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HNN > Session 2 > Flashcards

Session 2 Flashcards

1
Q

What is lymphadenopathy

A

Enlargement of a lymph node due to infection or malignancy

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2
Q

Lymphadenopathy can develop due to

A

Infection and/or inflammation (of tissues drained by that lymph node)

Malignancy (either from metastases or primary malignancy)

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3
Q

Most likely cause of a neck lump

A

Swollen lymph node secondary to recent infection

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4
Q

2 other causes of neck lump

A

Thyroid gland or congenital conditions

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5
Q

Characteristics of a neck lump

A

Location, palpation findings and associated symptoms - red flags

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6
Q

2 ways in which lymph nodes can be organised

A

Regional (superficial) and terminal (deep)

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7
Q

Examples of regional lymph nodes in the head and neck

A

Occipital, post auricular, submandibular

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8
Q

What do regional lymph nodes do

A

Drain specific areas, lie superficially within the superficial cervical fascia

Readily palpated when enlarged

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9
Q

Where are terminal lymph nodes and what do they do

A

Deep to investing layer of deep cervical fascia. Deep cervical nodes

Receive all the lymph from the head and neck, including lymph first drained by regional groups

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10
Q

What drain directly to deep cervical lymph nodes and why is this significant

A

Deep tissues and structures of neck already deep to investing layer

Larynx, thyroid gland

May first present a lump in neck due to enlarged deep cervical node

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11
Q

Terminal nodes are closely related to the

A

IJV- within carotid sheath

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12
Q

2 specific lymph nodes within deep cervical group

A

Jugulo-digastric and jugular-omohyoid

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13
Q

Where is the jugulo-Digastric node Located (tonsillar node), what does it drain

A

Just below and behind the angle of the mandible,

drains palatine tonsil, oral cavity and tongue

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14
Q

Which lymph node is Often swollen and tender in tonsillitis and can also become enlarged in cancers

A

Jugulo-Digastric (tonsillar node)

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15
Q

jugulo-omohyoid node is mainly associated with the lymph drainage of the

A

Tongue, oral cavity, trachea, oesophagus and thyroid gland

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16
Q

Another group of deep cervical lymph nodes of particular importance

A

Supraclavicular nodes found in posterior triangle, at root of neck on either side

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17
Q

Supraclavicular nodes enlarge when

A

In late stages of malignancies of the abdomen and thorax as they receive lymph from these areas before it drains via the thoracic duct into venous circulation

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18
Q

The arterial supply to the head and neck arises from branches of the

A

Right and left common carotid arteries and the vertebral arteries

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19
Q

Vertebral arteries are branches of the

A

Subclavian arteries

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20
Q

Vertebral arteries supply the

A

Posterior neck and posterior parts of brain (brain stem, cerebellum)

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21
Q

Vertebral artery ascends through the

A

Transverse foramina of the cervical vertebrae except C7, enters subarachnoid space between atlas and occipital bone

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22
Q

Vertebral artery route after occipital bone

A

Up through foramen magnum curving around medulla, joins vertebral artery from the other side to form the basilar artery

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23
Q

Basilar artery runs along the

A

Anterior aspect of brainstem (pons),

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24
Q

Right common carotid artery originates from the

A

Brachiocephalic artery behind right sternoclavicular joint

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25
Q

Left common carotid artery rises directly from

A

Arch of aorta, slightly longer as courses for 2 cm in superior mediastinum before entering neck

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26
Q

Each common carotid artery ascends through the neck enclosed within the

A

Carotid sheath

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27
Q

Carotid sheath is a fascial envelope enclosing the

A

Common carotid artery, internal carotid, internal jugular vein and vagus nerve

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28
Q

Where do the contents of carotid sheath lie relative to eachother

A

Artery lies medially within sheath whilst vein is lateral, and nerve behind and in between the vessels. Sympathetic chain lies outside of sheath, medially and behind

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29
Q

Common carotids most commonly terminate at the level of the

A

Upper border of the thyroid cartilage (C4 level), and divide into internal and external carotid arteries

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30
Q

What is of importance at the bifurcation of the common carotids

A

Internal carotid artery is more bulbous due to the carotid sinus (and carotid body),

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31
Q

site of carotid sinus clinical relevance

A

Rubbing this area firmly can alleviate supra-ventricular tachycardias (carotid massage)

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32
Q

Internal carotid artery is distinguished by a

A

Lack of branches in the neck

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33
Q

Internal carotid artery course

A

Enters base of skull through carotid canal, passes through cavernous sinus, gives branches to brain and eye

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34
Q

External carotid artery is major source of blood supply to the

A

Extra cranial structures of the head and neck- 8 branches, including facial artery (main supply for tissue of face)

