Anatomy Exam 4 – 2018

Included Content 

• Neck Triangles I 
• Neck Triangles II 
• Introduction to Cranial Nerves I 
• Introduction to Cranial Nerves II 
• Deep Neck 
• External Cranium 
• Face, Scalp, & Parotid Regions 
• Temporal & Infra-temporal Regions 
• Internal Cranium 
• Cranial Meninges, Brain Anatomy, & Blood Supply 
• Orbit 
• Pharynx 
• Nose 
• Oral Region 
• Larynx 
• Lymphoid Organ Histology 
• Ear 
• Pharyngeal Apparatus, Face & Neck 

1. A 45-year-old male patient presents to your clinic complaining of what he is calling a “lazy eye.” He states that he was recently in a bar fight where he was knocked in the head with a chair. Upon examination, you notice his right eye deviates medially when relaxed. Which of the following is the most likely diagnosis? 

1. Oculomotor nerve palsy 
2. Trochlear nerve palsy 
3. Abducent nerve palsy 
4. Optic nerve palsy 
5. Facial nerve palsy

2. Sinusitis is an inflammation or swelling of the tissue lining the sinuses that can lead to infection. One of the telltale signs of a sinus infection is facial pain and/or pressure located in the frontal region and around the eye. Which of the following nerves is most likely responsible for this symptom? 

1. CN II – Optic nerve 
2. CN III – Oculomotor nerve 
3. CN V1 – Ophthalmic branch of the Trigeminal nerve 
4. CN V3 – Mandibular branch of the Trigeminal nerve 
5. CN VII – Facial nerve 

3. A male patient presents with an extreme case of vasomotor rhinitis. If the surgeon wanted to permanently alleviate his symptoms (increased nasal secretion and lacrimation), which nerve would have to be severed?

1. Nerve to hypoglossal canal   
2. Nerve to pterygoid canal
3.  Nerve to ciliary ganglion
4. Nerve to sublingual gland
5. Nerve to zygomatic gland

4. A patient presenting with dysphagia, loss of gag reflex, and a decrease in parotid gland secretion is experiencing symptoms related to a syndrome of which opening?

1. Superior Orbital
2. Internal Acoustic Meatus
3. Hypoglossal canal
4. Jugular foramen
5. Optic canal

5. Which muscle is being contracted by the right eye in the following picture?

1. Superior Rectus
2. Inferior Rectus
3. Superior Oblique
4. Inferior Oblique
5. Medial Rectus

6. Tracheotomy is a surgical procedure which consists of making an incision on the anterior aspect of the neck and opening a direct airway through an incision in the trachea. In which order would the fascial layers of the neck have to be cut in order for a physician to perform this procedure?

1. Superficial fascia → Investing fascia → Visceral pretracheal layer 
2. Superficial fascia → Investing fascia → Muscular pretracheal layer → Visceral pretracheal layer 
3. Investing fascia → Superficial fascia → Muscular pretracheal layer → Visceral pretracheal layer 
4. Superficial fascia → Investing fascia → Carotid sheath → Visceral pretracheal layer 
5. Superficial fascia  → Muscular pretracheal layer → investing fascia → Visceral pretracheal layer 

7. An odontogenic infection is an infection that originates within a tooth or in the closely surrounding tissues. In addition to producing pain and discomfort, odontogenic infections can extend beyond natural barriers and result in potentially life-threatening complications, such as infections of the deep fascial spaces of the head and neck. In severe cases, odontogenic infections can cause systematic failures and travel to the mediastinum, aiding in heart failure. Through which fascial space would an odontogenic infection most likely travel through to reach the mediastinum?

1. Retropharyngeal space anterior to the alar fascia (anterior lamina)  
2. Retropharyngeal space between the anterior lamina and posterior lamina 
3. Pretracheal space 
4. Prevertebral space 
5. Buccal space 

8. Kehr’s sign is the occurrence of acute pain in the shoulder due to diaphragmatic irritation. Which of the following serves as an explanation for the occurence of Kehr’s sign? 

