Neck Flashcards
20967 – S. The investing layer of deep fascia is a relatively insensitive tissue BECAUSE R. the sensory supply of deep fascia is the same as that of the underlying muscle
both S and R and false
Last PAGE: 4
19809 – All EXCEPT one of the following statements about the investing layer of the deep cervical fascia are true. It
A. splits to enclose the trapezius muscle
B. splits to include the parotid gland
C. is attached to the hyoid bone
D. is attached to the superior nuchal line
E. splits to enclose the sterno-hyoid muscle
E
Last 9th. ed. PAGE: 421
- most superficial part of deep cervical fascai, encloses the whole neck
- splits around SCM and trapezius.
attached:
- posteriorly: ligamentum nuchae
- Anteriorly - hyoid bone
- superiorly - external occipital protuberance and superior nuchal line of occipital, mastoid process and ext aud meatus, lower marchin of zygmatic arch, body of mandible from angle to symphesis menti
- inferiorly - spine and acromial process of scapula, upper surface of clavical , suprasternal norch of manubrium
encloses the submandibular and parotid gland
15272 – S: Pus from an abscess in a cervical vertebra tracks down into the posterior mediastinum because R: the prevertebral fascia is attached inferiorly to the body of the sixth thoracic vertebra
Both S and R are false
Refer to Last, 10th Ed, Ch 6, page 323
It extends from the base of the skull in front of the longus capitis and rectus capitis lateralis downwards to the lower limit of the longus colli muscle (body of T3 vertebra)
22033 – The prevertebral layer of cervical fascia contributes to
1: the carotid sheath
2: the clavipectoral fascia
3: the suprapleural membrane
4: the axillary sheath
FFFT
Last 9 p423
Prevertebral fascia
- extends medially behind the carotid vessels where it assists in forming their sheath. passes in front of prevertebral muscular
- fixed above to base of skull and below behind the oesophagus into the posterior mediastinal cavity. descends in front of longus coli muscle
- in front of scalene muscle. forms a sheath for brachial nerves, subclavian artery, vein in the posterior triangle of neck. continues under the clavical as axillary sheath and attached to deep surface of coracoclavicular fascia.
it becomes prolonged over the artery below the clavicle as the axillary sheath. It does not invest the subclavian or axillary vein; these lie in loose areolar tissue anterior to it, free to dilate during times of increased venous return from the upper limb. The fascia is pierced by the four cutaneous branches of the cervical plexus (great auric ular, lesser occipital, transverse cervical and supraclavic ular nerves). The purpose of the prevertebral fascia is to provide a fixed basis on which the pharynx, oesophagus and carotid sheaths can glide during neck movements and swallowing, undisturbed by any movements of the prevertebral muscles.
23459 – Structures lying deep to the prevertebral fascia include
1: the cervical sympathetic trunk
2: the trunks of the brachial plexus
3: the third part of the subclavian artery
4: the scalenus anterior muscle
FTTT
Last 8th Edition PAGE: 422
In the posterior triangle of the neck it covers the muscles that floor the triangle, and, since it crosses in front of the anterior tubercles of the cervical transverse processes, all the cervical nerve roots (and thus the cervical plexus and trunks of the brachial plexus) lie deep to it. The lymph nodes of the posterior triangle and the accessory nerve lie superficial to it. It has also the third part of the subclavian artery (not the vein) deep to it
23844 – The thyroid gland
1: is related medially to the cricopharyngeus muscle
2: has a sheath derived from the pretracheal fascia
3: is related medially to the cricothyroid muscle
4: is covered by the thyrohyoid muscle
TTTF
Last 8th Edition PAGE: 430
10472, 19815 – During thyroidectomy
A. anterior jugular veins are seen deep to the investing layer of deep cervical fascia
B. the investing layer of the deep cervical fascia splits to enclose the infrahyoid muscles
C. the pretracheal fascia is divided as it envelops the gland and is firmly bound to the capsule of the gland
D. the internal laryngeal nerve may be damaged during ligation of the superior thyroid pedicle
E. the recurrent laryngeal nerve may be seen disappearing under the inferior border of the cricopharyngeus muscle
E
Last 8th ed. PAGE: 422; 428; 435; 464. The anterior jugular veins are superficial to the deep fascia at the level of the thyroid incision (A incorrect), and pierce the deep fascia at the suprasternal notch. The investing layer of deep fascia splits to enclose the sternomastoid and trapezius muscles (B incorrect). The pretracheal fascia is not firmly bound to the capsule of the thyroid gland (C incorrect). The external laryngeal nerve may be damaged during ligation of the superior thyroid pedicle (D incorrect). The recurrent laryngeal nerve enters the larynx by passing deep to the inferior border of cricopharyngeus anterior to the inferior cornu of the thyroid cartilage (E correct).
