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Which muscle is innervated by the external branch of the superior laryngeal nerve?
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A. Posterior cricoarytenoid
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B. Lateral cricoarytenoid
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The cricothyroid muscle is the only muscle of the larynx innervated by the external branch of the superior laryngeal nerve. All other laryngeal muscles are innervated by the recurrent laryngeal nerve.
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A 48-year-old male with massive head trauma does not have a gag reflex. Which nerve is responsible for the sensory nerve fibers that carry this reflex?
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A. Marginal mandibular nerve
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B. Recurrent laryngeal nerve
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D. Glossopharyngeal nerve
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The afferent limb of the gag reflex comes from the glossopharyngeal nerve (cranial nerve IX).
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The most common cause of a neck mass in males over the age of 60 is:
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Most neck masses in males over the age of 60 are as a result of metastatic spread from cancers in the chest and abdomen. These cancers frequently metastasize via lymphatic spread, and the most common location for the neck mass is within the supraclavicular fossa.
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A 2nd year Internal Medicine resident stops you in the hall with a painless, 2-cm, slowly enlarging parotid mass. What does this most likely represent?
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D. Mucoepidermoid carcinoma
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E. Adenoid cystic carcinoma
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Pleomorphic adenomas are the most common benign salivary gland tumors, comprising 85% of all salivary gland neoplasms. Tumors of the parotid gland are the most common of the salivary gland tumors with a 5 × higher incidence than tumors of the minor salivary glands. The vast majority of tumors of the parotid gland are benign in nature.
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A 14-year-old boy presents to the ER with epistaxis after being struck in the face with a baseball. Examination reveals a compressible, nontender mass involving the nasal septum. What is the most common complication resulting from this condition?
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B. Cavernous sinus thrombosis
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The physical examination reveals findings consistent with a nasal septal hematoma. The most common complication of this condition is a saddle-nose deformity as a result of avascular necrosis from an infected septal hematoma.
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You are admitting a patient in the ER and previous records indicate she underwent a radical neck dissection. This means she has had:
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A. An excisional biopsy of a neck mass
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B. Some of the lymph nodes removed in the anterior and posterior neck triangles
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C. All the lymph nodes removed but no vital structures removed from her neck
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D. All the lymph nodes removed and the spinal accessory nerve, the internal jugular vein, and the sternocleidomastoid removed
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E. All the lymph nodes removed and the spinal accessory nerve, the internal jugular vein, external carotid artery, and the sternocleidomastoid removed
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A radical neck dissection includes removal of all the ipsilateral lymph nodes from levels I through V along with the spinal accessory nerve, the sternocleidomastoid muscle, and the internal jugular vein. A modified radical neck dissection removes all the lymph nodes but preserves one or all of the nonlymphatic structures.
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What is the treatment for a Warthin tumor?
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C. Total parotidectomy with resection of the facial nerve
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D. Total parotidectomy with postoperative radiation
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E. Superficial parotidectomy
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A Warthin tumor is the second most common benign tumor of the parotid gland. It has an extremely low rate of malignant transformation (0.3%) as well as a low risk of recurrence (1.8% after local excision). The treatment is superficial parotidectomy, sparing the facial nerve. Simple enucleation is avoided because it increases the risk of recurrence and facial nerve injury.
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A 72-year-old man presents with a painless, gradually enlarging mass in the region of the left parotid with facial asymmetry and left-sided facial weakness. Following physical examination, what is the next step?
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A. Superficial parotidectomy
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B. Total parotidectomy with modified radical neck dissection
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C. Fine-needle aspiration (FNA) of the mass and MRI of the head and neck
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D. Esophagogastroduodenoscopy and colonoscopy
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E. Complete metastatic work-up
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The next step in the work-up includes an FNA and MRI of the head and neck. Given the patient’s age and symptoms, tissue diagnosis is required for definitive diagnosis and MRI is necessary to evaluate the extent of disease. Local spread is common, but the incidence of metatatic disease with malignant salivary gland tumors is rare.
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Following parotidectomy your patient has sweating in his retroauricular region while eating. This is most likely caused by:
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B. Cross-innervation of the vagus and sympathetic nerves to the skin
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C. Cross-innervation of the auriculotemporal nerve and sympathetic nerves to the skin
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D. Cross-innervation to the glossopharyngeal nerve and sympathetic nerves to the skin
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Gustatory sweating following parotidectomy is known as Frey’s syndrome. Injury to the auriculotemporal nerve can occur during parotid surgery. The auriculotemporal nerve carries sympathetic fibers to the sweat glands of the scalp and parasympathetic fibers to the parotid gland. Following injury and subsequent regeneration, the fibers can cross-innervate leading to gustatory sweating.
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A 10-year-old boy presents with a cyst and a cyst tract near the angle of his mandible. This cyst has had recurrent infections in it. This cyst most likely connects to the:
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A. External auditory canal
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First branchial cleft cysts typically originate at the angle of the mandible and often extend to the external auditory canal. Second branchial cleft cysts are found along the anterior border of the sternocleidomastoid muscle and connect with the tonsillar pillar.