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MRCS > Neck > Flashcards

Neck Flashcards

1
Q

At what vertebral levels is the larynx found

A

C3 - C6

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2
Q

What can the larynx be broadly divided into

A

Supraglottis
Glottis
Subglottis

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3
Q

How many cartilages make up the larynx and how many of these are paired

A

11
4 paired

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4
Q

What are the 4 paired cartilages of the larynx

A

Arytenoid
Corniculate cartilages of Santorino
Cuneiform cartilages of Wrisberg
Posterior sesamoid cartilage

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5
Q

What are the 3 unpaired cartilages of the larynx

A

Thyroid
Cricoid
Epiglottis

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6
Q

What is the laryngeal inlet and what are its borders

A

Laryngeal inlet connects the larynx to pharynx
Anterior/Superior borders - epiglottis
Lateral - aryepiglottic folds
Posterior - Intraarytenoid

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7
Q

What is the quadrangular membrane

A

Connective tissue layer that spans from the lateral aspect of the epiglottis to the arytenoids

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8
Q

The quadrangular membrane thickens inferiorly and forms what structure

A

Inferior margin thickens to form the vestibular ligament - which form the vestibular folds (false vocal cords)

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9
Q

Laryngeal ventricles are found where

A

In the space between the vestibular ligaments and the vocal cords

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10
Q

Where do the vocal cords extend to

A

From the midline surface on the inside of the thyroid cartilage (anterior commissure)
To the vocal process of the arytenoid cartilage

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11
Q

What is the anterior commissure

A

Midpoint between the thyroid notch and the lower border of thyroid

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12
Q

Describe the cricothyroid joint

A

Inferior horn of the thyroid cartilage articulates with the cricoid cartilage
At an encapsulated synovial joint

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13
Q

What movements are facilitated at the cricothyroid joint

A

Rotation
Gliding

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14
Q

What does contraction of the cricothyroid muscles

A

Forward and downwards tilting of the thyroid cartilage
Simultaneous upward movement of the cricoid

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15
Q

Describe the cricoarytenoid joint

A

Synovial articulation between the base of the arytenoid and the lamina of the cricoid cartilage
Surrounded by a loose joint capsule which inserts at a distance from the cartilage articulator surface margin allowing a wider range of movement

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16
Q

What movements are facilitated by the cricoarytenoid joint

A

Arytenoid cartilage can glide forwards and backwards over the cricoid lamina, rock medially and laterally and rotate around its axis.

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17
Q

What reinforces the cricoarytenoid joint capsule

A

Posterior cricothyroid ligament
The ligament fibres extend above the level of the articulation to insert to insert at the arytenoid process and vocal process

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18
Q

Where does the thyrohyoid membrane extend

A

Upper border of the thyroid cartilage to the hyoid bone

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19
Q

The thickenings of the thyrohyoid membrane form what

A

Median and lateral thyrohyoid ligaments

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20
Q

Which structures pierce the thyrohyoid membrane

A

Superior laryngeal vessels
Internal branch of the superior laryngeal nerve

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21
Q

What are the 2 free margins of the quadrangular membrane

A

Superior margin - forms the aryepiglottic fold (less defined)
Inferior margin - forms the vestibular ligament

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22
Q

What is the conus elasticas and where does it attach

A

Submucosal membrane originates from the upper border of the arch of the cricoid cartilage
Extends superiorly to attach to the inner plate of the thyroid cartilage anteriorly and the vocal process of the arytenoid posterirly

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23
Q

What is the conus elasticas also known as

A

Cricothyroid ligament

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24
Q

The conus elasticas is thickening laterally to form what structure

A

Vocal ligament

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25
Q

What forms the thyroid notch

A

A seperation at the superior aspect of the thyroid lamina

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26
Q

Describe the cricoid cartilage

A

Complete cartilaginous ring
Narrow cricoid arch anteriorly
Wider quadrate lamina posteriorly

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27
Q

Where are the facets of the cricoid cartilage found and what do they articulate with

A

At the junction of the arch and the lamina - small round facet that articulates with the lower horn of the thyroid
The superior margin of the lamina has 2 facets, which articulate with the base of the arytenoid cartilage

