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CPM II Test 3 > Deep Neck > Flashcards

Deep Neck Flashcards

1
Q

what is the sternoclavicular joint?

A

synovial joint with an articular disk between the clavicle and sternum, surrounded by a fibrous capsule

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2
Q

what is the only bony attachment of the upper extremity to the trunk?

A

sternoclavicular joint

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3
Q

what happens due to drug use in the sternoclavicular joint?

A

infections

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4
Q

what is worried about during dislocations on the sternoclavicular joint?

A

the vessels behind the clavicle

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5
Q

what is part of the carotid sheath?

A

common carotid a. (before bifurcation), internal carotid a. (after bifurcation), internal jugular v., vagus n. (X)

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6
Q

when does the common carotid a. bifurcate?

A

about the C3-C4 level = the vicinity of the angle of the mandible

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7
Q

what carries the bulk of the blood to the brain?

A

the 2 internal carotid aa. and the 2 vertebral aa.

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8
Q

what has no branches in the neck?

A

internal carotid a.

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9
Q

is the external carotid a. a content of the carotid sheath?

A

NO

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10
Q

what are the branches of the external carotid?

A

superior thyroid, ascending pharyngeal, lingual, facial, occipital, posterior auricular, superficial temporal, maxillary
Smelling A Loud Fart Only Prolongs Someone’s Misery

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11
Q

what is the primary drainage of the brain?

A

internal jugular v.

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12
Q

what is the course of the internal jugular v.?

A

begins at the jugular fossa and descends along the carotid a.
joins the subclavian v. to form the brachiochephalic

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13
Q

What is used as a common site for IV?

A

internal jugular v. when perpheral v. are unavailable

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14
Q

where is the internal jugular v.?

A

lateral to the carotid and deep to the sternocleidomastoid

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15
Q

what is the cervical plexus composed?

A

ventral rami of C1-C4

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16
Q

where do the cutaneous nn. of the neck come from?

A

loops between C2-C3 and C3-C4

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17
Q

What do motor nn. from each loop supply?

A

strap mm. of anterior cervical triangle
geniohyoid of the tongue
twigs to trapezius, levator scapulae, middle scalene mm.

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18
Q

what makes up the ansa cervivalis?

A

C1, C2, C3

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19
Q

what are the mm. of the root of the neck?

A

scalenus anterior, scalenus medius, scalenus posterior

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20
Q

what is the origin of the mm. of the root of the neck?

A

transverse processes of adjacent vertebra

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21
Q

what is the insertion of the scalenus anterior?

A

scalene tubercle of the 1st rib

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22
Q

what is the insertion of the scalenus medius?

A

1st rib

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23
Q

what is the insertion of the scalenus posterior?

A

2nd rib

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24
Q

what is the action of the mm. of the root of the neck?

A

elevate ribs during respiration; bilaterally stabilize neck

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25
Q

what is the innervation of the mm. of the root of the neck?

A

innervated by twigs from adjacent cervical nn.

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26
Q

where does the brachial plexus emerge?

A

between the anterior and middle brachial plexus

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27
Q

where does the left subclavian a. arise from?

A

aortic arch

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28
Q

where does the right subclavian a. arise from?

A

brachiocephalic trunk

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29
Q

where does the subclavian a. terminate and what does it become?

A

lateral border of the 1st rib to become the axillary a.

30
Q

where does the subclavian aa. run?

A

posterior to the anterior scalene m.

31
Q

How many divisions of the subclavian a. are there?

A

3

32
Q

what are the boundaries of the divisions of the subclavian a.?

A

first part- medial to anterior scalene m.
second part- posterior to anterior scalene m.
third part- lateral to anterior scalene m.

33
Q

what is in the first part of the subclavian a.?

A

thoracic duct on left, right lymphatic duct on right
ansa subclavia
branches of the subclavian a.

34
Q

where are the thoracic duct and right lymphatic duct?

A

at the jugulosubclavian angle

35
Q

where is the ansa subclavia?

A

loops around the subclavian a.

36
Q

what does the ansa subclavia connect?

A

connects middle and inferior cervical of the sympathetic chain

37
Q

what are the branches of the first part of the subclavian a.?

A

vertebral a.
thyrocervical trunk
internal thoracic a.

38
Q

what are the branches of the thyrocervical trunk?

A

transverse cervical a.
suprascapular a.
inferior thyroid a. —> ascending cervical a.

39
Q

what does the second part of the subclavian a. have?

A

costocervical trunk

  • ——–>deep cervical a.
  • ——–>highest intercostal a.
40
Q

where does the first and second parts of the subclavian a. lie?

