Physical Exam

You begin your physical exam with inspection of your patient. Despite the 20lbs weight loss, the patient does not look cachectic. The patient actually looks comfortable without any physical distress.

Examination of the mass reveals a 2cm x 3cm fixed, firm, non-tender mass just anterior to the left sternocleidomastoid muscle at the level of the thyroid cartilage. What else should you examine?

Neck Mass Physical Exam

Palpation of the rest of the neck reveals no other masses. Examination of the ear reveals a normal external auditory canal and a normal tympanic membrane. Nasal speculum exam is unremarkable. Inspection and bimanual examination of the oral cavity shows a 2 cm x 2.5cm ulcerative mass under the left side of the anterior tongue.

( Otolaryngology - Head and Neck Surgery 3rd Ed. (1999), Cummings et al.)

A flexible nasopharyngoscopy exam reveals normal nasal vault, nasopharynx, base of the tongue, hypopharynx, larynx, and normal mobility of the vocal cord.

Given the history and physical findings, what is the most likely diagnosis?

Tips for Diagnosis:

The Age Rule

Rule of 7s

80% Rule

Given the history and physical, what is the most likely diagnosis?

• Normal Structure
• Congenital
• Inflammatory
• Neoplastic