Head and Neck ( 20% )

Question 1

With regard to innervation of the face

• The infratrochlear n supplies the medial aspect of the lower eyelid.
• The auriculotemporal n is a branch of VII.
• The mental n is a branch of the inferior alveolar n
• The cutaneous sensation of the angle of the jaw is supplied by the marginal mandibular branch of VII.
• The maxillary n passes though the parotid.

Answer 1

The mental n is a branch of the inferior alveolar n

• The infraorbital nerve supplies the medial aspect of the lower eyelid.
  
  • Infra-trochlear = bridge of nose
• The auriculotemporal n is a branch of V3
• The cutaneous sensation of the angle of the jaw is supplied by the great auricular nerve, via C2,3 (cervical plexus)
  
  • ​ marginal mandibular branch of VII is a Motor nerve only
• The facial n passes though the parotid gland
  
  • Maxillary nerve enters from inferior orbit

Question 2

Which of the following is a branch of the mandibular n

• Infraorbital n
• external nasal n.
• zygomaticofacial n.
• auriculotemporal n
• zygomaticotemporal n
• infratrochlear n.
• greater palatine n
• posterior auricular n.
• zygomatic n.
• short ciliary nn

Answer 2

auriculotemporal n

• Maxillary (V2)
  
  • Infraorbital n.
    
    • Internal nasal branch (just inside nostril)
  • zygomatic n.
    
    • zygomaticofacial n.
    • zygomaticotemporal n.
  • Nasopalatine nerve
    
    • Greater and lesser palatine nerves
  • Pterygopalatine plexus
• Ophthalmic (V1)
  
  • Lacrimal
  • Nasociliary
    
    • Anterior ethmoidal
      
      • External nasal n
    • infratrochlear n.
  • Frontal Nerve
    
    • Supraorbital
    • Supratrochlear
• Mandibular nerve (V3)
  
  • Auriculotemporal nerve
  • Buccal
  • Lingual
  • Inferior alveolar nerve
    
    • Mental nerve
  • Nerve to mylohyoid
• Facial (motor)
  
  • posterior auricular n.
• short ciliary nn

Question 3

All of the following are branches of the ophthalmic division of the V except

• Lacrimal
• Infraorbital
• Supraorbital
• Infratrochlear
• Supratrochlear

Answer 3

Infraorbital

(off V2)

Question 4

A # through the roof of the maxillary sinus may result in sensory loss to the

• Tympanic membrane
• Lacrimal gland
• Upper molar teeth
• Upper incisors and canine teeth.
• Skin overlying the zygomatic bone

Answer 4

Upper incisors and canine teeth.

Infra-orbital nerve supply (why you nerve block this to numb upper teeth)

• Tympanic membrane - auriculotemporal (v3)
• Lacrimal gland - Ophthalmic branch (V1)
• Upper molar teeth ??
• Skin overlying the zygomatic bone - zygomaticofacial (V2)

Question 5

Cell bodies for the motor supply of V lie

• Hypothalamus
• Midbrain
• Posterior to cerebral aqueduct.
• Cortex
• Floor III ventricle

Answer 5

Posterior to cerebral aqueduct.

(Location of the pons)

• Midbrain = III + IV
• Pons = V
• Pons/medulla border = VI, VII, VIII
• Medulla = IX, X, XII

Question 6

Which nerve supplies the vertex of the scalp

• Greater occipital
• 3rd occipital
• auriculotemporal
• supraorbital.
• supratrochlear

Answer 6

supraorbital.

Greater occipital is listed as the answer but Moores states supraorbital supplies ‘scalp to vertex’.

GO only says occipital scalp.

(diagram for illustrative purposes only - go by what Moores says)

Question 7

corneal sensation synapses in which ganglion

• pterygopalantine
• geniculate
• otic
• ciliary
• V

Answer 7

ciliary

Corneal sensation sensed by nasociliary nerve branch of V1

Question 8

The ophthalmic division of the V

• Enters the face via the inferior orbital fissure
• Supplies sympathetic fibres to constrictor papillae muscles.
• Supplies sensation to the forehead and upper eyelid excluding the orbit
• Gives 3 branches, 2 of which contain sympathetic as well as sensory fibres
• Controls abduction of the eye

Answer 8

Gives 3 branches (frontal, lacrimal and nasociliary), 2 of which contain sympathetic as well as sensory fibres

(lacrimal to lacrimal gland, and ??? - Moores lists only lacrimal gland as having parasympathetic fibres)

Cannot confirm this answer.

• Enters the face via the superior orbital fissure.
  
  • V2 enters via inferiro orbital fissure
• Sympathetic supply to constrictor papillae muscles comes from ICA plexus and dilates pupils
• Supplies sensation to the forehead and upper eyelid excluding the orbit - ??inside superior orbit too (this may be right)
• Controls abduction of the eye - this is VI (V1 is purely sensory)

Question 9

Which of the following is incorrect regarding the V

• Has no motor fibres.
• Has 3 major divisions.
• Has 3 main branches from the ophthalmic division.
• The maxillary division traverses the foramen rotundum
• Gives rise to the infraorbital nerve.

Answer 9

Has motor fibres in the V3 branch: Muscles of mastication

• Has 3 major divisions - Ophthalmic (v1), maxillary (V2), mandibular (v3)
• Has 3 main branches from the ophthalmic division. (Frontal, lacrimal, nasociliary)
• The maxillary division traverses the foramen rotundum
  
  • Maxillary (V2) - foramen rotundum (base of greater wing of sphenoid) → pterygopalatine fossa → inferior orbital fissure (orbital floor)
• Gives rise to the infraorbital nerve - Via V2

Question 10

The base of skull

• Provides passage for the maxillary nerve via the foramen ovale.
• Has no muscular attachments.
• Provides passage for the vertebral arteries via the condylar canals.
• Accommodates the hypothalamus in the sella tursica.
• Accommodates the sigmoid sinus in the posterior fossa

Answer 10

Accommodates the sigmoid sinus in the posterior fossa

• Provides passage for the maxillary nerve via the Foramen rotundum. Ovale = mandibular nerve
• Does have muscular attachments - Styloid and mastoid muscles
• Provides passage for the vertebral arteries via the Foramen magnum
• Accommodates the pituitary in the sella tursica

Question 11

All of the following pass through the jugular foramen except

• Jugular vein
• IX
• XII
• XI
• X

Answer 11

XII

Jugular foramen transmits IJV, IX, X, XI

Question 12

What exits the stylomastoid foramen

• Middle meningeal a
• XI
• VII
• Artery to stapedius
• XII

Answer 12

VII

Facial nerve

• Middle meningeal a - foramen spinosum
• XI - jugular foramen
• XII -

Question 13

What runs through the foramen spinosum

• ICA
• Maxillary branch V
• Mandibular branch V
• Middle meningeal a
• Meningeal n

Answer 13

Middle meningeal a

• ICA - carotid canal
• Maxillary branch V - foramen rotundum
• Mandibular branch V - foramen ovale

Question 14

The anterior fontanelle is typically closed at

• 6 months
• 1 year
• 2 years
• 3 years
• 4 years

Answer 14

2 years

• Anterior fontanelle = 18 months
• Frontal suture = 8 years (begins at 2)
• Posterior fontanelle = 1 year

Question 15

In the skull

• The anterior fontanelle is usually closed by 2 months.
• The pterion overlies the middle meningeal artery
• The round foramen transmits the mandibular branch of the V.
• The cribriform plate is part of the sphenoid bone.
• All of the above are correct

Answer 15

The pterion overlies the middle meningeal artery

• The anterior fontanelle is usually closed by 18 months.
• The round foramen (foramen rotundum im guesing) transmits the maxillary branch of the V.
  
  • Foramen ovale is the mandibular nerve
• The cribriform plate is part of the ethmoid bone.

Question 16

The motor nuclei of the VII are in

• Pons
• Midbrain
• Medulla oblongata
• Cerebellum
• Floor of the 3rd ventricle

Answer 16

Pons

Nick says Pons, Moores says on the junction of pons/medulla

• Midbrain = III + IV
• Pons = V
• Pons/medulla border = VI, VII, VIII
• Medulla = IX, X, XII

Question 17

With regard to VII

• Paralysis of the temporal branch prevents blinking
• Is predominantly sensory.
• Paralysis of the buccal branch impedes chewing.
• The supraorbital n is a branch.
• Contains proprioceptive fibres.

Answer 17

Paralysis of the temporal branch prevents blinking.

