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Senior - ENT > 7 - Neck > Flashcards

7 - Neck Flashcards

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1
Q

Neck triangles?

A

Slide 4

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2
Q

Normal lymph node size in neck?

A

<1cm in length

> 1.5cm “enlarged”

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3
Q

Neck mass is usually? (Broken down by age)

A

> 40 = cancer
<30, >70 = lymphoma

Kids and young adults
- usually benign

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4
Q

Neck mass rule of 7’s?

A

7 days - inflammatory
7 weeks - 7 months - neoplastic
7 yrs - congenital

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5
Q

Neck abscesses?

A

Emergency

- can compromise airway

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6
Q

MC neck space infection

A

Ludwig’s angina

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7
Q

What is ludwig’s angina?

A

ENT emergency

  • bilateral infectio of submandibular space
  • tongue pushes up and blocks airway
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8
Q

Ludwig’s angina is often caused by?

A

Dental infection

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9
Q

MCC of deep neck abscess?

A

Odontogenic infections (dental)

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10
Q

Lemierre syndrome?

A

Rare cause of ludwig’s angina or deep neck abscess

  • thrombophlebitis of internal jugular vein 2/2 orophangeal inflammation
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11
Q

Typical pt for lemierre syndrome?

A

ICU pts w prolonged internal jugular central venous catheter

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12
Q

S/s of lemierre syndrome?

A

Severe HA

Pulmonary infiltrates

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13
Q

Causes of ludwig’s angina and deep neck abscesses?

A
  • Dental infection
  • Lemierre syndrome
  • Suppurative lymphadenitis
  • Pharyngeal infection
  • Penetrating trauma
  • Pharyngoesophageal foreign bodies
  • Cervical osteomyelitis
  • Intravenous injection of internal jugular vein
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14
Q

Recurrent deep neck infection suggests?

A

Underlying congeintal lesion

- brachial cleft cyst

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15
Q

Suppurative lymphadenopaty in middle-aged pt with tobacco and ETOH hx is?

A

Metastatic SCC until proven otherwise

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16
Q

PE for deep neck abscess?

A

Edema
Erythemia
Pain in neck/chin/floor of mouth
Displaced tongue (2/2 cellulitis and pus)

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17
Q

MC cause of deep neck abscess?

A

Streptococci
Staphylococci
Bacteroides
Fusobacterum

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18
Q

Studies for deep neck abscess?

A

Contrast CT

CT/MIR can id lemierre syndrome

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19
Q

Tx for Ludwig’s angina?

A

PCN + metronidazole
Ampicillin-sulbactam
Clinamycin
Cephalosporins

Dental consult

I/D of external abscess

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20
Q

Deep neck abscess tx?

A

Secure airway
- intubate/tracheotomy
IV abx
I/D

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21
Q

Lemierre syndrome tx?

A

Antibiotics for fusobacterium necrophorum + airway pathogens

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22
Q

MCC of neck masses of all ages?

A

Reactive cervical lymphadenopathy (LAD)

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23
Q

What is reactive cervical lymphadenopathy?

A

Painful enlargement of normal lymph nodes in response to infection/inflammation

  • infection of pharynx, salivary glands, scalp
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24
Q

Reactive cervical lymphadenopathy prognosis?

