Anatomy Module 1.2 Paco 2023
1. What related structure of the neck is found at C3? - Hyoid bone
2. What related structure of the neck is found between C3 and C4? - Bifurcation of the common carotid artery (external and internal branches)
3. What nerve innervates the platysma muscle? - Cervical branches of the facial nerve
4. What part of the neck is clinically important for anesthetizing the greater portion of the neck and face? - The nerve point of the neck (where CN XI and three cutaneous branches of the cervical plexus are located)
5. What two veins form a union to make the external jugular vein? - Retromandibular and posterior auricular vein
6. What muscle divides the neck into anterior and posterior triangles? - Sternocleidomastoid
7. What nerve innervates the posterior triangle of the neck? - CN XI
8. What muscles on the posterior portion of the neck elevate the first two ribs and are important in respiration? - Scalenes and levator scapulae
9. What vertebral levels encompass the brachial plexus? - C5-C8 and T1
10. What nerve arises from C5, C6, and C7 and passes through the middle scalene muscle and courses inferiorly to the serratus anterior? - Long thoracic nerve
11. All infrahyoid muscles are innervated by ansa cervicalis except - Thyrohyoid C1
12. Where are the carotid-body chemoreceptors located in the neck? - At the bifurcation of the common carotid arteries which respond to changes in pCO2 and pO2
13. What nerve innervates the carotid body and sinus? - CN IX (carotid sinus branch)
14. The vagus nerve and its superior laryngeal nerve are located in what triangle of the neck? - Carotid triangle
15. What artery originates from the brachiocephalic trunk and terminates at the lateral border of the first rib becoming the axillary artery? - Subclavian artery
16. The subclavian artery is divided into three parts. Describe their locations with regard to the anterior scalene muscle. - First part: anterior to the scalene
17. What are the branches off of the first part of the subclavian artery? - Vertebral artery, internal thoracic artery, and thyrocervical trunk
18. What is the branch off of the second part of the subclavian artery? - Costocervical trunk
19. What is the branch off of the third portion of the subclavian vein? - Dorsal scapular artery
20. What is the anatomical relationship of the subclavian vein to the anterior scalene muscle? - It is anterior to the anterior scalene muscle, superior to the first rib
21. What are the tributaries (other veins that flow into the subclavian)? - External jugular vein and transverse cervical vein
22. Describe the course of the thoracic duct in the neck to its termination. - The thoracic duct enters the neck just left of the midline (very long) and arches to upward to the left and turns anteriorly where it ends at the left subclavian and left internal jugular
23. Where does the cervical plexus originate? - From the ventral primary rami of C1-C4
24. What are the cutaneous branches of the cervical plexus? - Great auricular nerve, transverse cervical nerve, occipital nerve, supraclavicular nerve
25. What are the muscular branches of the cervical plexus? -Ansa cervicalis and the phrenic nerve
26. What two cranial nerves are associations of the cervical plexus? - Hypoglossal nerve and accessory nerve
27. What are the four cervical ganglia in the neck? - Superior, middle, vertebral, and inferior
28. Describe the distribution of the cervical branches. - Gray rami, cardiac branches, visceral branches to pharnyx /larynx/thyroid/parathyroid/trachea/esophagus, plexus of arteries into the head
29. The pretracheal fascia forms the anterior portion of the vertebral sheath. It covers the anterior aspect of what three structures? - Larynx, trachea, and thyroid gland
30. The posterior aspect of the visceral sheath called the buccopharyngeal fascia covers what two structures? - Pharynx and esophagus
31. Describe the anatomical parts of the thyroid gland - Two lateral lobes, an isthmus, and a pyramidal lobe (might be present)
32. What three arteries supply the thyroid gland? - Superior thyroid artery, inferior thyroid artery, and the thyroid ima (rarely present)
33. The four parathyroid glands are located posteriorly to the thyroid artery. What is their arterial supply? - Inferior thyroid artery
34. True or false: the trachea is posterior to the esophagus. - False! (it is anterior to the esophagus)
