head and neck spotter qs

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Q1 Identify this structure:

A. Ramus of mandibleB. CondyleC. Coronoid processD. Angle of mandibleE. Mental foramen

Q1 was not answered.

The correct answer was:Coronoid process

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The coronoid process is an anterior process of the ramus of mandible and provides the attachment for the temporalis muscle. The posterior process of the ramus is known as the condyle. The mandible is the largest and strongest bone of the face and consists of a horseshoe shaped body and a pair of rami. The body of the mandible meets the ramus on each side at the angle. The mandibular and mental foramina lie on the medial and lateral side of the body respectively and allow the inferior alveolar nerve and blood vessels to communicate through the jaw.

Q2 Identify this sinus:

A. MaxillaryB. FrontalC. EthmoidD. Superior sagittalE. Sphenoid


The correct answer was:Sphenoid


One of two sphenoid sinuses lies within the body of the sphenoid bone. The maxillary sinus is pyramidal in shape and lies within the maxilla bone on each side of the nasal cavity. The roof is formed by the floor of the orbit, and its floor is related to the roots of the premolar and molar teeth. The two frontal sinuses are contained within the frontal bone. The ethmoidal sinuses are anterior, middle and posterior and are contained within the ethmoid bone on each side. The superior sagittal sinus is not a paranasal cavity but rather a venous sinus formed at the superior surface of the falx cerebri.

Q3 Identify this gyrus:

A. Para-hippocampalB. CalcarineC. PrecentralD. PostcentralE. Cingulate


The correct answer was:Cingulate


The cingulate gyrus follows a path just superior to the corpus callosum. The white matter of the gyrus contains the cingulum which allows the frontal and parietal lobes to communicate with the parahippocampal and adjacent cortical regions. The calcarine sulcus is a depresion which can be seen posteriorly commencing from the corpus callosum continuing through to the occipital pole. The calcarine sulcus is joined at an acute angle by the parietooccipital sulcus about halfway along its length. The paracentral lobule is the area of the cerebral cortex that surrounds the indentation produced by the central sulcus. The anterior part of this lobule is a continuation of the precentral gyrus on the superior lateral surface, and the posterior part of the lobule is a continuation of the postcentral gyrus.

Q4 Which muscle attaches here?

A. TemporalisB. MasseterC. Lateral pterygoidD. Medial pterygoidE. Buccinator


The correct answer was:Temporalis


The temporalis muscle originates at the floor of the temporal fossa and inserts into the coronoid process of the mandible. The masseter muscle originates at the zygomatic arch and inserts at the lateral surface of the ramus. The lateral and medial pterygoid both originate from the lateral pterygoid plate area with insertions at the neck of the mandible / TMJ articular disc and medial surface of the angle of mandible respectively. Buccinator is a muscle of facial expression and therefore is supplied by the facial nerve unlike the muscles of mastication above which are supplied by the mandibular division of the trigeminal nerve. The muscle acts to compress the cheek and lips against the teeth.Q5 Damage to this structure may cause?

A. Homonymous hemianopiaB. Loss of left visual fieldC. Left eye blindnessD. Loss of right visual fieldE. Bitemporal hemianopia


The correct answer was:Left eye blindness


The optic nerve axons arise from cells of the retina. The nerve leaves the eyeball and passes through the optic canal to enter the middle cranial fossa and unite with the optic nerve of the opposite side to form the optic chiasm. In the chiasm, the fibres from the medial (nasal) half cross the midline and enter the optic tract of the opposite side, whereas fibres from the lateral (temporal) half of each retina pass posteriorly in the optic tract of the same side. Most of the fibres of the optic tract go on to synapse with nerve cells in the lateral geniculate body, which is a small projection from the posterior part of the thalamus. The axons of the nerve cells of the lateral geniculate body pass posteriorly as the optic radiation and terminate in the visual cortex of the cerebral hemisphere.

The left optic nerve carries both nasal and temporal components of the left eye. Thromboembolic disease can occlude the end artery which supplies the eye causing permanent or temporary left eye blindness by damaging the optic nerve and retinal cells. Homonymous hemianopia results from damage to the visual cortex, optic tract or optic radiation of either cerebral hemisphere. The result will be complete loss of either the left visual field if the right hemisphere is damaged or the right visual field if the left hemisphere is damaged. A bitemporal hemianopia results from damage to the optic chiasm.

Q6 Identify this nerve:

A. LingualB. VagalC. HypoglossalD. Spinal accessoryE. Phrenic


The correct answer was:Hypoglossal


The hypoglossal nerve is a motor nerve that leaves the skull through the hypoglossal canal. The nerve descends in the neck to reach the lower border of the digastric muscle. Here it turns forward and crosses the lateral surface of the external and internal carotid artery before connecting with fibres of C1. The nerve passes forward deep to the mylohyoid muscle and below the lingual nerve and submandibular duct. The vagus nerve runs within the carotid sheath and can be seen clearly just posterior to the carotid artery bifurcation. The spinal accessory nerve ascends alongside the spinal cord and enters the skull through the foramen magnum. The phrenic nerve (from C3, 4 and 5) is the only motor nerve supply to the diaphragm and runs vertically down the neck on the anterior surface of scalenus anterior muscle.


