A&P Exam 2
Your 89-year-old patient is losing vision due to macular degeneration. Relative to the image shown above of a right eye, where is this degeneration occurring?
At an oval area to the left (lateral) to the optic disk
Your 60-year-old patient is tearing excessively from her right eye. Her inferior lacrimal punctum is apparently congested. To locate this structure before clearing it, where would you look?
At the upper medial margin of the lower eyelid
To differentiate between idiopathic unilateral paralysis of the muscles of facial expression (Bell palsy) and a herpes zoster infection of CN VII, the physician must look for small herpetic lesions (vesicles or blisters). Where are these skin lesions located in a herpes zoster infection involving the facial nerve?
Auricle of the external ear
A 27-year-old paratrooper lands on a pine tree. Consequently, preganglionic parasympathetic nerves leaving the central nervous system are lacerated. Which of the following structures contain cell bodies of the damaged nerve fibers?
Brain stem and sacral spinal cord
A 10-year-old girl presents with a smooth, round neck mass the size of a golf ball at the upper third of the anterior border of her right sternocleidomastoid muscle, as seen in the photo. Her mother says this once small, peanut-sized mass grew without pain or inflammation after it became noticeable 2 months previously. The mass does not affect the girl's daily activities. What is the most likely diagnosis for the pictured mass?
Branchial cyst
Which of the following is located in the posterior cranial fossa?
Cerebellum
You are serving as a medical aide in an undeveloped country and your supervisor brings you the above CT of a newly arrived female patient. What is your diagnosis?
Cleft Palate
You arrive at the scene of a motor vehicle accident and the driver is severely bleeding from a laceration in his right brachial artery near the head of the humerus. You know you can control bleeding to this vessel by doing which of the following?
Compressing the subclavian artery against the first rib as it passes posterior to the scalenus anterior
Upon neurological examination, you notice a slow pupillary light reflex in a patient's right eye. Which of the following is consistent with this sign?
Compression of the right oculomotor nerve
You are examining an elderly patient and you notice that her external jugular veins (EJV) are very prominent throughout their course in the neck. You believe this patient may have which of the following?
Congestive heart failure
A 41-year-old woman overdoses on some prescription medications that have a common side effect of autonomic nerve stimulation. Which of the following conditions or actions results from stimulation of the parasympathetic fibers to the eyeball?
Contraction of the ciliary muscle
Your 40-year-old patient is complaining of an inability to securely close her right eye, eye pain and poor vision. She has no history of trauma. You diagnose her condition as Bell palsy, which typically involves inflammation of branches of which nerve?
Facial Nerve
A tumor is discovered embedded in the posterior wall of the tympanic cavity in a 45-year-old man. If the tumor erodes through this wall, which of the following structures will it first encounter?
Facial nerve
Most senior citizens dislike the bass audio frequencies augmented by a large subwoofer in a teenager's car. But, one 68-year-old man came to his doctor complaining of hyperacusis, or heightened sensitivity to these loud, low-frequency sounds. The results from an audiometer hearing test reveal normal hearing for a man of his age. Given the presentation, what cranial nerve is most likely involved with his hyperacusis?
Facial nerve
In examining a new born infant, you look for a sign of abnormal CSF pressure by doing which of the following?
Feeling at the future site of bregma
A 2-year-old boy presents with midfacial and mandibular hypoplasia, cleft palate, deformed external ear, and defect in hearing. Which of the following embryonic structures is most likely developed abnormally?
First pharyngeal arch
During a routine cranial nerve exam, the doctor asks his patient to stick out (protrude) his tongue. Which of the following muscles would be responsible for this action?
Genioglossus
A 10-year-old boy was admitted to the hospital with a sore throat, earache, and high fever. On examination, he had severely swollen palatine tonsils (tonsillitis). What nerve carries the sensory input for most of the patient's symptoms?
Glossopharyngeal
A pharyngeal (gag) reflex is the contraction of the pharyngeal constrictor muscles that is elicited by touching the back of a patient's pharynx (e.g., with a tongue depressor). Afferent nerve fibers that innervated the pharyngeal mucosa are branches of which of the following nerves?
Glossopharyngeal nerve
A 4-year-old girl was taken to her doctor because of a severe sore throat, difficult nasal respiration, mouth breathing, and ear pain. The physical examination and history taken by the physician revealed a high temperature but no cough or nasal discharge. The nasal mucosa and middle ear were mildly inflamed. The child's voice reflected a blocked nasal passageway. Lung sounds were normal. Which of the following statements best describes the most likely cause of the child's mouth breathing and rhinitis?
Hypertrophy of the pharyngeal tonsils (adenoiditis)
Your 78-year-old patient is experiencing a reduction in his taste sensations. The problem could involve any of the following nerves except?
Hypoglossal nerve
Sensory fibers in the pharyngeal plexus are conveyed primarily by cranial nerve ____.
IX
The nasolacrimal duct drains into the ______________.
Inferior Meatus
A 76-year-old man with swallowing difficulties undergoes imaging for a possible mass. The CT scan image at the level of the cricothyroid ligament in his neck should show which of the following structures?
Inferior laryngeal nerves
You are examining a child who has just swallowed a chicken bone that you suspect is lodged in his piriform recess. You are worried that the bone has pierced the mucosa and injured which nerve?
Internal laryngeal nerve
A 53-year-old woman with a severe middle ear infection comes to a hospital. On examination, a physician finds that the infection has injured the tympanic nerve. The damaged nerve:
Is a branch of the glossopharyngeal nerve
A kick fighter is brought into the locker room after being knocked out by his opponent. He has suffered severe trauma to the articular disk and capsule of the temporomandibular joint. This could result in paralysis of which of the following muscles?
Lateral pterygoid
You are examining a patient who is complaining of diplopia especially when looking directly to the left. Which nerve is most likely injured?
Left Abducent Nerve
A 45-year-old man has hypertension (200/120 mm Hg) and hypercholesterolemia (260 mg/dl). The patient also complains of headache and dizziness. A carotid Doppler ultrasound study revealed severe stenosis of both internal carotid arteries. Bilateral carotid endarterectomies are performed. After recovery from the surgery, you notice that the patient's tongue deviates to the left upon protrusion. Which nerve was most likely injured during the surgery?
Left hypoglossal nerve
A 60-year-old man is unable to open his eye because of a rare neuromuscular disease. Which of the following muscles would most likely be paralyzed?
Levator palpebrae superioris
Your 45-year-old patient complained of loss of sensation from the left side of his tongue following the extraction of an impacted left third molar. What was the nerve likely damaged by this procedure?
Lingual Nerve
A 55-year-old man presented with painful vesicles on his chin and lower lip. He was diagnosed with a dermatomal herpes zoster inflammation (shingles). Which of the following nerves likely transmitted the sensations of pain?
Mental Nerve
Lesion of the trunks of the brachial plexus is most likely to occur from a penetrating wound into which of the following labeled areas in the given drawing of the neck regions?
Occipital triangle
During a routine eye exam, the ophthalmologist noted the direct and consensual light reflexes of his patient were absent when he shined a flashlight in the right eye. Because the doctor found no problem with the visual acuity (eyesight) of the patient, which cranial nerve is most likely damaged in this patient?
Oculomotor Nerve
A 27-year-old woman with green eyes comes to her physician with noted asymmetry in her pupils (as seen in the figure). Her right pupil is abnormally dilated, and on examination, the right eye is slow to respond to light stimuli. Her visual acuity is not impaired, and no other signs and symptoms are noted. What structure is most likely affected in this patient?
Oculomotor nerve
A 65-year-old man with multiple vision problems comes to a local eye clinic. The pupillary light reflex can be eliminated by cutting which of the following nerves?
Oculomotor, short ciliary, and optic nerves
An 18-year-old male skier is brought to the emergency room after a high-speed collision with a tree. His forehead absorbed much of the impact, resulting in multiple fractures and lacerations. His ER physician noted a clear nasal discharge, which tested positive for glucose. Given the patient's presentation, what cranial nerve was most likely damaged?
Olfactory nerve
A 23-year-old man is suffering from numbness at the tip of his nose after being diagnosed with a brain tumor. Which of the following nerves is most likely being compressed by the tumor?
Ophthalmic division of the trigeminal nerve
When testing the sensory innervation of the face, a physician runs a cotton wisp along the skin of the tip of her patient's nose. If the patient can identify the location of the cotton wisp when her eyes are closed, what cranial nerve is intact and being tested by the doctor?
Ophthalmic division of the trigeminal nerve.
A 61-year-old woman is found to have ocular lymphoma invading her optic canal. Which of the following structures would most likely be damaged?
Opthalmic artery
A 46-year-old woman is seen by you for increasing visual loss An MRI revealed a tumor of the anterior pituitary gland. Further visual examination revealed "tunnel vision," that is, loss of the lateral (temporal) visual fields in both eyes (bi-temporal hemianopia). Which of the following structures was most likely being compressed by the tumor?
Optic Chiasm
On a report of a patient with a facial laceration, you see that the ED physician noted that the patient was not able to firmly close his palpebral fissure. What is the facial muscle that was affected by the injury?
Orbicularis oculi
As a result of facial injuries suffered in an automobile accident, a 17-year-old girl is unable to close her lips together tightly. Which of the following muscles is paralyzed?
Orbicularis oris
Adenoids are inflamed what?
Pharyngeal tonsils
A 38-year-old man comes to his doctor complaining of double-vision (diplopia). The doctor notes the patient looks "cross-eyed" due to the right eye directed medial to the midposition of his gaze. When the patient is asked to direct his vision to his right, the right eye is unable to go past the midposition. No other visual deficits are noted. What specific nerve is most likely damaged?
Abducent nerve
A benign tumor in the orbit of a 49-year-old man compresses a structure that runs through both the superior orbital fissure and the common tendinous ring. Which of the following structures is most likely damaged?
Abducent nerve
A 33-year-old woman develops Bell's palsy. She must be cautious because this can result in corneal inflammation and subsequent ulceration. This symptom results from which of the following conditions?
Absence of the corneal blink reflex
A 59-year-old man has pus in the loose connective tissue layer of the scalp, and consequently, his superior sagittal sinus is infected. The arachnoid granulations in the infected sinus:
Absorb CSF into the dural venous sinuses
The infraorbital groove contains __________________.
fibers of cells located in the trigeminal ganglion.
