Head & Neck — MCQs

An 87-year-old male presents to his neurologist for a follow-up visit. He is being followed for an inoperable tumor near his skull. He reports that he recently noticed that food has started to lose its taste. He also notes increasing difficulty with swallowing. He has a history of myocardial infarction, diabetes mellitus, hyperlipidemia, hypertension, and presbycusis. He takes aspirin, metoprolol, metformin, glyburide, atorvastatin, lisinopril, and hydrochlorothiazide. On examination, the patient is a frail-appearing male sitting in a wheelchair. He is oriented to person, place, and time. Gag reflex is absent on the right side. A taste evaluation is performed which demonstrates a decreased ability to detect sour and bitter substances on the right posterior tongue. The nerve responsible for this patient’s loss of taste sensation also has which of the following functions?

A 55-year-old woman with a 1-year history of left-sided tinnitus is diagnosed with a tumor at the left cerebellopontine angle affecting the glossopharyngeal nerve. Sialometry shows decreased production of saliva from the left parotid gland. The finding on sialometry is best explained by a lesion of the nerve that is also responsible for which of the following?

A 45-year-old man is brought to the emergency department after being found down in the middle of the street. Bystanders reported to the police that they had seen the man as he exited a local bar, where he was subsequently assaulted. He sustained severe facial trauma, including multiple lacerations and facial bone fractures. The man is taken to the operating room by the ENT team, who attempted to reconstruct his facial bones with multiple plates and screws. Several days later, he complains of the inability to open his mouth wide or to completely chew his food, both of which he seemed able to do prior to the surgery. Where does the affected nerve exit the skull?

A 72-year-old woman presents to the emergency department for vision loss. She was reading a magazine this afternoon when she started having trouble seeing out of her left eye. Her vision in that eye got progressively darker, eventually becoming completely black over the course of a few minutes. It then returned to normal after about 10 minutes; she reports she can see normally now. She had no pain and no other symptoms then or now. Past medical history is notable for hypertension and hyperlipidemia. A high-pitched sound is heard when the diaphragm of the stethoscope is placed on her left neck, but her physical exam is otherwise unremarkable; vision is currently 20/30 bilaterally. The etiology of her symptoms most likely localizes to which of the following anatomic locations?

A 12-year-old boy is brought in by his mother with a 2-day history of fever and generalized weakness. She says that her son was involved in a school fight with some other kids 4 days ago and sustained minor injuries to the face. He was otherwise well, until this morning, when he complained of pain in his right eye. Physical examination reveals periorbital erythema and edema of the right eye, along with ophthalmoplegia and proptosis. Which of the following findings will most likely be present in this patient on the affected side as a sequela of his current condition?

A 30-year-old man comes to the physician because of recurrent episodes of right-sided jaw pain over the past 3 months. The patient describes the pain as dull. He says it worsens throughout the day and with chewing, and that it can also be felt in his right ear. He also reports hearing a cracking sound while eating. Over the past 2 months, he has had several episodes of severe headache that improves slightly with ibuprofen intake. Vital signs are within normal limits. Physical examination shows limited jaw opening. Palpation of the face shows facial muscle spasms. Which of the following is the most likely underlying cause of this patient's symptoms?

An otherwise healthy 45-year-old man comes to the physician because of a painful ulcer on his tongue for 3 days. Examination shows a shallow, tender 5-mm wide ulcer on the lateral aspect of the tongue, adjacent to his left first molar. There is no induration surrounding the ulcer or cervical lymphadenopathy. A lesion of the cranial nerve responsible for the transmission of pain from this ulcer would most likely result in which of the following?

A 27-year-old man presents to a physician for evaluation of 3 months of increased vertigo. He says that occasionally he will experience several seconds of intense vertigo that makes him lose his balance. He came in for evaluation because this symptom is affecting his ability to drive to work. He has also been occasionally experiencing tinnitus. Physical exam reveals rotatory nystagmus that is delayed in onset and stops with visual fixation. The nerve that is most likely causing these symptoms exits the skull at which of the following locations?

A 28-year-old man comes to the physician because of a persistent tingling sensation in the right side of his face. The sensation began after he underwent an extraction of an impacted molar 2 weeks ago. Examination shows decreased sensation of the skin over the right side of the mandible, chin, and the anterior portion of the tongue. Taste sensation is preserved. The affected nerve exits the skull through which of the following openings?

A 55-year-old woman comes to the physician because of a 2-week history of painful swelling on the right side of her face. The pain worsens when she eats. Examination of the face shows a right-sided, firm swelling that is tender to palpation. Oral examination shows no abnormalities. Ultrasonography shows a stone located in a duct that runs anterior to the masseter muscle and passes through the buccinator muscle. Sialoendoscopy is performed to remove the stone. At which of the following sites is the endoscope most likely to be inserted during the procedure?