Anatomy Unit 2 Exam

What two nerves pierce through the belly of the middle scalene m? One innervates the rhomboids and levator scapulae while the other innervates serratus anterior.

- Dorsal Scapular N (C5) - Long Thoracic N (C5, C6, C7)

A central line is placed in the subclavian V. What are these used for?

- Long-term medication and chemotherapy - Inserting the needle risks puncturing the subclavian A and puncturing the pleura and lung, causing a pneumothorax (air between the lung and chest wall).

We said that the subclavian artery sits posterior to the anterior scalene. Also in this region is the subclavian vein and the brachial plexus. What do you think would be the result of swelling of any of the vessels or nerves in this area? How might a patient present?

- Posterior Thoracic Outlet Syndrome - Patient may present with ischemia, an embolism, pain etc. What is a rare way that this syndrome occurs? - Patients who have cervical ribs, the cervical rib often compresses the subclavian and anterior scalene together.

The common carotid A. splits into two branches the internal and external. While the external has several branches in the neck, the internal doesnt because it supplies the ________________________ and the ______________________.

- The brain and the orbit

What are the palpable posterior landmarks of the neck?

- vetebrae prominens (C7 or T1) - Nuchal ligament - External Occipital Protuberence

How does the pretracheal fascia contribute to the carotid sheath? What is the posterior of the pretrachial layer called?

-It contributes laterally to the carotid sheath. -The buccopharyngeal layer

What are the 6 superficial veins of the neck?

1. External Jugular V. - drains scalp and side of face 2. Communicating V- drains facial v 3. Anterior Jugular V- drains submandibular and thyroid 4. Posterior Auricular V- drains posterior scalp 5. Retromandibular V- drains lateral scalp and face 6. Facial V- drains submandibular and thyroid and face muscles

List the spaces of the neck starting anteriorly and moving posteriorly (5).

1. Visceral Space 2. Carotid Space 3. Retropharyngeal space 4. Posterior Cervical Space 5. Perivertebral Space

Name the branches off of the first part of the subclavian.

1st part: - Vertebral A. - Internal Thoracic A. - Thyrocervical Trunk a. inferior thyroid- supplies parathyroid gland b. suprascapular- supplies supraspinatus m. c. transverse cervical- supplies SCM and trapezius d. ascending cervical-supplies anterior scalene m., longus capitis m., spinal cord and meninges

Which of the following are "strap" muscles? a. sternohyoid b. cricothyroid c. omohyoid d. thyrohyoid e. sternothyroid

A, C, D, E - The infrahyoid muscles are also referred to as strap muscles. The cricothyroid is not apart of these, it is used in vocal production, it is an intrinsic muscle of the larynx, and is innervated by the vagus N.

Where is the thyroid ima artery? What common procedure would you want to know if a patient has one?

Artery inferior to the thyroid gland that can come from anywhere on the aortic arch. - Tracheostomy

What are the borders and contents of the submental triangle?

Borders: - Right anterior belly of digastric / left anterior belly of digastric - body of hyoid Contents: - lymph nodes - origin of anterior jugular v.

What are the borders and contents of the submandibular triangle?

Borders: - inferior border of mandible, anterior belly of digastric, posterior belly of digastric (and stylohyoid) Contents: - internal jugular vein, stylohyoid muscle, submandibular gland, facial artery and vein, hypoglossal n. (CN XII), lymph nodes

Borders and Contents of the carotid triangle (this ones nuts)

Borders: - superior belly of omohyoid, posterior belly of digastric, sternocleidomastoid Contents: - common carotid a. & carotid body, - internal & external carotid aa., superior thyroid a. & v., - lingual a. & v., facial a. & common facial v., occipital a. & v. (variable), ascending pharyngeal a., posterior auricular a. (variable), superior laryngeal a., internal jugular v., - lymph nodes, vagus n. (CN X), accessory n. (CN XI) (variable), hypoglossal n. (CN XII), ansa cervicalis, internal & external branches of superior laryngeal n.

What are the borders and contents of the muscular triangle?

