Head and Neck B

Question 1

Which of the following structures is not closely related to the carotid sheath? A. Sternothyroid muscle B. Sternohyoid muscle C. Hypoglossal nerve D. Superior belly of omohyoid muscle E. Anterior belly of digastric muscle

Answer 1

At its lower end the carotid sheath is related to sternohyoid and sternothyroid. Opposite the cricoid cartilage the sheath is crossed by the superior belly of omohyoid. Above this level the sheath is covered by the sternocleidomastoid muscle. Above the level of the hyoid the vessels pass deep to the posterior belly of digastric and stylohyoid. Opposite the hyoid bone the sheath is crossed obliquely by the hypoglossal nerve.

Question 2

A 21 year old develops tonsillitis. He is in considerable pain. Which of the following nerves is responsible for the sensory innervation of the tonsillar fossa? A. Facial nerve B. Trigeminal nerve C. Glossopharyngeal nerve D. Hypoglossal ner

Answer 2

The glossopharyngeal nerve is the main sensory nerve for the tonsillar fossa. A lesser contribution is made by the lesser palatine nerve. Because of this otalgia may occur following tonsillectomy.

Question 3

Question 12 of 328 A 22 year old man is involved in a fight and sustains a skull fracture with an injury to the middle meningeal artery. A craniotomy is performed, and with considerable difficulty the haemorrhage from the middle meningeal artery

Answer 3

Parasthesia of the ipsilateral external earThe auriculotemporal nerve is closely related to the middle meningeal artery and may be damaged in this scenario. The nerve supplied sensation to the external ear and outermost part of the tympanic membrane. The angle of the jaw is innervated by C2,3 roots and would not be affected. The tongue is supplied by the glossopharyngeal nerve

Question 4

Question 16 of 328 Where is the vomiting centre located? A. Medulla oblongata B. Substantia nigra C. Antrum of stomach D. Pons E. Midbrain

Answer 4

Medulla oblongataABC’s of Non- GI causes of vomitingAcute renal failureBrain (Increased ICP)Cardiac (Inferior MI)DKAEars (labyrinthitis)Foreign substances (Tylenol, theo, etc)GlaucomaHyperemesis GravidarumInfections (pyelonephritis, meningitis)

Question 5

Which of the following nerves conveys sensory information from the laryngeal mucosa? A. Glossopharyngeal B. Laryngeal branches of the vagus C. Ansa cervicalis D. Laryngeal branches of the trigeminal E. None of the above

Answer 5

Laryngeal branches of the vagusThe laryngeal branches of the vagus supply sensory information from the larynx

Question 6

Question 24 of 328 A 25 year old man sustains a severe middle cranial fossa basal skull fracture. Once he has recovered it is noticed that he has impaired tear secretion. This is most likely to be the result of damage to which of the following?

Answer 6

Greater petrosal nerveThe greater petrosal nerve may be injured and carries fibres for lacrimation (see below)

Question 7

Question 26 of 328 Which of the following pairings of foramina and their contents is not correct? A. Superior orbital fissure and the oculomotor nerve B. Foramina rotundum and the maxillary nerve C. Jugular foramen and the hypoglossal

Answer 7

Jugular foramen and the hypoglossal nerveThe hypoglossal nerve passes through the hypoglossal canal.

Question 8

Question 27 of 328 A 55 year old man with carcinoma of the larynx is undergoing a difficult laryngectomy. The surgeons divide the thyrocervical trunk, from which of the following vessels does this structure most commonly originate? A. Subcl

Answer 8

Subclavian arteryThe thyrocervical trunk is a branch of the subclavian artery. It arises from the first part between the subclavian artery and the inner border of scalenus anterior. It branches off the subclavian distal to the vertebral artery.

Question 9

Question 32 of 328 A man develops an infection in his external auditory meatus. The infection is extremely painful. Which of the following nerves conveys sensation from this region? A. Occipital branch of the trigeminal nerve B. Vestibul

Answer 9

Auriculotemporal nerveTensor tympania and stapedius are the only two muscles of the middle ear. Contraction of tensor tympani will tend to dampen the vibrations produced by loud sounds, it is innervated by a branch of the trigeminal nerve. The stapedius dampens movements of the ossicles in response to loud sounds and is innervated by a branch of the facial nerve.The auriculotemporal nerve, which is derived from the mandibular branch of the trigeminal nerve supplies this area.