Pretracheal fascia
- extends in front of carotid, envelops thydroid gland, prolonged in front of trachea. contains larynx osesophagus, pharynx, ensheaths the infrahyoid muscles.
fixed to hyoid bone above, below it blends with the fibrous pericardium . fused either side with the prevertebral fascia
22894 – Concerning the development of the thyroid gland
1: thyroid cells are all derived from the floor of the pharynx
2: the foramen caecum marks the site of origin of the thyroid downgrowth
3: thyroglossal cysts may be posterior to the body of the hyoid bone
4: the pyramidal lobe of the thyroid is the distal remnant of the thyroglossal duct
FTTT
Last PAGE: 42, 362
20607 – S. The inferior parathyroid is derived from a more rostral pharyngeal pouch (i.e. the third pouch) than the superior parathyroid (i.e. the fourth pouch) BECAUSE R. the third pharyngeal pouch contributes to the development of the thyroid gland
nswer: S is true and R is false
Last PAGE: 42,369
20043 – S. The thyroid gland moves with the larynx and trachea during swallowing BECAUSE R. the thyroid gland is bound to the larynx and trachea by the pretracheal fascia
S is true, R is true and a valid explanation of S
Last 8th Edition PAGE: 422, 430
22899 – The oesophagus
1: passes between the crura of the diaphragm
2: has a coat containing non-striated muscle fibres in its lower two-thirds
3: is not in contact with the right mediastinal pleura in the posterior mediastinum
4: pierces the diaphragm at the level of the tenth thoracic vertebra
FTFT
Last (8) PAGE: 250, 262, 433, 278
654 – The oesophagus
1: receives its motor innervation via the vagus nerves.
2: has a well defined anatomical sphincter at its lower end just below the diaphragm.
3: is drained by systemic veins only.
4: is constricted to some extent by the right main bronchus.
TFFF
The motor innervation to the oesophagus is via the vagus nerves (1 true). The left vagus supplies the anterior surface, the right the posterior surface. The upper striated muscle receives its nerve supply from the nucleus ambiguus within the medulla and runs via the cranial root of the accessory to the vagus. The smooth muscle in the lower part receives its supply via parasympathetic nerves from the dorsal motor vagal nucleus through the vagal plexus with relays in the oesophageal wall. A dense myenteric nerve plexus with abundant ganglia coordinates muscular activity. The cricopharyngeus, a striated muscle 3 to 5cm wide, closes the upper end of the oesophagus at rest, preventing inspired air entering the gut. The lower oesophageal sphincter has no defined anatomical features (2 false) but is represented by a zone of high resting pressure (10-15mm of mercury) in the lowest (intra-abdominal) segment below the diaphragm. Venous return from the upper oesophagus is to the brachiocephalic veins and from the midoesophagus via the azygos veins to vena cava. The lower oesophagus is drained by tributaries leading to the left gastric vein, emptying into the portal vein (3 false). This region of the lower oesophagus is the most important surgically relevant site of collaterals developing in portal hypertension. These submucosal varicosities can give rise to serious or fatal haemorrhage. The oesophagus crosses behind the left main bronchus at 27cm (11inches) from the incisor teeth where there is a slight constriction of oesophageal lumen (4 false).
