Block 5 Anatomy Wk 5 From Ta's W/Exp
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From your friendly anatomy ta's
- 1.
When a person burns the tip of his tongue drinking boiling hot coffee, the pain impulses will be carried to neurons located in the :
- A.
Geniculate Ganglion
- B.
Submandibular Ganglion
- C.
Trigeminal Ganglion
- D.
Pterygopalatine Ganglion
- E.
Inferior Glossopharyngeal Ganglion
Correct Answer
C. Trigeminal GanglionExplanation
pain and temperature of anterior 2/3 is V.3.Rate this question:
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- 2.
A 45 year-old female presents to the clinic with pain and swelling of the right face. After a thorough workup she is diagnosed with sialolithiasis. The stones are surgically removed by dilating the opening of Stensen’s Duct, which is located where?
- A.
Oral vestibule near 2nd maxillary premolar
- B.
Oral vestibule near 2nd mandibular molar
- C.
Oral cavity near 3rd maxillary molar
- D.
Oral vestibule near 2nd maxillary molar
Correct Answer
D. Oral vestibule near 2nd maxillary molarExplanation
Stensen’s (Parotid) duct opens in buccal mucosa near 2nd upper molar, Wharton’s (Submandibular) duct opens in caruncle of lingual frenulum, Sublingual ducts open along sublingual fold.Rate this question:
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- 3.
What part of the tongue directly drains lymph to the Inferior Deep Cervical Lymph Nodes?
- A.
Just the tip
- B.
Medial body
- C.
Lateral body
- D.
Base
Correct Answer
B. Medial bodyExplanation
tip-B/L submental LNs, Medial body-B/L Inferior Deep Cervical LNs, Lateral Body-I/L submandibular LNs, Base-B/L Superior Deep Cervical Lns.Rate this question:
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- 4.
After “accidently” stabbing Paul his throat swells and I need to place an emergency, invasive airway. Where am I going to cut him?
- A.
Superficial to the thyrohyoid membrane
- B.
Superficial to cricotracheal membrane
- C.
Superficial to hyoglossal membrane
- D.
Superficial to cricothyroid membrane
- E.
Superficial to the intratracheal membrane (between rings 2-3)
Correct Answer
D. Superficial to cricothyroid membraneExplanation
In order to place an emergency, invasive airway after accidentally stabbing Paul and causing his throat to swell, I would cut superficial to the cricothyroid membrane. This is the correct answer because the cricothyroid membrane is located between the cricoid cartilage and the thyroid cartilage in the larynx. By cutting superficial to this membrane, I would be able to access the airway and provide the necessary emergency intervention.Rate this question:
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- 5.
Which cranial nerves innervate the following three muscles: stylohyoid, styloglossus and stylopharyngeus, respectively?
- A.
VII, XII, IX
- B.
X, IX, VII
- C.
IX, X, VII
- D.
VII, IX, X
- E.
VIII, XII, IX
- F.
X, XII, VII
Correct Answer
A. VII, XII, IXExplanation
You learn about them separately, but they all have the same origin.Rate this question:
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- 6.
Teacher Collins Syndrome, among other deformities, results in hypoplasia of Meckel’s cartilage, which includes what ossicles?
- A.
Stapes
- B.
Malleus
- C.
Incus
- D.
A&B
- E.
B&C
- F.
A&C
- G.
All of the above
Correct Answer
E. B&CExplanation
1st pharyngeal arch. Note that stapes originates from 2nd arch hence stapedius muscle is innervated by CN VII.Rate this question:
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- 7.
During your Emergency Medicine rotation at Massachusetts General Hospital, a local Basic Life Support (BLS) rescue crew brings in a "code" (cardiac arrest patient). The patient is an obese 55 year old male with a history of HTN (hypertension) and angina pectoris (chest pain). The EMS crew is still aggressively working the patient via chest compressions and rescue breaths with a BVM (bag valve mask). As a observant student you note to your supervising Resident that the patient only has an OPA (oropharyngeal airway) adjunct inserted. Noticing your enthusiasm, your resident decides to assign you with the responsibility of removing the OPA and performing an intubation. You correctly take your mac blade and rest the tip of the blade between the root of the patient's tongue and the epiglottis. You then smoothly pass the ET (endotracheal) tube between the patient's vocal cords. During this procedure, what is the name of the groove in which you place your Mac blade?
- A.
