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Discussion Starter · #1 ·
A 17-year-old amateur detective is brought to the emergency room after being hit in the side of the head with an antique desk lamp. The patient undergoes an emergent CT scan, shown below.



This is consistent with a ruptured __________ artery, a branch of the __________ artery.
  • Middle cerebral, external carotid
  • Middle cerebral, internal carotid
  • Middle cerebral, maxillary
  • Middle meningeal, external carotid
  • Middle meningeal, internal carotid
  • Middle meningeal, maxillary
  • Temporal, external carotid
  • Temporal, maxillary
 

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F is the answer!

The answer is F (Middle meningeal, maxillary)...but D could be right too because Middle Meningeal is a branch of Maxillary artery, but Maxillary is a branch of External Carotid!...but I went with F because well, middle meningeal is a direct branch of Maxillary artery!

Please tell me if I am wrong!:sorry:
 

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F is correct

Exam questions in USMLE are not tricky ones like in Med school. I believe if they ask you about Middle meningeal they will ask about wich artery gives rise to it directly.
 

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Discussion Starter · #5 ·
I agree - the only trick is that, when you don't know the answer, the "sort-of-correct-but-not-the-best" choice can be a distractor. But if we know the answer and it is straightforward, then we can mark it and move on, thankful that we have an extra minute for a more complicated question!
 

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Discussion Starter · #7 ·
Excellent! That's just the picture I was going to put up in the explanation... so here's a different one:

The middle meningeal artery, a branch of the maxillary artery, runs deep to the pterion, the point where the frontal, parietal, temporal, and greater wing of the sphenoid bones all meet. The MMA supplies most of the dura, and a ruptured MMA is the most common source of an epidural hematoma.
Emedicine said:
Following injury, the patient may or may not lose consciousness. If he or she becomes unconscious, the patient may awaken or remain unconscious.
Other symptoms include the following:
  • Severe headache
  • Vomiting
  • Seizure
Patients with posterior fossa epidural hematoma (EDH) may have a dramatic delayed deterioration. The patient can be conscious and talking and a minute later apneic, comatose, and minutes from death.
The middle cerebral artery is what the internal carotid artery becomes after the Circle of Willis. It supplies much of the frontal, temporal, and paritetal lobes. It can be the root of subarachnoid hemorrhage if it forms a berry aneurism which bursts, or cause a serious stroke if restricted.



The temporal artery arises from the external carotid artery where the maxillary splits off, but it runs superficial to the skull. Thus, a ruptured temporal artery would result not in an epidural hematoma but rather an extracranial, subcutaneous hematoma. It is a common site of giant cell arteritis manifestation.

(Low yield: It is also the most common site of the "angry artery" sign in Japanese anime)

 

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I'm sorry Mondoshawan I didn't know that you were planing to use that picture for your explanation. Next time, I'll wait until you upload something...cool!
 

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Discussion Starter · #10 ·
I'm sorry Mondoshawan I didn't know that you were planing to use that picture for your explanation. Next time, I'll wait until you upload something...cool!
No, not at all! It's great when we use pictures when answering too. It encouraged me to go look for for pictures for the wrong options too (although perhaps I went a little overboard there this time....):)
 
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