1. a Patient Presents with Severe Dry Mouth. the Cranial Nerve(S) Most Likely Involved

ANATOMY

PRACTICE EXAM 3

Anatomy 46:

1. A patient presents with severe dry mouth. The cranial nerve(s) most likely involved: A. III B. V C. VII, IX D. X, XI E. IX, XII

2. A patient complains of lack of sensation on the bridge of their nose. The fibers that carry this informaion are found in what area of the nervous system? A. Trigeminal Ganglion B. Geniculate Ganglion C. Brainstem D. Pterygopalatine Ganglion E. Dorsal Root Ganglion

3. A patient is seen in the emergency room with a constricted pupil on the left side. The cranial nerve fibers responsible are: A. GVA B.GVE C.GSE D. SVA E. SVE

Anatomy 47:

1. A 15 year old male has impaled himself on a pipe while skateboarding. In addition to a host of other injuries you notice that the structures anterior to CV 4 have been injured. What structures may have been damaged?

a. Cricoid cart

b. Thyroid cart

c. Hyoid bone

d. All of the above

e. B and C

2. You determine that your elderly patient has a tumor has a tumor anterior to the carotid sheath. Which is the least likely happen as a consequence of this tumor?

a. Metastisis to the superior mediastinum b. Heart rate could be compromised

c. Pressure may be put on the infrahyoids and alter speech

d. Deep cervical fascia may stretch and rip

3. Petunia Switchblade (young problem-child sister to Johnny and Mose) is stabbed in the midline of the neck. The knife narrowly misses her trachea and stops at her thyroid gland. What layer of fascia was left intact?

a. Pretracheal

b. Infrahyoid fascia

c. Deep cervical fascia

d. Buccopharyngeal fascia

e. Superficial Fascia

Anatomy 48:

1) A victim of an attempted murder by strangulation presents to the emergency department with a fractured hyoid bone. A portion of the fractured bone has been displaced posteriorly. By palpation you find that the fragment is still anterior and medial to the sternocleidomastoid muscle. What triangle has the displaced portion most directly moved into?

a. Occipital b. Carotid c. Submandibular d. Submental e. Muscular

2) The patient from the previous question has bruising on the skin of the anterior neck. What nerve gives cutaneous innervation to this region of skin?

a. Facial nerve b. Lesser occipital nerve c. Greater auricular nerve d. Supraclavicular nerve e. Transverse cervical nerve

3) Injuries to the cervical vertebral column can also have effects on the muscles that are attached to it. Which posterior triangle muscle does not have an attachment to the vertebral column?

a. Omohyoid b. Levator scapulae c. Splenius capitus d. Posterior scalene e. Anterior scalene

Anatomy 49:

1. A patient complains of symptoms that seem to be related to a brachial plexus injury. When recalling your anatomy class in med school, you picture the anatomy of the brachial plexus and remember that the artery that runs through the brachial plexus is a. ascending scapular a. b. occipital a. c. descending scapular a. d. suprascapular a.

2. A 27 y/o male presents with a "sagging neck". You determine that there has been damage to CN VII, which is effecting a muscle that leads to this symptom. This is which muscle? a. mylohyoid b. digastric c. platysma d. SCM

3. Tommy Switchblade, cousin to Johnny, has rushed to the ER after receiving a laceration to the side of his neck. This laceration cuts, but does not completely sever, the upper half of the SCM. Which vein is most likely causing the severe bleeding from his wound? a. Internal jugular b. External jugular c. inferior thyroid vein d. transverse cervical vein

Anatomy 50:

1. A patient comes into the ED with significant lacerations to the anterior neck at approximately CV6 region. Besides the pain, the patient self describes their voice to be slightly deeper than normal. Which nerve was most likely injured (be specific)?

a. superior laryngeal nerve b. glossopharyngeal nerve c. external laryngeal nerve d. hypoglossal nerve

2. A 27 year old patient gets an MRI and the doctors nodes a small tumor pressing against the jugular foramen. The patient exhibits difficulty swallowing as a result of a lessened ability to elevate the pharynx and larynx. Which of the following may not function properly? a. carotid sinus b. carotid body c. stylopharyngeus muscle d. all of the above 3. A 67 year old patient underwent surgery to get rid of plaques in his internal carotid artery. Which of the following nerves had potential for injury during the procedure? a. CN IX b. CN X c. CN XI d. CN XII e. all of the above

Anatomy 51:

1. The subclavian artery is defined by the ______muscle. There is variation where the costocervical trunk comes off the subclavian. It can come off the _____ or ______part of the subclavian.

