Triangles of the Neck 3

Question 1

The anterior boundary of the root of the neck is the superior border of (____ + ____).

Answer 1

manubrium + clavicle

Question 2

The posterior boundary of the root of the neck is the superior border of (____ + ____) to the ___ process

Answer 2

T1 + scapula; coracoid

Question 3

Subclavian vessels, vertebral artery, thyrocervical turnk, internal thoracic artery, and costocervical trunk are all vessels found in the root of the neck. True or false?

Answer 3

true

Question 4

Irritation of the parietal pleura or parietal peritoneum covering diaphragm causes pain that is carried by the ____ nerve to the area supplied by the ____ nerves (shoulder_

Answer 4

phrenic; supraclavicular

Question 5

The ___ subclavian artery arises from the brachiocephalic artery behind the sternoclavicular joint

Answer 5

right

Question 6

The ___ subclavian artery arises from the arch of the aorta

Answer 6

left

Question 7

The subclavian artery is divided by the anterior scalene into 3 parts. Describe the course of the 1st part.

Answer 7

from its origin till anterior scalene

Question 8

The subclavian artery is divided by the anterior scalene into 3 parts. Describe the course of the 2nd part.

Answer 8

posterior to anterior scalene

Question 9

The subclavian artery is divided by the anterior scalene into 3 parts. Describe the course of the 3rd part.

Answer 9

lateral to anterior scalene till its end at the lateral border of 1st rib

Question 10

In regards to the subclavian artery on the right side, there are 2 nerves, 2 veins, and 2 muscles that are anterior to the 1st and 2nd parts of the artery. Name them.

Answer 10

2 nerves: vagus and ansa subclavia
2 veins: internal jugular vein and vertebral vein
2 muscles: sternohyoid and sternothyroid muscles

note: anterior scalene + right phrenic nerve are anterior only to the 2nd part

Question 11

In regards to the subclavian artery on the left side, there are two structures that are anterior to the 1st part of the artery. Name them.

Answer 11

thoracic duct; left phrenic nerve

Question 12

In regards to both subclavian arteries (right and left), what two structures are posterior to the 1st part of the arteries?

Answer 12

apex of lung and cervical pleura

Question 13

In regards to both subclavian arteries (right and left), what two structures are posterior to the 2nd part of the arteries?

Answer 13

lower trunk of brachial plexus and suprapleural membrane

Question 14

The suprapleural membrane extends from the tip of TS process of ___ to the inner border of the ___ rib

Answer 14

C7; 1st

note: separates the artery from pleura and lung

Question 15

In regards to both subclavian arteries (right and left), what structure lies above the 2nd part of the arteries?

Answer 15

upper and middle trunks of the brachial plexus

Question 16

In regards to both subclavian arteries (right and left), what structures lie anterior to the 3rd part of the arteries?

Answer 16

external jugular vein, suprascapular vessels, nerve to subclavius, insertion of anterior scalene

Question 17

This is the first branch of the 1st part of the subclavian artery in the root of the neck. It ascends medially to anterior scalene muscles

Answer 17

vertebral artery

Question 18

This artery is anterior to the vertebral artery.

hint: it is covered in the carotid sheath

Answer 18

common carotid artery

Question 19

This artery crosses the vertebral artery anteriorly.

Answer 19

inferior thyroid artery

Question 20

The transverse process of C7, along with the ventral rami from C7-C8 and the inferior cervical sympathetic ganglion are located ____ to the vertebral artery

Answer 20

posterior

Question 21

The 1st part of the vertebral artery is between the ___ ___ and ___ ___ muscles

Answer 21

anterior scalene; longus coli

Question 22

The 2nd part of the vertebral artery is located in the ___ ____ from the 6th vertebra below to the 1st above

Answer 22

foramina transversaria

Question 23

The 3rd part of the vertebral artery is in the ____ triangle behind the lateral mass of the atlas

Answer 23

suboccipital

Question 24

The 4th part of the vertebral artery is inside the ___ cavity

Answer 24

cranial

Question 25

The vertebral artery ends by joining its fellow of the opposite side to form the ___ artery

Answer 25

basilar

Question 26

This is another branch off of the 1st part of the subclavian artery. It arises close to the medial border of the anterior scalene

Answer 26

thyrocervical trunk

Question 27

This is the lowest branch of the thyrocervical trunk

Answer 27

Suprascapular artery

Question 28

The suprascapular artery passes laterally, crossing anterior to the ___ ___ muscle, ___ nerve, and __ part of subclavian artery

Answer 28

anterior scalene; phrenic; 3rd

Question 29

At the superior border of the scapula, the suprascapular artery crosses over the ___ ___ ligament to enter the supraspinous fossa

Answer 29

transverse scapular

Question 30

This is the middle branch of the thyrocervical trunk

Answer 30

transverse cervical artery

Question 31

The transverse cervical artery enters and crosses the base of the ___ triangle and then courses deep to the ___ muscle

