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Neuro 1 Exam > 6. Angiology and Neuro > Flashcards

6. Angiology and Neuro Flashcards

1
Q

Where does the common carotid a. branch from?

A
  • Right side: brachiocephalic trunk
  • Left side: aortic arch
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2
Q

Carotid Sheath houses the

A
  1. Common Carotid A.,
  2. Internal Jugular V.
  3. Vagus N.
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3
Q

What is the carotid sinus?

A

Swelling of common carotid a. where it branches into:

    1. Internal carotid A.
    1. External carotid A.
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4
Q

Does the internal carotid a. have cervical branches?

A

No

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5
Q

Where does the external carotid a. travel?

A
  • Travels superiorly between the mandible and the external ear, embedded in the parotid gland
  • terminates as the
    • Maxillary A.
    • Superficial Temporal A.
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6
Q

External Carotid branches

A
  1. Superior thyroid A -> goes inferiorly to thyroid gland, below infrahyoid ms.
    * Sternocleidomastiod Branch-> anastomoses with sternocleidomastoid branch of the occipital a.
    * Infrahyoid Muscular Branches
    * Superior Laryngeal A. -> larynx
  2. Ascending pharyngeal A-> travels superior, deep to internal carotid A.
    * -> Pharynx, Anterior Vertebral Muscles, Middle Ear and Cranial Meninges
  3. Lingual A -> travels superiorly, deep to hypoglossal N., stylohyoid m, and posterior belly of the digastric m
    * becomes the Dorsal Lingual A., Deep Lingual A. and Sublingual A. -> tongue
  4. Facial A -> travels up deep to digastric M. and stylohyoid m, gives off branches, goes underneath mandible -> face
    * Ascending Palatine Branch -> soft palate, where it anastomoses with Lesser Palatine A. from Descending Palatine A. of Maxillary A.
    * Tonsilar Branch -> palatine tonsils
    * Submental Branch -> submandibular gland
  5. Occipital A. -> goes to posterior scalp, superficial to the internal carotid A.
  • Sternocleidomastiod branch
  • Descending Branch
  1. Posterior Auricular A. -> goes posterior between external auditory. meatis and mastiod process
  • Parotid gland
  • Facial N
  • Temporal bone
  • Auricle scalpe

—-Terminates into—-

A. Maxillary A.

B. Superficial Temporal A.

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7
Q

Carotid sinuses are sensitive to __________ d/t …

Carotid bodies are sensitive to __________ d/t …

A

Carotid sinuses are sensitive to BP d/t baroreceptors

Carotid bodies are sensitive to blood composition (O2 content) d/t chemoreceptors.

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8
Q

CN: Carotid Sinus Hypersensitivity Syndrome:

The carotid sinus may be hypersensitive to pressure. Pressure of the artery can cause _____________.

A
  1. slow HR
  2. decreased BP
  3. Fainting (syncope)
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9
Q

Carotid bodies (chemoreceptors) exist at the__________ and monitor the oxygen content of blood before what?

A

Carotid Bodies (chemoreceptors) exist at the carotid sinus and monitor the oxygen content of blood before it reaches the brain.

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10
Q

Adjustments to heart rate, respiratory rate and blood pressure can be made accordingly based on the oxygen content in the carotid sinus via _______________.

A

1. Glossopharyngeal N.

2. Vagus N.

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11
Q

Regions of the subclavian A.

A
  • Region One (proximal to Anterior Scalene M.)
  • Region Two (deep to Anterior Scalene M.)
  • Region Three (distal to Anterior Scalene M., proximal to 1st Rib)
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12
Q

Subclavian A: Region 1

A

1. Vertebral A -> goes superiorly in the transverse foramina of
Cervical Vertebrae

  1. Internal thoracic A -> goes inferior to anterior chest wall

3. Thyrocervical Trunk

  • Inferior thyroid A -> thyroid gland
  • Suprascapular A -> goes through superior scapular notch over transverse scapular L -> supraspinatus m. and infraspinatus m.
  • Transverse Cervical A -> goes posterior across phrenic N and anterior scalene m and the brachial plexus to the deep surface of the Trapezius M
    • Superficial branch -> trapezius m.
    • Deep branch -> rhomboid major/minor, levator scapulae
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13
Q

Subclavian A: Region 2

(deep to anterior scalene)

A

Costocervical Trunk

  • Deep Cervical A.
    • -> goes to lateral and posterior neck muscles/ spinal branches and anastomoses with descending branch of Occipital A.
  • Supreme Intercostal A
    • ​-> 1st intercostal space
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14
Q

Subclavian A: Region 3

(distal to anterior scalene M, proximal to 1st rib)

A
  1. Dorsal scapular A.
    1. ​Goes superior to scapula -> along medial border of scapula -> [levator scapulae and rhomboid ms.]
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15
Q

Dorsal Scapular A can branch off of what?

