Head and Neck – Session 3
1
Complete this table (doing further questions will give you the
answers probably, so try and do this first without looking at
anything else)
Number
1
2
3
4
5
6
7
8
9
10
11
12
Number
1
2
3
4
5
6
7
8
9
10
11
12
Max.
Mark
6
Name
Function
Sensory
Motor
Trochlear
Abducant
Facial
Glossopharyngeal
Sensory
Both
Both
Spinal Accessory
Motor
Name
Olfactory
Optic
Oculomotor
Trochlear
Trigeminal
Abducant
Facial
Vestibulocochlear
Glossopharyngeal
Vagus
Spinal Accessory
Hypoglossal
Function
Sensory
Sensory
Motor
Motor
Both
Motor
Both
Sensory
Both
Both
Motor
Motor
Actual
Mark
2
Describe the special sensory function of Cranial Nerve I
Distributed to the uppermost part of the nasal cavity (x1)
Responsible for smell (x1)
Max.
Mark
Actual
Mark
1
3
Describe the course of Cranial Nerve I
Reaches the nose via the cribiform plate of the ethmoid bone (x1)
Max.
Mark
Actual
Mark
1
4
Max.
Mark
Describe what injury may damage Cranial Nerve I and what it
would result in. What sign is associated with this injury?
Fractures of the cribriform plate involving the dura mata (x1) May
be associated with leakage of CSF from the nose (rhinorrhea) (x1)
Fractures of the cribiform plate may result in anosmia (x1)
Actual
Mark
3
5
Max.
Mark
Describe what injuries and conditions may result in nerve
lesions on CN II and how it would present.
Direct trauma to eye or orbit (x1)
Fracture of the optic canal (x1)
Pressure on optic pathway (x1)
Loss of pupillary constriction and visual field defects (x1)
Actual
Mark
4
6
Describe the motor functions of Cranial Nerve III
Innervates the Extraocular muscles (x1)
Innervates the Ciliary muscles (x1)
Innervates the Sphincter Pupillae (x1)
Max.
Mark
Actual
Mark
7
Describe what injuries/conditions may cause a nerve lesion on
Cranial Nerve III and how it would present
Fractures involving the cavernous sinus (x1)
Aneurysms (x1)
Dilated pupil, ptosis, eye turns down and out, loss of pupillary reflex
on affected side
(1 mark for every 2 correct presentations)
Max.
Mark
Actual
Mark
4
8
Describe the motor functions of Cranial Nerve IV
Innervates the Superior Oblique of the Eye (x1)
Max.
Mark
Actual
Mark
1
9
Max.
Mark
Describe what injuries/conditions may lead to nerve lesions
on Cranial Nerve IV and how such lesions would present
Stretching of the nerve during its course around the brainstem (x1)
Orbit fractures (x1)
Inability to look down when eye is adducted (x1)
Actual
Mark
2
10
What are the three divisions of cranial nerve V?
Opthalmic (x1)
Maxillary (x1)
Mandibular (x1)
Max.
Mark
Actual
Mark
3
11
Max.
Mark
2
Describe the function of CN V1 and what reflex its responsible
for
Sensory (skin, cornea) (x1)
Corneal Reflex (x1)
Actual
Mark
12
Describe the function of CN V2
Max.
Mark
Sensory (x1)
Skin, Mucous membranes of nose, palate and upper dental arcade
(x1)
Actual
Mark
2
13
Max.
Mark
Describe the function of CN V2
Both (x1)
Sensory - Skin, lower teeth, cheek and anterior 2/3rd of tongue
(general sensation) (x1)
Motor – Muscles of mastication (x1)
Actual
Mark
3
14
Max.
Mark
How will nerve lesions of Cranial Nerve V manifest?
Paralysis of muscles and sharp intense facial pain
Actual
Mark
1
15
Describe the function of Cranial Nerve VI
Motor (x1)
Innervates the lateral rectus (x1)
Max.
Mark
Actual
Mark
2
16
Describe what injury may cause for Cranial Nerve VI to
become damaged and how this will manifest
Fractures involving the cavernous sinus or orbit (x1)
Eye fails to move laterally, diplopia on lateral gaze (x1)
Max.
Mark
2
Actual
Mark
17
Describe the sensory function of Cranial Nerve VII
Max.
