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Anatomy: head and neck > exam review 2 > Flashcards

exam review 2 Flashcards

exam 2

1
Q

On your pediatric clerkship you ask a 10 year-old boy to stick his tongue out and then say “ahh”. Which muscle is he using to protrude his tongue?

  1. Geniohyoid
  2. Palatoglossus
  3. Styloglossus
  4. Hyoglossus
  5. Genioglossus
A
  1. Genioglossus
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2
Q

The space between the teeth and the gingivae (gums) is known as the:

  1. Oral cavity
  2. Vestibule
  3. Oral pharynx
  4. Paralingual space
  5. Piriform recess
A
  1. Vestibule

The oral vestibule is the space in the mouth lying between the lips and the teeth.

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3
Q

You are assisting an oral surgeon who is about to remove a stone from a patient’s submandibular duct. Which nerve do you have to be careful not to injure while incising the duct directly under the floor of the mouth.

  1. Spinal accessory
  2. Chorda tympani
  3. Lingual
  4. Inferior alveolar
  5. glossopharyngeal
A
  1. Lingual
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4
Q

Lesion of the lingual nerve proximal to the chorda tympani joining it will lead to loss of:

A

Damage lingual nerve before being joined by chorda tympani, lose general sensation from anterior 2/3

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5
Q

damage to the chorda tympani leads to

A

lose taste and salivation

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6
Q

Damage lingual nerve after being joined by chorda tympani

A

lose taste, salivation, and general sensation

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7
Q

tongue muscles are derived from

A

occipital somites

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8
Q

tongue is derived from

A

1st- 4th pharyngeal arches

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9
Q

You examine a 68 year old man with a history of hypertension who has suffered a stroke. During an examination it is noted that his uvula deviates to the left and the right side of the palate is sagging. Which nerve has most likely been affected?

  1. Left glossopharyngeal nerve
  2. Left vagus nerve
  3. Right vagus nerve
  4. Left hypoglossal nerve
  5. Right hypoglossal nerve
A
  1. Right vagus nerve

The vagus nerve supplies muscles of the soft palate (except for tensor veli palati) and pharynx (except stylopharyngeus)

Uvula will be pulled away from affected side by pharyngeal muscles

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10
Q

which muscle is not innerated by CN 10:

  1. uvula
  2. palatoglossus
  3. palatopharyngeus
  4. levator levi palatini
  5. tensor veli palatini
A
  1. tensor veli palatini

innervated by CN V3

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11
Q

A 12-year-old boy was admitted to the hospital complaining of a severe sore throat and bilateral earache. After physical examination, the boy’s physician suggested that a tonsillectomy be performed to eliminate the problem once and for all.
●Where are the palatine, pharyngeal and lingual tonsils located?
● What nerves are at risk during a palatine tonsillectomy?

A

Palatine tonsils – between palatoglossus and palatopharyngeus muscles

Pharyngeal tonsils – in pharyngeal recess above torus tubarius

Lingual tonsils – posterior region of tongue behind foramen cecum

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12
Q

Infections of the palatine tonsils or oropharynx often involve enlargement of the ________ one of the deep cervical lymph nodes

A

jugulodigastric node

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13
Q

A 32 year old male visits the dentist to have a maxillary 3rd-molar tooth removed. The extraction was very difficult and several days later while eating, he experiences regurgitation of fluids from his oral pharynx to the nasal cavity. Explain what might have happened during the dental extraction.

A

The hamulus of the medial pterygoid plate, located behind the 3rd molar tooth, probably was fractured, affecting the tensor veli palatini. This muscle tenses the soft palate and prevents food from regurgitating from the oropharynx to the nasal cavity

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14
Q

A 50 year-old patient has difficulty swallowing and frequently aspirates fluids while drinking. She is diagnosed as having a skull-base tumor occupying the space behind the jugular foramen. Which structures has been affected to account for these findings?

A

vagus nerve

The vagus nerve, which exits through the jugular foramen, supplies all the muscles of the pharnyx except for stylopharyngeus (CN IX) and therefore allows for swallowing.

The recurrent laryngeal nerves, which are branches of the vagus, supply laryngeal muscles which close the laryngeal inlet during swallowing

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15
Q

muscles of the tongue innervated by the _____ except for

A

hypoglossal except palatoglossus innervated by CN 10

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16
Q

Muscles of soft palate innervated by ______ except for

A

CN 10 except for tensor veli palatini innervated by CN V3

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17
Q

Muscles of the pharynx innvervated by _______ except for

A

CN 10 except for stylopharyngeous innervated by CN 9

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18
Q

middle constrictor attaches to the

A

hyoid bone

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19
Q

superior constrictor attached to the

A

buccinator at the pterygomandibular raphe

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20
Q

inferior constrictor attaches to the

A

thyroid cartilage

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21
Q

inner longitudinal layer of the pharyngeous muscles act to (salpingopharygeous, palatopharyngeous, stylopharyngeous)

A

elevate and shorten the pharynx during swallowing

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22
Q

outer circular layer of the pharynx act to (s/m/i constrictors)

A

contract sequentally to move food into esophagus

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23
Q

A female patient complained of parotid pain that increased while eating. Intra-oral examination detected some pus oozing from the parotid duct opening. Where would one look in the oral cavity to locate the parotid duct opening?

