Head and Neck

Question 1

Arrange anterior to posterior:

anterior scalene, phrenic nerve, subclavian artery, subclavian vein

Answer 1

subclavian vein, phrenic nerve, anterior scalene, subclavian artery

Question 2

Parotitis:
Bug? ____
Population? ____, ____
Rx? ____, ____

Answer 2

staph; seen in elderly, dehydrated; rx: abx, drainage if abscess/not improving

Question 3

Painless mass on roof of mouth: ____ (_________, _________)

Answer 3

torus (bony exostosis, midline of palate)

Question 4

Which is worse and pre-malignant?

Erythroplakia or Leukoplakia?

Answer 4

Erythroplakia is worse and premalignant

Question 5

___ can reverse leukoplakia and reduce chance of 2nd head and neck malignancy

Answer 5

retinoids

Question 6

Head and Neck SCCa: Stage I, II (up to ___cm, no nodes) Rx with _____

Answer 6

4cm; rx with single modality (surgery or RT); III, IV get combined modality

Question 7

Nasopharyngeal SCCa present early/late ___?
(___% as neck mass),
Drain to ____.
Associated with ___.

Answer 7

present late;
50% as neck mass;
drain to posterior neck nodes;
associated with EBV

Question 8

Glottic cancerr: if cords not fixed, rx: ___.

If fixed, needs Rx: ____.

Answer 8

not fixed, then RT; if fixed, need surgery and RT

Question 9

Lip CA: (99% ____ origin)
upper or lower?
Rx? primary closure? flaps? dissection?

Answer 9

99% epidermoid carcinoma;
lower > upper due to sun exposure;
resect, primary closure if < 1/2 lip, otherwise flaps. Radical neck dissection if node +

Question 10

Tongue CA: Rx? ____.

Increase in ____.

Answer 10

usually need surgery and XRT.

increase in plummer vinson (dysphagia, spoon fingers, anemia)

Question 11

Larger salivary glands (parotid) = more likely for tumor to be benign or malignant?

Answer 11

benign

Question 12

________: #1 malignant salivary tumor overall

Answer 12

mucoepidermoid carcinoma

Question 13

________: #1 malignant salivary tumor of the submandibular/mino glands

Answer 13

adenoid cystic carcinoma

Question 14

Pleomorphic adenoma…. type? Rx? Exceptions?

Answer 14

mixted parotid tumor= #1 benign tumor, do not enucleate, needs superficial parotidectomy (spare CN7); if malignant, take whole parotid w/ CN7; if high grade (anaplastic), need radical neck dissection

Question 15

_______: #2 benign salivary tumor.
__% bilateral.
__% of bilateral ____ are this.
Rx: ______________.

Answer 15

Warthin’s tumor (adenolymphoma); 10% bilateral; 70% of bilateral parotid tumors are warthin’s tumor; Rx is superficial parotidectomy

Question 16

Radical neck dissection takes:

___, ___, __,____. Most morbid = ____.

Answer 16

CNXII, SCM, IJ, Submandibular gland. Most morbid = CN XII

Question 17

__________: Benign, in teen males, present w/ obstruction, epistaxis. Rx: _________.

Answer 17

Juvenile nasopharyngeal angiofibroma. Rx embolize (internal maxillary artery), then extirpate

Question 18

Frey’s syndrome: injury of….

Answer 18

injury of auriculotemporal nerve; gustatory sweating (crossed sweat/salivary fibers)

Question 19

Massive bleeding from trach is from __________. Present w small heraldic bleed. Avoid by _______.

Answer 19

from innominate artery (traceo-innominate fistula); avoid by making tracheostomy no lower than 3rd tracheal ring