Neck Lump

Question 1

Causes of persisting generalised lymphadenopathy

Answer 1

• glandular fever
• CMV infection
• toxoplasmosis
• leukaemia
• lymphoma
• SLE
• HIV

Question 2

Causes of acute localised cervical lymphadenopathy ?

Answer 2

• viral URTI
• tonsillitis
• glandular fever
• bacterial lymphadenitis
• dental infection
• Kawasaki disease

Question 3

Causes of persisting local cervical lymphadenopathy ?

Answer 3

• glandular fever
• TB
• atypical mycobacteria
• cat scratch disease

Question 4

Reactive causes of lymphadenopathy ?

Answer 4

Infective: bacterial, viral, toxoplasmosis

Non infective: sarcoidosis, amyloidosis, eczema, SLE etc

Question 5

Infiltrative causes of lymphadenopathy ?

Answer 5

• benign histiocytosis

- malignant: haematological (lymphoma, leukaemia), mets (breast, lung, bowel etc)

Question 6

Tests for neck lumps (5)

Answer 6

• ultrasound: shows consistency: cystic, solid, vascular etc
• CT: defines masses in relation to neighbouring anatomy
• virology and Mantoux test
• CXR
• consider FNA

Question 7

Differential diagnoses for neck lump in submandibular triangle (5)

Answer 7

• self limiting lymphadenopathy (

Question 8

Differential diagnoses of midline neck lump (4)

Answer 8

• dermoid cyst
• thyroglossal cyst (moves up on tongue protrusion, below hyoid
• thyroid isthmus mass (likely >20)
• chondroma (bony hard)

Question 9

Differential diagnoses of neck lumps in anterior triangle (6)

Answer 9

• branchial cyst- emerge under ant border of sternocleidomastoid
• parotid tumour - superoposterior
• laryngocele - painless, made worse by blowing
  pulsatile:
• carotid artery aneurysm
• tortuous carotid artery
• carotid body tumour (chemodectoma) - move side to side but not up and down, splay out the carotid bifurcation, anterior to upper 1/3 of sternocleidomastoid

Question 10

Differential diagnoses of neck lumps in the posterior triangle: (5)

Answer 10

• cervical ribs
• pharyngeal pouches - protrude into post triangle on swallowing(usually left sided)
• cystic hygromas - (usually infants), transilluminate brightly, arise from jugular lymph sac
• pancoasts tumour- lung apex (can cause horners syndrome)
• subclavian aneurysm (pulsatile)

Question 11

Causes of acute salivary gland swelling

Answer 11

• mumps

- HIV

Question 12

Causes of recurrent unilateral pain and swelling if salivary gland

Answer 12

• salivary stone

- 80% submandibular

Question 13

Presentation if salivary stone ?

Answer 13

Pain and swelling on eating, with red, tender, swollen but uninfected gland

Question 14

Which conditions may salivary stones coexist with ?

Answer 14

• hypothyroidism
• sjogrens
• bulimia

Question 15

What is the classic sign of parotid tumour ?

Answer 15

Deflection if ear outwards

Question 16

CN7 palsy with salivary gland swelling means what?.

Answer 16

Malignancy

Question 17

Where do tumours of head and neck usually metastasise to ?

Answer 17

Lymph nodes in submandibular region and upper anterior triangle

Question 18

Tumours of chest and abdomen usually metastasise to which lymph nodes ?

Answer 18

• lower part of posterior triangle

- Virchow’s node

Question 19

Causes of acute generalised lymphadenopathy ?

Answer 19

Most commonly viral/ post viral infection