Borders: - superior belly of omohyoid, sternocleidomastoid, anterior midline of neck Contents: - sternohyoid m., sternothyroid m., thyrohyoid m., lymph nodes, superior thyroid a. & v., thyroid ima a. (variable), branches from upper cervical spinal nn., thyroid & parathyroid glands

We know that the phrenic N. passes on top of the anterior scalene muscle and it supplies the diaphragm. Does it supply motor or sensory input?

Both!

What artery and nerve group would you expect to be damaged from a stab wound in between the anterior and middle scalenes?

Brachial plexus and subclavian artery

Which of the following would you not expect to find within the carotid sheath? a. Vagus Nerve b. Internal Jugular V c. Hypoglossal Nerve d. Common Carotid A e. Lymph nodes

C. Hypoglossal N

The vertebral artery ascends within the triangular space formed between the scalene, longus colli, and capitis muscles. It enters the transverse foramen of C ______ , runs medially along the posterior arch of C1, and then ascends superiorly to enter the foramen magnum. Distribution: R and L vertebral arteries join to form the ___________________ A.

C6 Basilar - Lots of variation in the vertebral A. the left vertebral A has more variation than the right.

Injury to what nerve results from the skin falling away from the neck in folds?

Cervical Branch of the Facial N.

Name the branches of the second part of the subclavian

Costocervical trunk: 1. Deep Cervical A. - can anastomose in suboccipital triangle, it supplies the epaxial and prevertebral muscles in the neck 2. Highest Intercostal A. - supplies first two intercostal spaces

Name the branch that may or may not come off the 3rd part.

Dorsal Scapular A. - Suprascapular may also arise here - Dorsal scapular can also arise with transverse cervical from a cervicodorsal trunk which branches from the thyrocervical trunk

The cervical plexus is made up of branches of C1-C5 spinal nerves. Which of the following correctly lists branches of the spinal nerves? a. Lesser Occipital (C2) b. Great Auricular (C2-C3) c. Transverse Cervical (C2-C3) d. Lateral, Intermediate and Medial Supracostal (C3-C4) e. a, b, and c only f. all of the above

E. A, B, and C only - D. Lateral, Intermediate, and Medial Supraclavicular Nerves (C3-C4)

What is Erb's point? If we reflect the SCM would this spot still exist? Why is Erb's point clinically significant?

Erb's point in the position where the sensory components emerge. If we reflect the SCM, Erb's point wouldn't exist because Erb's point is directly behind the posterior border of SCM. Erb's point is clinically significant because it is a spot for anesthetizing the whole neck.

The cervical plexus involves which of the following? a. Cutaneous motor nerves b. Ansa Cervicalis (motor) c. Phrenic N. d. Spinal Accessory (CN X) e. Direct Muscular Branches f. Some of the above

F. B, C, E. - It is important to note that the cervical plexus includes all of these. However, each one was tweaked slightly to test your knowledge. Below is what would be correct. a. Cutaneous sensory nerves b. Ansa Cervicalis (motor) c. Phrenic N. d. Spinal Accessory (CN XI) e. Direct Muscular Branches

An infection in the retropharyngeal space can be significant because it could span superiorly or inferiorly around the great vessels of the thorax. Which of the following are possibilities where the infection could have arose from? a. gums b. salivary glands c. tonsils d. sinuses e. nasopharynx f. C and E only g. all of the above

G. All of the above

What other nerve enters through the jugular foramen alongside the vagus?

Glossopharyngeal (CN IX)

Why are the infrahyoid muscles referred to as the "Rectus Cervicis" muscles?

In early development they are part of a continuous longitudinal sheet with sternalis and rectus abdominis muscles, and thus are also referred to as "rectus cervicis."

How far does the retropharyngeal space span?

It spans from cranial base to the superior mediastinum about the T2 level.

What is the space called between the two heads of the sternocleidomastoid (SCM)? Why is this space clinically significant?

