Head, neck, and TMJ

D) External occipital protuberance

B) Only the first statement is true.

The internal table is thinner and more brittle than the external table.

False

The skull bones are covered on the outer and inner surfaces with periosteum.

A) Parietal

Parietal and temporal bones are paired cranial bones.

B) Ethmoid

• The facial bones consist of the following:
•  Nasal bones
•  Inferior conchae
•  Lacrimal bones
•  Palatine bones
•  Zygomatic bones
•  Vomer
•  Maxillae 
•  Mandible

C) Only the second statement is true.

The anterior cranial fossa is separated from the middle cranial fossa by the lesser wing of the sphenoid bone.

C) None of these

Ophthalmic artery is a branch of the internal carotid artery.

C) Superior ophthalmic artery

It should be superior ophthalmic vein. The superior orbital fissure also transmits the oculomotor, trochlear, and abducent nerves.

B) It is situated behind the lateral end of the superior orbital fissure.

It is situated behind the medial end of the superior orbital fissure.

C) It perforates the lesser wing of the sphenoid bone.

It perforates the greater wing of the sphenoid bone.

A) It transmits the anterior meningeal artery from the infratemporal fossa.

It transmits the middle meningeal artery from the infratemporal fossa.

A) Vertebral veins

It should be vertebral arteries.

D) Only the second statement is true.

The hypoglossal canal is situated above the anterolateral boundary of the foramen magnum.

B) Hypoglossal nerve

The jugular foramen transmits the 9th, 10th, and 11th cranial nerves.

True

D) Both statements are false.

The internal acoustic meatus pierces the posterior surface of the petrous part of the temporal bone. It transmits the vestibulocochlear nerve and the motor and sensory roots of the facial nerve.

B) Internal acoustic meatus

Internal acoustic meatus is found in the posterior cranial fossa.

D) Foramen lacerum: greater wing of sphenoid

Foramen ovale, foramen rotundum, and foramen spinosum are found in the greater wing of the sphenoid.

Foramen lacerum is found between the petrous part of the temporal and sphenoid.

B) Internal carotid artery

The ophthalmic artery passes through the optic canal.

The superior ophthalmic vein passes through the superior orbital fissure.

The middle meningeal artery passes through the foramen spinosum.

A) Jugular foramen

Jugular foramen is found between the petrous part of temporal and the condylar part of occipital.

D) Both of these

True

In the young child, the skull may be likened to a table-tennis ball in that a localized blow produces a depression without splintering. This common type of circumscribed lesion is referred to as a "pond" fracture.

D) Anterior

In fractures of the anterior cranial fossa, the cribriform plate of the ethmoid bone may be damaged. This usually results in tearing of the overlying meninges and underlying mucoperiosteum. The patient will have bleeding from the nose (epistaxis) and leakage of cerebrospinal fluid into the nose (cerebrospinal rhinorrhea).

False

Fractures involving the orbital plate of the frontal bone result in hemorrhage beneath the conjunctiva and into the orbital cavity, causing exophthalmos.

A) Middle

Fractures of the middle cranial fossa are common, because this is the weakest part of the base of the skull. Anatomically, this weakness is caused by the presence of numerous foramina and canals in this region.

B) Hypoglossal nerve

The strong bony walls of the hypoglossal canal usually protect the hypoglossal nerve from injury.

A) Only the second statement is true.

The developing bones of a child's face are more pliable than an adult's, and fractures may be incomplete or greenstick.

C) Nasal bones

Fractures of the nasal bones, because of the prominence of the nose, are the most common facial fractures.

C) The bones are immobile on each other, being connected by fibrous tissue or cartilage.

The bones are mobile on each other, being connected by fibrous tissue or cartilage.

True

Meanwhile, the bones of the base are ossified in cartilage.

B) It is triangular in shape.

It is diamond in shape.

C) It lies between the two parietal bones in front and two temporal bones behind.

It lies between the two parietal bones in front and the occipital bone behind.

B) The internal acoustic meatus is almost entirely cartilaginous.

The external acoustic meatus is almost entirely cartilaginous.

B) Both statements are true.

C) None of these

The cranial vault, or skull, is composed of several bones: one frontal, two sphenoid, two parietal, two temporal, and one occipital.

D) Occipital

Cranial vault is also known as the skull.

D) Temporal

Skull is also known as the cranial vault.

C) 5

True

The facial bones develop more slowly than the cranial bones, reaching only 60% of their ultimate size by age 6.

A) Zygomatic bone

C) Retina

Conjunctiva is a transparent membrane covering the cornea, iris, pupil, lens, and sclera.

C) Conjunctiva

The conjunctiva is a thin membrane covering the majority of the anterior surface of the eye.

A) Sclera

A) It permits transmission of light through the pupil to the retina.

It permits transmission of light through the lens to the retina.

C) Only the second statement is true.

The iris is a circular, contractile muscular disc that controls the amount of light entering the eye.

B) Only the second statement is true.

The lens if a crystalline structure located immediately behind the iris that permits images from varied distances to be focused on the retina.

D) Retina

The retina is the primary sensory structure of the eye that transforms light impulses into electrical impulses that are then transmitted by the optic nerve to the brain, which interprets the impulses as the objects seen.

D) All of these

C) None of these

The cartilage of the nasal, frontal, ethmoid, and sphenoid bones form the roof of the nose.

B) Ethmoid bone

The cribriform plate of the ethmoid bone contains the sensory fibers of the olfactory nerve.

A) Inferior oblique

Inferior oblique is innervated by oculomotor nerve.

B) Superior oblique

Superior oblique is innervated by trochlear nerve.

A) Inferior rectus

Inferior rectus is innervated by oculomotor nerve.

D) No or momentary confusion

It should be slight confusion. No or momentary confusion is a characteristic of grade 1.

C) Grade 4

There is no grade 6 in Torg classification.

D) Grade 1

There is no grade 0 in Torg classification of concussion. Grade 2 has posttraumatic amnesia lasting less than 30 minutes.

A) Blurred vision

D) It is not self-limiting.

Post-concussion syndrome is self-limiting.

A) Elevated concussion threshold

It should be lowered concussion threshold.

C) IV

D) V

There is no grade VI concussion.

D) Subdural hemorrhage

It should be subarachnoid hemorrhage.

B) None of these

Migraine (definite pattern of irregular interval) and inadequate ventilation can also cause chronic, recurrent headache.

A) Aneurysm

It should be ruptured aneurysm.

C) Both of these

C) None of these

D) Trigeminal neuralgia

It should be occipital neuralgia. Trigeminal neuralgia manifests in the face.

C) Occipital neuralgia

It should be auriculotemporal neuralgia. Occipital neuralgia manifests in the occipital region.

C) None of these

Tumor also causes headache in the parietal region.

C) Hypotension

It should be hypertension.

B) Sinusitis

Sinusitis is usually worst in the morning.

D) Sleeping position

Headache brought about by sleeping position is usually worst in the morning.

B) Sinusitis

B) Migraine

C) Trigeminal

D) All of these

"Raccoon eyes" takes several hours to develop.

D) Sagging of the upper eyelid

It should be sagging of the lower eyelid. Sagging of the upper eyelid is associated with injury to the oculomotor nerve.

B) None of these

D) Both of these

C) Hyperesthesia

It should be hypoesthesia or anesthesia on the cheek, side of nose, upper lip, and teeth on the injured side.

C) Subdural hemorrhage from tearing of bridging veins between the brain and carotid sinus

It should be subdural hemorrhage from tearing of bridging veins between the brain and cavernous sinus.

C) Tachycardia

It should be bradycardia, which primarily occurs after a lucid interval.

D) Weakness on the same side of the body

It should be weakness on the side of the body opposite than on which the lesion has occurred.

B) With a Le Fort III fracture, the middle third of the face separates from the lower third of the face.

With a Le Fort III fracture, the middle third of the face separates from the upper third of the face. This is often called a craniofacial separation.