1. Because the transverse cervical nerves share cervical nerve origin C3 & C4 with the phrenic nerve 
2. Because the transverse cervical nerves share cervical nerve origin C4 & C5 with the phrenic nerve
3. Because the supraclavicular nerves share cervical nerves origin C3 & C4 with the phrenic nerve.  
4. Because the supraclavicular nerves share cervical nerves origin C4 & C5 with the phrenic nerve.   
5. Because the facial nerves share cervical nerves origin C3 & C4 with the phrenic nerve 

9. A patient comes in with a laceration to her neck. You are afraid she might have injured the nerves in her posterior neck triangle. You want to make sure you’re operating in the right area- what structure do you mainly look for to orient yourself?

1. Inferior border of the mandible
2. Sternocleidomastoid Muscle
3. Superior border of the clavicle
4. Borders of the Platysma
5. Hyoid bone

10. Which of the following are parts of the anterior neck triangle?

1. Muscular triangle
2. Carotid triangle
3. Greater supraclavicular fossa
4. A & B
5. All of the above

11. You are doing clinical rotations in the Emergency Department when a 56-year-old male patient presents with venous distension that is most prominent on the lateral side of his neck, just superficial to the sternocleidomastoid muscle. The attending physician explains that this can happen with increased pressure of the superior vena cava in the case of patients with cardiac and/or pulmonary disease. Which of the following venous structures would a physician most likely be visualizing in a patient displaying this symptom?

1. Anterior Jugular vein 
2. Internal Jugular vein 
3. External Jugular vein 
4. Facial vein 
5. Subclavian vein 

12. A patient presents to your clinic with a mass located on the right anterolateral portion of their neck, displaying a variety of symptoms. You take a biopsy and thankfully the tumor is benign. However, further imaging shows that the tumor is pressing against the sympathetic trunk in the neck. You diagnose them with Horner syndrome. Which of the following would be a symptom that this patient would display? 

1. Hyperhidrosis
2. Ptosis 
3. Mydriasis 
4. Exophthalmos   
5. Hyperlacrimation

13. You are on rotations when an attending asks you to assist with a thyroidectomy in order to excise a malignant tumor from a patient. During the surgery, the attending points to the parathyroid glands and asks you why he must take great care not to damage/remove these glands along with the thyroid. You respond: 

1. Because the patient can suffer from Tetany
2. Because the patient can suffer from Grave’s disease
3. Because the patient can suffer from Hashimoto’s disease 
4. Because the patient can suffer from hypercalcemia 
5. Because the patient can suffer from hypokalemia 

14. Which of the following vessels can be found traversing through the greater supraclavicular fossa and can be occluded by pressing it against the first rib?

1. External carotid artery
2. Accessory artery
3. Occipital artery
4. Subclavian artery
5. External jugular vein

15. You are out on the town one night and taking selfies with your friends. Everyone says “okay guys – duck lips!” to which you purse and close your lips together. Your friend turns to you and says, “wait you’re a doctor – tell us which muscles we just used!” You reply:

1. Risorius 
2. Levator labii superioris
3. Orbicularis oris
4. Orbicularis oculi
5. Depressor anguli oris

16. Which of the following muscles would you use to ensure that food does not get stuck between the teeth and the cheeks by pressing the cheek against the teeth during mastication (closing the oral cavity)?

1. Buccinator
2. Masseter
3. Temporalis
4. Genioglossus
5. None of the above 

17. Which of the following muscles is being used in the below 3 images (from left to right)?

1. Occipitofrontalis; corrugator supercilii, procerus and transverse part of nasalis 
2. Occipitofrontalis; procerus and transverse part of nasalis; corrugator supercilii
3. Occipitofrontalis; procerus; levator labii superioris 
4. Temporalis; corrugator supercilii, procerus and transverse part of nasalis 
5. Temporalis; procerus and transverse part of nasalis; corrugator supercilii 

18. Which of the following is a branch of the internal carotid artery?

1. Maxillary artery
2. Facial artery
3. Occipital artery
4. Ophthalmic artery 
5. Posterior auricular artery

19. You are shadowing an ENT surgeon in the OR performing a parotidectomy when they turn to you and ask “what is found within the parotid plexus?” You reply:

1. facial nerve, retromandibular vein, and internal carotid artery
2. facial nerve, internal jugular vein, and external carotid artery
3. facial nerve, retromandibular vein, and external carotid artery
4. glossopharyngeal nerve, common facial vein, and internal carotid artery
5. vagus nerve, common facial vein, and external carotid artery

20. A baseball player arrives to your ED after sustaining a blow to his temporomandibular joint. Upon further inspection you deduce that he has anteriores dislocated his temporomandibular joint.  What prevents posterior dislocation of the TMJ?

