COMSAE PHASE 1 HEAD & NECK ANATOMY
PRACTICE EXAM WITH ACTUAL
QUESTIONS AND VERIFIED ANSWERS,
PLUS EXPLAINED RATIONALES/EXPERT
VERIFIED FOR GUARANTEED 100% PASS
2026/LATEST UPDATE/INSTANT
DOWNLOAD PDF
1. Cranial Fossae and Foramina
A 32-year-old patient sustains a basilar skull fracture involving the
middle cranial fossa. On examination, the patient has decreased
sensation over the anterior two-thirds of the tongue, weakness of the
muscles of mastication, and loss of the corneal reflex on the affected
side. Which cranial nerve is most likely injured as it passes through the
foramen ovale?
A. Ophthalmic division of CN V
B. Maxillary division of CN V
C. Mandibular division of CN V
D. Facial nerve
E. Glossopharyngeal nerve
Answer: C. Mandibular division of CN V
Rationale: The mandibular division of the trigeminal nerve (V3) exits
the cranial cavity through the foramen ovale and provides both
sensory and motor innervation. It carries general somatic afferent
sensation from the lower face, anterior two-thirds of the tongue via the
lingual nerve, and motor fibers to the muscles of mastication. The
ophthalmic division passes through the superior orbital fissure,
whereas the maxillary division passes through the foramen rotundum.
1
,2. Cavernous Sinus
A patient develops cavernous sinus thrombosis following an infection in
the region of the upper lip. The patient has ophthalmoplegia, ptosis, and
facial sensory loss. Which cranial nerve is particularly vulnerable
because it travels directly through the center of the cavernous sinus
alongside the internal carotid artery?
A. CN III
B. CN IV
C. CN V1
D. CN V2
E. CN VI
Answer: E. CN VI
Rationale: The abducens nerve (CN VI) travels within the cavernous
sinus alongside the internal carotid artery, making it especially
vulnerable to cavernous sinus pathology. CN III, CN IV, V1, and V2
travel within the lateral wall of the cavernous sinus. CN VI injury
produces weakness of lateral rectus, resulting in impaired abduction
and medial deviation of the eye.
3. Facial Nerve
During parotid gland surgery, a surgeon accidentally transects a nerve
within the substance of the gland. The patient subsequently develops
paralysis of muscles of facial expression on the ipsilateral side. Which
structure was most likely injured?
A. Glossopharyngeal nerve
B. Facial nerve
C. Auriculotemporal nerve
2
,D. Hypoglossal nerve
E. Greater auricular nerve
Answer: B. Facial nerve
Rationale: The facial nerve enters the parotid gland and divides within
it into its major terminal branches: temporal, zygomatic, buccal,
marginal mandibular, and cervical. Although the facial nerve passes
through the parotid gland, it does not provide its parasympathetic
secretomotor innervation. Injury within the gland causes ipsilateral
paralysis of facial expression.
4. Muscles of Mastication
A patient develops difficulty elevating the mandible after trauma
involving the infratemporal fossa. Which muscle is primarily responsible
for elevation of the mandible and is innervated by the mandibular
division of the trigeminal nerve?
A. Lateral pterygoid
B. Medial pterygoid
C. Masseter
D. Mylohyoid
E. Buccinator
Answer: C. Masseter
Rationale: The masseter is one of the four principal muscles of
mastication and powerfully elevates the mandible. It receives motor
innervation from V3 through the masseteric nerve. The medial
pterygoid also elevates the mandible, while the lateral pterygoid
primarily assists protrusion and depression of the mandible.
5. Parotid Gland
3
, A lesion compresses structures traveling through the parotid gland.
Which sequence correctly describes the relative arrangement of the
facial nerve, retromandibular vein, and external carotid artery from
superficial to deep?
A. External carotid artery → retromandibular vein → facial nerve
B. Retromandibular vein → facial nerve → external carotid artery
C. Facial nerve → retromandibular vein → external carotid artery
D. Facial nerve → external carotid artery → retromandibular vein
E. Retromandibular vein → external carotid artery → facial nerve
Answer: C. Facial nerve → retromandibular vein → external
carotid artery
Rationale: Within the parotid gland, the facial nerve is the most
superficial of these three structures, followed by the retromandibular
vein and then the external carotid artery. This relationship is clinically
important during parotidectomy because facial nerve branches must
be carefully identified and preserved.
6. Tongue Innervation
A patient undergoes surgery involving the floor of the mouth.
Postoperatively, the patient has loss of general sensation and taste from
the anterior two-thirds of the tongue, but the patient retains normal
general sensation and taste from the posterior third. Which nerve carries
taste fibers from the anterior two-thirds of the tongue?
