GROSS ANATOMY 205 MIDTERM EXAMINATION......................OCTOBER 10, 1995

There are 50 questions on this examination. You have 90 minutes to complete this examination.This copy will be returned to you when grading is completed.MULTIPLE CHOICE QUESTIONS (choose the one correct answer and fillin the circle on the General Purpose Answer sheet)

1. Pronounced weakness in supination of the forearm is most likelythe result of damage to which of the following nerves?

a. median b. ulnar c. musculocutaneous d. anterior interosseous e. superficial radial

2. Ulnar nerve injury commonly occurs where the nerve passes behindthe medial epicondyle of the humerus. Injury to the ulnar nerve may resultin all of the following symptoms except

a. loss of sensation on the medial surface of the palm and digits 4 and 5 b. loss of abduction of the wrist c. loss of flexion at distal interphalangeal joints of digits 4 and 5 d. loss of abduction of digit 5 e. loss of adduction of the thumb

3. All of the following muscles are lateral rotators of the thighat the hip joint except

a. sartorius b. obturator externus c. obturator internus d. gracilis e. quadratus femoris

4. Gait or walking involves the initial contact and controlled loweringof one foot to the floor. Loss of this component of normal gait is referredto as "foot-drop." This condition may be characterized by allof the following statements except

a. the tibialis anterior muscle is paralyzed b. the common fibular (peroneal) nerve is damaged c. the patient has a high stepping gait so that the toes do not hit the ground d. there is loss of sensation from the skin over the anterolateral surface of the leg e. there is loss of sensation from the skin over the sole of the foot

7-10. A UCLA quarterback was tackled from behind while his rightarm was fully abducted as he was about to throw the football. His rightshoulder joint was dislocated anteriorly so that the head of the humeruscame to lie inferior to the glenoid cavity.

7. The dislocated humeral head came to rest directly against thetendon of which of the following muscles?

a. supraspinatus b. infraspinatus c. subscapularis d. teres minor e. teres major

8. The subglenoid dislocation forced the humeral head into the quadrangularspace which may cause damage to which of the following nerves?

a. musculocutaneous b. suprascapular c. radial d. axillary e. ulnar

9. If the above-mentioned nerve had been damaged in this patient,all of the following symptoms would occur except

a. some loss of sensation on the lateral aspect of the upper limb b. some weakness in lateral rotation at the shoulder joint c. some weakness in medial rotation at the shoulder joint d. impaired ability to abduct the arm e. impaired ability to adduct the arm

10. Several weeks after his shoulder dislocation was reduced, thequarterback complains of persistent pain when he abducts his arm to throwa football. Because it is commonly damaged in shoulder dislocations, yoususpect a persistent injury and inflammation of the tendons of which ofthe following muscles?

a. supraspinatus b. infraspinatus c. subscapularis d. teres minor e. teres major

11. The saphenous nerve is a sensory branch of which of the followingnerves?

a. sciatic b. femoral c. obturator d. common fibular (peroneal) e. tibial

12. All of the following nerves and arteries are in contact withthe humerus, and may be damaged in fractures of the humerus, except

a. posterior humeral circumflex artery b. profunda brachii artery c. ulnar artery d. ulnar nerve e. radial nerve

13. Which of the following muscles is innervated by posteriorprimary rami of spinal nerves?

a. trapezius b. latissimus dorsi c. serratus posterior d. erector spinae e. rhomboideus major

14-15. A young man is brought into the UCLA emergency room with adeep and jagged laceration extending from just behind his medial malleolusdown on to the medial aspect of the sole of his foot.

14. You are concerned that his injury may have damaged all of thefollowing muscles except

a. abductor hallucis b. flexor hallucis brevis c. flexor hallucis longus d. flexor digitorum longus e. tibialis posterior

15. Your examination reveals minimal muscle damage but the lacerationhas severed the medial plantar nerve. You would expect that all of the followingmuscles would be paralyzed except

a. abductor hallucis b. adductor hallucis e. flexor hallucis brevis d. flexor digitorum brevis

e. first lumbrical

16. All of the following statements about the knee joint are correct except

a. the principal movements of the knee joint are flexion and extension b. when the knee is fully extended, the anterior cruciate ligament prevents posterior displacement of the femur on the tibia and hyperextension of the knee c. when the knee is fully flexed, the posterior cruciate ligament prevents anterior displacement of the femur on the tibia and stabilizes the knee when walking downstairs d. when the knee is fully extended, it "locks" because of lateral rotation of the femur on the tibia e. the popliteus muscle contracts to "unlock" the knee so that flexion of the knee can occur

25. Two muscles form the floor of the femoral triangle on the frontof the thigh. Which of the following muscles forms the medial partof the floor?

a. pectineus b. vastus medialis c. adductor longus d. rectus femoris e. iliopsoas

27. In the sole of the foot, layer 2 consists of intrinsic musclesand tendons of extrinsic muscles. Therefore, all of the following musclesare considered part of layer 2 except

a. flexor digitorum longus b. flexor digitorum brevis c. flexor hallucis longus d. quadratus plantaeGROSS ANATOMY 205 FINAL WRITTEN EXAMINATION 12/12/95

Multiple Choice (select the one best answer).

1. All of the following muscles help to elevate the larynx during the act of swallowing. Which muscle also depresses (lowers) the hyoid bone?

a. thyrohyoid b. geniohyoid c. mylohyoid d. anterior digastric e. stylopharyngeus

2. Which of the following lymph nodes drains the oropharynx and often are referred to as the "tonsillar nodes" because theybecome inflammed in cases of tonsillitis?

a. submandibular b. subclavian c. subdigastric or jugulo-digastric d. bifurcation or jugulo-carotid e. jugulo-omohyoid

3. Damage to the facial (VII) nerve near the geniculate ganglion results in all of the following symptoms except

a. absence of blinking reflex on affected side b. absence of lacrimal secretion on affected side c. corner of mouth pulled to affected side d. hyperacusia or sensitivity to loud sounds e. reduced secretion of saliva into oral cavity

4. When the middle meningeal artery is ruptured but the meninges remain intact, blood enters the

a. subdural space b. epidural space c. subarachnoid space d. cavernous sinus e. sigmoid sinus

