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Chapter 6: Neck

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A 44-year-old man was referred to the outpatient surgery clinic with a diagnosis of a nodular mass in his left thyroid lobe. After needle biopsy, thyroid cancer was diagnosed and the patient underwent total thyroidectomy. Which nerve stimulates secretion of thyroid hormone?

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A. Motor fibers in ansa cervicalis

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B. Parasympathetic fibers traveling in the recurrent laryngeal nerve

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C. Parasympathetic fibers traveling in the superior laryngeal nerve

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D. Sympathetic fibers from the middle cervical ganglion

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E. None of the above

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Answer E. Endocrine secretion from the thyroid gland is regulated hormonally by thyrotropin (thyroid-stimulation hormone, TSH) released from the pituitary gland. Therefore, none of the nerves listed stimulate secretion from the thyroid gland.

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A 44-year-old man was referred to the outpatient surgery clinic with a diagnosis of a nodular mass in his left thyroid lobe. After needle biopsy, thyroid cancer was diagnosed and the patient underwent total thyroidectomy. In addition to the internal jugular veins, which vein also commonly receives blood from the gland?

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A. Left brachiocephalic

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B. Left subclavian

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C. Right brachiocephalic

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D. Right subclavian

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E. None of the above

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Answer A. The inferior thyroid veins drain into the left brachiocephalic vein. The superior and middle thyroid veins are tributaries of the internal jugular.

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A 44-year-old man was referred to the outpatient surgery clinic with a diagnosis of a nodular mass in his left thyroid lobe. After needle biopsy, thyroid cancer was diagnosed and the patient underwent total thyroidectomy. After surgery, the patient reported persistent hoarseness. Laryngoscopic examination reveals a paralyzed right vocal fold. Which nerve was most likely damaged during surgery?

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A. External laryngeal

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B. Internal laryngeal

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C. Recurrent laryngeal

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D. Superior laryngeal

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E. None of the above

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Answer C. The recurrent laryngeal nerve innervates all intrinsic laryngeal muscles except cricothyroid. In this case, the right recurrent laryngeal nerve was damaged during surgery, leaving the right vocal fold paralyzed.

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A first-year emergency medicine resident inserts a subclavian venous catheter using an infraclavicular approach. Subsequently, the patient has difficulty breathing. What nervous structure may have been injured?

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