Head & Neck

Question 1

Submandibular triangle

Answer 1

Anterior part of neck

Post: posterior belly of digastric m. and stylohyoid m.
Ant: anterior belly of digastric m.
Sup: inferior border of mandible

Contains submandibular (salivary) gland and LNs

Facial artery and vein pass through this area

Question 2

Submental triangle

Answer 2

Anterior part of neck

Inf: Hyoid bone
Post: anterior belly of digastric m.
Ant: midline of neck
Floor: mylohyoid m.

Contains submental LNs. Filter lymph from floor of mouth & parts of tongue

Question 3

Carotid triangle

Answer 3

Anterior part of neck

Sup: posterior belly of digastric m.
Ant: superior belly of omohyoid m.
Post: medial border of SCM

Contains CCA, bifurcation into ICA/ECA, IJV, hypoglossal and vagus nerves

Question 4

Muscular triangle

Answer 4

Anterior part of neck

Sup: hyoid bone
Ant: midline neck
Super/Post: Superior belly of omohyoid m.
Super/Inf: medial border of SCM

Contains infrahyoid m, pharynx, thyroid, parathyroid glands

Question 5

Anterior triangle of neck

Answer 5

Midline neck, medial border of SCM, mandible

Contains: submandibular, carotid, submental, and muscular triangles

Question 6

MEN 2

Answer 6

MEN 2A: MTC, pheo, Parathyroid hyperplasia
- Total thyroidectomy rec by age 6

MEN 2B: MTC, Marfanoid, pheo, mucosal neuromas, ganglioneuromas
- Total thyroidectomy rec by age 1

Question 7

MC side for non-recurrent laryngeal nerve

Answer 7

right

Question 8

Cause of L non-recurrent laryngeal nerve

Answer 8

right-sided aortic arch

Question 9

Cause of R non-recurrent laryngeal nerve

Answer 9

aberrant subclavian artery that runs behind esophagus (arteria lusoria)

Question 10

Dysphagia lusoria

Answer 10

Aberrant right subclavian artery coursing behind esophagus

dysphagia, chronic cough, unexplained ischemia of R arm

Question 11

Plane that divides right and left lobe of liver

Answer 11

Cantlie line
(Anatomic landmark) middle hepatic vein
Extends from GB fossa to IVC

Question 12

Lingual thyroid

Answer 12

posterior pharyngeal neck mass; incidental finding

located at base of tongue at location of foramen cecum

due to failure of descent by thyroid during embryologic development

Dx: radioiodine uptake scan (thyroid scintigraphy)

Question 13

DeQuervain Thyroiditis (Subacute Thyroiditis)

Answer 13

Affects W > M (3.5:1)
MC in younger pts
After URI
Neck pain, radiates to jaw
\+fevers, myalgias, malaise
Enlarged, painful thyroid
High T3/T4, Low TSH, High ESR/CRP, min uptake on radiouptake scan 
Tx: NSAIDs (1st), prednisone

Phase I: initial hyperthyroid phase - stored thyroid hormone released

Phase II: brief euthyroid phase, no new hormone made

Phase III: hypothyroid phase, high TSH, resume TH synthesis

Phase IV: euthyroid phase, full recovery

Question 14

Brachial Cleft Anomalies

Answer 14

Arise from 2nd pharyngeal arch
abnormal persistence of branchial apparatus
2nd MC neck anomaly found in kids

2nd brachial cleft cyst = MC branchial cleft anomaly

Tx: complete excision of mass and any fistulous tract

Question 15

Pleomorphic adenoma

Answer 15

Isolated, firm, round tumor, surrounded by capsule
MC benign tumor of salivary gland.
Rarely assoc w/ malignant transformation
90% affecting parotid gland lie superficial to facial nerve
Initial tx: superficial parotidectomy
Recurrence tx: radiation

Question 16

MC genetic alteration in thyroid cancer

Answer 16

BRAF V600E mutation

Assoc w/ increased recurrence and mortality

Question 17

MC genetic alteration in anaplastic thyroid cancer

Answer 17

BRAF V600E mutation

Question 18

FDA-approved meds for locally advanced/metastatic anaplastic thyroid cancers

Answer 18

Dabrafenib

Trametinib

Question 19

External branch of superior laryngeal nerve

Answer 19

Purely motor nerve. Innervates cricothyroid muscle (one of the intrinsic muscles of larynx)
Travels with superior thyroid artery. Separates ~1cm proximal to superior pole thyroid

SLN branch of RLN.

Question 20

Thyroglossal duct cyst

Answer 20

Remnant of thyroglossal duct. Connected foramen cecum to thyroid gland

Thyroid gland descends from foramen cecum at tongue base down to anatomic position in neck

Hyoid bone is MC location to find cyst

Best test: US & thyroid function test

Tx: remove cyst, tract, and central portion of hyoid bone (Sistrunk procedure)

Question 21

Recurrent laryngeal nerve relation to inferior thyroid artery

Answer 21

RLN runs anterior to inferior thyroid artery on R and posterior to inferior thyroid artery on L

Question 22

Course of RLN

Answer 22

Runs in tracheoesophageal groove posterior to thyroid lobe

RLN lies medial and anterior to superior parathyroid glands and then lateral and posterior to inferior thyroid glands.

Question 23

Exposure of penetrating neck injury with suspected tracheal injury

Answer 23

Initial incision along anterior border of SCM muscle

1) exposes carotid sheath, pharynx, cervical esophagus
2) lengthened if necessary
3) bilateral exploration w/ separate SCM incisions then connected inferiorly in U-shape

Raising flap in subplatysmal plane, allows exposure to every structure in neck