Answer 31

posterior; trapezius note: divides into superficial branch (trapezius) and deep branch (rhomboids)

Question 32

This is the superior continuation of the thyrocervical trunk. It ascends anterior to the anterior scalene muscle

Answer 32

inferior thyroid artery

Question 33

The inferior thyroid curves medially between the ___ artery (posterior) and the _____ sheath (anterior)

Answer 33

vertebral; carotid

Question 34

The inferior thyroid artery reaches the ___ surface of the thyroid gland to supply it

Answer 34

posterior note: as it curves medially to reach thyroid, it gives ascending cervical artery which supplies prevertebral muscles and spinal cord

Question 35

This is the 3rd branch of the 1st part of the subclavian artery in the root of the neck. It arises from its lower border of subclavian artery and descends to the thoracic cavity on both sides of the sternum.

Answer 35

internal thoracic artery

Question 36

The internal thoracic artery ends by dividing into what 2 arteries?

Answer 36

musculophrenic artery and superior epigastric artery

Question 37

On the left subclavian artery, the ___ ___ trunk arises form the 1st part at the medial border of the anterior scalene (instead of the 2nd part)

Answer 37

left costocervical

Question 38

This is the only branch from the 2nd part of the subclavian artery on the RIGHT side. (arises from the 1st part on the left side)

Answer 38

costocervical trunk

Question 39

On both sides, the costocervical trunk arches posteriorly above the apex of the ___ and ____ to reach the neck of 1st rib

Answer 39

lung; pleura

Question 40

The costocervical trunk (right side) ends by dividing into what two arteries?

Answer 40

deep cervical artery and supreme intercostal artery note: deep cervical artery ascends to back of neck to anastomose with descending branch of occipital artery

Question 41

Are there any branches from the 3rd part of the subclavian artery?

Answer 41

Dorsal scapular artery (30% arises form transverse cervical artery of the 1st part)

Question 42

The phrenic nerve arises from the ventral rami of ___-___

Answer 42

C3-C5

Question 43

This nerve arises in the root of the neck and is a branch of the right vagus nerve as it reaches the lower edge of the 1st part of the subclavian artery, passing around it to ascend in groove between trachea and esophagus

Answer 43

right recurrent laryngeal

Question 44

This nerve passes in the root of the neck. It is a branch of the left vagus nerve as it crosses the arch of aorta in the superior mediastinum

Answer 44

left recurrent laryngeal note: it passes below arch of aorta to ascend beside trachea to larynx

Question 45

The cervical sympathetic chain lies in front of the ___ ___ of cervical vertebrae and behind the ___ sheath

Answer 45

transverse processes; carotid note: consists of 3 ganglia ( superior, middle and inferior )

Question 46

Name the vascular branches to the superior ganglia (C1-C2) in the cervical sympathetic chain

Answer 46

internal and external carotid artery

Question 47

Name the vascular branch to the middle ganglia (C5-C6) in the cervical sympathetic chain

Answer 47

inferior thyroid artery

Question 48

Name the vascular branches to the inferior ganglia (C7-C8) in the cervical sympathetic chain

Answer 48

subclavian artery and vertebral artery

Question 49

The visceral branch to the superior ganglia is the superior cardiac nerve and supplies the ___, ___, and ___

Answer 49

larynx; pharynx; heart

Question 50

The visceral branch to the middle ganglia is the middle cardiac nerve and supplies the ___, ___, and ___

Answer 50

trachea; esophagus; and heart

Question 51

The visceral branch to the inferior ganglia is the inferior cardiac nerve and only supplies the heart. True or false?

Answer 51

true

Question 52

The ___ ganglia of the cervical sympathetic chain is connected to the inferior ganglia by a loop called nasa subclavia

Answer 52

middle

Question 53

The inferior ganglia of the cervical sympathetic chain fuses with T1 ganglion to form the ___ ganglion

Answer 53

stellate

Question 54

cells of origin of sympathetic fibers in the head and neck are ___ horn cells in upper 2-3 thoracic segments of spinal cord

Answer 54

lateral

Question 55

This syndrome is due to 2nd order neurons. Most of the preganglionic fibers to superior cervical ganglion are derived from the T1 segment. Thus, destruction of these fibers as they pass through the trunk of the T1 nerve occurs

Answer 55

preganglionic Horner's syndrome

Question 56

What are the symptoms of preganglionic Horner's syndrome? (5)

Answer 56

1. ptosis: drooping of upper eye lid 2. Miosis: constricted pupil 3. enopthalmos: sunken eyes 4. anhydrosis: loss of sweating 5. vasodilator skin arterioles

Question 57

What causes central Horner's sydrome?

Answer 57

1st order neuron defect (lesion in the reticulospinal fibers in brain stem or spinal cord)

Question 58

What causes postganglionic Horner's syndrome?

Answer 58

due to 3rd order neuron defect (lesion in the postganglionic fibers after relay in the superior cervical sympathetic ganglia)