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Practice Questions Flashcards

1
Q

A 19 y/o woman complains of numbness of the nasopharynx after surgical removal of the adenoid. A lesion of which of the following nerves would be expected?

A. Maxillary n.
B. Superior cervical ganglion
C. External laryngeal n.
D. Glossopharyngeal n.
E. Vagus n.
A

D. Glossopharyngeal n.

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2
Q

A 45 y/o woman is suffering from numbness over the tip of her nose. Which of the following nerves is most likely damaged?

A. Ophthalmic division of the trigeminal n.
B. Maxillary division of the trigeminal n.
C. Mandibular division of the trigeminal n.
D. Facial n.
E. Auriculotemporal n.

A

A. Ophthalmic division of the trigeminal n.

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3
Q

A 26 y/o singer visits her ENT and complains of changes in her voice. A laryngoscopic exam demonstrates a lesion of the superior laryngeal n., causing weakness of which of the following muscles?

A. Inferior pharyngeal constrictor
B. Middle pharyngeal constrictor
C. Superior pharyngeal constrictor
D. Thyroarytenoid
E. Thyrohyoid
A

A. Inferior pharyngeal constrictor

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4
Q

A 39 y/o woman presents to your clinic with complaints of headache and dizziness. She has an infection of a cranial dural sinus. The sinus that lies in the margin of the tentorium cerebelli and runs from the posterior end of the cavernous sinus to the transverse sinus is infected. Which of the following sinuses is affected by inflammation?

A. Straight sinus
B. Inferior sagittal sinus
C. Sphenoparietal sinus
D. Superior petrosal sinus
E. Cavernous sinus
A

D. Superior petrosal sinus

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5
Q

A 27 y/o paratrooper lands on a pine tree. Consequently, preganglionic parasympathetic nerves leaving the central nervous system are lacerated. Which of the following structures contain cell bodies of the damaged nerve fibers?

A. Cervical and sacral spinal cord
B. Cervical and thoracic spinal cord
C. Brainstem and cervical spinal cord
D. Thoracic and lumbar spinal cord
E. Brain stem and sacral spinal cord
A

E. Brainstem and sacral spinal cord

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6
Q

Following radical resection of a primary tongue tumor, a 72 y/o pt has lost general sensation on the anterior 2/3 of the tongue. This is probably due to injury to branches of which of the following nerves?

A. Trigeminal n.
B. Facial n.
C. Glossopharyngeal n.
D. Vagus n.
E. Hypoglossal n.
A

A. Trigeminal n.

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7
Q

During a carotid endarterectomy of a 57 y/o man who suffered a stroke, the carotid sinus is damaged. A third-year med student notices that the injured structure:

A. Is located at the origin of the external carotid a.
B. Is innervated by the facial n.
C. Functions as a chemoreceptor
D. Is stimulated by changes in blood pressure
E. Communicates freely with the cavernous sinus

A

D. Is stimulated by changes in blood pressure

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8
Q

A 37 y/o man feels a little discomfort when moving his tongue, pharynx, and larynx. Physical examination indicates that the muscles attached to the styloid process are paralyzed. Which of the following groups of cranial nerves are damaged?

A. Facial, glossopharyngeal, and hypoglossal nn
B. Hypoglossal, vagus, and facial nn
C. Glossopharyngeal, trigeminal, and vagus nn
D. Vagus, spinal accessory, and hypoglossal nn
E. Facial, glossopharyngeal, and vagus nn

A

A. Facial, glossopharyngeal, and hypoglossal nn

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9
Q

A young boy with a tooth abscess from a longstanding infection suffers damage of the lingual n. as it enters the oral cavity. Which of the following structures contain cell bodies of injured nerve fibers?

A. Geniculate and otic ganglia
B. Trigeminal and submandibular ganglia
C. Trigeminal and dorsal root ganglia
D. Geniculate and trigeminal ganglia
E. Geniculate and pterygopalatine ganglia
A

D. Geniculate and trigeminal ganglia

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10
Q

A 76 y/o man with swallowing difficulties undergoes imaging for a possible mass. The CT scan image at the level of the cricothyroid ligament in his neck should show which of the following structures?

