Term
| The root of the neck is a junctional region between the neck and _______ and between the neck and _______. |
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Definition
| The root of the neck is a junctional region between the neck and thorax and between the neck and upper limb (axilla). |
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Term
| What is the superior thoracic aperture bounded by? |
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Definition
| by T1 vertebra, lst rib and superior border of manubrium |
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Term
What does NOT pass through the superior thoracic aperture (more than one answer)?
TRACHEA
ESOPHAGUS
BRACHIOCEPHALIC TRUNK
L. COMMON CAROTID
R. & L. SUBCLAVIAN
R. & L. BRACHIOCEPHALIC
BRACHIAL PLEXUS
VAGUS (X)
PHRENIC NN.
THORACIC DUCT. |
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Definition
R. SUBCLAVIAN
BRACHIAL PLEXUS (in apex of the axilla) |
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Term
| What are the borders of the apex of the axilla (triangular)? |
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Definition
clavicle
1st rib
superior border of the scapula |
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Term
| What are the chief structures passing the apex of the axilla? |
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Definition
brachial plexus
subclavian artery and vein (which become axillary vessels at the outer margin of rib 1) |
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Term
| It is important to realize that the APEX OF THE LUNG and the CUPULA OF THE PLEURA project through the ____________ into the root of the neck |
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Definition
| superior thoracic aperture |
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Term
| Penetrating wounds (eg, gunshot) involving the apex of the lung can allow air to escape into the pleural cavity causing ___________ with subsequent collapse of the lung. |
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Definition
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Term
The brachiocephalic trunk arises form the ________ and enters the root of the neck, where it divides into the __________ and ____________.
What side is this on? |
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Definition
arch of the aorta
R. subclavian a.
R. common carotid a.
right side |
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Term
What does the R. subclavian a. supply to?
What does the R. common carotid a. supply to? |
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Definition
R. subclavian a. (to the arm or BRACHIUM)
R. common carotid a. (to the head or CEPHALIC region) |
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Term
| On the (right or left) side of the body, the common carotid a. and subclavian a. arise independently from the arch of the aorta. |
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Definition
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Term
| The subclavian a. is divided into 3 parts based on its relationship to the ________ muscle |
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Definition
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Term
| What are the branches of the 1st part of the subclavian artery and where do these branches supply to? |
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Definition
the vertebral a. (to the brain, runs up to get to transverse process)
internal thoracic a. (to the ant. chest wall)
thyrocervical trunk |
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Term
| What does the thyrocervical trunk (branch of subclavian a.) trifurcate into? |
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Definition
medially arching inf. thyroid a.
laterally directed transverse cervical and suprascapular aa. (both of which supply the shoulder region |
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Term
| What arises from either the 1st or 2nd part of the subclavian artery and arches backward over the cervical pleura to reach the neck of the first rib? |
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Definition
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Term
| What does the costocervical trunk (branch of subclavian a) divide into and where do they go? |
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Definition
deep cervical a. (which ascends in the back of the neck and supplies adjacent muscles and the spinal cord)
superior intercostal a. (which usually gives off the first two posterior intercostal aa.) |
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Term
| What artery sometimes arises form the 2nd or 3rd par of the subclavian artery and passes along the medial border of the scapula. |
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Definition
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Term
| What is the first and largest branch of the subclavian artery? |
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Definition
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Term
Where does the vertebral artery (branch of subclavian a) enter the transverse foramen?
What does it supply to and what other artery also supplies to this structure? |
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Definition
CV6 (not CV7)
the brain
internal carotid artery |
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Term
The R. & L. BRACHIOCEPHALIC VV. are formed on each side by the confluence of the ________ v. with the _______ v.
In the chest, the two brachiocephalic vv. unite to form the ______________. |
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Definition
The R. & L. BRACHIOCEPHALIC VV. are formed on each side by the confluence of the subclavian v. with the internal jugular v.
In the chest, the two brachiocephalic vv. unite to form the superior vena cava. |
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Term
| Is the left or right brachiocephalic vein longer? Why is that? |
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Definition
left
Blood from the left side is shunted over to the right side |
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Term
| What is the largest lymph vessel in the body? |
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Definition
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Term
Where does the thoracic duct begin?
It ascends through the thorax in close relation to the ____________.
In the root of the neck it arches laterally to end in the confluence of the ___________ and ___________. |
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Definition
in the abdomen as a sac-like structure (CISTERNA CHYLI)
vertebral colum
L. subclavian and L. internal jugular v (L venous angle) |
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Term
| What does the valve near the termination of the thoracic duct prevent? |
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Definition
| retrograde flow of blood into the duct |
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Term
Laceration of the thoracic duct may result in lymph escaping into the thoracic cavity at rates of 75 to 200 ml per hour, and eventually produce a __________.
The fluid may be removed by ___________ |
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Definition
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Term
What is the duct that drains the entire body and except the right quadrant?
