Anatomy Exam 1

A pleomorphic adenoma is discovered in the sublingual gland of a 53-year-old patient with a long history of using chewing tobacco. He complains of some xerostomia, dryness of the mouth caused by the lack of saliva production, and discomfort resulting from the presence of a mass under his tongue. Which nerve supplies the sublingual glands? A. Facial B. Glossopharyngeal C. Hypoglossal D. Vagus E. Mandibular

A. Facial

A 15-year-old boy was attacked and severely beaten about the head. Computed tomography (CT) scans revealed a fracture of the petrous portion of the temporal bone. What is the most likely consequence of such a fracture? A. Anosmia (loss of the sense of smell) B. Bleeding from the ear C. Bleeding from the nose D. Laceration of the cavernous sinus E. Paralysis of the tongue

B. Bleeding from the ear - petrous portion of internal carotid running along this portion - auditory ossicles sit in the petrous portion of the ear

A resident performing a neurological exam wants to test the pons. Identify the reflex most likely used. A. Gag reflex B. Corneal reflex C. Vestibuloocular reflex D. Accommodation reflex E. Pupillary light reflex

B. Corneal reflex - corneal reflex tests CN V and VII = pons - accommodation and pupillary light reflexes test CN II and III = forebrain and midbrain - gag reflex tests IX and X = medulla pons = 5, 6 pon/medulla junction = 7, 8

A 22-year-old woman is referred to an otolaryngeal clinic because of recurrent rhinitis and associated stuffiness in her right nostril. On examination it is noted that the patient has slight tenderness medial to and below the medial canthus of the eye. A computed tomography (CT) scan of the head is ordered, which demonstrates a polypoid growth arising from the mucosa lining the ethmoidal air cells. The polyp is removed by functional endoscopic sinus surgery (FESS). Three weeks after the surgery the patient returns to the clinic complaining of a clear, yellow-tinged nonclotting fluid running from her nose. Damage to which of the following structures is the most likely cause of this new complaint? A. Cavernous sinus B. Cribriform plate C. Maxillary sinus D. Perpendicular plate of ethmoid E. Inferior turbinate (concha)

B. Cribriform plate - CSF running from nose = fracture of base of skull

A 17-year-old girl arrives at the emergency department with a knife wound to the scalp that is bleeding profusely. The vessels that are most likely the source of the bleeding are located in which of the following layers of the scalp? A. Aponeurotic B. Dense connective tissue C. Loose connective tissue D. Pericranium E. Skin

B. Dense connective tissue ?? Skin - epithelial tissue creating skin Connective - (dense) not a lot of extra cellular space; fibers packed tightly together - collagen (very strong) - highly vascularized Aponeurosis - (tendonis material) FLAT; attachment for occipitofrontalis muscle Loose connective tissue - lots of space between fibers; gives scalp a lot of movement ** where fluid can accumulate in injury or infection Pericranium- outer portion of skull; dense connective tissue

A 26-year-old man arrives at the emergency department after being injured in an automobile collision. He has a dry eye, and x-ray films indicate a skull fracture. Which of the following nerves is most likely damaged, causing this deficit? A. Glossopharyngeal B. Facial C. Ophthalmic D. Vagus E. Trochlear

B. Facial nerve (greater petrosal branch) - innervates lacrimal gland

An 8-year-old boy has a tonsillectomy. After the procedure, he tells his parents that the back of his tongue feels funny. An examination by his pediatrician indicates he has lost feeling and taste on the posterior third of the tongue. The nerve most likely damaged during the surgical removal of his tonsils is which of the following? A. Facial B. Glossopharyngeal C. Hypoglossal D. Lingual E. Vagus

B. Glossopharyngeal - provides sensory and taste innervation to posterior 1/3

An 18-year-old man was involved in a fistfight that resulted in a medial orbit blowout fracture of his face and a subsequent trip to the emergency department. The attending physician is worried about a nasolacrimal duct obstruction due to the location of the fracture, so he decides to run an irrigation test to determine if the duct is still patent. If fluid is irrigated through a cannula in the lacrimal punctum, where should the fluid end up draining if the duct is still patent? A. Superior nasal meatus B. Inferior nasal meatus C. Oral cavity D. Spheno-ethmoidal recess E. Middle nasal meatus

B. Inferior nasal meatus

A 42-year-old opera singer is scheduled for removal of a small mucosal lesion in the laryngeal vestibule. Which of the following nerves must be anesthetized to provide pain control for the procedure? A. Mandibular B. Vagus C. Glossopharyngeal D. Hypoglossal E. Facial

B. Vagus - provides sensory and motor innervation to larynx?

An 83-year-old man suffers a stroke to the left facial motor nucleus of the pons, resulting in the paralysis of facial nerve. Which of the following motor deficits does he likely experience? A. Mandible deviates to the left when the mouth is opened B. Right corner of the mouth droops when smiling C. Left corner of the mouth droops when smiling D. Unable to wrinkle the forehead on the right side E. Mandible deviates to the right when the mouth is opened

C. Left corner of the mouth droops when smiling

Cauliflower ear is a condition usually caused by blunt force trauma to the external ear, often experienced by boxers and wrestlers. The trauma causes the overlying cartilage to separate from the perichondrium that supplies the blood and nutrients to the external ear. Due to the lack of nutrients and blood supply, areas of the external ear die and become fibrotic, resulting in a swollen and deformed ear that looks like cauliflower. Which of the following arteries most likely loses its ability to supply part of the external ear in these patients? A. Occipital artery B. Internal carotid artery C. Superficial temporal artery D. Facial artery E. Maxillary artery

C. Superficial temporal artery

A 45-year-old man presents with loss of sensation in his lower lip, chin, and jawline. A new resident ordered at CT scan, which revealed no cortical damage. Based on the symptoms, you suspect damage to one of the cranial nerves. Identify the cranial nerve that is most likely damaged in this patient. A. CN VII B. CN IV C. CN IX D. CN V E. CN VIII

