Head and Neck Surgery Flashcards by Isabelle Houston

What are the branches of the trigeminal nerve?

How well did you know this?

Not at all

Perfectly

What is the Weber test used for?

tests for lateralization (sound is heard louder in one ear than the other)

How well did you know this?

Not at all

Perfectly

What is the interperetation of the weber test?

The sound is normally heard equally in both ears. If not…

Conductive hearing loss
Occurs when something prevents sound from entering the outer or middle ear. In the Weber test, the sound will lateralize to the affected side.

Sensorineural hearing loss
Occurs when something prevents sound from reaching the inner ear or the hearing nerve from functioning properly. In the Weber test, the sound will lateralize to the contralateral side.

How well did you know this?

Not at all

Perfectly

Weber test: lateralization to the contralateral side

sensorineural loss

How well did you know this?

Not at all

Perfectly

Weber test: lateralization to affected side

conductive hearing loss

How well did you know this?

Not at all

Perfectly

What test do we use for air conduction vs bone conduction?

Rinne Test

How well did you know this?

Not at all

Perfectly

What test is being described: Place the base of a vibrating tuning fork on the mastoid process of the ear. Once the patient no longer hears a tone, immediately hold the “U” part of the fork over the outer ear and ask the patient if they can still hear it.

Rinne

How well did you know this?

Not at all

Perfectly

Which test is being described: Place the base of a vibrating tuning fork on the middle of the forehead and ask the patient from which ear the sound is louder.

Weber

How well did you know this?

Not at all

Perfectly

How does air vs bone conduction differ?

Air conduction is normally greater so in the case of the rinne test, the patient should still be able to hear the tuning fork next to the outer ear after they can no longer hear it when placed on the mastoid process.

How well did you know this?

Not at all

Perfectly

What is a normal rinne test result?

A normal result is when the patient can hear the sound through air conduction for twice as long as they can hear it through bone conduction. If the patient hears the sound through bone conduction for as long or longer than they hear it through air conduction, it could indicate conductive hearing loss.

How well did you know this?

Not at all

Perfectly

Clinical PE finding:
Head: Nuchal rigidity/reduced range of motion

Red flag diagnosis:

Meningism

How well did you know this?

Not at all

Perfectly

Clinical PE finding: Loss of cranial nerve function

Red flag dx:

Cranial nerve palsies
Ischemic stroke

How well did you know this?

Not at all

Perfectly

Clinical PE finding: EYE; Ptosis
Incomplete lid closure

Red flag dx:

Cranial nerve palsies
Ischemic stroke

How well did you know this?

Not at all

Perfectly

Xanthelasma

How well did you know this?

Not at all

Perfectly

Exophthalmos is a sign of…

Graves

How well did you know this?

Not at all

Perfectly

Conjunctival injection is a sign of…

conjunctivitis

How well did you know this?

Not at all

Perfectly

Angular chelitis is a sign of…

iron deficiency

How well did you know this?

Not at all

Perfectly

A neurologic disorder that causes a triad of miosis (an abnormally small pupil), partial ptosis (drooping of the upper eyelid), and facial anhidrosis (absence of sweating).

Horner Syndrome

How well did you know this?

Not at all

Perfectly

Risk factors for OE include exposure to water and injury to the skin of the EAC. OE is primarily a clinical diagnosis. It is characterized by ear pain, fullness, and/or itching, and tenderness of the tragus and/or pinna; otoscopy may show erythema, edema, debris, and/or otorrhea of the EAC.
EAC=external auditory canal

Otitis externa

How well did you know this?

Not at all

Perfectly

Infectious causes of acute otitis externa

Bacterial infections (most common cause of otitis externa)
Pseudomonas aeruginosa
Staphylococcus aureus

How well did you know this?

Not at all

Perfectly

Tx for acute otitis externa

For uncomplicated AOE, initiate topical therapy for OE.
Antibiotic (ofloxacin, ciprofloxacin, or gentamicin); ear drops

How well did you know this?

Not at all

Perfectly

Most common causes of acute otitis media?

Most commonly results from a bacterial superinfection with Streptococcus pneumoniae, Haemophilus influenza, or Moraxella catarrhalis following a viral upper respiratory tract infection.

How well did you know this?

