Head and Neck - All Questions

a

16. Following radical resection of a primary tongue tumor, a 72-year-old patient has lost general sensation on the anterior two-thirds of the tongue. This is probably due to injury to branches of which of the following nerves? (A) Trigeminal nerve (B) Facial nerve (C) Glossopharyngeal nerve (D) Vagus nerve (E) Hypoglossal nerve

b

16. A 42-year-old woman noticed that her right upper eyelid was drooping and her right pupil was constricted (see the given photo). She goes to her physician where a thorough examination revealed ptosis, miosis, anhydrosis, flushing of her face, and narrowing of the palpebral fissure (the slit between the upper and lower eyelids) on the right side of the patient. Which of the following structure is most likely damaged in this patient? (A) Superior division of the oculomotor nerve (B) Superior cervical ganglion (C) Nerve of the pterygoid canal (D) Ciliary ganglion (E) Ophthalmic division of trigeminal nerve

b

16. A 9-year-old girl with a history of strep throat has her palatine tonsils surgically removed. She returns to the hospital 3 days later with a high fever and chest pain. A physician orders a CT scan, which revealed spread of infection into the superior mediastinum. What is the most likely route for this infection to descend through the neck to reach the superior mediastinum? (A) Parapharyngeal space (B) Retropharyngeal space (C) Buccal space (D) Carotid sheath (E) Suprasternal space

c

1. A 38-year-old man has had thyroid surgery to remove his papillary carcinoma. The external laryngeal nerve that accompanies the superior thyroid artery is damaged during the surgery. This injury could result in a severe impairment of function of which of the following? (A) Relaxing the vocal cords (B) Rotating the arytenoid cartilages (C) Tensing the vocal cords (D) Widening the rima glottidis (E) Abducting the vocal cords

b

1. A 59-year-old man with a 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) Anterior belly of digastric (B) Lateral pterygoid (C) Masseter (D) Medial pterygoid (E) Temporalis

c

1. After asking a 47-year-old woman to open her mouth wide and say Ah, the physician notes deviation of the uvula to the left side and asymmetry in the elevation of the soft palate, with the right side of the palate sagging, as noted in the figure. What specific nerve is most likely damaged? (A) Left glossopharyngeal nerve (B) Left vagus nerve (C) Right vagus nerve (D) Left hypoglossal nerve (E) Right hypoglossal nerve

b

10. A 24-year-old man came to his physician with a history of chronic maxillary sinusitis. A computed tomography (CT) scan reveals a soft-tissue mass in the superior aspect (or roof) of the right maxillary sinus. Functional endoscopic sinus surgery (FESS) was performed to biopsy the mass. Postoperatively, the patient experiences paresthesia and numbness of the skin of the right inferior eyelid and upper lip. Which nerve was most likely damaged during the surgery? (A) First division of trigeminal nerve (B) Second division of trigeminal nerve (C) Third division of trigeminal nerve (D) Zygomatic branch of facial nerve (E) Buccal branch of facial nerve

c

10. A 33-year-old woman develops Bell's palsy. She must be cautious because this can result in corneal inflammation and subsequent ulceration. This symptom results from which of the following conditions? (A) Sensory loss of the cornea and conjunctiva (B) Lack of secretion of the parotid gland (C) Absence of the corneal blink reflex (D) Absence of sweating on the face (E) Inability to constrict the pupil

c

10. 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 tracheotomy to enable the man to breathe. Which subcutaneous structure was most likely cut during this procedure? (A) Cricoidcartilage (B) Thyrohyoid membrane (C) Cricothyroid membrane (D) Trachealrings (E) Isthmus of thyroid gland

C

100 Which of the following nerves passes through the foramen magnum? a) Hypoglossal b) Vagus c) Spinal accessory d) Glossopharyngeal e) None of these

D

101 The anterior facial vein communicates with and may infect the cavernous sinus via the a) angular vein b) ophthalmic veins c) pterygoid plexus d) all of the above e) none of the above

A

102 in removing a tumor from the deep part of the parotid gland, the surgeon must be aware of structures lying within it. These include the a) external carotid artery b) external jugular vein c) five branches of facial nerve d) facial artery e) stylomandibular ligament

A

103 Structures important in the suspension of the eyeball in the orbital cavity include the a) orbital fascia (= Tenon's capsule) b) superior rectus muscle c) levator palpebrae muscle d) suspensory ligament of the lens e) greater tarsal plate and muscle

D

104 With respect to the lacrimal apparatus, a) the lacrimal gland has a single duct, opening at the medial corner of the eye b) the nasolacrimal duct opens into the middle nasal meatus c) the lacrimal gland receives secretory innervation from the ciliary ganglion d) the lacrimal sac lies in a hollow of the maxillary and lacrimal bones e) the lacrimal sac is anterior to the medial palpebral ligament

B

105 Earache may be caused by oral lesions. Which of the following nerves would probably be responsible in this referred pain pathway? a) Greater auricular b) Auriculotemporal c) Auricular branch of facial d) Auricular branch of vagus e) None of the above nerves

C

106 Which of the following statements is true? a) At birth, the middle ear ossicles and mastoid air cells are fully developed b) Paralysis of the facial nerve may lead to hypersensitivity to sounds (hyperacusis) because the tensor tympani muscle is denervated c) Middle ear infection could affect the functions of both the submandibular and the otic ganglion d) The long process of the incus attaches to the tympanic membrane e) The chorda tympani lies on the stapes bone

B

107 A fracture through the horizontal plate of the ethmoid bone with meningeal tearing could lead to a) detachment of the falx cerebri b) loss of sense of smell (anosmia) c) cerebrospinal fluid leakage into the orbital cavity c/) loss of normal nasolacrimal sac drainage e) none of the above

C

108 In the infant skull a) the anterior fontanelle is normally closed by 1 year of age b) there is no mastoid process but the motor branch of the facial nerve is superficial and protected by the styloid process c) there is no diploic layer d) no paranasal sinuses have been formed at the time of birth e) the tympanic bone is a complete ring at birth

C

109 Thrombosis of a cavernous sinus may result from spread of infection from the so-called 'danger area' of the face. This part of the face includes the a) occipital region b) chin c) upper lip d) parotid region e) tragus and pinna of the ear

e

11. A 38-year-old woman comes to her family physician complaining of repeatedly tripping and double vision when descending stairs. While testing the eye movements in a cranial nerve examination, she was unable to move her left eye inferiorly when she followed the physician's finger to her right side, as seen in the given figure. What specific nerve is most likely damaged? (A) Left oculomotor nerve (B) Right oculomotor nerve (C) Left abducent nerve (D) Right abducent nerve (E) Left trochlear nerve

d

11. 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) Straight sinus (B) Inferior sagittal sinus (C) Sphenoparietal sinus (D) Superior petrosal sinus (E) Cavernous sinus

b

11. A 7-year-old boy was kicked in the right side of his head during a sledding accident. He arrived at the ER with no loss of consciousness but complained of a severe headache and vomiting. A computed tomography (CT) scan revealed a biconvex hyperdense extraaxial collection of blood, indicated by the arrows in the figure. What blood vessel is the most likely source of the bleed? (A) Superficial temporal artery (B) Middle meningeal artery (C) Superior cerebral veins (D) Cerebral arterial circle (of Willis) (E) Middle cerebral artery (MCA)

D

110 In excising tumors of the parotid gland, surgeons must be aware of structures embedded within it (either superficially or deep). These include the a) stem of the vagus nerve b) internal carotid artery c) otic ganglion d) origin of the maxillary artery e) accessory nerve (spinal part)

a

111 The otorhinolaryngologist can locate which of the following between the palatoglossal and palatopharyngeal folds? a) Palatine tonsil b) Pharyngotympanic tube c) Valleculae d) Adenoids e) Piriform recess

c

112 A wrestler, with a change of heart, fondly massages the neck of his opponent; the opponent falls on to the canvas and is counted out. Surprised, he feels the victim's pulse and finds it to be very slow. He is now relieved because he remembers that a) the carotid sinus lies at the carotid bifurcation, situated usually at the level of the cricoid cartilage b) the sinus is a chemoreceptor and responds to chemical changes in the blood c) the sinus, when stimulated, sends afferent impulses via the ninth nerve which initiates a reflex via the tenth nerve, causing slowing of the heart d) the cardioinhibitory reflex is mediated by the twelfth nerve on the afferent and the ninth nerve on the efferent side e) he was supposed to lose and not win this fight

B

113 With advancing age, the internal carotid artery narrows and reduces the blood supply to the brain. This can be diagnosed by noting an increased flow through the collateral anastomosis formed by the a) superior and inferior thyroid arteries b) branches of the ophthalmic artery and the facial artery c) branches of the ophthalmic artery and the superior thyroid artery d) facial and lingual arteries e) superficial temporal and occipital arteries

D

114 The branches of the external carotid artery include the a) supraorbital b) greater palatine c) inferior thyroid d) superior thyroid e) ophthalmic

C

115 The carotid body a) is located at the lower end of the common carotid artery b) is innervated by the ansa cervicalis c) lies at the level of the upper border of the thyroid cartilage d) is important in the regulation of the blood pressure e) all of the above are true

B

116 Enlargements of the thyroid gland commonly occur. a) The enlargements are commonly in an upward (superior) direction b) The enlargement is commonly in an inferior direction into the superior mediastinum, bringing it into relationship with the branches of the left brachiocephalic vein c) The enlarged gland moves on swallowing as it is attached to the hyoid bone d) The enlarged gland may compress the cervical sympathetic chain as it lies in the adjacent carotid sheath e) The enlarged gland may compress the vagus nerve which lies anteriorly

