Session 1

Question 1

Define the region of the neck

Answer 1

From the lower margin of the mandible to the suprasternal notch of the manubrium and the upper brder of the clavicle.

Question 2

Briefly describe how the neck is compartmentalised

Answer 2

Compartmentalised by cervical fascia.There is a superficial cervical fascia layer and then 4 deep cervical fascia layers (investing layer, pretracheal layer, prevertebrel layer and the carotid sheath)

Question 3

Describe the superficial fascia layer of the neck

Answer 3

Its a loose connective tissue largely containing adipose. within this layer lie superficial blood vessels e.g anterior and external jugular veins, superficial lymph nodes, cutaneous nerves and the playsma muscle

Question 4

Describe the investing layer of the deep cervical fascia

Answer 4

Primary detail needed: Its the mst superficial f the deep cervical fasciae and surrounds the entire neck like a collar. It splits to enclose the sternocleidomastoid and tarpezius muscles, submandibular and parotid salivary glands.

Extra detail: Its superior border is attached on each side to the entire lower margin of the mandible (midline to angle), the mastoid process, the superior nuchal line and the external occipital protuberance in the posterior midline. it also attaches t the spinus processes of the vertebrae and ligamentum nuchae posteriorly. Inferiorly the investing layer attaches to the upper border of the manubrium, the upper surface of the clavicle, acromion and spine of the scapula.

Question 5

Describe the pretracheal layer of the deep fasciae of the neck

Answer 5

thin and limited to the anterior and lateral part of the neck. Superiorly and anteriorly it is attached to the hyoid bone and inferiorly it extends into the thorax where it blends with the fibrous pericardium. it consists of a muscular layer enclosing the infrahyoid muscles, and a visceral layer, which encloses the thyroid gland (splitting around this to form a false capsule), the trachea and oesophagus.

The pretracheal fascia as it continues posteriorly to invest the muscles of the pharynx and oesophagus is known as the buccopharyngeal fascia (fascia associated with the pharynx and oesophagus).The buccopharyngeal fascial layer runs from the base of the skull superiorly, to the diaphragm inferiorly.

Question 6

Describe the carotid sheath

Answer 6

The carotid sheath is a tubular, fibrous structure that extends from the base of the skull through the root of the neck to the arch of aorta. It contains a number of structures including but not limited to the common carotid artery, internal jugular vein and the cranial nerve [CN], the vagus nerve (CN X).

Question 7

Describe the prevertebral layer of the deep fascia of the neck

Answer 7

The deepest layer.The prevertebral layer forms a sheath for the vertebral column and muscles associated with it. This layer extends from the base of the cranium to the 3rd thoracic vertebra and extends laterally as the axillary sheath that surrounds the axillary vessels and the brachial plexus of nerves running into the upper limb.

Question 8

What should you be clinically aware of when looking at the deep fascia of the neck?

Answer 8

The layers of deep cervical fascia form natural cleavage planes that not only allow structures to move and pass over one another with ease but allow easy separation of tissues during surgery. These facial layers also determine the direction and extent to which any infection occurring within the neck may spread.

Question 9

What are deep neck spaces?

Answer 9

to which any infection occurring within the neck may spread. The fascial compartmentalisation of structures in the neck gives rise to potential spaces between fascial planes. These deep neck spaces contain a loose connective tissue, so they are not technically “empty” spaces

Question 10

What is the risk of having deep neck spaces?

Answer 10

Infection or an abscess can arise between the fascial planes causing these “spaces” to distend. The infective source often originates in the teeth, tissues of the pharynx, sinuses or middle ear, and spreads. Deep neck space infections are rare but do pose significant risk to life

Question 11

What is the retropharyngeal space?

Answer 11

The retropharyngeal space, is one of the deep neck spaces, and lies between the prevertebral layer of fascia and the buccopharyngeal fascia. Up until the age of 3- 4 years, the superior part of this space contains lymph nodes, which drain areas of the nose, oral cavity and upper pharynx. It allows the pharynx to move freely on the vertebral column and expand during swallowing

Question 12

What risk does the retropharyngeal space posses?

Answer 12

As the retropharyngeal space lies between fascial layers that extend the length of the neck, into the mediastinum, retropharyngeal infections may spread inferiorly into the thorax, risking the development of mediastinitis (rare, but lifethreatening condition).

Question 13

How do retropharyngeal infections usually present and in who?

