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Neuro I > Area under SCM > Flashcards

Area under SCM Flashcards

1
Q

What are the general contents of the carotid sheath

A 
common and internal carotid aa
internal jugular v
vagus n
ansa cervicalis (superior root is in the sheath) inferior on its lateral surface
deep cervical lymph nodes
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2
Q

within the carotid sheath where do the a and v and n lay respectively

A

a lies medial and anterior
v lies lateral and posterior
n between vessels

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3
Q

Where do the common carotids branch from

A

left from arch of aorta

right from brachiocephalic trunk

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4
Q

what fascias of the neck contribute to carotid sheath

A

investing, pre-tracheal, pre-vertebral and cervical fascias

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5
Q

where is the carotid sinus found

A

dilated distal common carotid and proximal internal carotid

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6
Q

what does the carotid sinus sense

A

Pressure changes, HR

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7
Q

where is the carotid body located

A

at carotid bifurcation

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8
Q

what does the carotid body sense

A

changes in O2 tension, increase in rate and depth of respiration

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9
Q

what n carries afferents from carotid body

A

IX

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10
Q

Where does the internal carotid a enter skull

A

carotid canal

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11
Q

what are the branches of the external carotid a

A 
superior thyroid
ascending paryngeal
lingual
facial
occipital
posterior auricular
terminates as maxillary and superficial temporal aa
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12
Q

what are the boundaries of the carotid triangle

A

anterior border SCM, posterior border of superior belly omohyoid, inferior border of posterior belly digastric

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13
Q

What can be found in the carotid triangle

A

carotid bifurcation, internal jug v, vagus and hypoglossal nn and sympathetic trunk

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14
Q

if patient has voice changes after manipulation to carotid triangle area what nn are responsible

A

vagus and recurrent laryngeal because innervate mm of larynx

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15
Q

Why do atherosclerotic plaques form at carotid bifurcation?? which side is most common

A

turbulence

internal carotid area is usually more occluded

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16
Q

what is a carotid endarterectomy

A

removal of plaque from carotid bifurcation

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17
Q

What are the major branches of the superior thyroid a

A

superior laryngeal a
anterior branch
posterior branch

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18
Q

What are the branches of the ascending pharyngeal a

A

pharyngeal
palatine
inferior tympanic
meningeal

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19
Q

what are the branches of lingual a

A

dorsal lingual
deep lingual
sublingual

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20
Q

what is a “wet stroke”

A

hemorrhagic stroke, inside or around brain tissue

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21
Q

what is a “dry stroke”

A

ischemic stroke, occluded artery supplying brain tissue

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22
Q

where does facial a arise from off external carotid

A

either as trunk with lingual or right after it

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23
Q

what are the submandibular branches of the facial a

A

tonsillar, ascending palatine, glandular, muscular, submental

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24
Q

where does the occipital a run

A

passes in groove between transverse process of atlas and mastoid process
pierces fascia where trapezius and SCM come together
parallels greater occipital n

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25
Q

what are the main branches of occipital a

A 
sternocleidomastoid
meningeal a
auricular
mastoid
descending branch
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26
Q

what structure crosses over the occipital a where it branches of external a

A

hypoglossal n

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27
Q

what are the branches of the posterior auricular a

A 
muscular branches
parotid branches
stylomastoid
auricular
occipital
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28
Q

How does the internal jugular v receive blood

A

from dural venous sinuses

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29
Q

where does the internal jugular v begin

A

at jugular foramen as superior jugular bulb

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30
Q

where does the internal jugular vein end

A

as inferior bulb posteiror to sternoclavicular joint where it joins subclavian v to form brachiocephalic v

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31
Q

what are some tributaries to internal jugular veins

A 
occipital vv
pharyngeal vv
lingual v
facial v as common facial v
superior and middle thyroid v
32
Q

where can the right internal jugular v be accessed for Dx purposes

A

apex of triangle between clavicular and sternal heads of SCM with needle inserted lateral to common carotid pulse at 30 angle inferiorly to ipsilateral nipple

33
Q

What type of fibers are in vagus CN X

A

SVE, SVA, GVA, GSA and GVE-P

34
Q

what mm are inn by the SVE portion of vagus

A

pharynx, palate and laryngeal mm also proximal 1/3 esophagus

35
Q

What are the general afferents from vagus

A

GVA carotid body, epiglottis, larynx, respiratory system, GI to terminal colon
GSA to external ear, external auditory meatus, tympanic membrane, posterior cranial fossa dura mater

36
Q

What is the SVA portion of vagus

A

taste for epiglottic portion of tongue

37
Q

what is the GVE-P of vagus

A

PAN to heart, lungs and GI system

38
Q

where does vagus n exit brainstem

A

at medulla

39
Q

where does the vagus n exit skull

A

jugular foramen

40
Q

where does the vagus n eneter the thorax

A

R- between subclavian a and right brachiocephalic v

L- between junction of L common carotid with L subclavian and L brachiocephalic v

