Neck anatomy and physiology

Question 1

What are the anatomical contents of the neck?

Answer 1

Arteries
Veins
Nerves
Lymph nodes
Lymphatic channels
Thyroid gland
Parathyroid gland
Muscles
Trachea

Question 2

What are the boundaries of the neck?

Answer 2

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

Question 3

What are the 2 triangles of the neck?

Answer 3

Anterior and posterior triangles

Question 4

What are the borders of the anterior triangle of the neck?

Answer 4

Anterior- midline
Posterior- anterior border of sternocleidomastoid
Superior- mandible

Question 5

What are the borders of the posterior triangle of the neck?

Answer 5

Anterior- posterior boxer of sternocleidomastoid
Posterior- anterior border of trapezius
Inferior- clavicle

Question 6

What structures are in the anterior triangle of the neck?

Answer 6

Common carotid artery
External and internal carotid artery
Facial artery
Internal jugu;ar vein
Facial vein
Hypoglossal nerves
Vagus nerves
Glossopharyngeal nerves
Accessory nerves
Laryngeal nerves
Submandibular and submittal nodes

Question 7

What are the contents of the posterior triangle of the neck?

Answer 7

Accessory nerve
Cervical nerve plexus
Occipital artery
External jugular vein
Lymph nodes

Question 8

At what level does the common carotid divide?

Answer 8

C4

Question 9

What are the branches of the external carotid?

Answer 9

Superior thyroid
Ascending pharygeal
Lingual
Occipital
Facial
Posterior auricular
Maxillary
Superficial temporal

Question 10

What are the main veins of the head and neck?

Answer 10

External jugular
Anterior jugular
Communicating
Maxillary
Facial
Suprotrochlear
Supraorbital
Posterior external jugular
Oblique jugular
Retromandibular
Posterior auricular

Question 11

What are the lymph node levels?

Answer 11

I= submandibular;ar and submental
II-IV= Upper, middle and lower jugular
V= posterior triangle 
VI= Midline nodes

Question 12

What do the parotid nodes drain?

Answer 12

Scalp, face and parotid gland

Question 13

What do the occipital nodes drain?

Answer 13

Scalp

Question 14

What do the superficial and cervical nodes drain?

Answer 14

Breast and solid viscera

Question 15

What do the deep cervical nodes drain?

Answer 15

Final drainage pathway to the thoracic duct

Question 16

What do the submandibular nodes drain?

Answer 16

Tongue, nose, paranasal sinuses, submandibular gland, oral cavity

Question 17

What do the submental nodes drain?

Answer 17

Lips, floor of mouth

Question 18

What dot he supraclavicular nodes drain?

Answer 18

Breast, oesophagus, solid viscera

Question 19

What are the causes of lymphadenopathy?

Answer 19

Infective
Inflammatory
Malignant

Question 20

What is the structure of the thyroid gland?

Answer 20

2 lobes connected by isthmus

Question 21

What does the thyroid gland produce?

Answer 21

Thyroid hormones and calcitonin

Question 22

What does calcitonin do?

Answer 22

Acts to lower calcium and raise phosphate

Question 23

What is a thyroglossal cyst?

Answer 23

Dilation of the thyroglossal duct remnant

Question 24

What are the causes of a solitary thyroid nodule?

Answer 24

Cyst
Adenoma
Carcinoma
Lymphoma

Question 25

What causes a thyroid cyst?

Answer 25

Localised haemorrhage

Question 26

How is a solitary thyroid mass investigated?

Answer 26

Fine needle aspiration cytology and ultrasound scanning

Question 27

What causes diffuse thyroid enlargement?

Answer 27

Colloid gotre Grave's disease Thyroiditis

Question 28

What is Colloid goitre and what is the cause?

Answer 28

Iodine deficiency due to gland hyperplasia | Can be caused by puberty, pregnancy, lactation

Question 29

What is Grave's disease?

Answer 29

Autoimmune disease resulting in hyperthyroidism

Question 30

What does Grave's disease cause?

Answer 30

Thyroid eye disease Acrophachy/clubbing Pre tibial myxoedema

Question 31

What is the treatment of Grave's disease?

Answer 31

anti-thyroids Beta blockade Radio-iodine Surgery

Question 32

What causes multi nodular goitre?

Answer 32

Grave's disease or toxic goitre

Question 33

What investigations are carried out for multi-nodular goitre?

Answer 33

TFTs Fine needle aspration cytology CXR

Question 34

What are the forms of thyroid cancer?

Answer 34

Papillary FollicularMedullary Anaplastic

Question 35

What are the indications for a thyroidectomy?

Answer 35

``` Airway obstruction Malignancy/suspected malignancy Thyrotoxicosis Cosmesis Retrosternal extension ```

Question 36

What are the possible complications of a thyroidectomy?

Answer 36

``` Bleeding Voice hoarseness Thyroid storm Infection Hypoparathyroidism Hypothyroidism Scar ```

Question 37

How many parathyroid glands are there?

Answer 37

4 usually

Question 38

What is the function of the parathyroid glands?

Answer 38

Regulate calcium and phosphate levels

Question 39

Where are the parathyroid glands located?

Answer 39

Posterior to the poles of the thyroid

Question 40

What are the signs and symptoms of parathyroid disease?

Answer 40

Renal canaliculi, polyuria, renal failure Pathological fractures, osteropososis, bone pain Abdo pain, constipation, peptic ulceration, pancreatitis, weight loss Anxiety and depression, confusion, paranoia

Question 41

What investigations are carried out for parathyroid disease?

Answer 41

``` U+E, creatinine, Ca, phosphate Parathyroid hormone, bicarb Vit D Ultrasound CT/MRI Isotope scanning ```

Question 42

What is the treatment for hyperparathyroidism?

Answer 42

Surgery | Medical treatment

Question 43

What is the treatment for parathyroid disease, excluding hyperparathyroidism?

Answer 43

Medical treatment

Question 44

What surgical treatments can be done for hyperparathyroidism?

Answer 44

Removal of single or multiple adenomas or hyper plastic glands Removal of carcinomas with thyroid glands and lymph nodes

Question 45

What ar he 4 fascial layers of the neck?

Answer 45

Pre-tracheal Pre-vertebral Deep cervical Carotid sheath

Question 46

What are the indications for tracheostomy?

Answer 46

Airway obstruction Airway protection Poor ventilation to reduce dead space

Question 47

What are the causes of inspiratory stridor?

Answer 47

Laryngeal

Question 48

What are the causes of expiratory stridor?

Answer 48

Tracheobronchial

Question 49

What are the causes of biphasic stridor?

Answer 49

Glottic/subglottic

Question 50

How is stridor terated

Answer 50

O2 adrenaline (neb) IV dexamethasone Definitive airway management

Question 51

What is a brachial cyst?

Answer 51

Remnant of fusion failure of brachial arches or lymph node cystic degeneration

Question 52

Where do brachial cysts arise?

Answer 52

Anterior to sternocleidomastoid at junction between upper and middle thirds of trachea

Question 53

What is the treatment for a brachial cyst?

Answer 53

Excision

Question 54

What is a pharyngeal pouch?

Answer 54

Herniation of pharyngeal mucosa through thyropharyngeus and cricopharynxgeus muscles of the inferior constrictor of the pharynx

Question 55

What are the signs and symptoms of a pharyngeal pouch?

Answer 55

``` Voice hoarseness Regurgitation Dysphagia Weight loss Aspiration pneumonia Neoplasia ```

Question 56

What investigations are done for a pharyngeal pouch?

Answer 56

Barium swallow

Question 57

How is a pharyngeal pouch treated?

Answer 57

Excision | Dilation