NOSE
A 30-year-old male presents with chronic nasal congestion. A CT scan of his nasal cavity reveals hypertrophy of the middle and inferior nasal conchae. Which of the following correctly differentiates the inferior nasal conchae from the superior and middle nasal conchae?
A) The inferior nasal conchae are part of the ethmoid bone, while the superior and middle nasal conchae are separate bones.
B) The superior and middle nasal conchae are separate bones, while the inferior nasal conchae are part of the ethmoid bone.
C) The superior and middle nasal conchae arise from the ethmoid bone, while the inferior nasal conchae is its own separate bone.
D) The inferior nasal conchae arise from the ethmoid bone and articulate with the vomer.
E) The superior and middle nasal conchae are part of the maxilla, while the inferior nasal conchae are part of the sphenoid bone.
C) The superior and middle nasal conchae arise from the ethmoid bone, while the inferior nasal conchae is its own separate bone.
What is the name of the space found between the true vocal folds
A. Laryngeal inlet
B. Rima glottidis
C. Vallecula
D. Vestibule
E. Ventricle
B. Rima glottidis
During dissection you accidentally cut the vagus nerve in the patient's neck superior to the internal laryngeal nerve. Which of the soft palate would NOT be affected?
A. Levator veli palatini
B. Palatoglossus
C. Palatopharyngeus
D. Tensor veli palatini
D. Tensor veli palatini
A 27-year-old woman is admitted to the emergency department after she was thrown from a motor scooter. Radiographic evaluation reveals a type I LeFort fracture and comminuted fracture of the mandible and TMJ. Despite reconstructive surgery, the patient devel-
ops hyperacusis (sensitivity to loud sounds) due to facial nerve paralysis. Which of the following muscles is most likely paralyzed?
A. Posterior belly of digastric
B. Stapedius
C. Tensor tympani
D. Stylohyoid
E. Cricothyroid
B. Stapedius
A 45-year-old male presents the emergency department with odd statements for the past 2 hours. He says that he can “taste sounds”. History reveals that he has had multiple drug therapies to abstain from lysergic acid diethylamide (LSD). Mental status exam shows flight of ideas, hallucinations, and depersonalization. The attending physician decides to, jokingly, pimp the OMS-3 on how it could be possible to taste sound (this is not real). The medical student responds with correct anatomical knowledge of how this could be (it cannot be). Which of the following would have been the OMS-3’s statement on how one could taste sound?
a)Glossopharyngeal forms a tympanic plexus in the ear
b)Chordia tympani passes through the middle ear
c)V3 innervates the tensor tympani
d)Vagus provides sensation to the epiglottis and a portion of the ear
b)Chordia tympani passes through the middle ear
A 45-year-old man presents with facial pain and congestion localized around his cheeks. He reports worsening symptoms when bending forward. A CT scan confirms fluid accumulation in the maxillary sinus. Through which of the following pathways does the maxillary sinus normally drain?
A) Inferior meatus
B) Middle meatus via the semilunar hiatus
C) Superior meatus
D) Sphenoethmoidal recess
E) Nasopharynx via the Eustachian tube
B) Middle meatus via the semilunar hiatus
A 19 Y/O MALE FOUNDRY WORKER PRESENTS TO THE EMERGENCY DEPARTMENT WITH SWELLING AND SHARP PAIN IN HIS NECK AFTER A WORKPLACE ACCIDENT IN WHICH A METAL SPLINTER ENTERED HIS NECK. AN EMERGENCY ANGIOGRAPHY AND SURGICAL EXPLORATION ARE PERFORMED, AND A SEVERE HEMORRHAGE IS FOUND AND REPAIRED IN THE FIRST BRANCH OF THE EXTERNAL CAROTID ARTERY. THIS AFFECTED VESSEL IS ALSO KNOWN AS THE
A FACIAL ARTERY
B. LINGUAL ARTERY
C. MAXILLARY ARTERY
D. SUPERIOR THYROID ARTERY
E. THYROCERVICAL TRUNK
D. SUPERIOR THYROID ARTERY
You’re having a bad week and during a different dissection you cut the patients hypoglossal nerve. What extrinsic tongue muscle would still be able to function?
