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NE Clinical Exam 1 > Blue Boxes Triangles Lecture > Flashcards

Blue Boxes Triangles Lecture Flashcards

1
Q

What are some of the common causes of cervical pain?

A

Inflamed lymph nodes muscle strain protruding IC discs

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2
Q

What is the major underlying cause of chronic cervical pain?

A

Bony abnormalities or trauma

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3
Q

If somebody was strangled at the throat, what would you expect to see? With this injury, what illness would you be cautious of and why?

A

A fracture of the hyoid bone Would be cautious of an aspiration pneumonia When there is a fracture in the hyoid bone, there is a depression of the body of the hyoid bone on the thyroid cartilage which causes an issue with elevation of the hyoid, which impedes the movements of the tongue When this happens, there is not as much separation between the airway and the GI tract which can lead to an aspiration pneumonia because shit gets into the lungs

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4
Q

If the cervical branch of the facial nerve was injured, what would result?

A

Paralysis of the platysma: the skin would fall away from the neck in slack folds

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5
Q

What would happen if there is an infection in between the investing layer of deep fascia and the muscular part of the pretracheal fascia that is surrounding the infra hyoid muscles?

A

The infection will typically not spread past the superior edge of the manubrium

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6
Q

What would happen if there is an infection in between the investing layer of the fascia and the visceral later of the pretracheal fascia?

A

The infection can spread into the thoracic cavity and to the pericardium

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7
Q

What could happen if there is an abscess that is posterior to the SCM?

A

Can perforate into the prevertebral layer of the deep cervical fascia and enter into the retropharyngeal space, which can lead to difficulty swallowing and speaking

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8
Q

Where can infections in the head travel?

A

Can travel posterior to the esophagus and enter the posterior mediastinum OR can travel anterior to the trachea and enter the anterior mediastinum

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9
Q

What is the common cause of a congenital torticollis?

A

A fibrous tissue tumor that develops in the SCM before or shortly after birth which causes the typical presentation of torticollis

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10
Q

Describe a right cardiac catheterization

A

Used to take pressure measurements in the right side of the heart A catheter is introduced into the internal jugular vein and taken through the right brachiocephalic trunk and into the superior vena cava to the right side of the heart

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11
Q

Describe in detail what happens if the EJV is severed along the posterior border of the SCM

A

Lumen is held open by the investing layer of deep cervical fascia and the negative intrathoracic pressure air will suck air into the vein, resulting in a churning noise and cyanosis This can cause the right side of the heart to be filled with “froth” (air and blood) and eventually it will stop working

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12
Q

If a patient presented with decreased muscle strength of turning the head to the right side against resistance and abnormal neck movements including weakened elevation of the shoulders is noted, what could be one of the clinical possibilities?

A

lesion in the spinal accessory nerve

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13
Q

Drooping of the shoulder is an indication of what?

A

Lesion in the spinal accessory nerve

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14
Q

What would result in the severance of a phrenic nerve?

A

paralysis of half of the diaphragm

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15
Q

Describe a phrenic nerve crush

A

The surgeon compresses the nerve with forceps in order to damage the nerve and paralyze half of the diaphragm which is common in a diaphragmatic hernia repair

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16
Q

How do nerve blocks in the cervical plexus work?

A

Anesthetic is injected along the posterior border of the ECM, specifically at the nerve point of the neck (Erbs); half of the diaphragm will be effected because of the phrenic nerve coming off C3, C4, and C5

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17
Q

How would an injury to the supra scapular nerve happen? What would be the result?

A

Fracture to the middle third of the clavicle can damage the supra scapular nerve Loss of lateral rotation of the humerus in the glenohumeral joint waiters tip position

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18
Q

Which artery makes up for the ligation (decrease in blood flow-backwards almost) in the external carotid artery?

A

Descending branch of the occipital artery provides the collateral circulation and anastomoses with the vertebral and deep cervical arteries

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19
Q

If the vagus or the recurrent laryngeal nerves are damaged in surgery, what sx could present?

A

Alteration in the voice because these nerves supply the laryngeal muscles

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20
Q

What are the risks of a carotid occlusion?

A

TIA Stroke

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21
Q

What is a carotid endarterectomy?

