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Question 1
Correct
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Elevation of the eyeball is primarily produced by which of the following muscles:
Your 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 2
Incorrect
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Which of the following body location is the appropriate site to apply pressure when performing a carotid sinus massage?
Your Answer: Cricoid cartilage
Correct Answer: Thyroid cartilage
Explanation:The common carotid artery runs through the neck and divides into internal and external carotid arteries on both sides near the upper thyroid cartilage. In emergency situations, carotid sinus massage is also used to diagnose or treat paroxysmal supraventricular tachycardia. During the procedure, to maximize access to the carotid artery, the patient is put in a supine position with the neck extended (i.e. elevating the chin away from the chest). The carotid sinus is normally positioned inferior to the angle of the jaw, near the arterial impulse, at the level of the thyroid cartilage. For 5 to 10 seconds, pressure is administered to one carotid sinus. Although pulsatile pressure applied in a vigorous circular motion may be more effective, continuous pressure is preferred since it is more reproducible. If the predicted reaction is not obtained, the operation is repeated on the opposite side after a one- to two-minute wait.
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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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Which of the following nerves is responsible for relaying sensory information from the laryngeal mucosa?
Your Answer: Ansa cervicalis
Correct Answer: Laryngeal branches of the vagus
Explanation:Sensory innervation of the larynx is controlled by branches of the vagus nerve. The internal and external bifurcations of the superior laryngeal nerve is responsible for sensory innervation of the aspect of the larynx superior to the vocal cords, while the recurrent laryngeal nerve is responsible for sensory innervation of the intrinsic musculature of the larynx except for the cricothyroid muscle.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 4
Incorrect
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The mandibular nerve, which is the largest of the 3 divisions of the trigeminal nerve, exits the cranial cavity through which foramen?
Your Answer:
Correct Answer: Foramen ovale
Explanation:At the base of the skull the foramen ovale is one of the larger of the several holes that transmit nerves through the skull. The following structures pass through foramen ovale: mandibular nerve, motor root of the trigeminal nerve, accessory meningeal artery, lesser petrosal nerve, a branch of the glossopharyngeal nerve, emissary vein connecting the cavernous sinus with the pterygoid plexus of veins and occasionally the anterior trunk of the middle meningeal vein.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 5
Incorrect
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All the following statements are FALSE regarding the ophthalmic division of the trigeminal nerve, except:
Your Answer:
Correct Answer: The ophthalmic nerve is the smallest branch of the trigeminal nerve
Explanation:The ophthalmic nerve is the smallest of the three trigeminal divisions. The cutaneous branches of the ophthalmic nerve supply the conjunctiva, the skin over the forehead, the upper eyelid, and much of the external surface of the nose.
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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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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:
Correct 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 7
Incorrect
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Thyroid cancer has spread to the regional lymph nodes of a patient as seen in a staging CT scan. The lymph from the thyroid gland will drain directly to which of the following nodes?
Your Answer:
Correct Answer: Deep lateral cervical lymph nodes
Explanation:Lymphatic drainage of the thyroid gland involves the lower deep cervical, prelaryngeal, pretracheal, and paratracheal nodes. The paratracheal and lower deep cervical nodes, specifically, receive lymphatic drainage from the isthmus and the inferior lateral lobes. The superior portions of the thyroid gland drain into the superior pretracheal and cervical nodes.
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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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A 25-year-old male has tonsillitis and is in considerable pain. Which nerve is responsible for the sensory innervation of the tonsillar fossa?
Your Answer:
Correct Answer: Glossopharyngeal nerve
Explanation:A tonsillar sinus or fossa is a space that is bordered by the triangular fold of the palatoglossal and palatopharyngeal arches in the lateral wall of the oral cavity. The palatine tonsils are in these sinuses. The glossopharyngeal nerve is the main sensory nerve for the tonsillar fossa. The tonsillar branches of the glossopharyngeal nerve supply the palatine tonsils forming a plexus around it. Filaments from this plexus are distributed to the soft palate and fauces where they communicate with the palatine nerves. A lesser contribution is made by the lesser palatine nerve. Because of this otalgia may occur following tonsillectomy.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 9
Incorrect
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A 7 year old girl is taken to her family doctor because her mother is concerned that she has a small epithelial defect anterior to the left ear and it has been noted to discharge foul smelling material for the past 3 days. What is the most likely explanation?
