How to take a history of a lump
- When did you first notice it
- Where is it
- Spread to any other areas
- What has happened to it since? Grown bigger? More painful
- First episode?
- Any associated features? Weight loss, fever, night sweats
- What do you think it is?
Head and neck symptoms:
-Throat pain, ear ache, dysphagia, voice changes, dental pain
Systemic symptoms:
- Fever, weight loss, night sweats, malaise, rash
- Pain drinking alcohol
- Smoking and alcohol
Examination of the lump
- Look, palpate, percuss then auscultate (listen)
- Is there more than one swelling?
- Where is it? Anterior or posterior triangle? Level? Anatomy?
- Soft, firm, hard, fluctuant, tender, mobile/fixed
- Size, measured with a ruler
- Pulsatile? Does it beat
- Does it move on swallowing?
-Any pathology at primary sites?
Ear, nose throat, mouth, scalp, salivary glands?
-Any other lymph node basins involves (axillar, groins, abdomen)
What features should you look out for when examining a lump
Site Shape Size Surface Temperature Tenderness Transilluminate Colour Edge/margin Relations Nodes
How can you use sieves as a basic structure of diagnosis
Anatomical Sieve
- Skin
- Sebaceous gland
- Fat
- Hair
- Blood Vessels
- Nerves
- Lymphatics
- CT
- Muscles
- Bone
- Special structures (thyroid, parotid, thymus)
Surgical Sieve
- Metabolic
- Endocrine
- Degenerative
- Inflammatory
- Congenital
- Psychological
- Idiopathic
- Neurological
- Environmental
- Haemotological
- Autoimmune
- Traumatic
What are the boundaries of the anterior triangle of the neck
- Posterior border of the SCM
- Midline
- Inferior border of the mandible
What are the boundaries of the posterior triangle of the neck
- Posterior border of the SCM
- Middle third of the clavicle
- Anterior border of the trapezius
Anatomical Sieve related to lumps
- Vessels
- Nodes
- Salivary glands
- Muscles
- Nerves
- Mucosal surfaces
- Thyroid
- Bone
Levels of the neck
-Look at diagram
What should you do if you see a lateral neck mass
- Any lateral neck mass in an adult is a metastatic deposit until proven otherwise
- Refer in
Special Investigations for lumps
-Flexible nasendoscopy (look down the back of the nose)
-Fine needle aspiration cytology (FNAC)
With or without ultrasound guidance
-Imaging
Ultrasound, CT, MRI, PET scanning
-Blood tests
FBC, LFT, Bone screen, ESR, Thyroid function, EBV, HIV, CMV, Brucellosis, Glandular fever, cat scratch disease
-Important to work out if infection or not
Fine-Needle Aspiration Cytology procedure
- Get a needle
- Push into lump
- Aspirate some cells
- Look down a microscope
- Look for malignancies and make a diagnosis
-Operator dependent
Causes of Cervical Lymphadenopathy
Infective:
-Bacterial
Teeth (periocoronitis)
Skin
Tonsils
-Local Viral
URTI
Primary HSV
-Generally bacterial
TB
Cat scratch
Secondary syphilis
-Generally viral HIV CMV EBV Rubella
Neoplastic: -Local metastatic Aerodigestive Skin Salivary Thyroid Sinuses Breast Stomach
-General
Lymphoma
Leukaemia
Other:
- Drugs
- Sarcoidosis
Lateral Neck lumps possibilities
- Lymph Node most likely
- Epidermoid cyst
- Lipoma
- Fibroma
- Salivary glands
- Branchial cyst
- Cervical rib
- Hyoid bone
- Transverse process C1 and C6
- Ectatic carotid artery
- Carotid body tumour
- Congenital tortilcollis
Midline neck lumps possibilities
- Thyroid gland pathology
- Parathyroid gland
- Dermoid cyst
- Plunging ranula
- Thyroglossal duct cyst
Common Problems with the ear
- Hearing loss
- Otalgia- ear pain
- Otorrhoea- ear discharge
- Middle ear infection- common in children
- Facial palsy- important to find cause
- Disorders of balance
- Tinnitis- ringing in the ear
- Foreign bodies
- Aural drops
Otalgia causes
- Often cranial nerve related
- Look at the slides
Cholesteatoma definition
- Destructing and expanding growth consisiting of keratinizing epithelium in the middle ear
- Benign but can cause problems as they are erosive and expansive
Otitis externa and classification
Clinical manifestations
-Inflammation of the EAM
-Predisposing factors:
-Classification:
Infective (bacterial, fungal or viral)
Reactive (eczema, suborrhoeic dermatitis or psoriasis)
Investigations and management of otitis externa
- Microscopy, culture and sensitivity
- Piss in a pot
Aural toilet (manually clearing the ear)
-Splinting of the EAM
-Wick
Keep ear dry
Otitis media with effusion definition
-Also known as glue ear
-Eustachian tube dysfunction
-Conductive hearing loss, learning difficulties, speech delay
-Cleft palate
-Between 3-6 years
-Tympanic membrane
Dull red, grey or amber
Bulge forward or retracted
Air bubbles or fluid levels
-Common in kids
How could you notice otitis media in a kid
- Plunge at ear
- Decreased apetite
- Sucking aggravates pain
- Lymphadenopathy
Common problems with nose and paranasal sinuses
- Allergic rhinitis
- Nasal polyps
- Nasal infections
- Nasal septum
- Epistaxis
- Sinusitis
Epistaxis
Acute haemorrhage from the nose
Nose bleed
General and local factors associated with epistaxis
Systemic Disorders
- Arteriosclerosis, hypertension
- Blood dyscrasias (von Willerbrands, liver disease, haemophilia, thrombocytopenia)
Drugs Aspirin, NSAIDS Watfarin Clopidogrel Steroids Chemotherapy
Trauma
Nasal septal deviation, spurs and perforations
Iatrogenic
Inflammation (URTI, Sinusitis, Allergies, Chemical Irritation)
Environmental (Cold dry air, central heating)
Neoplasms
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Gastro-Intestinal Diseases125
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Oral Manifestations of Systemic Disease19
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Dermatology43
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Endocrinology66
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Infectious Diseases79
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Principles of Diagnosis and Treatment6
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Respiratory Disease74
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Cardiovascular Diseases43
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Infective Endocarditis and Rheumatic Fever26
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Neurology79
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Haematology81
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Cranial Nerves and Examination13
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Allergy to Dental Materials35
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Renal Disease26
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Rheumatology41
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Anaesthetic Assesment for Dental Patients34
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Lumps28
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Chemotherapy and Immune Suppression45
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Psycho-Social Disorders39
