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Section III Subspecialty Surgery P517 > Otolaryngology: Head and Neck Surgery, C70 P586-620 > Flashcards

Otolaryngology: Head and Neck Surgery, C70 P586-620 Flashcards

1
Q

Define:
Anosmia
P586

A

Inability to smell

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2
Q

Define:
Otorrhea
P586

A

Fluid discharge from ear

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3
Q

Define:
Dysphagia
P586

A

Difficulty swallowing

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4
Q

Define:
Odynophagia
P586

A

Painful swallowing

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5
Q

Define:
Globus
P586

A

Sensation of a “lump in the throat”

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6
Q

Define:
Otalgia
P586

A

Ear pain (often referred from throat)

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7
Q

Define:
Trismus
P586

A

Difficulty opening mouth

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8
Q

ANATOMY
Define the cranial nerves:
I
P586

A

Olfactory nerve

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9
Q

ANATOMY
Define the cranial nerves:
II
P586

A

Optic nerve

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10
Q

ANATOMY
Define the cranial nerves:
III
P586

A

Oculomotor nerve

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11
Q

ANATOMY
Define the cranial nerves:
IV
P586

A

Trochlear nerve

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12
Q

ANATOMY
Define the cranial nerves:
V
P586

A

Trigeminal nerve

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13
Q

ANATOMY
Define the cranial nerves:
VI
P586

A

Abducens nerve

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14
Q

ANATOMY
Define the cranial nerves:
VII
P586

A

Facial nerve

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15
Q

ANATOMY
Define the cranial nerves:
VIII
P586

A

Vestibulocochlear nerve

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16
Q

ANATOMY
Define the cranial nerves:
IX
P586

A

Glossopharyngeal nerve

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17
Q

ANATOMY
Define the cranial nerves:
X
P586

A

Vagus nerve

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18
Q

ANATOMY
Define the cranial nerves:
XI
P587

A

Accessory nerve

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19
Q

ANATOMY
Define the cranial nerves:
XII
P587

A

Hypoglossal nerve

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20
Q 
ANATOMY
Define motor/sensory
actions of the following
cranial nerves:
I
P567
A

Smell

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21
Q 
ANATOMY
Define motor/sensory
actions of the following
cranial nerves:
II
P567
A

Sight (sensory pupil reaction)

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22
Q 
ANATOMY
Define motor/sensory
actions of the following
cranial nerves:
III
P567
A 
Eyeball movement, pupil sphincter,
ciliary muscle (motor pupil reaction)
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23
Q 
ANATOMY
Define motor/sensory
actions of the following
cranial nerves:
IV
P567
A

Superior oblique muscle movement

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24
Q 
ANATOMY
Define motor/sensory
actions of the following
cranial nerves:
V
P567
A

Motor: chewing (masseter muscle)
Sensory: face, teeth, sinuses, cornea

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25
Q 
ANATOMY
Define motor/sensory
actions of the following
cranial nerves:
VI
P567
A

Lateral rectus muscle (lateral gaze)

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26
Q 
ANATOMY
Define motor/sensory
actions of the following
cranial nerves:
VII
P567
A

Motor: facial muscles, lacrimal/
sublingual/submandibular glands
Sensory: anterior tongue/soft palate, taste

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27
Q 
ANATOMY
Define motor/sensory
actions of the following
cranial nerves:
VIII
P567
A

Hearing, positioning

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28
Q 
ANATOMY
Define motor/sensory
actions of the following
cranial nerves:
IX
P567
A

Motor: stylopharyngeus, parotid, pharynx
Sensory: posterior tongue, pharynx,
middle ear

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29
Q 
ANATOMY
Define motor/sensory
actions of the following
cranial nerves:
X
P567
A

Motor: vocal cords, heart, bronchus,
GI tract
Sensory: bronchus, heart, GI tract,
larynx, ear

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30
Q 
ANATOMY
Define motor/sensory
actions of the following
cranial nerves:
XI
P567
A

Motor: trapezius muscle,

sternocleidomastoid muscle

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31
Q 
ANATOMY
Define motor/sensory
actions of the following
cranial nerves:
XI
P567
A

Motor: tongue, strap muscles (ansa

cervicalis branch)

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32
Q 
ANATOMY
What are the three divisions
of the trigeminal nerve
(cranial nerve V)?
P587
A
  1. Ophthalmic
  2. Maxillary
  3. Mandibular
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33
Q 
ANATOMY
What happens when the
hypoglossal nerve (cranial
nerve XII) is cut?
P588
A

When the patient sticks out the tongue, it
deviates to the same side as the injury
(wheelbarrow effect)

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34
Q

ANATOMY
Name the duct of the
submandibular gland.
P588

A

Wharton’s duct

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35
Q

ANATOMY
Name the duct of the
parotid gland.
P588

A

Stensen’s duct

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36
Q

ANATOMY
What is the source of blood
supply to the nose?
P588

A 
1. Internal carotid artery: anterior and
    posterior ethmoidal arteries via
    ophthalmic artery
2. External carotid artery: superior
    labial artery (via facial artery) and
    sphenopalatine artery (via internal
    maxillary artery)
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37
Q 
ANATOMY
Name the three bones that
make up the posterior nasal
septum.
P588
A
  1. Ethmoid (perpendicular plate)
  2. Vomer (Latin for “plow”)
  3. Palatine (some also include maxillary
    crest)
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38
Q

ANATOMY
Name the seven bones of
the bony eyeball orbit.
P588

A
  1. Frontal
  2. Zygoma
  3. Maxillary
  4. Lacrimal
  5. Ethmoid
  6. Palatine
  7. Sphenoid
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39
Q

ANATOMY
Name the four strap muscles.
P588

A

“TOSS”:

1. Thyrohyoid
2. Omohyoid
3. Sternothyroid
4. Sternohyoid
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40
Q 
ANATOMY
Which muscle crosses the
external and internal carotid
arteries?
P588
A

Digastric muscle

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41
Q

ANATOMY
In a neck incision, what is
the first muscle incised?
P588

A

Platysma

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42
Q

ANATOMY
Which nerve supplies the
strap muscles?
P588

A

Ansa cervicalis (XII)

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43
Q

ANATOMY
What are the anterior and
posterior neck triangles?
P589 (picture)

A

Two regions of the neck, divided by the

sternocleidomastoid muscle

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44
Q

ANATOMY
Which nerve runs with the
carotid in the carotid sheath?
P589

A

Vagus

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45
Q 
ANATOMY
Which nerve crosses the
internal carotid artery at
approximately 1 to 2 cm
above the bifurcation?
P589
A

Hypoglossal nerve

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46
Q

ANATOMY
Name the three auditory
ossicle bones.
P589

A
  1. Malleus (hammer)
  2. Incus (anvil)
  3. Stapes (stirrup)
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47
Q

ANATOMY
What comprises the middle
ear?
P589

A

Eustachian tube, ossicle bones, tympanic

membrane (“ear drum”), mastoid air cell

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48
Q

ANATOMY
What comprises the inner
ear?
P589

A

Cochlea, semicircular canals, internal

auditory canal

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49
Q

EAR
OTITIS EXTERNA (SWIMMER’S EAR)
What is it?
P589

A

Generalized infection involving the
external ear canal and often the tympanic
membrane

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50
Q

EAR
OTITIS EXTERNA (SWIMMER’S EAR)
What is the usual cause?
P590

A

Prolonged water exposure and damaged
squamous epithelium of the ear canal
(e.g., swimming, hearing aid use)

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51
Q 
EAR
OTITIS EXTERNA (SWIMMER’S EAR)
What are the typical
pathogens?
P590
A 
Most frequently Pseudomonas, may be
Proteus, Staphylococcus, occasionally
Escherichia coli, fungi (Aspergillus,
Candida), or virus (herpes zoster or
herpes simplex)
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52
Q 
EAR
OTITIS EXTERNA (SWIMMER’S EAR)
What are the signs/
symptoms?
P590
A

Ear pain (otalgia); swelling of external
ear, ear canal, or both; erythema; pain on
manipulation of the auricle; debris in
canal; otorrhea

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53
Q

EAR
OTITIS EXTERNA (SWIMMER’S EAR)
What is the treatment?
P590

A

Keep the ear dry; mild infections respond
to cleaning and dilute acetic acid drops;
most infections require complete removal
of all debris and topical antibiotics with or
without hydrocortisone (anti-inflammatory)

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54
Q

EAR
MALIGNANT OTITIS EXTERNA (MOE)
What is it?
P590

A

Fulminant bacterial otitis externa

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55
Q

EAR
MALIGNANT OTITIS EXTERNA (MOE)
Who is affected?
P590

A

Most common scenario: elderly patient
with poorly controlled diabetes (other
forms of immunosuppression do not
appear to predispose patients to MOE)

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56
Q 
EAR
MALIGNANT OTITIS EXTERNA (MOE)
What are the causative
organisms?
P590
A

Usually Pseudomonas aeruginosa

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57
Q

EAR
MALIGNANT OTITIS EXTERNA (MOE)
What is the classic feature?
P590

A

Nub of granulation tissue on the floor
of the external ear canal at the
bony–cartilaginous junction

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58
Q 
EAR
MALIGNANT OTITIS EXTERNA (MOE)
What are the other signs/
symptoms?
P590
A