D) Orbicularis oris

C) Both of these

C) Both of these

The palpebral part of the orbicularis oculi closes the eye gently, whereas the orbital part closes the eye forcefully.

D) Both of these

C) Zygomaticus minor

It should be zygomaticus major.

B) Orbicularis oris

C) Rotation or hinge movement occurs in the upper cavity of the joint, whereas gliding, translation, or sliding movement occurs in the lower cavity.

Gliding, translation, or sliding movement occurs in the upper cavity of the joint, whereas rotation or hinge movement occurs in the lower cavity.

D) Centric occlusion

Centric occlusion is the relation of the jaw and teeth when there is maximum contact of the teeth.

A) Medial occlusal position

B) Mouth slightly open, lips together, teeth not in contact

C) Hyoid

The hyoid bone, found in the anterior throat region, is sometimes referred to as the skeleton of the tongue. It serves as an attachment for the extrinsic tongue muscles and infrahyoid muscles.

D) Mandibular nerve

The temporomandibular joints are innervated by branches of the auriculotemporal and masseteric branches of the mandibular nerve.

False

The articular disc found in the temporomandibular joint is innervated along its periphery but is aneural and avascular in its intermediate (force-bearing) zone.

C) Temporomandibular ligament

Temporomandibular ligament is also known as the lateral ligament.

D) Lateral ligament

Lateral ligament is also known as the temporomandibular ligament.

D) All except temporomandibular ligament

C) Stylomandibular ligament

A) Up and forward

During extension of the neck, the mandible moves down and backward.

True

In addition, both temporomandibular joints are bilaterally rotating and translating equally.

A) Most of the clicking sensations occur during the first phase.

The second phase of mouth opening begins when the tongue loses contact with the roof of the mouth. Most of the clicking sensations occur during this phase.

True

If the deviation occurs to the right on opening, it is called a reverse C-type curve.

False

With C-type and reverse C-type curves, hypomobility is evident toward the side of deviation. This hypomobility is either caused by a displaced disc without reduction or unilateral muscle hypomobility.

A) Muscle imbalance

S-type or reverse S-type curves are usually caused by muscle imbalance or medial displacement as the condyle "walks around" the disc on the affected side.

C) Both statements are false.

Early deviation on mouth opening is usually caused by muscle spasm. Meanwhile, late deviation on mouth opening is usually caused by capsulitis or a tight capsule.

C) 35 to 55 mm

Normally, only about 25 to 35 mm of opening is needed for everyday activity.

B) 30

False

f the clicking upon mouth opening is eliminated with protrusion and accentuated with retrusion, it is likely the problem is an anterior disc displacement with reduction. Anterior disc displacement without reduction cannot be determined as confidently.

A) 7

B) 3 to 4 mm

B) 10 to 15 mm

Lateral deviation is also known as excursion.

D) Forward, down, and toward the motion side

Excursion is also known as lateral deviation.

True

For example, the left condyle on left lateral deviation or excursion, remains relatively stationary and becomes more prominent.

B) Tissue stretch

C) Stylohyoid

It should be mylohyoid. Depression of the mandible is synonymous with opening of the mouth.

B) Lateral pterygoid

Occlusion is synonymous with opening of the mouth and elevation of the mandible.

C) Temporalis (posterior fibers)

It should be temporalis (anterior fibers).

C) Lateral pterygoid

C) External pterygoid

D) None of these

D)  Contralateral external pterygoid

• During lateral deviation of the mandible towards, the following muscles are active:
•   1. Lateral (external) pterygoid (ipsilateral)
•   2. Medial (internal) pterygoid (contralateral)
•   3. Temporalis*
•   4. Masseter*

C) Mandibular (CN V)

D) Facial (CN VII)

The anterior belly of digastric is innervated by inferior alveolar (CN V), whereas the posterior belly of digastric is innervated by facial (CN VII).

C) Hypoglossal (CN XII)

C) Mandibular (CN V)

The anterior and posterior fibers of the temporalis are both supplied by mandibular (CN V).

D) Cheek, mandible to forehead or ear

C) Lateral cervical spine to posterolateral skull

B) None of these

It should be posterior mandible to temporomandibular joint.

B) Stage 2

D) Stage 3

There is no stage 5 in temporomandibular disc dysfunction.

A) Stage 4

Stage 1 may have mild or no pain.

C) Stage 4

C) Both of these

A) Extension, ipsilateral rotation, and contralateral side bending

C) None of these

It should be posterior border of SCM.

D) 18 months

The anterior fontanelle closes between 18 and 24 months, whereas the posterior fontanelle closes between 9 and 12 months.

C) Lambda

Once the posterior fontanelle closes, it will become the lambda.

D) Levator anguli oris

The levator anguli oris elevates the angle of the mouth.

B) Palatoglossus

Palatoglossus muscle is innervated by CN X via the stylopharyngeus plexus.

B) Right rotation and left translation

Remember: "IpsiROT ContraTRANS". Mandibular excursion is also known as lateral deviation.

A) None of these

It should be nasion. Basion refers to the anterior margin of the foramen magnum.

C) Neither

Cervical flexion is a bilateral action of the sternocleidomastoid and scalenes.

A) C4

C) Stylohyoid ligament

C) None of these

It should be 18 mm.

C) Posterior fibers of temporalis

Anterior and superior fibers of temporalis are responsible for mandibular protrusion.

D) Teardrop fracture

B) Lamina

D) Jefferson fracture

D) Pterion

C) Middle meningeal artery

B) 35-55 mm

Mandibular depression is also known as mouth opening.

C) Posterior belly of digastrics

B) Both

Both of these muscles are opposing mandibular excursion towards the left.

A) Neither

With weakness of left mandibular excursion, the right medial pterygoid and the left lateral pterygoid should be strengthened.

C) Bilateral anterior rotation followed by bilateral anterior translation

At the first 26 mm of mouth opening, bilateral anterior rotation occurs. Afterwards, bilateral anterior translation occurs.

B) Procerus

Procerus is also the muscle for disgust.

C) Corrugator supercilii

D) Skin

B) Periosteum

Periosteum, also known as pericranium, is the innermost layer of the scalp.

C) Squamosal suture

D) TMJ displacement

D) Anterior

A) Right lateral flexion and left rotation

D) 4 mm

The normal amount of mandibular retrusion is 3-4 mm.

C) Hyoid bone

D) Vomer

Vomer and mandible are unpaired facial bones.

C) Orbicularis oculi

Orbicularis oris is responsible for eye closing.

D) Posterior border of SCM

A) Presence of swelling

There is no swelling in TMJ capsulitis.

C) Sternothyroid

Omohyoid, sternohyoid, and sternothyroid are innervated by ansa cervicalis.

A) TMJ disc displacement

B) Anterior belly of digastrics

Anterior belly of digastrics is innervated by CN V.

A) Bilateral posterior translation followed by bilateral posterior rotation

D) Medial rectus

Inferior oblique, medial rectus, and superior oblique muscles move the eyeball medially.

D) Transverse ligament

Transverse ligament is also commonly subluxed in Down syndrome, leading to atlanto-axial instability.

D) None of these

A) Galea aponeurotics

D) When the mouth is closed, the convex condyle rides forward onto the articular eminence.

When the mouth is opened, the convex condyle rides forward onto the articular eminence.

D) Loose areolar tissue

D) CN IV

CN IV innervates the superior oblique, which moves the eyeballs downward and inward.

C) None of these

This patient most likely has TMJ hypermobility.

D) Orbicularis oris

Orbicularis oris is a facial muscle, which compresses the lips together.

C) Right sternocleidomastoid

C) Right scalenes

D) Hyoglossus

Palatoglossus is for tongue elevation; genioglossus is for tongue protrusion; and styloglossus is for tongue retraction.

C) II and V

D) Lesser occipital nerve

A) Greater occipital nerve

C) Platysma

A) Right TMJ; inferior glide manipulation

In the photo, the chin has deviated to the right at terminal mouth opening. The AROM will be limited with ipsilateral opening and a lateral deviation to the side of restriction for patients with a TMJ capsular pattern of restriction. Superior glide manipulation would compress the joint, not affording a stretch to the tight capsule.

