1. Which bone of the skull contains the optic foramen, foramen ovale, and foramen spinosum?
A. Frontal
B. Temporal
C. Sphenoid
D. Ethmoid
E. Occipital
2. The internal jugular vein
A. is located within the carotid sheath
B. receives venous drainage from the brain
C. is a tributary of the brachiocephalic vein
D. receives blood from the facial vein
E. All of the above
3. The following structure runs within the falx cerebri.
A. Inferior sagittal sinus
B. Transverse sinus
C. Sigmoid sinus
D. Cavernous sinus
E. 3rd ventricle
4. The vertebral artery
A. ascends through the transverse foramina of all seven cervical vertebra
B. arises from the first part of the axillary artery
C. terminates by joining with the posterior cerebellar artery
D. supplies branches to the thyroid gland
E. supplies the posterior cerebral circulation
5. A patient is taken to the emergency department after his wife noticed something wrong with the left side of his face during breakfast. He is found to have a problem with the nerve exiting the stylomastoid foramen, a disorder called Bell’s palsy. Which of the following problems is this patient likely to have?
A. He is unable to open his left eye.
B. He is unable to raise his eyebrow on the left side.
C. He is unable to protrude his tongue to the right.
D. He is unable to chew.
E. He is unable to feel pressure on his left cheek.
6. A patient came into the ER with a broken mandible resulting from an overswung bat. Which nerve is most likely affected by this injury?
A. Lingual nerve
B. Hypoglossal nerve
C. Zygomatic branches of facial nerve
D. Inferior alveolar nerve
E. Chorda tympani nerve
7. The muscle of mastication that inserts into the condylar process of the mandible and its articular disk and the capsule of the temporomandibular joint (TMJ) is the
A. medial pterygoid muscle
B. lateral pterygoid muscle
C. temporalis muscle
D. masseter muscle
E. buccinator muscle
8. A patient develops acromegaly secondary to a tumor in his pituitary gland secreting growth hormone. A transsphenoidal resection of the tumor is scheduled. During this process, part of the inferior and posterior nasal septum is removed. Which bone forms this part of the nasal septum?
A. Vomer
B. Ethmoid
C. Palatine
D. Temporal
E. Sphenoid
9. The lacrimal gland is innervated by
A. the facial nerve (VII)
B. the postganglionic neurons with the cell bodies in the pterygopalatine ganglion
C. the parasympathetic neurons
D. the lacrimal nerve
E. All of the above
10. A 2-year-old boy seen by his pediatrician was noticeably irritable and tugging at his ear. When his mother asked him in a normal tone to sit quietly, he covered his ears screaming in pain and asked her not to shout at him. On exam he was found to have a fever, and his tympanic membrane was red and bulging. He was diagnosed with otitis media and started on antibiotics. The child’s extreme sensitivity to sound (hyperacusis) suggests that the infection affected the stapedius muscle. The nerve that innervates this muscle is a branch of what nerve?
A. Maxillary division of trigeminal nerve
B. Mandibular division of trigeminal nerve
C. Facial nerve
D. Glossopharyngeal nerve
E. Vagus nerve
11. The innervation for the sternothyroid muscle is the
A. ansa cervicalis
B. facial nerve
C. hypoglossal nerve
D. accessory nerve
E. recurrent laryngeal nerve
12. A patient was having an animated discussion with his friends when he started coughing after swallowing a piece of chicken. He soon became unable to speak or cough. Two paramedics who were taking a break at the same fast-food restaurant quickly came to his help, and one stood behind the man and performed forceful abdominal thrusts (Heimlich maneuver). After several attempts of not being successful at dislodging the aspirated food, the paramedics decide to perform an emergency airway. Where is the most superior site to perform this procedure so that the airway is secured below the vocal folds?
A. Superior to the hyoid bone
B. Between the hyoid bone and the thyroid cartilage
C. Between the thyroid cartilage and the cricoid cartilage
D. Between the thyroid cartilage and the arytenoid cartilage
E. Superior to the manubrium in the jugular fossa
13. A patient is found to have a nodule in his neck. His calcitonin level is elevated, and a biopsy reveals medullary carcinoma of the thyroid. A thyroidectomy is performed. After surgery the patient’s voice is found to be hoarse. What nerve was most likely injured during surgery?
