Exam II Written Questions

Question 1

Which one of the following statements regarding the ciliary ganglion is correct?

A. Both sympathetic and parasympathetic fibers synapse here.

B. Parasympathetic fibers to the ciliary ganglion run in the superior division of the oculomotor nerve.

C. The short ciliary nerves carry postganglionic parasympathetic postganglionic sympathetic, and general sensory (afferent) fibers to the eye.

D. The parasympathetic innervation to the eye causes vasoconstriction of blood vessels in the retina.

E. Sympathetic fibers provide motor innervation to the sphincter pupillae muscle (to constrict the pupil).

Answer 1

C. The short ciliary nerves carry postganglionic parasympathetic, postganglionic sympathetic, and general sensory (afferent) fibers to the eye.

Question 2

Cell bodies of the post-ganglionic, parasympathetic fibers to the lacrimal gland are found in:

A. the pterygopalatine ganglion.

B. the ciliary ganglion.

C. the otic ganglion.

D. the superior cervical ganglion.

E. the submandibular ganglion.

Answer 2

A. the pterygopalatine ganglion.

Question 3

The only extraocular muscle which originates from the anterior aspect of the orbit is the:

A. inferior rectus

B. superior rectus

C. superior oblique

D. lateral rectus

E. inferior oblique

Answer 3

E. inferior oblique It originates from the maxilla.

Question 4

A diabetic patient complains of severe photophobia in her right eye. When light is shown directly into her right eye, her pupil does not constrict. You decide that, given her diabetes, she likely has a third cranial nerve neuropathy that involves only the periphery of this nerve, since her eye movements are all still normal. Which fibers running in the oculomotor nerve are most likely affected?

A. Sympathetic, preganglionic fibers

B. Sympathetic, postganglionic fibers

C. Parasympathetic, preganglionic fibers

D. General sensory fibers

E. Motor fibers

Answer 4

C. Parasympathetic, preganglionic fibers

Question 5

The optic nerve enters the orbit through what bony structure?

A. Superior orbital fissure

B. Optic canal

C. Inferior orbital fissure

D. Supraorbital foramen

E. Pterygomaxillary fissure

Answer 5

B. Optic canal

Question 6

A patient with hypertension and a long history of smoking suffers a series of transient ischemic attacks (TIAs). Upon evaluation, a carotid bruit is heard on the left. Further testing reveals stenosis of his left internal carotid artery due to atherosclerosis. The TIAs were due to embolism of the atherosclerotic placque. If the patient also complains of a dry left eye, which one of the following branches of the ophthalmic artery has most likely been blocked?

A. Lacrimal

B. Supraorbital

C. Supratrochlear

D. Anterior ethmoidal

E. Internal retinal

Answer 6

A. Lacrimal

Question 7

The ciliary processes are primarily responsible for which one of the following functions in the eye?

A. Constriction of the pupil

B. Dilation of the pupil

C. Production of aqueous humor

D. Pigmentation of the iris

E. Accommodation of the lens

Answer 7

C. Production of aqueous humor

Question 8

When LIGHT reaches the peripheral retina (NOT at the fovea), the photons will first encounter which retinal layer?

A. Pigmented epithelium

B. Photoreceptors (rods & cones)

C. Interneurons (bipolar, horizontal and amacrine cells)

D. Ganglion cell bodies and axons

E. Inner plexiform layer

Answer 8

D. Ganglion cell bodies and axons

Question 9

Which one of the following statements concerning the optic nerve is correct?

A. The optic nerve is composed of the axons of the photoreceptors.

B. The axons pierce the sclera at the lamina cribrosa.

C. The optic disc has the richest diversity of photoreceptors.

D. The dura covering the optic nerve is continuous with the uveal layer.

E. Aqueous humor is found surrounding the optic nerve.

Answer 9

B. The axons pierce the sclera at the lamina cribrosa.

Question 10

A 9 year old patient presents to the emergency room with high fever, headaches, and extreme pain when trying to flex her head forward. You immediately suspect increased intracranial pressure, and exam her retina. You see signs of papilledema, including venous engorgement, loss of venous pulsation, hemorrhages over & adjacent to the optic disc, blurring of optic margins and elevation of the optic disc (image below). Which one of the following vessels is responsible for the observed papilledema?

A. Ophthalmic artery

B. Central artery of the retina

C. Vorticose veins

D. Posterior ciliary artery

E. Central vein of the retina

Answer 10

E. Central vein of the retina

Question 11

A 27- year-old woman with a goiter comes to the hospital for surgical treatment. The surgeon must ligate the superior laryngeal artery before surgically resecting the goiter, so care must be taken to avoid injury to which of the following nerves?

A. External laryngeal nerve.

B. Internal laryngeal nerve.

C. Superior laryngeal nerve.

D. Vagus nerve.

E. Hypoglossal nerve. 

Answer 11

B. Internal laryngeal nerve.

Question 12

A young singer visits her physician and complains of vocal difficulties. During quiet breathing her vocal cords are adducted. She is unable to abduct the vocal cords. Which of the following muscles is most likely paralyzed?

A. Vocalis muscle.

B. Crico-thyroid muscle.

C. Posterior Crico-arytenoid muscle.

D. Lateral Crico-arytenoid muscle.

E. Transverse Arytenoid muscle.

Answer 12

C. Posterior Crico-arytenoid muscle.

Question 13

Which of the following is the primary tensor of the vocal cords?

A. Vocalis.

B. Posterior cricoarytenoid.

C. Transverse cricoarytenoid.

D. Cricothyroid

E. Thryoarytenoid

Answer 13

D. Cricothyroid

Question 14

The Cricothyroid muscle is associated with which branchial arch?

A. First.

B. Second.

C. Fourth.

D.Third.

E. Sixth. 

Answer 14

C. Fourth

Question 15

How many constrictor muscles exist in the pharynx?

A. 3

B. 4

C. 6

D. 1

E. 7

Answer 15

A. 3

Question 16

What innervates the cricothyroid?

A. Recurrent Laryngeal

B. External Laryngeal

C. Internal Laryngeal

D. CN IX

E. CN XI

Answer 16

B. External Laryngeal

Question 17

The lingual artery is deep to which muscle?

A. Styloglossus

B. Superior Constrictor

C. Tensor Veli Palatine

D. Hyoglossus

E. Stylohyoid

Answer 17

D. Hyoglossus

Question 18

The constrictors originate from:

A. A Raphe

B. Spine

C. Uvula

D. Esophagus

E. Brain

Answer 18

A. A Raphe

Question 19

The retropharyngeal space:

A. Was discovered in the ’80s

B. Is posterior to the spine

C. Is posterior to the prevertebral fascia

D. Is anterior to the buccopharyngeal fascia

E. Is continuous with the middle mediastinum

Answer 19

E. Is continuous with the middle mediastinum

Question 20

The radiation oncologist explains that your patient’s tumor is at the T3 level and is compressing and artery. What artery is it?

A. Descending Aorta

B. Ascending Aorta

C. Brachiocephalic

D. Right Subclavian

E. Musculophrenic

Answer 20

C. Brachiocephalic

Question 21

Your patient is a 25-year old male that was shot in the chest as he was being mugged. The bullet entered just below the sternal angle and lodged in a vertebra posteriorly. Which vertebrae?

A. T2

B. T3

C. T4

D. T5

E. T6

Answer 21

D. T5 T4 would also be a reasonably valid answer. (This is kind of a bad question)

Question 22

Your patient presents with a fracture of the costal cartilage of the 4th rib. You could localize this on the anterior chest wall by:

A. Counting down 2 ribs from the sternal angle

B. Counting down 3 ribs from the sternal angle

C. Counting down 4 ribs from the sternal angle

D. Counting down 2 ribs from the jugular notch

E. Counting down 3 ribs from the jugular notch

Answer 22

A. Counting down 2 ribs from the sternal angle

Question 23

Your patient has an osteosarcoma on the anterior surface of the T6 vertebral body. What artery would most likely be affected?

A. Right Anterior Intercostal

B. Right Posterior Intercostal

C. Left Anterior Intercostal

D. Left Posterior Intercostal

Answer 23

B. Right Posterior Intercostal

Question 24

During cardiac catheterization, the physician watches the blood flow from the right ventricle into which of the following:

A. Aorta

B. Left Coronary Artery

C. Inferior Vena Cava

D. Pulmonary Trunk

E. Pulmonary Veins

Answer 24

D. Pulmonary Trunk

Question 25

A 56-year old man develops chest pain and it is radiating to his left arm. He has a 50 pack/year smoking habit and a BMI of 33. He goes to the hospital and undergoes cardiac catheterization, which reveals his left anterior descending artery is occluded. Which area of the heart is affected by this obstruction?

A. Posterior Portion of the Left Ventricle

B. Anterior Interventricular Septum and the Anterior Ventricles

C. Left Atrium Only

D. Right Atrium Only

E. Both the SA and VA nodes

Answer 25

B. Anterior Interventricular Septum and the Anterior Ventricles

Question 26

In which heart chamber would you find the moderator band?

A. Right Atrium

B. Right Ventricle

C. Left Atrium

D. Left Ventricle

Answer 26

B. Right Ventricle

Question 27

In order to auscultate the bicuspid valve, you would place your stethoscope over the:

A. Second intercostal space to the right of the sternum

B. Second intercostal space to the left of the sternum

C. Fourth intercostal space to the right of the sternum

D. Fifth intercostal space to the right of the sternum

E. Fifth intercostal space in the mid-axillaty line

Answer 27

E. Fifth intercostal space in the mid-acillaty line

Question 28

Which of the following statements about the sphenopalatine foramen is true?

A. It is located on the medial wall of the nasal cavity

B. It transmits the sphenopalatine artery

C. It is on the lateral wall of the pterygopalatine fossa

D. It is an opening in the medial pterygoid plate

E. It provides direct communication between the nasal cavity and the hard palate

Answer 28

B. It transmits the sphenopalatine artery

Question 29

A 30 year old woman visited her doctor because of a painless swelling at the angle of mandible just anterior to the sternocleidomastoid muscle most likely the diagnosis is?

A. Branchial cyst

B. Thyroglossal duct cyst

C. Dermoid cyst

D. Swollen lymph node

E. Accessory thyroid tissue

Answer 29

A. Branchial cyst

Question 30

The derivatives of the third pharyngeal pouch are:

A. Auditory tube & middle ear cavity.

B. Superior & inferior parathyroid glands.

C. Thymus & inferior parathyroid gland.

D. Palatine tonsil & tonsillar fossa.

E. Parafollicular cells (C-Cells).

Answer 30

C. Thymus & inferior parathyroid gland.

Question 31

In the developing embryo, the second arch gives rise to muscles of facial expression, Posterior belly of digastric, Stylohyoid & Stapedius which of the following nerves is also derived from this arch?

A. III.

B. V.

C. VIII.

D. IX.

E. VII.

Answer 31

E. VII.

Question 32

An anatomy professor tagged the styloid process in the exam & asked which of the following muscles attached to the styloid process and is not derived from a pharyngeal arch?

A. Styloglossus.

B. Stylopharyngeus.

C. Stylohyoid.

D. Stapedius.

E. Tensor veli Palatini.

Answer 32

A. Styloglossus.

Question 33

Which is the most common congenital malformation of the head & neck region?

A. Anterior cleft palate.

B. Unilateral cleft lip.

C. Thyroglossalductcyst.

D. Posteriorcleftpalate.

E. Ankyloglossia.

Answer 33

B. Unilateral cleft lip.

Question 34

The most common site of a thyroglossal cyst is:

A. Dorsal aspect of the neck.

B. Anterior border of the sternocleidomastoid.

C. Base of the tongue.

D. Superior mediastinum.

E. Midline close to the hyoid bone.

Answer 34

E. Midline close to the hyoid bone.

Question 35

A congenital malformation affecting the mandible and the sphenomandibular ligament would be associated with the maldevelopment of which of the following structures?

A. Second pharyngeal arch.

B. Frontonasal process.

C. First pharyngeal arch.

D. Second pharyngeal pouch.

E. Third pharyngeal arch.

Answer 35

C. First pharyngeal arch.

Question 36

Which of the following is involved in the formation of a cleft palate?

A. The second pharyngeal arch

B. The frontonasal prominence.

C. The third pharyngeal arch.

D. The palatine shelves.

E. The maxillary prominence & medial nasal prominence.

Answer 36

D. The palatine shelves.

Question 37

The middle nasal concha is part of what bone?

