1 Done by : Ayman Khushaim Haifa al sarhani KFSHNeuro part 1 questions Done by : Ayman Khushaim Haifa al sarhani KFSH

2 BRAIN

3 The supramarginal gyrus and angular gyrus are part of which lobe: a)frontal. b)parietal. c)temporal. d)occipital. e)limbic system. b)parietal.

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6 The arrangement of the cranial nerves in the cavernous sinus from top to bottom is A) 3rd B) 4th C) 6th D) 5th E) division 1 F) 5th division 2

7 All of the following pass through the lateral wall of cavernous sinus except: a) Troclear nerve b) Occulomotor nerve c) Trigeminal nerve I d) Trigeminal nerve II e) Abducent nerve e) Abducent nerve SR 3rd edition, P 88

8 All of the following pass through the lateral wall of the cavernous sinus except:; A) 3rd CN B) 4th CN C) 5th CN 1 D) 5th CN 2 E) 6th CN 6th CN

9 The cavernous sinus is on either side of the pituitary gland and the body of the sphenoid bone connected across the midline by intercavernous sinuses. It lies between layers of Dura mater. The internal carotid artery passes through this sinus with the sixth cranial nerve lateral and inferior to it. The third and fourth cranial nerves and the ophthalmic and maxillary divisions of the fifth pass along the lateral wall of the cavernous sinus.

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12 Pituitary stalk diameter should not exceed: a.1mm b.4mm c.10mmThe answer most probably is 4mm.

13 Conclusions In conclusion, we have evaluated the normal pituitary stalk in detail by using 3T MR imaging, thereby providing a standard for the size of the normal pituitary stalk. The pituitary stalk frequently shows central hyperintensity with a peripheral rim of isointensity on high-resolution T2-weighted images, which may represent the infundibular stem and pars tuberalis, respectively.

14 RESULTS: The AP and transverse diameters of the pituitary stalk were 2RESULTS: The AP and transverse diameters of the pituitary stalk were 2.32 ± 0.39 mm and 2.16 ± 0.37 mm at the pituitary insertion, respectively, and 3.25 ± 0.43 mm and 3.35 ± 0.44 mm at the level of the optic chiasm. No significant differences were observed between the AP and transverse diameters at each level. The length of the stalk was 5.91 ± 1.24 mm, and the depth of the infundibular recess was 4.69 ± 0.87 mm. The stalk showed central hyperintensity with a peripheral rim of isointensity in 20 subjects (69%) and homogeneous isointensity in 9 subjects (31%).

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16 ENT surgeon for parotid how to track the facial nerve: aENT surgeon for parotid how to track the facial nerve: a.    retromandibular vein

17 Intra operatively the facial nerve is recognized at 3 constant land marks:At the tip of tragal cartilage where the nerve is 1cm deep and inferior At the posterior belly of digastric by tracing this backwards to the tympanic plate the nerve can be found between these two structures By locating the posterior facial vein at the inferior aspect of the gland where the marginal branch would be seen crossing it

18 One of the following is true regarding facial nerve: a) The horizontal part is seen in middle ear. b) It supplies the posterior belly of digastric muscle. The horizontal part is seen in middle ear SR, 3rd edition P 29

19 nerve passing in stylomastoid foramin : A) Facial n VII B) Trigeminal V C) VIII

20 The facial nerve, having emerged from the stylomastoid foramen.

21 Facial nerve

22 Facial nerve segments

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26 Intracranial segment (facial canal)

27 Facial nerve

28 Terminal motor branches within the parotid gland

29 For more info about the facial nerve go to http://teachmeanatomy

30 The structure medial to the facial n in the parotid gland is: A) facial vein B) facial artery C) retro-mandibular vein C) retro-mandibular vein

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33 which one does not pass through the superior orbital fissure: A) V2 of trigeminal nerve B) V1 of trigeminal nerve C) Ophthalmic vein D) Occulomotor nerve a) V2 of trigeminal nerve. SOF transmits: - 1st division of 5th cranial nerve. - 3rd, 4th & 6th cranial nerves. - sup. Ophthalmic vein. - branch of middle meningeal art I think the question is except: branch of middle meningeal art Stephanie Ryan, 2nd edition, page 10.

