H&N Practice MCQs
The carotid bifurcation can be found in which of the following regions of the neck? A. Anterior cervical triangle B. Sternocleidomastoid triangle C. Omoclavicular triangle D. Occipital triangle E. Posterior cervical triangle
A. Anterior cervical triangle Answer: The anterior cervical triangle contains the submandibular, submental, muscular, and carotid triangles.
Your patient arrives to the ED via ambulance due to a basilar skull fracture sustained in an auto racing accident. You notice that he has a bulging, pulsing eyeball and are immediately concerned that there is arterial blood in the cavernous sinus. Which of the following cranial nerves would NOT be affected by injury to the cavernous sinus? A. CN II B. CN III C. CN IV D. CN V E. CN VI
A. CN II Answer: CN III, IV, V, and VI are all close associated with the cavernous sinus and would likely be traumatized in this situation.
A radiology resident identifies an aneurysm of the posterior cerebral artery in one of her patients. Which nerve is at risk due to this finding? A. CN III B. CN IV C. CN V2 D. CN V3 E. CN IX
A. CN III Answer: CN III passes through the posterior cerebral and superior cerebellar arteries. Compression by one of these vessels could potentially damage the nerve.
Which of the following foramina is not associated with the sphenoid bone? A. Carotid canal B. Optic canal C. Foramen ovale D. Foramen rotundum E. Pterygoid canal
A. Carotid canal Answer: The carotid canal is located in the temporal bone.
You are pediatrician who informs your 4 year-old patient that she needs a shot so that she does not contract measles on her family's upcoming trip to Disneyland. She does not like this and pouts, sticking out her lower lip. Which of the following muscles is involved in this action? A. Mentalis B. Risorius C. Levator labii superioris D. Depressor labii superioris E. Platysma
A. Mentalis Answer: The mentalis elevates and protrudes the lower lip.
The external carotid artery is ligated during a surgical procedure. Blood flow to which of the following vessels will NOT be reduced? A. Ophthalmic artery B. Lingual artery C. Occipital artery D. Maxillary artery E. Ascending pharyngeal artery
A. Ophthalmic artery Answer: The ophthalmic artery is a branch of the internal carotid artery.
The pterion runs along which of the following sutures? A. Sphenoparietal B. Sphenosquamous C. Sphenofrontal D. Coronal E. Squamous
A. Sphenoparietal Answer: The pterion rests at the juncture of the frontal, parietal, sphenoid, and temporal bones along the sphenoparietal suture.
Which of the following statements regarding the dural venous sinuses is TRUE? A. They drain into the internal jugular of the neck. B. They contain an elaborate series of valves designed to stabilize intracranial pressure. C. They form between the dura and arachnoid matter. D. They drain the outer ear. E. The transverse sinus runs in the attached superior border of the falx cerebri.
A. They drain into the internal jugular of the neck. Answer: B - They are valveless C - They form between the meningeal and periosteal layers of the dura mater. D - They drain the inner ear. E - The superior sagittal sinus runs in the attached superior border of the falx cerebri.
Abducent nerve palsy would result in compromise of which of the following eye movements? A. Adduction B. Abduction C. Elevation D. Depression E. All of the above
B. Abduction Answer: CN VI only supplies the lateral rectus muscle, which controls muscle abduction.
While reviewing a patient's CT scan with Dr. Makris, you notice a small tumor on the patients pituitary gland that was not there 3 months ago. Dr. Makris then asks you which cranial nerve is likely to be affected by the tumor? A. CN I B. CN II C. CN III D. CN V E. CN VII
B. CN II Answer: The optic chiasm is located just inferior and anterior to the pituitary gland, so a pituitary tumor could potentially compress CN II, compromising vision.
A dentist is interested in repairing the maxillary incisor teeth of her patients. Which nerve block is most suitable for this procedure? A. CN V1 B. CN V2 C. CN V3 D. CN VII E. CN IX
B. CN V2 Answer: An infra-orbital nerve block (CN V2) would successfully anesthetize the maxilla and associated structures.
Your patient complains of a sharp, electric, unilateral pain on the right side of her face, right below her eye. She reports that it seems to become worse when she is applying her makeup. Which cranial nerve is most likely the source of her troubles? A. CN V1 B. CN V2 C. CN V3 D. CN VII E. CN III
B. CN V2 Answer: This patient has trigeminal neuralgia of CN V2.
Which of the following foramina is a point of exit for CN V3? A. Superior orbital fissure B. Foramen ovale C. Foramen rotundum D. Foramen lacerum E. Stylomastoid foramen
B. Foramen ovale Answer: Foramen ovale and the foramen spinosum are both foramina of exit for the mandibular branch of CN V.
