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 .
What is this ?
Thyroidectomy scar
What are the dangers of thyroid surgery?
Bleeding in the neck - as with any surgery.
Hoarseness/Voice Change (recurrent laryngeal nerve injury)
Hypocalcemia (Hypoparathyroidism) (carpo pedal spasm)
Seromas.
Infection.
What nerve may be damaged with thyroid surgery ?
recurrent laryngeal nerve
What is this ?
The pupil is smaller
miosis (constriction of the pupil)
What three things make up hornerns syndrome ?
ptosis (drooping of the upper eyelid)
miosis (constriction of the pupil)
anhidrosis (decreased sweating)
What is ptosis ?
ptosis (drooping of the upper eyelid)
What is the medical condition for drooping of the eyelid ?
Ptosis
What is miosis ?
miosis (constriction of the pupil)
What is the medical term for constriction of the pupil ?
Miosis
What is anhidrosis ?
anhidrosis (decreased sweating)
What is the medical termonology for decerased sweating?
Anhidrosis
ptosis, miosis and anhidrosis are signs of what ?
horners syndrome
how does horners syndrome happen ?
- Sympathetic fibres come from the hypothalamus and descend in the spinal cord.
2- exit at T1 and ascend in the cervical sympathetic chain on their way to the eye and the sweat glands of the face.3
3- Running close to the lung apex & subclavian artery
4- its compression on these nerves causes horners syndrome
What is P ?
Pancose tumour
What is this ?
**Key point- when you protrude the tongue the lump moves up
An irregular neck mass which develops from cells left over after the formation of the thyroid gland.
In the embryo, the thyroid develops in the floor of the pharynx and moves down to its final location in the neck.
What is this ?
What is casued by ?
Torticollis or ‘wry neck’
Caused by a spasm of the sternocleidomastoid muscle. It’s a common presentation in children presenting with the head pulled to one side. The cause is thought to be a strain or perhaps viral. Self limiting condition
What can causes this ?
Betel nut chewing
When do Fish bones comonly get stuck ?
piriform sinus
What can you see here?
Fish bone
Explain what a herniated disc is ?
It can cause nerve root compression with symptoms radiating down the arm.
What is a TIA ?
A TIA or transient ischaemic attack is caused by a temporary blockage of the internal carotid artery usually at a site of narrowing. The blood supply to the brain is interrupted and causes
neurological symptoms until the blockage clears.
It can also result from clots released from the left
atrium in atrial fibrillation.
History resembles a stroke with central nervous system symptoms but recovery takes place within 24 hours.
TIA patients have a 20% chance of a stroke in the next month and the highest risk in the next 72 hours !
What is amaurosis fugax ?
Amaurosis fugax- a type of TIA due
to clots passing through the retinal
circulation.
Management of suspected TIA?
offer immediate aspirin (300 mg daily), unless contraindicated.
refer immediately for specialist assessment and investigation, to be seen within 24 hours of onset of symptoms
Carotid imaging
after specialist assessment if considered for carotid endarterectomy
offer secondary prevention, in addition to aspirin, as soon as possible after the diagnosis of TIA is confirmed
What conditions cause a raised JVP ?
Congestive cardiac failure, constrictive pericarditis and superior vena caval obstruction
What is a normal JVP
4cm
What is the difference between internal and external jugular vein ?
Unlike the external vein it has no valves between it and the right atrium and reflects the pressure on the right side of the heart.
What bone can fracture as a result of trauma to cervical spine?
Odontoid fractures
In younger patients, the result of high-energy trauma RTA
In the elderly after lower energy impacts eg: falls from a standing position.