5. Which of the following muscles causes abduction of the vocal cords during quiet breathing?

a. cricothyroids b. thyroarytenoids c. posterior cricoarytenoids d. lateral cricoarytenoids e. oblique interarytenoids

6. All of the following structures are located within the carotid sheath except

a. internal jugular vein b. internal carotid artery c. common carotid artery d. vagus (X) nerve e. sympathetic chain

7. All of the following conditions or actions result from stimulation of the short ciliary nerves except

a. contraction of the ciliary muscle b. enhanced vision for distant objects c. decreased size of the pupil d. increased thickness of the lens e. altered blood flow to capillaries in the iris

8. All of the following structures enter the orbit by passing through the anulus tendineus (common tendinous ring) except

a. optic (II) nerve b. trochlear (IV) nerve c. abducens (VI) nerve d. nasociliary nerve e. ophthalmic artery

9. The accessory meningeal artery passes through which foramen to supply the trigeminal ganglion?

a. foramen ovale b. foramen spinosum c. foramen rotundum d. foramen lacerum e. foramen cecum

17. All of the following muscles attach to the thyroid cartilage except

a. cricopharyngeus b. stylopharyngeus c. inferior pharyngeal constrictor d. cricothyroid e. sternothyroid

18. If food enters the larynx, the laryngeal muscles go into spasm and the rima glottidis closes. If the food can not be dislodged,the person is in danger of asphyxiation and an emergency midline incision is made into which structure to open the airway?

a. median thyrohyoid ligament b. median cricothyroid ligament c. cricotracheal ligament d. vocal ligament e. thyroid cartilage

19. Which part of the larynx is most directly concerned with voice production?

a. aditus b. vestibule c. glottis d. ventricle e. infraglottic cavity

20. Damage to the sympathetic trunk in the neck interrupts the sympathetic nerve supply to the head and neck on that side. Thiscondition is known as the Horner syndrome which consists of all of the following symptoms except

a. pupillary constriction b. ptosis or drooping of upper eyelid c. vasoconstriction

d. absence of sweating e. apparent retraction of the eye into the orbit (enophthalmus)

21. Which of the following branches of the vagus (X) nerve supplies motor innervation to muscles of both the pharynx andlarynx?

a. pharyngeal nerve b. superior laryngeal nerve c. external laryngeal nerve d. internal laryngeal nerve or e. recurrent laryngeal nerve

22. Which of the following paranasal sinuses drains into the nasal cavities above the middle nasal conchae?

a. sphenoid b. maxillary

c. anterior ethmoidal d. middle ethmoidal e. posterior ethmoidal

23-26. A 19 year old male victim of a drive-by shooting presents in the emergency room with a .22 caliber bullet wound in theleft infratemporal fossa, just below the zygomatic arch and about one inch anterior to the external auditory meatus. The bulletpassed through the mandibular notch and imbedded at the base of the pterygoid process of the sphenoid bone. Following arelatively uncomplicated surgical extraction, the patient had paresis (weakness) and paralysis of his left masticatory muscles.

23. What structure was most likely severed by the bullet?

a. facial (VII) nerve b. maxillary (V2) nerve c. maxillary artery d. mandibular (V3) nerve e. retromandibular vein

24. With damage to the above structure, what other symptoms might you expect to see in this patient?

a. numbness of the left side of the eyelid and forehead b. numbness of the left ear or c. numbness of the left side of the tongue and sublingual region d. numbness of the left side of the oropharynx e. numbness of the left cheek and side of the nose

25. If the sense of taste from the anterior two-thirds of the tongue is normal, you might conclude that which of the followingnerves was not damaged by the bullet?

a. hypoglossal (XII) b. lingugl branch of V3 c. lesser petrosal branch of IX d. chorda tympani branch of VII e. greater petrosal branch of VII

26. Since secretions from the left parotid gland are reduced greatly, but sublingual and submandibular secretions are normal,which of the following ganglia was damaged?

a. geniculate b. submandibular c. otic d. trigeminal e. pterygopalatine

27-29. You and a classmate decide to play racketball after class but neither of you are wearing safety glasses. During thegame, your classmate is struck in the right eye by the ball and complains that her cheek and upper lip are numb and that she cannot look upward with her right eye. Suspecting that she has sustained a blowout fracture of the orbit, you take her to theemergency room.

27. When you reach the emergency room, your suspicions about the fracture are confirmed and you are told by the attendingphysician that the following has occurred?

a. the medial rectus muscle is entrapped by a fracture of the medial wall of the orbit b. the superior rectus muscle is entrapped by a fracture of the roof of the

orbit c. the lateral rectus muscle is entrapped by a fracture of the zygomatic bone d. the inferior rectus muscle is entrapped by a fracture of the maxillary bone e. the superior rectus muscle has detached from the eyeball

28. Since she is complaining of persistent numbness of her cheek and upper lip, which nerve has most likely been damaged bythis fracture?

a. supraorbital b. infraorbital c. supratrochlear d. infratrochlear e. buccal

29. There is no damage to the left orbit and, when your classmate is asked to look upward her left eye moves normally. Theability to look upward requires the simultaneous contractions of which two extraocular muscles?

a. superior rectus and superior oblique b. superror rectus and inferior oblique c. superior oblique and inferior oblique d. inferior rectus and inferior oblique e. inferior rectus and superior oblique

30. A 10 year old child is admitted to the hospital with a very high fever, rapid pulse and respiration, and complaining of a verysore throat. Your examination reveals bloody pus in her sputum and an abscess in her tonsillar area. A chest x-ray shows fluidaccumulation in the superior and posterior mediastinum. The fluid (pus) in the thorax indicates that the infection had penetratedinto which of the following spaces?

a. sublingual space b. pyriform recess c. pharyngeal recess d. retrovisceral space e. carotid sheath

31. Hyperflexion of the head and upper cervical vertebrae is limited primarily by which of the following?

a. posterior longitudinal ligament b. anterior longitudinal ligament c. posterior atlanto-occipital membrane d. mandible encountering the sternum or lower neck e. alar or check ligaments