A. The glossopharyngeal
B. The hypoglossal
C. The ansa cervicalis
D. The recurrent laryngeal
E. The phrenic
14. A child who has been vomiting is diagnosed with an obstruction in his gastrointestinal tract. He becomes severely dehydrated, and a sunken anterior fontanelle is felt. What is the youngest age at which this sign no longer would appear in a dehydrated child?
A. 1 month
B. 3 months
C. 6 months
D. 12 months
E. 24 months
15. The jugulodigastric lymph nodes that lie near the facial and internal jugular veins are also known as
A. parotid nodes
B. superior deep cervical nodes
C. inferior deep cervical nodes
D. retroauricular nodes
E. lateral cervical nodes
16. A patient develops severely elevated intracranial pressure due to a brain tumor obstructing the flow of cerebral spinal fluid (CSF). A shunt is placed to relieve this pressure because the CSF is blocked from being returned to the venous system. Where would this resorption normally take place?
A. At the choroid plexus
B. At the interventricular foramen
C. At the cerebral aqueduct
D. At the lateral apertures
E. At the arachnoid granulations
17. The vagus nerve (cranial nerve X)
A. leaves the skull through the carotid foramen
B. innervates the carotid sinus
C. is transmitted through the superior orbital fissure
D. innervates all of the muscles of the soft palate
E. None of the above
18. A 40-year-old obese woman has frequent headaches. Upon eye exam, she is found to have papilledema (swelling of the optic disc). It is suspected that she has elevated intracranial pressure. CT scan is negative for any strokes or tumors. She is diagnosed with idiopathic intracranial hypertension (pseudotumor cerebri). One complication of this disorder is downward displacement of the brainstem, which leads to stretching of the abducent nerve. How would you diagnose if this complication occurred in this patient?
A. She would be unable to move her eyes laterally.
B. She would be unable to move her eyes medially.
C. She would be unable to move her eyes superiorly.
D. She would be unable to move her eyes inferiorly.
E. She would be unable to rotate her eyes internally.
19. A 61-year-old firefighter was trapped for 12 hours in a collapsed building following an earthquake. Although he suffered a fractured tibia, the emergency room physician was also concerned about a deep scalp laceration that extended across the top of the patient’s head. Infection from this laceration could spread
A. to dural venous sinuses through emissary veins
B. into the neck in the loose areolar tissue
C. laterally beyond the zygomatic arches
D. to the epidural space
E. All of the above
20. A dentist who specializes in relief of facial pain is experimenting with a procedure to inject anesthetic into the pterygopalatine fossa through a lateral approach. The needle passes through the mandibular notch of the mandible, traverses the infratemporal fossa, and enters the pterygomaxillary fissure. Which of the following structures would be at risk during the procedure?
A. Maxillary artery
B. Mandibular division of the trigeminal nerve (CN III)
C. Pterygoid venous plexus
D. Otic ganglion
E. All of the above
21. Which of the following drains into the inferior meatus of the nasal cavity?
A. Nasolacrimal duct
B. Frontal sinus
C. Ethmoid sinus
D. Sphenoid sinus
E. Maxillary sinus
22. Which of the following vessels accompanies the optic nerve through the optic canal?
A. Supratrochlear artery
B. Supraorbital artery
C. Ophthalmic artery
D. Ophthalmic vein
E. Ophthalmic nerve
23. The nerve that innervates the middle ear muscle that changes the shape of the tympanic membrane is the
A. optic nerve
B. oculomotor nerve
C. trochlear nerve
D. trigeminal nerve
E. facial nerve
24. The branches of the cervical plexus
A. originate from the anterior rami of C1 through C4
B. innervate the sternocleidomastoid
C. carry preganglionic fibers that synapse in parasympathetic ganglia of the head
D. include only cutaneous nerves
E. include the greater occipital nerve
25. Intubation is necessary during surgery because, due to muscle relaxants and other drugs administered during the procedure, patients are unable to fully relax the vocal folds. Paralysis of which muscle prevents the relaxation of the vocal folds?
