Block 5 Anat Head Neck Mini Quest Prt 4

21 Questions | Total Attempts: 47

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Block 5 Anat Head Neck Mini Quest Prt 4

Questions and Answers
  • 1. 
    A 28‑year‑old biker received a hard blow to the side of his head. X‑ray revealed pooling of blood in his epidural space. The source of blood is MOST LIKELY a ruptured:
    • A. 

      Middle meningeal artery

    • B. 

      Emissary vein

    • C. 

      Cerebral vein

    • D. 

      Cerebral aneurysm

    • E. 

      Cerebral artery

  • 2. 
    A 55‑year‑old woman presents to her doctor with slight ptosis (drooping) of her left upper eyelid and mydriasis (dilation of pupil). A diagnosis of ophthalmoplegia (inability to move the eye) is made. This ptosis is due to:
    • A. 

      Denervation of the smooth muscle component of levator palpebrae superioris

    • B. 

      Compression of the pterygopalatine ganglion

    • C. 

      Denervation of orbicularis oculi

    • D. 

      Injury to the facial nerve

    • E. 

      Injury to the oculomotor nerve

  • 3. 
    A young boy is taken to the pediatrician because of a nose bleed. Examination of Little's area shows blood exuding from the major artery that supplies the nasal cavity, which is the:
    • A. 

      Greater palatine

    • B. 

      Sphenopalatine

    • C. 

      Anterior ethmoidal

    • D. 

      Posterior ethmoidal

    • E. 

      Superior labial

  • 4. 
    A 16‑year‑old male high school student, troubled with a bad case of acne, complains of severe headache and problems with movements of his eyes. It is noted that he also has a high fever and is sweating profusely. By the swelling of the tissues on the left side of his face from an infected pimple adjacent to the philtrum leading to the upper lip, you conclude, correctly, that an infection has spread retrograde from the area of the acute infection to the cavernous sinus by way of ...
    • A. 

      Tributaries of the anterior division of the retromandibular vein into the internal jugular vein.

    • B. 

      Ipsilateral (same side) facial vein into the ophthalmic veins.

    • C. 

      The left angular vein into the left superficial temporal vein.

    • D. 

      The common facial vein into the external jugular venous system

    • E. 

      Inferior labial vein into the deep facial venous system, and then into the posterior division of the retromandibular vein.

  • 5. 
    On examining a lateral X‑ray of the neck, one can usually identify the faint image of the hyoid bone at the level of the ...
    • A. 

      Fourth cervical vertebra

    • B. 

      First cervical vertebra

    • C. 

      Second cervical vertebra

    • D. 

      Third cervical vertebra

    • E. 

      Fifth cervical vertebra

  • 6. 
    As you examine the 14‑year‑old female patient from Portsmouth, you realize that the evidence on physical examination indicates clearly that she has a right‑sided Bell's palsy. Which of the following signs would lead you to this conclusion?
    • A. 

      The patient's jaw muscles are so weak that she has difficulty chewing

    • B. 

      She has no pain nor temperature sense in her right cheek

    • C. 

      She is unable to close her right eye tightly.

    • D. 

      Her right pupil is constricted more than her left pupil.

    • E. 

      Her tongue deviates to the left when it is protruded

  • 7. 
    During a fight in a tavern in Roseau, the 45‑year‑old construction worker received a shallow stab wound at a point near the middle of the left posterior triangle of the neck from a broken Kubuli bottle. On physical examination, it is noted that the left shoulder is drooping lower than the right shoulder, and the superior angle of the left scapula juts out slightly. Strength in turning the head to the right or left appears symmetric. From these facts, what has been injured?
    • A. 

      The origin of the left vagus nerve

    • B. 

      The site of termination of the left dorsal scapular nerve

    • C. 

      The anterior part of the left ansa cervicalis

    • D. 

      The proximal segment of the left phrenic nerve

    • E. 

      The left spinal accessory nerve, inferior to the sternocleidomastoid muscle

  • 8. 
    After a tonsillectomy your 14‑year‑old female patient has persistent bleeding from the tonsillar bed. Blood flow is slow but constant. The source of the blood is:
    • A. 

      Tonsillar branch of the facial artery

    • B. 

