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CHHD > Swellings of the head and neck > Flashcards

Swellings of the head and neck Flashcards

1
Q

Describe the position of the 2 triangles of the neck

A
  • Anterior - below digastric, in front of the sternomastoid

- Posterior - behind sternomastoid, in front of the trapezius, above the clavicle

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2
Q

What trauma can lead to acquired swelling of head/neck

A

Haematoma

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3
Q

What bacterial infections can lead to acquired swelling of the head/neck

A
  • Pyogenic - Lymphadenitis, suppurative sialadenitis
  • Tubercular CL
  • Syphilitic CL
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4
Q

What viral infection can lead to acquired swelling the head and neck

A
  • German measles
  • Infectious mononucleosis
  • Mumps
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5
Q

What immunologic factors can lead to acquired swelling of the head and neck

A
  • Orofacial granulomatosis

- Crohn’s disease

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6
Q

What neoplastic factors can lead to acquired swelling of the head and neck

A 
Leukaemia
Lymphoma
Metastatic carcinoma
Squamous cell carcinoma
Lipoma (benign)
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7
Q

What developmental factors can lead to swelling of the head and neck

A
  • Branchial cyst
  • Thyroglossal cyst
  • Dermoid cyst
  • Epidermal cyst
  • Cystic hygroma/lymphangioma
  • Fibrous dysplasia
  • Cervical rib
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8
Q

How would you take the history of a patient with swelling in the head and neck

A
  • Age of patient
  • Date of onset of symptoms
  • Duration and character of swelling
  • Details of the pain experienced - duration, character, radiation, aggravating and relieving factors
  • Associated symptoms
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9
Q

Name some of the things to note when examining a lump

A

Site, size, shape, surface, texture, temperature, tenderness, surrounding tissue, mobility, drainage lymph nodes

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10
Q

Describe the causes/aetiology for a branchial cyst

A

Proliferation of epithelial remnants from second

branchial cleft within lymph nodes

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11
Q

Describe the clinical features of a branchial cyst

A
  • Seen in children and adolescents

- Asymptomatic, un-inflamed swelling

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12
Q

Describe the site, surface and consistency of a branchial cyst

A

Site - upper part of the lateral neck beneath anterior border of SCM
Surface - smooth, globular, tense
Consistency - Soft or fluctuant

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13
Q

What is the most common developmental cyst of the neck

A

Thyroglossal cyst

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14
Q

Describe the causes/aetiology of thyroglossal cysts

A

Failure of complete descent of thyroid tissue from

foramen caecum with subsequent cystification

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15
Q

Describe the clinical features of thyroglossal cysts

A
  • Common in children and young adults

* Asymptomatic or infected

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16
Q

Describe the site of thyroglossal cysts

A
  • Midline swelling in neck above level of thyroid
  • In thyroid region, swelling is pushed to one side (usually left)
  • Swelling often moves on swallowing or tongue protrusion
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17
Q

Describe the causes/aetiology of dermoid cysts

A

Proliferation of epithelial rests

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18
Q

Describe the clinical features of dermoid cysts

A
  • Seen in young adults

- Asymptomatic, un-inflamed swelling

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19
Q

Describe the site of dermoid cysts

A

Site - Submandibular space (lateral neck swelling)

- Floor of mouth above mylohyoid muscle (double chin) or midline of the neck

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20
Q

Describe the surface and consistency of dermoid cysts

A

Surface - smooth, globular and tense

Consistency - Soft or fluctuant

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21
Q

Describe the causes/aetiology of lymphangioma/cystic hygroma

A

Proliferation of sequestrated lymphatic endothelium of the jugular sac

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22
Q

Describe the clinical features of lymphangioma/cystic hygroma

A
  • Presents at birth or manifests during infancy/childhood

- Asymptomatic, un-inflamed swelling

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23
Q

Describe the site, surface, consistency and colour of lymphangioma/cystic hygroma

A

Site - Lower third of the neck
Surface - smooth, diffuse and tense
Consistency - spongy, soft and translucent
Colour - lighter than surrounding tissue

