ANATOMY FINALS Flashcards
A 69-year-old woman complaining of a burning pain over the left shoulder and upper part of the left arm was seen by her physician. The pain had started approximately 2 weeks previously and had progressively worsened. The pain was made worse by moving the neck. At physical examination, the patient showed hyperesthesia of the skin over the lower part of the left deltoid muscle and down the lateral side of the arm. In addition, her left deltoid and biceps brachii muscles were weaker than those on the right side. At radiologic examination, extensive osteoarthritic changes of the vertebrae with spur formation on the bodies of the fourth, fifth, and sixth cervical vertebrae were seen.
Assuming that the osteoarthritic changes caused narrowing of the cervical intervertebral foramina, which spinal nerve roots were most likely to have been pressed on to cause the burning pain and the hyperesthesia?
A. C3 and 4 B. C6 C. C5 and 6 D. C7 E. C8 and T1
C. C5 and 6
The weakness of the left deltoid and biceps brachii muscles could have resulted from pressure on which nerve roots?
A. the posterior nerve roots of C5 and 6 zz B. the anterior nerve roots of C5 and 6 C. the anterior nerve roots of C7 and 8 D. the anterior nerve roots of C8 and T1 E. None of the above.
B. the anterior nerve roots of C5 and 6
The sensory and motor changes in this patient resulted from pressure on the cervical spinal nerves or their roots as they passed through the intervertebral foramina. The following structures form the boundaries of each foramen except which?
A. intervertebral discs B. bodies of the cervical vertebrae C. the posterior longitudinal ligament D. articular processes of the vertebrae E. pedicles of the vertebrae
C. the posterior longitudinal ligament
What ligament of the vertebral column is not traversed by the spinal needle, when the anesthesiologist does a lumbar tap?
A. Supraspinous ligament B. Interspinous ligament C. Ligamentum flavum D. Intertransverse ligament E. None of the above
D. Intertransverse ligament
A 59-year-old woman with a small swelling below the chin was seen by her physician. At physical examination, a single, hard swelling could be palpated in the submental triangle. It was mobile on the deep tissues and not tethered to the skin. A diagnosis of a malignant secondary deposit in a submental lymph node was considered. Using your knowledge of anatomy, where would you look for the primary carcinoma?
A. The posterior third of the tongue B. The maxillary sinus C. The angle of the mouth D. The center of the lower lip E. The lining of the cheek
D. The center of the lower lip
To where do the submental lymph nodes drain?
A. The superficial cervical lymph nodes B. The deep cervical lymph nodes C. The submandibular lymph nodes D. The tracheobronchial lymph nodes E. The anterior cervical lymph nodes
B. The deep cervical lymph nodes-
A 45-year-old man was riding his bicycle when he swerved to avoid a pothole and lost his balance. He then crashed and hit his head against a rock. When he regained consciousness in the emergency department of a neighboring hospital, it was immediately noted that he had medial strabismus (squint) of his right eye. At questioning, the cyclist admitted that he had not been wearing a crash helmet.
Which eye muscle was paralyzed in this injury?
A. The medial rectus muscle B. The inferior rectus muscle C. The superior rectus muscle D. The lateral rectus muscle E. The superior oblique muscle
D. The lateral rectus muscle
Which nerve was damaged by the crash? A. The facial nerve B. The oculomotor nerve C. The abducent nerve D. The trochlear nerve E. The ophthalmic division of the trigeminal nerve
C. The abducent nerve
Which anatomic structure is most likely to have damaged the nerve? A. The petrous part of the temporal bone B. The greater wing of the sphenoid bone C. The lesser wing of the sphenoid bone D. The tentorium cerebelli E. The falx cerebelli
A. The petrous part of the temporal bone
A 29-year-old woman was involved in an automobile accident. Her car skidded into a tree, and she was thrown forward, striking her right knee on the dashboard. At examination in the emergency department, she was found to have a posterior fracture dislocation of her right hip joint.
What bone or bones are likely to have been fractured?