In a case of massive head and facial trauma, ligation or therapeutic embolization of the maxillary artery may help control hemorrhage to all of the following except?
forehead
During a fight between two construction workers, one man strikes the other with a hammer at the pterion of the skull. Which of the following bones may be fractured?
greater wing of sphenoid bone
Which of the labeled structures is derived from the body of the first cervical vertebra in this labeled X-ray showing a transoral view of the upper cervical vertebrae?
odontoid process
A 15-year-old young man developed cavernous sinus thrombophlebitis after a 1-week history of a single acne-like lesion at the anterior tip of his nose. He presented with a headache, periorbital edema, diplopia, and a fever (103°F or 39.4°C). What vein is the most likely route for the spread of this infection to the cavernous sinus?
opthalmic nerve
A young girl complains of dryness of the nose and the palate. This would indicate a lesion of which of the following ganglia?
pterygopalatine ganglion
A bony overgrowth narrows the pterygomaxillary fissure, compressing the third part of the maxillary artery. As a result, blood flow will be reduced in which of the following arteries?
sphenopalatine
The hypoglossal nerve and facial artery are found within the _____________.
submandibular triangle
The pupil in the eye of a 43-year-old patient remains small even when room lighting is dim. Which of the following nerves would be injured?
superior cervical ganglion
A paralyzed right true vocal fold is most likely associated with which of the following situations?
surgical removal of thyroid gland
Your patient has a Zenker's diverticulum, which results from hypertrophy and spasm of the cricopharyngeus muscle and which interferes with swallowing. Where is this muscle located?
within inferior constrictor
Which of the following laryngeal muscles abducts the vocal folds?
Posterior cricoarytenoid
The buccopharyngeal fascia is continuous with _____________.
Pretracheal fascia
A 32-year-old woman has hoarseness in her voice, and her uvula is deviated to the left on phonation. Which of the following nerves is damaged?
Right Vagus Nerve
Your 56-year-old male patient is being evaluated for snoring and sleep apnea. An uvulopalatopharyngoplasty has been proposed, which removes the uvula. This structure is connected to which of the following?
Soft palate
A 25-year-old man is having surgery to repair a severely deviated nasal septum that has contributed to severe nasal congestion. This will mean a surgical procedure that could alter the shape of all of the following cartilages or bones except:
Sphenoid
A 14-year-old boy hits his head on the asphalt road after falling off his skateboard. His radiograph reveals damage to the sella turcica. This is probably due to fracture of which of the following bones?
Sphenoid bone
Your 24-year-old patient has a squamous cell carcinoma of the lateral aspect of her lower lip resulting from overexposure to direct sunlight. Metastatic spread from this cancer is likely to go through which of the following groups of lymph nodes?
Submandibular and deep cervical
A 17-year-old boy receives an injury to the phrenic nerve by a knife wound in the neck. The damaged nerve passes by which of the following structures in the neck?
Superficial to the anterior scalene
During a domestic incident, a 28-year-old woman receives a vertical stab wound that lacerates the pterygomandibular raphe. As a result, which of the following muscles would be paralyzed?
Superior pharyngeal constrictor and buccinator muscles
A 31-year-old football player with a head injury is brought to a local emergency department. Physical examination, radiogram, and a magnetic resonance imaging scan indicate a lesion of the trigeminal nerve. Which of the following muscles is most likely paralyzed?
Tensor veli palatini
Choose the appropriate lettered structure in this radiograph of the lateral view of the head (see figure). Which structure has numerous small cavities and lies between the orbit and the nasal cavity?
The ethmoid sinus has numerous small cavities and lies between the orbit and the nasal cavity.
In infants, a normal reflex involves tapping a spot between the two superciliary arches to elicit eye blinking. What is the name of the reflex test?
The glabella tapping reflex
As a treatment for intractable hiccups, an anesthesiologist plans to paralyze the left hemidiaphragm. Where will he likely inject an anesthetic solution?
The left phrenic nerve as it crosses anterior to the scalenus anterior muscle
Your 30-year-old patient has trigeminal neuralgia and radiofrequency ablation of the trigeminal ganglion has been recommended. The most direct route by which the surgeon will insert the electrode to perform this procedure is to insert it where?
Through the foramen ovale
An 18-year-old woman presents with a soft, smooth, and fluctuant mass (swelling) in the midline of her neck, situated just below the body of hyoid bone. She first noticed this swelling three years ago, and it has gradually increased in size, measuring 0.5 in. (1.25 cm) in diameter. The physician notes the mass moves upward on swallowing, but no other abnormal findings were discovered. What is the most likely diagnosis in this patient?
Thyroglossal duct cyst
Which of the following muscles is innervated by C1?
Thyrohyoid
Your 80-year-old patient just had an embolic event that occluded all blood flowing in the central artery of the retina in her right eye. What did your patient complained of?
Total blindness in her right eye
The muscles that are of branchiomeric origin are paralyzed in a 26-year-old patient. A lesion of which of the following nerves would cause muscle dysfunction?
Trigeminal Nerve
The drummer of a local band presents to your clinic with hearing loss. Otoscopic examination reveals loss of contraction of the tensor tympani and the stapedius, which prevents damage to the eardrum and middle ear ossicles. These muscles are most likely controlled by which of the following nerves?
Trigeminal and facial nerves
Your 53-year-old patient is suffering from hyperacusia (excessive acuteness of hearing). What is this condition most likely associated with?
Tumor of the facial nerve at the internal acoustic meatus
The buccinator is innervated by _______________.
VII
A 24-year-old man falls from his motorcycle and lands in a creek. Death may result from bilateral severance of which of the following nerves?
Vagus nerve
The superior sagittal sinus contains mostly ______________.
Venous blood
Palatoglossus is innervated by cranial nerve ________.
X
Choose the appropriate lettered structure in this MRI scan showing a transaxial section through the head (see figure). Which structure pierces the dural roof of the cavernous sinus between the anterior and middle clinoid processes?
The internal carotid artery pierces the dural roof of the cavernous sinus between the anterior and middle clinoid processes.
A special image reconstruction from a contrast-enhanced CT scan shows the "venous angle." What does this refer to?
The junction of the internal jugular and subclavian veins
Choose the appropriate lettered structure in this MRI scan showing a transaxial section through the head (see figure). Which structure may be paralyzed as a result of infection of the cavernous sinus?
The lateral rectus is innervated by the abducens nerve, which runs through the cavernous sinus.
A 55-year-old man consulted his family physician about a swelling antero-inferior to his left ear. At the exam, he also complained that the left side of his face felt weak and the corner of his mouth was drooping. On examination, the physician detected a hard mass deep within the substance of the parotid gland. He also observed that the man's facial muscles on the left side were weaker than on the right side. Which of the following statements best describes the most likely cause of the patient's complaints?
The parotid plexus of the facial nerve (CN VII) was being compressed by a carcinoma of left parotid gland.
Choose the appropriate lettered structure in this angiogram of the cerebral vasculature (see figure). Collateral circulations are discounted. Ischemia of the posterior inferior surface of the cerebellum is caused by obstruction of which artery?
The posterior inferior cerebellar artery supplies the posterior inferior surface of the cerebellum.
A middle-aged woman is receiving a shiatsu massage when her therapist notices that the client has numbness of her back. A lack of sensation overlying the skin over the anterior triangle of the neck may be due to injury to which of the following nerves?
Transverse cervical nerve
If normal evagination of the endodermal lining of the embryonic pharynx does not take place between the pharyngeal (branchial) arches, the pharyngeal (branchial) pouches will not form. Maldevelopment of the first pharyngeal pouch during embryonic weeks 4 to 5 is most likely to result in a congenital disorder of which of the following structures?
Tympanic Cavity
A 24-year-old swimmer presents with external ear canal inflammation (otitis externa). The patient coughs during your otoscopic examination. The cough results because some of the tympanic membrane and the external ear (concha) are supplied by a nerve that also innervates the larynx. What is this nerve?
Vagus nerve
A 60-year-old female yodeler with a 43-year history of smoking complains of pain during swallowing and hoarseness in her voice. A fiberoptic endoscopy reveals a laryngeal squamous cell carcinoma at the location identified by the arrow within the given figure. What structure is most likely affected by this laryngeal cancer?
Vocal folds
During a gang fight, a 17-year-old boy is punched, and his nasal septum is broken. Which of the following structures would be damaged?
Vomer and perpendicular plate of ethmoid
An angiogram of a 45-year-old man shows an occlusion of the costocervical trunk. This obstruction could produce a marked decrease in the blood flow in which of the following arteries?
deep cervical artery
Which of the following pairs of nasal sinuses are visible in the above coronal CT?
ethmoid and maxillary
A 33-year-old woman presents with rapid weight gain, particularly in the trunk and face with sparing of the limbs, excess sweating, thinning of the skin, and hirsutism (facial male-pattern hair growth). A full examination also reveals bitemporal hemianopsia (or tunnel vision). What of the following labeled areas on the given X-ray of the lateral skull will be of most interest to the physician?
hypophoseal fossa of sphenoid bone
A 47-year-old man has trouble with double vision (diplopia) after striking his head on the steering wheel in a car accident. During a subsequent eye examination, his ophthalmologist asks him to first look inward (toward his nose) and then upward (toward the ceiling). The integrity of which of the following extraocular muscles is being tested?
inferior oblique
A 9-year-old girl with a history of middle ear infections presents with pain, tenderness, and inflammation located posterior to her right auricle. What is the most likely diagnosis, given her current symptoms?
mastoiditis
In the above coronal MRI, note the differences in the appearance of the right and left optic nerves. The right nerve is showing inflammatory changes consistent with a demyelinating condition that often affects the optic nerve. Which of these conditions would it typically be?
multiple sclerosis
A dentist is about to inject a needle with an anesthetic solution into a foramen in the palate directly posterior to the space between the central incisors. What is the nerve the dentist is trying to anesthetize?
nasopalatine
A 7-year-old girl has difficulty breathing through her nose and is brought to her pediatrician. On examination, she is diagnosed with adenoids. Which of the following tonsils is enlarged?
pharyngeal tonsil
The thyrocervical arterial trunk supplies the _____________.
scapular region.
