Neck Lumps And ENT

Question 1

Why is knowing neck triangles important?

Answer 1

So you can refer to lump is

Question 2

What are two ways of referring to where a lump is?

Answer 2

Neck triangles
Neck levels

Question 3

Neck levels

Answer 3

Question 4

What are five questions for a lump?

Answer 4

Question 5

What would you ask about in a history for lumps?

Answer 5

Question 6

What do you look for in a lump examination?

Answer 6

Question 7

What are you looking for in the examination?

Answer 7

Question 8

Anatomical sieve? (Ie what is the thought process behind deciding cause of the lump?)

Answer 8

Question 9

Surgical sieve ? (Thought process on causes)

Answer 9

Question 10

What are the special investigations for a lump?

Answer 10

Question 11

Strategy for neck lump diagnosis?

Answer 11

Is it normal anatomy?

Is it a lymph node?

Is it another structure causing pathology?

Question 12

What are causes for cervical lymphadenopathy?

Answer 12

Infective OR Neoplastic

Question 13

Lateral neck lumps?

Answer 13

Question 14

Midline neck lumps?

Answer 14

• Thyroid gland pathology
• Parathyroid gland
• Dermoid cyst
• Plunging ranula
• Thyroglossal duct cyst

Question 15

Lymph nodes

Answer 15

Question 16

Why are lateral neck lumps important?

Answer 16

“any lateral neck mass in an adult is a metastatic deposit until proven otherwise”

(Lateral is not an actual type of lymph node - unsure of whether includes cervical or what else??)

Question 17

What cancers metastasise to cervical lymph nodes?

Answer 17

Oral squamous cell carcinoma

Squamous cell carcinoma

Melanoma

Question 18

Look at slides 24-27

Question 19

See slides 28+29

Question 20

What neck lump moves with swallowing ?
What neck lump moves with swallowing and protrusion of tongue?

Answer 20

With swallowing - thyroid lump

With swallowing and PROTRUSION OF TONGUE - Thyroglossal duct cyst

Question 21

See slide 30 + 31

Question 22

See slide 33 + 34

Question 23

Common ear problems?

Answer 23

Hearing loss
Otalgia
Otorrhea
Middle ear infection
Facial palsy
Disorders of balance
Tinnitis
Foreign bodies

Question 24

Question 25

What is cholesteatoma?

Answer 25

Abnormal, non cancerous skin growth Middle section of ear , behind eardrum Can be birth defect but more commonly caused by repeated middle ear infections

Question 26

What otitis externa?

Answer 26

Inflammation of external auditory meatus Infective - bacteria, viral, fungal Reactive - eczema, psoriasis Outer ear infection

Question 27

What is Otitis media with effusion?

Answer 27

Effusion = colllection of fluid Otitis = infection of middle ear Also known as glue ear Eustachian tube dysfunction Hearing loss, learning difficulties and speech delay Cleft palate Between 3-6 years Tympanic membrane ( also known as ear drum ) = dull red, grey or amber, bulge forward or retracted, air bubbles or fluid level

Question 28

Common nose problems?

Answer 28

Allergic rhinitis Nasal polyps Nasal infections Nasal septum’s Epistaxis ( also known as nose bleed ) Sinusitis

Question 29

What can cause epistaxis?

Answer 29

Hypertension Blood dyscrasias: Von willebrand, liver disease, haemophilia, thrombocytopenia Hereditary haemorrhagic telangiecstasia Drugs : Aspirin, NSAIDs, warfarin, steroids, clopidogrel, chemotherapy Trauma Neoplasms Nasal septum defects Rhinotillexis ( nose picking ) Inflammation : URTI, sinusitis Environmental - cold dry air, central heating

Question 30

Common throat problems

Answer 30

Dysphonia ( problems with voice ) Stridor Sore throat Tonsils and adenoids Dysphagia Snoring and sleep apnoea

Question 31

What Can cause dysphagia?

Answer 31

NEUROMUSCULAR: • Old age • Bulbar or pseudobulbar palsy • MND • Stroke • Constriction of cricopharyngeus muscle OBSTRUCTIVE: • Foreign body • Carcinoma of pharynx • Post-cricoid carcinoma • Oesophagitis • Carcinoma of oesophagus • Invasion by carcinoma of lung • Achalasia of the cardia