Anatomy and Physiology

Question 1

What are the boundaries of the neck?

Answer 1

Mandible (sup)
Clavicle (inf)
Anterior `midline (ant)
Trapezius (post)

Question 2

What are the boundaries of the anterior triangle?

Answer 2

Midline of neck (ant)

Anterior border of sternocleidomastoid (post)

Question 3

What are the boundaries of the posterior triangle?

Answer 3

Posterior border of the sternocleidomastoid (ant)

Anterior border of trapezius (post)

Question 4

What are the contents of the anterior triangle?

Answer 4

Common carotid artery (ext and int) 
Vagus nerve 
Internal jugular vein 
Laryngeal nerves 
Glossopharyngeal nerves 
Submandibular and submittal nodes

Question 5

What are the contents of the posterior triangle?

Answer 5

Occipital artery
External jugular vein
Accessory nerve
Cervical nerve plexus

Question 6

At what level does the carotid artery bifurcate?

Answer 6

C4

Question 7

What are the branches of the ECA in the neck?

Answer 7

Sup thyroid 
Ascending pharyngeal 
Lingual 
Occipital 
Facial 
Post auricular 
Maxillary 
Sup temporal

Question 8

What are the complications of central lines?

Answer 8

Pneumothorax 
Haematoma 
Cardiac tamponade 
Thrombosis 
Sepsis 
Air embolism

Question 9

What are the uses of central lines?

Answer 9

Central venous pressure 
Drug administration 
Cardiac pacing 
Haemodialysis 
IV nutrition

Question 10

Where do the lymph nodes in the head and neck drain to?

Answer 10

Cisterna chyli then to thoracic duct on left

Question 11

What type of gland is the thyroid gland?

Answer 11

Endocrine

Question 12

What does the thyroid gland produce?

Answer 12

Thyroxine

Calcitonin

Question 13

What is the effect of calcitonin?

Answer 13

Lowers calcium

Raises phosphate

Question 14

What is a thyroglossal cyst?

Answer 14

Dilatation of thyroglossal duct remnant

Question 15

What are the signs of a thyroglossal cyst?

Answer 15

Grows with age

Moves on tongue protrusion

Question 16

What is the treatment for thyroglossal cysts?

Answer 16

Ultrasound prior to excision

Question 17

What are the different types of thyroid masses?

Answer 17

Solitary thyroid nodule
Diffuse enlargement
Multi nodular goitre

Question 18

What are the risk factors for thyroid masses?

Answer 18

Neck X-rays in childhood

Ask about Chernobyl or other mass radiation exposure

Question 19

What could be the causes of a solitary thyroid nodule?

Answer 19

Cyst due to localised haemorrhage
Adenoma
Carcinoma
Lymphoma

Question 20

What are the investigations for a solitary thyroid nodule?

Answer 20

Fine needle aspiration (cant distinguish between adenoma and follicular carcinoma)
Ultrasound

Question 21

What is the treatment for a solitary thyroid nodule?

Answer 21

Thyroid lobectomy

Question 22

What are the different types of thyroid cancer?

Answer 22

Papillary (lymphatic mets)
Follicular (haematogenous mets)
Medullary (familial association)
Anaplastic (agressive, poor prognosis)

Question 23

What could be the causes of a diffuse thyroid enlargement?

Answer 23

Colloid goitre (iodine deficiency, puberty, pregnancy, gland hyperplasia)
Grave’s disease
Thyroiditis

Question 24

What are the signs of grave’s disease?

Answer 24

Clubbing
Pre tibial myxoedema
Acropachy
Thyroid eye disease

Question 25

What is the treatment for grave's disease?

Answer 25

Anti thyroids Beta blockade Radio iodine Surgery

Question 26

What are the indications for a thyroidectomy?

Answer 26

``` Airway obstruction Malignancy Cosmesis Thyrotoxicosis Retrosternal extension ```

Question 27

What are the complications of a thyroidectomy?

Answer 27

``` Bleeding Hoarseness Infection Hypoparathyroidism Hypothyroidism ```

Question 28

What are the causes of a multi nodular goitre?

Answer 28

Grave's disease | Toxic goitre

Question 29

How many parathyroid glands are present?

Answer 29

4

Question 30

What is the function of parathyroid glands?

Answer 30

Regulate calcium and phosphate levels

Question 31

Where are the parathyroid glands located?

Answer 31

Posterior to the poles of thyroid

Question 32

What are the signs of parathyroid disease?

Answer 32

Renal calculi, polyuria and failure Fractures, osteoporosis, bone pain Abdominal pain, constipation, peptic ulceration, pancreatitis, weight loss Anxiety, depression, paranoia, confusion

Question 33

What are the investigations for parathyroid disease?

Answer 33

U&Es, creatinine, calcium, phosphate Vitamin D Ultrasound CT/MRI

Question 34

What is the treatment for parathyroid disease?

Answer 34

Surgery on for hyperparathyroidism

Question 35

What are the different forms of hyperparathyroidism?

Answer 35

Adenoma Hyperplasia Malignancy

Question 36

What are the 4 fascial layers of the neck?

Answer 36

Pre tracheal Pre vertebral Deep cervical Carotid sheath

Question 37

What are the indications for a tracheostomy?

Answer 37

Airway obstruction Airway protection Poor ventilation

Question 38

What are the complications of a tracheostomy?

Answer 38

Need suctioning, humidification and long term care

Question 39

What is stridor?

Answer 39

Compromised airway due to obstruction

Question 40

What is the treatment for stridor?

Answer 40

Oxygen Nebulised adrenaline IV dexamethasone

Question 41

What is a brachial cyst?

Answer 41

Remnant of fusion failure of brachial arches | Lymph node cystic degeneration

Question 42

What is the treatment for brachial cysts?

Answer 42

Excision

Question 43

What is a pharyngeal pouch?

Answer 43

Herniation of pharyngeal mucosa between thyropharyngeus and cricopharyngeus muscles of the inferior constrictor of the pharynx

Question 44

What are the signs of a pharyngeal pouch?

Answer 44

``` Voice hoarseness Dysphagia Aspiration pneumonia Regurgitation Weight loss ```

Question 45

What is the treatment for pharyngeal pouches?

Answer 45

Excision after barium swallow diagnosis