A. Vestibular (false) foldB. SacculeC. Vocal (true) foldD. Cricoid cartilageE. Epiglottis


The correct answer was:Cricoid cartilage


The vocal fold is a mobile fold on each side of the larynx. It is formed of mucous membrane covering the vocal ligament and in life is white in colour. The vestibular fold lies just above and is a fixed fold on each side of the larynx. It is formed of mucous membrane covering the vestibular ligament and in life is pink in colour. The saccule is a diverticulum that ascends from the sinus of the larynx between the vestibular and vocal fold. The cricoid cartilage has a shallow arch in front and a broad lamina behind. It articulates with the thyroid and arytenoid cartilages. The epiglottis is leaf shaped and lies behind the root of tongue enabling it to protect the entrance to the larynx.


A. HippocampusB. FornixC. Corpus callosumD. Septum pellucidumE. Thalamus


The correct answer was:Hippocampus


The hippocampus forms part of the limbic system which in turn is involved with control of emotions, behaviour and memory. It is a curved elevation of grey matter that extends throughout the entire length of the floor of the inferior horn of the lateral ventricle. It is named hippocampus because it resembles a sea horse in coronal section. The parahippocampal gyrus is continuous with the hippocampus along the medial edge of the temporal lobe. The fornix is formed at the posterior end of the hippocampus and allows its fibres to decussate. It is composed of a thick bundle of fibres and eventually joins the mammilary body. Anteriorly, the body of the fornix is connected to the corpus callosum by the septum pellucidum. The thalamus is not part of the limbic system. It forms part of the diencephalon and is a region of great functional importance, serving as a cell station to all the main sensory systems.

Q9 Which blood vessel passes through this foramen?

A. Internal carotid arteryB. Vertebral arteryC. Internal jugular veinD. Middle meningeal arteryE. None of the above


The correct answer was:None of the above


The foramen lacerum is large and irregular in shape and lies between the apex of the petrous part of the temporal bone and the sphenoid bone. It allows the passage of the internal carotid artery through its superior portion only as the inferior portion is largely filled with cartilage and fibrous tissue. The foramen magnum transmits the two vertebral arteries and the jugular foramen transmits the internal jugular vein. The foramen spinosum is small and lies just posterolateral to the foramen ovale, it transmits the middle meningeal artery into the cranial vault. The answer to this question is therefore none of the above. In life the foramen lacerum is not hollow and could not facilitate the complete passage of the internal carotid artery.

Q10 This is the superior view of the eye. Identify this extra-ocular muscle:

A. Superior rectusB. Lateral rectusC. Inferior obliqueD. Superior obliqueE. Orbicularis oculi


The correct answer was:Superior oblique


The superior oblique muscle can be seen passing anteriorly along the superomedial angle of the orbit. It forms a tendon which traverses a loop of fibrous tissue, the trochlea, allowing the muscle to turn backwards across the surface of the eyeball. The medial, inferior, superior and lateral rectus all attach posteriorly to the common tendinous ring. Passing forwards they attach to the eyeball behind the corneoscleral junction and allow the eyeball to move medially, inferiorly, superiorly and laterally respectively.

The inferior oblique muscle is entirely in the anterior part of the orbit, attaching just lateral to the nasolacrimal canal. The orbicularis oculi muscle is innervated by the facial nerve and acts as a sphincter to the palpebral fissure.

Q11 Identify this part of the Corpus Callosum:

A. RostrumB. BodyC. SpleniumD. GenuE.


The correct answer was:Genu


Commisural fibres mainly consist of axons that interconnect similar regions in the opposite hemisphere. The corpus callosum is a massive commissural system that interconnects corresponding areas of the frontal, parietal, temporal and occipital lobes. Starting anteriorly the corpus callosum consists of the rostrum, genu, body and splenium. The genu (knee) forms the sharp bend present anteriorly. Together with the rostrum and body it is supplied by the anterior cerebral artery. The splenium is supplied by the posterior cerebral artery and is larger in proportion to other parts of the corpus callosum. This is due to its involvement in processing visual information.

Q12 Identify this artery:

A. MaxillaryB. Superficial temporalC. Middle meningealD. FacialE. Lingual


The correct answer was:Superficial temporal


The external carotid artery supplies all of the vessels mentioned in this question and has eight branches in total. The superficial temporal artery supplies the scalp and ascends over the zygomatic arch. It can be palpated just in front of the auricle. The maxillary artery runs forward medial to the neck of the mandible traveling through the infratemporal and pterygopalatine fossa before dividing to supply muscles of mastication, the nose, and the palate. The middle meningeal artery supplies the meninges and is a sub-division of the maxillary artery. It is therefore not a direct branch of the external carotid artery. The facial artery loops around the lower mandible, making a groove in the submandibular gland before eventually supplying the tonsil, muscles and skin of the face. The lingual artery loops upwards and forwards to supply the tongue.