C

117 The sternomastoid muscle a) covers the upper end of the carotid sheath b) receives its motor supply from the third, fourth and fifth cervical nerves c) turns the face towards the opposite shoulder should a contracture (torticollis) develop d) has the external jugular vein running through it e) has three heads interiorly

A

118 A tumor of the apex of the lung often invades the neck of the first rib and the structures crossing it. These include the a) stellate ganglion b) second thoracic nerve c) second intercostal vein d) vagus nerve e) phrenic nerve

E

119 Branches of the vagus (tenth cranial nerve in the neck a) may slow the heart b) take part in the swallowing mechanism c) may be implicated in earache d) may be implicated in the cough reflex e) all are true

e

12. A 34-year-old man in a bar fight suffers a knife wound that severs the abducens nerve proximal to its entrance into the orbit. Which of the following conditions results from this injury? (A) Ptosis of the upper eyelid (B) Loss of the ability to dilate the pupil (C) External strabismus (lateral deviation) (D) Loss of visual accommodation (E) Internal strabismus (medial deviation)

d

12. A 68-year-old woman with thyroid cancer undergoes a total thyroidectomy. Postoperatively, the surgeon notes hoarseness and dysphonia, or altered voice production, while conversing with the patient. What nerve was damaged during the thyroidectomy? (A) Lingual branch of glossopharyngeal nerve (B) Accessory nerve (C) Superior laryngeal nerve (D) Recurrent laryngeal nerve (E) Hypoglossal nerve

a

12. A newborn infant exhibits labored, gasping breathes and unusual vocal tones when crying. Thorough examination reveals the child has malformed vocal folds due to displaced attachments of the vocal ligaments. Which of the following structures is most likely defective in this condition? (A) Arytenoid cartilages (B) Cricoid cartilage (C) Epiglottic cartilage (D) Corniculate cartilages (E) Cuneiform cartilages

C

120 The accessory nerve—spinal portion — a) may be seen in the anterior triangle of the neck b) supplies strap muscles (infrahyoid muscles) c) is important in abducting the shoulder d) is involved in tongue sensation, posterior two-thirds e) is involved in tongue sensation, anterior one-third

D

121 You may often be puncturing the subclavian vein to insert a catheter. You should find this vein a) between the scalenus anterior and medius muscles b) above and lateral to the subclavian artery pulsation c) immediately above the horizontally running inferior belly of the omohyoid d) anterior to the scalenus anterior muscle and behind the clavicle e) deep to the lower trunk of the brachial plexus

C

122 The cervical sympathetic chain a) contains fibers which cause constriction of the pupil of the eye b) receives white rami from C5-8 c) sends gray rami to accelerate the heart d) is located in the carotid sheath e) joins its partner at the base of the skull to form a single ganglion

E

123 The hypoglossal nerve a) lies lateral to the carotid arteries b) crosses the loop of the lingual artery c) is a purely motor nerve d) hooks anteriorly around the occipital artery e) all the above are true

B

124 A patient has a swelling of the parotid gland and cannot close his eye; this combination is diagnostic of cancer of the gland. He cannot close his eye because of paralysis of the a) third nerve b) seventh nerve c) cervical sympathetic chain d) ophthalmic division of the fifth nerve e) masseter muscle

B

125 Persistent hiccup (spasmodic diaphragmatic contraction) may be relieved by blocking the phrenic nerve, if you know where It is. It lies a) on the scalenus medius muscle b) on the scalenus anterior muscle c) on the longus colli muscle d) superficial to the carotid sheath e) within the carotid sheath

D

126 On examining the nose, the doctor finds a discharge pooling in the middle nasal meatus. It may originate from a) the maxillary sinus b) the ethmoidal sinus c) the sphenoid sinus d) a and b only e) all of these

c

13. A 24-year-old man falls from his motorcycle and lands in a creek. Death may result from bilateral severance of which of the following nerves? (A) Trigeminal nerve (B) Facial nerve (C) Vagus nerve (D) Spinal accessory nerve (E) Hypoglossal nerve

b

15. A 60-year-old female yodeler with a 43-year history of smok- ing complains of pain during swallowing and hoarseness in her voice. A fiberoptic endoscopy reveals a laryngeal squamous cell carcinoma at the location identified by the arrow within the given figure. What structure is most likely affected by this laryngeal cancer? (A) Infraglottic cavity (B) Vocal folds (C) Vestibular folds (D) Laryngeal vestibule (E) Epiglottis

b

13. A 67-year-old man presents with shingles on his left forehead, upper eyelid, and bridge of the nose as shown in the figure. Shingles (or herpes zoster) is caused by the varicella zoster virus, which causes chickenpox in children and young adults. After the initial chickenpox outbreak, this virus usually resides latent in sensory ganglia in the body for many years. When a patient is immunocompromised, this virus can cause shingles unilaterally along the infected nerve's dermatome distribution. What sensory ganglion is most likely affected in this patient? (A) Otic ganglion (B) Trigeminal ganglion (C) Superior cervical ganglion (D) Ciliary ganglion (E) Submandibular ganglion

d

13. A baby girl presents with a disproportionately wide skull with a short occipitofrontal diameter, as depicted in the given surface shaded CT reconstruction. What cranial suture most likely closed prematurely to result in this cranial deformity? (A) Sphenosquamous (B) Sphenoparietal (C) Lambdoid (D) Coronal (E) Sagittal

a

14. A 13-year-old girl visits her pediatrician complaining of loss of sensitivity in her lower eyelid, the skin below her right eye, and in her upper lip and teeth. Which of the following sites is the most likely location for the nerve lesion responsible for these signs and symptoms? (A) Foramen rotundum (B) Foramen spinosum (C) Superior orbital fissure (D) Foramen ovale (E) Opticcanal

a

14. A 22-year-old man receives a stab wound in the left anterior cervical region, at the C2 vertebral level. The wound was 3 cm deep and located anterior to the sternocleidomastoid muscle (SCM) and superior to the greater horn of the hyoid bone. During a postoperative examination, the patient displays dysarthria, or difficulty speaking. Which of the following structures is most likely damaged? (A) Hypoglossal nerve (B) Accessory nerve (C) Mandibular division of trigeminal nerve (D) Lingual branch of glossopharyngeal nerve (E) Roots of the brachial plexus

c

14. A 25-year-old man is involved in an automobile accident and slams his head into a concrete wall of a bridge. His computed tomography (CT) scan reveals that the middle meningeal artery has ruptured but the meninges remain intact. Blood leaking from this artery enters which of the following spaces? (A) Subarachnoid space (B) Subdural space (C) Epidural space (D) Subpial space (E) Cranial dural sinuses

a

15. A 12-year-old boy suffers a fracture of the floor of the right side of the middle cranial fossa during an automobile accident. Subsequent physical examination reveals he is devoid of emotional tearing on the ipsilateral side. Which of the following nerves is most likely damaged? (A) Greater petrosal nerve (B) Lesser petrosal nerve (C) Deep petrosal nerve (D) Lacrimal nerve (E) Chorda tympani nerve

E

15. A 27-year-old paratrooper lands on a pine tree. Consequently, preganglionic parasympathetic nerves leaving the central nervous system are lacerated. Which of the following structures contain cell bodies of the damaged nerve fibers? (A) Cervical and sacral spinal cord (B) Cervical and thoracic spinal cord (C) Brain stem and cervical spinal cord (D) Thoracic and lumbar spinal cord (E) Brain stem and sacral spinal cord

b

17. A 23-year-old man was punched in the left eye in a bar fight, which resulted in periorbital edema and ecchymosis. In the ER, the man refuses to open his eye, and when his eyelids are pried opened he exhibits vertical diplopia, specifically when asked to look up. A coronal CT reformat image reveals asymmetry in the left orbit and the superior antrum of the maxillary sinus, apparent in the given image. What is the most likely cause of the patient's diplopia? (A) Paralysis of lateral rectus muscle (B) Entrapment of inferior rectus muscle (C) Detachedretina (D) Paralysis of superior oblique muscle (E) Damage to infraorbital nerve

e

17. A 32-year-old man presents with unilateral paralysis of the mus- cles of mastication on the right side. This condition has resulted in facial asymmetry as noted in the figure. Though he is uncomfortable with his appearance and has difficulty when chewing his food, his chief complaint is his difficulty swallowing (dysphagia). What muscle is most likely involved in his dysphagia? (A) Sternohyoid (B) Stylohyoid (C) Cricothyroid (D) Stylopharyngeus (E) Mylohyoid

e

17. A 67-year-old woman comes to her physician complaining of visual loss. Her magnetic resonance imaging (MRI) scan shows an enlarged pituitary gland that lies in the sella turcica, immediately posterior and superior to which of the following structures? (A) Frontal sinus (B) Maxillary sinus (C) Ethmoid air cells (D) Mastoid air cells (E) Sphenoid sinus

d

18 A 23-year-old female professional student wakes up with a facial nerve (CN VII or Bell) palsy. What muscle will continue to function despite this affliction? (A) Zygomaticus major (B) Levator labii superioris (C) Buccinator (D) Masseter (E) Platysma

c

18. A 27-year-old woman with green eyes comes to her physician with noted asymmetry in her pupils (as seen in the figure). Her right pupil is abnormally dilated, and on examination, the right eye is slow to respond to light stimuli. Her visual acuity is not impaired, and no other signs and symp- toms are noted. What structure is most likely affected in this patient? (A) Superior cervical ganglion (B) Optic nerve (C) Oculomotor nerve (D) Trochlear nerve (E) Abducent nerve

c

18. After having a tonsillectomy, a 57-year-old man with a long history of chewing tobacco use is unable to detect taste on the posterior one-third of his tongue. Which of the following nerves has most likely been injured? (A) Internal laryngeal nerve (B) Lingual nerve (C) Glossopharyngeal nerve (D) Greater palatine nerve (E) Chorda tympani

