Question 1

A 73-year-old woman visited her physician because she had noticed that the right side of her face was sagging downward. She first noticed the condition on waking up two mornings ago. Otherwise she felt very well. On examination the patient had a complete right-sided facial paralysis, the right lower eyelid was drooping, and the right angle of the mouth was sagging. A diagnosis of Bell's palsy was made.
-Further examination of this patient demonstrated the following signs and symptoms except which?

Accepted Answer

In this patient all the facial muscles on the right side were paralyzed. When making the diagnosis of Bell's palsy, it is imperative that one makes the distinction between an upper motor neuron palsy and a lower motor neuron palsy. The part of the facial nucleus of the facial nerve that controls the muscles of the upper part of the face receives corticonuclear fibers from both cerebral hemispheres. Therefore, it follows that with a lesion involving the upper motor neurons, only the muscles of the lower part of the face will be paralyzed. In this patient all the facial muscles on the affected side were paralyzed, indicating that the lesion was confined to the facial nerve.

Question 2

A 17-year-old boy was seen in the emergency department after receiving a stab wound at the front of the neck. The knife entrance wound was located on the left side of the neck just lateral to the tip of the greater cornu of the hyoid bone. Dur- ing the physical examination the patient was asked to protrude his tongue, which deviated to the left.
-The following statements would explain the physical signs in this patient except which?

Accepted Answer

The genioglossus muscle is supplied by the hypoglossal nerve.

Question 3

A 43-year-old woman was seen in the emergency department with a large abscess in the middle of the right posterior triangle of the neck. The abscess was red, hot, and fluctuant. The abscess showed evidence that it was pointing and about to rupture. The physician decided to incise the abscess and insert a drain. The patient returned to the department for the dressings to be changed 5 days later. She stated that she felt much better and that her neck was no longer painful. However, there was one thing that she could not understand. She could no longer raise her right hand above her head to brush her hair.
-The following statements explain the signs and symptoms in this case, suggesting that the spinal part of the accessory nerve had been incised, except which?

Accepted Answer

The spinal part of the accessory nerve lies superficial to the levator scapulae muscle in the posterior triangle of the neck.

Question 4

A 35-year-old woman had a partial thyroidectomy for the treatment of thyrotoxicosis. During the operation a ligature slipped off the right superior thyroid artery. To stop the hemorrhage, the surgeon blindly grabbed for the artery with artery forceps. The operation was completed without further incident. The following morning the patient spoke with a husky voice.
-The following statements about this patient would explain the husky voice except which?

Accepted Answer

The cricothyroid muscle is innervated by the external laryngeal nerve, which was damaged in this patient.

Question 5

A 43-year-old woman visited her physician complaining of severe intermittent pain on the right side of her face. The pain was precipitated by exposing the right side of her face to a draft of cold air. The pain was stabbing in nature and lasted about 12 hours before finally disappearing. When asked to point out on her face the area where the pain was experienced, the patient mapped out the skin area over the right side of the lower jaw extending backward and upward over the side of the head to the vertex.
-The following signs and symptoms in this patient strongly suggest a diagnosis of trigeminal neuralgia except which?

Accepted Answer

The motor portion of the trigeminal nerve is unaffected in patients with trigeminal neuralgia.

Question 6

A 10-year-old boy was playing darts with his friends. He bent down to pick up a fallen dart when another dart fell from the dart board and hit him on the side of his face. On examination in the emergency department a small skin wound was found over the right parotid salivary gland. Then, 6 months later, the boy's mother noticed that before mealtimes the boy began to sweat profusely on the facial skin close to the healed dart wound.
-The following statements can explain this phenomenon except which?

Accepted Answer

The secretomotor fibers to the parotid salivary gland originate in the inferior salivatory nucleus of the glossopharyngeal nerve.

Question 7

A 31-year-old woman fell off her bicycle and lacerated the skin of her forehead just above the left eyebrow.
-What is the sensory innervation of the skin of the forehead? Where may these nerves be blocked?

Accepted Answer

The answer of A 31-year-old woman fell off her bicycle...

Question 8

A 27-year-old man was involved in a motorcycle accident and was seen in the emergency department with extensive lacerations of the right ear. It was decided to suture the skin lesions under local anesthesia.
-How would you anesthetize the ear?

Accepted Answer

The answer of A 27-year-old man was involved in a...

Question 9

A 63-year-old woman visited her physician with a swelling over the parotid gland on the right side. She stated that she had first noticed the swelling 3 months previously, and since that time it had rapidly increased in size. Recently, she had noticed that the right side of her face "felt weak" and she could no longer whistle for her dog. On examination, a hard swelling deeply attached to the parotid gland was found. On testing the facial muscles, it was found that the muscles on the right side were weaker than those on the left side.
-What is the connection between the parotid swelling and the right-sided facial weakness?

Accepted Answer

The answer of A 63-year-old woman visited her physician with...

Question 10

On examination, a patient is found to have a bitemporal hemianopia. An enlargement of which anatomic structure is likely to cause this condition?

Accepted Answer

The answer of On examination, a patient is found to...

Question 11

A patient is suspected of having a lesion of the glossopharyngeal nerve. How would you test the integrity of this cranial nerve?

Accepted Answer

The answer of A patient is suspected of having a...

Question 12

A47-year-old woman is seen by a neurologist because of trouble reading the newspaper. She said that the print starts to tilt and she begins to see double. She also stated that she has difficulty walking down steps because she cannot easily look downward with her right eye. On physical examination, the patient was found to have weakness of the movement of the right eye, both downward and laterally. Using your knowledge of anatomy, explain the signs and symptoms.

Accepted Answer

The answer of A47-year-old woman is seen by a neurologist...

Quiz 15: The Cranial Nerves and Trigeminal Nerve Blocks

A 31-year-old woman fell off her bicycle and lacerated the skin of her forehead just above the left eyebrow. -What is the sensory innervation of the skin of the forehead? Where may these nerves be blocked?

A 27-year-old man was involved in a motorcycle accident and was seen in the emergency department with extensive lacerations of the right ear. It was decided to suture the skin lesions under local anesthesia. -How would you anesthetize the ear?

On examination, a patient is found to have a bitemporal hemianopia. An enlargement of which anatomic structure is likely to cause this condition?

A patient is suspected of having a lesion of the glossopharyngeal nerve. How would you test the integrity of this cranial nerve?