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Anatomy > Neck, axilla and breast > Flashcards

Neck, axilla and breast Flashcards

1
Q

Label the fascia of the neck

A

1= prevertebral fascia
2=Platysma
3=pretracheal fascia
4=Investing layer
5=Sternomastoid
6=Carotid sheath

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2
Q

Describe the attachments, innervation and action of the sternocleidomastoid muscle

A

Attachments -
Superiorly : lateral surface of mastoid process of temporal bone & nuchal line ; inferiorly: manubrium of sternum , medial third of clavicle

Innervation - spinal accessory nerve (CN XI); C2 and C3 (pain and proprioception)

Action - lateral flexion of neck , chin up and down , accessory muscle of respiration

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3
Q

Describe the location, innervation and function of the trapezius muscle

A

Location - posterior border of posterior triangle

Attachments - superiorly the nuchal ligament, occipital protuberance, spinous processes of C7-T12; inferiority the clavicle and scapula

Innervation- spinal accessory nerve (CN XI) ; C2 and C3 (pain and propioception)

Fucntion - elevate retract and rotate the scapulae

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4
Q

what is the clinical relevance of the scalene muscles

A

The brachial plexus and subclavian artery pass between the anterior and middle scalenes. The subclavian vein and phrenic nerve pass anteriorly to the anterior scalene as the muscle crosses over the first rib.

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5
Q

Name the 2 neck triangles and their subdivisions

A

Anterior triangle :

  • Submental
  • Submandibular
  • Carotid
  • muscular

Posterior triangle:

  • occipital
  • subclavian
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6
Q

What forms the superior/lateral/medial borders of the anterior triangle

A

Superior - mandible
Lateral - sternocleidomastoid muscle
Medial - anterior midline of neck

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7
Q

What anatomical landmarks are structurally significant when inserting a central venous catheter in the neck region?

A

catheter can be inserted either in internal jugular vein or the subclavian Veins

subclavian veins pass anterior to first rib

phrenic nerves/anterior scalene pass very close to the IJV and SCV

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8
Q

Muscular triangle boundaries and contents *

A

The muscular triangle contains some muscles and organs – the infrahyoid muscles, the pharynx, and the thyroid, parathyroid glands.

The boundaries of the muscular triangle are:

  • Superiorly – hyoid bone.
  • Medially – imaginary midline of the neck.
  • Supero-laterally – superior belly of the omohyoid muscle.
  • Infero-laterally – inferior portion of the sternocleidomastoid muscle.

More of a trapezium than a triangle

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9
Q

The external jugular vein passes above the

A

Sternocleidomastoid muscle

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10
Q

Submandibular triangle boundaries and contents

A

Boundaries :

Superiorly – body of the mandible.

Anteriorly – anterior belly of the digastric muscle.

Posteriorly – posterior belly of the digastric muscle.

Contents :

submandibular gland
facial artery and vein
submandibular lymph nodes - drains tongue mouth
salivary gland
Hypoglossal nerve (CN XII)

mylohyoid nerve

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11
Q

Carotid triangle contents and boundaries

A

Boundaries - posterior belly of digastric muscle, superior belly of omohyoid, SCM

Content:

Carotid sheath- common carotid artery, internal jugular vein, vagus nerve
Deep cervical lymph nodes
Hypoglossal nerve (CN XII)
Cervical plexus

thryoid gland

larynx/pharynx

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12
Q

Submental triangle boundaries and contents

A

Found just below chin

Boundaries : inferiorly, the hyoid bone; laterally by the right and left inferior bellies of the digastric muscles ; the apex is at the mandibular symphysis ; roof is formed by the mylohyoid bones

Content:
submental lymph nodes

anterior jugular vein ; facial artery and veins

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13
Q

pancoast tumour; what is it and describe the possible complications

A

Cancers that start in the apex of the lung and spread to : Upper ribs/nerves in upper thorax and neck/nerves near spinal cord/blood vessels supplying the upper limb

most are a non small cell cancer (squamous cell cancer arising from cells lining the airway)

can result in compression of brachial plexus or Horner syndrome

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14
Q

What does the prefix -omo mean?

A

Shoulder

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15
Q

What does jugular mean

A

Throat

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16
Q

Describe the hyoid bone

A

Not attached to another bone - suspended by muscles and ligaments

Attachments for neck and tongue muscles

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17
Q

Label the superior view of the atlas (C1)

A
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18
Q

Label the inferior view of the atlas

A
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19
Q

Describe the articulation between the atlas and axis articulation

A

The Atlantoaxial joint is composed of three synovial joints: one median atlantoaxial joint and two lateral atlantoaxial joints.

Lateral atlanto-axial joints (x2) – formed by the articulation between the inferior facets of the lateral masses of C1 and the superior facets of C2. These are plane type synovial joints.

Medial atlanto-axial joint – formed by the articulation of the dens of C2 with the articular facet of C1. This is a pivot type synovial joint.

The transverse ligament joins the axis and atlas

Allows the rotation of the neck left and right

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20
Q

What are the 3 main features of most cervical vertebrae

A

Triangular vertebral foramen.
Bifid spinous process – this is where the spinous process splits into two distally.
Transverse foramina – holes in the transverse processes. They give passage to the vertebral artery, vein and sympathetic nerves.

