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Yr2 Head and neck MA > Neck > Flashcards

Neck Flashcards

1
Q

What are the boundaries of the neck?

A

Mandible

Anterior midline

Trapezius

Clavicle

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2
Q

The neck can be divided into anterior and posterior triangles.

What are the boundaries of the anterior triangle?

A

Midline of the neck

Anterior border of the SCM

Mandible

Very top of manubrium

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3
Q

What are the boundaries of the posterior triangle of the neck?

A

Posterior border of SCM

Anterior border of trapezius

Clavicle

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4
Q

What are the contents of the anterior triangle?

Theres fkn tons so just overview

A

Arteries:

  • Common, External and internal carotid
  • Facial

Veins:

  • Internal jugular
  • Facial

Nerves:

  • Hypoglossal nerves
  • Vagus nerves CN X
  • Accessory nerves CN XI
  • Laryngeal nerves
  • Glossopharyngeal nerves

Lymphatic:

  • Submandibular nodes
  • Submental nodes
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5
Q

What are the contents of the posterior triangle of the neck?

A

Accessory nerve (CN XI)

Cervical nerve plexus

Occipital artery

External jugular vein

Lymph nodes

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6
Q

At what level does the common carotid divide?

A

C4

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7
Q

What branches of the internal carotid are given off in the neck?

A

Prankd

Only the external carotid gives off branches in the neck

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8
Q

What branches of the External carotid are given off in the neck?

A
  • Superior thyroid
  • Ascending pharyngeal
  • Lingual
  • Occipital
  • Facial
  • Posterior auricular
  • Maxillary
  • Superficial temporal
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9
Q

Identify these veins

A
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10
Q

What is a Central line?

A

Aka Central venous catheter

Catheter placed into a large vein. Catheters can be placed in veins in the neck (internal jugular vein), chest (subclavian vein or axillary vein) + other places on the body

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11
Q

What are the indications for using a central line?

A

Central venous pressure

Fluid resuscitation

Drug administration

Haemodialysis

Cardiac pacing

Intravenous nutrition

Blood sampling

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12
Q

What are the possible complications of Central lines?

A

Pneumothorax

Air embolism

Thrombosis

Haematoma

Chylothorax

Sepsis

Cardiac tamponade

False passage

Line blockage

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13
Q

Give an overview of the lymphatic drainage of the head and neck

A

600 lymph nodes in the head and neck (mainly neck)

Receive lymph/ tissue waste product

Drain to cisterna chyli

Then drain to thoracic duct on left

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14
Q

Identify the lymph node groups of the head and neck

A
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15
Q

Lymph node placements are described in both levels and groups (submental etc)

What are the lymph node levels?

A
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16
Q

What parts of the face drain to the Parotid nodes?

A

Scalp, face & parotid gland

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17
Q

Where does the occipital nodes receive lymph from?

A

Scalp

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18
Q

Where do the superficial cervical nodes drain?

A

Breast & solid viscera

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19
Q

What is the function of the deep cervical nodes?

A

Final drainage pathway to thoracic duct

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20
Q

What areas drain to the submandibular and submental nodes respectively?

A

Submandibular:

  • tongue, nose, paranasal sinuses, submandibular gland, oral cavity

Submental:

  • Lips & floor of mouth
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21
Q

What areas drain to the Supraclavicular nodes?

A

breast, oesophagus, solid viscera

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22
Q

What are the broad categories of lymphadenopathy?

A

Infective

Inflammatory

Malignant

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23
Q

What is the function of the thyroid?

A

Produce thyroid hormone & Calcitonin

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24
Q

What does thyroid hormone do?

