Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
187 Cards in this Set
- Front
- Back
label the parts: pharnyx (naso, oro, and hypo) and larynx, and trachea
|
* note the hypopharynx is with the esophagus, nt the larynx
|
|
WHat do you see? dx?
|
narrowing of trachea and larynx below glottis
laryngotracheobronchitis aka croup |
|
|
How do you identify the atlas from other vertebrate on axial ct?
|
1. large foramen
2. dens is ther anteriorly |
|
give it a try
|
|
|
|
can you palpate the transverse processes of the atlas?
|
yes!
|
|
|
WHat is steele's rule of thirds for the vertebral foramen at the atlas?
|
what takes up space
dens, cord, and "other |
|
|
What is the important thing to take from the rule of thirds? How much can the dens move before impinging.
|
therre is 1/3 of the space for the cord to move around, but if the dens moves more than 7-10 mm (1/3) bacl, then the cord will be damaged
|
|
|
What used to be a common fracture when people hit the tops of their head when not wearing seatbelts and flying out?
|
shattering the atlas, revealing the dens to stab the brain
|
|
2 POSSIBILITIES FOR WHAT THIS COULD BE.
|
1. Jefferson's fracture of atlas
2. pseudo jefferson's fracture that is in most (90%) of children who have not ossified yet |
|
|
When do pseudo jefferson's fxs go away?
|
4-6 years
|
|
|
What is McGregor's line? what are the landlarks?
What info do you take from it? |
line from back of hard palate to base of skull
dens shouldn't be more than .5cm above or else you have a basilar invagination of the peg into the foramen magnum |
|
|
What can cause this?
Mnemonic? |
jefferson's fx where the atlas separates away
McGregor needs to check if Jefferson is being naughty! |
|
What are you looking at?
|
open moouth x ray from the front
LOOK FOR SMOOTH LINES AND SYMMETRY you can see the axis and atlas in the mouth in C2 area, you can see inverted V that is bifid spinoous process (alien bug) In C7 area, you see ulcinate processes processes that are like cups when the vertebral bodies tack on one another |
|
see
what is wrong? |
towards bottom, the discs are very thin
|
|
what is this?
|
a step off (not smoothly alighned) probably does to jefferson's fx because it is on both sides
|
|
What is this? What does it inidcate?
|
Intact Harris ring which indicates that the dens is not fractures
|
|
|
Where should the harris ring be broken?
What if it is broken elsewhere? |
either 5 oc lcok or 7 clock
anywhere else is a dens fx |
|
how is the dens broken?
|
snapped back in dens fx
|
|
|
what motion breaks the dens?
|
hyperextension
|
|
|
What does a hangman's fx look like? what are the forces that cause these parts to break?
|
hyperextension uses dens as a fulcrum to break pars interarticularis/pedicles
|
|
|
Is there an intact harris ring in a hangman's fx?
|
yes
|
|
|
What causes dens fx then?
|
mostly MVC's
|
|
|
Do you include C2 in the posterior spinal line?
|
no, it is out of place normally
|
|
?
|
hangman's fx with breakage of pedicle
|
|
|
dissect platysma
|
platy- flat
flat muscle |
|
|
What is the main function of the platysma?
|
to make facial experssion
|
|
|
What happs to the platysma as we get older?
|
it gets saggly
|
|
|
What are the two most superficial layers of muscle in the neck?
|
1. platysma
2. trapezius and SCM |
|
|
What are two functions of the SCM?
|
1. extension, sidebending, and rotation of neck
2. pulling on mastoid to bring skull up keeps our line of sight forward when we move our body. |
|
|
What nerve causes spasmotic torticollis?
|
irritation of the spinal accessory nerve on that side (CN 11)
|
|
|
What does CN 11 innervate?
|
ipsilateral trapeziius and SCM
|
|
|
What can cause irritation of CN 11? (neural torticollis)
|
virus or injury
|
|
|
What is the tx for this type of torticollis?
|
injection at CN 11 at inside of trapezius to anesthetize it
|
|
|
What are some other effects you would see with torticollis tx?
|
drop shoulder (trapezius) and maybe head mvement towards other SCM
|
|
|
What causes congenital (muscular) torticollis?
|
No one knows for sure, but it may have to do with injury at birth causing a hematoma
after it resolves, there is fibrosis and shortening of the SCM |
|
|
What is the longstanding consequence of congenital torticollis?
|
1. permanent wry neck
2. flattened face 3. plagiocephaly (vertex of head is shifted) |
|
|
plagio-?
|
angled, oblqiue, slanted
|
|
|
What important nerve passes in front of the anterior scalenes?
|
the phrenic nerve
|
|
|
What passes through the scalene/interval triangle?