Q13 Identify this foramen:

A. Foramen ovaleB. Foramen lacerumC. Foramen spinosumD. Stylomastoid foramenE. Foramen rotundum


The correct answer was:Foramen rotundum


The foramen rotundum is just anterior to the foramen ovale. Both perforate the greater wing of the sphenoid and transmit the maxillary and mandibular divisions of the trigeminal nerve respectively. The foramen lacerum is large and irregular in shape and lies between the apex of the petrous part of the temporal bone and the sphenoid bone. It allows the passage of the internal carotid artery through its superior aspect. The foramen spinosum is small and lies just posterolateral to the foramen ovale, it transmits the middle meningeal artery into the cranial vault. The stylomastoid foramen lies adjacent to the styloid process and allows the passage of the facial nerve.

Q14 Identify this sinus:

A. Superior sagittalB. Inferior sagittalC. TransverseD. SigmoidE. Sphenoid


The correct answer was:Superior sagittal


The superior sagittal sinus lies at the upper border of falx cerebri. The inferior sagittal sinus lies at the lower border. The right and left transverse sinuses each begin as a continuation of the superior sagittal sinus and straight sinus respectively. Each sinus lies in the lateral attached margin of the tentorium cerebelli. They end on each side by becoming the sigmoid sinus which in turn drains into the internal jugular vein. The sphenoid sinus is a paranasal air sinus which lies within the body of the sphenoid bone.

Q15 Which movement is produced by this extra-ocular muscle?

A. Adduction + depressionB. Abduction + elevationC. Abduction + depressionD. ElevationE. Adduction + elevation


The correct answer was:Abduction + elevation


The inferior oblique acts to abduct and elevate the eye. The superior oblique muscle action is controversial in that many anatomists disagree as to its function. It is, however, widely thought to abduct and depress the eye. The superior, inferior, lateral and medial recti each move the eye in the direction from which they attach at corneoscleral junction. Damage to any of the extraocular muscles may result in a diplopia which is maximal when looking in the direction of the affected muscle movement.Q16 This patient is looking to the right. Which nerve has been affected?

A. Trigeminal (V)B. Oculomotor (III)C. Trochlear (IV)D. Abducent (VI)E. Optic (II)


The correct answer was:Abducent (VI)

This patient has a right abducent nerve (CN VI) palsy. The most notable clinical sign is a lack of movement in the affected eye when it is supposed to be abducted to the right side. The patient would experience double vision at this point. The most common cause for this is a diabetic neuropathy. However as the abducent nerve passes through the cavernous sinus it can be exposed to infection which may track through the venous system of the mid-face. An aneurysm of the internal carotid artery, which also travels through the sinus, can affect the nerves function as well.

Q17 Identify this area:

A. Caudate nucleusB. PutamenC. InsulaD. Internal capsuleE. Thalamus


The correct answer was:Insula


The insula is located in the depths of the lateral sulcus and is covered by the temporal lobe. Patients who have a lesion involving the insula have difficulty with pronouncing phonemes in the proper order and produce words which are close to the target but not exactly correct. The caudate nucleus and putamen form part of the striatum. This important component of the basal ganglia lies just medial to the insula and contains cholinergic neurons which influence mainly direct and indirect motor pathways. The internal capsule contains axons of virtually all neurons that enter or exit the cortex. It is often affected by a small vessel infarct which produces a marked contralateral motor or sensory deficit. The thalamus forms part of the diencephalon and is a region of great functional importance, serving as a cell station to all the main sensory systems.Q18 The parasympathetic supply to this gland is from which nerve?

A. Glossopharyngeal (IX)B. Facial (VII)C. Occulomotor (III)D. Vagus (X)E. Trigeminal (V)


The correct answer was:Facial (VII)


The submandibular gland is controlled by parasympathetic secretomotor fibres traveling via the the chorda tympani nerve, a branch of the facial nerve and synapsing at the submandibular ganglion. The parotid gland is supplied by parasympathetic secretomotor fibres traveling via the glossopharyngeal nerve and synapsing at the otic ganglion. The fibres traveling via the oculomotor nerve synapse at the ciliary ganglion and in turn control the constrictor pupillae of the iris and ciliary muscles. The vagus nerve controls various parasympathetic functions in the thorax such as control of smooth muscle contraction and heart rate. The trigeminal nerve has no parasympathetic outflow associated with its nucleus in the brainstem. It is however closely involved with the pterygopalatine parasympathetic ganglion.Q19 Identify the vessel in red:

A. Maxillary arteryB. Facial arteryC. Lingual arteryD. Maxillary veinE. Facial vein


The correct answer was:Facial artery


The facial artery follows a tortuous path looping around the lower mandible, making a groove in the submandibular gland and eventually supplying the tonsil, muscles and skin of the face. The maxillary artery runs forward medial to the neck of the mandible travelling through the infratemporal and pterygopalatine fossa before dividing to supply muscles of mastication, the nose and palate. The lingual artery loops upwards and forwards to supply the tongue. The maxillary vein is formed in the infratemporal fossa from the pterygoid venous plexus. The maxillary vein joins the superficial temporal vein to form the retromandibular vein. The facial vein runs straight in comparison to the facial artery and is a tributary of the internal jugular vein. Q20 The muscle fibres attached to this point elevate the mandible. Which other movement is produced?

