Neck lumps

Question 1

anatomy of the neck

Answer 1

QUIZLET

Question 2

examination of lymph nodes

Answer 2

be systematic 
along mandible
work backwards
feel down the anterior SCM
feel across the supraclavicular fossa
then behind the SCM
then back up behind the SCM
don't forget some that extend to the edge of the scapula

Question 3

superficial sebaceous cyst

Answer 3

enlargement of the spacious gland
often follows the hair line
has a punctum (where the hair would insert in the middle)
often symmetrical
ovoid, smooth
attached to the skin- embedded, cannot move separate to the skin

can become infected- tender, swollen, hot

Question 4

dermoid cyst

Answer 4

benign and do not change over life

Question 5

deeper- connective tissue and adipose tissue

Answer 5

lipoma

benign overgrowth of the lipid tissue.

malignant- liposarcoma (rare)

can be big, multiple
supraclavicular fossa, trunk, legs, around the back

Question 6

thyroglossal cyst

Answer 6

can have active thyroid tissue in them

usually at the level of the hyoid

protrudes with swallowing and tongue protrusion (fixed to thyroid and tongue)

if swallowing only- goitre (thyroid and not tongue)

Question 7

branchial cyst

Answer 7

outpouching
classically in the midline of the SCM
can become infected

Question 8

low grade lymphoma

Answer 8

tend to present in multiple lymph nodes
slow and indolent
rubbery

Question 9

branchial cyst

Answer 9

outpouching
classically in the midline of the SCM
can become infected
congenital- arising from the branchial cleft
soft and fluctuant
usually presents between the age of 20-40 y/o

Question 10

salivary gland

Answer 10

submental area
submandibular area
parotid gland

Question 11

salivary gland

Answer 11

submental area
submandibular area
parotid gland

inflammation- mumps, HIV
obstruction- calculi ,stricture
neoplasia

Question 12

facial nerve branches

Answer 12

*

Question 13

pharyngeal pouches

Answer 13

similar congenital defect
diverticulum- pouching of the pharyngeal mucosa
out-touching
dysphagia, emesis of undigested food with acid/bile. extreme halitosis

smooth, soft, deeply attached

Question 14

sternocleidomastoid tumor

Answer 14

rhabdomyosarcoma (rare)

not a tumor:
‘twisted neck’ torcicolli
results from trauma during birth and resolves spontaneously with growth

Question 15

cystic hygroma

Answer 15

deficiency of the drainer of the lymphatic systems
(rare)

palpate and feels like surgical emphysema
lumpy mass

tx: surgical

Question 16

carotid body tumour

Answer 16

distinct tumors
sit at the carotid bifurcation level III
slow growing
pulsatile*

*hoarse voice after op

Question 17

cervical rib

Answer 17

around the posterior triangle

supernummery rib abnormally located above the first normal rib

congenital
supraclavicular region
bony and hard

• upper limb thrombosis
• subclavian vein thrombosis- rib can interfere with the flow through the subclavian vein

tx: anticoagulant and remove the rib

Question 18

most common oral cancer

Answer 18

mucous lining of the oral cavity / lip

squamous cell carcinoma

Question 19

signs and symptoms of oral cancer

Answer 19

indolent ulcer on the lateral border of the tongue
most common

doesn’t resolve in 2-6 weeks

ulcers- bleed/painless (rolled edge)
leukoplakia
erythroplakia
speckled leukoplakia
dysphagia and odynophagia
lymphadenopathy

Question 20

risk factors for oral cancer

Answer 20

smoking (20 day)
heavy alcohol
HPV16 infection
sunlight

Question 21

investigations for oral cancer

Answer 21

biopsy
FNA
R/G to see if bone involvement
CT if site is deep

Question 22

lymphoma

Answer 22

core biopsy with USS

?

Question 23

lymphoma

Answer 23

core biopsy with USS
LDH- shows the proliferation of cells (increases when there is increased destruction of cells and when there is proliferation of white cells)

Question 24

describing a lump

INSPECT neumonic

Answer 24

INSPECT

Shape, Size (fruit, veg, nuts), Site

Palpation - pulse

Erythema

Contour lines (borders), Consistency (rubbery/firm), Content, Colour, Compressibility, Cough impulse (groins)

Tender, temperature (use back of hand over lump) tethering, transilumination