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What can a lump in the neck be?
- LYMPH NODES
- GLANDS
- GRANULOMATOUS DISEASE
- NEOPLASTIC
- OTHER DISCRETE LUMPS IN NECK
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What �other� lumps could it be, if not lymph node or salivary?
- Branchial Cyst
- Skin cyst
- Soft Tissue Neoplasms
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What is a Branchial cyst?
- At angle of mandible,
- Histo - lymphoepithelial cyst,
- developmental remnant
- Surgical removal
- complication Branchial fistula?
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How can a dermoid cyst present?
- can be I/O or E/O
- Doughy/fluctuant swelling
- FOM / midline of neck
- Double chin
- displaces tongue (interferes with speech/swallow)
- Surgical removal
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Why is the deep cervical chain of nodes important?
all head and neck lymphatic eventually drain into deep cervical nodes.
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What lymph nodes make up the cervical chain, along which vein do they run?
- Internal jugular vein
- most superior - jugulodigastric (tonsils)
- Jugulomyohyoid node - drainage from tongue
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What does Submandibular lymph node receive drainage from?
- gingivae
- teeth
- tongue
- structures along path of facial artery
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What does the submental lymph node receive drainage from?
- lower lip,
- FOM
- tip of tongue
- lower incisor teeth
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What consistency is a node assoc with inflammatory process (most likely due to infection)?
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Suggest general INFECTIVE causes of lymphad:
- Oral or local infection (dental, ENT)
- Upper respiratory tract infection (viruses)
- systemic infection (e.g HIV, CMV, EBV)
- Bacterial
- Viral
- Fungal
- Protozoa
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Suggest 6 viral causes of lymphadenopathy:
- HIV (PGL)
- Mumps
- EBV
- Herpes simplex
- Varicella zoster
- Measles
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Suggest Bacterial causes of lymphadenopathy:
- Local infections of head and neck
- TB
- Syphilis
- Cat scratch fever
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Suggest a Protozoal cause of lymphadenopathy:
Toxoplasmosis
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Suggest a Fungal cause of lymphadenopathy:
Histoplasmosis
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Tx for cat scratch and toxoplasmosis?
- Both self limiting.
- Long term tetracycline
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What are possible NEOPLASTIC causes of neck lumps?
- Oro-pharyngeal Squamous Cell Carcinoma
- Lymphoma
- Leukaemia
- Metastases
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Granulomatous cause of cervical lymphadenopathy?
- Sarcoidosis
- Pulmonary lesions most common
- cough / dyspnoea
- Bilateral hilar lymphadenopathy
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Oral symptoms of sarcoidosis?
- Lip swelling,
- cobblestone mucosa
- Ulcers or focal swellings
- Hyperplastic gingivitis
- Salivary swellings/ dry eyes / dry mouth (SS-like)
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In combo with uveitis, facial palsy, pyrexia and parotitis, sarcoidosis?
Heerfordts syndrome
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General principles of managing neck lumps?
- History
- Examination
- Special investigations
- ----Haematology and serology
- ----Microbiology
- ----Ultrasound +/- fine needle aspiration biopsy +/- core
- ----MRI
- Open biopsy � EUA
- Neck dissection
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