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Question 1
Correct
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A chest x ray of a patient reveals loculated fluid in the right chest, which can be easily aspirated if the needle is inserted through the body wall just above the 9th rib in the midaxillary line. Where is this fluid located?
Your Answer: Costodiaphragmatic recess
Explanation:The costodiaphragmatic recess is the lowest point of the pleural sac where the costal pleura becomes the diaphragmatic pleura. At the midclavicular line, this is found between ribs 6 and 8; at the paravertebral lines, between ribs 10 and 12 and between ribs 8 and 10 at the midaxillary line. The cardiac notch: is an indentation of the heart on the left lung, located on the anterior surface of the lung. Cupola: part of the parietal pleura that extends above the first rib. Oblique pericardial sinus: part of the pericardial sac located posterior to the heart behind the left atrium. Costomediastinal recess: a reflection of the pleura from the costal surface to the mediastinal surface, is on the anterior surface of the chest. The inferior mediastinum: is the space in the chest occupied by the heart.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 2
Correct
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A 4-year old boy is taken to the emergency room after a sudden onset of coughing and wheezing. Further investigation reveals that he was drawing quietly in his room, when suddenly, he became anxious and started coughing. The parents also noted that the eraser on top of the pencil was missing. A plain radiographic chest imaging is conducted, and confirmed foreign body aspiration. Which of the following areas in the tracheobronchial tree is the most probable location of the aspirated eraser?
Your Answer: Right main bronchus
Explanation:In foreign body aspiration, the foreign body is more likely to enter the right main bronchus because it is shorter, wider and more vertical than the left main bronchus. In a patient who is standing or sitting, the foreign body tends to become lodged in the posterobasal segment of the inferior lobe of the right lung.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 3
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: Canine space
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 4
Correct
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Which of the following foramina provides a passage through which the vestibulocochlear nerve, passes?
Your 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 5
Incorrect
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Of the following, which is NOT a branch of the abdominal aorta?
Your Answer: Renal artery
Correct 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 6
Incorrect
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A 18 year old student presents to ED with a headache, fever and photophobia. You suspect meningitis and agree to observe your junior performing a lumbar puncture. What is the highest safest vertebral level to perform lumbar puncture in adults:
Your Answer: L2/L3
Correct Answer: L3/L4
Explanation:In adults, the spinal cord typically ends between L1/L2 whereas the subarachnoid space extends to approximately the lower border of vertebra S2. Lumbar puncture is performed in the intervertebral space L4/L5 or L3/L4.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 7
Correct
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Where is the foramen ovale located?
Your 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 8
Incorrect
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The otic ganglion receives its preganglionic sympathetic fibres from which of the following nerves?
Your Answer: Chorda tympani nerve
Correct Answer: Glossopharyngeal nerve
Explanation:The otic ganglion is a small (2–3 mm), oval shaped, flattened parasympathetic ganglion of a reddish-grey colour, located immediately below the foramen ovale in the infratemporal fossa and on the medial surface of the mandibular nerve. The preganglionic parasympathetic fibres originate in the inferior salivatory nucleus of the glossopharyngeal nerve. They leave the glossopharyngeal nerve by its tympanic branch and then pass via the tympanic plexus and the lesser petrosal nerve to the otic ganglion. Here, the fibres synapse, and the postganglionic fibres pass by communicating branches to the auriculotemporal nerve, which conveys them to the parotid gland. They produce vasodilator and secretomotor effects.
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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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During quiet respiration, position of the right oblique fissure can be marked by a line drawn on the thoracic wall that:
Your Answer: Begins at the spinous process of T5, crosses the fifth intercostal space laterally and follows the contour of rib 5 anteriorly.
Correct Answer: Begins at the spinous process of T4, crosses the fifth intercostal space laterally and follows the contour of rib 6 anteriorly.
Explanation:During quiet respiration, the approximate position of the right oblique fissure can be marked by a line on the thoracic wall that begins at the spinous process of vertebra T4, crosses the fifth intercostal space laterally and then follows the contour of rib 6 anteriorly.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 10
Correct
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The ostium of the maxillary sinus opens into which of the following structures?