2. A Pancoast tumor interrupts the ______at the thoracic inlet. a. sympathetic chain b. third branch of CN V c. vertebral ganglion

3. What nerve joins cranial nerve VII to form the nerve to the pterygoid canal? a. Greater Petrosal b. Deep Petrosal c. Chorda Tympani

Anatomy 52:

1.) A fracture of the optic canal could damage which of the following: A.) CNIII B.) ophthalmic artery C.) Superior ophthalmic vein D.) CN V

2.) What branch of the trigeminal nerve goes through the foramen rotundum? A.) V1 B.) V2 C.) V3 D.) There isnt a branch of the trigeminal nerve that goes through the foramen rotundum.

3.) What is the name of the suture that separates the parietal and temporal bones? A.) Coronal B.) Lambdoidal C.) Squamosal D.) Nasal

Anatomy 53:

1. A 29 y/o baseball player was struck on the right side of the head with a baseball. He immediately loses consciousness, wakes up momentarily and then becomes comatose. He is rushed to the ER and is immediately given a CT scan. The scan shows a skull fracture and an accumulation of blood between the dura and the cranial bone on the side of his head, compressing his cerebrum. Which of the following types of hemorrhages does he have? a. Subdural b. Subarachnoid c. Epidural d. Intracerebral

2. A 93-year old woman suffers a stroke, with paralysis on the left side of her body. Neurological tests show that the intracerebral hemorrhage has interrupted the blood supply to the posterior part of the frontal, the parietal and medial portions of the temporal lobes of the right cerebral hemisphere. Which vessel was involved? a. Anterior cerebral artery b. Middle meningeal artery c. Accessory meningeal artery d. Middle cerebral artery

3. During childbirth, an excessive anteroposterior compression of the head may tear the anterior attachment of the falx cerebri from the tentorium cerebelli. The bleeding that follows is likely to be from which of the following venous sinuses? a. Superior Sagittal sinus b. Transverse Sinus c. Sigmoid Sinus d. Straight Sinus

Anatomy 54:

1:What is the path of venous of the vein that drains the majority of buccinator? a)buccinator vein -> common facial vein -> IJV b)buccinator vein -> pteragoid plexus-> EJV c)external Facial vein -> Superior laryngeal vein -> EJV d)buccinator Vein -> superior facial vein - > EJV

2:What muscles allow you to wiggle your ears? a) Orbicularis auricle muscle b) Zygomaticus Minor & Major muscles c) Occipitalis muscle d) Auricular muscles.

3:A 24 yo male patient presents with pain in the right check and a hard, solid mass over the massetor muscle. You decide that minor surgery is needed. What is the most likely cause? a) somatic disfuntion of the massetor muscle b) parotid gland infections c) parotid stone d) blocked parotid duct

Anatomy 55: 1. What ganglion does the nerve that supplies the parotic gland synapse in before it gets there? a. ciliary b. otic d. geniculate c. superior cervical

2. A man is diagnosed as having a damaged lesser petrosal nerve, what other nerve should you be worried about? a. zygomaticotemporal b. lesser occipital nerve c. temporal br. of VII d. auriculotemporal

3. Which one of these structures does not pass through the parotid gland? a. CN VII b. auriculotemporal nerve c. retromandibular vein d. internal carotid artery

Anatomy 56:

1. A 47 year-old patient presents with a tumor within the infratemporal fossa. Which structure(s) is most likely affected? a. Superficial temporal nerve b. Retromandibular vein c. Maxillary artery d. Greater auricular nerve e. Anterior tympanic artery

2. A few weeks later, the same patient complains that he can no longer feel anything along the front portion of his tongue. You see that the tumor has become larger, and is now affecting which structure? a. Vagus nerve b. Hypoglossal nerve c. Inferior alveolar nerve d. Masseteric nerve e. Lingual nerve

3. An 18-year-old male presents the ER with a break of the anterior portion of the coronoid process after suffering several punches to the face. You would suspect that your patient would have difficulty with which movement? a. Elevation of mandible b. Depression of mandible c. Protrusion of mandible d. Side-to-side movement of mandible

Anatomy 57: 1. A 14 year old girl complains of a sore throat. The doctor observes that back of her throat and finds enlarged palatine tonsils. These are structures found in which division of the pharynx? A. Nasopharynx B. Orophaynx C. Dorsalpharynx D. Laryngopharynx E. Superiorpharynx

2. A 43 year old male patient complains are difficulty swallowing. When the doctor observes the back of the oral cavity, she sees a deviated uvulae, and collapsed palatoglossal and palatopharyngeal arches on the right side. This is due to loss of function in which nerve? A. Vagus B. Facial C. Trigeminal D. Glossopharyngeal E. Hypoglossal

3. While eating supper, an 8 year old boy gets a fish bone stuck in their throat. The space it's most likely lodged in is: A. Laryngeal Inlet B. 3rd part of the esophagus C. Between the palatine tonsils D. Piriform Recess E. Gap 4 of the pharynx

