Neck swellings

Question 1

Where is the anterior triangle?

Answer 1

Lateral border SCM

Medial is midline

Question 2

Where is the posterior triangle?

Answer 2

Clavicle inferiorly
Lateral - anterior border of trapezius
Medial - lateral border of SCM

Question 3

Which swellings are found superficially?

Answer 3

Sebaceous cysts
Lipomas
Neurofibromas

Question 4

Which swellings are found in the midline?

Answer 4

Thyroid
Thyroglossal cyst
Dermoid cyst

Question 5

What swellings could be present in the anterior triangle?

Answer 5

Salivary glands
Lymph nodes
Branchial cyst
Carotid body tumour

Question 6

What swellings are present in the posterior triangle?

Answer 6

Lymph nodes

Cystic hygroma

Question 7

Which points in a Hx are important if symptom is cervical lymphadenopathy?

Answer 7

Fever, weight loss
Hoarseness, dyspnoea
melena, recent immigrant

Question 8

What investigations are needed if cervical lymphadenopathy?

Answer 8

CXR
Fine needle aspiration
Mantoux test or ZN stain
Check hepatospenomegaly
Check other nodes

Question 9

What is evident in examination of a thyroglossal cyst?

Answer 9

Moves with the tongue
Below hyoid
Presents in teenage years

Question 10

What is the treatment for a thyroglossal cyst?

Answer 10

Excision

Question 11

What are the features of a dermoid cyst?

Answer 11

Presents in youth
Soft
Non-fluctant 
In midline
Also found lateral to eye

Question 12

What is a branchial cyst?

Answer 12

Persistent part of 2nd branchial arch.
Teenage years
Half filled water bottle

Question 13

What may be contained in a branchial cyst?

Answer 13

Cholesterol crystals

Question 14

What is a caution with branchial cysts?

Answer 14

May fistulate to skin and leak saliva

Question 15

Where do cystic hygromas present?

Answer 15

Posterior triangle

Question 16

In whom do cystic hygromas present?

Answer 16

infants

Question 17

What are the features of cystic hygromas?

Answer 17

Lymph filled.
Transilluminable
Pressure symptoms

Question 18

What is the treatment for cystic hygromas?

Answer 18

Will shrink over time so just leave it

Question 19

Which cancer is most likely to appear on the ectopic thyroid tissue?

Answer 19

Papillary

Question 20

If the swelling moves on swallowing where it is likely to be?

Answer 20

Thyroid

Question 21

If the swelling move on sticking the tongue out what is not likely to be?

Answer 21

Dermoid cyst

Question 22

What is a chemodactoma?

Answer 22

Carotid body tumour

Question 23

If a swelling is soft, is it likely to be benign or malignant?

Answer 23

Benign

Question 24

What is Trosier’s sign?

Answer 24

Presence of Virchow’s node

Question 25

What is the structure called in the mouth which contains all the tonsils?

Answer 25

Waldeyer’s tonsillar ring

Question 26

Histologically, what kind of cancer is likely to be found in the oesophagus?

Answer 26

Squamous epithelial

Question 27

Where else can cystic hygromas present?

Answer 27

Axilla

Question 28

What parts of the history are particularly important in thyroid swellings?

Answer 28

FHx

Previous neck irradiation

Question 29

True or False

Hoarseness could be either benign or malignant

Answer 29

False.

Mostly malignant.

Question 30

Which nerve infiltration causes hoarseness?

Answer 30

recurrent laryngeal

Question 31

Which investigations should be done in a thyroid swelling?

Answer 31

TSH

USS-FNA

Question 32

What are the 5 responses of FNA?

Answer 32

Thy1- inadequate
Thy2- benign
Thy 3- suspicious
Thy4/5 malignant

Question 33

What further investigation is carried out in Thy3?

Answer 33

Thyroid lobectomy