What makes it up? |
bracial plexus and subclavian artery
anterior and middle scalene and 1st rib |
|
|
What other muscle in the chest area can affect the brachial plexus? Why?
|
pec minor because it overlies the plexus
|
|
|
Posterior muscles of the neck (very genereal)
What should you think when you see... spinalis splenius capitus |
spinalis- long spinor erectae from the spine
splenius- long oblique muscle capitus- short obqliue skull rotators |
|
|
definition of splenius?
show it's capitus and cervicis muscles? |
splenius = bandage
looks like a big ace bandage like a big V down the spine capitus raises the head cevicis raises the neck (based on what joint they span) |
|
What is that muscle underneath splenius capitus?
|
semispinalis (erector spinae!
|
|
|
What muscle is superficial to the splenius muscles?
|
trapezius
|
|
|
What is underneath the semispinalis?
|
the short capitus rotators
|
|
|
What does the dorsal ramus of C1 vs C2 innervate?
dermatome mnmonic? |
C1- tiny bit of posterior neck muscles
C2- posterior neck muscles and it goes over the scalp and under the jaw just like the deramatomes |
|
|
Define antalgic
|
counteracting or avoiding pain, as a posture or gait assumed so as to lessen pain
|
|
|
Why is it so important for back and neck pain to be treated?
|
because it will atrophy the muscles if not treated!!
|
|
|
Is the atrophy due to disuse aka antalgia?
|
nope
|
|
|
What is it due to?
|
activation of sympathetic system by the pain fibers will constrict the blood vessels
|
|
What is happnening and to what in this?
|
neck pain causes the deep posterior neck muscles to atrophy over time
|
|
|
What additional disorder can you get from untreated neck pain? (same reflex arc)
|
hypertension
|
|
|
What bone holds up the thyroid cartilage?
|
the hyoid bone
|
|
|
What often fractures the hyoid bone?
|
strangulation
|
|
|
top to bottom
greater horn lesser horn body |
|
|
what major ligament and muscle suspends the hyoid bone and to what>
|
there are many, but here is the stylohyoid ligament and muscle
|
|
|
Where is the styloid process?
|
sharp pointy thing right in front of the mastoid
|
|
|
What cartilage peaks right over the hyoid?
|
the epiglottis/cartilage of the larynx
|
|
|
What is a name that refers to where the hyoid bone is in space?
|
it is the floor of the mouth (where trachea meets the bttom of your head)
|
|
|
So what muscles are attached superiorly? (2 groups)
(show) |
tongue muscles and one that suspend the larynx to the jaw
|
|
|
what does thyroid mean?
|
"shield"
|
|
|
Why is shield appropriate?
|
because it bends at the midline like a shield and is open in the back
|
|
|
What ligament suspends the thyroid cartilage to the hyoid?
|
thyrohyoid membrane
|
|
|
What does cornu mean?
|
interchangable with "horn"
|
|
|
|
|
|
The whole larynx from the front toally looks like...
|
evill queen infused with some magneto spike for the horns
|
|
|
What part of the larynx makes the adam's apple?
|
|
|
|
What is the cricothyroid cartilage attached to? (3 things)
|
1. cricoid cartilage
2. thyroid cartilage 3. vocal cords |
|
|
Why is it easy to find this using vocal cords?
|
If you ask pt to hum, it will vibrate the most because of it's attachments
|
|
|
Why would you want to find the cricothyroid cartilage in an emergency?
|
to do cricoidotomoy to get an airway
|
|
|
WHat do you need to be very careful not to hit? How do you prevent this?
|
the vocal cords so you point the pen down away from them
|
|
|
does cricoid go all around the trachea?
|
yes!
|
|
|
Show the cricoid cartilage from 3 views. how does it change shape?
|
shorter in front, taller in back, bottom part stays level
|
|
|
Where is the vocal cord and it's cartiilage (aretinoid) in relation to the thyroid and cricoid? show
|
behind thyroid, above cricoid
|
|
|
What sits in front the first tracheal ring? (not cricoid)
Where does that ring start anyways? mnemonic? |
the first tracheal ring is under the cricoid
the thyroid gland overlies it the queen wears a thyroid on her necklace (cricoid all around) |
|
|
What type of muscles stabilize the larynx in space?
|
long flat muscles called strap muscles
|
|
|
What are the ttwo main types of strap muscles divided by location? (show)
|
supra and infrahyoid muscles
|
|
|
what does genio mean?
|
bend ... think genu
|
|
|
|
|
|
What do all the supra hyoid muscles have in common?