e

19. A 14-year-old boy hits his head on the asphalt road after falling off his skateboard. His radiograph reveals damage to the sella turcica. This is probably due to fracture of which of the following bones? (A) Frontal bone (B) Ethmoid bone (C) Temporal bone (D) Basioccipital bone (E) Sphenoid bone

c

19. A newborn baby girl is unable to move her head to the right, even when her pediatrician tries to assist the movement, as seen in the photo. Her range of motion in the neck is limited in rotation and lateral bending, and her head posture is abnormally tilted toward the right and her chin is elevated and turned toward the left side. What muscle is most likely responsible for the baby's abnormal range of movement and head posture? (A) Platysma (B) Trapezius (C) Sternocleidomastoid (D) Masseter (E) Digastric

d

19. To differentiate between idiopathic unilateral paralysis of the muscles of facial expression (Bell palsy) and a herpes zoster infection of CN VII, the physician must look for small her- petic 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) Temporal and parietal region of the scalp (C) Upper lip and cheek of the face (D) Auricle of the external ear (E) Bridge and tip of the external nose

b

2. A 27-year-old woman with a goiter comes to the hospital for surgical treatment. The surgeon must ligate the superior laryngeal artery before surgically resecting the goiter, so care must be taken to avoid injury to which of the following nerves? (A) External laryngeal nerve (B) Internal laryngeal nerve (C) Superior laryngeal nerve (D) Hypoglossal nerve (E) Vagus nerve

b

2. A 59-year-old man went to his doctor unable to close his right eye. The physical examination also revealed asymmetry in his smile and an inability to wrinkle the right side of his forehead, as seen in the figure. What cranial nerve is affected in this patient? (A) Trigeminal nerve (B) Facial nerve (C) Glossopharyngeal nerve (D) Vagus nerve (E) Hypoglossal nerve

c

2. A 64-year-old male professional angler is diagnosed with a skin melanoma above his right eyebrow after years of exces- sive sun exposure. His dermatologist removes this cancerous lesion, but the doctor needs to rule out possible metastasis. What group of lymph nodes would his physician first check for possible spread of the cancer? (A) Deep cervical (B) Retroauricular (C) Parotid (D) Submental (E) Submandibular

d

20. A 37-year-old man presented with decreased emotional tear- ing on the right side and intermittent headaches. Magnetic resonance images (MRIs) revealed a facial nerve schwannoma 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

d

43. Following a penetrated injury in the submandibular triangle, the tongue of a 45-year-old patient deviates to the left on protrusion. Which of the following nerves is injured? (A) Right lingual nerve (B) Left lingual nerve (C) Right hypoglossal nerve (D) Left hypoglossal nerve (E) Left glossopharyngeal nerve

e

20. The nerve accompanying the superior thyroid artery may be damaged during an operation on the thyroid gland. Which of the following functional defects may result from this injury? (A) Loss of sensation above the vocal cord (B) Loss of lateral rotation of the arytenoid cartilages (C) Paralysis of the vocalis muscle (D) Lack of abduction of the vocal cord (E) Decreased tension of the vocal cord

a

20.A professional student finds out she has a perfect score on the anatomy portion of her board examination and her muscles of facial expression produce a long anticipated smile. What muscle is assisting her in elevating her labial commissure bilaterally to smile? (A) Zygomaticus major (B) Zygomaticus minor (C) Levator labii superioris (D) Buccinator (E) Orbicularis oris

b

21. A 37-year-old patient has an infectious inflammation of the dural venous sinus closest to the pituitary gland and a secondary thrombus formation. Which of the following is the most likely site of infection? (A) Straight sinus (B) Cavernous sinus (C) Superior petrosal sinus (D) Sigmoid sinus (E) Confluence of sinuses

c

21. A 57-year-old woman presents with right unilateral facial paralysis and dizziness. During an examination, the physician also notes a loss of hearing on the right side. An MRI of the patient's head reveals a brain tumor, as noted by the asterisk in the figure. Based upon the patient's presentation and MRI, where is the tumor located? (A) Foramen rotundum (B) Foramen ovale (C) Internal acoustic meatus (D) Facial canal (E) Stylomastoid foramen

d

21. A physician noticed a keyhole appearance of the right pupil in a 21-year-old woman characteristic of a defect of the iris known as coloboma, as seen in the photo. When asked about her affected eye, the patient responds that she was born with the condition. What is the most likely cause of this coloboma of the iris? (A) Traumatic damage to the sphincter muscle of the pupil (B) Interruption of neural crest cell migration (C) Persistent pupillary membrane (D) Failure of fusion of the retinal fissure (E) Lack of fusion of inner and outer layers of the optic cup

c

22. A 3-year-old girl presents with headache, vomiting, and papilledema. A sagittal MRI of the patient's head reveals a large craniopharyngioma, or a tumor arising from the remnants of Rathke pouch, as noted in the figure. This suprasellar tumor, located above the diaphragm sellae, is compressing the pituitary gland. Given the location and size of this tumor, what visual disturbances are likely to be seen in this patient? (A) Monocular blindness (B) Binasal hemianopsia (C) Bitemporal hemianopsia (D) Right homonymous hemianopsia (E) Left homonymous hemianopsia

b

22. A 53-year-old woman is diagnosed as having a pituitary tumor. If the tumor is large enough, she could exhibit which of the following disorders? (A) Blindness (B) Bitemporal (heteronymous) hemianopia (C) Right nasal hemianopia (D) Left homonymous hemianopia (E) Binasal hemianopia

e

22. A 62-year-old male factory worker went to his doctor complaining of a progressive hearing loss. Audiometric tests reveal an inability to detect high-frequency sound waves, but the rest of his hearing scores within the normal range. What is the most likely location of injury for this sensorineural hearing loss? (A) Tympanic membrane (B) External acoustic meatus (C) Hair cells in the apex of the cochlea (D) Hair cells located in the middle of the cochlea (E) Hair cells in the base of the cochlea

c

23. A 4-year-old girl presents with nausea, vomiting, papilledema, and a headache, which is more severe when she wakes up in the morning. A sagittal T1-weighted MRI reveals a medulloblastoma, outlined in the image, in the posterior cranial fossa. Its location has compressed the 4th ventricle, impeding the flow of cerebrospinal fluid (CSF) from the 3rd ventricle via the cerebral aqueduct, indicated by the black arrow. The MRI shows massive dilation of the lateral and 3rd ventricles, shallow cortex, and effaced sulci within the cerebral hemispheres. Which of the following selections describes this condition? (A) Dandy-Walkersyndrome (B) Chiari malformation (C) Noncommunicating hydrocephalus (D) Congenital communicating hydrocephalus (E) Acquired communicating hydrocephalus

e

23. A patient damages the cranial nerve indicated by the arrow in the figure. What signs or symptoms would be evident in a patient with this nerve lesion? (A) Inability to elevate the ipsilateral shoulder (B) Deviation of the uvula to the contralateral side (C) Loss of gag reflex on the ipsilateral side (D) Ipsilateral loss of parotid gland secretion (E) Deviation of the tongue to the ipsilateral side

d

23. A young singer at the local music theater visits her physician and complains of vocal difficulties. On examination, she is unable to abduct the vocal cords during quiet breathing. Which of the following muscles is most likely paralyzed? (A) Vocalis muscle (B) Cricothyroid muscle (C) Oblique arytenoid muscle (D) Posterior cricoarytenoid muscle (E) Thyroarytenoid muscle

b

24. A 36-year-old woman comes to her physician complaining of heart palpitations, weight loss, anxiety, insomnia, fatigue, and amenorrhea. The physician palpates a 1.5-cm mass on her neck, which elevates when she swallows, located inferior to the cricoid cartilage yet off the midline. What is the most likely structure involved with her presentation? (A) Enlarged deep cervical lymph node (B) Thyroid nodule (C) Benign parathyroid adenoma (D) Thyroglossal duct cyst (E) Branchial cyst

b

24. A 71-year-old woman often visits an emergency department with swallowing difficulties and subsequent choking while eating food. Which of the following pairs of muscles is most instrumental in preventing food from entering the larynx and trachea during swallowing? (A) Sternohyoid and sternothyroid muscles (B) Oblique arytenoid and aryepiglottic muscles (C) Inferior pharyngeal constrictor and thyrohyoid muscles (D) Levator veli palatini and tensor veli palatini muscles (E) Musculus uvulae and geniohyoid muscles

b

24. In the provided X-ray, an opening in the skull is identified at the tip of the red arrow. If the nerve that traverses this cranial opening were damaged, what signs or symptoms would most likely be seen in the patient? (A) Unilateral muscles of facial expression paralysis (B) Unilateral muscles of mastication paralysis (C) Paresthesia of the upper lip, cheek, and lower eyelid (D) Decreased salivation of the submandibular gland (E) Decreased salivation of the parotid gland

d

44. A 47-year-old man cannot move his eye laterally. Which of the following conditions would cause this type of inability to move the eye? (A) Tumor of the pituitary gland (B) Occlusion of the posterior cerebral artery (C) Infection in the maxillary sinus (D) Infection in the cavernous sinus (E) Tumor in the anterior cranial fossa

c

25. A 27-year-old man comes to his family physician complaining of double vision. While sitting face-to-face, the doctor notes the patient exhibits strabismus, especially esotropia of the left eye, which gives the patient a cross-eyed appearance. When asked to follow the doctor's index finger with only his eyes, the patient is unable to look laterally, as illustrated in the figure. No other visual deficits are noted. What specific nerve is most likely damaged? (A) Left oculomotor nerve (B) Right oculomotor nerve (C) Left abducent nerve (D) Right abducent nerve (E) Left trochlear nerve