34 One of the following passes through the optic canal: A) SupOne of the following passes through the optic canal: A) Sup. Ophthalmic V. B) 4th CN C) 5th CN D) Frontopolar A. E) Ophthalmic A. Ophthalmic artery Optic nerve and the ophthalmic artery pass through the optic canal

35 Optic canal open into: a) greater wing of sphenoidOptic canal open into: a) greater wing of sphenoid. b) lesser wing of sphenoid. b) lesser wing of sphenoid. Stephanie Ryan, 2nd edi, page 10.

36 One of the following passes through the optic canal: a) Sup ophthalmic vein b) Trochlear nerve c) 1st branch of trigeminal nerve d) Frontopolar art e) Ophthalmic art Ophthalmic art

37 Which structure passes through foramen spinosum: a) Middle meningeal artery b) Accessory meningeal artery c) Internal maxillary artery d) 2nd branch of trigeminal nerve e) 3rd branch of trigeminal nerve. Middle meningeal artery SR 3rd edition, P 8

38 Which of the following passes through foramin rotundam : A) Mandibular branch of Trigeminal B) Maxillary branch of the Trigeminal B) Maxillary branch of the Trigeminal

39 Which of the following structures passes through foramen ovale : A) Maxillary branch of the Trigeminal The question is incomplete the answer is mandibular branch of trigeminal nerve

40 The foramen ovale is posterolateral to the foramen rotundum in the greater wing of sphenoid. It runs from the middle cranial fossa to the infratemporal fossa and transmits the third (mandibular)(V3) division of the fifth cranial nerve and the accessory meningeal artery.

41 the middle meningeal art. pass through foramen : a.       Spinosum

42 Which doesn’t pass jugular foramen a) 9th and 10th cranial nerve b) Transverse sinus

43 The jugular foramen is an irregular opening situated at the posterior end of the junction of the occipital and petrous bones. It runs downward and medially from the posterior cranial fossa. Transmits the internal jugular vein lateral to the ninth, tenth and eleventh cranial nerves. It also transmits the inferior petrosal sinus (which drains into the internal jugular vein), and ascending occipital and pharyngeal arterial branches.

44 Jugular foramen in relation to the hypoglossal foramen: a)medial & superior. b)lateral & superior. c)medial & inferior. d)lateral & inferior. e)at the same level & medial. b)lateral & superior.

45 the foramen rotundum is posterior to the superior orbital fissure in the greater wing of sphenoid. it runs from the middle cranial fossa to the pterygopalatine fossa and transmits the second (maxillary) division of the fifth cranial nerve (v2).

46 which structure is passing through optic canal: A. Infraorbital nerve B. CN III C. Ophthalmic artery D. Superior ophthalmic vein E. Infraorbital vein C. Ophthalmic artery

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55 Ptyregopalatine fossa opens into the nasal cavity through: a)Sphenopalatine fissure. b)sphenomaxillary fissure. c)Great palatine canal. d)foramen roundum. a)Sphenopalatine fissure. SR. P32

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57 The limbic system. one of the following is true: A) ExtThe limbic system. one of the following is true: A) Ext. capsule B) Globus pallidus C) Mammillary bodies D) Dentate gyrus The mammillary bodies, dentate gyrus & globus pallidus r true A lot of different references but most have all the 3 mentioned So maybe the question is except

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59 BPD is measured at what level: a. Latral ventricle bBPD is measured at what level: a.Latral ventricle b. Septum pellucidum c.Choroid plexus d. 4th ventricle B

60 CP angle is an inverted triangle, formed by: a. Cerebellum and pons bCP angle is an inverted triangle, formed by: a. Cerebellum and pons b. Cerebellum and tentorium c. Tentorium and petrous apex D. Tentorium and …… a. Cerebellum and pons

61 The cerebellopontine angle is a structure at the margin of the cerebellum and pons.contents : 1- facial N. (CN VII) 2- vestibulocochlear (CN VIII) 3- flocculus of the cerebellum 4- lateral recess of the 4th ventricle It is where vestibular schwannomas are usually found.

