Neck

Question 1

where does the visceral compartment of the neck lie?

Answer 1

anteriorly, and extends from the base of the skull to the thoracic outlet

Question 2

what bones, muscles, and structures are in the visceral compartment of the neck?

Answer 2

hyoid bone, suprahyoid and infrahyoid muscles, pharynx, esophagus, larynx, and trachea

Question 3

what layer of the deep cervical fascia encloses the structure in the visceral compartment of the neck?

Answer 3

pretracheal layer buccopharyngeal fascia is a continuation of the pretracheal fascia that surrounds the posterior aspect of the pharynx and esophagus

Question 4

where does the vertebral compartment of the neck lie?

Answer 4

posteriorly, and extends from the foramen magnum to the thoracic outlet

Question 5

what bones, muscles, and structures are in the vertebral compartment of the neck?

Answer 5

cervical vertebrae, skeletal muscles that attach to the vertebrae, the ventral rami of the cervical plexus and brachial plexus, and the vertebral arteries and veins

Question 6

what layer of the deep cervical fascia encloses the structures of the vertebral compartment of the neck?

Answer 6

prevertebral layer (that makes sense…)

Question 7

what separates the prevertebral layer from the buccopharyngeal fascia?

Answer 7

retropharyngeal space

Question 8

what is clinically relevant about the retropharyngeal space?

Answer 8

it is a potential space that allows the structures of the visceral compartment to glide against the prevertebral fascia during swallowing an infection in this space may spread inferiorly into the superior mediastinum

Question 9

both neck compartments are partially covered by what two superficial muscles? what layer of the deep cervical fascia then encloses both the compartments, as well as splits to enclose the two muscles?

Answer 9

investing layer of the deep cervical fascia encloses both compartments and splits to enclose the trapezius and sternocleidomastoid (SCM) which partially cover both neck compartments

Question 10

what forms the carotid sheath and where does it lie in the neck?

Answer 10

carotid sheath formed by contributions from the pretracheal, prevertebral, and investing layers of the deep cervical fascia it is situated between the vertebral and visceral compartments of the neck

Question 11

what structures are contained within the carotid sheath?

Answer 11

common carotid artery (which branches into the internal and external carotid arteries) carotid body carotid sinus internal jugular vein vagus nerve glossopharyngeal nerve accessory nerve hypoglossal nerve

Question 12

where does the common carotid artery branch?

Answer 12

at the upper corder of the thyroid cartilage

Question 13

what is the course of the internal carotid artery and what does it supply?

Answer 13

no branches in the neck!! enters the skull through the carotid canal gives rise to the ophthalmic artery (supplies orbit, retina, part of nasal cavity and face) ends by branching into anterior and middle cerebral artery

Question 14

what are the branches of the external carotid artery in the neck? where does the external carotid artery end?

Answer 14

6 branches in neck: Superior thyroid artery Ascending pharyngeal artery Lingual artery Facial artery Occipital artery Posterior auricular artery then ends posterior to mandible by dividing into a Maxillary artery and Superficial temporal artery **Some Aggressive Lovers Find Odd Positions More Stimulating

Question 15

what does the superior thyroid artery supply and what does it give rise to?

Answer 15

thyroid gland (duh) gives rise to the superior laryngeal artery that passes through the thyrohyoid membrane to supply the laryngopharynx and larynx

Question 16

where does the ascending pharyngeal artery course and what does it supply?

Answer 16

arises from posterior external carotid pharynx (obviously)

Question 17

where does the lingual artery course and what does it supply?

Answer 17

passes deep to the mylohyoid tongue (lingual… tongue… k)

Question 18

where does the facial artery course and what does it supply?

Answer 18

passes deep to the submandibular glands, crosses body of the mandible facial muscles and skin up to medial corner of eye (clearly these aren’t that hard)

Question 19

where does the occipital artery course and what does it supply?

Answer 19

crossed by the hypoglossal nerve posterior neck and posterior scalp (where your occipital bone and occipital sinus are)

Question 20

what does the posterior auricular artery supply?

Answer 20

posterior scalp

Question 21

what of the terminal branches of the external carotid are larger?

Answer 21

maxillary

Question 22

where is the carotid body and what is its function?