A. Thyroarytenoid muscles
B. Posterior cricoarytenoid muscles
C. Cricothyroid muscles
D. Transverse arytenoid muscles
E. Lateral arytenoids muscles
26. All of the innervation of the larynx, both sensory and motor, is supplied by
A. the vagus nerve
B. the glossopharyngeal nerve
C. the recurrent laryngeal nerve
D. the superior laryngeal nerve
E. None of the above
27. Which is the only laryngeal cartilage to completely encircle the airway?
A. Thyroid
B. Cricoid
C. Epiglottic
D. Arytenoid
E. Corniculate
28. A patient is in a knife fight and receives a stab wound between the sternocleidomastoid muscle and the superior belly of the omohyoid muscle. Profuse bleeding ensues due to penetration of the common carotid artery. Which structure within the same fascial sheath may also have been injured?
A. External jugular vein
B. Phrenic nerve
C. Internal jugular vein
D. Superior thyroid artery
E. Sympathetic trunk
29. A diabetic patient complains a severe photophobia (sensitivity to bright lights) in her right eye. When light is directly shined in her right eye her pupil does not constrict. The physician decides that, given her diabetes, she has a third cranial nerve neuropathy that involves the periphery of this nerve. Which ganglion is most likely involved in her physical findings?
A. Superior cervical
B. Pterygopalatine
C. Ciliary
D. Otic
E. Trigeminal
30. A patient with a long history of tobacco use goes to the dentist for a cleaning. The dentist notices a lesion on her patient’s lateral part of the body of the tongue and refers him to an otolaryngologist (ENT). The ENT biopsies the lesion and determines that the patient has squamous cell carcinoma of the tongue. A CT of the patient’s head and neck demonstrates metastasis to the patient’s lymph nodes. The primary group of lymph nodes for the drainage of this patient’s cancer is
A. superior deep cervical
B. inferior deep cervical
C. anterior superficial cervical
D. submandibular
E. submental
31. All of the following bones form a part of the nasal walls or floor except
A. Frontal
B. Ethmoid
C. Maxilla
D. Vomer
E. Palatine
32. The action of the medial pterygoid muscle is to
A. elevate the mandible
B. tense the soft palate
C. elevate the soft palate
D. elevate the hyoid bone
E. retract the mandible
33. A 63-year-old patient complains of difficulty speaking, chewing, and swallowing. On physical exam, you see that the patient’s tongue is atrophied, and when asked to stick out his tongue and say “ahh,” the patient’s tongue deviates to the left. Upon obtaining a medical history and physical exam, you find that the patient underwent recent surgery on his common carotid artery. Damage to which nerve has most likely caused the observed deficits?
A. Right glossopharyngeal nerve
B. Right hypoglossal nerve
C. Left hypoglossal nerve
D. Right lingual nerve
E. Left lingual nerve
34. The mandibular division of the trigeminal nerve (V3) passes through the foramen ovale into the
A. infratemporal fossa
B. pterygopalatine fossa
C. orbit
D. nasal cavity
E. oral cavity
35. A patient with hypertension and a long history of smoking suffers a series of transient ischemic attacks (TIAs). Upon evaluation a carotid bruit is heard. Further testing reveals severe stenosis of his internal carotid artery due to atherosclerosis. The TIAs were due to embolism of the atherosclerotic plaque. Which of the following is the first branch of the internal carotid artery likely to be affected by an embolism?
A. Superior thyroid
B. Lingual
C. Facial
D. Maxillary
E. Ophthalmic
36. A patient has thrombophlebitis of the right cavernous sinus due to a facial skin infection. The infection traveled via the angular vein to the superior ophthalmic vein and into the cavernous sinus. Which of the following is an additional symptom that this patient might exhibit?
A. Jugular venous distension on the right
B. Inability to smile
C. Inability to chew on the right
D. Loss of vision in the right eye
E. Loss of sensation to the right cheek
37. Which of the following artery is a branch of the internal carotid artery?
A. Posterior cerebral artery
B. Occipital artery
C. Labyrinthine artery
D. Ophthalmic artery
E. Middle meningeal artery
Answers and Explanations
1. C The sphenoid forms the posterior orbit and the floor of the middle cranial fossa between the frontal and temporal bones. Foramina of the sphenoid include the optic foramen, foramen ovale, foramen rotundum, foramen spinosum, and superior orbital fissure (Section 17.1a).