  1. The sublingual caruncle behind the lower central incisor teeth
  2. Mucosa of the cheek across the 2nd mandibular molar tooth
  3. Mucosa of the cheek across from the 2nd maxillary molar tooth
A
  1. Mucosa of the cheek across from the 2nd maxillary molar tooth
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24
Q

Your 38-year-old female patient has anorexia nervosa and often induces vomiting by placing her finger on the back of her tongue and oropharynx. Which nerve is responsible for the afferent limb of the gag reflex?

  1. Hypoglossal
  2. Glossopharyngeal
  3. Vagus
  4. Chorda tympani
  5. lingual
A
  1. Glossopharyngeal

The glossopharyngeal nerve supplies sensation from the posterior 1/3 of the tongue and oropharynx– it is responsible for the afferent (sensory) limb of the Gag Reflex

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25
Q

Gag Reflex
Touching the posterior 1/3 of tongue will normally cause the person to gag – pharyngeal muscles will be activated and pharynx will constrict and elevate

a. Sensory – afferent limb – ______
b. Motor – efferent – mostly ____ along with _____ which innervates stylopharyngeus

A

a. Sensory – afferent limb – CN IX

b. Motor – efferent – mostly CN X along with CN IX which innervates

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26
Q

An arteriogram of a 67 year-old man’s carotid system reveals atherosclerotic plaques within the common carotid arteries and the bifurcation of the vessels. A carotid endartectomy is then performed. Which nerve bundle running vertically within the carotid sheath must the surgeon be careful not to injure?

  1. Spinal accessory
  2. Cervical sympathetic trunk
  3. Glossopharyngeal
  4. Hypoglossal
  5. Vagus
A
  1. Vagus

The vagus nerve runs vertically within the carotid sheath, between the CAs and the IJV. The sympathetic trunk lies posteriorly, outside the carotid sheath

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27
Q

In this picture, the physician is using a straight blade (held in left hand) to elevate a laryngeal cartilage in order to guide the intubation tube past the vocal cords. Which laryngeal cartilage is it?

A. thyroid cartilage

B. cricoid cartilage

C. arytenoid cartilage

D. epiglottic cartilage

E, corniculate cartilage

A

D. epiglottic cartilage

28
Q

Area in lower part of laryngopharynx, leading to esophagus

A

piriform recess

29
Q

Space posterior to tongue and anterior to epiglottis

A

vallecula

30
Q

Region between true and false vocal cords

A

ventricle

31
Q

Space between vocal cords

A

rima glottidis

32
Q

Region bounded by epiglottis, aryepiglottic folds and arytenoid cartilages – the region above the vocal cords

A

vestibule

33
Q

Which of the following membranes:

  1. Thyrohyoid membrane
  2. Cricothyroid membrane
  3. Conus elasticus
  4. Quadrangular membrane

Gives rise to the false vocal cords

Has an upper free edge which forms the true vocal cords

Is pierced by the internal laryngeal nerve and superior laryngeal artery

Is incised to create an emergency airway

Has an upper free edge known as the aryepiglottic fold

A

Gives rise to the false vocal cords: quadrangular membrane

Has an upper free edge which forms the true vocal cords: conus elasticus

Is pierced by the internal laryngeal nerve and superior laryngeal artery: thyrohyoid membrane

Is incised to create an emergency airway: cricothyroid membrane

Has an upper free edge known as the aryepiglottic fold: quandrangular fold

34
Q

A newborn infant exhibits labored breathing and unusual vocal tones when crying. Thorough examination reveals the child has malformed vocal folds due to displaced attachments of the vocal ligaments. Which of the following structures forms the attachment for the vocal ligaments?

  1. Epiglottic cartilage
  2. Cricoid cartilage
  3. Arytenoid cartilages
  4. Corniculate cartilages
  5. Cuneiform cartilages
A
  1. Arytenoid cartilages

The vocal ligaments are the upper free edge of the conus elasticus and attach to the vocal processes of the arytenoid cartilages and the inside of the laryngeal prominence

35
Q

Rather than send a text to her friend, a woman decides to whisper in his ear.
Which laryngeal muscles does she use to whisper?

