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Head and Neck (Ben Gray) > neck anatomy, physiology and pathology > Flashcards

neck anatomy, physiology and pathology Flashcards

1
Q

what are the some of the gross anatomical structures within the neck?

A 
arteries
veins
nerves
lymph nodes 
lymphatic channels
thyroid and parathyroid glands
muscles
trachea
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2
Q

what is the superior boundary of the neck?

A

mandible

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3
Q

what is the inferior boundary of the neck?

A

clavicle

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4
Q

what is the anterior boundary of the neck?

A

anterior midline

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5
Q

what is the posterior boundary of the neck?

A

trapezius

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6
Q

what are the boundaries of the anterior triangle?

A

anterior: midline of neck
posterior: anterior border of sternocleidomastoid (SCM)

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7
Q

what are the boundaries of the posterior triangle?

A

anterior: posterior border of sternocleidomastoid
posterior: anterior border of trapezius

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8
Q

name the 4 arteries, 2 veins, 2 groups of lymph nodes and 5 nerve groups contained in the anterior triangle of the neck

A 
common carotid artery
external carotid artery
internal carotid artery
internal jugular vein
facial artery
facial vein
hypoglossal nerves
accessory nerves
vagus nerves
laryngeal nerves
glossopharyngeal nerves
submandibular and submental lymph nodes
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9
Q

name the 5 contents of the posterior triangle

A 
accessory nerve
occipital artery
lymph nodes
cervical nerve plexus
external jugular vein
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10
Q

where does the common carotid artery bifurcate?

A

vertebral level C4

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11
Q

what makes the common carotid artery unique within the neck?

A

only artery with branches in the neck

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12
Q

name 8 branches of the Common carotid artery

A 
superior thyroid
ascending pharyngeal
lingual
occipital
facial
posterior auricular
maxillary
superficial temporal
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13
Q

what are some uses of a central line?

A 
measuring central venous pressure
drug administration
cardiac pacing
blood sampling
fluid resuscitation
haemodialysis
IV nutrition
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14
Q

what are some complications that may result from insertion of a central line?

A 
pneumothorax
haematoma
cardiac tamponade
air embolism
chylothorax
false passage
thrombosis
sepsis
line blockage
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15
Q

where do the lymph nodes in the head and neck drain to BEFORE the thoracic duct?

A

cisterna chyli

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16
Q

what are the different groups of lymph glands in the head and neck?

A 
occipital
cervical
supraclavicular
submandibular
submental
parotid
-there are others
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17
Q

where do the parotid nodes drain from?

A

scalp, face and parotid gland

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18
Q

where do the occipital nodes drain from?

A

scalp

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19
Q

where do the superficial cervical nodes drain from?

A

breast and solid viscera

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20
Q

what is the function of the deep cervical nodes?

A

final drainage pathway to the thoracic duct

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21
Q

where do the submandibular nodes drain from?

A 
tongue
nose
paranasal sinuses
submandibular gland
oral cavity
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22
Q

where do the submental nodes drain from?

A

lips

floor of mouth

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23
Q

where do the supraclavicular nodes drain from?

A

breast
oesophagus
solid viscera

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24
Q

what are 3 broad categories that my cause lymphadenopathy?

A

infection
inflammation
malignancy

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25
Q

what kind of gland is the thyroid?

A

endocrine

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26
Q

what is the structure of the thyroid gland?

A

2 lobes joined by the isthmus

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27
Q

what does the thyroid produce?

A

thyroid hormone

calcitonin

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28
Q

what is the function of calcitonin?

A

lowers calcium and raises phosphate levels

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29
Q

what is a thyroglossal cyst?

A

dilatation of thyroglossal duct remnant - may become infected

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30
Q

what are some causes of thyroid masses?

A

solitary nodules
diffuse enlargement
multi nodular goitre

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31
Q

what are some causes of solitary thyroid nodules?

A 
cyst
adenoma
carcinoma
lymphoma
prominent nodule in multi nodular goitre
32
Q

what causes thyroid cysts?

A

localised haemorrhage

33
Q

what would be appropriate investigations in the case of a solitary thyroid nodule?

A

fine needle aspiration cytology (FNAC)

ultrasound scanning

34
Q

what can FNAC NOT distinguish between?

A

follicular adenoma and follicular carcinoma - tissue required for a histological diagnosis

35
Q

what are 4 classifications of thyroid cancer?

A

papillary
follicular
medullary
anaplastic

36
Q

what causes papillary thyroid cancer?

A

lymphatic metastasis

37
Q

what causes follicular thyroid cancer?

A

haematogenous metastasis

38
Q

what causes medullary thyroid cancer?

A

familial association (10%), arise from parafollicular C cells

39
Q

what are some characteristics of anaplastic thyroid cancer?