32. Paralysis or spasticity of which of the following muscles would prevent full opening of the mouth (depression of themandible)?

a. medial pterygoid b. lateral pterygoid c. masseter d. temporalis e. posterior digastric

33. Damage to the external laryngeal nerve during thyroid surgery will result in the patient's inability to

a. relax the vocal cords b. tense the vocal cords c. abduct the vocal cords d. adduct the vocal cords e. swallow normally

34. Each of the following sensory nerves is a branch of the cervical plexus except

a. great auricular b. transverse cervical c. greater occipital d. lesser occipital e. supraclavicular

35. All of the following muscles receive their motor innervation from the pharyngeal branch of the vagus (X) nerve except

a. salpingopharyngeus b. stylopharyngeus c. palatopharyngeus d. superior pharygneal constrictor e. palatoglossus

36. All of the following statements concerning the pterygopalatine fossa are correct except

a. the maxillary nerve enters the fossa through the foramen rotundum b. the maxillary artery enters the fossa through the pterygomaxillary fissure c. the zygomatic nerve exits the fossa through the inferior orbital fissure d. the nasopalatine nerve exits the fossa through the greater palatine foramen e. the posterior superior alveolar nerves exit the fossa through the pterygomaxillary fissure

37. All of the following statements concerning the sublingual region of the oral cavity are correct except

a. the duct of the submandibular gland opens lateral to the frenulum of the tongue b. the submandibular ganglion sends postganglionic parasympathetic fibers to the sublingual gland via branches of the lingual nerve c. the lingual artery lies lateral to the hyoglossus muscle d. the hypoglossal nerve enters the region by passing above the posterior margin of the mylohyoid muscle e. the lingual nerve supplies general sensory innervation to the sublingual mucosa

38-41. A 50 year old white male developed chronic rhinitis, an inflammation of the nasal mucosa with excessive mucussecretion and occasional epistaxis or profuse nose bleeding. His symptoms did not respond to medication and surgery wasdiscussed to relieve his chronic nasal discharge.

38. This condition can be treated surgically by resection of which of the following ganglia?

a superior cervical b. ciliary c. submandibular d. sublingual e. pterygopalatine

39. Preganglionic fibers which synapse in this ganglion are found in which of the following nerves?

a. greater petrosal b. lesser petrosal c. deep petrosal d. nasopalatine e. sympathetic chain

40. As a result of this surgery, secretions will be reduced in all of the following tissues except

a. pharyngeal mucosa above the soft palate b. mucosa lining the soft palate c. mucosa lining the hard palate d. sublingual gland e. lacrimal gland

41. Nose bleeding often originates at Kiesselbach's area where there is anastomosis of the septal branches of all of thefollowing arteries except

a. sphenopalatine b. greater palatine c. superior labial d. anterior ethmoidal e. posterior ethmoidal

42. During general anesthesia, care must be taken to prevent the tongue from falling back and blocking the patient's airway

because of total relaxation of which of the following muscles?

a. genioglossus b. styloglossus c. palatoglossus d. hyoglossus e. mylohyoid

43. All of the following statements concerning the ear are correct except

a. the mucosa of the middle ear is innervated by the tympanic plexus which contains the tympanic branch of IX and the caroticotympanic nerves b. the sensory innervation to the external ear and outer surface of the tympanic membrane is supplied by the auriculotemporal nerve c. the promontory is located on the medial wall of the middle ear and is produced by the basal coil of the cochlea d. the tegmen tympani is a thin plate of bone that separates the middle ear from the middle cranial fossa e. the spiral organ of Corti rests on the basilar membrane within the scala tympani of the cochlea

44. Which of the following conditions is least likely to result from the spread of infection from otitis media, an inflammation ofthe middle ear?

a. meningitis b. encephalitis c. mastoiditis d. rhinitis e. laryngitis

45. The labyrinthine artery supplies blood to the inner ear and is a branch of which of the following arteries?

a. internal carotid b. superior cerebellar c. posterior cerebral d. basilar e. vertebral

46-50. Each of the following glands receives its blood supply from branches of one of the arteries listed on the right. Matcheach gland with the most appropriate artery.

46. parotid __A___ a. external carotid

47. prostate __C___ b. internal carotid

48. lacrimal __B___ c. inferior vesical

49. parathyroid __E___ d. internal pudendal

50. greater vestibular __D___ e. thyrocervical

GROSS ANATOMY Final Written Examination 12/10/91

1. A large malignant tumor of bone invades the floor of the middlecranial fossa. Knowing the anatomy of the middle cranial fossa, youlook for symptoms that would indicate tumor invasion in all of thefollowing structures, except:

A. foramen spinosum. B. internal auditory meatus. C. foramen lace rum. D. foramen ovale. E. foramen rotundum.

2. A patient suffers from a dry and painful right cornea, numbness of the right nasal cavity as well as a loss of sensation along the rightside of the palate in the oral cavity. Which of the following could be the cause of these symptoms?

A. a small tumor pressing on the trigeminal ganglion.

B. a growth in the pterygopalatine fossa that compresses the pterygopalatine ganglion. C. a loss of cell bodies in the pterygopalatine ganglion. D. compression of the geniculate ganglion. E. a tumor that compresses the structures in the superior orbital fissure.

3. The following statements about the drainage of the paranasal sinuses are correct, except:

A. The sphenoid sinus drains into the sphenoethmoidal recess. B. The maxillary sinus drains into the middle meatus. C. The frontal sinus drains into the inferior meatus. D. The posterior ethmoidal sinus drains into the superior meatus. E. The anterior ethmoidal sinus drains into the ethmoidal infundibulum/middle meatus.

4. Each of the following statements regarding veins in the head and neck is true, except:

A. The retromandibular and facial veins unite to form the common facial vein. B. The external jugular vein lies superficial to the sternocleidomastoid muscle. C. The internal jugular vein is formed by the union of the inferior petrosal and sigmoid sinuses. D. The straight sinus is formed by the union of the superior and inferior sagittal sinuses. E. The facial vein lies superficial to the submandibular gland in the submandibular triangle.

