ANATOMY MCQ

CHAPTER
21. The cervical plexus of nerves supplies the
A. skin of the face.
B. strap muscles of the neck.
C. muscles of mastication.
D. skin of the back of the neck.
E. muscles of the tongue.
B.The skin of the face is all trigeminal territory.
The muscles of mastication are derived from the first branchial arch, supplied by the
mandibular nerve. Muscles of the tongue are supplied by the hypoglossal (XII) nerve.

22. Regarding the deep cervical fascia :

A. The investing layer forms a tube around the brachial plexus.
B. The prevertebral fascia covers the sternocleidomastoid muscle.
C. The carotid sheath also covers the internal jugular vein.
D. The pretracheal layer separates the trachea from the vertebral column.
E. None of the above.
C.This question illustrates the general features of the deep cervical fascia that we need to
know.
The investing layer is the outermost, thickest and most extensive layer, forming an almost
complete collar around the neck. ("Investment" has an older meaning : clothing!) It forms
envelopes around the trapezius and sternocleidomastoid muscles.
The prevertebral fascia covers the vertebrae and prevertebral muscles. As the nerves of the
brachial plexus emerge from the vertebral column, they drag a tube of the prevertebral layer
with them into the axilla. This tube of prevertebral fascia is called the cervicoaxillary canal.
The pretracheal layer is, as the name suggests, in front of the trachea - it cannot separate the
trachea from the vertebral column!
The carotid sheath is formed by parts of all three layers. The sheath encloses the common
and internal carotid arteries, internal jugular vein and the vagus nerve.
23. The ophthalmic division of the trigeminal nerve
A. passes through the optic canal.
B. supplies sensory fibres to the eyeball.
C. gives parasympathetic fibres to the lacrimal gland.
D. carries sensory fibres for smell.
E. supplies the orbicularis oculi muscle.
B.Only the optic nerve and ophthalmic artery pass through the optic canal. "Lesser mortals"
use the superior orbital fissure!
The ophthalmic nerve gives sensory fibres to all structures in the orbit, naturally including the
eyeball.
Branches of the ophthalmic nerve do carry parasympathetic (postganglionic) fibres to
involuntary muscles within the eyeball (those that control the pupil and lens focus), but not to
the lacrimal gland. Lacrimal gland receives parasympathetic supply through the facial nerve
and via the pterygopalatine ganglion.
Smell sensation is carried by the olfactory nerves.
Orbicularis oculi (the circular muscle that runs around the orbital opening) is a facial muscle,
supplied by the facial nerve.
24. Regarding the muscles of facial expression, all of the following are true EXCEPT
:
A. They develop from the second branchial arch.
B. They are supplied by the 7th cranial nerve.
C. They include the elevator of the upper eyelid (levator palpebrae superioris).
D. They all have at least one end attached to the skin.
E. They are under voluntary control.
C.A and B are straightforward!
Regarding C : The muscle that elevates the upper eyelid and thus "opens the eye" is a
member of the ocular muscle group, supplied by the oculomotor nerve (III). The orbicularis
oculi which tightly closes the eyes is a facial muscle,
Since the facial muscles move the skin, it is imperative that they have atleast one end
attached to the skin.
While some facial expressions are reflex, they are not involuntary in the sense that muscles of
internal organs are. Simply stated, we can make faces when we wish to!
25 . All of the following are dural venous sinuses EXCEPT :
A. Sigmoid sinus
B. Frontal sinus
C. Transverse sinus
D. Straight sinus
E. Cavernous sinus
B.Simple enough, just keep in mind that the term sinus is used for air containing cavities too.
The paranasal sinuses contain air, open in the nasal cavity, and are present in the frontal,
maxillary, ethmoid and sphenoid bones.
As an aside, also keep in mind that air containing cavities, communicating with the middle
ear, are also present in the mastoid part of the temporal bone. To confuse the poor student,
anatomists have characteristically named these "mastoid air cells".
26 . The maxillary division of the trigeminal nerve supplies
A. a large part of the nasal cavity
B. lower teeth
C. the posterior one third of the tongue
D. muscles of the soft palate
E. none of the above.
A.Remember the diagram of trigeminal territory. Click Here to refresh your memory.
Beware of little riders like "lower teeth" in B. If you read MCQs carefully you will not miss the
word "lower".
Also, the choice "muscles of the palate" is tempting! The maxillary nerve does give sensory
fibres to the palate, but not to its muscles!
Lastly, be careful whenever you choose "None of the above" and "All of the above".
27. Regarding structures which develop from branchial arches, which of the
following pairs is correctly matched?
A. Muscles of the tongue : first arch
B. Constrictors of the pharynx : third arch
C. Styloid process : second arch
D. Muscles of the larynx : third arch
E. Temporalis muscle : second arch
C.Muscles of the tongue are NOT of branchial arch origin at all.
Remember : Muscles of the palate (except the tensor), pharynx and larynx develop from 4th
and 6th arches.
Part of the hyoid bone, styoloid process (with the ligament that connects the two) and the
stapes in the middle ear develop from the skeletal element of the second arch.
The temporalis, like other muscles of mastication, develops from the first arch.
Branchial arch structures have been summarised in SAQs 41, 42 and 44 (click the link). We
might as well complete the list here by saying that the cartilages of the larynx are of 4th and
6th arch origin.
28 . Regarding the facial nerve
A. It is the nerve of the second branchial arch.
B. It carries fibres for the sensation of taste.
C. It emerges from the stylomastoid foramen.
D. A and B are true.
E. A, B and C are true.
E.By now you should have no problem with A!
Taste fibres in the facial nerve join the lingual nerve (via a branch called the chorda tympani)
and reach the anterior two-thirds of the tongue.
The facial nerve leaves the cranial cavity through the internal auditory meatus (with the
eighth nerve). It follows a doubly curved course through the temporal bone (details not
necessary) and finally emerges from the skull through the stylomastoid foramen - as the
name suggests, between the mastoid and the styloid processes.
29. The vagus nerve
A. supplies the anterior two thirds of the tongue.
B. carries parasympathetic fibres.
C. controls the secretion of the parotid salivary gland.
D. has a spinal root.
E. None of the above.
B.By now we have become experts on the nerve supply of the tongue, I hope! The vagus
nerve does supply a small part of the tongue at the posterior end with taste fibres (you may
forget that), but certainly not the anterior two thirds.
It does carry parasympathetic fibres but not for the major salivary glands. In fact, other than
the glands in the pharynx and larynx, its parasympathetic fibres are largely destined for
thoracic and abdominal viscera.
It is the accessory nerve that has the spinal root and it does not join the vagus.
30. Regarding the dural venous sinuses, which of the following pairs is matched
INCORRECTLY?
A. Superior sagittal sinus : arachnoid granulations.
B. Transverse sinus : sphenoid bone.
C. Inferior sagittal sinus : free margin of the falx cerebri.
D. Sigmoid sinus : jugular foramen.
E. Cavernous sinus : middle cranial fossa.
B. Note that this question asks for the INCORRECT matching.
The superior sagittal sinus runs along the attachment of the falx cerebri to the skull bones. It
has projections of the arachnoid for drainage of the cerebrospinal fluid.
The transverse sinus runs along the posterior attachment of the tentorium cerebelli in the
posterior cranial fossa.
The sigmoid sinus is continuous with the internal jugular vein through the jugular foramen.
The cavernous sinus is along the body of the sphenoid bone, in the middle cranial fossa.
Chapter maxillary artery
1.Which of the following structures travel through the substance of the parotid
gland?
a) The maxillary artery
b) The maxillary artery and retromandibular vein
c) The maxillary artery, retromandibular vein and facial artery
d) The maxillary artery, retromandibular vein, facial artery and buccal branch of the
mandibular nerve
b) The maxillary artery and retromandibular vein
Answer:
The maxillary artery is one of the terminal branches of the external carotid artery which
divides within the parotid gland; the retromandibular vein is the vein corresponding to the
external carotid artery within the gland. The buccal branch of the facial nerve arises within
the gland but the buccal branch of the trigeminal mandibular nerve does not pass through the
gland. The facial artery is closely associated with the submandibular gland.
2. A patient with damage to their cervical sympathetic chain will show the following
signs and symptoms.
a) Pupillary constriction
b) Pupillary constriction and vasodilation of facial vessels
c) Pupillary constriction, vasodilation of facial vessels and increased facial sweating
d) Pupillary constriction, vasodilation of facial vessels, increased facial sweating and
decreased lacrimation
b) Pupillary constriction and vasodilation of facial vessels
Answer:
Unopposed parasympathetic action will produce papillary dilatation and facial vessels will
dilate because of lack of sympathetic tone. However this is not accompanied by facial
sweating as might be expected because facial sweat glands are innervated by sympathetic
neurons. Lacrimation is increased by parasympathetic stimulation.

