Vlad Head and Neck part 1 IN PROGRESS

The ventricular system of the brain a. conducts CSF b. has 3 pairs of ventricles c. communicates with epidural space d. has middle ventricle e. has second ventricle

a. conducts CSF a. is correct because the ventricular system is a set of four interconnected cavities (ventricles) in the brain, where the cerebrospinal fluid (CSF) is produced b. is incorrect because the ventricular system is composed of 2 lateral ventricles, the third ventricle, the cerebral aqueduct, and the fourth ventricle c. is incorrect because the ventricular system does not communicate with the epidural space, it communicates with the subarachnoid space d. is incorrect because there is no middle ventricle, there is a third and fourth though e. is incorrect because there is no ventricle termed the second ventricle

Classic lucid interval is associated with a. epidural hematoma b. subdural hematoma c. stroke d. subarachnoid e. dural hematoma

a. epidural hematoma a. is correct because a lucid interval is a temporary improvement in a patient's condition after a traumatic brain injury, after which the condition deteriorates. A lucid interval is especially indicative of an epidural hematoma. An estimated 20 to 50% of patients with epidural hematoma experience such a lucid interval. b-e are incorrect because they are not associated with a classic lucid interval.

Maxillary division of the trigeminal nerve exits the cranium via a. foramen rotundum b. foramen ovale c. foramen magnum d. carotid canal e. jugular foramen

a. foramen rotundum a. is correct because the foramen rotundum conducts the maxillary division of trigeminal nerve b. is incorrect because the foramen oval conducts the manmandibular division of trigeminal nerve c. is incorrect because the foramen magnum transmits the medulla oblongata and its membranes, as well as the vertebral arteries, the anterior and posterior spinal arteries, the tectorial membranes, alar ligaments, and the the spinal component of the accessory nerve into the skull. d. is incorrect because the carotid canal is a passage within the petrous temporal bone and transmits the internal carotid artery and sympathetic plexus e. is incorrect because the jugular foramen conducts the vagus, glossopharyngeal, CN IX, X, and XI

Carotid endarterectomy is performed on a. internal carotid artery b. external carotid artery c. internal carotid vein d. external carotid vein e.external thyroid vein

a. internal carotid artery a. is the correct answer because a carotid endarterectomy is a surgical procedure used to reduce the risk of stroke by correcting stenosis (narrowing) in the common carotid artery or internal carotid artery. Endarterectomy is the removal of material on the inside (end(o)-) of an artery. b. is incorrect because the external carotid artery supplies the face with blood, not the brain. this would not reduce the risk of stroke in the brain. c and d are incorrect because they do not exist e. is incorrect because there is also no such structure. the thyroid veins are inferior, superior, or middle- not external

An epidural hematoma is classically associated with a. middle meningeal artery injury b. frontal bone fracture c. nerve injury d. vertebral artery injury e. vertebral vein injury

a. middle meningeal artery injury a. is correct because an epidural hematoma/ hemorrhage is classically a temporal fracture with injury to the middle meningeal artery, which is a branch of the external carotid artery b. is incorrect because a frontal bone fracture is not classical associated with an epidural hematoma. the temporal bone is associated with a epidural hematoma c. is incorrect because nerves have nothing to do with bleeding d. is incorrect because vertebral artery injury occurs with trauma to the neck where the artery is located e. is incorrect because vertebral vein injury would be caused by trauma to the neck where it is primarily located, not the head

Which sinus is the origin of the internal jugular vein a. sigmoid sinus b. superior saggital sinus c. inferior saggiatal sinus d. carotid sinus e. straight sinus

a. sigmoid sinus a. is correct because the sigmoid sinus receives blood from the transverse sinuses, which track the posterior wall of the cranial cavity, travels inferiorly along the parietal bone, temporal bone and occipital bone, and converges with the inferior petrosal sinuses to form the internal jugular vein. b