A

The lateral cricoarytenoid muscles – they adduct the vocal cords but leave a space between the arytenoid cartilages for air to pass

36
Q

Which of the following muscles:

  1. Thyroepiglottic
  2. Thyroarytenoid
  3. Vocalis
  4. Lateral cricoarytenoid
  5. Posterior cricoarytenoid
  6. Cricothyroid
  7. Transverse interarytenoid

Has a different innervation from the other ones?

Abducts the vocal cords?

Is attached directly to the vocal ligaments

Adducts the vocal cords

Relaxes the vocal cords

Widens the laryngeal inlet

A

Has a different innervation from the other ones?: cricothyroid

Abducts the vocal cords?: posterior cricoarytenoid

Is attached directly to the vocal ligaments: vocalis

Adducts the vocal cords: lateral cricoarytenoid and tranverse interarytenoid

Relaxes the vocal cords: vocalis

Widens the laryngeal inlet: thyroepiglottic

37
Q

A 71-year-old woman often visits an emergency department with swallowing difficulties and subsequent choking while eating food. Which of the following pairs of muscles is most instrumental in preventing food from entering the laryngeal inlet and trachea during swallowing?

  1. Levator veli palatini and tensor veli palatini
  2. Sternohyoid and sternothyroid
  3. Inferior constrictor and thyrohyoid
  4. Oblique and transverse arytenoid and aryepiglottic
  5. Palatoglossus and palatopharyngeus
A
  1. Oblique and transverse arytenoid and aryepiglottic
38
Q

When performing a cricothyrotomy, an incision is made in the cricothyroid membrane and a tube placed in the larynx to allow the person to breathe. In which space is the tube located?

  1. Vestibule
  2. Ventricle
  3. Vocal cords
  4. Rima glottidis
  5. Glottis
  6. Infraglottic cavity
A
  1. Infraglottic cavity

the area below the vocal folds

39
Q

An elderly patient presents with a thyroid carcinoma. These are aggressive malignancies that often penetrate the thyroid capsule and invade structures adjacent to the thyroid gland. You suspect tumor invasion of both of the recurrent laryngeal nerves because of all of the following EXCEPT:

  1. inability to abduct the vocal cords
  2. inability to adduct the vocal cords
  3. almost complete inability to speak
  4. loss of all sensation from the larynx
  5. inability to close the laryngeal inlet during swallowing
A
  1. loss of all sensation from the larynx

The internal laryngeal nerve supplies general sensation above the vocal cords. The recurrent laryngeal nerves supply motor innervation to all other muscles, except cricothyroid, and sensation below the volcal cords

40
Q

The external laryngeal nerve, which supplies the cricothyroid muscle (the tensor of the vocal cords), (and the inferior laryngeal constrictor) runs alongside the ____________

A

superior thyroid artery

41
Q

middle ear derived from ______

A

1st pharyngeal pouch

42
Q

malleus and incus derived from

A

1st pharyngeal arch cartilages

43
Q

stapes derived from

A

2nd pharyngeal cartilage

44
Q

A 3-year old boy is brought to the clinic with a runny nose, sore throat and fever of 2 days duration. His tonsils are inflamed and an examination of his ears shows that his tympanic membrane is red and bulging outward.
What is your diagnosis and how did he most-likely develop this condition?

A

An infection in the nasopharynx has traveled to the middle ear via the Eustachian (pharyngotympanic) tube. One of the earliest signs of otitis media is congestion of the eardrum that may be seen easily with otoscope.

45
Q

What surgical procedure may be used to treat the fluid build-up in the middle ear?

A

Surgical alleviation of fluid build-up includes myringotomy. This procedure involves making a curvilinear incision in the inferior portion of the tympanic membrane below the malleus handle. The incision should be long enough to allow good drainage

46
Q

A patient with chronic otitis media (middle ear infection) might have all the following complications EXCEPT:

  1. Inability to chew food due to injury of the mandibular division of the trigeminal nerve
  2. Loss of taste in the anterior part of the tongue due to injury to the chorda tympani
  3. Mastoiditis
  4. Decrease in salivation from the parotid, submandibular and sublingual glands
  5. Some degree of deafness due to damage to the auditory ossicles
A
  1. Inability to chew food due to injury of the mandibular division of the trigeminal nerve
47
Q

A 12-year old boy with recurrent left middle ear infection (otitis media) develops pain and redness behind his left ear. A physical examination indicates that the patient has mastoiditis. On which of the following walls of the middle ear is the opening to the mastoid air cells?

A.  Anterior
B. Lateral
C. Medial
D. Posterior
E. Roof
A

D. Posterior

The aditis – the opening into the antrum that leads to the mastoid air cells from the middle ear is located on the posterior wall of the middle ear.

