Grays questions Anatomy- Head and neck
A 68-year-old man is admitted to the emergency department after an acute cerebral vascular accident (stroke). Radiologic 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. Abducens nerve
Early closure of the fontanelles of the infant skull can result in compression of the brain, restricting brain growth. Which of the following fontanelles is located at the junction of the sagittal and coronal sutures and at what age does this fontanelle typically close? A. Posterior fontanelle, which closes at about 2 years B. Mastoid fontanelle, which closes at about 16 months C. Lambdoid fontanelle, which closes at 8 months to 1 year D. Sphenoidal fontanelle, which closes at 3 years E. Anterior fontanelle, which closes at 18 months
E. Anterior fontanelle, which closes at 18 months
A 17-year-old girl 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
E. Chorda tympani
A 22-year-old woman visits the outpatient clinic with a painless swelling on the right side of her neck. A CT scan examination reveals a well-defined cystic mass at the angle of the mandible, just anterior to the sternocleidomastoid muscle. What is the most likely diagnosis? A. Dermoid cyst B. Inflamed lymph node C. Accessory thyroid tissue D. Thyroglossal duct cyst E. Lateral cervical cyst
E. Lateral cervical cyst
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 following 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. Loss of gag reflex
A 5-day-old infant was born with a normal Apgar score. One month later the external acoustic meatus was atretic. Which of the following conditions was the most likely cause of this defect? A. Otic pit did not form B. Development of the first pharyngeal pouch was affected C. Meatal plug did not canalize D. Auricular hillocks did not develop E. The tubotympanic recess degenerated
C. Meatal plug did not canalize
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. Recurrent laryngeal
A 6-year-old boy, whose medical history includes a complicated delivery, has a continuously 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. Sternocleidomastoid
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 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. Sternohyoid
A 31-year-old woman is admitted to the hospital after an automobile collision. An MRI examination reveals a large hematoma inferior to the right jugular foramen. Physical examination reveals right pupillary constriction (miosis), ptosis of the eyelid, 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. Superior cervical
A 48-year-old man 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. Superior orbital fissure
A 5-week-old male infant is born without a thymus or inferior parathyroid glands. Which of the following pharyngeal arches is most likely involved? A. First B. Second C. Third D. Fourth E. Fifth
C. Third
A 3-month-old male infant is under observation in the pediatric clinic. The patient has congenital hypoparathyroidism, thyroid hypoplasia, and no thymus. Abnormal development of which of the following pharyngeal pouches or arches will most likely produce these defects? A. First and second B. Second and third C. Third and fourth D. Fourth E. Fourth and sixth
C. Third and fourth
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
C. Vagus nerve
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 and 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. 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. Ludwig's angina
A 4-year-old boy suffering from ankyloglossia is brought to the speech therapist. The examining physician recommends that the child be admitted for operation by a pediatric surgeon. Which of the following surgical procedures would be most appropriate for this condition? A. Removal of pterygomandibular raphe B. Resection of the pterygoid hamulus bilaterally C. Cutting the lingua l frenulum D. Repair of the palate E. Removal of the central segment of the hyoid bone
D. Repair of the palate
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. Oculomotor nerve
A 5-year-old girl is admitted to the hospital with an upper respiratory tract infection. During physical examination her sense of hearing appears to be poor. Her right ear is painful, and upon otoscopic examination a golden brown fluid can be observed through the tympanic membrane. Which is the most likely direct route for the spread of an infection from the upper respiratory tract to the middle ear cavity? A. Pharyngotympanic tube B. Choanae C. Nostrils D. Facial canal E. Internal acoustic meatus
A. Pharyngotympanic tube
