BRS Head&Neck Questions

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

C

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

C

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

C

60. A 37-year-old man receives a direct blow to his head and is brought to an emergency department. His x-ray film 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

C

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

A

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; ciliary ganglion (E) Ophthalmic and optic nerves; ciliary ganglion

C

66. 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 he paralyzed? (A) Masseter muscle (B) Medial pterygoid muscle (C) Lateral pterygoid muscle (D) Buccinator muscle (E) Temporalis muscle

C

68. 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

C

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

C

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 hone (D) Basioccipital bone (E) Sphenoid bone

C

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

C

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

A

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

A

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

A

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

A

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

A

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

B

40. A high school basketball player experiences a sudden difficulty in breathing and is brought to an emergency room. When a low tracheotomy is performed below the isthmus of the thyroid, which of the following vessels may be encountered? (A) Inferior thyroid artery (B) Inferior thyroid vein (C) Costocervical trunk (D) Superior thyroid artery (E) Right brachiocephalic vein

B

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

B

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

B

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

B

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

B

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

B

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

B

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

B

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

B

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

B

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

C

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

C

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

C

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

C

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

C

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

C

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

C

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

C

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

C

A pharyngeal (gag) reflex is the contraction of the pharyngeal constrictor muscles 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

C

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 most likely has been injured? (A) Internal laryngeal nerve (B) Lingual nerve (C) Glossopharyngeal nerve (D) Greater palatine nerve (E) Chorda tympani

C

During a game, a 26-year-old baseball player is hit in the head by a baseball that 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

C

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; one that lies in the margin of the tentonum 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 sinuses (B) Inferior sagittal sinus (C) Sphenoparietal sinus (D) Superior petrosal sinuses (E) Cavernous sinus

D

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

D

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

D

43. Following a penetrated injury in the submandibular triangle, the tongue of a 45-yearold 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

D

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

D

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

D

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

D

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

D

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

D

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

D

58. A 59-year-old woman with pain at the side of her skull comes to the emergency department. An emergent head computed tomography (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

D

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

D

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

D

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

D

70. 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

D

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

D

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

D

A 53-year-old woman with a severe middle ear infection comes to a hospital. On examination, a physician finds 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

D

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

D

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

D

During a carotid endarterectomy of a 57- year-old man who suffered a stroke, the carotid sinus is damaged. A third-year medical student in surgical rotation notices that the injured structure: (A) Is located at the origin of the external carotid artery (13) Is innervated by the facial nerve (C) Functions as a chemoreceptor (D) Is stimulated by changes in blood pressure (E) Communicates freely with the cavernous sinus

D

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

D.

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

E

48. A knife wound has severed the oculomotor nerve in a 45-year-old man. Which of the following conditions would 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

E

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

E

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

E

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

E

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)

E

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

E

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

E