Head and Neck IV

Question 1

During the approach to the left lobe of the thyroid for a large multinodular goitre you are required to retract the strap muscles.
Which of the following is part of this muscle group?
(Please select 1 option)
	 The anterior belly of digastric
	 The mylohyoid muscle
	 The posterior belly of digastric
	 The stylohyoid muscle
	 The thyrohyoid muscle

Answer 1

The thyrohyoid muscle This is the correct answerThis is the correct answer
The infrahyoid or ‘strap’ muscles all depress the hyoid bone and comprise

The sternothyroid muscle
Thyrohyoid muscle
Sternohyoid muscle and
Omohyoid muscle.

Question 2

A 36-year-old female presents with sudden onset of weakness of the right side of her face and is unable to close her right eye.

Answer 2

Orbicularis oculi
The eyelid muscles are orbicularis oculi, supplied by the facial nerve and levator palpebrae superioris, supplied by the oculomotor nerve and sympathetic nerves. Orbicularis oculi acts to close the eyelids and levator palpebrae superioris raises the upper lids.

Question 3

A 64-year-old lady with diabetes mellitus complains of double vision which is worst when looking to her left. On examination you find that the left eye is deviated medially and there is failure of lateral movement.

Answer 3

Lateral rectus
The extrinsic muscles of the eye include the superior rectus, inferior rectus, medial rectus, lateral rectus, superior oblique and inferior oblique. The lateral rectus rotates the eye so that the cornea looks laterally. The lateral rectus is supplied by the abducens nerve.

Question 4

A 48-year-old lady with myasthenia gravis complains of drooping of both upper eyelids.

Answer 4

Levator palpebrae superioris

Question 5

Which of the following is true of the diaphragm?
(Please select 1 option)
Develops from the septum transversum and cervical myotomes
Receives only a nerve supply from the phrenic nerves
Transmits the aorta at the level of the T8 vertebra
Transmits the inferior vena cava at the level of the T12 vertebra
Transmits the left phrenic nerve via an opening in the central tendon

Answer 5

Develops from the septum transversum and cervical myotomes

The diaphragm is a domed fibro-muscular sheet separating the thorax from the abdomen.

It develops mainly from septum transversum (central tendon) and cervical myotomes (muscular component).

The mesothelial linings are derived from the pleuro-peritoneal membranes (failure of its development leads to Bochdalek’s foramen and hernia).

Oesophageal mesentery also contributes to the formation of the diaphragm.

Morgagni’s foramen is a congenital defect arising at the junction of the costal and xiphoid origins.

Because of its cervical myotomal origin, it receives nerve supply from cervical roots; the phrenic nerves. The phrenic nerves pierce the muscular components not the central tendon to reach and supply the diaphragm from below.

The lower intercostal nerves give only proprioceptive supply to the periphery of the diaphragm.

The openings in diaphragm are:

Aortic opening - T12
Oesophageal opening - T10
Vena caval opening - T8.

Question 6

Which of the following is true of the internal jugular vein?
(Please select 1 option)
Begins at the jugular foramen as a continuation of the sigmoid sinus
Joins the axillary vein to form the brachiocephalic vein
Lies medial to the internal carotid artery within the carotid sheath
Passes behind the thoracic duct on the left side
Runs alongside a chain of superficial cervical lymph nodes

Answer 6

Begins at the jugular foramen as a continuation of the sigmoid sinus

The internal jugular vein originates at the jugular foramen as a continuation of the sigmoid sinus, descending medially and forwards within the carotid sheath to the root of the neck.

It lies lateral first to the internal and then to the common carotid artery within the carotid sheath.

It passes behind the clavicle where it joins the subclavian vein to form the brachiocehpalic vein.

The thoracic duct empties into the venous system of the neck at the union of the left internal jugular and subclavian veins.

