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Year 2 Head and neck (JK) > Anatomy and physiology of the neck > Flashcards

Anatomy and physiology of the neck Flashcards

1
Q

Anatomical contents of the neck…

A

Arteries, veins, nerves, lymphs, lymphatic channels, thyroid gland, parathyroid gland, muscles, trachea

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2
Q

4 boundaries of the neck

A

superior - mandible
inferior - clavicle
posterior - trapezius
anterior - anterior midline

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3
Q

Anterior triangle boundaries

A

midline of neck to anterior border of SCM

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4
Q

Posterior triangle boundaries

A

posterior border of SCM to anterior border of trapezius

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5
Q

Contents of anterior triangle

A

common carotid artery, ECA, ICA
IJV, facial vein
hypoglossal, accessory, laryngeal, vagus, glossopharyngeal
submandibular and submental nodes

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6
Q

Contents of posterior triangle

A

occipital artery
EJV
accessory nerve, cervical nerve plexus
lymph nodes

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7
Q

What does the accessory nerve supply?

A

SCM and trapezius

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8
Q

What level does the common carotid artery bifurcate and which artery goes on to give off branches in the neck?

A

C4

external carotid artery

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9
Q

ECA branches

A

superior thyroid, maxilla, occipital, lingual, frontal, superficial temporal, facial, ascending pharyngeal, posterior pharyngeal

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10
Q

indications for a central line

A 
monitor central venous pressure 
IV nutrition 
drug administration 
cardiac pacing 
blood samples 
haemodialysis
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11
Q

Complications of a central line

A

pneumothorax

chylothorax, haematoma, sepsis, air embolism, thrombosis, cardiac tamponade

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12
Q

Where do the lymph nodes from the head and neck drain?

A

cisterna chyli –> thoracic duct on the left

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13
Q

7 levels of lymph nodes

A

1 - submental and submandibular
2,3,4 - SCM in thirds
5 posterior triangle
6,7 - midline - important for thoracic cancer

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14
Q

Groups of lymph nodes and what they drain

A

parotid - scalp, face, parotid duct
submental - lips, floor of mouth
submandibular - tongue, nose, oral cavity, paranasal sinus, sub mandibular gland
occipital - scalp
superficial cervical - breast and solid viscera
deep cervical - final drainage pathway to thoracic duct
supraclavicular - breast, oesophagus, solid viscera

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15
Q

3 broad categories leading to lymphadenopathy

A

infective, inflammatory, malignant

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16
Q

What does the thyroid gland produce?

A

calcitonin and thyroid hormone

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17
Q

Calcitonin function

A

lower calcium, raise phosphate

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18
Q

Thyroglossal cyst

A

remnant of the thyroglossal duct dilated which moves on tongue protrusion in the midline which grows with age and may become infected
USS and removal

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19
Q

3 broad reasons for a thyroid mass

A

solitary nodule
multinodular goitre
diffuse enlargement

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20
Q

Reasons for a solitary nodule

A

cyst, adenoma, carcinoma, lymphoma, prominent nodule in multinodular goitre

21
Q

Solitary thyroid nodule epidemiology

A

Female, 30-40, 50% malignant of young

22
Q

How are solitary thyroid nodules investigated?

A

FNAC, USS

thyroid lobectomy

23
Q

Why is a biopsy needed after FNAC?

A

cannot tell follicular adenoma and carcinoma apart

24
Q

4 types of thyroid cancer - modes of spread, epidemiology

A

papillary - lymphatic metastasis
follicular - haematogenous metastasis
medullary - 10% familial, parafollicular C cells
Anaplastic - aggressive, local spread, very old, poor prognosis

25
Q

3 reasons for diffuse thyroid enlargement

A

colloid goitre
Grave’s disease
thyroiditis

26
Q

Colloid goitre - explain

A

due to gland hyperplasia
iodine deficiency
puberty, pregnancy, lactation
dysphagia and difficulty breathing

27
Q

Graves disease - results in hyperthyroidism or hypothyroidism?

A

hyperthyroidism

28
Q

Graves disease signs, Male or female predominant?

A

female
thyroid eye disease
acropachy, clubbing
pre-tibial myxoedema

29
Q

Treatment for grave’s disease

A

anti-thyroids, beta blockade, radio iodine and surgery

30
Q

Indications for thyroidectomy

A

airway obstruction, malignancy, thyrotoxicosis, comesis, retrosternal extension

31
Q

Thyroidectomy complications

A

voice hoarseness, infection, scar, hypo (para) thyroidism, thyroid storm, bleeding

32
Q

multinodular goitre - due to…?

A

graves disease or toxic goitre

33
Q

How to distinguish grave’s disease and toxic goitre

A

Graves: female, middle aged, hyperthyroid
Toxic: old, no eye signs, atrial fibrillation

34
Q

How to investigate multinodular goitre

A

thyroid function test, FNAC, CXR

35
Q

Parathyroid glands

A

4 - posterior poles of thyroid
Regulate calcium and phosphate
injured in surgery - hypocalcaemia

36
Q

Parathyroid disease - 4 symptoms

A

painful stones - renal calculi
psychic moans - anxiety, paranoia, pain
aching bones - fractures, osteoporosis
abdominal groans - pain, pancreatitis

37
Q

Parathyroid disease investigations

A

creatine, U +E, calcium, phosphate, parathyroid hormone, bicarbonate
Vitamin D
USS, CT/MRI, isotope scanning

38
Q

Surgery for hyperparathyroid or hypoparathyroid?

A

hyperparathyroid

39
Q

3 causes of hyperparathyroid

A

cancer, hyperplasia, adenoma

40
Q

Reasons for tracheostomy

A

airway obstruction, protection or poor ventilation

41
Q

Tracheostomy needs

A

long term care, humidification, suctioning

42
Q

Breath cycle stridor and location of blockage

A

inspiratory - laryngeal
expiratory - tracheobronchial
biphasic - glottis

43
Q

Treatment for airway obstruction

A

nebulised adrenaline
Oxygen
IV dexamethasone

44
Q

2 reasons for branchial cyst

A

remnant of fusion failure of branchial arteries

lymph node cystic degeneration

45
Q

Branchial cyst - location, treatment

A

anterior to SCM and junction of upper and middle thirds

transilluminates and becomes infected - excised

46
Q

Pharyngeal pouch

A

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

47
Q

Symptoms of pharyngeal pouch

A

regurgitation - old, undigested food

voice hoarseness, dysphagia, aspiration pneumonia, neoplasia and weight loss

48
Q

Investigation and treatment - pharyngeal pouch

A

barium swallow
excised - endoscopic or open
dilate

Year 2 Head and neck (JK) (13 decks)

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