Head and Neck Flashcards
What TSH level is ideal for increased radioiodine uptake in tumors?
>30mU/L
What modality is useful for detecting respiratory effort related arousals?
Esophageal manometry: esophageal tone and luminal pressure will become elevated prior to an RERA
What is UARS and what is it characterized by
Upper Airway Resistance Syndrome, majority of symptoms as OSA but with low AHI, they have high RERAs and sleep fragmentation, first line treatment is CPAP
Patients with upper lip carcinomas have a ____ prognosis than those with lower lip carcinoma
10-20% worse
Basal cell carcinomas are more commonly found in the ____ lip
Upper
What is the most common oral cavity subsite of cancer?
Lip
Kadish classification/staging of esthesioneuroblastoma
A - tumor limited to nasal cavity B - tumor limited to nasal cavity and paranasal sinuses C - tumor extends beyond the nasal cavity and sinuses (skull base, intracranial compartment) D - Cervical nodal mets
What is the probability that a hypofunctioning nodule found in a patient with Graves’ disease is thyroid CA:
45%
The most common malignant parotid mass in pediatric patients
mucoepidermoid carcinoma
What syndrome are osteomas associated with?
Gardner syndrome
What malignancy is associated with gardner syndrome
colon cancer
What is the likelihood that a cold module found in a graves patient is well diff thyroid CA
45%
What artery do both the superior and inferior parathyroid glands most commonly derive their blood supply?
Inferior thyroid artery
What is the most common benign lesion of the sinonasal tract?
Patrons
When should you do total thyroidectomy for multifocal disease
More than 5 foci that are 8-9mm in size
What percent of severely dysplastic lesions of the VC will undergo transformation to malignancy
30%
What is in Lugol’s solution
Potassium iodide and elemental iodine in water
Which histology of adenoid cystic carcinoma carries the worst prognosis
Ciribiform with greater than 30% solid
What are the four types of cells in a salivary unit
Acinar cells Intercollated cells Striated - most metabolic activity, red staining pattern/oxyphylic Epithelial AISE mnemonic
Which tumor do acinar cells give rise to?
Acinar cell carcinoma
Which salivary cells give rise to warthins tumor and Oncocytoma
Striated cells Stain oxyphylic
What I the most common malignant rumor of submandibular gland or minor salivary gland
Adenoid cystic carcinoma
What’s most common malignant tumor of parotid tumor
Mucoep carcinoma
Most common benign pediatric tumor
Hemangioma
What is risk if malignancy in carotid body tumor
3-6%
What is risk of malignancy in Vagal paraganglioma
10%
What is risk of malignancy in jugular paraganglioma
5%
What is risk of malignancy in orbital and laryngeal paraganglioma
25%
What is contained within the infratemporal fossa
Lateral and medial pterygoids Mandibular division of Trigeminal nerve Chorda tympani Otic parasympathetic ganglion Maxillary archery and branches Pterygoid venous plexus Deep lobe of parotid gland
Necrotizing sialometaplasia
Salivary tissue infarcts. Management is conservative and observation
What percentage of paragangliomas of the head and neck secrete catecholamines
1-3%
How long of a segment of bone can be harvested with fibula free flap?
25 cm
What is the percent change of agranulocytosis with antithyroid meds?
0.2%
What sinus is most frequently affected by osteomas?
Frontal. Then ethmoid, max, and sphenoid
What kind of module on fna of follicular neoplasm is less concerning?
Spongiform
How long prior to starting radioactive iodine therapy should you stop synthroid
6 weeks
What nerve supplies taste sensation to the anterior part of soft palate?
GSPN
What are the cell types of parathyroid gland
Chief cells and oxyphil cells
What’s the treatment of advanced laryngeal chondrosarcoma
Total laryngectomy
Where are the superior parathyroid glands usually located
1 cm above intersection of RLN and inferior thyroid artery
Describe the sympathetic, parasympathetic and sensory innervation of parotid gland
What is the name of this tumor if located in the cheek?
Pleomorphic adenoma
What is the most common presenting symptom of esthesioneuroblastoma?
hyposmia
What lesion on the posterior vocal cord is sessile, gray, and stains for S100 and PAS?
Granular cell tumor, 3% risk of malignant degeneration
Describe the stage of the melanomas depicted
T2B, T3
Describe the Pittsburgh staging system for temporal bone SCC
T1 - limited to the EAC without bony erosion or soft tissue involvement
T2 - partial bony erosion without involvement of middle ear
T3 - trans canal bony erosion with possible invovlement of middle ear or mastoid
T4 - invovlement of the carotid canal, jugular bulb, medial middle ear, petrous apex, or facial nerve
What is the blood supply to the temporalis muscle flap?
Anterior and posterior deep temporal arteries, superficial temporal artery also gives off a branch but is less important
what site of paraganglioma has the highest risk of malignancy?
orbital and laryngeal, 25% change
How long should someone be off isoretinoin before getting dermabrasion
6 months
Radiation of what dose to the salivary glands will result in permanent secretory hypofunction
over 2600 gray
What is the most common preesenting symptom of glosopharyngeal schwannoma and why?
Mid frequency SNHL and due to position with relation to the VIII nerve
What is a tumor marker for Melanoma?
HMB45
What does the chemo do in CRT for advanced Laryngeal CA
Improved locoregional control
What is a granular cell tumor?
benign mesenchymal neoplasm of Schwann cell origin. The oral cavity, specifically the tongue, is the most common site for its occurrence in the human body. There is also pseudoepitheliomatous hyperplasia (PEH) of the overlying epithelium
What effect does hashimotos have on thyroid cancer?
protective
What is Reidel’s thyroiditis
Autoimmune process where the thyroid gland replaced by fibrosis which extends beyond gland, thought to be related to IgG4 disease
How much more common is Thyroid cancer in graves disease compared to regular population
twice as more common
What is the overall malignant transformation rate of leukoplakic lesions in the larynx
14%, mean time to transformation 5 years
What muscles border the Killian Triangle
Cricopharyngeus and Thyropharyngeus
What borders the Laimer triangle
Cricopharyngeal muscle and most superior esophgeal circular muscle
In what patient population is mucoepidermoid carcinoma slightly more prevalent
in women
What is the risk of occult lymph node metastases in a parotid tumor that is > 4 cm in diameter
20% (vs 4% in smaller ones)
What is the most common location of metastatic disease in parathyroid carcinoma
lung
Based on NCCN for occult primary, what staining should be done on nodes of unknown primary that are adeno or undiff?
TTF1, PAX8, thyroglobulin, calcitonin
What is the most likely malignancy pictured here and how common is it?
Primary thyroid lymphoma (non hodgkins), less than 5% of thyroid malignancies (NOT TO BE CONFUSED WITH HODGKINS)
What are the most common malignancies that metastasize to the supraclavicular nodes
Esophagus, mediastinum, stomach, abdomen
How long after treatment with avastin do you do surgery?
6 weeks
What is the half life of T4? T3?
6-7 days, 1 day
What is the time frame in which to perform ENOG in acute facial nerve injury? Not acute?
3-14 days, 3-21 days
What is the most common location in the head and neck for synovial sarcoma to arise?
Hypopharynx
What is the viral etiology behind oral hairy leukoplakia?
EBV, in immunosuppressed state
Which vein collects the blood from the deep parts of the face/neck and the scalp?
EJ
Which vein collects the blood from the brain and the superficial prats of the face/neck?
IJ