A 25-year-old woman notes the pictured asymmetry in her neck when she tenses the skin of her inferior face and neck. This asymmetry may be due to a limited mesodermal migration in which of the following embryonic structures?
second pharyngeal arch
Lesion of the lingual nerve proximal to the chorda tympani joining it will lead to loss of _________________.
sensation from the anterior 2/3 of the tongue.
A 62-year-old patient with cervical intervertebral disc disease underwent discectomy and fusion performed from an anterior approach and suffered an unusual complication in which the right cervical sympathetic trunk was injured, causing the patient to have a right Horner syndrome. All of the following signs would have led the surgeon to this conclusion except:
A widely dilated right pupil
A 42-year-old man has a lymph node biopsy in the left side of his lateral cervical region or posterior triangle of his neck. After closure of the wound, the physician asks the patient to rotate his head to the right against resistance, as shown in the photo. What nerve is the doctor assessing with this test?
Accessory nerve
A 70-year-old woman goes to her physician complaining of headache, nausea, and vomiting. A head MRI reveals a tumor disrupting the visceral afferent fibers running into the solitary nucleus located within the medulla. What signs or symptoms would be manifested following the degeneration of these nerve fibers entering the solitary nucleus?
Altered taste
An oral surgeon is about to extract the right upper canine from a patient. It is important that the surgeon anesthetize which of the following structures so that the patient does not feel discomfort?
Alveolar process of maxillary bone
A 72-year-old man comes into his physician's office complaining of fever, nausea, vomiting, and the worst headache of his life. Tests and imaging examination suggest hydrocephalus (widening ventricles) resulting from a decrease in the absorption of cerebrospinal fluid (CSF). A decrease of absorption of CSF through which of the following structures could be responsible for these findings?
Arachnoid Villi
A tumor growing at the base of the skull impinges upon the opening indicated by the arrow, severely compressing its contents. Which of the following conditions is the most likely result?
Arterial supply to the dura mater is reduced
A 53-year-old woman is diagnosed as having a pituitary tumor. If the tumor is large enough, she could exhibit which of the following disorders?
Bitemporal (heteronymous) hemianopia
A 42-year-old man visited his primary care physician because of a swelling in his mouth and pain under his tongue. The physician examined his mouth and observed that there was inflammation and swelling around his right sublingual caruncle. When she asked the patient when he feels the pain, he said it occurs mostly when he eats. A CT exam revealed a large calculus (stone) in a structure under the tongue. Which of the following statements best describes the most likely cause of the sublingual swelling in the man's mouth?
Blockage of the right submandibular duct
A 37-year-old patient has an infectious inflammation of the dural venous sinus closest to the pituitary gland and a secondary thrombus formation. Which of the following is the most likely site of infection?
Cavernous Sinus
You are examining a 25-year-old patient in the ED after he was involved in a motorcycle accident in which he was not wearing a helmet. Fluid is leaking from his right nostril and he cannot smell on that side. Which of the following osseous structures is most likely fractured?
Cribriform plate
The nerve accompanying the superior thyroid artery may be damaged during an operation on the thyroid gland. Which of the following functional defects may result from this injury?
Decreased tension of the vocal cord
A 14-year-old girl presents with Horner syndrome, after surgical removal of a mass growing in her posterior mediastinum. What nerve would be affected by the loss of sympathetic innervation to the head?
Deep petrosal🡪 CN III
Vallate papillae are taste receptors located where?
Directly anterior to the terminal sulcus on the tongue
A 37-year-old man receives a direct blow to his head and is brought to an emergency department. His radiograph shows a fracture of the floor of the middle cranial cavity, causing severance of the greater petrosal nerve. Which of the following conditions could be produced by this injury?
Dryness in the nose and palate
A 31-year-old woman complains of headache and dizziness after hitting a kitchen cabinet door with her head. Her MRI scan and venogram show a large blood clot in the great cerebral vein of Galen. The obstructed vein of the brain is a direct tributary of which of the following venous structures?
Dural venous sinuses
Mandibulofacial dysostosis (Treacher-Collins syndrome) is a developmental disorder characterized by craniofacial deformities, including malformed or absent ears, zygomatic and mandibular hypoplasia, and downward slanting eyes exhibiting ptosis of the lateral eyelids, as shown in the photo. This condition is the result of lack of migration of neural crest cells into what pharyngeal arch?
First pharyngeal arch
A 3-year-old girl is admitted to the hospital with pain and hearing defect. An MRI examination reveals that she has developmental defects in the auditory tube and middle ear cavity. Which of the following pharyngeal pouches is most likely developed abnormally?
First pouch
A 34-year-old man visits his physician complaining of abnormal sensations and numbness in his upper teeth and in the skin of his lower eyelid, cheek, upper lip, and lateral external nose on his left side. Which of the following cranial openings is the most likely site for the nerve lesion responsible for these signs and symptoms?
Foramen rotundum
A physician examines a 53-year-old woman and notes deviation of the uvula to the right and asymmetry in the elevation of the soft palate, with the palatal arch of the left side sagging when compared to the right. The muscles involved in these abnormal findings are most likely derived from the mesoderm of what pharyngeal arch?
Fourth
A pitcher was hit on the right side of his head by a baseball. He fell to the ground and was unconscious for about 4 minutes. When he awoke, he complained of a severe headache and considerable pain and was rushed to hospital. He was initially conscious but suddenly became very drowsy. On examination, a large bruise was observed on his right temple and his right pupil was dilated. A radiograph of his cranium revealed a fracture of the squamous part of the temporal bone. Which of the following statements best describes the most likely cause of the pitcher's symptoms and signs?
Fracture of the calvaria and rupture of the middle meningeal artery producing an extradural hematoma
You are working in the ED and a patient is brought in by ambulance after an attempted strangulation. Once vital signs are established to be near normal, you are most likely concerned about which of the following conditions?
Fractured Hyoid bone
A 42-year-old man suffers from a rare tongue disease and comes to the emergency department. On examination, he is unable to protrude his tongue. Which of the following muscles is paralyzed?
Genioglossus
A 62-year-old male factory worker went to his doctor complaining of a progressive hearing loss. Audiometric tests reveal an inability to detect high-frequency sound waves, but the rest of his hearing scores within the normal range. What is the most likely location of injury for this sensorineural hearing loss?
Hair cells in the base of the cochlea
While jogging on a trail you come upon a child who fell off her bike and has severe facial lacerations that are bleeding profusely. In order to most effectively curtail the bleeding, where would you put pressure (bilaterally)?
Horizontal ramus of the mandible just anterior to the attachment of the masseter
A 22-year-old man receives a stab wound in the left anterior cervical region, at the C2 vertebral level. The wound was 3 cm deep and located anterior to the sternocleidomastoid muscle (SCM) and superior to the greater horn of the hyoid bone. During a postoperative examination, the patient displays dysarthria, or difficulty speaking. Which of the following structures is most likely damaged?
Hypoglossal Nerve
You previously examined a 36-year-old woman who had a large mass in her lower anterior neck. An ultrasound exam revealed it to be a benign tumor of her thyroid gland. After what should have been a simply partial thyroidectomy she is aspirating fluid into her lungs. Apparently, a nerve had been injured during the surgical procedure than innervated the upper part of her larynx. Which nerve was injured?
Internal Laryngeal Nerve
A 43-year-old man presents with loss of control of facial expression across the entire right side. The corner of his mouth droops on the right side, but he can clench his jaw and chew on demand. During examination, his physician also notes loss of hearing on the right side, and the patient has difficulty maintaining balance while standing on one foot. The patient's corneal (blink) reflex is absent in the right eye, but cutaneous sensation is normal on the entire face. The physician orders radiographic imaging in anticipation of finding a tumor. What is the most likely location of the tumor?
Internal acoustic meatus
A 57-year-old woman presents with right unilateral facial paralysis and dizziness. During an examination, the physician also notes a loss of hearing on the right side. An MRI of the patient's head reveals a brain tumor, as noted by the asterisk in the figure. Based upon the patient's presentation and MRI, where is the tumor located?
Internal acoustic meatus
A 38-year-old woman comes to her family physician complaining of repeatedly tripping and double vision when descending stairs. While testing the eye movements in a cranial nerve examination, she was unable to move her left eye inferiorly when she followed the physician's finger to her right side, as seen in the given figure. What specific nerve is most likely damaged?
Left trochlear nerve
Your 65-year-oldpatient has hearing loss due to otosclerosis of the auditory ossicles. This is interfering with sound reception, which normally proceeds from the tympanic membrane to the inner ear via which of the following order of structures?
Malleus, incus, stapes, oval window
A 57-year-old man comes to a local hospital with fever, headache, nausea, and vomiting. Laboratory tests reveal an infection, and radiologic examination localizes the infection to the cavernous sinus. Which of the following nerves would be unaffected by this condition?
Mandibular nerves
A 17-year-old girl uses Accutane, an acne drug implicated in interfering with normal development of the facial primordia, early in her unexpected pregnancy. Examination of the newborn reveals the craniofacial defect seen in the photo. In this case, the defect is related to failure of fusion of what craniofacial processes?
Maxillary and medial nasal processes
A young homeless child presents to the emergency department with high fever and low blood pressure. He had strep throat 2 weeks ago when seen in the free clinic; however, his parents could not afford antibiotic medication, and he did not take any. He now has an abscess in the auditory tube that is blocking communication between the nasopharynx and which of the following structures?
Middle Ear
Your 1-year-old has an infection that has reached his mastoid process (mastoiditis). A classical surgical approach has been to drain the primary infection via the mastoid antrum. What is the cavity the surgeon plans to drain via this route?
Middle ear
The patient shown above was complaining of double vision (diplopia). Based on the position of his left eye you suspect injury to which of the following cranial nerves?
Oculomotor Nerve
A 25-year-old woman is suffering from facial paralysis and exhibits ptosis (drooping of the upper eyelid). Injury to which of the following nerves would result in ptosis?
