releases VEGF`

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22
Q

central RVO

A

central retinal vein occulsion that can cause blindness of varying severity with no real treatment

caused by compression around teh optic nerve

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23
Q

Branch retinal artery occusion

A

blockage of the artery associated with carotid/cardiac dieases

may be considered emergent

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24
Q

hollenhort plaque

A

a piece of cholesterol or calcium from the carotid or heart valves that has lodged in a retinal artery

correlated with high risk of stroke

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25
Q

in central retinal artery occulsion, why would the fovea be red

causes

treatment

A

because the fovea doesn’t get much blood from the arteries of the eye

thrombosis, embolism

usually untreatable

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26
Q

ciloretinal artery

A

a branch of the retinal artery that has left the optic nerve and found a different way into the retina

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27
Q

SS optic neuritis

gender bias

imaging

A

MS

pain with eye movement

APD

usually makes a complete recovery

more young women

MRI is advisable

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28
Q

describe ischemic optic neuropathy

A

usually optic nerve swelling

usually irrerverislbe

artheritic or non arteritic, both usually in the eldery

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29
Q

describe arteritic ION

A

elderly women

related to PMR (tender scalp, headache, fever, jaw pain)

can progress to giant cell arteritis

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30
Q

treatment for arteritic ION

A

stat esr, CRP

immediate referral

start high dose steroids

schedule biopsy

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31
Q

describe non arteritic ION

A

No GCA symptoms

small disc cup

other involved 25-50%

might be related to nocturnal hypotension

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32
Q

what is one tool that can help localize the location of a stroke

A

central visual field defect

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33
Q

patient presents with a trauma that lacerates the retina

what might be sequela from this

A

some visual field lost from retinal artery occlusion

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34
Q

signs of background diabetic retinopathy

A

dot/blot hemorrhages

hard exudate

cotton wool spots

intraretinal microvascular abnormalities

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35
Q

what causes vision loss in background diabetic retinopathy

A

macular edema

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36
Q

what is the treatment of diabetic macular edema

advantages

A

focal laser

painless, mild side effects, reduces severe vision loss by half

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37
Q

pars plana

A

the area of the eye that can be incised without damaging other structures to allow access to the vitreous and retina

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38
Q

T/F presence of a fovea reflex indicates diabetic macular edema

A

false, it indicates good retainal health

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39
Q

what do cotton wool spots indicate in terms of progression in diabetic retinal edema

A

very davanced disease

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40
Q

what is the goal of laser treatment of diabetic edema

but

A

it coagulate microaneurysms

only 1 in 7 will regain vision

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41
Q

future treatments of DME

A

surgery

steroids

VEGF inhibitor

oral meds

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42
Q

proliferative diabetic retinopathy

A

neovascularization of the retina that causes the secretion of VEGF and infiltration of the vitreous

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43
Q

factors that are cocerning for proliferative diabetic retinopathy

A

can cause true blindness, esp in DM I

important to look for uncontrolled DMI as teens

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44
Q

treatments for PDR

A

laser

surgery

VEGF injections/steroids

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45
Q

PDR laser treatment

considerations

A

a more extensive laser treatment

more extensive, treats peripheral retina, can be painful, reduces side/night vision