Your Answer:
Correct Answer: Pre auricular sinus
Explanation:The preauricular sinus is a benign congenital malformation of the preauricular soft tissues. Mostly it is noted during routine ear, nose and throat examination, though can present as an infected and discharging sinus. Preauricular sinus is more often unilateral, only occasionally are bilateral forms inherited. The right side is more often involved and females more than males. Most sinuses are clinically silent, eventual, however not rare, appearance of symptoms is related to an infectious process. Erythema, swelling, pain and discharge are familiar signs and symptoms of infection. The most common pathogens causing infection are Staphylococcal species and, less frequently Proteus, Streptococcus and Peptococcus species.Courses of treatment typically include the following:- Draining the pus occasionally as it can build up a strong odour- Antibiotics when infection occurs.- Surgical excision is indicated with recurrent fistula infections, preferably after significant healing of the infection. In case of a persistent infection, infection drainage is performed during the excision operation. The operation is generally performed by an appropriately trained specialist surgeon e.g. a otolaryngologist or a specialist General Surgeon.The fistula can be excised as a cosmetic operation even though no infection appeared. The procedure is considered an elective operation in the absence of any associated complications.
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This question is part of the following fields:
- Head & Neck
- Pathology
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Question 10
Incorrect
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Where is the foramen ovale located?
Your Answer:
Correct Answer: Sphenoid
Explanation:The foramen ovale is an oval shaped opening in the middle cranial fossa located at the posterior base of the greater wing of the sphenoid bone, lateral to the lingula. It transmits the mandibular division of the trigeminal nerve (CN Vc), accessory meningeal artery, emissary veins between the cavernous sinuses and pterygoid plexus, otic ganglion, and occasionally the nervus spinosus and lesser petrosal nerve.
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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:
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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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:
Correct 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 13
Incorrect
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An 80-year-old female suffered a TIA 2 weeks ago. She has been admitted to the vascular ward as she will be undergoing carotid endarterectomy tomorrow morning. To explain the procedure and its complications, the surgeon gives her information about the procedure, telling her the artery will be tied during the operation. She inquires about the areas supplied by the different arteries. You explain that the internal carotid artery supplies the brain while the external carotid artery ascends the neck and bifurcates into two arteries. One of these arteries is the superficial temporal artery. Which of the following is the second branch?
Your Answer:
Correct Answer: Maxillary artery
Explanation:Carotid endarterectomy is the procedure to relieve an obstruction in the carotid artery by opening the artery at its origin and stripping off the atherosclerotic plaque with the intima. This procedure is performed to prevent further episodes, especially in patients who have suffered ischemic strokes or transient ischemic attacks. The external carotid artery terminates by dividing into the superficial temporal and maxillary branches. The maxillary artery is the larger of the two terminal branches and arises posterior to the neck of the mandible. The other arteries mentioned in the answer options branch off from the following: Temporal arteries from the maxillary artery Middle meningeal artery from the maxillary artery Lingual artery from the anterior aspect of the external carotid artery Facial artery from the anterior aspect of the external carotid artery
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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 regarding the arteries in the neck are TRUE?
Your Answer:
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 15
Incorrect
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A growing tumour is impinging on the lingual artery in the floor of the mouth. Which structure will experience decreased blood flow?
Your Answer:
Correct Answer: The sublingual gland
Explanation:The paired sublingual glands are major salivary glands in the mouth. They are the smallest, most diffuse, and the only unencapsulated major salivary glands. They provide only 3-5% of the total salivary volume. The gland receives its blood supply from the sublingual and submental arteries. The sublingual artery is a branch of the lingual artery, thus damage to the lingual artery will decrease the blood flow to the sublingual gland.
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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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The collaborative effort of the lateral pterygoid muscles produces which action on the jaw?