d

25. A 31-year-old woman complains of headache and dizziness after hitting a kitchen cabinet door with her head. Her MRI scan and venogram show a large blood clot in the great cerebral vein of Galen. The obstructed vein of the brain is a direct tributary of which of the following venous structures? (A) Emissary veins (B) Pterygoid venous plexus (C) Diploic veins (D) Dural venous sinuses (E) Internal jugular vein

d

25. During preparation to extract the right maxillary (upper) canine tooth, a dentist has difficulty anesthetizing this tooth and its associated gingivae. Therefore, the dentist administers a regional nerve block, depicted in the given photo, in which the anesthetic syringe needle penetrates the oral mucosa at the apex of the maxillary vestibule and is pushed beyond the roots of the teeth. Due to this injection, the patient experiences numbness and paresthesia within the upper canine and neighboring teeth, as well as the skin of the right inferior eyelid, cheek, lateral nose, and upper lip. What nerve was blocked and produced the described numbness? (A) Anterior superior alveolar (B) Externalnasal (C) Infratrochlear (D) Infraorbital (E) Nasopalatine

a

26. 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 informa- tion on whether the boxer has increased intracranial pressure? (A) Optic nerve (B) Oculomotor nerve (C) Olfactory nerve (D) Trigeminal nerve (E) Trochlear nerve

a

26. A 36-year-old man flips over the handlebars of his motorcycle and falls on the asphalt pavement, striking his head. He was not wearing a helmet. Although alert after the fall, he has a clear nasal discharge that tests positive for glucose. The patient most likely has a fracture of which of the following bones? (A) Ethmoid (B) Vomer (C) Sphenoid (D) Maxilla (E) Frontal

d

26. A 41-year-old woman overdoses on some prescription medications that have a common side effect of autonomic nerve stimulation. Which of the following conditions or actions results from stimulation of the parasympathetic fibers to the eyeball? (A) Enhanced vision for distant objects (B) Dilation of the pupil (C) Contraction of capillaries in the iris (D) Contraction of the ciliary muscle (E) Flattening of the lens

b

27. A 14-year-old girl presents with Horner syndrome, after surgical removal of a mass growing in her posterior mediastinum. What nerve would be affected by the loss of sympathetic innervation to the head? (A) Lesser petrosal (B) Deep petrosal (C) Greater petrosal (D) Chorda tympani (E) Optic

b

27. 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? (A) Hypoglossal (B) Accessory (C) Mandibular division of trigeminal (D) Greatauricular (E) Upper trunk of the brachial plexus

d

27. A 53-year-old woman with a severe middle ear infection comes to a hospital. On examination, a physician finds that the infection has injured the tympanic nerve. The damaged nerve: (A) Is a branch of the facial nerve (B) Contains postganglionic parasympathetic fibers (C) Synapses with fibers in the lesser petrosal nerve (D) Is a branch of the glossopharyngeal nerve (E) Forms the tympanic plexus in the external auditory meatus

e

28. 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) Greater palatine (B) Lesser palatine (C) Vagus (D) Posterior superior alveolar (E) Glossopharyngeal

b

28. A 13-year-old boy competing in a motocross competition falls from his bike and sustains massive head injuries. Which of the following cavities are separated from the middle cranial fossa by a thin layer of bone? (A) Auditory tube and bony orbit (B) Middle ear cavity and sphenoid sinus (C) Sigmoid sinus and frontal sinus (D) Sphenoid sinus and ethmoid sinus (E) Maxillary sinus and middle ear cavity

e

28. While planning a delicious dinner for his former anatomy pro- fessors, a doctor finds himself salivating at the thought of the feast. What description accurately describes the secretomotor pathway for innervation of the submandibular gland? (A) Parasympathetic fibers via the inferior alveolar nerve (B) Sympathetic fibers via the lingual nerve (C) Parasympathetic fibers via the mandibular branch of the facial nerve (D) Sympathetic fibers via the hypoglossal nerve (E) Parasympathetic fibers via the chorda tympani nerve

c

42. 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) Middle ethmoidal sinus (B) Maxillary sinus (C) Posterior ethmoidal sinus (D) Anterior ethmoidal sinus (E) Frontal sinus

b

29. A 10-year-old girl presents with a smooth, round neck mass the size of a golf ball at the upper third of the anterior border of her right sternocleidomastoid muscle, as seen in the photo. Her mother says this once small, peanut-sized mass grew without pain or inflammation after it became noticeable 2 months previously. The mass does not affect the girl's daily activities. What is the most likely diagnosis for the pictured mass? (A) Thyroglossal cyst (B) Branchial cyst (C) Undescended thymus (D) Preauricular cyst (E) Ectopic palatine tonsil

d

29. A 32-year-old house painter suffers from a head injury after falling off a ladder and has bleeding in his head. During intraoperative testing, the neurosurgeon notes loss of general sensation in the dura of the middle cranial fossa. Which of the following nerves has been affected? (A) Vagus nerve (B) Facial nerve (C) Hypoglossal nerve (D) Trigeminal nerve (E) Glossopharyngeal nerve

d

29. A 70-year-old woman goes to her physician complaining of headache, nausea, and vomiting. A head MRI reveals a tumor disrupting the visceral afferent fibers running into the solitary nucleus located within the medulla. What signs or symptoms would be manifested following the degeneration of these nerve fibers entering the solitary nucleus? (A) Blindness (B) Loss of sensation from the cornea (C) Loss of equilibrium (D) Altered taste (E) Deafness

d

3. A 19-year-old woman complains of numbness of the nasopharynx after surgical removal of the adenoid. A lesion of which of the following nerves would be expected? (A) Maxillary nerve (B) Superior cervical ganglion (C) External laryngeal nerve (D) Glossopharyngeal nerve (E) Vagus nerve

d

3. A 23-year-old man reports to physician due to shoulder weak- ness and instability. After removing his shirt, his left shoulder appears to reside lower than his right shoulder, asymme- try noted in the figure. During an examination, the patient is unable to abduct his left arm over his head and shows an inability to shrug (or elevate) his left shoulder against resis- tance. What nerve was most likely damaged in this patient? (A) Facial nerve (B) Glossopharyngeal nerve (C) Vagus nerve (D) Accessory nerve (E) Hypoglossal nerve

e

3. 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, as seen in the photo. Damage to what blood vessel most likely led to the death of this patient? (A) Common carotid artery (B) Middle meningeal artery (C) Facial artery (D) Superior cerebral veins (E) Cerebral arterial circle

c

30. A 31-year-old woman with an ongoing, long-term history of alcoholism becomes pregnant. The embryo she is carrying suffers a neural crest insufficiency during the critical period of development. Which of the following structures is most likely to be malformed as a result of this condition? (A) Laryngeal cartilages (B) Parietal bones (C) Maxillary bones (D) Common carotid arteries (E) Thyroid gland

d

30. During a carotid endarterectomy of a 57-year-old man who suffered a stroke, the carotid sinus is damaged. A third-year medical student in surgical rotation notices that the injured structure: (A) Is located at the origin of the external carotid artery (B) Is innervated by the facial nerve (C) Functions as a chemoreceptor (D) Is stimulated by changes in blood pressure (E) Communicates freely with the cavernous sinus

d

30. In the provided CT scan of the head, an opening in the skull is identified at the tip of the black arrow. What cranial nerve exits the cranium via this opening? (A) Trochlear nerve (B) Trigeminal nerve (C) Facial nerve (D) Glossopharyngeal nerve (E) Hypoglossal nerve

a

31. A 17-year-old girl uses Accutane, an acne drug implicated in interfering with normal development of the facial primordia, early in her unexpected pregnancy. Examination of the newborn reveals the craniofacial defect seen in the photo. In this case, the defect is related to failure of fusion of what craniofacial processes? (A) Maxillary and medial nasal processes (B) Opposite maxillary processes (C) Medial and lateral nasal processes (D) Maxillary and lateral nasal processes (E) Opposite medial nasal processes

e

31. A 46-year-old woman was cut on the right side of her face by a window that shattered. Her laceration was located at the anterior border of the inferior part of the masseter muscle. When she returns to her doctor to have the stitches removed, her physician notes asymmetry in her lower lip when she grimaces as seen in the figure. Damage to what nerve would cause the facial asymmetry seen in this patient? (A) Zygomatic branch of facial nerve (B) Temporal branch of facial nerve (C) Cervical branch of facial nerve (D) Buccal branch of facial nerve (E) Marginal mandibular branch of facial nerve

c

31. 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 following pairs of structures is most likely to be damaged? (A) Optic nerve and ophthalmic vein (B) Ophthalmic vein and ophthalmic nerve (C) Ophthalmic artery and optic nerve (D) Ophthalmic nerve and optic nerve (E) Ophthalmic artery and ophthalmic vein

d

32. A 43-year-old man has new onset of difficulty with speaking. Examination by the ENT resident reveals problems in elevating the hyoid bone and floor of the mouth, secondary to paralysis of the posterior belly of the digastric muscle. Which of the following nerves is most likely involved? (A) Accessory nerve (B) Trigeminal nerve (C) Ansa cervicalis (D) Facial nerve (E) Glossopharyngeal nerve

