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Head and Neck > Anatomy/Physiology of Neck > Flashcards

Anatomy/Physiology of Neck Flashcards

1
Q

What is the superior boundary of the neck?

A

Mandible

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2
Q

What is the inferior boundary of the neck?

A

Clavicle

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3
Q

What is the anterior boundary of the neck?

A

Midline

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4
Q

What is the posterior boundary of the neck?

A

Trapezius

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5
Q

What are the two triangles in the neck?

A

Anterior and posterior

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6
Q

What are the boundaries for the anterior triangle?

A
  • Inferior border of mandible
  • Anterior border of SCM
  • Midline of neck
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7
Q

What are the boundaries for the posterior triangle?

A
  • Anterior border of trapezius
  • Posterior border of the SCM
  • Superior border of the clavicle
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8
Q

Name four structures present in the posterior triangle

A

Accessory n
Occipital artery
Cervical nerve plexus
External jugular vein

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9
Q

At what level does the common carotid bifurcate in the neck?

A

C4

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10
Q

Which carotid artery has branches in the neck?

A

External carotid artery

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11
Q

Name 7 indications to input a central line

A
  • Central venous pressure
  • Drug administration
  • Cardiac pacing
  • Blood sampling
  • Fluid resuscitation
  • Haemodialysis
  • IV nutrition
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12
Q

What is a central line?

A

A long, thin tube that is inserted into a vein in your chest. Usually done under a local anaesthetic.

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13
Q

What are nine possible complication of central lines?

A
  • Pneumothorax
  • Haematoma
  • Cardiac tamponade
  • Air embolism
  • Chylothorax
  • False passage
  • Thrombosis
  • Sepsis
  • Line blockage
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14
Q

What is the process through lymph nodes?

A
  1. Receive lymph/tissue waste product
  2. Drain to cisterna chyli
  3. Drain to Left thoracic duct
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15
Q

How are lymph nodes described?

A

In groups and levels

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16
Q

Name the different lymph node groups in the head and neck

A
  • Submental
  • Submandible
  • Parotid
  • Occipital
  • Supraclavicular
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17
Q

How many different lymph node levels are there?

A

6

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18
Q

What lymph nodes are in level 1?

A

Submental and submandibular

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19
Q

What lymph nodes are in level 2?

A

Upper deep cervical chain (base of skull to inferior border of hyoid bone - over the SCM)

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20
Q

What lymph nodes are in level 3?

A

Middle deep cervical chain

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21
Q

What lymph nodes are in level 4?

A

Lower deep cervical chain

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22
Q

Where are the lymph nodes are in level 5?

A

In the posterior triangle

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23
Q

What lymph nodes are in level 6?

A

Pre-traceal lymph nodes down the midline of the neck)

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24
Q

What do the parotid nodes drain?

A

Scalp, face and parotid gland

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25
Q

What do the the occipital nodes drain?

A

Scalp

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26
Q

What do the the Superficial cervical nodes drain?

A

Breast and solid viscera

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27
Q

What do the the deep cervical nodes drain?

A

Final drainage pathway to thoracic duct

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28
Q

What do the the submandibular nodes drain?

A

Tongue, nose, paranasal sinuses, submandibular gland and oral cavity

29
Q

What do the submental nodes drain?

A

Lips and floor of mouth

30
Q

What do the supraclavicular nodes drain?

A

Breast, oesophagus and solid viscera

31
Q

What three conditions can cause lymphadenopathy?

A
  • Infection
  • Inflammation
  • Malignancy
32
Q

Is the thyroid gland endocrine or exocrine?

A

Endocrine

33
Q

Describe the structure of the thyroid gland

A

2 lobes joined by isthmus

34
Q

What is the role of the thyroid gland?

A

Produces thyroid hormone AND calcitonin

35
Q

What does calcitonin do?

A

Hormone which lowers calcium and raises phosphate

36
Q

What is a thyroglossal cyst?

A

Neck mass or lump that develops from cells and tissues remaining after the formation of the thyroid gland during embryonic development

37
Q

How does a thyroglossal cyst form?

A

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.

38
Q

How do you determine if patient has a thyroglossal cyst?

A

Ask patient to stick their tongue out and it will move upwards

USS prior to removal to ensure functioning thyroid tissue elsewhere

39
Q

What are three basic causes of a thyroid mass?

A
  • Solitary nodule
  • Diffuse enlargement
  • Multi-nodular goitre
40
Q

What is goitre?

