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BDS2; CHHD > Swellings of the head and neck > Flashcards

Swellings of the head and neck Flashcards

1
Q

Describe the anatomy of the neck

A

2 triangles

  1. Anterior = below digastric, infront of sternomastoid
  2. Posterior = behind sternomastoid, infront of trapezius and above clavicle
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2
Q

What is haematoma

A

Collection of blood as a result of trauma

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3
Q

What are pyogenic bacterial infections

A

Those that cause the collection and production of pus

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4
Q

What is lymphadenitis

A

Enlargement of one or more lymph nodes due to bacterial infection

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5
Q

What is acute pyogenic lymphadenitis

A

Collection of pus and enlargement of lymph nodes due to bacterial infection caused by skin infection of Staph. aureus or pharyngitis by group A strep. (occurs mainly in children) This causes swelling in cervical lymph nodes

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6
Q

What are suppurative bacterial infections

A

Those that cause exudate formation and discharge

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7
Q

What is sialadenitis

A

Inflammation of one or more salivary glands

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8
Q

What is suppurative sialadenitis caused by

A

Staph. aureus

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9
Q

What is tubercular CL

A

Acquired lymphadenopathy where the patient

  • coughs blood
  • has weight loss
  • night sweats
  • shortness of breath
  • fever + tiredness
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10
Q

What is syphilitic CL

A 
Acquired lymphadenopathy where the patient has
- painless oral ulceration
- general rash
- tiredness and fever
Resulting from secondary syphilis
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11
Q

What is German measles

A

Acquired lymphadenopathy where the patient has the rubella virus causing

  • red rash
  • fever
  • swollen lymph nodes
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12
Q

What is infectious mononucleosis

A

Glandular fever caused by EBV where patient has

  • sore throat
  • fever
  • tiredness
  • enlarged lymph nodes
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13
Q

What is mumps

A

Viral infection causing

  • fever
  • muscle ache
  • poor apetite
  • swelling of the parotid salivary glands
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14
Q

What is orofacial granulomatosis

A

An immunological lymphodenopathy where there is persistent enlargement of oral soft tissues causing
- angular chelitis
- gingivitis
- swollen lips
Commonly, these patients will have Crohn’s disease

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15
Q

What is acute lymphoblastic leukaemia

A

Commonly found in children and presents as
- fever
- lethargy
- bruising and bleeding tendencies
- muscular skeletal pain
- recurrent infections
Lymphadenopathy is found on investigation and there is enlarged lymph nodes in the neck as well as hepatosplenomegaly (liver and spleen enlargement)

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16
Q

How does lymphoma present

A

Hodgkins and non-hodgkins shows painless enlargement of lymph nodes in the neck groin or armpit area as well as

  • tieredness
  • night sweats
  • weight loss
  • bone pain
  • flu like symptoms
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17
Q

What is the most common type of head and neck cancer

A

Squamous cell carcinoma (because squamous epithelium lines the mouth nose and throat)

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18
Q

What is an epidermal cyst

A

A benign cyst found on the skin from ectodermal tissue which is made of a thin layer of squamous epithelium - this is on the floor of the mouth and is more prevalent in males 5-50years old

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19
Q

What is fibrous dysplasia

A

Benign body tumour occurring in craniofacial skeleton

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20
Q

What is a cervical rib

A

An additional rib arising from the 7th cervical vertebra; feels like a bony swelling in the neck

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21
Q

What is sialosis

A

Chronic bilateral diffuse non-inflammatory and non-neoplastic swelling of the parotid gland

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22
Q

How does connective tissue disease present in the head and neck

A

Swelling of the parotids/salivary glands

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23
Q

What type of drugs can cause lymph nodal swelling

A
  • antimalarials

- anti seizure

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24
Q

What is Kawasaki disease

A

Where the blood vessel is inflamed (usually <5 years old) and causes

  • high temperature
  • rashes
  • swollen neck glands
  • dry and cracked lips
  • red fingers, eyes and toes
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25
Q

What should be taken into consideration when palpating and examining a lump (10)

A
  1. Site
  2. Size
  3. Shape
  4. Surface (smooth or irregular)
  5. Texture
  6. Temperature
  7. Tenderness
  8. Surrounding tissue (is it attached)
  9. Mobility
  10. Drainage of lymph nodes
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26
Q

What are the 5 cystic lesions that can arise

A
  1. Branchial cyst
  2. Dermoid cyst
  3. Thyroglossal cyst
  4. Epidermal cyst
  5. Cystic hygroma/lymphangioma
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27
Q