A 38-year-old man is admitted to the hospital with a large mass in his lower anterior neck. Ultrasound examination reveals a benign tumor of his thyroid gland. Twenty-four hours following a partial thyroidectomy, it was noted that the patient could not abduct the true vocal cords due to a nerve injury during the operation. Which of the following muscles was most likely denervated? A. Posterior cricoarytenoid B. Lateral cricoarytenoid C. Thyroarytenoid D. Arytenoid E. Cricothyroid
A. Posterior cricoarytenoid
A 35-year-old woman is under general anesthesia. Before laryngeal intubation the rima glottidis is opened by which pair of muscles? A. Posterior cricoarytenoids B. Lateral cricoarytenoids C. Thyroarytenoids D. Transverse arytenoids E. Cricothyroids
A. Posterior cricoarytenoids
A 56-year-old man is diagnosed with an extradural tumor in the posterior cranial fossa. When the patient protruded his tongue during physical examination, the tongue deviated to the right. Which of the following muscles and nerves are most likely injured? A. Right hypoglossal nerve and right genioglossus B. Left hypoglossal nerve and left genioglossus C. Right hyoglossus and left styloglossus D. Right geniohyoid and first cervical nerve E. Contralateral vagus and hypoglossal nerves
A. Right hypoglossal nerve and right genioglossus
A 3-year-old boy is admitted to the hospital because of a soft anterior midline cervical mass. When he is asked to protrude his tongue, the mass in the neck is observed to move upward. Which of the following is the most likely diagnosis? A. A thyroglossal duct cyst B. Defect in sixth pharyngeal arch C. A branchial cyst D. Cystic fistula of the third pharyngeal arch E. Defect in first pharyngeal arch
A. A thyroglossal duct cyst
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. Abducens nerve
A 67-year-old woman 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. Accessory
An 8-year-old boy is admitted to the hospital with a drooping right eyelid (ptosis) (Fig. 7-4). The initial diagnosis is Horner's syndrome. Which of the following additional signs on the right side would confirm the diagnosis? A. Constricted pupil B. Dry eye C. Exophthalmos D. Pale, blanched face E. Sweaty face
A. Constricted pupil
A 3-day-old male infant has a small area of the right iris missing, and a diagnosis of coloboma of the iris is made. Which of the following is the most likely embryologic cause of the coloboma? A. Failure of the retinal/choroid fissure to close B. Abnormal neural crest formation C. Abnormal interactions between the optic vesicle and ectoderm D. Posterior chamber cavitation E. Weak adhesion between the inner and outer layers of the optic vesicle
A. Failure of the retinal/choroid fissure to close
While at summer camp, a 10-year-old boy develops severe pharyngitis and swollen tonsils. Infection may spread from the nasopharynx to the middle ear cavity along the derivative of which embryonic pharyngeal pouch? A. First B. Second C. Third D. Fourth E. Sixth
A. First
A 3-day-old male infant has a noticeably small mandible. A computed tomography (CT) scan and physical examinations reveal hypoplasia of the mandible, cleft palate, and defects of the eye and ear. Abnormal development of which of the following pharyngeal arches will most likely produce such symptoms? A. First arch B. Second arch C. Third arch D. Fourth arch E. Sixth arch
A. First arch
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. Internal laryngeal nerve
A 2-day-old female infant was born with a cleft palate. The major portion of the palate develops from which of the following embryonic structures? A. Lateral palatine process B. Median palatine process C. Intermaxillary segment D. Median nasal prominences E. Frontonasal eminence
A. Lateral palatine process
A 36-year-old woman is admitted to the hospital with severe head injuries after a car crash. During neurologic examination her uvula is found to be 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. Left vagus
A 35-year-old man is admitted to the hospital with severe headaches. A CT scan evaluation reveals a tumor in the infratemporal fossa. Physical examination reveals loss of general sensation from the anterior two thirds of his tongue, but taste and salivation are intact. Which of the following nerves is most likely affected by the tumor? A. Lingual proximal to its junction with the chorda tympani B. Chorda tympani C. Inferior alveolar D. Lesser petrosal E. Glossopharyngeal
A. Lingual proximal to its junction with the chorda tympani
