A: Front of neck practical

Question 1

Answer 1

Question 2

Answer 2

Question 3

Answer 3

Question 4

Answer 4

Question 5

Answer 5

Question 6

Name 3 sheets of deep cervical fascia and what they surround

Answer 6

• Investing layer: encircles the neck
• Pretracheal fascia: surrounds oesophagus, trachea and thyroid gland (ensures movement of thyroid gland during swallowing)
• Prevertebral fasica: covers vertebral column and muscles associated

Question 7

Contents of carotid sheath

Answer 7

• Common carotid artery
• Internal carotid artery
• Internal jugular vein (lateral to carotid artery)
• Deep cervical chain of lymph nodes
• Vagus nerve (posterior to artery)

Question 8

Name the spacial faces of the neck

Answer 8

Anterior triangle and posterior triangle

Question 9

Name boundaries of anterior triangle

Answer 9

• Anterior = midline of neck
• Posterior = anterior SCM
• Superior = mandible
• Apex = where SCM and midline meet

Question 10

Name 4 smaller triangles in anterior triangle + their boundaries

Answer 10

• Submental triangle (unpaired): apex = mandibular symphysis, base = hyoid bone, sides = anterior belly of digastric muscle
• Submandibular triangle: mandible, anterior and posterior bellies of digastric muscle
• Carotid triangle: SCM, posterior belly of digastric, superior belly of omohyoid
• Muscular triangle: midline, superior belly of omohyoid and anterior SCM

Question 11

Origin of right and left common carotid arteries

Answer 11

• Right: brachiocephalic trunk
• Left: arch of aorta

Question 12

Where and into what does the common carotid artery bifurcate?

Answer 12

Bifurcates into internal and external carotid arteries at superior border of thyroid cartilage (Adam’s apple)

Question 13

When and where is the carotid pulse palpated?

Answer 13

During cardiopulmonary resuscitation at carotid sinus

Question 14

What does carotid sinus detect and what’s its innervation?

Answer 14

• Has baroreceptors to detect changes in BP
• Glossopharyngeal nerve

Question 15

What characterizes carotid hypersensitivity?

Answer 15

Excessive decrease of BP and HR because of pressure on carotid sinus –> cerebral ischaemia –> fainting

Question 16

What are the branches of external carotid artery and how does it terminate?

Answer 16

• Branches: lingual, facial, and superior thyroid arteries
• Terminates posterior to neck of mandible by dividing into maxillary (larger, passes through parotid gland) and superficial temporal (anterior to ear) arteries

Question 17

Explain process of internal carotid artery atherosclerosis and its consequences

Answer 17

• Atherosclerotic plaques (fatty tissue) = thickening and hardening of artery + narrowing of lumen
• Narrowing of ICA –> reduces blood supply to brain
• Can cause Transient Ischaemic Attach (TIA) / Stroke (Cerebrovascular accident (CVA)) –> visual impairment/blindness (retinal artery), motor paralysis, sensory loss

Question 18

What does internal jugular vein drain and where does it go

Answer 18

• Face, brain and parts of neck
• Exists skull to enter carotid sheath through jugular foramina
• Deep to SCM
• Joins subclavian vein to form brachiocephalic vein

Question 19

What causes pulsations in IJV? Where can the pulse be seen?

Answer 19

• Pressure changes in right atrium (no valves) –> raises central venous pressure
• Pulse can be seen beneath SCM, above medial clavicle (when patient sitting at 45° = sternal notch)

Question 20

Explain catherization of IJV

Answer 20

• Performed to obtain central venous access
• Palpate common carotid artery and insert needle into IJV (lateral to artery) either through SCM or in gap between 2 heads of SCM

Question 21

What does external jugular vein drain and explain its path

Answer 21

• Scalp and face
• Begins at angle of mandible, crosses superficial SCM, pierces investing layer of deep cervical fascia at posterior SCM, descends to inferior of posterior triangle, terminates in subclavian vein

Question 22

Explain prominence of EJV

Answer 22

• Normally, prominent for a short distance above clavicle when patient lying down
• If EJV is prominent throughout its course on whole side of neck, it means venous pressure is raised –> can indicate heart failure or obstruction of SVC

Question 23

What does anterior jugular vein drain?

Answer 23

Anterior part of neck

Question 24

Explain air embolism of IJV

Answer 24

• IJV wall is cut –> air sucked in the vein –> embolism fills right side of heart with froth –> nearly stops blood flow through heart
• Adventitia of vein is attached to carotid sheath –> hinders collapse of vein
• Blind clamping of IJV is prohibited because of close relationship to vagus and hypoglossal nerves

Question 25

Boundaries of root of neck

Answer 25

Anterior: manubrium and upper margin of clacvicle
Posterior: T1 vertebra and upper margin of scapula

Question 26

Contents of root of neck

Answer 26

• Upper lobe of lungs (may be punctured during trauma/procedure in root of neck)
• Subclavian arteries

Question 27

Branches of subclavian artery

Answer 27

• Vertebral artery: ascend in foramen of cervical vertebrae to cranium
• Internal thoracic artery: enters thoracic cavity and descends on inner surface of anterior thoracic wall

Question 28

What can you do to control bleeding when there’s haemorrhage from the UL?

Answer 28

Occlude subclavian artery (passes over 1st rib)

Question 29

What is the only tributary to subclavian vein?

Answer 29

EJV

Question 30

Answer 30

Question 31

Answer 31

Question 32

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Question 33

Answer 33

Question 34

Answer 34

Question 35

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

Answer 35

Lateral to the pulse of common carotid artery, through SCM down the neck or between 2 heads of SCM