Download 1. The entry of bacteria through which space could lead to an

1. The entry of bacteria through which space could lead to an
infection in the mastoid air cells:
Auditory (nasopharyngeal) tube
Cochlea
External acoustic meatus
Internal acoustic meatus
Sacculus
2. Which structure is attached to the center of the tympanic
membrane?
Foot plate of the stapes
Handle (manubrium) of the malleus
Long process of the incus
Tragus
Utricle
3. A 45-year old woman with recurrent left middle ear infection (otitis
media) complained of partial dryness of her mouth to her ENT
surgeon. Taste sensation and hearing were normal. After a
thorough clinical examination at the hospital, the doctor concluded
that the infection must have spread to a component of the
glossopharyngeal nerve (CN IX) that supplies the parotid gland.
On which of the following walls of the middle ear is this nerve
component located?
Anterior
Lateral
Medial
Posterior
Roof
4. A 3-year-old girl ruptured her eardrum when she inserted a pencil
into her ear. Her mother took her to the emergency department
after noticing that the child was crying and complaining of pain in
her ear with a few drops of blood in the external auditory meatus.
The attending doctor examined the child for possible injury to a
nerve that runs across the eardrum. The most likely nerve to be
injured is the:
Auricular branch of the vagus
Chorda tympani
Glossopharyngeal (CN IX)
Lesser petrosal
Trigeminal (CN V)
5. An elderly patient with chronic otitis media (middle ear infection)
might have all the following complications EXCEPT:
Inabilty to chew food due to injury to the mandibular division of
the trigeminal nerve (CN V)
Loss of taste in the anterior part of the tongue due to injury to
the chorda tympani nerve
Mastoiditis
Paralysis of facial muscles due an injury to the facial nerve (CN
VII)
Some degree of deafness due to damage to the ossicles
6. A patient with a facial nerve paralysis suffers from inability to
dampen loud noises (hyperacusis) due to denervation of which
muscle?
Posterior belly of digastric
Stapedius
Tensor tympani
Stylohyoid muscle
7. All of the following are true about the middle ear EXCEPT:
The joints between ossicles are synovial
The chorda tympani nerve is related to the lateral wall
The facial nerve passes in a canal situated in the medial and
anterior walls
The auditory tube connects the nasopharynx with the anterior
wall
Its mucous membrane is supplied by the glossopharyngeal
nerve (CN IX)
8. A patient has sustained a fracture to the base of the skull.
Thorough examination concluded that the right greater petrosal
nerve, among other structures, has been injured. This conclusion
was based on which of the patient's signs:
Partial dryness of the mouth due to lack of salivary secretions
from the submandibular and sublingual glands
Partial dryness of the mouth due to lack of salivary secretions
from the parotid gland
Dryness of the right cornea due to lack of lacrimal secretion
Loss of taste sensation from the right anterior 2/3rd of the
tongue
Loss of general sensation from the right anterior 2/3rd of the
tongue
9. The location of the otic ganglion is in the:
Pterygopalatine fossa
Internal ear
Infratemporal fossa
Middle cranial fossa
None of the above
10.
A patient complains of loss of hearing in the right ear.
Examination reveals ankylosis (otosclerosis) of the footplate of the
stapes to the surrounding bone. Which part of the bony labyrinth is
involved?
Aditus ad antrum
Cochlear (round) window
Cochlear duct
Internal acoustic meatus
Vestibular (oval) window
11.
The geniculate ganglion is the sensory ganglion of which
nerve:
Facial
Glossopharyngeal
Trigeminal
Vagus
Vestibulocochlear
12.
Repeated middle ear infections have destroyed the tympanic
plexus in the middle ear cavity. The loss of preganglionic
parasympathetic fibers that pass through the plexus diminish
production of:
Mucus in the nasal cavity
Mucus on the soft palate
Saliva by the parotid gland
Saliva by the submandibular and sublingual glands
13.
Tears by the lacrimal gland
The soft palate is active in all of the following except:
Breathing
Chewing
Coughing
Swallowing
Yawning
14.