Severe ear pain, excessive purulent

discharge, and usually exposed bone

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59
Q 
EAR
MALIGNANT OTITIS EXTERNA (MOE)
What are the diagnostic
tests?
P591
A 
1. CT scan: shows erosion of bone,
    inflammation
2. Technetium-99 scan: temporal bone
    inflammatory process
3. Gallium-tagged white blood cell scan:
    to follow and document resolution
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60
Q

EAR
MALIGNANT OTITIS EXTERNA (MOE)
What are the complications?
P591

A

Invasion of surrounding structures to
produce a cellulitis, osteomyelitis of
temporal bone, mastoiditis; later, a facial
nerve palsy, meningitis, or brain abscess

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61
Q

EAR
MALIGNANT OTITIS EXTERNA (MOE)
What is the treatment?
P591

A 
Control of diabetes, meticulous local
care with extensive debridement,
hospitalization and IV antibiotics (anti-
Pseudomonas: usually an aminoglycoside
plus a penicillin)
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62
Q 
EAR
TUMORS OF THE EXTERNAL EAR
What are the most common
types?
P591
A

Squamous cell most common; occasionally,

basal cell carcinoma or melanoma

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63
Q 
EAR
TUMORS OF THE EXTERNAL EAR
From what location do they
usually arise?
P591
A

Auricle, but occasionally from the

external canal

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64
Q 
EAR
TUMORS OF THE EXTERNAL EAR
What is the associated risk
factor?
P591
A

Excessive sun exposure

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65
Q 
EAR
TUMORS OF THE EXTERNAL EAR
What is the treatment of the
following conditions:
Cancers of the auricle?
P591
A

Usually wedge excision

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66
Q 
EAR
TUMORS OF THE EXTERNAL EAR
What is the treatment of the
following conditions:
Extension to the canal?
P591
A

May require excision of the external ear

canal or partial temporal bone excision

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67
Q 
EAR
TUMORS OF THE EXTERNAL EAR
What is the treatment of the
following conditions:
Middle ear involvement?
P591
A

Best treated by en bloc temporal bone

resection and lymph node dissection

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68
Q

EAR
TYMPANIC MEMBRANE (TM) PERFORATION
What is the etiology?
P591

A 
Usually the result of trauma (direct or
indirect) or secondary to middle ear
infection; often occurs secondary to slap
to the side of the head (compression
injury), explosions
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69
Q

EAR
TYMPANIC MEMBRANE (TM) PERFORATION
What are the symptoms?
P592

A

Pain, bleeding from the ear, conductive

hearing loss, tinnitus

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70
Q

EAR
TYMPANIC MEMBRANE (TM) PERFORATION
What are the signs?
P592

A

Clot in the meatus, visible tear in the TM

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71
Q

EAR
TYMPANIC MEMBRANE (TM) PERFORATION
What is the treatment?
P592

A

Keep dry; use systemic antibiotics if there

is evidence of infection or contamination

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72
Q

EAR
TYMPANIC MEMBRANE (TM) PERFORATION
What is the prognosis?
P592

A

Most (90%) heal spontaneously, though
larger perforations may require surgery
(e.g., fat plug, temporalis fascia
tympanoplasty)

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73
Q

EAR
CHOLESTEATOMA
What is it?
P592

A

Epidermal inclusion cyst of the middle
ear or mastoid, containing desquamated
keratin debris; may be acquired or
congenital

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74
Q

EAR
CHOLESTEATOMA
What are the causes?
P592

A 
Negative middle ear pressure from
eustachian tube dysfunction (primary
acquired) or direct growth of epithelium
through a TM perforation (secondary
acquired)
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75
Q 
EAR
CHOLESTEATOMA
What other condition is it
often associated with?
P592
A

Chronic middle ear infection

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76
Q

EAR
CHOLESTEATOMA
What is the usual history?
P592

A

Chronic ear infection with chronic,

malodorous drainage

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77
Q

EAR
CHOLESTEATOMA
What is the appearance?
P592

A

Grayish-white, shiny keratinous mass
behind or involving the TM; often
described as a “pearly” lesion

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78
Q 
EAR
CHOLESTEATOMA
What are the associated
problems?
P592
A 
Ossicular erosion, producing conductive
hearing loss; also, local invasion resulting in:
    Vertigo/sensorineural hearing loss
    Facial paresis/paralysis
    CNS dysfunction/infection
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79
Q

EAR
CHOLESTEATOMA
What is the treatment?
P592

A

Surgery (tympanoplasty/mastoidectomy)
aimed at eradication of disease and
reconstruction of the ossicular chain

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80
Q

EAR
BULLOUS MYRINGITIS
What is it?
P593

A

Vesicular infection of the TM and

adjacent deep canal

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81
Q 
EAR
BULLOUS MYRINGITIS
What are the causative
agents?
P593
A

Unknown; viral should be suspected
because of frequent association with viral
URI (in some instances, Mycoplasma
pneumoniae has been cultured)

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82
Q

EAR
BULLOUS MYRINGITIS
What are the symptoms?
P593

A

Acute, severe ear pain; low-grade fever;

and bloody drainage

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83
Q 
EAR
BULLOUS MYRINGITIS
What are the findings on
otoscopic examination?
P593
A

Large, reddish blebs on the TM, wall of

the meatus, or both

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84
Q

EAR
BULLOUS MYRINGITIS
Is hearing affected?
P593

A

Rarely; occasional reversible sensorineural

loss

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85
Q

EAR
BULLOUS MYRINGITIS
What is the treatment?
P593

A

Oral antibiotics (erythromycin if
Mycoplasma is suspected); topical
analgesics may be used, with resolution of
symptoms usually occurring in 36 hours

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86
Q

EAR
ACUTE SUPPURATIVE OTITIS MEDIA (OM)
What is it?
P593

A

Bacterial infection of the middle ear,
often following a viral URI; may be
associated with a middle ear effusion

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87
Q

EAR
ACUTE SUPPURATIVE OTITIS MEDIA (OM)
What is the cause?
P593

A

Dysfunction of the eustachian tube that
allows bacterial entry from nasopharynx;
often associated with an occluded eustachian
tube, although it is uncertain whether
this is a cause or a result of the infection

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88
Q 
EAR
ACUTE SUPPURATIVE OTITIS MEDIA (OM)
What are the predisposing
factors?
P593
A

Young age, male gender, bottle feeding,
crowded living conditions (e.g., day care),
cleft palate, Down’s syndrome, cystic fibrosis

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89
Q

EAR
ACUTE SUPPURATIVE OTITIS MEDIA (OM)
What is the etiology?
P593

A 
1. Streptococcus pneumoniae (33% of
    cases)
2. Haemophilus influenzae
3. Moraxella catarrhalis
4. Staphylococcus
5. -hemolytic strep
6. Pseudomonas aeruginosa
7. Viral/no culture
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90
Q 
EAR
ACUTE SUPPURATIVE OTITIS MEDIA (OM)
What is the etiology in
infants younger than
6 months?
P594
A
  1. Staphylococcus aureus
  2. E. coli
  3. Klebsiella
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91
Q

EAR
ACUTE SUPPURATIVE OTITIS MEDIA (OM)
What are the symptoms?
P594

A

Otalgia, fever, decreased hearing, infant
pulls on ear, increased irritability; as many
as 25% of patients are asymptomatic

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92
Q

EAR
ACUTE SUPPURATIVE OTITIS MEDIA (OM)
What are the signs?
P594

A

Early, redness of the TM; later, TM
bulging with loss of the normal landmarks;
finally, impaired TM mobility on pneumatic
otoscopy

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93
Q 
EAR
ACUTE SUPPURATIVE OTITIS MEDIA (OM)
If pain disappears instantly,
what may have happened?
P594
A

TM perforation!

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94
Q

EAR
ACUTE SUPPURATIVE OTITIS MEDIA (OM)
What are the complications?
P594

A 
TM perforation, acute mastoiditis,
meningitis, brain abscess, extradural
abscess, labyrinthitis; if recurrent or
chronic, OM may have adverse effects on
speech and cognitive development as a
result of decreased hearing
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95
Q

EAR
ACUTE SUPPURATIVE OTITIS MEDIA (OM)
What is the treatment?
P594

A

10-day course of antibiotics; amoxicillin is
the first-line agent; if the patient is allergic
to PCN, trimethoprim-sulfamethoxazole
or erythromycin should be administered

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96
Q

EAR
ACUTE SUPPURATIVE OTITIS MEDIA (OM)
What is the usual course?
P594

A

Symptoms usually resolve in 24 to 36 hours

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97
Q 
EAR
ACUTE SUPPURATIVE OTITIS MEDIA (OM)
What are the indications for
myringotomy and PE tube
placement?
P594
A 
1. Persistent middle ear effusion over
    3 months
2. Debilitated or immunocompromised
    patient
3. More than three episodes over
    6 months (especially if bilateral)
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98
Q

EAR
ACUTE SUPPURATIVE OTITIS MEDIA (OM)
What is a PE tube?
P594

A

Pneumatic Equalization tube (tube placed

across tympanic membrane)

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99
Q

EAR
ACUTE SUPPURATIVE OTITIS MEDIA (OM)
What is a Bezold’s abscess?
P594

A

Abscess behind the superior attachment
of the sternocleidomastoid muscle resulting
from extension of a mastoid infection

