Block 5 Anat Triang Root Of Neck From Ta's W Expl Prt 1
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- 1.
You should find the bifurcation of the common carotid into the external carotid and internal carotid in which triangle?
- A.
Submental triangle
- B.
Submandibular triangle
- C.
Carotid triangle
- D.
Muscular triangle
- E.
Posterior triangle
Correct Answer
C. Carotid triangleExplanation
In the carotid triangle you find the internal jugular vein, common carotid, bifurcation of the common carotid, external carotid branches, carotid sinus, carotid body, vagus nerve, hypoglossal nerve, ansa cervicalis, thyrohyoid and inferior constrictor of the pharynx. Rate this question:
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- 2.
A 16 year-old female experiences swelling and tenderness underneath her chin one week after getting her lower lip pierced. In which triangle is the inflammed structure located?
- A.
Submandibular
- B.
Submental
- C.
Muscular
- D.
Carotid
Correct Answer
B. SubmentalExplanation
The submental triangle contains the submental lymph nodes which drain the lower lip, chin and the tip of the tongue.Rate this question:
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- 3.
Mr. Numair, who had surgery in the left carotid triangle complained to her physician that she has little sense of touch to the skin over the left side of her neck and difficulty swallowing. The patient's tongue is not affected. The physician suspects that the cervical plexus of nerves to the left side of her patient's neck was harmed during the surgical procedure. Loss of touch sensation to the skin over the anterior triangle would result from injury to which nerve?
- A.
Lateral supraclavicular nerve
- B.
Spinal accessory nerve
- C.
Hypoglossal nerve
- D.
Medial supraclavicular nerve
- E.
Transverse cervical nerve
Correct Answer
E. Transverse cervical nerveExplanation
Transverse cervical nerve. The cervical plexus is situated deep in the upper part of the neck, under cover of the internal jugular vein and the sternocleidomastoid (SCM). Formed by the anterior primary rami of cervical nerves 1-3, it gives rise to superficial branches, which emerge near the middle of the posterior border of the SCM. The branches are (1) the lesser occipital nerve, which hooks around the accessory nerve and ascends to the auricle; (2) the great auricular nerve which ascends superficial to the SCM and toward the parotid region; (3) the transverse cervical nerve, which crosses the SCM into the anterior neck; and (4) the supraclavicular nerves, which descend as three nerves that cross the clavicle and supply the skin over the shoulder.Rate this question:
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- 4.
You are doing an elective rotation in the Emergency department and have been closely monitoring a patient who was brought in earlier for cardiopulmonary arrest (“code blue”). The Emergency Medicine resident asks you to place a central venous catheter (line) in the right internal jugular vein. Which of the following external landmarks should be used in order to place the catheter?
- A.
The right and left axillary arteries
- B.
The clavicular and sternal heads of the sternocleidomastoid muscle
- C.
The anterior scalene muscle and the clavicular head of the sternocleidomastoid muscle
- D.
The anterior scalene muscle and the sternal head of the sternocleidomastoid muscle
- E.
The clavicle and the sternal head of the sternocleidomastoid muscle
Correct Answer
B. The clavicular and sternal heads of the sternocleidomastoid muscleExplanation
The right internal jugular vein is located just posterior to the Sternoclediomastoid muscle, lying lateral to the sternal head of the SCM and medial to the clavicular head of the SCM.Rate this question:
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- 5.
A 67-year-old female presents in your clinic with symptoms of malaise, fever, weight loss, miosis, anhidrosis and ptosis. You elicit a detailed H&P and discover your patient has a 50-pack-year history of cigarette smoking. You decide to order blood work and a chest radiograph. The results of the chest radiograph are displayed below. Which of the following is the most likely diagnosis for the patient’s presenting symptoms and physical findings.
- A.
Thoracic outlet syndrome
- B.
Pulmonary fibrosis
- C.
Emphysema
- D.
Cervical rib syndrome
- E.
Pancoast tumor
Correct Answer
E. Pancoast tumorExplanation
Pancoast tumors can compress the thoracic sympathetic chain and cause symptoms consistent with Horner’s syndrome.Rate this question:
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- 6.
