Anatomy Questions-Fall Flashcards
During dental procedures of the maxillary incisor teeth, local anesthesia is applied to what nerve?
A. Infra-orbital
B. Mental
C. Buccal
D. Facial
A. Infra-orbital
A baseball player gets distracted while playing catch and gets hit in the side of the head with a ball. The ball hit him slightly in front of the ear. What vessel is at risk when struct in this location?
A. The internal carotid artery
B. The superior sagittal sinus vein
C. The frontal middle meningeal artery
D. The cavernous sinus
C. The frontal middle meningeal artery
The skull is covered by the scalp, which is nicely named because it describes, in order, what the layers of tissues are. What are these layers?
A. Skin, connective tissues, aponeurosis epicardium, loose connective tissue, periosteum
B. Skin, connective tissues, aponeurosis epicranialis, loose connective tissue, pericrandium
C. Skin, calvarial tissue, aponeurosis epicranialis, loose connective tissue, periosteum
D. Skin, calvarial tissues, aponeurosis epicranialis, loose calvarial tissue, pericrandium
B. Skin, connective tissues, aponeurosis epicranialis, loose connective tissue, pericrandium
Deciding to celebrate finishing your last final, you decide to go to Bentleyville with your fabulous classmates. Unfortunately, the recently windy weather loosened one of the displays. To your dismay, one of the tyrannosaurus comes crashing down on another patron! Rushing to his aide, you and your cohort realize he managed to get out of the way, receiving only a minor scrape across his nose. You recommend he use antibiotic ointment and cover the injury because:
A. The lymphatics of that area drain to the parotid nodes and any infection will cause painful swelling in front of the ears
B. If it gets infected, he could end up with meningitis because the veins around the nose drain to the cavernous sinus.
C. If it gets infected, he could end up with encephalopathy because the bones of the face are so thin that they cannot prevent spread of infection.
D. The arteries of the nasal region are so close to the surface that infection can lead to increased swelling and bleeding.
B. If it gets infected, he could end up with meningitis because the veins around the nose drain to the cavernous sinus.
Which of the following is NOT a muscle of the palpebral fissure and nose?
A. the orbicularis oculi
B. the nasalis
C. the levator labii superioris alaeque nasi
D. the levator anguli oris
D. the levator anguli oris
A fracture to the bones that make up the Pterion from a blow to the side of the head has the potential of rupturing which artery?
A. Middle meningeal artery
B. Facial artery
C. Internal carotid
D. Occipital artery
A. Middle meningeal artery
CN VII has five terminal branches that come off of which nerve?
A. Facial nerve
B. Trigeminal nerve
C. Trochlear nerve
D. Optic nerve
A. Facial nerve
While shopping at target, you see a little boy begging his parents for a new Lego set. He gives his best puppy-dog eyes and sticks out his lower lip trying to persuade them. Which muscle is responsible for this lip movement?
A. Mentalis B. Obicularis Oris C. Depressor Anguli Oris D. Buccinator
A. Mentalis
A PA student stayed up too late studying for her anatomy exam. When she finally decided to go to bed, she tripped going up the stairs. Since her arms were occupied carrying her books, she hit her face on a step. Upon exam you tug on her upper incisors and there is mobility of the mid-face through the orbits, but the zygomatic arch remains fixed. What injury do you suspect?
A. Le Fort fracture type I B. Le Fort fracture type II C. Le Fort fracture type III D. Le Fort fracture type IV E. She is fine and can go home
B. Le Fort fracture type II
A 70-year-old male presents to your office complaining of a sharp pain in his lower jaw every time he bites down. You note upon physical examination that the patient has no bottom teeth and isn’t wearing his dentures. Which of the following is the correct sequence of structures, ending with the nerve responsible for his pain?
A. Trigeminal Ganglion, Trigenminal Nerve, Mandibular Nerve, Inferior Alveolar Nerve, Mental Nerve
B. Trigeminal Nerve, Trigeminal Ganglion, Mandibular Nerve, Inferior Alveolar Nerve, Mental Nerve
C. Trigeminal Nerve, Trigeminal Ganglion, Mandibular Nerve, Mental Nerve, Inferior Alveolar Nerve
D. Trigeminal Ganglion, Trigenminal Nerve, Mandibular Nerve, Mental Nerve, Inferior Alveolar Nerve
B. Trigeminal Nerve, Trigeminal Ganglion, Mandibular Nerve, Inferior Alveolar Nerve, Mental Nerve
The facial, superficial temporal, and occipital arteries are branches of the __________ ; while the supra-orbital and supratrochlear arteries are branches of the _______________ artery. These are all important in supplying the face and scalp with oxygenated blood.
A. internal jugular; internal carotid
B. External Carotid Artery; Internal jugular
C. Internal carotid; external carotid
D External Carotid; Internal carotid
D External Carotid; Internal carotid
NJ, 27-year-old presents to your clinic after taking an elbow to the side of the face and jaw region while playing boot hockey and the night before. He did not lose consciousness, and doesn’t remember any abnormal sensations because he had to jump up and score the game-winning goal. On exam today, you note tenderness and inflammation near the mandibular angle region. He reports a loss of sensation in his cheek and molars. He denies any sensation loss in the nasal region or forehead. He is having no trouble talking and you notice he is chewing gum (no problem with mastication).
You immediately consider the nerve responsible for sensory in the head, and have a hypothesis regarding what is going on. You send the patient for a CT scan to assess his injury. Meanwhile, you have a hunch that what is going on?
A. Blow to the side of the face injured the mandibular branch of the trigeminal nerve (CN V3), at the point where it leaves the foramen ovale
B. Blow to the side of the cheek injured the mandibular branch of the trigeminal nerve (CN V3), distal to the foramen ovale, at the level of the buccal nerve, unaffecting the other branches
C. Blow to the cheek injured the maxillary division of the trigeminal nerve, at the level of the inferior orbital fissure
D. Blow to the side of the face injured the mandibular branch of the facial nerve, at the point where it leaves the foramen ovale.
B. Blow to the side of the cheek injured the mandibular branch of the trigeminal nerve (CN V3), distal to the foramen ovale, at the level of the buccal nerve, unaffecting the other branches
To locate the superior nuchal line, what landmark do you palpate for?
A) External occipital protuberance
B) External occipital crest
C) Occipital condyle
D) Groove for occipital artery
A) External occipital protuberance
A 6 year old girl was playing with her little brother when things got a little carried away and threw a rock and struck her in the chin. She came in with a gaping wound from her the left side of her chin to her lower left lip and sutures were determined to be necessary. The nerve that needs to be blocked before suturing is a branch of which cranial nerve?
A) CN Vll
B) CN lX
C) CN V
D) CN Xll
C) CN V
When anesthetizing the skin and mucous membrane of the cheek to suture a knife wound after someone engages in a classic “Moore knife fight,” one will inject the mucosa covering the retromolar fossa. This is known as what type of nerve block?
A. mental and incisive nerve block B. infra-orbital nerve block C. buccal nerve block D. Facial nerve block E. CN VII block
C. buccal nerve block
A patient presents to your clinic with fever and worsening headache a few days after sustaining a scalp laceration and subsequent infection while she was riding her bike on a trail. She says that she now regrets attempting to exercise as there are so many possible injuries one can sustain from simply participating in physical activities. She is diagnosed with meningitis. You determine that the scalp layer involved is the
A. Scalp B. Connective tissue C. Aponeurosis epicranialis D. Loose connective tissue E. Pericranium
D. Loose connective tissue
A healthy 21 year old patient complains of sudden slurred speech and problems drinking water, shaving, and brushing his teeth. He reports no recent illness, no history of trauma or injury to his face or neck. He has had no major surgeries, but recently had a wisdom tooth removed while on vacation in Thailand. During your examination, you don’t see any drooping or facial abnormalities. You can’t stop looking at what looks like a flake of Cheeto stuck on his bottom lip and you nonchalantly wipe your mouth with the back of your hand in hopes that he’ll do the same. What do you expect has caused these symptoms?
A) Injury to the CN V
B) A lesion of CN I
C) Injury to the marginal mandibular branch of CNVII
D) Compression of the buccal branch of CN VII
A) Injury to the CN V
A 28 year old female trips and falls while carrying her laundry through the living room, during the fall she scrapes the side of her scalp on the coffee table, causing a fairly deep laceration. Despite applying pressure, the bleeding does not stop and she ends up in your ED seeking care. Which of the following are true regarding her head injury?
a. arteries of the scalp tend to bleed from both ends when lacerated, due to anastomoses
b. arteries of the scalp are less able to constrict than more superficial vessels
c. your patient will likely need stitches
d. A and C
e. all of the above
e. all of the above
The cutaneous innervation of the face is supplied primarily by the trigeminal nerve (CN V). Which branches of CN V are involved in this sensory innervation?
a. maxillary branch, ophthalmic branch, frontal branch
b. maxillary branch, ophthalmic branch, mandibular branch
c. mandibular branch, maxillary branch, frontal branch
d. ophthalmic branch, mandibular branch, zygomatic branch
b. maxillary branch, ophthalmic branch, mandibular branch
A high school track and field team is doing volunteer work after a homecoming football game. They decide to help pick up garbage and tidy the concession stand. Naturally, a sprinter and thrower from the team turn this into a competition to see who can pick up the most garbage in 10 minutes. They race to all the trash under the bleachers, but the sprinter forgets about the metal bars running lengthwise underneath the bleachers. She hits the frontal part of her head on the metal bar while mid-sprint. After she realizes what happens, she begins to experience severe pain at the base of her skull on the posterior side. She gradually forms a hematoma, tenderness, and additional bruising across her forehead. Considering the athlete hit the anterior aspect of her head and is now experiencing posterior skull pain, what is her most likely diagnosis?
a. Contrecoup (counterblow) fracture
b. Posterior Depressed fracture
c. Linear Calvarial fracture
d. Posterior Comminuted fracture
a. Contrecoup (counterblow) fracture
Your instructor asks you a very engaging question during a Fundamentals of Medicine lecture and you are stumped. Then the instructor says if you get the question correct, you win a million dollars. A common facial reaction to this feeling is to elevate your eyebrows in surprise. What facial muscle allows for this motion?
a) Orbicularis oculi
b) Corrugator supercilia
c) Levator labii superioris
d) Occipitofrontalis
d) Occipitofrontalis
A 32 year-old male presents to the ED after being struck on the side of the head with a metal bat when his son was hitting the pinata at his 8th birthday party. Due to the hard blow, the physician confirms that the man has ruptured his frontal branch of the middle meningeal artery, which was most likely a direct result from the fracture of what part of the man’s skull:
A: Glabella
B: Nasion
C: External Occipital Protuberance (Inion)
D: Pterion
D: Pterion
You are a PA student on Christmas break and your little niece wants to go visit Santa Claus at the mall to give him a kiss on the cheek. You tell her that in order to pucker up her lips, she should tense her:
A: Mentalis Muscle
B: Platysma Muscle
C: Orbicularis Oris Muscle
D: Risorius MuscleC: Orbicularis Oris Muscle
A concerned father brings his sickly 6 week old baby in to the ER after 3 days of intractable diarrhea. The PA is concerned about the amount of lost fluid, what can she use to check for dehydration in this infant?
A. Jugular venous distention
B. Buccal fat pads
C. Plagiocephaly
D. Fontanelle depression
D. Fontanelle depression
A PA student tripped on a curb and fell forward after responsibly celebrating the end of finals week at the local pub. She experienced a considerable amount of pain, and when she pulled on her central incisors to make sure that she had not avulsed part of her beautiful smile, her classmates gasped in disgust as they could see her face move with the motion. She was immediately assisted to the nearest ER. After an X-ray, the radiologist diagnosed a Le Fort III fracture. What bones are involved in this fracture?
A. ethmoid, nasal, sphenoid, zygomatic arches
B. lacrimals, ethmoids, maxillary sinuses
C. maxillary alveolar process and bony nasal septum
D. Angle of mandible, maxilla, hyoid
A. ethmoid, nasal, sphenoid, zygomatic arches
A 28-year old African American male is brought to the E.R. via ambulance after a head on motor vehicle accident. The patient presents with obvious facial deformities. The central part of the face appears appears to be sunken in with protruding zygomatic bones bilaterally. On x-ray, the radiologist notes fractures passing from the posterolateral maxillary sinus through the infraorbital foramina to the bridge of the nose. Which type of fracture is likely to cause this?
A. Le Fort Fracture III
B. Zygomaticomaxillary complex (tripod fracture)
C. Le Fort Fracture II
D. Smash Fracture
C. Le Fort Fracture II
Which bones make up the pterion?
A. Temporal, Frontal, Occipital, Parietal
B. Sphenoid, Temporal, Frontal, Parietal
C. Zygomatic, Sphenoid, Frontal, Temporal
D. Ethmoid, Sphenoid, Frontal, Temporal
B. Sphenoid, Temporal, Frontal, Parietal
You find out that you passed this exam and don’t need to stay Thursday to complete remediation! You are so excited, you could kiss someone. What muscle would you use to pucker your lips?
A. Depressor anguli oris
B. Mentalis
C. Orbicularis oris
D. Risorius
C. Orbicularis oris
You are working in the emergency department when a 26-year-old female patient is brought in after being bucked from a horse. You are told the patient had not been wearing a helmet and had hit their head in the fall. They had lost consciousness for several minutes, but awoke by the time paramedics arrived. The patient is currently awake and complains of a headache. You perform a CT scan and note enlargement of the meninges. A lumbar puncture is performed and there is blood present in the CSF. Between what layers of the meninges would you find CSF?
A. The periosteal lay and meningeal layer of the dura mater
B. Arachnoid mater and Pia mater
C. Dura mater and arachnoid mater
D. Pia mater and cerebral cortex of the brain
B. Arachnoid mater and Pia mater
A 64 year-old man present by ambulance to the emergency department with a severe “thunderclap” headache which began approximately 30 minutes ago while cooking dinner. He denies any trauma or falls but reports severe neck stiffness, before eventually losing consciousness. Which of the following is the most likely diagnosis based on history?
A. Subarachnoid hemorrhage
B. Epidural hemorrhage
C. Subdural hematoma
D. Cerebral hemorrhage
A. Subarachnoid hemorrhage
Which bony opening is not associated with the sphenoid bone?
A. Optic canal
B. Foramen ovale
C. Jugular foramen
D. Foramen rotundum
C. Jugular foramen
A very young couple comes to your office with concerns about a hole in the top of their baby’s head. After a thorough history and exam of the 2-month-old girl with normal findings, you tell the couple that the hole is completely normal in a young baby. You explain that it is where the sagittal, coronal, and frontal sutures of the skull intersect, and is called the anterior fontanelle. You also explain that the bones of the skull will eventually come together between 12-18 month of age and form the landmark known as the:
A. Lambda B. Pterion C. Foramen magnum D. Clivus E. Bregma
E. Bregma
What is it called when there is a misalignment between the upper and lower jaw?
A. Mandibular Tori B. Malocclusion C. Mental Shift D. Vertical Symphysis E. Dental Mishap
B. Malocclusion
If someone is having lack of sensation on their chin and cheek, which structure is most likely damaged?
A. CN III
B. CN V3
C. CN VII
D. CN V1
B. CN V3
A 30 year old female is rushed to the ED after she was thrown from an ATV. She was not wearing a helmet at the time and the side of her head struck a rock. The ED physician is concerned about the patient’s intracranial pressure. What relationship of structures is the greatest cause for the the physician’s concern?
A. Facial artery & mandible
B. CN I & Ethmoid bone
C. Superficial Temporal vein & Zygomatic arch
D. Middle meningeal artery & Pterion
D. Middle meningeal artery & Pterion
Which bone does NOT make up the orbit of the eye?
A. zygomatic
B. ethmoid
C. temporal
D. sphenoid
C. temporal
A 12 year old boy and his mother arrive to urgent care. The mother reports that their dog tripped the boy while on ice and he landed on the left side of his head. The first thing the PA notices when the boy walks in the exam room is a hematoma on the left side of his head at approximately the point of the pterion. With concerns of a fractured pterion, the PA is concerned that the hematoma developed from which vessel?
A. middle temporal vein
B. parietal branch of middle meningeal vein & artery
C. superficial temporal vein
D. frontal branch of middle meningeal vein & artery
D. frontal branch of middle meningeal vein & artery
Which of these is the strongest muscle of mastication?
A) Masseter
B)Temporal
C) Lateral Pterygoid
D) Medial Pterygoid
A) Masseter
Which nerve innervates the main muscles of mastication?
A) CN I
B) V2 of trigeminal nerve
C) V3 of trigeminal nerve
D) CN III
C) V3 of trigeminal nerve
Two days after Jonathon was born, his practitioner informed his mother that he would need to undergo surgery. The doctor diagnosed Jonathon with craniosynostosis. Specifically, Jonathon’s anterior fontanelle was absent, meaning there was not separation between Jonathon’s parietal bones. If left untreated, the infant’s cranium would grow long, narrow, and wedge-shaped, a condition called scaphocephaly. Which of Jonathon’s cranial sutures prematurely closed?
A. coronal suture
B. lambdoid suture
C. sagittal suture
D. squamous suture
C. sagittal suture
During a spontaneous intramural baseball game with friends, Dylan is up to bat. Unfortunately, the kids do not have proper equipment, and without wearing a batting helmet, an off-pitch hits Dylan in the side of the head, between the eye and the ear. He immediately loses consciousness, wakes up momentarily and then becomes comatose. His friends call 911, and Dylan is rushed to the ER and where he immediately undergoes a CT scan. The scan shows a skull fracture and an accumulation of blood between the external periosteal layer of the dura and the calvaria on the side of his head, compressing his cerebrum. He is rushed to surgery where a hole is bored into his skull to drain the blood and relieve the pressure. After a few tense hours, he regains consciousness. The hemorrhage from the fracture would be described as:
A) Exradural (epidural) Hemorrhage
B) Intracerebral Hemorrhage
C) Dural Border (Subdural) Hemorrhage
D) Subarachnoid Hemorrhage
A) Exradural (epidural) Hemorrhage
During transillumination of a patient’s sinuses, a PA placed the light under the medial aspect of the eyebrow and directed the light superiorly, which produced a glow superior to the orbit. What sinus was examined?
A. Ethmoid sinus
B. Maxillary sinus
C. Sphenoidal sinus
D. Frontal sinus
D. Frontal sinus
A 56-year-old female presents to the emergency department via EMS secondary to concern for possible stroke. The patient reports she awoke this morning with right sided facial tingling and weakness which progressively worsened throughout the day. She states she could not taste her food at lunch, and became concerned this afternoon when she went to the bathroom and saw right facial droop in the mirror. Upon arrival to the emergency department, the ER PA starts performing a neuro exam and asks the patient to raise her eyebrows, which she is unable to do on the right side. After further workup, the patient is diagnosed with Bell’s Palsy. What cranial nerve is affected in Bell’s Palsy?
A. CN VII
B. CN V
C. CN III
D. CN IV
A. CN VII
Which of the following muscles is most utilized to smile when you realize it is almost Winter Break?
A. Mentalis B. Zygomaticus Major C. Zygomaticus Minor D. Risorius E. Depressor Anguli Oris
D. Risorius
A 5 year-old patient presents with headaches, dizziness, and visual disturbances. She keeps running into things and has a black eye from “running into a doorknob.” Her mother is afraid that she may need glasses. There are some deficiencies in eye movements and the eyes are misaligned. Imaging reveals a large mass in the midbrain encroaching on and crowding the pons as well as forcing the temporal lobe to herniate through the tentorial notch and is later diagnosed with diffuse intrinsic pontine glioma. Which nerve is likely involved in causing this patient’s symptoms?
A. CN IV
B. CN III
C. CN II
D. CN I
B. CN III
Name the five layers of the scalp in order from superficial to deep.
A. Skin, loose connective tissue, aponeurosis, connective tissue (dense), pericranium
B. Skin, aponerurosis, loose connective tissue, pericranium, connective tissue (dense)
C. Skin, connective tissue (dense), aponeurosis, loose connective tissue, pericranium
D. Pericranium, connective tissue (dense), aponeurosis, loose connective tissue, skin
C. Skin, connective tissue (dense), aponeurosis, loose connective tissue, pericranium
A 63 year-old male on immunosuppresants presents to St. Luke’s Urgent Care. A painful, red, blistery rash had developed over the left side of the face. The patient also complained of a burning sensation. Patient had a 101 degree oral temperature, pulse of 115 bpm, and BP of 110/70. Upon inspection, the PA noticed that the blisters covered the skin anterior to the auricle, the oral mucosa, and skin of the chin on the left side of the patient’s face. Upon examination of the left ear, the PA also noticed blisters in the external acoustic meatus. What nerve is most likely affected?
