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Head and neck Flashcards

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1
Q

What is the superior boundary of the neck?

A

Superior – mandible

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2
Q

What is the inferior boundary of the neck?

A

Inferior – clavicle

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3
Q

What is the anterior boundary of the neck?

A

Anterior – anterior midline

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4
Q

What is the Posterior boundary of the neck?

A

Posterior – trapezius

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5
Q

What are the contents of the anterior triangle?

A

Common carotid – external, internal as well
Facial artery, vein
Hypoglossal, vagus, accessory, laryngeal, glossopharyngeal nerves
Internal jugular vein
Submandibular nodes, submental

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6
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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7
Q

What are the main arteries of the neck?

A 
Common carotid (divides at C4)
	Internal carotid – straight to brain, no branches
	External carotid – branches into
	Superior thyroid
	Ascending pharyngeal
	Lingual
	Occipital
	Facial
	Posterior auricular
	Maxillary
	Superficial temporal
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8
Q

What are the indications for a central line?

A 
Central venous pressure monitoring
Drug administration
Cardiac pacing
Blood sampling
Fluid resuscitation
Haemodialysis
IV nutrition
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9
Q

What are the possible complications of a central line?

A 
Pneumothorax
	Haematomoa
	Cardiac tamponade
	Air embolism
	Chylothorax
	False passage
	Thrombosis
	Sepsis
Line blockage
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10
Q

What are the lymph node levels?

A

I submental/submandibular
II-IV along sternocleidmastoid
V – posterior triangle

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11
Q

Where do the parotid lymph nodes drain?

A

Parotid nodes-scalp, face & parotid gland

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12
Q

Where do the occipital lymph nodes drain?

A

Occipital nodes-scalp

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13
Q

Where do the superficial cervical lymph nodes drain?

A

Superficial cervical nodes-breast & solid viscera

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14
Q

Where do the deep cervical nodes drain?

A

Deep cervical nodes-final drainage pathway to thoracic duct

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15
Q

Where do the submandibular lymph nodes drain?

A

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

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16
Q

Where do the submental lymph nodes drain?

A

Submental nodes-lips, floor of mouth

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17
Q

What are the three potential causes of lymphadenopathy?

A

Infective
Inflammatory
Malignant

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18
Q

Describe the thyroid gland

(Lobes, products, location, arterial supply)

A

Two lobes (right+left) joined by isthmus
Produces thyroid hormone and calcitonin
Calcitonin acts to lower calcium and raise phosphate
Located beneath the thyroid cartilage
Supplied from superior thyroid artery (branch of external carotid artery)

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19
Q

What are the types of thyroid mass?

A

Solitary nodule
Diffuse enlargement
Multi-nodular goitre

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20
Q

What are the types of solitary thyroid nodules?

A 
Cyst: due to localised haemorrhage
Adenoma: benign follicular tissue
Carcinoma
Lymphoma
Prominent nodule in multi-nodule goirre
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21
Q

Who is most likely to get a solitary thyroid nodule?

A

F> M 30-40 yrs

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22
Q

What two types of thyroid cancer can FNA not distinguish between?

A

Follicular adenoma
Follicular carcinoma

Need a tissue sample for diagnosis

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23
Q

What are the types of thyroid cancer?

A

Papillary – lymphatic metastasis
Follicular – haematogenous metastasis
Medullary – familial association (10%) arise from parafollicular C cells
Anaplastic – aggressive, local spread, normally old, poor prognosis

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24
Q

What can cause a diffuse thyroid enlargement?