A The frontal bone forms the forehead, the roof and superior rim of the orbit, and the floor of the anterior cranial fossa.
B The temporal bone forms part of the middle and posterior cranial fossa. Its foramina include the internal and external acoustic meatuses, carotid canal, and stylomastoid foramen.
D The ethmoid bone forms part of the anterior cranial fossa, medial walls of the orbit, and parts of the nasal septum and lateral nasal walls,
E The occipital bone forms most of the posterior cranial fossa. Its foramina include the foramen magnum, condylar canals, and jugular foramina.
2. E The internal jugular vein is located within the carotid sheath (A), contains venous drainage from the brain (B), is a tributary of the brachiocephalic vein (C), and receives blood from the facial vein (D) (Section 17.4).
A The internal jugular vein runs within the carotid sheath with the common carotid artery and vagus nerve. B, C, and D are also correct (E).
B Cerebral venous drainage flow primarily to the internal jugular veins. A, C, and D are also correct (E).
C The internal jugular veins join the subclavian veins to form the brachiocephalic veins. A, B, and D are also correct (E).
D The facial vein is a tributary of the internal jugular vein. A through C are also correct (E).
3. A The inferior sagittal sinus runs in the inferior edge of the falx cerebri and ends as the straight sinus (Section 18.1c).
B The transverse sinus runs along the posterolateral margins of the tentorium cerebelli.
C The sigmoid sinuses run in grooves of the occipital and temporal bones.
D The cavernous sinuses lie lateral to the sella turcica between the meningeal and periosteal dura.
E The 3rd ventricle lies between the right and left thalami of the diencephalon.
4. E The right and left vertebral arteries join to form the basilar artery. Together these arteries supply the posterior circulation of the brain (Section 18.2c).
A The vertebral artery ascends through the transverse foramina of C1–C6 vertebrae.
B The vertebral artery is a branch of the subclavian artery.
C The vertebral artery terminates by joining with the contralateral vertebral artery to form the basilar artery.
D The vertebral artery has no branches in the neck.
5. B CN VII, the facial nerve, exits the stylomastoid foramen and is responsible for the muscles of facial expression, including the occipitofrontalis muscle, which elevates the eyebrows (Section 18.3).
A The levator palpebrae superioris muscle elevates the eyelid and is innervated by CN III, the oculomotor nerve. In addition to the levator palpebrae superioris the occipitofrontalis muscle assists in raising the eyebrow, but because CN III is not affected the patient is able to open his eye. He is not, however, able to close his eye completely due to the paralysis of the orbicularis oculi muscle.
C CN XII, the hypoglossal nerve, innervates most of the tongue musculature. A left-sided hypoglossal injury would lead to the inability to protrude his tongue to the right.
D The muscles of mastication are innervated by the mandibular division of CN V, the trigeminal nerve. Although his ability to chew is unaffected, the patient does have some trouble eating because of paralysis to the buccinator muscle, which assists in positioning food in the oral cavity.
E Sensation to the cheek is conveyed through the maxillary division of the trigeminal nerve.
6. D The inferior alveolar nerve courses within the mandibular canal of the mandible and would be injured in this patient (Section 18.3).
A The lingual nerve courses through the infratemporal fossa and into the floor of the mouth.
B The hypoglossal nerve courses anteriorly below the angle of the mandible before entering the mouth at the posterior border of the mylohyoid muscle.
C Zygomatic branches of the facial nerve pass lateral to the masseter muscle as they cross the cheek.
E The chorda tympani travels with the lingual nerve in the infratemporal fossa and floor of the mouth.
7. B The lateral pterygoid muscle inserts into the condylar process of the mandible and its articular disk and the capsule of the temporomandibular joint (TMJ) (Section 19.2).
A The medial pterygoid inserts into the pterygoid tuberosity on the medial surface of the angle of the mandible.
C The temporalis inserts into the apex and medial surface of the coronoid process of the mandible.
D The masseter inserts into the masseteric tuberosity at the angle of the mandible.
E The buccinator inserts into the angle of the mouth and obicularis oris.
8. A The vomer makes up the inferior and posterior parts of the nasal septum (Section 19.7a).
B The ethmoid bone, through its perpendicular plate, makes up the superior and posterior parts of the nasal septum.