A. Opthalmic division of the trigeminal nerve
B. Maxillary division of the trigeminal nerve
C. Mandibular division of the trigeminal nerve
D. Buccal branch of the facial nerve
C. Mandibular division of the trigeminal nerve
While camping in the Boundary Waters, Patrick slipped on a mossy rock while portaging through the woods. His fall resulted in a deep scalp wound on the back of his head that bled profusely but was managed by Bria’s quick acting application of pressure. He did not lose consciousness, nor did he see stars or show any signs of confusion. After bandaging, Patrick wanted to continue the expedition, but Bria insisted they return. What was Bria’s primary concern regarding Patrick’s head wound?
A. Concussion leading to retrograde and anterograde amnesia
B. Development of a sebaceous cyst due to an obstructed hair follicle
C. Infection developing and spreading through the loose connective tissue layer
D. Paralysis of the facial muscles due to injury to the Greater Occipital nerve
C. Infection developing and spreading through the loose connective tissue layer
What is Trismus?
A. The forceful closing of the jaws from spasm of the muscles of mastication
B. Myofascial pain referred from muscles of mastication
C. Blood accumulating between the cartilage and the perichondrium
D. Pain occurring in an enlarged parotid gland
A. The forceful closing of the jaws from spasm of the muscles of mastication
A 22 year old female presents to your office following a hard blow to the right side of her head. She reports a loss of consciousness lasting approximately 30 seconds following the injury. You begin to worry if the blow hit her in the area of the head that overlies the frontal branches of the middle meningeal vessels as this can be life-threatening. What is the name of the area you are concerned about?
A) Lambda
B) Bregma
C) Pterion
D) Pterygoid
C) Pterion
- If a clinician needs to anesthetize one side of the skin and mucous membrane of the lower lip, and the skin of the chin, where would they inject the anesthetic agent?
A) Mental Foramen
B) Maxillary Foramen
C) Infra-orbital Foramen
D) Into the Lower Lip
A) Mental Foramen
Premature closure of the cranial sutures can result in several cranial malformations. The premature closure of the sagittal suture results in a long, narrow, wedge-shaped cranium. What is the name of this condition?
A) Oxycephaly
B) Scapheoncephaly
C) Plagiocephaly
D) None of the above
B) Scapheoncephaly
A patient comes in with an insect bite on the posterior scalp, 2 cm posteroinferiorly to the lambda. Which lymph nodes would you first expect to find enlarged if the insect bite is infected?
a) Parotid
b) Superficial cervical
c) Deep cervical
d) Occipital
d) Occipital
A 56 year old male is being examined by his primary care physician for recurrent attacks of severe facial pain. He describes the pain as stabbing and lasts for about 15 minutes. The pain seems to happen more commonly in the morning when he is washing his face, although he has experienced it at other times as well. He does not have any weakness or loss of function in his facial movement. What nerve is most likely involved in this patient’s symptoms?
a) Maxillary branch of the trigeminal nerve
b) Mandibular branch of the trigeminal nerve
c) Zygomatic branch of the facial nerve
d) Buccal branch of the facial nerve
a) Maxillary branch of the trigeminal nerve
A 38 year women reports to the emergency department after being struck by a ball at her sons baseball game. There is no evidence of external bleeding where she was struck just anterior to her right ear, however she has severe tenderness and swelling in the area. Upon results of imaging, the emergency room physician notes a fracture in the skull superior to the zygomatic arch and just posterior to the frontal process of the zygomatic bone. He immediately calls the Neurosurgeon on call to assist in the patient’s care. What is he most worried about?
A. Torn meningeal vessels creating an epidural space which is putting pressure on the brain.
B. Fracture of the pterion causing a rupture of the middle meningeal artery.
C. Limited blood flow to the face due to inflammation compressing the facial artery.
D. Fracture of the coronoid process of the mandible causing the excised piece to be retracted into the infratemporal fossa.
B. Fracture of the pterion causing a rupture of the middle meningeal artery.
An 84-year old woman suffers a stroke, with paralysis on the right side of her body. Neurological tests show that the intracerebral hemorrhage has interrupted the blood supply to the posterior part of the frontal, the parietal and medial portions of the temporal lobes of the left cerebral hemisphere. Which vessel was involved?
A) Anterior cerebral artery
B) Middle cerebral artery
C) Middle meningeal artery
D) Posterior cerebral artery
B) Middle cerebral artery
The loose connective tissue of the scalp is considered the dangerous layer of the scalp because blood/ pus can spread easily to the cranial cavity. Which vessel is responsible for the spread to the cranial cavity?
A) Emissary Veins
B) Superficial Vein of the Scalp
C) Diploic Vein
D) Posterior Auricular Vein
A) Emissary Veins
A 25 year old male is hit in the nose with a baseball. He denies any visual changes or loss of conscious but does state that he had a bloody nose, has been experiencing facial pain, and can’t seem to bite down or talk normally. During exam you tug on the upper incisors and there is mobility of the midface through the orbits, the zygomatic arch remains fixed. What kind of fracture does he have?
A) Le Fort I Fracture
B) Le Fort II Fracture
C) Le Fort III Fracture
D) Le Fort IV Fracture
B) Le Fort II Fracture
You diagnose a patient with stable angina and prescribe them sublingual nitroglycerin. What vessel is responsible for the absorption of sublingual medications?
A) Deep Lingual Vein
A 23-year-old man comes to you complaining that he can’t stop crying, i.e. tears regularly run down the right side of his face. You suspect that one of the lacrimal ducts on the right side of the face is blocked. You look into an endoscope to see if the nasolacrimal duct is blocked. Into which part of the nasal cavity would you look to see the opening of the duct?
A) Inferior meatus
All of the following are true about the middle ear except:
The facial nerve passes in a canal situated in the medial and anterior walls
A patient complaining of unilateral hearing loss is found to have a large impaction of cerumen in his left ear. Upon aggressive irrigation and curettage, the Pt begins coughing and feels as though he might pass out. What nerve is the culprit for his sudden onset of symptoms?
B. Auricular branch of Vagus nerve (CN X)
While chowing down on some end-of-semester-celebratory-sushi, you accidently bite the tip of your tongue. What sensory nerve is causing pain due to you mistaking your tongue for a California roll?
C. Lingual nerve (CN V3)
A “friend” was doing some “nasal exploration” while stopped at the stoplight and triggered a nose bleed. What area that is rich in anastomosing arteries in the nasal cavity was most likely affected by your “friend’s” digital trauma?
A. Kiesselbach area
A 19 year old male boxer comes into your office after being struck in his left ear. He states that his ear is tender to the touch. Upon examination, you observe a localized collection of blood causing distortion of the contours of the patient’s left auricle. You diagnose your patient with an auricular hematoma. What are you most worried about happening if your patient is left untreated?
B) Fibrosis developing under the skin leading to deformation.
If a patient comes in to your office with a bulging red tympanic membrane with observable fluid in the middle ear upon otoscopic examination what are you most likely to diagnose them with?
B) Otitis Media
A patient comes in to the emergency department complaining of immense pain after breaking their tooth while chewing on a cough drop. After examining the mouth you determine the broken tooth to be their 2nd molar. You decide to extract the remainder of the tooth but need to administer a nerve block before the procedure. What landmark will you use to guide your needle insertion?
Greater palatine foramen
During resection of an anterior lobe of the brain, what important nerve structure do surgeons need to be careful of in order for the patient to maintain their sense of smell?
Olfactory bulb
A 3-year-old patient presents to clinic with both parents who report recent high fever and has been complaining of left ear pain. They also state that everyone in the house, including the patient, had a cold last week. Upon examination of the patient, the PA noted the skin over the left pinna to be erythematous, swollen, and tender to palpation. Purulent drainage was present in the external acoustic meatus, and the tympanic membrane was noted to be inflamed and perforated. What most likely caused the tympanic membrane rupture?
C) Otitis Media
During an otoscopic examination of a child, how does a provider straighten out the external acoustic meatus for better visualization of the tympanic membrane?
B. Pulling the helix inferoposteriorly
A six-year old boy presents to the ED. He is extremely agitated, flushed, and is cupping his right ear. His mom states that he has been having trouble following directions and needs to be told instructions several times recently. He has been home sick with a cold the past two days. Vitals include an oral temperature of 101 degrees F, BP 105/60, respirations 13. What physical exam finding would prompt the need for more specialty care?
C. Inflammation of the mastoid process
An injury sustained to the peripheral auditory system localized in the cochlear duct and caused buzzing and ringing. What is this buzzing and ringing known as?
B) Tinnitus
A 20 year-old male patient presents to Urgent Care with a cough, mild fever, and complains of pain when swallowing. On examination, white and patchy tonsillar exudates are evident and when he breathes, you notice a distinct odor making you suspicious of streptococcal pharyngitis. You order a strep test and as you observe the RN swabbing the patient’s throat, they both gag. You surmise that one response may have been due to the odor and the other from the swab, itself. Which nerves are responsible for the patient’s response?
A. CN X and CN IX
A child walks into the clinic with his mother and shows off a big toothy grin with a gap between his permanent upper central incisors. What is the likely cause for his unique smile?
B. A large superior labial frenulum
An 18 year old high school baseball pitcher is brought into the ER after being struck directly in the nose with a line drive. The nose is visually displaced and epistaxis is present. The patient is having a difficult time smelling anything. Exam reveals a grossly deformed external nose and the septum is deviated to the left. You diagnose a fractured nose. What could be a potential complication of this fracture?
Cribiform plate fracture
You recently had your right 3rd molar extracted. You notice that you have altered sensation on the right side of your tongue. What important structure may have been damaged?
Lingual Nerve (CN V3)
A 54-year-old male patient presents to your clinic complaining of pain in his jaw. He states having increased sensitivity with cold drinks and chewing. Upon inspection, you note gingival recession and inflammation. During the examination, you use a tongue depressor to percuss the mandibular teeth, to which the patient endorses moderate pain. Which nerve would be responsible for pain felt throughout the mandible?
Mandibular nerve (CN V3)
You are 5-years-old and irritated with your sibling. What muscle would you use to stick your tongue out at your sibling?
Genioglossus
When viewing the tympanic membrane, which portion of the ear is the examiner grasping to facilitate insertion of the otoscope into the external auditory meatus?
C) helix
A 65 year old male presents to your clinic for a painful cyst on his back. While talking with him, you notice his speech sounds “off”. You can begin questioning him about his speech. He admits that he has mild ear pain, difficulty with swallowing and speech as well as has the sensation that “something is stuck” in his throat. His wife told him he sounds more hoarse than he has in the past. You palpate the tongue and find a mass on the posterior aspect of the tongue. Which node(s) do you suspect will be positive for lymphadenopathy?
B. bilateral deep cervical
You see a patient who complains of double vision. On exam their pupil is fully dilated and non-reactive to light. The pupil is also fully abducted and depressed (down and out). You also notice the superior eyelid is drooped and cannot be raised voluntarily. What is your suspected diagnosis?
A) Abducent Nerve (CN VI) Palsy
B) Trochlear Nerve (CN IV) Palsy
C) Oculomotor Nerve (CN III) Palsy
D) Opthalmic Nerve (CN V) Palsy
C) Oculomotor Nerve (CN III) Palsy
The floor of the eye is made up of all of the following bones except:
A) Maxilla
B) Palatine
C) Sphenoid
D) Zygomatic
C) Sphenoid
Which eye muscle is not paired with its respective nerve?
A) Inferior Oblique- Oculomotor Nerve (CNIII)
B) Lateral Rectus- Abducent Nerve (CNVI)
C) Superior Rectus- Trochlear Nerve (CN IV)
D) Inferior Rectus- Oculomotor Nerve (CNIII)
C) Superior Rectus- Trochlear Nerve (CN IV)
A 53 year old woman presents to your office with a complaint of decreased ability to chew. You remember that the muscles of mastication are the masseter, temporalis, medial pterygoid, and lateral pterygoid muslces. Which nerve is being affected leading to a paralysis in these muscles in your patient?
A) Marginal Mandibular Branch of CN VII
B) Buccal Branch of CN VII
D) Trigeminal Nerve
D) None of the above
D) Trigeminal Nerve
A 57 year old female presents to your office with a complaint of violent coughing. Upon examination you note there is bright red patches deep to and within her bulbar conjunctiva of her left eye. Otherwise there is not further appreciable symptoms or exam findings. What is your most likely diagnosis?
A) Conjunctivitis
B) Subconjunctival Hemorrhage
C) Hyperemia of the Conjunctiva
D) Corneal Laceration
B) Subconjunctival Hemorrhage
A 57 year old male presents to your office for an annual physical exam. During your neurological examination, you perform an exam to test for the patient’s corneal reflex by touching the cornea with a wisp of cotton. You note the patient does not blink when this exam is performed leading you to believe there is a lesion associated with what nerve?
A) Ophthalmic Branch of Trigeminal Nerve (CN V1)
B) Oculomotor Nerve (CN III)
C) Facial Nerve (CN VII)
D) Optic Nerve (CN II)
A) Ophthalmic Branch of Trigeminal Nerve (CN V1)
A 16 year old male presents to his primary care physician for pain in the front of his face following a “black eye” from being struck directly in the right eye with a football. He reports that the injury happened 3 days ago and the pain has gotten progressively worse. His vision is unaffected. Upon examination it is noted that the pain is localized to his right cheek. What is the most likely cause of this patient’s pain?
A. Bleeding into the maxillary sinus causing increased pressure.
B. Compression of the infraorbital nerve from inflammation
C. Rupture of the anterior ciliary artery
D. Fracture of the zygomatic bone causing impingement of the zygomatic nerve
A. Bleeding into the maxillary sinus causing increased pressure.
The eyelids contain dense fibrous bands of connective tissue where the eyelashes connect. What are these called?
A. Conjunctival fornices
B. Orbital septa
C. Palpebral ligaments
D. Tarsal plates
D. Tarsal plates
A patient is seen in your clinic with a piece of pencil lead embedded in the white area of his eye. After successfully removing the lead using careful technique and sending them off to pick up medicated eye drops, you begin to document the procedure in the patient’s chart. What part of the surface anatomy of the eye had been injured?
A. Bulbar Conjunctiva
B. Semilunar Conjunctival Fold
C. Palpebral Conjunctiva
D. Corneal Limbus
A. Bulbar Conjunctiva
Your grandfather claims to have noticed your grandmother has developed “bedroom eyes”. You politely ask him to never use to that phrase again, but further investigate with your grandmother and notice a bilateral droop in her superior eyelids and several empty bottles of “Artificial Tears” in the bathroom. What would be at the top of your differential for your grandmother?
A. Lesion of the optic nerve
B. Lesion of the ophthalmic nerve
C. Lesion of the abducent nerve
D. Lesion of the oculomotor nerve
D. Lesion of the oculomotor nerve
A high-school tennis player was hit in the eyeball with a tennis ball after it had been served by the opponent. The player was brought to the ED. Her BP was 127/82, oral temp 98.6, respirations 16. She complained of extreme pain in the right eye, a headache, and decreased visual acuity in the right eye. She denied any tenderness along the orbital margin and there was no ecchymosis of the right eye. What is the PA most likely to see during the eye examination?
A. Corneal abrasion using fluorescein dye
B. Layer of blood in the anterior chamber
C. Large subconjunctival hemorrhage
D. Dilated and tortuous veins
B. Layer of blood in the anterior chamber
A 65 year-old woman presents to her primary care provider because she is having pain on the right side of the cheek. The patient states that the pain increases when she is eating. The provider notes that the patient has posterolateral facial swelling and the opening on the buccual surface opposite the second maxillary molar is inflammed. What gland is involved?
A. Submandibular gland
B. Submental gland
C. Sublingual gland
D. Parotid gland
D. Parotid gland
A 12 year-old female presents to your clinic with a misalignment of her eyes. You test her ocular movements with your penlight, but notice that her right pupil remains adducted. Which nerve is likely paralyzed?
A. CN VI
B. CN III
C. CN IV
D. None of the above
A. CN VI
What is a hyphema?
A. Inflammation of the cornea
B. Hemorrhage of the posterior chamber
C. Inflammation of the posterior chamber
D. Hemorrhage of the anterior chamber
D. Hemorrhage of the anterior chamber
A patient was out with his family picking apples on a lovely fall day when a branch snapped backwards and struck him in the right eye. He immediately felt a sharp, burning pain in his right eye followed by intense photophobia. Fluorescein staining was done at urgent care and the patient was found to have two linear abrasions in his anterior right eye. What eye structure was injured?
A) Cornea
B) Lens
C) Iris
D) Sclera
A) Cornea
What eye disorder is characterized by increased intraocular pressure secondary to build up of aqueous humor in the anterior and posterior chambers of the eye?
A) Presbyopia
B) Glaucoma
C) Uveitis
D) Conjunctivitis
B) Glaucoma
A patient presents with upward drifting of the eye and vertical diplopea, which nerve is most likely damaged?
A) CN III
B) CN II
C) CN IV
D) CN I
C) CN IV
Bill Fresh, a 68 year old with hyperlipidemia and hypertension, reports to the emergency room in sheer panic because he has lost vision in his left eye. He was sitting on his sofa when it happened, and denied any history of trauma. The PA tests his extra-ocular movements, which are intact, despite his not being able to see out of one eye. He does not have any nystagmus, ptosis, or ecchymosis in the orbital region. There is no signs of retinal hemorrhage or hyphema. Due to his medical history, you auscultate his heart sounds and, when you get to the carotid arteries, notice a bruit in the Left carotid artery. You order some labs and imaging but suspect the diagnosis to be:
A. An embolism has occluded the proximal ophthalmic artery, at the point where it first branches off of the internal carotid artery.
B. An embolism has broken off from the external carotid artery and blocked the central artery of the retina, causing blindness
C. An embolism has broken off of the internal carotid artery and has blocked the infra-orbital artery
D. An embolism has broken off from the internal carotid artery and blocked the central artery of the retina, causing blindness
D. An embolism has broken off from the internal carotid artery and blocked the central artery of the retina, causing blindness
Decreased pupillary light reflex is a sign of what?
A. Subconjunctival Hemorrhage
B. Compression of CN III
C. Retinal detachment
D. CN V palsy
B. Compression of CN III
A 23 year old male presents to Urgent Care with complaints of jaw pain. He states that last night he was out a bar with some friends. At bar close he got in an altercation with someone. As he was talking smack to the person, one of his friends “sucker punched” him in the side of the face. The patient states that he is having pain in his face and around his ear. It is also difficult for him to open his mouth. Exam reveals tenderness over the TMJ area. X-ray’s were negative for fractures. What is most likely the cause of his pain?
A. TMJ dislocation
B. Alveolar nerve damage
C. Fractured mandible
D. Mastoiditis
A. TMJ dislocation
A 50 year old Turkish man presents to the clinic with red eyes. The patient also complains of blurry vision and pain but denies any itchy or scratchy sensations. You noticed that he has been diagnosed with Behcet Syndrome previously and immediately wonder if his current symptoms are a component of his large-vessel vasculitis. Due to his past medical history and his symptoms, you diagnose the patient with:
A. uveitis
B. retinal detachment
C. glaucoma
D. conjunctivitis
A. uveitis
This nerve follows the lateral wall of the orbit of the eye. It also controls the extraocular movement of abduction. Which nerve is this?
A. CN III
B. CN IV
C. CN V
D. CN VI
D. CN VI
Kelsey’s beautiful face presents to your clinic, but this time it has a deep laceration just inferior to her eyebrow. She explains that she was playing watermelon rugby while on a camping trip, when she was elbowed in the face. She did not have access to stitches at the time so Steri-strips were used to hold the laceration together. Now, several days after the incident, she complains that she cannot wink at “all the hotties.” What muscle would you expect to be injured preventing her from winking?
A. Orbicularis Oculi
B. Frontalis
C. Zygomaticus major
D. Levator palpebrae superioris
A. Orbicularis Oculi
You are so happy winter break has finally arrived that you cannot stop smiling. With this excessive smiling, which muscle is bound to get tired and sore?
A. Buccinator
B. Zygomaticus major
C. Masseter
D. Levator anguli oris
B. Zygomaticus major
A 60-year-old man presents to the emergency room, reporting a complete loss of vision in his right eye. While taking the patient’s history, the PA learns that the patient saw “flashes of light” behind his eye, before a curtain of darkness fell over his visual field. The patient is nearsighted, has hypertension, and has also been diagnosed with diabetes mellitus. On fundoscopic exam, the retina appears out of focus. The PA concludes that the man has suffered a retinal detachment. The PA remembers that this can be due to seepage of fluid between the neural and pigment cell layers of the retina. Which part of the retina is most commonly responsible for detachment?