Done by superior part of orbicularis oculi which is innervated by the temporal branch. Inferior part of the muscle innervated by zygomatic branch, is used for firmly closing eye

• No somatic sensation (facial sensation done by V)
• Paralysis of the buccal branch does not impedes chewing.
  
  • Muscles of mastication supplied by V3.
  • Buccal nerve supplies orbicularis oris
• The supraorbital n is a branch of the frontal nerve (from V1)
• Does not contains proprioceptive fibres - purely motor (As for (B)

Question 18

Facial n

• Emerges from the skull through the jugular foramen
• Supplies the anterior belly of the digastric.
• May result in corneal ulceration if damaged.
• Is the 5th cranial n.
• Will spare paralysis of the temporal branch in LMN lesions.

Answer 18

May result in corneal ulceration if damaged.

Inability to contract orbicularis oculis -> can’t close eye -> prone to FB​

• Emerges from the skull through the Stylomastoid foramen
• Supplies the posterior belly of the digastric (along with stylohyoid)
• Is the 7th cranial n.
• Will spare paralysis of the temporal branch in UMN lesions.
  
  • Unclear wording but probably implies that temporal branch receives dual UMN supply, hence sparing of forehead paralysis with UMN lesions but not in LMN lesions
  • ie the temporal branch receives a dual UMN supply, so a stroke etc will not cause paralysis of the upper face, but a LMN lesion (eg Bells palsy) will - one of the ways of telling them apart

Question 19

Regarding facial nerve, all are true except

• It carries taste fibres from the anterior 2/3 the tongue
• It has 5 branches exiting the parotid
• It carries sensation from the skin of the external acoustic meatus
• It exits the base of the skull via the foramen spinosum
• Its efferent fibres have cell bodies in the geniculate ganglion

Answer 19

It exits the base of the skull via the Stylomastoid foramen

Question 20

VII

• Supplies pain sensation to the anterior 2/3 of the tongue.
• Gives off the chorda tympani before entering the stylomastoid foramen.
• Supplies the anterior belly of the digastric muscle.
• Obicularis oris muscle is supplied by the zygomatic branch.
• Lies deep to the ECA.

Answer 20

Gives off the chorda tympani before entering the stylomastoid foramen.

• Supplies taste sensation to the anterior 2/3 of the tongue.
  
  • Lingual (V3) supplies pain
• Supplies the posterior belly of the digastric muscle (with stylohyoid).
  
  • Anterior supplied by nerve to mylohyoid (inf alveolar [V3])
• Obicularis oris muscle is supplied by the temporal branch.
• Lies superficial to the ECA (as it passes through the parotid)

Question 21

13. Which of the following about the facial nerve is incorrect?

• a. Supplies muscles of facial expression
• b. Supplies buccinator
• c. Gives the great petrosal nerve.
• d. Contains taste fibres.
• e. Contains fibres destined for the ciliary ganglion.

Answer 21

e. Contains fibres destined for the ciliary ganglion.

Pterygopalatine (para to lacrimal gland) and submandibular

Above is Nicks answer, I dont understand it.

• c. Gives the great petrosal nerve.
  
  • Merges with deep petrosal (symp) to form nerve of petrosal canal
• d. Contains taste fibres - Chorda tympani

Question 22

With respect to the ventricles in the brain all are true except

• IV ventricle extends as the central canal of the spinal cord
• Lateral ventricles open into the III ventricle by the interventricular foramen
• Ventricular apertures (foramen of luscka) drain CSF into the pontine cistern.
• IV ventricle lies between the pons and the upper medulla
• Foramen of Magendie (ventricular apertures) drains CSF into the IV ventricle.

Answer 22

Cerebral aqueduct aka Sylvian aqueduct drains CSF into the IV ventricle.

• IV ventricle extends as the central canal of the spinal cord
• Lateral ventricles open into the III ventricle by the interventricular foramen (aka foramen of Monro)
• Ventricular apertures (Foramen of Luscka) drains CSF into the pontine cistern.
  
  • 4th V -> Ventricular apertures (Foramina of Magendie (median) and 2 x of Luscka) -> cerebellomedually cistern -> subarachnoid space of spine and brain -> continuous with Pontine cistern
• IV ventricle lies between the pons and the upper medulla
  
  • Described in Moores as ‘in the posterior part of the pons and medulla’

Question 23

CSF communicates with the subarachnoid space via the

• 4th ventricle
• 3rd ventricle
• subarachnoid granulations.
• choroid plexus
• tela choroidia

Answer 23

4th ventricle

‘CSF drains into the subarachnoid space from the 4th ventricle through a single median aperture and paired lateral apertures. These apertures are the only means by which CSF enters the SAS’

subarachnoid granulations are where CSF moves from subarachnoid space into the venous system

Question 24

Which of the following is outside of the BBB

• Anterior pituitary
• Posterior pituitary

Answer 24

Posterior pituitary

Question 25

The blood brain barrier

• Only allows amino acids, fats and sugar to be transported.
• Lacks fenestrations and zonulae occudentes
• Has enveloping astrocyte foot processes instead of basal laminae
• Are innervated by sympathetic fibres only
• Is missing from parts of the hypothalamus

Answer 25

Is missing from parts of the hypothalamus

• Allows amino acids, fats and sugar to be transported, as well as Water, CO2, O2, lipid-soluble steroids not bound to plasma proteins

Will need to find answers to the below

• Lacks fenestrations and zonulae occudentes
• Has enveloping astrocyte foot processes instead of basal laminae
• Are innervated by sympathetic fibres only

Question 26

Where does the superior cerebral vein lie

• Deep in the sulci
• Between the dura and the skull
• In the arachnoid mater
• In the margins of the falx
• With the superior cerebral artery

Answer 26

In the arachnoid mater

• Veins cause subdural haemorrhages - slow-growing.*
• Arteries cause epidural haemorrhages - fast growing, high pressure.*

Question 27

regarding veins in the skull

• do not follow arteries
• lie subdurally.
• great cerebral vein drains into cavernous sinus.

Answer 27

do not follow arteries

• lie in the Subarachnoid space (subdural is normally just a potential space).
  
  • Venous sinuses lie in partitions within the dura
• great cerebral vein drains into Straight sinus (merging with inferior sagittal sinus)
  
  • ​Superior veins -> superior sagittal sinus
  • Inferior and superficial veins -> straight, transverse, and superior petrosal sinuses

Question 28

With regard to the venous sinuses of the brain

• Superior sagittal sinus drains the frontal lobes
• The transverse sinus runs between the layers of the falx cerebri.
• Sigmoid sinus grooves the mastoid part of the petrous bone
• The cavernous sinus has the III, IV and 2 divisions of V in its medial wall.
• Sigmoid sinus drains the occipital sinus.

Answer 28

Sigmoid sinus grooves the mastoid part of the petrous bone

• Superior sagittal sinus drains the superior cerebral veins
• The transverse sinus runs between the layers of the Tentorium cerebelli
• The cavernous sinus has the III, IV and 2 divisions of V in its Lateral wall
• Sigmoid sinus drains the occipital sinus. No such thing as occipital sinus

Question 29

Regarding the circle of Willis

• Posterior cerebral is a branch of the ICA.
• Anterior cerebral is the largest branch of the ICA
• Middle cerebral supplies motor but not sensory cortex.
• ICA gives off ophthalmic a
• Anterior communicating unites middle and anterior cerebral.

Answer 29

ICA gives off ophthalmic a

• Posterior cerebral is a branch of the Basilar artery
• Middle cerebral is the largest branch of the ICA.
• Middle cerebral supplies both motor and sensory cortex.
• Anterior communicating unites the 2 ACAs

Question 30

regarding the blood supply of the cortex

• MCA is contralat arm, leg and speech areas
• ACA is contralat leg, micturition and defaecation
• MCA is ipsilat arm, face and vision
• PCA is ipsilat vision
• ACA is contralat leg, auditory and speech

Answer 30

ACA is contralat leg, micturition and defaecation

I will have to take Nicks word for this

• Vision is ipsilateral ophthalmic artery (off ICA) to the eye, or the contralateral visual field homonymosly in the occipital cortex (PCA)
• MCA supplies motor and sensory cortex (contralateral arm and leg)
• Need to confirm speech and auditory areas - likely ACA.

Question 31

The blood supply to the spinal cord

• There are no anastomoses between anterior and posterior spinal arteries
• The radicular arteries are constant in number and origin
• The posterior spinal artery is usually a branch of the posterior cerebellar or vertebral aa.

Answer 31

The posterior spinal artery is usually a branch of the posterior cerebellar or vertebral aa.

