Lecture 1 - Neck Anatomy and Physiology Flashcards Preview

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Flashcards in Lecture 1 - Neck Anatomy and Physiology Deck (48)
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1

What are the anatomical contents of the neck?

Arteries, veins, nerves
Lymph nodes and lymphatic channels
Thyroid and parathyroid glands
Muscles
Trachea, larynx, swallowing oesophagus

2

What are the boundaries of the neck?

Superior - mandible
Inferior - clavicle
Anterior - anterior midline
Posterior - trapezius

3

What boundaries form the anterior triangle?

Anterior - midline of the neck
Posterior - anterior border of the sternocleidomastoid
Superior - mandible
Can be divided into submandibular, muscular, submental and carotid triangle

4

What are the boundaries forming the posterior triangle?

Anterior - posterior border of the sternocleidomastoid
Posterior - anterior border of trapezius
Inferior - middle third of clavicle

5

What are the contents of the anterior triangle?

Common carotid artery, facial artery, hypoglossal nerves, vagus nerves, glossopharyngeal nerves, submandibular nodes, submental nodes, internal carotid artery, internal jugular vein, facial vein, accessory nerves, laryngeal nerves

6

What are the contents of the posterior triangle?

Accessory nerve, occipital artery, lymph nodes, cervical nerve plexus, external jugular vein

7

What are the main arteries of the neck and from which common artery do they branch? (At what level?)

Common carotid artery splits into the internal and external carotid arteries at C4 in the neck

8

How can you differentiate between the ICA and ECA?

ICA lies more laterally than the ECA initially, and the ECA is the only one that will give off branches in the neck - the ICA supplies intracranially

9

What branches does the ECA give off in the neck?

Superior thyroid
Ascending pharyngeal
Lingual
Occipital
facial
Posterior auricular
Maxillary
Superficial temporal

10

What are the main veins in the neck?

Internal and external jugular

Internal is much larger than the external

11

Why is it important to understand the anatomy of the veins in the head and neck?

Useful for venous access
Can also be involved in bleeding, tumour spread, venous thrombosis which can track to the brain so must be careful when operating in the neck

12

What are the indications for central line use?

Struggling to get arterial or venous line in
Central venous pressure
Drug administration
Cardiac pacing
Blood sampling
Fluid resuscitation
Haemodialysis
IV nutrition

13

What are the possible complications of using central lines?

Pneumothorax
Air embolism
Thrombosis
Sepsis
Chylothorax
Haemotoma
Cardiac tamponade
False passage
Line blockage

14

Are there many lymph nodes in the neck? What is their use?

600 lymph nodes in the head and neck
Receive lymph/tissue waste product
Drain to cisterna chyli
the drain to thoracic duct on left

15

How are the lymph nodes in the neck described?

In groups
In levels (I-VI)
Level I - under mandible
Level II, III, IV - thirds of sternocleidomastoid
Level V - posterior triangle
Level VI - anterior/central compartments of the neck

16

Describe the lymph node drainage of the parotid, occipital, superficial cervical, deep cervical, submandibular, submental and supraclavicular nodes.

Parotid - scalp, face, parotid gland
Occipital - scalp
Superficial cervical - breast and solid viscera
Deep cervical - final drainage pathway to thoracic duct
Submandibular - tongue, nose, paranasal sinuses, submandibular glands, oral cavity
Submental - lips, floor of mouth
Supraclavicular - breast, oesophagus, solid viscera

17

What are three most common causes of lymphadenopathy?

Infective
Malignant
Inflammatory

18

What is the thyroid gland?
What substances does it produce and what are the actions of these substances in the body?

Endocrine gland
2 lobes joined by isthmus
Produces thyroid hormone (triiodothyronine (t3) and its pro hormone thyroxine (T4) - responsible for regulation of metabolism) and calcitonin (acts to lower Ca and raise phosphate)

19

What is hypothyroidism?

Patient not producing enough hormones from their thyroid - patient feels very tired and lethargic

Rx - thyroxine

20

What are the possible appearances of thyroid masses?

Solitary nodule
Diffuse enlargement
Multi-nodular goitre (large lumps)

21

In which group of people are thyroid masses more common?

Females

22

What can cause a solitary thyroid nodule? Who is most likely to get a solitary thyroid nodule?

Cyst - due to localised haemorrhage
Adenoma - benign follicular tissue
Carcinoma
Lymphoma
Women between the age of 30-40

23

What sort of questions do you want to be asking someone presenting with a solitary thyroid nodule?

Red flag symptoms
- Pain (pain going to ear very sensitive marker of malignancy)
- Weight loss
- Voice hoarseness
- Haematemesis

24

How do you investigate a solitary thyroid nodule?

USS
If USS shows nothing, reassure and discharge them
If shows something, do fine needle aspiration cytology
FNAC cannot distinguish between a follicular adenoma and a follicular carcinoma - therefore tissue required for histology diagnosis (graded 1-5: 1 - unsure; didn't get enough tissue, 2 - normal tissue, 3 - dysplasia, 4 - most likely cancer, 5 - carcinoma)

25

How would you treat a solitary thyroid nodule that is going to cause problems?

Thyroid lobectomy

26

What are the four types of thyroid cancer?

Papillary - lymphatic metastasis
Follicular - haematogenous metastasis
Medullary - familial agression, 10% arises from parafollicular C cells
Anaplastic - aggressive, local spread, very old, poor prognosis

27

What are the types of diffuse thyroid enlargement?

Colloid goitre
Grave's disease
Thyroiditis

28

What can cause colloid goitre?

Gland hyperplasia
Iodine deficiency
Puberty, pregnancy, lactation

29

What is goitre?
How do you test for retrosternal goitre?

Swelling in the neck cause by an enlarged thyroid gland (can cause compressive neck symptoms (dysphagia, stridor if compression of trachea)

Retrosternal goitre test - if choking after lifting arms (Pemberton's sign)

30

What is Grave's disease?
Who gets it most commonly?
What does it cause?
How is it treated?

Body creates auto-antibodies against thyroid stimulating hormone receptor - hyperthyroidism results

Most common in middle aged women

Causes thyroid disease, acropachy/clubbing, pre-tibial myxoedema

Rx - anti-thyroids, beta-blockage, radio-iodine, surgery