Superficial structures of the neck Flashcards
What divides the anterior and lateral cervical regions?
SCM
Heads of the SCM
Sternal head and clavicular head
Attachment of sternal head of SCM
Manubrium
Attachment of clavicular head of SCM
Medial third of superior surface of clavicle
Superior attachment of the SCM
Mastoid process, and superior nuchal line
Sheath that covers the SCM
Investing layer of the deep cervical fascia
Bilateral action of the SCM
Flex the neck anteriorly
Elevates clavicles and manubrium when head and neck are fixed
Unilateral action of the SCM
Flex the neck ipsilaterally and rotates head
Region posterior to the anterior borders of the trapezius
Posterior cervical region
Region deep to the superior part of the posterior cervical region
Suboccipital region
Muscles that form the floor of the lateral cervical region
Splenius capitis, levator scapulae, posterior and middle scalene (and sometimes, anterior ascalene)
Why is the occipital triangle named so?
Because the occipital artery appears at its apex
The most important nerve crossing the occipital triangle
Spinal accessory nerve (CN XI)
Why is the omoclavicular triangle also called subclavian triangle?
Because the third part of the subclavian artery lies deep in it
The inferior part of the EJV crosses this triangle superficially
Omoclavicular/ subclavian triangle
The suprascapular artery is a branch of the thyrocervical artery, but may alternatively arise directly from the third part of the subclavian artery. T/F
T
The cervicodorsal artery is also known as ___
Transverse cervical artery
The terminal branches of the thyrocervical artery
Ascending cervical and inferior thyroid artery
The occipital artery is a branch of which vessel?
External carotid
Muscle overlying the subclavian artery
Anterior scalene
Branches of the subclavian artery
Thyrocervical trunk, internal thoracic and vertebral arteries
The EJV lies on which muscle?
SCM
Which veins join to form the EJV?
Retromandibular vein and posterior auricular vein
To where does the EJV drain?
Subclavian vein
The subclavian vein passes posterior to the anterior scalene muscle. T/F
F
It passes anterior.
Which vessels unite to form the brachiocephalic vein?
Subclavian vein and IJV
The spinal accessory nerve passes the SCM and supplies it. T/F
T
Muscles supplied by CN XI
Trapezius and SCM
On which muscle does CN XI run?
Levator scapulae
The roots of the brachial plexus appear between which muscles?
Anterior and middle scalene
Thespinalaccessorynerveenterstheposteriorneckregionapproximatelyatthe
A.MiddlejunctionoftheposteriorborderoftheSCM
B.Middlejunctionoftheanteriorborderofthetrapezius
C.JunctionoftheupperandmiddlethirdsoftheposteriorborderoftheSCM
D.Junctionofthemiddleandlowerthirdsoftheanteriorborderofthetrapezius
D
Inferiorlimitofprevertebralfascia:
A.Clavicle
B.FibrousPericardium
C.T3
D.Alloftheabove
C
WhichofthefollowingisTRUEaboutthecarotidsystemofarteries?
A.Theexternalcarotidarterycanbeligatedwithnolossofneurologicalfunctionbecauseithas agoodanastomosiswiththeinternalcarotidartery
B.Thecommoncarotidarterycanbeligatedwithoutlossofneurologicalfunctionwhen thecollateralcirculationisadequate
C.TheinternalcarotidarterycanreceiveadequatecollateralcirculationfromtheCircleofWillisifoccluded
D.Itissafetoexertpressureonthecarotidarterialsystemtolowerheartrateandblood pressureinpatientswithischemicheartdisease
B
Asurgicaldissectioninthecarotidtrianglemayinjurethesebranchesoftheexternalcarotid arteryexcept:
A.Superiorthyroid B.Facial C.Lingual D.Posteriorauricular E.Ascendingpharyngeal
D
Describes the suboccipital region:
A. The splenius capitis forms a roof over the suboccipital triangle
B. The obliquus capitis superior muscle does not attach to the
occipital bone.
C. The ventral ramus of C1 innervates the suboccipital muscles.
D. Contraction of an obliquus capitis inferior muscle rotates
the head to the ipsilateral side.
D
The platysma lies in this layer of the deep cervical fascia.
