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Otorhinolaryngology > Head and neck > Flashcards

Head and neck Flashcards

1
Q

Where does the trachea run from and to?

A

Interiorly:
C6 to T4/5 where it bifurcates

Surface anatomy:
Ant Inf margins of cricoid cartilage to manubriosternal angle

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2
Q

Where is the thyroid located?

A

Just superior to the jugular notch

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3
Q

What marks the superior end of the oesophagus and trachea?

A

Cricoid cartliage

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4
Q

What structure spans the space between the thyroid and cricoid cartilage?

A

cricothyroid ligament

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5
Q

Where do the carotid arteries bifurcate?

A

Superior edge of thyroid cartilage (along with the carotid body and sinus)

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6
Q

What are the broad types of cervical lymph nodes?

A

superficial and deep

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7
Q

Where are the superficial cervical lymph nodes located?

A

along the course of the external jugular vein on the superficial surface of the sternocleidomastoid

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8
Q

Where do the superficial cervical lymph nodes drain to?

A

They send lymphatic vessels to the deep cervical lymph nodes.

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9
Q

Where are the deep cervical lymph nodes located?

A

Along the internal jugular vein (same surface anatomy as the superficial ones)

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10
Q

What is a branchial cyst and where do they form?

A

congential epithelial cysts within lymphoid tissue

in the middle 3rd of sternocleidomastoid region

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11
Q

Which age group to branchial cysts occur in?

A

below 30 yrs

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12
Q

What investigations should be done if a branchial cyst is suspected and what result would you expect?

A

fine-needle aspiration cytology (FNAC)

Expect:

a pus-like aspirate

rich in cholesterol crystals

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13
Q

What is the treatment for a branchial cyst?

A

surgical excision

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14
Q

Where does the thyroid cartilage originate from in an embryo?

A

The tongue base

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15
Q

What are thyroglossal cysts?

A

A fibrous cyst that forms from a persistent thyroglossal duct

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16
Q

When do thyroglassal cysts present?

A

NOT generally at birth

Childhood or adulthood

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17
Q

Where does the thyroglossal duct (in embryo) run from and to?

A

The foramen caecum of the tongue to

the thyroid gland

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18
Q

Where on the surface are thyroglossal cysts usually found?

A

In the midline

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19
Q

How can you check if a lump is likely to be a thyroglossal cyst?

A

Ask the pt to stick out their tongue and the cyst should move upwards.

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20
Q

How are thyroglossal cysts treated?

A

Surgical removal of the whole thyroglossal tract to prevent recurrance (they usually reoccur otherwise)

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21
Q

What are the two broad categories of thyroid enlargement?

A

Benign

Malignant

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22
Q

What are the two main types of goitre?

A

Diffuse enlargement

Nodular enlargement

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23
Q

What are the usual causes of diffuse goitre?

A

Grave’s disease

Iodine deficiency

Pregnancy

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24
Q

What is the hormonal cause of diffuse goitre and how does this link to Grave’s disease?

A

Excess TSH

This links to Grave’s as Grave’s produces thyroid stimulating immunoglobulin (TSI) which is very similar to TSH

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25
Q

What are the risk with nodular goitres?

A

They are higher risk of malignancy than diffuse

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26
Q

What are less concerning causes of multinodular goitres? (why may you still perform surgery)

A

alternating episodes of deficiency of

iodine or

TSH hyper secretion

(for cosmetic reasons)

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27
Q

What is a hot nodule in the thyroid region?

A

A part of the tyroid that takes up excess radioactive iodine on a scan

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28
Q

What chemicals are used to determine “hot” nodules?

A

It will take up radioiodine or technetium.

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29
Q

What is more dangerous a “hot” or “cold” ademona of the thyroid gland?

A

A cold ademona as 10-20% will in fact be malignant

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30
Q

What are the causes of neck lumps?

A

Thyroglossal cysts
Branchial cyst
Goitres (benign or malignant)

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31
Q

What are the types of non-cancerous salivary gland disease?

A 
viral infection
sialadenitis
sialolithiasis
granulomatous disease
Sjogren’s syndrome
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32
Q

What are the two main symptoms of salivary gland disease?

