W2L7 Neck Lumps

Question 1

What is the lumps and bumps mnemonic?

Answer 1

She Cuts The Fish PERfectly

Question 2

What are the 3 Ss of neck lumps?

Answer 2

Site - describe location briefly
Size - use your hand and fingers to estimate if you do not have a ruler with you
Surface/overlying skin

Question 3

What are the 3 Cs of neck lumps?

Answer 3

Colour
Contour - is the lump well-defined or irregular
Consistency - ?soft/firm/hard

Question 4

What are the 3 Ts of neck lumps?

Answer 4

Tenderness
Temperature - Is it hot/inflamed?
Transilluminable

Question 5

What are the 3 Fs of neck lumps?

Answer 5

Fluctuance - ?fluid-filled cyst Fixation - ?is it fixed to the underlying tissue or to the overlying skin
Fields - draining lymph glands in the area

Question 6

What does PER stand for?

Answer 6

Pulsatile (Is it an aneurysm?)
Expansile (Is it an aneurysm?)
Reducible (Is it a hernia?)

Question 7

What are the structures in Level 1 of the neck?

Answer 7

submandibular salivary glands, myohyoid and digastric muscles, nubmandibular LNs, vessels and nerves

Question 8

What are the structures in Level 2, 3, 4 of the neck?

Answer 8

internal and external carotids and carotid bodies, CNX in carotid sheath, IJV, LNs.

Question 9

What are the structures in Level 5 of the neck?

Answer 9

CNXI, LNs, brachial plexus

Question 10

What are the structures in Level 6 of the neck?

Answer 10

thyroid, hyoid, trachea, oesophagus, larynx, anterior jugular veins

Question 11

Top 3 neck lumps in a toddler?

Answer 11

INFECTION, congenital, neoplasm

Question 12

What does lymphadenitis look like?

Answer 12

Big red, inflamed lump in a sick child (acute process)

Question 13

What is scofula?

Answer 13

Mycobacterial cervical lymphadenitis, refers to a lymphadenitis of the cervical lymph nodes associated with non tuberculous (atypical) mycobacteria. Chronic process, so not febrile.

Question 14

Top 3 neck lumps in a young adult?

Answer 14

Infectious/ inflammatory, neoplastic, congenital

Question 15

What kind of neck lumps can acne/ scalp acne give you?

Answer 15

Reactive LNs

Question 16

What are the characteristics of a thyroglossal duct cyst?

Answer 16

Presentation is typically either as a painless rounded midline anterior neck swelling or, if infected, as a red warm painful lump. It may move with swallowing and classically elevates on tongue protrusion.

Question 17

Top 3 neck lumps in middle age?

Answer 17

Infection
Neoplasia
Thyroid

Question 18

How does a thyroid mass present?

Answer 18

Midline mass which moves on swallowing (in pretracheal fascia)

Question 19

How does a metastatic lymphadenopathy feel

Answer 19

“craggy”

Question 20

Where is virchow’s node and what is it’s significance?

Answer 20

Virchow’s node is a lymph node in the left supraclavicular fossa. It takes its supply from lymph vessels in the abdominal cavity–> thoracic duct. The finding of an enlarged, hard node (also referred to as Troisier’s sign) is indicative of the presence of cancer in the abdomen, specifically gastric cancer.

Question 21

What is the likely cause of a neck lump with erythematous, ulcerating skin and a suppurative exudate in an adult?

Answer 21

Infective lymphadenitis due to mycobacteria–> TB (particularly in an HIV patient)

Question 22

What is the first line imaging of a neck lump?

Answer 22

US

Question 23

What are the 4 kinds of biopsy?

Answer 23

FNA, incisional (eg core, wide needle), excisional, wide local excision.