A. Hypoglossal nerve
B. Glossopharyngeal nerve
C. Lingual nerve alone
D. Chorda tympani
E. Greater petrosal nerve
Answer: D. Chorda tympani
4
PRACTICE EXAM WITH ACTUAL
QUESTIONS AND VERIFIED ANSWERS,
PLUS EXPLAINED RATIONALES/EXPERT
VERIFIED FOR GUARANTEED 100% PASS
2026/LATEST UPDATE/INSTANT
DOWNLOAD PDF
1. Cranial Fossae and Foramina
A 32-year-old patient sustains a basilar skull fracture involving the
middle cranial fossa. On examination, the patient has decreased
sensation over the anterior two-thirds of the tongue, weakness of the
muscles of mastication, and loss of the corneal reflex on the affected
side. Which cranial nerve is most likely injured as it passes through the
foramen ovale?
A. Ophthalmic division of CN V
B. Maxillary division of CN V
C. Mandibular division of CN V
D. Facial nerve
E. Glossopharyngeal nerve
Answer: C. Mandibular division of CN V
Rationale: The mandibular division of the trigeminal nerve (V3) exits
the cranial cavity through the foramen ovale and provides both
sensory and motor innervation. It carries general somatic afferent
sensation from the lower face, anterior two-thirds of the tongue via the
lingual nerve, and motor fibers to the muscles of mastication. The
ophthalmic division passes through the superior orbital fissure,
whereas the maxillary division passes through the foramen rotundum.
1
,2. Cavernous Sinus
A patient develops cavernous sinus thrombosis following an infection in
the region of the upper lip. The patient has ophthalmoplegia, ptosis, and
facial sensory loss. Which cranial nerve is particularly vulnerable
because it travels directly through the center of the cavernous sinus
alongside the internal carotid artery?
A. CN III
B. CN IV
C. CN V1
D. CN V2
E. CN VI
Answer: E. CN VI
Rationale: The abducens nerve (CN VI) travels within the cavernous
sinus alongside the internal carotid artery, making it especially
vulnerable to cavernous sinus pathology. CN III, CN IV, V1, and V2
travel within the lateral wall of the cavernous sinus. CN VI injury
produces weakness of lateral rectus, resulting in impaired abduction
and medial deviation of the eye.
3. Facial Nerve
During parotid gland surgery, a surgeon accidentally transects a nerve
within the substance of the gland. The patient subsequently develops
paralysis of muscles of facial expression on the ipsilateral side. Which
structure was most likely injured?
A. Glossopharyngeal nerve
B. Facial nerve
C. Auriculotemporal nerve
2
,D. Hypoglossal nerve
E. Greater auricular nerve
Answer: B. Facial nerve
Rationale: The facial nerve enters the parotid gland and divides within
it into its major terminal branches: temporal, zygomatic, buccal,
marginal mandibular, and cervical. Although the facial nerve passes
through the parotid gland, it does not provide its parasympathetic
secretomotor innervation. Injury within the gland causes ipsilateral
paralysis of facial expression.
4. Muscles of Mastication
A patient develops difficulty elevating the mandible after trauma
involving the infratemporal fossa. Which muscle is primarily responsible
for elevation of the mandible and is innervated by the mandibular
division of the trigeminal nerve?
A. Lateral pterygoid
B. Medial pterygoid
C. Masseter
D. Mylohyoid
E. Buccinator
Answer: C. Masseter
Rationale: The masseter is one of the four principal muscles of
mastication and powerfully elevates the mandible. It receives motor
innervation from V3 through the masseteric nerve. The medial
pterygoid also elevates the mandible, while the lateral pterygoid
primarily assists protrusion and depression of the mandible.
5. Parotid Gland
3
, A lesion compresses structures traveling through the parotid gland.
Which sequence correctly describes the relative arrangement of the
facial nerve, retromandibular vein, and external carotid artery from
superficial to deep?
A. External carotid artery → retromandibular vein → facial nerve
B. Retromandibular vein → facial nerve → external carotid artery
C. Facial nerve → retromandibular vein → external carotid artery
D. Facial nerve → external carotid artery → retromandibular vein
E. Retromandibular vein → external carotid artery → facial nerve
Answer: C. Facial nerve → retromandibular vein → external
carotid artery
Rationale: Within the parotid gland, the facial nerve is the most
superficial of these three structures, followed by the retromandibular
vein and then the external carotid artery. This relationship is clinically
important during parotidectomy because facial nerve branches must
be carefully identified and preserved.
6. Tongue Innervation
A patient undergoes surgery involving the floor of the mouth.
Postoperatively, the patient has loss of general sensation and taste from
the anterior two-thirds of the tongue, but the patient retains normal
general sensation and taste from the posterior third. Which nerve carries
taste fibers from the anterior two-thirds of the tongue?
A. Hypoglossal nerve
B. Glossopharyngeal nerve
C. Lingual nerve alone
D. Chorda tympani
E. Greater petrosal nerve
Answer: D. Chorda tympani
4