      External palatine vein

    • C. 

      Ascending palatine artery

    • D. 

      Superior thyroid vein

    • E. 

      Ascending pharyngeal artery

  • 9. 
    Increased Cerebral Spinal Fluid pressure that compresses the contents of the optic nerve is MOST LIKELY to cause:
    • A. 

      Swelling of the optic disc or papilla

    • B. 

      Impaired vision

    • C. 

      Glaucoma

    • D. 

      Total blindness

    • E. 

      Degeneration of the retina

  • 10. 
    The 60‑year‑old woman had been experiencing chronic lancinating pain (very sharp, acute pain) between her left lower eyelid and her left upper lip. A diagnosis of tic douloureux is made and the decision is made to inject the ganglion wherein the highly irritable cell bodies are located which are responsible for the pain. Into which foramen should the needle be directed to reach the ganglion?
    • A. 

      The left infraorbital foramen

    • B. 

      The left stylomastoid foramen

    • C. 

      The left mental foramen

    • D. 

      The left jugular foramen

    • E. 

      The left supraorbital foramen

  • 11. 
    The 29‑year‑old female patient exhibits gustatory sweating, several months after having her left parotid gland removed because of a benign tumor; that is, she sweats profusely from the ipsilateral (same side) of the face when she smells food that she enjoys, or even thinks of it. This problem...
    • A. 

      Results from growth of fibers from the auriculotemporal nerve into the subcutaneous tissue in the area of the bed of the parotid gland.

    • B. 

      Occurs because sweat glands are activated by adrenergic (epinephrine or norepinephrine) chemical mediators

    • C. 

      Results from regeneration of sympathetic fibers accompanying the arterial supply of the parotid gland.

    • D. 

      Could be corrected simply by cutting the vagus nerve on the affected side of the face.

    • E. 

      Is one of the common side effects of Bell's palsy.

  • 12. 
    The 3‑year‑old child's eyelids had become swollen shut within a day after the dog had bitten her in the posterior part of her scalp. You, examining this suffering baby in the Emergency Department of the Staten Island Hospital in New York on your first evening of night call, know that ...
    • A. 

      The pain fibers from this injury are being carried by the dorsal primary ramus of the first cervical nerve.

    • B. 

      Bleeding, and possibly infection, have spread through the areolar layer of the scalp.

    • C. 

      The "danger zone" of the scalp is localized to the space between the connective tissue of the scalp and the aponeurotic layer of the scalp

    • D. 

      Bleeding has spread through the space between the periosteum and the skull from the back of the head to the region of the eyes

    • E. 

      The supratrochlear and supraorbital nerves must be anesthetized before anything else is done for the patient

  • 13. 
    A 62‑year‑old woman who was a passenger in a car involved in a multi‑vehicle accident suffered cuts and bruises on her face and a brain concussion when her head forcibly hit the inside door frame of the car. On neurological examination she was found to have no sensation over the posterior one‑third of her tongue and her gag response was absent. Cranial x‑ray revealed she had a fracture of the cranial base. The fracture went through what structure?
    • A. 

      Foramen spinosum

    • B. 

      Cavernous sinus

    • C. 

      Carotid canal

    • D. 

      Jugular foramen

    • E. 

      Hypoglossal canal

  • 14. 
    The orthopedic surgeon wanted to operate on the patient's hand without using general anesthesia. She recognized that she could inject anesthetic into the axillary connective tissue sheath containing the nerves of the upper limb and achieve a nice anesthetic condition of the hand, suitable for operation without causing the patient unnecessary pain or loss of consciousness. She knows she must exercise care, however, because paralysis of half of the diaphragm could occur if the anesthetic entered the space deep to the...
    • A. 

      Prevertebral fascia anterior to the anterior scalene muscle

    • B. 

      Retropharyngeal fascia

    • C. 

      Superficial fascia enclosing the platysma muscle.

    • D. 

      Alar fascia

    • E. 

      Investing fascia enclosing the sternocleidomastoid and trapezius muscles

  • 15. 
    A 14‑year‑old girl with a bad case of acne complains of severe headache, fever, tingling and burning in the skin of the midface and loss of all voluntary movement of her right eye. Physical and ophthalmoscopic examinations reveal swollen eye and engorged retinal veins. The loss of function of the right extraocular eye muscles is due to involvement of which structures that pass through the cavernous sinus?  
    • A. 

