Anatomy/Physiology of Neck Flashcards
What is the superior boundary of the neck?
Mandible
What is the inferior boundary of the neck?
Clavicle
What is the anterior boundary of the neck?
Midline
What is the posterior boundary of the neck?
Trapezius
What are the two triangles in the neck?
Anterior and posterior
What are the boundaries for the anterior triangle?
- Inferior border of mandible
- Anterior border of SCM
- Midline of neck
What are the boundaries for the posterior triangle?
- Anterior border of trapezius
- Posterior border of the SCM
- Superior border of the clavicle
Name four structures present in the posterior triangle
Accessory n
Occipital artery
Cervical nerve plexus
External jugular vein
At what level does the common carotid bifurcate in the neck?
C4
Which carotid artery has branches in the neck?
External carotid artery
Name 7 indications to input a central line
- Central venous pressure
- Drug administration
- Cardiac pacing
- Blood sampling
- Fluid resuscitation
- Haemodialysis
- IV nutrition
What is a central line?
A long, thin tube that is inserted into a vein in your chest. Usually done under a local anaesthetic.
What are nine possible complication of central lines?
- Pneumothorax
- Haematoma
- Cardiac tamponade
- Air embolism
- Chylothorax
- False passage
- Thrombosis
- Sepsis
- Line blockage
What is the process through lymph nodes?
- Receive lymph/tissue waste product
- Drain to cisterna chyli
- Drain to Left thoracic duct
How are lymph nodes described?
In groups and levels
Name the different lymph node groups in the head and neck
- Submental
- Submandible
- Parotid
- Occipital
- Supraclavicular
How many different lymph node levels are there?
6
What lymph nodes are in level 1?
Submental and submandibular
What lymph nodes are in level 2?
Upper deep cervical chain (base of skull to inferior border of hyoid bone - over the SCM)
What lymph nodes are in level 3?
Middle deep cervical chain
What lymph nodes are in level 4?
Lower deep cervical chain
Where are the lymph nodes are in level 5?
In the posterior triangle
What lymph nodes are in level 6?
Pre-traceal lymph nodes down the midline of the neck)
What do the parotid nodes drain?
Scalp, face and parotid gland
What do the the occipital nodes drain?
Scalp
What do the the Superficial cervical nodes drain?
Breast and solid viscera
What do the the deep cervical nodes drain?
Final drainage pathway to thoracic duct
What do the the submandibular nodes drain?
Tongue, nose, paranasal sinuses, submandibular gland and oral cavity
What do the submental nodes drain?
Lips and floor of mouth
What do the supraclavicular nodes drain?
Breast, oesophagus and solid viscera
What three conditions can cause lymphadenopathy?
- Infection
- Inflammation
- Malignancy
Is the thyroid gland endocrine or exocrine?
Endocrine
Describe the structure of the thyroid gland
2 lobes joined by isthmus
What is the role of the thyroid gland?
Produces thyroid hormone AND calcitonin
What does calcitonin do?
Hormone which lowers calcium and raises phosphate
What is a thyroglossal cyst?
Neck mass or lump that develops from cells and tissues remaining after the formation of the thyroid gland during embryonic development
How does a thyroglossal cyst form?
When the thyroid gland forms during embryonic development, it begins at the base of the tongue and moves down the neck through a canal called the thyroglossal duct. This duct normally disappears once the thyroid reaches its final position in the neck. Sometimes, portions of the duct remain leaving cavities or pockets called cysts. These cysts can fill with fluid or mucus, and may enlarge if they become infected.
How do you determine if patient has a thyroglossal cyst?
Ask patient to stick their tongue out and it will move upwards
USS prior to removal to ensure functioning thyroid tissue elsewhere
What are three basic causes of a thyroid mass?
- Solitary nodule
- Diffuse enlargement
- Multi-nodular goitre
What is goitre?