A

on the cupula

41
Q

what does the third part of the subclavian a. have?

A

usually no branches (occasionally contains the suprascapular and descending scapular aa.)

42
Q

what is the relationship of the subclavian a. and anterior scalene m.

A

subclavian a. runs posterior to the anterior scalene m.

43
Q

what is the relationship of the brachial plexus and scalene mm.

A

brachial plexus emerges between the anterior and middle scalene mm.

44
Q

what does the phrenic nn. have a relationship with in the deep neck and what is that relationship?

A

phrenic n. travels along the surface of the anterior scalene m. and is pinned to the m. by the transverse cervical and suprascapular aa.

45
Q

what parallels the phrenic n.?

A

the ascending cervical a. (usually a branch of the inferior thyroid)

46
Q

what is usually medial to the phrenic n.?

A

vagus n. (X) and sympathetic trunk

47
Q

where does the vagus n. (X) pass?

A

anterior to the first part of the subclavian a.

48
Q

what does the recurrent laryngeal nn.?

A

supply the intrinsic mm. of larynx except for cricothyroid

49
Q

where does the recurrent laryngeal nn. loop on each side?

A

R- loops around subclavian a.

L- loops around the aortic arch

50
Q

what are the nn. of the deep neck?

A

Vagus n. (X), phrenic, sympathetic chain

51
Q

what are the spinal segments of the phrenic n.?

A

C3, C4, C5

52
Q

What are the different parts of the sympathetic chain in the deep neck?

A

superior cervical ganglion
middle cervical ganglion
inferior cervical ganglion
ansa subclavia

53
Q

where is the superior cervical ganglion?

A

at the top of the chain

54
Q

where is the middle cervical ganglion?

A

near vertebral a. at about C6

55
Q

where is the inferior cervical ganglion?

A

near vertebral a. at level of first rib

sometimes fused with the first thoracic ganglion

56
Q

what is it called when the C8 and T1 ganglion are fused?

A

stellate ganglion

57
Q

what is the ansa subclavia?

A

connects middle and inferior ganglia

58
Q

where is the thyroid gland located?

A

located JUST inferior to thyroid cartilage

59
Q

what is the embryological development of the thyroid gland?

A

descends from the back of the tongue by the thyroglossal duct. when thyroid gets to its destination the duct goes away

60
Q

what is the usual structure of the thyroid gland?

A

two lobes connected by an isthmus

61
Q

what is an occasional structure anomaly and what is it caused by?

A

pyramidal lobe- some of the thyroid gland does not descend all the way and makes a little upward tongue like structure off of the main thyroid
lingual thyroid- NONE of the thyroid descends.
thyroglossal duct cyst- midline mass from when the duct did not atrophy in embryo

62
Q

what is the arterial supply of the thyroid gland?

A

superior thyroid a (from external carotid a.)
inferior thyroid a. (from thyrocervical trunk)
thyroid ima a. (from aorta. [also sometimes from brachiocephalic and rarely carotid] only present in 10% of population)–> complicates tracheotomies

63
Q

what is the venous drainage of the thyroid gland?

A

superior thyroid v. - drains into internal jugular v.
middle thyroid v. - drains into internal jugular v.
inferior thyroid v. - drains into brachiocephalic

64
Q

where is the parathyroid gland?

A

posterior to the thyroid gland

65
Q

what is the parathyroid gland involved in?

A

calcium metabolism

66
Q

what is important to know when doing a thyroidectomy?

A

arterial supply to know where to ligate vessels. In particular, you need to know about the 10% possibility of a thyroid ima a.

67
Q

what is the inferior thyroid artery intimately related to and what does this result in during a thyroidectomy?

A

recurrent laryngeal n.
due to association the inferior thyroid a. is ligated some distance away from gland. there is often some transient hoarseness following thyroid sx due to swelling in the vicinity of the recurrent laryngeal nn.

68
Q

due to the close association of the parathyroid glands with the thyroid what occurs during a thyroidectomy?

A

the posterior part of the thyroid gland is left intact during a subtotal thyroidectomy

69
Q

what must one be aware of during a tracheotomy and why?

A

inferior thyroid vv. - one might inadvertently puncture them and have excessive bleeding

70
Q

what results when there is lesioning/damage to the sympathetic trunk either by an invading tumor or sx and why?

A

Horner’s Syndrome

interrupt all sympathetic supply to the head and neck

71
Q

what are the components/symptoms of Horner’s Syndrome?

A 
Ptosis - dropping of eye lid
Miosis - constricted pupil
Anhidrosis - no sweating
Enophthalmos - eye sinks in
Flushed skin

CPM II Test 3 (7 decks)

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