Download Questions on the Head, Neck, and Upper Limb…

Questions on the Head, Neck, and Limbs…
A Practice Test (questions taken from a board review/test book)
1) All of the following statements correctly pertain to the sternocleidomastoid muscle EXCEPT
a) it divides the neck into anterior and posterior triangles
b) it receives innervation from a nerve that passes through the foramen magnum
c) the head is extended when both left and right sternocleidomastoid muscles contract simultaneously
d) unilateral contraction brings the chin toward the contralateral shoulder
2) A patient’s epicranial aponeurosis (galea aponeurotica) is penetrated, which results in severe gaping of
the wound. The structure underlying the epicranial aponeurosis is
a) a layer containing blood vessels
b) bone
c) the dura mater
d) the periosteum (pericranium)
e) the tendon of the epicranial muscles (occipitofrontalis)
Use the following scenario to answer questions 3-8
A 53-year old woman has paralysis of the right side of her face that produces an expressionless and
drooping appearance. She is unable to close her right eye, has difficulty chewing and dringking, preceives
sounds as annoyingly intense in her right ear, and experiences some pain in her right external auditory
meatus. Physical examination reveals loss of the blink reflex in the right eye upon stimulation of either
cornea, and loss of taste from the anterior two-thirds of the tongue on the right. Lacrimation appears normal
in the right eye, the jaw-jerk reflex is normal, and there appears to be no problem with balance.
3) The inability to close the right eye is the result of involvement of the
a) zygomatic branch of the facial nerve
b) buccal branch of the trigeminal nerve
c) levator palpebrae superioris muscle
d) superior tarsal muscle (of Muller)
e) orbital portion of the orbicularis oculi muscle
4) The difficulty with mastication is the result of paralysis of the
a) right buccinator muscle
b) right lateral pterygoid muscle
c) right masseter muscle
d) right zygomaticus major muscle
5) The pain in the external auditory meatus is due to involvement of sensory neurons that have their cell
bodies in the
a) facial nucleus
b) geniculate ganglion
c) pterygopalatine ganglion
d) spinal nucleus of cranial nerve V
e) trigeminal ganglion
6) The hyperacusia (abnormal acuteness of hearing due to increased irritability of sensory neural
mechanism) associated with the right ear results from involvement of
a) the auditory nerve
b) the chorda tympani nerve
c) the stapedius M.
d) the tensor tympani M.
e) the tympanic nerve of Jacobson
7) The branch of the facial nerve that conveys secretomotor neurons involved in lacrimation is the
1
a)
b)
c)
d)
e)
chorda tympani
deep petrosal N.
greater superficial petrosal N.
lacrimal N.
lesser superficial petrosal N.
8) To produce the described signs and symptoms, a lesion involving the facial (CN VII) N. would be
located
a) in the internal auditory meatus
b) at the geniculate ganglion
c) in the facial canal just distal to the geniculate ganglion
d) at the stylomastoid foramen
e) within the parenchyma of the parotid gland
9) A young boxer, after stumbling repeatedly, sees an opthalmologist. His vision is 20/20. Upon testing
the extraocular muscles, the examiner finds that elevation is balanced, but in depression the right
eyeball deviates toward the midline, and the patient reports seeing double. The examiner realizes the
problem is in the right
a) abducens N.
b) inferior division of the oculomoter N.
c) optic N.
d) superior division of the oculomoter N.
e) trochlear N.
