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Semester 4 > Head And Neck Session 2 > Flashcards

Head And Neck Session 2 Flashcards

1
Q

Which blood vessel is used to measure right atrial pressure and why?

A

Internal jugular vein as it is straighter therefore gives a better indication

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2
Q

Which jugular vein is more visible?

A

External

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3
Q

What is the difference in position of the internal and external jugular veins in relation to SCM?

A

External is superficial, internal is deep to SCM

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4
Q

How is jugular venous pressure calculated?

A

Height from sternal angle +5 cm

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5
Q

What structure gives the level of the bifurcation of the CCA?

A

Superior border of the thyroid cartilage

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6
Q

Which branches does the subclavian artery give rise to?

A

Thyrocervical trunk
Vertebral artery
Internal thoracic artery

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7
Q

What are the branches of the aorta in the neck?

A

Brachiocephalic trunk –> subclavian and common carotid

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8
Q

Describe the passage of vertebral arteries from the subclavian artery to the brain.

A

Ascend through L&R transverse foramina of C6-1 to anastomose with the internal carotid artery to form basilar arteries

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9
Q

Which branch of the CCA does not have any branches in the neck?

A

Internal

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10
Q

Describe the path of the internal carotid artery.

A

Through carotid canal to anastomose in the circle of Willis

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11
Q

What is the carotid sinus?

A

Swelling at the region of the carotid bifurcation where baroreceptors are located

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12
Q

What is a carotid body?

A

Peripheral chemoceptor with rich vascular supply that can detect arterial pO2

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13
Q

Why is the CCA bifurcation a common site for atheroma formation?

A

Turbulent flow occurs here

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14
Q

What percentage occlusion of the carotid artery must be achieved before it becomes symptomatic?

A

> 70%

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15
Q

What is the clinical importance of the carotid triangle of the neck?

A

Pulse point
Surgical access to carotid artery, IJV, vagus and hypoglossal nerves
Carotid sinus massage in SVT pts

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16
Q

Which are the terminal branches of the external carotid artery?

A

Superficial temporal and maxillary

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17
Q

What are the branches of the external carotid artery?

A 
Maxillary
Facial
Lingual
Superior thyroid
Ascending pharyngeal
Occipital
Posterior auricular
Superficial temporal
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18
Q

What are the two branches of the superficial temporal artery?

A

Frontal and parietal

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19
Q

What are the layers of the scalp?

A 
Skin
Dense CT
Aponeurosis
Loose CT
Periosteum
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20
Q

In which layer of the scalp do the blood vessels lie?

A

Dense CT

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21
Q

Which arteries supply the scalp?

A 
Superficial temporal
Occipital
Posterior auricular
Supratrochlear
Supraorbital
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22
Q

What are the supraorbital and supratrochlear arteries branches of?

A

Ophthalmic artery, a branch of the ICA

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23
Q

Why does the scalp bleed profusely if damaged?

A

Close attachment of artery walls to dense CT limits constriction
Numerous anastomoses

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24
Q

How can a deep laceration to the scalp cause profuse bleeding?

A

Opposing pull of occipitofrontalis via the epicranial aponeurosis holds arteries open

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25
Q

Why does loss of scalp not lead to bone necrosis?

A

Blood supply to the skull is mostly via the middle meningeal artery so this will be maintained

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26
Q

What forms the angular vein at the medial angle of the eye to empty into the facial vein?

A

Supraorbital and supratrochlear veins

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27
Q

Where do the veins in the deep part of the scalp empty?

A

Pterygoid venous plexus

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28
Q

Why can infection in the scalp spread to the cranial cavity and meninges?

A

Veins of scalp connect to diploid veins through several valveless emissary veins and thus to dural venous sinuses

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29
Q

What forms a groove near the coronal suture that is visible on internal view of the skull?

A

Anterior branch of middle meningeal artery

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30
Q

What is the pterion?

A

Relatively weak area of skull formed by fusion of temporal, frontal, sphenoid and parietal bones

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31
Q

Why can fracture of the pterion cause extradural/epidural haemorrhage?

A

Can rupture middle meningeal artery (especially anterior branch)

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32
Q

How is blood supply to the dura and skull preserved during craniotomy?

