ANATOMY Flashcards
The thyroid gland is invested by what structure?
a. Carotid sheath
b. Pretracheal fascia
c. Prevertebral fascia
d. Superficial layer of deep fascia
B. Pretracheal fascia
Superficial cervical fascia
(platysma)
Deep cervical fascia
1. Investing layer/ Superficial deep fascia
(SCM, Trapezius)
2. Pretracheal (thryoid gland)
3. Carotid sheath
4. Prevertebral (cervical vertebra)
Cranial nerve that descends through the neck in the Carotid sheath?
a. hypoglossal
b. vagus
c. accessory
d. glossopharyngeal
B. vagus
Enumerate: boundaries of Carotid sheath
LATERAL =
MEDIAL =
POSTERIOR =
Lateral = internal jugular vein Medial = common & internal carotid a. Posterior = vagus n.
Ludwig’s angina primarily involves which fascial planes?
a. visceral space
b. submandibular space
c. retropharyngeal space
d. masticatory space
e. carotid sheath
C. submandibular space
Ludwig’s angina
severe cellulitis involving floor of mouth
odontogenic
primarily from submandibular space
TRUE of mylohoid muscle, EXCEPT:
a. forms the floor of mouth
b. part of suprahyoid muscle
c. separates the submandibular & sublingual spaces
d. separates the submaxillary & submandibular space
EXCEPT D.
Mylohyoid
- forms the floor of mouth
- part of suprahyoid muscle
- separates the submandibular & sublingual spaces
The hyoid bone liest at what level of cervical vertebra?
a. 2
b. 3
c. 4
d. 5
B. C3
NECK. The only bone that does not articulate with another bone?
Hyoid bone
- serves as a moveable base for tongue
- at the level of C-3 vertebra
The ff muscles ELEVATE the hyoid bone, EXCEPT:
a. digastric
b. mylohyoid
c. sternothyroid
d. stylohyoid
e. geniohyoid
EXCEPT C. sternothyroid
Suprahyoid m. (elevates Hyoid)
- digastric
- mylohyoid
- stylohyoid
- geniohyoid
Infrahyoid m. (depresses Hyoid)
- omohyoid (superficial)
- sternohyoid (superficial)
- thyrohyoid (deep)
*SternoThyroid (deep)- depresses the LARYNX
“Ansa cervicalis” is the nerve supply of ALL the Hyoid depressors, EXCEPT:
a. omohyoid
b. sternohyoid
c. sternothyroid
d. thyrohyoid
EXCEPT D. thyrohyoid (innervated by C1)
- root of Ansa cervicalis
- C1, C2, C3
“Triangle of the neck” that is bounded by:
post. belly of diagstric
sup. belly of omohyoid
ant. border of SCM
a. muscular
b. digastric
c. carotid
d. submental
C. carotid triangle
Muscle that divided the neck into 2 triangles (post & ant)?
Sternocleidomastoid (SCM)
The ONLY unpaired “triangle of the neck”?
Submental triangle
boundaries:
- ant. belly of digastric
- hyoid bone
- mylohyoid (floor)
Muscle that separates the submandibular and sublingual space?
a. geniohyoid
b. digastric, post. belly
c. digastric, ant. belly
d. mylohyoid
D. mylohyoid
- floor of Submental & Digastric
The contents of the upper portion of the carotid sheath are crossed obliquely and anteriorly by?
a. omohyoid
b. digastric, ant. belly
c. digastric, post. belly
d. mylohyoid
C. digastric, post. belly
The carotid pulse is easily palpated on:
a. post. border of SCM
b. level of the inferior border of thyroid cartilage
c. level of the superior border of thyroid cartilage
d. level of the inferior border of hyoid bone
C. SUPERIOR border of thyroid cartilage
-just beneath the anterior border of SCM
NECK. What are the boundaries of the Muscular triangle?
3
Muscular triangle/ Strap muscles
- sup. belly of Omohyoid
- ant. midline of Neck
- ant. borders of SCM
What divides the occipital and supraclavicular triangle?
a. inf. belly of omohyoid
b. sup. belly of omohyoid
c. post. digastric
d. ant. digastric
A. inferior belly of omohyoid
Cranial nerve that crosses the Occipital triangle:
a. CN 9
b. CN 10
c. CN 11
d. CN 12
C. accessory nerve (CN 11)
Accessory nerve lesions
- “drooping of shoulder” (diff. shrugging the shoulder)
- trapezius m. weakness
- diff. elevating the scapula
- diff. in lateral rotation of scapula during arm abduction
“Neck triangle” that is crossed by external jugular vein & subclavian artery?
