Physician Assistant Written Examination Question Pool - Lower Limb and Back

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Lectures 56 and 57: Cervical Fascia

Essay - Handwritten Prose. 10 Points Each.

1. Discuss the boundaries, relationships, contents, and clinical significance of the pretracheal space.
2. Discuss the boundaries, relationships, contents, and clinical significance of the retropharyngeal space.
3. Discuss the boundaries, relationships, contents, and clinical significance of the "danger" space.
4. Discuss the boundaries, relationships, contents, and clinical significance of the carotid sheath.

Lecture 61: Face and External Skull. (J. Radler)

Essay - Handwritten Prose. 10 Points Each.

1. insert some clinical stem. Compare and contrast the facial musculature actively involved in production of a smile and of a frown. Address all aspects of facial expression, not just movements of the mouth. Include all relevant muscles and their actions. Describe the general distribution of the facial nerve branches on the face.

True/False. 1 Point Each.

1. The following muscles contribute to elevation of the upper lip (as during a smile): levator labii superioris, zygomaticus minor, orbicularis oris.
2. Complete transection of the left CN VII as it emerges from the stylomastoid foramen will result in denervation of the occipitofrontalis muscle bilaterally.
3. The auriculotemporal nerve, a branch of the ophthalmic division of the trigeminal nerve (V₁), innervates the side of the scalp anterior and superior to the auricle.
4. The anastamosis between the angular artery and the dorsal nasal artery serves as a connection between branches of the exteral carotid artery and the interal carotid artery.

Lecture 62: Parotid Region, Scalp, Facial Nerve. (M. Pearce-Clawson)

Essay - Handwritten Prose. 10 Points Each.

1. A patient presents to your office with clear loss of tone to the entire left side of their face. You perform an exam and observe that the patient doesn’t have any ability to move the muscles of facial expression on the left side of their face. You also note that the patients ability to taste is functioning as normal, there is no decrease in saliva production, and their ability to swallow is affected. Discuss the anatomy of the facial nerve as it pertains to the patients symptoms. Include in your answer the foramina and canals that the facial nerve passes through, the branches of the facial nerve affected, the nucleus that gives rise to the neurons that are affected, and why the patient is still able to taste and produce saliva.

True/False. 1 Point Each.

Lecture 63: Infratemporal Fossa & TMJ. (L. Urbanik)

Essay - Handwritten Prose. 10 Points Each.

1. A patient presents with pain, swelling and stiffness of the jaw and face. Upon examination, you note there is an inability to close the jaw as well as a misalignment of the upper and lower jaw. Discuss the anatomy of the temporomandibular joint, including bones, ligaments, muscles, movements, neurovasculature, cavities and contents. Provide a potential diagnosis for the patient.
2. Following an infection of the right third mandibular molar, a patient presents with severe right jaw pain and an inability to open their mouth. Discuss the anatomy of the infratemporal fossa, including bones, boundaries, contents, arterial supply, venous communications, innervation, ganglia and functional components. Provide a potential diagnosis for the patient.

True/False. 1 Point Each.

1. The superior synovial cavity is a gliding joint that allows for protraction and retraction of the mandible.
2. The inferior synovial cavity is a hinge joint that allows for elevation and depression of the mandible.
3. The temporomandibular ligament limits lateral and posterior displacement of the mandible.
4. The posterior fibers of the temporalis muscle can retract the mandible.
5. The superior head of the lateral pterygoid muscle inserts into the capsule of the TMJ.
6. The superficial temporal artery is not a content of the temporal fossa.
7. The pterygomaxillary fissure transmits the sphenopalatine artery from the infratemporal fossa into the pterygopalatine fossa.
8. The pterygoid plexus of veins communicates with the cavernous sinus by way of the emissary vein of Vesalius.
9. The inferior alveolar nerve, proximal to the mandibular foramen, carries both GSA and SVE fibers.
10. The lingual nerve is joined by the chorda tympani nerve carrying SVA and GVE fibers.
11. The parasympathetic root of the otic ganglion is the lesser superficial petrosal nerve.
12. Postganglionic axons leaving the superior cervical sympathetic ganglion travel as the internal carotid nerve.

Lecture 64: Cranial Meninges, Dural Venous Sinuses, and Bony Cranial Fossae. (M. Olsen)

Essay - Handwritten Prose. 10 Points Each.

True/False. 1 Point Each.

Lecture 65: Gross Anatomy, Function, Blood Supply of Brain. (M. Johnson)

Essay - Handwritten Prose. 10 Points Each.

