HBA 531 - THE BODY Head & Neck Written Examination ... & Neck Written Examination - November 7, ... of how this finding could explain his ... of the different kinds of teeth in the

HBA 531 - THE BODYHead & Neck Written Examination - November 7, 2011

Name: _______________________________________

1. A patient is brought into the emergency room unconscious. The EMT tells you that she was a front seat passenger inan automobile that was hit from the side, causing her temple to bang into the side window. What kind of intracranialhematoma is the patient at greatest risk to suffer? (2)

What is the cause of the bleeding and between what layers does the blood accumulate?

Is the patient’s sense of smell likely to be affected after the hematoma is drained and she is well enough to go home? Give a reason for your answer.

2. Describe the functions of the following kinds of axons within the recurrent laryngeal nerve:(6)

(a) somatic motor

(b) visceral motor

(c) sensory

Describe the relationships of the recurrent laryngeal nerve to the esophagus, trachea, thyroid gland, and cricothyroidjoint.

If the right recurrent laryngeal nerve is injured during parathyroid surgery, what will be the position of the right vocalfold and, irrespective of position, how will its appearance differ from that of the left vocal fold?

Describe the effect this will have the patient’s speech and coughing.

What nearby nerve carrying somatic motor fibers could be transected so that it could be anastomosed to the distalstump of the damaged recurrent laryngeal nerve, but at the same time cause insignificant loss of other function?

How does position and appearance of the vocal fold of a patient with recurrent laryngeal injury differ from that of apatient with damage to the right vagus nerve immediately inferior to the jugular foramen?

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HBA 531 - The Body - Head & Neck Written Exam 2011 Name: _______________________________________

3. You encounter an older patient with a history of smoking and arteriosclerosis. He says he has recently beenexperiencing bouts of dizziness and problems with coordination. You take his blood pressure in both arms and findthat it is 50 mm Hg higher in his left arm than his right arm, suggesting that his right subclavian artery is narrowedsomewhere along its course. Give a complete anatomical explanation of how this finding could explain hisneurological symptoms. (1)

4. The thoracic duct enters the neck on the left surface of the ___________________________. It then passes posterior

to the ____________________________________________________ to reach its termination at the

_____________________________________________. (1.5)

5. What is the surgical procedure for treatment of excessive facial blushing, and what is the rationale for choosing theprecise location of this procedure? (1)

6. Some people believe frontal migraine headaches are caused by compression and irritation of the two sensory nerves to

the forehead: _________________________ and ____________________________. These are direct branches of

the ___________________________ nerve, which in turn is a branch of ________________________________. In

order to relieve the compression, the _______________________________ may excised. (2)

7. Chronic intubation of a child is prone to lead to constriction of the airway after the tube is removed. At what site isthis likely to occur, and why here and not elsewhere? (1)

8. A patient comes into Richard Efem’s office complaining of being blind in herright eye. Richard sits directly facing her and covers her left eye, yet she still seessomething, proving her self diagnosis was wrong. What she sees when her lefteye is covered is shown in picture A. What she sees when her right eye is coveredis shown in picture B. What name do you give this condition, and damage to whatstructure will cause it? (1)

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9. If you want to assess the strength of the left muscles of mastication compared to the strength of the right muscles ofmastication, what test could you perform? Tell what observation would lead you to conclude that the left sidedmusculature was weaker than the right-sided musculature. (2)

10. You notice that a patient looks at you with his head positioned as shown in the drawing on theright. Injury to what nerve on what side is compatible with this position? (2)

If the patient had previously squeezed a pimple along side his nose, now has a fever, and hasswollen eyelids and dilated retinal veins on the same side as you just identified, where is theinfection likely to be located and how did it get there?

What other nerves may soon be involved if treatment does not quickly ensue?

11. A patient has fusion of the footplate of the stapes to the rim of the oval window. Describe how you would perform aRinne test on her, and state what she will report. (1.5)

If you perform surgery to replace the stapes with a prosthesis, what structure embedded in the temporal bone superiorto the oval window must be protected?

12. State the names and the numbers of the different kinds of teeth in the left half of the mandible of a typical adulthuman, then underline the teeth that have deciduous precursors. (2)

Would your answer be the same if the question had specified the left maxilla? If you answer “no”, describe thedifference.

