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ACEM Viva > Anatomy - Neck > Flashcards

Anatomy - Neck Flashcards

1
Q

Describe the joints between C1 and C2

A

-atlanto-axial joint has 3 articulations:

2 x lateral atlanto-axial joints = synovial joint between inferior facet of lateral mass of C1 and superior facet of C2 (gliding)

1 x median atlanto-axial joint = synovial joint between dens of C2 and anterior arch of atlas (pivot)

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2
Q

Describe the movements of the head and neck

A
  • rotation occurs at C1 on C2
  • flexion and extension occurs at C1 on atlanto-occipital joint (also lateral flexion and rotation)
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3
Q

What ligaments stabilise C1 and C2

A

1) cruciate ligaments of the atlas:
transverse ligament - strong, extends between lateral mass of C1
superior longitudinal band - weak, extends from transverse ligament to occipital bone
inferior longitudinal band - weak, extends from transverse ligament to body of C2

2) alar ligament: extends from dens of the axis to the lateral margins of the foramen magnum

3) tectorial membrane: superior continuation of the posterior longitudinal ligament

Winged Crusader Knights Templar

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4
Q

What are the characteristic features of a typical cervical vertebrae

A
  • typical are C3-C6, small, oval body, large vertebral canal, concave on superior surface, convex on inferior surface
  • spinous processes are short and bifid (except C1 and C7), facets joints are more horizontal, tp have foramen
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5
Q

Describe C1 vertebra

A

C1 = atlas:

  • anterior arch contains facet for dens
  • kidney shaped superior articular facets
  • foramen transversarium in transverse process (contains vertebral artery)
  • has groove for vertebral artery
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6
Q

Describe C2 vertebra

A

C2 = axis:

  • dens comes off body
  • bifid spinous process
  • foramen transversarium in transverse process (contains vertebral artery)
  • larger superior articular facets
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7
Q

Xray cervical spine: describe the image

A

bi-facet dislocation of C5-C6

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8
Q

What are the radiological lines to examine in a cervical xray

A

-4 lines:
anterior vertebral line
posterior vertebral line
spinolaminar line
posterior spinous line

-prevertebral thickness allowed:
7mm at C2
2cm at C7

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9
Q

What are the components of the soft tissue shadow located anterior to the upper cervical vertebrae

A

anterior longitudinal ligament
prevertebral fascia
retropharyngeal space

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10
Q

Using an xray, indicate where the ligamentous structures

A

anterior longitudinal ligament
posterior longitudinal ligament
ligamentum flavum
interspinous ligament
supraspinous ligament

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11
Q

What vascular structures can be identified in the neck root

A
  • SVC, left and right brachiocephalic arteries and veins
  • carotids and subclavians
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12
Q

branches of external carotid artery

A

Some Anatomists Like Freaking Out Poor Medical Students

Superior Thyroid

Ascending Pharyngeal

Lingual

Facial

Occipital

Posterior Auricular

Maxillary

Superficial Temporal

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13
Q

contents of carotid sheath

A

common carotid artery
internal jugular vein
vagus nerve

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14
Q

Identify the carotid triangle and its boundaries

A

-subsection of the anterior triangle
-bound by:
* superior belly of omohyoid muscle
* posterior belly of digastric
* anterior border of scm
-contents: common/internal/external carotid arteries

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15
Q

Describe boundaries and contents of the anterior triangle

A

boundaries:
- anterior: median line of neck
- posterior: anterior border of sternocleidomastoid muscle
- superior: inferior border of the mandible
- apex: jugular notch of manubrium
- roof: subcutaneous tissue containing platysma
- floor: pharynx, larynx, thyroid gland

contents:
- muscles: strap muscles
- lymph nodes
- arteries: common carotid, int/ext carotid, superior thyroid
- veins: brachiocephalic, subclavian
- nerve: recurrent laryngeal

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16
Q

Describe boundaries and contents of the posterior triangle

A

boundaries:
- anterior = posterior border of scm
- posterior = anterior border of trapezius
- inferior = middle 1/3 clavicle
- apex = where scm and trapezius meet occipital bone
- roof = deep cervical fascia
- floor = middle and posterior scalene muscles

contents:
- nerves: CNXI, brachial plexus, phrenic nerve
- vessels: subclavian artery, ejv
- muscles: inferior belly omohyoid, ant/mid/post scalene

