neck lumps Flashcards
(28 cards)
describe the location and divisions of the anterior triangle
- anterior to and including SCM
- split into digastric, carotid, muscular triangles
describe the location of the posterior triangle
- posterior to SCM
- anterior to trapezius
- superior to middle third of clavicle
describe the different levels of the neck
- I = submandibular and submental region
- II = upper SCM region
- III = middle SCM region
- IV = lower SCM region
- V = posterior triangle
- VI = anterior neck in front
what things should be covered when taking history of a neck lump? (up to 8)
- onset
- changes
- recurrence
- other lumps
- associated features (weight loss, fever, nausea, pain with alcohol)
- foreign travel
- pets
- social history
what needs to be included in the examination of a lump itself? (12)
- site, size, shape, surface
- temperature, tenderness, transillumination, texture
- colour
- margin
- pulsation
- mobile/fixed
give the causes of cervical lymphadenopathy (4)
- infective (local or general, bacterial, viral, etc)
- neoplastic (local metastases, general)
- drugs (eg phenytoin)
- sarcoidosis
give some bacterial causes of cervical lymphadenopathy (~4)
- local = dental, tonsil, face, scalp infections
- TB
- syphilis
- cat scratch disease
give some viral causes of cervical lymphadenopathy (~4)
- herpetic stomatitis (HSV)
- infectious mononucleosis (EBV)
- HIV infection
- childhood fevers, mumps, etc
give examples of primary and secondary neoplasms which may cause cervical lymphadenopathy
- primary = Hodgkin’s lymphoma, NHL, leukaemia
- secondary = SC/BC carcinoma, malignant melanoma, gastric and abdominal metastases
describe branchial cleft cysts (what, important differential, presentation, types)
- congenital epithelial cysts on lateral neck (in youth)
- must always exclude metastasis if >45yo
- small, painless, fluctuant mass often on anterior border of SCM +/- fistula (between levels III/IV)
- first arch = preauricular opening
- second arch = just below preauricular area
- third arch = levels III/IV, may open into larynx (finger sucking-indrawing sign)
which is the most common type of branchial cleft cyst?
second branchial cleft cyst (95%, 10-40yo)
give the groups of head and neck lymph nodes (~10)
- pre and post auricular
- parotid
- occipital
- tonsillar/jugulodigastric
- submental
- submandibular/submaxillary
- superficial cervical
- internal jugular/deep cervical chain
- supraclavicular/transverse cervical
- posterior cervical chain/spinal accessory
give some causes of dysphagia (up to 10)
neuromuscular:
- old age
- bulbar or pseudobulbar palsy
- motor neurone disease
- stroke
- constriction of cricopharyngeus muscle
obstructive:
- foreign body
- carcinoma of pharynx, post-cricoid or oesophagus
- oesophagitis
- invasion by carcinoma of lung
- achalasia of cardia
give some differentials for a superficial lump of the neck at any site (3)
- skin abscess
- lipoma
- dermoid cyst
give some differentials for midline-specific neck lumps (4)
- thyroid swelling = goitre, neoplasms
- thyroglossal duct cysts and persistent tracts
- submental lymph nodes
- sublingual dermoid cyst
what are the 3 types of malignant neoplasm of the thyroid and which has the worst prognosis?
- papillary carcinoma
- medullary carcinoma
- follicular carcinoma = worst
what may cause diffuse enlargement of the thyroid? (2)
- iodine deficiency
- autoimmune thyroiditis
how to tell the difference between a thyroid swelling and thyroglossal swelling?
- thyroid swelling moves on swallowing (also usually women)
- thyroglossal duct cyst moves on swallowing and tongue protrusion
give some differentials for an anterior neck triangle lump (5)
- lymphadenopathy
- submandibular gland
- tail of parotid gland swelling
- branchial and lymphoepithelial cysts
- thyroid lobe swellings
give some differentials for a posterior neck triangle lump (2/3)
- lymphadenopathy
- carotid body tumour
- Virchow’s node (left supraclavicular, Troisier’s sign)
what is TINCAMBEDO?
surgical sieve acronym:
Trauma
Infectious, inflammation, iatrogenic
Neoplastic
Congenital and developmental
Autoimmune
Metabolic
Bone, bowel, brain
Endocrine
Degenerative
Other
what is the first line imaging modality for soft tissue lumps?
ultrasound
pros and cons of MRI
+:
- soft tissues in a wide area
- identifies the composition of a lump
-:
- no metals
- enclosed space
- must lie still
- expensive and time-consuming
- contrast (bad for renal disease)
how many DPTs is equivalent to a medical CT scan?
200
