Head and Neck Overview

Question 1

What addtitional systems should be considered for head and neck.

Answer 1

musculoskeletal, neuro, lymph, endocrine, vascular

Question 2

What should you inspect the head for?

Answer 2

head position, shape symmetry, skull shape, scalp, hair pattern

Question 3

what should you auscultate the head for?

Answer 3

temporal arteries–> temporal bruits

Question 4

What are the neck mass classifications?

Answer 4

congenital, inflammatory, and neoplastic

Question 5

patient presents with midline anterior mass. it is about 2-4cm, and moves upon swallowing. what is the treatment?

Answer 5

thyroglossal duct cyst. occurs from the remanants of the descending thryoid tract. Can become infected. MOVES WITH SWALLOWING!! tx: surgical excision.

Question 6

patient present with midline neck mass, it is in the submental area. it does not move with swallowing or tongue protrusion

Answer 6

demoid cyst. It is from ectodermal and mesodermal layers.

Question 7

patient presents with a lesion on the floor of their mouth. It is midline. Why does this occur?

Answer 7

Ranula, occurs from mucus extravasation from blocked salivary duct. They can be simple or plunging. plunging goes into the muscle layers.

Question 8

what are your three midline congential neck masses?

Answer 8

thyroglossal duct cyst, dermoid cyst, ranula

Question 9

Patient presents with lateral mass on side of neck. Says it has been there for some time, and it is soft and painless to palpation. He noticed it after a URI.

Answer 9

Brachial Cleft cyst! they can occur anywhere long the SCM. 2nd cleft cysts are the most common. 1st brachial cysts appear high in the neck.

Question 10

How do you treat congential neck masses?

Answer 10

surgical excision

Question 11

How do you diagnose congential neck masses?

Answer 11

CT or excisional biopsy

Question 12

what is the most common cause of an inflammatory neck mass?

Answer 12

reactive lymphadenopathy. usually secondary to an infection. enlarged tender lymph nodes. usually 2-4 cm in size. SUBMANDIB OR CERV!

Question 13

What will patients usually show signs of with an inflammatory neck mass?

Answer 13

a uri or phayrngitis, with staph or strep or mono being the cause

Question 14

How do you diagnose an inflammatory neck mass?

Answer 14

labs: rapid strep, throat culture, cbc, ppd, toxoplasma titers, HIv test, bartonella, monospot

FNAB
Excisional biopsy
U/S

Question 15

What is the treatment for inflammatory neck masses

Answer 15

usually resolve on own, but keep an eye. IN GENERAL…ABX for 10-14 days if bacterial infection. (macro lid, PCN, ceph). Follow up.

Question 16

Neoplastic neck masses are most common in…

Answer 16

adults

Question 17

What are some examples of benign neoplastic masses?

Answer 17

lipomas, fibromas, sebaceous cysts, schwannomas

Question 18

What is the most common cause of malignant neck masses?

Answer 18

metastatic squamous cell carcinoma

Question 19

patient presents with enlarged lymph nodes, nontender, weight loss, night sweaters, the nodes are “rubbery”

Answer 19

lymphoma

Question 20

rhabdomysarcoma’s are..

Answer 20

more common in kids. they are neoplastic. they are painless and enlarging.

Question 21

a hard midline nodule that you can feel on the thryoid you may think…

Answer 21

thyroid cancer.

Question 22

How do you diagnose neoplastic neck masses?

Answer 22

CT scan with contrast, FNAB

Treatment will most likely need excision and biopsy

Question 23

Patient presents with painful enlargment of their parotid and submandibular glands. They are extremely tender to palapation. You notice purulent discharge from the duct.

Answer 23

Sialoadentitis. You want to treat with Abx, hyrdation, massage of gland, warm compress

Question 24

Describe Parotitis

Answer 24

inflammation of parotid glands. Bacterial need Abx. Viral could be mumps.

Question 25

What is the basis of sialolithiasis?

Answer 25

little stones cause intermittment swelling of the salivary glands (parotid and sub). Noticed more when eating, sxs subside in 24-48 hours.