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28
Q

The arytenoids are what shape and what do they articulate with

A

Pyramidal
Apex - articulates with the corniculate cartilage
Base - articulates with the cricoid cartilage
Vocal process - directed forward and gives attachment for the vocal ligament

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29
Q

Describe the epiglottis

A

Thin leaf shaped fibrocartilage which lies in the upper part of the larynx
Petiole - pointed inferior stalk
Attached to the inner surface of the thyroid cartilage via the thyroepiglottic ligament and anchored to the posterior surface of the hyoid by the hyoepiglottic ligament

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30
Q

What do the corniculate cartilages articulate with and where are they found

A

Articulate with the apex of the arytenoid
Located in the aryepiglottic fold

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31
Q

Other than the corniculate cartilage what is found in the aryepiglottic fold

A

Cuneiform cartilage

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32
Q

What is the function of the corniculate and cuneiform cartilage

A

Reinforce and support the aryepiglottic folds, helping the arytenoids move

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33
Q

Which muscles elevate the larynx

A

Mylohyoid
Digastric
Geniohyoid
Thyrohyoid
Stylopharyngeus
Palatopharyngeus
Salpingopharyngeus
Inferior constrictor

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34
Q

Where is the hyoid bone found and what suspends it

A

Anterior neck
Suspended by suprahyoid and tongue muscle

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35
Q

What are the subsites of the hypopharynx

A

Postcricoid area
Piriform sinus
Posterior pharyngeal wall

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36
Q

Describe the postcricoid area

A

Phayngooesophageal junction
Extends from the level of arytenoid and connecting folds to the inferior border of the cricoid cartilage
Forms the anterior wall of the hypopharynx

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37
Q

What area extends from the pharyngoepiglottic fold to the upper end of the oesophagus

A

Piriform sinus

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38
Q

What are the boundaries of the posterior pharyngeal wall

A

Superior level of hyoid bone
Level of inferior border of the cricoid cartilage

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39
Q

What are the intrinsic muscles of the larynx

A

Transverse arytenoid
Thyroarytenoid
Posterior cricoarytenoid
Lateral cricoarytenoid
Cricothyroid

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40
Q

Which is the only intrinsic muscles of the larynx to be innervated by the external branch of the superior laryngeal nerve

A

Cricothyroid

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41
Q

Describe the course of the superior laryngeal nerve

A

Arises from the inferior ganglion of the vagal nerve, contains both motor and sensory fibres
Passes downwards along the sides of the pharynx, medial to the carotid artery
Divides into internal and external branches

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42
Q

Where does the internal superior laryngeal nerve pass

A

Between the middle and inferior constrictor muscles
Pierces the thyrohyoid membrane with the superior laryngeal artery

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43
Q

Describe the course of the external laryngeal nerve

A

Continues on the external surface of the larynx beneath the sternothyoid muscle
Gives motor innervation to cricothyroid

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44
Q

How does the course of the right recurrent laryngeal nerve differ to the left

A

Right RLN - originates at the right subclavian artery, passes below and behind the artery
Left RLN - originates from the vagus in the chest, passes around the aortic arch
They then ascend running in the tracheooesophageal groove

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45
Q

Which muscles does the recurrent laryngeal nerve innervate

A

All intrinsic muscles other than cricothyroid

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46
Q

The recurrent laryngeal nerve provides sensory innervation for which area of the larynx

A

Subglottic region

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47
Q

Which branches of the vagus nerve are involved with the larynx

A

Superior laryngeal nerve
Inferior laryngeal nerve
Recurrent laryngeal nerve

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48
Q

Carotid artery surgery may risk which nerve

A

Superior laryngeal nerve

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49
Q

Thyroid or parathyroid surgery may risk which nerve

A

Inferior laryngeal nerve

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50
Q

Which branches of the carotid artery supply the larynx

A

Superior laryngeal artery which is a branch of the superior thyroid artery

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51
Q

Cricothyroid artery is a branch of which artery

A

Superior thyroid artery (common carotid)

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52
Q

the inferior laryngeal artery is a branch of which artery

A

Branch of the inferior thyroid artery which is a branch fo the inferior thyroid artery