What is the duct that drains the right side? |
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Definition
thoracic duct
Right lymphatic duct |
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Term
| As the thoracic duct enters the root of the neck, it lies between the left border of the ______ and the left ________. It then arches laterally behind the ______ sheath and in front of the _______ and ______ arteries to empty into the left venous angle. |
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Definition
esophagus
cupula
carotid
vertebral
subclavian |
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Term
| What nerve nerve passes anterior to the R subclavian artery and posterior to the R brachiocephalic vein to enter the thorax |
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Definition
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Term
| What nerve descends between the L common carotid and L subclavian arteries and posterior to the L brachiocephalic vein to enter the thorax. |
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Definition
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Term
Does the right or left laryngeal nerve loops around the 1st part of the R subclavian a?
Does the right or left laryngeal nerve arise in thorax and loops around the arch of the aorta? |
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Definition
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Term
| Both the right and left laryngeal nerves ascend in the ________________, supplying both _______ and _______ |
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Definition
tracheoesophageal groove
trachea and esophagus |
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Term
| What nerve is formed at the lateral borders of the anterior scalene mm (by the union of fibers from C3,4,5) |
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Definition
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Term
The phrenic nerve descents (anterior or posterior) to the anterior scalene mm. and then proceed between the _________ a and _________ v on each side to enter the thorax.
What does it supply to? |
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Definition
anterior
subclavian a and subclavian v
diaphragm |
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Term
| cervical portions of the sympathetic trunks lie anterolater to ___________, extending superiorly to the level of CV1. |
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Definition
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Term
| Apical lung cancer can damage the _________ as it passes through superior thoracic aperture |
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Definition
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Term
What is the largest endocrine gland?
What does it secrete? |
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Definition
thyroid gland
thyroxin (stimulant of body metabolism) |
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Term
| The thyroid gland is roughly ___-shaped, with 2 lateral lobes united by an _____ (passing anterior to tracheal rings __-__) |
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Definition
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Term
| The __________ of thyroid gland is common(~50%). It projects superiorly from isthmus |
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Definition
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Term
| What arterial supply does the thyroid gland receive (and to what part)? |
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Definition
The superior thyroid artery (from ECA) supplies mainly the anterosuperior part of the gland
the inferior thyroid artery (from thyrocervical trunk) supplies the posteroinferior part of the gland |
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Term
What is the small artery that is present in only ~10% people that originates from the brachiocephalic trunk or some other nearby artery to supply the thyroid?
What specific part of the thyroid does it supply it? |
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Definition
thyroid ima artery
isthmus of the thyroid gland |
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Term
| What nerves are in close relationship to the superior and inferior thyroid arteries? |
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Definition
ext. laryngeal n. and the sup. thyroid a
recurrent laryngeal n. and the inf. thyroid a. |
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Term
What do the external laryngeal n and recurrent laryngeal n supply to?
Damge to which one results in a hoarse voice?
Monotone voice? |
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Definition
intrinsic muscles of the larynx
Damage to the ext. laryngeal n. results in a monotone voice
damage to the recurrent laryngeal n. results in a hoarse voice. |
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Term
Which thyroid veins drain into the IJV?
Which drains into the brachiocephalic vv? |
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Definition
| sup. and mid. thyroid vv. drain into the IJV and inf. thyroid vv. into the brachiocephalic vv. |
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Term
Lymphatics from the thyroid gland drain into which nodes to the superior deep cervical nodes?
Which nodes to the inferior deep cervical nodes? |
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Definition
prelaryngeal nodes and then to the superior deep cervical nodes
pretracheal nodes and paratracheal nodes and then to the inferior deep cervical nodes. |
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Term
Nerve supply to the thyroid gland is from the ______________. These fibers accompany the superior and inferior thyroid arteries and are (secretomotor or vasomotor).
Endocrine secretion of the thyroid gland is hormonally regulated by the __________. |
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Definition
cervical sympathetic trunk
vasomotor
pituitary |
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Term
Identify the surface of the thyroid:
Trachea (or larynx), Esophagus (or pharynx), Recurrent laryngeal n.
Sternothyroid m. (and sternohyoid and SCM)
Carotid sheath (and contents), Parathyroid glands, Inferior thyroid a., Sympathetic trunk, Longus colli m. |
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Definition
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Term
What is a non-neoplastic and non-inflammatory enlargement of the thyroid gland?
Why does this happen?
What might this compress? |
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Definition
goiter
results from lack of iodine
may compress the trachea, esophagus and recurrent laryngeal nn. |
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Term
| What glands secrete hormones that stimulates the mobilization of calcium from the bones to maintain the normal blood calcium level. |
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Definition
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Term
| What does overactivity and under activity of the parathyroid gland cause? |
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Definition
Overactivity can lead to demineralization of bones (people may fracture ribs by turning over in bed) and renal stones.