Answer 22

bifurcation of common carotid artery chemoreceptor that monitors arterial levels of oxygen and carbon dioxide

Question 23

where is the carotid sinus and what is its function?

Answer 23

proximal part of the internal carotid artery baroreceptor that monitors arterial blood pressure **“sinus pressure”

Question 24

what innervates the carotid body and carotid sinus?

Answer 24

glossopharyngeal and vagus nerves (convey signals back into CNS)

Question 25

what is the baroreceptor reflex? disruption of the reflex results in what?

Answer 25

maintains blood pressure in response to changes in posture disruption of the reflex results in orthostatic hypotension- a decrease in BP when patient assumes an upright position

Question 26

what is the chemoreceptor reflex?

Answer 26

maintains blood gases by adjusting respiration, cardiac output, and peripheral BP a decrease in oxygen tension (PO2) and an increase in carbon dioxide tension (PCO2) will result in an increase in respiration, HR, and peripheral BP

Question 27

where does the internal jugular vein course and what does it receive blood from?

Answer 27

courses through the carotid sheath lateral to the common carotid artery formed inferior to the jugular foramen at the junction of the interior petrosal sinus and sigmoid sinus receives the facial, lingual, pharyngeal, and middle thyroid veins

Question 28

where does the vagus nerve course?

Answer 28

through the length of the neck in the carotid sheath posterior to the internal jugular vein and common carotid artery

Question 29

where do the glosspharyngeal, accessory, and hypoglossal nerves course?

Answer 29

pass through superior part of sheath to the pharynx, posterior triangle, and tongue, respectively

Question 30

where does the cervical part of the sympathetic trunk lie is respect to the carotid sheath? what does it contain?

Answer 30

posterior and medial contains superior, middle, and inferior cervical sympathetic ganglia

Question 31

the superior cervical ganglion receives preganglionic sympathetic axons from which spinal cord segment? its postganglionic sympathetic axons give rise to what to supply what?

Answer 31

T1 supply sweat glands, vascular smooth muscle in face and scalp, dilator pupillae and superior tarsal muscles in the orbit (elevates eyelids) form periarterial plexuses that course with internal and external carotid arteries and branches gives rise to gray rami that course with branches of C1-C4 spinal nerve supplying the neck

Question 32

the inferior cervical ganglion fuses with the first thoracic ganglion to form what ganglion? it then gives rise to gray rami that course with what ventral rami to supply what?

Answer 32

stellate ganglion course with C7 and C8 ventral rami branches supplies upper limb

Question 33

lesion of the stellate ganglion, cervical part of the sympathetic trunk or the superior cervical ganglion can cause what? what symptoms are associated?

Answer 33

Horner’s syndrome- anhydrosis (lack of sweat), ptosis (eyelid dropping), miosis (constricted pupils)

Question 34

what can be performed for patients who exhibit excessive vasoconstriction or sweating in the upper limb?

Answer 34

stellate ganglion block

Question 35

what are the boundaries of the posterior triangle, including the floor and the roof?

Answer 35

bounded by the trapezius, posterior sternocleidomastoid, and clavicle floor contains anterior scalene, middle scalene, posterior scalene, levator scalene, and splenius capitis muscles all covered by the prevertebral fascia roof formed by the investing layer of the deep cervical fascia

Question 36

what structures course through the posterior triangle?

Answer 36

external jugular vein, subclavian vein, suprascapular, transverse cervical, and occipital arteries, accessory nerve, phrenic nerve, ventral rami and trunks of the brachial plexus, subclavian artery, and cutaneous branches of the cervical plexus

Question 37

what forms the external jugular vein? where does it course? what does it drain into?

Answer 37

formed by nion of posterior auricular and retromandibular vein crosses the SCM obliquely, pierces the investing fascia drains into the subclavian vein

Question 38

where does the subclavian vein course? what does it join with and then become? what other structures drain here?

Answer 38

subclavian passes anterior to the phrenic nerve and anterior scalene it joins with the internal jugular vein to form a brachiocephalic vein posterior to the medial end of the clavicle the right lymphatic duct and thoracic duct drain into the right and left brachiocephalic veins, respectively

Question 39

where do the suprascapular and transverse cervical arteries arise from? where do they course? what do they supply?

