HEAD AND NECK - SELF EVALUATION EXAM I

by O.W. Henson, Jr., Ph.D.

University of North Carolina, Chapel Hill

Note that many of these questions may cover material that we have not discussed. Concentrate only on questions on material we have covered.

Each question in this examination consists of a stem accompanied by several statements. Each statement is treated as a separate question. Mark the statement True (T) or False (F) Correct answers are given on the last page.

Of the cervical vertebrae:

_____ 1. one has no body.

_____ 2. each has a transverse process with a foramen which transmits the vertebral artery.
_____ 3. each articulates with the vertebra above and below it
through synovial joints and through an intervertebral disk.
_____ 4. the fifth, sixth and seventh have spinous processes
which are usually palpable in a living subject.

The superficial layer of the cervical fascia:

_____ 5. is attached to the clavicle.
_____ 6. splits to go both superficial and deep to the sternocleidomastoid muscle.
_____ 7. is attached to the spine of the scapula.
_____ 8. contributes to the formation of the cartoid sheath.

The prevertebral layer of the cervical fascia:

_____ 9. encloses the deep muscles of the back of the neck and

the scalene muscles.
_____ 10. splits to enclose the trapezius muscle.
_____ 11. covers the muscular floor of the posterior triangle.
_____ 12. extends into the thoracic cavity so that an abscess
between this fascia and the visceral fascia could
extend into the mediastinum.

The external jugular vein:

_____ 13. lies just deep to the platysma muscle.
_____ 14. penetrates the superficial layer of the (deep) cervical fascia.
_____ 15. is often visible through the skin of a living person.
_____ 16. courses with the lesser occipital nerve.
_____ 17. is formed by the union of the posterior auricular and facial veins.
_____ 18. courses across the sternocleidomastoid muscle.

With regard to the triangles of the neck:

_____ 19. the sternocleidomastoid muscle forms a boundary of the
muscular, carotid, occipital, omoclavicular, anterior
and posterior triangles.

_____ 20. the midline of the neck forms a boundary of the
anterior and the submandibular triangles.
_____ 21. the accessory nerve lies on the surface of the levator
scapulae in the posterior triangle.
_____ 22. the omohyoid muscle subdivides the posterior triangle
into two smaller triangles.

The ansa cervicalis:

_____ 23. has a superior branch (root) which is joined with the hypoglossal nerve.
_____ 24. lies in part in the carotid sheath.
_____ 25. supplies efferent fibers to the infrahyoid muscles.
_____ 26. innervates both bellies of the digastric muscle.

The carotid sheath contains:

_____ 27. the vagus nerve.
_____ 28. the sympathetic trunk.
_____ 29. the jugular vein.
_____ 30. lymph nodes.

The submandibular gland:

_____ 31. lies in part of the external surface of the mylohyoid muscle.
_____ 32. sends its duct through the mylohyoid muscle.
_____ 33. is in close relationship to the facial artery.
_____ 34. is covered superficially by the platysma muscle.

Damage to the facial nerve or its branches would result in the impairment or loss of function of the:

_____ 35. lacrimal gland if the lesion were in the pterygoid canal.
_____ 36. muscles that close the eye lids if the lesion were in the pterygoid canal.
_____ 37. buccinator muscle if the lesion were at the stylomastoid foramen.
_____ 38. muscles that both open and tightly close the lips if
the lesion were at the stylomastoid foramen.

The parotid gland:

_____ 39. has a duct which lies on the superficial surface of the masseter muscle.

_____ 40. has a duct which pierces the buccinator muscle at the level of the second upper molar tooth.

_____ 41. if diseased, might cause paralysis of the muscles of facial expression since the facial nerve passes through the substance of the gland.

_____ 42. has a duct which can usually be palpated, and is associated with a papilla on the inside of the cheek.

The tentorium cerebelli:

_____ 43. contains the occipital sinus.
_____ 44. lies between the parietal cortex of the brain and
cerebellum.
_____ 45. has a free edge which arches over the mesencephalon.
_____ 46. has a dural venous sinus in its free border (edge).
_____ 47. contains the straight sinus, beginning at its junction
with the falx cerebri.

with regard to the blood vessels supplying the brain:

_____ 48. the anterior cerebral arteries arch over the corpus
callosum and supply much of the cerebral cortex
between the two cerebral hemispheres.
_____ 49. the middle cerebral arteries are distributed largely
to the lateral portions of the cerebral hemispheres.
_____ 50. the posterior cerebral arteries are the smallest
branches arising from the internal carotid and are
distributed largely to the occipital portion of the
brain.

