Laryngology, Salivary glands, Endocrine

Question 1

Only vocal abductor and nerve

Answer 1

Posterior Cricoarytenoid, inervated by reccurent laryngeal nerve)

Question 2

Plays biggest role in changing pitch of voice

Answer 2

Cricothyroid, (vocal adductor) innervated by superior laryngeal nerve

Question 3

Where do most malignancies occur in the vocal fold layers?

Answer 3

Squamous epithelium

Question 4

How mich can 1mm of edema in the air reduce the airway?

Answer 4

60%

Question 5

Forced air across a constricted zone causes negative pressure and causes the vocal cords to close again

Answer 5

Bernoulli’s effect

Question 6

Production of speech

Answer 6

Phonation

Question 7

Oral/nasal speech balance

Answer 7

Resonation

Question 8

Use of lips, teeth, tongue to produce speech sounds

Answer 8

Articulation

Question 9

Source of speech energy

Answer 9

Respiration

Question 10

Syllable stress, emphasis, inflection

Answer 10

Prosody

Question 11

Most common test to evaluate speech

Answer 11

Videostroboscopy

Question 12

Why do some pt’s “moan” or “pursed lips” breath?

Answer 12

Auto-PEPing

Question 13

Where is the source of snoring?

Answer 13

Nasopharynx

Question 14

Where is the source of gurgling sounds?

Answer 14

Oropharynx

Question 15

Source of inspiratory stidor

Answer 15

Supraglottic

Question 16

Source of inspiratory or biphasic stridor, hoarseness

Answer 16

Glottic

Question 17

Source of barking cough

Answer 17

Subglottic

Question 18

Expiratory stridor

Answer 18

Tracheobrachial

Question 19

Indications for endoscopy

Answer 19

SPECS-R: severity of obstruction, progression of SOB, eating difficulties, cyanosis, sleep apnea, radiologic findings

Question 20

Indications for tracheotomies

Answer 20

Bypass upper airway obstruction, prolonged intubation, pulmonary toilet, protect from aspiration, eliminate dead space with CNS depression

Question 21

Trach Care

Answer 21

New trach = 3-5 days before making trach changes, change INNER cannula every shift/every day, HUMIDITY, minimal amount of cuff pressure to decrease scarring, infections, erosions

Question 22

Most common congential laryngeal abnormality

Answer 22

Laryngomalacia

Question 23

Most common cause of stridoe in neonate and chronic peds

Answer 23

laryngomalacia

Question 24

S&S of laryngomalacia

Answer 24

Intermittent inspiratory stridor, worses with crying or feeding, has a floppy epiglottis that collapses inwards (Monitor)

Question 25

Trachea collapsing from immature tracheal cartilage

Answer 25

Tracheomalacia

Question 26

Most common vascular anomaly to cause stridor

Answer 26

Double aortic arch

Question 27

Most common vascular anomaly to compress the digestive tract

Answer 27

Retroeosophageal right subclavian artery

Question 28

High pitched stridor, mental retardation, microcephaly, narrowed endolarynx and interarytenoid cleft

Answer 28

Cri Du Chat, deletion of short arm of chromosome 5

Question 29

Dysphagia, drooling, dyspnea in >1y/o

Answer 29

Epiglottitis, is true emergency, cuased by H. Flu

Question 30

Dx epiglottitis

Answer 30

Thumb sign on lateral XR

Question 31

Barky cough, inspiratory or biphasic stidor, NO drooling or dysphagia

Answer 31

Croup, caused by parainfluenza 1 virus

Question 32

Dx of croup

Answer 32

Steeple sign with narrowed subglottis

Question 33

Second most common cause of hoarseness in children

Answer 33

Recurrent respiratory papillomatosis, HPV 6 and 11

Question 34

Most common head and neck neoplasm in children

Answer 34

Hemangioma

Question 35

Tx for hemangioma

Answer 35

usually goes away, can give beta blockers

Question 36

Sacoidosis: effect on larynx

Answer 36

Most commonly epiglottis

Question 37

Wegeners granulomatosis: effect on larynx

Answer 37

Most commonly subglottis

Question 38

Amyloidosis: effect on larynx

Answer 38

Anterior subglottic mass

Question 39

RA arthritis: effect on larynx

Answer 39

Criocoarytenoid joint affected, causes hoarse voice

Question 40

If bilateral contact ulcers in the middle and anterior third of vocal cords

Answer 40

Vocal cord abuse and trauma

Question 41

Unilateral "bump" on vocal cord

Answer 41

Vocal cord polyp

Question 42

Most common causes of vocal cord paralysis

Answer 42

Neoplastic causes

Question 43

Unilateral vocal cord paralysis

Answer 43

Breathy, hoarse voice

Question 44

Bilateral vocal cord paralysis

Answer 44

Stridor, dyspnea

Question 45

ADDuctor spasmodic dysphonia

Answer 45

More common, sudden stop of voice

Question 46

ABDuctor spasmodic dysphonia

Answer 46

Pt sounds breathy, botox posterior cricoarytenoid muscle

Question 47

Results from histamine-mediated urticarial reactions

Answer 47

Aquired laryngeal angioedema

Question 48

C1 esterase inhibitor deficiency

Answer 48

Congenital laryngeal angioedema

Question 49

Polypod degeneration of superficial lamina propria

Answer 49

Reinkes space edema, in smokers!