A. Ethmoid bone

B. Maxilla

C. Palatine bone

D. Sphenoid bone

E. Vomer

Answer 37

A. Ethmoid bone

Question 38

The soft palate is active in all of the following except:

A. Breathing

B. Chewing

C. Coughing

D. Swallowing

E. Yawning

Answer 38

A. Breathing

Question 39

Most paranasal sinuses and/or air cells drain, directly or indirectly, into the:

A. Inferior meatus

B. Middle meatus

C. Superior meatus

D. Nasal vestibule

E. Sphenoethmoidal recess

Answer 39

B. Middle meatus

Question 40

Irrigation of the maxillary sinus through its opening is a supportive measure to accelerate the resolution of a maxillary sinus infection. Which of the following nasal spaces is the most likely approach to the sinus opening?

A. Choana

B. Inferior meatus

C. Middle meatus

D. Sphenoethmoidal recess

E. Superior meatus

Answer 40

C. Middle meatus

Question 41

The nasolacrimal duct empties into which part of the nasal cavity?

A. Hiatus semilunaris

B. Inferior meatus

C. Middle meatus

D. Sphenoethmoidal recess

E. Vestibule

Answer 41

B. Inferior meatus

Question 42

The pharyngeal tonsils, or adenoids, may become inflamed and in serious cases need to be removed. Where would the physician search for them?

A. In the tonsillar fossa

B. In the pharyngeal recess

C. In the piriform recess

D. In the roof of the nasopharynx

E. Upon the dorsal surface of the tongue

Answer 42

D. In the roof of the nasopharynx

Question 43

The middle nasal concha is part of what bone?

A. Ethmoid bone

B. Maxilla

C. Palatine bone

D. Sphenoid bone

E. Vomer

Answer 43

A. Ethmoid bone

Question 44

The communication between the pharynx and the nasal cavity is known as the:

A. Aditus

B. Auditory tube

C. Choanae

D. Fauces

E. Piriform recess

Answer 44

C. Choanae

Question 45

Following thyroid surgery, it was noted that a patient frequently aspirated fluid into her lungs. Upon examination it was determined that the area of the piriform recess above the vocal fold of the larynx was numb. What nerve may have been injured?

A. External branch of the superior pharyngeal

B. Hypoglossal

C. Internal branch of the superior laryngeal

D. Lingual

E. Recurrent laryngeal

Answer 45

C. Internal branch of the superior laryngeal

Question 46

The laryngeal muscle most responsible for stretching (elongating) the vocal ligament is the:

A. Posterior cricoarytenoid

B. Lateral cricoarytenoid

C. Thyroarytenoid

D. Arytenoid

E. Cricothyroid

Answer 46

E. Cricothyroid

Question 47

Damage of the lingual nerve before it is joined by the chorda tympani in the infratemporal fossa would cause loss of:

A. general sensation to the anterior two thirds of the tongue

B. general sensation to the posterior one third of the tongue

C. secretion of the submandibular gland

D. taste sensation from the anterior two thirds of the tongue

E. taste sensation from the posterior one third of the tongue

Answer 47

A. general sensation to the anterior two thirds of the tongue

Question 48

Difficulty in swallowing is due to involvement of which muscle that elevates the tongue?

A. Genioglossus

B. Hyoglossus

C. Styloglossus

D. Stylohyoid

E. Stylopharyngeus

Answer 48

C. Styloglossus

Question 49

Cutting of the hypoglossal nerve in the hypoglossal canal would not interrupt the nerve supply to the:

A. Hyoglossus muscle

B. Genioglossus muscle

C. Palatoglossus muscle

D. Styloglossus muscle

Answer 49

C. Palatoglossus muscle

Question 50

A patient is unable to taste a piece of sugar placed on the anterior part of the tongue. Which cranial nerve is most likely to have a lesion?

A. Facial nerve

B. Glossopharyngeal nerve

C. Hypoglossal nerve

D. Trigeminal nerve

E. Vagus nerve

Answer 50

A. Facial nerve

Question 51

The chorda tympani contains which component before it joins the lingual nerve?

A. Preganglionic sympathetics

B. Postganglionic sympathetics

C. Preganglionic parasympathetics

D. Postganglionic parasympathetics

E. Taste fibers to the posterior third of the tongue

Answer 51

C. Preganglionic parasympathetics

Question 52

When one presses the tongue tip against the anterior (incisor) teeth, which of the following muscles must contract?

A. Styloglossus

B. Hyoglossus

C. Genioglossus

D. Superior longitudinal

E. Verticalis

Answer 52

C. Genioglossus

Question 53

The muscle responsible for raising the floor of the mouth in the early stages of swallowing is the:

A. genioglossus

B. geniohyoid

C. hyoglossus

D. mylohyoid

E. palatoglossus

Answer 53

D. mylohyoid

Question 54

A 46-year-old female patient comes to the emergency department complaining of pain in the area just below her mandible on the right side of her face. She says that the pain is particularly severe when she eats. The area of the submandibular gland is tender and swollen, as is the area in the floor of her mouth lateral to the tongue. You suspect a stone in the submandibular duct, and a plain film radiograph shows a density in that region consistent with a stone. In order to remove the stone, the duct must be incised in the floor of the mouth. What nerve, that loops around the duct, is in danger in such an incision?

A. Chorda Tympani

B. Glossopharyngeal

C. Hypoglossal

D. Internal branch of the superior laryngeal

E. Lingual

Answer 54

E. Lingual

Question 55

You are testing the extraocular muscles and their innervation in a patient who periodically experiences double vision. When you ask him to turn his right eye inward toward his nose and look downward he is able to look inward, but not down. Which nerve is most likely involved?

A. Abducens

B. Nasociliary

C. Oculomotor, inferior division

D. Oculomotor, superior division

E. Trochlear

Answer 55

E. Trochlear The superior oblique muscle is affected as the rectus muscles are being used to adduct the eye inwards, meaning only the superior oblique is left to turn it downwards.

Question 56

The outermost layer of the optic nerve sheath is a continuation of the:

A. Arachnoid membrane

B. Meningeal dura

C. Periosteal dura

D. Pia mater

E. Retina

Answer 56

B. Meningeal dura

Question 57

The inner lining of the eyelid is called the:

A. Orbital septum

B. Palpebral conjunctiva

C. Periorbita

D. Sclera

E. Tarsal plate

Answer 57

B. Palpebral conjunctiva

Question 58

What would the examining physician notice in the eye of a person who has taken a sympathetic blocking agent?

A. Exophthalmos and dilated iris

B. Enophthalmos and dry eye

C. Dry eye and inability to accommodate for reading

D. Wide open eyelids and loss of depth perception

E. Ptosis and miosis (pin-point pupil)

Answer 58

E. Ptosis and miosis (pin-point pupil)

Question 59

You have a patient with a drooping right eyelid. You suspect Horner’s syndrome. Which of the following signs on the right side would confirm this diagnosis?

A. Constricted pupil

B. Dry eye (lack of tears)

C. Exophthalmos

D. Pale, blanched face

E. Sweaty face

Answer 59

A. Constricted pupil

Question 60

Following endarterectomy on the right common carotid, a patient is found to be blind in the right eye. It appears that a small thrombus embolized during surgery and lodged in the artery supplying the optic nerve. What artery would be blocked?

A. Central artery of the retina

B. Infraorbital

C. Lacrimal

D. Nasociliary

E. Supraorbital

Answer 60

A. Central artery of the retina

Question 61

You are asked to check the integrity of the trochlear nerve in the right eye of a patient. Starting with the eyes directed straight ahead, you would have the patient look:

A. Inward, toward the nose and downward

B. Inward, toward the nose and upward

C. Toward the nose in a horizontal plane

D. Laterally in a horizontal plane

E. Outward, away from the nose and downward

F. Outward, away from the nose and upward

Answer 61

A. Inward, toward the nose and downward

Question 62

Starting from a position gazing straight ahead, to direct the gaze downward, the inferior rectus muscle must be active along with the:

A. Superior oblique

B. Inferior oblique

C. Medial rectus

D. Lateral rectus

E. Superior rectus

Answer 62

A. Superior oblique

Question 63

During a physical examination it is noted that a patient has ptosis. What muscle must be paralyzed?

A. Orbicularis oculi, lacrimal part

B. Orbicularis oculi, palpebral part

C. Stapedius

D. Superior oblique

E. Superior tarsal (smooth muscle portion of levator palpebrae)

Answer 63

E. Superior tarsal (smooth muscle portion of levator palpebrae)

Question 64

The extraocular muscle that does not originate at or near the apex of the orbit is the :

A. Inferior oblique

B. Inferior rectus

C. Levator palpebrae superioris

D. Superior oblique

E. Superior rectus

Answer 64

A. Inferior oblique It originates from the orbital surface of the maxilla

Question 65

If a person looking inward towards their nose is unable to look down, which nerve may be injured?

A. Abducens (CN VI)

B. Inferior division of oculomotor (III)

C. Optic (II)

D. Superior division of oculomotor (III)

E. Trochlear (IV)

Answer 65

E. Trochlear (IV)

Question 66

A mother brings her 5-year old to the ER suspecting that she has aspirated a marble. As the attending, you suspect that the object most likely entered the:

A. Right Main Bronchus

B. Left Main Bronchus

Answer 66

A. Right Main Bronchus It is larger and more vertical, making it more likely that the marble entered it here.

Question 67

The radiologist informs you that your patient’s tumor of the lower esophagus is compressing part of the lobe of a lung. The lobe most likely affected would be the:

A. Inferior Lobe of the Right Lung

B. Superior Lobe of the Right Lung

C. Middle Lobe of the Right Lung

D. Inferior Lobe of the Left Lung

E. Superior Lobe of the Left Lung

Answer 67

A. Inferior Lobe of the Right Lung

Question 68

Your patient has developed a hemothorax. Where could you insert your needle to withdraw the fluid without injuring the lung?

A. 2nd intercostal space along the parasternal line

B. 4th intercostal space in the midclavicular line

C. 6th intercostal space in the midclavicular line

D. 7th intercostal space in the midclavicular line

E. 8th intercostal space in the midaxillary line

Answer 68

D. 7th intercostal space in the midclavicular line

Question 69

Your patient has a large lipoma that is compressing the trachea where it divides into the bronchi. You decide to resect it via a lateral approach. Which intercostal space would you enter?

A. 1st

B. 2nd

C. 3rd

D. 4th

E. 5th

Answer 69

A. 1st The bronchi divide at the sternal angle which is the level of T4-5 which is at ribs 1 and 2, making it in the 1st intercostal space.

Question 70

The coronary sinus is derived from which of the following?

A. Truncus arteriosus

B. Bulbus cordis

C. Sinus venosus

D. Primitive atrium

E. Primitive ventricle

Answer 70

C. Sinus venosus

Question 71

Which of the three primary germ layers forms the endocardium of the heart?

A. Epiblast

B. Endoderm

C. Ectoderm

D. Mesoderm

E. Hypoblast

Answer 71

D. Mesoderm

Question 72

A male neonate was diagnosed as tetralogy of Fallot. Which of the following clinical signs would be most obvious on examination of this patient?

A. Diffusered rash

B. Sweaty palms

C. Lack of femoral pulse

D. Pulmonary hypertension

E. Cyanosis

Answer 72

E. Cyanosis

Question 73

The proximal part of the internal carotid artery is derived from which of the following?

A. 1st Aortic arch

B. 2nd Aortic arch

C. 3rd Aortic arch

D. 4th Aortic arch

E. 6th Aortic arch

Answer 73

C. 3rd Aortic arch

Question 74

Which of the following congenital heart malformations is most commonly associated with maternal rubella infection?

A. Dextrocardia

B. Patent ductus arteriosus

C. Coarctation of aorta

D. Double aortic arch

E. Persistent Truncus arteriosus

Answer 74

B. Patent ductus arteriosus

Question 75

Tetralogy of Fallot is a cardiac malformation that involves which of the following?

A. Atrialseptum

B. Aorticopulmonary septum

C. Interventricular septum

D. Atrioventricular canal

E. Sinus venosus

Answer 75

B. Aorticopulmonary septum

Question 76

The most common septal defect seen clinically is:

A. Premature closure of foramen ovale

B. Common ventricle

C. Membranous VSD

D. Foramen secundum defect.

E. Persistent Truncus arteriosus.

Answer 76

C. Membranous VSD

Question 77

The proximal part of right subclavian artery is derived from which of the following?