1. Berry, or saccular, aneurysms account for 90% of intracranial aneurysms. Describe the blood supply of the brain, including major sources of arterial blood, terminal branches and cerebral regions supplied, the circle of Willis, and venous drainage. Describe common regions where berry aneurysms occur.
2. A 71-year-old male with a history of cigarette smoking and hypertension comes to your clinic 5 months after experiencing an episode of right hand weakness and speech difficulty, “mixing up words.” He also experiences dim, blurry vision in the left eye. He has fallen on three separate occasions when his right leg suddenly gave out. What is the most likely cause of this patient’s transient neurologic episodes? For EACH of the episodes listed above, identify the artery involved and describe its pathway, including regions and functions supplied, and relationships.

True/False. 1 Point Each.

Lecture 66: Cranial Fossa, Cavernous Sinus. (G. Francis)

Essay - Handwritten Prose. 10 Points Each.

1. A 19-year-old patient presents to the clinic with fever, headache, and proptosis. An abscess located on the patient’s face near the upper lip leads you to suspect a cavernous sinus thrombosis. Describe the contents, relationships, and borders of the cavernous sinus. Include in your answer additional symptoms associated with cavernous sinus thrombosis and propose a pathway for the infection to have traveled from the abscess to the cavernous sinus.

True/False. 1 Point Each.

1. The optic nerve exits the anterior cranial fossa to enter the orbit by passing through the optic canal.
2. The abducens nerve is unique in that it is the only cranial nerve to arise from the brainstem’s posterior surface.
3. The vestibulocochlear nerve and glossopharyngeal nerve exit the posterior cranial fossa by passing through the internal acoustic meatus.
4. The diaphragma sellae consists of two layers of meningeal dura that lies inferior to the pituitary gland.
5. The dorsum sellae is a component of the anterior boundary of the middle cranial fossa.
6. Compression of the oculomotor nerve within the cavernous sinus can lead to mydriasis.

Lecture 70: Pharynx. (J. Radler)

Essay - Handwritten Prose. 10 Points Each.

1. A 55-year-old male was drinking when his friend made a hilarious joke. As he began laughing, the water shot out his nose and he began coughing. A critical role of the pharynx is preventing swallowed solids or liquids from entering the larynx or nasal cavity. Review the anatomy of each region of the pharynx. Discuss movements of the pharynx and larynx during swallowing that separate the pathway of swallowed contents from the pathway of respiration.

True/False. 1 Point Each.

1. The levator veli palatini, palatopharyngeus, and salpingopharyngeus muscles contribute to the movements of swallowing.
2. The palatine tonsils are located between the palatopharyngeal arch and the palatoglossal arch.
3. The vallecula is a space located between the posterior aspect of the tongue and the epiglottis.
4. The piriform recesses are regions of the laryngopharynx that lie lateral to the larynx itself.
5. CN IX is at risk for iatrogenic injury during routine palatine tonsillectomy due to its close relationship to the palatine tonsil.
6. The pharyngeal (adenoid) tonsil is commonly removed in young children because it reaches its largest size relative to the nasopharynx around 5 years of age and thus can impair normal breathing.
7. Elevation of the soft palate such that it forms a seal against the posterior wall of the pharynx is critical for clear phonation (speech) as well as preventing swallowed contents from entering the nasal cavity.

Lecture 73: Oral Region. (L. Urbanik)

Essay - Handwritten Prose. 10 Points Each.

1. A patient suffers a laceration to the neck just below the mandible on the right side. Following recovery, it is noted that when asked to protrude the tongue, the patient's tongue deviates towards the right side. Discuss the anatomy of the tongue, including intrinsic and extrinsic muscles, movements, and neurovasculature. Provide a potential diagnosis for the patient.
2. You take a sip of boilo and realize that, in addition to its great flavor, it is too hot to drink. Discuss the sensory pathways accounting for general sensation and taste from the anterior 2/3 and posterior 1/3 of the tongue.

True/False. 1 Point Each.

1. The oral vestibule is formed by the insertion of the buccinator muscle into the maxilla and mandible.
2. All of the intrinsic muscles of the tongue are innervated by the hypoglossal nerve (CN XII).
3. The hard palate forms the superior border of the oral cavity.
4. The sensation of taste (SVA) from the anterior 2/3 of the tongue is carried by the chorda tympani nerve.
5. The filiform papillae do not contain taste buds and therefore do not contribute to the sensation of taste.
6. The lingual nerve in the floor of the oral cavity is crossed superiorly by Wharton's duct.
7. The parotid gland secretes an entirely serous saliva that is carried to the oral cavity by Stenson's duct.
8. Both the hard palate and dorsal surface of the tongue are lined with masticatory mucosa.