D. CN V - specifically mandibular branch

A 23-year-old man presents to the emergency department with knife lacerations to the face. One laceration is a deep wound to the superior aspect of the chin. Identify the artery most likely damaged by this lesion. A. Angular artery B. Superior labial artery C. Transverse facial artery D. Mental artery E. Buccal artery

D. Mental artery

A 55-year-old man is the unrestrained driver of a motor vehicle involved in a crash at highway speeds. He is ejected from the vehicle and sustains multiple injuries including facial trauma, pelvic fracture, and ruptured spleen. Computed tomography of his brain and skull shows fractures of the nasal bones including bilateral cribriform plate fractures. Which sense is likely to be diminished following this particular injury? A. Balance B. Hearing C. Sight D. Smell E. Taste

D. Smell

A 10-year-old girl has a cut behind her right ear. It is left untreated and she develops a bacterial infection. Which of the following lymph nodes will initially become enlarged, showing signs of the infection? A. Jugulo-omohyoid B. Lower deep cervical C. Submandibular D. Superficial cervical E. Upper deep cervical

D. Superficial cervical - occipital, mastoid, parotid lymph nodes drain to superficial cervical - superficial cervical drains to deep cervical - deep cervical drains to jugular lymphatic trunks - jugular lymphatic trunks drain to LEFT thoracic duct or RIGHT IJV/brachiocephalic junction

A 67-year-old man presents with an arterial thromboembolism that has occluded his superior thyroid artery just after its branch point from the external carotid artery. Among other symptoms, this ischemic event has resulted in hoarseness of his voice. Which of the following branches of the superior thyroid artery is most likely occluded, resulting in ischemic damage within the larynx causing the hoarseness? A. Lingual artery B. Inferior laryngeal artery C. Ascending pharyngeal artery D. Superior laryngeal artery E. Inferior thyroid artery

D. Superior laryngeal artery

A 62-year-old woman has a parotidectomy. After the procedure, she has trouble chewing her food. Tests reveal that her trigeminal nerve has not been damaged. However, innervation to which of the following muscles was damaged during the procedure? A. Temporalis B. Medial pterygoid C. Masseter D. Lateral pterygoid E. Buccinator

E. Buccinator - muscle innervated by facial nerve that may be involved in chewing - sucks cheek toward teeth - other answer choices are innervated by trigeminal nerve

A 43-year-old patient sees his doctor because of loss of bitter and sour taste on the back third of his tongue and trouble swallowing. Identify the cranial nerve most likely to be injured in this patient. A. Oculomotor (CN III) B. Accessory (CN XII) C. Facial (CN VII) D. Trigeminal (CN V) E. Glossopharyngeal (CN IX)

E. Glossopharyngeal (CN IX)

A 57-year-old man sees a neurologist for a 6-month history of significant weight loss and difficulty swallowing. On examination, he is noted to have an absent gag reflex and difficulty elevating his shoulders and turning his head against resistance. In light of the significant weight loss, the neurologist feels that this man may have a malignant brain tumor. A tumor at what cranial foramen would cause these findings? A. Foramen ovale B. Foramen rotundum C. Foramen spinosum D. Internal auditory meatus E. Jugular foramen

E. Jugular foramen - houses vagus nerve, spinal accessory nerve, and glossopharyngeal nerve

Acromegaly is a hormonal condition in which the anterior pituitary gland produced too much growth hormone, causing some bones to increase in size, namely the bones of the face, hands, and feet. This gland can be found in which of the following cranial fossae? A. Anterior cranial fossa B. Superior cranial fossa C. Posterior cranial fossa D. Inferior cranial fossa E. Middle cranial fossa

E. Middle cranial fossa - found in hypophysial fossa covered by sella turcica

A physical examination of a 3-year-old girl with recurring otitis media shows that she has a poorly draining auditory tube. This condition is caused by hypertrophy of which of the following structures? A. Lingual tonsil B. Palatine tonsil C. Palatoglossal arch D. Palatopharyngeal arch E. Pharyngeal tonsil

E. Pharyngeal tonsil (pharyngotympanic tube)

A 40-year-old man with neck pain and swelling is diagnosed with tuberculosis of the spine (tuberculous spondylitis, or Pott disease) in the cervical region. His infection has resulted in abscess formation. The pus was originally contained within the layer of deep cervical fascia that surrounds the vertebral column and its associated muscles. With time, it has spread laterally within this compartment, pointed (i.e., come to a head), and ruptured through the fascia to enter the posterior cervical triangle. There it has formed an obvious swelling on the side of the neck. Which is the layer of fascia that originally confined the abscess? A. Buccopharyngeal fascia B. Carotid sheath C. Investing fascia D. Pretracheal fascia E. Prevertebral fascia

Prevertebral fascia

After undergoing a parotidectomy, a 34-year-old man experiences redness and sweating of the temples when eating. These symptoms occur because of connections formed between the postganglionic parasympathetic fibers to the gland and nerves that supply the sweat glands of the overlying skin. Which of the following pairs of nerves is involved? Auriculotemporal-great auricular Auriculotemporal-lesser occipital Facial-great auricular Great auricular-lesser occipital Infra-orbital-great auricular

Auriculotemporal- great auricular

A tympanostomy tube placement is recommended to patients with recurrent otitis media, or infections of the middle ear. This surgical placement is recommended to prevent the accumulation of fluid in the middle ear, subsequently relieving pressure on the tympanic membrane. Which of the following structures of the middle ear is blocked in these patients? A. Round window B. Pharyngotympanic (eustachian) tube C. Oval window D. Semilunar hiatus E. Tympanic canaliculus

B. Pharyngotympanic (eustachian tube)

A 32-year-old man comes to the physician complaining of hoarseness for the past 2 weeks. On examination, one vocal fold is deviated toward the midline and does not abduct during deep inspiration. The most likely cause is damage to which of the following nerves? A. Superior laryngeal B. Recurrent laryngeal C. Internal laryngeal D. Glossopharyngeal E. External laryngeal

