Block 5 Anatomy Wk 2 From Ta's W Xpl

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| By Chachelly

Chachelly

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| Attempts: 252 | Questions: 19

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1. When testing the sensory innervation of the face, it is important to remember that the skin of the tip of the nose is supplied by the:

Zygomatic branch of the facial nerve

Maxillary division of the trigeminal nerve

Ophthalmic division of the trigeminal nerve

Buccal branch of the mandibular nerve

Buccal branch of the facial nerve

The Ophthalmic division of the Trigeminal Nerve provides sensory innervation for the forehead, stopping at the level of the eyes and goes down the middle of the nose to the tip. It provides sensory to the upper eyelid. V2 is responsible for providing sensory to the lateral aspect of the nose.

Explanation

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About This Quiz

Explore complex clinical scenarios and anatomical challenges in this quiz, focusing on neuroanatomy and its implications in medical cases. Assess your understanding of nerve damage, muscle function, and... see morehematoma implications through practical, real-world examples. see less

2. Mr. Palmer is a 45 year old male complaining of soreness in his tongue. On inspection you find that he has an infection at the tip of his tongue. You think back to your anatomy days and remember the location of the lymph nodes that drain this area. And the answer is

Carotid triangle

Omoclavicular triangle

Omotracheal triangle

Submental triangle

Submandibular triangle

The submental lymph nodes are found in the submental triangle and they are responsible for draining the tip of the tongue and the lower lip.

Explanation

The submental lymph nodes are found in the submental triangle and they are responsible for draining the tip of the tongue and the lower lip.

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3. 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

Maxillary division of the trigeminal nerve

Mandibular division of the trigeminal nerve

Facial nerve

Auriculotemporal nerve

Trigeminal Nerve’s ophthalmic division’s dermatome includes the eye and anterior portion of the nose.

Explanation

Trigeminal Nerve’s ophthalmic division’s dermatome includes the eye and anterior portion of the nose.

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4. Which of the following muscles is NOT innervated by the facial nerve?

Buccinator

Masseter

Obicularis oris

Zygomaticus major

Frontalis

Masseter is a muscle of mastication so it’s innervated by V.3

Explanation

Masseter is a muscle of mastication so it’s innervated by V.3

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5. During an anterior neck operation, a surgeon accidentally severed the ansa cervicalis. Which of the following muscles did NOT lose its innervation?

Sternohyoid

Sternothyroid

Cricothyroid

Omohyoid

innervated by external branch of superior laryngeal nerve of CN X.

Explanation

innervated by external branch of superior laryngeal nerve of CN X.

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6. A 30-year old male postal worker presents with double vision. Upon examination, you observe that his right eye does not follow your finger horizontally to the right visual field. Damage to which structure is the likely reason for this defect?

Torn right medial rectus

Right lateral rectus torn from origin on maxilla

Left sided CN VI palsy

Right sided CN VI palsy

RIght sided CN IV palsy

right eye can’t abduct=lateral rectus paralyzed which is innervated by CN VI (Abducens Nerve).

Explanation

right eye can’t abduct=lateral rectus paralyzed which is innervated by CN VI (Abducens Nerve).

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7. Nerve to Mylohyoid innervates Mylohyoid muscle and what other muscle?

Anterior belly of Digastric

Posterior belly of Digastric

Geniohyoid

Thyrohyoid

CN V.3 innervates anterior belly of digastrics and mylohyoid via nerve to Mylohyoid.

Explanation

CN V.3 innervates anterior belly of digastrics and mylohyoid via nerve to Mylohyoid.

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8. If a person is looking inward towards their nose and is unable to look down, which muscle may be injured?

Inferior oblique

Superior oblique

Inferior rectus

Superior rectus

Medial rectus

Lateral rectus

adducted depression isolates the action of the superior oblique.

Explanation

adducted depression isolates the action of the superior oblique.