B) Absence of clicking and mouth opening limited to 26 to 30 mm; lateral movements limited to contralateral side; deflection to same side with protrusion

For example, the right TMJ is locked. Anterior translation occurs after the first 26 mm; therefore, opening will be restricted to 26 mm and deflection will occur to the right  (same side). Lateral movement towards the left (opposite side) will be restricted because the right TMJ cannot translate. Protrusion will deflect to the right side (same side) and be restricted.

A) Opening to 38 mm

38 mm is a reasonable opening range for function.

D) Exercises that avoid painful click such as hinge axis and midline opening

Add stabilization exercises within the click-free range. These patients may need anterior stabilization splinting if painful clicking and catching persists.

C) Anterior disc displacement without reduction

A locked joint will not unlock by using a splint.

B) With or without surgery, the joint will adapt and have functional opening with little or no pain.

Arthroscopy has not been found to be better than physical therapy in the treatment of reduced jaw ROM and pain due to intra-articular disease.

B) Aggressive PT to manipulate the joint to unlock in 3 to 4 visits

To alleviate a close locked disorder, aggressive PT may mobilize the joint to unlock in 3 or 4 visits. The disc may not have permanent deformation changes or adhesions form, if the patient is young and the mobilization is done early. If unsuccessful, additional less aggressive PT would be indicated to decrease joint inflammation, or a surgical consult may be necessary.

A) Muscle spasm of the TMJ

Dental trismus may be due to muscle spasm or to abnormally short jaw muscles. There is an inability to open the jaw fully.

D) All of these

Trismus, a condition seen as a sequela of radiation therapy in head and neck cancer, is the inability to open the mouth fully as a result of spasm in the masseter and lateral pterygoid muscles. In addition, radiation therapy can affect the surrounding local connective tissue, which contributes to the spasm.

A) Ectopic activity in the trigeminal nerve

Radiation-induced ectopic activity in the trigeminal nerve leads to neuropathic pain, weakness, and spasm of the masseter muscle.

A) It is responsible for the sensation of cornea.

D) Anterior and middle scalenes elevate the 2nd rib.

Anterior and middle scalenes elevate the 1st rib, whereas posterior scalene elevates the 2nd rib.

C) Superior rectus

The superior rectus attaches to the superoanterior porton of the sclera; the inferior rectus attaches to the inferoanterior portion of the sclera; and the lateral rectus attaches to the anterolateral portion of the sclera.

A) Both

D) Temporalis

B) Masseter

D) Internal pterygoid

Internal pterygoid is also known as medial pterygoid.

D) Inion

C) Anterior belly of digastrics

D) Condylar translation

Protrusion involves the arthrokinematic movement of anterior condylar translation. Mandibular depression (jaw opening) involves both condylar anterior rotation and translation. However, this question is asking only about the protrusion component.

D) Loose areolar connective tissue

The loose areolar connective tissue contains emissary veins, which connect the veins of the scalp to the diploic veins and intracranial venous sinuses.

D) Loose areolar connective tissue

The loose areolar connective tissue contains emissary veins, which are valveless veins which connect the extracranial veins of the scalp to the intracranial dural venous sinuses. The emissary veins are a potential pathway for the spread of infection from the scalp to the intracranial space.

C) The blood vessels of the scalp are adhered to the loose connective tissue, preventing the vasoconstriction that normally occurs in response to damage.

The blood vessels of the scalp are adhered to the dense connective tissue, preventing the vasoconstriction that normally occurs in response to damage.

A) Occipitofrontalis

C) Lesser occipital nerve

The auriculotemporal nerve supplies the skin anterosuperior to the pinna, while the zygomaticotemporal nerve supplies supplies the skin over the temple.

B) Frontal, ethmoid, sphenoid

C) Ethmoid

The cribriform plate is a sheet of bone seen on either side of the crista galli which contains numerous small foramina that transmit olfactory nerve fibers into the nasal cavity.

C) Cribriform plate

The cribriform plate of the ethmoid bone is the thinnest part of the anterior cranial fossa, and therefore most likely to fracture. A cribriform plate fracture can result to anosmia (loss of sense of smell) and CSF rhinorrhea (leakage of CSF into nasal cavity).

A) Frontal

The frontal bone contributes to the anterior and lateral boundaries.

The limbus of the sphenoid bone contributes to the posterior and medial boundaries.

The lesser wings of the sphenoid bone contributes to the posterior and lateral boundaries.

C) Facial

D) Glossopharyngeal

C) Dorsum sellae of sphenoid

A) Pituitary gland

The central part of the middle cranial fossa is formed by the bony of the sphenoid. It contains the sella turcica, which is a saddle-shaped bony prominence that holds and supports the pituitary gland.

A) Posterior

The posterior cranial fossa is the deepest of the three cranial fossae. It accommodates the brainstem and cerebellum.

B) Foramen magnum

The foramen magnum, a large opening that lies centrally in the floor of the posterior cranial fossa, transmits the medulla, meninges, vertebral arteries, spinal accessory nerve (ascending), dural veins, and anterior and posterior spinal arteries.

B) Spinal accessory nerve (ascending)

The jugular foramina transmits the spinal accessory nerve (descending), whereas the foramen magnum transmits the spinal accessory nerve (ascending). Other structures that pass through the jugular foramina are the vagus nerve, inferior petrosal sinus, and meningeal branches of the ascending pharyngeal and occipital arteries.

C) Only the first statement is true.

Cerebellar tonsillar herniation results in the compression of pons and medulla, which contain the cardiac and respiratory centers.

B) Petrous part of temporal bone

The petrous part of the temporal bone forms the floor of the middle cranial fossa.

A) Maxillary nerve

D) Pterygopalatine

The pterygopalatine ganglion is predominantly innervated by the greater petrosal branch of the facial nerve.

B) Sphenopalatine artery

In cases of chronic epistaxis, the pterygopalatine fossa can be surgically approached via the maxillary sinus, and the artery ligated to control bleeding.

D) Foramen ovale

B) Middle meningeal

The middle meningeal artery arises from the maxillary artery, and exits the infratemporal fossa via the foramen spinosum.

C) Lateral pterygoid

Meanwhile, the medial pterygoid forms the floor of the infratemporal fossa.

C) Only the first statement is true.

Trauma in this region can lead to a epidural hemorrhage as the middle meningeal artery lies deep to it.

B) Suprameatal triangle

The suprameatal triangle is also known as MacEwen's triangle or mastoid fossa.

D) None of the above

The mastoid fossa does not contain any important structure.

A) Mastoid antrum

The mastoid fossa, also known as MacEwen's or suprameatal triangle, overlies the mastoid antrum, the largest of the mastoid air cells.

D) Temporal

The calvarium is also known as the cranial roof. Meanwhile, all six cranial bones contribute to the formation of the cranial base.

D) Frontal

The frontal bone, typically a bone of the calvaria, is sometimes included as part of the facial skeleton.

D) Lacrimal

C) Inferior nasal concha

D) Nasal

The nasal bone is the most commonly fractured facial bone due to its prominent position at the bridge of the nose. There is often significant soft tissue swelling and associated epistaxis.

A) Maxillary

D) 20

C) Middle meningeal artery

C) Coronal; sagittal

Meanwhile, the occipital fontanelle represents the junction of the sagittal and lambdoid sutures.

D) Frontal, zygomatic, maxillary

C) Both statements are true.

A) Frontal

The frontal bone makes up the roof of the orbit.

C) Optic nerve

The optic nerve, together with the ophthalmic artery, enters the bony orbit via the optic canal.

D) Sphenoid

The sphenoid bone is said to be butterfly-shaped. It consists of a body, paired greater and lesser wings, and two pterygoid processes.

D) Greater wing

There are three foramina present in the greater wing of the sphenoid - the foramen rotundum, foramen ovale, and foramen spinosum.

