Lumps Flashcards
How to take a history of a lump
- When did you first notice it
- Where is it
- Spread to any other areas
- What has happened to it since? Grown bigger? More painful
- First episode?
- Any associated features? Weight loss, fever, night sweats
- What do you think it is?
Head and neck symptoms:
-Throat pain, ear ache, dysphagia, voice changes, dental pain
Systemic symptoms:
- Fever, weight loss, night sweats, malaise, rash
- Pain drinking alcohol
- Smoking and alcohol
Examination of the lump
- Look, palpate, percuss then auscultate (listen)
- Is there more than one swelling?
- Where is it? Anterior or posterior triangle? Level? Anatomy?
- Soft, firm, hard, fluctuant, tender, mobile/fixed
- Size, measured with a ruler
- Pulsatile? Does it beat
- Does it move on swallowing?
-Any pathology at primary sites?
Ear, nose throat, mouth, scalp, salivary glands?
-Any other lymph node basins involves (axillar, groins, abdomen)
What features should you look out for when examining a lump
Site Shape Size Surface Temperature Tenderness Transilluminate Colour Edge/margin Relations Nodes
How can you use sieves as a basic structure of diagnosis
Anatomical Sieve
- Skin
- Sebaceous gland
- Fat
- Hair
- Blood Vessels
- Nerves
- Lymphatics
- CT
- Muscles
- Bone
- Special structures (thyroid, parotid, thymus)
Surgical Sieve
- Metabolic
- Endocrine
- Degenerative
- Inflammatory
- Congenital
- Psychological
- Idiopathic
- Neurological
- Environmental
- Haemotological
- Autoimmune
- Traumatic
What are the boundaries of the anterior triangle of the neck
- Posterior border of the SCM
- Midline
- Inferior border of the mandible
What are the boundaries of the posterior triangle of the neck
- Posterior border of the SCM
- Middle third of the clavicle
- Anterior border of the trapezius
Anatomical Sieve related to lumps
- Vessels
- Nodes
- Salivary glands
- Muscles
- Nerves
- Mucosal surfaces
- Thyroid
- Bone
Levels of the neck
-Look at diagram
What should you do if you see a lateral neck mass
- Any lateral neck mass in an adult is a metastatic deposit until proven otherwise
- Refer in
Special Investigations for lumps
-Flexible nasendoscopy (look down the back of the nose)
-Fine needle aspiration cytology (FNAC)
With or without ultrasound guidance
-Imaging
Ultrasound, CT, MRI, PET scanning
-Blood tests
FBC, LFT, Bone screen, ESR, Thyroid function, EBV, HIV, CMV, Brucellosis, Glandular fever, cat scratch disease
-Important to work out if infection or not
Fine-Needle Aspiration Cytology procedure
- Get a needle
- Push into lump
- Aspirate some cells
- Look down a microscope
- Look for malignancies and make a diagnosis
-Operator dependent
Causes of Cervical Lymphadenopathy
Infective:
-Bacterial
Teeth (periocoronitis)
Skin
Tonsils
-Local Viral
URTI
Primary HSV
-Generally bacterial
TB
Cat scratch
Secondary syphilis
-Generally viral HIV CMV EBV Rubella
Neoplastic: -Local metastatic Aerodigestive Skin Salivary Thyroid Sinuses Breast Stomach
-General
Lymphoma
Leukaemia
Other:
- Drugs
- Sarcoidosis
Lateral Neck lumps possibilities
- Lymph Node most likely
- Epidermoid cyst
- Lipoma
- Fibroma
- Salivary glands
- Branchial cyst
- Cervical rib
- Hyoid bone
- Transverse process C1 and C6
- Ectatic carotid artery
- Carotid body tumour
- Congenital tortilcollis
Midline neck lumps possibilities
- Thyroid gland pathology
- Parathyroid gland
- Dermoid cyst
- Plunging ranula
- Thyroglossal duct cyst
Common Problems with the ear
- Hearing loss
- Otalgia- ear pain
- Otorrhoea- ear discharge
- Middle ear infection- common in children
- Facial palsy- important to find cause
- Disorders of balance
- Tinnitis- ringing in the ear
- Foreign bodies
- Aural drops