4. A lesion causing compression of the facial nerve at the stylomastoid foramen

will cause ipsilateral
a) paralysis of the facial muscles.
b) paralysis of the facial muscles and loss of taste.
c) paralysis of the facial muscles, loss of taste and lacrimation.
d) paralysis of the facial muscles, loss of taste, lacrimation and decreased salivation.
a) paralysis of the facial muscles.
Answer: a
Sensory branches supplying taste buds on the anterior tongue and parasympathetic branches
to the lacrimal and sublingual and submandibular salivary glands arise from the facial nerve
in and around the middle ear so will not be affected by a lesion at the given site.

4. Which of these branches of the trigeminal nerve contain somatic motor

processes?
a) The supraorbital nerve
b) The infraorbital nerve
c) The mental nerve
d) None of the above
d) None of the above
Answer:
These three branches are the major cutaneous sensory branches of the ophthalmic, maxillary
and mandibular divisions of the trigeminal nerve respectively. They are all purely sensory
nerves.

5. On which surfaces of the teeth is dental plaque most likely to accumulate in the
mouth of a patient with poor oral hygiene?
a) The palatal surfaces of the upper molars and lingual surfaces of the lower incisors.
b) The buccal surfaces of the upper molars and lingual surfaces of the lower incisors.
c) The palatal surfaces of the upper molars and labial surfaces of the lower incisors.
d) The buccal surfaces of the upper molars and labial surfaces of the lower incisors.
b) The buccal surfaces of the upper molars and lingual surfaces of the lower incisors.
Answer:
Major plaque deposits accumulate where saliva is most abundant which is where it enters the
mouth. The parotid ducts open opposite the buccal surfaces of the maxillary molar teeth and
the sublingual papillae marking the opening of the submandibular ducts are adjacent to the
lingual surfaces of the mandibular incisor teeth.

