Block 5 Anat Head Neck Mini Quest Prt 2

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Block 5 Anat Head Neck Mini Quest Prt 2 - Quiz

Questions and Answers
  • 1. 

    The prominent US political leader remembered that he had hit his head on a low‑ hanging branch of a tree while riding horseback, although he had not fallen from the saddle. The confusion and memory problems he was experiencing recently resulted in cranial examination with magnetic resonance and CT imaging. A subdural hematoma was diagnosed. Such an injury resulted from injury to ...

    • A.

      The anterior communicating artery

    • B.

      Middle meningeal artery

    • C.

      Inferior petrosal venous sinus

    • D.

      A parietal emissary vein, passing into the diploe from the scalp

    • E.

      A cerebral vein

    Correct Answer
    E. A cerebral vein
    Explanation
    The correct answer is a cerebral vein. A subdural hematoma is a condition where blood accumulates between the dura mater (the outermost layer of the meninges) and the arachnoid mater (the middle layer). It is usually caused by the tearing of bridging veins that connect the surface of the brain to the dural sinuses. These bridging veins are often found in the subdural space and can be damaged by a head injury, such as hitting the head on a low-hanging branch. The cerebral veins are a type of bridging vein that can be affected in this type of injury.

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  • 2. 

    The patient required excision of a mass in the floor of his mouth. Unfortunately the extent of the tumor resulted in post­operative problems with function of the tongue. When he was asked to protrude ("stick out") his tongue, it pointed to the patient's right; he could not point it straight ahead, nor to the left. The structure that has been paralyzed is the ...

    • A.

      Right vagus nerve

    • B.

      Left hyoglossus muscle

    • C.

      The left hypoglossal nerve

    • D.

      The right genioglossus muscle

    • E.

      The left lingual nerve

    Correct Answer
    D. The right genioglossus muscle
    Explanation
    The right genioglossus muscle is responsible for protruding the tongue straight ahead. In this case, the patient's inability to point their tongue straight ahead or to the left suggests that the right genioglossus muscle is paralyzed. This could be due to damage or dysfunction in the nerve innervating the muscle.

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  • 3. 

    The 35‑year‑old man presented with aching pain in his right upper teeth and a sensation of fullness and pulsation in his right cheek. Examinations reveal pus in his right middle nasal meatus. These symptoms are MOST suggestive of ...

    • A.

      Superior ethmoidal sinusitis

    • B.

      Maxillary sinusitis

    • C.

      Inflammation of the nasolacrimal duct

    • D.

      Sphenoidal sinusitis

    • E.

      Frontonasal sinusitis

    Correct Answer
    B. Maxillary sinusitis
    Explanation
    The given symptoms of aching pain in the right upper teeth, sensation of fullness and pulsation in the right cheek, and the presence of pus in the right middle nasal meatus are most suggestive of maxillary sinusitis. Maxillary sinusitis is an inflammation or infection of the maxillary sinuses, which are located in the cheek area. The symptoms described align with the typical presentation of maxillary sinusitis, including referred pain to the upper teeth and a sensation of fullness in the affected cheek.

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  • 4. 

    Which of the following events might be expected with laceration (cutting or tearing) of the middle meningeal artery at the region of the pterion?

    • A.

      Interruption of arterial blood supply to the frontal lobe of the brain on the affected side

    • B.

      Epidural hematoma, increased intracranial pressure

    • C.

      Detection of blood in the cerebrospinal fluid

    • D.

      Subdural hematoma, associated with herniation of the brainstem

    • E.

      Subarachnoid hemorrhage and spasm of cerebral arteries, followed by ischemia

    Correct Answer
    B. Epidural hematoma, increased intracranial pressure
    Explanation
    With laceration of the middle meningeal artery at the region of the pterion, an epidural hematoma is likely to occur. This is because the middle meningeal artery is located in the epidural space, and laceration of this artery can lead to bleeding into this space. As the blood accumulates, it can cause increased intracranial pressure, which can lead to symptoms such as headache, nausea, and confusion. Therefore, the occurrence of an epidural hematoma and increased intracranial pressure is expected in this scenario.

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  • 5. 

    One of the hazards in thyroid surgery is the possibility of injury to the recurrent laryngeal nerves, with resulting paralysis of the muscles that open the airway, separating the vocal cords. The muscles which perform this function are the ...

    • A.

      Posterior cricoarytenoids

    • B.