Underactivity leads to tetany, in which there are severe muscle spasms (since respiratory mm are affected this can lead to death). |
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Term
How many parathyroid glands are there usually?
Where are they located |
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Definition
usually 4 (pair of superior and pair of inferior)
hey are small (~6mm diameter) brownish-yellow bodies usually located on the medial ½ of the posterior surface of the lobes of the thyroid gland. |
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Term
| What artery usually supplies the parathyroid gland? |
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Definition
| inferior thyroid arteries |
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Term
| What is the venous and lymphatic drainage of the parathyroid gland? |
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Definition
The venous drainage is to the thyroid plexus of veins.
Lymphatic drainage is to the deep cervical nodes. |
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Term
| What is the nerve supply of the parathyroid gland and is it (vasomotor or secretomotor) |
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Definition
| Nerve supply is from the cervical sympathetic ganglia (vasomotor) (the parathyroid glands are hormonally regulated). |
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Term
| The trachea is ~___ cm in length, ~____ cm in diameter in adults and diameter of a pencil in infant |
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Definition
12 (6 in the neck 6 in the chest)
2.5 |
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Term
| The trachea begins at the level of the ______ cartilage (CV___), and ends in the thorax at the level of the TV____ intervertebral disc, where it divides into the R and L main bronchi. |
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Definition
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Term
| The trachea is kept patent by cartilaginous rings, which are joined to one another by ________ ligaments. |
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Definition
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Term
What is making an opening in the anterior wall of the trachea to establish an airway in patients with upper airway obstruction?
Where can the incision be? |
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Definition
tracheostomy
made above, through, or below the isthmus of the thyroid gland (easy to cut through its posterior wall and damage esophagus in infants) |
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Term
Where does the cervical part of the esophagus begin?
What muscle is it continuous with?
Where does it pass through the diaphragm?
Where does it end? |
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Definition
The cervical part begins at the level of CV 6, where it is continuous with the cricopharyngeus m of the pharynx.
passes through the diaphragm at the level of TV l0
ends in the stomach. |
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Term
What is the order from anterior to posterior?
Vertebral column
trachea
esophagus |
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Definition
trachea
esophagus
vertebral column |
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Term
| What are the 4 constrictions of the esophagus? |
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Definition
1) cricopharyngeal
2) aortic
3) constriction produced by L. main bronchus
4) constriction where esophagus passes through the diaphragm |
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Term
| What esophagus constriction is at the junction of the inf. constrictor m. of the pharynx and the esophagus. It is the NARROWEST PART OF THE GASTROINTESTINAL TRACT? |
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Definition
| cricopharyngeal constriction |
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Term
| Where does cancer of the esophagus tend to develop? |
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Definition
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Term
What is the most common present complaint of the esophagus?
When is it usually recognized? |
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Definition
| The most common presenting complaint is dysphagia (which is not usually recognized until the lumen is reduced by 30- 50%). |
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Term
| Painful swallowing in some patients suggests extension of the tumor to ___________ tissues. |
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Definition
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Term
| Compression of the recurrent laryngeal nn by a tumor produces __________. |
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Definition
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Term
What nerve innervate the esophagus?
These branches carry ____ to the striated muscle of the cervical part of the esophagus, ____ to the glands, and ____ to mucosa |
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Definition
recurrent laryngeal nn (X)
SVE
GVE
GVA |
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|
Term
| The cervical esophagus deviates slightly to the (right or left) as it descends, thus making it more accessible to the surgeon on this side |
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Definition
|
|
Term
| What is the most common congenital anomaly of the esophagus? |
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Definition
| tracheoesophageal fistula (TEF) |
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Term
| In the most common type of tracheoesophagel fistula (~90%), the (superior or inferior) part of the esophagus ends in a blind pouch (atresia) and the (superior or inferior )part communicates with the trachea (fistula |
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Definition
|
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Term
| What are the 3 zone of penetrating neck trauma? |
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Definition
Zone 1: Extends from the clavicles and manubrium to the inferior border of the cricoid cartilage (thus this zones
Zone 2: Extends from cricoid cartilage to level of angles of mandible.
Zone 3: Extends from angles of mandible superiorly. |
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Term
Which zone(s) of penetrating neck trauma do most injuries occur in?
Which zone(s) has a higher morbidity (complications following surgical procedures and other treatments) and mortality (fatal outcome)?
Why is this? |
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Definition
Zone 2
Zone 1 and 2
physicians can control vascular damage by direct pressure and can visualize and treat injured structures more easily in zone 2 |
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Term
| What is the anterior tubercle of the transverse process of CV6. It can be compressed against it (to control bleeding). |
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Definition
| carotid tubercle (The common carotid artery passes anterior to the tubercle) |
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Term
| What is the a bilobed gland which lies in the superior and anterior mediastinum of the chest, and sometimes in the root of the neck. |
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Definition
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