A

Pain and swelling

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33
Q

What are the main salivary glands?

A

Parotid
Sublingual
Submandibular

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34
Q

What is the most common cause of bilateral parotid gland enlargement? (where-else can it rarely affect?)

A

Mumps (caused by paramyxovirus)

rarely affects the submandibular gland

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35
Q

Which age group most commonly get mumps?

A

Children

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36
Q

What is the name of the virus which causes mumps?

A

paramyxovirus

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37
Q

What are the symptoms of mumps?

A

Bilateral parotid swelling

Pain (due to stretched parotid capsule)

Systemically unwell

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38
Q

Which infection increases ones risk of salivary gland infection?

A

HIV

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39
Q

What is sialadenitis?

A

Acute infection of the salivary glands

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40
Q

How does sialadenitis present?

A

Pain and swelling of the gland

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41
Q

What is a risk factor for acute parotitis?

A

Old age

Dehydration

Poor oral hygiene

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42
Q

What are the sings/symptoms of parotitis (aka parotid sialadenitis)?

A

Pyrexia
Swollen + tender gland
Pus leaking from the parotid papilla into the mouth

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43
Q

What are the symptoms of submandibular sialadenitis?

A

similar as to parotitis but with a different location

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44
Q

What is the treatment of sialadenitis?

A

High-dose antibiotics

Rehydration

Oral hygiene

Citrus mouthwash (it increases saliva flow)

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45
Q

What are the potential outcomes of sialadenitis?

A

Resolves with treatment

Abscess formation and then require drainage.

Recurring inflammation, infection and scarring leading to loss of architecture and subsequent excision is required.

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46
Q

What is Sialolithiasis?

A

Stones (calculi) within the salivary glands

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47
Q

What is the common precipitant for sialolithiasis?

A

chronic sialadenitis

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48
Q

What type of saliva is produced by the parotid gland?

A

serous, watery secretion

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49
Q

What type of saliva is produced by the submandibular gland?

A

mixed serous and mucous secretion

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50
Q

What type of saliva is produced by the sublingual gland?

A

mucous secretion

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51
Q

Which gland produces the most saliva daily and what % is it?

A

submandibular 60-70%

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52
Q

Where does sialolithiasis occur most often and why?

A

In the submandibular glands as they produce the most saliva and it is thicker than parotid saliva.

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53
Q

How does sialolithiasis usually present?

A

postprandial swelling

painful gland

54
Q

What would be found o/e of sialolithiasis?

A

painful
swollen
gland

maybe able to palpate the stone

55
Q

How are sialolithiasis investigated?

A

Using dye injection to image

56
Q

How are sialolithiasis treated?

A

oral fluids and

sialogogues (e.g. lemon drops which stimulate secretions)

If the situation becomes worse

the stone

or the gland can be surgically removed

57
Q

What can causes granulomatous disease swelling in the neck?

A

Both tuberculosis and non-tuberculous

They can infect the salivary gland and cause:

cold abscess of adjacent lymph nodes

58
Q

What is Sjogren’s syndrome?

A

Autoimmune destruction of the bodies exocrine glands (specifically the salivary and lacrimal glands)

59
Q

What are the symptoms of 1ry Sjogren’s syndrome?

A 
Dry mouth (xerostomia)
Dry eyes (keratoconjunctivitis sicca/xerophthalmia)
60
Q

What are the signs of Sjogren’s syndrome?

A

diffuse parotid gland enlargement

61
Q

How is Sjogren’s syndrome diagnosed and treated?

A

Dx biopsy

Tx is symptomatic relief with steroids

62
Q

What can increase suspicion that a parotid mass may be malignant?

A

If there is a facial nerve palsy (it is almost diagnostic)

63
Q

Are salivary malignancies normally painful?

A

yes

64
Q

Where are the most common places to get a salivary gland malignancy?

A

Sublingual gland

and

minor salivary glands

(thus swellings in these areas are highly suspicious)

65
Q

Where are the minor salivary glands located?

