[REVIEW TEST] HEAD and NECK

Question 1

Answer 1

• 1 C
  
  • The external laryngeal nerve innervates the cricothyroid muscle (major tensor)
• 2 B
  
  • The internal laryngeal nerve accompanies the superior laryngeal nerve

Question 2

Answer 2

• 3. D

The glossopharyngeal nerve supplies innervation to the mucosa of the upper pharynx

Question 3

Durin surgery on a 56 year od man for a squamous cell carcinoma of the enckm a surgeon notices profuse bleeding from the deep cervical artery. Which of the following arteries must be ligated imemdiately to stop bleeding?

• A. Inferior Thyroid Artery
• B. Transverse cervical artery
• C. Thyrocervical trunk
• D. Costocervical trunk
• E. Ascening cervical artery

Answer 3

• D
  
  • The surgeoun should litigate the costocervical trunk because it divides into the deep cervical and superior intercostal arteries

Question 4

Answer 4

• 5 E
  
  • Descends on the superficial surface of the anteror scalene muscle
  • passes into thorax posterior to the subcclavian vein
  • anterior to the subclavian artery and lateral to the common carotid artery
• 6 A
  
  • innervated by the external nasal branch of the nasociliary branck of the ophthalmic division of the trigeminal nerve

Question 5

Answer 5

• 7 A
  
  • The external laryngeal branch of the superior laryngeal nerve supplies the
    
    • cricothyroid
    • inferior pharyngeal constrictor muscle

Question 6

A 44 year old man with “crocodile tears syndrome” has spontaneous lacrimation during eating because of misdirection of regenerating autonomic nerve fibers. Which of the following nerves has been injured?

• A. Facial nerve proximal to the geniculate ganglion
• B. Auriculotemporal nerve
• C. Chorda tympani in the infratemporal fossa
• D. Facial nerve at the stylomastoid foramen
• E. Lacrimal nerve

Answer 6

A

• lacrimation during eating is caused by a lesion of the facial nerve proximal to the geniculate ganglion resuting from misdirection of regenerating parasympathetic fibers

Question 7

Answer 7

• 9 C
  
  • Postganglionic parasympatetic fibers origanting the pterygopalantine ganglion innervate glands in the palate and nasal mucosa
• 10 C
  
  • `due to paralysis of the orbicularis oculi, which closes the eyelid

Question 8

Answer 8

• 11 D
  
  • Superior petrosal sinus
    
    • runs from the cavernous sinus to the transverse sinus aong the attached margin of the tentorium cerebelli
  • Straight sinus
    
    • runs along the line of attachment of the falx cerebri to the tentorium cerebelli
  • Inferior sagital sinus
    
    • free edge of the falx cerebri
  • Sphenoparietal sinus
    
    • lies along posterior edge of the lesser wing of the sphenoid bone
  • Cavernous sinus
    
    • lies on each side of the sella turcica and the body of the sphenoid bone
• 12 E
  
  • th abducens nerve results in internal strabismus (medial deviation)

Question 9

Answer 9

• 13 C
  
  • bialteral severance of the vagus nerve causes a loss of reflex control of circulation beacause of an increase in heart rate and blood pressure
• 14 C
  
  • Epidural hemorrhage
    
    • middle meningeal artery
  • Subarachnoid hemorrhage
    
    • cerebral arteries and vein
  • Subdural
    
    • bridging cerebral veins as they pass from the brain surface into one of the venous sinus
  • Subpial
    
    • small vessels of the pia and brain tissue
  • Cranial dural sinus
    
    • contain venous blood

Question 10

Answer 10

• 15 E
  
  • Preganglionic neurons of the parasympathetic nervus sytem are located in the brain stem (cranial outflow) and sacral spinal cord segements S2-S4 (sacral outflow)
  • Preganglionic sympathetic neurons are located in the thoracic and lumbar spinal cord
• 16 A
  
  • the anterior 2/3 of the tongue is innervated by the lingual nerve, a branch of the mandibular division of the trigeminal nerve (CN V)
  • The posterior 1/3 of the tongue is innervated by the glossopharyngeal

Question 11

A 67 year old woman comes to her physician complaining of visual loss. her magnetic resonance imaging scan shows an enlarged pituitay gland that lies in the sella turcica, immediately posterior and superior to which of the following stuctures?

