Neck lump (oxford clin cases)

Question 1

What is the most likely diagnosis of a neck lump if the patient is a child?

Answer 1

Benign- it will usually be malformed lymph nodes or a flare up due to infection and immune response

Question 2

What is the most likely diagnosis of a neck lump if the patient is an adult

Answer 2

Most neck lumps will be malignant so this needs to be ruled out

Question 3

What features/symptoms of a neck lump will raise your suspicions its malignant?

Answer 3

If it has grown in size
If its not painful
If it has been present for more than a few weeks

Question 4

What features/symptoms of a neck lump will lower your suspicions its malignant?

Answer 4

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

Question 5

How can you differentiate between infection and malignancy if a patient describes symptoms like fever, malaise etc?

Answer 5

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

Question 6

What symptoms are usually not associated with head and neck cancer?

Answer 6

Weight loss

Question 7

What symptoms are usually associated with head and neck cancer?

Answer 7

Dysphagia
Vocal changes
Sounds when breathing
Discharge from ear/ nose 
Changes in hearing 
Cough
Haemoptysis

Question 8

What should you ask about if you suspect a neck lump is due to infection?

Answer 8

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

Question 9

What should you ask about if you suspect a neck lump is due to malignancy?

Answer 9

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

Question 10

What is a painful neck lump suggestive of?

Answer 10

A cyst, most other lumps will not be painful

Question 11

How can you test to see if the lump is under the trapezius muscle?

Answer 11

Ask them to lift up their shoulders against resistance, if the lump is under the trapezius it will be concealed when they do this

Question 12

What does a tender or warm lump indicate?

Answer 12

Infection

Question 13

What does a hard lump as opposed to a soft one indicate?

Answer 13

Malignancy

Question 14

What does a mobile vs non mobile lump indicate?

Answer 14

Non mobile= malignancy, it may be tethered to nearby structures
Mobile= most normal lymph nodes are mobile

Question 15

What does a pulsatile neck lump indicate?

Answer 15

Subclavian or carotid aneurysm

Question 16

What are the 2 main differential catagories when someone has a midline neck lump?

Answer 16

Thyroid causes and non thyroid causes

Question 17

What are differentials regarding the thyroid when someone has a midline lump in their neck?

Answer 17

Physiological goitre
Multinodular goitre
Grave's disease
Hashimoto's thyroiditis
Thyroglossal cyst
Thyroid cyst
Cancer

Question 18

What are non thyroid differentials when someone has a midline neck lump?

Answer 18

Lipoma
Dermal cyst
Epidermal cyst
Abcess

Question 19

What does a midline neck lump that appeared acutely suggest?

Answer 19

Haemorrhage into a thryoid cyst
A rare and fast growing thyroid carcinoma
Thyroglossal cyst that has appeared after a infection

Question 20

What characteristics of a midline lump in the neck will raise your suspicions its malignant?

Answer 20

If it grew in size slowly over time
The lump is not painful
There are other lumps present- lymphadenopathy in the surrounding area