Review Questions Flashcards
While participating in a bar fight, the orbit of a 25-year-old man is pierced by a broken pool cue stick, which extends back to the superior orbital fissure. Which of the following nerves is most likely damaged?
A. Optic nerve
B. Facial nerve
C. Mandibular division of trigeminal
D. Maxillary division of trigeminal
E. Ophthalmic division of trigeminal
E. Ophthalmic division of trigeminal
After falling off his bicycle and being rushed to the ED, the report on your patient indicated that she has a Le Fort Fracture. You understand this to mean that your patient has a fracture of which bone?
A. Hyoid bone
B. Maxilla and surrounding facial structures
C. Calvarium
D. Mandible
E. Occipital bone
B. Maxilla and surrounding facial structures
In 1861, the notorious outlaw, Jack Duggan, (a.k.a. the Wild Colonial Boy) was captured and hanged by Australian authorities. What type of injury “did him in”?
Hangman’s fracture - a bilateral fracture through the pedicles of C2
A 42-year-old man has a lymph node biopsy in the left side of his lateral cervical region or posterior triangle of his neck. After closure of the wound, the physician asks the patient to rotate his head to the right against resistance, as shown in the photo. What nerve is the doctor assessing with this test?
Test of the spinal accessory nerve which supplies sternocleidomastoid (and trapezius)
A trauma patient with a large gash in his neck needs stitches. You decide to anesthetize the area with a cervical plexus block. What surface landmark would you use to guide your needle to the correct location? Where in relation to this landmark would you inject the anesthetic? What is the name for this location? Could the block affect other nerves in the posterior triangle? Which ones?
The nerve point of the neck is located about halfway up the posterior edge of the SCM.
The block could affect the Spinal Accessory nerve, along with sensory nerves of the cervical plexus.
While driving his Lamborghini down the street, a 21 year old man(?) crashes into a tree and hits his head on the dashboard. He loses consciousness for several minutes, then complains of a severe headache and vomiting. In the ER, you examine the victim and find swelling in the area of the right temporal region and a CT scan revealed a biconvex hyperdense extraaxial collection of blood, indicated by the arrows in the figure. What do you suspect has happened to the victim?
Blow to the pterion –> middle meningeal artery rupture –> epidural hematoma
A 68-year-old man arrived at the ER with sudden onset of the worst headache of his life, lethargy, and nuchal rigidity. He quickly loses consciousness and dies. Autopsy reveals no traumatic injury; however, the man’s subarachnoid space is filled with blood. Damage to what blood vessel most likely led to the death of this patient?
A. Common carotid
B. Middle meningeal
C. Facial
D. Branches of cerebral arterial circle of Willis
E. Superior sagittal sinus
D. Branches of cerebral arterial circle of Willis
A 34-year-old female patient presented with a headache lasting for a few months. Intracranial magnetic resonance angiography (MRA) was performed and is shown below. This image indicates an aneurysm in which artery?
Posterior communicating artery
A 47 year old man falls from a ladder and hits his head and mandible on the pavement. A CT scan indicates that the inferior alveolar nerve is injured as it enters the mandible. Which of the following muscles might also be paralyzed as a result?
A. Geniohyoid
B. Hyoglossus
C. Mylohyoid
D. Stylohyoid
E. Posterior belly of digastric
C. Mylohyoid
The nerve to mylohyoid is a branch of the inferior alveolar nerve which innervates mylohyoid and anterior belly of digastric
You are examining a 25-year-old patient in the ED after he was involved in a motorcycle accident in which he was not wearing a helmet. Fluid is leaking from his right nostril and he cannot smell on that side. Which of the following osseous structures is most likely fractured?
A. Nasal bones
B. Sella turcica
C. Greater wing of sphenoid
D. Cribiform plate
E. Maxilla
D. Cribiform plate
What happened?
Fracture of cribiform plate may lead to CSF rhinorrhea. It most often accompanies a basal skull fracture
A 55 year old fall off a ladder while painting his house. An X-ray reveals a small, depressed fracture of the skull vertex and thrombosis of the superior sagittal sinus. A day later, the patient loses consciousness. An MRI then shows enlargement of the ventricles and hydrocephalus. What is the most likely cause of his loss of consciousness?
