Gray's Anatomy Review Questions: Head and Neck

A 1-day-old infant presents with a telencephalic vesicle; the eyes are fused, and a single nasal chamber is present in the midline. In addition, the olfactory bulbs and tracts and the corpus callosum are hypoplastic. Which of the following is the most likely diagnosis? A. Holoprosencephaly B. Smith-Lemli-Opitz syndrome C. Schizencephaly D. Exencephaly E. Meningoencephalocele

A

A 12-year-old boy is admitted to the emergency department with signs of meningitis. To determine the specific type of meningitis, it is necessary to aspirate cerebrospinal fluid with a lumbar puncture for laboratory examination. However, before performing a lumbar puncture, it must be established that the cerebrospinal fluid pressure is not elevated. What condition in the eye would indicate that cerebrospinal fluid pressure is too elevated for a lumbar puncture to be performed? A. Papilledema B. Separation of the pars optica retinae anterior to the ora serrata C. The foveal centralis exhibits hemorrhage from medial retinal branches. D. Obvious opacity of the lens E. Pitting or compression of the optic disc

A

A 15-year-old male is admitted to the emergency department with severe headache and hydrocephalus. Radiographic examination reveals a craniopharyngioma occupying the sella turcica, primarily involving the suprasellar space. Which of the following is the most likely cause of this tumor? A. Persistence of a small portion of the Rathke pouch B. Abnormal development of pars tubercles C. Abnormal development of foramina of Monro D. Abnormal development of the alar plates that form the lateral wall of diencephalon E. Abnormal development of diencephalon

A

A 16-year-old female volleyball player is admitted to the hospital after being hit in the eye with a ball spiked at the net. Radiographic examination reveals a blow-out fracture of the inferior wall of the orbit. Physical examination also reveals that the pupil of her eye cannot be turned upward. Which of the following muscles is (are) most likely injured? A. Inferior rectus and inferior oblique B. Medial and inferior recti C. Inferior oblique D. Medial rectus, inferior rectus, and inferior oblique E. Inferior rectus

A

A 17-year-old female visits the family dermatologist because of severe facial acne. During physical examination it was found that there was a rather obvious and painful lesion on the side of her nose. The patient was given antibiotics and warned not to press or pick at the large, inflamed swelling. If she were to squeeze, prick, or incise such a lesion in the area between the eye and the upper lip, or between the eye and the side of the nose, the infection could spread to the cavernous sinus. Which of the following pathways of spread of infection would be most typical? A. Nasal venous tributary to angular vein, to superior ophthalmic vein, then to cavernous sinus B. Retromandibular vein to supraorbital vein, then to inferior ophthalmic vein, then to cavernous sinus C. Dorsal nasal vein to superior petrosal vein, then inferior ophthalmic vein to cavernous sinus D. Facial vein to maxillary vein, then middle meningeal vein to cavernous sinus E. Transverse facial vein to superficial temporal vein to emissary vein to cavernous sinus

A

A 2-month-infant presents with small and flat maxillary, temporal and zygomatic bones. In addition, the patient has anotia and a dermoid tumor in the eyeball. Which of the following conditions is the most likely diagnosis? A. Hemifacial microsomia B. Treacher Collins syndrome C. Robin Sequence D. DiGeorge syndrome E. Velocardiofacial syndrome

A

A 2-month-old female infant is hospitalized with hydrocephalus. Radiographic examination reveals cerebrospinal fluid between the compressed brain and overlying bones of the skull. Which of the following conditions will most likely lead to this type of clinical picture? A. Lack of filtration through arachnoid granulations B. Occlusion of cerebral aqueduct (of Sylvius) C. Blockage of the foramina of Luschka D. Congenital absence of the foramen of Magendie E. Closure of the interventricular foramina of Monro

A

A 2-month-old male infant is admitted to the hospital after falling from his stroller. During physical examination the infant shows signs of facial nerve injury. What is the most common place for facial nerve injury in an infant? A. At the stylomastoid foramen B. Posterior to the parotid gland C. Anterior to the parotid gland D. Proximal to the stylomastoid foramen E. Mandibular involvement of zygomatic and buccal branches

A

A 22-year-old man is admitted to the emergency department after he was beaten up in a street fight. Radiographic examination reveals that he has suffered a forehead fracture from a blow with a club, resulting in black and swollen eyes (Fig. 7-6). Because the patient is suffering from severe pain, an anesthetic solution is ordered to be injected into his orbit. Which of the following nerves is most likely to be anesthetized? A. Ophthalmic B. Infraorbital C. Anterior ethmoidal D. Frontal E. Optic

A

A 22-year-old man is admitted to the emergency department with a sinus infection. Radiographic examination reveals posterior ethmoidal cell infection. During physical examination the patient complains of progressive loss of vision. Which of the following structures is most likely affected? A. Ophthalmic artery B. Nasociliary nerve C. Anterior ethmoidal nerve D. Trochlear nerve E. Optic nerve

A

A 24-year-old man is admitted to the hospital after a street fight. Radiographic examination reveals an inferior blow-out fracture of the orbit. Which of the following nerves is particularly vulnerable to this type of injury? A. Infraorbital B. Supratrochlear C. Frontal D. Inferior alveolar E. Optic

A

A 3-day-old male infant has a noticeably small mandible. A CT scan and physical examinations reveal hypoplasia of the mandible, underdevelopment of the bones of the face, downward-slanting palpebral fissures, defects of the lower eyelids, and deformed external ears. Abnormal development of which of the pharyngeal arches will most likely produce such symptoms? A. First arch B. Second arch C. Third arch D. Fourth arch E. Sixth arch

A

A 3-month-old infant is diagnosed with abnormal face, thymic hypoplasia, cleft palate, hypocalcemia, and a ventricular septal defect. Which of the following genes is defective? A. 22q11 B. SONIC HEDGEHOG C.PAX2 D. PAX 6 E. 47XXY

A

A 3-month-old infant was admitted to the hospital because of the parents' suspicion that the child was deaf. An MRI examination showed abnormal development of the membranous and bony labyrinths, leading the physician to the diagnosis of congenital deafness. Which of the following conditions can lead to congenital deafness? A. Infection with rubella virus B. Failure of the second pharyngeal arch to form C. Failure of the dorsal portion of first pharyngeal cleft D. Abnormal development of the auricular hillocks E. Failure of the dorsal portion of first pharyngeal cleft and second pharyngeal arch

A

A 3-month-old male infant is brought to the hospital by his parents because of white patches in his eyes. An ophthalmoscopic examination shows a congenital cataract. Which of the following conditions can cause a congenital cataract? A. Infection with rubella virus B. Choroid fissure fails to close C. Persistent hyaloid artery D. Toxoplasmosis infection E. Cytomegalovirus infection

A

A 3-year-old boy is brought to the outpatient clinic with a swelling in the side of his neck. Physical examination reveals a congenital mass of tissue anterior to the superior third of the sternocleidomastoid muscle (Fig. 7-10). The swelling is asymptomatic, non-painful, and soft. Which of the following is the most likely diagnosis? A. Branchial cleft cyst B. Ruptured sternocleidomastoid muscle C. Lymph node inflammation D. Torticollis E. External carotid artery aneurysm

A

A 32-year-old man is admitted to the hospital with nausea, vomiting, and severe headache. An MRI examination reveals an acoustic neuroma as shown in Fig. 7-9. Which of the following nerves is most likely compressed by the tumor? A. Facial B. Oculomotor C. Vagus D. Hypoglossal E. Abducens

A

A 32-year-old woman is undergoing a thyroidectomy. Two months postoperatively the patient suffers from loss of sensation within the larynx from the vocal folds upward to the entrance into the larynx, allowing for aspiration of liquids into the airway. Which of the following nerves is most likely injured? A. Internal laryngeal nerve B. External laryngeal nerve C. Glossopharyngeal nerve D. Hypoglossal nerve E. Recurrent laryngeal nerve

A

A 32-year-old woman underwent a thyroidectomy. Two months postoperatively, it was observed that the patient had lost the ability to notice the presence of foreign objects in the laryngeal vestibule. Which of the following nerves was most likely injured? A. Internal laryngeal nerve B. External laryngeal nerve C. Glossopharyngeal nerve D. Hypoglossal nerve E. Recurrent laryngeal nerve

A

A 34-year-old woman is admitted to the emergency department after her right cheekbone and bony orbit hit the dashboard in an automobile crash. Physical examination reveals that the patient has lost the ability for the affected eye to be directed downward when the pupil is in the adducted position. An MRI examination reveals a torn nerve. What is the most common location at which this nerve will be injured? A. As it pierces the dura of the tentorium cerebelli in the tentorial notch B. At the cavernous sinus C. At the sella turcica D. At the inferior orbital fissure E. At the superior orbital fissure

A

A 35-year-old female is under general anesthesia. Prior to laryngeal intubation the rima glottidis is opened by which pair of muscles? A. Posterior cricoarytenoids B. Lateral cricoarytenoids C. Thyroarytenoids D. Transverse arytenoids E. Cricothyroids

