Download 1. A person receives a shallow knife wound just behind the

1. A person receives a shallow knife wound just behind the
sternocleidomastoid muscle and about 1 1/2 inches above the
clavicle. There is an immediate numbness of the skin below the
wound and over the acromion and clavicle. The nerve most likely
severed was the
greater auricular
lesser occipital
supraclavicular
suprascapular
transverse cervical
2. Which muscle is innervated by a branch of the ansa cervicalis?
Sternocleidomastoid
Platysma
Sternohyoid
Trapezius
3. The layer of encircling cervical fascia that splits to enclose
sternocleidomastoid and trapezius muscles is the:
Superficial fascia
Superficial layer of deep fascia
Infrahyoid fascia
Prevertebral fascia
Visceral fascia
4. Which of the following is a dorsal ramus of a spinal nerve?
Supraclavicular n.
Transverse cervical n.
Great auricular n.
Greater occipital n.
Lesser occipital n.
5. Which of the following is true of the inferior thyroid arteries?
They arise from the external carotid arteries
They cross over the superior cervical sympathetic ganglion
They supply most of the anterior surface of the thyroid gland
They often supply all four parathyroid glands
6. A 20 year old man was brought into the emergency room with a
stab wound in the upper part of the neck. Although there was no
major damage done, he lost sensation from the skin over the angle
of the jaw. Which nerve has been cut?
Supraclavicular n.
Transverse cervical n.
Great auricular n.
Greater occipital n.
Lesser occipital n.
7. The triangle in which the superior branch of the ansa cervicalis
separates from the hypoglossal nerve is the:
Carotid
Muscular
Subclavian
Submental
Occipital
8. Exploration of the tracheoesophageal groove at the level of the
thyroid gland would reveal what important structure bilaterally?
Cervical sympathetic trunk
Phrenic nerve
Pyramidal lobe
Recurrent laryngeal nerve
Superior thyroid artery
9. A 35 year old woman was diagnosed with an adenoma of the
thyroid gland. This required excision of the lower pole (left lobe) of
the gland and ligation of the artery supplying that region. Which of
the following nerves accompanying the artery is most likely to be
damaged if the surgeon is not careful?
External branch of the superior laryngeal
Internal branch of the superior laryngeal
Recurrent laryngeal
Vagus proper
Sympathetic trunk
10.
One of the motor components of the cervical plexus, the
ansa cervicalis, innervates all of the following muscles except the:
Omohyoid
Sternohyoid
Sternothyroid
Stylohyoid
Thyrohyoid
11.
A man has metastatic carcinoma and enlarged deep cervical
lymph nodes. One of his symptoms is a hoarse voice, barely heard
above a whisper. Subsequently he succumbs to the disease and at
autopsy it is found that one of the enlarged nodes has put pressure
on a nerve in the tracheoesophageal groove. Presumably this was
the reason for the hoarse voice. What nerve was involved?
External branch of the superior laryngeal nerve
Internal branch of the superior laryngeal nerve
Nerve to the cricothyroid muscle
Pharyngeal branch of the glossopharyngeal nerve
Recurrent laryngeal branch of vagus
12.
You are called on to do a venous catheterization to measure
central venous pressure in the heart. Which muscle of the neck
would provide the best area of approach to the internal jugular
vein?
Anterior scalene
Digastric
Omohyoid
Sternocleidomastoid
Sternohyoid
13.
A patient is brought into the Emergency Room in respiratory
distress. It is quickly decided to create an emergency airway to
restore respiration. At what level could you rapidly create an
airway below the vocal cords with a minimum danger of
hemorrhage?
Just above the jugular notch
Just above the thyroid cartilage
Just below the cricoid cartilage
Just below the thyroid cartilage
Through the 3rd tracheal ring
14.
A 47-year-old woman is diagnosed as having a thyroid
tumor. Surgery to remove the cancerous growth is undertaken. In
which triangle of the neck will the surgeon make an incision to gain
access to the gland?
Carotid
Muscular
Subclavian
Submandibular
Submental
15.
A 50-year-old woman is brought to the operating room for a
biopsy of a suspicious looking nevus (mole) which is found along
the anterior border of her sternocleidomastoid muscle at about its
midlength. What nerve must be locally anesthetized for the
operation to proceed without pain?