The superior sagittal sinus:

_____ 51. lies in close relationship to the anterior and
posterior fontanelles in the skull of the infant.
_____ 52. is associated with arachnoid granulations and villi
which are important in the production of cerebrospinal
fluid.
_____ 53. receives blood from many superficial cerebral veins.
_____ 54. communicates with venous lacunae and emissary, diploic
and meningeal veins.
_____ 55. receives the great cerebral vein prior to emptying
into the occipital sinus.

With regard to the foramina of the skull:

_____ 56. the foramen magnum transmits the spinal cord, both
vertebral arteries and some fibers of the accessory nerves (XI).
_____ 57. the jugular foramen transmits all of the motor fibers
of the trigeminal nerve.
_____ 58. the foramen ovale transmits all of the motor fibers of the trigeminal nerve.
_____ 59. the foramen lacerum is in close relationship to the internal carotid artery.
_____ 60. the foramen spinosum is adjacent to the spine of the
sphenoid bone and transmits the middle meningeal artery.

_____ 61. the foramen rotundum transmits nerve fibers whose cell bodies lie within the trigeminal ganglion.

_____ 62. the condylar foramen lies adjacent to the condylar process of the mandible.

With regard to the scalp:

_____ 63. all of the striated muscles associated with it are
innervated by the facial nerve.
_____ 64. all of the sensory nerve fibers entering it have their
cell bodies in the trigeminal ganglion.
_____ 65. its mobility is permitted by the “scalping plane”
which lies deep to the epicranial aponeurosis.
_____ 66. its arterial supply is extensive and includes branches
of both the internal and external carotid arteries.

The cavernous sinus:

_____ 67. may receive venous blood from the orbit and face.
_____ 68. has the internal carotid artery within it.
_____ 69. contains, within it or its walls, the ophthalmic and
maxillary divisions of the trigeminal nerve, the
oculomotor, trochlear and abducens nerves and
sympathetic nerve fibers on the internal carotid
artery.

Of the palpable landmarks in the neck:

_____ 70. the lower edge of the cricoid cartilage marks the
beginning of the trachea.
_____ 71. the thyroid cartilage represents the second branchial arch.
_____ 72. the interval between the hyoid bone and upper surface
of the thyroid cartilage marks the level of the vocal cords.

A lesion at the foramen rotundum would be expected to block sensations to:

_____ 73. the upper teeth.
_____ 74. the mucosa of the hard palate.
_____ 75. the nasal cavity.
_____ 76. the lower incisor teeth.

A lesion of all structures entering the right internal acoustic meatus would be expected to result in:

_____ 77. complete paralysis of all of the ipsilateral muscles
of facial expression.
_____ 78. inability to blink or close the right eyelid.
_____ 79. excessive sensitivity to sound in the right ear due to
paralysis of tensor tympani muscle.
_____ 80. loss of taste to posterior one-third of tongue.

_____ 81. complete deafness in right ear.
_____ 82. imbalance and vertigo.
_____ 83. paralysis of right platysma muscle.
_____ 84. decreased secretion of lacrimal gland.

Nerves in immediate relationship to the mucous membrane of the middle ear cavity include:

_____ 85. the chorda tympani, a branch of the facial nerve
containing preganglionic parasympathetic fibers
influencing the secretion of saliva.
_____ 86. the chorda tympani, mediating taste to the anterior
two-thirds of the tongue.
_____ 87. the typanic plexus from the vagus nerve which
contributes preganglionic parasympathetic fibers to
the lesser petrosal nerve.
_____ 88. the tympanic branch of the glossopharyngeal nerve that
contributes parasympathetic fibers to the external ear
and accounts for the cough reflex when instruments are
inserted into the external acoustic meatus.
_____ 89. the greater petrosal nerve which contains
preganglionic visceral motor fibers for lacrimation.
_____ 90. the vestibulocochlear (VIII) nerve.

The eighth cranial nerve:

_____ 91. leaves the brain near the junction of the pons and
medulla and in close relation to the facial and
glossopharyngeal nerves.
_____ 92. has all of its cell bodies in the spiral ganglion.
_____ 93. passes through a bony opening which can usually be
identified in PA radiographs of the skull.

The auditory (Eustachian tube) :

_____ 94. is normally visible in the back of the mouth when the
tongue is elevated.
_____ 95. is held open most of the time by a C-shaped (in cross
section), cartilaginous tube.
_____ 96. has an opening closely associated with lymphatic
tissue which can enlarge and cause obstruction of the
tube.

HEAD AND NECK SELF-EVALUATION EXAMINATION I.

KEY

The following numbered questions are TRUE (T) :

1 37 69
5 38 70
6 39 73
7 40 74
8 41 75
9 42 77

11 78 78

l2 45 81
13 47 82
14 48 83
15 49 84
18 51 85
19 53 86
21 54 91
22 56 93
23 96
24 58
25 59
27 60
29 61
30 63
65
33 66
34 67

35 68