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Question 1
Incorrect
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A 50-year-old man presents with unilateral facial paralysis after being hit on the head. On examination, he has a right-sided facial nerve palsy and watery discharge from the nose. What is the most likely underlying cause?
Your Answer: Occipital bone fracture
Correct Answer: Petrous temporal fracture
Explanation:Nasal discharge of clear fluid and a recent head injury makes basal skull fracture the most likely underlying cause for facial nerve palsy.Facial palsy is a neurological condition in which function of the facial nerve (cranial nerve VII) is partially or completely lost. It is often idiopathic (Bell’s palsy) but in some cases, specific causes such as trauma (e.g. temporal bone fracture), infections, or metabolic disorders can be identified. Two major types are distinguished: 1. Central facial palsy—lesion occurs between cortex and nuclei in the brainstem2. Peripheral facial palsy—lesion occurs between nuclei in the brainstem and peripheral organs Diagnosis can usually be made clinically while patient’s history often helps in evaluating the underlying aetiology.Patients with basal skull fracture following head injury (as in this case) exhibit Battle’s sign on examination. It is an indication of fracture of middle cranial fossa of the skull and consists of bruising over the mastoid process as a result of extravasation of blood along the path of the posterior auricular artery. Clinical presence of CSF leak further supports the diagnosis.Assessment options for basal skull fracture include CT and MRI scan. Idiopathic facial nerve palsy is treated with oral glucocorticoids and, in severe cases, with antivirals. Treatment of the other types depends on the underlying cause. Prophylactic antibiotics are given in cases of CSF leak.
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This question is part of the following fields:
- Head & Neck
- Pathology
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Question 2
Correct
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The pterygoid plexus receives tributaries from which of the following veins?
Your Answer: Maxillary vein
Explanation:The pterygoid plexus of veins is the main venous component associated with the infratemporal fossa. It receives tributaries corresponding to the branches of the internal maxillary artery. This plexus communicates freely with the anterior facial vein; it also communicates with the cavernous sinus, by branches through the foramen of Vesalius, foramen ovale and foramen lacerum. The (internal) maxillary vein is a short trunk which accompanies the first part of the (internal) maxillary artery. It is formed by a confluence of the veins of the pterygoid plexus and passes backward between the sphenomandibular ligament and the neck of the mandible and unites with the temporal vein to form the posterior facial vein. It carries blood away from the infratemporal fossa.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 3
Incorrect
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Elevation of the mandible is produced primarily by which of the following muscles:
Your Answer: Digastric and masseter
Correct Answer: Temporalis, masseter and medial pterygoid
Explanation:Elevation of the mandible is generated by the temporalis, masseter and medial pterygoid muscles.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 4
Correct
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Of the following, which is NOT a branch of the abdominal aorta?
Your Answer: Superior phrenic artery
Explanation:The abdominal aorta begins at the level of the body of T12 near the midline, as a continuation of the thoracic aorta. It descends and bifurcates at the level of L4 into the common iliac arteries. The branches of the abdominal aorta (with their vertebra level) are: 1. Inferior phrenic arteries: T12 (upper border) 2. Coeliac artery: T12 3. Superior mesenteric artery: L1 4. Middle suprarenal arteries: L1 5. Renal arteries: Between L1 and L2 6. Gonadal arteries: L2 (in males, it is the testicular artery, and in females, the ovarian artery) 7. Inferior mesenteric artery: L3 8. Median sacral artery: L4 9. Lumbar arteries: Between L1 and L4 The superior phrenic artery branches from the thoracic aorta.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 5
Correct
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The left lateral pterygoid muscle is one of the muscles of mastication. When acting alone, it will shift the mandible towards which direction?
Your Answer: Laterally, to the right
Explanation:The lateral pterygoid or external pterygoid is a muscle of mastication with two heads. It lies superiorly to the medial pterygoid. When acting alone, it will shift the mandible laterally and to the right.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 6
Incorrect
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The following foetal anatomical features functionally closes earliest at birth?
Your Answer: Ductus arteriosus
Correct Answer: Foramen ovale
Explanation:Foramen ovale, ductus arteriosus (DA) and ductus venosus (DV) are the three important cardiac shunts in-utero. At birth the umbilical vessels constrict in response to stretch as they are clamped. Blood flow through the ductus venosus (DV) decreases but the DV closes passively in 3-10 days. As the pulmonary circulation is established, there is a drastic fall in pulmonary vascular resistance and an increased pulmonary blood flow. This increases flow and pressure in the Left Atrium that exceeds that of the right atrium. The difference in pressure usually leads to the IMMEDIATE closure of the foramen ovale. The DA is functionally closed within the first 36-hours of birth in a healthy full-term newborn. Subsequent endothelial and fibroblast proliferation leads to permanent anatomical closure within 2 – 3 weeks. Oxygenated blood from the placenta passes via the umbilical vein to the liver. Blood also bypasses the liver via the ductus venosus into the inferior vena cava (IVC). The Crista dividens is a tissue flap situated at the junction of the IVC and the right atrium (RA). This flap directs the oxygen-rich blood, along the posterior aspect of the IVC, through the foramen ovale into the left atrium (LA). The Eustachian valve also known as the valve of The IVC is a remnant of the crista dividens.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 7
Incorrect
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Regarding the tongue, which of the following statements is CORRECT:
Your Answer: The posterior root of the tongue is attached to the mandible and the thyroid cartilage.
