Applied anatomy of neck Flashcards
What are the landmarks for the anterior triangle ?
Superiorly – inferior border of the mandible.
Laterally – anterior border of the sternocleidomastoid.
Medially – sagittal line down the midline of the neck.
What are the landmarks for the posterior triangle ?
Anterior – posterior border of sternocleidomastoid.
Posterior – anterior border of trapezius
Inferior– middle 1/3 of the clavicle
What are the spinous process lines ?
What are the causes of neck swelling ?
Trauma
Inflammatory & infectious - acute (few days)
Bacterial –TB/ Staph/strep infection eg dental / impetigo/tonsillitis/quinsy/
Viral- urti / mumps
Mechanical- Blocked salivary duct / enlarges at mealtime
Neoplastic – tend to be subacute (weeks to months)
Metastatic nodes - head/neck or abdomen (Virchows node)
Benign –Lipoma – maybe chronic
Endocrine – chronic (months)
Goitre – Hashimotos, Graves diseases, iodine deficiency
Congenital – chronic (years)
Thyroglossal cyst
Neck lumps- key points to think of in your history & examination?
Age –
child-congenital cause or infection?
Young adult- infectious or inflammatory mass
Adults- goitre ?
Older-neoplasm-benign or malignant primary or secondary?
Duration acute/ subacute / chronic (see prior slide)
Symptoms of hyper- or hypo-thyroidism
Red flags of malignancy- weight loss, persistent hoarseness, cough, dysphagia
Haematological cancers- night sweats, fevers, fatigue
Neck lump - key expose things you should think of ?
Exposure to animals- cat scratch fever/toxoplasmosis / insect bites
Foreign travel- to areas of endemic TB
Risk factors for head & neck cancer –alcohol, smoking, betel nut chewing, radiation
Past history or family history of cancer
Occupational exposure –to wood dusts, nickel, asbestos
Explain how iodine deficiency can occur ?
Why does it not occur in this country?
Iodine deficiency occurs when the soil is poor in iodine, causing a low concentration in food products and insufficient iodine intake in the population. When iodine requirements are not met, the thyroid may no longer be able to synthesize sufficient amounts of thyroid hormone.
They put Iodine within the salt.
How would you describe a neck lump? Use SCT
Site
Size
shape
Surface
Colour
Consistency
compressible (fluctuant)
Transilluminable
Tender
Temperature
tethered
What is this ?
What can cause it ?
Enlarged Lymph Nodes.
Viral infections
Bacterial infections, tuberculosis
Metastatic cancers
Haematological cancers, lymphomas
What is this ?
What can cause it ?
Virchow’s node
This is an enlarged left-sided supraclavicular lymph node.
This node drains the lymph vessels in the abdominal cavity.
Its called a ‘sentinel node’ of cancer in the abdomen, particularly gastric cancer but also ovarian cancer, testicular cancer and kidney cancer.
What is this ?
What can cause it ?
How to treat it ?
Streptococcal infection with fever, swollen exudative tonsils & cervical lymphadenopathy.
Treat with 10 day course of phenoxymethylpenicillin (penicillin V)
What is this ?
What can cause it ?
Quinsy or peritonsillar abscess
+++UVULA DEVIATION
Its caused by a build up of pus due to an infection behind the tonsil.
Symptoms include fever, throat pain and difficulty
opening your mouth.
Pain is worse on the one side and the key feature is deviation of the uvula on examination.
Management is antibiotics or surgical drainage.
What is this ?
What can cause it ?
Impetigo
Seen in children
Staphylococcal skin infection.
Treated with antibiotic cream (Fucidin) or orally (erythromycin).
Very infectious.
Often swollen neighbouring nodes
What is this ?
Blocked Salivary duct
What are these signs of ?
Features of hypothroidism
What is this?
What is it commonly seen in?
Exophthalmos
Thyroid issue
What is this called?
When does it occur?
What would you be weary of?
Goiter
Hyper or hypothyroidism
‘A swelling due to an enlarged thyroid gland’
A thyroid swelling moves when swallowing.
Sometimes a goitre extends down behind the sternum
And compresses the trachea, a retrosternal goitre.
If the patient is breathless refer urgently !
What is this a sign of ?
What does it suggest
Pemberton’s sign flushing due to venous compression in the neck preventing drainage of blood from neck.
Stopping the blood from draining away and therefore going red .