Question 10

Question 38 of 328 What is the most useful test to clinically distinguish between an upper and lower motor neurone lesion of the facial nerve? A. Blow cheeks out B. Loss of chin reflex C. Close eye D. Raise eyebrow E. Open mouth

Answer 10

Raise EyebrowUpper motor neurone lesions of the facial nerve- Paralysis of the lower half of face.Lower motor neurone lesion- Paralysis of the entire ipsilateral face.

Question 11

Question 44 of 328 Which of the following does not pass through the superior orbital fissure? A. Oculomotor nerve B. Abducens nerve C. Ophthalmic artery D. Ophthalmic division of the trigeminal nerve E. Ophthalmic veins

Answer 11

The ophthalmic artery, a branch of the internal carotid enters the orbit with the optic nerve in the canal.

Question 12

Question 62 of 328 Which of these muscles is innervated by the cervical branch of the facial nerve? A. Masseter B. Sternocleidomastoid C. Platysma D. Geniohyoid E. Sternothyroid

Answer 12

The cervical branch of the facial nerve innervates platysma

Question 13

Question 63 of 328 During a thyroidectomy the surgeons ligate the inferior thyroid artery. From which vessel does this structure usually originate? A. External carotid artery B. Thyrocervical trunk C. Internal carotid artery D. Subc

Answer 13

Thyrocervical trunkThe inferior thyroid artery originates from the thyrocervical trunk. This is a branch of the subclavian artery.

Question 14

Question 73 of 328 Which of the following statements relating to the Cavernous Sinus is false? A. The pituitary gland lies medially B. The internal carotid artery passes through it C. The temporal lobe of the brain is a lateral relatio

Answer 14

The mandibular branch of the trigeminal and optic nerve lie on the lateral wallThe veins that drain into the sinus are important as sepsis can cause cavernous sinus thrombosis. The maxillary branch of the trigeminal and not the mandibular branches pass through the sinus

Question 15

Question 77 of 328 Which of the following muscles is supplied by the external laryngeal nerve? A. Transverse arytenoid B. Cricothyroid C. Thyro-arytenoid D. Posterior crico-arytenoid E. Oblique arytenoid

Answer 15

CricothyroidThe others are all supplied by the recurrent laryngeal nerve.

Question 16

Question 79 of 328 During a carotid endarterectomy the internal carotid artery is cross clamped. Assuming that no shunt is inserted, which of the following vessels will not have diminished or absent flow as a result? A. Anterior cerebral artery

Answer 16

Maxillary ArteryMnemonic for branches of the cerebral portion of the internal carotid artery ‘Only Press Carotid Arteries Momentarily’Only = OpthalmicPress = Posterior communicatingCarotid = ChoroidalArteries = Anterior cerebralMomentarily = Middle cerebralThe maxillary artery is a branch of the external carotid artery.

Question 17

Question 81 of 328 A 21 year old man is hit with a hammer and sustains a depressed skull fracture at the vertex. Which of the following sinuses is at risk in this injury? A. Superior sagittal sinus B. Inferior petrosal sinus C. Transverse

Answer 17

The superior sagittal sinus is at greatest risk in this pattern of injury. This sinus begins at the front of the crista galli and courses backwards along the falx cerebri. It becomes continuous with the right transverse sinus near the internal occipital protuberance.

Question 18

Question 84 of 328 A 22 year old man undergoes a superficial parotidectomy for a pleomorphic adenoma. The operation does not proceed well and a diathermy malfunction results in division of the buccal branch of the facial nerve. Which of the following

Answer 18

MentalisBuccal branch suppliesZygomaticus minor Elevates upper lipRisorius Aids smileBuccinator Pulls corner of mouth backward and compresses cheekLevator anguli oris Pulls angles of mouth upward and toward midlineOrbicularis Closes and tightens lips togetherNasalis Flares nostrils and compresses nostrils

Question 19

Question 85 of 328 At which of the following vertebral body levels does the common carotid artery typically bifurcate into the external and internal carotid arteries? A. C4 B. C2 C. C1 D. C6 E. C7

Answer 19

C4It terminates at the upper border of the thyroid cartilege, Which is usually located at C4

Question 20

Question 87 of 328 An 18 year old man is stabbed in the neck and has to undergo repair of a laceration to the internal carotid artery. Post operatively he is noted to have a Horners syndrome. Which of the following will not be present? A. Appare

Answer 20

Loss of sweating on the entire ipsilateral side of the faceThe anhidrosis will be mild as this is a distal lesion and at worst only a very limited area of the ipsilateral face will be anhidrotic.