The optic chiasm passes through which of the following fossa? A. Anterior cranial fossa B. Middle cranial fossa C. Posterior cranial fossa D. A and B E. None of the above
B. Middle cranial fossa Answer: The optic chiasm rests in the middle cranial fossa along with the temporal lobes and pituitary gland.
All of the following structures pass through the superior orbital fissure EXCEPT: A. Superior ophthalmic vein B. Opthalmic artery C. Lacrimal nerve D. Trochlear nerve E. Abducent nerve
B. Opthalmic artery Answer: The opthalmic artery follows the course of the optic nerve through the optic canal.
A patient arrives in the trauma bay with a stab wound to the right side of his neck. You are able to appreciate that that the blade pierced the space near the anterior scalene muscle. Which nerve is in jeopardy? A. Vagus B. Phrenic C. Accessory D. Hypoglossal E. Facial
B. Phrenic Answer: On the right side, the phrenic is located on the anterior face of the anterior scalene.
Your patient has an occlusion compromising blood flow to the subclavian artery. Which of the following structures is NOT at risk for ischemia? A. The cerebellum B. Sternocleidomastoid muscle C. Thyroid gland D. Parathyroid gland E. Larynx
B. Sternocleidomastoid muscle Answer: The cerebellum is supplied by the posteroinferior cerebellar arteries (from the vertebral artery). The Thyroid gland, parathyroid gland, and larynx are supplied by the inferior thyroid artery (from the thyrocervical trunk). The sternocleidomastoid is supplied by the occipital and superior thyroid arteries (from the external carotid) and would, therefore, be less susceptible to damage from a subclavian occlusion.
Which of the following statements regarding the ethmoid bone is FALSE? A. It contains ethmoid air cells. B. The crista galli forms part of the nasal septum. C. Superior and middle nasal concha form the lateral wall of the nasal cavity. D. It forms part of the anterior cranial fossa. E. The ethmoid contributes to the medial wall of the orbit.
B. The crista galli forms part of the nasal septum. Answer: The perpendicular plate forms parts of the nasal septum.
Which of the following is NOT a branch of the maxillary artery? A. Inferior alveolar artery B. Zygomatico-orbital artery C. Masseteric artery D. Descending palatine artery E. Sphenopalatine artyer
B. Zygomatico-orbital artery Answer: The zygomatico-orbital artery is a branch of the superficial temporal artery.
Which of the following muscles is pierced by the parotid duct on its journey to the oral cavity? A. Masseter B. Temporalis C. Buccinator D. Medial pterygoid E. Lateral pterygoid
C. Buccinator Answer: The parotid duct runs along the anterior border of the masseter and then pierces the buccinator to enter the oral cavity.
Which of the following nerves passes through the pterygopalatine fossa? A. CN III B. CN V1 C. CN V2 D. CN v3 E. CN VII
C. CN V2 Answer: The maxillary nerve (CN V2) passes through the pterygopalatine fossa, along with the maxillary artery.
Your patient has received a nerve block which results in loss of sensation in the skin and mucous membrane of the lower lip, the chin, and gingiva. Which cranial nerve has most likely been blocked? A. CN V1 B. CN V2 C. CN V3 D. CN VII E. CN IX
C. CN V3 Answer: This is an inferior alveolar nerve block, which anesthetizes the inferior alveolar nerve, a branch of CN V3.
Which branch of the external carotid artery supplies the submandibular gland? A. Superior thyroid artery B. Lingual artery C. Facial artery D. Occipital artery E. Ascending pharyngeal artery
C. Facial artery Answer: The facial artery passes deep to the submandibular gland before crossing the mandible to supply the face.
Which of the following statements is FALSE regarding the temporal bone? A. It encloses the tympanic membrane. B. It contains both a mastoid process and a styloid process. C. Its internal surface boasts grooves for the middle meningeal arteries. D. It forms part of the middle and posterior cranial fossae. E. It contains the internal acoustic meatus, carotid canal, and the stylomastoid foramen.
C. Its internal surface boasts grooves for the middle meningeal arteries. Answer: The parietal bone possesses grooves for the middle meningeal arteries.
Your patient in the emergency department has received a blow to the side of the head, fracturing the pterion. Which structure is at greatest risk for rupture in this case? A. Angular artery B. Facial artery C. Middle meningeal artery D. Internal carotid artery E. Superficial temporal vein
C. Middle meningeal artery Answer: A pterion fracture is a life-threatening emergency because it directly overlies the middle meningeal artery. Death will occur within hours in the case of an untreated middle meningeal artery bleed. Call neurosurgery stat.
Marcia Brady gets hit in the nose with a football and as a consequence has a massive nosebleed. Which of the following vessels is NOT contributing to the bleed? A. Greater palatine artery B. Sphenopalatine artery C. Transverse facial artery D. Lateral posterior nasal arteries E. Septal branches of the sphenopalatine
C. Transverse facial artery Answer: The transverse facial artery supplies the parotid gland and masseter. The rest are branches of the maxillary artery, the primary blood supply to the nose.