Ansa cervicalis
External branch of the superior laryngeal
Great auricular
Supraclavicular
Transverse cervical
16.
Following surgery on the upper pole of the right lobe of the
thyroid gland, a patient complains of hoarseness and weakness of
voice. What nerve may have been injured?
Ansa cervicalis
External branch of the superior laryngeal
Inferior laryngeal
Internal branch of the superior laryngeal
Recurrent laryngeal
17.
These structures are all located in the superficial fascia of
the neck EXCEPT
External jugular vein
Platysma muscle
Cervical branch of the facial nerve
Omohyoid muscle
Transverse cervical nerve
18.
The superior belly of the omohyoid forms the anterior border
of which cervical triangle?
Carotid
Muscular
Omoclavicular
Posterior
Submandibular
19.
The cervical plexus innervates all of the following structures
EXCEPT:
Diaphragm
Omohyoid muscle
Platysma
Skin over thyroid cartilage
Skin over clavicle
20.
An emergency room patient presented with considerable
bleeding from a shallow stab wound in the omoclavicular triangle.
Which vessel was most likely cut?
Axillary vein
Common carotid artery
External jugular vein
Inferior thyroid vein
Superior thyroid artery
21.
Which structure or area receives NO nerve fibers from the
cervical plexus?
Diaphragm
Skin over the angle of the mandible
Skin over the external occipital protuberance
Thyrohyoid muscle
22.
A six-year-old child, whose medical history includes a rather
difficult birth, has a permanently tilted head posture, with the right
ear near the right shoulder and the face turned upward and to the
left. Which of the following muscles was very likely damaged
during birth?
Anterior scalene
Omohyoid
Sternocleidomastoid
Trapezius
Platysma
23.
Any irritation of the diaphragm (e.g. infection, tumor) may
create referred pain that seems (to the patient) to originate in the
area atop the shoulder. This is due to the fact that the phrenic
nerve shares spinal segments with what cutaneous nerve in the
shoulder region?
Dorsal scapular
Lesser occipital nerve
Long thoracic nerve
Supraclavicular nerve
Suprascapular nerve
24.
Which of the following statements about the cervical plexus
is true?
It comprises spinal segments C1-C3
It consists solely of cutaneous nerves
It consists solely of ventral rami of spinal nerves
It supplies motor innervation to platysma
1. The correct answer is:
supraclavicular
The supraclavicular nerves come from C3 and C4 in the cervical plexus.
These cutaneous nerves provide sensory innervation to the skin of the
root of the neck, upper chest, and upper shoulder. These nerves
innervate the skin right above the clavicle, so they are the correct
answer. The great auricular nerve comes from C2 and C3 branches in
the cervical plexus; it provides sensory innervation to the ear and the
skin below the ear. The lesser occipital nerve comes from C2 in the
cervical plexus - it innervates the skin behind the ear. The transverse
cervical nerve is also a cutaneous branch from the cervical plexus - it is
from C2 and C3 and provides sensory innervation to the skin of the neck
anteriorly. The suprascapular nerve is not a cutaneous nerve - it comes
from the superior trunk of the brachial plexus and provides motor
innervation to supraspinatus and infraspinatus.
2. The correct answer is:
sternohyoid
The sternohyoid muscle is one of the strap muscles which runs from the
manubrium and the sternal end of the clavicle to the hyoid bone. It is
innervated by the ansa cervicalis, and it depresses and stabilizes the
hyoid bone. Platysma is a muscle of facial expression; it is innervated by
the cervical branch of CN VII, the facial nerve. Sternocleidomastoid and
trapezius are both innervated by the accessory nerve (CN XI).
Sternocleidomastoid receives fibers from C2 and C3 for proprioception,
while trapezius receives proprioceptive fibers from C3 and C4.
3. The correct answer is:
Superficial layer of deep fascia
The superficial layer of deep cervical fascia extends between trapezius
and sternocleidomastoid in the posterior triangle and between the paired
sternocleidomastoid muscles in the anterior triangle. Superficial fascia is
the same as subcutaneous tissue--the tissue that you see as you
remove the skin. Infrahyoid fascia is the layer of deep fascia that covers
the strap muscles in a sheet. Prevertebral fascia is the deep fascia
surrounding the vertebral column and the associated muscles (like the
scalenes). Finally, the visceral fascia is the fascia that encloses the deep
structures of the neck, including the thyroid, the larynx and trachea, and
the esophagus. The anterior part of that fascia is the pretracheal fascia,
and the posterior part of the visceral fascia is the buccopharyngeal
fascia. To get a better picture of this, see Netter plate 30.