1. Postglenoid tubercle
2. Stylomandibular ligament
3. Lateral ligament
4. Postglenoid tubercle and stylomandibular ligament
5. Postglenoid tubercle and lateral ligament

21. A woman enters your ER after receiving a blow to her infratemporal fossa during a domestic dispute. Examination reveals injury to the lateral pterygoid muscle. The patient presents with which decrease/loss of function?

1. Decreased ability to elevate mandible
2. Decreased ability to elevate mandible, loss of ability to retract mandible and close jaw
3. Decreased ability to protrude mandible and loss of larger chewing motions
4. Decreased ability to bilaterally elevate and protrude mandible, loss of small grinding motions

22. A young man comes into the ER with a cheek laceration from a broken bottle. It appears that most of the bleeding is coming from a damaged artery which passes laterally through the mandibular notch. Which artery has been damaged?

1. Inferior alveolar artery
2. Masseteric artery
3. Pterygoid artery
4. Anterior tympanic artery
5. Superficial temporal artery

23. After dancing and singing her heart out to “Redneck Woman” at a local family restaurant, an OMS1 takes a nasty fall and strikes her head on the edge of the table she was just getting down from. Imaging reveals a bilateral lesion of the medial precentral gyrus. If any, what would be the physiological ramifications of her actions?

1. The inability to operate the muscles of mastication, preventing the enjoyment of authentic Italian pizza
2. Impairment of lower limb musculature, she may never dance again
3. Impairment of the shoulder and arm muscles, so she can never repeat this mistake again
4. Paralysis of the facial muscles used for singing Gretchen Wilson songs
5. Lack of the ability to extend the third manual phalanx toward me for writing this question

24. One of your patients with a history of eating disorders has begun showing the symptoms of hypothalamic dysfunction. Which of the secondary brain vesicles is involved in this disorder?

1. Telencephalon
2. Diencephalon
3. Mesencephalon
4. Metencephalon
5. Myelencephalon

25. The junction where the pons and midbrain meet is important due to which of the following?

1. Basilar artery divides into superior cerebellar arteries and posterior cerebral artery
2. Subclavian artery gives rise to vertebral artery
3. Basilar artery gives rise to anterior inferior cerebellar artery
4. Internal carotid artery divides into its two terminal branches
5. Anterior communicating artery gives rise to anterior cerebral artery

26. Emerging studies on the impact of trauma on the developing brain show that children who have experienced traumatic events in their formative years tend to have overactive amygdalas and have a harder time turning “off” their extreme responses to perceived danger- which increases their likelihood of being involved in high risk situations and poorer health outcomes. The amygdala’s role is key in emotional responses, such as anger, anxiety and fear. Considering this, where is the amygdala most likely to be found?

1. Frontal lobe
2. Temporal lobe
3. Precentral gyrus 
4. Parietal lobe
5. Occipital lobe

27. Neural tube defects can arise from a deficiency in which of the following?

1. Vitamin A
2. Valproic acid
3. Folic acid
4. A & B
5. B & C

28. Which of the following is considered the most serious form of spina bifida? 

1. Meningocele 
2. Myeloschisis
3. Spina bifida occulta
4. Myelomeningocele

29. Which of the following is true regarding the development of the brain?

1. The pons and medulla oblongata develop from the Myelencephalon which arises from the rhombencephalon 
2. The medulla oblongata arises from the midbrain which arises from the Myelencephalon 
3. The Cerebral hemispheres arise from the Telencephalon which arises from the Prosencephalon 
4. The Conculli arise from the diencephalon which arises from the mesencephalon 
5. The Thalami arise from the Telencephalon which arises from the Rhombencephalon 