Which of the following structures passes through the inferior orbital fissure? A. Lacrimal nerve B. Frontal nerve C. Zygomatic nerve D. Supraorbital nerve E. Anterior ethmoidal nerve
C. Zygomatic nerve Answer: Both the zygomatic and infraorbital nerves pass through the inferior orbital fissure.
Which of the following structures might contribute to a cleft palate if it does not form appropriately during development? A. Maxillary prominence B. Median nasal prominence C. Labial frenula D. A and B E. All of the above
D. A and B Answer: Cleft lip occurs when the maxillary prominence and median nasal prominence do not fuse appropriately during development.
The orbit is drained by which of the following structures? A. Pterygoid venous plexus B. Supraorbital vein C. Dural venous sinuses D. A and C E. All of the above
D. A and C Answer: The pterygoid venous plexus drains areas supplied by the maxillary artery, including the the orbit. Dural venous sinuses drain the deep veins of orbit into the internal jugular vein.
Which branch of the external carotid artery supplies the ear? A. Facial artery B. Angular artery C. Occipital artery D. Ascending pharyngeal artery E. Posterior auricular artery
D. Ascending pharyngeal artery Answer: The ascending pharyngeal artery supplies the pharynx, ear, and deep neck muscles.
The facial vein connects with the pterygoid venous plexus via which vessel(s)? A. Superior ophthalmic vein B. Maxillary vein C. Deep facial vein D. B and C E. All of the above
D. B and C Answer: Due to the facial veins connections with the deep facial vein and maxillary vein, an infection in the face may spread to the pterygoid sinus. Connection between the facial vein and superior ophthalmic vein put the cavernous sinus at risk.
Your arch nemesis is approaching you in the hallway. In order to avoid a confrontation, you immediately look down at the floor, apparently inspecting the tiling. Which of the following muscles are involved in this movement? A. Inferior oblique B. Superior oblique C. Inferior rectus D. B and C E. A and B
D. B and C Answer: The inferior oblique abducts, elevates, and laterally rolls the eyeball (looking up and to the side). The superior oblique and inferior rectus both depress the eyeball.
You are an otolaryngologist treating a patient with an advanced parotid tumor requiring a parotidectomy. While counseling this patient about risks of the surgery, damage to which of the following nerves will likely be included on the list of potential complications? A. CN V1 B. CN V2 C. CN VI D. CN VII E. CN VIII
D. CN VII Answer: The parotid plexus of CN VII innervates the parotid gland.
Your patient comes into the ED with a suspected broken jaw. Which of the following structures is NOT potentially damaged? A. Coronoid process B. Condylar process C. Mental foramen D. Clinoid process E. Mandibular foramen
D. Clinoid process Answer: The clinoid process is part of the sphenoid bone, not the mandible.
Which of the following findings would you NOT expect in a patient who has a lesion of the cervical sympathetic trunk? A. Miosis B. Ptosis C. Facial flushing D. Lacrimation E. Anhydrosis
D. Lacrimation Answer: Lacrimation is under parasympathetic control. The other findings are all symptoms of Horner Syndrome.
Your patient in the emergency room reports that he went to take a big bite of his cheeseburger at lunch and is now unable to close his mouth. Which of the following muscles do you expect to be implicated in his affliction? A. Masseter B. Temporalis C. Medial pterygoid D. Lateral pterygoid E. Masseter
D. Lateral pterygoid Answer: Your patient likely has a dislocated TMJ, resulting from excessive contraction of the lateral pterygoid. The lateral pterygoid is responsible for depressing the mandible, and when it is excessively contracted, the jaw cannot elevate after opening.
Which of the following is the sinus that is most commonly infected? A. Frontal B. Sphenoid C. Ethmoid D. Maxillary E. All sinuses are equally at risk for infection
D. Maxillary Answer: Since the ostia of the maxillary sinus are located high on the superomedial walls, these sinuses are difficult to drain.
Your patient has an infection in the loose connective tissue layer of the scalp. Which of the following structures is responsible for making this a horrible, terrible, really bad situation? A. Deep facial vein B. Retromandibular vein C. Pterygoid venous plexus D. Parietal emissary vein E. None of the above
D. Parietal emissary vein Answer: Emissary veins drain the scalp and access intracranial structures, placing patients at high risk for meningitis. Bad.