Lesser Supraclavicular fossa. This is the site for the internal jugular vein, which would be important in putting an IV or catheter there. The right internal jugular vein is more ideal because its longer and straighter.

What nerve innervates the subclavius M.? What innervates supraspinatus and infraspinatus?

Nerve to the subclavian (C5-C6) Suprascapular N (C5-C6)

All of the following are considered ____-_____ _____________ roots. Rectus Capitis Lateralis (C1-2 loop) Rectus Capitis Anterior (C1-2 loop) Longus Capitis (C1-2 loop) Longus Colli (C2-4) Middle Scalene (C3-8) Levator Scapulae (C3-C4)

Non-ansa motor

Geniohyoid

O: Genial tubercle of mandible I: Body of hyoid A: Elevates hyoid bone and base of tongue N: C1 coursing with hypoglossal n.

Digastric M.

O: Mastoid notch of temporal bone I: Mandible near symphysis A: Raises hyoid and base of tongue; steadies hyoid; depresses mandible Inn: Facial n. and mandibular division of trigeminal

Omohyoid

O: Medial lip of scapular notch I: Lower border of hyoid A: Steadies hyoid bone; depresses and retracts hyoid and larynx N: C1, C2, and C3 ansa cervicalis

Mylohyoid

O: Mylohyoid line of the mandible I: Median raphe and hyoid bone A: Elevates hyoid and base of tongue, depresses mandible, raises floor of mouth N: Mylohyoid branch of mandibular division of trigeminal nerve

Thyrohyoid

O: Oblique line of thyroid cartilage I: Lower portion of body and greater horn of hyoid A: Depresses hyoid; elevates thyroid cartilage N: C1 coursing with hypoglossal n. (nerve to the thyrohyoid)

Sternothyroid

O: Posterior surface of manubrium I: Oblique line of thyroid cartilage A: Depresses thyroid cartilage N: C1, C2, and C3 ansa cervicalis

Sternohyoid

O: Posterior surface of manubrium and medial end of clavicle I: Lower border of body of hyoid A: Depresses hyoid and larynx N: C1, C2, and C3 ansa cervicalis

Stylohyoid M. (OIAN)

O: Styloid process of the temporal bone I: Body of hyoid bone A: Elevates and retracts the hyoid N: Facial nerve

Sternocleidomastoid

Origin: Manubrium and the Medial 1/3 of clavicle Insertion: Mastoid process Action: Extends Neck at Atlanto-Occipital joint Flexes the chin to chest Uni- ear to shoulder and turns the face away Innervation: Spinal Accessory (motor) C2-C4 (proprioception) Supply: Occipital A. and Superior thyroid A.

What nerve courses on the surface of the anterior scalene M.?

Phrenic N (C3-C5) - Motor and sensory innervation to the diaphragm - sometimes accessory phrenic N comes off laterally

After you get home from a long day of medical school, you look in the mirror to see a muscle contracting. This muscle is involved with facial expression and often conveys tension or stress. What is this muscle?

Platysma Muscle

Anterior, Middle, and Posterior Scalenes

Post: posterior tubercles to 2nd rib Mid: posterior tubercles to 1st rib Ant: anterior tubercles-scalene tubercle1st of rib Innervation: ventral rami of C2-C8 Supply: Ascending Cervical A. Action: Respiratory muscles, flex bilaterally, flex to one side unilaterally, raise 1st and 2nd ribs superiorly

_____________________ _______________________ vein and _________________________________ vein join together on top of the SCM to form the external Jugular Vein which will dump into the subclavian Vein. The subclavian vein is the major vein that drains the upper limb. The subclavian vein will join with the _______________________ _______________________ vein to from the brachiocephalic vein.

Posterior Auricular Retromandibular Internal Jugular

You are going to be responsible for information regarding the retropharyngeal space, Where does it sit relative to the fascia layers?

Posterior to the buccopharyngeal fascia and anteria to the prevertebral fascia.

Some attending like freaking out particular medical students. While this may seem mean, this helps us remember the branches of the external carotid which are?

