Chapter 12 - Necks

Instructions: Each group of extended matching questions consists of lettered options followed by a list of numbered problems/questions. For each numbered problem/question select the one lettered option that most closely answers the question. You can use the lettered options once, more than once, or not at all.

Options:

Hypothyroidism
Hyperthyroidism
Primary hyperparathyroidism
Thyroid nodule
Lipoma
Cervical lymphadenopathy
Branchial cyst
Thyroglossal cyst
Hypoparathyroidism
Multi-nodular goitre
Pharyngeal pouch
Carotid body tumour

Choose the correct diagnosis from the list of options for the following case presentations.

Scenario 1

Scenario 2

a)	A 32 year old woman attends her GP with a swelling of her neck near the midline. The GP palpates the swelling, which is firm and about 5 cm in diameter. He can find no palpable lymph nodes. He gets her to swallow and the swelling elevates on swallowing. He then gets her to protrude her tongue but nothing happens to the swelling.
Correct. The elevation of the swelling with swallowing identifies it as thyroid in origin. The lack of elevation with tongue protrusion excludes a thyroglossal cyst as a cause of the swelling. See page 348.Incorrect. See page 348.Your answer has been saved.

Scenario 3

a)	A 74 year old woman has reluctantly agreed to visit her GP with her daughter. She has recently become apathetic and tired. She is normally immaculately dressed but has let herself go and is unkempt. She has lost interest in her hobbies. She is wrapped up in several layers of clothing. Her hair is coarse and thinning and she speaks with a hoarse voice.
Correct. The description is classical of hypothyroidism - the slowing of metabolism leading to apathy and fatigue. Wearing several layers of clothing suggests that she has cold intolerance. See pages 403-404.Incorrect. See pages 403-404.Your answer has been saved.

Scenario 4

a)	A 28 year old woman goes to her GP with a swelling of the left side her neck near the midline. She is obese and the GP palpates the swelling which is soft, rubbery and mobile. There are no palpable lymph nodes. The swelling does not move with swallowing or protrusion of the tongue. When the GP gets the patient to push against her hand (tensing the sternomastoid muscle) the swelling is still palpable superficial to this muscle.
Correct. By getting a patient to tense their sternomastoid muscle this allows you to determine whether a swelling is superficial or deep (to the muscle). The swelling is superficial, soft and rubbery and has the hallmarks of a lipoma. See page: 343.Incorrect. See page 343.Your answer has been saved.

Scenario 5

a)	A 30 year old woman goes to her GP with a sore throat and pain on swallowing in the last week. She has also been febrile and unable to go to work. She has also noted some swelling in her neck which is tender. The GP tries to look at the back of her throat but she resists him as she feels that she is choking. When he palpates her neck he feels a number of swellings under the angle of the jaw the right side being greater in size than the left. They are firm rubbery and very tender.
Correct. The acute presentation of the sore throat would be in keeping with a viral infection causing an upper respiratory tract infection. It could also be a case of bacterial tonsillitis. However a good view of the tonsils and pharynx is necessary to be sure of the diagnosis. The tender swellings under the angle of the jaw are likely to be cervical lymphadenopathy. See page 343.Incorrect. See page 343.Your answer has been saved.