A. pigmented layer
B. ciliary part of the retina
C. neural layer
D. iridial part of the retina
C. neural layer
Which nerve does the pupillary light reflex involve?
A. oculomotor nerve (CN III)
B. optic nerve (CN II)
C. both A and B
D. none of the above
C. both A and B
Which cranial nerve is not associated with extraocular movement?
A. Facial nerve (CN VII)
B. Abducens (CN VI)
C. Oculomotor (CN III)
D. Trochlear (CN IV)
A. Facial nerve (CN VII)
A 78 year old female with a history of hypertension and atrial fibrillation presents to your primary care clinic with approximately 2 hours of sudden, painless, unilateral vision loss in the right eye. Exam reveals visual acuity of 20/200 in the right eye. You refer her emergently to the ophthalmologist. What is your primary concern?
A. Open-angle glaucoma resulting in reduced outflow of aqueous humor
B. Central retinal artery occlusion due to an embolus in the terminal branches of the retinal artery
C. Papilledema resulting from increased intracranial pressure from a cranial mass
D. Retinal detachment resulting in a small vitreous hemorrhage
B. Central retinal artery occlusion due to an embolus in the terminal branches of the retinal artery
Which cranial nerves are responsible for orbital movements?
A. Optic (II), Oculomotor (III), Abducens (VI)
B. Abducens (VI), Optic (II), Trochlear (IV)
C. Facial (VII), Trochlear (IV), Oculomotor (III)
D. Trochlear (IV), Abducens (VI), Oculomotor (III)
D. Trochlear (IV), Abducens (VI), Oculomotor (III)
Jackson, a college baseball player, was struck in the face from a line-drive while playing third-base last week. He presented to the E.R. with epistaxis and noted his right eyeball was protruding. X-ray confirmed orbital and nasal bone fractures. The patient presents to the clinic today for a follow-up and the PCP observes infection spread to the cavernous sinus. Which vessel allowed for the spread of infection to this area?
A. Facial Vein
B. Infra-orbital Vein
C. Middle Cerebral Artery
D. Ophthalmic Artery
A. Facial Vein
If a patient continually chews bubble gum, what should you warn them of?
a. Hypertrophy of the Masseter muscle
b. Inflammation of the Articular disc
c. Myalgia of the Temporalis muscle
d. All of the above
d. All of the above
A 46-year-old man goes in to visit his optometrist for his annual checkup. He mentions noticing slight vision changes in his right eye. He states that he closes just his right eye when reading at night due to fatigue. After the proper eye examination, the optometrist notices some extra-ocular muscle weakness, especially during convergence. As the patient followed the optometrist’s pointer in towards his nose in the attempt to cross his eyes, the right eye failed to converge in directly at midline between both eyes. As a result, the optometrist explains he has ocular muscle weakness. What muscle(s) would he be experiencing weakness in?
a. Lateral Rectus
b. Inferior oblique + Superior rectus
c. Medial Rectus
d. Superior oblique + Inferior rectus
c. Medial Rectus
All of the muscles of the orbit are supplied by CN III, except for the superior oblique muscles and the lateral rectus muscles. What are the innervations of these muscles, respectively?
A: CN X and CN II
B: CN IV and CN VI
C: CN VI and CN IV
D: Both supplied by CN VI
B: CN IV and CN VI
A 25 year-old patient presents to the ED after his friend accidentally hit him over the right side of the head with a paddle while on a canoeing trip to the Boundary Waters. Immediately, the physician notices that the patient cannot abduct the right pupil when asked to do so. The right pupil is reported to be fully adducted by the pull of the unopposed eye muscle. The physician begins to think that the man likely injured his right:
A: Oculomotor nerve (CN III) B: Optic nerve sheath C: Optic nerve (CN II) D: Abducent nerve (CN VI)
D: Abducent nerve (CN VI)
When President Lincoln was a child he was kicked in the head by a horse. For the rest of his life he had a droopy left eyelid and often described having diplopia. He was known for his “eyes rolling wildly” when he gave his fiery speeches and although considered “honest Abe” he could never quite look people straight in the eye. Which of President Lincoln’s nerves was most likely permanently damaged?
A) Oculomotor Nerve (CN (III)
B) Trochlear nerve (CN IV)
C) Abducent nerve (CN VI)
D) Opthalmic nerve (CN V1)
B) Trochlear nerve (CN IV)
Liz presents to your clinic after smacking the left side of her face on the handlebar of a treadmill. She knew better than to exercise and vows to take better care of her health by avoiding further unnecessary physical activity. She complains of diplopia and you suspect that the left abducens nerve has been damaged. Which direction will you instruct Liz to look to confirm that the left abducens nerve is damaged?
A. Up
B. Down
C. Left
D. Right
C. Left
A 67 year old women was diagnosed with a malignant salivary gland tumor. She underwent a parotidectomy, but unfortunately the surgeons were unable to preserve the nerve that is embedded in the parotid gland. What are effects will the patient have from severance of this nerve?
A. weakened mastication on the affected side
B. vision loss and strabismus on the affected side
C. decreased lacrimal fluid production on the affected side
D. facial muscle paralysis on affected side
D. facial muscle paralysis on affected side
Your friend went to her provider after being hit in eye with a baseball. During the eye exam, her provider mentioned that her left eye is not converging when gazing downward. Your friend was not sure what that meant so she asked you. You explained that the swelling from being hit by the ball caused damage to CN lV. This is affecting what muscle used in convergence?
A) Superior Oblique
B) Lateral Rectus
C) Superior Rectus
D) Inferior Oblique
A) Superior Oblique
Which of the following contains the correct muscles for mastication?
A) Masseter, mylohyoid, digastric, geniohyoid
B) Masseter, digastric, medial pterygoid, lateral pterygoid
C) Temporalis, masseter, medial pterygoid, lateral pterygoid
D) Temporalis, masseter, mylohyoid, geniohyoid
C) Temporalis, masseter, medial pterygoid, lateral pterygoid
Bill Fresh, a 68 year old with hyperlipidemia and hypertension, reports to the emergency room in sheer panic because he has lost vision in his left eye. He was sitting on his sofa when it happened, and denied any history of trauma. The PA tests his extra-ocular movements, which are intact, despite his not being able to see out of one eye. He does not have any nystagmus, ptosis, or ecchymosis in the orbital region. There is no signs of retinal hemorrhage or hyphema. Due to his medical history, you auscultate his heart sounds and, when you get to the carotid arteries, notice a bruit in the Left carotid artery. You order some labs and imaging but suspect the diagnosis to be:
A. An embolism has occluded the proximal ophthalmic artery, at the point where it first branches off of the internal carotid artery.
B. An embolism has broken off from the external carotid artery and blocked the central artery of the retina, causing blindness
C. An embolism has broken off of the internal carotid artery and has blocked the infra-orbital artery
D. An embolism has broken off from the internal carotid artery and blocked the central artery of the retina, causing blindness
D. An embolism has broken off from the internal carotid artery and blocked the central artery of the retina, causing blindness
A 12 year-old patient is having a supernumery maxillary incisor extracted prior to getting braces. In which location will the nerve block be performed prior to extraction?
D. Incisive foramen
Which of the following is not a structure of the middle ear?
A. Utricle
What is the most common site for anterior nosebleeds?
A. Kiesselbach Area
A 4 year old boy was brought to their primary care physician following three days of a high fever and earache. The external ear (pinna) was swollen and the boy expressed pain on palpation. The parents noted his pillowcase had “a yellow/green stain” on it this morning. On exam, the provider observed an inflamed tympanic membrane. Superior cervical lymphadenopathy was also noted on the affected side. What is the most likely diagnosis?
B. Acute Otitis Media and Tympanic Membrane Rupture
If a patient comes in complaining of symptoms that sound like GABH Strep, a rapid strep test will be performed. During this test, a patient has the posterior aspects of their mouth swabbed. This test can cause some patients to activate their gag reflex. Which two nerves produce the contraction of each side of the pharynx, initiating the gag reflex?
b. CN IX + CNX
How many teeth does the average adult have and how many of these are incisors, respectively?
32, 8
Which sinuses are located between the outer and inner tables of the frontal bone, posterior to the superciliary arches and the root of the nose?
A: Frontal Sinuses
A 5 year-old boy and his mom come into your clinic after the young boy was at school that day and got hit on the left side the head on the playground during recess, resulting in a lesion to his left facial nerve. The boy now tells you that ever since, every sound is very loud and uncomfortable for him to hear in his left ear. Being the good PA that you are, you believe that the boy’s left ear is unable to dampen large vibrations of the tympanic membrane. This would likely be the result of paralysis in which of the following ear structures:
D: Stapedius
An anonymous PA student picked a zit that was located midway between the right nares and the right superior vermillion border. It subsequently became infected with S. aureus, which lymph node would you expect to enlarge first?
submandibular
A 72 year-old man has undergone a right lower lobectomy following a diagnosis of large cell carcinoma of the right lung. Following the surgery, he develops a paradoxical depression of the right diaphragm with expiration. What nerve was injured in the procedure?
A. Vagus nerve
B. Phrenic nerve
C. Accessory spinal nerve
D. Recurrent laryngeal nerve
B. Phrenic nerve
Which of these muscles of the tongue is innervated by the Vagus nerve?
D)Palatoglossus
Owen Wilson had a few run ins with his team mates during high school football, which lead to his famous crooked nose. He complains of loss of smell. Which nerve was most likely damaged from his football injuries to the face?
D) CN I
Roy presented with cold symptoms that have lasted for two weeks and have not seemed to go away. His symptoms include a runny nose with thick nasal secretions and fatigue. Over the past few days, Roy states that he has been running fevers and has facial pain. When Roy is asked where his facial pain is located, he states that it is primarily between his eyes. Upon physical examination, the PA noted that the patient winced in pain during palpation of the bridge of the nose. The PA suspects that Roy has Sinusitis. Based on Roy’s reports and the PA’s observation, which sinus is most likely being affected?
A. Ethmoid Sinus
After viewing pictures of teeth and reading about dental caries, pulpitis, and tooth abscesses in far more detail that she ever wanted to, Kelsea headed to the sink to begin vigorously brushing her teeth. Mid-brush, Kelsea lurched forward having accidentally triggered her gag reflex. A sensory branch of which nerve triggered this reflex?
Glossopharyngeal Nerve (CNIX)
Jon was cleaning his ears with cotton swabs even though he knows this is bad. Liz sees him doing this and yells at him to stop. Unfortunately, Jon is startled and accidentally jabs the cotton swab into his ear. He is in a lot of pain, and there is some blood on the cotton swab. Liz drives him to the emergency department, and the PA examines his ear for possible injury to a nerve that runs across the eardrum. The most likely nerve to be injured is the:
Chorda tympani
Which structure is attached to the center of the tympanic membrane?
Handle (manubrium) of the malleus
Several years after being diagnosed with Sjogrens’s Disease, a 45 year old female went into her dentist because she had a severe toothache that began many months ago. Her dentist told her that she has developed an infection in her right first molar and needs to have the tooth pulled because the infection around that tooth could lead to what?
B) Sinusitis
All of the following are contents of the pterygopalatine fossa except:
Deep petrosal nerve
Ken Smith, 28-year-old male, whose wife left him the day before their wedding, left him attending their honeymoon in Florida solo. In an attempt to be funny, he tried taking a photograph kissing a crab he found on the beach, but it happened to clamp onto his tongue, and wouldn’t let go for a few minutes. Now he is in your office because the pain he’s experiencing in his tongue is worse than the embarrassment of how he got his injury. There is a significant amount of swelling and erythema of the dorsum and lateral side of the tongue, so you swipe your gloved finger across the area and he winces. You then ask him to do a series of tongue motions. He is able to stick his tongue out, retract it, and pull it flat against the floor of his mouth. However, you find that he can’t make his tongue into a “taco” shape; only one side was able to curl upward. What do you presume is the underlying cause of his pain?
Lacerated superior longitudinal muscle
If you were treating a woman with a metastasized cancerous lesion on the apex of her tongue, in which lymph node/s would you expect to feel lymphadenopathy?
Submental lymph nodes bilaterally
While explaining how to take nitroglycerin to a patient with new onset angina you accidentally use the term “sublingual” when describing how the medication is administered. The patient gives you a funny look and says “sublingual?” You remember that you shouldn’t use fancy medical terms and explain that sublingual means:
Under the tongue
The area at the back of the throat, posterior to the palatoglossal arch and palatopharyngeal arch, is called
Faucial isthmus
Where do the middle lower lip lymphatics drain to?
Submental nodes
What nerve would a dentist have to anesthetize in order to work on dental caries affecting one of the mandibular molar teeth?
Inferior Alveolar
A 74 year old white male complains of a “sore tongue”. When taking his history, you discover that he has used chewing tobacco since he was 15. Upon examination, you find a large mass that is irregularly shaped and firm. It covers the root and left side of his tongue but does not cross the midline or reach the tip. Which lymph nodes would you expect to find adenopathy?
A. Deep cervical and left submandibular nodes
Which nerve innervates the floor of the mouth?
C. CN V3
Which of the following can causes a decrease in the glow of the frontal sinus?a)
All of the above
A patient comes into your office complaining of hearing loss after she went to a rock concert. You discover her hearing is sensorineural and after asking a few questions, she tells you she was sitting directly in front of the speakers, so you determine her hearing loss is likely due to the level of noise which caused:
Damage to the hair cells of the cochlea
Which of the following muscles of the soft palate is not innervated by the Pharyngeal branch of vagus nerve (CN X) via the pharyngeal plexus?
Tensor veli palatini
You have in your office a 35-year-old female who has been suffering from chronic epistaxis her entire life. She has tried every imaginable treatment and prevention under the sun and still suffers from her condition. You decide to refer her to ENT. Being an astute PA, what branch of the Maxillary Artery do you suspect the ENT folk will target?
Pterygopalatine Branch
Where is the most common origin for epistaxis?
Kiesselbach area
A 65 year old white male presents to your office with a hard palpable mass on left lateral tongue without involvement in tongue tip. He reports that he noticed it 6 months ago and this is the first he has been able to get in for an appointment. He has a tobacco history of chewing 2 tins per week for the last 35 years. You notice on exam that he has enlarged lymph nodes. Which lymph nodes are most likely to be positive for lymphadenopathy
Left submandibular
A patient comes to see you with complaints of chest pain that comes on while shoveling snow. When instructing the patient on the correct way to take nitroglycerin, he laughs and states “what good is holding a pill under my tongue going to do?” Using your superior grasp of anatomy, you educate the patient that nitroglycerin is absorbed quickly into what vessel?
Deep lingual vein
A wrestler’s “cauliflower ear” is caused by leaving what condition untreated?
Auricular Hematoma*
All of these nerves innervate the extraocular muscles EXCEPT:
A. Optic Nerve (CN II)
B. Oculomotor Nerve (CN III)
C. Trochlear nerve (CN IV)
D. Abducent Nerve (CN VI)
A. Optic Nerve (CN II)
A 26 year old male was playing football and took a direct blow to the chest. He cannot abduct his left arm and has lost lateral rotation of the humerus at the glenohumeral joint. Because of this, his arm is pulled medially. You recognize this as “waiter’s tip position” and order an X-ray that reveals a clavicular fracture along the medial third. Which nerve was damaged by his injury?
A. Suprascapular Nerve
B. Subscapular Nerve
C. Axillary Nerve
D. Dorsal Scapular Nerve
A. Suprascapular Nerve
The masseter muscle is involved in all movements of the temporomandibular joint except:
A. Elevation (close mouth) B. Depression (open mouth) C. Protrusion (protrude chin) D. Retrusion (retrude chin) E. Lateral movements (grinding and chewing)
B. Depression (open mouth)
A 55 year old patient enters your office for a physical exam, and upon reviewing their quality of vision, they ask you why their vision declines with age. You explain that this structure controls the shape of the lens, becoming stiffer with age.
A. Dilator pupillae
B. Iris
C. Ciliary muscles of the ciliary body
D. Sphincter pupillae
C. Ciliary muscles of the ciliary body
Jenny Craig, a 60 year old female, presents to your clinic with right eye pain, exophthalmos, and vision loss. You assess her intra-ocular pressure and see that it is increased, and upon looking into her eye on funduscopic exam, you observe papilledema. You’re immediately worried about optic nerve compression and decide to act quickly. CT scan reveals a tumor in the middle cranial fossa, which confirms the compression of the optic disc. You decide that she needs the tumor removed immediately, and explain to her that the easiest access to the middle cranial fossa is through the:
A. Inferior orbital fissure
B. Infraorbital fissure
C. Superior orbital fissure
D. Optic canal
C. Superior orbital fissure
What nerve stimulates binocular movements of the lateral rectus muscle?
A. Abducent nerve (CN VI)
B. Oculomotor nerve (CN III)
C. Trochlear nerve (CN IV)
A. Abducent nerve (CN VI)
A 23-year-old presents to the clinic after being punched in the eye. She complains of seeing flashes of light and specks floating in her vision. What is the cause?
A. Detached Retina
B. Cataracts
C. Glaucoma
D. Papilledema
A. Detached Retina
During a physical exam, you are testing a patient’s ocular movements. You have them follow your finger downward and to the left. Which nerves control this motion?
A. Trochlear Nerve and Oculomotor Nerve B. Abducent Nerve and Trochlear Nerve C. Oculomotor Nerve and Abducent Nerve D. Optic Nerve and Trochlear Nerve
A. Trochlear Nerve and Oculomotor Nerve
A 27 year old female comes to your clinic complaining of headaches and ringing ears. Because you are an expert history taker, you know that she is in a competitive PA program and she has been very stressed. You noted erosion of her incisors and suspect she has been biting down on a pencil. Upon exam, you discover that she has trismus and crepitus at the temporomandibular joint. What best explains her symptoms?
A. Inflammation of articular discs and external auditory meatus B. Acute bacterial parotitis C. A fracture at the mandibular angle D. Thrombophlebitis of facial vasculature
A. Inflammation of articular discs and external auditory meatus
Which of the following muscles retracts the mandible?
A. Masseter
B. Temporalis
C. Lateral Pterygoid
D. Medial Pterygoid
B. Temporalis
Today you are first-assist in a procedure to remove a right parotid salivary gland tumor for an elderly gentleman. During the surgery, you reach the plane containing the parotid plexus. You carefully retract the plexus in order to access and dissect the deep portion of the parotid gland. You take extreme care not to damage these nerves and finish the procedure without any major complications. During a follow-up visit to your clinic, however, your patient presents with an inability to elevate his right labial commissure. Which terminal branch of which cranial nerve was injured?
A. buccal, CN VII
B. marginal mandibular, CN VII
C. zygomatic, CN V
D. mandibular CN V
B. marginal mandibular, CN VII
Which set of eye muscles is recruited when an individual looks up and to the right?
A. Superior rectus and inferior oblique
B. Superior rectus and superior oblique
C. Inferior rectus and superior oblique
D. Inferior rectus and inferior oblique
A. Superior rectus and inferior oblique
A 45 year old white male comes into your clinic for 2 week onset of pain and swelling of his right cheek. He states that pain increases during chewing, especially when he eats sour patch kids. His vitals are within normal limits and his he denies history of tobacco use. He has not had any recent trauma to the area and he is up to date on all his vaccinations. On clinical exam, you note a small, hard mass palpated in the region of the right buccal mucosa. What do you suspect as your patient’s most likely diagnosis?
a. salivary gland tumor
b. sialolithiais
c. sialadenitis
d. dental caries
b. sialolithiais
In another life, you decide to become a dentist. You have a patient come in to get a filling for a dental cavity that has been bothering them. The tooth in question is a molar on the mandible. Checking your supplies, you note that you need to order more novacaine soon, because you are running low. You are going to use the novacaine to block which nerve for this procedure?
a) Superior alveolar nerve
b) Lingual nerve
c) Mental nerve
d) Maxillary nerve
e) Inferior alveolar nerve
e)Inferior alveolar nerve
Which muscle is NOT innervated by the oculomotor nerve?
A. Inferior oblique B. Superior rectus C. Superior oblique D. Medial rectus E. Inferior rectus
C. Superior oblique
During a parotidectomy, which nerve is in danger of injury?
A. Maxillary
B. Trigeminal
C. Ansa cervicalis
D. Facial
D. Facial
A patient presents at your Urgent care with having a cold with bouts of coughing for the past few days. Earlier today during one of these bouts of coughing, she noticed a red spot on her eye prompting her to come in. What is the cause of this blood on her eye?