A. Genioglossus
B. Palatoglossus
C. Styloglossus
D. Hypoglossus
B. Palatoglossus
A 17-year-old girl is admitted to the hospital with tonsillitis. A tonsillectomy is performed and the patient complains postoperatively of ear pain. Which of the following nerves was most likely injured during the surgical procedure?
A. Auriculotemporal
B. Lesser petrosal
C. Vagus
D. Glossopharyngeal
E. Chorda tympani
D. Glossopharyngeal
A 30-year-old woman presents with progressive nasal congestion and pain around the inner corners of her eyes. CT imaging reveals ethmoid sinusitis affecting the anterior and middle air cells. Into which nasal meatus do these cells drain?
a)Superior nasal meatus
b)Inferior nasal meatus
c)Middle nasal meatus
d)Sphenoethmoidal recess
e)Frontal nasal duct
c)Middle nasal meatus
A 30-year-old man presents to the clinic with nasal congestion and difficulty breathing through his nose. A CT scan of the sinuses reveals hypertrophy of the inferior nasal concha, causing partial nasal obstruction. The physician explains that one of the nasal conchae is a separate bone, while the others are parts of larger bones.
Which of the following nasal conchae is a distinct, independent bone?
A) Superior nasal concha
B) Middle nasal concha
C) Inferior nasal concha
D) Ethmoidal concha
E) Sphenoidal concha
C) Inferior nasal concha
A patient receives a thyroidectomy and comes to his post operative appointment 1 week later. As you talk to them, you notice their voice is very hoarse and they can barely get words out of their mouth. You are worried you may have damaged a neurovascular structure that runs posterior to the thyroid. What structure is this?
A. Internal laryngeal nerve
B. Recurrent laryngeal nerve
C. External laryngeal nerve
D. Phrenic nerve
E. Vagus nerve
B. Recurrent laryngeal nerve
The genioglossus muscle, one of the extrinsic muscles of the tongue, is primarily responsible for which tongue movement?
A. Retrusion
B. Lateral excursion
C. Elevation
D. Fold
E. Protrusion
E. Protrusion
A 56-year-old man is diagnosed with an extradural tumor in the posterior cranial fossa. When the patient protruded his tongue during physical examination, the tongue deviated to the right. Which of the following muscles and nerves are most likely injured?
A. Right hypoglossal nerve and right genioglossus
B. Left hypoglossal nerve and left genioglossus
C. Right hyoglossus and left styloglossus
D. Right geniohyoid and first cervical nerve
E. Contralateral vagus and hypoglossal nerves
A. Right hypoglossal nerve and right genioglossus
A 52-year-old male presents to the clinic with complaints of progressive hoarseness and vocal fatigue over the past few weeks. He denies recent upper respiratory infections, cough, or difficulty swallowing. His medical history is significant for long-standing hypertension and a recent diagnosis of stage III lung cancer. On laryngoscopic examination, the patient is found to have a paralyzed right laryngeal muscle with an inability to adduct the right vocal cord. The affected vocal cord remains in a paramedian position at rest. Which of the following muscles is most likely paralyzed in this patient?
a)Cricothyroid
b)Posterior cricoarytenoid
c)Aryepiglottic
d)Vocalis
e)Thyroarytenoid
e)Thyroarytenoid
A 6-year-old boy is brought to the emergency department by his parents due to persistent nasal bleeding. The boy picks his nose frequently and has had several nosebleeds in the past, all of which stopped spontaneously after pinching the nose. The parents say that they have been pinching the nasal alae for over 30 minutes while the boy leans forward. Family history is negative for bleeding disorders. The patient takes no medications and has no allergies. Examination shows continuous blood trickle from his right nostril. Cautery is performed and the bleeding stops. Cautery was most likely applied to which of the following locations in this patient's nasal cavity?
a)Inferior turbinate
b)Middle meatus
c)Nasal septum
d)Posterior choanae
e)Posterolateral wall
c)Nasal septum
A patient comes in with difficulty speaking. He says that he has had symptoms for well over a month. As he talks, you notice his voice is incredibly monotone, and that he did not used to have this problem. His volume and speech quality seems okay. What muscle could be damaged?
A. Cricothyroid
B. Posterior cricoarytenoid
C. Vocallis
D. Transverse arytenoid
E. Lateral cricoarytenoid
A. Cricothyroid
The stylopharyngeus muscle receives motor innervation from which cranial nerve?
