Head & Neck Flashcards
Management for Follicular neoplasm or Suspicious for a follicular neoplasm on FNAB?
Lobectomy
Thyroid cancer histioptype with the poorest overall survival?
Anaplastic carcinoma
Given 7 to 10 days preop to decrese vascularity of thyroid ( lessen bleeding) and to lessen the risk of thyroid storm?
Lugol’s Iodine ( Potassium Iodide Saturated Solution)
Antithyroid drug preferred during pregnancy?
PTU ( Propylthiouracil)
Structures remove in radical neck dissection?
- Level I to V cervical nodes
- Spinal accessory nodes
- Internal jugular vein
- SCM muscle
Single most important test in the evaluation of thyroid nodules?
FNAB
Most accurate and practical diagnostic test to differentiate benign to malignant lesions of thyroid?
FNAB
Most common type of esophageal cancer world wide!
Squamous Cell Carcinoma
Procedure of choice for a Pituitary Tumor?
Transsphenoidal surgery
Cranial nerve involved in the Tic Doloreux
Trigeminal nerve
Management of middle ear and mastoid disease with cholesteatoma?
Radical mastoidectomy
Structures excised in composite resection?
- Primary tumor
- Cervical nodes
- Part of the mandible
Prognostic indicator in Medullary Thyroid Carcinoma Patients?
Calcitonin doubling time
Indications for post-op radiation therapy?
- Extranodal extension
- Perineural invasion
- Lymphovascular Invasion
- Positive Cervical Lymph nodes
Indications for surgical removal of nodular goiter?
- Suspicious for malignancy
- Symptoms of pressure
- Substernal extension
Treatment of choice in early stage tracheal neoplasm?
Surgery if completely resectable . Primary resection and anastomoses.
Vulnerability of esophagus to perforation?
- Lacks serosal layer
- Allows the smooth muscle to dilate with ease
Presentation of Calcium stone formation in hyperparathyroidism?
- Hypophosphatemia
- Increased calciuria
- Hypercalcemia
Most common etiology of primary hyperparathyroidism?
- Parathyroid adenoma 80%
- Prathyroid hyperplasia 15-20%
- Parathyroid carcinoma 1%
Cause of Secondary Hyperparathyroidism?
- Deficiency of vitamin D
- Uremia
Cause of tertiary hyperparathyroidism?
Long standing, severe, secondary HPT which has turned autonomous once the cause of secondary HPT has been removed.
A 30yo male complaining of a 6 cm hard, fixed, left mandibular mass with radiographic features of multi- loculated lesion in the parasymphyseal area is most likely suffering from?
Ameloblastoma
Most common thyroid cancer affecting young patients?
Papillary Thyroid Carcinoma
Which among the following types of thyroid cancer has the best prognosis?
Papillary
Most common nerve injured during parotidectomy?
Marginal mandibular nerve
The major advantage of neo-adjuvant radiotherapy for head and neck malignancies is?
Decrease recurrence after surgery
Thyroid cancer with the poorest overall survival is?
Anaplastic
During parotidectomy, which structure can be used to identify the facial nerve?
Stylomastoid foramen
Exit site of the facial nerve from the skull and landmark used in parotid surgery?
Stylomastoid foramen
A 25yo known case of Graves disease is being given iodine for the last 10 days prior to surgery. Iodine was given in order to?
Minimize intraop bleeding
Which is correct regarding carcinoma of esophagus?
Smoking is a risk factor
Characteristic radiologic finding of an odontogenic ,painless, benign, locally aggressive tumor presenting with an Andy-Gump deformity?
Soap bubble-appearance
This is an ameloblastoma
Predilection site of HPV positive Head and Neck Squamous Cell Carcinoma?
Oropharynx
Cervical lymph node levels removed in a posterolateral neck dissection?
II, III, IV, V
Supraomohyoid : I, II, III
Lateral: II, III, IV
Central: VI
Muscle that is superficial and parallel to the facial nerve?
Posterior belly of digastric
Ligament that attaches the thyroid gland to the cricoid cartilage?
Ligament of Berry
Prelaryngeal lymph nodes that group around the pyramidal lobe
Delphian nodes
Possible injury in thyroid surgery that causes airway obstruction and necessitates tracheostomy?
Bilateral Recurrent Laryngeal Nerve Injury
Unilateral RLN injury: vocal cord in the paramedian position , normal but weak voice
Vocal cord in abducted position: hoarse voice , weak cough
First muscle encountered during neck dissection?
Platysma
Only test necessary in most patients with thyroid nodules that clinically appear euthyroid?
TSH
Used for monitoring of differentiated thyroid cancer recurrence after total thyroidectomy and RAI ablation?
Serum thyroglobulin
Used for monitoring of differentiated thyroid cancer recurrence after total thyroidectomy and RAI ablation?
Serum thyroglobulin
Management of solitary thyroid nodule with an FNAB finding of suspicious for follicular neoplasia?
Lobectomy
Features of Follicular carcinoma that can not be seen on FNAB?
Capsular & Vascular Invasion
Hormone marker used for postoperative surveillance in Medullary Thyroid Carcinoma?
Calcitonin
Technique used for the preoperative localization of the parathyroid glands?
Sestamibi scan
Outcome of thymectomy in myasthenia gravis with thymoma?
25% resolve
Acute painful visual loss without red eye?
- Pituitary apoplexy
- Acute onset of headache
- Nausea
- Visual field loss
- Ocular paresis
Conditions that results in blindness?
- Glaucoma
- Uveitis
- Corneal ulcer
Treatment for dry eye syndrome aka Keratoconjunctivitis sicca?
- Tear supplementation
- Environment coping strategies
- Application of warm compress
- Amelioration of eyelid abnormalities
Contraindicated in Herpes Simplex Conjunctivitis?
Prednisone ophthalmic drops
Steroids could potentiate the infection
Acute red eye with no loss of vision risk?
Subconjunctival hemorrhage
Profuse purulent discharge from eye?
Gonococcal conjunctivitis
Neck Dissections: Identify the levels being dissected.
Supraomohyoid Dissection
Levels I, II, III
Neck Dissections: Identify the levels being dissected.
Lateral Neck Dissection
Levels II , III, IV
Neck Dissections: Identify the levels being dissected.
Posterolateral Neck Dissection
Levels II, III, IV, V
For Thyroid Malignancies
Neck Dissections: Identify the levels being dissected.
Thyroid Malignancies
Levels II, III, IV, V
Neck Dissections: Identify the levels being dissected.
Laryngeal Malignancies
Levels II,III,IV
LATERAL NECK DISSECTION
Neck Dissections: Identify the levels being dissected.
Oral Malignancies
Levels I, II, III
Supraomohyoid Dissection
What level is the posterior triangle of the neck ?
Level V
Tx for Medullary Thyroid CA with ret mutation carriers for MEN 2A?
Total Thyroidectomy before age 6
Tx for Medullary Thyroid CA with ret mutation carriers for MEN 2B?
Total Thyroidectomy before age 1
Preoperative localization test in primary hyperparathyroidism?
Sestamibi
Hormone responsible for ductal development ?
Estrogen
Hormone responsible for lobular development of the breast ?
Progesterone
Fundoscopy of the affected eye shows cherry red spot over a pale background. What’s your diagnosis?
Central Retinal Artery Occlusion / Amaurosis fugax
Tx : direct infusion of thrombolytic to the ophthalmic artery or by decreasing IOP. ( IV acetazolamide or Vitreous Paracentesis)
