Neck Questions (seems to include Head/Neck Nerve Lesions)

Question 1

A lesion in what nerve causes the patient to have a drooping upper eyelid?

Answer 1

more than one: superior cervical ganglion or the oculomotor nerve can cause ptosis

Question 2

A lesion in what nerve causes the patient’s uvula to deviate away from the side of a lesioned nerve?

Answer 2

vagus nerve (weakness of the levator veli palatini)

Question 3

A lesion in what nerve causes the patient to not feel a corneal stimulation, but does not affect ability to shut both eyes?

Answer 3

trigeminal nerve

ciliary branches of the opthalmic division convey sensation from the cornea

Question 4

A lesion in what nerve alters sensation from mucosa of the naval cavity?

Answer 4

trigeminal nerve

maxillary division and some contribution from ophthalmic division supply the nasal cavity

Question 5

A lesion in what nerve causes the patient to lose ability to shut an eye?

Answer 5

facial nerve (CN VII)

orbicularis oculi muscles shuts the eye

Question 6

A lesion in what nerve causes the patient inability to adduct an eye?

Answer 6

oculomotor nerve (CN III)

innervates all ocular muscles which adduct the eye

Question 7

A lesion in what nerve causes the patient inability to keep saliva from dripping out of a corner of the mouth?

Answer 7

facial nerve (CN VII)

orbicularis oris muscle closes the mouth

Question 8

A lesion in what nerve causes the patient to be hypersensitive to loud sounds?

Answer 8

facial nerve (CN VIII)

stapedius muscle limits movement of the stapes

Question 9

A lesion in what nerve causes the patient to have double vision?

Answer 9

more than one: lesion of CN III (oculomotor), IV (trochlear), or VI (abducens) can cause double vision

Question 10

A lesion in what nerve causes a patient difficulty in swallowing, but does not affect ability to feel tongue depressor touching the oropharynx?

Answer 10

vagus nerve

weakness of the pharyngeal constrictors causes dysphagia

Question 11

A lesion in what nerve causes a patient to feel pain over the mastoid process?

Answer 11

facial nerve (CN VII)

posterior auricular branch innervates the skin over the mastoid process

Question 12

A lesion in what nerve causes a patient’s pupils to not be equal in diameter?

Answer 12

more than one: lesion of superior cervical ganglion or the oculomotor nerve can cause a constricted or dilated pupil, respectively

Question 13

A lesion in what nerve causes the patient to not be able to change the shape of the lens in response to a near stimulus?

Answer 13

oculomotor nerve (CN III)

innervates the ciliary muscle that allows the lens to round up for near vision

Question 14

A lesion in what nerve causes the patient to lose the cough reflex?

Answer 14

vagus nerve (CN X)

sensory and motor fibers participate in cough reflex

Question 15

A lesion in what nerve causes the patient to have hoarseness?

Answer 15

vagus nerve (CN X): recurrent laryngeal nerve

weakness of laryngeal muscles

Question 16

A lesion in what nerve causes the patient’s face to be dry on one side?

Answer 16

superior cervical ganglion

Horner’s syndrome… lack of sweat/anhydrosis

Question 17

A lesion in what nerve causes the patient to lose ability to feel tongue depressor touching anterior 2/3 of the tongue?

Answer 17

trigeminal nerve: lingual nerve of CN V3

conveys general sensation from anterior 2/3 of tongue

Question 18

A lesion in what nerve causes the patient to have reduced salivary gland secretions?

Answer 18

more than one: CN VII (facial) and CN IX (glossopharyngeal) innervate salivary glands

Question 19

A lesion in what nerve allows the patient to stick the tip of the tongue inside a cheek, but has inability to feel the mucosa?

Answer 19

trigeminal nerve: buccal nerve of CN V3

conveys general sensation from oral mucosa

Question 20

A lesion in what nerve is associated with lesions of parasympathetic axons?

Answer 20

more than one: CN III (oculomotor), CN VII (facial), CN IX (glossopharyngeal), CN X (vagus)

all carry parasympathetic axons

Question 21

A lesion in what nerve causes the patient to have internal strabismus?