A. 1st aortic arch.

B. 2nd aortic arch.

C. 3rd aortic arch.

D. 4th aortic arch.

E. 6th aortic arch.

Answer 77

D. 4th aortic arch.

Question 78

A 4-day-old boy delivered at 32 weeks of gestation is experiencing respiratory distress syndrome. An echocardiogram confirmed a patent ductus arteriosus. Which embryonic structure is involved in this diagnosis?

A. Vitelline arteries.

B. Right 3rd aortic arch.

C. Left 3rd aortic arch.

D. Umbilical arteries.

E. Left 6th aortic arch.

Answer 78

E. Left 6th aortic arch.

Question 79

Following thyroid surgery, it was noted that a patient frequently aspirated fluid into her lungs. Upon examination it was determined that the area of the piriform recess above the vocal fold of the larynx was numb. What nerve may have been injured?

A. External branch of the superior pharyngeal

B. Hypoglossal

C. Internal branch of the superior laryngeal

D. Lingual

E. Recurrent laryngeal

Answer 79

C. Internal branch of the superior laryngeal Internal branch is purely sensory.

Question 80

The laryngeal muscle most responsible for stretching (elongating) the vocal ligament is the:

A. Posterior cricoarytenoid

B. Lateral cricoarytenoid

C. Thyroarytenoid

D. Arytenoid

E. Cricothyroid

Answer 80

E. Cricothyroid

Question 81

The muscle most responsible for the abduction of the vocal folds is the:

A. Arytenoid

B. Cricothyroid

C. Lateral cricoarytenoid

D. Posterior cricoarytenoid

E. Thyroarytenoid

Answer 81

D. Posterior cricoarytenoid

Question 82

The nerve that innervates all but one muscle of larynx is the:

A. Glossopharyngeal nerve, pharyngeal branch

B. Inferior laryngeal nerve

C. Superior laryngeal nerve, external branch

D. Superior laryngeal nerve, inferior branch

E. Thyrohyoid nerve

Answer 82

B. Inferior laryngeal nerve It is a branch of the recurrent laryngeal nerve.

Question 83

The vocalis muscle is most responsible for the fine control of phonation because of its attachment into the:

A. Arytenoid cartilage

B. Cricoid cartilage

C. Thyroid cartilage

D. Vestibular ligament

E. Vocal ligament

Answer 83

E. Vocal ligament

Question 84

The constrictor muscles of the pharynx receive their motor nerve supply from the:

A. Glossopharyngeal nerve

B. Hypoglossal nerve

C. Spinal accessory nerve

D. Sympathetic trunk

E. Vagus nerve

Answer 84

E. Vagus nerve

Question 85

In performing a thyroidectomy, caution should be exercised when ligating (tying) the inferior thyroid artery, as it lies in a very close relationship to which nerve?

A. Ansa cervicalis

B. Hypoglossal

C. Phrenic

D. Recurrent laryngeal

E. Vagus

Answer 85

D. Recurrent laryngeal

Question 86

A 55-year-old woman has difficulty swallowing and frequently aspirates fluids while drinking. She is diagnosed as having a skull base tumor occupying the space behind the jugular foramen. Involvement of which structure is responsible for the findings?

A. Ansa Cervicalis

B. Cervical Sympathetic Trunk

C. Accessory Nerve

D. Hypoglossal Nerve

E. Vagus Nerve

Answer 86

E. Vagus Nerve

Question 87

Any manipulation of the superior thyroid artery must be undertaken with care not to damage its small companion nerve, the:

A. Cervical sympathetic trunk

B. External branch of the superior laryngeal

C. Inferior root of the ansa cervicalis

D. Internal branch of the superior laryngeal

E. Recurrent laryngeal

Answer 87

B. External branch of the superior laryngeal

Question 88

Blockage of which of the following arteries would lead to ischemia of the apex of the heart?

A. Anterior interventricular (descending)

B. Left circumflex

C. Posterior interventricular (descending)

D. Right marginal

E. Right coronary

Answer 88

A. Anterior interventricular (descending)

Question 89

If the ductus arteriosus does not spontaneously close off soon after birth (to become the ligamentum arteriosum), it may have to be surgically ligated. When clamping or ligating it, what important structure immediately behind it must be identified and saved?

A. arch of the azygos vein

B. internal thoracic artery

C. left phrenic nerve

D. left recurrent laryngeal nerve

E. left superior intercostal vein

Answer 89

D. Left Recurrent Laryngeal Nerve It loops around the aorta on the left and it would be found in this region here.

Question 90

A stethoscope placed over the left second intercostal space just lateral to the sternum would be best positioned to detect sounds associated with which heart valve?

A. Aortic

B. Pulmonary

C. Mitral

D. Tricuspid

Answer 90

B. Pulmonary

Question 91

Which valves would be open during ventricular systole?

A. Aortic and pulmonary

B. Aortic and tricuspid

C. Mitral and aortic

D. Tricuspid and mitral

E. Tricuspid and pulmonary

Answer 91

A. Aortic and pulmonary

Question 92

Which chamber’s anterior wall forms most of the sternocostal surface of the heart?

A. Left atrium

B. Left ventricle

C. Right atrium

D. Right ventricle

Answer 92

D. Right ventricle The heart has three important surfaces: an anterior surface, a diaphragmatic surface, and a pulmonary surface. The anterior surface, or sternocostal surface, is mostly made up of the right ventricle. The diaphragmatic surface is mostly the left ventricle, but a little bit of the right ventricle sits on the diaphragm as well. Finally, the pulmonary surface, which is on the left, is mostly made up of the left ventricle.

Question 93

A 3rd-year medical student was doing her first physical exam. In order to properly place her stethoscope to listen to heart sounds, she palpated bony landmarks. She began at the jugular notch, then slid her fingers down to the sternal angle. At which rib (costal cartilage) level were her fingers?

A. 1

B. 2

C. 3

D. 4

Answer 93

B. 2

Question 94

A patient involved in an automobile accident presents with a sharp object puncture of the middle of the sternum at about the level of the 4th or 5th costal cartilage. If the object also penetrated pericardium and heart wall, which heart chamber would most likely be damaged?

A. Left atrium

B. Left ventricle

C. Right atrium

D. Right ventricle

Answer 94

D. Right ventricle

Question 95

Which statement is true of the right atrioventricular valve?

A. It is also called the mitral valve

B. It is open during ventricular diastole

C. It transmits oxygenated blood

D. It is opened by the pull of chordae tendineae

E. It consists of 2 leaflets

Answer 95

B. It is open during ventricular diastole

Question 96

An elderly lady suffers a coronary occlusion and subsequently it is noted that there is a complete heart block (that is, the right and left bundles of the conduction system have been damaged). The artery most likely involved is the:

A. acute marginal branch

B. circumflex branch

C. anterior interventricular (Left anterior descending)

D. obtuse marginal

E. posterior interventricular (posterior descending)

Answer 96

C. anterior interventricular (Left anterior descending)

Question 97

During fetal life and sometimes persisting into the adult there is an opening between the right and left atria; this opening is called the:

A. atrioventricular canal

B. coronary sinus

C. foramen ovale

D. sinus venosus

E. truncus arteriosis

Answer 97

C. foramen ovale

Question 98

The heart sound associated with the mitral valve is best heard:

A. In the jugular notch

B. In the second left intercostal space

C. In the second right intercostal space

D. In the fifth left intercostal space

E. To the right of the xiphoid process

Answer 98

D. In the fifth left intercostal space

Question 99

In preparation for thoracic surgery, a median sternal splitting procedure was carried out. But an improper depth setting on the saw blade resulted in a slight nick on the underlying sternocostal surface of the heart. Which heart chamber would most likely have been opened had the blade completely penetrated this wall?

A. Left atrium

B. Left ventricle

C. Right atrium

D. Right ventricle

Answer 99

D. Right ventricle

Question 100

Blockage of blood flow in the proximal part of the anterior interventricular artery could deprive a large area of heart tissue of blood supply, unless a substantial retrograde flow into this artery develops via an important anastomosis with which other artery?

A. Circumflex

B. Left marginal

C. Posterior interventricular

D. Right coronary

E. Right marginal

Answer 100

C. Posterior interventricular

Question 101

Traumatic, acceleration/deceleration injuries to the aorta usually occur where its mobile and fixed portions meet. This would be at the:

A. at the ligamentum arteriosum

B. junction of aortic arch with the descending portion

C. junction of the ascending aorta with the heart

D. origin of the brachiocephalic artery on the arch

E. point where the descending aorta passes through the diaphragm

Answer 101

A. at the ligamentum arteriosum

Question 102

In obstruction of the superior or inferior vena cava, venous blood is returned to the heart by an alternate route via the azygos vein, which becomes dilated in the process. Which of the following structures might it compress as a result?

A. trachea

B. root of the left lung

C. phrenic nerve

D. thoracic duct

E. descending aorta

Answer 102

D. thoracic duct

Question 103

Elevated systolic blood pressure in the right ventricle suggests stenosis of which valve?

A. Aortic

B. Mitral

C. Pulmonary

D. Tricuspid

Answer 103

C. Pulmonary

Question 104

During examination of a 62-year-old man, the senior resident tells you to put your stethoscope on the left 5th intercostal space, slightly below the nipple, and listen for a clearly audible murmur. You hear it distinctly and know it must be associated with severe stenosis of which heart valve?

A. Aortic

B. Mitral

C. Pulmonary

D. Tricuspid

Answer 104

B. Mitral

Question 105

A 26-year-old male is brought into the emergency room after having been kicked in the chest by a horse. After examination, it is concluded that the most likely immediate danger is cardiac tamponade (bleeding into the pericardial sac). You prepare to draw off some of the blood from the sac to relieve the pressure on the heart. The safest site at which to insert the needle of the syringe in order to miss the pleura would be:

A. Just below the nipple on the left

B. Just to the left of the xiphisternal junction

C. Near the sternal angle

D. Through the jugular notch

E. 4th left intercostal space in the midaxillary line

Answer 105

B. Just to the left of the xiphisternal junction

Question 106

While attempting to suture the distal end of a coronary bypass onto the anterior interventricular artery, the surgeon accidentally passed the needle through the adjacent vein. Which vein was damaged?

A. Anterior cardiac vein

B. Coronary sinus

C. Great cardiac vein

D. Middle cardiac vein

E. Small cardiac vein

Answer 106

C. Great cardiac vein

Question 107

While listening to a patient’s heart sounds with a stethoscope, you identify a high-pitched sound in the second right intercostal space, just lateral to the edge of the sternum. Your correct conclusion is that you have detected stenosis of which heart valve?

A. Aortic

B. Mitral

C. Pulmonary

D. Tricuspid

Answer 107

A. Aortic

Question 108

A young boy is brought to the hospital after a bicycle accident and possible pelvic fracture. While waiting a CT scan of his pelvis, a physician proceeds with a focal neurologic exam. In testing the child’s reflexes, which of the following nerves supplies the Cremaster muscle?

A. Subcostal nerve

B. Lateral femoral cutaneous nerve

C. Genitofemoral nerve

D. Iliohypogastric nerve

E. Femoral nerve

Answer 108

C. Genitofemoral nerve

Question 109

A-67-year old man with chronic bronchitis complained of a swelling & pain in his right groin. On examination, the physician noted that the anterior abdominal muscles were weak. He placed his fingers over the Hesselbach triangle & asked the man to hold nose and blow. This direct inguinal hernia:

A. Exits through the superficial inguinal ring

B. Is covered by spermatic fasciae

C. Lies medial to the inferior epigastric artery

D. Descends into the scrotum

E. Lies lateral to the inferior epigastric artery 

Answer 109

C. Lies medial to the inferior epigastric artery

Question 110

Which of the following defines the point at which the posterior lamina of internal oblique and the aponeurosis of the transversus abdominis become part of the anterior rectus sheath?

A. Arcuate line

B. Tendinous intersection

C. Linea Alba

D. Linea Semilunaris

E. Inguinal ligament

Answer 110

A. Arcuate line

Question 111

The aponeuroses of all three flat muscles of the anterolateral abdominal wall interlace in which of the following?

A. Inguinal ligament

B. Linea Alba

C. Linea Semilunaris

D. Rectus abdominis

E. Transversalis fascia

Answer 111

B. Linea Alba

Question 112

A large tumor mass impinges on the splenic artery and its branches as the artery passes out from below the greater curvature of the stomach. Branches of which of the following arteries would most likely be affected by the pressure on the splenic artery?