A. Corneal abrasion
B. Central Artery of the retina occlusion
C. Uveitis
D. Subconjunctival hemorrhage
D. Subconjunctival hemorrhage
Allison presented to the clinic with a chief complaint of not being able to lift her left arm. Upon examination, the PA noticed an obvious droop in Allison’s left shoulder, and she also had a difficult time turning her head to the right against the resistance. The patient recently had surgery to remove an abscess from the middle of the posterior triangle on the left side and had thought her symptoms would improve with recovery, but they have persisted. Given this information, which nerve do you suspect was injured during Allison’s surgery?
A. Facial Nerve (CN VII)
B. Hypoglossal (CN XII)
C. Subscapular Nerve
D. Spinal Accessory Nerve (XI)
D. Spinal Accessory Nerve (XI)
A 67 year old women was diagnosed with a malignant salivary gland tumor. She underwent a parotidectomy, but unfortunately the surgeons were unable to preserve the nerve that is embedded in the parotid gland. What are effects will the patient have from severance of this nerve?
A. weakened mastication on the affected side
B. vision loss and strabismus on the affected side
C. decreased lacrimal fluid production on the affected side
D. facial muscle paralysis on affected side
D. facial muscle paralysis on affected side
A patient presents to the ER with pain and swelling over her left clavicle. She must use her right arm to help initiate abduction of her left arm and she cannot laterally rotate her arm. A radiograph shows a fracture to the middle third of her clavicle. What nerve was injured?
A) Nerve to Subclavius
B) Upper Subscapular Nerve
C) Medial Pectoral Nerve
D) Suprascapular Nerve
D) Suprascapular Nerve
A 6 year-old has a permanently tilted head posture, with the right ear near the right shoulder and the face turned upward and to the left. Which of the following muscles was very likely damaged during birth?
A) Anterior scalene
B) Omohyoid
C) Sternocleidomastoid
D) Platysma
C) Sternocleidomastoid
A lesion of a cervical sympathetic trunk can result in Horner syndrome. Horner syndrome is characterized by all of the following except:
A) Bulging of the eye
B) Contraction of the pupil
C) Drooping of the superior eyelid
D) Absence of sweating on the face and neck
A) Bulging of the eye
What triangle is NOT part of the Anterior Cervical Region (Anterior Triangle)?
A. Submandibular (digastric) triangle B. Submental triangle C. Parotid triangle D. Muscular triangle E. Sternocleidomastoid triangle
E. Sternocleidomastoid triangle
A 10-month-old baby is brought into your clinic by her concerned parents who report that she was pulling herself up on the crib, slipped, and clotheslined herself on the bar of the crib. Surprisingly she has not cried or made any sounds since the injury but appears to be in distress and refuses to eat or drink. What muscle was most likely injured?
A. Mylohyoid
B. Middle Scalene
C. Sternoclydomastoid
D. Orbicularis oris
A. Mylohyoid
What makes up the anterior cervical region, muscular (omotracheal) triangle?
A. Submandibular (digastric) triangle, submental triangle, carotid triangle, muscular triangle
B. Rectus capitis posterior major, obliquus capitis superior, obliquus capitis inferior, vertebral artery
C. Sternohyoid muscle, stenothyroid muscle, thyroid, and parathyroid glands
D. Common carotid artery, internal jugular vein, vagus nerve, external carotid artery, hypoglossal nerve, superior root of ansa cervicalis
C. Sternohyoid muscle, stenothyroid muscle, thyroid, and parathyroid glands
A football player was tackled from behind and landed on an outstretched left hand. The player was experiencing pain, swelling, and nausea in the upper chest on the left side of his body. The athletic trainer asked him if he could abduct his arm, but he was unable to. The athletic trainer also noticed that when the football player’s arm was relaxed it was rotated medially. What nerve did the football player injure?
A. Suprascapular Nerve
B. Vagus Nerve
C. Accessory Nerve
D. Ansa cervicalis
A. Suprascapular Nerve
As little Jimmy was being birthed and the doctor was pulling him out, his neck was pulled excessively to the side. Several days after his birth, his mother brings him in to the clinical, stating that his arm is held at his side, adducted, and medially rotated. What nerve found in the deep anterior triangle would have been injured to cause a “waiter’s tip” position?
Phrenic nerve
Vagus nerve
Spinal accessory nerve
Suprascapular nerve
Suprascapular nerve
All of the following are superficial muscles of the neck EXCEPT:
A. Platysma
B. Sternocleidomastoid
C. Trapezius
D. Sternohyoid
D. Sternohyoid
A 68-year-old male patient presented to a rural emergency department via EMS and was found to be in severe septic shock. The ER PA is preparing to place a central venous line in the right subclavian vein via infraclavicular approach. She inserts the needle just inferior to the middle of the right clavicle and advances it medially. She recalls that if the needle is not inserted carefully, it can puncture the pleura and lung. What pulmonary complication can occur if the needle is not inserted carefully?
A) Pleural effusion
B) Pneumonia
C) Pneumothorax
D) Atelectasis
C) Pneumothorax
The carotid pulse is easily felt by palpating deep to the anterior border of what muscle?
A) Trapezius
B) Sternocleidomastoid
C) Sternohyoid
D) Mylohyoid
B) Sternocleidomastoid
Which structure does not run through the carotid sheath?
A. Common carotid artery
B. Internal jugular vein
C. Phrenic nerve
D. Vagus nerve
A. Phrenic nerve
A 72 year-old man has undergone a right lower lobectomy following a diagnosis of large cell carcinoma of the right lung. Following the surgery, he develops a paradoxical depression of the right diaphragm with expiration. What nerve was injured in the procedure?
A. Vagus nerve
B. Phrenic nerve
C. Accessory spinal nerve
D. Recurrent laryngeal nerve
B. Phrenic nerve
A 25 year old man is brought into the ED with a gunshot wound to the left lateral cervical region. He is still breathing adequately. Upon further examination it is noted that he has weakness in rotating his head to the right against resistance. The left shoulder also appears to be drooping. Damage to which structure is causing the weakness ?
A. Platysma
B. CN XI
C. Carotid artery
D. Superior trunk of brachial plexus
B. CN XI
What structure is commonly used in central line placement?
A. internal jugular vein
B. Radial artery
C. Subclavian Vein
D. Carotid artery
C. Subclavian Vein
Damage of the sympathetic trunk can occur from lung cancer, infection or neck injury. This injury can produce Horner syndrome which consists of what three symptoms?
A. partial ptosis, anhidrosis, missio
B. Proptosis, miosis, exophthalmos
C. night sweats, exophthalmos, mydriasis
D. mydriasis, partial ptosis, anhidrosis
A. partial ptosis, anhidrosis, miosis
Robby, a 23-year old caucasian male, recently joined a weekly dart league. While playing last night, an aberrant dart struck him in the neck. Robby has since noticed weakness in turning his head laterally to the left along with an inability to elevate and retract his right shoulder. Which nerve is likely to be damaged?
A. Transverse Cervical Nerve (C2 and C3)
B. Hypoglossal Nerve (CN XII)
C. Spinal Accessory Nerve (CN XI)
D. Vagus Nerve (CN X)
C. Spinal Accessory Nerve (CN XI)
CN XI innervates the trapezius and sternocleidomastoid muscles
Larry, a 60 year old man, is brought to the clinic by his wife. His wife reports that her husband was pulled over for stopping in the middle of the road earlier that day. Larry reports he stopped because he was dizzy and couldn’t remember where he was driving in a nearby town. His wife reports he’s made the trip numerous times and has concerns over his level of confusion. Larry states his confusion probably lasted for about 4 hours as it took him all morning to make the trip but he denies any current confusion, dizziness, or disorientation. The PA suspects a TIA and after completing a Doppler decides that Larry should have a carotid endartectomy. Which cranial nerve is the physician assistant NOT concerned about during the stripping of of the atherosclerotic plaque?
A. CN VIII
B. CN IX
C. CN X
D. CN XI
A. CN VIII
Which vessel is checked regularly during cardiopulmonary resuscitation (CPR)?
A. Internal jugular vein
B. Subclavian artery
C. Suprascapular artery
D. Carotid artery
D. Carotid artery
A 42 year old female patient suffering from thyroid cancer underwent thyroidectomy and is now presenting with muscle twitches and cramps. The provider realizes that the patient has tetany and treats her promptly and accordingly to prevent a life-threatening situation. What structure may have been damaged when removing the thyroid gland?
A. Vagus Nerve
B. Recurrent Laryngeal Nerve
C. Parathyroid Glands
D. Parotid Glands
C. Parathyroid Glands
What is the shared innervation of the sternohyoid, omohyoid, and sternothyroid muscles of the neck?
A. Ansa cervicalis
B. Hypoglossal nerve
C. Nerve to mylohyoid
D. Sympathetic trunk
A. Ansa cervicalis
Which of the following are causes of cervical pain?
a. Inflamed Lymph nodes
b. Muscle strain
c. Protruding intervertebral discs
d. All of the Above
d. All of the Above
A woman comes in after falling out of her deer stand. Later that week, she went to Snap Fitness for a workout and realized she was unable to sweat. On her drive home from the gym that night, she was having difficulty seeing and night blindness due to pupil constriction. Finally, by the time she got home, her husband noted that her eyes were slightly sunk back in her eye socket and she also was displaying ptosis bilaterally. Her husband drove her to the emergency department. Which of the following did the ED PA say to the patient?
a. “You likely have a lesion to your cervical sympathetic trunk, causing Horner’s Syndrome.”
b. “You likely have a lesion to your phrenic nerve, causing Horner’s Syndrome.”
c. “You likely have a lesion to your cervical sympathetic trunk, causing Wenger’s Syndrome.”
d. “You likely have a lesion to your phrenic nerve, causing Wenger’s Syndrome.”
a. “You likely have a lesion to your cervical sympathetic trunk, causing Horner’s Syndrome.”
A 20-year-old man was slashed in the right anterior cervical region (anterior triangle). An ambulance was called and the paramedics stopped the bleeding from the external jugular vein. He was taken to the ER where he was examined by a physician. When the man was asked to protrude his tongue, its apex was turned to the right side. The physician concluded there was a nerve legion. Which of the following most likely describes the cause of deviation of the man’s tongue?
A: Injury of the pharyngeal plexus of nerves
B: Paralysis of the right hypoglossal nerve (CN XII)
C: Injury of the transverse cervical nerve (C2 and C3)
D: Injury of the glossopharyngeal nerve (CN IX)
B: Paralysis of the right hypoglossal nerve (CN XII)
What structure below provides a movable base for the tongue and attachment site for the middle part of the pharynx, while also maintaining patency of the pharynx, which is required for swallowing and respiration?
A: Trachea
B: Hyoid Bone
C: Platysma
D: Cervical Vertebrae
B: Hyoid Bone
A PA student is really bummed that he has to take a four week holiday break. He frowns to express his feelings. Which nerve is responsible for innervating the muscle that causes him to frown in disappointment?
A) CN VII
B) CN XI
C) C2
D) C3
A) CN VII
“Hector sprang from his chariot to the ground, and seizing a great stone made straight for Teucer with intent to kill him…Hector struck him with the jagged stone….he hit him where the collar bone divides the neck from the chest, a very deadly place and broke the sinew of his arm so that his wrist was less, and his bow dropped from his hand as he fell forward on his knees.” -Homer, The Iliad, C. 800BC.
If Teucer had been able teleport to modern medicine, in what region of the neck would a 21st century PA find the most likely injured nerve of the fated Teucer?
A) Suboccipital Triangle (Deep)
B) Superficial Anterior Triangle
C) Deep anterior triangle
D) Superficial Posterior Cervical Region
C) Deep anterior triangle
In West Philadelphia born and raise, on a playground is where this 16 year old spent most of his days. As he was chilling-out and relaxing and playing it cool a couple of guys showed up from his school. As a gun was drawn and the trigger was released, the 16 year old dropped to his knees. He was taken to the hospital where the doctors said, they missed the carotid but now you can’t turn your head. So he was hit on the right side but now his head doesn’t turn left, the right shoulder doesn’t shrug, and he struggles to take a deep breath. As the doctor looked him in the eye he finally asked, you’ve damaged what nerve and who knows if it is coming back?
A) CN lX (Glossopharyngeal Nerve)
B) CN X (Vagus Nerve)
C) CN Xl (Spinal Accessory Nerve)
D) CN Xll (Hypoglossal Nerve)
C) CN Xl (Spinal Accessory Nerve)
An infection between which layers of the neck can lead to a spread of the infection to the thoracic cavity anterior to the pericardium?
A) Investing fascia and visceral part of the pretracheal fascia
B) Investing fascia and the carotid sheath
C) Pretracheal fascia and the carotid sheath
D) Investing fascia and prevertebral layer of deep cervical fascia
A) Investing fascia and visceral part of the pretracheal fascia
A patient presents to the ED with shortness of breath, chest pain, bilateral lower leg edema and jugular venous distention. You have determined their likely diagnosis is pulmonary hypertension. In order to measure the pulmonary blood pressure you choose to utilize right cardiac catheterization. Which vessel will you puncture in order to thread the catheter into the right heart chambers?
A) Carotid Artery
B) Internal Jugular Vein
C) Subclavian Vein
D) Subclavian Artery
B) Internal Jugular Vein
Which nerve supplies the platysma muscles of the neck?
A) Spinal Accessory Nerve
B) Mandibular Branch of Facial Nerve
C) Cervical Branch of Facial Nerve
D) None of the Above
C) Cervical Branch of Facial Nerve
A patient is brought into the emergency department with confusion, diaphoresis, tachycardia, tachypnea, pale skin and a weak pulse. You determine that they are in shock and decide to place a central line. To which vessel will you most likely place the line?
a) Ascending aorta
b) Superior vena cava
c) Subclavian vein
d) Internal carotid artery
c) Subclavian vein
What muscle makes up the posterior border of the anterior cervical region?
a) Stylohyoid
b) Posterior belly of the digastric
c) Posterior scalene muscle
d) Sternocleidomastoid muscle
d) Sternocleidomastoid muscle
If a pointy object were to enter the neck midline anterior and exit posterior, while missing the carotid sheaths entirely, in what order would it penetrate the cervical fascia layers?
A. Prevertebral, pretracheal visceral, pretracheal muscular, investing
B. Investing, pretracheal muscular, pretracheal visceral, prevertebral
C. Pretracheal muscular, pretracheal visceral, investing, prevertebral
D. Investing, prevertebral, pretracheal visceral, pretracheal muscular
B. Investing, pretracheal muscular, pretracheal visceral, prevertebral
A mother brings her 3-year-old boy to the ER after his twin brother pushed him off the chair he was standing on and he fell backwards, striking the back of his head on the table. On exam you note profuse bleeding from the occipital region. What vascular structures are you concerned about?
A. Occipitofrontalis artery and vein B. Cervical artery and vein C. Occipital artery and vein D. Carotid artery E. Ansa cervicalis artery and vein
C. Occipital artery and vein
What muscle divides the neck into anterior and lateral cervical regions?
A. SCM
B. Platysma
C. Trapezius
D. Sternohyoid
A. SCM
A 25- year old PA student notices that her left shoulder is drooping and she is unable to raise her hand in class to ask questions. Which nerve has been affected?
A. Spinal accessory nerve (CN XI)
B. Transverse cervical nerve
C. Phrenic nerve
D. Vagus nerve
A. Spinal accessory nerve (CN XI)
Which muscle elongates the floor of the mouth by elevating and retracting the hyoid?
A. Stylohyoid
B. Geniohyoid
C. Mylohyoid
D. Omohyoid
A. Stylohyoid
A 26 year old male was playing football and took a direct blow to the chest. He cannot abduct his left arm and has lost lateral rotation of the humerus at the glenohumeral joint. Because of this, his arm is pulled medially. You recognize this as “waiter’s tip position” and order an X-ray that reveals a clavicular fracture along the medial third. Which nerve was damaged by his injury?
A. Suprascapular Nerve
B. Subscapular Nerve
C. Axillary Nerve
D. Dorsal Scapular Nerve
A. Suprascapular Nerve
A patient presents to you in the ER with cough and shortness of breath. The astute PA you are, you find out he also has four pillow orthopnea and pedal edema. Looking for other signs of fluid back up, you check his neck for visible pulsations of which vessel?
A. External jugular vein B. Internal jugular vein C. Subclavian vein D. Internal carotid artery E. External carotid artery
A. External jugular vein
Which nerve in the neck is contained within the carotid sheath?
A. Spinal accessory nerve
B. Suprascapular nerve
C. Phrenic nerve
D. Lesser occipital nerve
E. Vagus nerve
E. Vagus nerve
The greater and lesser wings of the sphenoid bone as well as the squamous and petrous parts of the temporal bones form which structure?
A. The hypophyseal fossa
B. The anterior cranial fossa
C. The middle cranial fossa
D. The posterior cranial fossa
C. The middle cranial fossa
You are in clinic and are seeing a new family for the first time who recently made a move from sunny southern California. You notice at the outset that the teenage boy doesn’t seem to happy about the move and is sulking in his chair. When spoken to, he respectfully answers you questions, but he always seems to look at you with a sort of sideways glance and his head tilted to one side. You also note that he seems to wince when he has to turn his head to look at his mom. Upon examination, you note tenderness to palpation, tilting of the head to the left and a slight rotation to the right. Being an astute provider you diagnose this patient with Torticollis. Which muscle is affected and is responsible for his symptoms?
A. Anterior Scalene
B. Sternocleidomastoid Muscle
C. Superior fibers of the Trapezius
D. Posterior Scalene
B. Sternocleidomastoid Muscle
A man stumbles into your ER after a fight at a local bar. A beer glass was shattered and used as a weapon, but luckily only grazed your patients right neck missing any arteries. You get the bleeding controlled, but the patient is having continued difficulty breathing. Why does injury to the external jugular vein have an increased risk of air embolism?
A. Decreased number of valves
B. Size of the vessel
C. Negative intrathoracic pressure
D. Proximity to the airway
C. Negative intrathoracic pressure
Following a recent neck surgery, you notice the patient's skin on his seems loose. You know that the skin of the neck is usually held tight by the platysma, which is supplied by which branch of the facial nerve? A. Temporal B. Zygomatic C. Buccal D. Mandibular E. Cervical
E. Cervical
An 18 year old male presents to your ED after flipping backwards off of his 4-wheeler and having his 4-wheeler fall directly on his right shoulder. He is unable to initiate abduction of his right arm and cannot rotate his arm laterally. He states that his pain is 8/10 on the pain scale. After x-ray imaging, you determine his right clavicle is fractured within the middle third of the bone. Which nerve do you suspect is damaged?
a. Axillary nerve
b. Musculocutaneous nerve
c. Suprascapular nerve
d. Dorsal scapular nerve
c. Suprascapular nerve
Which nerve is responsible for contraction of the platysma?
A. Facial nerve (CN VII)
B. Trigeminal nerve (CN V)
C. Spinal accessory nerve (CN XI)
D. Vagus nerve (CN X)
A. Facial nerve (CN VII)
You are seeing a patient for a follow-up right-side carotid endarterectomy he had last week due to an occlusion. He notes that he is feeling great and has had no pain whatsoever. He mentions that he’s been a little weak, and has had some trouble putting his dishes in the cupboards, but chalks it up to post-procedure weakness. When you tell him not to ignore any weakness or sensation loss he shrugs his shoulders, holding his hands in the air, “I’m a stubborn Italian, what do you expect?”. As you observe his gesture, you notice a droopiness in his right shoulder. You worry that you may have damaged what nerve during the endarterectomy, which supplies the muscle responsible for shrugging the shoulders?
A. Glossopharyngeal Nerve (CN IX)
B. Hypoglossal Nerve (CN XII)
C. Facial Nerve (CN VII)
D. Accessory Nerve (CN XI)
D. Accessory Nerve (CN XI)
Although deglutition seems simple, there are many actions that compliment each other during this process. Which structure is responsible for permitting movement of the pharynx, esophagus, larynx, and trachea relative to the vertebral column during swallowing?
A Carotid Sheath
B. Retropharyngeal space
C Pre-vertebral fascial layer
D Investing (superficial) fascial layer
B. Retropharyngeal space
A 27 year old man presents to the ED with a chief complaint of a “sore neck” that started one month ago after he really got into World of Warcraft and has been playing for 12 hours a day. Inspection and palpation reveals a swelling in the sternocleidomastoid region of the neck that is red, warm, and painful. The patient is very hesitant to give a thorough history, but after much patience on the provider’s part he finally admits that his girlfriend tried to do some home acupuncture on his sore neck after she learned about it on her recent enlightening trip to Beijing. As a provider, what is your main concern about an abscess between the investing fascia and the visceral pretracheal fascia?