Superior Thyroid - supplies superior thyroid/parathyroid Ascending pharyngeal- supplies pharynx, middle ear, prevertebral Lingual- tongue muscles Facial - tonsilar, palantine, submandibular branches Occipital- posterior occiput Posterior auricular- (intrinsic and extrinsic) auricular mm., parotid gland, facial n., auricle (external ear), and scalp Maxillary Superficial temporal

What muscle divides the subclavian A? How does it do this?

The anterior scalene muscle divide the subclavian artery into 3 parts. The first part is medial to the anterior scalene, the second is behind the scalene muscle, and the third is lateral to this muscle.

What sheath does the superior ansa cervicalis run with?

The carotid sheath

The platysma muscle is embedded in the superficial fascia and attaches from the lower mandible to fascia of the pectoralis major and deltoid muscle. What nerve innervates the Platysma M.

The cervical branch of Facial Nerve. - Cranial Nerve VII (7)

What does the prevertebral layer enclose? How does it contribute to the carotid sheath?

The deep muscles of the spine. - It contributes posteriorly to the carotid sheath

What nerve passes on top of the anterior scalene? Where is this nerve headed?

The phrenic N is headed to the diaphragm.

How are the subclavian arteries asymmetrical?

The right common carotid artery and right subclavian artery branch from the brachiocephalic trunk. In contrast, the left common carotid artery and left subclavian artery arise separately from the arch of the aorta. - The brachiocephalic trunk arises posterior to the manubrium, near where it articulates with the right clavicle. Both subclavian arteries reach their apex posterior to the anterior scalene muscles.

What other Nerve exits the jugular foramen with the spinal nerve?

The vagus nerve (CN X)

Distonia means extended periods of contraction. Damage to Spinal Accessory can cause shortening of SCM which leads to the disorder known as?

Torticollis or "wry neck" - Most commonly caused by pulling on the child's head during child birth. - In extreme cases, detachment of an inferior head of SCM could allow one to head their head more normally, most of the time can be helped with physical therapy.

Because the spinal accessory N is close to the deep cervical lymph nodes, it is at risk of being damaged in lymph node biopsy. What muscle(s) would be affected and how would the patient present?

Trapezius would only be affected. The patient may have a wasting away of the trapezius m., a dropped shoulder, and difficulty abducting the arm over the horizontal.

What are the three anatomical borders of the posterior triangle? What is the triangle pierced by?

Trapezius, SCM, and clavicle "Roof"- Superficial investing fascia "Floor" Prevertebral fascia

A 20 year old girl comes into the emergency room that was just in a traumatic car accident. She complains of serious neck pain and you have an CT scan taken. She may have restricted blood flow in what artery of the neck?

Vertebral A. - (Vertebral Artery Dissection)- tearing of the artery wall from a neck injury can lead to clot formation which blocks flow to the brain and can be fatal.

If there was a tear or an incision made in the platysma, how would you want to suture it in order that a larger scar isn't made?

You would want to suture the platysma to the skin. The platysma can contract in several different directions which could create a larger scar.

The anterior triangle is "roofed" by the superficial layer of the deep cervical fascia (investing layer) anteriorly. Posteriorly it is "floored" by... a. pretracheal fascia (posterior visceral fascia) b. carotid sheath c. sternothyroid m. d. sternohyoid m. e. mylohyoid m. f. some of the above

a, b, e

So bringing it all together, which of the following is shared by both the glossopharyngeal N and vagus N? a. pharyngeal branches b. tympanic N c. recurrent laryngeal N d. lesser petrosal N. e. some of the above

a. Pharyngeal branches only

The spinal accessory N innervates is formed by the 2 roots. What are they? a. Spinal root and cranial root b. Spinal root and inferior root c. Spinal root and part of vagus nerve d. spinal root and cerbbral root.

