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Endocrine week 3 > Management of thyroid nodules (neck swellings) > Flashcards

Management of thyroid nodules (neck swellings) Flashcards

1
Q

What are the boundaries of the anterior triangle in the neck ?

A
  • Superiorly - mandible
  • Laterally - anterior aspect of SCM
  • Medially - imaginary line down the midline
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2
Q

What are the boundaries of the posterior triangle of the neck ?

A
  • Inferiorly - clavicle
  • Laterally - trapezuis
  • Medially - posterior aspect of SCM
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3
Q

What are the superficial causes of neck lumps ?

A
  • Sebaceous cysts
  • Lipomas
  • Neurofibromas
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4
Q

What are the main midline causes of neck lumps ?

A
  • Thyroid
  • Thyroglossal cyst (remember thyroglossal duct in thyroid development)
  • Dermoid cyst (sack like growth on or in the skin present at birth)
  • Pharyngeal pouch (this is rare)
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5
Q

What are the causes of neck lumps in the anterior triangle ?

A
  • Lymph nodes
  • Branchial cysts
  • Salivary glands
  • Carotid body tumour
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6
Q

What are the causes of neck lumps in the posterior triangle?

A
  • Lymph nodes
  • Cystic hygroma
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7
Q

What are the most common casuses of neck lumps ?

A
  1. Lymph nodes - 85%
  2. Goitre - 8%
  3. Other 7%
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8
Q

If a patient has cervical lymphadenopathy what do you also need to check ?

A
  • Look for other nodes
  • Hepatosplenomegaly
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9
Q

What are the potential causes of cervical lymphadenopathy ?

A
  • Infective
  • Malignant
  • Haemotoligcal - leukaemia/ lymphoma
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10
Q

If the patient has hoarseness and neck lump what are you worried about ?

A

Cancer - potentially causing damage to the recurrent laryngeal nerve resulting in hoarness

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11
Q

What can you do to find out the cause of a neck lump?

A
  • Exammine it
  • USS FNA
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12
Q

What complication can develop in thyroglossal cysts and branchial cysts ?

A

The can fistulate and saliva can then come out the hole

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13
Q

How do thyroglossal cysts commonly present ?

A
  • As a midline swelling
  • They contain lymphatics which can become inflamed
  • They move when the tongue is stuck out
  • Usually present in teenage years
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14
Q

How do dermoid cysts commonly present ?

A
  • Usually in teenage years
  • As a midline swelling
  • Sac like growth on or in the skin
  • Described as a ‘‘half filled water bottle’’
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15
Q

What are the clinical features suggestive of a pharyngeal pouch causing neck swelling ?

A
  • More common in older men
  • Midline lump in the neck that gurgles on palpation
  • Typical symptoms are dysphagia, regurgitation, aspiration and chronic cough

Note only large ones will cause neck swelling

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16
Q

What is a branchial cyst due to ?

A

Persisting second branchial arch

17
Q

What are the clinical features of a branchial cyst

A
  • Slowly enlarging
  • Smooth, soft, fluctuant
  • Non-tender
  • May develop a fistula ==> saliva may come out
18
Q

On FNA aspiration of a branchial cyst what would be seen?

A

Cholestrol crystals

19
Q

When/where do cystic hygromas/lymphangiomas commonly present ?

A
  • In posterior triangle
  • Majority in first year of life
  • They are lymph filled and transilluminable
20
Q

What investigations would you do for a thyroid gland swelling ?

A

TSH and USS FNA

21
Q

When you stick your tongue out the swelling moves - what is the cause of this neck swelling ?

A

Thyroglossal cyst

22
Q

What in the history may suggestive reactive (infection causing) lymphadenopathy ?

A

There may be a history of local infection or a generalised viral illness

23
Q

What features would potentially suggest lymphoma as the cause of neck swelling ?

A
  • Rubbery, painless lymphadenopathy
  • Night sweats
  • Splenomegaly
  • +/- the phenomenon of pain when drinking alcohol (see haem notes for specific lymphoma type)
24
Q

If a midline swelling moves when you swallow what do you think is the cause ?

What other features may be present with this type of swelling ?

A
  • Thyroid - it moves because pretacheal fascia envelops it
  • Additional features - May be hypo-, eu- or hyperthyroid symptomatically
25
Q

Why should you remember to check the mouth ?

A

As the neck swelling could be due to salivary gland swelling

26
Q

What are the 3 main salivary glands ?

A
27
Q

What is the main pathology affecting the parotid gland ?

A

Tumours

28
Q

What are the most common tumours of the parotid gland ?

A

They are usually benign, the most common 2 are:

  1. Pleomorphic adenomas - 80%
  2. Warthin’s tumour - 10%
29
Q

What are the clinical features of pleomorphic adenomas & warthins tumour affecting the parotid gland ?

A

Pleomorphic adenomas:

  • Middle age
  • Slow growing, painless lump

Warthin’s tumour:

  • Males, middle age
  • Softer, more mobile and fluctuant (although difficult to differentiate)
30
Q

What features may suggest a malignant cause of parotid gland swelling ?

A

Short hx, painful, hot skin, hard, fixation, CN VII involvement

31
Q

What is the main pathology affecting the submandibular gland ?

A
  1. Sialolithiasis = salivary gland calculi
  2. Occasionally Sialadenitis = infection of the gland
32
Q

What are the clinical features of Sialolithiasis affecting the sub-mandibular gland ?

A

Typically colicky pain and post-prandial swelling of the sub-mandibular gland

33
Q

What are the clinical features of Sialadenitis affecting the sub-mandibular gland ?

A

Pus may be seen leaking from the duct, erythema may also be noted

Endocrine week 3 (14 decks)

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