6 . The parotid duct runs

a) deep to masseter and enters the mouth opposite the upper second molar.
b) superficial to masseter and enters the mouth opposite the upper second molar.
c) deep to masseter and enters the mouth opposite the upper second premolar.
d) superficial to masseter and enters the mouth opposite the upper second premolar.
b) superficial to masseter and enters the mouth opposite the upper second molar.
Answer:
The parotid duct is a superficial structure and may be palpated as a cord-like structure
against a clenched masseter muscle. The duct enters the mouth opposite the upper second
molar tooth.
1. Which of the following connects margins of lateral masses of atlas with those of
posterior articular surfaces of axis?
a) Articular capsules
b) Posterior atlantoaxial
c) Anterior atlantoaxial
d) The transverse
Answer: a
Explanation: Articular capsules are thin, loose and connect the axis. Each is strengthened at
posterior and medial part by an accessory ligament which is attached below to the body of
axis near base of odontoid process.
Correct answer:
d) a combination of these three processes.
Answer:
Widening of the mandible allowing the tongue to drop and development of the cervical flexure
in the brain are physical changes occurring around the time of palatine elevation. It has been
demonstrated that these are not sufficient to explain elevation; accumulation of strongly
hydrophilic GAGs within the palatine processes play a major role

CHAPTER 32
1. The palatine processes begin to fuse at
a) six weeks post-fertilization.
b) eight weeks post-fertilization.
c) ten weeks post-fertilization.
d) twelve weeks post-fertilization.
c) ten weeks post-fertilization.
Answer:
The maxillary arches develop at six week from which the palatine processes develop. The
palatine processes elevate at 8 weeks, begin to fuse at 10 weeks and complete fusion by 12
weeks
2. Complete bilateral cleft palate is due to failure of fusion of the
a) palatine processes.
b) palatine and frontonasal processes.
c) palatine, frontonasal and secondary nasal processes.
d) palatine, frontonasal, secondary nasal processes and mandibular processes.
c) palatine, frontonasal and secondary nasal processes.
Answer:
The primary palate is derived from the frontonasal process. The palatine processes forming
the secondary palate arise from the maxillary processes; these must fuse with each other and
the primary palate. The palatine processes must also fuse with the secondary nasal processes
which are also derived from the maxillary processes.
3. Macrostomia results from failure of fusion of
a) maxillary and mandibular processes.
b) left and right mandibular processes.
c) maxillary and frontonasal processes.
d) mandibular and hyoid arches.
Correct answer:
a) maxillary and mandibular processes.
Answer:
Macrostomia, 'big mouth' in Greek, occurs when fusion between the maxillary and mandibular
arches does not proceed far enough; it can be unilateral or bilateral. Facial clefting due to
failure of the maxillary and frontonasal processes to fuse is very rare as is a midline
mandibular cleft when the two mandibular processes fail to fuse.

4. Palatine shelf elevation is due to the effect of

a) descent of the tongue.
 b) changes in flexure of the developing brain.
c) hydrophilic molecules increasing turgor pressure in the palatine shelves.
d) a combination of these three processes.
Correct answer:
d) a combination of these three processes.
Answer:
Widening of the mandible allowing the tongue to drop and development of the cervical flexure
in the brain are physical changes occurring around the time of palatine elevation. It has been
demonstrated that these are not sufficient to explain elevation; accumulation of strongly
hydrophilic GAGs within the palatine processes play a major role
Chapter 23: Multiple Choice Questions
1. Which of the following structures travel through the substance of the parotid gland?
a) The maxillary artery
b) The maxillary artery and retromandibular vein
c) The maxillary artery, retromandibular vein and facial artery
d) The maxillary artery, retromandibular vein, facial artery and buccal branch of the
mandibular nerve
b) The maxillary artery and retromandibular vein
Answer:
The maxillary artery is one of the terminal branches of the external carotid artery which
divides within the parotid gland; the retromandibular vein is the vein corresponding to the
external carotid artery within the gland. The buccal branch of the facial nerve arises within
the gland but the buccal branch of the trigeminal mandibular nerve does not pass through the
gland. The facial artery is closely associated with the submandibular gland

2. A patient with damage to their cervical sympathetic chain will show the following
signs and symptoms.
a) Pupillary constriction
b) Pupillary constriction and vasodilation of facial vessels
c) Pupillary constriction, vasodilation of facial vessels and increased facial sweating
d) Pupillary constriction, vasodilation of facial vessels, increased facial sweating and
decreased lacrimation
b) Pupillary constriction and vasodilation of facial vessels
Answer:
Unopposed parasympathetic action will produce papillary dilatation and facial vessels will
dilate because of lack of sympathetic tone. However this is not accompanied by facial
sweating as might be expected because facial sweat glands are innervated by sympathetic
neurons. Lacrimation is increased by parasympathetic stimulation.
3. A lesion causing compression of the facial nerve at the stylomastoid foramen
will cause ipsilateral
a) paralysis of the facial muscles.
b) paralysis of the facial muscles and loss of taste.
c) paralysis of the facial muscles, loss of taste and lacrimation.
d) paralysis of the facial muscles, loss of taste, lacrimation and decreased salivation.
a) paralysis of the facial muscles.
Answer:
Sensory branches supplying taste buds on the anterior tongue and parasympathetic branches
to the lacrimal and sublingual and submandibular salivary glands arise from the facial nerve
in and around the middle ear so will not be affected by a lesion at the given site.
4. Which of these branches of the trigeminal nerve contain somatic motor
processes?
a) The supraorbital nerve
b) The infraorbital nerve
c) The mental nerve
d) None of the above
d) None of the above
Answer:
These three branches are the major cutaneous sensory branches of the ophthalmic, maxillary
and mandibular divisions of the trigeminal nerve respectively. They are all purely sensory
nerves.
5. On which surfaces of the teeth is dental plaque most likely to accumulate in the
mouth of a patient with poor oral hygiene?
a) The palatal surfaces of the upper molars and lingual surfaces of the lower incisors.
b) The buccal surfaces of the upper molars and lingual surfaces of the lower incisors.
c) The palatal surfaces of the upper molars and labial surfaces of the lower incisors.
d) The buccal surfaces of the upper molars and labial surfaces of the lower incisors.
b) The buccal surfaces of the upper molars and lingual surfaces of the lower incisors.
Answer:
Major plaque deposits accumulate where saliva is most abundant which is where it enters the
mouth. The parotid ducts open opposite the buccal surfaces of the maxillary molar teeth and
the sublingual papillae marking the opening of the submandibular ducts are adjacent to the
lingual surfaces of the mandibular incisor teeth.
6. The parotid duct runs
a) deep to masseter and enters the mouth opposite the upper second molar.
b) superficial to masseter and enters the mouth opposite the upper second molar.
c) deep to masseter and enters the mouth opposite the upper second premolar.
d) superficial to masseter and enters the mouth opposite the upper second premolar.
b) superficial to masseter and enters the mouth opposite the upper second molar.
Answer:
The parotid duct is a superficial structure and may be palpated as a cord-like structure
against a clenched masseter muscle. The duct enters the mouth opposite the upper second
molar tooth.