A

Opening the affected artery and removing the plaque that lines the walls

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22
Q

What happens in the event of carotid sinus hypersensitivity?

A

External pressure on the carotid artery can cause a decrease in heart rate, fall in blood pressure, and syncope *** if someone has this, you do not want to check a carotid pulse, because it is sensitive and could cause them to faint

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23
Q

What is the function of the carotid bodies?

A

To monitor the amount of oxygen that is present in the blood before it gets to the brain can also monitor the amount of CO2 that is present in the blood

24
Q

What nerve carries the information from the carotid bodies to the respiratory centers?

A

Glossopharyngeal nerve (IX)

25
Q

When would a cervicothoracic ganglion block be utilized? What does it do?

A

Blocks the transmission of signals through the cervical and superior thoracic ganglia may relieve vascular spasms in the brain and the upper limb

26
Q

What would result from a lesion in the cervical sympathetic trunk?

A

Horners syndrome

27
Q

What are the characteristics of Horner’s syndrome?

A
  1. contraction of the pupil because of paralysis of the dilator pupillae muscles 2. Ptosis 3. Sinking of the eye from the paralysis of the rudimentary smooth muscle in the floor of the orbit 4. vasodilation and the absence of sweating on the face and neck caused by lack of sympathetic nerve supply to the blood vessels and sweat glands
28
Q

Describe the thyroid ima artery

A

Small unpaired artery that can arise from the brachiocephalic trunk, arch of the aorta, right common carotid or the subclavian It ascends on the anterior surface of the trachea to the isthmus of the thyroid gland

29
Q

What is a thyroglossal duct cyst?

A

the thyroglossal forms when the thyroid descends embryologically from the base of the tongue, it typically disappears but some people form a cyst in its presence near the inferior body of the hyoid bone

30
Q

What is an aberrant thyroid gland and where can they be found?

A

can be anywhere along the thyroglossal duct embryologically; can be at the base of the tongue resulting in a lingual thyroid gland, in the neck, or inferior to the hyoid have to be careful surgically removing these because you do not want to completely remove their only thyroid

31
Q

What is accessory thyroid glandular tissue?

A

Thyroid tissue that forms along the embryological pathway of the thyroid gland; an accessory gland can form on the thyrohyoid muscle and may be functional

32
Q

What is a pyramidal lobe of the thyroid gland?

A

50% of glands have these, it is an extension of the gland on the left lobe that rises superiorly from the isthmus; thought to be part of the remnant of the thyroglossal duct.

33
Q

What is a goiter? Why does it occur?

A

Enlargement of the thyroid gland that is due to a lack of iodine

34
Q

Discuss injuries of the recurrent laryngeal nerve

A

Common in surgery because of its close association with the inferior portion of the thyroid gland

Can cause aphonia or hoarseness in the case of a unilateral damage to the recurrent laryngeal nerve or even bruising of the nerve

35
Q

During surgical procedures of the neck, why are the parathyroid glands susceptible to inadvertant removal?

A

Because of their proximity to everything; particualrly the inferior ones; they are close to teh thyroid gland and must be careful not to excise them

36
Q

What would occur with complete removal of the parathyroid glands?

A

tetany; muscle twitches and cramps due to decreased calcium levels

The surgeons typically preserve the posterior part of the thyroid lobes of the thyroid gland

37
Q

If a patient has a laryngeal fracture, what is typically seen?

A

Submucous hemorrhaging and edema, respiratory obstruction, hoarseness, and the inability to speak

***common in contact sports like hocky or boxing

38
Q

What is a laryngoscopy

A

Visualization of the larynx and the structures inside of her; can be done with a mirror or a laryngoscope

39
Q

What is the valsalva maneuver? What happens to the vocal folds?

A

Forced expiratory effort against a closed airway (grunting down to take a poop, sneezing, etc)

The vocal folds are tightly adducted at the end of the deep inspiration and the pressure builds up and travels to the abdominal cavity and has an affect on the right ventricle so it can be used to raise venous pressure and affect cardiac output

***when they cardiovert somebody with medications, they have they “grit down like they are going to poop” in order to get their heart to pumping correctly with the added medication

40
Q

Describe what is happening in deatil when somebody administers the Heimlich maneuver

A

A foreign object is stuck in the larygeal inlet of the larynx, obstructing the airway and making it difficult for the person to breathe; causes violent coughing, inability to speak.

