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Block 5 Week 3 Meg > Sievert: Neck > Flashcards

Sievert: Neck Flashcards

1
Q

All muscles except (blank) are invested by cervical investing fascia. There are basically (blank) compartments.

A

platysma; four

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2
Q

What are the 4 fascial compartments?

A
  1. cervical investing fascia
  2. prevertebral fascia
  3. pretracheal fascia
  4. carotid sheath
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3
Q

The platysma muscle is (blank) to the compartments of the neck. It lies (blank) to the investing fascia and (blank) to the superficial fascia

A

superficial; superior; deep

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4
Q

The cervical investing fascia runs from above the (blank) muscle of the face superiorly to the (blank) inferiorly

A

temporalis; clavicle
**Investing fascia goes all the way down to the clavicle and continues up to the zygomatic arch and then goes up to temporalis muscle and attaches above it. This is a tough fascia.

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5
Q

What layer of fascia surrounds everything in the neck, except for the platysma?

A

cervical investing fascia

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6
Q

What layer of fascia surrounds all muscles associated with the vertebra (including the intrinsic back muscles and muscles anterior to the vertebral body)

A

prevertebral fascia

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7
Q

As the prevertebral fascia comes anterior to the vertebral body, it splits into to layers to form what compartment? What is significant about this compartment?

A

retropharyngeal space; makes up the danger space because of the potential for spread of infection

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8
Q

What layer of fascia surrounds the supra and infrahyoid muscles, as well as the visceral compartment of the thyroid gland, trachea, and esophagus?

A

pretracheal fascia

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9
Q

What is the layer of fascia directly behind the esophagus?

A

buccopharyngeal fascia

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10
Q

What layer of fascia has components of lots of different fascias, and contains the common carotid artery, internal carotid, IJV, vagus, branches of CN 9, and deep nodes?

A

carotid sheath

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11
Q

What is contained in the carotid sheath?

A 
common carotid
internal carotid
IJV
vagus
branches of CN 9
deep nodes
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12
Q

The retropharyngeal space runs from the base of the skull to the (blank). What does it allow for? What does this space constitute?

A

superior mediastinum of the thorax;
allows for movement of the esophagus and laryngeal apparatus during swallowing;
constitutes the danger space because potential for spread of infection

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13
Q

What are the superficial veins of the neck?

A

external jugular
internal jugular
anterior jugular
facial vein *drains to internal jugular

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14
Q

Superficial veins are potentially easy to cut, which can cause air to enter. Why is this dangerous?

A

large volume of air entering the heart will cause immediate block to blood flow

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15
Q

How can something potentially enter the danger space?

A

puncture the back of the pharynx and the buccopharyngeal fascia

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16
Q

The superficial veins of the neck have heavy (blank) between them. Both the anterior and external jugular drain into the (blank), while the main drainage of the facial vein is the (blank)

A

anastomoses;
subclavian vein;
internal jugular vein

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17
Q

What are the borders of the posterior triangle of the neck?

A

SCM (posterior side)
trapezius
clavicle

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18
Q

What important structures pass through the posterior triangle?

A 
spinal accessory nerve
cervical plexus nerves
scalene muscles
suprascapular artery
transverse cervical artery
subclavian artery
external jugular vein
roots of brachial plexus
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19
Q

What are the borders of the anterior triangle of the neck?

A

mandible
anterior midline
SCM

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20
Q

What important structures pass through the anterior triangle?

A 
carotid sheath and its contents
ansa cervicalis
thyroid gland
supra and infrahyoid muscles
viscera
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21
Q

This curly nerve will be coming down to the trapezius muscle through the posterior triangle, and will be imbedded in investing fascia

A

spinal accessory nerve

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22
Q

These muscles cross along the lower portion of the posterior triangle

A

scalene muscles

*anterior, middle, posterior

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23
Q

Between what two muscles will you observe roots of the brachial plexus coming through? What artery is also found between these muscles?

A

anterior and middle scalene;

subclavian artery

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24
Q

The posterior triangle has what muscle running across it?

A

omohyoid

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25
Q

What are the four triangles of the anterior triangle?

A

carotid
submandibular
submental
muscular

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26
Q

What are the borders of the carotid triangle?

A

posterior belly of digastric
anterior border of SCM
omohyoid muscle

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27
Q

What is important about the submandibular triangle?