Anatomy 58:

1. Thaddeus Switchblade is stabbed in the back of the neck by a fellow ruffian. It is believed that the nerve riding along the “straw” or muscle that middle constrictor is severed along with the nerve that rides along top of this muscle. What would still remain intact?

a. Sensory cough reflex

b. Motor Cough reflex

c. Sensory gag reflex

d. Motor cough reflex

2. A patient presents with a very deep voice. She is at the end stage of metastic cancer.

Which muscle is affected?

a. Cricoarytenoid

b. cricothyroid c. arytenoids

d. thyroarytenoids

3. What nerve innervates that muscle?

a. Internal laryngeal nerve

b. External laryngeal nerve

c. Recurrent laryngeal nerve

d. Superior pharyngeal nerve

Anatomy 59:

Use the following scenario for the next 2 questions:

A patient comes to see his family practice doctors. Pt complains of not being able to swallow, open the back of his mouth, eat or yawn. The physician asks the pt to open his mouth and say “Ah”. Physician notes that the palate is turned towards the right.

1. What nerves are damaged in this patient?

A. Vagus

B. Greater petrosal nerve

C. medial pterygoid nerve of mandibular nerve (V3)

D. Both A and C

2. Specifically, what nerve is damaged that would cause the palate to deviate to the right?

A. Right Vagus nerve

B. Left Vagus nerve

C. Right medial pterygoid nerve of mandibular nerve (V3)

D. Left medial pterygoid nerve of mandibular nerve (V3)

3. In a MVA, a patient has crushed his foramen rotundum. His infraorbital branch of the maxillary nerve has been severed. What deficiencies will this pt have? A. Can’t feel his upper, anterior teeth

B. Can’t feel his lower, anterior teeth

C. Can’t feel his upper, posterior teeth

D. Can’t feel his lower, posterior teeth

Anatomy 60:

1.) A patient presents complaining of pain in her anterior and middle teeth. The nerve providing sensation to this region could possibly be constricted at which of the following locations? a.) zygomaticofacial foramen b.) incisive fossa c.) infraorbital foramen d.) mandibular foramen

2.) An infection in the root of the tongue would most directly affect which of the following groups of lymph nodes? a.) submental b.) superior deep cervical c.) inferior deep cervical d.) submandibular 3.) As a physician, you see it in the patient's best interest to administer pharmaceuticals in a manner to avoid their break down in the liver. How would you administer these? a.) injection into the EJV b.) injection into the subclavian vein c.) injection into the brachiocephalic vein d.) sublingually

Anatomy 61:

1. A patient comes to your office with a tongue that is deviated to the right. You find a cranial nerve lesion on the right side. Which cranial nerve has a lesion? Is the lesion central or peripheral? a. CN X, central b. CN X, peripheral c. CN XII, central d. CN XII, peripheral

2. A patient injured the mandibular branch of the trigeminal nerve (V3). What is the only extrinsic tongue muscle that will be affected? a. palatoglossus b. styloglossus c. mylohyoid d. genioglossus

3. A patient has an infected taste bud on the very tip of her tongue. Which lymph nodes will receive drainage from this region? a. submental b. submandibular c. sublingual d. auricular

Anatomy 62:

1. A patient presents with a dilated pupil, ptosis, lateral deviation of the pupil, and the eyeball is oriented down and out. What nerve do you expect to be behind this? a. CN III b. CN IV c. CN V d. CN VI

2. A patient walks into your office complaining of cold symptoms. You treat him for the cold but also notice that his left eye is unable to abduct. Which nerves dysfunction is responsible? a. CN III b. CN IV c. CN V d. CN VI

3. You are treating a patient experiencing eye trouble, and suspect a problem with their Inferior Oblique. How would you test this muscle specifically? a. Have the patient first look in, then up. b. Have the patient first look up, then in. c. Have the patient look upwards. d. Have the patient look inwards.

Anatomy 63:

1. A doctor is doing a routine eyecheck for a 22 year old patient. The doctor wishes to test the right superior oblique muscle. Which way should the doctor instruct the patient to move their eye? a. look out then down b. look in then down c. look out then up d. look in then up

2. An X-ray is taken of a patient who is showing signs of Horner's syndrome. The chest X-Ray shows that a pancoast tumor is present. Which of the following is not a symptom of Horner's Syndrome? a. Ptosis b. miosis c. enopthalmos d. anhidrosis e. none of the above 3. A doctor shines light into the patient's left eye and receives no direct or consensual response. However, when the doctor shines light into the patient's right eye there is both a direct and consensual response (constriction of the pupils). What would you diagnose as the nerve that was damaged? a. left optic b. left oculomotor c. right optic d. right optic

