1.
A patient comes to you complaining of not being able to eat. On exam, you notice that she is having difficulty protracting her jaw. What muscle is most likely affected?
Correct Answer
B. Lateral pterygoid
Explanation
the fibers are nearly horizontal, so when they contract they pull the head of the mandible anteriorly
2.
The chorda tympani nerve contains which of the following fibers?
Correct Answer
D. Preganglionic parasympathetic
Explanation
remember SSA is Audio-visual, and SVA is olfaction and gestation.
3.
During a pathology rotation the attending physician points to a nerve as it crosses behind the body of the mandible and asks your class, "what nerve modalities are running in this part of the lingual nerve?" You confidently respond:
Correct Answer
C. SVA, GVE and GSA
Explanation
picks up GVE and SVA fibers from chorda tympani.
4.
Damage to the lingual nerve right before it is joined by the chorda tympani nerve would result in a loss of which of the following:
Correct Answer
E. Loss of somatic sensation to the anterior 2/3 of the tongue
Explanation
The lingual nerve itself (branch of CN V.3) only carries somatic sensation (GSA) to the anterior 2/3 of the tongue. The Chorda Tympani nerve (branch of Cranial nerve VII) provides PSNS innervation (GVE) to the SM/SL glands, as well as taste (SVA) to the anterior 2/3 of the tongue. If the lingual nerve is damaged AFTER it is joined by chorda tympani, a loss of all 3 modalities will be seen.
5.
A lesion to the chorda tympani nerve would cause what clinical sign?
Correct Answer
D. Patient is unable to taste his favorite cake with anterior 2/3 of tongue
Explanation
also decreased salivation (SM and SL)
6.
A small lesion has damaged the vagus nerve proximal to its pharyngeal branches.
Which muscle would still be functional?
Correct Answer
B. StylopHaryngous
Explanation
Only muscle innervated by CN IX
7.
An elderly man comes to see you in your office about large quantities of ear wax that have built up in his ears. You decide to clean the wax out, and while you are dislodging the ear wax for him, he starts to tell you that he is feeling faint and dizzy. His symptoms are a result of:
Correct Answer
C. Stimulation to his external auditory canal eliciting a vagus response
Explanation
wax builds up in external auditory canal which is partially innervated by CN X. Inner side of tympanic membrane is innervated by CN IX.
8.
Patient comes to your office complaining of inability to extend at the wrist, you suspect compressed brachial plexus. Which of the following could cause his symptoms?
Correct Answer
E. Pancoast tumor
Explanation
growing mass in apex of lung can cause various brachial plexopathies
9.
One of many potential symptoms of Bell's Palsy is hyperacousia. Which nerve and its associated muscle is damaged in hyperacousia?
Correct Answer
C. CN VII ; stapedius
Explanation
the lesion would have to be proximal to the nerve to stapedius. Tensor tympani is innervated by V.3.
10.
For his operation, Ned is given Ketamine as an adjunct to his general anesthesia. Adverse effects include post-operative delusions and vivid hallucinations. Currently, Ned believes he is a tiny person living inside a giant middle ear. If he looks out his bedroom window, which has a glorious view of the medial wall, what structures will he see (assuming Ned’s hallucinations are anatomically correct)?
Correct Answer
B. Oval window, round window, tympanic plexus
Explanation
The story is false, but the adverse effects of Ketamine are true. The labrynthine wall has prominences of lateral semicircular canal and facial canal, round and oval windows, and the tympanic plexus over the promontory.
11.
A 45-year-old woman is suffering from numbness just anterior to her left ear. Which of the following nerves is most likely to be damaged?
Correct Answer
C. Mandibular division of Trigeminal nerve
Explanation
auriculotemporal nerve from V.3 provides cutaneous sensation to this area.
12.
A young girl complains of dryness of the nose, palate, and eye. This would indicate a lesion to which of the following ganglia?
Correct Answer
C. Pterygopalatine ganglion
Explanation
post ganglionic fibers from PPG provide GVE to Lacrimal, Nasal mucosal, and Minor Palatine Salivary glands.
13.
To relieve Raynaud’s syndrome in your patient, where do you anesthetize?
Correct Answer
C. Stellate ganglion
Explanation
that’s one way to perform a sympathectomy. D would also cause Horner’s syndrome, which is bad.
14.
After having a few cervical lymph nodes biopsied, a patient has reduced ability to flex his head to the left or turn his head to the right. Which of the following structures was most likely damaged?
Correct Answer
A. CN XI
Explanation
SCM rotates head contralaterally and assists in ipsilateral lateral flexion (w/ scalenes)
15.
A patient is unable to taste a piece of sugar placed on the tip of the tongue. Which nerve is most likely to have a lesion?
Correct Answer
A. Facial nerve
Explanation
receives SVA from anterior 2/3 of tongue.
16.
Ned walks in to his 4th semester ICM practical exam to find that his standardized patient is Richard Kiel, the 7-foot actor who played Jaws in The Spy Who Loved Me and (possibly more notably) Mr. Larson in Happy Gilmore. Ned’s task is to examine the trigeminal and facial nerves. After washing his hands, greeting the patient, and inspecting the patient’s face, Ned asks Mr. Kiel to clench his jaws. This joke makes Ned giggle, but he’s able to palpate bilateral contractions of the appropriate muscles. Next, he instructs Mr. Kiel to open his mouth and move his mandible side to side. What muscle is Ned primarily testing with this last maneuver?
Correct Answer
B. Lateral Pterygoid
Explanation
The orientation of the lateral pterygoid muscle is nearly horizontal from the lateral side of the sphenoid bone to the medial side of the neck of the mandible. Contracting bilaterally the mandible protrudes, acting unilaterally and alternately the mandible moves side to side.
17.
A 35 year old extremely wealthy and successful Alto singer from California comes to your walk-in clinic claiming that she can no longer sing and appears to be very distraught. Recent PMH shows that she had a thyroglossal duct cyst surgically removed 2 weeks ago. You notice that the surgical incision was made below the level of the thyroid cartilage and was slightly lateral to the mid-line of the neck. Which nerve was most likely damaged during this patient's previous surgery that caused her chief complaint?
Correct Answer
E. External laryngeal nerve
Explanation
The external laryngeal nerve innervates the cricothyroid muscle. The cricothyroid muscle tenses the vocal cords, allowing for high pitch phonation which is essential for the Alto voice. Answer choice A is disputable, but considering that the patient is extremely wealthy, she would probably be less driven to malinger for a small personal gain (Also: Why would you pick a behavioral answer for an Anatomy Question? that's just silly).
18.
A 46-year-old man visits the speech therapist complaining of dryness of the mouth. The therapist performs a swallowing study and, on examination, finds that the man has a lack of salivary secretion from the submandibular gland. This indicates a lesion of which of the following nervous structures?
Correct Answer
B. Chorda tympani in the middle ear cavity
Explanation
carries preganglionic GVE to join with lingual nerve distal to its origin.
19.
Which of the following muscles retracts the mandible?
Correct Answer
A. A
Explanation
horizontal fibers of temporalis muscle retract the mandible.