(Iii-Surgery) Heent

Front 1

Common presentation of a Branchial Cleft cyst

Back 1

Nontender fluctuant mass

May present as an abscess, or with inflammation (if follows URI)
May present with dysphagia

Front 2

Most common location for a branchial cleft cyst

Back 2

Deep to the anterior border of the SCM

Front 3

Presentation of a thyroglossal duct cyst

Back 3

Usually asymptomatic midline mass that elevates when swallowing
If symptoms present, may be dysphagia, chocking if infected and swollen

Front 4

Thyroglossal duct cyst is suspected. What further workup MUST be done?

Back 4

Ultrasound to ensure that pt has additional thyroid tissue around in case you want to remove cyst

Front 5

This is the most common type of tumor in neonates:

Back 5

Hemangioma

Front 6

Infant has a bright red mass that grew rapidly but is starting to regress

Back 6

Infantile hemangioma

Front 7

Top 3 bugs in otitis externa:

Back 7

Pseudomans (especially in diabetics)
Staph Aureus
Fungus

Front 8

Treatment of otitis externa:

Back 8

Cleaning of ear canal, topical antibotics / steroids, WIC packing

Surgery in pts with malignant otitis external (debridement)

Front 9

Top 3 bugs in acute otitis media:

Back 9

Staph
Haemophilus Influenzae
Moaxella catarrhalis

Note: These are the same three bugs that cause COPD and sinusitis

Front 10

What is the pathophysiology behind ear infections?

Back 10

Viral or bacterial infection in the nasal passage leads to inflammation. Nose gets backed-up which leads to eustachian tube dysfunction.

Front 11

Risk factors for otitis media

Back 11

Exposure to tobacco
Day-care
Breast feeding
Time of the year

Front 12

Patient has hx of acute otitis media, which is causing pain, when all of the sudden they feel much better.

What happened?

Back 12

Perforation of tympanic membrane

Front 13

Number of adults who are carriers for EBV:

Back 13

90%

Front 14

What is the "intern's way" of diagnosing EBV?

Back 14

Give the patient penicillin, and if rash develops

Front 15

Ways to differentiate EBV from CMV as a cause of mono:

Back 15

Cervical lymphadenopathy and pharyngitis usually absent
-Negative for heterophile antibodies

Front 16

What is the time frame for being positive on monospot (heterophile) test?

Back 16

Will be positive within 4 weeks of infection with EBV, but undectable after 6 months.

Front 17

Complications of EBV:

Back 17

Hepatitis
Neuro complications (Bell's Palsy)
Splenic Rupture
Upper airway obstruction due to lymphadenopathy
Possible link to some oral cancers

Front 18

Which type of oral cancers is associated with EBV and China:

Back 18

Nasopharyngeal cancer

Front 19

Which type of cancer is associated with HPV?

Back 19

Oropharyngeal cancer

Front 20

What is the predominant cell type when it comes to cancers of the mouth and throat

Back 20

Squamous Cell Carcinoma

Front 21

Pt had a sore throat for approx 1 week and now complain of voice changes. On physical exam you note a deviated uvula. What is the diagnosis?

Back 21

Peritonsilar abscess (quinsy)

Front 22

Common bugs for peritonsillar abscess

Back 22

streptococci, staphylococci and hemophilus.

Front 23

Which type of neurofibromatosis is more often associated with bilateral schwanomas?

Back 23

NF2

Front 24

What are the earliest symptoms of schwannoma?

Back 24

Ipsilateral hearing loss +/- Tinnitus

As the tumor enlarges it may impinge on CNVII

Front 25

Imaging studies of choice for diagnosing schwannoma:

Back 25

CT with contrast, MRI with Gadolinium

Front 26

Treatment for schwannoma

Back 26

Watch and wait if pt is unfit for surgery

Surgery

Radiation therapy

Front 27

What do Schwann cells do?

Back 27

Make myelin sheath in periopheral nerve cells

Front 28

What is the indication for surgery for treatment of acute sinusitis

Back 28

Failure to control sx after 4-6 weeks of therapy

Front 29

Indications for tonsillectomy:

Back 29

Recurrent bacterial pharyngitis whose episodes don't respond to therapy

Front 30

Treatment of epiglottitis:

Back 30

Abx (Rocephin) + steroids. Tracheostomy if pt doesn't do well while being examined in OR

Front 31

How should you go about your physical exam for a patient with suspected epiglotitis?

Back 31

Do it in the OR under anesthesia

Front 32

What is the hallmark presentation of patient with acoustic neuroma:

Back 32

Progressive, unilateral hearing loss +/- disequilibrium

Front 33

Diagnostic tests for working up acoustic neuroma:

Back 33

Pure-tone audiometry
Speech discrimination score
Acoustic reflex

Front 34

Pattern recognition!

Male patient with long history of tobacco use who presents with a non-healing oral ulcer

Back 34

Squamous cell carcinoma

Front 35

Pattern recognition!

Patient who has several months of unilateral ear pain and tonsillar hypertrophy

Back 35

Oropharyngeal carcinoma

Front 36

Pattern recognition!

Patient who has several months of unilateral serous otitis media and ipsilateral (unilateral) epistaxis + congestion

Back 36

Nasopharyngeal carcinoma (SCC)

Front 37

Treatment of choice for nasopharyngeal carcinoma (SCC)

Back 37

Medical... Radiation

Front 38

Risk factors for cancers of the larynx:

Back 38

Tobacco
Alcohol
GERD
Laryngeal papilloma

Front 39

Treatment of mouth councer

Back 39

Primary resection is the first choice +/- radiation therapy

Front 40

Pattern recognition:

Young kid has hoarseness & stridor, but otherwise healthy.

Back 40

Papilloma

Cuased by HPV 6&11

Front 41

Location of Juvenile Nasopharyngeal Angiofibroma:

Back 41

POSTERIOR nasal cavity

Front 42

Treatment of papilloma:

Back 42

Ablation with CO2 laser

Front 43

Treatment for Juvenile Nasopharyngeal Angiofibroma

Back 43

Surgery +/- radiation