A. Inferior laryngeal nn.
B. External carotid aa.
C. Inferior thyroid vv.
D. Thyrocervical trunks
E. Internal laryngeal nn.
A

A. Inferior laryngeal nn.

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11
Q

A knife wound has severed the oculomotor n. in a 45 y/o man. Which of the following conditions will occur because of this injury?

A. Constricted pupil
B. Abduction of the eyeball
C. Complete ptosis
D. Impaired lacrimal secretion
E. Paralysis of the ciliary m.
A

E. Paralysis of the ciliary m.

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12
Q

During surgery for a malignant parotid tumor in a 69 y/o woman, the main trunk of the facial n. is lacerated. Which of the following muscles is paralyzed?

A. Masseter m.
B. Stylopharyngeus m.
C. Anterior belly of the digastric m.
D. Buccinator m.
E. Tensor tympani m.
A

D. Buccinator m.

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13
Q

The first step in rhodopsin signal desensitization is the phosphorylation of C-terminal serine and threonine residues, followed by interaction with the protein arrestin. Which of the following is true in regards to rhodopsin and vision?

A. Rhodopsin phoshpatase increases the degree of rhodopsin phosphorylation
B. Arrestin binds to phosphorylated opsin to inhibit signaling
C. Rhodopsin activation promotes the opening of a cGMP-gated ion channel
D. Phosphorylation of rhodopsin promotes the interaction with its G protein transducin (Gt)

A

B. Arrestin binds to phosphorylated opsin to inhibit signaling

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14
Q

A 20 y/o guard at the gate of the royal king’s palace blinks his eyes when a strong wind hits the cornea of his eye. The afferent fibers of the corneal reflex arc are carried by which of the following nerves?

A. Optic n.
B. Lacrimal n.
C. Nasociliary n.
D. Zygomatic n.
E. Oculomotor n.
A

C. Nasociliary n.

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15
Q

A 37 y/o man receives a direct blow to the head and is brought to the ED. His radiograph shows fracture of the floor of the middle cranial cavity, causing severance of the greater petrosal n. Which of the following conditions could be produced by this injury?

A. Increased lacrimal gland secretion
B. Loss of taste in epiglottis
C. Dryness in the nose and palate
D. Decreased parotid gland secretion
E. Loss of sensation in the pharynx
A

C. Dryness in the nose and palate

[the greater petrosal n. carries preganglionic parasympathetics which are secretomotor fibers to the lacrimal glands and mucous glands in the nasal cavity and palate]

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16
Q

A 71 y/o man suffers from a known benign tumor in the pterygoid canal. Which of the following nerve fibers could be injured by this condition?

A. Postganglionic parasympathetic fibers
B. Taste fibers from the epiglottis
C. General somatic afferent fibers
D. Preganglionic sympathetic fibers
E. General visceral afferent fibers
A

E. General visceral afferent fibers

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17
Q

A 65 y/o man with multiple vision problems comes to a local eye clinic. The pupillary light reflex can be eliminated by cutting which of the following nerves?

A. Short ciliary, ophthalmic, and oculomotor nn.
B. Long ciliary, optic, and short ciliary nn.
C. Oculomotor, short ciliary, and optic nn.
D. Optic and long ciliary nn. and ciliary ganglion
E. Ophthalmic and optic nn. and ciliary ganglion

A

C. Oculomotor, short ciliary, and optic nn.

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18
Q

A 22 y/o pt has dryness of the corneal surface of his eye because of a lack of tears. Which of the following nerves may be damaged?

A. Proximal portion of the lacrimal n.
B. Zygomatic branch of the facial n.
C. Lesser petrosal n.
D. Greater petrosal n.
E. Deep petrosal n.
A

D. Greater petrosal n.

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19
Q

A 12 y/o boy has difficulty in breathing because he is choking on food. A school nurse performs the valsalva maneuver to expel air from his lungs and thus dislodge the food. When that fails, she performs a needle cricothyrotomy, which would open into which of the following regions?

A. Rima glottidis
B. Laryngeal vestibule
C. Laryngeal ventricle
D. Infraglottic cavity
E. Piriform recess
A

D. Infraglottic cavity

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20
Q

A 2 y/o boy presents with midfacial and mandibular hypoplasia, cleft palate, deformed external ear, and defect in hearing. Which of the following embryonic structures is most likely developed abnormally?