A

1. Subclavian A.

2. Transverse cervical A (if so, it is known as the deep branch of the transverse cervical A)

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16
Q

What forms our superior vena cava (SVC)?

A

Union of R and L brachiocephalic V

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17
Q

Draw SVC

A
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18
Q

The ___________ is often the point of entry for central line placement, or other diagnostic or therapeutic purposes.

A

Subclavian Vein

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19
Q

Besides the subclavian vein, what other vein can we puncture for diagnostic/therapeutic purposes?

A
  • Internal Jugular Vein
  • Right Internal Jugular V. is typically preferred since it is larger and straighter.
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20
Q

CN: Central Line Placement

A

Central Lines are used to

  • administer venous nutritional fluids and medications
  • measure central venous pressure.

via the L/R subclavian vein.

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21
Q

The ____________ may serve as an “internal barometer”.

A

External Jugular V.

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22
Q

The External Jugular V. may serve as an “internal barometer”.

How so?

A
  • When venous pressure rises, the external jugular vein becomes much more visible along lateral neck.
  • This can tell us: CHF, SVC obstruction, enlarged supraclavivular LN or increased intrathoracic pressure.
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23
Q

What are your superificial cervical LN?

A
  1. Superficial Parotid Lymph Nodes
  2. Occipital Lymph Nodes
  3. Mastoid Lymph Nodes
  4. Lateral Superficial Lymph Nodes
  5. Anterior Superficial Lymph Nodes
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24
Q

Where do superificial cervical LN drain into?

A

Inferior Deep Cervical Lymph Nodes.

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25
Q

What are the deep cervical lymph nodes?

A
  1. Submental Lymph Nodes
  2. Pretracheal Lymph Nodes
  3. Infrahyoid Lymph Nodes d
  4. Paratracheal Lymph Nodes
  5. Thyroid Lymph Nodes
  6. Deep Parotid Lymph Nodes
  7. Superior Deep Lymph Nodes
  8. Submandibular Lymph Nodes
  9. Retropharyngeal Lymph Nodes
  10. Inferior Deep Lymph Nodes
26
Q

Deep cervical LN drain primarily into the __________.

A

Jugular Lymphatic Trunk

27
Q

Right Lymphatic Duct

Drains:

Empties into:

A
  • Drains: R jugular lymphatic trunk and R subclavian trunk
  • Empties lymph into venous circulation where the subclavian and internal jugular veins unite
28
Q

Thoracic Lymphatic Duct

Drains:

Empties into:

A
  • Drains: L jugular lymphatic trunk and L subclavian trunk and
  • Empties: lymph into venous circulation where the subclavian and Internal Jugular Vs. unite)
29
Q

Name our lymphatic organs.

A
    1. Lingual tonsils- on root of tongue
    1. Palatine tonsils
    1. Pharyngeal tonsils
30
Q

These tissues are called adenoids; they are lymphoid tissue in the superior most part of the Nasopharynx.

A

Pharyngeal Tonsil

31
Q

what tonsils are at the root of the tongue?

A

lingual tonsil

32
Q

CN: Tonsilectomy of the Palatine Tonsils is a removal of the palatine tonsils.

Why do we remove them?

A
  • They can become inflamed and obstruct the communication between [oral cavity and oropharynx].
  • Pharyngeal tonsils are also removed as well.
33
Q

When we remove the palatine tonsils, what vessels and nerves are subject to injury?

A
  1. Tonsilar A.
  2. Glossopharyngeal N.
  3. Internal Carotid A.
34
Q

What is adenoiditis?

A
  • Pharyngeal tonsils become inflamed and obstruct the nasal passageways
    • can cause: hearing impairment and lead to otitis media.
35
Q

Why do we remove lingual tonsils?

A

Inflammation can obstruct respiratory or digestive tracts.

36
Q

What are tonsilloliths (tonsil stones)?

A

Calcifications that form in the crypts of the Palatine Tonsils.

37
Q

What are the 3 CN that pass through the neck?

A

1. Vagus N.

2. Spinal accessory N.

3. Hypoglossal N.

38
Q

Path of vagus N.