17
Q

Describe the location of the thyroid gland

A
  • anteriorly at level of C5-T1, consists of left and right lobes and connecting isthmus in front of tracheal rings 2/3/4
  • deep to sternothyroid and sternohyoid muscles
18
Q

What are the surface marking and contents of the carotid sheath in the neck

A
  • course: runs along a line joining the sternoclavicular joint to a point midway between the mastoid process and mandible angle
  • contents: internal jugular vein, vagus nerve, common carotid artery
19
Q

What structures are at risk by insertion of central IJV line

A

external carotid artery
common carotid artery
vagus nerve
trachea
lung
thyroid

20
Q

What is the anatomical relationship of the internal jugular vein to the carotid artery

A

superiorly IJV lies posterior to ICA
passes down in carotid sheath (vagus between IJV and CCA)
inferiorly IJV lies lateral CCA

21
Q

What is the course of the internal jugular vein?

A
  • formed by continuation of sigmoid sinus, descends in carotid sheath (lies lateral) with internal carotid artery and vagus nerve
  • exits the skull via jugular foramen
  • runs deep to 2 head of sternocleidomastoid muscle
  • joins subclavian vein posterior to sternal end of clavicle to form the brachiocephalic vein
  • surface marking: from earlobe/mastoid to medial end of clavicle
22
Q

Discuss the anatomy of the right common carotid artery

A
  • brachiocephalic artery bifurcates into the common carotid and subclavian artery behind the sternoclavicular joint
  • lies within the carotid sheath, medial to vagus nerve and internal jugular vein
  • bifurcates at the level of the thyroid cartilage (C4) into internal and external carotid arteries
23
Q

What is the course of the right subclavian artery

A

arises from brachiocephalic trunk
passes over the first rib posterior to the anterior scalene
becomes axillary artery

24
Q

Name the branches of the external carotid artery: 2 to pass

A

superior thyroid
ascending pharyngeal
lingual
facial
occipital
posterior auricular
maxillary
superficial temporal

25
Q

Describe the course of the right and left recurrent laryngeal nerve and what does it supply

A
  • right hooks around the right subclavian artery and becomes the inferior laryngeal nerve
  • left hooks around the arch of the aorta and becomes the inferior laryngeal nerve
  • supplies motor to all intrinsic muscles of larynx except cricothyroid muscle (external branch of superior laryngeal nerve) and sensation below the cords
26
Q

What is the result of an injury to the recurrent laryngeal nerve

A
  • hoarse voice, if bilateral stridor occurs due to inability to abduct the cords (posterior cricoarythenoids are the only abductor)
  • partial lesion causes cords to take the adducted position as per Semon’s law
27
Q

What is the innervation of the larynx

A

Vagus nerve gives off superior laryngeal nerve and inferior laryngeal nerve

superior laryngeal nerve divides into internal and external branches
* external branch: cricothyroid muscle
* internal branch: sensation above the cords

inferior laryngeal nerve terminal branch of recurrent laryngeal nerve
* motor: all intrinsic muscles except the cricothyroid muscle
* sensory: sensation below the cords

28
Q

Name the muscles of vocalisation

A
  • cricothyroid (external br of superior laryngeal n, rest all by RLN)
  • thyroarythenoid
  • posterior cricoarythenoid
  • lateral cricoarythenoid
  • transverse and oblique arytenoids
  • vocalis
29
Q

What structures in upper airway could lead to airway obstruction

A

tongue
tonsils
pharynx
epiglottis
glottis

30
Q

Which cartilage is fully circumferential

A

cricoid cartilage

31
Q

What are the landmarks for a cricothyroidotomy

A

between thyroid cartilage and cricoid cartilage through the cricothyroid membrane

32
Q

Xray cervical spine: demonstrate boney features of C1 and C2

A

odontoid process pa

lateral mass of C1 = 1

odontoid process of C2 = 2

atlanto-axial joint of C1-C2 = 3

body of C2 = 4

spinous process of C2 = 5

ramus of mandible = 6

ACEM Viva (39 decks)

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