4. The correct answer is:
greater occipital nerve
The greater occipital nerve is the cutaneous branch of the dorsal primary
ramus of spinal nerve C2 - it provides cutaneous innervation to the
posterior scalp. The other nerves listed are all nerves from the cervical
plexus, which is formed by ventral primary rami C1-C4. The
supraclavicular nerves come from C3 and C4 in the cervical plexus.
These cutaneous nerves provide sensory innervation to the skin of the
root of the neck, upper chest, and upper shoulder. The great auricular
to the ear and the skin below the ear. The lesser occipital nerve comes
from C2 only - it innervates the skin behind the ear. The transverse
cervical nerve is also a cutaneous branch from the cervical plexus--from
C2 and C3, providing sensory innervation to the skin of the neck
anteriorly.
5. The correct answer is:
They often supply all four parathyroid glands
The inferior thyroid arteries are branches of the thyrocervical trunk. (The
superior thyroid arteries are branches of the external carotid artery.) The
inferior thyroid arteries are closely associated with the middle cervical
sympathetic ganglia and supply the inferior poles of the thyroid. They are
found on the posterior surface of the thyroid gland, which is where the
parathyroid glands are located. So, they are the primary source of blood
for the four parathyroid glands.
6. The correct answer is:
Great auricular n.
The great auricular nerve comes from C2 and C3 branches of the
cervical plexus; it provides sensory innervation to the ear and the skin
below the ear, including the angle of the jaw. The supraclavicular nerves
come from C3 and C4 in the cervical plexus. These cutaneous nerves
provide sensory innervation to the skin of the root of the neck, upper
chest, and upper shoulder. The transverse cervical nerves also come
from the cervical plexus--they are from C2 and C3 and provide sensory
innervation to the skin of the neck anteriorly. Finally, the lesser occipital
nerve comes from C2--it innervates the skin behind the ear. The greater
occipital nerve is not from the cervical plexus, which is the ventral rami of
C1-4--it is the cutaneous branch of the DORSAL primary ramus of spinal
nerve C2. It provides cutaneous innervation to the posterior scalp.
7. The correct answer is:
carotid
The superior branch of ansa cervicalis runs with the hypoglossal nerve
until the carotid triangle. In this triangle, the superior branch of ansa
cervicalis separates from the hypoglossal nerve and runs in the carotid
sheath, anterior to the carotid artery. Remember--the carotid sheath is
found in the carotid triangle, a space bounded laterally by the
sternocleidomastoid muscle, superiorly by the posterior belly of the
digastric, and anteriorly by the superior belly of omohyoid. The other
triangles listed are not the spaces where ansa cervicalis separates from
the hypoglossal nerve.
8. The correct answer is:
Recurrent laryngeal nerve
The left and right recurrent laryngeal nerves can be found in the left and
right tracheoesophageal grooves. This is a very characteristic
relationship that you need to know! The cervical sympathetic trunk is
much deeper in the neck--it lies in the prevertebral fascia, in front of the
prevertebral muscles. The phrenic nerve lies on the surface of the
anterior scalene muscles before it descends into the thorax to innervate
the diaphragm. The pyramidal lobe of the thyroid gland is a small tract of
tissue that may extend upward from the isthmus of the thyroid. This is a
developmental remnant that marks the thyroid's route of migration from
the foramen cecum of the tongue. The superior thyroid artery is a branch
of the external carotid artery--it travels to the superior lobes of the
thyroid and runs with the external branch of the superior laryngeal nerve.