      Cricothyroids

    • C.

      Transverse and oblique fibers of the arytenoideus

    • D.

      Lateral cricoarytenoids

    • E.

      Thyroarytenoids

    Correct Answer
    A. Posterior cricoarytenoids
    Explanation
    The correct answer is posterior cricoarytenoids. In thyroid surgery, there is a risk of injury to the recurrent laryngeal nerves, which can lead to paralysis of the muscles that open the airway and separate the vocal cords. The posterior cricoarytenoid muscles are responsible for this function. They are the only muscles listed among the options that perform the specific action mentioned in the question.

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  • 6. 

    A child is presented by his mother in the morning clinic. The young boy has a unilateral cleft lip, and the mother asks you for your advice on the proper course of corrective treatment. With your excellent grasp of embryology, you first remember that this defect results usually from a...

    • A.

      Failure of fusion of the mandibular prominences

    • B.

      Failure of fusion of the medial nasal swelling with the maxillary process

    • C.

      Persistence of the nasolacrimal groove

    • D.

      Failure of fusion of the lateral nasal swellings

    • E.

      Failure of fusion of the maxillary shelves (swellings) with each other

    Correct Answer
    B. Failure of fusion of the medial nasal swelling with the maxillary process
    Explanation
    The correct answer is failure of fusion of the medial nasal swelling with the maxillary process. During embryonic development, the face forms from a series of prominences that fuse together. The medial nasal swelling and the maxillary process are two of these prominences. In the case of a unilateral cleft lip, there is a failure of fusion between these two structures, resulting in a gap or cleft in the upper lip. This defect can be corrected through surgical intervention.

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  • 7. 

    Intralaryngeal structures are involved frequently in traumatic injuries, stress from overuse, infectious processes and other pathology. Which of the following statements is TRUE regarding laryngeal anatomy?

    • A.

      The space beneath the true vocal cord or ligament is drained by specific lymphatic vessels which drain directly to the prelaryngeal node (Delphian node) or to the juguloomohyoid nodes, bilaterally.

    • B.

      The rima glottidis is the space between the true vocal folds and the false vocal folds.

    • C.

      Sensory supply to the interior of the larynx from true vocal folds to vestibule is provided by the recurrent laryngeal nerves.

    • D.

      The glottis consists of the rima glottidis and the true vocal folds.

    • E.

      The vocal process of the corniculate cartilage provides attachment for the true vocal ligament.

    Correct Answer
    D. The glottis consists of the rima glottidis and the true vocal folds.
    Explanation
    The glottis consists of the rima glottidis and the true vocal folds. The glottis refers to the opening between the vocal cords in the larynx. It is composed of two parts - the rima glottidis, which is the space between the true vocal folds, and the true vocal folds themselves. This statement correctly describes the components of the glottis and their relationship to each other.

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  • 8. 

    During the course of a total physical examination in the Geriatrics division of the hospital, including Magnetic Resonance Imaging, the images provided evidence ‑ of the presence of a small (2.0 cm) tumor which involved several nerves in the cranial cavity of the 67‑year‑old male patient. His right shoulder drooped, in comparison with the left shoulder. He could not abduct the right arm above 90 degrees. He had difficulty swallowing. He had weakness turning his head to the left. On oral exam, his uvula pointed to the left, and sensitivity of his pharynx to stimuli was reduced. Lesions of which combination of nerves would BEST explain the signs?  

    • A.

      Right vagus, right spinal accessory, right glossopharyngeal

    • B.

      Left vagus, left spinal accessory, right glossopharyngeal

    • C.

      Right mandibular (V3), left glossopharyngeal, left superior laryngeal

    • D.

      Right recurrent laryngeal, right spinal accessory, right hypoglossal

    • E.

      Left recurrent laryngeal, left spinal accessory, left pharyngeal branch of vagus

    Correct Answer
    A. Right vagus, right spinal accessory, right glossopharyngeal
    Explanation
    The patient's symptoms of drooping right shoulder, limited right arm abduction, difficulty swallowing, weakness turning head to the left, uvula pointing to the left, and reduced sensitivity of the pharynx suggest the involvement of multiple nerves. The combination of the right vagus, right spinal accessory, and right glossopharyngeal nerves would best explain these signs. The right vagus nerve controls the function of the pharynx and larynx, which could explain the difficulty swallowing and the uvula deviation. The right spinal accessory nerve controls the trapezius muscle, which could explain the weakness in turning the head to the left and the drooping right shoulder. The right glossopharyngeal nerve controls the sensation of the pharynx, which could explain the reduced sensitivity to stimuli.