• A. Frontal sinus
• B. maxillary sinus
• C. ethmoid air cells
• D. mastoid air cells
• E. Sphenoid sinus

Answer 11

E

• The pituitay gland lies in the hypophyseal ossa of the sella turcica of the sphenoid bone, which lies immediately posterior and superior of the sphenoid sinus and medial to the cavernous sinus

Question 12

Answer 12

• 18 C
• 19 E

Question 13

Answer 13

• 20 E
  
  • The superior thyroid artery is accompanied by the externeak karyngeal nerve, which innervates the cricothyroid muscle
• 21 B
  
  • Cavernous sinus thrombophlebitis is an infectious inflammation of the sinus that may produce meningitis, papilledema, exophthalmos and opthaloplegia

Question 14

A 53 year old woman s diagnosed as having a pituitary tumor. If the tumor is large enough, she could exhibit whch of the following disorders?

• A. Blindness
• B. Bitemporal hemianopia
• C. right nasal hemianopia
• D. Left homonymous hemianopia
• E. Binasal hemianopia

Answer 14

B

• lesion sof the optic chiasma by a pituitary tumor in bitemporal hemianopia resulting in the nasal field of vision of both eyes

Question 15

Answer 15

• 23 D
  
  • posterior cricoarytenoid muscle is the only muscle that abducts the vocal cords during quiet breathing
• 24 B
  
  • The oblique arytenoid and aryepiglottic muscles tilt the arytenoid cartilages and approximate them, assisting in clossing off the larynx and preenting food from entering the larynx and trachea

Question 16

Answer 16

• 25 D
  
  • The veins of the brain are diect tributaries of the dural venous sinuses
• 26 D
  
  • When the parasympathetic fiber to the eyeball are stimulated, the pupil constricts and the ciliary muscle contracts, resulting in a thicker lens and enhanced vision for near objects (accomodation)

Question 17

Answer 17

• 27 D
  
  • The tympanic nerve or jacobson’s nerve is a branch of the glossopharyngeal nerve
  • contains preganglionic parasympathetic fibers
  • forms tympanic plexus on the medial wall of the middle ear with sympathetic fibers
• 28 B
  
  • the middle ear cavity is separated from the middle cranial fossa by the tegmen tympani

Question 18

Answer 18

• 29 D
  
  • the cranial dura in the middle cranial fossa is innervated by the maxillary and mandibular divisions of the trigeminal nerve
  • The dura in the anterior cranial fossa is innervated by the opthalmic division of the trigeminal nerve
• 30 D
  
  • spindle shaped dilatationof the origin of the ICA
  • pressoreceptor
  • at the origin of the ICA
  • innervated by caortid sinus branch of the glossopharyngeal nerve and nerve to the carotid bodyof the vagus nerve

Question 19

During a game, a 26 year old baseball player is hit in the head by a baseball, which fractures the optic canal. Which of the ff structures is most likely to be damaged?

• A. Optic nerve and opthalmic vein
• B. Opthalmic vein and ophthalmic nerve
• C. Opthalmic artery and optic nerve
• D. Opthalmic nerve and optic nerve
• E. Opthalmic artery and opthalmic vein

Answer 19

C

• The optic canal transmits the opric nerve and opthalmic artery
• The opthalmic nerve and opthalmic vein enter the orbit through the superior orbital fissure

Question 20

Answer 20

• 32 D
  
  • the digastric posterior belly is innervated by the facial nerve
  • the digastric anterior belly is innervated by the trigeminal nerve
• 33 B
  
  • the tensor tympani is innervated by the trigeminal nerve, and the stapedius is innervated by the facial nerve

