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Head and Neck (Year 2 GM) > Neck Anatomy and Physiology > Flashcards

Neck Anatomy and Physiology Flashcards

1
Q

What are the anatomical contents of the neck?

A

Arteries

Veins

Nerves

Lymph nodes

Lymphatic channels

Thyroid gland

Parathyroid glands

Muscles

Trachea

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2
Q

What are the superior and inferior boundaries of the neck?

A

Superior - mandible

Inferior - clavicle

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3
Q

What are the anterior and posterior boundaries of the neck?

A

Anterior - anterior midline

Posterior - trapezius

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4
Q

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

A

Anterior: midline of the neck

-Posterior: anterior border of sternocleidomastoid

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5
Q

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

A

Anterior: posterior border of sternocleidomastoid

-Posterior: anterior border of trapezius

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6
Q

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

A

Common carotid artery

Internal carotid artery

External carotid artery

Internal jugular vein

Facial artery

Facial vein

Hypoglossal nerves

Accessory nerves

Vagus nerves

Laryngeal nerves

Glossopharyngeal nerves

Submandibular nodes

Submental nodes

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7
Q

What are the contents of the posterior triangle?

A

Accessory nerve

Cervical nerve plexus

Occipital artery

External jugular vein

Lymph nodes

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8
Q

What are the branches of the ECA?

A

Some Anatomists Like Freaking Out Poor Medical Students

Superior thyroid

Ascending pharyngeal

Lingual

Facial

Occipital

Posterior auricular

Maxillary

Superficial temporal

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9
Q

What is meant by a central line?

A

an IV line that is inserted into a large vein (as the superior vena cava) typically in the neck or near the heart for therapeutic or diagnostic purposes (as to administer medicines or fluids or withdraw blood)

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10
Q

What are indications for central lines?

A

Central venous pressure

Fluid resuscitation

Drug administration

Haemodialysis

Cardiac pacing

Intravenous nutrition

Blood sampling

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11
Q

What are complications of central lines?

A

Pneumothorax

Air embolism

Thrombosis

Haematoma

Chylothorax

Sepsis

Cardiac tamponade

False passage

Line blockage

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12
Q

Where do the 600 lymph nodes in the head and neck drain>?

A

Receive lymph/ tissue waste product

Drain to cisterna chyli

Then drain to thoracic duct on left

Described in groups AND levels

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13
Q

What are the lymph node levels?

A

Level 1 – submental and submandibular

Upper 1 third, Middle 1 third, lower 1 third – levels of SCM – 2,3,4

5 – posterior triangle

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14
Q

What do the following lymph nodes drain?

Parotid nodes

Occipital nodes

Superficial cervical nodes

Deep cervical nodes

Submandibular nodes

Submental nodes

Supraclaviculas

A

Parotid nodes-scalp, face & parotid gland

Occipital nodes-scalp

Superficial cervical nodes-breast & solid viscera

Deep cervical nodes-final drainage pathway to thoracic duct

Submandibular nodes-tongue, nose, paranasal sinuses, submandibular gland, oral cavity

Submental nodes-lips, floor of mouth

Supraclaviculas nodes-breast, oesophagus, solid viscera

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15
Q

What are the types of lymphadenpathy?

A

INFECTIVE

INFLAMMATORY

MALIGNANT

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16
Q

What is the structure of the thyroid?

A

Endocrine gland

2 lobes, joined by isthmus

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17
Q

What does th thyroid hormone produce?

A

Produce thyroid hormone AND calcitonin

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18
Q

What is the effect of calcitonin?

A

Calcitonin acts to lower calcium and raise phosphate

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19
Q

What is a thyroglossal cyst?

A

Dilatation of thyroglossal duct remnant

May become infected

Midline; grows with age

Moves on tongue protrusion

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20
Q

What is the investigation and treatment for thyroglossal cyst?

A

Investigate by fine-needle aspiration cytology (FNAC) AND ultrasound scanning

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

Excised but chance of recurrence (sistrunk operation)

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21
Q

What are the causes of thyroid masses?

A

Solitary nodule

Diffuse enlargement

Multi-nodular goitre

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22
Q

What are the causes of soitary thyroid nodules?

A

Cyst: due to localised haemorrhage

Adenoma: benign follicular tissue

Carcinoma

Lymphoma

Prominent nodule in multi-nodular goitre

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23
Q

What is the epidaemiology of solitary thyroid nodule?

A

F>M

30-40 years

10% malignant in middle-aged, 50% malignant in young

24
Q

Why is tissue required for histological diagnosis of a follicular adenoma AND a follicular carcinoma?

