Download 1. During an intramural baseball game a player is hit in the side of

1. During an intramural baseball game a player is hit in the side of the
head, between the eye and the ear. He immediately loses
consciousness, wakes up momentarily and then becomes
comatose. He is rushed to the ER and is immediately given a CT
scan. The scan shows a skull fracture and an accumulation of
blood between the dura and the cranial bone on the side of his
head, compressing his cerebrum. He is rushed to surgery where a
hole is bored into his skull to relieve the pressure. After a few
tense hours, he regains consciousness and has an uneventful
recovery. The hemorrhage from the fracture would be described
as:
Epidural
Intracerebral
Subaponeurotic
Subarachnoid
Subdural
2. An infant was diagnosed as having hydrocephalus. It was
determined that there was a blockage in the ventricular system of
the baby's brain between the third and fourth ventricles. The
blockage therefore must have involved the:
Central canal
Cerebral aqueduct
Foramen of Luschka (lateral foramen)
Foramen of Magendie (medial foramen)
Interventricular foramen
3. An 84-year old woman suffers a stroke, with paralysis on the right
side of her body. Neurological tests show that the intracerebral
hemorrhage has interrupted the blood supply to the posterior part
of the frontal, the parietal and medial portions of the temporal
lobes of the left cerebral hemisphere. Which vessel was involved?
Anterior cerebral artery
Great cerebral vein
Middle cerebral artery
Middle meningeal artery
Posterior cerebral artery
4. A sixty-four-year old man was diagnosed with an acoustic
neuroma (tumor of the VIIIth cranial nerve) where it entered the
temporal bone. What other cranial nerve might also be affected
since this nerve uses the same foramen as the VIIIth in its course?
Abducens
Facial
Glossopharyngeal
Trigeminal
Vagus
5. Infections may spread from the nasal cavity to the meninges along
the olfactory nerves, as its fibers pass from the mucosa of the
nasal cavity to the olfactory bulb via the:
Cribriform plate of the ethmoid
Crista galli
Foramen caecum
Superior orbital fissure
6. The "danger zone" of the scalp is recognized as which of the
following layers?
Galea aponeurotica
Loose connective tissue
Pericranium
Skin
Subcutaneous connective tissue
7. The presence of blood in a spinal tap taken from an individual with
a closed head injury signals arterial bleeding into the:
Cavernous sinus
Epidural space
Subarachnoid space
Subdural space
8. An infection in which scalp layer is likely to spread most readily?
Skin
Connective tissue layer
Aponeurotic layer
Loose areolar tissue
Pericranium
9. A patient who has sustained a fracture to the middle cranial fossa
following a fall from a height, might have any of these nerves
injured EXCEPT:
Trigeminal
Oculomotor
Abducens
Trochlear
Hypoglossal
10.
The most likely source of blood in a patient with an epidural
hemorrhage is:
Vertebral artery
Middle meningeal artery
Superior cerebral veins
Anterior cerebral artery
Circle of Willis
11.
In a fall from a horse, a rider sustains a severe neck injury at
the C6 level. In addition to crushing the spinal cord, the left
transverse process of the C6 vertebra is fractured. What artery is
endangered?
Common carotid
Costocervical
Inferior thyroid
Internal carotid
Vertebral
12.
A 35-year-old man was admitted to the hospital complaining
of double vision (diplopia), inability to see close objects, and
blurred vision in the right eye. A vertebrobasilar angiogram
revealed an aneurysm of the superior cerebellar artery close to its
origin on the right side. The doctor attributed the symptoms to the
compression of an adjacent cranial nerve by the aneurysm. The
compressed nerve is the:
Abducens (CN VI)
Oculomotor (CN III)
Optic (CN II)
Trigeminal (CN V)
Trochlear (CN IV)
13.
An elderly patient developed fever and worsening headache
a few days after sustaining a scalp laceration and subsequent
infection due to a car accident. At the hospital the case was
diagnosed as meningitis and superior sagittal sinus thrombosis.
