HEAD AND NECK PRACTICE EXAM 2011 1. _____ Palsy of the hypoglossal nerve can often be difficult to diagnose. In early stages, patients may only complain of dysarthria (difficulty in speaking). Examination of the intrinsic muscles of the tongue may show little atrophy but, when tested, patients may show limited ability to change the shape of the tongue, such as making it narrower or broader. Which of the following intrinsic muscles of the tongue make the tongue narrower?
A. Longitudinal muscles
B. Transverse muscles
C. Vertical muscles
D. Hyoglossus muscle
E. Genioglossus muscle
2. _____ Spinal nerve C2 forms part of the cervical plexus which provides innervation to the skin of the neck. Which of the following nerves arise (at least in part from vertebral level C2?
A. Lesser occipital nerve
B. Great Auricular nerve
C. Supraclavicular nerves
D. Lesser Occipital and Great Auricular Nerves
E. Phrenic Nerve
3. _____ The major arteries to the head and neck arise from the arch of the Aorta.or from the Subclavian artery. Which of the following arteries arise from the first part of the Subclavian artery (as it courses medial to the Scalenus Anterior muscle)?
A. Vertebral artery
B. Costocervical trunk
C. Thoracoacromial artery
D. Posterior Auricular artery
E. Ascending Pharyngeal artery
4. _____ Which of the following structures divides the Posterior triangle of the neck into 'careful' and 'carefree' zones?
A. Accessory nerve
B. Supraclavicular nerve
C. Superficial cervical artery
D. Subclavian artery
E. Lesser Occipital nerve
5. _____ The Styloid process extends from the inferior surface of the temporal bone and is origin of muscles that move the tongue, pharynx and hyoid bone. These muscles receive innervation from a number of cranial nerves. Which of the following cranial nerves provide innervation to muscles originating from the styloid process?
A. V3, VII and X
6. _____ The Alar ligaments provide stability at the base of the skull by preventing excessive rotation of the head. Which of the following describes the bones to which the alar ligaments are attached?
A. Dens of axis (C2) to the occipital bone
B. Body of the axis (C2) to the occipital bone
C. Atlas (C1) to the occipital bone
D. Axis (C2) to the atlas (C1)
E. C3 to the Atlas (C1)
7. _____ The External Jugular vein courses superficially on the surface of the Sternocleidomastoid muscle and can, therefore, be utilized for insertion of catheters. Which of the following veins joins the Posterior division of the retromandibular vein to form the External Jugular vein?
A. Occipital vein
B. Posterior auricular vein
C. Maxillary vein
D. Superficial temporal vein
E. Facial vein
8. _____ Which of the following describes the course of the Glossopharyngeal nerve?
A. passes in the gap between the Superior constrictor muscle and the skull
D. passes in the gap between the Middle and Inferior constrictor muscles
E. passes on the surface of the Hyoglossus muscles
9. _____ Which of the following structures is found in the Anterior triangle of the neck?
A. Roots and Trunks of the Brachial plexus
B. Phrenic nerve
C. Suprascapular artery
D. Subclavian artery
E. Hypoglossal nerve
10. _____ Infections of the Maxillary sinus can be persistent due to poor drainage of the sinus. In which of the following is the opening of the Maxillary sinus located?
A. Sphenoethmoidal recess
B. Superior meatus
C. Superior concha
D. Hiatus semilunaris of the middle meatus
E. Inferior meatus
11. _____ The Salpingopharyngeus muscle takes origin from the auditory tube and acts to raise the pharynx in swallowing. Which of the following is the embryological origin of the Salpingopharyngeus muscle?
A. Fourth branchial arch
E. Occipital myotomes
12. _____ Posterior cleft palate occurs in 1:2500 births and is the result of failure of fusion of embryological structures in development. Which of the following structures fail to fuse and result in a Posterior cleft palate?
A. Medial nasal processes of the left and right sides.
B. Maxillary and Medial nasal processes
C. Maxillary processes of the left and right sides
D. Medial and lateral nasal processes
E. Maxillary and Mandibular processes
13. _____ The Ethmoidal air sinuses (air cells) are clinically important because they can expand in the elderly and extend over the orbit. Which of the following describes the opening of the Posterior Ethmoidal air sinus (air cells)?
A. Sphenoethmoidal recess
B. Superior meatus
C. Ethmoidal bulla of the Middle Meatus
D. Hiatus semilunaris of the Middle Meatus
E. Inferior meatus
14. _____ The nasal cavity has a rich innervation and blood supply derived from a number of sources. Which of the following statements correctly describes the anatomy of the nasal cavity?
A. receives sensory innervation from branches derived from both the ophthalmic (V1) and maxillary (V2) divisions of the Trigeminal nerve.
B. has venous drainage to both the pterygoid venous plexus and the ophthalmic veins.
C. has lymphatics that drain to the retropharyngeal nodes.
D. A and B
E. All of the above
15. _____ A patient complains that he has a sore throat. In laryngoscopic examination, the patient shows swelling of the mucosa of the larynx above the true vocal folds. Which of the following types of neurons provides innervation to this region of the larynx and in which nerve are these neurons contained?
