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ENT > Neck Lumps (incld Goitre) > Flashcards

Neck Lumps (incld Goitre) Flashcards

1
Q

three descriptions to note locations of a neck lump 3

A

anterior triangle

posterior triangle

midine
-vertically along the centre of teh neck

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2
Q

where are the anterior and posterior triagnles found on the neck

A

either side of the sterocleiodmastoid muslce [34]

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3
Q

differential diagnoiss in adults for neck lumps 12

A

normal structues (bony promineice)

skin absecess

lymphadenopathy

tumour

lipoma

goitre

salivary gland stones or infection

carotid body tumour

haematoma

thyroglassal cysts

brachial cysts

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4
Q

differntial diagnosis for young children with neck lumps 4

A

cystic hygroams

dermoid cysts

haemangiomas

venous malformations

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5
Q

red flag criteria for neck lumps (for a two week referral) 2

A

unexplained neck lump in someone aged 45 or above

persistent neck lump at any age

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6
Q

who should be referred for an urgent USS regarding neck lumps 1

A

patients with a lump that is growing in size
-wihtin 2 wks if 25 or older

within 48hrs in ptx under 25

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7
Q

other non specific syx for neck lumps that are red flags 3

A

unexplaiend weight loss

appetite losss

DVT

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8
Q

regarding neck lumps
what could ENT infections be a sign of 1

A

reactive lymph nodes

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9
Q

regarding neck lumps what could the following be a sign of
weight loss 2

A

mlaignancy

hypertrhyroidsim

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10
Q

regarding neck lumps what could the following be a sign of
skin pallor and bruising 1

A

leukaemia

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11
Q

regarding neck lumps what could the following be a sign of
focal chest sounds 1

A

lung ca

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12
Q

regarding neck lumps what could the following be a sign of
clubbing 1

A

lung ca

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13
Q

regarding neck lumps what could the following be a sign of
HSM

A

leukaemia

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14
Q

regarding neck lumps what could the following ON EXAMINATION be a sign of
transillumates with light

A

CYSTIC HYGROMA

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15
Q

regarding neck lumps what could the following ON EXAMINATION be a sign of
movement with swallowing

A

thyroid lumps

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16
Q

regarding neck lumps what could the following ON EXAMINATION be a sign of
movement with sticking out tongue

A

thyrogloassal cyscts

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17
Q

investigations for neck lumps 6

A

FBC and blood fild

HIV test

monospot and EBV ab

TFTs

ANA

LDH (a v non specific tumour marker for hodgkins lymphoma)

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18
Q

imaging options for a nekc lump 3

A

US - 1st line

CT or MRI

Nuclear medicine scan

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19
Q

how can biopsy of a neck lump be completed 4

A

FNA cytology

core biopsy (thicker needle)

incision biopsy (biopsy w scalpel

removal of lump

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20
Q

how can causes of lymphadenopayhy be grouped 4

A

reactive lymph nodes
-due to URTI, dental infection, tonsillitis

infected lymph nodes
-tuberculosis, HIV or EBV

Inflammatory
-SLE or sarcoidosis

Malignancy
-lymphoma, leukaemia or metastasis

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21
Q

which lymphadenpahty is of particular concer for malignancy 1

A

supraclavicular LNs

-can be caused by malginancy in chest or abdomen

22
Q

features of lymphadenopathy that are suggestive of malignancy 7

A

unexplained(no assoc infection)

persistently enlarged (over 3cm diameter)

abnormal shape (normally oval shaped where the length ismore than double the width)

hard or rubbery

non-tender

tetherd of fixed to skin or underlying tissues

assoc syx- night sweats, weight loss, fatigue or fevers

23
Q

presenation of EBV infection 4

A

fever

sore throat

fatigue

lymphadenopathy

24
Q

how else can EBV infection present 1

A

intensely tichy maculopapular rash in response to amoxicillin or cefalosporins

25
Q

1st line Ix for EBV infection

A

monospot test
-also possible to test for IgM (acute infection) and IgG (immunity) to the EBV

26
Q

managemnt of EBV infection

A

supportive

avoid alcohol (risk of liver impairment)

avoid contact sports (risk of splenic rupture)