Your Answer:
Correct Answer: Protrude the mandible
Explanation:The combined effort of the lateral pterygoid muscles results in the protrusion of the mandible. The lateral pterygoid muscle is a muscle of mastication located superiorly to the medial pterygoid muscle and has two heads. The superior head originates on the infratemporal surface and infratemporal crest of the greater wing of the sphenoid bone, and the inferior head on the lateral surface of the lateral pterygoid plate. The insertion of this muscle is on the front margin of the articular disc of the temporomandibular joint. The unilateral contraction of the pterygoid muscle results in the laterotrusion of the mandible. It is important to note that the lateral pterygoid muscle is the only muscle of mastication that can open the jaw.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 17
Incorrect
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When the breast cancer of a 60-year old patient metastasizes and compresses the intervertebral foramina between the fourth and fifth cervical vertebrae, as well as the fourth and fifth thoracic vertebrae, this causes back pain. Which pair of nerves is most likely affected?
Your Answer:
Correct Answer: Fifth cervical and fourth thoracic nerves
Explanation:The fifth cervical nerve passes between the fourth and fifth cervical vertebrae, and the fourth thoracic nerve passes between the fourth and fifth thoracic vertebrae. Therefore, when the cancer metastasizes in this area, they are most likely affected.
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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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The ostium of the maxillary sinus opens into which of the following structures?
Your Answer:
Correct Answer: Middle meatus
Explanation:The maxillary sinuses usually develop symmetrically. The maxillary sinus ostium drains into the infundibulum which joins the hiatus semilunaris and drains into the middle meatus.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 19
Incorrect
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This anatomic part lies at the heart of the tooth.
Your Answer:
Correct Answer: The pulp cavity
Explanation:Within the central portion of the tooth lies the dental pulp. The pulp chamber provides mechanical support and functions as a barrier from external stimuli and the oral microbiome. The dental pulp is a unique tissue that is richly innervated and has an extensive microvascular network. Maintaining its vitality increases both the mechanical resistance of the tooth and the long-term survival. The junctional epithelium forms a band around the tooth at the base of the gingival sulcus, sealing off the periodontal tissues from the oral cavity.
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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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Which of the following foramina provides a passage through which the vestibulocochlear nerve, passes?
Your Answer:
Correct Answer: Internal acoustic meatus
Explanation:The internal auditory meatus is a canal within the petrous part of the temporal bone of the skull between the posterior cranial fossa and the inner ear. It provides a passage through which the vestibulocochlear nerve, the facial nerve, and the labyrinthine artery (an internal auditory branch of the basilar artery) can pass from inside the skull to structures of the inner ear and face.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 21
Incorrect
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A 5 year old boy is taken to the doctor by his father. He has had an earache for the past day and he is constantly pulling and touching his ear. His father noticed a foul smelling discharge leaking from his ear after which the earache resolved. Which of the following is the most likely cause?
Your Answer:
Correct Answer: Acute otitis media
Explanation:Acute otitis media (AOM) is a painful type of ear infection. It occurs when the area behind the eardrum, the middle ear, becomes inflamed and infected.The following behaviours in children often mean they have AOM:- fits of fussiness and intense crying (in infants)- clutching the ear while wincing in pain (in toddlers)- complaining about a pain in the ear (in older children).Perforation of the tympanic membrane is not unusual as the process advances, most frequently in posterior or inferior quadrants. Before or instead of a single perforation, an opaque serum like exudate is sometimes seen oozing through the entire tympanic membrane.With perforation and in the absence of a coexistent viral infection, the patient generally experiences rapid relief of pain and fever. The discharge initially is purulent, though it may be thin and watery or bloody; pulsation of the otorrhea is common. Otorrhea from acute perforation normally lasts 1-2 days before spontaneous healing occurs. Otorrhea may persist if the perforation is accompanied by mucosal swelling or polypoid changes, which can act as a ball valve.
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This question is part of the following fields:
- Head & Neck
- Pathology
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Question 22
Incorrect
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The thyrocervical trunk branches into which artery that passes upward and in front of the vertebral artery and longus colli muscle:
Your Answer:
Correct Answer: Inferior thyroid
Explanation:The inferior thyroid artery is an artery in the neck. It arises from the thyrocervical trunk and passes upward, in front of the vertebral artery and longus colli muscle.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 23
Incorrect
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Which of the following statements is correct with regards to Horner's syndrome?