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100
Q 
EAR
ACUTE SUPPURATIVE OTITIS MEDIA (OM)
What are causes of chronic
otitis media?
P594
A

Mixed, S. aureus, P. aeruginosa

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101
Q 
EAR
ACUTE SUPPURATIVE OTITIS MEDIA (OM)
What are the signs/symptoms
of chronic otitis media?
P595
A

Otorrhea and hearing loss

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102
Q

EAR
OTOSCLEROSIS
What is it?
P595

A

Genetic disease characterized by abnormal
spongy and sclerotic bone formation in
the temporal bone around the footplate
of the stapes, thus preventing its normal
movement

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103
Q 
EAR
OTOSCLEROSIS
What is the inheritance
pattern?
P595
A

Autosomal dominant with incomplete

one-third penetrance

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104
Q

EAR
OTOSCLEROSIS
What are the symptoms?
P595

A

Painless, progressive hearing loss (may be

unilateral or bilateral), tinnitus

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105
Q 
EAR
OTOSCLEROSIS
What is the usual age of
onset?
P595
A

Second through fourth decade

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106
Q

EAR
OTOSCLEROSIS
How is the diagnosis made?
P595

A

Normal TM with conductive hearing loss
and no middle-ear effusion (though may
be mixed or even sensorineural if bone of
cochlea is affected)

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107
Q

EAR
OTOSCLEROSIS
What is Schwartze’s sign?
P595

A

Erythema around the stapes from

hypervascularity of new bone formation

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108
Q

EAR
OTOSCLEROSIS
What is the treatment?
P595

A 
Frequently surgical (stapedectomy with
placement of prosthesis), hearing aids, or
observation; sodium fluoride may be used
if a sensorineural component is present
or for preoperative stabilization
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109
Q

MISCELLANEOUS
FACIAL NERVE PARALYSIS
How is the defect localized?
P595

A 
Supranuclear—paralysis of lower face
    only, forehead muscles are spared
    because of bilateral corticobulbar supply
Intratemporal bone—paralysis of upper
    and lower face, decreased tearing,
    altered taste, absent stapedius reflex
Distal to stylomastoid foramen—paralysis
    of facial muscles only
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110
Q

MISCELLANEOUS
FACIAL NERVE PARALYSIS
What are the causes?
P596

A 
Bell’s palsy
Trauma
Cholesteatoma
Tumor (carcinoma, glomus jugulare)
Herpes zoster inflammation of geniculate
    ganglion (Ramsay-Hunt syndrome)
Peripheral lesions are usually parotid
    gland tumors
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111
Q 
MISCELLANEOUS
FACIAL NERVE PARALYSIS
What is the most common
cause of bilateral facial
nerve palsy?
P596
A

Lyme disease (Borrelia burgdorferi)

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112
Q

MISCELLANEOUS
BELL’S PALSY
What is it?
P596

A

Sudden onset, unilateral facial weakness
or paralysis in absence of CNS, ear, or
cerebellopontine angle disease (i.e., no
identifiable cause)

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113
Q

MISCELLANEOUS
BELL’S PALSY
What is the clinical course?
P596

A

Acute onset, with greatest muscle

weakness reached within 3 weeks

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114
Q

MISCELLANEOUS
BELL’S PALSY
What is the incidence?
P596

A

Most common cause of unilateral facial

weakness/paralysis

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115
Q

MISCELLANEOUS
BELL’S PALSY
What is the pathogenesis?
P596

A

Unknown; most widely accepted hypothesis
is viral etiology (herpes virus); ischemic and
immunologic factors are also implicated

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116
Q 
MISCELLANEOUS
BELL’S PALSY
What is the common
preceding event?
P596
A

URI

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117
Q 
MISCELLANEOUS
BELL’S PALSY
What are the signs/
symptoms?
P596
A

Pathology is related to swelling of the
facial nerve; may present with total facial
paralysis, altered lacrimation, increased
tearing on affected side, change in taste if
region above chorda tympani is affected,
dry mouth, and hyperacusis

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118
Q

MISCELLANEOUS
BELL’S PALSY
What is the treatment?
P596

A 
Usually none is required, as most cases
    resolve spontaneously in 1 month;
    protect eye with drops and tape closed
    as needed; most otolaryngologists
    advocate steroids and acyclovir
Surgical decompression of CN VII is
    indicated if paralysis progresses or
    tests indicate deterioration
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119
Q

MISCELLANEOUS
BELL’S PALSY
What is the prognosis?
P597

A

Overall, 90% of patients recover
completely; if paralysis is incomplete,
95% to 100% will recover without
sequelae

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120
Q

SENSORINEURAL HEARING LOSS
What is it?
P597

A

Hearing loss from a lesion occurring in
the cochlea or acoustic nerve, rather than
the external or middle ear

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121
Q

SENSORINEURAL HEARING LOSS
What are the symptoms?
P597

A

Distortion of hearing, impaired speech

discrimination, tinnitus

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122
Q

SENSORINEURAL HEARING LOSS
What are the signs?
P597

A 
Air conduction is better than bone
conduction (positive Rinne test), Weber
lateralizes to the side without the defect;
audiogram most commonly shows
greatest loss in high-frequency tones
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123
Q

SENSORINEURAL HEARING LOSS
What is the Weber vs. Rinne
test?
P597

A

Weber: tuning fork on middle of head
(lateral louder = either ipsilateral
conductive loss or contralateral
sensorineural)
Rinne: tuning fork on mastoid and then
next to ear (conductive loss louder on
mastoid)

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124
Q

SENSORINEURAL HEARING LOSS
What are the causes?
P597

A 
Aging (presbycusis)—leading cause
Acoustic injury from sudden or
    prolonged exposure to loud noises
Perilymph fistula
Congenital (TORCHES: maternal
    TOxoplasmosis, Rubella, CMV,
    HErpes, and Syphilis)
Ménière’s disease
Drug/toxin-induced
Acoustic neuroma
Pseudotumor cerebri
CNS disease
Endocrine disorders
Sarcoidosis
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125
Q

SENSORINEURAL HEARING LOSS
What is the most common
cause in children?
P597

A

Meningitis (bacterial)

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126
Q

SENSORINEURAL HEARING LOSS
What is the treatment?
P598

A

Treatment of underlying cause, hearing

aids, lip reading, cochlear implant

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127
Q

VERTIGO
What is it?
P598

A

Sensation of head/body movement, or
movement of surroundings (usually
rotational)

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128
Q

VERTIGO
What is the cause?
P598

A

Asymmetric neuronal activity between

right and left vestibular systems

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129
Q

VERTIGO
What is the history of
peripheral vertigo?
P598

A

Severe vertigo, nausea, vomiting, always
accompanied by horizontal or rotatory
nystagmus (fast component almost always
to side opposite disease), other evidence
of inner ear disease (tinnitus, hearing loss)

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130
Q

VERTIGO
What are the risk factors for
peripheral vertigo?
P598

A

Frequently associated with a previously
operated ear, a chronic draining ear,
barotrauma, or head trauma

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131
Q

VERTIGO
What is the history of central
vertigo?
P598

A

Found in brainstem or cerebellum:
insidious onset, less intense and more
subtle sensation of vertigo; occasionally,
vertical nystagmus

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132
Q

VERTIGO
What are the steps in
diagnostic evaluation?
P598

A 
Depends on probability of central versus
    peripheral; careful neurologic and
    otologic examinations are required
May need FTA/VDRL (syphilis), temporal
    bone scans/CT scan/MRI, ENG,
    position testing, audiometric testing
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133
Q

VERTIGO
What is the most common
etiology?
P598

A

Benign Paroxysmal Positional Vertigo
(BPPV); history of brief spells of severe
vertigo with specific head positions

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134
Q

VERTIGO
What is the differential
diagnosis?
P598

A 
Central: vertebral basilar insufficiency
    (often in older patients with DJD of
    spine), Wallenberg syndrome, MS,
    epilepsy, migraine
Peripheral: BPPV, motion sickness,
    syphilis, Ménière’s disease, vestibular
    neuronitis, labyrinthitis, acoustic
    neuroma, syphilis, perilymph fistula
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135
Q

VERTIGO
What is Tullio’s
phenomenon?
P599

A

Induction of vertigo by loud noises;

classically, result of otosyphilis

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136
Q

MÉNIÈRE’S DISEASE
What is it?
P599

A

Disorder of the membranous labyrinth,
causing fluctuating sensorineural hearing
loss, episodic vertigo, nystagmus, tinnitus,
and aural fullness, N/V

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137
Q

MÉNIÈRE’S DISEASE
What is the classic triad?
P599

A

Hearing loss, Tinnitus, Vertigo (H, T, V)

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138
Q

MÉNIÈRE’S DISEASE
What is the
pathophysiology?
P599

A

Obscure, but most experts believe
excessive production/defective resorption
of endolymph

139
Q

MÉNIÈRE’S DISEASE
What is the medical
treatment?
P599

A

Salt restriction, diuretics (thiazides),
antinausea agents; occasionally diazepam
is added; 80% of patients respond to
medical management, antihistamines

140
Q

MÉNIÈRE’S DISEASE
What are the indications for
surgery?
P599

A

Surgery is offered to those who fail medical
treatment or who have incapacitating
vertigo (60%–80% effective)

