Test

Question 1

Patient suffers penetrating knife wound that paralyzed his right diaphragm, which blood vessels are likely lacerated?

Answer 1

Diaphragmn is innervated by the phrenic nerve.

The transverse cervical (superior)

And suprascapular

Cross over the phrenic nerve

Question 2

Relative positions fyi

Answer 2

Carotid sheath is directly lateral to the retropharyngeal space

Internal laryngeal enters the thyrohyoid membrane.

sympathetic trunk is medial to vagus

Question 3

An infant has few small retinal hemmorhages. Diagnoses is shaken baby syndrome. What is the cause?

Answer 3

Tearing of the bridging veins leading to a subdural hemorrhage

Question 4

Tumor increases CSF in third ventricle. What could be obstructed?

Answer 4

Cerebral aqueduct (sylvia)

Question 5

When told to look ahead, patients eye is abducted and depressed. What other symptom?

Answer 5

Ptosis of upper eyelid (levator palpebrae)

Question 6

Unilateral dislocation of the mandible. What is true in the patient?

Answer 6

The mandibulqr condyle anterior the articular tubercle

Question 7

What would you observe in your examination of a patient with otosclerosis in the left temporal bone?

Answer 7

Vibrating fork in the midline would be heard from the ipsilateral side of conductive hearing loss.

Vibrating fork near the left external ear canal would not be heard if the vibration is too low to be heard against the left mastoid process.

Question 8

What do each of these muscles do?

Vocalis, posterior cricoarytenoid, lateral cricoarytenoid, cricoarytenoid, stylohyoid

Answer 8

Vocalis - relaxes the vocal folds

Posterior cricoarytenoid - abducts vocal folds

Lateral cricoarytenoid - adducts vocal folds via medial rotation of the vocal process.

Cricoarytenoid - tilts thyroid cartilage anteriorly which lengthens the vocal cord

Stylohyoid - lifts the hyoid bone for production of high notes

Question 9

Patient has hyperacusis, paralysis of facial muslces, diminished taste but can still cry (fucked up) where is lesion

Answer 9

Distal to the greater petrosal nerve branch off the genu

Question 10

Stenosis of sphenopalatine foramen can result in…

Answer 10

Reduction of blood flow to the mucosa lining the posterior nasal septum

Question 11

Would a lesion of the mandibular nerve passing through the foramen ovale affect taste?

Answer 11

No because the chorda tympani joins the lingual nerve distal to this lesion

Question 12

What causes a unilateral cleft lip and unilateral cleft primary palate

Answer 12

Incomplete fusion of the maxillary prominences and intermaxillary segment of the medial nasal prominences

Question 13

Patient has mass in anterior neck midline and mass moves with protrusion of tongue (hypoglossal- genioglossus)

Why?

Answer 13

Thyroglossal cyst

Question 14

Someone lacks neural crest migration into first pharyngeal arch. What is likely underdeveloped?

Answer 14

Facial bones - first pharyngeal arch mesenchyme forms much of the viscerocranium.

Question 15

Improper fusion of lateral lingual swellings…

Answer 15

Results in bifid tongue

Question 16

A patient has ptosis of the upper eyelid. Constriction of the pupil is fine. What lesion could cause this?

Answer 16

Any of the cervical ganglion that carry sympathetics.

Question 17

Your patient has a fixed dilated pupil. What is the likely cause?

Answer 17

Since the pupil is dilated, there is nothing wrong with sympathetics and therefore can not be lesion of the ciliary ganglion. This is affecting the parasympathetics so oculomotor only. An uncal herniation, herniation of the temporal lobe trhgou hthe tentorial notch pushing the oculomotor against the brain stem, is the likely culprit

Question 18

A high CSF pressure in the lateral ventricle of 200 mm H2O and CSF pressure in the lumbar subarachnoid space of 200 mm H2O indicates what?

Answer 18

Communicating hydrocephalus. The CSF is not being reabsorbed into the sinus via the arachnoid granulations.

Question 19

A patient exhibits medial strabismus of the right eye. What are two possible causes?

Answer 19

So this must be compression of the abducens nerve.

1. Aneurysm of the internal carotid running in the cavernous sinus because it is directly adjacent the abducens nerve.
2. Aneurysm of the Anterior Inferior Cervical Artery at its origin from the vertebral artery.

Question 20

What runs through the petrotympanic fissure and what does it connect?

Answer 20

It connects the middle ear cavity to the infratemporal fossa.

The chorda tympani of cranial nerve 7 goes through this fissure to join the lingual nerve.

Question 21

A patient’s mandible deviates to the left upon OPENING the mouth. What could be causing this?

Answer 21

Spasm of the right lateral pterygoid muscle

Question 22

Secretion from which glands can be affected by a middle ear infection?

Answer 22

Secretion from:

Submandibular gland and sublingual gland

Parotid gland (glossopharyngeal nerve of the tympanic plexus)

NOT lacrimation because the genu is at the boundary of inner and middle ears. So the greater petrosal nerve has come off by then.

Question 23

What provides sensation and blood supply to the piriform recess.

Answer 23

Sensation: internal laryngeal nerve senses food in the recess

Blood supply: superior and inferior thyroid arteries.

Question 24

Patient has blood and CSF leaking from the nose. What is a cause of this?

Answer 24

Fracture of the ethmoid bone (CSF) and lesion of a branch of the opthalmic artery (blood)

Question 25

Where does the nasolacrimal duct drain into?

