neck lumps

Question 1

anterior triangle borders

Answer 1

superior: mandible
medial: neck midline
lateral: SCM

Question 2

posterior triangle borders

Answer 2

inferior: clavicle
medial: SCM
posterior: trapezius

Question 3

2 week wait referral for…

Answer 3

• unexplained lump in someone ≥45yrs

- persistent unexplained neck lump at any age

Question 4

if lump is growing in size

Answer 4

USS

• within 2wks if ≥25yrs
• within 48hrs if < 25yrs

Question 5

lymphadenopathy

Answer 5

enlarged lymph noes

can be

• reactive
• infective
• inflammatory
• malignant

Question 6

lymphadenopathy - reactive

Answer 6

viral UTRI
tonsilitis
dental infection

Question 7

lymphadenopathy - infected

Answer 7

TB
HIV
infectious mononucleosis

Question 8

lymphadenopathy - inflammatory

Answer 8

SLE

sarcoid

Question 9

lymphadenopathy - malignancy

Answer 9

lymphoma
leukaemia
metastasis

Question 10

lymphadenopathy - features suggestive of malignancy

Answer 10

unexplained
persistently enlarged esp >3cm
abnormal shape
hard or rubbery 
non-tender
fixed to skin or underlying tissues
assoc symptoms: night sweats, weight loss, fever, fatigue

Question 11

what happens if treat someone with infective mononucleosis with amoxicillin

Answer 11

intensely itchy maculopapular rash

Question 12

infective mononucleosis - Ix

Answer 12

monospot test**

also IgM (acute) and IgG (immunity) for EBV

Question 13

infective mononucleosis - Mx

Answer 13

avoid alcohol - risk liver impairment

avoid contact sport - risk splenic rupture

Question 14

reasons for salivary gland enlargement

Answer 14

stones
infection
tumours

Question 15

carotid body

Answer 15

structure located above carotid bifurcation

contains glomus cells which are chemoreceptors

Question 16

Carotid Body Tumours

Answer 16

formed by excessive growth of glomus cells
aka paraganglioma

most benign

Question 17

Carotid Body Tumours - features

Answer 17

slow growing lump 
upper anterior triangle of neck 
painless
pulsatile 
assoc with bruit 
mobile side-to-side but not up and down

Question 18

Carotid Body Tumours - characteristic finding on imaging

Answer 18

splaying of internal and external carotid arteries

Lyre sign

Question 19

Carotid Body Tumours -Mx

Answer 19

surgical removal

Question 20

thyroglossal cyst

Answer 20

persistent of thyroglossal duct

Question 21

thyroglossal cyst - key differential diagnosis

Answer 21

ectopic thyroid tissue

Question 22

thyroglossal cyst - features

Answer 22

midline of neck
mobile 
non-tender
soft 
fluctuant

Question 23

thyroglossal cyst - key feature

Answer 23

move up and down with tongue movement

due to connection between thryoglossal duct and base of tongue

Question 24

thyroglossal cyst - Ix and Mx

Answer 24

USS or CT

surgical removal

Question 25

branchial cyst

Answer 25

congenital abnormality where 2nd branchial cleft fails to form properly

leaves a space surrounded by epithelial tissue in lateral asppect of neck

can fill with fluid –> branchial cyst

Question 26

branchial cyst - features

Answer 26

soft, round cystic swelling

between angle of haw + SCM in anterior triangle neck

Question 27

branchial cyst - presentation

Answer 27

tend to present >10yrs when cyst becomes noticeable or infected

Question 28

branchial cyst - Mx

Answer 28

conservative

surgical excision - recurrent infection, diagnostic doubt, other problems