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53
Q

What are the circular extrinsic muscles of the larynx

A

Superior, middle and inferior pharyngeal constrictor

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54
Q

What are the longitudinal extrinsic muscles of the larynx

A

Stylopharyngeus
Palatopharyngeus
Salpingopharyngeus

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55
Q

The extrinsic muscles of the larynx are innervated by which nerve and which is the exception

A

Vagus nerve
Stylopharngeus is innervated by glossopharyngeal nerve

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56
Q

What is the sensory innervation of the pharynx

A

Glossopharyngeal
Maxillary nerve innervates the anterior and superior aspect of the nasopharynx
Inferior aspect of the laryngopharynx (start of larynx) - innervated by vagus

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57
Q

What are the borders of the anterior triangle of the neck

A

Superior - inf aspect of the mandible
Lateral - anterior border of sternocleidomastoid
Medial - Sagittal line down the midline of the neck

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58
Q

What forms the roof of the anterior triangle

A

Investing fascia

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59
Q

Which supra hyoid muscles are found in the anterior triangle

A

Stylohyoid
Digastric
Mylohyoid
Geniohyoid

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60
Q

Which infrahyoid muscles are found in the anterior triangle

A

Omohyoid
Sternohyoid
Thyrohyoid
Sternohyoid

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61
Q

Which artery bifurcates in the anterior triangle

A

Common carotid

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62
Q

What vasculature is found in the anterior triangle

A

Common carotid - birfucates into internal and external carotid
Internal Jugular vein

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63
Q

Which cranial nerves are found in the anterior triangle

A

Facial - 7
Glossopharyngeal - 9
Vagus - 10
Accessory - 11
Hypoglossal - 12

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64
Q

What subdivides the anterior triangle into four further triangle

A

Hyoid bone
Suprahyoid
Infrahypid

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65
Q

What are the boundaries of the carotid triangle

A

Superior - posterior belly of digastric
Lateral - medial border of sternocleidomastoid
Inferior - superior border of omohyoid

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66
Q

What is the contents of the carotid triangle

A

Common carotid - bifurcates into internal and external
Internal jugular vein
Hypoglossal nerve
Vagus nerve

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67
Q

What are the boundaries of the submental triangle and what does it contain

A

Inferior - hyoid bone
Medial - midline of the neck
Lateral - anterior body of digastric
Submental lymph nodes

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68
Q

What are the boundaries of the submandibular triangle and what does it contain

A

Superior - body of mandible
Anterior - Anterior belly of digastric
Posterior - posterior belly of digastric
Submandibular gland, lymph nodes, facial artery and vein

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69
Q

What are the borders of the posterior triangle

A

Anterior - posterior border of sternocleidmastoid
Posterior -anterior border of trapezius
Inferior - middle 1/3 of the clavicle

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70
Q

What is the floor of the posterior triangle formed from

A

Prevertebral fascia

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71
Q

What are the contents of the posterior triangle

A

Omohyoid
External jugular vein
Subclavian vein
Transverse cervical and supra scapular veins
Subclavian, transverse cervical, suprascapular arteries and veins
Accessory nerve
Cervical plexus
Phrenic nerve
Trunks of the brachial plexus

72
Q

Why is the accessory nerve vulnerable to injury in the posterior triangle

A

Lies superficial

73
Q

Where do the common carotids originate from

A

Left common carotid - branch of the aorta
Right common carotid - from the bifurcation of the subclavian trunk

74
Q

Do the common carotids give off any branches in the neck

A

No

75
Q

Where does the common carotid bifurcate and into what
And what else is found here

A

At the carotid triangle
Carotid sinus - site of baroreceptors which detect stretch as a measure of BP

76
Q

What are the 6 branches of the common carotid artery

A

Superior thyroid artery
Lingual artery
Facial artery
Ascending pharyngeal artery
Occipital artery
Posterior auricular artery

77
Q

What does the external carotid terminate into

A

Superficial temporal artery
Maxillary artery

78
Q

Which three arteries supply the scalp

A

Superficial temporal
Occipital
Posterior auricular

79
Q

The middle meningeal artery is a branch of which artery

A

Branch of the maxillary artery
Which is a branch of the external carotids

80
Q

Does the internal carotid artery give off any branches in the neck

A

No

81
Q

Through which structure in which bone does the internal carotid artery enter the cranial cavity

