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2A - 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
Q

Thyroglossal cyst - clinical features

A
  • Moves on tongue protrusion
26
Q

Thryglossal cyst - investigations

A

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

27
Q

Thyroglossal cyst - treatment

A
  • Excised but chance of recurrence
28
Q

What are different kinds of thyroid mass?

A
  • 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
Q

Solitary nodule - pathology

A
  • Cyst due to localised haemorrhage
30
Q

Solitary nodule - aetiology

A
  • Adenoma
  • Carcinoma
  • Lymphoma
31
Q

Solitary nodule - epimiology

(sex, age)

A
  • Females more than males
  • 30 to 40 years
  • 10% malignant in middle-aged men, 50% malignant in young
32
Q

Solitary nodule - investigations

A
  • 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
Q

Diffuse enlargement - aetiology

A
  • 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
Q

Colloid goitre - aetiology

A
  • Due to gland hyperplasia
  • Iodine deficiency
  • Puberty, pregnancy, lactation
35
Q

Graves’ disease - pathology

A
  • Auto-antibodies against thyroid stimulating hormone receptor stimulate receptor
  • Hyperthyroidism results
36
Q

Graves’ disease - clinical features

A
  • Thyroid eye disease, acropachy/clubbing, pre-tibial myxoedema
37
Q

Graves’ disease - treatment?

A
  • Treatments are anti-thyroids, beta-blockade, radio-iodine and surgery
38
Q

Graves’ disease - epidemiology?

(sex)

A
  • Females more than males
39
Q

Multi-nodular goitre - aetiology?

A
  • Due to Grave’s disease or toxic goitre
40
Q

Toxic goitre - investigations?

A
  • Toxic goitre occurs in older, no eye signs, atrial fibrillation, investigations are thyroid function tests, FNAC, chest x-ray
41
Q

What are different kinds of thyroid cancer?

A
  • Papillary-lymphatic metastasis
  • Follicular-haematogenous metastasis
  • Medullary-familial association
    • Arise from parafollicular C cells
  • Anaplastic aggressive, local spread, very old, poor prognosis
42
Q

Indications for thyroidectomy?

A
  • Airway obstruction
  • Malignancy or suspected malignancy
  • Thyrotoxicosis
  • Cosmesis
  • Retrosternal extension
43
Q

Complications of thyroidectomy?

A
  • Bleeding
    • Primary or secondary
  • Voice hoarseness
  • Thyroid storm
  • Infection
  • Hypoparathyroidism
  • Hypothyroidism
  • Scar
44
Q

What do the parathyroid glands do?

A
  • Regulate calcium and phosphate levels
45
Q

How many parathyroid glands do people normally have?

A
  • 4 (usually)
46
Q

What is the presentation of parathyroid disease?

A
  • Renal calculi, polyuria, renal failure
  • Pathological fractures, osteoporosis, bone pain
  • Abdominal pain, constipation, peptic ulceration, pancreatitis, weight loss
  • Anxiety and depression, confusion, paranoia
47
Q

What investigations are done for parathyroid disease?

A
  • 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
Q

When is surgery used to treat parathyroid disease?

A

Surgery is only done for hyperparathyroidism

49
Q

Hyperparathyroidism - aetiology

A
  • 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
Q

Parathyroid disease - management

A
  • 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
Q

What are the 4 layers of fascia in the neck?

A
  • Pre-tracheal
  • Pre-vertebral
  • Deep cervical
  • Carotid sheath
52
Q

What are indications for tracheostomy?

A
  • Airway obstruction
  • Airway protection
  • Poor ventilation to reduce dead space
53
Q

What is stridor?

A
  • Clinical sign of airway obstruction
    • Inspiratory is laryngeal
    • Expiratory is tracheobronchial
    • Biphasic is glottis/subglottic
  • Treat with oxygen, nebulised adrenaline, IV dexamethasone
54
Q

Treatment for stridor?

A
  • Treat with oxygen, nebulised adrenaline, IV dexamethasone
55
Q

Where is the aetiology of stridor in the following:

  • inspiratory
  • expiratory
  • biphasic
A
  • Inspiratory is laryngeal
  • Expiratory is tracheobronchial
  • Biphasic is glottis/subglottic
56
Q

Branchial cyst - pathology

A
  • Remnant of fusion failure of bronchial arches or lymph node cystic degeneration
57
Q

Branchial cyst - complications

A
  • Becomes infected, enlarging
58
Q

Branchial cyst - treatment

A
  • Excised to prevent further infection
59
Q

Pharyngeal pouch - pathology

A
  • Herniation of pharyngeal mucosa between thyropharyngeus and cricopharyngeus muscles of the inferior constrictor of the pharynx
60
Q

Pharyngeal pouch - signs and symptoms

A
  • Voice hoarseness
  • Dysphagia
  • Aspiration pneumonia
  • Regurgitation
  • Weight loss
61
Q

Pharyngeal pouch - investigations

A
  • Barium swallow
  • Excision (endoscopic or open
  • Dilate

2A - Head and Neck (13 decks)

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