A 
Colloid goitre: Due to gland hyperplasia
	>Iodine deficiency
	>Puberty
	>Pregnancy
	>Location
	>Grave’s disease
Throiditis
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25
What is Grave's disease?
Autoantibodies against thyroid stimulating hormone receptor stimulate receptor Hyperthyroidism results Thyroid eye disease, acropachy/clubbing, pre tibial myxoedema More likely in females
26
What is the treatment for grave's disease?
antithyroids, beta blockage, radio iodine surgery
27
What are the indications for a thyroidectomy?
``` Airway obstruction Malignancy (or suspected) Thyrotoxicosis Cosmesis Retrosternal extension ```
28
What are the possible complications of a thyroidectomy?
``` Bleeding-primary or secondary Voice hoarseness Thyroid storm Infection Hypoparathyroidism Hypothyroidism Scar (keloid/hypertrophic) ```
29
What do the parathyroid glands do?
Regulate calcium and phosphate levels Located to poles of thyroid Can be injured in neck surgery
30
What is multi-nodular goitre?
Due to grave’s disease or toxic goitre Graves – women, middle-aged, over activity leads to hyperthyroidism Toxic goitre – older, no eye signs, AF
31
What do you do to test multi-nodular goitre?
Thyroid function tests, FNA, CXR
32
What are the symptoms of parathyroid disease?
Painful stones? Aching bones Psychic moans Abdominal groans Renal calculi, polyuria, renal failure Pathological fractures, osteoporosis, bone pain Abdominal pain, constipation, peptic ulceration, pancreatitis, weight loss Anxiety & depression, confusion, paranoia
33
What tests are used to investigate parathyroid disease?
Urea & electrolytes, creatinine, calcium, phosphate Parathyroid hormone, bicarbonate Vitamin D Ultrasound scan CT/MRI: identify ectopic glands Isotope scanning: detect diseased glands -Only treat for Hyperparathyroidism
34
What can cause parathyroid disease?
Adenoma (80%) Hyperplasia (12%) - common in secondary hyperparathyroidism due to low calcium Eg renal failure. Calcium levels normal but phosphate levels high Malignancy
35
How do you treat parathyroid disease?
Surgery easier if patient fit Remove single adenomas, or multiple Carcinomas removed with thyroid gland and lymph nodes
36
What are the four fascia layers of the neck?
Pre-tracheal Pre-vertebral Deep cervical Carotid sheath
37
What are the indications for a tracheostomy?
Airway obstruction Airway protection Poor ventilation to reduce dead space Need suctioning, humidifcation and long term care
38
What is stridor?
Clinical sign of airway obstruction Inspiratory - laryngeal Expiratory - tracheobronchial Biphasic – glottic/subglottic
39
How do you treat stridor?
Treat with O2, Nebulised Adrenaline, IV Dexamethasone, (Heliox), (Definitive) airway management
40
What is Branchial cyst?
Remnant of fusion failure of branchial arches OR lymph node cystic degeneration Transilluminates Anterior to sternocleidomastoid at junction between upper and middle thirds Becomes infected, enlarging Excised to prevent further infection
41
What is a pharyngeal pouch?
Herniation of pharyngeal mucosa between: thyropharyngeus and cricopharyngeus (muscles of the inferior constrictor of the pharynx)
42
What are the symptoms of pharyngeal pouches?
``` Voice hoarseness Regurgitation Dysphagia Weight loss Aspiration pneumonia Neoplasia 1% ```
43
How do you treat a pharyngeal pouch (+ diagnose)?
Diagnose with barium swallow Excision Dilation
44
What is the presentation of a reactive lymph node?
``` Oval Soft Smooth Mobile Tender ```
45
What is the presentation of malignant neck node?
``` Round Firm Irregular Fixed Non-tender ```
46
What can cause hoarseness?
``` Nodules Cysts Vocal abuse Laryngitis Infection Smoking Reflux Laryngeal cancer ```
47
What are the benign H&N disorders?
``` Congenital Infective Inflammatory Trauma Neoplasia ```
48
What are the malignant H&N disorders?
Cancer | 90% squamous carcinoma
49
What are the guidelines for removing tonsils?
