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Surgery Clerkship > Head and Neck > Flashcards

Head and Neck Flashcards

1
Q

What key questions to ask about hoarseness?

A

Duration
Progression
Quality

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2
Q

What are key risk factors for laryngeal cancer?

A
  1. Tobacco use, including chewing

2. Alcohol use

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3
Q

What is the pathophysiology of laryngeal cancer?

A

Chronic inflammation and increased cellular turnover from toxic insults cause dysplasia and invasive squamous cell carcinoma

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4
Q

At what point does hoarseness warrant consultation with an ENT?

A

Longer than 3-4 weeks

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5
Q

Would you expect a bloody sputum with laryngeal cancer?

A

No: suggests malignancy in upper aerodigestive tract or in lungs

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6
Q

What is the most common type of laryngeal cancer?

A

squamous cell carcinoma

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7
Q

What is the most common site of malignant lesions of the larynx?

A

Glottis

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8
Q

What 2 nerves innervate the larynx?

A

Superior laryngeal n.

Recurrent laryngeal n.

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9
Q

What does the superior laryngeal nerve innervate (motor)?

A

Inferior constrictor

Cricothyroid muscles

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10
Q

What does the recurrent laryngeal nerve innervate (motor)?

A

All intrinsic laryngeal muscles except cricothyroid

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11
Q

Do laryngeal papillomas cause cancer?

A

HPV 6, 11 - cause benign papillary tumors.

- RARELY are malignant

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12
Q

What is the examination for evaluation of the vocal cords?

A

Office: indirect laryngoscopy:
- Mirror laryngoscopy
- Flexible fiberoptic laryngoscopy
OR: Direct laryngoscopy

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13
Q

If laryngeal cancer is suspected, what additional tests are warranted?

A

CXR: r/o pulm disease

CT neck: look for mets

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14
Q

How is laryngeal cancer staged?

A

TNM

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15
Q

What is the treatment for early stage laryngeal cancer?

A

Surgery OR radiation

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16
Q

What is the treatment for late stage laryngeal cancer?

A

Combination therapy: surgery and radiation, chemo and radiation or combo
- May need cervical lymph node dissection

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17
Q

What is the goal in treating laryngeal cancer?

A

Try to preserve the larynx

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18
Q

What is the most prognostic factor for laryngeal cancer?

A

TNM

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19
Q

What may be necessary for late stage laryngeal cancer?

A

Tracheostomy to secure airway

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20
Q

What are the red flags in evaluation of a neck mass?

A 
Otalgia
Dysphagia
Dysphonia
Dyspnea
Trismus
Stridor
Hemoptysis
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21
Q

What key exam maneuvers should be done in evaluation of a neck mass?

A
  • Palpate base of tongue and tonsillar fossa for firmness

- Perform complete CN exam

22
Q

What are risk factors for head and neck cancer?

A 
Smoking
Alcohol
Age > 40
HPV
EBV
GERD
Chinese ethnicity
Plummer Vinson Syndrome
23
Q

What are primary tumors of the neck?

A 
Lymphoma
thyroid carcinoma
Salivary gland neoplasms
Schwannaoma
Paraganglioma
Lipoma
24
Q

What are the deep neck abscesses and who gets them?

A

Peritonsillar (kids > 10) - no airway obstruction usually
Retropharygneal (kids < 10) - cause cause airway obstruction
Parapharyngeal (all ages: dental infections, tonsillitis)

25
Q

What is the first step in workup of a neck mass?

A

Thorough head and neck exam: test all CNs

26
Q

After physical exam, what is the next step to workup a neck mass?

A

Flexible endoscopy: eval for primary tumor

27
Q

After flexible largyngoscopy, what is the next step to eval for neck mass?

A

FNA biopsy, CT scan with contrast of head/neck

28
Q

After FNA and CT head/neck, what next for neck mass to stage or look further?

A

chest CT, PET scan, CXR to see what else is present

29
Q

What to do if primary tumor cannot be found for a neck mass?

A

Panendoscopy: complete endoscopic eval or upper aerodigestive tract: laryngoscopy, esophagoscope and bronchoscopy

30
Q

What is the order of the workup for neck mass?

A

1 Full PE with CN testing
2 Flexible laryngoscopy
3 FNA biopsy/CT scan with contrast of head/neck
4 Chest CT, PET scan, CXR
5 Panendoscopy if primary can still not be located

31
Q

When is open neck biopsy done for neck mass?

A

After complete workup, including panendoscopy

- Due to increased risk of local/distant recurrence, increased morbidity, seeding of tumor cells

32
Q

What are key tipoffs for a malignant neck mass caused by cancer?

A

Unilateral neck mass: progressive in size, age > 40y

Unilateral otalgia, Dysphagia, Odynophagia, Dysphonia, Dyspnea, Trismus, stridor, hemoptysis

33
Q

What are symptoms of acute otitis media?

A 
Otalgia
Fever
Hearing loss
Tinnitus
Bulging and erythematous TM w/ decreased mobility, poor light reflex
< 3 weeks
34
Q

What are symptoms of otitis media with effusion (OME)?

A

Middle ear effusion w/o signs of acute infection

Hearing loss

35
Q

What are symptoms of chronic otitis media (COM)?

A

Recurrent or chronic ear infections that result in perforation of the tympanic membrane +/- otorrhea

36
Q

How does otitis external present?

A

Recent contact w/ warm water
Tender, swollen pinna
Erythematous ear canal

37
Q

What might regression in language suggest in kids?

A

Early sign of hearing loss

38
Q

What are 3 roles of Eustachian tubes?

A
  1. Maintain gas pressure homeostasis within the middle ear
  2. Prevent infection of the middle ear and reflux of contents from the nasopharynx
  3. Clears middle ear infections
39
Q

What organisms cause acute otitis media?

A

S. pneumoniae
Nontypeable H. flu
Moraxella catarrhalis

40
Q

What causes otitis media with effusion?

A
  1. residual fluid from suppurative AOM

2. isolated ETD

41
Q

How does nasopharyngeal carcinoma present?

A

unilateral OME in adults, more common in China, assoc. with EBV

42
Q

What is the best way to diagnose AOM?

A

H&P w/ otoscopy

43
Q

What is the best way to diagnose otitis externa?

A

H&P w/ otoscopy

44
Q

What is best way to diagnose OME?

A

Pneumatic otoscopy less invasive than myringotomy

- Adults: nasopharyngoscopy to eval for tumors obstructing ET

45
Q

What is treatment of AOM?

A

Antibiotics

46
Q

What is treatment generally of OME?

A

None: self resolve w/in 3 months

47
Q

When are PE tubes used for OME?

A

1 Symptomatic OME >3 months
2 Recurrent AOM with OME
3 Bilateral OME w/ hearing impairment
4. OME w/ vestibular problems, poor school performance, behavioral problems, otalgia

48
Q

What is most significant complication of OME?

A

conductive hearing loss

49
Q

What are long-term complications of untreated OME?

A 
Permanent hearing loss
ruptured TM
mastoiditis
temporal bone osteomyelitis
meningitis
sigmoid sinus thrombosis
brain abscess
50
Q

What to consider in any pediatric patient with unilateral aural fullness or otalgia?

A

Foreign body obstruction

51
Q

Any delay in language milestones, what is the next step?

A

Eval for hearing loss without an audiology consult

Surgery Clerkship (16 decks)

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