Review Questions Flashcards
1
Q
What structure exists in the superior and anterior mediastinum of children, but regresses by adulthood?
A
The thymus
2
Q
Name the two innermost intercostal muscles. What do they aid in?
A
Transversus thoracis and subcostalis muscles. They aid in expiration.
3
Q
What drains into the right venous angle?
What drains into the left venous angle?
A
Right: right lymphatic duct
Left: thoracic duct
4
Q
Which lung lobes are drained by the thoracic duct?
Which heart chambers are drained by the thoracic duct?
Which quadrants of the thorax are drained by the thoracic duct?
A
Upper left lobe of lung (lower lobes send lymph to the right side)
Right atrium, right ventricle
Upper Left, Lower Left, Lower Right quadrants
5
Q
Ductus arteriosus involves a shunt from which vessel to which vessel?
a) Aorta Arch => Left pulmonary artery
b) Left pulmonary artery => Aorta Arch
c) Left Atrium => Right Atrium
d) Right Atrium => Left Atrium
A
b) LEFT pulmonary artery to the aortic arch
6
Q
A 27 year old patient has an aneurysm of the aortic arch. This may compress which of the following structures?
a) right vagus nerve
b) left phrenic nerve
c) right sympathetic trunk
d) left recurrent laryngeal nerve
e) left greater splanchnic nerve
A
d) left recurrent laryngeal nerve
7
Q
Where is the left recurrent laryngeal nerve in relation to the ligamentum arteriosum?
A
The nerve loops under the aortic arch POSTERIOR to the ligamentum arteriosum.
8
Q
What does the right recurrent laryngeal nerve recurve around?
a) Right subclavian a.
b) Right common carotid a.
c) Right internal jugular v.
d) Brachiocephalic trunk
A
a) right subclavian artery
9
Q
Which structure lies just posterior to the left atrium?
a) Aorta
b) Azygous v.
c) Esophagus
d) Sympathetic Trunk
e) Trachea
A
c) esophagus (remember transesophogeal cardiography)
10
Q
At what spinal levels do the following structures pass through the diaphragm?
Inferior vena cava
Esophagus
Aorta
A
IVC: T8
Esophagus: T10
Aorta: T12 (this is where its name changes from the thoracic aorta to the abdominal aorta)
11
Q
Which vagus nerve passes anterior to the esophagus?
A
The left.
Remember LARP
12
Q
Patient has difficulty swallowing (dysphagia). Compression and constriction at which vertebra level may be the cause?
a) C4
b) T8
c) T10
d) T12
A
c) T10 (at the esophogeal hiatus - the diaphragmatic constriction)
13
Q
Which ganglionic nerve fibers are long? There are two answers.
a) Preganglionic Sympathetic
b) Postganglionic Sympathetic
c) Preganglionic Parasympathetic
d) Postganglionic Parasympathetic
A
b) postganglionic sympathetic
c) preganglionic parasympathetic
14
Q
Cardiac plexus contain which nerve fibers? There might be more than one answer.
a) CN X
b) CN XI
c) Cardiopulmonary Splanchnic
d) Greater Splanchnic
e) Thoracic Splanchnic
A
a) CN X is the vagus nerve (parasympathetic)
c) Cardiopulmonary splanchnic (T1-T4 sympathetic)
15
Q
Which of the following does NOT insert onto the linea alba?
a) External oblique
b) Internal oblique
c) Transverse abdominal
d) Rectus abdominis
e) Pyramidalis
A
d) Rectus abdominis (runs parallel to the linea alba and inserts on costal cartilages and the inferior xyphoid process)
16
Q
Name four things that happen at the linea semilunaris.
A
- Lateral border of the rectus abdominis.
- Border of the aponeurosis of the anterior abdominal muscles.
- Medial border of Hasselbach’s triangle (inside the abdomen).
- Spigelian hernias happen here
17
Q
Name all the layers (fascia and muscles) of the abdomen from superficial to deep.
A
Camper's fascia Scarpa's fascia External oblique Internal oblique Transversalis abdominis Transversalis fascia Extra-peritoneal CT Parietal peritoneum
18
Q
Do the external intercostal muscles exist in the condral portion of the ribs?