C The palatine forms the posterior palate and does not contribute to the nasal septum.
D The temporal forms the base and lateral side of the skull and does not contribute to the nasal septum.
E Although some of the sphenoid bone will be removed as a part of the procedure, it does not contribute to the nasal septum.
9. E The lacrimal gland is innervated by visceral motor fibers (preganglionic parasympathetic [C]) of the greater petrosal branch of the facial nerve (A). The postganglionic neuron is the zygomatic branch of the maxillary nerve (V2), which has its cell body in the pterygopalatine ganglion (B) and is then distributed to the lacrimal gland. The lacrimal nerve (D) provides sensory innervation to the lacrimal gland, conjunctiva, and upper eyelids (Section 18.3). A The lacrimal gland is innervated by visceral motor fibers (preganglionic parasympathetic of the greater petrosal branch of the facial nerve). B through D are also correct (E).
B The zygomatic branch of the facial nerve carries postganglionic parasympathetic fibers from the pterygopalatine ganglion to the lacrimal gland. A, C, and D are also correct (E).
C Parasympathetic fibers of the zygomatic nerve innervate the lacrimal gland. A, B, and D are also correct (E).
D The lacrimal nerve provides sensory innervation to the lacrimal gland, conjunctiva, and upper eyelids. A through C are also correct (E).
10. C The stapedius nerve arises from the facial nerve in the facial canal to innervate the stapedius muscle, which dampens sound waves transmitted through the middle ear (Section 20.2b).
A The maxillary nerve is distributed to the orbit, nasal cavity, and oral cavity, but it has no branches in the middle ear.
B The mandibular nerve innervates the tensor tympani, which tenses the tympanic membrane.
D The glossopharyngeal nerve transmits sensation from the tympanic cavity and pharyngotympanic tube and joins with sympathetic fibers of the internal carotid plexus to form the tympanic plexus.
E The vagus nerve transmits sensation from the external surface of the tympanic membrane.
11. A The ansa cervicalis innervates all of the infrahyoid muscles except the thyrohyoid (Sections 21.2 and Table 21.3a).
B The cervical branch of the facial nerve innervates the platysma
C The hypoglossal nerve innervates all of the tongue muscles, including the genioglossus, hyoglossus, and intrinsic tongue muscles.
D The accessory nerve innervates the trapezius and the sternocleidomastoid muscles and contributes to the pharyngeal plexus that helps to control the pharyngeal muscles.
E The recurrent laryngeal nerve, a branch of the vagus nerve, innervates the intrinsic muscles of the larynx.
12. C An emergency tracheotomy (or cricothyrotomy) is performed to secure an airway in a patient with respiratory failure who does not have time to have a procedure performed in the operating room. The quickest access to secure an airway is by incising the cricothyroid membrane (Section 21.6b).
A Superior to the hyoid bone is superior to the vocal folds and is also a difficult access site given the presence of the mylohyoid muscles.
B The thyrohyoid membrane is between the hyoid bone and the thyroid cartilage and is superior to the vocal folds.
D Between the thyroid and arytenoid cartilages is too posterior to access the airway and is also at the level of the vocal folds.
E Superior to the manubrium in the jugular fossa is a potential site for an airway (tracheostomy) but is more inferior to the cricothyroid membrane. Also, incising the tracheal cartilage or trying to access the airway between the tracheal cartilages is too difficult without the benefit of being in the operating room. Another benefit of a cricothyrotomy versus a tracheostomy is that there are fewer structures at risk for injury such as blood vessels, the recurrent laryngeal nerve, the thyroid gland, and the esophagus.
13. D The recurrent laryngeal nerve is a branch of the vagus nerve, which travels in the tracheoesophageal groove, lateral and posterior to the thyroid gland. Injury to this nerve causes hoarseness, among other complications (Sections 21.6e and 18.3).
A, B, C, and E The glossopharyngeal nerve, hypoglossal nerve, nerves of the ansa cervicalis, and the phrenic nerve do not travel close enough to the thyroid gland to be at risk during careful thyroid surgery.
14. E The anterior fontanelle is the fibrous area at the junction of the frontal and parietal bones. It closes between 18 and 24 months of age (Section 17.1c).
A, B, C, D The anterior fontanelle remains open until 18 to 24 months.
