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Head and Neck day 1

Total questions: 102

Worksheet time: 51mins

Name
Class
Date
1.

A 17-year-old female was admitted to the hospital with a high fever. Following intravenous administration of antibiotics, a routine CT scan revealed features consistent with thoracic outlet syndrome. Which symptom would most likely result from this syndrome?

a)

Problems with respiration because of pressure on the phrenic nerve

b)

Reduced blood flow to the thoracic wall

c)

Reduced venous return from the head and neck

d)

Numbness in the upper limb

e)

Distention of the internal jugular vein

2.

A 40-year-old unconscious man is admitted to the emergency department after being hit in the head with a baseball. A CT scan examination reveals a fractured pterion and an epidural hematoma. Branches of which of the following arteries are most likely to be injured?

a)

External carotid

b)

Superficial temporal

c)

Maxillary

d)

Deep temporal

e)

Middle meningeal

3.

A 31-year-old female is admitted to the hospital after an automobile collision. A CT scan examination reveals a large hematoma inferior to the right jugular foramen. Physical examination reveals right pupillary constriction (miosis) and anhidrosis (loss of sweating) of the face. Which of the following ganglia is most likely affected by the hematoma?

a)

Submandibular

b)

Trigeminal (semilunar or Gasserian)

c)

Superior cervical

d)

Geniculate

e)

Ciliary

4.

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

a)

Oculomotor nerve

b)

Optic nerve

c)

Facial nerve

d)

Ciliary ganglion

e)

Superior cervical ganglion

5.

A 35-year-old male patient is admitted to the hospital with severe headaches. A CT scan evaluation reveals a tumor in the infratemporal fossa. Physical examination reveals loss of general sensation from the anterior two-thirds of his tongue, but taste and salivation are intact. Which of the following nerves is most likely affected by the tumor?

a)

Lingual nerve proximal to its junction with the chorda tympani

b)

Chorda tympani

c)

Inferior alveolar

d)

Lesser petrosal

e)

Glossopharyngeal

6.

A 55-year-old man is admitted to the hospital after an injury sustained at work in a factory. He presents with severe scalp lacerations, which were sutured. After three days the wound is inflamed, swollen, and painful. Between which tissue layers is the infection most likely located?

a)

The periosteum and bone

b)

The aponeurosis and the periosteum

c)

The dense connective tissue and the aponeurosis

d)

The dense connective tissue and the skin

e)

The dermis and the epidermis

7.

A 36-year-old woman is admitted to the hospital with severe head injuries after a car crash. During neurologic examination, her uvula is deviated to the right. Which nerve is most likely affected to result in this deviation?

a)

Left vagus

b)

Right vagus

c)

Right hypoglossal

d)

Left glossopharyngeal

e)

Right glossopharyngeal

8.

A 7-year-old boy with a high fever is brought to the pediatrician. During physical examination the patient complains of pain in his ear. His throat appears red and inflamed, confirming the diagnosis of pharyngitis. Which of the following structures provided a pathway for the infection to spread to the tympanic cavity (middle ear)?

a)

Choanae

b)

Internal acoustic meatus

c)

External acoustic meatus

d)

Pharyngotympanic tube

e)

Pharyngeal recess

9.

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

a)

Optic and facial

b)

Optic and oculomotor

c)

Maxillary and facial

d)

Ophthalmic and oculomotor

e)

Ophthalmic and facial

10.

A 22-year-old male is admitted to the emergency department and intubated. An endotracheal tube is passed through an opening between the vocal folds. What is the name of this opening?

a)

Piriform recess

b)

Vestibule

c)

Ventricle

d)

Vallecula

e)

Rima glottidis

11.

A 48-year-old male patient complains of diplopia (double vision). On neurologic examination he is unable to adduct his left eye and lacks a corneal reflex on the left side. Where is the most likely location of the lesion resulting in the symptoms?

a)

Inferior orbital fissure

b)

Optic canal

c)

Superior orbital fissure

d)

Foramen rotundum

e)

Foramen ovale

12.

