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ENT > neck lumps > Flashcards

neck lumps Flashcards

1
Q

Landmarks of the Neck: bones

A

Mastoid process
Mandible
Hyoid (C3)
Clavicles (_supra-sternal notch/fossa)

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2
Q

Landmarks of the Neck: muscles

A

Sternocleidomastoid

Trapezius

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3
Q

Landmarks of the Neck: glands

A

Thyroid
Parotid
Submandibular
Sublingual

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4
Q

Landmarks of the Neck: other

A
  • laryngeal prominence (Adam’s apple C4)
  • Cricothyroid Membrane (C5-C6)
  • Trachea (C6)
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5
Q

nerves of the neck

A
  • cervical plexus (C1-C4)
  • Brachial plexus (C5-T1)
  • Phrenic
  • Vagus
  • Accessory
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6
Q

categorising neck lumps: superficial structures

A
  • sebaceous cyst
  • lipoma
  • abscess
  • dermoid cyst
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7
Q

categorising neck lumps: midline structures

A
  • thyroglossal cysts
  • thyroid swelling
  • laryngeal swelling
  • dermoid cyst
  • submental lymph nodes
  • chondroma of thyroid cartilage
  • radula
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8
Q

categorising neck lumps: lateral structures - anterior triangle

A
  • thyroid lobe swellings
  • pharyngeal pouch
  • brachial cyst
  • submandibular lymph gland pathology
  • lymphadenopathy
  • parotid gland swelling (mumps/tumour)
  • laryngocoele
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9
Q

categorising neck lumps: lateral structures - posterior structures

A
  • lymphadenopathy (malignancy, TB)
  • carotid artery aneurysm
  • carotid body tumour
  • cystic hygroma
  • cervical rb
  • torticollis
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10
Q

Lymphangioma

A

Degenerative lesions derived from lymphatics. Usually present from birth though can present in young adults. Appear anywhere in head and neck, feel cystic and transilluminate, may remain static or involute but often grow with child and can comprimise airway, eye forcing surgical intervention.

Microcystic or macrocystic – can be dealt with by intralesional injection with OK432 as a sclerosant agent

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11
Q

Thyroglossal cyst

A

Cyst along the thyroid tract as it descends. Moves on swallow and tongue protrusion.

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12
Q

Branchial cysts

A

are cystic masses that occur most commonly in young adults

They are usually found at the upper third of SCM unilateral and painless.

They can get recurrently infected.

4 theories exist – branchial appaatus theory, cervical sinus theory, thymppharyngeal dust theory and inclusion theory

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13
Q

cervical lymphadenopathy

A

Generally speaking. Cervical lymphadenopathy is either infection or malignancy.
Malignancy is either primary (lymphoma or leukiemia) or a metastasis from another H&N site.
Weird infections: TB/Cat scratch/brucellosis/toxoplasmosis/HIV
Systemic conditions:kawasaki/sarcoid

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14
Q

T.I.N.E.D A C.C.A.N

causes of neck lumps

A 
T- Trauma 
I- infective 
N- neoplastic 
E - Endocrine 
D- Drugs/allergies

C- Connective tissue/fascia
C- congenital
A- Arterio-venous/Lymphatics
N - Neurological

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15
Q

T - trauma

A
  • Fractures/muscle evulsion
  • Haematoma
  • Reactive oedema
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16
Q

I- infective

A
  • Insect bite
  • TB
  • Cat Scratch disease (Bartonella)
  • Mumps
  • Retropharyngeal abscess
  • Neck abscess
  • Lymphadenopathy (Glandular fever)
17
Q

N- neoplastic

A
  • Squamous Cell carcinoma
  • Lymphoma
  • Thyroid cancer
  • Salivary gland tumour
18
Q

E - Endocrine

A
  • goitre

- autoimmune

19
Q

D- Drugs/allergies

A
  • iodine deficiency

- anaphylaxis (laryngeal oedema)

20
Q

C- Connective tissue/fascia

A
  • Dermoid cyst

- Sebaceous cyst

21
Q

C- congenital

A
  • Thyroglossal cyst and fistuale
  • Cystic hygroma
  • Branchial cyst
  • Dermoid Cyst
22
Q

A- Arterio-venous/Lymphatics

A
  • Cystic hygroma (congenital)
  • Branchial cyst (congenital)
  • Carotid body tumour
23
Q

N - Neurological

A
  • Torticollis (Wry Neck)
24
Q

general history

A

PC – Swelling in neck, pain, weight loss, fatigue, dysphagia, dysphonia, fever, malaise

HPC – SOCRATES, site, onset, change in size, single/multiple, pain, referred pain ?pregnant

PMH – other relevant conditions, ?autoimmune –RA/sjrogens, previous operations,

DH and Allergies

FH – hereditary conditions

SH – Smoker – risk of ca, alcohol, occupation
Radiation exposure, Previous malignancy , trauma, recent travel, insect/animal bites

25
Q

history: associated symptoms

A
  • Dysphagia,
  • odynophagia,
  • sore throat,
  • dysphonia,
  • otalgia,
  • nasal obstruction,
  • wt loss,
  • anorexia,
  • malaise,
  • night sweats
26
Q

Lump Specific history

A

Classification: Onset, Site, Size, unilateral/bilateral, single/multiple, pain, fluctuance

Risk Factors
modifiable (smoking, alcohol, occupation, travel, no vaccinations)

non-modifiable (age, sex, previous conditions, FH, previous radiation exposure)

Associated Symptoms 
ENT specific (otalgia, dysphonia, sore throat, nasal obstruction)

General (Dysphagia, weight loss, night sweats, tremor, palpitations, temperatures)

27
Q

thyroid specific history

A

Appearance: Thyroid facies, eye signs, bilateral neck swelling, tremor, weight loss/gain

Psychiatric: Mood changes

GI: dysphagia, odynophagia, bowel habit, weight, appetite

GU: Menstrual disturbance

Respiratory: breathing difficulties/voice change

Cardiac: palpitations

Other: autoimmune conditions, malaise, restless

28
Q

examination

A

Ears, nose and throat

Neck examination including lumps

Lymph nodes

Thyroid examination

End pieces (systemic LN examination, other systems, tests, referrals)

29
Q

thyroid Examination

A

Consent and exposure

Inspect – front, side and back, noting lump, neck veins, thyroid status – face, hands, eyes, shins

Water test– goitre moves up

Protrude tongue – thyroglossal cyst moves up

Palpation from behind – one side then other, smooth vs nodular, unilateral or bilateral, swallow water and protrude tongue, LN exam

Percuss – down sternum for retrosternal goitre

Auscultation – thyroid bruit in graves disease

Reflexes – brisk in hyper, slow relaxing in hypo

End pieces – Full ENT examination, examine for systemic lymphadenopathy, routine investigations including TFTS +/- USS scan and FNA/core biopsy

30
Q

Investigations

A

Bloods – FBC, CRP, TFTs, Calcium, Calcitonin, PTH, antibodies

Radiology – USS, CT, MRI

Biopsy – FNA, core biopsy under LA or GA

Referral to endocrine or ENT specialist

ENT (7 decks)

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