30. You are on OB-GYN rotations when an attending asks you to observe a prenatal surgery. During the surgery he explains that he is correcting a condition called obstructive hydrocephalus. This condition is caused by a blockage of CSF as it is exiting the 3rd Ventricle. The surgeon asks you to identify the location of the obstruction. You tell him the obstruction is located in the:  

1. Cerebral aqueduct  
2. 4th Ventricle 
3. Foramen of monro 
4. Foramen of Luschka 
5. Central Canal 

31. A baby is born with an apparently serious defect. The spinal cord can be readily seen open on the back, with no skin, vertebra, or erector spinae present in the area. The baby likely has: 

1. Spina bifida oculta 
2. Spina Bifida cystica
3. Meningocele 
4. Meningomyelocele 
5. Spina bifida with myeloschisis

32. As part of FOPC lab, you direct your partner to look down at their nose to test for the function of CN IV (Trochlear) which innervates the superior oblique extraocular muscles. Your lab partner reminds you that the function of the Superior Oblique muscle is to pull the eye inferiorly and laterally and inquires as to whether or not you are performing your Cranial Nerve test correctly.  Your response to their question is:

1. Your lab partner is correct.  You should be testing for the functionality of the superior oblique muscle by looking down and laterally. 
2. You remind your partner that the action of the inferior rectus muscle also directs the gaze inferiorly and is weakest when looking down and medially.  Therefore, in order to isolate the functionality of the superior oblique muscle, you should test for its action in the direction where the inferior rectus muscle has no functionality. 
3. You explain that when testing for action of the motion of the superior oblique, you actually test to see if the eye drifts into the direction of the antagonist muscles.
4. Due to the pulley action of the tendon attached to the orbital fossa, the superior oblique muscle actually performs both actions (down and lateral + down and medial)

33. You notice that your grandfather needs to hold the newspaper farther from his eyes every year. Although he insists that as a top-star paratrooper from the Vietnam war he has the sight of an eagle you suggest he should go see an opthamologist to get his vision checked.  You back up your argument by stating that his accommodation reflex may have decreased because:

1. Aging neurons in the parasympathetic fibers of the ciliary nerve, a branch of V1 that causes contraction of the ciliary muscle and thickening of the lens, transmit signals more slowly with age.
2. the crystalline lens hardens making is more difficult for its shape to be changed by the ciliary muscle
3. the ciliary muscle was torn during the war.
4. Retina detachment has weakened the attachments of the ciliary muscle and decreased their function 
5. A and b 

34. A 35 year-old male patient presents to your clinic. Upon examination, you notice that the patient’s pupils are not reactive to light and remain dilated. Which of the following could be a potential reason for this patient’s symptoms?

1. The patient has a tumor compressing their superior cervical ganglion 
2. The patient has damaged their dilator pupillae 
3. The patient has taken Heroin, a parasympathomimetic drug. 
4. The patient has a lesion on the ciliary ganglion. 
5. Nothing is wrong, the patient’s eyes should dilate like this when exposed to light. 

35. When flying home for thanksgiving, you notice that the air pressure is starting to hurt your middle ear and your ears can’t seem to pop on their own to relieve the pressure. You decide to help the processes by yawning and masticating chewing gum. What cranial nerve are you using?

1. CN V3
2. CN IX
3. CN X
4. CN V2
5. CN XII

36. A 57 year-old male patient presents to your clinic with a persistent cough, difficulty swallowing, and a sore throat. The patient has a 25 year history of smoking cigarettes and further testing reveals a malignant tumor located on the posterior nasopharynx. Which of the following lymph nodes would biopsy first to check for metastasis? 

1. Parotid lymph nodes 
2. Superior cervical lymph nodes
3. Deep cervical lymph nodes
4. Submandibular lymph nodes
5. Submental lymph nodes

37. Vagal maneuvers are methods used to stimulate the vagus nerve in order to slow a patient’s heart rate and treat conditions such as supraventricular tachycardia (SVT). Based on this information, which of the following actions would most likely be considered a vagal maneuver? 