D

90 Which of the following does not lie in or pass through the jugular foramen? a) Glossopharyngeal nerve b) Accessory nerve c) Superior jugular bulb d) Superior cervical ganglion e) Meningeal branch of vagus

d

32. A male 1st-year medical student mistakenly enters the wom- en's locker room and finds a group of his female colleagues changing their clothes. He is shocked and embarrassed by his mistake and immediately runs away with his heart pounding. Given his agitated state, what ganglion, housing neuron cell bodies, is experiencing an extremely high rate of activity? (A) Ciliary ganglion (B) Trigeminal ganglion (C) Inferior (nodose) vagal ganglion (D) Superior cervical ganglion (E) Pterygopalatine ganglion

b

32. 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 tympani (C) Orbicularis oris (D) Levator veli palatini (E) Stylopharyngeus

b

33. A 25-year-old woman notes the pictured asymmetry in her neck when she tenses the skin of her inferior face and neck. This asymmetry may be due to a limited mesodermal migration in which of the following embryonic structures? (A) First pharyngeal arch (B) Second pharyngeal arch (C) Third pharyngeal arch (D) Fourth pharyngeal arch (E) Fifth pharyngeal arch

e

33. 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

b

33. The drummer of a local band presents to your clinic with hearing loss. Otoscopic examination reveals loss of contraction of the tensor tympani and the stapedius, which prevents damage to the eardrum and middle ear ossicles. These muscles are most likely controlled by which of the following nerves? (A) Chorda tympani and tympanic nerve (B) Trigeminal and facial nerves (C) Auditory and vagus nerves (D) Facial and auditory nerves (E) Trigeminal and accessory nerves

e

34. 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) Apex of the zygomatic bone (D) Lateral surface of the nasal bone (E) Inferior margin of the body of the mandible

b

34. An MRI of the right internal carotid artery reveals atheroscle- rotic plaques causing stenosis of the vessel's lumen within the cavernous sinus. The stenosis is causing increased pressure within the internal carotid artery as it courses through the cavernous sinus, resulting in an aneurysm. Given its location, what cranial nerve would most likely be damaged? (A) Trochlear nerve (B) Abducent nerve (C) Maxillary nerve (D) Ophthalmic nerve (E) Oculomotor nerve

b

34. The pupil in the eye of a 43-year-old patient remains small even when room lighting is dim. Which of the following nerves would be injured? (A) Trochlear nerve (B) Superior cervical ganglion (C) Oculomotor nerve (D) Ophthalmic nerve (E) Abducens nerve

c

35. A pharyngeal (gag) reflex is the contraction of the pharyngeal constrictor muscles that is elicited by touching the back of a patient's pharynx (e.g., with a tongue depressor). Afferent nerve fibers that innervated the pharyngeal mucosa are branches of which of the following nerves? (A) Trigeminal nerve (B) Facial nerve (C) Glossopharyngeal nerve (D) Vagus nerve (E) Hypoglossal nerve

d

35. Holoprosencephaly is a complex of developmental abnormalities characterized by the loss of midline structures to greater or lesser degrees. The pictured infant suffers multiple aspects of this disorder, including the midline cleft indicated. This specific developmental malformation is termed premaxillary agenesis, developmental failure of formation of the intermaxillary segment of the face. Which of the following structures is most likely to be affected in this condition? (A) Nasalbones (B) Softpalate (C) Inferior nasal conchae (D) Philtrum (E) Mandibular incisors

a

35. Most senior citizens dislike the bass audio frequencies aug- mented by a large subwoofer in a teenager's car. But, one 68-year-old man came to his doctor complaining of hypera- cusis, or heightened sensitivity to these loud, low-frequency sounds. The results from an audiometer hearing test reveal normal hearing for a man of his age. Given the presenta- tion, what cranial nerve is most likely involved with his hyperacusis? (A) Facial nerve (B) Vestibulocochlear nerve (C) Glossopharyngeal nerve (D) Vagus nerve (E) Hypoglossal nerve

c

36. A patient can move his eyeballs normally and see distant objects clearly but cannot focus on near objects. This condition may indicate damage to which of the following structures? (A) Ciliary ganglion and oculomotor nerve (B) Oculomotor nerve and long ciliary nerve (C) Short ciliary nerves and ciliary ganglion (D) Superior cervical ganglion and long ciliary nerve (E) Oculomotor, trochlear, and abducens nerves

b

36. Startled by a loud noise while shaving his head with a straight razor, a young man accidentally cuts his scalp, severing branches of the supraorbital and superficial temporal vessels. The scalp wound appears modest but bleeds profusely. In what layer of the scalp do the severed vessels reside? (A) Skin (B) Dense connective tissue (C) Epicranial aponeurosis (D) Loose connective tissue (E) Pericranium

b

37. A 9-year-old girl suffers from the mumps, causing unilateral inflammation of her right parotid gland, as seen in the photo. The girl is experiencing great pain due to the stretched capsule of the parotid gland. Her physician is also concerned about the condition of the structures contained within the gland. Which of the following structures may be directly compressed in this situation? (A) Buccal nerve of CN V3 (B) Auriculotemporal nerve (C) Posterior belly of the digastric muscle (D) External jugular vein (E) Facial artery

d

37. A benign tumor in the orbit of a 49-year old man compresses a structure that runs through both the superior orbital fissure and the common tendinous ring. Which of the following structures is most likely damaged? (A) Frontal nerve (B) Lacrimal nerve (C) Trochlear nerve (D) Abducens nerve (E) Ophthalmic vein

a

38. A 37-year-old man feels a little discomfort when moving his tongue, pharynx, and larynx. Physical examination indicates that the muscles attached to the styloid process are paralyzed. Which of the following groups of cranial nerves are damaged? (A) Facial, glossopharyngeal, and hypoglossal nerves (B) Hypoglossal, vagus, and facial nerves (C) Glossopharyngeal, trigeminal, and vagus nerves (D) Vagus, spinal accessory, and hypoglossal nerves (E) Facial, glossopharyngeal, and vagus nerves

d

38. As a result of facial injuries suffered in an automobile accident, a 17-year-old girl is unable to close her lips together tightly. Which of the following muscles is paralyzed? (A) Zygomaticus major (B) Buccinator (C) Levator labii superioris (D) Orbicularis oris (E) Mentalis

c

39. A 32-year-old woman has hoarseness in her voice, and her uvula is deviated to the left on phonation. Which of the following nerves is damaged? (A) Right trigeminal nerve (B) Left trigeminal nerve (C) Right vagus nerve (D) Left vagus nerve (E) Left glossopharyngeal nerve

c

39. A 50-year-old man presents with recurring dizziness, ataxia, vertigo, aphasia, and weakness in his right upper limb. A magnetic resonance angiogram (MRA) revealed a stenosis of the right subclavian artery (marked by the arrow) and poststenotic dilatation, which led to the diagnosis of subclavian steal syndrome. In this condition, blood is shunted from the left side arterial tree via collateral flow into the right side circulation. Through which of the following ipsilateral vessels is blood entering the right subclavian artery distal to the stenosis? (A) Internal thoracic artery (B) Common carotid artery (C) Vertebral artery (D) Superior thyroid artery (E) Suprascapular artery

c

4. A 10-year-old boy underwent surgery, a bilateral palatine tonsillectomy. During a postoperative examination, the doctor noted the boy did not possess a gag reflex on the right side on the posterior tongue. He also complained of abnormal taste sensations in the back of his oral cavity. The soft pal- ate elevated symmetrically when the gag reflex was tested. No other signs or symptoms were noted. What cranial nerve was damaged during the tonsillectomy? (A) Trigeminal nerve (B) Facial nerve (C) Glossopharyngeal nerve (D) Vagus nerve (E) Hypoglossal nerve

a

4. A 15-year-old young man developed cavernous sinus thrombophlebitis after a 1-week history of a single acne-like lesion at the anterior tip of his nose. He presented with a headache, periorbital edema, diplopia, and a fever (103°F or 39.4°C). What vein is the most likely route for the spread of this infection to the cavernous sinus? (A) Ophthalmic (B) Superiorcerebral (C) Great cerebral (of Galen) (D) Maxillary (E) Supraorbital

d

4. During surgery on a 56-year-old man for a squamous cell carcinoma of the neck, a surgeon notices profuse bleeding from the deep cervical artery. Which of the following arteries must be ligated immediately to stop bleeding? (A) Inferior thyroid artery (B) Transverse cervical artery (C) Thyrocervical trunk (D) Costocervical trunk (E) Ascending cervical artery

B

40. 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

a

40. A newborn infant has difficulty in breastfeeding due to unilateral atrophy in the area of the face occupied by the levator labii superioris, levator anguli oris, and lateral upper part of the orbicularis oris muscles. This region of the face is derived from which of the following embryonic sources? (A) Maxillary process (B) Mandibular process (C) Frontal process (D) Lateral nasal process (E) Medial nasal process

c

41. A 59-year-old man complains of numbness in the anterior cervical triangle. Therefore, damage has occurred to which of the following nerves? (A) Phrenic nerve (B) Greater auricular nerve (C) Transverse cervical nerve (D) Supraclavicular nerve (E) Lesser occipital nerve

e

41. A tumor growing at the base of the skull impinges upon the opening indicated by the arrow, severely compressing its contents. Which of the following conditions is the most likely result? (A) Venous drainage from the base of the brain is obstructed (B) Mucus secretion in the oral floor is reduced (C) Sensation from the mandibular teeth is lost (D) Motor control of the upper pharynx is lost (E) Arterial supply to the dura mater is reduced

a

42. A 43-year-old man presents with loss of control of facial expression across the entire right side. The corner of his mouth droops on the right side, but he can clench his jaw and chew on demand. During examination, his physician also notes loss of hearing on the right side, and the patient has difficulty maintaining balance while standing on one foot. The patient's corneal (blink) reflex is absent in the right eye, but cutaneous sensation is normal on the entire face. The physician orders radiographic imaging in anticipation of finding a tumor. What is the most likely location of the tumor? (A) Internal acoustic meatus (B) Foramen ovale (C) Foramen rotundum (D) Geniculum of the facial canal (E) Stylomastoid foramen

e

43. An 8-year-old boy suffers a fracture at the base of the skull from the impact of a terrorist bomb explosion. The skull trauma includes a lesion of the vagus nerve. Damage at which of the indicated openings would injure the vagus nerve?