A. First pharyngeal arch
B. Second pharyngeal arch
C. Third pharyngeal arch
D. Fourth pharyngeal arch
E. Sixth pharyngeal arch
A

A. First pharyngeal arch

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21
Q

A 64 y/o woman is unable to open her mouth or jaw because of tetanus resulting from a penetrating wound from a rusty nail. Which of the following muscles would most likely be paralyzed?

A. Masseter m.
B. Medial pterygoid m.
C. Lateral pterygoid m.
D. Buccinator m.
E. Temporalis m.
A

C. Lateral pterygoid m.

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22
Q

A 46 y/o man visits the speech therapist complaining of dryness of the mouth. The therapist performs a swallowing study and, on exam, finds that the man has a lack of salivary secretion from the submandibular gland. This indicates a lesion of which of the following nervous structures?

A. Lingual nerve at its origin
B. Chorda tympani in the middle ear cavity
C. Superior cervical ganglion
D. Lesser petrosal n.
E. Auriculotemporal n.
A

B. Chorda tympani in the middle ear cavity

[the chorda tympani n. contains preganglionic parasympathetic fibers for secretion of submandibular gland]

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23
Q

A 3 y/o girl is admitted to the hospital with pain and hearing defect. An MRI reveals that she has developmental defects in the auditory tube and middle ear cavity. Which of the following pharyngeal pouches is most likely developed abnormally?

A. First pouch
B. Second pouch
C. Third pouch
D. Fourth pouch
E. Second and fourth pouches
A

A. First pouch

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24
Q

Cleft lip, with or without cleft palate, occurs about once in 1000 births. Which of the following is considered to be the most important causative factor in the production of this anomaly?

A. Riboflavin deficiency
B. Infectious disease
C. Mutant genes
D. Cortisone administration during pregnancy
E. Irradiation
A

C. Mutant genes

25
Q

A 17 y/o girl is admitted with signs of cavernous sinus thrombosis. Thrombophlebitis in the “danger area” of the face can spread to the cavernous sinus and involve the ophthalmic branch of the trigeminal n. Which of the following symptoms will most likely be present during physical exam?

A. Pain in the hard palate
B. Anesthesia of the upper lip
C. Pain from the eyeball
D. Pain over the lower eyelid
E. Tingling sensation over the buccal region of the face
A

C. Pain from the eyeball

26
Q

A 31 y/o woman is admitted to the hospital after an automobile collision. An MRI exam reveals a large hematoma inferior to the right jugular foramen. PE reveals right pupillary constriction (miosis), ptosis of the eyelid, and anhydrosis (loss of sweating) of the face. Which of the following ganglia is most likely affected by the hematoma?

A. Submandibular
B. Trigeminal
C. Superior cervical 
D. Geniculate
E. Ciliary
A

C. Superior cervical

27
Q

A 55 y/o man is admitted to the hospital after an injury sustained at work. He presents with severe scalp lacerations, which were sutured. After 3 days the wound is inflamed, swollen, and painful. Between which tissue layers is the infection most likely located?

A. The periosteum and bone
B. The aponeurosis and the periosteum
C. The dense CT and the aponeurosis
D. The dense CT and the skin
E. The dermis and epidermis
A

B. The aponeurosis and the periosteum

28
Q

A 33 y/o woman is unconscious when she is admitted to the hospital after she fell, hitting her head. The physician in the ED performs a pupillary light reflex test. The integrity of which of the following nerves is being checked?

A. Optic and facial
B. Optic and oculomotor
C. Maxillary and facial
D. Ophthalmic and oculomotor
E. Ophthalmic and facial
A

B. Optic and oculomotor

29
Q

A 48 y/o man presents with a constricted right pupil that does not react to light. His left pupil and vision in both eyes are normal. These findings are most likely d/t a lesion involving which of the following right-sided structures?