Usually PICA

Question 32

cerebral circulation

• ACA/MCA/PCA are all terminal branches of ICA.
• ACA is most common site of embolization.
• ACA supplies motor and sensory control of urination and defecation

Answer 32

ACA supplies motor and sensory control of urination and defecation

• ACA + MCA ar terminal branches of ICA; PCA is a branch of basilar
• MCA is most common site of embolization.

Question 33

Regarding the cerebral circulation

• An artery that has entered the surface of the brain is always an end artery
• Supply originates from the ECA and vertebral system.
• Congenital aneurysms are most frequently found in the basilar part of the circle of Willis.
• The posterior cerebral artery arises from the internal carotid
• The middle cerebral artery is the smallest branch of the ICA.

Answer 33

An artery that has entered the surface of the brain is always an end artery

• Supply originates from the ICA and vertebral system.
• Congenital aneurysms are most frequently found in the Ant communicating most common, then Post comm, then MCA, then ICA
• The posterior cerebral artery arises from the Basilar artery
• The middle cerebral artery is the largest branch of the ICA (others are ACA, ophthalmic and post comm)

Question 34

The most common site for embolisation to the cerebral circulation is

• The posterior cerebral a
• The anterior communicating artery
• The middle cerebral a
• The basilar artery
• The posterior communicating

Answer 34

The middle cerebral a

Question 35

The ICA

• Enters the skull through the foramen lacerum
• Divides into the anterior and middle cerebellar arteries
• Gives off the ophthalmic artery
• Is accompanied within the skull by preganglionic sympathetic nerve fibres.
• Usually begins about the level of C6.

Answer 35

Gives off the ophthalmic artery

• Enters the skull through the Carotid canal. Passes on top of F lacerum
• Divides into the anterior and middle cerebral arteries
• Is accompanied within the skull by post-ganglionic sympathetic nerve fibres.
• Usually begins about the level of C3/4

Question 36

Regarding the basilar artery, all are true except

• Gives off branches to the anterior spinal artery.
• Divides to give off both posterior cerebral arteries
• Supplies branches to the pons
• Formed by the union of the vertebral arteries
• Lies on the ventral surface of the cerebral peduncles

Answer 36

Does not Give off branches to the anterior spinal artery.

Vertebrals do

Question 37

In the circle of Willis

• The basilar artery divides into right and left posterior cerebellar arteries.
• The middle cerebral arteries branch off and supply motor but not sensory cortex.
• The anterior communicating artery unites the middle cerebral artery to the internal cerebral artery
• It encircles the inferior brains stem at the C2-3 level.
• The ICA gives off the ophthalmic arteries before dividing into anterior and middle cerebral arteries

Answer 37

The ICA gives off the ophthalmic arteries before dividing into anterior and middle cerebral arteries

• The basilar artery divides into right and left posterior cerebral arteries.
  
  • Gives off superior and anterior inferior cerebellar arteries.
  • Vertebrals give off post inferior cerebellar arteries
• The middle cerebral arteries branch off and supply both motor and sensory cortex.
• The anterior communicating artery unites the two ACAs
• It encircles the inferior brains stem at the C2-3 level.
  
  • Does not circle the brainstem

Question 38

The blood supply of the spinal cord

• Is from a single anterior and posterior artery.
• Anteriorly is from the anterior spinal artery derived from the right brachiocephalic trunk.
• Lies in the subdural space.
• Receives important contributions from radicular arteries
• None of the above

Answer 38

Receives important contributions from radicular arteries

• Is from a single anterior and 2x posterior artery.
• Anteriorly is from the ​anterior spinal artery derived from the vertebral arteries
• Lies in the probably pia space.

Question 39

The infratrochlear n supplies

• Upper incisors.
• Labial gum.
• Bridge over the nose
• Upper lip.
• Skin of the lower eyelid.

Answer 39

Bridge over the nose

• Upper incisor - Infra-orbital
• Labial gum - Infra-orbital
• Upper lip - Infra-orbital
• Skin of the lower eyelid - Infra-orbital

Question 40

Fibres from II

• Pass to the superior colliculus for relay to the visual cortex.
• From the temporal surface of the retina cross at the chiasma.
• Receive blood supply from the branches of the anterior cerebral a
• Pass through the superior orbital fissure.
• Pass to the lateral geniculate body for constriction of the pupil.

Answer 40

Unclear answer

Receive blood supply from the branches of the anterior cerebral artery

• Nick says the above, but central retinal artery and all ciliary arteries are branches of ophthalmic artery (off ICA)*
• I cannot confirm nor deny the last answer*
• Pass to the LGB for relay to the visual cortex.
• From the nasal surface of the retina cross at the chiasma
• Pass through the Optic canal
• Pass to the lateral geniculate body for constriction of the pupil.
  
  • Some optic nerve afferents bypass the LGB, instead going to the pretectal nuclei in the sup colliculus, which then stimulate the E-W nucleus -> pre-G para in III -> ciliary G (from nasociliary of V1) -> post-G para in short ciliary nerves

Question 41

III

• Supplies lateral rectus
• Passes between superior cerebellar and posterior cerebral a
• Travels in the medial wall of the cavernous sinus.
• Divides into superior and inferior branches after exiting from the superior orbital fissure.
• Complete division causes miosis and ptosis.

Answer 41

Passes between superior cerebellar and posterior cerebral a

• CN VI supplies LR.
• Travels in the lateral wall of the cavernous sinus.
• Divides into superior and inferior branches before exiting from the superior orbital fissure.
• Complete division causes mydriasis and ptosis (carries parasympathetic fibres).
  
  • Miosis + ptosis is a Horner’s (sympathetic loss)

Question 42

The orbit contains all of the following except

• Branches of VII
• II
• III
• A subarachnoid space
• The IR muscle

Answer 42

Branches of VII

• Subarachnoid space surrounds the optic nerve in the optic sheath until it enters the eye (part of the reason you can see raised ICP in the discs)
• II (optic) and III (occulomotor) are in the orbit
• Inferior rectus obviously in the orbit

Question 43

regarding eye movements (2 CORRECT)

• IV paralysis = can’t look down when eye turned out.
• combined SR + IO = vertical up.
• SR moves eye up and out.
• VI paralysis = eyes look down and out.
• Combined IR +SO gives lat gaze.
• IR + SO move eye down
• SO action in full abduction is minimal.

Answer 43

combined SR + IO = vertical up.

Both elevate, and their adduction-abduction and intorsion-extorsion cancel out

IR + SO move eye down

(IR = depression and ADduction; SO depression + ABduction)

• IV paralysis = can’t look down when eye turned in
• SR moves eye up and in
• III paralysis = eyes look down and out due to unopposed SO and LR
  
  • ​VI palsy causes addiction (loss of abduction)
• Combined IR +SO gives Downwards gaze (see above)
• SO action in full abduction is minimal.
  
  • SO’s main action is depression in adduction. Is also an abductor

Question 44

With regard to the extraorbital muscles and their innervation all are correct except

• Superior rectus turns the eye up and out.
• There are 7 extraocular mm.
• Superior oblique is supplied by IV
• Medial rectus turns eye in
• In VI paralysis the eye cannot look outwards.

Answer 44

Superior rectus turns the eye up and in

• There are 7 extraocular mm.
  
  • According to Moore’s: LPS, 2 obliques, 4 recti
• Superior oblique is supplied by IV - SO4LR6
• Medial rectus turns eye in - (MR = adduction)
• In VI paralysis the eye cannot look outwards - true

Question 45

action of SO

• elevates eye.
• moves eye down and out
• extorsion. Intorsion
• medial deviation
• opposes all the other muscle actions

Answer 45

moves eye down and out

• SO = down and out*
• IO = up and out*
• SR = down and in*
• IR = up and in*
• MR/LR = adduction/abduction only*

Question 46

The orbit

• Floor consists of the maxilla.
• Superior orbital fissure leads to the anterior cranial fossa.
• Inferior orbital fissure leads to the middle cranial fossa.
• The superior oblique muscle causes the eye to look up and in.
• Trochlear nerve lies outside the cone of muscles.

Answer 46

Trochlear nerve lies outside the cone of muscles. ​

Enters through the superior orbital fissue, along with the Frontal Nerve and Lacrimal Nerve (V1)

• Floor consists of the maxilla, As well as zygomatic and palatine bones
• Superior orbital fissure leads to the Middle cranial fossa
• Inferior orbital fissure leads to the Pterygoid plexus
• The superior oblique muscle causes the eye to look Down and out

Question 47

Which bone makes up part of the roof of the orbit

• Sphenoid.
• Maxilla
• Lacrimal
• Ethmoid
• Temporal

Answer 47

Sphenoid.

