anatomy mcqs

HUMAN ANATOMYNeck

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NECK

Cylindrical region connecting Head and Trunk

EXTENT Above - lower border of body of mandible, line joining angle of Mandible to Mastoid

process, Mastoid process, Superior Nuchal line, External occipital protuberance. Below - Suprasternal notch of Manubrium sterni, Clavicle, Acromion Process, C7.

LAYERS Skin, Superficial fascia with cutaneous vessels nerves and Platysma Deep fascia is cervical fascia

CUTANEOUS NERVES

Branch Origin Muscles innervated

Lesser Occipital C2 Skin of neck, scalp posterosuperior to auricle

Great auricular n C2, C3Skin over parotid gland, posterior auricle, angle of mandible to mastoid process

Transverse cervical C2, C3 Skin of anterior triangle

Ansa cervicalis --- Infrahyoid (MAHE-95)

Phrenic C3 - C5 Diaphragm

Supraclavicular C3, C4 Skin over shoulder

CERVICAL FASCIA The deep fascia of the neck, divided into three layers – Investing, Pretracheal and

Prevertebral These form natural lines of cleavage through which tissues may be separated, and limit

the spread of pus from infections in the neck.

Investing layer of Deep Cervical FasciaForms a collar around the neck, located between the superficial fascia and the muscular layer

Attachments Features

Superiorly: external occipital protuberance, superior nuchal line, mastoid process, lower border of the mandibleInferiorly: spine of the scapula, acromion process, clavicle, manubriumPosteriorly: ligamentum nuchae, C7 spineAnteriorly: symphysis menti, body of hyoid

The investing layer splits to enclose - 2 muscles – Trapezius,

Sternocleidomastoid 2 salivary glands – Parotid,

Submandibular 2 spaces – Suprasternal,

Supraclavicular 2 pulleys to bind tendons – Digastric

and Omohyoid

Pretracheal layer of Deep Cervical Fascia


Superiorly: hyoid bone, oblique thyroid cartilage, cricoid cartilageInferiorly: arch of the aorta (superior mediastinum)

Lies deep to Infrahyoids, splits to enclose thyroid, trachea and esophagus

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HUMAN ANATOMYNeck

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Laterally: fuses with the carotid sheath

Prevertebral layer


Superiorly: base of the skullInferiorly: body of T4 vertebrae

Forms part of a fascial sleeve for the prevertebral muscles

The cervical plexus and proximal parts of the brachial plexus are deep to it; forms floor of posterior triangle of neck, axillary sheath is extension of this fascia

Carotid sheath

Completely enclosed within investing fascia, on either side of the pretracheal fascia Encloses the common and internal carotid arteries, internal jugular vein and Vagus nerve

(KCET-2010) The sympathetic chain is located posterior to (and outside) the sheath, ansa cervicalis

embedded in ant wall, runs from base of skull to sup mediastinum

Retropharyngeal Space: Potential space between the pretracheal fascia and prevertebral fascia.

MIDLINE STRUCTURES OF THE NECK1. Fibrous raphe of insertion of Mylohyoid extending from symphysis menti to hyoid bone-

derived from 1st branchial arch2. Body of the hyoid bone-derived from 2nd, 3rd branchial arches

3. Median thyrohyoid ligament and Thyrohyoid membrane pierced by Internal Laryngeal nerve and Superior Laryngeal vessels

4. Laryngeal prominence. Derived from 4th and 6th branchial arches

5. Cricothyroid ligament, Cricothyroid muscle

6. Cricoid cartilage

7. 1st tracheal ring

8. Isthmus and pyramidal lobe of the thyroid gland

9. Inferior thyroid veins

10. Jugular venous arch (joins the two anterior jugular veins)

TRIANGLES OF NECK Side of the neck is divided by Sternocleidomastoid into (AIPG-94, 95, 96)

1. Anterior triangle with apex directed downwards2. Posterior triangle with apex directed upwards

ANTERIOR TRIANGLE OF THE NECK (AIPG-2003)Boundaries

Base: lower border of mandible, line from the angle of mandible to mastoid processApex: Jugular notchAnterior border: midline of neck extending from Symphysis menti to Suprasternal notchPosterior border: anterior border of sternocleidomastoidRoof: skin, superficial fascia, investing layer of deep cervical fasciaFloor: pharynx, larynx, prevertebral fascia

The superior belly of Omohyoid and Digastric muscles divide the anterior triangle into 4 further triangles -

BOUNDARIES CONTENTS


HUMAN ANATOMYNeck

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1. SUB MENTAL TRIANGLE – MEDIAN TRIANGLE

