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Flashcards in Pestana ENT Deck (32)
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1

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

thyroglossal duct cyst

2

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

Branchial cleft cyst

3

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

cystic hygroma

4

What should you always get before surgically removing this:

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

5

What should you always get before surgically removing this:

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

6

What does surgical removal of the thyroglossal duct cyst entail?

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

7

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

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

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? 

rule out neoplasia

9

Ddx of persistent enlarged LN?

inflammatory

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

10

How does lymphoma usually present?

young person with multiple enlarged nodes

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

11

diagnosis and management of a patient with suspected lymphoma

LN exision for pathological analysis

chemotherapy

12

Where does metz to supraclavicular nodes originate from?

lung or intraabdominal tumors

13

management of a patient who presents with an enlarged supraclavicular nodes

LN exision for pathological analysis

14

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?

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

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

resection + radical neck dissection + radiotherapy + platinum based chemoRx

16

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?

persistent hoarseness

persistent painless ulcer in the floor of the mouth

persistent unilateral earache

17

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

acoustic neuroma

get an MRI

18

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

Diagnosis and next best step in management?

facial nerve tumor

Gadolinium-enhanced MRI

19

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

Diagnosis?

Bells Palsy

20

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

benign pleomorphic parotid tumors 

21

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

parotid cancer

22

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?

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

benefits of getting a superficial parotidectomy 4

benefits

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

24

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

sacrifice the nerve and get a graft done

25

common cause of unilateral ENT problems in toddlers

management?

key word: unilateral

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

26

Sudden unilateral paralysis of the face

Bell's palsy

27

treatment of Bell's palsy

antivirals + steroids

28

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

cavernous sinus thrombosis 

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

29

Epistaxis treatment in children

phenylephrine spray + local pressure

30

how do you manage an 18 year old with epistaxis?

think

  • cocaine use --> posterior packing
  • juvenile nasopharyngeal angiofibroma --> surgical resection