A. Left gastric

B. Left gastroepiploic

C. Right gastric

D. Right gastroepiploic

E. Gastro duodenal

Answer 112

B. Left gastroepiploic

Question 113

A 55-year-old woman comes to a local hospital with abdominal tenderness and acute pain. On examination, her physician observes that an abdominal infection has spread retroperitoneal. Which of the following structures is most likely affected?

A. Transverse colon

B. Ileum

C. Spleen

D. Stomach

E. Ascending colon

Answer 113

E. Ascending colon

Question 114

The superior pancreatico -duodenal artery which supplies the first part of the duodenum arise from which of the following arteries?

A. Right colic

B. Right Hepatic

C. Splenic

D. Gastro duodenal

E. Superior mesenteric

Answer 114

D. Gastro duodenal

Question 115

Which of the following ligaments enclose the portal triad?

A. Gastrocolic ligament

B. Hepatoduodenal ligament

C. Hepatorenal ligament

D. Hepatogastric ligament

E. Gastrosplenic ligament 

Answer 115

B. Hepatoduodenal ligament

Question 116

A-20- year old man with a ruptured appendix is sent to the ER for surgery. To cut off the blood supply to the appendix. A surgeon should ligate which of the following arteries?

A. Right colic artery

B. Ileocolic artery

C. Middle colic artery

D. Inferior mesenteric artery

E. Left colic artery

Answer 116

B. Ileocolic artery

Question 117

A 54-year- old man with a long history of alcohol abuse presents to the ER with rapidly increasing abdominal distention most likely resulting from an alteration in portal systemic flow. Which of the following characteristics is associated with the portal vein or portal venous system?

A. Lower blood pressure than in the IVC.

B. Least risk of venous varices because of portal hypertension.

C. Distension of portal vein because of its numerous valves.

D. Less blood flow than in the hepatic artery.

E. Esophageal varices & hemorrhoids caused by portal hypertension.

Answer 117

E. Esophageal varices & hemorrhoids caused by portal hypertension.

Question 118

Omental appendices ( appendices epiploica) and Taenia coli are located on which of the following structures?

A. Duodenum

B. Ileum

C. Ascending colon

D. Jejunum

E. Anal canal

Answer 118

C. Ascending colon

Question 119

The sympathetic fibers in the nerves to the jejunum and ileum originate in which of the following spinal cord segments?

A. C5-T1

B. T1-T5

C. T5-T9

D. T9-T12

E. L1-L2

Answer 119

C. T5-T9

Question 120

A football player presented to the ER with a tear in the psoas major muscle. Which nerve emerges from the anterior surface of the muscle is most likely will be injured?

A. Femoral nerve

B. Genitofemoral nerve

C. Obturator nerve

D. Iliohypogastric nerve

E. Ilioinguinal nerve

Answer 120

B. Genitofemoral nerve

Question 121

A 43 year old woman with known kidney disease presents to the hospital because her pain has become more severe. A physician performing kidney surgery must remember that:

A. Left kidney lies a bit lower than the right one.

B. Renal fascia doesn’t surround the suprarenal gland.

C. Left renal vein runs anterior to aorta and left renal artery

D. Left gonadal vein drains in IVC.

E. Perirenal fat lies external to the renal fascia.

Answer 121

C. Left renal vein runs anterior to aorta and Left renal artery

Question 122

A 55 year old man admitted to the ER complaining of adrenal ischemia which is due to occlusion of its blood supply. Which of the following arteries supplies the adrenal gland?

A. Lumbar arteries

B. Renal arteries

C. Inferior mesenteric arteries

D. Gonadal arteries

E. Inferior epigastric arteries

Answer 122

B. Renal arteries

Question 123

The inferior vena cava & the right phrenic nerve pass through the diaphragm at which of the following levels?

A. T10

B. T12

C. T9

D. T8

E. L1

Answer 123

D. T8

Question 124

The lateral arcuate ligaments are formed from thickenings from which of the following muscle fasciae?

A. Psoas major

B. Rectus abdominis

C. Transversus abdominis

D. Internal oblique

E. Quadratus Lumborum

Answer 124

E. Quadratus Lumborum

Question 125

Which of the following would be most likely to be damaged by a stab wound into the ischiorectal (ischioanal) fossa 2 cm lateral to the anal canal?
A. Crus of the Penis
B. Perineal Body
C. Pudendal Nerve
D. Inferior Rectal Artery
E. Vesicular Bulb

Answer 125

C. Pudendal Nerve

Question 126

Lymphatic drainage of the terminal portion of the gastrointestinal tract may flow initially into either the superficial inguinal nodes or the pararectal nodes, depending upon whether the lymph is formed above or below the:
A. Anorectal Junction
B. Muscular Sling of the Puborectalis Muscle
C. Pectinate Line
D. White Line
E. Cutaneous Zone

Answer 126

C. Pectinate Line

The pectinate line is the place where the lining of the anal canal changes from skin to mucosa. It is also a landmark that divides the lymphatic drainage, vascular supply, and innervation of the anal canal. Lymph coming from structures above the pectinate line drains to the inferior mesenteric lymph nodes or the internal iliac nodes. Lymph from structures below the pectinate line travels to the superficial inguinal lymph nodes.

Question 127

After agreeing to have no more children, a man and his wife decided he should have a vasectomy. What structure would then be surgically ligated?
A. Ductus deferens
B. Ejaculatory duct
C. Epididymis
D. Fossa navicularis
E Seminal vesicle

Answer 127

A. Ductus deferens

Question 128

Which pair of structures does NOT differentiate from comparable embryonic structures in the male and female?
A. Bulb of corpus spongeosum and vestibular bulb
B. Shaft of penis and labia majora
C. Glans of penis and glans of clitoris
D. Crus of corpus cavernosum penis and crus of corpus cavernosum clitoris

Answer 128

B. Shaft of penis and labia majora

Question 129

Which structure is found only in males?
A. Anterior recess of ischoianal fossa
B. Genital Hiatus
C. Ischiocavernosus muscle
D. Rectovesical pouch
E. Sphincter urethrae muscle

Answer 129

D. Rectovesical pouch

The rectovesicular pouch is a reflection of the peritoneum between the rectum and the bladder. It can only be found in males because females have the uterus sitting between the rectum and the bladder. This means that females have two pouches created by reflections of peritoneum draped over the pelvic viscera: the rectouterine and vesicouterine pouches.

Question 130

Which of the following is considered a part of the broad ligament?
A. Mesovarium
B. Ovarian ligament
C. Round ligament of the uterus
D. Suspensory Ligament of the ovary
E. Uterosacral ligament

Answer 130

A. Mesovarium

The mesovarium, mesometrium, and mesosalpinx are the three peritoneal sections that create the broad ligament. The mesosalpinx covers the uterine tube and hangs below it to meet with the mesovarium. The mesovarium covers the ovary and ovarian ligament. It extends posteriorly from the mesosalpinx like a shelf. The mesometrium makes up the rest of the broad ligament.

Question 131

Which of the following does not conduct spermatozoa?
A. Ampulla of the ductus deferens
B. Duct of the seminal vesicle
C. Epididymis
D. Prostatic Urethra

Answer 131

B. Duct of the seminal vesicle

It only conducts seminal fluid which carries fructose

Question 132

During the course of surgery for benign prostatic hypertrophy (benign enlargement of the prostate tissue which occludes the prostatic urethra) an electrical cutting device is inserted into the penile, then prostatic urethra, to remove the hypertrophic tissue. The posterior wall of the prostatic urethra is by necessity removed as well. Which part of the male seminal tract may also be partially removed?
A. duct of seminal vesicle
B. ductus deferens
C. ejaculatory duct
D. fossa navicularis
E. seminiferous tubule

Answer 132

C. ejaculatory duct

Question 133

A 27-year-old woman is examined by her gynecologist. Upon rectal examination, a firm structure, directly in front of the rectum in the midline, is palpated through the anterior wall of the rectum. This structure is the:
A. bladder
B. body of uterus
C. cervix of uterus
D. pubic symphysis
E. vagina

Answer 133

C. cervix of uterus

Question 134

The most inferior extent of the peritoneal cavity in the female is the:
A. Pararectal fossa
B. Paravesical fossa
C. Rectouterine pouch
D. Rectovesical pouch
E. Vesicouterine pouch

Answer 134

C. Rectouterine pouch

Question 135

The prostate gland:
A. Contains upper, middle and lower lobes
B. Encircles the urethra
C. Is well imaged radiologically using an intravenous urogram
D. Is extraperitoneal
E. B and D

Answer 135

E. B and D

Question 136

Structures within the lower gastrointestinal tract specialized for physical support of fecal material are the:
A. Transverse rectal folds
B. Circular folds
C. Anal valves
D. Anal columns

Answer 136

A. Transverse rectal folds

There are usually three transverse rectal folds in the lower rectum. These are specializations of the circular layer of musculature that are designed to support fecal mass. Although circular folds is somewhat descriptive of the transverse rectal folds, this is not the best answer. Anal columns are longitudinal folds of mucosa over rectal vessels. They are found on the inner wall of the anal canal. Anal valves are the folds of mucosa that join the anal columns at their inferior ends.

Question 137

A malignant tumor in the cutaneous zone of the anal canal would most likely metastasize (spread) to which group of lymph nodes?
A. Inferior mesenteric
B. Pararectal
C. Sacral
D. Superficial inguinal

Answer 137

D. Superficial inguinal

Question 138

Which of these features of the anal canal serves to indicate the point where the mucosal covering of the gastrointestinal atract ends and a skin-like covering begins?
A. Mucosal zone
B. White line
C. Transitional zone
D. Pectinate line

Answer 138

D. Pectinate line

Question 139

The expanded region of the lower rectum, where fecal matter is retained, is known as the:
A. Anal columns
B. Anal sinuses
C. Ampulla
D. Transverse folds

Answer 139

C. Ampulla

The ampulla is an expanded part of the lower rectum that stores feces. The transverse rectal folds are three folds in the ampulla which help to support fecal mass, but they are not the same as the actual region that stores the feces. Anal columns are longitudinal folds of mucosa over rectal vessels. They are found on the inner wall of the anal canal. Anal valves are folds of mucosa that join the anal columns at their inferior ends and create spaces between the wall and the valves known as anal sinuses.

Question 140

During a hysterectomy, the uterine vessels are ligated. However, the patient’s uterus continues to bleed. The most likely source of blood still supplying the uterus is from which artery?
A. Inferior vesical
B. Internal pudendal
C. Middle rectal
D. Ovarian
E. Superior vesical

Answer 140

D. Ovarian

Question 141

During a hysterectomy and an oophorectomy, the uterine and ovarian vessels must be ligated. These vessels can be found in which ligaments?
A. Broad and ovarian
B. Broad and suspensory
C. Round and ovarian
D. Round and suspensory
E. Suspensory and ovarian

Answer 141

B. Broad and suspensory

The uterine vessels are found in the inferior portion of the broad ligament, while the ovarian vessels are found in the suspensory ligaments of the ovaries. The suspensory ligaments of the ovaries are peritoneal folds covering ovarian arteries, veins, nerves, and lymphatics as the structures pass over the pelvic brim to reach the ovary.

The ovarian ligament proper is a round cord which attaches the ovary to the uterus, just below the entrance of the uterine tube into the uterus. The round ligament of the uterus is a connective tissue band that attaches to the inner aspect of the labium majus and the uterus–it traverses the inguinal canal and it is found in the broad ligament.