A

Reflect bone and scalp flap inferiorly to preserve MMA and superficial temporal artery

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33
Q

Where do the superficial arteries of the face arise from?

A

All from ECA except supraorbital and supratrochlear from the ICA

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34
Q

Where can the facial artery pulse be felt?

A

Inferior border of mandible, anterior to masseter

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35
Q

Which is the major branch of the maxillary artery?

A

MMA

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36
Q

What are the branches of the facial artery?

A

Superior and inferior labial
Lateral nasal
Angular

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37
Q

What is the danger triangle of the face?

A

Area between bridge of nose and corners of the mouth that allows retrograde infection from the nasal area to the brain

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38
Q

What can be the result of retrograde infection in the danger triangle of the face?

A

Cavernous sinus thrombosis
Meningitis
Brain abscess

39
Q

What are dural venous sinuses?

A

Endothelium-lined spaces between the periosteal and meningeal layers of dura formed at dural septae that receive blood from large veins draining the brain

40
Q

How many dural venous sinuses are there?

A

5

41
Q

What are the names of the dural venous sinuses that converge at the posterior of the skull?

A 
Superior sagittal
Inferior sagittal
Transverse
Cavernous
Sigmoid
42
Q

Where does the sigmoid sinus empty into?

A

IJV to leave skull through the jugular foramina

43
Q

What is the cavernous sinus?

A

Plexus of extremely thin-walled veins on the upper surface of sphenoid

44
Q

What are the contents of the cavernous sinus?

A

ICA

CN: II-oculomotor, IV-trochlear, VI-abducent and 2 branches of the trigemnial V1-ophthalmic and V2-maxillary

45
Q

Do veins in the face have valves?

A

No

46
Q

What does the facial vein communicate with at the medial angle of the eye to empty into the cavernous sinus?

A

Superior ophthalmic

47
Q

Where do the deep facial veins drain into?

A

Pterygoid venous plexus

48
Q

How is the internal jugular vein positioned in relation to the other carotid sheath structures?

A

Deep to SCM and lateral to CCA, deep cervical lymph nodes and the vagus nerve

49
Q

What is the lymphatic system?

A

Network of drainage vessels throughout the body with a series of nodes that return lymph to the blood circulation

50
Q

Where are lymph vessels not found?

A

Avascular areas

51
Q

Is the lymphatic system present in the CNS?

A

Yes

52
Q

Why does a small amount of fluid remain in the intersticium during tissue fluid formation?

A

High hydrostatic pressure at arteriole end pushes out small proteins that cannot move back at the venule end as the oncotic pressure is not small enough

53
Q

How much lymph is formed per day?

A

3-4 l

54
Q

Why is lymph needed?

A

To prevent development of oedema due to the accumulation of small proteins as net filtration is not equal to net reabsorption

55
Q

What is tissue fluid In a lymphatic capillary called?

A

Lymph

56
Q

What does lymph contain?

A

Depends on location: damaged cells, bacteria, cancer cells, chylomicrons

57
Q

How does the flow of lymph compare to that of blood?

A

Much lower, 2-3 ml vs 5000 ml per minute

58
Q

Describe the order of lymphatic flow.

A

Tissue fluid –> lymphatic capillary –> lymphatic vessels –> lymph nodes –> lymphatic vessel –> lymphatic trunks –> thoracic/R lymphatic ducts

59
Q

Which duct drains the majority of lymph in the body?

A

Thoracic

60
Q

How many lymphatic vessels enter and exit each lymph node?

A

Several afferent enter but only one efferent exits

61
Q

How is the one-directional flow, low pressure system with no central pump able to achieve return of tissue fluid to blood circulation?

A

Valves, passive constriction by muscles and arteries and intrinsic constriction by reflexively contracting smooth muscle cells

62
Q

What is lymphoedema?

A

Chronic condition of fluid retention and tissue swelling due to compromise of the lymphatic system

63
Q

What can cause lymphoedema?

A 
Removal/enlargement of lymph nodes
Infection e.g. Parasites
Damage to system e.g. Cancer (itself or Tx)
Lack of limb movement
Congenital
64
Q

Describe the tissue structure of a lymph node.