B. Recurrent laryngeal

A 46-year-old man has his gag reflex stimulated during a routine examination when the physician lightly swabs the area posterior to the palatine tonsil. Which cranial nerve carries the sensory (afferent) fibers that are part of this reflex? A. XII B. X C. IX D. VII E. V

C. IX - CN IX innervates sensory portion of pharynx - CN X innervates somatic motor portion of pharynx

A 63-year-old man presents with a thrombosis that is occluding his right external carotid artery. He displays symptoms of decreased blood flow to his right face, with an absent facial artery pulse in his right occipital region, the area behind his ear, his right temporal region, and the deep structures of the right face normally supplied by the maxillary artery. Based on the symptoms and vessels receiving decreased blood flow, where is the occlusion on the external carotid artery? A. Superior to the maxillary artery B. At the level of the ascending pharyngeal artery C. Just below the facial artery D. At the level of the occipital artery E. At the bifurcation of the common carotid artery

C. Just below the facial artery

A 46-year-old patient receives an injury to her eye involved in parasympathetic innervation during a surgical procedure in that region. Which of the following symptoms is most likely to occur? A. Miosis B. Hidrosis of the face C. Retraction of the upper eyelid D. Mydriasis E. Double vision

D. Mydriasis - mydriasis = dilation of pupil - if parasympathetic innervation is inhibited then pupil cannot constrict and thus pupil will be dilated

A 28-year-old man presents with recurrent sinusitis infections that have been causing severe discomfort, with headaches and pressure under his left cheek. A CT scan is indicated due to the frequency of his infections and the severity of his current infection. After analysis of this patient's CT scan, the diagnosis of sinusitis is confirmed with the visualization of a completely filled right-sided cavity corresponding to the area under his left orbit where the pressure is localized. Which of the following paranasal sinuses is most likely infected in this patient? A. Frontal sinus B. Sphenoid sinus C. Maxillary sinus D. Ethmoid sinus E. Mastoid air cells

C. Maxillary sinus

A 32-year-old man comes to the physician complaining of hoarseness for the past 2 weeks. On examination, one vocal fold is deviated toward the midline and does not abduct during deep inspiration. Dysfunction of which of the following laryngeal muscles is the most likely cause? A. Thyroarytenoid B. Transverse arytenoid C. Posterior cricoarytenoid D. Lateral cricoarytenoid E. Cricothyroid

C. Posterior cricoarytenoid ??

A 63-year-old man has thrombosis of the cavernous sinus. Three days earlier, he developed an infection after the extraction of an upper molar tooth. The most likely route through which the infection reached the cavernous sinus is through which of the following venous channels? A. Angular vein B. Inferior alveolar vein C. Pterygoid plexus of veins D. Superior ophthalmic vein E. Vertebral venous plexus

C. Pterygoid plexus of veins ??? (pterygoid plexus connects to cavernous sinus via emissary vein)

A 29-year-old man is found to have a tumor that is compressing the right hypoglossal canal at the base of the skull. Which of the following deficits would the patient most likely be displaying if the structure exiting the canal were impinged? A. Loss of blood supply to the right half of the tongue B. Loss of taste on the anterior two thirds of the tongue C. Right-sided tongue deviation when asked to protrude the tongue D. Loss of blood supply to the left half of the tongue E. Left-sided tongue deviation when asked to protrude the tongue

C. Right-sided tongue deviation when asked to protrude the tongue - IPSIlateral paralysis

Internuclear ophthalmoplegia (INO) is a medical condition that affects conjugate lateral gaze. The affected eye will display difficulty in adduction when gaze is directed in the contralateral direction (for example, if the left eye is affected, there is minimal adduction when looking to the right). Identify the nerve and muscle pair that would be responsible for abnormal eye movement. A. Oculomotor, lateral rectus B. Abducens, lateral rectus C. Optic, medial rectus D. Oculomotor, medial rectus E. Abducens, medial rectus

D. Oculomotor, medial rectus looking medially = medial rectus innervated by oculomotor

A 2-year-old girl is brought to her pediatrician because of a middle ear infection that has not resolved despite antibiotic treatment. The child now has a discharge from the ear (otorrhea), fever, and tenderness, redness, and swelling posterior to her ear. A CT scan shows that the infection has spread from the middle ear to the mastoid air cells. This infection has the potential to erode through bone and invade a dural venous sinus located just posterior to the mastoid air cells. Which dural venous sinus is this? A. Inferior sagittal sinus B. Occipital sinus C. Sigmoid sinus D. Straight sinus E. Superior petrosal sinus

C. Sigmoid sinus

A 23-year-old baseball pitcher sustained a traumatic blow to the head from a baseball that was hit directly back at him. He was immediately taken to the hospital and had a CT scan that revealed an epidural hematoma caused by the rupture of his left middle meningeal artery. On the basis of the bony anatomy of the skull and its relation to the middle meningeal artery, the baseball most likely struck which of the following locations? A. Bregma B. Asterion C. Vertex D. Pterion E. Mastoid process

D. Pterion

A 12-year-old boy is brought to the emergency department after being hit in the right eye with a stick. There is extensive swelling, and further examination shows loss of upward gaze in his right eye. Which of the following structures has most likely been injured? A. Inferior rectus muscle B. Musculus levator palpebrae superioris C. Superior rectus muscle D. Superior oblique muscle E. Trochlear nerve

C. Superior rectus muscle muscle that elevates eye is injured causing downward droop - trochlear nerve innervates superior oblique (depresses eye) - inferior rectus depresses eye - levator palpeerde superioris elevates EYELID

A 35-year-old patient presents to the emergency department after blunt force trauma to the right side of her skull. After the patient was stabilized, she underwent a neurological exam, revealing hyperacusis (louder than normal sound) of the right ear, right-sided facial paralysis, and difficulty tasting on the anterior portion of her tongue. Imaging reveals a fracture of the temporal bone that most likely severed the facial nerve. Which of the following is most likely not functioning properly and the cause of the hearing problem in this patient? A. Tensor tympani muscle B. Stapedius muscle C. Levator veli palatini D. Temporalis E. Anterior auricular muscle

