Neck Conditions

Question 1

what are the boundaries of the anterior triangle?

Answer 1

Sternocleidomastoid

Question 2

What are the borders of the posterior triangle?

Answer 2

Trapezius

Question 3

5 characteristics of a neck swelling?

Answer 3

Size, Shape, Consistency,mobility and tendorness

Question 4

Where is Virchows’s node located? what might its enlargement signify?

Answer 4

Left supraclavicular fossa and malignancy of the Abdomen in GI tract

Question 5

Name 3 possible causes of enlarged cervical nodes?

Answer 5

infection
Malignancy
Autoimmune disorders

Question 6

What anatomical features mean that voice change and hypocalcaemia are risks of thyroid surgery?

Question 7

What is Horner’s syndrome?

Question 8

Landmarks of the anterior triangle?

Answer 8

Superiorly - inferior border of the mandible
Laterally - Anterior border of the Sternocleidomastoid
Medially - Sagittal line down the midline of the neck

Question 9

Landmarks of the posterior triangle?

Answer 9

Anterior - Posterior border of Sternocleidomastoid
Posteriorly- anterior border of trapezius
Inferiorly -middle 1/3 of the clavicle

Question 10

Midline of the neck

Answer 10

Sagittal

Question 11

Great vessels

Answer 11

Thyroid gland
Thyroid cartilage

Question 12

spinous process

Question 13

Causes of neck swelling and duration

Answer 13

In history, ask how long have you had it for.

• it could be trauma, inflammation, infections - acute few days

1. This could be bacterial-TB/ staphylococcus, or streptococcus infection, or could be raised because of dental/ impetigo/ tonsilitis/ quinsy ( inflammation of the throat)
2. Viral - Urti/mumps

• neoplastic (Tumour) - weeks to months

endocrine- chronic for months
This could be Goitre- Hashmito’s, Grave’s , iodine deficiency

• congenital ( birth disorders) - Thyroglossal cyst chronic for years

Question 14

History of the patients ?

Answer 14

age - child- cause of infection , young adult -infections or inflammatory mass, adult- goitre,older - neoplasm-beginin or malignant primary or secondary ?

Duration- Acute/subacute/chronic

Symptoms- hyper / hypo

Red flags of malignancy - weight loss, persistant hoarseness, cough, dysphagia

Haematological cancers- night sweats , fever, fatigue

Question 15

Neck lumps - key points to think in your history and examination?

Answer 15

• Foreign travel - areas of endemic
• Exposure to animals - cat scratch fever, toxoplasmosis( infection from poo, infected cats) , insect bites
• risk factors of head and neck
• past history and family history
• Occupational exposure - to wood dusts, nickel, asbestos

Question 16

quinsy or peritonissor abscess

Answer 16

• caused by the build up of pus- due to infection behind the tonsil
• Symptoms- Fever, throat pain and difficulty opening ypur mouth
• Pain is worse on the side
  the key feature is deviation of the uvulanon examination
• Management - antibiotics or surgical drainage

Question 17

Impetigo

Answer 17

Staphyloccocus skin infection

Question 18

Impetigo treated with?

Answer 18

antibiotic cream (fucidin)
orally ( erythromycin)
it is very infectious and often swollen neighbouring nodes

Question 19

Blocked salivary duct

Question 20

Features of Hypothyroidism

Answer 20

• dry hair
• coarse features - the features of the face is not defined properly, eyebrows are thing from the lateral side
• puffy dull face with dry skin, periorbital oedema ( fluid build up under the eyes),

Question 21

Features of hypothyroidsim ?

Answer 21

• Bulging of the eyes are called Exopthalamus or proptosis
• Reness of the eyes
• eyelids retract

Question 22

What is a Goitre ?

Answer 22

Swelling due to an enlarged thyroid gland - could be hyper/hypo

The swelling moves while swallowing and it can extend behind the sternum sometimes and compress the trachea - this is called as retrosternal goiter!

if the patient feels breathless - they need to be referred to the hospital

Question 23

Causes of Goitre

Answer 23

Hyper or hypo
Pregnancy
menopause
puberty
idoine dietary deficiency
iatrogenic
Inflammation of the thyroid Gland - Thyroiditis

Question 24

other causes of thyroid masses

Answer 24

Thyroid Nodule
Thyroid Carcinoma
Thyroid Cyst
Thyroid Adenoma

Question 25

dangers of thyroid surgery

Answer 25

* bleeding in the neck * it affects the recurrent laryngeal nerve * Hypocalcemia Build of bodily fluids after the surgery Infection

Question 26

Drooping of the upper eyelid ?

Answer 26

ptosis

Question 27

Constriction of the pupil ( smaller pupil)

Answer 27

miosis

Question 28

decreased sweating

Answer 28

anhidrosis

Question 29

what is hornors syndrome?

Answer 29

interruption of nerve supply from the brain to the face and eye, on one side of the body. This leads to miosis, ptosis and anhydrosis

Question 30

Hornor's syndrome affects ?

Answer 30

sympathetic fibres comes from the hypothalamus and get into the spinal cord It then exit from T1 and ascend in the cervical sympathetic chain on their way to the eye and the sweat glands of the face. running close to the lungs and apex subclavian artery

Question 31

TIA?

Answer 31

TRANSIENT ISCHAEMIC STROKE - recovery time can take up to 24 hrs It is caused by a temporary blockage in the internal carotid arteries usually at the place of narrowing.

Question 32

What is the management of TIA?

Answer 32

Management -Patients must be seen within 24hrs , offer immediate aspirin 300mg daily unless contradicated refer them immediately for specialist assessment investigation to be seen with 24hrs of symptoms offer secondary prevention - on top of aspirin as soon as possible after the diagnosis of TIA is confirmed

Question 33

Investigations of TIA

Answer 33

**Blood test **such as FBC, ESR,CRP, Platalets, Urea, Blood glucose, syphilis serology **Chest X ray** **monitor ECG** for 24 hrs to look for arrythmia **Transesophageal & transthoracic** of echocardiography **Carotid duplex test ** - non-invasive ultrasound which shows how well the blood is flowing through the carotid arteirs - carotid angiography **Carotid imaging **

Question 34

After a patient gets TIA, they're more likely to get a stroke ? that's called secondary prevention which are as follows

Answer 34

**Antiplatalet tablets * * Anticoagulant Therapy * Carotid endarterectomy Modi**fying several risk factors for stroke including **HTN, cholestrol and smoking **

Question 35

JVP

Answer 35

Jugular Venous Pressure can be observed in the internal jugular vein It can be seen in between the sternuma and teh clavicle head of the sternocleidomastoid muscle The pressure reflects on the right atrium, right side of the heart

Question 36

Conditions that cause Raised JVP ?

Answer 36

* Constrictive Pericardities * Congestive Cardiac failure

Question 37

Virchow's Node

Answer 37

Enlarged Left supraclavicular node which drains lymph vessels in the abdomen cavity. Called as 'Senitol Node' of cancer in the abdomen. It is particularly gastric cancer but can also be kidney. testicles and ovarian cancer. Also, Known as Troisier's sign

Question 38

Torticollis or wry neck

Answer 38

Caused due to the spasm of the sternocleidomastoid muscle. Commonly present in children where the head is pulled towards one side This could be a strain or viral but can be self limited