Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ENT > NECK LUMPS > Flashcards

NECK LUMPS Flashcards

1
Q

What is contained within the anterior triangle of the neck?

A

Carotid arteries
Internal jugular vein
Vagus nerve
Salivary glands
Muscles of the floor of the mouth
Larynx
Trachea
Hypopharynx
Oesophagus
Cervical lymph nodes

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

What is contained within the posterior triangle of the neck?

A

Accessory nerve
Cervical nerve plexus
Fibre fatty lymphatic tissues
Brachial plexus
Subclavian artery

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

Examination of a neck lump

A

Inspection - site, size, shape, overlying skin, mobility, related to structures
Scars
Skin changes
Tongue protrusion (thyroglossal cyst)
Swallowing (thyroid goitre)

Palpate lump - may check for transillumination and bruit also
Palpate lymph nodes

Inspect upper aerodigestive tract - oropharyngeal exam and then a trans nasal endoscope examination

Palpate thyroid gland
Palpate submandibular gland

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

What is a branchial cyst?

A

A benign, developmental defect of the branchial arches. Develop due to failure of obliteration of the second branchial cleft in embryonic development The cyst is filled with acellular fluid with cholesterol crystals and encapsulated by stratified squamous epithelium.

They can have a fistula and therefore be prone to infection

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

When do branchial cysts present and how?

A

Late childhood or early adulthood

Present as asymptomatic unilateral, oval mobile lump usually anterior to sternocleidomastoid near the angle of the mandible - slowly enlarging, smooth, soft, fluctuant, no movement on swallowing and no transillumination

Typically presents in young adults when an upper RTI causes it to increase in size. May also be painful during acute infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Investigtaions to consider for ?branchial cyst?

A

consider and exclude other malignancy
ultrasound
referral to ENT
fine-needle aspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Treatment for branchial cysts?

A

ENT surgeons manage them conservatively or surgically remove them

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

DDx for a neck lump in a child?

A

congenital: branchial cyst, thyroglossal cyst, dermoid cyst, vascular malformation, cystic hygroma
inflammatory: reactive lymphadenopathy, lymphadenitis,
neoplastic: lymphoma, thyroid tumour, salivary gland tumour

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

What is a cystic hygroma?

A

A lymphangioma - a congenital benign lymphatic lesion typically identified prenatally or at birth (90% before age 2)

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

How do cystic hygromas present?

A

Typically found on the left side of the neck

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

Whats the most common benign neck lump?

A

A lipoma

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

How does a lipoma in the neck feel?

A

Painless
Soft
Mobile
Discrete subcutaneous mass

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

Whats the most common type of skin cyst?

A

Epidermoid/sebaceous

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

How do sebaceous cysts present?

A

Smooth, spherical or dome shaped, firm, mobile but tethered to epidermis.
Covered with normal epidermis but may appear yellow or white and there may be creamy discharge

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

How common are thyroid nodules?

A

In 3-7% of adults

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

Types of benign thyroid nodules?

A

Colloid nodules
Hyperplasticity nodules
Cysts
Follicular adenomas

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

Types of malignant thyroid cancers?

A

Papillary
Follicular
Medullary
Anaplastic

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

Where are most of salivary gland tumours found?

A

80% found in the parotid gland

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

In which salivary glands is risk of malignancy highest?

A

Submandibular and minor salivary glands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How do benign salivary gland tumours present?

A

Solitary neck mass
Well-defined
Painless
Slow-growing
Mobile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How do malignant salivary gland tumours present?

A

Solitary neck lump
Painful
Rapid growth
Skin fixation
Paraesthesia
Facial nerve involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Types of maligannt salivary glands tumours?

A

Much epidermoid carcinoma
Adenocarcinoma
Metastatic SCC of face or scalp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Whats the most common congenital cyst?

A

A thyroglossal cyst

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Who are thyroglossal cysts usually found in?

A

Adults <20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How do thyroglossal cysts present?

A

Slow growing lump - may grow rapidly after an URTI
Mid-line
Well-defined
Not tethered to underlying skin
Non-tender
Moves upwards when sticking tongue out

May also become secondarily infected and present as an inflammatory swelling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is a thyroglossal cyst?

A

A cyst arising from persistent epithelial tissue along the thyroglossal embryological pathway - most commonly found in the midline between the isthmus of the thyroid and the hyoid bone

27
Q

How does a dermoid cyst present?

A

In children and young adults - superficial mid-line well-defined soft painless and tethered to underlying skin

28
Q

What is ectopic thyroid tissue?

A

Thyroid gland tissue not located in the usual location

29
Q

What is a laryngocele? how does it present?

A

A rare, benign unilateral dilatation of the laryngeal saccule
A reducible tense mass that can increase in size during sneezing or nose blowing

30
Q

What is a pharyngeal diverticulum?

A

Aka zenkers diverticulum
A pharyngeal pouch more common in old men
Its a posteromedial herniation between the thyropharyngeus and the cricopharyngeus muscles

31
Q

Presentation of a pharyngeal diverticulum?

A

Not usually visible but if large they may have a midline neck lump. It gurgles on palpation
Dysphagia
Regurgitation
Aspiration
Chronic cough
Halitosis

32
Q

Whats the most likely cause of neck lumps in children?

A

Lymphadenopathy

33
Q

What can cause lymphadenopathy?

A

Inflammation
Infection
Dental problems
Trauma
Malignancy - leukaemia, lymphoma, mets
Amyloidosis, Sarcoidosis, CTD, TB, catscratch disease

34
Q

Presentation of leukaemia?

A

Generalised lymphadenopathy
Splenomegaly
Pallor
Fatigue
Fever
Persistent infection
Bruising
Bleeding

35
Q

Presentation of lymphoma?

