Anterior neck (Clinical case questions)

Question 1

A person receives a shallow knife wound just behind the sternocleidomastoid muscle and about 1 1/2 inches above the clavicle. There is an immediate numbness of the skin below the wound and over the acromion and clavicle. The nerve most likely severed was the:

Answer 1

Supraclavicular

Question 2

Which muscle is innervated by a branch of the ansa cervicalis?

Answer 2

Sternohyoid

Question 3

The layer of encircling cervical fascia that splits to enclose sternocleidomastoid and trapezius muscles is the:

Answer 3

Superficial layer of deep fascia

Question 4

Which of the following is a dorsal ramus of a spinal nerve?

Answer 4

Greater occipital nerve

Question 5

Which of the following is true of the inferior thyroid arteries?

Answer 5

They often supply all four parathyroid glands

Question 6

A 20 year old man was brought into the emergency room with a stab wound in the upper part of the neck. Although there was no major damage done, he lost sensation from the skin over the angle of the jaw. Which nerve has been cut?

Answer 6

Great auricular n.

Question 7

The triangle in which the superior branch of the ansa cervicalis separates from the hypoglossal nerve is the:

Answer 7

Carotid

Question 8

Exploration of the tracheoesophageal groove at the level of the thyroid gland would reveal what important structure bilaterally?

Answer 8

Recurrent laryngeal nerve

Question 9

A 35 year old woman was diagnosed with an adenoma of the thyroid gland. This required excision of the lower pole (left lobe) of the gland and ligation of the artery supplying that region. Which of the following nerves accompanying the artery is most likely to be damaged if the surgeon is not careful?

Answer 9

Recurrent laryngeal nerve

Question 10

One of the motor components of the cervical plexus, the ansa cervicalis, innervates all of the following muscles except the:

Answer 10

Stylohyoid

Question 11

A man has metastatic carcinoma and enlarged deep cervical lymph nodes. One of his symptoms is a hoarse voice, barely heard above a whisper. Subsequently he succumbs to the disease and at autopsy it is found that one of the enlarged nodes has put pressure on a nerve in the tracheoesophageal groove. Presumably this was the reason for the hoarse voice. What nerve was involved?

Answer 11

Recurrent laryngeal branch of vagus

Question 12

You are called on to do a venous catheterization to measure central venous pressure in the heart. Which muscle of the neck would provide the best area of approach to the internal jugular vein?

Answer 12

Sternocleidomastoid

Question 13

A patient is brought into the Emergency Room in respiratory distress. It is quickly decided to create an emergency airway to restore respiration. At what level could you rapidly create an airway below the vocal cords with a minimum danger of hemorrhage?

Answer 13

Just below the thyroid cartilage

Question 14

A 47-year-old woman is diagnosed as having a thyroid tumor. Surgery to remove the cancerous growth is undertaken. In which triangle of the neck will the surgeon make an incision to gain access to the gland?

Answer 14

Muscular

Question 15

A 50-year-old woman is brought to the operating room for a biopsy of a suspicious looking nevus (mole) which is found along the anterior border of her sternocleidomastoid muscle at about its midlength. What nerve must be locally anesthetized for the operation to proceed without pain?

Answer 15

Transverse cervical

Question 16

Following surgery on the upper pole of the right lobe of the thyroid gland, a patient complains of hoarseness and weakness of voice. What nerve may have been injured?

Answer 16

External branch of the superior laryngeal

Question 17

These structures are all located in the superficial fascia of the neck EXCEPT

Answer 17

Omohyoid muscle

Question 18

The superior belly of the omohyoid forms the anterior border of which cervical triangle?

Answer 18

Carotid

Question 19

The cervical plexus innervates all of the following structures EXCEPT

Answer 19

Platysma

Question 20

An emergency room patient presented with considerable bleeding from a shallow stab wound in the omoclavicular triangle. Which vessel was most likely cut?

Answer 20

External jugular vein

Question 21

Which structure or area receives NO nerve fibers from the cervical plexus?

Answer 21

Skin over the external occipital protuberance

Question 22

A six-year-old child, whose medical history includes a rather difficult birth, has a permanently tilted head posture, with the right ear near the right shoulder and the face turned upward and to the left. Which of the following muscles was very likely damaged during birth?

Answer 22

Sternocleidomastoid

Question 23

Any irritation of the diaphragm (e.g. infection, tumor) may create referred pain that seems (to the patient) to originate in the area atop the shoulder. This is due to the fact that the phrenic nerve shares spinal segments with what cutaneous nerve in the shoulder region?

Answer 23

Supraclavicular nerve

Question 24

Which of the following statements about the cervical plexus is true?

Answer 24

It consists solely of ventral rami of spinal nerves