Otolaryngology

Question 1

Where is a thyroglossal duct cyst located?

Answer 1

Midline at the level of the hyoid bone

Question 2

Pulling on the tongue retracts what kind of mass?

Answer 2

Thyroglossal duct cyst

Question 3

What is the treatment of thyroglossal duct cyst?

Answer 3

Surgical removal of the cyst, the middle segment of the hyoid bone, and the track that leads to the base of the tongue

Question 4

Where does a branchial cleft cyst occur?

Answer 4

Anterior edge of the SCM muscle, anywhere from in front of the tragus (ear) to the base of the neck

Question 5

Where is a cystic hygroma located?

Answer 5

Base of the neck as a large, mushy ill-defined mass that occupies the entire supraclavicular area and extends deeper into the chest

Question 6

What needs to be arranged prior to surgical removal of a cystic hygroma?

Answer 6

CT scan of the mediastinum (cystic hygroma can extend into the mediastinum)

Question 7

T/F: Most recently discovered enlarged lymph nodes are benign.

Answer 7

True! H&P should be taken and an appointment made in 3-4 weeks; if nodes still enlarged, begin workup

Question 8

Young people with multiple enlarged nodes (in the neck and elsewhere) that have been suffering from low-grade fever and night sweats:

Answer 8

lymphoma

FNA can be done, but usually a node has to be removed for pathologic study

Question 9

A metastatic tumor to the supraclavicular nodes usually comes from

Answer 9

lung or intraabdominal tumors (not the head and neck!)

Note: the node may be removed to help establish tissue diagnosis

Question 10

T/F: A SCC mucosal tumor’s metastasis to the neck should undergo open biopsy.

Answer 10

FALSE! Never, because an incision of the neck for that purpose will eventually interfere with the appropriate surgical approach for the tumor

Question 11

A patient with a neck node who is an alcoholic, smoker, old man with rotten teeth…
next step?

Answer 11

Likely metastatic mucosal SCC to jugular chain in neck (submental, I believe…).
Work up is triple endoscopy (panendoscopy) looking for primary (primaries)

Question 12

Treatment of mucosal SCC:

Answer 12

resection, radical neck dissection, and very often radiotherapy and platinum-based chemo

Question 13

Presentations of SCC in head and neck:

Answer 13

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

Question 14

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?

Answer 14

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

Question 15

Gradual unilateral facial nerve paralysis (vs sudden onset):

Answer 15

Facial nerve tumor (vs Bell’s palsy). MRI with contrast

Question 16

Visible, palpable mass in front of the ear or around the angle of the mandible:

Answer 16

parotid tumor

Question 17

Most parotid tumors are _____________, which are benign but have the potential for malignant degeneration.

Answer 17

pleomorphic adenomas

Question 18

T/F: Parotid pleomorphic adenomas can cause pain or facial nerve paralysis.

Answer 18

False! Parotid cancer can, though!! And it is a very hard nodule

Question 19

FNA of parotid tumors may be done, but _____________ is absolutely contraindicated.

Answer 19

Open biopsy

Question 20

What is the treatment of a parotid tumor?

Answer 20

Superficial parotidectomy (or superficial AND deep if the tumor is deep to the facial nerve)

Question 21

In malignant parotid tumors, what is done with the facial nerve?

Answer 21

The nerve is sacrificed and a graft is done

Question 22

What is the next move in a pediatric patient with unilateral earache, unilateral rhinorrhea, or unilateral wheezing?

Answer 22

Endoscopy under anesthesia to allow for extraction of a foreign body

Question 23

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?

Answer 23

Ludwig angina

Question 24

What is the treatment of Ludwig angina?

Answer 24

Incision and drainage, but intubation and tracheostomy may also be needed if the airway is compromised!!

Question 25

Patients who have normal facial nerve function at the time of admission for trauma and later develop paralysis should have what treatment?

Answer 25

None! Their paralysis is due to swelling and will resolve spontaneously. Facial nerve injuries sustained in the trauma will have paralysis right away

Question 26

Patient with frontal or ethmoid sinusitis who develops diplopia:
Why is the diplopia happening?

Answer 26

Cavernous sinus thrombosis

Diplopia due to paralysis extrinsic eye muscles

Question 27

What can be used to treat Bell’s palsy?

Answer 27

Steroids (prednisone), acyclovir

Question 28

Epistaxis in children is typically from nosepicking; the bleeding comes from the _____________, and ______________ controls the problem.

Answer 28

bleeding comes from the anterior septum

phenylephrine spray and local pressure controls the problem

Question 29

In an 18 year old, epistaxis may be due to two main causes:

Answer 29

1) cocaine abuse (with septal perforation; requires posterior packing)
2) juvenile nasopharyngeal angiofibroma (benign, but eats and nearby structures; requires surgical resection)

Question 30

What is the treatment of epistaxis in the elderly population?

Answer 30

Posterior packing; sometimes ligation of bleeding vessels is required (blood loss can be copious and life-threatening)

Question 31

How can you distinguish between dizziness due to vestibular problems vs neural problems?
What is the next step/treatment for both?

Answer 31

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