A. ProtractionB. DepressionC. RotationD. RetractionE.


The correct answer was:Retraction

The muscle which originates from this area is the temporalis. Anterior and superior fibres of the muscle elevate the mandible, posterior fibres retract the mandible. The masseter muscle raises the mandible to occlude teeth in mastication. The lateral pterygoid muscle acts to pull the neck of the mandible and articular disc forward thus protruding. The medial pterygoid muscle acts to raise the mandible. Depression of the mandible arises from the action of digastric, mylohyoid and geniohyoid muscles with a contribution from lateral pterygoid as it acts on the articular disc. Rotation of the jaw is not possible however a lateral chewing movement is accomplished by alternately protruding and retracting the mandible on each side.Q21 Identify this cranial nerve:

A. Optic (II)B. Olfactory (I)C. Oculomotor (III)D. Trochlear (IV)E. Abducent (VI)


The correct answer was:Oculomotor (III)


The cranial nerves are numbered in rostrocaudal order starting with the olfactory nerve (I) which has an extension, the olfactory tract, to the cribriform plate. The two optic nerves (II) join at the optic chiasm which can easily be seen. The oculomotor nerve (III) is highlighted with the yellow arrow as it emerges at the anterior surface of the midbrain followed by the trochlear nerve (IV) emerging from the posterior surface which cannot be seen. The abducent nerve (VI) emerges from the anterior surface of the brain at the junction between the pons and medulla oblongata.Q22 The thyroid gland is represented below in green. Identify the nerve which is highlighted.

A. Recurrent laryngealB. Superior laryngealC. Internal laryngealD. External laryngealE. Vagus


The correct answer was:Vagus


The vagus nerve descends vertically in the neck within the carotid sheath with the internal jugular vein and internal / common carotid artery. It descends through the thorax in the mediastinum, passing behind the lung before entering the abdomen. The recurrent and superior laryngeal nerves are both important divisions of the vagus which can be easily damaged during surgical procedures involving the thyroid gland. The recurrent laryngeal nerve supplies all intrinsic muscles to the larynx except cricothyroid and loops down below the arch of the aorta on the left and the subclavian artery on the right. The superior laryngeal nerve divides into internal and external divisions which are sensory and motor respectively.Q23 Identify this artery:

A. Superficial temporalB. FacialC. LingualD. MaxillaryE. Internal carotid


The correct answer was:Maxillary


The maxillary artery runs forward medial to the neck of the mandible traveling through the infratemporal and pterygopalatine fossa before dividing to supply muscles of mastication, the nose and palate. The superficial temporal artery supplies the scalp and ascends over the zygomatic arch, where it may be palpated just in front of the auricle. The facial artery loops around the lower mandible, making a groove in the submandibular gland before eventually supplying the tonsil, muscles and skin of the face. The lingual artery loops upwards and forwards to supply the tongue. The internal carotid artery ascends the neck in the carotid sheath, passes deep to the parotid gland and does not branch before entering the cranial cavity. Q24 This cystic swelling at the base of the tongue is an embryological remnant from which gland?

A. ParotidB. SubmandibularC. ThyroidD. SublingualE. Thymus


The correct answer was:Thyroid


The thyroid gland develops from a small region of tissue near the base of the tongue. This tissue descends as the thyroglossal duct from the foramen caecum in the posterior aspect of the tongue. The thyroid tissue continues to migrate inferiorly and eventually comes to rest at the anterior aspect of the trachea in the root of the neck.

Consequently, the migration of thyroid tissue may be arrested anywhere along the embryological descent of the gland. Ectopic thyroid tissue is quite rare. The cystic swelling that is highlighted is more likely to have arisen from the thyroglossal duct. The duct can be excised surgically but the procedure is complicated and requires the partial removal of the hyoid bone.Q25 This patient is experiencing double vision and has a ptosis on the right side. Which nerve has been affected?