C) Sphenoid

This type of surgery is known as endoscopic transsphenoidal surgery.

B) Ethmoidal labyrinths

C) Falx cerebri

The falx cerebri is a fold of dura mater that descends vertically in the longitudinal fissure between the cerebral hemispheres. It attaches anteriorly at the crista galli.

A) Superior 2/3

A) Squamous

D) Masseter

The masseter attaches to the lateral zygomatic process of the temporal bone, while the temporalis attaches to the inferior part of the squamous portion of the temporal bone.

D) Mandible

A) Mandible

B) Superior

The alveolar border contains 16 sockets to hold the lower teeth.

C) Mandibular foramen

B) Inferior alveolar nerve

When the inferior alveolar nerve leaves the mandibular foramen, it becomes the mental nerve.

D) Digastric

The digastric attaches to the internal surface of the body of the mandible. Other muscles which attach to the external surface of the body of the mandible are platysma and depressor anguli oris.

D) Rami

The masseter, temporalis, and pterygoids attach to the mandibular rami.

A) Vomer

C) Middle

The anterior compartment transmits the inferior petrosal sinus, while the posterior compartment contains the sigmoid sinus and transmits the meningeal branches of the occipital and ascending pharyngeal arteries.

D) Both statements are true.

B) Sphenoid

The optic canal is bounded medially by the body of the sphenoid and laterally by the lesser wing of the sphenoid.

D) Foramen rotundum

The foramen rotundum transmits the maxillary division of the trigeminal nerve.

A) Nasociliary nerve

The nasociliary nerve is conducted by the superior orbital fissure.

B) The superior fibers draw the tip of the tongue up and back.

The superior fibers of the genioglossus draw the tip of the tongue down and back.

A) Lingual nerve

D) Cecum

The foramen cecum is a blind-ended pit located in the midline of the tongue at the junction of the anterior 2/3 and posterior 1/3.

A) Frenulum

A) Facial nerve

The chorda tympani branch of the facial nerve supplies taste sensation to the anterior 2/3 of the tongue.

B) Procerus

The procerus also lies superficially to the other muscles of facial expression.

C) 2nd

Thus, muscles of facial expression are innervated by the facial nerve.

A) 1st

Thus, the muscles of mastication are innervated by a branch of the trigeminal nerve, the mandibular nerve.

B) Masseter

The masseter is quadrangular in shape and has two parts: deep and superficial.

B) Temporalis

D) Both statements are true.

In contrast to the levator palpebrae superioris, the superior tarsal muscle is innervated by the sympathetic nervous system.

C) Both statements are true.

D) Superior oblique

D) Lateral rectus

C) Parotid ganglion

The parasympathetic ganglion associated with the parotid gland is the otic ganglion.

B) Facial nerve

The superior salivatory nucleus receives pre-ganglionic fibers from the greater petrosal nerve, a branch of the facial nerve.

B) Dorsal motor nucleus

C) Ciliary

The ciliary ganglion provides innervation to the sphincter pupillae muscle. If this ganglion is damaged, there loss of innervation to the sphincter pupillae, resulting to a permanently dilated pupil that does not constrict in the presence of light. This is known as Adie's pupil.

D) Pterygopalatine

Pterygopalatine ganglion is also known as the sphenopalatine ganglion.

D) Superior cervical ganglion

The superior cervical ganglion gives rise to the internal carotid nerve, which supplies the superior tarsal muscle.

C) Inferior thyroid

The common carotid artery is associated with the postganglionic fibers of the superior cervical ganglion, while the subclavian and vertebral arteries are associated with those of the inferior cervical ganglion.

A) All of these

The superior, middle, and inferior cervical ganglion each contribute a branch to the cardiac plexus.

A) Trigeminal ganglion

Meckel's cave is also known as trigeminal cave.

B) Lacrimal

C) Frontal

C) None of these

The lacrimal, frontal, and nasociliary nerves are all sensory branches of the ophthalmic nerve.

B) Upper eyelid

It should be lower eyelid. The upper eyelid is supplied by the ophthalmic division.

A) Lacrimal gland

Postganglionic fibers from the pterygopalatine (sphenopalatine) ganglion travel with the maxillary nerve to the lacrimal gland and the mucus glands of the nasal mucosa.

C) Malleus

B) Only the first statement is true.

Although the mandibular nerve carries parasympathetic fibers, these are derived from other cranial nerves.

B) Fibrocartilage

C) Auriculotemporal nerve

The facial and auriculotemporal nerves run close to the temporomandibular joint, and can be damaged if the injury is traumatic.

C) Facial

D) Retromandibular vein

A) Sublingual

A) Submental artery

A) Superior salivatory nucleus

D) Anterior digastric

Meanwhile, the posterior digastric is found posterior to the submandibular gland.

C) Hypoglossal

A) Trochlear

C) Olfactory

C) Cranial meninges

Due to its unique anatomical relation to the brain, the optic nerve is surrounded by cranial meninges, not endo-, peri-, or epineurium like most other nerves.

C) Left temporal and right nasal

The nasal fibers cross over in the optic chiasm, so the right nasal fibers and the left temporal fibers form the left optic tract. They carry information from the left nasal and right temporal visual fields.

C) Only the first statement is true.

The upper optic radiation travels through the parietal lobe to reach the visual cortex.

Meanwhile, the lower optic radiation carries fibers from the inferior retinal quadrants, corresponding to the superior visual field quadrants. It travels through the temporal lobe, via a pathway known as the Meyer's loop, to reach the visual cortex.

D) Bitemporal hemianopsia

Within the middle cranial fossa, the pituitary gland lies in close proximity to the optic chiasm. Compression of the optic chiasm particularly affects the fibers that are crossing over from the nasal half of each retina. This produces a visual defect affecting the peripheral vision in both eyes, known as bitemporal hemianopsia.

D) Medial rectus

The superior branch of the oculomotor nerve supplies the levator palpebrae superioris and the superior rectus. Sympathetic fibers run with the superior branch to supply the superior tarsal muscle

The inferior branch of the oculomotor nerve supplies the medial rectus, the inferior rectus, and the inferior oblique. It also supplies the pre-ganglionic parasympathetic fibers to the ciliary ganglion, which ultimately supplies the sphincter pupillae and the ciliary muscles.

B) Somatic motor

The trochlear nerve has only somatic motor function as it innervates the superior oblique muscle.

D) Trochlear

D) Contralateral superior oblique

As the fibers from the trochlear nucleus cross in the midbrain before they exit, the trochlear neurons innervate the contralateral superior oblique.

C) Head tilt towards the affected side

It should be head tilt away from the affected side.

D) Trigeminal

B) 1st

The trigeminal nerve is associated with muscles derived from the 1st pharyngeal arch: muscles of mastication, anterior digastric, mylohyoid, tensor tympani, and tensor veli palatini.

D) Abducens

A) Temporal

The internal acoustic meatus is a 1 cm long canal in the petrous part of the temporal bone.

B) Buccal branch

The buccal nerve is released within the parotid gland. It is a motor nerve, supplying the orbicularis oris, bucinator, and zygomaticus muscles.

A) Within the parotid gland

The external carotid artery, retromandibular vein, and facial nerve all pass through the parotid gland.

The five terminal branches of the facial nerve are: temporal, zygomatic, buccal, marginal mandibular, and cervical. These branches are responsible for innervating the muscles of facial expression.

C) Within the facial canal

C) Lesser petrosal nerve

It should be greater petrosal nerve. This nerve provides parasympathetic innervation to the mucus glands and lacrimal gland.

A) Both of these

A) Stylomastoid foramen

D) Within the facial canal

The nerve to stapedius, the first motor branch of the facial nerve, arise within the facial canal.

D) Anterior auricular nerve

It should be posterior auricular nerve.

C) Stylopharyngeus

The remaining muscles of the pharynx are innervated by the vagus nerve.

D) 3rd

C) Vagus

D) Vagus

A) Vagus

C) Vagus

B) Both statements are true.

