5 - Head & Neck - Blood Vessels + Lymphatics

Question 1

The vertebral arteries are branches of which arteries?

Answer 1

Subclavian arteries

Question 2

Describe the route of the vertebral arteries from their origin to the formation of the basilar artery:

Answer 2

• Branch from subclavian arteries
• Ascend through transverse foramina of c-spine (except C7)
• Enter subarachnoid space between atlas and occipital bone
• Passes through foramen magnum
• Curves around medulla to join other vertebral artery = basilar artery

Question 3

Beneath which anatomical landmark does the right common carotid branch from the brachiocephalic artery?

Answer 3

Behind the right sternoclavicular joint

Question 4

Where do the common carotid arteries terminate?

Answer 4

• Upper border of the Thyroid Cartilage level, deep to SCM

~ C4

Question 5

How can you locate the site of the carotid sinus? Why may this be helpful?

Answer 5

• Upper border of the Thyroid Cartilage level, deep to SCM
  ~ C4 level
• Carotid massage: Rubbing this area can alleviate a supra-ventricular tachycardia

Question 6

When measuring the JVP, are you looking for the external or internal jugular vein?

Answer 6

Internal Jugular Vein

Question 7

Which of the internal and external carotid arteries give branches during its ascent through the neck?

Answer 7

External carotid artery

Question 8

Name the 8 branches of the external carotid artery:

Answer 8

1) Superior Thyroid
2) Lingual
3) Facial
4) Ascending pharyngeal
5) Occipital
6) Posterior auricular
7) Superficial Temporal
8) Maxillary

Question 9

Which 2 branches does the external carotid give within the parotid gland?

Answer 9

1) Superficial Temporal

2) Maxillary

Question 10

Which vein drains most of the structures of the face?

Answer 10

Facial vein

- drains into internal jugular vein

Question 11

Why is it important to remember that the facial vein recieves blood from the sup. and inf. ophthalmic veins?

Answer 11

Sup. and Inf. ophthalmic veins are directly connected to the Pterygoid venous plexus and the Cavernous sinus
= Potential route for infection or clot into the intracranial system

Question 12

Where is the danger triangle of the face?

Answer 12

From corners of mouth to bridge of nose

- Incl. nose + maxilla

Question 13

Which veins provide a potential route for infection from the scalp into the cranial cavity?

Answer 13

Emissary veins

Question 14

List some structures which do not contain lymphatic vessels:

Answer 14

• Cornea
• Lens
• Inner ear
• Cartilage

Question 15

What cells are found in lymph nodes?

Answer 15

• B cells
• T cells
• Macrophages

Question 16

Which deep cervical lymph node is most frequently enlarged?

Answer 16

Jugulo-digastric node

- drains palatine tonsil

Question 17

Where is the jugulo-digastric lymph node located, and what structures does it drain?

Answer 17

• Below and behind the angle of the mandible

- Oral cavity, pharynx, larynx, palatine tonsil, tongue

Question 18

Which lymph node is often swollen in tonsillitis?

Answer 18

Jugulo-digastric node

Question 19

Which deep cervical lymph node drains the trachea, oesophagus and thyroid gland?

Answer 19

Jugulo-omohyoid node

Question 20

What is the name often given to an enlarged left supraclavicular lymph node?

Answer 20

Virchow’s node

Question 21

What is Trosier’s sign?

Answer 21

A hard, enlarged left supraclavicular lymph node, a sign of metastatic abdominal malignancy

Question 22

Which superficial lymph node drains the lips and chin?

Answer 22

Submental node

Question 23

Which superficial lymph node drains the face (except the lips and chin)?

Answer 23

Submandibular node

Question 24

Which superficial lymph nodes drain the back and sides of the head (including the auricle)?

Answer 24

Pre- and Post Auricular nodes

Occipital node

Question 25

Which superficial lymph nodes drain the neck?

Answer 25

• Anterior cervical
• Posterior cervical
• Superficial cervical

Question 26

Name the superficial lymph nodes of the head + neck region:

Answer 26

• Submental
• Submandibular
• Pre-auricular
• Post-auricular
• Occipital
• Anterior cervical
• Posterior cervical
• Superficial cervical

Question 27

Into which vessel do the deep cervical lymph nodes drain?

Answer 27

Thoracic duct

- Into the left subclavian vein

Question 28

Into which vessel does the thoracic duct drain into?

Answer 28

Left subclavian vein

Question 29

Lymph may contain:

Answer 29

• Tissue fluid
• Small proteins
• Lipids (chylomicrons from gut lymphatics)
• Damaged cells
• Bacteria
• Cancer cells

Question 30

How many litres of lymph is produced on average per day?

Answer 30

~ 3-4 L

Question 31

The lymphatic system has no central pump, so how does it ensure one-directional flow?

Answer 31

• Valves

- Uses artery pulsation or muscle contraction to keep up flow

Question 32

What structures does the Thoracic duct drain?

Answer 32

• Entire L side of body
• Right side of pelvis
• Right lower limb

Question 33

What structures does the right lymphatic duct drain?

Answer 33

• Right side of head + neck
• Right arm
• Right side of torso

Question 34

Define lymphoedema:

Answer 34

Abnormal collection of protein-rich fluid, causing tissue swelling, due to compromised lymphatic system

Question 35

List some causes of lymphoedema:

Answer 35

• Infection (parasites)
• Removal of lymph nodes
• Damage to lymphatic system (ie chemotherapy)
• Lack of limb movement
• Congenital (ie Milroy’s syndrome)

Question 36

Which tonsils form the Waldeyer’s tonsillar ring?

Answer 36

• Pharyngeal tonsils (adenoids)
• Tubal/Eustachian/Gerlach’s tonsils
• Palatine tonsils
• Lingual tonsils

Question 37

Where is the Waldeyer’s tonsillar ring?

Answer 37

Within the naso- and oro-pharynx

Question 38

Before performing a carotid massage, what would a doctor do to minimise the risk of causing a TIA/stroke?

Answer 38

Listen with stethoscope over the carotid artery for bruits, which may indicate atheroma formation