Classification of neck lumps

Question 1

What are the two basic classifications of a neck lump?

Answer 1

Benign / Malignant

Question 2

What are five subgroups of a benign neck lump?

Answer 2

Lumphoid
Thyroid
Salivary
Infection
Congenital

Question 3

What are four subgroups of a malignant neck lump?

Answer 3

Lymphoma
Thyroid
Salivary
Metastic

Question 4

What are the different types of exams used in the diagnostic pathway?

Answer 4

Local, regional and general

Question 5

What does a regional exam describe?

Answer 5

Usually in terms of midline or lateral lumps

Question 6

When describing a lump what structures can be referred to?

Answer 6

Skin
Fat
Muscle
Blood vessels
Lymph nodes
Salivary glands
Thyroid

Question 7

Which are the two most important triangles of the neck?

Answer 7

Anterior / Posterior

Question 8

In addition to named lymph node groups, the lymph nodes are subdivided into how many levels?

Answer 8

5 (I, II, III, IV, V)

Question 9

Which lymph nodes are contained within lymph node level I?

Answer 9

Submandibular and submental triangle

Question 10

Which lymph nodes are contained within lymph node level II?

Answer 10

Upper jugular chain lymph nodes (including the jugulodigastric lymph node)

Question 11

Which lymph nodes are contained within lymph node level III?

Answer 11

Mid-jugular chain nodes (including the jugulo omohyoid node)

Question 12

Which lymph nodes are contained within lymph node level IV?

Answer 12

Lower jugular chain lymph nodes (including lymph nodes overlying scalenus anterior muscle and those in the supraclavicular fossa)

Question 13

Which lymph nodes are contained within lymph node level V?

Answer 13

Lymph nodes of the posterior triangle lying along the course of the spinal accessory nerve

Question 14

What anatomical structures are important when looking at the neck midline?

Answer 14

Submental node; hyoid bone; possible thyroglossal cysts; thyroid gland; sternocleidomastoid muscle; thyroid cartilage; branchila cysts (or other level II mass); submadibular nodes

Question 15

List some special investigative techniques.

Answer 15

Blood
Radiology
Microbiology
Serology
Cytology
Histology

Question 16

Describe different blood tests.

Answer 16

Full blood count
Urea and electrolytes
Liver function test
Specific antibodies
Thyroid function

Question 17

Describe different radiological tests.

Answer 17

Plain
Ultrasound
Sialography
CT
MRI
Isotope
PET (positron emission tomography)

Question 18

What is MC&S and what is it used for?

Answer 18

Microscopy, culture and sensitivity; used for TB and Actinomycosis

Question 19

Describe different cytological/histological tests.

Answer 19

Fine needle aspiration
Trucut
Cell blocks
Imprint cytology
Open biopsy
Resection

Question 20

What is a trucut sample?

Answer 20

Where a core is taken from the lump and studied.

Question 21

What is imprint cytology?

Answer 21

Where the sample is halved and dabbed onto a tissue slide.

Question 22

How can you tell the difference between an MRI and a CT?

Answer 22

MRI: bone appears dark

CT and plain RG: Bone appears white

Question 23

What are the classifications of thyroid cytology?

Answer 23

Th1
Th2
Th3
Th4
Th5

Question 24

Define thyroid cytology Th1.

Answer 24

Inadequate sampling

Question 25

Define thyroid cytology Th2.

Answer 25

Benign

Question 26

Define thyroid cytology Th3.

Answer 26

Follicular

Question 27

Define thyroid cytology Th4.

Answer 27

Suspicious for malignancy

Question 28

Define thyroid cytology Th5.

Answer 28

Malignant

Question 29

What are the first two stages of the surgical sieve?

Answer 29

Congenital (can include up to 21yrs) and acquired

Question 30

What are the main five causes of congenital lumps?