Oculomotor nerve
On August 13, 1913, Dr. Edwin Cobb was called to the hospital to see a patient who had been thrown out of a buggy in a runaway accident. The patient was a woman, 46-years-old, and had been unconscious for ten hours when he arrived at the hospital. He noted a small discoloration over the external and superior margins of her right orbit. Upon regaining consciousness the patient showed a complete ptosis of the right lid; widely dilated pupil, with no reaction to light or accommodation, and diplopia was present. The right eye appeared prominent with a slight bulging. What structure is lesioned and where is the most likely location of the lesion?
Oculomotor nerve as its exits midbrain
After ingesting a toxic substance found in her friend's home, a 12-year-old girl is unable to close her lips. Which of the following muscles may be paralyzed?
Orbicularis oris
The radiology report on the MRI of the brain on your 30-year-old female patient indicates the presence of "empty sella syndrome." This is a condition in which the diaphragmatic sellae is deficient and the depression within the sella turcica is largely filled with CSF. This excess fluid depresses and flattens the structure located there. What is the structure?
Pituitary gland
Your 17-year-old patient is frustrated because every time she ingests any food that is very cold, especially ice cream, she gets a headache. Such patients are believed to have a very sensitive parasympathetic ganglion that is located directly superior to the posterolateral aspect of the hard palate. What is this ganglion?
Pterygopalatine
A 34-year-old singer has been diagnosed with thyroid cancer and consequently has a thyroidectomy. He has been hoarse ever since the surgery 8 weeks ago. It has been suspected that a nerve was injured during the operation. Which of the following nerves is most likely damaged?
Recurrent Laryngeal Nerve
A 24-year-old man came to his physician with a history of chronic maxillary sinusitis. A computed tomography (CT) scan reveals a soft-tissue mass in the superior aspect (or roof) of the right maxillary sinus. Functional endoscopic sinus surgery (FESS) was performed to biopsy the mass. Postoperatively, the patient experiences paresthesia and numbness of the skin of the right inferior eyelid and upper lip. Which nerve was most likely damaged during the surgery?
Second division Trigeminal nerve
A 59-year-old stroke patient is unable to swallow because of a nerve injury. Which of the following nerves is unaffected?
Spinal accessory nerve
While speaking at a charity program, an elderly woman suddenly collapses to the ground. She is found to have a massive stroke, but it is unclear where the vascular lesion is located. She undergoes a cerebral arteriogram. Normally, the great cerebral vein of Galen drains directly into which of the following sinuses?
Straight sinus
A 45-year-old man is in surgery. While seated at the head of the operating table, the anesthesiologist periodically checks the patient's pulse by palpating the artery located anterior to the tragus of the external ear. Which of the following arteries is being utilized to monitor the patient's pulse?
Superficial Temporal
A male 1st-year medical student mistakenly enters the women's locker room and finds a group of his female colleagues changing their clothes. He is shocked and embarrassed by his mistake and immediately runs away with his heart pounding. Given his agitated state, what ganglion, housing neuron cell bodies, is experiencing an extremely high rate of activity?
Superior Cervical Ganglion
The following computed tomography (CT) scan shows a left crescent-shaped extra-axial hematoma, indicated by the arrows, compressing the brain of a 17-year-old woman, who impacted the front of her head on the steering wheel during a head-on motor vehicular accident. Given the radiologic imaging results and the history of the accident, what blood vessel(s) is/are the most likely source for this cerebral hemorrhage?
Superior cerebral veins
A 42-year-old woman noticed that her right upper eyelid was drooping and her right pupil was constricted (see photo). She goes to her physician where a thorough examination revealed ptosis, miosis, anhydrosis, flushing of her face, and narrowing of the palpebral fissure (the slit between the upper and lower eyelids) on the right side of the patient. Which of the following structure is most likely damaged in this patient?
Superior cervical ganglion
A 48-year-old patient complains of double vision, cannot abduct her eye and lacks a corneal reflex. Where is the likely location of the lesion?
Superior orbital fissure
A 39-year-old woman presents to your clinic with complaints of headache and dizziness. She has an infection of a cranial dural sinus. The sinus that lies in the margin of the tentorium cerebelli and runs from the posterior end of the cavernous sinus to the transverse sinus is infected. Which of the following sinuses is affected by inflammation?
Superior petrosal sinus
An 82-year-old woman develops a dural meningioma (tumor) that compresses the confluence of the dural venous sinuses. On the given contrast venogram from an angiographic series, drainage from which of the following labeled vessels would be impeded by the tumor?
Superior sagittal sinus
A 40-year-old woman suffers from headaches, nausea, vomiting, and multiple lower cranial nerve involvement. Her physician orders a CT soft tissue neck study, and the given coronal CT shows a mass lesion (tumor) centered at the jugular foramen and identified by arrows. This tumor has destroyed the jugular foramen and hypoglossal canal on the right side and damaged the cranial nerves traversing these foramina. In this patient, which of the following functions will remain intact?
Taste in the anterior two thirds of the tongue
A 38-year-old man has had thyroid surgery to remove his papillary carcinoma. The external laryngeal nerve that accompanies the superior thyroid artery is damaged during the surgery. This injury could result in a severe impairment of function of which of the following?
Tensing the vocal cords
While resecting a tumor in the palate, a surgical intern removes the mass but finds that it is deeply invasive into the tendon that loops around the pterygoid hamulus. Which of the following muscles would most likely be paralyzed?
Tensor veli palatini
The radiologic report on your 65-year-old patient indicates a brain tumor associated with cerebral edema (swelling) that has resulted in herniation of the uncus of the brain through the tentorial notch with potentially life threatening consequences. The tentorial notch is an opening in which of the following?
Tentorium Cerebelli
A 67-year-old man is known to have infection in the superior petrosal sinus. The infected sinus lies in the margin of which of the following structures?
Tentorium cerebelli
Your 45-year-old patient was seen by her optometrist who told her she had presbyopia. She doesn't understand what that it is. How would you explain it?
A decrease in the focusing power of the lens
Your 35-year-old patient is having difficulty speaking. A photograph of her larynx taken during a laryngoscope exam is shown above. What does it reveal?
A papilloma on her left vocal fold
You examine a comatose patient in the emergency room. His wife relates that she "accidentally" struck her husband in his "temple" with a baseball bat. After an initial short period of unconsciousness, he had a period of lucency but then had progressive drowsiness and finally was unresponsive. You suspect that the patient is suffering from which of the following?
An extradural (epidural) hematoma caused by a laceration of a branch of the middle meningeal artery
In the ED, you examine a patient complaining of severe maxillary sinus pain. Upon looking in his mouth, you observe severely degenerated maxillary molars. The patient admits that he has not been treated by a dentist for many years and recently had an upper posterior toothache. Which of the following is the most likely cause of the patient's pain?
An infection has spread via the root of an upper maxillary molar into the maxillary sinus
A newborn infant exhibits labored, gasping breathes and unusual vocal tones when crying. Thorough examination reveals the child has malformed vocal folds due to displaced attachments of the vocal ligaments. Which of the following structures is most likely defective in this condition?
Arytenoid cartilages
In order to perform a submandibular sialogram (radiographic study of the submandibular duct) a cannula for injection of contrast material would be placed into the orifice where in that duct?
At the base of the lingual frenulum
A 9-year-old girl suffers from the mumps, causing unilateral inflammation of her right parotid gland, as seen in the photo. The girl is experiencing great pain due to the stretched capsule of the parotid gland. Her physician is also concerned about the condition of the structures contained within the gland. Which of the following structures may be directly compressed in this situation?
Auriculotemporal nerve
Following total removal of your patient's parotid gland, he suffers from a condition known as gustatory sweating, whereby he sweats profusely on his ipsilateral cheek every time he eats. This occurred because the damaged fibers in the nerve that innervated his parotid gland communicated with the sweat glands on the face after regeneration. What is the name of this nerve that carries parasympathetic fibers to the parotid gland?
Auriculotemporal nerve
A 3-year-old girl presents with headache, vomiting, and papilledema. A sagittal MRI of the patient's head reveals a large craniopharyngioma, or a tumor arising from the remnants of Rathke pouch, as noted in the figure. This suprasellar tumor, located above the diaphragm sellae, is compressing the pituitary gland. Given the location and size of this tumor, what visual disturbances are likely to be seen in this patient?
Bitemporal hemianopsia
A 35-year-old woman comes to her dentist complaining of tenderness and pain in her cheek near the parotid gland, as well as bad breath and a foul-tasting mouth at meal times. A radiopaque fluid is injected into the parotid duct system through cannulation, and this sialography of the parotid duct confirms blockage by a calculus (sialolith). What muscle, through which the parotid duct passes, is most likely causing the stenosis where the sialolith now resides, blocking the drainage of the parotid duct?
Buccinator
The arrow in the above coronal CT image points to a muscle that, if paralyzed, results in the cheek being bitten during mastication. What is this muscle?
Buccinator
You are in the ED about to check an accident patient's carotid pulse when the attending physician corrects your finger place by lowering it. The attending physician notes that you need to keep your fingers low because certain patients have which of the following?
Carotid sinus hypersensitivity
A 68-year-old man who had a severe cold became acutely ill about two weeks later. His wife consulted their family physician, who said to bring him to his office as soon as possible. During her examination the physician noted that he had a high fever, pain in his eyeballs, a severe headache, paranasal sinusitis, no pupillary reflex, and dilation of the pupil. She also noted that his right eyeball was abducted and directed slightly inferiorly. Which of the following statements best describes the most likely cause of the man's symptoms and signs?
Cavernous sinus thrombophlebitis involving the occulomotor nerve (CN III)
A 68-year-old man arrived at the ER with sudden onset of the worst headache of his life, lethargy, and nuchal rigidity. He quickly loses consciousness and dies. Autopsy reveals no traumatic injury; however, the man's subarachnoid space is filled with blood, as seen in the photo. Damage to what blood vessel most likely led to the death of this patient?
Cerebral arterial circle
A 33-year-old woman undergoes a stapedectomy (removal of the stapes) due to otosclerosis, or abnormal bone growth in the middle ear. Following the surgery, she complains that she has lost her sense of taste in the anterior part of the tongue. What nerve is most likely to have been iatrogenically injured during the surgical procedure?
Chorda Tympani
A 46-year-old man visits the speech therapist complaining of dryness of the mouth. The therapist performs a swallowing study and, on examination, finds that the man has a lack of salivary secretion from the submandibular gland. This indicates a lesion of which of the following nervous structures?
