Pharynx, Larynx, Nasal & Oral Cavity

1. After getting into an emotional argument with her parents, Stacy runs up to her room, slams the door, puts her face in the pillow and starts crying. After 20 mins, she finally stops, her eyes are swollen and nose is stuffed. What caused her stuffy nose?

Lacrimal duct draining into the Inferior meatus

Frontal sinus draining into the inferior meatus

Maxillary sinus filling and irritating the maxillary nerve

Lacrimal duct draining into the semi lunar hiatus

Lacrimal duct is the only structure that drains into the inferior meatus and is the cause of a stuffy nose after increase secretes of the duct.

Explanation

Lacrimal duct is the only structure that drains into the inferior meatus and is the cause of a stuffy nose after increase secretes of the duct.

2. What nerve passes down the nasal septum to part of the mucosa of the hard palate and what foramen does it pass to get there?

Sphenopalatine n. , sphenopalatine fossa

Anterior ethmoidal n., incisive foramen

Nasopalatine n., incisive foramen

Posterior ethmoidal n., sphenopalatine fossa

From the sphenopalatine fossa, down the nasal septum, through the incisive foramen, and to the mucosa covering the hard palate is the nasopalatine nerve (V2).

Explanation

From the sphenopalatine fossa, down the nasal septum, through the incisive foramen, and to the mucosa covering the hard palate is the nasopalatine nerve (V2).

3. Which of the following groups involving the paranasal sinuses are correctly paired together?

Frontal sinus drains out of the sphenoethmoidal recess

Frontal sinus drains out of the middle meatus

Nasolacrimal duct drains out of the superior meatus

Nasolacrimal duct drains out of the semilunar hiatus

Maxillary sinus drains out of the inferior meatus

Maxillary sinus drains out of the superior meatus

The frontal sinus drains via the frontonasal duct through the semilunar hiatus, which is located in the middle meatus. Therefore answer A is made incorrect. The nasolacrimal duct drains in the inferior meatus, therefore answers C and D are incorrect. The maxillary sinus drains in the posterior part of the semilunar hiatus, which is part of the middle meatus. Therefore, answer E and F are in incorrect.

Explanation

The frontal sinus drains via the frontonasal duct through the semilunar hiatus, which is located in the middle meatus. Therefore answer A is made incorrect. The nasolacrimal duct drains in the inferior meatus, therefore answers C and D are incorrect. The maxillary sinus drains in the posterior part of the semilunar hiatus, which is part of the middle meatus. Therefore, answer E and F are in incorrect.

4. The inferior meatus is involved in drainage of which of the following structures?

Anterior ethmoid air cells

Frontal sinus

Posterior ethmoid air cells

Nasolacrimal duct

Maxillary sinus

The nasolacrimal duct is the only structure that drains into the inferior meatus. The maxillary sinus, frontal sinus, middle and anterior ethmoid air cells drain into the middle meatus which also contains the semilunar hiatus. The posterior ethmoid air cells drain into the superior meatus.

Explanation

The nasolacrimal duct is the only structure that drains into the inferior meatus. The maxillary sinus, frontal sinus, middle and anterior ethmoid air cells drain into the middle meatus which also contains the semilunar hiatus. The posterior ethmoid air cells drain into the superior meatus.

5. You decide to quit Med school and become a dentist. In your first operation, you are removing the upper, back molars, which have abscesses, from a chronic alcoholic's maxilla. He subsequently complains of "throbbing" headache, nuchal rigidity and dies a week later. Which of the following was he most likely to have at the time of his death?

Bell's Palsy

Blindness

Cavernous Thrombophlebitis

V3 irritation

he has an infection from his tooth abscess with spread to his maxillary sinus, this is a common cause of infectious spread to the meningitis. He would less likely to suffer from the neuro deficits as this is a bacterial infection.

Explanation

he has an infection from his tooth abscess with spread to his maxillary sinus, this is a common cause of infectious spread to the meningitis. He would less likely to suffer from the neuro deficits as this is a bacterial infection.

6. Entry of bacteria through which space could lead to an infection in the mastoid air cells?

Auditory (nasopharyngeal) tube

External acoustic meatus

Internal acoustic meatus

Sacculus

Cochlea

The auditory (nasopharyngeal) tube is a connection between the nasal portion of the pharynx and the tympanic cavity that allows pressure to equalize on either side of the tympanic membrane. It is located in the anterior wall of the middle ear and is comprised of bone at the tympanic end and cartilage on the pharyngeal end. The pharyngeal mucosa is continuous with the lining of the tympanic cavity and mastoid air cells. This allows infectious material to pass to the middle ear and mastoid area.

Explanation

The auditory (nasopharyngeal) tube is a connection between the nasal portion of the pharynx and the tympanic cavity that allows pressure to equalize on either side of the tympanic membrane. It is located in the anterior wall of the middle ear and is comprised of bone at the tympanic end and cartilage on the pharyngeal end. The pharyngeal mucosa is continuous with the lining of the tympanic cavity and mastoid air cells. This allows infectious material to pass to the middle ear and mastoid area.