6. Your room mate finally indicates that he has been rather subdued because he has had a persistent headache for about two weeks. Having Just started your ophthalmology clerkship, you examine his eyes and find that he has bilateral papilledema (edema of the optic disc) and congested retinal veins. You immediately suspect some intracranial pathology that has increased his cerebrospinal fluid pressure. The reason for your diagnosis is:

A. Since the retina is an outgrowth of the brain it reflects all neuropathology of the brain by developing papilledema. B. Since the optic nerve is covered with the meninges, an increase in the pressure of the cerebrospinal fluid will compress the optic nerve and the venous drainage of the retina leading to papilledema. C. Since the opthalmic artery is so small, increased intracranial pressure compromises blood flow through it as it enters the orbit. D. Since the vitreous humor communicates with the subarachnoid space, its pressure rises when cerebrospinal fluid pressure rises. E. The pain associated with an increase in intracranial pressure causes a reflex constriction of the central artery of the retina.

9. You and your date are sharing an extra thick milkshake. To impress your date with your new knowledge of anatomy, you tell her: "I will beable to suck more of the milkshake into my straw because I have stronger facial muscles, namely, the following pair:

A. levator labii superioris and zygomaticus minor. B. buccinator and orbicularis oris. C. platysma and zygomaticus major. D. risorius and levator anguli oris. E. depressor anguli oris and mentalis.

10. A teenage girl with acne was in the habit of picking at thepimples on her face. As a result, one pimple located near the corner ofher mouth became infected. Within a few days the girl complained of abad headache and noticed a faint red streak that extendedsubcutaneously from the infected pimple toward the medial angle of hereye. Within a few days her condition worsened. She felt weak andfatigued and showed signs of exophthalmos (bulging of the eye), ptosis (drooping of the eyelid) and impairment of normal movements of theeyeball on her left side. She finally consulted an ophthalmologist whoplaced her immediately in the hospital and administered massive dosesof antibiotics to treat her meningitis. The following conclusions aboutthis girl's condition are true, except:

A. The infection from her picked pimple spread to her cavernous sinus. B. The facial vein, which has no valves, communicates with the dural venous sinuses through the ophthalmic vein. C. The three cranial nerves supplying the extra ocular muscles pass through or along the wall of the cavernous sinus, thus explaining their involvement in her symptoms. D. Her meningitis is due to the fact that the cavernous sinus drains directly into the transverse sinus. E. Impairment of some sympathetic innervation can be expected because the internal carotid artery and its overlying plexus of sympathetic fibers do course through the cavernous sinus.

12. During a gang fight, one of the combatants receives a knife woundwhich penetrates into the substance of his parotid gland. In theEmergency Room you would look for damage to the following structures,except:

A. external carotid artery. B. great auricular nerve. C. facial nerve. D. retromandibular vein. E. mental nerve

14. The following areas of mucous membrane are innervated by the namednerve, except:

A. cheek - buccal branch of the mandibular nerve. B. posterior nasal septum - nasopalatine nerve. most of the hard palate - lesser (posterior) palatine nerve. C. vestibular folds (false vocal cords) - internal laryngeal nerve. E. frontal sinus - supraorbital nerve.

15. You have a bad head cold, but have to fly to Boston for yourinterview as a resident. Take-off is quite painful for you because yourstuffed-up auditory tube makes equalizing pressure in you middle eardifficult. To take your mind off the discomfort during landing you tryto remember the names of the muscles which, because of their attachmentto the auditory tube, could help equalize middle ear pressure. As yourears "pop," you remember that these are the muscles, with oneexception. Indicate that exception.

A. levator palati. B. tensor palati. C. tensor tympani. D. stapedius. E. salpingopharyngeus.

16. Through the various foramina in the skull, structures enter and leave the cranial cavity. The following are correct statements, except:

A. The spinal and cranial components of the spinal accessory nerve enter the cranial cavity through the foramen magnum. B. The middle meningeal artery enters the cranial cavity through the foramen spinosum. C. Sensory information from the retina enters the cranial cavity through the optic canal. D. Efferent fibers of the twelfth cranial nerve leave the cranial cavity by passing through the hypoglossal canal. E. Blood in the dural sinus system leaves the cranial cavity by passing through the jugular foramina.

17. The following muscular attachments are correct, except:

A. superior constrictor - pterygomandibular raphe. B. buccinator - pterygomandibular raphe. C. middle constrictor - thyroid cartilage. D. inferior constrictor - cricoid cartilage. E. musculus uvulae - hard palate.

18. As an academic physician you discover the first case of an hypertrophied annul us tendineus which compresses those structureswhich pass through it. You expected and found symptoms of malfunction of the following nerves, except:

A. optic nerve. B. trochlear nerve. C. abducent nerve. D. nasociliary nerve. E. oculomotor nerve.

19. Each of the following statements regarding muscle action is correct, except:

A. the posterior cricoarytenoid muscles adduct the vocal cords. B. the lateral rectus muscles abduct the eyeballs. C. the stylopharyngeus elevates the larynx and pharynx during swallowing. D. the genioglossus muscles protrude the tongue. E. the mylohyoid muscles elevate the hyoid bone.

21. The following statements about the temporo-mandibular joint are correct, except:

A. As the jaw is opened the contraction of the medial pterygoid muscles pulls the mandible forward so that the articular discmoves forward onto the articular tubercle of the temporal bone.B. During closure of the mouth, the posterior fibers of the temporalis pull the mandible back into the mandibular fossa.C. The digastrics, geniohyoid and mylohyoid muscles depress the jaw.D. Elevation of the mandible involves contraction of the temporalis and masseter. E. Lateral chewing movements are produced by alternating protruding and retracting each side of the mandible.

22. The following structures are derived from the indicated branchial arch, except:

A. muscles of mastication - first arch. B. stapes and stapedius - second arch. C. cricoid cartilage and cricothyroid - third arch. D. posterior belly of digastric and stylohyoid - second arch. E. tensor palati and tensor tympani - first arch

23. An aneurysm of either the posterior cerebral or superior cerebellar artery might very likely compress one or both of the following pair of nerves because they pass between these two arteries as they emerge from the brain:

A. vagus and glossopharyngeal. B. abducens and vagus. C. abducens and glossopharyngeal. D. optic and oculomotor. E. oculomotor and trochlear.