Chapter 24: Multiple Choice Questions

1. The infraorbital nerve
a) is a terminal branch of the maxillary division of the trigeminal nerve.
b) is a terminal branch of the maxillary branch of the facial nerve.
c) carries parasympathetic secretomotor neurons to the lacrimal gland.
d) innervates the inferior part of the orbicularis oculi muscle.
a) is a terminal branch of the maxillary division of the trigeminal nerve.
Answer:
The infraorbital nerve is the terminal cutaneous sensory branch of maxillary division of the
trigeminal and contains no motor or autonomic neurons. There is no maxillary division of the
facial nerve but branches of this nerve supply the orbicularis oculi muscles; they also carry
parasympathetic neurons to the lacrimal gland.
2. The lateral pterygoid muscle
a) is attached to the coronoid process and elevates the mandible.
b) is attached to the condylar process and elevates the mandible.
c) is attached to the coronoid process and protrudes the mandible.
d) is attached to the condylar process and protrudes the mandible.
d) is attached to the condylar process and protrudes the mandible.
Answer:
The lateral pterygoid muscle is attached to the pterygoid fovea on the anterior aspect of the
condylar neck of the mandible and its principal action is protrusion of the mandible.
Which of the following statements is true of the temporomandibular joint?
a) It has an articular disc of hyaline cartilage
b) Its articular surfaces are covered by hyaline cartilage
c) Proprioceptive information is carried by the chorda tympani and deep temporal nerves
d) Proprioceptive information is carried by the masseteric and auriculotemporal nerves.
d) Proprioceptive information is carried by the masseteric and auriculotemporal nerves.
Answer:
The articular surfaces of the TMJ are covered by fibrocartilage, and the disc comprises dense
fibrous tissue.
4. The major concentrations of proprioceptive receptors providing information
about position of the TMJ are located in
a) the capsule and ligaments of the TMJ and the medial pterygoid muscle.
b) the capsule and ligaments of the TMJ and the lateral pterygoid muscle.
c) the articular disc of the TMJ and the medial pterygoid muscle.
d) the articular disc of the TMJ and the lateral pterygoid muscle.
b) the capsule and ligaments of the TMJ and the lateral pterygoid muscle.
Answer:
The capsule and ligaments of all synovial joints contain large numbers of proprioceptive nerve
endings. In the TMJ, proporioceptive information from the lateral pterygoid muscles also plays
a significant rtole in monitoring joint position.
5. Which muscle is the most active during a right lateral excursion of the mandible?
a) Left lateral pterygoid muscle
b) Right lateral pterygoid muscle
c) Left medial pterygoid muscle
d) Right medial pterygoid muscle
a) Left lateral pterygoid muscle
Answer:
The lateral pterygoid muscles protrude the mandible whereas the medial pterygoids elevate
it. Lateral excursion is the equivalent of a unilateral protrusion on the opposite side from the
deviation; thus the left muscle is most active during as right excursion.
6. When you examine a patient who has suffered an unfavourable fracture of the
body of the mandible, you would expect the
a) anterior fragment to be displaced downwards by the action of the digastric muscle.
b) posterior fragment to be displaced anteriorly by the action of the lateral pterygoid muscle.
c) anterior fragment to be displaced backwards by action of the temporalis muscle.
d) posterior fragment to be displaced medially by action of the medial pterygoid muscle.
a) anterior fragment to be displaced downwards by the action of the digastric muscle.
Answer:
The elevator muscles of the mandible would displace the posterior fragment upwards and the
suprahyoid muscles would displace the anterior fragment downwards thus separating the
bones at the fracture line.
Chapter 26 MANDIBLE
1. Which of the following muscles initiates elevation of the mandible?
a) Masseter
b) Temporalis
c) Lateral pterygoid
d) Medial pterygoid.
d) Medial pterygoid.
Answer:
Medial pterygoid is the first of the elevator muscles to exhibit contractile activity as the mouth
closes; the masseter and temporalis begin to fire shortly after medial pterygoid. Lateral
pterygoid is largely involved in mouth opening.
In Angle's Class II Div 2 occlusion there is
a) excess overbite of the upper lateral incisors.
b) negative overjet of the upper central incisors.
c) excess overjet of the upper lateral incisors.
d) excess overjet of the upper central incisors.
c) excess overjet of the upper lateral incisors.
Answer:
Excess overjet is characteristic of a Class II occlusion whereas negative overjet indicates a
Class III occlusion. Remember that Class II occlusions are subdivided into division i where all
four upper incisors show a marked overjet and division ii in which only the lateral incisors
exhibit a prominent overjet
Chapter 27 NASAL CAVITY SINUSES
1. The walls of the maxillary sinus are sinus is related to
a) the floor of the orbit.
b) the floor of the orbit and the upper posterior teeth.
c) the floor of the orbit, the upper posterior teeth and the infratemporal fossa.
d) the floor of the orbit, the upper posterior teeth, the infratemporal fossa and the hard
palate.
c) the floor of the orbit, the upper posterior teeth and the infratemporal fossa.
Answer:
The superior wall forms the orbital floor, the posterolateral wall forms part of the wall of the
infratemporal fossa and the floor is in close contact with the roots of the posterior maxillary
teeth. The medial wall forms the lateral wall of the nasal cavity and the hard palate is medial
to this so is not related to the maxillary sinus.
2. Which of the following paranasal sinuses open into the middle meatus?
a) The anterior ethmoidal sinuses
a) The anterior ethmoidal sinuses
b) The anterior ethmoidal and frontal sinuses
c) The anterior ethmoidal, frontal and maxillary sinuses
d) The anterior ethmoidal, frontal, maxillary and sphenoidal sinuses
Correct answer:
c) The anterior ethmoidal, frontal and maxillary sinuses
Answer:
All the paranasal air sinuses open into the middle meatus except the sphenoidal sinus which
opens into the sphenoethmoidal recess and the posterior ethmoidal air cells which open into
the superior meatus
The maxillary sinus
a) is lined by stratified squamous epithelium.
b) drains into the superior meatus of the nasal cavities.
c) is innervated by branches of the maxillary division of the trigeminal nerve.
d) Receives its blood supply from the first part of the maxillary artery.
c) is innervated by branches of the maxillary division of the trigeminal nerve.
Answer:
In common with the rest of the respiratory tract, the air sinuses are lined with respiratory
mucosa. The maxillary sinus drains into the middle meatus and receives its blood supply from
the third part of the maxillary artery by the superior alveolar arteries. The superior alveolar
nerves innervate the sinus and the maxillary teeth, hence the referral of pain from one to the
other structure during toothache or sinusitis
3. A patient is most likely to experience pain due to infection of the ethmoidal air
cells sinus
a) at the base of the skull.
b) on the forehead.
c) in the cheeks.
d) between the eyes.
d) between the eyes.
Answer:
Pain during sinusitis is often poorly localized. Sphenoidal pain is usually experienced at the
base of the skull, frontal sinus on the forehead and maxillary sinusitis produces tenderness in
the cheeks.