A. compression of the trachea, causing respiratory distress
B. compression of the carotid artery, causing syncope
C. tracking of infection down the mediastinum to the thorax
D. tracking of infection up the carotid sheath into the cranium
C. tracking of infection down the mediastinum to the thorax
Which region of the neck serves as the junction between the thorax and the neck?
A. anterior cervial region
B. posterior cervical region
C. carotid triangle
D. root of neck
D. root of neck
You are called on to do a venous catheterization to measure central venous pressure in the heart. Which muscle of the neck would provide the best area of approach to the internal jugular vein?
A. Anterior scalene B. Digastric C. Omohyoid D. Sternocleidomastoid E. Sternohyoid
D. Sternocleidomastoid
Which of the following hyoid muscles is an important landmark in both the anterior and posterior triangles of the neck?
A. geniohyoid B. mylohyoid C. omohyoid D. sternohyoid E. stylohyoid
C. omohyoid
The preferred route in right cardiac catheterization involves all but which of the following:
A. External Jugular Vein
B. Superior Vena Cava
C. Right Brachiocephalic Vein
D. Internal Jugular Vein
A. External Jugular Vein
Allison presented to the clinic with a chief complaint of not being able to lift her left arm. Upon examination, the PA noticed an obvious droop in Allison’s left shoulder, and she also had a difficult time turning her head to the right against the resistance. The patient recently had surgery to remove an abscess from the middle of the posterior triangle on the left side and had thought her symptoms would improve with recovery, but they have persisted. Given this information, which nerve do you suspect was injured during Allison’s surgery?
A. Facial Nerve (CN VII)
B. Hypoglossal (CN XII)
C. Subscapular Nerve
D. Spinal Accessory Nerve (XI)
D. Spinal Accessory Nerve (XI)
You see a patient who recently had a tonsillectomy. He is now experiencing difficulty chewing, speaking, and swallowing. During examination you see some atrophy of his tongue. When you ask him to stick out his tongue who notice it deviates to the right. You determine that during his tonsillectomy damage occurred to what nerve?
A) Vagus Nerve (CN X)
B) Spinal Accessory Nerve (CN XI)
C) Superior Laryngeal Nerve (CNX)
D) Hypoglossal Nerve (CN XII)
D) Hypoglossal Nerve (CN XII)
What are the layers of the cervical viscera from superficial to deep?
a. Alimentary, Endocrine, Respiratory
b. Endocrine, Alimentary, Respiratory
c. Respiratory, Endocrine, Alimentary
d. Endocrine, Respiratory, Alimentary
d. Endocrine, Respiratory, Alimentary
A patient is diagnosed with Thyroid cancer and is later hospitalized for a thyroidectomy. The surgeon explains to the patient that patient will take calcium supplements for the rest of their life, and hormone replacement (Levothyroxine). The surgeon explains the reason for the calcium supplement is because of the 4 structures that are located either within the thyroid capsule or just behind it that are commonly injured during surgery. These 4 structures help regulate calcium levels, and without them, it can cause serious complications. What are these 4 small structures located dorsally to the thyroid?
a. Parathyroid glands
b. Lymph Nodes
c. Thymus
d. Isthmus
a. Parathyroid glands
A patient comes in to your office for a follow up visit following surgery for a herniated cervical disk. You notice that his voice is unusually hoarse. He does not report any other symptoms or feeling ill. He has no history of smoking or other tobacco product use. He reports no history of exposure to irritants. He says he “feels fine and was just following orders to come for a follow up visit.” You realize you need to consult with his surgeon because you are concerned that that patient’s __________________has been injured.
A) Vagus Nerve
B)Thyroid branches of inferior thyroid artery
C) Ascending cervical arteries
D) Right recurrent laryngeal nerve
D) Right recurrent laryngeal nerve
You are a WHO health care worker in Ghana and are really concerned because a Chinese unfortified salt importer just undercut the national costs of fortified salt down 3 cents per kg. What issue are you most concerned about?
A) Goiter
B) Scurvy outbreak
C) Hypocalcemia
D) Kwashiorkor
A) Goiter
A 70 year old female presents to your clinic for new onset of 3 month persistent, progressive dysphagia. She has a history significant for Barrett’s esophagus and reports that she has “never been good about taking that GERD medicine.” After gathering more of her history you note that she has had an unintentional weight loss of 20lbs over the last 2 months. Her exam is positive for lymphadenopathy of her inferior deep cervical lymph nodes and you note hoarseness of her voice. What is the first thing you list on your differential diagnosis?
a. Foreign body aspiration
b. Esophageal cancer
c. Benign stricture of the esophagus
d. Esophageal trauma
b. Esophageal cancer
A 70 year old female presents to your clinic for new onset of 3 month persistent, progressive dysphagia. She has a history significant for Barrett’s esophagus and reports that she has “never been good about taking that GERD medicine.” After gathering more of her history you note that she has had an unintentional weight loss of 20lbs over the last 2 months. Her exam is positive for lymphadenopathy of her inferior deep cervical lymph nodes and you note hoarseness of her voice.
In the question listed above, compression of which nerve is responsible for the patient’s hoarse voice?
A. Recurrent laryngeal nerve
B. Vagus nerve (CN X)
C. Spinal accessory nerve (CN XI)
D. Glossopharyngeal nerve (CN IX)
A. Recurrent laryngeal nerve
A mother states her newborn keeps coughing and choking when she tries to feed her. You notice the infant becomes cyanotic when coughing. A radiograph shows that the infant’s stomach is distended with air. What is the most likely cause of the infant’s symptoms?
A) Esophageal Atresia and Tracheoesophageal Fistula
B)Esophageal Atresia
C)Esophageal Stenosis and Dysphagia
D) Tracheoesophageal Fistula
A) Esophageal Atresia and Tracheoesophageal Fistula
The primary palate forms via the fusion of which 2 prominences in the midline?
a. Lateral Nasal
b. Medial Nasal
c. Maxillary
d. Frontal
b. Medial Nasal
In normal embryology, pharyngeal cleft 1 will develop into the external auditory meatus. If a mother who did research on WedMD brings in their child into the clinic with a defect to this process, what physical findings are present?
a. Split earlobe
b. Tonsillar deformity
c. Preauricular cysts
d. Mastoid process deformity
c. Preauricular cysts
When performing a thyroidectomy it is important to leave the parathyroid glands in because they regulate what element in the blood stream?
A. Iodine
B. Calcium
C. Potassium
D. Sodium
B. Calcium
Enlargement of the thyroid gland is associated with deficiency of which element?
A. Calcium
B. Iodine
C. Potassium
D. Fluoride
B. Iodine
A 15 year-old female is seen in your emergency department with bleeding after a tonsillectomy 2 days ago. She was doing fine for 24 hours after surgery, but on day 2 she began spitting up blood. On exam you note blood oozing from her oropharynx. What blood vessel do you suspect has been injured?
A. Superior thyroid vein
B. Internal jugular vein
C. Maxillary vein
D. External palatine vein
D. External palatine vein
The UWS goalie was pulled from the ice during the last few minutes of a hockey game for an extra skater on the ice. A forward from UWS acted as goalie as the CSS players were swarming the net, about to score. A CSS player pulled a wrist shot, and hit the UWS player acting as goalie in the neck. The UWS player fell on the ice and was transported to the nearest hospital after establishing an airway. The UWS player was unable to speak. The attending physician noticed submucous hemorrhage and edema upon physical examination using a nasopharyngoscope. What is the player likely experiencing?
A. Tracheo-Esophageal Fistula
B. Hyoid Bone Fracture
C. Goiter
D. Laryngeal Skeleton Fracture
D. Laryngeal Skeleton Fracture
What artery is present in 10% of people that branches from the brachiocephalic trunk and must be considered when performing procedures in the midline of the neck inferior to the isthmus due to bleeding risk?
A. Inferior Thyroid Artery
B. Middle Thyroid Artery
C. Thyroid Ima Artery
D. Ascending Cervical Branch of Inferior Thyroid Artery
C. Thyroid Ima Artery
What is “Deglutition”?
A. Swallowing
B. Sneezing
C. Choking
D. Snoring
A. Swallowing
Amy was diagnosed with mononucleosis on her 30th birthday (true story) and consequently spent the summer in bed. As she began recovering, her darling boyfriend referred to the enlarged lymph glands encircling her neck as her “neckticles”. What structure draining into the posterior cervical lymph nodes was contributing to their enlargement?
A. Pharyngeal Tonsil (Adenoids)
B. Palatine Tonsils
C. Parathyroid Glands
D. Paratracheal lymph nodes
A. Pharyngeal Tonsil (Adenoids)
A PA determines that he needs to perform a tracheostomy to establish an airway in an infant with upper airway obstruction. He starts by making a transverse incision through the skin of the neck and anterior wall of the trachea. He recalls that the trachea is small, mobile, and soft in infants, and this makes it easy to inadvertently cut through the posterior wall. What structure would be damaged if a cut were made through the posterior wall of the trachea?
A)Thyroid gland
B) Esophagus
C) Isthmus
D) Cricothyroid membrane
B) Esophagus
What artery, when it is tortuous and lies directly lateral to the tonsil, is especially vulnerable during tonsillectomy?
A) Ascending cervical artery
B) Inferior thyroid artery
C) Internal carotid artery
D) Inferior laryngeal artery
C) Internal carotid artery
Goiter is a non-inflammatory, non-neoplastic enlargement of the thyroid gland. During such an enlargement, the trachea can move in many directions. The movement of the trachea in which direction is not possible due to its attachments to the sternothyroid and sternohydoid muscles?
A. Inferior
B. Superior
C. Posterior
D. Anterior
B. Superior
A 12-year-old boy presented with bilateral nasal obstruction, mouth breathing, anterior nasal discharge, and a new habit of snoring. The symptoms began four months ago and have gotten worse over time. More recently, the young patient has been experiencing severe nasal obstruction. His mother stated that she thought the boy developed allergies, but the symptoms have not improved with local or systemic decongestants or antihistamines. Upon examination with a nasopharyngoscope, a large mass was found in the lymphatic tissue located in the posterosuperior nasopharynx. After a relatively routine surgery to remove the structure that the mass occupied, the boy’s symptoms were completely resolved. What surgery was performed?
A. Tonsillectomy
B. Rhinoplasty
C. Adenoidectomy
D. Endoscopic Ethmoidectomy
C. Adenoidectomy
A patient and her husband present to your office following a thyroidectomy of the superior pole of the thyroid. The husband does much of the talking due to the patient is having difficulty with her speech, mainly with changing the pitch, but overall there is poor vocal quality. She endorses coughing following drinking liquids, but denies difficulty breathing. You suspect that she is experiencing paralysis of her cricoid muscle. What nerve do you believe was damaged during her surgery?
A. Recurrent laryngeal nerve
B. External branch of superior laryngeal nerve
C. Internal branch of the superior laryngeal nerve
D. Cervical sympathetic trunk
B. External branch of superior laryngeal nerve
Which lymphatic tissue is found in the most superior portion of Waldeyer’s Ring?
A. Pharyngeal (adenoid) tonsil B. Tubal tonsil C. Palatine tonsil D. Lateral pharyngeal bands E. Lingual tonsil
A. Pharyngeal (adenoid) tonsil
A 65 year old male presents to the ED after swallowing a piece of bone while scarfing down his favorite BBQ chicken wings. He complains that he can “feel the piece of bone lodged in his throat”. Because you are a superstar PA, you remember that when foreign bodies are swallowed they can become lodged in the piriform fossae and that since the swallowed bone may be sharp you should be worried about which of the following?
A) Paralysis of the vocal folds
B) Injury to the internal laryngeal nerve
C) Injury to the hypoglossal nerve
D) All of the above
B) Injury to the internal laryngeal nerve
Which of the following is NOT a main function of the cervical respiratory viscera?
A) Producing Voice
B) Providing a patent airway and means of sealing it off temporarily
C) Routing air and food into the respiratory tract and esophagus
D) All of the above are functions of the cervical respiratory viscera
D) All of the above are functions of the cervical respiratory viscera
Which of the following is NOT innervated by the the inferior laryngeal nerve?
A. Cricothyroid B. Posterior crico-arytenoid C. Lateral crico-arytenoid D. Transverse and oblique arytenoids E. Vocalis
A. Cricothyroid
You are seeing in your office an elderly gentleman status-post carotid endarterectomy. When asked to stick out his tounge, his tounge deviates to the right. Additionally, the patient has difficulty swallowing. Damage to which two nerves would cause his tongue deviation and difficulty swallowing, respectively?
A. Hypoglossal, Glossopharyngeal
B. Hypoglossal, Vagus
C. Vagus, Glossopharyngeal
D. Vagus, Lingual
B. Hypoglossal, Vagus
A customer is dining at Olive Garden (lovingly referred to as “pasta prison”) for Never Ending Pasta Bowl. He hasn’t had a bite to eat all day and is prepared for the occasion. In his haste, he gobbles down a meatball and starts to choke as it becomes lodged in his throat. A superstar server rises to the occasion and performs the Heimlich maneuver, but bad turns to worse and the obstruction cannot be relieved. What is the next and likely last resort to relieve the obstruction in a hurry?
A. Needle cricothyrotomy and tracheostomy
B. Tracheal intubation and tracheostomy
C. Bag mask ventilation
D. Surgical removal of the obstruction
A. Needle cricothyrotomy and tracheostomy
In tracheostomy, what structure is cut through to establish an airway?
A. Cricothyroid membrane
B. Laryngeal skeleton
C. Thyroid gland
D. None of the above
A. Cricothyroid membrane
Dayna has been belting out Shakira songs for the last week, but today she realized her voice will no longer hit the high notes. What muscle can she no longer constrict?
A) Thyroarytenoid muscle
B) Transverse arytenoid muscle
C) Oblique arytenoid muscle
D) Cricothyroid muscle
D) Cricothyroid muscle
On Burrito Monday, Paige was so excited to finally get her burrito, she started chowing down instantly. Within the first few bites a piece got stuck in the vestibule of her larynx and she couldn’t breath. Mackenzie had just learned that instead of doing the Heimlich Maneuver, she could do a cricothyrotomy to get air into the lungs. She was able to save Paige, but because she inserted the needle too far left, Paige can no longer constricts the walls of her pharynx to swallow. Mackenzie mistakenly hit what nerve?
A) CN lX
B) CN X
C) CN Xl
D) CN Xll
B) CN X
Prior to making the Clear Eyes commercial, Ben Stein underwent surgery to remove his thyroid. After surgery, Mr. Stein complained of a hoarse and easily fatigued voice. Months after, he noted he was still unable to produce a pitched voice and was thus monotone. Mr. Stein went to the clinic because he was worried about his upcoming advertising gig and needed to have his pitched voice back.The physician noted the symptoms were due to paralysis of the cricothyroid muscle. What nerve was affected?
A. Vagus Nerve
B. Superior Laryngeal Nerve
C. Inferior Laryngeal Nerve
D. Hypoglossal Nerve
(A is also technically correct, because the Superior Laryngeal Nerve is a branch of the Vagus Nerve.)
B. Superior Laryngeal Nerve
A is also technically correct, because the Superior Laryngeal Nerve is a branch of the Vagus Nerve.
To relieve stress after taking a Fun Med exam, a Physician Assistant student enrolled in kickboxing classes. During class, the student was kicked in the neck. The patient’s voice was instantly altered and he had severe pain when swallowing. He began coughing up frothy blood and went to the E.R. immediately. The E.R. physician was instantly worried about his airway becoming obstructed. What injury occurred?
A. Omohyoid Paralysis
B. Arytenoid Subluxation
C. Laryngeal Fracture
D. Thyroiditis
C. Laryngeal Fracture
Which of the following statements about the intrinsic muscles of the larynx is false?
A. They are all innervated by the inferior laryngeal nerve
B. The posterior coricoarytenoid muscle abducts the vocal folds
C. The lateral coricoarytenoid muscle adducts the vocal folds
D. The cricothyroid muscle stretches and tenses the vocal ligament
A. They are all innervated by the inferior laryngeal nerve
You are performing a routine physical exam to establish care for a new patient. The patient is a 46-year old Caucasian female. While examining her neck, you find a 2cm nodule on the right side of her thyroid. The nodule is firm and mobile in relation to the underlying tissue. Vital signs and the remainder of the examination are normal. She has a family history of thyroid cancer. If the patient had cancer and had to undergo a thyroidectomy, what could signify that surrounding structures were injured during surgery?
A. Stridor B. Hoarse voice C. High-pitched voice D. A and B E. A and C
D. A and B
A 36 year old female has been hospitalized following recent smoke inhalation. The patient has been hospitalized and intubated for a few days. Her providers believe that she may have some permanent damage to her throat and therefore may need a tracheostomy. The surgeon visits the patient prior to surgery to discuss location (incision between the first and second tracheal rings) and the risks associated with the procedure including all possible vessels that may be severed. Which vessel is at the highest risk for severance?
A. superior thyroid artery
B. superior thyroid vein
C. inferior thyroid vein
D. subclavian artery
C. inferior thyroid vein
All of the muscles of the pharynx are innervated by cranial nerve X except:
A. superior pharyngeal constrictor
B. palatopharyngeus
C. salpingopharyngeus
D. stylopharyngeus
D. stylopharyngeus
A 40 year old male presents to your office with a persistent hoarse voice. He states that this has been going on for a few weeks and he has recently developed an earache. He has also noted some difficulty swallowing. He volunteers that he has used chewing tobacco every day since he was 16. What physical exam finding would you expect to find in this patient?
A. Enlarged pretracheal or paratracheal lymph nodes
B. Carotid bruits
C. Post auricular lymphadenopathy
D. Diminished breath sounds over right upper lobe
A. Enlarged pretracheal or paratracheal lymph nodes
The laryngeal nerve is nicked during a surgery, what is the most likely result of this?
A. Left tongue paralysis
B. Vocal fold paralysis
C. Loss of sensation on face
D. Loss of taste over right tongue
B. Vocal fold paralysis
A student decides that school is too difficult and wants to join the circus. She attempts sword swallowing and fails. After being stabilized, it was noted that she frequently aspirated fluid into her lungs. Upon examination it was determined that the area of the piriform sinus above the vocal fold of the larynx was numb. What nerve that would supply sensory innervation to this area could have been injured?
A. External branch of the superior pharyngeal
B. Internal branch of the superior laryngeal
C. Hypoglossal
D. Lingual
E. Recurrent laryngeal
B. Internal branch of the superior laryngeal
The nerve that innervates all but one muscle of larynx is the:
A. Inferior laryngeal nerve
B. Glossopharyngeal nerve, pharyngeal branch
C. Superior laryngeal nerve, external branch
D. Superior laryngeal nerve, internal branch
E. Thyrohyoid nerve
A. Inferior laryngeal nerve
A baseball player comes into your clinic after taking a fast pitch to the front of the neck, just below the hyoid bone. Miraculously, there was no broken bones or damaged nerves. The swelling of the infrahyoid musculature has caused compression of the left brachiocephalic vein, occluding it. Which part of the thyroid is unable to drain due to this injury?
A. Superior poles of the thyroid
B. Middle lobes of the thyroid
C. Inferior poles of the thyroid
D. Lower parathyroid glands
C. Inferior poles of the thyroid
Damage to the inferior laryngeal nerve results in a loss of function in all intrinsic muscles of the larynx EXCEPT for the __________, which is responsible for elongating and tightening the vocal ligaments, ultimately _________ the pitch of the voice.
A. Crico-arytenoid; raising
B. Cricothyroid; raising
C. Cricothyroid; lowering
D. Crico-arytenoid; lowering
B. Cricothyroid; raising
What muscle is most responsible for abduction of the vocal folds?
A. Posterior crico-arytenoid
B. Lateral crico-arytenoid
C. Transverse arytenoid
D. Oblique arytenoid
A. Posterior crico-arytenoid
A 60-year-old male presents to the clinic with complaints of a hoarse voice and difficulty breathing. Just yesterday he had a partial thyroidectomy where they had to ligate the Inferior thyroid artery. Which nerve is in close relationship to this artery and was injured?
A. Recurrent laryngeal nerve
B. External laryngeal nerve
C. Internal laryngeal nerve
D. External branch of the superior laryngeal nerve
A. Recurrent laryngeal nerve
In what procedure would the possible presence of a thyroid ima artery be important to consider?