24. The following statements regarding the parasympathetic ganglia in the head are correct, except:

A. Fibers of the greater petrosal nerve synapse in the pterygopalatine ganglion. B. Fibers of the deep petrosal nerve synapse in the pterygopalatine ganglion. C. Fibers of the lesser petrosal nerve synapse in the otic ganglion. D. Fibers of the chorda tympani nerve synapse in the submandibular ganglion. E. Fibers running in the inferior division of the oculomotor nerve synapse in the ciliary ganglion.

25. Which of the following routes of the parasympathetic innervation to the eye is correct?

A. inferior division of the oculomotor - ciliary ganglion- short ciliary nerves - ciliary body and pupillary constrictor. B. nasociliary nerve - ciliary ganglion- short ciliary nerves - ciliary body and pupillary dilator. C. inferior division of the oculomotor - nasociliary nerve - ciliary ganglion- ciliary body. D. superior division of the oculomotor - ciliary ganglion- long ciliary nerves - pupillary dilator. E. nasociliary nerve - communicating branch to the ciliary ganglion- ciliary ganglion- infratrochlear nerve – arteries to the retina.

26. With respect to the skull of the newborn infant, the following statement(s) is(are) true:

1. The paranasal air sinuses are already formed. 2. The facial bony skeleton represents about the same percentage that the face comprises in the adult skull. 3. At birth the mandible is already a single bone. 4. The different bones of both the neurocranium and facial skeleton form by intramembranous or intracartilaginous bone formation.

CODE: A(1,2,3); B(1,3); C (2,4); D(4); E(all).

27. The chorda tympani nerve

1. carries taste fibers from the posterior one-third of the tongue. 2. courses on the promontory of the middle ear. 3. contains preganglionic fibers for the otic gang lion. 4. joins the lingual nerve.

29. As reiterated in this year's radiology lecture on the head and neck, the pharyngobasilar fascia may serve as a plane through whichinfection or cancer may spread out of the pharynx. In "weak" regions of the pharynx, gaps occur in the constrictor muscle layer surrounding thepharyngobasilar fascia. Regions where these gaps are found include:

1. at the base of the skull above the superior constrictor. 2. posterior to the cricothyroid joint. 3. in the bed of the palatine tonsil. 4. directly posterior to the hyoid bone.

CODE: A(1,2,3); B(1,3); C(2,4); D(4); E(all).

30. Because of their lymphatic drainage, infections of the following structures may lead to palpable swellings of the indicated lymph nodes:

1. tip of the tongue - submental nodes. 2. back of the scalp - occipital nodes. 3. the middle ear - parotid nodes. 4. maxillary air sinus - submandibular nodes.

CODE: A(1,2,3); B(1,3); C(2,4); D(4); E(all).

31. In a very competitive game, a student who is not wearing goggles is hit directly on the right eye by the racquet ball. After seeing herin the Emergency Room, you request a head X-ray, suspecting a blow-out fracture of the orbital floor. Which observation(s) would most directlysupport your diagnosis?

1. the patient has a loose right incisor. 2. the patient is unable to look up with the right eye. 3. the patient has pain in the right ear. 4. the patient's right upper lip and lateral nose are numb.

CODE: A(1,2,3); B(1,3); C(2,4); D(4); E(all).

32. The above diagram from your text has been modified. The illustration(s) which demonstrate(s) the correct action of theindicated extra ocular muscle acting alone is(are):

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

CODE: A(1,2,3); B(1,3); C(2,4); D(4); E(all).

33. Indicate the correct match(es).

1. ophthalmic artery - superior orbital tissue. 2. vestibulocochlear nerve - internal auditory meatus. 3. mandibular nerve - foramen rotundum. 4. middle meningeal artery - foramen spinosum.

CODE: A(1,2,3); B(1,3); C(2,4); D(4); E(all).

34. After reviewing gross anatomy until 3 AM, the medical student was accosted on the way to his car. In the ensuing struggle, he received apenetrating knife cut in the side of his neck. In the Emergency Room you examine the patient and find that he has difficulty turning hishead to the left and shrugging his right shoulder. When asked to protrude his tongue it deviates to the right. From these symptoms youconclude that the knife had damaged the following cranial nerve(s):

l. XI (spinal accessory). 2. IX (glossopharyngeal). 3. XII (hypoglossal). 4. VII (facial).

CODE: A(1,2,3); B(1,3); C(2,4); D(4), E(all).

36. The glossopharyngeal nerve

1. provides sensory innervation to the posterior tongue. 2. supplies the stylopharyngeus muscle. 3. sends preganglionic fibers to the otic gang lion. 4. supplies sensory fibers to the carotid sinus.

CODE: A(1,2,3); B(1,3); C(2,4); D(4); E(all).

37. Nerve(s) formed from posterior primary rami of spinal nerves include(s):

1. suboccipital nerve 2. third occipital nerve. 3. greater occipital nerve. 4. lesser occipital nerve.

39. During thyroidectomy the surgeon accidentally cuts the left recurrent laryngeal nerve. The symptom(s) resulting from this accidentinclude(s):

1. a hoarse voice. 2. loss of sensation above the vocal chords. 3. a weakened cough. 4. a denervated cricothyroid muscle.

42. Very loud noises could cause extreme deflection of the ear drum were it not for the __________________ muscle which damps down these vibrations.

43. An elderly man developed an aneurysm of the right internal carotid artery just below the base of the skull, about at the level of the second cervical vertebra. Within 3 months, he demonstrated the following symptoms: miosis (constricted pupil), anhydrosis (absence of sweating), ptosis (drooping eyelid) and vasodilation of peripheral arteries causing flushing - all on the right side of his face. You recognize that these symptoms were probably all due to the aneurysm compressing the _______________________________.

44. Otitis media is an inflammation of the middle ear cavity and is commonly caused by spread of an infection from the nasopharynx viathe auditory tube. Pain associated with this condition is carried by what nerve? ______________________________ (be specific).