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9. What embryological arch derivative is the Posterior belly of the Digastric muscle derived from?

III

that’s why it’s innervated by CN VII

Explanation

that’s why it’s innervated by CN VII

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10. The innervation of the Carotid body & the Carotid Sinus is?

C.N. VIII

C.N. IX

C.N. X

Mixed VIII & IX

Mixed IX & X

The carotid sinus is innervated by CN IX. The carotid body is innervated by branches from both CN IX and CN X. Think Body = Both

Explanation

The carotid sinus is innervated by CN IX. The carotid body is innervated by branches from both CN IX and CN X. Think Body = Both

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11. Which extra-ocular muscle(s) do(es) NOT originate from the Annulus tendineus?

Superior Oblique

Superior Rectus

Inferior Rectus

Inferior Oblique

C&D

A&D

B&C

Oblique muscles’ origin is on the wall of the orbit.

Explanation

Oblique muscles’ origin is on the wall of the orbit.

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12. During a battle for Ned dominance against Other-Ned, I lose because I'm not a fighter. Also, have you seen him? I don't stand a chance. In the process I suffer a blow out fracture to my orbit with subsequent loss of CN IV. In what direction will my pupil present?

Down and out

Down and in

Up and out

Up and in

Trochlear Nerve innervates superior oblique which normally depresses and abducts the eye. If this is lost, primary position will be up and slightly in (hyper-esotropia), so patients prefer to tilt their head down and away from the side of the palsied muscle to avoid diplopia (double vision).

Explanation

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13. A tumor suppressing the Trochlear nerve would result in the impairment of what eye movement?

In and up

Out

Out and down

In and down

Out and down (the Trochlear nerve (CN IV) innervates the Superior Oblique muscle which abducts and depresses the eye.)

Explanation

Out and down (the Trochlear nerve (CN IV) innervates the Superior Oblique muscle which abducts and depresses the eye.)

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14. A patient presents to the clinic with constricted pupils and no sweating on the same side of the face. You suspect they have Horner's syndrome. You would also expect to see which of the following on the same side of the face?

Dense ptosis, due to a functional loss of the Superior Tarsal muscle

Dense ptosis, due to a functional loss of the Levator Palpebrae muscle

Fine ptosis, due to a functional loss of the Superior Tarsal muscle

Fine ptosis, due to a functional loss of the Levator Palpebrae muscle

Horner's is a loss of Sympathetic innervation to the head. The 2 eye muscles innervated by the SNS are the dilator pupilae muscle and the superior tarsal muscle. The functions of both of these muscles are lost in Horner's so the pupil is constricted and the eyelid droops but only slightly. You would only see dense, or complete, ptosis if Levator Palpebrae (innervated by CN3) is damaged.

Explanation

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15. A strong, healthy, attractive man walks into a female doctor's office. He describes a pain he has been feeling the last few days in his right neck. The doctor puts him in the chair and begins to study all the muscles of the neck taking note of the strength and firmness. His strap muscles are weak on the right side, but that he has no deficits in mouth or tongue muscles. No lymph nodes are swollen on palpation and there is no visible goiter. She tells him it is probably just a pinched nerve and that he works out too much. The most likely nerve that she is describing is the –

Nerve that runs inside the carotid sheath carrying Branchial Efferent fibers to the muscles of the muscular triangle

Nerve that loops around the internal jugular vein

Nerve that runs with the lingual artery superior to the hyoid bone

Nerve that leaves between the anterior and middle scalene muscles

Nerve being described is Ansa Cervicalis which innervates most infrahyoid muscles.

Explanation

Nerve being described is Ansa Cervicalis which innervates most infrahyoid muscles.