141
Q

MÉNIÈRE’S DISEASE
What are the surgical
options?
P599

A 
1. Shunt from membranous labyrinth to
    subarachnoid space
2. Vestibular neurectomy
3. Severe cases with hearing loss:
    labyrinthectomy
142
Q

GLOMUS TUMORS
What are they?
P599

A 
Benign, slow-growing tumors arising in
glomus bodies found in the adventitial
layer of blood vessels; often associated
with cranial nerves IX and X in the middle
ear
143
Q

GLOMUS TUMORS
What is the usual location?
P599

A

Middle ear, jugular bulb, course of CN

IX to XII

144
Q

GLOMUS TUMORS
How common are they?
P599

A

Most common benign tumor of the

temporal bone

145
Q

GLOMUS TUMORS
What is the treatment?
P600

A

Surgical resection, radiation therapy for
poor operative candidates or for
recurrences

146
Q

NOSE AND PARANASAL SINUSES
EPISTAXIS
What is it?
P600

A

Bleeding from the nose

147
Q 
NOSE AND PARANASAL SINUSES
EPISTAXIS
What are the predisposing
factors?
P600
A

Trauma, “nose picking,” sinus infection,
allergic or atrophic rhinitis, blood
dyscrasias, tumor, environmental
extremes (hot, dry climates; winters)

148
Q

NOSE AND PARANASAL SINUSES
EPISTAXIS
What is the usual cause?
P600

A

Rupture of superficial mucosal blood
vessels (Kiesselbach’s plexus if anterior,
sphenopalatine artery if posterior)

149
Q 
NOSE AND PARANASAL SINUSES
EPISTAXIS
What is the most common
type?
P600
A

Anterior (90%); usually the result of

trauma

150
Q

NOSE AND PARANASAL SINUSES
EPISTAXIS
Which type is more serious?
P600

A

Posterior; usually occurs in the elderly or
is associated with a systemic disorder
(hypertension, tumor, arteriosclerosis)

151
Q

NOSE AND PARANASAL SINUSES
EPISTAXIS
What is the treatment?
P600

A

Direct pressure; if this fails, proceed to
anterior nasal packing with gauze strips,
followed if necessary by posterior packing
with Foley catheter or lamb’s wool; packs
must be removed in <5 days to prevent
infectious complications

152
Q 
NOSE AND PARANASAL SINUSES
EPISTAXIS
What is the treatment of last
resort?
P600
A 
Ligation or embolization of the
sphenopalatine artery (posterior) or
ethmoidal artery (anterior)
153
Q 
NOSE AND PARANASAL SINUSES
EPISTAXIS
What infectious disease
syndrome is seen with nasal
packing?
P600
A

Toxic shock syndrome: fever, shock, rash
caused by exotoxin from Staphylococcus
aureus

154
Q 
NOSE AND PARANASAL SINUSES
EPISTAXIS
What is the treatment of this
syndrome?
P600
A

Supportive with removal of nasal packing,
IV hydration, oxygen, and antistaphylococcal
antibiotics

155
Q

NOSE AND PARANASAL SINUSES
ACUTE RHINITIS
What is it?
P601

A

Inflammation of nasal mucous membrane

156
Q 
NOSE AND PARANASAL SINUSES
ACUTE RHINITIS
What is the most common
cause?
P601
A 
URI infection; rhinovirus is the most
common agent in adults (other nonallergic
causes: nasal deformities and tumors,
polyps, atrophy, immune diseases,
vasomotor problems)
157
Q

NOSE AND PARANASAL SINUSES
ALLERGIC RHINITIS
What are the symptoms?
P601

A

Nasal stuffiness; watery rhinorrhea;
paroxysms of morning sneezing; and
itching of nose, conjunctiva, or palate

158
Q 
NOSE AND PARANASAL SINUSES
ALLERGIC RHINITIS
How is the condition
characterized?
P601
A

Early onset (before 20 years of age),
familial tendency, other allergic disorders
(eczema, asthma), elevated serum IgE,
eosinophilia on nasal smear

159
Q 
NOSE AND PARANASAL SINUSES
ALLERGIC RHINITIS
What are the findings on
physical examination?
P601
A 
Pale, boggy, bluish nasal turbinates
coated with thin, clear secretions; in
children, a transverse nasal crease
sometimes results from repeated “allergic
salute”
160
Q

NOSE AND PARANASAL SINUSES
ALLERGIC RHINITIS
What is the treatment?
P601

A 
Allergen avoidance, antihistamines,
decongestants; steroids or sodium
cromylate in severe cases; desensitization
via allergen immunotherapy is the only
“cure”
161
Q

NOSE AND PARANASAL SINUSES
ACUTE SINUSITIS
What is the typical history?
P601

A

Previously healthy patient with
unrelenting progression of a viral URI or
allergic rhinitis beyond the normal 5- to
7-day course

162
Q

NOSE AND PARANASAL SINUSES
ACUTE SINUSITIS
What are the symptoms?
P601

A

Periorbital pressure/pain, nasal obstruction,
nasal/postnasal mucopurulent discharge,
fatigue, fever, headache

163
Q

NOSE AND PARANASAL SINUSES
ACUTE SINUSITIS
What are the signs?
P602

A

Tenderness over affected sinuses, pus in
the nasal cavity; may also see reason for
obstruction (septal deviation, spur, tight
osteomeatal complex); transillumination
is unreliable

164
Q

NOSE AND PARANASAL SINUSES
ACUTE SINUSITIS
What is the pathophysiology?
P602

A 
Thought to be secondary to decreased
ciliary action of the sinus mucosa and
edema causing obstruction of the sinus
ostia, lowering intrasinus oxygen tension
and predisposing patients to bacterial
infection
165
Q 
NOSE AND PARANASAL SINUSES
ACUTE SINUSITIS
What are the causative
organisms?
P602
A 
Up to 50% of patients have negative
cultures and cause is presumably
(initially) viral; pneumococcus, S. aureus,
group A streptococci, and H. influenzae
are the most common bacteria cultured
166
Q

NOSE AND PARANASAL SINUSES
ACUTE SINUSITIS
What is the treatment?
P602

A

14-day course of antibiotics (penicillin G,
amoxicillin, Ceclor®, and Augmentin® are
commonly used), topical and systemic
decongestants, and saline nasal irrigation

167
Q 
NOSE AND PARANASAL SINUSES
ACUTE SINUSITIS
What is the treatment for
fungal sinusitis?
P602
A 
Fungal sinusitis is commonly caused by
Mucor and seen in immunosuppressed
patients; treatment is IV antifungals
(e.g., amphotericin or caspofungin) and
surgical débridement of all necrotic
tissue
168
Q

NOSE AND PARANASAL SINUSES
CHRONIC SINUSITIS
What is it?
P602

A

Infection of nasal sinuses lasting longer
than 4 weeks, or pattern of recurrent
acute sinusitis punctuated by brief
asymptomatic periods

169
Q

NOSE AND PARANASAL SINUSES
CHRONIC SINUSITIS
What is the pathology?
P602

A 
Permanent mucosal changes secondary
to inadequately treated acute sinusitis,
consisting of mucosal fibrosis, polypoid
growth, and inadequate ciliary action,
hyperostosi
170
Q

NOSE AND PARANASAL SINUSES
CHRONIC SINUSITIS
What are the symptoms?
P603

A

Chronic nasal obstruction, postnasal drip,
mucopurulent rhinorrhea, low-grade
facial and periorbital pressure/pain

171
Q 
NOSE AND PARANASAL SINUSES
CHRONIC SINUSITIS
What are the causative
organisms?
P603
A 
Usually anaerobes (such as Bacteroides,
Veillonella, Rhinobacterium); also
H. influenzae, Streptococcus viridans,
Staphylococcus aureus, Staphylococcus
epidermidis
172
Q

NOSE AND PARANASAL SINUSES
CHRONIC SINUSITIS
What is the treatment?
P603

A 
Medical management with decongestants,
mucolytics, topical steroids, and
antibiotics; if this approach fails, proceed
to endoscopic or external surgical
intervention
173
Q

NOSE AND PARANASAL SINUSES
CHRONIC SINUSITIS
What is FESS?
P603

A

Functional Endoscopic Sinus Surgery

174
Q 
NOSE AND PARANASAL SINUSES
CHRONIC SINUSITIS
What are the complications
of sinusitis?
P603
A

Orbital cellulitis (if ethmoid sinusitis),
meningitis, epidural or brain abscess
(frontal sinus), cavernous sinus thrombosis
(ethmoid or sphenoid), osteomyelitis
(a.k.a. Pott’s puffy tumor if frontal)

175
Q 
NOSE AND PARANASAL SINUSES
CANCER OF THE NASAL CAVITY AND PARANASAL SINUSES
What are the usual
locations?
P603
A

Maxillary sinus (66%)
Nasal cavity
Ethmoid sinus
Rarely in frontal or sphenoid sinuses

176
Q 
NOSE AND PARANASAL SINUSES
CANCER OF THE NASAL CAVITY AND PARANASAL SINUSES
What are the associated cell
types?
P603
A

Squamous cell (80%)
Adenocellular (15%)
Uncommon: sarcoma, melanoma

177
Q 
NOSE AND PARANASAL SINUSES
CANCER OF THE NASAL CAVITY AND PARANASAL SINUSES
What rare tumor arises from
olfactory epithelium?
P603
A

