Neck and Skull

thyroid nodule

"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"

Ethmoid

"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"

Accessory

"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"

Branchial cyst

"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"

Maxillary bones

"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"

Maxillary and medial nasal processes

"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"

Second pharyngeal arch

"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"

Inferior margin of the body of the mandible

"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"

Vertebral artery

"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"

Arterial supply to the dura mater is reduced

"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"

Inability to close the eyelides

"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"

Tympanic cavity

"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"

Paralysis of several infrahyoid (strap) muscles

"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"

Pedicle

"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"

Surgical removal of the thyroid gland

"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"

Facial nerve

"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"

Thyroglossal duct cyst

"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"

Greater wing of the sphenoid bone

"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"

Sagittal

"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"

Taste in the anterior two thirds of the toungue

"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"

Tension of the vocal cord

"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"

Third

"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"

Tensing the vocal chords

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

Vagus nerve

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

Coronal

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

Brain stem and sacral spinal cord

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

Internal laryngeal nerve

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

Decreased tension of the vocal cord

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

Contraction of the ciliary muscle

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

Middle ear cavity and sphenoid sinus

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

Is stimulated by changes in blood pressure

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

Facial nerve

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

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?

Costocervical trunk

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

Inferior thyroid vein

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

Transverse cervical nerve

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

D

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

Interior laryngeal nerves

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

Superficial to the anterior scalene muscle

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

Vomer and perpendicular plate of ethmoid

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

Jugular foramen

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

Internal jugular vein and vagus nerve

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?

Deep cervical artery

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

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?

General visceral afferent fibers

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

Infraglottic cavity

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

Spinal accessory nerve

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

First pharyngeal arch

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

Inferior pharyngeal constrictor

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

Chorda tympani in the middle ear cavity

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

First pouch

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

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?

Fourth

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?

A

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

Hypoglosaal nerve

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) Hypoglossalnerve (B) Accessorynerve (C) Mandibular division of trigeminal nerve (D) Lingual branch of glossopharyngeal nerve (E) Roots of the brachial plexus"

Lingual frenulum

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

Cricothyroid membrane

A 68-year-old man was choking on a piece of steak at a family restaurant. Despite attempts to dislodge the food via abdomi- nal 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

Sternocleidomastoid

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"

First pharyngeal arch

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