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46
Q

pars plana vitrectomy

A

surgical removal of part of the vitreous

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47
Q

diabetic screening for retinal health

A

DM I, yearly dilated exams starting a puberty or within 5 years of diagnosis

DM II, at diagnosis and yearly after

Gestational: in the first trimester, each trimester as indicated

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48
Q

talking points for patients about diabetic eye disease

A

most damage is assymptomatic

control is of the ut must importance

encourage them to take charge

DMII can be managed with diet and exercise

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49
Q

T/F HTN is a direct cause of vision loss

A

false, it can cause many eye issues indirectly

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50
Q

how does HTN affect the eye

A

worsens DR

vein/artery occlusions

aneurysyms

optic nerve issues

macular degeneration

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51
Q

HTN related signs of poor retinal health

A

arterial narrowing

AV nicking

exudate

optic nerve swelling

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52
Q

common cause of blindness related to HIV

A

CMV retinitis

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53
Q

patient presents with hard exudate but no DM or HTN

what might be the cause

A

hyper lipidemia

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54
Q

retinal side effect of plaquenil

screening

A

toxicity that can cause bullseye maculopathy

need to have eye exam yearly

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55
Q

T.F maculopathy from plaquenil is reversible

A

false

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56
Q

structures of the outer ear

A

auricle and ear canal

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57
Q

strucutres of the middle ear

A

tympanic membrane, ossicles, middle ear space

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58
Q

structures of the inner ear

A

cochlea, semicircular canal, internal auditory canals

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59
Q

types of hearing loss

A

conductive, sensorineural, mixed

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60
Q

what will cause conductive hearing loss

A

dysfunction of the EAC, TM, or ossicles

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61
Q

what will cause sensorineural hearing loss

A

dysfunction of the cochlea or neural components of the auditory system

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62
Q

what are the weber and rinne tests used for

A

to differentiate between senory and conductive hearing loss

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63
Q

what will happen during the weber test if there is CHL

SNHL

normal

A

CH - sound lateralizes to the bad ear

SNHL - sound lateralizes to the good ear

normal hearing - sound hear equally in both ears

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64
Q

what will happen in a rinne test with normal hearing

CHL

SNHL

A

air condicution will be better than bone

bone conduction will be equal or better than air

ac conduction will be better than bone

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65
Q

typical causes of conductive hearing loss in the outer ear

A

wax

otitis externa

trauma

exostosis

osteoma

squamous cell carcinoma

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66
Q

middle ear causes of conductive hearing loss

A

otitis media

cholesteatoma

otosclerosis

TM perforation

Eustachian tube issue

middle ear barotrauma

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67
Q

causes of SNHL

A

prebycusis

ototoxic drugs

meniere disease

acoustic neuroma

MS

autoimmune

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68
Q

auricular hematoma

presentation

treatment

complications

A

tender, fluctuant collection of blood floowling a blunt trauma

drainage, pressure to keep the hematoma from forming, ABx

infection, recurrance, hematoma, cauliflower ear

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69
Q

consideration of treatment for cerumen impaction

A

treat symptomatic patients

keep in mind you don’t know what is behind the wax

sometimes a patient cannot adequately express their symptoms

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70
Q

what age is most likely to present with a foreign body in the EAC

A

6

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71
Q

treatment for EAC foreign object

presentation

what types of objects require immediate action

A

hearing loss, otalgia, otorrhea

penetrating foreign bodies, batteries, live insects

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72
Q

what should be used to kill life insects in the ear

A

ethanol, mineral oil, lidocaine

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73
Q

common causes for otitis externa

what bacteria are the most common vectors in otitis externa

A

infection, allergy, dermatological reasons

pseudmonas and staphylococcus

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74
Q

ramsay huny syndrome (herpes zoster oticus)

definition

presentation

A

an otologic complication of the herpes zoster virus

ipsilateral face paralysis, ear pain, vesicles in the auditoy canal and auricle

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75
Q

clinical presentation of otitis externa

A

otalgia, itching, ear fullness, possible hearing loss

tenderness at the tragus or pinna

diffuse ear canal edema, erythema

purulent otorrhea

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76
Q

treatment for otitis externa

are ABx always nessasry

A

Aural toliet

topical therapy with steroids

analgesics

no ABx unless there is an extenstion out side the ear canal or comorbities that raise concern (diabetes, immune deficiency

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77
Q

Eustachian tube dysfunction

etiology

presentation

A

commonly associated with edema of the URT (viral URI or allegery)

earfullness, popping or cracking when swallowing, mild to moderate hearing loss, retraction or decreased mobility on pneumatic otoscopt

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78
Q

typical presentation of an Overly patent eustachian tube (a.k.a. patulous eustachian tube)

treatment

A

autophony (exaggerated ability to hear ones breathing and voice)

directed at treating an underlying condition

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79
Q

typical cause of barotrauma

A

usually flying or scuba diving, in conjuction with an ET dysfunction that prevents equalization

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80
Q

barotrauma

presentation

prevention

referral?

A

ear pressure, hearing loss, otalgia, tinnitus

avoid activities that might cause injury

if there is SNHL or dizziness, but most will heal on their own

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81
Q

medical prevention of barotrauma

A

decongestants, antihistamines

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82
Q

causative factors for TM perforation

A

barotrauma, foreign body injury, infection

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83
Q

what determines the presentaion of hearing loss with TM perforation

A

depends on the size and location of the perforation

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84
Q

treatment of TM perforation

A

treat causative factor

most heal on their own, refere for surgical correction

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85
Q

mastoiditis defined

presentation

A

common complication of acute otitis media that is associated with mastoid bone destruction

fever, post auricular erythema/tenderness, ear proptosis, acute otitis media on otoscopy

