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Anatomy Exam 3 Blue Boxes > Cervical Triangles/Submandibular > Flashcards

Cervical Triangles/Submandibular Flashcards

1
Q

fractures and dislocations of the cervical vertebra can injure which important structures?

A
  • spinal cord

- vertebral arteries and sympathetic plexuses that pass through foramen transversarium

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2
Q

manual strangulation causes?

A

fracture of the hyoid and styloid process of temporal bone

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3
Q

inability to move the hyoid results in?

A

difficulty swallowing and separating the alimentary and respiratory tracts —> aspiration pneumonia

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4
Q

which nerve if injured leads to paralysis of platysma?

A

cervical branch of CN VII

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5
Q

why do the edges of platysma have to be sutured when repairing neck wounds?

A

wound can be “distracted” aka pulled in different directions and the contracting platysma can cause an ugly scar to develop

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6
Q

the deep cervical fascia functions to?

A

prevent the spread of abscesses (purulent infections)

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7
Q

if an infection occurs between the deep cervical fascia and the muscular part of pretracheal fascia surrounding infrahyoid muscles, how far does the infection spread?

A

not beyond superior edge of manubrium

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8
Q

infection between deep cervical fascia and visceral part of pretracheal fascia, how far can infection spread?

A

thoracic cavity anterior to pericardium

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9
Q

how can an abscess end up posterior to sternocleidomastoid?

A

infection posterior to prevertebral layer of deep cervical fascia can extend laterally into neck

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10
Q

where else can pus from prevertebral layer spread to?

A

retropharyngeal space (retropharyngeal abscess)

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11
Q

a retropharyngeal abscess can cause?

A

difficulty swallowing (dysphagia) and speaking (dysarthria)

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12
Q

how can an infection spread into the mediastinum?

A

infection in retropharyngeal space or in head

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13
Q

what is pneumomediastinum?

A

air from ruptured trachea, bronchus, or esophagus; can pass into neck

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14
Q

what is torticollis?

A

contraction or shortening of cervical muscles that causes twisting of neck and slanting the head

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15
Q

how does torticollis most commonly develop?

A

fibrous tissue tumor in the SCM before or shortly after birth

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16
Q

if torticollis develops prenatally, what usually occurs?

A

breech delivery

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17
Q

how can muscular torticollis occur?

A

during a difficult birth –> hematoma around CN XI becomes fibrotic and entraps nerve

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18
Q

how can muscular torticollis be fixed?

A

surgical release of SCM inferior attachments

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19
Q

what is cervical dystonia?

A

abnormal tonicity of the cervical muscles or aka spasmodic torticollis

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20
Q

what are some characteristics of spasmodic torticollis?

A
  • shifting head laterally or anteriorly unintentionally

- shoulder is elevated and displaced anteriorly on the side to which the chin turns

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21
Q

where do you place a central line?

A

subclavian vein

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22
Q

what is a central line used for?

A
  • used to administer fluids and medications

- measure central venous pressure

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23
Q

what is the hand placement for an infraclavicular subclavian vein approach to a central line placement?

A

thumb of one hand is placed on the middle clavicle and the index finger is placed on the jugular notch in the manubrium

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24
Q

what can happen from a poorly placed central line?

A
  • puncture the pleura and lungs, resulting in pneumothorax

- needle may enter subclavian artery

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25
Q

what is right cardiac catheterization used for?

A

to measure pressures in right chambers of heart

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26
Q

how do you get a catheter into the right chambers of the heart?

A

puncture of inferior jugular vein to right brachiocephalic to SVC to right atrium

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27
Q

what is an alternate puncture point for a right cardiac catheterization?

A

external jugular vein

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28
Q

which vessel serves as an internal barometer?

A

EJV

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29
Q

what happens to EJV when venous pressure rises?

A

EJV can be seen along its course in the side of the neck (normally only visible slightly above clavicle)

30
Q

what happens if EJV is severed at posterior border of SCM?

A

lumen of EJV is held open by investing layer of deep cervical fascia & cause air to be sucked into the vessel

31
Q

air in a vein (venous air embolism) causes?

A
  • churning noise in thorax
  • cyanosis
  • right side of heart fills with “froth” –> lower blood flow and dypsnea
32
Q

patients with CN XI injuries will have problems doing what motion?

A

turning their head to the opposite side of the lesion against resistance

33
Q

what is an obvious sign of a CN XI injury?

A

drooping of the shoulder

34
Q

what is a phrenic nerve block used for?

A

short paralysis of hemidiaphragm for surgery

35
Q

if an accessory phrenic nerve is present, what does this indicate?

