neck anatomy, physiology and pathology

Question 1

what are the some of the gross anatomical structures within the neck?

Answer 1

arteries
veins
nerves
lymph nodes 
lymphatic channels
thyroid and parathyroid glands
muscles
trachea

Question 2

what is the superior boundary of the neck?

Answer 2

mandible

Question 3

what is the inferior boundary of the neck?

Answer 3

clavicle

Question 4

what is the anterior boundary of the neck?

Answer 4

anterior midline

Question 5

what is the posterior boundary of the neck?

Answer 5

trapezius

Question 6

what are the boundaries of the anterior triangle?

Answer 6

anterior: midline of neck
posterior: anterior border of sternocleidomastoid (SCM)

Question 7

what are the boundaries of the posterior triangle?

Answer 7

anterior: posterior border of sternocleidomastoid
posterior: anterior border of trapezius

Question 8

name the 4 arteries, 2 veins, 2 groups of lymph nodes and 5 nerve groups contained in the anterior triangle of the neck

Answer 8

common carotid artery
external carotid artery
internal carotid artery
internal jugular vein
facial artery
facial vein
hypoglossal nerves
accessory nerves
vagus nerves
laryngeal nerves
glossopharyngeal nerves
submandibular and submental lymph nodes

Question 9

name the 5 contents of the posterior triangle

Answer 9

accessory nerve
occipital artery
lymph nodes
cervical nerve plexus
external jugular vein

Question 10

where does the common carotid artery bifurcate?

Answer 10

vertebral level C4

Question 11

what makes the common carotid artery unique within the neck?

Answer 11

only artery with branches in the neck

Question 12

name 8 branches of the Common carotid artery

Answer 12

superior thyroid
ascending pharyngeal
lingual
occipital
facial
posterior auricular
maxillary
superficial temporal

Question 13

what are some uses of a central line?

Answer 13

measuring central venous pressure
drug administration
cardiac pacing
blood sampling
fluid resuscitation
haemodialysis
IV nutrition

Question 14

what are some complications that may result from insertion of a central line?

Answer 14

pneumothorax
haematoma
cardiac tamponade
air embolism
chylothorax
false passage
thrombosis
sepsis
line blockage

Question 15

where do the lymph nodes in the head and neck drain to BEFORE the thoracic duct?

Answer 15

cisterna chyli

Question 16

what are the different groups of lymph glands in the head and neck?

Answer 16

occipital
cervical
supraclavicular
submandibular
submental
parotid
-there are others

Question 17

where do the parotid nodes drain from?

Answer 17

scalp, face and parotid gland

Question 18

where do the occipital nodes drain from?

Answer 18

scalp

Question 19

where do the superficial cervical nodes drain from?

Answer 19

breast and solid viscera

Question 20

what is the function of the deep cervical nodes?

Answer 20

final drainage pathway to the thoracic duct

Question 21

where do the submandibular nodes drain from?

Answer 21

tongue
nose
paranasal sinuses
submandibular gland
oral cavity

Question 22

where do the submental nodes drain from?

Answer 22

lips

floor of mouth

Question 23

where do the supraclavicular nodes drain from?

Answer 23

breast
oesophagus
solid viscera

Question 24

what are 3 broad categories that my cause lymphadenopathy?

Answer 24

infection
inflammation
malignancy

Question 25

what kind of gland is the thyroid?

Answer 25

endocrine

Question 26

what is the structure of the thyroid gland?

Answer 26

2 lobes joined by the isthmus

Question 27

what does the thyroid produce?

Answer 27

thyroid hormone | calcitonin

Question 28

what is the function of calcitonin?

Answer 28

lowers calcium and raises phosphate levels

Question 29

what is a thyroglossal cyst?

Answer 29

dilatation of thyroglossal duct remnant - may become infected

Question 30

what are some causes of thyroid masses?

Answer 30

solitary nodules diffuse enlargement multi nodular goitre

Question 31

what are some causes of solitary thyroid nodules?

Answer 31

``` cyst adenoma carcinoma lymphoma prominent nodule in multi nodular goitre ```

Question 32

what causes thyroid cysts?

Answer 32

localised haemorrhage

Question 33

what would be appropriate investigations in the case of a solitary thyroid nodule?

Answer 33

fine needle aspiration cytology (FNAC) | ultrasound scanning

Question 34

what can FNAC NOT distinguish between?

Answer 34

follicular adenoma and follicular carcinoma - tissue required for a histological diagnosis

Question 35

what are 4 classifications of thyroid cancer?

Answer 35

papillary follicular medullary anaplastic

Question 36

what causes papillary thyroid cancer?

Answer 36

lymphatic metastasis

Question 37

what causes follicular thyroid cancer?

Answer 37

haematogenous metastasis

Question 38

what causes medullary thyroid cancer?

Answer 38

familial association (10%), arise from parafollicular C cells

Question 39

what are some characteristics of anaplastic thyroid cancer?

Answer 39

aggressive local spread old patients poor prognosis

Question 40

what are some causes of diffuse thyroid enlargement?

Answer 40

colloid goitre grave's disease thyroiditis

Question 41

what can cause colloid goitre?

Answer 41

``` gland hyperplasia iodine deficiency puberty pregnancy lactation ```

Question 42

what is the pathology of graves disease?