A. Oculomotor n.
B. Superior cervical ganglion
C. Nervus intermedius
D. Edinger-Westphal nucleus
E. Trigeminal ganglion
A

B. Superior cervical ganglion

30
Q

The arterial circle of Willis contributes greatly to cerebral arterial circulation when one primary artery becomes occluded by atherosclerotic disease. Which of the following vessels does not contribute to the circle?

A. Anterior communicating artery
B. Posterior communicating artery
C. Middle cerebral artery
D. Internal carotid artery
E. Posterior cerebral artery
A

C. Middle cerebral artery

31
Q

A 54 y/o man is admitted to the hospital d/t severe headaches. A CT reveals an internal carotid artery aneurysm inside the cavernous sinus. Which of the following nerves would typically be affected first?

A. Abducens n.
B. Oculomotor n.
C. Ophthalmic n.
D. Maxillary n.
E. Trochlear n.
A

A. Abducens n.

32
Q

The arachnoid villi allow CSF to pass between which two of the following spaces?

A. Choroid plexus and subdural space
B. Subarachnoid space and superior sagittal sinus
C. Subdural space and cavernous sinus
D. Superior sagittal sinus and jugular vein
E. Epidural and subdural space

A

B. Subarachnoid space and superior sagittal sinus

33
Q

A 21 y/o man was brought to the ED d/t severe epistaxis from the nasal septum. This area, known as Kiesselbach’s area, involves mostly anatomoses between which arteries?

A. Ascending palatine and ascending pharyngeal
B. Posterior superior alveolar and accessory meningeal
C. Lateral branches of posterior ethmoidal and middle meningeal
D. Septal branches of the sphenopalatine and superior labial
E. Descending palatine and tonsillar branches of the pharyngeal

A

D. Septal branches of the sphenopalatine and superior labial

34
Q

A 35 y/o woman is under general anesthesia. Before laryngeal intubation, the rima glottidis is opened by which pair of muscles?

A. Posterior cricoarytenoids
B. Lateral cricoarytenoids
C. Thyroarytenoids
D. Transverse arytenoids
E. Cricothyroids
A

A. Posterior cricoarytenoids

[vocal cord abduction = posterior cricoarytenoid m]

35
Q

24 hours following a partial thyroidectomy, it is noted that your patient frequently aspirates fluid into her lungs. Upon exam, it is determined that the area of the piriform recess above the vocal fold of the larynx was anesthetized. Which of the following nerves was most likely iatrogenically injured?

A. External branch of superior pharyngeal
B. Hypoglossal
C. Internal branch of superior laryngeal
D. Lingual
E. Recurrent laryngeal
A

C. Internal branch of superior laryngeal

36
Q

Which of the following symptoms needs to be identified during PE to confirm diagnosis of greater petrosal n. injury?

A. Partial dryness of mouth d/t lack of salivary secretions from submandibular and sublingual glands
B. Partial dryness of the mouth d/t lack of salivary secretions from parotid gland
C. Dryness of right cornea d/t lack of lacrimal gland secretion
D. Loss of taste sensation from right anterior 2/3 tongue
E. Loss of general sensation from right anterior 2/3 tongue

A

C. Dryness of right cornea d/t lack of lacrimal gland secretion

37
Q

A woman complains of diplopia when walking down stairs. A lesion of which of the following nerves is most likely responsible?

A. Optic
B. Oculomotor
C. Abducens
D. Trochlear
E. Frontal
A

D. Trochlear

38
Q

Infection may spread from the nasopharynx to the middle ear cavity along the derivative of which embryonic pharyngeal pouch?

A. First
B. Second
C. Third
D. Fourth
E. Sixth
A

A. First

39
Q

A pt is diagnosed with Bell’s palsy characterized by accumulation of saliva in oral cavity and dribble from corner of his mouth. Which muscle is most likely paralyzed?

A. Zygomaticus major m.
B. Orbicularis oculi m.
C. Buccinator m.
D. Levator palpebrae superioris m.
E. Orbicularis oris m.
A

C. Buccinator m.

40
Q

An 11 y/o boy with swollen palatine tonsils is examined by an otolaryngologist. Which of the following arteries supplies most of the blood to these tonsils?

A. Ascending pharyngeal
B. Facial
C. Lingual
D. Descending palatine
E. Superior thyroid
A

B. Facial

41
Q

Which of the following is responsible for the sensory innervation of the inner surface of the TM?