Correct Answer: The lymphatic supply of the tongue drains to the jugulo-omohyoid node of the deep cervical chain.
Explanation:All lymphatics from the tongue ultimately drain into the deep cervical chain of nodes along the internal jugular vein, particularly the jugulo-omohyoid lymph node.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 8
Incorrect
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Elevation of the eyeball is primarily produced by which of the following muscles:
Your Answer: Superior rectus and superior oblique
Correct Answer: Superior rectus and inferior oblique
Explanation:Elevation of the eyeball is produced by the superior rectus and the inferior oblique muscles.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 9
Correct
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A suspicious growth on the posterior tongue of a 40-year-old man was discovered by his dentist and was immediately referred for possible oral cancer. The lymph from the posterior tongue will drain to which of the following nodes?
Your Answer: Deep cervical nodes
Explanation:Lymph from the medial anterior two thirds of the tongue travels to the deep cervical lymph nodes. Lymph from the lateral anterior tongue goes to the submandibular nodes.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 10
Correct
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A 45-year-old woman gives a two-week history of fatigue, muscle cramps, and paraesthesia of her fingers and toes. She has low serum calcium and low serum parathyroid hormone levels on investigations. She appears slightly confused, likely due to hypocalcaemia, and cannot give a full account of her past medical history, but can recall that she recently was admitted to the hospital. What is the most likely cause of her hypoparathyroidism?
Your Answer: Thyroidectomy
Explanation:The most common cause of hypoparathyroidism is injury or removing the parathyroid glands. They can be injured accidentally during surgery to remove the thyroid as they are located posterior to the thyroid gland. A result of both low parathyroid hormone and low calcium is likely to mean that the parathyroid glands are not responding to hypocalcaemia. The hypocalcaemia can cause confusion, and the stay in the hospital is likely to refer to her surgery. While a parathyroid adenoma is fairly common and can cause hypoparathyroidism, it much more likely causes hyperparathyroidism. Chronic kidney disease is likely to cause hypocalcaemia, which would increase parathyroid hormone production in an attempt to increase calcium levels, causing hyperparathyroidism. Vitamin D is activated by the kidneys and then binds to calcium to be absorbed in the terminal ileum so that a deficiency would cause hyperparathyroidism.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 11
Incorrect
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An 80 year old woman is due for cataract surgery. There are no contraindications to regional anaesthesia so a peribulbar block was performed. 8mls of 2% lidocaine was injected using an infratemporal approach. However, there is still movement of the globe after 5 mins. The least likely extraocular muscle to develop akinesia is:
Your Answer: Lateral rectus
Correct Answer: Superior oblique
Explanation:The fibrotendinous ring formed by the congregation of the rectus muscles at the apex of the orbit does not include superior oblique. This muscle is completely outside the ring and so it is the most difficult muscle to anaesthetise completely. A good grasp of the anatomy of the area being anaesthetised is important with all regional anaesthetic techniques so that potential problems and complications with a block can be anticipated. The borders of this pyramid whose apex points upwards and outwards of the bony orbit are as follows: Floor – Zygoma and Maxilla Roof – frontal bone Medial wall – maxilla, ethmoid, sphenoid and lacrimal bones. Lateral wall – greater wing of the sphenoid and the zygoma. The four recti muscles (superior, medial, lateral and inferior) originate from a tendinous ring (the annulus of Zinn) and extend anteriorly to insert beyond the equator of the globe. Bands of connective tissue are present between the rectus muscles forming a conical structure and hinder the passage of local anaesthetic. The superior oblique muscle is situated outside this ring and is the most difficult muscle to anaesthetise completely, particularly with a single inferotemporal peribulbar injection. An additional medial injection may help to prevent this. The cranial nerve supply to the extraocular muscles are: 3rd (inferior oblique, inferior recti, medial and superior) 4th (superior oblique), and 6th (lateral rectus). The long and short ciliary nerves provide the sensory supply to the globe and these are branches of the nasociliary nerve, (which is itself a branch of the ophthalmic division of the trigeminal nerve). To achieve anaesthesia for the eye, these nerves which enter the fibrotendinous ring need to be fully blocked to anaesthetise the eye for surgery.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 12
Incorrect
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Which of the following muscles is innervated by the inferior branch of the right recurrent laryngeal nerve?
