Are You Patient Person

21 Questions | By Chachelly | Updated: Mar 21, 2022 | Attempts: 65

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1.

Tumors or infections that develop in the middle ear cavity can affect structures associated with the various walls of the chamber. An infectious process that invades the promontory of the medial wall would MOST LIKELY involve the ...
- A.
  
  Internal carotid artery in the carotid canal
- B.
  
  Pyramid of the stapedius muscle
- C.
  
  Temporal lobe of the brain
- D.
  
  Jugular bulb
- E.
  
  Cochlea
2.

The patient had suffered a hemisection of the lower part of the cervical portion of the spinal cord (approximately C6, 7, 8). As a result, one would expect to see ...
- A.
  
  Complete ptosis of the ipsilateral superior palpebra
- B.
  
  Decrease in sweating on the ipsilateral side of the face
- C.
  
  Paralysis of the ipsilateral hemidiaphragm
- D.
  
  Loss of the contralateral abdominal reflex
- E.
  
  A Babinski sign in the contralateral foot
3.

He had sustained a sharp blow to his right eye from the soccer ball, kicked with great force by the man facing him, and fell to the ground in pain. At the hospital, the eye was gently checked for injury and the ability to move it. The eye was adducted; the pupil could be turned slightly upward or downward slightly from that position, but he could not abduct the eye. It could therefore be rightly assumed that ...
- A.
  
  The trochlea had been torn from its attachment to the upper medial orbital wall.
- B.
  
  The lower division of the oculomotor nerve had been injured.
- C.
  
  The force had fractured the lamina papyracea, with entrapment of the medial rectus.
- D.
  
  He had suffered a break in the orbital plate of the maxilla and the inferior rectus was caught in the crack of the bone.
- E.
  
  The abducens nerve had been severed (cut) at the superior orbital fissure
4.

Imaging studies demonstrated that the patient's prostatic cancer had spread upward through the vertebral canal by way of the venous plexus of Batson in the epidural space. A metastatic tumor had grown in the posterior cranial fossa, there affecting cranial nerves leaving the skull. The patient's left shoulder drooped lower than the right shoulder. When protruded, his tongue deviates to the left. He has weakness in turning his head to the right. From this evidence, one can easily deduce which nerves have been affected:
- A.
  
  Right cranial nerves IX, X, XI and XII
- B.
  
  Left cranial nerves X, XII and right XI, together with cervical nerves C3 and C4
- C.
  
  Right cranial nerves X, XI, XII
- D.
  
  Left cranial nerves XI and XII
- E.
  
  Right cranial nerve XI, left cranial nerve XII
5.

The patient responds properly as you check the blink reflex (corneal reflex) in both eyes, closing and opening both eyes. But, as you examine the patient's right eye with a small, bright flashlight, the right pupil does not constrict in response to the light, although the contralateral pupil does. You would be CORRECT in thinking that ...
- A.
  
  The patient obviously suffers from glaucoma in the right eye.
- B.
  
  The left oculomotor nerve is not functioning properly
- C.
  
  The parasympathetic fibers in the right oculomotor nerve are not functional
- D.
  
  The patient is blind in the right eye
- E.
  
  The right oculomotor nerve is paralyzed
6.

A staphylococcal infection that spreads from a region of abscess of a mandibular tooth into the soft tissues of the floor of the mouth and neck can result in suffocation, if antibiotic therapy is not instituted promptly. This clinical problem is referred to as ...
- A.
  
  Ranula
- B.
  
  Torus mandibularis
- C.
  
  Submaxillary cellulitis (Ludwig's angina)
- D.
  
  Quinsy
- E.
  
  Ankyloglossia
7.

The recurring infections in the young boy seemed to indicate a need for removal of his palatine tonsils. These lymphoid organs are found in the...
- A.
  
  Oropharynx
- B.
  
  Oral vestibule
- C.
  
  Pharyngeal recess
- D.
  
  Laryngopharynx
- E.
  
  Oral cavity propber
8.

The 28 YO female has come to you complaining hoarsely of difficulty swallowing (especially liquids) and in speaking. As you performed the physical examination, you observe that touching the posterior 1/3 of her tongue or pharyngeal wall on the right side produced no noticeable result. When the contralateral areas were stimulated, however, there was a distinct gag reflex and the uvula moved distinctly toward the left side of the pharynx. Use of a laryngoscope in examination of the true vocal folds would confirm that the patient had paralysis of the ...
- A.
  
  Right vagus and right glossopharyngeal nerves
- B.
  
