Neck Lumps

Question 1

important neck lumps are usually found where in the neck?

Answer 1

anterior triangle and midline

Question 2

what can cause swelling in midline?

Answer 2

thyroid problem
dermoid cyst
thyroglossal cyst

Question 3

what is a thyroglossal cyst?

Answer 3

remnants of thyroid cells left in thyroglassal duct as the thryroid descends during development

Question 4

what is a branchial cyst?

Answer 4

swelling caused by remnant of 2nd branchial cleft in the neck
smooth swelling at anterior border of sternocleidomastoid
usually present in young adults

Question 5

what is the most common parotid swelling?

Answer 5

pleomorphic adenoma

Question 6

which nerves can be affected in a parotid swelling?

Answer 6

trigeminal nerve
facial nerve (most common)

Question 7

how can you tell if a swelling is thyroid related?

Answer 7

it moves up and down on swallowing (as its invested in pre-tracheal fascia)

Question 8

how common are malignant thyroid lumps?

Answer 8

5% of women have thyroid lumps

5% of those are malignant

Question 9

important questions to ask about a thyroid lump?

Answer 9

family history
fosset symptoms (pain, swallowing problems?)
previous history of neck radiation

Question 10

examination in thyroid lump?

Answer 10

lymph node involvement (indicates papillary)
hoarse voice (indicates recurrent laryngeal nerve involvement)

Question 11

investigations in thyroid lump?

Answer 11

always do TSH levels
if TSH is suppressed (hyperthyroid) then do an isotope scan as risk of solitary toxic adenoma
always do US
if suspicious do US guided FNA

Question 12

when is surgery indicated for thyroid lump?

Answer 12

//

Question 13

what surgery is done?

Answer 13

whole thyroid removed in high risk

lobectomy done in low risk

Question 14

high risk vs low risk thyroid tumours?

Answer 14

high risk = patient >50 and tumour >4cm

low risk = patient <50 and tumour <4cm?

Question 15

causes of hyperthyroid?

Answer 15

graves disease (antobody against TSH - trab antibody)
toxic nodules (singular or toxic multinodular goitre)

Question 16

how is graves disease managed?

Answer 16

carbimazole or propriothiouracil (anti-thyroid drugs)

Question 17

risks of carbimazole?

Answer 17

agranulocytosis (always do FBC urgently if they get a sore throat)
can cause hypothyroid in foetus in pregnant women should therefore use propriothiouracil in pregnancy

Question 18

definitive treatment of thyrotoxicosis?

Answer 18

radioactive iodine

surgical removal of thyroid

Question 19

complications of thyroidectomy?

Answer 19

damage to recurrent laryngeal nerve
damage/accidental removal of parathyroids (results in hypercalcaemia etc)
lifelong need for thyroxine
chance of bleeding/haematoma in neck which can compress airway

Question 20

most thyroid cancers are whcih type?

Answer 20

papillary

Question 21

tumour marker in thyroid?

Answer 21

thyroglobulin

used in papillary and follicular thyroid cells

Question 22

what is medullary thyroid cancer?

Answer 22

cancer of parafollicular cells so causes increased calcitonin which can be used as a tumour marker
can be caused my MEN1 and MEN2

Question 23

features which indicate a thyroid lump is malignanct?

Answer 23

firm nodule fixed to adjacent structures
symptoms of compression
abnormal cervical lymph nodes
irregular nodule with calcification

Question 24

Thy classification system of thyroid lumps?

Answer 24

thy 1 = non-diagnostic
2 = non-neoplastic
3a = possible neoplasm (atypical features)
3f = follicular neoplasm
4 = suspicious of malignancy
5 = malignant

Question 25

how does thy classification influence next steps?

Answer 25

thy 1 and 2 = US +/- FNA
3a = repeat US and FNA
3f = diagnostic hemithyroidectomy
4 = diagnostic hemithyroidectomy
5 = usually surgery

Question 26

U classification system?

Answer 26

U1 = normal
U2 = benign
U3 = intermediate
U4 = suspicious
U5 = malignant
only do FNA in U3-5