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Block 5 - Pulm and Skeletal > Intro Lecture and neck mass > Flashcards

Intro Lecture and neck mass Flashcards

0
Q

What is Ozena or empty nose syndrome?

A

After resection of all the turbinates

Patient will complain of chronic congestion and have severe nasal crusting rather than feeling more open

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1
Q

What is kiesselbach’s plexus?

A

Area particularly prone to bleed

Place where the blood vessels supplying the nose converge in the nasal septum

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2
Q

What are vibrissae? What happens after they do their job?

A

Special hairs within nostrils that filter larger particles

Cilia then beat things trapped in mucus to pharynx where it is swallowed and sent to acidic stomach to be disposed of

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3
Q

What is rhinorrhea? What do different colors signify?

A

Nasal discharge
Clear - allergic, viral vasomotor or CSF
Green - sinusitis, foreign body

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4
Q

How can clear rhinorrhea be differentiated from CSF?

A

CSF has higher glucose content
Beta 2 transferrin present in CSF but not mucus
Bloody CSF forms ring sign when dripped onto paper towel

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5
Q

What is anosmia?

A

Loss of sense of smell
Can occur with severe blockage
Can be conductive or sensorineural
Can tat with alcohol, mustard, or other pungent items

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6
Q

What is epistaxis? What can cause it?

A

Nose bleeds
Clotting problems, high pressure, trauma, dryness and irritation, vascular abnormalities
JVN - vascular mass seen in adolescent boys with frequent unilateral severe nose bleeds
Hereditary hemorrhagic telangiectasia

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7
Q

What is the source of pain in the nose?

A

Often from sinuses

Nose innervation by branches of V

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8
Q

What is rhino sinusitis?

A

Most common cause of congestion
Inflammation of nose and sinuses
Includes allergic and viral rhinitis as well as rhinitis medicamentosa

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9
Q

What is meningocele?

A

Evagination of meninges into nasal cavity through dehiscence in floor of cranium

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10
Q

Why can a vasoconstrictor help during a nasal exam?

A

Cause turbinates to shrink and allow more light to enter nose
Can now see more of the middle and superior turbinates

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11
Q

What is the general rule of thumb regarding use of ct or MRI to evaluate nose?

A

CT better for bony structure

MRI better for soft tissue

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12
Q

What is xerostomia?

A

Dry mouth

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13
Q

What are dysphagia and odynophagia?

A

Difficulty swallowing

Pain with swallowing

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14
Q

What is an insidious symptom of the OC/OP to look out for?

A

Otalgia
Common complaint in primary oropharyngeal cancer is result of referred pain from CN IX
Can also be present in tonsillitis

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15
Q

Chronic intermittent pain that waxes and wanes, worsens acutely, but then goes back to dull roar most of the time
Pain under the chin

A

Submandibular gland inflammation

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16
Q

History of medication exposure such as chemotherapy or recent antibiotics would raise suspicion for what?

A

Thrush

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17
Q

Ddx for sore throat and odynophagia

A

Infectious and inflammatory processes (tonsillitis, peritonsillar abscess, thrush, epiglottitis, and cancer)
Absence of odynophagia can narrow differential

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18
Q

Ddx of sore throat and voice change

A

Peritonsillar abscess - hot potato voice

Seen in mono or tonsillitis and sometime lymphoma

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19
Q

Ddx of sore throat and lymphadenopathy

A

Infectious and neoplastic processes
Posterior - mono, ear and scalp inf
Anterior - tonsillitis, strep pharyngitis

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20
Q

Ddx of sore throat and globus (sensation of something stuck in throat)

A

LPR (reflux), PND, neoplasm, vocal cord granuloma, tonsillitis, actual foreign body

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21
Q

If fever is present, what can be ruled out of the differential?

A

Thrush - does not present with fever

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22
Q

Small painful ulcerations of unknown etiology that resolve over time

A

Apthous ulcers (canker sores)

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23
Q

White patch of mucosa in mouth

A

Leukoplakia

May indicate premalignant state

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24
Q

Smooth tongue

A

Glossitis

25
Q

Thrush vs. leukoplakia

A

Thrush can be scraped away, leukoplakia cannot

26
Q

White plaque on reddened pharynx

A

Strep pharyngitis

27
Q

Painful, red bulging of tissues around tonsil and possible deviation of uvula to opposite side

A

Peritonsillar abscess

28
Q

Why do laryngeal cancers tend to not metastasize if caught early enough?