Question 142

A female patient comes to your office with lower abdominal pain. She missed her last menses and her pregnancy test is positive. Ultrasound imaging reveals a cyst-like structure in the right uterine tube which you feel may be a tubal pregnancy. In order to confirm your diagnosis and to remove the tubal embryo, you can gain access to the patient’s lower pelvic cavity by passing a culdoscope through the vagina and the:
A. vesicouterine pouch
B. posterior fornix
C. cervix
D. isthmus
E. ampulla

Answer 142

B. posterior fornix

Question 143

An elderly patient notices red blood in his stool. As part of his examination, you insert a proctoscope (sigmoidoscope) through his anal canal. As you pass the scope superiorly through the rectum, the most prominent features to be seen are:
A. longitudinal muscle bands
B. tenia coli
C. transverse rectal folds
D. rectovesical pouches
E. haustra

Answer 143

C. transverse rectal folds

Question 144

An elderly patient is having difficulty in voiding (urinating). He complains that after voiding, he still feels as though he needs “to go” again. You suspect that this patient suffers from benign prostatic hypertrophy, which has caused enlargement of the __________ of the bladder.
A. seminal colliculus
B. interureteric crest
C. ampulla
D. trigone
E. uvula

Answer 144

E. uvula

Question 145

During a hysterectomy, care must be taken in ligation of the uterine vessels because they cross the _________ superiorly.
A. ureter
B. round ligament of the uterus
C. ovarian artery
D. lumbosacral trunk
E. inferior hypogastric plexus

Answer 145

A. ureter

Question 146

The part of the broad ligament giving attachment and support to the uterine tube is the:
A. mesometrium
B. mesovarium
C. mesosalpinx
D. round ligament

Answer 146

C. mesosalpinx

Question 147

Which structure is NOT found within the true pelvis?
A. Femoral nerve
B. Hypogastric nerve
C. Internal pudendal artery
D. Obturator artery
E. Pelvic splanchnic nerves

Answer 147

A. Femoral nerve

Question 148

A structure which is homologous to the male scrotum:
A. Labia minora
B. Labia majora
C. Glans
D. Shaft of corpus cavernosum

Answer 148

B. Labia majora

Question 149

Which skeletal feature would you consider to be most characteristic of the female pelvis?
A. Subpubic angle of 90 degrees or greater
B. Marked anterior curvature of the sacrum
C. Tendency to vertical orientation of the iliac bones
D. Prominent medial projection of the ischial spines

Answer 149

A. Subpubic angle of 90 degrees or greater

Question 150

The rectouterine pouch is the lowest extent of the female peritoneal cavity. At its lowest, it provides a coat of peritoneum to a portion of the:
A. urinary bladder
B. urethra
C. uterine cervix
D. vagina

Answer 150

D. vagina

Question 151

In a CT scan of the pelvis, the uterus is located:
A. posterior to the bladder and rectum
B. posterior to the bladder and anterior to the rectum
C. anterior to the bladder and rectum
D. anterior to the bladder and posterior to the rectum

Answer 151

B. posterior to the bladder and anterior to the rectum

Question 152

The lesser omentum and falciform ligament is derived from the:

A. Dorsal mesentery of the colon

B. Dorsal mesentery of the small intestine

C. Midgut loop

D. Dorsal mesentery of the stomach

E. Ventral mesentery of the stomach

Answer 152

E. Ventral mesentery of the stomach

Question 153

Which one of the following structures is derived from the midgut:

A. Stomach

B. Liver

C. Spleen

D. Appendix

E. Sigmoid colon

Answer 153

D. Appendix

Question 154

The failure of the vitelline duct to involute during the embryonic development leads to a persistent diverticulum occurs in 2% of the population:

A. Omophalocele

B. Meckel’s Diverticulum

C. Gastroschisis

D. Intestinalstenosis

E. Analagenesis

Answer 154

B. Meckel’s Diverticulum

Question 155

A male infant was born with a fist-size mass in the proximal part of the umbilical cord. The swelling was covered by peritoneum & amnion. Which of the following is the most likely the diagnosis?

A. Omophalocele
B. Intestinalstenosis
C. Analagenesis
D. Gastroschisis
E. Meckel’s Diverticulum

Answer 155

A. Omophalocele

Question 156

Which of the following arteries supplies the midgut and form an axis of rotation :

A. Celiac trunk

B. Right umbilical artery

C. Right lumbar artery

D. Superior mesenteric artery

E. Inferior mesenteric artery

Answer 156

D. Superior mesenteric artery

Question 157

The pancreatic islets consist of alpha, beta and delta cells. These cells are derived from :

A. Mesoderm

B. Neuralcrestcells

C. Endoderm

D. Ectoderm

E. Neuroectoderm

Answer 157

C. Endoderm

Question 158

A 38-year-old man died from complications after surgery. The pathologist found about 2 liters of blood in the omental bursa. The omental bursa or lesser sac:

A. Develops in the mesenchyme of the ventral mesentery

B. Develops in the mesenchyme of the dorsal mesentery

C. A closed pouch

D. Results from rotation of the midgut loop.

E. Lies between the stomach and anterior abdominal wall.

Answer 158

B. Develops in the mesenchyme of the dorsal mesentery

Question 159

Derivatives of the caudal part of the embryonic foregut are supplied by which of the following arteries?

A. Middle colic artery.

B. Inferior mesenteric artery.

C. Superior mesenteric artery.

D. Cystic artery.

E. Celiac trunk.

Answer 159

E. Celiac trunk.

Question 160

The usual location for an appendectomy incision is the:
A. left lower quadrant
B. left upper quadrant
C. right lower quadrant
D. right upper quadrant

Answer 160

C. right lower quadrant

Question 161

During a routine physical exam, the physician taps a patient’s patellar ligament with a reflex hammer and elicits a knee‐jerk reflex. Which of the following nerves mediates this patellar reflex?

A. Common fibular

B. Femoral

C. Obturator

D. Saphenous

E. Tibial

Answer 161

B. Femoral

Question 162

You are called to see a 35‐year‐old man who was admitted to hospital earlier that day. He was involved in a road traffic accident and sustained a fracture of his left tibia. He is now complaining of pain, and on examination his leg appears white and cold. You are unable to palpate his foot pulses. He is diagnosed with compartment syndrome affecting the extensor compartment of his leg. Which nerve supplies the extensor compartment of the leg?

A. Deep peroneal nerve

B. Femoral nerve

C. Sciatic nerve

D. Superficial peroneal nerve

E. Sural nerve

Answer 162

A. Deep peroneal nerve

Question 163

The terminal ends of the ilioinguinal nerves in the female are referred to as:
A. Anterior cutaneous branches
B. Anterior labial
C. Cremasterics
D. Iliohypogastrics

Answer 163

B. Anterior labial

Question 164

The usual location for an appendectomy incision is the:
A. left lower quadrant
B. left upper quadrant
C. right lower quadrant
D. right upper quadrant

Answer 164

C. right lower quadrant

Question 165

The inferior border of the rectus sheath posteriorly is called the:
A. Falx inguinalis
B. Inguinal ligament
C. Internal inguinal ring
D. Arcuate line
E. Linea alba

Answer 165

D. Arcuate line

Question 166

A medical student was asked by her preceptor to palpate the margin of the superficial inguinal ring of a healthy male patient. After passing her finger down the edge of the medial crus of the superficial inguinal ring, she felt a bony protuberance deep to the lateral edge of the spermatic cord, which she correctly identified as the :
A. pecten pubis
B. pubic symphysis
C. pubic tubercle
D. iliopubic eminence
E. iliopectineal line

Answer 166

C. pubic tubercle

Question 167

Following an emergency appendectomy your patient complained of having paresthesia (numbness) of the skin at the pubic region. The most likely nerve that has been injured during the operation is:
A. Genitofemoral
B. Iliohypogastric
C. Subcostal
D. Spinal nerve T10
E. Spinal nerve T9

Answer 167

B. Iliohypogastric

The iliohypogastric nerve is a branch of the lumbar plexus. It provides sensory innervation to the skin of the lower abdominal wall, upper hip and upper thigh. This is the region where the patient is experiencing paresthesia, so this nerve must be injured. The genitofemoral nerve is another nerve from the lumbar plexus. It provides sensory innervation to the skin of the anterior scrotum or labia majora and upper medial thigh. The subcostal nerve is the ventral primary ramus of T12–it is the equivalent of an intercostal nerve at a higher thoracic level. It provides sensory innervation to the anterolateral abdominal wall, but in an area superior to the pubic region. A spinal nerve would not have been injured in the operation. Remember–the spinal nerve is just that small segment of nerve that exists once the dorsal and ventral rootlets come together, before the dorsal and ventral primary rami branch off. In any case, the T9 and T10 dermatomes are superior to the area where the patient is experiencing paresthesia.

Question 168

An obstetrician decides to do a Caesarean section on a 25-year-old pregnant woman. A transverse suprapubic incision is chosen for that purpose. All of the following abdominal wall layers will be encountered during the incision EXCEPT the:
A. Anterior rectus sheath
B. Posterior rectus sheath
C. Rectus abdominis muscle
D. Skin and subcutaneous tissue
E. Transversalis fascia, extraperitoneal fat, and peritoneum

Answer 168

B. Posterior rectus sheath

Question 169

In order to reduce a hernia (return it to the abdominal cavity), a surgeon finds it necessary to ligate an artery in the extraperitoneal connective tissue (preperitoneal fat) running vertically just medial to the bowel as the bowel passes through the abdominal wall. This artery is the:
A. Deep circumflex iliac
B. Inferior epigastric
C. Superficial circumflex iliac
D. Superficial epigastric
E. Superficial external pudendal

Answer 169

B. Inferior epigastric

Question 170

The posterior layer of the rectus sheath ends inferiorly at the
A. Arcuate line
B. Intercrestal line
C. Linea alba
D. Pectineal line
E. Semilunar line

Answer 170

A. Arcuate line

Question 171

Surgical approaches to the abdomen sometimes necessitate a midline incision between the two rectus sheaths, i.e., through the:
A. Linea aspera
B. Arcuate line
C. Semilunar line
D. Iliopectineal line
E. Linea alba

Answer 171

E. Linea alba

Question 172

The internal thoracic artery is sometimes surgically cut near the caudal end of the sternum and used to supply blood to a region of the heart. In these cases, maintenance of adequate blood flow to the rectus abdominis may be dependent on increased flow through which artery?
A. Superficial epigastric
B. Inferior epigastric
C. Umbilical
D. Superficial circumflex iliac
E. Deep circumflex iliac

Answer 172

B. Inferior epigastric

If the internal thoracic artery was ligated, blood would no longer flow to the superior epigastric artery, which is the branch of the internal thoracic that supplies blood to rectus abdominis. However, the superior epigastric artery communicates with the inferior epigastric artery, a branch of the external iliac artery. This means that blood could flow from the external iliac, to the inferior epigastric, to the superior epigastric and the rectus abdominis. The superficial epigastric and superficial circumflex iliac arteries are two superficial branches of the femoral artery. They do not supply deep structures in the abdomen. The distal portions of the umbilical arteries are obliterated in adults–they are the medial umbilical ligaments that form the medial umbilical folds. The deep circumflex iliac artery courses along the iliac crest on the inner surface of the abdominal wall. It is too lateral to supply blood to rectus abdominis.

Question 173

The normal pattern of venous and lymphatic drainage of the superficial tissues of the anterior abdominal wall is arranged around a horizontal plane. Above that plane, drainage is in a cranial direction; below the plane drainage is in a caudal direction. This reference plane corresponds to:
A. Transpyloric plane
B. Level of anterior superior iliac spines
C. Transtubercular line
D. Level of arcuate line
E. Level of umbilicus

Answer 173

E. Level of umbilicus

Question 174

Which of the following nerves mediates the patellar reflex?

A. Common Fibular

B. Femoral

C. Obturator

D. Saphenous

E. Tibial

Answer 174

B. Femoral

Question 175

A first year student is asked to demonstrate the location of the dorsalis pedis pulse. Which of the following landmarks would be a reliable guide for finding this artery?

A. Lateral to the externsor hallucis longus tendon

B. Medial to the extensor digitorum longus tendons

C. Over the intermediate cuneiform bone

D. Over the second metatarsal bone

E. Web space between toes 1 and 2

Answer 175

A. Lateral to the externsor hallucis longus tendon

Question 176

A long distance runner is examines by her physician after complining of pain along the anteromedial aspect of her left leg, from below the knee to above the anke. She has been running on a hard surface and notices that the pain is especially acute as she pushes off from the gound. Which of the following muscles is most likely afected?

A. Extensor digitorum longus

B. Fibularis Longus

C. Gastrocnemius

D. Popliteus

E. Tibialis Posterior

Answer 176

E. Tibialis Posterior

Question 177

A 23-year old accidentally steps on a tack, which pierces the medial side of the sole of her foor at about the midpoint. That tack has impaled the flexor digitorum longus tendon and damaged the adjacent nerve. Which of the following muscles is most likely affected?