C) Cricothyroid

The cricothyroid is innervated by the external laryngeal nerve.

A) Splenic flexure of large intestine

A) Away

A) C1-C5/C6

D) Foramen magnum

The spinal part of the accessory nerve enters the cranial cavity via the foramen magnum. It then leaves the cranium through the jugular foramen.

B) Vagus nerve

For this reason, the cranial part of the accessory nerve is considered as part of the vagus nerve.

B) Somatic motor

The hypoglossal nerve supplies the majority of the tongue muscles.

D) C1-C2

The hypoglossal nerve exits the cranium via the hypoglossal canal and receives a branch of the cervical plexus that conducts fibers from C1-C2. These fibers do not combine with the hypoglossal nerve, but they merely travel within its sheath.

B) Genioglossus

D) Thyroihyoid

The C1/C2 spinal nerve roots branch off to innervate the geniohyoid and thyrohyoid muscles. Another branch containing C1/C2 fibers descend to supply the ansa cervicalis.

B) Facial

The cranial nerves IX, X, XI, and XII can also be found in the anterior triangle.

C) Common carotid artery

The common carotid artery bifurcates into external and internal carotid arteries.

A) Subclavian vein

A) Glossopharyngeal nerve

• The main contents of the carotid triangle are:
•  1. Common carotid artery, which bifurcates into external and internal carotid branches within the triangle
•  2. Internal jugular vein
•  3. Vagus nerve
•  4. Hypoglossal nerve

C) Mylohyoid

The submental triangle of the neck is bounded inferiorly by the hyoid bone, medially by the midline of the neck, and laterally by the anterior belly of the digastrics.

B) None of these

B) Muscular

The muscular triangle of the neck is bounded by the hyoid bone superiorly, by the imaginary midline of the neck medially, by the superior belly of omohyoid superolaterally, and by the inferior portion of sternocleidomastoid inferolaterally.

A) Mylohyoid

The muscular triangle contains the infrahyoid muscles, the pharynx, and the thyroid and parathyroid glands. Mylohyoid is a suprahyoid muscle.

D) Accessory nerve

The accessory nerve lies relative superficial in the posterior triangle of the neck, leaving it vulnerable to injury.

D) Inferior belly of omohyoid

The inferior belly of omohyoid crosses the posterior triangle of the neck, travelling in a supero-medial direction.

A) Inferior: proximal 1/3 of clavicle

It should be inferior: middle 1/3 of clavicle.

C) Longus colli

The floor of the posterior triangle of the neck is formed by the splenius capitis, the levator scapulae, and the anterior, middle, and posterior scalenes. The longus colli is a neck flexor located on the anterior aspect of the neck.

A) External jugular vein

Within the posterior triangle of the neck, the external jugular vein pierces the investing layer of the fascia and empties into the subclavian vein.

A) Posterio border of SCM

Local anaesthetic is injected along the posterior border of sternocleidomastoid at the junction of its superior and middle thirds. This junction is where the cutaneous branches of the cervical plexus emerge, known as the nerve point of the neck.

D) None of these

The subclavian triangle is also known as the supraclavicular triangle.

A) Only the first statement is true.

The posterior arch of the atlas contains a groove for the vertebral artery and C1 spinal nerve.

B) Only the first statement is true.

Lateral atlanto-axial joints are classified as plane type synovial joints.

Medial atlanto-axial joint is formed by the articulation of the dens of the axis with the articular facet on the anterior arch of the atlas. This is classified as pivot type synovial joint.

D) Transverse ligament

The transverse ligament connects the lateral masses of the atlas, and in doing so anchors the dens in place.

C) Both

The nuchal ligament is the superior continuation of the supraspinous ligament, attaching the tips of the spinous processes from C1-C7.

A) Hangman's fracture

Hangman's fracture refers to a fracture of the pars interarticularis, a bony column between the superior and inferior articular facets of the axis.

A) Teardrop fracture

Teardrop fracture refers to the fracture of the dens (odontoid process) of the axis.

A) Jefferson's fracture

Diving into an excessively shallow water can compress the lateral masses of the atlas between the occipital condyles and the axis. This causes them to be driven apart, fracturing one or both anterior or posterior arches. If the fall occurs with enough force, the transverse ligament of the atlas may also be ruptured.

A) Lesser horn

The lesser horn of the hyoid bone projects superoposteriorly towards the styloid process of the temporal bone.

B) Styloglossus

It should be genioglossus.

B) Posterior; greater

D) C1

The suboccipital nerve arises from the posterior ramus of C1.

C) Obliquus capitis inferior

The obliquus capitis inferior originates from the spinous process of the C2 vertebra, and attaches into the transverse process of C1.

A) Rectus capitis posterior minor

• The following are the borders of the suboccipital triangle:
•  1. Superomedial: rectus capitis posterior major
•  2. Superolateral: obliquus capitis superior
•  3. Inferior: obliquus capitis inferior
•  4. Floor: posterior atlanto-occipital membrane and posterior arch of atlas
•  5. Roof: semispinalis capitus

C) None of these

The suprahyoid muscles are a group of four muscles located superior to the hyoid bone of the neck. They all act to elevate the hyoid bone - an action involved in swallowing.

A) Stylohyoid

A) Stylohyoid

C) Mylohyoid

Mylohyoid is a broad, triangular-shaped muscle which elevates the hyoid bone and the floor of the mouth.

B) Geniohyoid

The stylohyoid is innervated by the stylohyoid branch of the facial nerve.

The mylohyoid is innervated by the inferior alveolar nerve, a branch of the mandibular division of the trigeminal nerve.

The anterior belly of digastrics is innervated by the inferior alveolar nerve, a branch of the mandibular division of the trigeminal nerve. Meanwhile, the posterior belly of digastrics is innervated by the digastric branch of the facial nerve.

C) Sternothyroid and thyrohyoid

Meanwhile, the omohyoid and sternohyoid are found in the superficial plane.

C) Thyrohyoid

Sternothyroid and thyrohyoid are continuous.

C) Anterior ramus of C1, carried by the hypoglossal nerve

Meanwhile, the superior and inferior omohyoids, the sternohyoid, and the sternothyroid muscles are innervated by the anterior rami of C1-C3, carried by the ansa cervicalis.

A) Inferior belly of omohyoid

D) Sternothyroid

Meanwhile, the thyrohyoid muscle depresses the hyoid bone. If the hyoid bone is fixed, this muscle can elevate the larynx.

C) Posterior scalene

Meanwhile, the anterior and middle scalenes insert into the scalene tubercle of the first rib.

B) 1st

The anterior and middle scalenes insert into the scalene tubercle of the first rib.

C) Middle scalene

The middle scalene has several long, thin muscle bellies arising from the cervical spine, which converge into one large belly that inserts into the first rib.

C) Posterior scalene

B) Anterior and middle scalanes

D) Anterior scalene

The subclavian vein courses horizontally across the anterior scalene, while the phrenic nerve runs vertically down the muscle.

C) Cricoid cartilage

C) C1-C4

A) Middle of the posterior border of the sternocleidomastoid

This is known as the Erb's area, and is a useful landmark when performing a cervical plexus block.

D) Greater auricular nerve

The greater auricular nerve is formed by fibers from C2 and C3 roots. It provides sensation to the external ear and to the skin over the parotid gland.

C) Nerve to mylohyoid

It should be nerve to geniohyoid. Mylohyoid is innervated by the inferior alveolar nerve, a branch of the mandibular division of the trigeminal nerve.

C) Phrenic nerve

A cervical nerve block can also affect the phrenic nerve, so it is not usually performed on those with co-existing cardiac or respiratory diseases.

A) Anterior scalene

The phrenic nerve arises at the lateral border of the anterior scalene muscle. It then passes inferiorly over the anterior surface of the anterior scalene.

A) Endocardium

Sensory fibers from the phrenic nerve supply the central part of the diaphragm, including the surrounding pleura and peritoneum. The nerve also supplies sensation to the mediastinal pleura and the pericardium.

