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Question 1
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: Inferior laryngeal nerve
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 2
Incorrect
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What is the innervation of the laryngeal mucosa inferior to the true vocal cord?
Your Answer: Superior laryngeal nerve
Correct 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 3
Correct
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A 21-year-old student presents to the minors area of your Emergency Department with a laceration on his external nose that occurred during sparring in a kickboxing class. The area is bleeding profusely and will require suturing. Pressure is being applied. The laceration extends through some of the nasal muscles. Motor innervation of the nasal muscles of facial expression is provided by which of the following ? Select ONE answer only.
Your Answer: Facial nerve
Explanation:The facial nerve (the labyrinthine segment) is the seventh cranial nerve, or simply CN VII. It emerges from the pons of the brainstem, controls the muscles of facial expression, and functions in the conveyance of taste sensations from the anterior two-thirds of the tongue. Motor innervation of the nasal muscles of facial expression is provided by the facial nerve (CN VII).
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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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With regards to the internal carotid artery, which of these statements is correct.
Your Answer: Grooves the greater wing of the sphenoid bone
Correct Answer: Enters the skull and divides into the anterior and middle cerebral arteries
Explanation:The internal carotid artery passes through the carotid canal in the petrous part of the temporal bone into the cranial cavity. It does NOT groove the sphenoid bone. The internal carotid artery gives off no branches in the neck and is a terminal branch of the common carotid artery. These structures pass between the external and internal carotid arteries: the styloglossus and stylopharyngeus muscles, the glossopharyngeal nerve (CN IX), and the pharyngeal branch of the vagus. Accompanied by its sympathetic plexus, the internal carotid artery, passes through the cavernous sinus and is crossed by the abducent nerve.
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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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All the following statements are FALSE regarding the ophthalmic division of the trigeminal nerve, except:
Your 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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Which nerve does NOT pass through the posterior triangle of the neck?
Your Answer: Lesser occipital nerve
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 7
Incorrect
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Post thyroidectomy, a 50-year-old male singer noticed some hoarseness in his voice. Now, he presents to his general physician as it has been the same for the past few weeks. A complication is noted in the post-thyroidectomy report regarding an injury to the external laryngeal nerve. Which muscle has been affected due to loss of innervation by the damaged nerve, and whose improper functioning can lead to hoarseness in the patient's voice?
Your Answer:
Correct Answer: Cricothyroid
Explanation:All of the muscles of the larynx are innervated by the recurrent laryngeal nerve, except the cricothyroid muscle. Cricothyroid muscle is located deep in the anterior neck, between the cricoid and thyroid cartilage and is innervated by the external laryngeal nerve. Any injury to this muscle can cause paralysis and lead to hoarseness. When cricothyroid muscle contracts, it leads to tightening, stretching and thinning of the vocal folds. This produces higher-pitched sounds during vocalization. A patient experiencing hoarseness due to possible injury to the external laryngeal nerve should be reassured that the hoarseness will resolve in time due to increased compensation from the other muscles.
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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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Where does Stensens duct primarily open?
Your Answer:
Correct Answer: Opposite the second molar tooth
Explanation:The parotid duct (Stensen’s duct), which provides an exit for the gland’s secretions, passes through the anterior edge of the gland in the superficial lobe, turns medially at the anterior border of the masseter, penetrates the buccinator, then enters the oral cavity lateral to the second maxillary molar.
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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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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 10
Incorrect
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A 50-year-old male is planned for elective parotidectomy for pleomorphic adenoma. The surgeon intends to use a nerve integrity monitor thus avoiding neuromuscular blockade. Which of the following nerves is liable to injury in parotidectomy?
