Anatomy and Physiology of the Neck Flashcards Preview

ENT > Anatomy and Physiology of the Neck > Flashcards

Flashcards in Anatomy and Physiology of the Neck Deck (93)
Loading flashcards...
1
Q

What are the anatomical contents of the neck?

A
Arteries
Veins
Nerves
Lymph nodes
Lymphatic channels 
Thyroid gland
Parathyroid gland
Muscles 
Trachea
2
Q

What is the superior border of the neck?

A

Mandible

3
Q

What is the inferior border of the neck?

A

Clavicle

4
Q

What is the anterior border of the neck?

A

Anterior midline

5
Q

What is the posterior border of the neck?

A

Trapezius

6
Q

What triangles are found in the neck?

A

Anterior triangle

Posterior triangle

7
Q

Anterior border of the anterior triangle

A

Midline of the neck

8
Q

Posterior border of the anterior triangle

A

Anterior border of sternocleidomastoid

9
Q

Anterior border of the posterior triangle

A

Posterior border of the sternocleidomastoid

10
Q

Posterior border of the posterior triangle

A

Anterior border of the trapezius

11
Q

Contents of the anterior triangle

A
Common carotid artery 
External carotid artery 
Facial artery 
Hypoglossal nerves
Vagus nerves
Glossopharyngeal nerves 
Submandibular nodes
Submental nodes
Internal carotid artery 
Internal jugular vein 
Facial vein 
Accessory veins
Laryngeal veins
12
Q

Contents of the posterior triangle

A
Accessory nerve 
Occipital artery 
Lymph nodes
Cervical nerve plexus
External jugular vein
13
Q

What level do the common carotid arteries divide?

A

C4

14
Q

Branches of the external carotid artery in the neck

A
Superior thyroid
Ascending pharyngeal 
Lingual 
Occipital 
Facial 
Posterior auricular 
Maxillary 
Superficial temporal
15
Q

Indications for central lines

A
Central venous pressure
Drug administration 
Cardiac pacing
Blood sampling
Fluid resuscitation 
Haemodialysis
IV nutrition
16
Q

Complications of central lines

A
Pneumothorax
Haematoma
Cardiac tamponade 
Air embolism 
Chylothorax 
False passage 
Thrombosis
Sepsis 
Line blockage
17
Q

What are the 4 fascia of the neck?

A

Pre-tracheal
Pre-vertebral
Deep cervical
Carotid sheath

18
Q

Anatomy of thyroid gland

A

2 lobes

Isthmus

19
Q

What type of gland is the thyroid gland?

A

Endocrine

20
Q

What hormones does the thyroid gland produce?

A

Thyroid hormones

Calcitonin

21
Q

Function of calcitonin

A

Lower calcium

Raise phosphate

22
Q

Movement of the thyroid with swallowing. Why?

A

Moves with swallowing

It is attached to the laryngeal framework

23
Q

What is a thyroglossal cyst?

A

Dilatation of thyroglossal duct remnant

24
Q

Where is a thyroglossal cyst found?

A

Midline of neck

25
Q

What happens to a thyroglossal cyst as age increases?

A

It grows

26
Q

When does a thyroglossal cyst move?

A

With tongue protrusion

27
Q

What needs to be done before a thyroglossal cyst is removed? Why?

A

USS

To ensure functioning thyroid tissue elsewhere

28
Q

Types of thyroid mass

A

Solitary nodule
Diffuse enlargement
Multi nodular goitre

29
Q

Causes of a solitary thyroid nodule

A
Cyst
Adenoma
Carcinoma
Lymphoma 
Prominent nodule in a multi nodular goitre
30
Q

Which gender gets more solitary thyroid nodules?

A

F

31
Q

What age gets solitary thyroid nodules?

A

30 - 40 y/o

32
Q

What is a red flag symptom for neck lump history?

A

Pain

33
Q

Investigations of a solitary thyroid nodule

A

FNAC

USS

34
Q

What can FNAC not distinguish between?

A

Follicular adenoma and follicular carcinoma

35
Q

THY classification of solitary thyroid nodules

A

Type 1 - not diagnostic, not enough thyroid tissue
Type 2 - normal
Type 3 - Borderline, not sure about malignant potential
- adenoma
- carcinoma
Type 4 - concerning, most likely cancer
Type 5 - cancer

36
Q

Types of thyroid cancer

A

Papillary
Follicular
Medullary
Anaplastic

37
Q

Causes of diffuse thyroid enlargement

A

Colloid goitre due to

  • gland hyperplasia
  • iodine deficiency
  • puberty
  • pregnancy
  • lactation
  • graves disease
  • thyroiditis
38
Q

What may be compressive neck symptoms of a huge diffuse thyroid swelling?

A

Dysphagia
Stridor if compresses trachea
SOB on exertion
Retrosternal goitre if grows behind

39
Q

What test should be done to see if a goitre is growing retrosternally?

A

Difficulty to reach up without choking

40
Q

Which gender gets graves disease more?

A

F > M

41
Q

Pathology of graves disease

A

Auto antibodies against TSH stimulate receptor

Hyperthyroidism results

42
Q

Clinical signs of graves disease

A

Thyroid eye disease
Acropachy/clubbing
Pre-tibial myxoedema

43
Q

Treatment of graves disease

A

Anti-thyroid drugs
Beta blockers
RAI
Surgery

44
Q

Indications for a thyroidectomy

A
Airway obstruction 
Malignancy or suspected 
Thyrotoxicosis
Cosmesis
Retrosternal extension
45
Q

Complications of thyroidectomy

A
Bleeding
Voice hoarseness
Thyroid storm 
Infection 
Hypoparathyroidism 
Hypothyroidism 
Scar (keloid/hypertrophic)
46
Q

Causes of a multi nodular goitre

A

Graves disease

Toxic goitre

47
Q

How many parathyroid glands are there?