A 34-year-old male complains of hyperacusis (sensitivity to loud sounds). Injury to which of the following cranial nerves is responsible?

a)

Trigeminal nerve

b)

Facial nerve

c)

Vestibulocochlear nerve

d)

Glossopharyngeal nerve

e)

Vagus nerve

13.

A 55-year-old male has a complaint of left-sided maxillary tooth pain. A dental examination reveals no abnormalities of his teeth. During physical examination tapping on his right maxilla elicits sharp pain on the right side of his face. The patient reports that he has no allergies. Which of the following conditions will be the most likely diagnosis?

a)

Sphenoid sinusitis

b)

Anterior ethmoidal sinusitis

c)

Posterior ethmoidal sinusitis

d)

Maxillary sinusitis

e)

Frontal sinusitis

14.

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

a)

Hypoglossal

b)

Facial

c)

Accessory

d)

Vagus

e)

Glossopharyngeal

15.

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

a)

Vestibulocochlear

b)

Vagus

c)

Trigeminal

d)

Facial

e)

Accessory

16.

A 29-year-old woman underwent a thyroidectomy. Postoperatively, the patient presented with hoarseness. Which of the following nerves was most likely injured during the operation?

a)

Internal laryngeal

b)

External laryngeal

c)

Recurrent laryngeal

d)

Superior laryngeal

e)

Glossopharyngeal

17.

A 48-year-old man presents with a constricted right pupil that does not react to light. His left pupil and vision in both eyes are normal. These findings are most likely due to a lesion involving which of the following right-sided structures?

a)

Oculomotor nerve

b)

Superior cervical ganglion

c)

Nervus intermedius

d)

Edinger-Westphal nucleus

18.

A 55-year-old woman is diagnosed with a tumor at the base of the skull, resulting in a decrease in tear production. Which of the following nerves is most likely injured?

a)

Chorda tympani

b)

Deep petrosal

c)

Greater petrosal

d)

Lesser petrosal

e)

Nasociliary

19.

A 45-year-old woman is admitted to the hospital for severe ear pain. Physical examination reveals chronic infection of the mastoid air cells (mastoiditis). The infection can erode the thin layer of the bone between the mastoid air cells and the posterior cranial fossa and spread most commonly into which of the following venous structures?

a)

Superior sagittal sinus

b)

Inferior sagittal sinus

c)

Straight sinus

d)

Cavernous sinus

e)

Sigmoid sinus

20.

A 24-year-old man is admitted to the hospital after a street fight. Radiographic examination reveals an inferior (blow-out) fracture of the orbit. Orbital structures would most likely be found inferiorly in which of the following spaces?

a)

Ethmoidal sinus

b)

Frontal sinus

c)

Maxillary sinus

d)

Nasal cavity

e)

Sphenoidal sinus

21.

A patient suffers a fracture involving the medial wall of the orbit. This injury most commonly causes herniation of orbital contents into which adjacent air-filled sinus?

a)

Frontal sinus

b)

Sphenoid sinus

c)

Maxillary sinus

d)

Ethmoidal air cells

22.

The Oculomotor Nerve (CN III) supplies four extrinsic eye muscles. The one muscle that wraps around the trochlea to change its pull direction, allowing the eye to look down and out, is supplied by which different cranial nerve?

a)

CN I

b)

CN IV

c)

CN VI

d)

CN VII

23.

A lesion affecting the Abducens Nerve (CN VI) will cause the eye to deviate medially (cross-eyed) because of the unopposed action of which muscle?

a)

Superior rectus

b)

Inferior oblique

c)

Medial rectus

d)

Lateral rectus

24.

The Trigeminal Nerve (CN V) has three major divisions. Which division carries the secretomotor fibers for the lacrimal gland before they eventually join the lacrimal nerve?

a)

Ophthalmic (V1)

b)

Maxillary (V2)

c)

Mandibular (V3)

d)

Facial (CN VII)

25.

The Superior Orbital Fissure transmits several crucial structures. Which is the only structure that passes outside the common tendinous ring to enter the orbit?

a)

Nasociliary nerve

b)

Oculomotor nerve (superior division)

c)

Abducens nerve

d)

Lacrimal nerve

26.

