Head and Neck

A 38-year-old man has had thyroid surgery to remove his papillary carcinoma. The external laryngeal nerve that accompanies the superior thryroid artery is damaged during the surgery. This injury could result in a severe impairment of function of which of the following?

A) Relaxing the vocal cords
B) Rotatingthe arytenoid cartilages
C) Tensing the vocal cords
D) Widening the rima glottidis
E) Abducting the vocal cords

A 27-year-old woman with goiter comes to the hospital for surgical treatment. The surgeon must ligate the superior laryngeal artery before surgically resecting the goiter, so care must be taken to avoid injury to which of the following nerves?

A) External laryngeal nerve
B) Internal laryngeal nerve
C) Superior laryngeal nerve
D) Hypoglossal nerve
E) Vagus nerve

A 19-year-old woman complains of numbness of the nasopharynx after surgical rmoval of the adenoid. A lesion of which of the following nerves would be expected?

A) Maxillary nerve
B) Superior cervical ganglion
C) External laryngeal nerve
D) Glossopharyngeal nerve
E) Vagus nerve

During surgery on a 56-year-old man for a squamous cell carcinoma of the neck, a surgeon notices profuse bleeding from the deep cervical artery. Which of the following arteries must be ligated immediately to stop bleeding?

A) Inferior thyroid artery
B) Transverse cervical artery
C) Thyrocervical trunk
D) Costocervical trunk
E) Ascending cervical artery

A 17-year-old boy receives an injury to the phrenic nerve by a knife wound in the neck. The damaged nerve passes y which of the following structures in the neck?

A) Anterior to the subclavian vein
B) Posterior to the subclavian artery
C) Deep to the brachial plexus
D) Medial to the common carotid artery
E) Superficial to the anterior scalene muscle

A 45-year-old woman is suffering from numbness over the tip of her nose. Which of the following nerves is most likely to be damaged?

A) Ophthalmic division of the trigeminal nerve
B) Maxillary division of the trigeminal nerve
C) Mandibular division of the trigeminal nerve
D) Facial nerve
E) Auriculotemporal nerve

A 26-year-old singer visits her physician- an ear, nose, and throat (ENT) surgeon-and complains of changes in her voice. A laryngoscopic examination demonstrates a lesion of the superior laryngeal nerve, causing weakness of which of the following muscles?

A) Inferior pharyngeal constrictor
B) Middle pharyngeal constrictor
C) Superior pharyngeal constrictor
D) Thyroarytenoid
E) Thyrohyoid

A 44-year-old man with "crocodile tears syndrome" has spontaneous lacrimation during eating because of misdirection of regenerating autonomic nerve fibers. Which of the following nerves has been injured?

A) Facial nerve proximal to the geniculate ganglion
B) Auriculotemporal nerve
C) Chorda tympani in the infratemporal fossa
D) Facial nerve at the stylomastoid foramen
E) Lacrimal nerve

A young girl complains of dryness of the nose and the palate. This would indicate a lesion of twhih of the following ganglia?

A) Nodose ganglion
B) Otic ganglion
C) Ptrerygopalatine ganglion
D) Submandibular ganglion
E) Ciliary ganglion

A 33-year-old woman develops Bell's palsy. She must be cautious because this can result in corneal inflammation and subsequent ulceration. This symptom results from which of the following conditions?

A) Sensory loss of the cornea and conjunctiva
B) Lack of secretion of the parotid gland
C) Absence of the corneal blink reflex
D) Absence of sweating on the face
E) Inability to constrict the pupil

A 39-year-old woman presents to your clinic with complaints of headache and dizziness. She has an infection of a cranial dural sinus. This sinus that lies in the margin of the tentorium cerebelli and runs from the posterior end of the cavernous sinus to the transverse sinus is infected. Which of the following sinuses is affected by inflammation?

A) Staight sinus
B) Inferior sagittal sinus
C) Sphenoparietal sinus
D) Superior petrosal sinus
E) Cavernous sinus

a 34-year-old man in bar fight suffers a knife wound that severs the abducens nerve proximal to its entrance into the orbit. Which of the following conditions results from this injury?

A) Ptosis of the upper eyelid
B) Loss of the ability to dialate the pupil
C) External strabismus (lateral deviation)
D) Loss of visual accomodation
E) Internal strabismus (medial deviation)

A 24-year-old man falls from his motorcycle and lands in a creek. Death may result from bilateral severance of which of the following nerve?