Answer 13

Infection in the retropharyngeal space is usually secondary to an upper respiratory tract infection (e.g. nasal cavity, nasopharynx, oropharynx) and is most commonly seen in children, usually under the age of 5 years. Infection in this space may develop into an abscess.
A retropharyngeal abscess can present with a variety of signs and symptoms including a visible bulge on inspection of the oropharynx, sore throat, difficulty swallowing, stridor, reluctance to move their neck and a high temperature

Question 14

How can thyroid lumps be distinguished from other neck lumps?

Answer 14

Asking a patient with a swelling or lump in their neck to swallow and observing whether it moves, can help localise pathology to the thyroid gland. This is because the thyroid gland is enclosed by pre-tracheal fascia, which is attached to the hyoid bone. The hyoid bone and larynx move up with swallowing, as such so too will the thyroid gland, and any swelling or lump involving this gland

Question 15

What are retrosternal goitres and how do they present?

Answer 15

An enlarged thyroid gland (goitre) can sometimes extend retrosternally (behind the sternum), through the root of the neck because the lower limit of the pre-tracheal fascia extends into the thorax. Retrosternal extension of a goitre can lead to compression of other structures running through the root of the neck (thoracic inlet) such as the trachea and venous blood vessels. This can lead to symptoms such as breathlessness and stridor due to tracheal compression, and facial oedema because of compression impeding venous drainage from the head and neck.

Question 16

How are the muscles of the head and face divided?

Answer 16

divided into two broad groups, based on commonalities in their function and nerve supply. The groups include the muscles of facial expression, (including the muscle of the scalp [occipitofrontalis] and muscle of the cheek [buccinators]), and the muscles of mastication.

Question 17

Describe the general location, attachment and role of the muscles of facial expression.

Answer 17

Most of the muscles of facial expression lie in the subcutaneous tissue, and attach to bone, fascia and often each other. Many attach just beneath the skin such that their contraction pulls the skin in particular ways, giving rise to the breadth of facial expressions we possess.
Generally the muscles will act as either sphincters or dilators around the orifices of the face- the orbits of the eye, the nose or mouth. One exception to this though is the buccinators

Question 18

Which nerve innervates the muscles of facial expression?

Answer 18

Branches of the facial nerve (cranial nerve 7)

Question 19

How does injury or pathlogy of the facial nerve present?

Answer 19

Will cause weakness of the muscles of facial expression on the ipsilateral side, causing that half of the face to ‘droop’.

Question 20

What is the most common cause of non-traumatic facial paralysis?

Answer 20

Inflammation of the facial nerve (Bell’s palsy). The inflammation causes oedema and compression of the nerve as it runs through the base of the skull.

Question 21

What is the likely cause of weakness of the facial muscles in assocaiation with an ipsilateral parotid enlargement?

Answer 21

highly likely to be a parotid cancer. The cancerous cells invade and damage the facial nerve during its course through the gland. It is rare for benign, infective or inflammatory conditions of the parotid gland e.g. mumps, to cause damage to the facial nerve and thus these conditions are not typically associated with facial muscle weakness

Question 22

What are the muscles of mastication?

Answer 22

The muscles of mastication, of which there are only four, all act to move the mandible at the temporomandibular joint (TMJ), as is needed when chewing food
(masticating).

The masseter

The temporalis

Lateral pterygoid

Medial pterygoid

Question 23

What nerve innervates the muscles of mastication?

Answer 23

They are all supplied by branches from the mandibular division of the trigeminal nerve (a branch of CN V).

Question 24

Which of the muscles of mastication are palpable?

Answer 24

When clenching your jaw you can easily palpate the contraction of the temporalis and masseter muscles by feeling over the area of your temples (temporalis), and at the corner of your jaw as you clench your teeth (masseter).

The pterygoid muscles, however, are not palpable and lie deep to the mandible

Question 25

Describe the origins and insertions of the pterygoid muscles

Answer 25

They take their origin from two bony plate-like projections at the base of the skull, called the pterygoid plates (hence the name of the muscles). Each pterygoid muscle is angled slightly different, and inserts on to separate areas of the mandible thus conferring their different actions on the jaw (opening vs closing).

Question 26

Which muscles are involved in the opening and closing of the jaw?

Answer 26

All the muscles of mastication, except one, act to elevate the mandible (close the jaw).
The action of depressing the mandible (opening the jaw) involves a number of muscles, of which only one is part of the ‘muscles of mastication’ group. The muscles mainly involved in depressing the mandible, are collectively called the ‘suprahyoids’ (they all lie above the hyoid bone). These are assisted by the pull of gravity and the lateral pterygoid.