1. Exercising 
2. Shrugging your shoulders 
3. Hyperventilation 
4. Gagging
5. Speaking  

38. Your patient comes in showing dysphasia (difficulty swallowing) and dysarthria (difficulty speaking). You ask the patient to open their mouth and say “ahh”.  You observe uvula deviation, a diminished gag reflex and a lack of mobility of the palatal arches indicative of a stroke at the nucleus of CN X. You recommend the patient for speak therapy rehab to strengthen which of the following pharyngeal muscles? 

1. Stylopharyngeus muscle 
2. Inferior pharyngeal constrictor 
3. Superior pharyngeal constrictor 
4. Salpingopharyngeus 
5. Palatopharyngeus 

39. An 8 year-old female patient presents to your clinic with an earache. Upon examination, you confirm the patient is suffering from a middle ear infection. The mother is frustrated because this is the child’s 3rd ear infection just this year. She asks you why this is such a common occurrence with her child. What do you say?

1. You tell her that she needs to do a better job of cleaning her child’s ears. 
2. You tell her that her child is more susceptible to ear infections due to a familial germline mutation affecting the auditory tube.  
3. You explain that children are more susceptible to ear infections since the pharyngotympanic tube is more horizontal.
4. You explain that children are more susceptible to ear infections since the eustachian tube is at a sharper angle than in adults.
5. You explain that females are more susceptible to ear infections due to the angle of the auditory tube. 

40. Your patient presents with pain in the shoulder and a diminished ability to shrug. As part of your history, you discover that one month ago he had successful surgery to remove a lymph node from the posterior cervical triangle. Which of the following would be the best next course of action? 

1. You suspect myofascial and muscular compensatory problems affecting the shoulder and suggest performing muscle energy techniques to improve functionality
2. Upon inspection of his oropharynx you notice no signs of neuropathy so you suggest that Dr McWhorter take ultrasound images of the shoulder and upper back region to look for tendinopathies.
3. You suspect an injury to the XI cranial nerve from iatrogenic causes. 
4. You suspect an injury to cranial nerve X from iatrogenic causes. 
5. You suspect AC joint impairment and refer your patient to Dr Fotopoulos for HVLA

41. 70 year old male presents to your ENT office with right sided epistaxis which began 24 hours ago. He is currently taking warfarin (blood thinner) and notes that he has had a few episodes of epistaxis prior to this one while taking the medication. Physical examination reveals no evidence of an anterior bleeding point within Little’s Area. What do you do?

1. Tell them to get off of the blood thinner, cardiac issues are pretty much nothing compared to episodic nosebleeds
2. Perform a nasal endoscopy to look further into the nasal cavity, as the bleed could be coming from the sphenopalatine artery in the posterior nasal cavity 
3. Perform a nasal endoscopy to look further into the nasal cavity, as the bleed could be coming from a posterior ethmoid artery in the posterior nasal cavity 
4. Perform a nasal endoscopy to look further into the nasal cavity, as the bleed could be coming from a branch of the facial artery in the posterior nasal cavity 
5. Tell them to stop picking their nose and using illicit drugs, then do a Hoover test and call them a drug seeker even if its not positive 

42. A 5 year-old male presents to your clinic for a yearly wellness visit. While the patient is sitting on the exam table, you notice that he has the distal phalanx of his left 1st digit shoved up his right nare. As everything checks out and you are handing the child a lollipop for being such a good patient, you notice a drop of blood coming from his right nostril. You hand the patient a tissue and instruct him to lean forward. This epistaxis is most likely due perforation of the: 

1. Posterior ethmoidal artery 
2. Anterior ethmoidal artery 
3. Sphenopalatine artery 
4. Artery of pterygoid canal 
5. Kiesselbach area

43. A 60 year-old female presents with recurrent sinusitis. She reports that she is currently suffering from symptoms of severe facial pressure, green nasal drainage, fever and nasal congestion. You are able to obtain an in office CT scan of the sinuses which demonstrates complete opacification of all of the sinuses (pansinusitis). You review the results of the exam with her when she asks how many sinuses you have, what they are named and the innervation to all of them. You look at her and try to recall your medical school training. You answer:

1. “You have four sinuses located on both sides of the face. They are called the maxillary, frontal, ethmoidal and sphenoidal sinuses. They are each innervated by branches of the facial nerve and are each lined with mucosa”
2. “You have four sinuses located on both sides of the face. They are called the maxillary, frontal, ethmoidal and sphenoidal sinuses. They are each innervated by branches of the trigeminal nerve and are each lined with mucosa”
3. “You have four sinuses located on both sides of the face. They are called the maxillary, frontal, mandibular and ethmoidal sinuses. They are each innervated by branches of the trigeminal nerve and are each lined with mucosa”
4. “You have four sinuses located on both sides of the face. They are called the maxillary, frontal, ethmoidal and paranasal sinuses. They are each innervated by branches of the trigeminal nerve and are each lined with mucosa”
5. “Lady, trust me, I’m a doctor”

44. 23 year old male presents for chronic nasal congestion. He states that he has brought a sample of his boogers in today for you to exam (whoopie!!!) Looking into the tissue, you observe black crusties. He tells you he is a non-smoker and works in construction. Your treatment advice to him would most likely be something like:

1. “You should wear a mask at work because the color is most likely the result of inhaled soot and dirt working construction”
2. “I’m placing you on a 2 week antifungal medication as this is commonly seen in fungal infections of the sinuses”
3. “I’m placing you on an antibiotic for the next 3 weeks as this is commonly seen in bacterial infections of the sinuses”
4. “You should stop smoking”
5. “That’s gross and not normal”

45. Which structure of the tongue lacks taste buds?

1. the fungiform papillae on the anterior ⅓ of the tongue 
2. the filiform papillae on the middle region of the tongue 
3. the foliate papillae on the posterior ⅔ of the tongue
4. the foliate papillae on the median surface of the tongue
5. the vallate papillae on the posterior ⅓ of the tongue

46. Emily H. goes to the doc and presents with the inability to retract, depress, or protrude her tongue, but she is still able to swallow. Which nerve would you suspect was injured upon physical examination?

1. Submandibular ganglion
2. Internal laryngeal nerve
3. Glossopharyngeal nerve
4. Lingual nerve
5. Nucleus of hypoglossal nerve

47. A patient presents with speech difficulty. Upon physical examination, the patient is able to depress his tongue, but is unable to elevate his tongue. The patient also has weak retraction of the tongue. Which nerve do you suspect to be injured?

1. Nerve to hyoglossus
2. Hypoglossal nerve
3. Nerve to styloglossus
4. Nerve to geniohyoid
5. Mandibular branch of the trigeminal nerve

48. An abscess in the root of the left 1st molar would drain to which oral region?

1. Left Sublingual space
2. Left Submandibular space
3. Right Pterygoid space
4. Left terminal sulcus space
5. Foramen cecum

49. You are on your flight home for Thanksgiving break and just about to relax when the passenger next to you grasps their throat and begins to flail about, hitting you in the face. Startled from your rest, you quickly assess the situation and examine the oral cavity, which is unremarkable for an obvious foreign body obstruction. What do you do?

1. Scream out, “is there a doctor on the plane?!?!?!?!”
2. Identify the thyroid cartilage (located at about the level of C4-C5), cricoid cartilage (at about the level of C6) and then the space between the two, before piercing a sharp object through the median cricoarytenoid ligament 
3. Take your ball point pen and plunge into the trachea 
4. Identify the thyroid cartilage (located at about the level of C4-C5), cricoid cartilage (at about the level of C6) and then the space between the two, before piercing a sharp object through the median cricothyroid ligament 
5. Identify the thyroid cartilage (located at about the level of C3), cricoid cartilage (at about the level of C6) and then the space between the two, before piercing a sharp object through the median cricothyroid ligament 

50. You are skating with a friend when they suddenly wipe out on the ice, smacking the back of their face on the ice. You run to their aid to find and assess the situation. Your friend is having difficulty breathing, has sustained severe facial trauma in the fall and hit their head on the ice. You:

1. Call 911 and perform an immediate tracheotomy to open the airway, as massive facial trauma can result in obstruction and you need to ensure a patent airway while you wait for the ambulance to arrive
2. Immobilize their head and perform an emergency cricothyrotomy
3. Perform CPR
4. Keep skating – they’ll be fine, you called an ambulance right tho?
5. Laugh at them for being uncoordinated – must be due to a cerebellar issue LOL

51. Lady Gaga presents to your office with intermittent hoarseness and dyspnea, exacerbated by singing. You perform an ENT exam which is unremarkable. Flexible laryngoscopy (assessment of the vocal cords with the use of a scope that passes through the nose, nasopharynx, oropharynx and enters above the level of the vocal cords – think “up your nose with a rubber hose”) reveals some mild erythema and edema of the vocal folds, consistent with mild dehydration. As you watch the vocal folds open and close during the procedure while Gaga alternates her breathing and talking, which muscles are you focused on with regards to the opening and closing of the vocal folds and what innervates them?