Piriform Recess
- B.
Vestibule of the Larynx
- C.
Ventricle of the Larynx
- D.
Choana
- E.
Epiglottic Vallecula
Correct Answer
E. Epiglottic ValleculaExplanation
The space in which you insert a Mac blade is the Vallecula, more importantly for examination purposes is the relationship of this groove to the tongue and the epiglottis. Note however, if this procedure was done with a Miller blade, the tip of the blade would actually overlap the epiglottis and make its way toward the vestibule of the larynx. The ventricles of the larynx would be below the false vocal cords. The choana is the point of distinction between the oro- and naso-pharynx. The pirifom recess is the area were (highyield phrase) "a chicken bone will get stuck" during a swallow.
Sorry for the long winded question, but the intubation procedure is one that you will eventually need to know how to perform, so you’re best off understanding some of the anatomy behind it. Note: there are additional steps following the insertion of an ET tube. Read up on it and go save a life!Rate this question:
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- 8.
A 6 year-old male presents with fever and a productive cough. In order to cough, he raises intrathoracic pressure against a closed glottis and then uses which muscle to abduct the vocal cords when he forcibly expels sputum?
- A.
Transverse arytenoids
- B.
Lateral cricoarytenoid
- C.
Oblique arytenoids
- D.
Posterior cricoarytenoid
- E.
Cricothyroid
Correct Answer
D. Posterior cricoarytenoidExplanation
The posterior cricoarytenoid muscle is responsible for the abduction of the vocal cords. When the 6-year-old male forcibly expels sputum, he needs to open his vocal cords to allow the air to pass through the glottis. The posterior cricoarytenoid muscle contracts to pull the arytenoid cartilages away from the midline, resulting in the abduction of the vocal cords. This action allows for the forceful expulsion of sputum during coughing.Rate this question:
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- 9.
Paralysis of which of the following muscles will most likely cause breathing difficulties?
- A.
Palatoglossus
- B.
Styloglossus
- C.
Genioglossus
- D.
Hyoglossus
- E.
Stylopharyngeous
Correct Answer
C. GenioglossusExplanation
When you give a paralytic like Succinyl Choline, you better be ready to intubate. Genioglossus holds the tongue forward, so when the patient’s supine, the tongue can slide to the back of the throat and occlude the airway.Rate this question:
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- 10.
When preparing to remove a Submandibular duct cyst, what structures (rostral to caudal) should the surgeon expect to find?
- A.
Lingual Nerve, Lingual Artery, Glossopharyngeal Nerve
- B.
Lingual Artery, Lingual Nerve, Glossopharyngeal Nerve
- C.
Lingual Nerve, Lingual Artery, Hypoglossal Nerve
- D.
Lingual Artery, Lingual Nerve, Hypoglossal Nerve
- E.
Hyoglossus, Lingual Nerve, Hypoglossal Nerve
Correct Answer
C. Lingual Nerve, Lingual Artery, Hypoglossal NerveExplanation
Keep in mind, the Lingual Nerve and Hypoglossal Nerve start rostral and loop down to the area of the submandibular (Wharton’s) duct. Since the surgery is on Wharton’s Duct, that is the area in questionRate this question:
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- 11.
You are at the dentist because you cracked your canine tooth on the upper left side of your mouth. The dentist tells you he must anesthetize the tooth before working on it. In order for him to do this he must inject his needle close to the exit point of the appropriate nerve into your mouth. Which nerve needs to be injected and what is its exit point into the mouth/palate?
- A.
Greater palantine nerve, Greater palantine foramen
- B.
Nasopalantine nerve, incisive fossa
- C.
Lesser palantine nerve, lesser palantine foramen
- D.
Superior alveolar nerve, incisive fossa
Correct Answer
B. Nasopalantine nerve, incisive fossaExplanation
Nasopalatine nerve innervates the maxillary incisors and canines, whereas the greater and lesser palatine nerves innervate the hard and soft palate respectivelyRate this question:
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- 12.
During a neck surgery, you accidentally severed the nerve innervating the cricothyroid. Which nerve did you damage?
- A.
Vagal
- B.
Internal Laryngeal
- C.
External Laryngeal
- D.
Recurrent Laryngeal
- E.
Inferior Laryngeal
Correct Answer
C. External LaryngealExplanation
The cricothyroid muscle is innervated by the external laryngeal nerve. Therefore, if this nerve is accidentally severed during neck surgery, it would result in damage to the external laryngeal nerve.Rate this question:
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- 13.
