Review Questions

Question 1

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

Answer 1

E. Ophthalmic division of trigeminal

Question 2

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

Answer 2

B. Maxilla and surrounding facial structures

Question 3

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”?

Answer 3

Hangman’s fracture - a bilateral fracture through the pedicles of C2

Question 4

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?

Answer 4

Test of the spinal accessory nerve which supplies sternocleidomastoid (and trapezius)

Question 5

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?

Answer 5

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.

Question 6

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?

Answer 6

Blow to the pterion –> middle meningeal artery rupture –> epidural hematoma

Question 7

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

Answer 7

D. Branches of cerebral arterial circle of Willis

Question 8

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?

Answer 8

Posterior communicating artery

Question 9

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

Answer 9

C. Mylohyoid

The nerve to mylohyoid is a branch of the inferior alveolar nerve which innervates mylohyoid and anterior belly of digastric

Question 10

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

Answer 10

D. Cribiform plate

Question 11

What happened?

Answer 11

Fracture of cribiform plate may lead to CSF rhinorrhea. It most often accompanies a basal skull fracture

Question 12

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

Answer 12

C. Obstruction of CSF resorption

Question 13

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

Answer 13

D. Absorb CSF to the dural sinuses

Question 14

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

Answer 14

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

Question 15

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

Answer 15

C. Meningeal branches of the ethmoidal nerve

Question 16

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

Answer 16

C. It passes anterior to the anterior scalene muscle

Question 17

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

Answer 17

B. Recurrent laryngeal

Question 18

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

Answer 18

C. Cricothyroid membrane

Question 19

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

Answer 19

C. Paralysis of several of the infrahyoid muscles

Question 20

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?

Answer 20

Thyroglossal duct cyst

Question 21

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?

Answer 21

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

Question 22

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

Answer 22

D. Superior petrosal sinus

Question 23

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

Answer 23

B. Palatine

Question 24

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?

Answer 24

A

Question 25

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?

Answer 25

Abducens nerve (CN VI), lateral rectus muscle

Question 26

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

Answer 26

C. Total blindness in her right eye -no anastomoses

Question 27

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

Answer 27

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.

Question 28

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

Answer 28

B. Superior rectus and inferior oblique ## Footnote 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

Question 29

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?

Answer 29

The Superior Oblique muscle (CN IV trochlear)

Question 30

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.

Answer 30

The parotid tumor is compressing the motor fibers of the **Facial Nerve (CN VII)** – causing paralysis of the facial muscles, including the buccinator

Question 31

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

Answer 31

D. Around tragus of the ear ## Footnote Sensation around external ear by CN VII can lead to this reflex arc --\> smile!

Question 32

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

Answer 32

E. Zygomaticus major

Question 33

During extraction of her impacted wisdom teeth, a 22-year-old woman suffers damage to her right inferior alveolar nerve. Which of the following conditions is most likely to result? A. Inability to compress the cheek B. Loss of sensation of the lower lip C. Weakness in closing the jaw D. Decreased salivation E. Reduced taste in the anterior part of the tongue

Answer 33

B. Loss of sensation of the lower lip ## Footnote The mental nerve is the terminal branch of the inferior alveolar nerve (which supplies sensation from the mandibular teeth) and supplies sensation from the skin of the lower lip

Question 34

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

Answer 34

B. Auriculotemporal (V3)

Question 35

A 78-year-old man presents with signs of reduced blood flow into the right side of his face. His physician wishes to take a pulse of the facial artery on both sides to help evaluate the situation. The pulse of the facial artery can be readily palpated at which of the following locations? A. Lateral side of the body of the hyoid bone B. Inferior edge of the zygomatic arch C. Anterior to the external ear D. About halfway up the anterior edge of the sternocleidomastoid E. Inferior edge of the body of the mandible