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86
Q

how does mastoiditis present on CT scan

A

loss of mastoid air cells and local bone destruction

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87
Q

treatment of mastoiditis

A

IV ABx directed against staph pneumo, h flu, strep pyo

myringotomy (incsion of the TM to drain fluid)

mastoid ectome if medical therapy fails

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88
Q

otosclerosis

A

process in which the stapes loses mobility by excessive bone growth at the oval window

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89
Q

presentation of otosclerosis

treatment

A

slowly progressive conductive hearing loss that is usually bilateral and assymetric

tinnitus, SNHL

refer to ENT for hearing amplification or surgery

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90
Q

two categories of causes leading to vertigo

A

peripheral (benign paroxsysmal positional vertigo)

central (MS)

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91
Q

DDx for tinnitus

A

SNHL (most common)

neuro

ototoxic meds

infection

metabolic disorders

autoimmune

vascular disorders

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92
Q

DDx for tinnitus: neurologic

A

MS, Tumor

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93
Q

DDx for tinnitus: ototoxic meds

A

aminoglycosides, cisplatin, aspirin, loop diuretics

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94
Q

DDx for tinnitus; infection

A

rubella, neurosyphylis, lymdisease

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95
Q

DDx for tinnitus: metabolic disorders

A

thyroid, chronic renal failure

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96
Q

DDx for tinnitus: autoimmune

A

RA, SLE

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97
Q

DDx for tinnitus

when to suspect a vascular cause

lab studies?

A

when the tinnitus is pulsatile

contrast CT, MRI, and angiography

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98
Q

benign paroxysmal positional vertigo etiology

A

most commonly associated with calcium debris of the posterior semicircular canal (canalthiasis)

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99
Q

benign paroxysmal positional vertigo presentation

A

recurrent episodes of vertigo lasting one minute or less provoked by sudden head movement

positive dix hallpike manuver with characteristic nystagmus

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100
Q

benign paroxysmal positional vertigo treatment

A

particle reposition with the epley manuver

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101
Q

labyrinthitis etiology

A

unknown, maybe viral infection

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102
Q

labyrinthitis presentation

A

vertigo lasting for several days to a week accompanied by hearing loss

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103
Q

labyrinthitis treatment

A

vestibular suppressants

anti emetics

corticosteroids

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104
Q

T/F labyrinthtis will recover completely with with time

A

false, patients my have sporadic vertigo and might never regain hearing

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105
Q

meniere disease etiology

A

possible fluid in the ear due to abnormal ion homeostasis

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106
Q

meniere disease presentation

A

episodic vertigo

SNHL that fluctuates and typically affects lower frequencies

tinnitis

aural fullness

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107
Q

meniere disease acute treatment

A

vestivbular suppressants and antiemetics

108
Q

meniere disease long term therapy

A

avoid triggers (high salt, caffiene, alcohol, stress)

diuretics with lifestyle control is ineffective

vestibular rehab with hearingaids

109
Q

hall mark presentaton of prebycusis

other symptoms

A

progressive, systemic loss of hearing over many years (SNHL)

tinnitus, vertigo

110
Q

Presbycusis treatment

A

hearing aids

assistive listening devices

cochlear implants if hearing aids are ineffective

111
Q

Vestibular schwannoma (acoustic neuroma) defined

A

Schwann cell-derived tumors-commonly originating from the vestibular potion of cranial nerve VIII

112
Q

Vestibular schwannoma (acoustic neuroma) presentation

diagnostic studies

treatment

A

unilateral SNHL accompanied by tinnitus

MRI is the standard for diagnosis

surgery, radiation, observation

113
Q

common cold etiology

A

rhinovirus

114
Q

Common Cold presentation

A

rhinitis, congestion, sore throat, cough, sometimes conjunctivitis

typically NOT fever

115
Q

common cold treatment

A

symptomatic therapy

116
Q

Acute rhinosinusitis (ARS) defined

A

inflammation of the nasal passages and paranasal sinuses lasting up to four weeks combined with purulent nasal discharge, nasal obstruction, sinus pain and pressure

117
Q

Acute rhinosinusitis (ARS) common cause

A

viral etiology along with URI or common cold

118
Q

Acute rhinosinusitis (ARS) presentation

A

drainage, clogged nose, sinus pain or pressure, fever, fatigue, cough, ear pressure

