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