Most paranasal sinuses and/or air cells drain, directly or
indirectly, into the:
Inferior meatus
Middle meatus
Superior meatus
Nasal vestibule
Sphenoethmoidal recess
15.
Irrigation of the maxillary sinus through its opening is a
supportive measure to accelerate the resolution of a maxillary
sinus infection. Which of the following nasal spaces is the most
likely approach to the sinus opening?
choana
inferior meatus
middle meatus
sphenoethmoidal recess
superior meatus
16.
In assessing a deep laceration of the right side of the nose,
the attending physician determines that the cartilage on the lateral
side of the nostril has been cut. What cartilage was injured?
Accessory
Alar
Lateral
Septal
None of the above
17.
The nasolacrimal duct empties into which part of the nasal
cavity?
Hiatus semilunaris
Inferior meatus
Middle meatus
Sphenoethmoidal recess
Vestibule
18.
The pharyngeal tonsils, or adenoids, may become inflamed
and in serious cases need to be removed. Where would the
physician search for them?
In the tonsillar fossa
In the pharyngeal recess
In the piriform recess
In the roof of the nasopharynx
19.
Upon the dorsal surface of the tongue
The middle nasal concha is part of what bone?
Ethmoid bone
Maxilla
Palatine bone
Sphenoid bone
Vomer
20.
A 23-year-old man comes to you complaining that he can't
stop crying, i.e. tears regularly run down the right side of his face.
You suspect that one of the lacrimal ducts on the right side of the
face is blocked. You look into an endoscope to see if the
nasolacrimal duct is blocked. Into which part of the nasal cavity
would you look to see the opening of the duct?
Hiatus semilunaris
Inferior meatus
Middle meatus
Sphenoethmoidal recess
21.
Superior meatus
Which structure forms a border of the tonsillar fossa?
Torus tubarius
Palatopharyngeal fold
Salpingopharyngeal fold
Lateral glossoepiglottic fold
Medial pterygoid plate
22.
The communication between the pharynx and the nasal
cavity is known as the:
Aditus
Auditory tube
Choanae
Fauces
Piriform recess
1. The correct answer is:
Auditory (nasopharyngeal) tube
The auditory (nasopharyngeal) tube is a connection between the nasal
portion of the pharynx and the tympanic cavity that allows pressure to
equalize on either side of the tympanic membrane. It is located in the
anterior wall of the middle ear and is comprised of bone at the tympanic
end and cartilage on the pharyngeal end. The pharyngeal mucosa is
continuous with the lining of the tympanic cavity and mastoid air cells.
This allows infectious material to pass to the middle ear and mastoid
area.
The cochlea is the organ of hearing that receives, interprets, and
transmits sound via the vestibulocochlear nerve (CN VIII). The external
acoustic meatus is the opening in the temporal bone that allows sound
waves to reach the tympanic membrane. The internal acoustic meatus is
the foramen in the temporal bone that allows the vestibulocochlear nerve
and the facial nerve to pass into the skull at the base of the brain.
Finally, the sacculus is a fluid filled sac that is part of the balancing
apparatus of the ear - it is located in the vestibule of the ear.
2. The correct answer is:
handle (manubrium) of the malleus
The handle of the malleus is attached to the center of the tympanic
membrane. The head of the malleus then articulates with the body of
incus, and the long process of incus articulates with the head of stapes.
The foot plate of stapes sits in the oval window. Take a look at Netter
Plate 88 for a better idea of how these ossicles connect!
The tragus is a cartilagenous structure of the external ear, located
anterior to the external auditory meatus. It is hard to describe the tragus;
it is labeled in the upper left picture of Netter Plate 88. The utricle is a
part of the balancing apparatus of the ear--like the saccule, it is a fluid
filled sac in the vestibule.
3. The correct answer is:
Medial
To answer this question, you first need to identify the component of the
glossopharyngeal nerve that innervates parotid gland. Remember-preganglionic parasympathetic fibers from CN IX are arriving at the otic
ganglion via the lesser petrosal nerve and synapsing in the ganglion; the
postganglionic fibers then travel on the auriculotemporal nerve (V3) and
innervate the parotid gland. So, the lesser petrosal nerve, or fibers that
create the lesser petrosal nerve, must have been injured. Now, you just
need to think about where these fibers are in the ear.
