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MBChB - Y2 - Head and Neck > Neck Anatomy and Physiology > Flashcards

Neck Anatomy and Physiology Flashcards

1
Q

What are 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 superior and inferior boundaries of the neck?

A

Superior - mandible

Inferior - clavicle

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3
Q

What are the anterior and posterior boundaries of the neck?

A

Anterior - anterior midline

Posterior - trapezius

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4
Q

What are the boundaries of the anterior triangle of the neck?

A

Anterior: midline of the neck

-Posterior: anterior border of sternocleidomastoid

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5
Q

What are the boundaries of the posterior triangle of the neck?

A

Anterior: posterior border of sternocleidomastoid

-Posterior: anterior border of trapezius

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6
Q

What are the contents of the anterior triangle of the neck?

A

Common carotid artery

Internal carotid artery

External carotid artery

Internal jugular vein

Facial artery

Facial vein

Hypoglossal nerves

Accessory nerves

Vagus nerves

Laryngeal nerves

Glossopharyngeal nerves

Submandibular nodes

Submental nodes

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7
Q

What are the contents of the posterior triangle?

A

Accessory nerve

Cervical nerve plexus

Occipital artery

External jugular vein

Lymph nodes

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8
Q

What are the branches of the ECA?

A

Some Anatomists Like Freaking Out Poor Medical Students

Superior thyroid

Ascending pharyngeal

Lingual

Facial

Occipital

Posterior auricular

Maxillary

Superficial temporal

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9
Q

What is meant by a central line?

A

an IV line that is inserted into a large vein (as the superior vena cava) typically in the neck or near the heart for therapeutic or diagnostic purposes (as to administer medicines or fluids or withdraw blood)

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10
Q

What are indications for central lines?

A

Central venous pressure

Fluid resuscitation

Drug administration

Haemodialysis

Cardiac pacing

Intravenous nutrition

Blood sampling

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11
Q

What are complications of central lines?

A

Pneumothorax

Air embolism

Thrombosis

Haematoma

Chylothorax

Sepsis

Cardiac tamponade

False passage

Line blockage

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12
Q

Where do the 600 lymph nodes in the head and neck drain>?

A

Receive lymph/ tissue waste product

Drain to cisterna chyli

Then drain to thoracic duct on left

Described in groups AND levels

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13
Q

What are the lymph node levels?

A

Level 1 – submental and submandibular

Upper 1 third, Middle 1 third, lower 1 third – levels of SCM – 2,3,4

5 – posterior triangle

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14
Q

What do the following lymph nodes drain?

Parotid nodes

Occipital nodes

Superficial cervical nodes

Deep cervical nodes

Submandibular nodes

Submental nodes

Supraclaviculas

A

Parotid nodes-scalp, face & parotid gland

Occipital nodes-scalp

Superficial cervical nodes-breast & solid viscera

Deep cervical nodes-final drainage pathway to thoracic duct

Submandibular nodes-tongue, nose, paranasal sinuses, submandibular gland, oral cavity

Submental nodes-lips, floor of mouth

Supraclaviculas nodes-breast, oesophagus, solid viscera

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15
Q

What are the types of lymphadenpathy?

A

INFECTIVE

INFLAMMATORY

MALIGNANT

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16
Q

What is the structure of the thyroid?

A

Endocrine gland

2 lobes, joined by isthmus

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17
Q

What does th thyroid hormone produce?

A

Produce thyroid hormone AND calcitonin

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18
Q

What is the effect of calcitonin?

A

Calcitonin acts to lower calcium and raise phosphate

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19
Q

What is a thyroglossal cyst?

A

Dilatation of thyroglossal duct remnant

May become infected

Midline; grows with age

Moves on tongue protrusion

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20
Q

What is the investigation and treatment for thyroglossal cyst?

A

Investigate by fine-needle aspiration cytology (FNAC) AND ultrasound scanning

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

Excised but chance of recurrence (sistrunk operation)

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21
Q

What are the causes of thyroid masses?

A

Solitary nodule

Diffuse enlargement

Multi-nodular goitre

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22
Q

What are the causes of soitary thyroid nodules?

A

Cyst: due to localised haemorrhage

Adenoma: benign follicular tissue

Carcinoma

Lymphoma

Prominent nodule in multi-nodular goitre

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23
Q

What is the epidaemiology of solitary thyroid nodule?

A

F>M

30-40 years

10% malignant in middle-aged, 50% malignant in young

24
Q

Why is tissue required for histological diagnosis of a follicular adenoma AND a follicular carcinoma?

A

FNAC CANNOT distinguish between a follicular adenoma AND a follicular carcinoma

Potential for thyroid lobectomy

25
Q

What are the different forms of thyroid cancer?

A

Papillary-lymphatic metastasis

Follicular-haematogenous metastasis

Medullary-familial association 10%, arise from parafollicular C cells

Anaplastic-aggressive, local spread, very old, poor prognosis

26
Q

What are the causes of diffuse thyroid enlargement?

A

Colloid goitre

Grave’s disease

Thyroiditis

27
Q

What causes colloid goitre?

A

due to gland hyperplasia, iodine deficiency, puberty, pregnancy, lactation

28
Q

What are common symptoms of diffuse thyroid enlargement?

