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Year 5 - ENT > ENT - neck lumps > Flashcards

ENT - neck lumps Flashcards

1
Q

What are the borders of the triangles in the neck?

A

These two triangles are on either side of the sternocleidomastoid muscle.

The borders of the anterior triangle are:

  • Superior - mandible
  • Medial - Midline of the neck
  • Lateral - Sternocleidomastoid

The borders of the posterior triangle are:

  • Inferior - Clavicle forms the inferior border
  • Posterior - Trapezius
  • Lateral - Sternocleidomastoid
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2
Q

Differential diagnosis of neck lumps in adults

A

Skin abscess

Lymphadenopathy (enlarged lymph nodes)

Tumour (e.g., squamous cell carcinoma or sarcoma)

Lipoma

Goitre (swollen thyroid gland) or thyroid nodules

Salivary gland stones or infection

Carotid body tumour

Haematoma (a collection of blood after trauma)

Thyroglossal cysts
Branchial cysts

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3
Q

On examination, lump may be

A

Pulsatile - e.g. carotid body tumour

Movement with swallowing (e.g. thyroid lumps) or sticking their tongue out (e.g. thyroglossal cysts)

Transilluminates with light (e.g., cystic hygroma – usually in young children)

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4
Q

General examination findings…

A

Ear, nose and throat infections (e.g., reactive lymph nodes)

Weight loss (e.g., malignancy or hyperthyroidism)

Skin pallor and bruising (e.g., leukaemia)

Focal chest sounds (e.g., lung cancer)

Clubbing (e.g., lung cancer)

Hepatosplenomegaly (e.g., leukaemia)

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5
Q

Neck lump 2WW referral criteria

A

An unexplained neck lump in someone aged 45 or above

A persistent unexplained neck lump at any age

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6
Q

Consider an urgent ultrasound scan if

A

Lump is growing in size:

  • within 2 weeks in patients 25 and older
  • within 48 hours in patients under 25

If this suggests soft tissue sarcoma - 2WW referral

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7
Q

Investigations in neck lumps

A

Bloods (not every neck lump):
- FBC and blood film for leukaemia and infection
HIV test
Monospot test or EBV antibodies for infectious mononucleosis
Thyroid function tests for goitre or thyroid nodules
Antinuclear antibodies for systemic lupus erythematosus
Lactate dehydrogenase (LDH) is a very non-specific tumour marker for Hodgkin’s lymphoma

Imaging - first line is USS usually

  • Also could do MRI/CT
  • Nuclear medicine scan (e.g., for toxic thyroid nodules or PET scans for metastatic cancer)

Biopsy may be needed

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8
Q

What can cause lymphadenopathy in the neck?

A

Reactive e.g. URTI, tonsillitis

Infected LNs e.g. TB, HIV, infectious nucleosis

Inflammatory conditions e.g. SLE, sarcoidosis

Malignancy - lymphoma, leukaemia or metastasis

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9
Q

What is infectious mononucleosis?

A

EBV virus infection (spread by bodily fluid contact, especially saliva)

This presents with:

  • Fever
  • Sore throat
  • Fatigue
  • Lymphadenopathy

Mononucleosis can present with an intensely itchy maculopapular rash in response to amoxicillin or cephalosporins.

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10
Q

What is the investigations and management of mononucleosis?

A

Monospot test - first line investigation
- Can also test for IgM IgM (acute infection) and IgG (immunity) to EBV

Management is supportive

  • Avoid alcohol (risk of liver impairment)
  • Avoid contact sport (for at least a month) - due to a risk of splenic rupture
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11
Q

How does lymphoma present?

A

Lymphadenopathy is the key symptom
B cancer symptoms

Reed sternberg cell on LN biopsy in Hodgkin’s

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12
Q

How does thyroid pathology present?

A

Will move with swallowing

Goitre - generalised swelling:

  • Graves disease (hyperthyroidism)
  • Toxic multinodular goitre (hyperthyroidism)
  • Hashimoto’s thyroiditis (hypothyroidism)
  • Iodine deficiency
  • Lithium

Individual lumps:

  • Benign hyperplastic nodules
  • Thyroid cysts
  • Thyroid adenomas (benign tumours the can release excessive thyroid hormone)
  • Thyroid cancer (papillary or follicular)
  • Parathyroid tumour

Symptoms of hypo or hyperthyroidism

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13
Q

Salivary glands and what can enlarge them

A

3 salivary glands:

  • Parotid glands
  • Submandibular glands
  • Sublingual glands

3 main reasons for enlargement:

  • Stones blocking drainage (sialolithiasis)
  • Infection
  • Tumours (benign or malignant)
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14
Q

Carotid body tumours - what are they?

A

The carotid body is just above the carotid bifurcation

Excessive growth of glomus cells in the carotid body.

Most are benign

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15
Q

Presentation of carotid body tumours

A

Slow growing lump that is:

  • Near the angle of the mandible (anterior triangle)
  • Painless
  • Pulsatile
  • Bruit on auscultation
  • Mobile side to side but not up and down

May compress CN9-12 nerves

CN10 compression can cause Horner syndrome

  • Ptosis
  • Miosis
  • Anhidrosis (loss of sweating)
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16
Q

Investigations in carotid body tumours and treatment

A

MRI can show splaying (separating) of the internal and external carotid arteries (lyre sign).

Mostly treated with surgical removal

17
Q

Presentation of lipoma

A

Lump is soft, painless and mobile

Typically treated conservatively with reassurance (after excluding other pathology)

Can be surgically removed

18
Q

What is thyroglossal cyst? How does it present?

A

Thyroglossal duct is a embryological structure that usually disappears

If it persists, cysts can occur (thyroglossal cyst)

Lump:

  • Midline of neck
  • Mobile
  • Non-tender
  • Soft
  • Fluctuant
  • Moves up with protrusion of the tongue (due to the connection between the thyroglossal duct and the base of the tongue)
19
Q

What is a key differential for thyroglossal cyst? Investigations? Management?

A

Ectopic thyroid tissue is a key differential diagnosis

USS (or CT) can confirm diagnosis

Thyroglossal cysts are usually surgically removed to provide confirmation of the diagnosis on histology and prevent infections.

20
Q

What is a potential complication of thyroglossal cyst?

A

Infection is the main complication:

- Hot tender painful lump

21
Q

What is a Branchial cyst?

A

Congenital abnormality that arises when the second branchial cleft fails to form properly during foetal development.

Leaving a space where fluid can fill (in lateral neck)

22
Q

How do branchial cysts present?

A

Branchial cysts present as a round, soft, cystic swelling between the angle of the jaw and the sternocleidomastoid muscle in the anterior triangle of the neck.

Most commonly present in young adults

23
Q

Management of branchial cyst?

A

Conservative - where no symptoms

Surgical excision where recurrent infections, diagnostic doubt, or it is causing other problems

Year 5 - ENT (21 decks)

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