neck lumps and airway disorders

Question 1

what is a lump that moves on swallowing and is in the midline of the neck

Answer 1

thyroglossal cyst

Question 2

what is a lump that moves on swallowing and is laterally on the neck

Answer 2

thyroid mass

Question 3

what is a lump that doesn’t move on swallowing but there are many of them/ they appear in the posterior triangle

Answer 3

lymph nodes

Question 4

what is a lump that doesn’t move on swallowing and is cystic

Answer 4

a cyst

Question 5

what is a lump that doesn’t move on swallowing and is “rock hard”

Answer 5

tumour

Question 6

what is a lump that doesn’t move on swallowing and is not cystic but not hard

Answer 6

other e.g. TB abcess, subclavian artery aneurysm

Question 7

what could a superfical inflammatory neck swelling be

Answer 7

infected sebaceous cyst

Question 8

atypical mycobacteria lump in the neck presentation (5)

Answer 8

1. painless
2. “cold abscess”
3. may fistulate an discharge
4. submandibular region
5. necrosis of the fat leaving a dermal ulceration

Question 9

atypical mycobacteria (neck) mgx (3)

Answer 9

1. initally - oral carithromycin 6/52
2. surgery w nodal excision (risk of nerve injury)
3. surgery w curretage

Question 10

what is a scrofula

Answer 10

“collar stud abscess” - a swelling of the several lymph nodes in your neck fused together caused by a bacterial infection (usually TB)

Question 11

what micro-organisms are implicated in scrofula formation usually (2)

Answer 11

1. mycobacterium tuberculosis
2. mycobacterium avid intracellulare

Question 12

scrofula mgx (4)

Answer 12

1. drain nodule (may need to be done in theatre)
   triple therapy:
2. rifampicin
3. ethambulol
4. isoniazid

Question 13

what is a primary lymph node malignancy

Answer 13

lymphoma

Question 14

what malignancy is usually the cause for secondary lymph node malignancy

Answer 14

squamous cell cancer in the throat (oral cavity, base of tongue, larynx etc.)

Question 15

how to cure metastatic SCC

Answer 15

Find primary site and cure this

Question 16

2 investigations for lymph node swelling

Answer 16

1. USS fine needle aspiration (if non-lymphoma swelling)
2. USS core biopsy (suspected lymphoma)

Question 17

what is virchow’s node and what other set of symptoms should be asked about

Answer 17

a left supraclavicular lymph node - it recieves drainage from may areas incl. abdomen and plevis => it is an indicator of gastric cancer

ask about bowel/GI symptoms

Question 18

typical HPC of pt with throat SCC (2)

Answer 18

1. sore throat
2. recurrent “tonsillitis” that wont go away

Question 19

what area cannot be treated w radiotherapy and why (ENT)

Answer 19

the oral cavity - risk of osteoradionecrosis

Question 20

how many times can a pt have radiotherapy (head and neck cancer)

Answer 20

once - on 6 week course

Question 21

what can cause high mortality rates in deep neck space infections

Answer 21

airway compromise

Question 22

deep neck space infection presentation

Answer 22

1. pain
2. fever
3. malaise
4. odynophagia (pain when swallowing)
5. dysphagia
6. trismus (difficulty openingn mouth)
7. troticollis (tilted head)
8. neck swelling (may be late presentation)

Question 23

where might abscesses arise in deep neck space infection (3)

Answer 23

1. submandibular
2. retropharyngeal
3. parapharyngeal

Question 24

deep neck space infection mgx (6)

Answer 24

1. airway stabilisation
2. imaging (CT)
3. incision and drainage of abscess
4. IV abx with mixed polymicrobial cover
5. surgery
6. close monitoring post-op (FBC, ESR, CRP etc.)

Question 25

where can deep neck space infections spread into

Answer 25

the mediastinum and spine

Question 26

what is ludwig’s angina

Answer 26

a bacterial infection (cellulitis) that affects your neck and the floor of your mouth -> collection of fluid pushes tongue up and back leading to characteristic swelling under chin, tongue protrusion and rapid airway compromise

Question 27

what is usually the aetiology of ludwig’s angina

Answer 27

dental disease

Question 28

what is a retropharyngeal abscess usually secondary to (3) and what is the mgx (2)

Answer 28

secondary to:
1. TB
2. suppuration adenoiditis
3. trauma

mgx:
1. urgent airway stabilisation
2. theatre for drainage

Question 29

what is stretor

Answer 29

noisy breathing caused by partial obstruction of the respiratory tract above the larynx -snoring (even while awake) e.g. due to tonsillitis or a tumour

Question 30

what is stridor and what are the types (3)

Answer 30

noisy breathing caused by partial obstruction of the respiratory tract at or below the larynx
1. inspiratory -> obstruction at vocal chords or above
2. biphasic chords e.g. croup
3. expiratory ->wheeze e.g. asthma

Question 31

signs of impending airway obstruction (8)

Answer 31

1. stretor/ stridor
2. increased respiratory rate
3. increased use of muscles
4. tracheal tug
5. difficulty talking
6. tachycardia
7. nasal flaring
8. cyanosis

Question 32

examples of causes of stertor (6)

Answer 32

1. mid-facial trauma
2. downs syndrome (macroglossia)
3. tonsillitis
4. micrognathia
5. tonsil tumour

Question 33

8 causes of stridor

Answer 33

1. laryngomalacia
2. bilateral vocal chord palsy
3. subglottic stenosis
4. tumours
5. foreign body
6. trauma
7. epiglottitis
8. psychogenic

Question 34

medical mgx of stridor (4)

Answer 34

1. oxygen
2. heliox (21% O2, 79% He w reduced density)
3. nebuliser adrenalin 5ml
4. steroid

Question 35

3 types of airway mgx performed by anaesthetists

Answer 35

1. nasophayngeal airway (swelling confined to oral cavity)
2. guidel airway (bag and mask)
3. endotracheal tube

Question 36

3 surgical ariway mgx

Answer 36

1. cricothyroidotomy
2. mini trach
3. tracheostomy

Question 37

example of when intubation should be considered

Answer 37

bilateral vocal chord palsy

Question 38

example of when surgical airway mgx should be considered

Answer 38

epiglotitis (airway blocked by solid structure)