A

A 35-year-old male patient is admitted to the hospital with severe headaches. A CT scan evaluation reveals a tumor in the infratemporal fossa. Physical examination reveals loss of general sensation from the anterior two thirds of his tongue, but taste and salivation are intact. Which of the following nerves is most likely affected by the tumor? A. Lingual proximal to its junction with the chorda tympani B. Chorda tympani C. Inferior alveolar D. Lesser petrosal E. Glossopharyngeal

A

A 36-year-old man is admitted to the emergency department with a painful skin rash on the dorsum of his nose. Physical examination reveals that a herpetic lesion is affecting the dorsum of the nose and the eye- ball. Which of the following nerves is most likely to be responsible for transmission of the virus to the eye? A. Nasociliary B. Supratrochlear C. Infraorbital D. Posterior ethmoidal E. Anterior ethmoidal

A

A 36-year-old woman is admitted to the hospital with severe head injuries after a car crash. During neurologic examination her uvula is deviated to the right. Which nerve is most likely affected to result in this deviation? A. Left vagus B. Right vagus C. Right hypoglossal D. Left glossopharyngeal E. Right glossopharyngeal

A

A 36-year-old woman is admitted to the hospital with severe head injuries after a car crash. During neurologic examination it is noted that her uvula is deviated to the right. Which of the following muscles is paralyzed? A. Left levator veli palatini B. Left tensor veli palatini C. Right levator veli palatini D. Right tensor veli palatini E. Right tensor veli palatini and left elevator veli palatini

A

A 38-year-old man is admitted to the hospital with a large mass in his lower anterior neck. Ultrasonic examination reveals a benign tumor of his thyroid gland. Twenty-four hours following a partial thyroidectomy, it was noted that the patient could not abduct the true vocal cords due to a nerve injury during the operation. Which of the following muscles was most likely denervated? A. Posterior cricoarytenoid B. Lateral cricoarytenoid C. Thyroarytenoid D. Arytenoid E. Cricothyroid

A

A 45-year-old woman is admitted to the hospital with severe headache. The patient is diagnosed with hypertension and arrhythmias. To reduce the patient's blood pressure, massage is initiated at a pressure point located deep to the anterior border of the sternocleidomastoid muscle at the level of the superior border of the thyroid cartilage. Which of the following structures is targeted by the massage? A. Carotid sinus B. Carotid body C. Thyroid gland D. Parathyroid gland E. Inferior cervical ganglion

A

A 5-year-old girl is admitted to the hospital with an upper respiratory tract infection. During physical examination her sense of hearing appears to be poor. Her right ear is painful, and upon otoscopic examination a golden brown fluid can be observed through the tympanic membrane. Which is the most likely direct route for the spread of an infection from the upper respiratory tract to the middle ear cavity? A. Pharyngotympanic tube B. Choanae C. Nostrils D. Facial canal E. Internal acoustic meatus

A

A 54-year-old man is admitted to the hospital due to severe headaches. A CT examination reveals an internal carotid artery aneurysm inside the cavernous sinus. Which of the following nerves would be typically affected first? A. Abducens nerve B. Oculomotor nerve C. Ophthalmic nerve D. Maxillary nerve E. Trochlear nerve

A

A 55-year-old male farmer is admitted to the emergency department after falling from the hayloft in his barn. Radiographic examination reveals a small, depressed fracture of the skull vertex and thrombosis of the superior sagittal sinus. A day later the patient loses consciousness. What is the most likely cause of his loss of consciousness? A. Obstruction of CSF resorption B. Obstruction of the cerebral aqueduct (of Sylvius) C. Laceration of the middle meningeal artery D. Fracture of the cribriform plate with CSF rhinorrhea E. Aneurysm of the middle cerebral artery

A

A 55-year-old man is admitted to the emergency department after slipping on wet pavement and falling. Physical examination reveals that the patient has a hematoma that formed in the danger zone of the scalp, spreading to the area of the eyelids. Which of the following layers is regarded as the "danger zone"? A. Loose, areolar layer B. Skin C. Galea aponeurotica D. Pericranium E. Subcutaneous layer

A

A 55-year-old man is admitted to the emergency department with a complaint of pain when chewing over the previous 3 months. Physical examination reveals the patient suffers from odynophagia and some hoarseness in his speech. Radiographic examination reveals a tumor at the tracheoesophageal groove. Which of the following nerves is most likely affected by the tumor? A. Recurrent laryngeal B. Internal laryngeal C. Vagus D. External laryngeal E. Phrenic

A

A 55-year-old man with severe ear pain visits the ENT doctor. During otoscopic examination the tympanic membrane is ruptured. Which of the following nerves is responsible for the sensory innervation of the inner surface of the tympanic membrane? A. Glossopharyngeal B. Auricular branch of facial C. Auricular branch of vagus D. Great auricular E. Lingual

A

A 55-year-old woman has undergone facial surgery for the excision of a malignant parotid tumor. A week postoperatively, marked weakness is seen in the musculature of the patient's lower lip. Which of the following nerves was most likely injured during the parotidectomy? A. Marginal mandibular branch of facial B. Zygomatic branch of facial C. Mandibular division of the trigeminal nerve D. Buccal branch of facial E. Buccal nerve

A

A 55-year-old woman is admitted to the emergency department with chest angina. ECG examination reveals an acute myocardial infarction. A series of medications is administered to the patient, including sublingual nitroglycerin for reducing her blood pressure. Which of the following structures is most likely to be the route of absorption of this drug? A. Deep lingual vein B. Submandibular duct C. Sublingual duct D. Lingual vein E. Sublingual vein

A

A 56-year-old man is diagnosed with an extradural tumor in the posterior cranial fossa. When the pa- tient protruded his tongue during physical examination, the tongue deviated to the right. Which of the following muscles and nerves are most likely injured? A. Right hypoglossal nerve and right genioglossus B. Left hypoglossal nerve and left genioglossus C. Right hyoglossus and left styloglossus D. Right geniohyoid and first cervical nerve E. Contralateral vagus and hypoglossal nerves

A

A 56-year-old woman is admitted to the hospital with eye pain. During physical examination the patient complains of excruciating pain when she performs any movement of the eye. An MRI examination reveals that the optic nerve is inflamed. What is the most likely explanation? A. The anular tendon (of Zinn) is inflamed. B. The inflammation has affected the nerves innervating the eye muscles. C. The muscles are contracting due to generalized inflammation. D. The nasociliary nerve is affected. E. The ophthalmic artery is constricted.

A

A 62-year-old man visits the outpatient clinic complaining of spontaneous lacrimation during eating. Which of the following nerves has developed a lesion to cause this condition? A. Facial nerve proximal to the geniculate ganglion B. Greater petrosal nerve C. Lesser petrosal nerve D. Lacrimal nerve E. Chorda tympani

A

A 64-year-old man is admitted to the hospital in an unconscious condition. A CT scan examination re- veals that the patient has suffered a cerebral vascular accident (stroke), with a small hematoma produced by the superior cerebellar artery. Which of the following nerves will most likely be affected by the hematoma? A. Trochlear nerve B. Abducens nerve C. Facial nerve D. Vestibulocochlear nerve E. Glossopharyngeal nerve

A

A 67-year-old female is admitted to the emergency department with a severe swelling on the right side of her neck. An MRI examination reveals an abscess. The abscess is surgically removed from the middle of the posterior cervical triangle on the right side. During recovery the patient notices that her shoulder droops and she can no longer raise her right hand above her head to brush her hair. Which of the following nerves has most likely been iatrogenically injured? A. Accessory B. Ansa cervicalis C. Facial D. Hypoglossal E. Suprascapular

A

A 9-year-old girl is admitted to the emergency department with a painful swelling behind her ear. An MRI examination reveals mastoiditis (Fig. 7-12). Which of the following structures is most likely to be affected by the inflammation? A. Transverse sinus B. Petrous part of the temporal bone C. Middle ear D. Occipital sinus E. Internal carotid artery

A

A newborn infant presents with severe brain abnormalities. The calvaria is defective and the brain is protruding from the cranium. A rudimentary brainstem and some functioning neural tissue are present. A diagnosis is made of meroencephaly. Which of the following is the most likely cause of this condition? A. Failure of the rostral neuropore to close in the fourth week B. Cytomegalovirus infection C. Failure of the hypophyseal diverticulum to develop D. Failure of the neural arch to develop E. Abnormal neural crest formation

A

An 8-year-old male is admitted to the hospital with a drooping right eyelid (ptosis). The initial diagnosis is Horner's syndrome (Fig. 7-4). Which of the following additional signs on the right side would confirm the diagnosis? A. Constricted pupil B.Dryeye C. Exophthalmos D. Pale, blanched face E. Sweaty face

A

An unconscious 48-year-old woman is admitted to the hospital. CT scan reveals a tumor in her brain. When she regains consciousness, her right eye is directed laterally and downward, with complete ptosis of her upper eyelid, and her pupil is dilated. Which of the following structures was most likely affected by the tumor to result in these symptoms? A. Oculomotor nerve B. Optic nerve C. Facial nerve D. Ciliary ganglion E. Superior cervical ganglion

