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Prof. Dr. M. Saeed ShafiMBBS, M.Phil, FIAS (UK), DCPS (HPE), MP-HSE(US), FISAMS(PRC)

Member AACA (USA); Member AMEE(UK)Member Pakistan Medical Research CouncilConvenor, PMRC Expert Panel in Anatomy.

Principal &DeanSahara Medical College & Sughra Shafi Medical Complex, Narowal-Pakistan

(A Project of SAHARA for Life Trust- Registered Charity in Pak/USA/UK &Japan)Tel: +92-42-509-2228; Mobile: +92-321-4539461.

Fax:+92-423-596-3940 & +92-423-666-9095.E-mail: msaeedshafi@hotmail.com & principal@saharaforlife.org

URL: www.saharaforlife.org

Q1. A 55-year old female was brought to the emergency room withbilateral decreased eye movements and decreased vision. There ishistory of boil nose 5 days ago. MRI scan showed cavernous sinusthrombosis. The infection spread from the facial vein to thecavernous sinus thorough which of following veins.

• Angular vein

• Pterygoid venous plexus

• Deep facial vein

• Maxillary vein

• Ophthalmic veins

C: Ophthalmic Veins

Q2. A 40 year old woman presented with complaint of severeintermittent pricking pain affecting right side of her face. This painwas precipitated while washing face and when exposed to cold air.Pain also aggravated while taking cold drinks. Which of thefollowing nerve is involved in this case?

A. CN VII

B. CN IX

C. CN XII

D. CN X

E. CN V

E: 5th CN

Q3. Carotid bodies are located in the carotid triangle of the neck.They have very rich nerve supply. Which of the following suppliesthe carotid body?

A. Accessory nerve

B. Vagus nerve

C. Hypoglossal nerve

D. Glossopharyngeal nerve

E. Middle cervical ganglion

D: 9th CN

Q4. A 42-year old business man went for a late lunch to a fast food restaurant andordered an extra large beef burger. He had to open his mouth extra wide for a big bite.There was a clicking sound from the jaw and he could not close the mouth. He was takento the hospital where he was diagnosed to have dislocation of temporomandibular joint(TMJ). Which of the following nerve can be damaged as a result of this dislocation

A. facial

B. auriculotemporal

C. zygomaticotemporal

D. zygomaticofacial

E. great auricular

B: Auriculotemporal N.

Q5. A soldier presented in the emergency with bullet injury to neck. Intraoperatively thebullet track was found passing through anterior part of digastric triangle. Which of thefollowing is most likely to be damaged?

A. Internal jugular vein

B. Vagus nerve

C. Stylopharyngeus muscle

D. Glossopharyngeal nerve

E. Facial artery

E: Facial A.

Q6. The characteristic feature of Atlas is its:

A. odontoid process

B. massive body

C. absent body

D. long spinous process

E. absent foramen transversarium

C: Absent body

Q7. One of the following muscles is inserted into articular disc of temporomandibularjoint.

A. Masseter

B. Medial pterygoid

C. Lateral pterygoid

D. Anterior fibers of temporalis

E. Posterior fibers of temporalis

C: Lateral pterygoid

Q8. A 20-year old medical student has a infection involving the upper eyelid. Which of thefollowing group of lymph nodes will be enlarged as a result of the spread of infection?

A. Buccal

B. Anterior cervical

C. Submandibular

D. Mastoid

E. Superficial parotid

E: Superficial parotid

Q9. A 50 years old male patient presented to ENT OPD with a palpable mass in leftsubmandibular region along with drooping of left angle of mouth. FNAC of the massshowed it to be adenoid cystic carcinoma. Which of the following muscle is affected?

A. Orbicularis oris

B. levator labii superioris

C. Levator labii superioris aleque nasi

D. Depressor anguli oris

E. levator anguli oris

D: Depressor anguli oris

Q10. A 50 years old male patient presented to ENT OPD with a palpable mass in leftsubmandibular region along with drooping of left angle of mouth. FNAC of the massshowed it to be adenoid cystic carcinoma. In the above patient which branch of facialnerve has been damaged?

A. Zygomatic

B. Buccal

C. Mandibular

D. Cervical

E. Temporal

C: Mandibular

Q11. A 15- years old male patient presented with bilateral painfulparotid swellings diagnosed as mumps. The pain is caused bystretching of the parotid capsule. Which of the following nerves actas afferent for the pain sensation in this case?

A. Auriculotemporal

B. Zygomaticotemporal

C. Zygomaticofacial

D. Great auricular

E. Transverse cervical

D: Great auricular N.

Q12. A patient is being operated upon for removal of a tumor inthe deep lobe of parotid gland. The surgeon will find the deep lobein relation to which of the following parts of the mandible?

A. Ramus

B. Body

C. Angle

D. Condyloid process

E. Coronoid process

A: Ramus

Q13. An ENT surgeon is doing submandibular gland excision due totumor. Which one of the following structures is at maximum riskwhen submandibular duct is divided?

A. Glossopharyngeal nerve

B. Lingual nerve

C. Submandibular ganglion

D. Facial artery

E. Facial vein

B: Lingual N.