Question 7

Which of the following is true regarding a cervical rib?
(Please select 1 option)
Can cause compression of the axillary artery
Is always calcified
Is apparent on palpation in the supraclavicular region
Occurs in approximately 5% of the population
Originates from the seventh cervical vertebra

Answer 7

Originates from the seventh cervical vertebra This is the correct answerThis is the correct answer
In 0.5-1% of individuals, the costal elements of the seventh cervical vertebra form projections called cervical ribs. They are usually cartilaginous but may be partially/totally calcified.

Commonly they have a head, neck, and tubercle, with varying amounts of body. They extend into the posterior triangle of the neck where they may be free anteriorly, or be attached to the first rib and/or sternum.

Usually these ribs cause no symptoms, and are diagnosed after incidental finding on CXR.

In some cases, the subclavian artery and the lower trunk of the brachial plexus are kinked where they pass over the cervical rib. Compression of these structures between this extra rib and the anterior scalene muscle may produce symptoms of nerve and arterial compression, producing the ‘neurovascular compression syndrome’.

Often the tingling, numbness, and impaired circulation to the upper limb do not appear until the age of puberty when the neck elongates and the shoulders tend to droop slightly.

Question 8

Which of the following is correct regarding the internal carotid artery?
(Please select 1 option)
Enters the skull and divides into the anterior and middle cerebral arteries CorrectCorrect
Grooves the greater wing of the sphenoid bone
Is separated from the external carotid artery by the omohyoid
Lies in the roof of the middle ear
Lies lateral to the abducent nerve

Answer 8

It enters the cranial cavity through the carotid canal in the petrous part of the temporal bone.

The internal carotid artery does not groove the sphenoid bone.

These are the terminal branches of the internal carotid artery. The internal carotid artery gives off no branches in the neck.

The styloglossus muscle and the stylopharyngeus muscle, CN IX, and the pharyngeal branch of the vagus, pass between the external and internal carotid arteries.

The internal carotid artery, accompanied by its sympathetic plexus, courses through the cavernous sinus and is crossed by the abducent nerve.

Question 9

Which of following statements is correct regarding the parathyroid glands?
(Please select 1 option)
They are easily distinguishable from fat globules IncorrectIncorrect answer selected
They are found on the anterior surface of the thyroid gland
They contain chief cells which have dark staining nuclei This is the correct answerThis is the correct answer
They develop from the second pharyngeal pouch endoderm
They receive blood supply from the middle thyroid arteries

Answer 9

As they are ovoid bodies the parathyroid glands are easily mistaken for fat globules.

The parathyroid glands lie external to the fibrous thyroid capsule, but are embedded in the posterior surface of the thyroid gland.

It is believed that parathyroid hormone (PTH) is secreted early in fetal life by the chief cells, to regulate calcium metabolism.

The inferior parathyroid glands develop from endodermal cells of the third pharyngeal pouch and the superior glands from the fourth pouch.

They receive blood from the superior and inferior thyroid arteries.

Question 10

Which of the following is true regarding the blood supply of the spinal cord?
(Please select 1 option)
The anterior spinal arteries arise from the internal carotid arteries
The anterior spinal artery anastomoses with the posterior artery over the conus medullaris
The anterior two thirds of the spinal cord is supplied by the paired anterior spinal arteries
The artery of Adamkiewicz usually arises from a posterior intercostal artery between T2 and T6
The posterior spinal arteries supply the posterior two thirds of the spinal cord

Answer 10

The anterior spinal artery anastomoses with the posterior artery over the conus medullaris

The anterior spinal arteries arise from the vertebral arteries (not carotids) and unite below the foramen magnum to form a single artery.

This single artery (not paired) then supplies the pia mater and anterior two thirds of the spinal cord, including the anterior and lateral columns (major motor tracts). It anastomoses with the posterior artery over the conus medullaris.

The posterior spinal arteries arise from the vertebral arteries, which pass down the spinal cord but they do not unite. They supply the posterior one third of the spinal cord (including the major sensory tracts).