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24
Q

Name and many cervical lymph nodes as you can

A 
Posterior auricular
Occipital
Superficial cervical
Deep cervical 
Posterior cervical
Supraclavicular
Preauricular
Parotid
Tonsillar
Submental 
Submandibular
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25
Q

What mechanisms cause lymph nodes to enlarge

A
  • Increase in the number of cells

- Infiltration with cells

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26
Q

What can cause the number of lymph node cells to increase

A

Benign lymphocytes and macrophages in response to antigens

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27
Q

What can cause infiltration of the lymph nodes and cause them to enlarge

A
  • Inflammatory cells in infection (lymphadenitis)
  • In situ proliferation of malignant lymphocytes or macrophages
  • Metastatic malignant cells
  • Metabolite laden macrophages (lipid storage diseases)
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28
Q

At what time in life do lymph nodes become more dangerous

A
  • Children/young adults – more likely to respond to minor stimuli with lymphoid hyperplasia
  • Lymph nodes aged < 30 are clinically benign in 80% of cases whereas in patients over the age of 50 only 40% are benign
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29
Q

What types infections can lead to Cervical lymphadenopathy (CL)

A
  • Viral upper respiratory tract

- Pyogenic infection in the local area of drainage

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30
Q

Name some systemic bacterial infections that can cause CL

A
  • Tuberculosis

- Syphilis

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31
Q

Name some systemic viral infections that can cause CL

A
  • Infectious mononucleosis
  • Cytomegalovirus
  • HIV infection
32
Q

Name some systemic fungal infections that can cause CL

A
  • Histoplasmosis
33
Q

Name some systemic parasitic infections that can cause CL

A

Toxoplasmosis

34
Q

Name some malignant disease that can cause CL

A
  • Metastatic carcinoma
  • Leukaemia
  • Squamous cell carcinoma
  • Lymphoma
  • Langerhan’s histocytosis
35
Q

What other causes are there for CL

A
  • Drugs - Phenytoin
  • Mucocutaneous lymph node syndrome (Kawasaki disease)
  • Connective tissue disease
  • Sarcoidosis
36
Q

Describe the causes/aetiology of pyogenic lymphadenopathy

A

Oral inflammatory conditions esp. dental abscess

37
Q

Describe the clinical features of pyogenic lymphadenopathy

A

Can present as single or multiple painful nodes

38
Q

Describe the site, surface and consistency of pyogenic lymphadenopathy

A

Site - Depends on site of infection
Surface - Smooth, diffuse and tense
Consistency - soft when acute, not mixed to surrounding tissue

39
Q

Describe the causes/aetiology of viral lymphadenopathy (infectious mononucleosis)

A

EBV - Epstein-Barr Virus

40
Q

Describe the clinical features of viral lymphadenopathy (infectious mononucleosis)

A
  • Affects young adults
  • Fever, malaise and sore throat
  • Lymph nodes are firm, discrete, tender and mobile
  • Purpura or petechiae in the palate
41
Q

What is needed for diagnosis of viral lymphadenopathy (infectious mononucleosis)

A

+ve paul-bunnell or mono spot slide test

42
Q

Describe the causes/aetiology of Tuberculous lymphadenopathy

A

Mycobacterium tuberculosis transmitted by sputum

droplets from infected patients

43
Q

Describe the clinical features of Tuberculous lymphadenopathy

A
  • Single or multiple swelling in lateral neck
  • Indurated, asymptomatic and firm
  • Fever, malaise, night sweats, weight loss, persistent cough, SOB
  • Undergoes caseous necrosis to form collar stud abscess
  • Ulcer on dorsum of tongue
44
Q

What is needed for diagnose of Tuberculous lymphadenopathy

A
  • Ziehl-Neelsen stain
  • PCR
  • Mantoux test
  • Culture on Lowenstein Jensen (LJ) medium
  • Biopsy and radiograph
45
Q

Describe the causes/aetiology of malignant lymphadenopathy

A
  • Unknown (Hodgkin’s)
  • Epstein-Barr virus (Burkitt’s)
  • Human Immunodeficiency virus (Lymphoma)
46
Q

