Clinical anatomy + presentation of neck lumps

Question 1

Anterior triangle borders

Answer 1

superior = mandible
anterior = midline of neck
posterior = anterior margin of sternocleidomastoid

Question 2

Posterior triangle borders

Answer 2

inferior = clavicle
posterior = trapezius
anterior = posterior margin of sternocleidomastoid

Question 3

Facial nerve branches

Answer 3

temporal
zygomatic
buccal
marginal mandibular
cervical

Question 4

Spinal nerve roots of phrenic nerve

Answer 4

C3,4,5

Question 5

What muscles does the accessory nerve supply?

Answer 5

motor supply to trapezius and sternocleidomastoid

Question 6

Injury to what can cause a Horner’s syndrome?

Answer 6

cervical sympathetic trunk

Question 7

Horner’s syndrome signs

Answer 7

ptosis
miosis
anhidrosis
enophthalmos

Question 8

What vessels supply the thyroid gland?

Answer 8

superior and inferior thyroid artery

Question 9

What is the superior thyroid artery a branch of?

Answer 9

external carotid artery

Question 10

What is the inferior thyroid artery a branch of?

Answer 10

thyrocervical trunk

Question 11

How many veins drain the thyroid?

Answer 11

3

Question 12

What specific questions should be asked in a neck lump history?

Answer 12

pain
throat symptoms
pain swallowing (odynophagia)
difficulty swallowing (dysphagia)
hoarse voice (dysphonia)
noisy breathing (stridor/stertor)
B symptoms (weight loss, night sweats, fevers)
referred otalgia
smoker/drinker
abroad travel

Question 13

Why do thyroid swellings move up and down on swallowing?

Answer 13

thyroid gland is attached posteriorly to the cricoid and thyroid cartilages by a layer of pre-tracheal fascia called Berry’s ligament

(NB lymph nodes do not move on swallowing)

Question 14

What is the most common congenital cyst in the neck?

Answer 14

thyroglossal cyst

Question 15

When do thyroglossal cysts move?

Answer 15

swallowing
tongue protrusion

Question 16

What is a thyroglossal cyst?

Answer 16

embryological remnant of thyroid gland (so must ensure thyroid gland is present)

Question 17

Where do branchial cysts occur?

Answer 17

swelling deep to upper 1/3 of SCM

Question 18

How should branchial cysts be investigated?

Answer 18

USS FNA and MRI to exclude deep tract/sinus
treatment = surgery as can become infected

Question 19

What cancer can masquerade as a branchial cyst?

Answer 19

metastatic SCC - mainly in smokers and males>40 - PET scan preoperatively

Question 20

What is a carotid body tumour and where are they found?

Answer 20

pulsatile lateral neck swelling at bifurcation of common carotid artery, possible bruit on auscultation

generally benign

surgery

Question 21

What is a schwannoma?

Answer 21

benign nerve sheath tumour
slow growing + typically painless

Question 22

Schwannoma examination findings

Answer 22

mobility in only antero-posterior direction
NOT supero-inferiorly

Question 23

What condition can schwannomas be associated with?

Answer 23

Neurofibromatosis

Question 24

What salivary gland is most commonly affected by stones?

Answer 24

submandibular gland

Question 25

Are larger or smaller salivary glands more at risk of malignancy?

Answer 25

smaller salivary glands

Question 26

What nerve runs through the parotid gland?

Answer 26

facial nerve

Question 27

Neck mass red flags

Answer 27

painful mass
rapidly increasing mass
7th nerve weakness
lymph nodes
paraesthesia
trismus (difficulty opening mouth)

Question 28

Where can a parotid SCC be a metastasis from?

Answer 28

scalp or pinna

Question 29

What could bilateral parotid swelling indicate?

Answer 29

systemic eg. infection (mumps) or inflammatory (Sjogren’s)

Question 30

Physiological causes of thyroid goitre

Answer 30

pregnancy
puberty
OCP

Question 31

Iatrogenic causes of thyroid goitre

Answer 31

lithium
carbamazepine

Question 32

Toxic causes of thyroid goitre

Answer 32

nodule
graves

Question 33

Inflammatory causes of thyroid goitre

Answer 33

Hashimotos
De Quervains thyroiditis
RIedels

Question 34

Red flags of thyroid cancer

Answer 34

family history of thyroid cancer
history of radiation exposure
<20y, >70y
male
lymph nodes palpable
vocal cord palsy

Question 35

Thyroid goitre investigations

Answer 35

TFTs
USS +/- FNA

Question 36

When to treat thyroid nodules

Answer 36

4C’s
Cosmesis
Compression
Cancer
Fear of Cancer

Question 37

What do sebaceous cysts look/feel like?

Answer 37

attached to skin
punctum

Question 38

What do lipomas look/feel like?

Answer 38

soft
indistinct margins
may be attached to muscle deep with reduced mobility
(rapidly increasing = consider malignant change –> liposarcoma)

Question 39

What do lymphangiomas look/feel like?

Answer 39

congenital
fluid filled –> fluctuant
transilluminate due to v thin wall
can be present at birth (eg. cystic hygroma)

Question 40

Main investigation of potentially malignant lymph nodes

Answer 40

USS FNA
suspected lymphoma = USS core biopsy to diagnose and subtype

Question 41

What is the name for TB neck?

Answer 41

scrofula

Question 42

TB neck signs/symptoms

Answer 42

may be painful
can have non-erythematous lymph nodes
can have abscess formation + erythema
collar stud abscess

Question 43

How can sarcoidosis affect lymph nodes?

Answer 43

multiple rubbery nodes
can look like lymphoma
can affect any organ in body
non-caseating granulomas seen on aspiration
ACE may be raised