Esthesioneuroblastoma; usually arises
high in the nose (cribriform plate) and is
locally invasive

178
Q 
NOSE AND PARANASAL SINUSES
CANCER OF THE NASAL CAVITY AND PARANASAL SINUSES
What are the signs/
symptoms?
P603
A 
Early—nasal obstruction, blood-tinged
    mucus, epistaxis
Late—localized pain, cranial nerve
    deficits, facial/palate asymmetry, loose
    teeth
179
Q

NOSE AND PARANASAL SINUSES
CANCER OF THE NASAL CAVITY AND PARANASAL SINUSES
How is the diagnosis made?
P604

A

CT scan can adequately identify extent of
the disease and local invasion; MRI is often
also used to evaluate soft-tissue disease

180
Q

NOSE AND PARANASAL SINUSES
CANCER OF THE NASAL CAVITY AND PARANASAL SINUSES
What is the treatment?
P604

A

Surgery with or without x-ray therapy

181
Q

NOSE AND PARANASAL SINUSES
CANCER OF THE NASAL CAVITY AND PARANASAL SINUSES
What is the prognosis?
P604

A

5-year survival for T1 or T2 lesions

approaches 70%

182
Q

NOSE AND PARANASAL SINUSES
JUVENILE NASOPHARYNGEAL ANGIOFIBROMA
What is it?
P604

A

Most commonly encountered vascular
mass in the nasal cavity; locally aggressive
but nonmetastasizing

183
Q

NOSE AND PARANASAL SINUSES
JUVENILE NASOPHARYNGEAL ANGIOFIBROMA
What is the usual history?
P604

A

Adolescent boys who present with nasal
obstruction, recurrent massive epistaxis,
possibly anosmia

184
Q

NOSE AND PARANASAL SINUSES
JUVENILE NASOPHARYNGEAL ANGIOFIBROMA
What is the usual location?
P604

A

Site of origin is the roof of the nasal
cavity at the superior margin of
sphenopalatine foramen

185
Q 
NOSE AND PARANASAL SINUSES
JUVENILE NASOPHARYNGEAL ANGIOFIBROMA
Into what can the mass
transform?
P604
A

Fibrosarcoma (rare cases reported)

186
Q

NOSE AND PARANASAL SINUSES
JUVENILE NASOPHARYNGEAL ANGIOFIBROMA
How is the diagnosis made?
P604

A

Carotid arteriography, CT scan; biopsy is
contraindicated secondary to risk of
uncontrollable hemorrhage

187
Q 
NOSE AND PARANASAL SINUSES
JUVENILE NASOPHARYNGEAL ANGIOFIBROMA
What are indications for
biopsy?
P604
A

None!

188
Q

NOSE AND PARANASAL SINUSES
JUVENILE NASOPHARYNGEAL ANGIOFIBROMA
What is the treatment?
P604

A

Surgery via lateral rhinotomy or sublabial
maxillotomy with bleeding controlled
by internal maxillary artery ligation or
preoperative embolization, in the setting
of hypotensive anesthesia; preoperative
irradiation has also been used to shrink
the tumor

189
Q 
ORAL CAVITY AND PHARYNX
PHARYNGOTONSILLITIS
What is the common site of
referred throat pain
P605
A

EAR

190
Q

ORAL CAVITY AND PHARYNX
PHARYNGOTONSILLITIS
What is it?
P605

A 
Acute or chronic infection of the
nasopharynx or oropharynx and/or
Waldeyer’s ring of lymphoid tissue
(consisting of palatine, lingual, and
pharyngeal tonsils and the adenoids)
191
Q

ORAL CAVITY AND PHARYNX
PHARYNGOTONSILLITIS
What is the etiology?
P605

A

Acute attacks can be viral (adenovirus,
enterovirus, coxsackievirus, Epstein-Barr
virus in infectious mononucleosis) or
bacterial (group A -hemolytic streptococci
are the leading bacterial agent); chronic
tonsillitis often with mixed population,
including streptococci, staphylococci, and
M. catarrhalis

192
Q

ORAL CAVITY AND PHARYNX
PHARYNGOTONSILLITIS
What are the symptoms?
P605

A 
Acute—Sore throat, fever, local
    lymphadenopathy, chills, headache,
    malaise
Chronic—Noisy mouth breathing, speech
    and swallowing difficulties, apnea,
    halitosis
193
Q

ORAL CAVITY AND PHARYNX
PHARYNGOTONSILLITIS
What are the signs?
P605

A

Viral—Injected tonsils and pharyngeal
mucosa; exudate may occur, but less
often than with bacterial tonsillitis
Bacterial—Swollen, inflamed tonsils with
white-yellow exudate in crypts and on
surface; cervical adenopathy

194
Q

ORAL CAVITY AND PHARYNX
PHARYNGOTONSILLITIS
How is the diagnosis made?
P605

A

CBC, throat culture, Monospot test

195
Q 
ORAL CAVITY AND PHARYNX
PHARYNGOTONSILLITIS
What are the possible
complications?
P605
A 
Peritonsillar abscess (quinsy),
retropharyngeal abscess (causing
airway compromise), rheumatic fever,
poststreptococcal glomerulonephritis
(with -hemolytic streptococci)
196
Q

ORAL CAVITY AND PHARYNX
PHARYNGOTONSILLITIS
What is the treatment?
P606

A 
Viral—Symptomatic → acetaminophen,
    warm saline gargles, anesthetic throat
    spray
Bacterial—10 days PCN (erythromycin if
    PCN-allergic)
197
Q 
ORAL CAVITY AND PHARYNX
PHARYNGOTONSILLITIS
What are the indications for
tonsillectomy?
P606
A 
Sleep apnea/cor pulmonale secondary
to airway obstruction, suspicion of
malignancy, hypertrophy causing
malocclusion, peritonsillar abscess,
recurrent acute or chronic tonsillitis
198
Q 
ORAL CAVITY AND PHARYNX
PHARYNGOTONSILLITIS
What are the possible
complications?
P606
A

Acute or delayed hemorrhage

199
Q

ORAL CAVITY AND PHARYNX
PERITONSILLAR ABSCESS
What is the clinical setting?
P606

A

Inadequately treated recurrent acute or

chronic tonsillitis

200
Q

ORAL CAVITY AND PHARYNX
PERITONSILLAR ABSCESS
What is the assoc
P606

A

Mixed aerobes and anaerobes (which

may be PCN resistant)

201
Q

ORAL CAVITY AND PHARYNX
PERITONSILLAR ABSCESS
What is the site of formation?
P606

A

Begins at the superior pole of the tonsil

202
Q

ORAL CAVITY AND PHARYNX
PERITONSILLAR ABSCESS
What are the symptoms?
P606

A

Severe throat pain, drooling dysphagia,
odynophagia, trismus, cervical adenopathy,
fever, chills, malaise

203
Q 
ORAL CAVITY AND PHARYNX
PERITONSILLAR ABSCESS
What is the classic
description of voice?
P606
A

“Hot-potato voice”

204
Q

ORAL CAVITY AND PHARYNX
PERITONSILLAR ABSCESS
What are the signs?
P606

A

Bulging, erythematous, edematous
tonsillar pillar; swelling of uvula and
displacement to contralateral side

205
Q

ORAL CAVITY AND PHARYNX
PERITONSILLAR ABSCESS
What is the treatment?
P606

A

IV antibiotics and surgical evacuation
by incision and drainage; most experts
recommend tonsillectomy after
resolution of inflammatory changes

206
Q

ORAL CAVITY AND PHARYNX
LUDWIG ANGINA
What is it?
P606

A 
Infection and inflammation of the floor of
the mouth (sublingual and submandibular)
207
Q

ORAL CAVITY AND PHARYNX
LUDWIG ANGINA
What is the source?
P607

A

Dental infection

208
Q

ORAL CAVITY AND PHARYNX
LUDWIG ANGINA
What is the treatment?
P607

A

Antibiotics, emergency airway, I & D

209
Q

ORAL CAVITY AND PHARYNX
CANCER OF THE ORAL CAVITY
What is the usual cell type?
P607

A

Squamous cell (90% of cases)

210
Q 
ORAL CAVITY AND PHARYNX
CANCER OF THE ORAL CAVITY
What are the most common
sites?
P607
A

Lip, tongue, floor of mouth, gingiva,

cheek, and palate

211
Q

ORAL CAVITY AND PHARYNX
CANCER OF THE ORAL CAVITY
What is the etiology?
P607

A

Linked to smoking, alcohol, and smokeless
tobacco products (alcohol and tobacco
together greatly increase the risk)

212
Q 
ORAL CAVITY AND PHARYNX
CANCER OF THE ORAL CAVITY
What is the frequency of the
following conditions:
Regional metastasis?
P607
A

≈30%

213
Q 
ORAL CAVITY AND PHARYNX
CANCER OF THE ORAL CAVITY
What is the frequency of the
following conditions:
Second primary?
P607
A

≈25%

214
Q 
ORAL CAVITY AND PHARYNX
CANCER OF THE ORAL CAVITY
What is the frequency of the
following conditions:
Nodal metastasis?
P607
A

Depends on size of tumor and ranges
from 10% to 60%, usually to jugular and
jugulodigastric nodes, submandibular
nodes

215
Q 
ORAL CAVITY AND PHARYNX
CANCER OF THE ORAL CAVITY
What is the frequency of the
following conditions:
Distant metastasis?
P607
A

