Return to Scenario ListShow 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)
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 1
Applied 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
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
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)
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
Population Health 
   - Epidemiology of lymphoma and thyroid cancer
   - Epidemiology of tuberculosis
Conditions to be considered relating to this scenario
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
thyroglossal cyst, pharyngeal pouch, carotid paraganglioma (chemodectoma), dermoid cyst, carotid artery aneurysm, ranula