A) Trigeminal nerve
B) Facial nerve
C) Vagus nerve
D) Spinal accessory nerve
E) Hypoglossal nerve

A 25-year-old man is involed in an automobile accident and slams his head into a concreate wall of a bridge. His computed tomography (CT scan) reveals that the middle meningeal artery has ruptured but the meninges remain intact. Blood leaking from this artery enters which of the following spaces?

A) Subarachnoid space
B) Subdural space
C) Epidural space
D) Subpial space
E) Cranial dural sinuses

A 27-year-old paratrooper lands on a pinetree. Consequently, preganglionic parasympathetic nerves leaving the central nervous system are lacerated. Which of the following structures contain cell bodies of the damaged nerve fibers?

A) Cervical and sacral spinal cord
B) Cervical and thoracic spinal cord
C) Brain stem and cervical spinal cord
D) Thoracic and lumbar spinal cord
E) Brain stem and sacral spinal cord

Following radical resection of a primary tongue tumor, a 72-year-old patient has lost general sensation on the anterior two thirds of the tongue. This is probably due to injury to branches of which of the following nerves?

A) Trigeminal nerve
B) Facial nerve
C) Glossopharyngeal nerve
D) Vagus nerve
E) Hypoglossal nerve

A 67-year-old woman comes to her physician complaining of visual loss. Her magnetic resonance imaging (MRI) scan shows an enlarged pituitary gland that lies in the cella turcica, immediately posterior and superior to which of the following structures?

A) Frontal sinus
B) Maxillary sinus
C) Ethmoid air cells
D) Mastoid air cells
E) Sphenoid sinus

After having a tonsillectomy, a 57-year-old man with a long history of chewing tobacco use is unable to detect taste on the posterior one third of his tongue. Which of the following nerves has most likely been injured?

A) Internal laryngeal nerve
B) Lingual nerve
C) Glossopharyngeal nerve
D) Greater palatine nerve
E) Chordae timpani

A 14-year-old boy hits his head on the asphalt road after falling off his skateboard. His radiograph reveals damage to the cella turcica. This is probably due to fracture of which of the following bones?

A) Frontal bone
B) Ethmoid bone
C) Temporal bone
D) Basioccipital bone
E) Sphenoid bone

The nerve accompanying the superior thyroid artery may be damaged during an operation on the thyroid gland. Which of the following functional defects may result from this injury?

A) Loss of sensation above the vocal cord
B) Loss of lateral rotation of the arytenoid cartilage
C) Paralysis of the vocalis muscle
D) Lack of abduction of the vocal cord
E) Decreased tension of the vocal cord

A 37-year-old patient has an infectious inflammation of the dural venous sinus closest to the pituitary gland and a secondary thrombus formation. Which of the following is the most likely site of infection?

A) Straight sinus
B) Cavernous sinus
C) Superior petrosal sinus
D) Sigmoid sinus
E) Confluence of sinuses

A 53-year-old woman is diagnosed as having a pituitary tumor. If the tumor is larged enough, she could exhibit which of the following disorder?

A) Blindness
B) Bitemporal (heteronymous) hemianopia
C) Right nasal hemianopia
D) Left homonymous
E) Binasal hemianopia

A young singer at the local music theatre visits her physician and complains of vocal dificulties. On examination she is unable to abduct the vocal cords during quiet breathing. Which of the following muscle is most likely paralyzed?

A) Vocalis muscle
B) Cricothyroid muscle
C) Oblique arytenoid muscle
D) Posterior cricoarytenoid muscle
E) Thyroarytenoid muscle

A 71-year-old woman often visits an emergency department swallowing difficulties and subsequent choking while eating food. Which of the following pair of muscles is most instrumental in preventing food from entering the larynx and trachea during swallowing?

A) External hyoid and external thyroid muscle
B) Oblique arytenoid and aryepiglottic muscle
C) Inferior pharangeal constrictor and thyroid muscle
D) Levator veli palatini and tensor palatini muscles
E) Musculus uvulae and geniohyoid muscle

A 31-year-old woman complains of headache and dizziness after hitting a kitchen cabiner door with her head. Her magnetic resonance imaging (MRI) scan and venogram show a large blood clot in the great cerebral vein of the Galen. The obstructed vein of the brain is a direct tributary of which of the following venous structures?

