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109 Cards in this Set
- Front
- Back
The anterior neck triangle contains the carotid sheath. What are the borders? |
SCM muscle, sternal notch and inferior border of the digastric muscle
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The posterior neck triangle contains the spinal accessory nerve and the brachial plexus. What are the borders?
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posterior border of SCM muscle, trapezius muscle and the clavicle
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In the neck, on what muscle does the phrenic nerve sit?
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anterior scalene muscle
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Three glands in the mouth can be identified by their secretions:
____ glands - secrete mostly serous fluid. ___ glands - secrete mostly mucin. ___ glands - 50/50 |
parotid
sublingual submandibular |
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In the larynx, where are the false vocal cords located in relation to the true vocal cords?
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superior
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What are the three branches of the trigeminal nerve?
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ophthalmic, maxillary, mandibular
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What nerve provides motor function to face? and sensory?
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facial, trigeminal
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What nerve provides sensory to posterior tongue. Motor to stylpharngeus. Injury affects swallowing?
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Glossopharyngeal nerve
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Hypoglossal nerve provides motor to all of tongue except what muscle?
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palatoglossus
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Recurrent laryngeal nerve innervates all of larynx except which muscle? What is it innervated by?
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cricothyroid is innerved by superior thyroid nerve
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What syndrome occurs after parotidectomy; injury of auriculotemporal nerve that then cross-innervates with sympathetic fibers to sweat glands of skin • Symptom: gustatory sweating?
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Frey’s syndrome
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What are the 5 branches of the thyrocervical trunk with mnemonic?
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STAT, suprascapular artery, transverse cervical artery, ascending cervical artery, inferior thyroid artery
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What is the 1st branch of the external carotid artery?
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superior thyroid artery
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What artery is the trapezius flap based on?
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transerve cerivcal artery
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What aretery is pectoralis major based on?
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thoracoacromial artery
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___ – congenital bony mass on upper palate of mouth. Tx: nothing
___ – similar to above but on the anterior lingual surface of the mandible |
Torus palatini
Torus mandibular |
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What procedure takes accessory nerve (CN XII), sternocleidomastoid, internal jugular, omohyoid, submandibular gland, sensory nerves C2–C5, cervical branch of facial nerve, and ipsilateral thyroid • Most morbidity occurs from accessory nerve resection.
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Radical neck dissection
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What procedure takes omohyoid, submandibular gland, sensory nerves C2–C5, cervical branch of facial nerve, ipsilateral thyroid?
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Modified radical neck dissection
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What is the most common cancer of the oral cavity, pharynx, and larynx?
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squamous cell CA
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What are the two biggest risk factors for squamous cell CA of the oral cavity, pharynx and larynx?
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tobacco and ETOH
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What is considered more pregmalignant, leukoplakia or erythroplakia?
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erythroplakia
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What is the most common site for oral cavity CA?
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lower lip
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What location for oral cavity cancer has the lowest survival rate because it is hard to resect?
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hard palate tumors
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Glossitis, cervical dysphagia from esophageal web, spoon fingers, iron deficiency anemia and increased oral cavity CA
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Plummer-Vinson Syndrome
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In the tx for oral cavity CA. Wide resection if tumor is < ___, need 1-2 cm margins.
If larger or if clinically positive nodes do what? |
2 cm
MRND |
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What is the postop tx for oral cavity CA for advanced lesions (>2 cm, positive margins, nerve/vascular/lymphatic invasion)?
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XRT
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What location with lip CA is associated with more aggressive lesions?
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commissure
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Well-differentiated tumor of the cheek • Not aggressive • Tx: full cheek resection +/− flap; no MRND
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Verrucous ulcer
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What is the tx for cancer of the maxillary sinus?
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maxillectomy
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What is the primary tx for nasopharyngeal SCCA? and what for tumors > 2 cm or clinically positive nodes?
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XRT, MRND with postop chemo for advanced disease
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What is the #1 tumor of the nasopharynx in children and what is the tx?
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lymphoma, chemo
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What is the most common benign neoplasm of the nose/paranasal sinuses?
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papilloma
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What is the best way to bx tonsillary CA?
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tonsillectomy
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Benign tumor • Presents in males < 20 years (obstruction or epistaxis) • Extremely vascular • Tx: angiography and embolization (usually internal maxillary artery), followed by resection
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Nasopharyngeal angiofibroma
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What is the most common benign lesion of the larynx?