A. Glossopharyngeal
B. Auricular branch of facial
C. Auricular branch of vagus
D. Great auricular
E. Lingual
A

A. Glossopharyngeal

42
Q

Which of the following is regarded as the “danger zone” of the scalp?

A. Loose, areolar layer
B. Skin
C. Galea aponeurotica
D. Pericranium
E. Subcutaneous layer
A

A. Loose, areolar layer

43
Q

Which of the following nerves must be functioning properly if the patient is to be able to turn the eye laterally without difficulty and without upward or downward deviation?

A. Superior division of oculomotor, ophthalmic n., abducens n.
B. Trochlear n., abducens n., nasociliary n.
C. Inferior division of oculomotor, trochlear, abducens
D. Oculomotor and ophthalmic nn
E. Superior division of oculomotor, trochlear, and abducens n.

A

C. Inferior division of oculomotor, trochlear, abducens

44
Q

55 y/o man is admitted with c/o severe headaches. Lumbar puncture reveals traces of blood in CSF. Which of the following conditions has most likely occurred in this patient?

A. Fracture of the pterion with vascular injury
B. A ruptured “berry” aneurysm
C. Leakage of branches of the middle meningeal v. within temporal bone
D. Tear of cerebral v. at entrance to superior sagittal sinus
E. Occlusion of the internal carotid a. by a clot generated in the left atrium

A

B. A ruptured “berry” aneurysm

45
Q

Pt has removal of tumor from left jugular canal. Postop, the pt has no gag reflex when the ipsilateral pharyngeal wall is stimulated, although the pharynx moved upward and a gag reflex resulted when the right pharyngeal wall was stimulated. The uvula was deviated to the right and the left vocal cord had drifted toward midline. Which of the following structures will contain the neural cell bodies for the motor supply of the paralyzed mm?

A. Nucleus solitarius
B. Trigeminal motor nucleus
C. Dorsal motor nucleus
D. Nucleus ambiguus
E. Superior or inferior ganglia of vagus
A

D. Nucleus ambiguus

46
Q

Radiologic exam reveals intracranial thrombus probably d/t leakage from a cerebral v. over the right cerebral hemisphere. From what type of bleeding is the pt most likely suffering?

A. Subarachnoid bleeding
B. Epidural bleeding
C. Intracranial bleeding into the brain parenchyma
D. Subdural bleeding
E. Bleeding into the cerebral ventricular system

A

D. Subdural bleeding

47
Q

Radiologic exam reveals a tumor in the middle ear cavity, invading through the bony floor. Which of the following structures will most likely be affected?

A. Cochlea and lateral semicircular canal
B. Internal carotid a.
C. Sigmoid venous sinus
D. Internal jugular bulb
E. Aditus and antrum of the mastoid region and the facial n.

A

D. Internal jugular bulb

48
Q

During PE, what sign would one expect to see first if nerve compression has occurred within the cavernous sinus?

A. Inability to gaze downward and medially on the affected side
B. Complete ptosis of the superior palpebra (upper eyelid)
C. Bilateral loss of accommodation and loss of direct pupillary reflex
D. Ipsilateral loss of consensual corneal reflex
E. Ipsilateral paralysis of abduction of the pupil

A

C. Bilateral loss of accommodation and loss of direct pupillary reflex

49
Q

A pt experiences marked weakness in the musculature of the lower lip following removal of a parotid tumor. Which of the following nerves was most likely injured during the parotidectomy?

A. Marginal mandibular branch of facial
B. Zygomatic branch of facial
C. Mandibular division of the trigeminal
D. Buccal branch of facial
E. Buccal n.
A

A. Marginal mandibular branch of facial

50
Q

You’re closing your eyes during an exam trying to remember a specific slide. What is occurring in your retina?

A. Decreased release of glutamate
B. Hyperpolarization of rod cell membranes
C. Increased release of GABA
D. Inhibition of optic n. bipolar cells

A

D. Inhibition of optic n. bipolar cells

51
Q

You open your eyes once you remember the answer. Which of the following is true regarding what is occurring in your retina?