These fibers from the glossopharyngeal nerve are covering the
promontory on the medial wall of the ear. The tympanic nerve is a
branch of the glossopharyngeal nerve that carries the preganglionic
parasympathetic fibers that will eventually travel to the otic ganglion. The
tympanic nerve lies on the promontory and creates the tympanic plexus,
which gives rise to the lesser petrosal nerve. Given the clinical
presentation, the patient must have an infection in the tympanic nerve,
tympanic plexus or lesser petrosal nerve. And, all of these nerves are
associated with the medial wall of the middle ear.
What are the important associations with the other walls of the ear? The
lateral wall is formed by the tympanic membrane, and the chorda
tympani courses across this membrane. The anterior wall contains the
opening of the auditory tube and a semicanal for tensor tympani. The
posterior wall of the ear has the aditus ad antrum, which is the entrance
to the mastoid antrum and air cells. The facial nerve (VII) and a small
branch of the facial nerve which innervates stapedius are found on the
posterior wall.
4. The correct answer is:
chorda tympani
When this girl ruptured her eardrum, she damaged the tympanic
membrane. So, you need to think about the nerve and structures that
are associated with the tympanic membrane (ie, on the lateral wall of the
middle ear). Chorda tympani lies across the tympanic membrane, so it's
possible that this nerve was injured by the pencil.
The auricular branch of the vagus nerve is a small branch of the vagus
that supplies afferent sensory innervation to the external acoustic
meatus. This nerve is not close to the tympanic membrane The
glossopharyngeal nerve and lesser petrosal nerve are associated with
the promontory of the ear, which is on the medial wall of the middle ear.
The trigeminal nerve is not close to the ear and would not be damaged
by the injury.
What might happen if chorda tympani was injured? No taste sensation to
the anterior 2/3 of the tongue and no secretomotor innervation to the
sublingual and submandibular glands!
5. The correct answer is: Inability to chew food due to injury to the
mandibular division of the trigeminal nerve (CN V3)
The mandibular division of the trigeminal nerve is not associated with the
middle ear. So, chronic ear infections should have no effect on this
structure. All of the other answers refer to structures that are closely
associated with the middle ear--a chronic infection in this area could
cause any of the other listed complications. The chorda tympani nerve
travels along the lateral wall of the middle ear, running across the
tympanic membrane. It could be damaged by chronic infection and
inflammation. Remember--chorda tympani provides secretomotor
innervation to the submandibular and sublingual glands and taste
sensation to the anterior 2/3 of the tongue. Mastoiditis is an infection of
the mastoid air cells. Since these air cells connect to the middle ear
through the aditus ad antrum on the posterior wall, an infection in the
middle ear could easily spread to the mastoid air cells. The facial nerve
is also located on the posterior wall of the middle ear, so it could also be
damaged by the chronic infection. Finally, a chronic infection can
damage the three ossicles and lead to deafness.
6. The correct answer is:
Stapedius
Stapedius is a small muscle in the ear innervated by the facial nerve. It
dampens large vibrations of the stapes and the tympanic membrane;
this allows the ear to diminish loud noises. If the facial nerve is paralyzed
(as seen with Bell's palsy), the nerve to stapedius is lost, and the ear
cannot lessen the vibrations of stapedius. This causes hyperacusis.
The digastric muscle elevates the hyoid bone and depresses the
mandible. Its posterior belly is innervated by the facial nerve, so this
muscle would be paralyzed if the facial nerve was damaged. However,
the posterior belly of the digastric is not involved with the ear. Tensor
tympani is a muscle in the ear with a similar function to stapedius--it
dampens vibrations of the tympanic membrane. This muscle is
innervated by the mandibular branch of the trigeminal nerve (V3)--not the
facial nerve. Stylohyoid elevates and retracts the hyoid bone. It's
innervated by the facial nerve, but it does not have any effect on the ear.
7. The correct answer is: The facial nerve passes in a canal situated
in the medial and anterior wall.
