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Systems: Head and Neck AB > Neck > Flashcards

Neck Flashcards

1
Q

What are the anatomical content of the neck?

A
  • Arteries
  • Veins
  • Nerves
  • Lymph nodes
  • Lymphatic channels
  • Thyroid gland
  • Parathyroid glands
  • Muscles
  • Trachea
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2
Q

What is the superior boundary of the neck?

A

Mandible

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3
Q

What is the anterior boundary of the neck?

A

Anterior midline

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4
Q

What is the inferior boundary if the neck?

A

Clavicle

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5
Q

What is the posterior boundary of the neck?

A

Trapezius

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6
Q

What is the anterior and posterior boundary of the anterior triangle?

A
  • Anterior: midline of the neck

- Posterior: anterior border of sternocleidomastoid

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7
Q

What is the anterior and posterior boundary of the posterior triangle?

A

Anterior: posterior border of sternocleidomastoid
Posterior: anterior border of trapezius

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8
Q

What are the contents of the anterior triangle?

A
  • Common carotid artery
  • External carotid artery
  • Facial artery
  • Hypoglossal nerves
  • Vagus nerves
  • Glossopharyngeal nerves
  • Submadibular nodes
  • Submental nodes
  • Internal carotid artery
  • Internal jugular vein
  • Facial vein-Accessory nerves
  • Laryngeal nerves
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9
Q

What are the contents of the posterior triangle?

A
  • Accessory nerve
  • Occipital artery
  • Lymph nodes
  • Cervical nerve plexus
  • External jugular vein
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10
Q

What is the main artery supplying the head and neck?

A

Common carotid artery

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11
Q

At what vertebral level does the common carotid artery divide?

A

C4

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12
Q

What is the only artery with branches in the neck?

A

External carotid artery

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13
Q

What are the branches of the external carotid artery?

A

-Superior thyroid
-Ascending pharyngeal
Lingual
-Occipital
-Facial
-Posterior auricular
-Maxillary
-Superficial temporal

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14
Q

Give examples of indications for central lines.

A
  • Central venous pressure
  • Drug administration
  • Cardiac pacing
  • Blood sampling
  • Fluid resuscitation
  • Haemodialysis
  • Intravenous nutrition
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15
Q

What are the possible complications of central lines?

A
  • Pneumothorax
  • Haematoma
  • Cardiac tamponade
  • Air embolism
  • Chylothorax
  • False passage
  • Thrombosis
  • Sepsis
  • Line blockage
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16
Q

How many lymph nodes are there in the head and neck?

A

600

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17
Q

What do the lymph nodes receive?

A
  • Lymph

- Tissue waste product

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18
Q

Where do the lymph nodes of the head and neck drain to?

A

Cisterna chyli then drain to thoracic duct on left

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19
Q

How are lymph nodes described?

A

In groups and levels

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20
Q

How are the lymph nodes described in terms of levels?

A
  • I and IV anterior to sternocleidomastoid muscle
  • II, III and IV down the sternocleidomastoid muscle
  • V posterior to the sternocleidomastoid muscle
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21
Q

What do the parotid lymph nodes drain?

A
  • Scalp
  • face
  • Parotid gland
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22
Q

What do the occipital nodes drain?

A

Scalp

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23
Q

What do the superficial cervical nodes drain?

A
  • Breast

- Solid viscera

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24
Q

What do the deep cervical nodes drain?

A

Final drainage pathway to thoracic duct

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25
Q

What do the submandibular nodes drain?

A
  • Tongue
  • Nose
  • Paranasal sinuses
  • Submandibular gland
  • Oral cavity
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26
Q

What do the submental nodes drain?

A
  • Lips

- Floor of mouth

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27
Q

What do the supraclavicular nodes drain?

A
  • Breast
  • Oesophagus
  • Solid viscera
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28
Q

What are the 3 categories of causes of lymphadenopathy?

A
  • Infective
  • Inflammatory
  • Malignant
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29
Q

What type of gland is the thyroid gland?

A

Endocrine

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30
Q

What is the structure of the thyroid gland?

A

2 lobes joined by isthmus

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31
Q

What does the thyroid gland produce?

A
  • Thyroid hormone

- Calcitonin

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32
Q

What does calcitonin do?

A

Acts to lower calcium and raise phosphate

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33
Q

Thyroglossal cyst

A

Dilatation of thyroglossal duct remnant

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34
Q

What can happen to a thyoglossal cyst?

A

Can become infected

35
Q

How does a thyroglossal cyst appear?

A
  • Midline
  • Grows with age
  • Moves on tongue protrusion
36
Q

What is needed before removal of a thyroglossal cyst?

A

Ultrasound scan to ensure functioning thyroid tissue elsewhere

37
Q

What may a thyroid mass be?

A
  • Solitary nodule
  • Diffuse enlargement
  • Multi-nodular goitre
38
Q

What may a solitary thyroid nodule be?

A
  • Cyst due to localised haemorrhage
  • Adenoma (benign follicular tissue)
  • Carcinoma
  • Lymphoma
  • Prominent nodule in multi-nodular goitre
39
Q

What is the prevalence of solitary thyroid nodules?

A
  • F>M
  • 30-40 years
  • 10% malignant in middle-aged
  • 50% malignant in young
40
Q

How should a solitary thyroid nodule be investigated?

A
  • Fine needle aspiration cytology

- Ultrasound

41
Q

What can FNAC not distinguish between?

A

A follicular adenoma and a follicular carcinoma

42
Q

How is a tissue acquired for histological diagnosis of solitary thyroid nodule?

A

Thyroid lobectomy

43
Q

How does papillary thyroid cancer present?

A

Lymphatic metastasis

44
Q

How does follicular thyroid cancer present?