A

A 1-day-old infant was born with the vault of the skull undeveloped, leaving the malformed brain exposed. A diagnosis of exencephaly is made. What is the embryologic cause of this condition? A. Toxoplasmosis infection B. Failure of closure of the cephalic part of the neural tube C. Ossification defect in the bones of the skull D. Caudal displacement of cerebellar structures E. Maternal alcohol abuse

B

A 1-year-old infant is admitted to the hospital with fever. Radiographic examination reveals a sinus infection. Which of the following sinuses is present at this age? A. Frontal sinus B. Maxillary sinus C. Sphenoid sinus D. Middle ethmoidal air cells E. Posterior ethmoidal air cells

B

A 10-year-old girl is admitted to the hospital with tonsillitis. A tonsillectomy is performed and the tonsils are removed. On physical examination one week later the patient has absence of the gag reflex on the left when the posterior part of the tongue is depressed. The sensory portion of which of the following nerves was most likely injured? A. Facial B. Glossopharyngeal C. Mandibular D. Maxillary E. Hypoglossal

B

A 14-year-old female has been suffering from quinsy in the right side of her oropharynx. In surgical removal of the pathologic tissue, or for incision and drainage of the area, which of the following arteries will be at greatest risk? A. Lingual B. A branch of facial C. Superior laryngeal artery D. Ascending pharyngeal artery E. Descending palatine artery

B

A 27-year-old man is admitted to the hospital after a middleweight boxing match. During physical examination the strength and symmetry of strength in opening the jaws are tested. Which of the following muscles is the most important in jaw protrusion and depressing the mandible? A. Anterior portion of temporalis B. Lateral pterygoid C. Medial pterygoid D. Masseter E. Platysma

B

A 27-year-old woman is admitted to the emergency department after she was thrown from a motor scooter. Radiographic evaluation reveals a type I Lefort fracture and comminuted fracture of the mandible and TMJ. Despite reconstructive surgery, the patient develops hyperacusis (sensitivity to loud sounds) due to facial nerve paralysis. Which of the following muscles is most likely paralyzed? A. Posterior belly of digastric B. Stapedius C. Tensor tympani D. Stylohyoid E. Cricothyroid

B

A 31-year-old mother visits the pediatric outpatient clinic with her 6-month-old baby complaining that her baby is not developing quickly and has no teeth. Which of the following teeth are expected to appear first? A. Superior medial incisors at 8 to 10 months of age B. Inferior medial incisors at 6 to 8 months of age C. Superior lateral incisors at 8 to 10 months of age D. Inferior lateral incisors at 12 to 14 months of age E. First molar at 6 to 8 months of age

B

A 32-year-old man is admitted to the emergency department with visual problems. Radiographic examination reveals a tumor of the adenohypophysis (anterior pituitary gland). Physical examination reveals a loss of the lateral halves of the fields of vision of both eyes (bitemporal hemianopia or "tunnel vision"). Which of the following structures was most likely compressed by the tumor? A. Optic nerve B. Optic chiasm C. Optic tract D. Oculomotor E. Abducens nerve

B

A 33-year-old woman is unconscious when she is admitted to the hospital after she fell, hitting her head. The physician in the emergency department performs a pupillary light reflex test. The integrity of which of the following nerves is being checked? A. Optic and facial B. Optic and oculomotor C. Maxillary and facial D. Ophthalmic and oculomotor E. Ophthalmic and facial

B

A 34-year-old male complains of hyperacusis (sensitivity to loud sounds). Injury to which of the following cranial nerves is responsible? A. Hypoglossal B. Facial C. Accessory D. Vagus E. Glossopharyngeal

B

A 34-year-old man is admitted to the emergency department after falling off his motorbike, suffering an injury to his head. The patient has multiple lacerations in the skin over the frontal bone. Which of the following veins could most likely provide a pathway of transmission of infection from the veins of the scalp to the underlying dural venous sinuses? A. Supratrochlear vein B. Diploic veins C. Anterior cerebral veins D. Superior sagittal sinus E. Supraorbital vein

B

A 34-year-old swimmer presents to your office with an external ear canal infection (otitis externa). The patient coughs during inspection of the external auditory meatus with a speculum. The cough results from the irritation of which nerve that innervates an area of the external auditory meatus? A. Vestibulocochlear B. Vagus C. Trigeminal D. Facial E. Accessory

B

A 34-year-old woman is admitted to the emergency department with a painful eye. Physical examination reveals a lump in the lower eyelid that consists of debris (Fig. 7-13). A diagnosis of a chalazion is made. Which of the following structures is (are) most likely blocked by the chalazion? A. Lacrimal ducts B. Tarsal glands C. Sclera D. Pupil E. Nasolacrimal duct

B

A 35-year-old man is admitted to the hospital with severe pain in the area of his right submandibular gland. Radiographic examination reveals a tumor of the gland. An incision is made and the submandibular gland and its duct are removed. Which of the following nerves is most commonly injured in this type of procedure? A. Buccal B. Lingual C. Inferior alveolar D. Nerve to mylohyoid E. Glossopharyngeal

B

A 35-year-old woman is hospitalized due to cavernous sinus thrombosis resulting from an infection on the face. Which of the following is the most direct route for spread of infection from the face to the cavernous sinus? A. Pterygoid venous plexus B. Superior ophthalmic vein C. Frontal venous plexus D. Basilar venous plexus E. Parietal emissary vein

B

A 38-year-old patient is admitted to the dental clinic with acute dental pain. The attending dentist found penetrating dental caries (tooth decay) affecting one of the mandibular molar teeth. Which of the fol- lowing nerves would the dentist need to anesthetize to remove the caries in that tooth? A. Lingual B. Inferior alveolar C. Buccal D. Mental E. Mylohyoid

B

A 45-year-old man came to the outpatient clinic after stumbling and hitting his head on a table in a restaurant. During the neurologic examination photographs were taken of the patient's eyes as shown in Fig. 7-8. Which of the following nerves to the left eye was most likely injured? A. Trochlea B. Abducens C. Oculomotor D. Optic E. Oculomotor and abducens

B

A 45-year-old man is admitted to the emergency department with a red, painful eye. During physical examination it is noted that the conjunctiva of the affected eye is infected. Which of the following lymph node groups would be first involved if the infection spread? A. Submandibular B. Parotid C. Jugulodigastric D. Submental E. Preauricular

B

A 45-year-old man is admitted to the hospital with breathing problems. During physical examination the patient shows signs of airway obstruction. A CT scan examination reveals a nasal polyp obstructing the airway (Fig. 7-14). Drainage from which of the following structures is also obstructed? A. Sphenoid sinus B. Maxillary sinus C. Ethmoidal sinus D. Frontal sinus E. Nasolacrimal duct

B

A 46-year-old woman is admitted to the hospital with a large mass in her lower anterior neck. Ultrasonic examination reveals a benign tumor of her thyroid gland. During the procedure to remove the tumor the superior thyroid artery is identified and used as a landmark in order not to damage its small companion nerve. Which of the following nerves is most likely to accompany the superior thyroid artery? A. Cervical sympathetic trunk B. External branch of the superior laryngeal C. Inferior root of the ansa cervicalis D. Internal branch of the superior laryngeal E. Recurrent laryngeal

B

A 47-year-old woman is admitted to the hospital with signs of cavernous sinus thrombosis. Radiographic examination reveals a pituitary tumor involving the cavernous sinus, confirming the initial diagnosis (Fig. 7-3). During physical examination it is suspected that the right abducens nerve of the patient has been damaged by the tumor. In which direction will the physician most likely ask the patient to turn her right eye to confirm the abducens nerve damage, assuming she is unable to perform this task? A. Inward B. Outward C. Downward D. Down and out E. Down and in

B

A 48-year-old man presents with a constricted right pupil that does not react to light. His left pupil and vision in both eyes are normal. These findings are most likely due to a lesion involving which of the following right-sided structures? A. Oculomotor nerve B. Superior cervical ganglion C. Nervus intermedius D. Edinger-Westphal nucleus E. Trigeminal (semilunar, Gasserian) ganglion

B

A 54-year-old male is to undergo bilateral thyroidectomy. During this procedure there is the possibility of bilateral paralysis of muscles that can open the airway. If a particular nerve is injured bilaterally, there is significant risk of asphyxiation postoperatively unless the patient is intubated or the airway is opened surgically. Which of the following muscle pairs opens the airway? A. Cricothyroids B. Posterior cricoarytenoids C. Arytenoideus D. Thyroarytenoids E. Lateral cricoarytenoids

B

A 54-year-old woman is admitted to the emergency department after experiencing sudden problems with her vision for the preceding 5 days. Radiographic examination reveals that an aneurysm of one of the arteries at the base of the brain is compressing the optic chiasm. Which of the following arteries will most likely be involved? A. Middle cerebral B. Anterior communicating C. Anterior cerebral D. Superior cerebellar E. Posterior superior cerebellar