Sudden compression of the abdomen can cause and increase in pressure, diaphragm contraction, and expulsion of the foreign body

41
Q

What is a cricothrotomy

A

In the event of severe facial trauma or choking, the EMS can insert a large needing in the cricothyroid membrane to permit the fast entry of air

typically followed by a tracheostomy placement surgically

42
Q

What are the important relationships to keep in mind when performing a tracheostomy?

  1. Inferior thyroid veins
  2. Thryoid ima artery
  3. left brachiocephalic vein
  4. thymus in kids
  5. Infants trachea
A
  1. The inferior thyroid veins arise from the venous plexus on teh thyroid and descend anterior to the trachea; be careful not to hit these
  2. thyroid ima can travel to the isthmus of the thyroid and can be punctured
  3. brachiocephalic vein can be punctured in small children
  4. thymus covers the inferior part of the trachea in kids

5/ trachea is small in infants; what to be careful not to cut through it and into the esophagus

43
Q

When there is injury to the laryngeal nerve, what happens? If this is unilateral what can occur to compensate?

A

paralysis of the vocal folds

If it is unilateral, evenutally the other vocal fold will compensate and cross the midline to connect with the other fold and result in phonation

44
Q

In progressive lesions of the vocal fold, which action is lost first?

A

Abduction followed by adduction; think about it only one muscle (posterior cricothyroid) is involved in abduction compared to the three that are involved in adduction

45
Q

What results from paralysis of the superior laryngeal nerve?

A

anesthesia of the superior larygneal mucosa; protective measure to keep stuff out of the larynx is broken and foreign bodies are able to enter more easily

46
Q

What results from an injury to the external branch of the superior laryngeal nerve?

A

monotonous voice

47
Q

How does a superior laryngeal nerve block work?

A

Needle is inserted midway between the thyroid cartilage and the hyoid, 1-5 cm anterior to the greater horn of the hyoid, and the nerve is penetrated with anesthetics

48
Q

What causes an increased risk of larygeal cancer. What are some of the warning signs?

A

Smoking or chewing tobacco

Hoarse voice, enlarged lymph nodes, difficulty swallowing

49
Q

Describe the age changes that occur with the larynx

A

from 5-12 not much happens

in boys, the increased testosterone in puberty causes hardening of the larynx which results in the adams apple and the lengthening of the vocal folds, which cases a deep voice

50
Q

During a tonsillectomy, where does the bleeding typically occur from?

A

From the external palatine vein

glossopharyngeal nerve accompanies the tonsillar artery

51
Q

Describe a branchial fistula

A

Due to the persistance of the 2nd pharyngeal pouch and groove, which can result in a connection of the tonsils to the external neck, and the area can leak mucous

52
Q

Describe a tracheo-esophageal fistula

A

birth defect where the siperoir part of the esophagus ends in a blind part and the inferior portion communicates with the trachea which can cause aspiration

53
Q

What is the most common complaint with someone who has esophageal cancer?

A

Difficulty swallowing

54
Q

What are the zones of penetrating neck trauma? Describe them

Zone 1

A
  1. root of the nexk from the clavicles and the manubrium to the cricoid cartilage

structures at risk: apices of the lungs, thyroid and paratyroid, esophagus, common carotid arteries, jugular veins, and cervical vertebrae

55
Q

What are the zones of penetrating neck trauma? Describe them

Zone 2

A

extends from the crico cartilage to the angles of the mandible

structures at risk: superior poles of the thyroid gland, cricocartiages, larynx, carotid artieres, esophagus, cervical vertebrae

56
Q

What are the zones of penetrating neck trauma? Describe them

Zone 3

A

Angles of the mandibles and superiorly

Structures at risk: salivary gland, oral and nasal cavities, oropharynx and the nasopharynx

57
Q

What is a radical neck dissection?

A

Performed when cancer has invaded the lymphatics of the neck; the deep cervical nodes and the tissues surrounding them are removed as much as possible

NE Clinical Exam 1 (20 decks)

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