A. The greater tuberosity of the femur B. The floor of the acetabulum C. The posterior rim of the acetabulum and fracture of the femoral head D. The lesser trochanter of the femur E. The anterior inferior iliac spine
C. The posterior rim of the acetabulum and fracture of the femoral head
What anatomic structure is likely to be compromised in a hip dislocation of this type?
A. The tendon of obturator internus B. The sciatic nerve C. The quadratus femoris muscle D. The gluteus maximus muscle E. The superior gluteal nerve
B. The sciatic nerve
A 69-year-old man was walking down a flight of steps when he slipped and fell. On impact, his left foot hit the ground and was forcibly inverted and medially rotated. He stated that he felt something give on the lateral side of the dorsum of the foot. Though shocked by the fall and the resulting foot pain, he was able to walk home. Within 2 h, the left foot and ankle had swollen considerably, which made examination by his physician difficult. Movements of the ankle were clearly possible, but inversion was extremely painful. On standing, the patient could bear his body weight without too much discomfort. The physician ordered an anteroposterior and a lateral radiograph of the ankle region, both of which showed nothing abnormal. This patient was diagnosed as having an acute sprain of the lateral ankle.
Which ligament is most likely to have been damaged?
A. The deltoid ligament
B. The anterior talofibular ligament
C. The plantar calcaneonavicular ligament
D. The anterior ligament of the inferior tibiofibular joint
E. The posterior talofibular ligament
B. The anterior talofibular ligament
After a football injury, an orthopedic surgeon noted that the right tibia of the patient could be moved anteriorly with excessive freedom when the knee was flexed. 13. In this patient, which ligament is most likely to be torn? A. The lateral collateral ligament B. The posterior cruciate ligament C. The anterior cruciate ligament D. The medial collateral ligament E. The patellar ligament
C. The anterior cruciate ligament
A 30-year-old plasterer was finishing a difficult ceiling in a remodeled kitchen. He was standing on top of a stepladder with his right arm above his head. As he used his right hand to move the trowel, loaded with plaster, across the ceiling, he suddenly felt an acute spasm of pain over the tip of the right shoulder. At physical examination of the patient in the emergency department, it was found that the pain in the right shoulder recurred in the middle range of abduction and that there was extreme tenderness over the greater tuberosity of the humerus.
What is the most likely structural damage in this patient?
A. Fracture of the upper end of the humerus B. Tearing of the deltoid muscle C. Fracture of the acromion D. Lesion of the rotator cuff E. Tearing of the trapezius muscle
D. Lesion of the rotator cuff
A 17-year-old girl was thrown from her horse while attempting a difficult jump. She landed on her right shoulder and the right side of her head. It was noticed after a week of hospitalization that she kept her right arm medially rotated and close to her side with the forearm pronated. At physical examination, an area of anesthesia was found along the lateral side of the upper part of the arm
Which of the following was damaged during the accident?
A. The lower trunk of the brachial plexus
B. The axillary nerve
C. The radial nerve
D. The middle trunk of the brachial plexus
E. The C5 and C6 roots of the brachial plexus
E. The C5 and C6 roots of the brachial plexus
The position adopted by the right arm in this patient can be explained by paralysis of which of the following groups of muscles?
A. Supraspinatus, deltoid, biceps brachii, greater part of brachialis, infraspinatus, and teres minor
B. Latissimus dorsi, triceps, anconeus, brachioradialis, and supinator
C. Flexor digitorum superficialis, flexor pollicis longus, flexor carpi radialis longus, and flexor carpi ulnaris
D. Extensor carpi ulnaris, supinator, extensor indicis, and extensor digiti minimi
E. Pectoralis major, abductor pollicis longus, extensor pollicis brevis, and extensor pollicis longus
A. Supraspinatus, deltoid, biceps brachii, greater part of brachialis, infraspinatus, and teres minor
A 19-year-old girl was seen in the emergency department and found to have a knife wound to the front of her left wrist. A careful examination revealed that two superficial tendons on either side of the median nerve had been severed.
Which of the following tendons were likely to have been cut?
