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Conditions + definitions > Head and neck > Flashcards

Head and neck Flashcards

1
Q

What is the superior boundary of the neck?

A

Superior – mandible

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2
Q

What is the inferior boundary of the neck?

A

Inferior – clavicle

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3
Q

What is the anterior boundary of the neck?

A

Anterior – anterior midline

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4
Q

What is the Posterior boundary of the neck?

A

Posterior – trapezius

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5
Q

What are the contents of the anterior triangle?

A

Common carotid – external, internal as well
Facial artery, vein
Hypoglossal, vagus, accessory, laryngeal, glossopharyngeal nerves
Internal jugular vein
Submandibular nodes, submental

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6
Q

What are the contents of the posterior triangle?

A

Accessory nerve, cervical nerve plexus
Occipital artery
External jugular vein
Lymph nodes

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7
Q

What are the main arteries of the neck?

A 
Common carotid (divides at C4)
	Internal carotid – straight to brain, no branches
	External carotid – branches into
	Superior thyroid
	Ascending pharyngeal
	Lingual
	Occipital
	Facial
	Posterior auricular
	Maxillary
	Superficial temporal
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8
Q

What are the indications for a central line?

A 
Central venous pressure monitoring
Drug administration
Cardiac pacing
Blood sampling
Fluid resuscitation
Haemodialysis
IV nutrition
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9
Q

What are the possible complications of a central line?

A 
Pneumothorax
	Haematomoa
	Cardiac tamponade
	Air embolism
	Chylothorax
	False passage
	Thrombosis
	Sepsis
Line blockage
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10
Q

What are the lymph node levels?

A

I submental/submandibular
II-IV along sternocleidmastoid
V – posterior triangle

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11
Q

Where do the parotid lymph nodes drain?

A

Parotid nodes-scalp, face & parotid gland

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12
Q

Where do the occipital lymph nodes drain?

A

Occipital nodes-scalp

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13
Q

Where do the superficial cervical lymph nodes drain?

A

Superficial cervical nodes-breast & solid viscera

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14
Q

Where do the deep cervical nodes drain?

A

Deep cervical nodes-final drainage pathway to thoracic duct

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15
Q

Where do the submandibular lymph nodes drain?

A

Submandibular nodes-tongue, nose, paranasal sinuses, submandibular gland, oral cavity

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16
Q

Where do the submental lymph nodes drain?

A

Submental nodes-lips, floor of mouth

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17
Q

What are the three potential causes of lymphadenopathy?

A

Infective
Inflammatory
Malignant

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18
Q

Describe the thyroid gland

(Lobes, products, location, arterial supply)

A

Two lobes (right+left) joined by isthmus
Produces thyroid hormone and calcitonin
Calcitonin acts to lower calcium and raise phosphate
Located beneath the thyroid cartilage
Supplied from superior thyroid artery (branch of external carotid artery)

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19
Q

What are the types of thyroid mass?

A

Solitary nodule
Diffuse enlargement
Multi-nodular goitre

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20
Q

What are the types of solitary thyroid nodules?

A 
Cyst: due to localised haemorrhage
Adenoma: benign follicular tissue
Carcinoma
Lymphoma
Prominent nodule in multi-nodule goirre
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21
Q

Who is most likely to get a solitary thyroid nodule?

A

F> M 30-40 yrs

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22
Q

What two types of thyroid cancer can FNA not distinguish between?

A

Follicular adenoma
Follicular carcinoma

Need a tissue sample for diagnosis

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23
Q

What are the types of thyroid cancer?

A

Papillary – lymphatic metastasis
Follicular – haematogenous metastasis
Medullary – familial association (10%) arise from parafollicular C cells
Anaplastic – aggressive, local spread, normally old, poor prognosis

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24
Q

What can cause a diffuse thyroid enlargement?

A 
Colloid goitre: Due to gland hyperplasia
	>Iodine deficiency
	>Puberty
	>Pregnancy
	>Location
	>Grave’s disease
Throiditis
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25
Q

What is Grave’s disease?

A

Autoantibodies against thyroid stimulating hormone receptor stimulate receptor
Hyperthyroidism results
Thyroid eye disease, acropachy/clubbing, pre tibial myxoedema
More likely in females

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26
Q

What is the treatment for grave’s disease?