41
Q

What other nn does the vagus communicate with

A

IX, XI XII superior cervical ganglion and spinal nn C1 and C2

42
Q

What are the branches of vagus n in the neck

A 
meningeal
auricular
pharyngeal
nerve to carotid body
superior laryngeal
cervical cardiac branches
recurrent laryngeal n
43
Q

describe meningeal branch of vagus n

A

GSA to dura of posterior cranial fossa

44
Q

describe auricular branch of vagus n

A

GSA posterior surface of pinna, auditory canal and external surface of tympanic membrane

45
Q

describe pharyngeal branch of vagus n

A

SVE branches to mm of pharynx and soft palate

46
Q

describe nerve to cartoid body off vagus

A

from pharyngeal, afferent limb from O2 chemoR in bifurcation

GVA

47
Q

where does superior laryngeal n course in regards to the carotid sheath

A

medial

48
Q

What are the branches of superior laryngeal n

A

internal SVA GVA GVE-P

external SVE

49
Q

what does the internal branch of superior laryngeal n provide

A

taste and general sensation and PAN to base of tongue (mucous glands), also to epiglottis, aryepiglottic folds and internal portion of larynx above true vocal fold

50
Q

What a does the external branch of superior laryngeal run with

A

superior thyroid a

51
Q

what type of fibers are in external branch superior laryngeal n and inn what?

A

SVE

circothyroid m and inferior constrictor m

52
Q

what are the cervical cardiac branches of vagus and type of fiber information

A

GVE-P GVA

superior and inferior cardiac nn

53
Q

where are the superior cardiac nn found

A

near origin of superior laryngeal n and descend medial to carotid sheath

54
Q

where are the inferior cardiac nn from vagus found

A

in root of neck near 1st rib

55
Q

what nn form deep cardiac plexus

superficial cardiac plexus?

A

deep: superior cardiac nn and right inferior cardiac nn
superficial: left inferior cardiac n

56
Q

What type of fibers are within the recurrent laryngeal n

A

SVE GVE-P and GVA

57
Q

what structures are inn by recurrent laryngeal

A

mm of larynx, secretory to mucous

sensory to mucosa inferior to true vocal folds

58
Q

where are the recurrent laryngeals found

A

R n recurs around subclavian a

L n recurs around aortic arch at ligamentum arteriosum

59
Q

Once the recurrent laryngeal nn are in the larynx what are they called

A

inferior laryngeal nn

60
Q

what are the branches off recurrent laryngeal nn

A

cardiac branches to deep cardiac plexus
branches to mm and glands of trachea and esophagus
pharyngeal branches to inferior constrictor
laryngeal branches to all m of larynx EXCEPT cricothyroid

61
Q

What divides the deep cervical lymph nodes into superior and inferior

A

omohyoid m

62
Q

what lymph nodes are found in superior carotid triangle

A

superior deep cervical

retropharyngeal, deep parotid, jugulodigastric and jugulo-omohyoid

63
Q

where do the superior deep nodes drain to

A

inferior nodes

64
Q

where do the inferior deep cervical nodes receive lymph from

A 
superficial cervical
superior deep
accessory chain of posterior triangle
transverse cervical nodes
juxtavisceral nodes of anterior triangle: infrahyoid, pre-laryngeal, pre-tracheal and paratracheal
65
Q

what are the jugular lymph trunks

A

on L: thoracic duct
R: subclavian and right bronchi-mediastinal trunks join to make right lymphatic duct that enters where internal jug meets subclavian

66
Q

in radical neck dissection ofr metastatic cancer in supraclavicular nodes what lymph is taken out

A

all of the deep cervical lymph and cutaneous branches of cervical plexus

67
Q

Where does CN XII leave skull

A

hypoglossal canal medial to internal jugular v and internal carotid a

68
Q

What spinal nn make up cervical plexus

A

C1-C4 ventral rami

69
Q

what is inn by cervical plexus

A

motor: deep cervical mm, infra hyoids and diaphragm
sensory: lateral head, neck, superolateral shoulder and upper anterior thorax
carries all postganglionic sympathetics for C1-4

70
Q

What are the sensory nn off cervical plexus and contributing levels

A

lesser occipital C2-3
great auricular C2-3
transverse cervical n C2-3
supraclavicular nn C3-4
phrenic C345
sensory fibers C1C2 join hypoglossal to post dura
proprioceptive C2-4 in spinal accessory: 2-3 to SCM 3-4 to trapezius

71
Q

What are the motor nn off cervical plexus

A

ansa cervicalis
C1 in hypoglossal
muscular branches to longus capitis, longus coli and middle scalene
phrenic

72
Q

What levels give rise to superior root of ansa cervicalis and inn what

A

C1-C2

73
Q

what levels give rise to inferior root of ansa cervicalis

A

C2-C3

74
Q

what mm are inn by the ansa cervicalis individual branches

A

infrahyoid mm

sternothyroid sternohyoid and omohyoid

75
Q

what cord level inn the geniohyoid and thyrohyoid mm

A

C1- run in hypoglossal

76
Q

where does accessory phrenic n most commonly arise from

A

C5 spinal n

Neuro I (9 decks)

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