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YEAR 4 ENT > Swelling in neck > Flashcards

Swelling in neck Flashcards

1
Q

Congenital causes for lump in neck?

A

Brachial cyst
Thyroglossal duct cyst

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2
Q

What is branchial cyst?

A

Benign, developmental defect of branchial arches

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3
Q

Why are branchial cysts prone to infections?

A

May have fistula - so infection can manifest.

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4
Q

What may be in immediate PMH in pt presenting w/ branchial cyst?

A

Respiratory tract infection —> branchial cysts enlarge after a resp infection

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5
Q

Epidemiology of branchial cyst? Who?

A

Pt is late childhood/early adulthood
Female

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6
Q

Ddx for branchial cyst?

A

Congential: Thyroglossal duct cyst, Dermoid cyst, Vascular malformation
Inflammatory: Reactive lymphadenopathy, Lymphadenitis
Neoplastic: lymphoma, thyroid tumour, salivary gland tumour

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7
Q

Inv for branchial cyst?

A

USS
Referral to ENT (if in GP setting)
Fine needle aspiration

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8
Q

Management for branchial cyst?

A

Conservative
Surgical excision
Abx for any acute infection

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9
Q

How does thyroglossal duct cyst arise?

A

Thyroid develops from floor of pharynx.
Thyroid is connected to tongue by the thyroglossal duct.
Normally TGD atrophies but sometimes persists = TGDC

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10
Q

Presentation of thyroglossal duct cyst?

A

Pt <20yrs
Midline lump
Moves upwards on tongue protrusion
Painless usually. Painful if infected

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11
Q

Management of thyroglossal duct cyst?

A

Surgical excision
Abx if infected

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12
Q

Malignant causes of neck lumps?

A

Metastatic cancer
Thyroid cancer
Lymphoma

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13
Q

Borders of anterior triangle of neck?

A

Superiorly – inferior border of the mandible (jawbone).
Laterally – anterior border of the sternocleidomastoid.
Medially – sagittal line down the midline of the neck.

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14
Q

Borders of posterior triangle of neck?

A

Anterior – posterior border of the sternocleidomastoid.
Posterior – anterior border of the trapezius muscle.
Inferior – middle 1/3 of the clavicle.

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15
Q

Name superficial lymph nodes in neck

A

Submental
Submandibular
Pre-auricular
Post-auricular
Occipital
Superficial cervical
Posterior cervical
Anterior cervical

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16
Q

Name three deep lymph nodes in the neck

A

Jugulo-digastric
Jugulo-omohyoid
Supraclavicular

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17
Q

Differentials for cervical lymphadenopathy?

A

Acute infection - viral infection, infective mononucleosis, toxoplasmosis, infected eczema

Chronic infection - TB, HIV, syphilis

Malignancy - Hodgkin’s and non-Hodgkin’s lymphoma, chronic lymphocytic leukaemia, acute lymphoblastic leukaemia,
secondary malignancy - thyroid, nasopharyngeal, breast, lung, stomach

Other causes - RA, sarcoidosis, phenytoin reaction, Kawasaki’s syndrome

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18
Q

What to ask in Hx for neck lump?

A

Lump:
◦ Duration
◦ Position, Mobility
◦ Pain, tender
◦ Relation to swallowing

Associated symptoms:
◦ Sore throat/Dysphagia/Odynophagia
◦ Dysphonia/Otalgia/Other neck lumps
◦ Fever, night sweats, TB contact, travel abroad
◦ Smoking, alcohol

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19
Q

What examinations would you do for neck lump?

A

Clinical ENT examination
—> clinical neck examination - Site, size, shape
—> flexible endoscopy to visualize the nose,
nasopharynx, oropharynx, hypopharynx and larynx

Think - is it in posterior or anterior triangle? Midline or lateral placement? Movement on swallowing or tongue protrusion? Palpation features?
- feel deeper? superficial?
- hard/soft/smooth/irregular?
- fixed or mobile?
- tender? non-tender?
- overlying skin changes? redness etc

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20
Q

What investigations to do for neck lump?

A

Bloods
◦ FBC, CRP, monospot
FNAC (fine needle aspiration cytology) - Don’t incise or excise neck mass if might be SCC
CXR/USS/CT/MRI
Endoscopy and formal biopsy of primary

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21
Q

What are red flags for neck lump?

A

Persists 6+ weeks
Fixed, hard, irregular
Rapidly growing in size
Associated with generalised lymphadenopathy
Systemic signs- weight loss, night sweats
Change in voice/hoarseness
Dysphagia/Odynophagia

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22
Q

Risk factors for head and neck cancer?

A

Smoking
Alcohol misuse
HPV, EBV
Radiation exposure - UV, CT scanners
Immunosuppression
Occupation - acid mists, asbestos, wood dust
FHx

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23
Q

General clinical presentation of head and neck cancers?

A

Hoarsness/change in voice
Throat pain
Tongue ulcers
Painless neck lump

Sx present for 3+ weeks

If tumour is endocrine in nature - have weight loss, hormonal Sx

24
Q

Presentation of laryngeal cancer (to refer via 2ww)?

A

Persistent, unexplained hoarseness
Unexplained lump in neck

25
Q

Presentation of oral cancer (to refer for 2ww)?

A

Unexplained ulceration in oral cavity for 3+ weeks
Persistent, unexplained lump in neck
Lump on lip or in oral cavity
Red/red and white patch in oral cavity - erythroplakia/erythroleukoplakia

26
Q

Presentation of thyroid cancer (to refer for 2ww)?

