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Oral Disease > Classification of neck lumps > Flashcards

Classification of neck lumps Flashcards

1
Q

What are the two basic classifications of a neck lump?

A

Benign / Malignant

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2
Q

What are five subgroups of a benign neck lump?

A 
Lumphoid
Thyroid
Salivary
Infection
Congenital
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3
Q

What are four subgroups of a malignant neck lump?

A

Lymphoma
Thyroid
Salivary
Metastic

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4
Q

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

A

Local, regional and general

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5
Q

What does a regional exam describe?

A

Usually in terms of midline or lateral lumps

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6
Q

When describing a lump what structures can be referred to?

A 
Skin
Fat
Muscle
Blood vessels
Lymph nodes
Salivary glands
Thyroid
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7
Q

Which are the two most important triangles of the neck?

A

Anterior / Posterior

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8
Q

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

A

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

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9
Q

Which lymph nodes are contained within lymph node level I?

A

Submandibular and submental triangle

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10
Q

Which lymph nodes are contained within lymph node level II?

A

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

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11
Q

Which lymph nodes are contained within lymph node level III?

A

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

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12
Q

Which lymph nodes are contained within lymph node level IV?

A

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

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13
Q

Which lymph nodes are contained within lymph node level V?

A

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

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14
Q

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

A

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

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15
Q

List some special investigative techniques.

A 
Blood
Radiology
Microbiology
Serology
Cytology
Histology
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16
Q

Describe different blood tests.

A 
Full blood count
Urea and electrolytes
Liver function test
Specific antibodies
Thyroid function
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17
Q

Describe different radiological tests.

A 
Plain
Ultrasound
Sialography
CT
MRI
Isotope
PET (positron emission tomography)
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18
Q

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

A

Microscopy, culture and sensitivity; used for TB and Actinomycosis

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19
Q

Describe different cytological/histological tests.

A 
Fine needle aspiration
Trucut
Cell blocks
Imprint cytology
Open biopsy
Resection
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20
Q

What is a trucut sample?

A

Where a core is taken from the lump and studied.

21
Q

What is imprint cytology?

A

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

22
Q

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

A

MRI: bone appears dark

CT and plain RG: Bone appears white

23
Q

What are the classifications of thyroid cytology?

A 
Th1
Th2
Th3
Th4
Th5
24
Q

Define thyroid cytology Th1.

A

Inadequate sampling

25
Q

Define thyroid cytology Th2.

A

Benign

26
Q

Define thyroid cytology Th3.

A

Follicular

27
Q

Define thyroid cytology Th4.

A

Suspicious for malignancy

28
Q

Define thyroid cytology Th5.

A

Malignant

29
Q

What are the first two stages of the surgical sieve?

A

Congenital (can include up to 21yrs) and acquired

30
Q

What are the main five causes of congenital lumps?

A 
Lymphangioma
Dermoid cysts
Thyroglossal cysts
Branchial cysts
Pharyngeal pouch
31
Q

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

A 
TIIINMAN:
Traumatic
Infective
Inflammatory
Iatrogenic
Neoplastic
Metabolic
Autoimmune
No idea
32
Q

Give some examples of neck lumps caused by trauma.

A

Haematoma
Dissection
Air emphysema

33
Q

Give some examples of neck lumps caused by infection.

A 
Dental Infection
Neck space infections
EBV
Cat scratch disease
Toxoplasma
TB
CMV
HIV (Persistant Generalised Lymphadenopathy)
34
Q

What is persistant generalised lymphadenopathy?

A

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

35
Q

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

A

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.

36
Q

Give some examples of neck lumps caused by inflammation.

A

Sialadenitis
Sarcoidosis
Rheumatoid

37
Q

What is sialadenitis?

A

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

38
Q

What is sarcoidosis?

A

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.

39
Q

Describe a metabolic cause of a neck lump.

A

Endocrine: thyroid (usually in the midline

Diabetes

40
Q

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

A

Benign / Malignant

“Tumour”

41
Q

Give a rough description of a benign tumour.

A

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

42
Q

Give a rough description of a primary metastatic tumour.

A

Infiltrating; fast-growing; damaging; affects nerves

43
Q

Give a rough description of secondary metastatic malignant tumours.

A

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

44
Q

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

A

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)

45
Q

Why would a malignant thyroid tumour affect the voice?

A

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.

46
Q

What is casein necrosis?

A

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

47
Q

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

A

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

48
Q

What is the most common benign parotid salivary gland tumour?

A

Pleomorphic adenoma

Oral Disease (3 decks)

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