40 Questions
Which of the following infections can cause swollen lymph nodes?
Tuberculosis
What is the purpose of taking a detailed history in lymphadenopathy?
To identify potential causes and guide further evaluation and treatment
What is the typical presentation of lymphadenopathy?
Palpable or visible swollen lymph nodes
What is the general treatment for lymphadenopathy?
Addressing the underlying cause of the swelling
Which of the following is NOT a symptom of lymphadenopathy?
Difficulty swallowing
What is the purpose of conducting blood tests in lymphadenopathy?
To identify the underlying cause of the swelling
What is the advantage of fine needle aspiration (FNA) or biopsy of the lymph node?
It helps in identifying the underlying cause of the swelling
What is the significance of travel history in lymphadenopathy?
It is crucial in identifying the potential cause of the swelling
What forms the roof of the posterior triangle of the neck?
Investing layer of fascia
Which of the following veins lies superficially in the posterior triangle?
External jugular vein
What is the point of access to the venous system via a central catheter?
Subclavian vein
Which muscle forms the border of the posterior triangle?
Sterno cleidomastoid muscle
What becomes the axillary artery as it crosses the first rib?
Subclavian artery
Which of the following is not a part of the floor of the posterior triangle?
External jugular vein
Where does the external jugular vein empty into?
Subclavian vein
What is the location of the subclavian artery in the posterior triangle?
Between the anterior and middle scalene muscles
Which nerve exits the cranial cavity and descends down the neck?
Accessory nerve
What is the layer of fascia that the accessory nerve crosses in the posterior triangle?
Investing fascia
Which of the following structures forms within the muscles of the floor of the posterior triangle?
Cervical plexus
What is the direction of the accessory nerve in the posterior triangle?
Oblique and inferoposterior
What is the term used to describe the swelling or enlargement of lymph nodes?
Lymphadenopathy
Which of the following is a possible cause of lymphadenopathy in the lateral neck?
Inflammatory conditions
What is the layer of fascia that the phrenic nerve descends down the neck within?
Prevertebral fascia
Which structure is innervated by the phrenic nerve?
Diaphragm
What is the appropriate treatment for cancer?
Surgery, radiotherapy, and chemotherapy
What is the primary cause of sialadenitis?
Bacterial infections
What is the purpose of taking a history of sialadenitis?
To identify the underlying cause of the condition
What diagnostic test may be used to visualize the salivary glands?
All of the above
What is the primary goal of treatment for sialadenitis?
To eliminate the underlying cause of the condition
What is the term used to describe the enlargement of the thyroid gland?
Goitre
What is a potential cause of goitre?
Iodine deficiency
What may be prescribed to help with saliva flow in sialadenitis?
Sialogogues
What is an essential aspect of taking a history for goitre?
Inquiring about symptoms like neck swelling and difficulty swallowing
What is the primary purpose of thyroid function tests in the investigation of goitre?
To determine the underlying cause of the goitre
What is a common cause of branchial cysts?
Remnants of tissues from the branchial arches
What is an important aspect of history taking in branchial cysts?
Inquiring about the progression of the swelling
What is the primary purpose of imaging studies in the investigation of branchial cysts?
To visualize the cyst and its relationship to surrounding structures
What is a possible symptom of goitre?
Difficulty swallowing
What is a possible treatment approach for goitre?
Medication and iodine supplements
What is a characteristic of branchial cysts?
They are fluid-filled sacs
Study Notes
Anatomy of Lateral Neck
- The posterior triangle of the neck is an anatomical area located at the posterolateral aspect of the neck.
- The posterior triangle has three borders:
- Roof: formed by the investing layer of fascia
- Floor: formed by the prevertebral fascia
- The area contains many muscles, including vertebral muscles (covered by prevertebral fascia) that form the floor of the posterior triangle.
Vasculature
- The external jugular vein is a major vein of the neck region, formed by the retromandibular and posterior auricular veins.
- The external jugular vein lies superficially, entering the posterior triangle after crossing the sternocleidomastoid muscle.
- The subclavian vein is often used as a point of access to the venous system, via a central catheter.
- The transverse cervical and suprascapular veins also lie in the posterior triangle.
Nerves
- The accessory nerve (CN XI) exits the cranial cavity, descends down the neck, and innervates sternocleidomastoid.
- The accessory nerve enters the posterior triangle, crossing it in an oblique, inferoposterior direction, within the investing layer of fascia.
- The cervical plexus forms within the muscles of the floor of the posterior triangle.
- The phrenic nerve arises from the anterior divisions of spinal nerves C3-C5 and descends down the neck, within the prevertebral fascia, to innervate the diaphragm.
Epidemiology
- The lateral neck region contains various structures that can give rise to different types of swellings, including lymph nodes, salivary glands, thyroid gland, carotid artery, jugular vein, and muscles like the sternocleidomastoid muscle.
Differentials of Lateral Neck Swelling
1. Lymphadenopathy
- Lymphadenopathy is a term used to describe the swelling or enlargement of lymph nodes.
- Causes of lymphadenopathy include infections (bacterial, viral, fungal), inflammatory conditions (autoimmune diseases), and malignancies (cancers).
- Clinical signs and symptoms include palpable or visible swollen lymph nodes, tenderness or pain in the affected area, redness or warmth over the lymph nodes, and sometimes systemic symptoms like fever, night sweats, or unexplained weight loss.
- Management involves history taking, investigation (blood tests, imaging studies, fine needle aspiration or biopsy), and treatment (addressing the underlying cause, which may include medications, surgery, radiotherapy, and chemotherapy).
2. Sialadenitis
- Sialadenitis is a condition where the salivary glands become inflamed due to various causes, including infections, blockages, autoimmune conditions, and tumors.
- Clinical symptoms include swelling, pain, and tenderness in the affected area.
- Management involves history taking, investigation (physical examination, ultrasound, sialography, CT scans, or MRI), and treatment (antibiotics, pain management, warm compresses, and potentially surgical intervention).
3. Goitre
- Goitre is a term used to describe the enlargement of the thyroid gland.
- Causes of goitre include iodine deficiency, inflammation, or thyroid nodules.
- Clinical signs and symptoms include neck swelling, difficulty swallowing, or breathing issues.
- Management involves history taking, investigation (thyroid function tests, ultrasound imaging, fine needle aspiration cytology), and treatment (medication, iodine supplements, or surgery).
4. Branchial Cyst
- Branchial cysts are fluid-filled sacs that can develop in the neck.
- Causes of branchial cysts include remnants of tissues from the branchial arches, infections, inflammation, or blockages of the salivary glands.
- Clinical symptoms include swelling or discomfort.
- Management involves history taking, investigation (imaging studies such as ultrasound, CT scans, or MRI), and treatment (surgical removal).
This quiz covers the anatomy of the posterior triangle of the neck, including its borders, roof, and related structures. It also touches on the differential diagnosis of lateral neck swelling.
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