The Neck

Question 1

What is the neck a junction between?

Answer 1

head and thorax

Question 2

What is the superior limit of the neck?

Answer 2

mandible and base of skull

Question 3

What is the inferior limit of the neck?

Answer 3

thoracic inlet

Question 4

Where is the thoracic inlet?

Answer 4

the opening at the top of the thoracic cavity.

Question 5

What Is the thoracic inlet also referred to as?

Answer 5

superior thoracic aperture

Question 6

What is the neck divided by anatomically?

Answer 6

sternocleidomastoid

Question 7

What is the proximal attachment of the sternocleidomastoid?

Answer 7

mastoid process

Question 8

What is the distal attachment of the sternocleidomastoid?

Answer 8

sternum and clavicle

Question 9

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

Answer 9

sternocleidomastoid
midline of neck
mandible border

Question 10

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

Answer 10

sternocleidomastoid
trapezius muscle
middle 1/3 of clavicle

Question 11

What are the contents of the anterior triangle?

Answer 11

glands
nerves
vessels
muscles
viscera
skeletal elements

Question 12

What are the anterior triangle muscles?

Answer 12

strap muscles (infra hyoid)
mylohyoid
anterior belly of digastric

Question 13

What are the strap muscles?

Answer 13

thyrohyoid: deep and lateral.
omohyoid: superficial and lateral.
sternohyoid: superficial and medial.
sternothyroid: deep and medial.

Question 14

What skeletal elements are in the anterior triangle (cartilage and bone)?

Answer 14

thyroid cartilage
cricoid cartilage
hyoid bone
trachea

Question 15

What are the laryngeal cartilages?

Answer 15

cricoid, thyroid, epiglottis
arytenoid, corniculate and cuneiform (paired)

Question 16

What are the glands of the anterior triangle?

Answer 16

thyroid gland
submandibular gland
parathyroid gland

Question 17

What is the thyroid gland enclosed in?

Answer 17

pre-tracheal fascia

Question 18

What arteries supplies the thyroid gland?

Answer 18

Supplied by the superior (external carotid artery) and
inferior thyroid (thyrocervial trunk) arteries

Question 19

What does the thyrocervial trunk arise from?

Answer 19

Thyrocervical trunk arises from the subclavian artery.

Question 20

How to check if the thyroid gland is enlarged (goitre)?

Answer 20

asking the patient to swallow, when lightly pressing on the neck from behind the patient, will allow you to see if it is enlarged

Question 21

What spinal region is the thyroid gland found in?

Answer 21

C5-T1

Question 22

What do thyroid hormones do?

Answer 22

raise the basal metabolic rate
influences synthesis of proteins
responsible for nerve growth/development
essential for the development of cells in the body

Question 23

What are the two lobes of the thyroid gland linked by?

Answer 23

isthmus

Question 24

What is the pyramidal lobe in the thyroid gland?

Answer 24

embryological remnant of where the thyroid gland developed from in the floor of the mouth – at the foramen caecum of the tongue.

Question 25

What population have more than 4 parathyroid glands?

Answer 25

5%

Question 26

What is the function of the PTH?

Answer 26

raise calcium levels

Question 27

How does PTH increase blood calcium?

Answer 27

1.Increasing absorption from the gut 2.Increasing reabsorption from the kidney 3.Increased activity of osteoblasts – break down bone and release calcium.

Question 28

What are the nerves of the anterior triangle?

Answer 28

vagus phrenic (c3, 4, 5) hypoglossal

Question 29

What are the roles of the vagus nerve?

Answer 29

Motor – innervates the muscles of the larynx, pharynx and soft palate Parasympathetic – smooth muscle of the trachea, bronchi (slows breathing), slows heart rate and increases gut motility Special sensory fibres – innervation for taste sensation in the epiglottis and root of the tongue General sensory – internal aspect of larynx and the ear canal. Also provides visceral sensory innervation to the heart and abdominal structures.

Question 30

What does the phrenic nerve to?

Answer 30

motor innervation of diaphragm sensation to the diaphragm

Question 31

What are the vessels of the anterior triangle?

Answer 31

common carotid artery jugular veins

Question 32

What are the arteries of the anterior triangle (7)?

Answer 32

superior thyroid ascending pharyngeal lingual facial occipital posterior auricular superficial temporal

Question 33

What are the veins of the posterior triangle (5)?

Answer 33

anterior jugular retromandibular external internal vertebral

Question 34

What are the contents of the posterior triangle?

Answer 34

nerves muscles vessels lymph nodes

Question 35

What are the nerves of the posterior triangle?

Answer 35

Acessory nerve Parts of brachial plexus Cutaneous cervical plexus

Question 36

What are the parts of the accessory nerve?