Chorda tympani in the middle ear cavity
A 51-year-old woman traveling through British Columbia can see the beautiful blue sky with white clouds but is unable to focus on her face in the mirror. Her lack of accommodation results from paralysis of which of the following muscles?
Ciliary Muscles
A baby girl presents with a disproportionately wide skull with a short occipitofrontal diameter, as depicted in the given surface shaded CT reconstruction. What cranial suture most likely closed prematurely to result in this cranial deformity?
Coronal
During surgery on a 56-year-old man for a squamous cell carcinoma of the neck, a surgeon notices profuse bleeding from the deep cervical artery. Which of the following arteries must be ligated immediately to stop bleeding?
Costocervical trunk
A 33-year-old singer visits his physician and complains of changes in his voice. A laryngoscopic examination demonstrates a lesion of the superior laryngeal nerve. Which of the following muscles would be affected by such a lesion?
Cricothyroid
A 68-year-old man was choking on a piece of steak at a family restaurant. Despite attempts to dislodge the food via abdominal thrusts (or the Heimlich maneuver), his upper airway remained blocked. An emergency medical technician (EMT), eating at the scene, performed an emergency tracheotomy to enable the man to breathe. Which subcutaneous structure was most likely cut during this procedure?
Cricothyroid membrane
Startled by a loud noise while shaving his head with a straight razor, a young man accidentally cuts his scalp, severing branches of the supraorbital and superficial temporal vessels. The scalp wound appears modest but bleeds profusely. In what layer of the scalp do the severed vessels reside?
Dense connective tissue
A patient damages the cranial nerve indicated by the arrow in the figure. What signs or symptoms would be evident in a patient with this nerve lesion?
Deviation of the tongue to the ipsilateral side
A 23-year-old man was punched in the left eye in a bar fight, which resulted in periorbital edema and ecchymosis. In the ER, the man refuses to open his eye, and when his eyelids are pried open he exhibits vertical diplopia, specifically when asked to look up. A coronal CT reformat image reveals asymmetry in the left orbit and the superior antrum of the maxillary sinus, apparent in the given image. What is the most likely cause of the patient's diplopia?
Entrapment of inferior rectus muscle
A 25-year-old man is involved in an automobile accident and slams his head into a concrete wall of a bridge. His computed tomography (CT) scan reveals that the middle meningeal artery has ruptured but the meninges remain intact. Blood leaking from this artery enters which of the following spaces?
Epidural Space
A newborn infant was referred to a pediatrician because she was coughing and choking when attempts were made to feed her. The referring physician stated that the infant became cyanotic when she was coughing. Suctioning of excess secretions from the mouth and pharynx resulted in some improvement, but the symptoms quickly recurred. Attempts to insert a catheter into the stomach were unsuccessful. Radiographic studies revealed that the stomach was distended with air. Which of the following statements best describes the most likely cause of the infant's symptoms and signs?
Esophageal atresia and tracheoesophageal fistula
A 36-year-old man flips over the handlebars of his motorcycle and falls on the asphalt pavement, striking his head. He was not wearing a helmet. Although alert after the fall, he has a clear nasal discharge that tests positive for glucose. The patient most likely has a fracture of which of the following bones?
Ethmoid
An infection in which of the following paranasal sinuses is most likely to be associated with optic neuritis?
Ethmoid
A physician noticed a keyhole appearance of the right pupil in a 21-year-old woman characteristic of a defect of the iris known as coloboma, as seen in the photo. When asked about her affected eye, the patient responds that she was born with the condition. What is the most likely cause of this coloboma of the iris?
Failure of fusion of the retinal fissure
A 59-year-old woman with pain at the side of her skull comes to the emergency department. An emergent head CT scan shows a large lesion in the internal auditory meatus. This condition may progress and damage which of the following pairs of structures?
Facial and vestibulocochlear nerves
A 43-year-old man goes to his doctor complaining he is unable to close his left eye. His physical examination reveals an inability to wrinkle the left side of his forehead and asymmetry in his smile. Which of the following nerves is most likely damaged?
Facial nerve
A 43-year-old man has new onset of difficulty with speaking. Examination by the ENT resident reveals problems in elevating the hyoid bone and floor of the mouth, secondary to paralysis of the posterior belly of the digastric muscle. Which of the following nerves is most likely involved?
Facial nerve
A 59-year-old man went to his doctor unable to close his right eye. The physical examination also revealed asymmetry in his smile and an inability to wrinkle the right side of his forehead, as seen in the figure. What cranial nerve is affected in this patient?
Facial nerve
A 67-year-old man is complaining to his physician of immediate lacrimation (tearing) during eating. He also told his physician that he had had a severe and long-lasting episode of Bell palsy. The physician recognized the syndrome as "crocodile tears syndrome" that results because of misdirection of regenerating autonomic nerve fibers. Which of the following nerves has been injured?
Facial nerve proximal to the geniculate ganglion
A 37-year-old man feels a little discomfort when moving his tongue, pharynx, and larynx. Physical examination indicates that the muscles attached to the styloid process are paralyzed. Which of the following groups of cranial nerves are damaged?
Facial, glossopharyngeal, and hypoglossal nerves
A dentist prepares for an extraction of the second mandibular molar. To anesthetize the tooth, she injects a local anesthetic to block the mandibular division of the trigeminal nerve as it leaves the skull. What skull foramen is she targeting?
Foramen ovale
A 13-year-old girl visits her pediatrician complaining of loss of sensitivity in her lower eyelid, the skin below her right eye, and in her upper lip and teeth. Which of the following sites is the most likely location for the nerve lesion responsible for these signs and symptoms?
Foramen rotundum
A 46-year-old man presents to you complaining of loss of taste and general sensation in the posterior part of his tongue. A CT scan suggests that the patient has Eagle's syndrome, in which there is an elongated styloid process and/or a heavily calcified stylohyoid ligament that may be impinging on which nerve?
Glossopharyngeal Nerve
Your 18-year-old female patient has anorexia nervosa and often induces vomiting by placing her finger on the back of tongue and oropharynx. The sensory fibers responsible for this reflex are carried in which of the following nerves?
Glossopharyngeal Nerve
A 10-year-old boy underwent surgery, a bilateral palatine tonsillectomy. During a postoperative examination, the doctor noted the boy did not possess a gag reflex on the right side on the posterior tongue. He also complained of abnormal taste sensations in the back of his oral cavity. The soft palate elevated symmetrically when the gag reflex was tested. No other signs or symptoms were noted. What cranial nerve was damaged during the tonsillectomy?
Glossopharyngeal nerve
A 19-year-old woman complains of numbness of the nasopharynx after surgical removal of the adenoid. A lesion of which of the following nerves would be expected?
Glossopharyngeal nerve
After having a tonsillectomy, a 57-year-old man with a long history of chewing tobacco use is unable to detect taste on the posterior one-third of his tongue. Which of the following nerves has most likely been injured?
Glossopharyngeal nerve
The above image shows a woman with a protuberance in her neck that is associated with a lack of iodine. The swelling is called a ____________ and it results from enlargement of ___________________.
Goiter, thyroid gland
Your patient is having an upper third molar tooth removed. This is a difficult procedure because of the secure joint between the tooth and the socket in the alveolar process of the maxillary bone. What is this joint known as?
Gomphosis
A 12-year-old boy suffers a fracture of the floor of the right side of the middle cranial fossa during an automobile accident. Subsequent physical examination reveals he is devoid of emotional tearing on the ipsilateral side. Which of the following nerves is most likely damaged?
Greater petrosal nerve
A 22-year-old patient has dryness of the corneal surface of his eye because of a lack of tears. Which of the following nerves may be damaged?
Greater petrosal nerve
A neuroma at the entrance to the internal acoustic meatus could impinge upon all the following structures except?
Greater petrosal nerve
A young child is evaluated by his pediatrician for chronic nosebleeds. He is referred to an allergist when it is determined that his nasal cavity is chronically dry because of a lack of glandular secretions. A possible etiology may be a lesion of which of the following structures?
Greater petrosal nerve
The above axial CT image is of a child with a 4th ventricle mass (arrow) that is blocking his cerebral aqueduct. You would expect CT images cephalad to the one shown to reveal which of the following?
Hydrocephalus
Some patients with colds have used a commercially available homeopathic remedy for colds (gel placed in nostrils) that contains zinc. Some users subsequently developed anosmia (loss of sense of smell) thought to be due to destruction of the olfactory neurons located within the olfactory epithelium by overexposure to zinc. Where is this epithelium located?
In the superior parts of the lateral and septal walls of the nasal cavity
During a difficult childbirth, a physician uses obstetric forceps to grip the infant's head as an aid to extracting her from the birth canal. However, the forceps are misapplied at the right stylomastoid foramen and crush its contents at the opening of the foramen. Which of the following ipsilateral deficits is the baby most likely to suffer?
Inability to close the eyelids
The radiologic report on your 63-year-old patient stated, "possible jugular foramen syndrome." You suspected this diagnosis based on all of the following signs and symptoms except?
Inability to protrude tongue
A 78-year-old man presents with signs of reduced blood flow into the right side of his face. His physician wishes to take a pulse of the facial artery on both sides to help evaluate the situation. The pulse of the facial artery can be readily palpated at which of the following locations?
Inferior margin of the body of the mandible
A 12-year-old boy has difficulty in breathing because he is choking on food. A school nurse performs the Valsalva maneuver to expel air from his lungs and thus dislodge the food. When that fails, she performs a needle cricothyrotomy, which would open into which of the following regions?
Infraglottic cavity
During preparation to extract the right maxillary (upper) canine tooth, a dentist has difficulty anesthetizing this tooth and its associated gingivae. Therefore, the dentist administers a regional nerve block, depicted in the given photo, in which the anesthetic syringe needle penetrates the oral mucosa at the apex of the maxillary vestibule and is pushed beyond the roots of the teeth. Due to this injection, the patient experiences numbness and paresthesia within the upper canine and neighboring teeth, as well as the skin of the right inferior eyelid, cheek, lateral nose, and upper lip. What nerve was blocked and produced the described numbness?