SupraClavicular triangle
-AKA “subclavian triangle”, “omoclavicular”, “Suboccipital”
Structure that connects the right and left lobes of the thyroid gland?
ISTHMUS
-at the level of 2,3,4 tracheal rings
Ave. normal weight of thyroid gland?
20 gms (GRAMS)
Fibrous or muscular band that connects the pyramidal lobe of thyroid to the hyoid bone?
Levator Glandulae Thyroidea
*Pyramidal lobe - usually projects upward from the isthmus to the LEFT of the midline
What is the blood supply of the MIDDLE thyroid gland?
NONE.
Blood supply:
sup. thyroid = External carotid
inf. thyroid = Thyrocervical trunk
Venous drainage:
sup. thyroid = IJV
MIDDLE thyroid = IJV
inf. thyroid = brachiocephalic
Up to 12% of the population presents with a small midline artery that can be a significant source of bleeding when performing a midline approach thyroid surgery. This is known as?
Thyroidea Ima a.
- arises from Aortic arch OR Brachiocephaic trunk
A narrow tube that connects the developing thyroid gland to the tongue, that atrophies at birth —>
ThyroGlossal Duct
remnant = Foramen cecum
most common ectopic thyroid = Lingual
s/sx: painless, progressively enlarging movable mass
*ask the patient to stick out tongue (the mass will move)
Cancer cells of the thyroid malignancy will metastasize first to this group of cervical lymph nodes:
a. Cervical LN II
b. CLN III
c. CLN IV
d. CLV V
D. CLN V
primary tumors on:
- Oral cavity, lip = metastasize to CLN I, II, III
- Oropharynx, hypopharynx, larynx = CLN II, III, IV
- Nasopharynx, thyroid = CLN V
True about the Pharynx.
a. extends from the base of the skull up to the lower border of the THYROID Cartilage
b. it communicates with a total of SEVEN cavities
c. the wall is deficient POSTERIORLY
d. it is CYLINDRICAL in shape
B. 7 Cavities:
-R/L Nasal, R/L Tympanic, Oral cavity, Laryngeal cavity, Esophageal cavity
Other options are wrong because:
a. its up to CRICOID (C6)
c. deficient wall ANTERIORLY
d. FUNNEL shaped
Efferent limb of the GAG reflex?
efferent = Vagus n.
afferent:
a. Glossopharyngeal n. (UPPER pharynx)
b. Vagus n. (LOWER pharynx & larynx)
Post-palatine tonsillectomy, the patient experienced lost of GENERAL and TASTE sensation of the posterior 1/3 of the tongue, what nerve maybe injured?
Glossopharyngeal n.
Tongue SENSORY
a. COMMON (ex. pinprick)
- ant 2/3 = CN 5
- post 1/3 = CN 9
b. SPECIAL (ex. taste)
- ant 2/3 = CN 7
- post 1/3= CN 9
Tongue MOTOR
-ALL by CN 12,
EXCEPT Palatoglossus = CN 10 (pharyngeal branch)
Afferent limb of papillary light relfex?
Papillary light reflex:
afferent= CN 2
efferent CN 3
Corneal reflex:
a. = CN5
e. = CN 7
Efferent limb of mastication?
mastication = CN 5
facial expression = CN 7
deglutition = CN 9
phonation = CN 10
A “ring” formed by the lymphoid tissues that surrounds the opening into the Respiratory and Digestive system -
Waldeyer Ring
lateral = Palatine & Tubal tonsils upper = Pharyngeal tonsil lower = Lingual tonsil
What cartilage forms the laryngeal prominence of the neck?
a. thyroid cart.
b. cricoid cart.
c. epiglottis
d. arytenoid cart.
A. thyroid cartilage
UNPAIRED cartilage
- epiglottis - leaf shaped; elastic cartilage
- thyroid - adam’s apple; hyaline cartilage
- cricoid - signet ring; hyaline cartilage
PAIRED cartilage
- arytenoid - pyramid shaped
- corniculate - conical shaped
- cuneiform - rod shaped
Laryngeal membrane that extends bet. epiglottis and the arytenoid cartilages; has a thickened inf. margin that forms the VESTIBULAR ligament:
a. thyrohyoid membrane
b. cricotracheal ligament
c. quadrangular membrane
d. cricothyroid ligament
C. quadrangular membrane
- Thyrohoid membrane = pierced on each side by Sup. laryngeal vessels &Internal laryngeal n.
