Head and cranial nerves Qs

Lateral pterygoid

1. A 59-year-old man with a herpes zoster infection within the mandibular division of the trigeminal nerve (CN V3) complains of weakness when opening his mouth. A comprehensive evaluation reveals that his problems are due to difficulty protruding the mandible, and when protrusion is accomplished the mandible deviates to the left side, as seen in the figure. What muscle is most likely weakened? (A) Anterior belly of digastric (B) Lateral pterygoid (C) Masseter (D) Medial pterygoid (E) Temporalis

Retropharyngeal space

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

Trigeminal nerve

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

Optic nerve

26. A 25-year-old professional boxer loses a fight when he is rendered unconscious by his opponent. After he regains consciousness, the ringside physician notes the boxer has a severe headache, nausea, and even vomiting. Being concerned about intracranial trauma, what cranial nerve can be observed by the physician, without the aid of radiographic imaging, to gain more information on whether the boxer has increased intracranial pressure? (A) Optic nerve (B) Oculomotor nerve (C) Olfactory nerve (D) Trigeminal nerve (E) Trochlear nerve

Deep petrosal

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

Is a branch of the glossopharyngeal nerve

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

Glossopharyngeal

28. A 10-year-old boy was admitted to the hospital with a sore throat, earache, and high fever. On examination, he had severely swollen palatine tonsils (tonsillitis). What nerve carries the sensory input for most of the patient's symptoms? (A) Greaterpalatine (B) Lesserpalatine (C) Vagus (D) Posterior superior alveolar (E) Glossopharyngeal

Middle meningeal artery

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

Right vagus nerve

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

Right hypoglossal nerve

7. A 45-year-old man goes to his physician complaining of having trouble with his speech (dysarthria) and involuntary contractions (fasciculations) within his tongue muscles. The doctor notes that his tongue deviates to the right when the patient attempts to protrude his tongue, as seen in the figure. What nerve is most likely damaged in this patient? (A) Left hypoglossal nerve (B) Right hypoglossal nerve (C) Left glossopharyngeal nerve (D) Left vagus nerve (E) Right vagus nerve

Mastoiditis

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

Masseter

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

Ciliary muscles

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

Opening of the parotid duct

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

Opthalmic division of trigeminal

74. While participating in a bar fight, the orbit of a 25-year-old man is pierced by a broken pool cue stick, which extends back to the superior orbital fissure. Which of the following nerves is most likely damaged? (A) Optic nerve (B) Facial nerve (C) Mandibular division of trigeminal (D) Maxillary division of trigeminal (E) Ophthalmic division of trigeminal

E

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

C

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

Facial nerve proximal to the geniculate ganglion

8. A 44-year-old man with "crocodile tears syndrome" has spontaneous lacrimation during eating because of misdirection of regenerating autonomic nerve fibers. Which of the following nerves has been injured? (A) Facial nerve proximal to the geniculate ganglion (B) Auriculotemporal nerve (C) Chorda tympani in the infratemporal fossa (D) Facial nerve at the stylomastoid foramen (E) Lacrimal nerve

Levator palpebrae superioris

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

Olfactory nerve

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

B

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

D

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

A

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

B

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

A

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

D

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

E

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

C

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

D

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

B

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

Parasympathetic fibers via the chorda tympani nerve

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

Trigeminal nerve

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

Altered taste

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

Glossopharyngeal nerve

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

Accessory nerve

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

Cerebral arterial circle

3. A 68-year-old man arrived at the ER with sudden onset of the worst headache of his life, lethargy, and nuchal rigidity. He quickly loses consciousness and dies. Autopsy reveals no trau- matic injury; however, the man's subarachnoid space is filled with blood, as seen in the photo. Damage to what blood vessel most likely led to the death of this patient? (A) Common carotid artery (B) Middle meningeal artery (C) Facial artery (D) Superior cerebral veins (E) Cerebral arterial circle