A. prevertebral
B. pretracheal
C. investing
D. none of the above
D
Following its course posteroinferiorly, the spinal accessory nerve lies on the surface of
A. Scalenus anterior
B. Splenius capitis
C. Levator scapulae
D. Trapezius
C
The tributaries of the anterior jugular vein are found in this triangle
A. Digastric B. Submandibular C. Carotid D. Muscular E. None of the above
E
Which of the following nerves cannot possibly be seen in the
Anterior Triangle?
A. CN IX B. CN X C. CN XI D. CN XII E. Transverse Cervical
C
Structure traced from sternoclavicular joint to the angle of the mandible
A. Carotid artery B. IJV C. EJV D. anterior jugular vein E. Great auricular nerve
A
A patient was brought to the ER department with a deep stab wound at Zone 2 of the neck. Which is not included in the list of possible signs and symptoms?
A. IJV transection B. Carotid Artery Laceration C. Blood in the Vomitus D. Weakened Arterial pulse in the ipsilateral wrist E. Injury to the larynx
D
The floor of the submandibular triangle
A. geniohyoid
B. mylohyoid
C. both A and B
D. none of the above
B
The base of the submental triangle
A. tongue
B. hyoid bone
C. mandible
D. thyroid cartilage
B
Found on the lateral surface of the hypoglossus of the submandibular triangle
A. facial vein
B. hypoglossal nerve
C. cervical branch of the facial nerve
D. submandibular lymph node
B
The sympathetic trunk is located within the carotid sheath
A. anteriorly
B. posteromedially
C. posterolaterally
D. none of the above
D
A knife thrust horizontally into the center of the
belly of your left sternoclediomastoid muscle at the level of C7 would most probably injure the ____________ first before it reaches your trachea.
A. common carotid artery
B. internal jugular vein
C. thoracic duct
D. esophagus
B
What passes between the subclavian artery and vein?
A. vagus nerve
B. spinal accessory nerve
C. phrenic nerve
D. both A and C
D
What is the lateral boundary of Simon’s triangle?
A. inferior laryngeal nerve
B. recurrent laryngeal nerve
C. trachea
D. common carotid artery
D
When there is an alteration in the central hemodynamic status of an individual, this can be reflected in the height of this particular structure when one examines the posterior neck. This structure is the:
A. internal jugular vein B. subclavian vein C. external jugular vein D. brachiocephalic vein E. superior vena cava
C
In which triangle would you find Virchow’s node?
A. Subclavicular triangle B. Occipital Triangle C. Supraclavicular Triangle D. Suboccipital Triangle E. NOTA
C
Hypoglossal nerve passes through
A. superior to superior constrictor
B. between superior and middle constrictor
C. between middle and inferior constrictor
D. inferior to inferior constrictor
C
When performing an incision on the middle of the submental triangle, what order of structures will be affected?
A. mylohyoid-geniohyoid-genioglossus
B. platysma-mylohyoid-genioglossus
C. mylohyoid-genioglossus-geniohyoid
D. platysma-geniohyoid-genioglossus
C
Anteriorly, the floor of the submandibular triangle is formed by the
A. Hyglossus
B. Mylohyoid
C. Anterior Digastric
D. Pharyngeal constrictors
B
Most medial roof of the muscular triangle.
A. omohyoid
B. sternothyroid
C. mylohyoid
D. sternohyoid
D
Posteriorly located in carotid sheath
A. sympathetic trunk
B. common carotid artery
C. phrenic nerve
D. vagus nerve
D
In its downward course from the neck to the thorax, the ______ passes between the subclavian artery &vein
A. sympathetic trunk B. vagus nerve C. phrenic nerve D. all of the above E. B &C
E
What structure would most likely to be free from surgical maneuver if the dissection is maintained within the limit of the posterior triangle?
A. suprascapular n. B. phrenic n. C. supraclavicular n. D. brachial plexus E. subclavian artery
B
What condition causes EJV to be highly prominent in the neck indicating a central hemodynamic change?
A. occlusion of the IJV
B. superior vena cava compression
C. decrease in heart pressure
D. occlusion of the brachiocephalic trunk
A
Where is anesthesia given in order to anesthetize the diaphragm?
A. C3
B. C4
C. C5
D. C6
B
During a subclavian catheterization, one has to remember these anatomical landmarks as the operator’s guide.
