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ENT > Neck Masses > Flashcards

Neck Masses Flashcards

1
Q

What is the only muscle of the larynx that is not supplied by the recurrent laryngeal nerve? What is it supplied by?

A
  • Cricothyroid muscle

- External branch of the superior laryngeal nerve (branch of CN X)

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2
Q

What are the boundaries of the occipital triangle?

A
  • Trap
  • SCM
  • Omohyoid
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3
Q

What are the boundaries of the submental triangle?

A
  • Anterior digastric

- Mandible

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4
Q

What are the boundaries of the submandibular triangle?

A
  • Ant digastric
  • Post digastric
  • Mandible
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5
Q

What are the boundaries of the carotid triangle?

A
  • Omohyoid
  • SCM
  • Stylohyoid
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6
Q

What are the boundaries of the muscular triangle?

A
  • SCM
  • Omohyoid
  • Midline
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7
Q

What are the boundaries of the subclavian triangle?

A
  • Clavicle
  • SCM
  • Trap
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8
Q

Who in particular can feel their carotid bulb?

A

People who lose weight

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9
Q

Where are lymphatic areas II, III, and IV in the neck?

A

Along the SCM from superior to inferior, and transecting it into thirds

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10
Q

Where is the lymphatic area I in the neck?

A

Submental /submandibular triangle

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11
Q

Where is the lymphatic area VI in the neck?

A

Muscular triangle

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12
Q

Where is the lymphatic area V in the neck?

A

Posterior triangle

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13
Q

What percent of neck masses in kids 0-15 years are benign?

A

90%

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14
Q

What is the “rule of 80s” for adults greater than 40 yo in terms of neck masses?

A

80% of neck masses are neoplasms, and 80% of those are malignant

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15
Q

Upper jugular chain masses are mets from where? (1)

A

Nasopharynx

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16
Q

Mets in the posterior triangle are from where? (4)

A
  • Nasopharynx
  • Ear
  • Temporal bone
  • Skull base
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17
Q

Mets in the lower jugular chain are from where? (2)

A

Upper esophagus or thyroid

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18
Q

Mets in the submandibular triangle are from where? (3)

A
  • Anterior 2/3 of tongue
  • Floor of
  • Cheek
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19
Q

Mets in the Submental area are from where?

A

Lip

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20
Q

Mets in the mid jugular chain area are from where? (3)

A

Any portion of the oral cavity, pharynx, or larynx

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21
Q

What are the risk factors for developing head and neck cancers?

A
  • Chronic sun exposure
  • Poor dentition
  • Smoking/EtOH use
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22
Q

What is the classic presentation of a cancerous lesion in the oral or nasopharynx? (5)

A
  • Nonhealing ulcer
  • Persistent sore throat
  • Dysphagia
  • Change in voice
  • Otalgia with exam
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23
Q

Where in particular should you assess when suspecting a neck neoplasm?

A
  • Tonsillar fossa

- Pharynx and larynx with a fundoscope

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24
Q

What are ways that can aid you in assessing for neoplasms in the head and neck?

A

Rotation in both flexion and extension

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25
Q

Palpation of the neck with what two maneuvers may aid you in identifying pathology in the larynx and thyroid?

A

Swallowing or Valsalva

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26
Q

What should always be done with an inflammatory neck mass, prior to further investigation?

A

2 week course of abx

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27
Q

What are the ways to diagnose neoplasms of the neck? What is the standard?

A
  • FNA bx
  • CT
  • MRI
  • US
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28
Q

True or false: if a neck mass is NOT an obvious abscess should be biopsied

A

True

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29
Q

Persistence of a neck mass after how many weeks of abx should be biopsied?

A

2 weeks

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30
Q

Any mass measuring how many cm should be biopsied?