Which of the following nerves are responsible for relaying information to/from the carotid sinus?
- A.
Cervical Sympathetic Fibers
- B.
Vagus Nerve
- C.
CN X and CN IX
- D.
CN IX only
Correct Answer
C. CN X and CN IXExplanation
Recall, the vagus and glossopharyngeal nerves are both involved in the relaying of information from the carotid sinus. If the question was asking what nerve carries the sensory information from the pressure receptors the answer would have been the glossopharyngeal alone.Rate this question:
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- 7.
A patient presents with a large goiter of the thyroid. In which Anterior neck triangle is this gland found?
- A.
Muscular Triangle
- B.
Submental Triangle
- C.
Carotid Triangle
- D.
Submental Triangle
Correct Answer
A. Muscular TriangleExplanation
The muscular (omotracheal) triangle contains the infrahyoid muscles, thyroid gland and parathyroid glands.Rate this question:
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- 8.
In ascending order, from the bifurcation of the carotid superiorly, the arteries that branch off of the external carotid are…
- A.
Superior thyroid, ascending pharyngeal, facial, lingual, occipital, posterior auricular, maxillary, superficial temporal.
- B.
Superior thyroid, ascending pharyngeal, lingual, facial, occipital, posterior auricular, maxillary, superficial temporal
- C.
Superior thyroid, ascending pharyngeal, lingual, facial, posterior auricular, occipital, maxillary, superficial temporal.
- D.
Superior thyroid, lingual, ascending pharyngeal, facial, posterior auricular, occipital, maxillary, superficial temporal.
Correct Answer
B. Superior thyroid, ascending pharyngeal, lingual, facial, occipital, posterior auricular, maxillary, superficial temporalExplanation
The arteries arising off the external carotid in ascending order follow the mnemonic “Some Angry Lady Figured Out P. M. S.” The terminal branches of the external carotid are the maxillary and superficial temporal arteries.Rate this question:
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- 9.
The muscle compromising the lateral border of the anterior cervical triangle has its most superior attachment where?
- A.
C1
- B.
C2
- C.
Styloid process
- D.
Mastoid process
- E.
Occipital protuberance
Correct Answer
D. Mastoid processExplanation
This is referring to the Sternocleidomastoid muscle.Rate this question:
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- 10.
A soccer player gets a blow to the head, specifically the posterior triangle area; you as a physician notice weakness of the right SCM . A most likely associated finding to be found in this patient is:
- A.
Pain / weakness of masseter muscle
- B.
Decreased sensation on the contralateral face
- C.
Decreased sensation on the ipsilateral neck
- D.
Weakness of the Traps (Trapezius muscle)
Correct Answer
D. Weakness of the Traps (Trapezius muscle)Explanation
Both the trapezius and the SCM are innervated by the spinal accessory nerve (remember: this nerve is at risk in the neck's posterior triangle )Rate this question:
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- 11.
A patient needs to be cutaneously anesthetized over the parotid gland to the mastoid process to drain an abscess. What cutaneous branch and nerve roots are responsible for this area?
- A.
Lesser occipital n., C2 C3
- B.
Transverse cervical n., C2 C3
- C.
Greater auricular n., C2 C3
- D.
Lesser occipital n., C2
Correct Answer
C. Greater auricular n., C2 C3Explanation
The Greater auricular nerve (C2 C3) a branch from Erb's point provides cutaneous innervation to the angle of the mandible to the mastoid process. The Lesser occipital nerve does provide cutaneous innervation to the posterior ear, but it is posterior superior to the ear.Rate this question:
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- 12.
You are performing a surgical dissection of the carotid triangle in attempt to control lymph node metastasis. During the surgery you visualize the anterior scalene muscle, and make sure to avoid severing a structure passing directly anteriorly to the muscle as it crosses the rib. What is this structure?
- A.
Vagus nerve
- B.
Subclavian artery
- C.
Common carotid artery
- D.
Phrenic nerve
- E.