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16. While running a red light at a busy intersection, Mr. Batman was involved in a car vs. car Motor Vehicle Accident (MVA). The other vehicle involved hit the driverside flank of the batmobile. Gotham City EMS arrived on scene to find a somewhat intoxicated Mr. Batman with no injuries. However, the passenger (Robin) was found unconscious in the passenger's seat with his face on the dash. Robin regained consciousness while being extracted from the batmobile. A head CT was performed on Robin 3 hrs. post-MVA and was found to be unremarkable. Approximately 72 hrs. later Robin lost consciousness again. Below is the image from Robin's 2nd head CT:

What type of hematoma does the CT display and can the hematoma cross to the opposite brain hemisphere?

Sub Arachnoid; Yes

Epidural; Yes

Epidural; No

Subdural; Yes

Subdural; No

The image is of the typical crescent or concave spreading pattern seen in head CT's of subdural hematomas. Subdural hematomas can not cross to the opposite brain hemisphere due to the dividing barrier called the falx cerebri. The clinical presentation includes a biphasic episodic loss of consciousness (LOC). The reason for this is that the initial traumatic event causes the first LOC, and the second LOC is due to brain compression and displacement. The second LOC can occur up to 72 hrs. later because the torn bridging veins involved in this hematoma bleed at a slow but continuous rate, as appose to an arterial bleed which is fast and spurting in nature.

Explanation

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17. A 3 year-old male presents to the pediatrician with fever, dysphagia (trouble swallowing), stiff neck, odynophagia (pain on swallowing), and stridor (inspiratory wheeze). History reveals an upper respiratory infection which gradually worsened. Visual examination of the oropharynx was not performed for fear of occluding the airway, but tender cervical lymphadenopathy was discovered. A CBC, blood culture, and a contrast-enhanced CT scan were performed. The CBC revealed leukocytosis with PMN predominance. The CT image below confirms a retropharyngeal abcess (A&B), so the patient is started on empirical antibiotics and scheduled for surgical drainage.

What forms the lateral border of the retropharyngeal space in the cervical region?

Alar Fascia

Pretracheal fascia

Prevertebral fascia

Carotid Sheath

Visceral pleura

Carotid sheath is formed by all 3 layers of deep cervical fascia and serves as the lateral border of the retropharyngeal space in the cervical region. This clinical vignette was based on “Retropharyngeal infections in children” in UptoDate.

Explanation

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18. A younger man of 27 years comes to the clinic complaining of loss of movement of facial muscles on the left side of his face. After a quick physical exam you determine that the patient has a compression to a nerve where it is exiting the stylomastoid foramen, causing an appearance of sagging features on the left face. After your epidemiology class, you remember that because the patient is younger, this is will most likely be a transient event that should clear up in a few weeks. However you caution the patient that-

His left eye will be dry and irritated due to loss of the greater petrosal nerve sending parasympathetic innervation to the lacrimal gland

The gland in the triangle bordered by the anterior and posterior bellies of the digastric and the mandible will not be functioning properly due to loss of parasympathetic innervation from the chorda tympani

He will have difficulty rotating his head to the right and tilting his head to the left

His left eye will become dry and irritated due to the loss of function of orbicularis oculi and that it could help if he taped his eyelid shut while sleeping

Opening the mouth will be difficult due to loss of innervation to the muscles comprising the left lateral border and floor of the submental triangle

D - is correct because it’s innervated by facial nerve. A is incorrect because Greater Petrosal Nerve is proximal to the compression. C is CN XI. E is CN V.3

Explanation

D - is correct because it’s innervated by facial nerve. A is incorrect because Greater Petrosal Nerve is proximal to the compression. C is CN XI. E is CN V.3

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19. The inferior thyroid vein drains into which of the following veins?

Internal Jugular Vein

External Jugular Vein

Brachiocephalic Vein

Subclavian Vein

Anterior Jugular Vein

The superior and middle thyroid veins drain into the internal jugular vein, and the inferior thyroid veins empty into the right and left brachiocephalic veins, respectively.

Explanation

The superior and middle thyroid veins drain into the internal jugular vein, and the inferior thyroid veins empty into the right and left brachiocephalic veins, respectively.

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