A. Laceration of the middle meningeal artery
B. Fracture of the cribiform plate with CSF rhinorrhea
C. Obstruction of CSF resorption
C. Obstruction of CSF resorption
A 59-year-old man has pus in the loose connective tissue layer of the scalp, and consequently, his superior sagittal sinus is infected. The arachnoid granulations in the infected sinus:
A. Filter blood into CSF
B. Produce CSF
C. Allow CSF to return to the ventricles of the brain
D. Absorb CSF into the dural sinuses
E. Store CSF
D. Absorb CSF to the dural sinuses
The radiologic report on your 65-year-old patient indicates a brain tumor associated with cerebral edema (swelling) that has resulted in herniation of the brain through the tentorial notch with potentially life threatening consequences. The tentorial notch is an opening in the tentorium cerebelli which separates which two parts of the brain?
A. The two halves of the cerebral cortex
B. The pons and the medulla
C. The occipital lobes and the cerebellum
D. The two halves of the cerebellum
E.The frontal and temporal lobes
C. The occipital lobes and the cerebellum
other answers:
A. Two halves of cerebral cortex - that is the falx cerebri
D. Two halves of the cerebellum - that is the falx cerebelli
A 54 year old man is admitted to the hospital for severe headaches. A CT scan reveals a tumor in his brain occupying the medial portion of the anterior cranial fossa adjacent to the falx cerebri. Which of the following nerves is responsible for the sensation of pain from headache in this case?
A. Meningeal branches of the maxillary nerve
B. Meningeal branches of the mandibular nerve
C. Meningeal branches of the ethmoidal nerve
D. Tentorial branch of V1
E. C2 and C3 fibers
C. Meningeal branches of the ethmoidal nerve
During a fight, a 14-year-old boy receives an injury to the phrenic nerve from a knife wound in the neck. Which of the following anatomical relationships is correct about this nerve?
A. It passes medial to the common carotid artery
B. It passes anterior to the subclavian vein
C. It passes anterior to the anterior scalene muscle
D. It passes posterior to the subclavian artery
E. It passes deep to the brachial plexus
C. It passes anterior to the anterior scalene muscle
A 35 year old woman was diagnosed with cancer of the thyroid gland. This required excision of the lower pole (right lobe) of the gland and ligation of the artery supplying that region.
Which of the following nerves accompanying the artery is most likely to be damaged if the surgeon is not careful?
A. Vagus
B. Recurrent laryngeal
C. Phrenic
D. Brachial plexus
E. Spinal accessory
B. Recurrent laryngeal
A 68-year-old man was choking on a piece of steak at a family restaurant. Despite attempts to dislodge the food via abdominal thrusts (or the Heimlich maneuver), his upper airway remained blocked. An emergency medical technician (EMT), eating at the scene, performed an emergency procedure to enable the man to breathe. Which subcutaneous structure was most likely cut during this procedure?
A. Cricoid cartilage
B. Thyrohyoid membrane
C. Cricothyroid membrane
D. Tracheal rings
E. Isthmus of thyroid gland
C. Cricothyroid membrane
In the process of removing cervical lymph nodes during a radical neck dissection, a surgeon mistakenly lesions the ansa cervicalis. Which of the following deficits may occur?
A. Reduced sensation in the skin of the posterior triangle of the neck
B. Paralysis of the platysma muscle
C. Paralysis of several of the infrahyoid muscles
D. Inability to sense blood pressure from the carotid sinus
E. Paralysis of the vocal cords
C. Paralysis of several of the infrahyoid muscles
Your patient has a swelling in the anterior part of his neck near the hyoid bone. This abnormal structure was attached to the cecum of the tongue. It also moved superiorly when he stuck out his tongue but did not move when he swallowed
What is your diagnosis?
Thyroglossal duct cyst
A 35-year old man develops an infection on his face and subsequently experiences double vision, headache, and eye pain. A MRI shows an infection in the middle cranial fossa on one side of the body of the sphenoid. What is this area called and how could his symptoms come about? Which cranial nerves run through the cavernous sinus?
Cavernous sinus infection. Danger triangle, facial veins –> superior and inferior ophthalmic veins –> cavernous sinus.
Cranial nerves in the cavernous sinus: III, IV, VI, V1 and V2
A 39-year-old 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. Superior sagittal sinus
B. Straight sinus
C. Inferior sagittal sinus
D. Superior petrosal sinus
E.Cavernous sinus
D. Superior petrosal sinus
Your 19-year-old male patient was punched in the orbit and has sustained a fracture of one of the bones that form the orbital margin. Which of the following bones would you not expect to have sustained a fracture?