Question 21

Answer 21

B

When the pupil remains small in a dimly lit rooms it is an indication that postganglionic sympathetic fibers that originate from the superior cervical ganglion and innervate the dilator puppilae (radial muscles of the iris)

Question 22

Answer 22

C

The afferent limb of the pharyngeal (gag) reflex is a pharngeal branch of the glossopharyngeal nerve, whereas the vagus nerve mediates the efferent limb

Question 23

Answer 23

• 36 C
  
  • damage to the parasympathetic ciliary ganglion and parasympathetic fibers in the short ciliary nerve impairs the ability to focus on close objects
• 37 D
  
  • The abducens nerve enters the orbit through the superior orbital fissure and the common tendinous ring

Question 24

Answer 24

• 38 A
  
  • The styloid process provides attachments for the stylohyoid, styloglossus and stylopharyngeus muscles
  • the stylohyoid is innervated by the facial nerve
  • styloglossus is innervated by the hypoglossal nerve
  • stylopharyngeus is innervated by the glossopharyngeal nerve
• 39 C
  
  • The vagus nerve innervates the musculus uvulae. A lesion of the vagus nerve causes deviation of the uvula toward the opposite side of the injury

Question 25

A high school basketball player experiences a sudden difficulty in breathing and is brought to an emergency department. When a low tracheotomy is performed below the isthmus of the thyroid, which of the following vessels may be encountered? * A. Inferior thyroid artery * B. Inferior thyroid vein * C. Costocervical trunk * D. Superior thyroid artery * E. Right brachiocephalic vein

Answer 25

B * The inferior thyroid veins drain the thyroid gland, descend in front of the thyroid gland, and enter the brachiocephalic veins

Question 26

Answer 26

* 41 C * the transverse cervical nerve turns around the psoterior border of the SCM and innervates the skin of the anterior cervical triangle. * 42 C * Th posterior ethoidal sinus opens into the superior nasal meatus * The maxillary, frontal, and anterior and middle ethmoidal sinuses drain into the **middle nasal meatus**

Question 27

Answer 27

* 43 D * A lesion of the hypoglossal erve causes deviation of the tongue toward the injured side on potrusion * 44 D * The abducens nerve, which innervates the lateral rectus muscle runs through the ,iddle cavernous sinus

Question 28

A young boy with a tooth abscess from a longstanding infection suffers damage of the lingual nerve as it enters the oral cavity.Which of the following structures contain cell bodies of the injured nerve fibers * A. Geniculate and otic ganglia * B. trigeminal an submandibular ganglia * C. Trigeminal and dorsal root ganglia * D. geniculate and trigeminal ganglia * E. Geniculate and pterygopalatine ganglia

Answer 28

D The **lingual nerve** is joined by the chorda tympani in the infratemporal fossa. Therfore, the lingual nerve contains **GSA fibers** whose cell bodies are located in the **trigeminal ganglon** and **special somatic afferent or taste fibers** that have cell bodies located in the **geniculate ganglion**

Question 29

Answer 29

* 46 E * The optic canal transmits the opthalmic artery and optic nerve * The opthalmic nerve, opthalmic vein, and oculomotor and trochlear nerves enter the orbit through the superior orbital fissure * 47 A * A CT scan through the cricothyroid ligament shows the inferior laryngeal nerves, which are the terminal portion of the recurrent laryngeal nerves above the lower border of the cricoid cartilage

Question 30

Answer 30

* 48 E * The oculomotor nerve carries parasympathetic fiber to the ciliary and sphincter pupillae ciliary muscles * 49 C * SVE nerve fibers originate from the first branchial arch (trigeminal), the second arch (facial), the third arch (glossopharyngeal), and the fourth and sixt arches (vagus) * Nerves that supply the muscles of the eyeball (oculomotor, trochlear, and abducens) and tongue (hypoglossal) are not of banchiomeric origin

Question 31

During surgery for a malignant parotid tumor in a 69 year old woman, the main trunk of the facial nerve is lacerated, Which of the following muscles is paralyzed * A. Masseter muscle * B. Stylopharyngeus muscle * C. Anterior belly of the digastric muscle * D. Buccinator muscle * E. Tensor tympani