Answer 36

upper, middle and lower fibres

Question 37

What segments does the trapezius cover?

Answer 37

C7-T12

Question 38

What does the accessory nerve supply?

Answer 38

sternoclediomastiod muscle trapezius

Question 39

What spinal segments does the branchial plexus come from?

Answer 39

C5-T1

Question 40

What are lymph nodes?

Answer 40

Small oval to bean shaped structures. They filter lymph. Offer defence against the spread of infection. Returned to larger veins.

Question 41

What do the superficial lymph nodes drain?

Answer 41

drain face, neck and scalp and pass to the superficial ring of lymph nodes at the junction of head and neck

Question 42

What do deep lymph nodes drain?

Answer 42

deep cervical lymph nodes. Left jugular lymphatic trunk passes to the thoracic duct ->left subclavian vein

Question 43

What are the nerve roots of the brachial plexus?

Answer 43

Ventral rami of C5-T1

Question 44

What is the purpose of the brachial plexus?

Answer 44

Sensory and motor innervation to the upper limb

Question 45

What are the terminal branches of the brachial plexus?

Answer 45

Musculocutaneous axillary median ulnar radial nerves

Question 46

When may the brachial plexus be commonly injured?

Answer 46

Upper roots can be damaged during child birth while the lower ones can be torn during overstretching of the upper limb e.g. falling from a tree and grabbing upwards onto a branch

Question 47

What is the nerve supply to the sternoclediomastiod and trapezius?

Answer 47

accessory

Question 48

What does sternocleidomastoid do on its own (i.e. left sternocleidomastoid or right sternocleidomastoid), and what do they do acting together?

Answer 48

On its own rotation of the head towards the opposite side and superior rotation of the head. Joint contraction with the left and right results in flexion of the neck

Question 49

What is torticollis?

Answer 49

Excess contraction or shortening of sternocleidomastoid

Question 50

What fibres (e.g. sensory, motor, autonomic) are in the phrenic nerve?

Answer 50

Motor to diaphragm sensory to the mediastinal pleura, diaphragmatic peritoneum and pericardium

Question 51

The phrenic nerve used to be sectioned up until the 1950’s for TB. Why is this not the practice now for TB?

Answer 51

Paralysis of the diaphragm resulted in excessive secretions in the lung due to poor respiration resulting in pneumonia. There are very effective anti-TB drugs available

Question 52

What do the two major branches of the common carotid artery supply?

Answer 52

Internal carotid artery supplies the brain and the external carotid artery supplies the head eg face, scalp and neck structures

Question 53

At what cervical level does the common carotid artery bifurcate?

Answer 53

C4/5

Question 54

Why does stenosis (blockage) occur at the bifurcation?

Answer 54

Excess turbulence occurs at the bifurcation due to the change of direction of blood hitting against the superior aspect of the split damaging the intimal lining

Question 55

What does the hypoglossal nerve supply?

Answer 55

Genioglossus, hyoglossus and styloglossus

Question 56

When may the hypoglossal nerve be partially sectioned to reinnervate another nerve close by?

Answer 56

Facial paralysis less than 1 year old not resolving i.e. hypoglossal-facial anastomosis

Question 57

What problem can occur with hypoglossal-facial anastomosis?

Answer 57

Contraction of both facial and tongue muscles. Intense physiotherapy is undertaken and facial injection of botulinum toxin (botox)!

Question 58

What does the thyroid gland produce?

Answer 58

Thyroid hormones (T3 and T4)

Question 59

Why are the secretions produced by thyroid gland important?

Answer 59

Essential for normal neural and growth development

Question 60

What is the arterial supply of the thyroid gland?

Answer 60

superior and inferior thyroid arteries

Question 61

What emergency procedure is undertaken between the thyroid and cricoid cartilages?

Answer 61

Cricothyroidotomy for emergency airway access

Question 62

What comprises the “strap” muscles?

Answer 62

Sternohyoid, thyrohyoid, omohyoid, sternothyroid

Question 63

What is the function of the “strap” muscles?

Answer 63

Depression of the hyoid bone in swallowing

Question 64

What is the function of the digastric muscle?

Answer 64

Opens the jaw

Question 65

Where does the submandibular gland open into the oral cavity?

Answer 65

Opposite the lingual frenulum

Question 66

What does the vagus nerve supply?

Answer 66

Pharyngeal musculature and parasympathetic innervation to the heart, lungs, GI tract

Question 67

What are the main branches of the vagus nerve?

Answer 67

Superior laryngeal (external and internal branches) and the recurrent laryngeal nerves

Question 68

What nerve fibres are in the vagus nerve?

Answer 68

motor, parasympathetic