anatomy exam 2

cricothyrotomy

small needle is inserted in cricothyroid ligament to establish airway

recurrent laryngeal nerve palsy

lead to hoarse voice and inability to speak

intracerebral aneurysms

- arise from the vessels in and around the circle of willis - occur in and around the anterior communicating artery. posterior communicating a, branches of the middle cerebral a, distal end of basilar a, and posterior inferior cerebellar a - risk of rupture - "thunderclap" headache, neck stiffness and vomiting - blood within subarachnoid space - catheter to seal rupture

extradural hemorrhage

- arterial damage and results from tearing of the branches of the MMA, typically occurs in the region of the pterion - blood collects b/t periosteal layer of dura and calvaria - drowsiness and unconsciousness

depressed skull fracture

- bony fracture is depressed below the normal skull convexity - may lead to 2° arterial and venous damage w/ hematoma formation - 1° brain injury can result from this fracture

hydrocephalus

- dilation of cerebral ventricular system - due to an obstruction to the flow of CSF, overproduction of CSF, or failure to reabsorption of CSF - CSF is secreted by choroid plexus with the lateral third and fourth ventricles of the brain - common cause in adults >interruption of normal CSF absorption via arachnoid granulation > blood enters subarachnoid space after subarachnoid hemorrhage, passes over brain and interferes with normal CSF absorption >congenital obstruction of aqueduct of sylvias > tumor > choroid plexus tumors that secrete CSF - Children > dramatic in later stages > increases the size and dimension of the ventricle > brain enlarges > head extends because skull sutures are not fused

compound fracture

- fracture of bone together with a breach of the skin - may allow infection to enter - associated with scalp lacerations and can be treated with antibiotics - can lead to meningitis - also includes fractures across sinuses > should be considered in patients who develop intracranial infections > potential cause of morbidity

orbital fracture

- frequently occur within the floor and medial wall - upward gaze failure

tracheotomy

- hole is made in trachea and tube is inserted - incision is made in the 2nd and 3rd trachea rings

cataracts

- increase age and certain diseases - lens of eye become become opaque - increase opacity results in increase visual impairment - replace cloudy lens with man made lens

stroke (cerebrovascular accident CVA)

- interruption of blood floe to the brain or brainstem resulting in impaired neurological function lasting more than 24 hours - TIA (transient ischemic attack aka ministroke): resolves within 24 hours - rapid onset hemiparesis, hemisensory loss, visual field deficits, dysarthria, ataxia, decreased level of consciousness

brain tumor

- intracranial (within the brain) or extracranial (outside the brain) - typical extracranial tumors are out of the meninges and acoustic neuromas (at and around the vestibulocochlear nerve [VIII] - intracranial lesions are wither primary or secondary (most common) - metastatic tumor lesions are typically found in patients w/ breast carcinoma or lung carcinoma

glaucoma

- intraocular pressure rises if the normal cycle of aqueous humor fluid production and absorption is disturbed so that the amount of fluid increases - can lead to blindness

CSF leak

- leakage of CSF from subarachnoid space - after a procedure in and around the brain, spinal cord and meninges - CSF leaks out of subarachnoid space and through the dura mater - dizziness, nausea, fatigue, metallic taste in mouth, facial nerve weakness, double vision

pterion fracture

- pterion: frontal, parietal and greater wing of sphenoid, and temporal bones come together - contains middle meningeal artery - injury to vessel may produce a significant extradural hematoma

Meningitis

- rare infection of leptomeninges (combo of arachnoid, and pia mater) - occur via a blood borne route - May be direct spread (trauma) or from nasal cavities - inflammation and sepsis w/ cerebral irritation can cause the patient to pass into a come and die - usually treatable with antibiotics - mild headache, fever, drowsiness, nausea, photophobia, ecchymosis - Kernig's sign: straight leg raising causes neck pain - Brudzinski neck sign

endarterectomy

- remove atheromatous plaque from arteries - atheromatous plaque - plaque is removed and vessels reopen - patch of material sewn over the hole in vessels to enable flow and prevent narrowing

trigeminal neuralgia

- sensory disorder - pain is in the region of the mandibular (V3) and maxillary (V2) - sudden onset - excruciating and may be triggered by touching a sensitive region of skin - surgical exploration may be necessary to remove aberrant vessels