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  • 9. 

    A 71‑year‑old woman is brought to the hospital complaining of difficulty in breathing. The attending physician decides that she should be given an emergency tracheostomy, but when the midline incision is made through the skin below the thyroid cartilage, profuse bleeding occurs. After tying off the bleeding vessel and inserting the tracheal tube, the physician then remembers (too late) that in some 10% of individuals a variable artery lying in the midline below the thyroid gland can be damaged during tracheostomy. The vessel can arise from the aortic arch, the vertebral artery, or the common carotid artery. This vessel is the

    • A.

      Ascending cervical artery

    • B.

      Middle thyroid artery

    • C.

      Ascending pharyngeal artery

    • D.

      Thyroid ima artery

    • E.

      Superior laryngeal artery

    Correct Answer
    D. Thyroid ima artery
    Explanation
    The correct answer is the thyroid ima artery. In some individuals, a variable artery called the thyroid ima artery can be damaged during a tracheostomy. This artery can arise from different sources such as the aortic arch, vertebral artery, or common carotid artery. In this case, the profuse bleeding that occurred after the midline incision suggests that the thyroid ima artery was damaged.

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  • 10. 

    The young patient was to undergo a tonsillectomy for removal of the palatine tonsils. The pediatric surgeon, performing this procedure by himself for the first time, reviewed the anatomy of this area. He should remember ....

    • A.

      The palatine tonsil is found within the oropharynx

    • B.

      The glossopharyngeal nerve passes deep to the lymphoid tissue of the tonsillar fossa.

    • C.

      The principal source of arterial supply to the palatine tonsil arises from the facial artery.

    • D.

      The lymphoid tissue to be removed lies just behind the structure that forms the anterior pillar of the fauces.

    • E.

      All of the statements listed in the choices of this question are true.

    Correct Answer
    E. All of the statements listed in the choices of this question are true.
    Explanation
    The correct answer is that all of the statements listed in the choices of this question are true. This means that the palatine tonsil is found within the oropharynx, the glossopharyngeal nerve passes deep to the lymphoid tissue of the tonsillar fossa, the principal source of arterial supply to the palatine tonsil arises from the facial artery, and the lymphoid tissue to be removed lies just behind the structure that forms the anterior pillar of the fauces.

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  • 11. 

    At your rural clinic a five‑year‑old girl is brought in by her parents because she has a "wry neck." Physical examination reveals no increased tone in neck muscles and all cranial nerve tests are normal. Her history reveals a difficult breech ("feet­first") birth, however, during which excessive traction was put on her head and neck. You diagnose Congenital Torticollis. Damage to what structure(s) accounts for this condition?

    • A.

      Ansa cervicalis

    • B.

      Sternocleidomastoid muscle

    • C.

      Posterior scalene muscle

    • D.

      Ligamentum nuchae

    • E.

      Anterior scalene muscles

    Correct Answer
    B. Sternocleidomastoid muscle
    Explanation
    The correct answer is the Sternocleidomastoid muscle. Congenital torticollis is a condition characterized by the abnormal positioning of the head due to the shortening or tightness of the sternocleidomastoid muscle. In this case, excessive traction during birth likely caused damage to the muscle, leading to the wry neck. The absence of increased tone in neck muscles and normal cranial nerve tests suggest that the issue is localized to the sternocleidomastoid muscle rather than other structures mentioned in the options.

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  • 12. 

    The 25‑year‑old, 3rd semester medical student was hit in the left eye by the football, which had just been thrown with great force by the former professional quarterback on the opposite team. The football lacerated the upper eyelid, which was closed at the time of impact, compressing the eyeball with force. On examination, you discover a severe hematoma (bruise) of the upper lid, and echymoses (broken blood vessels) in the lateral portion of the sclera of the eye. The iris of the left eye appears sunken in comparison to the right. When you test extraocular eye function, the patient cannot look up with the left eye when it is abducted, or look up when the left eye is adducted. What is the MOST LIKELY diagnosis?

    • A.

      Direct damage to the inferior division of CN III and CN IV

    • B.

      Blow cut fracture and entrapment of inferior rectus and inferior oblique muscles

    • C.

      Direct damage to the superior division of CN III and CN VI

    • D.

