Neck lumps Flashcards
Thyroiglossal vs branchial cysts
Thyroglossal- midline
Branchial- anterior border of SCM
Differentials for neck lumps
SKin- sebaceous cysts, dermoid
Lipomas
Thyroglossal vs branchial cysts
Lymph nodes- infected, inflammatory, neoplastic: benign or malignant
Neuromas
Blood vessels: hemangiomas, prominent normal vessels
PAragangliomas - carotid body or vagus nerve tumours
Salivary glands - infection, inflammation, neoplasm, autoimmune disease, stones
Thyroid- cysts, adenomas, carcinomas, goitres
Bones and cartilage- normal anatomy e.g. transverse process of C1, hyoid
Neck lump investigations
USS and FNA
Bloods- HIV, other viral screens
Chest Xray or chest CT
OGD
Panendoscopy, ipsilateral tonsillectomy with biopsies of nasopharynx, base of tongue and hypo pharynx under anaesthetic
Neck node biopsy if lymphoma suspected
Vocal cord palsy presentation and investigations
Weak breathy voice
scan full course of recurrent laryngeal nerve and a chest xray
Presentation in voice of tumours
Progressive, hoarse voice
Presentation of vocal cord nodules in voice
Treatment
Husky voice. Professional voice users, children shouting.
Voice therapy
Presentation of laryngitis in voice
Acute, URTI.
Patient is well
Patient gets better on own
Presentation of muscle tension dysphonia
Investigation
Strain/tension. overuse. abnormal use of larynx muscles
VOice therapy
Presentation of Reinke’s oedema and treatment
Deep voice in smoked caused by vocal cord oedema.
Stop smoking
Do tumours get better when patient is on holiday
NO. gets worse
Voice car advise for those with most voice problems
avoid shouting and whispering (both strain the larynx)
avoid irritants like smoking, air conditioning, caffeine
keep well hydrated
avoid throat clearing
avoid dry swallowing (forcefully swallowing saliva without any liquid in mouth)
What to do when someone presents with globes
Examine mouth, oropharynx, neck, ENT flexiscope
Need to exclude other pathology like cancer, masses, infection, reflux
History key- older smoker, dysphagia, constant and progressive symptoms with otalgia you should worry
if no cause of globes found, what to do
Explain to patient their symptoms are due to sensitivity/hyperawareness
Symptomatic treatment of globes
Avoid irritants- caffeine, smoking, throat clearing, dry swallowing
Ice cold sparkling water sips
Treat laryngopharyngeal reflux
