Blood Supply

Question 1

Does the EJV lie posterior or anterior to SCM

Answer 1

Anterior

Question 2

Where does bifurcation of common carotid happen

Answer 2

C4/ superior border of thyroid cartilage

Question 3

What are the borders of the carotid triangle

Answer 3

Posterior belly of digastric
Superior border of omohyoid
Medial border of SCM

Question 4

Why is carotid triangle important

Answer 4

Contains bifurcation of common carotid
Central pulse
Carotid sinus massage
Access for IJV - central line

Question 5

Where is atherosclerosis common

Answer 5

At bifurcation

Plague can rupture and send embolus to brain = stroke TIA or amaurosis fugax

Question 6

What is a carotid endarterectomy

Answer 6

Removal of plaque tissue and stitched back up

Question 7

What does a carotid sinus massage do

Answer 7

Increase baroreceptor activity feedback to heart to slow it down

Question 8

How many branches does the internal carotid artery give off in the neck

Answer 8

None- trick question

Question 9

Where does the internal carotid enter skull

Answer 9

Carotid canal

Question 10

Where do vertebral arteries enter brain and how do they get to it

Answer 10

Up through transverse foramina and through foramen magnum

Question 11

Where is the carotid canal found

Answer 11

Petrous part of temporal bone

Question 12

After the carotid canal where does ICA go

Answer 12

Cavernous sinus

Question 13

What is the cavernous sinus and where is it found

Answer 13

Venous type structure on upper surface of sphenoid bone

Question 14

What else runs through cavernous sinus

Answer 14

Carotid artery

CN 3,4,6,V1,V2

Question 15

What is the 1st branch of the ICA

Answer 15

Ophthalmic

Question 16

Other branches of ICA

Answer 16

Anterior cerebral
Middle cerebral
Posterior communicating
Forming anterior circulation of circle of willis

Question 17

Branches of ECA

SALF

Answer 17

Superior thyroid
Ascending pharyngeal
Lingual
Facial

Question 18

Branches of ECA

OPMS

Answer 18

Occipital
Posterior auricular
Maxillary
Superficial temporal

Question 19

What are the terminal arteries of ECA

Answer 19

Maxillary

Superficial temporal

Question 20

Why is the superficial temporal clinically important

Answer 20

Giant cell arteritis
Temporal arteritis

Headaches
Jaw pain
Loss of vision 
Scalp tenderness
T: steroids

Question 21

Blood supply to scalp

Answer 21

ICA:
Supraorbital
Supratrochlear
ECA:
Superficial temporal
Posterior auricular 
Occipital

Question 22

Layers of scalp

Answer 22

Skin
Connective tissue dense- vessels
Aponeurosis
Loose areolar tissue
Periosteum

Question 23

Why does the scalp bleed heavily

Answer 23

Artery walls held open by CT so can’t constrict

If involve aponeurosis of occipitofrontalis then it pulls cut open

Question 24

Maxillary artery of ECA branches

Answer 24

Middle meningeal- dura mata

Sphenopalatine- nasal

Question 25

Where does the MMA enter skull

Answer 25

Foramen Spinosum | Anterior section passes under pterion

Question 26

Significance of MMA rupture

Answer 26

``` Pterion fracture Middle meningeal artery rupture Haematoma Unsticks periosteal layer of dura but stops at suture lines Extradural haemorrhage ```

Question 27

EJV venous drainage

Answer 27

``` Superficial temporal Occipital Supraorbital Supratrochlear Facial ```

Question 28

Drainage of scalp and brain into

Answer 28

Brain into dural venous sinuses | Scalp drains via emissary veins to sinuses

Question 29

Face drainage and implications

Answer 29

From superior and inferior ophthalmic. Into cavernous sinus and pterygoid plexus Hence risk of intracranial infection as directly connected

Question 30

What is the danger triangle

Answer 30

Region where facial veins can drain backwards into cavernous sinus. Via facial vein to dural venous sinuses

Question 31

Name the dural venous sinuses

Answer 31

Superior sagittal Inferior sagittal Sigmoid Transverse

Question 32

What does the cavernous sinus drain into

Answer 32

IJV

Question 33

How to measure JVP

Answer 33

``` Right side more direct path 45 degrees Head to left Pulsations Measure height from sternal angle 3cm = elevated Add 5cm Gives estimated cmH2O ```