Head And Neck Surgery Flashcards
A 34 year old lady presents with a long standing offensive discharge from the ear and on examination is noted to have a reduction in her hearing of 40 decibels compared to the opposite side. What is the most likely cause?
Otosclerosis Acute otitis media Cholesteatoma Long standing perforation of the pars tensa Otitis externa
Cholesteatoma
The combination of long history, offensive discharge and hearing loss is strongly suggestive of cholesteatoma
A dentist treating a woman with rheumatoid arthritis for recurrent episodes of dental sepsis notices that both parotid and submandibular glands are symmetrically enlarged. What is the most likely diagnosis?
Sjogren's syndrome Mikulicz's syndrome Alcoholism Liver cirrhosis Metastatic cancer
Sjogren’s is associated with autoimmune disorders. Mikulicz’s is similar but there is no sicca or arthritis.
A 29 year old man has had a sore throat for the past 5 days. Over the past 24 hours he has noticed increasingly severe throbbing pain in the region of his right tonsil. He is pyrexial and on examination he is noted to have a swelling of this area. What is the most likely cause?
Tonsillar cancer Lymphoma Quinsy Glandular fever Common cold
Unilateral swelling and fever is usually indicative of quinsy. Surgical drainage usually produces prompt resolution of symptoms
A 42 year old singer is admitted for a thyroidectomy. Post operatively she is only able to make a gargling noise. Her voice sounds breathy. What is the most likely explanation?
Bilateral inferior laryngeal nerve injury Unilateral inferior laryngeal nerve injury Unilateral superior laryngeal nerve injury Bilateral superior laryngeal nerve injury Lacunar infarct
Unilateral inferior laryngeal nerve injury
This patient has diplophonia which causes a gargling sound. This is associated with dysphagia. This can also be caused by a vagus nerve lesion, but the recurrent laryngeal nerve is more at risk of damage. In bilateral injury, the airway is at risk and therefore this takes precedence.
A 53 year old man presents with a mass lesion slightly inferior to the tragus of his right ear. An FNA and USS are performed and a 2cm pleomorphic adenoma is diagnosed. What is the most appropriate course of action?
USS guided core biopsy Radical parotidectomy Superficial parotidectomy Discharge MRI scanning of the region
Superficial parotidectomy
Pleomorphic adenomas a usually benign tumours. However, they will enlarge over time and a proportion can undergo malignant transformation. Therefore, all pleomorphic adenomas are excised and a superficial parotidectomy is generally the procedure of choice. The facial nerve is preserved. More recently, there has been a move towards partial superficial parotidectomy. However, complete resection of the lesion is still mandatory
A child is brought to casualty complaining of a headache and a sensation of pressure between the eyes. On examination, she is febrile with a smooth swelling overlying the superomedial aspect of the right eye. The eye is uncomfortable and there is a purulent discharge from the inner canthus. What is the most likely cause?
Maxillary sinusitis Ethmoidal sinusitis Nasal polyps Ethmoid sinus cancer Maxillary sinus cancer
Ethmoidal sinusitis
Ethmoidal sinusitis may spread to the periorbital tissues resulting in periorbital cellulitis. The superomedial distribution makes a maxillary sinusitis less likely.
An 8 year old boy presents with a lump in his neck. On examination, he is found to have a lump in the midline of the neck immediately below the hyoid which moves on tongue protrusion. What is the most likely diagnosis?
Benign lymphadenopathy Malignant lymphadenopathy Thyroglossal cyst Branchial cyst Dermoid cyst
Thyroglossal cyst
Both dermoid and thyroglossal cysts are often located in the midline. Dermoid cysts are usually found above the hyoid and do not move on swallowing. Thyroglossal cysts lie below the hyoid and move on tongue protrusion
An 18 year old boy presents with pancreatitis. He has bilateral painful parotid enlargement. What is the most likely underlying cause?
Sialectasis Bacterial parotitis Viral parotitis Mucoepidermoid carcinoma Sjogren's syndrome
Viral parotitis
In a young adult with parotid swelling and pancreatitis/orchitis/reduced hearing/meningoencephalitis suspect mumps.