119
Q

Acute bacterial rhinosinusitis (ABRS) must fit one of what three presentations

A

acute rhinosinusitis lasting for 10 days after the onset of URI

acute rhinosinusitis worsening within 10 days after initial improvement

onset of sever symptoms of signs of high fever (+102F), purulent discharge or facial pain, lasting for at least 3-4 days at the beginning of illness

120
Q

Acute bacterial rhinosinusitis (ABRS) treatment

A

ABx (amoxicillin or augmentin)

NSAIDs and tylenol

intranasal saline irrigation

intranasal corticosteroids

121
Q

when would augmentin be prescribed for treatment of Acute bacterial rhinosinusitis (ABRS)

what if they are cilin allegeric

A

likely ABx resistance (ABx use in the last month)

moderate to severe infection

presence of comorbidities (Diabetes)

use doxyclyclin

122
Q

Acute bacterial rhinosinusitis (ABRS) complications

A

orbital cellulitis and abcess

osteomyelitis

intracranial extension

cavernous sinus thrombosis

123
Q

Recurrent acute rhinosinusitis defined

A

4+ episodes of acute bacterial rhinosinusitis per year without signs or symptoms of rhinosinusitis between episodes

124
Q

chronic rhinosinusitis defined

A

12 weeks or more with

mucopurulent drainage, nasal obstruction, facial pain/pressure, decreased sense of smell AND inflammation documented

125
Q

chronic rhinosinusitis ways to document inflammation

A

purulent mucus and edema in the middle meatus or anterior ethmoid

polyps in the nasal cavity or middle meatus

radiographs showing inflamation of the sinuses

126
Q

classifications of allergic rhinitis

A

temporal pattern (seasonal)

perennial

episodic

determined by frequency and severity of symptoms

127
Q

Allergic rhinitis clinical presentation

A

paroxysms of sneezing, rhinorrhea, nasal itching, obstruction

post nasal drip, cough, fatigue

128
Q

Allergic rhinitis diagnosis

A

HP consistent with allegic cause

nasal congestion, rhinorrhea, itchy nose, sneezing

129
Q

Allergic rhinitis treatment

A

intranasal glucocorticoids

oral antihistamines

antihistamine sprays

decongestant/antihistamine combo

intranasal cromolyn sodium

montelukast

immunotherapy

130
Q

Allergic rhinitis treatment with Intranasal glucocorticoids

onset of action

continuous vs intermittent use?

adverse drug reactions

A

3-5 to 36 hours after first dose

continuous is better than intermittent

headache, throat irriation, epistaxis, nasal dryness

131
Q

Allergic rhinitis treatment with oral antihistamines

issues with first generation (benedryl)

issues with second (claritin)

A

lots of side effects (drowsiness)

cause less sedation and useful with patients who need relief from intermittent symptoms

132
Q

Allergic rhinitis treatment with Oral antihistamine/decongestant combinations

why use them?

adverse drug reactions

A

nonsedating antihistamines combined with pseduoephedrine provide better relief than antihistamine alone

limit us, include HTN, insomnia, irritability, headache

133
Q

Intranasal cromolyn sodium

how effective of a treatment is it for allergic rhinitis

A

mast cell stabilizer that inhibits mast cell degranulation

frequently less effective than intranasal glucocorticoids or 2nd gen antihistamine

134
Q

montelukast

how it it used in treating allergic rhinitis

A

selective leukotriene receptor antagonist, less effecive than intranasal glucocorticoids

sometimes used for people with allegies and asthma or nasal polyps

135
Q

when is immunotherapy used in allergic rhinitis

A

typically for refractory or severe cases

136
Q

nasal polyps

A

pale, edematous, mucosa covered masses that form in the nasal cavity or paranasal sinuses

137
Q

conditions related to nasal polyps in adults

in kids

A

chronic sinusitis, ashtma, aspirin sensitivty

cystic fibrosis

138
Q

samters triad

A

asthma, aspirin sensitivity, nasal poyps

139
Q

first line treatment for nasal polyps

A

intranasal corticosteroids

140
Q

anterior nose bleeds most typically comes from what

posterior comes from what

A

up to 90% area of kiesselbach’s plexus

originate most cmmonly from the posterolateral branches of the sphenopalatine artery

