Neck Lumps Flashcards

1
Q

What are the red flags associated symptoms for neck lumps

A
  • Hoarseness of voice
  • Weight loss
  • Ulceration of mouth
  • Painless neck lump
  • Lymphadenopathy – enlarged supraclavicular nodes are the most concerning for malignancy of the cervical lump nodes (can be caused by malignancy in chest or abdomen)
  • Night sweats (e.g. indicating lymphoma)
  • Fevers
  • Fatigue
  • Symptoms >3 weeks
  • Risk factors – FH, age, smoking status
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2
Q

What 4 categories can lymphadenopathy be generally grouped into?

A
  • Reactive
  • Infected
  • Inflammatory
  • Malignancy
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3
Q

Give some examples of reactive lymph nodes

A
  • swelling caused by viral URTIs
  • dental infections
  • tonsillitis
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4
Q

What are reactive lymph nodes?

A

Reactive lymphadenopathy is when lymph glands respond to infection by becoming swollen.

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5
Q

What are infective lymph nodes?

A

Lymphadenitis is an infection in one or more lymph nodes.

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6
Q

Give some examples of infected lymph nodes

A

TB, HIV, infectious mononucleosis

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7
Q

What are some inflammatory conditions can cause lymphadenopathy

A

SLE, sarcoidosis

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8
Q

What malignancies can cause lymphadenopathy?

A

Leukaemia, lymphoma, metastasis

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9
Q

What are the 6 S’s of examining any neck lump?

A
  • Size
  • Shape
  • Smoothness
  • Surface
  • Surroundings
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10
Q

Gives some red flag features of a neck lump

A
  • Unexplained (e.g. no infection)
  • Persistently enlarged (particularly >3cm in diameter)
  • Abnormal shape (normally oval shape where the length is more than double the width)
  • Hard or ‘rubbery
  • Non-tender
  • Tethered or fixed to skin or underlying tissues
  • Associated symptoms e.g. night sweats, weight loss, fatigue, fevers
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11
Q

What should you always remember to examine in a neck lump examination

A

Oral cavity!

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12
Q

What is the urgent 2 week referral criteria for a neck lump?

A

2 week wait referral for:

  • An unexplained neck lump in someone aged 45 or above
  • A persistent unexplained neck lump at any age
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13
Q

What is the urgent ultrasound referral criteria for a neck lump?

A

A lump that is growing in size:

  • Within 2 weeks in patients 25 and older
  • Within 48 hours in patients under 25
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14
Q

Give some blood tests indicated in a neck lump

A
  • FBC & blood film → leukaemia, infection
  • HIV test
  • Monospot test or EBV antibodies → for infectious mononucleosis
  • TFTs → for goitre or thyroid nodules
  • Antinuclear antibodies (ANA)
  • Lactate dehydrogenase
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15
Q

What do ANAs indicate?

A

SLE

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16
Q

What is LDH a non-specific tumour marker for?

A

Hodgkin’s lymphoma

17
Q

What is the 1st line imaging investigation in a neck lump?

A

US

18
Q

What is fine needle aspiration cytology?

A

Aspirating cells from lump using a needle and then analyse under microscope

19
Q

What is a core biopsy?

A

taking a sample of tissue with a thicker needle

20
Q

What is an incision biopsy?

A

cutting out a tissue sample with a scalpel

21
Q

What are the 3 possible locations of a neck lump?

A
  1. Anterior triangle
  2. Posterior triangle
  3. Midline
22
Q

What separates the anterior and posterior triangles of the neck?

A

Sternocleidomastoid muscle

23
Q

What are the borders of the anterior triangle?

A

anterior → midline of neck

superior → mandible

lateral → sternocleidomastoid

24
Q

What are the borders of the posterior triangle?

A

inferior → clavicle

posterior → trapezius

lateral → sternocleidomastoid