Superficial Structures of Neck: Cervical Regions

Question 1

What is torticollis?

Answer 1

Contraction/Shortening of the cervical muscles that produce twisting of the neck/slanting of the head.

Question 2

Most common type of torticollis?

Answer 2

Fibrous Tissue Tumor in the SCM

Question 3

Why is prenatal torticollis especially significant?

Answer 3

It may mandate that the child is a breech delivery.

Question 4

How can torticollis develop in a difficult birth?

Answer 4

Infant’s head pulled too much, torn muscle fibers.

Hematoma may occur, develops into a fibrotic mass that entraps XI.

Question 5

Another name for cervical dystonia?

Answer 5

Spasmodic torticollis

Question 6

What is spasmodic torticollis?

Answer 6

Sustained turning, tilting, flexing of the neck with involuntary shifting. Occurs in adulthood.

Question 7

How do you give a subclavian vein puncture?

Answer 7

Infraclavicular subclavian approach –
Thumb to Clavicle, Index on jugular notch
Start needle in skin under thumb, move tip toward tip of index until its in

Question 8

How do you perform a right cardiac catheterization?

Answer 8

Puncture IJV to introduce catheter thru BC to the SVC. EJV can be used, but you don’t want to.

Question 9

What can we learn from the prominence of the EJV?

Answer 9

More prominent vein indicated higher pressure. Gives indication of heart failure, SVC obstruction, or high intrathoracic pressure.

Question 10

Consequences of a severed EJV?

Answer 10

Lumen held open by fascia. Air can get in, churning sound and eventual venous air embolism.

Question 11

A subject with a CN XI lesion would display…

Answer 11

unilateral paralysis of the trapezious, difficulty turning head

Question 12

Result of a phrenic nerve block?

Answer 12

Temporary paralysis of half of a diaphragm (for lung surgery)

Question 13

Result of a phrenic nerve crush?

Answer 13

Weeks of paralyisis (like in a diaphragmatic hernia)

Question 14

Where do you numb for a neck surgery?

Answer 14

Cervical Plexus– several points along SCM

Watch out for diaphragm paralysis

Question 15

Result of suprascapular nerve damage?

Answer 15

Loss of lateral rotation of the humerus – goes to waiters tip position

Question 16

When the ECA is ligated, who provides the main collateral circulation?

Answer 16

Occipital (anastamosing with the vertebral/deep cervical arteries.)

Question 17

What structures are accessible in surgical dissection of the carotid triangle?

Answer 17

Carotid and branches, IJV, vagus, hypoglossal, cervical sypathetic

Question 18

Risk of surgical dissection of the carotid triangle?

Answer 18

There are a bunch…but moore specifies damage to the vagus or recurrent laryngeal.

Question 19

A partial occlusion of the ICA may cause…

Answer 19

Transient Ischemic Attack, Minor Stroke

Question 20

How can you observe obstructions of blood flow in the carotid?

Answer 20

Doppler color study

Question 21

What is a carotid endarterectomy?

Answer 21

Open artery and strip off arthrosclerotic plaque with the intima. Followed by clot inhibitors till healing is done.

Question 22

CN at risk in carotid endarerectomy?

Answer 22

9, 10, 11, 12

Question 23

Carotid pulse is felt with artery btw what structures?

Answer 23

Trachea and infrahyoid

Question 24

If a person has carotid sinus hypersensitivity, what happens?

Answer 24

Pressure on sinus –> slowed HR, drop in BP, ischemia leading to faiting

Question 25

Aside from O, what do carotid sinuses respond to?

Answer 25

CO2 tension, free H in blood

Question 26

What can an IJV pulse tell us about?

Answer 26

Heart activity corresponging to ECG and right atrial pressure

Question 27

How do you observe an IJV pulse?

Answer 27

Trendelenburg

Question 28

Which IJV do you use for a puncture?

Answer 28

Right

Question 29

How do you find the IJV for puncture?

Answer 29

Find common carotid and insert needle lateral to it at a 30 degree angle. Hit the apex of the triangle between the sternal and clavicular heads of the SCM