A) CN IX
B) CN XII
C) CN X
D) CN XI
E) CN VII
A) CN IX
A 56-year-old woman has just undergone a complete thyroidectomy. After she recovers from the anesthesia a hoarseness of her voice is noted that persists for 3 weeks. Subsequent examination shows a permanently adducted vocal fold on the right side. Surgical trauma to the innervation of which of the following muscles is most likely to be responsible for the position of the right vocal fold?
A. Aryepiglottic
B. Posterior cricoarytenoid
C. Thyroarytenoid
D. Transverse arytenoids
E. Vocalis
B. Posterior cricoarytenoid
A 40-year-old woman presents with excessive tearing (epiphora) and recurrent infections around the medial canthus of her eye. On examination, there is erythema and swelling over the nasolacrimal sac. Which nasal passage is the endpoint of the nasolacrimal duct?
a)Middle nasal meatus
b)Inferior nasal meatus
c)Superior nasal meatus
d)Sphenoethmoidal recess
e)Frontal nasal duct
b)Inferior nasal meatus
A 40-year-old man presents to the clinic with facial pain and pressure over his forehead, worsened by bending forward. He also has nasal congestion and postnasal drip. The physician suspects frontal sinusitis and explains that the pain is mediated by a specific cranial nerve branch.
Which of the following nerves provides sensory innervation to the affected sinus?
A) Ophthalmic nerve (V1) – Supraorbital branch
B) Maxillary nerve (V2) – Infraorbital branch
C) Mandibular nerve (V3) – Auriculotemporal branch
D) Facial nerve (CN VII) – Greater petrosal branch
E) Glossopharyngeal nerve (CN IX) – Tympanic branch
A) Ophthalmic nerve (V1) – Supraorbital branch
A 45-year-old male presents to his ENT surgeon with difficulty in swallowing and hoarseness of voice after surgery. History shows that he experienced a carotid artery dissection which warranted emergency surgery. He has no history of recent infections. Vitals show HR 110, BP 145/87, R 18, T 99.3, BMI 33. On examination, there is weakness and hypotonicity of various muscles near the hyoid bone. Diagnostic exploratory surgery reveals the superior and inferior roots of the ansa cervicalis have been severed but they hypoglossal nerve is completely intact. Which of the following muscles will demonstrate normal function on electromyography (EMG)?
A. Sternohyoid
B. Sternothyroid
C. Thyrohyoid
D. Omohyoid
C. Thyrohyoid
A 3-month-old boy is brought to the office for follow-up due to a unilateral cleft lip and palate. The patient has been doing well feeding with specialized bottle nipples and is gaining weight. As part of his care, the parents are told that he will need to be monitored for ear infections and hearing loss. This is because the patient most likely has dysfunction of which of the following muscles?
a)Lateral pterygoid
b)Levator veli palatini
c)Orbicularis oris
d)Stapedius
e)Superior pharyngeal constrictor
b)Levator veli palatini
A 32-year-old woman is undergoing a thyroidectomy. Postoperatively the patient suffers from loss of sensation within the larynx from the vocal folds upward to the entrance into the larynx, allowing for aspiration of liquids into the airway. Which of the following nerves is most likely injured?
A. Internal laryngeal nerve
B. External laryngeal nerve
C. Glossopharyngeal nerve
D. Hypoglossal nerve
E. Recurrent laryngeal nerve
A. Internal laryngeal nerve
A 50 Y/O MAN COMES TO THE OFFICE DUE TO A LUMP IN HIS NECK THAT HAS BEEN PRESENT FOR 4 MONTHS AND IS ENLARGING. ON EXAMINATION, THERE IS A FIRM, NONTENDER, NONMOBILE MASS IN THE RIGHT ANTERIOR NECK. OTOSCOPIC EXAMINATION SHOWS A CLEAR RIGHT MIDDLE EAR EFFUSION. NEEDLE BIOPSY OF THE NECK MASS IS CONSISTENT WITH REGIONAL NODAL SPREAD OF SQUAMOUS CELL CARCINOMA. WHICH OF THE FOLLOWING IS THE MOST LIKELY SIGHT OF THE TUMOR.
A. BASE OF TONGUE
B. NASOPHARYNX
C. PAROTID GLAND
D. PIRIFORM SINUS
E. THYROID GLAND
F. VOCAL CORD
B. NASOPHARYNX