Your Answer: Thyroarytenoid
Correct Answer: Posterior cricoarytenoid
Explanation:The posterior cricoarytenoid muscle, which is the sole abductor of the vocal folds, receives its innervation from the inferior laryngeal nerve which is a continuation of the recurrent laryngeal nerve.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 13
Correct
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Which extraocular muscle is entrapped in a patient with a blowout fracture?
Your Answer: Inferior rectus
Explanation:A blowout fracture is an isolated fracture of the orbital walls without compromise of the orbital rims. The common mechanisms are falls, high-velocity ball-related sports, traffic accidents, and interpersonal violence. The frontal, ethmoidal, sphenoid, zygomatic, and lacrimal bones form the bony structures of the orbit. Medially, the maxillary and the lacrimal bone form the lacrimal fossa. Together with the lamina papyracea of the ethmoid bone, they form the medial wall. The sphenoid bone forms the posterior wall and houses the orbital canal. Lateral to the orbital canal lies the superior orbital fissure housing cranial nerves III, IV, V, and VI. The zygomatic bone forms the lateral wall. Superior and inferior borders are the frontal and maxillary bones. Located around the globe of the eye and attached to it are 6 extraocular muscles; the 4 rectus muscles and the superior and inferior oblique muscles. The fat and connective tissue around the globe help to reduce the pressure exerted by the extraocular muscles. The goal of treatment is to restore aesthetics and physiological function. The problem with orbital blowout fractures is that the volume of the orbit can be increased, resulting in enophthalmos and hypoglobus. In addition, the orbital tissue and inferior rectus muscle can become trapped by the bony fragments leading to diplopia, limitation of gaze, and tethering. Finally, the orbital injury can lead to retinal oedema, hyphema, and significant loss of vision. While some cases may be managed with conservative care, others may require some type of surgical intervention.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 14
Incorrect
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Which of the following statements is correct with regards to Horner's syndrome?
Your Answer: Mydriasis is a typical feature.
Correct Answer: Miosis occurs due to paralysis of the dilator pupillae muscle.
Explanation:The characteristics of Horner’s syndrome are pupil constriction, partial ptosis and anhidrosis.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 15
Incorrect
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The muscles of the soft palate (other than the tensor veli palatini) are innervated by which of the following nerves:
Your Answer: Glossopharyngeal nerve
Correct Answer: Vagus nerve
Explanation:All of the muscles of the soft palate are innervated by the vagus nerve (from the pharyngeal plexus), except for the tensor veli palatini, which is innervated by a branch of the mandibular nerve.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 16
Incorrect
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A 23-year-old student presents with a fever and sore throat. Upon physical examination, it was observed that he had bilaterally enlarged tonsils that are covered in large amounts of exudate. A diagnosis of tonsillitis was made. The lymph from the tonsils will drain to which of the following nodes?
Your Answer: Superficial cervical lymph nodes
Correct Answer: Deep cervical lymph nodes
Explanation:The tonsils are collections of lymphatic tissue located within the pharynx. They collectively form a ringed arrangement, known as Waldeyer’s ring: pharyngeal tonsil, 2 tubal tonsils, 2 palatine tonsils, and the lingual tonsil. Lymphatic fluid from the lingual tonsil drains into the jugulodigastric and deep cervical lymph nodes. Lymphatic fluid from the pharyngeal tonsil drains into the retropharyngeal nodes (which empty into the deep cervical chain), and directly into deep cervical nodes within the parapharyngeal space. The retropharyngeal and the deep cervical lymph nodes drain the tubal tonsils. The palatine tonsils drain to the jugulodigastric node, a node of the deep cervical lymph nodes, located inferior to the angle of the mandible.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 17
Correct
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The glossopharyngeal nerve provides the parasympathetic innervation of the:
Your Answer: Parotid salivary gland
Explanation:The glossopharyngeal nerve provides parasympathetic innervation for the parotid salivary gland via the auriculotemporal nerve. The facial nerve supplies the parasympathetic innervation of the lacrimal, nasal, sublingual and submandibular glands.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 18
Incorrect
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A 36 year old opera singer is admitted for a right thyroid lobectomy. Post operatively, he is unable to sing high notes. Which muscle is likely to demonstrate impaired function?
Your Answer: Posterior cricoarytenoid
Correct Answer: Cricothyroid
Explanation:Thyroidectomy has been reported as the most frequent cause of external branch of superior laryngeal nerve (EBSLN) injury. Diagnosis of EBSLN injury may be difficult because the symptoms are nonspecific in many cases. However, advanced diagnostic techniques have revealed the incidence to be relatively high, ranging from 5 to 28%. Paralysis of the EBSLN causes difficulty with high pitch phonation and decreased pitch range secondary to failure of cricothyroid muscle stimulation and lack of tension in the vocal cord. This symptom may be extremely serious for professional voice users. EBSLN injury can also cause vocal fatigue, hoarseness, breathy sounding voice, and vocal nodules.