|
they originate in the skull and attach to the hyoid
|
|
|
Why is the geniohyoid named what it is?
|
attaches the GENU of the madible to the hyoid
|
|
|
Why is the mylohyoid named what it is?
|
mylo = molar
attaches the hyoid bone to the molars |
|
|
What surface does the mylohyoid muscle create and what common action in swallowing does it create?
|
the floor of the mouth
it is responsible for raising the floor in swallowing |
|
|
Why is the anterior and posterior digastric named what it is?
|
there are two (DI) bellies to it going perpendicularly.
|
|
|
Why is the sylohyoid named what it is?
|
hooked up to the styloid process behind out ear
|
|
|
What do the infra and supra hyoid muscles have in common in their naming?
|
they both end with hyoid
(or at least what is in the hyoid direction is the last part of the name) |
|
Name these
|
|
|
|
What is the most lateral infrahyoid muscle?
|
the omohyoid
|
|
|
What does omo mean?
|
scapula
|
|
|
What is special about the location and connection of the omohyoid's tendon?
|
it is in the middle of the muscle belly and anchored to the clavicle to allow it to have two movements.
|
|
|
What important landmark does the omohyoid pass over?
|
the scalene triangle
|
|
|
How can you feel the omohyoid moving on yourself?
|
swallow (raises hyoid bone) and feel by your scalene triable. It should be contracting.
|
|
|
Where are the other infrahyoid muscles attached?
|
medially in the manubrium
|
|
|
sumary, show all the suspensions for the hyoid bone
|
|
|
|
What cervical levels is the hyoid, thyroid, and cricoid located at?
|
thyroid is C4-C5
|
|
|
What are 3 things that begin/end at C6? (remeber this is where the cricoid is)
|
1. border of larynx and trachea
2. border of pharynx and esopagus 3. vertebral arteries enter transverse foramen |
|
just appreciate
|
|
|
|
What is the arcuate foramen? is it dangerous?
|
an antomical variation of the atlas. no danger
|
|
|
Why is the thickness of prevertebral soft tissue important?
|
it is a very good indication of any cercical spine traume
|
|
What is the rule for what it should be? Is this normal?
What normal activities can vary the thickness (but the rules allow for this) |
yes it is normal
C1-4- less than half the thickness of the vertebral body C4-7- less than the full thickness of the vertebral body |
|
What is the outline of the throat here?
|
|
|
Is dr. carsia's ct normal?
why does the throat look like it is shifted forward at the bottom? What is this part called? |
yes
this is because the esophagus is there and closed off. the opening to the trachea here is called the additus (opening). |
|
Show where the soft palate/uvula and the epliglottis is.
|
|
|
Where is the hyoid bone and thyroid crtilage here?
|
|
|
|
What does glottis mean?
|
the opening in between the vocal cords
|
|
|
What does rima mean?
|
slit
|
|
|
What is rima glottis?
|
the space between the folds of the vocal cords (like slits)
same as glottis |
|
|
Show how the epiglottis sits above the rima glottis.
|
|
|
|
In a frontal x ray, what should you see as the trachea gets to the rima glottis?
|
an abrupt tapering, pointed end because the vocal cords are closed here
|
|
|
How open is your glottis in quiet breathing vs talking? Why?
|
composite pictures
very small slit in talking because you need to provide the eddy currents for phonation. in breathing, you want more air to go through |
|
What is the dx when you see a gradual tapering rather than an abrupt one?
What is this sign called and what causes it? |
laryngotracheobronchitis aka croup
"steeple" sign caused by edema from the viral infection |
|
|
What is the biggest issue in a hyperextension fx!
|
loss of the support of the posterior elements if the bones break.
|
|
|
and what can happen on the anterior side?
|
an avulsion fracture from breaking of the anterior longitudinal ligament
|
|
|
What are two things that can happen with a hyperflexion injury?
|
1. pulling forward and separation of the posterior ligaments
2. vulsion fracture in the back |
|
What is he trying to show me here?
|
that the dens is intact in both pics and there can be avulsion (teardrop) fxs both ways
|
|
|
Which way should the head be in tacking in football? Why?
|
in extension to prevent more grievous injury
|
|
|
What runs in the carotid sheath?
where does it run in the neck |
internal jugular
common carotid deep cervical lymphatics vagus nerve runs posterolateral to the trachea |
|
|
Where does the phrenic nerve course?
|
just medial to the carotid sheath
|
|
|
where does the brachial plexus come out relative to the carotid sheath?
|
posterior to it in the prevertebral layer between the scalenes
|
|
|
Where are the parathyroids?
|
just at the tips of the thyroid posteriorly
|
|
where is the Common carotid in relation to the internal jugular? How can ou deduce thisfrom where they go in the head?
