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Flashcards in Pestana ENT Deck (32)
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1
Q

This congenital cyst is located at the midline, at the level of the hyoid bone and seems to elevate with tongue protrusion

A

thyroglossal duct cyst

2
Q

This congenital cyst occurs along the anterior edge of the SCM and may have a little opening and blind tract under the overylying skin

A

Branchial cleft cyst

3
Q

This congenital cyst is found at the base of the neck as a large, mushy, ill-defined mass that occupies the entire supraclavicular area and may extend into the mediastinum

A

cystic hygroma

4
Q

What should you always get before surgically removing this:

A

cystic hygroma - CT scan because this tends to extend into the mediastinum

5
Q

What should you always get before surgically removing this:

A

thyroglossal duct cyst - radionuclide scan to assess location of normal thyroid tissue

6
Q

What does surgical removal of the thyroglossal duct cyst entail?

A

removal of the cyst, the middle segment of the hyoid bone, the tract that leads to the base of the tongue

7
Q

Patient comes in with a recently discovered LN. What is the next best step in management?

A

Since most are benign, get a good H&P, f/u in 3-4 weeks, and if it’s still there, then continue with a w/u

8
Q

Patient comes in and complains of an enlarged LN that’s been there for over a month. What is the next best step in management?

A

rule out neoplasia

9
Q

Ddx of persistent enlarged LN?

A

inflammatory

neoplastic (lymphoma, abdominal metz to supraclavicular nodes, SCC of H&N mucosa)

10
Q

How does lymphoma usually present?

A

young person with multiple enlarged nodes

typically have been suffering from low-grade fever + night sweats

11
Q

diagnosis and management of a patient with suspected lymphoma

A

LN exision for pathological analysis

chemotherapy

12
Q

Where does metz to supraclavicular nodes originate from?

A

lung or intraabdominal tumors

13
Q

management of a patient who presents with an enlarged supraclavicular nodes

A

LN exision for pathological analysis

14
Q

Patient with history of smoking, alcohol, and poor dental hygiene presents with a node in the neck along the jugular chain.

What is the next best step in management?

What should you avoid doing and why?

A

think squamous cell carcinoma of the mucosa of H&N

Get a triple endoscopy to look for the primary tumor. Once found, biopsy it and get a CT to establish the extent of it.

Avoid getting an open biopsy of the neck mass because it will interfere with the appropriate surgical approach for the tumor

15
Q

Treatment of squamous cell carcinoma of the H&N mucosa? 4

A

resection + radical neck dissection + radiotherapy + platinum based chemoRx

16
Q

Patient with history of smoking, alcohol, and poor dental hygiene presents with a node in the neck along the jugular chain usually has squamous cell carcinoma of the mucosa of H&N. What other symptoms could be present?

A

persistent hoarseness

persistent painless ulcer in the floor of the mouth

persistent unilateral earache

17
Q

suspect this tumor in an adult who presents with sensory hearing loss in one ear. Next best step in management?

A

acoustic neuroma

get an MRI

18
Q

patient presents with gradual unilateral facial nerve paralysis (forehead + lower face affected)

Diagnosis and next best step in management?

A

facial nerve tumor

Gadolinium-enhanced MRI

19
Q

patient presents with rapid unilateral facial nerve paralysis (forehead + lower face affected)

Diagnosis?

A

Bells Palsy

20
Q

suspect this tumor in an adult who presents with a visible and palpable mass in front of the ear that is painless without facial nerve paralysis

A

benign pleomorphic parotid tumors

21
Q

suspect this tumor in an adult who presents with a visible and palpable mass in front of the ear that is painful with facial nerve paralysis

A

parotid cancer

22
Q

suspect this tumor in an adult who presents with a visible and palpable mass in front of the ear. What is the next best step in managment?

A

suspect parotid adenoma or cancer

Get an superficial parotidectomy, which has the benefit of excising the tumor, biopsying it, preventing recurrences, and sparing the facial nerve.

23
Q

benefits of getting a superficial parotidectomy 4

A

benefits

  • excising the tumor
  • biopsying it
  • preventing recurrences
  • sparing the facial nerve.
24
Q

what should you do in a patient with suspected partoid cancer (hard mass that has produced facial nerve paralysis)

A

sacrifice the nerve and get a graft done

25
Q

common cause of unilateral ENT problems in toddlers

management?

A

key word: unilateral

think FOREIGN BODIES - get an endoscopy under anesthesia to extract the foreign body

26
Q

Sudden unilateral paralysis of the face

A

Bell’s palsy

27
Q

treatment of Bell’s palsy

A

antivirals + steroids

28
Q

development of diplopia in a patient suffering from sinusitis should make you think of this. What is the next best step in management?

A

cavernous sinus thrombosis

this is an ENT emergency - give IV abx, CT/MRI, and drain the affected sinuses

29
Q

Epistaxis treatment in children

A

phenylephrine spray + local pressure

30
Q

how do you manage an 18 year old with epistaxis?

A

think

  • cocaine use –> posterior packing
  • juvenile nasopharyngeal angiofibroma –> surgical resection
31
Q

how do you manage epistaxis in the elderly or HTNive

A

posterior packing +/- surgical ligation of feeding vessels

32
Q

differential and management of dizziness

A
  • if suspect inner ear disease (patients describe the room as spinning) –> meclizine, phenergan, diazepam
  • if suspect cerebral disease (patients is unsteady, but the room is perceived to be stable) –> neurologic workup