SidesAnterior bellies of Digastric muscles

Muscles ---

Base Hyoid bone Arteries & Veins ---

Apex Symphysis menti Nerves ---

FloorMylohyoid muscle (KCET-03, AIPG-99)

Miscellaneous Sub mental lymph nodes

2. DIGASTRIC TRIANGLE

Anterior Anterior belly of DigastricAnterior part

Muscles ---

PosteriorPosterior belly of DigastricStylohyoid

Arteries & VeinsFacial arteryFacial veinMylohyoid vessels

Nerves Mylohyoid nerve

BaseBase of mandibleLine from angle to mastoid process

Miscellaneous Superficial part of Submandibular gland Submandibular lymph nodes

Posterior part

RoofSkinSuperficial fasciaDeep fascia

Muscles Stylopharyngeus

Arteries & VeinsInternal carotid arteryInternal jugular vein

Floor

MylohyoidHyoglossusMiddle constrictor of pharynx

Nerves Hypoglossal nerve (AIPG-99)Vagus nerve

Miscellaneous Lower pole of parotid gland

3. CAROTID TRIANGLE

Anterosuperiorly

Posterior belly of DigastricStylohyoid

Muscles ---

Anteroinferiorly

Superior belly of Omohyoid Arteries

Common Carotid Artery and its two terminal branchesBranches of External Carotid Artery – Superior ThyroidLingualFacialAscending pharyngealOccipital

PosteriorlyAnterior border of Sternocleidomastoid

VeinsInternal Jugular Vein and tributaries

RoofSkinSuperficial fasciaDeep fascia

Nerves

HypoglossalAnsa cervicalisVagusExternal laryngealInternal laryngealCervical part of Sympathetic trunk


HUMAN ANATOMYNeck

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Floor

ThyrohyoidHyoglossusMiddle and Inferior constrictors of pharynx

Miscellaneous---

4. MUSCULAR TRIANGLE

BehindAnterior border of Sternocleidomastoid Infrahyoid muscles - These are all

innervated by the Ansa cervicalis except Thyrohyoid, which is innervated by C1 nerve

Surgical approach for thyroid, larynx, trachea and esophagus (deep to this triangle)

Infront and above

Posterior belly of DigastricStylohyoid

Infront and below

Superior belly of Omohyoid

Medial Midline

Importance of Carotid triangle Carotid sinus – baroreceptor at the bifurcation of the common carotid, innervated by the

sinus branch of IX cranial nerve; Pressure on the carotid sinus syncope, cessation of heart beat

Carotid body – chemoreceptor posterior to the bifurcation of the common carotid; reflex change in respiration

Important surgical approach for carotid arteries, internal jugular vein, vagus nerve, hypoglossal nerve, cervical sympathetic trunk

Carotid pulse – absence indicates cardiac arrest


HUMAN ANATOMYNeck

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REGION MUSCLE ORIGIN INSERTION INNERVATION FUNCTION

Suprahyoid

Mylohyoid Mylohyoid line of mandible Body of hyoid Inferior alveolar branch of Mandibular nerve (V3)

Elevate hyoid and floor of mouth (KCET-98)

Geniohyoid Inferior genial tubercle of Symphysis menti of mandible

Body of hyoid C1 (via XII) Pull hyoid antero-superiorly

Stylohyoid Styloid process Body of hyoid Facial (VII) Elevate and retract hyoidDigastric -2 bellies -Anterior, Posterior (AIIMS-93, MAHE-94)

Anterior belly - digastric fossa of MandiblePosterior belly - Mastoid notch of Temporal bone to fascial sling (PGI-2003)

Intermediate tendon-in position by sling of deep fascia, gap at insertion of Stylohyoid

Anterior belly: inferior alveolar (Mandibular branch of V3) (APPSC-99, AIPG-99, AIIMS-03)Posterior belly: facial (VII) (COMEDK-2006)

Depress mandible (AIIMS-90)Elevate hyoid

Infrahyoid (AIIMS-06)

Sternohyoid Sternoclavicular joint, clavicle, manubrium sterni

Lower border of body of hyoid

Ansa cervicalis (C1-C3) Depress hyoid

Sternothyroid Posterior surface of manubrium sterni

Oblique line on Thyroid cartilage


Thyrohyoid Oblique line on Thyroid cartilage

Lower border of Body and greater horn of hyoid

C1 (via XII) Depress hyoid

Omohyoid –2 bellies-Superior (near insertion)Inferior (near origin)

Inferior belly from superior border of scapula –near suprascapular notch

Superior belly into inferior border of body of hyoid


Hyoglossus is not included in Suprahyoid muscles


HUMAN ANATOMYGross Anatomy

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POSTERIOR TRIANGLE OF THE NECKBoundaries

