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Surgery > Neck lumps > Flashcards

Neck lumps Flashcards

1
Q

Characteristics of a lump

A

4S: Site, size, shape, sound

4T: Temperature, tenderness, transillumination, tethering/mobility

4C: Contour, consistency, colour, compression

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2
Q

Borders of the anterior triangle of the neck

A

Midline, mandible, sternocleidomastoid

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3
Q

Borders of the posterior triangle of the neck

A

Sternocleidomastoid, clavicle, anterior margin of the trapezius

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4
Q

Lymph node compartments/levels of the neck

A
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5
Q

DDx of pulsatile masses in the anterior triangle

A

Carotid body tumour

Carotid artery aneurysm

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6
Q

DDx of non-pulsatile masses in anterior triangle

A

Midline:

  • Thyroglossal cyst (moves upwards with tongue)
  • Dermoid cyst (non-mobile)
  • Chondroma

Non-midline:

  • Goitre (may be retrosternal, may be uni/multinodular, may have bruits)
  • Branchial cyst
  • Laryngeocoele
  • Pharyngeal pouch
  • Lymphadenopathy
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7
Q

DDx of posterior triangle masses

A

Malignancy until proven otherwise!

Reactive lymphadenopathy

Pharyngeal pouch

Lymphoma

Cervical rib

Cystic hygroma

Subclavian aneurysm

Pancoast’s tumour

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8
Q

Features of hyperthyroidism

A

Sweating

Weight loss/weakness (proximal myopathy)

Emotional lability

Appetite increased

Tremor/tachycardia

Irritability, irregular mensturation, intolerance of heat

Nodules/goitre

GI problems (diarrhoea)

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9
Q

Common causes of hyperthyroidism (overactive thyroid gland)

A

Graves’ (autoimmune)

Toxic multinodular goitre/solitary adenoma

Amiodarone (high I2 content)

High beta-HCG (pregnancy, hydratiform mole)

Pituitary adenoma

Follicular thyroid cancer

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10
Q

Causes of thyrotoxicosis (not necessarily overactive thyroid gland, detected by reduced I2 uptake)

A

Hyperthyroidism

De Quervain’s thyroiditis (followed by hypothyroidism, self-limiting)

Supre-therapeutic Levothyroxine

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11
Q

Features of Graves’ disease

A

Lid lag

Exophthalmos

Chemosis

Bruits

Smooth uniform goitre

Reduced eye movements

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12
Q

Features of hypothyroidism

A
  • Symptoms
    • Weight gain
    • Low mood
    • Tiredness
    • Amennorhea/menstrual distrubances
    • Cold sensitivity
    • Hoarseness
    • Memory impairment
  • Signs
    • Bradycardia
    • dry skin
    • Hair loss (outer 1/3 of eyebrows)
    • Coarse facial features
    • Malar flush
    • Painless goitre
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13
Q

Causes of hypothyroidism

A

Autoimmune: Hashimoto’s (most common!)

Iatrogenic: Radiation, drugs (amiodarone, lithium, carbimazole)

Other: Iodine deficiency, post-partum, congenital

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14
Q

DDx of parotid lump

A

Parotitis

Salivary gland tumour

Stone

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15
Q

DDx of lateral neck lump

A

Artery: Carotid aneurysm, carotid body tumour, subclavian aneurysm

Lymph nodes: Infective, malignant, granulomatous

Nerve: Neurofibroma, schwannoma

Larynx: Laryngocoele

Pharynx: Pharyngeal pouch

Branchial: Cyst/sinus/fistula

Skin: Lipoma, epidermal cyst, abscess

Musculoskeletal: Cervical rib, sarcoma

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16
Q

Most common causes of neck lumps in children

A

75% benign causes (congenital malformations, inflammatory lymphadenitis)

17
Q

Most common causes of neck lumps in adults

A

75% malignant (80% mets, 20% lymphomas)

18
Q

Painful neck lumps

A

Infective lymphadenitis

Infected branchial cyst

19
Q

How does duration of neck lump presence change differential?

A

<few weeks:> Infective/inflammatory lymphadenopathy (NB: may be ‘suddenly’ notice by patient)</few>

>few weeks: Must exclude malignancy

Years: Benign most likely

20
Q

DDx if lumps present elsewhere

A

Disseminated malignancy (e.g. lymphoma)

Systemic disease (e.g. EBV, HIV)

21
Q

Hx questions for neck lumps

A

Recent infection/contact with infected person

Symptoms of head/neck cancer: Voice/swallowing changes, inspiratory noises/difficulty breathing, hearing loss/otalgia

Radiotherapy of neck

Smoking/alcohol intake

22
Q

DDx of superficial neck lumps

A

Lipomas, abscesses, epidermal/dermoid cysts

23
Q

Associated symptoms of pharyngeal pouch

A

halitosis, dysphagia, gurgling on palpation, chronic cough

24
Q

How to examine relationship of lump to muscle

A

Ask pt to nod head against resistance (SCM) or shrug shoulder against resistance (trapezius)

Deep to muscle –> concealed

25
Q

Effect of malignancy on lymph node texture + tethering

A

Malignant lymph nodes may be tethered to adjacent structures + are hard

26
Q

Differentiating finding of benign vs malignant parotid tumour

A

Facial nerve palsy in malingnant but not benign

27
Q

Differential for thyroid lumps in order of commonality

A

Physiological goitre

Multinodular goitre

Graves’ disease

Hashimoto’s thyroiditis

Thyroglossal cyst

Solitary adenoma

Carcinoma

Subactue thyroiditis (e.g. de Quervain’s)

28
Q

Risk factors for thyroid malignancy

A

Age <20 or >70

Radiation of neck

FHx of thyroid malignancy/endocrine neoplasias

Rapid growth/compression symptoms

Firm, hard nodule

Cervical lymphadenopathy

29
Q

Thyroid status in thyroid malignancy

A

Almost always euthyroid

30
Q

Clinical features of EBV infx

A

Sore throat

Swollen tonsils

Lymphadenopathy

Splenomegaly

Fever

31
Q

Effect of smoking in Graves disease

A

Increase risk of eye signs (specific to Grves)

32
Q

Turner’s syndrome is a risk factor for which neck lump?

A

Cystic hygromas

33
Q

Sjogren’s is a risk factor for which neck lump

A

Non-Hodgkin lymphoma

34
Q

Pathophysiology of Graves

A

Autoantibodies to TSH receptor –> hyperthyroidism (antibody-mediated stimulation)

35
Q

Pathophysiology of Hashimoto’s

A

T-cell mediated destruction of thyroid cells –> hypothyroidism

36
Q

Types of thyroid malignancy in order of prevalence

A

Papillary

Follicular

Medullary

Lymphoma

Anaplastic

Please FML…

Surgery (3 decks)

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