A

Via the carotid canal
In the petrous part of the temporal bone

82
Q

The vertebral arteries are a branch of which main artery

A

Subclavian

83
Q

The vertebral arteries enter the cranial cavity through which structure and what do they combine to form

A

Forman Magnum
Converge to form basilar artery

84
Q

What forms the thyrocervical artery and what does this then branch to form

A

Right and left subclavian arteries give rise to the thyrocervical artery
Branches to give:
Inferior thyroid artery
Ascending cervical artery
Transverse cervical artery
Suprascapular artery

85
Q

Which 2 veins form the external jugular vein

A

Posterior auricular vein
Retromandibular vein

86
Q

Where does the external jugular vein form

A

Immediately posterior to the angle of mandible, and inferior to the outer ear

87
Q

The posterior external jugular, transverse cervical and suprascapular veins drain into which main vein

A

External jugular vein

88
Q

The external jugular vein terminates by draining into which vein

A

Subclavian vein

89
Q

What is the internal jugular vein a continuation of

A

Sigmoid sinus

90
Q

In the neck where is the internal jugular vein found

A

In the carotid sheath

91
Q

The facial, lingual, occipital, superior and middle thyroid veins drain into which main vein

A

Internal jugular vein

92
Q

The internal jugular terminates by combining with what to form what

A

Combines with the subclavian vein to form the brachiocephalic vein

93
Q

Where are the cavernous sinus found

A

At the lateral aspect of the sphenoid bone

94
Q

Which structures are found within the cavernous sinus

A

Internal carotid artery
Abducens nerve (CN VI)
Oculomotor never (CN III)
Trochlear nerve (CN IV)
Opthalmic nerve (V1)
Maxillary nerve (V2)

95
Q

What connects the facial vein to the cavernous sinus

A

Superior ophthalmic vein

96
Q

Which are the superficial lymph node groups of the head and neck

A

Occipital
Mastoid
Pre-auricular
Parotid
Submental
Submandibular
Facial
Superficial cervical

97
Q

What are the deep lymph node groups of the head and neck

A

Prelaryngeal
Pretracheal
Paratracheal
Retropharyngeal
Infrahyoid
Jugulodigastric (tonsilar)
Jugulo-omohyoid
Supraclavicular

98
Q

What is Virchows node and what does it suggest

A

Enlarged supraclavicular node
Troisiers sign - highly suggestive of cancer in the abdomen, particularly gastric cancer

99
Q

What makes up Waldeyers ring

A

Tonsillar ring
Made up of - lingual tonsil, palatine tonsil, tubal tonsil, pharyngeal tonsil

100
Q

Where is the superficial cervical fascia found

A

Between the dermis and the deep cervical fascia

101
Q

What is contained in the superficial cervical fascia

A

Neurovascular supply to the skin
Superficial veins
Superficial lymph nodes
Fat
Platsyma

102
Q

Describe the platysma muscle

A

Paper thin muscle
Originates from the fascia of pec major and deltoid
Inserts into the mandible

103
Q

What innervates platysma

A

Facial nerve

104
Q

What are the three layers of the deep cervical fascia

A

Investing layer
Pretracheal layer
Prevertebral layer

105
Q

What does the investing fascia cover

A

All structures in the neck
Over trapezius and sternocleidomastoid, it splits, covering them completely

106
Q

What are the attachments of the investing fascia

A

Superior - attaches to the external occipital protuberance, and the superior nuchal line of the skull
Anterior - hyoid bone
Inferior - Spine and acromion of the scapule, the clavicle and the manubrium of the sternum
Posterior - nuchal line of the vertebra

107
Q

Where is the pretracheal fascia found in the neck

A

Anteriorly

108
Q

What does the pretracheal fascia fuse with

A

The pericardium

109
Q

What are the two parts of the pretracheal fascia

A

Visceral
Muscular

110
Q

What does the visceral part of the pretracheal fascia enclose

A

thyroid gland, trachea and oesophagus

111
Q

The visceral pretracheal fascia receives contributions from which structure

A

Bucopharyngeal fascia

112
Q

What does the muscular part of the pretracheal fascia enclose

A

Infrahyoid muscles

113
Q

What does the prevertebral fascia surround

A

Vertebral column and its associated muscles - scalene muscles, prevertebral muscles, and the deep muscles of the back

114
Q

What forms the axillary sheath

A

The prevertebral fascia

115
Q

What are the contents of the carotid sheath

A

Common carotid artery
Internal jugular vein.
Vagus nerve.
Accompanying cervical lymph nodes.

