Otolaryngology (ENT) Flashcards
What are the possible origins of neck masses? What are their typical characteristics?
- Congenital: Affects young patients and are present for years before they become symptomatic
- Inflammatory: Develop in days or weeks, after which, they reach some kind of resolution (drainage or resolution)
- Neoplastic: Characterized by several months of relentless growth
What is a thyroglossal duct cysts?
Congenital 1-2 cm mass located midline at level of the hyoid bone and connected to the tongue (puling the tung retracts the mass).
How are thyroglossal duct cysts managed?
Surgical removal of the cysts and middle segment of hyoid bone.
What is a brachial cleft cyst?
Congenital mass of several centimeters along the anterior edge of the sternocleidomastoid. Can have a little opening and blind tract in the skin overlying it
What is a cystic hygroma?
Congenital, large, mushy, ill-defined mass found at base of the neck, occupying the entire supraclavicular area and extending deeper into the chest (often into mediastinum)
How is a cystic hygroma managed?
Mandatory CT scan bc it extends into mediastinum. IT can be surgically removed.
What should be done in case of a recently discovered enlarged lymph node?
- Most are bening
- Complete hx and physical f/u w appointment in 3-4 weeks.
- Work up only if mass is still there
What should be done in case of a persistent enlarged lymph node (weeks/months)?
- Can still be inflammatory, but neoplasia needs to be r/o
- Look at specific diagnostic patterns
What are multiple enlarged lymph nodes w low-grade fever and night sweats suspicious for?
- Lymphoma
- Enlarged lymph nodes can appear in the neck or elsewhere
- FNA can be done, but node is usually removed for pathologic study
- Chemotherapy is the usual treatment
What are enlarged supraclavicular nodes worrisome for?
- Metastatic tumor
- Invariably from bellow the clavicle (NOT head and neck)
- Lung or intraabdominal tumors are the usual primaries
- The node itself may be removed for tissue diagnosis
What type of cancer is commonly seen in old men who smoke, drink and have rotten teeth, as well as in AIDS patients?
- Squamous Cell Carcinoma of the mucosae of the head and neck
- Common first sign is metastatic node in the neck (from jugular chain)
How is SCC of the head and neck mucosae diagnosed?
- Triple endoscopy (or panendoscopy) looking for primary tumor(s).
- Bx of primaries establishes dx
- FNA of node should be done, but bx of neck mass should NEVER be done (neck incision will interfere w appropriate surgical approach for the tumor)
How is SCC of the head and neck mucosae treated?
-Resection, radical neck dissection and (often) radiotherapy and platinum-based chemo.
What are other presentations of SCC of the head and neck mucosae?
- Persistent hoarseness
- Persistent painless ulcer in the floor of the mouth
- persistent unilateral earache
What should be suspected in an adult w sensory hearing loss in one ear, but not the other?
- Acoustic nerve neuroma
- MRI is best for dx
- Note: if patient practices sport shooting r/o hearing damage from noise to one ear
What produces gradual unilateral facial nerve paralysis on both forehead and lower face? Best imaging test to diagnose this?
- Facial nerve tumors
- If sudden: Bell’s Palsy
- Gadolinium-enhanced MRI is best for dx
What can a visible and palpable mass in front of the ear, or around the angle of the mandible be?
- Parotid tumor
- They DO NOT produce pain or facial nerve paralysis
What are most parotid tumors?
-Pleomorphic adenomas (benign) w malignant potential.
What can a hard, painful parotid mass be?
- Parotid cancer
- FNA can be done, but open bx is ABSOLUTELY CONTRAINDICATED!!
How are parotid cancers treated?
- Superficial (or superficial and deep) parotidectomy in order to bx and prevent recurrence while sparing the facial nerve
- Enucleation alone leads to recurrence
What can be done regarding the facial nerve in the case of malignant parotid tumors?
-Facial nerve is sacrificed durin excision and a graft is done
What is most common cause of unilateral ENT problems in toddlers? How are they managed?
- Foreign bodies
- Sx of unilateral earache, rhinorrhea or wheezing in a toddler means there is a toy stuck it his/her ear canal, nose, or bronchus.
- Appropriate endoscopy under anesthesia is the way to tx
What is Ludwig angina? How is it treated?
- Abscess of the floor of the mouth commonly from a tooth infection
- Major problem is its threat to the airway
- Incision and drainage are done, but intubation and tracheostomy may also be needed
How does Bell’s Palsy present?
-Sudden Paralysis of the facial nerve for no apparent reason
How is Bell’s palsy managed?
- Prompt use of antiviral medication
- Steroids may also be administered
How are facial nerve injuries from trauma be differentiated from compression of the facial nerve by swelling in a trauma patient?
- Facial nerve injuries produced by trauma present with paralysis right away
- If pt is admitted with normal facial nerve function and develops paralysis, it is caused by swelling that will eventually resolve
What does developing of diplopia mean in a patient with frontal or ethmoid sinusitis?
- Cavernous sinus thrombosis
- Causes paralysis of extrinsic eye movements
- SERIOUS EMERGENCY
- Hospitalization, IV abx, CT scans, and drainage of sinuses is needed
What causes Epistaxis (nose bleeds) in children? How is it managed?
- Most commonly from nosepicking
- Phenylephrine spray and local pressure control it
What are the most common causes of Epistaxis in an 18-year-old? How is it managed?
- Cocaine use w septal perforation (Posterior packing needed)
- Juvenile nasopharyngeal angiofibroma (Surgical resection needed: benign tumor, but eats away at nearby structures)
What is different about Epistaxis in the elderly and hypertensive?
- They can be copious and life-threatening
- BP needs to be controlled
- posterior packing is required
- sometimes surgical ligation of feeding vessels is needed
What are the major ENT causes of dizziness?
-Inner ear disease or cerebral disease
How does inner ear disease present? How is it managed?
- The patient describes the room to be spinning around them .
- Meclizine, Phenergan, or diazepam may help
How is dizziness described when the problem comes form the brain?
- Patients is unsteady, but describes the room as being stable
- Neurologic workup is in order
