Neck Lump

Question 1

Lymphadenitis

Answer 1

. inflammation of the lymph glandular tissues

Question 2

Lymphoma

Answer 2

Swelling of lymph (canceR)

Question 3

NHL stands for

Answer 3

Non-hodkin’s lymphoma

Question 4

FNA stands for

Answer 4

. Fine needle aspiration

. Technique used around neck to get sample of lymph node for review

Question 5

Virchow’s node

Answer 5

. Left supraclavicular nodes

. Indication of mediastinal/chest/stomach metastatic cancer

Question 6

Categories of head and neck masses

Answer 6

. Congenital 
. Neoplastic
. Traumatic 
. Metabolic 
. Infectious 
. Psychogenic/psychosomatic

Question 7

Examination techniques for head and neck

Answer 7

. Inspection
. Palpation (no percussion of neck, only sinuses)
. Auscultation for bruits and airways

Question 8

Anatomic great vessels of the neck

Answer 8

. R/L External jugular v. (Ant. To SCM)
. R/L common carotid a. (Deep to SCM)
. Sternomastoid mm.
.find internal jugular for placing central venous line in neck (lat. to carotid)

Question 9

Contents of anterior triangle of neck

Answer 9

. Mandible, SCM, midline of neck (hyoid, thyroid cartilage, circoid cartilage, tracheal rings, and thyroid gland)

Question 10

Contents of post. Triangle of neck

Answer 10

. SCM
. Trapezius
. Clavicle
. Omohyoid m.

Question 11

Cervical lymph nodes

Answer 11

. Pre and post. Auricular 
. Occipital 
. Tonsillar 
. Sumandibular 
. Submental 
. Superficial and deep cervical (chain)
. Post. Cervical 
. Supraclavicular 
. Examine cranial to caudal

Question 12

Concerning head and neck symptoms

Answer 12

. Headache
. Sore throat 
. Swollen glands 
. Goiter
. Hoarseness

Question 13

Acute hoarseness potential diagnoses

Answer 13

. Viral laryngitis
. Bacterial pharyngitis
. Voice overuse
. Neck trauma

Question 14

Chronic hoarseness differential diagnoses

Answer 14

. Over 2 weeks 
. Hypothyroid
. GERD
. Vocal cord nodules 
. Cancer 
. Parkinson’s 
. Horner’s syndrome (n. Impingement) 
. Myasthenia Gravis
. Amyotrophic lat. sclerosis

Question 15

Thunder clap headache

Answer 15

. Worst headache of life
. Indicative of subarachnoid hemorrhage
. order CT scan of head w/o contrast
. If neg. then spinal tap for blood

Question 16

Warning signs of cancer

Answer 16

. Fever
. Night sweats
. Weight loss

Question 17

Hyperthyroidism

Answer 17

. High levels T3/4
. Symptoms: nervousness, weight loss, excessive sweating, heat intolerance, palpitations, frequent bowel movements, tremors and/or proximal muscle weakness

Question 18

Graves’ disease

Answer 18

. Hyperthyroidism 
. Eye changes (staring, lid lag, exophthalmos)
. Tachycardia 
. Accentuated S1 
. Tremors and prox. Muscle weakness

Question 19

Hypothyroidism

Answer 19

. Low T3/4
. Fatigue
. Weight gain
. Cool, dry, yellow skin
. Cold intolerance 
. Swelling of hands/face/legs (nonpitting edema)
. Constipation 
. Muscle cramps 
. Impaired memory/hearing loss 
. Bradycardia 
. Peripheral neuropathy 
. Diminished ankle reflexes

Question 20

Primary hypothyroidism

Answer 20

. Failure of thyroid gland itself
. Low T3/4
. High TSH and TRH
. Most common

Question 21

Secondary hypothyroidism

Answer 21

. Pituitary disease causing reduced TSH
. Rare
. Low T3/4 and TSH
. High TRH

Question 22

Tertiary hypothyroidism

Answer 22

. Hypothalamic disease causing dec. TRH
. Most rare
. Low T3/4, TSH, and TRH

Question 23

Lymphadenopathy

Answer 23

. In ant. Chain: infectious

. In post. Chain: infectious, TB, lymphoma, other neck/head malignancy

Question 24

Lymphoma

Answer 24

. NHL or Hodkins
. Painless nodules
. Rule out infectious causes first

Question 25

Brachial cleft cyst

Answer 25

. 20% pediatric neck masses | . Infected cyst and ant. Lymph nodes

Question 26

Thyroglossal duct cyst

Answer 26

. Midline mass of ant. Neck | . Present as infected cyst/URTI

Question 27

Cat scratch disease

Answer 27

. Infection w/ bartonella henselae from cat scratch/bite . Has primary papule where bite occurred . Regional lymphadenopathy that is tender in periacuricular, submandibular, or cervical nodes . Treatment: Azithromycin

Question 28

Types of enlargement of thyroid and most common differentials w/ each type

Answer 28

. Diffuse: graves, hashimoto, endemic goiter . Single node: malignancy vs. benign growth . Multnodular goiter: metabolic disarrangement vs. malignancy . Get us initially, then FNA biopsy

Question 29

Enlargement of parotid gland differentials

Answer 29

. Acute bilateral: mumps . Acute unilateral: blocked duct stone (sialolithiasis) . Acute/chronic unilateral: neoplasm . Chronic bilateral: obesity, DM, cirrhosis

Question 30

Posterior cervical space contents

Answer 30

``` . Fat . Accessory N. XI . Brachial plexus . Lymph nodes . Remnants 3rd branchial pouch ```

Question 31

Posterior cervical space pathology

Answer 31

``` . Lipoma . Schwannoma, neurofibromas . Lymphoma . Cystic hygroma, lymphangioma . 3rd branchial cleft cyst ```

Question 32

Bacterial pharyngitis

Answer 32

``` . Swollen uvula . White spots . Red, swollen tonsils . Throat redness . Gray, furry tongue ```

Question 33

Viral pharyngitis

Answer 33

. Red, swollen tonsils | . Throat redness