48
Q

Mastoiditis – inflammation of the mastoid antrum and mastoid air cells – usually caused by untreated ___________

A

otitis media

49
Q

A 56 year-old man comes to the clinic with a complaint of severe headaches and ear pain. A CT scan reveals a tumor in the middle ear invading through the bony floor. Which of the following structures will most likely be affected?

  1. The cochlea and lateral semicircular canal
  2. The internal carotid artery
  3. The tympanic membrane
  4. The internal jugular vein
  5. The aditus and antrum of the mastoid region and facial nerve
A
  1. The internal jugular vein

The internal jugular vein lies on the floor of the middle ear cavity.

50
Q

The pharyngeal tonsils, or adenoids, may become inflamed along with the palatine tonsils, and in serious cases need to be removed. Where are these located?

A. In the vallecular fossa

B. In the piriform recess

C. Between the palatoglossus and palatopharyngeus

D. Above the torus tubarius in the nasopharynx

E. In the danger space

A

D. Above the torus tubarius in the nasopharynx

51
Q

Blood supply to tonsillar bed:

A

ascending palatine and tonsillar branches of the facial artery, the palatine branch of the ascending pharyngeal artery, the dorsal lingual branch of the lingual artery, and the descending palatine branch of the maxillary artery

52
Q

f the Eustachian tube is blocked, air is resorbed by the middle ear and a negative pressure, anaerobic environment is created in the middle ear. The negative pressure may result in aspiration of nasopharyngeal contents, including bacteria, into the middle ear that then proliferate to cause otitis media. Which muscle opens the auditory (Eustachian) tube (as when we yawn)?

A

The tensor veli palatini

53
Q

A 23-year old woman comes to the clinic with the following complaints:
A feeling of dizziness when she is standing (vertigo)
A progressive (months) loss of hearing in her left ear
A persistent ringing and sense of pressure in her left ear

What is your diagnosis and what is the cause of her symptoms?

A

Meniere’s Syndrome

54
Q

Meniere’s Syndrome

A

A disorder of the inner ear that can affect hearing and balance to a varying degree. It is characterized by episodes of
●vertigo (feeling of motion when one is stationary)
●low pitched tinnitus (“ringing” – perception of sound in absence of external sound)
●hearing loss.

  • believed to be linked to endolymphatic hydrops, an excess of fluid in the inner ear due to blockage of the endolymphatic duct
55
Q

perilymph is in continuity with

A

CSF

56
Q

A 37 year-old highway construction worker whose job involves using a jackhammer to dig holes comes to the clinic complaining of a progressive loss of hearing over the past year. Which type of hearing loss do you likely suspect he has?

a. High-tone deafness
b. Conductive hearing loss
c. Sensorineural hearing loss

A

a. High-tone deafness

High tone Deafness – persistent exposure to excessively loud sounds causes degenerative changes in the spiral organ of Corti, resulting in loss of sensitivity to high-frequency sounds

57
Q

When cotton tipped applicators are used to clean ear wax, there is a risk of perforating the tympanic membrane. This structure is formed between which two embryonic structures?

a. 1st and 2nd pharyngeal arches
b. 2nd and 3rd pharyngeal arches
c. 1st and 2nd pharyngeal pouches
d. 1st pharyngeal cleft and 1st pharyngeal pouch
e. 2nd pharyngeal cleft and 2nd pharyngeal pouch

A

d. 1st pharyngeal cleft and 1st pharyngeal pouch

58
Q

A patient complains of loss of hearing in the right ear. Examination reveals bone growth (otosclerosis) of the footplate of the stapes to the surrounding bone. Which part of the bony labyrinth is involved?

A. Aditus

B. Round window

C. Oval window

D. Internal acoustic meatus

E. Cochlear duct

A

C. Oval window

59
Q

Aditus

A

The aditus is the opening from the middle ear to the mastoid antrum, a space leading to the mastoid air cells

60
Q
  • the spatial arrangement of where sounds of different frequency are processed in the brain
A

Tonotopy

61
Q

After losing a bet to his golf buddies, a slightly intoxicated 56 year old man is made to dance like a ballerina, but after spinning around only once, loses his balance and falls. Which of the following contain structures which are sensitive to rotational movements of the head?

A. The spiral organ of Corti
B. Semicircular canals
C. Utricle and saccule
D. Scala vestibuli
E. Vestibule
A

B. Semicircular canals

62
Q

The three semicircular canals have swellings, called ampullaeand within each ampulla is the sense organ, called the

A

crista.

63
Q

The sensory epithelia are overlaid by a gelatinous substance that contains calcium carbonate crystals and in which the cilia are embedded. These crystals are called the

A

otoliths

64
Q

what makes the ice cream cone?

A

Malleus and incus

65
Q

between retropharyngeal and alar fascia

A

Retropharyngeal space –

66
Q

between alar and prevertebral fascia

A

Danger space –

Anatomy: head and neck (31 decks)

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