A

antithyroids,
beta blockage,
radio iodine
surgery

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27
Q

What are the indications for a thyroidectomy?

A 
Airway obstruction
Malignancy (or suspected)
Thyrotoxicosis
Cosmesis
Retrosternal extension
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28
Q

What are the possible complications of a thyroidectomy?

A 
Bleeding-primary or secondary
	Voice hoarseness
	Thyroid storm
	Infection
	Hypoparathyroidism
	Hypothyroidism
Scar (keloid/hypertrophic)
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29
Q

What do the parathyroid glands do?

A

Regulate calcium and phosphate levels
Located to poles of thyroid
Can be injured in neck surgery

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30
Q

What is multi-nodular goitre?

A

Due to grave’s disease or toxic goitre
Graves – women, middle-aged, over activity leads to hyperthyroidism

Toxic goitre – older, no eye signs, AF

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31
Q

What do you do to test multi-nodular goitre?

A

Thyroid function tests,
FNA,
CXR

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32
Q

What are the symptoms of parathyroid disease?

A

Painful stones?
Aching bones
Psychic moans
Abdominal groans
Renal calculi, polyuria, renal failure
Pathological fractures, osteoporosis, bone pain
Abdominal pain, constipation, peptic ulceration, pancreatitis, weight loss
Anxiety & depression, confusion, paranoia

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33
Q

What tests are used to investigate parathyroid disease?

A

Urea & electrolytes, creatinine, calcium, phosphate
Parathyroid hormone, bicarbonate
Vitamin D
Ultrasound scan
CT/MRI: identify ectopic glands
Isotope scanning: detect diseased glands
-Only treat for Hyperparathyroidism

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34
Q

What can cause parathyroid disease?

A

Adenoma (80%)
Hyperplasia (12%) - common in secondary hyperparathyroidism due to low calcium
Eg renal failure. Calcium levels normal but phosphate levels high
Malignancy

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35
Q

How do you treat parathyroid disease?

A

Surgery easier if patient fit
Remove single adenomas, or multiple
Carcinomas removed with thyroid gland and lymph nodes

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36
Q

What are the four fascia layers of the neck?

A

Pre-tracheal
Pre-vertebral
Deep cervical
Carotid sheath

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37
Q

What are the indications for a tracheostomy?

A

Airway obstruction
Airway protection
Poor ventilation to reduce dead space
Need suctioning, humidifcation and long term care

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38
Q

What is stridor?

A

Clinical sign of airway obstruction
Inspiratory - laryngeal
Expiratory - tracheobronchial
Biphasic – glottic/subglottic

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39
Q

How do you treat stridor?

A

Treat with O2, Nebulised Adrenaline, IV Dexamethasone, (Heliox), (Definitive) airway management

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40
Q

What is Branchial cyst?

A

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

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41
Q

What is a pharyngeal pouch?

A

Herniation of pharyngeal mucosa between:
thyropharyngeus and cricopharyngeus
(muscles of the inferior constrictor of the pharynx)

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42
Q

What are the symptoms of pharyngeal pouches?

A 
Voice hoarseness	
Regurgitation
	Dysphagia
Weight loss
Aspiration pneumonia		
Neoplasia 1%
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43
Q

How do you treat a pharyngeal pouch (+ diagnose)?

A

Diagnose with barium swallow
Excision
Dilation

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44
Q

What is the presentation of a reactive lymph node?

A 
Oval
	Soft
	Smooth
	Mobile
Tender
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45
Q

What is the presentation of malignant neck node?

A 
Round
	Firm
	Irregular
	Fixed
Non-tender
46
Q

What can cause hoarseness?

A 
Nodules
Cysts
Vocal abuse
Laryngitis
Infection
Smoking
Reflux
Laryngeal cancer
47
Q

What are the benign H&N disorders?

A 
Congenital
Infective
Inflammatory
Trauma
Neoplasia
48
Q

What are the malignant H&N disorders?

A

Cancer

90% squamous carcinoma

49
Q

What are the guidelines for removing tonsils?

A

Bacterial Tonsillitis: (pus covering, neck nodes, fever, no cough)
6-7 attacks in 1 year (5 per year over two years, 3 per year over three years)
Disrupting daily activities
More than 1 quinsy

50
Q

What is the function of the nose?