141
Q

epistaxis etiology

A

trauma

neoplasm

hereditary hemorrhagic telangectasia (osler-weber-rendu)

wegeners

coagulopathy

blood thiners

infection

142
Q

epistaxis diagnosis

A

HP with airway and CV assessment

work up for anemia and coagulopathy

143
Q

labs for severe epistaxsis

A

CBC for anemia and thrombocytosis

coagulation (PT, INR, PTT)

blood type

144
Q

epistaxis treatment

A

ABC’s

conservative (squeeze your nose, bend at the waist

2 sprays of oxymetazoline

chemical or electrocautery for anteriot nose bleed

if the bleeding stops and no source is visualized, observe for recurrance

145
Q

if epistaxis doesn’t stop with convervative measures

if that doesn;t work then what

if that doesn’t work then what

A

nasal packing with ABx

ENT consult, pack the oppostive nasal cavity

consider posterior source

146
Q

unilateral purulent discharge in a young patient suggests what

A

a foreign body of organic nature

147
Q

T/F inorganic foreing bodies cause more severe symptoms

A

false, they are typically assymptomatic

148
Q

nasal foreign body dx

A

history or visualized foreign body

149
Q

when is urgent removeal for a nasal foreign body required

treatment

when to refer

A

button batteries or paired magnets

positive pressure or direct instrumentation

when the object is posteriorly located, impacted, or penetrating

150
Q

leukoplakia often indicates what

how often will it progress to carcinoma

when should it be biopsied

A

hyperkeratosis from chronic infection

1-20% within 10 yrs

indurated or enlarged lesions

151
Q

erythroplakia

is this more or less indicative of malignancy compared to leukoplakia

A

red mucosal plaques

more likely to be malignant, should be biopsied

152
Q

atrophoic glossitis

causes

A

inflammation of the tonhe that makes the tongue look glossy

iron, b12, folic acid deficient

low protein diet

infection

sjogrens

celiac

153
Q

what is the most common of periodontal disease

it is a precursor to what

how can it be reversed

A

gingivits

periodontitis

can be reversed withgood dental hygiene

154
Q

periodonitis

A

gingival inflammation that leads to loss of connective tissue and alvolar bone that causes tooth loss

155
Q

sialadenitis bacterial cause

viral

A

infection of the salivary glands cuased by staph, strep, h flu though to be caused by retrograde contamination from the oral cavity

mumps

156
Q

Acute suppurative sialadenitis presentation

A

pain and swelling of the affected gland

induration, edema, tenderness

possible expression of pus

157
Q

Acute suppurative sialadenitis treatment

A

correct predisposing factors

warm compress

sour lozenges

ABx (augmentin)

parotiditis usuallly needs IV Abx

158
Q

Sialolithiasis

A

salivary stones, presents with pain and swelling exacerbated by eating

can be imaged if suspected but PE doesn’t reveal an obvious probelm

159
Q

Sialolithiasis treatment

A

hydration, warm compress, treat underlying infection

refer if treatment is ineffective or have severe symtpoms

160
Q

what is considered head and neck cancer

what type of cell is usually effected

A

generally cancer of the upper aerodigestive tract

usually squamous cells

161
Q

what is the primary risk factor for head and neck cancer

A

tobacco use

162
Q

what does a head and neck oncologist do

A

management of cerival lymph nodes, salivary glands, thyroid malignancy, otologic maliganancy, paranasal sinus malignancy, cranial base malignancy

163
Q

diagnostic categories of neck masses

A

inflammatory

congenital

neiplastic

traumatic

164
Q

inflammatory neck masses

A

lymphadenopathy, abscess

165
Q

congenital neck masses

A

thyroglossal duct cyst, brachial cleft cyst, dermoid, laryngocele, thymic masses

166
Q

neoplastic neck masses

A

benign (paraganglioma, schwannoma, hemangioma, lipoma)

malignant (lymphoma, sailvary, thyroid)

metastatic

167
Q

DDx of lymphadenopathic neck masses

A

infection (bacterial, abscess)

caseating granuloma

reactive

sarcoidosis

168
Q

History clues that can help Dx a neck mass

A

congenital (age, duration)

inflammatory (infection, pain, fever)

neoplastic (rapid growth, associated symptoms, risk factors, location)