A

Haematogenous metastasis

45
Q

How do medullary thyroid cancers present?

A
  • Familial association

- 10% arise from parafollicular C cells

46
Q

How do anaplastic thyroid cancers present?

A
  • Aggressive
  • Local spread
  • Very old
  • Poor prognosis
47
Q

What may colloid goitre be due to?

A
  • Gland hyperplasia
  • Iodine deficiency
  • Puberty
  • Pregnancy
  • Lactation
48
Q

What may a diffuse thyroid enlargement be due to?

A
  • Colloid goitre
  • Grave’s disease
  • Thyroiditis
49
Q

What is the prevalence of Grave’s disease?

A

F>M

50
Q

Why does hyperthyroidism occur with Grave’s disease?

A

Auto-antibodies against thyroid stimulating hormone receptor stimulate receptor

51
Q

What are the signs of Grave’s disease?

A
  • Thyroid eye disease
  • Acropathy/clubbing
  • Pre-tibial myxoedema
52
Q

What is the treatment for Grave’s disease?

A
  • Anti-thyroids
  • B blockade
  • Radio-iodine
  • Surgery
53
Q

What are the indications for a thyroidectomy?

A
  • Airway obstruction
  • Malignancy or suspected malignancy
  • Thyrotoxicosis
  • Cosmesis
  • Retrosternal extension
54
Q

What are the complications of a thyroidectomy?

A
  • Bleeding (primary or secondary)
  • Voice hoarseness
  • Thyroid storm
  • Infection
  • Hypoparathyroidism
  • Hypothyroidism
  • Scar (keloid/hypertrophic)
55
Q

What can multi-nodular goitre be due to?

A
  • Grave’s disease

- Toxic goitre

56
Q

What is the typical patient of multi-nodular goitre due to Grave’s?

A
  • Female
  • Middle ages
  • Over activity leading to hyperthyroidism
57
Q

What is the typical patient of multi-nodular goitre due to toxic goitre?

A
  • Older
  • No eye signs
  • Atrial fibrillation
58
Q

What investigations should be carried out fro multi-nodular goitre?

A
  • Thyroid function tests
  • FNAC
  • CXR
59
Q

How many parathyroid glands do you usually have?

A

4

60
Q

What do parathyroid glands do?

A

Regulate calcium and phosphate levels

61
Q

Where are the parathyroid glands located?

A

Posterior to poles of thyroid

62
Q

When can parathyroid glands be injured?

A

Neck surgery

63
Q

What are the signs of parathyroid disease?

A
  • Painful stones
  • Aching bones
  • Psychic moans
  • Abdominal groans
64
Q

How can parathyroid disease manifest itself in relation to painful stones?

A
  • Renal calculi
  • Polyuria
  • Renal failure
65
Q

How can parathyroid disease manifest itself in relation to aching bones?

A
  • Pathological fractures
  • Osteoporosis
  • Bone pain
66
Q

How can parathyroid disease manifest itself in relation to abdominal groans?

A
  • Abdominal pain
  • Constipation
  • Peptic ulceration
  • Pancreatitis
  • Weight loss
67
Q

How can parathyroid disease manifest itself in relation to psychic moans?

A
  • Anxiety and depression
  • Confusion
  • Paranoia
68
Q

What investigations are important in parathyroid disease?

A
  • U+Es
  • Creatinine
  • Calcium
  • Phosphate
  • Parathyroid hormone
  • Bicarbonate
  • Vitamin D
  • US
  • CT/MRI to identify ectopic glands
  • Isotope scanning to detect disease glands
69
Q

When is the only time surgery is indicated in parathyroid disease?

A

Hyperparathyroidism

70
Q

What can cause hyperparathyroidism?

A
  • Adenoma
  • Hyperplasia
  • Malignancy (rare)
71
Q

Why is hyperplasia common in secondary hyperparathyroidism?

A

Due to low calcium

72
Q

What is the management for parathyroid disease?

A
  • Medical treatment
  • Surgery if patient is fit
  • Remove single adenomas
  • Remove multiple adenomas
  • Remove 3 or 3.5 hyperplastic glands through neck exploration
  • Carcinomas removed with thyroid gland and lymph nodes
73
Q

What are the 4 fascial layers of the neck?

A
  • Pre-tracheal
  • Pre-vertebral
  • Deep cervical
  • Carotid sheath
74
Q

What are the indications for a tracheostomy?

A
  • Airway obstruction
  • Airway protection
  • Poor ventilation to reduce dead space
75
Q

What is needed after a tracheostomy is fitted?

A

-Suctioning
-Humidification
Long term care

76
Q

What can the timing of stridor tell you about the site of airway obstruction?

A
  • Inspiratory: laryngeal
  • Extrinsic: tracheobronchial
  • Biphasic: glottis/subglottic
77
Q

Stridor

A

Clinical sign of airway obstruction

78
Q

How is stridor treated?

A

-O2
-Nebulised adrenaline
IV Dexamethasone
-Airway management

79
Q

Brachial cyst

A

Remnant of fusion failure of branchial arches or lymph node cystic degeneration

80
Q

Where do branchial cysts occur?

A

Anterior to sternocleidomastoid at junction between upper and middle thirds

81
Q

Why are brachial cysts excised?

A

To prevent further infection

82
Q

Pharyngeal pouch

A

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

83
Q

What are the signs of pharyngeal pouches?

A
  • Voice hoarseness
  • Dysphagia
  • Aspiration pneumonia
  • Regurgitation
  • Weight loss
  • Neoplasia
84
Q

What is the treatment for pharyngeal pouches?

A
  • Barium swallow
  • Excision (endoscopic or open)
  • Dilate

Systems: Head and Neck AB (15 decks)

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