116
Q

What is the retropharygneal space between

A

Buccopharyngeal fascia (posterior aspect of the visceral pretracheal fascia) and the prevertebral fascia.

Extends from the base of the skull to the posterior mediastinum

117
Q

The phrenic nerve arises at which border of which muscle

A

Lateral border of the anterior scalene muscle

118
Q

Where is the cervical plexus found

A

In the posterior triangle of the neck
Halfway up the sternocleidomastoid muscle
Within the prevertebral fascia

119
Q

What forms the cervical plexus

A

Anterior rami of C1 - C4

120
Q

What muscular branches arise from the cervical plexus

A

Phrenic nerve
Nerve to geniohyoid and thryohyoid
Ansa cervicalis

121
Q

What branches arise from the ansa cervicalis

A

Superior belly of the omohyoid muscle
Inferior belly of omohyoid muscle
Sternohyoid
Sternothyroid

122
Q

What sensory branches arise from the cervical plexus

A

Greater auricular nerve
Transverse cervical nerve
Lesser occipital nerve
Supraclavicular nerve

123
Q

What muscles attach to the hyoid bone

A

Middle pharyngeal constrictor, hyoglossus, genioglossus
Digastric, stylohyoid, geniohyoid, mylohyoid
Thyrohyoid, omohyoid, sternohyoid

124
Q

Which 3 ligaments attach to the hyoid bone

A

Stylohyoid ligament
Thyrohyoid ligament
Hyoepiglottic ligament

125
Q

What are the 4 suprahyoid muscles

A

Stylohyoid
Digastric
Mylohyoid
Geniohyoid

126
Q

What is the nerve Innervation of the stylohyoid muscle

A

Stylohyoid branch of the facial nerve (CN VII)

127
Q

Describe the innervation of digastric

A

Anterior belly - innervated by inferior alveolar nerve (branch of CN V)
Posterior belly - innervated by CN VII

128
Q

Which suprahyoid muscle would be defined as a thin strap muscle

A

Stylohyoid

129
Q

What does mylohyoid form the floor of

A

The mouth

130
Q

What is the innervation of mylohyoid

A

Inferior alveolar nerve (branch of mandibular branch of CN V)

131
Q

Geniohyoid is found deep to which muscle

A

Mylohyoid

132
Q

What innervates geniohyoid

A

C1 nerve roots running with hypoglossal nerve

133
Q

What is the arterial supply to the hyoids

A

Facial artery
Occipital artery
Lingual artery

134
Q

What are the superficial infrahyoid muscles

A

Omohyoid
Sternohyoid

135
Q

What are the deep infra hyoid muslces

A

Sternothyroid
Thyrohyoid

136
Q

All of the infrahyoid muscles are supplied by the ansa cervicalis other than

A

Thyrohyoid
Supplied by Anterior ramus of C1 carried by hypoglossus

137
Q

Which infrahyoid muscle is found in both the anterior and posterior triangle

A

Hypoglossal nerve

138
Q

How many scalene muscles are there

A

3 paired muscles
Anterior, middle and posterior

139
Q

What is the action of the scalene muscles

A

Accessory muscles of respiration
Flexion of the neck

140
Q

Which structures pass between the anterior and middle scalene

A

Brachial plexus
Subclavian arteyr

141
Q

Which structures pass between the anterior and middle scalene

A

Brachial plexus
Subclavian artery

142
Q

What structures pass anterior to the anterior scalene

A

Subclavian vein
Phrenic nerve

143
Q

Where is the subclavian artery in relation to the anterior scalene

A

Posterior to the anterior scalene

144
Q

What is an interscalene block

A

Local anaesthetic injected into the brachial plexus at the point where it is between the anterior and middle scalene muscles.
LA is injected between these muscles at the level of the cricoid cartilage (C6)

145
Q

What are the four sub occipital muscles

A

Rectus capitis posterior major
Rectus capitis posterior minor
Obliquus capitis inferior
Obliquus capitis superior