The facial nerve passes in a canal situated in the posterior and medial
walls of the middle ear. It is not associated with the anterior wall. The
other 4 statements are true. The ossicles articulate with each other at
synovial joints. The chorda tympani is a branch of the facial nerve that is
related to the lateral wall of the middle ear, near the tympanic
membrane. It passes between the malleus and incus. The auditory tube
is found in the anterior wall--it is a path of communication between the
nasal portion of the pharynx and the tympanic cavity that allows
pressure to equalize on either side of the tympanic membrane. Finally,
the mucous membrane of the middle ear is supplied by branches of the
tympanic plexus, which is formed by the tympanic branch of the
glossopharyngeal nerve.
8. The correct answer is:
lacrimal secretion.
Dryness of the right cornea due to lack of
The greater petrosal nerve is a branch of the facial nerve that arises
adjacent to the geniculate ganglion. It carries preganglionic
parasympathetic fibers to the pterygopalatine ganglion. The fibers
synapse in this ganglion, and the postsynaptic parasympathetic fibers go
on to innervate the lacrimal gland, mucous glands of the palate, and the
mucous glands of the nasal cavity. So, if the greater petrosal nerve was
damaged, the presynaptic parasympathetic fibers would be lost, and the
lacrimal gland would not function properly.
The sublingual and submandibular glands are innervated by the chorda
tympani, which brings preganglionic parasympathetic fibers to the
submandibular ganglion. The chorda tympani also provides taste
sensation to the anterior 2/3 of the tongue. Although the chorda tympani,
like the greater petrosal nerve, is a branch of the facial nerve, the chorda
tympani never runs with the greater petrosal nerve. So, injuring the
greater petrosal nerve would not harm the chorda tympani. The parotid
gland is innervated by the lesser petrosal nerve, a branch of the
glossopharyngeal nerve (CN IX). The fibers from this nerve go to the otic
ganglion, synapse there, and then continue on to the parotid gland via
the auriculotemporal nerve. Finally, general sensation to the anterior 2/3
of the tongue is carried by the lingual nerve, a branch of V3.
9. The correct answer is:
Infratemporal fossa
The otic ganglion is in the infratemporal fossa, just inferior to the
foramen ovale, medial to the mandibular nerve and posterior to the
medial pterygoid muscle. It is the ganglion where fibers from the lesser
petrosal nerve synape. The postsynaptic parasympathetic fibers from
the otic ganglion are secretory to the parotid gland--they reach the
parotid gland by the auriculotemporal nerve. The pterygopalatine fossa
is a small pyramidal space inferior to the apex of the orbit. It lies
between the pterygoid process of the sphenoid bone posteriorly and the
posterior aspect of the maxilla anteriorly. It contains the terminal part of
the maxillary artery, the maxillary nerve, and the pterygopalatine
ganglion. The internal ear is buried in the petrous part of the temporal
bone--it contains the vestibulocochlear organ which allows for the
reception of sound and maintaining balance.
Finally, the middle cranial fossa is the large depression in the cranial
base, formed by the greater wings of the sphenoid and squamous parts
of the temporal bones laterally and the petrous parts of the temporal
bones posteriorly. It contains four important foramina: the superior orbital
fissure, which transmits the ophthalmic veins and the nerves entering
the orbit (CN III, CN IV, CN V1 and CN VI); the foramen rotundum which
transmits CN V2; the foramen ovale, which transmits CN V3, and the
foramen spinosum, which transmits the middle meningeal vessels.
10. The correct answer is:
Vestibular (Oval) Window
The oval window is a fossa in the medial wall of the middle ear--it is
found just above the promontory. It leads into the vestibule of the bony
labyrinth. In life, this fossa is completely covered by the footplate of the
stapes. So, if there was otosclerosis of the stapes to the surrounding
bone, there would be damage to the oval window. The round window is
also a fossa in the medial wall of the middle ear, but it is located below
the promontory. The round window is covered by a thin membrane.
The aditus ad antrum is an opening on the posterior wall of the middle
ear. It is the opening to the mastoid antrum and mastoid air cells. The
cochlear duct is the spiral tube suspended in the cochlear canal--it is
part of the membranous labyrinth. Finally, the internal acoustic meatus is
a foramen in the base of the skull. The facial nerve (CN VII) and the
vestibulocochlear nerve (CN VIII) enter the petrous temporal bone
through this foramen.
