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Gross Anatomy # 46 – Cranial Nerves 1 ) What cranial nerves are both sensory and motor (contain a GSA functional component)? a) III, IV, VI b) I, II, V, XI, XII c) V, VII, IX, X d) XII e) V only 2 ) What cranial nerves carry GVE-P axons (preganglionic parasympathetic)? a) X only b) III, VII, IX, X c) III, IV, VI, X d) VI, X, XI, XII e) I, II, III, VI, X 3 ) A patient presents in the Emergency Room with a possible aneurysm. You can test CN III, CN IV, and CN VI by having them follow a target through the six principle positions of gaze; covering all the muscles involved. Which shape should you have them trace? a) T b) P c) O d) A e) H 4 ) What cranial nerve provides general visceral afferent innervation to root of the tongue? a) CN V b) CN VII c) CN IX d) CN X e) CN XII 5 ) What cranial nerves innervate tongue muscles? a) X, XII b) XI, XII c) IX, X d) XII only e) VII, IX, X 6 ) A patient presents with a traumatic head injury. The neurologist strikes a tuning fork and places it on the middle of the patient’s forehead. The neurologist says he is checking for unilateral neurosensory loss and unilateral conductive loss. What nerve is she testing? a) CN VIII b) CN VII c) CN V d) CN II e) CN I 7 ) What cranial nerve has a special somatic efferent (SSE) component? a) CN I b) CN II c) CN V
d) CN VII e) CN VIII 8 ) A “brain freeze” is a phenomenon that some people experience after consuming cold beverages. As the cold beverage hits the roof of the mouth, the vasculature contracts to conserve heat. As the arteries return to size (vasodilate) the nerves in this region sense pain and transmit the sensation to the associated ganglia. This pain is referred pain to the forehead, below the orbits, and some other surrounding regions. Which cranial nerve is associated with this phenomenon? a) CN VII b) CN IX c) CN V d) CN XII e) CN X 9 ) What cranial nerve innervates the palatoglossal muscle of the tongue? a) CN V b) CN VII c) CN IX d) CN X e) CN XII 10 ) What cranial nerve provides parasympathetic innervation to the sublingual salivary gland? a) Oculomotor b) Facial c) Glossopharyngeal d) Vagus e) Hypoglossal 11 ) A patient presents with unilateral arm drive, unilateral facial droop, and mumbled words. The physician asks a nurse to go into the break room for vanilla extract, peppermint, or coffee grounds. What nerve does this physician plan to test? a) CN VIII b) CN VII c) CN V d) CN II e) CN I 12 ) What cranial nerve provides parasympathetic innervation to the lacrimal gland? a) CN XII b) CN X c) CN IX d) CN VII e) CN III 13 ) Where are the neurons situated that provide GSE innervation to the pharynx and larynx muscles? a) Brainstem b) Superior ganglion of the vagus c) Inferior ganglion of the vagus d) Trigeminal ganglion
prominent neck muscle, doing the same test on the other side and noting any deficits. What cranial nerve is the clinician testing? a) CN XII b) CN XI c) CN IX d) CN VII e) CN V 21 ) The facial cranial nerve has all of the following ganglion EXCEPT: a) Geniculate b) Submandibular c) Ptergopalatine d) Chorda tympani 22 ) Taste sensation from the posterior 1/3 of the tongue goes to what ganglion? a) Otic b) Trigeminal c) Geniculate d) Superior glossopharyngeal e) Inferior glossopharyngeal 23 ) You are checking on a patient with metastatic squamous cell cancer of the head and neck. While testing their cranial nerves, you notice their left eye is deviating inward (esotropic). The patient complains of double vision that gets worse as they gaze to the left (horizontal diplopia). The image below shows the patient trying to look to the left. Which nerve do you suspect is injured? a) CN III b) Right CN IV c) Left CN IV d) Right CN VI e) Left CN VI 24 ) A patient presents with a history of meningitis. There is eyelid ptosis and the right pupil is more dilated than the left. The patient presents as shown in the image below. Which nerve do you suspect is injured? a) CN IV b) Right CN III c) Left CN III d) Right CN VI e) Left CN VI 25 ) GVA innervation to the middle ear and auditory tube (internal surface of tympanic membrane) is associated with what cranial nerve?