Answer 39

thyrocervical trunk of the subclavian pass anterior to the anterior scalene and phrenic nerve, and cross the posterior triangle trapezius, rhomboids, levator scapulae, muscles that attach to posterior scapula

Question 40

where does the occipital artery arise from and what is its course in the posterior triangle?

Answer 40

external carotid artery (this is in a previous flashcard…..) passes through the apex of the posterior triangle

Question 41

the accessory nerve (CN XI)’s motor axons arise from which ventral roots? what is its course? what does it innervate?

Answer 41

first 4-5 cervical nerves enters the subarachnoid space, passes through the foramen magnum into the cranial cavity exits skull through the jugular foramen (with glossopharyngeal and vagus nerves) innervates the SCM, then crosses the posterior triangle to innervate the trapezius

Question 42

what occurs with a lesion to the accessory nerve within the posterior triangle?

Answer 42

weakness of the trapezius muscle–>patient has difficulty elevating the scapula (shrugging shoulder) and in laterally rotating the scapula during abduction of the arm if the lesion is inferior to the jugular foramen, may also have weakness in the SCM–>decreased ability to turn the chin to the side opposite the lesioned nerve

Question 43

where does the phrenic nerve course in the posterior triangle?

Answer 43

anterior surface of the anterior scalene muscle, deep to the prevertebral fascia

Question 44

what lies between the anterior and middle scalene muscles in the posterior triangle?

Answer 44

ventral rami and the trunks of the brachial plexus and the subclavian artery

Question 45

where do the cutaneous branches of the cervical plexus arise from? where do they course?

Answer 45

ventral rami of the C1-C4 spinal segments pierce the investing and superficial fascia emerge posterior to the SCM halfway between its sternal and mastoid atachments

Question 46

what branches are included in the cutaneous branches of the cervical plexus?

Answer 46

great auricular nerve (C2, C3) lesser occipital nerve (C2) transverse cervical nerve (C2, C3) supraclavicular nerves (C2, C3, C4)

Question 47

what do the cutaneous branches of the cervical plexus supply?

Answer 47

skin of the anterior and lateral neck (including skin over the angle of the mandible) skin of the scalp posterior to the vertex of the skull, the coronal plane through the most superior aspect of the cranium

Question 48

what does the superficial cervical fascia contain?

Answer 48

platysma (muscle of facial expression)

Question 49

what are the boundaries of the anterior triangle of the neck?

Answer 49

anterior border of the SCM, anterior midline, mandible

Question 50

what is contained in the anterior triangle?

Answer 50

structures in the visceral compartment of the neck hyoid bone infrahyoid muscles suprahyoid muscles

Question 51

where is the hyoid bone situated?

Answer 51

anterior triangle at the level of the C3 vertebra

Question 52

what are the 4 infrahyoid muscles?

Answer 52

sternohyoid sternothyroid superior and inferior bellies of the omohyoid thyrohyoid

Question 53

what innervates the infrahyoid muscles?

Answer 53

muscular branches of the cervical plexus, specifically– sternohyoid, sternothyroid, superior and inferior bellies of omohyoid: ansa cervicalis thyrohyoid: C1 fibers

Question 54

what makes up the ansa cervicalis?

Answer 54

superior root from C1 ventral ramus that hitchhikes with the hypoglossal nerve inferior root from C2 and C43 central rami that joins with superior root anterior to carotid sheath

Question 55

what are the 4 suprahyoid muscles?

Answer 55

geniohyoid, mylohyoid, stylohyoid, and anterior and posterior bellies of the digastric

Question 56

what innervates the suprahyoid muscles?

Answer 56

mylohyoid and anterior belly of digastric: trigeminal nerve stylohyoid and posterior belly of digastric: fascial nerve geniohyoid: C1 fibers from cervical plexus

Question 57

what are the parts of the pharynx and where is the pharynx located?

Answer 57

nasopharynx, oropharynx, laryngopharynx fibromuscular tube that extends from the nasal cavity to the cricoid cartilage at the 6th vertebra

Question 58

where is the nasopharynx located?

Answer 58

superior to soft palate and posterior to naval cavity

Question 59

the lateral wall of the nasopharynx contains openings for what structures?