The attending physician suggested that infection to the sinus
initially spread through one of the scalp layers. The scalp layer
involved is:
Areolar tissue
Connective tissue
Epicranial aponeurosis
Periosteum
Skin
14.
While riding her bicycle on campus without a helmet a
student is hit by a car and falls, hitting her head on the pavement.
She is brought to the Emergency Room in an unconscious state
with signs of a closed head injury. Tests reveal blood in her
cerebrospinal fluid taken from a spinal tap. Diagnosis is of torn
cerebral veins as they pass from the brain to the superior sagittal
sinus. From which of the following was the bloody fluid taken?
Cavernous sinus
Epidural space
Subarachnoid space
Subdural space
Verterbal venous plexus
15.
You have been asked to assess the neurological deficit that
might exist in a patient diagnosed with cavernous sinus
thrombosis. You will focus your examination on cranial nerves
related to the sinus that includes all the following EXCEPT:
Abducens (CN VI)
Facial (CN VII)
Oculomotor (CN III)
Ophthalmic division of the trigeminal nerve (CN V1)
Trochlear (CN IV)
16.
The glossopharyngeal nerve exits the skull via what
opening?
Foramen ovale
Carotid canal
Jugular foramen
Hypoglossal canal
Stylomastoid foramen
17.
An infant was found to have hydrocephalus. Studies
revealed that the hydrocephalus was caused because CSF could
not get out of the third ventricle. The passage blocked was the:
Central canal
Cerebral aqueduct
Interventricular foramen
Lateral foramen (of Luschka)
Medial foramen (of Magendie)
18.
A person develops a cavernous sinus thrombosis. Because
of its relationship to the sinus, which cranial nerve might be
affected?
Abducens
Facial
Mandibular V3
Olfactory
Optic
19.
Blockage of the flow of cerebrospinal fluid (CSF) within the
cerebral aqueduct (of Sylvius) normally would result in the
enlargement of all of the following ventricular spaces except the:
Fourth ventricle
Interventricular foramen (of Monro)
Lateral ventricle
Third ventricle
20.
All of the following nerves exit the cranial cavity by way of
bony openings located in the middle cranial fossa EXCEPT:
Abducens
Trochlear
Oculomotor
Trigeminal
Facial
21.
During childbirth, an excessive anteroposterior compression
of the head may tear the anterior attachment of the falx cerebri
from the tentorium cerebelli. The bleeding that follows is likely to
be from which of the following venous sinuses?
Occipital sinus
Sigmoid sinus
Straight sinus
Superior sagittal sinus
Transverse sinus
22.
The inferior sagittal sinus is found in the free edge of what
structure?
Diaphragma sellae
Falx cerebelli
Falx cerebri
Filum terminale
Tentorium cerebelli
1. The correct answer is:
Epidural
An epidural hemorrhage is a hemorrhage of blood into the space
between the dura and the skull. These hemorrhages are usually caused
by rupturing the middle meningeal artery, which supplies blood to the
dura and the bones of the cranial vault. This hemorrhage results in
compression of the dura mater and the brain; if it is not drained, it may
result in the brain herniating through the tentorium and death. An
intracerebral hemorrhage is a hemorrhage within the cerebral
hemispheres. A subaponeurotic hemorrhage could be a collection of
blood under the aponeurosis of the scalp, but this is not really a brain
hemorrhage and is not as clinically significant as the other answer
choices. A subarachnoid hemorrhage is an acute condition where blood
collects in the area between the pia mater and arachnoid mater. This is
often secondary to a head injury or a ruptured aneurysm. A subdural
hemorrhage is characterised by a collection of blood beneath the dura,
often caused by a head injury.
2. The correct answer is:
cerebral aqueduct
The cerebral aqueduct is the part of the ventricular system that carries
cerebrospinal fluid from the third ventricle to the fourth ventricle. So, this
must be the part of the ventricular system that was blocked. The central
canal is the space where CSF flows through the spinal cord. It is
continuous with the 4th ventricle. The foramina of Luschka (lateral
aperatures) and foramen of Magendie (median aperature) are small
foramina in the 4th ventricle that allow the CSF to leave the ventricular
system and enter the subarachnoid space. The interventricular foramina
are passages from the lateral ventricles that allow the CSF to enter the
3rd ventricle.
3.
The correct answer is:
middle cerebral artery
The middle cerebral artery supplies blood to most of the lateral surface
of cerebral hemispheres, and the temporal pole, including the frontal,
parietal, and medial portions of the temporal lobes. So, the specific
damage to the temporal lobe suggests that the middle cerebral artery
was disrupted. The other arteries listed do not distribute to the same
territory. The anterior cerebral artery supplies the medial and superior
surfaces of the brain, including the frontal pole. The posterior cerebral
artery supplies the inferior surface of the brain and the occipital pole.
Strokes occur in arteries, not veins, so that's one reason why the great
cerebral vein is not correct. Veins also drain regions of blood--they don't
supply blood to areas. The middle meningeal artery supplies blood to the
dura mater and the cranial vault bones--it does not supply blood to the
brain.
4. The correct answer is:
facial
The facial nerve enters the temporal bone with the vestibulocochlear
nerve--both cross into the internal acoustic meatus. Abducens (CN VI)
crosses through the superior orbital fissure, along with the oculomotor
nerve (CN III), the trochlear nerve (CN IV) and the ophthalmic division of
the trigeminal nerve (CN V1). The glossopharyngeal (CN IX), vagus (CN
X), and spinal accessory nerve (CN XI) all leave through the jugular
foramen. Finally, the three divisions of the trigeminal nerve all leave
through different foramina: V1, the ophthalmic division, exits through the
superior orbital fissure; V2, the maxillary division, leaves through
foramen rotundum; V3, the mandibular division, leaves through foramen
ovale.
5. The correct answer is:
cribriform plate of the ethmoid.
The olfactory nerve exits the skull through the cribriform plate of the
ethmoid bone--an infection in the nasal cavity may be carried to the
olfactory bulb by the nerves that are passing through the cribriform plate.
The crista galli is a ridge on the ethmoid bone between the two sides of
the cribriform plate; it provides an anchor for the falx cerebri. Foramen
cecum is a small hole in the frontal bone near the anterior end of the
crista galli--it transmits an emissary vein. Finally, the superior orbital
fissure is a hole in the sphenoid bone that transmits many cranial
nerves: the oculomotor nerve (CN III), the trochlear nerve (CN IV), the
ophthalmic division of the trigeminal nerve (CN V1) and the abducens
nerve (CN VI) all pass through the superior orbital fissure.
6.
The correct answer is:
loose connective tissue
The scalp is comprised of the following layers, from superficial to deep:
Skin, Connective tissue, Aponeurosis, Loose connective tissue, and
Pericranium. If you take the first letter of each, it spells SCALP. So, now
that you know the order of the layers, you need to figure out which one is
the danger zone--the place where infections can spread very quickly.
And that layer is layer 4, the loose connective tissue. Pus or blood can
spread easily in this layer, and infections in this layer can pass into the
cranial cavity through emissary veins. So, infections in the loose
connective tissue can pass into intracranial structures such as the brain
and meninges. Although layer 2 is a connective tissue layer, too, this
layer is a bit thicker and is not a place where infections can easily
spread.
7. The correct answer is:
subarachnoid space
Remember back to the spinal cord - when taking cerebrospinal fluid for a
spinal tap, you are removing fluid from the subarachnoid space. The
subarachnoid space of the spinal cord is continuous with the
subarachnoid space around the brain, so you know that the patient must
have had a subarachnoid hemorrhage. Subarachnoid hemorrhages are
acute events, often caused by an aneurysm or a closed head injury.
In the spinal cord, the epidural space is filled with fat, and the subdural
space is really a potential space only - there is no fluid in this area. The
cavernous sinus is a venous sinus of the brain, on the lateral surface of
the body of the sphenoid bone.
8. The correct answer is:
loose areolar tissue
Loose areolar tissue is another name for the loose connective tissue
layer of the scalp. Pus or blood can spread easily in this layer, and
infections in this layer can pass into the cranial cavity through emissary
veins. So, infections in the loose connective tissue can pass into
intracranial structures such as the brain and meninges. This can also be
called the "danger layer" of the scalp.
Remember--the scalp is comprised of the following layers, from
superficial to deep: Skin, Connective tissue, Aponeurosis, Loose
connective tissue, and Pericranium. (SCALP!) Although layer 2 is a
connective tissue layer, too, this layer is a bit thicker and is not a place
where infections can easily spread.
9.
The correct answer is:
hypoglossal
The middle cranial fossa is the part of the skull that supports the
temporal lobes of the brain. It is made of the greater wings of the
sphenoid and squamous part of the temporal bones laterally and the
petrous part of the temporal bones posteriorly. See Netter Plate 6 and 7
for a better picture of this.
Several cranial nerves enter foramina in the middle cranial fossa; all of
these nerves might have been damaged in the fall. The trigeminal nerve
(CN V) has three divisions that all leave through spaces in the middle
cranial fossa. V1, the ophthalmic division, exits through the superior
orbital fissure; V2, the maxillary division, leaves through foramen
rotundum; V3, the mandibular division, leaves through foramen ovale.
The oculomotor nerve (CN III) crosses through the superior orbital
fissure, along with abducens (CN VI), the trochlear nerve (CN IV) and
the ophthalmic division of the trigeminal nerve (CN V1). So, all of these
nerves might have been damaged in the fall.
The hypoglossal nerve, however, leaves the base of the skull by passing
through the hypoglossal canal, which is in the occipital bone and the
posterior cranial fossa. It is not likely that this nerve was injured in the
fall.
10. The correct answer is:
middle meningeal artery
The middle meningeal artery supplies most of the dura mater and the
bones of the cranial vault. It is this artery or vein that is usually ruptured
in an epidural hemorrhage. The vertebral artery carries blood to the
deep neck, cervical spinal cord, and hindbrain. It does not supply blood
to the dura. Superior cerebral veins drain blood into the superior sagittal
sinus. When injured, they bleed into the subdural space and cause a
subdural hematoma. The anterior cerebral artery supplies blood to the
frontal pole of the brain. It is not found near the epidural space. Finally,
the circle of Willis is an important anastomosis at the base of the brain
between the following arteries: posterior cerebral arteries, posterior
communicating arteries, internal carotid arteries, anterior cerebral
arteries, and anterior communicating arteries.
11. The correct answer is:
Vertebral
The paired vertebral arteries travel through the transverse foramina of
the C1-C6 vertebrae. So, since the C6 vertebra was damaged, the
vertebral artery could also be ruptured. The other arteries are not closely
related with the vertebrae. The common carotid arteries come off the
brachiocephalic trunk on the right side and the aortic arch on the left
side, giving off many arteries that supply the head and neck. The
costocervical trunk is a branch of the subclavian artery that supplies the
deep neck and the first 2 intercostal spaces. The inferior thyroid artery is
a branch of the thyrocervical trunk that supplies the thyroid. Finally, the
internal carotid artery is a branch of the common carotid that joins the
circle of Willis and supplies the brain.
12. The correct answer is:
Oculomotor (CN III)
Given the patient's symptoms, it seems that some nerve involving vision
and the ability to control the eye has been injured. Now, you need to
think about which nerve might be damaged by an aneurysm of the
superior cerebellar artery. The oculomotor nerve, which innervates the
superior rectus, medial rectus, inferior rectus, and inferior oblique
muscles, passes between the posterior cerebral artery and the superior
cerebellar artery. It could be injured if there was enlargement of or
damage to either of these vessels. None of the other cranial nerves are
in the right position to be injured from an aneurysm of the superior
cerebellar artery.
13. The correct answer is:
Areolar tissue
Areolar tissue is another name for the loose connective tissue layer of
the scalp. Pus or blood can spread easily in this layer, and infections in
this layer can pass into the cranial cavity through emissary veins. So,
infections in the loose connective tissue can pass into intracranial
structures such as the superior sagittal sinus, causing conditions like the
superior sinus thrombosis.
Remember--the scalp is comprised of the following layers, from
superficial to deep: Skin, Connective tissue, Aponeurosis, Loose
connective tissue, and Pericranium. (SCALP!) Although layer 2 is a
connective tissue layer, too, this layer is thicker and it's not where
infections can easily spread.
14. The correct answer is:
Subarachnoid space
Remember back to the spinal cord - when taking cerebrospinal fluid for a
spinal tap, you are removing fluid from the subarachnoid space. The
subarachnoid space of the spinal cord is continuous with the
subarachnoid space around the brain, so you know that the patient must
have had a subarachnoid hemorrhage. Subarachnoid hemorrhages are
acute events, often caused by an aneurysm or a closed head injury.
In the spinal cord, the epidural space is filled with fat, and the subdural
space is really a potential space only - there is no fluid in this area. The
cavernous sinus is a venous sinus of the brain, lateral to the body of the
sphenoid bone. The vertebral venous plexus are the veins that drain the
spinal cord - they are valveless veins, so they are an important route that
cancer cells can use to metastasize.
15. The correct answer is:
Facial (CN VII)
The cavernous sinus is a venous sinus of the brain, lateral to the body of
the sphenoid bone. All of the cranial nerves and vessels that pass out of
the skull at the superior orbital fissure pass through the cavernous sinus.
This includes the oculomotor nerve, the trochlear nerve, the ophthalmic
division of the trigeminal nerve, and the abducens nerve. The internal
carotid artery also passes through the cavernous sinus. Since three of
the nerves in the cavernous sinus control the motions of the extraocular
muscles, testing eye movements would be a good way to see if nerves
in the cavernous sinus were disrupted. The ophthamic division of the
trigeminal nerve, which supplies cutaneous sensation to the skin of the
upper face, could be tested by evaluating the sensations on the
forehead.
The facial nerve is not associated with the cavernous sinus. It passes
through the internal acoustic meatus and exits the skull through the
stylomastoid foramen. So, you would not need to test to see if the facial
nerve was intact.
16. The correct answer is:
Jugular foramen
The glossopharyngeal nerve (CN IX), vagus (CN X) and accessory
nerve (CN XI) exit the skull at the jugular foramen. The posterior
meningeal artery enters the skull through this space. The mandibular
division of the trigeminal nerve (V3) exits the skull through foramen
ovale. The carotid canal is the place where the internal carotid artery
and the internal carotid nerve plexus enter the skull. The hypoglossal
canal is where the hypoglossal nerve (CN XII) leaves the skull. The
stylomastoid foramen is the hole that the facial nerve (CN VII) uses to
exit the skull.
17. The correct answer is:
Cerebral aqueduct
For CSF to travel from the third ventricle to the 4th ventricle and the
central canal of the spinal cord, it must pass through the cerebral
aqueduct. So, this is the passageway that must be blocked. The central
canal is the space where CSF flows through the spinal cord. It is
continuous with the 4th ventricle. The foramen of Luschka and foramen
of Magendie are small foramina in the 4th ventricle that allow the CSF to
leave the ventricular system and enter the subarachnoid space. The
interventricular foramina are passages in the lateral ventricles that allow
the CSF to leave the lateral ventricles and enter the 3rd ventricles. See
Netter Plate 102 for a diagram of the ventricles of the brain.
18. The correct answer is:
Abducens (CN VI)
The cavernous sinus is a venous sinus of the brain, lateral to the body of
the sphenoid bone. All of the cranial nerves and vessels that pass out of
the skull at the superior orbital fissure pass through the cavernous sinus.
This includes the abducens nerve, the oculomotor nerve, the trochlear
nerve, and the ophthalmic division of the trigeminal nerve. Any of these
nerves might be affected by a cavernous venous sinus thrombosis.
The facial nerve is not associated with the cavernous sinus. It passes
through the internal acoustic meatus and exits the skull through the
stylomastoid foramen. The mandibular division of the trigeminal nerve
(V3) exits the skull through foramen ovale. The olfactory nerves enter the
skull through the cribriform plate of the ethmoid bone. The optic nerve
exits the skull through the optic canal. None of these nerves are
associated with the cavernous sinus.
19. The correct answer is:
Fourth ventricle
If the cerebral aqueduct was blocked, CSF would not flow from the third
ventricle into the fourth ventricle and the central canal. So, all the spaces
proximal to the blockage would enlarge, while all the spaces distal to the
blockage would be normal. The third ventricle, lateral ventricle, and
interventricular foramen are proximal to the blockage of CSF; fluid
circulates from the lateral ventricles, through the interventricular
foramen, to the third ventricle before reaching the cerebral aqueduct.
This means that all of these spaces should be enlarged with fluid. The
fourth ventricle, however, needs the cerebral aqueduct to be open so
that it can receive fluid--it would not become distended from the
blockage in the aqueduct.
20.
The correct answer is:
facial
The middle cranial fossa is the part of the skull that supports the
temporal lobes of the brain. It is made of the greater wings of the
sphenoid and squamous parts of the temporal bones laterally and the
petrous parts of the temporal bones posteriorly. See Netter Plate 6 and 7
for a better picture of this.
Several cranial nerves enter foramina in the middle cranial fossa. The
abducens (CN VI) crosses through the superior orbital fissure, along with
the oculomotor nerve (CN III), trochlear nerve (CN IV) and ophthalmic
division of the trigeminal nerve (CN V1). The trigeminal nerve (CN V) has
three divisions that all leave through spaces in the middle cranial fossa.
V1, the ophthalmic division, exits through the superior orbital fissure; V2,
the maxillary division, leaves through foramen rotundum; V3, the
mandibular division, leaves through foramen ovale.
The facial nerve, however, leaves the base of the skull by passing
through the internal acoustic meatus, which is in the part of the temporal
bone that is in the posterior cranial fossa.
21. The correct answer is:
Straight sinus
The straight sinus drains the deep cerebrum--it lies within the junction of
the falx cerebri and tentorium cerebelli. This is exactly the location that
was damaged in birth, so this is the correct answer. The occipital sinus
drains the cerebellum--it lies within the dura mater at base of falx
cerebelli. It is inferior to the straight sinus. The sigmoid sinus drains the
blood from the brain into the internal jugular vein--it lies within sigmoid
groove, covered by dura mater. The superior sagittal sinus drains the
cerebral hemispheres--it lies superiorly within falx cerebri, near the
superior border of the skull. The transverse sinus lies within the
attachment of tentorium cerebelli to the inner surface of the calvaria.
When trying to understand these sinuses, a picture is really worth a
thousand words, so take a look at Netter 97 and 98!
22.
The correct answer is:
falx cerebri
The falx cerebri is a crescent-shaped, sagittally-oriented fold of dura
mater lying between cerebral hemispheres. The inferior sagittal sinus
runs in the inferior margin of the falx cerebri. The falx cerebelli is a small
fold of dura mater lying between cerebellar hemispheres--it is the
location of the occipital sinus. The diaphragma sellae is a piece of dura
mater which forms the roof of the hypophyseal fossa; it is pierced by the
stalk of the hypophysis. The tentorium cerebelli is a tent-like sheet of
dura mater covering of cerebellum, oriented somewhat transversely. The
straight sinus is found in the junction of the falx cerebri and tentorium
cerebelli. The filum terminale is an extension of the pia mater below the
end of the spinal cord at L2. It is a structure of the spinal cord, not the
brain.