Pestana ENT Flashcards
This congenital cyst is located at the midline, at the level of the hyoid bone and seems to elevate with tongue protrusion
thyroglossal duct cyst
This congenital cyst occurs along the anterior edge of the SCM and may have a little opening and blind tract under the overylying skin
Branchial cleft cyst
This congenital cyst is found at the base of the neck as a large, mushy, ill-defined mass that occupies the entire supraclavicular area and may extend into the mediastinum
cystic hygroma
What should you always get before surgically removing this:
cystic hygroma - CT scan because this tends to extend into the mediastinum
What should you always get before surgically removing this:
thyroglossal duct cyst - radionuclide scan to assess location of normal thyroid tissue
What does surgical removal of the thyroglossal duct cyst entail?
removal of the cyst, the middle segment of the hyoid bone, the tract that leads to the base of the tongue
Patient comes in with a recently discovered LN. What is the next best step in management?
Since most are benign, get a good H&P, f/u in 3-4 weeks, and if it’s still there, then continue with a w/u
Patient comes in and complains of an enlarged LN that’s been there for over a month. What is the next best step in management?
rule out neoplasia
Ddx of persistent enlarged LN?
inflammatory
neoplastic (lymphoma, abdominal metz to supraclavicular nodes, SCC of H&N mucosa)
How does lymphoma usually present?
young person with multiple enlarged nodes
typically have been suffering from low-grade fever + night sweats
diagnosis and management of a patient with suspected lymphoma
LN exision for pathological analysis
chemotherapy
Where does metz to supraclavicular nodes originate from?
lung or intraabdominal tumors
management of a patient who presents with an enlarged supraclavicular nodes
LN exision for pathological analysis
Patient with history of smoking, alcohol, and poor dental hygiene presents with a node in the neck along the jugular chain.
What is the next best step in management?
What should you avoid doing and why?
think squamous cell carcinoma of the mucosa of H&N
Get a triple endoscopy to look for the primary tumor. Once found, biopsy it and get a CT to establish the extent of it.
Avoid getting an open biopsy of the neck mass because it will interfere with the appropriate surgical approach for the tumor
Treatment of squamous cell carcinoma of the H&N mucosa? 4
resection + radical neck dissection + radiotherapy + platinum based chemoRx
Patient with history of smoking, alcohol, and poor dental hygiene presents with a node in the neck along the jugular chain usually has squamous cell carcinoma of the mucosa of H&N. What other symptoms could be present?
persistent hoarseness
persistent painless ulcer in the floor of the mouth
persistent unilateral earache
suspect this tumor in an adult who presents with sensory hearing loss in one ear. Next best step in management?
acoustic neuroma
get an MRI
patient presents with gradual unilateral facial nerve paralysis (forehead + lower face affected)
Diagnosis and next best step in management?
facial nerve tumor
Gadolinium-enhanced MRI
patient presents with rapid unilateral facial nerve paralysis (forehead + lower face affected)
Diagnosis?
Bells Palsy
suspect this tumor in an adult who presents with a visible and palpable mass in front of the ear that is painless without facial nerve paralysis
benign pleomorphic parotid tumors
suspect this tumor in an adult who presents with a visible and palpable mass in front of the ear that is painful with facial nerve paralysis
parotid cancer
suspect this tumor in an adult who presents with a visible and palpable mass in front of the ear. What is the next best step in managment?
suspect parotid adenoma or cancer
Get an superficial parotidectomy, which has the benefit of excising the tumor, biopsying it, preventing recurrences, and sparing the facial nerve.
benefits of getting a superficial parotidectomy 4
benefits
- excising the tumor
- biopsying it
- preventing recurrences
- sparing the facial nerve.
what should you do in a patient with suspected partoid cancer (hard mass that has produced facial nerve paralysis)
sacrifice the nerve and get a graft done
common cause of unilateral ENT problems in toddlers
management?
key word: unilateral
think FOREIGN BODIES - get an endoscopy under anesthesia to extract the foreign body
Sudden unilateral paralysis of the face
Bell’s palsy
treatment of Bell’s palsy
antivirals + steroids
development of diplopia in a patient suffering from sinusitis should make you think of this. What is the next best step in management?
cavernous sinus thrombosis
this is an ENT emergency - give IV abx, CT/MRI, and drain the affected sinuses
Epistaxis treatment in children
phenylephrine spray + local pressure
how do you manage an 18 year old with epistaxis?
think
- cocaine use –> posterior packing
- juvenile nasopharyngeal angiofibroma –> surgical resection
how do you manage epistaxis in the elderly or HTNive
posterior packing +/- surgical ligation of feeding vessels
differential and management of dizziness
- if suspect inner ear disease (patients describe the room as spinning) –> meclizine, phenergan, diazepam
- if suspect cerebral disease (patients is unsteady, but the room is perceived to be stable) –> neurologic workup