45. In addition to the first and fifth, the only other odd numbered cranial nerve that does not carry preganglionic parasympathetic fibers is _____________________________.

46. During swallowing, ingested fluids pass lateral to the laryngeal inlet through the ______________________________ fossa.

48. You and your husband, who is a computer engineer, have your first baby. Your husband gets quite concerned every time the baby cries, he believes that she has a serious cold because her nose runs. As the physician in the family you point out that your baby doesn't have a cold, it's just that,her tears are transported to the nasal cavity through the ______________________ ducts.

-49. All taste fibers in the chorda tympani nerve have their cell bodies in the _______________________ ganglion.

2. All of the following muscles receive motor innervation from the tibial division of the sciatic nerve except

a. semitendinosus b. semimembranosus c. long head of biceps femoris d. short head of biceps femoris e. popliteus

6. In addition to weakening flexion at the elbow joint, partial damage to the musculocutaneous nerve will also weaken

a. abduction of the arm b. pronation of the forearm c. supination of the forearm d. abduction of the hand e. adduction of the hand

7. Your patient is a major league baseball pitcher who comes to you complaining of pain in his right shoulder and difficulty in lifting thearm over his head. Since damage to the "rotator cuff" is common in pitchers, you suspect damage to the tendon of the

a. subscapularis b. supraspinatus c. infraspinatus d. teres minor e. deltoid

10 - 12. A young woman is thrown from her horse while riding in the Santa Monica mountains. As she lands, the right side of her neck andshoulder strike a fallen tree trunk. When you examine her several day later, you observe that her right arm hangs limply and is mediallyrotated. Her forearm is pronated and she complains of numbness along the lateral side of her arm.

10. Which part of the brachial plexus was most likely damaged in the fall?

a. superior trunk b. middle trunk c. inferior trunk d. medial cord e. lateral cord

11. Because her arm is medially rotated, the nerve supply to which of the following was not completely damaged?

a. supraspinatus b. infraspinatus c. subscapularis d. teres minor e. deltoid

12. To account for the unopposed pronation of her forearm, which of the following muscles is paralyzed?

a. biceps brachii b. triceps brachii c. brachialis d. coracoobrachialis e. brachioradialis

13. When you stop your car suddenly to avoid a jogger, your right knee hits the dashboard with such force that the tibia is driven posteriorlyon the femur. You suspect ligament damage which, if not repaired, would make walking down stairs difficult. Which of the followingligaments of the knee joint was torn?

a. patellar b. anterior cruciate c. posterior cruciate d. tibial collateral e. fibular collateral

18. In the hand, the four lumbrical muscles arise from tendons of the ______________________________ muscle, wind around the radial side of the fingers and insert into the tendons of the ______________________________ muscle.

19. Adduction of the fingers occurs at the ________________________ joints when the ___________________________ muscles contract. Adduction of the thumb occurs at the ___________________________ joint when the ____________________________ muscle contracts.

20. The axillary nerve is derived from the ________________________ cord of the brachial plexus. It passes through the _________________________ space with the __________________________ artery and supplies motor innervation to the ______________________ and ____________________________ muscles.

21. Collateral circulation around the scapula could provide blood to the upper arm if the second part of the axillary artery becomes occluded. The flow of blood in the _____________________ artery and its major branch, the _______________________ artery, is reversed whenthese collateral channels are used to supply the upper limb.

23 - 25. A young man has sustained a deep wound on the sole of this foot. He stepped on a piece of broken glass while jogging barefoot on the beach. The severe bleeding which resulted from damage to his deep plantar arch is difficult to control.

23. You recall that the deep plantar arch is formed when the deep plantar branch of the _________________________ artery joins the _________________________(medial/lateral) plantar branch of the _____________________________ artery.

24. To control his bleeding, you try digital pressure to compress the first artery against the navicular bone just ________________________ (medial/lateral) to the tendon of extensor hallucis longus.

25. You also try to compress the other artery as it passes behind the medial malleolus and enters the sole of the foot along with the tendons of the _____________________________________ and ____________________________ and ________________________ muscles.

1. Hyperacusia or excessive sensitivity to loud sounds results from damage to the

a. facial (VII) nerve b. vestibulocochlear (VIII) nerve c. glossopharyngeal (IX) nerve d. tympanic membrane e. cochlear membrane

2. Damage to the nerves passing through the foramen ovale would result in all of the following symptoms except

a. loss of taste sensation from the anterior two-thirds of the tongue b. loss of general sensation from the floor of the oral cavity c. loss of general sensation from the lower lip d. reduced salivary secretions e. weakness of soft palate movements during swallowing

3. Pressure on the oculomotor (III) nerve within the middle cranial fossa could result in all of the following symptoms except

a. loss of accommodation for near vision b. pupillary dilation c. lateral deviation of the eyeball d. ptosis or drooping of the eyelid e. loss of the corneal blink reflex

4. Local anesthetics injected midway along the posterior border of the sternocleidomastoid muscle produce a superficial cervical block. All of the following nerves would be anesthetized except

a. great auricular b. greater occipital c. lesser occipital d. transverse cervical e. supraclavicular

5. A tumor of the vestibulocochlear (VIII) nerve has compressed all of the structures in the internal auditory meatus and produced each of the following symptoms except

a. loss of hearing b. nystagmus (involuntary eye movements) c. loss of lacrimal secretion d. difficulty in chewing e. difficulty in swallowing

6. The paranasal sinus whose opening is in the poorest position for drainage when the head is held erect is the

a. frontal b. sphenoid c. maxillary d. anterior ethmoid e. posterior ethmoid

7. The intrinsic muscles of the larynx can be divided into two groups; 1) those concerned with protecting the larynx during swallowing, and 2) those concerned with adjustments during phonation and respiration. A muscle of the first group is the

a. cricothyroid b. posterior cricoarytenoid c. transverse interarytenoid d. aryepiglotticus e. vocalis

8. Infection of the middle ear can spread to surrounding areas by all of the following pathways except

a. through the tegmen tympani to the middle cranial fossa b. through the medial wall to the labyrinth c. through the floor to the internal jugular vein d. through the aditus to the mastoid antrum and air cells e. through the epitympanic recess to the internal auditory meatus

9. The temporomandibular joint usually dislocates anteriorly during yawning. Spasm of which muscles would cause the heads of the mandibleto dislocate anterior to the articular tubercles?

a. mylohyoids b. medial pterygoids c. lateral pterygoids d. masseters e. temporalis

10. Most of the pain associated with a traumatic dislocation of the temporomandibular joint is carried by which nerve?

a. zygomaticotemporal branch of V2 b. auriculotemporal branch of V3 c. posterior auricular branch of VII d. auricular branch of X e. tympanic branch of IX

16. The cell bodies for the special sensory (taste) fibers which are located in the oropharynx are found in which of the following ganglia?

a. trigeminal (V) b. geniculate (VII)

c. inferior ganglion of IX d. inferior ganglion of X e. both c. and d.

