ENT
NECK LUMP
There was only one written question on this. There was also a trial OSCE
PromptDifferential - Fever, fatigue and neck lump in teenager
ResponseInflammatory/infectious
- EBV (glandular fever)
- Bacterial tonsillitis
- Other bacterial infection with nodular reaction
- Hyperthyroidism with thyroid mass
- Lymphoma - Hodgkins/non hodgkins
- Lukaemia
PromptImportant historic features of neck lump
ResponseSore throat ? tonsillitis
Dysphagia - Suggests oropharyngeal pathology
Night sweats - suggests lymphoma
History of infection in reginal drainage area of the node
History suggestive of TB
HIV exposure
back/chest/abdo pain - suggests more generalised nodal involvement
Easy bruising - suggests lukaemia
Features of hypothyroidism - thyroid
Dysphagia - Suggests oropharyngeal pathology
Night sweats - suggests lymphoma
History of infection in reginal drainage area of the node
History suggestive of TB
HIV exposure
back/chest/abdo pain - suggests more generalised nodal involvement
Easy bruising - suggests lukaemia
Features of hypothyroidism - thyroid
PromptImportant examination in neck lump
ResponseFeatures of tonsillitis or mass - infection or malignancy
Lymphadenopathy - neck, axilla, groin, hepatosplenomegaly - suggests lymphoma
Anaemia/thrombocytopaenia (petechiae/purpura/bruising) - suggests leukemia
Size location and mobility of lump - Enlarged matted fixed masses usually malignant
Features of infection or malignancy in drainage areas of the nodes involved
Examination of the thyroid - ? thyroid malignancy
Features of pleural effusion - suggest malignant process
Lymphadenopathy - neck, axilla, groin, hepatosplenomegaly - suggests lymphoma
Anaemia/thrombocytopaenia (petechiae/purpura/bruising) - suggests leukemia
Size location and mobility of lump - Enlarged matted fixed masses usually malignant
Features of infection or malignancy in drainage areas of the nodes involved
Examination of the thyroid - ? thyroid malignancy
Features of pleural effusion - suggest malignant process
PromptDescribe 5 investigations that might be most helpful in diagnosing this boys illness and explain how each may be of use
ResponseCBE: may be normal or show anaemia, low wbc, high wbc, thrombocytopaenia
LDH may be high if this is a lymphoma
LFT’s likely normal but may be elevated in EBV (or similar) infection
Chest x-ray to look for signs of infection or mediastinal nodes
Ultrasound of neck mass
Needle biopsy of neck mass
CT of chest and abdomen to look for other nodes
ESR and CRP may be elevated in infection or with a lymphoma
Cultures (throat, other local lesions, blood) for bacterial infection
Viral serology for EBV, CMV, HIV
LDH may be high if this is a lymphoma
LFT’s likely normal but may be elevated in EBV (or similar) infection
Chest x-ray to look for signs of infection or mediastinal nodes
Ultrasound of neck mass
Needle biopsy of neck mass
CT of chest and abdomen to look for other nodes
ESR and CRP may be elevated in infection or with a lymphoma
Cultures (throat, other local lesions, blood) for bacterial infection
Viral serology for EBV, CMV, HIV