ENT - Adult neck masses Flashcards Preview

Year 2 Specialty Medicine > ENT - Adult neck masses > Flashcards

Flashcards in ENT - Adult neck masses Deck (32):
1

where do nasopharynx tumors metastasize?

upper jugular chain

2

where do nasopharynx / posterior scalp / ear / temporal bone / skull base tumors metastasize?

posterior triangle

3

where do thyroid / piriform sinus / upper esophagus tumors metastasize?

lower jugular chain

4

where do anterior 2/3 tongue / floor of mouth / gums / cheek mucosa tumors metastasize?

submandibular triangle

5

where do lip cancer tumors metastasize?

submental triangle

6

where do oral cavity (any location) / pharynx / larynx tumors metastasize?

midjugular chain

7

a tumor just behind the ear will be a metastasis from where?

nasopharynx

8

what should be the first step in addressing a neck mass / pain, especially with any inflammatory symptoms (redness, pain)?

2 week course of abx (prior to invasive treatment)

9

what is the standard diagnostic test for neck masses? what are the indications?

FNA

- neck mass that is not an obvious abscess
- persistence after 2 wk abx
- progressive growth / supraclavicular / over 3 cm
- B symptoms

10

what is radionucleotide scanning used for?

- salivary and thyroid masses
- location: glandular vs extra-glandular
- functional information

11

80% of asymmetric neck masses are of what origin?

SCC

12

if there is unilateral otalgia with normal otoscopy, where should you suspect a neoplasm?

nasopharynx - tonsil, tongue base, supraglottis, hypopharynx

13

if there is unilateral serous otitis, where should you look?

nasopharynx (direct examination) - obstructing auditory tube

14

what is the nodal mass workup in the adult?

- panendoscopy (FNA)
- directed biopsy
- synchronous primaries
- open excisional biopsy (only if neg workup)

15

what is the most common anterior neck mass?

thyroid mass

16

what are the signs and symptoms of lymphoma?

- lateral neck mass (discrete, rubbery, nontender)
- fever
- hepatosplenomegaly
- diffuse adenopathy

17

what diagnostic tests are done for lymphoma?

- FNA (first line)
- if suggestive for lymphoma: open biopsy
- full workup: CT chest, abdomen, head neck, bone marrow

18

does skin fixation indicate benign or malignant?

malignant

19

what are the diagnostic tests for salivary gland tumors?

- open excisional biopsy preferred
- FNA
- CT (deep lobe tumors, intra vs extra parotid)

20

for salivary gland tumor resection, what should you be prepared to do?

- total parotidectomy with possible facial nerve sacrifice

21

how is lipoma diagnosis confirmed?

excision

22

neurogenic tumors arise from what germ layer?

neural crest

23

what is the most common neurogenic head and neck tumor?

schwannoma

24

what are the neurogenic tumors?

- schwannoma
- neurofibroma
- malignant peripheral nerve sheath tumor

25

what are the s/sx of schwannoma?

- medial tonsillar displacement
- hoarseness
- horners syndrome

26

which branchial cleft has the highest incidence of cysts?

2nd

27

WHEN do branchial cleft cysts most commonly present? what is the presentation?

- post URI
- smooth fluctuant mass underyling SCM

28

what is the treatment for branchial cleft cysts?

- initial control of infection
- surgical excision, including tract

29

do thyroglossal duct cysts move with swallowing?

yes (elevates on swallowing / protrusion of tongue)

30

what is the treatment for lymphangiomas?

surgical excision if easily accessible

31

what is the treatment for hemangiomas?

surgical excision for rapid growth in vital structures or thrombocytopenia

32

what is required for equivocal or suspicious FNA in the pediatric nodal mass?

open excisional biopsy to rule out malignant or granulomatous disease