Clinically Oriented Anatomy 7th Ed By Agur Dalley

Clinically Oriented Anatomy 7th Ed By Agur Dalley Test Bank

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_____________ :Name: __________________________ Date .1

?lines of the skin (Langer) Which of the following is true pertaining to the tension (A .Surgical incisions should be made parallel to these lines to minimize scaring (B Surgical incisions should avoid cutting through these lines because they contain .neurovascular bundles (C Surgical incisions should avoid cutting through these lines because they indicate .(retinacula cutis) the position of the underlying skin ligaments (D .in obese individuals (striae gravidarum) They become stretch marks (E .They separate fascial compartments

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Upon examining a radiograph of a skull, you notice an extra bone within the sagittal :suture. Your immediate reaction is to (A bones (wormian) dismiss the finding because there are often small sutural .within skull sutures that have no clinical significance (B request a head CT because these bones often develop after head injuries and can .be associated with seizures (C .assume that your patient had a vitamin D deficiency during childhood (D assume that your patient had a fontanelle that remained open beyond the normal .period (E .assume that your patient has a minor case of hydrocephalus

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?Which of the following is incorrect pertaining to joints .They receive blood from vessels surrounding the joint Most articular nerves are branches of the nerves to the muscles that cross the .joint .Loss of nerve supply results in avascular necrosis of the joint .Some joints do not permit any movement .Joint nerves transmit proprioceptive information

(A (B (C (D (E .4 (A (B (C (D (E

:A motor unit contains fewer muscle fibers in muscles that perform precise movements .compared to those that perform gross movements .refers to all the nerves that innervate a muscle ,.e.g) refers to all the muscles that perform a single movement at a joint .(synergistic muscles at the elbow ganglion at a particular (spinal) refers to all the fibers entering a dorsal root .spinal level refers to all the nerve fibers innervating a particular muscle within a peripheral .nerve

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.5 (A (B (C (D (E

:A coronal knife cut through the head could potentially .from the rest of the auricle (auricle) separate the lobule of the outer ear .separate the tip of the nose from the rest of the nose .from the head (auricle) separate the entire outer ear .separate the brain from the spinal cord .separate one nostril from the other

(A (B (C (D (E

?Circumduction is a combination of which of the following movements flexion and extension flexion and rotation flexion, extension, adduction, abduction abduction, adduction, medial rotation, lateral rotation flexion, extension, medial rotation, lateral rotation

(A (B (C (D (E

?Which of the following is incorrect pertaining to a fracture of a bone .The fracture should be “reduced” to heal properly .forms to hold the bones together while healing (callus) A collar of bone .Greenstick fractures are most common in the elderly .Osteoporotic bones break more easily than normal bones .Tearing of the periosteum accounts for the acute pain associated with fracture

(A (B (C (D (E

:Fusion of the diaphysis with the epiphysis .occurs at different ages for different long bones .is evident radiologically throughout life .is a permanent weak spot in bones .is technically a symphysis .only occurs in bones of the skull

(A (B (C (D (E

:Osteoarthritis .develops from osteoporosis .is associated with a loss of articular cartilage .primarily affects non-weight bearing joints .is associated with a reduction in vascular supply to a joint .results in joints that are hypermobile

(A (B (C (D (E

?Which of the following associations is incorrect saddle joint—carpometacarpal joint of the thumb condyloid joint—permit circumduction ball and socket joint—hip joint plane joint—acromioclavicular joint pivot joint—biaxial joint

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.11 (A (B (C (D (E

?Which of the following associations is incorrect repetitive strenuous exercise—hypertrophy of skeletal muscle smooth muscle in uterus during pregnancy—hyperplasia of muscle cells testing of muscle activity—electromyography cardiac muscle—regenerates after a heart attack muscle testing—diagnosis of nerve injury

(A (B (C (D (E

:A concentric muscle contraction .occurs when a muscle exerts a force and lengthens .is an isometric contraction .occurs when a muscle exerts a force and shortens .only occurs in limb muscles .occurs only in smooth muscle

(A (B (C (D (E

:Arteriosclerosis .is associated with increased elasticity of arterial walls .is associated with ischemia .occurs in venules .is most significant clinically in collateral arteries .only occurs in vessels supplying the heart

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:The leg depicted below is characterized by

(A (B (C (D (E

.insufficient arterial supply .loss of muscle tone .varicose veins .muscle atrophy .hypertrophy of epidermal cells

