H&N 3: Blood Vessel And Lymphatics

Question 1

The vertebral arteries are branches of which arteries?

Answer 1

Subclavian

Question 2

What is the path of the vertebral arteries?

Answer 2

From subclavian arteries, ascend through the transverse foramina of the cervical vertebrae and go through the foramen magnum. They curve around the medulla and meet the vertebral artery on the other side to form the basilar artery

Question 3

What do the vertebral arteries supply?

Answer 3

Posterior parts of neck and posterior parts of brain

Question 4

Which common carotid artery is longer and why?

Answer 4

The left is slightly longer, as it arises directly form the arch of the aorta whereas the right CCA arises from the brachiocephalic trunk

Question 5

Where do the common carotids terminate?

Answer 5

At the superior level of the thyroid gland

Here they divide into their internal and external branches

Question 6

How can rubbing the carotid sinus alleviate supra ventricular tachycardias?

Answer 6

This is where the baroreceptors are located

Rubbing stimulates the effect of raised BP so will signal to the heart to beat slower

Question 7

How could you tell the difference between the IJV and EJV in the neck?

Answer 7

IJV lies under SCM, lateral to common carotid

EJV lies over SCM, and has lots of branches

Question 8

The carotid sinus and carotid body have which important receptors?

Answer 8

Carotid sinus has baroreceptors which detect arterial BP changes
Carotid body has chemoceptors which deter arterial O2

Question 9

Is the carotid triangle a division of the anterior or posterior triangle?

Answer 9

Anterior

Question 10

What are the boundaries of the carotid triangle?

Answer 10

Superior: posterior belly of digastric
Lateral: SCM
Medial: superior belly of omohyoid

Question 11

What are the contents of the carotid triangle?

Answer 11

Bifurcation of the common carotid artery, internal jugular vein

Question 12

What are the branches of the external carotid artery?

Answer 12

(Some anatomists like freaking out poor medical students)
Superior thyroid
Ascending pharyngeal
Lingual
Facial
Occipital
Posterior auricular
Maxillary 
Superficial temporal

Question 13

What is the blood supply to the scalp? And which branches are from the ICA or the ECA?

Answer 13

Supraorbital & supratrochlear are from the ICA (branches of ophthalmic)

Superficial temporal, posterior auricular and occipital are from the ECA

Question 14

What is the venous drainage of the scalp?

Answer 14

Supraorbital
Supratrochlear
Superficial temporal
Posterior auricular
Occipital

Question 15

How is a scalp infection able to spread to the cranial cavity and possibly affect the meninges?

Answer 15

Valveless emissary veins of the scalp connect to diploic veins of the skull and then to dural venous sinuses

Question 16

What is the significance of a skull fracture at the pterion?

Answer 16

Weakest part of the cranium, anterior branch of middle meningeal artery lies behind the pterion so is likely to be damaged, if ruptured it can lead to an extradural haematoma where blood accumulates between the dura and the skull

Question 17

Which bone does the cavernous sinus lie by?

Answer 17

Sphenoid bone

Question 18

What is the cavernous sinus?

Answer 18

A pair of dural venous sinuses
Located next to the sphenoid bone
Within it is: internal carotid artery (allows arterial blood to cool before reaching the brain), CN III (oculomotor), IV (trochlear), V1 (ophthalmic), V2 (maxillary), V1 (abducens)

Question 19

How can an infection of the face spread to the venous sinuses?

Answer 19

The facial vein is connected to the cavernous sinus by the superior ophthalmic vein
Facial vein is valveless so blood can reverse direction

Question 20

JVP is observing pulsations through which vein?

Answer 20

IJV
this lies behind SCM so we look for muscle pulsing
Use the right IJV as it effectively connection to the right atrium
Have the patient at 45 degree angle

Question 21

What is the difference between regional and terminal lymph nodes in the head and neck?

Answer 21

Regional lymph nodes drain into terminal lymph nodes
Regional lymph nodes drain specific areas, lie in the superficial cervical fascia and can be readily palpated
Terminal lymph nodes receive drainage from a number of regional lymph nodes, and lie in the deep cervical fascia (most are in the carotid sheath)

Question 22

What are the superficial lymph nodes of the head and neck?

Answer 22

Submental
Submandibular
Pre auricular 
Post auricular
Occipital
Superficial cervical
Anterior cervical
Posterior cervical

Question 23

What are the deep lymph nodes of the head and neck?

Answer 23

Jugulodigastric
Juguloomohyoid
Supra clavicular

Question 24

How would swollen lymph nodes feel in infection?

Answer 24

Tender and mobile

Question 25

How would swollen lymph nodes feel in malignancy?

Answer 25

Hard, matted, non-tender

Question 26

Which lymph node is often swollen and tender in tonsillitis?

Answer 26

Jugulodigastric node (aka tonsillar node, drains palatine tonsils, posterior third of tongue, pharynx and larynx)

Question 27

Which deep cervical lymph node is associated with drainage of the tongue, oral cavity, oesophagus, trachea and thyroid gland?

Answer 27

Jugulo-omohyoid

Question 28

In malignancies of the abdomen and thorax, which deep cervical lymph nodes can enlarge?

Answer 28

Supra clavicular lymph nodes (one on either side of the neck)

Question 29

What does Virchow’s node refer to?

Answer 29

Enlarged left supra clavicular lymph node, may or may not be pathological

Question 30

What does Trosier’s sign refer to?

Answer 30

An enlarged, hard Virchow’s node (left supra clavicular lymph node p) which is considered a sign of metastatic abdominal malignancy as Virchow’s node receives lymph drainage from the abdominal cavity

Question 31

What is Waldeyer’s ring?

Answer 31

The collection of lymphatic tissue surrounding the superior pharynx that responds to pathogens that may be ingested or inhaled
Composed of lingual tonsil, palatine tonsil, tubal tonsils, pharyngeal tonsil

Question 32

Lymph is drained into venous circulation via which veins?

Answer 32

Right lymphatic duct into right subclavian vein (R head, neck, arm and thorax)
Thoracic duct into left subclavian (most of the body)

Question 33

Which cranial nerves courses under the arch of aorta?

Answer 33

Left recurrent laryngeal branches off the left vagus nerve and courses beneath the arch of aorta, ascending to supply muscles controlling left vocal cord
Hence damage to this nerve could be card by aortic arch aneurysm, cardiac and thyroid surgery

Question 34

Which cranial nerve course under the riot subclavian artery?

Answer 34

The right recurrent laryngeal nerve, before it ascends up to supply the muscles controlling the right vocal cord