The blood supplied by the anterior and posterior spinal arteries is augmented by collateral radicular arteries, the most important being the branches of the posterior intercostal arteries at the sites of the cervical and lumbar cord enlargements.

The artery of Adamkiewicz (greater radicular artery) supplies blood to the anterior spinal artery and distal cord. It usually arises from an intercostal branch between T8 and T12.Which of the following is true regarding the brachial plexus?
(Please select 1 option)
After emerging from the intervertebral foramina, the plexus roots lie anterior to scalenus anterior
Each of the three trunks divides into two cords at the lateral edge of the first rib
It is formed from the anterior rami of the second to fifth cervical roots
The cords form the terminal branches
The plexus lies within a sheath which starts where the plexus passes under the clavicle

Question 11

Which of the following is true regarding the inferior thyroid artery?
(Please select 1 option)
Divides into four to five branches within the pretracheal fascia
Gives off a hyoid branch before entering the thyroid
Gives off oesophageal branches before entering the thyroid
Is the first branch of the external carotid artery
Lies behind the recurrent laryngeal nerve as it enters the thyroid

Answer 11

Gives off oesophageal branches before entering the thyroid

The inferior thyroid artery is a branch of the thyrocervical trunk. It passes superiorly and medially behind the lower pole of the thyroid to divide outside the pretracheal fascia into four or five branches, which in turn pierce the fascia separately.

The recurrent laryngeal nerve lies in the groove between the trachea and oesophagus as it approaches the thyroid, and usually has the inferior thyroid artery lying in front.

Question 12

Which of the following is true regarding the cranial nerves?
(Please select 1 option)
The accessory nerve leaves the skull through the foramen magnum
The glossopharyngeal nerve leaves the skull through the jugular foramen
The maxillary branch of the trigeminal nerve leaves the skull through the foramen ovale
The oculomotor nerve leaves the skull through the inferior orbital fissure
The vagus nerve leaves the skull through the foramen magnum

Answer 12

The glossopharyngeal nerve leaves the skull through the jugular foramen

The oculomotor nerve enters the orbit through the lower part of the superior orbital fissure.

The three branches of the trigeminal nerve leave the skull through the following foramina

Ophthalmic - superior orbital fissure
Maxillary - foramen rotundum
Mandibular - foramen ovale.
The glossopharyngeal, vagus and accessory nerves all leave the skull through the jugular foramen.

Question 13

Which of the following is true regarding the infratemporal fossa?
(Please select 1 option)
Floor attaches the lateral pterygoid muscle
Medial wall is formed by the ramus of the mandible
Roof is formed by the lesser wing of the sphenoid bone
Transmits the inferior alveolar nerve superiorly within the fossa
Transmits the maxillary artery superficially within the fossa

Answer 13

Transmits the maxillary artery superficially within the fossa This is the correct answerThis is the correct answer
Infratemporal fossa is the space lying beneath the base of the skull between the side wall of the pharynx and the ramus of the mandible.

The roof of the infratemporal fossa is formed by the infratemporal surface of the greater wing of the sphenoid, its medial wall is formed by the lateral pterygoid plate of the sphenoid bone and its lateral wall is formed by the ramus of the mandible.

The posterior wall shows the presence of styloid process of the temporal bone. The infratemporal fossa has no anatomical floor.

The lateral pterygoid muscle lies in the roof of the fossa and runs horizontally from the region of the pterygoid plate to the mandibular condyle.

Branches of the mandibular nerve lie deep to the fossa while the maxillary artery is superficial. The buccal branch of the mandibular nerve passes between the two heads of the lateral pterygoid.

The medial pterygoid, lingual and the inferior alveolar nerves emerge below its inferior border and the deep temporal nerves and vessels emerge from its upper border.

A venous network, the pterygoid venous plexus, lies around and within lateral pterygoid.