Infrequent

216
Q

ORAL CAVITY AND PHARYNX
CANCER OF THE ORAL CAVITY
How is the diagnosis made?
P607

A 
Full history and physical examination,
dental assessment, Panorex or bone scan
if mandible is thought to be involved,
CT scan/MRI for extent of tumor and
nodal disease, FNA (often U/S guided)
217
Q

ORAL CAVITY AND PHARYNX
CANCER OF THE ORAL CAVITY
What is the treatment?
P607

A 
Radiation, surgery, or both for small
lesions; localized lesions can usually
be treated surgically; larger lesions
require combination therapy, possible
mandibulectomy and neck dissection
218
Q

ORAL CAVITY AND PHARYNX
CANCER OF THE ORAL CAVITY
What is the prognosis?
P608

A 
Depends on stage and site:
    Tongue: 20% to 70% survival
    Floor of mouth: 30% to 80% survival
Most common cause of death in
    successfully treated head and neck
    cancer is development of a second
    primary (occurs in 20%–40% of cases)
219
Q 
ORAL CAVITY AND PHARYNX
SALIVARY GLAND TUMORS
What is the frequency of
gland involvement?
P608
A 
Parotid gland (80%)
Submandibular gland (15%)
Minor salivary glands (5%)
220
Q 
ORAL CAVITY AND PHARYNX
SALIVARY GLAND TUMORS
What is the potential for
malignancy?
P608
A 
Greatest in minor salivary gland
tumors (80% are malignant) and least in
parotid gland tumors (80% are benign);
the smaller the gland, the greater the
likelihood of malignancy
221
Q 
ORAL CAVITY AND PHARYNX
SALIVARY GLAND TUMORS
How do benign and
malignant tumors differ
in terms of history and
physical examination?
P608
A 
Benign—mobile, nontender, no node
    involvement or facial weakness
Malignant—painful, fixed mass with
    evidence of local metastasis and facial
    paresis/paralysis
222
Q 
ORAL CAVITY AND PHARYNX
SALIVARY GLAND TUMORS
What is the diagnostic
procedure?
P608
A

FNA; never perform excisional biopsy of
a parotid mass; superficial parotidectomy
is the procedure of choice for benign
lesions of the lateral lobe

223
Q

ORAL CAVITY AND PHARYNX
SALIVARY GLAND TUMORS
What is the treatment?
P608

A

Involves adequate surgical resection,
sparing facial nerve if possible, neck
dissection for node-positive necks

224
Q 
ORAL CAVITY AND PHARYNX
SALIVARY GLAND TUMORS
What are the indications for
postop XRT?
P608
A

Postoperative radiation therapy if highgrade
cancer, recurrent cancer, residual
disease, invasion of adjacent structures,
any T3 or T4 parotid tumors

225
Q 
ORAL CAVITY AND PHARYNX
SALIVARY GLAND TUMORS
What is the most common
benign salivary tumor?
P608
A 
Pleomorphic adenoma (benign mixed
    tumor) 66%
Think: Pleomorphic = Popular
226
Q

ORAL CAVITY AND PHARYNX
SALIVARY GLAND TUMORS
What is the usual location?
P608

A

Parotid gland

227
Q

ORAL CAVITY AND PHARYNX
SALIVARY GLAND TUMORS
What is the clinical course?
P609

A

They are well delineated and slow

growing

228
Q 
ORAL CAVITY AND PHARYNX
SALIVARY GLAND TUMORS
What is the second most
common benign salivary
gland tumor?
P609
A

Warthin’s tumor (1% of all salivary gland

tumors)

229
Q

ORAL CAVITY AND PHARYNX
SALIVARY GLAND TUMORS
What is the usual location?
P609

A

95% are found in parotid; 3% are

bilateral

230
Q

ORAL CAVITY AND PHARYNX
SALIVARY GLAND TUMORS
Describe the lesion.
P609

A

Slow-growing, cystic mass is usually
located in the tail of the superficial
portion of the parotid; it rarely becomes
malignant

231
Q 
ORAL CAVITY AND PHARYNX
SALIVARY GLAND TUMORS
What is the most common
malignant salivary tumor?
P609
A 
Mucoepidermoid carcinoma (10% of
    all salivary gland neoplasms) Think:
    Mucoepidermoid = Malignant
Most common parotid malignancy
Second most common submandibular
    gland malignancy
232
Q 
ORAL CAVITY AND PHARYNX
SALIVARY GLAND TUMORS
What is the second most
common malignant salivary
tumor in adults?
P609
A

Adenoid cystic carcinoma; most common
malignancy in submandibular and minor
salivary glands

233
Q

ORAL CAVITY AND PHARYNX
LARYNX ANATOMY
Define the three parts.
P609

A
  1. Glottis: begins halfway between the
    true and false cords (in the ventricle)
    and extends inferiorly 1.0 cm below
    the edge of the vocal folds
  2. Supraglottis: extends from superior
    glottis to superior border of hyoid and
    tip of epiglottis
  3. Subglottis: extends from lower border
    of glottis to inferior edge of cricoid
    cartilage
234
Q

ORAL CAVITY AND PHARYNX
LARYNX ANATOMY
Innervation?
P610

A 
Vagus nerve: superior laryngeal and
recurrent laryngeal nerves; superior
laryngeal supplies sensory to supraglottis
and motor to inferior constrictor and
cricothyroid muscle; recurrent laryngeal
supplies sensory to glottis and subglottis
and motor to all remaining intrinsic
laryngeal muscles
235
Q

ORAL CAVITY AND PHARYNX
CROUP (LARYNGOTRACHEOBRONCHITIS)
What is it?
P610

A

Viral infection of the larynx and trachea,

generally affecting children (boys > girls)

236
Q

ORAL CAVITY AND PHARYNX
CROUP (LARYNGOTRACHEOBRONCHITIS)
What is the usual cause?
P610

A

Parainfluenza virus

Think: crouP = Parainfluenza

237
Q 
ORAL CAVITY AND PHARYNX
CROUP (LARYNGOTRACHEOBRONCHITIS)
What age group is affected
most?
P610
A

6 months to 3 years of age

238
Q 
ORAL CAVITY AND PHARYNX
CROUP (LARYNGOTRACHEOBRONCHITIS)
Is the condition considered
seasonal?
P610
A

Yes; outbreaks most often occur in

autumn

239
Q 
ORAL CAVITY AND PHARYNX
CROUP (LARYNGOTRACHEOBRONCHITIS)
What are the precipitating
events?
P610
A

Usually preceded by URI

240
Q

ORAL CAVITY AND PHARYNX
CROUP (LARYNGOTRACHEOBRONCHITIS)
What is the classic symptom?
P610

A

Barking (seal-like), nonproductive cough

241
Q 
ORAL CAVITY AND PHARYNX
CROUP (LARYNGOTRACHEOBRONCHITIS)
What are the other
symptoms?
P610
A

Respiratory distress, low-grade fever

242
Q

ORAL CAVITY AND PHARYNX
CROUP (LARYNGOTRACHEOBRONCHITIS)
What are the signs?
P610

A

Tachypnea, inspiratory retractions,
prolonged inspiration, inspiratory stridor,
expiratory rhonchi/wheezes

243
Q 
ORAL CAVITY AND PHARYNX
CROUP (LARYNGOTRACHEOBRONCHITIS)
What is the differential
diagnosis?
P610
A

Epiglottitis, bacterial tracheitis, foreign
body, diphtheria, retropharyngeal
abscess, peritonsillar abscess, asthma

244
Q

ORAL CAVITY AND PHARYNX
CROUP (LARYNGOTRACHEOBRONCHITIS)
How is the diagnosis made?
P610

A

A-P neck x-ray shows classic “steeple sign,”
indicating subglottic narrowing; ABG
may show hypoxemia plus hypercapnia

245
Q

ORAL CAVITY AND PHARYNX
CROUP (LARYNGOTRACHEOBRONCHITIS)
What is the treatment?
P611

A

Keep child calm (agitation only worsens
obstruction); cool mist; steroids; aerosolized
racemic EPI may be administered to
reduce edema/airway obstruction

246
Q 
ORAL CAVITY AND PHARYNX
CROUP (LARYNGOTRACHEOBRONCHITIS)
What are the indications for
intubation?
P611
A

If airway obstruction is severe or child

becomes exhausted

247
Q

ORAL CAVITY AND PHARYNX
CROUP (LARYNGOTRACHEOBRONCHITIS)
What is the usual course?
P611

A

Resolves in 3 to 4 days

248
Q 
ORAL CAVITY AND PHARYNX
CROUP (LARYNGOTRACHEOBRONCHITIS)
What type of secondary
infection occurs?
P611
A

Secondary bacterial infection

streptococcal, staphylococcal

249
Q

ORAL CAVITY AND PHARYNX
EPIGLOTTITIS
What is it?
P611

A

Severe, rapidly progressive infection of

the epiglottis

250
Q 
ORAL CAVITY AND PHARYNX
EPIGLOTTITIS
What is the usual causative
agent?
P611
A

Haemophilus influenzae type B

251
Q

ORAL CAVITY AND PHARYNX
EPIGLOTTITIS
What age group is affected?
P611

A

Children 2 to 5 years of age

252
Q 
ORAL CAVITY AND PHARYNX
EPIGLOTTITIS
What are the signs/
symptoms?
P611
A 
Sudden onset, high fever (40C);
“hot-potato” voice; dysphagia
(Sudden onset, high fever (40C);
“hot-potato” voice; dysphagia
( → drooling); no cough; patient prefers
to sit upright, lean forward; patient
appears toxic and stridulous
253
Q