169
Q

what percent of neck masses in kids are benign vs malignant

what about adults

A

80% benign, 20% malignany

8-% maliganant, 20% benign

170
Q

DDx of a +2cm inflammatory neck mass in children

A

atypical TB, lymphadenitis

171
Q

DDx of a +2cm congenital neck mass in kids

A

brachial cleft cyst, thyroglossal duct cyst

172
Q

DDx of a +2cm neoplastic neck mass in kids

A

lymphoma, thyroid, sacroma

173
Q

DDx of +2cm neoplastic neck mass in an adult

A

SCCA, thyroid, salivary gland, lymphoma

174
Q

DDx of +2cm inflammatory neck mass in an adult

A

HIV, TB

175
Q

DDx of +2cm congenital neck mass in an adult

A

branchial cleft cyst, thyroglossal duct cyst

176
Q

what are lymph node stages used for in head and neck surgery

A

certain primary cancers are know to spread to certain lymph nodes so those nodes can be targeted and removed

177
Q

describe a brachial cleft cyst

A
  • Lateral neck
  • Increase in size with URI
  • Second cleft most common
  • First associated with parotid
  • Third may be associated with thyroiditis
178
Q

describe thyroglossal duct remnants

A
  • Midline
  • Move with swallowing, tongue protrusion
179
Q

types of imaging used for neck masses

A

US

CT

MRI

PET

nuc med

180
Q

midline head and neck cancers

A

thyroglossal duct cyst

level I lymph nodes

dermoids

thyroid masses

level IV pathology

181
Q

indications for removal of a substernal goiter

A

airway obstruction or dysphagia

182
Q

how is a substernal goiter removed

A

transcerivcally, sometimes by sternotomy

183
Q

types of thyroid carcinoma

A
  • Papillary
  • Follicular
  • Medullary
  • Anaplastic
  • Lymphoma
  • Metastatic (melanoma, renal and others rarely)
184
Q

what type of thyroid cancer has the best prognosis

A

papillary, it also is the most common

185
Q

treatment for thyroid carcinoma

A

most require total thyroid

radioactive iodine

synthyroid

occasionally external beam

186
Q

T/F there are many things that can present as a cyst, so it is important to not assume things are a cystic

A

true

187
Q

what must be done when lymphoma is suspected

A

fine needle biopsy to exclude carcinoma

188
Q

types of carotid body tumor

A

chemodectoma

paraganglioma

189
Q

lyre sign

A

a splayed appearance of the internal and external carotids indicative of carotid body tumor

190
Q

best treatment for carotid body tumor

A

surgical removal, but conservative can be used in ellderly patient

191
Q

what percent of parotid cancers are benign

what percent of submandubular cancer are benign

A

80% parotid

50% submandibular

192
Q

T/F sublingula tumors are rare

A

true

193
Q

ranula

A

a mucocele found on the floor of the mouth

194
Q

what type of cancerous cells are found in parotid tumors

are they primary or mets

A

squamous cell carcinoma.

usually mets from a cutaneous lesion, but rarely is a primary lesion

195
Q

pleiomorphic adenoma

A

a benign tumor of the parotid gland that can convert into a more serious issue if allowed to grown

196
Q

risks of a deep lobe tumor in the parotid gland

A

more likely to have a facial nerve insult that causes facial paralysis

197
Q

T/F squamous cell parotid tumors require nothing post op

A

false, they need aggressive surgical managment and post operative radiation

198
Q

vascular lesions associated with head and neck surgery

A

hemangioma, lymphangioma, vascular malformations

199
Q

what type of neck masses are most common in children

young adults

adults

A

inflammatory

congenital or inflammatory

neoplasia

200
Q

T/F fine needle biopsy is a last resort for aneck mass

A

false, open biopsy is a last resort

201
Q

types of head and neck neoplasia

A
  • Carcinoma
  • Salivary Gland
  • Lymphoma
  • Thyroid
  • Carotid Body
  • Sarcoma
  • Melanoma
202
Q

the unknown primary

A

cancer in a cervical node with no detectable primary tumor

usually a squamous, undifferentiated tumor

203
Q

how does HPV cause metastatic head and neck cancer

A

HPV causes occult tonsil cancer or base of tongue cancer

virus dies, but the tumor still grows

204
Q

nasopharyngeal carcinoma is related to what virus

A

epstein bar

205
Q

common presentation of unknown primary cancer

A

painless unilateral mass, typically in a non smoking white male

206
Q

T/F HPV positve oropharyngeal cancers have a worse prognosis than those who have cancer realted to tobacco

