Review of DSA Material

Question 1

How do you differentiate between the different parts of the Subclavian Artery?

Answer 1

Question 2

Which two arteries will supply blood to the brain?

Answer 2

1. Vertebral (Posterior Brain - 20%): Terminates as the Basilar Arteries
2. Internal Carotid (Anterior Brain - 80%): Terminates as Anterior Cerebral and Middle Cerebral Arteries

Question 3

Describe the process of “auto-regulation” that is performed by the Circle of Willis.

Answer 3

Shunting of blood from one region of circulation to another may result in hyperperfusion and cerebral edema

Question 4

Describe the phenomena of Subclavian Steal Syndrome.

Answer 4

Causes: OBSTRUCTION of the subclavian artery PROXIMAL to the vertebral artery

• EPISODIC increase in peripheral circulatory demand in the associated with the extremity
• You will have shunting of blood from the VERTEBRO-BASILAR circulation into the DISTAL SUBCLAVIAN artery which will result in VERTEBRAL-BASILAR INSUFFICIENCY (VBI)

Signs and Symptoms: Dizziness, Cranial Nerve Dysfuction, Paralysis (All four limbs), Loss of Consciousness

Question 5

What is the bony landmark for the bifurcation of the Common Carotid Artery?

Answer 5

Hyoid Bone

Question 6

What are the terminal branches of the External Carotid Artery?

Answer 6

1. Maxillary Artery
2. Superficial Temporal Artery

Question 7

Answer 7

Question 8

What is the terminal branch of the Maxillary Artery?

Answer 8

Sphenopalatine Artery

Question 9

The Retromandibular vein is important because it has a relationship with which structure?

Answer 9

Facial Nerve

Question 10

Why would you remove all of the veins in a radical neck surgery?

Answer 10

Lymph Nodes are Adherent to the VEINS!!!

Question 11

All of the Lymph Nodes in the Neck are going to drain into which Main Node?

Answer 11

Deep Cervical Lymph Node

Question 12

What is the first branch of the external carotid artery?

Answer 12

Superior Thyroid Artery

Question 13

Which gland does the facial artery go through?

Answer 13

Submandibular Gland

Question 14

The vertebral artery is going to pass through which structure and which cervical vertebrae?

Answer 14

Transverse Foramina

C6-C1 (***NO C7)

Question 15

Which structure is embedded in the prevertebral fascia just posterior to teh common carotid artery?

Answer 15

Sympathetic Chain

Question 16

The distal branches of the inferior thyroid artery have a direct relationship with which structure?

Answer 16

Recurrent Laryngeal Nerve

Question 17

1. The transverse venous sinus drains into the ________.
2. The veins in the orbit drain into the ___________.
3. The retromandibular vein has a direct relationship with the __________ nerve.
4. The thoracic duct drains into the ____________.
5. The posterior group of superficial cervical lumph nodes are distributed adjacent to the ___________.

Answer 17

1. Sigmoid Sinus
2. Cavernous Sinus
3. Facial
4. IVJ/Subclavian/Brachiocephalic Junction
5. External Jugular Vein

Question 18

What are the nerve contributions of the Superior and Inferior Roots of the Ansa Cervicalis? What does it innervate?

Answer 18

Superior Root: C1-C2

Inferior Root: C2-C3

*** Innervates Strap Muscles

Question 19

Describe the relationships between the Clavicle, Anterior Scalene M., Subclavian Vein, Phrenic Nerve, Brachial Plexus and the Subclavian Artery. In which triangle is the Subclavian Artery and the Brachial Plexus located?

Answer 19

In front of Anterior Scalene –> Clavicle, Subclavian V., Phrenic Nerve

Behind Anterior Scalene –> Brachial Plexus, Subclavian Artery

*** Interscalene Triangle

Question 20

Differentiate between the different functional components (GSA, GVA, GSE, GVE, and SVE).

Answer 20

Divided up by their EMBRYONIC origin!

ONLY 2 GSE muslces in the Head: 1. Extra-occular muscles and 2. Tongue

All the other muscles in the HEAD are SVE!

Question 21

List the 3 General Visceral Efferent (GVE) Nuclei in the head and where they are headed.

Answer 21

1. Superior Salivatory –> Submandibular Ganglion –> Submandibular Gland
2. Inferior Salivatory –> Otic Ganlgion –> Parotid Gland
3. Dorsal Motor Nucleus of X –> Scattered Ganglia –> Thorax and Abdomen

Question 22

Describe what will happen if you have a lesion at Cranial Nerves IX-XII.

Answer 22

IX: Loss of gag reflex, slight dysphagia, loss of sensation in pharynx and posterior 1/3 of tongue

X: Dysphonia, Dysphagia, Dyspnea, Loss of gag or laryngeal cough reflex

XI: Unilateral lesions of the spinal accessory nerve result in an isplateral inability to shrug the shoulder, and flex and rotate the head

XII: Lesions result in deviation of the protruded tongue towards the affected SIDE!

Question 23

Describe the “Collet-Sicard’s” Syndrome.

Answer 23

Penetrating injury to the RETROPAROTID region

• Secondary to missile or penetrating injuries
• Lesions of IX-XII and CERVICAL sympathetic trunk

Question 24

Describe Vernet’s Syndrome.

Answer 24

Basilar skull fracture involving the JUGULAR FORAMEN

• IPSILATERAL paralysis of IX, X, and XI

Question 25

Answer 25

1. Collet-Sicard Syndrome 2. Internal Jugular Vein 3. Nucleus Ambiguus 4. Intermediolateral Cell Column 5. Superior Salvitory Nucleus

Question 26

Answer 26

5. Vagus 6. Left Hypoglossal Nerve 7. IX; X 8. X (Internal Branch of Superior Laryngeal Nerve); X (Recurrent Laryngeal Nerve)

Question 27

Which Cranial Nerves Pass through the Jugular Foramen?

Answer 27

CN IX, X, and II