Answer 59

auditory tube, levator veli palatini, tensor veli palatini, salpingopharyngeus

Question 60

what innervates the mucosa of the nasopharynx?

Answer 60

pharyngeal nerve, branch of maxillary division of V2, branches of the glossopharyngeal nerve (CN IX) in the pharyngeal plexus

Question 61

where is the oropharynx located?

Answer 61

between the soft palate and the tip of the epiglottis (posterior to the oral cavity)

Question 62

the lateral wall of the oropharynx contains what structures?

Answer 62

palatoglossal arches: containing palatoglossal muscles palatopharyngeal arches: containing palatopharyngeal muscles the two arches are separated by the tonsillar fossa: contains the palatine tonsil

Question 63

the floor of the oropharynx contains what structure? and what is that structure innervated by?

Answer 63

posterior 1/3 of the tongue both taste and general sensation of the tongue are carried by the lingual branches of the glossopharyngeal nerve (CN IX)

Question 64

where is the laryngopharynx and what is it continuous with?

Answer 64

extends from the epiglottis behind the larynx to the level of the cricoid cartilage then it is continuous with the esophagus

Question 65

what does the lateral wall of the laryngopharynx contain?

Answer 65

piriform recess the internal branch of the superior laryngeal nerve of the vagus nerve and the superior laryngeal artery course in the wall of the piriform recess

Question 66

what innervates the mucosa of the laryngopharynx?

Answer 66

internal branch of the superior laryngeal nerve of the vagus?

Question 67

the pharynx consists of skeletal muscles that form two layer, which is circular and which is longitudinal?

Answer 67

outer is circular inner is longitudinal

Question 68

the circular layer is formed by what 3 muscles?

Answer 68

superior, middle, and inferior constrictor muscles which overlap and interdigitate in the posterior midline at the pharyngeal raphe

Question 69

contraction of the 3 constrictor muscles results in what action?

Answer 69

propels a bolus through the oropharynx and laryngopharynx during swallowing

Question 70

the inner longitudinal muscle layer is formed by what 3 muscles?

Answer 70

salpingopharyngeus, palatopharyngeus, stylopharyngeus which expand and insert into the pharyngeal wall

Question 71

what is the action of the inner longitudinal muscles?

Answer 71

elevate the pharynx during swallowingq

Question 72

all the muscles of the pharynx are innervated by what?

Answer 72

branches of the vagus nerve (through the pharyngeal plexus) EXCEPT the stylopharyngeus is innervated by the glossopharyngeal nerve ADDITIONALLY, the inferior constrictor is also innervated by the external laryngeal nerve and the recurrent laryngeal branches of the vagus

Question 73

at what level of the vertebra dos the esophagus begin and what pharynx muscle is continuous with it?

Answer 73

C6, inferior constrictor

Question 74

what structures enter between the superior constrictor of the pharynx and the base of the skull?

Answer 74

auditory tube, levator veli palatini muscle, and ascending palatine artery enter the nasopharynx at this location

Question 75

what structures enter between the superior and middle constrictors of the pharynx?

Answer 75

stylopharyngeus, stylohyoid ligament, glossopharyngeal nerve (CN IX) enter the oropharynx at this location

Question 76

what structures enter between the middle and inferior constrictors of the pharynx?

Answer 76

internal branch of the superior laryngeal nerve of the vagus (CN X) and the superior laryngeal artery and vein enter the laryngopharynx at this lcoation

Question 77

what structures enter the pharynx between the inferior constrictor and the esophagus?

Answer 77

inferior laryngeal nerve of CN X and the inferior laryngeal artery

Question 78

what types of axons and fibers does the glossopharyngeal nerve (CN IX) contain?

Answer 78

skeletal motor axons, preganglionic parasympathetic axons, taste fibers, general sensory fibers

Question 79

what part of the skull does the glossopharyngeal nerve transverse?

Answer 79

jugular foramen

Question 80

what muscles does the glossopharyngeal nerve innervate?

Answer 80

only the stylopharyngeus

Question 81

where do the preganglionic parasympathetic axons of the glossopharyngeal nerve course and what do they innervate?