Glossopharyngeal nerve

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

Left oculomotor nerve

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

Pterygopalatine ganglion

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

A

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

E

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

C

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

Facial, glossopharyngeal, and hypoglossal nerves

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

Orbicularis oris

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

Right vagus nerve

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

Glossopharyngeal nerve

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

Opthalmic

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

Maxillary process

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

Superior cerebral veins

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

Superior sagittal sinus

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

Thoracic anterior roots

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

Second division of trigeminal nerve

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

Absence of the corneal blink reflex

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

Left trochlear nerve

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

Superior petrosal sinus

11. A 39-year-old woman presents to your clinic with complaints of headache and dizziness. She has an infection of a cranial dural sinus. The sinus that lies in the margin of the tentorium cerebelli and runs from the posterior end of the cavernous sinus to the transverse sinus is infected. Which of the following sinuses is affected by inflammation? (A) Straight sinus (B) Inferior sagittal sinus (C) Sphenoparietal sinus (D) Superior petrosal sinus (E) Cavernous sinus

Internal strabismus (medial deviation)

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

Recurrent laryngeal nerve

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

Arytenoid cartilages

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

Trigeminal ganglion

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

Foramen rotundum

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

Epidural space

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

Greater petrosal nerve

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

Vocal folds

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

Superior cervical ganglion

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

Pharyngeal tonsil

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

Entrapment of the inferior rectus muscle

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

Mylohyoid

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

Sphenoid sinus

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

Masseter

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

Oculomotor nerve

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

Glossopharyngeal nerve

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

Sphenoid bone

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

Auricle of the external ear (only cutaneous innervation)

19. To differentiate between idiopathic unilateral paralysis of the muscles of facial expression (Bell palsy) and a herpes zoster infection of CN VII, the physician must look for small herpetic lesions (vesicles or blisters). Where are these skin lesions located in a herpes zoster infection involving the facial nerve? (A) Mental region of the mandible (B) Temporal and parietal region of the scalp (C) Upper lip and cheek of the face (D) Auricle of the external ear (E) Bridge and tip of the external nose

Facial nerve

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

Parotid

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

Presynaptic parasympathetic fibers

20. A 37-year-old man presented with decreased emotional tearing on the right side and intermittent headaches. Magnetic resonance images (MRIs) revealed a facial nerve schwannoma located within the right pterygoid (vidian) canal. What nerve fibers are most likely injured by this tumor? (A) Taste fibers to the anterior two thirds of the tongue (B) Parasympathetic innervation to the submandibular and sublingual glands (C) Presynaptic sympathetic fibers (D) Presynaptic parasympathetic fibers (E) Postsynaptic parasympathetic fibers

Zygomaticus major

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

Cavernous sinus

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

Internal acoustic meatus

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

Failure of fusion of the retinal fissure

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

Bitemporal hemianopsia

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

Bitemporal (heteronymous) hemianopia

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

Hair cells in the base of the cochlea

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

Noncommunicating hydrocephalus

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

Deviation of the tongue to the ipsilateral side (thats the hypoglossal)

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

Posterior cricoarytenoid muscle

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

Oblique arytenoid and aryepiglottic muscles

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

Unilateral muscles of mastication paralysis

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

Left abducent nerve

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

Dural venous sinuses

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

Infraorbital

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

Parasthesia of the lower lip

56. During extraction of her impacted wisdom teeth, a 22-year-old woman suffers damage to her right inferior alveolar nerve. Which of the following conditions is most likely to result? (A) Inability to compress the cheek (B) Paresthesia of the lower lip (C) Weakness in closing the jaw (D) Decreased salivary flow (E) Reduced taste in the body of the tongue

Marginal mandibular branch of facial nerve

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

Opthalmic artery and optic nerve

31. During a game, a 26-year-old baseball player is hit in the head by a baseball, which fractures the optic canal. Which of the following pairs of structures is most likely to be damaged? (A) Optic nerve and ophthalmic vein (B) Ophthalmic vein and ophthalmic nerve (C) Ophthalmic artery and optic nerve (D) Ophthalmic nerve and optic nerve (E) Ophthalmic artery and ophthalmic vein

Superior cervical ganglion

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

Tensor tympani

32. A young child suffers a debilitating condition that includes progressive degeneration of the motor axons that innervate the masseter muscle. Which of the following muscles is most likely to exhibit the same fate? (A) Genioglossus (B) Tensor tympani (C) Orbicularis oris (D) Levator veli palatini (E) Stylopharyngeus