B

A 55-year-old man is admitted to the emergency department with fever of 4 days' duration. Radiographic examination reveals the presence of an infection that is spreading from the retropharyngeal space to the posterior mediastinum. Between which of the following fascial layers are the infections most likely located? A. Between alar and prevertebral B. Between alar and pretracheal C. Between pretracheal and prevertebral D. Between buccopharyngeal and alar E. Between buccopharyngeal and prevertebral

B

A 55-year-old man is admitted to the hospital after an injury sustained at work in a factory. He presents with severe scalp lacerations, which were sutured. After three days the wound is inflamed, swollen, and painful. Between which tissue layers is the infection most likely located? A. The periosteum and bone B. The aponeurosis and the periosteum C. The dense connective tissue and the aponeurosis D. The dense connective tissue and the skin E. The dermis and the epidermis

B

A 55-year-old man is admitted to the hospital with a complaint of severe headaches. A lumbar puncture reveals traces of blood in the cerebrospinal fluid. Which of the following conditions has most likely occurred in this patient? A. Fracture of the pterion with vascular injury B. A ruptured "berry" aneurysm C. Leakage of branches of the middle meningeal vein within the temporal bone D. A tear of the cerebral vein at the entrance to the superior sagittal sinus E. Occlusion of the internal carotid artery by a clot generated in the left atrium

B

A 55-year-old woman is admitted to the emergency department with ear pain, ringing in her ear (tinnitus), dizziness, and vertigo. Radiographic examination reveals indications of Ménière's disease. Which of the following structures is most likely affected by the edema that is associated with Ménière's disease? A. Middle ear B. Endolymphatic sac C. Semicircular canals D. Cochlea E. Helicotrema

B

A 55-year-old woman is admitted to the hospital with severe hypertension. Laboratory examination reveals hypertension (190/110 mm Hg) and hypercholes- terolemia (250 mg/dl). During physical examination the patient complains of headaches and dizziness. Radiographic examination reveals 90% occlusion of both common carotid arteries. A carotid endarterectomy is performed and large atherosclerotic plaques are removed. During a postoperative physical examination on the right side, it was noted that her tongue deviated toward the right when she was asked to stick it out. Which of the following nerves was most likely injured during the procedure? A. Right glossopharyngeal B. Right hypoglossal C. Left hypoglossal D. Left lingual E. Left vagus

B

A 56-year-old woman has just undergone a complete thyroidectomy. After she recovers from the anesthesia a hoarseness of her voice is noted that persists for 3 weeks. Subsequent examination shows a permanently adducted vocal fold on the right side. Surgical trauma to the innervation of which of the following muscles is most likely to be responsible for the position of the right vocal fold? A. Aryepiglottic B. Posterior cricoarytenoid C. Thyroarytenoid D. Transverse arytenoids E. Vocalis

B

A 56-year-old woman is admitted to the hospital with rheumatoid arthritis of her temporomandibular joint (TMJ) and severe ear pain. An image from her radiographic examination is shown in Fig. 7-2. Which of the following nerves is most likely responsible for conducting the pain sensation? A. Facial B. Auriculotemporal C. Lesser petrosal D. Vestibulocochlear E. Chorda tympani

B

A 57-year-old man is admitted to the emergency department with dizziness and severe headaches. A CT scan evaluation reveals a tumor in the superior orbital fissure. Upon physical examination the patient's eyeball is fixed in an abducted position, slightly depressed, and the pupil is dilated. In addition, the superior palpebrae are ptotic. When the patient is asked to move the pupil toward the nose, the pupil rotates medially. Consensual corneal reflexes are normal. Which of the following nerves is most likely affected? A. Trochlear nerve B. Oculomotor nerve C. Abducens nerve and sympathetic nerve plexus accompanying the ophthalmic artery D. Ophthalmic nerve and short ciliary nerve E. Superior division of oculomotor nerve and the nasociliary nerve

B

A 6-month-old infant is admitted to the emergency department with hydrocephalus. Upon physical examination a spina bifida cystica is noted. Radiographic examination reveals a caudal displacement of the cerebellar structures through the foramen magnum. Which of the following is the most likely diagnosis? A. Arnold-Chiari malformation B. Holoprosencephaly C. Smith-Lemli-Opitz syndrome D. Schizencephaly E. Exencephaly

B

A 6-year-old boy is admitted to the hospital with high fever and pain over the parotid gland (Fig. 7-7). A diagnosis of parotiditis (mumps) is established, and the boy is sent back home. Which of the following nerves is responsible for painful sensations from the region of the parotid gland? A. Facial B. Auriculotemporal C. Lesser petrosal D. Lingual E. Chorda tympani

B

A 62-year-old man is admitted to the hospital with blurred vision. Physical examination reveals a long history of gradual loss of his visual field. The intraocular pressure is high, and a diagnosis of glaucoma is made. Which of the following spaces first receives the aqueous humor secreted by the epithelium of the ciliary body? A. Anterior chamber B. Posterior chamber C. Pupil D. Vitreous E. Lacrimal sac

B

A 67-year-old man visits the outpatient clinic with complaints of deteriorating vision. A form of glaucoma is diagnosed in which the aqueous humor does not drain properly into the scleral venous sinus at the iridoscleral angle of the eyeball. The aqueous fluid is secreted by the epithelium of the ciliary body directly into which of the following spaces? A. Iridoscleral angle B. Posterior chamber C. Pupil D. Vitreous body E. Lacrimal sac

B

A 68-year-old woman is suffering from excruciating, sudden bouts of pain over the area of her midface. Laboratory studies indicate that she has tic douloureux (trigeminal neuralgia). Which ganglion is the location of the neural cell bodies of the nerve mediating the pain? A. Geniculate B. Trigeminal (semilunar or Gasserian) C. Inferior glossopharyngeal D. Otic E. Pterygopalatine

B

A patient with enlarged cervical lymph nodes has a malignant tumor of the cecum. Which of the following lymph nodes of the neck is most frequently associated with malignant tumors of the gastrointestinal tract? A. Left inferior deep cervical B. Left supraclavicular C. Right inferior deep cervical D. Right supraclavicular E. Jugulodigastric

B

An 11-year-old boy is examined by an ENT doctor for his swollen palatine tonsils. The palatine tonsils are located between the anterior and posterior tonsillar pillars. Which of the following muscles form these pillars? A. Levator veli palatini and tensor veli palatini B. Palatoglossus and palatopharyngeus C. Styloglossus and stylopharyngeus D. Palatopharyngeus and salpingopharyngeus E. Superior and middle pharyngeal constrictors

B

An 11-year-old boy with swollen palatine tonsils is examined by an otolaryngologist. Which of the following arteries supplies most of the blood to these tonsils and must be protected when its tonsillar branch is divided? A. Ascending pharyngeal B. Facial C. Lingual D. Descending palatine E. Superior thyroid

B

An unconscious 54-year-old female is admitted to the hospital. A CT scan reveals a tumor in her brain, producing a tentorial herniation. When she regains consciousness, her right eye is directed laterally and downward, with complete ptosis of her upper eyelid and pupillary dilation. Which of the following lobes of the brain is affected by the tumor? A. Parietal B. Temporal C. Occipital D. Frontal E. Parietal and temporal

B

An unconscious 57-year-old man is transported to the emergency department after falling from a tree. A CT scan evaluation reveals a fracture of the cribriform plate (Fig. 7-5). Which of the following conditions will most likely be present during the physical examination? A. Entrapment of the eyeball B. Anosmia C. Hyperacusis D. Tinnitus E. Deafness

B

Cardiac pain is referred in some cases to the mandible and the region of the TMJ. Cutaneous sensation over the angle of the mandible is normally supplied by which of the following nerves? A. Cervical branch of facial B. Great auricular nerve C. Mandibular branch of trigeminal nerve D. Mandibular branch of facial nerve E. Transverse cervical nerve

B

The arachnoid villi allow cerebrospinal fluid to pass between which two of the following spaces? A. Choroid plexus and subdural space B. Subarachnoid space and superior sagittal sinus C. Subdural space and cavernous sinus D. Superior sagittal sinus and jugular vein E. Epidural and subdural space

B

A 1-day-old infant presents with meningohydroencephalocele. Which of the following bones is most commonly affected? A. Squamous part of temporal bone B. Petrous part of temporal bone C. Squamous part of occipital bone D. Sphenoid bone E. Ethmoid bone

C

A 12-year-old girl is admitted to the emergency department with a middle ear infection. Physical ex- amination reveals a long history of chronic middle ear infections that have produced a lesion in the tympanic plexus in the middle ear cavity. Since the preganglionic parasympathetic fibers that pass through the plexus have been lost, which of the following conditions will be detectable during physical examination? A. Diminished mucus in the nasal cavity B. Diminished mucus on the soft palate C. Diminished saliva production by the parotid gland D. Diminished saliva production by the subman- dibular and sublingual glands E. Diminished tear production by the lacrimal gland

