Pestana ENT

Question 1

This congenital cyst is located at the midline, at the level of the hyoid bone and seems to elevate with tongue protrusion

Answer 1

thyroglossal duct cyst

Question 2

This congenital cyst occurs along the anterior edge of the SCM and may have a little opening and blind tract under the overylying skin

Answer 2

Branchial cleft cyst

Question 3

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

Answer 3

cystic hygroma

Question 4

What should you always get before surgically removing this:

Answer 4

cystic hygroma - CT scan because this tends to extend into the mediastinum

Question 5

What should you always get before surgically removing this:

Answer 5

thyroglossal duct cyst - radionuclide scan to assess location of normal thyroid tissue

Question 6

What does surgical removal of the thyroglossal duct cyst entail?

Answer 6

removal of the cyst, the middle segment of the hyoid bone, the tract that leads to the base of the tongue

Question 7

Patient comes in with a recently discovered LN. What is the next best step in management?

Answer 7

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

Question 8

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?

Answer 8

rule out neoplasia

Question 9

Ddx of persistent enlarged LN?

Answer 9

inflammatory

neoplastic (lymphoma, abdominal metz to supraclavicular nodes, SCC of H&N mucosa)

Question 10

How does lymphoma usually present?

Answer 10

young person with multiple enlarged nodes

typically have been suffering from low-grade fever + night sweats

Question 11

diagnosis and management of a patient with suspected lymphoma

Answer 11

LN exision for pathological analysis

chemotherapy

Question 12

Where does metz to supraclavicular nodes originate from?

Answer 12

lung or intraabdominal tumors

Question 13

management of a patient who presents with an enlarged supraclavicular nodes

Answer 13

LN exision for pathological analysis

Question 14

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?

Answer 14

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

Question 15

Treatment of squamous cell carcinoma of the H&N mucosa? 4

Answer 15

resection + radical neck dissection + radiotherapy + platinum based chemoRx

Question 16

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?

Answer 16

persistent hoarseness

persistent painless ulcer in the floor of the mouth

persistent unilateral earache

Question 17

suspect this tumor in an adult who presents with sensory hearing loss in one ear. Next best step in management?

Answer 17

acoustic neuroma

get an MRI

Question 18

patient presents with gradual unilateral facial nerve paralysis (forehead + lower face affected)

Diagnosis and next best step in management?

Answer 18

facial nerve tumor

Gadolinium-enhanced MRI

Question 19

patient presents with rapid unilateral facial nerve paralysis (forehead + lower face affected)

Diagnosis?

Answer 19

Bells Palsy

Question 20

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

Answer 20

benign pleomorphic parotid tumors

Question 21

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

Answer 21

parotid cancer

Question 22

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?

Answer 22

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.

Question 23

benefits of getting a superficial parotidectomy 4

Answer 23

benefits

• excising the tumor
• biopsying it
• preventing recurrences
• sparing the facial nerve.

Question 24

what should you do in a patient with suspected partoid cancer (hard mass that has produced facial nerve paralysis)

Answer 24

sacrifice the nerve and get a graft done

Question 25

common cause of unilateral ENT problems in toddlers

management?

Answer 25

key word: unilateral

think FOREIGN BODIES - get an endoscopy under anesthesia to extract the foreign body

Question 26

Sudden unilateral paralysis of the face

Answer 26

Bell’s palsy

Question 27

treatment of Bell’s palsy

Answer 27

antivirals + steroids

Question 28

development of diplopia in a patient suffering from sinusitis should make you think of this. What is the next best step in management?

Answer 28

cavernous sinus thrombosis

this is an ENT emergency - give IV abx, CT/MRI, and drain the affected sinuses

Question 29

Epistaxis treatment in children

Answer 29

phenylephrine spray + local pressure

Question 30

how do you manage an 18 year old with epistaxis?

Answer 30

think

• cocaine use –> posterior packing
• juvenile nasopharyngeal angiofibroma –> surgical resection

Question 31

how do you manage epistaxis in the elderly or HTNive

Answer 31

posterior packing +/- surgical ligation of feeding vessels

Question 32

differential and management of dizziness

Answer 32

• 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