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FAB > Neck > Flashcards

Neck Flashcards

1
Q

Why is the neck considered a conduit

A

It is the portion of the body connecting the head and thorax

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2
Q

Give the borders of the neck posteriorly and anteriorly

A

Posterior: from base of skull to top of T1 vertebra

Anterior: from mandible to top of manubrium and 1st costal cartilage

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3
Q

What is the fundamental differences between the neck and trunk

A

Neck does not contain a coelomic cavity

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4
Q

Where does the oesophageal striated muscle come from embryologically

A

Occipital somites

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5
Q

Which abdominal organs are protected by the ribs

A

Liver
Stomach
Spleen
Kidneys

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6
Q

What innervates the diaphragm

A

Phrenic nerve from the cervical plexus

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7
Q

Which bronchus is more likely to received an inhaled foreign body

Why

A

Right main bronchus

It is more vertically oriented

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8
Q

What produces a pneumothorax

What do you call blood in the pleural cavity

A

Puncturing the lung

Haemothorax

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9
Q

What are the compartments of the fasciae of the neck

A

Cervical fascia
Prevertebral fascia
Carotid sheath
Pretracheal fascia

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10
Q

Describe the cervical fascia

A

Attached posteriorly to ligamentum nuchae
Continuous around the neck
Encloses sternocleidomastoid, trapezius and parotid glands

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11
Q

Describe the prevertebral fascia of the neck

A

A transverse septum anterior to prevertebral muscles and posterior to pharynx and oesophagus

Covers cervical and brachial plexuses as well as muscles in the floor of the posterior triangle

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12
Q

Describe the carotid sheath

A

Consists of areolar tissue which is strong over the carotid arteries and weak over the jugular vein

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13
Q

Why is the carotid sheath weak over the jugular veins

A

To allow for expansion

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14
Q

Describe the pretracheal fascia

A

Attached to thyroid and cricoid cartilages and time the 2nd-4th tracheal rings

Invests the thyroid gland and passed down into the thorax and pericardium

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15
Q

What are the boundaries of the anterior triangle

A

Posterior: anterior border of sternocleidomastoid

Anterior: midline, between Mentum and suprasternal notch

Superior: inferior aspect of mandible, rising to an ape at the mastoid process of the temporal bone

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16
Q

What are the major structures passing through the anterior triangle of the neck (10)

A 
Pharynx 
Larynx
Trachea
Oesophagus
Thyroid
Common, internal and external carotid arteries 
Jugular veins
Vagus
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17
Q

Where is the posterior triangle of the neck

A

Lateral

It spirals around the neck

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18
Q

Where is the apex of the posterior triangle

A

Near the mastoid process

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19
Q

What are the boundaries of the posterior triangle of the neck

A

Posterior: anterior border of trapezius

Anterior: posterior border of sternocleidomastoid

Inferior: middle third of clavicle

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20
Q

What passes through the posterior triangle of the neck

A

Most structures supplying upper limb as well as spinal accessory nerve

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21
Q

Where is the fleshy insertion of sternocleidomastoid

Is there another?

A

Fleshy insertion on medial clavicle

Tendinous insertion on anterior manubrium

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22
Q

What does sternocleidomastoid do

A

Rotated face in opposite direction and tilts ear towards same shoulder

Acting bilaterally the muscles both flex lower cervical spine and extend upper cervical spine

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23
Q

How does trapezius affect the head when acting

a) bilaterally
b) unilaterally

A

a) extend cervical spine

b) rotates head to other side

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24
Q

What are the insertions (3) and origins (4) of trapezius

A

Origin: superior nuchal line
External occipital protuberance
Ligamentum nuchae
Spines and supraspinous ligaments of all T vertebrae

Insertion: lateral 1/3 of posterior clavicle, medial acromion, upper border of spine of scapula

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25
Q

True or false sternocleidomastoid and trapezius are supplied by the same nerve

A

True! The spinal accessory nerve

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26
Q

Where does the accessory nerve emerge and how does it reach trapezius

What is characteristic about its appearance

A

1/3 of the way down posterior sternocleidomastoid and crosses posterior triangle to supply trapezius

Wavy and superficial

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27
Q

What forms the floor of the posterior triangle

What covers this floor

A

Scalene muscles and levator scapulae

Prevertebral fascia

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28
Q

What is the origin of the scalenes

Which direction do the fibres run in

A

Arise from transverse processes of cervical vertebrae

Inferolaterally

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29
Q

What are the attachments of the scalenes

A

Scalenus anterior and medius: first rib

Scalenus posterior: second rib

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30
Q

What is the structure of the hyoid bone

A

U shaped with a body and greater and lesser horns

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31
Q

What is the hyoid particularly important for

A

Important support for the floor of the mouth and tongue

Intimately associated with pharynx and larynx

32
Q

What is important for control of the muscles controlling the tongue

A

Hyoid

33
Q

What are the suprahyoid muscles

A

Digastric
Stylohyoid
Mylohyoid
Geniohyoid

34
Q

Describe the digastric muscle

What is its function

A

Has 2 bellies and an intermediate tendon

Anterior belly arises from digastric fossa on the back of the mandible while the posterior belly descends from deep to the mastoid process

Elevate the hyoid in swallowing and depress mandible when chewing

35
Q

What are the strap muscles

A

Infrahyoid muscles

They include: sternohyoid, sternothyroid, omohyoid, thyrohyoid

36
Q

Which infrahyoid muscle has 2 bellies

A

Omohyoid

Extending from scapula to hyoid

37
Q

What are all infrahyoid muscles used in

Also

A

Chewing
Swallowing
Speech

They also stabilise the hyoid for the suprahyoid muscles

38
Q

What supplies the infrahyoid muscles

A

The ansa cervicalis (C1-3)