146
Q

What does the sub occipital triangle contain

A

Vertebral artery

147
Q

What movements are facilitated by the sub occipital muscles

A

Extend and rotate the head

148
Q

What is the atlas

A

C1

149
Q

What is the axis

A

C2

150
Q

Which ligaments support the Atlanto-axial joint

A

Lateral atlanto-axial joint x 2
Medial atlanto-axial joint

151
Q

Which 4 ligaments are present throughout the vertebral column

A

Anterior and posterior longituidnal ligaments
Ligamentum flavum
Interspinous ligament

152
Q

Which 2 ligaments are just present in the cervical spine

A

Nuchal ligament
Transverse ligament of the atlas

153
Q

Describe the nuchal ligament

A

A continuation of the supraspinous ligament
Attaches to C1-C7
Proximal attachment for rhomboids and trapezius

154
Q

The ondontoid process of C2 articulates with which part of C1

A

The anterior arch of atlas

155
Q

What is a Jeffersons fracture

A

Compression of the lateral masses of the atlas between the occipital condyles and the axis.
This causes them to be driven apart, fracturing one or both anterior/posterior arches.

156
Q

What is a hangmans fracture

A

Fracture of the pars interarticularis (bony column between the superior and inferior articular facets of the axis).

157
Q

Fracture of the odontoid process accounts for what % of C2 fractures

A

40%

158
Q

How long is the oesophagus and where does it start and end

A

25cm
C6 - T11

159
Q

The external muscular layer of the oesophagus changes with each third of the oesophagus
Describe the external muscular layer in the superior, middle and inferior third

A

Superior third - voluntary striated muscle
Middle third - voluntary striated and smooth muscle
Inferior third - smooth muscle

160
Q

The internal muscular layer of the oesophagus is what type of muscle

A

Circular

161
Q

What produces the upper oesophageal sphincter

A

Cricopharyngeus muscle

162
Q

What 4 factors maintain the lower oesophageal sphincter

A

Oesophagus enters the stomach at an acute angle.
Walls of the intra-abdominal section of the oesophagus are compressed when there is a positive intra-abdominal pressure.
Prominent mucosal folds at the gastro-oesophageal junction aid in occluding the lumen.
Right crus of the diaphragm has a “pinch-cock” effect.

163
Q

At what 4 points is the oesophagus externally compressed

A

Arch of aorta
Bronchus (left main stem)
Cricoid cartilage
Diaphragmatic hiatus

164
Q

What is the arterial supply of the oesophagus

A

Thoracic oesophagus - thoracic aorta, inferior thyroid artery
Abdominal oesophagus - left gastric vein

165
Q

What is the venous drainage of the oesophagus

A

Thoracic oesophagus - azygos veins and inferior thyroid veins
Abdominal oesophagus
Portal circulation - via left gastric vein
Systemic circulation - azygos vein

166
Q

The nucleus ambiguus controls which oesophageal sphincter

A

Upper oesophageal sphincter

167
Q

The lower oesophageal sphincter is innervated by

A

Fibres from dorsal motor nucleus.

168
Q

What is the lymphatic drainage of the oesophagsu

A

Superior third - Deep cervical lymph nodes
Middle third - Superior and posterior mediastinal lymph nodes
Inferior third - Left gastric and coeliac nodes

169
Q

At what vertebral level is the thyroid found

A

C5-T1

170
Q

What fascial layer covers the thyroid gland

A

Pretracheal fascia

171
Q

Which muscles are anteriorly related to the thyroid

A

Sternohyoid
Superior belly of omohyoid
Sternohyoid

172
Q

What is the origin of the superior thyroid artery compared to the inferior thyroid artery

A

Superior - first branch of the external carotid
Inferior - from the thyrocervical trunk

173
Q

In what % of people is the thryoidae ima artery present and where does it arise from

A

10%
From the brachiocephalic trunk

174
Q

What pharyngeal pouch is are the parathyroid glands from

A

Superior parathyroid gland - 4th pharyngeal pouch
Inferior parathyroid gland - 3rd pharyngeal pouch

175
Q

What is the blood supply of the parathyroid glands

A

Inferior thyroid artery
Superior, middle and inferior thyroid veins

176
Q

What is the lymphatic drainage of the parathyroids

A

Paratracheal and deep cervical nodes

MRCS (17 decks)

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