Answer 21

abducens nerve

loss of lateral rectus causes medial deviation of the eye

**strabismus is abnormal deviation of the eye

Question 22

A lesion in what nerve causes the patient to have diplopia when attempting to depress an eye from the adducted position?

Answer 22

trochlear nerve

superior oblique is the eye depressor from the adducted position

**what depresses the eye from the abducted position? inferior rectus by CN III (oculomotor)

Question 23

A lesion in what nerve causes the patient to have diplopia during attempted convergence?

Answer 23

oculomotor (CN III)

medial rectus muscle which contracts to converge eyes during near response

**(diplopia is double vision)

Question 24

A lesion in what nerve causes a reduced peristalsis in the pharynx?

Answer 24

vagus nerve

weakness of the pharyngeal muscles can cause dysphagia and decreased peristalsis

Question 25

A lesion in what nerve causes an altered taste sensation from the tongue?

Answer 25

more than one: CN VII (facial) and IX (glossopharyngeal) convey taste from the tongue

Question 26

A male teenager is admitted to the emergency room with a stab wound of the neck. The wound is several inches inferior to the mastoid process, just posterior to the SCM. The next week, the patient complains of weakness in ability to shrug his shoulder on the side of the injury.

What else might be observed in the patient?
A. weakness in ability to protract the scapula
B. weakness in ability to abduct the arm above his head to comb his hair
C. weakness in ability to depress the hyoid bone
D. weakness in ability to turn the face to the opposite side of the injury
E. weakness in ability to depress the mandible

Answer 26

B. weakness in ability to abduct the arm above his head to comb his hair

accessory nerve lesion! (in posterior triangle)

most commonly lesioned in the posterior triangle and results in weakness of trapezius which acts to elevate and rotate the scapula during abduction of the arm

C– lesion of ansa cervicalis (C1, C2, C3) or the C1 fibers which innervate the sternohoid, sternothyroid, omohyoid, and thyrohyoid
D– would also be from an accessory nerve lesion, but just inferior to the jugular foramen to cause weakness in SCM–>decreased ability to turn chin to opposite side of lesioned nerve
E– would have been from weakness in the digastric (anterior belly) innervated by the nerve to mylohyoid (V3) or weakness in the infrahyoid (strap muscle) innervated by ansa cervicalis or C1 fibers

Question 27

Your patient suffered a stab wound to the neck that lacerates structures entering the pharynx through the thyrohyoid membrane.

Which of the following symptoms might the patient have?
A. weakness in ability to adduct the vocal cord
B. decreased ability to detect a foreign body in contact with mucosa below the vocal fold
C. weakness in ability to tense the vocal ligament
D. hoarseness
E. decreased ability to detect a foreign body in contact with mucosa in the piriform recess

Answer 27

E. decreased ability to detect a foreign body in contact with mucosa in the piriform recess

internal branch of the superior laryngeal nerve!

innervates the mucosa of the laryngopharynx and mucosa of the larynx above the vocal folds

A– lesion in recurrent laryngeal nerve of X (lateral cricoarythenoid)
B–recurrent laryngeal nerve also innervates mucosa below the vocal cords
C– lesion in the external branch of the superior laryngeal nerve of X which innervates the cricothyroid
D– lesion in vagus nerve’s recurrent laryngeal nerve branch (weakness in laryngeal muscles)

Question 28

A tonsillectomy procedure to remove the palatine tonsil lesions a nerve in the lateral wall of the tonsillar fossa.

What might an examination reveal?
A. the patient may have absence of the gag reflex of the side of the lesion
B. patient’s tongue may deviate on protrusion toward the side of the tonsillectomy
C. patient may have a deviated uvula
D. patient may have hyperacusis
E. patient may not be able to open the auditory tube when swallowing

Answer 28

A. the patient may have absence of the gag reflex of the side of the lesion

lesion of the CN IX (glossopharyngeal nerve)

B– lesion of hypoglossal nerve which innervates the muscles of the tongue (genioglossus, hypoglossus, styloglossus)
C– lesion of vagus nerve causing weakness of levator veli palatini so that uvula deviate away from side of lesioned nerve
D– hyperacusis= increased sensitivity to loud sounds; from weakness of facial nerve if it includes nerve to stapedius (contracts reflexively to protect the inner ear from high intensity vibrations)
E– lesion of vagus nerve (pharyngeal plexus) which innervates the levator veli palatini that helps to open the auditory tube and elevates the soft palate

Question 29

A thyroidectomy procedure lesions a nerve that enters the pharynx at the junction of the inferior constrictor and esophagus.

