| Show Learning Points most relevant to Phase 1: |
Neck lump
| Clinical Discipline(s)/Organ System(s) Anatomical Pathology, Endocrinology, General Practice, Otorhinolaryngology, General Surgery, Haematology | Progress Test Topic(s) ENT |
Description
A 72 year old NZ European man comes to the Pre-Admission Clinic before a knee replacement operation. During the examination you notice a lump in his neck. He says that he has not noticed it and feels well.
Progress Test-Type Questions: Question 1Applied Science for Medicine
- Anatomy of the neck
- Define the anterior and posterior triangles of the neck (and lymph node groups)
- Anatomy and function of the lymphatic system
- Anatomy and common pathologies of the salivary glands
- Physiology of the thyroid gland and pathology of thyroid nodules
- Outline the histopathology of lymphomas
- Anatomy of the neck
- Define the anterior and posterior triangles of the neck (and lymph node groups)
- Anatomy and function of the lymphatic system
- Anatomy and common pathologies of the salivary glands
- Physiology of the thyroid gland and pathology of thyroid nodules
- Outline the histopathology of lymphomas
Clinical and Communication Skills
- Elicit a history from a patient with a neck lump; enquire regarding red flag symptoms
- Examine the neck, test swallowing and determine the origin of a lump
- Recognise airway compromise, Pemberton's sign and a goitre
- Differential diagnosis of a neck lump
- Differential diagnosis of a goitre and thyroid nodule
- Risk factors for thyroid cancer and lymphoma
- Organs involved in the multiple endocrine neoplasia syndromes
- Interpret thyroid function tests and understand the limitations of the diagnostic evaluation of thyroid cancer
- Indications for ultrasound scan and Fine Needle Aspiration (FNA), excision biopsy, radioisotope scan, CT scan
- Outline the management of thyroid cancer
- Outline the management of lymphoma
- Elicit a history from a patient with a neck lump; enquire regarding red flag symptoms
- Examine the neck, test swallowing and determine the origin of a lump
- Recognise airway compromise, Pemberton's sign and a goitre
- Differential diagnosis of a neck lump
- Differential diagnosis of a goitre and thyroid nodule
- Risk factors for thyroid cancer and lymphoma
- Organs involved in the multiple endocrine neoplasia syndromes
- Interpret thyroid function tests and understand the limitations of the diagnostic evaluation of thyroid cancer
- Indications for ultrasound scan and Fine Needle Aspiration (FNA), excision biopsy, radioisotope scan, CT scan
- Outline the management of thyroid cancer
- Outline the management of lymphoma
Personal and Professional Skills
- Discuss uncertainty with the patient without causing undue anxiety
- Breaking bad news to patients and family/whānau
- Consent for Fine Needle Aspiration (FNA)
- Discuss uncertainty with the patient without causing undue anxiety
- Breaking bad news to patients and family/whānau
- Consent for Fine Needle Aspiration (FNA)
Hauora Māori
- Awareness of differing risk profiles for Māori (and other disadvantaged populations) compared with non-Māori in New Zealand presenting with neck lumps
- Psychological and social impact of cancer on individuals and whānau
- Awareness of differing risk profiles for Māori (and other disadvantaged populations) compared with non-Māori in New Zealand presenting with neck lumps
- Psychological and social impact of cancer on individuals and whānau
Conditions to be considered relating to this scenario
Common
multinodular goitre, thyroid nodule/adenoma, lymphadenopathy (reactive), sebaceous cyst, branchial cleft cyst, lipoma
multinodular goitre, thyroid nodule/adenoma, lymphadenopathy (reactive), sebaceous cyst, branchial cleft cyst, lipoma
Less common but 'important not to miss'
thyroid cancer, Hodgkin and non-Hodgkin lymphomas, HIV, tuberculosis, metastatic cancer, lymphadenitis
thyroid cancer, Hodgkin and non-Hodgkin lymphomas, HIV, tuberculosis, metastatic cancer, lymphadenitis
Uncommon
thyroglossal cyst, pharyngeal pouch, carotid paraganglioma (chemodectoma), dermoid cyst, carotid artery aneurysm, ranula
thyroglossal cyst, pharyngeal pouch, carotid paraganglioma (chemodectoma), dermoid cyst, carotid artery aneurysm, ranula