The Corneal Reflex involves the afferent limb (touch sensation) and the efferent limb (motor response). The efferent component causing closure of the eyelids is supplied by which nerve?

a)

CN V3

b)

CN V1

c)

CN VII

d)

CN III

27.

A small branch of the Facial Nerve (CN VII) carries taste fibers from the anterior two-thirds of the tongue. This nerve branch is the:

a)

Greater petrosal nerve

b)

Nerve to stapedius

c)

Chorda tympani

d)

Lingual nerve

28.

The Optic Nerve (CN II) is developmentally a protrusion of the diencephalon and is sheathed by meninges. The only blood vessel supplying the retina that runs within the optic nerve is the:

a)

Superior ophthalmic vein

b)

Central retinal artery

c)

Inferior ophthalmic artery

d)

Ciliary artery

29.

Parasympathetic fibers traveling with the Oculomotor Nerve (CN III) synapse in the Ciliary Ganglion. Postganglionic fibers then supply which muscle?

a)

Dilator pupillae

b)

Superior tarsal muscle

c)

Sphincter pupillae

d)

Superior oblique

30.

Which cranial nerve exits the brainstem dorsally before winding around the midbrain to enter the orbit?

a)

Oculomotor nerve

b)

Abducens nerve

c)

Trochlear nerve

d)

Trigeminal nerve

31.

The Cavernous Sinus is traversed by several nerves. Which cranial nerve runs within the lateral wall of the sinus and lies most superiorly?

a)

CN III

b)

CN IV

c)

CN V1

d)

CN VI

32.

Ptosis can occur due to damage to the sympathetic supply of which muscle?

a)

Orbicularis oculi

b)

Levator palpebrae superioris

c)

Superior tarsal muscle

d)

Frontalis muscle

33.

The pupillary light reflex involves which midbrain nucleus for central integration?

a)

Red nucleus

b)

Substantia nigra

c)

Pretectal nucleus

d)

Inferior colliculus

34.

The Lingual Nerve carries general sensation from the anterior two-thirds of the tongue and is joined by which nerve carrying taste fibers?

a)

Hypoglossal nerve

b)

Glossopharyngeal nerve

c)

Chorda tympani

d)

Auriculotemporal nerve

35.

Which branch of the mandibular nerve contains both sensory fibers to the cheek and motor fibers to the buccinator muscle?

a)

Auriculotemporal nerve

b)

Lingual nerve

c)

Inferior alveolar nerve

d)

Buccal nerve

36.

Which muscle opens the pharyngotympanic tube during swallowing?

a)

Tensor tympani

b)

Stapedius

c)

Tensor veli palatini

d)

Levator veli palatini

37.

Sensation of the external surface of the tympanic membrane is supplied by auriculotemporal nerve and which other nerve?

a)

CN V1

b)

CN III

c)

CN IX

d)

CN X

38.

Tensor tympani is supplied by which nerve?

a)

CN VII

b)

CN V3

c)

CN IX

d)

CN X

39.

Stapedius muscle is supplied by which nerve?

a)

CN IX

b)

CN V3

c)

CN VII

d)

CN X

40.

The promontory of the middle ear is formed by which structure?

a)

Lateral semicircular canal

b)

Utricle

c)

Basal turn of cochlea

d)

Vestibule

41.

Facial nerve supplies which middle ear muscle?

a)

Tensor tympani

b)

Stapedius

c)

Tensor veli palatini

d)

Salpingopharyngeus

42.

Fluid in scala vestibuli and scala tympani is called:

a)

Endolymph

b)

Intralymph

c)

Perilymph

d)

Aqualymph

43.

Chorda tympani passes between which ossicles?

a)

Incus and stapes

b)

Malleus and incus

c)

Malleus and stapes

d)

Stapes and promontory

44.

Mastoid air cells communicate with middle ear via:

a)

Round window

b)

Oval window

c)

Aditus to mastoid antrum

d)

Tympanic canal

45.

Linear acceleration is detected by receptors in:

a)

Semicircular canals

b)

Cochlea

c)

Utricle and saccule

d)

Scala media

46.

Deepest sensation of external auditory canal is supplied by:

a)

Auriculotemporal nerve

b)

Great auricular nerve

c)

Vagus nerve

d)

Facial nerve

47.

