Neck lumps

Question 1

investigations for lymphadenopathy

Answer 1

Ultrasound scan
FNA cytology
CT scan

Question 2

5 risk factors for squamous cell carcinoma

Answer 2

• Human papilloma virus
• Epstein Barr virus
• Betel nut chewing
• Alcohol
• Smoking

Question 3

Human papilloma virus increases risk of;

Answer 3

head and neck cancers in younger patients (20-40s)

Question 4

Epstein Barr virus increases risk of;

Answer 4

nasopharyngeal carcinoma

Question 5

Betel nut chewing increases risk of;

Answer 5

oropharyngeal carcinoma

Question 6

alcohol increases the risk of;

Answer 6

upper aerodigestive tract malignancy

Question 7

management of Squamous cell carcinoma

Answer 7

• Panendoscopy + biopsy
• CT skull base to diaphragm
• MDT discussion

Question 8

causes of lympahdenopathy? (2)

Answer 8

• infection

- metastatic spread from a carincoma

Question 9

Dysphonia is…

Answer 9

hoarse voice

Question 10

pathology of the larynx that can cause Dysphonia (3)

Answer 10

• Acute laryngitis
• Chronic laryngitis
• SCC of larynx

Question 11

how can thyroid disease cause dysphonia?

Answer 11

malignant thyroid disease invading the recurrent laryngeal nerve

Question 12

differentials for a vocal cord lesion (2)

Answer 12

• SCC of larynx

- Vocal fold polyp

Question 13

findings on examination of larynx with a flexible nasendoscope?

Answer 13

• white coloured lesion; if the SCC produces keratin

Question 14

what are vocal fold polyps?

Answer 14

inflammatory lesions of the vocal fold usually resulting from overuse

Question 15

management of vocal fold polyp?

Answer 15

• speech therapy

- surgery using endoscope, microscope and specialised laryngeal surgery may be required

Question 16

investigations of vocal fold lesion

Answer 16

• FNA cytology
• Ultrasound of neck
• CT scan neck + chest

Question 17

management of metastatic SCC

Answer 17

• radiotherapy
• surgical
• chemotherapy
• palliative management for symptom control
• rehabilitation (voice + swallowing problems)

Question 18

TNM staging is …

Answer 18

Tumour size
Nodes involved
Mets presence

Question 19

most common thyroid cancer is ? and 2nd most common

Answer 19

1st = Papillary
2nd = Follicular

Question 20

causes of generalised thyroid swellings (3)

Answer 20

• Multinodular goitre
• Hashimotos
• Graves disease

Question 21

what is stridor

Answer 21

inspiratory noisy breathing suggesting narrowing of the upper airway

Question 22

cause of unexplained hoarseness

Answer 22

invasion of recurrent laryngeal nerve or the larynx

Question 23

Management of Papillary + Follicular Thyroid carcinomas (3)

Answer 23

• Total thyroidectomy
• Followed by radioiodine to kill residual cells
• Yearly thyroglobulin levels to detect early recurrent disease

Question 24

what is Reinke’s oedema

Answer 24

Condition where the vocal folds become v. oedematous w/ accumulation of a gelatinous material within the fold

Question 25

Management of Reinke’s oedema

Answer 25

• smoking cessation
• GORD control
• incision of the vocal fold with removal of gelatinous material