A

Tough fibrous outer capsule with reticular CT inside

65
Q

What do lymph nodes contain large numbers of?

A

Lymphocytes and macrophages

66
Q

How do lymph nodes play a key role in immune defence?

A

Physical filter
Phagocytic filter
Lymphocytes for immune surveillance

67
Q

What size can a lymph node normally be?

A

Anywhere from microscopic to 2.5 cm

68
Q

What shape are lymph nodes normally?

A

Bean

69
Q

What can cause swollen lymph nodes?

A

Infection or malignancy

70
Q

How can a swollen lymph node to due infection be differentiated from one due to malignancy?

A

Infection: tender, firm and mobile
Malignancy: hard, matted and non-tender

71
Q

What does presentation with a swollen lymph node require?

A

Comprehensive history
Examination of area drained by node
Examine other lymph nodes and body systems if cancer is suspected

72
Q

How are lymph nodes organised?

A

Regional/superficial nodes that are readily palpable drain specific areas and empty into terminal/deep nodes that receive lymph from multiple regional nodes

73
Q

Where are superficial lymph nodes palpable?

A 
Neck
Armpit
Abdomen
Pelvis
Groin
74
Q

How many lymph nodes are there in the neck?

A

300

75
Q

What is the most common cause of swelling in the neck?

A

Enlarged cervical lymph nodes

76
Q

What separates cervical lymph nodes into superficial and deep?

A

Investing layer of deep cervical fascia

77
Q

Where are most of the deep cervical lymph nodes found?

A

In the carotid sheath associated with the IJV

78
Q

What are the 8 groups of superficial cervical lymph nodes?

A 
Submental
Submandibular
Preauricular
Postauricular
Occipital
Superficial (EJV)
Posterior cervical
Anterior cervical
79
Q

What are the three groups of deep cervical lymph nodes?

A

Jugulo-digastric (tonsillar)
Jugulo-omohyoid
Supraclavicular

80
Q

Which muscle are the deep cervical lymph nodes deep to?

A

SCM

81
Q

Where do the L&R supraclavicular lymph nodes receive lymph from?

A

R: mid-section chest, oesophagus, lungs
L: abdomen and thorax

82
Q

What is the alternative name for the left supraclavicular node?

A

Virchow’s node

83
Q

What areas of the face do the submandibular lymph nodes receive drainage from?

A 
Upper lip and teeth
Lateral lower lip
Most of face
Anterior nasal cavity
Cheeks
Middle tongue
Submental and lingual glands
84
Q

Which areas of the face do the submental nodes receive drainage from?

A

Lower lip and teeth
Anterior chin
Tip of tongue
Floor of mouth

85
Q

Which areas of the head do the preauricular lymph nodes receive drainage from?

A

Middle posterior scalp
Skin of lateral ear
Parotid gland

86
Q

Which areas of the head do the postauricular lymph nodes receive drainage from?

A

Posterior scalp
Cranial surface of pinna
Back of external acoustic meatus

87
Q

Which region of the head do the occipital lymph nodes receive drainage from?

A

Posterior scalp and neck

88
Q

Where do the superficial cervical (including anterior and posterior) lymph nodes receive drainage from?

A

Skin of neck

Preauricular, postauricular and occipital nodes

89
Q

Where do the entire head and neck superficial lymph nodes drain into?

A

Deep cervical nodes

90
Q

Where do the jugulo-digastric nodes receive drainage from?

A

Palatine tonsil and posterior 1/3 of tongue

91
Q

Where do the jugulo-omohyoid nodes receive their drainage from?

A

Anterior 2/3 tongue, oral cavity, trachea, larynx, oesophagus and thyroid gland

92
Q

What is Waldeyer’s ring?

A

Ring of lymphoid tissue in the naso- and oropharynx consisting of pharyngeal tonsils, 2 eustaschian tonsils, 2 palatine tonsils, 1 or more lingual tonsils and lots of MALT

93
Q

Why is the lymphoid tissue in Waldeyer’s ring considered tissue instead of nodes?

A

Lack fibrous CT surrounding them

Semester 4 (33 decks)

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