Which structure exits the cranium via the jugular foramen? a. vagus nerve b. facial nerve c. ophthalmic nerve d. spinal cord e. vertebral artery

a. vagus nerve a. is correct because the vagus as well as the glossopharyngeal, and CN IX, X, and XI exit the cranium via the jugular foramen b. is incorrect because the facial nerve exits the cranium via the internal acoustic meatus, facial canal, and stylomastoid foramen (which are all interconnected) c. is incorrect because the ophthalmic artery exits the cranium via the optic canal? d. is incorrect because the spinal cord runs through the spinal canal within the vertebral foramen e. is incorrect because the vertebral artery starts at C6 and runs through the transverse foramen

Face has excellent blood supply provided by the a. branches of the internal carotid artery b. branches of the external carotid artery c. vertebral artery d. basilar artery e. multiple arterial anastomosis

b. branches of the external carotid artery a. is incorrect because the internal carotid artery does not have branches and supplies blood to the brain b. is correct because the branches of the external carotid artery supply blood to the face c. is incorrect because the vertebral artery helps supply blood to the upper spinal cord, brainstem, cerebellum, and posterior part of brain. d. is incorrect because the basilar artery supplies blood to the cerebellum, brainstem, and occipital lobes for the brain and central nervous system. e. is incorrect because multiple arterial anastomosis do not exist in the face. the large anterior branches anastomoses with similar branches of the opposite side and with the submittal artery. at the medial angle of the eye terminal branches of the facial artery anatomies with branches of the ophthalmic artery.

Which nerve is visualized during superficial parotidectomy a. maxillary branch of the facial nerve b. mandibular branch of the facial nerve c. hypoglossal nerve d. ophthalmic nerve e. cervical branch of trigeminal nerve

b. mandibular branch of the facial nerve a. is incorrect because the maxillary branch is of the trigeminal nerve b. is correct because the mandibular branch of the facial nerve is visualized during the superficial parotidectomy c. and d. are incorrect because the hypoglossal and ophthalmic nerves are not visualized e. is incorrect because the cervical branch is of the facial nerve

The foramen magnum transmits a. ophthalmic nerve b. medulla c. carotid artery d. carotid vein e. trigeminal nerve

b. medulla a. is incorrect because the ophthalmic nerve b. is correct because the foramen magnum transmits the medulla oblongata and its membranes, as well as the vertebral arteries, the anterior and posterior spinal arteries, the tectorial membranes, alar ligaments, and the the spinal component of the accessory nerve into the skull. c. is incorrect because the carotid artery runs in the neck and the carotid canal is a passage within the petrous temporal bone and transmits the internal carotid artery and sympathetic plexus d. is incorrect because the carotid vein does not exist e. is incorrect because the trigeminal nerve has the ophthalmic, maxillary, and mandibular branches which leave the skull through 3 separate foramina: the superior orbital fissure, the foramen rotundum, and the foramen ovale

Mandibular division of the trigeminal nerve exits cranium via a. foramen magnum b. stylomastoid foramen c. foramen ovale d. foramen lacerum e. jugular foramen

c. foramen ovale a. is incorrect because the foramen magnum the foramen magnum transmits the medulla oblongata and its membranes, as well as the vertebral arteries, the anterior and posterior spinal arteries, the tectorial membranes, alar ligaments, and the the spinal component of the accessory nerve into the skull. b. is incorrect because the stylomastoid foramen conducts facial nerves c. is correct because the foramen oval conducts the manmandibular division of trigeminal nerve d. is incorrect because the foramen lacerum conducts one of the terminal branches of the ascending pharyngeal artery (itself a branch of the external carotid artery) e. is incorrect because the jugular foramen conducts the vagus, glossopharyngeal, CN IX, X, and XI

Vertebral artery a. enters transverse foramina at C7 level b. second branch off of the subclavian artery c. forms basilar artery d. important blood supply of face e. terminates in internal carotid artery

c. forms basilar branch a. is incorrect because the vertebral artery enters the transverse foramina at the C6 level b. is incorrect because the vertebral artery is the first branch off the subclavian artery. the second branch is the thyrocervical trunk and the third branch is the internal thoracic. (picture) c. is correct because the two vertebral arteries come together and from the basilar artery d. is incorrect because the blood supply to the face is supplied by the internal carotid artery. the vertebral artery supplies blood to the upper spinal cord, brainstem, cerebellum, and posterior part of brain. e. is incorrect because the vertebral artery basically terminates at the basilar artery because it forms the basilar artery in the skull near the pons

