Tutw of head n neck and anatomy physiology clinical controversial

1. HB18: TUTORIAL ON HEAD

2. • A 12-year-old boy involved in a street fight was scratched by a dirty
fingernail. The scratch occurred about two inches posterior to the vertex of
the head on the right side bled briefly and then stopped. The scratch was
ignored for several days until an abscess formed in that site. He suffered
with headache, fever and general malaise. The boy was taken to the
hospital, treated with antibiotics and the pus was drained and cleaned. He
was responded well to the treatment and was discharged from the
hospital.
1. Describe the layers of the scalp.
2. Which layer of the scalp is considered as dangerous and involved in the
above condition.
3. How does an infection from scalp can enter into the cranial cavity ?
4. Explain the anatomical basis of black eye due to injuries in the scalp.

3. MCQS
1. A 45-year-old woman is admitted to the hospital for severe ear pain.
Physical examination reveals chronic infection of the mastoid air cells
(mastoiditis). The infection can erode the thin layer of the bone between the
mastoid air cells and the posterior cranial fossa and spread most commonly
into which of the following venous structures?
• A. Superior sagittal sinus
• B. Inferior sagittal sinus
• C. Straight sinus
• D. Cavernous sinus
• E. Sigmoid sinus
• Ans E

4. 2. A 34-year-old swimmer presents to your office with an external ear canal
infection (otitis externa). The patient coughs during inspection of the
external auditory meatus with a speculum. The cough results from the
irritation of which nerve that innervates an area of the external auditory
meatus?
A. Vestibulocochlear
B. Vagus
C. Trigeminal
D. Facial
E. Accessory
Ans: D

5. 3. A 68-year-old woman is suffering from excruciating, sudden bouts of pain
over the area of her midface. Laboratory studies indicate that she has tic
douloureux (trigeminal neuralgia). Which ganglion is the location of the
neural cell bodies of the nerve mediating the pain?
A. Geniculate
B. Trigeminal
C. Inferior glossopharyngeal
D. Otic
E. Pterygopalatine
Ans: B

6. 4. A 54-year-old man is admitted to the hospital due to severe
headaches. A CT examination reveals an internal carotid artery
aneurysm inside the cavernous sinus. Which of the following nerves
would be typically affected first?
A. Abducens nerve
B. Oculomotor nerve
C. Ophthalmic nerve
D. Maxillary nerve
E. Trochlear nerve
Ans: A

7. 5. A 24-year-old male had a third molar (wisdom tooth) extracted from his
lower jaw. This resulted in the loss of general sense and taste sensation from
the anterior two thirds of the tongue. This loss was most likely due to injury
of which of the following nerves?
A. Auriculotemporal
B. Chorda tympani
C. Lingual
D. Mental
E. Inferior alveolar
Ans: C

8. 6. A 59-year-old man is admitted to the emergency department with acute
pain on his mandible. An MRI examination reveals an acute infl ammation of
the TMJ due to arthritis. Which of the following muscles will most likely be
affected by the inflammatory process of the TMJ?
A. Temporalis
B. Medial pterygoid
C. Masseter
D. Lateral pterygoid
E. Buccinator
Ans: D

9. 7. A 16-year-old boy is admitted to the hospital with fever, confused mental
state, and drowsiness. During physical examination it is noted that the boy
suffers from severe acne. Radiologic examination reveals cavernous sinus
thrombosis. Which of the following routes of entry to the cavernous sinus
would most likely be responsible for the infection and thrombosis?
A. Carotid artery
B. Mastoid emissary vein
C. Middle meningeal artery
D. Ophthalmic vein
E. Parietal emissary vein
Ans: D

10. 8. Which of the following nerves arises by two roots that surround the
middle meningeal artery?
(A) auriculotemporal nerve
(B) buccal nerve
(C) mental nerve
(D) zygomaticotemporal nerve
(E) zygomaticofacial nerve
Ans: A

11. T/F
9. Regarding the muscles of mastication?
• a. Dislocation of the temporomandibular joint usually occurs posteriorly.
• b. The medial pterygoid takes origin from the lateral pterygoid plate.
• c. Of the muscles of mastication only the lateral pterygoid is involved in
protracting the mandible.
• d. All the muscles of mastication are innervated by the maxillary division of
the trigeminal nerve.
• e. All of the muscles of mastication are supplied by branches of the
maxillary artery
• Ans: F, T, T, F, T

12. T/F
10. Regarding the salivary glands
a. The stylomandibular ligament separates the submandibular and
sublingual glands.
b. The parotid duct is also known as Wharton’s duct.
c. Stensen’s duct empties alongside the frenulum of the tongue.
d. Preganglionic parasympathetic fibres to the submandibular gland are
transmitted via the chorda tympani nerve.
e. The submandibular gland is related to the posterior border of mylohyoid
Ans: F, F, F, T, T