Lesser wing contributes to roof at the apex

Question 48

regarding the infratemporal fossa

• the maxillary a enters posteriorly deep to the spheno mandibular ligament.
• the medial pterygoid plate represents part of the medial wall.
• the mandibular branch of the V gives off the chorda tympani immediately on entering the region.
• the lingual n is separated from the mandible by the medial pterygoid m.
• none of the above are correct

Answer 48

none of the above are correct

• the maxillary a enters posteriorly superficial to the spheno mandibular ligament.
• the lateral pterygoid plate represents part of the medial wall.
• the facial nerve (VII) gives off the chorda tympani immediately on entering the region.
• Lingual nerve lies between mandible and medial pterygoid

Question 49

The parotid gland

• Duct opens opposite the 2nd lower molar tooth.
• Is supplied by the ICA.
• The VII lies on the anteromedial surface of the gland.
• The ECA lies superficial within the gland.
• The retromandibular vein lies immediately deep to VII

Answer 49

The retromandibular vein lies immediately deep to VII

• Duct opens opposite the 2nd upper molar tooth
• Is supplied by the ECA (lies deep within the gland)
• The VII lies within the gland (superficial to ECA and RMV)
• The ECA lies deep within the gland.

Question 50

where do the cell bodies with afferent taste fibres from the anterior tongue lie

• otic ganglion
• geniculate ganglion.
• V ganglion
• Submandibular ganglion

Answer 50

geniculate ganglion.

Facial nerve as it turns within the temporal bone. Taste to anterior 2/3 tongue

Question 51

After tonsillectomy a patient complains of loss of taste from the posterior tongue, which nerve is damaged

• XII
• IX
• Lingual

Answer 51

IX

IX does sensation and taste to posterior 1/3rd

VII (chorda tympani) does anterior 2/3rds taste

V (lingual branch of V3) does anterior sensation

IX does all motor

Question 52

With regards to the tongue

• It is covered by epithelium derived from the 1st, 2nd and 3rd branchial arches
• All tongue muscles are innervated by XII.
• Each side may drain lymph to nodes on the contralateral side of the neck
• It elevates the epiglottis through attachment of the lateral glossoepiglottic folds
• All of the above are true

Answer 52

Each side may drain lymph to nodes on the contralateral side of the neck

• All tongue muscles except palatoglossus are innervated by XII.
• ??? It elevates the epiglottis through attachment of the lateral glossoepiglottic folds

Question 53

Regarding the tongue

• It is moved only by the intrinsic and extrinsic muscle.
• It is supplied entirely by the dorsal lingual a.
• There is free communication between vessels on both sides.
• Lymphatic drainage goes to ipsilateral and contralateral sides of the neck
• The lingual nerve supplies sensation to the entire tongue.

Answer 53

Lymphatic drainage goes to ipsilateral and contralateral sides of the neck

• It is moved only by the intrinsic and extrinsic muscle.
  
  • Unclear why this is false. Lots of other muscles move the mouth
  • Intrinsic alter shape of tongue, extrinsic alter its position
  • All supplied by IX except palatoglossus
• It is supplied lingual artery (branch of ECA). Branches - deep - supplies body; dorsal - supplies root
• There is free communication between deep lingual arteries only at the apex
• The lingual nerve supplies sensation to the anterior tongue, IX posterior 1/3

Question 54

The tongue

• Has an excellent collateral blood supply across its midline.
• Has lymph drainage only to its ipsilateral lymph nodes.
• Has intrinsic and extrinsic muscles all of which are supplied by the hypoglossal n.
• Has sensory nerve supply to its posterior third from the lingual n.
• Is covered by columnar epithelium in its posterior 1/3

Answer 54

Is covered by columnar epithelium in its posterior 1/3

• Has collaterals only at the apex (deep lingual arteries)
• Has lymph drainage to both its ipsilateral and contralateral lymph nodes.
• Has intrinsic and extrinsic muscles all of which are supplied by the hypoglossal n except Palatoglossus by X
• Has sensory and taste nerve supply to its posterior third from the hypoglossal nerve (IX)
  
  • ​**Lingual nerve (branch V3) supplies sensation to anterior 2/3rds (chorda tympani of VII does taste)

Question 55

Which of the following enters into the inferior meatus of the nose

• Frontal sinus.
• Ethmoid sinus.
• Maxillary sinus.
• Nasolacrimal duct
• Auditory tube

Answer 55

Nasolacrimal duct

• Frontal sinus - Hiatus semi-lunaris (middle meatus)
• Ethmoid sinus - Anterior with frontal, middle via bulla on the uncinate (also middle), posterior into superior meatus
• Maxillary sinus - Hiatus semi-lunaris (middle)
• Auditory tube - Posterior to the meati

Question 56

The blood supply to the nasal cavity

• Is only from the external carotid.
• Mainly enters through the nostril.
• Does not communicate with intracranial vessels
• Mainly enters the sphenopalatine foramen
• Arrives to Little’s area from ophthalmic artery branches

Answer 56

Mainly enters the sphenopalatine foramen

• Is from both external carotid and internal carotid
  
  • ECA - sphenopalatine and greater palatine (from maxillary) and superior labial (from facial artery)
  • ICA - Anterior and posterior ethmoidal (from ophthalmic a.)
• Mainly enters through the Sphenopalatine recess
• Does communicate with intracranial vessels. As for (A)
• Arrives to Little’s area from ophthalmic artery branches
  
  • Appears to be primarily facial and maxillary branches

Question 57

The nose

• Kieselbach’s plexus is formed from branches of the sphenopalatinal, superior labial and greater palatine arteries.
• Lymphatics follow the arteries
• Inferior nasal concha is the smallest
• Nasolacrimal duct opens behind the superior concha.
• Is supplied by the frontal n.

Answer 57

Kieselbach’s plexus is formed from branches of the sphenopalatinal, superior labial and greater palatine arteries.

• Lymphatics follow the ?veins
• Superior nasal concha is the smallest
• Nasolacrimal duct opens behind the Inferior nasal concha
• Is supplied by the:
  
  • Posteroinferior - both branches of maxillary (V2)
    
    • Septum is by nasopalatine,
    • lateral wall by greater palatine
  • antero-superior by anterior and posterior ethmoidal (nasolacrimal [V1])
  • frontal n. supplies the forehead

Question 58

1. The blood supply of Little’s area (anteroinferior part of the septum) is best described by

• a. Anterior and posterior ethmoidal arteries from the ophthalmic artery
• b. The sphenopalatine branch of the maxillary artery
• c. Sphenopalatine artery and septal branch of the superior labial branch of the facial artery
• d. All of the above
• e. None of the above

Answer 58

d. All of the above

Question 59

11. The blood supply to the nasal cavity

• a. Is only from the external carotid.
• b. Mainly enters through the nostril
• c. Does not communicate with intracranial vessels.
• d. Mainly enters the sphenopalatine foramen
• e. Arrives to Little’s area from ophthalmic artery branches. Unclear why this is not truw

Answer 59

d. Mainly enters the sphenopalatine foramen

• a. Is from the external carotid and internal carotid - Anterior and posterior ethmoidal from ophthalmic arteries (ICA)
• c. Does communicate with intracranial vessels.
• e. Arrives to Little’s area from ophthalmic artery branches.
  
  • Unclear why this is not true, but seems to be primarily maxillary and facial branches

Question 60

2. the septum of the nasal cavity is innervated by

• a. nasopalatine nerve from cranial nerve V2
• b. posterior ethmoidal nerve from V1.
• c. greater palatine nerve from V2.
• d. lesser palatine nerve from V2.
• e. none of the above

Answer 60

a. nasopalatine nerve from cranial nerve V2

Posteroinferior septum

• b. posterior ethmoidal nerve from V1 - Doesn’t reach into the cavity
  
  • ​Anterior ethmoidal nerve supplies anterior septum
• c. greater palatine nerve from V2 - Branches innervate the lateral wall
• d. lesser palatine nerve from V2 - Not involved

Question 61

The afferent path of the sneeze reflex is mediated by the

• Ophthalmic n
• Maxillary n.
• Mandibular n
• X
• IX

Answer 61

Maxillary n.

Somatic sensation from the nose

(Not sure why ophthalmic also does not count)

Question 62

Which receives afferents for the sneeze reflex

• Otic ganglion.
• V ganglion
• Ciliary ganglion.