Do the internal intercostal muscles continue posterior to the angles of the ribs?
A
No, no
19
Q
Herpes zoster virus can cause painful blisters in a dermatomal pattern via infection of the cell bodies of…?
a) Dorsal root ganglia
b) Ventral horn
c) Dorsal primary rami
d) Ventral primary rami
A
a) dorsal root ganglia (sensory nerves)
20
Q
Patient presents with severe shoulder pain. Tests rule out upper brachial plexus abnormality or damage to the axillary n. You suspect pain originating from the pleura space. Which nerve and which specific region of the pleura is the likely culprit?
A
Phrenic nerve (C3-C5)
Diaphragmatic and mediastinal parietal pleura (intercostal nerves innervate the costal pleura)
21
Q
Patient’s chest x-ray reveals a “water-bottle” silhouette and presents with three pathognomonic symptoms.
1) What does this patient have?
2) What are the symptoms?
3) What is the Treatment?
A
Acute pericardial effusion with cardiac tamponade.
Beck’s triad:
- Muffled heart sounds
- Low BP
- Internal jugular vein distension
Tx is pericardiocentesis
22
Q
A senior resident asks you to retrieve the cardiac muscle biopsy of a patient’s right atrium. At the lab, you grab the sample labeled:
a) Chordae tendinae
b) Pectinate
c) Septomarginal trabeculae
d) Sinus venarum
e) Trabeculae carnae
A
b) pectinate - muscle of the right atrium
the other things are:
Septomarginal trabeculae – moderator band
Sinus venarum – smooth tissue of atrium
Trabeculae carnae – cardiac m. of ventricle
23
Q
A 25 year old woman sustained a chest injury with the steering wheel during a car crash. An X-ray revealed a fracture of the manubrium at the sternomanubrial joint. Which of the following ribs would also most likely be involved in such an injury?
a) First
b) Second
c) Third
d) Fourth
e) Fifth
A
b) second
24
Q
A 37-year-old house painter fell from a ladder and fractured his left third rib and the structures with which it articulated. Which of the following structures might also be damaged?
A. Manubrium of the sternum
B. Spinous process of the third thoracic vertebra
C. Body of the second thoracic vertebra
D. Body of the fourth thoracic vertebra
E. Transverse process of the second thoracic vertebra
A
C. Body of the second thoracic vertebra
25
1. A 29 year old man is involved in a motor vehicle accident in which his spinal cord is crushed and severed between C8 and T1. How would such an injury affect his respiration?
2. Which other motor, sensory or autonomic functions might be lost in the thorax or abdomen?
1. Intercostal muscles, which are used in respiration and, supplied by intercostal nerves T1 – T12, would be paralyzed.
2. Sensation from thoracic wall and anterior abdominal wall are also supplied by intercostal nerves.
Sympathetic nerves, T1 – L2, parasympathetic nerves from S2 – S3.
26
You are preparing to insert a needle in the midaxillary line of your patient in order to relieve a tension pneumothorax. Which of the following structures will be avoided by the needle piercing the chest wall?
```
A. Internal intercostal muscle
B. Serratus anterior muscle
C. Transversus thoracis muscle
D. Parietal pleurae
E. Innermost intercostal muscle
```
C. Transversus thoracis muscle (its located on the anterior chest wall)
27
```
During a routine physical examination, a physician asks her 62-year-old male patient to breathe normally while she assesses the patient's respiration. Which of the following is TRUE of the mechanics of inspiration during normal quiet respiration?
A. The diaphragm descends
B. The sternum moves inferiorly
C. The ribs spread apart from each other
D. The abdominal wall muscles contract
E. The scalene muscles contract
```
A. the diaphragm descends
28
A twenty-three year old female presents to your clinic with complaints of being easily tired, pain in her lower extremities with weakness and cold feet, frequent headaches, and epistaxis (nosebleed). On physical exam you find: cool lower extremities with an absence of distal pulses and diminished femoral pulses, the blood pressure in the upper extremities is elevated while the blood pressure in the lower extremities is low.
An X-ray of this patient’s chest shows significant “notching of the ribs”.
What type of pathology do these findings indicate?
Coarctation of the aorta – intercostal vessels carry more blood than usual in order to bypass coarctated aorta.
