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SURGERY > Pretest_13_Otolaryngology > Flashcards

Pretest_13_Otolaryngology Flashcards

1
Q

A strong association exists between nasopharyngeal cancer and which virus?

A

EBV (EBV titers can be used to follow a patient’s response to treatment)

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2
Q

Most patients with nasopharyngeal cancer present with what finding on PE?

A

neck mass

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3
Q

What is the initial treatment of choice for primary nasopharyngeal cancer?

A

radiation therapy

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4
Q

T/F: IN patients with severe head injury leading to facial or mandibular trauma, evaluation fo the cervical spine should precede facial studies.

A

True

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5
Q

Which facial fractures are frequently associated with severe nasal and nasopharyngeal hemorhage?

A

maxillary fractures (in extreme cases, ligation or embolization of the internal maxillary artery may be necessary)

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6
Q

T/F: Chemo is helpful in childhood and adolescent squamous cell pharyngeal cancer, but its role in adult pharyngeal cancer is uncertain.

A

True

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7
Q

What is the treatment of nasopharyngeal squamous cell cancer?

A

Radiation, followed by radical neck dissection if lymph node metastases have not been controlled

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8
Q

T/F: OROpharyngeal cancers respond equally well to surgery and radiation, and in the hypopharynx, surgery is the optimal treatment.

A

TRUE

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9
Q

Where are pleiomorphic adenomas of the salivary glands most often located? What is their consistency?

A

lips, tongue, palate (major or minor salivary glands)

rubbery, slow-growing

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10
Q

What is the internal opening of the first branchial pouch?

A

The external auditory canal

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11
Q

What is the internal opening of the second branchial pouch?

A

posterolateral pharynx below the tonsillar fossa

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12
Q

Repairing a fistula of the first branchial pouch may result in damage to what nerve? The second?

A

first (external auditory canal) = facial

second (posterolateral pharynx) = hypoglossal

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13
Q

In childhood, most branchial cleft anomalies present how?

A

as a painless nodule along the lateral border of the sternocleidomastoid muscle

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14
Q

Painless swelling in the midline of the neck that moves with protrusion of the tongue or swallowing:

A

thyroglossal duct cyst

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15
Q

What is the Sistrunk procedure?

A

resection of a thyroglossal duct cyst and the central portion of the hyoid bone (through which the tract runs)

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16
Q

Where do tongue cancers metastasize?

A

submandibular or cervical nodes

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17
Q

The ________ nerve moves the tongue; the _________ nerve provides sensation

A 
moves = hypoglossal
sensation = lingual (branch of V3)
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18
Q

T/F: Buccal carcinoma is associated with smoking, chewing, snuff dipping, alcohol abuse, and lichen planus

A

True

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19
Q

Acute epiglottitis is caused by which infection?

A

Haemophilus influenza

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20
Q

Most commonly, lymphadenopathy in an adult is indicative of

A

metastatic squamous cell carcinoma (not sure if only LAN of the neck or in general…)

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21
Q

Metastatic SCC to the lymph nodes in the neck originates most frequently from

A

nasopharynx, oropharynx, hypopharynx

22
Q

A dermoid tumor is a (lateral/midline) tumor in the adult neck.

A

midline

23
Q

What is the preferred method of evaluation for patients with severe maxillofacial trauma?

A

CT (over X ray)

24
Q

What is the treatment of nasopharyngeal squamous cell carcinoma?

A

Radiation, followed by neck dissection if LN mets have not been controlled.

25
Q

What is the treatment of OROpharyngeal cancers?

A

Surgery OR radiation (both treatments employed)

26
Q

What is the treatment for HYPOpharyngeal cancers?

A

surgery is the optimal treatment with postoperative radiation. Surgery for these cancers often includes radical neck dissection because LN mets occur frequently and are not well controlled by radiation alone.

27
Q

What is the treatment of branchial cleft cyst?

A

excision

28
Q

What is the treatment of buccal carcinoma?

A

Surgery followed by postoperative radiation

29
Q

A mass that hangs off the inferior turbinate and obstructs the inferior meatus likely blocks what structure?

A

the nasolacrimal duct, which drains into the ipsilateral inferior meatus

30
Q

What drains into the MIDDLE meatus?

A

maxillary sinus, ethmoid sinus (which also drains int othe superior meatus)

31
Q

What drains into the SUPERIOR meatus?

A

frontal sinus, ethmoid sinus (which also drains int othe middle meatus)

32
Q

First line treatment for acute sinusits?

A

amoxicillin

33
Q

How does cavernous sinus thrombosis present?