1. Posterior cricoarytenoid opens the cords, lateral cricoarytenoid closes the cords. Innervated by the recurrent laryngeal nerve
2. Lateral cricoarytenoid opens the cords, posterior cricoarytenoid closes the cords. Innervated by the recurrent laryngeal nerve 
3. Lateral cricoarytenoid opens the cords, posterior cricoarytenoid closes the cords. Innervated by the external laryngeal nerve
4. Posterior cricoarytenoid opens the cords, lateral cricoarytenoid closes the cords. Innervated by the external laryngeal nerve 
5. I don’t know who Lady Gaga is 

52. You are babysitting your 4 year-old sister when she starts giving you sass while eating her dinner. Suddenly, she forms the universal choking signal with her hands at her throat, as the laryngeal muscles go into spasm and the rima glottidis closes. As you get behind her to perform the heimlich maneuver, you consider where the food could have become lodged in her throat. The most likely culprit is:

1. The right bronchus 
2. The carina of the trachea
3. Piriform fossa
4. Pisiform fossa
5. Aorta

53. A patient comes in complaining of dizziness and feeling like the room is spinning. The physician diagnoses the patient with vertigo and asks you which structure in the inner ear is most likely affected due to this condition, you respond with?

1. Spiral Organ
2. Cochlear Aqueduct
3. Maculae 
4. Ampullary Crest
5. Scala Vestibuli

54. An exasperated mother comes in with her adolescent daughter. She explains to you that this is the third time in the past month where her daughter has complained of ear pain. You start to evaluate the patient and notice that her left tympanic membrane is red and bulging. You quickly diagnose the patient with left otitis media and begin to treat the patient. The mother is so tired of this happening to her daughter and she asks you for a recommendation on how best to avoid her daughter from getting recurring earaches. What would you suggest to help the mother?

1. Have a myringotomy performed
2. Have a tympanostomy performed 
3. Tell the mother that her daughter’s symptoms are likely due to a UTI, so it’s important that her daughter take good care of her hygiene
4. Tell the mother that otitis media is common and there is nothing really that can be done since the pharyngotympanic tube in children is more horizontal and prone to infection so her daughter will eventually grow out of it
5. Maybe her daughter will get cauliflower ear, and hey that can be pretty cute 

55. Your friend decides to be rebellious and get yet another ear piercing. She’s over piercing her lobules and has now decided to pierce her tragus. She tells everyone that it doesn’t hurt, but you’ve seen her cry from the pain with every single piercing and this time is no different. What nerve is allowing your friend to feel this pain?

1. Lesser occipital Nerve
2. Auriculotemporal Nerve
3. Greater Auricular Nerve
4. Facial Nerve
5. Auricular Branch of the Vagus Nerve

56. Your patient presents with classic symptoms of DiGeorge disease. The patient was born without a thymus and has facial anomalies to name just a few symptoms. This patient has this disease because during embryological development, what failed to occur?

1. Fusion of the first and second pharyngeal arches 
2. Fusion of the maxillary prominences
3. Fusion of the third and fourth pharyngeal arches
4. Fusion of the maxillary prominence with the medial nasal prominence
5. Fusion of the lateral and medial swellings

57. A developing child fails to form the 6th pharyngeal arch of the laryngeal apparatus. Which effect will most likely occur?