15. B The superior deep cervical nodes lie between the jugular and facial veins and the anterior belly of the digastric (Section 17.5). A The parotid nodes are superficial nodes that overlie the parotid gland on the side of the face.
C The inferior deep cervical nodes lie in the neck near the inferior part of the internal jugular vein.
D The retroauricular nodes are superficial nodes that lie along the posterior margin of the auricle.
E The lateral cervical nodes are superficial nodes that lie along the external jugular vein in the neck.
16. E The CSF is reabsorbed into the venous system by the arachnoid granulations, which protrude into the superior sagittal sinus (Section 18.2b).
A The choroid plexus is the site of CSF production in each of the four ventricles (the two first and second [lateral], the third, and the fourth).
B The interventricular foramen is the communication between the lateral ventricles.
C The cerebral aqueduct is the communication between the third and fourth ventricles.
D The lateral apertures are the communication between the fourth ventricle and the subarachnoid space.
17. E None of the answers above describes the vagus nerve correctly (Section 18.3).
A The vagus nerve leaves the skull through the jugular foramen with the glossopharyngeal and spinal accessory nerves.
B The carotid sinus is innervated by the glossopharyngeal nerve.
C The oculomotor nerve (III), trochlear nerve (IV), abducent nerve (VI), ophthalamic nerve (V1), and ophthalmic vein are transmitted through the superior orbital fissure.
D The vagus nerve innervates all of the muscles of the soft palate except the tensor veli palatini, which is supplied by the mandibular division of the trigeminal nerve.
18. A The abducent nerves innervate the lateral rectus muscles, which move the eyes laterally (Section 18.3).
B Medial movement of the eyes is controlled by the oculomotor nerves via the medial rectus muscles.
C Superior movement of the eyes is controlled by the oculomotor and trochlear nerves via the superior rectus and inferior oblique muscles.
D Inferior movement of the eyes is controlled by the oculomotor nerves via the inferior rectus and the superior oblique muscles.
E Internal rotation of the eyes, also called intorsion or rotation along the long axis of the eye, is controlled by the trochlear nerves via the superior oblique muscles. This movement is normally prevented by the action of the inferior oblique muscles.
19. A Emissary veins communicate with veins of the scalp and can carry infections intracranially to the dural venous sinuses (Section 19.1).
B The attachment of the occipitofrontalis muscle to the skull prevents infections of the scalp from spreading into the neck.
C The attachment of the epicranial aponeurosis to the zygomatic arches prevents further lateral spread of infection.
D Spread of infection intracranially occurs through the emissary veins, which communicate with the dural sinuses, not with the epidural space.
E Not applicable.
20. E The infratemporal fossa contains the maxillary artery and many of its branches, the mandibular nerve, the pterygoid plexus, and the otic ganglion, as well as the medial and lateral pterygoid muscles (Section 19.5).
A The infratemporal fossa contains the maxillary artery, but choices B, C, and D are also correct (E).
B The infratemporal fossa contains the mandibular nerve, but choices A, C, and D are also correct (E).
C The infratemporal fossa contains the pterygoid plexus, but choices A, B, and D are also correct (E).
D The infratemporal fossa contains the otic ganglion, but choices A, B, and C are also correct (E).
21. A The nasolacrimal duct drains tears from the medial corner of each eye into the inferior meatus (Sections 19.7a and 20.1b).
B The frontal sinus drains into the middle meatus through a frontonasal duct.
C The ethmoid sinus drains into the superior and middle meatuses.
D The sphenoid sinus drains into the sphenoethmoidal recess in the posterosuperior part of the nasal cavity.
E The maxillary sinus drains into the middle meatus.
22. C Only the ophthalmic artery and optic nerve enter the orbit through the optic canal (Sections 17.1d and 20.1e).
A The supratrochlear artery is a branch of the ophthalmic artery in the orbit that supplies the scalp.
B The supraorbital artery is a branch of the ophthalmic artery in the orbit that supplies the scalp.
D The ophthalmic vein enters the orbit through the superior orbital fissure.
E The ophthalmic nerve (CN V1) enters the orbit through the superior orbital fissure.