A. Quadratus plantae

B. Flexor digitorum brevis

C. Adductor Hallucis

D. Plantar Interossei

E. Abductor Digiti Minimi

Answer 177

B. Flexor digitorum brevis

Question 178

The femoral canal contains the:
A. Deep inguinal lymph node(s)
B. Femoral artery
C. Femoral nerve
D. Femoral vein
E. Ilioinguinal nerve

Answer 178

A. Deep inguinal lymph node(s)

Question 179

Which movement would fail in case of paralysis of the quadriceps femoris muscle?
A. Adduction at the hip
B. Extension at the hip
C. Extension at the knee
D. Flexion at the knee
E. Medial rotation at the knee

Answer 179

C. Extension at the knee

Question 180

Which structure does NOT enter or leave the inguinal region by passing deep to the inguinal ligament?
A. Femoral artery
B. Femoral nerve
C. Femoral vein
D. Psoas major muscle
E. Round ligament of the uterus

Answer 180

E. Round ligament of the uterus

Question 181

An elderly woman was found to have a hernial sac in the right femoral triangle and a marked weakness in adduction at the right hip joint. Which nerve was likely compressed by this herniation?
A. Femoral
B. Inferior gluteal
C. Obturator
D. Pudendal
E. Sciatic

Answer 181

C. Obturator

Question 182

If the femoral artery is occluded at the beginning of the adductor canal, which artery could help provide viability to the leg through collateral circulation?
A. Descending branch of the lateral circumflex femoral
B. Descending genicular
C. First perforating branch of the deep femoral
D. Medial circumflex femoral
E. Obturator

Answer 182

A. Descending branch of the lateral circumflex femoral

Question 183

At which site could one expect to enter the femoral vein with a simple percutaneous (through the skin) introduction of an instrument?
A. Above the middle of the inguinal ligament
B. Lateral to the femoral arterial pulse
C. Lateral to the pubic tubercle
D. Medial to the femoral arterial pulse
E. Medial to the pubic tubercle

Answer 183

D. Medial to the femoral arterial pulse

Question 184

Following a penetrating injury to the left femoral triangle, a patient related that walking was virtually impossible because at every step the left knee collapsed into flexion. This history suggests paralysis of which muscle?
A. Adductor magnus.
B. Biceps femoris.
C. Gluteus maximus.
D. Quadriceps femoris.
E. Sartorius.

Answer 184

D. Quadriceps femoris.

Question 185

An obturator hernia that compresses the obturator nerve in the obturator canal may affect the function of all of the following muscles EXCEPT:
A. Adductor brevis
B. Adductor longus
C. Gracilis
D. Obturator externus
E. Pectineus

Answer 185

E. Pectineus

Question 186

Inability to extend the knee and loss of cutaneous sensation over the anterior surface of the thigh would indicate a lesion or compression of the:
A. Superior gluteal nerve
B. Lateral femoral cutaneous nerve
C. Sciatic nerve
D. Femoral nerve
E. Obturator nerve

Answer 186

D. Femoral nerve

Question 187

Which statement is true?
A. The femoral artery lies medial to the femoral vein
B. The femoral vein lies medial to the femoral artery
C. The external iliac veins join to form the inferior vena cava
D. The inferior vena cava can not be imaged radiographically
E. A and C

Answer 187

B. The femoral vein lies medial to the femoral artery

Question 188

Blood flow around an occlusion of the femoral (superficial femoral) artery at the apex of the femoral triangle could be provided by:
A. Anterior tibial recurrent
B. Descending branch of the lateral circumflex femoral
C. Descending genicular
D. Medial circumflex femoral
E. Perforating branches of the deep femoral

Answer 188

B. Descending branch of the lateral circumflex femoral

Question 189

In the middle third of the thigh, the superficial and deep femoral arteries are separated by:
A. Adductor longus
B. Adductor magnus
C. Gracilis
D. Pectineus
E. Vastus medialis

Answer 189

A. Adductor longus

Question 190

Fracture of the femoral neck may lead to avascular necrosis of the femoral head due to the interruption of which artery?
A. First perforating branch of the deep femoral
B. Inferior epigastric
C. Internal pudendal
D. Lateral circumflex femoral
E. Medial circumflex femoral

Answer 190

E. Medial circumflex femoral

It supplies the blood of the femoral neck.

Question 191

Following surgical opening of the adductor canal, a patient experienced a loss of cutaneous sensation of the medial side of the leg. Which nerve was cut?
A. Ilioinguinal
B. Femoral
C. Obturator
D. Medial sural cutaneous
E. Saphenous

Answer 191

E. Saphenous

Question 192

During recovery from a gunshot wound of the right pelvis, the patient notices a lurch in his gait. When he lifts his left foot off of the ground, his pelvis dips down on the left side. The nerve that appears to have been injured is the:
A. nerve to piriformis
B. nerve to obturator internus
C. sciatic nerve
D. femoral nerve
E. superior gluteal nerve

Answer 192

E. superior gluteal nerve

Question 193

The team doctor tells a football player that he has “a pulled hamstring” muscle. This results from a tearing of the origin of a hamstring muscle from the:
A. sacrum
B. posterior gluteal line
C. ischial tuberosity
D. obturator membrane
E. iliac tubercle

Answer 193

C. ischial tuberosity

Question 194

If the head of the femur is dislocated postero-medially, compression of which nerve is likely to result?
A. Femoral
B. Lumbosacral trunk
C. Obturator
D. Sciatic
E. Superior gluteal

Answer 194

D. Sciatic

Question 195

What muscle passes through the lesser sciatic foramen?
A. Gluteus minimus
B. Obturator internus
C. Piriformis
D. Quadratus femoris
E. Superior gemellus

Answer 195

B. Obturator internus

Question 196

As a patient with paralyzed gluteus medius and minimus muscles on the left side attempts to stand on the left limb only, the right side of the pelvis typically:
A. Drops
B. Elevates
C. Rotates laterally
D. Rotates medially
E. Thrusts forward

Answer 196

A. Drops

Question 197

When the femur is fractured, the broken distal end often turns posteriorly to enter the popliteal fossa due to muscle traction. Because of its position deepest in the fossa, which structure is most vulnerable to laceration?
A. Common fibular n.
B. Lesser saphenous v.
C. Popliteal a.
D. Popliteal v.
E. Tibial n.

Answer 197

C. Popliteal a.

Question 198

The deep femoral artery is the principle blood source for the muscles in which compartment of the thigh?
A. Anterior
B. Lateral (gluteal)
C. Medial (adductor)
D. Posterior (hamstring)

Answer 198

D. Posterior (hamstring)

Question 199

A fracture of the ischial tuberosity might be expected to most directly affect the muscles that produce which lower limb movement?
A. Abduction at the hip
B. Adduction at the hip
C. Extension at the knee
D. Flexion at the hip
E. Flexion at the knee

Answer 199

E. Flexion at the knee

Question 200

When, in approximately 12% of people, the common fibular nerve passes through the piriformis muscle, the nerve may be compressed. This would affect part of which muscle?
A. Adductor magnus
B. Biceps femoris
C. Gluteus maximus
D. Semimembranosus
E. Semitendinosus

Answer 200

B. Biceps femoris

Question 201

During surgical repair of a popliteal artery aneurism, ligation of the femoral artery at mid-thigh would not interrupt supply to the hamstring muscles because the
A. Genicular anastomosis ensures blood supply to the posterior thigh
B. Cruciate anastomosis ensures blood supply to the posterior thigh
C. Perforating branches of the deep femoral artery supply the posterior thigh
D. Obturator artery supplies the posterior thigh
D. Anterior and posterior femoral circumflex arteries anastomose with the inferior gluteal artery

Answer 201

C. Perforating branches of the deep femoral artery supply the posterior thigh

Question 202

The hamstrings muscles are supplied by branches of which artery?
A. Deep femoral
B. Fibular
C. Obturator
D. Pudendal
E. Superficial femoral

Answer 202

A. Deep femoral

Question 203

Of the branches of the internal iliac artery, the one exiting from the greater sciatic foramen superior to the piriformis muscle is the:
A. Iliolumbar artery
B. Internal pudendal artery
C. Lateral sacral artery
D. Superior gluteal artery

Answer 203

D. Superior gluteal artery

Question 204

A patient complains of localized pain in a swollen lower calf and cannot strongly plantar flex his foot. What tendon may have ruptured?
A. calcaneal
B. fibularis tertius
C. flexor digitorum longus
D. flexor hallucis longus
E. tibialis anterior

Answer 204

A. calcaneal

Question 205

A tennis player feels a “pop” in her calf as she is playing. Her calf becomes tender and there is some slight amount of swelling. Upon examination, her physician informs her that she has ruptured the slender tendon of a small muscle that attaches to the calcaneus. She has apparently ruptured the:
A. gastrocnemius
B. plantaris
C. popliteus
D. soleus
E. tibialis posterior

Answer 205

B. plantaris

Question 206

A football player tears his calcaneal tendon. You would expect to find weakness in:
A. dorsifiexion of the foot
B. eversion of the foot
C. extension of the knee
D. inversion of the foot
E. plantarflexion of the foot

Answer 206

E. plantarflexion of the foot

Question 207

While on vacation in Florida following her final exams, a scuba diving medical student is accidentally speared by her diving partner. The end of the spear passes medial to lateral, posterior to the medial malleolus. It severs an artery there, which is the:
A. anterior tibial
B. dorsalis pedis
C. fibular
D. medial plantar
E. posterior tibial

Answer 207

E. posterior tibial

Question 208

A patient has stepped on a board with a long nail sticking up from it, and the nail penetrated the patient’s foot between the bases of the first and second metatarsals. What artery is most likely injured at this location?
A. arcuate
B. deep plantar
C. dorsalis pedis
D. lateral plantar
E. medial plantar

Answer 208

B. deep plantar

Question 209

A deep laceration, 2 cm in length, immediately posterior to the medial malleolus, may injure any of the following EXCEPT:
A. fibular artery
B. tibial nerve
C. tendon of tibialis posterior m.
D. tendon of flexor digitorum longus m.
E. tendon of flexor hallucis longus m.

Answer 209

A. fibular artery

Question 210

A construction worker lacerates the dorsum of his foot just below his ankle. Profuse bleeding that occurs would result from cutting which vessel?
A. small saphenous vein
B. dorsalis pedis artery
C. medial plantar artery
D. anterior tibial artery
E. fibular artery

Answer 210

B. dorsalis pedis artery

Question 211

Compression of the lateral plantar nerve as it passes between the flexor digitorum brevis and quadratus plantae could result in weakness of any of the following actions EXCEPT:
A. abduction of the great toe
B. adduction of the middle toe
C. abduction of the little toe
D. adduction of the great toe
E. abduction of the middle toe

Answer 211

A. abduction of the great toe

Question 212

Pain may result from friction of the tendon of which muscle that passes deep to the anterior fibers of the long plantar ligament.
A. tibialis posterior
B. flexor hallucis longus
C. fibularis longus
D. tibialis anterior
E. flexor hallucis brevis

Answer 212

C. fibularis longus

Question 213

In an accident involving farm machinery, a farmer recieves a cut on the dorsum of his ankle. As you inspect the wound and test for functional and sensory deficits, you find that no tendons have been cut, but the dorsalis pedis artery and the accompanying nerve have been cut. You would expect to find:
A. club foot
B. foot drop
C. inability to extend the big toe
D. numbness between the first and second toes
E. weakness in inversion of the foot

Answer 213

D. numbness between the first and second toes

The nerve running with the dorsalis pedis artery is the deep fibular nerve. This nerve innervates the anterior compartment of the leg and the extensors on the dorsum of the foot. At the point where it was cut, the nerve had already given off all its branches to the anterior compartment of the leg. So, the farmer should still be able to dorsiflex his foot (preventing foot drop), and all of the muscles that invert his foot should be intact. Although extensor hallucis brevis (on the dorsum of the foot) has been denervated, extensor hallucis longus is in the anterior compartment of the leg, and that muscle should still be able to extend the great toe. However, the deep fibular nerve would have been cut before it could supply fibers to the area of cutaneous innervation between the first and second toe. So, there would be numbness in that area of skin.

