PMDC Step-1 Formative assessment Day-4 Head & Neck Review

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2. Prof. Dr. M. Saeed Shafi
MBBS, M.Phil, FIAS (UK), DCPS (HPE), MP-HSE(US), FISAMS(PRC)
Member AACA (USA); Member AMEE(UK)
Member Pakistan Medical Research Council
Convenor, PMRC Expert Panel in Anatomy.
Principal &Dean
Sahara Medical College & Sughra Shafi Medical Complex, Narowal-Pakistan
(A Project of SAHARA for Life Trust- Registered Charity in Pak/USA/UK &Japan)
Tel: +92-42-509-2228; Mobile: +92-321-4539461.
Fax:+92-423-596-3940 & +92-423-666-9095.
E-mail: msaeedshafi@hotmail.com & principal@saharaforlife.org
URL: www.saharaforlife.org

3. Q1. A 55-year old female was brought to the emergency room with
bilateral decreased eye movements and decreased vision. There is
history of boil nose 5 days ago. MRI scan showed cavernous sinus
thrombosis. The infection spread from the facial vein to the
cavernous sinus thorough which of following veins.
• Angular vein
• Pterygoid venous plexus
• Deep facial vein
• Maxillary vein
• Ophthalmic veins
C: Ophthalmic Veins

4. Q2. A 40 year old woman presented with complaint of severe
intermittent pricking pain affecting right side of her face. This pain
was precipitated while washing face and when exposed to cold air.
Pain also aggravated while taking cold drinks. Which of the
following nerve is involved in this case?
A. CN VII
B. CN IX
C. CN XII
D. CN X
E. CN V
E: 5th CN

5. Q3. Carotid bodies are located in the carotid triangle of the neck.
They have very rich nerve supply. Which of the following supplies
the carotid body?
A. Accessory nerve
B. Vagus nerve
C. Hypoglossal nerve
D. Glossopharyngeal nerve
E. Middle cervical ganglion
D: 9th CN

6. Q4. A 42-year old business man went for a late lunch to a fast food restaurant and
ordered an extra large beef burger. He had to open his mouth extra wide for a big bite.
There was a clicking sound from the jaw and he could not close the mouth. He was taken
to the hospital where he was diagnosed to have dislocation of temporomandibular joint
(TMJ). Which of the following nerve can be damaged as a result of this dislocation
A. facial
B. auriculotemporal
C. zygomaticotemporal
D. zygomaticofacial
E. great auricular
B: Auriculotemporal N.

7. Q5. A soldier presented in the emergency with bullet injury to neck. Intraoperatively the
bullet track was found passing through anterior part of digastric triangle. Which of the
following is most likely to be damaged?
A. Internal jugular vein
B. Vagus nerve
C. Stylopharyngeus muscle
D. Glossopharyngeal nerve
E. Facial artery
E: Facial A.

8. Q6. The characteristic feature of Atlas is its:
A. odontoid process
B. massive body
C. absent body
D. long spinous process
E. absent foramen transversarium
C: Absent body

9. Q7. One of the following muscles is inserted into articular disc of temporomandibular
joint.
A. Masseter
B. Medial pterygoid
C. Lateral pterygoid
D. Anterior fibers of temporalis
E. Posterior fibers of temporalis
C: Lateral pterygoid

10. Q8. A 20-year old medical student has a infection involving the upper eyelid. Which of the
following group of lymph nodes will be enlarged as a result of the spread of infection?
A. Buccal
B. Anterior cervical
C. Submandibular
D. Mastoid
E. Superficial parotid
E: Superficial parotid

11. Q9. A 50 years old male patient presented to ENT OPD with a palpable mass in left
submandibular region along with drooping of left angle of mouth. FNAC of the mass
showed it to be adenoid cystic carcinoma. Which of the following muscle is affected?
A. Orbicularis oris
B. levator labii superioris
C. Levator labii superioris aleque nasi
D. Depressor anguli oris
E. levator anguli oris
D: Depressor anguli oris

12. Q10. A 50 years old male patient presented to ENT OPD with a palpable mass in left
submandibular region along with drooping of left angle of mouth. FNAC of the mass
showed it to be adenoid cystic carcinoma. In the above patient which branch of facial
nerve has been damaged?
A. Zygomatic
B. Buccal
C. Mandibular
D. Cervical
E. Temporal
C: Mandibular

13. Q11. A 15- years old male patient presented with bilateral painful
parotid swellings diagnosed as mumps. The pain is caused by
stretching of the parotid capsule. Which of the following nerves act
as afferent for the pain sensation in this case?
A. Auriculotemporal
B. Zygomaticotemporal
C. Zygomaticofacial
D. Great auricular
E. Transverse cervical
D: Great auricular N.

14. Q12. A patient is being operated upon for removal of a tumor in
the deep lobe of parotid gland. The surgeon will find the deep lobe
in relation to which of the following parts of the mandible?
A. Ramus
B. Body
C. Angle
D. Condyloid process
E. Coronoid process
A: Ramus

15. Q13. An ENT surgeon is doing submandibular gland excision due to
tumor. Which one of the following structures is at maximum risk
when submandibular duct is divided?
A. Glossopharyngeal nerve
B. Lingual nerve
C. Submandibular ganglion
D. Facial artery
E. Facial vein
B: Lingual N.

