Neck

Question 1

Boundaries of posterior triangle

Answer 1

Anterior - posterior border of SCM
Posterior - anterior border of trapezius
Base - Middle third of clavicle

Question 2

Where is the retro pharyngeal space?

Answer 2

Anterior to prevertebral fascia, behind the pharynx

Extends from base of skull to the mediastinum

Question 3

Clinical features of retropharyngeal abscess

Answer 3

Commonly in young children, after a URTI 
Neck help rigid and upright 
Systemically unwell
Airway compromise 
Dysphagia

Question 4

Investigation and management of retropharyngeal abscess

Answer 4

Investigations: CT neck
Management: secure airway, IV antibiotics, surgery - incision and drainage

Question 5

Complications of retropharyngeal abscess

Answer 5

Airway obstruction

Mediastinitis

Question 6

What is Ludwigs angina?

Answer 6

Infection of the space between the floor of the mouth and mylohyoid, most commonly associated with dental infection

Question 7

Clinical features of Ludwigs angina

Answer 7

Swelling of floor of mouth 
Painful mouth 
Protruding tongue
Airway compromise 
Drooling

Question 8

Investigation and management of Ludwigs angina

Answer 8

Investigation: CT neck, OPG
Management: secure airway, IV antibiotics, surgery to drain any collection of fluid

Question 9

Where is the parapharyngeal space?

Answer 9

Postero-lateral to the oropharynx and nasopharynx, which is divided by the styloid process.

Question 10

Clinical features of parapharyngeal abscess

Answer 10

Present similarly to peritonsilar abcsess:
History of febrile illness
Odynophagia
Trismus (spasm of jaw muscles)
Reduced neck movement 
Swelling in neck around upper SCM

Question 11

Complications of parapharyngeal abscess

Answer 11

Spread to carotid sheath structures

Question 12

Management of parapharyngeal abscess

Answer 12

Secure airway, IV antibiotics, surgical drainage

Question 13

Cause of epiglottitis

Answer 13

Normally haemophilus influenzae

Question 14

Presentation of epiglottitis

Answer 14

Mainly seen in children aged 2-6, is an emergency
Strider
Drooling
Pyrexia

Question 15

Management of epiglottitis

Answer 15

Secure the airway - intubation

IV antibiotics

Question 16

Possible causes and locations of neck lumps

Answer 16

Parotid neoplasm
Jugulodigastric node
Submandibular gland
Carotid body tumour or aneurysm 
Thyroglossal cyst (midline between hyoid bone and thyroid gland)
Branchial cyst (anterior border of SCM) 
Thyroid nodule
Virchows node

Question 17

Investigation of neck lumps

Answer 17

Ultrasound guided fine needle aspiration

Question 18

Nasopharynx borders

Answer 18

Superiorly bounded by base of skull

Inferiorly by imaginary line at level of soft palate

Question 19

Contents of nasopharynx

Answer 19

Adenoids

Eustachian tube opening

Question 20

Oropharynx borders

Answer 20

Level of soft palate to superior border of epiglottis

Question 21

Oropharynx contents

Answer 21

Palatine tonsils, anterior and posterior arches

Question 22

Hypo pharynx borders

Answer 22

Superior border of epiglottis to inferior border of cricoid cartilage
Posterior to the larynx

Question 23

Muscles of the pharynx

Answer 23

Superior constrictor
Middle constrictor
Inferior constrictor
Cricopharyngeus

Question 24

What is Killians dehiscence?

Answer 24

Area of deficient muscle between inferior constrictor and cricopharyngeus
Site of pharyngeal pouch formation

Question 25

Presentation of pharyngeal pouches

Answer 25

Dysphagia Delayed regurgitation of food Recurrent chest infections from aspirated food

Question 26

Muscles that elevate and depress the pharynx

Answer 26

Stylopharyngeus Salpingopharyngeus Palatopharyngeus

Question 27

What is obstructive sleep apnoea?

Answer 27

Complete obstruction of the airway during sleep which requires the patient to wake up and alter position to open the airway again. Lead to poor nights sleep and strain on CVS system

Question 28

Commonest causes of obstructive sleep apnoea in a child vs in an adult

Answer 28

Child - Adenotonsillar hypertrophy | Adult - Obesity, obstructive lung disease, right heart failure

Question 29

Treatment of obstructive sleep apnoea

Answer 29

Advice and lifestyle changes eg weight loss CPAP - Continuous positive airway pressure Mandible at positioning devices Surgery - adenotonsillectomy in children

Question 30

Bacterial causes of tonsillitis

Answer 30

``` Beta haemolytic streptococci Staphylococci Streptococcus pneumoniae Haemophilus influenzae Escherischia coli ```

Question 31

Viral causes of tonsillitis

Answer 31

Rhinovirus Adenovirus Enters virus Epstein-Barr virus

Question 32

Clinical features of tonsillitis

Answer 32

``` Pyrexia Dysphasia Lymphadenopathy Odynophagia Trismus Swollen tonsils with or without exudate Referred pain ```

Question 33

Management of tonsillitis

Answer 33

Analgesia Antibiotics (not amoxicillin - causes rash in presence of EBV) Drainage of peritonsilar abscess Tonsillectomy in recurrent tonsillitis

Question 34

Boundaries of anterior triangle

Answer 34

Medical - midline of neck Lateral - medial border of SCM Superior - lower border of mandible