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Respiratory/Musculoskeletal > CM- The Neck Mass > Flashcards

CM- The Neck Mass Flashcards

1
Q

What are the bones/cartilage landmarks of the neck?

A
  1. mastoid tip- behind the ear at the top of SCM
  2. madible angle
  3. hyoid bone- difficult in obese/females
  4. thryroid cartilage
  5. cricoid cartilage- more prominent in females
  6. trachea
  7. C1 vertebral transverse process
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2
Q

What are the glandular landmarks of the neck?

A
  1. parotid- tail is anterior to SCM, posterior to mandible
  2. submandibular
  3. Thyroid- anterior
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3
Q

What are the vessel landmarks in the neck?

A
  1. Carotid: the bulb (bifurcation) is located on the center of the SCM but really can fall anywhere from cricoid to the mandible
  2. External jugular vein- surface of SCM
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4
Q

The ________divides the neck into anterior and posterior triangles.

A

SCM

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5
Q

The anterior triangle contains what 3 subdivisions?

What nodal levels are associated with each?

A
  1. submental triangle - nodal Ia
  2. submaxillary/submandibular triangle- nodal Ib
  3. vascular triangle - nodal II, III, IV
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6
Q

What nodal levels are associated with:

  1. submental triangle
  2. submaxillary
  3. vascular triangle
  4. posterior
A
  1. 1a
  2. 1b
  3. II, III, IV
  4. V
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7
Q

In addition to the 5 lymph node levels, What are the other groups of lymph nodes?

A
  1. pre-auricle
  2. post-auricle
  3. occipital
  4. superficial to SCM along ex. jugular vein
  5. perifacial= along facial artery at mandible
  6. supraclavicular (Virchow’s node) = on the left
  7. paratracheal
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8
Q

When you feel a neck mass, what is the order for what you presume it to be in adult? Children?

A

Adults:

  1. tumor (carcinoma if NOT tender)
  2. infection
  3. developmental

Children

  1. infection (reactive lymph nodes to URI, otitis)
  2. developmental (branchial cleft cysts, thyroglossal duct cysts)
  3. tumor (sarcoma, lymphoma)
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9
Q

What is the most prominent neck feature on a male? female?

A

Male- thyroid notch, so locate and work inferior

Female - cricoid, so locate and work superior

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10
Q 
What cancers are likely to be correlated to the following areas of the neck?
I
II
III
IV
V
VI
A 
I- skin and oral
II- oropharynx, parotid, UADT (upperaero-digestive tract)
III- UADT
IV- UADT, Delphian nodule, Thyroid 
V- nasopharynx
VI- thyroid
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11
Q

What are the 4 major ways neck masses can be categorized? Give examples of each.

A
  1. Normal variant
    - carotid artery
  2. Congenital/developmental anomaly
    - branchial cleft cyst
    - thyroglossal duct cyst
    - vascular
    - lymphatic malformation
  3. infection/inflammation
    - reactive lymphadenopathy
  4. Neoplastic
    - primary= salivary gland, thyroid tumor, nerve sheath tumor
    - metastatic= from head and neck, metastatic
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12
Q

Sex of the patient is only important in _____ neck masses.
Females are more likely to have _________.
Males are more prone to __________________.

A

ADULT

Females- thyroid
Males- squamous cell carcinoma

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13
Q

You are examining a female patient and notice a supraclavicular node on the left. What is this node called?
Where should you search for the primary legion?

A

It is Virchow’s node- on a female look for breast and ovarian cancer

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14
Q

You are examining a male patient and notice a supraclavicular node on the left. What is the node called?
Where should you search for primary legion?

A

Virchow’s node on a male you want to look for lung or prostate origins

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15
Q

When taking the past medical history, it is important to ask about time of onset of the mass.

If the mass come on rapidly, it is more likely an ___________ whereas if it comes on slowly it is more likely a ____________.
If it remains stable for a long period of time it is probably________________________.
If it fluctuates it is most likely ______________.

A

Rapid = infection

Insidious = neoplasm

Stable for long period of time = benign, congenital, developmental

Fluctuating = branchial or salivary cysts

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16
Q

Tobacco and alcohol are carcinogens for ___________________ of the larynx and lung.

UV radiation is a carcinogen for _______.

HIV seropositivity is a risk factor for ________ and _______.

A 
Tobacco/alcohol = squamous cell carcinoma
UV = skin cancer 
HIV = parotid gland lymphoepithelial cysts and lymphoma
17
Q

Where is the likely location of the mass for:

  1. epistaxis
  2. dysarthria
  3. trismus
  4. odynophagia
  5. stridor
A
  1. nasal cavity
  2. oral cavity
  3. oropharyngeal
  4. hypopharynx
  5. laryngeal and/or tracheal
18
Q

A patient comes in claiming they have TMJ. You are suspcious of otalgia.
What are the possible locations of the neck mass?

