Throat Lumps

Question 1

Which of the following is typically the 1st line imaging for a neck lump?

1 - MRI
2 - CT
3 - ultrasound
4 - PET scan

Answer 1

3 - ultrasound

May be with or without a needle biopsy, and other imaging can be used to stage any potential malignancies

Question 2

Which of the following is a malignant cause of lymphadenopathy?

1 - Infectious mononucleosis
2 - Tuberculosis or Atypical mycobacterium
3 - Lymphoma (Hodgkin’s, Non-Hodgkin’s)
4 - Toxoplasmosis
5 - Cat scratch disease
6 - Actinomycosis

Answer 2

3 - Lymphoma (Hodgkin’s, Non-Hodgkin’s)

Question 3

What is the most common form of midline cyst?

1 - Thyroglossal duct cyst
2 - Branchial cleft cysts
3 - Lymphangioma
4 - Dermoid and epidermoid cysts
5 - Thymic cyst

Answer 3

1 - Thyroglossal duct cyst

Question 4

Thyroglossal duct cyst is the most common form of midline cyst. When comparing a Thyroglossal duct cyst with a goitre (enlarged thyroid), which moves with swallowing and tongue protrusion?

Answer 4

• Thyroglossal duct cyst

Rises with hyoid bone due to its close proximity

Goitre only moves up with swallowing

Question 5

Thyroglossal duct cyst can be diagnosed using ultrasound with a needle biopsy. How is this typically treated?

1 - wait and see as most are self resolving
2 - steroids
3 - thyroidectomy
4 - excision of cyst, tract and central portion of hyoid bone

Answer 5

4 - excision of cyst, tract and central portion of hyoid bone

Called a Sistrunk’s procedure, and reduces recurrence rates

Question 6

Which of the following is most likely to cause the following:

• lid lag, retraction, proptosis
• thinning of hair/eye brow loss
• pretibial myxoedema
• hypereflexia

1 - Hashimotos disease (hypothyroid)
2 - Graves disease (hyperthyroid)
3 - Addisons disease (low cortisol/aldosterone)
4 - Cushings syndrome (hypercortisolism)?

Answer 6

2 - Graves disease (hyperthyroid)

Question 7

In Graves disease (hyperthryroidism) which of the following would we expect to see?

1 - high TSH, T3 and T4
2 - high TSH, low T3 and T4
3 - low TSH, T3 and T4
4 - low TSH, high T3 and T4

Answer 7

4 - low TSH, high T3 and T4

Negative feedback inhibits pituitary and TSH
TSH antibodies on thyroid mimic TSH despite low levels and increase T3 and T4 production

Question 8

In Graves disease with a patient with a neck lump, which of the following examinations is least likely to be performed?

1 - head MRI
2 - ultrasound of the neck
3 - antibody test (TSH, TPO, TG)
4 - blood tests (TSH, T3 and T4)

Answer 8

1 - head MRI

Question 9

In a patient with a confirmed diagnosis of Graves disease in a patient with a neck lump, which of the following would NOT be used as part of the patients management?

1 - total thyroidectomy
2 - radioactive iodine
3 - levothyroxine
4 - carbimazole (1st) vs propylthiouracil (2nd)

Answer 9

3 - levothyroxine

Used for hypothyroidism

Question 10

Which of the following relates to salivary stones, and a common cause of parotid lumps?

1 - liver failure
2 - malignancy
3 - sialiolithiasis
4 - nerve palsy

Answer 10

3 - sialiolithiasis

Salivary stone formation that typically swells after eating

Question 11

Which of the following infections can lead to enlarged parotid glands?

1 - mumps
2 - HIV
3 - herpes simplex virus
4 - human papillomavirus

Answer 11

1 - mumps

Lumps can be benign or malignant

Question 12

What does facial paralysis with a parotid lump most likely suggest?

1 - alcoholic liver disease
2 - stroke
3 - malignancy
4 - wilsons disease

Answer 12

3 - malignancy

Always think of malignancy until proven otherwise, so need to rule out signs or malignancy

Question 13

All of the following are forms of parotid lumps, but which is the most common?

1 - Warthin’s Tumour/Adenolymphoma
2 - Mucoepidermoid carcinoma
3 - Adenoidcystic carcinoma
4 - Pleomorphic salivary adenoma

Answer 13

4 - Pleomorphic salivary adenoma

Mucoepidermoid carcinoma is the most common salivary gland cancer

Question 14

Sialadenitis is inflammation of the salivary glands. Which of the following salivary glands does this occur in most commonly?

1 - parotid
2 - submandibular
3 - sublingual
4 - all equally likely

Answer 14

1 - parotid

Question 15

Sialadenitis is inflammation of the salivary glands. Which of the following is the primary risk factor for sialadenitis?

1 - ageing
2 - sialolithiasis
3 - poor oral hygiene
4 - dehydration
5 - viral (mumps)

Answer 15

4 - dehydration

Question 16

Which of the following are symptoms of Sialadenitis?

1 - painful swelling
2 - fevers
3 - Pus draining from parotid duct (opposite 2nd upper molar) or submandibular duct (floor of mouth)
4 - unilateral or bilateral symptoms
5 - all of the above

Answer 16

5 - all of the above

Question 17

Ultrasound and blood tests will be performed if we suspect abscess. However, which of the following is NOT a typical management option?

1 - parotidectomy
2 - oral rehydration and sialagogues
3 - antibiotics if infected (oral or IV)
4 - surgical drainage of abscess

Answer 17

1 - parotidectomy

Unlikely, but could happen in extreme cases and if this is recurring

Question 18

Which 2 of the following are the most common types of deep neck space abscesses?

1 - peritonsillar abscess
2 - retropharyngeal abscess
3 - submandibular abscess
4 - parapharyngeal abscess

Answer 18

2 - retropharyngeal abscess
- posterior to pharynx

4 - parapharyngeal abscess
- lateral to the pharynx

Question 19

Patients with a deep neck space abscess can present in a variety of ways. Which of the following do patients typically present with?

1 - neck swelling
2 - torticollis (neck turned to one side)
3 - dysphagia/odynophagia/ drooling
4 - airway compromise
5 - trismus (spasm of jaw muscles)
6 - all of the above

Answer 19

6 - all of the above

Question 20

Deep neck space abscess are commonly associated with all of the following, EXCEPT which one?

1 - hypoglossal nerve palsy
2 - tonsillitis
3 - dental abscess
4 - peritonsillar abscess

Answer 20

1 - hypoglossal nerve palsy

Question 21

Deep neck space abscess can cause all of the following complications, but which is the least likely?

1 - mediastinitis
2 - mastoiditis
3 - thrombus
4 - septic emboli

Answer 21

2 - mastoiditis

Question 22

Which of the following blood tests should be requested in a patient with suspected deep neck space abscess?

1 - FBC
2 - group and save
3 - clotting factors
4 - blood cultures
5 - all of the above

Answer 22

5 - all of the above

Question 23

Which of the following imaging modalities is most useful for identifying deep neck space abscess?

1 - ultrasound
2 - MRI
3 - CT with contrast
4 - X-ray

Answer 23

3 - CT with contrast

Question 24

All of the following can be used in a patient with a deep neck space abscess, but which should be considered if there is a restricted airway?

1 - IV antibiotics
2 - fluids
3 - surgical drainage
4 - tracheostomy

Answer 24

4 - tracheostomy

Often reversible