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ENT > Anatomy and Physiology of the Neck > Flashcards

Anatomy and Physiology of the Neck Flashcards

1
Q

What are the anatomical contents of the neck?

A 
Arteries
Veins
Nerves
Lymph nodes
Lymphatic channels 
Thyroid gland
Parathyroid gland
Muscles 
Trachea
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2
Q

What is the superior border of the neck?

A

Mandible

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3
Q

What is the inferior border of the neck?

A

Clavicle

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4
Q

What is the anterior border of the neck?

A

Anterior midline

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5
Q

What is the posterior border of the neck?

A

Trapezius

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6
Q

What triangles are found in the neck?

A

Anterior triangle

Posterior triangle

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7
Q

Anterior border of the anterior triangle

A

Midline of the neck

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8
Q

Posterior border of the anterior triangle

A

Anterior border of sternocleidomastoid

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9
Q

Anterior border of the posterior triangle

A

Posterior border of the sternocleidomastoid

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10
Q

Posterior border of the posterior triangle

A

Anterior border of the trapezius

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11
Q

Contents of the anterior triangle

A 
Common carotid artery 
External carotid artery 
Facial artery 
Hypoglossal nerves
Vagus nerves
Glossopharyngeal nerves 
Submandibular nodes
Submental nodes
Internal carotid artery 
Internal jugular vein 
Facial vein 
Accessory veins
Laryngeal veins
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12
Q

Contents of the posterior triangle

A 
Accessory nerve 
Occipital artery 
Lymph nodes
Cervical nerve plexus
External jugular vein
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13
Q

What level do the common carotid arteries divide?

A

C4

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14
Q

Branches of the external carotid artery in the neck

A 
Superior thyroid
Ascending pharyngeal 
Lingual 
Occipital 
Facial 
Posterior auricular 
Maxillary 
Superficial temporal
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15
Q

Indications for central lines

A 
Central venous pressure
Drug administration 
Cardiac pacing
Blood sampling
Fluid resuscitation 
Haemodialysis
IV nutrition
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16
Q

Complications of central lines

A 
Pneumothorax
Haematoma
Cardiac tamponade 
Air embolism 
Chylothorax 
False passage 
Thrombosis
Sepsis 
Line blockage
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17
Q

What are the 4 fascia of the neck?

A

Pre-tracheal
Pre-vertebral
Deep cervical
Carotid sheath

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18
Q

Anatomy of thyroid gland

A

2 lobes

Isthmus

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19
Q

What type of gland is the thyroid gland?

A

Endocrine

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20
Q

What hormones does the thyroid gland produce?

A

Thyroid hormones

Calcitonin

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21
Q

Function of calcitonin

A

Lower calcium

Raise phosphate

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22
Q

Movement of the thyroid with swallowing. Why?

A

Moves with swallowing

It is attached to the laryngeal framework

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23
Q

What is a thyroglossal cyst?

A

Dilatation of thyroglossal duct remnant

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24
Q

Where is a thyroglossal cyst found?

A

Midline of neck

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25
Q

What happens to a thyroglossal cyst as age increases?

A

It grows

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26
Q

When does a thyroglossal cyst move?

A

With tongue protrusion

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27
Q

What needs to be done before a thyroglossal cyst is removed? Why?

A

USS

To ensure functioning thyroid tissue elsewhere

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28
Q

Types of thyroid mass

A

Solitary nodule
Diffuse enlargement
Multi nodular goitre

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29
Q

Causes of a solitary thyroid nodule

A 
Cyst
Adenoma
Carcinoma
Lymphoma 
Prominent nodule in a multi nodular goitre
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30
Q

Which gender gets more solitary thyroid nodules?

A

F

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31
Q

What age gets solitary thyroid nodules?

A

30 - 40 y/o

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32
Q

What is a red flag symptom for neck lump history?

A

Pain

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33
Q

Investigations of a solitary thyroid nodule

A

FNAC

USS

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34
Q

What can FNAC not distinguish between?

A

Follicular adenoma and follicular carcinoma

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35
Q

THY classification of solitary thyroid nodules

A

Type 1 - not diagnostic, not enough thyroid tissue
Type 2 - normal
Type 3 - Borderline, not sure about malignant potential
- adenoma
- carcinoma
Type 4 - concerning, most likely cancer
Type 5 - cancer

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36
Q

Types of thyroid cancer

A

Papillary
Follicular
Medullary
Anaplastic

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37
Q

Causes of diffuse thyroid enlargement

A

Colloid goitre due to

  • gland hyperplasia
  • iodine deficiency
  • puberty
  • pregnancy
  • lactation
  • graves disease
  • thyroiditis
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38
Q

What may be compressive neck symptoms of a huge diffuse thyroid swelling?

A

Dysphagia
Stridor if compresses trachea
SOB on exertion
Retrosternal goitre if grows behind

39
Q

What test should be done to see if a goitre is growing retrosternally?

A

Difficulty to reach up without choking

40
Q

Which gender gets graves disease more?

A

F > M

41
Q

Pathology of graves disease

A

Auto antibodies against TSH stimulate receptor

Hyperthyroidism results

42
Q

Clinical signs of graves disease

A

Thyroid eye disease
Acropachy/clubbing
Pre-tibial myxoedema

43
Q

Treatment of graves disease

A

Anti-thyroid drugs
Beta blockers
RAI
Surgery

44
Q

Indications for a thyroidectomy

A 
Airway obstruction 
Malignancy or suspected 
Thyrotoxicosis
Cosmesis
Retrosternal extension
45
Q

Complications of thyroidectomy

A 
Bleeding
Voice hoarseness
Thyroid storm 
Infection 
Hypoparathyroidism 
Hypothyroidism 
Scar (keloid/hypertrophic)
46
Q

Causes of a multi nodular goitre

A

Graves disease

Toxic goitre

47
Q

How many parathyroid glands are there?

