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H+N - C > Neck Anatomy and Physiology > Flashcards

Neck Anatomy and Physiology Flashcards

1
Q

What are the indications for a central line?

A 
Central venous pressure
Drug administration
Cardiac pacing
Blood sampling
Fluid resuscitation
Haemodialysis
IV nutrition
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2
Q

What are the complications of a central line?

A 
Pneumothorax
Haematoma
Cardiac Tamponade
Air embolism
Chylothorax
False passage
Thrombosis
Sepsis
Line blockage
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3
Q

What is a thyroglossal cyst?
How do you test for one in clinical examination?
What is its management?

A

Dilation of thyroglossal duct remnant
May become infected
Midline; grows with age

Moves on tongue protrusion

Need ultrasound scan prior to removal to ensure functioning thyroid tissue elsewhere

Excised but chance of recurrence

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4
Q

What are some of the causes of a solitary thyroid nodule?

A 
Cyst: due to local haemorrhage
Adenoma: benign follicular tissue
Carcinoma
Lymphoma
Prominent nodule in multi-nodular goitre
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5
Q

What is the epidemiology of solitary thyroid nodule?

A

F>M
30-40 years
10% malignant in middle-aged,
50% malignant in young

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6
Q

How do you investigate a solitary thyroid nodule?

A

Investigate by Fine Needle Aspiration Cytology (FNAC) AND ultrasound scan

FNAC CANNOT distinguish between a follicular adenoma and a follicular carcinoma

Therefore tissue required for histological diagnosis
Thyroid lobectomy

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7
Q

What are the different types of thyroid cancer?

A

Papillary - lymphatic metastasis
Follicular - haematogenous metastasis
Medullary - familial association 10%, arise parafollicular C cells
Anaplastic - aggressive, local spread, very old, poor prognosis

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8
Q

What are some reasons for diffuse thyroid enlargement?

A

Colloid goitre:

  • Due to gland hyperplasia
  • Iodine deficiency
  • Puberty, pregnancy, lactation

Graves disease

Thyroiditis

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9
Q

What is Grave’s Disease?

A

F>M

Autoantibodies against thyroid stimulating hormone receptor
This activates the receptor
Hyperthyroidism

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10
Q

What are the sign’s for Grave’s Disease?

A

Thyroid eye disease
Acropathy/ clubbing
Pre-tibial myxodema

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11
Q

What are the treatments for Grave’s Disease?

A

Anti-thyroids
beta-blockade
radio-iodine
Surgery

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12
Q

What are the indications for a thyroidectomy?

A 
Airway obstruction
Malignancy or suspected malignancy
Thyrotoxicosis
Cosmetics
Retrosternal extension
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13
Q

What are the complications of a thyroidectomy?

A 
Bleeding-primary or secondary
Voice hoarseness
Thyroid storm
Infection
Hypoparathyroidism
Hypothyroidism
Scar (keyloid/hypertrophic)
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14
Q

Explain multi-nodular Goitre

A

Due to Grave’s disease or toxic goitre

Grave’s: Women, Middle-aged, Overactivity (hyperthyroidism)

Toxic Goitre: Older, No eye sign’s, atrial fibrillation

Thyroid function tests, FNAC, chest x-ray

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15
Q

What are the parathyroid glands?

A

Usually there are 4
Regulate calcium and phosphate levels
Located posterior to poles of thyroid
Can be injured in neck surgery

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16
Q

What can parathyroid disease cause?

A

PAINFUL STONES: Renal calculi, polyuria, renal failure

ACHING BONES: pathological fractures, osteoporosis, boan pain

PSYCHIC MOANS: Anxiety, depression, confusion, paranoia

ABDOMINAL GROANS: Abdominal pain, constipation, peptic ulceration, pancreatitis, weight loss

17
Q

What investigations can you carry out for Parathyroid disease?

A 
U+E, Creatinine, Calcium, Phosphate
Parathyroid hormone, Bicarbonate
Vitamin D
USS
CT/MRI: look for ectopic glands
Isotope scanning: detect disease glands

Surgery for Hyperparathyroidism ONLY

18
Q

What can hyperparathyroidism cause?

A

Adenoma: 80% hyperparathyroidism, single or multiple

Hyperplasia: 12 % of hyperparathyroidism
-Common in secondary hyperparathyroidism due to low calcium e.g. renal failure.

Malignancy (rare):

19
Q

What is the management for hyperparathyroidism?

A 
Management
Medical treatment
Surgery easier if patient fit
Remove single adenomas
Remove multiple adenomas too
Carcinomas removed with thyroid gland and lymph nodes
20
Q

What are the indications for tracheostomy?

A

Airway obstruction
Airway protection
Poor ventilation to reduce dead space

Need suctioning
Need humidification
Need long term care

21
Q

What is stridor?

A

Clinical sign of airway obstruction

  • Inspiratory = laryngeal
  • Expiratory = tracheobronchial
  • Biphasic = glottis/subglottic
22
Q

What is a branchial cyst?

A

Remnant of fusion failure of brachial arches OR lymph node cystic degeneration

Transilluminates
Anterior to sternocleidosatoid at junction between upper and middle thirds
Becomes infected, enlarged
Excised to prevent further infection

23
Q

What is a pharyngeal pouch?

A

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

24
Q

What are the clinical features of pharyngeal pouch?

A 
Voice hoarseness
Dysphagia
Aspiration pneumonia
Regurgitation
Weight loss
Neoplasia 1%
25
Q

How do you deal with pharyngeal pouch?

A

Barium swallow
Excision (endoscopic or open)
Dilate

26
Q

What do the parotid glands drain?

A

Scalp
Face
Parotid galnd

27
Q

What do the occipital nodes drain?

A

Scalp

28
Q

What do the superficial cervical nodes drain?

A

Breast and solid viscera

29
Q

What do the deep cervical nodes drain?

A

Final drainage pathway to thoracic duct

30
Q

What do the submandibular nodes drain?

A 
Tongue
Nose
Paranasal sinuses
Submandibular gland
Oral cavity
31
Q

What do the submental nodes drain?

A

Lips

Floor of mouth

32
Q

What do the supraclavicular nodes drain?

A

Breast
Oesophagus
Solid viscera

33
Q

What are the 3 causes of lymphadenopathy?

A

Infective
Inflammatory
Malignant

34
Q

What is myxoedema?

A

Myxedema or myxoedema is a term used synonymously with severe hypothyroidism. It is also used to describe a dermatological change that can occur in hypothyroidism, and some forms of hyperthyroidism

35
Q

What is pre-tibial myxoedema?

A

Pretibial myxedema (aka Graves Dermopathy) is an infiltrative dermopathy, resulting as a rare complication of Graves’ disease, with an incidence rate of about 1-5% in patients.

36
Q

How do you manage stridor?

A
  • Treat with O2
  • Nebulised Adrenaline
  • IV Dexamethasone
  • (Heliox)
  • (Definitive) Airway Management

H+N - C (17 decks)

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