This document provides guidance on evaluating neck swellings, including taking a history and performing an examination. It discusses assessing when the lump was first noticed, any associated symptoms, past medical history, and risk factors. A physical exam evaluates the lump's location, size, mobility, and texture. Potential causes of neck swellings include inflammatory/infectious processes, neoplasms, congenital/developmental abnormalities, and other rare entities. Further testing may be needed to arrive at a diagnosis and guide treatment.

1. • History Taking
• Causes & Classification

2. 
 BIODATA
 Age
 Gender
 Occupation

3.  HOPI
NECK SWELLING
 When do you first notice the lump?
 Rule of 7:
7 days = inflammatory/infection
7 weeks/months = tumour
7 years = congenital/development
 What do you think is the cause?
 History of trauma
 Previous TB
 How do you notice it?
 Noticed accidentally
 Told by others
 Painful
 How does the lump disturbs you?
 Associated symptoms
pain, discharge, dysphagia, dyspnea,
cosmetically disfiguring, fear of
malignancy
 Any changes to the lump since
you first notice it?
 Size
 Has the lump ever disappears before?
 Lying down supine
 Any activity
 Do you ever had any other lumps
before this?
 Multiplicity

5. 
 Systemic Review
 Head & Neck symptoms
 Pain in mouth / throat
 Mouth ulceration
 Nasal discharge
 Pain / blockage of
airway
 Voice changes
 Difficulty breathing
 Systemic illness
 Suggestive of malignancy
 Anorexia, weight loss and symptoms from other systems
 Suggestive of infection
 Malaise, fever, rigors, local symptoms

6. 
 PAST MEDICAL HISTORY
 DRUG & ALLERGY
 FAMILY HISTORY
 SOCIAL HISTORY
 Thyroid cancer & radiation
 Previous skin cancer / lesion
 Smoking
 Chewing tobacco
 Alcohol
 Malignancy

7. 

8. 

9.   Inflammatory / Infection
 Lymphadenopathy
 Bacterial / viral
 Granulomatous
 Tuberculous
 Cat-scratch
 Fungal
 Sarcoidosis
 Sialadenitis
 Parotid
 Submaxillary
 Neoplasia
 Metastatic
• Unknown primary
• Epidermoid carcinoma
• Primary head & neck
• Melanoma
 Primary
• Adenocarcinoma
• Thyroid
• Lymphoma
• Salivary
• Lipoma
• Glomus vagale
• Carotid body tumor
• Rhabdomyosarcoma
 Congenital / Developmental
 Sebaceous cysts
 Branchial cleft cysts
 Thyroglossal cysts
 Lymphangioma/hemangioma
 Dermoid cyst
 Ectopic thyroid tissue
 Layngocele
 Thymic cysts

10.  SUPERFICIAL
o Sebaceous cyst
o Lipoma
o Dermoid cyst
o Abscess
 Lymph nodes  DEEP
 Anterior Triangle
o Move with swallowing
 Thyroid
 Thyroglossal cyst
 Lymph node
o Do not move with swallowing
 Salivary gland
 Brachial cyst
 Carotid body tumor
 Carotid aneurysm
 Posterior Triangle
o Cervical rib
o Subclavian artery aneurysm
o Pharyngeal pouch
o Cystic hygroma

11. 
 Miscellaneous cysts
 Dermoid cyst
 Thyroglossal duct cyst
 Brachial clelf cyst
 Cystic hygroma
 Midline neck masses
 Thyroglossal duct remnants (cysts)
 Dephian lymph nodes
 Pryramidal lobe of thyroid gland
*Mass at sternal notch: tuberculous abscess,
dermoid cyst, or a fatty tumor associated with
Cushing's syndrome similar to the Dowager's
hump. Fullness of the sternal notch can occur in
leukemia (Jaccoud's sign)
 Lateral neck masses
 Brachial cysts
 Carotid body tumors

12. 
 Unilateral Neck swelling
 Parotid & submandibular glands
 Bilateral Neck Swelling
 Mikulicz’s disease
 Bilateral parotitis
 Dehydration
 Drug effect (sulfonamides, iodides, propythiouracil)
 Infection (chriomeningitis or mumps)
 Malignancy (leukemia, lymphoma)
 Metabolic disease (alcoholism, malnutrition, vit A deficiency, DM)
 Autoimmune disease (SLE, sarcoidosis)

13. 
1) Jones N, Hibbert J, Luxon LM. Scott-Brown’s Otorhinolaryngology: Head
and Neck Surgery cd-rom (A Hodder Arnold Publication). 7th ed.
Gleeson MJ, Clarke RC, Browning GG, editors. London: Oxford
University Press, USA; 2008.
2) Schwetschenau E, Kelley DJ. The Adult Neck Mass [Internet]. 2002 [cited
2015 Sep 14].
Available from: http://www.aafp.org/afp/2002/0901/p831.html
3) Williams ME. Assessment of the Neck and Lymph Nodes in the Elderly
Patient [Internet]. Medscape. 2009 [cited 2015 Sep 14].
Available from: http://www.medscape.com/viewarticle/712256_5
4) Neck Lump [Internet]. Fastbleep Biology Notes. [cited 2015 Sep 14].
Available from: http://www.fastbleep.com/biology-notes/9/11/356

14. 
Thank You For Listening!