13. Name the visual condition that arises when the optic chiasm is compressed: ________________________________

Tumor of what nearby structure is likely to do this? ________________________________

Explain why it is a misnomer to call this tunnel vision. (1.5)

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14. Name one muscle, and state its nerve supply, that has the listed function. If the muscle is supplied by a cranial nerve,name that nerve, not a branch. (2.5)

Muscle Nerve Supply

(a) promotes drainage of fluid from the middle ear

(b) goes into spasm to protect the anteriorlongitudinal ligament after whiplashinjury (hyperextension) of the neck

(c) moves the posterior wall of the nasopharynxforward during swallowing

(d) insures that during swallowing the

tongue swells upward, not downward,to contact the palate

(e) pulls the larynx inferiorly when makinglow sounds

15. Name one structure that satisfies each of the following statements. (5)

(a) opens into the nasopharynx posterior to inferior nasal meatus ________________________________

(b) the spinal nerve that is tested when you assess sensation from the earlobe ______________________________

(c) when prematurely fused, leads to scaphocephaly _____________________________

(d) passes transversely 1 finger’s breadth below the zygomatic arch ________________________________

(e) occupies most of the digastric triangle ________________________________

(f) is the nerve deep to platysma, at the superior border of the digastric triangle __________________________

(g) is the laryngeal structure penetrated in emergency access to the subglottic airway _____________________________

(h) opens into the oral cavity just lateral to the lingual frenulum ________________________________

(i) lies immediately anterior to the 2nd- 4th tracheal rings (be specific) ____________________________

(j) is the nerve in greatest danger if you place forceps behind the ear of baby being born _________________________

16. Skull base tumors can compress the nerves exiting via the jugular foramen. Describe two tests of motor function, each ofwhich would demonstrate damage to a different nerve exiting this foramen. In each case, state the muscle being tested,the nerve that innervates it, and the results of the test if the nerve is injured. (2)(a)

(b)

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17. Dr. Dagum performs surgery to remove a tumor from the left parotid gland. The tumor is so extensive that he mustremove the entire gland. What nerve must be sacrificed during this surgery? (2)

In order to improve the patient’s postoperative function, Dr. Dagum cuts the ipsilateral hypoglossal nerve and sutures itsproximal segment to the distal segment of the sacrificed nerve. Circle the picture that illustrates how the patient’s tongueappears when he is asked to stick out his tongue.

Describe the effect of cutting one hypoglossal nerve on (a) speaking, (b) swallowing, and (c) chewing.

18. The three pictures below show the eyes of a man looking at you. On the left, nothing has been done to him, In the middle,a light is being shone in his left eye. Then the light is swung to his right eye, the result of which is shown on the right. (2)

What, if anything, is wrong with this person?

Explain why you draw this conclusion.

19. The pictures to the right represent how a patient’s eyes appear when she is asked to lookup & to the right (A), up & to the left (B), down & to the right (C), and down & to the left(D). These provide evidence of weakness of what muscle ? (2)

With the patient looking straight ahead, and without asking her to alter the direction of her gaze, what could you ask her todo that will illustrate weakness of this muscle? State what you would see and why you would see it.

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20. Based on the appearance of the patient illustrated at the right, name all themuscles that are paralyzed. (Be sure to specify side.) (2)

What nerve(s) must be damaged to produce these paralyses?

21. Jane normally looks like photo A. One morning she woke up looking likephoto B. What nerve has been damaged? (4)

Identify three features of her appearance that lead to this diagnosis. In eachcase identify any paralyzed muscle or area of skin having lost sensation.

a)

b)

c)

22 The patient depicted below had surgery to remove a tumor. This surgery required sacrifice of a nerve.What nerve? ______________________________________ (2)What accounts for her appearance in photograph A?

What accounts for her appearance in photograph B?

What accounts for her appearance in photograph C?

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23. Name the muscles that need to be used when looking at an object brought close to the bridge of your nose. (2)

_______________________________, ________________________________, ____________________________

What is the fundamental anatomic problem in a far-sighted (hyperopic) person?

24. Where is aqueous humor produced (be specific)? (1.5)

Where does it go from here?

25. To the right is a scout film indicating the level of the CT shown below.Label the CT as indicated. (3)

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26. Below are two sections from a T1-weighted coronal MRI of the head. The image on the right is 1.2 cm posterior to theone on the left. Label as indicated. (5)

A ___________________________________________ B ____________________________________________

C ___________________________________________ D ____________________________________________

E ___________________________________________ F (be specific) __________________________________

G ___________________________________________ H ____________________________________________

I ___________________________________________ J ____________________________________________

K ___________________________________________ L ____________________________________________

M ___________________________________________ N ____________________________________________

O ___________________________________________ P ____________________________________________

Q___________________________________________ R ____________________________________________

S ___________________________________________ T ____________________________________________

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HBA 531 - THE BODY Head & Neck Written Examination ... & Neck Written Examination - November 7, ... of how this finding could explain his ... of the different kinds of teeth in the

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