Infraorbital
A 32-year-old woman consulted her family physician about a circumscribed, hyperpigmented swelling of the skin on the right side of her neck. The physician examined the lesion located in the lateral cervical region (posterior triangle) along the posterior border of the SCM. He was concerned when she said the nevus (mole) was gradually becoming larger. Concerned that the nevus might be a malignant melanoma, he referred her to a dermatologist. During removal, the dermatologist found that the nevus was adherent to the underlying fascia, so she performed an extensive tissue dissection. Pathological study of the nevus revealed that it was a melanoma. The skin was closed, and the patient returned home. When the patient arose the next day, she had difficulty shrugging (elevating) her right shoulder and combing her hair due to diminished ability to perform movements requiring her right upper limb to be elevated to or above the horizontal level. She called the dermatologist who asked her to come to her office. On physical examination, the physician noted drooping of her right shoulder. Which of the following statements best describes the most likely cause of the weakness of the woman's right upper limb?
Injury of the spinal accessory nerve (CN XI)
A 21-year-old woman presents to her physician with a swelling on her neck. On examination, she is diagnosed with an infection within the carotid sheath. Which of the following structures would be damaged?
Internal Jugular and Vagus nerve
A 34-year-old man in a bar fight suffers a knife wound that severs the abducens nerve proximal to its entrance into the orbit. Which of the following conditions results from this injury?
Internal strabismus (medial deviation)
Metastatic prostate cancer is frequently found in vertebrae. A possible direct route of spread of this cancer to vertebrae is via which of the following?
Internal vertebral venous plexus
While shaving, a 75-year-old man noticed that his left superior eyelid was drooping. His wife, who was concerned that he might have had a mild stroke, insisted that he see their family physician. On examination, ptosis (drooping of the superior eyelid), miosis (contraction of the pupil), and a lack of facial sweating was detected. Which of the following statements best describes the most likely cause of the man's eye problems?
Interruption of the cervical sympathetic trunk
During a carotid endarterectomy of a 57-year-old man who suffered a stroke, the carotid sinus is damaged. A third-year medical student in surgical rotation notices that the injured structure:
Is stimulated by changes in blood pressure.
During a fight, a 14-year-old boy receives an injury to the phrenic nerve from a knife wound in the neck. Which of the following anatomical relationships is correct about this nerve?
It passes anterior to the anterior scalene muscle.
A 58-year-old woman comes to a hospital and complains of progressive loss of voice, numbness, loss of taste on the back part of her tongue, and difficulty in shrugging her shoulders. Her MRI scan reveals a dural meningioma that compresses the nerves leaving the skull. These nerves leave the skull through which of the following openings?
Jugular foramen
An 8-year-old boy suffers a fracture at the base of the skull from the impact of a terrorist bomb explosion. The skull trauma includes a lesion of the vagus nerve. Damage at which of the indicated openings would injure the vagus nerve?
Jugular foramen
A 29-year-old baseball player whose head is hit by a high-speed baseball is brought to an emergency department. Physical examination and radiogram reveal fracture of the temporal bone and damage to the lesser petrosal nerve. Which of the following conditions could occur as a result of injury to the lesser petrosal nerve?
Lack of Parotid Gland secretion
A 32-year-old woman undergoes LASIK refractive surgery to improve her visual acuity and rid herself of eyeglasses. To combat dry eyes, a common complication of this surgery, her ophthalmologist inserts a silicone plug, marked by an arrow in the given photo, to block drainage of tears from the patient's left eye. Obstruction of what structure prevents tears from entering the lacrimal apparatus?
Lacrimal punctum
Lesion of cranial nerve VII will lead to the loss of ______________ ipsilateral to the lesion.
Lacrimation
A man with a neuromuscular autoimmune disease has another attack at home. His wife calls the doctor's office because he is unable to speak. Once at the office, he is unable to open his jaw because of paralysis of which of the following muscles?
Lateral Pterygoid
Following a very wide yawn, your 36-year-old patient found that she was unable to close her mouth. Your diagnosis is anterior dislocation of the TMJ (temporomandibular joint). The excessive contraction of which of the following muscles likely resulted in the dislocation?
Lateral Pterygoid
A 59-year-old man with a herpes zoster infection within the mandibular division of the trigeminal nerve (CN V3) complains of weakness when opening his mouth. A comprehensive evaluation reveals that his problems are due to difficulty protruding the mandible, and when protrusion is accomplished the mandible deviates to the left side, as seen in the figure. What muscle is most likely weakened?
Lateral pterygoid
A patient goes to her dentist with her mouth fixed in an open position. She explains that after yawning, she was unable to close her mouth. Which of the following muscles most likely spasmed during the yawn causing the dislocation of her temporomandibular joint?
Lateral pterygoid
A 27-year-old man comes to his family physician complaining of double vision. While sitting face-to-face, the doctor notes the patient exhibits strabismus, especially esotropia of the left eye, which gives the patient a "cross-eyed" appearance. When asked to follow the doctor's index finger with only his eyes, the patient is unable to look laterally, as illustrated in the figure. No other visual deficits are noted. What specific nerve is most likely damaged?
Left abducent nerve
Following a penetrated injury in the submandibular triangle, the tongue of a 45-year-old patient deviates to the left on protrusion. Which of the following nerves is injured?
Left hypoglossal nerve
A 54-year-old man comes to his doctor complaining of an inability to open his left eye. When he physically pries open his affected eye with his fingers (see photo), the gaze of his left eye is directed inferiorly and laterally, causing diplopia. His left pupil is also dilated in comparison to the right one. What nerve is most likely affected in this patient?
Left oculomotor nerve
A physician directs a small light into only the left eye of a patient to test pupillary constriction. The left pupil does not respond to the light; however, the right pupil constricts. What nerve is most likely damaged in this patient?
Left oculomotor nerve
A 3-year-old female child, whose mother described a difficult delivery, has a fixed head posture with the left ear tilted toward the left shoulder but the face turned to the right. Which of the following muscles was most likely damaged during birth and what is this condition called?
Left sternocleidomastoid, torticollis
A 75-year-old man tells his physician he has been having progressively more trouble opening his left eye because his upper eyelid tends to droop. Which of the following muscles is most likely weakened?
Levator palpebrae superioris
Mrs. Jones was riding in the front seat of her son's van when the vehicle abruptly stopped. Unfortunately, she was not wearing her seatbelt and was thrown forward. As a result of the accident, the transverse processes of her cervical vertebrae were crushed against the dashboard of the van. Which of the following muscles might be paralyzed?
Levator scapulae
A 27-year-old man comes to his doctor complaining that the floor of his mouth is painful and swollen. Bimanual palpation and later computed tomography show an 8-mm stone (sialolith) in the right submandibular salivary duct, as indicated by the arrow in the figure. If the submandibular duct is partially obstructed, where would the physician observe salivation in the oral cavity after applying pressure to the right submandibular gland?
Lingual frenulum
Being 'tongue-tied' refers to the presence of an overly large ________________.
Lingual frenulum
A 23-year-old man has an impacted left third mandibular molar (or wisdom) tooth extracted. Following the surgery, the patient reports numbness in the anterior aspect of his tongue. Which of the following nerves is damaged?
Lingual nerve
You are assisting an oral surgeon who is about to remove a calculus (stone) from a patient's submandibular duct. The surgeon asks you to remind him what nerve he has to be careful not to injure while incising the duct directly under the floor of the mouth. What is your reply?
Lingual nerve
A patient is brought to the ED after much of his scalp has been removed as a result of a motorcycle accident in which the patient's head abutted the back bumper of a semitrailer. The layer of the anatomical scalp in which the separation occurred is most likely?
Loose areolar tissue
An elderly patient presents with a thyroid mass. Needle biopsy showed this to be an anaplastic thyroid carcinoma. These are aggressive malignancies that often penetrate the thyroid capsule and invade structures adjacent to the thyroid gland. You suspect tumor invasion of both of the recurrent laryngeal nerves because of all the following except:
Loss of all sensation from the larynx
A 46-year-old woman was cut on the right side of her face by a window that shattered. Her laceration was located at the anterior border of the inferior part of the masseter muscle. When she returns to her doctor to have the stitches removed, her physician notes asymmetry in her lower lip when she grimaces as seen in the figure. Damage to what nerve would cause the facial asymmetry seen in this patient?
Marginal mandibular branch of facial nerve
Following right parotid gland surgery to remove a tumor, a 45-year-old woman found that saliva was constantly dripping from the right margin of her mouth. The surgery apparently damaged which nerve?
Marginal mandibular branch of facial nerve
A 21-year-old professional boxer receives a series of powerful punches to the side of his face, which fractures the left mandible slightly superior to the mandibular angle as indicated by the arrow on the given CT scan. Resultant muscle spasticity causes his jaw to close, making it difficult to remove his mouthpiece. Which of the following muscles is acting to close the jaw?
Masseter
A 23-year-old female professional student wakes up with a facial nerve (CN VII or Bell) palsy. What muscle will continue to function despite this affliction?
Masseter
A 31-year-old woman with an ongoing, long-term history of alcoholism becomes pregnant. The embryo she is carrying suffers a neural crest insufficiency during the critical period of development. Which of the following structures is most likely to be malformed as a result of this condition?
Maxillary bones
A 31-year-old hockey player is hit in the head by a puck. His radiogram shows a fracture of the foramen rotundum. Which of the following nerves would be damaged by this event?
Maxillary nerve
A newborn infant has difficulty in breastfeeding due to unilateral atrophy in the area of the face occupied by the levator labii superioris, levator anguli oris, and lateral upper part of the orbicularis oris muscles. This region of the face is derived from which of the following embryonic sources?
Maxillary process
A 13-year-old boy competing in a motocross competition falls from his bike and sustains massive head injuries. Which of the following cavities are separated from the middle cranial fossa by a thin layer of bone?
Middle ear cavity and sphenoid sinus
A 7-year-old boy was kicked in the right side of his head during a sledding accident. He arrived at the ER with no loss of consciousness but complained of a severe headache and vomiting. A computed tomography (CT) scan revealed a biconvex hyperdense -collection of blood, indicated by the arrows in the figure. What blood vessel is the most likely source of the bleed?
