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Test yourself on this quiz on neck lumps! Be sure to read the stem carefully 

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Approach to the patient with lump in the neck

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Question 1

Stem 1, question 1 of 4

Martha, a 26 year old female, presents to GP with lump in her neck. She also has noticed other lumps around her shoulders, chest and her genitals. She has no other symptoms or PMH of note.
What is the most likely diagnosis?
A
Thyroglossal duct cyst
B
Cystic hygroma
C
Branchial cyst
D
Thyroid enlargement
E
Epidermal cyst
Question 1 Explanation: 
Epidermal cysts presents as slow growing lumps around the face, neck, chest, shoulders and skin around the genitals in young to middle aged adults. These form when surface keratinocytes move deeper into the skin and multiple forming a cyst wall. The other options mostly present as a single lump. A thyroglossal duct cyst would be in the midline, a cystic hygroma tends to present before 2 years old, branchial cysts are unilateral and palpable anterior to sternocleidomastoid. Thyroid enlargement is may to be accompanied by other symptoms and may be be multiple smaller nodules.
Question 2

Stem 1, question 2 of 4

The GP performs an examination of the neck lump.
What is the likely examination finding?
A
Located in the posterior triangle of the neck
B
Palpable mass in the midline
C
Mass moves superiorly with protrusion of the tongue
D
A moveable, dome shaped, smooth surface mass
E
Small, firm non tender masses
Question 2 Explanation: 
This question tests your understanding of examination findings of common neck lumps. Given that in the previous question we learnt this was likely an epidermal cyst we are looking for a description of a moveable, dome shaped, smooth surfaced mass that is millimetres to several centimetres in size, hence the 4th answer. The other options are describing other neck lumps respectively: Cystic hygroma, thyroglossal duct cyst, thryoglossbal duct cyst, reactive lymph node. It is helpful to have a system to describe lumps, there are many different ones available so be sure to find your favourite.
Question 3

Stem 1, question 3 of 4

Later the GP sees another patient with a neck lump. Ethan, an 18month male, is brought in by his Father as they are concerned about a large lump in the posterior aspect of his neck.  The Father reports occasionally hearing high pitched noises when Ethan breathes. The lump is soft, fluctuant and transilluminates.
What is the underlying pathology of this neck lump?
A
Failure of duct obliteration creating a cavity
B
Malformation of the lymphatic system
C
Remanent of embryological cervical sinus
D
A form of vasculitis
E
Thyroid parenchymal expansion
Question 3 Explanation: 
This is a harder question so let's break it down into steps. Firstly, we need to understand what the most likely diagnosis is. The stem should point you in the direction of a cystic hygroma. These are soft, painless masses that are fluctuant and transilluminating and tend to present before 2 years old. Step two is knowing the underlying pathology of a cystic hygroma, which is a malformation of the lymphatic system, hence the lump is soft and fluid filled. The other answer options are related to the following causes of neck lumps respectively: thyroglossal cyst, branchial cyst, Kawasaki disease, thyroid enlargement
Question 4

Stem 1, question 4 of 4

How can a cystic hygroma be managed?¬†Select all¬†that apply¬†  
A
Lymphatic sclerotherapy
B
Surgical excision
C
Corticosteroids
D
Monitoring
E
Radio-idodine
Question 4 Explanation: 
Many cystic hygromas do not require treatment so monitoring is a valid management option. In those that are bothersome, surgical excision and lymphatic sclerotherapy can be used to treat the lymphatic malformation with low risk of recurrence. Corticosteroids and radio-iodine would not be appropriate treatments in this case.
Question 5

Stem 2, question 1 of 3

Amy, a 17 year old female, presents to GP with 3 small, firm and non-tender lumps in her neck, two on the left, one of the right. She has no other symptoms but says last week she had a cold.
What structure separates the anterior and posterior triangles of the neck?
A
Anterior scalene
B
Trapezius
C
Omohyoid superior belly
D
Digastric
E
Sternocleidomastoid
Question 5 Explanation: 
The neck is anatomically divided into two large triangles: Anterior and posterior. The anterior triangle can be further subdivided into carotid, submental, submandibular and muscular triangles. The sternocleidomastoid is the separation between the anterior and posterior. As always, teachmeanatomy is a great resource with lots of clear pictures!
Question 6

Stem 2, question 2 of 3

What is the most likely cause of Amy's neck lumps?
A
Thyroid enlargement
B
Reactive nodes
C
Kawasaki disease
D
Sialendenitis
E
Branchial cyst
Question 6 Explanation: 
Amy most likely has a collection of reactive nodes following a viral infection. Reactive nodes may persist for weeks to months. Kawasaki disease can also cause cervical lymphadenopathy but are painful and accompanied by fever. Thyroid enlargement can cause multiple nodes but given the recent viral infection reactive nodes are more likely. Sialendenitis is inflammation of the salivary glands. Branchial cysts arise in lateral neck anterior to Sternocleidomastoid typically and are unilateral.
Question 7

Stem 2, question 3 of 3

6 months later, Amy returns with another lump in her neck. This lump is in the midline and moves when she swallow or sticks her tongue out
What is the most likely diagnosis?
A
Cervical lymphadenopathy
B
Goitre
C
Thyroglossal duct cyst
D
Epidermal cyst
E
Branchial cyst
Question 7 Explanation: 
This question is describing the presentation of a thyroglossal cyst which is a congenital fluid filled sac. The thyroid originates from the foramen caecum of the tongue and migrates inferiorly to the neck via a duct. This duct should fully obliterate, however cysts occur when portions of this remain, creating cavities that can fill with fluid.
Question 8
Which of the following is NOT an imaging technique used to investigate neck lumps?
A
Ultrasound
B
CT
C
MRI
D
Facial radiographs
E
Upper GI endoscopy
Question 8 Explanation: 
Ultrasound, CT, MRI and facial radiographs can all be used to investigate neck lumps. Ultrasound is very commonly used as it is cost effective and there is no radiation. Facial radiographs can show is sialoliths (salivary gland stones) are present. Upper GI endoscopy is not commonly used to investigate neck lumps but investigate the oesophagus, stomach and duodenum.
Question 9
Which of the following are red flag findings relating to neck lumps? Select all that apply
A
Hard and fixed lump
B
Cranial nerve palsies
C
Associated otalgia, dysphagia and stridor
D
Epistaxis and unilateral nasal congestion
E
Unexplained weight loss
Question 9 Explanation: 
All of these answer options are red flag findings for neck lumps! In children additional red flags are presence of supraclavicular masses, lumps larger than 2cm and previous history of malignancy.
Question 10
The thyroid gland can cause neck lumps and is found in the visceral compartment of the neck.
Which of the following structure(s) are also found in the visceral compartment of the neck? Select all that apply 
A
Trachea
B
Oesophagus
C
Pharynx
D
Brachial plexus
E
Carotid artery
Question 10 Explanation: 
The visceral compartment is a large neck compartment that extends inferiorly to the fibrous pericardium and contains the trachea, oesophagus, pharynx and thyroid gland. The branchial plexus is contained within the vertebral compartment and the carotid artery is within the vascular compartment. These fascial layer permit the free movement of neck structures. Grey's Anatomy has very helpful images of neck compartments.
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