Question 50

Mainly serous gland

Answer 50

Parotid gland, stensons duct and facial nerve

Question 51

Mixed serous and mucinous gland

Answer 51

Submandibular gland, whartons duct, facial/lingial artery, hypoglossal nerve

Question 52

Mainly mucuous gland

Answer 52

Sublingual gland, ducts of rivinus

Question 53

Tx of ptyalism and sialorrhea

Answer 53

Anticholinergics

Question 54

What risk does xerostomia pose?

Answer 54

dental carries

Question 55

Most common cause of acute sialadentis

Answer 55

Staph aureus

Question 56

Acute salivary gland infection

Answer 56

Acute sialadentis

Question 57

Stone in salivary gland duct

Answer 57

Acute sialoLITHiasis

Question 58

Bilateral painful parotic swelling

Answer 58

Mumps, paramyxovirus

Question 59

Firm enlargement of submandibular gland, cirrhotic changes with destruction of acinar cells

Answer 59

Kuttner Tumor

Question 60

Dry eyes, xerostomia, partoic swelling

Answer 60

Sjogren Syndrome, associated with non-hodgkins lymphoma

Question 61

Cyst that extends into cervical tissues and may look like a neck mass

Answer 61

Plunging Ranula

Question 62

If a tumor is found in a small gland…

Answer 62

The more likely it is malignant

Question 63

Most common salivary gland malignancy in children

Answer 63

Mucoepidermoid tumor

Question 64

Most common tumor of each gland

Answer 64

Pleomorphic ademoa

Question 65

Second most common salivary gland tumor

Answer 65

Warthin Tumor

Question 66

Signs of salivary gland malignancy

Answer 66

Solitary nodule, facial nerve involvement, pain, trismus, cervical lymphadenopathy

Question 67

Most common submandibular and minor salivary gland malignancy

Answer 67

Adenoid cystic carcinoma

Question 68

Injury to auriculotemporal nerve results in aberrant innervation of cutaneous sweat glands, results in sweating while eating

Answer 68

Frey Syndrome

Question 69

Stored in the thyroid

Answer 69

T3 and T4

Question 70

What does TSH do?

Answer 70

Increases iodide uptake

Question 71

Excess Iodine inhibits thyroid hormone

Answer 71

Wolff-Chaikoff effect

Question 72

Effects of thyroid hormone

Answer 72

Elevates metabolic rate, releases steriod hormones, stimulates erythopoiesis, increases sympathetic activity

Question 73

Free T4 is specific for…

Answer 73

hypo/hyperthyroidism

Question 74

TSH is most sensitive test for…

Answer 74

primary hypo/hyperthyroidism

Question 75

FNA indication

Answer 75

>5mm…do if high risk or suspicious nodule

Question 76

Bethesda grading system for thyroid pathology

Answer 76

1: need better specimen, 2:benign, 3:atypia or redo FNA, 4: follicular neoplams, so surgical lobectomy, 5:suspicious for cancer so thyroidectomy, 6:malignant so thyroidectomy

Question 77

Most common FNA cytology result

Answer 77

Papillary cells: papillary carcinoma, but not necessarily bad prognosis, see Psammoma bodies

Question 78

2nd most common FNA cytology result

Answer 78

Follicular cells: Common, not necessarily a bad prognosis, most common in elderly females

Question 79

Aggressive FNA cytology result

Answer 79

Bizarre cells, suggests anaplastic carcinoma, in elderly, grows and erodes thru trachea

Question 80

Decreased uptake of thyroid radionucleotide studies

Answer 80

Graves disease and hyperthyroidism

Question 81

High risk thyroid neoplasia pts

Answer 81

AMES, Age (>41males, >51 females), metastatis, extent, size (>5cm)

Question 82

Most common thyroid cancer

Answer 82

Papillary carcinoma, most common in young females, increased risk with radiation exposure and Gardner syndrome

Question 83

Genes associated with Medullary Thyroid Carcinoma

Answer 83

MEN IIA/B mutation, RET-3 oncogene association

Question 84

S&S of medullary thyroid carcinoma

Answer 84

elevated calcitonin and CEA

Question 85

Thyroid Storm

Answer 85

Acute extreme state of thyrotoxicosis, sudden fever, profuse sweating, tachycardia, nausea, abd pain, tremors, restless, psychosis, coma, stupor,NEED IMMEDIATE IODINE

Question 86

Cause of goiters

Answer 86

Iodine deficiency, iodine excess, lithium, thyroid hormone resistance

Question 87

Thyroid stimulating immunoglobins stimulate hyperplasia from TSH, leading to unregulated overproduction of thyroid hormones with no negative feedback to turn off

Answer 87

Graves disease

Question 88

Tx of Graves disease

Answer 88

I131, propranolol, subtotal thryoidectomy

Question 89

Most common painful thyroiditis, presents usually with malaise or flu-like illness prior to pain

Answer 89

De Quervain, aka subactue granulomatous thyroiditis

Question 90

Most common cause of hypothyroidism, chronic autoimmune

Answer 90

Hashimoto thyroiditis