27
Q

key finding in hodgkins lymphoma lymph node biopsy

A

reed sternberg cell

28
Q

charcatersitc presentaiton of hodgkins lymphoma 6

A

lymphadenopathy
-neck axiallm or inguinal

non-tender and feel rubbery

some ptx experience pain when they drink alcohol

B syx
-fever
-weight loss
-night sweats

29
Q

typical leuamkia syx 7

A

faitgue

fever

pallor due to anaemia

petechiae and abnormal buriusing due to rhombocytopenia

abnormal bleeding

lymphadenopathy

HSM

30
Q

causes of a goitre 5

A

hyperthyroidism (graves)

toxic multinodular goiter (hyperthyroidim)

hypothyroidis (hashimotos thyroidistiis )

iodine deficieny

lithium

31
Q

individual lumps in the thyroid causes

A

benign hyperplastic noduels

thyroid cysts

thyroid adenomas

thyroid cancecr (papillary or follicular(

parathyroid tumour

32
Q

what are the three locations of salivary glands 3

A

parotid glands

submandibular glands

sublingula glands

33
Q

what can cause enlargement of salivary glands 3

A

stones- blocking the drainage of the glands through the ducts

infection

tumours (benign or malignant)

34
Q

location of the carotid body

A

structure located just above the carotid bifurcation (where common carotid becomes internal and external carotid)

35
Q

what does the carotid body contain and what is its function

A

contains glomus cells
-they are chemorepetors that detect the bloods o2, CO2 and pH

groups of glomus cells are called paraganglia

36
Q

how are carotid body tumours formed

A

by excesive gorwth of the glomus cells

-also called paragangliomas

37
Q

presentaiton of carotid body tumours

A

most benign and slow growing

in the upper anteior triangle of the neck (near the angle of the mandible)

painless

pulsatile

assoc w bruit on asulcutation

mobile side to side but not up and down

38
Q

what can carotid body tumours compress and give rise to

A

can compress CN IX,X,XI,XII

can also put pressure on sympathetic nerves which may result in horner syndrome

39
Q

define horner syndroem

A

triad of ptosis miosis anhirdorsis

40
Q

characerisitc finding on imaging of carotid body tumoours
–whats management

A

finding on imaging
-splaying (separaring) of the internal and external carotid arteries (Lyre sign)

-most treated with surgical removal

41
Q

define lipomas

A

benign tumours of fat (adipose) tissue

0can occur anywhere in the body where there is adipose tissue

42
Q

examination findings of lipoms 4

A

soft

painless

mobile

do not cause skin changes

43
Q

Mx of lipomas

A

conseravtiely w reassurance after excluding other pathologies

alternatively can be surgically removed

44
Q

basic pathophys of thyroglassal cysts

A

during fetal development
-thyroid gland starts at base of tonuge then moves down
-leaves behind track called thyroglassal duct which disappears

-if part of thyroglossal gland persists can cause fluid filled cysts
-called a thyroglossal cyst

45
Q

key differetnail Dx for thyroglassal cyst

A

ectopic thyroid tissue

46
Q

examination findigns for thyroglassal cysts 5

A

occur in midline

mobile

non-tender

soft

fluctant

KEY FINDING- MOVE UP AND DOWN WITH MOVEMNT OF TOUNGE

47
Q

diagnosis of thyroglassal cyst

A

US or CT scan

48
Q

Mx of thyroglossal cyst

A

surgical removal

-to provide confirmation of dx to histology and prevent infection

49
Q

main complication fo thyroglossal cyst

A

infection
–can cause hot tender painful lump

50
Q

bascic pathophsy of branchial cyst

A

congenital abnromality
aries when second branchial cleft dails to form properly during fetal development

51
Q

presenation and mangemnt of branchial cysts

A

round soft cystic swelling between the angle of the jaw and the steroncleiodmastoiid muscle in the anterior triangle

tend to present after 10yo

MX
-conservative
-surgical excision (if recurrent infections are occurring, Diagnoistc doubt or causing other problems)

ENT (32 decks)

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