23. D The mandibular division of the trigeminal nerve innervates the tensor tympani muscle, which lessens damage from loud sounds by tensing the tympanic membrane (Section 20.2b).
A The optic nerve carries sensory innervation from the neural retina to the lateral geniculate nucleus.
B The oculomotor nerve innervates most of the extraocular muscles of the eye and the intrinsic muscles of the eye.
C The trochlear nerve innervates the superior oblique extraocular muscle of the eye.
E The facial nerve innervates the stapedius muscle, which dampens the vibrations of the stapes on the oval window.
24. A The cervical plexus originates from the anterior rami of C1–C4 (Section 21.3a).
B The accessory nerve (CN XI) innervates the sternocleidomastoid.
C Only the oculomotor, facial, and glossopharyngeal nerves carry preganglionic parasympathetic nerves that synapse in the head.
D The cervical plexus has both sensory and motor components. The sensory nerves of the plexus, the lesser occipital, great auricular, transverse cervical, and supraclavicular nerves innervate the skin of the anterior and lateral neck and lateral scalp. The ansa cervicalis, the motor part of the plexus, innervates most of the infrahyoid muscles.
E The greater occipital nerve is supplied by the posterior rami of spinal nerves C1–C3 and is therefore not a branch of the cervical plexus.
25. B The only muscles that relax the vocal folds are the posterior cricoarytenoid muscles. Note that there are other results of anesthesia that also necessitate intubation (Section 21.6d).
A The thyroarytenoid closes the vocal folds.
C The cricothyroid muscles do not have direct actions on the vocal folds.
D The transverse arytenoid muscles close the vocal folds.
E The lateral arytenoid muscles close the vocal folds.
26. A All of the innervation of the larynx, both sensory and motor, is supplied by the superior and inferior (recurrent) laryngeal branches of the vagus nerve (CNX) (Section 21.6e).
B The glossopharyngeal nerve (IX) innervates the tympanic cavity and pharyngotympanic (auditory) tube; the pharynx (sensory and motor), the tonsils, palate, posterior one third of the tongue (sensory and taste), and the stylopharyngeus muscle. It also innervates the carotid body and carotid sinus.
C The recurrent laryngeal nerve is a branch of the vagus nerve that innervates all of the muscles of the larynx except the cricothyroid and carries sensation from the lower half of the larynx (from the vocal cords downward).
D The superior laryngeal nerve innervates the cricothyroid muscle, which helps to tense the vocal folds and provides sensation to the upper half of the larynx (above the vocal cords).
E Not applicable.
27. B The only laryngeal cartilage to completely encircle the airway is the cricoid cartilage (Section 21.6a).
A The U-shaped thyroid cartilage has two laminae that join in the anterior midline to form a laryngeal prominence.
C The epiglottic cartilage, a single leaf-shaped cartilage, forms the anterior wall of the laryngeal inlet at the root of the tongue.
D Paired arytenoid cartilages articulate with the superior borders of the cricoid laminae. Their vocal processes attach to the thyroid cartilage through the vocal ligaments.
E Corniculate cartilages appear as small tubercles within the aryepiglottic fold.
28. C The common carotid artery, internal jugular vein, and vagus nerve are contained within the carotid sheath (Section 21.1).
A The external jugular vein is not within the carotid sheath.
B The phrenic nerve lies on the anterior scalene muscle behind the carotid sheath.
D The superior thyroid artery is a branch of the external carotid artery and does not travel in the carotid sheath.
E The sympathetic trunk lies behind the carotid sheath.
29. C Parasympathetic fibers of the oculomotor nerve (CN III) synapse in the ciliary ganglion and are responsible for pupil constriction (Section 20.1e).
A The superior cervical ganglia are sympathetic ganglia and not involved in the constriction of the pupils.
B The pterygopalatine ganglia are parasympathetic ganglia involved in lacrimation.
C The otic ganglia are parasympathetic ganglia involved in saliva production by the parotid glands.
E The trigeminal ganglia are sensory ganglia of the trigeminal nerve involved in sensation of the face and parts of the oral cavity.
30. D The submandibular lymph nodes are the primary nodes of the lateral part of the body of the tongue (Section 19.8c).
A The superior deep cervical nodes are the primary nodes of the root of the tongue.
B The inferior deep cervical are the primary nodes of the medial parts of the body of the tongue.
