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08. Year 2: Head and Neck > Neck Anatomy & Physiology > Flashcards

Neck Anatomy & Physiology Flashcards

1
Q

What are some of 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 following boundaries of the neck:

  • superior
  • inferior
  • anterior
  • posterior
A
  • Superior
    • Mandible
  • Inferior
    • Clavicle
  • Anterior
    • Anterior midline
  • Posterior
    • Trapezius
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3
Q

What triangles can the neck be split into?

A
  • Anterior triangle
    • Anterior boundary
      • Midline of the neck
    • Posterior boundary
      • Anterior border of sternocleidomastoid
  • Posterior triangle
    • Anterior boundary
      • Posterior border of sternocleidomastoid
    • Posterior boundary
      • Anterior border of trapezius
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4
Q

What are the following boundaries of the anterior triangle::

  • anterior
  • posterior
A
  • Anterior triangle
    • Anterior boundary
      • Midline of the neck
    • Posterior boundary
      • Anterior border of sternocleidomastoid
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5
Q

What are the following boundaries of the posterior triangle:

  • anterior
  • posterior
A
  • Posterior triangle
    • Anterior boundary
      • Posterior border of sternocleidomastoid
    • Posterior boundary
      • Anterior border of trapezius
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6
Q

What is the contents of the anterior triangle?

A
  • Common carotid artery
  • External carotid artery
  • Facial artery
  • Hypoglossal nerves
  • Vagus nerves
  • Glossopharyngeal nerves
  • Submandibular nodes
  • Submental nodes
  • Internal carotid artery
  • Internal jugular vein
  • Facial vein
  • Accessory nerves
  • Laryngeal nerves
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7
Q

What is the contents of the posterior triangle?

A
  • Accessory nerve
  • Occipital artery
  • Lymph nodes
  • Cervical nerve plexus
  • External jugular vein
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8
Q

What is the main artery in neck?

A
  • Divides at C4 level
  • External carotid is the only artery with branches in the neck
    • Superior thyroid
    • Ascending pharyngeal
    • Lingual
    • Occipital
    • Facial
    • Posterior auricular
    • Maxillary
    • Superficial temporal
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9
Q

What level does the common carotid artery divide?

A

C4

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10
Q

Does the internal or external carotid branch in the neck?

A
  • External carotid is the only artery with branches in the neck
    • Superior thyroid
    • Ascending pharyngeal
    • Lingual
    • Occipital
    • Facial
    • Posterior auricular
    • Maxillary
    • Superficial temporal
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11
Q

What are some branches of the external carotid artery?

A
  • Superior thyroid
  • Ascending pharyngeal
  • Lingual
  • Occipital
  • Facial
  • Posterior auricular
  • Maxillary
  • Superficial temporal
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12
Q

What are the main veins of the neck?

A
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13
Q

What are indications for a central venous line?

A
  • Central venous pressure
  • Drug administration
  • Cardiac pacing
  • Blood sampling
  • Fluid resuscitation
  • Haemodialysis
  • Intravenous nutrition
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14
Q

What are possible complications of central venous line?

A
  • Pneumothorax
  • Haematoma
  • Cardiac tamponade
  • Air embolism
  • Chylothorax
  • False passage
  • Thrombosis
  • Sepsis
  • Line blockage
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15
Q

Where do lymph nodes of the neck drain to?

A
  • 600 lymph nodes in the head and neck
  • Receive lymph/tissue waste product
  • Drain to cisterna chyli
  • Then drain to thoracic duct on left
  • Descried in groups and levels
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16
Q

What are some lymph node groups of the neck?

A
  • Parotid nodes
    • Scalp, face and parotid gland
  • Occipital nodes
    • Scalp
  • Superficial cervical nodes
    • Breasts and solid viscera
  • Deep cervical nodes
    • Final drainage pathway to thoracic duct
  • Submandibular nodes
    • Tongue, nose, paranasal sinuses, submandibular gland and oral cavity
  • Submental nodes
    • Lips and floor of mouth
  • Supraclavicular nodes
    • Breast, oesophagus and solid viscera
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17
Q

What are the different lymph node levels?