A

contains the submandibular gland

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28
Q

What makes up the muscular floor of the posterior triangle?

A

Levator scapulae
Three (3) scalene muscles
Inferior belly of omohyoid
Brachial plexus between anterior and middle scalenes

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29
Q

What 2 important structures pass between the anterior and middle scalene muscles?

A

brachial plexus

subclavian artery

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30
Q

What things can cause compression of the brachial plexus or the subclavian artery as they pass through the anterior and middle scalene muscles?

A

compression from the cervical rib

increased tone of the muscles

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31
Q 
Subclavian artery and 
brachial plexus pass
between the anterior 
and middle scalene and
can be compressed
causing numbness and
ischemia.
A

scalenus anticus syndrome

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32
Q

What is the difference between scalenus anticus syndrome and thoracic outlet syndrome?

A

both compress the subclavian artery, but thoracic outlet syndrome involves compression between the first rib and the clavicle, while scalenus anticus syndrome involves compression between the muscles

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33
Q

List the cutaneous branches of the cervical plexus from superior to inferior

A

lesser occipital *posterolateral head and a bit of ear
greater auricular *supplies a bit of the ear
transverse cervical *to anterolateral neck
supraclavicular *down to innervate shoulder, etc

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34
Q

the cutaneous branches of the cervical plexus originate beneath which muscle

A

sternocleidomastoid

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35
Q

The lesser occipital nerve supplies the psoterolateral side of the head and a bit of the ear. It is a (blank) ramus of a spinal nerve.

A

ventral

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36
Q

Which cutaneous nerve from the cervical plexus basically goes straight across the neck and innervates the anterolateral part of the neck

A

transverse cervical

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37
Q

Why are the cutaneous branches of the cervical plexus important?

A

in anesthesia, they must all be taken care of

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38
Q

What cervical nerves comprise the cervical plexus?

A

C1 - C4

*C1 to a lesser extent

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39
Q

What is Sievert’s way of thinking about the branches of the cervical plexus?

A

C2 and C3 come together and travel up
C3 goes across
C3 and C4 go down and combine to form supraclaviculars

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40
Q

A branch of C1 travels along with the (blank) nerve to the geniohyoid muscle

A

hypoglossal

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41
Q

What are the motor parts of the cervical plexus?

A

nerve to geniohyoid and thyrohyoid from C1
ansa cervicalis superior and inferior limbs to all infrahyoid muscles
phrenic

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42
Q

What cervical roots does the phrenic arise from? What does this nerve supply? What is unique about this nerve? Why do you have to be especially careful with anesthesia and the phrenic nerve?

A

C3, 4, and a bit of 5
supplies the diaphragm
it is not in the anterior or posterior triangle (it’s behind the SCM)
don’t want to paralyze the diaphragm

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43
Q

The superior limb of the ansa cervicalis comes from (blank), jumps on the (blank) nerve, then gives off branches to which two muscles?

A

C1; hypoglossal; geniohyoid and thyrohyoid

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44
Q

What does the ansa cervicalis lie just on top of?

A

the internal jugular vein

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45
Q

An inflammed gallbladder can irritate the peritoneum on the undersurface of the diaphragm. Pain from the diaphragm enters the dorsal horns of which cervical nerves? Supraclaviular nerves arise from which cervical nerves and innervate the skin of the shoulder? What does this mean in terms of referred pain?

A

C3, C4, C5;
C3 and 4;
anything close to the diaphragm (i.e. the gallbladder) can cause referred pain to the shoulder

46
Q

The hypoglossal nerve leaves the hypoglossal nucleus (in the medulla) and leaves through the (blank). It provides motor innervation to all (blank) muscles - any muscle with the name glossus except for the (blank)

A

hypoglossal canal;
tongue;
palatoglossus

47
Q

The hyoid bone is essentially (blank) and has muscles attaching both superior and inferior to aid in elevation and depression during what two actions?

A

floating;

vocalization and swallowing

48
Q

Does the hyoid bone articulate with any other bone?

A

no, it’s floating

49
Q

When can you palpate the greater horn on one side of the hyoid bone?

A

when it is steadied on the other side

50
Q

What is a dysarthria? What can cause it?

