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3rd year > Neck lumps > Flashcards

Neck lumps Flashcards

1
Q

Which lymph nodes can you palpate in healthy people?

A

Submandibular
axillary
inguinal

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2
Q

What causes cervical lymphadenopathy? 11

A 
1- URTI (reactive lymphadenit-
2-Infectious mononucleosis
3-HIV
4-Hepatitis
5-Syphilis 
6-Dengue fever
7-TB 
8-Metastatic disease
9-Lymphoma 
10-Acute leukaemia 
11-SLE
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3
Q

What are the red flag symptoms of cervical lymphadenopathy? 12

A 
1- persistent lymph node/s for >6 weeks 
2-firm, hard lymph nodes 
3- lymph node >2cm 
4-rapidly increasing in size
5- weight loss 
6- night sweats 
7- appetite loss 
8- exposure to HIV or hepatitis 
9- unexplained fever in returning traveller 
10- breast lumps 
11-symptoms suggesting bronchogenic cancer
12- associated generalised lymphadenopathy
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4
Q

What is the normal size of lymph nodes?

A

up to 1cm

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5
Q

What causes painful lymph nodes?

A

Inflammatory process or suppuration- normally

can also result from haemorrhage into the necrotic centre of a malignant node

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6
Q

What do stony-hard nodes suggest?

A

Cancer usually metastatic

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7
Q

What will nodes feel like in lymphoma?

A

very firm and rubbery

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8
Q

What will nodes feel like due to infection?

A

softer

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9
Q

What do shotty nodes suggest?

A

Viruses, especially in children

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10
Q

What are the benign causes of matted nodes? 3

A

TB
sarcoidosis
lymphgranuloma venereum

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11
Q

What are the malignant causes of matted nodes? 2

A

Metastatoc carcinoma

or lymphoma

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12
Q

What are right supraclavicular nodes associated with?

A

cancer in the mediastinum, lungs or oesophagus

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13
Q

What are left supraclavicular nodes (Virchow’s) associated with?

A

cancer in the testes, ovaries, kidneys, pancreas, prostate, stomach or gallbladder

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14
Q

What investigations should you do in cervical lymphadenopathy? 10

A

FBC- crucial if suspecting acute leukaemia
U&Es
CRP
LFTs
Monospot test
CXR- if bronchogenic cancer is suspected
HIV, syphilis or hepatitis testing- in high risk patients
USS of abdomen- if suspect hepatosplenomegaly
Paul Bunnel test- if positive indicates infectious mononucleosis

If these don’t make a diagnosis- do an excisional biopsy of the largest and most abnormal lymph node

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15
Q

Which patients should undergo a lymph node biopsy?4

A

Patients with unexplained localised lymphadenopathy
who have constitutional signs and symptoms
risk factors for malignancy
or lymphadenopathy that persists for more than 3-4 weeks

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16
Q

When should lymph node biopsy not be carried out?

A

In patients with probable viral illness as lymph node pathology in these patients may look like lymphoma–> false positives

17
Q

When should lymphadenopathy be referred?10

A

If the node persist for more than 6 weeks
If it is >2cm and not improving
If it is rapidly enlarging
If you suspect TB –> urgent to respiratory
HIV, syphilis, hepatitis positive
Unexplained fever in a returning traveller
Any significant systemic symptoms
generalised lymphadenopathy
significant abnormalities on blood work or imaging
Evidence of hepatomegaly or splenomegaly

18
Q

Where in the parotid gland do tumours typically occur?

A

In the tail of the gland, as a discrete mass in an otherwise normal gland

19
Q

Are most parotid tumours benign or malignant?

A

benign

20
Q

What are the most common malignant tumours of the parotid gland?

A

Adeonoid cyst carcinoma- most common
mucoepidermoid carcinoma
acinic cell carcinoma

21
Q

What are the most common benign tumours of the parotid gland?

A

Pleomorphic adenoma - most common parotid tumour
- it’s slow growing and asymptomatic
Warthin’s tumour- 2nd most common

22
Q

When do malignant parotid tumours tend to present?

A

after 60

23
Q

When do benign parotid tumours tend to present?

A

after 40

24
Q

What are the risk factors for parotid tumours? 4

A

Radiation
smoking is linked to Warthin’s tumour
previous skin cancer
sjorgen’s syndrome

25
Q

What are the red flag symptoms of parotid tumours? 6

A

facial nerve weakness

rapid increase in the size of the lump

ulceration or induration of the mucosa or skin overlying

paraesthesia or anaesthesia of nearby sensory nerves

Intermittent pain, increasingly relentless

History of previous skin cancer, Sjorgen’s syndrome or radiation to head or neck

26
Q

What investigations should be done in suspected parotid tumours?

A

USS- limted used in visualising the deep lobe however
USS guided fine needle aspiration for cytology
MRI or CT to evaluate
-the tumour bulk
-local invasion
-perineural spread- only if tumour is thought to be in the deep lobe

27
Q

How do you manage parotid tumours?

A

Radiotherapy- following surgery for high grade ones or alone for non-resectable ones

Superficial parotidectomy

chemotherapy- for palliative care only

28
Q

Which salivary gland is most likely to swell?

A

Parotid

29
Q

What causes parotid swelling? 7

A 
Viral parotitis--> mumps 
stone 
tumour 
Sjorgen's syndrome 
Sarcoidois-Heerford'ts syndrome
bacterial parotitis 
wegner's granulomatosis 
HIV related lymphocytic infiltration
30
Q

What are the features of mumps? 3

A

Bilateral parotid gland swelling
low grade pyrexia
malaise

31
Q

What causes submandibular gland swelling? 3

A

stone in salivary duct
tumours
Sjorgern’s syndrome

32
Q

What are the risk factors for salivary gland swelling? 8

A 
Bulimia 
anorexia 
Cushing's 
DM 
Hypothyroidism 
Coeliac and malnutrition 
alcoholism 
Drugs- thiourea, anticholinergics
33
Q

What are the signs and symptoms of salivary gland swellings? 6

A

pain may be referred to ear or throat
dry mouth
abnormal or foul tastes- due to purulent discharge
mouth of facial pain, especially associated with eating
decreased mouth opening- difficulty talking
fever/ systemically unwell

34
Q

What is a sign of parotid gland swelling?

A

loss of the angle of the jaw

35
Q

Where will swelling be present in sublingual swelling?

A

beneath and anterior to the angle of the jaw

the floor of the mouth

36
Q

What investigations should be done in salivary gland swelling?

A 
FBC 
CRP 
ESR 
U&Es 
blood culture 
viral serology or salivary antibody testing 
Pus swab- for culture 
sialography 
USS
CT/MRI scan to rule out neoplasm 
fine needle aspirate or incisional biopsy
37
Q

How do you manage salivary gland swellings?

A

Mumps= self limiting

Acute suppurative infection- Abx, incision and drainage if abscess

Encourage salivary flow:

  • warm compress
  • sialagogues e.g. lemon drops, gum or vitamin C lozenges
  • hydration
  • salivary gland massage
  • oral hygiene

Remove stones

3rd year (9 decks)

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