Where are the scalenes? |
common carotid is more in frnt and medial because it comes out at the optic ciasm whereas the internal jugular goes back near the internal auditory meatus
scalenes are right in front/next to the vertebrae because the brachial plexus/vagus need to exit between them |
|
|
What is subclavian steal syndrome?
What is wrong, what are the sx? |
when the subclavian (usually left) is occluded from the aorta and then STEALS blood from collaterals in the vertebral arteries instead.
Normally no sx except you get left arm pain and dizziness when you try to use your left arm too much |
|
|
What does a normal vein do when lesioned?
|
it will collapse and stop running blood
|
|
What is special about a jugular vein injury?
how could it kill you? |
it is held open from all the fascia and due to increasing negative pressure, they suck air in and can kill you will an air embolism.
|
|
|
Where do the superficial vs deep cervical nerves go?
|
superficial C1-4- to the skin
deep- to the arm |
|
|
How are the strap muscles innervated?
|
C1- supplies geniohyoid and thyrohyoid
C1,2,3- form a loop called the ANSA CERVICALIS that supples the rest of the muscles |
|
|
What CN comes out with spinal nerve C1?
Why does this make sense? |
the hypoglossal, which is in the same area and the suprahyoid strap muscles that are innervated by C1
|
|
|
Where are most of the fibers in the superior cervical ganglion coming from?
|
T1
|
|
|
What level mainlky supples the phrenic nerve.
|
C,3,4, and 5
but mostly C4 |
|
|
Do you remember what gives sensory fibers to the phrenic nerve?
|
1. bottom of the parietal pleura
2. mediastinum 3. Mesentery of a bunch of RUQ visceral vessels |
|
|
So what kind of referred pain will you get with irritation to the mediastinal and diaphragmatic pleura?
|
supra clavicular pain in C4 dermatome (low collar shirt)
|
|
|
What kind of referred pain would you get with lower lobe pleuritis then?
|
shoulder or supraclavicular pain
|
|
|
Why may some people get neck-tounge syndrome (pain in upper neck and lateral tongue) when turning their head?
|
they may have stenosis of the spinal cord there, which pinches C2 when they turn the head
|
|
|
What else cold cause neck/occipital pain?
|
something irritating the dura in the posterior cranial fossa
|
|
|
What line are all the lymph nodes of the head and necl below?
|
the orbito-meatal line from the orbit to the external audiotry meatus
|
|
|
Where are the 3 nodes draining the scalp? What is their vessel distribution?
|
1. preauricular
2. retroauricular/mastoid 3. occipital They drain the area directly above them |
|
|
What does it usually indicate if these nodes are bilaterally swollen vs unilaterally swollen?
|
bilateral- diffuse infection and immune reaction in blood
unilateral- some local infection in area of drainage |
|
|
If you find unilateral lymph swelling, what should you check for next?
|
the area that it drains to see if there is a tick bite or a wound
|
|
|
What nodes drain the parts of the face?
|
Submandibular and submental nodes
|
|
|
What is a sentinel node?
|
the first node that receives lymph from an area of drainage (will be first to see cancer)
|
|
|
How do you see if a sentinel node has cancer?
|
you have to run a whole test with injecting colloid and sampling the node
|
|
|
What is a signal node then?
What are they useful for screening for? |
a node that becomes swollen/crackly when there is cancer in one region even though it may not be the first node draining it.
They are visible from the outside if they get the cancer. |
|
|
Where do a lot of cervical lymph nodes seem to be located along the neck?
How do we know this from earlier? |
along the internal jugular vein
because they are enclosed in the carotid sheath! |
|
|
Where are the jugulo-digastric nodes and jugulo-omohyoid nodes?
What are their alternate names and why? |
where the jugular vein meets the digastric muscle attachments and the omohyoid genu.
they are named for the areas that they drain |
|
|
Where would you see swelling in a pt with strep throat or tonsilitis?
|
probably bilaterally below the mastoid process
(in the tonsilar/digastric-jugular nodes) |
|
|
Where would you see swelling in a pt with mouth cancer from smoking?
|
in the lower neck where the jugular meets the omohyoid in the tounge nodes.
|
|
|
What is the supraclavicular node?
|
the node on the right where the jugular meets with the top of the clavicle.
|
|
|
Where is Virchow's node located and what important structure is it by?
pic or it didn't happen |
it is basically the supraclavicular node of the left which sits next to the thoracic duct which drains all the body's lymph
|
|
|
What does the thoracic duct drain most directly though? (think about cholesterol and fat)
|
the intestines (drops off chylomicrons into the blood this way)
|
|
|
So What is the most likely reason to find a swollen virchow's node? What is this sign called?
|
Troisier's sign
abdominal (especially gastric) cancer that is spreading to lymph |
|
|
But what are the two supraclavicular nodes capable of signalling overall?
