Superficial Structures of Neck: Cervical Regions

Question 1

congenital torticollis

Answer 1

contraction or shortening of cervical muscles that produces twisting of neck and slanting of head

Question 2

what causes the most common type of torticollis?

Answer 2

fibrous tissue tumor in SCM around birth

Question 3

if torticollis occurs prenatally, what type of delivery is necessary?

Answer 3

breech delivery

Question 4

muscular torticollis

Answer 4

when SCM is injured when an infant’s head is pulled too much during a difficult birth - causes hematoma that forms a fibrotic mass -> compression of CN XI

Question 5

cervical dystonia

Answer 5

abnormal tonicity of cervical muscles - aka spasmodic torticollis

Question 6

what muscles does cervical dystonia involve?

Answer 6

any bilateral combo of lateral neck muscles - especially SCM and trap

Question 7

characteristics of cervical dystonia

Answer 7

• sustained turning/tilting of neck
• involuntary shifting of head lat or ant
• shoulder elevated and moved ant on side to which chin turns

Question 8

what vein is used for central line placement?

Answer 8

R or L subclavian vein

Question 9

infraclavicular subclavian vein approach

Answer 9

• thumb on middle of clavicle
• index finger on jugular notch (manubrium)
• needle -> inferior to thumb, moved medially toward index finger until tip enters venous angle

Question 10

what can happen if the needle is inserted incorrectly in subclavian vein puncture?

Answer 10

pneumothorax

Question 11

purpose of right cardiac catheterization

Answer 11

to take measurements of pressure in the right chambers of the heart

Question 12

path for right cardiac catheterization

Answer 12

needle -> IJV to R brachiocephalic v. to SVC to right side of heart

Question 13

homeostatic purpose of EJV

Answer 13

internal barometer - prominent throughout course on neck if venous pressure up

Question 14

what can prominent EJV indicate?

Answer 14

• heart failure
• SVC obstruction
• enlarged supraclavicular lymph nodes
• increased intrathoracic pressure

Question 15

what happens if EJV is severed where it pierces roof of lateral cervical region?

Answer 15

-lumen held open by investing fascia
-negative intrathoracic pressure sucks air into vein
=churning noise in thorax + cyanosis

Question 16

venous air embolism caused by severed EJV - what happens?

Answer 16

fills right side of heart w/ froth -> nearly stops blood flow through it -> dyspnea

Question 17

how can CN XI be damaged? (4 things)

Answer 17

• penetrating trauma
• surgical procedures in lateral cervical region
• tumors at cranial base or cancerous cervical lymph nodes
• fractures of jugular foramen

Question 18

signs of unilateral paralysis of the trapezius

Answer 18

• inability to elevate and retract shoulder
• difficulty elevating upper limb superior to horizontal
• normal prominence of trap in neck is reduced

Question 19

what does drooping of shoulder indicate?

Answer 19

injury of CN XI

Question 20

what is the most common iatrogenic nerve injury?

Answer 20

CN XI

Question 21

what does severance of phrenic nerve cause?

Answer 21

paralysis of hemidiaphragm

Question 22

phrenic nerve block: action, where injected?

Answer 22

short period of paralysis of hemidiaphragm

injected around the nerve where it lies on anterior surface of middle 1/3 of anterior scalene

Question 23

phrenic nerve crush

Answer 23

can be caused by compression during surgery - longer period of paralysis

Question 24

cervical plexus block: what is it used for, where injected, who is it not used on?

Answer 24

before neck surgery -> no nerve impulse conduction

several points along posterior border of SCM, but mainly nerve point of neck

not used w/ pulmonary or cardiac disease b/c it usually paralyzes the phrenic nerve to half the diaphragm

Question 25

what is used for upper limb anesthesia and where is it injected?

Answer 25

supraclavicular brachial plexus block around the supraclavicular part of brachial plexus - superior to midpoint of clavicle

Question 26

when is the suprascapular nerve vulnerable to injury? (what type of fracture)

Answer 26

fractures of middle 1/3 of clavicle

Question 27

what does injury to suprascapular nerve cause?

Answer 27

- loss of lateral rotation of humerus at glenohumeral joint - relaxed limb rotates medially -> waiter's tip position - can't initiate limb abduction

Question 28

ligation of external carotid artery: when used, what happens?

Answer 28

to control bleeding from one of its inaccessible branches decreases but does not eliminate blood flow -> retrograde flow instead (main collateral by occipital artery)

Question 29

what does the carotid triangle provide access to surgically?

Answer 29

- carotid system of arteries - IJV - vagus n. - hypoglossal n. - cervical sympathetic trunk

Question 30

what can obstruct blood flow of the internal carotid artery?

Answer 30

atherosclerotic thickening of intima

Question 31

what can a partial occlusion of the internal carotid cause?

Answer 31

- transient ischemic attack (TIA) | - minot stroke

Question 32

what is TIA?

Answer 32

sudden focal loss of neurological function (dizziness and disorientation) that disappears w/i 24h

Question 33

what is a minor stroke?

Answer 33

loss of neurological function (weakness, sensory loss on one side of body) that exceeds 24h but disappears w/i 3 weeks

Question 34

how can obstruction of blood flow be observed?

Answer 34

doppler color study - emits ultrasonic beam and detects it reflection from moving fluid in a manner that distinguishes fluid from static surrounding tissue -provides info on pressure, velocity, turbulence

Question 35

how can carotid occlusion be relieved?

Answer 35

carotid endarterectomy - opening artery at origin and removing atherosclerotic plaque w/ intima

Question 36

what nerves are at risk during carotid endarterectomy?

Answer 36

- CN IX - CN X (or superior laryngeal n. branch) - CN XI - CN XII

Question 37

carotid sinus hypersensitivity

Answer 37

exceptional responsiveness of the carotid sinuses in various types of vascular disease

Question 38

what is syncope?

Answer 38

fainting caused by cardiac ischemia/fall in blood pressure

Question 39

what causes symptoms of all forms of syncope?

Answer 39

sudden and critical decrease in cerebral perfusion

Question 40

what method of checking pulse is recommended for people with cardiac and vascular disease/ carotid sinus hypersensitivity?

Answer 40

not carotid - use radial instead

Question 41

functions of carotid bodies

Answer 41

- monitor O2 content of blood before it reaches brain - responds to increased CO2 tension or free H+ in blood info conducted along CN IX -> reflexive stimulation of respiratory centers of brain that increase depth and rate of breathing

Question 42

what can pulsations of the IJV tell you?

Answer 42

info about heart activity corresponding to ECGs and right atrial pressure

Question 43

what position must a patient be in to feel pulsations of IJV?

Answer 43

Trendelenburg position - when person's head is inferior to lower limbs

Question 44

which IJV is examined and why?

Answer 44

the right IJV b/c it has a straighter, more direct course to RA