a) Olfactory b) Auditory c) Glossopharyngeal d) Vagus e) Hypoglossal 26 ) Sensory information from the dura mater of the posterior cranial fossa is associated with what cranial nerve? a) Olfactory b) Auditory c) Glossopharyngeal d) Vagus e) Hypoglossal 27 ) A patient is being shown a set of colored slides. What cranial nerve allows them to see the different colors? a) CN II b) CN III c) CN IV d) CN VI e) CN VII 28 ) Which of the following cranial nerves is necessary for depression of the eyeball? a) CN III b) CN IV c) CN VI d) CN V e) None of the above 29 ) A patient presents after having a stroke. You ask them to open their mouth and say “Ahh.” You notice that their uvula is deviated to their right side. The left side of their palate is at a lower level than the right side. Which nerve do you suspect is injured? a) Left CN X b) Right CN X c) Left CN IX d) Right CN IX e) CN VII 30 ) Which of the following cranial nerves is necessary for elevation of the eyeball? a) CN III b) CN IV c) CN VI d) CN V e) None of the above 31 ) Which of the following is NOT a function of CN III? a) Elevation of eyes b) Constriction of pupil c) Adduction of eyes d) Dilatation of pupil e) Changing the shape of the lens
b) CN IX only c) CN IX, CN X d) CN V, CN IX e) CN V, CN IX, CN XI 40 ) Which of the following cranial nerves does NOT carry motor fibers to skeletal muscle? a) Optic b) Facial c) Hypoglossal d) Vagus e) Mandibular branch of trigeminal 41 ) The facial nerve contains all of the following types of fibers EXCEPT: a) Motor b) Parasympathetic preganglionic c) Special sensory from taste buds d) General sensory from the facial skin e) General sensory from the mucous membranes 42 ) Parasympathetic fibers contained in the facial nerve are responsible for innervating all of the following EXCEPT: a) Lacrimal gland b) Nasal and oral mucous glands c) Submandibular salivary gland d) Sublingual salivary gland e) Parotid salivary gland 43 ) The glossopharyngeal nerve innervates: a) Taste buds in the posterior third of the tongue b) General sensory receptors in the posterior third of the tongue c) Stylopharyngeus muscle d) Baroreceptors in the carotid sinus e) All of the above 44 ) You ask a patient to stick out their tongue. Upon doing so, you notice their tongue deviates to the right side and has wasting (atrophy) of the right half. Which of the following nerves would you expect NOT to be fully functional? a) Left hypoglossal b) Right hypoglossal c) Left glossopharyngeal d) Right glossopharyngeal e) Vagus Gross Anatomy #47 – Fascia & Spaces
- The Sellick Maneuver is performed during endotracheal intubation to prevent regurgitation. It is done by applying direct pressure to the cricoid cartilage. What anatomical structure can be palpated directly superior to the cricoid cartilage to ensure accurate location? a) Epiglottis b) Hyoid bone
c) Thyrohyoid ligament d) Thyroid cartilage e) Tracheal rings
- A medical examiner is performing an autopsy and finds a fractured hyoid bone. What is this finding a strong indicator of? a) Drowning b) Hangman’s fracture c) Strangulation d) Cervical spondylolisthesis e) CPR being performed
- The thyroid cartilage projects back to what cervical vertebral level(s)? a) C b) C c) C3-C d) C e) C4-C
- The hyoid bone projects back to what cervical vertebral level(s)? a) C3-C b) C4-C c) C5-C d) C e) C
- The cricoid cartilage projects back to what cervical vertebral level(s)? a) C3-C b) C4-C c) C5-C d) C e) C
- What fascial layer of the neck contains lymph nodes and the platysma muscle? a) Superficial cervical fascia b) Deep investing fascia c) Deep infrahyoid fascia d) Deep cervical fascia e) Deep prevertebral fascia
- What fascial layer completely surrounds the neck and spans from the superior to inferior border of the neck? a) Superficial cervical fascia b) Deep investing fascia c) Deep infrahyoid fascia d) Deep cervical fascia e) Deep prevertebral fascia
- What fascial layer attaches to the base of the skull and encloses the deep muscles? a) Superficial cervical fascia b) Deep investing fascia c) Deep infrahyoid fascia d) Deep cervical fascia
b) The sternum c) The scapular spines d) The pericardium e) The diaphragm
