Throat Lumps Flashcards
Which of the following is typically the 1st line imaging for a neck lump?
1 - MRI
2 - CT
3 - ultrasound
4 - PET scan
3 - ultrasound
May be with or without a needle biopsy, and other imaging can be used to stage any potential malignancies
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
3 - Lymphoma (Hodgkin’s, Non-Hodgkin’s)
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
1 - Thyroglossal duct cyst
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?
- Thyroglossal duct cyst
Rises with hyoid bone due to its close proximity
Goitre only moves up with swallowing
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
4 - excision of cyst, tract and central portion of hyoid bone
Called a Sistrunk’s procedure, and reduces recurrence rates
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)?
2 - Graves disease (hyperthyroid)
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
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
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)
1 - head MRI
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)
3 - levothyroxine
Used for hypothyroidism
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
3 - sialiolithiasis
Salivary stone formation that typically swells after eating
Which of the following infections can lead to enlarged parotid glands?
1 - mumps
2 - HIV
3 - herpes simplex virus
4 - human papillomavirus
1 - mumps
Lumps can be benign or malignant
What does facial paralysis with a parotid lump most likely suggest?
1 - alcoholic liver disease
2 - stroke
3 - malignancy
4 - wilsons disease
3 - malignancy
Always think of malignancy until proven otherwise, so need to rule out signs or malignancy
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
4 - Pleomorphic salivary adenoma
Mucoepidermoid carcinoma is the most common salivary gland cancer
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
1 - parotid
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)
4 - dehydration
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
5 - all of the above
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
1 - parotidectomy
Unlikely, but could happen in extreme cases and if this is recurring
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
2 - retropharyngeal abscess
- posterior to pharynx
4 - parapharyngeal abscess
- lateral to the pharynx
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
6 - all of the above
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
1 - hypoglossal nerve palsy
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
2 - mastoiditis
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
5 - all of the above
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
3 - CT with contrast
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
4 - tracheostomy
Often reversible