      Fracture to the greater wing of the sphenoid bone and lateral orbital wall and entrapment of lateral rectus and inferior oblique muscles

    • E.

      Direct damage to the zygomaticofacial branch of CN VII and ophthalmic division of CN V

    Correct Answer
    B. Blow cut fracture and entrapment of inferior rectus and inferior oblique muscles
    Explanation
    The patient's inability to look up with the left eye when it is abducted or adducted suggests a problem with the inferior rectus and inferior oblique muscles. The severe hematoma and broken blood vessels in the eye, along with the sunken appearance of the iris, indicate trauma to the eye. The most likely explanation is a blow cut fracture, which involves a fracture to the orbital bones and entrapment of the muscles. This would explain the restricted eye movements and the other findings observed during examination.

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  • 13. 

    The cranial nerve that would be affected FIRST in cavernous sinus thrombosis, due to the passage of the nerve through the sinus, separated from its contents only by a thin layer of endothelium, is the ...

    • A.

      Ophthalmic nerve

    • B.

      Maxillary nerve

    • C.

      Mandibular nerve

    • D.

      Abducens nerve

    • E.

      Optic nerve

    Correct Answer
    D. Abducens nerve
    Explanation
    Cavernous sinus thrombosis is a condition where a blood clot forms in the cavernous sinus, a large vein located at the base of the brain. The cavernous sinus is surrounded by important cranial nerves, including the abducens nerve (cranial nerve VI). Due to its location, the abducens nerve is most likely to be affected first in cavernous sinus thrombosis. This can result in paralysis of the lateral rectus muscle, leading to double vision and difficulty in moving the affected eye laterally. Therefore, the abducens nerve is the correct answer.

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  • 14. 

    The 2‑year‑old child suffered major congenital problems of the first branchial (pharyngeal) arch. Structures that would MOST READILY be affected in such a case would be the ...

    • A.

      Malleus and incus

    • B.

      Stapedius muscle

    • C.

      Stylopharyngeus muscle

    • D.

      Vagus nerve

    • E.

      Stylohyoid ligament

    Correct Answer
    A. Malleus and incus
    Explanation
    In embryonic development, the first branchial arch gives rise to several structures in the head and neck region. The malleus and incus are two small bones located in the middle ear that are derived from the first branchial arch. Therefore, if a child has major congenital problems of the first branchial arch, it is most likely that the malleus and incus would be affected. These bones play a crucial role in transmitting sound vibrations from the eardrum to the inner ear, so any abnormalities in them can lead to hearing impairments or other related issues.

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  • 15. 

    The eighth grade boy was observed in the clinic because of a midline, fluid‑filled swelling just below the center of the hyoid bone. After palpating the soft mass, and suspecting its origin, you ask the boy to stick out his tongue. When he does this, you observe that the cervical mass also moves. It also moves when he swallows. This confirms your diagnosis that the lad has...

    • A.

      An internal branchial cyst

    • B.

      A cervical branchial cyst

    • C.

      A pharyngeal fistula

    • D.

      Aberrant thymic tissue

    • E.

      A thyroglossal duct cyst

    Correct Answer
    E. A thyroglossal duct cyst
    Explanation
    The correct answer is a thyroglossal duct cyst. The presence of a midline, fluid-filled swelling just below the center of the hyoid bone, which moves when the boy sticks out his tongue and swallows, suggests a thyroglossal duct cyst. The thyroglossal duct is a developmental remnant that connects the thyroid gland to the tongue during embryonic development. If the duct fails to close properly, it can result in the formation of a cyst. This is a common congenital anomaly that typically presents as a painless, mobile midline neck mass.

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  • 16. 

    In checking the integrity of the cranial nerves, the examiner will typically check the major actions of the muscles of mastication. Which of the following muscles is of major importance both in opening the mouth and for protruding the jaw?  

    • A.

      Temporalis

    • B.

      Masseter

    • C.

      Lateral pterygoid

    • D.

      Medial pterygoid

    • E.

      Buccinator

    Correct Answer
    C. Lateral pterygoid
    Explanation
    The lateral pterygoid muscle is of major importance both in opening the mouth and for protruding the jaw. This muscle is responsible for moving the mandible forward and sideways, allowing for the opening of the mouth and protrusion of the jaw. The temporalis and masseter muscles are involved in the closing of the jaw, while the medial pterygoid muscle helps in elevating the jaw. The buccinator muscle is primarily involved in the movement of the cheeks. Therefore, the lateral pterygoid muscle is the correct answer as it plays a crucial role in both opening the mouth and protruding the jaw.

