NBDE Quiz # 28
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NBDE Quiz # 28
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1. Question
A 60-year-old female comes to the emergency department with significant left periorbital edema, ptosis, mydriasis, and a history consistent with a dental infection of an upper left molar for the past 7 days. Her signs and symptoms suggest cavernous sinus thrombosis. This complication involves which of the following cranial nerves?
CorrectThe correct answer is D. The cavernous sinus exists in the middle cranial fossa and receives tributaries from the surrounding dural sinuses and venous plexuses from the face. These veins are valveless and are susceptible to retrograde flow; in turn, this can be a pathway for septic emboli from facial infectious to travel into the cavernous sinus. Patients generally have sinusitis or a midface infection for 5 to 10 days. The cavernous sinus contains cranial nerves III, IV, V (V1, V2), and VI, in addition to the internal carotid artery and associated sympathetic nerve branches. Lateral gaze palsy (isolated cranial nerve VI) is usually seen first since CN VI lies freely within the sinus in contrast to CN III and IV that lie within the lateral walls of the sinus. Without effective therapy, signs appear in the contralateral eye by spreading through the communicating veins to the contralateral cavernous sinus. Eye swelling begins as a unilateral process and spreads to the other eye within 24 to 48 hours via the intercavernous sinuses. This is pathognomonic for cavernous sinus thrombosis.
IncorrectThe correct answer is D. The cavernous sinus exists in the middle cranial fossa and receives tributaries from the surrounding dural sinuses and venous plexuses from the face. These veins are valveless and are susceptible to retrograde flow; in turn, this can be a pathway for septic emboli from facial infectious to travel into the cavernous sinus. Patients generally have sinusitis or a midface infection for 5 to 10 days. The cavernous sinus contains cranial nerves III, IV, V (V1, V2), and VI, in addition to the internal carotid artery and associated sympathetic nerve branches. Lateral gaze palsy (isolated cranial nerve VI) is usually seen first since CN VI lies freely within the sinus in contrast to CN III and IV that lie within the lateral walls of the sinus. Without effective therapy, signs appear in the contralateral eye by spreading through the communicating veins to the contralateral cavernous sinus. Eye swelling begins as a unilateral process and spreads to the other eye within 24 to 48 hours via the intercavernous sinuses. This is pathognomonic for cavernous sinus thrombosis.