11. The correct answer is:
Facial nerve
The geniculate ganglion is the sensory ganglion of the facial nerve.
These fibers travel as part of the chorda tympani to provide taste
sensation to the anterior 2/3 of the tongue. The glossopharyngeal nerve
has superior and inferior ganglia, located near the jugular foramen.
These ganglia contain the cell bodies for the afferent components of this
nerve. The trigeminal nerve has a trigeminal ganglion which contains the
cell bodies of neurons composing the sensory root of this nerve. The
vagus nerve also has a superior and inferior ganglion, which are located
near the ganglia of the glossopharyngeal nerve. The superior ganglion is
concerned with the general sensory component of the nerve, and the
inferior ganglion is concerned with the visceral sensory component of
the nerve. Finally, the vestibulocochlear nerve has a vestibular ganglion,
which houses the neurons for balance, and the cochlear ganglion, which
houses the neurons concerned with hearing.
12. The correct answer is:
Saliva by the parotid gland
The tympanic plexus is formed by the tympanic nerve, a branch of the
glossopharyngeal nerve (CN IX). The tympanic plexus provides sensory
innervation to the mucosal lining of the middle ear. The lesser petrosal
nerve also comes out of the tympanic plexus. This nerve carries
preganglionic parasympathetic fibers from the tympanic plexus - these
fibers eventually synapse in the otic ganglion. The postsynaptic fibers
that leave the otic ganglion provide parasympathetic secretomotor
innervation to the parotid gland. So, if the tympanic plexus was
destroyed, the lesser petrosal nerve would be destroyed and the parotid
gland would not secrete saliva.
Mucosal secretions in the nasal cavity and the soft palate and tear
secretions by the lacrimal gland are all mediated by the postganglionic
fibers of the pterygopalatine ganglion. This ganglion receives
preganglionic fibers from the greater petrosal nerve, a branch of the
facial nerve (CN VII). The submandibular and sublingual glands receive
their preganglionic fibers from the chorda tympani - another branch of
the facial nerve.
13.
The correct answer is:
Breathing
The soft palate is the movable posterior 1/3 of the palate, which is
suspended from the posterior border of the hard palate. When a person
swallows, the soft palate is initially tensed to allow the tongue to press
against it, squeezing the bolus of food to the back of the mouth. The soft
palate is elevated posteriorly and superiorly against the wall of the
pharynx, thereby preventing the passage of food into the nasal cavity.
The soft palate functions similarly to prevent the bolus of food from
passing into the nasal cavity while chewing and to prevent expectorated
material from entering the nasal cavity while coughing. The soft palate
also elevates when yawning. The soft palate does not elevate during
breathing--if it did rise during breathing, the air inspired through the nose
might be blocked from entering the trachea.
14.
The correct answer is:
middle meatus
The middle meatus contains the semilunar hiatus, which receives
drainage from the frontonasal duct (draining the frontal sinus), the
anterior ethmoidal air cells, and the maxillary sinus. So, it's draining most
of the paranasal sinuses. The inferior meatus receives the nasolacrimal
duct which conducts tears from the orbit. The superior meatus receives
drainage from the posterior ethmoidal air cells. The nasal vestibule is the
opening of the nose--none of the sinuses drain directly into this area.
The sphenoethmoidal recess is the opening for the sphenoethmoidal
sinus.
15. The correct answer is:
middle meatus
The middle meatus contains the semilunar hiatus, which receives
drainage from the maxillary sinus, the frontonasal duct (draining the
frontal sinus), and the anterior ethmoidal air cells. The maxillary sinus is
draining into the middle meatus, so it would be easiest to approach the
maxillary sinus through this space. The choana is the space where the
nasal cavity opens into the nasopharynx--it is found at the very posterior
border of the nasal cavity. The inferior meatus receives the nasolacrimal
duct which conducts tears from the orbit. The sphenoethmoidal recess is
the opening for the sphenoethmoidal sinus. Finally, the superior meatus
receives drainage from the posterior ethmoidal air cells.
