Otolaryngology Flashcards
14 yo boy is brought to medical attention b/c of nasal fullness and bleeding. inspection reveals enlarged cervical lymph nodes as well. biopsy of a LN confirms nasopharyngeal carcinoma. What is the best management strategy for this patient?
a. chemoradiation
b. external beam radiation therapy
c. intracavitary radiation therapy
d. surgical resection
e. surgical resection followed by adjuvant chemoradiation
A
nasopharyngeal carcinoma
tx
- chemoradiation
- intracavitary & external beam radiation therapy
RF
- environment, ethnicity, tobacco
- EBV infections
dx = biopsy of primary tumor
a young motorcycle driver is thrown against a concrete bridge abutment and sustains severe trauma about the face, with marked periorbital edema and ecchymosis as well as epistaxis. he is obtunded with rapid, shallow breathing. which of the following is the next appropriate step in his workup and management?
a. evaluation of cervical spine
b. blind nasopharyngeal intubation with cervical in-line stabilization
c. oropharyngeal intubation with cervical in-line stabilization
d. emergency tracheostomy
e. emergency cricothyroidotomy
C
likely associated airway problems (ABCDE)
periorbital ecchymosis = raccoon eyes” –> likely due to basilar skulll fracture
dx
- CT of facial series
48yo man with strong hx of cigarette use and heavy EtOH intake presents with an intraoral mass. biopsy shows squamous cell cancer. CXR shows hyperinflated lungs but is otherwise normal. which of following is indicated as part of his staging workup?
a. measurement of serum alk phos and calcium levels
b. bronchoscopy
c. esophagoscopy
d. echocardiology
e. no further workup is necessary
C
also possibly cancer of the esophagus/ airway
normal CXR = no cancer of trachea / bronchus (so no need for bronchoscopy yet)
your pt presents with a complaint of a mass of her R cheek, which has been slowly enlarging. biopsy shows a pleomorphic adenoma. which is the next step in her management?
a. superficial parotidectomy with preservation of the facial n.
b. superficial parotidectomy with resection of the facial n.
c. total parotidectomy with preservation of the facial n.
d. total parotidectomy with resection of the facial n.
e. enucleation of the adenoma
A
pleomorphid adenoma of the parotid gland ==> superficial parotidectomy + preservation of facial nerve.
don’t squeeze it –> can cause tumor spillage
can occur in major / minor salivary glands –> esp. @ lips, tongue, palate.
5yo child presents with a small mass near the anterior border of the sternocleidomastoid muscle. the mass is associated with localized erythema and induration, and the child is febrile. which of the following is the definitive treatment of this problem?
a. antibiotic therapy
b. incision and drainage
c. incision and drainage, followed by complete excision after resolution of the inflammation and infection
d. partial excision followed by clinical observation
e. immediate excision followed by postoperative antibiotic therapy for 1 week.
C
==> brachial cleft remnant (cyst, sinus, fistula) ==> esp. in 1st and 2nd brachial pouhes
==> brachial cyst is infected due to accumulation of secretion
21yo woman asks you to evaluate a small painless lump in the midline of her neck that moves with swallowing. you make the clinical diagnosis of thyroglossal duct cyst. which of teh following is the most appropriate management of this pt?
a. excision of the cyst
b. excision of the cyst and central portion of the hyoid bone
c. excision of the cyst, central portion of the hyoid bone, and the tract to the base of the tongue
d. excision of the cyst, central portion of the hyoid bone, and the tract to the base of the tongue, with sampling of the cervical lymph nodes
e. excision of the cyst, central portion of the hyoid bone, and the tract to the base of the tongue, with biopsy of the thyroid gland
C. thyroglossal duct cyst ==> due to retention of an epithelial tract between the thyroid and its embryologic origin in the foramen cecum at the base of the tongue.
==> Sistrunk procedure = local resection of cyst & central portion of hyoid bone along with the thyroglossal tract all the way to the base of the tongue.
no need for sampling of LN.
60yo smoker is seen b/c of a 3cm midline ulcerating mass that is visualized when he sticks out his tongue. biopsy establishes that this is SCC. which of the following is the most appropriate treatment of his cancer?
a. radiation therapy alone
b partial glossectomy
c.partial glossectomy & cervical lymph node sampling
d. partial glossectomy and b/l neck dissections
e. partial glossectomy followed by chemoradiation
D
as needed
> 2cm tumor –> neck dissection for prognostic
38yo woman who underwent total thyroidectomy for multinodular goiter 6mo ago presents with persistent horaseness. which of the following nerves was most likely injured during her operation
a. superior laryngeal nerve
b. b/l recurrent laryngeal nerves
c. U/L recurrent laryngeal nerve
d. hypoglossal nerve
e. marginal mandibular branch of the facial nerve
C
hoarse = U/L stridor = B/L
damage to superior laryngeal nerve –> voice weakness, difficulties with pitch
4yo boy is brought into the ED by his parents for difficulty in breathing and swallowing. on exam, the child is febrile, tachycardic, and tachypneic. he is anxious, drooling and becomes increasingly exhausted while struggling to breathe. a lateral cervical spine radiograph shows what looks like a thumb sticking into the larynx at the level of the mandible. which of the following is the most appropriate management of this patient?
a. examine the larynx at bedside
b. IV antibiotics and admission to the floor
c. immediate endotracheal intubation in the ED
d. immediate endotracheal intubation in the OR
e. immediate tracheostomy in the OR
D
“thumb sign” = epiglottitis
need an airway, safest in the OR.
if unable - tracheostomy
==> attempts ot visualize the larynx (at bedside or in ED) –> can result in sudden airway occlusion with aspiration & respiratory arrest.
58yo man is found to have a small mass in the R neck on a yearly exam. the pt reports that the mass has been slowly growing for the last few months and is not associated with pain or drainage. he has an otherwise negative ROS. on exam, there is a hard, mobile 2cm mass along the mid-portion of the R sternocledomastoid muscle. which of the following is the most appropriate initial step in the workup of the neck mass?
a. no further workup is needed. reevaluate the mass after a course of Abx for 2w
b. FNA
c. core needle biopsy
d. incisional biopsy
e. excisional biopsy
B. FNA for malignancy until proven ottherwise. Can tell us benign v. malignant
would want core needle biopsy for follicular thyroid cancer = but this would likely not be it.
parathyroid?
62yo man presents with a 3mo hx of an enlarged lymph node in the L neck. he is a long-time smoker of cigarettes and denies fevers, night sweats, fatigue, or cough. on exam, there is a 1.5cm hard, fixed mass below the angle of the mandible in the L neck. which of the following is the most likely cause of an enlarged LN in the neck?
a. thyroglossal duct cyst
b. dermoid tumor
c. carotid body tumor
d. brachial cleft cyst
e. metastatic SCC.
E
hard and fixed = CANCER
hx of smoking
lymphadenopathy (he has a hx of it) and how has a mass –> most likely metastatic SCC