Answer 62

V ganglion

• Otic ganglion - Somatic afferents from parotid gland via auriculotemporal (V3)
• Ciliary ganglion - Afferents are somatic from the eye via nasociliary (V1)

Question 63

The cutaneous innervation of the ear

• Is the lesser auricular n
• Involves the dermatome C3
• Includes the zygomaticotemporal branch of the V
• Includes the X
• Involves the greater occipital n

Answer 63

Includes the X

• Auricular branch of the vagus - supplies the concha*
• Involves the auriculotemporal nerve and greater auricular nerve, as well as the auricular branch of the vagus

Question 64

The alar ligaments connect:

• adjacent laminae
• tips of adjacent spinous processes
• adjacent vertebral bodies posteriorly
• dens to foramen magnum
• bodies of the axis to foramen magnum

Answer 64

dens to foramen magnum

• Supraspinous ligament* = tips of adjacent spinous processes
• Posterior longitudinal ligament =* adjacent vertebral bodies posteriorly
• Longitudinal bands of the Cruciate ligament =* bodies of the axis to foramen magnum

Question 65

C7

• Is typical.
• Has a bifid spinous process.
• Transmits the vertebral artery through the foramen in the transverse process.
• Has the supra-pleural membrane attached to the anterior tubercle
• Has a short spinous process.

Answer 65

Has the supra-pleural membrane attached to the anterior tubercle

Above not mentioned in Moores neck section, but others all are, and are clearly wrong

• Is Atypical (vertebra prominens)
• Has a non-bifid spinous process which is long
  
  • ​C2-6 have a short, bifid processes
• Does not transmits the vertebral artery through the foramen in the transverse process.
  
  • Vertebral artery starts at C6 foramina and heads superiorly, hence why C7 TP foramen is small

Question 66

The atlas

• Has no foramen in the transverse process
• Is the narrowest cervical vertebra
• Has a body
• Has a posterior arch grooved by the vertebral a
• Has a short spinous process

Answer 66

Has a posterior arch grooved by the vertebral a

Atlas (C1) has no body or spinous process, is the widest cervical vertebra, and has foramina transversaria

Question 67

Regarding the cervical vertebrae

• Cervical ribs are due to elongation of the costal elements of C4 vertebra
• The vertebral foramina are smaller than the bodies of the vertebrae.
• All cervical vertebrae have bifid spinous processes.
• The carotid tubercle is found on C6 vertebra
• The vertebral foramina are round in cross section.

Answer 67

The carotid tubercle is found on C6 vertebra

• Cervical ribs are due to elongation of the costal elements of C4 vertebra
• The vertebral foramina are larger than the bodies of the vertebrae - spinal cord is largest in cervical spine, and neck is mobile so bodies need to be small
• All cervical vertebrae except C1 and C7 have bifid spinous processes.
• The vertebral foramina are triangular in cross section - wider laterally than AP

Question 68

A typical cervical vertebra

• Has costal facets.
• Has a circular vertebral foramen.
• Bodies are often wedge shaped.
• Has a bifid spinous process
• Has an intervertebral canal in the lamina

Answer 68

Has a bifid spinous process

• No costal facets as no ribs attach
• Has a triangular vertebral foramen.
• Bodies are often oval shaped
• Has an intervertebral canal in the transverse processes (foramina transversaria for vertebral arteries and veins)

Question 69

C2

• Has a very small spinous process.
• Articulates with the occiput.
• Has a bifid spinous process
• Is referred to as the atlas.
• Has a dens that occupies the posterior 1/3 spinal canal.

Answer 69

Has a bifid spinous process

• Has a large bifid spinous process
• Does not articulate with the occiput - Only the atlas does
• Is referred to as the axis
• Has a dens that occupies the anterior 1/3 spinal canal - comes off the vertebral body and occupies region in C1 where the body should be

Question 70

The Atlas

• Articulates with the dens at the posterior arch.
• Allows rotation of the head at the atlanto-occipital joints.
• Has a single vertebral body.
• Provides attachment for the cruciform ligament
• Has a bifid spinous process.

Answer 70

Provides attachment for the cruciform ligament

• Articulates with the dens at the anterior arch
• Allows Flexion/extension of the head at the atlanto-occipital joints. Rotation occurs at the atlanto-axial joint
• Has no vertebral body, just anterior and posterior arches
• Has no spinous process

Question 71

In the C spine

• Typical vertebrae are C3-7 only
• Vertebrae have foramen in the spinous process
• The specialised joint, the atlanto-occipital joint allows head rotation
• The upper articular surfaces of the atlas are kidney shaped
• The axis plays a role in weightbearing.

Answer 71

The upper articular surfaces of the atlas are kidney shaped

• Typical vertebrae are C3-6 only
• Vertebrae have foramen in the transverse processes
• The specialised joint, the atlanto-axial joint allows head rotation
• The axis plays a role in weightbearing.
  
  • Poorly worded - its must bear at least some weight. Moore’s clearly states the atlas bears the weight of the head but does not mention any specifics about whether C2 bears weight

Question 72

Regarding triangles of the neck, all of the following structures are boundaries of the triangle named except:

• submental triangle, mandible.
• anterior triangle, mandible
• digastric triangle, mandible
• carotid triangle, SCM
• anterior triangle, SCM

Answer 72

submental triangle, mandible.

• The mandibular symphysis provides the apex of the triangle (but not really a border)*
• Must be an old question - Moores does not use these names for the triangles*

Question 73

Which of the following is not among the contents of the posterior triangle of the neck

• XI
• The second part of the subclavian a.
• The suprascapular vessels
• The cutaneous branches of the cervical plexus
• The inferior belly of the omohyoid

Answer 73

The third part of the subclavian a.

• XI and occipital artery are in occipital region*
• Inferior belly of omohyoid divides the triangle into occipital and omoclavicular triangles*

Question 74

Regarding the posterior triangle

• The external carotid a is the anterior border.
• The lateral third of the clavicle is its floor.
• The investing layer of deep cervical fascia is the floor.
• The triangle contains cervical plexus.
• The triangle contains division of the brachial plexus.

Answer 74

The triangle contains cervical plexus. ​

• SCM is the anterior border.
• The middlel third of the clavicle is its floor/base of triangle
• The investing layer of deep cervical fascia is the Roof.
  
  • Floor is the muscles covered in pre-vertebral fascia (scalenes, lev scapuli, splenius capitus)
• The triangle contains roots and trunks of the brachial plexus

Question 75

The posterior triangle

• Contains the superior bell of the omohyoid.
• Is bordered by the anterior border of the SCM.
• Is bordered by the middle 1/3 clavicle
• Has the inferior nuchal line at its apex.
• All the above are correct

Answer 75

Is bordered by the middle 1/3 clavicle

• Contains the inferior belly of the omohyoid (divides into two)
• Is bordered by the posterior border of the SCM.
• Has the superior nuchal line at its apex.

Question 76

With respect to the triangles in the neck

• The posterior triangle contains the IJV.
• The anterior triangle contains the 3rd part of the subclavian a.
• Posterior belly of the digastric crosses the posterior triangle.
• The posterior triangle contains the EJV.
• The trunks of the brachial plexus lie in the posterior triangle above the prevertebral fascia.

Answer 76

The posterior triangle contains the EJV.

A part of it

• The anterior triangle contains the IJV.
• The posterior triangle contains the 3rd part of the subclavian a.
• Posterior belly of the omohyoid crosses the posterior triangle.
• The trunks of the brachial plexus lie in the posterior triangle lateral / superficial to the pre-vertebral fascia (which covers the scalene muscles)

Question 77

In the neck

• The pretracheal fascia is prolonged to form the axillary sheath.
• The posterior belly of the digastric muscle is supplied by XII.
• The IJV lies medial to the CCA.
• The trachea begins at the level of C6.
• The thyroid isthmus is adherent to the 3rd, 4th and 5th tracheal rings.

Answer 77

The trachea begins at the level of C6. ​

• The prevertebral fascia is prolonged to form the axillary sheath -
  
  • extends from the anterior and middle scalene muscles to surround the brachial plexus and subclavian artery as these structures pass into the axilla
• The posterior belly of the digastric muscle is supplied by VII
• The IJV lies lateral to the CCA.
  
  • CCA is medial, IJV lateral, vagus posterior
• The thyroid isthmus is adherent to the 2nd and 3rd tracheal rings.

Question 78

Contents of the posterior triangle include all except

• Occipital LN.
• XI
• Cervical plexus.
• Inferior belly of the omohyoid
• Transverse cervical vessels

Answer 78

Occipital LN.

Contains superficial cervical lymph nodes

Question 79

The posterior triangle of the neck

• Contains the anterior rami of the upper 4 cervical nerves.
• Contains the 3rd part of the subclavian artery through its centre.
• Has deep cervical fascia lining its floor.
• Lies between the posterior border of SCM and the posterior border of trapezius and the clavicle.
• Contains the subclavian vein.

