Head and Neck II Flashcards
Afferent fibres from the carotid sinus travel via which of the following?
(Please select 1 option)
Accessory nerve. IncorrectIncorrect answer selected
Cervical sympathetics
Glossopharyngeal nerve. This is the correct answerThis is the correct answer
Recurrent laryngeal nerve.
Vagus nerve
The sinu-carotid nerve (a branch of the glossopharyngeal nerve) supplies the carotid sinus and carotid body.
The fibres pass centrally to the vasomotor centre.
A 78-year-old woman presents with low back bone pain and lethargy. The pathologist reports a diagnosis of multiple myeloma after bone marrow biopsy.
Plasma cells
Bone marrow in multiple myeloma would show greater than 10% of cells being of plasma cell origin.
A 21-year-old man presents with recent onset seizures. Following a brain biopsy a diagnosis of glioblastoma multiforme is made.
Astrocytes
Glioblastoma multiforme is an anaplastic, highly cellular tumour with poorly differentiated, round, or pleomorphic cells, occasional multinucleated cells, nuclear atypia, and anaplasia.
A 16-year-old male attends casualty following an assault. He sustained a blow to the left side of his jaw during the attack.
Examination reveals lower lip numbness. An x ray demonstrates a mandibular fracture.
Which nerve has been damaged with this injury?
(Please select 1 option)
The chorda tympani nerve
The hypoglossal nerve
The inferior alveolar nerve
The lingual nerve
The posterior superior alveolar nerve
The inferior alveolar nerve
The inferior alveolar nerve enters the mandible through the inferior alveolar foramen to supply sensation to the lower teeth and skin of the chin and lower lip.
Fractures of the ramus of the mandible can injure the inferior alveolar nerve.
The stapes is derived from which embryological structure? (Please select 1 option) The first pharyngeal arch The first pharyngeal pouch The second pharyngeal arch The second pharyngeal pouch The third pharyngeal pouch
The second pharyngeal arch
The stapes bone is derived from the second pharyngeal arch.
The pharyngeal arches are derivatives of the embryological branchial system.
Derivatives of the second pharyngeal arch also include
Styloid Stylohyoid ligament Upper body and lesser horn of hyoid Muscles of facial expression Posterior belly of digastric, stylohyoid and stapedius.
A 38-year-old man has recently undergone surgery to repair a perforated tympanic membrane. He is now complaining of an altered sense of taste. Which nerve is responsible for this altered sensation? (Please select 1 option) The chorda tympani nerve The glossopharyngeal nerve The greater petrosal nerve The hypoglossal nerve The lesser petrosal nerve
The chorda tympani nerve
The chorda tympani nerve passes between the layers of the tympanic membrane and over the handle of the malleus.
It can be injured during tympanic membrane and middle ear surgery.
The chorda tympani supplies taste fibres to the anterior two-thirds of the tongue.
A 74-year-old gentleman is undergoing a carotid endarterectomy for recurrent TIAs and the external carotid artery is exposed. Which is the first branch of the external carotid artery? (Please select 1 option) The lingual artery The maxillary artery The occipital artery The superficial temporal artery The superior thyroid artery
The superior thyroid artery This is the correct answerThis is the correct answer
The superior thyroid artery is the first branch of the external carotid artery.
It runs inferiorly on the side of the pharynx before passing anteriorly to supply the upper pole of the thyroid gland.
You are examining a child with a neck lump which is located within the anterior triangle of the neck.
Which of the following structures forms a boundary of the anterior triangle?
(Please select 1 option)
The anterior border of trapezius
The clavicle
The lower border of the mandible
The posterior belly of digastric
The posterior border of sternocleidomastoid
The lower border of the mandible
The anterior triangle is bounded by the lower border of the mandible, as well as the anterior border of sternocleidomastoid and the midline of the neck.
A 29-year-old lady has undergone a partial thyroidectomy for thyrotoxicosis.
She has since complained of a husky voice.
Damage to which nerve has caused the change in her voice?
(Please select 1 option)
The external laryngeal nerve
The glossopharyngeal nerve
The internal laryngeal nerve
The lesser petrosal nerve
The recurrent laryngeal nerve
The recurrent laryngeal nerve This is the correct answerThis is the correct answer
The recurrent laryngeal nerve supplies all the intrinsic muscles of the larynx except for cricothyroid.
It is closely related to the inferior thyroid artery which must be divided during thyroid surgery and consequently the recurrent laryngeal nerve can be injured during the procedure.
A 16-year-old girl is admitted for excision of a thyroglossal cyst which will include resection of a portion of the hyoid. At what cervical level can the hyoid bone be identified? (Please select 1 option) C2 C3 C4 C5 C6
C3
The hyoid bone is at the level of C3.
The thyroid cartilage is at the level of C4 and C5.
The cricoid cartilage is at the level of C6.
A 42-year-old woman undergoes a thyroidectomy for a papillary carcinoma and sustains transient damage to her external laryngeal nerve. Which muscle will be affected during this period of nerve damage? (Please select 1 option) Cricothyroid muscle Lateral cricoarytenoid muscle Posterior cricoarytenoid muscle Thyroarytenoid muscle Thyrohyoid muscle
Cricothyroid muscle
The external cricothyroid muscle is supplied by the external laryngeal nerve.
All of the other intrinsic muscles of the larynx are supplied by the recurrent laryngeal nerve.
A 62-year-old woman is scheduled to undergo excision of her submandibular gland for recurrent sialadenitis. Which of the following structures is an important medial relation to the gland? (Please select 1 option) Genioglossus muscle Lateral pterygoid muscle Mylohyoid muscle The maxillary artery The temporomandibular joint
The mylohyoid muscle is a close medial relation to the superficial part of the submandibular gland.