1. Difficulty breathing
2. Loss of facial sensation
3. Loss of facial expression
4. Loss of taste
5. Paralysis of Cricothyroid

58. An ER physician who didn’t care about anatomy during med school and didn’t take the time to make sure patients wouldn’t suffer from the physician’s future ignorance inadvertently severes an important nerve while performing an emergency right subclavian stent (huh, who would have guessed that you might need to be familiar enough with anatomy in an ER scenario to be able to do something quickly and competently without a trauma specialist holding your hand). The ignorant physician panicked from not knowing which nerve was damaged. Meanwhile, you, a caring, competent student doctor who put in the boring, tedious time to make sure you knew anatomy realized immediately that all of the following muscle would be affected except:

1. Posterior cricoarytenoid
2. Cricothyroid
3. Lateral cricoarytenoid
4. Transverse arytenoid
5. Thyroarytenoid

59. A patient presents to the clinic with a loss of conscious proprioception from the right upper limb. Medical imaging shows blockage in a branch of the posterior inferior cerebellar artery. Which of the following structures has most likely been affected? 

1. Right nucleus cuneatus 
2. Left nucleus cuneatus 
3. Left nucleus gracilis 
4. Right nucleus gracilis 
5. Left pyramid 

60. A lesion in which of the following locations would result in loss of movement of the hands and feet but no loss of either cranial nerve reflexes or sensation from the body or head?

1. Fasciculus gracilis 
2. Fasciculus cuneatus 
3. Medial lemniscus 
4. Red Nucleus 
5. Internal arcuate fibers (decussation of pyramids)

61. A patient presents to the clinic with dysphagia (difficulty swallowing). Imaging shows that the patient has a tumor compressing the portion of the brainstem involved in swallowing. Which of the following structures is most likely being compressed?

1. Fasciculus cuneatus 
2. Hypoglossal nucleus 
3. Vestibular nuclei 
4. Medial lemniscus 
5. Nucleus ambiguus 

62. What is the location of a medullary vascular lesion that results in a loss of pain and thermal sensation on the right side of the face and on the left side of the body?

1. Right posterior inferior cerebellar artery
2. Left posterior inferior cerebellar artery
3. Right anterior spinal artery
4. Left anterior spinal artery
5. Left anterior inferior cerebellar artery

63. You are on rotations in the Emergency room when a patient presents with a suspected stroke. He is unable to abduct his right eye and is exhibiting left-sided paralysis of the upper and lower extremities. Your attending guesses that he has some sort of lesion in the brain stem and asks you where you think it could be located. The lesion is most likely located in the:

1. Anterolateral area of the right basilar pons 
2. Anterolateral area of the left basilar pons 
3. Medial area of the left basilar pons 
4. Medial area of the right basilar pons 
5. Posterolateral area of the left basilar pons 

64. A 78 year old female patient presents with a lesion located in the posterior medulla, caudal to the obex. She is exhibiting slurred speech, combined with loss of pain and thermal sensation on the right side of the face and left side of the body. Which of the following vessels is most likely being affected?

1. Right Posterior inferior cerebellar artery 
2. Left Posterior inferior cerebellar artery 
3. Right vertebral artery 
4. Left vertebral artery 
5. Anterior spinal artery 

65. Which vessel is involved with a hemorrhagic lesion of the anterior lobe of the cerebellum, involving the cortex and nuclei?

1. Inferior anterior cerebellar artery 
2. Superior cerebellar artery
3. Posterior cerebral artery 
4. Anterior inferior cerebellar artery 
5. Posterior inferior cerebellar artery 

66. What is the source of climbing fibers in the cerebellum?

1. Abducens nucleus 
2. Facial motor nucleus 
3. Trigeminal sensory nucleus
4. Inferior olivary nucleus 
5. Superior olivary nucleus

68. A dude is like wow it’s dark outside and then goes to bed. Then that dude is like oh wow I can’t sleep because I have a specific sleep disorder cause a part of my brain don’t work so good. Which part of his brain don’t work so good?

1. Lateral geniculate nucleus
2. Hippocampus
3. Thalamic reticular nucleus
4. Suprachiasmatic nucleus
5. Ventromedial nucleus of the hypothalamus

69. A dude is like wow it’s hot out here and then he goes somewhere not as hot. What system of the forebrain coordinated this drive-related behavior?

1. Thalamus
2. Hypothalamus
3. Internal capsule
4. Basal nuclei
5. Limbic system