Head & Neck Practice Questions

Question 1

A 28-year-old man is admitted to the hospital for the evaluation of symmetric, ascending weakness that started in his feet and has become progressively worse over the past 5 days. A lumbar puncture is performed to confirm the diagnosis. As the needle is advanced during the procedure, there is resistance just before entering the epidural space. This resistance is most likely due to which of the following structures?

Accepted Answer

Ligamentum flavum

Answer

Dura mater

Answer

Supraspinous ligament

Answer

Interspinous ligament

Answer

Superficial fascia

Question 2

A 65-year-old male presents to the emergency room complaining of a severe headache. He developed a sudden-onset severe throbbing headache while watching a football game on television. His past medical history is significant for migraines and hypertension; however, he states that this headache is different from his normal migraine headaches. He has a 30 pack-year smoking history. His family history is notable for stroke in his mother and father. His temperature is 98.9°F (37.2°C), blood pressure is 150/90 mmHg, pulse is 100/min, and respirations are 14/min. On examination, he is oriented to person, place, and time. Neck motion is limited due to pain. Strength is 5/5 bilaterally in both the upper and the lower extremities and sensation is grossly intact across all the dermatomal distributions. Patellar, brachioradialis, and Achilles reflexes are 2+ bilaterally. The vessel that is most commonly involved in this patient's likely condition directly branches off which of the following vessels?

Accepted Answer

Internal carotid artery

Answer

Middle cerebral artery

Answer

Maxillary artery

Answer

Anterior cerebral artery

Answer

Posterior cerebral artery

Question 3

A 60-year-old male is admitted to the ICU for severe hypertension complicated by a headache. The patient has a past medical history of insulin-controlled diabetes, hypertension, and hyperlipidemia. He smokes 2 packs of cigarettes per day. He states that he forgot to take his medications yesterday and started getting a headache about one hour ago. His vitals on admission are the following: blood pressure of 160/110 mmHg, pulse 95/min, temperature 98.6 deg F (37.2 deg C), and respirations 20/min. On exam, the patient has an audible abdominal bruit. After administration of antihypertensive medications, the patient has a blood pressure of 178/120 mmHg. The patient reports his headache has increased to a 10/10 pain level, that he has trouble seeing, and he can't move his extremities. After stabilizing the patient, what is the best next step to diagnose the patient's condition?

Accepted Answer

CT head without intravenous contrast

Answer

Doppler ultrasound of the carotids

Answer

CT head with intravenous contrast

Answer

MRI head without intravenous contrast

Answer

MRI head with intravenous contrast

Question 4

A 16-year-old girl presents with a sore throat. The patient says symptoms onset acutely 3 days ago and have progressively worsened. She denies any history of cough, nasal congestion or rhinorrhea. No significant past medical history or current medications. The vital signs include: temperature 37.7°C (99.9°F), blood pressure 110/70 mm Hg, pulse 74/min, respiratory rate 20/min, and oxygen saturation 99% on room air. Physical examination is significant for anterior cervical lymphadenopathy. There is edema of the oropharynx and tonsillar swelling but no tonsillar exudate. Which of the following is the next best step in management?

Accepted Answer

Rapid strep test

Answer

Reassurance

Answer

Empiric treatment with antibiotics

Answer

Empiric treatment with antivirals

Answer

Ultrasound of the anterior cervical lymph nodes

Question 5

A 45-year-old patient presents with difficulty speaking and swallowing following a stroke. MRI reveals an infarct in the medulla. Which of the following cranial nerve nuclei is most likely affected?

Accepted Answer

Nucleus ambiguus

Answer

Vestibulocochlear nucleus

Answer

Trigeminal nerve nucleus

Answer

Facial nerve nucleus

Question 6

A 78-year-old man is brought in to the emergency department by ambulance after his wife noticed that he began slurring his speech and had developed facial asymmetry during dinner approximately 30 minutes ago. His past medical history is remarkable for hypertension and diabetes. His temperature is 99.1°F (37.3°C), blood pressure is 154/99 mmHg, pulse is 89/min, respirations are 12/min, and oxygen saturation is 98% on room air. Neurologic exam reveals right upper and lower extremity weakness and an asymmetric smile. Which of the following is the next best step in management?

Accepted Answer

CT head

Answer

Alteplase

Answer

MRI brain

Answer

Aspirin

Answer

CTA head

Question 7

A 72-year-old woman is brought in to the emergency department after her husband noticed that she appeared to be choking on her dinner. He performed a Heimlich maneuver but was concerned that she may have aspirated something. The patient reports a lack of pain and temperature on the right half of her face, as well as the same lack of sensation on the left side of her body. She also states that she has been feeling "unsteady" on her feet. On physical exam you note a slight ptosis on the right side. She is sent for an emergent head CT. Where is the most likely location of the neurological lesion?

Accepted Answer

Medulla

Answer

Pons

Answer

Internal capsule

Answer

Cervical spinal cord

Answer

Midbrain

Question 8

During a surgical procedure involving the posterior triangle of the neck, which of the following muscles forms its anterior boundary?

Accepted Answer

Sternocleidomastoid

Answer

Scalene anterior

Answer

Trapezius

Answer

Omohyoid

Question 9

A 26-year-old man is brought to the emergency department by ambulance after being involved in a motor vehicle collision. He does not open his eyes on command or respond to verbal cues. A CT scan of the head shows a hyperdense fluid collection in the right medial temporal lobe with medial displacement of the uncus and parahippocampal gyrus of the temporal lobe. Which of the following cranial nerves is most likely to be injured as a result of this patient's lesion?

Accepted Answer

Oculomotor

Answer

Vagus

Answer

Facial

Answer

Abducens

Answer

Trigeminal

Question 10

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?

Accepted Answer

Parasympathetic innervation to the parotid gland

Answer

Somatic sensory innervation to the roof of the pharynx

Answer

Parasympathetic innervation to the trachea

Answer

Somatic sensory innervation to the lower lip

Answer

Parasympathetic innervation to the submandibular gland

Head & Neck

Study Resources

Lessons

Questions

Flashcards

Lessons

Skull and cranial cavity

Face and scalp

Orbital structures

Ear anatomy and vestibular system

Nasal cavity and paranasal sinuses

Oral cavity and pharynx

Larynx and vocal apparatus

Triangles of the neck

Deep structures of the neck

Cranial nerves and their pathways

Cervical sympathetic chain

Practice Questions

Flashcards

About Head & Neck for USMLE

Lessons in Head & Neck

Master Head & Neck