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Flashcards in Neck Deck (33)
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1

How do we divide the neck?

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

2

Whats contained in the anterior triangle?

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

3

Whats contained in the post triangle?

- External Jugular Vein
- Lymph nodes
- Occipital Art
- Accessory Nerve (CN XI) and cervical nerve plexus

4

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

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

Where does the Common carotid divide?

At C4

6

Where do we insert a cental line?

Into the subclavian vein

7

When would we use a central line?

Tests:
- Central Venous pressure
- Blood sampling

Treatment:
- Drugs
- Cardiac Pacing
- Haemodialysis
- Fluid Resus
- IV nutrition

8

Complications of a central line?

- Pneumothorax
- Air Embolism
- Thrombosis
- Haematoma
- Chylothorax
- Sepsis
- Cardiac Tamponade
- False Passage
- Line Blockage

9

How does neck lymph drain?

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

10

How do we describe lymph nodes in the neck?

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

Where do the various groups of neck lymph nodes drain?

Supraclavicular

12

What does the thyroid gland and parathyroid glands do?

Thyroid:
- Thyroid hormone
- Calcitonin (Lowers Ca and raises Phosphate)

Parathyroid glands:
Regulate ca & phosphate levels

13

Describe the structure of the thyroid and parathyroid glands?

Thyroid gland is two lobes connected by an isthmus.

4 parathyroid glands are located posteriorly to the thyroid poles

14

What is a thyroglossal cyst?

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

How do we divide thyroid masses?

Solitary Nodules
Diffuse Goitre
Multi-nodular Goitre

16

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

Itll move with the thyroid on swallowing

17

What could cause a solitary thyroid nodule?

- Cysts
- Adenoma
- Carcinoma
- Lymphoma

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

18

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

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

What are the types of thyroid cancer?

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

What causes a diffuse thyroid enlargement?

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

What is grave's disease?

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

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

Its most common in women and the middle aged

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

23

What could cause multi-nodular goitre?

Could also be Grave's disease
But also Toxic Goitre

24

What is toxic goitre?

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

When would you perform a thyroidectomy?

- 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

Complications of a thyroidectomy?

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

27

What are the manifestations of parathyroid disease?

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

How do we test for parathyroid disease?

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

29

How do we treat parathyroid disease?

Surgery if theres hyperparathyroidism
Usually down to adenoma, hyperplasia or malignancy

30

What does stridor tell us about an airway obstruction?

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