A. The flexor pollicis longus and the pronator quadratus tendons
B. The flexor carpi ulnaris and the flexor digitorum profundus tendons
C. The flexor digitorum superficialis and the flexor carpi radialis tendons
D. The brachioradialis and the pronator teres tendons
E. The abductor pollicis longus and the extensor pollicis brevis tendons
C. The flexor digitorum superficialis and the flexor carpi radialis tendons
On examination of a 53-year-old woman, it was found that she could abduct her left shoulder to only a 15° position. She told her physician that 10 years ago she had fallen on ice outside her front door and had dislocated her left shoulder joint. It was noted that the head of the humerus was in its normal position relative to the scapula on the left side. Her left shoulder when compared with the right shoulder, however, showed flattening and had lost most of the normal curvature.
Which of the following muscles was likely to have been paralyzed by the dislocation of the shoulder joint 10 years ago?
A. The rhomboid minor B. The deltoid C. The supraspinatus D. The teres minor E. The subscapularis
B. The deltoid
A 14-year-old boy fell off a wall and fractured his right humerus at midshaft. The wrist joint immediately assumed a flexed position that the patient was unable to correct. Extension and supination of the forearm was weakened but not abolished, and skin sensation over the lateral side of the dorsum of the hand was diminished.
Which damaged peripheral nerve could account for these symptoms and signs?
A. The ulnar nerve B. The median nerve C. The radial nerve D. The axillary nerve E. The musculocutaneous nerve
C. The radial nerve
A 56-year-old man was seen by his physician because the patient had noticed that his “bowel was protruding from his anus after defecation. On questioning, the patient stated that for the past 2 years he had frequently passed blood stained stools. Digital rectal examination revealed nothing abnormal. Proctoscopic examination showed that the mucous membrane above the level of the anal valves tended to bulge downward in three areas when the patient strained. The swollen mucous membrane contained large, congested veins beneath the surface.
Based on your knowledge of anatomy, make a reasoned diagnosis.
A. External hemorrhoids B. Perianal abscess C. Complete rectal prolapse D. Internal hemorrhoids E. Chronic anal fissures
D. Internal hemorrhoids
What is the venous drainage of the mucous membrane of the anal canal?
A. Middle rectal veins only B. Inferior rectal veins only C. Superior and inferior rectal veins D. Middle and inferior rectal veins E. Internal pudendal veins
C. Superior and inferior rectal veins
A 21-year-old woman complaining of severe pain in the right iliac region was seen in the emergency department. Just before admission, she had fainted. On physical examination, her abdominal wall was extremely tender on palpation in the right iliac region, and some rigidity and guarding of the lower abdominal muscles were noticed. A vaginal examination revealed that a tender, “dough-like” mass could be felt through the posterior fornix. The patient had missed her last period. The diagnosis of a ruptured ectopic pregnancy was made. In this ectopic pregnancy, the embryo was implanted in the right uterine tube. Rupture of the tube produced the symptoms and the signs that were noted.
Using your knowledge of anatomy, explain the relationship of the uterine tube to the peritoneal cavity.
A. The tube is retroperitoneal.
B. The tube lies within the peritoneal cavity.
C. The tube lies within the broad ligament near its base.
D. The tube lies in the free margin of the broad ligament.
E. The tube lies within the parametrium.
D. The tube lies in the free margin of the broad ligament.
The tender, dough-like mass felt through the posterior wall of the vagina resulted from what?
A. A retroverted uterus B. Blood in the pouch of Douglas C. A full bladder D. Blood in the uterovesical pouch E. A prolapsed ovary
B. Blood in the pouch of Douglas
What was responsible for the guarding (partial contraction) of the lower abdominal muscles?
