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Questions and Answers
What symptom is indicative of potential airway obstruction in a patient with a laryngeal tumor?
What symptom is indicative of potential airway obstruction in a patient with a laryngeal tumor?
Which condition is associated with progressive dysphagia when eating solids?
Which condition is associated with progressive dysphagia when eating solids?
Which serious complication can arise if the recurrent laryngeal nerve is paralyzed due to a tumor?
Which serious complication can arise if the recurrent laryngeal nerve is paralyzed due to a tumor?
Which symptom is not typically associated with a tumor compressing the airway?
Which symptom is not typically associated with a tumor compressing the airway?
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What is the significance of hoarseness in a patient with a suspected upper airway tumor?
What is the significance of hoarseness in a patient with a suspected upper airway tumor?
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What is a common source of malignancy that can drain into the supraclavicular lymph nodes?
What is a common source of malignancy that can drain into the supraclavicular lymph nodes?
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Which condition is most likely to cause cervical lymphadenopathy in children?
Which condition is most likely to cause cervical lymphadenopathy in children?
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What key question should be asked during the history-taking process for a patient with a neck lump?
What key question should be asked during the history-taking process for a patient with a neck lump?
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In adolescents, which symptom is associated with mononucleosis?
In adolescents, which symptom is associated with mononucleosis?
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What significant factor affects the differential diagnosis of a neck lump in patients?
What significant factor affects the differential diagnosis of a neck lump in patients?
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Which neck condition is rare in children but carries a high likelihood of being malignant if a growing lesion is present?
Which neck condition is rare in children but carries a high likelihood of being malignant if a growing lesion is present?
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Which statement about the behavior of lymph nodes in children is true?
Which statement about the behavior of lymph nodes in children is true?
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What aspect of associated symptoms is important in diagnosing lymphoma in young adults?
What aspect of associated symptoms is important in diagnosing lymphoma in young adults?
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Study Notes
Neck Lumps: Differential Diagnosis
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Initial Assessment: Evaluating a neck lump requires a comprehensive approach:
- Detailed patient history
- Physical examination of neck (including triangles, lymph node palpation)
- Anatomical knowledge of neck triangles aids differential diagnosis.
Potential Causes of Neck Lumps
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Malignancy:
- Metastatic cancer is a significant possibility, often originating from breast (draining to supraclavicular area) or upper gastrointestinal tract (Virchow's node). Lung cancer can also present in the supraclavicular region.
- Important to consider malignancy in the differential diagnosis regarding the patient's life expectancy.
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Infection:
- Lymph node enlargement (lymphadenopathy) can be caused by infections, often affecting jugulodigastric (tonsil-related) nodes.
History Taking: Crucial Considerations
- Likelihood of malignancy: Patient history directs evaluation.
- Multiple lumps? A patient with multiple lumps is more likely to have a systemic issue.
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Age-specific considerations:
- Children: Infections are frequent; tonsillitis often presents with cervical lymphadenopathy. Active immune systems can cause lymph node enlargement. Ask about preceding infections. Lymphoma, though rare, can occur in children; note persistent, enlarging nodes. Thyroid lesions, also rare, warrant concern if growing.
- Adolescents: Benign lesions are more common, but infections (URTs, mononucleosis - characterized by painful swallowing, exudate on tonsils, systemic symptoms) can cause lymphadenopathy. Contact sports avoidance is advised post-infection due to possible hepato-splenomegaly and liver function changes. Lymphoma is possible, requiring a history of persistent node enlargement and evaluation of weight loss, night sweats, and fever. Nasopharyngeal carcinoma, rare but present, can cause unilateral conductive hearing loss. Melanoma, though less common in the neck, should be considered.
- Adults: Malignancy is relatively more common. Key questions include duration of the lump, change in size (rate), presence of additional lumps, and concerning symptoms. Weight loss, night sweats, fever, progressive dysphagia (solid, minced, liquid), and odynophagia are red flags. Hyperthyroidism and TB can present with weight loss
Specific Lesions in the Neck
- Thyroglossal cysts: Midline neck swelling that moves with protrusion of the tongue, due to remnant tissue connection (foramen caecum).
- Branchial cysts: Should be considered alongside thyroglossal cysts.
- Apical Lung Tumors: Can present as a neck lump.
Airway Compression
- Laryngeal/Tracheal Tumors: Large thyroid nodules, especially in the supine position, can compress the trachea. Stridor (noisy breathing) and hoarseness are significant symptoms of upper airway obstruction, especially a supraglottic mass. The vocal cords are a critical point; hoarseness might indicate recurrent laryngeal nerve paralysis. Tracheostomy might be necessary.
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Description
Test your knowledge on the differential diagnosis of neck lumps in this quiz. Focus on causes such as malignancy, infection, and the importance of patient history. Enhance your understanding of neck anatomy and clinical assessment techniques.
