Neck problem set

Question 1

What are the alphanumeric designations for the typical cervical vertebrae? What are the alphanumeric designations for the atypical cervical vertebrae?

Answer 1

Typical are C3-C6

Atypical are C1-C2 and C7

Question 2

• Vertebral body: small; inferior surface is convex; superior surface is concave
• Vertebral foramen: large and triangular in shape
• Transverse process: has foramina transversaria, a passage for vertebral vein and artery (typically, only vertebral vein passes through the C7 foramina transversaria)
• Spinous process: bifid

Answer 2

C3-C6

Question 3

• Ring-like
• No spinous process
• No body
• Right and left lateral masses
• Anterior arch
• Posterior arch
• Superior articular facets-form atlanto-occipital joint
• Has a groove for vertebral artery

Answer 3

C1

Question 4

• has a “peg-like” projection, the dens (odontoid process) that projects superiorly
• Dens has an anterior articular facet for the anterior arch of C1
• Dens has a posterior articular facet for the transverse ligament of the atlas

Answer 4

C2

Question 5

• The vertebra prominens
• Long spinous process
• Spinous process is not bifid
• Large transverse processes
• Small foramina transersaria

Answer 5

C7

Question 6

At what cervical vertebrae level would you typically find the hyoid bone

Answer 6

C3

Question 7

The hyoid bone is suspended by muscles that connect to bones or bone processes. List these bones or specific bone processes.

Answer 7

styloid process of temporal bone
manubrium of sternum
scapule

Question 8

What bone processes does the stylohyoid ligament attach to?

Answer 8

styloid process of temporal bone

Question 9

– Anterior: posterior sternocleidomastoid m.
– Posterior: anterior trapezius m.
– inferior: middle 1/3 of clavicle between sternocleidomastoid m. and trapezius m.
– Apex: where sternocleidomastoid m. and trapezius m. Meet on the superior nuchal line of occipital bone
– Roof: investing layer of deep cervical fascia
– Floor: muscles covered by prevertebral layer of deep fascia

Answer 9

lateral cervical region = posterior cervical triangle

Question 10

– Anterior: median line of the neck
– Posterior: anterior sternocleidomastoid m.
– Superior: inferior border of mandible
– Apex: jugular notch in the manubrium
– Roof: subcutaneous tissue containing the platysma m.
– Floor: pharynx, larynx, and thyroid gland

Answer 10

anterior cervical region = anterior cervical triangle

Question 11

Splenius capitis
Levator scapulae
Middle scalene
Posterior scalene
Sometimes the inferior part of anterior scalene

What region contains these

Answer 11

lateral cervical region or posterior cervical triangle

Question 12

Lateral branches of thyrocervical trunk
Part of the subclavian a.
Suprascapular a.
Cervicodorsal trunk
-	Superficial cervical a.
-	Dorsal scapular a.
Ascending cervical a.
Inferior thyroid a.

what neck region contains these

Answer 12

lateral cervical region or posterior cervical triangle

Question 13

External jugular vein (unites with subclavian v.)
Cervical dorsal v.
Suprascapular v.

Answer 13

lateral cervical region or posterior cervical triangle

Question 14

Spinal accessory (CN XI)
Roots of the brachial plexus (anterior rami of C5-C8 and T1)
Suprascapular n.
Roots of the cervical plexus (Anterior rami of C1-C4)
Ansa cervicalis n.
Lesser occipital n.
Greater auricular n. 
Transverse cervical n.
Supraclavicular n.
Phrenic n.

Answer 14

lateral cervical region or posterior cervical triangle

Question 15

Superficial cervical lymph nodes lie along external jugular vein
Deep cervical lymph nodes lie along internal jugular vein in carotid sheath.

Answer 15

lateral cervical region or posterior cervical triangle

Question 16

Suprahyoid and infrahyoid muscles

what region of neck

Answer 16

anterior cervical region

Question 17

Submental triangle
-Submental lymph nodes
Submandibular triangle
-Submandibular lymph nodes

what region of neck

Answer 17

anterior cervical region

Question 18

Submandibular triangle
-Submandibular gland
Thyroid
Parathyroid

what region of neck

Answer 18

anterior cervical region

Question 19

– Common carotid arteries
• Right—from brachiocephalic trunk
• Left—from aortic arch
– Internal and External carotid arteries
• Six branches of the external carotid a.
• Carotid sinus—dilation of the proximal internal carotid a.; innervated primarily by CN IX (carotid sinus nerve); baroreceptor reflex
• Carotid body—chemoreceptors; detect changes in blood gases; innervated primarily by CN IX (carotid sinus nerve)

what region of neck

Answer 19

anterior cervical region

Question 20

internal jugular vein

what neck region

Answer 20

anterior cervical region

Question 21

platysma

what is its attachment, innervation , action

Answer 21

attachment: inferior border of mandible and subcutaneous tissue of infra and supra clavicular tissue
innervation: cervical branch of facial nerve CN 7

action: bring skin around lower part of mouth -> down and out
- tenses skin of neck and depresses mandible

Question 22

A 40-year-old man had thyroid surgery to remove his papillary carcinoma. The external laryngeal nerve that accompanies the superior thyroid artery is injured. What would injury to this nerve affect in terms of the muscle and its action

Answer 22

cricothyroid muscle a tensor of the vocal ligaments

Question 23

A 30-year-old woman with a goiter must have her superior laryngeal artery ligated before surgical resection of the goiter. What nerve accompanies the superior laryngeal artery?