29
Can you explain why a postductal (inferior) lesion in the fetus is more compatible with long term survival versus a preductal lesion?
A postductal lesion forces good collateral circulation to develop from proximal to distal portions of the aorta via the anterior intercostals from internal thoracic artery anastomosing with posterior intercostal branches of descending aorta. A preductal lesion presents a life threatening situation early in infancy. The distal aorta is initially filled via a patent ductus arteriosus, but as the ductus closes blood flow to the distal aorta diminishes, and the infant's survival may be threatened.
30
Enlargement of which lymph nodes can lead to a flattening and widening of the carina?
The inferior tracheobronchial nodes.
31
1. While removing a lung tumor during surgery, you notice that it has caused inflammation of the visceral pleura on the posterior aspect of the lung. Would your patient feel somatic pain from this inflammation?
2. What if the inflammation had spread to the parietal pleura in this location? What nerves do pain fibers from the parietal pleura travel in?
1. No, visceral pleurae are not sensitive to somatic pain – temperature,touch, pressure.
2. Parietal pleurae are sensitive to somatic pain which is carried by intercostal (costal pleurae) and phrenic nerves (diaphragmatic and mediastinal pleurae).
32
1. Your patient has fluid in her pleural cavity. Where should you insert the needle to perform a thoracocentesis, but avoid injuring the lung and main neurovascular structures?
2. If you wanted to perform a pericardiocentesis where would you insert the needle?
1. Below the 8th rib and above the lower rib in the intercostal space to avoid the main neurovascular bundle – in the middle to avoid the collateral bundle.
2. 5th intercostal space just to left of sternum to pass needle through “bare area” and avoid the parietal pleura.
33
A 23-year old male is rushed to the ER in a state of respiratory distress after being shot in the left chest. He has absent breath sounds on the left side and very rapid heart rate, with cyanosis in his face and upper limb. An X-ray shows his mediastinum has been shifted to the right.
What is the problem with this patient and why is it a life-threatening emergency?
Most likely a tension pneumothorax – can lead to obstruction of great vessels, reduced cardiac output and death.
34
A twelve-year old boy suffers from shortness of breath, wheezing and chest pain, particularly after playing outdoors. Your diagnosis is chronic asthma, an inflammatory disease characterized by airway obstruction and bronchospasm. Your plan of treatment is to prescribe a breath inhaler which delivers a albuterol, a sympathomemetic substance to dilate his airways. Explain why this can be an effective treatment for asthma.
The sympathetic nervous system will relax smooth muscle within the bronchi and inhibit production of mucous, reducing the obstruction of the airways in diseases such as asthma.
35
A 42 year old male was admitted to the hospital after a head-on vehicular collision in which he received severe blunt trauma to his sternum from the steering wheel. Which part of the heart would be most likely to be injured by the impact?
a) Right ventricle
b) Left ventricle
c) Left atrium
d) Right atrium
e) Apex of the left ventricle
a) right ventricle
36
During an aortic valve replacement procedure, the surgeon explores the oblique pericardial sinus. Where is this area and which structures can be palpated there?
This is an area located inside the pericardial sac and between the pulmonary veins. The esophagus lies posterior to it, the left atrium lies anterior.
The transverse pericardial sinus is located behind the ascending aorta and pulmonary trunk, and in front of the SVC.
37
Enlargement of the left atrium can impinge on which structure that lies posterior to it?
The esophagus
38
A 47-year-old man with a known atrial fibrillation returns to see his cardiologist for follow-up of his cardiac health. The right atrium is important in this case because it:
a) Is hypertrophied by pulmonary valve stenosis
b) Is associated with the apex of the heart
c) Contains the SA and AV nodes
d) Receives the right pulmonary vein
e) Contains papillary muscles
c) contains the SA and AV nodes
39
A 6 year old boy with Tetralogy of Fallot shows pulmonary stenosis and right ventricular hypertrophy in addition to other symptoms. Which of the following structures is likely to be found in the hypertrophied right ventricle?
a) Sinus venarum
b) Crista terminalis
c) Pectinate muscles
d) Moderator band
e) Opening of coronary sinus
d) moderator band
all other choices are in the right atrium
40
A 57-year-old patient has a heart murmur resulting from the inability to maintain constant tension on the cusps of the AV valve. Which of the following structures is most likely damaged?
a) Pectinate muscles
b) Crista terminalis
c) Moderator band
d) Chordae tendinae
e) Trabeculae carnae
d) chordae tendinae
41
1. An MRI shows that your patient’s right coronary artery is blocked. What areas of the heart would be affected by this blockage?