A. Rhodopsin is activated which leads to increased levels of cGMP
B. There is photon induced isomerization of 11-trans-retinal to 11–cis-retinal
C. There is continual loss of calcium which will eventually induce recovery by increasing guanylate cyclase activity
D. cGMP-gated ion channels open

A

C. There is continual loss of calcium which will eventually induce recovery by increasing guanylate cyclase activity

52
Q

It is widely agreed upon that the retinoid cycle is important and more convoluted than necessary. Which of the following is true regarding the retinoid cycle?

A. LRAT esterifies all trans retinol to all trans retinyl in the RPE
B. RPE converts all trans retinyl to 11 cis retinol in the rod cell
C. 11 cis retinol is oxidized to 11 cis retinal which then diffuses back into the rod cell
D. ABCA4 prevents buildup of all cis retinal in the RPE

A

A. LRAT esterifies all trans retinol to all trans retinyl in the RPE

53
Q

A 22 y/o male presents to ED following an MVA. After initial workup, pt is taken to xray which finds fracture to neck of mandible. Which of the following structures is most likely affected?

A. Auriculotemporal n.
B. Lingual n.
C. Inferior alveolar n.
D. Mental n.

A

A. Auriculotemporal n.

54
Q

A 55 y/o male is admitted with fever of 4 days duration. Radiology reveals presence of an infection that is spreading from the retropharyngeal space to the posterior mediastinum. Between which of the following fascial layers is the infection most likely located?

A. Between alar and prevertebral
B. Between alar and pretracheal
C. Between pretracheal and prevertebral
D. Between buccopharyngeal and alar
E. Between buccopharyngeal and prevertebral
A

A. Between alar and prevertebral

55
Q

A 65 y/o man is admitted to the ED after a TIA. Radiology reveals an aneurysm in the region between the posterior cerebral artery and the superior cerebellar artery. Which of the following nerves will most likely be compressed from the aneurysm?

A. Trochlear
B. Abducens
C. Oculomotor
D. Vagus
E. Optic
A

C. Oculomotor

56
Q

A 55 y/o woman presents to the ENT clinic with episodes of vertigo, fluctuating hearing loss, ringing of the right ear, and feeling of fullness in her ear. Diagnosis is Menieres disease. Which of the following is most likely affected by the edema associated with this disease?

A. Middle ear
B. Endolymphatic sac
C. Semicircular canals
D. Cochlea
E. Helicotrema
A

B. Endolymphatic sac

57
Q

A 45 y/o woman visits the outpatient clinic with PMH of dysphagia, nighttime fits of coughing, repeated chest infections, and a palpable swelling in her neck. Radiology reveals a persistent congenital pharyngeal pouch. Between which muscles is this pouch most likely located?

A. Between styloglossus and stylopharyngeus
B. Between palatoglossal arch and median glossoepiglottic fold
C. Between upper and middle pharyngeal constrictors
D. Between the cricopharyngeal and thyropharyngeal portions of inferior pharyngeal constrictor
E. Between the middle and inferior pharyngeal constrictors

A

D. Between the cricopharyngeal and thyropharyngeal portions of inferior pharyngeal constrictor

58
Q

Pt presents with dizziness and headaches. CT reveals a tumor in the superior orbital fissure. Upon PE, pt’s eyeball is fixed in abducted position, slightly depressed, and pupil is dilated. In addition, upper lid is droopy. When pt is asked to move pupil toward the nose, the pupil rotates medially. Consensual corneal reflexes are normal. Which of the following nerves is most likely affected?

A. Trochlear
B. Oculomotor
C. Abducens n. and sympathetic n. plexus accompanying the ophthalmic a.
D. Ophthalmic n. and short ciliary n.
E. Superior division of oculomotor n. and nasociliary n.

A

B. Oculomotor

59
Q

Pt complains of tenderness in upper right thorax, painful to compression. PE reveals slight ptosis of right eyelid. The right pupil is constricted more than the contralateral pupil. Which of the following is the most likely diagnosis?

A. Raynaud’s disease
B. Frey’s syndrome
C. Bell’s palsy
D. Quinsy
E. Pancoast tumor
A

E. Pancoast tumor

Neuro Personal (15 decks)

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