16.
The correct answer is:
alar cartilage
The alar cartilage is found on the inferolateral side of the nose. This is
probably the cartilage that was injured in this laceration. The septal
cartilage creates the septum of the nose. The lateral cartilage is a
specialization of the septal cartilage that is superior to the alar cartilage,
also on the lateral side of the nose. The accessory cartilage is a small
piece of cartilage between the alar cartilage and the lateral cartilage
17. The correct answer is:
inferior meatus
The inferior meatus receives the nasolacrimal duct which conducts tears
from the orbit. The semilunar hiatus is found in the middle meatus--it
receives drainage from the frontonasal duct (draining the frontal sinus),
the anterior ethmoidal air cells, and the maxillary sinus. The
sphenoethmoid recess is the opening for the sphenoethmoidal sinus.
The vestibule of the nose is the opening of the nose that is covered with
skin and stiff hairs.
18. The correct answer is:
In the roof of the nasopharynx
The pharyngeal tonsil is located on the roof of the nasopharynx. The
pharyngeal recess is a space located posterior to the torus tubarius in
nasopharynx. The tonsillar fossa is the space where the palatine tonsil is
located--it is found between the palatoglossal fold and the
palatopharyngeal fold. The piriform recess is a shallow depression
located lateral to the aryepiglottic fold in the laryngopharynx. This is a
common place where food can get stuck. The piriform recess is also
significant because the internal branch of the superior laryngeal nerve is
located immediately deep to the mucosa of this region--so, an injury
here may damage this nerve! Finally, the lingual tonsil is found on the
dorsal surface of the tongue.
19. The correct answer is:
ethmoid
The superior and middle nasal conchae are part of the ethmoid bone.
The maxillary bone is the bone that forms the midface. It forms the
inferior orbital margin and contains the teeth and maxillary sinus. The
palatine bone forms the posterior part of the hard palate. The sphenoid
bone is an irregularly shaped bone forming the central portion of the
skull. It has many parts, including a body, greater wing, lesser wing and
pterygoid plates. The vomer is a thin plate of bone forming the
posteroinferior part of the nasal septum.
20. The correct answer is:
Inferior meatus
The inferior meatus receives the nasolacrimal duct which conducts tears
from the orbit. So, this is the place where you should be looking to see
the opening of the nasolacrimal duct. The semilunar hiatus is found in
the middle meatus--it receives drainage from the frontonasal duct
(draining the frontal sinus), the anterior ethmoidal air cells, and the
maxillary sinus. The sphenoethmoid recess is the opening for the
sphenoethmoidal sinus. The superior meatus is the opening for the
posterior ethmoidal air cells.
21.
The correct answer is:
Palatopharyngeal fold
The tonsillar fossa is the place where you find the palatine tonsil - it is a
space found between the palatoglossal and palatopharyngeal folds.
Torus tubaris is a mucosal fold covering the anteromedial end of the
auditory tube cartilage - it projects toward the midline from the lateral
wall of the nasopharynx. The salpingopharyngeal fold is a vertical fold of
mucous membrane that extends from the medial end of the auditory
tube - it covers the salpingopharyngeus muscle. The lateral
glossoepiglottic fold is a small fold extending from the tongue to the
epiglottis - it is found posterior to the tonsillar fossa. Finally, the medial
pterygoid plate is a part of the sphenoid bone in the skull - it is the
attachment of the superior pharyngeal constrictor muscle and the
pharyngobasilar fascia.
22.
The correct answer is:
choanae
The choanae are the opening at the posterior border of the nasal cavity
that allow the nasal cavity to communicate with the nasopharynx. The
aditus is the laryngeal inlet - this is the space that is covered by the
epiglottis when swallowing. The auditory tube is a tube that connects the
nasopharynx with the middle ear, allowing for pressure to equalize on
both sides of the tympanic membrane. The fauces is the passage from
the mouth to the oropharynx, including the lumen and its boundaries.
Finally, the piriform recess is a shallow depression located lateral to the
aryepiglottic fold in the laryngopharynx. This is a place where food is
commonly lodged.