Answer 31

D The buccinator muscle is innervated by the facial nerve

Question 32

Answer 32

* 51 C * the nasal septum is fomed primarily by the vomer, the perpendicular plate of ethmoid bone and the septal cartilage * 52 D * A loss of voice is due to an injury to the recurrent laryngeal nerve of the vagus nerve * Glossopharyngeal nerve, vagus nerve, accessory nerve exit the skull throgh the **jugular foramen**

Question 33

Answer 33

* 53 C * The carotid sheath contains the **internal jugular vein**, **vagus nerve** and **common and internal carotid arteries** * 54 D * The costocervical trunk gives rise to * deep cervical * superior intercostal

Question 34

A 20 year old guard at the gate of thhe 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 nerve * B. Lacrimal nerve * C. Nasociliary nerve * D. Zygomatic nerve * E. Oculomotor nerve

Answer 34

C * The afferent limb of the corneal refle arc is the nasociliary nerve * Efferent limb is the facial nerve

Question 35

Answer 35

* **56 D** * The mandibular division of the trigeminal nerve does not lie in the wall of the cavernou sinus * Occulomotor, abducensm trochear, and opthalmic nerves do * **57 B** * The enlarged phharyngeal tonsil is called an adenoid. * An adenoid obstruct passage of ai from the nasal cavities throught the choanae intothe nasopharynx, thus causing difficulty in nasal breathing and phonation. * Tubal tonsil = estachian tonsil * palatine tonsil = faucial tonsil * Submerged tonsil = palatine tonsil

Question 36

Answer 36

D The internal auditory meatus transmits the facial and vestibulocochlear nerves The jugular foramen transmits the glossopharyngeal, vagus and accessory nerves, and th internal jugular vein

Question 37

After ingesting a toxic substance found in her friend's home, a 12 year old girl is unable to close her lips. Which of the following muscles may be paralyzed? * A. Levator labii superioris * B. Zygomaticus minor * C. Orbicularis oculi * D. Lateral pterygoid * E. Depressor labii inferioris

Answer 37

C

Question 38

Answer 38

* 60 C * The greater petrosal nerve carries parasympathetic (preganglionic) fiber, which are secretomotor fibers, to the lacrimal glands and mucous glands in the nasal cavity and palate * 61 E * The nerve of the pterygoid canal (viridian nerve) contains taste (SVA) fibers from the palate, GVA fibers, postganglionic sympathetic fibers and pregaglionic parasympathetic fibers

Question 39

Answer 39

* 62 C * efferent limb: parasympathetic preganglionic fibers in the **oculomotor nerve**, parasympathetic fibers and ganglionic cells in the ciliary ganglion, parasympathetic postganglionic fibers in te **short ciliary nerves** * Afferent limb: **optic nerves** * 63 D * the secretomotor fibers to the lacrimal gland are parasympathetic fibers that run in the * facial * greater petrosal * viridian * maxillary * zygomatic * zygomaticotemporal * lacrimal

Question 40

Answer 40

* 64 D * The **infraglottic cavity** extends from the rima glottidis to the lower border of the cricoid cartilage * **Rima glottidis** is the space between the vocal folds and arythenoid cartilage * **Vestibule** extends from the laryngeal inlet to the vestibualr folds * **Ventricle** extends between the vestibular fold and the vocal fold * **Piriform recess** in the wall of the laryngopharynx lateral to the arytenoid * 65 B * The spinal accessory nervesupplies the SCM and trapezius, which are not invovled in the act of swallowing

Question 41

Answer 41

* 66 A * The first pharyngeal arch develops into muscles of mastication, mylohyoid, digastric anterior bellym tensor veli palatini, maxilla, mandible, malleus, incus, zygomatic bone, temporal bone, palatine bone, vomer and sphenomandibular ligament * 67 C * The lateral pterygoid muscles opens the mouth by depressing the jaw

Question 42

Answer 42

D Levator palpebrae superioris muscle opens the eye by elevating the upper eyelid.