All of the following structures pass through the jugular foramen EXCEPT: A. Internal jugular vein B. Glossopharyngeal nerve C. Posterior meningeal artery D. Posterior spinal artery E. Accessory nerve
D. Posterior spinal artery Answer: The posterior spinal artery passes through the foramen magnum
A post-surgical patient in your care has been intubated due to respiratory distress. Before being intubated, it was determined that he was aphonic (unable to speak). You find out the procedure that he had done was a thyroidectomy and suspect that which of the following structures was damaged? A. Phrenic B. Vagus C. CN IX D. Recurrent laryngeal E. CN XII
D. Recurrent laryngeal Answer: The recurrent laryngeal nerve lies immediately posterior to the thyroid.
Which of the following does NOT act as a boundary of the nasal cavity? A.Palatine B. Sphenoid C. Ethmoid D. Maxilla E. All of the above act as boundaries of the nasal cavity
E. All of the above act as boundaries of the nasal cavity
Which of the following muscles could potentially be affected in a patient with Bell palsy? A. Orbicularis oculi B. Buccinator C. Orbicularis Oris D. A and C E. All of the above
E. All of the above. Answer: A-C are all innervated by CN VII which when injured or traumatized results in Bell palsy. This condition is understandably associated with decreases in vision as well as chewing.
During a well-child visit with your 12 month old patient, you notice that her head appears to be taking on an asymmetrical appearance. You are concerned that which of the following sutures has close prematurely? A. Sagittal B. Coronal C. Lambdoid D. A or C E. B or C
E. B or C Answer: Your patient likely has plagiocephaly indicating premature closure of the coronal or lambdoid sutures (or both). This causes an asymmetric appearance. Premature closure of the sagittal sinus results in a long, narrow but symmetrical cranial appearance (scaphocephaly).
Your patient reports that she has been having some difficulty closing her right eye tightly. You perform a corneal reflex test. When the cotton touches her cornea, she moves away but is not able to tightly close her eyelid. Which nerve are you concerned about? A. CN II B. CN III C. CN V2 D. CN V3 E. CN VII
E. CN VII Answer: The corneal reflex does test corneal sensation (CN V1), but your patient clearly felt the sensation of the cotton. The inability to completely contract her orbicularis oculi suggests a CN VII deficit.
During your family medicine rotation, you see a patient who is recovering from a stroke. You notice that his tongue is deviated to one side and appears slightly atrophied. Your attending asks you which nerve is responsible for these findings. You reply with much gusto: A. CN V2! B. CN V3! C. CN IX! D. CN X! E. CN XII!
E. CN XII! Answer: Your attending is duly impressed that you know that hypoglossal nerve damage results in lingual deviation and atrophy.
Which of the following statements regarding the cavernous sinus is FALSE? A. It is located laterally to the sella turnica. B. It is formed between the meningeal and periosteal layers of the dura mater. C. It contains the internal carotid artery. D. Thrombophlebitis of the facial vein can result in acute meningitis due its connection with the cavernous sinus. E. It contains CN V1, V2, and V3
E. It contains CN V1, V2, and V3. Answer: The cavernous sinuses only contain V1 and V2. V3 passes through the foramen ovale.
Which of the following structures are NOT part of the viscerocranium? A. Vomer B. Mandible C. Inferior nasal concha D. Lacrimal E. Sphenoid
E. Sphenoid Answer: The viscerocranium includes the mandible, vomer, paired inferior nasal concha, maxillary, nasal, lacrimal, zygomatic, and palatine bones. Do you see the spend on that list? No? There you go.
You are a geriatrician working in a skilled nursing facility. One of the nurses on your team reports that your patient, Ethyl, is having difficulty chewing due to reported muscle weakness. Which of the following muscles would you be LEAST concerned about in this situation? (Bonus: Which nerve innervates the muscles that you ARE worried about?) A. Temporalis B. Masseter C. Lateral pterygoid D. Medial pterygoid E. Stylohyoid
E. Stylohyoid Answer: Answers A-D are the muscles of mastication and are all involved in elevating and depressing the mandible. They are innervated by CN V3. The stylohyoid (innervated by CN VII) is more important in deglutition than mastication.
Which of the following statements regarding the vertebral arteries is FALSE? A. They are branches of the subclavian artery. B. They join to form the basilar artery. C. They supply the cranial meninges and cerebellum. D. They give rise to the posterior community arteries. E. They supply branches to the cavernous sinus.
E. They supply branches to the cavernous sinus. Answer: The cavernous sinus is supplies by the internal carotid artery.
Someone with an occlusion to the first major branch of the internal carotid artery would likely experience difficulties with which of the following? A. Smelling their coffee in the morning B. Frequent and intense sinusitis C. Singing a merry tune D. Listening to someone complain loudly E. Watching the Fellowship of the Ring
E. Watching the Fellowship of the Ring Answer: The opthalmic artery is the first major branch of the internal carotid and supplies the retina through the central retinal artery. A person with an occlusion would have difficulty with vision.