A

speaking problems associated with the muscular apparatus;

can be caused by damage to CN 12, paralysis of facial muscles, damage to muscles of mastication

51
Q

This muscle comes down and makes a sling-like structure with a midline seam that connects them to the mandible and the hyoid bone. It makes up the floor of the mouth

A

mylohyoid muscle

52
Q

What innervates the mylohyloid muscle?

A

mylohyoid nerve off of the inferior alveolar nerve off of posterior division of V3

53
Q

What are the suprahyoid muscles?

A

mylohyoid
stylohyoid
digastric
geniohyoid

54
Q

What are the 4 infrahyoid muscles?

A

sternohyoid
thryrohyoid
sternothyroid
omohyoid

55
Q

What innervates the anterior belly of the digastric muscle? What innervates the posterior belly?

A

CN 5; CN 7

56
Q

What muscles goes from the hyoid to the styloid process and runs in between the sling of the digastric bellies?

A

stylohyoid muscle

57
Q

This muscle goes from omohyoid tubercle to hyoid bone, has an inferior and superior belly, and is held down by a fascial sling

A

omohyoid

58
Q

What innervates suprahyoid muscles?

A

cranial nerves *except for geniohyoid from C1

59
Q

What innervates the infrahyoid muscles?

A

cervical plexus *these are known as the strap muscles

60
Q

3 muscles that arise from the styloid process

A

stylohyoid
styloglossus
stylopharyngeus

61
Q

Which muscle comes from the posterior aspect of the styloid process, splits around the digastric, is from branchial arch 2, and is innervated by CN 7?

A

stylohyoid

62
Q

Which muscle comes from the anterior portion of the styloid process, is derived from postotic somites and is innervated by CN 12?

A

styloglossus

63
Q

Which muscle comes from the medial surface of the styloid process, is derived from branchial arch 3 and is innervated by CN 9?

A

stylopharyngeus

64
Q

What muscle runs from the genial tubercle of the mandible inferior and posterior to the hyoid bone (branch of C1 traveling w hypoglossal)

A

geniohyoid

65
Q

The carotid triangle has the (blank) running on top of the carotid sheath, which contains what three things?

A

ansa cervicalis;
common carotid artery
internal jugular vein
vagus nerve

66
Q

Which carotid artery has no branches until it enters the cranial cavity?

A

internal carotid

67
Q

Which carotid artery only has branches to the face and neck?

A

external carotid

68
Q

T/F: Internal and external carotid arteries form anastomotic connections.

A

true

69
Q

The internal carotid artery passes through the (blank) and has a relation to the (blank) sinus

A

carotid canal; cavernous sinus

70
Q

This vertebral artery comes off of the (blank) artery, passes through (blank) transverse foramina, through the foramen (blank), and becomes the (blank) artery

A

subclavian; C6-C1; magnum; basilar

71
Q

The internal carotid artery passes OVER this opening, but does not pass through it

A

foramen lacerum

72
Q

The carotid canal has both a (blank) and a (blank) opening

A

internal; external

73
Q

A swelling at the origin of the carotid artery
Innervated by CN 9
Is a baroreceptor

A

carotid sinus

74
Q

Is a mass of tissue at the bifurcation of the common carotid artery
Innervated by CN 9
Is a chemoreceptor

A

carotid body

75
Q

Where do afferents from CN 9 from the carotid sinus and body go?

A

to the nucleus solitarius

76
Q

Baroreceptors send info in on which cranial nerve and out on which?

A

in on 9; out on 10

77
Q

What components does CN 9 have?

A

general sensory
viscerosensory
visceromotor
branchiomotor

78
Q

What are the branches of the external carotid artery?

A 
SALFOPMS
superior thyroid
ascending pharyngeal
lingual
facial
occipital
posterior auricular
maxillary
superficial temporal
79
Q

Which branch off the external carotid DIVES into the oral cavity???

A

lingual

80
Q

Which branch off the external carotid catches CN 12?

A

occipital

81
Q

Again, what’s in the carotid sheath?

A

common carotid artery
internal jugular vein
vagus nerve

82
Q

What is a very important branch off the vagus nerve? What does it supply? Why is it important to take note of?

A

recurrent laryngeal nerve;
motor to all muscles of the larynx (except the cricothyroid -_-);
can be damaged during thyroid surgery

83
Q

This is a branch off of the vagus.
It’s internal branch is sensory above the vocal cords.
External branch is motor to cricothyroid.