A. Optic (II)B. Abducent (VI)C. Oculomotor (III)D. Trochlear (IV)E. Facial (VII)

The correct answer was:Oculomotor (III)

This patient has a right oculomotor nerve (CN III) palsy. Clinical signs include a droopy upper eyelid as a result of partial paralysis of the levator palpebrae muscle; an eye that looks down and out as a result of paralysis of the superior, medial, inferior recti and inferior oblique muscle; a fixed and dilated pupil because of paralysis to the sphincter pupillae. It is important to be able to recognise the above clinical signs as transtentorial herniation as a result of increased intracranial pressure may cause stretching of the oculomotor nerve. This can often be the first sign warning the clinician that prompt surgical or medical care is needed. Q26 Identify this branch of the maxillary nerve:

A. Greater palatineB. InfraorbitalC. NasalD. PharyngealE. Zygomatic


The correct answer was:Infraorbital


All divisions of the maxillary nerve are sensory. The infraorbital nerve is the anterior continuation of the maxillary nerve and is easily seen passing through the infraorbital foramen to supply the cheek, upper lip, lower eyelid and external nose. The greater palatine nerve passes through the palatine canal to innervate the mucosa and glands of the hard palate. The nasal nerves pass medially through the sphenopalatine foramen to enter the nasal cavity. The pharyngeal nerve passes posteriorly from the pterygopalatine ganglion to supply mucosa and glands of the nasopharynx. The zygomatic nerve (seen just superolateral to infraorbital nerve) passes forward on the lateral orbital wall and divides into zygomaticotemporal and zygomaticofacial nerves to supply skin of the temporal and zygomatic area respectively.Q27 This patient sustained an injury to his temporal area after an assault. Identify the lesion?

A. Subdural haematomaB. Subarachnoid haemorrhageC. Extradural haematomaD. Intracerebral haematomaE. Brain tumour


The correct answer was:Extradural haematoma


This CT scan shows a lens shaped (biconvex) hyperdensity adjacent to bone on the left side. This is characteristic of an extradural haematoma. A skull fracture near the temporal area can damage the underlying middle meningeal artery. The patient may present clinically with a lucid interval for a few hours followed by rapid deterioration.This is an emergency requiring surgical evacuation of the haematoma to prevent a rapid rise in intracranial pressure.Q28 Identify this area of the tongue:

A. Terminal sulcusB. Vallate papillaeC. Filiform papillaeD. Foramen caecumE. Foliate papillae


The correct answer was:Foramen caecum


The foramen caecum, marks the site in the embryo where the epithelium invaginated to form the thyroid gland. The terminal sulcus is v-shaped and separates the oral from the pharyngeal surface of the tongue. The foramen caecum is located at the apex of terminal sulcus. The papillae increase the surface area of the tongue and usually have taste buds on their surface.The large cylindrical vallate papillae are immediately anterior to the sulcus terminalis. The filiform papillae are slightly further anterior, more numerous and cone shaped. The foliate papillae are linear folds of mucosa on the sides of the tongue near the terminal sulcus.

Q29 Which part of the cerebellum is highlighted?

A. Anterior lobe vermisB. Posterior lobe vermisC. Flocculo-nodular lobeD. Anterior lobe hemisphereE. Falx cerebelli


The correct answer was:Anterior lobe hemisphere


This is a superior view of the cerebellum which is located in the posterior cranial fossa and covered superiorly by the tentorium cerebelli. It lies posterior to the fourth ventricle, pons and the medulla oblongata. The cerebellum consists of two hemispheres joined by a narrow midline vermis. The superior, middle and inferior peduncles form the connection to the brainstem. The anterior lobe vermis is highlighted as seen on the superior surface of the cerebellum. The anterior lobe hemisphere is situated lateral to the vermis. The posterior lobe vermis is situated on the inferior surface as is the small floculonodular lobe. The falx cerebelli is a dural fold which separates the two hemispheres and has been removed.Q30 Identify this branch of the facial nerve:

A. TemporalB. ZygomaticC. BuccalD. MandibularE. Cervical


The correct answer was:Buccal


The facial nerve lies between the superficial and deep part of the parotid gland. The nerve gives off one posterior and five anterior terminal branches. These nerves are known as the muscles of facial expression and starting superiorly are the temporal, zygomatic, buccal, mandibular and cervical. The structure highlighted is the buccal nerve which supplies the buccinator muscle. The function of this nerve can be tested when the cheeks are blown out. The posterior auricular nerve comprises the one posterior branch of the facial nerve. It enables some people to wiggle their ears. Surgeons are particularly careful when operating on the parotid gland to ensure that the facial nerve is not damaged.Q31 Identify this structure:

A. Thyroid cartilageB. Arytenoid cartilageC. Cricoid cartilageD. EpiglottisE. Hyoid bone


The correct answer was:Hyoid bone


The hyoid bone is horseshoe shaped and provides an attachment for muscles involved with swallowing and mastication.The thyroid cartilage is the largest component of the larynx and consists of two laminae each of which has inferior and superior cornu. On the outer surface is an oblique line for attachment of muscles.The two arytenoid cartilages are pyramidal in shape and allow modification of the vocal cords. The cricoid cartilage has a shallow arch in front and a broad lamina behind. It articulates with the thyroid and arytenoid cartilages. The epiglottis is leaf shaped and lies behind the root of tongue enabling it to protect the entrance to the larynx.Q32 Damage to this structure may cause?