A

NP
OP/OC
hypopharynx
Larynx

With referred ear pain

19
Q

A patient comes in with full hearing loss. Where is the likely neck lesion?

A

NP obstructing Eustachian tube and causing severe otitis media

20
Q

What symptoms are associated with a nose mass?

What are possible causes?

A
  1. epistaxis
  2. pain
  3. obstruction

Caused by NP, nose, sinus lesion

21
Q

A patient comes in with dysphagia, odyngophagia, dysarthria, and trismus. Where is the mass?
What is the likely cause?

A

Mass in the OC/OP.

Caused by lesions in the OC/OP, OP, OC

22
Q

A patient comes in with dysphagia and odynophagia. Where is the likely mass?
What are the causes?

A

Hypopharynx- lesion

23
Q

A patient comes in with stridor, hoarseness, odynophagia, dysphagia. Where is the mass? What are causes?

A

Mass in the larynx caused by:

  1. lesion on vocal cord
  2. lesion on trachea
  3. lesion spreading to hypopharynx or espophagus
24
Q

A patient comes in wheezing and with stridor. Where is their neck mass?
What are causes?

A

Trachea- obstructing lesion

25
Q

A patient comes to see you and they say they have painful submandibular gland swelling that is intermittent and exacerbated by eating. What is the most likely cause?

A

submandibular duct obstruction

26
Q

What is the mass most likely to be if it is :

  1. midline
  2. anterolateral
  3. supraclavicular
  4. I
  5. II, III, IV
  6. V
A
  1. thyroglossal duct cyst
  2. branchial cleft cyst
  3. neoplasm
  4. glands
  5. lymph nodes
  6. hemangioma, venolymphatic, lymphangioma, malformation
27
Q

Metastatic carcinoma of the UADT can be involved with bacterial superinfection, so the nodes along II, III, IV will be tender.
How do you differentiate a bacterial infection from a bacterial infection WITH metastatic carcinoma?

A

Metastatic deposit will persist after the infection is treated.
If the entire mass resolves with antbiotics, it is most likely JUST infection

28
Q

A person has a mass that moves with deglutition (up and down when swallowing). What type of mass is this almost definitely?

A

Thyroid mass

29
Q

A person comes in with a mass that only moves medial lateral but NOT cranial/caudal. What is the mass most likely to be?

A

A mass fixed to the carotid

30
Q

A __________should be obtained if suspicious of infection or neoplasm.
_____ and ______ tests should be ordered if the mass is in VI area or if you are suspicious for lesion in these glands.

A

CBC:
high WBC with lots of PMNs suggests infection
low RBC suggest neoplasm

Thyroid and parathyroid function tests can be order if these glands are thought to be involved

31
Q

When would you use a plain X ray for evaluating neck masses?

A

You wouldnt. They are of no value

32
Q

When would you do CXR for neck masses?

A

rule out pulmonary lesions (TB or neoplastic)

33
Q

When is it reasonable to use ultrasound for neck masses?

A
  1. When cystic masses are suspected
  2. to locate carotid and other structures
  3. thyroid masses
34
Q

When is nuclear medicine (PET scans) used in evaluating neck masses?

A 
Occasionally with thyroid masses:
Cold nodules (decreased I uptake) are cancerous 
Hot nodules are hyperfunctioning and are not cancerous
35
Q

What is the most helpful study to evaluate neck masses and other soft tissue anatomy?
What are the 2 major drawbacks?

A

CT

  1. it doesn’t diagnose WHAT it is, just where and what is stuck to it
  2. requires good kidney function bc uses IV contrast
36
Q

What are the 2 reasons why thyroid masses are evaluated with ultrasonography and NOT usually CT?

A
  1. sonogram allows FNA to occur at the same time
  2. thyroid cancers are often treated with thyroidectomy AND radioactive iodine. CT with contrast saturates the thyroid/cancer with iodine, so they will not absorb as much later when iodine is being used as radioactive killer of the tumor
37
Q

When would you use angiogram for neck masses?

A
  1. vascular tumors (aneurysm, hemangioma)
  2. paragangliomas
  3. determine if a tumor surrounding the internal carotid can be done
38
Q

What is the rule of thumb for obtaining a histologic diagnosis (biopsy) for a neck mass?

A
  1. NEVER perform a biopsy until all the other diagnostic modalities have been completed
  2. have an experienced head and neck surgeon perform the exam prior to biopsy
39
Q

Why must a head and neck surgeon do the biopsy of the neck?

A
  1. excessive scarring can disrupt lymphatic drainage
  2. future operations can be compromised otherwise
  3. risk of seeding of the tumor is great

Respiratory/Musculoskeletal (36 decks)

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