What is a branchial cyst

A

Congenital epithelial cyst containing remnants from second branchial cleft within the lymph nodes on the upper part of the lateral neck beneath the anterior border of sternoclaelomastoid muscle

28
Q

Describe the clinical presentation of a branchial cyst

A

Seen in children and adolescents, asymptomatic, un-inflamed swelling

  • smooth, globular and tense
  • soft or fluctuant (because it is fluid filled)
29
Q

What is a thyroglossal cyst

A

It is an embryonic remnant of the thyroglossal duct and is due to the failure of complete descent of thyroid tissue from foramen caecum with subsequent cystification

30
Q

Describe the clinical presentation of a thyroglossal cyst

A

Seen in children and young adults, asymptomatic or infected

  • it is a midline swelling in neck above the thyroid
  • in the thyroid region the swelling is usually pushed to the LHS
  • the swelling moves on swallowing or tongue protrusion
31
Q

What is a dermoid cyst

A

It is made of epidermal and dermal components (keratinocytes, hair follicles, sweat glands) and this is seen in the submandibular space (lateral neck swelling) and floor of mouth above the mylohoid muscle (double chin) or midline of neck

32
Q

Describe the clinical presentation of a dermoid cyst

A

Swelling seen in the submandibular space (lateral neck swelling) and floor of mouth above the mylohoid muscle (double chin) or midline of neck

It is smooth, globular and tense, soft or fluctuant

33
Q

What is a lymphangioma/cystic hygroma

A

A proliferation of sequestrated lymphatic endothelium of the jugular sac

It is a congenital lymphatic lesion usually occurring on the left posterior triangle which contains a fluid filled sac due to blockage of the lymphatic system

34
Q

Describe the clinical presentation of a lymphangioma/cystic hydroma

A

Present at birth or manifests in infancy/childhood and is an asymptomatic un-inflamed swelling at the lower third of neck in the posterior triangle

It has a smooth, diffuse and tense surface, is spongy soft and translucent and the colour is lighter than the surrounding tissue

It is the only neck swelling that will transluminate when light is shone on it because it is fluid filled

35
Q

List the head and neck lymph nodes

A
  1. Preauricular
  2. Posterior auricular
  3. Occipital
  4. Superficial cervical (lower ear and parotid)
  5. Deep cervical (head+neck, scalp, ear, tongue, trachea, nasopharynx, nasal cavities, palate, oesophagus)
  6. Posterior cervical
  7. Supraclavical
  8. Submandibular (cheek, side of nose, lower lip, Gump, anterior tongue)
  9. Submental (lower lip, floor of mouth, apex of tongue)
  10. Tonsillar (jugulodigastric)
  11. Parotid
36
Q

Why do lymph nodes enlarge

A
  1. Increase in the number of cells: benign lymphocytes and macrophages in response to antigens
  2. Infiltration with cells
    - inflammatory cells in infection = lymphadenitis
    - proliferation of malignant lymphocytes/macrophages
    - metastatic malignant cells
    - metabolite laden macrophages (lipid storage disease)
37
Q

What characteristics of enlarged lymph nodes suggest a poor prognosis

A

If they are hard and firm, greater than 2cm large

- further investigations should be taken

38
Q

What is histoplasmosis

A

A fungal infection that causes cervical lymphadenopathy due to breathing in spores which can affect the lungs;

the patient presents with cough, fever, hemoptysis, tiredness, headaches and lymphadenopathy

39
Q

What is Langerhan’s histocytosis

A

Where there is excess tissue macrophages which collect in the lymph nodes causing cervical lymphadenopathy

40
Q

Which drug can cause cervical lymphadenopathy

A

Phenytoin

41
Q

What is a mucocutaneous lymph node

A

= Kawasaki disease; there is swelling and inflammation of blood vessels leading to cervical lymphadenopathy and this affects children under 5years

42
Q

What is sarcoidosis

A

This is an abnormal inflammatory response which causes collection of tissue and granulomas and can cause cervical lymphadenopathy

43
Q

Describe the clinical presentation of pyogenic lymphadenopathy

A

It can present as single or multiple painful nodules in association with dental abscesses and these have a smooth, diffuse and tense surface and are soft when acute and not fixed to the surroundings

44
Q

Describe the clinical presentation of infectious mononucleosis (viral lymphadenopathy)

A

Affects young adults, fever, malaise, sore throat

  • firm, discrete, tender and mobile lymph nodes
  • purport or petechiae in the palate
45
Q

How is infectious mononucleosis diagnosed

A
  1. Positive Paul-Brunnell test
  2. Positive Monospot slide test

Both of these are sensitive to hetrophile antibodies and this is what EBV produces once the B lymphocytes have been infected