A

Respiration, filtration, humidification/ warming of air

Olfaction Reception of sinus and eye secretions Continuous mucosal lining with sinuses Rhino–sinusitis

51
Q

Describe the mucosa of the nasal passage

A

Columnar, ciliated
Squamo-columnar junction
Nasal hair in vestibule

52
Q

What makes up the external nose?

A

Dorsum (bridge) root to tip
1/3 bony
2/3 cartilaginous

53
Q

What are the cartilages of the nose?

A 
Septal cartilage (middle)
Lateral (two of them)
Alar cartilage (also two)
54
Q

What processes can cause nasal deformity?

A

Trauma

Fractures

55
Q

What forms the midline partition of the internal nose?

A

Septal cartilage
Perpendicular plate of ethmoid
Vomer (bone)

56
Q

What forms the lateral walls of the nose?

A 
Turbinates
>Superior
>Middle
>Inferior
>Meati
57
Q

What forms the roof of the internal nose?

A

Cribriform plate

58
Q

What forms the floor of the internal nose?

A

Hard palate

59
Q

What are the common pathologies of the internal nose?

A

Nasal septum deviation
>Through trauma
>Congeital
>Has risk of septal haematoma

Swelling
>Rhinitis
>Infection
>Can block nose, treated with steroid sprays

60
Q

What are the boundaries of the nasopharynx?

A

Choana
Sphenoid sinuses
Prevertebral fascia and muscle
Soft palate

61
Q

What are the contents of the nasopharynx?

A

Eustachian openings
Adenoids
Has muci-ciliary lining

62
Q

What is the blood supply to the nose? (5)

A 
Sphenopalatine artery
>Branch of maxillary artery from external carotid
Greater palatine artery
Ascending labial artery
Ethmoid arteries (internal carotid)
Capillary plexus - littles area
63
Q

What is epistaxis?

A

Haemorrhage from:
>Nostril
>Nasal cavity
>Nasopharynx

64
Q

What nerves supply the nose?

A 
Olfactory nerve (olfactory epithelium)
Infraorbital nerve (branch of 5th cranial - trigeminal)
65
Q

What conditions can affect the olfactory nerve?

A 
Hyposmia or anosmia
Via:
>trauma
>Virus
>Tumour
>Rhinitis
66
Q

What conditions can affect the infraorbital nerve of the nose?

A

Paraesthesia in trauma

Iatrogenic damage in tumours

67
Q

What are the sinuses?

A

Air filled spaces
Continous muco-ciliary lining with nose
Development is age dependent

68
Q

What sinuses are there?

A

Frontal x1 + septal partition
Maxillary x2
Ethmoid x2
Sphenoid 1

69
Q

How + where does the frontal sinus drain?

A

Via frontonasal duct

Into middle meatus

70
Q

Where does the posterior ethmoid sinuses drain?

A

Into superior meatus

71
Q

Where does the middle and anterior ethmoid sinuses drain?

A

Into middle meatus

72
Q

How + where does the maxillary sinus drain?

A

At hiatus semilunaris
Into middle meatus
Drainage near frontal drainage

73
Q

Where does the nasolacrimal duct drain?

A

inferior meatus

74
Q

What are the potential dangers to sinisitus?

A 
intracranial sepsis
cerebrospinal fluid (CSF) leak
damage to the orbit
optic nerve
carotid artery
75
Q

What sinuses drain into the middle meatus?

A

Frontal sinus
Middle ethmoidal sinus
Anterior ethmoidal sinus
Maxillary sinus

76
Q

What sinuses drain into the superior meatus?

A

Posterior ethmoidal sinus

77
Q

What drains into the inferior meatus?

A

Nasolacrimal duct

78
Q

What structure can be damage in frontal sinusitis due to its close relation?

A

Anterior cranial fossa

79
Q

What structure can be damage in ethmoidal sinusitis due to its close relation?

A

Anterior cranial fossa (cribriform plate)

80
Q

What structure can be damage in maxillary sinusitis due to its close relation?

A

Orbits

Oral cavity/teeth

81
Q

What structure can be damage in Sphenoid sinusitis due to its close relation?

A

Optic nerve
Internal carotid artery
Pituitary gland

82
Q

What makes up the external ear?

A

Auricla /pinnea
External acoustic meatus
Ceruminous + sebacous glands
>Make wax

83
Q

What makes up the Auricle/pinnea?