A

4

48
Q

Function of parathyroid glands?

A

Regulate calcium and phosphate levels

49
Q

Where are the parathyroid glands found?

A

Posterior poles of the thyroid

50
Q

Results / Presentation of parathyroid disease

A 
Renal calculi 
Polyuria
Renal failure
Pathological fractures
Osteoporosis
Bone pain 
Anxiety
Depression 
Confusion 
Paranoia
Abdo pain 
Constipation 
Peptic ulceration 
Pancreatitis 
Weight loss 
U and E, creatinine, calcium, phosphate disturbance
51
Q

Causes of hyperparathyrodisim

A

Adenoma (80%)
Hyperplasia (12%)
Malignancy (rare)

52
Q

Types of lymphadenopathy

A

Infective
Inflammatory
Malignant

53
Q

Indications for tracheostomy

A

Airway obstruction
Airway protection
Poor ventilation to reduce dead space

54
Q

What is inspiratory stridor a sign of?

A

Laryngeal obstruction

55
Q

What is expiratory stridor a sign of?

A

Tracheobronchial obstruction

56
Q

What is biphasic stridor a sign of?

A

Glottic / subglottic obstruction

57
Q

Treatment of stridor

A 
O2
Nebulised adrenaline
IV dexamethasone
Heliox
Definitive airway management
58
Q

Pathology of a branchial cyst

A

Remnant of fusion failure of branchial arteries
OR
Lymph node cystic degeneration

59
Q

Where are the branchial cysts found?

A

Anterior to the sternocleidomastoid at the junction between the upper and middle thirds - between the SCM and the pharynx

60
Q

What is a clinical feature of a branchial cyst?

A

Transilluminates

61
Q

What can happen to branchial cysts?

A

Become infected, enlarging

62
Q

What is a pharyngeal pouch?

A

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

63
Q

Symptoms of pharyngeal pouch

A 
Voice hoarseness
Dysphagia 
Aspiration pneumonia 
Regurgitation 
Weight loss
64
Q

What % of pharyngeal pouches are neoplasic?

A

1%

65
Q

How many lymph nodes are in the head and neck?

A

600

66
Q

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

A

Cisterna chyli then

thoracic duct on left

67
Q

What are the lymph glands of the head and neck?

A 
Parotid
Submental 
Submandibular 
Clavicle
Supraclavicuar 
Cervical 
Occipital 
Post auricular
Pre auricular
68
Q

What are the lymph node vessels of the head and neck?

A 
I; submandibular and submental 
II; Upper II
III; middle III
Posterior triangle; 5
Midline is 6
69
Q

What does the parotid lymph glands drain?

A

Scalp
Face
Parotid gland

70
Q

What do the occipital nodes drain?

A

Scalp

71
Q

What do the superficial cervical nodes drain?

A

Breast

Solid viscera

72
Q

What do the deep cervical nodes drain?

A

Final drainage pathway to the thoracic duct

73
Q

What do the submandibular nodes drain?

A 
Tongue
Nose
Paranasal sinuses
Submandibular gland
Oral cavity
74
Q

What do the submental nodes drain?

A

Lips

Floor of mouth

75
Q

What do the supraclavicular nodes drain?

A

Breast
Oesophagus
Solid viscera

76
Q

What is the most common cause of neck swelling?

A

Reactive lymphadenopathy

77
Q

What may there be a history of with reactive lymphadenopathy?

A

Local infection

General viral illness

78
Q

What would rubbery, painless lymphadenopathy indicate?

A

Lymphoma

79
Q

Associations of lymphoma

A

Night sweats
Splenomegaly
Pain when drinking alcohol (very uncommon)

80
Q

What is a feature of a thyroid swelling?

A

Moves upwards with swallowing

81
Q

What age is a thyroglossal cyst most common?

A

< 20 y/o

82
Q

Who is a pharyngeal pouch more common in?

A

Older men

83
Q

What is a cystic hygroma?

A

A congenital lymphatic lesion (lymphangioma) typically found in the neck on the left side

84
Q

When does a cystic hygroma present?

A

Most are evident at birth

90% before 2 years old

85
Q

When do brachial cysts usually present?

A

Early adulthood

86
Q

Who are cervical rib most common in?

A

Adult females

87
Q

What % develop which condition if they have a cervical rib?

A

Thoracic outlet syndrome - 10%

88
Q

What are epidermoid cysts?

A

Common cutaneous cysts that result from the proliferation of epidermal cells within a circumscribed space of the dermis

89
Q

What age gets epidermoid cysts?

A

Any age

90
Q

Presentation of epidermoid cyst

A

Asymptomatic
Firm round nodule of various sizes
Central punctum may be present

91
Q

When do deep cervical abscesses tend to occur?

A

Following a source of infection such as

  • recent dental work
  • URTI
  • Neck or oral cavity trauma
92
Q

Presentation of a deep cervical abscess

A

Painful and tender swelling
Hot to touch
Other signs of infection - fever, chills, aches and pains

93
Q

Presentation of lipoma

A

Soft and mobile
Within the dermal layer of the skin
On transillumination the area is equal to the surrounding tissue

ENT (17 decks)

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