Otolaryngology Flashcards
Midline mass at level of hyoid
Connected to tongue
Tx?
Thyroglossal duct cyst
Removal of cyst, middle of hyoid, tract to base of tongue
Difference in presentation between inflammatory and neoplastic neck masses
Inflammatory: timetable measured in days or weeks
Neoplastic: several months of consistent growth
Mass on anterior edge of sternocleidomastoid
Several cm
Small opening in skin overlying
Branchial cleft cyst
Large, mushy, ill-defined mass overlying supraclavicular area
Often extend into mediastinum
Dx, Tx?
Cystic hygroma
CT scan
Surgical removal
Pt with enlarged lymph node
Whats is diagnostic approach
< 1 month probably inflammatory, follow
> 1 month probably inflammatory, but workup for neoplasia
Multiple enlarged lymph nodes
Low grade fever, night sweats
Dx, tx?
Lymphoma
FNA, but node removal necessary for typing
Chemotherapy
Supraclavicular node tumor
Metastatic tumor from lung or abdomen
Risk factors for squamous cell carcinoma of head and neck mucosa
Age Smoking Alcohol Poor dental hygiene AIDS
Dx, tx of squamous cell carcinoma of head and neck mucosa
Triple endoscopy, biopsy
FNA enlarged neck nodes, no open biopsy!
Resection and radical neck dissection
Radiotherapy, platinum based chemo
Persistent hoarseness
Persistent painless ulcer on floor of mouth
Persistent unilateral earache
Squamous cell carcinoma of mucosa
Sensory hearing loss in one ear
Dx?
Acoustic neuroma
MRI
Gradual unilateral facial nerve paralysis
Both forehead and face
Dx?
Facial nerve tumor
Gadolinium enhanced MRI
Sudden unilateral facial nerve paralysis
Forehead and face
Bell’s palsy
Most common parotid tumor
Pleomorphic adenoma
Painless, no facial n involvement
Tx for parotid tumor
Superficial parotidectomy
Sacrifice facial nerve if malignant
Unilateral ENT problem in toddlers
Tx?
Foreign body
Endoscopic removal
Abscess in floor of mouth
Poor dental hygiene
Tx?
Ludwig angina
I&D, intubation and tracheostomy if airway threatened
Tx for Bell’s palsy
Antivirals, steroids
Cause of late onset facial nerve paralysis after trauma
Swelling
Nerve injuries cause paralysis immediately
New onset diplopia in pt with frontal or ethmoid sinusitis
Dx, tx?
Cavernous sinus thrombosis
CT scan
IV antibiotics, drainage of affected sinus
Tx for epistaxis in children
Cause?
Local pressure
Epinephrine spray
Nosepicking
Tx for epistaxis in teenager
Cause?
Posterior packing- cocaine
Resection- juvenile nasopharyngeal fibroma
Tx for epistaxis in elderly
Control BP
Posterior packing
Ligation of feeding vessels
Dizziness
Room perceived to be spinning
Tx?
Inner ear dizziness
Meclizine, phenergan, diazepam
