Otolaryngology Flashcards
Where is a thyroglossal duct cyst located?
Midline at the level of the hyoid bone
Pulling on the tongue retracts what kind of mass?
Thyroglossal duct cyst
What is the treatment of thyroglossal duct cyst?
Surgical removal of the cyst, the middle segment of the hyoid bone, and the track that leads to the base of the tongue
Where does a branchial cleft cyst occur?
Anterior edge of the SCM muscle, anywhere from in front of the tragus (ear) to the base of the neck
Where is a cystic hygroma located?
Base of the neck as a large, mushy ill-defined mass that occupies the entire supraclavicular area and extends deeper into the chest
What needs to be arranged prior to surgical removal of a cystic hygroma?
CT scan of the mediastinum (cystic hygroma can extend into the mediastinum)
T/F: Most recently discovered enlarged lymph nodes are benign.
True! H&P should be taken and an appointment made in 3-4 weeks; if nodes still enlarged, begin workup
Young people with multiple enlarged nodes (in the neck and elsewhere) that have been suffering from low-grade fever and night sweats:
lymphoma
FNA can be done, but usually a node has to be removed for pathologic study
A metastatic tumor to the supraclavicular nodes usually comes from
lung or intraabdominal tumors (not the head and neck!)
Note: the node may be removed to help establish tissue diagnosis
T/F: A SCC mucosal tumor’s metastasis to the neck should undergo open biopsy.
FALSE! Never, because an incision of the neck for that purpose will eventually interfere with the appropriate surgical approach for the tumor
A patient with a neck node who is an alcoholic, smoker, old man with rotten teeth…
next step?
Likely metastatic mucosal SCC to jugular chain in neck (submental, I believe…).
Work up is triple endoscopy (panendoscopy) looking for primary (primaries)
Treatment of mucosal SCC:
resection, radical neck dissection, and very often radiotherapy and platinum-based chemo
Presentations of SCC in head and neck:
1) neck node in old, AIDS, smoker, drinker, poor dental hygiene
2) persistent ear pain unilaterally
3) persistent painless ulcer in floor of mouth
4) persistent hoarseness
Acoustic nerve neuroma should be suspected in an adult who has (conductive/sensory) hearing loss in one ear, but not the other (and who does not engage in sport shooting or anything that would expose one ear to more noise than the other)
Findings on Rinne test? Weber test?
sensory loss. Do MRI
Rinne: negative! Will still be able to hear after bone has stopped conducting (air conduction > bone conduction)
Weber: affected ear will hear the noise quieter
Gradual unilateral facial nerve paralysis (vs sudden onset):
Facial nerve tumor (vs Bell’s palsy). MRI with contrast
Visible, palpable mass in front of the ear or around the angle of the mandible:
parotid tumor
Most parotid tumors are _____________, which are benign but have the potential for malignant degeneration.
pleomorphic adenomas
T/F: Parotid pleomorphic adenomas can cause pain or facial nerve paralysis.
False! Parotid cancer can, though!! And it is a very hard nodule
FNA of parotid tumors may be done, but _____________ is absolutely contraindicated.
Open biopsy
What is the treatment of a parotid tumor?
Superficial parotidectomy (or superficial AND deep if the tumor is deep to the facial nerve)
In malignant parotid tumors, what is done with the facial nerve?
The nerve is sacrificed and a graft is done
What is the next move in a pediatric patient with unilateral earache, unilateral rhinorrhea, or unilateral wheezing?
Endoscopy under anesthesia to allow for extraction of a foreign body
What is the name given to an abscess of the floor of the mouth (inflamed submandibular/sublingual regions), often the result of a bad tooth infection?
Ludwig angina
What is the treatment of Ludwig angina?
Incision and drainage, but intubation and tracheostomy may also be needed if the airway is compromised!!
Patients who have normal facial nerve function at the time of admission for trauma and later develop paralysis should have what treatment?
None! Their paralysis is due to swelling and will resolve spontaneously. Facial nerve injuries sustained in the trauma will have paralysis right away
Patient with frontal or ethmoid sinusitis who develops diplopia:
Why is the diplopia happening?
Cavernous sinus thrombosis
Diplopia due to paralysis extrinsic eye muscles
What can be used to treat Bell’s palsy?
Steroids (prednisone), acyclovir
Epistaxis in children is typically from nosepicking; the bleeding comes from the _____________, and ______________ controls the problem.
bleeding comes from the anterior septum
phenylephrine spray and local pressure controls the problem
In an 18 year old, epistaxis may be due to two main causes:
1) cocaine abuse (with septal perforation; requires posterior packing)
2) juvenile nasopharyngeal angiofibroma (benign, but eats and nearby structures; requires surgical resection)
What is the treatment of epistaxis in the elderly population?
Posterior packing; sometimes ligation of bleeding vessels is required (blood loss can be copious and life-threatening)
How can you distinguish between dizziness due to vestibular problems vs neural problems?
What is the next step/treatment for both?
1) vestibular problems –> patient is stable, but room spinning around them. Treat with meclizine, pheergan, or diazepam
2) neural: patient is unsteady, but room perceived as stable. Neurologic workup