B. Stapedius muscle - stapedius muscle innervated by facial nerve which dampens noise - tensor tympani innervated by mandibular nerve - temporals innervated by mandibular nerve

A 31-year-old woman has been unable to chew her food adequately since injuring the upper mandible and infratemporal fossa in an automobile collision. Examination shows malocclusion. The most likely cause of the malocclusion is disruption of which of the following nerves? A. Vagus B. Trigeminal C. Hypoglossal D. Glossopharyngeal E. Facial

B. Trigeminal - muscles of mastication - lateral and medial pterygoid are located in the infratemporal fossa

A 50-year-old man is attacked by a knife-wielding assailant. He sustains a deep laceration to the lateral aspect of his face. He is seen in the emergency department approximately 1 hour after the event. He is noted to have an approximately 4-cm long oblong gash beginning at the tragus of the left ear and progressing medially and inferior toward the left commissure of the lip. Sensation is diminished along a strip of skin medial to the laceration for about 2 cm. What is the most likely diagnosis? A. Injury to the auricular branch of the vagus nerve B. Injury to the greater occipital nerve C. Injury to the mandibular division of the trigeminal nerve D. Injury to the ophthalmic nerve E. Injury to the zygomatic branch of the facial nerve

C. Injury to the mandibular division of the trigeminal nerve

A 6-year-old child presents to the clinic after an infection of the tubal tonsils spread to his middle ear. The bacteria from the tubal tonsils need to pass through which of the following structures to infect his middle ear cavity? A. Eustachian tube B. Pharyngeal recess C. Sphenoid sinus D. Epitympanic recess E. Retropharyngeal space

A. Eustachian tube

A 46-year-old man is asked to keep his eyelids closed while the examining physician tries to open them. This procedure tests which of the following nerves? A. Facial B. Mandibular C. Maxillary D. Oculomotor E. Ophthalmic

A. Facial - innervates orbicularis oculi which closes the eye

An experienced surgeon is delicately removing an adenocarcinoma in the submandibular triangle. He dissects away the subcutaneous fat and identifies the cancerous tissue, and then identifies the local neurovascular structures that he wants to preserve in the surrounding area. The surgeon finds the facial vein and the facial artery but has trouble finding the nerve that also passes near the submandibular gland. Which of the following nerves is the surgeon likely trying to identify? A. Hypoglossal B. Facial C. Accessory D. Maxillary E. Mandibular

A. Hypoglossal contents of submandibular triangle: - submandibular nodes + glands - facial artery + vein - hypoglossal nerve CN XII

Uveitis is an inflammatory condition of the uveal coat of the eye that is often associated with systemic inflammatory disorders. Uveitis can be further specified as anterior, intermediate, posterior, or panuveitis based on the areas of the uvea affected. Which of the following structures of the uvea would most likely be affected in posterior uveitis? A. Choroid B. Iris C. Sclera D. Ciliary body E. Lens

A. Choroid - uvea = vascular layer = choroid, ciliary body, and iris - iris = anterior - ciliary body = middle - choroid = posterior

A 45-year-old man presents with a chief complaint of progressive hearing loss and dizziness. His history reveals a long career in the boxing industry, in which he sustained many blows to the head over his lifetime. You fear that he has incurred some cell loss in certain areas of his brain. Which of the following areas of cell loss would explain your patient's hearing difficulty? A. Corti ganglion B. Pterygopalatine ganglion C. Vestibular (Scarpa) ganglion D. Superior cervical ganglion E. Otic ganglion

A. Corti ganglion

A 52-year-old woman had a thyroidectomy. During ligation of the superior thyroid artery, a nerve was inadvertently cut. Which of the following laryngeal muscles is most likely paralyzed as a result of this injury? A. Cricothyroid B. Lateral cricoarytenoid C. Posterior cricoarytenoid D. Thyroartenoid E. Transverse arytenoid

A. Cricothyroid ??

A 21-year-old man sustained a laceration wound to his upper lip from a fall he had while celebrating his 21st birthday. After suboptimal care for the cut, the wound became infected as evidenced by redness, warmth to the touch, and swelling around the area of the cut. The patient believed it was a minor infection and neglected to seek medical attention. Several days following the infection, the patient presented to the emergency department demonstrating symptoms of cavernous sinus syndrome, an infection of the cavernous sinus through which passes many important structures. In your assessment of the etiology, you surmise that a retrograde infection had spread from his facial laceration to his cavernous sinus. Through which of the following structures did the infection likely spread to this patient's cavernous sinus? A. Inferior ophthalmic vein B. Maxillary vein C. Inferior sagittal sinus D. Ophthalmic artery E. Superficial temporal vein

A. Inferior ophthalmic vein ophthalmic veins can drain to facial vein, pterygoid plexus, or cavernous sinus

A 73-year-old woman presents with the following symptoms: left progressive hearing loss, unsteady gait, vertigo, and left-sided facial weakness. On physical examination, she is also found to have decreased sensation over the left side of her face. As part of her evaluation, this woman's physician orders an MRI (magnetic resonance imaging) scan, which shows a lesion consistent with an intracranial tumor. What is the most likely location of this lesion? A. Internal acoustic meatus B. Foramen ovale C. Foramen rotundum D. Hypoglossal canal E. Jugular foramen F. Superior orbital fissure

A. Internal acoustic meatus - answer is actually Cerebellopontine angle = connection of pons and cerebellum - internal acoustic meatus house CN VII and CN VIII

A 24-year-old woman has severe pain in her jaw, which she thinks resulted from excessive yawning. Physical examination indicates dislocation of the temporomandibular joint. This injury would most likely be caused by contraction of which of the following muscles? A. Lateral pterygoid B. Masseter C. Medial pterygoid D. Styloglossus E. Temporalis