A

FNAC CANNOT distinguish between a follicular adenoma AND a follicular carcinoma

Potential for thyroid lobectomy

25
What are the different forms of thyroid cancer?
Papillary-lymphatic metastasis Follicular-haematogenous metastasis Medullary-familial association 10%, arise from parafollicular C cells Anaplastic-aggressive, local spread, very old, poor prognosis
26
What are the causes of diffuse thyroid enlargement?
Colloid goitre Grave's disease Thyroiditis
27
What causes colloid goitre?
due to gland hyperplasia, iodine deficiency, puberty, pregnancy, lactation
28
What are common symptoms of diffuse thyroid enlargement?
Dysphagia (if pressing on oesophagus), SOB on exertion, tracheal pressure, choking when the patient raises their hands (retrosternal goitre)
29
What is Grave's disease?
A swelling of the neck and protrusion of the eyes resulting from an overactive thyroid gland.
30
Why does hyperthyroidism result from grave's disease?
Auto-antibodies stimulate the receptor that responds to thyroid stimulating hormone
31
What are features of Grave's disease?
Hyperthyroidism Thyroid eye disease Acropachy (soft tissue swelling of the hands and finger clubbing) Pre-tibial myxoedema - Skin lesions or areas of non-pitting edema appear on the anterior or lateral aspects of the legs or in sites of old or recent trauma in patients with Graves disease.
32
What are indications of thyroidectomy?
Airway obstruction Malignancy or suspected malignancy Thyrotoxicosis (another term for hyperthyroidism) Cosmesis Retrosternal extension
33
What are complications of thyroidectomy?
Bleeding-primary or secondary Voice hoarseness Thyroid storm (During thyroid storm, an individual's heart rate, blood pressure, and body temperature can soar to dangerously high levels.) Infection Hypoparathyroidism Hypothyroidism Scar (keloid/ hypertrophic)
34
What are the two causes of multi-nodular goitre?
Grave's disease or toxic goitre
35
What are the features of both causes of multi-nodular goitre?
_Graves_: Women Middle-aged Over-activity→hyperthyroidism _Toxic Goitre:_ Older, no eye signs, atrial fibrillation
36
What are the investigations for multi-nodular goitre?
Thyroid function tests, FNAC, chest x-ray
37
How many parathyroid glands are there?
4
38
What is the role of the parathyroid gland?
Regulate calcium & phosphate levels
39
Where are the parathyroid glands located?
Located posterior to poles of thyroid
40
What are the different presentations of parathyroid disease?
_Kidney_: * Renal calculi * Polyuria * Renal failure _Bones:_ * Pathological fracture * Osteoporosis * Bone pain _GI_: * Abdominal pain * Constipation * Peptic ulceration * Pancreatitis * Weight loss _Neural_ * Anxiety and Depression * Confusion * Paranoia
41
What is found in blood samples for those with Hyperparathyroidism?
High calcium with corresponding high parahyroid hormone
42
What are other investigations for parathyroid disease?
Urea & electrolytes, creatinine, calcium, phosphate Parathyroid hormone, bicarbonate Vitamin D Ultrasound scan CT/MRI: identify ectopic glands Isotope scanning: detect diseased glands Bone x-rays and a bone density test (DXA) can help detect fractures, bone loss, and bone softening. Ultrasound and CT scans may be done to view the parathyroid glands in the neck. Surgery for Hyperparathyroidism ONLY
43
Which demographic is vulnerable to hyperparathyroidism?
Post-menopausal women
44
What are the causes of hyperparathyroidism?
Adenoma (80%) Hyperplasia (12%) Malignancy
45
When might hyperplasia of parathyroid glands result?
During renal failure - results in low calcium and vitamin D - high PTH to compensate - calcium levels become normal but phosphate levels are high
46
What is the management of parathyroid disease?
Management Medical treatment Surgery easier if patient fit Remove single adenomas Remove multiple adenomas too Remove 3 or 3.5 hyperplastic glands through neck exploration Carcinomas removed with thyroid gland and lymph nodes
47
What are the 4 fascial layers of the neck?
Pre-tracheal Pre-vertebral Deep cervical Carotid sheath
48
What are the indications for tracheostomy?
Airway obstruction Airway protection Poor ventilation to reduce dead space
49
Where is the airway obstruction in the presence of? Inspiratory - added sounds Expiratory - added sounds Biphasic – added sounds
Inspiratory - laryngeal Expiratory - tracheobronchial Biphasic – glottic/subglottic
50
What is the treatment for stridor?
Treat with O2, Nebulised Adrenaline, IV Dexamethasone, (Heliox), (Definitive) airway management Dexamethasone: Dexamethasone is a steroid that prevents the release of substances in the body thatcause inflammation
51
What are the two causes of branchial cyst?
Remnant of fusion failure of branchial arches Lymph node cystic degeneration
52
Where are branchial cysts located?
Anterior to sternocleidomastoid at junction between upper and middle thirds
53
What causes a pharyngeal pouch?
The pharyngeal mucosa herniates between two muscles of the inferior pharyngeal constrictor. These muscles are the thyropharyngeus and the circopharyngeus.
54
What are the symptoms of a pharyngeal arch?
Voice hoarseness Dysphagia Aspiration pneumonia Regurgitation Weight loss Neoplasia
55

Head and Neck (Year 2 GM) (12 decks)

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