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Flashcards in Neck Deck (33)
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1
Q

How do we divide the neck?

A

Into 2 triangles
Ant - From midline to ant border of SCM
Post - From post border of SCM to ant border of Trapezius

2
Q

Whats contained in the anterior triangle?

A
  • Carotids
  • IJV
  • Facial art/vein
  • Submental/Submandibular lymph nodes
  • Cr Ns 9->12
3
Q

Whats contained in the post triangle?

A
  • External Jugular Vein
  • Lymph nodes
  • Occipital Art
  • Accessory Nerve (CN XI) and cervical nerve plexus
4
Q

The ext carotid branches in the neck, what are its branches?

A

Post -> Sup:

  • Sup Thyroid
  • Asc Pharyngeal
  • Lingual
  • Occipital
  • Facial
  • Posterior Auricular
  • Maxillary
  • Superficial Temporal

Order is not certain so don’t worry about it just a rough guide.

5
Q

Where does the Common carotid divide?

A

At C4

6
Q

Where do we insert a cental line?

A

Into the subclavian vein

7
Q

When would we use a central line?

A

Tests:

  • Central Venous pressure
  • Blood sampling

Treatment:

  • Drugs
  • Cardiac Pacing
  • Haemodialysis
  • Fluid Resus
  • IV nutrition
8
Q

Complications of a central line?

A
  • Pneumothorax
  • Air Embolism
  • Thrombosis
  • Haematoma
  • Chylothorax
  • Sepsis
  • Cardiac Tamponade
  • False Passage
  • Line Blockage
9
Q

How does neck lymph drain?

A

Into deep cervical lymph nodes
Then into left and right jugular lymphatic trunks
Then into thoracic and right lymphatic ducts respectively.

10
Q

How do we describe lymph nodes in the neck?

A
By group, covered in Yr 1
By level:
1 - Submental/Submandibular region
2-4 - The SCM is split into 3rds starting at the top
5 - Posterior triangle
6 - Midline
11
Q

Where do the various groups of neck lymph nodes drain?

A

Supraclavicular

12
Q

What does the thyroid gland and parathyroid glands do?

A

Thyroid:

  • Thyroid hormone
  • Calcitonin (Lowers Ca and raises Phosphate)

Parathyroid glands:
Regulate ca & phosphate levels

13
Q

Describe the structure of the thyroid and parathyroid glands?

A

Thyroid gland is two lobes connected by an isthmus.

4 parathyroid glands are located posteriorly to the thyroid poles

14
Q

What is a thyroglossal cyst?

A

The thyroglossal duct from the back of the tongue to the thyroid gland persists (should be lost during embryological development)..

It the dilates froming a cyst which appears in the midline and grows with age.

You must do an US then excise or drain the cyst.

15
Q

How do we divide thyroid masses?

A

Solitary Nodules
Diffuse Goitre
Multi-nodular Goitre

16
Q

How do we tell if a mass is thyroid in nature on exam?

A

Itll move with the thyroid on swallowing

17
Q

What could cause a solitary thyroid nodule?

A
  • Cysts
  • Adenoma
  • Carcinoma
  • Lymphoma

They’re more common in women and the middle aged with malignancy more likely amongst younger sufferers

18
Q

How do we investigate if there is a single nodular thyroid mass?

A

Fine needle aspiration cytology (FNAC).
However it doesnt tell us about the masses capsule so it cant differentiate adenoma vs carcinoma.
Therefore, if you suspect cancer youll require a thyroid lobectomy and histology

19
Q

What are the types of thyroid cancer?

A

Papillary - usually metastesisses to lymph nodes

Follicular - spreads through blood

Medullary - 10% show a familial associated. Arise from parafollicular C cells so a raised calcitonin is an indicator

Anaplastic - Spreads locally, very aggressive and poor prognosis

20
Q

What causes a diffuse thyroid enlargement?

A

Colloid Goitre:
Which is a benign overgrowth of the thyroid gland often due to hyperplasia, iodine deficiency or hormonal changes in puberty, pregnancy or lactation.

Can also be Grave’s disease

Or Thyroiditis

21
Q

What is grave’s disease?

A

An auto-immune condition where auto-antibodies attack thyroid stimulating hormone receptor triggering hyperthyroidism

This leads to

  • thyroid eye disease
  • diffuse enlargement
  • Acropachy (Soft tissue swelling of the hands and clubbing)
  • pre-tibial myxoedema (waxy/red orange peel appearance to skin)
22
Q

Who gets grave’s disease and how do we treat it?

A

Its most common in women and the middle aged

Treat with anti-thyroids, beta blockers, radio-iodine and surgery.

23
Q

What could cause multi-nodular goitre?

A

Could also be Grave’s disease

But also Toxic Goitre

24
Q

What is toxic goitre?

A

A hyperthyroidism due to iodine deficiency
(Iodine deficiency -> Low thyroid hormones -> Thyroid hyperplasia -> Hyperthyroidism).

Its commoner in the old. Can cause Afib but unlike graves doesnt cause thyroid eye disease

25
Q

When would you perform a thyroidectomy?

A
  • Causing an airway obstruction
  • If you suspect malignancy
  • Thyrotoxicosis (excess thyroid hormones increasing rate of metabolism)
  • Cosmesis (Fix an aesthetic problem)
  • Retrosternal extension (i.e. it enlarges down into the chest)
26
Q

Complications of a thyroidectomy?

A
Bleeding
Hoarseness
Infection
Hypoparathyroidism
Hypothyroidism
Thyroid storm (hugely excess thyroid hormones causing HR/BP/Temp to soar dangerously)
27
Q

What are the manifestations of parathyroid disease?

A

Think stones - Bones - Psychic Moans - Abdo Groans

Stones:
- Renal calculi, polyuria, renal failure

Bones:
- Bone pain, osteoporosis, pathological fracture

Groans:
- Abdo pain, constipation, weight loss, pancreatitis, peptic ulceration

Moans:
- Anxiety/depression, confusion, paranoia

28
Q

How do we test for parathyroid disease?

A
U&E - Creatinine, Ca Phosphate
Parathyroid hormone
Bicarbonate
Vit D
US/CT/MRI
Isotope scan of glands
29
Q

How do we treat parathyroid disease?

A

Surgery if theres hyperparathyroidism

Usually down to adenoma, hyperplasia or malignancy

30
Q

What does stridor tell us about an airway obstruction?

A

Inspiratory its a laryngeal obstruction
Expiratory its probably tracheobronchial
Biphasic its probably glottic/sub-glottic

31
Q

What is a branchial cyst?

A

Either a remnant cleft from failure of the branchial arches to fuse
Or cystic degeneration of a lymph node.

They grow slowly and can become inflamed.

Most commonly ant to SCM between upper & middle 3rds.

Must be excised to prevent further infection

32
Q

What is a pharyngeal pouch?

A

A herniation of the pharyngeal mucosa through the inferior constricter (between thyro- & crico-pharyngeus muscles) of the pharynx forming a pouch which can trap food.

They present with hoarseness, regurg, dysphagia, weight loss and aspiration pneumonia.

33
Q

How do we treat a pharyngeal pouch?

A

Barium swallow to spot

Then we can excise the pouch.