Mark
Special sensory (taste) for anterior 2/3rds of the tongue (x1)
General sensory fibres supply part of the external acoustic meatus
and auricle (x1)
Actual
Mark
2
18
Describe the motor function of Cranial Nerve VII
Muscles of facial expression (x1)
Parasympathetic secretomotor to submandibular and sublingual
salivary glands via the chorda tympani (x1)
Parasympathetic secretomotor to glands of nasal mucosa,
paranasal sinuses, palate and lacrimal gland (x1)
Max.
Mark
Actual
Mark
3
19
Max.
Mark
Describe how laceration or contusion in the parotid region,
leading to subsequent damage to Cranial Nerve VII would
manifest.
Paralysis of facial muscles, eye remains open, angle of mouth
droops, forehead does not wrinkle (x1)
Bells Ballsy (x1)
Actual
Mark
2
20
Describe how fracture of the temporal bone, leading to
subsequent damage to Cranial Nerve VII would manifest.
Bells Palsy (x1)
Involvement of the cochlear nerve and chorda tympani, dry cornea,
loss of taste in anterior 2/3rds of the tongue (x1)
Max.
Mark
Actual
Mark
21
Describe how an intracranial haematoma, leading to
subsequent damage to Cranial Nerve VII would manifest.
Forehead becomes wrinkled because of bilateral innervation of
frontalis muscle (x1)
Paralysis of contralateral forehead muscles (x1)
Max.
Mark
Actual
Mark
22
Describe the special sensory functions of Cranial Nerve VIII
Max.
Mark
Balance & Hearing (x1)
Vestibular branch controls balance (x1)
Cochlear branch controls hearing (x1)
23
Actual
Mark
Describe what injuries/conditions may lead to nerve lesions of
Cranial Nerve VIII
Skull fractures (x1)
Ear infections (x1)
Tumour of the nerve (acoustic neuroma) (x1)
Max.
Mark
Actual
Mark
3
24
Max.
Mark
4
Describe how nerve lesions of Cranial Nerve VIII would
manifest
Progressive, unilateral hearing loss (x1)
Tinnitus (x1)
Vertigo (x1)
Acoustic Neuroma frequently impairs the facial nerve aswell (x1)
Actual
Mark
25
Describe the sensory function of Cranial Nerve IX
General and special sensory to posterior 1/3rd of the tongue (x1)
Sensory to carotid body and sinus (x1)
General sensory widely distributed to the pharynx, oropharyngeal
isthmus, dorsum of palate, auditory tube and related structures, the
mastoid antrum and the mastoid air cells (x1)
Max.
Mark
Actual
Mark
3
26
Describe the motor function of Cranial Nerve IX
Innervates the stylopharyngeus (x1)
Parasympathetic fibres to parotid salivary gland (x1)
Max.
Mark
Actual
Mark
2
27
Max.
Mark
Describe what injuries/conditions might cause nerve lesions
to Cranial Nerve IX and how this would manifest
Deep lacerations of the neck (x1)
Loss of taste to posterior 1/3rd of the tongue (x1)
Actual
Mark
2
28
Max.
Mark
Describe the sensory functions of Cranial Nerve X
General sensory to lower pharynx and larynx, external auditory
meatus and back of auricle (x1)
Special sensory (taste) to epiglottis (x1)
Actual
Mark
2
29
Describe the motor functions of Cranial Nerve X
Max.
Mark
Innervates all muscles of the pharynx, except stylopharyngeus (x1)
Innervates muscles of airways, larynx, heart and GI tract (x1)
Innervates all of the palate muscles, except tensor veli palatine (x1)
3
Actual
Mark
30
Max.
Mark
Describe what conditions/injuries might cause nerve lesions
to the recurrent laryngeal branch of the Cranial Nerve X
Bronchial or oesophageal carcinoma (x1)
Enlarged mediastinal lymph nodes (x1)
Stretched over aortic arch aneurysm (x1)
Actual
Mark
3
31
Describe how a nerve lesion to the recurrent laryngeal branch
of Cranial Nerve X would manifest and why
Hoarseness of voice (x1)
Due to vocal cord paralysis (x1)
Max.
Mark
Actual
Mark
2
32
Max.
Mark
A patient comes in with palpitations, chest pain and
haemoptysis. Upon auscultation, the first heart sound is very
loud and a mid-diastolic rumbling murmur can be heard at the
apical region with the bell of a stethoscope. What condition
does this patient have and how can it eventually come to
affect the left recurrent laryngeal nerve?
