Neck lump (oxford clin cases) Flashcards
What is the most likely diagnosis of a neck lump if the patient is a child?
Benign- it will usually be malformed lymph nodes or a flare up due to infection and immune response
What is the most likely diagnosis of a neck lump if the patient is an adult
Most neck lumps will be malignant so this needs to be ruled out
What features/symptoms of a neck lump will raise your suspicions its malignant?
If it has grown in size
If its not painful
If it has been present for more than a few weeks
What features/symptoms of a neck lump will lower your suspicions its malignant?
If its small and hasn’t changed in size
If there are other lumps present over the body- makes it likely it could be systemic eg and infection
If its been present for a long time/ since birth
If its been there less than a few weeks
How can you differentiate between infection and malignancy if a patient describes symptoms like fever, malaise etc?
Ask about the onset of symptoms- if onset is acute its more likely infection, if onset is gradual and has been going on for a while eg weight loss over a month its more likely malignancy
What symptoms are usually not associated with head and neck cancer?
Weight loss
What symptoms are usually associated with head and neck cancer?
Dysphagia Vocal changes Sounds when breathing Discharge from ear/ nose Changes in hearing Cough Haemoptysis
What should you ask about if you suspect a neck lump is due to infection?
Have they had any other infections recently eg upper resp tract
Have they had recent contact with someone who had an infection
Have they had any insect/animal bites recently
Has there been recent trauma
What should you ask about if you suspect a neck lump is due to malignancy?
Has there been previous cancer Is there family history of cancer Has there been radiotherapy to the neck Do they smoke/have they ever What is their alcohol intake like
What is a painful neck lump suggestive of?
A cyst, most other lumps will not be painful
How can you test to see if the lump is under the trapezius muscle?
Ask them to lift up their shoulders against resistance, if the lump is under the trapezius it will be concealed when they do this
What does a tender or warm lump indicate?
Infection
What does a hard lump as opposed to a soft one indicate?
Malignancy
What does a mobile vs non mobile lump indicate?
Non mobile= malignancy, it may be tethered to nearby structures
Mobile= most normal lymph nodes are mobile
What does a pulsatile neck lump indicate?
Subclavian or carotid aneurysm
What are the 2 main differential catagories when someone has a midline neck lump?
Thyroid causes and non thyroid causes
What are differentials regarding the thyroid when someone has a midline lump in their neck?
Physiological goitre Multinodular goitre Grave's disease Hashimoto's thyroiditis Thyroglossal cyst Thyroid cyst Cancer
What are non thyroid differentials when someone has a midline neck lump?
Lipoma
Dermal cyst
Epidermal cyst
Abcess
What does a midline neck lump that appeared acutely suggest?
Haemorrhage into a thryoid cyst
A rare and fast growing thyroid carcinoma
Thyroglossal cyst that has appeared after a infection
What characteristics of a midline lump in the neck will raise your suspicions its malignant?
If it grew in size slowly over time
The lump is not painful
There are other lumps present- lymphadenopathy in the surrounding area