From the question above, what blood vessel may have been at risk during this procedure?
- A.
External Jugular vein
- B.
Inferior Thyroid Artery
- C.
Middle Thyroid Vein
- D.
Superior Thyroid Artery
- E.
Inferior Thyroid Vein
Correct Answer
D. Superior Thyroid ArteryExplanation
it runs with the external branch of laryngeal nerve for a little ways.Rate this question:
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- 14.
Dock Ellis is famous among baseball and LSD fans alike. In 1970 he pitched a no-no while on acid. A feat that has never been repeated. During the game he had an illusion that home plate was the floor of the tympanic cavity. If his illusion was anatomically correct, what structure lies directly beneath home plate?
- A.
Mastoid air cells
- B.
Posterior cranial fossa
- C.
Sphenopalatine Foramen
- D.
Internal Jugular vein
Correct Answer
D. Internal Jugular veinExplanation
The floor is also called the jugular fossa for that reason. Please note that your TAs do not condone the use of illicit drugs.Rate this question:
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- 15.
Which nerve supplies General Somatic Afferent innervation to the tympanic cavity?
- A.
Trigeminal
- B.
Facial
- C.
Vagus
- D.
Vestibulocochlear
- E.
Glossopharyngeal
Correct Answer
E. GlossopharyngealExplanation
The correct answer is Glossopharyngeal. The glossopharyngeal nerve is responsible for providing general somatic afferent innervation to the tympanic cavity. This nerve carries sensory information from the middle ear to the brain, allowing us to perceive sounds and maintain balance. The trigeminal nerve supplies innervation to the face, the facial nerve controls facial muscles, the vagus nerve innervates various organs in the body, and the vestibulocochlear nerve is responsible for hearing and balance.Rate this question:
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- 16.
A patient with a lesion to the stapedius muscle will most likely present:
- A.
Deaf in the affected ear
- B.
Everything sounds like a whisper
- C.
The local radio show sounds like a rock concert
- D.
Constant ringing
Correct Answer
C. The local radio show sounds like a rock concertExplanation
hyperacusisRate this question:
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- 17.
While snacking on some potato chips, you accidentally lacerate the root of your tongue immediately left to the tongue's mid-line. The very same night you forget to brush your teeth. In the morning, you look into the mirror and notice some erythema on your tongue in the same location that you lacerated it. Where would this bacterial infection directly drain via the body's lymphatic system?
- A.
Virchow's Node
- B.
Left Inferior Deep Cervical Lymph Node
- C.
Right Inferior Deep Cervical Lymph Node
- D.
Left Superior Deep Cervical Lymph Node
- E.
Right Superior Deep Cervical Lymph Node
Correct Answer
E. Right Superior Deep Cervical Lymph NodeExplanation
The root of the tongue drains bilaterally to the Superior Deep Cervical Lymph Nodes, and according to MDA textbook, the medial portions of the tongue body and root drain contralaterally. Therefore your infection would progress from the left surface to the right LN. Virchow's Node is associated with abdominal drainage and specially Gastric Adenocarcinoma.Rate this question:
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- 18.
A 46 year old woman comes in to the health clinic with pain underneath the mandible. The doctor diagnoses an acute bacterial abscess in the submandibular gland and operates to take out the gland along with the duct. A few weeks later the woman notices decreased GSA fiber sensation. Where is this decreased sensation most likely to be present?
- A.
The skin overlying the lower mandible
- B.
The skin overlying the pre-auricular surface of the face
- C.
The anterior 2/3rds of the tongue
- D.
The temporal-mandibular joint
- E.
The posterior 1/3rd of the tongue
- F.
The lower chin
Correct Answer
C. The anterior 2/3rds of the tongueExplanation
lingual nerve is crossed by Wharton’s (submandibular) duct. At this point it’s carrying both GSA and SVA to anterior 2/3 of tongue. Keep in mind that Marginal Mandibular branch of CN VII, and hypoglossal nerve are also at risk, but don’t provide cutaneous sensation.Rate this question:
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- 19.
While doing your third thyroidectomy for the afternoon, you take special care in avoiding a variant blood vessel that is present in a small, but significant portion of the population. In doing so, where can you visualize this artery just before it enters the thyroid gland?