Your 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 11
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 12
Incorrect
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The collaborative effort of the lateral pterygoid muscles produces which action on the jaw?
Your Answer: Close the mandible
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 13
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 XII
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 14
Incorrect
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The orbicularis oculi us a muscle that closes the eyelids. What is the motor innervation of this muscle?
Your Answer: A branch of a nerve that exits through the superior orbital foramen
Correct Answer: A branch of a nerve that exits through the stylomastoid foramen
Explanation:The orbicularis oculi is a muscle in the face that closes the eyelids. It is supplied by zygomatic branch of the facial nerve (cranial nerve VII), which exits through the stylomastoid foramen.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 15
Correct
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The posterior boundary of the carotid triangle is bounded by which of the following muscles?
Your Answer: Sternocleidomastoid
Explanation:The carotid triangle is a portion of the anterior triangle of the neck. It is bounded superiorly by the posterior belly of the digastric muscle, antero-inferiorly by the superior belly of omohyoid and posteriorly by the sternocleidomastoid. The floor is formed by the thyrohyoid, hyoglossus, middle and inferior pharyngeal constrictors and the roof is formed by the skin, superficial fascia, platysma and deep fascia.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 16
Correct
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What are some of the derivatives of the second pharyngeal arch?
Your Answer: Stylohyoid muscle
Explanation:Also known as the hyoid arch, it forms the side and front of the neck. From its cartilage develops the styloid process, stylohyoid ligament and lesser cornu of the hyoid bone. The muscular derivatives include the muscles of facial expression, stapedius, stylohyoid and the posterior belly of the digastric. All these are innervated by cranial nerve VII but migrate into the area of the mandibular arch.
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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 the excision of the submandibular salivary gland, which one of the following nerves is at risk of injury as the duct is mobilised?
Your Answer: Facial nerve
Correct Answer: Lingual nerve
Explanation:The lingual nerve wraps around Wharton’s duct, and thus, is at risk of injury as the submandibular gland is mobilised. The lingual nerve provides sensory supply to the anterior 2/3 of the tongue.Note:- Submandibular duct (Wharton’s duct): It opens lateral to the lingual frenulum on the anterior floor of the mouth. It is around 5 cm in length.- Lingual nerve wraps around Wharton’s duct. As the duct passes forwards, it crosses medial to the nerve, above it and then crosses back, lateral to it, to reach a position below the 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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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: Tympanic part
Correct 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 19
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 20
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 21
Incorrect
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A 42 year old lady has acute onset of painless weakness on her left side of the face with a drooping mouth and difficulty speaking. With no significant past medical history and after relevant investigations, you rule out stroke as a possible cause. The lady is suspected to have suffered Bell's palsy, an idiopathic paralysis of the facial nerve. What symptoms are you most likely to find on examination in a patient with Bell's palsy?
Your Answer: Bilateral ptosis
Correct Answer: Taste impairment of the anterior tongue
Explanation:Bell’s palsy is facial muscle weakness or paralysis that arises from idiopathic damage to the facial nerve. It can occur at any age but is commonly associated with some conditions: 1. pregnancy 2. diabetes 3. upper respiratory ailment 4. GBS 5. Toxins The common symptoms of Bell’s palsy are: 1. Abnormal corneal reflex as the facial nerve controls the motor aspect of the corneal reflex. 2. The loss of control of facial muscles and eyelids leads to decreased tear production. 3. mild weakness to total paralysis on one side of the face, occurring within hours to days. 4. Bell’s palsy is a lower motor neuron lesion that usually spares the forehead while the upper motor near lesions, like stroke, involves the entire face. 5. The anterior two-thirds of the tongue is supplied by the chorda tympani branch of the facial nerve, thus resulting in loss of taste. 6. Ptosis can be a feature of Bell’s palsy but Bell’s palsy would typically show unilateral symptoms rather than bilateral.
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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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The thyrocervical trunk branches into which artery that passes upward and in front of the vertebral artery and longus colli muscle:
Your Answer: Transverse cervical
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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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: Facial artery
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 24
Incorrect
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What vessel is NOT considered a major branch of the descending thoracic aorta?