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21
Q

label these three structures; indicate the point of entry for an emergency cricothyroidotomy

A 
1 = hyoid bone
2= thyroid cartilage 
3= cricoid cartilage
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22
Q

Identify the coloured structures

A
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23
Q

Define anterior, posterior and primary ramus

A

The anterior/ventral ramus innervates the skin and muscle on the anterior aspect of the trunk, while the posterior/dorsal ramus innervates the post-vertebral muscles and the skin of the back

The roots of the brachial plexus are the anterior ramii

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24
Q

Label the structures in the root of the neck

A

Phrenic nerve anterior to anterior scalene
Subclavian artery posterior to anterior scalene

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25
Q

Contents of the vertebral artery triangle

A

Carries the vertebral artery and phrenic nerve

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26
Q

Borders of the axilla

A
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27
Q

Identify the muscles here

A
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28
Q

Contents of axilla

A

Brachial plexus
Axillary arteries, veins and lymph nodes
Bicep and corachobrachialis tendons

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29
Q

What is the most common direction in which dislocation occurs?
Which nerve is in most danger when the shoulder joint is dislocated ?

A

Anterior dislocation
Axillary nerve

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30
Q

The axillary artery passes under and over which muscles ?

A

Under the pec minor
Over the teres major

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31
Q

Identify the axillary artery and vein

A
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32
Q

The subclavian vein branches into the ____ ____ and the _____ _____

A

Cephalic vein and axillary vein

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33
Q

Label the breast

A

The lobules are the milk glands that produce milk

the lactiferous ducts transfer the milk from the lobules to the nipple

suspensory ligaments attach the breast to the dermis and pectoral fascia as well as separating the secretory lobules of the breast

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34
Q

What vessels will supply and drain the breast tissue

A

Superior thoracic artery
Internal mammary artery
Acromiothoracic artery
Ancillary artery
Thoracodorsal artery

Axillary vein
Lateral thoracic vein
Internal mammary vein

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35
Q

Posterior triangle boundaries, roof and floor

A

Sternocleidomastoid muscle
Trapezius
Clavicle

Roof - deep investing fascia
Floor - prevertebral fascia

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36
Q

Contents of posterior triangle

A

Cervical plexus/brachial plexus/subclavian artery (found between mid scalene muscle and the anterior scalene muscle)
External jugular vein
Floor - omohyoid muscle , transverse cervical and suprascapular arteries, spinal accessory nerve (CN XI), the 3 scalene muscles , splenius capitis, levator scapulae,

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37
Q

Omohyoid muscle

A

in the posterior triangle region

split into two bellies by a tendon.

The inferior belly crosses the posterior triangle, travelling in an supero-medial direction, and splitting the triangle into two (occipital triangle and supraclavicular triangle).

The muscle then crosses underneath the SCM to enter the anterior triangle of the neck.

38
Q

Label the suprahyoid and infrahyoid muscles of the neck

A
39
Q

Where does the subclavian artery become the axillary artery?

A

Once it passes below the clavicle it becomes the axillary artery

40
Q

Veins of the neck

A

SVC —> R and L brachiocephalic veins

R and L brachiocephalic veins —> L/R subclavian vein +L/R internal jugular vein

41
Q

Great arteries of neck

A

Seen at C7

42
Q

What are fascia

A

Strand or sheets of fibrous connective tissue that wrap around the organs to form compartments

43
Q

Contents of superficial fascia

A

Outermost layer of fascia
Subcutaneous tissue , platysma tissue and cutaneous vein,artery and nerve

44
Q

Location/contents/boundaries of the deep investing fascia

A

Just below superficial fascia
Encircles the neck
Envelops the traps/SCM
Forms the rood of the posterior triangle
Pierced by cutaneous branches of cervical plexus and EJV

Boundaries :
Anteriorly - mandible, hyoid, sternum
Posteriorly - occipital, nuchal ligament, traps

45
Q

Location/contents of pretracheal fascia

A

Forms visceral compartment - contains trachea, thyroid, recurrent laryngeal nerve, oesophagus, parathyroid gland

46
Q

summarise the branches of the brachial plexus and the muscles they innervate

A
47
Q

define the terms anterior (ventral) and posterior (dorsal) primary ramus​

A

A primary ramus is a branch of a spinal nerve​

48
Q

summarise the brachial plexus

A

remember to drink cold beer

49
Q

groups of ventral rami

A

Cervical plexus (C1-C5) supplies head & neck​

​

Brachial plexus (C5-T1) supplies upper limb​

​

Nerves of the trunk (T1-L1) supply trunk​

​

Lumbosacral plexus (L1-S3) supplies trunk & lower limb​

​

Sacrococcygeal plexus (S3-S5) supplies pelvis & lower trunk​

50
Q

location of cervical plexus

A

located in posterior triangle of neck halfway up SCM, and within prevertebral fascia ; derived from cervical rami C1-C4