Mitral stenosis (x1)
Causes an enlarged left atrium (x1)
This pushes up the left pulmonary artery (x1)
This compresses the left recurrent laryngeal nerve against the
aortic arch (x1)
Actual
Mark
4
33
Max.
Mark
2
How might the superior laryngeal nerve be damaged in a
thyroidectomy?
External branch lies close to superior thyroid artery (x1)
May be damaged when ligating the blood vessel (x1)
Actual
Mark
34
Max.
Mark
Describe the different components of CN XI and what they
innervate
Cranial component (x1) – Innervates the pharynx, larynx and soft
palate (x1)
Actual
Mark
Spinal component (x1) – Innervates the trapezius and
sternoclanomastoid muscles (x1)
4
35
Max.
Mark
Describe some injuries/conditions that could cause nerve
lesions to Cranial Nerve XI and how this would present
Surgery or lacerations to the neck (x1)
Paralysis of SCM and superior fibres of Trapezius (x1)
Shoulder droop (x1)
Actual
Mark
3
36
Describe the motor functions of Cranial Nerve XII
Motor (x1) – Innervates all of the Extrinsic and Intrinsic muscles of
the tongue except palatoglossus (x1)
Max.
Mark
Actual
Mark
2
37
Max.
Mark
Describe some injuries/conditions that could cause nerve
lesions to Cranial Nerve XII and how this would present
Neck lacerations and basal skull fractures may cause nerve lesions
(x1)
Protruded tongue deviates towards affected side (x1)
Actual
Mark
2
38
Max.
Mark
4
Name where the autonomic sympathetic innervation of the
head and neck comes from and describe its location
Sympathetic Trunk (x1)
Anterolateral to vertebral column (x1)
Lying on the prevertebral fascia and muscles (x1)
Deep to carotid sheath (x1)
Actual
Mark
39
Max.
Mark
Describe where preganglionic autonomic sympathetic fibres
arise and where they may synapse
Arise mainly in the first thoracic neural segment (x1)
May synapse in one of the three cervical sympathetic ganglia (x1)
Superior, Middle and Inferior (x1)
Actual
Mark
3
40
Generally, after synapsing, what do the postganglionic fibres
travel as?
What do they travel with?
Internal and External Carotid Nerves (x1)
Along blood vessels (x1)
Max.
Mark
Actual
Mark
2
41
Max.
Mark
Specifically, after synapsing, what do the postganglionic
fibres from the Superior Cervical Ganglion pass with and
where do they branch to?
Pass with Internal and External carotid arteries and its branches
(x1)
Pharyngeal Plexus (x1)
Upper 4 cervical nerves (x1)
Cardiac Branch to the cardiac plexus (x1)
Actual
Mark
4
42
Max.
Mark
3
Specifically, after synapsing, what do the postganglionic
fibres from the Middle Cervical Ganglion pass with and where
do they go to?
Pass with the Inferior Thyroid Artery (x1)
5th and 6th Cervical Nerves (x1)
Cardiac branch to the Cardiac Plexus (x1)
Actual
Mark
43
Max.
Mark
Specifically, after synapsing, what do the postganglionic
fibres from the Inferior Cervical Ganglion pass with and where
do they branch to?
Vertebral artery (x1)
7th and 8th Cervical Nerves (x1)
Cardiac Branch to the Cardiac Plexus (x1)
Actual
Mark
3
44
Max.
Mark
In 80% of people, what happens to the Inferior Cervical
Ganglion?
Combines with the 1st Thoracic Ganglion (x1) to form the Stellate
ganglion (x1)
Actual
Mark
2
45
Max.
Mark
Name the 4 pairs of autonomic parasympathetic ganglia
Ciliary Ganglion (x1)
Pterygopalatine Ganglion (x1)
Submandibular Ganglion (x1)
Otic Ganglion (x1)
Actual
Mark
4
46
Which 4 Cranial Nerves have brainstem nuclei?
Max.
Mark
Oculomotor (CN III) (x1)
Facial (CN VII) (x1)
Glossopharyngeal (CN IX) (x1)
Vagus (CN X) (x1)
Actual
Mark
4
47
Max.
Mark
3
Which of these three nerves have branches that reach the
autonomic parasympathetic ganglia? Match them
Oculomotor (CN III) → Ciliary Ganglion (x1)
Facial (CN VII) → Pterygopalatine/Submandibular Ganglion (x1)
Glossopharyngeal (CN IX) → Otic Ganglion (x1)
Actual
Mark
48
Max.