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  • 17. 

    A tumor that invades the jugular canal is MOST LIKELY to result in

    • A.

      Hyperacusis

    • B.

      Hoarseness

    • C.

      Deafness

    • D.

      A paralyzed and atrophied tongue

    • E.

      Loss of voluntary closure of the eyelids

    Correct Answer
    B. Hoarseness
    Explanation
    A tumor that invades the jugular canal is most likely to result in hoarseness. The jugular canal contains important structures such as the jugular vein and cranial nerves, including the vagus nerve. The vagus nerve controls the movement of the vocal cords, and if it is affected by a tumor, it can lead to hoarseness.

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  • 18. 

    In the performance of the physical examination of the patient after the automobile accident, in which the woman had hit her forehead against the dashboard of the vehicle, you observe that her right pupil cannot be turned medially and downward. [She can adduct the affected eye medially toward the nose, but she cannot direct the pupil downward from that position.] She has no difficulty looking upward or laterally. If she first gazes laterally with the affected eye, she can look downward with it. It is probable from these signs that she has a nerve lesion or paralysis of the ...

    • A.

      Right abducens nerve

    • B.

      Right inferior rectus muscle

    • C.

      Right inferior oblique muscle

    • D.

      Right oculomotor nerve

    • E.

      Right trochlear nerve

    Correct Answer
    E. Right trochlear nerve
    Explanation
    The given signs indicate a problem with the right trochlear nerve. The trochlear nerve is responsible for controlling the superior oblique muscle, which is responsible for downward and inward movement of the eye. In this case, the patient is unable to direct the pupil downward when the eye is turned medially, indicating a dysfunction of the trochlear nerve. This is further supported by the fact that she has no difficulty looking upward or laterally, suggesting that other cranial nerves involved in eye movement are functioning properly.

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  • 19. 

    A four year old girl, Cherylee, was brought to your office because of frequently occurring colds and sore throat. Her mother told you that Cherylee was sick far more often than her two older brothers and her younger sister. When you asked the mother if the child had ever had any other problems, she mentioned that when Cherylee was born she had a connection between her "heart artery" and her "lung artery," and you realized that she was referring to the presence of a patent ductus arteriosus in the newly born baby. With this information, plus other evidence that Cherylee seems to be immunologically compromised, you correctly deduce that the child ...

    • A.

      Has the characteristics of Treacher Collins syndrome

    • B.

      Is suffering from malar hypoplasia

    • C.

      Possesses the Robin sequence, with resultant severe defects of the first arch

    • D.

      Has abnormal development of the 1st pharyngeal pouch

    • E.

      Suffers abnormal development of 3rd and 4th pharyngeal pouch derivatives

    Correct Answer
    E. Suffers abnormal development of 3rd and 4th pharyngeal pouch derivatives
    Explanation
    The correct answer is that the child suffers abnormal development of 3rd and 4th pharyngeal pouch derivatives. This is because the presence of a patent ductus arteriosus in the newborn baby, along with the frequent colds and sore throat, suggests that the child has an immunological compromise. Abnormal development of the 3rd and 4th pharyngeal pouch derivatives can lead to immune system deficiencies and recurrent respiratory infections.

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  • 20. 

    Two weeks following a thyroidectomy, a 45‑year‑old opera singer complains that she has difficulty in changing the tone of her voice. You examine her larynx with a laryngoscope and note that while the arytenoid cartilages move normally, the thyroid cartilage does not tilt forward when you ask her to change the tone of her voice. Clearly there has been damage to a nerve. With which artery DOES the damaged nerve run?

    • A.

      Internal laryngeal artery

    • B.

      Inferior thyroid artery

    • C.

      Superior laryngeal artery

    • D.

      Inferior laryngeal artery

    • E.

      Superior thyroid artery

    Correct Answer
    E. Superior thyroid artery
    Explanation
    The superior thyroid artery is the correct answer because it supplies blood to the external branch of the superior laryngeal nerve, which innervates the cricothyroid muscle. Damage to this nerve can result in difficulty changing the tone of the voice, as seen in the patient's complaint. The other arteries listed do not have a direct relationship with the damaged nerve.

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  • Mar 19, 2023
    Quiz Edited by
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