62 Choroidal fissure pial is a thin line connecting subarachnoid space with: a. Temporal horn of lateral ventricle b. 3rd ventricle c. 4th ventricle a. Temporal horn of lateral ventricle is the most probable answer

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64 Angio

65 regarding middle meningial artery: A) Branch from maxillary artery B) anastomose with the ophthalmic artery A) Branch from maxillary artery B) anastomose with the ophthalmic artery Both answers r true so lets assume that the question is except

66 It is a branch from maxillary artery, enters the skull through foramen spinosum, and supplies the dura matter the bone of the cranium. It may anstomse with ophthalmic art. To form connection between internal & external carotid systems.

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68 The maxillary artery has several important branches. Thoseof the first part are: • The middle meningeal artery

69 Branches from first part include:Deep auricular artery Anterior tympanic artery Middle meningeal artery Inferior alveolar artery which gives off its mylohyoid branch just prior to entering the mandibular foramen Accessory meningeal artery

70 The branches of the second part are the branches totemporalis, pterygoid and masseter muscles. The branches of the third part are: • The superior dental artery The infraorbital artery The greater palatine artery The sphenopalatine artery is the terminal part of the maxillary artery.

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72 All are direct branches from ICA except : A) Anterior communicating arteryA direct branch of the internal carotid art: a) Meningo-hypophyseal art b) Ant communicating art c) Frontopolar art d) Internal maxillary art e) Superficial temporal art a) Meningo-hypophyseal art

73 direct branches of internal carotid artery , all except: A) Basilar artery B) Anterior choroidal artery C) Posterior communicating artery D) Meningiohypopheseal A) Basilar artery

74 Which of the following is a direct branch of the internal carotid artWhich of the following is a direct branch of the internal carotid art.: a) menegiohypopheseal art.

75 Branches of the internal carotid arteryThe cervical portion has no branches. Two small branches each arise from the petrous and cavernous parts of the internal carotid artery but are seldom visible on angiography. These are: • The caroticotympanic artery to the ear drum;( • The pterygoid artery to the pterygoid canal and plate; • The cavernous artery to the walls of the cavernous sinus; and • The meningohypophyseal artery which supplies the dura of the anterior cranial fossa and sends branches to the pituitary.

76 There are seven segments in the Bouthillier classification:cervical segment petrous (horizontal) segment lacerum segment cavernous segment clinoid segment ophthalmic (supraclinoid) segment communicating (terminal) segment

77 C2: petrous (horizontal) segmentcaroticotympanic artery vidian artery C4: cavernous segment meningohypophyseal trunk inferolateral trunk C6: ophthalmic (supraclinoid) segment ophthalmic artery superior hypophyseal artery

78 C7: communicating segmentposterior communicating artery anterior choroidal artery anterior cerebral artery middle cerebral artery

79 Except for the terminal segment (C7) the odd numbered segments usually have no branches, whereas the even numbered segments (C2, C4, C6) each have two branches.

80  Please Let Children Consume Our Candy

81 Ophthalmic artery: Posterior communicating artery Anterior choroidal artery Striate arteries The terminal division of the internal carotid artery is into the anterior cerebral and middle cerebral arteries.

82 anterior cerebral artery branches:• Recurrent artery (of Heubner) • Anterior communicating artery • Orbitofrontal artery • Frontopolar artery • Callosomarginal artery • Pericallosal artery • Central branches

83 Middle cerebral artery branches:1.Medial and lateral striate (or lenticulostriate) arteries. 2. Cortical branches : — Frontal branches — Parietal branches — Angular branches; and — Superior temporal branches.

84 Ophthalmic artery: This is the first large (visible on angiography) branch of the internal carotid artery and is its first branch after emerging from the cavernous sinus.

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86 All are deep brain veins except a) Vein of Troland b) Vein of Rosenthal c) Internal cerebral vein d) Great vein of Galen 000 The superior anastomostic vein (of Trolard), which runs from the posterior end of the lateral sulcus posterosuperiorly to the superior sagittal sinus in the parietal region. The inferior anastomostic vein (of Labbe), which runs posteroinferiorly from the posterior end of the lateral sulcus to the transverse sinus;

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89 Deep veins

90 The veins draining the central nervous system do notfollow the same courses as the arteries that supply it. Generally, venous blood drains to the nearest venous sinus, except in the case of that draining from the deepest structures, which drain to deep veins. These, in turn, drain to the venous sinuses. The intracerebral veins do not have valves.