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This question is part of the following fields:
- Head & Neck
- Pathology
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Question 19
Correct
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A patient complaining of loss of taste in the anterior 2/3 of the tongue has most likely suffered damage to which nerve?
Your Answer: Facial nerve
Explanation:The hypoglossal nerve (CN XII) provides motor innervation to all of the intrinsic and extrinsic muscles of the tongue except for the palatoglossus muscle, which is innervated by the vagus nerve (CN X). It runs superficial to the hyoglossus muscle. Lesions of the hypoglossal nerve cause deviation of the tongue to the ipsilateral (i.e., damaged) side.Taste to the anterior two-thirds of the tongue is achieved through innervation from the chorda tympani nerve, a branch of the facial nerve (CN VII). General sensation to the anterior two-thirds of the tongue is by innervation from the lingual nerve, a branch of the mandibular branch of the trigeminal nerve (CN V3). The lingual nerve is located deep and medial to the hyoglossus muscle and is associated with the submandibular ganglion.On the other hand, taste to the posterior one-third of the tongue is accomplished through innervation from the glossopharyngeal nerve (CN IX), which also provides general sensation to the posterior one-third of the tongue.Taste perception also is performed by both the epiglottis and the epiglottic region of the tongue, which receives taste and general sensation from innervation by the internal laryngeal branch of the vagus nerve (CN X). Damage to the vagus nerve (CN X) causes contralateral deviation (i.e., away from the injured side) of the uvula.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 20
Incorrect
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Functions of the glossopharyngeal nerve include the following except:
Your Answer: Transmission of sensory input from posterior 1/3 of the tongue
Correct Answer: Proprioceptive input from muscles of the tongue and larynx
Explanation:The glossopharyngeal nerve is a mixed nerve consisting of both sensory and motor fibers. It has several branches and five distinct general functions:Branchial motor- Special visceral efferent- supplies the Stylopharyngeus muscle and superior constrictor muscle.Visceral motor- general visceral efferent- provides parasympathetic innervation of the parotid gland.Visceral sensory- general visceral afferent- carries visceral sensory information from the carotid sinus and carotid body.General sensory- general somatic afferent- provides general sensory information from the inner surface of the tympanic membrane, upper pharynx and posterior one third of the tongue.Visceral afferent- special visceral afferent- provides taste sensation from the posterior one third of the tongue including the circumvallate papillae.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 21
Correct
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In adults, there are normally how many teeth:
Your Answer: 32
Explanation:In adults, there are 32 teeth, 16 in the upper jaw and 16 in the lower jaw. On each side in both upper and lower arches, there are two incisors, one canine, two premolars and three molar teeth.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 22
Correct
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Of the following, which is NOT a branch of the external carotid artery?
Your Answer: Mandibular artery
Explanation:The external carotid artery has eight important branches: 1. Superior thyroid artery 2. Ascending pharyngeal artery 3. Lingual artery 4. Facial artery 5. Occipital artery 6. Posterior auricular artery 7. Maxillary artery (terminal branch) 8. Superficial temporal artery (terminal branch) There is no mandibular artery but the first part of the maxillary artery is called the mandibular part as it is posterior to the lateral pterygoid muscle. The maxillary artery is divided into three portions by its relation to the lateral pterygoid muscle: first (mandibular) part: posterior to the lateral pterygoid muscle second (pterygoid or muscular) part: within the lateral pterygoid muscle third (pterygopalatine) part: anterior to the lateral pterygoid muscle
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 23
Correct
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The thyroid gland is a large ductless gland located in which part of the neck?
Your Answer: Visceral space
Explanation:The thyroid gland is an endocrine gland in the neck, consisting of two lobes connected by an isthmus. It is situated at the front and sides of the neck in the visceral space.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 24
Incorrect
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A 50-year-old man has complained of persistent hoarseness and dry cough. He has a history of smoking 20 cigarettes per day. The examination reveals no significant clinical signs of cranial nerve damage. Referred to an ENT specialist, the patient is explained how coughing is usually a defence mechanism of the body which is activated more than usual by the chemical irritants in cigarette smoke. However, the ENT doctor suspects a nerve involvement in the cough reflex as the patient also presents with hoarseness with the dry cough. Which nerves is the ENT doctor suspecting to have been affected in this patient?
Your Answer: CN X and XI
Correct Answer: CN IX and X
Explanation:Cough is an important defensive reflex that helps clear secretions and particulates from the airways. A complex reflex arc generates each cough. The cough reflex begins with irritation of the cough receptors present in the epithelium of the trachea, main carina, branching points of large airways, and more distal smaller airways. These receptors are responsive to both mechanical and chemical stimuli. Afferent pathway: Impulses from stimulated receptors are transmitted via sensory nerve fibres of the vagus nerve (mainly) and glossopharyngeal nerve and travel to the medulla diffusely. CN 5 is also thought to contribute to the afferent limb. However, the vagus is the main nerve. Central pathway: The cough centre is located in the upper brain stem and pons Efferent pathway: Impulses from the centre travel via the vagus, phrenic nerve, and spinal motor nerves to the diaphragm, abdominal wall, and muscles.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 25
Incorrect
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A 35 year old opera singer undergoes a thyroidectomy and post-operatively, he develops stridor and is unable to speak. What is the best explanation for this symptom?