Internal jugular vein
Correct Answer
D. Phrenic nerveExplanation
The phrenic nerve is the only structure from the options listed that passes anteriorly to the anterior scalene muscle. The subclavian vein also passes anteriorly to the anterior scalene muscle as it crosses the rib, but it is not an option in this particular question. (A), (C), and (E) are wrong because these structures will be found in the carotid sheath. (B) is wrong because the subclavian artery runs between the anterior and middle scalene muscles and does not pass anteriorly to the anterior scalene muscle.Rate this question:
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- 13.
During a venous catheterization procedure, you are asked to find the best route of entry. You locate the internal jugular vein and your colleague asks which muscle did you use to locate this vein. Which muscle did you reply?
- A.
Upper portion of trapezius
- B.
Anterior scalene
- C.
Omohyoid
- D.
Sternocleidomastoid
- E.
Digastric
Correct Answer
D. SternocleidomastoidExplanation
The other muscles are not as convenient as the Sternocleidomastoid when locating the Carotid Triangle. Remember the Carotid triangle composes of the Internal Jugular Vein and is just medial to the omohyoid and lateral to the sternocleidomastoid. Anterior Scalene is found just posterior to the Carotid Triangle.Rate this question:
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- 14.
A man chokes a woman, she presents with inability to speak clearly. Physical Exam shows an inability to elevate the hyoid symmetrically and bilaterally which of the following sites of fracture is most likely to produce such a deficit?
- A.
Central
- B.
Lesser horn
- C.
Greater horn
- D.
Flabella
Correct Answer
B. Lesser hornExplanation
The lesser horn is the attachment for the stylohoid ligament which is responsible for the elevation and stabilization. A) would at least be a symmetrical deficits, D) not real. C) attachment for muscle groups, which is at least working because the woman is able to swallow, just not effectivelyRate this question:
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- 15.
An abscess on the lateral aspect of the tongue drains into lymph nodes in which triangle?
- A.
Submental triangle
- B.
Submandibular triangle
- C.
Carotid triangle
- D.
Muscular triangle
- E.
Posterior triangle
Correct Answer
B. Submandibular triangleExplanation
The lateral tongue drains into the submandibular lymph nodes, which are in the submandibular triangle. Remember the tip of the tongue drains to the submental nodes in the submental triangle.Rate this question:
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- 16.
Mrs. Smith present to your clinic with a sore throat, dysphagia, odynophagia, neck pain, and dyspnea for the past 3 months. The patient is warm to touch and vital readings show a fever of 102 F. To investigate this patient further, you order a CBC with differential. Of significance in the report is an elevated white blood cell count; specifically neutrophils. MRI study reveals a small mass in the prevertebral region. This mass is most likely located in a space formed by which of the following structures?
- A.
Thyrohyoid Membrane/ Buccopharyngeal Membrane
- B.
Prevertebral Fascia/ Thyrohyoid Membrane
- C.
Transcervical Fascia/ Buccopharyngeal Membrane
- D.
Buccopharyngeal Membrane/ Prevertebral Fascia
Correct Answer
D. Buccopharyngeal Membrane/ Prevertebral FasciaExplanation
The clincial vignette clearly describes a patient with a retropharyngeal abscess in the retropharyngeal space. The symptoms, elevated WBC count, and MRI study highly suggest a bacterial retropharyngeal abscess as a strong differential diagnosis. The retropharyngeal space is a potential space formed by the buccopharyngeal membrane/fascia anteriorly and the prevertebral fascia posteriorly.Rate this question:
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- 17.
Which of the following is true for the carotid body:
- A.
It is located in the omotracheal triangle and is sensitive to hypoxia
- B.
It is located in the carotid triangle and is innervated by the cervical plexus
- C.
It is located in the carotid triangle and is a baroreceptor responsible for maintaining blood pressure
- D.
It is located in the carotid triangle and is sensitive to hypoxia
- E.
It is located in the submental triangle and is a baroreceptor responsible for maintaing blood pressure
Correct Answer
D. It is located in the carotid triangle and is sensitive to hypoxiaExplanation
the carotid body is located in the carotid triangle and are chemoreceptors that are sensitive to hypoxia.Rate this question:
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