anatomy answer scheme

ANATOMY 2010/2009

PROBLEM1

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

5-area drained ny affected LN:NOSE,CHEECK,UPPER LIP,LOWER LIP,FRONT OF SCALP.

PROBLEM2

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

ESSAY QUESTIONS:

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
f(x)	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 4^th 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 (4^th  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.

2008-2009

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.

PROBLEM2

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

PROBLEM 3

-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

ESSAY QUESTIONS:

 1.      carotid triangle:

boundries:

-anterior border of sternomastoid muscle

-posterior belly of digastrics

-superior belly of omohyoid muscle

floor

-ant:thyrohyoid&hyoglossus muscle

-post:middle&inf constrictor of pharynx

roof:

-skin

-superficial fascia

-investing layer of deep fascia

contents:

arteries:-carotid arteries(common,iternal&external)

veins-internal jugular vein

nerves:last 3 cranail nerve(10^th ,11^th,12^th )

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 1^st  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: 2^nd and 3^rd  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.

THANK YOU, GOOD LUCK