Answer 23

internal laryngeal nerve

Question 24

A 21 year-old man is injured when an assailant shoots him in the neck. The 21-year-old man has injury to his phrenic nerve. What spinal roots are associated with the phrenic nerve?

Answer 24

C3, C4, C5

Question 25

A 21 year-old man is injured when an assailant shoots him in the neck. The 21-year-old man has injury to his phrenic nerve. What muscle does the phrenic nerve pass by in the neck?

Answer 25

anterior scalene muscle

Question 26

A 16 year-old singer complains of vocal difficulty, and on examination she is unable to abduct the vocal cords during quiet breathing. What muscle is paralyzed?

Answer 26

posterior cricoarytenoid muscle

Question 27

A 75-year-old woman has difficulty in swallowing. What pair of muscles is most important in preventing food from entering the larynx during swallowing?

Answer 27

oblique arytenoid muscles and aryepiglottic muscles

Question 28

A 52-year-old man has difficulty in speaking. He cannot elevate his hyoid bone and floor of his mouth due to paralysis of the posterior belly of the digastric muscle. What nerve innervates this muscle?

Answer 28

posterior belly of digastric muscle is innervated by cranial nerve 7- facial nerve

Question 29

What nerve innervates the anterior belly of the digastric muscle?

Answer 29

CN V- V3 mandibular division

Question 30

What nerve innervates the stylopharyngeous muscle

Answer 30

glossopharyngeal nerve CN IX

Question 31

what nerve innervates the infrahyoid muscle

Answer 31

ansa cervicalis

Question 32

The pharyngeal reflex or gag reflex involves the contraction of the pharyngeal constrictor muscles and is evoked by touching the back of the pharynx. Afferent fibers that innervate the pharyngeal mucosa are branches of what nerve?

Answer 32

glossopharyngeal nerve IX

Question 33

A 46-year-old man experiences pain when moving his tongue, pharynx, and larynx. He has paralysis of three muscles that attach to the styloid process. What are these three muscles and what nerve innervates each of these muscles?

Answer 33

1. stylohyoid muscle - facial nerve 2. sytloglossus muscle- hypoglossal nerve 3. styloopharyngeus muscle - glossopharyngeal nerve

Question 34

A 16-year-old boy requires a low tracheotomy. This is done below the isthmus of the thyroid gland. What vein may be encountered when performing a low tracheotomy?

Answer 34

inferior thyroid vein

Question 35

A 20-year-old woman presents with a swelling on her neck and examination reveals infection of the carotid sheath. What structures would be potentially affected?

Answer 35

``` internal jugular vein, vagus nerve, common carotid artery, internal carotid artery, glossopharyngeal nerve of carotid sinus and carotid body, sympathetic nerve fibers, deep cervical lymph nodes. ```

Question 36

A cricothyrotomy is performed on a 13-year-old boy. Answer the following questions based on this case. What ligament has to be pierced? What is the space between the vocal folds and arytenoid cartilages?

Answer 36

1. cricothyroid ligament | 2. rima glottidis

Question 37

What is the cavity extending from the rima glottidis to the lower border of the cricoid cartilage?

Answer 37

infraglottic cavity

Question 38

What is the space that extends from the laryngeal inlet to the vestibular folds?

Answer 38

laryngeal vestibule

Question 39

What is the space that extends between the vestibular fold and the vocal fold?

Answer 39

middle part of the laryngeal cavity

Question 40

What is the “pear-shaped” recess that is in the wall of the laryngopharynx lateral to the arytenoid cartilage?

Answer 40

pirifrom recess

Question 41

what type of cartilage forms the epiglottis

Answer 41

elastic cartilage

Question 42

identify the prevertebral muscles

Answer 42

longus coli muscle longus capitus muscle rectus capitus anterior muscle anterior scalene muscle

Question 43

what are the attachments, innervation and action of the trap

Answer 43

Origin: occipital bone, cervical and thoracic spinous processes Insertion: lateral 1/3 clavicle, acromion process of scapula, spine of scapula Action: elevate, retract, rotate, depress scapula

Question 44

what are the attachments, innervation and action of the SCM

Answer 44

Origin: Sternal head of manubrium, clavicular head of clavicle Insertion: Mastoid process of temporal bone Action: flex head, rotate head to opposite side

Question 45

Describe the anatomical relationship (i.e., relative locations) of the thyroid gland, parathyroid glands, larynx, trachea and esophagus.

Answer 45

thyroid gland is anterior to the trachea which is anterior to the esophagus. The parathyroid glands are typically on the posterior of the thyroid gland.

Question 46

What type of cartilage forms the larynx not including the epiglottis.

Answer 46

hyaline cartilage

Question 47

What is the name of the potential space between the fascial covering of the pharynx and the preverterbral fascia?

Answer 47

retropharyngeal space

Question 48

What are the cranial and caudal limits of the retropharyngeal potential space?

Answer 48

caudally the superior mediastinum cranially the base of the cranium

Question 49

What fascial layer begins at the midline posteriorly and ensheathes the sternocleidomastoid and trapezius muscles?

Answer 49

investing layer of deep fascia of neck

Question 50

What fasciae contribute to the formation of the carotid sheath?

Answer 50

deep cervical fascia, blends with the investing and pretracheal fascia anteriorly, the prevertebral fascia posteriorly

Question 51

What fascial layer covers the levator scapulae m., scalene m., and other prevertebral muscles in the floor of the posterior cervical triangle?

Answer 51

prevertebral layer

Question 52

Trace two typical routes for arterial blood supply to the thyroid gland.

Answer 52

external carotid artery -> superior thyroid artery subclavian artery -> thyrocervical trunk -> inferior thyroid a.