Posterior neck (Clinical case questions)

Question 1

A muscular patient who regularly lifts weights presents with pain and weakness in his right upper limb that has been slowly developing over time. His limb is cool and there is an obvious vascular insufficiency in his upper extremity. Subsequent tests show that a large vessel passing between the anterior and middle scalene muscles is being occluded by hypertrophy (enlargement) of the muscles due to the excercise. The artery involved is the:  
A. axillary 
B. brachial  
C. brachiocephalic 
D. subclavian 
E. suprascapular

Answer 1

D. subclavian

Question 2

In repairing a damaged right subclavian artery, the surgeon notices and protects a large nerve passing around to the posterior surface of the artery. This nerve, which does not encircle the subclavian on the left side, is the: 
A. Phrenic  
B. Vagus  
C. Recurrent laryngeal  
D. Sympathetic trunk

Answer 2

C. Recurrent laryngeal

Question 3

A stab wound just above the left clavicle, lateral to the sternocleidomastoid muscle, may be life-threatening because of the possibility of injury to the:
A.Brachial plexus  
B.Internal jugular vein  
C. Axillary artery  
D. Subclavian artery  
E. Thoracic duct

Answer 3

D. Subclavian artery

Question 4

A 27-year-old man who is a professional weight lifter comes to his physician complaining of recent weakness in his left arm and frequent tingling in his hand and fingers during exercise sessions which subsides with rest. He is diagnosed as having vasuclar insufficiency due to scalenus anticus syndrome and as a remedy it is decided to transect the anterior scalene muscle where it inserts on the first rib. During surgery, which structure in contact with the anterior surface of the muscle must the surgeon be careful of sparing?

Answer 4

Phrenic nerve

Question 5

A 60-year-old man with a previous history of right carotid endarterectomy, comes to his physician complaining of light-headedness and dizziness whenever he uses his right hand vigorously. He is diagnosed as having subclavian steal syndrome due to an atherosclerotic plaque at the point where his subclavian artery branches from the brachiocephalic trunk. The cerebral insufficiency is the result of blood being stolen from which artery?

Answer 5

Vertebral artery

Question 6

A first year resident attempts to insert a central venous catheter into the heart by a subclavicular approach to the subclavian vein. Following the attempt, it is noted that the patient has difficulty breathing. What nervous structure lying immediately deep to the subclavian vein, as it crosses the anterior scalene muscle, may have been injured?

Answer 6

Phrenic nerve

Question 7

Which statement is true of the internal jugular vein?
A. It drains all of the thyroid gland on that side of the body
B. It drains into the external jugular vein
C. It is accompanied by the deep cervical chain of lymph nodes
D. It lies deep to the prevertebral fascia
E. It passes superficial to the sternocleidomastoid muscle

Answer 7

C. It is accompanied by the deep cervical chain of lymph nodes

Question 8

Which structure lies immediately anterior to the right anterior scalene muscle at its costal attachment?  
A. Subclavian artery  
B. Subclavian vein 
C. Thoracic duct  
D. Thyrocervical trunk  
E. Vagus nerve

Answer 8

B. Subclavian vein

Question 9

A person develops a primary tumor of the thyroid gland and, among other symptoms, drooping of the eyelid and constriction of the pupil on the right side of the eye are noted. What nerve fibers have been interrupted by the tumor? 
 A. postganglionic parasympathetic  
B. postganglionic sympathetic 
C. preganglionic parasympathetic  
D. the carotid nerve 
E. the cervical sympathetic trunk

Answer 9

E. the cervical sympathetic trunk

Question 10

An abscess was surgically removed from the middle of the posterior triangle on the right side. During recovery the patient noticed that her shoulder drooped and she could no longer raise her right hand above her head to brush her hair. Which nerve has been cut?

Answer 10

Spinal Accessory (XI)

Question 11

A surgeon doing a deep cervical lymph node dissection may encounter these structures upon the anterior surface of the anterior scalene muscle EXCEPT:  
A. Phrenic nerve  
B. Subclavian vein  
C. Middle trunk of the brachial plexus  
D. Transverse cervical artery  
E. Cervical part of the thoracic duct

Answer 11

C. Middle trunk of the brachial plexus

Question 12

The middle cervical sympathetic ganglion, recurrent laryngeal nerve, and parathyroid glands are all closely related with which blood vessel?  
A. Inferior thyroid artery
B. Inferior thyroid vein 
C. Superior thyroid artery 
D. Superior thyroid vein

Answer 12

A. Inferior thyroid artery

Question 13

. During surgical procedures of the neck, structures within the carotid sheath can be retracted (pulled aside) as a unit. Which of the following structures would remain in place when the carotid sheath is retracted?
A. common carotid artery
B. cervical sympathetic trunk
C. internal jugular vein D. internal carotid artery
E. vagus nerve

Answer 13

B. cervical sympathetic trunk

Question 14

. Which of the following nerves is derived from the dorsal primary rami of spinal nerves?  
A. great auricular 
B. greater occipital 
C. lesser occipital 
D. phrenic 
E. supraclavicular

Answer 14

B. greater occipital

Question 15

Which of the following hyoid muscles is an important landmark in both the anterior and posterior triangles of the neck?  
A. geniohyoid 
B. mylohyoid 
C. omohyoid 
D. sternohyoid 
E. stylohyoid

Answer 15

C. omohyoid