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ABSITE Flashcards > Head & Neck > Flashcards

Head & Neck Flashcards

1
Q

Anterior to posterior structures

A

Subclavian vein
Phrenic nerve
Anterior scalene
Subclavian artery

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2
Q

Parotitis

A

Staph
Elderly, dehydrated
Tx with abx, I&D

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3
Q

Painless mass on roof of mouth

A

Torus

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4
Q

Leukoplakia vs erythroplakia

A

Erythoplakia - pre-malignant

Retinoids can reverse leukoplakia nad reduce chance of 2nd head and neck malignancy

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5
Q

Nasopharyngeal SCC features

A

Drain to posterior neck nodes

EBV

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6
Q

Glottic cancer tx

A

XRT if cords not fixed

If fixed-surgery + XRT

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7
Q

Lip CA features

A 
lower>upper incidence
epidermoid carcinoma
tx: <1/2 lip - primary closure
>1/2 lip - flaps
Radical neck dissection if node +
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8
Q

Tongue CA tx

A

surgery + XRT

Increased in plummer vinson

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9
Q

Large salivary glands (parotid) sign of?

A

More likely tumor is benign

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10
Q

MC malignant salivary tumor

A

mucoepidermoid carcinoma

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11
Q

MC malignant salivary tumor of submandibular /minor salivary glands

A

adenoid cystic carcinoma

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12
Q

MC benign parotid tumor

A

Pleomorphic adenoma

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13
Q

Tx of pleomorphic adenoma

A

Superficial parotidectomy

If malignant - take whole parotid with CN7, if high grade - radical neck dissection

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14
Q

Warthin’s tumor

A

2 bengin tumor

10% bilateral
70% of bilateral parotid tumors
Tx: superfical parotidectomy

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15
Q

Radical neck dissection takes?

A

CN XII (most morbid)
SCM
IJ
Submandibular gland

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16
Q

Juvenile nasopharyngeal angiofibroma

A

Benign in teen males
Presents w/obstruction, epistaxis
Tx-embolize (internal maxillary a, then extirpate)

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17
Q

Frey’s syndrome

A

Auriculotemporal nerve injury

Gustatory sweating

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18
Q

Tracheo-innominate fistula

A

massive bleeding from trach

small heraldic bleed

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19
Q

Work up of an enlarged neck node

A

FNA

Endoscopy/possible open biopsy

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20
Q

Pleomorphic adenoma

A

Benign parotid mass
Most common benign mass
90% are superficial to facial nerve

21
Q

Warthin’s tumor

A

2nd MC benign parotid mass
A/w tobacco use
10% bilateral

22
Q

Mucoepidermoid carcinoma

A

MC malignant parotid mass

23
Q

Treatment of the benign parotid mass

A

Surgical resection - resect facial nerve if involved

Can usually be enucleated or undergo superifical parotidectomy

24
Q

Treatment of malignant parotid mass

A

Superficial lobe without involvement of facial nerve: superficial parotidectomy with adjuvant XRT
Deep lobe: Total parotidectomy
Adjuvant XRT for high grade cancer, neural invasion, invasion into surrounding structures, or mets

25
Q

Complications of parotidectomy

A

Frey syndrome: gustatory sweating secondary to parasympathetic damage to auriculotemporal nerve
Facial nerve dysfunction
Recurrence
Salivary fistula
Sensory loss in lower third of external ear (from transecting greater auriculur nerve)

26
Q

Palpable LN in the neck with unknown primary

A

FNA
Endoscopy
CT scan
If all negative, proceed with modified radical neck dissection with ipsi XRT

27
Q

Dx and tx of Frey syndrome

A

Dx: Minor starch/iodine test
Tx: antiperspirant application to the affected skin

28
Q

Laryngeal cancer categories and most common presenting symptom

A

Glottic, subglottic, supraglottic

Otalgia is most common presenting symptom

29
Q

Le Fort fracture

A

Separation of maxilla from skull base

Results in mid face mobility on bi-manual exam

30
Q

Injury to greater auricular nerve is associated with

A

sensory to preauricular/postauricular area
difficulty shaving, wearing earrings
usually resolves within a few months

31
Q

Tuberculous lymphadenitis

A

MC in the cervical LN, MC extra-pulmonary TB form
Most patients have no systemic symptoms and a normal CXR
TB in this form is contagious
Tx: 6 months of TB antibiotic therapy

32
Q

Intraoperative nerve monitoring or direct visualization of RLN - which is better?

