DDx of Lump in the Neck

1. Multiple lumps: lymph nodes

2. Single lump
o Anterior triangle

Moves with swallowing
Solid: thyroid gland, thyroid isthmus lymph nodes
Cystic: thyroglossal cyst

Does not move with swallowing
Solid: lymph nodes, carotid body tumor
Cystic: cold abscess, branchial cyst
o Posterior triangle

Solid: lymph nodes

Cystic: cystic hygroma, pharyngeal pouch

Pulsating: subclavian aneurysm
Informed Consent
A. All points must be described
Risks and benefits
Understandable language
Full information regarding alternative treatments
B. All major adverse effects must be described
C. Consent is required for each specific procedure
Rt. & Left
Appendicitis & Ca. Colon
D. Beneficence is not sufficient to eliminate the need for consent e.g. cancer cases on nasal turbinate during
endoscopy.
E. Decisions made when competent are valid when capacity is lost
The patients last known wishes documented in writing following verbally expressed wishes is
perfectly valid
Oral consent is valid if proved
F. The person performing the procedure should obtain consent: telephone consent is valid
G. All forms of verbal communication, oral advance directive, and telephone consent are more difficult to
prove if contested. However they are equally valid. The real questions about telephone consent are:
Is the person you are speaking to really the surrogate?
Does the person know the patients Wishes?
Did you get the oral/ telephone consent witnessed by another person so that the person giving
consent cannot later deny having given consent?
H. Pregnant Women Can Refuse Therapy
The prevailing consensus is that a fetus is not a person until birth
The mother can refuse a lifesaving. Transfusion & caesarian section to remove the child even if
this will put the life of the fetus at risk.
For any question concerning reproductive rights, decisions are based entirely on maternal wishes
The father has no legal right to make an informed consent for any pregnancy related issues because
the question concerns the body of the mother.
Only the mother can sign informed consent for any procedure or treatment during pregnancy.