Structure lying inferior to middle ear cavity:

a)

Internal carotid artery

b)

External carotid artery

c)

Internal jugular vein

d)

Transverse sinus

48.

Round window is closed by:

a)

Basilar membrane

b)

Tectorial membrane

c)

Secondary tympanic membrane

d)

Tympanic membrane

49.

Otic ganglion supplies which gland?

a)

Lacrimal

b)

Sublingual

c)

Parotid

d)

Submandibular

50.

Epitympanic recess lies above which ossicle?

a)

Stapes

b)

Incus

c)

Malleus

d)

Lenticular process

51.

Taste buds innervated by CN IX are present in:

a)

Filiform papillae

b)

Fungiform papillae

c)

Foliate papillae

d)

Circumvallate papillae

52.

Posterior epistaxis commonly involves which artery?

a)

Anterior ethmoidal

b)

Posterior ethmoidal

c)

Greater palatine

d)

Sphenopalatine

53.

Which artery does not contribute to Kiesselbach plexus?

a)

Anterior ethmoidal

b)

Superior labial

c)

Greater palatine

d)

Posterior ethmoidal

54.

Which tongue muscle is supplied by vagus nerve?

a)

Genioglossus

b)

Hyoglossus

c)

Styloglossus

d)

Palatoglossus

55.

Olfactory nerve passes through:

a)

Sphenoid

b)

Vomer

c)

Ethmoid

d)

Nasal bone

56.

Afferent limb of gag reflex is:

a)

CN X

b)

CN V2

c)

CN VII

d)

CN IX

57.

Pharyngeal constrictors insert into:

a)

Hyoid bone

b)

Thyroid cartilage

c)

Pharyngeal raphe

d)

Cricothyroid membrane

58.

Foreign body in piriform recess endangers:

a)

Recurrent laryngeal nerve

b)

External laryngeal nerve

c)

Internal laryngeal nerve

d)

Vagus nerve

59.

Lymph from tip of tongue drains to:

a)

Upper deep cervical

b)

Retropharyngeal

c)

Submental

d)

Pretracheal

60.

Tonsil in nasopharynx:

a)

Palatine

b)

Lingual

c)

Tubal

d)

Pharyngeal

61.

Tonsil at base of tongue:

a)

Pharyngeal

b)

Palatine

c)

Lingual

d)

Tubal

62.

Hypoglossal nerve crosses superficial to:

a)

Facial artery

b)

Lingual artery

c)

Superior thyroid artery

d)

Occipital artery

63.

Pterygoid venous plexus connects to cavernous sinus via:

a)

Foramen ovale

b)

Foramen rotundum

c)

Foramen Vesalii

d)

Foramen spinosum

64.

Buccinator is pierced by:

a)

Submandibular duct

b)

Sublingual duct

c)

Parotid duct

d)

Minor salivary duct

65.

Anterior ethmoidal artery enters nasal cavity through:

a)

Maxilla

b)

Sphenoid

c)

Ethmoid

d)

Frontal

66.

Orbit, Eye Muscles and Cranial Nerves — The muscle that elevates the upper eyelid develops from which embryological structure?

a)

Surface ectoderm

b)

Neural crest cells

c)

Preotic somites

d)

Optic vesicle

67.

Orbit, Eye Muscles and Cranial Nerves — Superior oblique muscle of the eye is supplied by:

a)

Oculomotor nerve

b)

Trochlear nerve

c)

Abducent nerve

d)

Ophthalmic division of trigeminal nerve

68.

Orbit, Eye Muscles and Cranial Nerves — All extraocular muscles except superior oblique and lateral rectus are supplied by:

a)

CN II

b)

CN III

c)

CN IV

d)

CN VI

69.

Orbit, Eye Muscles and Cranial Nerves — The common tendinous ring (annulus of Zinn) gives origin to all except:

a)

Superior rectus

b)

Inferior rectus

c)

Lateral rectus

d)

Inferior oblique

70.

Orbit, Eye Muscles and Cranial Nerves — The parasympathetic fibers to the pupil travel via:

a)

Optic nerve

b)

Oculomotor nerve

c)

Trigeminal nerve

d)

Abducent nerve

71.