A
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18
Q

What do the following lymph nodes drain:

  • parotid
  • occipital
  • superficial cervical
  • deep cervical
  • submandibular
  • submental
  • supraclavicular
A
  • Parotid nodes
    • Scalp, face and parotid gland
  • Occipital nodes
    • Scalp
  • Superficial cervical nodes
    • Breasts and solid viscera
  • Deep cervical nodes
    • Final drainage pathway to thoracic duct
  • Submandibular nodes
    • Tongue, nose, paranasal sinuses, submandibular gland and oral cavity
  • Submental nodes
    • Lips and floor of mouth
  • Supraclavicular nodes
    • Breast, oesophagus and solid viscera
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19
Q

Aetiology of lymphadenopathy?

A
  • Infective
  • Inflammatory
  • Malignant
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20
Q

What does the thyroid hormone produce?

A
  • Produces thyroid hormone and calcitonin
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21
Q

What are the 2 lobes of the thyroid gland joined by?

A

Isthmus

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22
Q

What does calcitonin do?

A
  • Calcitonin acts to lower calcium and raise phosphate
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23
Q

Thyroglossal cyst - pathology

A
  • Dilation of the thyroglossal duct remnant
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24
Q

Thyroglossal cyst - complications

A
  • May become infected
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25
Thyroglossal cyst - clinical features
* Moves on tongue protrusion
26
Thryglossal cyst - investigations
Need ultrasound scan prior to removal to ensure functioning thyroid tissue elsewhere
27
Thyroglossal cyst - treatment
* Excised but chance of recurrence
28
What are different kinds of thyroid mass?
* **Solitary nodule** * Cyst due to localised haemorrhage * Adenoma * Carcinoma * Lymphoma * Females more than males * 30 to 40 years * 10% malignant in middle-aged men, 50% malignant in young * Investigate by fine-needle aspiration cytology (FNAC) and ultrasound scanning * FNAC cannot distinguish between a follicular adenoma and a follicular carcinoma, therefore tissue required for histological diagnosis * Done by thyroid lobectomy * **Diffuse enlargement** * Colloid goitre * Due to gland hyperplasia * Iodine deficiency * Puberty, pregnancy, lactation * Grave’s disease * Females more than males * Auto-antibodies against thyroid stimulating hormone receptor stimulate receptor * Hyperthyroidism results * Thyroid eye disease, acropachy/clubbing, pre-tibial myxoedema * Treatments are anti-thyroids, beta-blockade, radio-iodine and surgery * Thyroiditis * **Multi-nodular goitre** * Due to Grave’s disease or toxic goitre * Toxic goitre occurs in older, no eye signs, atrial fibrillation, investigations are thyroid function tests, FNAC, chest x-ray
29
Solitary nodule - pathology
* Cyst due to localised haemorrhage
30
Solitary nodule - aetiology
* Adenoma * Carcinoma * Lymphoma
31
Solitary nodule - epimiology | (sex, age)
* Females more than males * 30 to 40 years * 10% malignant in middle-aged men, 50% malignant in young
32
Solitary nodule - investigations
* Investigate by fine-needle aspiration cytology (FNAC) and ultrasound scanning * FNAC cannot distinguish between a follicular adenoma and a follicular carcinoma, therefore tissue required for histological diagnosis * Done by thyroid lobectomy
33
Diffuse enlargement - aetiology
* **Colloid goitre** * Due to gland hyperplasia * Iodine deficiency * Puberty, pregnancy, lactation * **Grave’s disease** * Females more than males * Auto-antibodies against thyroid stimulating hormone receptor stimulate receptor * Hyperthyroidism results * Thyroid eye disease, acropachy/clubbing, pre-tibial myxoedema * Treatments are anti-thyroids, beta-blockade, radio-iodine and surgery * **Thyroiditis**
34
Colloid goitre - aetiology
* Due to gland hyperplasia * Iodine deficiency * Puberty, pregnancy, lactation