A

throughout the oral and nasal cavities (thus tumours can occur anywhere)

66
Q

What is the most common malignant tumour of savliary glands?

A

Mucoepidermoid tumours

67
Q

What is the prognosis of mucoepidermoid tumours?

A

it can vary from good to bad depending on their grade.

68
Q

Where do adenoid cystic carcinomas often invade into?

A

The nerves

69
Q

What is the prognosis of adenoid cyctic carcinoma?

A

Long-term it is poor

however its slow growing so a pt can live with it for many years

70
Q

Where is the most common place for a salivary gland neoplasm?

A

85% will arise in the parotid gland

71
Q

What proportion of parotid masses will be benign?

A

85%

72
Q

How should salivary gland tumours be investigated and treated?

A

Fine needle aspiration (FNA) and excision

as incisional excision could lead to spread

73
Q

How do benign salivary gland tumours present?

A

slow growing (they may have been there for a long time)

painless masses

74
Q

What tends to push a salivary gland tumour away form suspicion of malignancy?

A

No nerve palsy

Smooth,

subcutaneous swelling

with no skin attachment

no pain

75
Q

What are the most common salivary gland tumour?

A

Pleomorphic adenoma

76
Q

Where do pleomorphic adenomas most commonly arise?

A

Usually in the parotid gland

77
Q

What is the risk with pleomorphic adenomas?

A

If they have been present for years they may become malignant.

78
Q

What is the treatment for pleomorhpic ademomas?

A

Surgical excision

with a healthy margin to prevent recurrance

79
Q

What is a Warthin’s tumour?

A

a benign
cystic tumor
of the salivary glands

containing abundant lymphocytes

80
Q

What is Warthin’s tumour also known as?

A

adenolymphoma

monomorphic adenoma

81
Q

Where do Warthin’s tumours usually develop and in whom?

A

In the parotid tail

In older men

82
Q

What is unusual in Warthin’s tumours?

A

They occasionally occur bilaterally

83
Q

What is the treatment for Warthin’s tumour?

A

Surgical excision

84
Q

Where does the parotid duct open in to?

A

Cheek opposite the second molar

85
Q

What structure pass through the parotid gland?

A 
Facial nerve (more superficial)
External carotid artery (deeper)
86
Q

Where does the submandibular duct open?

A

a papilla next to the frenulum of the tongue

87
Q

What important structures pass through the submandibular gland?

A

The hypoglossal nerve

Lingual nerve a branch of the mandibular nerve of (CN 5)

marginal mandibular branch of CN 7

88
Q

Where does the sublingual gland lie?

A

Along the course of the submandibular duct.

89
Q

How does the sublingual gland secrete saliva into the mouth?

A

10-15 ducts secrete either

directly into the mouth or

into the submandibular duct

90
Q

Is radiotherapy used in salivary gland tumours?

A

Yes in highly malignant salivary tumours

91
Q

What is Frey’s syndrome?

A

Post-surgery

secretormotor fibres redirect to the sweat glands and activate during meals

thus sweat over parotid during meals

92
Q

What is the association of otalgia and head + neck malignancies?

A

Otalgia may actually be referred pain from the tumour

93
Q

How is a diagnosis of leukoplakia made?

A

It is a diagnosis of exclusion.

94
Q

What is leukoplakia?

A

white patches adhering to the oral mucosa

that cannot be removed by rubbing

and represents a hyperkeratosis of the oral epidermis

95
Q

What can cause leukoplakia?

A

Local irritation e.g. smoking, alcohol, dentures, etc

96
Q

What is the prognosis of leukoplakia?

A

1/3 will become cancerous

97
Q

What is the prevelance of leukoplakia?

A

1%

98
Q

What is the epidemiology of leukoplakia?

A

Common in

50-70 y/o’s

twice as common in men

99
Q

Where is leukoplakia normally found?

A

On the tongue

100
Q

What are the lesions of leukoplakia like?

A

Bright

raised

sharply defined

101
Q

What is a sign that leukoplakia is undergoing malignant change?

A

If there are erosions or ulcerations

102
Q

What is the treatment for leukoplakia?

