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head and neck cancer > neck examination > Flashcards

neck examination Flashcards

1
Q

Which 7 things should be asked about when taking a history of a neck lump?

A
  1. Duration (how long has it been present for?)
  2. First symptom noticed (what made them notice it?)
  3. Any other symptoms? (painful, interfere with swallowing).
  4. The progression of the lump - any changes?
  5. Persistence - whether it has gone and come back etc.
  6. Multiplicity (any others?)
  7. Cause - ‘what do you think caused the lump?’
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2
Q

If a patient UNDER 16 presents with a lump, what type is this most likely to be?

A

Inflammatory or Congenital (cyst)

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3
Q

If a patient between 16-40 presents with a neck lump, what is the most common cause of this?

A

Inflammatory or Congenital like under 16s BUT malignant causes are more likely.

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4
Q

If a patient over 40 presents with a neck lump, what should it be considered as until proven otherwise?

A

Neoplastic and potentially malignant - especially if the pt smokes or drinks.

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5
Q

Other important factors to determine from a neck lump history:

A
  1. Any history of head and neck cancer?
  2. Any history of skin cancer of the face and scalp?
  3. History of immunosuppression?
  4. Has the pt noticed any weight loss / night sweats / fever.
  5. Have they been in contact with any relatives with an infectious disease / animals /occupational exposures /travel.
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6
Q

Thinking in terms of culture and the development of cancer prevention, which age group would be more susceptible to head and neck SCCs and why this might be the case?

A

Older generations as growing up, they were not aware of the importance of sun cream/UV protection.

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7
Q

How does being a transplant patient impact the risk of head and neck cancers?

A

Transplant patients are on anti-rejection medications which therefore makes them more at risk of cancer.

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8
Q

Name 2 situations where weight loss may occur in relation to disease.

A
  1. Cancer
  2. Systemic Problems (e.g: lymphoma or TB)
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9
Q

How long would a lump have to be present for to raise concerns?

A

2-3 weeks.

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10
Q

Name 2 common risk factors that might increase the risk of malignancy in a neck lump?

A

Alcohol and use of Tobacco.

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11
Q

Identify 5 OTHER head and neck symptoms that might indicate malignancy.

A
  1. Change in voice / hoarseness.
  2. Blood in saliva.
  3. Dysphagia / odynophagia.
  4. Otalgia
  5. Nasal congestion.
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12
Q

What is dysphagia?

A

Difficulty or discomfort in swallowing.

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13
Q

What is otalgia?

A

Ear pain (due to relation to the eustachian tubes).

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14
Q

What is the ICE procedure prior to examining the neck?

A

WASH HANDS BEFORE EXAMINATION

I - introduce yourself
C - consent; explain what you are going to do.
E - expose the area to be examined.

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15
Q

When looking for movement of a midline lump, what could you get the patient to do to assess this?

A

Ask the patient to swallow a sip of water.

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16
Q

How would you conduct a biannual palpation of the submandibular gland?

A

Push up on the outside and roll finger into the floor of the mouth inside, feeling for any lumps and stones.

This pushes the submandibular gland into the floor of the mouth.

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17
Q

What would be the underlying anatomical structure if the neck lump lay in the midline?

A

Thyroid gland.

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18
Q

What would be the underlying anatomical structure if the neck lump lay in the pre-auricular region?

A

The Parotid

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19
Q

If it is not possible to measure a neck lump using a ruler, what could be used instead?

A

Comparing to common objects / food (e.g: golf ball, pea etc).

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20
Q

What would be the underlying anatomical structure if the neck lump lay in the lateral neck region?

A

Lymph Nodes

21
Q

When describing the surface of a neck lump, what may it be described as?

A

Smooth or irregular.

22
Q

When describing the edge of the neck lump, how could this be described?

A

Well defined/discrete or diffuse (an irregular border).

23
Q

What are the 5 potential descriptors of a lump?

