Cranial Nerves
A 51 YO woman traveling through British Columbia can see the beautiful blue-sky w/ 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?
Ciliary muscles
A 17 YO boy is involved in a gang fight & receives a penetrating injury to the neck. Which of the following conditions is most likely exhibited by this misadventure?
Constricted pupil
Anosmia results from damage to which cranial nerve?
Cranial nerve 1
A 25 YO woman's a neck was injured in an automobile accident. At examination, she reports difficulty in turning her head away from the side of her neck that was injured. She also has a visible shoulder droop. Which nerve was likely damaged?
Cranial nerve 11
Which cranial nerve's fibers are myelinated by oligodendrocytes?
Cranial nerve 2
A 23 YO woman suffers from a fracture of the jugular foramen by car accident. Which of the following nerves is/are most likely damaged?
Cranial nerves 9, 10, and 11
A 47 YO man has trouble w/ diplopia after striking his head on the steering wheel in a car accident. During a subsequent eye exam, his ophthalmologist asks him to first look inward & then upward. The integrity of which of the following extraocular muscles is being tested?
Inferior oblique
The orbicularis oculi are innervated by:
Facial nerve
A 44 YO 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?
Facial nerve proximal to the geniculate ganglion
CN 9, 10, and 11
Foramen jugular
A branch of the maxillary artery
Foramen rotundum
The maxillary division of the trigeminal nerve is transmitted through which of the following?
Foramen rotundum
The nerve that innervates the buccinator muscle
Foramen spinosum
What type of injury or condition might cause a lesion to the olfactory tract?
Fracture of the cribriform plate
A 71 YO man suffers from a known benign tumor in the pterygoid canal. Which of the following nerve fibers could be injured by this condition?
GVA fibers
A young boy w/ 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?
Geniculate and trigeminal ganglis
A 10 YO boy was admitted to the hospital with a sore throat, earache, & high fever. On exam, he had severely swollen palatine tonsils (tonsillitis). What nerve carries the sensory input for most of the patient's SX?
Glossopharyngeal nerve
A 19 YO woman complains of numbness of the nasopharynx after surgical removal of the adenoid. A lesion of which of the following nerves would be expected?
Glossopharyngeal nerve
A 28 YO woman comes to her family physician and complains of difficulty in swallowing. Further exam reveals that she has no taste sensation of the posterior 1/3 of her tongue & a lack of secretion of the parotid gland. Which of the following would most likely cause this condition?
Glossopharyngeal nerve
A 50 YO retired army major complained of severe pain in the ear & throat. Pain was episodic & triggered by swallowing, chewing, coughing, & laughing. SX included loss of gag (pharyngeal) reflex; analgesia & anesthesia in the region of the tonsils; & dysphagia. A lesion of which cranial nerve would produce these neurologic deficits.
Glossopharyngeal nerve
All muscles of facial expression develop from which pharyngeal arch?
2nd
After having a tonsillectomy, a 57 YO man w/ a long history of chewing tobacco use is unable to detect taste on the posterior 1/3 of his tongue. Which of the following nerves has most likely been injured?
Glossopharyngeal nerve
Innervates the parotid gland
Glossopharyngeal nerve
Which of the following passes through the gap b/w the superior and middle constrictors?
Glossopharyngeal nerve
A 22 YO patient has dryness of the corneal surface of his eye because of a lack of tears. Which of the following nerves may be damaged?
Greater petrosal nerve
A patient can move his eyeballs normally & see distant objects clearly but cannot focus on near objects. This condition may indicate damage to which of the following structures?
Short ciliary nerves and ciliary ganglion
The muscles of mastication are associated w/ which branchial arch?
1st
A superficial neck laceration might result in which abnormal finding.
A paralysis of the SCM and superior fibers of the trapezius, drooping of the shoulder
A benign tumor in the orbit of a 49 YO man compresses a structure that runs through both the superior orbital fissure & the common tendinous ring. Which of the following structures is most likely damaged?
Abducens nerve
What nerve emerges between the labyrinthine artery & the anterior inferior cerebellar artery?
Abducens nerve
Which nerve might be damaged by a fracture involving the cavernous sinus?
Abducens nerve, oculomotor nerve, trochlear nerve
A 33 YO woman develops Bell's palsy. She must be cautious because this can result in corneal inflammation & subsequent ulceration. This SX results from which of the following conditions?
Absence of the corneal blink reflex
A 31 YO man w/ a penetrating injury to the posterior triangle of the neck is unable to shrug his shoulder & turn his head to the opposite side. Which of the following nerves is most likely damaged?