A. Visceral sensory (GVA) neurons in the Recurrent Laryngeal nerve
B. Visceral sensory (GVA) neurons in the Internal Laryngeal nerve
C. Somatic sensory (GSA) neurons in the Recurrent Laryngeal nerve
D. Somatic sensory (GSA) neurons in the Internal Laryngeal nerve
E. Visceral sensory (GVA) neurons in the External Laryngeal nerve
16_____ The Submandibular salivary glands are located inferior to the ramus of the mandible but also extend posteriorly to the floor of the mouth. Which of the following forms the opening of the submandibular ducts.
A. Fimbriated fold (Plica fimbriata)
B. Sublingual fold (Plica sublingualis)
C. Sublingual papilla
D. Sulcus terminalis
E. Foramen cecum
17. _____ Block examinations are both stressful and challenging. Which of the following best describes the strategy to be used on the night before a Block examination containing questions on the anatomy of the Head and Neck?
cram the maximum amount of information possible
guess which handouts will be emphasized and stay awake all night staring at them
lie awake wondering what the V in SVE actually means
attend a midnight party with other students and panic collectively
go to bed early
18. ______ The tongue is a large muscular mass with extensive lymphatic drainage. Which of the following describes the lymph nodes that drain the anterior two thirds of the tongue (but not including the tip of the tongue)?
E. Submental and Deep cervical nodes
19. _____ The structural integrity of the larynx depends upon ligaments that link the cartilages as well as membranes that lie deep to laryngeal mucosa. Which of the following is the attachment for the Quadrangular membrane of the larynx?
A. Epiglottis and arytenoid cartilages
B. Cricoid and arytenoid cartilages
C. Thyroid and arytenoid cartilages
D. Epiglottis and thyroid cartilages
E. Thyroid and cricoid cartilages
20. _____ Which of the following cranial nerves innervates the mucosa overlying the Piriform recesses?
21. _____ Which of the following structures pass(es) in the gap between the Middle and Inferior constrictor muscles?
A. Auditory tube
B. Internal Laryngeal nerve
C. External Laryngeal nerve
D. Recurrent Laryngeal nerve
E. Inferior Thyroid artery
22. _____ The blood supply to the Submandibular salivary gland is normally derived from the
A. Lingual artery
B. Sublingual artery
C. Facial artery
D. Inferior alveolar artery
E. Posterior superior alveolar artery
23. _____ The size of the opening of the larynx (rima glottidis) is under muscular control. It is expanded during deep breathing and exercise. Which of the following muscles act(s) to expand (open) the rima glottidis?
A. Posterior cricoarytenoid
B. Lateral cricoarytenoid
24.____ A child who was eating popcorn complains that he (she) has something ‘stuck in my throat’. Inspection with a mirror shows that a piece of popcorn is lodged on the posterior 1/3 of the tongue. Which of the following is the most likely structure in which the popcorn is lodged?
E. Laryngeal sinus
25. _____ When performing thyroid surgery, a physician is careful to find and identify the Recurrent laryngeal nerve. The nerve can be located by tracing the artery with which it courses. Which of the following arteries courses with the Recurrent Laryngeal nerve?
A. Superior Thyroid Artery
B. Inferior Thyroid Artery
C. Subclavian Artery
D. Vertebral Artery
E. Internal Thoracic Artery
26. _____ Bleeding in the palate can be profuse and difficult to control because of extensive anastomoses among arterial branches. Which of the following arteries gives rise to Ascending Palatine artery?
A. Posterior Superior Alveolar artery
B. Infraorbital artery
C. Lingual artery
D. Maxillary artery
E. Facial artery
27. _____ Which of the following structures passes through the incisive foramen?
A. Infraorbital nerve (branch of V2)
B. Nasopalatine nerve (branch of V2)
C. Buccal nerve (branch of V2)
D. Anterior ethmoidal nerve (branch of V1)
E. Infratrochlear nerve (branch of V1)
28. _____ A CT scan of a patient with metastatic carcinoma shows a small mass at the foramen ovale. The mass appears to compress only the structures passing through the foramen. Which of the following symptoms would be most likely to be present in this patient?
A. Numbness in the anterior two thirds of the tongue on that side but no loss of taste.
B. Numbness in both the anterior two thirds and posterior one third of the tongue on that side but no loss of taste.
C. Numbness and loss of taste in the anterior two thirds of the tongue on that side.
E. Numbness and loss of taste in both the anterior two thirds and posterior one third of the tongue on that side.
29. _____ Which of the following structures is found within the carotid sheath?
A. Accessory nerve
B. Sympathetic chain
C. Superior Thyroid artery
D. Glossopharyngeal nerve
E. Vagus nerve
30.______ Which of the following nerves contains preganglionic parasympathetics to the parotid gland?
A. Greater Petrosal nerve