A

it must also be given an anesthetic to completely paralyze the diaphragm

36
Q

what is a cervical plexus block used for?

A

regional anesthesia before neck surgery

37
Q

where is a cervical plexus block injected?

A

several locations along posterior border of SCM @ junction of superior and middle thirds

38
Q

what is the junction of the superior and middle thirds of the SCM called?

A

nerve point of the neck

39
Q

a cervical nerve block usually causes what other side effect?

A

paralysis of phrenic nerve

40
Q

because of paralysis of phrenic nerve, cervical nerve blocks aren’t used on which kind of patients?

A

those with pulmonary or cardiac disease

41
Q

fractures of the middle third of the clavicle can damage which nerve?

A

suprascapular nerve

42
Q

damage to suprascapular nerve results in?

A

loss of lateral rotation of humerus at glenohumeral joint —> waiter’s tip position

43
Q

when is ligation of the external carotid artery necessary?

A

to control bleeding from one of its inaccessible branches

44
Q

what artery provides collateral circulation when the external carotid or subclavian arteries are ligated?

A

descending branch of occipital artery (anastomoses with vertebral and deep cervical arteries)

45
Q

what is a main side effect of surgical dissection of the carotid triangle?

A

alteration in the voice due to recurrent laryngeal nerve supplying the laryngeal muscles

46
Q

a partial occlusion of the ICA can cause?

A

transient ischemic attach

47
Q

what are symptoms of a TIA?

A

sudden focal loss of neurological function (dizziness & disorientation)

48
Q

what is a minor stroke?

A

arterial occlusion causing neurological functions that last longer than 24 hours but less than 3 weeks

49
Q

how is obstruction in the ICA visualized?

A

doppler color study

50
Q

what is a carotid endarterectomy?

A

opening the ICA and stripping it of atherosclerotic plaque

51
Q

what kind of drugs are given after a carotid endarterectomy?

A

drugs that inhibit clot formations

52
Q

which CNs can be injured during a carotid endarterectomy?

A

IX, X (superior laryngeal nerve), XI, & XII

53
Q

where is a carotid pulse felt?

A
  • where the common carotid lies in a groove between the trachea and infrahyoid muscles on the side of the neck
  • deep to anterior border of SCM at superior border of thyroid cartilage
54
Q

what is the carotid pulse important for?

A
  • checked during CPR

- absent in cardiac arrest

55
Q

what is carotid sinus hypersensitivity?

A

exceptional responsiveness of carotid sinus in vascular diseases

56
Q

external pressure on the carotid artery can cause?

A

slowing of heart rate, fall in blood pressure, cardiac ischemia —> fainting (syncope)

57
Q

checking the carotid pulse is not recommended for which patients?

A

elderly and those with cardiac or vascular diseases

58
Q

which pulse is checked in people with carotid sinus hypersensitivity?

A

radial pulse

59
Q

what is used to monitor oxygen content of blood before it reaches the brain?

A

carotid bodies

60
Q

a decrease in partial pressure of oxygen occurs from?

A

increase in altitude or pulmonary diseases

61
Q

a decrease in partial pressure of oxygen causes?

A

activation of aortic and carotid chemoreceptors which increases alveolar ventilation

62
Q

which nerve(s) send information from the carotid bodies to the brain?

A

CN IX and maybe CN X

63
Q

what happens when the brain receives info from carotid body about a decrease in partial pressure of oxygen?

A
  • the brain increases the depth and rate of breathing
  • pulse rate and blood pressure increases
  • intake more oxygen to reduce CO2 level
64
Q

pulsations of the IJV are important for monitoring?

A

ECG recordings and right atrial pressure

65
Q

how can the pulsations of IJV be monitored?

A

can’t be palpated directly, but it can be observed beneath SCM superior to medial end of clavicle by transmission of it’s pulsations through surrounding structures

66
Q

where do the pulsations of IJV come from?

A

no valves in SVC or brachiocephalic vein, so “waves of contraction” pass up into IJV

67
Q

what position are the IJV pulsations seen best?

A

when the person’s head in inferior to lower limbs (Trendelenburg position)

68
Q

what disease increases IJV pulse?

A

mitral valve disease (increases pressure in pulmonary circulation and right side of heart)

69
Q

why is the right IJV examined instead of the left?

A

the right has a straighter and direct course to the right atrium than the left does

70
Q

where is an IJV puncture placed?

A

apex of triangle between sternal and clavicular heads of SCM (less supraclavicular fossa)

Anatomy Exam 3 Blue Boxes (12 decks)

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