A

4

48
Q

Function of parathyroid glands?

A

Regulate calcium and phosphate levels

49
Q

Where are the parathyroid glands found?

A

Posterior poles of the thyroid

50
Q

Results / Presentation of parathyroid disease

A
Renal calculi 
Polyuria
Renal failure
Pathological fractures
Osteoporosis
Bone pain 
Anxiety
Depression 
Confusion 
Paranoia
Abdo pain 
Constipation 
Peptic ulceration 
Pancreatitis 
Weight loss 
U and E, creatinine, calcium, phosphate disturbance
51
Q

Causes of hyperparathyrodisim

A

Adenoma (80%)
Hyperplasia (12%)
Malignancy (rare)

52
Q

Types of lymphadenopathy

A

Infective
Inflammatory
Malignant

53
Q

Indications for tracheostomy

A

Airway obstruction
Airway protection
Poor ventilation to reduce dead space

54
Q

What is inspiratory stridor a sign of?

A

Laryngeal obstruction

55
Q

What is expiratory stridor a sign of?

A

Tracheobronchial obstruction

56
Q

What is biphasic stridor a sign of?

A

Glottic / subglottic obstruction

57
Q

Treatment of stridor

A
O2
Nebulised adrenaline
IV dexamethasone
Heliox
Definitive airway management
58
Q

Pathology of a branchial cyst

A

Remnant of fusion failure of branchial arteries
OR
Lymph node cystic degeneration

59
Q

Where are the branchial cysts found?

A

Anterior to the sternocleidomastoid at the junction between the upper and middle thirds - between the SCM and the pharynx

60
Q

What is a clinical feature of a branchial cyst?

A

Transilluminates

61
Q

What can happen to branchial cysts?

A

Become infected, enlarging

62
Q

What is a pharyngeal pouch?

A

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

63
Q

Symptoms of pharyngeal pouch

A
Voice hoarseness
Dysphagia 
Aspiration pneumonia 
Regurgitation 
Weight loss
64
Q

What % of pharyngeal pouches are neoplasic?

A

1%

65
Q

How many lymph nodes are in the head and neck?

A

600

66
Q

Where do lymph nodes in the head and neck drain to?

A

Cisterna chyli then

thoracic duct on left

67
Q

What are the lymph glands of the head and neck?

A
Parotid
Submental 
Submandibular 
Clavicle
Supraclavicuar 
Cervical 
Occipital 
Post auricular
Pre auricular
68
Q

What are the lymph node vessels of the head and neck?

A
I; submandibular and submental 
II; Upper II
III; middle III
Posterior triangle; 5
Midline is 6
69
Q

What does the parotid lymph glands drain?

A

Scalp
Face
Parotid gland

70
Q

What do the occipital nodes drain?

A

Scalp

71
Q

What do the superficial cervical nodes drain?

A

Breast

Solid viscera

72
Q

What do the deep cervical nodes drain?

A

Final drainage pathway to the thoracic duct

73
Q

What do the submandibular nodes drain?

A
Tongue
Nose
Paranasal sinuses
Submandibular gland
Oral cavity
74
Q

What do the submental nodes drain?

A

Lips

Floor of mouth

75
Q

What do the supraclavicular nodes drain?

A

Breast
Oesophagus
Solid viscera

76
Q

What is the most common cause of neck swelling?

A

Reactive lymphadenopathy

77
Q

What may there be a history of with reactive lymphadenopathy?

A

Local infection

General viral illness

78
Q

What would rubbery, painless lymphadenopathy indicate?

A

Lymphoma

79
Q

Associations of lymphoma

A

Night sweats
Splenomegaly
Pain when drinking alcohol (very uncommon)

80
Q

What is a feature of a thyroid swelling?

A

Moves upwards with swallowing

81
Q

What age is a thyroglossal cyst most common?

A

< 20 y/o

82
Q

Who is a pharyngeal pouch more common in?

A

Older men

83
Q

What is a cystic hygroma?

A

A congenital lymphatic lesion (lymphangioma) typically found in the neck on the left side

84
Q

When does a cystic hygroma present?

A

Most are evident at birth

90% before 2 years old

85
Q

When do brachial cysts usually present?

A

Early adulthood

86
Q

Who are cervical rib most common in?

A

Adult females

87
Q

What % develop which condition if they have a cervical rib?

A

Thoracic outlet syndrome - 10%

88
Q

What are epidermoid cysts?

A

Common cutaneous cysts that result from the proliferation of epidermal cells within a circumscribed space of the dermis

89
Q

What age gets epidermoid cysts?

A

Any age

90
Q

Presentation of epidermoid cyst

A

Asymptomatic
Firm round nodule of various sizes
Central punctum may be present

91
Q

When do deep cervical abscesses tend to occur?

A

Following a source of infection such as

  • recent dental work
  • URTI
  • Neck or oral cavity trauma
92
Q

Presentation of a deep cervical abscess

A

Painful and tender swelling
Hot to touch
Other signs of infection - fever, chills, aches and pains

93
Q

Presentation of lipoma

A

Soft and mobile
Within the dermal layer of the skin
On transillumination the area is equal to the surrounding tissue