B) C3

The phrenic nerve roots are C3-C5, so the patient is most likely to experience pain in these dermatomes.

A) C4

C4 spinal nerve root provides the main contribution, with lesser contributions from C3 and C5 and some communicating fibers from the cervical plexus.

C) Only the first statement is true.

The affected side of the diaphragm moves upward during inspiration and downward during expiration.

B) Sternocleidomastoid

The investing layer of deep cervical fascia completely encloses the trapezius and sternocleidomastoid muscles.

D) Retropharyngeal

The retropharyngeal space extends from the base of the skull to the posterior mediastinum.

C) Posterior triangle

The anterolateral portion of the prevertebral fascia forms the floor of the posterior triangle of the neck.

B) Sphenoidal sinuses

The sphenoid sinuses lie most posterior in comparison to the other paranasal sinuses.

A serious complication of sphenoid sinusitis, due to its posterior position and communications, is cavernous sinus thrombosis.

B) C6-C7

The vertebral arteries enter the transverse process of C6 or C7 and pass superiorly in the transverse foramen of each cervical vertebra.

The upper border of thyroid cartilage (C3/C4 level) is the level at which the carotid bifurcation occurs.

The esophagus narrows in the cervical region at the level of cricopharyngeus (C5/C6 level).

The hyoid bone is found at the base of the mandlible (C3 level).

B) Upper border of thyroid cartilage (C3/C4 level)

The upper border of thyroid cartilage (C3/C4 level) is the level at which the carotid bifurcation occurs.

The esophagus narrows in the cervical region at the level of cricopharyngeus (C5/C6 level).

The isthmus of the thyroid gland is found halfway between the thyroid cartilage and the sternal notch.

The hyoid bone is found at the base of the mandible (C3 level).

The vertebral arteries enter the transverse process of C6 or C7 and pass superiorly in the transverse foramen of each cervical vertebra.

D) Sphenoid

The pituitary gland can be surgically accessed through the sphenoid sinus. Transphenoidal surgery is mainly used to remove tumours of the pituitary gland.

B) Inferior nasal meatus

The lacrimal drainage system begins at the superior and inferior puncta, which drains into their respective canaliculi. The two canaliculi join to form the common canaliculus, which then drains into the lacrimal sac. The lacrimal sac then opens into the nasolacrimal duct, which then drains into the inferior meatus of the nose.

• The middle meatus drains the :
• Maxillary sinus
• Frontal sinus
• Anterior ethmoidal sinus

• The superior meatus drains the:
• Posterior ethmoidal sinus

The spheno-ethmoidal recess drains the sphenoid sinus.

B) Anterior ethmoidal artery

Kiesselbach's plexus (also known as Little's area) is an anastomosis which supplies the nasal septum. It is comprised of five arteries, including anterior ethmoidal, sphenopalatine, posterior ethmoidal, greater palatine and superior labial arteries. It is a common site for nosebleeds.

B) Nasion

The nation lies at the inferior aspect of the glabella, which lies between the two brow ridges.

C) Inferior thyroid vein

The inferior laryngeal vein flows into the inferior thyroid vein after draining the larynx. Thereafter, the inferior thyroid vein drains into the left brachiocephalic vein.

The superior laryngeal vein also provides venous drainage to the larynx. This vein then flows into the superior thyroid vein and then into the internal jugular vein.

C) Ethmoid, lacrimal, sphenoid, maxillary

A) Only the first statement is true.

Light/dark perception is the worst in this region of the eye but improves as the density of rods increases towards the periphery of the eye.

C) T4/T5

B) T2

B) Foramen ovale

The lesser petrosal nerve exits via foramen ovale shortly after branching from cranial nerve IX. It contains the pre-ganglionic parasympathetic fibres destined for synapse within the otic ganglion.

Foramen rotundum contains cranial nerve V2 (maxillary branch of the trigeminal nerve).

Foramen spinosum contains the middle meningeal artery, middle meningeal vein, and the meningeal branch of the mandibular nerve (V3).

Jugular foramen contains the cranial nerves IX, X, and XI, and the internal jugular vein.

D) Schlemm's canal

Schlemm's canal is also known as scleral venous sinus.

C) Vagus nerve

The carotid sheath in the neck is the main protective fibrous connective tissue surrounding the neurovascular component of the neck. There are four main structures within the carotid sheath - vagus nerve, internal jugular vein, common carotid and deep lymphatics. 

The ansa cervicalis (formed by C1) is adherent to the anterior wall of the carotid sheath, but not classically found within the carotid sheath.

D) Zygomatic



The pterion is where the frontal, parietal, temporal, and sphenoid bones join. This is on the side of the head, and is an important anatomical landmark, as the middle meningeal artery lies just beneath it. 

Trauma to this area can cause this artery to rupture, resulting in an extradural hematoma.

C) Galea aponeurotic

The main purpose of the galea aponeurotica is to form a potential space that allows fluid and blood to pass from the scalp to the upper eyelids. Potential fracture or trauma to the skull which has damaged the blood vessels within the scalp will allow blood to flow beneath the galea and cause the racoon eyes.

B) Superficial temporal artery



The external carotid artery divides into its terminating branches, superficial temporal and maxillary artery within the parotid gland.

• A useful mnemonic for the branches of the external carotid artery is Some Anatomists Like Freaking Out Poor Medical Students:
• Superior thyroid artery 
• Ascending pharyngeal artery 
• Lingual artery 
• Facial artery 
• Occipital artery 
• Posterior auricular artery 
• Maxillary artery 
• Superficial temporal artery

C) Greater petrosal nerve

It should be lesser petrosal nerve.

E) Optic nerve

The optic nerve does not pass through the cavernous sinus.

The contents of the cavernous sinus can be learned using the mnemonic OTOM CAT. 'O TOM' are the first letters of components of the lateral wall of cavernous sinus considered vertically, from the top to the bottom. CA are the first letters of the structures located within the sinus. CA continues virtually at the level of the T of 'O TOM'. So that the T represents the point of conjunction of the two words:

Oculomotor nerve

• Trochlear nerve
• Ophthalmic branch of the trigeminal nerve
• Maxillary branch of the trigeminal nerve

• Internal Carotid artery
• Abducens nerve
• Trochlear nerve

D) Second

The best way to work out what pharyngeal arch a muscle is derived from is to recall its associated cranial nerve. In this case, the buccinator is a muscle of facial expression, therefore it is innervated by the facial nerve (CN VII).

The second pharyngeal arch gives rise to the facial nerve, and thus all the muscles innervated by that nerve. Therefore the buccinator is derived from pharyngeal arch number two.

The first pharyngeal arch gives rise to the maxillary division of the trigeminal nerve.

The third pharyngeal arch gives rise to the glossopharyngeal nerve.

The fourth pharyngeal arch gives rise to the superficial branch of the laryngeal nerve (part of the vagus nerve).

The fifth pharyngeal arch disintegrates.

The sixth pharyngeal arch gives rise to the recurrent branch of the laryngeal nerve (part of the vagus nerve).

B) Ethmoid bone

The middle nasal concha (also known as the middle nasal turbinate) is formed by the ethmoid bone.

B) Depression of the larynx

Contraction of the omohyoid muscle results in depression of the larynx. The omohyoid muscle is one of the extrinsic muscles of the larynx.

C) Haller's

• The choroid contains four layers, with the size of blood vessels diminishing with each deeper layer:
•      1. Haller's (most superficial) - largest diameter
•      2. Sattler's
•      3. Choriocapillaris
•      4. Bruch's membrane (deepest)

A) Rostrum of corpus callous

All of these structures can be found in the midline of a sagittal section of the brain, with the exception of the foramen of Monro which is slightly lateral.

If the answer is not immediately known, it can be worked out by ruling out the other possibilities.

The interthalamic adhesion is found between the thalami, the thalami themselves being used as a marker for the posterior limb of the internal capsule. It, therefore, cannot be the most anterior.