Answer 35

E. Inferior edge of the body of the mandible

Question 36

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

Answer 36

C. Superficial temporal

Question 37

A 4 year-old boy comes to your office with a cold and runny nose. You tell his mother that “things are s’nots so good”. The fact that mucous is being produced in his nasal cavity indicates that which of the following ganglia is functioning normally: A. Submandibular ganglion B. Superior cervical ganglion C. Otic ganglion D. Pterygopalatine ganglion E. Geniculate ganglion

Answer 37

D. Pterygopalatine ganglion ## Footnote The pterygopalatine ganglion has cell bodies of post-ganglionic parasympathetics which supply the lacrimal gland as well as glands in the nasal cavity and palate

Question 38

A 37-year-old man presented with decreased emotional tearing on the right side and intermittent headaches. Magnetic resonance images (MRIs) revealed a facial nerve tumour located within the right pterygoid (vidian) canal. What nerve fibers are most likely injured by this tumor? A. Taste fibers to the anterior two thirds of the tongue B. Parasympathetic innervation to the submandibular and sublingual glands C. Presynaptic sympathetic fibers D. Presynaptic parasympathetic fibers E. Postsynaptic parasympathetic fibers

Answer 38

D. Presynaptic parasympathetic fibers

Question 39

Which of the following structures contain the cell bodies of the preganglionic parasympathetic fibers which innervate the parotid gland? A. Superior cervical ganglion (post-ganglionic sympathetics) B. Edinger-Westphal nucleus (pre-ganglionic – CN III) C. Superior salivatory nucleus (pre-ganglionic CN VII) D. Inferior salivatory nucleus (pre-ganglionic CN IX) E. Otic ganglion (post-ganglionic CN IX)

Answer 39

D. Inferior salivatory nucleus (pre-ganglionic CN IX)

Question 40

A 49-year-old female patient complained of parotid pain that increased while eating. Intraoral examination detected some pus oozing from the parotid duct opening. Where would one in the oral cavity to locate the parotid duct opening? A. The lingual caruncle behind the lower central incisor teeth B. Mucosa of the cheek across the 2nd mandibular molar tooth C. Mucosa of the cheek across from the 2nd maxillary molar tooth

Answer 40

C. Mucosa of the cheek across from the 2nd maxillary molar tooth

Question 41

What happened?

Answer 41

Stone in submandibular duct – may cause pain beneath mandible after after eating

Question 42

You are performing surgery to remove a thyroid tumor that has invaded the root of the neck. After surgery, you notice that your patient has the following symptoms on the right side of her face: constricted pupil, ptosis, vasodilation and absence of sweating. What is your patient’s problem? How did it occur? Explain why your patient exhibits the above symptoms.

Answer 42

The patient has Horner’s Syndrome – the sympathetic trunk or superior cervical ganglion has been damaged by the surgery

Question 43

A knife wound has severed the oculomotor nerve in a 45-year-old man. Which of the following conditions will occur because of this injury? A. Impaired lacrimal secretion B. Complete ptosis C. Inability to abduct the eyeball D. Inability to round up the lens for near-vision E. Constricted pupil

Answer 43

D. Inability to round up the lens for near-vision (parasympathetic innervation from CN III --\> constrictor pupillae and **ciliaris** muscles) other answers: lacrimal secretion: greater petrosal nerve of CN VII ptosis: sympathetic fibers to the superior tarsal muscle abduction of the eyeball: CN VI (abducens) constricted pupil: wouldn't happen with loss of parasympathetic input

Question 44

An aneurysm in which two arteries in the circle of Willis can compress CN III?

Answer 44

Posterior communicating and superior cerebellar a.s.

Question 45

A physician directs a small light into only the left eye of a patient to test pupillary constriction. The left pupil does not respond to the light; however, the right pupil constricts. What nerve is most likely damaged in this patient? A. Right optic nerve B. Left optic nerve C. Right ophthalmic nerve D. Right oculomotor nerve E. Left oculomotor nerve

Answer 45

E. Left oculomotor nerve

Question 46

A 51 year old woman finds that she can see distant objects clearly but need glasses to see nearby objects and to read. Her lack of accommodation results from paralysis of which of the following muscles? A. Dilator pupillae muscle B. Constrictor pupillae muscle C. Superior tarsal muscle D. Ciliaris muscle E. Levator palpibrae muscle What is this condition called?