Answer 25

The inferior meatus

Question 26

What nerve transmits the pain of an ethmoidal sinusitis?

Answer 26

Nasociliary nerve.

Question 27

The mucosa of the epiglottis is derived from which arch with which cranial nerve?

Answer 27

Laryngeal cartilage - pharyngeal arch 4 You know superior laryngeal nerve of vagus is responsible for everything above the vocal folds which includes epiglottis.

Question 28

The infant lacks a philtrum but has a primary palate. What structure was affected?

Answer 28

The medial nasal prominence of the intermaxillary segment responsible for the philtrum. The medial nasal prominence still come together to form a primary palate.

Question 29

What runs with the superior thyroid artery? What enters the thyrohyoid membrane.

Answer 29

With the superior thyroid artery is the external laryngeal nerve. The internal laryngeal nerve with the Superior Laryngeal Artery.

Question 30

The right maxillary artery is obstructed immeediately proximal to entering the pterygomaxillary fissure. Which arteries can have retrograde blood flow?

Answer 30

Nasal branches of the sphenopalatine artery Infraorbital artery Descending palatine artery Lesser palatine artery

Question 31

What provides sensation from the mucosa covering the conus elasticus?

Answer 31

The reccurent laryngeal nerve.

Question 32

A patient has weakness in turning his head to the left against resistance. What other symptom of head movement would be seen?

Answer 32

That is the right sternocleidomastoid/accessory nerve. The trapezius is the other thing that is innervated by the accessory. That would be tilting his head to the right against resistance.

Question 33

When the left cornea is touched, only the left eye blinks. What can you say with certainty?

Answer 33

There is a lesion of the right facial nerve.

Question 34

Muscles of mastication are innervated by the mandibular division. However, what specific branch innervates the pterygoids and masseter?

Answer 34

Inferior alveolar nerve.

Question 35

Ligation of the superior thyroid artery can damage a nerve leading to what symptom regarding the larynx?

Answer 35

You can damage the external laryngeal nerve which travels with the superior thyroid artery. This will damage the cricothyroid muscle leading to a defect in tensing the vocal folds.

Question 36

A lesion of the structures lying on the promontory of the middle ear cavity can also result in loss of what?

Answer 36

Secretion of the parotid gland.

Question 37

What do the aortic arches 4 and 6 form?

Answer 37

Aortic arch IV forms the right subclavian and the aortic arch on the LEFT. Aortic arch VI forms the ductus arteriosis and the pulmonary artery --ON THE LEFT> This is why the left reccurent laryngeal nerve needs to loop under because it gets caught in the ductus arteriosis and pulmonary artery connection.

Question 38

What does lymphocyte do? What do monocytes do? What does neutrophil do?

Answer 38

1. Involved in immune system 2. Monocytes are precursors to macrophages. They are the largest circulating leukocytes - They produce CSF which spurs formation of specific lines of developing (Colony Forming Unit) 3. Neutrophil - phagocytoses bacteria

Question 39

What does basophil and eosinophil do?

Answer 39

Basophil - releases histamine and other shit Eosinophil - attacks parasites and reduces inflammation created by the products of basophils and mast cells.

Question 40

What are the branches of the maxillary artery after it enters the pterygopalatine fossa?

Answer 40

The infraorbital artery traveling through the inferior orbital fissure The sphenopalatine artery after passing through the sphenopalatine foramen The Descending palatine artery after going through the greater palatine foramen.

Question 41

How do sympathetics reach the nasal cavity and palate?

Answer 41

The DEEP petrosal nerve carries the postganglionic sympathetics through the pterygoid canal to the pterygopalatine ganglion and then it disperses all over.

Question 42

Describe the pathway for lacrimation

Answer 42

The greater petrosal nerve comes off at the genu > > it combines with DEEP to form the nerve of the pterygoid canal > it goes up the pterygopalatine nerves > it joins the maxillary nerve and travels with its branch the zygomatic nerve > it then travels through the communicating branch that allows the connection between the zygomatic and the lacrimal nerve > it reaches the lacrimal gland.

Question 43

How does the greater petrosla nerve go from the inner ear to the pterygopalatine fossa?

Answer 43

It starts in the inner ear. Then it goes through the hiatus for the greater petrosal nerve. Then its in the middle cranial fossa. To get into the pterygopalatine fossa it goes through the foramen lacerum Enters the pterygoid canal and reaches the PG.

Question 44

The sinus that lies in the margin of the tentorium cerebelli and runs from the posterior end of the cavernous sinus is affected and joins the transverse is infected. What is this sinus?

Answer 44

The superior petrosal sinus.

Question 45

What goes through the inferior orbital fissure? (3 things)

Answer 45

1. inferior opthalmic vein 2. Infraorbital nerve (V2) 3. Zygomatic nerve (V2)

Question 46

What three nerves superiorly are not in the common ring tendon

Answer 46

1. Frontal nerve 2. Lacrimal nerve 3. Trochlear nerve.

Question 47

A patient can move his eyeballs normally and see distant objects but cannot focus on near objects. This condition could arise from what?

Answer 47

Lesion of the short ciliary nerves and ciliary ganglion. (constrictor pupillae and cilliary muscle)

Question 48

The tonsillar artery which supplies the palatine tonsils is a branch of which artery?

Answer 48

The facial artery