Session 2 - Lymph and Cervical Vertebrae

Question 1

Outline the special features of cervical vertebrae

Answer 1

Transverse foramen transmit vertebral arteries

Bifid spinous process which end in anterior and posterior tubercles

Question 2

What joint is the atlas involved in?

Answer 2

Atlanto-occipital joint

Question 3

What is the axis?

Answer 3

C2, carries the Atlas

Question 4

What is the use of the dens and how is it supported?

Answer 4

Prevents horizontal displacement of the atlas

Supported by the transverse ligament of the atlas

Question 5

Describe features of C3-C7

Answer 5

Large vertebral canal

Spinous process of C3-C6 short and bifid

Question 6

Give a distinguishing feature of C6

Answer 6

Anterior tubecle know as “carotid tubercles”

Can compresses carotid artery there to halt bleeding

Question 7

Give distinguishing features of C7

Answer 7

Long spinous process, not bifid

Vertebral do not pass through

Question 8

why are cervical vertebrae prone to dislocation?

Answer 8

Have an almost horizontal alignment of articular facets, so not very well supported.

Question 9

What is ligamentum nuchae?

Answer 9

Found in the cervical region and is a continuation of the interspinous and supraspinous lifaments of the thoracic and lumbar vertebrae.

Main funciton is to preserve the normal curvature of the cervical spine

Question 10

What occurs in fracture of dens? (2 possibilities)

Answer 10

Fractured due to fall on head
May injure spinal cord - Quadriplegia
May injure medulla of brainstem - Death

Question 11

What happens in hyperflexion of cervical region?

Answer 11

Rupture of lower intervertebral discs (C5/C6 and C6/C7) resulting in compression of spinal roots C6 and C7
Pain is felt in neck, shoulder, arm and hand

Question 12

What happens in hyperextension of cervical region? (name at least three effects)

Answer 12

o Whiplash injury (rear-end car collision)
o Tearing of anterior and posterior longitudinal ligaments, fracture of cervical spinous processes, disc rupture, neck muscle injury, blood vessel injury

Question 13

Why is osteoarthritis bad?

Answer 13

o Joints of the vertebral arches (zygopophyseal joints) are close to intervertebral foramina through which spinal nerves emerge
o When these joints are affected by Osteoarthritis (osteophyte formation), related spinal nerves are compressed, causing pain along dermatomes and muscle spasms along myotomes

Question 14

What occurs in a broken neck?

Answer 14

o Compression of the cervical spine against the shoulder
o May involve spinal cord damage
 Partial or complete paralysis
 Death
o Most common at C2, C6 and C7
o The most fatal injuries occur in the upper part of the spine (C1 or C2)

Question 15

Name 12 regional lymph nodes

Answer 15

o	Occipital
o	Retroauricular (A.k.a. Mastoid)
o	Parotid
o	Buccal  (A.k.a. Facial)
o	Submandibular
o	Submental
o	Anterior
o	Cervical
o	Superficial Cervical
	Along the course of External Jugular Vein
o	Retropharyngeal
o	Laryngeal
o	Tracheal

Question 16

Name 5 main terminal group lymph nodes

Answer 16

Deep cervical nodes 
Jugulo-digastric
Jugulo-omohyoid
Deep cervical nodes in posterior traingle of neck 
Supracalvicular nodes

Question 17

What do deep cervical lymph nodes receive?

Answer 17

 Receive all the afferent lymph vessels of the head and neck, either directly or indirectly, via one of the regional groups.

Question 18

What are deep cervical lymph nodes related to?

Answer 18

Carotid sheath (IJV)

Question 19

Where is jugulo digastric node?

Answer 19

Below and behind angle of mandible

Question 20

What do jugulodigastric node drain?

Answer 20

Tonsil and tongue

Question 21

What do jugulo-omohyoid node drain?

Answer 21

tongue, oral cavity, trachea, oesophagus and the thyroid gland

Question 22

Where do deep cervical nodes in posterior triangle lie with?

Why is this important?

Answer 22

Spinal accessory nerve

Both may be removed in malignancy of neck

Question 23

What is importance of supraclavicular nodes?

Answer 23

 Enlarge in late stages of malignancies of the thorax and abdomen
 Virchow’s Node associated with Gastric Carcinoma

Question 24

What does thoracic duct drain?

Answer 24

Left side of body

Question 25

What does right lymphatic duct drain?

Answer 25

Right chest, arm, head, neck

Question 26

What does an infected lymph node feel like?

Answer 26

Tender, smooth

Question 27

What does a malignant node feel like?

Answer 27

Non tender, craggy

Question 28

Give three causes of swollen nodes in neck

Answer 28

Glandular fever
Lymphoma
Head and neck cancer

Question 29

How could you detect if node was due to head and neck cancer?

Answer 29

Fine need aspiration cytology

Question 30

What is cervical block dissection?

Answer 30

This procedure involves the removal, as a unit (en bloc), of the Internal Jugular Vein, Fascia, Lymph Nodes and the Submandibular Salivary Gland.

Question 31

What is the paracortex of a lymph node?

Answer 31

The paracortex contains lymphocytes, accessory cells and supporting cells.
The Paracortex is the predominant site for T-Lymphocytes in the lymph node.

Question 32

What is the medulla of a lymph node?

Answer 32

The medulla is rich in macrophages and comprises:
o Large blood vessels
o Medullary cords
 Rich in plasma cells
 Produced Ab’s pass out of the node via the efferent lymphatic
o Medullary sinuses