Neck lumps

Question 1

Lumps that can appear anywhere (2)

Answer 1

lipomas

sebacious cysts

Question 2

Features of lipomas (4)

Answer 2

soft, fluctuant lump

skin can be “pinched off” it

benign

often present for many yrs

Question 3

Features of and epidemiology of sebacious cysts (6)

Answer 3

hard lump w. smooth surface

punctum

mobile

within skin

non-tender

more commonly affects males

Question 4

Causes of midline masses (6)

Answer 4

if <20yrs:

• dermoid cyst
• thyroglossal cyst

if>20 yrs:

• thyroid mass
• chondroma
• pharyngeal pouch
• laryngocele

Question 5

Features of dermoid cysts (2)

Answer 5

teratoma (mature)

large, hard midline lump

Question 6

Pathology, features and Ix of thyroglossal cysts (4)

Answer 6

due to thyroglossal duct which pulls thyroid down from tongue remaining patent>cyst formation

move on protrusion of tongue

transilluminates

in children do radioiodine uptake scan to ensure they have functioning thyroid.

Question 7

Features and subtypes of thyroid masses (5)

Answer 7

move up on swallowing,

not on tongue protrusion

papilloma

anaplastic

follicular

medullary

Question 8

Features of thyroid papilloma (4)

Answer 8

most common

20-55yrs

often multifocal

cells have finger-like projections, ground glass nuclei and psammoma bodies

Question 9

Features and presentation of anaplastic thyroid ca. (6)

Answer 9

most dangerous

rare

> 65yrs

hard, irregular lump

locally invasive

presents w. sudden onset wt. loss and hoarse voice w. surrounding lymphadenopathy.

Question 10

Features of follicular thyroid ca.

Answer 10

can’t Dx w. FNA

Question 11

Features of medullary thyroid ca. (2)

Answer 11

(C cell)
assoc. w. MEN2a

presents w. diarrhoea

assoc. w. CEA

Question 12

Features of chondromas (2)

Answer 12

hard, bony lump

benign cartilaginous tumour

Question 13

Features of pharyngeal pouches (2)

Answer 13

halitosis (bad breath)

gurgles on palpation

Question 14

Pathology and features of laryngoceles (3)

Answer 14

outpouching of larynx from pressure

smooth, reducible lump

causes discomfort
(think trombone players)

Question 15

Causes of neck lumps in submandibular triangle (6)

Answer 15

benign lymphadenopathy-most common cause

malignant lymphadenopathy

submandibular salivary stone

tumour

sialadenitis

cervical rib

Question 16

Causes of benign submandibular lymphadenopathy (5)

Answer 16

TV

viruses: EBV, CMV HIV

bartonella (cat scratch)

toxoplasmosis

lymphoma

Question 17

Features of malignant submandibular lymphadenopathy (2)

Answer 17

firm

non-tender

Question 18

Features of submandibular salivary stones (3)

Answer 18

calculus in submandibular salivary gland

dull pain and swelling

intense pain may occur after eating

Question 19

Features of sialadenitis

Answer 19

inflamed salivary gland

Question 20

Causes of anterior triangle lumps (3)

Answer 20

branchial cysts

carotid body paraganlgiomas

carotid artery aneurysms

Question 21

Pathology and features of branchial cysts (4)

Answer 21

due to failure of obliteration of 2nd branchial cleft in embryological development

oval, fluctuant, cystic, non-tender mass

between pharynx and sternocleidomastoid

can become infected>fistula

Question 22

Epidemiology and common presentation of branchial cysts (2)

Answer 22

M>F

often present w. URTI

Question 23

Ix and Rx of branchial cysts

Answer 23

aspiration>cholesterol crystals

Rx w. sclerotherapy or surgery, aspiration not sufficient

Question 24

Features of carotid body paraganliomas (5)

Answer 24

tumour of carotid body

hard

pulsatile w. no bruit

move horizontally but not vertically

more common at high altitude

Question 25

Features of carotid artery aneurysms (4)

Answer 25

pulsatile bruit soft and fluctuant w/i anterior triangle

Question 26

Ix for carotid artery aneurysms (2)

Answer 26

digital subtraction angiography 1st line can also do doppler US

Question 27

Causes of posterior triangle masses (5)

Answer 27

LNs lymphoma cystic hygroma sternocleidomastoid tumour of infancy cervical rib

Question 28

Features and Rx of cystic hygromas (5)

Answer 28

soft lump transilluminates brightly multiple cyst-like cavities containing lymph common in babies/neonates can be drained/Mx w. sclerosing agents

Question 29

Features and Rx of sternocleidomastoid tumours of infancy (5)

Answer 29

presents between 2wks-3mo palpable, hard, mobile and painless felt in lower middle third of sternocleidomastoid assoc. w. congenital torticollis benign, Rx w. physio and stretching.

Question 30

Sx of cervical ribs (2)

Answer 30

due to compression-thoracic outlet syndrome: - wasting of intrinsic hand muscles (brachial plexus) - Raynaud's (subclavian artery)

Question 31

Ix for neck lumps (6)

Answer 31

US for consistency but can't Dx biopsy is gold standard: FNAC/core biopsy CT to show exact location virology: HPV, EBV Mantoux for TB CXR for TB/sarcoid.