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papilloma
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What are the three locations for laryngeal cancer?
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Supraglottic SCCA
Glottic SCCA Subglottic SCCA |
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What is the tx for small laryngeal cancer?
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XRT or conservative surgery (glottic is laser or chordectomy with recurrence)
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What are the three treatments for large laryngeal cancer?
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laryngectomy, MRND, post op XRT
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With glottic laryngeal cancer, what treatment is required for fixed cords?
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laryngectomy
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What is the most frequent salivary gland for malignant tumor?
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parotid
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Is a mass in a large salivary gland more likely benign or malignant? and a small salivary gland?
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mass in large gland is more likely benign
mass in small glands is more likely malignant |
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What is the #1 type of malignant tumor of the salivary gland?
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Mucoepidermoid CA
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What is the #2 type of malignant tumor of the salivary glands and the #1 malignant salivary tumor of the minor salivary glands?
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Adenoid cystic CA
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Tx for malignant tumor of the salivary gland is resection of the gland and if high grade or SCCA what are 2 other additional treatments?
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prophylactic MRND and postop XRT
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With parotidectomy when should the facial nerve be sacrificed?
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facial nerve should be sacrificed only for direct tumor invasion or for preexisting facial paralyses
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What is the #1 benign tumor of the salivary glands? what
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pleomorphic adenoma
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What percentage of pleomorphic adenoma have malignant degeneration?
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5%
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What is the difference in tx for pleomorphic adenoma and one with malignant degeneration?
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superficial parotidectomy for pleomorphic adenoma and total parotidectomy with malignant degeneration with MRND if high grade
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What is the #2 benign tumor of the salivary glands?
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Warthin's tumor
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What sex preference for Warthin's tumor? what percent are bilateral?
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males, 10%
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What is the tx for Warthin's tumor?
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superficial parotidectomy
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What is the most common injured nerve with parotid surgery and what is the sx?
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greater auricular nerve, numbness over lower portion of auricle
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For submandibular gland resection what three nerves need to be found?
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mandibular branch of the facial nerve, lingual nerve and hypoglossal nerve
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What is the most common salivary gland tumor in children?
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hemangiomas
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The facial nerve runs between what two lobes of the parotid gland?
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superficial and deep
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What is the physiology of cauliflower ear? and tx?
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undrained hematomas that organize and calcify; need to be drained to avoid this
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What is the name of a vascular tumor of the middle ear (paraganglionoma), tx: surgery and +/- XRT
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chemodectomas
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CN VIII, tinnitus, hearing loss, unsteadiness; can grow into cerebellar/pontine angle. Tx: craniotomy and resection; XRT is alternative to surgery
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Acoustic neuroma
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Epidermal inclusion cyst of ear; slow growing but erode as they grow; present with conductive hearing loss and clear drainage from ear. Tx: surgical excision.
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Cholesteatoma
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20% of Ear SCCA metastasize to where?
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parotid gland
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What is the most common childhood aural malignancy (although rare) of the middle or external ear?
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rhabdomyosarcoma
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What is the tx for septal hematoma?
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need to drain to avoid infection and necrosis of septum
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What is the tx for nasal fractures?
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set after swelling decreases
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CSF rhinorrhea usually indicates what fracture?
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cribiform plate
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CSF rhinorrhea tx is conservative for how long? then try epidural catheter, may need transethmoid repiar.
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2-3 weeks
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What percentage of epistaxis is anterior and can be controlled with packing?
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90%
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Persistant posterior epistaxis, consider ligation (direct or angiographically) of what two arteries?
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internal maxillary artery or ethmoid artery
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Slow-growing odontogenic malignancy; soap bubble appearance on xray; can have metastases. Tx: wide-local excision.
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Ameloblastoma
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Treatment for TMJ dislocation?
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closed reduction
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What nerve damage can cause lip numbness?
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inferior alveolar nerve
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What is the tx for Stensen's duct laceration? why not ligation?
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repair over catheter stent. Ligation can cause painful parotid atrophy and facial asymmetry
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What is the most common organism is suppurative parotitis?
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staph
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Tx for suppurative parotitis includes fluids, salivation, antibiotics; and ___ if abscess develops or pt not improving.
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drainage
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Acute inflammation of the salivary gland related to a stone in the duct; most calculi near orifice. Recurrent is thought to be due to ascending infection from the oral cavity. 80% of the time affects the submandibular or sublingual glands.
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Sialoadenitis
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What is the tx for sialoadenitis? and for recurrent disease?
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incise duct and remove stone, gland excision may eventually be necessary for recurrent diesease
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What age group is peritonsillar abscess more common? and retropharyngeal abscess?
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older kids (>10 years), younger kids (<10 years)
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Which is an airway emergency peritonsillar abscess or retropharyngeal abscess?
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retropharyngeal abscess
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Retropharyngeal abscess is usually seen in younger kids but can be seen in the elderly with what disease?
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Pott's disease
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What is the 1st tx for peritonsillar abscess? and if no relief in 24 hrs?
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Needle aspiration 1st, then drainage through tonsillar bed if no relief in 24 hours May need to intubate to drain; will self-drain with swallowing once opened
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Retropharyngeal abscess is an airway emergency. What is the tx?
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Intubate the patient in a calm setting; drainage through posterior pharyngeal wall; will self-drain with swallowing once opened.
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What age group does parapharyngeal abscess occur in?
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all age groups
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Morbitity in parapharyngeal abscess comes from ___ and mediastinal spread via prevertebral and retopharyngeal spaces.
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vascular invasion
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Tx for parapharyngeal abscess includes drainage through lateral neck to avoid damaging what 2 structures? will need to leave drain in.
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internal carotid and internal jugular veins
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Acute infection of the floor of the mouth, involves mylohyoid muscle • Most common cause is dental infection of the mandibular teeth • May rapidly spread to deeper structures and cause airway obstruction • Tx: airway control, surgical drainage, antibiotics
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Ludwig's angina
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All lumps near ear are what until proven otherwise?
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parotid tumors
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What is the most common distant metastases location for head and neck tumors?
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lung
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With posterior neck masses, if no obvious malignant epithelial tumor, considered to have what until proven otherwise? and how to dx?
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Hodgkin's lymphoma, FNA or open bx
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Neck mass workup:
• 1st – history and exam, laryngoscopy, antibiotics if thought to be inflammatory, ___ if hard • 2nd – panendoscopy with multiple random biopsies, neck and chest CT • 3rd – still cannot figure it out → perform ____; need to be prepared for MRND |
FNA, excisional biopsy
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Adenocarcinoma found in neck mass workup suggests what 3 possible primaries?
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breast, GI or lung
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Epidermoid CA found in cervical node without known primary
• 1st – ___ with random biopsies • 2nd – CT scan • 3rd – still cannot find primary → ipsilateral MRND, ipsilateral tonsillectomy, bilateral ___ |
panendoscopy,
XRT |
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What is the most common location for esophageal foreign body (95%)?
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just below the cricopharyngeus
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Perforation risk with esophageal foreign body increases with what?
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length of time in the esophagus
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Fever and pain after rigid EGD for esophageal foreign body. What next?
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CXR and gastrografin followed by barium swallow to rule out perforation
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Laryngeal foreign body, what might be needed as a last resort to secure airway?
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cricothyroidotomy
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Lip lacerations – apposition of the ___ is key. ___ closure is preferred
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vermillion border, Layered
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Prolonged intubation – can lead to ___, which is treated with laser, dilatation, possible excision
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subglottic stenosis
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Tracheostomy should be considered in any pt who will require intubation for more than how many days?
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7-14
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Tracheostomy decreases secretions, provides easier ventilation, and decreases what other risk?
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pneumonia risk
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Rapid exsanguination after tracheostomy, think what? and do what?
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tracheo-innominate fistula, median sternotomy
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Tracheo-innominate fistula can be avoided by keeping tracheostomy above what?
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3rd tracheal ring
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Median rhomboid glossitis is failure of tongue fusion. What is the tx?
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none necessary
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Cleft lip should be repaired at how many weeks, how many pounds and with a Hgb of what? Repair nasal deformities at the same time.
Cleft palate should be repaired at what age? |
10 weeks, 10 lb, Hgb 10.
12 months |
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What is the most common benign head and neck tumor in adults?
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hemangioma
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Thumbprint sign on lateral neck film indicates what?
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Epiglottitis
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Why is epiglottits rare?
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H. influenzae type B vaccine
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What is the tx for epiglottitis?
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early control of airway and abx
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What are the most common sites for Kaposi's sarcoma?
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oral and pharyngeal mucosa
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What is the most common neoplasm in pts with AIDS?
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Kaposi's sarcoma
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What are the 2 treatments for Kaposi's sarcoma?
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XRT and intratumor vinblastine
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