Your Answer: Bronchial artery
Correct Answer: Inferior thyroid artery
Explanation:The descending thoracic aorta begins at the lower border of T4 near the midline as a continuation of the arch of the aorta. It descends and ends at the level of T12 at the aortic hiatus in the diaphragm, where it becomes the abdominal aorta. The aorta gives off the following branches: (descending order) 1. Bronchial arteries 2. Mediastinal arteries 3. Oesophageal arteries 4. Pericardial arteries 5. Superior phrenic arteries The posterior intercostal arteries are branches that originate throughout the length of the posterior aspect of the descending thoracic aorta. The inferior thyroid artery is usually derived from the thyrocervical trunk, a branch of the subclavian artery.
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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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Depression of the eyeball is primarily produced by which of the following muscles:
Your Answer: Superior rectus and inferior oblique
Correct Answer: Inferior rectus and superior oblique
Explanation:Depression of the eyeball is produced by the inferior rectus and the superior oblique muscles.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 26
Correct
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A patient is diagnosed with a tumour of the parotid gland. During surgical removal of the gland, which artery is vulnerable to injury?
Your Answer: External carotid artery
Explanation:The external carotid artery is a major artery of the head and neck. It arises from the common carotid artery when it splits into the external and internal carotid artery. It supplies blood to the face and neck. The external carotid artery begins opposite the upper border of the thyroid cartilage and, taking a slightly curved course, passes upward and forward and then inclines backward to the space behind the neck of the mandible, where it divides into the superficial temporal and internal maxillary arteries. It rapidly diminishes in size in its course up the neck, owing to the number and large size of the branches given off from it. At its origin, this artery is more superficial and placed nearer the midline than the internal carotid and is contained within the carotid triangle. The external carotid artery is covered by the skin, superficial fascia, platysma, deep fascia and anterior margin of the sternocleidomastoid. It is crossed by the hypoglossal nerve, by the lingual, ranine, common facial and superior thyroid veins; and by the digastric and stylohyoid; higher up it passes deeply into the substance of the parotid gland, where it lies deep to the facial nerve and the junction of the temporal and internal maxillary veins. It is here that it is in danger during surgery of the parotid gland.
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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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Which of the following occurs primarily to produce passive expiration:
Your Answer: Relaxation of diaphragm and external intercostal muscles
Explanation:Passive expiration is produced primarily by relaxation of the inspiratory muscles (diaphragm and external intercostal muscles) and the elastic recoil of the lungs. In expiration, depression of the sternal ends of the ribs (‘pump handle’ movement), depression of the lateral shafts of the ribs (‘bucket handle’ movement) and elevation of the diaphragm result in a reduction of the thorax in an anteroposterior, transverse and vertical direction respectively. This results in a decreased intrathoracic volume and increased intrathoracic pressure and thus air is forced out of the lungs.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 28
Incorrect
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A 46 -year old patient diagnosed with chronic rhinosinusitis, was to undergo surgery to improve drainage from his frontal sinus to the nose. Which is a route that one would take to enter into the frontal sinus through the nasal cavity?
Your Answer: Superior meatus
Correct Answer: Middle meatus
Explanation:The middle meatus is a nasal passageway located inferior to the middle concha and superior to the inferior concha. On the superior aspect of this meatus is a bulge produced by the middle ethmoidal cells known as the bulla ethmoidalis. Below this bulge is a curved fissure, the hiatus semilunaris, which is also bordered inferiorly by the edge of the uncinate process of the ethmoid. It is through this curved fissure, hiatus semilunaris, that the middle meatus communicates with the frontal sinus. It first forms a communication with a curved passage way known as the infundibulum. The infundibulum anteriorly communicates with the anterior ethmoidal cells and continues upward as the frontonasal duct into the frontal sinus.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 29
Correct
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Which of the following foramen provides passage of the facial nerve?
Your 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 30
Correct
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Regarding the tongue, which of the following statements is CORRECT:
Your 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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SESSION STATS - PERFORMANCE PER SPECIALTY