A. Blood in the peritoneal cavity causing irritation of the parietal peritoneum and reflex contraction of the lower abdominal muscles
B. Apprehension of the patient
C. Reflex contraction of the abdominal muscles because of damage to the wall of the uterine tube
D. Stretching of the peritoneum of the broad ligament
E. The high level of blood estrogen causing irritability of the abdominal muscles
A. Blood in the peritoneal cavity causing irritation of the parietal peritoneum and reflex contraction of the lower abdominal muscles
A 10-year-old girl was seen in the emergency department with a temperature of 101°F, a furred tongue, and pain in the right iliac region. On physical examination, the skin in the right lower quadrant was hyperesthetic and tender to touch, and the abdominal muscles showed rigidity and guarding. A diagnosis of acute appendicitis was made.
The skin in the right lower quadrant was tender to touch because which of the following nerves was (were) stimulated by the inflamed appendix?
A. The eighth right intercostal nerve B. The tenth right intercostal nerve C. The subcostal and first lumbar nerves D. The sympathetic autonomic afferent nerves from the appendix E. The seventh right thoracic nerve
C. The subcostal and first lumbar nerves
Which of the following muscles was (were) contracted in the right lower quadrant to produce the increased tone and guarding?
A. The right rectus abdominis muscle B. The right pyramidalis muscle C. The right psoas muscle D. The right external oblique, internal oblique, and transversus abdominis muscles E. The right quadratus lumborum muscle
D. The right external oblique, internal oblique, and transversus abdominis muscles
A 54-year-old man with a long history of duodenal ulcer was seen in the emergency department after vomiting blood-stained fluid and exhibiting all the signs and symptoms of severe hypovolemic (loss of blood) shock.
Assuming the ulcer had perforated the posterior wall of the first part of the duodenum, name the artery that is most likely to have been eroded.
A. The splenic artery B. The right gastric artery C. The gastroduodenal artery D. The right gastroepiploic artery E. The right renal artery
C. The gastroduodenal artery
If the duodenal ulcer had perforated the anterior wall of the duodenum, where in the peritoneal cavity would the duodenal contents have entered?
A. The lesser sac B. The right anterior subphrenic space C. The left lateral paracolic gutter D. The right posterior subphrenic space E. The pouch of Douglas
D. The right posterior subphrenic space
A 53-year-old man was admitted to hospital complaining of a chronic gastric ulcer that was not responding to medical treatment. The surgeon decided to perform a vagotomy. The anterior vagal trunk was divided between sutures as it lies on the anterior surface of the abdominal part of the esophagus. Which of the following is likely to result from this procedure?
A. A loss of secretomotor nerve supply to the mucosal glands of the stomach.
B. Hoarse voice because of paralysis of the intrinsic muscles of the larynx on the left side.
C. Increased heart rate because of decreased parasympathetic input to the cardiac plexus.
D. Incontinence because of an absence of parasympathetic input to the bladder.
E. Compromised input into the greater splanchnic nerves.
A. A loss of secretomotor nerve supply to the mucosal glands of the stomach.
A 45-year-old obese woman complaining of indigestion was admitted to hospital for investigation. She had a past history of gallstones and transient attacks of jaundice. Large gallstones have been known to erode through the posterior wall of the gallbladder and enter the intestinal tract.
Which part of the intestinal tract is likely to initially contain the stone? A. The sigmoid colon B. The descending colon C. The transverse colon D. The ascending colon E. The jejunum
C. The transverse colon
A 35-year-old woman was seen in the emergency department after an automobile accident. While driving her car, she had been wearing a lap belt but without the shoulder strap; she hit a utility pole head-on. Examination of the thoracic cage revealed a fracture of the body of the sternum and of the third and the fourth left ribs.
In this case, the following structure(s) located behind the body of the sternum and the left ribs could have been injured except which one(s)?
A. The pericardium B. The right ventricle of the heart C. The right atrium of the heart D. The left ventricle of the heart E. The esophagus
E. The esophagus
In such an accident, the patient’s age may play a large role in the extent of anatomic injury. Which of the following statements accounting for this fact is likely to be correct?
A. The increased elasticity of fibrous structures in elderly people.
B. Higher risk in persons who have been using steroids for a long time
C. The ossification of the xiphoid cartilage that occurs with age.
D. Higher risk of experiencing sternal fractures in premenopausal women.
E. Usually seen in young adults.
F. Not taking vitamin supplements.
B. Higher risk in persons who have been using steroids for a long time????
or E???
