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HNN > Cervical Lymph Nodes + Other Neck Lumps > Flashcards

Cervical Lymph Nodes + Other Neck Lumps Flashcards

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1
Q

Role of the lymphatic system

A
  • remove excess fluid from interstitial space
  • restores small proteins + fluid that leaked from capillaries to veins
  • immune defence + surveillance
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2
Q

What are clinical manifestations of diseases involving the lymphatic system?

A

Lymphadenopathy
Lymphoedema

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3
Q

What is lymphadenopathy?

A

Enlarged lymph nodes due to infection/inflammation or malignancy

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4
Q

Where can you palpate enlarged lymph nodes?

A

Cervical (Neck)
Axilla
Inguinal (Groin)

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5
Q

What is Waldeyer’s ring?

A

Annular collection of lymphoid tissue surrounding upper aero digestive tract (tonsils)

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6
Q

What lymph nodes can be palpable in well children?

A

Cervical lymph nodes

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7
Q

What are the different tonsils?

A

Pharyngeal tonsil/adenoids
Tubal tonsils
Palatine tonsils
Lingual tonsil

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8
Q

Location of pharyngeal tonsil + tubal tonsils

A

In nasal pharynx

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9
Q

Location of palatine tonsils

A

At back of throat

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10
Q

Location on lingual tonsil

A

Posterior surface of the tongue

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11
Q

What can enlargement of pharyngeal tonsil lead to?

A
  • Obstruction of nasal breathing: mouth breathing, snoring
  • Blockage of eustachian tube > middle ear problems
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12
Q

What is tonsillitis?

A

Enlargement of palatine tonsils

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13
Q

Is tonsillitis most commonly caused by viruses or bacteria?

A

Viral

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14
Q

What bacteria most commonly causes tonsillitis?

A

Strep pyrogenes

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15
Q

What two tools can be used to estimate the probability that tonsillitis is due to bacterial infection?

A

Centor criteria
FeverPAIN score

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16
Q

Outline the Centor criteria
What is it used for?

A
  • Used to estimate the probability that tonsillitis is due to bacteria
  • score >3 = 40-60% chance > offer antibiotics
    .
  • fever >38C
  • tonsillar exudates
  • absence of cough
  • tender anterior cervical lymph nodes
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17
Q

Outline the FeverPAIN score
What is it used for?

A
  • Used to estimate the probability that tonsillitis is due to bacteria
  • score 2-3 = 34-40% chance
  • score 4-5 = 62-65% chance
    .
  • fever
  • Pus on tonsils
  • Attended within 3 days of onset of symptoms
  • Inflamed tonsils
  • No cough
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18
Q

Treatment of bacterial tonsillitis

A

phenoxymethylpenicillin for 10 days
clarithromycin is penicillin allergy

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19
Q

Complications of tonsillitis

A
  • peritonsillar abscess
  • otitis media
  • scarlet fever
  • rheumatic fever
  • post-streptococcal glomerulonephritis
  • post-streptococcal reactive arthritis
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20
Q

Outline superficial/regional cervical lymph nodes

A
  • In superficial cervical fascia, just beneath skin
  • Drains regions of face, scalp + tongue into deeper lymph nodes
  • Form a ring from chin to occiput
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21
Q

Outline deep/terminal cervical lymph nodes

A
  • Most associated with IJV within carotid sheath
  • Drain lymph from superficial lymph nodes + directly from deeper tissues e.g. thyroid gland
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22
Q

What is the bony prominence of chin?

A

Mental protuberance

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23
Q

What is the bony protuberance of the occipital bone?

24
Q

What are the superficial cervical lymph nodes draining the face + scalp?