Q14. A dysfunction of one of the following muscles will allow foodto collect in the vestibule of the mouth

A. Orbicularis oris

B. Zygomaticus major

C. Lateral pterygoid

D. Masseter

E. Buccinator

E: Buccinator

Q15. A boxer receives an upwardly directed blow on the mandible. Which of the following structures will prevent dislocation of the temporo-mandibular joint?

A. Masseter

B. Medial pterygoid

C. Stylomandibular ligament

D. Sphenomandibular ligament

E. Lateral temporomandibular ligament

E: Lateral temporomandibular ligament

Q16. A 43- year old woman was seen in emergency department with a large abscess in the middle of right posterior triangle of neck .It was red and hot. The physician decided to incise it. The patient came after 5 days with the complaint that she couldn’t raise her right hand above her head to brush her hair. It is due to involvement of which one of the following nerve/s?

A. Cervical plexusB. Sympathetic plexusC. Upper trunk of brachial plexusD. Lower trunk of plexusE. Spinal part of accessory nerve

E: 11th CN; Spinal part

Q17. Defective formation of intermaxillary segment will affect the development of which of the following?

A. PhiltrumB. Lower lipC. Upper cheekD. Apex of noseE. Alae of nose

A: Philtrum

Q19. A 65-year-old man is admitted to hospital for biopsy of a chronic ulcer on the posterior third of the tongue. Biopsy result revealed it to be malignant. Which of the following lymph nodes will be ultimately involved?

A. SubmentalB. SubmandibularC. Jugulo-omohyoidD. jugulo-digastricE. supraclavicular

D

Q20. A 45 years old male is brought to the operating room for the excision of pleomorphic adenoma of right parotid gland. Which of the following is least likely to be damaged during the excision of the gland?

A. Facial nerveB. Posterior auricular nerveC. Superficial temporal arteryD. Retromandibular veinE. External carotid artery

B

Q23. A 30- year old primigravida delivered a baby boy with a cleft palate. These congenital anomalies occur at which period of intrauterine life.

A. 4th & 5th weekB. 5th & 6th weekC. 6th & 7th weekD. 7th &8th weekE. 8th & 9th week

D

Q25. A 50-year-old chronic smoker has recently been diagnosed as having bronchogenic cancer. Later he developed metastases in the left supraclavicular lymph nodes, resulting in the involvement of the stellate ganglion. Which type of ganglion is this one?

A. SympatheticB. ParasympatheticC. Dorsal rootD. SpinalE. Sensory

A

Q29. A 60 years old male Naswar addict, presented with a mass in floor of mouth. The biopsy of the mass showed it to be a malignant tumor. Which of the following lymph node groups will be involved first?

A. Sub-mentalB. SubmandibularC. Anterior cervical D. Superficial cervical E. Deep cervical

A

Q31. Yawning induces drainage of the pterygoid venous plexus. This structure has a close relationship to which of the following muscles?

A. MasseterB. TemporalisC. BuccinatorD. Lateral pterygoidE. Medial pterygoid

D

Q33. A 35 years old male presented with complaints of left sided painful parotid swelling for the last 3 days. Pussy discharge was seen coming out of the opening of parotid duct that opens opposite:

A. Upper first premolarB. Upper second molarC. Lower second molarD. Lower first molarE. Lower third molar

B

Q36. A 55 years old female presented with facial nerve paralysis due to middle ear tumor. This lesion will affect which of the following muscles

A. OmohyoidB. ThyrohyoidC. GeniohyoidD. MylohyoidE. Stylohyoid

E

Q37. Which muscle is responsible for producing wrinkles on forehead?

A. OccipitalisB. FrontalisC. Orbicularis OculiD. ProcerusE. Levator palpebral superiorus

B

Q42. A 25 years old female presented with history of numbness in front of the right ear and an area of skin extending from the angle of the mandible to mastoid process following removal of lymph nodes from her posterior triangle. Which of the following nerves is likely to be affected?

A. Transverse cervicalB. Great auricularC. AuriculotemporalD. ZygomaticotemporalE. Zygomaticofacial

B

Q45. A 7-year- old boy presented with a well circumscribed painful hematoma in the left parietal eminence after his head bumped against a wall. There is no skull fracture. Which of the following locations is the site of this hematoma?

A. SkinB. Dense Connective tissue. C. Epicranial Aponeurosis. D. Loose areolar tissue.E. Pericranium.

D

Q 47. A 27-year-old woman with a goiter comes to the hospital for surgical treatment. The surgeon must ligate the superior laryngeal artery to secure hemostasis. Surgeon must take care to avoid injury to which of the following nerves?

A. External laryngeal nerveB. Internal laryngeal nerveC. Superior laryngeal nerveD. Hypoglossal nerveE. Vagus nerve

A

Q48. A 43-year-old man has new onset of difficulty with speaking. Examination by the ENT resident reveals problems in elevating the hyoid bone and floor of the mouth, secondary to paralysis of the posterior belly of the digastric muscle. Which of the following nerves is most likely involved?

A. Accessory nerveB. Trigeminal nerveC. Ansa cervicalisD. Facial nerveE. Glossopharyngeal nerve

D