A

false, HPV has a better prognosis

207
Q

History for unknow primary cancer

A
  • Risk Factors
  • Prior Malignancy
  • Prior Surgery (including skin or neck)
  • Head and Neck Symptoms
  • Oromandibular and Dental
  • Dysphagia/Odynophagia/Voice complaints
  • Epistaxis, Nasal Congestion/obstruction
  • Otalgia, Hearing Loss
  • Weight Loss
  • Fever, Chills, Sweats
208
Q

clinical presentation of oral cavity cancer

A

non-healing ulcer, dysarthria, bleeding, pain, loose teeth

209
Q

clinical presentation of oropharyngeal cancer

A

referred otalgia, trismus, throat pain, dysphagia, odynophagia

210
Q

clinical presentation of nasopharyngeal cancer

A

epistaxis, nasal obstruction, unlateral hearing loss, SOm, Neck mass, cranial nerve palse

211
Q

why is nasopharyngeal cancer unique

A

EBV is the carcinogen

212
Q

what is the treatment for nasopharyngel carcinoma

A

chemo

213
Q

clinical presentation of cancer below the pharynx

A

dysphagia, odynophagia, hoarseness, otalgia, neck mass, sore throat

214
Q

clinical presentation of laryngeal cancer

A

muffled voice, hoarseness, sore throat, otaligia, airway obstruction

215
Q

clinical presentation is tongue cancer

A

leukoplakia

erythroplasia

mass

ulceration

ill fitting dentures

pain

otalgia

neck mass

216
Q

what happens during panendoscopy

A
  • Palpation of the base of tongue facilitated
  • Evaluation of the pyriform sinuses
  • Biopsy of inaccessible regions
  • Telescopic Mapping
  • Screening for multiple primaries
217
Q

indications for biopsy of a neck mass

A
  • Progressively enlarging nodes
  • Single, asymmetric nodal mass
  • Persistent nodal mass, Esp. if no prior signs of infection
  • Active infection not responding to conventional antibiotics with routine cultures indeterminate
218
Q

what is the use of fine needle aspiriation

A
  • Differentiates benign from malignant
  • Carcinoma vs. Lymphoid
  • Avoids open biopsy
  • Standard work-up for thyroid nodule
  • Can be used for culture
219
Q

classic radical neck dissection removes what

A

internal jugular

SCM

CN XI

220
Q

modified neck dissection spares what

Type I

Type II

Type III

A

Type I CN XI

type II IJV and XI

Type III IVJ, SCM, XI

221
Q

Unusual Presentations of Head and Neck Cancer and Sinonasal and Skull Base Tumors

A
  • Trismus
  • Proptosis (unilateral)
  • Cheek swelling
  • Facial numbness
  • Facial Pain
  • Intermittent epistaxis
  • Facial nerve paralysis
  • Nasal obstruction
222
Q

Lip-Splitting Incisions

A

Straight

Curved around mental sulcus and chin

“Z” and “V”

Stepped approaches

223
Q

function of the vocal chords

A

phonation

airway patency

valsalva

224
Q

what is the larynx suspended from

A

the hyoid bone

225
Q

what is the only complete ring of cartilage in the larynx

A

the cricoid cartilage, below the thyroid cartilage

226
Q

accumulation of mucous around teh cricoid cartilage may cause what

A

stenosis

227
Q

where is the arytenoid cartilage

A

on the upper border of the posterior cricoid cartilage

228
Q

whatis the function of the arytenoid cartilage

A

allow for attachment of intrinsic muscles of the neck that perfrom complex movements of the larynx

229
Q

diseases that cause fibrosis or fixation of teh cricoarytenoid cartilage

A

RA, trauma

230
Q

describe the composition and location of the true vocal cords

A

bands of msucle, ligaments, mucosa that run from the arytenoids posterior to the midline of the thyroid cartilage posterior

231
Q

where are the false vocal cords

what separates them from the true vocal cords

A

above the true vocal cords

the laryngeal ventricle, that contains mucous producing glands that produce lubrication for the true vocal cords

232
Q

subdivisions of the larynx

A

supraglottis, glottis, subglottis

233
Q

structures in the supraglottis

A

structures above the true vocal cords

epiglottis, false vocal cords, arytenoglottal folds, arytenoids

234
Q

location and structures in the glottis of the larynx

A

true vocal cords and the area adjecent extending 1 cm below

235
Q

location and structures of the subglottis

A

the region of the larynx extending from the inferior edge of the glottis down to the inferior edge of the cricoid cartilage

236
Q

what CN innervates the laryngopharynx

A

the vagus

237
Q

describe the course of the reccurrent laryngeal nerve

A

on the left it passes under the aortic arch, on the right it passes under the subclavian, then it reenters the ekc at the thoracic inlet