2. A heart block occurs and your patient’s ventricles begin to contract erratically. Explain how the heart block occurred and how the conduction system has been interrupted. How could this problem be corrected?
1. Right ventricle, right atrium (including SA and AV nodes), posterior 1/3 of the interventricular septum.
2. SA and AV nodes got messed up. The problem could be corrected by a coronary artery bypass graft (CABG).
42
A 68 year old man comes to the hospital with intense chest pain. An ECG reveals myocardial infarction in the anterior 2/3 of the interventricular septum, and the left anterior wall. The patient;s ECG also exhibited left bundle branch block. Which of the following arteries is most likely occluded?
a) Left circumflex
b) Right coronary
c) Left coronary
d) Anterior Interventricular artery (LAD)
e) Posterior interventricular artery
d) Anterior Interventricular artery (LAD)
43
Name which coronary artery runs with each cardiac vein (great, middle, small).
Great and middle cardiac veins run between the ventricles anteriorly, and posteriorly, respectively. The great cardiac vein runs along with the LAD (anterior interventricular). The middle cardiac vein runs along with the posterior interventricular artery (could be from right or left coronary artery).
The small cardiac vein runs along with the right coronary artery as it wraps around to the posterior heart.
44
A 43 year old patient (below, right) with coronary artery disease is scheduled to have a bypass of his anterior interventricular (left anterior descending) coronary artery. When this artery is exposed to perform the bypass procedure, which accompanying vein must be protected from injury?
a) Middle cardiac
b) Great cardiac
c) Small cardiac
d) Coronary sinus
b) great cardiac vein
45
A 57 year old patient is admitted to the ER with dyspnea. During physical examination, you notice that her S1 sound is very loud. Which of the following valves is/are responsible for production of the S1 (“lub”) sound?
a) Mitral valve
b) Pulmonary and aortic
c) Aortic and mitral
d) Tricuspid
e) Tricuspid and mitral
e) tricuspid and mitral
46
Individuals who complain of chest pain upon exertion are often administered drugs which will prolong the diastolic phase of the cardiac cycle. What is the anatomical basis for this?
Coronary artery perfusion occurs during diastole, so prolongation of this phase helps with cardiac ischemia.
47
Following a 13-hour flight from Tokyo to New York, a 58 year old woman with a history of peripheral occlusive vascular disease (deep venous thrombosis DVT) suddenly develops sharp stabbing pain in the left side of her chest. Her physical signs show she has difficulty breathing and an elevated heart rate. What do you suspect is happening with this patient?
Most-likely a pulmonary embolism brought on by deep venous thrombosis.
48
A 48-year old heavy smoker has a 1-week history of neck swelling, dyspnea, and the sensation of something pushing on his throat. Three weeks previously, he developed nasal stuffiness and voice hoarseness. He has a reddish-blue face, facial edema and jugular venous distention. A CT scan shows a mass in the upper lobe of the right lung.
1. What is your most likely diagnosis?
2. What is the cause?
3. What anatomical structures are likely involved?
1. Dx is superior vena cava syndrome
2. Obstruction of SVC by tumor in upper portion of right lung.
3. SVC and its tributaries – brachicephalic vein, IJV, subclavian veins.
49
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) Azygous vein
b) Internal thoracic vein
c) Left brachiocephalic vein
d) Right brachiocephalic vein
e) Hemiazygous vein
c) Left brachiocephalic vein
50
While performing transesophageal echocardiography on a patient, the posterior wall of the esophagus, immediately behind the left atrium, was punctured from within. The patient subsequently developed an infection in the space around the esophagus at this point, namely the:
a) Anterior mediastinum
b) Superior mediastinum
c) Middle mediastinum
d) Posterior mediastinum
d) posterior mediastinum
51
What is pretty much the only thing in the anterior mediastinum?