A) Emissary veins
B) Pterygoid venous plexus
C) Dipoloic veins
D) Dural venous sinuses
E) Internal jugular vein

A 41-year-old woman overdoses on some prescription medications that have a common side effect of autonomic nerve stimulation. Which of the following conditions or actions results from stimulation of the parasympathetic fibers to the eyeball?

A) Enhanced vision for distant obects
B) Dilation of the pupil
C) Contraction of capillaries in the iris
D) Contraction of the ciliary muscle
E) Flattening of the lens

A 53-year-old woman with a severe middle ear infection comes to a hospital. On examination, physician finds that the infection has injured the tympanic nerve. The damaged nerve:

A) Is a branch of the facial nerve
B) Contains postganglionic parasympathetic fibers
C) Synapses with fibers in the lesser petrosal nerve
D) Is a branch of the glossopharyngeal nerve
E) Forms the tympanic plexus in the external auditory meatus

A 13-year-old boy competing in a motocross competition falls from his bike and sustains massive head injuries. Which of the following cavities are sperated from the middle cranial fossa by a thin layer of bone?

A) Auditory tube and bony orbit
B) Middle ear cavity and sphenoid sinus
C) Sigmoid sinus and frontal sinus
D) Sphenoid sinus and ethmoid sinus
E) maxillary sinus and middle ear cavity

A 32-year-old house painter suffered from a head injury after falling off a ladder and has bleeding in his head. During intraoperative testing, the neurosurgeon notes loss of general sensation in the dura of the middle cranial fossa. Which of the following nerves has been affected?

A) Vagus nerve
B) Facial nerve
C) Hypoglossal nerve
D) Trigeminal nerve
E) Glossopharyngeal nerve

During a carotid endarterectomy of a 57-year-old man who suffered a stroke, the carotid sinus is damaged. A third year medical student in medical rotation notices that the injured structure:

A) Is located at the origin of the external carotid artery
B) Is inervated by the facial nerve
C) Functions as a chemoreceptor
D) Is stimulated by changes in blood pressure.
E) Communicated freely cavernous sinus

During a game, a 26-year old baseball player is hit in the head by a baseball, which fractured the optic canal. Which of the following pairs of structures is most likely to be damaged?

A) Optic nerve & ophthalmic vein
B) Opthalmic vein & opthalmic nerve
C) Opthalmic artery & optic nerve
D) Opthalmic nerve & optic nerve
E) Opthalmic artery & opthalmic vein

A 43-year-old man has new onset of difficulty with speaking. Examination by the ear nose and throat (ENT) resident reveals problems in elevating the hyoid bone and floor of the mouth, secondary to paralysis of the posterior belly of the digastric muslce. Which of the following nerves is most likely involved?

A) Accessory nerve
B) Trigeminal nerve
C) Ansacervicalis
D) Facial nerve
E) Glossopharyngeal nerve

The drummer of a local band presents to your clinic with hearing loss. Otoscopic examination reveals loss of contraction of the tensor tympani and the stapedius, which prevents damage to the ear drum and middle ear ossicles. These muscles are most likely controlled by which of the following nerves?

A) Chorda Tympani & yympanic nerve
B) Trigeminal and facial nerves
C) Auditory & vagus nerves
D) Facial & auditory nerves
E) Trigeminal & accessory nerves

The pupil in the eye of a 43-year-old patient remains small even when room lighting is dim. Which of the following nerve will be injured?

A) Trochlear nerve
B) Superior cervical ganglion
C) Oculomotor nerve
D) Ophthalmic nerve
E) Abducens nerve

A pharyngeal (GAG) reflex is the contraction of the pharyngeal muscle that is a elicited by touching the back of a patients pharynx (e.g., with a tongue depressor). Afferent nerve fibers that inervated the pharyngeal mucosa are branches of which of the following nerves?

A) Trigeminal nerve
B) Facial nerve
C) Glossopharyngeal nerve
D) Vagus nerve
E) Hypoglossal nerve

A patient can move his eyeballs normally and see distant object clearly but cannot focus on near objects. This condition may indicate damage to which of the following structures?

A) Ciliary ganglion and oculomotor nerve
B) Oculomotor nerve and long ciliary nerve
C) Short ciliary nerve and ciliary ganglion
D) Superior cervical ganglion and long ciliary nerve
E) Oculomotor, trochlear, and abducens nerves

A benign tumor in the orbit of a 49-year-old man compresses a structure that runs through both the superior orbital fissure on the common tendinous ring. Which of the following structures is most likely damaged?