35
Graves' disease - pathology
* Auto-antibodies against thyroid stimulating hormone receptor stimulate receptor * Hyperthyroidism results
36
Graves' disease - clinical features
* Thyroid eye disease, acropachy/clubbing, pre-tibial myxoedema
37
Graves' disease - treatment?
* Treatments are anti-thyroids, beta-blockade, radio-iodine and surgery
38
Graves' disease - epidemiology? | (sex)
* Females more than males
39
Multi-nodular goitre - aetiology?
* Due to Grave’s disease or toxic goitre
40
Toxic goitre - investigations?
* Toxic goitre occurs in older, no eye signs, atrial fibrillation, investigations are thyroid function tests, FNAC, chest x-ray
41
What are different kinds of thyroid cancer?
* Papillary-lymphatic metastasis * Follicular-haematogenous metastasis * Medullary-familial association * Arise from parafollicular C cells * Anaplastic aggressive, local spread, very old, poor prognosis
42
Indications for thyroidectomy?
* Airway obstruction * Malignancy or suspected malignancy * Thyrotoxicosis * Cosmesis * Retrosternal extension
43
Complications of thyroidectomy?
* Bleeding * Primary or secondary * Voice hoarseness * Thyroid storm * Infection * Hypoparathyroidism * Hypothyroidism * Scar
44
What do the parathyroid glands do?
* Regulate calcium and phosphate levels
45
How many parathyroid glands do people normally have?
* 4 (usually)
46
What is the presentation of parathyroid disease?
* Renal calculi, polyuria, renal failure * Pathological fractures, osteoporosis, bone pain * Abdominal pain, constipation, peptic ulceration, pancreatitis, weight loss * Anxiety and depression, confusion, paranoia
47
What investigations are done for parathyroid disease?
* Urea & electrolytes, creatinine, calcium, phosphate * Parathyroid hormone, bicarbonate * Vitamin D * Ultrasound scan * CT/MRI to identify ectopic glands * Isotope scanning to detect diseased glands
48
When is surgery used to treat parathyroid disease?
Surgery is only done for hyperparathyroidism
49
Hyperparathyroidism - aetiology
* Adenoma * 80% of the time is the cause * Single or multiple * Hyperplasia * 12% of the time is the cause * Common in secondary hyperparathyroidism due to low calcium * Calcium levels normal but phosphate levels high * Malignancy (rare)
50
Parathyroid disease - management
* Medical treatment * Surgery if patient fit * Remove single or multiple adenomas * Remove 3 or 3.5 hyperplastic glands through neck exploration * Carcinomas removed with thyroid gland and lymph nodes
51
What are the 4 layers of fascia in the neck?
* Pre-tracheal * Pre-vertebral * Deep cervical * Carotid sheath
52
What are indications for tracheostomy?
* Airway obstruction * Airway protection * Poor ventilation to reduce dead space
53
What is stridor?
* Clinical sign of airway obstruction * Inspiratory is laryngeal * Expiratory is tracheobronchial * Biphasic is glottis/subglottic * Treat with oxygen, nebulised adrenaline, IV dexamethasone
54
Treatment for stridor?
* Treat with oxygen, nebulised adrenaline, IV dexamethasone
55
Where is the aetiology of stridor in the following: - inspiratory - expiratory - biphasic
* Inspiratory is laryngeal * Expiratory is tracheobronchial * Biphasic is glottis/subglottic
56
Branchial cyst - pathology
* Remnant of fusion failure of bronchial arches or lymph node cystic degeneration
57
Branchial cyst - complications
* Becomes infected, enlarging
58
Branchial cyst - treatment
* Excised to prevent further infection
59
Pharyngeal pouch - pathology
* Herniation of pharyngeal mucosa between thyropharyngeus and cricopharyngeus muscles of the inferior constrictor of the pharynx
60
Pharyngeal pouch - signs and symptoms
* Voice hoarseness * Dysphagia * Aspiration pneumonia * Regurgitation * Weight loss
61
Pharyngeal pouch - investigations
* Barium swallow * Excision (endoscopic or open * Dilate

08. Year 2: Head and Neck (13 decks)

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