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HNN > Cervical Lymph Nodes + Other Neck Lumps > Flashcards

Cervical Lymph Nodes + Other Neck Lumps Flashcards

1
Q

Role of the lymphatic system

A
  • remove excess fluid from interstitial space
  • restores small proteins + fluid that leaked from capillaries to veins
  • immune defence + surveillance
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2
Q

What are clinical manifestations of diseases involving the lymphatic system?

A

Lymphadenopathy
Lymphoedema

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3
Q

What is lymphadenopathy?

A

Enlarged lymph nodes due to infection/inflammation or malignancy

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4
Q

Where can you palpate enlarged lymph nodes?

A

Cervical (Neck)
Axilla
Inguinal (Groin)

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5
Q

What is Waldeyer’s ring?

A

Annular collection of lymphoid tissue surrounding upper aero digestive tract (tonsils)

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6
Q

What lymph nodes can be palpable in well children?

A

Cervical lymph nodes

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7
Q

What are the different tonsils?

A

Pharyngeal tonsil/adenoids
Tubal tonsils
Palatine tonsils
Lingual tonsil

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8
Q

Location of pharyngeal tonsil + tubal tonsils

A

In nasal pharynx

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9
Q

Location of palatine tonsils

A

At back of throat

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10
Q

Location on lingual tonsil

A

Posterior surface of the tongue

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11
Q

What can enlargement of pharyngeal tonsil lead to?

A
  • Obstruction of nasal breathing: mouth breathing, snoring
  • Blockage of eustachian tube > middle ear problems
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12
Q

What is tonsillitis?

A

Enlargement of palatine tonsils

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13
Q

Is tonsillitis most commonly caused by viruses or bacteria?

A

Viral

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14
Q

What bacteria most commonly causes tonsillitis?

A

Strep pyrogenes

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15
Q

What two tools can be used to estimate the probability that tonsillitis is due to bacterial infection?

A

Centor criteria
FeverPAIN score

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16
Q

Outline the Centor criteria
What is it used for?

A
  • Used to estimate the probability that tonsillitis is due to bacteria
  • score >3 = 40-60% chance > offer antibiotics
    .
  • fever >38C
  • tonsillar exudates
  • absence of cough
  • tender anterior cervical lymph nodes
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17
Q

Outline the FeverPAIN score
What is it used for?

A
  • Used to estimate the probability that tonsillitis is due to bacteria
  • score 2-3 = 34-40% chance
  • score 4-5 = 62-65% chance
    .
  • fever
  • Pus on tonsils
  • Attended within 3 days of onset of symptoms
  • Inflamed tonsils
  • No cough
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18
Q

Treatment of bacterial tonsillitis

A

phenoxymethylpenicillin for 10 days
clarithromycin is penicillin allergy

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19
Q

Complications of tonsillitis

A
  • peritonsillar abscess
  • otitis media
  • scarlet fever
  • rheumatic fever
  • post-streptococcal glomerulonephritis
  • post-streptococcal reactive arthritis
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20
Q

Outline superficial/regional cervical lymph nodes

A
  • In superficial cervical fascia, just beneath skin
  • Drains regions of face, scalp + tongue into deeper lymph nodes
  • Form a ring from chin to occiput
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21
Q

Outline deep/terminal cervical lymph nodes

A
  • Most associated with IJV within carotid sheath
  • Drain lymph from superficial lymph nodes + directly from deeper tissues e.g. thyroid gland
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22
Q

What is the bony prominence of chin?

A

Mental protuberance

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23
Q

What is the bony protuberance of the occipital bone?

A

Occiput

24
Q

What are the superficial cervical lymph nodes draining the face + scalp?

A
  • submental
  • submandibular
  • pre-auricular + parotid
  • post-auricular
  • occipital
  • superior cervical
  • posterior cervical
  • anterior cervical
25
Q

What do the occipital lymph nodes drain?

A

Posterior scalp

26
Q

What do the post-auricular lymph nodes drain?

A

Posterolateral half of scalp

27
Q

What do the pre-auricular (+parotid) lymph nodes drain?

A

Anterolateral scalp
Upper half face including eye lids (conjunctiva)
Cheek

28
Q

What do the submental lymph nodes drain?

A

Inferior + posterior chin
Floor of mouth
Tip of tongue
Lower incisor teeth + gums

29
Q

What do the submandibular lymph nodes drain?