9. The correct answer is:
recurrent laryngeal
The inferior thyroid artery supplies the lower lobes of the thyroid. It is a
branch of the thyrocervical trunk. Branches of this artery cross the
recurrent laryngeal nerve, so this is the nerve that might be damaged
during the surgery. The external branch of the superior laryngeal nerve
runs with the superior thyroid artery--this artery and nerve might be
damaged when removing the superior lobes of the thyroid. The internal
branch of the superior laryngeal nerve runs with the superior laryngeal
artery, piercing the thyrohyoid membrane. The vagus nerve proper runs
with the common carotid artery, in the carotid sheath. It gives off the
recurrent laryngeal nerve, but it does not come as close to the inferior
thyroid artery. Finally, the sympathetic trunk is in the deep neck, near the
vertebral bodies. It should not be damaged in thyroid surgery.
10. The correct answer is:
stylohyoid
The stylohyoid muscle runs from the posterior portion of the digastric
muscle to the body of the hyoid bone. It elevates and retracts the hyoid,
and it is innervated by the facial nerve (CN VII). Omohyoid, sternohyoid,
sternothyroid, and thyrohyoid are all strap muscles which are innervated
by ansa cervicalis (although thyrohyoid receives its branch via the
hypoglossal nerve).
11. The correct answer is:
recurrent laryngeal branch of the vagus
Damage to the recurrent laryngeal nerve is one possible cause of
hoarseness. The recurrent laryngeal nerve changes its name to the
inferior laryngeal nerve at the level of the inferior border of the cricoid
cartilage. The inferior laryngeal nerve goes on to innervate all the
intrinsic muscles of the larynx except cricothyroideus. So, if this nerve
innervating all the muscles of the larynx was damaged, a patient would
have a hoarse voice. A very significant piece of information that tells you
that the recurrent laryngeal nerve was injured is the location of the
injury-- remember, recurrent laryngeal travels in the tracheoesophageal
groove.
The external and internal branches of the superior laryngeal nerve
innervate cricothyroid, the inferior pharyngeal constrictor, and provide
secretomotor fibers to mucosal glands of the larynx above the vocal
folds. The pharyngeal branch of the glossopharyngeal nerve provides
sensory innervation to the pharynx. None of these nerves are running in
the tracheoesophageal groove!
12. The correct answer is:
Sternocleidomastoid
The internal jugular vein is found in the carotid triangle, which is
bounded medially by omohyoid, laterally by sternocleidomastoid, and
superiorly by the posterior belly of digastric. Of these three muscles,
sternocleidomastoid is the easiest landmark to find on the neck and the
most practical muscle to find when looking for the carotid triangle and
the internal jugular vein. The anterior scalene is posterior to the internal
jugular vein, and is not related to the vessel. Sternohyoid is a strap
muscle in the muscular triangle; it is not associated with the internal
jugular vein.
13. The correct answer is:
Just below the thyroid cartilage
To create an emergency airway, a midline cut can be made through the
cricothyroid ligament and membrane. So, an opening is created between
the thyroid cartilage and the cricoid cartilage. Since this is below the
glottis and the tracheal inlet (which is the usual place where things get
lodged), this is a good spot to make the cut. It is also easy to find the
thyroid cartilage on a patient and make the incision right below that spot.
14. The correct answer is:
muscular
The muscular triangle is found in the anterior triangle of the neck. It is
bounded by the midline as its medial border, the superior belly of the
omohyoid as its superolateral border, and sternocleidomastoid as its
inferolateral border. The strap muscles, thyroid, and parathyroids are
found in this triangle. Since the thyroid is found at the midline, deep to
the strap muscles, you would need to cut into this triangle to perform
surgery on the thyroid gland.
The carotid triangle is bounded laterally by the sternocleidomastoid,
superiorly by the posterior belly of the digastric, and anteriorly by the
superior belly of the omohyoid muscle. The carotid vessels and carotid
sheath can be found in this triangle. The subclavian triangle is the same
as the omoclavicular triangle. It is found in the posterior triangle of the
neck. This triangle is bounded superiorly by the inferior belly of the
omohyoid muscle, anteriorly by the sternocleidomasoid muscle, and
inferiorly by the clavicle. The third part of the subclavian artery and the
subclavian vein are located in this triangle.
The submandibular triangle is bounded anteriorly by the anterior belly of
the digastric, posteriorly by the posterior belly of the digastric, and
superiorly by the lower border of the mandible. It contains the superficial
portion of the submandibular gland and the facial artery and vein. The
submental triangle is laterally bordered by the anterior bellies of the
digastric muscles. It is inferiorly bordered by the hyoid bone. Submental
lymph nodes are found in this triangle.