Answer 46

D. Ciliaris muscle condition is called presbyopia

Question 47

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?

Answer 47

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

Question 48

What are these?

Answer 48

left: conjunctivitis right: blepharitis (eyelid inflammation)

Question 49

A 42-year-old man suffers from a rare tongue disease and comes to the emergency department. On examination, he is unable to protrude his tongue. Which of the following muscles is paralyzed? A. Geniohyoid B. Palatoglossus C. Styloglossus D. Hyoglossus E. Genioglossus

Answer 49

E. Genioglossus

Question 50

Name the muscles and their innervation.

Answer 50

1. Palatoglossus (CN X) 2. Styloglossus (CN XII) 3. Hyoglossus (CN XII) 4. Geniohyoid (C1 via hypoglossal) 5. Genioglossus (CN XII)

Question 51

A 23 year-old man claims to have lost taste on the right anterior part of his tongue. Which structure may be damaged and what other visceral function could be affected?

Answer 51

The chorda tympani; salivation from submandibular and sublingual glands would also be affected

Question 52

Lesion of the lingual nerve proximal to the chorda tympani joining it will lead to loss of: A. Salivation from the submandibular and sublingual glands B. Salivation from the parotid gland C. Taste from the anterior 2/3 of the tongue D. Taste from the posterior 1/3 of the tongue E. Sensation from the anterior 2/3 of the tongue

Answer 52

E. Sensation from the anterior 2/3 of the tongue

Question 53

A patient with chronic otitis media (middle ear infection) might have all the following complications EXCEPT: A. Inability to chew food due to injury of the mandibular division of the trigeminal nerve B. Loss of taste in the anterior part of the tongue due to injury to the chorda tympani C. Stimulation of the parotid gland D. Paralysis of facial muscles due to an injury to the facial nerve E. Some degree of deafness due to damage to the auditory ossicles

Answer 53

A. Inability to chew food due to injury of the mandibular division of the trigeminal nerve

Question 54

Your 18-year-old female patient has anorexia nervosa and often induces vomiting by placing her finger on the back of tongue and oropharynx. Which nerve is responsible for this? A. Hypoglossal B. Glossopharyngeal C. Vagus D. Chorda tympani E. Lingual Which efferent nerve stimulates the gag reflex and which muscle is stimulated?

Answer 54

B. Glossopharyngeal Gag reflex: Sensory – afferent limb – CN IX Motor – efferent – mostly CN X along with CN IX which innervates stylopharyngeus

Question 55

You are assisting an oral surgeon who is about to remove a calculus (stone) from a patient's submandibular duct. The surgeon asks you which nerve he has to be careful not to injure while incising the duct directly under the floor of the mouth. Which one is it? A. Spinal accessory B. Chorda tympani C. Lingual D. Inferior alveolar E. Glossopharyngeal Follow-up question: Where is the lingual artery in relation to the duct and this nerve?

Answer 55

C. Lingual ## Footnote The lingual artery is deep to the mylohyoid muscle, not superficial to it, as are the lingual nerve, hypoglossal nerve and submandibular duct

Question 56

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

Answer 56

E. Submandibular and deep cervical

Question 57

A 10 year old boy is diagnosed with tonsillitis. Which of the following nodes is most likely to be enlarged first because of this infection? A. Submandibular B. Submental C. Parotid D. Superior deep cervical E. Jugulodigastric

Answer 57

E. Jugulodigastric

Question 58

During your ER rotation, a patient arrives with his jaw locked in the open position after yawning too widely. You are asked to reduce the dislocation by depressing his jaw, then carefully pressing it backwards and upwards to its normal position. How did this patient dislocate his jaw, and why are precautions needed to prevent injury to yourself?

