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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
Q

What does calcitonin do?

A

Calcitonin acts to lower calcium and raise phosphate

This is to counter the actions of the para-thyroid hormone

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26
Q

Identify the parts of the thyroid glands anatomy if you fancy it

A
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27
Q

What is a thyroglossal cyst?

A

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
Q

Where are thyroglossal cysts located?

A

In the midline of the neck

  • most common cause of midline neck masses

Usually just below the Hyoid bone

29
Q

What is a common complication of thryoglossal cysts?

A

Infection

30
Q

How would a thryoglossal cyst present?

A

Neck mass that has grown with age

Moves on tongue protrusion

31
Q

How are thyroglassal cysts investigated and treated?

A

Ultrasound scan - prior to removal to ensure function thyroid tissue remains

Removed surgically (excised) - still chance of recurrence however

32
Q

What is a solitary thyroid nodule?

A

A palpably discrete swelling within an otherwise apparently normal gland

Usually a benign lesion but must be investigated to check for cancers etc

33
Q

What are causes of solitary thyroid nodules?

A

Cysts:

  • Due to localised haemorrhage

Adenoma:

  • Benign follicular tissue

Carcinoma

Lymphoma

Multi-nodular goitre (with prominent nodule)

34
Q

Who is most likely to get solitary thyroid nodules?

A

F > M

30-40 years

50% malignant in young people

10% malignant in middle aged people

35
Q

How is a solitary thyroid nodule investigated?

A

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
Q

What are the types of thyroid cancer?

A

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
Q

What are causes of diffuse thyroid enlargement?

A

Colloid Goitre

Grave’s disease

Thyroiditis

38
Q

What is colloid goitre and what causes it?

A

Benign, non-cancerous enlargement of the thyroid tissue

Due to:

  • Gland hyperplasia
  • iodine deficiency
  • puberty, pregnancy & lactation
39
Q

What is Grave’s disease?

A

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
Q

How does Grave’s disease present?

A

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
Q

How is Grave’s disease treated?

A

Anti-thyroids - Reduce thyroid production

Beta-blockade

Radio-iodine therapy

Surgery - thyroidectomy if indicated

42
Q

What are the indications for a thyroidectomy?

A
  • Airway obstruction
  • Malignancy or suspected malignancy
  • Thyrotoxicosis
  • Cosmesis
    • Surgery to restore normal appearance
  • Retrosternal extension
43
Q

What are the possible complications of a thyroidectomy?

A

Bleeding - primary or secondary

Voice hoarseness

Thyroid storm

  • HR, BP, Body temp get high as a kite

Infection

Hypoparathyroidism

Hypothyroidism

Scar (keloid/ hypertrophic)

44
Q

What causes Multi-nodular goitre?

A

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
Q

How is multi-nodular goitre investigated?

A

Thyroid function tests

FNAC

CXR

46
Q

Tell me about the parathyroid glands

A
  • Usually 4 of them
  • Regulate calcium and phosphate levels
  • Located posteriorly to the poles of the thyroid
  • Can be injured in neck surgery
47
Q

What is the most common disease of the parathyroid glands?

A

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
Q

Hyperparathyroidism causes a group of symptoms which are collectively known as what?

A

Moans, Stones, Groans & Bones

49
Q

What are the symptoms of hyperparathyroidism/parathyroid disease?

A

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
Q

How is parathyroid disease investigated?

A

U&Es, creatinine, calcium, phosphate

Parathyroid hormone, bicarbonate

Vitamin D

Ultrasound scan

CT/MRI: identify ectopic glands

Isotope scanning: detect diseased glands

51
Q

When is surgery indicated for parathyroid disease?

A

Only for Hyperparathyroidism

52
Q

What are the causes of hyperparathyroidism?

A

Adenoma (most common)

Hyperplasia of them

Malignancy (rare)

53
Q

Whats the difference between primary and secondary hyperparathyroidism?

A

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
Q

Describe the surgical approach to treating parathyroid disease

A

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
Q

What are the 4 fascial layers of the neck?

A

Pre-tracheal

Pre-vertebral

Deep cervical

Carotid sheath

56
Q

Identify the labels if you can be bothered

A
57
Q

What is a tracheostomy?

A

Procedure where a tube is inserted into the trachea through a cut in the cricothyroid membrane

58
Q

What are the indications for a tracheostomy?

A

Airway obstruction

Airway protection

Poor ventilation to reduce dead space

59
Q

What are the types of Stridor and the obstruction locations that cause them?

A

Inspiratory - laryngeal

Expiratory - tracheobronchial

Biphasic – glottic/subglottic

60
Q

How is stridor treated?

A

Oxygen

Nebulised Adrenaline

IV Dexamethasone

(Heliox)

(Definitive) airway management

61
Q

What is a branchial cyst?

A

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
Q

What is a pharyngeal pouch?

A

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

63
Q

How does a pharyngeal pouch present?

A

Voice hoarseness

Regurgitation

Dysphagia

Weight loss

Aspiration pneumonia

Neoplasia 1%

64
Q

How is a pharyngeal pouch investigated and treated?

A

Barium swallow

excision (endoscopic or open); dilate

65
Q
A

Yr2 Head and neck MA (5 decks)

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