Question 27

What is the skull and how can it be divided?

Answer 27

The skull is callled the cranium and can be divided into the neurocranium (bone that surrounds the brain) and the viscerocranium (facial skeleton)

Question 28

What is the temporomadibular joint?

Answer 28

Where the mandible articulates with the neurocranium

Question 29

What are the surface regions of the head?

Answer 29

Face and scalp

Question 30

What are the main vessels of the face?

Answer 30

Facial artery and vein

Question 31

How might the shape of a facial muscle determine its function?

Answer 31

Circumferential muscles are generally sphincters and more linear shaped muscles are dilators.

Question 32

What are the extra-cranial terminal branches of the facial nerve (cranial nerve 7)?

Answer 32

Temporal, Zygomatic, Buccal, Mandibular, Cervical

Question 33

What gland does the facial nerve pass through and how is this clinically relevent

Answer 33

Parotid gland. Passes superficially through it so succeptible to damage. Malignancy or injury in parotid can cause facial weakness on ipsilateral side.

Question 34

What is the main sensory nerve of the face?

Answer 34

Trigeminal nerve

Question 35

What are the key branches of the trigeminal nerve?

Answer 35

Opthalmic division, maxillary division and mandibular division

Question 36

What is different about the madibular division of the trigeminal nerve?

Answer 36

Not only a sensory nerve but also provides motor function to the muscles of mastication

Question 37

Explain the arterial blood supply in the head and neck

Answer 37

Common carotid artery is the main arterial supply via its terminal branches. The first branch of the aorta is called the brachiocephalic trunk. From here it splits into the right sublavian artery and the right common carotid artery. The right common carotid artery then runs up into the neck. On the left side however, the left common carotid artery comes directly from the second branch of the aorta and doesnt split. Instead the left subclavian originates from the 3rd branch of the aorta. Both common carotid arteries split at C4 at the laryngeal prominance. They each split into the left/right internal carotid artery and the left/right external carotid artery. The external carotid artery splits and the the facial artery branch supplies the face. The pulse from this can be palpated as it runs through the masseter muscles.

Question 38

Explain the venous drainage from the head and face

Answer 38

The Internal jugular veins are the main head and neck draining vessels. It recieves venous drainage from the face via the facial vein. The internal jugular veins run next to the common carotid arteries.

The external jugular veins also recieves veins draining the scalp and face and runs much more superficially than the internal jugular vein.

Question 39

Why is it important clinically to not mix up the internal and external jugular veins?

Answer 39

When we look at jugular venous pressure we use the internal jugular vein. catherters are also inserted into the internal jugular vein.

Question 40

Which structures of the neck are easily palapable?

Answer 40

Hyoid bone, thyroid cartilage and cricoid cartilage

Question 41

Name the muscles of the neck

Answer 41

Platysma

Trapezius

Sternocleidomastoid

Scalene muscles

Supra- and Infar-hyoids

Question 42

Describe the platysma

Answer 42

Broad thin sheet running in the superficial cervical fascia. Runs from the lower border of the madible, down the neck and blends with the anterior border of the chest or the clavicle and the acromion. It tenses the skin of the neck. (Allows you to grimace). There is one on each side of the neck and it is a muscle of facial expression so innervated by the facial nerve.

Question 43

Describe the sternocleidomastoid muscle

Answer 43

There is one on either side of the neck. It has two heads (one from the sternum and the other from the clavicle) that join together to form one belly that inserts into the mastoid process of the temporal bone. It has an oblique orientation across the neck and so when it contacts in pulls the mastoid process to the shoulder so it laterally flexes and rotates the neck. It is innervated by the spinal accessory nerve.

Question 44

How do we test the nerve that supplies the sternocleidomastoid muscle and trapezius?

Answer 44

Put our hand against their face and ask the patient to rate their head against resistance. (sternocleidomastoid testing). Ask the patient to shrug their shoulders against resistance (superior fibres of the trapezius). This tests the spinal accessory nerve.

Question 45

Describe the trapezius involvement in the neck

Answer 45

Superior fibres are involved in the neck and insert into the spinous processes of the cervical spine. Allows you to shrug the shoulders and rotate the scapular after arm has been abducted to 90 degrees. Innervated by the spinal accessory nerve.

Question 46

Define the borders of the posterior triangle of the neck

Answer 46

Posterior border of sternocleidomastoid, anterior border of the trapezius and the clavicle. There is a posterior triangle on either side of the neck.