35. What is the primary nerve innervating the espohagus? - Recurrent branch of the vagus nerve
36. What structures mark the superior boundary of the neck? - Mental symphysis, body and angle of mandible, mastoid process, and occipital bone
37. What structures make up the inferior boundary of the neck? - Suprasternal thoracic aperture (suprasternal notch, first rib, junction between C7 and T1)
38. What important structure is palpable at C3? - Hyoid bone
39. At what levels does the bifurcation of the common carotid occur at? - C3/4
40. At what levels does thyroid cartilage exist? - C4 and C5
41. What four important structures exist at C6? - Cricoid cartilage, beginning of esophagus, beginning of trachea, vertebral artery enters transverse foramen
42. Where does the isthmus of the thyroid gland occur? - C6
43. What are the boundaries of the posterior triangle? - Anterior boundary is SCM muscle, posterior is trapezius, and inferior is the middle third of the clavicle
44. What are the boundaries of the anterior cervical triangle? - Posterior border is the SCM, anterior is the midline, and superior border is the inferior border of the mandible
45. The trachea, thyroid gland, hyoid bone, and cricoid cartilage are all located in what cervical triangle of the neck? - Anterior
46. Name the origin, insertion, innervation, and action of the SCM - Originates at the manubrium of the sternum, inserts at the mastoid process, innervated by CN XI, rotates head, flexes head and neck
47. What two types of fibers innervate the cutaneous nerves from the cervical plexus? - Afferent and postganglionic sympathetic fibers
48. What is the nerve point of the neck? - The clinically important level of the neck, defined as the midpoint of the posterior border of the SCM where CN XI and the three cutaneous branches of the cervical plexus can be found (can insert anesthetic into this spot)
49. What four nerves does the brachial plexus give rise to? - Dorsal scapular nerve, suprascapular nerve, subclavian nerve, and long thoracic nerve
50. What vertebral levels does the brachial plexus reside in? - C5-T1
51. What two muscles does the brachial plexus sit in between? - Anterior and middle scalene muscles
52. What are the 4 arteries coming off of the external carotid? - Facial, lingual, occipital, and superior thyroid
53. What two superior veins drain into the external jugular vein? - Retromandibular and posterior auricular
54. Is the external or internal jugular vein superficial to the SCM? - External
55. In what triangle of the neck are the submental lymph nodes within? - Submental triangle
56. What 5 cranial nerves innervate the neck? - XI, V3, VII, IX, X
57. What Muscle groups does the ansa cervicalis innervate? - All infrahyoid muscles except the thyrohyoid muscle
58. What fascial structure envelops the thyroid gland? - Pretracheal
59. What is the arterial supply to the thyroid gland? - Superior thyroid and inferior thyroid arteries
60. Describe the musculature of the trachea. - Composed of C shaped cartilaginous rings and the trachealis muscle posteriorly
61. What levels do the esophagus and trachea begin at? - Esophagus: begins at the level of the cricoid cartilage, C6 and Trachea: begins just below the cricoid cartilage
62. What structures border the superior thoracic aperture? - Manubrium, first rib, and the body of the first thoracic vertebra
63. What bone makes up the medial wall of the orbit? - Ethmoid bone (with ethmoid air cells)
64. What bone makes up the roof of the orbit? - Frontal bone (anterior cranial fossa, frontal lobe of brain)
65. What principal bone makes up the floor of the orbit? - Maxilla (maxillary sinus)
66. What bones make up the lateral wall of the orbit? - Zygomatic, sphenoid (temporal fossa, frontal lobe of the brain)
67. What two important structures run through the optic canal? - Optic nerve, ophthalmic artery
68. What five important structures run through the superior orbital fissure? - III, IV, V1, VI, superior ophthalmic vein
69. What two structures run through the inferior orbital fissure? - Infraorbital nerve, artery, and vein
70. What are the four fibrous layers deep to the orbicularis oculi? - Orbital septum, levator palpebrae superioris (and its aponeurosis), superior tarsal muscle, and the tarsal plate