A. carotid endarterectomy
B. tonsilectomy
C. laryngoscopy
D. tracheostomy
D. tracheostomy
One week before his Ironman, Frank went out for one more 30 mile “shakeout” bike ride. Suddenly, a deer came bounding out of the woods, and in an effort to avoid hitting the creature, Frank ended up going over his handlebars and striking his anterior cervical region on his aerobars. What symptoms seen by the ER physicians who accepted Frank from the paramedics would suggest a laryngeal fracture?
A. uncontrollable coughing fits, followed by wheezing and stridor
B. respiratory obstruction from submucous hemorrhage
C. hoarseness and sever sore throat, but able to speak
D. dysphagia, hemoptysis, an inabilty to speak
B. respiratory obstruction from submucous hemorrhage
A patient presents with fever, decreased hearing, and sense of smell. Enlargement of what lymph node is the cause of these complaints?
A. Pharyngeal lymph nodes
B. Tonsillar lymph nodes
C. Submental lymph nodes
D. Posterior auricular lymph nodes
A. Pharyngeal lymph nodes
While observing an exploratory laryngoscopy, the HEENT physician asks the PA student “What are the white strips at the entry to the trachea?”
A. Vestibular folds
B. Vocal folds
C. Ary-glottic fold
D. Laryngeal vestibule walls
B. Vocal folds
Having decided to go into endocrinology, you are excited to be first assisting on your first surgery–a near total thryoidectomy for a malignant tumor of the thyroid gland! You decide to review the anatomy of the thyroid before the day of the surgery because you know there are a number of avoidable risks, including:
A) Severe hemorrhage that may compress the trachea
B) Damaging the recurrent laryngeal nerve
C) Removing the parathyroid glands.
D) A and B only
E) A, B, and C
E) A, B, and C
Which tonsil is also known a the adenoid?
A) The pharyngeal tonsil
B) The palantine tonsil
C) The lingual tonsil
D) The jugulo-digastric tonsil
A) The pharyngeal tonsil
A patient comes in to your office complaining of an unusual sensation in his throat. He tells you that about a week ago he choked on a small bone while eating but was eventually able to cough it out. Since then he has had an abnormal feeling while eating or drinking. He denies any pain, or difficulty swallowing, and his voice is not hoarse. Which nerve could be the culprit for causing this abnormal sensation?
a) Recurrent laryngeal nerve
b) External branch of superior laryngeal nerve
c) Internal branch of superior laryngeal nerve
d) Inferior laryngeal nerve
c) Internal branch of superior laryngeal nerve
Which of the following structures relationships is incorrect?
a) Thyroid: Endocrine Layer
b) Pharynx: Respiratory layer
c) Esophagus: Alimentary layer
d) Trachea: Respiratory layer
b) Pharynx: Respiratory layer
The day has finally come for your first assist in a total thyroidectomy! As the surgeon attempts to locate the parathyroid to avoid resecting them completely, you think back to anatomy class in PA school and know that the parathyroid glands are located:
A. Posterior to the mylohyoid muscle
B. Inferior to the sternal angle
C. Posterior to the trachea and esophagus
D. Any number of places from the superior edge of the hyoid down to the manubrium
D. Any number of places from the superior edge of the hyoid down to the manubrium
What is presbyphonia?
A. Loss of voice due to talking on the phone too long
B. Loss of voice due to total thyroidectomy
C. Loss of voice due to old age
D. Loss of voice due to epiglottitis
C. Loss of voice due to old age
Which structure plays a key role in signaling and coordinating development? It is required for “patterning” the surrounding tissues.
A) Notochord
B) Embryoblast
C) Trophoblast
D) Blastocyst
A) Notochord
An infant is born with Spina Bifida. What is the cause?
A) Failure of the neural tube to close during the first month of embryonic development, leading to the spinal cord not enclosed in the backbone.
B) The neural tube fails to close and results in a missing or malformed brain or spinal cord
C) CMV infection that causes stunted growth and microcephaly.
D) Failure of proper maturation of midline mesoderm and ventral body wall formation during embryonic development, leading to the heart abnormally located outside of the chest.
A) Failure of the neural tube to close during the first month of embryonic development, leading to the spinal cord not enclosed in the backbone.
What is the cause of OBLIQUE FACIAL CLEFT?
A) Bilateral failure of maxillary and medial nasal prominences to fuse
B) Unilateral failure of maxillary, medial and lateral nasal prominences to fuse
C) Incpomlete lateral merging of maxillary and mandibular processes
D) Hyperplasia of inferior frontonasal prominence, thus preventing fusion of the medial nasal prominences.
B) Unilateral failure of maxillary, medial and lateral nasal prominences to fuse
A child presents to the clinic with an inflamed and infected “bump” below his mandible, located centrally when the neck is extended. When you palpate the “bump” and ask the child to stick his tongue out, it moves along with the muscles. What is the “bump” most likely?
A. Enlarged lymph node
B. Sebaceous cyst
C. Thyroglossal cyst
D. Thyroid cancer
C. Thyroglossal cyst
Which pharyngeal cleft develops into the external auditory meatus?
A. Pharyngeal cleft 1 B. Pharyngeal cleft 2 C. Pharyngeal cleft 3 D. Pharyngeal cleft 5 E. Pharyngeal cleft 6
A. Pharyngeal cleft 1
What pouch is the thyroid gland derived from?
A. First pharyngeal pouch
B. Second pharyngeal pouch
C. Third pharyngeal pouch
D. It is not derived from any of the pharyngeal pouches
D. It is not derived from any of the pharyngeal pouches
Hannah loves to eat pizza. Sometimes she chews her pizza instead of inhaling it; because of this her favorite pharyngeal cleft forms the muscles of mastication. What pharyngeal cleft is Hannah’s favorite?
A. pharyngeal cleft 1
B. pharyngeal cleft 2
C. pharyngea cleft 3
D. pharyngeal cleft 4
A. pharyngeal cleft 1
“The Bubble Boy” has to walk around in a plastic bubble suit because he has a congenital immunodeficiency. A little known fact about the character played by Jake Gyllenhaal in the 2001 coming-of-age movie is that he was born without a thymus which contributed to his immunodeficiency. What other abnormalities would one expect to see if the aplastic thymus is a result of pharyngeal pouch dysfunction?
A. conductive hearing loss due to external ear canal malformation
B. hypoparathyroidism
C. thyroid dysfunction
D. difficulties with facial expressions
B. hypoparathyroidism
The pharyngeal arches are all innervated by cranial nerves. What is the innervation of the second pharyngeal arch?
A) Cranial Nerve V (Trigeminal Nerve)
B) Cranial Nerve VII (Facial Nerve)
C) IX (Glossopharyngeal Nerve)
D) X (Vagus Nerve)
B) Cranial Nerve VII (Facial Nerve)
A disruption in the development of facial prominences can result in anatomic anomalies. What is the anatomic anomaly that is caused by incomplete fusion of the medial nasal prominence?
A) Frontonasal dysplasia
B) Cleft Palate
C) Macrostoma
D) Median Cleft Lip
D) Median Cleft Lip
A patient presents to your clinic with an acute onset of fever, chills, and a sore throat. Upon examination you note an erythematous throat with exudates. Upon results of a rapid antigen test you determine the patient has strep throat. The exudates you visualized were most likely on the tissue derived from which pharyngeal pouch?
A. Pharyngeal pouch 1
B. Pharyngeal pouch 2
C. Pharyngeal pouch 3
D. Pharyngeal pouch 4
B. Pharyngeal pouch 2
Which nerve is responsible for motor innervation of the posterior 1/3 of the tongue?
A. Glossopharyngeal nerve
B. Vagus nerve
C. Hypoglossal nerve
D. Alveolar nerve
C. Hypoglossal nerve
Which of the following muscles is derived from the 3rd pharyngeal arch in embryonic development?
A. Stylohyoid
B. Stylopharyngeus
C. Cricothyroid
D. Cricopharyngeus
B. Stylopharyngeus
Children born with DiGeorge syndrome have a developmental abnormality from the 2nd and 3rd pharyngeal arches. Symptoms of this syndrome include thymic hypoplasia (T cell deficiency), micrognathia (small jaw), and cleft palate. Another possible feature is conductive hearing loss, which results from a disruption in which embryologic pharyngeal groove?
A. 1st
B. 2nd
C. 3rd
D. 4th
A. 1st
In embryology and fetal development, the 1st pharyngeal arch contributes to the majority of the:
A. Frontal and parietal bones
B. Cerebral cortex
C. Upper and lower jaw
D. Trachea and esophagus
C. Upper and lower jaw
A father brings his 3-year-old son in to the clinic with concerns about a lump in his chest. He denies recent trauma and states that he honestly isn’t certain how long the lump has been there, but he noticed it last night at bath time. Upon examination of the child’s chest, you palpate a 3x3 mm cyst along the anterior border of the sternocleidomastoid muscle, just superior to the clavicle. With embryology in mind, what is on your differential?
A. Remnant of pharyngeal cleft I
B. Remnant of pharyngeal cleft IV
C. Disappearing twin syndrome
D. DiGeorge Syndrome
B. Remnant of pharyngeal cleft IV
The first pharyngeal arch, associated with the 1st aortic arch, is innervated by CN V and splits into what two prominences?
A. Upper mandibular, lower aortic arch
B. Upper external auditory meatus, lower maxillary
C. Upper maxillary, lower mandibular
D. Upper maxillary, lower aortic arch
C. Upper maxillary, lower mandibular
A patient presents due to slight difficulty in breathing and swallowing. The patient has also noted a lump on his neck that is tender on palpation. The mass moves upward with swallowing and the physician believes it is a cyst secondary to a congenital defect. How do you differentiate between cysts from ectopic thyroid tissue and cervical cysts from remnants of pharyngeal clefts 2-4?
A. Thyroid cysts are found on the midline along the thyroglossal duct and cervical cysts are lateral to the SCM
B. Thyroid cysts are found on the superior neck, cervical cysts are inferior
C. Thyroid cysts are lateral and cervical cysts are found on the midline
D. Thyroid cysts are found on the inferior neck, cervical cysts are superior
A. Thyroid cysts are found on the midline along the thyroglossal duct and cervical cysts are lateral to the SCM
A patient presents to clinic with pain and swelling on the right side of his neck. Initial workup was done and his white count returned elevated. After further workup, the patient was found to have an infected branchial fistula. This uncommon cervical canal results from remnants of what pharyngeal pouch?
A. Pharyngeal pouch 3
B. Pharyngeal pouch 4
C. Pharyngeal pouch 2
D. Pharyngeal pouch 1
C. Pharyngeal pouch 2
When the embryonic cervical sinus fails to disappear, it may retain its connection with the lateral surface of the neck by a narrow canal. This is known as what?
A. Branchial sinus
B. Piriform sinus
C. Sphenoid sinus
D. Transverse dura sinus
A. Branchial sinus
A patient comes to your office complaining of this ‘bump’ they found just below their ears and they state it is not painful but it has been getting progressively more erythmatic. Upon exam, you deterine it is below the ear just lateral to the sternocleidomastoid. They state they have had it for a while, but it keeps getting bigger and now it is red. Upon palpation, the ‘bump’ is hard. What is the most likely origination of this bump?
A) Pharyngeal cleft 1
B) Pharyngeal cleft 2-4
C) Pharyngeal pouch 1
D) Pharyngeal pouch 2-4
B) Pharyngeal cleft 2-4
Which of the following nerves is not associated with the five pharyngeal arches?
A) CN V
B) CN lX
C) CN X
D) CN Xl
D) CN Xl
A two-year old boy presents to the clinic with his mother. The family recently moved to the area and is establishing care at the clinic. Upon general assessment, you notice that the boy has a facial anomaly. The left side of the boy’s face appears broader than the right. Being a superstar PA, you are not surprised to see Macrostoma on the patient’s chart. Macrostoma is usually caused by what disruption in development?
A. Failure of maxillary and medial nasal prominences to fuse
B. Incomplete lateral merging of maxillary and mandibular processes
C. Hyperplasia of the inferior frontonasal prominence
D. Incomplete fusion of medial nasal prominences
B. Incomplete lateral merging of maxillary and mandibular processes
Pharyngeal cleft 1 develops into what?
A. Eustachian tube
B. External Auditory Meatus
C. Tongue
D. Thyroid gland
B. External Auditory Meatus
A mother brings in her 1 year old child to Urgent Care. She brought her child in last week with and upper respiratory infection. She now returns after she noticed a mass on her childs neck. On exam, you note a midline neck mass that is just inferior to the hyoid bone. When the child swallows you notice the mass moves upward. What is the most likely explanation for the mass?
A. Malignant tumor
B. Subcutaneous cyst
C. Thyroglossal duct cyst
D. Thyroid gland inflammation
C. Thyroglossal duct cyst
A 48 year old man is thrown from his motorcycle and complains of sever pain in the lower right side of his chest. A radiograph shows fractures of the eighth and ninth ribs. What internal organ would most likely be injured?
A) Right Lung
B) Pleura
C) Spleen
D) Heart
C) Spleen
A patient reports attending a super bowl party when he began to choke. He states that his wife performed the Heimlich maneuver. He has had a cough since. Bronchoscopy revealed an object in a bronchus. Where would the foreign body most likely be located?
A) Left Main Bronchus
B) Right Main Bronchus
C) Right Lower Lobe Bronchus
D) Left Superior Segmental Bronchus
B) Right Main Bronchus
A patient is in need of thoracentesis. How should the needle be inserted between the ribs?
A. Angled upward at the superior border of the rib
B. Angled downward at the superior border of the rib
C. Angled upward at the inferior border of the rib
D. Angled downward at the inferior border of the rib
A. Angled upward at the superior border of the rib
A patient arrives via CCU to be sent straight to the cath lab for a STEMI. In which coronary artery is the clot most likely to occur and cause the greatest amount of damage?
A Circumflex branch of the LCA
B Anterior IV branch of the LCA
C Posterior IV branch of the RCA
D. Right marginal branch of the RCA
B Anterior IV branch of the LCA
A PA is concerned that her patient may have right hemidiaphragm paralysis. What would she expect to see radiographically to support a diagnosis of hemidiaphragm paralysis?
A) Paralyzed dome of diaphragm ascends during inspiration
B) Paralyzed dome of diaphragm descends during inspiration
C) Paralyzed dome of diaphragm descends during expiration
D) A&C
E) None of the above
D) A&C
A patient presents to the emergency department following a motor vehicle accident. She is complaining of numbness in her right fingers as well as pain near her right shoulder and neck. The ER PA determines she has thoracic outlet syndrome. What structures could be compressed in a patient with thoracic outlet syndrome?
A) Veins B) Arteries C) Nerves D) All of the above E) None of the above
D) All of the above
When auscultating the heart, it is important to keep in mind bony landmarks that can be palpated to help the clinician determine where to place their stethoscope. During a physical exam, a PA began by palpating the jugular notch and then slide their fingers down to the sternal angle. At which rib level were their fingers?
A) 1st
B) 2nd
C) 3rd
D) 4th
B) 2nd
Following an automobile accident resulting in a compound fracture of the right femur, a patient returns to the ED a week later suffering from acute respiratory distress. What is the most likely cause of the respiratory distress?
A) Sepsis
B) Asthma Attack
C) Pulmonary Embolism
D) Myocardial Infarction
C) Pulmonary Embolism
A 44 year old women was at the dentist to repair a filling. As the dentist was attempting to fill the tooth, a part of the tooth broke off and patient aspirated it. Where in the lung did the broken tooth most likely lodge?
A. The left stem bronchus
B. The right stem bronchus
C. The carina
D. An alveolar sac of the right stem bronchus
B. The right stem bronchus
A 51 year old male, with a history of heavy smoking and diabetes, arrives at the ED with crushing chest pain that radiates to the jaw and left arm. The emergency room PA comments that the blockage occurred in the most common site of coronary artery occlusion after viewing the coronary angiogram. What is the site of the blockage?
A. Right coronary artery
B. Circumflex branch of the left coronary artery
C. Anterior interventricular branch
D. Posterior interventricular branch
C. Anterior interventricular branch
Upon conducting a breast exam on a 45 year old female patient, you notice abnormal contours and a Peau d’orange sign on her left breast. Which lymph nodes would you primarily expect to be enlarged upon palpation?
A. Axillary Lymph Nodes
B. Subscapular Lymph Nodes
C. Supraclavicular Lymph Nodes
D. Deep Cervical Lymph Nodes
A. Axillary Lymph Nodes
What area of particular surgical significance to cardiac surgeons can be used to posteriorly access the large vessels of the heart in order to stop or divert circulation in these vessels?
A. The superior vena cavae
B. The oblique pericardial sinus
C. The transverse pericardial sinus
D. The superior mediastinum
C. The transverse pericardial sinus
Where should a needle be inserted for pericardiocentesis?
A. 5th intercostal space near midaxillary line
B. 3rd intercostal space near midaxillary line
C. 7th intercostal near midclavicular line
D. Infrasternal angle using a superoposterior insertion
D. Infrasternal angle using a superoposterior insertion
A 60 year old male with a long history of smoking presents to the ED with complaints of severe chest pain. He has tried taking sublingual nitroglycerin with no relief. The ECG shows ST elevation in V1, V2, and V3. Where else could the ER PA expect the patient to feel pain?
A. Left palm
B. Right palm
C. Right leg
D. Left leg
A. Left palm
Which valvular malfunction occurs when there is regurgitation into the left atrium during systole?
A. mitral valve insufficiency
B. pulmonary valve incompetence
C. aortic valve insufficiency
D. mitral valve stenosis
A. mitral valve insufficiency
A 64 year old male is placed in the ICU after an extensive heart surgery. The surgeon called the surgery a success but the patient been having significant dyspnea and accessory muscle use since coming out of sedation. You choose to stabilize him with intubation and do some investigating. You wonder if the phrenic nerve was damaged and the chest X-ray confirms that there is a hemidiaphragm. Which of the following were NOT used when the patient was using his accessory muscles to breathe?
A. sternocleidomastoid muscle
B. scalene muscles
C. pectoralis major muscle
D. rectus abdominus
C. pectoralis major muscle
A 63-year-old male patient presents in clinic complaining of chest pain radiating into his jaw and left shoulder. He states the pain came on about 45 minutes ago and has been persistent. You suspect he may be having an MI and order an EKG and Troponins. The Troponin levels come back elevated and the EKG is as shown:
——–EKG——-
Occlusion of which “widow maker” artery would lead to ischemia at the apex of the heart?
A. Left circumflex
B. Posterior interventricular (descending)
C. Right coronary
D. Anterior interventricular (descending)
D. Anterior interventricular (descending)
During ventricular diastole, period of ventricular filling, which two valves of the heart are open?
A. Mitral and Tricuspid valves
B. Aortic and Pulmonary valves
C. Mitral and Aortic valves
D. Tricuspid and Pulmonary valves
A. Mitral and Tricuspid valves
A patient enters the ED after experiencing a car accident. The patient explains that he was rear ended from someone while he was stopped at a stop sign, causing his ribcage to crush against his steering wheel. This caused multiple rib fractures and allows his thoracic wall to move freely. During inspiration, his thorax wall moves inward and during expiration it moves outward. The patient is in severe pain and O2 saturation is at 89%. Which of the following injuries did this patient experience?
a) Intercostal muscle weakness
b) Flail chest
c) Sternal Fracture
d) Paralysis of diaphragm
b) Flail chest
If an endotracheal tube is inserted in the trachea further that the level of the sternal angle, what is most likely the result?
a) Fractured rib
b) Vomiting
c) Atelectasis
d) Pulmonary Embolism
c) Atelectasis
A 22-year-old man who was thrown from his motorcycle complained of severe pain in the lower left side of his chest. He held his hand over his lower left ribs near the midaxillary line. A radiograph of his thorax revealed fractures of the eighth and ninth ribs. What internal organ would most likely be injured?
A: Left Lung
B: Spleen
C: Pleura
D: Contusion of Lung
B: Spleen
A 63-year-old male presents to the emergency room with chest pain that began one month ago while walking his dog but has since progressed and continues at rest. Man has positive Levine’s sign, is anxious and diaphoretic. The man is rushed to the cath lab where the provider determines the need for a coronary artery bypass. During surgery, the ascending aorta and pulmonary trunk are ligated via a surgical clamp. What is the area called that allows for surgical tool access posterior to these vessels?
A. Sinus Venarum of Right Atrium
B. Transverse Pericardial Sinus
C. Aortic Orifice
D. Oblique Sinus
B. Transverse Pericardial Sinus
After getting in a serious mountain biking accident, Carl presents to urgent care noting progressive dyspnea. The Physician Assistant noted he injured the motor supply from the phrenic nerve to his right diaphragm and thus paralyzed that half of his diaphragm. What would you expect to see in the unaffected dome of the diaphragm?