a. Spinal root and cranial root

The cervical plexus involves which of the following? a. Dorsal Rami of C1-C5 b. Sensory and Motor Components c. Anterior Rami of C1-C4 d. Epaxial rami of C1-C4 e. Posterior Rami of C1-C4 f. Ventral C5 that innervates the diaphragm g. some of the above

b, c, and f

Complete the list of the muscles you would expect to find in the posterior triangle. a. Semispinalis capitis. m b. c. Levator Scapulae m d. e. ____________________, _________________, ________________ scalenes

b. Splenius Capitis d. Inferior belly of omohyoid m. e. Anterior, Middle, and Posterior

The suprahyoid muscles act to elevate the hyoid during swallowing or speaking. Which of the following is a suprahyoid muscle? a. omohyoid b. stylohyoid c. thyrothyroid d. sternothyroid e. sternohyoid f. some of the above

b. Stylohyoid

There are two nerves that pierce through the middle scalene m, but do not innervate it. The more superior is the ______________________ ___________________ nerve and the more inferior is the ____________________ __________________. a. Nerve to subclavius / dorsal scapular b. dorsal scapular N / long thoracic c. suprascapular N / long scapular d. Lateral Thoracic N / transverse cervical e. long thoracic N / dorsal scapular

b. dorsal scapular / long thoracic N

The superior thoracic aperture is a passageway for structures going into the head and the rest of the body. What are the boundaries of the superior thoracic aperture? a. manubrium, 1st pair of ribs, T2-T3 vertebrae b. manubrium, 1st pair of ribs, T1 vertebrae c. manubrium, clavicle, T1 vertebrae d. manubrium, clavicle 1st pair of ribs

b. manubrium, 1st pair of ribs, T1 vertebrae

Which of the following muscles separates the anterior triangle of the neck from the posterior triangle of the neck? a. Trapezius b. sternocleidomastoid c. Sternothyroid d. Omohyoid

b. sternocleidomastoid

What muscle overlies most of the thyroid gland? a. Sternohyoid b. Sternothyroid c. Thyrohyoid d. thyrothyroid e. some of the above

b. sternothyroid

Which of the following structures does not make up the boundaries of the neck? a. base of skull b. superior surface of clavicle c. lower border of mandible d. superior thoracic aperture

b. superior surface of clavicle

Which of the following is not a direct branch of the internal Jugular V, but still runs inside the anterior triangle of the neck? a. Superior Thyroid V b. Middle Thyroid V c. Inferior Thyroid V d. all of the above are branches

c.

There are 12 pairs of cranial nerves that exit through either side of the head. On the lab practical, you will need to name each based on the side that they are on (right or left). All exit the skull through foramina, some passing into the facial area and others into or through the neck. Which of the following Cranial Nerves runs within the carotid sheath, what is it's name? a. CN XI b. CN XII c. CN X d. CN IX

c. CN X - Vagus N. - The vagus nerve enters the neck through the jugular foramen of the skull. It passes inferiorly within the posterior part of the carotid sheath.

The C1 root of the ansa cervicalis will "stick" to which of the following cranial nerves? a. CN X b. CN XI c. CN XII d. CN IX

c. CNXII - Hypoglossal N

The pretracheal fascia encloses the visceral compartment of the neck. Which of the following is missing from this list? a. esophagus b. trachea c. d. pharynx e.

c. Larynx e. Thyroid Gland

Anterior to the middle scalene and posterior to the anterior scalene we find the __________________ _________________. These include the ventral rami of C5-T1. You know this structure too well, which of the following nerves branches from the superior trunk to and runs inferiorly to the superior transverse scapular ligament? a. Nerve to subclavius b. dorsal scapular N c. suprascapular N d. Lateral Thoracic N e. long thoracic N

c. Suprascapular N

A surgeon performs a tracheostomy on a patient. Which of these structures, if present, might the surgeon be in danger of severing in the region of incision? a. Superior thyroid v. b. external jugular v c. thyroid ima a. d. Right common carotid a. e. superior thyroid a.

c. Thyroid Ima a.

