Anatomy of the Face, Neck, Eye, Ear, and Oral Cavity Practice Questions

25 multiple-choice questions on Anatomy of the face, neck, eye, ear, and oral cavity for paramedic and EMT students, from Chapter 34 (Face and Neck Trauma). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. A man fell forward onto his chin. He has a small chin laceration and pain just in front of both ears when he opens his mouth. You should suspect:

   1. A. A simple bruise of the chin only
   2. B. Fractures of the mandibular condyles
   3. C. Bilateral ruptured eardrums only
   4. D. Fractures of the two zygomatic arches
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   Answer: B. Fractures of the mandibular condyles

   Force to the chin is transmitted up the mandible to the condyles at the jaw joints, which often fracture, sometimes on both sides, causing pain in front of the ears and malocclusion. The pain location is not explained by a chin bruise or eardrum injury, and zygomatic arch fractures follow a blow to the side of the face.

2. After his forehead struck a dashboard, a driver has a depressed, tender area just above the eyebrows and clear fluid dripping from his nose. You should suspect:

   1. A. Frontal sinus fracture, CSF leak
   2. B. A simple nasal bone fracture only
   3. C. A Le Fort I fracture of the maxilla
   4. D. An orbital floor blowout fracture
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   Answer: A. Frontal sinus fracture, CSF leak

   The frontal sinus lies behind the forehead above the eyebrows; a depressed fracture there can extend through its back wall to the brain coverings, causing CSF rhinorrhea and infection risk. Allow the fluid to drain, avoid nasal airways and nose-blowing, and transport. An isolated nasal fracture does not depress the forehead, a Le Fort I fracture runs above the upper teeth well below the frontal sinus, and an orbital floor fracture lies beneath the eye rather than above the eyebrows.

3. The prominence of the cheek is formed mainly by the:

   1. A. Maxilla
   2. B. Temporal bone
   3. C. Sphenoid
   4. D. Zygoma
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   Answer: D. Zygoma

   The zygoma, or malar bone, forms the cheekbone and part of the lateral and inferior orbit. The maxilla lies medial to it, beneath the eye and beside the nose.

4. The thin bone that forms the orbital floor is weakest where it overlies the:

   1. A. Frontal sinus
   2. B. Nasal septum
   3. C. Maxillary sinus
   4. D. Ethmoid air cells
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   Answer: C. Maxillary sinus

   The orbital floor is the roof of the maxillary sinus and is only a few millimeters thick, so a blow to the globe can blow it out into the sinus. The frontal sinus lies above the orbit, in the forehead.

5. Sensation of the face is carried mainly by which cranial nerve?

   1. A. Facial (CN VII)
   2. B. Glossopharyngeal (CN IX)
   3. C. Trigeminal (CN V)
   4. D. Hypoglossal (CN XII)
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   Answer: C. Trigeminal (CN V)

   The three branches of the trigeminal nerve carry facial sensation and also supply the muscles of chewing. The facial nerve controls the muscles of facial expression, not sensation of the facial skin.

6. A deep laceration in front of the ear leaves a patient unable to close the eye or raise the corner of the mouth on that side. The structure most likely injured is the:

   1. A. Trigeminal nerve
   2. B. Oculomotor nerve
   3. C. Hypoglossal nerve
   4. D. Facial nerve
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   Answer: D. Facial nerve

   The facial nerve (CN VII) runs through the parotid gland in front of the ear and controls the muscles of facial expression. The trigeminal nerve carries sensation, so its injury causes numbness rather than weakness of expression.

7. A cheek laceration over the parotid gland drains clear fluid when the patient eats. The structure most likely injured is the:

   1. A. Parotid duct
   2. B. Thoracic duct
   3. C. Lacrimal duct
   4. D. Facial artery
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   Answer: A. Parotid duct

   The parotid (Stensen) duct crosses the cheek to open opposite the upper second molar, and a cut duct leaks saliva. Lacrimal ducts drain tears near the inner corner of the eye, not the mid-cheek.

8. A man was hammering a steel chisel when something struck his eye. He has mild irritation and a tiny mark on the eye, and his vision is near normal. You should:

   1. A. Irrigate forcefully to wash it out
   2. B. Suspect a penetrating fragment; shield
   3. C. Patch the eye firmly and transport
   4. D. Evert the upper lid to search for the particle
   Show answer

   Answer: B. Suspect a penetrating fragment; shield

   Metal-on-metal hammering can launch tiny, fast fragments that penetrate the globe with few symptoms, so an intraocular foreign body must be assumed. Place a rigid shield without pressure, discourage straining, and transport for imaging. Forceful irrigation, lid eversion, or a firm patch puts pressure on the globe and could worsen a penetrating injury, and minimal symptoms do not exclude one.