Your Answer: Unilateral recurrent laryngeal nerve injury
Correct Answer: Bilateral recurrent laryngeal nerve injury
Explanation:This patient has aphonia due to bilateral damage to the recurrent laryngeal nerve. Bilateral recurrent laryngeal nerve (RLN) injury is rare for benign thyroid lesions (0.2%). After extubation-stridor, respiratory distress, aphonia occurs due to the closure of the glottic aperture necessitating immediate intervention and emergency intubation or tracheostomy. Intra-operative identification and preservation of the RLN minimizes the risk of injury. The recurrent laryngeal nerves control all intrinsic muscles of the larynx except for the cricothyroid muscle. These muscles act to open, close, and adjust the tension of the vocal cords, and include the posterior cricoarytenoid muscles, the only muscle to open the vocal cords. The nerves supply muscles on the same side of the body, with the exception of the interarytenoid muscle, which is innervated from both sides.The nerves also carry sensory information from the mucous membranes of the larynx below the lower surface of the vocal fold, as well as sensory, secretory and motor fibres to the cervical segments of the oesophagus and the trachea.
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This question is part of the following fields:
- Head & Neck
- Pathology
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Question 26
Correct
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The occipital artery is accompanied by which nerve as it arises from the external carotid artery?
Your Answer: Hypoglossal nerve (CN XII)
Explanation:Three main types of variations in the relations of the occipital artery and the hypoglossal nerve are found according to the level at which the nerve crosses the external carotid artery and the point of origin of the occipital artery. In Type I, the hypoglossal nerve crosses the external carotid artery inferior to the origin of the occipital artery; in Type II, the nerve crosses the external carotid artery at the level of origin of the occipital artery; and in Type III, it crosses superior to that level. In Type III the occipital artery makes a loop around the hypoglossal nerve and is in a position to pull and exert pressure on the nerve. This possibility should be taken into consideration in the diagnosis of peripheral paresis or paralysis of the tongue and during surgery in this area.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 27
Correct
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The medial and lateral pterygoid muscles are innervated by which of the following nerves:
Your Answer: Mandibular division of the trigeminal nerve
Explanation:Both the medial and lateral pterygoids are innervated by the mandibular division of the trigeminal nerve.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 28
Correct
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A 20-year-old woman, presented to her GP after swallowing a tiny, sharp bone and is referred to an ENT. She explains that the bone feels stuck in her throat. A laryngoscopy is performed and it shows the bone is lodged in the piriform recess. Name the nerve at highest risk of damage by the bone?
Your Answer: Internal laryngeal nerve
Explanation:The internal laryngeal nerve lies inferior to the piriform recess mucous membrane, placing it at high risk of irritation or damage by sharp foreign objects which become lodged in the recess. Any attempt to retrieve lodged foreign objects must be done careful as there is also a high risk of damage during this process. The other mentioned nerves are not at risk of being affected.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 29
Incorrect
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Your consultant requests that you do a lumbar puncture on a patient who is suspected of having meningitis. This patient, a 15-year-old female, presented to the emergency department with a fever, headache, and neck stiffness. Where should you aspirate a sample of CSF?
Your Answer: Space between the dura mater and the spinal canal
Correct Answer: Subarachnoid space
Explanation:A lumbar puncture, also known as a spinal tap, is a procedure that involves inserting a needle into the lower back’s lumbar region. A needle is inserted into the space between the arachnoid mater and the pia mater, also known as the subarachnoid space, to remove a sample of cerebrospinal fluid.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 30
Correct
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A 35 year old male patient sustained a traumatic head injury. The patient had loss of consciousness, woke up momentarily when he was in the emergency room but became drowsy and comatose a few hours after. CT scan of the brain showed accumulation of blood between the dura and the cranial bone on the left side of his head. What type of haemorrhage did the patient have?
Your Answer: Epidural
Explanation:Epidural hematoma, also known as epidural bleeding, is a type of traumatic brain injury (TBI) in which a build-up of blood occurs between the dura mater (the tough outer membrane of the central nervous system) and the skull. The spinal cord is also covered by a layer of dura mater, so epidural bleeds may also occur in the spinal column. Often due to trauma, the condition is potentially deadly because the build-up of blood may increase pressure in the intracranial space, compressing delicate brain tissue, and causing brain shift. The condition is present in one to three percent of head injuries. Around 15–20% of epidural hematomas are fatal.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 31
Incorrect
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Which of the following statements regarding the arteries in the neck are TRUE?