Which of the following functions will be affected by the lesion?
A. ability to elevate the larynx during swallowing
B. ability to elevate the palate during swallowing
C. ability to abduct the vocal fold
D. ability to contract the middle constrictor during swallowing
E. ability to detect the presence of a foreign body in the mucosa of the vestibule of the larynx

Answer 29

C. ability to abduct the vocal fold

inferior laryngeal nerve lesion!

innervates all muscles of the larynx except cricothyroid

A- lesion of the glossopharyngeal nerve or vagus nerve (pharyngeal plexus) which innervate the stylopharyngeus and palatopharyngeus
B– lesion in vagus nerve (pharyngeal plexus) which innervates the levator veli palatini which elevates soft palate
D– lesion in vagus nerve which innervates middle constrictor
E– lesion in internal branch of superior laryngeal nerve

Question 30

A woman undergoes surgery for removal of a swelling in the left love of her thyroid gland. Postoperative examination reveals that her voice is hoarse.

What nerve may have been affected by the surgical procedure?
A. Superior laryngeal nerve
B. Internal laryngeal nerve
C. Recurrent laryngeal nerve
D. External laryngeal nerve

Answer 30

C. recurrent laryngeal nerve

results in fixed vocal cord and transient hoarseness

A, B, D– superior laryngeal nerve lesion is usually asymptomatic bc mainly sensory. but if motor fibers to cricothyroid are affected by lesion to external branch–>mild hoarseness and slight decrease in vocal strength with tendency to produce monotonous speech. internal branch innervates laryngeal mucosa above the vocal cords.

Question 31

Your patient presents with hoarseness that results from an inability to abduct or adduct the right vocal cord. The patient is able to swallow normally, and the palate elevates symmetrically during testing of the gag reflex.

A complete lesion of which of the following neural structures might account for the patient's symptoms?
A. glossopharyngeal nerve
B. vagus nerve
C. superior laryngeal nerve
D. recurrent laryngeal nerve
E. internal laryngeal nerve

Answer 31

D. recurrent laryngeal nerve

innervates all muscles that abduct or adduct the vocal ligaments

A– loss of sensory limb of gag reflex with X, reduction in output of saliva
B– nasal speech, nasal regurgitation, palate droop, tip of uvula deviates away from lesioned nerve, dysphagia, loss of motor limb of gag reflex with IX, hoarseness, loss of cough reflex
C, E–superior laryngeal nerve lesion is usually asymptomatic bc mainly sensory. but if motor fibers to cricothyroid are affected by lesion to external branch–>mild hoarseness and slight decrease in vocal strength with tendency to produce monotonous speech. internal branch innervates laryngeal mucosa above the vocal cords

Question 32

Your patient exhibits a decrease in parotid gland secretions on the right, and stimulation of the oropharyngeal mucosa on the right does not result in elevation of the palate or contraction of pharyngeal constrictors.

Which of the following might account for these symptoms?
A. A tumor in the posterior cranial fossa compressing nerve fibers that traverse the jugular foramen
B. A lesion of the glossopharyngeal nerve as its passes between the superior and middle pharyngeal constrictors
C. A tonsillectomy procedure that lacerates the glossopharyngeal nerve in the tonsillar fossa
D. An infection in the middle ear
E. A thyroidectomy procedure that lesions the right recurrent laryngeal nerve

Answer 32

A. A tumor in the posterior cranial fossa compressing nerve fibers that traverse the jugular foramen

–>complete lesion of all fibers of the glossopharyngeal nerve (loss in gag reflex)

B– would affect everything but the innervation of stylopharyngeus
C– would affect lingual branch resulting in loss of all sensation from the posterior 1/3 of the tongue
D– affects preganglionic parasympathetic axons of CN IX which synapse in otic ganglion resulting in reduced parotid gland secretions
E– fixed vocal cord and transient hoarseness