Question 14

Which of the following is correct regarding the thymus gland?
(Please select 1 option)
Blood supply is from the superior thyroid artery
Can be distinguished from fat due to its slightly different colour
Consists of a main body
Extends from the level of the seventh costal cartilage to the lower poles of the thyroid in children
Lies superficial to the pretracheal fascia

Answer 14

Can be distinguished from fat due to its slightly different colour

The thymus gland lies in the anterior part of the superior mediastinum.

It consists of right and left lobes which are closely applied to each other. It is usually most prominent in children, where it may extend from the level of the fourth costal cartilages to the lower poles of the thyroid.

In front of it lie the

Pretracheal fascia
Sternohyoid and sternothyroid muscles
Manubrium/sternum.
The lobes are overlapped on each side by the pleura, to which the pretracheal fascia is firmly attached. Behind lie the pericardium, great vessels and trachea.

The gland can be distinguished from fat due to its pink/brown colour.

Question 15

Which of the following is not a branch of the facial nerve?
(Please select 1 option)
Infratrochlear nerve
Marginal mandibular branch
Muscular branch to the posterior belly of digastric muscle
Posterior auricular nerve
Zygomatic nerve

Answer 15

Infratrochlear nerve

The facial nerve emerges from the base of the skull through the stylomastoid foramen. It immediately gives off the posterior auricular nerve.

A muscular branch is next given off to the posterior belly of digastric and stylohyoid.

The nerve then passes through the substance of the parotid gland to give five main groups of branches:

Temporal
Zygomatic
Buccal
Marginal mandibular
Cervical.
The zygomatic facial nerve is a branch of the maxillary nerve and the infratrochlear nerve is a branch of the ophthalmic, which in turn is a branch of the trigeminal.

Question 16

Which of the following is true regarding the phrenic nerve?
(Please select 1 option)
Is anterior to scalenus anterior
Is contained within the carotid sheath
Is deep to the common carotid artery
Is posterior to scalenus medius
Passes through the aortic opening in the diaphragm

Answer 16

Is anterior to scalenus anterior

The phrenic nerve enters the thorax anterior to the main arterial structures (common carotid, origin of subclavian artery), posterior to the venous structures and lateral to the vagus nerve.

The phrenic nerve passes inferiorly on the anterior surface of scalenus anterior beneath the pre-vertebral surface.

Scalenus medius lies posterior and lateral to scalenus anterior.

The carotid sheath contains

The common, internal and part of the external carotid arteries
The internal jugular vein
Parts of the glossopharyngeal, vagus and accessory nerves.
The phrenic nerve descends on the fibrous pericardium to supply the muscle of the diaphragm, excluding the crura.

The parietal pleura are supplied by somatic nerves (intercostals); the diaphragmatic pleura are supplied by the phrenic nerves and by intercostal nerves around the periphery.

The visceral pleura have only an autonomic supply. The phrenic nerve arises from the anterior rami of C3-5 (principally C4).

Question 17

Which of the following is correct regarding the basilar artery?
(Please select 1 option)
Enters the cranium through the foramen magnum
Is formed by the union of the two carotid arteries
Supplies the motor cortex
Supplies the sensory cortex
Supplies the vermis through its superior cerebellar branch

Answer 17

Supplies the vermis through its superior cerebellar branch This is the correct answerThis is the correct answer
The basilar artery runs through the pontocerebellar cistern to the superior border of the pons, where it bifurcates into the posterior cerebral arteries.

The vertebral arteries begin in the root of the neck as branches of the first part of the subclavian arteries and unite at the caudal border of the pons to form the basilar artery.

The basilar arteries and their branches supply the brainstem, cerebellum, and the inferior aspect of the cerebral hemispheres and occipital lobe.

The median portion of the cerebellum, the vermis, is supplied by the superior cerebellar artery, which is a branch of the basilar artery.

The motor cortex is supplied mainly by the middle cerebral artery, except the leg area, which is supplied by the anterior cerebral artery.

