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Pestana's > Otolaryngology (ENT) > Flashcards

Otolaryngology (ENT) Flashcards

1
Q

What are the possible origins of neck masses? What are their typical characteristics?

A
  • 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
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2
Q

What is a thyroglossal duct cysts?

A

Congenital 1-2 cm mass located midline at level of the hyoid bone and connected to the tongue (puling the tung retracts the mass).

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3
Q

How are thyroglossal duct cysts managed?

A

Surgical removal of the cysts and middle segment of hyoid bone.

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4
Q

What is a brachial cleft cyst?

A

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

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5
Q

What is a cystic hygroma?

A

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)

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6
Q

How is a cystic hygroma managed?

A

Mandatory CT scan bc it extends into mediastinum. IT can be surgically removed.

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7
Q

What should be done in case of a recently discovered enlarged lymph node?

A
  • Most are bening
  • Complete hx and physical f/u w appointment in 3-4 weeks.
  • Work up only if mass is still there
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8
Q

What should be done in case of a persistent enlarged lymph node (weeks/months)?

A
  • Can still be inflammatory, but neoplasia needs to be r/o

- Look at specific diagnostic patterns

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9
Q

What are multiple enlarged lymph nodes w low-grade fever and night sweats suspicious for?

A
  • 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
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10
Q

What are enlarged supraclavicular nodes worrisome for?

A
  • 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
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11
Q

What type of cancer is commonly seen in old men who smoke, drink and have rotten teeth, as well as in AIDS patients?

A
  • Squamous Cell Carcinoma of the mucosae of the head and neck
  • Common first sign is metastatic node in the neck (from jugular chain)
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12
Q

How is SCC of the head and neck mucosae diagnosed?

A
  • 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)
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13
Q

How is SCC of the head and neck mucosae treated?

A

-Resection, radical neck dissection and (often) radiotherapy and platinum-based chemo.

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14
Q

What are other presentations of SCC of the head and neck mucosae?

A
  • Persistent hoarseness
  • Persistent painless ulcer in the floor of the mouth
  • persistent unilateral earache
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15
Q

What should be suspected in an adult w sensory hearing loss in one ear, but not the other?

A
  • Acoustic nerve neuroma
  • MRI is best for dx
  • Note: if patient practices sport shooting r/o hearing damage from noise to one ear
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16
Q

What produces gradual unilateral facial nerve paralysis on both forehead and lower face? Best imaging test to diagnose this?

A
  • Facial nerve tumors
  • If sudden: Bell’s Palsy
  • Gadolinium-enhanced MRI is best for dx
17
Q

What can a visible and palpable mass in front of the ear, or around the angle of the mandible be?

A
  • Parotid tumor

- They DO NOT produce pain or facial nerve paralysis

18
Q

What are most parotid tumors?

A

-Pleomorphic adenomas (benign) w malignant potential.

19
Q

What can a hard, painful parotid mass be?

A
  • Parotid cancer

- FNA can be done, but open bx is ABSOLUTELY CONTRAINDICATED!!

20
Q

How are parotid cancers treated?

A
  • Superficial (or superficial and deep) parotidectomy in order to bx and prevent recurrence while sparing the facial nerve
  • Enucleation alone leads to recurrence
21
Q

What can be done regarding the facial nerve in the case of malignant parotid tumors?

A

-Facial nerve is sacrificed durin excision and a graft is done

22
Q

What is most common cause of unilateral ENT problems in toddlers? How are they managed?

A
  • 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
23
Q

What is Ludwig angina? How is it treated?

A
  • 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
24
Q

How does Bell’s Palsy present?

A

-Sudden Paralysis of the facial nerve for no apparent reason

25
Q

How is Bell’s palsy managed?

A
  • Prompt use of antiviral medication

- Steroids may also be administered

26
Q

How are facial nerve injuries from trauma be differentiated from compression of the facial nerve by swelling in a trauma patient?

A
  • 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
27
Q

What does developing of diplopia mean in a patient with frontal or ethmoid sinusitis?

A
  • Cavernous sinus thrombosis
  • Causes paralysis of extrinsic eye movements
  • SERIOUS EMERGENCY
  • Hospitalization, IV abx, CT scans, and drainage of sinuses is needed
28
Q

What causes Epistaxis (nose bleeds) in children? How is it managed?

A
  • Most commonly from nosepicking

- Phenylephrine spray and local pressure control it

29
Q

What are the most common causes of Epistaxis in an 18-year-old? How is it managed?

A
  • Cocaine use w septal perforation (Posterior packing needed)
  • Juvenile nasopharyngeal angiofibroma (Surgical resection needed: benign tumor, but eats away at nearby structures)
30
Q

What is different about Epistaxis in the elderly and hypertensive?

A
  • They can be copious and life-threatening
  • BP needs to be controlled
  • posterior packing is required
  • sometimes surgical ligation of feeding vessels is needed
31
Q

What are the major ENT causes of dizziness?

A

-Inner ear disease or cerebral disease

32
Q

How does inner ear disease present? How is it managed?

A
  • The patient describes the room to be spinning around them .
  • Meclizine, Phenergan, or diazepam may help
33
Q

How is dizziness described when the problem comes form the brain?

A
  • Patients is unsteady, but describes the room as being stable
  • Neurologic workup is in order

Pestana's (13 decks)

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