Complete Test Bank for Netter Atlas of Human Anatomy: Classic Regional Approach, 8th
Edition
## Section 1: Head and Neck (Questions 1-40)
**1. A 46-year-old woman presents with painful erythematous vesicular eruptions over the right
upper eyelid and forehead, spreading into her hairline. She is diagnosed with herpes zoster (shingles).
Which nerve is most likely responsible for transmitting this virus?**
A) Auriculotemporal nerve
B) Greater petrosal nerve
C) Nasociliary nerve
D) Supraorbital nerve
E) Zygomatic nerve
**Answer: D**
*Rationale:* The supraorbital nerve, a branch of the ophthalmic division of the trigeminal nerve (V1),
provides sensory innervation to the forehead, upper eyelid, and scalp. Herpes zoster follows the
dermatomal distribution of the affected sensory nerve. The nasociliary nerve innervates the cornea
and tip of the nose, not the forehead hairline .
**2. A teenage gang member receives a knife cut inferior to the angle of the mandible. The patient's
hypoglossal nerve was completely severed. Which muscle would most likely be affected?**
A) Anterior belly of the digastric
B) Genioglossus
C) Geniohyoid
D) Mylohyoid
E) Stylohyoid
**Answer: B**
*Rationale:* The hypoglossal nerve (CN XII) innervates all intrinsic and extrinsic muscles of the tongue,
including the genioglossus. The genioglossus is the primary muscle that protrudes the tongue.
Damage to CN XII causes the tongue to deviate toward the affected side upon protrusion. The
anterior belly of the digastric, mylohyoid, and geniohyoid are innervated by the trigeminal nerve (CN
V3); the stylohyoid is innervated by the facial nerve (CN VII) .
,**3. A 2-month-old infant presents with no evidence of a thymus and uncertainty regarding the
number of parathyroid glands and location of parathyroid tissue. Which pharyngeal pouch may be
responsible for these findings?**
A) First pouch
B) Second and third pouches
C) Third pouch
D) Third and fourth pouches
E) Fourth pouch
**Answer: D**
*Rationale:* The third and fourth pharyngeal pouches give rise to the thymus and parathyroid glands.
The third pouch forms the inferior parathyroid glands and the thymus; the fourth pouch forms the
superior parathyroid glands. Abnormal development of these pouches can lead to DiGeorge
syndrome, characterized by thymic aplasia and parathyroid agenesis .
**4. A tumor compresses the sympathetic trunk in the lower neck. Which muscle is most likely
affected?**
A) Ciliary muscle
B) Orbicularis oculi
C) Pupillary constrictor
D) Superior tarsal muscle
E) Levator palpebrae superioris
**Answer: D**
*Rationale:* The superior tarsal muscle (Mueller's muscle) is innervated by sympathetic fibers from
the superior cervical ganglion. Compression of the sympathetic trunk in the lower neck can result in
Horner syndrome, characterized by ptosis (due to paralysis of the superior tarsal muscle), miosis, and
anhidrosis .
**5. A 31-year-old man is diagnosed with a benign pituitary adenoma that has impinged on the right
aspect of the cavernous sinus. Which clinical sign is most likely to be evident?**
A) Bilateral painful ophthalmoplegia
B) Left-sided diplopia
C) Left-sided complete ptosis
D) Right-sided pupillary dilation
,E) Right-sided dry eye
**Answer: D**
*Rationale:* The cavernous sinus contains cranial nerves III (oculomotor), IV (trochlear), V1
(ophthalmic), V2 (maxillary), and VI (abducens), as well as the internal carotid artery. Compression of
the oculomotor nerve (CN III) causes pupillary dilation (mydriasis) and ptosis on the ipsilateral side
due to paralysis of the pupillary constrictor and levator palpebrae superioris muscles. The abducens
nerve (CN VI) is most commonly affected, but pupillary dilation is a classic sign of cavernous sinus
involvement .
**6. A 56-year-old woman presents with diplopia of the left eye, complete left-sided ptosis, and an
absent corneal reflex. A lesion at which location would most likely account for this presentation?**
A) Foramen ovale
B) Foramen rotundum
C) Inferior orbital fissure
D) Optic canal
E) Superior orbital fissure
**Answer: E**
*Rationale:* The superior orbital fissure transmits cranial nerves III, IV, V1, and VI, as well as the
ophthalmic veins. A lesion at this location can cause ophthalmoplegia (diplopia), ptosis (CN III), and
loss of corneal reflex (CN V1). This combination of findings is classic for superior orbital fissure
syndrome .