Apex: superior nuchal lineBase: middle 1/3 of clavicleAnteriorly: posterior border of sternocleidomastoidPosteriorly: anterior border of trapeziusRoof: skin, superficial fascia, investing cervical fasciaFloor: prevertebral fascia (over splenius capitis, levator scapulae, scalenus anterior, medius, posterior)

Posterior triangle is divided by inferior belly of Omohyoid into1. Upper larger Occipital triangle

2. Lower Supraclavicular / Subclavian triangle

BOUNDARIES CONTENTS

1. OCCIPITAL TRIANGLE

Apex Superior nuchal line Muscles ---

Anteriorly Posterior border of Sternocleidomastoid

Arteries & Veins

Transverse cervical arteryOccipital arteryExternal Jugular Vein

Posteriorly

Anterior border of Trapezius

Nerves

Spinal accessory nerveCutaneous branches of Cervical plexus – Lesser Occipital nerveGreat Auricular nerveTransverse Cervical nerveSupra Clavicular nervesMuscular branches – Levator ScapulaeTrapezius(C3, 4)Rhomboids (C5)Upper part of Brachial plexus

Base Inferior belly of Omohyoid

2. SUB CLAVIAN TRIANGLE

Apex At junction of sternocleidomastoid and inferior belly of Omohyoid Muscles ---

Anteriorly Lower part of posterior border of Sternocleidomastoid

Arteries & Veins

3rd part of Subclavian artery with its branchesSubclavian veinSuprascapular artery (thyrocervical trunk)

Posteriorly

Anterior border of Trapezius

Nerves

3 trunks of brachial plexusNerve to Serratus anteriorNerve to SubclaviusSuprascapular nerve (last two are branches of upper trunk of brachial plexus)

Base Middle 1/3 of clavicle

EXTERNAL JUGULAR VEIN (EJV) Formed by the union of the Retromandibular and Posterior Auricular Veins (KCET-2000) Pierces and fuses with investing cervical fascia about 5 cm above clavicle, if cut, fascia prevents

it from closing and can cause intravenous air embolus.



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It can fill and become visible from holding breath, or from congestive heart failure. Most of the facial veins drain into the External Jugular Vein. Transverse Cervical (from back of danger zone) and Supra scapular veins drain into External

Jugular vein.

BRACHIAL PLEXUS Forms from the anterior rami of cervical nerves C5 to C8 and thoracic nerve T1 The contributions of each of these nerves, which are between the anterior and middle scalene

muscles, are the roots of the brachial plexus. Branches from the roots are dorsal scapular nerve to the rhomboid muscles, long thoracic

nerve to the Serratus anterior muscle, nerve to the Subclavius muscle, suprascapular nerve to the supra spinatus and infra spinatus muscles.

As the roots emerge from between these muscles - the anterior rami of C5 and C6 form the upper trunk, the anterior ramus of C7 forms the middle trunk; the anterior rami of C8 and T1 form the lower trunk. The trunks cross the base of the posterior triangle.

Branches from upper trunk are nerve to Subclavius, Suprascapular nerve. Erb’s point - 6 nerves meet at this point - C5,C6 roots joining to form upper trunk, anterior and

posterior branches of upper trunk branches of upper trunk - nerve to Subclavius, Suprascapular nerve. Lesion of this region (forceps delivery, forced expulsion of fetal head in breech delivery) causes Erb’s paralysis.

CERVICAL PLEXUS – C1-C4 Formed from ventral primary rami of upper four cervical nerves, supplies skin, muscles of neck,

and Diaphragm. All come of Cervical Plexus and penetrate investing fascia of the posterior triangle

Cutaneous nerves Lesser occipital nerve (C2-3) – supplies skin of the neck and the scalp posterosuperior to the

auricle Great auricular nerve (C2-3) – supplies skin over the parotid gland, posterior aspect of the

auricle and skin extending from the angle of the mandible to the mastoid process Transverse cervical nerve (C2-3) – skin covering the anterior triangle Supra Clavicular nerve (C2-4) – skin of the neck, clavicle and anterior shoulder

Phrenic nerve (C3-C4-C5) Caries motor, sensory and sympathetic fibers; innervates diaphragm, mediastinal pleura and

pericardium.