Question 214

While walking barefoot on the beach in Florida following final exams, a medical student steps on a sharp shell which punctures the sole of her foot. She notices that she can no longer spread her toes apart (without using her hands, that is). Which nerve must have been injured?
A. deep fibular
B. lateral plantar
C. medial plantar
D. sural
E. tibial

Answer 214

B. lateral plantar

Question 215

The lateral plantar nerve is a branch of which nerve?
A. Deep fibular
B. Femoral
C. Saphenous
D. Sural
E. Tibial

Answer 215

E. Tibial

Question 216

A patient with a fracture to the left upper tibia was treated with a plaster cast. A few days later he started to develop progressive numbness over the dorsum of the foot and weakness in dorsiflexion. The cast was quickly changed and the signs were attributed to nerve compression. The compressed nerve was most likely the:
A. Tibial
B. Obturator
C. Sciatic
D. Femoral
E. Common fibular

Answer 216

E. Common fibular

Question 217

While at the beach in Florida after final exams, a medical student steps on a stingray, which responds by stinging her in the ankle. The stinger pierces the skin, subcutaneous tissue, and flexor retinaculum of the ankle. Which other structure passing under the retinaculum may be injured?
A. Tibial nerve
B. Tibialis anterior
C. Quadratus plantae
D. Anterior tibial artery
E. Plantar arterial arch

Answer 217

A. Tibial nerve

Question 218

Your patient was struck by a car’s bumper as she crossed the street, and her fibular neck is broken. After the bone has healed, she has “foot drop”, i. e. she cannot dorsiflex her foot, and so it flops onto the ground during walking. Denervation (paralysis) of which of the following muscles would be associated with foot drop?
A. fibularis longus
B. tibialis posterior
C. fibularis brevis
D. tibialis anterior
E. popliteus

Answer 218

D. tibialis anterior

Question 219

A pedestrian is struck by a car, and his fibular neck is fractured. There is no indication of foot drop, but he cannot evert his foot and the top of his foot is numb. This apparent nerve lesion would affect which of the following muscles?
A. Tibialis posterior
B. Tibialis anterior
C. Fibularis tertius
D. Fibularis longus
E. Adductor hallucis

Answer 219

D. Fibularis longus

Question 220

A patient has been diagnosed with bone cancer in the fibula that necessitates its removal. Which of the following muscles would be least affected following removal of the fibula?
A. biceps femoris
B. extensor digitorum longus
C. flexor digitorum longus
D. flexor hallucis longus
E. peroneus tertius

Answer 220

C. flexor digitorum longus

Question 221

A player is kicked on the front of his leg during a soccer game, and a large bruise develops. A hematoma deep to the crural fascia can create extreme pressure within the anterior compartment of the leg, compressing structures within it. The most likely finding resulting from this anterior compartment syndrome is:
A. numbness on the dorsum of the foot
B. inability to evert the foot
C. inability to invert the foot
D. foot drop
E. inability to plantarflex the foot

Answer 221

D. foot drop

Question 222

An athlete has a knee injury, and the doctor performs a “drawer test” by pulling and pushing on the leg with the knee flexed. If the leg translates anteriorly, i. e. “gives” or moves anteriorly when the leg is pulled anteriorly, what joint structure is most likely injured?
A. anterior cruciate ligament
B. lateral collateral ligament
C. medial collateral ligament
D. medial meniscus
E. posterior cruciate ligament

Answer 222

A. anterior cruciate ligament

Question 223

One of the menisci of the knee is often injured in a sprain of the knee because the:
A. Anterior cruciate ligament is attached to the lateral meniscus
B. Anterior cruciate ligament is attached to the medial meniscus
C. Lateral collateral ligament is attached to the lateral meniscus
D. Medial collateral ligament is attached to the medial meniscus
E. Posterior cruciate ligament is attached to the lateral meniscus

Answer 223

D. Medial collateral ligament is attached to the medial meniscus

Question 224

A young man involved in a head-on automobile collision had his flexed knee hit the dashboard of the car. He was later found to have a major instability of the knee, in that his tibia could be moved posteriorly relative to the femur. What ligament was likely damaged?
A. Lateral collateral ligament
B. Deltoid
C. Medial collateral ligament
D. Anterior cruciate ligament
E. Posterior cruciate ligament

Answer 224

E. Posterior cruciate ligament

Question 225

During a basketball game, the center of the team went up for a rebound and when coming down, her foot landed on the foot of another player, sharply everting it. She limped off the floor, having severely sprained the medial side of her ankle. Which ligament was injured?
A. Calcaneofibular
B. Deltoid
C. Short plantar ligament
D. Plantar calcaneonavicular
E. Tibial collateral ligament

Answer 225

B. Deltoid

Question 226

Which ligament limits extension at the hip joint?
A. Iliofemoral
B. Ligamentum capitis femorus
C. Pubofemoral
D. Zona orbicularis

Answer 226

A. Iliofemoral

Question 227

In injuries of the knee, the medial meniscus is frequently torn because it is firmly attached to which structure?
A. Anterior cruciate ligament
B. Fibular collateral ligament
C. Tibial collateral ligament
D. Patellar ligament
E. Patellar retinaculum

Answer 227

C. Tibial collateral ligament

Question 228

The thoracic wall is innervated by:
A. Dorsal primary rami
B. Intercostal nerves
C. Lateral pectoral nerves
D. Medial pectoral nerves
E. Thoracodorsal nerves

Answer 228

B. Intercostal nerves

Question 229

You are caring for a 68-year-old male who has copious amounts of fluid in the left pleural cavity due to acute pleurisy. When you examine him as he sits up in bed (trunk upright), where would the fluid tend to accumulate?
A. costodiaphragmatic recess
B. costomediastinal recess
C. cupola
D. hilar reflection
E. middle mediastinum

Answer 229

A. costodiaphragmatic recess

Question 230

When inserting a chest tube, intercostal vessels and nerves are avoided by placing the tube immediately:
A. above the margin of a rib
B. below the margin of a rib

Answer 230

A. above the margin of a rib

Question 231

The portion of the parietal pleura that extends above the first rib is called the :
A. costodiaphragmatic recess
B. costomediastinal recess
C. costocervical recess
D. cupola
E. endothoracic fascia

Answer 231

D. cupola

Question 232

You are attending an operation to remove a thymic tumor from the superior mediastinum. The surgeon asks, “What important nerve lying on and partly curving posteriorly around the arch of the aorta should we be careful of as we remove this mass?” You quickly answer, “The–
A. left phrenic
B. left sympathetic trunk
C. left vagus
D. right phrenic
E. right sympathetic trunk

Answer 232

C. left vagus

Question 233

In cardiac surgery it is sometimes necessary to clamp off all arterial flow out of the heart. This could be done within the pericardial sac by inserting the index finger immediately behind the two great arteries and compressing them with the thumb of the same hand. The index finger would have to be inserted into which space?
A. Cardiac notch
B. Coronary sinus
C. Oblique pericardial sinus
D. Coronary sulcus
E. Transverse pericardial sinus

Answer 233

E. Transverse pericardial sinus

Question 234

During a heart transplant procedure, the surgeon inserted his left index finger through the transverse pericardial sinus, and then pulled forward on the two large vessels lying ventral to his finger. Which vessels were these?
A. Pulmonary trunk and brachiocephalic trunk
B. Pulmonary trunk and aorta
C. Pulmonary trunk and superior vena cava
D. Superior vena cava and aorta
E. Superior vena cava and right pulmonary artery

Answer 234

B. Pulmonary trunk and aorta

Question 235

The pleural cavity near the cardiac notch is known as the:
A. Costodiaphragmatic recess
B. Costomediastinal recess
C. Cupola
D. Hilum
E. Pulmonary ligament

Answer 235

B. Costomediastinal recess

Question 236

The tubercle of the 7th rib articulates with which structure?
A. Body of vertebra T6
B. Body of vertebra T7
C.Body of vertebra T8
D. Transverse process of vertebra T6
E. Transverse process of vertebra T7

Answer 236

E. Transverse process of vertebra T7

Question 237

You are called to perform thoracentesis (remove fluid from the pleural cavity). If you are to avoid injuring lung or neurovascular elements, where would you insert the aspiration needle?
A. the top of interspace 8 in the midclavicular line
B. the bottom of interspace 8 in the midclavicular line
C. the top of interspace 9 in the midaxillary line
D. the bottom of interspace 9 in the midaxillary line
E. the top of interspace 11 in the scapular line

Answer 237

D. the bottom of interspace 9 in the midaxillary line

Question 238

The pleural space into which lung tissue just above the cardiac notch would tend to expand during deep inspiration is the:
A. Anterior mediastinum
B. Costodiaphragmatic recess
C. Costomediastinal recess
D. Cupola
E. Pulmonary ligament

Answer 238

C. Costomediastinal recess

Question 239

Which feature is found only in the left lung?
A. Cardiac notch
B. Horizontal fissure
C. Oblique fissure
D. Superior lobar bronchus
E. Three lobes

Answer 239

A. Cardiac notch

Question 240

Which of the following nerves would be most vulnerable to irritation when the tracheobronchial lymph nodes are enlarged due to a diseased situation?
A. Right phrenic
B. Left phrenic
C. Right recurrent laryngeal
D. Left recurrent laryngeal
E. Right vagus

Answer 240

D. Left recurrent laryngeal

Question 241

Which part of the left lung might partially fill the costomediastinal recess in full inspiration?
A. Apex
B. Cupola
C. Hilum
D. Lingula
E. Middle lobe

Answer 241

D. Lingula

Question 242

The oblique fissure of the right lung separates which structures?
A. Lower lobe from lingula
B. Lower lobe from upper lobe only
C. Lower lobe from both upper and middle lobes
D. Lower lobe from middle lobe only
E. Upper from middle lobe

Answer 242

C. Lower lobe from both upper and middle lobes

Question 243

In a post-soccer match brawl, a 35-year-old man was stabbed in the back with a knife that just nicked his left lung halfway between its apex and diaphragmatic surface. Which part of the lung was most likely injured?
A. Hilum
B. Inferior lobe
C. Lingula
D. Middle lobe
E. Superior lobe

Answer 243

B. Inferior lobe

Question 244

Which statement is true about the right lung?
A. it is slightly smaller than the left lung
B. it has a lingular segmental bronchus
C. it occupies the rightmost portion of the mediastinum
D. its upper lobar bronchus lies behind and above the right pulmonary artery
E. it has the right phrenic nerve passing posterior to the lung root

Answer 244

D. its upper lobar bronchus lies behind and above the right pulmonary artery

Question 245

A 22-year-old male involved in a bar-room brawl suffered a stab wound through the posterior thoracic wall that entered the posterior surface of the right lung half way between its apex and diaphragmatic surface. Which part of the lung did the knife first enter?
A. Cupola
B. Inferior lobe
C. Lingula
D. Middle lobe
E. Superior lobe

Answer 245

B. Inferior lobe

Question 246

You are observing a doctor perform a bronchoscopy. As he passes the bronchoscope down the trachea, a cartilagenous structure is observed separating the right and left main stem bronchi. He asks what it is called. You reply that it really does look like a ship’s keel and that it is called the:
A. Carina
B. Cricoid cartilage
C. Costal cartilage
D. Pulmonary ligament
E. Tracheal ring

Answer 246

A. Carina

Question 247

The minor (horizontal) fissure separates:
A. the lower lobe from the lingula
B. the upper lobe from the lingula
C. the lower lobe from both the middle and upper lobes
D. the lower lobe from the middle lobe
E. the middle lobe from the upper lobe

Answer 247

E. the middle lobe from the upper lobe

Question 248

Which vessel courses across the mediastinum in an almost horizontal fashion?
A. Left subclavian artery
B. Left subclavian vein
C. Left brachiocephalic vein
D. Left internal jugular vein
E. Left common carotid artery

Answer 248

C. Left brachiocephalic vein

Question 249

A 78-year-old female presented with edema of the left upper limb due to poor venous return. Examination revealed an aneurysm of the ascending aorta that was impinging on a large vein lying immediately anterosuperior to it, most likely the:
A. Azygos v.
B. Internal thoracic v.
C. Left brachiocephalic v.
D. Left superior intercostal v.
E. Right brachiocephalic v.

Answer 249

C. Left brachiocephalic v.

Question 250

Intermediate mesoderm will give rise to :

A. Neuraltube

B. Heart

C. Notochord

D. Somites

E. Kidney & Gonads

Answer 250

E. Kidney & Gonads

Question 251

A urachal cyst is a remnant of :

A. Urogenital ridge

B. Urogenital sinus

C. Allantois

D. Mesonephric duct

E. Cloaca

Answer 251

C. Allantois

Question 252

A 4-year-old boy is admitted to the children’s hospital with an abdominal pain & fever. An- MRI reveals that he has a double ureter which of the following embryonic structures is most likely failed to develop :

A. Paramesonephric duct

B. Pronephros

C. Metanephros

D. Ureteric bud

E. Mesonephric duct

Answer 252

D. Ureteric bud

Question 253

A 5 month-old male infant is admitted to the children’s hospital because he has no testis in his scrotum. The pediatrician palpated the testis in the inguinal canal. What is the diagnosis?