A

> Stratified keratinising squamous epithelium

>Elastic cartilage

84
Q

What makes up the external acoustic meatus?

A

> Lateral 1/3 cartilage and skin

>Medial 2/3 bone and skin

85
Q

Describe is the tympanic membrane

A

The eardrum
Roughly 1 cm in diameter
Part of sound conduction
3 layers

86
Q

What are the three layers of the tympanic membrane?

A

Outer squamous epithelial
Middle - fibrous connective tissue
Inner - columnar ciliated mucus membrane

87
Q

What can cause tympanic membrane perforation?

A

Trauma

Suppuration

88
Q

What is the function of the ossicular chain?

A

Important in sound conduction

89
Q

What can disrupt the ossicular chain?

A

Trauma
Chronic suppuration
Bony sclerosis (otosclerosis)

90
Q

What are the important relations of the middle ear?

A

Middle cranial fossa
Internal jugular vein
Internal carotid artery

91
Q

Describe the middle ear

A

Area that connects the
>mastoid system via aditus
>Post nasal pace via eustachian tubes

Lined by cilunar ciliated epithelium
>Produce mucus, catarrh and glue

92
Q

What does the middle eat contain?

A

Ossicles
Facial nerve
Chorda tympani

93
Q

What is found in the middle ear?

A 
Vestibulo-cochlear organ:
Bony labyrinth
Membranous labryinth
Fluid 
>Perilymph
>Endolymph
94
Q

What makes up the bony labyrinth?

A

Cochlea
Vestibule
Semi-circular canal

95
Q

What is the function of the membranous labyrnth?

A

Is the sensory epithelium for hearing

96
Q

What nerves supply hearing?

A

Cochlear fibres/nerves
>Travels through Internal auditory meatus
>Joins brainstem at pontomedullary junction
Cochlear+ vestibular = vestibulococclear nerve (CN VIII)

97
Q

What supplies mixed innervation to the ear?

A

Cervical root branches
Cn V - trigeminal
CN IX - glossopharyngeal
CN X - vagus

98
Q

What are potential complications of infection or trauma to the ear?

A

Intracranial sepsis
Facial nerve damage
Deafness
Dizziness

99
Q

What is the internal auditory meatus?

A

Junction of inner ear to brainstem

1cm long bony canal CN VII and CNVIII

100
Q

What is the internal auditory meatus the clinical site of?

A

Acoustic neuroma

Vestibular schwannoma

101
Q

What are the main things that affect hearing?

A 
Wax/physical obstructions
>Minimal unless impinging on TM
TM perforation
>relatively small
Loss of ossicular continuity
>Very large effect
102
Q

What is the types of hearing loss?

A

Conductive

Sensioneural

103
Q

How does the cochlea hear sound?

A

Hairs within organ of corti produce electrical activity via vibrations
>Transmitted by endolymph and perilymph
Activity becomes neural impulse and travels to brain

104
Q

How is balance interpreted?

A

Via vestibule and semicircular canals
Hair cells + otoconia produce electricla activity
>Becomes neural impulse

105
Q

What are the three semicircular canals?

A

Lateral
Posterior
Superior

Connected via saccule and utricle

106
Q

How is loudness interpreted by the ear?

A

Produces increased intensity for increased loudness
0 decibals minimum hearing
Pain at 130

107
Q

How is pitch interpreted by the ear?

A

500-2000Hz - range of speech
Due to turns in cochlea
>Basal turn - high freq
>Apical turn low freq

108
Q

What is audiometry?

A

Subjective test which measures amplitude or intensity of sound and frequency in the ear

109
Q

What is tympanometry?

A

Measure of tympanic membrane compliance involving middle ear and ear canal pressureBecause of Eustachian tube function
canal pressure should = middle ear pressure

110
Q

What is tympanometry useful to diagnose?

A

Eustachian tube dysfunction

Middle ear effusion (glue-ear)

111
Q

What pitches tend to be lost in conductive + sensioneural loss?

A

Conductive - low notes lost

Sensorioneural - high notes lost

112
Q

Why is sound input important in children?

A

Key in development of auditory complex
Links to speech cortex

Children born deaf in one ear will grow up with element of auditory cortex “adaptation”
Severely deaf - unable to develop normal speech
If prfound deaf, never speak unless achieved before age of 4

Conditions + definitions (68 decks)

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