Otolaryngology Flashcards
(27 cards)
15-year-old girl has a round, 1 cm cystic mass in the midline of her neck at the level of the hyoid bone. When the mask is palpated at the same time that the tongue is pulled, there seems to be a connection between the two. The mass has been present for 10 years, but only recently bother the patient because it got infected. What is it? What is the management?
Thyroglossal of duct cyst
Sistrunk operation– Removal of the mass and the tract to the base of the tongue, along with medial segment of the hyoid bone.
Name the categories of neck masses.
Congenital, neoplastic, inflammatory.
18-year-old woman has a 4 cm, fluctuant round mass on the side of her neck, just beneath and in front of the sternomastoid. She reports that it has been there at least 10 years, although she thinks it has become somewhat larger than the last year or two. CT scan shows the mass to be cystic.
Branchial cleft cyst. Do Elective surgical removal.
Mushy, fluid filled mass at the base of the neck is been noted for several years. 6 cm, occupies most of the supraclavicular area and seems by physical examination to go deeper into the neck and chest.
Cystic hygroma
Get a CT scan to see how deep this thing goes. They can extend down into the chest and mediastinum. Surgical removal will eventually be done
Name three types of congenital masses.
Thyroglossal duct cyst
Branchial cleft cyst
Cystic hygroma
Enlarged lymph node in the neck that is 2 cm, firm, not tender, discovered six weeks ago. History of low-grade fever and night sweats for the past three weeks. Physical exam reveals enlarged lymph nodes in both exit was in the left groin. What is it? What is the next step in management?
Lymphoma.
Tissue diagnosis will be needed. Start with fine needle aspiration of available notes, but eventually node biopsy will be needed to establish diagnosis and type of lymphoma
4 cm hard mass in the left supraclavicular area. Nontender, present for three months. 20 pound weight loss in the past two months. What is it? What is the next step?
Malignant metastasis to a supper clavicular node from a primary tumor below the Neck
Look for obvious primary tumors: lung, stomach, colon, pancreas, kidney. Node May be biopsied
69-year-old man who smokes and drinks and has rotten teeth has a hard, fixed, 4 cm mass in his neck. Mass is just medial and in front of the sternomastoid muscle, at the level of the upper notch of the thyroid cartilage. It has been there for at least six months, and is growing. Diagnosis and management?
Metastatic squamous cell carcinoma to a jugular chain node, from a primary in the mucosa of the head and neck.
Don’t biopsy! Triple endoscopy – examination under anesthesia of the mouth, pharynx, larynx, esophagus, and tracheobronchial tree, also known as a panendoscopy.
Treatment includes radiation, platinum based chemotherapy, surgery
Young patient, asymptomatic, with a mass present for years. Location midline, at the level of the hyoid bone
Thyroglossal duct cyst
Young patient, asymptomatic, with a mass present for years. In front of and under the sternocleidomastoid muscle
Congenital, branchial cleft cyst
Young patient, asymptomatic, but mass present for years. In the supraclavicular area, Mushy
Congenital, cystic hygroma
Neck mass that is relentlessly growing for a few months.
It is neoplastic
Young patient multiple enlarged nodes, low-grade fever, night sweats
Lymphoma
Supper clavicular node
Metastasis from a primary location below the clavicles
On the side of the neck. In an old man who smokes and drinks and has rotten teeth
Metastasis from squamous cell carcinoma of the mouth, pharynx, or larynx
Explain a nasal hemorrhage pathophysiology?
90% anterior epistaxis from keisselbach’s plexus at septum (anterior ethmoid artery from ophthalmic artery)
10% posterior epistaxis from Internal maxillary artery - SPHENOPALATINE BRANCH - more common in elderly.
Old man who smokes and drinks and has rotten teeth with hard, fixed, 4 cm mass in his neck. Mass is just medial and in front of the sternomastoid muscle, at the level of the upper notch of the thyroid cartilage. It has been there for at least 6 months and is growing. What is it? Management?
Metastatic SCC to jugular chain node from primary in mucosa of the head and neck
Don’t biopsy the node! TRIPLE ENDOSCOPY - mouth, pharynx, larynx, esophagus, tracheobronchial tree. CT scan. Radiation, platinum based chemotherapy, surgery if possible.
56-year-old man develops slow progressive paralysis of the facial nerve. It took several weeks for the full-blown paralysis to become obvious and it is been present for three months. It affects both the fore head and the lower face. What is it? Diagnosis.
Gradual, unilateral nerve paralysis suggests a neoplastic process.
Diagnosed with gadolinium enhanced MRI
45-year-old man presents with a 2 cm firm mass in front of the left ear, present for four months. The mass is deep to the skin, and it is painless. The patient has normal function of the facial nerve. What is it? How do you diagnose it?
Pleomorphic adenoma (mixed tumor) of the parotid gland.
Never biopsy in office or under local anesthesia!
Referred to head and neck surgeon for formal superficial parotidectomy
A two-year-old has unilateral ear ache.
A two-year-old has unilateral foul-smelling purulent rhinorrhea.
A two-year-old has unilateral wheezing, and along on that side looks darker on x-rays then the other side
Unilateral versions of common bilateral ENT conditions and Tabers suggest foreign body. Appropriate x-rays, physical examination or endoscopies, and extraction obviously under anesthesia
45-year-old lady with a history of recent tooth infection shows up with huge, hot, red, tender fluctuant mass occupying the lower left side of face and upper neck, underside of the mouth. She is febrile. What is it? Management.
Ludwig angina – an abscess of the floor of the mouth.
Maintain airway. Incision and drainage, intubation or tracheostomy may also be required.
29-year-old lady called your office at 10 AM with a history that she woke up that morning with one side of her face paralyzed.
Bell palsy. Start right away on antiviral medication and steroids.
Patient with multiple trauma from car accident. The next day it is noted that he has a facial nerve paralysis on one side.
Trauma to the temporal bone can transect the facial nerve, but when that happens the nerve is paralyzed right there. Paralysis appearing late is from edema. Nothing needs to be done.
Middle aged lady with a history of repeated episodes of sinusitis. Six days ago was started on decongestants and oral antibiotics for what you diagnosed as frontal and ethmoid sinusitis. She woke up today and is seeing double. What is it? Management.
Cavernous sinus thrombosis vs. Orbital cellulitis
Emergency. Immediate hospitalization,
High-dose IV antibiotic treatment,
surgical drainage of the paranasal sinus or the orbit.
CT scan needed to guide the surgery
This is a big fucking problem