238
Q

what nerve innervates all the intrinsic muscles of the larynx

A

the reccurrent laryngeal nerve

239
Q

problems assocaited with laryngeal dysfunction

A

hoarseness (often with weakness, fatigue, strained voice)

stridor

240
Q

when should hoarseness be refered to ENT

A

when there are no URI symptoms, lasts more than 2 weeks

accompanied by risk factors for head and neck cancer, severe cough, hemoptysis, unlateral ear or throat pain, dysphagia, unexplained weight loss

241
Q

typical causes of hoarseness

A

acute/chronic laryngitis

benign vocla cord lesion

maliganacy

neuro dysfunction

systemic condition

242
Q

how long does acute laryngitis last

what is it usually associared with

A

3 weeks (self-limiting)

usually a URI (rhinorrhea, cough, sore throat) or acute vocal strain

243
Q

typical vectors that can cause acute laryngitis

treatment

A

M cat, H flue, strep pneumo

usually resolves with conservative treatment
ABx not needed
sterds can be given if there is a pressing need to use their voice

244
Q

chronic laryngitis

A

laryngitis that lasts longer than 3 weeks

245
Q

factors associatd with chronic laryngitis

referral?

A

inhaled irritants (smoke, GERD, alcohol)

yes, requires laryngoscopy

246
Q

laryngopharyngeal reflux

A

retrograde movemnt of gastric contents into the laryngopharnyx

247
Q

Laryngopharyngeal Reflux symptoms

A

–dysphonia/hoarseness

–globus pharyngeus

–mild dysphagia

–chronic cough

–nonproductive throat clearing

248
Q

globus

A

feeling like there is something in the throat

249
Q

T/F most people are aware of Laryngopharyngeal Reflux and easy to diagnose

A

false, they are often assymptomatic so all other conditions must be ruled out then confirmed with laryngoscopy

250
Q

treatment for Laryngopharyngeal Reflux

A

full strength PPI for 3 months

251
Q

Laryngopharyngeal Reflux reccomendation

A

avoid foods that strip mucous from the esophagus (coffee, tea, peppermit(

avoid acidic foods

no smoking

eat smaller meals

avoid exercise for 2 hours after eating

252
Q

what causes Unilateral Vocal Cord Paralysis

A

unilateral RLN injury from malignancy, iatrogenic injury, ET tubes, trauma, degenerative disorders

253
Q

Unilateral Vocal Cord Paralysis signs

A

weak, breathy voice

risk for aspiration

254
Q

Bilateral Vocal Cord Paralysis caauses what

why

A

stridor

beccause the non functrional vocal cords cause glottal stenosis

255
Q

T/F Bilateral Vocal Cord Paralysis leaves the voice intact but has impaired respiratory function ranging from moderate stridor to respiratory distress

A

treu

256
Q

causes of Bilateral Vocal Cord Paralysis

A

iatrogenic

ALS, diabetic neuropathy, myasthenia gravis, organophosphate pesticide toxicity, stroke, head injury

257
Q

Laryngeal Growths are manifestations fo what

A

irritation caused by smoking, reflux, muscle tension, trauma

258
Q

T/F Laryngeal Growths tend to be bilateral

A

false, they tend to be unilateral with a contralateral friction lesion, though some “screamer nodes” can occur that are bilateral

259
Q

epiglottis

A

Infectious epiglottitis is a cellulitis of the epiglottis and adjacent tissues that can result from bacteremia and/or direct invasion of the epithelial layer by the pathogen

260
Q

what is the major risk of epiglottis

A

infection that will cause swelling and eventually result in airway obstruction

261
Q

what is the most common cause of epiglottis in kids

A

H flu, but also associated with strep, staph, mrsa

262
Q

what is the most common cause of epiglottis in adults

A

viruses, but can be bacterial, fungal, or a combination

263
Q

epiglottis in immunocompromised hosts can be caused by wha

A

pseudomonas aeruginosa or candida

264
Q

clinical findings associated with epiglottis in kids

A

respiratory distress (stridor, tachypnea, tripod breathing)

sore throat

dysphasia

muffled voice

retractions

265
Q

management and treatment of epiglottis

A

intubation

epiglottal culture

ABx

266
Q

T/F pediatric epiglottitis can be confirmed with a through oral exam

A

false, adults can be examined but children can gag and completely close their glottis

267
Q

thumb sign

A

a radiographic sign of epiglottis where it is so inflammed it looks like a thumb in the neck

Clinical Medicine (11 decks)

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