A

ptosis, ipsilateral cranial nerve palsies, headache, sepsis (look for focal neurological deficits in C 3,4,5,6)

34
Q

What are the Centor criteria?

A

Used to make a diagnosis of streptococcal pharyngitis:
1) fever
2) cervical adenopathy
3) absence of cough
4) tonsillar exudates
(note that pharyngeal edema is NOT one of them!!)

35
Q

Epiglottis is associated with this sign on cervical radiograph:

A

thumbprint sign (thickened epiglottis)

36
Q

What is the best surgical management for penetrating neck injuries to zone:
1?
2?
3?

A

zone 1: angiography, followed by open surgery
zone 2: open surgery (no imaging)
zone 3: angiography with embolization

37
Q

What is the management of an infant with a red and well circumscribed firm rubbery mass that came out of nowhere (not born with it)?

A

watchful waiting! probably infantile hemangioma (the most common tumor of infancy) and will regress over 5 to 8 years

However, if the lesions become ulcerated and bleed, become infected, cause visual defects if grow into visual structures or cause high output heart failure, laser resection or surgical excision needed. But try prednisone first, then interferon.

38
Q

45% of thyroglossal duct cysts contain this type of tissue:

A

functional thyroid tissue!

39
Q

Which chromosomal abnormality is most common associated with cystic hygroma?

A

Turner syndrome

40
Q

Temporal bone fractures are associated with which kind of hearing loss? How does that manifest on Weber/Rinne testing?

A

conductive
Weber: lateralization to affected side (This finding is because the conduction problem of the middle ear (incus, malleus, stapes, and eustachian tube) masks the ambient noise of the room, while the well-functioning inner ear (cochlea with its basilar membrane) picks the sound up via the bones of the skull, causing it to be perceived as a louder sound in the affected ear.)
Rinne: air>bone conduction

41
Q

What is the fist step in management of LeFort 1 fracture?

A

surgically place the dentition in class 1 occlusion

42
Q

What is the first step in managemet of a LeFort 3 fracture?

A

placement of tracheostomy

43
Q

For mandibular fractures, what is the beneft of a Panorex radiograph series?

A

To distinguish condylar from angle fractures (AP and lateral plain films can indicate dislocation, damage to the dentition, and horizontal rami vs angle fractures on their own)

44
Q

What is the greatest risk factor for nasopharyngeal carcinoma?

A

tobacco use AND alcoholism together

other risk factors: >65, male, history of GERD, genetic syndromes, asbestos, HPV, poor nutrition

45
Q

Warthin tumors are the second most common parotid tumor after pleiomorphic adenomas.
What kinds of patients are they each found in?

A

Pleiomorphic adenoma: middle aged
Warthin: elderly

Treatment of both is surgical excision

46
Q

Type 1 diabetic with vomiting, fever, blurry vision, and eyelid swelling; neutrpenia; sinusits and retronasal/retroorbital bony erosion. What is the treatment?

A

amphotericin B! for necrotizing fungal (mucormycosis) infection. After abx started, get MRI or CT

(voriconzaole, fluconazole, and casponfungin not as effective)

47
Q

Paitent with family history of conductive hearing loss, can hear best with background noise, “ringing in ears”…what are finding characteristic of the disease process?

A

otosclerosis–an inherited disease of abnormal bone growth near middle ear. Impingement of abnormal bone on stapes footplate; may involve from stapes footplate to oval window. Typically have abnormal acoustic reflex (which is involuntary tensor tympani muscle contraction in response to high intensity sound)

48
Q

Patient complaining of hoarseness and dysphagia x1 year found to have carotid body tumor. Initial workup should include?

A

likely a paraganglioma (a neuroendocrine tumor). Characteristic salt and pepper appearance on T1 MRI. More common in chronic hypoxic patients or patients in high elevations
Should look at urinary catecholamines. Do not perform incisional biopsy as tumors are very vascular and may bleed profusely.

49
Q

Slow growing parotid mass in 67M showing “cystic tumor lined with bilayered epithelium with multiple lymphocytes and germinal centers.”

A

Warthin tumor (benign salivary gland tumor that is most strongly associated with SMOKING). Treatment is surgical excision.

50
Q

What does a radical neck dissection, used in cervical metastasis of SCC, involve removal of?

A

all ipsilateral lymph nodes levels I to V, including those around the spinal accessory nerve, internal jugular vein, and SCM
Clinically palpable disease = modified radical neck dissection, in which the nodes around those 3 structures are spared

SURGERY (21 decks)

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