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35
Q

Branches of the external carotid artery can be remembered by the mnemonic

A

Some anatomists like freaking out poor medical students

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36
Q

2 terminal branches of external carotid artery

A

Maxillary and superficial temporal arteries (artiste at a level behind neck of mandible), travel through parotid gland and provide major source of blood

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37
Q

Maxillary artery supplies

A

Parotid gland and deep tissue and bone structures of face- gives middle meningeal artery which supplies meninges and skull

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38
Q

Superficial temporal artery supplies

A

Parotid gland, tissues of scalp (joins with other branches)

39
Q

Superficial temporal artery can be affected in a condition called

A

Temporal arthritis- form of vasculitis involving small and medium size vessels. Presents as unilateral headache and jaw claudication in older people

40
Q

Most of the structures of the face drain via the

A

Facial vein- runs from medial angle of eye towards inferior border of mandible

41
Q

Facial vein then joins the

A

Internal jugular vein, then connect with superior and inferior ophthalmic veins

42
Q

Superior and inferior ophthalmic veins have a direct connection with the

A

Cavernous sinus and pterygoid venous plexus - therefore blood draining face can potentially drain intracranially as cavernous sinus drains intracranially

43
Q

Implications of cavernous sinus

A

Infections involving face as can spread to involve intra cranial structures- e.g. septic thrombi in facial vein can travel via ophthalmic veins to cavernous sinus and cause a cavernous sinus thrombosis

44
Q

Important anastomosis between extra cranial veins and intracranial veins

A

Veins of scalp and intra cranial (dural) venous sinuses- connected by emissary veins provide potential route for infection of scalp to spread into cranial cavity

45
Q

What is this

A

Danger triangle- can track intra-cranially

46
Q

Internal jugular vein (IJV right and left) arises as a continuous of which venous (dural) structure found within the skull

A

Sigmoid sinus

47
Q

IJV route

A

Runs length of neck (within carotid sheath)- straight line running from lobule of the ear to the sternoclavicular joint

48
Q

What happens to Sternocleidomastoid muscle at inferior end of IJV

A

Splits into clavicular and sternal heads forming a gap anterior to the vein- hence readily accessed for central lines, jugular venous pulsation can be seen

49
Q

Doctors use JVP for what

A

Indication of the pressures within the venous circulation and right side of heart- right is favoured as straighter more vertical route into right atrium so better reflects pressures

50
Q

Central lines usage

A

Monitoring central venous pressure, administration of drugs, ease of repeated blood sampling, temporary haemodialysis

Very unwell patients

51
Q

IJV recieves blood from what other veins during its descent

A

Facial vein, veins draining thyroid gland and tongue

52
Q

IJV ends by

A

Joining with the subclavian vein (behind medial need of clavicle) to form Brachiocephalic vein, which drains into superior vena cava and hence the right atrium

53
Q

The External jugular vein is formed by

A

Joining of veins that have drained the scalp and the deep structures of the face

Runs in superficial cervical fascia of the neck

54
Q

EJV relativity

A

Deep to platysma, superficial to Sternocleidomastoid- more readily visible than IJV

55
Q

EJV terminal part

A

Drains into subclavian vein, after piercing investing layer of deep cervical fascia and lower end of neck

56
Q

Why are the vessels of the neck important

A

Major vessels supplying and draining brain
Access route
Important in clinical examination
Pathology can be seen in disease or injury to these vessels

57
Q

Clinical importance of inferior thyroid artery

A

Near to recurrent laryngeal nerve

58
Q

Site of baroreceptors

A

Common carotid artery

59
Q

What forms superior border of carotid triangle

A

Posterior belly of Digastric

60
Q

What forms medial/inferior border of carotid triangle

A

Superior belly of omohyoid

61
Q

What forms lateral border of carotid triangle

A

Medial border of SCM

62
Q

Importance of carotid triangle

A

Bifurcation of common carotid accounts here, important clinically for surgery

63
Q

Clinical significance of artery in carotid triangle

A

Atherosclerosis, carotid sinus massage, central pulse

Access site for vagus and hypoglossal nerves

Access site for central line placement as contains internal jugular vein

64
Q

Atherosclerosis in carotid triangle

A

Bifurcation is a common site of atherosclerosis, causes artery to narrow/stenosis, plaque rupture can release an embolus which can travel to brain, cause stroke or TIA, or transient loss of vision (Amaurosis Fugax)