Question 18

Which of the following is correct concerning the median nerve?
(Please select 1 option)
Damage at the wrist causes wasting of the hypothenar muscles
Derives its fibres from spinal segments C6-8 and T1
Gives off a muscular branch to the triceps
Gives off sensory branches to the dorsal aspect of the lateral 2 and a half fingers
Supplies the ulnar half of the flexor digitorum profundus (FDP)

Answer 18

Derives its fibres from spinal segments C6-8 and T1

The median nerve (fibres derived from C6,7,8,T1) can be compressed at the wrist as in carpal tunnel syndrome causing selective wasting of the thenar muscles.

The radial nerve supplies the triceps.

The ulnar (medial) half of FDP is supplied by the ulnar nerve, the lateral half of FDP is supplied by the anterior interosseous branch of the median nerve (C8/T1).

The median nerve supplies the flexor digitorum superficialis.

Sensory supply is to the lateral two and a half fingers on the palmar aspect of the hand, and to the skin over the dorsal middle and distal phalanges of these lateral fingers.

Question 19

Which of the following is correct regarding the thoracic duct?
(Please select 1 option)
Bends laterally in front of the carotid sheath at the level of the C7 vertebra
Enters the thorax through the caval opening of the diaphragm
Passes anterior to the left phrenic nerve at the medial border of the scalenus anterior muscle
Passes behind the first part of the subclavian artery
Terminates in the right subclavian vein

Answer 19

Passes anterior to the left phrenic nerve at the medial border of the scalenus anterior muscle

The thoracic duct leaves the cisterna chyli at L1-2 and ascends through the aortic opening in the diaphragm to the right of the descending aorta.

It carries lymph from the

Lower limbs
Pelvis
Abdomen
Left thorax
Left head
Neck and
Left arm.
It gradually crosses the midline to reach the left side of the oesophagus and proceeds upward into the neck.

It arches at the C7 level behind the carotid sheath, passing anterior to the left phrenic nerve and medial border of the scalenus anterior.

Finally it crosses in front of the left subclavian artery to drain into the junction of the left subclavian and left internal jugular veins.

Question 20

A 17-year-old male is brought into the resuscitation area in the emergency department. He had been found hanging in the garage by his father 40 minutes ago and there is no pulse or respiratory effort. You suspect the cause of death was a cervical fracture.

Answer 20

C2
The hangman’s fracture consists of bilateral pedicle or pars fractures involving the C2 vertebral body. It is associated with anterior subluxation or dislocation of the C2 vertebral body. It results from a severe extension injury such as from a road traffic accident when there is forced hyperextension of the cervical spine, or from hanging.

Question 21

Which of the following is true of the thyroid gland?
(Please select 1 option)
Contains cells derived from the third pharyngeal pouches
Develops from the second and third pharyngeal arches
Has the recurrent laryngeal nerve ascending anteriorly
Is covered by the pretracheal fascia
Is supplied mainly by the middle thyroid artery

Answer 21

Is covered by the pretracheal fascia

The thyroid gland develops as an endodermal thickening in the midline of the floor of the pharynx between the tuberculum impar and the copula.

It contains cells from both the fourth and fifth pharyngeal pouches (ultimobranchial bodies).

The arteries to the thyroid gland are the superior thyroid artery, the inferior thyroid artery, and sometimes the thyroid ima.

The thyroid is surrounded by a sheath derived from the pretracheal layer of deep fascia. The sheath attaches the gland to the larynx and the trachea. They ascend laterally.

Question 22

Which of the following is a branch of the external carotid artery?
(Please select 1 option)
	 The inferior thyroid artery
	 The lacrimal artery
	 The occipital artery
	 The thyrocervical trunk
	 The vertebral artery

Answer 22

The occipital artery

The vertebral arteries begin in the root of the neck as branches of the first part of the subclavian artery.

