Adult Neck Masses Flashcards

1
Q

an abnormal lesion, congenital or acquired that is visible, palpable, or seen on an imaging study below the mandible, above the clavicle and deep to the skin

A

neck mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

fluctuating in size = ___

persistently enlarging = ___

A

fluctuating = inflammatory or congenital

persistently enlarging = malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

age difference in ddxs

A

pedia: inflammatory, congenital > neoplasm
adult: neoplasm > inflammatory, congenital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

t/f adult neck mass should be considered malignant unless proven otherwise

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

detailed examination of the mass

A
appearance
borders
consistency and color
dimensions
extent
fixation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

borders of anterior triangle

A
S inferior border of mandible
L anterior border of the scm
M sagittal line down the midline of the neck
R investing fascia
F visceral fascia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

borders of carotid angle

A

S posterior belly of digastric muscle
L medial border of scm
I superior belly of omohyoid muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

contents of carotid triangle

A

common carotid artery
internal jugular vein
hypoglossal nerve
vagus nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

borders of submental triangle

A

I hyoid bone
M midline of neck
L anterior belly of digastric muscle
F mylohyoid muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

contents of submental triangle

A

submental lymph nodes (filters lymph from floor of mouth and tongue)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

borders of submandibular triangle

A

S body of mandible
A ant belly of digastric
P posterior belly of digastric

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

contents of submandibular triangle

A

submandibular gland and lymph nodes

facial artery and veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

borders of muscular triangle

A

S hyoid
M imaginary midline of neck
SL superior belly of omohyoid muscle
IL inferior portion of scm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

contents of muscular triangle

A

infrahyoid muscle
pharynx
thyroid gland
parathyroid gland

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

most vital structures in ant triangle

A

thyroid gland
carotid and jugular
submandibular
lymphatics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

borders of posterior triangle

A

A posterior border of scm
I middle 1/3 of clavicle
P ant border of trapezius

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

muscle that splits post triangle into 2 triangles

A

omohyoid muscle -> occupital triangle and subclavian triangle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

level 1 of lymph

submental and submandibular

A

lip, oral cavity, skin of lower face

19
Q

level 2 of lymph

upper jugular

A

oropharynx (tonsil and tongue)

parotid gland

20
Q

level 3 of lymph

mid jugular

A

hypopharynx and thyroid gland

21
Q

level 4 of lymph

supraclavicular

A

larynx, hypopharynx, thyroid, non-head or neck sits (lung, breast, gi, gu)

22
Q

enlarged __ indicated abdominal malignancy

A

virchow’s node

23
Q

level 5 of lymph

post triangle

A

scalp, lymphoma, nasopharynx

24
Q

level 6 of lymph

paratracheal

A

thyroid and larynx

25
Q

nasopharynx pe

A

e tube orifices, superior and posterior walls through nasal endoscopy

26
Q

hypopharynx pe

A

pyriform sinuses and post pharyngeal wall

27
Q

most frequently used modality for adults

A

ct scan (adults > pedia)

28
Q

uts is more used in ___

A

pedia and thyroid nodules

can distinguish between solid and fluid filled masses

29
Q

when to use mri

A
  • most detailed anatomic soft tissue info

- best for salivary gland masses and determination of perineural extension

30
Q

when to use mra/cta

A

vascular structures (vascular tumors)

31
Q

what does pet scan do

A
  • functional imaging
  • bright spots = cells with higher metabolic rate
  • detection and surveillance of h&n cancer
32
Q

indications for pet scan

A
  • detection of unknown primary tumor site
  • tumor staging
  • radiotherapy planning
  • treatment response assessment
  • detection of recurrent disease
33
Q

initial method for obtaining pathologic tissue sample of neck mass

A

fna biopsy

34
Q

t/f there is no need to prepare a cell block

A

false, lymphoma is always a concern so always prepare cell block

35
Q

indications for fna

A
  • single asymmetric node >1.5 cm
  • persistent enlarged node without prior signs of active infection
  • persistence after trial of antibiotics and observation >2-4 wks
  • increasing size of mass
36
Q

local s/sx for infection

A
  • warmth
  • erythema of overlying skin
  • localized swelling
  • tenderness to palpation
37
Q

if (+) for infection ___

A

empiric broad spectrum antibiotic therapy (2 wks)

38
Q

if (-) for infection ___

A

determine signs of increased risk for malignancy, don’t give antibiotics

39
Q

increased risk for malignancy

A
  • lack of hx of infectious etiology
  • present >2 wks without significant fluctuation
  • uncertain duration
  • > 1 of ff:
    fixation to adjacent tissues, firm consistency, size >1.5 cm, ulceration of overlying skin
40
Q

other suspicious findings on hx and pe

A

read

41
Q

when to refer

A
  • mass does not resolve within 2-4 wks following antibiotics
  • sus malignant
  • mass with rapid enlargement w/ or w/o inflammation
  • thyroid/ salivary mass
  • fixed mass
42
Q

indications for open biopsy

A
  • > 2 cm and growing
  • low cd4
  • asymmetric, unilateral, or localized lymphadenopathy
  • constitutional symptoms of unknown origin
  • mediastinal adenopathy
  • hepatosplenomegaly
43
Q

t/f incision biopsy should be avoided for metastatic sq cell carcinoma

A

true, look for the primary tumor, refer to specialist

44
Q

management

A
  • surgical
  • chemo for lymphoma
  • tb meds for tb adenitis
  • antibiotics for bacterial lymphadenitis