10) Concerning the arterial supply to the brain, all of the following statements correctly pertain to the
cerebral arterial circle (of Willis) EXCEPT
a) it should provide collateral circulation when a cerebral artery or internal carotid artery becomes
occluded
b) it is complete in less than 50% of the population
c) it is particularly prone to aneurysms
d) it will adequately supply the lateral aspect of the left cerebral hemisphere in the event of occlusion
of the left middle cerebral artery in the lateral fissure
11) Reflexes that protect the inner ear from excessive noise involve the contraction of the tensor tympani
and stapedius muscles. Correct statements about the tensor tympani muscle include all the following
EXCEPT
a) it inserts onto the malleus
b) in is derived from the first branchial arch
c) it is innervated by the chorda tympani N.
d) it lies parallel to the auditory tube
12) Infection may spread from the nasal cavity to the meninges along the olfactory nerves. Olfactory fibers
pass from the mucosa of the nasal cavity to the olfactory bulb via the
a) anterior and posterior ethmoidal foramina
b) cribiform plate
c) hiatus semilunaris
d) nasociliary nerves
e) sphenopalatine foramen
13) Injury to the motor root of the mandibular division of the trigeminal N. (CN V3) would incur paralysis
of all the following EXCEPT the
a) anterior belly of the digastric M.
b) buccinator M.
c) mylohyoid M.
d) tensor tympani M.
e) tensor veli palatini M.
2
14) During a neck dissection, the styloid process is used as a landmark. Which of the following statements
correctly pertains to one of the four structures that attach to the styloid process?
a) The stylohyoid M. attaches to the lesser horn of the hyoid bone.
b) The styloglossus M. acts to protrude the tongue.
c) The stylohyoid ligament attaches to the lingula of the mandible.
d) Distally the stylopharyngeus M. is split by the digastric muscle.
15) The muscles originating from the styloid process are innervated by all the following nerves EXCEPT
the
a) facial N.
b) glossopharyngeal N.
c) hypoglossal N.
d) mylohyoid N.
16) If the nerves passing through the jugular foramen are severed as a result of a cranial fracture, one M.
that would remain functional is the
a) palatoglossus M.
b) sternocleidomastoid M.
c) styloglossus M.
d) stylopharyngeus M.
e) trapezius M.
17) Like all endocrine glands, the thyroid is highly vascular. The thyroid gland receives its blood supply in
part from the branches of the
a) internal carotid A.
b) lingual A.
c) subclavian A.
d) transverse cervical A.
e) vertebral A.
Match each incident of bleeding with the injury that usually produces it.
a) Cerebral vein rupture
b) Hemorrhage within the “danger space”
c) Middle meningeal artery tear
d) Ruptured aneurysm of a branch of the middle cerebral A.
18)
19)
20)
21)
Extracranial (epicranial) hematoma
Epidural hematoma
Subarachnoid hemorrhage with blood in the CSF
Subdural hematoma
Match each of the following questions to the appropriate cranial N.
a) CN II
b) CN V
c) CN VII
d) CN X
e) CN XII
22)
23)
24)
25)
Which N. accompanies the ophthalmic artery?
Which N. carries taste from the epiglottic taste buds?
Which N. innervates the conjunctiva of the eye?
Which N. passes through the anterior condylar canal?
3
26) Injury to the posterior cord of the brachial plexus involves all the following nerves EXCEPT the
a) axillary N.
b) long thoracic N.
c) radial N.
d) subscapular N.
e) thoracodorsal N.
27) Innervation to the rotator cuff M. that medially rotates the arm is provided by the
a) axillary N.
b) suprascapular N.
c) thoracodorsal N.
d) upper and lower subscapular nerves
28) A fracture to the medial epicondyle of the humerus with damage to a related N. may be associated with
all the following symptoms EXCEPT
a) anability to adduct the digits
b) inability to grasp a pen in the web space between the thumb and index finger
c) paresthesia (abnormal sensation such as burning, prickling, tingling) of the hypothenar portion of
the hand
d) total paralysis of the fourth and fifth digits
e) weakness of ulnar deviation and wrist flexion
Use the following scenario to answer questions 29-32
A 52-year old man is brought to the ER after a fall in the park. He complains of severe pain in his
left arm and is, indeed, found to have a broken humerus. The patient can extend his forearm at the elbow,
but supination appears to be weak, when compared to his uninjured arm. Neurologic exam reveals an
inability to extend the wrist (wristdrop).