Which palpable landmark is not correctly matched with its vertebral level? a. Transverse process of atlas - C1 b. Hyoid bone - C2 level c. Thyroid Cartilage - C3 level d. Cricoid Cartilage - C6 level e. Jugular Notch - T2-T3 level

c. Thyroid cartilage C3 Thyroid cartilage spans C4-C6 levels

Which structure is inclosed in the pretracheal fascia of the neck? a. Internal Jugular V. b. Trapezius M. c. Thyroid Gland d. Parotid Gland e. Brachial Plexus

c. Thyroid gland

What Landmark occurs at the carotid sinus? a. vertebra prominens, C7 b. Laryngeal prominence at C4-C5 c. Cricoid cartilage, C6 d. Greater horn of hyoid at about c3

d.

Which of the following nerves is not appropriately matched to the structure that it innervates? a. lesser occipital n (C2-C3) innervates the skin behind the ear b. greater auricular n (C2-C3) innervates the external ear, angle of the jaw, and the parotid area that is anterior to the ear c. transverse cervical n. (C2-C3)- innervates the anterior neck d. supraclavicular nerves (C3-C4)- innervates the clavicle, shoulder, and lower thorax

d. There are medial, intermediate, and lateral branches of the supraclavicular nerves that innervate the clavicle, shoulder, and upper thorax

Which of the following does not correctly describe the spinal accessory nerve once it has left the jugular foramen? a. Supplies SCM from the deep side b. Exposed on surface of levator scapulae c. Innervates trapezius d. heads away from deep cervical lymph nodes

d. Heads away from deep cervical lymph nodes - The spinal accessory N is close to deep cervical lymph nodes

The anterior triangle can be divided into four other triangles which does not include: a. submental b. submandibular c. Muscular d. Hyoid e. Carotid

d. Hyoid - all other 4 are triangles w/n the anterior triangle

What two triangles does the omohyoid m. split the posterior triangle in to? What structures are found there? a. Occipital Triangle, Medial Triangle b. Omohyoid triangle, occipital triangle c. Occipital triangle, Lateral triangle d. Occipital triangle, omoclavicular triangle e. none of the above

d. Occipital Triangle and Omoclavicular Triangle - Occipital Artery - External Jugular Vein - Spinal Accessory N - 3rd part of subclavian A.

The Vagus Nerve has ________________ different branch sets. Which of the following is not included in these? a. Superior Laryngeal Branches b. meningeal branches c. pharyngeal branches d. tympanic nerve e. carotid branches f. recurrent laryngeal nerve g. auricular branches h. cardiac branches

d. Tympanic N. - Tympanic N. branches from the glossopharyngeal N.

Richard Zednik is a hockey player who was sliced in the lateral throat with a hockey skate during a fight. After being cut, he was bleeding perfusely and needed immediate medical attention. Richard Zednik made a recovery and was seen at a press conference 2 days later. Which of the following was most likely severed? a. internal carotid a. b. external jugular v c. internal jugular v d. external carotid a. e. common carotid a.

d. external carotid A. - Severing the internal or common carotid would have shut off flow to the brain and more than likely would have been fatal. - He actually had variation where is carotid sinus branched at about the c5 level instead of c3

The ansa cervicalis is composed of a superior ramus from C1 and C2, and an inferior ramus from C2 and C3. The "superior" ramus is in fact anterior, but it begins at C1, the highest spinal nerve. Distribution from the ansa cervicalis is within the anterior triangle of the neck, innervating all the infrahyoid muscles and the.... a. stylohyoid m b. mylohyoid m c. thyroid gland m d. geniohyoid m e. submandibular gland f. digastric m

d. geniohyoid m

Which of the following is deep to the mylohyoid muscle? a. omohyoid m b. stylohyoid m c. digastric m d. geniohyoid m e. some of the above

d. geniohyoid m

Which of the following correctly orders the deep fascial layers of the neck from superficial to deep? a. superficial investing, carotid sheath, prevertebral, pretracheal b. superficial investing, pretracheal, carotid sheath, prevertebral c. superficial investing, prevertebral, pretracheal, carotid sheath d. superficial investing, pretracheal, prevertebral, carotid sheath

d. superficial investing, pretracheal, prevertebral, carotid sheath *The carotid sheath is made up of all three other layers.