Your Answer:
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 24
Incorrect
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Lisa is a 75-year-old female rushed into the emergency department by first-aid responders. The ambulance team give a history of vomiting, homonymous hemianopia, weakness of the left upper and lower limb, and dysphasia. Lisa adds that she has a headache that keeps worsening. Lisa takes Warfarin as she is a known case of atrial fibrillation. Her INR is 4.3 despite the ideal target being 2-3. CT scan of the head suggests anterior cerebral artery haemorrhage. What areas of the brain are affected by an anterior cerebral artery stroke?
Your Answer:
Correct Answer: Frontal and parietal lobes
Explanation:The anterior cerebral artery supplies the midline portion of the frontal lobe and the superior medial parietal lobe of the brain. It also supplies the front four-fifths of the corpus callosum and provides blood to deep structures such as the anterior limb of the internal capsule, part of the caudate nucleus, and the anterior part of the globus pallidus. The cerebral hemispheres are supplied by arteries that make up the Circle of Willis. The Circle of Willis is formed by the anastomosis of the two internal carotid arteries and two vertebral arteries. Clinically, the internal carotid arteries and their branches are often referred to as the anterior circulation of the brain. The anterior cerebral arteries are connected by the anterior communicating artery. Near their termination, the internal carotid arteries are joined to the posterior cerebral arteries by the posterior communicating arteries, completing the cerebral arterial circle around the interpeduncular fossa, the deep depression on the inferior surface of the midbrain between the cerebral peduncles. The middle cerebral artery supplies part of the frontal, temporal and parietal lobes. The posterior cerebral artery supplies the occipital lobe.
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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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In adults, there are normally how many teeth:
Your Answer:
Correct 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 26
Incorrect
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A man suffers damage to his vagus nerve during surgery on his neck. The vagus nerve is cut near its exit from the skull. The man loses his parasympathetic tone raising his heart rate and blood pressure. What other feature will be likely present with a vagus nerve injury?
Your Answer:
Correct Answer: Hoarse voice
Explanation:The vagus nerve is a mixed nerve with both autonomic and somatic effects. Its most important somatic effect is the motor supply to the larynx via recurrent laryngeal nerves. If one vagus nerve is damaged, the result will be the same as damage to a single recurrent laryngeal nerve, leading to hoarseness of voice. The vagus exits the skull via the jugular foramen, accompanied by the accessory nerve. Anal tone, erections, and urination are all controlled by the sacral parasympathetic and would not be affected by the loss of the vagus. Parasympathetic controlled pupillary constriction is via the oculomotor nerve and would not be affected by the loss of the vagus.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 27
Incorrect
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Which nerve does NOT pass through the posterior triangle of the neck?
Your Answer:
Correct Answer: Ansa cervicalis
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 – greater auricular nerve, transverse cervical nerve, lesser occipital nerve, supraclavicular nerve (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 28
Incorrect
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Which of the following structures, is the area in which the superior cerebral veins drain into?
Your Answer:
Correct 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 29
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:
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 30
Incorrect
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A 30 year-old male patient sustained a sharp blow to the right side of the head, over the temporal region during a vehicular accident. This resulted to the rupture of the principal artery that supplies the meninges. Which artery is affected?
Your Answer:
Correct Answer: Middle meningeal artery
Explanation:The middle meningeal artery is typically the third branch of the first part of the maxillary artery, one of the two terminal branches of the external carotid artery. After branching off the maxillary artery in the infratemporal fossa, it runs through the foramen spinosum to supply the dura mater and the calvaria. The middle meningeal artery is the largest of the three (paired) arteries that supply the meninges, the others being the anterior meningeal artery and the posterior meningeal artery. The anterior branch of the middle meningeal artery runs beneath the pterion. It is vulnerable to injury at this point, where the skull is thin. Rupture of the artery may give rise to an epidural hematoma. An injured middle meningeal artery is the most common cause of an epidural hematoma.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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SESSION STATS - PERFORMANCE PER SPECIALTY