Muscle Origin Insertion Innervation Function

Sternocleido mastoid (AIPG-09)

Sternal head

Upper part of anterior surface of manubrium of sternum

Lateral one-half of superior nuchal line

Accessory nerve [XI] and branches from anterior rami of C2 to C3 (C4)

Individually - will tilt head towards shoulder on same side rotating head to turn face to

Clavicular head

Superior surface of medial one-

Lateral surface of mastoid process



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third of clavicle

opposite sideActing together - draw head

Trapezius

Superior nuchal line; external occipital protuberance; ligamentum nuchae; spinous processes of vertebrae CVII to TXII

Lateral one-third of clavicle; acromion; spine of scapula

Motor-accessory nerve [XI]; proprioception - C3 and C4

Assists in rotating the scapula during abduction of humerus above horizontalUpper fibers - elevate, middle fibers - adduct, lower fibers - depress scapula

OmohyoidSuperior border of scapula medial to scapular notch

Inferior border of body of hyoid bone

Ansa cervicalis; anterior rami of C1 to C3

Depress the hyoid bone

Anterior scalene

Anterior tubercles of the transverse processes of vertebrae CIII to CVI

Scalene tubercle and upper surface of rib I

Anterior rami of C4 to C7

Elevation of rib I

Middle scalene

Transverse processes of vertebrae CII to CVII

Upper surface of rib I between tubercle and groove for subclavian artery


Elevation of rib I

Posterior scalene

Posterior tubercles of transverse processes of vertebrae CIV to CVI

Upper surface of rib II


Elevation of rib II

Splenius capitis

Lower half of ligamentum nuchae; spinous processes of vertebrae CVII to TIV

Mastoid process, skull below lateral one-third of superior nuchal line

Posterior rami middle cervical nerves

Together - draw head back-wardsIndividually - draw and rotate head to one side (turn face to same side)

SUB OCCIPITAL GROUP OF BACK MUSCLES

Muscle Origin Insertion Innervation Function

Rectus capitis posterior major

Spinous process of axis (C2)

Lateral portion of occipital bone below inferior nuchal line

Posterior ramus of C1

Extension of headRotation of face to same side as muscle

Rectus capitis posterior

Spinous process of atlas (C1)

Medial portion of occipital bone below


Extension of head



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minor inferior nuchal line

Obliquus capitis superior

Transverse process of atlas (C1)

Occipital bone between superior and inferior nuchal lines


Extension of head and bends it to same side

Obliquus capitis inferior

Spinous process of axis (C2)

Transverse process of atlas (CI)


Rotation of face to same side

The sub occipital muscles are innervated by the posterior ramus of the first cervical nerve, which enters the area between the vertebral artery and the posterior arch of the atlas. The vascular supply to the muscles in this area is from branches of the vertebral and occipital arteries

Contents of Sub Occipital Triangle Sub occipital nerve, Vertebral artery, Vertebral plexus of veins

BRANCHES OF THE EXTERNAL CAROTID ARTERY (KCET-97, AIPG-2001)

Arteries Supplies

Branches from Medial aspect of external carotid artery

Ascending pharyngeal artery (AIPG-2003)

Pharyngeal constrictors and Stylopharyngeus muscle, palate, tonsil, pharyngotympanic tube, meninges in posterior cranial fossa

Branches from Anterior aspect of external carotid artery

Superior thyroid artery

Thyrohyoid muscle, internal structures of the larynx, sternocleidomastoid and cricothyroid muscles, thyroid gland

Lingual artery (APPG-1994, 2001)

Muscles of the tongue, palatine tonsil, soft palate, epiglottis, floor of mouth, sublingual gland

Facial arteryAll structures in the face from the inferior border of the mandible anterior to the masseter muscle to the medial corner of the eye, soft palate, palatine tonsil, pharyngotympanic tube, submandibular gland (AIPG-92, 98, AIIMS-2001)

Branches from Posterior aspect of external carotid artery

Occipital arterySternocleidomastoid muscle, meninges in posterior cranial fossa, mastoid cells, deep muscles of the back, posterior scalp (MAHE-99)

Posterior auricular artery

Parotid gland and nearby muscles, external ear and scalp posterior to ear, middle and inner ear structures

Terminal Branches of external carotid artery (KCET-2001)

Superficial temporal artery

Parotid gland and duct, masseter muscle, lateral face, anterior part of external ear, temporalis muscle, parietal and temporal fossae

Maxillary artery (AIPG-94, 95)

External acoustic meatus, lateral and medial surface of tympanic membrane, temporomandibular joint, dura mater on lateral wall of skull and inner table of cranial bones, trigeminal ganglion and dura in vicinity, mylohyoid muscle, mandibular teeth, skin on chin, temporalis muscle, outer table of bones of skull in temporal fossa, structures in infratemporal fossa, maxillary sinus, upper teeth and gingiva, infra-orbital skin, palate, roof of pharynx, nasal cavity (MAHE-2002)



