Anatomy/Physiology of the Neck

Question 1

What are the boundaries of the neck?

Answer 1

Superior- mandible
Inferior- clavicle
Anterior- anterior midline
Posterior- Trapezius

Question 2

What muscle separates the anterior and posterior triangles of the neck?

Answer 2

The sternocleidomastoid

Question 3

What are the branches of the external carotid artery?

Answer 3

Superior thyroid
Ascending pharyngeal
Laryngeal
Facial
Occipital
Posterior auricular
Maxillary
Superficial temporal

Question 4

What are the complications of a central line?

Answer 4

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

Question 5

How do the lymph nodes of the head and neck drain?

Answer 5

They drain to the cisterna chyli, then into the thoracic duct on the left

Question 6

What structures are drained by the parotid nodes?

Answer 6

Scalp, face and parotid gland

Question 7

What structures are drained by the occipital nodes?

Answer 7

Scalp

Question 8

What structures are drained by the superficial cervical nodes?

Answer 8

Breast and solid viscera

Question 9

What structures are drained by the deep cervical nodes?

Answer 9

Final drainage pathway of other nodes to thoracic duct

Question 10

What structures are drained by the submandibular nodes?

Answer 10

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

Question 11

What structures are drained by the submental nodes?

Answer 11

Lips and floor of mouth

Question 12

What structures are drained by the supraclavicular nodes?

Answer 12

Breast, oesophagus and solid viscera

Question 13

What are the main causes of lymphadenopathy?

Answer 13

Infective
Inflammatory
Malignant

Question 14

What hormones does the thyroid gland produce?

Answer 14

Thyroid hormone and calcitonin

Question 15

What are the characteristics of a thyroglossal cyst?

Answer 15

Dilatation of thryoglossal duct remnant
May become infected
Lies in midline and grows with age
Moves with tongue protrusion
Excised but chance of recurrence

Question 16

What are the different kinds of thyroid masses?

Answer 16

Solitary nodule
Diffuse enlargement
Multi-nodular goitre

Question 17

What are the causes of a solitary thyroid nodule?

Answer 17

Cyst due to localised haemorrhage
Adenoma
Carcinoma
Lymphoma
Prominent nodule in multi-nodule goitre

Question 18

How are solitary thyroid nodules investigated?

Answer 18

Fine needle aspiration and ultrasound scanning

Thyroid lobectomy if follicular adenoma or carcinoma is suspected to differentiate between the two

Question 19

What are the different kinds of diffuse thyroid enlargement?

Answer 19

Colloid goitre- due to gland hyperplasia, iodine deficiency, puberty, pregnancy or lactation
Grave’s disease
Thyroiditis

Question 20

What are the characteristics of Grave’s disease?

Answer 20

F>M
Auto-antibodies against thyroid-stimulating hormone receptor stimulate receptor and causes hyperthyroidism
Thyroid eye disease
Acropachy/clubbing
Pre-tibial myxoedema

Question 21

How is Grave’s disease treated?

Answer 21

Anti-thyroids
Beta-blockade
Radio-iodine
Surgery

Question 22

What are the indications for a thyroidectomy?

Answer 22

Airway obstruction
Malignancy/suspected malignancy
Thyrotoxicosis
Cosmesis
Retrosternal extension

Question 23

What are the complications of a thyroidectomy?

Answer 23

Bleeding
Voice hoarseness
Thyroid storm
Infection 
Hypoparathyroidism
Hypothyroidism
Scar

Question 24

What are the causes of a multi-nodular goitre?

Answer 24

Grave’s disease

Toxic goitre

Question 25

What are the characteristics of a toxic goitre?

Answer 25

Older patients No eye signs Atrial fibrillation often co-morbidity

Question 26

How should multi-nodular goitres be investigated?

Answer 26

Thyroid function tests Fine needle aspiration cytology Chest X-ray

Question 27

What is the role of the parathyroid glands and where are they found?

Answer 27

Regulate calcium and phosphate levels | Located posterior to the poles of the thyroid

Question 28

What are the symptoms of parathyroid disease?

Answer 28

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

Question 29

How can parathyroid disease be investigated?

Answer 29

``` Urea and electrolytes, creatinine, calcium, phosphate Parathyroid hormone, bicarbonate Vitamin D Ultrasound scan CT/MRI Isotope scanning ```

Question 30

What are the causes of hyperparathyroidism?

Answer 30

Adenoma Hyperplasia Malignancy

Question 31

How is parathyroid disease managed?

Answer 31

Medical treatment Surgery easier if patient is fit Remove adenomas or hyperplastic glands or carcinomas

Question 32

What are the indications for a tracheostomy?

Answer 32

Airway obstruction Airway protection Poor ventillation to reduce dead space

Question 33

What are the characteristics of a branchial cyst?

Answer 33

Remnant of fusion failure of branchial arches or lymph node cystic degeneration Transilluminates Anterior to sternocleidomastoid at junction between upper and middle thirds Becomes infected, enlarging Excised to prevent further infection

Question 34

What is the cause of a pharyngeal pouch?

Answer 34

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

Question 35

What are the symptoms of a pharyngeal pouch?

Answer 35

``` Voice hoarseness Dysphagia Aspiration pneumonia Regurgitation Weight loss Neoplasia (1%) ```

Question 36

How is a pharyngeal pouch managed?

Answer 36

Barium swallow | Excision or dilation