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 (CSF) B. Excess production of CSF C. Increased size of the head D. Disturbances in the resorption of CSF E. Failure of the neural tube to close
A. Obstruction in the circulation of the cerebrospinal fluid (CSF)
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. Subarachnoid space and superior sagittal sinus
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. Auriculotemporal
A 46-year-old woman is admitted to the hospital with a large mass in her lower anterior neck. Ultrasound examination suggests a benign tumor of her thyroid gland, which is confirmed with a biopsy. 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. External branch of the superior laryngeal
A 34-year-old man complains of hyperacusis (sensitivity to loud sounds). Injury to which of the following cranial nerves is most likely responsible? A. Hypoglossal B. Facial C. Accessory D. Vagus E. Glossopharyngeal
B. Facial
A 10-year-old girl is admitted to the hospital with tonsillitis. A tonsillectomy is performed and the tonsils are removed. On physical examination 1 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. Glossopharyngeal
A 38-year-old woman 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 following nerves would the dentist need to anesthetize to treat the caries in that tooth? A. Lingual B. Inferior alveolar C. Buccal D. Mental E. Mylohyoid
B. Inferior alveolar
A 54-year-old man is admitted to the hospital with severe pain in his nasal cavity. Radiographic examination reveals a carcinoma in his nasal cavity. In which of the following locations would the carcinoma block the hiatus of the maxillary sinus? A. Inferior meatus B. Middle meatus C. Superior meatus D. Nasopharynx E. Sphenoethmoidal recess
B. Middle meatus
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. Optic and oculomotor
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. Outward
An 11-year-old boy is examined by an otorhinolaryngologist for his swollen palatine tonsils. The palatine tonsils are located between the anterior and posterior tonsillar pillars. Which of the following muscles form these pillars? A. Levator veli palatini and tensor veli palatini B. Palatoglossus and palatopharyngeus C. Styloglossus and stylopharyngeus D. Palatopharyngeus and salpingopharyngeus E. Superior and middle pharyngeal constrictors
B. Palatoglossus and palatopharyngeus
A 62-year-old man is admitted to the hospital with blurred vision. Taking of his history and performance of a physical examination reveals a long history of gradual loss of his visual field. The intraocular pressure is high, and a diagnosis of glaucoma is made. Which of the following spaces first receives the aqueous humor secreted by the epithelium of the ciliary body? A. Anterior chamber B. Posterior chamber C. Pupil D. Vitreous E. Lacrimal sac
B. Posterior chamber
A 56-year-old woman has just undergone a complete thyroidectomy. After she recovers from the anesthesia a hoarseness of her voice is noted that persists for 3 weeks. Subsequent examination shows a permanently adducted vocal fold on the right side. Surgical trauma to the innervation of which of the following muscles is most likely to be responsible for the position of the right vocal fold? A. Aryepiglottic B. Posterior cricoarytenoid C. Thyroarytenoid D. Transverse arytenoids E. Vocalis
B. Posterior cricoarytenoid
A 55-year-old woman is admitted to the hospital with severe hypertension. Examination reveals hypertension (190/110 mm Hg) and hypercholesterolemia (250 mg/dL). During physical examination she complains of headaches and dizziness. An arteriogram 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 protrude it. 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. Right hypoglossal
A 27-year-old woman is admitted to the emergency department after she was thrown from a motor scooter. Radiographic evaluation reveals a type I LeFort fracture and comminuted fracture of the mandible and TMJ. Despite reconstructive surgery, the patient develops hyperacusis (sensitivity to loud sounds) due to facial nerve paralysis. Which of the following muscles is most likely paralyzed? A. Posterior belly of digastric B. Stapedius C. Tensor tympani D. Stylohyoid E. Cricothyroid
B. Stapedius
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. Superior cervical ganglion
A 35-year-old woman is hospitalized due to cavernous sinus thrombosis resulting from an infection on her 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. Superior ophthalmic vein
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 3 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. The aponeurosis and the periosteum