c

44. During a difficult childbirth, a physician uses obstetric forceps to grip the infant's head as an aid to extracting her from the birth canal. However, the forceps are misapplied at the right stylomastoid foramen and crush its contents at the opening of the foramen. Which of the following ipsilateral deficits is the baby most likely to suffer? (A) Reduced blood flow to the inner ear (B) No sensation in the external acoustic meatus (C) Inability to close the eyelids (D) Lack of taste on the body of the tongue (E) Inability to tense the eardrum

d

45. 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 injured nerve fibers? (A) Geniculate and otic ganglia (B) Trigeminal and submandibular ganglia (C) Trigeminal and dorsal root ganglia (D) Geniculate and trigeminal ganglia (E) Geniculate and pterygopalatine ganglia

d

45. Which of the following labeled areas indicates the petrous portion of the temporal bone?

e

46. A 61-year-old woman is found to have ocular lymphoma invading her optic canal. Which of the following structures would most likely be damaged? (A) Ophthalmic vein (B) Ophthalmic nerve (C) Oculomotor nerve (D) Trochlear nerve (E) Ophthalmic artery

e

46. If normal evagination of the endodermal lining of the embryonic pharynx does not take place between the pharyngeal (branchial) arches, the pharyngeal (branchial) pouches will not form. Maldevelopment of the first pharyngeal pouch during embryonic weeks 4 to 5 is most likely to result in a congenital disorder of which of the following structures? (A) Thyroid gland (B) Thymus gland (C) Parathyroid glands (D) Facial muscles (E) Tympanic cavity

c

47. A 35-year-old man complains to his physician that he feels congested, has trouble with nasal breathing, and is experiencing a yellowish nasal mucus discharge. He also mentions that his right side upper molar teeth ache terribly. A thorough physical examination reveals maxillary sinusitis. The discharge from this sinus initially drains into the nasal cavity at which of the labeled points within this drawing of the lateral nasal wall?

a

47. A 76-year-old man with swallowing difficulties undergoes imaging for a possible mass. The CT scan image at the level of the cricothyroid ligament in his neck should show which of the following structures? (A) Inferior laryngeal nerves (B) External carotid arteries (C) Inferior thyroid veins (D) Thyrocervical trunks (E) Internal laryngeal nerves

c

48. 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

e

48. 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) Constricted pupil (B) Abduction of the eyeball (C) Complete ptosis (D) Impaired lacrimal secretion (E) Paralysis of the ciliary muscle

a

49. A 32-year-old woman undergoes LASIK refractive surgery to improve her visual acuity and rid herself of eyeglasses. To combat dry eyes, a common complication of this surgery, her ophthalmologist inserts a silicone plug, marked by an arrow in the given photo, to block drainage of tears from the patient's left eye. Obstruction of what structure prevents tears from entering the lacrimal apparatus? (A) Lacrimal punctum (B) Lacrimal canaliculus (C) Lacrimal sac (D) Nasolacrimal duct (E) Inferior nasal meatus

c

49. The muscles that are of branchiomeric origin are paralyzed in a 26-year-old patient. A lesion of which of the following nerves would cause muscle dysfunction? (A) Oculomotor nerve (B) Trochlear nerve (C) Trigeminal nerve (D) Abducens nerve (E) Hypoglossal nerve

e

5. A 17-year-old boy receives an injury to the phrenic nerve by a knife wound in the neck. The damaged nerve passes by which of the following structures in the neck? (A) Anterior to the subclavian vein (B) Posterior to the subclavian artery (C) Deep to the brachial plexus (D) Medial to the common carotid artery (E) Superficial to the anterior scalene muscle

d

5. A 23-year-old man has an impacted left third mandibular molar (or wisdom) tooth extracted. Following the surgery, the patient reports numbness in the anterior aspect of his tongue. Which of the following nerves is damaged? (A) Chorda tympani nerve (B) Mylohyoid nerve (C) Inferior alveolar nerve (D) Lingual nerve (E) Glossopharyngeal nerve

e

5. A 27-year-old man comes to his doctor complaining that the floor of his mouth is painful and swollen. Bimanual palpation and later computed tomography show an 8-mm stone (sialolith) in the right submandibular salivary duct, as indicated by the arrow in the figure. If the submandibular duct is partially obstructed, where would the physician observe salivation in the oral cavity after applying pressure to the right submandibular gland? (A) Second maxillary molar tooth (B) Oral vestibule (C) Palatine mucosa (D) Sublingual fold (E) Lingual frenulum

d

50. 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

d

50. 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) Decreased blood flow to the larynx (B) Lymphedema in the carotid triangle of the neck (C) Reduced sensation in the skin over the posterior triangle of the neck (D) Paralysis of several infrahyoid (strap) muscles (E) Paralysis of the intrinsic laryngeal muscles

c

51. During a gang fight, a 17-year-old boy is punched, and his nasal septum is broken. Which of the following structures would be damaged? (A) Septal cartilage and nasal bone (B) Inferior concha and vomer (C) Vomer and perpendicular plate of ethmoid (D) Septal cartilage and middle concha (E) Cribriform plate and frontal bone

b

51. Identify the structure indicated with the letter X in this X-ray of the lateral neck. (A) Vertebral body (B) Pedicle (C) Intervertebral disc space (D) Superior articular process (E) Inferior articular process

d

52. A 58-year-old woman comes to a hospital and complains of progressive loss of voice, numbness, loss of taste on the back part of her tongue, and difficulty in shrugging her shoulders. Her MRI scan reveals a dural meningioma that compresses the nerves leaving the skull. These nerves leave the skull through which of the following openings? (A) Foramen spinosum (B) Foramen rotundum (C) Internal auditory meatus (D) Jugular foramen (E) Foramen lacerum

d

52. A paralyzed right true vocal fold is most likely associated with which of the following situations? (A) Repair of a patent ductus arteriosus (B) Repair of an aortic aneurysm (C) A gunshot wound below the second rib (D) Surgical removal of the thyroid gland (E) Obstruction of the thoracic duct

c

53. A 21-year-old woman presents to her physician with a swelling on her neck. On examination, she is diagnosed with an infection within the carotid sheath. Which of the following structures would be damaged? (A) Vagus nerve and middle cervical ganglion (B) Internal carotid artery and recurrent laryngeal nerve (C) Internal jugular vein and vagus nerve (D) Sympathetic trunk and common carotid artery (E) External carotid artery and ansa cervicalis

a

53. Lesion of the trunks of the brachial plexus is most likely to occur from a penetrating wound into which of the following labeled areas in the given drawing of the neck regions?

b

54. A 47-year-old man has trouble with double vision (diplopia) after striking his head on the steering wheel in a car accident. During a subsequent eye examination, his ophthalmologist asks him to first look inward (toward his nose) and then upward (toward the ceiling). The integrity of which of the following extraocular muscles is being tested? (A) Superior oblique (B) Inferior oblique (C) Lateral rectus (D) Inferior rectus (E) Superior rectus

d

54. An angiogram of a 45-year-old man shows an occlusion of the costocervical trunk. This obstruction could produce a marked decrease in the blood flow in which of the following arteries? (A) Superior thoracic artery (B) Transverse cervical artery (C) Ascending cervical artery (D) Deep cervical artery (E) Inferior thyroid artery

c

55. A 20-year-old guard at the gate of the 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

b

55. Which of the labeled structures is derived from the body of the first cervical vertebra in this labeled X-ray showing a transoral view of the upper cervical vertebrae?

d

56. A 57-year-old man comes to a local hospital with fever, headache, nausea, and vomiting. Laboratory tests reveal an infection, and radiologic examination localizes the infection to the cavernous sinus. Which of the following nerves would be unaffected by this condition? (A) Oculomotor nerves (B) Abducens nerves (C) Trochlear nerves (D) Mandibular nerves (E) Ophthalmic nerves

b

56. 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) Paresthesia of the lower lip (C) Weakness in closing the jaw (D) Decreased salivary flow (E) Reduced taste in the body of the tongue

b

57. A 7-year-old girl has difficulty breathing through her nose and is brought to her pediatrician. On examination, she is diagnosed with adenoids. Which of the following tonsils is enlarged? (A) Palatine tonsil (B) Pharyngeal tonsil (C) Tubal tonsil (D) Lingual tonsil (E) Eustachian tonsil

d

57. The following computed tomography (CT) scan shows a left crescent-shaped extraaxial hematoma, indicated by the arrows, compressing the brain of a 17-year-old woman, who impacted the front of her head on the steering wheel during a head-on motor vehicular accident. Given the radiologic imaging results and the history of the accident, what blood vessel(s) is/are the most likely source for this cerebral hemorrhage? (A) Middle meningeal artery (B) Superficial temporal artery (C) Cerebral arterial circle (D) Superior cerebral veins (E) Occipital artery

a

58. A 35-year-old woman comes to her dentist complaining of tenderness and pain in her cheek near the parotid gland, as well as bad breath and a foul-tasting mouth at meal times. A radiopaque fluid is injected into the parotid duct system through cannulation, and this sialography of the parotid duct confirms blockage by a calculus (sialolith). What muscle, through which the parotid duct passes, is most likely causing the stenosis where the sialolith now resides, blocking the drainage of the parotid duct? (A) Buccinator (B) Mentalis (C) Temporalis (D) Orbicularis oris (E) Masseter

d

58. A 59-year-old woman with pain at the side of her skull comes to the emergency department. An emergent head CT scan shows a large lesion in the internal auditory meatus. This condition may progress and damage which of the following pairs of structures? (A) Vagus and glossopharyngeal nerves (B) Internal carotid and vertebral arteries (C) Internal jugular vein and trigeminal nerve (D) Facial and vestibulocochlear nerves (E) Hypoglossal and accessory nerves

c

59. A 33-year-old woman presents with rapid weight gain, particularly in the trunk and face with sparing of the limbs, excess sweating, thinning of the skin, and hirsutism (facial male-pattern hair growth). A full examination also reveals bitemporal hemianopsia (or tunnel vision). What of the following labeled areas on the given X-ray of the lateral skull will be of most interest to the physician?

