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19 Cards in this Set
- Front
- Back
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A 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 mass 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 at least 10 years, but only recently bothered the patient because it got infected and drained some pus.
Diagnosis? Management? |
Diagnosis: Thyroglossal Duct Cyst
Management: Sistrunk operation (removal of the mass and the track to the base of the tongue, along with the medial segment of the hyoid bone). |
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An 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 is has been there at least 10 years, although she thinks that it has become somewhat larger in the last year or two. A CT scan shows the mass to be cystic.
Diagnosis? Management? |
Diagnosis: Branchial Cleft Cyst
Management: Elective removal |
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A 6 year old child has a mushy, fluid filled mass at the base of the neck, that has been noted for several years. The mass is about 6 cm. in diameter, occupies most of the supraclavicular area and seems by physical exam to go deeper into the neck and chest.
Diagnosis? Management? |
Diagnosis: Cystic Hygroma
Management: 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. |
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A 22 year old lady notices an enlarged lymph node in her neck. The node is in the jugular can, measures about 1.5 cm, is not tender, and was discovered by the patient yesterday. The rest of the history and physical exam are unremarkable.
Management? |
We don't know what it is. Could be inflammatory or neoplastic. Best thing to do is give it time to see if it will regress, stay the same, or grow, then act accordingly
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A 22 year old lady seeks help regarding an enlarged lymph node in her neck. The node is in the jugular chain, measures about 2cm, is firm, not tender, and was discovered by the patient six weeks ago. There is a history of low grade fever and night sweats for the past three weeks. Physical examination reveals enlarged lymph nodes in both axillas and in the left groin
Diagnosis? Management? |
Diagnosis: Lymphoma most likely
Management: Node biopsy will be needed |
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A 72 year old man has 4 cm. hard mass in the left supraclavicular area. The mass is movable, non tender and has been present for three months. The patient has had a 20 pound weight loss in the past two months, but is otherwise asymptomatic.
Diagnosis? Management? |
Diagnosis: Metastasis
Management: Look for the primary tumor - stomach, colon, liver, lungs |
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A 69 year old man who smokes and drinks and has rotten teeth has a hard, fixed, 4 cm. mass in his neck. The 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 it is growing.
Diagnosis? Management? |
Diagnosis: Metastatic SCC to cervical chain node from the head and neck
Management: Don't biopsy the node! Do a triple endoscopy and FNA |
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unilateral sensory hearing loss on one side only. He does not engage in any activity (such as sport shooting) that would subject that ear to noise that spares the other side.
Diagnosis Mangement |
Diagnosis: Acoustic Neuroma
Management: MRI for diagnosis |
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A 56 year old man develops slow, progressive paralysis of the facial nerve on one side. It took several weeks for the full blown paralysis to become obvious, and it has been present now for three months. It affects both the forehead as well as the lower face.
Diagnosis Management |
Diagnosis: Unilateral paralysis suggests a neoplastic process
Management: Gadolinium-enhanced MRI |
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A 45 year old man presents with a 2 cm. firm mass in front of the left ear, which has been present for four months. The mass is deep to the skin and it is painless. The patient has normal function of the facial nerve.
Diagnosis |
Diagnosis: Pleomorphic Adenoma (Mixed cell tumor) of the Parotid Gland
Management: FNA is appropriate, but the point of the question will be to bring out the fact that parotid masses are never biopsied in the office or under local anesthesia. Look for the option that offers referral to a head and neck surgeon for formal superficial parotidectomy |
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A 65 year old man present with a 4 cm. hard mass in front of the left ear, which has been present for six months. The mass is deep to the skin and it is fixed. He has constant pain in the area, and for the past two months has had gradual progression of left facial nerve paralysis. He has rock-hard lymph nodes in the left neck.
Diagnosis Management |
Diagnosis: Parotid Cancer
Management: Referal to head and neck surgeon for removal |
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A child with unilateral wheezing or unilateral purulent drainage that smells awful or a unilateral earache
Diagnosis? |
All foreign bodies
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A 4 year old child is brought by his mother to the emergency room because “she is sure that he must have swallowed a marble”. The kid was indeed playing with marbles and apparently completely healthy when he was put to bed, but four hours later he had developed inspiratory stridor, a fever of 103 and obvious respiratory distress. The kid is sitting up, leaning forward, drooling at the mouth and looking very sick indeed
Diagnosis Management |
Diagnosis: Acute Epiglottitis
Management: Lateral X-rays; Intubation; IV antibiotics for H-Flu |
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A 45 year old lady with a history of a recent tooth infection shows up with a huge, hot, red, tender, fluctuant mass occupying the left lower side of her face and upper neck, including the underside of the mouth. The mass pushes up the floor of the mouth on that side. She is febrile.
Diagnosis Management |
Diagnosis: Ludwig's Angina
Management: Tracheostomy and I&D of the abscess |
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A 29 year old lady calls your office at 10 AM with the history that she woke up that morning with one side of her face paralyzed.
Diagnosis Managemetn |
Diagnosis: Bell's Palsy
Management: Start anti-virals ASAP |
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A patient with multiple trauma from a car accident is being attended to in the emergency room. As multiple invasive things are done to him, he repeatedly grimaces with pain. The next day it is noted that he has a facial nerve paralysis on one side.
Diagnosis Management |
Diagnosis: Facial nerve compression from edema
Management: Nothing has to be done; Will resolve on its own |
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Your office receives a phone call from Mrs. Rodriguez. You know this middle aged lady very well because you have repeatedly treated her in the past for episodes of sinusitis. In fact, six days ago you started her on decongestants and oral antibiotics for what you diagnoses as frontal and ethmoid sinusitis. Now she tells you over the phone that ever since she woke up this morning, she has been seeing double
Diagnosis Management |
Diagnosis: Cavernous Sinus Thrombosis or Orbital Cellulitis
Management: Emergency; Drainage of paranasal sinus, IV antibiotics; CT-guided drainage |
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A 10 year old girl has epistaxis. Her mother says that she picks her nose all the time.
Diagnosis Management |
Diagnosis: Epistaxis
Management: Phenylephrine spray and pressure |
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An 18 year old boy has epistaxis. The patient denies picking his nose. No source of anterior bleeding can be seen by physical examination.
Diagnosis? Management? |
Diagnosis: Either septal perforation from cocaine abuse, or posterior juvenile nasopharyngeal angiofibroma.
Management: Fuck it, call ENT |