A 68-year-old woman is suffering from excruciating, sudden bouts of pain over the area of her midface. Physical examination indicates 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. Trigeminal (semilunar or Gasserian)
A 34-year-old man who swims regularly 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. Vagus
A 24-year-old man had a third molar (wisdom tooth) extracted from his lower jaw. This resulted in the loss of general sense and taste sensation from the anterior two thirds of the tongue. This loss was most likely due to injury of which of the following nerves? A. Auriculotemporal B. Chorda tympani C. Lingual D. Mental E. Inferior alveolar
C. Lingual
An 8-year-old boy had a 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 the accumulation of saliva in the vestibule of his oral cavity and dribble from the corner of his mouth. Which of the following muscles was most likely paralyzed? A. Zygomaticus major B. Orbicularis oculi C. Buccinator D. Levator palpebrae superioris E. Orbicularis oris
C. Buccinator
A 3-year-old girl ruptured her tympanic membrane (eardrum) when she inserted a pencil into her external ear canal. 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. Check if there is paraesthesia at the TMJ
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. Maxillary sinus
A 12-year-old girl is admitted to the emergency department with a middle ear infection. Physical examination 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 submandibular and sublingual glands E. Diminished tear production by the lacrimal gland
C. Diminished saliva production by the parotid gland
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, suggesting that the right greater petrosal nerve has been injured. Which of the following symptoms 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 gland 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. Dryness of the right cornea due to lack of lacrimal gland secretion
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. Facial
A 45-year-old woman is admitted to the hospital with severe headaches, dizziness, and vomiting. Radiologic 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. Facial nerve
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. Great auricular
A 55-year-old woman is diagnosed with a tumor at the base of the skull, resulting in a decrease in tear production. Which of the following nerves is most likely injured? A. Chorda tympani B. Deep petrosal C. Greater petrosal D. Lesser petrosal E. Nasociliary
C. Greater petrosal
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 tracheostomy 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. Inferior thyroid vein and thyroidea ima artery
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 compressing the nerve exiting 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. Internal acoustic meatus
6 A 34-year-old woman is admitted to the hospital with a large mass in her lower anterior neck. Ultrasound examination reveals a benign tumor of her thyroid gland. Twenty-four hours following a partial thyroidectomy, it was noted that the patient frequently aspirates fluid into her lungs. Upon examination it was determined that the area of the piriform recess above the vocal fold of the larynx was anesthetized. Which of the following nerves was most likely iatrogenically injured? A. External branch of the superior pharyngeal B. Hypoglossal C. Internal branch of the superior laryngeal D. Lingual E. Recurrent laryngeal
C. Internal branch of the superior laryngeal
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. Middle cerebral artery
Cleft lip, with or without cleft palate, occurs about once in 1000 births. Which of the following is considered to be the most important causative factor in the production of this anomaly? A. Riboflavin deficiency B. Infectious disease C. Mutant genes D. Cortisone administration during pregnancy E. Irradiation
C. Mutant genes
A 22-year-old woman is admitted to the hospital with an injury to her eye. The corneal reflex is tested and found to be present. Which of the following nerves is responsible for the afferent limb of this reflex? A. Frontal B. Lacrimal C. Nasociliary D. Oculomotor E. Optic
C. Nasociliary
A 5-day-old male infant has an abnormally large head. A CT scan examination reveals enlarged lateral and third ventricles but a fourth ventricle of normal size. Stenosis of the cerebral aqueduct (of Sylvius) is suspected. Which of the following conditions will be characteristic of these symptoms? A. Nonobstructive hydrocephalus B. Anencephaly C. Obstructive hydrocephalus D. Meroanencephaly E. Holoprosencephaly