A

Unexplained thyroid lump

27
Q

Causes of a neck lump?

A

Reactive lymphadenopathy - v v common
Lymphoma
Thyroid swelling
Thyroglossal duct cyst
Pharyngeal pouch
Branchial cyst
Cervical rib
Carotid aneurysm

28
Q

Presentation of Hodgkin’s lymphoma?

A

Lymphadenopathy - non-tender, painless, asymmetrical
Systemic Sx - weight loss, pruritus, night sweats, fever
Painful LN after drinking alcohol
LDH raised
Normocytic anaemia, eosinophilia

29
Q

Name of cell characteristically seen in Hodgkin’s lymphoma?

A

Reed-Sternberg cell

30
Q

Staging for Hodgkin’s and non-Hodgkin’s lymphoma?

A

Ann-Arbor staging

31
Q

Management for lymphoma?

A

Watchful waiting
Radiotherapy
Chemotherapy
Flu and pneumococcal vaccine

32
Q

Investigations for neck lump / suspected lymphoma

A

Bloods:
* FBC
* ESR
* LDH
* HIV test
* blood film
Procedures
* Excisional node biopsy
Imaging:
* CT CAP
* PET scan for any bone marrow involvement

33
Q

Presentation of thyroid cancer?

A

Neck lump
Compressive Sx - swallow problem, feel like being strangled
Voice changes

34
Q

Types of thyroid cancer?

A

Papillary adenocarcinoma - most common (80%)
Follicular adenocarcinoma - (10%)
Medullary carcinoma
Anaplastic carcinoma

35
Q

Investigations for thyroid cancer?

A

Triple assessment
1. Full Hx + Ex,
2. Imaging - USS
3. Needle biopsy - fine needle aspiration cytology

36
Q

Management for thyroid cancer?

A

Thyroidectomy
Radioactive Iodine
Radiotherapy or chemotherapy

37
Q

Features specific to papillary adenocarcinoma?

A

Age 30-40
Locally compress trachea
Can met to bone and lungs

38
Q

Features specific to follicular adenocarcinoma?

A

Common in areas of low iodine
Women > men
Likely to metastasise into lung and bones (rather than locally invade)

39
Q

Features specific to medullary thyroid cancer?

A

Worse prognosis than papillary or follicular
Comes from calcitonin producing C cells- so can present with hypocalcaemia and diarrhoea
Mets to LN - lymphadenopathy

40
Q

Features specific to anaplastic thyroid cancer?

A

Age 60-70
V aggressive - pt presents with rapid growing neck lump
Already invaded into trachea and recurrent laryngeal nerve when presents
Survival 8m - v poor.

41
Q

Autoimmune condition associated with thyroid lymphoma?

A

Hashimoto’s thyroiditis

42
Q

Presentation of sialadenitis?

(inflame of salivary glands - usually parotid or sub-mandibular)

A

Pain
Tenderness
Redness
Localised swelling
- Swelling in neck - if submandibular gland
- Swelling at parotid gland if this is affected

43
Q

Ddx of sialadenitis?

A

Reactive lymphadenopathy
Malignant lymphadenopathy
Tumour
Sub-mandibular salivary stone

44
Q

Management of sialadenitis?

A

Abx, oral hygiene advice
Encourage salivary flow - e.g. lemon juice
Associated abscess = incision and drainage

45
Q

Presentation of Ludwig’s angina?

A

Neck swelling
Dysphagia
Fever

46
Q

Pathophysiology of Ludwig’s angina?

A

Progressive cellulitis
Invades floor of mouth and soft tissues of neck
From odontogenic infection (tooth infection)—> spreads into submandibular space

47
Q

Management of Ludwig’s angina?

A

Airway obstruction can occur as a result - so this is an emergency!
Need:
- airway management
- IV abx

48
Q

Presentation of pharyngeal pouch?

A

Older man
Midline lump
Gurgles on palpation
Dysphagia
Regurgitation
Aspiration
Chronic cough
Halitosis

49
Q

Inv for pharyngeal pouch?

A

Barium swallow combined with dynamic video fluoroscopy

Avoiding endoscopy due to risk of perforating the lesion

50
Q

Management for pharyngeal pouch?

A
  • If the pouch is small and asymptomatic, no treatment is necessary.
  • For larger or symptomatic pouches, surgical approaches may be employed such as resection of the diverticulum, or incision of the cricopharyngeus muscle.
51
Q

Presentation of carotid aneurysm?

A

Pulsaive lateral neck mass
Does not move on swallowing

52
Q

How to clinically distinguish between a thyroglossal cyst and thyroid nodule?

A

Thyroglossal duct cyst moves upwards on tongue protrusion
Thyroid nodule moves upwards on swallowing

53
Q

Risks of thyroid surgery on pt who is hyperthyroid?

A

Thyrotoxic storm
and
Higher risk of bleeding

54
Q

Complications of carrying on thyroid surgery on a euthyroid patient?

A

Bleeding
Infection
Damage to recurrent laryngeal nerves
Hypothyroidism
Hypoparathyroidism

55
Q

After thyroidectomy, what blood test would you do?
Symptoms to suggest this blood test being low?

A

Calcium
Tingling around mouth and fingertips. If v v low = muscle spasms

YEAR 4 ENT (20 decks)

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