Answer 42

auto antibodies against thyroid stimulating hormone receptor stimulate the receptor, resulting in hyperthyroidism

Question 43

what is the treatment for graves disease?

Answer 43

anti thyroids, beta blockade, radio iodine and surgery

Question 44

what are indications for a thyroidectomy?

Answer 44

``` airway obstruction malignancy or suspected malignancy thyrotoxicosis cosmesis retrosternal extension ```

Question 45

what are possible complications of a thyroidectomy?

Answer 45

``` bleeding - primary or secondary voice hoarseness thyroid storm infection hypoparathyroidism hypothyroidism scarring (keloid/hypertrophic) ```

Question 46

what are causes of multi nodular goitre?

Answer 46

graves disease or toxic goitre

Question 47

what kind of patient would you expect to see in a toxic goitre case?

Answer 47

older no eye signs atrial fibrillation

Question 48

what kind of patient would you expect to see where the cause of multi nodular goitre is graves disease?

Answer 48

woman middle aged over active thyroid (hyperthyroidism)

Question 49

what tests would you perform if you suspected multi nodular goitre?

Answer 49

thyroid function tests FNAC CXR

Question 50

how many parathyroid glands are there usually?

Answer 50

4

Question 51

what is the function of the parathyroid glands?

Answer 51

regulate calcium and phosphate levels

Question 52

where are the parathyroid glands located?

Answer 52

posterior to the poles of the thyroid

Question 53

what are some renal signs of parathyroid disease?

Answer 53

renal calculi polyuria renal failure

Question 54

what are some alimentary signs of parathyroid disease?

Answer 54

``` abdominal pain constipation peptic ulceration pancreatitis weight loss ```

Question 55

what are some bony (awful name sorry) signs of parathyroid disease?

Answer 55

pathological fractures osteoporosis bone pain

Question 56

what are some psychological signs of parathyroid disease?

Answer 56

anxiety depression confusion paranoia

Question 57

what tests would you run (exluding imaging tests) to try and diagnose parathyroid disease?

Answer 57

``` U & Es creatinine calcium and phosphate levels parathyroid hormone levels bicarbonate levels vitamin D ```

Question 58

what IMAGING tests would you run to try and diagnose parathyroid disease?

Answer 58

ultrasound scan CT/MRI - identify ectopic glands Isotope scanning - detect diseased glands

Question 59

when would surgery be indicated in parathyroid disease?

Answer 59

hyperparathyroidism ONLY

Question 60

what are some causes of hyperparathyroidism?

Answer 60

adenoma hyperplasia malignancy in rare cases

Question 61

what accounts for the majority of hyperparathyroidism?

Answer 61

adenomas account for 80%

Question 62

what percentage of hyperparathyroidism does hyperplasia account for?

Answer 62

12% - common in secondary hyperparathyroidism due to low calcium

Question 63

how is hyperparathyroidism managed?

Answer 63

can be treated medically surgery easier if patient is fit remove single and multiple adenomas remove 3 or 3.5 hyperplastic glands through neck exploration carcinomas removed along with the thyroid gland and lymph nodes

Question 64

what are the 4 fascial layers of the neck?

Answer 64

pre-tracheal pre-vertebral deep cervical carotid sheath

Question 65

what is a tracheostomy?

Answer 65

A tracheostomy is an opening created at the front of the neck so a tube can be inserted into the windpipe (trachea) to help the patient breathe

Question 66

what are some indications for a tracheostomy?

Answer 66

airway obstruction airway protection poor ventilation to reduce dead space

Question 67

what would be a sign of laryngeal stridor?

Answer 67

inspiratory stridor

Question 68

what would be a sign of tracheobronchial stridor?

Answer 68

expiratory stridor

Question 69

what would be a sign of glottic/subglottic stridor?

Answer 69

biphasic stridor

Question 70

what causes a branchial cyst?

Answer 70

remnant of fusion failure of branchial arches | lymph node cystic degeneration

Question 71

where are branchial cysts located?

Answer 71

anterior to the SCM at the junction between the upper and middle thirds

Question 72

how are branchial cysts managed?

Answer 72

excised to prevent further infection

Question 73

what is a "pharyngeal pouch"?

Answer 73

herniation of the pharyngeal mucosa between the thyropharyngeus and cricopharyngeus muscles of the inferior constrictor of the pharynx

Question 74

what are some signs of a pharyngeal pouch?

Answer 74

``` voice hoarseness dysphagia aspiration pneumonia regurgitation weight loss neoplasia (1%) ```

Question 75

how is a pharyngeal pouch diagnosed?

Answer 75

barium swallow

Question 76

what is the treatment for a pharyngeal pouch?

Answer 76

excision | dilatation