A. Lateral pterygoid - depresses mandible during yawning

A 91-year-old woman suffers a stroke and is seen in the emergency department. An MRI shows damage to the right trigeminal motor nucleus. Which of the following muscles is most likely affected by the damage in this patient? A. Lateral pterygoid muscle B. Frontalis muscle C. Buccinator muscle D. Zygomaticus major muscle E. Orbicularis oris muscle

A. Lateral pterygoid muscle - this is a muscle of mastication innervated by the trigeminal nerve

A colloid cyst is a type of slow-growing non-neoplastic cyst that is found near the center of the brain. These cysts can often grow to cause obstruction of the foramen of Monro, leading to hydrocephalus. Based on this location of obstruction, in which ventricular chamber would there be a buildup of cerebrospinal fluid (CSF)? A. Lateral ventricle B. Third ventricle C. Cerebral aqueduct D. Central canal E. Fourth ventricle

A. Lateral ventricle foramen of Monroe = inter ventricular foramen = drains lateral into 3rd ventricle

After suffering a stroke, a 67-year-old woman describes symptoms localized to her right side consisting of pain along with difficulties in sensation of touch and temperature. Which of the following brain regions is most likely affected by the stroke? A. Left thalamus B. Left hypothalamus C. Basal ganglia D. Right thalamus E. Right hypothalamus

A. Left thalamus - relay center for sensory information (except olfaction)

A 42-year-old man has had severe headaches for 2 weeks. The result of a computed tomographic scan of his head shows a meningioma that is blocking the intracranial opening of the foramen rotundum. A neurological examination would most likely demonstrate a lack of response from which of the following? A. Pain receptors in the membrane of the lateral wall of the nasal cavity B. Pain receptors in the mucous membrane of the ethmoidal sinuses C. Pain receptors in the skin of the chin D. Secretory cells in the lacrimal gland E. Secretory cells in the submandibular gland

A. Pain receptors in the membrane of the lateral wall of the nasal cavity - maxillary nerve supplies mucosa of posterior nasal cavity and maxillary sinuses - exits rotundum - mandibular supplies pain receptors of chin - exits ovale - facial nerve supplies secretory cells of lacrimal and submandibular gland - exits internal acoustic meatus and stylomastoid foramen

A 20-year-old college student suffers a C3 spinal cord injury as a result of a trampoline accident. He is quadriplegic and in respiratory distress and is initially placed on a respirator. Several months later he is surgically implanted with a phrenic nerve pacemaker, which stimulates his phrenic nerve in a rhythmic pattern, resulting in contraction of the diaphragm that mimics normal breathing. At which site could a surgeon access this nerve to attach the stimulating electrode to it? A. Posterior triangle B. Middle triangle C. Anterior triangle D. Muscular triangle E. Carotid triangle

A. Posterior triangle Contents of posterior triangle: - splenius, levator scapulae, scalenes - CN XI, brachial plexus, phrenic nerve - EJV - subclavian artery

A 39-year-old patient is suffering from Sjögren's syndrome, an autoimmune disease characterized by the destruction of exocrine glands that produce tears and saliva, resulting in keratoconjunctivitis and xerostomia, respectively. She is particularly irritated by her dry eyes and wants an explanation of why this disease causes this problem. You explain to her the normal function of the lacrimal gland in the production of the tears needed to keep the eye lubricated. She asks you where this gland is located in the orbit, and you respond: A. Superolateral aspect of the orbit B. Inferomedial aspect of the orbit C. Superomedial aspect of the orbit D. Inferolateral aspect of the orbit E. Medial aspect of the orbit (caruncle)

A. Superolateral aspect of the orbit

A 42-year-old man begins to taste very hot coffee and quickly withdraws his tongue when the tip touches the hot liquid. The pain he experiences is conducted by which nerve? A. Trigeminal B. Glossopharyngeal C. Hypoglossal D. Vagus E. Facial

A. Trigeminal - mandibular nerve supplies sensory (pain) receptors to anterior tongue - facial nerve supplies taste to anterior tongue - glossopharyngeal supplies taste and sensory to posterior tongue

A 44-year-old woman is scheduled to undergo liposuction to remove deposits of adipose tissue in her neck. Injection of local anesthetic into one location will result in significant anesthesia of most of the skin of the neck. Which of the following would be the best location? At the stylomastoid foramen At the midpoint of the posterior border of sternocleidomastoid Between the anterior and middle scalene muscles Inferior to the suboccipital triangle In the infratemporal fossa

At the midpoint of the posterior border of sternocleidomastoid

A 4-week-old infant is brought to her pediatrician because of poor feeding, irritability, and frequent vomiting. Examination reveals that her head circumference falls in the 99th percentile for her age, dilated veins are easily visible in her scalp, and her anterior fontanelle is tense and bulging. After appropriate imaging studies, a diagnosis of congenital hydrocephalus is made. A physician tells the parents that as the baby gets older, without appropriate treatment, the part of the skull formed from anterior fontanelle closure would be malformed. In her notes, the physician uses the medical term for this adult skull region. Which of the following correctly describes this location? A. Asterion B. Bregma C. Lambda D. Pterion E. Vertex

B. Bregma - bregma is connection of coronal and sagittal sutures - anterior fontanella is at site of bregma - posterior fontanelle is at site of lambdoid (sagittal and lambda suture)

An 82-year-old woman develops cancer of the tongue after chewing tobacco for 35 years. Lymph nodes in which of the following areas are most likely involved in the initial spread of this tumor? A. Anterior cervical B. Deep cervical C. Pretracheal D. Submandibular E. Superficial cervical

B. Deep cervical ?? superficial drains to deep?

A 20-year-old man becomes ill with a high-grade fever, severe headache, and malaise. His physician prescribes antibiotics, but the man's condition worsens. He develops chills, nausea, vomiting, and episodes of delirium. His eyes ache and he develops an internal strabismus. The diagnosis is cavernous sinus thrombosis. Which venous structure is unlikely to seed the cavernous sinus with infectious material? A. Facial vein B. Great cerebral vein C. Superior ophthalmic vein D. Superior petrosal sinus E. The contralateral cavernous sinus