Accessory nerve
Is a pure motor nerve
Accessory nerve
PS fibers from CN 9 travel to the parotid gland via which of the following nerves?
Auriculotemporal nerve
The foramina in the cribriform plate transmit which of the following?
Axons of olfactory cells
A 53 YO woman is diagnosed as having a pituitary tumor. If the tumor is large enough, she could exhibit which of the following disorders?
Bitemporal (heteronymous) hemianopia
A 27 YO paratrooper lands on a pine tree. Consequently, preganglionic PS nerves leaving the CNS are lacerated. Which of the following structures contain cell bodies of the damaged nerve fibers?
Brainstem and sacral spinal cord
During surgery for a malignant parotid tumor in a 69 YO woman, the main trunk of the facial nerve is lacerated. Which of the following muscles is paralyzed?
Buccinator muscle
Which of the following best describes the pathway of PS fibers to the lacrimal gland?
CN 7, greater petrosal nerve, nerve of pterygoid canal, pterygopalatine ganglion, zygomatic branch of V2, lacrimal branch of V1
A 50 YO family physician has vertical diplopia; the man feels unsure when descending stairs. He can eliminate the double vision by tilting his chin toward the paretic side. Which of the following extraocular muscles is responsible for the ocular malalignment?
Superior oblique
4 cranial nerves traverse this orifice
Superior orbital fissure
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., w/ a tongue depressor). Afferent nerve fibers that innervated the pharyngeal mucosa are branches of which of the following nerves?
Glossopharyngeal nerve
A 59 YO woman with pain at the side of her skull comes to the ED. An emergent head CT scan shows a large lesion in the internal auditory meatus. This condition may progress & damage which of the following pairs of structures?
Facial and vestibulocochlear nerve
A 43 YO man has new onset of difficulty with speaking. Exam by the ENT resident reveals problems in elevating the hyoid bone and floor of the mouth, secondary to paralysis of the posterior belly of the digastric muscle. Which of the following nerves is most likely involved?
Facial nerve
A lesion of the hypoglossal nerve would result in which of the following?
Deviation of the protruded tongue toward the affected side
A laceration or contusion in the parotid region or a fracture of the temporal bone might damage which nerve.
Facial nerve
A lesion to the zygomatic branch of CN 7 would cause:
Drooping lower eyelid
A 37 YO man feels a little discomfort when moving his tongue, pharynx, & larynx. PE indicates that the muscles attached to the styloid process are paralyzed. Which of the following groups of cranial nerves are damaged?
Dryness in the nose & palate
A tumor is discovered embedded in the posterior wall of the tympanic cavity in a 45 YO man. If the tumor erodes through this wall, which of the following structures will it first encounter?
Facial nerve
Is the efferent limb of the corneal reflex
Facial nerve
Muscles derived from the second (hyoid) pharyngeal arch are innervated by which of the following cranial nerves?
Facial nerve
The nerve that innervates the skin of the upper lip
Facial nerve
A 22 YO man receives a stab wound in the left anterior cervical region, at the C2 vertebral level. The wound was 3cm deep & located anterior to the sternocleidomastoid muscle & superior to the greater horn of the hyoid bone. During a postop exam, the patient displays dysarthria, or difficulty speaking. Which of the following structures is most likely damaged?
Hypoglossal nerve
A 47 YO man cannot move his eyeball laterally. Which of the following conditions would cause such a clinical sign?
Infection in the cavernous sinus
A 16 YO boy presents with double vision. Further exam reveals that he has difficulty in turning his eye inferolaterally & trouble going downstairs. Which of the following nerves is most likely damaged?
Trochlear nerve
The nerve that projects to the otic ganglion
Innominate canal
A 43 YO man presents w/ 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 & chew on demand. During exam, his physician also notes loss of hearing on the right side, & the patient has difficulty maintaining balance while standing on 1 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?
Internal acoustic meatus
A 34 YO 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?
Internal strabismus
A 53 YO woman w/ a severe middle ear infection comes to a hospital. On exam, a physician finds that the infection has injured the tympanic nerve. The damaged nerve:
Is a branch of the glossopharyngeal nerve
During a carotid endarterectomy of a 57 YO man who suffered a stroke, the carotid sinus is damaged. A 3rd-year med student in surgical rotation notices that the injured structure:
Is stimulated by changes in BP
A 58 YO woman comes to a hospital & complains of progressive loss of voice, numbness, loss of taste on the back part of her tongue, & difficulty in shrugging her shoulders. Her MRI scan reveals a dural meningioma that compresses the nerves leaving the skull. These nerves leave the skull through which of the following openings?