46
Q

Describe the clinical presentation of tuberculous lymphadenopathy

A

Single or multiple swellings in lateral neck

  • indurated, asymptomatic, firm and fixed to surrounding
  • fever, malaise, night sweats, weight loss, persistent cough
  • the swelling undergoes necrosis to form collar-stud abscesses
  • ulcers on dorsum of tongue
47
Q

How can tuberculous lymphadenopathy be diagnosed

A
  1. Ziehl-Neelsen strain (test sputum for acid fast bacilli)
  2. Polymerised chain reaction (PCR)
  3. Mantoux test (latent TB injected, a small hard lump forms when there is latent TB)
  4. Culture on Lowenstein Jensen medium
  5. Biopsy and radiographs
48
Q

What are malignant lymphadenopathies

A

= proliferation of lymphocytes within nodal/extranodal sites

  • caused by Hodgkins/Non-Hodgkin’s lymphoma
  • EBV or Burkitt’s lymphoma
  • HIV
49
Q

Describe the clinical presentations of malignant lymphadenopathy

A

Arise in middle aged and elderly with exception of Burkitt’s lymphoma which is seen in children and young adults

  • single or bilateral swelling in lateral neck
  • asymptomatic and slowly enlarging
  • firm rubbery matted lymphnodes
  • fever, malaise, night sweats, weight loss
50
Q

How can malignant lymphadenopathy be diagnosed

A

Biopsy; look for Reed-Sternberg cells (Hodgkin’s)

Burkitt’s cells = Burkitt’s lymphoma

51
Q

How does metastatic carcinoma (malignant lymphadenopathy) present

A

Usually single but can be multiple swellings on one side of neck usually affecting middle aged and elderly

  • progressive increase in size
  • indurated masses, fixed to surrounding tissue, rocky hard and painless
52
Q

Where do metastatic carcinomas typically affect in the head and neck lymph nodes

A
  1. Submandibular LN

2. Jugulodigastric LN

53
Q

How can metastatic carcinomas be diagnosed

A
  • biopsy shows metastatic cells
54
Q

What symptoms are associated with cervical rib and why

A

Neurological = pain, paraesthesia, anaesthesia of forearm and hands - this is because it will commonly press on the branchial plexus

Vascular - excessive pulsation and thill in subclavian artery, arm pain, hands appear pale white and feel cold

55
Q

What is a lipoma and what are the clinical features of this

A

Benign tumour made of fat tissue (not as common in neck)

  • rare, slow growing, posterior neck
  • solo, semi-fluctuant, lobulated mass
  • painless and asymptomatic
  • appears yellow intra-orally
56
Q

Describe the manifestation of parotid lesions

A

A neck mass when the tail of the parotid is affected

57
Q

What is a Warthin’s tumour

A

A parotid neoplasm which is indurated, asymptomatic, and a unilateral hard lump

58
Q

What is Sjogren’s syndrome

A

A bilateral, diffuse parotid lesion with a soft swelling plus sicca complex - this presents as dry mouth, eyes and skin and severe tiredness

59
Q

What is metabolic sialosis

A

A multifocal bilateral, noninflammatory, non-neoplastic enlargement of the parotid salivary gland that is painless and common in alcoholics, diabetics, anorexics and those with nutritional deficiencies

60
Q

What is acute viral sialadenitis

A

Bilateral painful infection of the parotid gland causing systematic manifestations; fever, malaise, muscle aches, headaches, tiredness, poor apetite

61
Q

What can be seen in the intraoral examination of parotitis

A

Pus at papilla

62
Q

What is thyroid goitre

A

Midline neck swelling due to hyper/hypo thyroidism (can be diffuse or nodular)

63
Q

What is a thyroid nodule and describe its clinical presentation

A

It is an overgrowth of normal thyroid tissue and presents as a firm painless midline swelling in the area of the thyroid gland

64
Q

What is a carotid body tumour

A

A malignant proliferation of the carotid body cells (cluster of chemoreceptors and other cells) located at the bifurcation in the carotid artery

65
Q

Describe the clinical presentation of carotid body tumours

A

They are rare and affect adults, are usually benign and present as a firm movable mass in the neck at carotid bifurcation

It is painless and pulsatile but could cause compression effects on nerves supplying the face. It is typically a unilateral swelling in the lateral neck

66
Q

What is Horner’s syndrome and what is it associated with

A

This is where there is SNS nerve damage causing ptosis, anhydrosis and myosis

This is associated with carotid body tumours as they can lead to nerve compression

BDS2; CHHD (32 decks)

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