15. The correct answer is:
Transverse cervical
To answer this question, you want to figure out which nerves supply
sensory innervation to the skin of the anterior neck. The transverse
cervical nerves, which come off the C2 and C3 roots of the cervical
plexus, are the nerves that supply the skin of the neck anteriorly. So,
these nerves would need to be anesthetized. The great auricular and
supraclavicular nerves are also cutaneous sensory nerves from the
cervical plexus. The great auricular nerve innervates the skin of the ear
and the area below the ear. The supraclavicular nerves innervate the
skin at the root of the neck and the upper chest and upper shoulder.
Ansa cervicalis is a branch of the cervical plexus which innervates the
strap muscles--it's a motor nerve, not a sensory nerve. The external
branch of the superior laryngeal nerve is a motor nerve, too--it
innervates the cricothyroid muscle.
16. The correct answer is:
Exernal branch of the superior laryngeal
The external branch of the superior laryngeal nerve travels with the
superior thyroid artery toward the superior pole of the thyroid. So, it's in
the right place to be injured by surgery on the upper pole of the gland.
The external branch of the superior laryngeal nerve innervates
cricothyroid, the muscle responsible for elongating the vocal cords. The
patient's symptoms of horseness and a weak voice would fit with an
injury to this nerve and the denervation of this muscle.
The inferior laryngeal and recurrent laryngeal nerves are one in the
same--the recurrent laryngeal changes its name to the inferior laryngeal
at the inferior border of cricopharyngeus. This nerve innervates all of the
other muscles of the larynx, besides cricothyroid. It runs with the inferior
thyroid artery to the inferior poles of the thyroid--it could be injured in any
surgery involving the inferior thyroid artery or inferior aspects of the
gland. The internal branch of the superior laryngeal nerve pierces the
thyrohyoid membrane along with the superior laryngeal artery--it is a
sensory nerve only. It supplies sensory innervation to the mucosa of the
larynx, superior to the vocal folds.
Ansa cervicalis is a branch of the cervical plexus which innervates the
strap muscles. It does not innervate any muscles in the larynx.
17. The correct answer is:
Omohyoid muscle
The omohyoid muscle is a muscle found in the anterior and posterior
triangle of the neck. It depresses and stabilizes the hyoid bone. Like all
muscles (except the muscles of facial expression), the omohyoid is not
found in the superficial fascia. The external jugular vein is a small vein
found in the superficial tissue on the lateral side of the neck. The
platysma is a muscle of facial expression that draws down the corners of
the mouth and depresses the mandible. It inserts into the skin, so it is
found in the superficial fascia. The cervical branch of the facial nerve,
which innervates the platysma, is also in the superficial fascia. Finally,
the transverse cervical nerve is a branch of the cervical plexus that
innervates the skin of the anterior neck. Because it is providing
cutaneous innervation, it is found in the superficial fascia.
18. The correct answer is:
Carotid
The carotid triangle is bounded anteriorly by the superior belly of the
omohyoid muscle, laterally by the sternocleidomastoid, and superiorly by
the posterior belly of the digastric. The carotid vessels and carotid
sheath can be found in this triangle. The muscular triangle is bounded by
the midline as its medial border, the superior belly of the omohyoid as its
superolateral border, and sternocleidomastoid as its inferolateral border.
The strap muscles, thyroid, and parathyroids are found in this triangle.
The omoclavicular triangle, in the posterior neck, is bounded superiorly
by the inferior belly of the omohyoid muscle, anteriorly by the
sternocleidomastoid muscle, and inferiorly by the clavicle. The third part
of the subclavian artery and the subclavian vein are located in this
triangle. The posterior triangle of the neck is bounded anteriorly by the
sternocleidomastoid muscle, posteriorly by trapezius, and inferiorly by
the clavicle. The submandibular triangle is bounded anteriorly by the
anterior belly of the digastric, posteriorly by the posterior belly of the
digastric, and superiorly by the lower border of the mandible. It contains
the superficial portion of the submandibular gland and the facial artery
and vein.
