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Flashcards in Neck Masses Deck (100):
1

What is the only muscle of the larynx that is not supplied by the recurrent laryngeal nerve? What is it supplied by?

-Cricothyroid muscle
-External branch of the superior laryngeal nerve (branch of CN X)

2

What are the boundaries of the occipital triangle?

-Trap
-SCM
-Omohyoid

3

What are the boundaries of the submental triangle?

-Anterior digastric
-Mandible

4

What are the boundaries of the submandibular triangle?

-Ant digastric
-Post digastric
-Mandible

5

What are the boundaries of the carotid triangle?

-Omohyoid
-SCM
-Stylohyoid

6

What are the boundaries of the muscular triangle?

-SCM
-Omohyoid
-Midline

7

What are the boundaries of the subclavian triangle?

-Clavicle
-SCM
-Trap

8

Who in particular can feel their carotid bulb?

People who lose weight

9

Where are lymphatic areas II, III, and IV in the neck?

Along the SCM from superior to inferior, and transecting it into thirds

10

Where is the lymphatic area I in the neck?

Submental /submandibular triangle

11

Where is the lymphatic area VI in the neck?

Muscular triangle

12

Where is the lymphatic area V in the neck?

Posterior triangle

13

What percent of neck masses in kids 0-15 years are benign?

90%

14

What is the "rule of 80s" for adults greater than 40 yo in terms of neck masses?

80% of neck masses are neoplasms, and 80% of those are malignant

15

Upper jugular chain masses are mets from where? (1)

Nasopharynx

16

Mets in the posterior triangle are from where? (4)

-Nasopharynx
-Ear
-Temporal bone
-Skull base

17

Mets in the lower jugular chain are from where? (2)

Upper esophagus or thyroid

18

Mets in the submandibular triangle are from where? (3)

-Anterior 2/3 of tongue
-Floor of
-Cheek

19

Mets in the Submental area are from where?

Lip

20

Mets in the mid jugular chain area are from where? (3)

Any portion of the oral cavity, pharynx, or larynx

21

What are the risk factors for developing head and neck cancers?

-Chronic sun exposure
-Poor dentition
-Smoking/EtOH use

22

What is the classic presentation of a cancerous lesion in the oral or nasopharynx? (5)

-Nonhealing ulcer
-Persistent sore throat
-Dysphagia
-Change in voice
-Otalgia with exam

23

Where in particular should you assess when suspecting a neck neoplasm?

-Tonsillar fossa
-Pharynx and larynx with a fundoscope

24

What are ways that can aid you in assessing for neoplasms in the head and neck?

Rotation in both flexion and extension

25

Palpation of the neck with what two maneuvers may aid you in identifying pathology in the larynx and thyroid?

Swallowing or Valsalva

26

What should always be done with an inflammatory neck mass, prior to further investigation?

2 week course of abx

27

What are the ways to diagnose neoplasms of the neck? What is the standard?

-**FNA bx**
-CT
-MRI
-US

28

True or false: if a neck mass is NOT an obvious abscess should be biopsied

True

29

Persistence of a neck mass after how many weeks of abx should be biopsied?

2 weeks

30

Any mass measuring how many cm should be biopsied?

3 cm

31

True or false: any neck mass that is accompanied by s/sx of lymphoma should not be biopsied, since it is almost always lymphoma

False

32

What are the four major indications for FNA of a neck mass

-Not obvious abscess
-Persistence after 2 weeks of abx
-Progressive growth or more than 3 cm
-s/sx of lymphoma

33

True or false: there is a risk of seeding cancer with a FNA

False

34

How many samples of the mass should be taken with a FNA?

4

35

What are the benefits of a CT scan when evaluating a neck mass?

Can identify cystic or solid, and can see if it is a met from a distant site/ see the primary site

36

When should a CT with contrast not be obtained when evaluating a neck mass?

If suspected thyroid lesion

37

When is an MRI preferable to CT in evaluating head and neck tumors?

Skull based or vascular invasion

38

What is the role of radionuclide scanning in evaluating head/neck masses?

-salivary and thyroid masses
-Functional information

39

Which are classically cancerous: hot or cold thyroid nodules?

Cold

40

What is the most common type of cancer of the head and neck?

SCC

41

Ipsilateral otalgia with a normal ear examination should be suspicious for a tumor where?

Tonsils, tongue base, supraglottic area

42

Asymptomatic, unilateral serous otitis should be suspicious for what?

Nasopharyngeal tumor obstructing the eustachian tube

43

What are the two indications for a panendoscopy?

-FNAB + with no primary mass located
-FNAB equivocal or negative in a high risk pt

44

What is the incidence of synchronous primary tumors in the nasopharynx?

10-20%

45

When is an open excisional bx indicated for head and neck?

Only if complete workup is negative

46

What are the two work ups that should be done on a neck mass if it does not respond to abx?

CA vs TB

47

What is the leading cause of anterior neck masses?

thyroid CA

48

What is the most common neoplastic condition of the head and neck in children? Which gender is usually affected? Are these usually benign or malignant?

Thyroid masses
Males
Malignant

49

What gender is more affected with thyroid masses in the adult population? Are these usually benign or malignant?