Answer 81

course in the tympanic nerve and in the lesser petrosal nerve the lesser petrosal nerve passes through the foramen ovale and synapses in the otic ganglion, located in the infratemporal fossa (just below the foramen ovale) post ganglionic parasympathetic axons from the otic ganglion join with the auriculotemporal nerve to innervate the parotid gland

Question 82

what are the sensory and taste branches of the glossopharyngeal nerve and what do they innervate?

Answer 82

through the pharyngeal plexus (also containing vagus nerve fibers and postganglionic sympathetics), it innervates the mucous membranes of the posterior wall of the oropharynx and the nasopharynx inferior to the entrance of the auditory tube the lingual branch conveys sensation and taste from the posterior 1/3 of the tongue the tonsillar branch supplies the mucosa of the palatoglossal and palatopharyngeal arches and the intervening tonsillar fossa the carotid sinus branch innervates the carotid body and the carotid sinus

Question 83

what is the gag reflex and how does it work?

Answer 83

uses sensory fibers of the glossopharyngeal nerve in the oropharyngeal mucosa and motor fibers in the vagus nerve when CN IX is stimulated, the pharyngeal musculature bilaterally contracts and elevates the soft palate

Question 84

what is jugular foramen syndrome and what are the symptoms associated?

Answer 84

lesions of the glossopharyngeal nerve can occur in conjunction with the vagus nerve and accessory nerve in jugular foramen syndrome it is diagnosed by loss of the gag reflex

Question 85

what can be lesioned during tonsilectomy and what symptoms does this result in?

Answer 85

lingual branch of CN IX loss of all sensation from the posterior 1/3 of the tongue

Question 86

middle ear infections can infect what nerve and will result in what associated symptoms?

Answer 86

preganglionic parasympathetic axons of CN IX that synapse in the otic ganglion reduced parotid gland secretions this is difficult to evaluate because the submandibular and sublingual salivatory glands which are innervated by the facial nerve continue to contribute to the volume of saliva

Question 87

what types of axons and fibers does the vagus nerve (CN X) contain?

Answer 87

same as glossopharyngeal…. skeletal motor axons, preganglionic parasympathetic axons, taste fibers, general sensory fibers

Question 88

what part of the skull does the vagus nerve transverse?

Answer 88

same as glossopharyngeal…. jugular foramen

Question 89

what muscles does the vagus nerve innervate?

Answer 89

all muscles of the palate EXCEPT the tensor veli palatini all muscles of the pharynx EXCEPT for the stylopharyngeus all the muscles of the larynx

Question 90

what mucosa does the vagus nerve innervate?

Answer 90

root of the tongue and in the laryngopharynx and larynx

Question 91

the vagus nerve also carries visceral sensations other than pain from and its preganglionic parasympathetic axons go to terminal ganglia in what areas of the body?

Answer 91

thoracic and abdominal viscera

Question 92

what occurs with lesions to the vagus nerve?

Answer 92

complete lesions result in weakness of palate, pharyngeal, and laryngeal muscles weakness of the levator veli palatini–>drooping of palate on side of the injured nerve and a deviation of the uvula to the opposite site; nasal speech and nasal regurgitation of liquids during swallowing weakness of pharyngeal constrictors–>dysphagia (difficulty swallowing) if the lesion includes the laryngeal nerves–>weakness of all laryngeal muscles on the affected side so that the vocal cord assume a fixed position midway between abduction and adduction–>hoarse speech and week lesions of the pharyngeal branch and laryngeal nerves–>loss in motor limb of the gag reflex and cough reflex, respectively

Question 93

what is the general purpose of the larynx?

Answer 93

consists of cartilage and skeletal muscles that open and close the airway to allow phonation

Question 94

where is the vestibule of the larynx located?

Answer 94

at the inlet of the larynx behind the epiglottis and extends to the vestibular folds

Question 95

what is the ventricle of the larynx and where is it lcoated?

Answer 95

narrow eclipse-shaped space, situated between vestibular folds and the vocal folds

Question 96

what is contained in the infraglottic space and where is this space located?

Answer 96

inferior to the vocal folds rima glottis and glottis

Question 97

what is the rima glottis?

Answer 97

opening between the vocal folds

Question 98

what is the glottis?

Answer 98

rima glottidis+vocal folds

Question 99

what cartilages make up the larynx?