Your Answer:
Correct Answer: Facial nerve
Explanation:Parotidectomy is basically an anatomical dissection. Identification of the facial nerve trunk is essential during parotid gland surgery because facial nerve injury is the most daunting potential complication of parotid gland surgery owing to the close relation between the gland and the extratemporal course of the facial nerve. After exiting the stylomastoid foramen, the facial nerve enters the substance of the parotid gland and then gives off five terminal branches: From superior to inferior, these are the: – Temporal branch supplying the extrinsic ear muscles, occipitofrontalis and orbicularis oculi – Zygomatic branch supplying orbicularis oculi – Buccal branch supplying buccinator and the lip muscles – Mandibular branch supplying the muscles of the lower lip and chin – Cervical branch supplying platysma. There are two approaches to identify the facial nerve trunk during parotidectomy—conventional antegrade dissection of the facial nerve, and retrograde dissection. Numerous soft tissue and bony landmarks have been proposed to assist the surgeon in the early identification of this nerve. Most commonly used anatomical landmarks to identify facial nerve trunk are stylomastoid foramen, tympanomastoid suture (TMS), posterior belly of digastric (PBD), tragal pointer (TP), mastoid process and peripheral branches of the facial 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 elderly man presents with bilateral lower facial swelling around the mandible and upper neck. A CT scan of his neck was performed and the results were conclusive with Ludwig's angina. Which of the following spaces is most likely affected based on the case presented?
Your Answer:
Correct Answer: Submandibular space
Explanation:Ludwig’s angina is life-threatening cellulitis of the soft tissue involving the floor of the mouth and neck. It involves three compartments of the floor of the mouth: the sublingual, submental, and submandibular. Ludwig’s angina usually originates as a dental infection of the second or third mandibular molars. The infection begins in the subgingival pocket and spreads to the musculature of the floor of the mouth. It progresses below the mylohyoid line, indicating that it has moved to the sublingual space. As the roots of the second and third mandibular molars lie below this line, infection of these teeth will predispose to Ludwig’s angina. The infection spreads lingually rather than buccally because the lingual aspect of the tooth socket is thinner. It initially spreads to the sublingual space and progresses to the submandibular space. The disease is usually polymicrobial, involving oral flora, both aerobes, and anaerobes. The most common organisms are Staphylococcus, Streptococcus, Peptostreptococcus, Fusobacterium, Bacteroides, and Actinomyces.
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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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What intrinsic muscle of the larynx is responsible for the tensing of the vocal cords?
Your Answer:
Correct Answer: Cricothyroid muscle
Explanation:The cricothyroid muscle is the only tensor muscle of the larynx aiding with phonation. It attaches to the anterolateral aspect of the cricoid and the inferior cornu and lower lamina of the thyroid cartilage. Its action tilts the thyroid forward to help tense the vocal cords.
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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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A 42 - year old male patient with an acute onset headache was brought in to the emergency department with suspicion of a subarachnoid haemorrhage (SAH). The SHO on call decided to have a diagnostic lumbar puncture after computed topography scan failed to support the suspicion. To perform a successful lumbar puncture without causing injury to the spine, which anatomical landmark should guide the SHO to locate the fourth vertebra for insertion of the spinal needle?
Your Answer:
Correct Answer: Iliac crest
Explanation:The safest spinal level for conducting a lumbar puncture, is at the level of the fourth lumbar vertebra. The anatomical landmark used to locate the fourth lumbar vertebra (L4), is the iliac crest. The needle can safely be inserted either above or below L4. The conus medullaris is at the level of the border of L1 and L2 so L4 is safely distant from it.
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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 muscles is solely contained in the anterior triangle of the neck and divides the anterior triangle into three smaller triangles?
Your Answer:
Correct Answer: Digastric
Explanation:The digastric muscle is a small muscle located under the jaw. It lies below the body of the mandible, and extends, in a curved form, from the mastoid process to the symphysis menti. The digastric divides the anterior triangle of the neck into three smaller triangles:- The submaxillary triangle, bounded above by the lower border of the body of the mandible and a line drawn from its angle to the sternocleidomastoid, below by the posterior belly of the digastric and the stylohyoid and in front by the anterior belly of the digastric- The carotid triangle, bounded above by the posterior belly of the digastric and stylohyoid, behind by the sternocleidomastoid and below by the omohyoid- The suprahyoid or submental triangle, bounded laterally by the anterior belly of the digastric, medially by the midline of the neck from the hyoid bone to the symphysis menti and inferiorly by the body of the hyoid bone.
