Friday, 7 January 2011

CORRECTION: anatomy answer scheme past year question (2008/2009)


A 44 year old man fall from tree&develop a severe scalp hematoma.the superficial temporal artery continued to bleed internally because he took an anticoagulant drugs for artificial valve.

1- which arteries must be ligated?-->EXTERNAL CAROTID ARTERY

2- what is the site beginning of the ligated artery?-->AT THE UPPER BORDER OF THE THYROID CARTILAGE (BETWEEN C3 & C4)

3- What is the site of termination of this artery?-->INSIDE THE PAROTID GLAND (BEHIND THE NECK OF THE MANDIBLE)

Thursday, 6 January 2011

internal structure of pons





1)Basillar part(basis pontis),consists of:
                    a)pontine nuclei
                    b)ponto cerebellar fibers
                    c)cortico-pontine fibers
                    d) pyramidal tracts

2)Tegmentum part consists of
             a)Cranial nerve nuclei
                         -Trigeminal nuclei (main sensory and motor nuclei)
                         -Abducent nucleus
                         -Facial nuclei (motor,superior salivary,solitary nuclei)
                         -Vestibular nuclei (superior,medial, and lateral nuclei)
                         -Cochlear nuclei (ventral and dorsal)
             b)Other nuclei
                         -superior olivary nucleus
                         -Tectospinal tract
                         -Lemnisci (medial,trigeminal,spinal,and lateral)
            d)Medial longitudinal bundle/fasciculus


     Arteial .Supply      : pontine br. of the basilar art
     Venous drainage   : to inf. petrosal sinuses & the basillar venous plexus

anatomy check list!!

3RD YEAR IUMP 2010/2011
·         Scalp (BVs,nerves,lymphatic & applied anatomy)
·         Face
·         Post triangle of neck
·         Ant triangle of neck
·         Thyroid gland
·         Cranial nerve (most important the last 4 )
·         Cranial cavity
·         Venous sinus
·         Pituitary gland
·         Cavernous sinus
·         Tentorium cerebelli
·         LN of head & neck

·         Branchial apparatus(ectoderm,endoderm,muscular,mesoderm derivatives)
·         Development & its congenital anomalies
ü  Face
ü  Palate
ü  thyroid gland
ü  pituitary gland.


30 Q for 30 marks
Time provided : only
30 minutes.

Written :
2 problems (cases)
5-6 Q short essays
Time provided : one and half hours.
·         Spinal cord (external n internal structures)
·         Brain stem (pons,midbrain n medulla)
·         Cranial nerve nuclei
·         Cerebral cortex (sulci n gyri & functional area)
·         Insula
·         Internal capsule
·         Basal nuclei (caudate & lentiform nuclei)
·         Cerebellum
·         Diencephalon
·         Ventricles
·         CSF
·         Blood supply of brain

·         Eye :
ü  Orbit
ü  Muscles of eyeball
ü  Nerves supply
ü  Ciliary ganglion
ü  Opthalmic artery & veins
ü  Fascia & ligaments
ü  Eye ball

·         Ear
ü  External,middle & inner ear
ü  Facial nerve (origin,termination,courses & its branches)
ü  Walls of middle ear

anatomy answer scheme

ANATOMY 2010/2009

Hosam ,abcess in the lat wall of left side of his nos..Q.(the only ANSWERS FROM DR AHMED GUNAID)

1-proper diagnosis:-->CAVERNOUS SINUS THROMBOSIS

2-infection spread from lat wall of nose through?OPHTALMIC VEIN

3-loss of sensation from middle part of face due to infection of:MAXILLARY NERVE

4-affected LN:submandibular LN


A 56 year old man…right arm weakness&difficulty of speaking:

1-      1)artery affected-MIDDLE CEREBRAL ARTERY

2-     2) position of cortical area affected:
-motor area4-precentral gyrus of left hemisphere
-broca’s speech area-post  part of inf frontal gyrus in dominant hemisphere.

3- part of internal capsule through which the fibres controlling the movement of are pass:
            anterior half of POSTERIOR LIMB.

4-tract carrying the motor fibres:pyramidal tract

1.Relation of post limb of internal capsule:between thalamus&lentiform nucleus.
-Fibers passing through post limb of internal capsule:
Ascending fibers
Descending fibers
Sup thalamic radiation
-corticospinal fibers
-frontopontine fibers
-frontorubral fibers/corticorubral

2.origin&course of facial artery in face:
Origin: arise from the ant aspect of external carotid A in upper part of neck.

Course:it reach the face by piercing the deep fascia of neck at lower border of mandible.
-then it curve at antero-infero angle of masseter.
-in face,it has tourtous course upward &forward anterior to ant facial vein.
-it end at the angle of eye by becoming the angular artery(lateral nasal artery).

3.The lobes &f(x) of cerebellum:

Ant lobe
Post lobe
Flocculonodular lobe
Regulation of muscle tone
Coordination of movement
Concerned with equilibrium

4.Cranial nerve nuclei in the pons:
1-      trigeminal nuclei:
a)      motor nucleus:its axon form the motor root of trigeminal nerve which join the mandibulat nerve
b)      main sensory nucles:receive afferent touch&pressure sensation from trigeminal area fo face &scalp
send efferent fibres which cross to join the opposite trigeminal lemniscus

2-      abducent nerve nuclei:
site:in the post aspect of the lower part of the pons near the floor of 4th ventricle.
-it is encircle by the fibres of facial nerve,raising a bulge called the facial colliculus

 3- facial nerve nucleus:
a)      motor nucleus:it efferent fibres encircle the abducent nucleus then pass anterolaterally to emerge at junction between medulla &pons.

b)      Sup. Salivary nucleus:
its efferent fibres run in facial nerve as preganglionic parasympathetic fibres to relay in the spenopalatine &submandibular ganglia

3-      vestibulocochlea nucleus:

a)      vestibular nucleus:
b)      cochlea nucleus:dorsal &ventral nuclei lying dorsal&ventral to inf cerebellar peduncle in the lower part of the pons.they receive impulse from internal ear via cochle nerve.