A. Monocular blindnessB. Homonymous hemianopiaC. Loss of left visual fieldD. Bitemporal hemianopiaE. Loss of right visual field


The correct answer was:Loss of left visual field

Damage to the optic chiasm results in a bitemporal hemianopia (poor vision in both outer fields) as both nasal fibres converge here. A tumour of the pituitary gland can often present in this way. Monocular blindness results from damage to the optic nerve. Homonymous hemianopia results from damage to the visual cortex, optic tract or optic radiation of either cerebral hemisphere. The result will be complete or partial loss of either the left visual field if the right hemisphere is damaged or the right visual field if the left hemisphere is damaged.

Q33 Identify this nerve:

A. Inferior alveolarB. LingualC. Chorda tympaniD. Mandibular division of trigeminalE. Maxillary division of trigeminal


The correct answer was:Inferior alveolar


The inferior alveolar nerve originates from the larger, posterior, sensory division of the mandibular nerve. It is highlighted emerging through the mandibular foramen to supply the teeth of the lower jaw before passing through the mental foramen to supply the skin of the chin. The lingual nerve, also from the posterior division of the mandibular nerve, descends in front of the inferior alveolar nerve to enter the mouth. It runs forward on the side of the tongue crossing the submandibular duct and is joined by the chorda tympani nerve along its course. The mandibular division of the trigeminal nerve is both motor and sensory. It leaves the trigeminal ganglion and passes through the foramen ovale to enter the infratemporal fossa. The maxillary division of the trigeminal nerve is purely sensory. It leaves the skull through the foramen rotundum and crosses the ptergopalatine fossa to enter the orbit through the inferior orbital fissure.Q34 Identify this artery:

A. Anterior cerebralB. Anterior communicatingC. BasilarD. Posterior cerebralE. Middle cerebral


The correct answer was:Middle cerebral


This specimen shows the arterial supply to the base of brain. The middle cerebral artery is the largest terminal branch of the internal carotid artery. It runs through the lateral cerebral sulcus to supply the majority of the lateral surface of the cerebral hemisphere. The anterior cerebral artery, also a terminal branch of the internal carotid artery, passes forward between the cerebral hemispheres to supply the medial and superolateral surfaces. It is joined to the artery of the opposite side by the anterior communicating artery. The two vertebral arteries join to form the basilar artery which ascends in a groove on the anterior surface of the pons.The basilar artery supplies important branches to the cerebellum before dividing into two posterior cerebral arteries. The posterior cerebral artery supplies the inferolateral surface of the hemisphere and communicates with the middle and anterior cerebral arteries to complete an anastomosis known as the Circle of Willis.Q35 Which of the following drains here?

A. Nasolacrimal ductB. Maxillary sinusC. Frontal sinusD. Sphenoid sinusE. Ethmoidal sinus


The correct answer was:Nasolacrimal duct


The nasolacrimal duct opens below the inferior concha which is highlighted. The opening being guarded by a fold of mucous membrane. The maxillary sinus opens into the middle meatus of the nose through the hiatus semilunaris. The frontal sinus opens into the middle meatus of the nose through the infundibulum . The sphenoid sinus opens into the sphenoethmoidal recess above the superior concha. The anterior and middle ethmoidal sinuses open into the middle sinus via the infundibulum and bulla ethmoidalis respectively. The posterior sinus opens into the superior meatus.Q36 Identify this muscle:

A. HyoglossusB. StyloglossusC. GeniohyoidD. GenioglossusE. Mylohyoid


The correct answer was:Genioglossus


The genioglossus is fan shaped and makes a significant contribution to the structure of the tongue. The geniglossus muscle acts to depress the central part and protrude the anterior part of the tongue. The hyoglossus muscles are thin quadrangular muscles lateral to genioglossus. They act to depress the tongue. Styloglossus originates from the styloid process and inserts into the lateral aspect of the tongue. The muscle acts to retract the tongue and pull the back of the tongue superiorly. Geniohyoid and mylohyoid are both innervated by the mandibular division of the trigeminal nerve and are not extrinsic muscles of the tongue. They play an important part in supporting the floor of the oral cavity.Q37 This patient is trying to smile. Which cranial nerve has been damaged and on which side?

A. Right oculomotor (III)B. Right facial (VII)C. Left facial (VII)D. Left oculomotor (III)E. None of the above


The correct answer was:Right facial (VII)


This an example of a right facial nerve palsy. We can assume it to be a lower rather upper motor neurone deficit because the patient cannot furrow her brow on that side. Clinical signs include an inability to blink the eye or raise the eyebrow on the right side because of an impaired nerve supply to orbicularis oculi and frontalis muscles. On this same side the patient cannot smile because of a palsy to the many muscles which control this action.Q38 This elderly patient sustained a head injury after a fall. What is the the diagnosis?