The other three incorrect structures: columns of the fornix, interventricular foramen of Monro, and mammillary bodies are all located between the anterior limbs of the internal capsules. The interventricular foramen is an opening between the lateral ventricles and the third ventricle, the anterior wall of this opening is formed by the column of the fornix, and so cannot be the correct option.

The column of the fornix does form a slight 'C' shape curve as it descends down towards the mammillary bodies, however, as it must rest on the anterior commissure it cannot extend too far forward. The columns then become more posterior as they meet the mammillary bodies and thus are ruled out as most anterior.

The rostrum of the corpus callosum is a beak shaped structure that connects to the front of the anterior commissure and so whilst the columns of the fornix meet at the anterior commissure, the rostrum is the most anterior.

A) Posterior communicating artery

The posterior communicating artery is also sometimes referred to as 'PComm'. It connects the middle cerebral artery and the posterior cerebral artery. The posterior communicating artery's main purpose is to provide redundancy for blood circulation throughout the brain, such that if one circulatory system was affected by disease (e.g. stroke), the other circulatory system could take over and provide blood and oxygen to the affected part of the brain.

Clinically, aneurysms of the PComm artery can cause oculomotor nerve palsy given its relation to the oculomotor nucleus.

B) Occipital bone and mastoid process of the temporal bone

The splenius capitis muscle of the neck inserts into the occipital bone (specifically on the rough surface of the occipital bone below the lateral third of the superior nuchal line) and the mastoid process of the temporal bone. The splenius capitis muscle can be classified as one of the intrinsic muscles of the back.

The splenius capitis muscle originates from the nuchal ligament and spinous processes of C7-T13.

The trapezius muscle originates from the external occipital protuberance and spinous processes of C7-T12 (as well as from other structures).

A) Inferior meatus

The nasolacrimal duct empties into the inferior meatus of the nasal cavity. The nasolacrimal duct carries tears from the lacrimal sac of the eye into the nasal cavity.

A) Middle meatus

The maxillary sinus opens into the middle meatus in the nasal cavity. The maxillary sinus is the largest air containing sinus in the body.

A) Frontal bone

The asterion is formed by the parietal, occipital and temporal bones and is found just behind the ear. It represents the point where the lambdoid, parieto-mastoid, and occipito-mastoid sutures meet.

This is not to be confused with the pterion, which is the craniometric point where the frontal, parietal, temporal, and sphenoid bones join together. It is located on the side of the skull, just behind the temple.

E) Petrous

The temporal bone is comprised of four main parts: the squamous part, petrous part, tympanic part and styloid process.

The squamous part forms the thin anterosuperior component and includes the zygomatic process, although these are sometimes considered distinct components.

The petrous part (aka petromastoid) is the thick inferoposterior component and includes the middle and inner ear.

The styloid process is a distinct spindle-like structure found inferiorly.

The tympanic part forms the region around the external acoustic meatus.

B) Posterior wall of the maxillary sinus

The pterygopalatine fossa is a bilateral, cone-shaped depression located between the infratemporal fossa and the nasal cavity. It contains the maxillary nerve, the pterygopalatine ganglion, and the maxillary artery.

The posterior wall of maxillary sinus forms the anterior border of the pterygopalatine fossa. The maxillary sinus is a clinically significant border as it allows a surgical approach to access the pterygopalatine fossa, for example, to tie off the sphenopalatine artery in chronic epistaxis.

The pterygoid process of sphenoid bone forms the posterior border of the pterygopalatine fossa.

The palatine bone and palatine canals form the inferior border of the pterygopalatine fossa.

The inferior orbital fissure forms the superior border of the pterygopalatine fossa.

The perpendicular plate of palatine bone forms the medial border of the pterygopalatine fossa.

The pterygomaxillary fissure forms the lateral border of the pterygopalatine fossa.

D) Superior

The epitympanic recess of the middle ear lies superior to the tympanic membrane. The malleus and incus partially extend into this recess.

This recess is significant as it can act as a route of infection into the mastoid air cells.

C) C3-C6

The larynx is located in the anterior compartment of the neck at the level of C3 - C6.

The larynx is an organ responsible for the production of voice, protecting the trachea and it is involved in the process of breathing. It is continuous with the trachea inferiorly and pharynx superiorly.

C) Common carotid artery

• A good way to remember the structures in the posterior triangle of the neck is the mnemonic "Charlie Sheen Epic Biwinning":
• Cranial nerve XI (accessory)
• Subclavian artery
• External jugular vein
• Brachial Plexus trunks

The common carotid artery is located in the carotid sheath, which is in the anterior triangle of the neck.

C) Sympathetic fibers

The sympathetic nerve fibers arise from the sympathetic plexus, which is also known as the internal carotid plexus. This plexus runs along the lateral side of the internal carotid artery into the middle cranial fossa via the carotid canal. The sympathetic fibers have two main motor functions: to raise the eyelid and dilate the pupil. The fibers also provide innervation to the sweat glands of the face. They can be damaged if there is a base-of-skull fracture and can result in an ipsilateral Horner's syndrome.

• The other options are incorrect for the reasons below.
•      1. Parasympathetic fibers do not arise from the carotid plexus.
•      2. The optic nerve (cranial nerve II) does not pass through the carotid canal. It passes through the optic canal as an extension of the central nervous system.
•      3. The oculomotor nerve (cranial nerve III) passes through the superior orbital fissure. Incidentally, parasympathetic fibres do arise from the Erdinger-Westphal nucleus and travel along the superior orbital fissure to cause constriction of the pupil.

D) Hyoid bone

C) Eustachian tube

The middle ear lies in the petrous part of the temporal bone between the tympanic membrane and the oval window. It communicates anteriorly with the nasal cavity via the Eustachian tube, which is also known as pharyngotympanic tube or auditory tube. This tube is important in equalizing pressure in the middle ear and preventing damage. The middle ear also communicates posteriorly with the mastoid air cells in the mastoid process - this can be important in the spread of infection from the middle ear given the close proximity of the mastoid process to the sigmoid sinus and cerebellum.

D) Vagus nerve

A bovine cough is a non-explosive cough due to inability to close the glottis. It is seen vagus nerve lesions (particularly recurrent laryngeal nerve palsy), and may be associated with dysphonia.

C) Loose areolar connective tissue

Th skin is an ectoderm-derived tissue forming a barrier against the external environment. The dura mater is the outermost layer of meninges.

C) Protection of the sternocleidomastoid muscle and carotid triangle

The Platysma is a sheet of muscle extending from the superior fascia of the pectoralis major and deltoid muscles to the inferior edge of the mandible where it merges with the anterior inferior facial muscles.

The Platysma constricts during shouts, grimaces and any facial expressions associated with anger or fear. The purpose for this is to create a solid mass of muscle to defend the sternocleidomastiod muscle and the carotid triangle from injury. The Carotid triangle contains the carotid artery, the vagus nerve and the jugular vein so protecting it whilst experiencing aggression or fear is an evolutionary reflex.

A) Temporalis tendon

Originating on the temporal bone at the superior temporal line, the fan-like temporalis converges mostly into a common tendon that inserts onto the coronoid process of the mandible. Some of the temporalis muscle continues and attaches directly onto the anterior surface of the coronoid process of the mandible without tendinous insertion. This allows the temporalis to elicit elevation of the jaw, facilitating both phonation and mastication.

The masseter attaches to the inferior aspect of the zygomatic arch.

The temporal fascia attaches to the superior aspect of the zygomatic arch.

The orbicularis oris inserts into the labial skin and fascia of the mouth. It is not in the vicinity of the zygomatic arch.

The biceps brachii is found in the upper limb, specifically the arm (brachium). It does not pass through the zygomatic arch.

D) Retrimandibular vein

The retromandibular vein, which is also known as the posterior facial vein, arises within the parotid gland. This vein is formed by the union of the maxillary and superficial temporal veins.

A) C1 via the hypoglossal nerve

The glenohyoid muscle (one of the suprahyoid muscles of the neck) is innervated by C1 via the hypoglossal nerve. This innervation forms part of the ansa cervicalis.