Females
Benign

50

True or false: lymph node involvement with papillary thyroid carcinomas is relatively common

True--40%

51

What should be done if there is an inadequate sample taken with a FNA of the thyroid?

Repeat in 1 month

52

What percent of kids with lymphoma have a neck mass?

80%

53

What are the neck s/sx of lymphomas?

-Lateral neck mass
-Fever
-HSM
-Diffuse adenopathy

54

What is the first line test for evaluating a neck mass that is suspicious for a lymphoma?

FNA

55

What should be done if a FNA comes back positive for lymphoma?

Open bx and full CT scan of the head/neck, chest, and abdomen

56

What percent of parotid tumors are benign?

80+%

57

What are the associated symptoms of salivary gland tumors?

-rapid growth
-Skin fixation
-CN palsies

58

What is the accuracy of FNA with salivary gland tumors?

More than 90% sensitive and 80% specific

59

What is the treatment for parotid gland tumor?

Total parotidectomy, with possible facial nerve sacrifice

60

What are the characteristics of carotid body tumors?

-Pulsatile mass that is compressible
-Mobility medially and laterally, but NOT superior/inferiorly

61

How do you diagnose carotid body tumors?

Clinically or confirmed with angio CT

62

What is the treatment for a carotid body tumor?

XRT or close observation in the elderly

63

How common are carotid body tumors in children?

Extremely rare

64

Where is the carotid body?

At the bifurcation of the carotids

65

What are the characteristics of lipomas?

Soft, asymptomatic masses

66

What is the age range that usually gets lipomas?

35+

67

how do you diagnose lipomas?

Clinically

68

What is the role of FNA with lipomas?

Not very beneficial--just get ghost image

69

What are the cells that give rise to neurogenic tumors?

neural crest cells

70

What are the neurogenic tumors in the head/neck region?

-Schwannoma
-Neurofibroma
-Malignant peripheral nerve sheath tumor

71

What inherited disease predisposes pts to neurogenic tumors?

NF

72

Are schwannomas usually more sporadic or caused by diseases like NF2?

Sporadic

73

What is the age range that more commonly gets schwannomas?

20-50 years

74

Where are schwannomas usually located?

Mid-neck in poststyloid compartment

75

What are the usual s/sx of schwannomas? (3)

-Medial tonsillar displacement
-Hoarseness (vagal nerve compression)
-Horner's syndrome

76

What nerve, if compressed, leads to hoarseness?

Recurrent laryngeal branch of CN X

77

What is the most common congenital/developmental mass?

Epidermal and sebaceous cysts

78

How do you diagnose epidermal / sebaceous cysts?

Clinically, with excisional bx as confirmation

79

What are the PE findings of epidermal / sebaceous cysts?

-Elevation and movement of overlying skin
-Skin dimple or pore

80

Which of the branchial clefts usually develop into branchial cleft cysts? Which rarely do?

2nd is the most common, and 1st less but still

3 and 4 rarely reported

81

Where are branchial cleft cysts of the 2nd branchial cleft located?

tract medial to CN XII between internal, and external carotid

82

Which branchial cleft is associated with CN VII?

2nd

83

When do branchial clefts cysts usually become apparent? Why?

After a URI, since infection will stimulate mucus production, and the clefts are enclosed mucous membranes

84

What are the PE findings of branchial cleft cysts?

-Smooth, fluctuant mass underlying the SCM
-TTP and erythema if infected

85

What is the treatment for branchial cleft cysts?

Surgical excision, including tract

86

Which branchial cleft cyst may need a parotidectomy to treat?

First

87

What is the most common type of congenital neck mass?

Thyroglossla duct cysts

88

What percent of thyroglossal duct cysts present before age 20?

50%

89

Where are thyroglossal duct cysts usually located? What are the common signs of this, then?

-Just inferior to the hyoid bone
-Elevates on swallowing/protrusion of the tongue

90

What is the treatment for thyroglossal duct cysts?

Surgical removal

91

What are the two major vascular tumors of the head and neck? When do they usually present?

-Lymphangiomas and hemangiomas
-1st year of life

92

What is the prognosis for hemangiomas and lymphangiomas?

-Hemangiomas = Resolve spontaneously
-Lymphangiomas = remain unchanged

93

What is the treatment for lymphangiomas and hemangiomas?

-Lymphangiomas = surgical excision
-Hemangiomas = Surgical excision if rapidly growing and involving vital structures, or associated with thrombocytopenia

94

How common is lymphadenitis?

very common, especially in the first decade

95

What are the signs of lymphadenitis?

Tender noes with signs of systemic infection

96

What is the treatment for lymphadenitis?

abx

97

What are the indications for FNA for lymphadenitis?

-Actively infectious
-Progressively enlarging
-Solitary and asymmetric
-Supraclavicular mass
-Persistent nodal mass

98

What is granulomatous lymphadenitis?

a chronic specific granulomatous inflammation of the lymph node with caseation necrosis, caused by infection with Mycobacterium tuberculosis or other bacteria

99

What are the PE findings of granulomatous lymphadenitis?

Firm, fixed node with injection of the skin

100

Actinomycosis is usually found in people with what condition?

Poor dental hygeine