Study These Flashcards
A
  • submental
  • submandibular
  • pre-auricular + parotid
  • post-auricular
  • occipital
  • superior cervical
  • posterior cervical
  • anterior cervical
25
What do the occipital lymph nodes drain?
Posterior scalp
26
What do the post-auricular lymph nodes drain?
Posterolateral half of scalp
27
What do the pre-auricular (+parotid) lymph nodes drain?
Anterolateral scalp Upper half face including eye lids (conjunctiva) Cheek
28
What do the submental lymph nodes drain?
Inferior + posterior chin Floor of mouth Tip of tongue Lower incisor teeth + gums
29
What do the submandibular lymph nodes drain?
Centre of face + cheek Teeth + gums Anterolateral tongue
30
What are the deep cervical lymph nodes?
- jugulo-digastric - jugulo-omohyoid - supraclavicular
31
What do jugulo-omohyoid lymph nodes drain?
Part of tongue Oral cavity Trachea Oesophagus Thyroid gland 3Ts 2Os
32
What deep cervical lymph nodes are found in the posterior triangle?
Supraclavicular lymph nodes
33
Why is there reason to worry in the case of supraclavicular lymphadenopathy?
Strong suspicion of malignancy
34
What is an enlarged left supraclavicular lymph node suggestive of?
Gastric cancer
35
How do reactive lymph nodes feel (non cancerous)?
Tender Mobile - doesn’t feel stuck to surrounding tissues
36
What features of enlarged lymph nodes suggests metastases?
Hard Tethered to surrounding tissues Painless to palpation
37
What features of enlarged lymph nodes suggests lymphoma?
**malignant** Rubbery Painless to palpation Fast growing
38
What are red flags for lymphadenopathy?
- on palpation: **fixed, hard, irregular** - **rapidly grows** in size - associated with generalised lymphadenopathy - systemic signs: **weight loss, night sweats** - associated with **persistent unexplained changes in voice, difficultly swallowing**
39
History for neck lumps
Age Duration Progression Associated symptoms Potential risk factors
40
Examination of neck lumps
- **Location**: midline, anterior or posterior triangle - **Movement with swallowing** - **Movement with sticking out tongue**
41
Palpation feature of neck lump
- superficial or deep - mobile or fixed - hard, soft, rubbery, irregular - does it feel fluctuant? Filled with fluid - tender? - overlying skin changes
42
Possible causes of neck lumps
- cervical lymphadenopathy - benign lesions of skin or subcutaneous tissue - congenital lesions - thyroid gland pathology - salivary gland pathology - vascular - dermoid cyst - branchial cyst
43
What do the jugulo-digastric lymph nodes drain?
- tonsils - pharynx - part of tongue
44
What should you do if the submental or submandibular lymph nodes are enlarged?
**Check mouth** - teeth - gum - tongue: tip, top, bottom
45
What could a midline neck lump be?
Dermoid cyst Thyroglossal duct cyst Pathology of the thyroid gland
46
Outline a dermoid cyst
- Congenital cystic teratoma - Sits high on midline of neck - teratoma > can contain hair, teeth or skin glands
47
Outline a thyroglossal duct cyst?
- congenital filled sac in the midline of the neck - moves superiorly with protrusion of the tongue - surgical removal (includes removal of hyoid bone)
48
What could a lateral lump in the neck be?
- pathology of salivary glands - carotid body tumour - branchial cysts - cystic hygroma
49
What is a cystic hygroma?
- collection of fluid filled sacs - in posterior triangle - compressible + transilluminable - often in young children
50
Management of cystic hygroma
Surgical excision Drainage
51
Who do cystic hygromas occur in?
Infants + young children
52
Outline a branchial cyst
- congenital cyst on anterior superior SCM - originates from incomplete obliteration of branchial arches
53
Investigations of neck lumps
- **Ultrasound** first line - Fine needle aspiration if suspicious - CR or MRI scans if needed further
54
What is the best imaging for neck lumps?
Ultrasound
55
What is a neck lump moves on sticking out the tongue indicative of?
Thyroglossal duct cyst
56
A patient, presenting with a neck lump, complains of pain after eating. What is the likely diagnosis?
Salivary gland pathology
57
A patient has a neck lump that moves on swallowing, what is the likely diagnosis?
**Goitre** (thyroid gland swelling)

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