The thymus/thymic remnants
52
While viewing an exploratory surgery on a patient injured in an automobile accident, you see the surgeon elevate the esophagus off the vertebral bodies and look in the area between the azygos vein and descending aorta. What structure was she most likely looking for?
```
A. Left recurrent laryngeal nerve
B. Right pulmonary artery
C. Inferior vena cava
D. Thoracic duct
E. Left brachiocephalic vein
```
D) Thoracic duct
53
Examination of a 35 year old man involved in a motor vehicle accident shows that she is tachychardic. What is the location of the pre-ganglionic cell bodies involved in increasing the heart rate?
a) Medulla portion of brainstem
b) Intermediolateral cell columns of T5 to T9
c) Spinal cord levels of T1 to T4
d) Superior, middle and inferior cervical ganglia
e) Ventral primary rami of C3 – C5
c) Spinal cord levels of T1-T4
54
An obstetrician decides to do a Caesarean section on a 25-year-old pregnant woman. A transverse suprapubic incision about 2 inches above the pubic symphysis 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 abdominus muscle
d) Transversalis fascia and peritoneum
b) posterior rectus sheath (it goes away inferior to the arcuate line)
55
A 32 –year old woman arrives in the ER with severe abdominal pain and a decision was made to perform an emergency laparotomy to identify the problem. Where would the incision most likely be made to separate the left and right rectus sheaths?
a) Midaxillary line
b) Arcuate line
c) Semilunar line
d) Tendinous intersection
e) Linea alba
e) Linea alba
56
A pediatric surgeon has resected a structure that is a fibrous remnant of an embryonic or fetal artery in a 5-year-old child. To which of the following structures does this structure correspond?
```
A. Median umbilical fold
B. Medial umbilical fold
C. Lateral umbilical fold
D. Ligamentum teres hepatis
E. Ligamentum venosus
```
What do the other folds correspond to?
B. Medial umbilical fold (remnant of the obliterated umbilical artery)
Other folds:
Median Umbilical fold – urachus – obliterated allantois (diverticulum of the bladder).
Two Medial Umbilical Folds – obliterated umbilical arteries
Two Lateral Umbilical Folds – patent inferior epigastric arteries
57
A 9 year old male is admitted to the hospital with an indirect inguinal hernia. During the procedure the spermatic cord and transversalis fascia are identified. Which component of the spermatic cord is derived from the internal oblique muscle?
a) External spermatic fascia
b) Cremaster muscle
c) Tunica vaginalis
d) Internal spermatic fascia
b) Cremaster fascia
58
What is responsible for pulling the testicles through the inguinal canal during development?
The gubernaculum.
59
What sensory and motor nerves are involved in the cremasteric reflex?
Afferent (sensory) limb of Cremaster reflex – Ilioinguinal nerve – L1.
Efferent (motor) limb of cremaster reflex – genitofemoral nerve – L1/L2.
60
```
A physician is conducting a physical examination of a 43 year old male. In order to palpate a potential inguinal hernia, a digit is inserted into the scrotum towards the superficial inguinal ring. The superficial inguinal ring is an opening in which of the following?
A. Transversalis fascia
B. External oblique aponeurosis
C. Conjoint tendon
D. Peritoneum
E. Transversus abdominus aboneurosis
```
B. External oblique aponeurosis
61
Two patients come in at the same time complaining of pain, constipation, and bloating. The first patient is a 9 year-old boy with a discernable bulge in his left inguinal region and scrotum. The second patient is a 60 year-old man with a small reducible lump in his left groin region about midway between the ASIS and the pubic tubercle. Using the information you have at this time, what type of hernia do you suspect that each of your patients has?
The 9 year old boy most likely has an indirect inguinal hernia. The 60 year old man most liely has a direct inguinal
62
A 25 year old female has a palpable hernia just lateral to the rectus abdominus on the right. Which of the following hernias best describes this condition?
a) Umbilical hernia
b) Spigelian hernia
c) Epigastric hernia
d) Femoral hernia
e) Omphalocele
b) Spigelian hernia
63
A 25-year-old man is brought into the ER with a high fever, lethargy, and a stiff neck. After taking a history and performing a physical exam, you strongly suspect meningitis. In order to find cause of his problem, you order a lumbar puncture.
