Neck disorders

Question 1

Describe how to differentiate between different causes of dysphagia

Answer 1

if liquid is harder to swallow that solid, this suggests a neuromuscular issue rather than a mechanical one

Question 2

List the possible causes of hoarseness

Answer 2

Problem with vocal chords
 - vocal abuse
 - cysts/nodules
Laryngitis
Infection
Smoking
Reflux
Recurrent laryngeal nerve damage
Cancer

Question 3

List the common investigations used

Answer 3

FNAC - fine needle aspiration and cytology
Barium swallow
CT/MRI
Endoscopy (laryngoscopy, nsolaryngoscopy)
Ultrasound

Question 4

How are disorders of the neck and throat classified?

Answer 4

Benign vs Malignant
Benign can be further classified:
 - congenital
 - infective
 - inflammatory
 - trauma
 - neoplasia

Question 5

List common disorders of the neck and throat

Answer 5

Tonsilitis, Reactive lymphadenopathy
Head and neck cancer/lymphoma
Salivary gland disease
Vocal chord nodules, Laryngitis
Thyroglossal cyst
Pharyngeal pouch
Globus pharyngeus
Thyroid abnormalities

Question 6

When would a patient be offered tonsillectomy as treatment for tonsilitis?

Answer 6

SIGN guidelines:

• 6-7 attacks of bacteria tonsilitis in a year
• or 5 attacks per year for two years
• or 3 attacks per year for three years
• disrupting daily activities
• more than 1 quinsy

Question 7

What is quinsy?

Answer 7

aka peritonsilar abscess
potentially serious complication of tonsilitis
abscess between tonsil and wall of throat

Question 8

What is infectious mononucleosis more commonly known as?

Answer 8

Glandular fever

Question 9

Describe the characteristics of reactive vs malignant neck nodes

Answer 9

Reactive vs Malignant

• oval vs - round
• soft vs - firm
• smooth vs - irregular
• mobile vs - fixed
• tender vs - non-tender

Question 10

In a neck lump, what does tenderness usually indicate?

Answer 10

tenderness = inflammation

Question 11

What is the likely cause of a tender and fluctuant palpable lymph node?

Answer 11

Acute infection

Question 12

What is the likely cause(s) of a non-tender, rubbery palpable lymph node?

Answer 12

Lymphoma

Lymphocytic leukaemia

Question 13

What is the likely cause of a non-tend and hard palpable lymph node?

Answer 13

Metastatic cancer

Question 14

What is Virchow’s node?

Answer 14

An enlarged left supraclavicular node due to metastasis of visceral (classically gastric) malignancy

Question 15

Give three types of neck cysts

Answer 15

Thyroglossal cyst
Branchial cyst
Cystic hygroma

Question 16

What is a branchial cyst?

Answer 16

A congenital defect causing a fluid filled lump to develop in the neck. It is smooth and fluctuant but does not move on swallowing. Treatment in by excision.

Question 17

What red flag symptoms should you watch out for in a patient presenting with a neck lump?

Answer 17

Night sweats.
Weight loss.
Unexplained bruising or bleeding.
Persistent fatigue.
Breathlessness.

Question 18

Describe the characteristic position of a branchial cyst

Answer 18

A smooth swelling in front of the anterior border of the sternomastoid at the junction of its upper and middle thirds

Question 19

Describe the characteristic position of a branchial cyst

Answer 19

A smooth swelling in front of the anterior border of the sternomastoid at the junction of its upper and middle thirds

Question 20

What mnemonic can be used to remember how to examine neck lumps?

Answer 20

She Cuts The Fish PERfectly