Which of the following originates from the external carotid A.? a. common carotid a. b. vertebral a. c. deep cervical a. d. superior thyroid a. e. ascending cervical a.

d. superior thyroid a.

Which of the following are contained within the carotid triangle? a. internal jugular v b. external jugular v c. external carotid a d. both a and b e. both a and c f. both b and c

e. Both A and C

General Somatic Afferent neurons (GSA) or sensory components, make up the cervical plexus (C2-C4) and emerge around the middle of the posterior border of the sternocleidomastoid muscle at Erb's point to supply the skin of the neck, scalp, and anterior aspect of the chest and shoulder. Which of the following is not included in Erb's point? a. lesser occipital n (C2-C3) b. greater auricular n (C2-C3) c. transverse cervical n. (C2-C3) d. supraclavicular nerves (C3-C4) e. accessory n (C3-C4)

e. accessory n is not apart of erb's point - AKA Spinal accessory which is Cranial Nerve Eleven

Which of the following appropriately describes the superficial investing layer of fascia? a. Posteriorly, it is continuous with the ligamentum nuchae b. It contributes medially to the carotid sheath c. Splits to enclose trapezius posteriorly and sternocleidomastoid anteriorly d. a and c only e. all of the above

e. all of the above.

The root of the neck is the region where the neck joins the thorax. In this region, vessels, nerves, the esophagus, and the trachea pass from the thorax through the superior thoracic aperture to the neck and head. Which of the following is not bound by the superior thoracic aperture? a. manubrium of the sternum b. body of the first thoracic vertebra c. first pair of ribs d. costal cartilages e. cervical vertebrae

e. cervical vertebrae

So Dr. Ballard discussed the posterior triangle of the neck, we are now going to switch gears and look at the anterior triangle of the neck. Which of the following does not make up the anterior triangle? a. inferior border of the mandible b. the anterior border of the sternocleidomastoid muscle c. midline of the neck d. superficial layer of the deep cervical fascia (investing) e. prevertebral fascia f. pretracheal fascia

e. prevertebral fascia

With the vagus nerve, the glossopharyngeal leaves the skull through the jugular foramen. It passes superficial to the stylopharyngeus muscle, and forward between the internal and external carotid arteries, and follows the upper border of the middle pharyngeal constrictor to enter the pharynx. It distributes to the posterior third of the tongue, both general and special sensation. Which of the following is not a branch of the glossopharyngeal? a. pharyngeal branches b. muscular branch to stylopharyngeus muscle c. sinus nerve to carotid sinus/body d. tympanic n e. lesser petrosal n f. meningeal branches

f. Meningeal branches to dura mater - CN IX and X have lots of overlap in the structures they innervate.

Which of the following are inferior to the hyoid bone? a. anterior belly of the digastric m. b. sternohyoid c. mylohyoid d. submandibular gland e. thyroid gland f. some of the above g. all of the above

f. b and e

Which of the following can be used to take a pulse? a. Ascending pharyngeal b. Superficial Temporal c. Internal Carotid d. External Carotid e. Facial f. Maxillary g. some of the above

g. (b, d, e)

Our cells are surrounded by interstitial fluid that is found in "spaces" within tissues. When interstitial fluid enters the lymphatic system, it is called lymph. Lymph removes waste from cells and provides them with nutrients. The lymphatic system returns this fluid back to blood circulation. Which of the following can be found in lymph? a. White blood cells b. triglycerides c. proteins d. bacteria e. cancer cells f. some of the above g. all of the above

g. All of the above

A 10 year old girl comes in to your practice that has punctured her anterior pharynx right below the intersection between the floor of the mouth and the anterior of the neck called the ____________________. The puncture was above a structure at the C4 vertebral level called the _________________ _____________________.

hyoid; thyroid cartilage

Hypoglossal N passes deep to the posterior belly of the digastric and between the external carotid artery and internal jugular vein. It supplies innervation to the internal and external muscles of the ________________________.

tongue