1. Where along the vertebral column is a needle inserted for a lumbar puncture? Which landmark can you use to find this level?
2. 2. During a lumbar puncture, the syringe needle is inserted in the midline and within the median plane. What structures, ligaments and others, does the needle traverse before entering the lumbar cistern?
1. Between the L3 and L4 or L4 and L5 vertebrae, using the iliac crest (at L4) as a guide.
2. Skin, fascia, supraspinous, intraspinous ligaments, ligamentum flavum, dura mater, arachnoid mater.
64
Spina bifida results from failure of the ___________________.
a. Intervertebral disks to form
b. Primary curvatures to develop
c. Secondary curvatures of the vertebral column to form
d. Vertebral bodies to correctly align
e. Vertebral arches to form correctly
e. Vertebral arches to form correctly
65
During examination, a doctor notes a tuft of hair and a dimple on the skin of a patient's lower back. A plain film reveals a congenital defect in his L5 vertebra, indicated by the black arrow in the given X-ray. No other structural abnormalities are noted. Based on these findings, what is the most likely diagnosis for this patient?
a. Meningocele
b. Spina bifida occulta
c. Meningomyelocele
d. anencephaly
b. Spina bifida occulta
66
A 34-year-old woman crashes into a tree during a skiing lesson and is brought to a hospital with multiple injuries that impinge the dorsal primary rami of several spinal nerves. Such lesions could affect which of the following muscles?
a. Latissimus dorsi
b. Serratus posterior superior
c. Levator scapulae
d. Rhomboid major
e. Iliocostalis
e. Iliocostalis
67
The insertion of artificial intervertebral disks has been attempted for patients with chronic back pain. These artificial disks are intended to replace both parts of a natural disk. What are these two parts?
Annulus fibrosus and nucleus pulposus
68
1. A 20 year old female comes to the ER with a high fever, severe headache, nausea and stiff neck for 3 days. The attending physician suspects meningitis and obtains a sample of CSF using a lumbar puncture. From which of the following spaces was the CSF collected?
a. Epidural space
b. Subdural space
c. Subarachnoid space
d. Vertebral canal
e. Vertebral venous plexus
2. At which vertebral level is it considered safe to perform the lumbar puncture and which landmark can you use to locate this level?
1. c - subarachnoid space
| 2. Below L2 – use iliac crest to determine L4 level.
69
Which of the following is true of the conus medullaris?
A. exhibits both a cervical and lumbar enlargement.
B. has a modification of neural tissue extending from its termination to the coccygeal ligament.
C. gives origin to most of the cauda equina.
D. is found at its lowest extent at S2.
E. is normally anesthetized to perform a spinal tap.
Correct answer is: C. gives origin to most of the cauda equina.
```
Wrong answers:
A – this is the spinal cord
B. This is the filum terminale
D. This is the dural sac – conus medullaris ends at L1 or L2
E. This is the cauda equina
```
70
In the final stages of labor a caudal anesthetic is sometimes given via a needle inserted into the sacral hiatus. The anesthetic is thus placed around the outside of the sacral spinal nerve roots and into the:
```
A. Central canal
B. Dural sinus
C. Epidural space
D. Subarachnoid space
E. Subdural space
```
C. Epidural space
71
A 44-year-old woman comes to her physician and complains of headache and backache. On examination, she is found to have fluid accumulated in the spinal epidural space because of damage to blood vessels or meninges. Which of the following structures is most likely ruptured?
a. Lumbar cistern
b. External vertebral plexus
c. Internal vertebral plexus
d. Vertebral vein
e. Vertebral artery
c. Internal vertebral plexus
72
Your patient has a hyperextension injury of the neck. Which ligament likely ruptured with this injury?
a. Ligamentum flavum
b. Anterior longitudinal ligament
c. Posterior longitudinal ligament
d. Supraspinous ligament
e. Interspinous ligament
b. Anterior longitudinal ligament
73
A 40 year old female is diagnosed with constriction of the lumbar vertebral canal. A laminectomy of two vertebrae is preformed. Which of the following ligaments will most likely also be removed?