(think about their drainage) |
any kind of serious disease below the clavicle
|
|
|
What are the two lobes of the thyroid connected by? What attaches it superiorly?
|
the isthmus (means connection)
connected superiorly by lalouette's pyrimid |
|
|
What was it connected to superiorly in the embryo?
Is it the same shape in everyone? |
to the base of the tongue/the hyoid bone
the thyroid descended and disconnected. The pyrimidal lobe may look different in each person |
|
|
Where does the superior laryngeal nerve branch off to lit the larynx?
What nerve does it come off of? |
right when you pass it! (pretty direct)
it comes off the vagus just like the recurrent laryngeal nerve braches out of the carotid sheath |
|
|
What does the superior laryngeal nerve branch into?
|
the external and internal laryngeal nerves
|
|
|
What is thyroidea ima artery?
Show it. |
a congenital anomaly where there is an extra artery to the thyroid that comes off the inominants
|
|
|
What procedure is dangerous for people with this congenital vascular variation?
|
a tracheotomy
|
|
|
What is a better airway intervention for people with thyroidea ima artery?
|
cricoidotomy because this area is above the thyroid.
|
|
|
When is a cricoithyroidotomy done vs a tracheotomy?
|
cricothyroidotomy- in an emergent situation when you can't get an airway via the nose or moouth
tracheotomy- in the hospital with the right equipment for long term respiratory support |
|
where do the recurrent laryngeal nerve wrap around and in what direction?
|
left- wraps in front and goes up behind the aorta
right- wraps in front and goes up behind the right subclavian |
|
|
Where do the recurrent laryngeal nerves travel in the neck?
show |
behind the thyroid on either side of the trachea
|
|
|
Where were the parathyroids in that pic?
|
tiny little thing at the outer edges of the thyroid
|
|
|
What procedure has a high change of nicking the superior laryngeal nerve then?
|
thyroid or parathyroid surgery
|
|
What is this and what is in front of it?
|
in front is the hyoid bone
|
|
|
What is a lingual thyroid? is it normal?
|
it is a superiorly displace thyroid that is a congential abnormality
|
|
|
Why do people get lingual thyroid, embryologically speaking?
|
because their thyroid failed to descend far enough from their tongue.
|
|
top view of same lingual thyroid
What are these muscles? |
geniohyoid (paired strap muscles arising from the genu of the mental protuberance)
|
|
What is this?
|
myohyoid
|
|
What is this?
|
submandibular glands
|
|
What is this?
|
parotid glands
|
|
|
What cervical level does the common carotid bifurcate?
|
C4- level of top of thyroid
|
|
What is this?
|
internal jugular
|
|
What is this?
|
the internal and external carotid
|
|
|
Why was the right jugular larger than the left?
|
it usually is because it accept the majority of the drainage of the brain
|
|
What is this?
|
vertebral arteries
|
|
What is this?
|
SCM
|
|
What is this?
What are the keywords to describe it? |
Lingual thyroid
strawberry-like lump at the base of the tongue. |
|
|
what is a persistant thyroglossal duct?
|
a failure of the duct that led the descent of the thyroid from the base of the tongue to atrophy
|
|
|
What are pts with persistent thyroglossal duct prone to?
|
cysts in this duct
|
|
|
What do these cysts usually look like and how dangerous are they?
|
they look like a lump in the midline maybe a little to the left (only one duct)
they are usually pretty benign except if they significantly interfere with swallowing and breathing |
|
|
Why is it a little to the left?
|
cause the thyroid drops in a little to the left (look at the pyrimidal lobe)
|
|
|
What are these cysts usually associated with?
|
excess thyroid tissue or even lingual thyroid
|
|
|
How can you check to see if this is a thyroglossal duct cyst in an exam?
Why does this work? |
ask pt to move tongue up and down to see if it moves.
the duct is connected to the tongue so it should move |
|
|
Is this cyst painful or malignant?
|
no
|
|
|
Is a thyroglossal duct cyst in front or behind of the hyoid?
How do you deduce this? |
in front because otherwise it would totally close off the larynx and be a huge threat
|
|
Is the hyoid broken in this?
|
no, you are just seeing the body and the two horns on the side
|
|
|
What is the tx for a persistent thyroglossal duct?
|
you have to inject dye to see how far it spans and then take out the whole duct
|