A. Frontal
B. Palatine
C. Maxilla
D. Lacrimal
E. Zygomatic
B. Palatine
Your patient develops a tumor at the base of the brain, posterior to the optic chiasm, which compresses the right optic tract. What would happen to that person’s field of vision? Would it look like A, B or C?
A
After examining your patient’s MRI, you discover that she has a small aneurysm in the wall of the internal carotid artery in the cavernous sinus.
Which nerve would most-likely be affected first and which muscle affected?
Abducens nerve (CN VI), lateral rectus muscle
Your 80-year-old patient just had an embolic event that occluded all blood flowing in the central artery of the retina in her right eye. What did your patient complained of?
A. Diplopia
B. Partial blindness in her right eye
C. Total blindness in her right eye
D. Itchy discomfort in the right eye
E. Dry eye
C. Total blindness in her right eye
-no anastomoses
A 25-year-old professional boxer loses a fight when he is rendered unconscious by his opponent. After he regains consciousness, the ringside physician notes the boxer has a severe headache, nausea, and even vomiting. Being concerned about intracranial trauma, what cranial nerve can be observed by the physician, without the aid of radiographic imaging, to gain more information on whether the boxer has increased intracranial pressure?
A. Optic nerve
B. Oculomotor nerve
C. Olfactory nerve
D. Trigeminal nerve
E. Trochlear nerve
A. Optic nerve
-The physician can use an ophthalmoscope to look for papilledema – blurring of the retinal arteries and veins as a result of increased intracranial pressure
CN III (oculomotor) can also be compressed on the petrous part of the temporal bone, affecting eye movements.
When looking straight ahead, which extraocular muscle(s) must be used simultaneously to produce a pure elevation of the eyeball?
A. Superior rectus and lateral rectus
B. Superior rectus and inferior oblique
C. Superior rectus and superior oblique
D. Superior rectus and medial rectus
E. Superior rectus alone
B. Superior rectus and inferior oblique
During primary gaze (looking straight ahead) the superior rectus moves the eye up and in, the inferior oblique moves the eye up and out – the in and out motions cancel, giving a pure elevation
You ask a patient to cross their eyes by looking IN and then DOWN. Which extraocular muscle are you testing? Which nerve does this test?
The Superior Oblique muscle (CN IV trochlear)
Your patient is having problems with chewing – especially with food collecting in the space between his cheek and teeth, and food dribbling out of the corner of his mouth. Upon visual inspection, you notice that his left lower eyelid and corner of the mouth are drooping. An MRI reveals a parotid tumor. Explain how a parotid tumor could cause your patient’s symptoms.
The parotid tumor is compressing the motor fibers of the Facial Nerve (CN VII) – causing paralysis of the facial muscles, including the buccinator
To differentiate between unilateral paralysis of the muscles of facial expression (Bell palsy) and a herpes zoster infection of CN VII, the physician must look for small herpetic lesions (vesicles or blisters). Where are these skin lesions located in a herpes zoster infection involving the facial nerve?
A. Mental region of the mandible
B. Over the buccal region of the cheek
C. Upper lip and cheek of face
D. Around tragus of the ear
E. Bridge and tip of nose
D. Around tragus of the ear
Sensation around external ear by CN VII can lead to this reflex arc –> smile!
An MBS student finds out he has a perfect score on the anatomy exam and his muscles of facial expression produce a long anticipated smile. What muscle is assisting him in elevating the corners of his mouth bilaterally to smile?
A. Buccinator
B. Orbicularis oris
C. Levator labii superioris
D. Zygomaticus minor
E. Zygomaticus major
E. Zygomaticus major
A 6 year old boy is admitted to the hospital with high fever and pain over the parotid gland. You diagnose him with a case of mumps and send him home.
Which of the following nerves is responsible for pain from the region of the parotid gland?
A. Facial
B. Auriculotemporal
C. Lesser petrosal
D. Lingual
E. Buccal branch of V3
B. Auriculotemporal (V3)
A 45-year-old man is in surgery. While seated at the head of the operating table, the anesthesiologist periodically checks the patient’s pulse by palpating the artery located anterior to the tragus of the external ear. Which of the following arteries is being utilized to monitor the patient’s pulse?