C The anterior superficial cervical nodes are the primary nodes of the skin anterior muscles of the neck and are not the primary lymph nodes of any part of the tongue.
E The submental nodes are the primary nodes of the apex and frenulum of the tongue.
31. A The ethmoid, maxilla, vomer, palatine, lacrimal, nasal, and inferior nasal concha form the bony skeleton of the nasal cavity (Section 19.7a).
B The ethmoid forms the cribriform plate at the roof of the nasal cavity, the superior and middle nasal concha of the lateral walls, and part of the nasal septum.
C The maxilla forms the anterior part of the palate on the floor of the nasal cavity.
D The vomer forms part of the nasal septum.
E The palatine bone forms the posterior part of the palate on the floor of the nasal cavity.
32. A The medial pterygoid muscle forms a sling with the masseter muscle to elevate the mandible (Section 19.2 and Table 19.3).
B The tensor veli palatini tenses the soft palate.
C The levator veli palatini elevates the soft palate.
D The suprahyoid muscles, including digastric, geniohyoid, stylohyoid, and mylohyoid, elevate the hyoid. The medial pterygoid can only elevate the hyoid secondarily by first elevating the mandible.
E The posterior part of the temporalis muscle retracts the mandible.
33. C The hypoglossal nerve (CN XII) innervates all muscles of the tongue except for the palatoglossus. When damaged, muscles on the affected side atrophy and fail to contribute to protrusion of the tongue. This causes the tongue to deviate to the side of the lesion (left side in this patient). The nerve is at risk during surgery on the common carotid artery because of its proximity to the carotid bifurcation (Section 18.3).
A The stylopharyngeus is the only muscle innervated by the glossopharyngeal nerve.
B Damage to the left hypoglossal nerve would cause atrophy of the left side of the tongue and deviation to the right side with protrusion.
D The lingual nerve, a branch of the mandibular division of the trigeminal nerve, transmits sensation from the anterior tongue. It also carries parasympathetic fibers via the chorda tympani to the submandibular and sublingual glands and taste from the anterior tongue.
E The lingual nerve, a branch of the mandibular division of the trigeminal nerve, transmits sensation from the anterior tongue. It also carries parasympathetic fibers via the chorda tympani to the submandibular and sublingual glands and taste from the anterior tongue.
34. A The mandibular division enters the infratemporal fossa where it sends motor branches to muscles of mastication and sensory branches to the tongue, mandibular teeth, oral cavity, and skin of the lower and lateral face (Section 18.3).
B The maxillary division of the trigeminal nerve passes through the foramen rotundum to the pterygopalatine fossa.
C The ophthalmic branch of the trigeminal nerve passes through the superior orbital fissure to the orbit.
D The maxillary branch of the trigeminal nerve innervates the nasal cavity.
E The lingual nerve passes from the infratemporal fossa into the oral cavity.
35. E The internal carotid arteries do not have branches in the neck. The ophthalmic arteries are the first major branches of the internal carotid arteries (Section 18.2c).
A The superior thyroid is a branch of the external carotid artery.
B The lingual artery is a branch of the external carotid artery.
C The facial artery is a branch of the external carotid artery.
D The maxillary artery is a branch of the external carotid artery.
36. E The cavernous sinus contains the oculomotor, trochlear, abducent, and ophthalmic and maxillary divisions of the trigeminal nerve. The maxillary division of the trigeminal nerve supplies sensation to the cheek (Section 18.1c).
A Jugular venous distension is caused by a decrease of venous return to the heart.
B The inability to smile is caused by a lesion to the facial nerve.
C The inability to chew is caused by a lesion to the mandibular division of the trigeminal nerve.
D Loss of vision is caused by a lesion to the optic nerve, which does not travel through the cavernous sinus. Note that there are additional causes of loss of vision, none of which are related to the cavernous sinus.
37. D The ophthalmic artery is the first major branch of the internal carotid artery in the anterior cranial fossa (Section 17.3b).
A The posterior cerebral is the terminal branch of the basilar artery.
B The occipital artery is a branch of the external carotid artery.
C The labyrinthine artery is a branch of the basilar artery.
E The middle meningeal artery is a branch of the maxillary artery, which is a branch of the external carotid artery.