c

59. 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 oris (D) Lateral pterygoid (E) Depressor labii inferioris

a

6. A 45-year-old woman is suffering from numbness over the tip of her nose. Which of the following nerves is most likely to be damaged? (A) Ophthalmic division of the trigeminal nerve (B) Maxillary division of the trigeminal nerve (C) Mandibular division of the trigeminal nerve (D) Facial nerve (E) Auriculotemporal nerve

c

6. A 47-year-old woman with a history of multiple sclerosis comes to her doctor complaining of sudden bursts (parox- ysms) of pain in her mandible, especially in the lower lip, mandibular teeth and gingivae, and cheek on her right side. This debilitating pain is often triggered by eating, talking, or brushing her teeth and often gets worse as the day progresses. Which nerve is the source of her pain? (A) First division of trigeminal nerve (B) Second division of trigeminal nerve (C) Third division of trigeminal nerve (D) Buccal branch of facial nerve (E) Marginal mandibular branch of facial nerve

e

6. A 65-year-old man complains of a persistent nosebleed. His physician uses a cotton swab to apply pressure at the source, the inferior and posterior aspects of the lateral nasal wall. Which artery is the most likely source of the bleeding? (A) Greater palatine (B) Infraorbital (C) Facial (D) Anterior ethmoidal (E) Sphenopalatine

c

60. A 37-year-old man receives a direct blow to his head and is brought to an emergency department. His radiograph shows a fracture of the floor of the middle cranial cavity, causing severance of the greater petrosal nerve. Which of the following conditions could be produced by this injury? (A) Increased lacrimal gland secretion (B) Loss of taste sensation in the epiglottis (C) Dryness in the nose and palate (D) Decreased parotid gland secretion (E) Loss of sensation in the pharynx

e

60. A tumor is discovered embedded in the posterior wall of the tympanic cavity in a 45-year-old man. If the tumor erodes through this wall, which of the following structures will it first encounter? (A) Internal jugular vein (B) Tympanic membrane (C) Internal carotid artery (D) Brain (E) Facial nerve

e

61. A 71-year-old man suffers from a known benign tumor in the pterygoid canal. Which of the following nerve fibers could be injured by this condition? (A) Postganglionic parasympathetic fibers (B) Taste fibers from the epiglottis (C) General somatic afferent (GSA) fibers (D) Preganglionic sympathetic fibers (E) General visceral afferent fibers

d

61. An 8-year-old boy comes to his physician with a painless and smooth mass located in the midline of his neck at the level of the hyoid bone, as noted by the arrow in the given photo. This palpable, midline neck mass was asymptomatic, but due to recent expansion, it has caused difficulty and pain when swallowing. When he swallows or protrudes his tongue, the mass moves superiorly. What is the most likely diagnosis? (A) Enlarged deep cervical lymph node (B) Thyroid nodule (C) Benign parathyroid adenoma (D) Thyroglossal duct cyst (E) Branchial cyst

c

62. A 65-year-old man with multiple vision problems comes to a local eye clinic. The pupillary light reflex can be eliminated by cutting which of the following nerves? (A) Short ciliary, ophthalmic, and oculomotor nerves (B) Long ciliary, optic, and short ciliary nerves (C) Oculomotor, short ciliary, and optic nerves (D) Optic and long ciliary nerves and ciliary ganglion (E) Ophthalmic and optic nerves and ciliary ganglion

a

90. A blockage of which artery may cause ischemia of the midbrain and the temporal and occipital lobes of the cerebrum?

b

62. During a fight between two construction workers, one man strikes the other with a hammer at the pterion of the skull. Which of the following bones may be fractured? (A) Zygomatic process of the temporal bone (B) Greater wing of the sphenoid bone (C) Mastoid process of the temporal bone (D) Lateral pterygoid plate of the sphenoid bone (E) Coronoid process of the mandible

d

63. A 22-year-old patient has dryness of the corneal surface of his eye because of a lack of tears. Which of the following nerves may be damaged? (A) Proximal portion of the lacrimal nerve (B) Zygomatic branch of the facial nerve (C) Lesser petrosal nerve (D) Greater petrosal nerve (E) Deep petrosal nerve

b

63. The given photo shows a superior view of the head of a baby boy with scaphocephaly. Which of the following sutures closed prematurely in this infant? (A) Coronal (B) Sagittal (C) Lambdoid (D) Metopic (E) Squamous

d

64. A 12-year-old boy has difficulty in breathing because he is choking on food. A school nurse performs the Valsalva maneuver to expel air from his lungs and thus dislodge the food. When that fails, she performs a needle cricothyrotomy, which would open into which of the following regions? (A) Rima glottidis (B) Laryngeal vestibule (C) Laryngeal ventricle (D) Infraglottic cavity (E) Piriform recess

b

64. A bony overgrowth narrows the pterygomaxillary fissure, compressing the third part of the maxillary artery. As a result, blood flow will be reduced in which of the following arteries? (A) Superficial temporal (B) Sphenopalatine (C) Inferior alveolar (D) Middle meningeal (E) Ophthalmic

e

65. A 17-year-old woman presents with an anterior dislocation of her temporomandibular joint (TMJ), as shown in the diagram. With her mandible stuck in the protruded (protracted) position, her dentist pulls the mandible inferiorly to enable the tone of a muscle to retrude (retract) the mandible to its normal position. Which muscle returns the mandibular condyle back into its normal position after it clears the articular eminence? (A) Lateral pterygoid (B) Masseter (C) Medial pterygoid (D) Stylohyoid (E) Temporalis

b

65. A 59-year-old stroke patient is unable to swallow because of a nerve injury. Which of the following nerves is unaffected? (A) Hypoglossal nerve (B) Spinal accessory nerve (C) Vagus nerve (D) Facial nerve (E) Trigeminal nerve

a

66. A 2-year-boy presents with midfacial and mandibular hypoplasia, cleft palate, deformed external ear, and defect in hearing. Which of the following embryonic structures is most likely developed abnormally? (A) First pharyngeal arch (B) Second pharyngeal arch (C) Third pharyngeal arch (D) Fourth pharyngeal arch (E) Sixth pharyngeal arch

d

66. During a mixed martial arts (MMA) 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

b

67. A 40-year-old woman suffers from headaches, nausea, vomiting, and multiple lower cranial nerve involvement. Her physician orders a CT soft tissue neck study, and the given coronal CT shows a mass lesion (tumor) centered at the jugular foramen and identified by arrows. This tumor has destroyed the jugular foramen and hypoglossal canal on the right side and damaged the cranial nerves traversing these foramina. In this patient, which of the following functions will remain intact? (A) Control of the true vocal fold (B) Taste in the anterior two thirds of the tongue (C) Symmetric protrusion of the tongue (D) Sensation in the tympanic cavity (E) Elevation of the shoulder

c

67. A 64-year-old woman is unable to open her mouth or jaw because of tetanus resulting from a penetrating wound from a rusty nail. Which of the following muscles would most likely be paralyzed? (A) Masseter muscle (B) Medial pterygoid muscle (C) Lateral pterygoid muscle (D) Buccinator muscle (E) Temporalis muscle

d

68. A 60-year-old man is unable to open his eye because of a rare neuromuscular disease. Which of the following muscles would most likely be paralyzed? (A) Orbicularis oculi (B) Orbicularis oris (C) Frontalis (D) Levator palpebrae superioris (E) Superior rectus

d

68. The external laryngeal nerve of a 23-year-old man becomes ensnared and tightly compressed by a tortuous superior thyroid artery, which parallels the course of this nerve. Which of the following functions is most likely to be affected? (A) Sensation above the true vocal fold (B) Sensation below the true vocal fold (C) Abduction of the vocal cord (D) Tension of the vocal cord (E) Depression of the hyoid bone

c

69. A 31-year-old hockey player is hit in the head by a puck. His radiogram shows a fracture of the foramen rotundum. Which of the following nerves would be damaged by this event? (A) Ophthalmic nerve (B) Mandibular nerve (C) Maxillary nerve (D) Optic nerve (E) Trochlear nerve

a

69. An 82-year-old woman develops a dural meningioma (tumor) that compresses the confluence of the dural venous sinuses. On the given contrast venogram from an angiographic series, drainage from which of the following labeled vessels would be impeded by the tumor? (A) Superior sagittal sinus (B) Transverse sinus (C) Cavernous sinus (D) Superior petrosal sinus (E) Inferior petrosal sinus

c

7. A 16-year-old girl experiences mild ptosis and miosis (pupillary constriction) in her right eye following resection of a lymphangioma from the apex of her right lung, as seen in the photo. Vision in each eye is normal. These findings are most likely due to a lesion involving which structure on the right? (A) Cervical posterior roots (B) Thoracic posterior roots (C) Thoracic anterior roots (D) Thoracic posterior primary rami (E) Thoracic gray rami communicantes

a

7. A 26-year-old singer visits her physician—an ear, nose, and throat (ENT ) surgeon—and complains of changes in her voice. A laryngoscopic examination demonstrates a lesion of the superior laryngeal nerve, causing weakness of which of the following muscles? (A) Inferior pharyngeal constrictor (B) Middle pharyngeal constrictor (C) Superior pharyngeal constrictor (D) Thyroarytenoid (E) Thyrohyoid

b

7. 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) Left glossopharyngeal nerve (D) Left vagus nerve (E) Right vagus nerve