A

Dysphagia (if pressing on oesophagus), SOB on exertion, tracheal pressure, choking when the patient raises their hands (retrosternal goitre)

29
Q

What is Grave’s disease?

A

A swelling of the neck and protrusion of the eyes resulting from an overactive thyroid gland.

30
Q

Why does hyperthyroidism result from grave’s disease?

A

Auto-antibodies stimulate the receptor that responds to thyroid stimulating hormone

31
Q

What are features of Grave’s disease?

A

Hyperthyroidism

Thyroid eye disease

Acropachy (soft tissue swelling of the hands and finger clubbing)

Pre-tibial myxoedema - Skin lesions or areas of non-pitting edema appear on the anterior or lateral aspects of the legs or in sites of old or recent trauma in patients with Graves disease.

32
Q

What are indications of thyroidectomy?

A

Airway obstruction

Malignancy or suspected malignancy

Thyrotoxicosis (another term for hyperthyroidism)

Cosmesis

Retrosternal extension

33
Q

What are complications of thyroidectomy?

A

Bleeding-primary or secondary

Voice hoarseness

Thyroid storm (During thyroid storm, an individual’s heart rate, blood pressure, and body temperature can soar to dangerously high levels.)

Infection

Hypoparathyroidism

Hypothyroidism

Scar (keloid/ hypertrophic)

34
Q

What are the two causes of multi-nodular goitre?

A

Grave’s disease or toxic goitre

35
Q

What are the features of both causes of multi-nodular goitre?

A

Graves:

Women

Middle-aged

Over-activity→hyperthyroidism

Toxic Goitre:

Older, no eye signs, atrial fibrillation

36
Q

What are the investigations for multi-nodular goitre?

A

Thyroid function tests, FNAC, chest x-ray

37
Q

How many parathyroid glands are there?

A

4

38
Q

What is the role of the parathyroid gland?

A

Regulate calcium & phosphate levels

39
Q

Where are the parathyroid glands located?

A

Located posterior to poles of thyroid

40
Q

What are the different presentations of parathyroid disease?

A

Kidney:

  • Renal calculi
  • Polyuria
  • Renal failure

Bones:

  • Pathological fracture
  • Osteoporosis
  • Bone pain

GI:

  • Abdominal pain
  • Constipation
  • Peptic ulceration
  • Pancreatitis
  • Weight loss

Neural

  • Anxiety and Depression
  • Confusion
  • Paranoia
41
Q

What is found in blood samples for those with Hyperparathyroidism?

A

High calcium with corresponding high parahyroid hormone

42
Q

What are other investigations for parathyroid disease?

A

Urea & electrolytes, creatinine, calcium, phosphate

Parathyroid hormone, bicarbonate

Vitamin D

Ultrasound scan

CT/MRI: identify ectopic glands

Isotope scanning: detect diseased glands

Bone x-rays and a bone density test (DXA) can help detect fractures, bone loss, and bone softening. Ultrasound and CT scans may be done to view the parathyroid glands in the neck.

Surgery for Hyperparathyroidism ONLY

43
Q

Which demographic is vulnerable to hyperparathyroidism?

A

Post-menopausal women

44
Q

What are the causes of hyperparathyroidism?

A

Adenoma (80%)

Hyperplasia (12%)

Malignancy

45
Q

When might hyperplasia of parathyroid glands result?

A

During renal failure - results in low calcium and vitamin D - high PTH to compensate - calcium levels become normal but phosphate levels are high

46
Q

What is the management of parathyroid disease?

A

Management

Medical treatment

Surgery easier if patient fit

Remove single adenomas

Remove multiple adenomas too

Remove 3 or 3.5 hyperplastic glands through neck exploration

Carcinomas removed with thyroid gland and lymph nodes

47
Q

What are the 4 fascial layers of the neck?

A

Pre-tracheal

Pre-vertebral

Deep cervical

Carotid sheath

48
Q

What are the indications for tracheostomy?

A

Airway obstruction

Airway protection

Poor ventilation to reduce dead space

49
Q

Where is the airway obstruction in the presence of?

Inspiratory - added sounds

Expiratory - added sounds

Biphasic – added sounds

A

Inspiratory - laryngeal

Expiratory - tracheobronchial

Biphasic – glottic/subglottic

50
Q

What is the treatment for stridor?

A

Treat with O2, Nebulised Adrenaline, IV Dexamethasone, (Heliox), (Definitive) airway management

Dexamethasone: Dexamethasone is a steroid that prevents the release of substances in the body thatcause inflammation

51
Q

What are the two causes of branchial cyst?

A

Remnant of fusion failure of branchial arches

Lymph node cystic degeneration

52
Q

Where are branchial cysts located?

A

Anterior to sternocleidomastoid at junction between upper and middle thirds

53
Q

What causes a pharyngeal pouch?

A

The pharyngeal mucosa herniates between two muscles of the inferior pharyngeal constrictor. These muscles are the thyropharyngeus and the circopharyngeus.

54
Q

What are the symptoms of a pharyngeal arch?

A

Voice hoarseness

Dysphagia

Aspiration pneumonia

Regurgitation

Weight loss

Neoplasia

55
Q
A

MBChB - Y2 - Head and Neck (12 decks)

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