Middle meningeal artery
During a mixed martial arts (MMA) fight, one fighter punched his opponent in the anterior neck, resulting in a fracture of the hyoid bone. Which of the following muscles would be most directly affected by this injury?
Middle pharyngeal constrictor
A 3-year-old boy asked his mother why his head was tilted to the side. His mother took him to a pediatrician because she thought he might have injured his neck. The deformity developed after delivery. The pediatrician found that the cervical region of the boy's vertebral column was permanently held in a position of slight left lateral flexion (bending). She also observed that his head was tilted to the left side with his occiput rotated toward his shoulder. Furthermore, she detected a palpable pea-sized mass in the inferior aspect of a protruding muscle. AP and lateral radiographs of the boy's neck were normal as were the deep cervical lymph nodes. Which of the following statements best describes the most likely cause of the boy's twisted neck?
Muscular torticollis resulting from injury of the sternocleidomastoid (SCM) muscle at birth
A 32-year-old man presents with unilateral paralysis of the muscles of mastication on the right side. This condition has resulted in facial asymmetry as noted in the figure. Though he is uncomfortable with his appearance and has difficulty when chewing his food, his chief complaint is his difficulty swallowing (dysphagia). What muscle is most likely involved in his dysphagia?
Mylohyoid
A 20-year-old guard at the gate of the Royal King's palace blinks his eyes when a strong wind hits the cornea of his eye. The afferent fibers of the corneal reflex arc are carried by which of the following nerves?
Nasociliary nerve
A 4-year-old girl presents with nausea, vomiting, papilledema, and a headache, which is more severe when she wakes up in the morning. A sagittal T1-weighted MRI reveals a medulloblastoma, outlined in the image, in the posterior cranial fossa. Its location has compressed the 4th ventricle, impeding the flow of cerebrospinal fluid (CSF) from the 3rd ventricle via the cerebral aqueduct, indicated by the black arrow. The MRI shows massive dilation of the lateral and 3rd ventricles, shallow cortex, and effaced sulci within the cerebral hemispheres. Which of the following selections describes this condition?
Noncommunicating hydrocephalus
A 71-year-old woman often visits an emergency department with swallowing difficulties and subsequent choking while eating food. Which of the following pairs of muscles is most instrumental in preventing food from entering the larynx and trachea during swallowing?
Oblique arytenoid and aryepiglottic muscles
A 56-year-old man comes to his physician complaining of an inability to open his right eye. When his doctor pries his right eye open, the right eye is directed laterally and inferiorly. What cranial nerve is most likely damaged?
Oculomotor Nerve
As part of an initial oral examination of a new patient, a dental hygienist inspects the vestibule of the mouth. Which of the following structures is encountered in this area?
Opening of the parotid duct
The corneal blink response involves which of the following two nerves?
Ophthalmic and facial
During a game, a 26-year-old baseball player is hit in the head by a baseball, which fractures the optic canal. Which of the following pairs of structures is most likely to be damaged?
Ophthalmic artery and optic nerve
A 45-year-old woman is suffering from numbness over the tip of her nose. Which of the following nerves is most likely to be damaged?
Ophthalmic division of the trigeminal nerve
While participating in a bar fight, the orbit of a 25-year-old man is pierced by a broken pool cue stick, which extends back to the superior orbital fissure. Which of the following nerves is most likely damaged?
Ophthalmic division of trigeminal
A 25-year-old professional boxer loses a fight when he is rendered unconscious by his opponent. After he regains consciousness, the ringside physician notes the boxer has a severe headache, nausea, and even vomiting. Being concerned about intracranial trauma, what cranial nerve can be observed by the physician, without the aid of radiographic imaging, to gain more information on whether the boxer has increased intracranial pressure?
Optic Nerve
There are four parasympathetic ganglia in the head, each of which receives preganglionic fibers from a single cranial nerve. Which of the following shows the correct relationship between a parasympathetic ganglion and the cranial nerve that supplies it with preganglionic parasympathetic fibers?
Otic ganglion, glossopharyngeal nerve
Your 2-year-old patient is constantly tugging at his ear. He also is spitting out food suggesting that food is not tasting well to him. What condition do you believe the patient has?
Otitis media (inflammation of middle ear), which is affecting his chorda tympani nerve
Your 19-year-old male patient was punched in the orbit and has sustained a fracture of one of the bones that form the orbital margin. Which of the following bones would you not expect to have sustained a fracture?
Palatine
Your 6-year-old patient is about to have his palatine tonsils removed. The surgeon will excise the tonsils that lie in the tonsillar bed between the _________ and __________ arches, and will need to excise the ____________fascia.
Palatopharyngeal, palatoglossal, pharyngobasilar
In the process of removing cervical lymph nodes during a radical neck dissection, a surgeon mistakenly lesions the ansa cervicalis. Which of the following deficits may occur?
Paralysis of several infrahyoid (strap) muscles
A 20-year-old man was slashed in the right anterior cervical region (anterior triangle). An ambulance was called and the paramedics stopped the bleeding from the external jugular vein. He was taken to an emergency room where a physician examined him. When the man was asked to protrude his tongue, its apex deviated to the right side. The physician concluded that there was a nerve lesion. Which of the following statements best describes the most likely cause of the deviation of the man's tongue?
Paralysis of the right hypoglossal nerve (CN XII)
While planning a delicious dinner for his former anatomy professors, a doctor finds himself salivating at the thought of the feast. What description accurately describes the secretomotor pathway for innervation of the submandibular gland?
Parasympathetic fibers via the chorda tympani nerve
During extraction of her impacted wisdom teeth, a 22-year-old woman suffers damage to her right inferior alveolar nerve. Which of the following conditions is most likely to result?
Paresthesia of the lower lip
A 64-year-old male professional angler is diagnosed with a skin melanoma above his right eyebrow after years of excessive sun exposure. His dermatologist removes this cancerous lesion, but the doctor needs to rule out possible metastasis. What group of lymph nodes would his physician first check for possible spread of the cancer?
Parotid
Which of the following regions does not communicate with the pterygopalatine fossa via the indicated route?
Phenoid sinus via the pterygoid canal
Holoprosencephaly is a complex of developmental abnormalities characterized by the loss of midline structures to greater or lesser degrees. The pictured infant suffers multiple aspects of this disorder, including the midline cleft indicated. This specific developmental malformation is termed "premaxillary agenesis," developmental failure of formation of the intermaxillary segment of the face. Which of the following structures is most likely to be affected in this condition?
Philtrum
You suspect a patient has mitral valve disease and you want to see if you can feel an increase in internal jugular vein pulse. Your attending physician does not think that is possible but, you show it is using the easiest approach that involves doing which of the following?
Placing your fingers deep to the right SCM superior to the medial end of the clavicle
A middle-aged woman complains to her physician of vocal difficulties. On examination, she is unable to abduct her vocal cords during quiet breathing. Which of the following muscles is most likely paralyzed?
Posterior crico-arytenoid muscle
A young singer at the local music theater visits her physician and complains of vocal difficulties. On examination, she is unable to abduct the vocal cords during quiet breathing. Which of the following muscles is most likely paralyzed?
Posterior cricoarytenoid muscle
During inhalation, the action of which pair of muscles will open the rima glottides in order to facilitate laryngeal intubation?
Posterior cricoarytenoids
A 53-year-old man has difficulty with breathing through his nose. On examination, his physician finds that he has swelling of the mucous membranes of the superior nasal meatus. Which opening of the paranasal sinuses is most likely plugged?
Posterior ethmoidal sinus
A 37-year-old man presented with decreased emotional tearing on the right side and intermittent headaches. Magnetic resonance images (MRIs) revealed a facial nerve schwannoma located within the right pterygoid (vidian) canal. What nerve fibers are most likely injured by this tumor?
Presynaptic parasympathetic fibers
Your 43-year-old patient has a large infected swelling posterior to her sternocleidomastoid (abscess) and has dysphagia (difficulty swallowing). You suspect that the infection has penetrated what layer of the cervical fascia to enter what space?
Prevertebral, retropharyngeal
A performer at the traveling circus for the state fair has injured her shoulder during a routine. When she fell off the trapeze, she struck the ground on her back, and most of the blunt force was directed toward her shoulders. A crush injury of the suboccipital nerve would result in paralysis of which of the following muscles?
Rectus capitis posterior major of the back
A 68-year-old woman with thyroid cancer undergoes a total thyroidectomy. Postoperatively, the surgeon notes hoarseness and dysphonia, or altered voice production, while conversing with the patient. What nerve was damaged during the thyroidectomy?
Recurrent laryngeal nerve
A 9-year-old girl with a history of strep throat has her palatine tonsils surgically removed. She returns to the hospital 3 days later with a high fever and chest pain. A physician orders a CT scan, which revealed spread of infection into the superior mediastinum. What is the most likely route for this infection to descend through the neck to reach the superior mediastinum?
Retropharyngeal space
A 45-year-old man goes to his physician complaining of having trouble with his speech (dysarthria) and involuntary contractions (fasciculations) within his tongue muscles. The doctor notes that his tongue deviates to the right when the patient attempts to protrude his tongue, as seen in the figure. What nerve is most likely damaged in this patient?
Right hypoglossal nerve
A 26-year-old woman with the flu comes to an outpatient clinic. On examination, a physician diagnoses her with sinus and palate infection, and her uvula deviates to the left side on phonation. Which of the following nerves is injured?
Right vagus nerve
After asking a 47-year-old woman to open her mouth wide and say "Ah," the physician notes deviation of the uvula to the left side and asymmetry in the elevation of the soft palate, with the right side of the palate sagging, as noted in the figure. What specific nerve is most likely damaged?
Right vagus nerve
The given photo shows a superior view of the head of a baby boy with scaphocephaly. Which of the following sutures closed prematurely in this infant?
Sagittal suture
A patient can move his eyeballs normally and see distant objects clearly but cannot focus on near objects. This condition may indicate damage to which of the following structures?
Short ciliary nerves and ciliary ganglion
A 67-year-old woman comes to her physician complaining of visual loss. Her magnetic resonance imaging (MRI) scan shows an enlarged pituitary gland that lies in the sella turcica, immediately posterior and superior to which of the following structures?