A swelling of the neck resulting from enlargement of the thyroid gland
Give five examples of solitary thyroid nodules
- Cyst (due to localised haemorrhage)
- Adenoma (benign follicular tissue)
- Carcinoma
- Lymphoma
- Prominent nodule in multi-nodular goitre
What are first line investigations of solitary thyroid nodules?
Fine-needle aspiration cytology (FNAC) AND ultrasound scan
What is a disadvantage of FNAC with regards to identifying cancer?
Cannot distinguish between a follicular adenoma and a follicular carcinoma
What investigation is used for histological diagnosis for solitary thyroid nodule?
Thyroid lobectomy for tissue biopsy
Name 4 different types of thyroid cancers
- Papillary (lymphatic spread)
- Follicular (haematogenous spread)
- Medullary
- Anaplastic
What type of cells do medullary (thyroid) carcinomas arise from?
Parafollicular C cells
Name 3 conditions to cause diffuse thyroid enlargement
- Colloid goitre
- Grave’s disease
- Thyroiditis
What can cause a colloid goitre?
- Gland hyperplasia
- Iron deficiency
- Puberty, pregnancy, lactation
What is Grave’s disease?
Autoimmune disease where auto-antibodies stimulates thyroid-stimulating hormone receptor to over produce hormones causing hyperthyroidism
What can hyperthyroidism cause?
- Thyroid eye disease
- Acropachy/clubbing
- Pre-tibial myxoedema
What is the treatment of hyperthyroidism?
- Anti-thyroids
- Beta-blockade
- Radio-iodine
- Surgery
Name 5 indications to carry out a thyroidectomy
- Airway obstruction
- Malignancy or suspected malignancy
- Thyrotoxicosis
- Cosmesis
- Retrosternal extension
What are possible complications of a thyroidectomy?
- Bleeding
- Voice hoarseness
- Thyroid storm
- Infection
- Hypoparathyroidism
- Hypothyroidism
- Scar (keloid/hypertrophic)
What are two causes of multi-nodular goitre?
Grave’s disease OR toxic goitre
What can toxic goitre cause?
Atrial fibrillation
What investigations are carried out for multi-nodular goitre?
- Thyroid function tests
- FNAC
- CXR
What is the role of the parathyroid glands?
To regulate calcium and phosphate levels
What can parathyroid disease cause?
- Renal calculi, polyuria, renal failure
- Osteoporosis
- Abdominal pain, constipation, peptic ulcer
- Anxiety & depression
What investigations are carried out to determine parathyroid disease?
- U+Es, creatinine, Ca, phosphate
- Parathyroid hormone, bicarbonate
- Vit D
- USS
- CT/MRI (identify octopi glands)
- Isotope scanning (detect diseased glands)
What is the treatment for hyperparathyroidism?
Surgery
What are causes of hyperparathyroidism?
- Adenoma
- Hyperplasia
- Malignancy (rare)
Name signs of hyperplasia causing parathyroid disease
- Common in secondary hyperparathyroidism due to low calcium i.e. renal failure
- Calcium levels normal, but phosphate is high
What are the four fascial layers of the neck?
- Pre-tracheal
- Pre-vertebral
- Deep cervical
- Carotid sheath
What are three indications to carry out a tracheostomy?
- Airway obstruction
- Airway protection
- Poor ventilation to reduce dead space
Use if unable to intubate
What is the treatment of stridor?
- O2
- Nebulised adrenaline
- IV Dexamethasone
What can cause a branchial cyst?
Remnant of fusion failure of branchial arches OR lymph node cystic degeneration
What is the pharyngeal pouch?
Herniation of pharyngeal mucosa between thyropharyngeus and cricopharynxgeus muscle of the inferior constrictor of the pharynx
What are signs of a pharyngeal pouch?
- Voice hoarseness
- Dysphagia
- Aspiration pneumonia
What investigation is used for a pharyngeal pouch?
Barium swallow