Flashcards in Neck Anatomy and Physiology Deck (36)
What are the indications for a central line?
Central venous pressure
What are the complications of a central line?
What is a thyroglossal cyst?
How do you test for one in clinical examination?
What is its management?
Dilation of thyroglossal duct remnant
May become infected
Midline; grows with age
Moves on tongue protrusion
Need ultrasound scan prior to removal to ensure functioning thyroid tissue elsewhere
Excised but chance of recurrence
What are some of the causes of a solitary thyroid nodule?
Cyst: due to local haemorrhage
Adenoma: benign follicular tissue
Prominent nodule in multi-nodular goitre
What is the epidemiology of solitary thyroid nodule?
10% malignant in middle-aged,
50% malignant in young
How do you investigate a solitary thyroid nodule?
Investigate by Fine Needle Aspiration Cytology (FNAC) AND ultrasound scan
FNAC CANNOT distinguish between a follicular adenoma and a follicular carcinoma
Therefore tissue required for histological diagnosis
What are the different types of thyroid cancer?
Papillary - lymphatic metastasis
Follicular - haematogenous metastasis
Medullary - familial association 10%, arise parafollicular C cells
Anaplastic - aggressive, local spread, very old, poor prognosis
What are some reasons for diffuse thyroid enlargement?
-Due to gland hyperplasia
-Puberty, pregnancy, lactation
What is Grave's Disease?
Autoantibodies against thyroid stimulating hormone receptor
This activates the receptor
What are the sign's for Grave's Disease?
Thyroid eye disease
What are the treatments for Grave's Disease?
What are the indications for a thyroidectomy?
Malignancy or suspected malignancy
What are the complications of a thyroidectomy?
Bleeding-primary or secondary
Explain multi-nodular Goitre
Due to Grave's disease or toxic goitre
Grave's: Women, Middle-aged, Overactivity (hyperthyroidism)
Toxic Goitre: Older, No eye sign's, atrial fibrillation
Thyroid function tests, FNAC, chest x-ray
What are the parathyroid glands?
Usually there are 4
Regulate calcium and phosphate levels
Located posterior to poles of thyroid
Can be injured in neck surgery
What can parathyroid disease cause?
PAINFUL STONES: Renal calculi, polyuria, renal failure
ACHING BONES: pathological fractures, osteoporosis, boan pain
PSYCHIC MOANS: Anxiety, depression, confusion, paranoia
ABDOMINAL GROANS: Abdominal pain, constipation, peptic ulceration, pancreatitis, weight loss
What investigations can you carry out for Parathyroid disease?
U+E, Creatinine, Calcium, Phosphate
Parathyroid hormone, Bicarbonate
CT/MRI: look for ectopic glands
Isotope scanning: detect disease glands
Surgery for Hyperparathyroidism ONLY
What can hyperparathyroidism cause?
Adenoma: 80% hyperparathyroidism, single or multiple
Hyperplasia: 12 % of hyperparathyroidism
-Common in secondary hyperparathyroidism due to low calcium e.g. renal failure.
What is the management for hyperparathyroidism?
Surgery easier if patient fit
Remove single adenomas
Remove multiple adenomas too
Carcinomas removed with thyroid gland and lymph nodes
What are the indications for tracheostomy?
Poor ventilation to reduce dead space
Need long term care
What is stridor?
Clinical sign of airway obstruction
-Inspiratory = laryngeal
-Expiratory = tracheobronchial
-Biphasic = glottis/subglottic
What is a branchial cyst?
Remnant of fusion failure of brachial arches OR lymph node cystic degeneration
Anterior to sternocleidosatoid at junction between upper and middle thirds
Becomes infected, enlarged
Excised to prevent further infection
What is a pharyngeal pouch?
Herniation of pharyngeal mucosa between thyropharyngeus and cricopharyngeus muscles of the interior constrictor of the pharynx
What are the clinical features of pharyngeal pouch?
How do you deal with pharyngeal pouch?
Excision (endoscopic or open)
What do the parotid glands drain?
What do the occipital nodes drain?
What do the superficial cervical nodes drain?
Breast and solid viscera
What do the deep cervical nodes drain?
Final drainage pathway to thoracic duct