Not at all

Perfectly

What procedure is this: A procedure in which an incision is made in the tympanic membrane to drain purulence from severe acute otitis media. Can be used to facilitate placement of a tube (i.e., tympanostomy) to allow continued drainage (e.g., to treat recurrent acute otitis media).

Myringotomy

How well did you know this?

Not at all

Perfectly

Myringotomy

A procedure in which an incision is made in the tympanic membrane to drain purulence from severe acute otitis media. Can be used to facilitate placement of a tube (i.e., tympanostomy) to allow continued drainage (e.g., to treat recurrent acute otitis media).

How well did you know this?

Not at all

Perfectly

What is the pathophys behind acute otitis media?

Obstruction/blockage of the eustachian tube (ET) → lack of ventilation and drainage of the middle ear → Accumulation of middle ear secretions → bacterial superinfection → pus in the middle ear → bulging tympanic membrane → severe otalgia, fever

Why are infants more proned to acute otitis media?

Infants: shorter, narrower, and more horizontal eustachian tube

Pathogens associated with AOM?

S. pneumoniae Haemophilus influenzae Moraxella catarrhalis

Tx for AOM?

Amoxicillin is the first-line agent in antibiotic-naive patients.

Pathophys of mastoiditis

infection spreads from the middle ear cavity into the mastoid, which is a closed bony compartment → collection of pus under tension and hyperemic resorption of the bony walls → destruction of the air cells (coalescent mastoiditis) → mastoid becomes a pus-filled cavity (empyema mastoid)

Recent hx of AOM, tender edematois mastoid, and ear displaced laterally

Clinical features of mastoiditis

How do you get bacterial labrynthitis?

Inflammation spreads to the inner ear through the round window (from an episode of AOM) Use weber test to help dx

How is otitis media with effusion different from acute otitis media?

OME= chronic, greater than 3 months AOM= acute, infections note that for OME can be caused by eustachian tube dysfunction in kiddos but in adults we need to rule out nasopharyngeal cancer

_____________________ is a special form of chronic otitis media in which keratinizing squamous epithelium grows from the tympanic membrane or the auditory canal into the middle ear mucosa or mastoid.

Cholesteastoma

refers to abnormal bone growth of the bony labyrinth, primarily at the oval window. It manifests at the stapes, which becomes increasingly fixated to the oval window. This process leads to progressive conductive hearing loss because the ossicle's ability to vibrate becomes increasingly limited.

otosclerosis

Simple pathophys of otosclerosis

Stapedial otosclerosis (most common site) → fixation of stapes to oval window → conductive hearing loss

Most common site of bleedingin epitaxis

Kiesselbach plexus

is an autosomal dominant vasculopathy characterized by telangiectasia on the skin and mucosa, It commonly presents with nosebleeds but can also cause acute or chronic bleeding from the GI tract, requiring blood transfusions and iron supplementation.

Osler-Weber-Rendu syndrome Hereditary hemorrhagic telangiectasia

are benign epithelial tumors of the nasal cavity which mainly affect males between 40–60 years of age.

Nasal papillomas

Predisposing factors for nasal papillomas

The exact etiology is unknown, but human papillomavirus infection, smoking, and chronic sinusitis are predisposing factors for the development of nasal papillomas.

Why should nasal papillomas be completely excised?

All nasal papillomas should be completely excised. Although benign, nasal papillomas are locally aggressive, have a malignant potential, and a high recurrence rate if incompletely excised.

Cause of tonsillopharyngitis

Viral (50–80% of cases): adenovirus, EBV, CMV, HSV, rhinovirus, coronavirus, influenza and parainfluenza viruses, HIV Bacterial (15–30% of cases) Streptococcus pyogenes Neisseria gonorrhoeae, Corynebacterium diphtheriae, Mycoplasma pneumonia

Tx for acute tonsillitis/pharyngitis

Abx typically if GAS,

Why are deep neck infections potentially life threatening?

deep neck infections are clinically significant because of their potentially life-threatening complications, including the spread of infection to vital nearby structures and airway compromise.

Peritonsillar abscesses are often caused by what pathogen?

Strep pyogenes

A limited ability to open the jaw due to tonic spasms of the jaw musculature. Most commonly associated with tetanus. Can also arise secondary to peritonsillar abscess, infection in the jaw muscles, and trigeminal nerve pathology.

Trismus

What atructures do we incldue in 'oral cavity cancers'?

malignant tumors of the oral mucosa, tonsils, and salivary glands.