Chapter 28 THYROID
1. The respiratory tract is crossed by the isthmus of the thyroid gland at the level
of the
 a) thyroid cartilage.
b) cricothyroid membrane.
c) cricoid cartilage.
d) tracheal rings.
d) tracheal rings.
Answer:
The tyroid gland is low in the neck and the upper poles of the lobes of the gland only extend
as far as the thyroid cartilage. The isthmus crosses the trachea, usually at the level of the
second to fourth rings.
2. The muscles of the soft palate are innervated by branches of the
a) trigeminal and glossopharyngeal nerves.
b) facial and glossopharyngeal nerves.
c) trigeminal and vagus nerves.
d) facial and vagus nerves.
c) trigeminal and vagus nerves.
Answer:
The muscles of the soft palate are derived from the fourth pharyngeal arch with the exception
of tensor veli palatini which is a first arch derivative. It follows that the muscles are innervated
by the vagus nerve (through the pharyngeal plexus) and a specific branch of the mandibular
trigeminal nerve to tensor veli palatini.
3. The mucosa of the upper larynx is innervated by the
a) internal laryngeal nerve which is the afferent limb of the cough reflex.
b) external laryngeal nerve which is the afferent limb of the gag reflex.
c) internal laryngeal nerve which is the afferent limb of the gag reflex.
d) external laryngeal nerve which is the afferent limb of the cough reflex.
a) internal laryngeal nerve which is the afferent limb of the cough reflex.
Answer:
The internal branch of the superior laryngeal nerve is sensory to the mucosa of the larynx
whereas its external branch is motor to the cricothyroid muscle. The cough reflex occurs due
to irritation of the laryngeal mucosa whereas the gag reflex occurs in response to foreign
bodies in the oropharynx
Laryngeal oedema is usually confined to the larynx above the vocal folds because
a) there are numerous mucous glands in the vestibular folds.
b) the mucosa covering the vocal folds is tightly attached to underlying tissues.
c) fluid will drain rapidly into the thorax below the vocal folds.
d) the mucosa above the vocal folds is more vascular than that below the vocal folds.
b) the mucosa covering the vocal folds is tightly attached to underlying tissues.
Answer:
Oedema usually occurs between the mucosal layer and underlying connective tissue and
gravitates down the larynx. The stratified squamous epithelium forming the superficial surface
of the mucosa covering the vocal folds is tightly bound down to the connective tissue covering
the vocalis muscle and prevents flow of fluid below that point. There are mucous glands in the
vestibular folds and there is no apparent difference in vascular density in different parts of the
larynx.
Tonsillar tissue is commonly found
a) on the posterior wall of the oropharynx.
b) under the mucosa of the ventral surface of the tongue.
c) between the palatoglossal and palatopharyngeal folds.
d) at all three sites.
c) between the palatoglossal and palatopharyngeal folds.
Answer:
Tonsillar tissue forms the pharyngeal tonsil on the posterior wall of the nasopharynx, the
lingual tonsil on the posterior part of the dorsal surface of the tongue. The palatine tonsils are
located between the palatoglossal and palatopharyngeal folds.
The auditory tube
 a) connects the inner ear and nasopharynx.
b) is derived from the second pharyngeal pouch.
c) is opened by the action of levator veli palatini.
d) is closed by the action of tensor veli palatini.
c) is opened by the action of levator veli palatini.
Answer:
The auditory tube connects the middle ear and nasopharynx. It is a derivative of the first
pharyngeal pouch embryologically. Both tensor and levator veli palatine muscles attach to the
auditory tube but their action is to open the tube to equalise pressure across the tympanic
membrane and drain fluid from the middle ear.
Laryngoscopic examination of the vocal folds after suspected recurrent laryngeal
nerve damage usually shows that the vocal fold on the injured side is tensed and in
an intermediate position between adduction and abduction. This is because
a) cricothyroid muscle is still functional but the interarytenoid muscles are fully active.
b) cricothyroid muscle is still functional but the interarytenoids are weak.
c) cricothyroid muscle is paralyzed but the interarytenoids are fully active.
d) cricothyroid muscle is paralyzed but the interarytenoids are weak.
b) cricothyroid muscle is still functional but the interarytenoids are weak.
Answer:
The cricothyroid muscle is supplied by the external branch of the superior laryngeal nerve
therefore is not affected by recurrent laryngeal nerve damage; it tenses the vocal fold and its
action will be unopposed because vocalis is paralyzed. The interarytenoids are unusual in that
they cross the midline and receive a bilateral nerve supply from both recurrent laryngeal
nerves; if one nerve is injured the muscle will still receive some nerve supply but its action is
weaker resulting in the intermediate position. Again its action is unopposed because the
posterior cricothyroid muscles are paralyzed.
When an emergency opening into the airway is required, the cricothyroid
membrane should be pierced immediately
a) superior to the thyroid cartilage.
b) inferior to the thyroid cartilage.
c) inferior to the cricoid cartilage.
d) superior to the thyroid isthmus.
b) inferior to the thyroid cartilage.
Answer:
The cricothyroid membrane is in the anterior midline of the neck between the inferior border
of the thyroid cartilage and the cricoid cartilage. It is palpable between the two cartilages
especially if the neck is extended.
Chapter 30 ORBIT
1. A possible effect of damage to the third cranial nerve by trauma to the orbit is
a) a convergent strabismus.
b) ptosis.
c) pupillary contriction.
d) bitemporal hemianopia.
b) ptosis.
Answer:
The oculomotor nerve supplies levator palpebrae superioris so the upper eyelid may droop
after injury to the nerve. Damage to the abducens nerve is likely to produce a convergent
squint because lateral rectus is non-functional. Parasympathetic neurons in the third nerve
innervate the pupillary constrictors; if they are not innervated, the pupil will be dilated. Tunnel
vision is due to damage to the optic chiasma.
Which orbital wall is most likely to collapse in a 'blow out' fracture?
a) The roof
b) The floor
c) The lateral wall
d) The medial wall
b) The floor
Answer:
The bones of the roof and lateral walls are robust Although the bone forming the medial wall
is thinnest, it is buttressed by the bone separating the ethmoidal air cells. The comparatively
thin bone of the floor of the orbit and roof of the maxillary sinus has no support and therefore