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.15 (A (B (C (D (E .16 (A (B (C (D (E .17

The system by which nutrient-rich blood passes from the capillary beds of the :of the liver is an example of (sinusoids) alimentary tract to the capillary beds .an arteriovenular anastomosis .a lymphatic network .a double-flow system .a double-absorption system .a portal venous system ?Which of the following is incorrect pertaining to the lymphatic system It provides a means by which extracellular fluid can be drained back into the .venous circulation .All lymph from the body enters the venous circulation via the thoracic duct .It provides a pathway for spread of carcinoma .Blockage often results in edema of the affected region .In lymphangitis, red streaks can appear in the skin

:The central nervous system (A .consists of the sympathetic and parasympathetic systems (B from injury via renewed growth and reconnection of (slowly) typically recovers .the damaged neurons (C .consists of the brain and the 12 cranial nerves (D .consists of the brain, spinal cord, and the 12 cranial nerves (E .is separated from cerebrospinal fluid by the pia mater

.18 (A (B (C (D (E

:A dermatome is .all of the muscles innervated by a peripheral nerve .all of the skin innervated by a peripheral nerve .all of the muscles innervated by a single spinal nerve .all of the skin innervated by a single spinal nerve .all of the skin overlying a group of synergistic muscles

(A (B (C (D (E

might be (rhizotomy) root of a spinal nerve (ventral) Transecting an anterior :recommended to .relieve muscle weakness .reduce severe limb pain .increase heart rate .reduce lymph flow .(spasticity) reduce excessive muscle tone

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?Which of the following is incorrect pertaining to the sympathetic motor system (A .It consists of preganglionic and postganglionic neurons (B .Postganglionic neurons typically liberate norepinephrine (C .Preganglionic fibers pass through both the “white” and “gray” rami (D .It contains fibers that reach viscera using splanchnic nerves (E .It facilitates sweating

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:The parasympathetic system (A .is a lumbosacral outflow system (B .has a greater distribution than the sympathetic system (C .causes reduced blood flow to the limbs in cold conditions (D .has relatively short postganglionic neurons compared to the sympathetic system (E .is associated with fibers that convey pain from the limbs

.22 (A (B (C (D (E .23

?Which of the following is incorrect pertaining to plain radiographs .In a PA projection the x-rays traverse the patient from posterior to anterior To minimize distortion the region of the body being examined should be as .close as possible to the x-ray film or detector Compact bone appears white on a radiograph because bone is relatively .radiolucent Enhancement of the visibility of certain structures on radiographs is facilitated .by having the patient ingest a barium-containing compound .Standard chest radiographs should be viewed as if you were facing the patient

?Which of the following is incorrect pertaining to radiology CT scans should be viewed as if you were standing at the feet end of a bed of a .supine patient (B .Ultrasonography of the pelvic viscera is facilitated by an empty bladder (C .MRI is based on magnetic signals transmitted by protons within body structures (D Nuclear magnetic imaging requires the intravenous administration of .radioactive material (E .PET scans can reveal the activation of specific regions of the brain (A

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:The image below represents

(A (B (C (D (E

.a plain radiograph .a CT scan .a nuclear medicine scan .an MRI scan .a myelogram

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Answer Key .1 .2 .3 .4 .5 .6 .7 .8 .9 .10 .11 .12 .13 .14 .15 .16 .17 .18 .19 .20 .21 .22 .23 .24

A A C A B C C A B E D C B B E B E D E C D C B C

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Name: __________________________ Date: _____________ 1. Which of the following is incorrect pertaining to the ribs?

A) The first 7 are referred to as vertebrosternal ribs.

B) Ribs 11 and 12 are typically “floating” (vertebral, free) ribs.

C) The tubercle of a typical rib attaches to the inferior articular facet of the corresponding vertebrae.

D) The head of a typical rib articulates with the bodies of two vertebrae.

E) The costal groove is associated with the intercostal vessels and nerve.

2. Rib fractures: A) are more likely to occur in children than adults.

B) are most likely to occur at the junction of the rib and its corresponding vertebrae.

C) most often occur in the 1st rib.

D) in the lower ribs may be associated with tearing of the diaphragm.

E) are not typically painful.

3. The sternal angle: A) indicates the location of the joint between the costal cartilage of the 2nd rib and the sternum.

B) occurs where the 1st rib attaches to the sternum.