5.Development of thyroid gland: (from slide dr wafaa)
·         the thyroid bud develops as andodermal thickening fromm floor of primitive pharynx between tuberculumm impar&copula of His of developing tougue at the midline

        Blind end of thyroid budàdilatesà descend caudally to the level of ultimobranchial body (4th  pouch) which prevents its further descend in the thorax.

        The hollow distal blind endà solid flask shapedà solid crescenticà solid bilobed.

        Endodermal cells of thyroid budà thyroid follicles ( thyroxine).

        Ultimobranchial bodyà parafollicular cells ( c- cells) à calcitonin.

        Proximal part of the budà narrowà stalk attached to the tongue( thyroglossal ductà degenerate except at foramen caecum in the tongue.

Congenital anomalies of thyroid gland:
      1- Persistant thyroglossal duct:
         a- Accessory thyroid tissue formed from remnants of the duct.
         b- Thyroglossal cyst : lies inferior to hyoid bone at the mid line of the neck ( movable with deglutition & painless).
          c- Thyroglossal fistula: formed after rupture of the cyst.

      2- Ectopic thyroid gland:
         a- Lingual & sublingual thyroid due to incomplete descendà development inside or under the tongue.
         b- Retrosternal thyroid : due to excessive descend.

      3- Agenesis: due to failure of growthà critinism.

      4- superficial thyroid: It lies superficial to infrahyoid muscles.


Problem 1
A 56 year old man…right arm weakness&difficulty of speaking:

1.artery affected-MIDDLE CEREBRAL A

2.position of cortical area affected:
-motor area4-precentral gyrus of left hemisphere
-broca’s speech area-post paor of inf frontal gyrus in dominant hemisphere.

3- part of internal capsule through which the fibres controlling the movement of arm pass:
anterior half of POSTERIOR LIMB.

A 44 year old man fall from tree&develop a severe scalp hematoma.the superficial temporal artery continued to bleed internally because he took an anticoagulant drugs for artificial valve.

1-      which arteries must be ligated?-->OCCIPITAL ARTERY

2-      what is the site beginning of the ligated artery?-->ARISE FROM BACK OF THE EXTERNAL CAROTID ARTERY

3-      What is the site of termination of this artery?-->POSTERIOR PART OF THE SCALP

-65 year old patient
-underwent carotid end arterectomy due to carotid artery occlusion
-on approaching internal carotid artery,the surgeon severed a nerve embedded in the anterior wall of carotid sheath.

a)the severe nerve is?-->ANSA CERVICALIS

b)the nerve embedded in post wall of sheath?-->SYMPATHETIC TRUNK

c)what is the origin of severed nerve?-->C1,C2,C3


 1.      carotid triangle:

-anterior border of sternomastoid muscle
-posterior belly of digastrics
-superior belly of omohyoid muscle

-ant:thyrohyoid&hyoglossus muscle
-post:middle&inf constrictor of pharynx

-superficial fascia
-investing layer of deep fascia

arteries:-carotid arteries(common,iternal&external)
veins-internal jugular vein
nerves:last 3 cranail nerve(10th ,11th,12th )

2.blood supply of thyroid gland:

a)      a) arterial supply:
-sup thyroid artery
-inf thyroid artery
-thyroidea ima artery

 b)venous drainage:
-sup thyroid vein
-inf thyroid vein
-middle thyroid vein

 3.the arteries forming the circulus arteriosus:

-internal carotid artery
-ant cerebral artery
-post cerebral artey
-ant communicating artery
-post communicating artey

            4.pathway of vibration sensation from lower half of the body:GRACILE TRACT:
1st neuron
$dorsal root ganglia
-their central process enter the spinal cord &ascend (without relay)in post column as gracile tract to reach the medulla
2nd neuron
$gracile nuclei
-axon of these cells curve forward &medially forming the internal arcuate fibers which cross the medulla forming sensory decussation
-then thes fibers ascend in opposite side as medial lemniscus
-medial lemniscus ascend to terminate in PLVN of thalamus
3rd neuron
$PLVN of thalamus
-axon of these cells pass post limb of internal capsule to reach postcentral gyrus.


       5.Development of tongue: (from slide dr wafaa)

1- The anterior  two thirds:

  Origin: The 1st  Pharyngeal arch (mandibular processes)à two lateral lingual processes+ one tuberculum imparà meet à fuse  à anterior  2/3  of the tongueà U shaped sulcusà mobile tongue leaving frenulum linguae.

2- The pharyngeal part (posterior  third):

Origin: 2nd and 3rd  pharyngeal archesà four swellings à meet à fuseà copula of Hisà posterior third of the tongue.

Musle of tongue:
  Three or four occipital myotomes migrate to enter the tongue forming muscles of the tongue.
  The occipital myotomes are supplied by the hypoglossal nerve which migrate with them to supply the tongue muscles during their development.

Congenital anomalies:
  1- Bifid tongue: Due to incomplete fusion between the two lateral lingual swellings.
  2- Trifid tongue: The tuberculum impar elongates& separates the lateral swellings à three parts.
  3- Tie tongue ( ankyloglossia): due to attachment of frenulum linguae to the tip of the tongueà interfere with protrusion and speech.
  4- Macroglossia: large tongue.
  5- Microglossia: small tongue.
  6- Hemiglossia: Non development of one lateral swelling.
  7- Aglossia: no tongue.