B. Great cerebral vein

To secure the airway during surgery, an anesthesiologist must pass an endotracheal tube through the vocal folds into the trachea of an anesthetized patient. The anesthesiologist visualizes the epiglottis with a laryngoscope. Where are the vocal folds and therefore the entrance to the trachea found? A. Before the epiglottis is seen B. Inferior to the epiglottis C. Lateral to the epiglottis D. Medial to the epiglottis E. Superficial to the epiglottis

B. Inferior to the epiglottis

A 23-year-old patient was admitted to the emergency department with a laceration injury to the top of the head. The injury was deep enough to penetrate the muscular aponeurotic layer of the scalp but did not affect any layer below it. Which of the following layer(s) remained before the laceration would have reach bone? A. Periosteum B. Loose connective tissue layer and periosteum C. Skin and loose connective tissue layer D. Subcutaneous connective tissue layer E. Subcutaneous connective tissue layer and periosteum

B. Loose connective tissue layer and periosteum S-C-A-L-P

A 6-year-old boy presents to the emergency department with difficulty breathing, stridor, and constellational symptoms associated with a severe acute tonsillitis. A throat (oropharynx) swab is taken, and a rapid strep test confirms an infection caused by Streptococcal pyogenes. Examination of his throat through an open mouth view reveals significantly enlarged hypertrophic tonsils that are actually contacting each other, referred to as "kissing tonsils," obstructing this child's airway. Identify the tonsils that are likely the enlarged and hypertrophied tonsils seen at the back of the patient's throat. A. Lingual tonsils B. Palatine tonsils C. Pharyngeal tonsils (adenoids) D. Tubal tonsils E. Esophageal tonsils

B. Palatine tonsils - these are the tonsils seen upon examination on either side of the uvula

A 22-year-old woman was brought to the emergency department with a severely lacerated cheek after being thrown from a horse and landing on a barbed wire fence. During the reconstructive surgery, the plastic surgeon had to repair which muscle lying immediately lateral to the vestibule of the oral cavity? A. Temporalis B. Occipitofrontalis C. Buccinator D. Masseter E. Medial pterygoid

C. Buccinator - buccinator deeper than masseter --> sucks cheek into teeth

A 45-year-old man complains of facial paralysis. Physical examination shows a partial ptosis of the left eyelid, weeping from the left eye, drooping of the left corner of the mouth, and failure of that corner of the mouth to respond when the man smiles. Injury to which of the following cranial nerves would produce the symptoms in this patient? A. Trigeminal (CN V) B. Abducens (CN VI) C. Facial (CN VII) D. Glossopharyngeal (CN IX) E. Vagus (CN X)

C. Facial (CN VII) - innervates orbicularis oculi, lacrimal gland, and zygomatic major/minor/ muscles of facial expression

A 10-year-old boy presents with a rare aggressive soft tissue tumor in the orbit of the eye that requires excision. During the procedure the surgeon unintentionally nicks the ophthalmic artery. She immediately clamps the ophthalmic artery to control the bleeding. Which of the following areas will temporarily lose blood supply as a result of this clamping? A. Upper lip B. Ear C. Forehead D. Cheek E. Lower eyelid

C. Forehead

A 31-year-old woman presents with a throbbing pain and a feeling of pressure in her forehead above her eyebrows. Examination reveals an infection of the sinus in this region. Which paranasal sinus is most likely infected, causing pain in the region the patient describes? A. Ethmoid sinuses (ethmoid air cells) B. Maxillary sinus C. Frontal sinus D. Sphenoid sinus E. Spheno-ethmoidal recess

C. Frontal sinus

A 57-year-old man who has smoked cigarettes for 40 years has a small lump in the submental triangle. On palpation, the lump appears to be a single hard nodule; it is mobile and not tethered to skin. The preliminary diagnosis is a secondary malignancy of a submental lymph node. A primary malignancy would most likely be located in which of the following areas? A. Base of the tongue B. Deep cervical nodes C. Gingiva of the lower incisors D. Maxillary sinus E. Submandibular gland

C. Gingiva of the lower incisors

A 20-year-old man presents with loss of taste sensation on the anterior two thirds of his tongue. He also reports a feeling of dryness in the mouth (xerostomia). Examination reveals that secretion from the submandibular and sublingual salivary glands is greatly reduced. Taste on the posterior one third of the tongue remains intact, as does general sensation on the entire tongue. No other defects are noted. What nerve injury would account for this clinical picture? Chorda tympani injury in the middle ear Facial nerve injury at the internal acoustic meatus Glossopharyngeal nerve injury at the jugular foramen Hypoglossal nerve injury near the hyoid bone Injury to the lingual nerve near the foramen ovale

Chorda tympani injury in the middle ear

A 54-year-old man is undergoing a routine physical examination when the physician discovers that the man has an enlarged thyroid. An MRI scan shows a mass in the left lobe of the thyroid. During the thyroidectomy, the recurrent laryngeal nerve is injured. Which of the following intrinsic muscles of the larynx would be spared? Cricothyroid Lateral crico-arytenoid Posterior crico-arytenoid Transverse arytenoid Vocalis

Cricothyroid

A 29-year-old woman sustains a traumatic head injury after falling from a 20-foot cliff face while rock climbing without a harness. Fortunately, she was not climbing alone, and her friends were able to contact emergency services relatively quickly. After being transported by the emergency helicopter to the hospital, she underwent a diagnostic CT scan followed by a MRI of the skull. These scans revealed the presence of a penetrating lesion of the white matter tract that connects the two hemispheres of her cerebrum, also known as "split-brain." Once the patient is stabilized, the attending neurologist explains to the patient's family that some functions of the brain that are lateralized, like language and facial recognition, may show some deficits because the two hemispheres of the brain can no longer communicate. Which of the following white matter tracts of the brain is most likely severed in this patient? A. Fornix B. Optic tract C. Olfactory tract D. Corpus callosum E. Meyer's loops (optic radiations)