C

A 17-year-old woman is admitted to the hospital with signs of cavernous sinus thrombosis, as revealed by radiographic and physical examinations. Thrombophlebitis in the "danger area" of the face can spread to the cavernous sinus and involve the ophthalmic branch of the trigeminal nerve. Which of the following symptoms will most likely be present during physical examination? A. Pain in the hard palate B. Anesthesia of the upper lip C. Pain from the eyeball D. Pain over the lower eyelid E. Tingling sensation over the buccal region of the face

C

A 20-year-old man is admitted to the emergency department with a stab wound in the superior region of his neck. A radiographic examination reveals that the wound has not affected any major structures. Physical examination reveals that the patient has lost sensation from the skin over the angle of the jaw. Which of the following nerves is most likely injured? A. Supraclavicular B. Transverse cervical C. Great auricular D. Greater occipital E. Lesser occipital

C

A 22-year-old woman is admitted to the emergency department unconscious after falling over the handlebars of her bicycle. An emergency tracheotomy is performed to insert a tracheotomy tube. What is the most common tracheal cartilage level at which a tracheotomy incision is performed? A. First to second B. Second to third C. Third to fourth D. Fourth to fifth E. Fifth to sixth

C

A 22-year-old woman is admitted to the hospital with an injury to her eye. The corneal reflex is tested and found to be present. Which of the following nerves is responsible for the afferent limb of this reflex? A. Frontal B. Lacrimal C. Nasociliary D. Oculomotor E. Optic

C

A 24-year-old male had a third molar (wisdom tooth) extracted from his lower jaw. This resulted in the loss of general sense and taste sensation from the anterior two thirds of the tongue. This loss was most likely due to injury of which of the following nerves? A. Auriculotemporal B. Chorda tympani C. Lingual D. Mental E. Inferior alveolar

C

A 24-year-old man is admitted to the hospital after a street fight. Radiographic examination reveals an inferior (blow-out) fracture of the orbit. Orbital structures would most likely be found inferiorly in which of the following spaces? A. Ethmoidal sinus B. Frontal sinus C. Maxillary sinus D. Nasal cavity E. Sphenoidal sinus

C

A 29-year-old woman underwent a thyroidectomy. Postoperatively, the patient presented with hoarseness. Which of the following nerves was most likely injured during the operation? A. Internal laryngeal B. External laryngeal C. Recurrent laryngeal D. Superior laryngeal E. Glossopharyngeal

C

A 3-month-old male infant is admitted to the hospital because he cries continuously. During physical examination it is observed that the infant has a dry right eye. Upon the basis of imaging studies, the neuroophthalmologist diagnoses a lesion at the neural cell bodies of the preganglionic axons of the pterygopalatine ganglion. Which of the following structures contains the neural cell bodies of the preganglionic axons? A. Superior cervical ganglion B. Edinger-Westphal nucleus C. Superior salivatory nucleus D. Inferior salivatory nucleus E. Nucleus ambiguus

C

A 3-year-old girl ruptured her eardrum when she inserted a pencil into her external ear canal. She was urgently admitted to the emergency department. Physical examination revealed pain in her ear and a few drops of blood in the external auditory meatus. There was the concern that there might possibly have been an injury to the nerve that principally innervates the external surface of the tympanic membrane. Which of the following tests is most likely to be performed during physical examination to check for injury to this nerve? A. Check the taste in the anterior two thirds of the tongue. B. Check the sensation to the pharynx and palate. C. Check if there is paraesthesia at the TMJ. D. Check for sensation in the larynx. E. Check for sensation in the nasal cavity.

C

A 31-year-old female is admitted to the hospital after an automobile collision. A CT scan examination reveals a large hematoma inferior to the right jugular foramen. Physical examination reveals right pupillary constriction (miosis) and anhydrosis (loss of sweating) of the face. Which of the following ganglia is most likely affected by the hematoma? A. Submandibular B. Trigeminal (semilunar or Gasserian) C. Superior cervical D. Geniculate E. Ciliary

C

A 32-year-old female patient asks you what is the soft, thin ridge of tissue that she can feel running forward across the masseter muscle toward her upper lip. You reassure her that is perfectly normal. Which of the following is the most likely structure she is feeling? A. Facial artery B. Maxillary artery C. Parotid duct D. Marginal mandibular branch of facial nerve E. Facial vein

C

A 32-year-old man is admitted to the emergency department unconscious after a severe car crash. During an emergency cricothyroidostomy an artery is accidentally injured. Two days later the patient shows signs of aspiration pneumonia. Which of the following arteries was most likely injured? A. Superior thyroid B. Inferior thyroid C. Cricothyroid D. Superior laryngeal E. Suprahyoid

C

A 34-year-old woman is admitted to the hospital with a large mass in her lower anterior neck. Ultrasonic examination reveals a benign tumor of her thyroid gland. Twenty-four hours following a partial thyroidectomy, it was noted that the patient frequently aspirates fluid into her lungs. Upon examination it was determined that the area of the piriform recess above the vocal fold of the larynx was anesthetized. Which of the following nerves was most likely iatrogenically injured? A. External branch of the superior pharyngeal B. Hypoglossal C. Internal branch of the superior laryngeal D. Lingual E. Recurrent laryngeal

C

A 35-year-old woman is admitted to the emergency department after a violent automobile crash. The patient's upper airway is obstructed with blood and mucus, and a midline tracheotomy inferior to the thyroid isthmus is performed. Which of the following vessels are most likely to be present at the site of incision and will need to be cauterized? A. Middle thyroid vein and inferior thyroid artery B. Inferior thyroid artery and inferior thyroid vein C. Inferior thyroid vein and thyroidea ima artery D. Cricothyroid artery and inferior thyroid vein E. Left brachiocephalic vein and inferior thyroid artery

C

A 36-year-old female racquetball player is admitted to the hospital after being struck in the orbital region. Radiographic examination reveals a blow-out fracture of the medial wall of the orbit. Physical examination also reveals that the pupil of the affected eye cannot be turned laterally. Which of the following muscles is most likely injured or trapped? A. Lateral rectus B. Medial and inferior recti C. Medial rectus D. Medial rectus and superior oblique E. Inferior rectus

C

A 40-year-old woman presents with severe headaches and dizziness. An MRI reveals a brain tumor, and a biopsy confirms it as a melanoma. She dies 2 months later. Pigmented lesions are not seen on her skin or scalp at the time of diagnosis or during postmortem examination. Which of the following is the most likely source of the malignant melanoma cells? A. Superior sagittal sinus B. Sphenoidal sinus C. Retina of the eye D. Pituitary gland E. Thymus

C

A 43-year-old man is admitted to the emergency department with a fracture of the base of his skull. A thorough physical examination reveals that a number of structures have been injured, possibly including the right greater petrosal nerve. Which of the following conditions needs to be identified during physical examination to confirm the diagnosis of greater petrosal nerve injury? A. Partial dryness of the mouth due to lack of salivary secretions from the submandibular and sublingual glands B. Partial dryness of the mouth due to lack of salivary secretions from the parotid gland C. Dryness of the right cornea due to lack of lacrimal secretion D. Loss of taste sensation from the right anterior two thirds of the tongue E. Loss of general sensation from the right anterior two thirds of the tongue

C

A 43-year-old man is diagnosed with laryngeal carcinoma. A surgical procedure is performed and the tumor is successfully removed from the larynx. The right ansa cervicalis is anastomosed with the right recurrent laryngeal nerve in order to reinnervate the muscles of the larynx and restore phonation. Which of the following muscles will most likely be paralyzed after this operation? A. Sternocleidomastoid B. Platysma C. Sternohyoid D. Trapezius E. Cricothyroid

C

A 45-year-old female is admitted to the hospital with severe headaches, dizziness, and vomiting. Radiographic examination reveals an intracranial tumor. Upon physical examination the patient has dryness of the nasal and paranasal sinuses, loss of lacrimation, and loss of taste from the anterior two thirds of the tongue. Which of the following structures is most likely involved with the tumor? A. Auriculotemporal nerve B. Lesser petrosal nerve C. Facial nerve D. Inferior salivatory nucleus E. Pterygopalatine ganglion

C

A 45-year-old man was suffering from trigeminal neuralgia (tic douloureux). The pain was so severe that the patient had considered suicide as a way to escape the pain. Even light, gentle stimuli to the skin between the lower eyelid and the upper lip resulted in severe, agonizing pain. It was decided to lesion the nerve branch involved by injection of alcohol into the nerve. To reach the nerve, the needle will most likely need to be inserted through which of the following openings? A. Foramen ovale B. Foramen spinosum C. Infraorbital foramen D. Mandibular foramen E. Foramen magnum

C

A 45-year-old man with a complaint of ear pain and difficulty hearing is diagnosed with tonsillitis. Otoscopic examination reveals fluid in the middle ear cavity. Hypertrophy of which of the following structures would be most likely to compromise the drainage of the auditory tube? A. Lingual tonsil B. Palatine tonsil C. Pharyngeal tonsil D. Superior constrictor muscle E. Uvula

C

A 48-year-old male patient complains of diplopia (double vision). On neurologic examination he is unable to adduct his left eye and lacks a corneal reflex on the left side. Where is the most likely location of the lesion resulting in the symptoms? A. Inferior orbital fissure B. Optic canal C. Superior orbital fissure D. Foramen rotundum E. Foramen ovale

