General Surgery_Neck Masses

Question 1

What is the greatest concern when an adult presents with a neck mass?

Answer 1

Malignancy (risk of malignancy increases with age)

Question 2

What factors increase the likelihood of neck malignancy?

Answer 2

• Smoking
• heavy alcohol use
• history of radiation treatment
• chronic sun exposure
• family history

Question 3

What is the most common site of neck masses?

Answer 3

Lymph nodes

Question 4

What are the most common congenital neck masses of the lateral neck?

Answer 4

Brachial anomalies (cyst, sinus, fistula)

Question 5

What is the most common type of branchial anomaly and how does it typically present?

Answer 5

• Second arch branchial cyst presenting in infants as a painless fluctuant mass in the anterior triangle

Question 6

What is the most common congenital neck mass of the midline neck?

Answer 6

Thyroglossal duct cyst

Question 7

What kind of malignancy has been reported within thyroglossal duct cysts?

Answer 7

Thyroid carcinoma

Question 8

What signs and symptoms indicate that a neck mass is most likely due to an inflammatory process?

Answer 8

• Recent infection, fever, tenderness and erythema at site of mass, rapidly growing

Question 9

Viruses, bacteria, typical and atypical mycobacteria, parasites, and fungi can all cause infection leading to inflammatory neck masses. Which is the most common?

Answer 9

Viruses

Question 10

What is the treatment for neck abscesses?

Answer 10

Surgical incision and drainage and/or intravenous (IV) antibiotics

Question 11

What types of bacteria are the most common cause of neck masses?

Answer 11

Staphylococcus and streptococcus bacteria

Question 12

What is the treatment for neckmasses due to bacterial infection?

Answer 12

10-day course of beta-lactamase resistant antibiotic

Question 13

What pathogen causes cat scratch disease?

Answer 13

Bartonella henselae

Question 14

What are the common clinical findings in cat scratch disease?

Answer 14

• Large lymphadenopathy (usually unilateral) that enlarges or does not resolve
• low grade fever
• joint or muscle aches

Question 15

To diagnose Kawasaki syndrome (vasculitis in children 5 years old or less) five of six criteria must be met, one of which is high fever for more than 5 days. What are the other five criteria?

Answer 15

1. Cervical adenopathy (at least 1.5 cm in diameter)
2. Conjunctival injection
3. Rednessof the oral cavity
4. Polymorphous exanthem
5. Reddening and/or swelling of the palms/soles (sometimes desquamation occurs)

Question 16

What cardiovascular complication may arise from Kawasaki?

Answer 16

Coronary artery aneurysm

Question 17

What is the treatment used to prevent the complications of Kawasaki?

Answer 17

• IV immunoglobulin and
• aspirin (one of the few indications for aspirin use in children)

Question 18

If a patient has a neck mass that by history is suggestive of an infectious process but has not responded to broad-spectrum antibiotic treatment, what tests should you order next?

Answer 18

PPD(test for TB) and chest x-ray

Question 19

What is scrofula?

Answer 19

Neck lymphadenitis due to mycobacteria (including but not limited to tuberculosis)

Question 20

How does scrofula typically present?

Answer 20

• As a single large cervical lymph node with an overlying violaceous color appearing later
• strongly reactive PPD when due to tuberculosis

Question 21

What pathogen causes a disease characterized by acute pharyngitis and cervical lymphadenitis and is thought to have a role in the development of Burkitt lymphoma and nasopharyngeal carcinoma?

Answer 21

Epstein-Barr virus

Question 22

What are some examples of benign neoplasms that occur in the neck?

Answer 22

• Lipomas
• hemangiomas
• neuromas
• fibromas

Question 23

Lymphadenopathy in the neck region may signify malignancy. What is significant about lymphadenopathy in the supraclavicular fossa?

Answer 23

The patient may have malignancy somewhere below the neck region (Lungs, GI tract Reproductive system, Kidneys)

Question 24

When the cause of a neck mass is unclear, in general, what is the best imaging modality for evaluating it?

Answer 24

CT with contrast