Question 21

Question 89 of 328 A 23 year old man is stabbed in the neck, in the region between the omohyoid and digastric muscles, the injury is explored surgically. At operation a nerve injury is identified immediately superior to the lingual artery as is branc

Answer 21

Paralysis of the ipsilateral side of the tongueThe hypoglossal nerve runs anterior to the external carotid, above the lingual arterial branch. If damaged then ipsilateral paralysis of the genioglossus, hyoglossus and styloglossus muscles will occur. If the patient is asked to protrude their tongue then it will tend to point to the affected side.

Question 22

Question 104 of 328 A 23 year old lady with sialolithiasis of the submandibular gland is undergoing excision of the gland. Which of the following nerves is at risk as the duct is mobilised? A. Lingual nerve B. Buccal nerve C. Facial nerve

Answer 22

The lingual nerve wraps around Whartons duct. The lingual nerve provides sensory supply to the anterior 2/3 of the tongue.

Question 23

Question 105 of 328 Which of the following is true in connection with the phrenic nerves? A. They both lie anterior to the hilum of the lungs B. They are derived from spinal roots C 2,3,4 C. They pierce the diaphragm at the level of T7

Answer 23

They both lie anterior to the hilum of the lungsC3,4,5Keeps the diaphragm alive!They both lie anterior to the hilum of the lung. The phrenic nerves have both motor and sensory functions. For this reason sub diaphragmatic pathology may cause referred pain to the shoulder.

Question 24

Question 109 of 328 Which nerve lies medially on the thyroid gland, in the groove between the oesophagus and trachea? A. Vagus nerve B. External laryngeal nerve C. Recurrent laryngeal nerve D. Ansa cervicalis E. Phrenic nerve

Answer 24

Recurrent laryngeal nerveThe recurrent laryngeal nerve may be injured at this site during ligation of the inferior thyroid artery.

Question 25

Question 111 of 328 Which of the following nerve roots contribute nerve fibres to the ansa cervicalis? A. C1 only B. C1, C2 and C3 C. C2, C3 and C6 D. C2, C4 and C5 E. C4, C5 and C6

Answer 25

C1, C2 and C3Ansa cervicalis muscles:GHost THought SOmeone Stupid Shot IreneGenioHyoidThyroidHyoidSuperior OmohyoidSternoThyroidSternoHyoidInferior OmohyoidThe ansa cervicalis is composed of a superior and inferior root, derived from C1, C2 and C3. The superior root arises where the nerve crosses the internal carotid artery. It descends anterior to the carotid sheath in the anterior triangle. It is joined in the region of the mid neck by the inferior root. The inferior root may pass either superficially or deep to the internal jugular vein.

Question 26

Question 115 of 328 Considering the pituitary gland, which of the following is false? A. The anterior pituitary secretes thyroid stimulating hormone B. The anterior pituitary develops from Rathkes pouch C. Patients with craniopharyngioma m

Answer 26

The pituitary is in direct contact with the optic chiasmAlthough the optic chiasm is closely related to the pituitary, and craniopharyngiomas may compress this structure leading to bitemporal hemianopia, it is separated from the chiasm itself by a dural fold.

Question 27

Question 116 of 328 A 24 year old man is involved in a fight and his face is cut with a knife. The wound lies immediately anterior to the tragus of the ear and extends anteriorly. The wound is surgically explored and the laceration is found to be mai

Answer 27

The retromandibular vein lies slightly more deeply than the facial nerve in the parotid gland. It is formed from the maxillary and superficial temporal vein.

Question 28

Question 118 of 328 An ENT surgeon is performing a radical neck dissection. She wishes to fully expose the external carotid artery. To do so she inserts a self retaining retractor close to its origin. Which of the following structures lies posterolat

Answer 28

The internal carotid artery lies posterolaterally to the external carotid artery at their origin from the common carotid. The superior thyroid, lingual and facial arteries all arise from its anterior surface.

Question 29

Question 125 of 328 A 28 year old man has a pleomorphic adenoma and the decision is made to resect this surgically. Which of the following structures is least likely to be encountered during surgical resection of the parotid gland? A. External c

Answer 29

Mandibular nerveStructures passing through the parotid gland Facial nerve and branches External carotid artery (and its branches; the maxillary and superficial temporal) Retromandibular vein Auriculotemporal nerveThe mandibular nerve is well separated from the parotid gland.The maxillary vein joins to the superficial temporal vein and they form the retromandibular vein which then runs through the parotid gland.The auriculotemporal nerve runs through the gland. Following a parotidectomy this nerve may be damaged and during neuronal regrowth may then attach to sweat glands in this region. This can then cause gustatory sweating (Freys Syndrome).