D. Corpus callosum - commissural tract

A 12-year-old patient presents with facial burns that have blistered after extended sun exposure. The attending physician diagnoses them as second-degree burns. The grading of burns is dependent on the depth of the burn relative to the layers of the skin. A first-degree burn is considered a superficial burn, while a second degree burn is slightly deeper involving another layer of the skin. What layer(s) of skin have likely been damaged in this patient? A. Epidermis B. Epidermis and hypodermis C. Hypodermis and dermis D. Epidermis and dermis E. Epidermis, dermis, and hypodermis

D. Epidermis and dermis

An 83-year-old man is admitted to the hospital with acute onset of right hemiplegia. Tests show that this is due to a large embolus in the middle cerebral artery. This embolus most likely originated in which of the following structures? A. Left subclavian artery B. Left external carotid artery C. Right internal jugular vein D. Left internal carotid artery E. Right internal carotid artery

D. Left internal carotid artery - internal carotid artery branches into middle and anterior cerebral arteries - left side of brain responsible for right side of body

A 65-year-old man who is right handed has had a stroke. Although his speech is fluid and melodic and he articulates well, he makes little sense and uses few meaningful words. He is unable to name common objects and does not seem to understand the physician's questions. He has diminished sensation in his right arm and hand. This patient's stroke has most likely affected which of the following arteries? A. Anterior cerebral B. Callosomarginal C. Lenticulostriate D. Middle cerebral E. Posterior cerebral

D. Middle cerebral - affecting wernickes area (lateral portion of parietal/temporal lobe)

An 18-year-old man presents to the emergency department because of epistaxis (nosebleed) and blood draining down the throat after being hit in the face by a hockey puck. The physician determines that the nose is fractured, but he is more concerned about stopping the bleeding. Further examination reveals that this is a posterior epistaxis, meaning that one of the vessels in the posterior aspect of the nasal cavity is actively bleeding. Which of the following vessels is most likely ruptured in this patient? A. Septal branch of the superior labial artery B. Greater palatine artery C. Posterior superior alveolar artery D. Sphenopalatine artery E. Anterior ethmoidal artery

D. Sphenopalatine artery

A 32-year-old man comes to his physician because he is unable to look laterally. On examination, he is asked to look medially and then downward. Which of the following muscles is being tested? A. Orbicularis oculi B. Superior rectus C. Inferior rectus D. Superior oblique E. Inferior oblique

D. Superior oblique FIRST adduct THEN look down = oblique muscle working - inferior rectus moves eye down and medially from starting position - orbicularis oculi closes eyelid - superior rectus moves eye up and medial - superior oblique moves eye down and laterally - inferior oblique moves eye up and laterally

Cycloplegia is a condition in which the ciliary muscle is paralyzed, resulting in a loss of visual accommodation. Identify the condition in which a patient with cycloplegia would have the most difficulty seeing clearly. A. Viewing objects at a distance B. Abducting the eye C. Abducting and depressing the eye D. Viewing close objects E. Adducting the eye

D. Viewing close objects - ciliary muscle unable to contract = suspensory ligaments contracted pulling lens thin = distant vision okay - unable to thicken lens for near vision - moving the eyeball is unaffected

To decompress the stomach, a nasogastric tube must be passed and connected to suction. The tube goes into one of the nares, traverses the nasopharynx into the esophagus, and then passes into the stomach. To avoid trauma to the nasopharynx, in what direction should you angle the tip of the tube as you pass it into the nares? Directly posterior, along the floor of the nasal cavity Directly cephalad, toward the top of the head Medially, toward the nasal septum Laterally, away from the nasal septum Medially for 2 cm, then laterally

Directly posterior, along the floor of the nasal cavity

A 65-year-old woman comes to the emergency department complaining of difficulty swallowing and pain in the back of her throat. She had a fishbone "stuck in her throat" about 5 days earlier. She has had subjective fevers and malaise. On physical exam a submucosal mass is visible protruding into the back of her throat. A lateral radiograph of the neck reveals anterior displacement of the esophagus and trachea by a mass in the posterior pharynx. This mass contains air bubbles. What is the most likely diagnosis? A. Abscess in the sheath of omohyoid muscle B. Abscess in the carotid sheath C. Abscess under the deep cervical fascia D. Abscess in the visceral portion of pretracheal layer of cervical fascia E. Abscess in the retropharyngeal abscess space

E. Abscess in the retropharyngeal abscess space

A 5-year-old girl presents with symptoms of frequent headaches, nausea, vomiting, and sleepiness that have been gradually been getting worse over the past month. The patient's mother also reports a notable decrease in her child's visual acuity over this time period. Physical exam of the patient reveals homonymous visual field defects and papilledema. Upon further investigation, a brain MRI shows a tumor involving a structure located in the left lateral ventricle that is causing increased cerebrospinal fluid (CSF) production. Based on the anatomical location and presentation of the tumor, which of the following structures is the tumor most likely involving? A. Third ventricle B. Fornix C. Superior sagittal sinus D. Anterior cerebral artery E. Choroid plexus

E. Choroid plexus

A 12-year-old boy has a bacterial infection causing inflammation of the tonsillar tissue superior to the opening of the auditory tube. Spread of bacteria from this infection is most likely to move toward which group of lymph nodes? A. Superficial cervical B. Submental C. Submandibular D. Posterior auricular E. Deep cervical

E. Deep cervical

A 77-year-old woman complains that food no longer tastes like it used to. A thorough evaluation by a neurologist examines each step in the sensory pathway mediating taste from the anterior two thirds of the tongue. What nerve may be damaged? A. Mandibular B. Hypoglossal C. Glossopharyngeal D. Vagus E. Facial

E. Facial

A 35-year-old man presents to the emergency department with a fractured mandible after a bar fight. After the mandibular reconstruction surgery, the patient is noted to have loss of sensation in his lower lip. After further testing, it is determined that the patient has damage to the mandibular branch of his trigeminal nerve. Which of the following symptoms would also likely fit this diagnosis? A. Loss of sensation of the upper lip B. Ability to swallow is diminished C. Ability to forcefully close the eyes is diminished D. Ability to raise the corner of the mouth is diminished E. Loss of sensation in the tip of the tongue