Answer 30

``` Lymphangioma Dermoid cysts Thyroglossal cysts Branchial cysts Pharyngeal pouch ```

Question 31

What is the mnemonic for the aetiology of aquired lumps? (or aetiology of any disease)

Answer 31

``` TIIINMAN: Traumatic Infective Inflammatory Iatrogenic Neoplastic Metabolic Autoimmune No idea ```

Question 32

Give some examples of neck lumps caused by trauma.

Answer 32

Haematoma Dissection Air emphysema

Question 33

Give some examples of neck lumps caused by infection.

Answer 33

``` Dental Infection Neck space infections EBV Cat scratch disease Toxoplasma TB CMV HIV (Persistant Generalised Lymphadenopathy) ```

Question 34

What is persistant generalised lymphadenopathy?

Answer 34

Enlarged non-painful lymph nodes occurring in a couple of different areas for more than three to six months for which no other reason can be found. This condition occurs frequently in people in the latency period of HIV/AIDS

Question 35

What is cat scratch disease? By what other names is it known by?

Answer 35

It is a common and usually benign infectious disease caused by a bacterium, either Bartonella henselae or Bartonella quintana - most commonly found in children following a scratch or bite from a cat within about one to two weeks. AKA cat scratch fever, Teeny's Disease, inoculation lymphoreticulosis, and subacute regional lymphadenitis.

Question 36

Give some examples of neck lumps caused by inflammation.

Answer 36

Sialadenitis Sarcoidosis Rheumatoid

Question 37

What is sialadenitis?

Answer 37

Inflammation of the salivary gland divided into acute, chronic and recurrent.

Question 38

What is sarcoidosis?

Answer 38

A disease involving abnormal collections of inflammatory cells (granulomas) that can form as nodules in multiple organs. The granulomas are most often located in the lungs or its associated lymph nodes, but any organ can be affected.

Question 39

Describe a metabolic cause of a neck lump.

Answer 39

Endocrine: thyroid (usually in the midline | Diabetes

Question 40

What are the two subtypes of neoplastic lumps? What layman's term is usually used?

Answer 40

Benign / Malignant | "Tumour"

Question 41

Give a rough description of a benign tumour.

Answer 41

Slow-growing; well-rounded; moveable; compressible .

Question 42

Give a rough description of a primary metastatic tumour.

Answer 42

Infiltrating; fast-growing; damaging; affects nerves

Question 43

Give a rough description of secondary metastatic malignant tumours.

Answer 43

Remnants of primary metastasis (previous investigations main clue) resulting in lymph node involvement

Question 44

What are the "red flags" for a lump seen on clinic?

Answer 44

Rapid growth; effect on adjacent structures (nerve, skin, airway); risk factors (age, smoking, radiation, family history, previous investigations; systemic symptoms or "B symptoms" (fever, night sweats, itching)

Question 45

Why would a malignant thyroid tumour affect the voice?

Answer 45

The recurrent laryngeal nerves (from left a right vagus nerves) run in the opposite direction to the vagus: the left recurrent laryngeal nerve loops under the aorta while the right recurrent laryngeal nerve branches at the level of the subclavian artery. Both nerves ascend a groove at the junction of the trachea and oesophagus . They then pass behind the posterior, middle part of the outer lobes of the thyroid gland and enter the larynx underneath the inferior constrictor muscle, passing through the thyrohyoid membrane. The terminal branch is called the inferior laryngeal nerve.

Question 46

What is casein necrosis?

Answer 46

The curdled-milk appearance of tuberculosis infected lymph nodes when seen under the microscope.

Question 47

What kinds of cysts are common in children and young adults?

Answer 47

Sebaceous cysts: a cyst that originates from sebaceous glands and contain sebum (rare) Epidermoid cysts: a cyst that originates from the epidermis and contains keratin Pilar cysts: a cyst that originates from the base of the hair follicle and also contain keratin

Question 48

What is the most common benign parotid salivary gland tumour?

Answer 48

Pleomorphic adenoma