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ENT > Clinical anatomy + presentation of neck lumps > Flashcards

Clinical anatomy + presentation of neck lumps Flashcards

1
Q

Anterior triangle borders

A

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

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2
Q

Posterior triangle borders

A

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

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3
Q

Facial nerve branches

A

temporal
zygomatic
buccal
marginal mandibular
cervical

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4
Q

Spinal nerve roots of phrenic nerve

A

C3,4,5

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5
Q

What muscles does the accessory nerve supply?

A

motor supply to trapezius and sternocleidomastoid

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6
Q

Injury to what can cause a Horner’s syndrome?

A

cervical sympathetic trunk

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7
Q

Horner’s syndrome signs

A

ptosis
miosis
anhidrosis
enophthalmos

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8
Q

What vessels supply the thyroid gland?

A

superior and inferior thyroid artery

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9
Q

What is the superior thyroid artery a branch of?

A

external carotid artery

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10
Q

What is the inferior thyroid artery a branch of?

A

thyrocervical trunk

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11
Q

How many veins drain the thyroid?

A

3

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12
Q

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

A

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

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13
Q

Why do thyroid swellings move up and down on swallowing?

A

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)

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14
Q

What is the most common congenital cyst in the neck?

A

thyroglossal cyst

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15
Q

When do thyroglossal cysts move?

A

swallowing
tongue protrusion

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16
Q

What is a thyroglossal cyst?

A

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

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17
Q

Where do branchial cysts occur?

A

swelling deep to upper 1/3 of SCM

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18
Q

How should branchial cysts be investigated?

A

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

19
Q

What cancer can masquerade as a branchial cyst?

A

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

20
Q

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

A

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

generally benign

surgery

21
Q

What is a schwannoma?

A

benign nerve sheath tumour
slow growing + typically painless

22
Q

Schwannoma examination findings

A

mobility in only antero-posterior direction
NOT supero-inferiorly

23
Q

What condition can schwannomas be associated with?

A

Neurofibromatosis

24
Q

What salivary gland is most commonly affected by stones?

A

submandibular gland

25
Are larger or smaller salivary glands more at risk of malignancy?
smaller salivary glands
26
What nerve runs through the parotid gland?
facial nerve
27
Neck mass red flags
painful mass rapidly increasing mass 7th nerve weakness lymph nodes paraesthesia trismus (difficulty opening mouth)
28
Where can a parotid SCC be a metastasis from?
scalp or pinna
29
What could bilateral parotid swelling indicate?
systemic eg. infection (mumps) or inflammatory (Sjogren's)
30
Physiological causes of thyroid goitre
pregnancy puberty OCP
31
Iatrogenic causes of thyroid goitre
lithium carbamazepine
32
Toxic causes of thyroid goitre
nodule graves
33
Inflammatory causes of thyroid goitre
Hashimotos De Quervains thyroiditis RIedels
34
Red flags of thyroid cancer
family history of thyroid cancer history of radiation exposure <20y, >70y male lymph nodes palpable vocal cord palsy
35
Thyroid goitre investigations
TFTs USS +/- FNA
36
When to treat thyroid nodules
4C's Cosmesis Compression Cancer Fear of Cancer
37
What do sebaceous cysts look/feel like?
attached to skin punctum
38
What do lipomas look/feel like?
soft indistinct margins may be attached to muscle deep with reduced mobility (rapidly increasing = consider malignant change --> liposarcoma)
39
What do lymphangiomas look/feel like?
congenital fluid filled --> fluctuant transilluminate due to v thin wall can be present at birth (eg. cystic hygroma)
40
Main investigation of potentially malignant lymph nodes
USS FNA suspected lymphoma = USS core biopsy to diagnose and subtype
41
What is the name for TB neck?
scrofula
42
TB neck signs/symptoms
may be painful can have non-erythematous lymph nodes can have abscess formation + erythema collar stud abscess
43
How can sarcoidosis affect lymph nodes?
multiple rubbery nodes can look like lymphoma can affect any organ in body non-caseating granulomas seen on aspiration ACE may be raised
44

ENT (14 decks)

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