Anatomy and Physiology of the Neck Flashcards
(93 cards)
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
What happens to a thyroglossal cyst as age increases?
It grows
26
When does a thyroglossal cyst move?
With tongue protrusion
27
What needs to be done before a thyroglossal cyst is removed? Why?
USS
| To ensure functioning thyroid tissue elsewhere
28
Types of thyroid mass
Solitary nodule
Diffuse enlargement
Multi nodular goitre
29
Causes of a solitary thyroid nodule
```
Cyst
Adenoma
Carcinoma
Lymphoma
Prominent nodule in a multi nodular goitre
```
30
Which gender gets more solitary thyroid nodules?
F
31
What age gets solitary thyroid nodules?
30 - 40 y/o
32
What is a red flag symptom for neck lump history?
Pain
33
Investigations of a solitary thyroid nodule
FNAC
| USS
34
What can FNAC not distinguish between?
Follicular adenoma and follicular carcinoma
35
THY classification of solitary thyroid nodules
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
Types of thyroid cancer
Papillary
Follicular
Medullary
Anaplastic
37
Causes of diffuse thyroid enlargement
Colloid goitre due to
- gland hyperplasia
- iodine deficiency
- puberty
- pregnancy
- lactation
- graves disease
- thyroiditis
38
What may be compressive neck symptoms of a huge diffuse thyroid swelling?
Dysphagia
Stridor if compresses trachea
SOB on exertion
Retrosternal goitre if grows behind
39
What test should be done to see if a goitre is growing retrosternally?
Difficulty to reach up without choking
40
Which gender gets graves disease more?
F > M
41
Pathology of graves disease
Auto antibodies against TSH stimulate receptor
| Hyperthyroidism results
42
Clinical signs of graves disease
Thyroid eye disease
Acropachy/clubbing
Pre-tibial myxoedema
43
Treatment of graves disease
Anti-thyroid drugs
Beta blockers
RAI
Surgery
44
Indications for a thyroidectomy
```
Airway obstruction
Malignancy or suspected
Thyrotoxicosis
Cosmesis
Retrosternal extension
```
45
Complications of thyroidectomy
```
Bleeding
Voice hoarseness
Thyroid storm
Infection
Hypoparathyroidism
Hypothyroidism
Scar (keloid/hypertrophic)
```
46
Causes of a multi nodular goitre
Graves disease
| Toxic goitre
47
How many parathyroid glands are there?
4
48
Function of parathyroid glands?
Regulate calcium and phosphate levels
49
Where are the parathyroid glands found?
Posterior poles of the thyroid
50
Results / Presentation of parathyroid disease
```
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
Causes of hyperparathyrodisim
Adenoma (80%)
Hyperplasia (12%)
Malignancy (rare)
52
Types of lymphadenopathy
Infective
Inflammatory
Malignant
53
Indications for tracheostomy
Airway obstruction
Airway protection
Poor ventilation to reduce dead space
54
What is inspiratory stridor a sign of?
Laryngeal obstruction
55
What is expiratory stridor a sign of?
Tracheobronchial obstruction
56
What is biphasic stridor a sign of?
Glottic / subglottic obstruction
57
Treatment of stridor
```
O2
Nebulised adrenaline
IV dexamethasone
Heliox
Definitive airway management
```
58
Pathology of a branchial cyst
Remnant of fusion failure of branchial arteries
OR
Lymph node cystic degeneration
59
Where are the branchial cysts found?
Anterior to the sternocleidomastoid at the junction between the upper and middle thirds - between the SCM and the pharynx
60
What is a clinical feature of a branchial cyst?
Transilluminates
61
What can happen to branchial cysts?
Become infected, enlarging
62
What is a pharyngeal pouch?
Herniation of pharyngeal mucosa between thyropharyngeus and cricopharyngeus muscles of the inferior constrictor of the pharynx
63
Symptoms of pharyngeal pouch
```
Voice hoarseness
Dysphagia
Aspiration pneumonia
Regurgitation
Weight loss
```
64
What % of pharyngeal pouches are neoplasic?
1%
65
How many lymph nodes are in the head and neck?
600
66
Where do lymph nodes in the head and neck drain to?
Cisterna chyli then
| thoracic duct on left
67
What are the lymph glands of the head and neck?
```
Parotid
Submental
Submandibular
Clavicle
Supraclavicuar
Cervical
Occipital
Post auricular
Pre auricular
```
68
What are the lymph node vessels of the head and neck?
```
I; submandibular and submental
II; Upper II
III; middle III
Posterior triangle; 5
Midline is 6
```
69
What does the parotid lymph glands drain?
Scalp
Face
Parotid gland
70
What do the occipital nodes drain?
Scalp
71
What do the superficial cervical nodes drain?
Breast
| Solid viscera
72
What do the deep cervical nodes drain?
Final drainage pathway to the thoracic duct
73
What do the submandibular nodes drain?
```
Tongue
Nose
Paranasal sinuses
Submandibular gland
Oral cavity
```
74
What do the submental nodes drain?
Lips
| Floor of mouth
75
What do the supraclavicular nodes drain?
Breast
Oesophagus
Solid viscera
76
What is the most common cause of neck swelling?
Reactive lymphadenopathy
77
What may there be a history of with reactive lymphadenopathy?
Local infection
| General viral illness
78
What would rubbery, painless lymphadenopathy indicate?
Lymphoma
79
Associations of lymphoma
Night sweats
Splenomegaly
Pain when drinking alcohol (very uncommon)
80
What is a feature of a thyroid swelling?
Moves upwards with swallowing
81
What age is a thyroglossal cyst most common?
< 20 y/o
82
Who is a pharyngeal pouch more common in?
Older men
83
What is a cystic hygroma?
A congenital lymphatic lesion (lymphangioma) typically found in the neck on the left side
84
When does a cystic hygroma present?
Most are evident at birth
| 90% before 2 years old
85
When do brachial cysts usually present?
Early adulthood
86
Who are cervical rib most common in?
Adult females
87
What % develop which condition if they have a cervical rib?
Thoracic outlet syndrome - 10%
88
What are epidermoid cysts?
Common cutaneous cysts that result from the proliferation of epidermal cells within a circumscribed space of the dermis
89
What age gets epidermoid cysts?
Any age
90
Presentation of epidermoid cyst
Asymptomatic
Firm round nodule of various sizes
Central punctum may be present
91
When do deep cervical abscesses tend to occur?
Following a source of infection such as
- recent dental work
- URTI
- Neck or oral cavity trauma
92
Presentation of a deep cervical abscess
Painful and tender swelling
Hot to touch
Other signs of infection - fever, chills, aches and pains
93
Presentation of lipoma
Soft and mobile
Within the dermal layer of the skin
On transillumination the area is equal to the surrounding tissue