E) Superior sagittal sinus

The superior sagittal sinus meets the straight sinus at the confluence of the sinuses. These then drain into the transverse sinus. Blood then passes into the sigmoid sinus and jugular vein on the way back to the heart.

A) Occipital bone

The clivus is a gently sloping part of the anterior part of the occipital bone, located just posteriorly to the dorsum sellae of the sphenoid bone. Posterior to the clivus itself is located the foramen magnum.

D) Cranial nerve IV (left)

This is a classical description of a 4th nerve palsy, in this instance the left cranial nerve IV is likely to be damaged. Remember that cranial nerve IV (trochlear) is the only cranial nerve that innervates the contralateral side of the body.

A problem with the right cranial nerve IV is unlikely, given that this would cause problems with the left eye.

Cranial nerve VI (abducens) is responsible for abduction of the eye, and would not cause the eye to turn upwards during an examination if damaged.

Damage to the sympathetic chain can cause Horner's syndrome. This does not cause abnormal eye movements, but can cause mild drooping of the eye (ptosis) due to loss of sympathetic innervation of the superior tarsal muscle which retracts the eyelid.

C) Lateral flexion and rotation of the cervical spine to the ipsilateral side

Contraction of the splenius cervicis muscle causes lateral flexion and rotation of the cervical spine to the ipsilateral side. This muscle also causes extension of the cervical spine. The splenius cervicis can be classified as an intrinsic muscle of the back.

D) Bony labyrinth

Perilymph and endolymph are fluids found in the inner ear. Specifically, the perilymph is located within the bony labyrinth (cochlea, vestibule, semicircular canals) and the endolymph is located within the membranous labyrinth (a system of ducts and sacs which are within the bony labyrinth).

C) Posterior tubercles of the transverse processes of C1 - C4 vertebrae

• The origin and insertion of the levator scapulae are as follows:
•      1. Origin: posterior tubercles of the transverse processes of C1 - C4 vertebrae
•      2. Insertion: superior part of the medial border of the scapula

B) Ascending cervical artery

The ascending cervical artery provides the blood supply to the scalene muscles. It is a branch of the thyrocervical trunk and ascends medial to the phrenic nerve on the prevertebral fascia.

E) External and internal carotid arteries

The scalp receives its blood supply from branches of the external and internal carotid arteries.

The external carotid artery supplies the scalp via the superficial temporal, occipital and posterior auricular arteries.

The internal carotid artery supplies the scalp via the supratrochlear and supraorbital arteries.

B) Palatine

Other paired bones that comprise the nasal septum include the maxillary and nasal bones.

The ethmoid and vomer bones are unpaired bones that contribute to the nasal septum.

D) Left hypoglossal nerve

The hypoglossal nerve (CN XII) supplies motor innervation to the tongue and is evaluated by observing the tongue at rest, and by asking the patient to protrude the tongue in the midline.

A lesion of the hypoglossal nerve will eventually cause atrophy of the ipsilateral half of the tongue. The tongue will deviate towards the side of the lesioned nerve when protruded. This is due to a weakness of the genioglossus muscle on the affected side, which normally functions to deviate the tongue towards the contralateral side.

Because this patient's tongue deviates to the left, we can safely assume that the left hypoglossal nerve has been compromised. 

A fun way to remember this is "lick your wounds" as the tongue will deviate towards the injured side.

The glossopharyngeal nerves (CN IX) innervate the palate rather than the tongue.

The spinal accessory nerves (CN XI) innervate the trapezius and sternocleidomastoid muscles which control neck movement.

E) Greater occipital nerve

The posterior portion of the scalp is innervated by the greater occipital nerve.

The mneumonic 'Z-GLASS' can aid in remembering the innervation of the scalp: zygomaticotemporal, greater occipital, lesser occipital, auriculotemporal, supratrochlear and supraorbital nerves.

C) 4

The zygomatic bone articulates with 4 facial bones. These facial bones include the maxilla, sphenoid, frontal and temporal bones.

C) Zygomatic branch

The zygomatic branch of the facial nerve innervates the orbicularis oculi muscle.

The remaining branches do not innervate this muscle. The buccal branch innervates orbicularis oris, buccinator and zygomaticus muscles. The marginal mandibular branch innervates the mentalis muscle. The cervical branch innervates the platysma.

E) Buccinator

The parotid duct passes from the parotid gland, turning medially on the border of the masseter muscle and passing directly through the buccinator muscle, before opening into the oral cavity.

The parotid duct does not pass through masseter but borders it.

The trigeminal ganglion is a nerve ganglion superior and posterior to the parotid duct. The two have no clinical relation.

The mandible has a number of foramina through which several structures pass, including the inferior alveolar nerve and inferior alveolar artery. However, the parotid duct does not.

The lateral pterygoid is a muscle of mastication innervated by the trigeminal nerve (CN V). It serves to depress and protrude the mandible, allowing the mouth to open. It also plays a role in moving the mandible from side to side.

B) Buccinator

Stensen's (parotid) duct pierces the buccinator as it courses from the parotid gland to the oral mucosa.

Arising from the parotid gland, the duct travels anteriorly, on the lateral surface of the masseter. Upon reaching the anterior-most aspect of the masseter, Stensen's duct makes an abrupt turn medially and pierces the buccinator muscle. This does not seem to affect the function of the buccinator muscle.

The temporals muscle is located too posteriorly to be affected by Stensen's duct. Similarly, the pterygoideus medialis and lateralis are too deep, and lie on the internal surface of the mandible.

B) C6-C8 anterior rami

The posterior scalene muscle is innervated by the anterior rami of C6-C8.

The anterior scalene muscle is innervated by the anterior rami of C5-C6.

The middle scalene muscle is innervated by the anterior rami of C3-C8.

Note that the anterior rami of C6-C8 form part of the brachial plexus.

C) Sympathetic trunk

The sympathetic trunk is found outside the carotid sheath.

The contents of the carotid sheath include common carotid artery, internal carotid artery, vagus nerve, internal jugular vein and deep cervical lymphatics.

C) CN3, CN4, CN5(i, ii), CN6

• These are the five cranial nerves (CN) that pass through the cavernous sinus:
•      1. Oculomotor nerve (CN3)
•      2. Trochlear nerve (CN4)
•      3. Trigeminal nerve (CN5 - ophthalmic and maxillary division)
•      4. Abducens nerve (CN6)

B) C6

The esophagus begins at the level of C6 at the inferior border of the cricoid cartilage, where it is continuous with the laryngopharynx.

At T1, the esophagus enters the superior mediastinum. The other answers hold no significance for the path of the esophagus.

E) Posterior ethmoid sinus

• A nasal meatus is a nasal passage of the nasal cavity, of which there are three; the superior meatus, middle meatus and inferior meatus (A meatus is a passage or opening in the body, especially one which is open to the exterior). The nasal meatuses are located beneath each of the corresponding nasal conchae.​​
•      1. Superior nasal meatus drains the posterior ethmoid and sphenoid sinuses.
•      2. Middle nasal meatus drains the frontal, maxillary and anterior ethmoid sinuses.
•      3. Inferior nasal meatus drains the nasolacrimal duct.

D) Pars opercularis and pars triangularis

Broca’s area is formed of the pars opercularis and pars triangularis which are two of the three divisions of the inferior frontal gyrus. Pars opercularis and triangularis are separated by the anterior ascending ramus whilst pars triangularis is limited anteriorly by the anterior horizontal ramus. In front of the anterior horizontal ramus is pars orbitalis, which as the name infers - is above the orbits.

The function of Broca’s area is speech production, and in the majority of individuals is localised to the left hemisphere.

E) Thyroid gland

The contents of the submandibular triangle are: submandibular gland, facial artery, facial vein, stylohyoid muscle, hypoglossal nerve and lymph nodes.

The contents of the muscular triangle are: infrahyoid muscles, thyroid gland and parathyroid glands.

The contents of the carotid triangle are: carotid arteries, hypoglossal nerve and vagus nerve.