Neck Lumps

Question 1

Cervical Lymphadenopathy

Answer 1

Lymphadenopathy suggests abnormality in lymph node size, consistency or number. Can be localised, regional or generalised .

Question 2

Causes of Lymphadenopathy

Answer 2

Malignancy: Hodgkin’s and Non-Hodgkin’s Lymphoma
Hypersensitivity: Serum sickness disease
Infection: Infectious mononucleosis
Collagen Vascular DiseaseL SLE, Dermatomyositis, Sjogren’s Syndrome
Atypical lymphoproliferative disorders: Castleman’s disease, Kawasaki’s disease, Kikuchi’s Disease
Granulomatous disease: Sarcoidosis, Wegener’s Granulomatosis, Crohn’s Disease

Question 3

How common is Cervical Lymphadenopathy

Answer 3

Most common in Young children

Question 4

Risk Factors for Cervical Lymphadenopathy

Answer 4

1. EBV
2. HIV
3. adenovirus
4. CMV
5. Herpes Zoster
6. streptococcal Pharyngitis
7. Phenytoin use

Question 5

Symptoms and signs of Cervical Lymphadenopathy

Answer 5

Infection: painful, develops quickly, less than 1cm, soft and unfixed

Malignancy: painless, develops slowly, fever, night sweats, weight loss, larger nodes, hard and fixed, rubbery

Question 6

Investigations for Cervical Lymphadenopathy

Answer 6

Examine the nodes for extent, site, size, consistency, tenderness, fixation
FBC, WCC
Throat Culture 
Monospot test- EBV
HIV test
Chest X-ray- Sarcoidosis, TB, Malignancy

Question 7

Differentials for Lymphadenopathy

Answer 7

Acute Complications of Sarcoidosis, AML, CML, Hodgkin, Non-Hodgkin Lymphoma, Kawasaki Disease, Measles, Neuroblastoma, Chickenpox, HIV infection, Serum Sickness

Question 8

Treatment for Cervical Lymphadenopathy

Answer 8

Antibiotics for Infection

Biopsy

Question 9

Complications for Cervical Lymphadenopathy

Answer 9

Abscess, cellulitis, internal jugular vein thrombosis, sepsis, quinsy- inflammation of the throat

Question 10

Parotid Tumours

Answer 10

Tumours of the Parotid, submandibular and sublingual glands.
80% benign: Pleomorphic adenoma, Warthin’s tumour
20% malignant: Mucoepidermoid carcinoma, Adenoid cystic carcinoma

Question 11

Risk factors for Parotid Tumours

Answer 11

Age
Radiation exposure
Occupational risks: silica, nickel, alloy, plumbing
Smoking- Warthin's Tumour
EBV infection

Question 12

Symptoms and signs of Parotid Tumours

Answer 12

Enlarging painless mass 
Facial nerve palsy, facial pain
Lack of saliva
Dysphagia
Hoarseness
Airway obstruction

Question 13

Investigations for Parotid Tumours

Answer 13

1. Tissue biopsy: benign or malignant (grading and staging)

2. Imaging: CT, USS with FNA

Question 14

Differentials for Parotid Tumours

Answer 14

Sialolithiasis (calcified mass within salivary gland or duct)
Sialadenitis
Mumps - common in children
TB and syphilis - granuloma formation

Question 15

Treatment for Parotid Tumours

Answer 15

Partial resection 
Parotidectomy
Lymph node resection 
Radiation
Chemotherapy

Question 16

Complications for Parotid Tumours

Answer 16

Facial nerve damage
Frey’s Syndrome: complication following parotidectomy
Salivary fistula

Question 17

Salivary Gland Swelling

Answer 17

Swellings of the parotid, submandibular and sublingual.

Question 18

Causes of Salivary Gland Swelling

Answer 18

Benign or malignant neoplasms
Sialolithiasis and ductal stenosis
Infections 
Precursors for malignancy- Sjogren's syndrome and HIV
Lymphadenopathy

Question 19

Symptoms of Salivary Gland Swellilng

Answer 19

rapid onset of pain and swelling, malaise, fever and lymphadenopathy, unilateral, tenderness, facial nerve weakness

Question 20

Investigations

Answer 20

USS, MRI, FNA, Bloods