- Cricotracheal lig. = connects cricoid cart. to 1st tracheal ring
- Cricothyroid lig. = forms the Vocal ligament (interior of vocal cords)
The TRUE VOCAL CORDS lie _______ to the cricothyroid membrane:
a. anterior
b. posterior
c. superior
d. inferior
C. superior
cricoid cartilage - C6 vertebra
*Cricothyroid membrane - located INFERIOR to the Thyroid cartilage and SUPERIOR to the Cricoid cartilage
Differentiate the 2 types of Laryngeal Folds:
Vestibular Fold
- fixed
- vascular
- PINK
Vocal Fold/cord
- mobile
- Avascular
- WHITE
In thyroidectomy, what nerve maybe injured during the ligation of the SUPERIOR thyroid artery?
a. internal laryngeal
b. superior laryngeal
c. external laryngeal
d. inferior laryngeal
C. external laryngeal
*ligation:
Superior thyroid a. = External LN
Inferior thyroid a. = Inferior/ Recurrent LN
laryngeal muscle that acts as the CHIEF TENSOR of the vocal cords?
CricoThyroid = tensor
post. CricoArytenoid = ABductor
lat. CricoArytenoid = ADductor
ThyroArytenoid = Relaxor
*ALL are supplied by Recurrent/Inferior LN, EXCEPT:
Cricothyroid (external LN)
Which of the ff muscles is most important to allow air movement through larynx?
a. cricothryoid
b. infrahyoid
c. post. cricoarytenoid
d. lat. cricoarytenoid
C. posterior CricoArytenoid (ABductor)
LEFT or RIGHT? : most commonly injured Recurrent laryngeal nerve.
LEFT.
Left = hooks around ARCH of AORTA Right = hooks around RIGHT Subclavian a.
Boundaries of the Trachea (in relation with the neck):
ant/post/lateral
ant. = Isthmus of thryoid, jugular arch
post. = R/L recurrent LN, esophagus, vertebral
lat. = R/L thyroid g
Trachea
- U-shaped bars of HYALINE CARTILAGE
- from (cricoid) C6 to T4 (sternal angle)
During tracheostomy, opening is made in the trachea between:
a. 1st & 2nd tracheal ring
b. 2nd & 4th tracheal ring
c. NOTA
d. AOTA
D. AOTA
Results from the improper division of the FOREGUT by the tracheoesophageal septum:
TracheoEsophageal Fistula.
most common - Esophageal atresia w/ TEF at DISTAL END
Most common ectopic location of Inferior parathyroid gland?
Superior Mediastinum.
*CHIEF CELLS - produces PTH
Muscle that separates the subclavian artery & vein?
Scalenus anterior
*from ANTERIOR to POSTERIOR
Subclavian Vein > Phrenic nerve > Scalene ant. > Subclavian Artery > Brachial Plexus
The ONLY motor nerve supply to the Diaphragm
Phrenic nerve.
-C3, C4, C5
Most commonly injured ZONE in penetrating neck trauma?
ZONE 2.
Zone 1 = root of neck TO inf. border of cricoid cartilage
Zone 2 = cricoid TO angle of mandible
Zone 3 = ABOVE the angle of mandible
Sternal angle of louie corresponds to what vertebral level?
T4 vertebra
level of T4:
- bifurcation of trachea
- aortic arch begins
- aortic arch ends
The xiphoid process articulates with the body of manubrium at what vertebral level?
T9 vertebra (xiphisternal joint)
The body of T4 vertebra articulates with which of the following parts of the ribs?
a. head of 3rd rib
b. neck of 4th rib
c. head of 5th rib
d. tubercle of 5th rib
C. head of 5th rib
TRUE ribs
-1st to 7th
FALSE ribs
- 8th to 12th
* 8,9,10 - atttaches to the 7th rib
* 11, 12 - floating ribs (with post. attachment only)
TYPICAL ribs
-3rd to 9th (with head, neck, tubercle, shaft)
ATYPICAL ribs
-1, 2, 10, 11, 12
Broadest and most curved rib?
Rib 1.
* w/ prominent SCALENE tubercle
Rib 2.
- thinner
- w/ SERRATUS ant. tubercle
Rib 10
- articulates with T10 vertebra only
Rib 11 -12
-have NO neck or tubercle
What is the WEAKEST part of the rib?
point ANTERIOR to its ANGLE
*5th to 9th - most commonly fractured
Boundaries of the Thoracic Outlet:
ant/post/lat
ant. = Manubrium sterni
post. = T1 vertebra
lat. = medial border of 1st rib