Question 30

Question 126 of 328 During a radical thyroidectomy for carcinoma the surgeons inadvertently damage the ansa cervicalis nerve. Which of the muscles below is most likely to be affected? A. Mylohyoid muscle B. Palatopharyngeus muscle C. Thyro

Answer 30

Sternothyroid muscleThe ansa cervicalis is derived from nerve roots C1, C2, C3 and is a nerve loop that accompanies the internal jugular vein. It innervates sternohyoid, thyrohyoid, sternothyroid and omohyoid. Geniohyoid is innervated from the C1 root via the hypoglossal nerve, as is thyroidhyoid. Mylohyoid is innervated from the mylohyoid branch of the inferior alveolar nerve. Palatopharyngeus is innervated by the pharyngeal plexus.

Question 31

Question 128 of 328 A 56 year old man is undergoing a carotid endarterectomy. The internal carotid artery is mobilised. How many branches does this vessel give off in the neck? A. 0 B. 1 C. 2 D. 3 E. 6

Answer 31

0

Question 32

Question 131 of 328 From which of these foraminae does the opthalmic branch of the trigeminal nerve exit the skull? A. Foramen ovale B. Foramen rotundum C. Foramen spinosum D. Superior orbital fissure E. Foramen magnum

Answer 32

Superior orbital fissureMnemonic:Standing Room Only -Exit of branches of trigeminal nerve from the skullV1 -Superior orbital fissureV2 -foramen RotundumV3 -foramen OvaleThe opthalmic branch of the trigeminal nerve exits the skull through the superior orbital fissure.

Question 33

Question 133 of 328 Which of the following nerves is responsible for the motor innervation of the sternocleidomastoid muscle? A. Ansa cervicalis B. Accessory nerve C. Hypoglossal nerve D. Facial nerve E. Vagus nerve

Answer 33

Theme from January 2013 ExamThe motor supply to the sternocleidomastoid is from the accessory nerve. The ansa cervicalis supplies sensory information from the muscle.

Question 34

Question 138 of 328 Which option is false in relation to the trigeminal nerve? A. The nerve originates at the pons B. The posterior scalp is supplied by the trigeminal nerve C. The maxillary nerve exits via the foramen rotundum D. The m

Answer 34

The posterior scalp is supplied by the trigeminal nerveThe posterior scalp is supplied by C2-C3.

Question 35

Question 139 of 328 A 45 year old man is undergoing a lymph node biopsy from the posterior triangle of his neck. Which structure forms the posterior border of this region? A. Trapezius muscle B. Diagastric muscle C. External jugular vein

Answer 35

Trapezius muscle

Question 36

Question 142 of 328 A 36 year old male is admitted for elective surgery for a lymph node biopsy in the supraclavicular region. Post operatively the patient has difficulty shrugging his left shoulder. What is the most likely reason? A. Phrenic ne

Answer 36

Accessory nerve lesionTheme from September 2011 ExamTheme from September 2013 ExamThe accessory nerve lies in the posterior triangle and may be injured in this region. Apart from problems with shrugging the shoulder, he may also have difficulty lifting his arm above his head.

Question 37

Question 145 of 328 Which of the following statements relating to the posterior cerebral artery is false? A. It supplies the visual cortex B. It is closely related to the 3rd cranial nerve C. It is a branch of the basilar artery D. It i

Answer 37

It is connected to the circle of Willis via the superior cerebellar arteryThe posterior cerebral arteries are formed by the bifurcation of the basilar artery and is connected to the circle of Willis via the posterior communicating artery.The posterior cerebral arteries supply the occipital lobe and part of the temporal lobe.

Question 38

Question 154 of 328 A 72 year old male with end stage critical ischaemia is undergoing an axillo-femoral bypass. What structure is not closely related to the axillary artery? A. Posterior cord of the brachial plexus B. Scalenus anterior muscl

Answer 38

Scalenus anterior muscleThe axillary artery is the continuation of the subclavian artery. It is surrounded by the cords of the brachial plexus (from which they are named). The axillary vein runs alongside the axillary artery throughout its length.

Question 39

Question 155 of 328 A 28 year old man is shot in the right chest and develops a right haemothorax necessitating a thoracotomy. The surgeons decide to place a vascular clamp across the hilum of the right lung. Which of the following structures will li

Answer 39

The phrenic nerve lies anteriorly at the root of the right lung.

Question 40

Question 160 of 328 Where does Stensens duct primarily open? A. Immediately lateral to the foramen caecum B. Floor of mouth C. Opposite the second molar tooth D. Opposite the fifth molar tooth E. Into the post nasal space

Answer 40

Opposite the second molar toothStensens duct conveys secretions from the parotid gland and these enter the oral cavity at the level of the second molar tooth.