A

Primarily responsible for the regulation of metabolism

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25
What does calcitonin do?
Calcitonin acts to lower calcium and raise phosphate This is to counter the actions of the para-thyroid hormone
26
Identify the parts of the thyroid glands anatomy if you fancy it
27
What is a thyroglossal cyst?
a fibrous cyst that forms from a persistent thyroglossal duct Thyroglossal cysts can be defined as an irregular neck mass or a lump which develops from cells and tissues left over after the formation of the thyroid gland during developmental stages
28
Where are thyroglossal cysts located?
In the midline of the neck * most common cause of midline neck masses Usually just below the Hyoid bone
29
What is a common complication of thryoglossal cysts?
Infection
30
How would a thryoglossal cyst present?
Neck mass that has grown with age Moves on tongue protrusion
31
How are thyroglassal cysts investigated and treated?
Ultrasound scan - prior to removal to ensure function thyroid tissue remains Removed surgically (excised) - still chance of recurrence however
32
What is a solitary thyroid nodule?
A palpably discrete swelling within an otherwise apparently normal gland Usually a benign lesion but must be investigated to check for cancers etc
33
What are causes of solitary thyroid nodules?
_Cysts_: * Due to localised haemorrhage _Adenoma_: * Benign follicular tissue Carcinoma Lymphoma Multi-nodular goitre (with prominent nodule)
34
Who is most likely to get solitary thyroid nodules?
F \> M 30-40 years 50% malignant in young people 10% malignant in middle aged people
35
How is a solitary thyroid nodule investigated?
**Fine-needle aspiration cytology (FNAC)** AND **ultrasound scanning** **Thyroid Lombectomy** needed for a cancer diagnosis - FNAC can not differentiate between follicular adenoma or follicular carcinoma
36
What are the types of thyroid cancer?
_Papillary_: * Most common (~80%) with pretty good prognosis * Tends to metastasize to nearby lymph nodes _Follicular_: * More likely to spread to organs elsewhere in the body via **Haematogeous spread** _Medullary_: * Familial association * Arises from C cells _Anaplastic_: * Local spreading & aggressive * Poor prognosis but rare
37
What are causes of diffuse thyroid enlargement?
Colloid Goitre Grave's disease Thyroiditis
38
What is colloid goitre and what causes it?
Benign, non-cancerous enlargement of the thyroid tissue Due to: * Gland hyperplasia * iodine deficiency * puberty, pregnancy & lactation
39
What is Grave's disease?
Auto-immune disease of the thyroid which causes Hyperthyroidism & enlargement... * Auto-antibodies against thyroid-stimulating hormone receptor stimulate receptor Also known as Toxic diffuse goitre F \> M
40
How does Grave's disease present?
**_Thyroid eye disease/exophthalmos_** * Anterior swelling/displacement of eyes _**Diffuse palpable goitre** (often with bruit)_ _Acropachy / Clubbing_ * Swelling of hands _Pre-tibial Myxoedema_ * Swelling of skin with a waxy look Vague symptoms include Fatigue, Tremor, tachycardia
41
How is Grave's disease treated?
Anti-thyroids - Reduce thyroid production Beta-blockade Radio-iodine therapy Surgery - thyroidectomy if indicated
42
What are the indications for a thyroidectomy?
* Airway obstruction * Malignancy or suspected malignancy * Thyrotoxicosis * Cosmesis * Surgery to restore normal appearance * Retrosternal extension
43
What are the possible complications of a thyroidectomy?
Bleeding - primary or secondary Voice hoarseness Thyroid storm * HR, BP, Body temp get high as a kite Infection Hypoparathyroidism Hypothyroidism Scar (keloid/ hypertrophic)
44
What causes Multi-nodular goitre?
Grave's disease or Toxic goitre _Grave's disease_ - tend to be women, middle-aged with hyperthyroidism and eye signs _Toxic Goitre_ - Older, no eye signs, A-fib
45
How is multi-nodular goitre investigated?
Thyroid function tests FNAC CXR
46
Tell me about the parathyroid glands
* Usually 4 of them * Regulate calcium and phosphate levels * Located posteriorly to the poles of the thyroid * Can be injured in neck surgery
47
What is the most common disease of the parathyroid glands?
_Hyperparathyroidism_ * Overactivity of one or more of the glands * Too much parathyroid hormone is produced * it leads to hypercalcemia which in turn leads to a bunch of shit
48
Hyperparathyroidism causes a group of symptoms which are collectively known as what?
Moans, Stones, Groans & Bones
49
What are the symptoms of hyperparathyroidism/parathyroid disease?
_Stones (*relating to kidneys*):_ * **Renal calculi (kidney stones)**, Polyuria, Renal failure _Bones:_ * Fractures, **Osteoporosis**, bone pain/aches _Groans (*relating to abdomen*):_ * Abdo pain, constipation, peptic ulceration, pancreatitis, weight loss _Moans (*psychological):*_ * **Fatigue**, **Depression**, **memory loss**, anxiety, confusion, paranoia
50
How is parathyroid disease investigated?
U&Es, creatinine, calcium, phosphate Parathyroid hormone, bicarbonate Vitamin D Ultrasound scan CT/MRI: identify ectopic glands Isotope scanning: detect diseased glands
51
When is surgery indicated for parathyroid disease?
Only for Hyperparathyroidism
52
What are the causes of hyperparathyroidism?
**Adenoma** (most common) Hyperplasia of them Malignancy (rare)
53
Whats the difference between primary and secondary hyperparathyroidism?
_Primary hyperparathyroidism:_ * Calcium = HIGH * Parathyroid hormone = HIGH * Phosphate = HIGH _Secondary hyperparathyroidism:_ * Calcium = Normal * Parathyroid hormone = HIGH * Phosphate = HIGH Secondary hyperparathyroidism is more common with hyperplasia as the cause. Associated with renal failure.
54
Describe the surgical approach to treating parathyroid disease
Remove single adenomas & multiple adenomas too Remove 3 or 3.5 hyperplastic glands through neck exploration Carcinomas removed with thyroid gland and lymph nodes
55
What are the 4 fascial layers of the neck?
Pre-tracheal Pre-vertebral Deep cervical Carotid sheath
56
Identify the labels if you can be bothered
57
What is a tracheostomy?
Procedure where a tube is inserted into the trachea through a cut in the cricothyroid membrane
58
What are the indications for a tracheostomy?
Airway obstruction Airway protection Poor ventilation to reduce dead space
59
What are the types of Stridor and the obstruction locations that cause them?
Inspiratory - laryngeal Expiratory - tracheobronchial Biphasic – glottic/subglottic
60
How is stridor treated?
Oxygen Nebulised Adrenaline IV Dexamethasone (Heliox) (Definitive) airway management
61
What is a branchial cyst?
A congenital cyst that is a Remnant of fusion failure of branchial arches OR lymph node cystic degeneration If it becomes infected - it will enlarge Treated through excision Anterior to sternocleidomastoid at junction between upper and middle thirds
62
What is a pharyngeal pouch?
Herniation of pharyngeal mucosa between thyropharyngeus and cricopharyngeus muscles of the inferior constrictor of the pharynx
63
How does a pharyngeal pouch present?
Voice hoarseness Regurgitation Dysphagia Weight loss Aspiration pneumonia Neoplasia 1%
64
How is a pharyngeal pouch investigated and treated?
Barium swallow excision (endoscopic or open); dilate
65

Yr2 Head and neck MA (5 decks)

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