A

No statistical difference in incidence of RLN palsy with either method

33
Q

Spinal accessory nerve course

A

Exits jugular foramen with CN IX and X
Passes anterior to jugular vein
Then enters posterior SCM
Exits cephaled to Erb point (bundle of sensory nerves emerges from SCM posteriorly)

34
Q

When should emergent cricothyroidotomies be converted to trachs?

A

Within 24-48hrs to avoid risk of subglottic laryngeal stenosis

35
Q

At what level should tracheostomies be placed?

A

2nd or 3rd tracheal ring

Any lower puts patient at risk of erosion of tube or cuff into inominate artery = TI fistula

36
Q

Bethesda FNA categories

A

I: insufficient for diagnosis
II: benign, manage according to FNA results alone
III: atypical or follicular lesion of uncertain signficance
IV: follicular neoplasm
V: suspicious for malignancy, manage according to FNA results alone
VI: definitely malignant

Category III and IV: can do gene expression panel assay to predict benign behavior accurately

37
Q

Inherited non-medullary thyroid cancer syndromes

A 
FAP
Cowden
Carney
Pendred
Werner
38
Q

Cowden syndrome features

A

Autosomal dominant
Oral hamartomas
Large head circumference
Familial thyroid cancers

39
Q

First step when TI fistula begins to bleed

A

Overinflate the cuff
Direct digital pressure towards the sternum

Definitive surgical management: ligate fistulous portion of inominate artery

40
Q

Recurrence rate after thyroglossal duct cyst excision

A

10% recurrence rate

41
Q

Chyle leak management

A

Low output (<1 L/day): strict fat-free diet, medium chain TG diet, surgical drain should be left in place

High volume or persistent chyle leaks: surgery - open or thoracoscopic ligation of the thoracic duct in the chest, embolization of the thoracic duct by IR

42
Q

Where does thoracic duct empty?

A

Left subclavian vein

43
Q

Risk factors for pharyngeal cancer

A 
HPV (high risk subtype 16)
EBV
Plummer-Vinson syndrome
Metabolic polymorphisms
Malnutrition
Mutagenic agent exposure
44
Q

High risk BCC features

A

Head and neck location, >6 mm
Recurrent tumors
Tumor in area that was previously radiated
Ill-defined borders
Morpheaform
Aggressive growth patterns
Immunocompromised, especially transplant patients (MC malignancy in transplant patients)

Needs wider margins 6 mm or greater

45
Q

Central neck node dissection borders

A

Superior: hyoid
Lateral: carotid sheath
Medial: tracheal midline
Inferior: thoracic inlet

46
Q

What test should be done before excision of thyroglossal duct cyst?

A

Neck ultrasound to confirm that is not the patient’s only source of thyroid tissue

47
Q

What cranial nerves are at risk of injury during CEA?

A

VII, IX, X, XI, XII

48
Q

MC CN injury during CEA?

A

Hypoglossal
close to the carotid bifurcation
injury causes tongue deviation to ipsi side

49
Q

Common nerve injuries during CEA

A

Hypoglossal: ipsi deviation of the tongue
Vagus/non-recurrent laryngeal nerve: hoarseness, vocal cord palsy
Superior laryngeal nerve: loss of high pitch, projection
Marginal mandibular branch of facial nerve: between platysma and deep carotid fascia - drooping of mouth to ipsi side
Glossopharyngeal: especially during division of posterior belly of digastric and styloid process - impaired swallowing and loss of taste sensation, gag reflex impaired on ipsi side
Spinal accessory: winging of scapula, possibly by traction to SCM

ABSITE Flashcards (19 decks)

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