A

Stop potential irritants (e.g. smoking)

Also potentially:

Retinoids (chemically related to Vit A)

Surgical excision

103
Q

What is hairy leukoplakia?

A

leukoplakia but with a hairy appearance

associated with EBV and HIV

104
Q

How can hairy leukoplakia be treated

A

Antivirals

Retinoids

Surgery

Vigorous brushing

105
Q

What is erythroplakia?

A

A red patch in the mouth that cannot be accounted for by any reason.

106
Q

How would you describe erythroplakia?

A

Erythematous

macular/papular

well defined

velvety texture

107
Q

What is the risk of erythroplakia?

A

It if often associated with dysplasia and

hence a precancerous lesion

108
Q

What is the treatment for erythroplakia?

A

Biopsy and

surgical excision

109
Q

What is the role of the trigeminal nerve (CN V)?

A

Sensation

and pain of the face

muscles of mastication

corneal reflex

110
Q

What is the role of the facial nerve (CN 7)?

A

Facial muscles

Taste of anterior 2/3 of tongue

111
Q

What is the role of the glossopharyngeal and vagus nerves (CN 9+10)?

A

Taste to posterior 1/3 of tongue

sensation of soft palate

swallowing

gag reflex

uvula displacement (to normal side)

vocal cords.

112
Q

What is the role of the spinal accessory nerve (CN 11)?

A

Trapezius muscle

Sternocleidomastoid muscle

113
Q

What is the role of the hypoglossal nerve (CN 12)?

A

Muscles of the tongue with deviation towards the affected side

114
Q

What type of cancers are most common in the head and neck?

A

SCCs

115
Q

Where do half of all head and neck cancers originate from?

A

The mouth

116
Q

How long should you wait before referring someone with a white or erythematous patch?

A

2 weeks

117
Q

Is weight loss common in head and neck cancers?

A

No very common, more likely due to the actual obstruction of the oesophagus is present.

118
Q

How much saliva is produced in 24 hours?

A

1-1.5 litres

119
Q

Which medications increase salivation?

A

Parasympathomimetics e.g. Pilocarpine (used in glaucoma)

120
Q

What bacteria is most common to infect the parotid gland?

A

Staphylococcus

121
Q

What initially does sialolithiasis cause?

A

Sialectasis - a cystic dilation of the ducts of salivary glands

122
Q

What symptoms occur in 2ry Sjogrens syndrome?

A 
Dry mouth (xerostomia)
Dry eyes (keratoconjunctivitis sicca/xerophthalmia)
Connective tissue disease (50% of the time it is RA)
123
Q

What is the risk of Sjogrens syndrome?

A

1 in 6 will develop non-hodgekin’s B-cell lymphoma

124
Q

What is the most common site of salivary tumours?

A

80% in the parotid

125
Q

Are benign or malignant tumours of the salivary gland more common?

A

80% are benign

126
Q

Which salivary glands have more malignant tumours than in other glands?

A

only 60% of submandibular gland tumours are benign

only 30% of minor salivary gland tumours are benign

127
Q

What are the antigens specific to Sjogren’s syndrome?

A

Anti-Sjögren’s-syndrome-related antigen A (SSA)

Anti-Sjögren’s-syndrome-related antigen B (SSB)

128
Q

What are the types and frequencies of malignant thyroid tumours

A

Papillary carcinomas - 75%
Follicular carcinomas - 20%
Medullary carcinoma (parafollicular cells) - less than 5%
Anaplastic thyroid cancer - less than 5%

129
Q

What are the types of malignant salivary gland tumour in order of frequency?

A

Adenoid cystic carcinoma
Carcinoma ex pleomorphic adenoma
Adenocarcinoma
Lymphoma

130
Q

What are the tumours of variable malignancy in the salivary glands?

A

Mucoepidermoid carcinoma

Acinic cell carcinoma

131
Q

What are the benign tumours of the salivary gland?

A

Pleomorphic adenomas

Warthin’s tumour (a.k.a. adenolymphoma, however not actually a type of lymphoma)

Otorhinolaryngology (7 decks)

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