C

A 5-year-old boy fell from a tree and was admitted to the emergency department unconscious. When an emergency tracheostomy was performed, profuse dark venous bleeding suddenly occurred from the midline incision over the trachea. Which of the following vessels was most likely accidentally cut? A. Superior thyroid vein B. Inferior thyroid vein C. Left brachiocephalic vein D. Middle thyroid vein E. Jugular arch connecting the anterior jugular veins

C

A 54-year-old man is admitted to the hospital with severe headaches. A CT scan reveals a tumor in his brain occupying a portion of the anterior cranial fossa. Which of the following is responsible for the sensation of pain from headache in this case? A. Meningeal branches of the maxillary nerve B. Meningeal branches of the mandibular nerve C. Meningeal branches of the ethmoidal nerve D. Tentorial nerve E. C2 and C3 fibers

C

A 54-year-old man was admitted to the emergency department after he was struck by an automobile. Radiographic examination revealed a fracture through the crista galli of the anterior cranial fossa, resulting in slow, local bleeding. Which of the following is the most likely source of bleeding? A. Middle meningeal artery B. The great cerebral vein of Galen C. Superior sagittal sinus D. Straight venous dural sinus E. Superior ophthalmic vein

C

A 55-year-old woman is diagnosed with a tumor at the base of the skull, resulting in a decrease in tear production. Which of the following nerves is most likely injured? A. Chorda tympani B. Deep petrosal C. Greater petrosal D. Lesser petrosal E. Nasociliary

C

A 55-year-old woman visits the outpatient clinic complaining of loss of sensation in the posterior third of her tongue. Radiographic examination reveals Eagle's syndrome, in which the styloid process and stylohyoid ligament are elongated and calcified. Which of the fol- lowing nerves is most likely affected by Eagle's syndrome in this patient? A. Vagus B. Facial C. Glossopharyngeal D. Hypoglossal E. Vestibulocochlear

C

A 58-year-old man is admitted to the emergency department with progressive unilateral hearing loss and ringing in the affected ear (tinnitus) of 4 months' duration. Radiographic examination reveals a tumor at the cerebellopontine angle. Which of the following nerves is most likely affected? A. Vagus B. Hypoglossal C. Vestibulocochlear D. Glossopharyngeal E. Trigeminal

C

A 59-year-old painter fell from the scaffolding and was admitted to the emergency department in an unconscious condition. An emergency tracheostomy is performed and brisk arterial bleeding suddenly occurs from the midline incision over the trachea. Which of the following vessels was most likely cut accidentally?. A. Inferior thyroid branch of thyrocervical trunk B. Cricothyroid branch of the superior thyroid artery C. Thyroidea ima artery D. Middle thyroid vein E. Jugular arch connecting the anterior jugular veins

C

A 6-year-old male child, whose medical history includes a complicated delivery, has a permanently tilted head posture, with the right ear near the right shoulder and the face turned upward and to the left. Which of the following muscles was most likely damaged during birth? A. Anterior scalene B. Omohyoid C. Sternocleidomastoid D. Trapezius E. Platysma

C

A 63-year-old man with hearing loss in his left ear complains of a loss of taste and drooling from the left side of his mouth. A CT scan shows a tumor compress- ing the nerve entering the skull through which of the following openings? A. Foramen ovale B. Foramen rotundum C. Internal acoustic meatus D. Jugular foramen E. Superior orbital fissure

C

A 65-year-old man is admitted to the emergency department after an episode of a transient ischemic attack. Radiographic examination reveals an aneurysm in the region between the posterior cerebral artery and superior cerebellar artery. Which of the following nerves will most likely be compressed from the aneurysm? A. Trochlear B. Abducens C. Oculomotor D. Vagus E. Optic

C

A 65-year-old man is admitted to the emergency department after his head hit the dashboard in an automobile collision. Radiographic and physical examinations reveal that the inferior alveolar nerve is injured at its origin. Which of the following muscles would most likely be paralyzed as a result? A. Geniohyoid B. Hyoglossus C. Mylohyoid D. Stylohyoid E. Palatoglossus

C

A 67-year-old man visits the outpatient clinic with hearing problems. During physical examination a Rinne test for hearing is performed by placing a tuning fork on his head to test for bone conduction. Upon what specific point should the tuning fork be placed to test conduction? A. Temporal bone B. Frontal bone C. Mastoid process D. External occipital protuberance E. Vertex of the head

C

A 68-year-old woman visits the outpatient clinic with a complaint of chronic dizziness and headaches. Cranial and cervical angiography (Fig. 7-11) reveals an occluded vessel. Which of the following vessels is most likely occluded? A. External carotid B. Internal carotid C. Common carotid D. Vertebral E. Superior thyroid

C

A 7-year-old boy was suffering from a severe infection of the middle ear (otitis media), which spread to the mastoid air cells (mastoiditis). Surgery was required but resulted in the following: right corner of the mouth drooping, unable to close his right eye, food collection in his right oral vestibule. Which nerve was injured? A. Glossopharyngeal B. Vagus C. Facial D. Maxillary division of the trigeminal nerve E. Mandibular division of the trigeminal nerve

C

A 73-year-old male patient visits the outpatient clinic with a complaint of progressive, painless loss of vision. Radiographic examination reveals thrombophlebitis of the cavernous sinus. Through which of the following structures must a thrombus pass to cause the symptoms of this patient? A. Subarachnoid space B. Central artery of the retina C. Central vein of the retina D. Optic chiasm E. Ciliary ganglion

C

An 11-year-old boy visits the outpatient clinic with a history of recurrent infections of his tonsils. Which of the following lymph nodes is most likely to first become visibly enlarged during tonsillitis? A. Submandibular B. Parotid C. Jugulodigastric D. Submental E. Preauricular

C

An 8-year-old boy had an extensive mastoidectomy due to an infection that did not respond to antibiotics. Postoperatively he had Bell's palsy (facial paralysis), and one of the features was that saliva tended to accumulate in the vestibule of his oral cavity and dribble from the corner of his mouth. Which of the following muscles was paralyzed to allow this condition to occur? A. Zygomoaticus major B. Orbicularis oculi C. Buccinator D. Levator palpebrae superioris E. Orbicularis oris

C

During the routine ophthalmologic exam, the globe, the retina, and the cornea of each eye are tested. Which of the following nerves must be functioning properly if the patient is to be able to turn the eye laterally (abduction) without difficulty and without upward or downward deviation? A. Superior division of oculomotor, ophthalmic nerve, abducens nerve B. Trochlear nerve, abducens nerve, nasociliary nerve C. Inferior division of oculomotor, trochlear, abducens D. Oculomotor and ophthalmic nerves E. Superior division of oculomotor, trochlear, and abducens nerves

C

The arterial circle (of Willis) contributes greatly to cerebral arterial circulation when one primary artery becomes occluded by atherosclerotic disease. Which of the following vessels does not contribute to the circle? A. Anterior communicating artery B. Posterior communicating artery C. Middle cerebral artery D. Internal carotid artery E. Posterior cerebral artery

C

A 1-day-old infant who exhibits absence of the ocular lens is admitted to the pediatric intensive care unit. Laboratory examination reveals a mutation in the PAX6 gene. Which of the following conditions is the most likely diagnosis? A. Cyclopia B. Coloboma C. Anophthalmia D. Aphakia and aniridia E. Microphthalmia

D

A 17-year-old female was admitted to the hospital with a high fever. Following intravenous administration of antibiotics, a routine CT scan revealed a "thoracic outlet" syndrome. Which symptom would most likely result from this syndrome? A. Problems with respiration because of pressure on the phrenic nerve B. Reduced blood flow to the thoracic wall C. Reduced venous return from the head and neck D. Numbness in the upper limb E. Distention of the internal jugular vein

D

A 17-year-old woman is admitted to the hospital with tonsillitis. A tonsillectomy is performed and the patient complains postoperatively of ear pain. Which of the following nerves was most likely injured during the surgical procedure? A. Auriculotemporal B. Lesser petrosal C. Vagus D. Glossopharyngeal E. Chorda tympani

D

A 21-year-old male baseball player is brought to the emergency department after feeling severe dizziness. During physical examination the patient demonstrates lack of equilibrium and memory impairment. A 3-cm wound is noted in his scalp from an injury suffered in a game several weeks earlier. A lumbar puncture does not reveal blood in the cerebrospinal fluid. Which of the following is the most likely diagnosis? A. The middle meningeal artery was torn, resulting in epidural hematoma. B. There is a fracture in the pterion with injury to the adjacent vasculature. C. The injury resulted in the bursting of a preexisting aneurysm of the anterior communicating artery of the cerebral circle. D. A cerebral vein is torn. E. The cavernous sinus has a thrombus.