**7. A young child falls while sucking on a lollipop, and the stick lacerates the posterior wall of the
oropharynx. As a precaution, the physician prescribes a broad-spectrum antibiotic. Which space is
most likely to harbor an infection after this type of puncture wound?**
A) Epidural space
B) Mediastinum
C) Pretracheal space
D) Retropharyngeal space
E) Subdural space
**Answer: D**
*Rationale:* The retropharyngeal space lies between the buccopharyngeal fascia and the
prevertebral fascia, extending from the base of the skull to the superior mediastinum. A puncture
, wound to the posterior wall of the oropharynx can introduce infection into this space, which can then
spread inferiorly into the mediastinum. This is a surgical emergency .
**8. A baseball player is hit in the left eye and orbital region, resulting in a blow-out fracture with
inferior herniation of orbital contents. Into which space did the orbital contents herniate?**
A) Cavernous sinus
B) Ethmoid sinus
C) Frontal sinus
D) Maxillary sinus
E) Sphenoid sinus
**Answer: D**
*Rationale:* Blow-out fractures of the orbit typically involve the thin floor of the orbit (orbital plate of
the maxilla). Increased orbital pressure forces orbital contents (such as the inferior rectus muscle and
orbital fat) through the fracture into the underlying maxillary sinus. This can cause entrapment of the
inferior rectus muscle, leading to limited upward gaze .
**9. A traumatic injury to the right side of the neck requires significant surgical attention. The patient
has a hoarse voice that will not resolve with time. Which nerve was most likely damaged?**
A) Ansa cervicalis
B) Hypoglossal
C) Recurrent laryngeal
D) Superior laryngeal
E) Sympathetic trunk
**Answer: C**
*Rationale:* The recurrent laryngeal nerve innervates all intrinsic muscles of the larynx except the
cricothyroid, which is innervated by the external branch of the superior laryngeal nerve. Damage to
the recurrent laryngeal nerve causes ipsilateral vocal fold paralysis, resulting in a hoarse voice. The
ansa cervicalis innervates the infrahyoid muscles; the hypoglossal nerve innervates the tongue; and
the sympathetic trunk affects pupillary function .
**10. An elderly woman stumbles while walking down stairs but catches herself before falling. On
examination, she presents with diplopia when looking inferiorly. Which nerve is most likely
affected?**
Edition
## Section 1: Head and Neck (Questions 1-40)
**1. A 46-year-old woman presents with painful erythematous vesicular eruptions over the right
upper eyelid and forehead, spreading into her hairline. She is diagnosed with herpes zoster (shingles).
Which nerve is most likely responsible for transmitting this virus?**
A) Auriculotemporal nerve
B) Greater petrosal nerve
C) Nasociliary nerve
D) Supraorbital nerve
E) Zygomatic nerve
**Answer: D**
*Rationale:* The supraorbital nerve, a branch of the ophthalmic division of the trigeminal nerve (V1),
provides sensory innervation to the forehead, upper eyelid, and scalp. Herpes zoster follows the
dermatomal distribution of the affected sensory nerve. The nasociliary nerve innervates the cornea
and tip of the nose, not the forehead hairline .
**2. A teenage gang member receives a knife cut inferior to the angle of the mandible. The patient's
hypoglossal nerve was completely severed. Which muscle would most likely be affected?**
A) Anterior belly of the digastric
B) Genioglossus
C) Geniohyoid
D) Mylohyoid
E) Stylohyoid
**Answer: B**
*Rationale:* The hypoglossal nerve (CN XII) innervates all intrinsic and extrinsic muscles of the tongue,
including the genioglossus. The genioglossus is the primary muscle that protrudes the tongue.
Damage to CN XII causes the tongue to deviate toward the affected side upon protrusion. The
anterior belly of the digastric, mylohyoid, and geniohyoid are innervated by the trigeminal nerve (CN
V3); the stylohyoid is innervated by the facial nerve (CN VII) .
,**3. A 2-month-old infant presents with no evidence of a thymus and uncertainty regarding the
number of parathyroid glands and location of parathyroid tissue. Which pharyngeal pouch may be
responsible for these findings?**
A) First pouch
B) Second and third pouches
C) Third pouch
D) Third and fourth pouches
E) Fourth pouch
**Answer: D**
*Rationale:* The third and fourth pharyngeal pouches give rise to the thymus and parathyroid glands.
The third pouch forms the inferior parathyroid glands and the thymus; the fourth pouch forms the
superior parathyroid glands. Abnormal development of these pouches can lead to DiGeorge
syndrome, characterized by thymic aplasia and parathyroid agenesis .