Mark
In the 4 Cranial nerves that have brainstem nuclei, where do
their preganglionic fibres synapse?
In either the aforementioned ganglia (x1)
Or the in the walls of the organs they supply in the neck, thorax and
abdomen (x1)
Actual
Mark
2
49
Max.
Mark
Where does the Ciliary Ganglion lie?
In the orbital cavity, lateral to optic nerve (x1)
Actual
Mark
1
50
Max.
Mark
Where does the Ciliary Ganglion receive its parasympathetic
fibres from?
What do these supply?
Sphincter Papillae (x1)
Ciliary Muscles (x1)
Actual
Mark
2
51
Where does the Ciliary Ganglion receive its sympathetic fibres
from?
What do these supply?
Superior Cervical Ganglion (x1)
Via the plexus on the Opthalmic artery (First branch of the Internal
Carotid Artery) (x1)
Distributed to the eyeball (x1)
Max.
Mark
Actual
Mark
3
52
Where does the Pterygopalatine Ganglion lie?
Lies in the pterygopalatine fossa (x1)
Max.
Mark
1
Actual
Mark
53
Max.
Mark
Where does the Pterygopalatine Ganglion receive its
parasympathetic fibres from?
What do these supply?
Derived from the Facial Nerve (CN VII) via the greater petrosal
nerve (x1)
Lacrimal glands (x1)
Glands of the nose, palate and nasopharynx (x1)
Actual
Mark
3
54
Max.
Mark
Where does the Pterygopalatine Ganglion receive its
sympathetic fibres from?
What do these supply?
Superior Cervical Ganglion (x1)
Via the plexus on the internal carotid artery (x1)
Distributed to the nose, palate and nasopharynx (x1)
Actual
Mark
3
55
Where does the Submandibular Ganglion lie?
Suspended from the lingual nerve by small branches (x1)
Max.
Mark
Actual
Mark
1
56
Max.
Mark
4
Where does the Submandibular Ganglion receive its
parasympathetic fibres from?
What do these supply?
From the Facial Nerve (CN VII) via the Chorda Tympani, then the
lingual nerve (x1)
Submandibular Gland (x1)
Sublingual Gland (x1)
Other glands on the floor of the oral cavity (x1)
Actual
Mark
57
Max.
Mark
Where does the Submandibular Ganglion receive its
sympathetic fibres from?
What do these supply?
Sympathetic fibres come from the Superior Cervical Ganglion along
the facial artery (x1)
Pass to the glands in the floor of the oral cavity (x1)
Actual
Mark
2
58
Max.
Mark
59
Where does the Otic Ganglion receive its parasympathetic
fibres from?
What do these supply?
Derived from the glossopharyngeal nerve via the auricotemporal
nerve (x1)
Actual
Mark
Where does the Otic Ganglion receive its sympathetic fibres
from?
What do these supply?
Come from Superior Cervical Ganglion along the Middle Meningeal
Artery (x1)
Pass into the parotid gland (x1)
Max.
Mark
Actual
Mark
2
60
Describe the direct autonomic supply of CN IX
Glands of the oropharynx (x1)
Posterior third of the tongue (x1)
Max.
Mark
Actual
Mark
2
61
Max.
Mark
2
Describe the direct autonomic supply of CN X
Glands of the laryngopharynx, larynx, oesophagus and trachea (x1)
Ganglion cells are on the viscus (x1)
Actual
Mark
61
What is the name of the resulting condition of interruption of a
cervical sympathetic trunk or ganglia?
Why does it present?
Horners Syndrome (x1)
Manifested by the absence of sympathetically stimulated functions
on the ipsilateral side of the head (x1)
Max.
Mark
Actual
Mark
2
62
Describe some of the symptoms of interruption of a cervical
sympathetic trunk or ganglia and why they happen
Miosis/Constriction of the pupil (x1) – Parasympathetically
stimulated Sphincter Papillae of the pupil is unopposed (x1)
Max.
Mark
Ptosis/Drooping of the superior eyelid (x1) – Paralysis of the
smooth muscle fibres interdigitated with the aponeurosis of the
Lavater Palpebrae Superiosis that collectively constitute the
Superior Tarsal muscle (x1)
Vasodilation/Redness and increased skin temperature (x1) – Loss
of sympathetic tone (x1)
Anhydrosis/Absence of sweating (x1) – Loss of sympathetic tone
(x1)
8
Actual
Mark