A

3 cm

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31
Q

True or false: any neck mass that is accompanied by s/sx of lymphoma should not be biopsied, since it is almost always lymphoma

A

False

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32
Q

What are the four major indications for FNA of a neck mass

A
  • Not obvious abscess
  • Persistence after 2 weeks of abx
  • Progressive growth or more than 3 cm
  • s/sx of lymphoma
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33
Q

True or false: there is a risk of seeding cancer with a FNA

A

False

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34
Q

How many samples of the mass should be taken with a FNA?

A

4

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35
Q

What are the benefits of a CT scan when evaluating a neck mass?

A

Can identify cystic or solid, and can see if it is a met from a distant site/ see the primary site

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36
Q

When should a CT with contrast not be obtained when evaluating a neck mass?

A

If suspected thyroid lesion

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37
Q

When is an MRI preferable to CT in evaluating head and neck tumors?

A

Skull based or vascular invasion

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38
Q

What is the role of radionuclide scanning in evaluating head/neck masses?

A
  • salivary and thyroid masses

- Functional information

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39
Q

Which are classically cancerous: hot or cold thyroid nodules?

A

Cold

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40
Q

What is the most common type of cancer of the head and neck?

A

SCC

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41
Q

Ipsilateral otalgia with a normal ear examination should be suspicious for a tumor where?

A

Tonsils, tongue base, supraglottic area

42
Q

Asymptomatic, unilateral serous otitis should be suspicious for what?

A

Nasopharyngeal tumor obstructing the eustachian tube

43
Q

What are the two indications for a panendoscopy?

A
  • FNAB + with no primary mass located

- FNAB equivocal or negative in a high risk pt

44
Q

What is the incidence of synchronous primary tumors in the nasopharynx?

A

10-20%

45
Q

When is an open excisional bx indicated for head and neck?

A

Only if complete workup is negative

46
Q

What are the two work ups that should be done on a neck mass if it does not respond to abx?

A

CA vs TB

47
Q

What is the leading cause of anterior neck masses?

A

thyroid CA

48
Q

What is the most common neoplastic condition of the head and neck in children? Which gender is usually affected? Are these usually benign or malignant?

A

Thyroid masses
Males
Malignant

49
Q

What gender is more affected with thyroid masses in the adult population? Are these usually benign or malignant?

A

Females

Benign

50
Q

True or false: lymph node involvement with papillary thyroid carcinomas is relatively common

A

True–40%

51
Q

What should be done if there is an inadequate sample taken with a FNA of the thyroid?

A

Repeat in 1 month

52
Q

What percent of kids with lymphoma have a neck mass?

A

80%

53
Q

What are the neck s/sx of lymphomas?

A
  • Lateral neck mass
  • Fever
  • HSM
  • Diffuse adenopathy
54
Q

What is the first line test for evaluating a neck mass that is suspicious for a lymphoma?

A

FNA

55
Q

What should be done if a FNA comes back positive for lymphoma?

A

Open bx and full CT scan of the head/neck, chest, and abdomen

56
Q

What percent of parotid tumors are benign?

A

80+%

57
Q

What are the associated symptoms of salivary gland tumors?

A
  • rapid growth
  • Skin fixation
  • CN palsies
58
Q

What is the accuracy of FNA with salivary gland tumors?

A

More than 90% sensitive and 80% specific

59
Q

What is the treatment for parotid gland tumor?

A

Total parotidectomy, with possible facial nerve sacrifice

60
Q

What are the characteristics of carotid body tumors?

A
  • Pulsatile mass that is compressible

- Mobility medially and laterally, but NOT superior/inferiorly

61
Q

How do you diagnose carotid body tumors?

A

Clinically or confirmed with angio CT

62
Q

What is the treatment for a carotid body tumor?

A

XRT or close observation in the elderly

63
Q

How common are carotid body tumors in children?

A

Extremely rare

64
Q

Where is the carotid body?

A

At the bifurcation of the carotids

65
Q

What are the characteristics of lipomas?

A

Soft, asymptomatic masses

66
Q

What is the age range that usually gets lipomas?

A

35+

67
Q

how do you diagnose lipomas?

A

Clinically

68
Q

What is the role of FNA with lipomas?