A. Nothing; each dome has a separate nerve supply
B. Ascension of the dome during inspiration
C. Descension of the dome during expiration
D. Deviation of the left dome towards the affected side
A. Nothing; each dome has a separate nerve supply
B. & C. are expected findings of the paralyzed dome
Where does most of the lymph from the breasts drain to, resulting in this being a very common site for metastasises from breast cancer to migrate to?
A: Lactiferous ducts B: Thoracic duct C: Axillary lymph nodes D: Parasternal lymph nodes
C: Axillary lymph nodes
Which procedure is performed to relieve cardiac tamponade?
A. Thoracentesis
B. Pericardiocentesis
C. Cardiac catheterization
D. Anterior thoracotomy
B. Pericardiocentesis
A 52 year-old female presents to your primary care clinic for evaluation of changes in her left breast. On exam, you note that the left breast elevates when the left pectoral muscles are contracted. You refer her for a mammogram and biopsy, suspecting cancer. What is your primary concern?
A. Fibrous degeneration of the suspensory ligaments
B. Lymphedema caused by a lymphatic blockage
C. Involvement of the retromammary space
D. Metastases involving the pectoral muscles
C. Involvement of the retromammary space
A 69 year old male with a 50 pack year smoking history presents to the emergency department with retrosternal chest tightness that radiates to left lateral neck and back. A STAT EKG is ordered and performed in 7 minutes, the cardiologist diagnosed a ST segment elevation myocardial infarction and the patient immediately went to the cath lab. Door to balloon time was 27 minutes, go team! The patient suffered myocardial infarction at the sight of the SA node, causing an arrhythmia that was later treated with an implanted cardiac defibrillator and pacemaker device. What is the most likely sight of arterial occlusion in this patient?
A. Anterior interventricular artery
B. Right coronary artery
C. circumflex branch of the RCA
D. posterior IV artery
B. Right coronary artery
During a CABG procedure, the heart is placed on a coronary bypass machine. What landmark is important for surgeons in the case of putting the large vessels on bypass?
A. transverse pericardial sinus
B. junction of ascending aorta and aortic arch
C. oblique pericardial sinus
D. ligamentum arteriosum
A. transverse pericardial sinus
A 45 year old male presents to the ED with chest pain that is worse with laying down and swallowing and relieved by leaning forward while sitting. During examination you discover a pericardial friction rub, a respiration rate of 32, and a heart rate of 116. Upon imaging and EKG results you determine the patient likely has pericarditis with an effusion and you decide to perform a pericardiocentesis to remove the fluid. You know that there is an area on the left sternocostal aspect of the pericardium that is not covered by parietal pleura or lung tissue where you can insert the needle. What is this area called?
a) Transverse pericardial sinus
b) Triangle of auscultation
c) Bare area of the pericardium
d) Oblique pericardial sinus
c) Bare area of the pericardium
The hilum of the lung contains which of the following vascular structures?
a) Aorta
b) Pulmonary veins
c) Pulmonary trunk
d) Superior vena cava
b) Pulmonary veins
An ultrasound shows a large amount of fluid in the fibrous sac surrounding the heart. What is the best approach to remove this fluid?
A. Chest tube B. Thoracotomy C. Pericardiocentesis D. Diuresis E. Wait for fluid to reabsorb on its own
Pericardiocentesis
A trauma patient is brought in after a car accident where their airbag failed to deploy, causing the steering wheel to impact the side of their chest. While watching their chest during respiration you notice a section of the chest wall moves opposite compared to the rest. What is this paradoxical movement caused by?
A. Pneumothorax B. Pleural effusion C. Rib dislocation D. Multiple rib fractures E. Xiphoid fracture
D. Multiple rib fractures
In an MI, what is the most common site of a coronary artery occlusion?
A. Anterior left coronary artery
B. Right coronary artery
C. Circumflex branch of the LCA
D. Marginal artery
A. Anterior left coronary artery
A 4-year-old boy presents to the clinic after swallowing a bead. Where would you expect it to be?
A. Left main bronchus
B. Right main bronchus
C. Terminal branch of the right lower lobe
D. Lingular segment of the left lung
B. Right main bronchus
Whenever possible, surgical incisions are made in the ______ quadrants of the breast due to fewer vascular structures than the others.
A. Supeiolateral & superomedial
B. Inferolateral & superolateral
C. Superomedial inferomedial
D. Inferomedial & inferolateral
D. Inferomedial & inferolateral
A seasoned cardiologist invited a student who was shadowing him into the OR to observe an open heart surgery. To show off, he told the student that he could stick his finger through the patient’s heart without causing a tear, bleeding, or any harm whatsoever. The doctor plunged his finger into the beating heart and out the other side, he snickered as the student’s eye’s widened in shock. How was the doctor able to do this?
A. He is magical
B. The patient had a hole in his heart
C. His finger went through the canal of Schlemm
D. His finger went through the Transverse pericardial sinus
D. His finger went through the Transverse pericardial sinus
During a cardiac surgical procedure, you resect the pericardium in the left ventricle region for direct access to the myocardium. You are careful to avoid injury to the pericardiacophrenic artery, however you notice that you’ve damaged the accompanying vein. Blood draining from this portion of the pericardium no longer has a direct route to which closest tributary vein?
A. Left brachiocephalic vein
B. Anterior intercostal veins
C. Subclavian vein
D. Superior Vena Cava
A. Left brachiocephalic vein
If, during the cardiac surgical procedure, you would’ve damaged the nerve accompanying the pericardiacophrenic artery, what innervation would be lost with this damage (pertaining to the heart)?
A. Motor innervation of the myocardium
B. Motor innervation of the pericardium
C. Sensory innervation of the pericardium
D. Sensory innervation of the myocardium
C. Sensory innervation of the pericardium (you lacerated the phrenic nerve)
A patient is brought into the hospital after a severe motor vehicle accident. He has several broken ribs on the lower right side, a broken ulna, and many abrasions. After several nights in the hospital, while on opioids for his pain, he is sent home. After weening himself off his pain meds, he notices that every breath he takes, he is in significant pain. He has also noticed becoming increasingly short of breath. He returns to the clinic for a visit regarding this pain and he tells his provider that no matter how he breaths, he has pain with the breath. He states that when he breaths, it feels like the lower right side is moving opposite the left side and the upper right side. What injury has the patient sustained?
A) Pleural Effusion
B) Flail Chest
C) Pneumothorax
D) Pulmonary Embolism
B) Flail Chest
A 46 year old female, who travels frequently for work, has had two pulmonary emboli in the past six months. Her provider decided to place a filter in her inferior vena cava to catch the clots. Unfortunately, she was not taking her warfarin as prescribed so she threw several more clots that got lodged in her IVC, so now blood can no longer flow through. Which of the following vessels are not used to reroute venous blood from the abdomin, thoracic cavity, and back to the heart?
A) Azygos Vein
B) Hemiazygos Vein
C) Accessory Hemiazygos Vein
D) Posterior Azygos Vein
D) Posterior Azygos Vein
What is the flap-like structure of the embryonic heart that allows blood to bypass the right ventricle and lungs? Upon the baby’s first breath, it closes for the for the last time.
A. foramen ovale (oval fossa)
B. interventricular septum
C. sulcus terminalis
D. conus arteriosus
A. foramen ovale (oval fossa)
After years of asking for a trampoline, Benny’s parents finally gave in. With mom and dad distracted, Benny decided that he wanted to try to jump off of the nearby pine tree onto the trampoline. Upon lift-off, Benny’s pant leg got caught on the branch, and he went tumbling downward. After hearing him cry out, Benny’s parents found him and rushed him to urgent care. Benny had a few scrapes and had early signs of bruising on many areas of his body. He also reported pain on the right side of his thorax that became more severe when he inhaled and also when he twisted his thorax to either side. A chest x-ray showed that Benny had two fractured ribs. What area of the rib is most prone to fracture?
A. head
B. neck
C. angle
D. costal groove
C. angle
Which vessel is most commonly harvested in coronary artery bypass grafting (CABG)?
A. Lesser saphenous vein
B. Radial vein
C. Greater saphenous vein
D. Femoral vein
C. Greater saphenous vein
A 40 year old male presents to your clinic with concerns regarding a “hard lump” on his anterior chest that he noticed earlier this week. His vitals are within normal limits. He denies any recent illnesses/exposures. He denies weight loss, fatigue, hemoptysis, cough, chest pain, abdominal pain, dyspnea, peripheral edema, and general pain. Lungs are clear to auscultation; heart has a regular rate and rhythm without murmurs, gallop, or rub. Upon palpation of his substernal area you note the “hard lump.” This is most likely due to:
A. Cancerous tumor
B. Pectus cavenatum
C. Partially ossified xiphoid process
D. Broken rib
C. Partially ossified xiphoid process
A 43-year old receptionist presents to clinic complaining of nocturnal paresthesias and pain in her left hand. She states these symptoms started a few months ago and have since been progressively worsening. The patient states her symptoms are now affecting her ability to grip objects and have weakened her thumb. What is most likely going on?
A. Injury to the radial nerve
B. Distal compression of median nerve
C. Brachial plexus injury
D. Ulnar neuropathy
B. Distal compression of median nerve
A 2-year-old patient, who presents to urgent care with both parents, is crying and holding her right arm. She refuses to use the arm, which is pronated and flexed at the elbow. Her distressed father explains that about 25 minutes ago, while playing at home, he picked the patient up by the forearm. He states she screamed and started holding her right arm immediately after, and has not moved it since. What injury has most likely occurred?
A. Fracture of the radial notch of ulna
B. Articular cartilage injury
C. Radial head subluxation (nursemaid’s elbow)
D. Medial epicondylitis
C. Radial head subluxation (nursemaid’s elbow)
All of the following are manifestations of a broken clavicle except:
A) Elevation of the medial bone fragment
B) Shortening of the clavicle
C) Shoulder drop
D) Elevation of the lateral bone fragment
D) Elevation of the lateral bone fragment
An injury to the inferior brachial plexus can occur when an infant’s upper limb is pulled excessively during delivery. An injury to this portion of the brachial plexus will cause what manifestation?
A) Waiter’s Tip
B) Claw Hand
C) Hyperabduction of the arm
D) Wrist Drop
B) Claw Hand
A patient comes in to Urgent Care with complaints wrist pain only on the right side. She is concerned that she may have sprained her wrist. She fell about a week ago on an icy driveway and the pain is not getting better. She is also having noticeable difficulty gripping objects in her right hand. What nerve is likely affected?
A Median nerve
B Ulnar nerve
C Lateral antebrachial cutaneous nerve
D Radial nerve
B Ulnar nerve
A man stumbles into the Emergency Department after being stabbed in his left side. The provider is worried that the long thoracic nerve has been damaged. What physical evidence would you expect to see if the nerve was involved?
A. Inability to ADDuct the arm
B. Inability to ABuct the arm above the horizontal position
C. Winged scapula
D. Both B and C
D. Both B and C
Damage to the radial nerve would result in decreased supination of the hand and forearm. What other strong supinating muscle would be spared and remain unaffected?
A) Brachioradialis
B) Supinator
C) Biceps Brachii
D) Brachialis
C) Biceps Brachii
An 18 year old male was struck in his right lateral thorax with a knife. As a result his right scapula is now moved laterally and posteriorly away from the thoracic wall (winged scapula). Which nerve is most likely to have been affected?
A) Thoracodorsal Nerve
B) Serratus Anterior Nerve
C) Long Thoracic Nerve
D) Median Nerve
C) Long Thoracic Nerve
A former professional baseball player plans to undergo a “Tommy John procedure.” The palmaris longus tendon is threaded through holes drilled into the medial epicondyle of the humerus and the lateral aspect of the coronoid process of the ulna. Which ligament is being repaired?
A. Fibrous layer of the joint capsule
B. Annular ligament of the radius
C. Radial Collateral Ligament
D. Ulnar Collateral Ligament
D. Ulnar Collateral Ligament
An athletic trainer is tending to a softball player who slid into third base. The athletic trainer comments that the third digit resembles a mallet. What joint is the softball player not going to be able to extend?
A. Metacarpophalangeal joint
B. Distal interphalangeal joint
C. Proximal interphalangeal joint
D. Carpometacarpal joint
B. Distal interphalangeal joint
In what fracture could you see a “Dinner Fork Deformity” develop?
A. Colles Fracture
B. Fracture of the Hamate
C. Fracture of the Phalanges
D. Greenstick Fracture
A. Colles Fracture
While working as the Knight in Shining Armor at the MN Renaissance Festival, Blake was forcefully struck on the right side while jousting. Upon inspection, you note that the medial border of the right scapula has moved laterally and posteriorly from the thoracic wall creating a “wing-like” appearance when he leans on his right hand. What nerve has Blake most likely injured?
A. Spinal Accessory
B. Dorsal Scapular Nerve
C. Long Thoracic Nerve
D. Cervical Nerve
C. Long Thoracic Nerve
An 83 year women presents with severe right shoulder pain. She states that she slipped and fell as she was getting out of her shower. She reached out her hand and tried to catch herself. She does have a history of osteoporosis. She also has weakness while trying to abduct her right arm past 15 degrees and has lost sensation over her deltoid muscle. What structure may have been damaged?
A. Ulnar nerve
B. Axillary Nerve
C. Median Nerve
D. Long Thoracic Nerve
B. Axillary Nerve
What is the most commonly ruptured muscle of the rotator cuff?
A. Teres minor
B. Subscapularis
C. Supraspinatus
D. Infraspinatus
C. Supraspinatus
Marissa and Paige decide to go out to a bar the Saturday night before finals week to let loose. While there, another girl makes fun of Marissa’s pants. Paige becomes so upset and she doesn’t listen to her mother’s advice to never pick fights. She proceeds to punch the mean girl. The mean girl must get in fights frequently because she pulls out a knife and strikes Paige below her right axilla. Marissa and Paige realize this girl must be nuts and run away. Marissa is debating whether she should bring Paige into the emergency department when she notices that Paige can no longer fully abduct her right arm and her right scapula has a winged appearance. Which of Paige’s nerves were injured during Paige and Marissa’s night out?
A. thoracodorsal
B. long thoracic
C. cranial nerve XI
D. dorsal scapular
B. long thoracic
Which structure is NOT contained in the cubital fossa?
A. median nerve
B. radial nerve
C. musculocutaneous nerve
D. brachial artery
C. musculocutaneous nerve
Following a thoracic surgery, a patient states they can no longer lift their left arm higher than 90 degrees from the side. On examination, you note that the patient has limited range of motion in abduction and elevation of their left arm. You also find that they have a “winged” scapula. What nerve was damaged during the surgery that can lead to a “winged” scapula?
A. Long thoracic nerve
B. Axillary nerve
C. Dorsal scapular nerve
D. Lower subscapular nerve
A. Long thoracic nerve
During carpal tunnel release surgery, the flexor retinaculum is cut in order to release which nerve?
A. Ulnar nerve
B. Superficial branch of radial nerve
C. Median nerve
D. Dorsal branch of ulnar nerve
C. Median nerve
After a long first semester of PA school, the first class decides to walk across the street to the Tavern for happy hour. Each student orders 64 ounces of their favorite beverage and noticed some difficulty picking up the glass off the table. This was due to endless hours of studying and lack of physical activity, leading to muscle weakness, especially during flexion during mid-pronation. Which muscle are these students experiencing weakness in?
a. Flexor Carpi Ulnaris
b. Flexor Digitorum Profundus
c. Flexor Digitorum Superficialis
d. Brachioradialis
d. Brachioradialis
What portion of the Clavicle is most commonly fractured?
a. Distal 1/3
b. Middle 1/3
c. Proximal 1/3
d. None of the above
b. Middle 1/3
While playing in his first MLB game, Jose EsTerrrible dove into third base and jammed his second digit. His trainer noted he avulsed the long extensor tendon from the phalanx due to hyperflexion. What motion would you expect the patient to be incapable of?
A. Flexion of the PIP joint
B. Flexion of the DIP joint
C. Extension of the PIP joint
D. Extension of the DIP joint
D. Extension of the DIP joint
While rock climbing, Sarah slipped and fell fifteen feet before (luckily) grabbing a branch to stop her fall. This sudden superior pull of the upper limb injured her inferior brachial plexus (C8 and T1) causing Klumpke paralysis. What would you expect to see?
A. Waiter’s Tip
B. Wrist Drop
C. Claw Hand
D. Baseball finger
C. Claw Hand
Waiter’s tip is seen in injury to the superior brachial plexus
What forms the superior boundary of the cubital fossa in the arm?
A: Where the biceps brachii muscle turns into the biceps tendon B: An imaginary line connecting the medial and lateral epicondyles of humerus
C: Medial bicipital groove
D: Proximal radio-ulnar joint
B: An imaginary line connecting the medial and lateral epicondyles of humerus
Avril Lavigne was skateboarding when her skateboard caught on a large crack in the cement. She fell on the palm of her hand with it fully abducted. Since her hand was very swollen and painful, she was brought to the ED. Upon exam, Avril tells you that most of the pain is on the lateral side, especially when she dorsiflexes and abducts her hand. Although this injury is commonly misdiagnosed as a severely sprained wrist, you decide you want to do an x-ray of her hand and diagnose it as:
A: Fracture of scaphoid bone B: Fracture of radius bone C: Laceration of palmar arches D: Trauma to median nerve
A: Fracture of scaphoid bone
Which part of the scapula is most frequently fractured?
a. Corocoid process
b. Inferior angle
c. Superior angle
d. Acromion process
d. Acromion process
A 19 year-old male is seen in the emergency department with a hand injury. He initially reports falling off of a skateboard, but you suspect that he has punched something, as the x-ray show’s a boxer’s fracture. Which bone is broken?
A. 5th metacarpal
B. 5th proximal phalanx
C. scaphoid
D. lunate
A. 5th metacarpal
During the EKG lab with fellow students, one PA student is psyched to show off her only “party trick”, her right winged scapula. She says she’s never injured that shoulder before, it just “started to happen.” You dig further into her social history and find out she was a professional log peeler for 10 years before becoming a PA student. She says her only complaint is numbness and tingling in her right hand sometimes. Which nerve has she most likely damaged to cause this?
A) The Long Thoracic Nerve
B) The Suprascaular nerve
C) The Axillary Nerve
D) The Lower Subscapular nerve
A) The Long Thoracic Nerve
A 22 year old male patient comes in complaining of deep pain in his left shoulder and difficulty sleeping. He says it’s difficult to open doors with his left arm and it’s painful to lift his arm. You take a social history of the patient and find out that he is a college baseball player. What do you think is most likely going on for this patient?
A) A torn supraspinatus tendon
B) A fracture of the proximal humeral epiphysis
C) Degenerative tendonitis of the teres minor tendon
D) Inflammation of the subscapularis tendon
A) A torn supraspinatus tendon
You are excising lymph nodes on a patient with breast cancer. You remove the affected pectoral lymph nodes, which other node should you remove in order to best rule out metastasis?
A. humoral
B. apical
C. subscapular
D. supraclavicular
B. apical
Your boyfriend was biking home from work to save the environment and got the front wheel caught in some train tracks, which resulted in him going over the handlebars and landing on his left elbow and striking the left side of his head. Luckily, he was wearing a helmet and did not sustain any injuries to the cranium, minus his pride. After a week, you finally convinced him to get his sore elbow radiographed, and an X-ray revealed a fracture of the medial epicondyle. After a healing period of a few months, his doctor discovered he had also sustained an ulnar nerve injury. Which of these symptoms would he not experience?
A. difficulty with flexion of wrist
B. difficulty with adduction at the wrist
C. hyperextension of 4th and 5th MCP
D. difficulty with flexion of DIP of medial 3 phalanges
D. difficulty with flexion of DIP of medial 3 phalanges
During a post-op follow up appointment form a mastectomy, a 38 year old rock climbing instructor states that she feels great overall and seems to have regained her strength, however she attempted to return to work and was unable to pull herself up during climbing. What nerve was most likely damaged during the procedure?
a) Long thoracic
b) Radial nerve
c) Median nerve
d) Thoracodorsal nerve
d) Thoracodorsal nerve
What structure compresses the ulnar nerve in handlebar neuropathy?
a) Hook of hamate
b) Flexor retinaculum
c) Styloid process of ulna
d) Extensor retinaculum
a) Hook of hamate
A small elderly women presents at your office complaining of wrist pain. She states she lost her balance early that day and struck the wall with her palm to stop her fall. The X-ray looks clear but she complains of extreme pain when pressure is applied to her anatomical snuff box. She has no loss of grip strength. Which bone is most likely broken?