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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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What is the innervation of the tensor tympani muscle?
Your Answer:
Correct Answer: Trigeminal nerve
Explanation:The tensor veli palatini is innervated by the medial pterygoid nerve, a branch of mandibular nerve, the third branch of the trigeminal nerve (CN V3) – the only muscle of the palate not innervated by the pharyngeal plexus, which is formed by the vagal and glossopharyngeal nerves.
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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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Which of the following foramen provides passage of the facial nerve?
Your Answer:
Correct Answer: Internal acoustic meatus
Explanation:The internal auditory meatus 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 17
Incorrect
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During uterogrowth, the second branchial arch gives rise to which structures?
Your Answer:
Correct 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 18
Incorrect
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Elevation of the eyeball is primarily produced by which of the following muscles:
Your Answer:
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 19
Incorrect
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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:
Correct 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 20
Incorrect
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A 39-year-old woman, is scheduled for a thyroidectomy for her previously diagnosed Grave's disease. She is eligible for surgery as medical treatment options have failed to control her symptoms and she is the sole guardian for her young children, so radioiodine treatment is unsuitable. While gaining her consent for the surgery, she is told of possible complications of thyroidectomy, which include damage to the sensory branch of the superior laryngeal nerve. What is the name of the sensory nerve that arises from the superior laryngeal nerve?
Your Answer:
Correct Answer: Internal laryngeal nerve
Explanation:The superior laryngeal nerve gives off two branches: the sensory branch which is the internal laryngeal nerve, and the motor branch which is the external laryngeal nerve. The recurrent laryngeal nerve (RLN) rises from the vagus nerve which supplies the intrinsic muscles of the larynx, except the cricothyroid muscles.
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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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Which of the following foramina will the ophthalmic artery pass through in order to reach the eye?
Your Answer:
Correct Answer: Optic canal
Explanation:The optic foramen is the opening to the optic canal. The canal is located in the sphenoid bone; it is bounded medially by the body of the sphenoid and laterally by the lesser wing of the sphenoid. The superior surface of the sphenoid bone is bounded behind by a ridge, which forms the anterior border of a narrow, transverse groove, the chiasmatic groove (optic groove). The groove ends on either side in the optic foramen, which transmits the optic nerve and ophthalmic artery into the orbital cavity. Compared to the optic nerve, the ophthalmic artery is located inferolaterally within the canal.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 22
Incorrect
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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:
Correct 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 23
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 24
Incorrect
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In a neurological exam on a robbery with violence victim, it was discovered that the victim had lost sense of touch to the skin over her cheek and chin (maxilla and mandible region). Where are the cell bodies of the nerve that is responsible for touch sensations of this region located?
Your Answer:
Correct Answer: Cranial nerve V ganglion
Explanation:The skin over the cheek and the maxilla are innervated by the trigeminal nerve (CN V). The trigeminal nerve has three major branches and it is the largest cranial nerve. The three branches of the trigeminal nerve are; the ophthalmic nerve, the maxillary nerve and the mandibular nerve. The trigeminal nerves ganglion is a sensory nerve ganglion know as the trigeminal ganglion (also referred to as the Gasser’s ganglion or the semilunar ganglion). It is contained in the dura matter in a cavity known as the Meckel’s cave, which covers the trigeminal impression near the apex of the petrous part of the temporal bone.
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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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Which of the following two cerebral veins join up to form the great cerebral vein, otherwise also known as the great vein of Galen?
