Neck Lump Flashcards
Lymphadenitis
. inflammation of the lymph glandular tissues
Lymphoma
Swelling of lymph (canceR)
NHL stands for
Non-hodkin’s lymphoma
FNA stands for
. Fine needle aspiration
. Technique used around neck to get sample of lymph node for review
Virchow’s node
. Left supraclavicular nodes
. Indication of mediastinal/chest/stomach metastatic cancer
Categories of head and neck masses
. Congenital . Neoplastic . Traumatic . Metabolic . Infectious . Psychogenic/psychosomatic
Examination techniques for head and neck
. Inspection
. Palpation (no percussion of neck, only sinuses)
. Auscultation for bruits and airways
Anatomic great vessels of the neck
. R/L External jugular v. (Ant. To SCM)
. R/L common carotid a. (Deep to SCM)
. Sternomastoid mm.
.find internal jugular for placing central venous line in neck (lat. to carotid)
Contents of anterior triangle of neck
. Mandible, SCM, midline of neck (hyoid, thyroid cartilage, circoid cartilage, tracheal rings, and thyroid gland)
Contents of post. Triangle of neck
. SCM
. Trapezius
. Clavicle
. Omohyoid m.
Cervical lymph nodes
. Pre and post. Auricular . Occipital . Tonsillar . Sumandibular . Submental . Superficial and deep cervical (chain) . Post. Cervical . Supraclavicular . Examine cranial to caudal
Concerning head and neck symptoms
. Headache . Sore throat . Swollen glands . Goiter . Hoarseness
Acute hoarseness potential diagnoses
. Viral laryngitis
. Bacterial pharyngitis
. Voice overuse
. Neck trauma
Chronic hoarseness differential diagnoses
. Over 2 weeks . Hypothyroid . GERD . Vocal cord nodules . Cancer . Parkinson’s . Horner’s syndrome (n. Impingement) . Myasthenia Gravis . Amyotrophic lat. sclerosis
Thunder clap headache
. Worst headache of life
. Indicative of subarachnoid hemorrhage
. order CT scan of head w/o contrast
. If neg. then spinal tap for blood
Warning signs of cancer
. Fever
. Night sweats
. Weight loss
Hyperthyroidism
. High levels T3/4
. Symptoms: nervousness, weight loss, excessive sweating, heat intolerance, palpitations, frequent bowel movements, tremors and/or proximal muscle weakness
Graves’ disease
. Hyperthyroidism . Eye changes (staring, lid lag, exophthalmos) . Tachycardia . Accentuated S1 . Tremors and prox. Muscle weakness
Hypothyroidism
. Low T3/4 . Fatigue . Weight gain . Cool, dry, yellow skin . Cold intolerance . Swelling of hands/face/legs (nonpitting edema) . Constipation . Muscle cramps . Impaired memory/hearing loss . Bradycardia . Peripheral neuropathy . Diminished ankle reflexes
Primary hypothyroidism
. Failure of thyroid gland itself
. Low T3/4
. High TSH and TRH
. Most common
Secondary hypothyroidism
. Pituitary disease causing reduced TSH
. Rare
. Low T3/4 and TSH
. High TRH
Tertiary hypothyroidism
. Hypothalamic disease causing dec. TRH
. Most rare
. Low T3/4, TSH, and TRH
Lymphadenopathy
. In ant. Chain: infectious
. In post. Chain: infectious, TB, lymphoma, other neck/head malignancy
Lymphoma
. NHL or Hodkins
. Painless nodules
. Rule out infectious causes first
Brachial cleft cyst
. 20% pediatric neck masses
. Infected cyst and ant. Lymph nodes
Thyroglossal duct cyst
. Midline mass of ant. Neck
. Present as infected cyst/URTI
Cat scratch disease
. Infection w/ bartonella henselae from cat scratch/bite
. Has primary papule where bite occurred
. Regional lymphadenopathy that is tender in periacuricular, submandibular, or cervical nodes
. Treatment: Azithromycin
Types of enlargement of thyroid and most common differentials w/ each type
. Diffuse: graves, hashimoto, endemic goiter
. Single node: malignancy vs. benign growth
. Multnodular goiter: metabolic disarrangement vs. malignancy
. Get us initially, then FNA biopsy
Enlargement of parotid gland differentials
. Acute bilateral: mumps
. Acute unilateral: blocked duct stone (sialolithiasis)
. Acute/chronic unilateral: neoplasm
. Chronic bilateral: obesity, DM, cirrhosis
Posterior cervical space contents
. Fat . Accessory N. XI . Brachial plexus . Lymph nodes . Remnants 3rd branchial pouch
Posterior cervical space pathology
. Lipoma . Schwannoma, neurofibromas . Lymphoma . Cystic hygroma, lymphangioma . 3rd branchial cleft cyst
Bacterial pharyngitis
. Swollen uvula . White spots . Red, swollen tonsils . Throat redness . Gray, furry tongue
Viral pharyngitis
. Red, swollen tonsils
. Throat redness
