A: Front of neck

Question 1

Carotid Sheath

Answer 1

Deep fascia surrounding common + internal carotid arteries, internal jugular vein, deep cervical chain of lymph nodes + vagus nerve.

Question 2

Retropharyngeal space:

Answer 2

Between prevertebral fascia + posterior extension of pretracheal fascia.
Infection here can compress pharynx and result in difficulty swallowing, infection can spread from neck to posterior mediastinum.

Question 3

Pretracheal space

Answer 3

Lies between inverting layer of cervical fascia + pretracheal fascia.

Question 4

Third space

Answer 4

Within prevertebral fascia + covers anterior surface of cervical vertebrae. Passes from base of skull into posterior mediastinum.

Question 5

Boundaries of anterior triangle of neck

Answer 5

Anterior = anterior midline of neck
Posterior = anterior border of SCM
Superior = mandible
Apex = where SCM meets midline

Question 6

4 smaller triangles in anterior triangle

Answer 6

Submandibular triangle
Submental triangle
Carotid triangle
Muscular triangle

Question 7

Carotid sinus

Answer 7

Dilation of distal common carotid artery + proximal internal carotid artery.
Contains baroreceptors which detect changes in blood pressure + is innervated by glossopharyngeal nerve.

Question 8

Sinus hypersensitivity

Answer 8

Excessive decrease in HR and BP as a consequence of pressure on carotid sinus. Leads to cerebral ischaemia - causing fainting.

Question 9

Internal carotid artery atherosclerosis

Answer 9

Thickening + hardening of artery, with narrowing of lumen by atherosclerotic plaques.
Narrowing + occlusion of internal carotid arteries reduces blood supply to brain –> Transcient Ischaemic attack/ stroke.

Question 10

External carotid artery branches

Answer 10

Superior thyroid artery
Lingual artery
Facial artery

Question 11

External carotid artery termination

Answer 11

Posterior to neck of mandible, where it divides into superior temporal artery (which ascends anterior to ear) and maxillary artery (which passes through parotid gland).

Question 12

How does IJV exit the skull

Answer 12

Through jugular foramen, enters carotid sheath.

Question 13

Pressure changes in RA effet on IJV?

Answer 13

Cause pulsations since there are no valves between it and heart.
Pulse not palpable but can be seen beneath SCM above medial end of clavicle.

Question 14

Importance of jugular venous pulse

Answer 14

An important clinical sign indicating functioning of right side of heart.
If pressure in RA is raised, central venous pressure is raised and pulsations in IJV are higher in neck + more visible.

Question 15

Air embolism of internal jugular vein

Answer 15

complication of a cut wall of this vessel. Air is sucked into vein and air embolism will fill right side of heart with froth which nearly stops blood flow.
Cannot blind clamp IJV during bleeding due to close relationship to vagus + hypoglossal nerves.

Question 16

Branches of subclavian artery:

Answer 16

Vertebral arteries
Internal thoracic arteries

Question 17

Risk of subclavian venous access

Answer 17

Can injure subclavian artery/ pleura/ thoracic duct.

Question 18

You are examining your patient at the bedside. How do you access central venous pressure? What is this known as?

Answer 18

When the patient is sitting at a 45o angle, the height of pulsation of the internal jugular vein (deep to SCM) is measured.
Known as Jugular Venous Pulse (JVP).

Question 19

You are examining the Jugular Venous Pulse (JVP) of your patient. What would you expect in a normal healthy patient? What is
an abnormal result?

Answer 19

Normally: JVP maybe visible at the level of the sternal notch.
If JVP higher in neck than sternal notch  central venous pressure is raised.

Question 20

Explain why pulsations in the IJV can be used to determine central venous pressure.

Answer 20

Systemic veins (SVC, IVC) drain to the Right Atrium (RA) of heart.
If pressure in RA is raised, central venous pressure is raised.
Changes in pressure in the RA during the cardiac cycle cause pulsations in IJV because there are no valves between IJV and heart.
Therefore, pulsations in the IJV (Jugular Venous Pulse (JVP)) can be used to determine central venous pressure.
The higher the visible pulsations  the higher the central venous pressure.

Question 21

What are the surface landmarks used to insert a central line into the internal jugular vein?

Answer 21

Lateral to pulse of common carotid artery, directly through SCM halfway down neck or in gap between 2 head of SCM.

Question 22

The external jugular vein is prominent on your patient. What is the surface landmark of the EJV?

Answer 22

On the side of the neck from the angle of mandible,
- crosses superficial surface of SCM.
- posterior border of SCM, pierces investing layer of deep cervical fascia.
- descends to inferior of Posterior Triangle of neck
- terminates in subclavian vein.

Question 23

The external jugular vein is prominent on the side of the neck of your patient who is sitting up. What may this be a sign of?

Answer 23

Indicates venous pressure is raised.
This increased venous pressure maybe due to heart failure or obstruction of the SVC

Question 24

Root of neck + its boundaries

Answer 24

Area where inferior part of neck joins superior part of thorax.
Anterior: manubrium of sternum and upper margin of clavicles
Posteriorly: T1 vertebra and upper margin of scapulae.

Question 25

Submandibular triangle boundaries:

Answer 25

Located between inferior border of mandible and anterior & posterior bellies of digastric muscle

Question 26

Submental triangle boundaries:

Answer 26

Apex = mandibular symphysis
Base = hyoid bone
Sides = anterior belly of digastric

Question 27

Carotid triangle boundaries

Answer 27

Superior belly of omohyoid/ posterior belly of digastric/ anterior border of SCM

Question 28

Muscular triangle boundaries

Answer 28

Superior belly of omohyoid, anterior border of SCM, midline of neck

Question 29

What is the surface landmark of the bifurcation of the right common carotid artery?

Answer 29

Bifurcates at Upper border of thyroid cartilage

Question 30

Branches of subclavian artery:

Answer 30

vertebral + internal thoracic arteries