A

Self-limiting and resolves spontaneously over weeks

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25
Tx for reactive cervical lymphadenoapathy
``` Abx FNA if - >1.5 cm - hx of tobacco/etoh/ca - persistent ```
26
Common causes of reactive cervical lymphadenopathy (LAD)
Tumor: - scc - lymphoma - mets Infection: - virus - mycobacteria - cat scratch disease
27
Clinical presentation of reactive cervical lymphadenopathy (LAD)
Firm, mobile, tender Rapid increase in size (rule 7’s) - nodes can become necrotic and abscess R/o cancer of >40
28
Ddx of infectious lymphadenopathy?
Typical mycobacterial infection - single non-painful lesion Atypical (non-tb) mycobacterial infection - kids, no TB hx - leads to chronic fistula Cat scratch disease - bartonella henselae Toxoplasmosis - single node in posterior triangle Mono - acute pharyngitis Syphilis - should always be in ddx
29
i say spirochete borrelia burgodorferi, you say?
Lyme disease from the ixodes tick
30
Lyme HEENT symptoms?
75% of pts have HEENT symptoms - Facial paralysis - Dysesthesias (distorted touch) - Dysgeusia (distorted taste) - Cranial neruopathies - HA - Neck pain - Cervical LAD
31
OSA vs snoring?
Snoring = noise OSA = disruption of sleep (clinical eval)
32
Prevalence of snoring/OSA?
OSA Males - 20-30% Females - 10-15%
33
Snoring/OSA are attributed to?
Narrowing of the upper aerodigestive tract during sleep due to changes in: - position - muscle tone - soft tissue hypertrophy - laxity
34
S/s of snoring/OSA?
Snoring Daytime somnolence HA Wt gain May or may not have demonstratable apnea or hypopnea on formal testing
35
PE for snoring OSA?
Excessive oropharyngeal tissue Retrognathia Large neck circumference Obesity Epworth sleepiness scale (ESS)
36
Diagnostics for OSA?
Polysmnography - an overnight test to eval sleep d/o
37
Snoring/OSA tx?
Wt loss PT Non-surg - mandibular advancement appliances - CPA - BiPAP Surgical - stiffen palate - UPPP - craniofacial procedure - hypoglossal nerve stimulation (implantable neurostimulator)
38
uvulopaletopharyngoplasty (UPPP)
Throat and uvula trimmed, folded and sutured | - pic on 34
39
Difference between crichothyrodotomy and tracheotomy?
You can smoke cigarettes through a tracheotomy Seriously google it crazy... Crichothyrotomy: acute emergency - less risk (pneumothorax, hemorrhage) Tracheotomy: - air way obstruction - respiratory failure w prolonged vent
40
Why would you transition from intubation to tracheotomy?
Prevention of: - Subglotic stenosis - Aspiration pneumonia - sleep apnea
41
MC congenital mass of the lateral neck?
Branchial cleft cyst
42
What causes the branchial cleft cyst?
Remnants of the embryological development of the neck
43
Presentation of branchial cleft cyst?
Soft, slow growing painless lesion anywhere along the sternocleomastoid Typically appear on face near auricle H/o infection 2nd/3rd decade of life
44
Dx of branchial cleft cyst
CT: cystic mass medial to SCM
45
Tx for branchial cleft cyst?
Excise completely along fistulous tracts - recurrent infection/carcinoma possible but rare Send to path
46
MC congenital mass on central neck?
Thyroglossal duct cyst
47
Thyroglossal duct cyst developes from?
Remnant occurring along the embryologic descent of thyroid
48
Presentation of thyroglossal duct cyst?
< 20 yo Thyroglossal duct cysts are midline - often just below hyoid bone - moves w swallowing and tongue protrusion
49
Diagnosis for thyroglossal duct cyst?
TSH - indicates amount of thyroid tissue in neck | CT
50
Tx for thyroglossal duct cyst?
Surgical removal - preop US to confirm position of thyroid Sistrunk procedure - resection of the thyroglossal duct to the base of tongue w removal of the cyst and medial segment of they hyoid bone
51
Lipomas, hemangiomas and neurofibromas are all?
Benign Slow growing No invasion
52
Where in the neck does cancer like to mets to?
Lateral neck area
53
Almost 95% of head and neck cancer is?
SCC
54
Pt population who get SCC in the neck?
Middle-aged to elderly - upper aerodigestive tract carcinogen exposure - cigarette smoke - ethanol So basically bikers (sorry “motorcycle enthusiasts”)
55
Head and neck cancer gets a triple endoscopy. WTF is that?
Triple endoscopy - direct laryngoscopy - bronchoscopy - esophagoscopy Conducted under anesthesia
56
Why is SCC in the neck bad?
Its like a super highway mets to: - lymph nodes of neck - lung - liver - bone - brain
57
What is the condition knowns as unknown primary?
When the primary tumor cannot be found | - about 10% of the time
58
What type of endoscope is used for biopsy?
ENT surgeons use rigid endoscops b/c they are better for biopsy But you can use both
59
Adult pt with lump on neck and not good reason for it>?
Cancer until proven otherwise Get complete HEENT exam Get triple endoscopy
60
SCC lesions need? (Diagnostic)
FNA of lymph node | - then find the primary cancer
61
SCC presentation?
``` Sore throat Referred otalgia Hoarseness Airway obstruction Fixed reactive LAD Tender Constitutional symptoms ```
62
Thyroid Cancer type prevalence?
``` Papillary carcinoma - 80% - slow Follicular carcinoma - 10% - more aggressive Medullary carcinoma - 5% Anaplastic (undifferentiated) - <2% - most aggressive ```
63
Rule of 7’s <7 weeks
Suspect infectious source - abx - f/u 2-4 wks - CXR, PPD
64
Rule of 7’s | 7 weeks - 7 months
Suspect neoplasm - CT w contrast and FNA - Endoscopy - Management based on histology and stage
65
Rule of 7’s | > 7yrs
Suspect congenital anomaly - CT - excisional biopsy
66
Neck tattoos used to mean “watch out motherfucker”
Now they mean “i’d like to read you poems about my vegan bicycle”

Senior - ENT (8 decks)

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