Answer 79

Bad/old question - 3 of the options are correct as per Moores.

Contains the anterior rami of the upper 4 cervical nerves.

C1-C4 forms the cervical plexus

Has deep cervical fascia lining its floor(prevertebral layer)

AND r**oof (investing layer)

• Contains the 3rd part of the subclavian artery at the base
• Lies between the posterior border of SCM and the anterior border of trapezius and the clavicle (middle third)
• Contains the subclavian vein.
  
  • Must be an old question as this is marked wrong, however…
  • Moores: ‘the subclavian vein…curves through the inferior part of the lateral cervical region. It passes anterior to the anterior scalene and phrenic nerve and unites at the medial border of th muscle with the IJV to form the brachiocephalic vein, posterior to the medial end of the clavicle.’

Question 80

All of the following are branches of the ECA except:

• sup thyroid a
• hypoglossal a
• facial a
• lingual a
• ascending pharyngeal a

Answer 80

hypoglossal a

ECA branches: ascending pharyngeal, occipital, posterior auricular, superior thyroid, lingual, facial

Hypoglossal is off internal carotid

Question 81

Branches of the external carotid artery include

• Inferior thyroid.
• Ascending pharyngeal
• Internal thoracic
• Superficial cervical
• Thymic

Answer 81

Ascending pharyngeal

Ascending pharyngeal, occipital, posterior auricular, superior thyroid, lingual, facial

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Question 82

The external carotid gives off which vessel from the medial side

• Superior thyroid.
• Lingual.
• Facial.
• Ascending pharyngeal
• Occipital

Answer 82

Ascending pharyngeal

1 medial, 2 posterior, 3 anterior

• Occipital - Posterior
• Posterior auricular - posterior
• Superior thyroid - Anterior
• Lingual - Anterior
• Facial - Anterior

Question 83

The common carotid artery

• Lies laterally within the carotid sheath.
• Has its bifurcation at the level of the lesser horn of the hyoid.
• Has the superior thyroid artery as one of its branches
• Arises from the brachiocephalic trunk on the left side of the neck.
• Has often the carotid sinus as a dilation of its terminal portion.

Answer 83

Has its bifurcation at the level of the lesser horn of the hyoid.

C3 = hyoid

Superior thyroid cartilage/birfucastion = C4 level

• Lies medially within the carotid sheath.
• External carotid has the superior thyroid artery as one of its branches.
• Arises from the brachiocephalic trunk on the right side of the neck.
• Has often the carotid sinus as a dilation of its terminal portion.
  
  • The sinus is usually a dilatation of the proximal ICA but ‘may’ involve the CCA.
  • It is a baroreceptor innervated by IX

Question 84

In the lymphatic drainage of the head and neck in general

• Superficial cervical nodes lie adjacent to the IJV.
• Upper deep cervical nodes receive lymph from the face.
• Lower deep cervical nodes receive lymph from the tonsil.
• There are no nodes within the parotid.
• Lymph drains into the jugular lymph trunk

Answer 84

Lymph drains into the jugular lymph trunk

• Superficial cervical nodes lie adjacent to the EJV
  
  • ​Deep nodes with IJV
• Superficial cervical nodes receive lymph from the face.
• Upper deep cervical nodes receive lymph from the tonsil.
• Parotid glands are superficial lymph nodes

Question 85

The IJV

• Is a continuation of the transverse sinus.
• Superficial cervical nodes lie lateral to the vein.
• Lies on the lateral mass of the atlas.
• Thoracic duct crosses behind the right IJV at C7.
• Drains directly into the superior vena cava. Into brachiocephalic trunk then SVC

Answer 85

Lies on the lateral mass of the atlas. ​

• Is a continuation of the sigmoid sinus.
• Deep cervical nodes lie lateral to the vein.
• Thoracic duct crosses behind the left IJV at C7
• Drains Into brachiocephalic trunk then SVC

Question 86

7. The internal jugular vein

• a. Drains into the subclavian vein on the left.
• b. Lies in the carotid sheath with the carotid artery and the sympathetic trunk.
• c. Lies lateral to the internal carotid artery at the base of the skull.
• d. Lies lateral to the carotid artery in the lower neck
• e. Lies anterior to the sternocleidomastoid.

Answer 86

d. Lies lateral to the carotid artery in the lower neck

CCA is medial, IJV latera, Vagus posterior

• a. Joins the subclavian vein on the left to form brachiocephalic vein
  
  • ​EJV drains into subclavian
• b. Lies in the carotid sheath with the carotid artery and the vagus nerve. Sympathetic trunk is posterior to the sheath, in the prevertebral fascia
• c. Lies lateral to the internal carotid artery at the base of the skull.
  
  • Somewhere other than lateral ​
• e. Lies deep to the sternocleidomastoid.

Question 87

10. Branches of the external carotid artery include

• a. Inferior thyroid artery
• b. Ascending pharyngeal artery
• c. Internal thoracic
• d. Superficial cervical
• e. Thymic artery

Answer 87

b. Ascending pharyngeal artery

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Superior Thyroid

Ascending Pharyngeal

Lingual

Facial

Occipital

Posterior auricular

Superficial Temporal

Maxillary

• Inferior thyroid off thyrocervical trunk (first part subclavian)
• Internal thoracic off subclavian

Question 88

Regarding the facial vein, all are true except

• It drains to the internal jugular vein
• It has no valves.
• It communicates with the cavernous sinus via the ophthalmic vein
• It runs inferoposteriorly anterior to the facial artery.
• It communicates with the pterygoid plexus via the deep facial vein

Answer 88

It runs inferoposteriorly posterior to the facial artery.

• It drains to the internal jugular vein
• It has no valves.
  
  • Relevant because infections can therefore travel backwards into the cavernous sinus. Essentially no veins superior to the root of neck have valves.
• It communicates with the cavernous sinus via the ophthalmic vein
• It communicates with the pterygoid plexus via the deep facial vein

Question 89

Venous drainage of the face

• Is both deep and superficial
• Empties ultimately into the IJV alone.
• Communicates indirectly with the cavernous sinus via the deep facial vein.
• Communicates directly with the cavernous sinus via the supraorbital vein.
• All of the above

Answer 89

Communicates indirectly with the cavernous sinus via the deep facial vein.

Indirectly because it goes through the pterygoid plexus

• Is both deep and superficial
  
  • Unclear why this is not true - drains into facial veins AND through cavernous sinus
• Empties mostly into the IJV, however transverse facial vein -> superficial temporal vein -> EJV
• Communicates indirectly with the cavernous sinus via the supraorbital vein, because the ophthalmic veins are in between

Question 90

The IJV

• Is surrounded by the thickest portion of carotid sheath.
• Receives drainage from all the parathyroid glands.
• Is crossed posterior by the accessory nerve
• Is crossed anteriorly by the thoracic duct.
• Contains valves within its lumen.

Answer 90

Contains valves within its lumen.

Inferior bulb of IJV has a bicuspid valve to prevent backflow to head

• Is surrounded by the thinnest portion of carotid sheath to allow for expansion (is thick around the carotids)
• Receives drainage from all the parathyroid glands -
  
  • Parathyroid veins drain into thyroid venous plexus. Then superior and middle thyroid veins -> IJV but inferior thyroid veins -> brachiocephalic veins
  • Parathyroids supplied mainly by inf thyroid art but can receive blood from any arterial branch of the neck.
• Is crossed anteriorly by the accessory nerve.
• Is crossed posteriorly by the thoracic duct.

Question 91

Regarding the thyroid

• The ima a enters the lower part of the isthmus in 20% people.
• The bulk of the sympathetic n supply is derived from the middle cervical ganglion.
• The inferior border is at the level of C3.
• Blood supply is purely via the superior thyroid in 20% people.
• There are 4 symmetrical lobes joined by an isthmus.

Answer 91

The bulk of the sympathetic n supply is derived from the middle cervical ganglion.

Superior, middle and inferior

• The ima a enters the lower part of the isthmus in 10% people.
• The inferior border of the gland is at the level of T1; C5 is the superior border.
  
