Neck Masses Flashcards

1
Q

Neck mass by age

Most likely inflammatory or neoplastic

  • 0-16yrs
  • 16-40yrs
  • 40+yrs

What percent of non-thyroid neck masses in 40+ are malignant?

A

Most likely inflammatory or neoplastic

  • 0-16yrs - Inflammatory
  • 16-40yrs - Inflammatory
  • 40+yrs - Neoplastic

What percent of non-thyroid neck masses in 40+ are malignant?

  • 80%
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2
Q

Neck mass by location

Midline

Anterior

Posterior

A

Neck mass by location

Midline

  • Plunging ranula (inflam)
  • Thyroid mass (neoplasm)
  • Thyroglossal duct cyst (congential)
  • Dermoid cyst (congenital)
  • Lymphoma (neoplasm)

Anterior

  • Sialadenitis
  • Lymphadenitis
  • Branchial cleft cyst (congenital)
  • Met
  • Lymphoma
  • Salivary gland tumor
  • Carotid body tumor
  • Schwannoma

Posterior

  • Lymphangioma (congenital)
  • Scrofula
  • Lymphoma (Turberculosis)
  • Met
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3
Q

Infection

  • Most common microbe
  • Microbe in cat-scratch
  • Microbe in scrofula
A

Infection

  • Streph / Staph = common microbe
  • Bartonella henselae = Microbe in cat-scratch
  • Mycobacterium tuberculosis = Microbe in scrofula
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4
Q

Infection

Viral (4)

Parasitic (1), found where?

Fungal (1) found where?

A

Infection

Viral (4)

  • EBV, HIV, HSV, CMV

Parasitic (1), found where?

  • Toxoplasmosis gondii (cat feces)

Fungal (1) found where?

  • Coccidiodies immitis, southwest USA, respiratory
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5
Q

Lymphangioma

  • What age does it appear
  • Which neck triangle? Posterior to which muscle?
  • Treatment
A

Lymphangioma

  • Present at birth, continues to grow
  • Posterior to SCM (posterior triangle)
  • Treatment: sclerotherapy + excision if disfiguring/impairs function
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6
Q

Branchial cleft cyst

  • Present at what age?
  • Location
  • Which branch is most common
  • Treatment
  • What causes them to suddenly increase in size?
A

Branchial cleft cyst

  • Present at birth
  • 2nd branch most common 95%
  • Treatment: Sometimes surgery is required, recurrence common, may include tonsillectomy if 2nd branch
  • Can be asymptomatic until infected causing sudden rapid growth
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7
Q

Most common developmental/congenital cyst in neck

A

Most common developmental/congenital cyst in neck

Thyroglossal duct cyst

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8
Q
  • Thyroglossal duct cyst
  • Present at what age
  • Clinical presentation
  • Key diagnostic manuever during exam
  • Location
  • Treatment
A

Thyroglossal duct cyst

Present at what age

  • present at birth

Clinical presentation

  • Size increase after URTI

Key diagnostic manuever during exam

  • Moves with tongue protrusion/swallowing

Location

  • Midline neck superior to hyoid

Treatment

  • Sistrunk (Excision with midbody of hyoid)
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9
Q

Dermoid Cyst

  • Present at what age
  • Clinical presentation
  • Key diagnostic manuever during exam
  • Location
  • Treatment
A

Present at birth, includes all three germ layers

Clinical presentation

  • Painless, doughy, slow growing

Key diagnostic manuever during exam

  • Does not move with tongue protrusion/swallowing

Location

  • Midline neck/FOM

Treatment

  • Excision
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10
Q

Thyroid mass - inflammatory

  • Two diseases
  • Which is most common
  • Treatment for each
A

Thyroid mass - inflammatory

Two diseases

  • Goiter (nutritional deficiency, puberty, pregnancy)
  • Hashimotos

Which is most common

  • Hashimotos (15% of all women)

Treatment for each

  • Hashimotos = Thyroid hormone
  • Goiter = depends on etiology
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11
Q

Thyroid mass - neoplasm

  • Which age group is mostly benign
  • Which age group is mostly malignant
  • Clinical differentiation benign vs malignant
  • Most common benign lesion
  • Most common malignant lesion
  • Second most common malignant lesion
  • Which is associated with MEN 2A/2B
  • Which is associated with hashimotos
  • Which secretes calcitonin
  • Which has a poor prognosis
  • Which has psammoma bodies
A

Thyroid mass - neoplasm

  • Children = Which age group is mostly benign
  • Adult = Which age group is mostly malignant
  • Benign is firm and fixed = Clinical differentiation benign vs malignant
  • Adenoma = Most common benign lesion
  • Papillary adenocarcinoma = Most common malignant lesion
  • Follicular adenocarcinoma = Second most common malignant lesion
  • Medullary carcinoma = Which is associated with MEN 2A/2B
  • Lymphoma = Which is associated with hashimotos
  • Medullary carcinoma = Which secretes calcitonin
  • Anaplastic = Which has a poor prognosis
  • Papillary adenocarcinoma = Which has psammoma bodies
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12
Q

Carotid body tumor

  • What type of neoplasm?
  • Location
  • Clinical symptoms
A

Carotid body tumor

  • Neuroendocrine tumor
  • Anterior neck on medial aspect of bifurcation
  • Clinical symptoms due to nerve compression
    • Tongue paresis (CN XII)
    • Hoarseness (recurrent laryngeal)
    • Horner Syndrome (sympathetic nerve trunk)
    • Dysphagia (CN IX)
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13
Q

Horner syndrome

  • Which system is impaired?
  • Clinical symptoms
  • Management
A

Horner syndrome

  • Impaired sympathetic
  • Clinical symptoms are therefore unapposed parasympathetic
    • Miosis, Anhydris (no sweating), eyelid ptosis (Muller’s muscle)
  • Management
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