Answer 99

single cartilages: cricoid cartilage and thyroid cartilage pair of arytenoid cartilages

Question 100

where do the cartilages lie in relationship to one another in the larynx?

Answer 100

all articulate with one another at synovial joints thyroid cartilage (V-shaped) articulates inferiorly with the cricoid cartilage (ring-shaped) inferior to that, the cricoid is continuous with the trachea arytenoid cartilages lie on the posterosuperior aspect of the cricoid cartilage and have muscular and vocal processes - the vocal ligaments extend anteriorly from the vocal processes to attach to the posterior thyroid cartilage

Question 101

what 3 structures make up the vocal fold/cord?

Answer 101

vocal ligament covered by a thyroarytenoid muscle which is then covered by mucosa

Question 102

what are the two sets of 2 skeletal muscles of the larynx which each have antagonistic actions?

Answer 102

lateral cricoarytenoid muscles (adduct vocal ligaments) and posterior cricoarytenoid muscles (abduct vocal ligaments) - both rotate the arytenoid cartilages on the cricoid cartilage thryoarytenoid muscles (relax vocal ligaments) and cricothyroid muscles (tense vocal ligaments)

Question 103

how do the thyroarytenoid muscles and cricothyroid muscles relax and tense the vocal ligaments? what regulates both the tension?

Answer 103

thyroarytenoid muscles pull the arytenoid cartilages closer to the thyroid cartilage cricothyroid muscles rock the superior aspect of the thyroid superiorly at its articulation with the cricoid, increasing the distance between the cartilages the vocalis mucles (medial part of the thyroarytenoid) adjusts the tension in small segments of the vocal ligament

Question 104

what innervates the muscles of the larynx?

Answer 104

inferior laryngeal nerve, a branch of the recurrent laryngeal nerve of the vagus (except the cricohyoid muscle, which is innervated by the external branch of the superior laryngeal nerve)

Question 105

what innervates the mucosa above and below of the vocal cords?

Answer 105

above: internal branch of the superior laryngeal nerve below: recurrent laryngeal nerve

Question 106

what symptoms are associated with lesions to the superior laryngeal nerve?

Answer 106

largely asymptomatic because its fibers are mainly sensory if the motor fibers to the cricothyroid are affected by a lesion of the external branch–>mild hoarseness and slight decrease in vocal strength with tendency to produce monotonous speech

Question 107

during surgeries involving the thyroid gland, which nerves are susceptible to injury? what symptoms will this result in?

Answer 107

both recurrent laryngeal nerves fixed vocal cord and transient hoarseness

Question 108

which recurrent laryngeal nerve is more at risk for injury? why?

Answer 108

left recurrent laryngeal nerve injured more frequently because in the superior mediastinum it hooks around the arch of the aorta and might be compressed during an aortic aneurysm the right is found only in the neck where it hooks around the subclavian artery

Question 109

at what level of the vertebra does the trachea begin?

Answer 109

C6 begins inferior to the cricoid cartilage

Question 110

at what level of the vertebra does the trachea bifurcate?

Answer 110

between T4 and T5

Question 111

how are the cartilage and muscle of the trachea structured?

Answer 111

cartilage rings that are incomplete posteriorly and a posterior wall of smooth muscle

Question 112

how is the thyroid gland and its parts positioned in relation to the trachea?

Answer 112

lobes are lateral to the trachea isthmus passes anterior to the second or third tracheal rings and interconnects the lobes

Question 113

what hormones does the thyroid gland produce?

Answer 113

triiodothyronine (T3), thyroxine (T4) and calcitonin

Question 114

how many parathyroid glands are there? where are they positioned in relation to the thyroid gland? what do the parathyroid glands produce?

Answer 114

4 (pair of superior glands and pair of inferior glands) posterior to the lobes of the thyroid, nearly embedded parathyroid hormone (has opposite action to calcitonin)

Question 115

what arteries supply the thyroid and parathyroid glands?

Answer 115

superior and inferior thyroid arteries

Question 116

which nerve courses with the superior thyroid artery and where? which nerve courses in proximity to the inferior thyroid artery and where?

Answer 116

external branch of the superior laryngeal nerve of the vagus courses with the superior thyroid artery recurrrent laryngeal nerve courses in the groove between the trachea and esophagus in proximity to the inferior thryoid artery