9. A woman has superglue in her eye; the eyelids are stuck together. The best field care is to:

   1. A. Pull the eyelids apart firmly at once
   2. B. Cut the eyelashes to free the lids
   3. C. Apply acetone to dissolve the glue
   4. D. Use warm, moist gauze; do not pry
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   Answer: D. Use warm, moist gauze; do not pry

   Cyanoacrylate glue bonds quickly to lashes and lids but usually does not harm the eye itself. Forcing the lids open can tear the skin and cornea, cutting lashes risks injury, and solvents such as acetone damage the eye. Warm, moist compresses loosen the glue over time, and the patient should be evaluated.

10. After facial trauma, a patient's pupils both constrict when light is shone in the uninjured eye, but both dilate slightly when the light moves to the injured eye. This finding suggests injury to the:

    1. A. Oculomotor nerve on the other side
    2. B. Optic nerve on the injured side
    3. C. Cornea of the uninjured eye
    4. D. Eyelid muscles on the injured side
    Show answer

    Answer: B. Optic nerve on the injured side

    This is a relative afferent pupillary defect: the injured eye does not transmit light signals normally, so both pupils dilate when the light swings to it, indicating optic nerve or severe retinal injury. Oculomotor injury affects the pupil's ability to constrict (efferent), not the sensing of light, and eyelid or contralateral corneal injuries do not produce this pattern.

11. An alert man with a GCS of 15 was punched in the right eye. His right pupil is moderately dilated and reacts sluggishly; the left is normal. The most likely cause is:

    1. A. Direct injury to the iris muscle
    2. B. Brain herniation on the right side
    3. C. A drug that dilates the pupils
    4. D. A normal finding in most adults
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    Answer: A. Direct injury to the iris muscle

    A blow to the eye can damage the iris sphincter (traumatic mydriasis), causing a dilated, sluggish pupil in an otherwise alert patient. Herniation causes a falling level of consciousness, and drugs affect both eyes. Still document it and reassess mental status, since a head injury may coexist.

12. After a head injury, a patient cannot move his right eye outward toward the ear, and he has double vision looking right. The cranial nerve most likely affected is the:

    1. A. Optic (CN II)
    2. B. Facial (CN VII)
    3. C. Abducens (CN VI)
    4. D. Trigeminal (CN V)
    Show answer

    Answer: C. Abducens (CN VI)

    The abducens nerve controls the lateral rectus, which turns the eye outward. Its long course makes it vulnerable to head trauma and raised intracranial pressure. The optic nerve carries vision, the facial nerve controls facial expression, and the trigeminal nerve carries facial sensation and jaw motor function.

13. Most of the protective structures around the eye, including the eyelids and the bony orbit, serve mainly to:

    1. A. Produce the aqueous humor
    2. B. Focus light onto the retina
    3. C. Regulate the size of the pupil
    4. D. Shield the globe from impact
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    Answer: D. Shield the globe from impact

    The orbital rim takes the force of most blows, and the eyelids close reflexively to protect the cornea. Aqueous humor is made by the ciliary body inside the eye, not by these external structures.

14. The small bones of the middle ear that transmit sound from the tympanic membrane to the inner ear are the:

    1. A. Ossicles
    2. B. Cochleae
    3. C. Turbinates
    4. D. Mastoids
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    Answer: A. Ossicles

    The malleus, incus, and stapes form the ossicular chain in the middle ear. The cochlea is the inner ear organ that converts vibration to nerve signals.

15. After being slapped hard over the ear, a patient has severe vertigo, nausea, and jerking eye movements, along with hearing loss. These findings suggest injury to the:

    1. A. External ear canal only
    2. B. Inner ear
    3. C. Eustachian tube alone
    4. D. Outer cartilage of the ear
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    Answer: B. Inner ear

    Vertigo, nystagmus, and hearing loss after a blow or pressure injury point to the inner ear (for example, a perilymph fistula or labyrinth concussion), which needs ENT evaluation. An injury limited to the ear canal, Eustachian tube, or pinna does not cause true vertigo with nystagmus. Keep the patient still and give an antiemetic per protocol.

16. The visible external ear, made of cartilage covered by skin, is called the:

    1. A. Tragus
    2. B. Mastoid
    3. C. Pinna
    4. D. Cochlea
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    Answer: C. Pinna

    The pinna, or auricle, collects sound and has a poor blood supply, so it heals slowly after injury. The tragus is only the small flap in front of the ear canal.