Ear (External, Middle, Inner) — External auditory canal develops from:

a)

First pharyngeal pouch

b)

First pharyngeal cleft

c)

Second pharyngeal arch

d)

Otic placode

72.

Ear (External, Middle, Inner) — The malleus and incus are derived from:

a)

First pharyngeal arch

b)

Second pharyngeal arch

c)

Third pharyngeal arch

d)

Neural crest cells

73.

Ear (External, Middle, Inner) — Stapes develops mainly from:

a)

First arch

b)

Second arch

c)

Third arch

d)

Otic vesicle

74.

Ear (External, Middle, Inner) — Inner ear structures develop from:

a)

Endoderm

b)

Mesoderm

c)

Otic placode

d)

Neural crest

75.

Ear (External, Middle, Inner) — The scala media of cochlea contains:

a)

Perilymph

b)

Endolymph

c)

Cerebrospinal fluid

d)

Blood plasma

76.

Nose, Tongue and Olfactory Pathway — Olfactory epithelium is derived from:

a)

Endoderm

b)

Mesoderm

c)

Neural crest

d)

Surface ectoderm

77.

Nose, Tongue and Olfactory Pathway — The cribriform plate allows passage of:

a)

Optic nerve fibers

b)

Facial nerve

c)

Olfactory nerve fibers

d)

Trigeminal nerve

78.

Nose, Tongue and Olfactory Pathway — Anterior two-thirds of tongue develops from:

a)

Second pharyngeal arch

b)

Third pharyngeal arch

c)

First pharyngeal arch

d)

Fourth pharyngeal arch

79.

Nose, Tongue and Olfactory Pathway — Taste sensation from anterior two-thirds of tongue is carried by:

a)

Glossopharyngeal nerve

b)

Hypoglossal nerve

c)

Chorda tympani

d)

Lingual nerve only

80.

Nose, Tongue and Olfactory Pathway — Posterior one-third of tongue is supplied for taste by:

a)

Facial nerve

b)

Vagus nerve

c)

Glossopharyngeal nerve

d)

Hypoglossal nerve

81.

Pharynx, Larynx, Thyroid and Parathyroid — Laryngeal cartilages develop from:

a)

First pharyngeal arch

b)

Second pharyngeal arch

c)

Fourth and sixth pharyngeal arches

d)

Third pharyngeal arch

82.

Pharynx, Larynx, Thyroid and Parathyroid — Recurrent laryngeal nerve is a branch of:

a)

Glossopharyngeal nerve

b)

Facial nerve

c)

Vagus nerve

d)

Hypoglossal nerve

83.

Pharynx, Larynx, Thyroid and Parathyroid — Thyroid gland develops from:

a)

Foramen cecum

b)

Second pharyngeal pouch

c)

Third pharyngeal pouch

d)

Fourth pharyngeal arch

84.

Pharynx, Larynx, Thyroid and Parathyroid — Inferior parathyroid glands develop from:

a)

Second pharyngeal pouch

b)

Third pharyngeal pouch

c)

Fourth pharyngeal pouch

d)

Thyroglossal duct

85.

Pharynx, Larynx, Thyroid and Parathyroid — Histologically, thyroid follicles are lined by:

a)

Stratified squamous epithelium

b)

Simple cuboidal epithelium

c)

Simple columnar epithelium

d)

Pseudostratified epithelium

86.

Orbit and Eye Muscles — Which wall of the bony orbit is most commonly fractured in a ‘blowout’ injury due to its thin nature (lamina papyracea)?

a)

Roof (orbital plate of frontal bone)

b)

Lateral wall (zygomatic and sphenoid bones)

c)

Medial wall (orbital plate of ethmoid bone)

d)

Floor (orbital plate of maxilla)

87.

Orbit and Eye Muscles — A patient presents with a complaint of difficulty looking down and out, and the eye rests in a position of slight elevation. This presentation is characteristic of a lesion in which cranial nerve?

a)

Oculomotor nerve (CN III)

b)

Trochlear nerve (CN IV)

88.