C. Obstructive hydrocephalus
A 17-year-old girl 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. Pain from the eyeball
A 3-month-old male infant has a lump in his neck. A biopsy of the lump shows it to be thymic tissue. Based on embryonic origin, which of the following additional structures is most likely to have an ectopic location? A. Jugulodigastric lymph node B. Lingual tonsil C. Parathyroid gland D. Submandibular gland E. Thyroid gland
C. Parathyroid gland
A 32-year-old woman 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 the facial nerve E. Facial vein
C. Parotid duct
A 45-year-old man with a complaint of ear pain, difficulty hearing in one ear, nose bleeds, and difficulty breathing through the nose is diagnosed with postnasal carcinoma. Otoscopic examination reveals fluid in the middle ear cavity. Hypertrophy of which of the following structures would be most likely to compromise the drainage of the auditory tube A. Lingual tonsil B. Palatine tonsil C. Pharyngeal tonsil D. Superior constrictor muscle E. Uvula
C. Pharyngeal tonsil
A 7-year-old boy with a high fever is brought to the pediatrician. During physical examination the patient complains of pain in his ear. His throat appears red and inflamed, confirming the diagnosis of pharyngitis. Which of the following structures provided a pathway for the infection to spread to the tympanic cavity (middle ear)? A. Choanae B. Internal acoustic meatus C. External acoustic meatus D. Pharyngotympanic tube E. Pharyngeal recess
D. Pharyngotympanic tube
A 34-year-old woman is admitted to the hospital with a large mass at her thyroid gland. Ultrasound examination suggests a benign tumor, which is confirmed with a biopsy. 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. Recurrent laryngeal
A 34-year-old man is admitted to the hospital with severe headaches, dizziness, and vomiting. Imaging studies reveal a tumor at the hypoglossal canal. Which of the following muscles will most likely be affected? A. Geniohyoid B. Mylohyoid C. Palatoglossus D. Genioglossus E. Thyrohyoid
D. Genioglossus
A 49-year-old woman is admitted to the hospital with headaches and dizziness. Radiologic 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
D. Glossopharyngeal
A 25-year-old medical student discovers that his alarm has not worked and he is running late. Desperate to get to his biochemistry lecture in time, yet unbearably hungry, he quickly throws some bread in the toaster as he gets ready. Despite the toast burning a little, he eats it quickly and rushes out the door. The burnt parts of the toast scratch the roof of his mouth, leaving him with a stinging sensation there. What nerve is collecting this sensation from the hard palate? A. Posterior superior alveolar nerve B. Inferior alveolar nerve C. Lingual nerve D. Greater palatine nerve E. Lesser palatine nerve
D. Greater palatine nerve
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 temporomandibular joint due to arthritis. Which of the following muscles will most likely be affected by the inflammatory process of this joint? A. Temporalis B. Medial pterygoid C. Masseter D. Lateral pterygoid E. Buccinator
D. Lateral pterygoid
A 55-year-old man has a complaint of left-sided tooth pain in his upper jaw. A dental examination reveals no abnormalities of his teeth. During physical examination tapping on his left maxilla elicits sharp pain on the left side of his face, including his maxillary teeth on that side. The patient reports that he has no allergies. Which of the following conditions will be the most likely diagnosis? A. Sphenoid sinusitis B. Anterior ethmoidal sinusitis C. Posterior ethmoidal sinusitis D. Maxillary sinusitis E. Frontal sinusitis
D. Maxillary sinusitis
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 to contain the virus in this case? A. Auriculotemporal B. Buccal C. Lesser petrosal D. Mental E. Infraorbital
D. Mental
A 17-year-old girl has suffered from a painful discoloration of her hand for the past year. A magnetic resonance imaging (MRI) scan revealed "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. Numbness in the upper limb
A 16-year-old boy is admitted to the hospital with fever, a 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. Ophthalmic vein
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. Otic ganglion
