Neck lump: hilum or pus?

Question 1What feature most supports a reactive lymph node?

1. aAn oval shape with a bright central hilum
2. bA round shape with no hilum
3. cSwirling contents with pressure
4. dComplex fluid with posterior enhancement

Question 2A round neck lump has complex fluid, no hilum and posterior enhancement. What is likely?

1. aA normal node
2. bAn abscess or a liquefying node
3. cThe carotid artery
4. dA thyroid nodule

Question 3A 55-year-old has a painless cystic neck lump. What should you consider?

1. aA metastatic node, so refer on the urgent suspected cancer pathway
2. bA normal finding
3. cA branchial cyst only, with no follow-up
4. dA simple abscess needing antibiotics only

Question 4A child with a neck swelling has drooling and difficulty swallowing. What next?

1. aUrgent senior and ENT review: a deep neck infection is possible
2. bDischarge with oral antibiotics
3. cReassure: it is a reactive node
4. dUltrasound only and review in a week

Question 5What does colour Doppler usually show in a reactive node?

1. aFlow entering through the hilum
2. bNo flow anywhere
3. cFlow only at the edge, never centrally
4. dAliasing throughout