A. Extradural haematomaB. Intracerebral haemorrhageC. Subdural haematomaD. Subarachnoid haemorrhageE. Brain tumour


The correct answer was:Subdural haematoma


This CT scan shows a crescent shaped hyperdensity on the left side that hugs contours of the brain. This is characteristic of an subdural haematoma and is due to venous blood located between the dura and arachnoid. The condition is commonly seen in the elderly and alcoholics after a fall. This causes a shearing force to damage bridging veins in the subdural space. The blood accumulates slowly and the patient declines over a period of days to weeks.Q39 Identify the structure marked:

A. Fourth ventricleB. Third ventricleC. Choroid plexusD. Arachnoid granulationE.


The correct answer was:Choroid plexus


Cerebrospinal fluid is produced by the choroid plexuses spread within the lateral, third and fourth ventricles of the brain. It escapes from the ventricular system of the brain through the three formina in the roof of the fourth ventricle and so enters the subarachnoid space. The structure highlighted is choroid plexus located in the lateral ventricle which is responsible for the majority of CSF production. The arachnoid granulations are protusions of the arachnoid mater into a venous sinus to form arachnoid villi. The arachnoid villi are found mainly in the superior sagittal sinus and allow diffusion of CSF into the bloodstream. The adult ventricular system and subarachnoid space contain 90-150ml of CSF, whereas 400-500ml are produsced daily.Q40 Which artery supplies the area marked in yellow?

A. Middle cerebralB. Anterior cerebralC. VertebralD. BasilarE. Posterior cerebral


The correct answer was:Posterior cerebral


The area marked in yellow is the inferolateral surface of the cerebral hemisphere and is supplied by the posterior cerebral artery. An interruption to the arterial supply of this area can damage the visual cortex and its associated pathway leading to a complete or partial loss of the visual field.The middle cerebral artery is the largest terminal branch of the internal carotid artery. It runs through the lateral cerebral sulcus to supply the vast majority of the lateral surface of the cerebral hemisphere. The anterior cerebral artery, also a terminal branch of the internal carotid artery, passes forward between the cerebral hemispheres to supply the medial and superolateral surfaces.

The two vertebral arteries join to form the basilar artery which ascends in a groove on the anterior surface of the pons.The basilar artery supplies important branches to the cerebellum, internal ear and pons before dividing into two posterior cerebral arteries.Q41 Identify this vessel:

A. Retromandibular veinB. Internal jugular veinC. Facial veinD. Maxillary veinE. External jugular vein


The correct answer was:Facial vein


The facial vein descends down the face with the more convoluted facial artery and passes lateral to the mouth. It crosses the lower margin of the mandible and is joined by the anterior division of the retromandibular vein before draining into the internal jugular vein.The maxillary vein is formed in the infratemporal fossa from the pterygoid venous plexus. The maxillary vein joins the superficial temporal vein to form the retromandibular vein.The external jugular vein is formed at the angle of the jaw by the union of the posterior auricular vein with the posterior division of the retromandibular vein. It descends anterior to the sternocleidomastoid muscle as compared to the internal jugular which descends in the carotid sheath deep to the sternocleidomastoid muscle.Q42 Identify this cavity:

A. Third VentricleB. Fourth VentricleC. Cerebello-medullary cisternD. Lateral ventricleE. Cavernous sinus


The correct answer was:Fourth Ventricle


The fourth ventricle is a tent shaped cavity filled with cerebrospinal fluid. It is situated anterior to the cerebellum and posterior to the pons. It is continuous above with the third ventricle via the cerebral aqueduct.The cerebellomedullary cistern is an expansion of the subarachnoid space just inferior to the cerebellum and fourth ventricle. The lateral ventricles are C shaped and follow, roughly, the form of the cerebral hemispheres. They have parts in each of the four lobes. Each lateral ventricle communicates with the third ventricle by way of a interventricular foramen. The cavernous sinus is a venous sinus with no direct connection to the fourth ventricle. It is situated either side of the sphenoid bone and is important clinically because of its potential to allow infection to spread to the brain.Q43 Identify this area:

A. Cerebral aqueductB. Fourth VentricleC. Central canal of spinal cordD. Median apertureE. Foramen of Luschka


The correct answer was:Cerebral aqueduct


The cerebral aqueduct is a narrow channel which allows cerebrospinal fluid to flow from the third to the fourth ventricle. The fourth ventricle is a tent shaped cavity filled with cerebrospinal fluid. It is situated anterior to the cerebellum and posterior to the pons. It is continuous below with the central canal of the spinal cord. The roof or posterior wall of the fourth ventricle is pierced in the midline by a large median aperture commonly known as the foramen of Magendie. Lateral openings of the fourth ventricle extend through a recess on either side of the roof passing anteriorly around the medulla. These openings are known as the foramen of Luschka and together with foramen of Magendie allow the cerebrospinal fluid produced in the ventricular system to communicate with the cerebral subarachnoid space.Q44 Identify this area:

A. Straight sinusB. Inferior sagittal sinusC. Transverse sinusD. Sigmoid sinusE. Cavernous sinus


The correct answer was:Straight sinus


The straight sinus joins the inferior sagittal sinus at the lower border of the falx cerebri to the transverse sinus. The transverse sinus lies in the lateral attached margin of the tentorium cerebelli and ends on each side by becoming a sigmoid sinus which in turn drains into the internal jugular vein. The two cavernous sinuses lie on the lateral side of the sphenoid bone. Each sinus connects anteriorly with the inferior opthalmic and facial vein thus providing an important route for spread of infection from the cutaneous area. The sinuses drain posteriorly into the transverse sinus through the superior petrosal sinus.Q45 Identify this muscle:

A. SternocleidomastoidB. SternohyoidC. ThyrohyoidD. PlatysmaE. Omohyoid


The correct answer was:Omohyoid


The superior belly of the omohyoid muscle acts to depress the hyoid along with all other infrahyoid muscles except sternothyroid. The muscle originates from the scapula and inserts into the body of the hyoid. The intermediate tendon being bound to the clavicle. The structure immediately lateral to the omohyoid is sternocleidomastoid. The structure just medial is the sternohyoid muscle which obscures the view of the thyrohyoid. During swallowing the thyrohyoid muscle will act to elevate the larynx towards the more stable hyoid bone and thus help protect the airway. The platysma muscle has been removed from this dissection. It is large thin muscle connected to the deep fascial layer of the upper chest which acts to depress the body of the mandible.Q46 Which cranial nerve supplies this extra-ocular muscle?

A. Oculomotor (III)B. Trochlear (IV)C. Trigeminal (V)D. Abducent (VI)E. Optic (II)




The lateral rectus is innervated by the abducent nerve (CN VI). The superior oblique muscle is innervated by the trochlear nerve (CN IV). The superior, inferior and medial recti and inferior oblique muscles are innervated by the oculomotor nerve (CN III). The examination of extraocular muscle movement is an integral part of the clinical neurological examination.Q47 Identify this cranial nerve:

A. Optic (II)B. Oculomotor (III)C. Trochlear (IV) D. Abducent (VI)E. Trigeminal (V)




The cranial nerves are numbered in rostrocaudal order, in this dissection the abducent nerve (VI) is highlighted as it emerges from anterior surface of the brain between the pons and medulla oblongata.The two optic nerves (II) join at the optic chiasm which can easily be seen. The oculomotor nerve (III) emerges next at the anterior surface of the midbrain followed by the trochlear nerve (IV) emerging from the posterior surface which cannot be seen. The trigeminal nerve (V) is the largest cranial nerve leaving the anterolateral aspect of the pons with a large sensory and small motor root.Q48 The parasympathetic supply to this gland runs through which cranial nerve?

A. Oculomotor (III)B. Glossopharyngeal (IX)C. Facial (VII)D. Vagus (X)E. Trigeminal (V)


The correct answer was:Trigeminal (V)


The parotid gland is supplied by parasympathetic secretomotor fibres traveling via the glossopharyngeal nerve and synapsing at the otic ganglion. The fibres traveling via the oculomotor nerve synapse at the ciliary ganglion and in turn control the constrictor pupillae of the iris and ciliary muscles. Parasympathetic fibres reach the submandibular ganglion via the the chorda tympani nerve, a branch of the facial nerve, before going on to supply the submandibular and sublingual glands. The vagus nerve controls various parasympathetic functions in the thorax such as control of smooth muscle contraction and heart rate. The trigeminal nerve has no parasympathetic outflow from its nucleus in the brainstem. It is however closely involved with the pterygopalatine parasympathetic ganglion.Q49 Identify this structure:

A. FornixB. Septum pellucidumC. Corpus callosumD. Lateral ventricleE. Interventricular foramen


The correct answer was:Septum pellucidum


The septum pellucidum is a thin vertical sheet of nervous tissue consisting of white and gray matter and covered by ependyma. It stretches between the fornix and the corpus callosum. It is essentially a double membrane with a small closed cavity between the membranes. The septum pellucidum forms a partition between the anterior horns of the lateral ventricles. The interventricular foramen allows a communication between the lateral ventricles and the single third ventricle. It is situated inferior to the septum pellucidum at the anterior part of the medial wall of the lateral ventricle.Q50 This is the medial aspect of a mandible. Identify the muscle:

A. Lateral pterygoidB. MasseterC. TemporalisD. BuccinatorE. Medial pterygoid


The correct answer was:Medial pterygoid


The medial pterygoid together with lateral pterygoid originates from the lateral pterygoid plate area with insertions at the medial surface of the angle of mandible and TMJ articular disc / neck of mandible respectively. The masseter muscle originates at the zygomatic arch and inserts at the lateral surface of the ramus. The temporalis muscle originates at the floor of the temporal fossa and inserts into the coronoid process of the mandible. Buccinator is a muscle of facial expression and is therefore supplied by the facial nerve, it acts to compress the cheek and lips against the teeth.