17. Which structure is the most prominent landmark on the anterior neck, especially in men?

    1. A. Cricoid cartilage
    2. B. Hyoid bone
    3. C. Thyroid cartilage
    4. D. Thyroid gland
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    Answer: C. Thyroid cartilage

    The thyroid cartilage forms the Adam's apple and shields the vocal cords. The cricoid cartilage lies just below it and is smaller and less prominent.

18. During a surgical cricothyrotomy, keeping the incision at the cricothyroid membrane rather than lower on the neck helps avoid:

    1. A. The vocal cords above the membrane
    2. B. The esophagus in front of the trachea
    3. C. The carotid arteries in the midline
    4. D. The vascular thyroid isthmus
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    Answer: D. The vascular thyroid isthmus

    The thyroid isthmus crosses the upper tracheal rings below the cricoid and bleeds briskly if cut, which is one reason the cricothyroid membrane, above it, is the target. The vocal cords lie above the thyroid cartilage, the esophagus is behind the trachea, and the carotid arteries lie laterally, not in the midline.

19. In an obese patient whose neck landmarks are hard to feel, a reliable way to find the cricothyroid membrane before a surgical airway is to:

    1. A. Stabilize the larynx and walk a finger down
    2. B. Measure two fingers above the sternal notch
    3. C. Use the angle of the jaw as the landmark
    4. D. Cut where the neck creases at its base
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    Answer: A. Stabilize the larynx and walk a finger down

    The laryngeal handshake technique stabilizes the larynx between the thumb and middle finger, finds the thyroid cartilage, and slides the index finger down to the dip of the cricothyroid membrane above the cricoid ring. In a difficult neck, a vertical skin incision first helps palpation. Fixed distances from the sternal notch or jaw are unreliable, and skin creases do not mark the membrane.

20. A 27-year-old man has a laceration on the side of his neck with dark, steady, nonpulsatile bleeding. The most likely source is the:

    1. A. Common carotid artery
    2. B. Internal jugular vein
    3. C. Vertebral artery
    4. D. Facial artery
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    Answer: B. Internal jugular vein

    Venous bleeding is dark red and flows steadily, and the jugular veins carry a large volume close to the skin. Carotid bleeding is bright red and pulsatile.

21. Which vessels, running alongside the trachea within the carotid sheath, supply most of the blood to the brain?

    1. A. External jugular veins
    2. B. Common carotid arteries
    3. C. Subclavian arteries
    4. D. Internal thoracic arteries
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    Answer: B. Common carotid arteries

    Each carotid sheath holds the common carotid artery, the internal jugular vein, and the vagus nerve. The external jugular veins lie superficially, outside the sheath, and drain blood away from the head.

22. The esophagus lies in which position relative to the trachea?

    1. A. Directly posterior
    2. B. Directly anterior
    3. C. Lateral to the right
    4. D. Lateral to the left
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    Answer: A. Directly posterior

    The esophagus runs behind the trachea, in front of the cervical spine. This is why a penetrating wound deep enough to injure it often injures the airway or spine too.

23. The thyroid gland is clinically important in neck trauma because it:

    1. A. Protects the vocal cords from direct impact
    2. B. Forms the floor of the mouth
    3. C. Contains the cricothyroid membrane
    4. D. Is highly vascular and bleeds briskly
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    Answer: D. Is highly vascular and bleeds briskly

    The thyroid gland straddles the trachea below the cricoid and has a rich blood supply, so lacerating it causes significant bleeding. It is the thyroid cartilage, not the gland, that shields the vocal cords.

24. During airway management, the tongue is most likely to obstruct the airway because it is attached to the:

    1. A. Maxilla
    2. B. Hyoid only
    3. C. Mandible
    4. D. Epiglottis
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    Answer: C. Mandible

    The tongue anchors to the mandible, so when jaw muscles relax or the mandible is fractured, the tongue falls back. This is why a jaw thrust lifts the tongue off the posterior pharynx.

25. Which statement about the blood supply of the face and scalp is correct?

    1. A. It is poor, so wounds heal slowly
    2. B. It is rich, so wounds infect easily
    3. C. It comes mainly from the internal carotids
    4. D. It is rich, so wounds bleed heavily
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    Answer: D. It is rich, so wounds bleed heavily

    Branches of the external carotid supply the face and scalp densely, so even small lacerations bleed briskly but heal well. That same rich supply helps facial wounds resist infection, and the internal carotid arteries mainly supply the brain and eyes rather than the face and scalp.