(ranging from solid-soft)

A
  1. Solid/Rock hard (bone)
  2. Firm - hard but not as hard as bone.
  3. Rubbery - slightly squashable like a rubber ball.
  4. Spongey - squashable with some resistance.
  5. Soft
24
Q

If a lump is very mobile, what is this NOT indicative of?

A

A cancer that is metastasising.

25
Q

What kind of mobility would be expected in a cancerous neck lump? Why/

A

Fixed position as this indicates it has invaded adjacent structures.

26
Q

Temperature is also an indicator as to what type of lump may be present. What would a hot lump indicate?

A

The presence of an inflammatory process (e.g: abscess).

27
Q

At a late stage of development, cancer will start to fungate. What does this mean?

A

The cancer has invaded the adjacent tissues and broken free to form an ulcer.

28
Q

Name 4 characteristics to look for when considering the overlying skin of a neck lump.

A
  1. Colour
  2. Breaks in the skin / ulceration.
  3. Puckering
  4. Orange peel skin (suggests oedema around the lump).
29
Q

What is fluctuance a sign of?

A

A fluid-filled cavity - soft tissue cyst.

water balloon

30
Q

If a lump is cancerous, what would the expected size be?

A

Greater than 1cm

31
Q

What kind of shape would a neck lump be to warrant concern in combination with other characteristics?

A

Round or irregular.

32
Q

What would the mobility and consistency of a neck lump be to warrant concern?

A

The lump would be firm and fixed.

33
Q

Would a cancerous lump be tender to touch?

A

No.

34
Q

Considering size, shape, mobility, consistency, temperature, tenderness and overlying skin, what are 7 characteristics of a cancerous neck lump?

A

Size - greater than 1mm.
Shape - round or irregular.
Mobility - fixed.
Consistency - firm.
Temperature - normal temperature.
Tenderness - non-tender.
Overlying Skin - ulcerated (fungating).

35
Q

What type of diagnosis will a surgical sieve give you?

A

Differential Diagnosis

36
Q

What pneumonic can be used to provide a differential diagnosis for a neck lump?

A

VITAMIN C, D, E

37
Q

What does the C stand for in the VITAMIN C, D, E pneumonic?

A

Congenital - meaning this person was born with it.

38
Q

When do ‘Acquired’ lumps usually occur?

A

Later in life.

39
Q

The VITAMIN C, D, E pneumonic describes the potential origin of a lump. Expand this.

A

V - vascular
I - inflammatory or infective
T - traumatic
A - autoimmune
M - metabolic
I - idiopathic
N - neoplastic

D - degenerative
E - environmental.

40
Q

What could be a vascular cause of a neck lump?

A

Carotid body tumour, aneurism or haemangioma.

41
Q

What is the most common cause on an inflammatory/infective neck lump?

A

Dental Abscess

42
Q

Name the most common cause of a congenital neck lump.

A

Thyroglossal Duct Cyst:

  • primarily seen in people under 20.
  • fluctuant as it is cystic
  • painless unless it becomes infected
  • commonly find at the level of the hyoid bone
  • MOVES WHEN THE PT MOVES TONGUE
43
Q

Another type of congenital neck lump is a Haemangioma, which type of patient will this normally be seen in?

A

Paediatric patients as it is a common paediatric tumour.

44
Q

If an abscess is sitting above the mylohyoid muscle, where will a lump form?

A

In the floor of the mouth.

45
Q

If an abscess sits above the buccinator muscle, where will a swelling form?

A

Buccally.

46
Q

What kind of path will an abscess always take concerning its positioning?

A

A path of least resistance.

47
Q

What is a common cause for an inflammatory, traumatic, autoimmune, metabolic and neoplastic neck swelling?.

A

The THYROID

48
Q

What is a primary neoplasm in the neck?

A

The tumour has originated in the neck.

49
Q

What is a metastatic neoplasm in the neck?

A

When a cancer develops elsewhere in the head/neck and has spread to one of the glands in the neck.

head and neck cancer (5 decks)

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