Bacterial Tonsillitis: (pus covering, neck nodes, fever, no cough) 6-7 attacks in 1 year (5 per year over two years, 3 per year over three years) Disrupting daily activities More than 1 quinsy
50
What is the function of the nose?
Respiration, filtration, humidification/ warming of air | Olfaction Reception of sinus and eye secretions Continuous mucosal lining with sinuses Rhino–sinusitis
51
Describe the mucosa of the nasal passage
Columnar, ciliated Squamo-columnar junction Nasal hair in vestibule
52
What makes up the external nose?
Dorsum (bridge) root to tip 1/3 bony 2/3 cartilaginous
53
What are the cartilages of the nose?
``` Septal cartilage (middle) Lateral (two of them) Alar cartilage (also two) ```
54
What processes can cause nasal deformity?
Trauma | Fractures
55
What forms the midline partition of the internal nose?
Septal cartilage Perpendicular plate of ethmoid Vomer (bone)
56
What forms the lateral walls of the nose?
``` Turbinates >Superior >Middle >Inferior >Meati ```
57
What forms the roof of the internal nose?
Cribriform plate
58
What forms the floor of the internal nose?
Hard palate
59
What are the common pathologies of the internal nose?
Nasal septum deviation >Through trauma >Congeital >Has risk of septal haematoma Swelling >Rhinitis >Infection >Can block nose, treated with steroid sprays
60
What are the boundaries of the nasopharynx?
Choana Sphenoid sinuses Prevertebral fascia and muscle Soft palate
61
What are the contents of the nasopharynx?
Eustachian openings Adenoids Has muci-ciliary lining
62
What is the blood supply to the nose? (5)
``` Sphenopalatine artery >Branch of maxillary artery from external carotid Greater palatine artery Ascending labial artery Ethmoid arteries (internal carotid) Capillary plexus - littles area ```
63
What is epistaxis?
Haemorrhage from: >Nostril >Nasal cavity >Nasopharynx
64
What nerves supply the nose?
``` Olfactory nerve (olfactory epithelium) Infraorbital nerve (branch of 5th cranial - trigeminal) ```
65
What conditions can affect the olfactory nerve?
``` Hyposmia or anosmia Via: >trauma >Virus >Tumour >Rhinitis ```
66
What conditions can affect the infraorbital nerve of the nose?
Paraesthesia in trauma | Iatrogenic damage in tumours
67
What are the sinuses?
Air filled spaces Continous muco-ciliary lining with nose Development is age dependent
68
What sinuses are there?
Frontal x1 + septal partition Maxillary x2 Ethmoid x2 Sphenoid 1
69
How + where does the frontal sinus drain?
Via frontonasal duct | Into middle meatus
70
Where does the posterior ethmoid sinuses drain?
Into superior meatus
71
Where does the middle and anterior ethmoid sinuses drain?
Into middle meatus
72
How + where does the maxillary sinus drain?
At hiatus semilunaris Into middle meatus Drainage near frontal drainage
73
Where does the nasolacrimal duct drain?
inferior meatus
74
What are the potential dangers to sinisitus?
``` intracranial sepsis cerebrospinal fluid (CSF) leak damage to the orbit optic nerve carotid artery ```
75
What sinuses drain into the middle meatus?
Frontal sinus Middle ethmoidal sinus Anterior ethmoidal sinus Maxillary sinus
76
What sinuses drain into the superior meatus?
Posterior ethmoidal sinus
77
What drains into the inferior meatus?
Nasolacrimal duct
78
What structure can be damage in frontal sinusitis due to its close relation?
Anterior cranial fossa
79
What structure can be damage in ethmoidal sinusitis due to its close relation?
Anterior cranial fossa (cribriform plate)
80
What structure can be damage in maxillary sinusitis due to its close relation?
Orbits | Oral cavity/teeth
81
What structure can be damage in Sphenoid sinusitis due to its close relation?
Optic nerve Internal carotid artery Pituitary gland
82
What makes up the external ear?
Auricla /pinnea External acoustic meatus Ceruminous + sebacous glands >Make wax
83
What makes up the Auricle/pinnea?