**4. A tumor compresses the sympathetic trunk in the lower neck. Which muscle is most likely
affected?**
A) Ciliary muscle
B) Orbicularis oculi
C) Pupillary constrictor
D) Superior tarsal muscle
E) Levator palpebrae superioris
**Answer: D**
*Rationale:* The superior tarsal muscle (Mueller's muscle) is innervated by sympathetic fibers from
the superior cervical ganglion. Compression of the sympathetic trunk in the lower neck can result in
Horner syndrome, characterized by ptosis (due to paralysis of the superior tarsal muscle), miosis, and
anhidrosis .
**5. A 31-year-old man is diagnosed with a benign pituitary adenoma that has impinged on the right
aspect of the cavernous sinus. Which clinical sign is most likely to be evident?**
A) Bilateral painful ophthalmoplegia
B) Left-sided diplopia
C) Left-sided complete ptosis
D) Right-sided pupillary dilation
,E) Right-sided dry eye
**Answer: D**
*Rationale:* The cavernous sinus contains cranial nerves III (oculomotor), IV (trochlear), V1
(ophthalmic), V2 (maxillary), and VI (abducens), as well as the internal carotid artery. Compression of
the oculomotor nerve (CN III) causes pupillary dilation (mydriasis) and ptosis on the ipsilateral side
due to paralysis of the pupillary constrictor and levator palpebrae superioris muscles. The abducens
nerve (CN VI) is most commonly affected, but pupillary dilation is a classic sign of cavernous sinus
involvement .
**6. A 56-year-old woman presents with diplopia of the left eye, complete left-sided ptosis, and an
absent corneal reflex. A lesion at which location would most likely account for this presentation?**
A) Foramen ovale
B) Foramen rotundum
C) Inferior orbital fissure
D) Optic canal
E) Superior orbital fissure
**Answer: E**
*Rationale:* The superior orbital fissure transmits cranial nerves III, IV, V1, and VI, as well as the
ophthalmic veins. A lesion at this location can cause ophthalmoplegia (diplopia), ptosis (CN III), and
loss of corneal reflex (CN V1). This combination of findings is classic for superior orbital fissure
syndrome .
**7. A young child falls while sucking on a lollipop, and the stick lacerates the posterior wall of the
oropharynx. As a precaution, the physician prescribes a broad-spectrum antibiotic. Which space is
most likely to harbor an infection after this type of puncture wound?**
A) Epidural space
B) Mediastinum
C) Pretracheal space
D) Retropharyngeal space
E) Subdural space
**Answer: D**
*Rationale:* The retropharyngeal space lies between the buccopharyngeal fascia and the
prevertebral fascia, extending from the base of the skull to the superior mediastinum. A puncture
, wound to the posterior wall of the oropharynx can introduce infection into this space, which can then
spread inferiorly into the mediastinum. This is a surgical emergency .
**8. A baseball player is hit in the left eye and orbital region, resulting in a blow-out fracture with
inferior herniation of orbital contents. Into which space did the orbital contents herniate?**
A) Cavernous sinus
B) Ethmoid sinus
C) Frontal sinus
D) Maxillary sinus
E) Sphenoid sinus
**Answer: D**
*Rationale:* Blow-out fractures of the orbit typically involve the thin floor of the orbit (orbital plate of
the maxilla). Increased orbital pressure forces orbital contents (such as the inferior rectus muscle and
orbital fat) through the fracture into the underlying maxillary sinus. This can cause entrapment of the
inferior rectus muscle, leading to limited upward gaze .
**9. A traumatic injury to the right side of the neck requires significant surgical attention. The patient
has a hoarse voice that will not resolve with time. Which nerve was most likely damaged?**
A) Ansa cervicalis
B) Hypoglossal
C) Recurrent laryngeal
D) Superior laryngeal
E) Sympathetic trunk
**Answer: C**
*Rationale:* The recurrent laryngeal nerve innervates all intrinsic muscles of the larynx except the
cricothyroid, which is innervated by the external branch of the superior laryngeal nerve. Damage to
the recurrent laryngeal nerve causes ipsilateral vocal fold paralysis, resulting in a hoarse voice. The
ansa cervicalis innervates the infrahyoid muscles; the hypoglossal nerve innervates the tongue; and
the sympathetic trunk affects pupillary function .
**10. An elderly woman stumbles while walking down stairs but catches herself before falling. On
examination, she presents with diplopia when looking inferiorly. Which nerve is most likely
affected?**
