Anatomy & Physiology of Neck

Question 1

Boundaries of anterior triangle of neck (2)

Answer 1

Anterior - midline of neck

Posterior - anterior border of SCM

Question 2

Contents of anterior triangle of neck

• salivary gland (1)
• arteries (3)
• veins (2)
• nerves (3)
• lymph nodes (3)

Answer 2

Salivary gland - submandibular (FILLS MOST OF ANTERIOR TRIANGLE)

Arteries - CCA, ECA, facial

Veins - IJV, facial

Nerves - CN X - XII

Lymph nodes - deep cervical, submental, submandibular

Question 3

Boundaries of posterior triangle of neck (2)

Answer 3

Anterior - posterior border of SCM

Posterior - anterior border of trapezius

Question 4

Contents of posterior triangle of neck

• arteries (3)
• veins (3)
• nerves (2)
• lymph nodes (1)

Answer 4

Arteries - occipital, subclavian, suprascapular

Veins - EJV, subclavian, suprascapular

Nerves - accessory, cervical plexus

Lymph nodes - supraclavicular

Question 5

Terminal branches of ECA

Answer 5

Maxillary and superficial temporal arteries

Question 6

2 fascia layers of the neck

Answer 6

Superficial cervical fascia - between skin and deep cervical fascia

Deep cervical fascia

Question 7

4 component layers of deep cervical fascia + what they each compartmentalise

Answer 7

Investing layer of fascia - most superficial

Pre-tracheal fascia (cover visceral compartment)

Pre-vertebral fascia (covers vertebral column and muscles around it)

Carotid sheath (covers neurovascular compartment)

Question 8

Thyroid gland structure

Answer 8

2 lobes joined by isthmus

Question 9

Function of calcitonin produced by thyroid gland

Answer 9

Lowers serum calcium and raises phosphate

Question 10

Blood supply of thyroid gland

Answer 10

Superior and inferior thyroid artery

Question 11

What veins in the neck area are used for central lines

Answer 11

IJV

Subclavian

Question 12

Where do lymph nodes in the head and neck ultimately drain into

Answer 12

Cisterna chyli (L1) –> drains into thoracic duct

Question 13

How many groups of lymph nodes are there in the neck + name them (think clinical examination)

Answer 13

10:
Supraclavicular
Superficial cervical - anterior/posterior cervical chain
Parotid
Submandibular
Submental
Pre-auricular
Post-auricular/ mastoid
Occipital
Facial

Deep cervical

Question 14

How many levels are lymph nodes are divided into

*in surgery, referred to as lymph node levels; not their group

Answer 14

Level I

Level II - IV

Level V

Level VI

Question 15

What group of lymph nodes in the neck receives all the lymph in the head and neck

Answer 15

Deep cervical lymph nodes - either lymph directly drains into them or lymph from superficial lymph nodes drain into them

Question 16

Where does lymph from deep cervical lymph nodes ultimately drain into

Answer 16

Thoracic duct

Question 17

What 3 things could lymphadenopathy be due to

Answer 17

Infection
Inflammation
Malignancy

Question 18

What is a thyroglossal cyst

Answer 18

Dilation of thyroglossal duct remnant in the midline of the neck

Question 19

What was the purpose of the thyroglossal duct

Answer 19

Thyroid gland arised from it embryologically

Question 20

Physical diagnosis of thyroglossal cyst

Answer 20

Cyst moves up when you stick tongue out because thyroglossal duct opens up in posterior tongue

Question 21

Treatment of thyroglossal cyst

Answer 21

Surgical excision of cyst + thyroglossal duct

Question 22

Investigations for a thyroid mass (3)

Answer 22

FNAC
USS
Thyroid lobectomy

Question 23

4 types of thyroid cancer

Answer 23

Papillary - spreads lymphatic ally
Follicular - blood spread
Medullary
Anaplastic

Question 24

What can’t FNAC distinguish in a thyroid mass

Answer 24

If it’s a follicular adenoma or carcinoma

Question 25

What is colloid goitre due to

Answer 25

Thyroid gland hyperplasia

Question 26

What is grave's disease + who does it affect more

Answer 26

Autoimmune disease of thyroid gland | Females

Question 27

Pathophysiology of grave's disease

Answer 27

Autoantibodies act against thyroid stimulating hormone receptor, causing it to become OVER-ACTIVE --> HYPERTHYROIDISM

Question 28

Grave's disease is the NO.1 cause of what

Answer 28

Hyperthyroidism

Question 29

Complications of Graves' disease (2)

Answer 29

Thyroid eye disease | Pre-tibial myxoedema (graves' dermopathy) - red swollen skin on shins and feet

Question 30

Treatment of Graves' disease (4)

Answer 30

Anti-thyroids Beta blockers Radio-iodine Surgery - thyroidectomy

Question 31

Indications for thyroidectomy (3)

Answer 31

Airway obstruction Malignancy Thyrotoxicosis

Question 32

A thyroid mass can be classified into what 3 groups

Answer 32

Solitary nodule Diffuse enlargement Multi-nodular goitre

Question 33

What is a multi-nodular goitre

Answer 33

Lump containing many thyroid nodules

Question 34

What is a toxic goitre

Answer 34

multi-nodular thyroid gland swelling that contains thyroid nodules which function independent of thyroid stimulating hormone, i.e. produces thyroid hormone whenever it wants without having to be stimulated by TSH --> hyperthyroidism

Question 35

Do you get bulging eyes in people with a toxic goitre

Answer 35

No

Question 36

Investigations for toxic goitre (3)

Answer 36

Thyroid function tests - TSH, T3/4 FNAC CXR

Question 37

What lymph nodes make up the level I neck lymph nodes (2)

Answer 37

submental, submandibular

Question 38

What lymph nodes make up the level II-IV neck lymph nodes

Answer 38

Deep cervical chain (deep to SCM)

Question 39

What lymph nodes make up the level V neck lymph nodes

Answer 39

Lymph nodes in posterior triangle of neck, e.g. supraclavicular

Question 40

What lymph nodes make up the level VI neck lymph nodes

Answer 40

Lymph nodes in anterior midline of neck, e.g. pre-tracheal