A

A swelling of the neck resulting from enlargement of the thyroid gland

41
Q

Give five examples of solitary thyroid nodules

A
  • Cyst (due to localised haemorrhage)
  • Adenoma (benign follicular tissue)
  • Carcinoma
  • Lymphoma
  • Prominent nodule in multi-nodular goitre
42
Q

What are first line investigations of solitary thyroid nodules?

A

Fine-needle aspiration cytology (FNAC) AND ultrasound scan

43
Q

What is a disadvantage of FNAC with regards to identifying cancer?

A

Cannot distinguish between a follicular adenoma and a follicular carcinoma

44
Q

What investigation is used for histological diagnosis for solitary thyroid nodule?

A

Thyroid lobectomy for tissue biopsy

45
Q

Name 4 different types of thyroid cancers

A
  • Papillary (lymphatic spread)
  • Follicular (haematogenous spread)
  • Medullary
  • Anaplastic
46
Q

What type of cells do medullary (thyroid) carcinomas arise from?

A

Parafollicular C cells

47
Q

Name 3 conditions to cause diffuse thyroid enlargement

A
  • Colloid goitre
  • Grave’s disease
  • Thyroiditis
48
Q

What can cause a colloid goitre?

A
  • Gland hyperplasia
  • Iron deficiency
  • Puberty, pregnancy, lactation
49
Q

What is Grave’s disease?

A

Autoimmune disease where auto-antibodies stimulates thyroid-stimulating hormone receptor to over produce hormones causing hyperthyroidism

50
Q

What can hyperthyroidism cause?

A
  • Thyroid eye disease
  • Acropachy/clubbing
  • Pre-tibial myxoedema
51
Q

What is the treatment of hyperthyroidism?

A
  • Anti-thyroids
  • Beta-blockade
  • Radio-iodine
  • Surgery
52
Q

Name 5 indications to carry out a thyroidectomy

A
  • Airway obstruction
  • Malignancy or suspected malignancy
  • Thyrotoxicosis
  • Cosmesis
  • Retrosternal extension
53
Q

What are possible complications of a thyroidectomy?

A
  • Bleeding
  • Voice hoarseness
  • Thyroid storm
  • Infection
  • Hypoparathyroidism
  • Hypothyroidism
  • Scar (keloid/hypertrophic)
54
Q

What are two causes of multi-nodular goitre?

A

Grave’s disease OR toxic goitre

55
Q

What can toxic goitre cause?

A

Atrial fibrillation

56
Q

What investigations are carried out for multi-nodular goitre?

A
  • Thyroid function tests
  • FNAC
  • CXR
57
Q

What is the role of the parathyroid glands?

A

To regulate calcium and phosphate levels

58
Q

What can parathyroid disease cause?

A
  • Renal calculi, polyuria, renal failure
  • Osteoporosis
  • Abdominal pain, constipation, peptic ulcer
  • Anxiety & depression
59
Q

What investigations are carried out to determine parathyroid disease?

A
  • U+Es, creatinine, Ca, phosphate
  • Parathyroid hormone, bicarbonate
  • Vit D
  • USS
  • CT/MRI (identify octopi glands)
  • Isotope scanning (detect diseased glands)
60
Q

What is the treatment for hyperparathyroidism?

A

Surgery

61
Q

What are causes of hyperparathyroidism?

A
  • Adenoma
  • Hyperplasia
  • Malignancy (rare)
62
Q

Name signs of hyperplasia causing parathyroid disease

A
  • Common in secondary hyperparathyroidism due to low calcium i.e. renal failure
  • Calcium levels normal, but phosphate is high
63
Q

What are the four fascial layers of the neck?

A
  • Pre-tracheal
  • Pre-vertebral
  • Deep cervical
  • Carotid sheath
64
Q

What are three indications to carry out a tracheostomy?

A
  • Airway obstruction
  • Airway protection
  • Poor ventilation to reduce dead space

Use if unable to intubate

65
Q

What is the treatment of stridor?

A
  • O2
  • Nebulised adrenaline
  • IV Dexamethasone
66
Q

What can cause a branchial cyst?

A

Remnant of fusion failure of branchial arches OR lymph node cystic degeneration

67
Q

What is the pharyngeal pouch?

A

Herniation of pharyngeal mucosa between thyropharyngeus and cricopharynxgeus muscle of the inferior constrictor of the pharynx

68
Q

What are signs of a pharyngeal pouch?

A
  • Voice hoarseness
  • Dysphagia
  • Aspiration pneumonia
69
Q

What investigation is used for a pharyngeal pouch?

A

Barium swallow

Head and Neck (12 decks)

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