D

A 21-year-old man was brought to the emergency department because of severe epistaxis (nosebleed) from the nasal septum. This area, knows as Kiesselbach's (or Little's) area, involves mostly anastomoses between which of the following arteries? A. Ascending palatine and ascending pharyngeal B. Posterior superior alveolar and accessory meningeal C. Lateral branches of posterior ethmoidal and middle meningeal D. Septal branches of the sphenopalatine and superior labial E. Descending palatine and tonsillar branches of the pharyngeal

D

A 32-year-old woman is admitted to the hospital after losing consciousness and collapsing in the middle of the street. A neurologic examination reveals absence of the accommodation reflex of her right eye. Which of the following is most likely involved in the pathology in this patient? A. Superior salivatory nucleus B. Superior cervical ganglion C. Nervus intermedius D. Edinger-Westphal nucleus E. Trigeminal ganglion

D

A 34-year-old man is admitted to the hospital with severe headaches, dizziness, and vomiting. Imaging studies reveal a tumor at the hypoglossal canal. Which of the following muscles will most likely be affected? A. Geniohyoid B. Mylohyoid C. Palatoglossus D. Genioglossus E. Thyrohyoid

D

A 34-year-old woman is admitted to the hospital with a large mass at her thyroid gland. Ultrasound examination reveals a benign tumor. Twenty-four hours following a partial thyroidectomy, in which the inferior thyroid artery was also ligated, the patient speaks with a hoarse voice and has difficulty in breathing on exertion. Which of the following nerves was most likely injured during the surgical procedure? A. Internal branch of superior laryngeal B. Ansa cervicalis C. Ansa subclavia D. Recurrent laryngeal E. External branch of superior laryngeal

D

A 40-year-old woman suffers severe head trauma in a car crash. After radiographic examination she is diagnosed with a fracture of the temporal bone resulting in a lesion of the facial nerve proximal to the origin of the chorda tympani in the posterior wall of the tympanic cavity. Which of the following functions would most likely remain intact in this patient? A. Control of muscles in lower half of face B. Control of secretions by submandibular gland C. Taste sensation from anterior two thirds of tongue D. Tear production by the lacrimal gland E. Voluntary closure of the eyelid

D

A 45-year-old woman visits the outpatient clinic with past history of dysphagia, nighttime fits of coughing, repeated chest infections, and a palpable swelling in her neck. Radiographic examination reveals the presence of a congenital pharyngeal pouch. Between which muscles is this pouch located? A. Between styloglossus and stylopharyngess B. Between palatoglossal arch and median glos- soepiglottic fold C. Between upper and middle pharyngeal constrictors D. Between the cricopharyngeal and thyropharyngeal portions of inferior pharyngeal constricter E. Between the middle and inferior pharyngeal constrictors

D

A 5-year-old boy is admitted to the hospital with otitis media. Otoscopic examination reveals a bulging and inflamed eardrum. It is decided to incise the tympanic membrane to relieve the painful pressure and allow drainage of the infection associated with otitis media. Which of the following is the best location to make an opening (myringotomy) for drainage? A. The anterior superior quadrant of the eardrum B. The posterior superior quadrant of the ear- drum C. Directly through the site of the umbo D. The posterior inferior quadrant of the eardrum E. A vertical incision should be made in the eardrum, from the 12 o'clock position of the rim of the eardrum to the 6 o'clock position of the rim.

D

A 50-year-old woman complained of pain over her chin and lower lip. A few days later small vesicles appeared over the same area and soon began erupting. She was diagnosed with a dermatomal herpes zoster inflammation (shingles). Which of the following nerves was most likely responsible for the transmission of the virus in this case? A. Auriculotemporal B. Buccal C. Lesser petrosal D. Mental E. Infraorbital

D

A 54-year-old man is admitted to the emergency department with a fracture at the frontozygomatic suture. During physical examination the eyelid of the patient exhibits multiple lacerations and the sclera contains small fragments from his broken glasses. What site would be preferable for needle insertion to anes- thetize the orbital contents and then the area of the eyelid injury? A. Into the sclera in the limbic region and also into the infraorbital foramen B. Into the lacrimal fossa and also beneath the lateral bulbar conjunctiva C. Into the supraorbital foramen and also into the lacrimal caruncle D. Through the upper eyelid deeply toward the orbital apex and also between the orbital septum and the palpebral musculature laterally E. Directly posteriorly through the anulus ten- dineus and superior orbital fissure

D

A 55-year-old male has a complaint of left-sided maxillary tooth pain. A dental examination reveals no abnormalities of his teeth. During physical examination tapping on his right maxilla elicits sharp pain on the right side of his face. The patient reports that he has no allergies. Which of the following conditions will be the most likely diagnosis? A. Sphenoid sinusitis B. Anterior ethmoidal sinusitis C. Posterior ethmoidal sinusitis D. Maxillary sinusitis E. Frontal sinusitis

D

A 55-year-old man is admitted to the neurosurgical clinic for a scheduled removal of a tumor in the left jugular canal. Postoperatively, the patient has no gag reflex when the ipsilateral pharyngeal wall is stimulated, although the pharynx moved upward, and a gag reflex resulted when the right pharyngeal wall was stimulated. The uvula was deviated to the right and the left vocal cord had drifted toward the midline. Which of the following structures will contain the neural cell bodies for the motor supply of the paralyzed muscles? A. Nucleus solitarius B. Trigeminal motor nucleus C. Dorsal motor nucleus D. Nucleus ambiguus E. Superior or inferior ganglia of vagus

D

A 55-year-old woman visits the outpatient clinic with a swelling in her neck. Radiographic and ultrasound examinations reveal a benign thyroid gland tumor. Three days after thyroidectomy the patient shows air bubbles in the CT of her brain. Which of the following is the most likely cause of the air bubbles in this case? A. Injury to inferior thyroid artery B. Injury to inferior and superior thyroid arteries C. Injury to superior thyroid artery and vein D. Injury to superior and middle thyroid veins E. Injury to superior, middle, and inferior thyroid veins

D

A 56-year-old female complains of diplopia (double vision) when walking down stairs. A lesion of which of the following nerves is most likely responsible for this patient's complaint? A. Optic B. Oculomotor C. Abducens D. Trochlear E. Frontal

D

A 56-year-old man visits the outpatient clinic with a complaint of severe headaches and ear pain. Radiographic examination reveals a tumor in the middle ear cavity, invading through the bony floor. Which of the following structures will most likely be affected? A. The cochlea and lateral semicircular canal B. The internal carotid artery C. The sigmoid venous sinus D. The internal jugular bulb E. The aditus ad antrum of the mastoid region and the facial nerve

D

A 59-year-old man is admitted to the emergency department with acute pain on his mandible. An MRI examination reveals an acute inflammation of the TMJ due to arthritis. Which of the following muscles will most likely be affected by the inflammatory process of the TMJ? A. Temporalis B. Medial pterygoid C. Masseter D. Lateral pterygoid E. Buccinator

D

A 63-year-old man had his prostate gland tumor removed 2 years before his present admission to the hospital, complaining of various neurologic problems, including headache. Radiographic examination reveals that the cancer has spread from the pelvis to the posterior cranial fossa by way of the internal vertebral venous plexus (of Batson). During physical examination the patient's right shoulder droops noticeably lower than the left, he exhibits considerable weakness in turning his head to the left, and his tongue points to the right when he attempts to protrude it directly from his mouth. There are no other significant findings. Which of the following nerves are most likely affected? A. Right vagus, right accessory, and right hypoglossal nerves B. Left accessory, right glossopharyngeal, right vagus, and left hypoglossal nerves C. Left hypoglossal, right trigeminal, and left glossopharyngeal nerves D. Right accessory and right hypoglossal nerves E. Left facial, left accessory, right accessory, and vagus nerves

D

A 65-year-old male is admitted to the hospital three weeks after a "small bump of his head" according to his narrative. He suffered the accidental bump from a low-hanging branch while driving his tractor through the apple orchard during harvesting season. During physical examination the patient displays mental confusion and poor physical coordination. Radiographic examination reveals leakage from a cerebral vein over the right cerebral hemisphere. From what type of bleeding is the patient most likely suffering? A. Subarachnoid bleeding B. Epidural bleeding C. Intracerebral bleeding into the brain parenchyma D. Subdural bleeding E. Bleeding into the cerebral ventricular system

D

A 7-day-old infant is admitted to the pediatric intensive care unit with microphthalmia. Which of the following is the most likely cause of this condition? A. Infection with rubella virus B. Choroid fissure failed to close C. Persistent hyaloid artery D. Toxoplasmosis infection E. Epstein-Barr virus infection

D

A 7-year-old boy with a high fever is brought to the pediatrician. During physical examination the patient complains of pain in his ear. His throat appears red and inflamed, confirming the diagnosis of pharyngitis. Which of the following structures provided a pathway for the infection to spread to the tympanic cavity (middle ear)? A. Choanae B. Internal acoustic meatus C. External acoustic meatus D. Pharyngotympanic tube E. Pharyngeal recess

D

A 70-year-old man is admitted to the hospital with severe headaches. During physical examination he has difficulty coughing and swallowing. A CT scan shows a tumor affecting a cranial nerve. Which nerve is most likely affected? A. Mandibular B. Maxillary C. Glossopharyngeal D. Vagus E. Hypoglossal