71. Inferior to the tarsal muscle in the eye is a clear membranous structure that is responsible for lubricating the eye. What is the name of this structure? - Palpebral Conjunctiva
72. Describe the path a tear follows starting with the lacrimal gland. - Tears are produced in the lacrimal gland, secreted into the superior fornix of conjunctival sac, flow medially across the eye, drain into the lacrimal canaliculi via the lacrimal puncta (hole), lacrimal sac, nasolacrimal duct, inferior nasal meatus
73. Describe the path of parasympathetic innervation to the lacrimal glands. - Superior salivary nucleus → CN VII → greater petrosal nerve → synapse in pterygopalatine ganglion → lacrimal glands
74. What is the primary structure that makes up the posterior compartment in the eye? - Vitreous humor
75. What are the three components of the vascular coat of the eye? - Choroid, ciliary body, and iris
76. Where is aqueous humor produced and where does it drain from the anterior chamber? - Produced in the ciliary process (posterior chamber) and is drained into the iridocorneal angle and into the sinus venosus sclerae
77. What are the four structures that are refractive media? - Cornea, aqueous humor, lens, vitreous body
78. What are the three smooth muscles in the eye? - Ciliary muscle, sphincter pupillae, and dilator pupillae
79. What two muscles in the eye are under sympathetic control? - Superior tarsal and pupillary dilators
80. What two muscles in the eye are under parasympathetic control? - Pupillary constrictor and ciliary muscles
81. What muscle is responsible for elevating the upper eyelid? - Levator palpebrae superioris
82. What muscle attaches just superiorly to the tarsal plate? - Levator palpebrae superioris
83. The levator palpebrae is innervated by what CN? - Oculomotor, III
84. A cyst is formed by the blockage of a duct in what gland? - Tarsal gland
85. What two extraocular muscles only have one action? - Medial and lateral rectus
86. Which extraocular muscle is the only muscle innervated by the trochlear nerve? - Superior oblique
87. What are the primary and secondary actions of the superior oblique? - Depression and abduction (think russian twists, you are strengthening your oblique abdominal muscles as you are abducting)
88. What are the primary and secondary actions of the superior rectus? - Elevation and adduction
89. What is the only extraocular muscle innervated by CN VI? - Lateral rectus
90. If you are trying to test the oblique eye muscles. Start at a position of rest and then have your patient look _________, then either up or down. - Medially/ Adduct
91. What two movements test a patient’s inferior oblique? - From a position of rest, have them look medially (adduct) and then look up (elevate)
92. Describe the principle behind testing the extraocular muscles for weakness. - To test the muscle, one must position the muscle so that the direction of pull of the muscle coincides with the visual axis. In this position it loses its secondary action and becomes the only muscle capable of the primary action.
93. Both the ciliary muscle and sphincter pupillae are innervated by the parasympathetic division. Where are their pre- and postganglionic bodies located? - Preganglionic bodies are in the nucleus of edinger-westphal, and their postganglionic bodies are in the ciliary ganglion.
94. The superior tarsal muscle and dilator pupillae are under sympathetic control. Where are the pre and postganglionic cell bodies? - The preganglionic cell bodies are in the IMLCC, and postganglionic are in the superior cervical ganglion.
95. The ciliary ganglion has connections to what nerves? - Oculomotor and short ciliary nerves
96. What types of fibers innervate the oculomotor nucleus? - Efferent to skeletal muscle fibers (terminating in the levator palpebrae, SR, IR, MR, IO)
97. What is the primary arterial supply of the retina - Central retinal artery
98. What vein empties into the cavernous sinus? - Superior ophthalmic sinus
99. What nerve runs in close proximity parallel to the posterior communicating arteries and is thus at risk when there is an aneurysm in said artery? - CN III
100. Describe the muscular tension of the ciliary muscles and zonule fibers in an unaccommodated state as if someone was looking at a tree 25 feet away - The concentric ciliary muscles (PA) are constricting, causing the zonule fibers to constrict, thus flattening the lens