A 21-year-old man was brought to the emergency department because of severe epistaxis (nosebleed) from the nasal septum. This area, known as Kiesselbach's (or Little's) area, involves mostly anastomoses between which of the following arteries? A. Ascending palatine and ascending pharyngeal B. Posterior superior alveolar and accessory meningeal C. Lateral branches of posterior ethmoidal and middle meningeal D. Septal branches of the sphenopalatine and superior labial E. Descending palatine and tonsillar branches of the pharyngeal
D. Septal branches of the sphenopalatine and superior labial
A 5-year-old boy is admitted to the hospital with otitis media. Otoscopic examination reveals a bulging and inflamed eardrum. It is decided to incise the tympanic membrane to relieve the painful pressure and allow drainage of the infectious fluid associated with otitis media. Which of the following is the best location to make an opening (myringotomy) for drainage? A. The anterior superior quadrant of the eardrum B. The posterior superior quadrant of the eardrum C. Directly through the site of the umbo D. The anterior inferior quadrant of the eardrum E. A vertical incision should be made in the eardrum, from the 12 o'clock position of the rim of the eardrum to the 6 o'clock position of the rim
D. The anterior inferior quadrant of the eardrum
A 5-day-old female infant was born with a laryngeal defect. The greater cornuae and the inferior part of the hyoid bone were absent at birth. Failure of development of which of the following embryonic structures most likely led to these defects? A. Maxillary prominence B. Mandibular prominence C. Second pharyngeal arch D. Third pharyngeal arch E. Fourth pharyngeal arch
D. Third pharyngeal arch
A 56-year-old woman complains of diplopia (double 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. Trochlear
A 70-year-old man is admitted to the hospital with severe headaches. During the physical examination he has difficulty coughing and swallowing. An MRI 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. Vagus
A 2-day-old male infant has a noticeable gap in his upper lip. The diagnosis is a cleft lip. Failure of fusion of which of the following structures is the most likely cause of this anomaly? A. Lateral nasal and maxillary prominences/ processes B. Medial nasal prominences/processes C. Lateral nasal and medial nasal prominences/ processes D. Lateral prominences/processes E. Maxillary prominences/processes and the intermaxillary segment
E. Maxillary prominences/processes and the intermaxillary segment
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. Middle meningeal
A 44-year-old woman is being treated for Raynaud's disease. A sympathetic blocking drug is administered in high doses. Which of the following conditions will most likely 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. Ptosis and miosis
A 22-year-old man is admitted to the emergency department and intubated. An endotracheal tube is passed through an opening between the vocal folds. What is the name of this opening? A. Piriform recess B. Vestibule C. Ventricle D. Vallecula E. Rima glottidis
E. Rima glottidis
A 2-month-old male infant presents with a small pit at the anterior border of his left sternocleidomastoid muscle, with mucus dripping intermittently from the opening. The pit extended to the tonsillar fossa as a branchial fistula. Which of the following embryologic structure(s) is (are) involved in this anomaly? A. Second pharyngeal arch B. Second pharyngeal pouch and groove C. Third pharyngeal pouch D. Thyroglossal duct E. Second pharyngeal pouch and cervical sinus
E. Second pharyngeal pouch and cervical sinus
A 45-year-old woman is admitted to the hospital for severe ear pain. Physical examination reveals chronic infection of the mastoid air cells (mastoiditis). The infection can erode the thin layer of the bone between the mastoid air cells and the posterior cranial fossa and spread most commonly into which of the following venous structures? A. Superior sagittal sinus B. Inferior sagittal sinus C. Straight sinus D. Cavernous sinus E. Sigmoid sinus
E. Sigmoid sinus
A 54-year-old man 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 gain access to the cranial cavity? A. Cribriform plate B. Cavernous sinus C. Frontal sinus D. Maxillary sinus E. Sphenoidal sinus
E. Sphenoidal sinus
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. Submental
A 32-year-old woman is admitted to the hospital with headaches and dizziness. During physical examination 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. Superior tarsal (of Müller)
A 43-year-old man 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. Trochlear
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. Vagus nerve