A 22-year-old man was seen in the emergency department after a street shootout. The patient showed signs of severe hemorrhagic shock. A small entrance wound was found in the third left intercostal space approximately 1 in. (2.5 cm) from the lateral margin of the sternum, but there was no exit wound. The left side of his thorax was dull on percussion, and breath sounds were absent on that side of the chest. It was decided to open the chest (thoracotomy) through the fourth left intercostal space, after which it was found that the left atrium had been perforated by the bullet.
When the thoracotomy incision was made to enter the pleural cavity, the following structures were incised except for which one?
A. The skin and subcutaneous tissue
B. The pectoral muscles and the serratus anterior muscle
C. The latissimus dorsi muscle
D. The external intercostal muscle and the anterior intercostal membrane
E. The internal intercostal and innermost intercostal muscles
F. The endothoracic fascia and the parietal pleura
C. The latissimus dorsi muscle
The following important structures are in the region of the thoracotomy incision except which one?
A. The internal thoracic artery B. The intercostal nerve C. The superior epigastric artery D. The intercostal artery E. The intercostal vein
C. The superior epigastric artery
A 4-year-old boy with cyanosis was examined by a pediatrician. The child had apparently become cyanotic during his 1st year of life. Since that time, sudden attacks of breathlessness had occurred on exertion. After a careful workup, a diagnosis of tetralogy of Fallot was made. In this congenital anomaly of the heart there are four cardiac defects.
Which of the following is the most characteristic of the condition?
A. Pulmonary stenosis with hypertrophy of the right ventricle
B. Large atrial septal defect
C. Hypertrophy of the left ventricle
D. Stenosis of the aorta
E. High blood pressure in the left ventricle
A. Pulmonary stenosis with hypertrophy of the right ventricle
A patient was seen in the emergency department with a myocardial infarction. After a thorough clinical examination, including an electrocardiogram, it was concluded that the anterior interventricular branch of the left coronary artery was occluded.
From the areas of the heart listed below select the one most likely to be involved.
A. The entire diaphragmatic surface of the left ventricle
B. The anterior part of the ventricular septum and the anterior (septal) papillary muscle of the left ventricle
C. The posterior wall of the right atrium
D. The atrioventricular bundle
E. The right auricle
B. The anterior part of the ventricular septum and the anterior (septal) papillary muscle of the left ventricle
A patient was admitted in to hospital with acute pericarditis. Because the movements of the heart were compromised by the excess of fluid in the pericardial cavity, and the cause of the infection was unknown, it was decided to perform a pericardiocentesis. A specimen of the fluid was kept for bacteriological examination.
Pericardiocentesis is best performed by passing a needle through
A. the fourth intercostal space.
B. the sixth intercostal space at the left paravertebral border.
C. the second intercostal space at the midclavicular line.
D. the subcostal angle
E. the second intercostal space at the right sternal angle.
D. the subcostal angle
A patient was seen in the Emergency Department in cardiac arrest.
During cardiopulmonary resuscitation the posterior surface of the heart was compressed by which of the following structures?
A. The body of the sternum B. The heads of the ribs C. The tracheal bifurcation D. The inferior vena cava E. The bodies of the vertebrae
E. The bodies of the vertebrae
A patient is examined in the standing position with a left-sided pleurisy.
Where would you expect the pleural fluid to gravitate down to?
A. The oblique fissure B. The cardiac notch C. The costomediastinal recess D. The costodiaphragmatic recess E. The horizontal fissure
D. The costodiaphragmatic recess
A 24-year-old woman was seen by her ophthalmologist because of a red infected skin abrasion involving the lateral ends of both right eyelids.
Which lymph nodes should be examined for evidence of spread of infection from the skin abrasion? A. Mastoid nodes B. Superficial cervical nodes C. Submandibular nodes D. Parotid nodes E. Submental nodes
D. Parotid nodes