Jugular foramen
Which of the following is NOT a symptom of Horner syndrome?
Lack of lacrimation
Following a penetrated injury in the submandibular triangle, the tongue of a 45 YO patient deviates to the left on protrusion. Which of the following nerves is injured?
Left hypoglossal nerve
A 75 YO 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?
Levator palpebrae superioris
What innervates the tensor tympani?
Mandibular nerve
A 57 YO man comes to a local hospital with fever, headache, nausea, & vomiting. Lab tests reveal an infection, & radiologic exam localizes the infection to the cavernous sinus. Which of the following nerves would be unaffected by this condition?
Mandibular nerves
A 31 YO 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?
Maxillary nerve
Which of the following is innervated by the trigeminal nerve?
Mylohyoid
A 20 YO 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?
Nasociliary nerve
Ptosis results from a lesion of which nerve?
Oculomotor nerve
A 65 YO 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?
Oculomotor, short ciliary, and optic nerves
During a game, a 26 YO 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?
Ophthalmic artery and optic nerve
A 45 YO woman is suffering from numbness over the tip of her nose. Which of the following nerves is most likely to be damaged?
Ophthalmic division of the trigeminal nerve
While participating in a bar fight, the orbit of a 25 YO 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?
Ophthalmic division of trigeminal nerve
PS fibers from CN 9 synapse in which ganglion before traveling to the parotid gland?
Otic ganglion
A knife wound has severed the oculomotor nerve in a 45 YO man. Which of the following conditions will occur because of this injury?
Paralysis of ciliary muscle
A young girl complains of dryness of the nose & the palate. This would indicate a lesion of which of the following ganglia?
Pterygopalatine ganglion
The maxillary nerve gives off branches to which of the following ganglia:
Pterygopalatine ganglion
Following a penetrated injury in the submandibular triangle, the tongue of a 45 YO patient deviates to the left on protrusion. Which of the following nerves is injured?
Right hypoglossal nerve
A 59 YO man complains of numbness in the anterior cervical triangle. Therefore, damage has occurred to which of the following nerves?
Spinal accessory nerve
A 17 YO boy receives an injury to the phrenic nerve by a knife wound in the neck. The damaged nerve passes by which of the following structures in the neck?
Superficial to the anterior scalene muscle
A 40 YO woman suffers from headaches, nausea, vomiting, & multiple lower cranial nerve involvement. Her physician orders a CT soft tissue neck study, & the given coronal CT shows a mass lesion (tumor) centered at the jugular foramen. This tumor has destroyed the jugular foramen & hypoglossal canal on the right side & damaged the cranial nerves traversing these foramina. In this patient, which of the following functions will remain intact?
Taste in anterior 2/3 of tongue
A 27 YO man came to his physician with ptosis, a dilated pupil, & a difficulty in focusing on close objects. Furthermore, he has an internal strabismus & inability to look inferiorly when the eye is adducted. Which of the following is the most likely cause?
Thrombosis in the cavernous sinus
The drummer of a local band presents to your clinic with hearing loss. Otoscopic exam reveals loss of contraction of the tensor tympani & the stapedius, which prevents damage to the eardrum & middle ear ossicles. These muscles are most likely controlled by which of the following nerves?
Trigeminal and facial nerves
A 32 YO house painter suffers from a head injury after falling off a ladder & 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?
Trigeminal nerve
Following radical resection of a primary tongue tumor, a 72 YO patient has lost general sensation on the anterior 2/3 of the tongue. This is probably due to injury to branches of which of the following nerves?
Trigeminal nerve
The muscles that are of branchiomeric origin are paralyzed in a 26 YO patient. A lesion of which of the following nerves would cause muscle dysfunction?
Trigeminal nerve
Innervates the infratentorial dura
Vagal nerve
Is the efferent limb of the gag reflex
Vagal nerve
A 24 YO man falls from his motorcycle and lands in a creek. Death may result from bilateral severance of which of the following nerves?
Vagus nerve
A 32 YO woman has hoarseness in her voice, & her uvula is deviated to the left on phonation. Which of the following nerves is most likely damaged?
Vagus nerve
Sagging of the soft palate, deviation of the uvula to the normal side, & hoarseness might be caused by a lesion to which nerve.
Vagus nerve