16. Q14. A dysfunction of one of the following muscles will allow food
to collect in the vestibule of the mouth
A. Orbicularis oris
B. Zygomaticus major
C. Lateral pterygoid
D. Masseter
E. Buccinator
E: Buccinator

17. Q15. A boxer receives an upwardly directed blow on the mandible.
Which of the following structures will prevent dislocation of the
temporo-mandibular joint?
A. Masseter
B. Medial pterygoid
C. Stylomandibular ligament
D. Sphenomandibular ligament
E. Lateral temporomandibular ligament
E: Lateral temporomandibular ligament

18. Q16. A 43- year old woman was seen in emergency department
with a large abscess in the middle of right posterior triangle of
neck .It was red and hot. The physician decided to incise it. The
patient came after 5 days with the complaint that she couldn’t
raise her right hand above her head to brush her hair. It is due to
involvement of which one of the following nerve/s?
A. Cervical plexus
B. Sympathetic plexus
C. Upper trunk of brachial plexus
D. Lower trunk of plexus
E. Spinal part of accessory nerve
E: 11th CN; Spinal part

19. Q17. Defective formation of intermaxillary segment will affect the
development of which of the following?
A. Philtrum
B. Lower lip
C. Upper cheek
D. Apex of nose
E. Alae of nose
A: Philtrum

20. Q19. A 65-year-old man is admitted to hospital for biopsy of a
chronic ulcer on the posterior third of the tongue. Biopsy result
revealed it to be malignant. Which of the following lymph nodes
will be ultimately involved?
A. Submental
B. Submandibular
C. Jugulo-omohyoid
D. jugulo-digastric
E. supraclavicular
D

21. Q20. A 45 years old male is brought to the operating room for the
excision of pleomorphic adenoma of right parotid gland. Which of
the following is least likely to be damaged during the excision of
the gland?
A. Facial nerve
B. Posterior auricular nerve
C. Superficial temporal artery
D. Retromandibular vein
E. External carotid artery
B

22. Q23. A 30- year old primigravida delivered a baby boy with a cleft
palate. These congenital anomalies occur at which period of
intrauterine life.
A. 4th & 5th week
B. 5th & 6th week
C. 6th & 7th week
D. 7th &8th week
E. 8th & 9th week
D

23. Q25. A 50-year-old chronic smoker has recently been diagnosed as
having bronchogenic cancer. Later he developed metastases in the
left supraclavicular lymph nodes, resulting in the involvement of
the stellate ganglion. Which type of ganglion is this one?
A. Sympathetic
B. Parasympathetic
C. Dorsal root
D. Spinal
E. Sensory
A

24. Q29. A 60 years old male Naswar addict, presented with a mass in
floor of mouth. The biopsy of the mass showed it to be a malignant
tumor. Which of the following lymph node groups will be involved
first?
A. Sub-mental
B. Submandibular
C. Anterior cervical
D. Superficial cervical
E. Deep cervical
A

25. Q31. Yawning induces drainage of the pterygoid venous plexus.
This structure has a close relationship to which of the following
muscles?
A. Masseter
B. Temporalis
C. Buccinator
D. Lateral pterygoid
E. Medial pterygoid
D

26. Q33. A 35 years old male presented with complaints of left sided
painful parotid swelling for the last 3 days. Pussy discharge was
seen coming out of the opening of parotid duct that opens
opposite:
A. Upper first premolar
B. Upper second molar
C. Lower second molar
D. Lower first molar
E. Lower third molar
B

27. Q36. A 55 years old female presented with facial nerve paralysis
due to middle ear tumor. This lesion will affect which of the
following muscles
A. Omohyoid
B. Thyrohyoid
C. Geniohyoid
D. Mylohyoid
E. Stylohyoid
E

28. Q37. Which muscle is responsible for producing wrinkles on
forehead?
A. Occipitalis
B. Frontalis
C. Orbicularis Oculi
D. Procerus
E. Levator palpebral superiorus
B

29. Q42. A 25 years old female presented with history of numbness in
front of the right ear and an area of skin extending from the angle
of the mandible to mastoid process following removal of lymph
nodes from her posterior triangle. Which of the following nerves is
likely to be affected?
A. Transverse cervical
B. Great auricular
C. Auriculotemporal
D. Zygomaticotemporal
E. Zygomaticofacial
B

30. Q45. A 7-year- old boy presented with a well circumscribed painful
hematoma in the left parietal eminence after his head bumped
against a wall. There is no skull fracture. Which of the following
locations is the site of this hematoma?
A. Skin
B. Dense Connective tissue.
C. Epicranial Aponeurosis.
D. Loose areolar tissue.
E. Pericranium.
D

31. Q 47. A 27-year-old woman with a goiter comes to the hospital for
surgical treatment. The surgeon must ligate the superior laryngeal
artery to secure hemostasis. Surgeon must take care to avoid
injury to which of the following nerves?
A. External laryngeal nerve
B. Internal laryngeal nerve
C. Superior laryngeal nerve
D. Hypoglossal nerve
E. Vagus nerve
A

32. Q48. A 43-year-old man has new onset of difficulty with speaking.
Examination by the ENT resident reveals problems in elevating the
hyoid bone and floor of the mouth, secondary to paralysis of the
posterior belly of the digastric muscle. Which of the following
nerves is most likely involved?
A. Accessory nerve
B. Trigeminal nerve
C. Ansa cervicalis
D. Facial nerve
E. Glossopharyngeal nerve
D