- What space is located posterior to the retropharyngeal visceral space, which is bounded anteriorly by buccopharyngeal fascia? a) Masticatory space b) Pretracheal space c) Danger space d) Suprasternal space e) Visceral space Gross Anatomy #48 – Triangles & Superficial Structures
- Which of the following is NOT part of the deep wall of the posterior neck triangle? a) Omohyoid muscle b) Levator scapulae muscle c) Digastric muscle d) Splenius capitus muscle e) Scalene muscles
- What nerve innervates the muscles that border the posterior triangle anteriorly and posteriorly? a) Cervical nerves b) Ansa cervicalis c) Dorsal scapular nerve d) Axillary nerve e) CN XI
- A patient presents with a history of Parkinson disease and current, spasmodic, torticollis. Their head is tilted to the left side with the chin elevated and turned toward the right side. What muscle is causing these symptoms? a) Left sternocleidomastoid b) Right sternocleidomastoid c) Left levator scapulae and right splenius capitus d) Right levator scapulae and left splenius capitus e) Left Platisma
- What muscle forms the border between the carotid triangle and the muscular triangle? a) Sternocleidomastoid b) Omohyoid c) Trapezius d) Digastric e) Scalenes
- Which of the following triangles is NOT bilateral? a) Muscular b) Carotid c) Occipital d) Submental e) Supraclavicular
- What two veins come together to form the external jugular vein? a) Communicating vein and common facial vein b) Common facial vein and facial vein c) Facial vein and posterior auricular vein d) Posterior auricular vein and retromandibular vein e) Anterior jugular vein and communicating vein
- A patient is being seen by a cardiologist to measure their right atrial pressure to determine the effectiveness of a cardiac pacemaker during vagal stimulation. The patient has carotid disease on their left side. Which vessel on the right side would be the best option for catheterization to measure pressure? a) Common carotid b) Internal carotid c) External carotid d) Internal jugular e) External jugular
- What vein fuses with the facial vein to form the common facial vein? a) Posterior auricular vein b) Communicating vein c) Retromandibular vein d) Anterior jugular vein e) Internal jugular vein
- A male patient presents to the Emergency Department with a great deal of bleeding on the lateral aspect of their neck after accidentally cutting themselves while shaving. What vein was likely damaged and what pressure-related complication should considered? a) External jugular; Air embolism b) Internal jugular; Air embolism c) External jugular; Pulmonary clot embolism d) Internal jugular; Pulmonary clot embolism e) External jugular; Pneumothorax
- All of the following dermatome areas (nerves) meet at the nerve point of the neck directly behind the sternocleidomastoid EXCEPT: a) Greater auricular (C2-3) b) Dorsal rami (C3-5) c) Transverse cutaneuous (C2-3) d) Lesser occipital (C2) e) Supraclavicular (C3-4)
- An anesthesiologist is prepping a patient for a superficial cervical plexus nerve block for a carotid endarterectomy. Where should the physician inject the anesthesia? a) Anterior to the sternocleidomastoid at the midpoint of the muscle b) Anterior to the sternocleidomastoid at the lower border of the muscle c) Anterior to the sternocleidomastoid at the upper border of the muscle d) Posterior to the sternocleidomastoid at the midpoint of the muscle e) Posterior to the sternocleidomastoid at the lower border of the muscle
- What muscles do the trunks of the brachial plexus pass between? a) Sternocleidomastoid and anterior scalene b) Anterior scalene and middle scalene
b) Between the posterior and middle scalenes c) Through the middle scalene muscle d) Between the middle and anterior scalenes e) Anterior to the anterior scalene muscle
- What landmark can be used to find the descending scapular artery when it is a branch of the subclavian artery? a) Runs on top of the clavicle b) Runs along sternocleidomastoid on the anterior border of the posterior triangle c) Runs through the brachial plexus d) Runs out between anterior and middle scalene muscles then dives deep between middle and posterior scalene muscles e) Runs along trapezius on the posterior border of the posterior triangle