is the wall that collapses.
Chapter 22 SKULL
1. The coronal suture joins the
a) frontal and parietal bones.
b) left and right parietal bones.
c) parietal and occipital bones.
d) parietal, squamous temporal and greater wing of the sphenoid.
a) frontal and parietal bones.
Answer:
Examine the disposition of the sutures on the superior view of the skull in Fig 22.6. The
sagittal suture joins the parietal bones, the lambdoid suture the parietal and occipital bones
and the pterion marks the junction of the major bones forming the lateral aspect of the cranial
vault
Which of the following bones has a process that joins with the zygomatic bone to
form the zygomatic arch?
a) The maxillary bone
b) The temporal bone
c) The sphenoid bone
d) The frontal bone
b) The temporal bone
Answer:
The zygomatic arch is formed from the zygomatic bone and the zygomatic process of the
temporal bone.
Which of the following foramina pierce the sphenoid bone?
a) The foramen ovale
b) The foramen ovale and rotundum
c) The foramen ovale, rotundum and spinosum
d) The foramen ovale, rotundum and spinosum and foramen lacerum
c) The foramen ovale, rotundum and spinosum
Answer:
The three foramina named in parts a) b) and c) all pierce the sphenoid bone but the foramen
lacerum is where the sphenoid, petrous and occipital bones meet.
Chapter 21 arches
Question 1
Pharyngeal mucosa is innervated by the glossopharyngeal nerves because it
develops from the
a) first pharyngeal arch.
b) second pharyngeal arch.
c) third pharyngeal arch.
d) fourth pharyngeal arch.
c) third pharyngeal arch.
Feedback:
First arch derivatives are innervated by branches of the trigeminal nerves, second arch
derivatives by the facial nerves, third arch derivatives by the glossopharyngeal nerves and
fourth arch derivatives by the vagus nerves. Because the pharyngeal mucosa is innervated by
the ninth cranial nerve it tells you that it originated from the third pharyngeal arch.
What is the embryological origin of the hyoid bone?
a) The first pharyngeal arch
b) The first and second pharyngeal arches
c) The second pharyngeal arch
 d) The second and third pharyngeal arches
d) The second and third pharyngeal arches
Feedback:
it can be seen that the mandible and two of the three ear ossicles develop from the first arch,
the remaining ossicle and part of the hyoid from the second arch and the remainder of the
hyoid from the third arch.
Which of the following muscles are derived from the first brachial arch?
a) The muscles of mastication
b) The muscles of mastication and anterior belly of digastric
c) The muscles of mastication and anterior and posterior bellies of digastric
d) The muscles of mastication, anterior and posterior bellies of digastric and geniohyoid
b) The muscles of mastication and anterior belly of digastric
Feedback:
Table 21.1 shows the muscles derived from each pharyngeal arch. Each muscle belly of the
digastric muscle is derived from a different arch, the anterior belly from the first arch and the
posterior belly from the second arch. The geniohyoid is probably derived from cervical
myotomes as it is innervated by branches of the cervical plexus.
Chapter cranial nerves
Loss of somatic sensation over the anterior two-thirds of the tongue indicates
damage to the
a) lingual branch of the mandibular trigeminal nerve.
b) chorda tympani branch of the facial nerve.
c) lingual branch of the glossopharyngeal nerve.
d) hypoglossal nerve
a) lingual branch of the mandibular trigeminal nerve.
Feedback:
The chorda tympani carries taste sensation from the anterior tongue and the
glossopharyngeal nerve conveys taste and somaesthetic sensation from the posterior third.
The hypoglossal nerve is the motor nerve to the tongue muscles.
.
The seventh cranial nerve supplies
a) taste buds on the posterior third of the tongue.
b) muscles of the soft palate.
c) muscles of the lower lip.
d) the parotid salivary gland.
c) muscles of the lower lip.
Feedback:
Taste buds in the posterior tongue and the parotid gland are supplied by the ninth cranial
nerve, muscles of the soft palate by the tenth nerve. The facial nerve supplies the muscles of
facial expression which include the muscles of the lips.
Chapter 15 nervous system
1. In the spinal cord, motor neuron cell bodies are located in
a) Lamina I.
b) Lamina II.
c) Lamina V.
d) Lamina IX
d) Lamina IX
Feedback:
Laminae I to VI constitute the dorsal horn of the spinal cord and are the sites where the
processes of peripheral sensory neurons terminate and the cell bodies of thalamic projection
neurons are located. Laminae VIII and IX form the ventral root and lamina IX contains motor
neuron cell bodies.
2. A patient is admitted after a head injury and sinks rapidly into a coma. An MRI
scan indicates an extradural haemorrhage because extravasated blood can be
detected between the
 a) skull bones and dura mater.
b) dura mater and arachnoid.
c) arachnoid and pia mater.
d) pia mater and brain surface.
a) skull bones and dura mater.
Feedback:
Extradural haemorrhage is external to the outermost layer of the meninges, the dura. The
other common place for blood accumulation is into the subarachnoid space - a subarachnoid
haemorrhage.
Emissary veins connect the intracranial venous sinuses to
a) veins draining the scalp.
b) veins draining the eye.
c) the pterygoid venous plexus.
d) All of the above areas.
d) All of the above areas.
Feedback:
The intracranial venous sinuses are connected in several areas to the deep and superficial
venous drainages of the head by emissary veins; these pass through small unnamed foramina
or larger named foramina in the base of the skull. These routes are potential conduits for the
spread of infection into the cranial cavity.
Which one of the following brain areas is supplied by branches of the subclavian
arteries?
a) The frontal lobe
b) The parietal lobe
c) The hypothalamus
d) The cerebellum
d) The cerebellum
Feedback:
The vertebral arteries are branches of the subclavian arteries and give rise to the
vertebrobasilar system of arteries supplying the midbrain, hindbrain including cerebellum and
the occipital and lower temporal lobes of the cerebrum. All other areas are supplied by
branches of the internal carotid arteries.
Cerebrospinal fluid circulates around the brain between the
a) skull and dura mater.
b) dura mater and arachnoid mater.
c) arachnoid and pia maters.
d) pia mater and brain surface.
c) arachnoid and pia maters.
Feedback:
CSF circulates in the only true space between the skull, meninges, and brain and spinal cord
which is the subarachnoid space between the arachnoid and pia.