A 53-year-old lady has recently undergone submandibular gland excision for recurrent sialadenitis.
Review on the ward round reveals that she has some drooping to one corner of her mouth.
Which nerve has been damaged during the surgery?
(Please select 1 option)
The buccal branch of the facial nerve
The cervical branch of the facial nerve
The marginal mandibular branch of the facial nerve
The mental nerve
The zygomatic branch of the facial nerve
The marginal mandibular branch of the facial nerve
The marginal mandibular branch of the facial nerve lies below the mandible for part of its course.
Therefore submandibular incisions should be made well below the mandible to avoid damage to the nerve which results in drooping of the corner of the mouth.
You are required to gain central venous access via the external jugular vein in a 46-year-old woman with severe acute pancreatitis. On which structure does this vein lie? (Please select 1 option) The pretracheal fascia The scalenus anterior muscle The sternocleidomastoid muscle The thyroid gland The trapezius muscle
The sternocleidomastoid muscle
The external jugular vein begins in the parotid gland.
It passes obliquely across the surface of the sternocleidomastoid muscle to open into the subclavian vein.
During a thyroid lobectomy the inferior thyroid artery is identified and its main trunk preserved to supply the parathyroids.
Of which artery is the inferior thyroid artery a branch?
(Please select 1 option)
The external carotid artery
The internal carotid artery
The internal thoracic artery
The thyrocervical trunk of the subclavian artery
The vertebral artery
The thyrocervical trunk of the subclavian artery
The thyrocervical trunk of the subclavian artery branches medially as the inferior thyroid artery and crosses the vertebral artery to supply the thyroid gland.
During a routine head and neck examination you identify an arterial pulsation on the mandible at the anterior border of the masseter muscle. Which artery are you palpating? (Please select 1 option) The facial artery The lingual artery The marginal mandibular artery The maxillary artery The superficial temporal artery
Facial artery
The facial artery curls around the mandible to the face.
It continues on a tortuous course to reach the medial canthus of the eye.
A 69-year-old male is due to have a laryngectomy and left radical neck dissection for squamous carcinoma of the larynx. Prior to the operation the surgeon explains that he will have some drooping of the left shoulder with weakness of shoulder elevation as a consequence of the surgery.
Which nerve will be sacrificed during the operation?
(Please select 1 option)
The cranial root of the accessory nerve
The great auricular nerve
The spinal root of the accessory nerve
The supraclavicular nerve
The transverse cervical nerve
The spinal root of the accessory nerve
The spinal root of the accessory nerve crosses the posterior triangle of the neck and is sacrificed in a radical neck dissection.
Section of the spinal root of the accessory nerve results in unilateral paralysis of the trapezius and is manifested as shoulder drooping with difficulty elevating the arm above 90 degrees.
The internal auditory meatus pierces the surface of which of the following? (Please select 1 option) The frontal bone The occipital bone The sphenoid bone The temporal bone The zygomatic bone
Temporal bone
The internal auditory meatus pierces the posterior surface of the petrous part of the temporal bone in the posterior cranial fossa.
An elderly male smoker attends clinic with a three month history of a hoarse voice.
You proceed to examine his larynx by indirect laryngoscopy and ask him to take a deep breath in so that you can assess vocal cord abduction.
Contraction of which muscle causes vocal cord abduction?
(Please select 1 option)
The cricothyroid muscle
The lateral cricoarytenoid muscle
The posterior cricoarytenoid muscle
The thyroarytenoid muscle
The transverse arytenoid muscle
The posterior cricoarytenoid muscle
The posterior cricoarytenoid muscle is an important muscle as it is the only muscle that abducts the vocal cords.
It extends from the back of the cricoid to the muscular process of the arytenoids and is supplied by the recurrent laryngeal nerve.
A patient is undergoing a selective neck dissection of the posterior triangle of the neck.
Which of the following structures will be identified during the dissection?
(Please select 1 option)
The inferior belly of omohyoid
The internal carotid artery
The internal jugular vein
The upper, middle and lower branches of the brachial plexus
The vagus nerve
The inferior belly of omohyoid
The posterior triangle of the neck contains
The accessory nerve
Lymph nodes
The occipital artery
The inferior belly of omohyoid
The external jugular vein
Transverse cervical and suprascapular vessels and
Cutaneous branches of the cervical plexus.
The brachial plexus lies deep to the prevertebral fascia.
You are examining a 24-year-old lady who has presented with clumsiness and paraesthesia. You test reflex elbow flexion.
C5/C6
Limb reflexes:
Biceps C5/C6 Triceps C7/C8 Supinator C5/C6 Knee L3/L4 Ankle S1/S2
You are examining an 89-year-old lady who has presented with slurred speech. You test reflex elbow extension.
C7/C8
Limb reflexes:
Biceps C5/C6 Triceps C7/C8 Supinator C5/C6 Knee L3/L4 Ankle S1/S2
A 36-year-old female undergoes a CT of the thorax which reveals an anterior mediastinal mass.
Thymus
Classically the mediastinum is divided into three compartments: anterior, middle and posterior. The anterior compartment is limited anteriorly by the sternum, and posteriorly by the anterior margin of the pericardium, aorta and brachiocephalic veins.
The posterior compartment is bounded anteriorly by the posterior margins of the pericardium and great vessels and posteriorly by the thoracic vertebral bodies.
A 42-year-old male is noted to have a posterior mediastinal mass on CT scan.
Oesophagus
The middle compartment is defined by the margins of the anterior and posterior compartments. The anterior mediastinum is usually empty but the commonest causes of masses in this region include Thymoma/thymic cyst/goitre/lymph nodes.
Structures within the posterior mediastinum include neural structures, paravertebral masses, descending aorta and the oesophagus.