Your Answer: The facial artery courses superficial to the submandibular salivary gland
Correct Answer: The thyrocervical trunk typically gives rise to the inferior thyroid artery, transverse cervical artery and suprascapular artery
Explanation:The thyrocervical trunk is one of the three branches of the first part of the subclavian artery and gives numerous branches which supply viscera of the neck, the brachial plexus, neck muscles and scapular anastomoses. The vertebral arteries are major arteries of the neck. They arise as branches from the subclavian arteries and merge to form the single midline basilar artery. The carotid sinus is a dilated area at the base of the internal carotid artery just superior to the bifurcation of the internal carotid and external carotid at the level of the superior border of thyroid cartilage.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 32
Incorrect
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In adults, the conus medullaris of the spinal cord lies at which of the following vertebral levels:
Your Answer: L3/L4
Correct Answer: L1/L2
Explanation:At birth, the conus medullaris lies at L3. By the age of 21, it sits at L1/L2.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 33
Correct
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Which of the following statements is true regarding the relation to the liver?
Your Answer: The caudate lobe is superior to the porta hepatis
Explanation:Ligamentum venosum is an anterior relation of the liver: The ligamentum venosum, the fibrous remnant of the ductus venosus of the fetal circulation, lies posterior to the liver. It lies in the fossa for ductus venosus that separates the caudate lobe and the left lobe of the liver. The portal triad contains three important tubes: 1. Proper hepatic artery 2. Hepatic portal vein 3. Bile ductules It also contains lymphatic vessels and a branch of the vagus nerve. The bare area of the liver is a large triangular area that is devoid of any peritoneal covering. The bare area is attached directly to the diaphragm by loose connective tissue. This nonperitoneal area is created by a wide separation between the coronary ligaments. The porta hepatis is a fissure in the inferior surface of the liver. All the neurovascular structures (except the hepatic veins) and hepatic ducts enter or leave the liver via the porta hepatis. It contains the sympathetic branch to the liver and gallbladder and the parasympathetic, hepatic branch of the vagus nerve. The caudate lobe (segment I) lies in the lesser sac on the inferior surface of the liver between the IVC on the right, the ligamentum venosum on the left, and the porta hepatis in front
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 34
Incorrect
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A young 16 year old boy presented to the ENT clinic with a history of sore throat for the past 1 day. On examination there was a pharyngeal purulent discharge. Which of the following types of inflammation is seen in this boy?
Your Answer: Abscess formation
Correct Answer: Acute inflammation
Explanation:A 1 day history suggests the purulent discharge is due to acute inflammation. Acute inflammation has 3 features: 1) the affected area is occupied by a purulent discharge composed of proteins, fluids and cells from local blood vessels2) the infective agent i.e. bacteria is present in the affected area 3) the damaged tissue can be liquified and the debris removed from the site. If the inflammation lasts over weeks or months, then it is termed as chronic inflammation. Granulomatous inflammation is characterised by the presence and formation of granulomas. Exudate is not a feature of resolution or a complication of inflammation. Abscess formation takes more than 1 day to form and is usually within a capsule/cavity.
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This question is part of the following fields:
- Head & Neck
- Pathology
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Question 35
Correct
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To reach the oral vestibule, the parotid duct must pierce this muscle:
Your Answer: Buccinator muscle
Explanation:The parotid duct or Stensen duct is a duct and the route that saliva takes from the major salivary gland, the parotid gland into the mouth. The parotid duct is formed when several interlobular ducts—the largest ducts inside the parotid gland join. It emerges from the gland and runs forward along the lateral side of the masseter muscle. In this course, the duct is surrounded by the buccal fat pad. It takes a steep turn at the border of the masseter and passes through the buccinator muscle, opening into the vestibule of the mouth, between the cheek and the gums, at the parotid papilla, which lies across the second superior molar tooth.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 36
Correct
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An 11-year-old boy was brought to the emergency room due to fever and pain in the ears. Upon physical examination, it was observed that the mastoid area is erythematous and there is a presence of a boggy, tender mass. A diagnosis of acute mastoiditis was made. Which of the following parts of the temporal bone is most likely involved?
Your Answer: Petrous part
Explanation:Mastoiditis is the inflammation of a portion of the temporal bone referred to as the mastoid air cells. The mastoid air cells are epithelium lined bone septations that are continuous with the middle ear cavity. The temporal bone is composed of four parts: the mastoid process, the petrous pyramid, the squamous, and tympanic portions. The mastoid process and the petrous pyramid are the portions of particular interest because of the prevalence of suppurations within these parts of the temporal bone.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 37
Correct
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Where is the mental foramen located?
Your Answer: In the mandible
Explanation:The mental foramen is found bilaterally on the anterior surface of the mandible adjacent to the second premolar tooth. The mental nerve and terminal branches of the inferior alveolar nerve and mental artery leave the mandibular canal through it.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 38
Correct
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During a car accident, the side mirror shattered and a broken piece of glass severed the posterolateral aspect of the driver's neck. A physical examination reveals that the driver is unable to elevate the tip of his shoulder on the side that was injured. Which nerve was injured?