Answer 58

Opening the jaw too much causes the condylar head of the mandible to slide forward over the articular eminence of the temporal bone --\> stuck

Question 59

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

Answer 59

E. Lateral pterygoid

Question 60

In reducing the dislocation of the mandible, a surgeon, Dr. Butterfingers, MD, provoked an intense hemorrhage by lacerating the artery coursing transversely just medial to the neck of the condyle. Which artery was did he lacerate? A. Superficial temporal B. Maxillary C. Middle meningeal D. Sphenopalatine E. Lingual

Answer 60

B. Maxillary

Question 61

A 56 year old woman is admitted to the hospital with rheumatoid arthritis of her temporomandibular joint and severe ear pain. Which of the following nerves is most likely responsible for conducting the pain sensations? A. Facial B. Chorda tympani C. Lesser petrosal D. Vestibulocochlear E. Auriculotemporal

Answer 61

E. Auriculotemporal

Question 62

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?

Answer 62

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

Question 63

A 49 year old woman arrives in the ER after a fever of 4 days duration. An X-ray reveals the presence of an infection that is spreading from behind his pharynx to the posterior mediastinum. Between which fascial layers is the infection most likely located? A.I nvesting and carotid sheath B. Investing and visceral (pretracheal) C. Prevertebral and alar D. Alar and retropharyngeal E. Carotid sheath and investing

Answer 63

C. Prevertebral and alar

Question 64

What is this space called?

Answer 64

Danger space

Question 65

1. Which of the following pairs of nasal sinuses are visible in the above coronal CT? 2. Which sinuses cannot drain into the nasal cavity by gravity without tipping the head? A. Frontal B. Sphenoid C. Maxillary D. Ethmoid

Answer 65

1. Ethmoid and maxillary 2. C - maxillary

Question 66

A 53-year-old man has difficulty with breathing through his nose. On examination, his physician finds that he has swelling of the mucous membranes of the superior nasal meatus. Which opening of the paranasal sinuses is most likely plugged? A. Frontal sinus B. Maxillary sinus C. Middle ethmoidal air sinus D. Posterior ethmoidal air sinus E. Sphenoid sinus

Answer 66

D. Posterior ethmoidal air sinus

Question 67

In a case of massive head and facial trauma, ligation or therapeutic embolization of the external carotid artery may help control hemorrhage to all of the following except? A. Nasal cavity B. Face C. Dura mater D. Forehead E. Oral cavity

Answer 67

D. Forehead -he is referring to the supraorbital artery, a branch of the ophthalmic a. from the **ICA**

Question 68

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

Answer 68

E. Sphenoidal sinus

Question 69

The thin-skinned autocratic leader of the Former Soviet Union gets a speck of sand in his eye and blinks. Explain the Blink Reflex - what are the nerves and muscles involved?

Answer 69

Afferent: V1 nasociliary (short and long ciliary nerves) Efferent: CN VII --\> orbicularis oculi m.

Question 70

A 38-year-old an consulted his physician about a persistent cough, nasal congestion, and pain in his left cheek and superior molar teeth. After examination, the physician told him he had acute paranasal sinusitis. Which of the following statements best describes the most likely cause of the patient's symptoms? A. Acute maxillary sinusitis B. Acute frontal sinusitis C. Acute ethmoidal sinusitis D. Acute sphenoidal sinusitis

Answer 70

A. Acute maxillary sinusitis Superior alveolar nerve goes through the maxillary sinus --\> pain referred to upper teeth

Question 71

During a Physical Diagnosis class, two Tufts M’18 students attempt to palpate each other’s carotid pulse simultaneously on both sides of the neck, when one of them suddenly passes out and ends up on the floor. What happened?

