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CHHD > Swellings of the head and neck > Flashcards

Swellings of the head and neck Flashcards

(75 cards)

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1
Q

Describe the position of the 2 triangles of the neck

A
  • Anterior - below digastric, in front of the sternomastoid

- Posterior - behind sternomastoid, in front of the trapezius, above the clavicle

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2
Q

What trauma can lead to acquired swelling of head/neck

A

Haematoma

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3
Q

What bacterial infections can lead to acquired swelling of the head/neck

A
  • Pyogenic - Lymphadenitis, suppurative sialadenitis
  • Tubercular CL
  • Syphilitic CL
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4
Q

What viral infection can lead to acquired swelling the head and neck

A
  • German measles
  • Infectious mononucleosis
  • Mumps
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5
Q

What immunologic factors can lead to acquired swelling of the head and neck

A
  • Orofacial granulomatosis

- Crohn’s disease

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6
Q

What neoplastic factors can lead to acquired swelling of the head and neck

A 
Leukaemia
Lymphoma
Metastatic carcinoma
Squamous cell carcinoma
Lipoma (benign)
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7
Q

What developmental factors can lead to swelling of the head and neck

A
  • Branchial cyst
  • Thyroglossal cyst
  • Dermoid cyst
  • Epidermal cyst
  • Cystic hygroma/lymphangioma
  • Fibrous dysplasia
  • Cervical rib
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8
Q

How would you take the history of a patient with swelling in the head and neck

A
  • Age of patient
  • Date of onset of symptoms
  • Duration and character of swelling
  • Details of the pain experienced - duration, character, radiation, aggravating and relieving factors
  • Associated symptoms
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9
Q

Name some of the things to note when examining a lump

A

Site, size, shape, surface, texture, temperature, tenderness, surrounding tissue, mobility, drainage lymph nodes

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10
Q

Describe the causes/aetiology for a branchial cyst

A

Proliferation of epithelial remnants from second

branchial cleft within lymph nodes

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11
Q

Describe the clinical features of a branchial cyst

A
  • Seen in children and adolescents

- Asymptomatic, un-inflamed swelling

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12
Q

Describe the site, surface and consistency of a branchial cyst

A

Site - upper part of the lateral neck beneath anterior border of SCM
Surface - smooth, globular, tense
Consistency - Soft or fluctuant

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13
Q

What is the most common developmental cyst of the neck

A

Thyroglossal cyst

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14
Q

Describe the causes/aetiology of thyroglossal cysts

A

Failure of complete descent of thyroid tissue from

foramen caecum with subsequent cystification

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15
Q

Describe the clinical features of thyroglossal cysts

A
  • Common in children and young adults

* Asymptomatic or infected

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16
Q

Describe the site of thyroglossal cysts

A
  • Midline swelling in neck above level of thyroid
  • In thyroid region, swelling is pushed to one side (usually left)
  • Swelling often moves on swallowing or tongue protrusion
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17
Q

Describe the causes/aetiology of dermoid cysts

A

Proliferation of epithelial rests

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18
Q

Describe the clinical features of dermoid cysts

A
  • Seen in young adults

- Asymptomatic, un-inflamed swelling

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19
Q

Describe the site of dermoid cysts

A

Site - Submandibular space (lateral neck swelling)

- Floor of mouth above mylohyoid muscle (double chin) or midline of the neck

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20
Q

Describe the surface and consistency of dermoid cysts

A

Surface - smooth, globular and tense

Consistency - Soft or fluctuant

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21
Q

Describe the causes/aetiology of lymphangioma/cystic hygroma

A

Proliferation of sequestrated lymphatic endothelium of the jugular sac

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22
Q

Describe the clinical features of lymphangioma/cystic hygroma

A
  • Presents at birth or manifests during infancy/childhood

- Asymptomatic, un-inflamed swelling

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23
Q

Describe the site, surface, consistency and colour of lymphangioma/cystic hygroma

A

Site - Lower third of the neck
Surface - smooth, diffuse and tense
Consistency - spongy, soft and translucent
Colour - lighter than surrounding tissue