- You are performing neck surgery and cannot find a superficial cervical artery or a descending scapular artery. What artery would you find in place of these? a) Transverse cervical artery b) Suprscapular artery c) Deep cervical artery d) Occipital artery e) Dorsal scapular artery
- What artery runs along the superior part of the posterior triangle? a) Transverse cervical artery b) Suprscapular artery c) Deep cervical artery d) Occipital artery e) Dorsal scapular artery
- Which of the following is NOT a direct branch off of the thyrocervical trunk? a) Ascending cervical artery b) Transverse cervical artery c) Inferior thyroid artery d) Superficial cervical artery e) Suprascapular artery
- Which of the following nerves is NOT in the posterior triangle? a) CN XI b) Subscapular c) Phrenic d) Nerve to subclavius e) Long thoracic
- What nerve runs out of the jugular foramen with the internal jugular vein? a) CN XI b) Dorsal scapular c) Brachial plexus d) Suprascauplar e) Long thoracic
- The cervical plexus provides proprioceptive fibers to what nerve? a) CN XI b) Dorsal scapular
c) Accessory phrenic d) Suprascauplar e) Long thoracic
- What muscle does the dorsal scapular nerve pierce through in the posterior triangle? a) Sternocleidomastoid b) Anterior scalene c) Middle scalene d) Posterior scalene e) Trapezius
- A volleyball player presents with difficulty moving her rotator cuff. She said the problem was getting worse with each serve and eventually she stopped playing completely. It has been over a month since she has last played. Upon examination, the posterior scapular muscles show signs of wasting on the affected side. What nerve is likely damaged? a) Long thoracic b) Median c) Axillary d) Suprascapular e) Dorsal scapular
- All of the following muscles elevate the hyoid bone EXCEPT: a) Digastric b) Sternohyoid c) Stylohyoid d) Mylohyoid e) Geniohyoid
- Which of the following muscles has the same function as the omohyoid muscle? a) Stylohyoid b) Plastisma c) Digastric d) Scalenus anterior e) Thyrohyoid
- The thyroid is an ____ shaped gland sitting on the front of the ____. a) O; Trachea b) H; Trachea c) L; Trachea d) O; Esophagus e) H; Esophagus
- The thyroid gland is supplied by ____ arteries and ____ veins. a) 2; 2 b) 2; 3 c) 2; 4 d) 3; 2 e) 4; 2
- What variable artery runs superiorly off the internal carotid artery to the thyroid? a) Superior thyroid artery b) Inferior thyroid artery
d) C
- In the neck, what is the arterial supply to the esophagus? a) Aortic esophageal branches b) Superior thyroid artery c) Deep cervical artery d) Occipital artery e) Inferior thyroid artery
- During a tracheostomy procedure, the patient begins to bleed from the neck. The blood is deep blue in color and flows constantly. What vessel was likely severed? a) Superior thyroid artery b) Superior thyroid vein c) Inferior thyroid artery d) Inferior thyroid vein e) Thyroid ima Gross Anatomy #50 – Area Under the Sternocleidomastoid
- The carotid sheath contains all of the following EXCEPT: a) Deep cervical lymph nodes b) Superior root of ansa cervicalis c) Phrenic nerve d) Internal jugular vein e) Common and internal carotid arteries
- At what level does the common carotid artery bifurcate into the internal and external? a) C b) C2-C c) C4-C d) C6-C
- At what location does the external carotid artery terminate (bifurcate)? a) At the superior border of the parotid gland b) At the apex of the ear c) At the middle of the temple d) At the superior border of the posterior triangle e) At the posterior occipital protuberance
- You are thinking about a question during an anatomy exam with your hand under your jaw supporting the weight of your head (“The Thinker”). You feel your pulse against the ramus of your mandible. What branch of the carotid artery is this? a) Buccal b) Lingual c) Maxillary d) Facial e) Occipital
- A patient presents the day after a tonsillectomy with complaints of a metallic taste and black, tarry, stools (melana). The physician thinks there is an open bleed at the surgical site. What artery is likely bleeding? a) Deep lingual b) Sublingual
c) Dorsal lingual d) Ascending palatine e) Tonsillar
- Which of the following is NOT a branch of the facial artery? a) Tonsillar b) Sublingual c) Glandular d) Muscular e) Submental