  • Isthmus is at the level of the 2nd-3rd cricoid rings
  • Hyoid C3, Thyroid cartilage C4, cricoid C6
• Inferior thyroid arteries are the largest branches of the thyrocervical trunks (also gives off trans Cx and suprascapular), so will always be present
• There are 4 asymmetrical lobes joined by an isthmus - Superior larger than inferior

Question 92

Regarding thyroid, all are true, except

• It is supplied by the superior, middle and inferior thyroid arteries.
• The ima artery may arise from the arch of the aorta.
• The isthmus is related to the 2nd, 3rd tracheal cartilage
• It is related anterolaterally to the sternohyoid muscle.
• The external laryngeal nerve is related to the gland

Answer 92

It is supplied by the superior and inferior thyroid arteries.

Superior (ECA) and inferior (thyrocervical trunk) only

• The ima artery may arise from the arch of the aorta o**r brachiocephalic trunk
• The isthmus is related to the 2nd, 3rd tracheal cartilage
• It is related anterolaterally to the sternohyoid muscle.
  
  • Possible typo – sternohyoid is anterolateral to the thyroid.
• The external laryngeal nerve is related to the gland

Question 93

with regard to the thyroid

• its isthmus lies in front of 1st, 2nd and 3rd tracheal rings.
• the superior thyroid artery is a branch of the ICA.
• it has the parathyroids lying behind its medial lobe.
• parafollicular cells are more abundant than follicular cells
• the recurrent laryngeal nerve is always behind the pretracheal fascia

Answer 93

the recurrent laryngeal nerve is always behind the pretracheal fascia

Ascend in the tracheooesophageal groove

• its isthmus lies in front of 2nd and 3rd tracheal rings
• the superior thyroid artery is a branch of the ECA
• it has the parathyroids lying behind its medial lobe - There is no medial lobe
• parafollicular cells are more abundant than follicular cells

Question 94

Which is true of swallowing

• It is entirely voluntary
• The oropharyngeal portion is voluntary
• Peristalsis speeds as the bolus descends
• The voluntary stage commences as food enters the oesophagus
• It is initially voluntary and then involuntary

Answer 94

It is initially voluntary and then involuntary

Stage 1: Mouth, pushing food back into the oropharynx (voluntary

Stage 2: Oropharynx, sealing off naso and laryngopharynxes (involuntary)

Stage 3: Oesophagus, all 3 muscles contract in peristalsis (involuntary)

Question 95

Protection of the airway during swallowing is not facilitated by

• The sphincteric action of the aryepiglottic mm
• Closure of the glottis
• Elevation of the larynx
• Contraction of the cricothyroid m
• Posterior bulging of the tongue assisting in closing the larynx

Answer 95

Contraction of the cricothyroid m

This muscle stretches and tenses the vocal ligament

Question 96

Structure of larynx includes

• The inlet being bounded posteriorly by the epiglottis.
• The posterior cricoarytenoid being an adductor of the cords.
• The aryepiglottic fold contains the cuneiform cartilage
• The rima of the vestibule being the fissure between the 2 cords.
• The cricoid cartilage not being circumferential.

Answer 96

The aryepiglottic fold contains the cuneiform cartilage

• The inlet being bounded anteriorly by the epiglottis
• The posterior cricoarytenoid being an ABductor of the cords.
• The rima glottidis being the fissure between the 2 cords.
  
  • rima vestibuli is between vestibular ligaments (false VC)
• The cricoid cartilage being the only circumferential laryngeal cartilage

Question 97

cricothyroid membrane

• has an action to shorten the vocal folds.
• is a rectangular muscle
• is supplied by the recurrent laryngeal n.
• is visible in anterior dissection of the neck
• diverges from lamina of cricoid cartilage

Answer 97

is visible in anterior dissection of the neck

Median CT membrane is cut for a surgical airway. Lateral CT membrane attaches to the vocal cords

• Cricothyroid Muscle - Stretches/lengthens the VC by tilting the thyrooid cartilarge forwards
• is a ?fan-shaped muscle - small origin, large insertion
• is supplied by the e**xternal branch (motor) of superior laryngeal nerve
  
  • ​Only laryngeal muscle not supplied by recurrent laryngeal
• diverges from lamina of thyroid cartilage
  
  • Lamina is the large flat area - the cricoid lamina is posteriorly where the bulk of the cartilage is

Question 98

Concerning nerve supply of the larynx

• All muscles of the larynx supplies by the recurrent laryngeal n except thyroarytenoid.
• With partial lesion of recurrent laryngeal n the vocal fold takes up an abducted position.
• The mucous membrane of the larynx above the level of the vocal fold is supplied by the internal laryngeal nerve
• Internal laryngeal nerve is main supply of the larynx. Sensory to level of the cords. Recurrent laryngeal supplies all muscles except cricothyroid
• The sympathetic supply comes from anterior cervical sympathetic ganglion

Answer 98

The mucous membrane of the larynx above the level of the vocal fold is supplied by the internal laryngeal nerve

• All muscles of the larynx supplies by the recurrent laryngeal n except Cricothyroid (external branch superior laryngeal nerve)
• With complete lesion of recurrent laryngeal n the vocal fold takes up an abducted position causing partial airway obstructioon.
  
  • ​Cannot find/be bothered what a partial injury does.
• Internal laryngeal nerve provides sensory to level of the cords.
  
  • External laryngeal supplies cricothyroid
  • ​Recurrent laryngeal supplies all muscles except cricothyroid

Question 99

The larynx

• Lies above the hyoid bone in the midline of the neck.
• Is found at the level of the C3-6 vertebrae. C3 (hyoid) to C6 (cricoid), according to Moore’s (however this is listed as the correct answer)
• Has musculature supplied by the internal and external laryngeal nn.
• Is lined by pseudo-stratified columnar epithelium.
• Is supplied solely by the superior thyroid artery.

Answer 99

Is found at the level of the C3-6 vertebrae.

C3 (hyoid) to C6 (cricoid)

• Lies below the hyoid bone in the midline of the neck.
• Has musculature supplied by the recurrent/inferior laryngeal and external laryngeal nn.
  
  • Internal is sensation only
• Is lined by pseudo-stratified columnar epithelium.
  
  • (apparently…) Stratified squamous epithelium on the cords only, otherwise this is true. https://www.ncbi.nlm.nih.gov/pubmed/9197504
• Is supplied by the superior and inferior thyroid arteries Supplied by laryngeal branches of inferior and superior thyroid arteries, which give the sup + inf laryngeal arteries respectively

Question 100

In the larynx

• Cricoid cartilage is incomplete posteriorly.
• The epiglottis is attached to the arytenoid cartilages.
• Lateral cricoarytenoid is the abductor of the vocal cords
• All the muscles are supplied by the recurrent laryngeal n.
• All the mucous membrane is supplied by the recurrent laryngeal n. Internal branch of the superior laryngeal supplies sensation above the cords, recurrent laryngeal supplies sensation below

Answer 100

The epiglottis is attached to the arytenoid cartilages.

Epiglottis attaches directly to thyroid cart only but linked to arytenoids by quadrangular membrane (forms the ary-epiglottic fold)

• Cricoid cartilage is the only complete cartilaginous ring
• Lateral cricoarytenoid is the ADductor of the vocal cords (with transverse and oblique arytenoids)
• All the muscles are supplied by the recurrent laryngeal n, except Cricothyroid by external branch of superior laryngeal
• Mucous membrane below the cords is supplied by the recurrent laryngeal n.
  
  • Internal branch of the superior laryngeal supplies sensation above the cords

Question 101

Regarding the larynx

• All muscles are supplied by the recurrent laryngeal nerve.
• Thyroarytenoid muscle alters the tension of the cords
• Recurrent laryngeal nerve passes anterior to the cricothyroid joint.
• During swallowing the epiglottis acts as a passive flap
• All of the larynx is covered by pseudostratified columnar epithelium.

Answer 101

Thyroarytenoid muscle alters the tension of the cords

Contraction = relaxes

• All muscles are supplied by the recurrent laryngeal nerve, except Cricothyroid by external branch of SLN
• Recurrent laryngeal nerve passes posterior to the cricothyroid joint.
• During swallowing the epiglottis acts as an active flap.
  
  • During swallowing, contraction of the lateral crico-arytenoids, transverse and oblique arytenoids, and aryepiglottic muscles brings the ary-epiglottic folds together and pulls the arytenoid cartilages toward the epiglottis
• All of the larynx is covered by pseudostratified columnar epithelium, except the Vocal cords which have stratified squamous epi

Question 102

Which muscle controls vocal cord abduction

• Aryepiglottic
• Transverse arytenoid
• Lateral cricoarytenoid
• Posterior cricoarytenoid
• Cricothyroid

Answer 102

Posterior cricoarytenoid

• Lateral cricoarytenoid = ADduction
• transverse arytenoid = ADduction of arytenoid cartilages -> adduct cords + close posterior rima glottidis)
• Cricothyroid -> lengthen/stretch cords
• Aryepiglottic = ??? (not mentioned in Moores)

Question 103

The larynx

• Is a respiratory organ whose essential function is phonation.
• Extends from the anterior upper border of the epiglottis to the level of C6.
• Consists of 2 single cartilages, the thyroid and the cricoid.
• Is hauled up beneath the tongue with the epiglottis tilted anterior and upwards during swallowing.
• Is supplied by the external laryngeal nerve except for the cricothyroid muscle which is supplied by the recurrent laryngeal nerve.