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24
Q

Name and many cervical lymph nodes as you can

A 
Posterior auricular
Occipital
Superficial cervical
Deep cervical 
Posterior cervical
Supraclavicular
Preauricular
Parotid
Tonsillar
Submental 
Submandibular
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25
What mechanisms cause lymph nodes to enlarge
- Increase in the number of cells | - Infiltration with cells
26
What can cause the number of lymph node cells to increase
Benign lymphocytes and macrophages in response to antigens
27
What can cause infiltration of the lymph nodes and cause them to enlarge
* Inflammatory cells in infection (lymphadenitis) * In situ proliferation of malignant lymphocytes or macrophages * Metastatic malignant cells * Metabolite laden macrophages (lipid storage diseases)
28
At what time in life do lymph nodes become more dangerous
* Children/young adults – more likely to respond to minor stimuli with lymphoid hyperplasia * Lymph nodes aged < 30 are clinically benign in 80% of cases whereas in patients over the age of 50 only 40% are benign
29
What types infections can lead to Cervical lymphadenopathy (CL)
- Viral upper respiratory tract | - Pyogenic infection in the local area of drainage
30
Name some systemic bacterial infections that can cause CL
- Tuberculosis | - Syphilis
31
Name some systemic viral infections that can cause CL
- Infectious mononucleosis - Cytomegalovirus - HIV infection
32
Name some systemic fungal infections that can cause CL
- Histoplasmosis
33
Name some systemic parasitic infections that can cause CL
Toxoplasmosis
34
Name some malignant disease that can cause CL
* Metastatic carcinoma * Leukaemia * Squamous cell carcinoma * Lymphoma * Langerhan’s histocytosis
35
What other causes are there for CL
* Drugs - Phenytoin * Mucocutaneous lymph node syndrome (Kawasaki disease) * Connective tissue disease * Sarcoidosis
36
Describe the causes/aetiology of pyogenic lymphadenopathy
Oral inflammatory conditions esp. dental abscess
37
Describe the clinical features of pyogenic lymphadenopathy
Can present as single or multiple painful nodes
38
Describe the site, surface and consistency of pyogenic lymphadenopathy
Site - Depends on site of infection Surface - Smooth, diffuse and tense Consistency - soft when acute, not mixed to surrounding tissue
39
Describe the causes/aetiology of viral lymphadenopathy (infectious mononucleosis)
EBV - Epstein-Barr Virus
40
Describe the clinical features of viral lymphadenopathy (infectious mononucleosis)
- Affects young adults - Fever, malaise and sore throat - Lymph nodes are firm, discrete, tender and mobile - Purpura or petechiae in the palate
41
What is needed for diagnosis of viral lymphadenopathy (infectious mononucleosis)
+ve paul-bunnell or mono spot slide test
42
Describe the causes/aetiology of Tuberculous lymphadenopathy
Mycobacterium tuberculosis transmitted by sputum | droplets from infected patients
43
Describe the clinical features of Tuberculous lymphadenopathy
- Single or multiple swelling in lateral neck - Indurated, asymptomatic and firm - Fever, malaise, night sweats, weight loss, persistent cough, SOB - Undergoes caseous necrosis to form collar stud abscess - Ulcer on dorsum of tongue
44
What is needed for diagnose of Tuberculous lymphadenopathy
- Ziehl-Neelsen stain - PCR - Mantoux test - Culture on Lowenstein Jensen (LJ) medium - Biopsy and radiograph
45
Describe the causes/aetiology of malignant lymphadenopathy
* Unknown (Hodgkin’s) * Epstein-Barr virus (Burkitt’s) * Human Immunodeficiency virus (Lymphoma)
46
Describe the clinical features of malignant lymphadenopathy
- Arise in middle-aged and elderly with exception of Burkitt's seen in children and young adults - Single or bilateral swelling in lateral neck - Asymptomatic and slowly enlarging firm, rubbery matted lymph nodes - Fever, malaise, night sweats and weight loss
47
What is needed to diagnose malignant lymphadenopathy
Biopsy - Reed-sternberg cells (Hodgkin's)
48
Describe the causes/aetiology of a metastatic carcinoma
Metastatic oral cancer/nasopharyngeal lesion
49
Describe the clinical features of a metastatic carcinoma
- Usually single but maybe multiple (rarely bilateral) - Seen in middle aged and elderly - Progressive increase in size - Indurated masses, fixed to surrounding tissue, rocky hard and painless - Commonly affects submandibular and jugulodigastric nodes
50
What is needed for a diagnosis of metastatic carcinoma
- Biopsy showing metastatic cells | - Signifies advanced disease with poorer prognosis
51
What are the clinical features of congenital cervical rib
* Arises from the 7th cervical vertebra * Feels like a bony swelling in the neck * Symptoms can be neurological or vascular
52
What are the neurological symptoms of cervical rib
- Pain - Paraesthesia + Anaesthesia of forearm - Hands
53
What are the vascular symptoms of cervical rib
- Excessive pulsation and thrill subclavian artery | - Arm pain, arm and/or hand can appear pale white in colour and it can also feel cold
54
What is needed to diagnose cervical rib
CXR and x ray of the neck
55
What is lipoma
A benign tumour made of fat tissue
56
Describe the clinical features of lipoma
- Rare - Slow-growing - Posterior neck space is the most common site - Soft, semi fluctuant, lobulated mass of varying size - Painless and asymptomatic - Intra-orally appears yellowish
57
What is needed to diagnose lipoma
- USS | - Biopsy
58
What is a thyroid nodule
Overgrowth of normal thyroid tissue
59
What are the clinical features of a thyroid nodule
- Firm - Painless and asymptomatic - Midline swelling in area of thyroid gland - Uncommon - 90-95% are benign, 3-5% are malignant
60
What is needed to diagnose a thyroid nodule
- USS | - Biopsy
61
What are the causes/aetiology of a carotid body tumour
Neoplastic transformation of carotid body cells
62
What clinical features are there for carotid body tumour
- rare, affects adults - Usually benign, some can show malignant behaviour - Firm, moveable mass in neck at carotid bifurcation - Painless, pulsatile and asymptomatic - Can cause compression effects - Bruit and thrill may be apparent - Unilateral swelling in lateral neck
63
What is needed to diagnose carotid body tumour
CT/MRI head and neck
64
How can you tell if a swelling is mostly developmental in origin
There are midline lesions
65
What do bilaterally symmetrical and unilateral swellings show about the swelling
``` Bilateral = anatomical structure Unilateral = neoplastic and infective ```
66
What colour and temperature indicate the presence of melanoma
Black/brown pigmentation
67
What does purple/red pigmentation indicate
Angioma or Kaposi sarcoma
68
What colour and temp are inflammatory swellings
Red and warm
69
What sort of movement indicates carcinomas
Fixed to adjacent structures
70
What does fluctuant consistency show
Cystic fluid, mucus, pus or blood present in swelling
71
What does a soft consistency show
Acute inflammatory swellings
72
What does a hard (indurated) swelling show
Carcinoma
73
What do well defined and poorly defined margins indicate
Well defined = benign growth | Poorly defined = malignancy
74
What does nodular and ulcerative surfaces indicate
carcinomas
75
What do uniform and smooth surface textures indicate
Cystic lesions

CHHD (27 decks)

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