A. Maxillary
B. Posterior auricular
C. Superficial temporal
D. Facial
E. Internal carotid
C. Superficial temporal
What happened?
Stone in submandibular duct – may cause pain beneath mandible after after eating
One day during your Family Medicine clerkship you see two patients with painful lesions around their eyes. One has a lump on the edge of her lower eyelid (patient A) and the other on the inside of his eyelid (patient B). What are the names of these structures and what are their causes?
Patient A: Hordeolum (external stye) – an infection of the sebaceous glands (of Zeis) at base of eyelashes
Patient B: Chalazion – (internal stye) – a cyst on the inside of the eyelid caused by inflammation of a meibomian gland – which produces an oily substance that prevents evaporation of lacrimal fluid
What are these?
left: conjunctivitis
right: blepharitis (eyelid inflammation)
Name the muscles and their innervation.
- Palatoglossus (CN X)
- Styloglossus (CN XII)
- Hyoglossus (CN XII)
- Geniohyoid (C1 via hypoglossal)
- Genioglossus (CN XII)
Your 24-year-old patient has a squamous cell carcinoma of the lateral aspect of his tongue resulting from many years of chewing tobacco. Metastatic spread from this cancer is likely to go through which of the following groups of lymph nodes?
A. Submental and parotid
B. Submental and auricular
C. Submental and occipital
D. Submandibular and parotid
E. Submandibular and deep cervical
E. Submandibular and deep cervical
A 59-year-old man with a left-sided herpes zoster infection within the mandibular division of the trigeminal nerve (CN V3) complains of weakness when opening his mouth. A comprehensive evaluation reveals that his problems are due to difficulty protruding the mandible, and when protrusion is accomplished the mandible deviates to the left side, as seen in the figure. What muscle is most likely weakened?
A. Masseter
B. Temporalis
C. Medial pterygoid
D. Anterior belly of digastric
E. Lateral pterygoid
E. Lateral pterygoid
A 30 year old boxer arrives at Tufts Medical Center with severe bruising and pain below the left eye. He also complains of double vision.
A CT scan indicates an inferior (blow-out) fracture of the orbit. Orbital structures would most likely be found inferiorly in which paranasal sinus? Which muscle(s) would most likely be affected and in which position might the eye be fixed?
An inferior orbital blowout fracture would result in orbital structures in the maxillary sinus – the inferior rectus and inferior oblique muscles would likely be entrapped, causing the eye to be fixed in a depressed position
What is this space called?
Danger space
- Which of the following pairs of nasal sinuses are visible in the above coronal CT?
- Which sinuses cannot drain into the nasal cavity by gravity without tipping the head?
A. Frontal
B. Sphenoid
C. Maxillary
D. Ethmoid
- Ethmoid and maxillary
- C - maxillary
A 5 year old male is diagnosed with a pituitary tumor. An anterior approach to the sella turcica through the nasal cavity is performed. Through which of the following routes is the surgeon likely to enter the cranial cavity?
A. Cribiform plate
B. Cavernous Sinus
C. Frontal sinus
D. Sphenoidal sinus
E. Maxillary sinus
E. Sphenoidal sinus
A 45-year-old man goes to his physician complaining of having trouble with his speech (dysarthria) and involuntary contractions (fasciculations) within his tongue muscles. The doctor notes that his tongue deviates to the right when the patient attempts to protrude his tongue, as seen in the figure. What nerve is most likely damaged in this patient?
A. Left hypoglossal nerve
B. Right hypoglossal nerve
C. Right vagus nerve
D. Left glossopharyngeal nerve
E. Right mandibular (CN V3) nerve
B. Right hypoglossal nerve
u examine a 68 year old man with a history of hypertension who has suffered a stroke. During an examination it is noted that his uvula deviates to the left and the right side of the palate is sagging. Which nerve has most likely been affected?
A. Left glossopharyngeal nerve
B. Left vagus nerve
C. Right vagus nerve
D. Left hypoglossal nerve
E. Right hypoglossal nerve
C. Right vagus nerve
Uvula deviates away from affected side due to pull of muscular uvula, palatopharyngeus, levator palatini and tensor veli palatini on the unaffected side
What is the one important thing that runs deep to the hyoglossus muscle?
The lingual artery, check it…