  Right glossopharyngeal and left vagus nerves
- C.
  
  Left vagus nerve only
- D.
  
  Right glossopharyngeal nerve only
- E.
  
  Left vagus and left glossopharyngeal nerves
9.

The second semester student had gone to Roseau because pain from a bad molar tooth was distracting him from his preparations for the second Mini exam at Ross. The dentist who treated the student injected a bolus of anesthetic into the region just anterior to the mandibular lingula. In a few minutes, the student observed that he had lost all sensations on the anterior parts of the tongue ipsilateral to the injection. He realized that the loss of tongue sensation was due to the fact that the anesthetic had directly affected the ...
- A.
  
  Inferior alveolar nerve
- B.
  
  Auriculotemporal nerve
- C.
  
  Lingual nerve
- D.
  
  Buccal nerve
- E.
  
  Chorda tympani nerve
10.

Unilateral clefts of the upper lip are common, occurring about once in 1000 births. The underlying cause for this congenital defect is known to be the lack of fusion....
- A.
  
  Between palatine shelves
- B.
  
  Between the primary and secondary palate and distorsion of the lateral palatine processes, preventing their migration
- C.
  
  Of the maxillary processes
- D.
  
  Between maxillary and mandibular processes
- E.
  
  Between a maxillary prominence and the medial nasal prominence
11.

The 10 YO boy had been teased cruelly by the other children in his class, the mother told you, because his head had been tilted to one side since birth. You respond by telling her that the lad has congenital torticollis and that it can be corrected rather easily by a surgical procedure. The condition resulted from fibrosis of the ...
- A.
  
  Splenius musculature, unilaterally
- B.
  
  Levator scapulae muscle
- C.
  
  Sternocleidomastoid
- D.
  
  Omohyoid
- E.
  
  Ipsilateral strap muscles
12.

The fourth semester student was asked by the examining clinician in the ICM program to check the functions of the masticatory muscles in an elderly woman from Portsmouth. After the student asked the woman to clench her jaws together tightly he could feel on palpation that there was a lack of symmetry in size and strength of the muscles from one side of the jaw to the other, as noted both by the lack of fullness under his examining fingertips and the unequal strength of the jaws as the patient closed her mouth against resistance. When the patient was asked to "stick out your chin," (in other words, protrude her mandible directly forward) the mandible deviated to the right. This would MOST LIKELY occur as a direct result of paralysis to the ...
- A.
  
  Posterior segment of her left temporalis
- B.
  
  Right medial pterygoid
- C.
  
  Left masseter
- D.
  
  Right lateral pterygoid
- E.
  
  Left lateral pterygoid
13.

The 72 YO woman had a lesion in the middle of her right vocal cord which biopsy revealed to be carcinoma. Further treatment would be dictated by the position of the tumor and by the location of the lymph nodes draining the area. The lymph nodes which receive lymph directly from this part of the vocal cord are the ...
- A.
  
  Juguloomohyoid node
- B.
  
  Sentinal node
- C.
  
  Submental nodes
- D.
  
  Jugulodigastric node
- E.
  
  None of the above is a correct response
14.

During the Saturday morning Morbidity and Mortality Conference in the Staten Island Hospital, the conclusion was offered that the patient under discussion had almost died as a result of asphyxiation (suffocation) because both recurrent laryngeal nerves had been injured during the removal of the patient's diseased thyroid glands. The young resident, a graduate of Ross Medical School, left no doubt in the minds of those attending the conference that one pair of laryngeal muscles would still be innervated after bilateral injuries to the recurrent laryngeal nerves. The continuing contraction of this muscle brought the vocal cords together in the heavily sedated patient, thereby blocking the airway. The financial loss to the hospital in a lawsuit would have been great if she had not observed the problem and ordered respiratory intubation for the patient. The muscle that was still functioning was the ...
- A.
  
  Cricothyroid
- B.
  
  Posterior cricoarytenoid
- C.
  
  Arytenoideus
- D.
  
  Lateral cricoarytenoid
- E.
  
  Thyroarytenoid
15.

While treating young children from the local public school, you examine the swollen, and angry‑red eardrum of Carolon, a 7 YO girl with a middle ear infection. Which of the following statements do you remember as being TRUE, as you review the clinical anatomy of the area?
- A.
  
  Umbo is a drug formulated from leaves of the dashish plant to be inserted into the ear to cure infections in the middle ear and the pharyngotympanic tube.
- B.
  