What are predisposing factors to oral cavity cancer?

smoking, oral tobacco consumption, long term alcohol use, and human papilloma virus infection.

Risk factors for pharyngeal cancer

Alcohol and tobacco use are the two most important risk factors and are responsible for the majority of cases.

What infection is associated with nasopharyngeal carcinoma?

EBV! A cancer of the nasopharynx that can cause painless lymphadenopathy, obstruction of the Eustachian tube (which causes recurrent otitis media and conductive hearing loss), nasal discharge, nosebleeds, and/or impaired nasal breathing. Associated with Epstein-Barr virus infection.

What is the difference in unilateral vs bilateral cervical lymphadenopathy in terms of causes?

Acute UCL is most commonly caused by S. aureus and Streptococcus species, while chronic UCL can be the result of tuberculous or nontuberculous mycobacterial infections. Bilateral cervical lymphadenopathy (BCL), which refers to swelling on both sides of the neck, is most commonly caused by viral infections of the upper respiratory tract. Adenoviruses and enteroviruses are the most common causes of acute BCL, while Epstein-Barr virus (EBV) and cytomegalovirus (CMV) are most commonly responsible for subacute/chronic BCL. Noninfectious causes of lymphadenopathy: Malignancies: Leukemia, Lymphoma Rare syndromes: Kawasaki disease

condition is often caused by odontogenic infection, and diabetes mellitus is a predisposing factor. The patient has a molar infection along with fever, dysphagia, and swelling of the submandibular and anterior portion of the neck, which suggests that the infection has spread from the molar towards the submandibular and sublingual space.

Ludwig Angina, it is a form of ceelulitis

characterized by a necrotizing inflammation of the external auditory canal. Most frequently caused by Pseudomonas aeruginosa. Risk factors include poorly controlled diabetes mellitus and immunosuppression.

Malignant otitis externa

Initial empiric therapy for malignany otitis externa

high-dose IV ciprofloxacin, which is usually combined with another antipseudomonal agent from a different class (e.g., cefepime, ceftazidime, or piperacillin/tazobactam).

Severe ear pain, otorrhea, otoscopic findings of granulation tissue, and ear canal edema as well as evidence of bone destruction on CT scan suggest ________________________

Malignant otitis externa

The triad of vertigo, tinnitus, and sensorineural hearing loss associated with ear fullness is classic for

Meniere Disease

An idiopathic condition characterized by impaired resorption of endolymphatic fluid, resulting in endolymphatic hydrops. Usually presents with episodes of vertigo, hearing loss, and tinnitus lasting from minutes to hours.

Meniere disease

Dislodged otoliths can cause the severe vertigo attacks seen in

benign paroxysmal positional vertigo (BPPV)

What can you give to a pt with tonsillitis if they are allergic to penicillins?

Clarithromycin or azithromycin (MACROLIDES aka)

secretion of purulent material from the salivary duct is concerning for...

supprative sialadenitis

Typically a polymicrobial infection secondary to local penetrating trauma or spread of oral, upper respiratory tract, or other deep infections of the neck (e.g., from nasopharynx, sinuses, adenoids). Clinical features include tonsillitis, neck asymmetry with unilateral swelling of the posterior pharyngeal wall, and torticollis.

Retropharyngeal abscess

When is emergency airway management indicated for a pt with a retropharyngeal abscess?

Emergency airway management is indicated in patients with suspected retropharyngeal abscess who present with features of impending respiratory compromise (e.g., inspiratory stridor, hypoxemia, and labored breathing with accessory muscle use).

Complication retropharyngeal abscess when infection spreads

The spread of infection along the deep cervical fascia has likely led to mediastinitis, as indicated by the severe chest pain and widened mediastinum on chest x-ray. Additionally, the patient is showing signs of sepsis (hypotension and elevated pulse).

empiric therapy for retropharyngeal abscess

Intravenous ampicillin-sulbactam

Retropharyngeal abscess is likely caused by what organisms?

streptococci, staphylococci, Haemophilus influenzae, and/or oral anaerobes,

This condition is generally precipitated by a reduction in the flow of saliva (e.g., in postoperative patients). Physical examination shows swelling and tenderness of the left parotid gland as well as oral erythema with scant purulent discharge upon parotid gland massage.

Supprative sialadenitis