A

Painless, rubbery, soft mobile lymphadenopathy that grows rapidly - most commonly in posterior triangle
Fever
Night sweats
Fatigue
Weight loss

Later may get diffuse lymphadenopathy and hepatosplenomegaly

36
Q

What gland is most commonly affected by sialedenitis?

A

Parotid gland

37
Q

Who is sialedenitis most common in?

A

Older people with dehydration or following dental procedures

38
Q

What causes sialedenitis?

A

Most commonly bacterial - staph aureus
Viral - mumps, HIV

39
Q

Symptoms of sialedenitis?

A

Rapid onset pain and swelling
Local erythema
Oedema
Localised tenderness
Bimanual compression towards the duct opening may cause purulent discharge into the oral cavity

40
Q

What can cause chronic obstructive sialadeneitis?

A

Obstruction of the duct and reduced salivary flow e..g by a stone or structure
Granulomatous diseae e.g. TB or sarcoidosis
Autoimmune disease e.g. sjogrens

41
Q

What gland is most commonly affected by sialolithiasis?

A

The submandibular gland

42
Q

How does sialolithiasis present?

A

Swelling and tenderness for mins/hours that worsens when eating

43
Q

Who is a cervical rib most likely to affect?

A

40 year old thin women with a long neck and drooping shoulders
After neck trauma or pt with anatomical predispositions e.g. cervical rib

44
Q

What complication do 10% of pt with a cervical rib get?

A

Thoracic outlet syndrome

45
Q

What is thoracic outlet syndrome?

A

Compression of the brachial plexus, subclavian vein or artery at the site of thoracic outlet

46
Q

Whats more common, vascular or neurogenic thoracic outlet syndrome?

A

Vascular - accounts for 90% of cases

47
Q

How does vascular thoracic outlet syndrome present?

A

If veins… Painful, diffuse arm swelling with distended veins
If artery… Painful arm claudication ulceration and ganagrne

48
Q

How does neurogenic thoracic outlet syndrome present?

A

Painless muscle wasting
Hand weakness
Numbness
Tingling
Cold hands
Blanching
Swelling

49
Q

What is a carotid body tumour?

A

a highly vascular paraganglioma that arises from the paraganglion cells of the carotid body. It is located at the carotid bifurcation

50
Q

How does a carotid body tumour present?

A

Slow-growing painless swelling in upper anterior triangle of the neck
Pulsating
Compressible
Has a bruit or thrill
Can be moved form side to side but not up or down
Does not move on swallowing

51
Q

What can cause pre and post auricular lymphadenopathy?

A

Scalp infections
Mycobacteria infection
Scalp neoplasm
Head and neck SCC
Lymphoma

52
Q

What can cause supraclavicular lymphadenopathy?

A

Abdominal or thoracic neoplasm
Thyroid disease
Laryngeal disease
Mycobacterium/Fungal infections

53
Q

What can cause submandibular and anterior cervical lymphadenopathy?

A

Mononucleosis
URTI
Mycobacterium infection
Toxoplasmosis
CMV
Dental disease
Rubella
SCC of head and neck
Leukaemias
Lymphoma

54
Q

What are the characteristics of abnormal lymph nodes?

A

> 1.5cm in juguladigastric area or >1cm elsewhere
3cm may suggest malignancy
Rapid increase in size

55
Q

Who should you arrange a 2WW for with a thyroid lump?

A

An unexplained thyroid lump.
A thyroid mass associated with unexplained hoarseness or voice change.
A thyroid mass associated with cervical lymphadenopathy or supraclavicular lymphadenopathy.
Sudden onset of a rapidly expanding painless thyroid mass, significantly increasing in size over days and weeks.
A suspected thyroid nodule with other red flags or risk factors for malignancy.
A suspected thyroid nodule with associated compressive symptoms, such as breathlessness or dysphagia.

56
Q

What should you do if you find an unexplained persistent neck lump in someone >45?

A

2WW

57
Q

What should you do if you find an unexplained enlarging neck lump in someone >25?

A

Urgent neck USS within 2 weeks

58
Q

What should you do if you find an unexplained enlarging neck lump in someone <25?

A

Very urgent neck USS within 48 hours

59
Q

What are red flags for a neck lump?

A

Hard and fixed lump
Persistent or rapidly growing
lymph node >3cn
Pt is >35
Presence of a mucosa lesion
Persistent hoarseness or dysphagia
Presence of trismus
Ipsilateral otalgia
Fatigue, night sweats, fever, weight loss, bruising, bleeding, infections, alcohol-induced pain

60
Q

If a neck lump transilluminates what is it likely to be?

A

Fluid-filled e.g. a cystic hygroma

61
Q

Investigtaions for a neck lump?

A

TFTs
Routine bloods - FBC, U&Es, CRP
USS or other imaging
Fine needle aspiration
Referral to ENT

62
Q

Causes of a midline neck lump?

A

Lymph node
Lipoma
Dermoid cyst
Epidermoid cyst
Enlarged thyroid gland
Thyroid nodule
Thyroglossal cyst
Laryngocele

63
Q

Causes of a neck lump in the anterior triangle?

A

Lymph node
Lipoma
Epidermoid cyst
Submandibular gland swelling
Branchial cyst
Carotid artery aneurysm
Carotid body tumour
Laryngocele

64
Q

Causes of neck lumps in the posterior triangle?

A

Lymph node
Lipoma
Epidermoid cyst
Subclavian aretry aneurysm
Pharyngeal pouch
Cystic hygroma - typically on the left
Branchial cyst
Mass in the tail of the parotid gland e.g. plemorphic adenoma or primary parotid malignancy

ENT (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions