Head and Neck

Question 1

Which are the contents of the scalene traingle?

Answer 1

subclavian artery and trunks of brachial plexus (lower trunk C8, T1)

Question 2

What is and what can cause a thoracic outlet syndrome?

Answer 2

• compression of the content of scalene triangle: lower trunk of brachial plexus usually first affected (C8,T1) and subclavian artery
• tumors of the neck (Pancoast on apex tumor), cervical rib or hypertrophy of scalene muscles

Question 3

Symptoms of thoracic outlet syndrome

Answer 3

• numbness and pain of medial forearm and arm
• “claw hand”
• wekened radial pulse
• Horner’s syndrome (if affects cervical sympathetic trunk)
• hoarseness (if affect recurrent laryngeal nerve)

Question 4

Where is the meningeal artery come from?, and what can occur if it lacerates?

Answer 4

• maxillary artery (branch of external carotid) in the infratemporal fossa
• epidural hematoma

Question 5

Immunologic problems, hypocalcemia, cardiovascular defects, (persistent ductus arteriosis), abnormal ears, and micrognatia

Answer 5

DiGeorge sequence

Question 6

Pharyngeal groove give rises to what structure?, what happen with 2 to 4 grooves?

Answer 6

• groove 1: epithelial linning of external lining of external auditory meatus
• they obliterate, when fail to complete it: lateral cervical cyst

Question 7

The pharyngeal pouches are lined with endoderm, what structure rises in 4 pharyngeal pouch come from neural crest cells?

Answer 7

C-cells of thyroid

Question 8

Which muscle of the tongue is not innervate by XII CN?

Answer 8

palatoglossus muscle

Question 9

What structures fail to fuse in cleft lip?

Answer 9

maxillary prominence fails to fuse with medial nasal prominence

Question 10

What structures fail to fuse in cleft palate?

Answer 10

palatine shelves (from maxillary prominence) fail to fuse with each other or the primary palate (intermaxillary segment)

Question 11

What does the DiGeorge sequence cause?

Answer 11

pharyngeal pouches 3 and 4 fail to differentiate into parathyroid glands and thymus. Neural crest involve

Question 12

What cause the first arch syndrome that consist in a abnormal formation of pharyngeal arch 1? Examples.

Answer 12

faulty migration of neural crest cells - facial anomalies

- pierre robin sequence, treacher collins syndrome

Question 13

Where does the internal carotid artery pass?

Answer 13

foramen lacerum

Question 14

Where does the spinal cord of the XI CN come to the craneal cavity?

Answer 14

foramen magnum

*motor fibers by jugular foramen with IX, X

Question 15

What can cause jugular foramen syndrome? symptoms.

Answer 15

• tumor pressing on CN IX, X, XI
• hoarseness, dysphagia (IX, X), loss of sensation oropharynx and posterior third of tongue (IX), weakness trapezius and sternocleidomastoid (XI). XII may be involved (deviation of tongue to lesioned side)

Question 16

What major sinuses drain at confluens of sinuses?

Answer 16

superior sagital, straight and occipital sinuses.

Question 17

What can cause an alteration of the nerves in cavernous sinus?

Answer 17

• cavernous sinus thrombosis
• expansion of pituitary gland
• internal carotid aneurism

Question 18

Initial clinical sign of cavernous sinus thrombosis

Answer 18

• internal strabismus (VI lesion - first affected)

* then all eye movements affected, altered sensation of upper face and scalp

Question 19

Most common sites of rupture of cerebral aneurysm

Answer 19

• most common: anterior part of circle of willis - branch point of the anterior cerebral and anterior communicating arteries
• other common: proximal part of middle cerebral artery, at junction of internal carotid and posterior communicating arteries