91 Superficial veins

92 The retromandibular vein descends through the parotidgland deep to the facial nerve and superficial to the external carotid artery. Below this, it divides in two. The anterior branch joins with the facial vein to join the internal jugular vein. The posterior branch joins with the posterior auricular vein (which drains the posterior scalp) to form the external jugular vein.

93 External carotid artery branchesSome American Ladies Found Our Pyramids Most Satisfactory S - superior thyroid artery A - ascending pharyngeal artery L - lingual artery F - facial artery O - occipital artery P - posterior auricular artery M - maxillary artery S - superficial temporal artery

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95 Branch of the vertebral artery one is true : A) PICA B) AICA C) Posterior choroidal artery D) Frontopolar artery E) Thalamostrait artery A) PICA

96 vertebral artery branches:Spinal branches • Muscular branches. • Meningeal branch. • Posterior spinal artery (more frequently arises from PICA) descends as two branches anterior and posterior to the dorsal roots; • Anterior spinal artery • Small branches to the medulla oblongata; • Posterior inferior cerebellar artery (PICA) - the largest branch of the vertebral artery. PICA terminates as: — The medial branch (inferior vermian artery) to the inferior vermis and adjacent inferior surface of the cerebellar hemispheres; and — The lateral branch to the lateral aspect of the inferior surface of the cerebellum

97 Posterior limb of internal capsule blood supply: a)middle cerebral artery b)anterior communicating artery c)posterior choroidal d)anterior cerebral artery e)anterior choroidal artery e)anterior choroidal artery SR. p55

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100 Arachnoid vili location: A) Straight sinus B) Superior sagittal sinus C) Transverse sinus D) Internal jugular They r present in most of the dural sinuses , however the largest is in the SSS so its the most probable answer

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102 Head and neck

103 The sphenoid air cells drain into the sphenoethmoidal recess.• The posterior group of ethmoidal air cells drain into the superior meatus. • The frontal sinus opens in the most anterior opening of the middle meatus.  The anterior ethmoidal air cells and maxillary sinus drain into the middle meatus at the hiatus semilunaris, below the ethmoid bulla. • The nasolacrimal duct opens into the inferior meatus, draining the lacrimal secretions.

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106 Regarding larynx, one true: A) False cord below true cord (the opposite) B) True cord attach to the cricoid cartilage (false) C) Cricoid cartilage is incomplete cartilage(is the only complete ring) D) False cord appear fatty density is CT I didn’t find an answer

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108 The hypoglossal fossa is separated from submandibular space by : A) Mylohyoid B) Hypoglossus C) Genoglossus D) Daigastric A) Mylohyoid

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110 Which of the following is attached to coronoid process of mandible: a) Lateral pterygoid b) Digastrics c) Temporalis d) Masseter e) Frontalis c) Temporalis

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112 Lateral to the false vocal cord Piriform sinus Saccule Thyroid cartliage .Piriform sinus most probable answer , see the image next slide

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115 Contents of masticator space: A) Branches of V2 B) Ext. Carotid AContents of masticator space: A) Branches of V2 B) Ext. Carotid A. C) Mylohyoid D) Pterygoid muscle D) Pterygoid muscle Neck spaces which is false a) Carotid space extend from base of the skull down to aortic arch

116 Contents muscles of mastication : masseter musclemedial pterygoid muscle lateral pterygoid muscle temporalis muscle ramus and body of mandible inferior alveolar nerve inferior alveolar vein and artery mandibular division of the trigeminal nerve (V3) enters the masticator space via the foramen ovale

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119 parapharyngeal space Contents fat (main component) trigeminal nerve (CN V) internal maxillary artery ascending pharyngeal artery pterygoid venous plexus

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123 The terminal part of the external carotid artery runsthrough the isthmus, dividing into superficial temporal and maxillary branches within the substance of the gland, and the confluence of the veins of the same name form the posterior facial vein just superficial to the artery. The facial nerve, having emerged from the stylomastoid foramen, runs through the deep part of the gland via the isthmus to the superficial part within which it branches into its five terminal divisions. It passes superficial to the internal carotid artery and retromandibular vein in the isthmus

124 The strongest levator muscle for vocal cords:I didn’t find an answer for this question

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126 Structure seen in middle ear cavity in CT a)chorda tympani b)tensor tympani c)vestibule aquesduct d)sacule e)parse of santorini a)chorda tympani b)tensor tympani both answers are true

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128 false vocal cords shape A) Elliptical & large in transverse diameter B) Round C) triangular D) Square E) Pinpoint

129 the muscles that is related to soft palate, all except: A) Levator veli palatine B) Palategloasus C) Palatephryngesus D) Hyoglossous E) Tensor veli palatini D) Hyoglossous

130 The strongest bone in the orbital cavity is: A) Roof B) Nasal C) Lateral D) Basal E) All the sameStephanie Ryan, 2nd edition, page 10.

