Neck Lumps & Common ENT Conditions: Flashcards
What are the different levels of the neck?
Level 1- submandibular & submental region
Level 2- upper sternocleidomastoid region
Level 3- middle sternocleidomastoid region
Level 4- lower sternocleidomastoid region
Level 5- posterior triangle of neck
Level 6- anterior triangle of neck
What are the 2 triangles of the neck?
Anterior triangle (digastric triangle, carotid triangle, muscular triangle)
posterior triangle (bounded by anterior border of trapezius, posterior border of sternocleidomastoid, and middle third of clavicle)
What questions should you ask regarding a lump in a patient?
When did you first notice it?
What has happened to it since?
Ever had it before?
Any other lumps?
Any associated features?
What important things are in the history that is relevant if the patient has lumps?
-Foreign travel e.g tuberculosis
-Pets e.g cat scratch disease
-Weight loss
-Night sweats
-Fever
-Pain with alcohol
-Smoking
-Alcohol
What different things should you look for when examining a lump?
Site - know your head and neck anatomy!
Size - greater than 3-4cm is worrying
Shape
Surface - has it changed the colour/surface of skin?
Temperature
Tenderness
Mobile/fixed - does it move on swallowing?
Transillumination - does the lump glow when a light is held next to it?
Pause for pulsation
Colour
Margin
Relations
Nodes - involvement of any lymph nodes?
What does the anatomical sieve consist of?
(Sieve = way of sorting what the pathological cause of the lump is)
Start from superficial to deep
-Skin
-Hair
-Fat
-Blood vessels
-Nerves
-Lymphatics
-Connective tissue
-Muscles
-Bone
-Special structures (thyroid, parotid, thymus)
(important for pathological diagnosis)
What does the surgical sieve consist of and what is it important for?
It’s an approach to making a differential diagnosis based on the pathological process and it consists of:
-Congenital or acquired
-Traumatic
-Infective/inflammatory
-Neoplastic
-Metabolic/immune
-Drug
-Degenerative
-Vascular
-Iatrogenic
-Psychogenic
What are some special investigations that you can do in terms of investigating a head or neck lump?
-Nasendoscopy (looking into nose/nasopharynx)
-Fine needle aspiration
-Imaging (DPT, ultrasound, CT, MRI, PET scan)
-Blood tests (FBC, LFT, bone screen, ESR, thyroid function, EBV, CMV, HIV, brucellosis, toxoplasmosis, glandular fever, cat scratch disease)
What are the many different causes of cervical lymphadenopathy?
infective:
bacterial
local viral
general bacterial
general viral
neoplastic:
local metastatic
general
other:
Drugs eg phenytoin
Sarcoidosis - a chronic disease of unknown cause characterized by the enlargement of lymph nodes in many parts of the body
What are some examples of lateral neck lumps?
-Epidermoid cyst
-Lipoma
-Fibroma
-Salivary glands
-Branchial cyst - usually in patients over 3rd decade. Patients in their 40’s be careful as it may not be a brachial cyst but a malignant metastases.
-Cervical rib - can cause vascular/nerve pain in arms
-Hyoid bone (normal anatomy misdiagnosed as pathology)
-Transverse process C1 & C6 (as above)
-Ectatic carotid artery
-Congenital torticollis
What are some examples of common midline neck lumps?
-Thyroid gland pathology
-Parathyroid gland
-Dermoid cyst - usually presents in the Submental region
-Plunging ranula - cyst of the sublingual gland, whilst its getting bigger it can plunge through Mylohyoid muscle and present as a neck lump
-Thyroglossal duct cyst
What is an axiom of diagnosing a lateral neck mass?
Any lateral neck mass in an adult is a metastatic deposit until proven otherwise.
Therefore investigations must be taken
What does a branchial cyst (cervical lymphoepithelial cyst) look and feel like?
Usually presents as a lateral neck mass, anterior to the sternocleidomastoid muscle
Usually in late adolescence/early adulthood
It’s fluctuant and feels like it’s half fluid-filled
Generally treated by surgical excision
Where does a thyroglossal duct cyst present and how can you diagnose it?
It’s a midline neck lump
It’s an embryological remnant cyst from where the thyroid first develops at the base of the tongue near the foramen cecum
Diagnosis: it is the only neck lump that moves with swallowing AND with protrusion of the tongue
What does Ludwig’s angina look like?
Infective process
Emergency drainage needed/rapid referral
Can be fatal
What common conditions affect the ear?
-Hearing loss
-Otalgia - pain in the ear
-Otorrhoea - discharge from the ear
-Middle ear infection
-Facial palsy
-Disorders of balance
-Tinnitus
-Foreign bodies
What is a cholesteatoma?
An abnormal, noncancerous skin growth that can develop in the middle section of your ear, behind the eardrum.
It may be a birth defect, but it’s most commonly caused by repeated middle ear infections
Can cause smelly discharge from the ear
From what different sources can pain be referred to the ear?
slides
What steps should you follow to treat a patient with ear pain?
slides
What is otitis externa?
Inflammation of the external auditory meatus
What are some common causes of otitis externa?
Infective: Bacterial, fungal, viral
Reactive: Eczema, psoriasis
What it otitis media with effusion?
Also known as glue ear and tends to affect children very commonly
It’s a Eustachian tube dysfunction
What can glue ear cause?
It can lead to conductive hearing loss, learning difficulties, and speech delay, associated with cleft lip & palate
When is urgent treatment needed in glue ear?
When you can see pus behind the tympanic membrane
Also put them on a course of antibiotics
What common problems arise from the nose?
-Allergic rhinitis
-Nasal polyps
-Nasal infections
-Nasal septum
-Epistaxis - nose bleed
-Sinusitis
What can be some causes of epistaxis?
-Hypertension
-Blood dyscrasias: von Willebrands, liver disease, haemophilia, thrombocytopenia
-Hereditary haemorrhagic telangiectasia
-Drugs: aspirin (NSAIDs), warfarin, steroids, clopidogrel, chemotherapy
-Trauma
-Rhinotillexis
-Nasal septum defects
-Neoplasms
-Inflammation: URTI, sinusitis
-Environmental: cold dry air, central heating
What are some common conditions affecting the throat?
-Dysphonia - problems with the voice
-Stridor - narrowing of airway causing sound
-Sore throats
-Tonsils and Adenoids
-Dysphagia - difficulty swallowing
-Snoring and sleep apneoa
What should a persistent sore throat with a changing voice, especially a hoarse voice longer than 2 weeks, be treated as?
Laryngeal cancer, until proven otherwise
What are some causes of dysphagia?
Neuromuscular:
-Old age; bulbar or pseudobulbar palsy; MND; stroke; constriction of cricopharyngeus muscle
Obstructive (in lumen, wall, outside wall):
-Foreign body; carcinoma of pharynx; post-cricoid carcinoma, oesophagitis; carcinoma of oesophagus; invasion by carcinoma of lung; achalasia of the cardia