What is the primary action of the Superior Oblique muscle when the eye is in the anatomical neutral position?

a)

Elevation

b)

Abduction

c)

Intorsion (internal rotation)

d)

Adduction

89.

Which cranial nerve branch passes through the superior orbital fissure but is located outside the common tendinous ring?

a)

Abducens nerve (CN VI)

b)

Oculomotor nerve (CN III) - Superior division

c)

Trochlear nerve (CN IV)

d)

Optic nerve (CN II)

90.

Complete ptosis (drooping eyelid) and a fixed, dilated pupil (mydriasis) are classic signs of injury to which component of the nervous system?

a)

Oculomotor nerve (CN III)

b)

Facial nerve (CN VII)

c)

Sympathetic trunk in the neck

d)

Trigeminal nerve (CN V)

91.

The parasympathetic preganglionic fibers that synapse in the ciliary ganglion originate from which nucleus?

a)

Superior Salivatory Nucleus

b)

Edinger-Westphal Nucleus

c)

Inferior Salivatory Nucleus

d)

Nucleus Ambiguus

92.

The general sensory innervation to the skin of the forehead, upper eyelid, and side of the nose is primarily supplied by branches of which division of the Trigeminal nerve (CN V)?

a)

Mandibular division (CN V3)

b)

Maxillary division (CN V2)

c)

Ophthalmic division (CN V1)

d)

Facial nerve (CN VII)

93.

Which boundary of the orbit is formed entirely by the maxilla and zygomatic bone?

a)

Superior margin

b)

Medial margin

c)

Inferior margin

d)

Lateral margin

94.

Which specific branch of the Ophthalmic nerve (CN V1) carries the postganglionic sympathetic fibers that reach the dilator pupillae muscle?

a)

Lacrimal nerve

b)

Long ciliary nerves (from the Nasociliary nerve)

c)

Short ciliary nerves

d)

Frontal nerve

95.

Which cranial nerve provides the motor innervation to the Superior Rectus muscle?

a)

Abducens nerve (CN VI)

b)

Trochlear nerve (CN IV)

c)

Oculomotor nerve (CN III)

d)

Ophthalmic nerve (CN V1)

96.

The lateral wall of the orbit separates the orbital cavity from which other anatomical space?

a)

Ethmoid sinuses

b)

Anterior cranial fossa

c)

Temporal fossa

d)

Maxillary sinus

97.

Damage to which cranial nerve would specifically result in hyperacusis (increased sensitivity to loud sounds) due to paralysis of the stapedius muscle?

a)

Trigeminal nerve (CN V)

b)

Vestibulocochlear nerve (CN VIII)

c)

Facial nerve (CN VII)

d)

Glossopharyngeal nerve (CN IX)

98.

What sensory components are carried by the chorda tympani nerve?

a)

General sensation from the external acoustic meatus

b)

Taste sensation from the anterior two-thirds of the tongue

c)

Taste sensation from the posterior one-third of the tongue

d)

General sensation from the tympanic membrane

99.

A complete unilateral lesion of the Optic nerve (CN II) would result in which visual field defect?

a)

Bitemporal hemianopsia

b)

Contralateral homonymous hemianopsia

c)

Total blindness in the ipsilateral eye

d)

Upper quadrantanopsia

100.

Which cranial nerve provides general somatic efferent (motor) fibers to the sternocleidomastoid and trapezius muscles?

a)

Trigeminal nerve (CN V)

b)

Facial nerve (CN VII)

c)

Accessory nerve (CN XI)

d)

Hypoglossal nerve (CN XII)

101.

The tensor tympani muscle is innervated by a branch of which cranial nerve?

a)

Facial nerve (CN VII)

b)

Trigeminal nerve (CN V3)

c)

Glossopharyngeal nerve (CN IX)

d)

Vagus nerve (CN X)

102.

Which of the following nerves carries preganglionic parasympathetic fibers that exit the skull through the jugular foramen and synapse in the otic ganglion?

a)

Facial nerve (CN VII)

b)

Glossopharyngeal nerve (CN IX)

c)

Vagus nerve (CN X)

d)

Trigeminal nerve (CN V)