  The "cone of light" is due to reflection of the otoscope light toward the posterior inferior quadrant of the eardrum.
- C.
  
  The vagus nerve, auriculotemporal nerve and glossopharyngeal nerve are all involved in the sensory supply of the eardrum.
- D.
  
  An incision for drainage of a middle ear infection should be made in the upper, posterior quadrant of the tympanic membrane.
- E.
  
  The tympanic branch of the glossopharyngeal nerve is called "chorda tympani" because it crosses the upper inner aspect of the eardrum
16.

Magnetic resonance imaging can provide excellent visualization of soft tissues of the body. With such imaging methodology, for instance, it could be demonstrated that one of the following DOES NOT pass through the superior orbital fissure:
- A.
  
  Trochlear nerve
- B.
  
  Abducens nerve
- C.
  
  Ophthalmic artery
- D.
  
  Oculomotor nerve
- E.
  
  Superior ophthalmic vein
17.

A 14 YO female patient from Calibishe, Dominica is seen in the Portsmouth hospital by the small group of nervous 4th semester students (nervous, but highly self‑confident). It is immediately apparent that the girl has a bad case of acne. She complains of severe headache, pain superficially and deeply in her midface, and loss of all voluntary movement of her right eye. She has an elevated temperature. Physical and ophthalmoscopic examination reveal ipsilateral ptosis, a swollen palpebra and engorged retinal veins. Which of the following combinations of structures possibly involved in this case of coronary sinus thrombosis might BEST explain the ocular findings?
- A.
  
  CN VII and CN VI
- B.
  
  CN III, CN IV and CN VI
- C.
  
  CNV1, CNV2 and CN III
- D.
  
  CN I, CN VI, CNV, and CNV2
- E.
  
  CN III, CN IV, CN VI and CN V3
18.

The knowledge that important nerves often accompany named arteries (so‑called "neurovascular pairs") can be of great assistance to the clinician when looking for a particular nerve. An example of such an association is that of the ...
- A.
  
  Angular artery and the buccal branch of the facial nerve
- B.
  
  The external laryngeal nerve with the superior laryngeal artery
- C.
  
  The inferior thyroid artery and the recurrent laryngeal nerve
- D.
  
  Superficial temporal artery and the facial nerve
- E.
  
  The lingual artery and the buccal nerve
19.

The 30 YO male medical student enters the campus clinic following one of the Embryology lectures, seeking confirmation of his self‑diagnosis. The student has a small, soft lump on the anterior border of his left sternocleidomastoid muscle and he has decided to ask the opinion of the campus physician about it. A mucoid secretion can be seen oozing from the soft mass of tissue. The clinician's classic training leads him to agree with the medical student that the proper diagnosis is ...
- A.
  
  Branchial or pharyngeal fistula
- B.
  
  Aberrant thymic tissue
- C.
  
  Persistent 2nd pharyngeal pouch
- D.
  
  Inflamed and severely infected deep cervical lymph nodes
- E.
  
  Ectopic palatine tonsil
20.

The left side of the face of the 60 YO fruit salesman in the clinic appears to be strangely smooth, with absence of the nasolabial furrow and less wrinkling of the skin of his forehead than on the contralateral side. The corner of his mouth on the left side droops noticeably. He complains that he had to stuff a little piece of cloth into his left ear because sounds heard with that ear seemed so loud (hyperacusis). Physical examination reveals absence of the sense of taste on the left side of his tongue anteriorly. Function of his lacrimal gland on that side seems to be normal. With these facts in mind, you can conclude that the lesion of the involved nerve is probably located ...
- A.
  
  In the petrous part of the temporal bone, proximal to the location of the geniculate ganglioin
- B.
  
  At the stylomastoid foramen
- C.
  
  In the internal acoustic (auditory) meatus
- D.
  
  In the petrous part of the temporal bone, distal to the origin of the greater petrosal nerve
- E.
  
  Within the parotid gland
21.

The little girl was obviously small for her age and her eyes were so far apart that you include hypertelorism as one of your observations during the physical exam. In response to your cautious questioning, the mother tells you that the child suffers from recurring colds. Laboratory studies reveal that the little patient also has a condition of hypocalcemia, leading you to decide on a diagnosis of DiGeorge Syndrome. Which of the following might BEST explain the chronic colds the little girl is suffering?
- A.
  
  Internal branchial fistula
- B.
  
  Ectopic parathyroid glands
- C.
  
  Hypoplastic thymus gland
- D.
  
  Persistent thyroglossal duct
- E.
  
  Cervical cysts