Anatomy 64:

1. A construction worker falls off a scaffold and presents in the ER with bleeding from his right ear. You suspect he has ruptured his tympanic membrane. Which vessel could be ruptured? a. Stylomastoid branch from the Posterior Auricular b. Ascending Pharyngeal c. Tympanic branch from the Internal Carotid d. Petrosal branch from the Middle Meningeal

2. While playing darts with his friends, a 17 y/o boy was accidentally hit in the side of the face in the region of his left parotid gland. Five months after the wound has healed, he presents in the ER with the complaint of profuse sweating in the region of the healed wound before and during meals. Which of the following scenarios is most likely? a. The Facial nerve has been damaged by the dart b. Upon regeneration of the damaged Auriculotemporal nerve, it crossed with the sympathetic nerves to the sweat glands c. The Chorda Tympani crossed with the sympathetic nerves to the sweat glands d. Upon regeneration of the damaged Lesser Petrosal nerve, it crossed with Chorda Tympani upon regeneration

3. A 47 y/o female presents with the chief complaint that she is experiencing a diminished loss of hearing. After inspection, you suspect Otosclerosis. What is this due to? a. Proliferation and inflammation of the ossicle joints b. Detatchment of the tensor tympani from the Malleus c. Fusion of the tensor tympani with the stapedius d. Degeneration of the ossicle joints resulting in fusion of the bones

4. What cranial nerves innervate the auditory canal? a. V & VII b. IX c. X & XI d. IV and VI

5. What is one function of the muscles in the middle ear?

6. The tympanic membrane is innervated by CN ___ on the inside and by CN ____ & _____ on the outside. a. IX; V & X b. V; IX & X c. IX and X only d. X only Anatomy 65:

1. Position of all pre-ganglionic sympathetic cell bodies for sympathetic innervation of head and neck viscera: a) IML levels T1-T4 b) IML levels T5-T8 c) superior cervical sympathetic ganglion d) pterygopalatine ganglion

2. Fibers leaving the superior cervical ganglion to enter with the internal carotid artery and will innervate the deep glands(such as the glands of the middle ear) of the cranium are: a)Preganglionic Parasympathetic b)Postgranglionic Parasympathetic c)Preganlgionic Sympathetic d)Postganglionic Sympathetic

3. Incomplete Horner's Syndrome results from lesions past what structure (considering nerve signal direction)? a) Otic Ganglion b) Geniculate Ganglion c) Pterygopalatine ganglion d)Superior Cervical Ganglion

Anatomy 66:

1.) How would you test for CN IX damage? a. Touch the back of the nasopharynx b. Touch the back of the oropharynx c. Touch the back of the laryngopharynx d. Ask the patient to cough 2.) A patient comes in and cannot taste anything on the anterior 2/3rds of their tongue. Which nerve has been affected? a. CN X b. Greater petrosal c. Lesser petrosal d. Chorda tympani 3.) Which nerve supplies sensory innervation for the tip of the chin? a. V1 b. V2 c. V3 d. VII Anatomy 67: Questions for the practice test: 1.

What kind of view is shown in the above CT scan? a. mandibular b. transverse c. horizonal d. coronal e. sagittal

2. Select all that apply that make up the components of the nasal septum. a. vomer b. perpendicular plate of ethmoid c. crista galli of ethmoid d. cartilage e. superior, middle and inferior nasal concha d. uvula

3. What structure can be found on the skull that is unique enough to identify a person? (besides the teeth) a. mastoid air cells b. vomer bone c. maxillary sinus e. frontal sinus

ANSWERS:

Anatomy 46:

1. C 2. C 3. B

Anatomy 47:

3.d Anatomy 48:

Anatomy 49:

1. c 2. c 3. b

Anatomy 50:

1. c 2. d 3. e

Anatomy 51:

1. anterior scalene, 1st or 2nd 2. A 3. B

Anatomy 52:

1. B 2. B

Anatomy 53:

1. c 2. d 3. d

Anatomy 54:

Anatomy 55:

Anatomy 56:

1. c 2. e 3. a

Anatomy 57:

1. B 2. A 3. D

Anatomy 58:

3.b Anatomy 59:

2. D 3. A

Anatomy 60:

1.)C 2.)B 3.)D

Anatomy 61:

1. d 2. c 3. a

Anatomy 62:

Anatomy 63:

1. b 2. e 3. a

Anatomy 64:

1. c 2. b 3. D

4. A & C 5. Muscles of the middle ear restrict movement of ear bones as a protective mechanism. 6. A

Anatomy 65: 1. A

2. c 3. d

Anatomy 66: 1. b

Anatomy 67:

1. d 2. a,b,d 3. e