A

Not a lot of lymphatics in the glottis

29
Q

Intermittent hoarseness in patient also experiencing nasal discharge, itchy nose, eyes and soft palate

A

Allergic rhinitis causing hoarseness

Post nasal drip related hoarseness

30
Q

What is reinke’s edema?

A

Diffuse vocal cord edema that causes low gravely voice

Causes are cigarette smoke, vocal abuse

31
Q

Hoarseness and cancer

A

Common finding in laryngeal carcinoma or disruption of recurrent laryngeal by lung neoplasm
Supraglottis neoplasms cause problems swallowing before hoarseness

32
Q

Waxing and waning symptoms of hoarseness vs. persistent or worsening

A

Voice misuse, reflux, post nasal drip, or combo vs.

Structural problem

33
Q

Sore throat, odynophagia, fever, stridor, and hoarseness in children

A

Epiglottitis - caused by bacteria

34
Q

What is stridor and what can cause it?

A

Impediment to normal laminar flow causes noisy breathing from larynx
Infection - croup or epiglottitis
Neoplasm - laryngeal, thyroid, or lung
Dev. Phenomenon
Allergy/immune phenomenon - angioedema, anaphylaxis, ACEI use
Trauma

35
Q

Increased respiratory rate, use of accessory muscle of breathing in chest, pallor or cyanosis, tripod positioning, difficulty handling secretions, waning level of consciousness

A

Signs of severe stridor that may need emergency airway management

36
Q

When should certain ancillary studies be used to evaluate the larynx?

A

X ray - for foreign ladies, airway narrowing in croup, epiglottitis
CT of neck/pharynx - first study of choice for laryngeal, neck masses, injuries
MRI - soft tissue better than bone
Barium swallow - helpful for dysphagia

37
Q

What are the different triangles of the neck?

A

Sub mental (nodal level Ia)
Submandibular (nodal level Ib)
Vascular (anterior) (nodal levels II, III, IV)
Posterior (nodal level v)

38
Q

What are the different nodal groups of the neck?

A 
Pre auricular
Post auricular 
Occipital
Superficial (to scm, along external jugular vein)
Peri facial (along facial artery)
Supraclavicular (virchows) 
Para tracheal
39
Q

What are the different categories of neck masses?

A

Normal variant anatomy
Congenital or dev anomaly
Inf or inflammatory process
Neoplasm

40
Q

Midline mass

A

Thyroglossal duct cyst

41
Q

Lateral (level II) mass, fluctuating in size

A

Branchial cleft cyst

42
Q

When is gender an important determination in neck masses?

A

Adult neck masses
Females more prone to have thyroid masses
Males more prone to squamous cell carcinomas
Different origins of cancers

43
Q

What possible neck masses have otalgia?

A

Lesion anywhere with referred pain

44
Q

What neck masses have hearing loss or fullness?

A

Lesion in NP obstructing Eustachian tube and causing otitis media

45
Q

What kind of lesion does trismus (trouble swallowing or opening mouth) suggest?

A

Lesion in OP extending deep

46
Q

Mass with surrounding soft tissue inflammation

A

Deep neck abscess

47
Q

Soft mass is usually?

A

Benign reactive node

48
Q

Mass moves with deglutination

A

Thyroid mass

49
Q

When should a CBC be obtained?

A

If infection or neoplasm is suspected

Erythrocytes sedimentation rate and routine electrolytes never really useful

50
Q

When is a plain x ray indicated with a neck mass?

A

Never

51
Q

When is a chest x ray indicated with neck masses?

A

Can rule out pulmonary lesions

52
Q

When is ultrasound indicated with neck masses?

A

Mass suspected of being cystic

Standard for diagnosing thyroid masses

53
Q

When is nuclear medicine indicated with neck masses?

A

Good for evaluating cancer

Cold more likely to be cancer than hot nodules

54
Q

When is CT scan indicated with neck masses?

A

Best initial scan

But must have good kidney function

55
Q

When is an MRI indicated with neck masses?

A

Soft tissue detail when CT insufficient

When CT cannot be used

56
Q

When is an angiogram indicated with neck masses?

A

Vascular tumors

Determines resectability - Pre-OP study

57
Q

What is the role of biopsies in neck masses?

A

Never biopsy until all other diagnostic modalities have been completed, then use experienced head and neck surgeon

58
Q

When is endoscopy indicated with neck masses?

A

To search for primary lesion in upper aerodigestive tract if neck mass is found to be a malignancy and imaging studies fail to reveal primary site

59
Q

What is the first step if you have an unknown primary carcinoma in the neck?

A

Take out the tonsils

Block 5 - Pulm and Skeletal (19 decks)

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