Question 47

Define the borders of the anterior triangle of the neck

Answer 47

lower border of the mandible, anterior border of the sternocleidomastoid and the midline of the neck. There is one either side of the neck.

Question 48

Generally, what is the difference between the content of the anterior and posterior triangles of the neck?

Answer 48

Structures found in the anterior triangle generally communicate with the chest whereas they generally communicate with the upper limb are found in the posterior triangle.

Question 49

Where are the scalene muscles found

Answer 49

In the floor of the posterior triangle of the neck

Question 50

What can be found in the posterior triangle of the neck?

Answer 50

Exernal jugular vein, scalenes, trunks of the brachial plexus, subclavian artery and vein and the omohyoid

Question 51

Describe the of the omohyoid muscle

Answer 51

Two bellys. Runs underneath sternocleidomastoid muscle. Originates from clavicle and inserts on the hyoid bone. One of the strap muscles.

Question 52

What is the other name of the strap muscles, where are they and what do they do?

Which strap muscle do you need to know?

Answer 52

Infrahyoid muscles. Insert generally into the hyoid bone. Lie deep to the Sternocleidomastoid muscles and superficially to the thyroid gland. They depress the hyoid and help stabilise it.

Omohyoid

Question 53

How many suprahyoid muscles are there, where are they and what do they do?

Which suprahyoid muscle do you need to know?

Answer 53

4 suprahyoid muscles. they are above the hyoid bone. originate from the jaw or base of skull and insert into the hyoid bone. They elevate the hyoid and depress the mandible.

Digastric muscle

Question 54

Define the boundaries of the carotid triangle and what can be easily accessed through it?

Answer 54

Posterior belly of digastric, superior belly of omohyoid and anterior border of sternocleidomastoid.

Easily access the carotid artery and interbnal jugular vein.

One carotid triangle on either side of the neck.

Question 55

Label the thyroid cartilage, cricoid cartilage, thyroid gland

Answer 55

lol

Question 56

In what plane are the sturctures of the neck viewed in a CT scan?

Answer 56

Axial (transverse/horizontal)

Question 57

Label the structures and fascia in the neck

Answer 57

add picture to both question and answer

Question 58

When looking at a cross sectional image of the neck, if you can see the isthmus of the thyroid gland, what is the vertebral level?

Answer 58

C7

Question 59

Label the platysma muscle and describe its origin/insertion, innervation and function

Answer 59

Originates from skin/fascia of lower face and mandible and inserts into fascia covering anterior chest wall. It runs superficial to SCM and over clavicles. Innervated by cervical branch of facial nerve. Depresses angle of mouth; also used to tense skin of neck.

Question 60

Label the orbicularis oculi muscle and describe its origin/insertion, innervation and function

Answer 60

Lies directly underneath the surface of the skin around the eyes. Originates/inserts from/into the eye socket. Innervated by the Temporal and zygomatic branches of the facial nerve.

Orbital part - closes the eyelids firmly in a volunary action.

Palpebral part - Closes eyelids gently in involunary or refex blinking

Question 61

Label the occipitofrontalis muscle and describe its origin/insertion, innervation and function

Answer 61

Frontalis region inserts into the skin around the eyebrows and top of the nose and originates from the aponeurosis of the occipitofrontalis (galea aponeurotica). Temporal branch of facial nerve. Function - Raises eyebrows and wrinkles forhead.

Occipitalis region inserts into the aponeurosis of occipitofrontalis and originates from the occipital bone and mastoid process of the temporal bone. Innervated by the facial nerve (posterior auricular branch)

Function- Pull back scalp

Question 62

Label the orbicularis oris muscle and describe its origin/insertion, innervation and function

Answer 62

The orbicularis oris muscle controls movements of the mouth and lips. Specifically, it encircles the mouth, originating in the maxilla (upper jaw and palate) and mandible (lower jaw) bones. The muscle inserts directly into the lips. Innervated by buccal branch of the facial nerve

Question 63

Describe the buccinator muscle’s origin, insertion, innervation and function. Label it too.

Answer 63

Buccinator compresses the cheeks and so assists muscles of mastication by keeping food in the right place. Innervated by buccal branch of facial nerve (cranial nerve VII).

Origin: The maxilla, the mandible, and deep to the mandible, along the pterygomandibular raphe.
Insertion: Attaches to the orbicularis oris and the fibers from the deep portion of the lips

Question 64

Describe the location, innervation and function of the dilator muscles of the mouth (zygomaticus muscles, risorius). Label them too.