ORAL CAVITY AND PHARYNX
EPIGLOTTITIS
How is the diagnosis made?
P611

A

Can usually be made clinically and does
not involve direct observation of the
epiglottis (which may worsen obstruction
by causing laryngospasm)

254
Q

ORAL CAVITY AND PHARYNX
EPIGLOTTITIS
What is the treatment?
P611

A

Involves immediate airway support in the
O.R.: intubation or possibly tracheostomy,
medical treatment is comprised of steroids
and IV antibiotics against H. influenzae

255
Q

ORAL CAVITY AND PHARYNX
MALIGNANT LESIONS OF THE LARYNX
What is the incidence?
P611

A

Accounts for ≈2% of all malignancies,

more often in males

256
Q 
ORAL CAVITY AND PHARYNX
MALIGNANT LESIONS OF THE LARYNX
What is the most common
site?
P611
A

Glottis (66%)

257
Q 
ORAL CAVITY AND PHARYNX
MALIGNANT LESIONS OF THE LARYNX
What is the second most
common type?
P612
A

Supraglottis (33%)

258
Q 
ORAL CAVITY AND PHARYNX
MALIGNANT LESIONS OF THE LARYNX
Which type has the worst
prognosis?
P612
A

Subglottic tumors (infrequent)

259
Q

ORAL CAVITY AND PHARYNX
MALIGNANT LESIONS OF THE LARYNX
What are the risk factors?
P612

A

Tobacco, alcohol

260
Q

ORAL CAVITY AND PHARYNX
MALIGNANT LESIONS OF THE LARYNX
What is the pathology?
P612

A

90% are squamous cell carcinoma

261
Q

ORAL CAVITY AND PHARYNX
MALIGNANT LESIONS OF THE LARYNX
What are the symptoms?
P612

A

Hoarseness, throat pain, dysphagia,
odynophagia, neck mass, (referred)
ear pain

262
Q

ORAL CAVITY AND PHARYNX
SUPRAGLOTTIC LESIONS
What is the usual location?
P612

A

Laryngeal surface of epiglottis

263
Q

ORAL CAVITY AND PHARYNX
SUPRAGLOTTIC LESIONS
What area is often involved?
P612

A

Pre-epiglottic space

264
Q

ORAL CAVITY AND PHARYNX
SUPRAGLOTTIC LESIONS
Extension?
P612

A

Tend to remain confined to supraglottic
region, though may extend to vallecula or
base of tongue

265
Q 
ORAL CAVITY AND PHARYNX
SUPRAGLOTTIC LESIONS
What is the associated type
of metastasis?
P612
A

High propensity for nodal metastasis

266
Q

ORAL CAVITY AND PHARYNX
SUPRAGLOTTIC LESIONS
What is the treatment?
P612

A

Early stage = XRT

Late stage = laryngectomy

267
Q

ORAL CAVITY AND PHARYNX
GLOTTIC LESIONS
What is the usual location?
P612

A

Anterior part of true cords

268
Q

ORAL CAVITY AND PHARYNX
GLOTTIC LESIONS
Extension?
P612

A

May invade thyroid cartilage, cross
midline to invade contralateral cord, or
invade paraglottic space

269
Q 
ORAL CAVITY AND PHARYNX
GLOTTIC LESIONS
What is the associated type
of metastasis?
P612
A

Rare nodal metastasis

270
Q

ORAL CAVITY AND PHARYNX
GLOTTIC LESIONS
What is the treatment?
P612

A

Early stage = XRT

Late stage = laryngectomy

271
Q 
ORAL CAVITY AND PHARYNX
NECK MASS
What is the usual etiology in
infants?
P613
A

Congenital (branchial cleft cysts,

thyroglossal duct cysts)

272
Q 
ORAL CAVITY AND PHARYNX
NECK MASS
What is the usual etiology in
adolescents?
P613
A

Inflammatory (cervical adenitis is #1),

with congenital also possible

273
Q 
ORAL CAVITY AND PHARYNX
NECK MASS
What is the usual etiology in
adults?
P613
A

Malignancy (squamous is #1), especially

if painless and immobile

274
Q

ORAL CAVITY AND PHARYNX
NECK MASS
What is the “80% rule”?
P613

A

In general, 80% of neck masses are
benign in children; 80% are malignant
in adults older than 40 years of age

275
Q 
ORAL CAVITY AND PHARYNX
NECK MASS
What are the seven cardinal
symptoms of neck masses?
P613
A

Dysphagia, odynophagia, hoarseness,
stridor (signifies upper airway obstruction),
globus, speech disorder, referred ear pain
(via CN V, IX, or X)

276
Q

ORAL CAVITY AND PHARYNX
NECK MASS
What comprises the workup?
P613

A 
Full head and neck examination, indirect
laryngoscopy, CT scan and MRI, FNA for
tissue diagnosis; biopsy contraindicated
because it may adversely affect survival if
malignant
277
Q 
ORAL CAVITY AND PHARYNX
NECK MASS
What is the differential
diagnosis?
P613
A

Inflammatory: cervical lymphadenitis,
cat-scratch disease, infectious
mononucleosis, infection in neck
spaces
Congenital: thyroglossal duct cyst (midline,
elevates with tongue protrusion),
branchial cleft cysts (lateral), dermoid
cysts (midline submental), hemangioma,
cystic hygroma
Neoplastic: primary or metastatic

278
Q 
ORAL CAVITY AND PHARYNX
NECK MASS
What is the workup of
node-positive squamous cell
carcinoma and no primary
site?
P613
A

Triple endoscopy (laryngoscopy,
esophagoscopy, bronchoscopy) and
blind biopsies

279
Q

ORAL CAVITY AND PHARYNX
NECK MASS
What is the treatment?
P613

A

Surgical excision for congenital or
neoplastic; two most important
procedures for cancer treatment are
radical and modified neck dissection

280
Q 
ORAL CAVITY AND PHARYNX
NECK MASS
What is the role of adjuvant
treatment in head and neck
cancer?
P614
A

Postoperative chemotherapy/XRT

281
Q

ORAL CAVITY AND PHARYNX
RADICAL NECK DISSECTION
What is involved?
P614

A 
Classically, removal of nodes from
clavicle to mandible, sternocleidomastoid
muscle, submandibular gland, tail of
parotid, internal jugular vein,
digastric muscles, stylohyoid and
omohyoid muscles, fascia within the
anterior and posterior triangles, CN XI,
and cervical plexus sensory nerves
282
Q

ORAL CAVITY AND PHARYNX
RADICAL NECK DISSECTION
What are the indications?
P614

A
  1. Clinically positive nodes that likely
    contain metastatic cancer
  2. Clinically negative nodes in neck, but
    high probability of metastasis from a
    primary tumor elsewhere
  3. Fixed cervical mass that is resectable
283
Q 
ORAL CAVITY AND PHARYNX
RADICAL NECK DISSECTION
What are the
contraindications?
P614
A
  1. Distant metastasis
  2. Fixation to structure that cannot be
    removed (e.g., carotid artery)
  3. Low neck masses
284
Q 
ORAL CAVITY AND PHARYNX
MODIFIED NECK DISSECTION
What are the types:
Type I?
P614
A

Spinal accessory nerve preserved

285
Q 
ORAL CAVITY AND PHARYNX
MODIFIED NECK DISSECTION
What are the types:
Type II?
P614
A

Spinal accessory and internal jugular vein

preserved

286
Q 
ORAL CAVITY AND PHARYNX
MODIFIED NECK DISSECTION
What are the types:
Type III?
P614
A

Spinal accessory, IJ, and

sternocleidomastoid nerves preserved

287
Q

ORAL CAVITY AND PHARYNX
MODIFIED NECK DISSECTION
What are the advantages?
P614

A 
Increased postoperative function and
decreased morbidity (especially if
bilateral), most often used in NO lesions;
these modifications are usually
intraoperative decisions based on the
location and extent of tumor growth
288
Q

ORAL CAVITY AND PHARYNX
MODIFIED NECK DISSECTION
What are the disadvantages?
P615

A

May result in increased mortality from

local recurrence

289
Q

FACIAL FRACTURES
MANDIBLE FRACTURES
What are the symptoms?
P615

A

Gross disfigurement, pain, malocclusion,

drooling

290
Q

FACIAL FRACTURES
MANDIBLE FRACTURES
What are the signs?
P615

A

Trismus, fragment mobility and
lacerations of gingiva, hematoma in floor
of mouth

291
Q 
FACIAL FRACTURES
MANDIBLE FRACTURES
What are the possible
complications?
P615
A

Malunion, nonunion, osteomyelitis, TMJ

ankylosis

292
Q

FACIAL FRACTURES
MANDIBLE FRACTURES
What is the treatment?
P615

A

Open or closed reduction
MMF = MaxilloMandibular Fixation
(wire jaw shut)