Sphenoid Sinus
A 65-year-old man complains of a persistent nosebleed. His physician uses a cotton swab to apply pressure at the source, the inferior and posterior aspects of the lateral nasal wall. Which artery is the most likely source of the bleeding?
Sphenopalatine
A newborn baby girl is unable to move her head to the right, even when her pediatrician tries to assist the movement, as seen in the photo. Her range of motion in the neck is limited in rotation and lateral bending, and her head posture is abnormally tilted toward the right and her chin is elevated and turned toward the left side. What muscle is most likely responsible for the baby's abnormal range of movement and head posture?
Sternocleidomastoid
A young man presents to your clinic with a 3-month history of an enlarging mass in his right neck. He undergoes a CT scan that reveals a fluid-filled mass where the common carotid artery bifurcates. Which of the following is another structure that would be located at this level?
Superior border of the thyroid cartilage
The above is a volume rendered CT angiogram to examine the carotid artery system in a patient who has had a stroke. The red arrow is pointing to which of the following arteries?
Superior thyroid
During a palatine tonsillectomy, a surgeon must ligate arteries to avoid bleeding within the surgical field. Which of the following arteries can be spared?
Superior thyroid artery
An anesthesiologist is about to perform a cervical plexus block prior to surgery. She injects the anesthetic agent at several points directly posterior to the sternocleidomastoid, especially at the "nerve point." Which of the following nerves would likely not be affected by this procedure?
Suprascapular
A young child suffers a debilitating condition that includes progressive degeneration of the motor axons that innervate the masseter muscle. Which of the following muscles is most likely to exhibit the same fate?
Tensor Tympani
Following removal of part of the lower esophagus because of carcinoma, your patient is often vomiting because the contents of the stomach are not emptying into the small intestine properly. Why do you suspect this is occurring?
The anterior and posterior vagal trunks were transected
Choose the appropriate lettered structure in this angiogram of the cerebral vasculature (see figure). Collateral circulations are discounted. A lesion of which artery may cause oxygen deficiency to the medial surface of the frontal and parietal lobes of the brain?
The anterior cerebral artery supplies the medial surface of the frontal and parietal lobes of the cerebrum.
A 36-year-old male patient has weakness in all of his right facial musculature, has lost of taste from the anterior 2/3 of the right side of his tongue but has normal lacrimation in his right eye. You believe there is a lesion on which of the following?
The facial nerve between the geniculate ganglion and the origin of the chorda tympani
Choose the appropriate lettered structure in this MRI scan (see figure) showing a sagittal section through the head and neck. A lesion of the first cervical spinal nerve would cause functional impairment of which structure?
The geniohyoid muscle is innervated by the first cervical nerve through the hypoglossal nerve.
Choose the appropriate lettered structure in this MRI scan (see figure) showing a sagittal section through the head and neck. Tears drain through the nasolacrimal duct into the space below which structure?
The inferior nasal meatus below the inferior concha receives the nasolacrimal duct.
Choose the appropriate lettered structure in this MRI scan (see figure) showing a sagittal section through the head and neck. When the nerve on the right side is damaged, which structure is deviated to the left side?
The musculus uvulae is innervated by the vagus nerve. A lesion of the right vagus nerve causes deviation of the uvula to the left side.
Your 75-year-old patient is having excessive tearing. You are asked to look at the above coronal CT and determine if there is any obstruction in the region where the nasolacrimal duct drains. You would look specifically at the region indicated by which letter?
The nasolacrimal duct drains into the inferior meatus, which is inferior and lateral to the inferior concha.
Choose the appropriate lettered structure in this MRI scan (see figure) showing a sagittal section through the head and neck. Which structure runs along the line of attachment of the falx cerebri to the tentorium cerebelli?
The straight sinus runs along the line of the attachment of the falx cerebri to the tentorium cerebelli, which supports the occipital lobe of the cerebrum and covers the cerebellum.
Choose the appropriate lettered structure in this MRI scan showing a transaxial section through the head (see figure). Which structure may be obliterated by a pituitary tumor?
The suprasellar cistern can be obliterated by a pituitary tumor.
A 47-year-old woman with a history of multiple sclerosis comes to her doctor complaining of sudden bursts (paroxysms) of pain in her mandible, especially in the lower lip, mandibular teeth and gingivae, and cheek on her right side. This debilitating pain is often triggered by eating, talking, or brushing her teeth and often gets worse as the day progresses. Which nerve is the source of her pain?
Third division of trigeminal nerve
A 20-year-old man was concerned about a swelling in the anterior aspect of his neck because it was gradually becoming larger. He was urged by his mother to consult a physician. During the examination it was noted that his voice was hoarse. The young man said that he has had a cold for about two weeks. On further examination, the physician observed a nonpulsatile, well defined swelling in the midline of the man's neck superior to the thyroid gland. He asked the man to stick out his tongue and then to swallow. The neck swelling moved superiorly when he stuck out his tongue but did not move when he swallowed. Which of the following statements best describes the most likely cause of the swelling in the young man's neck?
Thyroglossal duct cyst
An 8-year-old boy comes to his physician with a painless and smooth mass located in the midline of his neck at the level of the hyoid bone, as noted by the arrow in the given photo. This palpable, midline neck mass was asymptomatic, but due to recent expansion, it has caused difficulty and pain when swallowing. When he swallows or protrudes his tongue, the mass moves superiorly. What is the most likely diagnosis?
Thyroglossal duct cyst
Your young patient presented with in a lump in his neck (see above sagittal CT). The abnormal structure (red star) was attached to the foramen cecum of the tongue. What is your diagnosis?
Thyroglossal duct cyst
A 36-year-old woman comes to her physician complaining of heart palpitations, weight loss, anxiety, insomnia, fatigue, and amenorrhea. The physician palpates a 1.5-cm mass on her neck, which elevates when she swallows, located inferior to the cricoid cartilage yet off the midline. What is the most likely structure involved with her presentation?
Thyroid nodule
A 59-year-old man complains of numbness in the anterior cervical triangle. Therefore, damage has occurred to which of the following nerves?
Transverse cervical nerve
A 56-year-old woman reports difficulty with diplopia (double-vision) when descending stairs. During an eye-movement exam, her right eye was unable to look downward when her eye was adducted (or in a medial position). Which of the following cranial nerves is most likely damaged in this patient's right eye?
Trochlear nerve
A 32-year-old house painter suffers from a head injury after falling off a ladder and has bleeding in his head. During intraoperative testing, the neurosurgeon notes loss of general sensation in the dura of the middle cranial fossa. Which of the following nerves has been affected?
Trigeminal Nerve
Following radical resection of a primary tongue tumor, a 72-year-old patient has lost general sensation on the anterior two-thirds of the tongue. This is probably due to injury to branches of which of the following nerves?
Trigeminal Nerve
A 67-year-old man presents with shingles on his left forehead, upper eyelid, and bridge of the nose as shown in the figure. Shingles (or herpes zoster) is caused by the varicella zoster virus, which causes chickenpox in children and young adults. After the initial chickenpox outbreak, this virus usually resides latent in sensory ganglia in the body for many years. When a patient is immunocompromised, this virus can cause shingles unilaterally along the infected nerve's dermatome distribution. What sensory ganglion is most likely affected in this patient?
Trigeminal ganglion
A patient comes to her physician complaining of burning the anterior aspect of her tongue following drinking an extremely hot cup of coffee. Which cranial nerve is most likely responsible for the pain she is feeling?
Trigeminal nerve
Your 61-year-old diabetic patient is complaining of vertical diplopia, especially while trying to read. You do an eye muscle testing exam and determine that the right superior oblique muscle is weak. You thus believe which of the following nerves was affected by his diabetes?
Trochlear Nerve
Your 25-year-old patient sustained an injury to her neck that you think injured her spinal accessory nerve prior to it innervating the right sternocleidomastoid (SCM) muscle. You would most likely directly test the action of this muscle by asking your patient to do which of the following?
Turn her head to the opposite side (chin turned to left) against resistance
Your 23-year-old alcoholic patient gives birth to a child with fetal alcohol syndrome. The obstetrician who delivered the child noted that the child shows the typical fetal alcohol syndrome sign of a missing philtrum. Where do you look to confirm this?
Under the child's right nostrils
A 50-year-old man presents with recurring dizziness, ataxia, vertigo, aphasia, and weakness in his right upper limb. A magnetic resonance angiogram (MRA) revealed a stenosis of the right subclavian artery (marked by the arrow) and poststenotic dilatation, which led to the diagnosis of subclavian steal syndrome. In this condition, blood is shunted from the left side arterial tree via collateral flow into the right side circulation. Through which of the following ipsilateral vessels is blood entering the right subclavian artery distal to the stenosis?
Vertebral artery
A professional student finds out she has a perfect score on the anatomy portion of her board examination and her muscles of facial expression produce a long anticipated smile. What muscle is assisting her in elevating her labial commissure bilaterally to smile?
Zygomaticus major
Following a procedure to remove the thyroid gland (thyroidectomy), a surgeon reports the right recurrent laryngeal nerve was incised accidentally. Which of the following muscles would continue to function despite this iatrogenic damage?
cricothyroid
Giant cell arteritis frequently causes headaches, jaw pain, and blurred or double vision, blindness and, less often, stroke. It most commonly affects the superficial temporal artery. Most of the blood flowing through this artery initially travels in which of the following arteries?
external carotid
A 47-year-old man cannot move his eye laterally. Which of the following conditions would cause this type of inability to move the eye?
infection in the cavernous sinus
The muscle that indents the submandibular gland and divides it into superficial and deep parts is paralyzed because of compression by a large salivary glandular tumor. Which of the following muscles is involved?
mylohyoid
The external laryngeal nerve of a 23-year-old man becomes ensnared and tightly compressed by a tortuous superior thyroid artery, which parallels the course of this nerve. Which of the following functions is most likely to be affected?
tension of the vocal cord
Genetic testing of a baby boy with facial and cardiovascular anomalies reveals a small deletion in chromosome 22, specifically 22q11.2. This 22q11.2 deletion (DiGeorge) syndrome often results in migration defects of neural crest cells within the pharyngeal pouches. In this DiGeorge syndrome patient, the thymus and inferior parathyroid glands are absent. Which of the following pharyngeal pouches is most likely affected?
third