Your Answer: Accessory
Explanation:The tip of the shoulder is formed by the acromion of the scapula. This part is moved by the trapezius muscle which is innervated by the accessory nerve. Damage to this nerve therefore will prevent the patient from lifting the tip of the shoulder.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 39
Correct
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A 51 year old female presents with a sensation of grittiness in her eyes which has been present for the past few months. She also complains of symptoms of a dry mouth. On examination, she is seen with a swelling of her parotid gland. However, she has no evidence of facial nerve palsy. Which of the following is the most likely underlying diagnosis?
Your Answer: Sjogren's syndrome
Explanation:Sjogren syndrome (SS) is a long-term autoimmune disease that affects the body’s moisture-producing glands. Primary symptoms are a dry mouth and dry eyes. Other symptoms can include dry skin, vaginal dryness, a chronic cough, numbness in the arms and legs, feeling tired, muscle and joint pains, and thyroid problems. Those affected are at an increased risk (5%) of lymphoma. It primarily affects women in their peri and post-menopausal years of life.
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This question is part of the following fields:
- Head & Neck
- Pathology
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Question 40
Incorrect
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Regarding the lacrimal apparatus, which of the following statements is CORRECT:
Your Answer: The lacrimal gland is located in the superomedial region of the orbit.
Correct Answer: Lacrimal fluid is drained from the eyeball through the lacrimal punctum.
Explanation:Lacrimal fluid is drained from the eyeball through the lacrimal punctum.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 41
Correct
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During uterogrowth, the second branchial arch gives rise to which structures?
Your Answer: Stylohyoid muscle
Explanation:The second pharyngeal arch or hyoid arch, is the second of six pharyngeal arches that develops in fetal life during the fourth week of development and assists in forming the side and front of the neck. Derivatives: Skeletal – From the cartilage of the second arch arises: Stapes, Temporal styloid process, Stylohyoid ligament, and Lesser cornu of the hyoid bone.Muscles: Muscles of face Occipitofrontalis muscle Platysma Stylohyoid muscle Posterior belly of Digastric Stapedius muscle Auricular musclesNerve supply: Facial nerve
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 42
Correct
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What is the innervation of the laryngeal mucosa inferior to the true vocal cord?
Your Answer: Recurrent laryngeal nerve
Explanation:Motor innervation to all other muscles of the larynx and sensory innervation to the subglottis is by the recurrent laryngeal nerve.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 43
Correct
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Which of the following structures, is the area in which the superior cerebral veins drain into?
Your Answer: Superior sagittal sinus
Explanation:The superior cerebral veins are predominantly located on the superior aspect of the brain. They are 8 to 12 in number and they drain the lateral, medial and superior aspects of the cerebral hemispheres. These veins drain into the superior sagittal sinus, also known as the superior longitudinal sinus – which is located along the attached margin of the falx cerebri.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 44
Correct
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A 20-year old involved in a brawl was stabbed in the anterior chest in a structure that is in close proximity to where the first rib articulates with the sternum. What is the structure that was most likely injured?
Your Answer: Sternoclavicular joint
Explanation:The first rib articulates with the sternum right below the sternoclavicular joint. The sternal angle articulates with the costal cartilage of the second rib. The nipple is found between the fourth and the fifth ribs, in the fourth intercostal space. The xiphoid process is located right below the point of articulation of the costal cartilage of rib 7 with the sternum. The root of the lung is the part of the lung where neurovascular structures enter and leave the lung. Acromioclavicular joint is the point of articulation between the acromion process and the clavicle, near the shoulder.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 45
Correct
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All of the muscles of the tongue (other than the palatoglossus) are innervated by which of the following nerves:
Your Answer: Hypoglossal nerve
Explanation:All of the muscles of the tongue are innervated by the hypoglossal nerve, except for the palatoglossus, which is innervated by the vagus nerve.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 46
Incorrect
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Which structure does NOT lie in the posterior triangle of the neck?
Your Answer: External jugular vein
Correct Answer: Internal jugular vein
Explanation:The sternocleidomastoid muscle divides the neck into anterior and posterior triangles on both sides of the neck. The posterior triangle has the following boundaries: anteriorly – sternocleidomastoid muscle posteriorly – trapezius roof – investing layer of deep cervical fascia floor – prevertebral fascia overlying splenius capitis, levator scapulae, and the scalene muscles The contents of the posterior triangle are: 1. fat 2. lymph nodes (level V) 3. accessory nerve 4. cutaneous branches of the cervical plexus (A major branch of this plexus is the phrenic nerve, which arises from the anterior divisions of spinal nerves C3-C5) 5. inferior belly of omohyoid 6. branches of the thyrocervical trunk (transverse cervical and suprascapular arteries) 7. third part of the subclavian artery 8. external jugular vein
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 47
Correct
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Which of the following muscles attaches to the pterygomandibular raphe?