39
Q

Where is the thyroid

A

Within the pretracheal fascia, deep to the strap muscles

40
Q

How are the lobes of the thyroid connected

A

By an isthmus lying across the 2nd-4th tracheal rings

41
Q

How high can the thyroid rise

Why

What does this mean in thyroid expansion

A

Cannot ascend high than the oblique line

Overlying sternothyroid attached to thyroid cartilage

An enlarged thyroid must expand laterally and downwards even into superior mediastinum

42
Q

What produces calcitonin

What does it do

A

Thyroid gland

Lowers serum calcium

43
Q

Which arteries supply the thyroid

A

Superior thyroid (from external carotid) and inferior thyroid (from thyrocervical trunk from subclavian) arteries

44
Q

What is the venous drainage of the thyroid

A

Via superior, middle and inferior thyroid veins

45
Q

What produces parathormone

What does it do

A

Parathyroid glands

Raises serum calcium by mobilising it from skeleton

46
Q

True or false: upper parathyroid glands are more variable in position

A

No - lower parathyroid are more variable

47
Q

What arteries supply the parathyroid

A

Anastomoses between Superior and inferior thyroid arteries

48
Q

Which nerves are associated with the thyroid

A

Superior laryngeal

Recurrent laryngeal

49
Q

Where does the carotid sheath attach to the skull

A

The margins of the carotid foramen

50
Q

Where is the vagus nerve in the neck

A

Posterior to IJV and common carotid

51
Q

Where is the phrenic nerve in the neck

A

Under the prevertebral fascia on scalenus anterior

52
Q

How is the EJV formed

Where does it enter the subclavian

A

Union of the posterior division of retro-mandibular vein with posterior auricular vein

Midpoint of clavicle

53
Q

The EJV is superficial to what

A

Sternocleidomastoid

54
Q

Where does the IJV join the subclavian

A

Behind the Sternoclavicular joint to form the brachiocephalic vein

55
Q

How are the deep cervical nodes divided

A

Into superior and inferior groups lying among the IJV

56
Q

Describe the superior deep cervical nodes

From Where do they receive (6)

A

Contain jugulodigastric nodes associated with afferents from the palatine tonsils

They receive from sub mandibular nodes, cranium, tongue, larynx, lower pharynx, and thyroid gland

57
Q

Which nodes are associated with tongue drainage

A

Jugulo-omohyoid nodes (inferior group of deep cervical nodes)

58
Q

Where does the inferior group of deep cervical nodes receive from

A

Tongue

Lower neck

59
Q

Where does lymph from deep cervical nodes go

A

Forms as single trunk (the jugular lymphatic trunk) which opens into the thoracic duct or right lymphatic duct

60
Q

Where does the IJV run

Why is this important

How is the IHV accessed

A

From lobe of ear to Sternoclavicular joint

For insertion of central venous lines

Between sternal and clavicular heads of sternocleidomastoid or deep to posterolateral border of the muscle

61
Q

Where does the EJV run

A

From lobe of ear to mid clavicle

62
Q

What valves are between IJV and right atrium

What does this mean

Why is this not true or EJV

A

None

The height of the column of blood provides a direct measure of right atrial pressure

EJV has valves and passage through musculo- fascial layers

63
Q

How can IJV pulsation be seen

A

double wave flutter

By positioning patient at 45 degree angle to horizontal and shining a light across the neck

64
Q

Where is IJV pressure measured

A

Above manubrio-sternal angle (<3cm)

65
Q

What can be seen in the neck if right upper abdomen if compressed

What is this called

Why is this important clinically

A

Temporary rise in Jugular vein pressure

Hepatojugular reflex

Elevation of jugular vein pressure is a sign of heart failure and excessive infusion of IV fluids

66
Q

What is torticollis

A

Wryneck

When spinal accessory nerve is irritated by surrounding lymph nodes

There is excessive contraction of sternocleidomastoid and trapezius in that side

Face is rotated in opposite direction

67
Q

What can cause torticollis in babies

A

A tear during birth

68
Q

What is the danger of lymph node biopsy in posterior triangle

A

Injury to spinal accessory nerve

Complete loss of function leads to droopy shoulder due to paralysis of trapezius and unopposed action of opposite sternocleidomastoid

69
Q

What is important to remember in thyroid surgery

A

Superior and inferior thyroid arteries can be ligated
If this happens great care must be taken to avoid damage to external branch of superior laryngeal nerves and recurrent laryngeal nerves

70
Q

What is tracheostomy

A

Division of the vascular thyroid isthmus and incision of 2nd and 3rd tracheal rings for passage of a tube

71
Q

What do you do if the airway is blocked above the larynx

A

Emergency access to the airway can be gained via an incision in the cricothyroid membrane

72
Q

What is enlarged in tonsilitis

A

Jugulo omohyoid nodes

73
Q

What can a stab wound in the posterior triangle damage

A

Trunks of the brachial plexus

74
Q

Where does the thyroid develop

A

Lower end of the thyroglossal duct which begins at the developing tongue

75
Q

Where can thyroglossal cysts form

What is the sign

A

Anyway along the thyroglossal duct

Midline swelling that move up on protrusion of the tongue

76
Q

What is a lingual thyroid

A

Remnants of thyroid tissue found on the surface of the tongue

77
Q

What are brachial cysts

A

Lateral swellings resulting from a failure of normal pharyngeal development

FAB (10 decks)

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