Answer 71

Pressure on the neck overstimulated the carotid sinuses, causing the vagus nerve to slow the heart rate and resulting in insufficient cardiac output. Afferent nerve is glossopharyngeal, efferent to the heart is the vagus.

Question 72

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

Answer 72

B. Right hypoglossal nerve

Question 73

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

Answer 73

C. Right vagus nerve ## Footnote Uvula deviates away from affected side due to pull of muscular uvula, palatopharyngeus, levator palatini and tensor veli palatini on the unaffected side

Question 74

A 12-year-old boy was admitted to the hospital complaining of a severe sore throat and bilateral earache. After physical examination, the boy's physician suggested that a tonsillectomy be performed to eliminate the problem once and for all. The boy was readmitted to the hospital for surgery two weeks after his most recent infection had cleared up. ●Where are the palatine, pharyngeal and lingual tonsils located? ●What lymphatic structures are often secondarily affected in tonsillitis?

Answer 74

Palatine tonsils are between the palatoglossal arch and the palatopharyngeal arch. Pharyngeal tonsils are located in the nasopharynx near the opening to the eustachian tube. Lingual tonsils are on the back of the tongue. The jugulo-digastric node would be swollen

Question 75

Vallate (circumvallate) papillae are taste receptors located where? A. On the hard palate B. On the soft palate C. In the epiglottis D. Directly anterior to the terminal sulcus E. On the posterior 1/3 of the tongue

Answer 75

D. Directly anterior to the terminal sulcus

Question 76

A 10-year-old boy was admitted to the hospital with a sore throat, earache, and high fever. On examination, he had severely swollen palatine tonsils (tonsillitis). What nerve carries the sensory input for most of the patient's symptoms? A. Superior alveolar B. Long buccal branch of V3 C. Glossopharyngeal D. Vagus E. Nasopalatine

Answer 76

C. Glossopharyngeal ## Footnote The glossopharyngeal nerve supplies most of the sensation from the palatine tonsils as well as the oral pharynx and posterior 1/3 of the tongue.

Question 77

A 32 year old male visits the dentist to have a maxillary 3rd-molar tooth removed. The extraction was very difficult. Several days later while eating, he experiences regurgitation of fluids from his oral pharynx to the nasal cavity. Explain what might have happened during the dental extraction.

Answer 77

The hamulus of the medial pterygoid plate was fractured, preventing the tensor veli palatini muscle from supporting the elevated soft palate and allowing fluid to regurgitate from the oral pharynx into the nasal cavity

Question 78

A young child suffers a debilitating condition that includes progressive degeneration of the motor axons that innervate the masseter muscle. Which of the following muscles is most likely to exhibit the same fate? A. Genioglossus B. Tensor veli palatini C. Orbicularis oris D. Levator veli palatini E. Stylopharyngeus

Answer 78

B. Tensor veli palatini (V3)

Question 79

During a mixed martial arts fight, one fighter punched his opponent in the anterior neck, resulting in a fracture of the hyoid bone. Which of the following muscles would be most directly affected by this injury? A. Palatopharyngeus B. Stylopharyngeus C. Superior pharyngeal constrictor D. Middle pharyngeal constrictor E. Inferior pharyngeal constrictor

Answer 79

D. Middle pharyngeal constrictor

Question 80

Your 56-year-old patient has dysphagia (trouble swallowing) that you believe is neural in origin. Which of the following nerves is least likely to have an effect on deglutition? A. Hypoglossal B. Recurrent laryngeal C. External laryngeal D. Mandibular division of Trigeminal E. Pharyngeal branches of vagus

Answer 80

B. Recurrent laryngeal ## Footnote The recurrent laryngeal nerve is the nerve which supplies motor and sensory innervation from the larynx. The other nerves supply muscles of the tongue (CN XII) , mastication (CN V3) and pharynx (CN X)

Question 81

What is the one important thing that runs deep to the hyoglossus muscle?

Answer 81

The lingual artery, check it...