>Stratified keratinising squamous epithelium | >Elastic cartilage
84
What makes up the external acoustic meatus?
>Lateral 1/3 cartilage and skin | >Medial 2/3 bone and skin
85
Describe is the tympanic membrane
The eardrum Roughly 1 cm in diameter Part of sound conduction 3 layers
86
What are the three layers of the tympanic membrane?
Outer squamous epithelial Middle - fibrous connective tissue Inner - columnar ciliated mucus membrane
87
What can cause tympanic membrane perforation?
Trauma | Suppuration
88
What is the function of the ossicular chain?
Important in sound conduction
89
What can disrupt the ossicular chain?
Trauma Chronic suppuration Bony sclerosis (otosclerosis)
90
What are the important relations of the middle ear?
Middle cranial fossa Internal jugular vein Internal carotid artery
91
Describe the middle ear
Area that connects the >mastoid system via aditus >Post nasal pace via eustachian tubes Lined by cilunar ciliated epithelium >Produce mucus, catarrh and glue
92
What does the middle eat contain?
Ossicles Facial nerve Chorda tympani
93
What is found in the middle ear?
``` Vestibulo-cochlear organ: Bony labyrinth Membranous labryinth Fluid >Perilymph >Endolymph ```
94
What makes up the bony labyrinth?
Cochlea Vestibule Semi-circular canal
95
What is the function of the membranous labyrnth?
Is the sensory epithelium for hearing
96
What nerves supply hearing?
Cochlear fibres/nerves >Travels through Internal auditory meatus >Joins brainstem at pontomedullary junction Cochlear+ vestibular = vestibulococclear nerve (CN VIII)
97
What supplies mixed innervation to the ear?
Cervical root branches Cn V - trigeminal CN IX - glossopharyngeal CN X - vagus
98
What are potential complications of infection or trauma to the ear?
Intracranial sepsis Facial nerve damage Deafness Dizziness
99
What is the internal auditory meatus?
Junction of inner ear to brainstem | 1cm long bony canal CN VII and CNVIII
100
What is the internal auditory meatus the clinical site of?
Acoustic neuroma | Vestibular schwannoma
101
What are the main things that affect hearing?
``` Wax/physical obstructions >Minimal unless impinging on TM TM perforation >relatively small Loss of ossicular continuity >Very large effect ```
102
What is the types of hearing loss?
Conductive | Sensioneural
103
How does the cochlea hear sound?
Hairs within organ of corti produce electrical activity via vibrations >Transmitted by endolymph and perilymph Activity becomes neural impulse and travels to brain
104
How is balance interpreted?
Via vestibule and semicircular canals Hair cells + otoconia produce electricla activity >Becomes neural impulse
105
What are the three semicircular canals?
Lateral Posterior Superior Connected via saccule and utricle
106
How is loudness interpreted by the ear?
Produces increased intensity for increased loudness 0 decibals minimum hearing Pain at 130
107
How is pitch interpreted by the ear?
500-2000Hz - range of speech Due to turns in cochlea >Basal turn - high freq >Apical turn low freq
108
What is audiometry?
Subjective test which measures amplitude or intensity of sound and frequency in the ear
109
What is tympanometry?
Measure of tympanic membrane compliance involving middle ear and ear canal pressureBecause of Eustachian tube function canal pressure should = middle ear pressure
110
What is tympanometry useful to diagnose?
Eustachian tube dysfunction | Middle ear effusion (glue-ear)
111
What pitches tend to be lost in conductive + sensioneural loss?
Conductive - low notes lost | Sensorioneural - high notes lost
112
Why is sound input important in children?
Key in development of auditory complex Links to speech cortex Children born deaf in one ear will grow up with element of auditory cortex "adaptation" Severely deaf - unable to develop normal speech If prfound deaf, never speak unless achieved before age of 4

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