Neck Lumps

Question 0

Ddx lateral lumps in the neck

Answer 0

Lymph node
Solitary thyroid nodule
Sebaceous cyst/lipoma
Cystic hygroma/branchial cyst
Vascular: aneurysm, carotid body tumour
Salivary glands
Nerve: neurofibroma

Question 1

Ddx Midline lumps in the neck

Answer 1

Goitre

Thyroglossal cyst

Question 2

Indications for thyroid goitre surgery

Answer 2

Failure of medical treatment
Large goitre
Patient choice
Intolerance of medication (eg rashes - 1/20 get w/ carbimazole)

Question 3

Complications of thyroid goitre surgery

Answer 3

(Acute, early, rare) 
Bleeding 
Thyroid crisis (fast afib/pul oedema/hyperthermia)
(Damage to local structures)
Hypoparathyroidism- hypocalcaemia 
Damage to recurrent laryngeal nerve
(Common)
Late hypothyroidism
Recurrent hyperthyroidism

Question 4

If you were assisting thyroid surgery how would you help prevent bleeding?

Answer 4

Tie off dual blood supply (superior thyroid a. from external carotid and inferior thyroid a. from subclavian a.)

Question 5

How would you avoid damage to recurrent laryngeal nerve?

Answer 5

Stay anterior to pretrachael fascia

Question 6

Commonest large goitre

Answer 6

Multinodular goitre

Question 7

Test for retrosternal goitre

Answer 7

Pemberton’s test

Patient raises arms and holds above head -> pink face -> temp obstruction of SVC

Question 8

Embryological remnant cysts?

Answer 8

Thyroglossal cyst (mid line, moves with sticking out tongue)
Cystic hygroma (on left, cavernous lymphangioma, there from birth or early childhood, brilliant translumination, usually in posterior triangle)
Branchial cyst (lateral from deep behind upper border of Sterno-mastoid at level of hyoid bone, from second brachial cleft, teens/young adults, usually transluminates, fluid rich in cholesterol crystals, risk of damage to 12th CN)

Question 9

Carotid aneurysm

Answer 9

Localised, pulsating and LATERALLY expansile

Question 10

Carotid cyst

Answer 10

Localised, pulsating, VERTICALLY expansile

Question 11

Carotid body tumour (chemodectoma)

Answer 11

Slowly enlarging firm mass
High in neck, arising from the carotid bifurcation
Hard, solid, nontransluminable, pulsating, not expansile
Causing splaying of internal and external carotids

Question 12

Causes of lymphadenopathy

Answer 12

Acute infection
Chronic infection
Neoplastic local spread
Distant spread
Hodgkins, non-Hodgkins, CLL

Question 13

Causes of cervical nodes - local

Answer 13

Acute infection - tonsillitis, otitis externa
Chronic infection - cold abscess of TB
Neoplastic - local spread from head and neck
Distant spread from breast, lung, abdomen

Question 14

Causes of cervical nodes - generalised

Answer 14

Acute infection - acute mononucleosis
Chronic infection - TB, syphilis, HIV
Neoplasms - Hodgkins, non-Hodgkins, CLL

Question 15

Lipoma

Answer 15

Subcutaneous 
Soft
Mobile, not attached to skin
Fluctuant
Anywhere but palms, soles, scalp

Question 16

Epidermoid (sebaceous) cyst

Answer 16

Smooth, round
Attached to skin at punctum
Mobile over deep tissues
Firm
All sites except palms and soles

Question 17

Neurofibromatosis

Answer 17

Autosomal dominant
Solitary or generalised
Check for axillary freckling plus cafe au lait spots
Type 2 associated with acoustic neuroma
Check facial nerve, corneal reflex and hearing

Question 18

Types of salivary glands

Answer 18

Parotid, submandibular, sublingual

Question 19

Causes of enlarged salivary glands

Answer 19

Acute viral infection
Acute bacterial infection - staph 2o to dehydration, DM, malnutrition, dry mouth of phenothiazines, alcoholism, pancreatitis
Calculi and distal infection
Sjögren's syndrome eg with RA
Tumours

Question 20

Parotid tumour

Answer 20

Pleomorphic adenoma
Suspect malignancy if pain, fixation, VII etc
Awlays test facial nerve
Parotid duct by 2nd molar

Question 21

Submandibular gland

Answer 21

Submandibular duct under tongue on either side of frenulum

Bimanual Palpation of submandibular distinguishes from lymph node