Your Answer: Superior pharyngeal constrictor muscle
Explanation:The pterygomandibular raphé (pterygomandibular ligament) provides attachment on its posterior border to the superior pharyngeal constrictor and on its anterior border to the buccinator muscle.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 48
Correct
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Which of the following types best describe the epithelium on the external aspect of the tympanic membrane?
Your Answer: Stratified squamous
Explanation:The external aspect of the tympanic membrane is lined by stratified squamous epithelium. Clinical correlation: Following middle ear infections, this type of epithelium can migrate into the middle ear through a perforated tympanic membrane.The ear is composed of three anatomically distinct regions: – External ear: Auricle is composed of elastic cartilage covered by skin. The lobule has no cartilage and contains fat and fibrous tissue. External auditory meatus is variable in length, measuring approximately 2.5cm long in fully grown children. Lateral third of the external auditory meatus is cartilaginous, and the medial two-thirds is bony. The greater auricular nerve innervates the region. The auriculotemporal branch of the trigeminal nerve supplies most of the external auditory meatus and the lateral surface of the auricle. – Middle ear: It is the space between the tympanic membrane and cochlea. The aditus leads to the mastoid air cells is the route through which middle ear infections may cause mastoiditis. Anteriorly the eustachian tube connects the middle ear to the nasopharynx. The tympanic membrane consists of an outer layer of stratified squamous epithelium, a middle layer of fibrous tissue and an inner layer of mucous membrane continuous with the middle ear. The chorda tympani nerve passes on the medial side of the pars flaccida. The glossopharyngeal nerve and pain innervate the middle ear. Thus, pain may radiate to the middle ear following tonsillectomy. – Ossicles:Malleus attaches to the tympanic membrane (the Umbo). Malleus articulates with the incus (synovial joint). Incus attaches to stapes (another synovial joint). – Internal ear:It consists of the cochlea, semicircular canals, and vestibule. Organ of Corti is the sense organ of hearing and is located on the inside of the cochlear duct on the basilar membrane. Vestibule accommodates the utricle and the saccule. These structures contain endolymph and are surrounded by perilymph within the vestibule. The semicircular canals lie at various angles to the petrous temporal bone. All share a common opening into the vestibule.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 49
Correct
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The tympanic membrane is a thin semi-transparent membrane that separates the tympanic cavity from the bottom of the external acoustic meatus. The interior of the tympanic membrane is innervated by which of the following cranial nerves?
Your Answer: Glossopharyngeal
Explanation:The glossopharyngeal nerve, known as the ninth cranial nerve (CN IX), is a mixed nerve that carries afferent sensory and efferent motor information. The glossopharyngeal nerve has five distinct general functions: – The branchial motor (special visceral efferent), supplies the stylopharyngeus muscle.- The visceral motor (general visceral efferent), provides parasympathetic innervation of the parotid gland via the otic ganglion. – The visceral sensory (general visceral afferent), carries visceral sensory information from the carotid sinus and carotid body. – The general sensory (general somatic afferent), provides general sensory information from the inner surface of the tympanic membrane, upper pharynx (GVA), and the posterior one-third of the tongue.- The visceral afferent (special visceral afferent), provides taste sensation from the posterior one-third of the tongue, including the circumvallate papillae.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 50
Correct
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A 10-year-old develops tonsillitis and presents to the hospital in considerable pain. Which among the following nerves carries the sensation from the tonsillar fossa?
Your Answer: Glossopharyngeal nerve
Explanation:The glossopharyngeal nerve is the primary sensory nerve for the tonsillar fossa. The lesser palatine nerve makes a smaller contribution. Because of this, otalgia may occur following tonsillectomy.Anatomical Rationale:Each palatine tonsil has two surfaces, a medial surface which projects into the pharynx and a lateral surface that is embedded in the wall of the pharynx.The primary arterial supply is from the tonsillar artery, a branch of the facial artery. Its veins pierce the constrictor muscle to join the external palatine or facial veins. The external palatine vein is immediately lateral to the tonsil, which may result in bleeding during a tonsillectomy.Lymphatic drainage is the jugulodigastric node and the deep cervical nodes.TonsillitisThe inflammation of tonsils is usually due to bacterial aetiology (50%) – group A Streptococcus, the remainder of the causes are viral.May be complicated by the development of an abscess (quinsy), which may distort the uvula.Indications for tonsillectomy include recurrent acute tonsillitis, and enlargement causing sleep apnoea.Dissection tonsillectomy is the preferred technique with haemorrhage being the most frequent complication. Delayed otalgia may occur owing to irritation of the glossopharyngeal nerve.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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SESSION STATS - PERFORMANCE PER SPECIALTY