1. You suspect that your patient has an enlarged submandibular salivary gland.
You expect the enlarged gland
a) to be palpable intraorally..
b) to be palpable extraorally.
c) to be palpable both intra- and extraorally.
d) only to be detectable by radiographical examination
c) to be palpable both intra- and extraorally.
Feedback:
The submandibular gland has a superficial and deep lobe partially separated by the mylhyoid
muscle; when enlarged both lobes should be palpable, the superficial lobe extraorally and the
deep lobe intraorally.

During an inferior alveolar nerve block the needle ideally passes

 a) posterior and medial to medial pterygoid.
b) anterior and lateral to medial pterygoid.
c) through medial pterygoid.
d) inferior to medial pterygoid.
b) anterior and lateral to medial pterygoid.
Feedback:
The medial pterygoid muscle forms the medial wall of the pterygoid space so the needle
should be lateral to the muscle and anterior to its anterior border as it enters the space. Scare
yourself by reading about the consequences of going "off route" in

You notice that your patient's submandibular lymph nodes are enlarged. You would
look for potential infection sites in the
a) hard palate.
b) hard palate and upper lip.
c) hard palate, upper lip and upper central incisor.
d) hard palate, upper lip, upper central incisor and lower first molar.
d) hard palate, upper lip, upper central incisor and lower first molar.
Feedback:
The submandibular lymph nodes drain a very wide area of the face and the oral cavity
including most of the roof of the mouth and associated structures. The search for source of
infection will be very wide if you are going to cover all eventualities.