80 year old male is complaining of sudden left sided weakness and slurred speech. you suspect which of the following? a. epidural hematoma b. subdural hematoma c. internal carotid artery embolism d. subarachnoid hematoma e. dural hematoma

c. internal carotid artery embolism a, c, d, and e are all incorrect because we automatically suspect a stroke first with those symptoms c. is correct because an CIA embolism has a high likelihood of leading to a stroke

Branches of the facial nerve include all but which of the following a. temporal b. zygomatic c. maxillary d. cervical e. mandibular

c. maxillary a, b, d, and e are incorrect because the facial nerves branches to the temporal, zygomatic, cervical, and mandibular as well as the buccal regions c. is incorrect because maxillary is not innervated by the facial nerve. it is actually innervated by the branches of CN V, or the trigeminal nerve

Subdural hematoma a. is located in subarachnoid space b. biconvex in shape c. caused by arterial injury d. caused by venous injury e. caused by tear in middle meningeal artery

d. caused by venous injury a. is incorrect because a subdural hematoma is located in the subdural space, not the subarachnoid space. subarachnoid hemorrhage would be located in the subarachnoid space. b. is incorrect because a subdural hematoma is classically crescent-shaped, with a concave surface away from the skull. extradural hematomas are typically biconvex in shape and can cause a mass effect with herniation. c. is incorrect because a subdural hematoma is caused by venous injury, not arterial injury. an epidural hematoma is caused by arterial injury d. is correct because subdural hematomas occur due to venous injury to bridging veins and classically occur in elderly patients e. is incorrect because a tear in the middle meningeal artery would cause an epidural hematoma.

Corneal blink reflex a. afferent limb is facial nerve b. afferent limb is facial artery c. efferent limb is trigeminal artery d. efferent limb is facial nerve e. motor and sensory limbs are by the same nerve

d. efferent limb is facial nerve a. is incorrect because the blink reflex is motor not sensory, so if efferent b. is incorrect because the blink reflex is motor, therefore efferent not afferent. also, arteries do not have control over reflexes c. is incorrect because the trigeminal nerve does not innervate the muscles of facial expression, the facial nerve does. d. is correct because the facial nerve does control the motor function of closing the eye. e. is incorrect because motor and sensory limbs are not the same. afferent is accepting signals towards the brain, and efferent sends signals away from the brain.

Trigeminal nerve a. innervates muscles of the face b. has buccal branch c. divides into two major divisions d. has mandibular branch e. has zygomatic branch

d. has mandibular branch a. is incorrect because the trigeminal nerve deals with sensation b. is incorrect because there is no buccal branch of the trigeminal nerves. the three branches are ophthalmic nerve (V1), the maxillary nerve (V2) and the mandibular nerve (V3). c. is incorrect because there are three major divisions, hence the TRIgeminal name d. is correct because there is a mandibular, as well as ophthalmic and maxillary branch. e. is incorrect because there is no zygomatic branch of the trigeminal nerve. the three branches are ophthalmic nerve (V1), the maxillary nerve (V2) and the mandibular nerve (V3).

venous drainage of the brain is via a. internal jugular artery b. external jugular artery c. internal vertebral vein d. jugular foramen e. carotid canal

d. jugular foramen a and b are incorrect because arteries carry oxygenated blood and therefore would not be the venous drainage of the brain c. is incorrect because there is no such thing d. is correct because the brains venous drainage is via the jugular foramen e. is incorrect because the carotid canal carries the carotid artery

Internal carotid artery a. major blood supply of face b. enters skull via foramen magnum c. has multiple external branches d. origin of middle cerebral artery e. is in proximity to internal carotid vein

d. origin of middle cerebral artery a. is incorrect because the external carotid artery is the major blood supply of the face b. is incorrect because the internal carotid artery enters the skull via the carotid canal c. is incorrect because the internal carotid artery has no branches. the external carotid artery has multiple branches though d. is correct because the internal carotid is the origin of the middle cerebral artery e. is incorrect because there is no such vein