A
  1. Exits jugular foramen
  2. Travels in carotid sheath
  3. In the neck, branches into :
    1. Pharyngeal branch
    2. Superior Laryngeal N.
    3. Right Recurrent Laryngeal N.
  4. Goes into thorax via superior thoracic aperature and makes:
    1. Left Recurrent Laryngeal N.
39
Q

Vagus N and Branches

A

Vagus N

While in neck:

  1. Pharyngeal branch (probs wont see): makes pharyngeal plexus
    * Innervates all but 1 pharyngeal ms (stylopharyngeus m)
  2. Superior Laryngeal N: comes from Inferior Vagal Ganglion, divides in carotid sheath into:
  • Internal laryngeal N
    • I: laryngeal mucosa above vocal folds
  • External laryngeal N
    • I: Cricothyroid M.
  1. Recurrent Laryngeal N.
  • R recurrent laryngeal N: originates from the Vagus N. in the Neck travels under the right Subclavian A. and returns to the Larynx.
  • L recurrent laryngeal N: originates from the Vagus N. in the Thorax, goes under the Aortic Arch and returns to the Larynx
    • Branches into Inferior laryngeal N. (a continuation of recurrent laryngeal N, just. before it reaches the larynx.
40
Q

What is the one oddball for laryngeal muscles?

A
  • External laryngeal N innervates cricothyroid m.
  • All of the other ones are innervated by recurrent laryngeal N.
41
Q

Spinal Accessory N. path

A
  • Through posterior triangle -> deep to trapezius m.
  • Innervates: Sternocleidomastoid M. and Trapezius M.
42
Q

Hypoglossal N path.

A
  • Travels with anterior ramus of C1 ->
  • Exits the Hypoglossal Canal->
  • Passes between External Carotid A. and Internal Jugular V.
  • Anterior ramus of C1 will split into Superior Root of the Ansa Cervicalis
    • I: Geniohyoid and Throhyoid M
  • Hypoglossal N goes to tongue muscles
43
Q

Cervical Plexus (___-> ___)

A

C1 to C5

44
Q

Draw the cerivical plexus:

A
45
Q

Lesser Occipital N.

A

C2

46
Q

Great Auricular N.

A

C2 and C3

47
Q

Transverse Cervical N.

A

C2 and C3

48
Q

Supraclavicular N.

A

C3 and C4

49
Q
  • Ansa Cervicalis
  • Superior root of Ansa Cervicalis
  • Inferior root of Ansa Cervicalis
A
  • C1- C3
  • C1
  • C2-C3
50
Q

Phrenic N.

A

C3-C5

51
Q

Brachial Plexus

A

C5-T2

52
Q

What does hypoglossal N. do in the neck?

A

nothing!

53
Q

What is Erbs point?

A

Nerve point of the neck where cutaneous branches arise from:

    1. Transverse cervical N.
    1. Great auricular N.
    1. Lesser occipital. N.
    1. Medial, intermediate and later supraclavicular Ns.
54
Q

Path of phrenic N.

A
  1. Anterior to anterior scalene M.
  2. Deep to internal jugular v.
  3. Goes between subclavian A and V
  4. -> thorax
55
Q

What does brachial plexus pass between?

A

Anterior and middle scalene M

56
Q

Sympathetic presynaptic CB of the cervical region are located where?

A

Lateral horn of the thoracic SC.

57
Q

Path of sympathetics to cervicals

A
  1. Presynaptic fibers: lateral horns of the thoracic SP
  2. Go to sympathetic trunk, ascend and synapse on paravertebral ganglia in cervical sympathetic trunk
  • Superior cervical ganglion
  • Middle cervical ganglion
  • Inferior cervical ganglion
58
Q

Superior Cervical Ganglion

Located:

Feature:

Sends branches to:

A
  • Located at: C1/C2
  • Largest cervical ganglion.
  • Sends branches to:
      1. Internal carotid A -> forming internal carotid sympathetic plexus
      1. Sends branches to anterior rami of the superior four Cervical Spinal nerves
59
Q

Middle Cervical Ganglion

Feature:

Sends branches to:

A
  • Smallest cervical ganglion
  • Sends branches to C5 and C6 spinal nerves
60
Q

Inferior Cervical Ganglion

Features:

Sends branches to:

A
  • Fuses with first thoracic sympathetic ganglion, making large stellate ganglion.
  • Sends branches to: C7 and C8
61
Q

Lesions of the Cervical Sympathetic Trunk result in what?

A

Horner Syndrome

Sx: PAM

  • Ptosis
  • Anhydrosis
  • Miosis
  • Enopthalamos- sinking of eye

Neuro 1 Exam (24 decks)

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