A

aggressive
local spread
old patients
poor prognosis

40
Q

what are some causes of diffuse thyroid enlargement?

A

colloid goitre
grave’s disease
thyroiditis

41
Q

what can cause colloid goitre?

A 
gland hyperplasia
iodine deficiency
puberty
pregnancy
lactation
42
Q

what is the pathology of graves disease?

A

auto antibodies against thyroid stimulating hormone receptor stimulate the receptor, resulting in hyperthyroidism

43
Q

what is the treatment for graves disease?

A

anti thyroids, beta blockade, radio iodine and surgery

44
Q

what are indications for a thyroidectomy?

A 
airway obstruction
malignancy or suspected malignancy
thyrotoxicosis
cosmesis
retrosternal extension
45
Q

what are possible complications of a thyroidectomy?

A 
bleeding - primary or secondary
voice hoarseness
thyroid storm
infection
hypoparathyroidism
hypothyroidism
scarring (keloid/hypertrophic)
46
Q

what are causes of multi nodular goitre?

A

graves disease or toxic goitre

47
Q

what kind of patient would you expect to see in a toxic goitre case?

A

older
no eye signs
atrial fibrillation

48
Q

what kind of patient would you expect to see where the cause of multi nodular goitre is graves disease?

A

woman
middle aged
over active thyroid (hyperthyroidism)

49
Q

what tests would you perform if you suspected multi nodular goitre?

A

thyroid function tests
FNAC
CXR

50
Q

how many parathyroid glands are there usually?

A

4

51
Q

what is the function of the parathyroid glands?

A

regulate calcium and phosphate levels

52
Q

where are the parathyroid glands located?

A

posterior to the poles of the thyroid

53
Q

what are some renal signs of parathyroid disease?

A

renal calculi
polyuria
renal failure

54
Q

what are some alimentary signs of parathyroid disease?

A 
abdominal pain
constipation
peptic ulceration
pancreatitis
weight loss
55
Q

what are some bony (awful name sorry) signs of parathyroid disease?

A

pathological fractures
osteoporosis
bone pain

56
Q

what are some psychological signs of parathyroid disease?

A

anxiety
depression
confusion
paranoia

57
Q

what tests would you run (exluding imaging tests) to try and diagnose parathyroid disease?

A 
U & Es
creatinine
calcium and phosphate levels
parathyroid hormone levels
bicarbonate levels
vitamin D
58
Q

what IMAGING tests would you run to try and diagnose parathyroid disease?

A

ultrasound scan
CT/MRI - identify ectopic glands
Isotope scanning - detect diseased glands

59
Q

when would surgery be indicated in parathyroid disease?

A

hyperparathyroidism ONLY

60
Q

what are some causes of hyperparathyroidism?

A

adenoma
hyperplasia
malignancy in rare cases

61
Q

what accounts for the majority of hyperparathyroidism?

A

adenomas account for 80%

62
Q

what percentage of hyperparathyroidism does hyperplasia account for?

A

12% - common in secondary hyperparathyroidism due to low calcium

63
Q

how is hyperparathyroidism managed?

A

can be treated medically
surgery easier if patient is fit
remove single and multiple adenomas
remove 3 or 3.5 hyperplastic glands through neck exploration
carcinomas removed along with the thyroid gland and lymph nodes

64
Q

what are the 4 fascial layers of the neck?

A

pre-tracheal
pre-vertebral
deep cervical
carotid sheath

65
Q

what is a tracheostomy?

A

A tracheostomy is an opening created at the front of the neck so a tube can be inserted into the windpipe (trachea) to help the patient breathe

66
Q

what are some indications for a tracheostomy?

A

airway obstruction
airway protection
poor ventilation to reduce dead space

67
Q

what would be a sign of laryngeal stridor?

A

inspiratory stridor

68
Q

what would be a sign of tracheobronchial stridor?

A

expiratory stridor

69
Q

what would be a sign of glottic/subglottic stridor?

A

biphasic stridor

70
Q

what causes a branchial cyst?

A

remnant of fusion failure of branchial arches

lymph node cystic degeneration

71
Q

where are branchial cysts located?

A

anterior to the SCM at the junction between the upper and middle thirds

72
Q

how are branchial cysts managed?

A

excised to prevent further infection

73
Q

what is a “pharyngeal pouch”?

A

herniation of the pharyngeal mucosa between the thyropharyngeus and cricopharyngeus muscles of the inferior constrictor of the pharynx

74
Q

what are some signs of a pharyngeal pouch?

A 
voice hoarseness
dysphagia
aspiration pneumonia
regurgitation
weight loss
neoplasia (1%)
75
Q

how is a pharyngeal pouch diagnosed?

A

barium swallow

76
Q

what is the treatment for a pharyngeal pouch?

A

excision

dilatation

Head and Neck (Ben Gray) (8 decks)

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