      CN IV and CN VI

    • B. 

      CN VII and CN VI

    • C. 

      CN III, CN IV and CN VI

    • D. 

      CN V1, CN V2 and CN VIII

    • E. 

      CN III, CN IV and CN V

  • 16. 
    A teenager is diagnosed with cavernous sinus thrombosis. Infected blood drains from the cavernous sinus directly into the:
    • A. 

      Sigmoid sinus

    • B. 

      Straight sinus

    • C. 

      Occipital sinus

    • D. 

      Superior and inferior petrosal sinuses

    • E. 

      Internal jugular vein

  • 17. 
    A 35‑year‑old woman suffers from maxillary sinusitis. Pus generated in the maxillary sinus is MOST LIKELY to drain into what part of the nasal cavity?
    • A. 

      Inferior meatus

    • B. 

      Sphenoethmoidal recess

    • C. 

      Superior meatus

    • D. 

      Middle meatus

    • E. 

      Vestibule

  • 18. 
    A 45‑year‑old man visits his doctor because of ringing in his left ear. Physical examination reveals an infection of the middle ear. If the infection spreads into the facial canal located in the medial wall of the tympanic cavity, which of the following signs and symptoms is LEAST LIKELY to occur?
    • A. 

      Vertigo (dizziness)

    • B. 

      Loss of lacrimation

    • C. 

      Reduced salivation

    • D. 

      Loss of taste from tip of tongue

    • E. 

      Sounds are annoyingly loud

  • 19. 
    The 22‑year‑old woman is to undergo bilateral (both sides) removal of the C6 ‑ T2 segments of her sympathetic chains, in an attempt to correct the excessive, chronic vasoconstriction in her upper limbs that was causing ischemia (loss of adequate blood supply) to her hands, especially in her fingers. You must caution her that this procedure will result in ...
    • A. 

      A slight drooping of her upper eyelids (partial ptosis).

    • B. 

      Excessive facial sweating

    • C. 

      An inability to smile symmetrically

    • D. 

      Dilation of her pupils, which will interfere with her night driving by automobile

    • E. 

      Loss of sensation from the upper and middle parts of her face.

  • 20. 
    The parasympathetic portion of the Autonomic Nervous System acts to maintain homeostasis, insuring the normal functions of processes vital to life. With regard to this system, it is well known that ...
    • A. 

      Parasympathetic stimulation of the heart results in a negative chronotropic effect in cardiac activity.

    • B. 

      The parasympathetic supply to the vascular smooth muscle and sweat glands of the upper limbs passes into the limb in the adventitia of the axillary artery.

    • C. 

      The chemical mediator released by postganglionic parasympathetic neurons at the target tissues is most commonly norepinephrine

    • D. 

      The preganglionic parasympathetic neurons for the heart, lungs and esophagus have their cell bodies in the intermediolateral cell column of upper thoracic segments of the spinal cord.

    • E. 

      Postganglionic parasympathetic fibers usually travel through the gray communicating rami from the ganglionated chain

  • 21. 
    A 22‑year‑old male comes into your office complaining of hoarseness and an unsettling inability to change the tone of his voice normally. He has never smoked and he drinks alcohol in moderation. He is of normal weight and has no nasal, oral, or pharyngeal obstructions. When you examine him with the laryngoscope you note that the laryngopharyngeal mucosa is normal, all movements of the arytenoid cartilages seem normal, and the vocal folds are free of inflammation and polyps. You do notice an asymmetrical dislocation of the rima glottidis to the left when the patient attempts to speak in a higher tone of voice, indicating that the forward rotation of the thyroid cartilage is weakened. The only noteworthy point of the patient's history is that he is a kick boxer and sustained a blow to the right side of his throat the night before he noted the alterations in his voice. Damage to which nerve is responsible for his symptoms?
    • A. 

      Pharyngeal plexus

    • B. 

      Internal laryngeal nerve

    • C. 

      External laryngeal nerve

    • D. 

      Recurrent laryngeal nerve

    • E. 

      Glossopharyngeal nerve

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