Gray's Anatomy Review Questions: Head and Neck

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

A

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

A

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

A

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

A

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

A

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

A

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

A

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

B

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

B

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

B

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

B

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

B

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

B

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

B

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

B

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

B

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

B

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

C

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

C

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

C

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

C

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

C

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

C

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

C

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

D

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

D

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

E

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

A

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

A

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

A

A 5-day-old infant is diagnosed with a noncommunicating hydrocephalus (Fig. 7-1). Which of the following is most likely to lead to such a condition? A. Obstruction in the circulation of the cerebrospinal fluid B. Excess production of cerebrospinal fluid C. Increased size of the head D. Disturbances in the resorption of cerebrospinal fluid E. Failure of the neural tube to close

A

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

A

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

A

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

A

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

A

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

A

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

A

A 68-year-old man is admitted to the emergency department after an acute cerebral vascular accident (stroke). Radiographic studies reveal that the primary damage was to the anterior inferior cerebellar artery, resulting in a small hemorrhage of the artery at its origin from the main trunk. Which of the following nerves will most likely be immediately affected by the hemorrhage? A. Optic nerve B. Oculomotor nerve C. Trochlear nerve D. Trigeminal nerve E. Abducens nerve

E

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

E

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

E

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

C

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

C

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

C

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

C

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

C

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

C

A 16-year-old boy is admitted to the hospital with fever, confused mental state, and drowsiness. During physical examination it is noted that the boy suffers from severe acne. Radiologic examination reveals cavernous sinus thrombosis. Which of the following routes of entry to the cavernous sinus would most likely be responsible for the infection and thrombosis? A. Carotid artery B. Mastoid emissary vein C. Middle meningeal artery D. Ophthalmic vein E. Parietal emissary vein

D

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

D

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

D

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

A

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

A

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

A

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

A

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

A

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

A

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

A

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

A

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

A

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

A

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

A

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

B

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

B

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

B

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

B

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

B

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

B

A 22-year-old male is admitted to the hospital after he was hit in the right eye with a frozen fish, thrown playfully by a friend while they were passing through the seafood section of the market. During physical examination considerable swelling and discoloration of the eyelids was observed. In addition, the patient could not turn his pupil laterally from forward gaze, indicating probable muscle entrapment. Which of the following bones was most likely fractured? A. Orbital plate of the frontal bone B. Lamina papyracea of the ethmoid bone C. Orbital plate of the maxilla D. Cribriform plate of the ethmoid bone E. Greater wing of the sphenoid bone

B

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

B

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

B

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

B

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

B

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

B

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

B

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

B

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

B

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

B

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

B

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

B

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

B

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

B

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

B

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

B

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

B

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

B

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

C

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

C

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

C

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

C

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

C

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

C

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

C

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

C

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

C

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

C

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

C

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

C

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

C

A 45-year-old woman is admitted to the hospital with a swelling on the side of her face of 2 months' duration. Radiographic examination reveals a parotid gland tumor. An operative procedure is performed in which the tumor is removed from the parotid gland. Three months postoperatively the patient complains that her face sweats profusely when she tastes or smells food, and a diagnosis is made of Frey syndrome (gustatory sweating). Which of the following nerves was most likely injured during the procedure? A. Buccal B. Inferior alveolar C. Auriculotemporal D. Facial E. Lingual

C

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

C

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

C

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

C

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

C

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

C

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

C

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

C

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

C

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

C

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

D

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

D

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

D

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

D

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

D

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

D

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

D

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

D

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

D

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

E

A 32-year-old woman is admitted to the hospital with headaches and dizziness. During physical exami- nation it is noted that the patient has partial ptosis (drooping eyelid). Which of the following muscles is most likely paralyzed? A. Orbicularis oculi, lacrimal part B. Orbicularis oculi, palpebral part C. Levator palpebrae superioris D. Superior oblique E. Superior tarsal (of Müller)

E

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

E

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

E

A 44-year-old patient is admitted to the hospital with Raynaud's disease. A sympathetic blocking drug is administered in high doses. Which of the following conditions will be expected to occur as an adverse effect of the drug? A. Exophthalmos and dilated pupil B. Enophthalmos and dry eye C. Dry eye and inability to accommodate for reading D. Wide-open eyelids and loss of depth perception E. Ptosis and miosis

E

A 45-year-old man is admitted to the emergency department with severe dyspnea. During physical examination there is swelling in the floor of his mouth and pharynx so that his airway is nearly totally occluded. In addition, there is a swelling in his lower jaw and upper neck. His physical history indicates that one of his lower molars was extracted a week ago and he had been feeling worse every day since that event. Which of the following conditions will be the most likely diagnosis? A. Quinsy B. Torus palatinus C. Ankyloglossia D. Ranula E. Ludwig's angina

E

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

E

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

E

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

E

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

E

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

E