A

superior laryngeal nerve

84
Q

This is a branch off of the vagus.
It is sensory below the vocal cords.
It is motor to all other muscles of the larynx besides the cricothyroid.
It recurs around the subclavian artery or the aortic arch.

A

recurrent laryngeal nerve

85
Q

What are the components of CN 10?

A

general sensory
viscerosensory *carotid body and sinus
visceromotor *to all structures as far as the left colic flexure
branchiomotor *to muscles from 4th and 6th arch (cricothyroid, etc)

86
Q

What reflexes is the vagus nerve involved in?

A

carotid body and sinus

cough

87
Q

Where do preganglionic parasympathetics on CN 10 from the heart, thorax, and abdomen synapse?

A

in the dorsal motor nucleus of X

88
Q

Where does sensory from ear and lower pharyn traveling on CN 10 synapse?

A

in the superior ganglion of X

89
Q

Where does taste from the epiglottis traveling on CN 10 synapse?

A

inferior ganglion of X

90
Q

Where does info from the thorax and abdomen traveling on CN 10 synpase?

A

inferior ganglion of X

91
Q

From what nucleus are there projections to striated muscle, the soft palate, the pharynx, larynx and upper esophagus?

A

nucleus solitarius

92
Q

This nerve can be damaged in thyroid surgery which is dangerous due to the number of muscles it innervates

A

recurrent laryngeal nerve

93
Q

Where do the superior thyroid arteries originate from? Where do the inferior thyroid arteries originate from?

A

external carotid arteries;

subclavian arteries via the thyrocervical trunk

94
Q

T/F: There are anastomoses between the superior and inferior thyroid arteries

A

true

95
Q

Superior thyroid veins drain into (blank) veins
Middle thyroid veins drain into (blank) veins
Inferior thyroid veins drain into (blank) veins

A

internal jugular;
internal jugular;
brachiocephalic

96
Q

This is a remnant on the thyroid gland from the descent of the tongue

A

pyramidal lobe

97
Q

3 important landmarks of the thyroid gland

A

thyrohyoid membrane
cricothyroid cartilage
crcothyroid ligament

98
Q

What is the thyorid gland surrounding?

A

the trachea

99
Q 
What are these?
lingual
intralingual
thyroglossal tract
prelaryngeal
intratracheal
substernal
A

these are all places where remnants of thyroid tissue can be found due to its origin at the base of the tongue

100
Q

Preganglionic fibers of the sympathetic trunk ascend from the (blank) and synapse in one of 3 ganglia. What are they? What happens to the postganglionic fibers?

A

thorax; superior, middle, inferior cervical ganglion; postganglionic fibers join cervical spinal nerves to their targets or travel on blood vessels to the head

101
Q

What does Horner’s syndrome cause?

A

ptosis
flushed face
dry face
constricted pupils **due to overriding parasympathetic tone

102
Q

What are the branches of the subclavian artery?

A

vertebral
internal thoracic *diving inferior
thyrocervical trunk (inferior thyroid, transverse cervical, suprascapular)
costocervical trunk

103
Q
  • Can occur by cutting sympathetic chain above T1
  • By damaging T1-T3 preganglionic neurons in the lateral horn
  • By damaging outflow to head that is traveling on internal carotid
  • By damaging the input to preganglionic sympathetics
A

Horner’s syndrome

**can occur in multiple ways, not just damage at sympathetic trunk

104
Q

These nodes are associated with the internal jugular vein

A

deep cervical nodes

105
Q

What are the nodes in pericervical collar?

A 
occipital
retro-auricular
parotid
buccla
submandibular
submental
106
Q

What is unique about the submental lymph nodes from the median part of the tongue?

A

they drain lymph to both the right and left side, so lymph can cross over, which provides an easy route for spread of cancer/infection from one side to the other

107
Q

Nodes of the neck ultimately drain to the (blank) nodes and then to the lymphatic or thoracic ducts

A

deep cervical

108
Q

Lie along the course of the internal jugular vein

A

deep cervical lymph nodes

109
Q

Which of the deep cervical nodes is most clinically important? Why?

A

supraclavicular nodes;

can indicate pathology in the head, neck or thoracic cage

110
Q

Where does the thoracic duct enter?

A

enters the junction of the subclavian and internal jugular veins
*courses up posterior to the junction

Block 5 Week 3 Meg (10 decks)

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