51
Q

Label the cervical spine

A
52
Q

Nerves of cervical plexus

A
53
Q

Name the nerves of the cervical plexus innervating each of the highlighted areas and the vertebral origin

A
54
Q

Label this diagram of the superficial fascia

A
55
Q

Platysma - attachments, innervation and actions

A

Attachments - superiorly : inferior border mandible, skin and subcutaneous tissue of lower face. Inferiorly : fascia covering superior parts of pec major and deltoid

Innervation - cervical branch off the facial nerve (CN VII)

Actions - draws corners of mouth inferiorly and widens in expression of sadness and fright

56
Q

label the structures within the neck at level of C7

A
57
Q

label the infra hyoid muscles

A
58
Q

label the clavicle; describe the superior and inferior surfaces

A

superior surface is mostly subcutaneous ; inferior surface - attachment of subclavius muscle and site of important ligaments attaching it to the coracoid process

59
Q

label the mandible

A
60
Q

label the hyoid bone

A
61
Q
A
62
Q

Label the arteries of the neck

A
63
Q

Identify the structures X and Y of the brachial plexus

A
64
Q

Identify the muscles of the posterior wall

A
65
Q

Boundaries of delta pectoral triangle

A

Clavicle
Deltoid
Clavicular head of deltopectoral triangle

The deltopectoral triangle is a palpable hollow area

66
Q

Lymph vessels drain into the

A

Venous system

67
Q

What causes Horner syndrome and what are the symptoms?

A

Lesion of a sympathetic trunk in the neck

  • Pupillary constriction resulting from paralysis of the dilator pupillae muscle.
  • Ptosis (drooping of the superior eyelid), resulting from paralysis of the smooth (tarsal) muscle intermingled with striated muscle of the levator palpebrae superioris.
  • Sinking in of the eyeball (enophthalmos), possibly caused by paralysis of smooth (orbitalis) muscle in the floor of the orbit.
  • Vasodilation and absence of sweating on the face and neck (anhydrosis), caused by a lack of sympathetic (vasoconstrictive) nerve supply to the blood vessels and sweat glands.
68
Q

Pressure on the brachial plecuts can cause specific symptoms ; describe them

A

Severe pain in the shoulder or scapula

pain in the arm or weakness of the hand in the affected side

69
Q
A
70
Q

The shoulder joint is formed by articulation between the ____ ____ with the ____ ____

what type of joint is it and what kind of cartilage covers it?

A

Humeral head ; glenoid fossa (of scapula)

synovial joint; covered by hyaline cartilage

71
Q

Why should special attention be given to the parathyroid glands during a thyroidectomy

A

parathyroid glands are situated behind the lateral lobes of thyroid

high risk of being damaged/removed during surgery

as parathyroid responsible for increase [Ca2+], remove results in hypocalcaemia

hypocalcaemia symptoms ; tetanus, muscle cramps, tingling of fingers/toes/mouth

72
Q

Which nerve are close to the (a) superior thyroid artery and the (b) inferior thyroid artery and why Is this clinically relevant

A

A) external laryngeal nerve

b) recurrent laryngeal nerve

important to not damage during thyroid surgery as this can cause problems with speech and Swallowing

73
Q

describe carotid sinus hypersensitivity

A

Exaggerated response to carotid sinus baroreceptor stimulation = HR/BP dangerously fall = fainting and falls (particularly dangerous in older patients)

often in people with atheroscleoris

74
Q

Where on the axillary artery must a blockage occurs for the anastomosis to maintain an uncompromising supply of blood to the rest of the upper limb?

A

Between 1st part of the subclavian artery and 3rd part of axillary artery

75
Q

Define anastomosis

A

Communication between neighbouring vessels via branching pre-capillaries

76
Q

Label the axial projection of the shoulder joint

A
77
Q

Damage to the C5/6 roots of brachial plexus

symptoms

A

Loss of lateral rotation of shoulder

loss of abduction and elbow flexion

reduced ability to extend wrist

sensory loss at thumb and index

78
Q

symptoms of damage to C8/T1

A

Loss of finger extension

finger and thumb flexion

sensory loss of ring/little finger

Horner syndrome may occur - drooping of eyelid/absence of sweat in cheek/excess pupil constriction/posterior displacement of eye

79
Q

Which root and trunks of the brachial plexus will be most likely to be affected by a Pancoasts tumour?

A

C5/6 in early disease = arm and shoulder pain

C8/T1 in late disease = horners syndrome

80
Q

some people are born with an extra rib above the first rib called the cervical rib

Describe the possible complications

A

Thoracic outlet syndrome via compression of C8/T1

81
Q
A
82
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A
83
Q
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84
Q
A
85
Q
A
86
Q
A
87
Q
A
88
Q
A
89
Q

The lateral chord forms branches off into

A

Lateral pectoral nerve

musculocutaneus nerve

lateral root of median nerve

90
Q

The posterior chord branches off into

A

Superior subscapular nerve,

thoracodorsal nerve

inferior subscapulnar

axillary nerve

radial nerve

91
Q

the medial chord branches off into

A

Medial pectoral

medial cutaneous nerves of arm and forearm

medial root of median nerve

ulnar nerve

Anatomy (8 decks)

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