Your Answer:
Correct Answer: Internal cerebral veins
Explanation:The great vein of Galen or great cerebral vein, is formed by the union of the internal cerebral veins and the basal veins of Rosenthal. This vein curves upwards and backwards along the border of the splenium of the corpus callosum and eventually drains into the inferior sagittal sinus and straight sinus at its anterior extremity.
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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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Which of the following nerves is responsible for the symptoms of a patient who presented with ophthalmic herpes zoster and a few vesicles on the nose?
Your Answer:
Correct Answer: Trigeminal nerve
Explanation:Hutchinson sign relates to involvement of the tip of the nose from facial herpes zoster. It implies involvement of the external nasal branch of the nasociliary nerve which is a branch of the ophthalmic division of the trigeminal nerve. The nasociliary branch of the trigeminal nerve innervates the apex and lateral aspect of the nose, as well as the cornea. Therefore, lesions on the side or tip of the nose should raise suspicion of ocular involvement.
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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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A 15-year-old girl who has undergone a recent excision of the left submandibular gland presents to the follow-up clinic with complaints of tongue weakness on the ipsilateral side.What is the nerve that is most likely to be damaged?
Your Answer:
Correct Answer: Hypoglossal nerve
Explanation:The presenting features and the surgical site provided in the clinical scenario are highly suggestive of ipsilateral hypoglossal nerve injury.Note:Three cranial nerves may be injured during submandibular gland excision.- Marginal mandibular branch of the facial nerve- Lingual nerve- Hypoglossal nerveHypoglossal nerve damage may result in the paralysis of the ipsilateral aspect of the tongue. The nerve itself lies deep to the capsule surrounding the gland and should not be injured during an intracapsular dissection. The lingual nerve is probably at higher risk of injury. However, the effects of lingual nerve injury are predominantly sensory rather than motor.Thus, the most appropriate answer is the hypoglossal nerve.
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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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A 33 year old woman complains of a persistent offensive discharge from the left ear. On examination, the hearing of left ear is found to be reduced to 40 decibels compared to the right side. Which of the following is the most likely cause of this presentation?
Your Answer:
Correct Answer: Cholesteatoma
Explanation:Cholesteatoma is a special form of chronic otitis media in which keratinizing squamous epithelium grows from the tympanic membrane or the auditory canal into the middle ear mucosa or mastoid. The presence of abnormal epithelium in an abnormal location triggers an inflammatory response that can destroy surrounding structures such as the ossicles. Cholesteatomas may be congenital or acquired later in life. Acquired cholesteatomas are usually associated with chronic middle ear infection. Cardinal symptoms are painless otorrhea and progressive hearing loss. Important diagnostic procedures include mastoid process x-rays, temporal bone CT scans, and audiometric tests. Left untreated, erosion of the surrounding bone by a cholesteatoma can lead to facial nerve palsy, extradural abscess, and/or sigmoid sinus thrombosis. Therefore, even if a cholesteatoma is asymptomatic, surgery is always indicated. Surgical treatment involves tympanomastoidectomy to excise the cholesteatoma, followed by repair of the damaged middle ear structures.
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This question is part of the following fields:
- Head & Neck
- Pathology
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Question 29
Incorrect
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In relation to the muscles of facial expression, It is true to say:
Your Answer:
Correct Answer: They are in the same subcutaneous plane as the platysma muscle
Explanation:The facial muscles generally originate from the facial bones and attach to the skin, in the same plane as the platysma muscle. They are all innervated by cranial nerve VII (the facial nerve). The occipitofrontalis muscle consists of two parts: The occipital belly, near the occipital bone, and the frontal belly, near the frontal bone.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 30
Incorrect
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During thyroidectomy, the recurrent laryngeal nerves are vulnerable to injury. Which of the following muscles will not be affected in cases where the recurrent laryngeal nerve is severed?
Your Answer:
Correct Answer: Cricothyroid
Explanation:All muscles of the larynx are supplied by the recurrent laryngeal nerve except for the cricothyroid which is supplied by the vagus 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