Answer 64

Around the lips. Buccal and zygomatic branches of the facial nerve (cranial nerve VII). Draws the angle of the mouth superiorly and posteriorly to allow one to smile.

Question 65

What is the innervation, function, origin/insertion of the medial pterygoid. Label it too.

Answer 65

Mandibular branch of the trigeminal nerve (cranial nerve V). Elevates mandible (to close the jaw), protrudes mandible and assists the lateral pterygoid in moving the jaw side to side. originates from the pterygoid plate, palatine bone and maxillary tuberosity. Inserts onto the mandible.

Question 66

What is the innervation, origin/insertion and function of the lateral pterygoid? Label it too.

Answer 66

Innervated by the mandibular branch of the trigeminal nerve (cranial nerve V). Originates from the pterygoid plate and greater wing of the sphenoid bone. Inserts into the mandible and temperomandibular joint. Depresses the Mandible (open mouth), protrudes mandible and side to side movement of the mandible.

Question 67

What is the innervation, origin/insertion and function of the masseter muscle? Label it too

Answer 67

Mandibular branch of the trigeminal nerve (Cranial nerve V). Originates from the zygomatic bone and inserts onto the mandible. Function is as the main elevatorof the mandible.

Question 68

Describe the innervation, origin/insertion and function of the temporalis muscle. Label it too

Answer 68

Mandibular branch of the trigeminal nerve (cranial nerve V). Originates from the parietal bone and temporal surface of the spenoid bone, and inserts onto the mandible. Elevates the mandible and posterior fibres also retract it.

Question 69

Describe the origin/insertion, innervation and function of the levator palpebrae superioris muscle.Llabel it too

Answer 69

Originates from the sphenoid bone and inserts onto the tarsal plate and upper eyelid. Innervated by the oculomotor nerve. Function is to elevate and retract the upper eyelid.

Question 70

Define lymphadenopathy

Answer 70

Swollen lymph node (s) due to infection or malignancy (primary or secondary)

Question 71

Briefly describe the roles of the lymphatic system

Answer 71

Remove excess fluid from the interstitial space.

Return small proteins (including pathogens) and fluid that leaked from caplillaries

Key role in immune defence and immune surveillance - Physical and phagocytic barrier - source of lymphocytes

Question 72

All substances transported in lymph, travel through how many lymph nodes?

Answer 72

Minimum 1

Question 73

Why do lymph nodes swell/enlarge during infection?

Answer 73

Full of lymphocytes (T and B cells) which activate and proliferate in the lymph node causing it to swell

Question 74

Where in the body can lymph nodes be palpated in and where are they most commonly found?

Answer 74

Neck (cervical lymph nodes), Armpit (Axillary lymph nodes), groin (femoral lymph nodes)

Nearly half of th body’s lymph nodes are found in the neck

Question 75

How can we distinguish between enlarged lymph nodes caused by infection and those caused by malignancy?

Answer 75

When lymphadenopathy is caused by infection (most commonly) the lymph nodes will be tender and mobile wherea with infection theyll be hard, matted and non-tender ,or for lymphoma, rubbery, mobile and fast growing.

Question 76

What is the course of action if an enlarged lymph node is found?

Answer 76

Take a comprehensive history.

Examine the area of tissue it drains.

If systemic disease/malignancy suspeceted then examine other lymph nodes and body systems

Question 77

Describe the organisation of the cervical lymph nodes

Answer 77

Superficial lymphnodes found in the superficial cervical fascia under the skin drain into deep lymph nodes past the investing layer of the deep cervical fascia. Many of the deep lymph nodes are associated with the route of the internal jugular vein in the carotid sheath.

Question 78

Which of the cervical lymph nodes are more palpable?

Answer 78

The superficial lymph nodes as they lie underneath the skin.

Question 79

Name the superficial lymph nodes labelled in the picture.

Answer 79

1. Submental
2. Submandibular
3. Pre-auricular
4. Porst-auricular
5. Occipital
6. Superficial cervical
7. posterior cervical
8. anterior cervical

Question 80

Which regions of the head drain into which superficial lymph nodes?

Answer 80

Insert picture

Question 81

Swelling in which lymph nodes can be seen in conjunctivitis and why?

Answer 81

Pre auricular superficial lymph nodes. This is because the region around the eye drains into these lymph nodes

Question 82

Where are the deep cervical lymph nodes found?