131 the following bone does not contribute in formation the orbital walls A) Frontal B) Nasal C) Ethmoid D) Zygomatic E) Palatine b) Nasal Stephanie Ryan, 2nd edition, page 10

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133 Lacrimal gland located in which of the following boneLacrimal gland located in which of the following bone? A) Frontal B) Maxillary C) Zygomatic D) Lacrimal E) ethmoidal a) Frontal bone. The lacrimal gland lies on the suprolateral part of the orbit. Stephanie Ryan, 2nd edition, page 24

134 Lacrimal gland innervation: a)vagus nerve b)occulomotor c)trigeminal d)facial e)abducentSnell p712

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137 Spinal cord

138 the spinal cord in pediatric end at the level of : A. L1 B. L2 C. L3 Dthe spinal cord in pediatric end at the level of : A. L1 B. L2 C. L3 D. L4 E. T12 L1 L2

139 The conus lies at the level of the L3 vertebra at birth and at the lower limit of L1 or upper limit of L2 at the age of 20. (SR 94)

140 Regarding the spinal cord: A) Ends at the level of L3 B) LP at the level of L3-4 likely cause injury C) Not covered by pia matter D) Covered by neural sac which ends at S1 - in adults it terminates at the level of the lower border of L1. - in young children ends at the upper border of L3. - covered with all the 3 meninges. Snell clinical anatomy, 7th edition, page 941.

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142 Transverse process being the nose.The pedicles forming the eye. The inferior articular process being the leg. The superior articular facet represent the ear. Pars interarticularis equivalent to neck of the dog.

143 Some clinical questions

144 ANSWER: paraganglioma (radiopaedia).NOTE: DDx: jagular schwannoma, bony mets and jagular bulb thrombosis.

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147 paravertebral paraganglia : related to sympathetic nervous system and often (~ 50%) secretecatecholamines  thus extra-adrenal pheochromocytomas : locations include organ of Zuckerkandl and bladder (rare) paraganglia : related to the great vessels of the head and neck and base of skull scattered in other tissues : bladder, ciliary ganglion, pharynx and larynx

148 ANSWER: medulloblastoma (fundementlas pg. 137)NOTE: it is the second most common after pilocytic astrocytoma, affect children under 10 years of old, peak btw 4-8, more in males 60% and arises from the cerebella vermis in 85% of the cases.

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151 Agenesis of corpus callosum (ACC)Fibers that usually cross through corpus callosum run in longitudinal bundles (bundles of Probst) along the medial walls of the lateral ventricles (lateral displacement) and end randomly in occipital and parietal lobes. The 3rd ventricle is pathologically elevated because of this abnormality. Order of development: genu anterior body posterior body splenium rostrum.

152 Cystic spinal lesion (syringohydromyelia) Criteria: Syringomyelia: cavity in spinal cord; may or may not communicate with central canal; for hydromyelia: dilatation of central canal. Cannot be differentiated with imaging. Causes Primary • Chiari

153 Causes Primary • Chiari malformations • Spinal dysraphism • DW • Diastematomyelia Acquired • Tumor Astrocytoma Ependymoma • Inflammatory Arachnoiditis/meningitis SAH • Trauma Spinal cord injury Vascular insult

154 Meningioma Tumor originates from arachnoid cap cells. Age: 40 to 60 years. Three times more common in females. Represents 20% of all brain tumors. Meningiomas are uncommon in children and if present are commonly associated with NF2. 90% are supratentorial. Classification • Typical “benign” meningioma, 93% • Atypical meningioma, 5% • Anaplastic (malignant) meningioma, 1%-2%

155 Location • Cerebral convexity along falx and lateral to it,45% • Sphenoid ridge, 20% • Juxtasellar, 10% • Olfactory groove, 10% • Posterior fossa clivus, 10%