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Muscles Origin Insertion Innervation Function

Rectus capitis anterior

Inferior surface of basilar part of occipital bone

Anterior surface of lateral part of atlas and its transverse process

Branches from anterior rami of C1, C2

Flexes head at Atlanto-occipital joint

Rectus capitis lateralis

Inferior surface of jugular process of occipital bone

Superior surface of transverse process of atlas

Flexes head laterally to same side

Longus colli Body T3, C1-C3Anterior tubercle of axis

Branches from anterior rami of C1, C2

Flex neck

Longus capitis

Inferior surface of basilar part of occipital bone

Tendinous slips to transverse processes of vertebrae CIII to CVI

Branches from anterior rami of C1 to C3

Flexes the head

LYMPH NODES AND THE LYMPHATIC DRAINAGE OF THE HEAD AND NECK

Location Area of drainage-

From To

Superior Horizontal Chain

Sub mental nodes Sub mental triangleSkin of chin, lip, floor of mouth, tip of tongue

Submandibular nodes or jugular chain

Submandibular nodes Submandibular triangle

Sub mental nodes, oral cavity, face, except forehead and part of lower lip

Intermediate jugular nodes, deep posterior cervical nodes

Pre auricular (parotid) nodes

In front of tragusLateral surface of pinna, side of scalp

Deep cervical nodes

Post auricular (mastoid) nodes

Mastoid process

Temporal scalp, medial surface of pinna, external auditory meatus

Deep cervical nodes

Occipital nodesBetween mastoid process and external occipital protuberance

Back of scalp Deep cervical nodes

Vertical chain

Posterior cervical (posterior triangle) nodes

Superficial

Along exterior jugular vein Sub parotid nodes,

jugular chain, occipital, and mastoid area

Supraclavicular and deep cervical nodes

DeepAlong spinal accessory nerve

Intermediate (jugular) nodes

All other nodes of neckLymphatic trunks to left and right thoracic ducts

Juguloparotid (subparotid) nodes

Angle of mandible, near parotid nodes

Jugulodigastric (subdigastric) nodes

Junction of common facial and internal

Palatine tonsils



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jugular veins

Jugulocarotid (bifurcation) nodes

Bifurcation of common carotid artery close to carotid body

Tongue, except tip

Juguloomohyoid (Omohyoid) nodes

Crossing of Omohyoid and internal jugular vein

Tip of tongue

Anterior (visceral) nodes Parapharyngeal nodes

Lateral and posterior wall of pharynx

Deep face and esophagus

Intermediate nodes

Paralaryngeal nodes Lateral wall of larynxLarynx and thyroid gland

Deep cervical nodes

Paratracheal nodes Lateral wall of tracheaThyroid gland, trachea, esophagus

Deep cervical and mediastinal nodes

Prelaryngeal (Delphian) nodes

Cricothyroid ligament Thyroid gland, pharynx Deep cervical nodes

Pretracheal nodesAnterior wall of trachea below isthmus of thyroid gland

Thyroid gland, trachea, esophagus

Deep cervical and mediastinal nodes

ROOT OF THE NECK

The root of the neck is the junction between the neck and thorax Important structures are the superior thoracic aperture, cervical pleura and scalenus anterior

muscle.

Boundaries of the thoracic inletPosterior: T1 vertebraLateral: 1st rib and costal cartilageAnterior: Manubrium

Contents of the Root of the NeckNerves

1. Vagus nerve and recurrent laryngeal nerve

2. Sympathetic chain

3. Phrenic nerve (on scalenus anterior, deep to prevertebral fascia)

Arteries1. Right brachiocephalic trunk (right subclavian, right common carotid posterior to

Sternoclavicular joint)2. Left Subclavian artery

3. Left common carotid artery

4. Subclavian artery (medial, posterior and lateral parts by scalenus anterior)i. Vertebral artery, internal thoracic artery, thyrocervical trunkii. Costo cervical trunk (from 1st part on the left)iii. Suprascapular and/or dorsal scapular arteries

Veins (unite posterior to Sternoclavicular joint)1. Subclavian vein

2. Internal jugular vein



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Lymphatics1. Left side – thoracic duct

2. Right side – Jugular, Subclavian, Broncho mediastinal lymph trunks (right lymphatic duct)

Viscera1. Trachea

2. Oesophagus

3. Apex of the lung (and pleural cupula)

Muscles1. Longus colli

2. Sternal ends of sternocleidomastoid, Sternohyoid, Sternothyroid

3. Scalene muscles (marginal)

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