subarachnoid hemorrhage

- significant cerebral trauma - results from a ruptured intracerebral aneurysm arising from the circle of willis

fracture of skull vault

- strong structure b/c is protects the brain - biomechanics prevents fracturing - fracture it of little consequence - minimize the extent of primary brain injury and treat potential secondary complications

thyroidectomy

- usually for benign diseases - excision of part of thyroid - possibility of damaging the parathyroid gland and recurrent laryngeal nerve

subdural hematome

- venous bleeding - torn cerebral veins where they enter the superior sagital sinus - young and elderly most at risk

concussion

-mild traumatic brain injury - rapid deceleration of the head or by a rotation of the brain withing the cranial cavity - posttraumatic amnesia, confusion, loss of consciousness, headache, dizziness, vomiting, lack of motor coordination and light sensitivity

A 20yo man fell off a motorcycle and sustained a head injury. A CT scan of his head revealed a fracture of the sella turcica. Which of the following bones was most likely damaged in this patient? A. Sphenoid B. Temporal C. Occipital D. Ethmoid E. Frontal

A. the butterfly shaped middle cranial fossa has a central part composed of the sella turcica on the body of the sphenoid and large depressed lateral parts on each side temporal bones are situated at the sides and base of the skull and consist of the squama temporalis, mastoid portion, petrous portion, tympanic part, zyfomatic process and styloid process. occipital bone is at the back lower part of the skull and contains the foramen magnum ethomoid and frontal bones are in the anterior fossa

The arachnoid villi allow CSF to pass between which two of the following spaces? A. Choroid plexus and subdural space B. Subarachnoid space and superior sagittal sinus C. Subdural space and cavernous sinus D. Superior sagittal sinus and jugular vein E. Epidural and subdural space

B. Arachnoid villi are extension of the arachnoid mater into the superior sagittal sinus. the villi allow for proper drainage of the CSF into the venous bloodstream from the subarachnoid space in which the CSF circulates. These villi are a crucial element in maintaining proper intracranial pressure and circulation of the CSF

A 55 yo man is admitted to the hospital with a complain of severe headaches. A lumbar puncture reveals traces of blood in the CSF. Which of the following conditions has most likely occurred in this patient? A. Fracture of the pterion with vascular injury B. A ruptured "berry" aneurysm C. Leakage of the middle meningeal vein within the temporal bone D. A tear of the cerebral vein at the entrance to the superior sagittal sinus E. Occlusion of the internal carotid artery by a clot generated in the left atrium

B. When a berry aneurysm ruptures the blood flows into the subarachnoid space and therefore mixes with CSF blood would be present in CSF when a lumbar puncture is performed Pterion overlies the anterior branch of the middle meningeal vessels and damage to these vessels result in an epidural hematoma with compression of the brain Leakage of branches of the middle meningeal artery within the temporal bone would cause blood within the bone to leak w/o direct connection to the CSF. A tear of the cerebral vein in the superior sagittal sinus would lead to a subdural hematoma in which blood collects in the subdural space w/o entry to the CSF occlusion of the internal carotid artery by the way of a clot would not lead to a leakage into CSF

A 54yo woman is admitted to the emergency department after experiencing sudden problems with vision over the past 5 days. MRO reveals thats an aneurysm of one arteries at the base of the brain is compressing the optic chiasm. Which of the following arteries will most likely be involved? A. Middle cerebral B. Anterior communicating C. Anterior cerebral D. Superior cerebellar E. posterior superior cerebellar

B. the anterior communicating artery is directly superior to the optic chiasim and an aneurysm would likely compress the chiasm

A 29 year old woman underwent a thyroidectomy. Postoperatively, the patient presented with hoarseness. Which of the following nerves was most likely injured during the operation? A. internal laryngeal B. External laryngeal C. Recurrent laryngeal D. Superior laryngeal E. Glossopharyngeal