293
Q

FACIAL FRACTURES
MIDFACE FRACTURES
How are they evaluated?
P615

A

Careful physical examination and CT scan

294
Q 
FACIAL FRACTURES
MIDFACE FRACTURES
Classification
Le Fort I?
P615 (picture)
A

Transverse maxillary fracture above the
dental apices, which also traverses the
pterygoid plate; palate is mobile, but
nasal complex is stable

295
Q 
FACIAL FRACTURES
MIDFACE FRACTURES
Classification
Le Fort II?
P616 (picture)
A

Fracture through the frontal process of
the maxilla, through the orbital floor and
pterygoid plate; midface is mobile

296
Q 
FACIAL FRACTURES
MIDFACE FRACTURES
Classification
Le Fort III?
P616 (picture)
A

Complete craniofacial separation;
differs from II in that it extends through
the nasofrontal suture and frontozygomatic
sutures

297
Q 
FACIAL FRACTURES
MIDFACE FRACTURES
Classification
What is a “tripod” fracture?
P616 (picture)
A 
Fracture of the zygomatic complex;
involves four fractures:
    1. Frontozygomatic suture
    2. Inferior orbital rim
    3. Zygomaticomaxillary suture
    4. Zygomaticotemporal suture
298
Q

FACIAL FRACTURES
MIDFACE FRACTURES
What is a “blowout” fracture?
P617

A

Orbital fracture with “blowout” of
supporting bony structural support of
orbital floor; patient has enophthalmos
(sunken-in eyeball)

299
Q

FACIAL FRACTURES
MIDFACE FRACTURES
What is “entrapment”?
P617

A 
Orbital fracture with “entrapment” of
periorbital tissues within the fracture
opening, including entrapment of
extraocular muscles; loss of extraocular
muscle mobility (e.g., lateral tracking)
and diplopia (double vision)
300
Q

FACIAL FRACTURES
MIDFACE FRACTURES
What is a “step off”?
P617

A

Fracture of the orbit with palpable
“step off” of bony orbital rim (inferior
or lateral)

301
Q 
FACIAL FRACTURES
MIDFACE FRACTURES
Are mandibular fractures
usually a single fracture?
P617
A

No; because the mandible forms an
anatomic ring, >95% of mandible
fractures have more than one fracture
site

302
Q 
FACIAL FRACTURES
MIDFACE FRACTURES
What is the best x-ray study
for mandibular fractures?
P617
A

Panorex

303
Q 
FACIAL FRACTURES
MIDFACE FRACTURES
What must be ruled out and
treated with a broken nose
(nasal fracture)?
P617
A

Septal hematoma; must drain to remove

chance of pressure-induced septal necrosis

304
Q 
ENTWARD QUESTIONS
How can otitis externa be
distinguished from otitis
media on examination?
P617
A

Otitis externa is characterized by severe

pain upon manipulation of the auricle

305
Q

ENTWARD QUESTIONS
What causes otitis media?
P617

A

Most cases are caused by pneumococci

and H. influenzae

306
Q

ENTWARD QUESTIONS
What causes otitis externa?
P617

A

Pseudomonas aeruginosa

307
Q

ENTWARD QUESTIONS
What must be considered in
unilateral serous otitis?
P617

A

Nasopharyngeal carcinoma

308
Q

ENTWARD QUESTIONS
What is the most common
cause of facial paralysis?
P617

A

Bell’s palsy, which has an unidentified

etiology

309
Q 
ENTWARD QUESTIONS
What is the single most
important prognostic factor
in Bell’s palsy?
P618
A

Whether the affected muscles are
completely paralyzed (if not, prognosis is
>95% complete recovery)

310
Q

ENTWARD QUESTIONS
What is the most common
cause of parotid swelling?
P618

A

Mumps

311
Q

ENTWARD QUESTIONS
What is Heerfordt’s
syndrome?
P618

A

Sarcoidosis with parotid enlargement,

facial nerve paralysis, and uveitis

312
Q

ENTWARD QUESTIONS
Which systemic disease
causes salivary gland stones?
P618

A

Gout

313
Q 
ENTWARD QUESTIONS
What is the most common
salivary gland site of stone
formation?
P618
A

Submandibular gland

314
Q

ENTWARD QUESTIONS
What is Mikulicz’s
syndrome?
P618

A

Any cause of bilateral enlargement of the

parotid, lacrimal, and submandibular glands

315
Q

ENTWARD QUESTIONS
What are the three major
functions of the larynx?
P618

A
  1. Airway protection
  2. Airway/respiration
  3. Phonation
316
Q

ENTWARD QUESTIONS
What is a cricothyroidotomy?
P618

A

Emergent surgical airway by incising the

cricothyroid membrane

317
Q 
ENTWARD QUESTIONS
Name the four major
indications for a
tracheostomy.
P618
A 
1. Prolonged mechanical ventilation
    (usually 2 weeks)
2. Upper airway obstruction
3. Poor life-threatening pulmonary toilet
4. Severe obstructive sleep apnea
318
Q

ENTWARD QUESTIONS
What is a ranula?
P618

A

Sublingual retention cyst arising from

sublingual salivary glands

319
Q

ENTWARD QUESTIONS
What is Frey’s syndrome?
P618

A

Flushing, pain, and diaphoresis in the
auriculotemporal nerve distribution
initiated by chewing

320
Q

ENTWARD QUESTIONS
What causes Frey’s
syndrome?
P618

A 
Cutting the auriculotemporal nerve
causes abnormal regeneration of the
sympathetic/parasympathetic nerves,
which, once destined for the parotid
gland, find new targets in skin sweat
glands; thus, people sweat when eating
321
Q

ENTWARD QUESTIONS
What is the classic triad of
Ménière’s disease?
P619

A

Hearing loss, tinnitus, vertigo (HTV)

322
Q 
ENTWARD QUESTIONS
What is the most
common posterior fossa
tumor and where is it
located?
P619
A

Acoustic neuroma, usually occurring at

the cerebellopontine angle

323
Q

ENTWARD QUESTIONS
What is the most common
site of sinus cancer?
P619

A

Maxillary sinus

324
Q

ENTWARD QUESTIONS
What tumor arises from
olfactory epithelium?
P619

A

Esthesioneuroblastoma

325
Q 
ENTWARD QUESTIONS
What cell type is most
common in head and neck
cancer?
P619
A

Squamous cell

326
Q 
ENTWARD QUESTIONS
What are the most
important predisposing
factors to head and neck
cancer?
P619
A

Excessive alcohol use and tobacco abuse

of any form

327
Q

ENTWARD QUESTIONS
What is the most frequent
site of salivary gland tumor?
P619

A

Parotid gland

328
Q 
ENTWARD QUESTIONS
What is the most common
salivary gland neoplasm:
Benign?
P619
A

Pleomorphic adenoma

329
Q 
ENTWARD QUESTIONS
What is the most common
salivary gland neoplasm:
Malignant?
P619
A

Mucoepidermoid carcinoma

330
Q

ENTWARD QUESTIONS
What is the classic feature of
croup?
P619

A

Barking, seal-like cough

331
Q

ENTWARD QUESTIONS
What are the classic features
of epiglottitis?
P619

A

“Hot-potato” voice, sitting up, drooling,
toxic appearance, high fever, leaning
forward

332
Q

ENTWARD QUESTIONS
What comprises the workup
of neck mass?
P619

A

Do not biopsy; obtain tissue via FNA

and complete head and neck examination

333
Q

ENTWARD QUESTIONS
What is Ramsay-Hunt
syndrome?
P620

A

Painful facial nerve paralysis from herpes

zoster of the ear

334
Q 
ENTWARD QUESTIONS
What is the most common
malignant neck mass in
children, adolescents, and
young adults?
P620
A

Lymphoma

335
Q 
ENTWARD QUESTIONS
What is the most common
primary malignant solid
tumor of the head and neck
in children?
P620
A

Rhabdomyosarcoma

336
Q

ENTWARD QUESTIONS
Throat pain is often referred
to what body area?
P620

A

Ear

337
Q 
ENTWARD QUESTIONS
What ENT condition is
described as “crocodile
tears”?
P620
A

Frey’s syndrome!

338
Q

ENTWARD QUESTIONS
What is Brown’s sign?
P620

A

Tympanic membrane pulsations that
cease with positive pressure (from a
“pneumatic” otoscope); seen with middle
ear tumor mass

339
Q

RAPID-FIRE REVIEW OF MOST COMMON CAUSES
OF ENT INFECTIONS
Croup?
P620

A

Parainfluenza virus

340
Q

RAPID-FIRE REVIEW OF MOST COMMON CAUSES
OF ENT INFECTIONS
Otitis externa?
P620

A

Pseudomonas

341
Q

RAPID-FIRE REVIEW OF MOST COMMON CAUSES
OF ENT INFECTIONS
Epiglottitis?
P620

A

H. influenzae

342
Q

RAPID-FIRE REVIEW OF MOST COMMON CAUSES
OF ENT INFECTIONS
Malignant otitis externa?
P620

A

Pseudomonas

343
Q

RAPID-FIRE REVIEW OF MOST COMMON CAUSES
OF ENT INFECTIONS
Parotitis?
P620

A

Staphylococcus

344
Q 
RAPID-FIRE REVIEW OF MOST COMMON CAUSES
OF ENT INFECTIONS
Acute suppurative otitis
media?
P620
A

S. pneumoniae (33%)

Section III Subspecialty Surgery P517 (11 decks)

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