The inferior thyroid artery is a branch of the thyrocervical trunk, which itself arises from the subclavian artery.

The lacrimal artery is a branch of the ophthalmic artery.

Question 23

Which of the following structures is found in the posterior triangle of the neck?
(Please select 1 option)
	 The accessory nerve
	 The ansa cervicalis
	 The common carotid artery
	 The glossopharyngeal nerve
	 The hypoglossal nerve

Answer 23

Accessory nerve

The posterior cervical triangle is bounded

Anteriorly by the posterior border of the sternocleidomastoid muscle
Posteriorly by the anterior border of the trapezius muscle and
Inferiorly by the middle third of the clavicle.
The arteries in the posterior triangle are

The third part of the subclavian artery
The transverse cervical artery
The suprascapular artery and
The occipital artery.
The nerves in the posterior triangle include the supraclavicular part of the brachial plexus.

Along with the accessory nerve the posterior triangle contains

The cervical plexus
The lesser occipital nerve
Great auricular nerve
Transverse cervical nerve
Supraclavicular nerves and
The phrenic nerve.

Question 24

Which of the following is true with reference to capillaries?
(Please select 1 option)
Capillaries in the dermis actively constrict in response to sympathetic stimulation
Cerebral capillaries have microscopically visible ‘leaks’
Fenestrations are not present in the renal glomerular capillaries
The diameter of a capillary in skeletal muscle is usually about twice the diameter of a red blood cell
When skeletal muscle is active, more capillaries are open than when it is at rest

Answer 24

When skeletal muscle is active, more capillaries are open than when it is at rest This is the correct answerThis is the correct answer
Capillaries link the arterioles and venules and are involved in the delivery of blood to the cells themselves. Therefore capillaries permit the leakage of plasma through fenestrations.

The ability of blood to flow through these capillaries is closely controlled by arteriolar tone. They do not have smooth muscle themselves. Hence exercise can stimulate greater opening up of the capillary beds.

The diameter of a capillary is 5 - 10 microns. Erythrocyte diameter is 6-8 microns.

Question 25

With reference to the regulation of arterial blood pressure and cardiac output (CO), which of the following is correct?
(Please select 1 option)
Coronary blood flow (CBF) varies with the cardiac output
Decrease in the force of ventricular contraction is one effect of an increase in sympathetic activity
During muscular exercise, the total peripheral resistance is unchanged
If cardiac output decreases, the arterial pressure will invariably be decreased
The main factor causing the increase in blood flow to exercising muscles is an increase in arterial blood pressure

Answer 25

Coronary blood flow (CBF) varies with the cardiac output

There is close regulation of arterial peripheral resistance {PR} and cardiac output {CO} for the preservation of blood pressure. It is determined through the equation of BP = CO × PR.

With a decrease in CO, BP need not necessarily be decreased if the heart rate (HR) or peripheral resistance (PR) increases.

With increased HR and BP in exercise, TPR may fall.

Adrenergic stimulation produces increased force of ventricular contraction.

There is a variation of CBF with HR and CO particularly as CBF occurs during diastole, hence increased HR with reduced diastolic time reduces coronary diastolic filling.

Question 26

Which of the following structures does not pass through the foramen magnum?
(Please select 1 option)
	 Anterior spinal artery
	 Dura
	 Spinal accessory nerve
	 Vagus nerve
	 Vertebral artery

Answer 26

The vagus nerve is the longest of the cranial nerves.

Its name is derived from Latin meaning “wandering”.

The nerve exits the brain stem through rootlets in the medulla that are caudal to the rootlets for the ninth cranial nerve. The rootlets form the tenth cranial nerve and exit the cranium via the jugular foramen.

Question 27

Direct lymphatic drainage of the breast does not occur via which of the following?
(Please select 1 option)
	 Abdominal lymph nodes
	 Axillary lymph nodes
	 Mandibular lymph nodes
	 Parasternal lymph nodes
	 Trochlear lymph nodes

Answer 27

Mandibular lymph nodes

Direct drainage does occur to the axillary, parasternal, trochlear and abdominal lymph nodes.