- What branch of the occipital artery provides an anastamoses with the cervical artery as well as the vertebral artery? a) Meningeal b) Auricular c) Descending d) Mastoid e) Muscular
- What nerve runs over the top of the occipital artery? a) Trigeminal b) Facial c) Glossopharyngeal d) Vagus e) Hypoglossal
- The carotid sinus (baroreceptor) is a dilation at the ____ end of the internal carotid where the tunica intima is ____ and adventitia is ____. The tunica adventitia includes nerve endings (mainly CN IX). a) Lower; Thinner; Thicker b) Upper; Thinner; Thicker c) Lower; Thicker; Thinner d) Upper; Thicker; Thinner e) Lower; Thinner; Thinner
- The carotid body (chemoreceptor) is located at the ____ and is innervated by CN IX, CN X, and pre-ganglionic sympathetics. a) Carotid sinus b) Carotid crotch (bifurcation) c) Mid-common carotid d) Mid-internal carotid e) Mid-external carotid
- A patient presents with a knife wound to the neck. The subclavian artery has been severed proximal to the thyrocervical trunk. The patient feels tingling in his arm, but there is still adequate perfusion for the limb to survive. What vessel is providing collateral circulation to the upper limb? a) Occipital branch of posterior auricular artery b) Auricular branch of occipital artery c) Descending branch of occipital artery d) Superior thyroid artery from non-damaged side e) Facial artery from non-damaged side
- What nerve innervates the cricothyroid muscle and is closely associated with the superior thyroid artery? a) Vagus b) Internal laryngeal (from superior) c) External laryngeal (from superior) d) Inferior laryngeal e) Recurrent laryangeal
- What nerve provides sensory innervation to the larynx? a) Vagus b) Internal laryngeal (from superior) c) External laryngeal (from superior) d) Inferior laryngeal e) Recurrent laryangeal
- After an internal carotid artery puncture procedure, the patient is having difficulty talking and cannot depress their hyoid bone. What nerve was likely damaged? a) Trigeminal b) Facial c) Hypoglossal d) Vagus e) Ansa cervicalis
- What nerve lies on top of the carotid sheath and passes into the mandibular region towards the tongue? a) Trigeminal b) Facial c) Hypoglossal d) Vagus e) Ansa cervicalis
- The first cervical nerve “hitches a ride” with what cranial nerve before innervating the thyrohyoid and geniohyoid muscles? a) Trigeminal b) Facial c) Glossopharyngeal d) Vagus e) Hypoglossal
- What lymph nodes running along the internal jugular vein would be enlarged with an infection to the face, scalp, tongue, mouth, tonsils, or pharynx? a) Deep cervical b) Retropharyngeal c) Submandibular d) Tracheal e) Parotid Gross Anatomy #51 – Root
- All of the following are borders of the root of the neck EXCEPT: a) 1st ribs b) 1st costal cartilages
c) Body of C d) Manubrium e) Sternum
- Which of the following muscles is the most superficial? a) Longus capitus b) Longus colli c) Rectus capitus anterior d) Rectus capitus lateralis e) Splenius capitis
- Which of the following muscles can rotate the vertebra to the same side with its superior fibers and the opposite side with its inferior fibers? a) Rotatores b) Rectus capitus lateralis c) Rectus capitus anterior d) Longus colli e) Longus capitus
- What veins do the inferior thyroid veins drain into? a) Brachiocephalic b) Subclavian c) Axillary d) Internal jugular e) External jugular
- Which of the following is NOT true regarding a subclavian venipuncture? a) The suprapleural fascia is very close to the puncture site b) Subclavian arteriopuncture is not a direct risk c) The vein runs over the first rib d) The vein runs under the clavicle e) The insertion site is just below the clavical
- The three parts of the subclavian artery are named based on their anatomical relation to what muscle? a) Sternocleidomastoid b) Anterior scalene c) Middle scalene d) Posterior scalene e) Levator scapulae
- The internal thoracic artery and thyrocervical trunk are branches off of the: a) Aorta b) First part of subclavian artery c) Second part of subclavian artery d) Third part of subclavian artery e) Axillary artery
- What artery runs backwards behind the anterior scalene over the dome of the pleura? a) Descending scapular artery b) Vertebral artery c) Costocervical trunk d) Deep cervical artery