20. The only muscles which open the rima glottidis are the

a. cricothyroids b. posterior cricoarytenoids c. lateral cricoarytenoids d. thyroarytenoids e. interarytenoids

21. Each of the following neck muscles is innervated by anterior primary rami of cervical spinal nerves except the

a. posterior scalene b. rectus capitis lateralisc. longus colli d. rectus capitis posterior major e. middle scalene

22. When you ask your patient to protrude his tongue, it deviates to the right side. You immediately suspect paralysis of which muscle?

a. right styloglossus b. right hyoglossus c. right genioglossus d. left genioglossus e. left styloglossus

23. Sustained tension of the vocal cords is lost and the voice "tires easily" when which of the following muscles is paralyzed?

a. cricothyroid b. posterior cricoarytenoid c. lateral cricoarytenoid d. thyroarytenoid e. vocalis

24. Each of the following arteries is a branch of the internal carotid artery except

a. anterior cerebral b. middle cerebral c. posterior cerebral d. posterior communicating e. ophthalmic

25. During surgical removal of an impacted "wisdom" tooth, the right lingual nerve is severed inadvertently as it passes just below thethird mandibular molar. This patient would show ipsilateral loss of all of the following except

a. general sensation from anterior two-thirds of tongue b. taste sensation from anterior two-thirds of tongue c. secretions from submandibular and sublingual glands d. general sensation from floor of the mouth e. general sensation from the lower lip

26. When you ask your patient to open wide and say "Ah," you noticethat his soft palate deviates to the right side. You immediatelysuspect damage to which of the following nerves?

a. right trigeminal (V) b. right glossopharyngeal (IX) c. left glossopharyngeal (IX) d. left vagus (X) e. right vagus (X)

27. During reconstructive surgery to protrude or slide forward the lower jaw of a micrognathic patient, you must take care not to severthe inferior alveolar nerve. Recalling the anatomy of the infratemporal fossa, you would transect (saw through) the mandible

a. below the lingula b. above the lingula c. below the mandibular foramen d. through the middle of the mylohyoid ridge e. just posterior to the mental foramen

28. Swelling of the optic disc or papilledema occurs when venous return from the retina is slowed due to increased pressure of the

a. aqueous humor in the anterior chamber b. aqueous humor in the posterior chamber c. vitreous humor behind the lens d. cerebrospinal fluid around the optic nerve e. blood in the ophthalmic artery

29. During general anesthesia, the risk of airway obstruction is overcome by inserting a tube into the patient's larynx. This is done because total relaxation of which of the following muscles could lead to suffocation?

a. genioglossus b. hyoglossus c. styloglossusd. palatoglossus e. aryepiglotticus

30. Herpes zoster is a viral infection causing blisters and rash in regions supplied by the sensory branches of a peripheral nerve. Youobserve such eruptions on the oropharynx and in the middle ear cavity and suspect involvement of which cranial nerve? a. trigeminal (V) b. facial (VII) c. vestibulocochlear (VIII) d. glossopharyngeal (IX) e. vagus (X)

31. During baseball practice, a batter was hit on the side of the head by a wild pitch. Because he was not wearing protective gear, he wasstunned initially but recovered quickly. Several hours later, he lost consciousness and was brought to the emergency room. You suspect thathis intracranial pressure is elevated because of epidural hemorrhaging from the

a. middle meningeal artery b. middle cerebral artery c. basilar artery d. deep temporal artery e. superficial temporal artery

32. Severe bleeding can occur after tonsillectomy because the palatine tonsils are supplied by branches of all of the following arteriesexcept

a. descending palatine b. ascending pharyngeal c. lingual d. facial e. sphenopalatine

33. Preganglionic parasympathetic fibers exit the brainstem in each of the following cranial nerves except

a. oculomotor (III) b. trigeminal (V) c. facial (VII) d. glossopharyngeal (IX) e. vagus (X)

34. A metastatic tumor arising in a scalene (deep cervical) lymph node destroys the cervical sympathetic chain in the root of the neck. Whichof the following symptoms will you observe in this patient?

a. drooping of the eyelid b. dilation of the pupil c. loss of lacrimal secretion d. loss of accommodation e. all of the above

35. Because the oropharynx drains directly into them, which of the following lymph nodes would most likely be enlarged due to spread ofinfection from the palatine tonsils?

a. submandibular b. retropharyngeal c. jugulo-digastric d. jugulo-omohyoid

e. subclavian

Match each cranial nerve (listed on the left) with the deficit seen when it is damaged (listed on the right).

36. Oculomotor (III) ____ a. absence of gag reflex 37. Trochlear (IV) ____ b. inability to look up and out 38. Abducens (VI) ____ c. inability to look down and out 39. Facial (VII) ____ d. absence of blink reflex 40. Glossopharyngeal(IX) ____ e. diplopia (double vision) on lateral gaze

Match the area of mucous membrane (listed on the left) with its appropriate sensory nerve (listed on the right). You may use any nervemore than once.

41. Pyriform recess ____ a. glossopharyngeal (IX) 42. Pharyngeal recess ____ b. recurrent laryngeal (X) 43. infraglottic cavity ____ c. internal laryngeal (X) 44. oropharynx ____ d. pharyngeal branch of V2 45. valleculae (taste) ____ e. pharyngeal branch of X

MIDTERM - SEPTEMBER 23, 1992

A. FILL-IN BLANKS (be as precise as possible)

1. In general, flexor muscles in the limbs are supplied by_______________(ventral/dorsal) nerve divisions whereas extensor muscles are supplied by _______________(ventral/dorsal) nerve divisions.