29) The observation that extension at the elbow seems normal, but forearm supination seems weak,
warrants localization of the N. lesion to the
a) posterior cord of the brachial plexus in the axilla
b) posterior divisions of the brachial plexus
c) radial N. at the distal third of the humerus
d) radial N. in the midforearm
e) radial N. in the vicinity of the head of the radius
30) The patient exhibits marked weakness of supination when the elbow joint is fully extended, but there is
little weakness of supination evident when the elbow is partially flexed. The reason for this is
a) the biceps brachii M. is a powerful supinator
b) the brachialis M. is functional
c) the pronator teres is functional
d) the supinator M. is not paralyzed
31) The thumb action that is totally affected by radial N. trauma is
a) abduction
b) adduction
c) extension
d) flexion
32) Flexion and extension of the fingers depend on a unique relationship among several flexor and
extensor tendons. All the following statements concerning these relationships are true EXCEPT
a) dorsal and palmer interossei arise from the sides and fronts of the metacarpals in such a way that
the dorsal interossei abduct and the palmar interossei adduct the fingers
b) extensor tendons all insert into the dorsal or extensor hood of each finger
c) flexor digitorum profundus tendons insert into the bases of the four distal phalanges
4
d) flexor digitorum superficialis pierces the tendon of the flexor digitorum profundus before inserting
into the bases of the four proximal phalanges
e) lumbricals arise from the deep flexor tendons and flex the metacarpophalangeal joints as well as
extend the interphalangeal joints
33) Compression of a N. within the carpal tunnel produces inability to
a) abduct the thumb
b) adduct the thumb
c) flex the distal phalanx of the thumb
d) oppose the thumb
34) The type of femoral fracture most likely to result I avascular necrosis of the femoral head in adults is
a) acetabular
b) cervical
c) intertrochanteric
d) subtrochanteric
35) Intramuscular (IM) injections into the inferomedial gluteal quadrant may result in N. injury that could
produce all the following signs or symptoms EXCEPT
a) footdrop (inability to dorsiflex the foot)
b) inability to rise from a chair
c) inability to maintain a level pelvis when one is walking
d) loss of Achilles tendon reflex
e) inability to extend the thigh at the hip joint and flex the knee
36) Muscles of the anterior compartment of the leg, which act as dorsiflexors of the foot, include all the
following EXCEPT the
a) extensor digitorum longus
b) extensor hallicis longus
c) peroneus longus
d) peroneus tertius
e) tibialis anterior
37) Injury to the sciatic N. by IM injection can be avoided if the needle is inserted into the upper lateral
quadrant of the buttock. This is because the sciatic N. has all the following relationships EXCEPT
a) it emerges through the greater sciatic foramen inferior to the piriformis M.
b) it is located midway between the ischial tuberosity and the posterior superior iliac spine
c) it lies deep to the gluteus medius and minimus muscles
d) it lies deep to the gluteus maximus M.
e) it passes into the thigh between the greater trochanter and the ischial tuberosity
For questions 38-40 select the nerve with which it would be most closely associated.
a) Femoral N.
b) Tibial N.
c) Common peroneal N.
d) Obturator N.
e) Superior gluteal N.
38) Atrophy of the flexor muscles of the thigh and loss of the knee-jerk reflex
39) Inability to evert the foot
40) Inability to adduct the thigh as a result of a knife wound.
5
Answers!
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
11)
12)
13)
14)
15)
16)
17)
18)
19)
20)
21)
22)
23)
24)
25)
26)
27)
28)
29)
30)
31)
32)
33)
34)
35)
36)
37)
38)
39)
40)
C
A
A
A
B
C
C
C
E
E
C
B
B
A
D
C
C
B
C
D
A
A
D
B
E
B
D
D
C
A
C
D
D
B
C
C
C
A
C
D
Hope these are helpful. Remember, if you want clarification on some of the answers, ask me. I’ve got the
book that tells all! 
Have a great turkey day, good luck with your studying!
Neeru
6