A. The 1st metacarpal
B. Hamate
C. Ulna
D. Scaphoid
D. Scaphoid
A football player is helped to the sidelines after getting tackled. You noticed that during the play, the tacklers helmet struck your player directly in the shoulder. Upon palpation of the shoulder you notice a Step-deformity, which is an injury of what joint?
A. Sternoclavicular
B. Acromioclavicular
C. Scapulothoracic
D. Glenohumeral
B. Acromioclavicular
What nerve palsy causes “wrist drop”
A. Radial
B. Ulnar
C. Median
D. Axillary
A. Radial
While trying to do jumping jacks, Anna noticed she could only abduct her arm an initial 15 degrees. What muscle was injured not allowing her to complete a full arm abduction?
A. Deltoid
B. Supraspinatus
C. Infraspinatus
D. Teres minor
A. Deltoid
A man was brought to the ER with a stab wound injury to his right lateral rib cage. What nerve is the admitting PA worried about that could cause a winged scapula and the inability to abduct the arm above the horizontal position?
A. Thoracodorsal nerve
B. Long thoracic nerve
C. Radial nerve
D. Upper subscapular nerve
B. Long thoracic nerve
What is the correct order of the segments of the brachial plexus beginning at the spine?
A. Trunk, root, division, cord, branch
B. Root, division, cord, branch, trunk
C. Root, trunk, division, cord, branch
D. Branch, cord, division, trunk, root
C. Root, trunk, division, cord, branch
You were walking with your grandma on a slippery winter day when she stepped on a sheet of black ice and fell. She reached out her hand to catch herself and ended up falling on an outstretched hand. On X-ray you note a Colle’s Fracture. What pair of bones has been fractured?
A) Ulna and radius
B) Ulna and hammate
C) Radius and hammate
D) Radius and scaphoid
A) Ulna and radius
A 24 year old patient arrived in the ER after a violent altercation. Upon examination you note a winged right scapula. Which is the most likely cause of his winged scapula?
A) Knife wound to his right subscapularis
B) Knife wound to his right teres major
C) Knife wound to his right serratus anterior
D) Knife wound to his right infraspinatus
C) Knife wound to his right serratus anterior
Elma, a 68-year-old woman with osteoporosis, presented to the emergency room with wrist pain and swelling. She states that she was trying to get her necklace back from Mr. Whiskers when she tripped and fell onto an outstretched hand. Upon examination, the PA notices that the wrist is also displaced and orders an x-ray. The x-ray shows that the distal 2 cm of the radius has fractured. What is this fracture known as?
A. Isolated Fracture involving the radio-ulnar joint
B. Greenstick Fracture
C. Styloid Process Fracture
D. Colles Fracture
D. Colles Fracture
What is the most commonly fractured carpal bone?
A. Hamate
B. Scaphoid
C. Prisiform
D. Lunate
B. Scaphoid
Which lower limb vein is commonly used in arterial bypass grafting?
A) Great saphenous vein
B) Lesser saphenous vein
C) Femoral vein
D) Popliteal vein
A) Great saphenous vein
A 65-year-old male presents to clinic with pain in his left posterior thigh. He states he was working out at the Y last week when he felt he pulled a muscle in his left buttock. The patient reports he initially only had pain in his left buttock, but over the past 4 days the pain has radiated down the back of his thigh. He describes the pain in his left posterior thigh as sharp and shooting. Injury to what nerve is most likely the cause of his pain?
A) Femoral nerve
B) Saphenous nerve
C) Obturator nerve
D) Sciatic nerve
D) Sciatic nerve
An decreased angle of inclination causes mild shortening of the lower limb and limits passive abduction of the hip. Which of the following is associated with a decreased angle of inclination?
A) Coxa Vara
B) Coxa Valga
C) Genu Valgum
D) Genu Varum
A) Coxa Vara
Which ligament is most commonly torn in an ankle sprain?
A) Calcaneofibular Ligament
B) Posterior Talofibular Ligament
C) Anterior Talofibular Ligament
D) Deltoid Ligament
C) Anterior Talofibular Ligament
A patient presents to the Emergency Department after being hit by a car in a parking lot during the frenzied early morning hours of Black Friday shopping. She has pain and swelling in her left leg and it is very painful to stand. Xray reveals a fracture of the fibular head. When she is able to ambulate again without pain, she finds her gait has been permanently affected. What deficiency in movement might the patient be noticing?
A. Inability to flex the foot at the ankle
B. Inability to invert the foot at the ankle
C. Inability to extend the foot at the ankle
D. Inability to extend the leg at the knee
E. Inability to flex the leg at the knee
C. Inability to extend the foot at the ankle
A patient received an antibiotic intramuscular injection to the buttocks on the right side and became very upset, complaining of intense pain. When he tried to storm out, the nurse noticed that he had begun to limp as his left hip sagged while he put weight on it. What nerve may be affected?
A. Fibular division of the sciatic nerve
B. Obturator nerve
C. Tibial division of the sciatic nerve
D. Superior gluteal nerve
E. Inferior gluteal nerve
D. Superior gluteal nerve
A 16 year old present to the clinic with an inability to extend his right knee. The PA determines the most likely diagnosis is a paralysis of the quadriceps femoris muscle. Which nerve is associated with this muscle paralysis?
A) Femoral Nerve
B) Sciatic Nerve
C) Pudendal Nerve
D) Tibial Nerve
A) Femoral Nerve
A 42 year old avid skier presents to your office with pain in the dorsum of his left foot radiating to the web space between the 1st and 2nd toes. Upon examination you notice edema associated with the anterior compartment of his left leg and minor weakness in his dorsiflexion of the left foot. What is the most likely cause of this symptoms?
A) Tibialis Anterior Strain (Shin Splints)
B) Paralysis of the Common Fibular Nerve
C) Gastrocnemius Strain
D) Deep Fibular Nerve Entrapment
D) Deep Fibular Nerve Entrapment
A sedentary 47 year-old male decides to fulfill a life goal and run Grandma’s Marathon. After training for two weeks, he goes to see his primary care PA and complains of pain in his anterior lower legs. The PA notices that there is bilateral edema in the distal two thirds of the tibia. What muscle is most likely injured due to repetitive microtrauma?
A. Tibialis anterior
B. Fibularis longus
C. Extensor digitorum longus
D. Extensor hallucis longus
A. Tibialis anterior
A 37 year-old woman comes to the clinic for a monthly intragluteal injection. The nurse places her second digit on the ASIS and spreads the rest of her digits posteriorly along the iliac crest. What area of the buttocks should the injection take place?
A. Triangular area between the fourth and fifth digit
B. Triangular area between the second and third digit
C. The most prominent part of the buttocks
D. Injections should never be administered in the buttocks
B. Triangular area between the second and third digit
Hannah stopped running outside once the temperatures went below freezing and didn’t touch her trail shoes again until mid-May. Despite knowing better, she signed up for Grandma’s marathon and figured she was fit enough to make it to the finish line, despite inconsistent training. Because she does have remarkable stamina and focus, she survived the race. The next week, however, she experienced edema and significant pain in the area of the distal two thirds of both tibial bones. What condition was Hannah suffering from?
A. Injury to the Tibial Nerve
B. Fractures of the distal femur
C. Tibialis Anterior Strain
D. Popliteal Aneurysm
C. Tibialis Anterior Strain
What injury causes the lower leg to slide anteriorly under a fixed femur (known as the “Anterior Drawer Sign”)?
A. ACL rupture
B. PCL rupture
C. Patellar Dislocation
D. Prepatellar bursitis
A. ACL rupture
After a beautiful 70 degree day, you wake up to blizzard conditions. As you leave the house, you are so confused by this weather pattern that you do not realize it is slippery until you step off the sidewalk and slide into the bumper of your car with your left leg. You then notice that you are unable to dorsiflex your left foot. Being the astute PA student that you are, you know that you have injured the:
A. Common Fibular Nerve
B. Tibial Nerve
C. Sciatic Nerve
D. Obturator Nerve
A. Common Fibular Nerve
If the medial collateral ligament is torn, what other structure is likely injured as well?
A. Femoral artery
B. Patellar tendon
C. Medial meniscus
D. Lateral meniscus
C. Medial meniscus
A 17 year old female presents to urgent care after her brother hit her while backing out of the driveway. Upon examination, the PA finds weak plantar flexion and loss of sensation to the sole of the foot. Imaging was done showing a posterior dislocation of the tibial bone. Which nerve are you concerned was damaged during this accident?
A. Tibial
B. Deep fibular
C. Superficial fibular
D. Common fibular
D. Common fibular
Which muscle has been affected when the pelvis drops while walking resulting in a steppage or swing-out gait?
A. piriformis
B. gluteus maximus
C. gluteus medius
D. quadratus femoris
C. gluteus medius
The other day in pharmacology, your last class of a very long day, you were given a break to stretch and get some fresh air. As you stood up from your desk, you felt a shooting pain go through your leg. It originated in your gluteal region and radiated down the posterior aspect of the thigh and leg. Paige, being such an awesome classmate, offered to give you a piriformis massage. By massaging the piriformis what nerve would should be attempting to release?
A. Sciatic nerve
B. Superior gluteal nerve
C. Femoral nerve
D. Inferior gluteal nerve
A. Sciatic nerve
Excessive eversion of the foot at the ankle can cause tearing of what structure?
A. Calcaneal tendon
B. Medial ligament
C. Lateral ligament
D. Fibularis longus tendon
B. Medial ligament
What is the main muscle in gait that is used to for dorsiflexion?
a. Soleus
b. Tibialis Posterior
c. Tibialis Anterior
d. Fibularis Longus
c. Tibialis Anterior
Mackenzie goes out for a walk along Woodland Avenue between classes for a mental break. She comes across a pack of wild cats. One cat charges her and nips her right in the calcaneal tendon. In between tears, she noticed that the pack of cats are all foaming at the mouth and likely rabid. She goes to the emergency room and gets tested, and is positive for rabies. She is informed to start treatment ASAP, so they brought informed her she will be needing Intramuscular rabies shots intragluteally. She excitedly told the Registered Nurse that she is a PA student and that she knows where to give a intragluteal injection. Which of the following is the correct directions that Mackenzie give the RN for where to place the needle for an intragluteal injection?
a) Place your index finger on the Anterior Superior Iliac Spine, Pinky on Posterior Superior Iliac Spine, and place your middle finger on the Iliac Crest and give the injection between the index and middle finger anteriorly.
b) Place your index finger on the Anterior Superior Iliac Spine, Pinky on Posterior Superior Iliac Spine, and place your middle finger on the Iliac Crest and give the injection between the index and middle finger posteriorly.
c) Place your index finger on the Posterior Superior Iliac Spine, Pinky on the Iliac Crest, and place your middle finger on the Anterior Superior Iliac Spine, and give the injection between the index and middle finger posteriorly.
d) Place your index finger on the Posterior Superior Iliac Spine, Pinky on the Iliac Crest, and place your middle finger on the Anterior Superior Iliac Spine, and give the injection between the index and middle finger anteriorly.
a) Place your index finger on the Anterior Superior Iliac Spine, Pinky on Posterior Superior Iliac Spine, and place your middle finger on the Iliac Crest and give the injection between the index and middle finger anteriorly.
While running her first half marathon, Debbie heard an audible snap and felt extreme pain in her left posterior ankle. Swelling in her ankle was observed at the medical tent along with absence of plantarflexion of her affected foot. What compensatory action is commonly seen in this type of injury? (Calcaneal Tendon Rupture)
A. Medial rotation of affected foot during stance phase.
B. Medial rotation of unaffected foot during stance phase.
C. Lateral rotation of affected foot during stance phase.
D. Lateral rotation of unaffected foot during stance phase.
C. Lateral rotation of affected foot during stance phase.
(Many patients rotate their foot as laterally as possible to disable passive dorsiflexion and allow more effective push off)
While training to try and regain his Nike contract (or his ex-wife), Tiger Woods began excessively working his gluteal muscles. After months of this, he began to feel pain in his buttocks and noted paresthesia that radiated down his posterior thigh. What muscle was likely to cause these symptoms? (Sciatic Nerve Compression)
A. Gluteus Maximus
B. Piriformis
C. Superior Gemellus
D. Gluteus minimus
B. Piriformis
Upon graduation, Paige packed up all the tears she had shed during PA school and was trying to put it in the garbage when it slipped out of her hands, since it was so heavy, and hit her in the right knee. She fell to the ground and complained to Dayna that there was severe knee pain and loss of sensation in the sole of her foot. Dayna decided that she didn’t want to just leave her lying there, so she brought Paige to the ED. The physician detected a peripheral nerve injury and X-rays of her knee showed a comminuted fracture of the proximal tibia. Which of the following most likely caused the peripheral nerve damage?
A: Compression of sciatic nerve
B: Severance of tibial nerve by fragments of the fractured tibia
C: Deep fibular nerve entrapment
D: Injury of common fibular nerve
B: Severance of tibial nerve by fragments of the fractured tibia
Compression or entrapment of this particular nerve in the leg causes pain to occur in the dorsum of the foot which usually radiates to the web of the space between the 1st and 2nd toes. This can occur typically as a result of excessive use of the muscles around this nerve or as a result of ill-fitted boots. You would classify this as entrapment of which nerve:
A: Tibial Nerve B: Deep Fibular Nerve C: Lateral Plantar Nerve D: Medial Plantar Nerve
B: Deep Fibular Nerve
A 28 year-old female is sent to for emergency surgery following a severe care accident, which resulted in a deep laceration to the anterior proximal thigh. To stop the bleeding, the surgeon has to ligate the femoral artery midway down the thigh. Which vessel will be able to continue providing collateral circulation to the distal limb?
a. Medial circumflex femoral artery
b. Obturator artery
c. Lateral circumflex femoral artery
d. Profunda femoris artery
c. Lateral circumflex femoral artery
Which muscle can be magically repositioned to replace a non-functioning external anal sphincter?
a. Semitendinosus
b. Semimembranosus
c. Gracilis
d. Sartorius
c. Gracilis
What artery is the source of profuse bleeding from a puncture wound to the sole of the foot?
A. deep plantar arch
B. posterior tibial artery
C. lateral planar artery
D. medial plantar artery
A. deep plantar arch
Your entire family went to Lutsen for a weekend of skiing, you did not go because you are a PA student and all you do is study. Your mother called to tell you that your eccentric uncle fell off the ski lift towards the top, and landed ten feet below with the vast majority of the weight impacting his right leg which was in extension. She tells you that he suffered a common type of “hip fracture”. Being the astute PA student that you are, you know the likely anatomical term for this fracture is:
A. avulsion of the ischial tuberosity of the ischium
B. fracture of the intertrochanteric crest of the femur
C. transcervical fracture of femoral neck
D. avulsion of the anterior inferior iliac spine
C. transcervical fracture of femoral neck
What artery is the source of profuse bleeding from a puncture wound to the sole of the foot?
A. deep plantar arch
B. posterior tibial artery
C. lateral planar artery
D. medial plantar artery
A. deep plantar arch
During her annual physical, a 28 year old female mentions that she has a strange mass on her proximal anterior thigh and that she sometimes has pain when she stands up or lifts heavy objects. Upon examination you discover a small bulge just inferior to her inguinal ligament. What is your most likely diagnosis based on her symptoms and your findings?
a) Swollen inguinal lymph nodes
b) Femoral hernia
c) Hematoma of the femoral artery
d) Rupture of the iliopsoas muscle
b) Femoral hernia
What structure makes up the superolateral boundary of the popliteal fossa?
a) Semimembranosus
b) Imaginary line connecting the medial and lateral condyles
c) Biceps femoris
d) Plantaris
c) Biceps femoris
You are watching a local basketball game. During the game a player goes up for a lay-up, and while landing she slips on the floor and lands hard the anterior aspect of her knee. What ligament is most likely to tear in this scenario?
A. Medial collateral ligament
B. Anterior cruciate ligament
C. Patellar ligament
D. Posterior cruciate ligament
D. Posterior cruciate ligament
A local skier comes in complaining of pain in the anterior compartment of his shin and the dorsum of his foot. Compression of what nerve is the cause of his complaints?
A. Deep fibular nerve
B. Tibial nerve
C. Superficial fibular nerve
D. Sural nerve
A. Deep fibular nerve
Fracture to the neck of the femur can compromise which artery?
A. Medium circumflex artery
B. Lateral circumflex artery
C. Internal Pudendal
D. First perforating branch of the femoral artery
A. Medium circumflex artery
A basketball player suffered a knee injury during a game. On examination the tibia could be moved anteriorly relative to the fixed femur, also known as the anterior drawer sign. What ligament was damaged?
A. Anterior cruciate ligament
B. Posterior cruciate ligament
C. Medial collateral ligament
D. Laterall collateral ligament
A. Anterior cruciate ligament
The most important muscle for stabilizing the knee joint is the:
A. Patellar ligament
B. Plantaris
C. Biceps femoris
D. Quadriceps femoris
D. Quadriceps femoris
A young mother brings her daughter in to the clinic for a routine 2nd year check-up. When asked if the mother has any concerns about her daughter’s development, she expresses dismay that her daughter is bowlegged and that she’ll always look like she just got off a horse. With a straight face you explain to the woman that this is quite normal in a child her age and that she is very likely to grow out of it. In an adult, this condition would be due to a decrease in the Q-angle of the femur and tibia, and is called:
A. Genu Varum
B. Genu Valgum
C. Coxa Vara
D. Coxa Valga
A. Genu Varum
A patient presents with foot drop, what bone has he most likely damaged?
A) Femur
B) Tibia
C) Calcaneus
D) Head of Fibula
D) Head of Fibula
Which muscle is most important in abducting the hip during the support phase?
A) Gracilis
B) Gluteus medius
C) Tibialis anterior
D) Rectus femoris
B) Gluteus medius
A 30 year old was taken to the ER after being hit by a car. She was in the crosswalk and didn’t see the car coming. Since the car had significantly slowed down before she was hit, she didn’t think she had any injuries. As she was getting up from the hospital bed, she realized she wasn’t able to lift her foot was every step, it was just dragging behind. What nerve was likely injured?
A) Tibial Nerve
B) Common Fibular Nerve
C) Femoral Nerve
D) Obtrator Nerve
B) Common Fibular Nerve
Since starting PA school you have becoming very observant of everyone around you. When walking behind a stranger you note that his left hip drops slightly when he is standing on his right leg. From what you have learned this semester, you determine this is caused by what?
A) Damage to the right superior gluteal nerve
B) Damage to the left superior gluteal nerve
C) Damage to the right inferior gluteal nerve
D) Damage tot he left inferior gluteal nerve
A) Damage to the right superior gluteal nerve
Striking the knee to elicit the patellar tendon reflex, which tests the integrity of the femoral nerve and the L2-L4 segments of the spinal cord, should result in what movement(s):
A. Contraction of the Quadriceps Only
B. Flexion of the Leg at the Knee Only
C. Extension of the Leg at the Knee Only
D. Contraction of the Quadriceps and Flexion of the Leg at the Knee
E. Contraction of the Quadriceps and Extension of the Leg at the Knee
E. Contraction of the Quadriceps and Extension of the Leg at the Knee
It was leg day at the gym, and Brock was feeling especially energetic. Although a hefty portion of his two-hour gym session was spent finding the perfect pose to take a pic of and post on insta, he did manage to find time to beat his record of number of sets on the hip abductor machine. Brock was also taught how to strengthen his lateral hip rotators by squatting with a resistance band around his legs. The following morning, Brock woke up unable to extend his right hip, flex his leg, or move his ankle or foot. This was a far cry from his usually post-workout fatigue. After giving a call to his friend in PA school, he is told that his sciatic nerve has been compressed by an inflamed muscle that he had been working out the previous day. Given Brock’s symptoms and the focus of yesterday’s workout, what muscle is responsible for compressing the sciatic nerve?
A. Gluteus maximus
B. Biceps femoris
C. Piriformis
D. Quadratus femoris
C. Piriformis
As we age, the angle of inclination between the long axis of the femoral neck and femoral shaft decreases. In extreme cases this can also cause shortening of the lower limb with limited passive abduction at the hip. This is commonly referred to as:
A. Coxa valga
B. Coxa vara
C. Ossification of hip joint
D. Greater trochanter avulsion
B. Coxa vara
You are on the sidelines at a football game and observe a rough tackle. One of the players injures his knee and the AT runs out on the field to check him out. You notice that upon exam the AT is able to pull the tibia forward anteriorly under the fixed femur. Which ligament is most likely torn?
a. Medial collateral ligament
b. Posterior cruciate ligament
c. Lateral collateral ligament
d. Anterior cruciate ligament
d. Anterior cruciate ligament