A 14 year old boy presents with enlarged tonsils that meet in the midline. Oropharyngeal examination confirms this finding and you also notice peticheal haemorrhages affecting the oropharynx. On systemic examination he is noted to have splenomegaly. What is the most likely cause?
Oral candidiasis Infection with Streptococcus pyogenes Infection with Rickettsia rickettsii Infection with Epstein Barr virus Infection with Staphylococcus aureus
Infection with Epstein Barr virus
A combination of pharyngitis and tonsillitis is often seen in glandular fever. Antibiotics containing penicillin may produce a rash when given in this situation, leading to a mistaken label of allergy. Infection with candidiasis can occur in individuals with systemic illness of which splenomegaly may be a feature.
A 70 year old lady presents with a painless neck lump. There is a mass noted beneath the sternocleidomastoid muscle. There is a long history and somewhat unkindly her husband remarked on her rather noticeable halitosis. What is the most likely explanation?
Branchial cyst Branchial fistula Pharyngeal pouch Thyroglossal cyst Dental caries
Pharyngeal pouch
Usual history of regurgitation of undigested food or coughing at night. Associated with halitosis and throat infections.
A 21 year old man presents with a unilateral facial nerve palsy after being hit on the head. On examination, he has a right sided facial nerve palsy and a watery discharge from his nose. What is the most likely cause?
Pleomorphic adenoma Cerebrovascular accident Occipital bone fracture Petrous temporal fracture Sarcoidosis
Petrous temporal fracture
Nasal discharge of clear fluid and recent head injury makes a basal skull fracture the most likely underlying diagnosis.
A 4 year old is brought to the general practitioner by her mother. She has been distressed with ear pain for the past 14 hours. She is constantly touching and pulling at her ear. Whilst she is sat in the waiting room her mother notices a discharge of foul smelling fluid from the ear, following which the pain resolves. What is the most likely cause?
Acute otitis media Otitis externa Cholesteatoma Mastoiditis Otosclerosis
Acute otitis media
In young children acute suppurative otitis media is a common condition. Rupture of the tympanic membrane is a rare, but recognised complication.
A 40 year old woman presents as an emergency with a painful mass underneath her right mandible. The mass has appeared over the previous week with the pain worsening as the lump has increased in size. On examination, there is a 4cm mass underneath her mandible, there is no associated lymphadenopathy. What is the most likely diagnosis?
Submandibular gland cancer Submandibular gland calculus Carotid body tumour Papilloma of Whartons duct Carotid body aneurysm
Submandibular gland calculus
The sub mandibular gland is the most common site for salivary calculi. Patients will usually complain of pain, which is worse on eating. When the lesion is located distally the duct may be laid open and the stone excised. Otherwise the gland will require removal.
A 46-year-old woman is referred to endocrine surgery for a possible thyroidectomy. She has a tender neck swelling. Blood results are as follows:
TSH <0.1 mU/l
T4 188 nmol/l
Hb 14.2 g/dl
Plt 377 * 10^9/l
WBC 6.4 * 10^9/l
ESR 65 mm/hr
Technetium thyroid scan shows decreased uptake globally
What is the most likely diagnosis?
Sick thyroid syndrome Acute bacterial thyroiditis Hashimoto's thyroiditis Subacute thyroiditis Toxic multinodular goitre
Subacute thyroiditis
This patient does not need surgery! Subacute thyroiditis is suggested by the tender goitre, hyperthyroidism and raised ESR. The globally reduced uptake on technetium thyroid scan is also typical. This should resolve without any active intervention.
Which of the following statements relating to branchial cysts is untrue?
The greater auricular nerve may be divided during excision They typically occur in young adults They move upwards on swallowing They are rare over the age of 40 years They are usually located in the anterior triangle of the neck
They move upwards on swallowing
They do not move on swallowing. They should be diagnosed with caution in those aged >40 years, as lumps in this age group may in fact be metastatic disease from oropharyngeal cancer.