Answer 82

Deep to sternocleidomastoid, closely related to the internal jugular vein in the carotid sheath.

Question 83

Which deep cervical lymph node swells in tonsilitis and where is it found?

Answer 83

Jugulo-digastric. Superior portion of carotid sheath

Question 84

Which deep cervical lymph node swells in oesophageal and thyroid cancer? Where is it found?

Answer 84

Jugulo-omohyoid and its found in the inferior portion of the carotid sheath.

Question 85

Where are the supraclavicular lymph nodes found? What would cause them to swell

Answer 85

Within supraclavicular fossa. GI cancers

Question 86

What are the deep cervical lymph nodes in the neck called?

Answer 86

In order of appearence superiorly to inferiorly: Jugulo-digastric, Jugulo-omohyoid and supraclavicular lymph nodes

Question 87

If cancer or an ulcer is found in the inner side of the lip or tip, which superficial lymph node would be swollen?

Answer 87

Submental

Question 88

Would tonsilitis present with superficial lymph node swelling?

Answer 88

No, the region affected drains directly into the deep lymph node: Jugulo-digastric. This is the same for cancers/ulcers at the posterior end of the toungue.

Question 89

Draw and label waldeyers ring. What is its function?

Answer 89

Lymphoid tissue around the pharynx to stop infection. Insert image

Question 90

When taking a history about neck lump, what is important to consider?

Answer 90

Age - some lymph nodes are more likely to swell in children. Cancers are more likely to affect older patients.

Duration, progression, associated signs and symptoms (including red flags)

Question 91

What should we do when examining a neck lump?

Answer 91

Relate location of lump to knowledge of underlying structure.

Anterior or posterior triangle? Midline or laterally placed?

Movement with swallowing and sticking out tongue?

Palpation features:

• Does it feel superficial, just beneath the skin and quite mobile? or deeper?
• Hard/soft/smooth/irregular
• Fixed to surrounding tissue?
• Tender? (inflammed/infected lumps likley painful)
• Overlying skin changes e.g redness

Question 92

What are the common causes of neck lumps?

Answer 92

Superficial, within superficial fascia/skin e.g sebaceous cyst, dermoid cyst, lipoma, skin abcess

Inflammatory/infected lymph node e.g tonsilitis, mouth ulcer

Congenital lesions e.g thyroglossal cysts, branchial cyst, laryngocoele, pharyngeal pouch

Thyroid pathology (malignant or benign)

Primary (lymphoma) or secondary malignant (metastatic) disease involving a lymph node

Salivary gland pathology (calculus, infection, tumour)

Other e.g chronic infection (Tuberculosis, HIV) can cause lymphadenopathy,carotid artery aneurysm

Question 93

What are the red flags for lymphadenopathy (presenting as a neck lump)?

Answer 93

Persisting longer than 6 weeks

Fixed, hard and irregular

Rapidly growing in size

Associated with generalised lymphadenopathy

Associated with systemic signs/symptoms such as weight loss and night sweats (signs of lymphoma)

Associated with persistent (unexplained) change in voice/hoarseness or difficulty swallowing (possible cancer of pharynx or larynx)

Question 94

What are some important midline neck lumps that should be considered? (not related to lymphadenopathy)

Answer 94

If on the midline, superficial, high up on the neck, doesn’t move when swallowing and pea sized it could be a dermoid cyst (has congenital origin). Often found in children.

Also found on midline high in the neck, a thyroglossal cyst (congenital origin). Thyroid develops from diverticulum from base of tongue which descends. Normally channel is obliterated however when this persists it can fill with fluid to become a thyroglossal cyst. will move when swallowing or sticking tongue out as its attached to tongue and thyroid.

Goitre - Enlarged thryoid. Will move when swallowing.

Question 95

What are some important lateral neck lumps that should be considered? (not related to lymphadenopathy)

Answer 95

Found upper half of the anterior border of sternocleidomastoid. Congenital origin. Branchial cyst.

Submandibular salivary gland cancer - Will be more painful when eatingwhereas if its a lymph node swelling then eating will have no effect

Question 96

Typically, what is the first-line imaging choice for investigating a neck lump e.g lymph node (with red flags) thyroid related?

Answer 96

Ultrasound as it doesn’t use radiation (least harmful to patient). Could also biopsy the lump

Question 97

What is a lipoma?

Answer 97

A benign tumour of fatty tissue

Question 98

What would be a very important differential diagnosis to consider when a patient presents unwell with apparent neck stiffnss?

Answer 98

Meningitis