Answer 103

Extends from C3 (hyoid) to C6 (cricoid cartilage)

Epiglottis rests against hyoid

• Is a respiratory organ whose essential function is Airway protection
• Consists of 3 single cartilages: the thyroid and the cricoid, and the Epiglottis
  
  • Also 3x paired: arytenoids, cuneiforms, and corniculate
• Is hauled up beneath the tongue with the epiglottis tilted posterior and downwards during swallowing.
• Is supplied by the recurrent laryngeal nerve except for the cricothyroid muscle which is supplied by the external laryngeal nerve.

Question 104

Regarding the larynx

• The external laryngeal nerve supplies the posterior cricoarytenoid muscle.
• The internal laryngeal nerve supplies cricothyroid
• Blood supply above the vocal cords is by a branch of the ICA
• Normal vocal cords are always covered by stratified squamous epithelium
• Recurrent laryngeal nerve lies immediately behind the cricoarytenoid joint

Answer 104

Normal vocal cords are always covered by stratified squamous epithelium

• The external laryngeal nerve supplies the cricothyroid muscle
• The internal laryngeal nerve supplies sensation above the vocal cords, including superior surface of the cords
• Blood supply above the vocal cords is by a branch of the ECA (superior thyroid -> sup laryngeal)
  
  • ​Inferior is off thyrocervical trunk/subclavian
• ????Recurrent laryngeal nerve lies immediately behind the cricoarytenoid joint

Question 105

3. The posterior cricoarytenoid muscles

• a. Abduct the vocal cords
• b. Adduct the vocal cords
• c. Tensor of the vocal cords
• d. Relaxors of the vocal cords
• e. Act as a sphincter

Answer 105

a. Abduct the vocal cords

Pull the ends of arytenoids posteriorly, which due to the way they are hinged causes abduction.

Question 106

4. The superior laryngeal nerve

• a. Divides into internal and recurrent laryngeal nerves
• b. Supplies the cricothyroid muscle via an external laryngeal branch
• c. Supplies all the intrinsic muscles of the larynx
• d. Is sensory to larynx below the vocal cords
• e. None of the above

Answer 106

b. Supplies the cricothyroid muscle via an external laryngeal branch

• a. Divides into internal and external laryngeal nerves
• c. Supplies only cricothyroid, the recurrent laryngeal (-> inferior laryngeal nerve) supplies all others of the larynx
• d. Is sensory to larynx above the vocal cords by way of its internal branch

Question 107

The trachea

• Starts at the thyroid cartilage.
• Bifurcates behind the manubriosternal angle
• Passes through the posterior mediastinum.
• Is not supplied by the recurrent laryngeal nerve.
• Blood supply is from the superior thyroid artery.

Answer 107

Bifurcates behind the manubriosternal angle (T4-5)

• Begins at bottom of larynx = bottom of cricoid cartilage (C6)
• Passes through the Superior mediastinum, then divides on entering the posterior
• Is supplied by recurrent laryngeal and vagus
• Blood supply is: Upper 2/3 inferior thyroid artery, lower 1/3 bronchial arteries

Question 108

The landmarks of the trachea are

• Thyroid cartilage to sternal notch
• Hyoid bone to sternal angle
• Cricoid cartilage to sternal angle
• Thyroid cartilage to sternal angle
• Cricoid cartilage to sternal notch

Answer 108

Cricoid cartilage to sternal angle

Question 109

5. The surface markings of the trachea include

• a. Origin at lower end of the cricoid at C4 vertebra.
• b. Origin at C6 vertebra level
• c. Termination at T2 at expiration
• d. Termination at T4 level at maximal inspiration
• e. 3rd to 5th rings covered anteriorly by isthmus of the thyroid

Answer 109

b. Origin at C6 vertebra level

Origin = C6 / cricoid

Termination = T4,5 / sternal angle

2nd+3rd rings covered by thyroid isthmus

Question 110

The midbrain

• Is largely in the middle cranial fossa.
• Is supplied by the anterior cerebellar artery.
• Lies between the pons and the upper spinal cord
• Contains the III nuclei
• Contains the V nuclei

Answer 110

Contains the III nuclei

• Is largely in the posterior cranial fossa.
• ?basilar artery
• Lies between the pons and cerebrum (midbrain-pons- medulla)

Question 111

Which of the following pathways is not concerned with posture and movement

• Spinocerebellar
• Vestibulospinal
• Tractus solitarius
• LRST
• MRST

Answer 111

Tractus solitarius.

Cardiac and respiratory control centre

Question 112

The posterior column transmits which of the following

• Afferent pain and temperature
• Afferent tendon stretch impulses
• Motor tracts

Answer 112

Afferent tendon stretch impulses

• Dorsal column – vibration, proprioception, fine touch.
• Anterolateral spinothalamic tract – crude touch, pressure.
• Lateral spinothalamic tract – pain, temperature
• Spinocerebellar - balance
• Lateral + anterior corticospinal tract - LMNs

Question 113

Regarding the speech centres

• Broca’s area is on the left side in most left-handed people.
• Broca’s area is posterior.
• Wernicke’s area controls motor response
• Damage to Broca’s area produces motor aphasia
• Damage to Wernicke’s area produces expressive aphasia.

Answer 113

Damage to Broca’s area produces motor aphasia

• Broca’s area is on the left side in 50% of left-handed people.
• Broca’s area is Anterior to the primary motor cortex in the pre-central gyrus (frontal lobe)
• Wernicke’s area controls Interpretation from primary auditory cortex (parietal lobe)
• Damage to Wernicke’s area produces receptive aphasia

Question 114

Regarding the medulla oblongata

• It is the part of the brainstem between the pons and the spinal cord
• Is largely within the middle cranial fossa
• Is supplies by the anterior inferior cerebellar a

Answer 114

It is the part of the brainstem between the pons and the spinal cord

• Is largely within the posterior cranial fossa
• Is supplies by the ?basilar artery

Question 115

The visceral afferent fibres for taste from posterior 1/3 tongue have their origin in

• Otic ganglion
• Nucleus ambiguus.
• Nucleus of tractus solitarius.
• Cochlear nucleus
• Spinal nucleus of V

Answer 115

Nucleus of tractus solitarius.

• Gustatory nucleus for special sensation in diagram*
• Nucleus ambiguus.* - Motor nucleus for parasympathetic efferents

Question 116

Regarding the motor system of the cortex, all are true except

• Nerves from the primary motor sensory cortex project via the corticospinal tracts
• The motor area separating the leg lies on the medial side of the hemisphere
• Damage to the speech area will not cause laryngeal paralysis
• Posture is largely mediated via the supplementary motor area
• The motor areas have no connections with the opposite motor cortex

Answer 116

The motor areas have no connections with the opposite motor cortex

Question 117

hemisection of the spinal cord in the cervical region you would expect to see

• loss of pain ipsilaterally.
• paralysis contralaterally.
• loss of vibration unilaterally
• greater weakness in arms than legs.
• a Horner’s on the contralateral side.

Answer 117

loss of vibration unilaterally

• loss of pain Contralateral
• paralysis ipisilaterally
• greater weakness in arms than legs. Pyramidal in arms and legs (UL extensors, LL flexor weakness)
• Not a Horner’s on the contralateral side - Sympathetic nerves emerge from thoracic and lumbar levels

Question 118

A 40yo man suffers a whiplash injury and now complains of pain along the lateral aspect of his left forearm, and there is weakness of his biceps, most likely pathology is

• Prolapsed 4th cervical disc impinging on C4
• Prolapsed 4th cervical disc impinging on C5
• Prolapsed 5th cervical disc impinging on C6
• Prolapsed 6th cervical disc impinging on C6
• Prolapsed 6th cervical disc impinging on C7

Answer 118

Prolapsed 5th cervical disc impinging on C6

In the cervical spine, the nerve root emerages above the vertebrae (ie C6 emerges between C5 and C6), and the discs are number according to the vertebrae above. So C5 disc will impinge C6 nerve root. C6 disc is one space below and less likely to impinge C6 nerve root, but not impossible.