A. superior border, clavicle; jugular notch, middle third, clavicle
B. inferior border, clavicle; jugular notch, middle third, clavicle
C. superior border, clavicle; sterna angle, middle third, clavicle
D. inferior border, clavicle; subclavian triangle, middle third, clavicle
E. simply the subclavian triangle
B
The left neck node, when enlarged, is called Virchow’s node. This is found in the:
A. carotid triangle B. supraclavicular tri C. muscular tri D. occipital tri E. submental tri
B
What is known as the “danger zone”?
A. intervertebral sheath
B. carotid sheath
C. retropharyngeal sheath
D. pretracheal sheath
D
You are now an intern and you attempt to cannulate the
subclavian vein using the clavicles as a landmark in your approach. During the long attempt to do the procedure, you notice that the patient is starting to develop labored breathing. What structure lying
immediately deep to the SCV as it crosses the scalene muscle may have been injured?
A. superior laryngeal nerve B. vagus nerve C. recurrent laryngeal nerve D. phrenic nerve E. sympathetic trunk
D
Triangles of the lateral cervical region
Omoclavicular/supraclavicular/subclavian triangle
Occipital triangle
The posterior rami of cervical spinal nerves pierce and therefore, innervate the trapezius. T/F
F
It pierces, but does not innervate the trapezius.
Smallest scalene
Anterior scalene
The suprascapular artery passes inferolaterally of which muscle?
Anterior scalene
The cervicodorsal trunk passes superficially and laterally across which muscle?
Anterior scalene
Which muscle separates the EJV and IJV?
SCM
Which muscle lies between the subclavian artery and vein?
Anterior scalene
Suprahyoid muscles
Geniohyoid, Mylohyoid, Stylohyoid, Digastric muscles
Infrahyoid muscles
Sternohyoid, Omohyoid, Sternothyroid, Thyrohyoid
Superficial plane of the infrahyoid muscles
Sternohyoid, Omohyoid
Deep plane of infrahyoid muscles
Sternothyroid, Thyrohyoid
The fibrous ring that allows the tendons of the digastric bellies to slide anteriorly and posteriorly is derived from which fascia?
Pretracheal layer of the deep cervical fascia
The digastric bellies have different innervation due to different embryonic origns. T/F
T
The anterior is from the first pharyngeal arch. The posterior is from the second.
The omohyoid has two bellies. T/F
T
The sternothyroid is wider than the sternohyoid. T/F
T
The sternothyroid lies medial to the thyrohyoid. T/F
F
The sternothyroid lies inferior to the thyrohyoid of which it is a continuation.
The superficial of the infrahyoid muscles lie side to side, with the omohyoid lateral to the sternohyoid. T/F
T
The common carotid artery in the common carotid sheath ascends to the level of the superior border of the thyroid cartilage with which vein and nerve?
IJV and vagus nerve
Where does the common carotid bifurcate into the external and internal carotid arteries?
On the level of the superior border of the thyroid cartilage
Terminal branches of the carotid arteries
External and internal carotid arteries
Which terminal branch of the common carotid has no branches in the neck?
Internal carotid artery
Branches of the external carotid arteries
Ascending pharyngeal, occipital, posterior auricular, superior thyroid, lingual, fascial, maxillary, superficial terminal arteries
Medial branch of the external carotid artery
Ascending pharyngeal artery
Posterior branches of the external carotid artery
Occipital artery, posterior auricular artery
Anterior branches of the external carotid artery
Superior thyroid artery, lingual artery, facial artery
Terminal branches of the external carotid artery
Maxillary artery and superior tempor`al artery
A slight dilation of the internal carotid artery, which may involve the common carotid artery
Carotid sinus
A small, reddish brown ovoid mass of tissue in life that lies on the medial side of the bifurcation of the common carotid artery
Carotid body
Innervation of the carotid sinus
Carotid sinus nerve (CN IX) and CN X
Innervation of the carotid body
Carotid sinus nerve (CN IX) and CN X
A baroreceptor on the ICA that reacts in arterial blood pressure
Carotid sinus
Function of carotid sinus
Baroreceptor
Function of carotid body
Chemoreceptor
A chemoreceptor between ECA and ICA that monitors blood oxygen
Carotid body
Arrangement of neurovascular structures in carotid sheath
IJV laterally, carotid vessels medially, vagus nerve posteriorly
On which side of the carotid sheath is ansa cervicalis?
Anterolateral
Muscles in the muscular triangle
Infrahyoid muscles