E. Loss of sensation in the tip of the tongue

A 26-year-old man is brought to the emergency department after a high-speed car crash in which he suffered head trauma. A CT scan of the head shows a basilar skull fracture involving the foramen rotundum. Identify the structure that would most likely be damaged due to injury to the foramen rotundum. A. Carotid artery B. Middle meningeal artery C. Mandibular nerve D. Maxillary artery E. Maxillary nerve

E. Maxillary nerve - carotid artery = carotid canal - middle meningeal artery = spinosum - maxillary artery turns into meningeal artery at spinosum - mandibular nerve = ovale

A 47-year-old man presented with complaints of headache and blurred vision. Initial examination was inconclusive. He returned several days later with ptosis, diplopia, and nuchal rigidity. CT scans revealed an isolated infection of one of the sinuses that appears to have eroded through the walls of the sinus, endangering the cavernous sinus, pituitary, optic nerves, optic chiasm, and meninges. Which of the following sinuses is most likely affected in this patient? A. Anterior ethmoidal sinuses B. Frontal sinuses C. Mastoid air cells D. Maxillary sinuses E. Sphenoid sinuses

E. Sphenoid sinuses - these lie most posterior

A 52-year-old woman arrives at the emergency department after being injured in an automobile collision. She is in respiratory distress and cannot be intubated because the vocal ligaments are fully adducted. A midline artificial airway must be created. An incision between which of the following structures will allow a rapid and safe entrance into the airway of this patient? A. Fourth tracheal ring and jugular notch B. Hyoid bone and thyroid cartilage C. Second and third tracheal rings D. Third and fourth tracheal rings E. Thyroid cartilage and cricoid cartilage

E. Thyroid cartilage and cricoid cartilage

A 56-year-old woman has surgery to remove a large brain tumor compressing a nearby neurological structure. After the surgery, she has a loss of pain sensation on the anterior part of the tongue. The sensory loss suggests that the tumor was most likely compressing which of the following nerve? A. Facial B. Vagus C. Glossopharyngeal D. Hypoglossal E. Trigeminal

E. Trigeminal **somatic sensory innervation to anterior ⅔ of tongue - mandibular branch of trigeminal nerve** - facial nerve supplying taste to anterior ⅔ - glossopharyngeal supply taste and somatic sensory to posterior ⅓ - vagus supplying taste all over) - hypoglossal supplying motor innervation to the tongue

A 57-year-old man sustains facial trauma during an altercation. Examination reveals bruising around the left orbit with subconjunctival hemorrhage. The pupils are equal, round, and appropriately reactive. Eye movements are normal in all directions except up, producing diplopia on upward gaze. The eye on the injured side does not move upward to follow a target moved by the examiner. Computed tomography shows an orbital floor fracture on the left, with soft tissue within the fracture site. Which of the following is the most likely explanation? Entrapment of the superior oblique muscle at the fracture site Entrapment of the inferior rectus muscle at the fracture site Entrapment of the lateral rectus muscle at the fracture site Entrapment of the medial rectus muscle at the fracture site Entrapment of the inferior oblique muscle

Entrapment of the inferior rectus muscle at the fracture site ???? inferior rectus muscle is caught between bone and thus the muscles moving the eye up can't overcome this force ????

During extraction of an impacted last lower molar tooth, a patient suffers damage to the nerve that travels between the medial pterygoid muscle and mandible and below the molar. When anesthesia wears off, the patient still reports lack of general sensation on half the tongue ipsilateral to the molar tooth that was extracted. This nerve contains which of the following functional components? General somatic afferent (GSA) fibers, special visceral afferent (SVA) fibers, general visceral efferent (GVE) fibers GSA fibers, special visceral efferent (SVE fibers) general visceral afferent (GVA) fibers GVA fibers, GVE fibers, SVE fibers GVE fibers, GVA fibers, GSA fibers SVA fibers, general somatic efferent (GSE) fibers, GVA fibers

General somatic afferent (GSA) fibers, special visceral afferent (SVA) fibers, general visceral efferent (GVE) fibers - glossopharyngeal nerve providing taste, parotid gland innervation, and sensory innervation to the tongue

A 55-year-old woman complains of bone pain and has suffered several pathological bone fractures. She is diagnosed with primary parathyroidism and is scheduled for exploratory surgery with resection of abnormal glands. During the operation the surgeon is unable to locate the inferior parathyroid glands in their usual location. He searches for ectopic parathyroid tissue based on his knowledge of the embryological origin of the parathyroids. Which structure is derived from the same pharyngeal pouch as the inferior parathyroids and is a likely location for ectopic parathyroid tissue? Anterior two thirds of tongue Larynx Palatine tonsil Thymus Thyroid

Thymus

While driving an all-terrain vehicle, a 19-year-old man is injured by a low hanging branch, receiving a horizontal blow across the anterior aspect of the neck (a "clothesline" injury) at the level of the C5 vertebra. He develops dyspnea (difficulty in breathing) and dysphonia (difficulty in speaking). Which structure is most likely to have been injured by a blow at the C5 level resulting in the observed symptoms? A. Hyoid bone B. Internal laryngeal nerve C. Isthmus of the thyroid gland D. Thyroid cartilage E. Trachea

Thyroid cartilage - thyroid cartilage covers larynx and trachea - hyoid aids in swallowing

You are performing a neurologic examination on a 43-year-old patient that recently had a cranial mass resected near the internal opening of the right jugular foramen. Based on the location of the surgery near the jugular foramen, you plan to test the function of cranial nerve XI (CN XI). Identify the physical exam finding that would most likely be observed if there was damage to this nerve. Weakness when superiorly shrugging the left shoulder against resistance Difficulty swallowing Inability to hear your fingers rubbing together near the right ear Weakness when superiorly shrugging the right shoulder against resistance Inability to hear your fingers rubbing together near the left ear

Weakness when superiorly shrugging the right shoulder against resistance