a. Anterior longitudinal
b. Denticulate
c. Ligamentum flavum
d. Posterior longitidinal
e. Supraspinous
c. Ligamentum flavum
74
A direct inguinal hernia:
a) enters the deep inguinal ring
b) lies lateral to the inferior epigastric artery
c) is covered by spermatic fascia
d) descends into the scrotum
e) develops after birth
e) develops after birth
the other choices are characteristic of an indirect inguinal hernia
75
Patient suffers from a protrusion along the semilunar line.
a) Umbilical hernia
b) Incisional hernia
c) Spigelian hernia
d) Femoral hernia
c) Spigelian hernia
76
A patient suffers from a bulge just under the Inguinal ligament. This is most likely:
a) Umbilical hernia
b) Incisional hernia
c) Spigelian hernia
d) Femoral hernia
d) femoral hernia
77
```
Patient is found to be unresponsive when the inner thigh is stroked. What action is being tested? What nerve(s) would normally be involved?
Femoral n.
Intercostal n.
Genitofemoral n.
Iliohypogastric n.
Ilioinguinal n.
```
cremasteric reflex
```
ilioinguinal nerve (L1) for sensory/afferent
genitofemoral nerve (L1/L2) for motor/efferent
```
78
Which nerve supplies sensation to the pubic area and motor innervation to transversus abdominis and internal oblique muscles?
Iliohypogastric nerve
79
What condition often seen later in life may cause hyperkyphosis?
Osteoporosis
80
Patient with hyperlordosis of the lumbar vertebra may strengthen these muscles to offset symptoms.
Hamstrings, gluteus maximus
81
Someone with respiratory issues may suffer from?
a) Kyphosis
b) Lordosis
c) Scoliosis
d) Kyphoscoliosis
d) Kyphoscoliosis
82
Your patient is unable to flex or extend her thoracic vertebra. What is wrong with her?
A: NOTHING!
Cervical = Axial plane - Flex/extend, lateral bend, rotate
Thoracic = Coronal plane - Rotate (NO flex/extend)
Lumbar = Saggital plane - Flex/extend (NO rotate)
83
What nerve structure supplies the facet joints of the vertebrae?
a) Dorsal primary rami
b) Ventral primary rami
a) Dorsal primary rami
84
Lateral sacral crest is formed from?
Median sacral crest is formed from?
Lateral sacral crest is formed from?
Fusion of transverse processes
Median sacral crest is formed from?
Fusion of spinous processes
85
At which vertebral level exist the transverse foramina? What do they do?
A: Cervical vertebrae – transmit vertebral a., which come from subclavian a.
Vertebral a. => supplies upper spine
Aorta a. => Posterior intercostal a. => supplies lower spine
86
Which vertebra supports the weight of the skull?
Atlas (C1)
87
Patient with which form of spina bifida is most exposed to injury to the spinal cord?
a) Occulta
b) Meningocele
c) Meningomyelocele
c) Meningomyelocele
88
Hyperflexion of lumbar spine may injure…
a) Anterior longitudinal ligament
b) Interspinous ligament
c) Ligamentum flavum
d) Posterior longitudinal ligament
e) Supraspinous ligament
All except a!
b) Interspinous ligament
c) Ligamentum flavum
d) Posterior longitudinal ligament
e) Supraspinous ligament
89
Patient has a “chin on chest” type spinal deformity. What does this person have?
a) Spondylolithesis
b) Spondylolysis
c) Spondylolithesis and Spondylolysis
d) Ankylosing Spondylitis
d) Ankylosing Spondylitis
| - buzz terms are "chin on chest" and "bamboo spine" - spine looks fused on x-ray
90
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C6 nerve passes ____ C6 vertebra
C7 nerve passes ____ C7 vertebra
T1 nerve passes ____ T1 vertebra
a) Above
b) Below
```
C6 nerve passes above C6 vertebra
C7 nerve passes above C7 vertebra
T1 nerve passes below T1 vertebra
91
At what vertebral level does the spinal cord end? What is this point called?
L1/L2 - conus medularis
92
Below the end of the spinal cord, the remaining lumbar and sacral nerves form what?
Cauda equina
93
Which layer and what location in the spine contain CSF? At which vertebral level would you insert a needle?
A: Subarachnoid space, lumbar cistern
| Around L4 - trans iliac plane