Left oculomotor nerve

33. A physician directs a small light into only the left eye of a patient to test pupillary constriction. The left pupil does not respond to the light; however, the right pupil constricts. What nerve is most likely damaged in this patient? (A) Right optic nerve (B) Left optic nerve (C) Right ophthalmic nerve (D) Right oculomotor nerve (E) Left oculomotor nerve

Trigeminal and facial nerves

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

Abducent nerve

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

Superior cervical ganglion

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

Glossopharyngeal nerve

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

Philtrum

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

Facial nerve

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

Short ciliary nerves and ciliary ganglion

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

Dense connective tissue

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

Auriculotemporal nerve

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

Abducens nerve

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

Internal acoustic meatus

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

Posterior ethmoidal sinus

42. A 53-year-old man has difficulty with breathing through his nose. On examination, his physician finds that he has swelling of the mucous membranes of the superior nasal meatus. Which opening of the paranasal sinuses is most likely plugged? (A) Middle ethmoidal sinus (B) Maxillary sinus (C) Posterior ethmoidal sinus (D) Anterior ethmoidal sinus (E) Frontal sinus

Left hypoglossal nerve

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

Infection in the cavernous sinus

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

Geniculate and trigeminal ganglia

45. A young boy with a tooth abscess from a longstanding infection suffers damage of the lingual nerve as it enters the oral cavity. Which of the following structures contain cell bodies of injured nerve fibers? (A) Geniculate and otic ganglia (B) Trigeminal and submandibular ganglia (C) Trigeminal and dorsal root ganglia (D) Geniculate and trigeminal ganglia (E) Geniculate and pterygopalatine ganglia

Opthalmic artery

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

C

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

Superficial temporal

48. A 45-year-old man is in surgery. While seated at the head of the operating table, the anesthesiologist periodically checks the patient's pulse by palpating the artery located anterior to the tragus of the external ear. Which of the following arteries is being utilized to monitor the patient's pulse? (A) Maxillary (B) Posterior auricular (C) Superficial temporal (D) Facial (E) Internal carotid

Paralysis of the ciliary muscle

48. A knife wound has severed the oculomotor nerve in a 45-year-old man. Which of the following conditions will occur because of this injury? (A) Constricted pupil (B) Abduction of the eyeball (C) Complete ptosis (D) Impaired lacrimal secretion (E) Paralysis of the ciliary muscle

Lacrimal punctum

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

Trigeminal nerve

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

Lingual nerve

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

Buccinator

50. During surgery for a malignant parotid tumor in a 69-year-old woman, the main trunk of the facial nerve is lacerated. Which of the following muscles is paralyzed? (A) Masseter muscle (B) Stylopharyngeus muscle (C) Anterior belly of the digastric muscle (D) Buccinator muscle (E) Tensor tympani

Inferior oblique

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

Nasociliary nerve

55. A 20-year-old guard at the gate of the Royal King's palace blinks his eyes when a strong wind hits the cornea of his eye. The afferent fibers of the corneal reflex arc are carried by which of the following nerves? (A) Optic nerve (B) Lacrimal nerve (C) Nasociliary nerve (D) Zygomatic nerve (E) Oculomotor nerve

Mandibular nerves

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

Buccinator

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

Facial and vestibulocochlear nerves

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

C

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

Orbicularis oris

59. After ingesting a toxic substance found in her friend's home, a 12-year-old girl is unable to close her lips. Which of the following muscles may be paralyzed? (A) Levator labii superioris (B) Zygomaticus minor (C) Orbicularis oris (D) Lateral pterygoid (E) Depressor labii inferioris

Opthalmic division of the trigeminal nerve

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

Third division of the trigeminal nerve

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

Sphenopalatine

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

Dryness in the nose and palate

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

Oculomotor, short ciliary, and optic nerves

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

Greater petrosal nerve

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

Sphenopalatine

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

Temporalis

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

Middle pharyngeal constrictor

66. During a mixed martial arts (MMA) fight, one fighter punched his opponent in the anterior neck, resulting in a fracture of the hyoid bone. Which of the following muscles would be most directly affected by this injury? (A) Palatopharyngeus (B) Stylopharyngeus (C) Superior pharyngeal constrictor (D) Middle pharyngeal constrictor (E) Inferior pharyngeal constrictor

Lateral pterygoid muscle

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

Levator palpebrae superioris

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

Maxillary nerve

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