Question 43

Answer 43

* 69 C * The maxillary nerve runs through the **foramen rotundum** * the opthalmic nerve runs through the **supraorbital fissure** * mandibular nerve passes through the **foramen ovale** * optic nerve pass through the **optic canal** * trochlear nerve passes through the **superior orbital fissure** * 70 B * The chorda tympani nerve contains preganglionic parasympathetic fibers for secretion of submandibular gland

Question 44

Answer 44

* 71 D * occur with contraction of the ciliary muscles and is mediated by parasympathetic fibers running within the oculomotor nerve * 72 A * The **first** pharyngeal pouch gives rise to the auditory tube and middle ear cavity. * The **second** pouch forms the palatine tonsil * **third** pouch gives rise to the inferior parathyroid gland and thymus * **Fourth** pouch develops into the superior parathyroid gland and ultimobranchial body of the thyroid

Question 45

* **73.** Which structure lies lateral to the lateral wall of the nasal cavity and inferior to the floor of the orbit * **74.** Middle ear infection may spread into which structure * **75**. Which structure has numerous small cavities and lies between the orbit and the nasal cavity? * **76**. Which structure would spread infection into the anterior part of the middle nasal meatus through the frontonasalduct * **77.** CSF is formed by vascular choroid plexus in which structure?

Answer 45

* 73 C * maxilalry sinus * 74 B * mastoid air cells throug the antrum and aditus * 75 D * Ethmoid sinus * 76 E * Frontal sinus * 77 A * ventricles

Question 46

* **78.** When the nerve on the right side is damaged, which structure is deviated to the left side * **79.** A lesion of the first cervical spinal nerve would cause functional impairment of which structure * **80.** Tears drain through the nasolacrimal duct into the space below with structure * **81.** Which structure runs along the line of attachment of the falx cerebri to the tentorium cerebelli * **82.** Tumor of which structure can be removed through the transphenoidal approach following the septum of the nose through the body of the sphenoid

Answer 46

* 78 E * musculus uvulae is innervated by the vagus nerve * 79 C * geniohyoid muscle is innervated by the first cervical nerve through the hypoglossal nerve * 80 B * inferior nasal meatus below the inferior concha receives the nasolacrimal duct * 81 D * Straight sinus runs along the line of the attachment of the falx cerebri to the tentorium cerebelli * 82 A * pituitary gland can be reached through the transphenoidal approach following the septum of the nose through the body of the sphenoid

Question 47

* **83**. Whih structure mediates the afferent limb of the pupillary light reflex * **84**. Which structure is formed by the perpendicular plate of the ethmoid bone, vomer, and septal cartilage * **85.** Which structure may be paralyzed as a result of infection of the cavernous inus * **86.** Which structure pierces the dural roof of the cavernous sinus between the anterior and middle clinoid processes * **87.** Which structure may be obliterated by a pituitary tumor

Answer 47

* 83 B * optic nerve * 84 A * nasal septum * 85 D * lateral rectus is innervated by abducens nerve, which runs through the cavernous sinus * 86 E * Internal carotid artery * 87 C * suprasellar cistern

Question 48

* **88.** Aneurysm of which artery causes a perichiasmal lesion that may cause nasal hemianopia * **89.** Large tumor in the foramen magnum may decrease blood flow in which artery * **90.** Blockage if which artery may cause ischemia of the midbrain and the temporal and occipital loves of the cerebrum * **91.** ischemia of the posterior inferior surface of the cerebellum is caused by obstruction of which artery * **92.** Lesion of which artery may cause oxygen deficiency to the medial surface of the frontoal and parietal lobe of the brain

Answer 48

* 88. D * Internal carotid artery * 89. B * basilar artery is formed by the union of 2 vertebral arteries at the lower border of the pons * 90. A * posterior cerebral artery * 91. E * posterior inferior cerebellar artery * 92. C * Anterior cerebral artery supplies the medial surface of the frontal and parietal of the cerebrum