- A.
Trachea
- B.
Cricoid cartilage
- C.
Thyroid cartilage
- D.
Superior thyroid artery
- E.
Internal thyroid artery
Correct Answer
A. TracheaExplanation
Thyroid Ima artery in ~10% of population usually arises from brachiocephalic trunk and travels midline toward isthmus of thyroid glandRate this question:
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- 20.
A coin is lying perfectly horizontal in the larynx between the true and false vocal cords of your friend. You quickly grab your pocket knife and Bic pen that you have been using for your notes and begin to perform an emergency cricothyrotomy. The situation is:
- A.
The coin is lying in the ventricle, and the pen is inserting into the vestibule
- B.
The coin is lying in the pyriform recess and the pen is inserting into the vestibule
- C.
The coin is lying in the ventricle, and the pen is inserting into the infraglottic space
- D.
The coin is lying in the vestibule, and the pen is inserting into the infraglottic space
Correct Answer
C. The coin is lying in the ventricle, and the pen is inserting into the infraglottic spaceExplanation
The coin is in the ventricle and the pen is in the infraglottic space. Although rare that a coin would make its way into the ventricle past the vestibular folds, the question stem stated the location. Remember that the vocal ligament runs from the vocal processes on the arytenoid to the inside of the thyroid cartilage. This would mean that the cricothyroid ligament should allow insertion beneath the vocal fold- infraglottic space.Rate this question:
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- 21.
Your first semester friend runs in and says "I couldn't find the local anesthetic, what if we just cut the nerves that supply sensation to the area inside the larynx where the pen pokes through?" You reply:
- A.
Great idea, let me just go to the tracheoesophageal grooves and clip the recurrent laryngeal nerves.
- B.
Great idea, right behind the sternothyroid muscles I can clip the external laryngeal nerves before it pierces into the inferior pharyngeal constrictor.
- C.
Great idea, right where the superior laryngeal arteries pierce into the thyrohyoid membrane, the nerves that pierce with it I could just clip.
- D.
Terrible idea, clipping the nerves that supply that area would cause the patient’s vocal cords to adduct and it would worsen the situation - stupid first semester
Correct Answer
D. Terrible idea, clipping the nerves that supply that area would cause the patient’s vocal cords to adduct and it would worsen the situation - stupid first semesterExplanation
Although the locations and relationships stated for each of the other nerves is correct, none of these supply sensation to beneath the vocal ligament other than the recurrent laryngeal nerves. You already realized that clipping these would not allow for your friend to abduct his vocal cords using the posterior crico-arytenoids.Rate this question:
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- 22.
You have noticed a decrease in the amount of saliva you produce from the Parotid gland after an ear infection that you left untreated. What nerve was most likely directly damaged?
- A.
Zygomatic
- B.
Lingual
- C.
Auriculotemporal
- D.
Vagus
- E.
Lesser Petrosal
Correct Answer
E. Lesser PetrosalExplanation
formed from tympanic plexusRate this question:
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- 23.
From the above question- what wall of the ear can you then conclude is damaged?
- A.
Anterior
- B.
Posterior
- C.
Medial
- D.
Lateral
- E.
Roof
Correct Answer
C. MedialExplanation
runs over the promontory of the medial wallRate this question:
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- 24.
Lesion to the external laryngeal nerve would lead to which of the following:
- A.
Increase in pitch of the voice, because the thyrohyoid muscle would lose its function
- B.
Increase in the amplitude of the voice, because the cricothyroid muscle would be paralyzed
- C.
Decrease in pitch of the voice, because the cricitothyroid muscle would be paralyzed
- D.
Decrease in amplitude of the voice, because the vocalis muscle would be paralyzed
- E.
Decrease in pitch of the voice, because the vocalis muscle would be paralyzed
Correct Answer
C. Decrease in pitch of the voice, because the cricitothyroid muscle would be paralyzedExplanation
All the intrinsic muscles of the larynx are innervated by the recurrent branch of the laryngeal nerve (from CN X) except for cricothyroid which is innervated by the external laryngeal nerve, a branch off of the superior laryngeal nerve (also from CN X). The function of the cricothryoid is to tense the vocal cords, thus elevating the pitch of the voice, so if its nerve supply is compromised, the patient will present with a decreased pitch of their voice. The muscle whose function it is to lower the pitch of the voice is the vocalis muscle.Rate this question:
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