19. The correct answer is:
Platysma
Platysma is a muscle of facial expression. It inserts into the skin and
helps lower the angle of the mouth and depress the mandible. It is
innervated by the cervical branch of the facial nerve (CN VII). All of the
other muscles or areas of skin are innervated by branches of the cervical
plexus, a plexus made of the ventral primary rami of the C1-C4 spinal
nerves. The diaphragm is innervated by the phrenic nerve, which is
made from the C3, C4 and C5 ventral primary rami. The omohyoid
muscle is innervated by ansa cervicalis, a motor branch of the cervical
plexus. The skin over the thyroid cartilage is innervated by the
transverse cervical nerve, a cutaneous sensory nerve from C2 and C3
roots of the cervical plexus. The skin over the clavicle is innervated by
other cutaneous sensory nerves from the C3 and C4 roots of the cervical
plexus--the supraclavicular nerves.
20. The correct answer is:
External jugular vein
The external jugular vein is a superficial vein on the lateral side of the
neck. It is in the superficial fascia, so it could be easily injured by a
superficial wound. Since this vein travels in the omoclavicular triangle,
this is the structure that was injured. The axillary vein is the continuation
of the subclavian vein lateral to the first rib--it is important in draining the
upper limb, but it's not associated with the triangles of the neck. The
common carotid artery is found in the carotid sheath and carotid triangle.
The inferior thyroid vein and superior thyroid artery are both found near
the thyroid gland; therefore, they are both in the muscular triangle.
21.
The correct answer is:
Skin over the external occipital protuberance
The skin over the external occipital protuberance is innervated by the
greater occipital nerve, which is from the dorsal primary ramus of C2.
Since the cervical plexus is made of the ventral primary rami of C1
through C4, the greater occipital nerve has no connection with the
cervical plexus. The diaphragm is innervated by the phrenic nerve,
which receives contributions from the ventral primary rami of C3, C4,
and C5. The skin over the angle of the jaw is innervated by the great
auricular nerve, which comes from C2 and C3 branches of the cervical
plexus. Finally, the thyrohyoid muscle is innervated by the ansa
cervicalis (specifically, C1 and C2 fibers carried by hypoglossal nerve), a
motor component of the cervical plexus that innervates the strap
muscles.
22.
The correct answer is:
Sternocleidomastoid
If the sternocleidomastoid is damaged at birth and becomes shortened,
a patient may have muscular torticollis. The neck will appear twisted and
the chin elevated because the sternocleidomastoid muscle will be too
short on one side. This patient has an injured right sternocleidomastoid,
since his head is turned down on the right side where the
sternocleidomastoid is too short. Patients may also have spasmotic
torticollis, where the neck is twisted and elevated due to a temporary
spasm of the sternocleidomastoid muscle. None of the other muscles
listed would cause similar symptoms if they were injured.
It's important to remember the association between torticollis and the
sternocleidomastoid!
23. The correct answer is:
Supraclavicular nerve
The phrenic nerve consists of contributions from the ventral primary rami
of C3, C4, and C5. The supraclavicular nerves come from the C3 and
C4 roots of the cervical plexus. So, these nerves share spinal segments.
This explains why pain from the diaphragm is referred to the area where
the supraclavicular nerves provide cutaneous innervation. The lesser
occipital nerve is another cutaneous nerve from the cervical plexus, but
it is mostly made of fibers from the C2 ventral rami. The other nerves
listed are all motor nerves from the brachial plexus. The dorsal scapular
nerve comes from the C5 ventral primary ramus-- it innervates
rhomboideus major and minor and the lower portion of levator scapulae.
The long thoracic nerve comes from C5, C6, and C7 ventral primary
rami--it innervates serratus anterior. The suprascapular nerve comes
from the superior trunk of the brachial plexus--it innervates
supraspinatus and infraspinatus.
24. The correct answer is:
nerves
It consists solely of ventral rami of spinal
The cervical plexus consists solely of the ventral primary rami of spinal
nerves C1-C4. It supplies cutaneous innervation through nerves like the
lesser occipital, great auricular, supraclavicular and transverse cervical.
It also supplies motor innervation to the strap muscles through the ansa
cervicalis. So, it has a motor and sensory component. It does not
innervate the platysma--platysma is a muscle of facial expression
innervated by the cervical branch of the facial nerve (CN VII).