21958 – With respect to the cervical oesophagus
1: the muscle is supplied by the recurrent laryngeal nerve
2: there is no submucosa
3: it inclines slightly to the left of midline but enters the thoracic inlet in the midline
4: external to its muscle layer is a layer of connective tissue which is firmly adherent to the prevertebral fascia
TFTF
Last’s 9th Ed., p277.
643 – The oesophagus is closely related to the vertebral bodies from the
A. cricoid cartilage to the median arcuate ligament.
B. cricoid cartilage to the oesophageal hiatus in the diaphragm.
C. cricoid cartilage to the lower limit of the superior mediastinum.
D. thoracic inlet to the oesophageal hiatus of the diaphragm.
E. thoracic inlet to the limit of the superior mediastinum.
C
The oesophagus extends from the cricoid cartilage at the level of the sixth cervical vertebra to the cardiac orifice of the stomach at the level of the tenth thoracic vertebra (left seventh costal cartilage). In the adult it is approximately 25cm (10 inches) long and is normally collapsed and empty with functional sphincters at its upper and lower ends. On endoscopy the oesophagus starts below the cricopharyngeal sphincter at 15cm (6 inches) from the incisor teeth and extends to the cardiac orifice 40cm (16 inches) from the incisor teeth. It lies predominantly in the midline but inclines to the left as it descends from its cervical origin through the thorax and into the abdomen. The oesophagus is directly in front of the vertebral bodies at its origin at C6 vertebral level, and stays in contact with the vertebral bodies throughout the superior mediastinum, which extends to the lower border of T4 (level of manubriosternal joint and tracheal bifurcation) (C true). After passing behind the left main bronchus the oesophagus inclines forward away from the vertebral bodies to reach the oesophageal opening in the diaphragm at the level of T10 just to the left of the midline.
21073 – The cervical oesophagus
1: is related posteriorly to longus capitis muscle
2: is supplied by oesophageal branches of the inferior thyroid artery
3: enters the mediastinum to the right of the midline
4: has venous drainage to the brachiocephalic veins
FTFT
Last 9th Edition PAGE: 434
20775 – S. The dehiscence of Killian is a common site for pharyngeal diverticula BECAUSE R. the dehiscence is a weak area of the pharyngeal wall below the cricopharyngeus
S is true and R is false
Last 9th Edition PAGE: 488
22139 – An incision along the anterior border of sternomastoid to expose the common carotid artery bifurcation will commonly divide the
1: supraclavicular nerves
2: a sternomastoid branch of the occipital artery
3: transverse cervical nerve
4: common facial vein
FTTT
Last 8th Edition PAGE: Plate 31
23724 – The carotid sheath
1: is attached to the aortic arch
2: invests the vagus nerve
3: is attached to the pretracheal fascia
4: is attached to the carotid foramen
TTTT
Last 9th Edition PAGE: 423; 464
- areolar tissue that surrounds the carotid arteries (common and internal), internal jugular vein and vagus nerve
-The sheath is attached to the base of the skull at the margins of the carotid canal, and is continued downwards along the
vessels to the aortic arch. In front the lower part of the sheath is firmly attached to the deep surface of the sternocleidomastoid and along this line the pretracheal fascia blends with it. Behind the carotid sheath there is a minimum of loose areolar tissue between it and the prevertebral fascia
22174 – The common carotid artery lies anterior to
1: the cervical sympathetic chain
2: the prevertebral fascia
3: the cervical transverse processes
4: the inferior thyroid artery
TTTT
Last 8th Edition PAGES: 434; 440
23464 – Nerves commonly at risk during exposure of the bifurcation of the
common artery are
1: hypoglossal nerve
2: superior laryngeal nerve
3: lingual nerve
4: accessory nerve
TTFF
Last 9th ed. Page: 463.