A. Hypospadias

B. Cryptorchidism

C. Male pseudo hermaphroditism

D. Epispadias

E. Chordee

Answer 253

B. Cryptorchidism

Question 254

The Y chromosome carries a gene on its short arm that codes for:

A. Mullerian-inhibiting substance (MIS)

B. Estrogen

C. Progesterone

D. Testosterone.

E. Testes-determining factor (TDF).

Answer 254

E. Testes-determining factor (TDF).

Question 255

6. The uterine tubes are derived embryologically from which of the following?

A. Uterovaginal primordium

B. Mesonephric duct

C. Mesonephric tubules

D. Paramesonephric duct

E. Pronephros

Answer 255

D. Paramesonephric duct

Question 256

Immediately after birth of a boy, a moist red protrusion of tissue is noted superior to pubic symphysis. Urine drainage is noted from this tissue mass. What is the diagnosis?

A. Horseshoe kidney

B. Exstrophy of the bladder

C. Urachal cyst

D. Polycystic kidney.

E. Pelvic kidney.

Answer 256

B. Exstrophy of the bladder

Question 257

The trigone of the urinary bladder is derived from:

A. Ectoderm.

B. Neural crest cells.

C. Mesoderm.

D. Endoderm.

E. Mesoderm & ectoderm.

Answer 257

C. Mesoderm.

Question 258

The labia majora arise embryologically from which of the following structures?

A. Paramesonephric ducts.

B. Urogenital folds.

C. Sinovaginal bulbs.

D. Labioscrotal swelling.

E. Phallus.

Answer 258

D. Labioscrotal swelling.

Question 259

Which nerve fiber would have its cell body in the lateral horn of the spinal cord at segmental level T1?
A. Afferent fiber from cutaneous blood vessels of the nose
B. Afferent fiber from skin around the nipple
C. Efferent fibers to sweat glands in the lumbar region
D. Efferent fibers to skin of the forehead
E. Parasympathetic fibers to the heart

Answer 259

D. Efferent fibers to skin of the forehead

Efferent fibers to the skin of the forehead might have their cell bodies located in the lateral horn of the T1 level. Because these fibers are at the superior edge of the thoracolumbar outflow (located from T1 to L2), they might go up the chain, synapse at a higher ganglion, and provide sympathetic innervation to the head and face. Afferent fibers would not have their cell bodies located in the lateral horn–afferent sensory fibers have cell bodies in dorsal root ganglia. Efferent fibers to the sweat glands of the lumbar region would be sympathetic fibers, but these cell bodies would be located at the T12, L1, or L2 levels–not at T1. T1 is too high for the lumbar region! Finally, parasympathetic fibers to the heart come from the vagus nerve.

Question 260

In the midregion of the thorax the thoracic duct lies immediately posterior to the:
A. aorta
B. azygos vein
C. esophagus
D. superior vena cava
E. trachea

Answer 260

C. esophagus

Question 261

Since the puncture in the previous question was through the posterior wall of the esophagus, the doctors were also very concerned about possible damage to a thin-walled vessel just behind the esophagus and between the azygos vein and aorta, i.e., the:
A. Hemiazygos vein
B. Left bronchial vein
C. Left pulmonary vein
D. Superior vena cava
E. Thoracic duct

Answer 261

E. Thoracic duct

Question 262

An enlarging lymph node gradually constricts the flow of blood in the azygos venous arch. Which vessel would enlarge as a result of collateral drainage?
A. Superior vena cava
B. Inferior vena cava
C. Internal thoracic vein
D. Right brachiocephalic vein
E. Superior epigastric vein

Answer 262

C. Internal thoracic vein

Question 263

A frail, elderly man, suspected of having widespread cancer of the lungs and bronchi, is brought in for bronchoscopic examination. The instrument is inserted into the airway, where it accidentally punctures the thin, brittle posterior wall of the diseased right main bronchus. A sudden gush of blood immediately indicates that the instrument has also torn the wall of the blood vessel immediately behind the right main bronchus, i.e., the:
A. Azygos vein
B. Left brachiocephalic artery
C. Pericardiacophrenic artery
D. Right pulmonary vein
E. Superior vena cava

Answer 263

A. Azygos vein

Question 264

If one were to make an incision parallel to and 2 inches above the inguinal ligament, one would find the inferior epigastric vessels between which layers of the abdominal wall?
A. Camper’s and Scarpa’s fascias
B. External abdominal oblique and internal abdominal oblique muscles
C. Internal abdominal oblique and transversus abdominis muscles
D. Skin and deep fascia of the abdominal wall
E. Tranversus abdominis muscle and peritoneum

Answer 264

E. Tranversus abdominis muscle and peritoneum

Question 265

A man is moving into a new house and during the process lifts a large chest of drawers. As he lifts he feels a severe pain in the lower right quadrant of his abdomen. He finds that he can no longer lift without pain and the next day goes to see his physician. Surgery is indicated and during the surgery the surgeon opens the inguinal region and finds a hernial sac with a small knuckle of intestine projecting through the abdominal wall just above the inguinal ligament and lateral to the inferior epigastric vessels. The hernia was diagnosed as:
A. A congenital inguinal hernia
B. A direct inguinal hernia
C. A femoral hernia
D. An incisional hernia
E. An indirect inguinal hernia

Answer 265

E. An indirect inguinal hernia

Question 266

A loop of bowel protrudes through the abdominal wall to form a direct inguinal hernia; viewed from the abdominal side, the hernial sac would be found in which region?
A. Deep inguinal ring
B. Lateral inguinal fossa
C. Medial inguinal fossa
D. Superficial inguinal ring
E. Supravesical fossa

Answer 266

C. Medial inguinal fossa

Question 267

During your peer presentation of the inguinal region dissection, you would indicate the position of the deep inguinal ring to be:
A. Above the anterior superior iliac spine
B. Above the midpoint of the inguinal ligament
C. Above the pubic tubercle
D. In the supravesical fossa
E. Medial to the inferior epigastric artery

Answer 267

B. Above the midpoint of the inguinal ligament

Question 268

A pediatrician has diagnosed a newborn baby of having right-sided cryptorchidism (undescended testis). The testis may have been trapped in any site EXCEPT:
A. At the deep inguinal ring
B. Just outside the superficial inguinal ring
C. Pelvic brim
D. Perineum
E. Somewhere in the inguinal canal

Answer 268

D. Perineum

Question 269

A 15-year-old boy was admitted to the emergency room for having large bowel obstruction resulting from a left-sided indirect inguinal hernia. The most likely intestinal segment involved in this obstruction is the:
A. ascending colon
B. cecum
C. descending colon
D. rectum
E. sigmoid colon

Answer 269

E. sigmoid colon

Question 270

The boundaries of the inguinal triangle include all except:
A. Arcuate line
B. Inferior epigastric vessels
C. Inguinal ligament
D. Lateral border of rectus abdominus muscle

Answer 270

A. Arcuate line

Question 271

The superficial inguinal ring is an opening in which structure?
A. External abdominal oblique aponeurosis
B. Falx inguinalis
C. Internal abdominal oblique muscle
D. Scarpa’s fascia
E. Transversalis fascia

Answer 271

A. External abdominal oblique aponeurosis

Question 272

During exploratory surgery of the abdomen, an incidental finding was a herniation of bowel between the lateral edge of the rectus abdominis muscle, the inguinal ligament and the inferior epigastric vessels. These boundaries defined the hernia as a(n):
A. Congenital inguinal hernia
B. Direct inguinal hernia
C. Femoral hernia
D. Indirect inguinal hernia
E. Umbilical hernia

Answer 272

B. Direct inguinal hernia

Question 273

A patient was diagnosed with bleeding ulcer of the lesser curvature of the stomach. Which artery is most likely involved?
A. Gastroduodenal
B. Left gastric
C. Left gastro-omental (epiploic)
D. Right gastro-omental (epiploic)
E. Short gastrics

Answer 273

B. Left gastric

Question 274

During a full workup on a 2-month-old infant with a history of intermittent gastrointestinal pain and vomiting, physicians discovered that the cause was lack of emptying of the stomach. They immediately suspected that the cause was a spasmodic contraction of which of the following parts of the stomach?
A. cardiac notch
B. fundus
C. lesser curvature
D. pylorus
E. rugae

Answer 274

D. pylorus

Question 275

While performing a splenectomy (removal of the spleen) following an automobile accident, the surgeons were especially attentive to locate and preserve the tail of the pancreas which is closely associated with the spleen. This they found in the:
A. gastrocolic ligament
B. gastrosplenic ligament
C. phrenicocolic ligament
D. splenorenal ligament
E. transverse mesocolon

Answer 275

D. splenorenal ligament

Question 276

Which of the following structures does not lie at least partially in the retroperitoneum?
A. adrenal gland
B. duodenum
C. kidney
D. pancreas
E. spleen

Answer 276

E. spleen

Question 277

A 60-year-old male executive who had a history of a chronic duodenal ulcer was admitted to the ER exhibiting signs of a severe internal hemorrhage. He was quickly diagnosed with perforation of the posterior wall of the first part of the duodenum and erosion of an artery behind it by the gastric expellent. The artery is most likely the:
A. Common hepatic
B. Gastroduodenal
C. Left gastric
D. Proper hepatic
E. Superior mesenteric

Answer 277

B. Gastroduodenal

Question 278

A patient presented with a swollen spleen, which protruded medially toward the umbilicus in the abdomen. A vertical and downward expansion of the spleen was resisted by the:
A. Tail of the pancreas
B. Left colic flexure
C. Left kidney
D. Left renal artery
E. Stomach

Answer 278

B. Left colic flexure

Question 279

Which of the following is NOT in contact with the spleen?
A.Colon
B. Diaphragm
C. Duodenum
D. Pancreas
E. Stomach

Answer 279

C. Duodenum

Question 280

During an emergency splenectomy, the surgeon accidentally tore the gastrosplenic ligament and its contents. The artery (ies) likely to be damaged in this event is (are) the:
A. Left gastric
B. Splenic
C. Short gastric
D. Middle colic
E. Caudal pancreatic

Answer 280

C. Short gastric

Question 281

During preparations to remove the left kidney from a 28-year-old female patient, the surgeon asked an observing medical student where best to ligate the renal vein. Upon hearing the reply: “as close to the inferior vena cava as possible, leaving just enough stump to ensure tight closure,” the surgeon’s eyebrow shot up. “Do you mean to say you’re willing to compromise the venous drainage of the other structures that drain into the renal vein?” By this he meant all of the following except:
A. diaphragm
B. pancreas
C. ovary
D. suprarenal gland

Answer 281

B. pancreas

Question 282

The vagus nerve passes into the abdomen by passing through the
A. Aortic hiatus
B. Esophageal hiatus
C. Caval foramen
D. Lateral arcuate ligament
E. Medial arcuate ligament

Answer 282

B. Esophageal hiatus

Question 283

The nerves of the lumbar plexus are arranged around specific muscles of the posterior abdominal wall. Which of these nerves lies immediately medial to the psoas major muscle?
A. Femoral
B. Genitofemoral
C. Ilioinguinal
D. Obturator

Answer 283

D. Obturator

Question 284

To stop hemorrhaging from a ruptured spleen, it was necessary to temporarily ligate the splenic artery near the celiac trunk. The blood supply to which structure is least likely to be affected by the ligation?
A. Duodenum
B. Greater omentum
C. Body of pancreas
D. Tail of pancreas
E. Stomach

Answer 284

A. Duodenum

Question 285

A patient was admitted with symptoms of an upper bowel obstruction. Upon CT examination, it was found that the third (transverse) portion of the duodenum was compressed by a large vessel causing the obstruction. The vessel involved is most likely to be the:
A. inferior mesenteric artery
B. superior mesenteric artery
C. inferior mesenteric vein
D. portal vein
E. splenic vein

Answer 285

B. superior mesenteric artery

Question 286

An ulcer near the pyloroduodenal junction perforated and eroded a large artery immediately posterior to the duodenum. The ligation of the eroded vessel at its origin would LEAST affect the arterial supply to the:
A. First part of the duodenum
B. Second part of the duodenum
C. Greater curvature of the stomach
D. Head of the pancreas
E. Tail of the pancreas

Answer 286

E. Tail of the pancreas

Question 287

The inferior mesenteric artery is often occluded by atherosclerosis without symptoms; its normal area of distribution therefore must be supplied by collateral blood flow between which arteries?
A. Ileocolic and right colic
B. Left and middle colic
C. Left colic and sigmoidal
D. Right and middle colic
E. Sigmoidal and superior rectal

Answer 287

B. Left and middle colic