HBA 531 - THE BODY Head & Neck Written Examination October 23, 2014 Name: NOTE 2: When asked to trace nerve, artery, or vein pathways, do so by using arrows, e.g., structure a structure b structure c... destination. If pathways branch, indicate by branching arrows. 1. What blood vessels and/or nerves pass through the following openings in the skull? (3) a) the mandibular foramen b) the superior orbital fissure c) the jugular foramen d) the foramen rotundum e) the foramen spinosum f) foramen magnum 2. In which ganglia do cell bodies for the following reside? (3) a) postganglionic parasympathetic neurons innervating parotid gland b) postganglionic parasympathetic neurons innervating lacrimal gland c) sensory neurons conveying taste from anterior two-thirds of tongue d) postganglionic sympathetic neurons innervating dilator pupillae e) postganglionic parasympathetic neurons innervating sublingual gland f) postganglionic parasympathetic neurons innervating mucous glands of maxillary sinus 3. When performing a tracheostomy between the 2 nd and 3 rd tracheal rings, what structure is most likely to be in your way (be specific)? (1) 4. Glossopharyngeal neuralgia is characterized by bouts of excruciating pain emanating throughout the sensory distribution of CN IX. List three anatomical structures (or specific portions thereof) from which such pain would originate. (1.5) 5. The following figure presents three images from a CT angiogram of the vessels of the neck. On the left is a left anterior oblique view; in the middle is a straight anterior view; on the right is a right anterior oblique view. The left subclavian artery, as it arises from the aortic arch, is indicated by an asterisk. Identify the lettered structures. (6)
A B C D E F G H Trace the path of blood flow from the aortic arch into E. How does the path of blood flow into H differ from what you just described? 6. At monthly routine well-baby visits, a pediatrician palpates the anterior fontanelle of an infant. What is the anterior fontanelle and where is it located? (1.5) She is concerned when she can no longer palpate the fontanelle of 5 month old infant. Why? 2
7. What is the greatest threat to the health and well being of a patient with Bell's palsy, and how does this threat arise? (2) Describe two additional physical symptoms of Bell's palsy that are particularly annoying when eating. 8. Bonnie and Kate decide they would both like to learn how to ice skate. At their first lesson, Bonnie falls backwards, hitting the back of her head on the ice. Kate tries to help her, but loses her balance and falls hitting the side of her head against the rim of the ice rink. (3) is more likely to have suffered an epidural hematoma. Explain her injury including the names of relevant anatomical structures. is more likely to have suffered a subdural hematoma. Explain her injury including the names of relevant anatomical structures. is more likely to later experience a diminished sense of smell. Explain her injury including the names of relevant anatomical structures. 9. When you hold the stem of a vibrating tuning fork against the vertex of a patient's head, he reports to you that the vibrations sound louder to him in his right ear. What is the name of the test that you have just performed? (4) In this test, the vibrations of the tuning fork are transmitted to the cochlea by what mechanism? Provide two alternative explanations for the patient s report that the sound from the tuning fork was louder in this right ear. Name and briefly describe a follow-up test that might be performed to determine which of the alternative diagnoses summarized above is the correct one. 3
10. For each of the following, identify the anatomical structure that best fits the given description: (7) a) functions to protect the cochlea from loud sounds b) passes through a canal in the root of the medial pterygoid plate of the sphenoid c) passes within the labyrinthine wall of the tympanic cavity immediately superior to the oval window d) enters into the cranial cavity directly superior to the cartilage filling the foramen lacerum e) are responsible for detecting angular accelerations of the head f) is firmly bound to the internal surface of the tympanic membrane (be specific) g) courses inferiorly across posterior surface of the stylopharyngeus h) smooth muscle on the deep surface of the levator palpebrae superioris aponeurosis i) provides sensory innervation to the larynx superior to the vocal folds (be specific) j) functions to protract the tongue k) traverses the tympanic cavity by passing between the neck of the malleus and the long limb of the incus l) opens into the nasopharynx posterior to the inferior nasal meatus m) opens into the inferior nasal meatus n) open at the anterior ends of the plica sublingualis on either side of the frenulum 11. Describe the corneal reflex including the names of the nerve(s) involved. (1) 12. What nerve provides sensation to the teeth in the lower jaw? (1) If a dentist were to inject a local anesthetic near the site where the above named nerve enters the mandible, what other nerve in close proximity can also be affected by the anesthetic? 4
13. For each of the following, describe or name the visual defect that would result of the structure was damaged. Using the outline of the eyes on the right, show how the visual field would be affected. (6) a) right optic nerve b) optic chiasm c) right optic tract 14. If you suspect a patient has suffered damage to one of the cranial nerves listed below, describe the test you could perform to detect the damage in each case, and what you should observe. (3) a) right vagus nerve b) left hypoglossal nerve c) left accessory nerve 15. The picture shown on the right indicates the sensory nerve supply for the face. Name the specific nerves indicated. (2.75) 16. List four symptoms or signs of Horner s Syndrome. (2) 5
17. The young child in the image on the right displays a developmental abnormality. What is the general name for this type of developmental defect? (2.5) Explain his appearance with reference to specific anatomical structures. 18. The woman pictured to the right comes into your office with her head flexed slightly toward her left shoulder (upper image). She says that she can t hold her head straight upright because if she does she sees double. Name the two muscles whose paralysis would account for the behavior (make sure you specify the appropriate side). (3) In the lower image, the patient has been asked to look down and to the left. Which eye is abnormal? Explain your reasoning. You ask the patient to tilt her head to the right. In the space below, draw the eyes as you would expect them to appear. 19. Biopsy of a nodular mass in a man s left thyroid lobe indicates thyroid cancer. After a partial thyroidectomy removing the left thyroid lobe, the patient reports persistent hoarseness. What structure was most likely damaged during the surgery? (1.5) Describe two other symptoms he may also display. 20. The superior ophthalmic vein is sometimes described as being essentially an emissary vein. Explain what an emissary vein is, and then explain why it is appropriate to think of the superior ophthalmic vein in this way, naming all relevant anatomical structures. (2) 21. Fill in the blanks in the following statements: (1.25) The phrenic nerve is derived from the of spinal nerves. Below the level of the cricoid cartilage in the neck, the phrenic nerve lies to the scalenus anterior, to the suprascapular artery, and to the thoracic duct. 6
22. Presented below is a series of six axial CT images of the neck and head with intravascular contrast. Identify the structures (A X) to which lines are drawn. Note: structures H and O are labeled in more than one section. (6) A: B: C: D: E: F: G: H: I: J: K: L: M: N: O: P: Q: R: S: T: U: V: W: X: 7
23. Presented below are two coronal T1 MRIs of the head. The planes of these coronal sections are shown on the sagittal section at the right. Identify the structures (A X) to which lines are drawn. (6) A: B: C: D: E: F: G: H: I: J: K: L: M: N: O: P: Q: R: S: T: U: V: W: X: 8