A

Not very beneficial–just get ghost image

69
Q

What are the cells that give rise to neurogenic tumors?

A

neural crest cells

70
Q

What are the neurogenic tumors in the head/neck region?

A
  • Schwannoma
  • Neurofibroma
  • Malignant peripheral nerve sheath tumor
71
Q

What inherited disease predisposes pts to neurogenic tumors?

A

NF

72
Q

Are schwannomas usually more sporadic or caused by diseases like NF2?

A

Sporadic

73
Q

What is the age range that more commonly gets schwannomas?

A

20-50 years

74
Q

Where are schwannomas usually located?

A

Mid-neck in poststyloid compartment

75
Q

What are the usual s/sx of schwannomas? (3)

A
  • Medial tonsillar displacement
  • Hoarseness (vagal nerve compression)
  • Horner’s syndrome
76
Q

What nerve, if compressed, leads to hoarseness?

A

Recurrent laryngeal branch of CN X

77
Q

What is the most common congenital/developmental mass?

A

Epidermal and sebaceous cysts

78
Q

How do you diagnose epidermal / sebaceous cysts?

A

Clinically, with excisional bx as confirmation

79
Q

What are the PE findings of epidermal / sebaceous cysts?

A
  • Elevation and movement of overlying skin

- Skin dimple or pore

80
Q

Which of the branchial clefts usually develop into branchial cleft cysts? Which rarely do?

A

2nd is the most common, and 1st less but still

3 and 4 rarely reported

81
Q

Where are branchial cleft cysts of the 2nd branchial cleft located?

A

tract medial to CN XII between internal, and external carotid

82
Q

Which branchial cleft is associated with CN VII?

A

2nd

83
Q

When do branchial clefts cysts usually become apparent? Why?

A

After a URI, since infection will stimulate mucus production, and the clefts are enclosed mucous membranes

84
Q

What are the PE findings of branchial cleft cysts?

A
  • Smooth, fluctuant mass underlying the SCM

- TTP and erythema if infected

85
Q

What is the treatment for branchial cleft cysts?

A

Surgical excision, including tract

86
Q

Which branchial cleft cyst may need a parotidectomy to treat?

A

First

87
Q

What is the most common type of congenital neck mass?

A

Thyroglossla duct cysts

88
Q

What percent of thyroglossal duct cysts present before age 20?

A

50%

89
Q

Where are thyroglossal duct cysts usually located? What are the common signs of this, then?

A
  • Just inferior to the hyoid bone

- Elevates on swallowing/protrusion of the tongue

90
Q

What is the treatment for thyroglossal duct cysts?

A

Surgical removal

91
Q

What are the two major vascular tumors of the head and neck? When do they usually present?

A
  • Lymphangiomas and hemangiomas

- 1st year of life

92
Q

What is the prognosis for hemangiomas and lymphangiomas?

A
  • Hemangiomas = Resolve spontaneously

- Lymphangiomas = remain unchanged

93
Q

What is the treatment for lymphangiomas and hemangiomas?

A
  • Lymphangiomas = surgical excision

- Hemangiomas = Surgical excision if rapidly growing and involving vital structures, or associated with thrombocytopenia

94
Q

How common is lymphadenitis?

A

very common, especially in the first decade

95
Q

What are the signs of lymphadenitis?

A

Tender noes with signs of systemic infection

96
Q

What is the treatment for lymphadenitis?

A

abx

97
Q

What are the indications for FNA for lymphadenitis?

A
  • Actively infectious
  • Progressively enlarging
  • Solitary and asymmetric
  • Supraclavicular mass
  • Persistent nodal mass
98
Q

What is granulomatous lymphadenitis?

A

a chronic specific granulomatous inflammation of the lymph node with caseation necrosis, caused by infection with Mycobacterium tuberculosis or other bacteria

99
Q

What are the PE findings of granulomatous lymphadenitis?

A

Firm, fixed node with injection of the skin

100
Q

Actinomycosis is usually found in people with what condition?

A

Poor dental hygeine

ENT (7 decks)

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