Question 28

Which of the following is true regarding the parathyroid glands?
(Please select 1 option)
Inferior pair is supplied by the inferior thyroid arteries
Inferior pair is usually situated on the inferomedial aspect of the thyroid gland
Superior pair arise from the second brachial pouch
Superior pair is commonly found along the distal internal carotid arteries
Superior pair is supplied by the ascending pharyngeal arteries

Answer 28

Inferior pair is supplied by the inferior thyroid arteries

The parathyroid glands (two pairs) are oval bodies about 3-5 mm in diameter which are embedded in the posterior surface of the lateral lobes of the thyroid gland.

The location of the glands, however, may vary since they can lie anywhere along the route from the brachial pouches, from which they descend during development. Ectopic parathyroid glands occur in 15-20% of patients.

Some of the anatomical locations include near or even within the thyroid or thymus, bifurcation of the common carotid artery, anterior or posterior mediastinum, retro-oesophageal region and pre-vertebral region.

The parathyroid gland depends on the thyroid gland for its blood supply and venous drainage.

The upper half of the parathyroid is supplied by the superior thyroid artery, and the lower half is supplied by the inferior thyroid artery.

Question 29

Which one of the following has a lower concentration in the cerebrospinal fluid (CSF) than plasma?
(Please select 1 option)
	 Bicarbonate
	 Chloride
	 Magnesium
	 Glucose
	 Sodium

Answer 29

Glucose

The concentration of glucose in CSF is 64 mg/dL whilst in plasma it is 100 mg/dL.

The concentration of HCO3- in CSF is 25.1 meq/L, whilst in plasma it is 24.8 meq/L.

The concentration of Chloride in CSF is 130 mmol/L, whilst in plasma is 100 mmol/L.

Magnesium has a concentration of 2.2 meq/kg H2O in CSF, whilst in plasma it is 1.6 meq/kg H2O.

The concentration of sodium in CSF is 140 mmol/L, whilst in plasma is 135 mmol/L.

Also, the concentration of potassium in CSF is 2.9 mmol/L, whilst in plasma it is 3.5 mmol/L.

The concentration of protein is 0.3 g/L in CSF and in plasma is 60-80 g/L.

Question 30

Which one of the following statements regarding the sympathetic trunk ganglion is true?
(Please select 1 option)
Branches of the aortic plexus pass along the superior mesenteric artery to supply the sigmoid colon
The coeliac plexus gives branches to the ovaries
The left and right sacral sympathetic trunks join on the anterior wall of the rectum
The lumbar sympathetic trunk gives branches to the lower oesophageal sphincter
The pelvic plexuses are formed from the right and left branches of the hypogastric plexus

Answer 30

The pelvic plexuses are formed from the right and left branches of the hypogastric plexus This is the correct answerThis is the correct answer
The lumbar sympathetic trunk gives off visceral branches to the aortic plexus which also descend to the hypogastric plexus.

The left and right sacral sympathetic trunks join on the coccyx at the ganglion impar.

Presynaptic fibres from the coeliac plexus pass to the adrenal medullas.

Branches of the aortic plexus pass along the inferior mesenteric artery to supply the sigmoid colon.

The pelvic plexuses are formed from the right and left branches of the hypogastric plexus and the sacral sympathetic trunk.

Question 31

What is the sensory nerve supply to the angle of the jaw?

A.	Maxillary branch of the trigeminal nerve
B.	Mandibular branch of the trigeminal nerve
C.	C3-C4
D.	Greater auricular nerve (C2-C3)
E.	Buccal branch of the facial nerve

Answer 31

Greater auricular nerve (C2-C3)

The trigeminal nerve is the major sensory nerve to the face except over the angle of the jaw. The angle of the jaw is innervated by the greater auricular nerve.