7. A 7 year old male undergoes routine tonsillectomy. During the procedure, the surgeon ligates a pulsatile-bleeding vessel damaged during excision of the tonsils. What is the origin of this vessel?

Internal Carotid A

External Carotid A.

Thyrocervical Trunk

Internal Jugular V.

The most common artery (pulsatile bleeding) damaged during tonsillectomy is the Tonsillar Branch of the Facial A. The Facial Artery originates off of the external carotid A.

Explanation

The most common artery (pulsatile bleeding) damaged during tonsillectomy is the Tonsillar Branch of the Facial A. The Facial Artery originates off of the external carotid A.

8. A 25-year-old male presents to the emergency room with severe facial injuries after hitting his car against a brick wall. The physician, upon seeing the patient, berates the paramedics for placing a nasopharyngeal airway. Which of the following signs or symptoms was particularly upsetting to the physician in this case?

Broken teeth in the mouth‬

Upper extremity paralysis‬‬‬‬‬‬

Altered level of consciousness‬‬‬‬‬‬

CSF dripping from the nose‬‬‬‬‬‬

Lacerations over the temporal bone‬‬

CSF rhinorrhea is a sign of an anterior cranial fossa fracture, which is an absolute contraindication for nasopharyngeal airways (forcing the tube inside the nose may cause its path to deviate into the brain, since the bony barrier between the nasal cavity and the anterior cranial fossa is broken). In these cases, alternate methods of airway preservation are indicated. The remainder of these signs and symptoms are not conclusive for a fracture of the anterior cranial fossa.‬

Explanation

CSF rhinorrhea is a sign of an anterior cranial fossa fracture, which is an absolute contraindication for nasopharyngeal airways (forcing the tube inside the nose may cause its path to deviate into the brain, since the bony barrier between the nasal cavity and the anterior cranial fossa is broken). In these cases, alternate methods of airway preservation are indicated. The remainder of these signs and symptoms are not conclusive for a fracture of the anterior cranial fossa.‬

9. A 29 year old male who recently sampled some of the local beef chili while at the county fair has been complaining of decreased saliva production, difficulty talking, droopy eyelids and difficulty swallowing. He went to the emergency room and they confirmed he has been subjected to botulinum toxin. Which of the following nerves if rendered ineffective due to the botulinum toxin would cause the patient to have difficulty swallowing?

Hypoglossal neve (CN XII)

Glossopharyngeal (IX)

Stylopharyngeal nerve

Vagus nerve (CN X)

Lesser palatine nerve

The vagus nerve (CN X) is responsible for innervating the levator veli palatini and palatopharyngeus. These muscles close the nasopharyngeal isthmus to aid in swallowing.

Explanation

The vagus nerve (CN X) is responsible for innervating the levator veli palatini and palatopharyngeus. These muscles close the nasopharyngeal isthmus to aid in swallowing.

10. What is the normal course of the Sphenopalatine artery?

External carotid → Maxillary a. → Greater Palatine a. → Sphenopalatine a. ‬

External carotid → Facial a. → Greater Palatine a. → Sphenopalatine aa‬‬‬‬‬‬

External carotid → Maxillary a. → Sphenopalatine a. ‬‬‬‬‬‬

External carotid → Facial a. → Sphenopalatine a.‬‬

The correct answer is "External carotid → Maxillary a. → Sphenopalatine a." This is the normal course of the Sphenopalatine artery. The Sphenopalatine artery is a branch of the Maxillary artery, which in turn is a branch of the External carotid artery. Therefore, the correct sequence is External carotid → Maxillary a. → Sphenopalatine a.

Explanation

The correct answer is "External carotid → Maxillary a. → Sphenopalatine a." This is the normal course of the Sphenopalatine artery. The Sphenopalatine artery is a branch of the Maxillary artery, which in turn is a branch of the External carotid artery. Therefore, the correct sequence is External carotid → Maxillary a. → Sphenopalatine a.

11. The Vagus Nerve (CN X) innervates which of the following sets of muscles:

Levator veli palatini, Stylopharyngeus, and Palatopharyngeus

Stylopharyngeus, Palatopharyngeus, and Salpingopharyngeus

Tensor Veli palatini, Palatopharyngeus, and Salpingopharyngeus

Levator veli palatini, Palatopharyngeus, and Salpingopharyngeus

Tensor veli palatini, Stylopharyngeus, and Levator veli palatini

The vagus nerve innervates palatopharyngeus, salpingopharyngeus, levator veli palatini, as well as the pharyngeal constrictors. Stylopharyngeus is innervated by the glossopharyngeal nerve (CN IX). Tensor veli palatini is innervated by the mandibular division of trigeminal nerve (CN V3).

Explanation

The vagus nerve innervates palatopharyngeus, salpingopharyngeus, levator veli palatini, as well as the pharyngeal constrictors. Stylopharyngeus is innervated by the glossopharyngeal nerve (CN IX). Tensor veli palatini is innervated by the mandibular division of trigeminal nerve (CN V3).

