Neck Flashcards
What is the superior border of the neck?
Mandible
What is the inferior border of the neck?
Clavicle
What is the anterior border of the neck?
Anterior midline
What is the posterior border of the neck?
Trapezius
What is the anterior and posterior borders of the anterior triangle?
Anterior = midline of neck Posterior = anterior border of sternocleidomastoid
What is the anterior and posterior borders of the posterior triangle?
Anterior = posterior border of sternocleidomastoid Posterior = anterior border of trapezius
Which arteries are in the anterior triangle?
Common carotid
External carotid
Internal carotid
Facial
Which veins are in the anterior triangle?
Internal jugular
Facial
Which nerves are in the anterior triangle?
Hypoglossal Vagus Glossopharyngeal Accessory Laryngeal
Which lymph nodes are in the anterior triangle?
Submandibular
Submental
Which nerves are in the posterior triangle?
Accessory
Cervical nerve plexus
Which blood vessels are in the posterior triangle?
Occipital artery
External jugular vein
Which level does the common carotid artery divide?
C4
What are the branches of the external carotid artery?
Superior thyroid Ascending pharyngeal Lingual Occipital Facial Posterior auricular Maxillary Superficial temporal
What are central lines used for?
Central venous pressure Drug administration Cardiac pacing Blood sampling Fluid resuscitation Haemodialysis IV nutrition
What are the complications of central lines?
Pneumothorax Haematoma Cardiac tamponade Air embolism Chylothorax False passage Thrombosis Sepsis Line blockage
Where do the lymph nodes in the neck drain to?
Cisterna chyli then to thoracic duct (left)
What do the parotid nodes drain?
Scalp
Face
Parotid gland
What do the occipital nodes drain?
Scalp
What do the superficial cervical nodes drain?
Breast
Solid viscera
What do deep cervical nodes drain?
Final drainage pathway to thoracic duct
What do submandibular nodes drain?
Tongue Nose Paranasal sinuses Submandibular gland Oral cavity
What do submental nodes drain?
Lips
Floor of mouth
What do supraclaviculas nodes drain?
Breast
Oesophagus
Solid viscera
What type of gland is the thyroid?
Endocrine
What is the structure of the thyroid gland?
2 lobes (left and right) Joined by isthmus
What does the thyroid gland produce?
Thyroid hormone
Calcitonin
What is the role of calcitonin?
Acts to lower calcium and raise phosphate
What is a thyroglossal cyst?
Dilatation of thyroglossal duct remnant
What are the causes of a solitary thyroid nodule?
Cyst (localised haemorrhage)
Adenoma (benign follicular tissue)
Carcinoma
Lymphoma
How is investigation of a solitary thyroid nodule done?
Fine-needle aspiration cytology AND USS
What are the different types of thyroid cancer?
Papillary = lymphatic metastasis Follicular = haematogenous metastasis Medullary = familial association Anaplastic = aggressive, local spread
What are the causes of diffuse thyroid enlargement?
Colloid goitre (gland hyperplasia, iodine deficiency, puberty, pregnancy, lactation)
Grave’s disease
Thyroiditis
What is Grave’s disease?
When auto-antibodies against thyroid-stimulating hormone receptor stimulates receptor = hyperthyroidism
What is the treatment for Grave’s disease?
Anti-thyroids
Beta-blockage
Radio-iodine
Surgery
What are the indications for a thyroidectomy?
Airway obstruction Malignancy or suspected malignancy Thyrotoxicosis Cosmesis Retrosternal extension
What are the complications of a thyroidectomy?
Bleeding (primary or secondary) Voice hoarseness Thyroid storm Infection Hypoparathyroidism Hypothyroidism Scar
What is a multi-nodular goitre?
Due to Grave’s disease or toxic goitre
What investigations are done for multi-nodular goitre?
Thyroid function tests
FNAC
CXR
What is the role of parathyroid glands?
Regulate calcium and phosphate levels
What are the signs of parathyroid disease?
Renal calculi, polyuria, renal failure
Pathological fractures, osteoporosis, bone pain
Abdominal pain, constipation, peptic ulceration, pancreatitis, weight loss
Anxiety, depression, confusion, paranoia
What are the investigations for parathyroid disease?
U+Es, creatinine, calcium, phosphate
Parathyroid hormone, bicarbonate, vitamin D, USS, CT/MRI (identify ectopic glands), isotope scanning (detect diseased glands)
Surgery (ONLY for hyperparathyroidism)
What are the causes for hyperparathyroidism?
Adenoma
Hyperplasia (12%)
Malignancy (rare)
How is parathyroid disease managed?
Medical treatment
Surgery
Remove single/multiple adenomas
Remove 3 or 3.5 hyperplastic glands through neck exploration
Carcinomas removed with thyroid gland and lymph nodes
What are the 4 fascial layers of the neck?
Pre-tracheal
Pre-vertebral
Deep cervical
Carotid sheath
What are the indications for a tracheostomy?
Airway obstruction
Airway protection
Poor ventilation to reduce dead space
What is the sign of laryngeal obstruction?
Inspiratory stridor
What is the sign of tracheobronchial obstruction?
Expiratory stridor
What is the sign of glottic/subglottic obstruction?
Biphasic stridor
How is stridor treated?
O2
Nebulised adrenaline
IV dexamethasone
What is a branchial cyst?
Remnant of fusion failure of branchial arches OR lymph node cystic degeneration
What is a pharyngeal pouch?
Herniation of pharyngeal mucosa between thryopharyngeus and cricopharyngeus muscles of the inferior constrictor of the pharynx
What are the signs of a pharyneal pouch?
Voice hoarseness Dysphagia Aspiration pneumonia Regurgitation Weight loss Neoplasia (1%)