Which vessel is not part of the circle of Willis? a. posterior cerebral b. posterior communicating c. anterior communicating d. middle cerebral e. basilar artery

e. basilar artery a. is incorrect because the posterior cerebral artery is located within the circle of willis and supplies oxygenated blood to the posterior aspect of the brain (occipital lobe) b. is incorrect because the posterior communicating artery is part of the circle of willis and is located at the base of the brain, where is is essentially connecting the posterior cerebral artery to the middle cerebral artery c. is incorrect because the anterior communicating artery is part of the circle of willis and it connects the left and right anterior cerebral arteries d. is incorrect because the middle cerebral artery is part of the circle of willis and it supplies blood to the cerebrum e. is incorrect because the basilar artery is formed by the joining of the two vertebral arteries and is inferior to the circle of willis. it does help form the branches of arteries in the circle, but does not actually form the circle.

Which of the following is not a branch of the external carotid artery? a. maxillary artery b. facial artery c. superficial temporal artery d. superior thyroid artery e. inferior thyroid artery

e. inferior thyroid artery a. is incorrect because the maxillary artery supplies deep structures of the face. It branches from the external carotid artery just deep to the neck of the mandible. b. is incorrect because the facial artery is a branch of the external carotid artery that supplies structures of the superficial face c. is incorrect because the superficial temporal artery branches off from the external carotid artery and it assists in delivering oxygenated blood from the heart to regions within the neck and head. d. is incorrect because the superior thyroid is a branch of the external carotid artery and supplies the larynx and thyroid gland e. is correct because the internal thyroid artery is not a branch of the external carotid. it is actually a branch of the thyrocervical trunk of the subclavian artery and supplies the superior thyroid and other parts of the thyroid gland

Facial dermatomes a. innervated by facial nerves b. overlap each other c. innervated by ophthalmic division of trigeminal nerve only d. innervated by the maxillary division of trigeminal nerve only e. innervated by supraorbital nerve

e. innervated by supraorbital nerve a. is incorrect because facial dermatomes are innervated by supraorbital nerves. facial nerves innervate the muscles of facial expression (temporal, zygomatic, buccal, marginal mandibular, cervical) b. is incorrect because facial dermatomes do not overlap c. is incorrect because facial dermatomes are innervated by supraorbital nerves d. is incorrect because facial dermatomes are innervated by supraorbital nerves e. is correct because facial dermatomes are innervated by the supraorbital nerve

Jugular foramen transmits a. olfactory nerve b. hypoglossal nerve c. vertebral artery d. carotid artery e. vagus nerve

e. vagus nerve a. is incorrect because the olfactory nerve is conducted by the cribriform plate b. is incorrect because the hypoglossal nerve is conducted by the hypoglossal canal c. is incorrect because the vertebral artery comes from the first branch of the subclavian and forms the basilar artery d. is incorrect because the carotid arteries are located in the neck e. is correct because the jugular foramen conducts the vagus, glossopharyngeal, CN IX, X, and XI

Which structure is not identified during carotid endarterectomy a. vagus nerve b. internal jugular vein c. hypoglossal nerve d. external carotid artery e. vertebral artery

e. vertebral artery a-d are incorrect because during a carotid endarterectomy, the internal jugular vein is visualized, and the carotid sheath is opened along the anterior border of the vein. the internal jugular vein is retracted laterally, and the common facial vein is ligated. dissection is continued anterior to the CCA to keep from injuring the vagus nerve. the vagus nerve usually lies in a posterior lateral position within the carotid sheath but occasionally may spiral anteriorly, particularly in the lower end of the incision. attention should be paid to cranial nerves IX (glossopharyngeal nerve), X (vagus nerve), XI (accessory nerve), and XII (hypoglossal nerve), as well as the marginal mandibular branch of VII (facial nerve) and the rare nonrecurrent laryngeal nerve that comes directly off the vagus to innervate the vocal cords. e. is correct because the vagus and hypoglossal nerve, as well as the internal jugular vein and external carotid artery are identified during a carotid endarterectomy. the vertebral artery is too deep and within the transverse foramina.