2. The dorsal interosseous muscles of the hand are innervated by the __________________ nerve and the dorsal interosseous muscles of the foot are supplied by the _____________________ nerve.

3. Is it the anterior (ventral) or the posterior (dorsal) primary rami of spinal nerves that supply the muscles of the limbs? ______________

4. The tendon of the ________________ muscle forms the medial border of the "anatomical snuff box."

5. Eversion of the foot is produced mainly by the contraction of the_______________ and the _______________ muscles.

6. The ______________ artery courses through the adductor canal, passes through the hiatus in the _______________ muscle and becomes the _________________ artery.

7. In the superior mediastinum, the most posterior structure (tube) is the ______________.

8. Cardiac veins drain into the ____________ which empties into the ______________ atrium.

9. In the superior mediastinum, the recurrent laryngeal branch of the _______________ (right/left) vagus nerve "recurs" around the ___________________ just behind the ___________________.

10. The cusps of the atrioventricular valves are attached to papillary muscles by the _______________.

11. The _____________ vein arches over the root of the right lung and drains into the _____________________.

13. The actions at the shoulder joint which are produced by the pectoralis major, latissimus dorsi and teres major are ______________ and __________________.

14. The brachioradialis is innervated by the _________________ nerve and acts as a __________________(flexor/extensor) at the elbow joint.

15. The principal action of the obturator internus muscle at the hip joint is ____________________.

16. In the forearm, the common interosseous artery is a branch of the _______________ artery and the anterior interosseous nerve is a branch of the _______________ nerve.

17. Which of the following muscles produces lateral rotation of the armat the shoulder joint?

a. supraspinatus b. infraspinatus c. teres major d. pectoralis major e. subscapularis

20. A ruptured tendo calcaneus ("Achilles tendon") would result in severe impairment or loss of which of the following movements?

a. plantarflexion b. dorsiflexion c. inversion d. eversion e. rotation

21. Which of the following muscles is not an abductor?

a. gluteus maximus b. gluteus medius c. deltoid d. supraspinatus e. dorsal interosseous

22. All of the following structures pass through the respective space or foramen except

a. axillary nerve - quadrangular space b. circumflex scapular artery - triangular space c. suprascapular artery - suprascapular foramen d. posterior humeral circumflex artery - quadrangular space e. suprascapular nerve - suprascapular foramen

23. A young woman is brought to the emergency room after being struck by an automobile while jogging. As she crossed a busy intersection, the front bumper of the automobile collided with her left leg and she was thrown to the ground. You observe a large traumatic bruise on the lateral side of her left leg just below the knee. Remembering your gross anatomy, you warn her that she may experience all of the following symptoms except

a. footdrop or the inability to dorsiflex her foot b. inability to evert her foot c. inability to flex her toes d. loss of sensation on the dorsum (top) of her foot e. a possible fracture of the fibula

25. A young man is brought to the emergency room after falling from a tree. As he began to fall, he grabbed for a branch with his left arm. This caused avulsion (pulled out of the spinal cord) of the spinal roots which form the lower trunk of the brachial plexus. Remembering your gross anatomy, you inform the young man that he will have difficulty in

a. shrugging his shoulder b. rotating his arm laterally c. flexing arm at his elbow d. abducting his thumb e. adducting and abducting his fingers26. Contraction of the flexor digitorum profundus muscle produces flexion at the

a. distal interphalangeal joints b. middle interphalangeal joints c. metacarpophalangeal joints d. radiocarpal (wrist) joint e. all of the above

27. Which of the following muscles is innervated by the lateral plantar nerve?

a. abductor hallucis b. abductor digiti minimi c. flexor hallucis brevis d. flexor digitorum brevis e. first lumbrical

28. Which of the following muscles are used during forced respiration?

a. pectoralis major b. serratus anterior c. serratus posterior d. all of the above e. none of the above

29. Which of the following muscles is not innervated by the obturatornerve?

a. pectineus b. adductor brevis c. adductor longus d. adductor magnus e. gracilis

31. A 25 year old man suffered a deep laceration of his left medialforearm approximately 2 to 2 1/2 inches proximal to the wrist. Therewas some damage to the flexor carpi ulnaris muscle tendon. The patientcannot abduct or adduct his fingers.

a. the loss of muscle function in the hand is most likely due to damage to the ______________ nerve. b. he can not adduct fingers 2,4,5 because the ____________________ muscles are paralyzed. c. he can not abduct fingers 2,3,4,5 because the ___________________ and __________________ muscles are paralyzed. d. he can not _______________(abduct/adduct) his thumb. e. he has loss of sensation to the skin over the ______________ (thenar/hypothenar) eminence.

E. MATCHING COLUMN

34. Match the structure listed in the right column with the mostappropriate structure in the left column (i.e. muscle - action or nerve supply, artery - branch, bone - process or joint surface)

adductor magnus _________ A. external obliqueabductor pollicis longus _________ B. internal obliqueabductor hallucis _________ C. obturator nervebiceps brachii _________ D. radial nerveplantar arch _________ E. medial plantar nervesuperficial palmar arch _________ F. lateral plantar arterycephalic vein _________ G. ulnar arterycoronary sinus _________ H. right atriummitral valve _________ I. left ventricleintercostal vein _________ J. azygos veininguinal ligament _________ K. axillary veincremaster muscle _________ L. supination

35. Match the anatomical structure listed in the left column with theappropriate clinical symptom or problem listed in the right column.

median nerve _________ A. wrist-dropradial nerve _________ B. foot-dropcommon peroneal nerve _________ C. heart murmursuperior gluteal nerve _________ D. angina pectorisfemoral ring _________ E. shoulder separationmitral valve _________ F. shoulder dislocationcoronary artery _________ G. femoral herniaacromioclavicular joint _________ H. carpal tunnel syndromeglenohumeral joint _________ I. gluteal gait or gluteus medius limp