The regional lymphatic drainage of the left side of the tip of the tongue is to the
a) left submental lymph node.
b) left and right submental lymph nodes.
c) left submandibular lymph node.
d) left and right submandibular lymph nodes
b) left and right submental lymph nodes.
Feedback:
The central fascia septum is deficient anteriorly and posteriorly; the tip of the tongue
therefore drains bilaterally into the closest lymph nodes, the submental nodes. Lymph will
eventually reach the submandibular nodes on both sides.
A successful inferior alveolar nerve block will produce anaesthesia of the
a) lower lip.
b) lower lip and mandibular teeth.
c) lower lip, mandibular teeth and labial gingivae of the anterior mandibular teeth.
d) lower lip, mandibular teeth and labial gingivae of the anterior and buccal gingivae of the
posterior mandibular teeth.
b) lower lip, mandibular teeth and labial gingivae of the anterior mandibular teeth.
Feedback:
An ID block will anaesthetise all branches of the nerve peripheral to the point of injection; all
the ipsilateral mandibular teeth together with the skin of the lower lip and the labial gingivae,
both supplied by the mental branch, should be anaesthetic. The posterior buccal gingivae are
supplied by the buccal nerve.
Chapter mandible emberyology
Question 1
Which of the following bones develop by endochondral ossification?
a) The ribs
b) The ribs and sternum
c) The ribs, sternum and clavicle
d) The ribs, sternum, clavicle and vertebrae
b) The ribs and sternum
Feedback:
All bones of the postcranial skeleton develop by endochondral ossification except the clavicle
which is formed by intramembranous ossification.
Which of one of the following statements about the postnatal growth of the maxilla
is correct?
a) Pneumatisation by enlargement of the developing maxillary sinus ceases at puberty
b) Space is created for the eruption of the permanent molars by resorption of the maxillary
tuberosity
c) The zygomaticomaxillary sutures contribute to increase in height and length of the maxilla
d) The intermaxillary suture closes about eight years postnatally
c) The zygomaticomaxillary sutures contribute to increase in height and length of the maxilla
Feedback:
The maxilla, like all bones of the viscerocranium, follows the somatic growth pattern so does
not cease growth until maturity. The maxillary sinus is still enlarging and growth at the
intermaxillary and zygomaticomaxillary sutures takes place until maturity. The orientation of
the zygomaticomaxillary suture means that bone addition here adds to length and height of
the bone. Bone deposition takes place at the maxillary tuberosity.
Which one of the following statements about the growth of the mandible is correct?
a) The mental symphysis closes at about 1 year postnatally
b) The condylar growth cartilage ceases activity at puberty
c) The ossification centre appears about 8 weeks I.U.L medial to Meckel's cartilage
d) The functional matrix acting on the angle of the mandible is the lateral pterygoid muscle
a) The mental symphysis closes at about 1 year postnatally
Feedback:
The condylar growth cartilage is active until maturity. The mandible is the second bone in the
body (after theclavicle) to begin ossification at 7 weeks; the bone begins to form lateral to
Meckel's cartilage. The lateral pterygoid muscle is attached to the condyle and influences its
growth; the masseter and medial pterygoid muscles attached to the angle affect growth in
that area
The bones of the viscerocranium develop initially by
a) endochondral ossification and follow the somatic growth pattern.
b) endochondral ossification and follow the neural growth pattern.
c) intramembranous ossification and follow the somatic growth pattern.
d) intramembranous ossification and follow the neural growth pattern.
c) intramembranous ossification and follow the somatic growth pattern.
Feedback:
Endochondral ossification occurs in the postcranial skeleton (except the clavicle) and the
basicranium (chondrocranium). Intramembranous ossification occurs in the neurocranium and
viscerocranium; the neurocranium follows the neural growth pattern whereas the
viscerocranium follows the somatic growth pattern.
The spheno-occipital synchondrosis
a) is a secondary growth cartilage.
b) influences the position of the viscerocranium.
c) ceases activity at 7 years of age.
d) can be reactivated in patients affected by acromegaly.
b) influences the position of the viscerocranium.
Feedback:
Primary cartilages are those that form the cartilaginous template of bones that develop by
endochondral ossification; a secondary cartilage appears in a bone developing by
intramembranous ossification. The body of the sphenoid and the basal part of the occiput
contribute to the cranial base which develops by ECO. The cranial base continues to grow
after 7 years to harmonise the growth of the neurocranium following the neural growth
pattern with the viscerocranium following the somatic growth pattern. Acromegaly can
reactivate the condylar secondary cartilage and remnants of primary cartilages in the bones
of the hand and feet.
A "dished face" profile is often associated with
a) a protruding mandible due to reactivation of the condylar cartilage by acromegaly.
b) a recessive maxilla due to failure of elongation of the cranial base.
 c) an enlarged frontal bone due to hydrocephaly.
d) defective development of the maxillary air sinus.
b) a recessive maxilla due to failure of elongation of the cranial base.
Feedback:
A dished face is the profile when the forehead and mandible are normal in size but the mid-
face is sunken in because it is not pushed far enough forward when the cranial base does not
elongate sufficiently. Acromegaly produces a protrusive mandible but does not affect the
forehead so markedly; likewise hydrocephaly produces an enlarged forehead but does not
affect the mandible. The maxillary sinus affects the size of the maxilla but not its position.