b

70. A 46-year-old man visits the speech therapist complaining of dryness of the mouth. The therapist performs a swallowing study and, on examination, finds that the man has a lack of salivary secretion from the submandibular gland. This indicates a lesion of which of the following nervous structures? (A) Lingual nerve at its origin (B) Chorda tympani in the middle ear cavity (C) Superior cervical ganglion (D) Lesser petrosal nerve (E) Auriculotemporal nerve

c

70. A 9-year-old girl with a history of middle ear infections presents with pain, tenderness, and inflammation located posterior to her right auricle. What is the most likely diagnosis, given her current symptoms? (A) Otitisexterna (B) Blockage of pharyngotympanic tube (C) Mastoiditis (D) Perforated tympanic membrane (E) Ménière syndrome

d

71. A 21-year-old professional boxer receives a series of powerful punches to the side of his face, which fractures the left mandible slightly superior to the mandibular angle as indicated by the arrow on the given CT scan. Resultant muscle spasticity causes his jaw to close, making it difficult to remove his mouthpiece. Which of the following muscles is acting to close the jaw? (A) Temporalis (B) Lateral pterygoid (C) Zygomaticus major (D) Masseter (E) Posterior digastric

d

71. A 51-year-old woman traveling through British Columbia can see the beautiful blue sky with white clouds but is unable to focus on her face in the mirror. Her lack of accommodation results from paralysis of which of the following muscles? (A) Tarsal muscle (B) Sphincter pupillae (C) Dilator pupillae (D) Ciliary muscles (E) Orbitalis muscles

a

72. A 3-year-old girl is admitted to the hospital with pain and hearing defect. An MRI examination reveals that she has developmental defects in the auditory tube and middle ear cavity. Which of the following pharyngeal pouches is most likely developed abnormally? (A) First pouch (B) Second pouch (C) Third pouch (D) Fourth pouch (E) Second and fourth pouches

b

72. As part of an initial oral examination of a new patient, a dental hygienist inspects the vestibule of the mouth. Which of the following structures is encountered in this area? (A) Lingual frenulum (B) Opening of the parotid duct (C) Opening of the submandibular duct (D) Uvula (E) Palatine tonsil

c

73. Genetic testing of a baby boy with facial and cardiovascular anomalies reveals a small deletion in chromosome 22, specifically 22q11.2. This 22q11.2 deletion (DiGeorge) syndrome often results in migration defects of neural crest cells within the pharyngeal pouches. In this DiGeorge syndrome patient, the thymus and inferior parathyroid glands are absent. Which of the following pharyngeal pouches is most likely affected? (A) First (B) Second (C) Third (D) Fourth (E) Fifth

c

73. Which structure lies lateral to the lateral wall of the nasal cavity and inferior to the floor of the orbit?

b

74. A middle ear infection may spread into which structure?

e

74. 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

d

75. A physician examines a 53-year-old woman and notes deviation of the uvula to the right and asymmetry in the elevation of the soft palate, with the palatal arch of the left side sagging when compared to the right. The muscles involved in these abnormal findings are most likely derived from the mesoderm of what pharyngeal arch? (A) First (B) Second (C) Third (D) Fourth (E) Sixth

d

75. Which structure has numerous small cavities and lies between the orbit and the nasal cavity?

e

76. Which structure would spread infection into the anterior part of the middle nasal meatus through the frontonasal duct?

a

77. Cerebrospinal fluid is formed by vascular choroid plexus in which structure?

e

78. When the nerve on the right side is damaged, which structure is deviated to the left side?

c

79. A lesion of the first cervical spinal nerve would cause functional impairment of which structure?

a

8. 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

c

8. A 75-year-old man tells his physician he has been having progressively more trouble opening his left eye because his upper eyelid tends to droop. Which of the following muscles is most likely weakened? (A) Orbicularis oculi (B) Frontalis (C) Levator palpebrae superioris (D) Superiorrectus (E) Orbital muscle

a

8. An 18-year-old male skier is brought to the emergency room after a high-speed collision with a tree. His forehead absorbed much of the impact, resulting in multiple fractures and lacerations. His ER physician noted a clear nasal discharge, which tested positive for glucose. Given the patient's presenta- tion, what cranial nerve was most likely damaged? (A) Olfactory nerve (B) Optic nerve (C) Abducent nerve (D) Facial nerve (E) Hypoglossal nerve

b

80. Tears drain through the nasolacrimal duct into the space below which structure?

d

81. Which structure runs along the line of attachment of the falx cerebri to the tentorium cerebelli?

a

82. A tumor of which structure can be removed through the transsphenoidal approach following the septum of the nose through the body of the sphenoid?

b

83. Which structure mediates the afferent limb of the pupillary light reflex?

a

84. Which structure is formed by the perpendicular plate of the ethmoid bone, vomer, and septal cartilage?

d

85. Which structure may be paralyzed as a result of infection of the cavernous sinus?

C

86 A swelling just below the chin is most likely to be a submental lymph node. The area of drainage is from the a) center of the upper lip b) molar teeth c) tip of the tongue d) posterior one-third of the tongue e) thyroid gland

e

86. Which structure pierces the dural roof of the cavernous sinus between the anterior and middle clinoid processes?

E

87 The external jugular vein may be used for the passage of catheters. It can be located by a line from the angle of the mandible to the a) suprastemal notch b) mastoid process c) xiphoid process d) acromion e) middle of clavicle

c

87. Which structure may be obliterated by a pituitary tumor?

D

88 In a patient who has had a stroke, the food often collects between the teeth and cheeks. This is due to paralysis of the a) masseter muscle b) orbicularis oris muscle c) temporalis muscle d) buccinator muscle e) mentalis muscle

d

88. Aneurysm of which artery causes a perichiasmal lesion that may cause nasal hemianopia?

A

89 A patient complains of loss of taste at the anterior two-thirds of his tongue. He may have a) inflammation of the middle ear b) a tumor in the external auditory meatus c) injured the angle of his mandible d) a tumor of his vocal cord e) divided the hypoglossal nerve as a result of an accident

b

89. A large tumor in the foramen magnum may decrease blood flow in which artery?

a

9. A 54-year-old man comes to his doctor complaining of an inability to open his left eye. When he physically pries open his affected eye with his fingers (see photo), the gaze of his left eye is directed inferiorly and laterally, causing diplopia. His left pupil is also dilated in comparison to the right one. What nerve is most likely affected in this patient? (A) Left oculomotor nerve (B) Right oculomotor nerve (C) Left abducent nerve (D) Right abducent nerve (E) Left trochlear nerve

c

9. A young girl complains of dryness of the nose and the palate. This would indicate a lesion of which of the following ganglia? (A) Nodose ganglion (B) Otic ganglion (C) Pterygopalatine ganglion (D) Submandibular ganglion (E) Ciliary ganglion

a

9. Mandibulofacial dysostosis (Treacher-Collins syndrome) is a developmental disorder characterized by craniofacial defor- mities, including malformed or absent ears, zygomatic and mandibular hypoplasia, and downward slanting eyes exhibit- ing ptosis of the lateral eyelids, as shown in the photo. This condition is the result of lack of migration of neural crest cells into what pharyngeal arch? (A) First pharyngeal arch (B) Second pharyngeal arch (C) Third pharyngeal arch (D) Fourth pharyngeal arch (E) Fifth pharyngeal arch

C

91 In drinking while bending over a water fountain, nasal regurgitation of water is prevented by the contraction of several muscles under control of the fifth nerve. One of these is the a) palatoglossus b) palatopharyngeus c) tensor palati (tensor veli palatini) c superior constrictor e) stylopharyngeus

e

91. Ischemia of the posterior inferior surface of the cerebellum is caused by obstruction of which artery?

C

92 When one burns the tip of one's tongue by drinking boiling chicken soup, the pain impulse will be carried to neurons located in the a) geniculate ganglion b) submandibular ganglion c) semilunar ganglion (trigeminal) d) sphenopalatine (pterygopalatine) ganglion e) inferior glossopharyngeal ganglion

c

92. A lesion of which artery may cause oxygen deficiency to the medial surface of the frontal and parietal lobes of the brain?

E

93 The scalenus anterior is a readily found landmark for the straying surgeon. It enables him to find a nerve which runs on it. This nerve is the a) vagus b) ansa cervicalis c) sympathetic trunk d) lower trunk of brachial plexus e) phrenic

B

94 It is said that the most important muscle in the body is that which opens the laryngeal glottis to allow breathing. This Is the a) cricothyroid b) posterior cricoarytenoid c) lateral cricoarytenoid d) vocalis e) thyrohyoid

D

95 A speck of dust is prevented from entering your eye by the blinking reflex between the a) trigeminal and oculomotor nerves b) C2 and facial nerves c) facial and oculomotor nerves d) trigeminal and facial nerves e) lacrimal and oculomotor nerves

D

96 A cervical rib may cause undue tension and compression of structures passing between the anterior and middle scalene muscles of the neck. One of these is the a) phrenic nerve b) sympathetic trunk c) subclavian vein d) subclavian artery e) thoracic duct

D

97 The middle meningeal artery may be involved in a head injury. It lies a) subdurally b) in the subarachnoid space c) in the subpial space d) extradurally e) between the two clinoid processes

B

98 Below the floor of the pituitary fossa (sella turcica) lies the a) cavernous sinus b) sphenoid sinus c) straight sinus d) sigmoid sinus e) internal carotid artery

B

99 A fracture involves the posterior cranial fossa. It may injure the a) ninth cranial nerve entering the internal auditory meatus b) eighth nerve entering the internal auditory meatus c) mandibular division of the fifth nerve passing through the foramen ovale d) twelfth nerve exiting the foramen magnum e) middle meningeal artery entering the foramen spinosum