A) Frontal nerve
B) Lacrimal nerve
C) Trochlear nerve
D) Abducens nerve
E) Ophthalmic vein

A 37-year-old man feels a little discomfort when moving his tongue, pharynx and larynx. Physical examination indicated that the muscles attached to the styloid process are paralyzed. Which of the following groups of cranial nerves are damaged?

A) Facial, glossopharyngeal and hypoglossal nerve
B) Hypoglossal, vagus, and facial nerves
C) Glossopharyngeal, and vagus nerves
D) Vagus, spinal accessory, and hypoglossal nerves
E) Facial, glossopharyngeal, vagus

A 30-year-old woman has horseness in her voice, and her uvula is deviated to the left on phonation. Which of the following nerves is damaged?

A) Right trigeminal nerve
B) Left trigeminal nerve
C) Right vagus nerve
D) Left vagus nerve
E) Glossopharyngeal nerve

I high school basketball player experiences a sudden difficulty in breathing and is brought an emergency room. When a low tracheotomy is performed below the isthmus of the thyroid, which of the following vessels may be encountered?

A) Inferior thyroid artery
B) Inferior thyroid vein
C) Costocervical trunk
D) Superior thyroid artery
E) Right brachial cephalic vein

A 59-year-old man complains of numbness in the anterior cervical triangle. Therefore, damage has occured to which of the following nerve?

A) Phrenic nerve
B) Great auricular nerve
C) Transverse cervical nerve
D) Supraclavicular nerve
E) Lesser occipital nerve

A 53-year-old man has difficulty with breathing through his nose. On examination, his physician finds that he swelling of the mucous membrane of the superior nasal meatus. Which opening of the paranasal sinuses is most likely clogged?

A) Middle ethmoidal sinus
B) Maxillary sinus
C) Posterior ethmoidal sinus
D) Anterior ethmoidal sinus
E) Frontal sinus

Following a penetrated injury in the submandibular triangle, the tongue of a 45-year-old patient deviates to the left on protrusion. Which of the following nerves is injured?

A) Right lingual nerve
B) Left lingual nerve
C) Right hypoglossal nerve
D) Left hypoglossal nerve
E) Left glossopharyngeal nerve

A 47-year-old man cannot move his eye laterally. Which of the following conditions will cause this type of inability to move the eye?

A) Tumor of the pituitary gland
B) Oclusion of the posterior cerebral artery
C) Infection in the maxillary sinus
D) Infection in the cavernous sinus
E) Tumor in the anterior cranial fossa

A young boy with a tooth abscess from a long standing infection suffers damage of the lingual nerve as it enters the oral cavity. Which of the following structures contain cell bodies of injured nerve fibers?

A) Geniculate and otic ganglia
B) Trigeminal and submandibular ganglia
C) Trigeminal and dorsal root ganglia
D) Geniculate and trigeminal ganglia
E) Geniculate and pterygopalatine ganglia

A 61-year-old woman is found to have ocualar lymphoma invading her optical canal. Which of the following structures will most likely be damaged?

A) Ophthalmic vein
B) Ophthalmic nerve
C) Oculomotor nerve
D) Trochlear nerve
E) Ophthalmic artery

A 76-year-old man with swallowing difficulties undergoes imaging for a possible mass. The computed tomographic (CT) scan image at the level of the cricothyroid ligament in his neck should show which of the following structures?

A) Inferior laryngeal nerve
B) External carotid arteries
C) Inferior thyroid veins
D) Thyrocervical trunks
E) Internal laryngeal nerves

A knife ound has severed the oculomotor nerve in a 45-year-old man. Which of the following conditions will occur because of this injury?

A) Constricted pupil
B) Abduction of the eyeball
C) Complete ptosis
D) Impaired lacrimal secretion
E) Paralysis of the ciliary muscle

The muscles that are of branchiomeric origin are paralyzed in a 26-year-old patient. A lesion of which of the following nerves would cause muscle disfunction?

A) Oculomotor nerve
B) Trochlear nerve
C) Trigeminal nerve
D) Abducens nerve
E) Hypoglossal nerve

During surgery for a malignant parotid tumor in a 69-year-old woman, the main trunk of the facial nerve is lacerated. Which of the following muscles is paralyzed?

A) Masseter muscle
B) Stylopharyngeal muscle
C) Anterior belly of the digastric muscle
D) Buccinator muscle
E) Tensor tympanic muscle