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54 Cards in this Set

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What must you suspect in adult with a neck mass present for longer than one week?
cancer
Why do older patients have a more pronounced sub-mandibular gland?
due to atrophy of the platsyma muscle
What are factors that should increase the index of suspicion for a neck mass?
• dysphagia
• halitosis
• hemoptysis
• hoarseness of the voice
• respiratory distress
• weight loss
True/False: Fine-needle biopsy can be used to rule-out malignancy
• Fine-needle biopsy can confirm diagnosis but does not rule-out malignancy
• The correct answer is: False
What imaging study should be used to evaulate neoplasms in bone?
CT scan w/ contrast
What imaging study should be used to evaluate neoplasms in soft tissue?
MRI w/ gadolinium
What are brachial cleft cysts?
• originate from the failure of pharyngobranchial ducts to obliterate during early development
• present when they become swollen after a cold or URI
• characteristically fluctuant in nature and have a cystic feel
What is the most common source of brachial cleft cysts?
second branchial cleft (located just anterior the SCM muscle
What is the definitive treatment for a brachial cleft cyst?
surgical removal
How does a patient with a thyroglossal duct cyst present?
• midline round soft (sometimes fluctuant) mass at the level of the hyoid bone or below
• mass rise with tongue protrusion
What is the treatment for a thyroglossal duct cyst?
• excision with the tract
• includes removal of the center portion of the hyoid bone (Sistrunk procedure)
What is a cystic hygroma? What is the treatment?
• aka lymphagnioma
• an abnormality in development of regional lymphatics
• Tx: Surgical excision of the lympathic tissue
What is the most common head and neck neoplasm in children?
hemangioma
True/False: Chemotherapy, used alone, is an effective treatment modality for head and neck cancer
• Chemotherapy alone is not an effective treatment modality and is only used as part of multimodality treatment for advanced lesions
• The correct answer is: False
What are the different tests used to evaluate thyroid goiter & nodules?
• 1st line: ultrasound
• 2nd line: fine-needle aspiration
• 3rd line: nuclear scan
Which nuclear scan result has a better prognosis, a hot or cold nodule?
• Cold Nodules may indicate malignancy and have a worse prognosis
• Hot nodules are functioning tissue (better prognosis)
Which iodine contrast is diagnostic and which is therapeutic?
• Diagnostic: I 123
• Therapeutic: I 131
What are the 4 types of thyroid neoplasms?
• papillary adenocarcinoma (80%)
• follicular carcinoma (20%)
• medullary (<10%)
• anaplastic (5%)
Which thyroid neoplasm is the most aggressive?
anaplastic
What are complications of thyroid surgery?
• transient hypocalcemia
• vocal cord paralysis (due to injury to the recurrent laryngeal nerve)
• thyroid deficiency
What are 2 signs of hypocalcemia?
• Chvostek's sign
• Trousseau's sign
What are causes of a hoarse voice in children?
• hemangiomas
• laryngeal web
• papilomas
• screamers nodules
• subglottic stenosis
What must be ruled-out in children with a hoarse voice?
airway compromise
What are causes of a hoarse voice in an adult?
• chronic hypertrophic laryngitis
• laryngitis
• spastic dysphonia
• squamous cell carcinoma
What is spastic dysphonia?
clapping of vocal cords
What is the treatment for vocal cord nodules?
speech therapy
What is the treatment for reflux laryngitis?
• anti-reflux medications
• diet
What is the treatment for acute laryngitis?
voice hygiene
What is the treatment for chronic laryngitis?
• voice rest
• speech therapy
What is the treatment for laryngeal carcinoma?
• radiation therapy
• surgery
If a patient has a problem with their left vocal cord, you should suspect a lesion in this area?
lung
If the patient has a problem with their right vocal cord, you should suspect a lesion in this area?
brain
What is the most common congenital abnormality of the larynx?
laryngomalacia
What is the laryngomalacia?
• immature development results in soft laryngeal walls that close airway
• usually the child outgrows this; no treatmnet necessary
What is the most prominent symptom of laryngomalacia?
inspiratory stridor
How do you manage a laryngeal hemangioma?
• most resolve within two years
• may require debulking or interferon
What are symptoms of congenital webbing?
inspiratory and expiratory stridor
What is the treatment of a congenital web?
surgical ligation and cauterization (may regrow)
Why should you not intubate a patient with epiglottis?
may cause spasm
What is the treatment for epiglottitis?
• admit
• IV antibiotics
• oxygen
What is laryngotracheitis (croup)?
inflammation of the subglottic larynx/upper trachea
What are signs and symptoms of croup?
• recent URI
• barking cough
• symptoms worse at night
What is the treatment for croup?
• cool mist
• epinephrine
• oxygen
What is the treatment for vocal cord carcinoma?
radiation therapy (90% cure rate)
What is the most common cause of vocal cord polyps?
secondary to endotracheal intubation
What is the general incidence of malignancy of a salivary neoplasm of the parotid gland? submandibular gland? sublingual gland?
• parotid gland (25%)
• submandibular gland (50%)
• sublingual (75%)
What is the treatment for a pleomorphic adenoma?
surgical removal
What is the treatment for a Wharthin's tumor?
surgical removal
What is sialadenitis?
inflammation of the salivary ducts from non-specific bacterial infection or blocked excretory ducts
What is the most commonly affected gland with invasion of bacteria from the oral cavity?
parotid
What is the treatment for parotitis?
• antibiotics
• dilation stenson's duct
• Sialogogues
• increased hydration
What is the treatment for sialoadenitis?
• antibiotics
• dilation stenson's duct
• Sialogogues
• increased hydration
Sialolithiasis are more commonly associated with which glands?
submaxillary glands
What is the treatment for sialolithiasis?
marsupilization