Review Questions with Pictures

Question 1

A 47 year old male is asked to inhale and this is what his X-ray looks like. What is the problem with this patient?

Answer 1

The left hemidiaphragm is elevated - consistent with paralysis of the left phrenic nerve.

Question 2

A 48 year old man arrives in the ER with severe shortness of breath. Bronchoscopy reveals that the lymphadenopathy in the mediastinum. Which groups of lymph nodes may be enlarged as a consequence of pulmonary disease such as lung cancer?

Answer 2

Paratracheal nodes, superior and inferior tracheobronchial nodes, bronchomediastinal (hilar) nodes, pulmonary nodes.

Question 3

A 49 year old man comes to the ER with chest pain that has persisted for the past three days. During this time he has also had a very bad cold. He claims that the pain is somewhat relieved when he leans forward. On examination, you detect a scratchy, leathery sound during both systole and diastole. His heart sounds are also somewhat muffled compared to normal. You order a chest CT scan which looks like the following:

1. What is this patient’s problem?
2. Why does he have pain?

Answer 3

1. Most-likely a pericardial effusion brought on by pericarditis.
2. Pain from pericarditis – may be referred to shoulder (via phrenic) and chest (via the sympathetic fibers from T1 – T4).

Question 4

A 42 year old woman who has experienced hoarseness for the past month is admitted to the hospital. Physical examination reveals a downward tug on her trachea during systole. Her chest X-ray shows a significant abnormality (arrow).

What is the most likely diagnosis for this patient?

Answer 4

The recurrent laryngeal nerve is being stretched by the aortic arch aneurysm.

Question 5

In an 87-year-old woman with severe osteoporosis, which of the following would you most likely expect?

A. Thoracic kyphosis
B. Lumbar lordosis
C. Cervical lordosis
D. Scoliosis

Answer 5

A. Thoracic kyphosis

Question 6

A 62 year old woman is admitted to the hospital because of severe back pain. An X-ray reveals the L4 vertebral body has slipped anteriorly with fracture of the facet joint with L5. What is the proper name of this condition?

A. Spina bifida
B. Spondylosis
C. Spondylolisthesis
D. Spondylolisthesis and spondylolysis
E. Intervertebral disk herniation

What is the exact name of the part of the vertebra that was fractured?

Answer 6

D. Spondylolisthesis and spondylolysis

Pars interarticularis is what fractured

Question 7

Strenuous physical activity such as bending over to shovel snow, can cause pain in the back. Pain from the skin or from muscle strain along the distribution shown at the left is conveyed to the central nervous system by which of the following?

a. Ventral roots
b. Intercostal nerves
c. Ventral primary rami
d. Dorsal primary rami
e. Sympathetic nerve fibers

Answer 7

d. Dorsal primary rami

Question 8

Answer 8

1. Ligamentum flavum
2. Supraspinous ligament
3. Interspinous ligament
4. Posterior longitudinal ligament