65
Q

What is carotid endarterectomy

A

Incision to neck and carotid, removal of plaque tissue and stitched back up

66
Q

How does carotid sinus massage work

A

Increased baroreceptor activity feedback to the heart to slow down

67
Q

Carotid canal is within what part of what bone

A

Petrous part of temporal bone

68
Q

What is cavernous sinus and what runs through it

A

Venous type structure on upper surface of sphenoid bone

Carotid artery
CN III (oculomotor)
CN IV (trochlear)
CN VI (Abducens)
2 branches of CN V (trigeminal) (CN V1 ophthalmic and CN 2 maxillary)

69
Q

What arteries supply eye

A

Supratrochlear, supra-orbital and central retinal

70
Q

Distribution of external carotid

A

Superior thyroid
Ascending pharyngeal
Lingual
Facial
Occipital
Posterior auricular
Maxillary
Superficial Temporal

71
Q

What happens in temporal arteritis if not treated

A

Permanent loss of eye sight

72
Q

Layers of scalp

A

Skin, connective tissue, aponeurosis, loos areolar tissue, periosteum

73
Q

Why does the scalp bleed

A

Heavy bleeding seen in scalp injuries
Artery walls held open by connective tissue and so can’t constrict
Lots of anastomoses
Lacerations deep enough to involve epicranial aponeurosis of occipitofrontalis can pull cuts open

74
Q

Blood supply to scalp

A

Internal carotid- supraorbital and supratrochlear

superficial temporal, posterior auricular, occipital (external carotid)

75
Q

Key branches of maxillary artery

A

Middle meningeal artery and sphenopalatine artery

76
Q

Middle meningeal artery clinical relevance

A

Anterior branch of MMA close relation to Pterion
Pterion is thin area of bone
Fracture at this site can rupture MMA
Causes intracranial haemorrhage - extramural haemorrhage
Needs surgical treatment

77
Q

Extramural haemorrhage management

A

Needs specialist neurosurgical treatment, craniotomy- opening of the cranium to relieve pressure, evacuate clot forming and stop bleeding

78
Q

How to get estimate of right atrial pressure in cmh20

A

Measure height from sternal angle and add 5cm

79
Q

Role of lymphatic system within the body

A

Remove XS fluid and pathogens from interstitial space

Returns small proteins and fluid that leaked from capillaries back into venous circulation

Role in immune defence and surveillance (physical and phagocytic Barrier, source of lymphocytes)

80
Q

Describe waldeyer’s ring

A

Annular collection of lymphoid tissue surrounds the upper aero digestive tact- enlargement can lead to obstruction of nasal breathing, blocking of dust ACh Ian tube (leads to middle ear problems)

81
Q

Describe what makes up Waldeyer’s ring from a lateral view top to bottom

A

Pharyngeal tonsil, tubal tonsil, palatine tonsil and lingual tonsil

82
Q

What are concerning features of a lump that may suggest malignancy

A

Hard, tethered to surrounding tissues, painless to palpation, rubbery, fast growing

weight loss

83
Q

General red flags for lymphadenopathy

A

Persisting for longer than 6 weeks
Fixed, hard and irregular (palpation findings)
Rapidly growing in size
Associated with generalised lymphadenopathy
Associated systemic signs and symptoms such as weight loss, night sweats
Associated with a persistent change in voice/hoarseness or difficulty swallowing

84
Q

Superficial lymph nodes draining the face, scalp and neck form a

A

Ring from chin to occipital bone

85
Q

What is Virchow’s node

A

Left nodes- abdominal cavity and thorax, enlarged, suggestive of gastric cancer

86
Q

Movement with swallowing and movement with sticking out tongue indicate respectively

A

Thyroid gland pathology, thyroglossal duct cyst

87
Q

What would suggest vascular lump

A

Pulsatile mass- carotid body tumour, carotid artery aneurysm (rare)

88
Q

Salivary gland pathology

A

Calculus (stone), inflammation or infection, neoplasm (benign or malignant)

89
Q

thyroid gland pathology

A

Malignant or benign neoplasm
Disease e.g grave’s

90
Q

Congenital lesions

A

Thyroglossal duct cysts, branchial cyst, dermoid cyst, laryngocoele, cystic hygromas (posterior triangle, kids under 2), in children usually

91
Q

benign lesions of skin or subcutaneous tissue

A

Sebaceous cyst, lipoma

92
Q

midline lump suggests

A

Midline- thyroid gland disease, congenital lesions (dermoid cyst, thyroglossal duct cyst)

93
Q

Lateral lump suggests

A

Lateral- salivary gland pathology A , carotid body tumour, congenital lesions (branchial cyst A, cystic hygroma P)

94
Q

First line imaging choice for investigating neck lump, in order

A

Ultrasound

if suspicious feature can perform US guided fine needle aspiration

HNN (19 decks)

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