A

Centre of face + cheek
Teeth + gums
Anterolateral tongue

30
Q

What are the deep cervical lymph nodes?

A
  • jugulo-digastric
  • jugulo-omohyoid
  • supraclavicular
31
Q

What do jugulo-omohyoid lymph nodes drain?

A

Part of tongue
Oral cavity
Trachea
Oesophagus
Thyroid gland

3Ts 2Os

32
Q

What deep cervical lymph nodes are found in the posterior triangle?

A

Supraclavicular lymph nodes

33
Q

Why is there reason to worry in the case of supraclavicular lymphadenopathy?

A

Strong suspicion of malignancy

34
Q

What is an enlarged left supraclavicular lymph node suggestive of?

A

Gastric cancer

35
Q

How do reactive lymph nodes feel (non cancerous)?

A

Tender
Mobile - doesn’t feel stuck to surrounding tissues

36
Q

What features of enlarged lymph nodes suggests metastases?

A

Hard
Tethered to surrounding tissues
Painless to palpation

37
Q

What features of enlarged lymph nodes suggests lymphoma?

A

malignant
Rubbery
Painless to palpation
Fast growing

38
Q

What are red flags for lymphadenopathy?

A
  • on palpation: fixed, hard, irregular
  • rapidly grows in size
  • associated with generalised lymphadenopathy
  • systemic signs: weight loss, night sweats
  • associated with persistent unexplained changes in voice, difficultly swallowing
39
Q

History for neck lumps

A

Age
Duration
Progression
Associated symptoms
Potential risk factors

40
Q

Examination of neck lumps

A
  • Location: midline, anterior or posterior triangle
  • Movement with swallowing
  • Movement with sticking out tongue
41
Q

Palpation feature of neck lump

A
  • superficial or deep
  • mobile or fixed
  • hard, soft, rubbery, irregular
  • does it feel fluctuant? Filled with fluid
  • tender?
  • overlying skin changes
42
Q

Possible causes of neck lumps

A
  • cervical lymphadenopathy
  • benign lesions of skin or subcutaneous tissue
  • congenital lesions
  • thyroid gland pathology
  • salivary gland pathology
  • vascular
  • dermoid cyst
  • branchial cyst
43
Q

What do the jugulo-digastric lymph nodes drain?

A
  • tonsils
  • pharynx
  • part of tongue
44
Q

What should you do if the submental or submandibular lymph nodes are enlarged?

A

Check mouth
- teeth
- gum
- tongue: tip, top, bottom

45
Q

What could a midline neck lump be?

A

Dermoid cyst
Thyroglossal duct cyst
Pathology of the thyroid gland

46
Q

Outline a dermoid cyst

A
  • Congenital cystic teratoma
  • Sits high on midline of neck
  • teratoma > can contain hair, teeth or skin glands
47
Q

Outline a thyroglossal duct cyst?

A
  • congenital filled sac in the midline of the neck
  • moves superiorly with protrusion of the tongue
  • surgical removal (includes removal of hyoid bone)
48
Q

What could a lateral lump in the neck be?

A
  • pathology of salivary glands
  • carotid body tumour
  • branchial cysts
  • cystic hygroma
49
Q

What is a cystic hygroma?

A
  • collection of fluid filled sacs
  • in posterior triangle
  • compressible + transilluminable
  • often in young children
50
Q

Management of cystic hygroma

A

Surgical excision
Drainage

51
Q

Who do cystic hygromas occur in?

A

Infants + young children

52
Q

Outline a branchial cyst

A
  • congenital cyst on anterior superior SCM
  • originates from incomplete obliteration of branchial arches
53
Q

Investigations of neck lumps

A
  • Ultrasound first line
  • Fine needle aspiration if suspicious
  • CR or MRI scans if needed further
54
Q

What is the best imaging for neck lumps?

A

Ultrasound

55
Q

What is a neck lump moves on sticking out the tongue indicative of?

A

Thyroglossal duct cyst

56
Q

A patient, presenting with a neck lump, complains of pain after eating. What is the likely diagnosis?

A

Salivary gland pathology

57
Q

A patient has a neck lump that moves on swallowing, what is the likely diagnosis?

A

Goitre
(thyroid gland swelling)

HNN (24 decks)

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