12. There are several sinuses that drain into the middle meatus of the nasal cavity. Select all that apply:

Frontal sinus

Nasolacrimal duct

Anterior ethmoidal air cells

Posterior ethmoidal air cells

Middle ethmoidal air cells

Maxillary sinus

Answers are: A, C, E, F: A way to remember what drains into the middle meatus is “AM/FM”. This stands for Anterior and Middle ethmoidal air cells, and Frontal and Maxillary sinuses. As far as we are concerned, these drain into the middle meatus of the nasal cavity via the semilunar hiatus.

Explanation

Answers are: A, C, E, F: A way to remember what drains into the middle meatus is “AM/FM”. This stands for Anterior and Middle ethmoidal air cells, and Frontal and Maxillary sinuses. As far as we are concerned, these drain into the middle meatus of the nasal cavity via the semilunar hiatus.

13. A patient complains of a dry nose and dry eyes. Which ganglion could be damaged to produce these symptoms?

Otic ganglion‬‬‬‬‬‬

Ciliary ganglion

Stellate ganglion‬‬‬‬‬‬

Pterygopalatine ganglion‬‬‬‬‬‬

Submandibular ganglion‬‬‬‬‬‬

Superior cervical ganglion‬‬‬‬‬‬

Post-ganglionic parasympathetic fibers innervating the lacrimal glands arise from the pterygopalatine ganglion (PGP). Remember: CN VII → PGP ganglion → V2 → V1 → lacrimal gland. Pre-ganglionic parasympathetic fibers of the facial nerve synapse in the PGP ganglion and go on to innervate the nasal mucosal glands also. Lastly, also from the facial nerve and synapsing in the PGP ganglion are fibers that innervate the palatine salivary glands.‬‬‬‬

Explanation

Post-ganglionic parasympathetic fibers innervating the lacrimal glands arise from the pterygopalatine ganglion (PGP). Remember: CN VII → PGP ganglion → V2 → V1 → lacrimal gland. Pre-ganglionic parasympathetic fibers of the facial nerve synapse in the PGP ganglion and go on to innervate the nasal mucosal glands also. Lastly, also from the facial nerve and synapsing in the PGP ganglion are fibers that innervate the palatine salivary glands.‬‬‬‬

14. While examining your teeth, your dentist accidentally pokes your upper palate right behind your incisors. The pain from this poke is carried by which nerve?

Greater palatine nerve - a branch of Maxillary Nerve (V2)

Lesser palatine nerve - a branch of Maxillary Nerve (V2)

Nasopalatine nerve - a branch of Maxillary Nerve (V2)

Nerve of Pterygoid Canal - branch of Maxillary Nerve (V2)

The naspalatine nerve innervates the upper palate behind the incisors. The greater palatine nerve supplies the rest of the hard palate. The lesser palatine innervates the soft palate.

Explanation

The naspalatine nerve innervates the upper palate behind the incisors. The greater palatine nerve supplies the rest of the hard palate. The lesser palatine innervates the soft palate.

15. X-ray of a patient complaining of a headache shows an air-fluid level in the frontal sinus. Which of the following is most likely to cause this?

Obstructed Bulla

Obstructed Superior Meatus

Obstructed Nasolacrimal Duct

Obstructed Infundiblium

frontal sinus drains into the semilunar meatus, which is in the middle meatus via the infundibulum. The other answers drain other sinuses.

Explanation

frontal sinus drains into the semilunar meatus, which is in the middle meatus via the infundibulum. The other answers drain other sinuses.

16. You have just boarded your plane back "home" after a long and stressful medical school semester in Dominica. You have indulged most of the plane ride in much deserved sleep when you suddenly hear the screeching cries of a young infant on the plane. Soon after, you feel your ears "pop" as the captain begins his descent to your destination. Being a studious, caring, and passionate medical student that you are, you think back to your 2nd semester anatomy and tell the mother of the young infant to breast feed her baby to reduce his pain. The mother asks you why and you tell her simply that the sucking and swallowing actions of the baby with help reduce the pressure in the baby's ears which causes his pain. The muscle responsible for opening the eustachian tube and "equalizing" the pressure is innervated by?

V1

X

V2

IX

V3

The main muscle responsible for opening the eustachian tube and thus equalizing internal and external pressure against the tympanic membrane is the tensor veli palatini INNERVATED BY the MANDIBULAR branch of CNV (i.e., V3).

Explanation

The main muscle responsible for opening the eustachian tube and thus equalizing internal and external pressure against the tympanic membrane is the tensor veli palatini INNERVATED BY the MANDIBULAR branch of CNV (i.e., V3).

17. A patient presents with complaints of pain in his ears when flying, after a through history you discover that he has a rare connective tissue disorder in which collagen produced by his body loses it's natural rigidity and strength. Which of the following muscles is likely to account for his symptoms?

Tensor veli palatini

Levator veli palatini

Salpingopharyngus

Stylopharyngeus

The question indicates that this patient has a trouble with changes in altitude. The major muscle which allows for pressure equalization is salpingopharyngeus. Also, the collagen disorder is a hint that it's attached to the torus tubarius

Explanation

The question indicates that this patient has a trouble with changes in altitude. The major muscle which allows for pressure equalization is salpingopharyngeus. Also, the collagen disorder is a hint that it's attached to the torus tubarius