C. Recurrent laryngeal nerve supplies most of the motor innervation to the larynx and sensation below the true vocal folds.The thyroid gland and recurrent laryngeal nerve are in close proximity and thus the nerve is most likely to be injured with a thyroidectomy. injury to recurrent can result in speech defects, including hoarseness Superior laryngeal nerve innervates the mucous membranes of the larynx above the vocal folds external laryngeal nerve innervates cricothyroid muscles which tenses the vocal folds glossopharyngeal nerve is located superiorly to the true vocal folds and are not affected

an mri scan of the thoracic spine of a 68 yo man with acute midback pain revealed a large tumor arising from the anterior median fissure of the spinal cord at the level of T3 vertebra. The artery compressed by the tumor is most likely formed superiorly by direct branches from which of the following arteries? A. Ascending cervical B. Segmental medullary C. Vertebral D. Segmental spinal E. Posterior spinal

C. The anterior spinal artery lies in the anterior median fissure and would likely be compressed by the tumor. This artery is formed superiorly by the union of two branches that directly arise from the vertebral arteries Ascending cervical artery is not found within the vertebral canal and does not contribute to the blood supply of the spinal cord the segmental spinal arteries follow the spinal nerves and provide the segmental medullary vessels which run along the dorsal and ventral roots to supply the lateral aspect of the spinal cord Each posterior spinal arteries are located in the posterolateral sulcus on the posterior aspect and have only small branches to the direct area

The arterial circle (of Willis) contribute greatly to cerebral arterial circulation when one primary artery becomes occluded by atherosclerotic disease. Which of the following vessels does not contribute to the circle? A. Anterior communicating artery B. posterior communicating artery C. Middle cerebral artery D. Internal carotid artery E. Posterior cerebral artery

C. The circle of receives its blood from the internal carotid artery and vertebral artery. The middle cerebral artery is the lateral continuation of the internal carotid artery and therefore is not part of the arterial circle. Although it receives its bloods supply from the Circle of Willis is does not form any part of the circle

A 5yo boy fell from a tree and was admitted to the emergency department unconscious. when an emergency tracheostomy was performed , profuse dark venous bleeding suddenly occurred from the midline incision over the trachea. Which of the following vessels was most likely accidentally cut? A. Superior thyroid vein B. Inferior thyroid vein C. Left brachiocephalic vein D. Middle thyroid vein E. Jugular arch connecting the anterior jugular veins

C. the left brachiocephalic vein is the most likely vein punctured in the procedure because it extends across the trachea from the left side of the body, joining the right brachiocephalic vein to form the superior vena cava located just to the right of the midline superior thyroid veins drain the superior aspects of the thyroid glands and join the internal jugular veins bilaterally and superiorly to the sight of the incision middle thyroid veins drain the middle portions of the thyroid glands and terminate in the internal jugular veins laterally, superior to the incision inferior thyroid veins drain the inferior aspects of the thyroid glands and descends bilaterally to the trachea to join the right and left brachiocephalic veins, respectively the jugular arch connecting the anterior jugular veins is quite superficial and is not typically a source of concern

A 65 yo man is admitted to the hospital 3 weeks after a "small bump of his head", according to his narrative. He suffered the accidental bump from a low hanging branch while driving his tractor through the apple orchard during harvesting season. During physical examination the patient displays mental confusion and poor physical coordination. Radiologic examination reveals an intracranial thrombus probably due to leakage from a cerebral vein over the right cerebral hemisphere. from what type of bleeding is the patient most likely suffering? A. subarachnoid bleeding B. Epidural bleeding C. Intracerebral bleeding into the parenchyma D. Subdural bleeding E. Bleeding into the cerebral ventricular system

D. Subdural bleeding usually result from tears in veins that cross the subdural space between the dura and the arachnoid. This bleeding may cause a gradual increase in intracranial pressure and may result in leakage in intracranial pressure and may result in leakage

A 40 year old unconscious man is admitted to the emergency department after being hit in the head with a base ball bat. A CT scan examination reveals a fractured pterion and epidural hematoma. Branches of which of the following arteries are most likely to be injured? A. External carotid B. Superficial temporal C. Maxillary D. Deep temporal E. Middle meningeal

E. The middle meningeal artery is a branch of the maxillary artery and courses between the mater and the skull close to the pterion. Any fracture or impact trauma to this location typically results in a laceration of the mma resulting in an epidural hematoma. the External Carotid Artery ends behind the mandible by dividing into the maxillary and the superficial temporal artery, neither are directly affect the meninges of the brain. the deep temporal arteries do not penetrate the bony skull and thus would not contribute to an epidural hematoma

primary brain hemorrhage

aneurysm rupture, hypertension, and bleeding after cerebral infarction