D

A newborn infant is finally delivered with forceps after a difficult delivery. Upon physical examination of the newborn a cephalohematoma is noted from rupture of small periosteal arteries. Between which of the following layers of tissue does the blood accumulate? A. Between skin and dense connective tissue layer B. Between loose connective tissue layer and galea aponeurotica C. Between galea aponeurotica and pericranium D. Between pericranium and calvaria E. At the subcutaneous layer

D

A young couple hiking in a wilderness area discovered the body of a man apparently in his 20s. He appeared to have been dead a few days, but animal predation was minimal. A postmortem examination was performed by the county medical examiner, and no evidence of penetrating wounds (bullet, lacerations, etc.) was found. A plain radiograph showed a fractured hyoid bone, but the calvaria and other bones appeared to be intact. Which of the following is the most likely cause of death? A. Myocardial infarction (heart attack) B. A fall from a height that resulted in fatal internal bleeding C. Subdural hematoma D. Strangulation E. Ingestion of a poisonous substance

D

An 8-year-old boy was suffering from a severe infection of the right middle ear. Within the course of a week, the infection had spread to the mastoid antrum and the mastoid air cells. The organisms did not respond to antibiotics, so the surgeon decided to perform a radical mastoid operation. Following the operation, it was noticed that the boy's face was distorted. The mouth was drawn upward to the left, and he was unable to close his right eye. Saliva tended to accumulate in his right cheek and dribble from the corner of his mouth. What structure was most likely damaged during the operation? A. Mandibular nerve B. Parotid duct C. Vagus nerve D. Facial nerve E. Glossopharyngeal nerve

D

Where is the location of the postganglionic parasympathetic neural cell bodies that directly innervate the parotid gland? A. Trigeminal (semilunar, Gasserian) ganglion `B. Inferior salivatory nucleus C. Superior cervical ganglion D. Otic ganglion E. Submandibular ganglion

D

A 22-year-old male is admitted to the emergency department and intubated. An endotracheal tube is passed through an opening between the vocal folds. What is the name of this opening? A. Piriform recess B. Vestibule C. Ventricle D. Vallecula E. Rima glottidis

E

A 22-year-old woman visits the outpatient clinic with a sinus infection of two weeks' duration. Physical examination reveals that the patient has focal inflammation, with mucosal edema in the inferior nasal meatus. Drainage from which of the following structures is most likely to be obstructed by this inflammation and edema? A. Anterior ethmoidal air cells B. Frontonasal duct C. Maxillary sinus D. Middle ethmoidal air cells E. Nasolacrimal duct

E

A 32-year-old man is admitted to the hospital with severe headache and visual problems. The dilator pupillae muscle, the smooth muscle cell fibers of the superior tarsal muscle (of Müller, part of the levator palpebrae superioris), and the smooth muscle cells of the blood vessels of the ciliary body are supplied by efferent nerve fibers. Which of the following structures contains the neural cell bodies of these fibers? A. Pterygopalatine ganglion B. IML (lateral horn) C1 to C4 C. Geniculate ganglion D. Nucleus solitarius E. Superior cervical ganglion

E

A 34-year-old female is admitted to the hospital because of hoarseness for the past 3 months. Radiographic examination reveals a cancerous growth in her larynx with no evidence of metastasis. In addition, the area in which the tumor is growing is characterized by very limited lymphatic drainage. Which of the following locations is most likely to contain a tumor with these characteristics? A. Anterior commissure of the vocal ligaments B. Interarytenoid fold C. Laryngeal ventricle D. Cricothyroid ligament E. Middle segment of the vocal cord

E

A 40-year-old unconscious man is admitted to the emergency department after being hit in the head with a baseball. A CT scan examination reveals a fractured pterion and an epidural hematoma. Branches of which of the following arteries are most likely to be injured? A. External carotid B. Superficial temporal C. Maxillary D. Deep temporal E. Middle meningeal

E

A 43-year-old male is admitted to the hospital complaining of diplopia (double vision) when walking down stairs. During physical examination of the extraocular muscles the patient experiences diplopia, and when he is asked to turn his right eye inward toward his nose and look down, he is able to look inward but not down. Which nerve is most likely involved? A. Abducens B. Nasociliary C. Oculomotor, inferior division D. Oculomotor, superior division E. Trochlear

E

A 45-year-old female is admitted to the emergency department with visual problems when she walks down stairs. During physical examination the patient exhibits weakness of her downward medial gaze. Cerebral arteriography and CT images indicate that a nerve is being compressed by an arterial aneurysm just inferior to the tentorium cerebelli. Which of the following arteries and nerves is most likely being compressed? A. Internal carotid artery/abducens nerve B. Middle cerebral artery/oculomotor nerve C. Posterior cerebral artery/ophthalmic nerve D. Basilar artery/ophthalmic nerve E. Superior cerebellar artery/trochlear nerve

E

A 45-year-old male construction worker slips and falls on a nail protruding from a board. The nail penetrates the skin overlying the submental triangle lateral to the midline. Which of the following muscles would be the last to be penetrated? A. Platysma B. Mylohyoid C. Anterior belly of the digastric D. Geniohyoid E. Genioglossus

E

A 45-year-old woman is admitted to the hospital for severe ear pain. Physical examination reveals chronic infection of the mastoid air cells (mastoiditis). The infection can erode the thin layer of the bone be- tween the mastoid air cells and the posterior cranial fossa and spread most commonly into which of the following venous structures? A. Superior sagittal sinus B. Inferior sagittal sinus C. Straight sinus D. Cavernous sinus E. Sigmoid sinus

E

A 49-year-old woman is admitted to the hospital with headaches and dizziness. Radiographic examination reveals a tumor in the jugular canal. Upon physical examination, when the right side of the pharyngeal wall is touched with a tongue depressor, the uvula deviates to the left and the left pharyngeal wall contracts upward. When the left pharyngeal wall is touched, the response is similar. Which of the following nerves is most likely to have been injured by the tumor? A. Right glossopharyngeal B. Left glossopharyngeal C. Right mandibular D. Left hypoglossal E. Right vagus

E

A 52-year-old man is admitted to the emergency department with a bullet wound in the infratemporal fossa. During physical examination it is observed that the patient has lost unilateral sensation of hot, cold, pain, and pressure from the front part of the tongue, but taste and salivary function are preserved. Which of the following is the most likely diagnosis? A. The facial nerve was transected distal to the origin of the chorda tympani. B. Receptors for hot, cold, pain, and pressure are absent in the patient's tongue. C. The glossopharyngeal nerve has been injured in the pharynx. D. The superior laryngeal nerve was obviously severed by the bullet. E. The lingual nerve was injured at its origin near the foramen ovale.

E

A 54-year-old male is diagnosed with an aneurysm of the basilar artery close to the cavernous sinus. An anterior approach to the sella turcica through the nasal cavity is performed. Through which of the following routes is the surgeon most likely to enter the cranial cavity? A. Cribriform plate B. Cavernous sinus C. Frontal sinus D. Maxillary sinus E. Sphenoidal sinus

E

A 55-year-old woman is admitted to the hospital with difficulty swallowing. Physical examination reveals that the patient has episodes of severe headaches and frequently aspirates fluids when drinking them. A radiographic examination reveals a skull base tumor occupying the space behind the jugular foramen. Involvement of which of the following structures is most likely responsible for the findings in the patient? A. Ansa cervicalis B. Cervical sympathetic trunk C. External laryngeal nerve D. Hypoglossal nerve E. Vagus nerve

E

A 60-year-old man presents with a swelling in his neck. Physical examination and biopsy show a benign tumor in his piriform recess. The mucosa of the piriform recess must be anesthetized during the removal of the tumor. Which nerve supplies general sensation to the mucous membrane of the laryngeal vestibule and piriform recesses? A. External laryngeal B. Glossopharyngeal C. Hypoglossal D. Inferior laryngeal E. Internal laryngeal

E

A 65-year-old woman is admitted to the hospital with signs of cavernous sinus thrombosis. Radiographic examination reveals an aneurysm of the internal carotid artery within the cavernous sinus. During physical examination what sign would one first expect to see if nerve compression has occurred within the cavernous sinus? A. Inability to gaze downward and medially on the affected side B. Complete ptosis of the superior palpebra C. Bilateral loss of accommodation and loss of direct pupillary reflex D. Ipsilateral loss of the consensual corneal reflex E. Ipsilateral paralysis of abduction of the pupil

E

A 70-year-old man has a biopsy of a growth on his lower lip. The biopsy reveals a squamous cell carcinoma. Which lymph nodes will most likely be first involved in the spread of the cancer cells? A. Occipital B. Parotid C. Retropharyngeal D. Jugulodigastric E. Submental

E

A 70-year-old man is admitted to the hospital with chronic headache and enlarged lymph nodes. A CT scan shows a tumor at the jugular foramen. Which of the fol- lowing would be the most likely neurologic deficit? A. Loss of tongue movements B. Loss of facial expression C. Loss of sensation from the face and the scalp D. Loss of hearing E. Loss of gag reflex

E