Describe the clinical features of malignant lymphadenopathy

A
  • Arise in middle-aged and elderly with exception of Burkitt’s seen in children and young adults
  • Single or bilateral swelling in lateral neck
  • Asymptomatic and slowly enlarging firm, rubbery matted lymph nodes
  • Fever, malaise, night sweats and weight loss
47
Q

What is needed to diagnose malignant lymphadenopathy

A

Biopsy - Reed-sternberg cells (Hodgkin’s)

48
Q

Describe the causes/aetiology of a metastatic carcinoma

A

Metastatic oral cancer/nasopharyngeal lesion

49
Q

Describe the clinical features of a metastatic carcinoma

A
  • Usually single but maybe multiple (rarely bilateral)
  • Seen in middle aged and elderly
  • Progressive increase in size
  • Indurated masses, fixed to surrounding tissue, rocky hard and painless
  • Commonly affects submandibular and jugulodigastric nodes
50
Q

What is needed for a diagnosis of metastatic carcinoma

A
  • Biopsy showing metastatic cells

- Signifies advanced disease with poorer prognosis

51
Q

What are the clinical features of congenital cervical rib

A
  • Arises from the 7th cervical vertebra
  • Feels like a bony swelling in the neck
  • Symptoms can be neurological or vascular
52
Q

What are the neurological symptoms of cervical rib

A
  • Pain
  • Paraesthesia + Anaesthesia of forearm
  • Hands
53
Q

What are the vascular symptoms of cervical rib

A
  • Excessive pulsation and thrill subclavian artery

- Arm pain, arm and/or hand can appear pale white in colour and it can also feel cold

54
Q

What is needed to diagnose cervical rib

A

CXR and x ray of the neck

55
Q

What is lipoma

A

A benign tumour made of fat tissue

56
Q

Describe the clinical features of lipoma

A
  • Rare
  • Slow-growing
  • Posterior neck space is the most common site
  • Soft, semi fluctuant, lobulated mass of varying size
  • Painless and asymptomatic
  • Intra-orally appears yellowish
57
Q

What is needed to diagnose lipoma

A
  • USS

- Biopsy

58
Q

What is a thyroid nodule

A

Overgrowth of normal thyroid tissue

59
Q

What are the clinical features of a thyroid nodule

A
  • Firm
  • Painless and asymptomatic
  • Midline swelling in area of thyroid gland
  • Uncommon
  • 90-95% are benign, 3-5% are malignant
60
Q

What is needed to diagnose a thyroid nodule

A
  • USS

- Biopsy

61
Q

What are the causes/aetiology of a carotid body tumour

A

Neoplastic transformation of carotid body cells

62
Q

What clinical features are there for carotid body tumour

A
  • rare, affects adults
  • Usually benign, some can show malignant behaviour
  • Firm, moveable mass in neck at carotid bifurcation
  • Painless, pulsatile and asymptomatic
  • Can cause compression effects
  • Bruit and thrill may be apparent
  • Unilateral swelling in lateral neck
63
Q

What is needed to diagnose carotid body tumour

A

CT/MRI head and neck

64
Q

How can you tell if a swelling is mostly developmental in origin

A

There are midline lesions

65
Q

What do bilaterally symmetrical and unilateral swellings show about the swelling

A 
Bilateral = anatomical structure
Unilateral = neoplastic and infective
66
Q

What colour and temperature indicate the presence of melanoma

A

Black/brown pigmentation

67
Q

What does purple/red pigmentation indicate

A

Angioma or Kaposi sarcoma

68
Q

What colour and temp are inflammatory swellings

A

Red and warm

69
Q

What sort of movement indicates carcinomas

A

Fixed to adjacent structures

70
Q

What does fluctuant consistency show

A

Cystic fluid, mucus, pus or blood present in swelling

71
Q

What does a soft consistency show

A

Acute inflammatory swellings

72
Q

What does a hard (indurated) swelling show

A

Carcinoma

73
Q

What do well defined and poorly defined margins indicate

A

Well defined = benign growth

Poorly defined = malignancy

74
Q

What does nodular and ulcerative surfaces indicate

A

carcinomas

75
Q

What do uniform and smooth surface textures indicate

A

Cystic lesions

CHHD (27 decks)

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