C) is the least likely part of the sternum to fracture in the elderly.

D) occurs at the sternoclavicular joint.

E) is a depression in the body of the sternum.

4. Which of the following is incorrect pertaining to the sternum?

A) It may be surgically split in the median plane to gain access to the thoracic cavity.

B) It may be used for a bone marrow biopsy.

C) It may have a perforation (sternal foramen) that is sometimes the site of a pleural herniation, which is a life-threatening situation.

D) In violent thoracic trauma (e.g., automobile accident), comminuted fractures are not uncommon.

E) Its xiphoid process may partially ossify, producing a pronounced lump.

5. The superior thoracic aperture: A) is bounded posteriorly by the axis.

B) is bounded anterolaterally by the clavicle.

C) is bounded anteriorly by the trachea.

D) is a larger opening than the inferior thoracic aperture.

E) is, anatomically, the thoracic inlet.

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6. Which of the following associations is incorrect?

A) rib separation—separation of a rib and its costal cartilage B) rib dislocation (slipping rib syndrome)—separation of a costal cartilage from the sternum C) joints between costal cartilage of ribs 2–7 and sternum—symphyses D) rib movements—mostly around a transverse axis passing through the head, neck, and tubercle E) rib movements—increase A-P diameter of the thorax during respiration 7. Which of the following associations is incorrect?

A) serratus posterior superior—potentially can elevate superior ribs B) scalenus anterior—stabilizes 1st rib enabling more effective rib elevation during forced inspiration C) external intercostal muscles—attach to the sternum D) intercostal vessels and nerve—travel between internal and innermost intercostals muscles E) diaphragm—primary muscle of respiration 8. The endothoracic fascia: A) is continuous with the clavipectoral fascia.

B) provides a surgical cleavage plane between the thoracic wall and the costal parietal pleura.

C) attaches to the suspensory ligaments of the breast.

D) contains the intercostal muscles.

E) may become fibrous and thus interfere with normal respiratory movements.

9. A patient complains to you of pain in a limited strip on one side of his chest and back. Upon examination you notice that the skin associated with the T3 dermatome of that side is red with vesicular eruptions. Which of the following is your most reasonable conclusion about your patient's illness?

A) He has syphilis.

B) He has shingles (herpes zoster).

C) He has localized dermatitis.

D) An underlying thoracic disease has spread through the thoracic wall to the skin.

E) It is likely that the condition will spread to surrounding dermatomes before it improves.

10. Which of the following is incorrect pertaining to the internal thoracic (mammary) artery?

A) It helps supply the breast via its anterior intercostal branches.

B) It passes anterior to the clavicle.

C) It lies superficial to the slips of the transverse thoracic muscle.

D) It is in contact with the parietal pleura.

E) It terminates in the 6th intercostal space by becoming the superior epigastric and musculophrenic arteries.

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11. A women patient complains to you that her breasts have a strange appearance. Upon examination you notice dimples in the skin of her breast. You know that the most likely explanation for these dimples (peau d' orange sign) is: A) interference with lymph drainage.

B) pregnancy.

C) overproduction of milk.

D) menopause.

E) bacterial infection of the lactiferous ducts (ductus lactiferi).

12. Lymphatic drainage of the breast: A) is principally to the ipsilateral parasternal lymph nodes.

B) and ultimately from both breasts enters the thoracic duct.

C) is principally to the ipsilateral internal thoracic vein.

D) is principally to the ipsilateral axillary nodes.

E) is principally to the ipsilateral lymph vessels running deep to the pectoralis major.

13. Simple mastectomy for breast cancer involves removal of: A) all breast tissue and the underlying muscles.

B) the nipple and areola.

C) only one breast quadrant.

D) all breast tissue superficial to the retromammary space.

E) all of the lymph nodes that drain the breast.

14. Your examination of a male patient reveals a tender subareolar mass in his breast.

Which of the following conditions is most likely based on this finding?

A) gynecomastia B) Klinefelter's syndrome C) cancer D) shingles E) fibrous atrophy of his pectoralis major 15. It is common to explain the relationships between the lung and surrounding structures by using the analogy of a fist inserted into a balloon. Accordingly, which of the following group of associations would be accurate?

A) fist—pleural cavity; space between inner and outer balloon layers—mediastinum; outer layer of balloon—endothoracic fascia B) fist—lung; space between inner and outer balloon layers—pleural cavity; outer layer of balloon—endothoracic fascia C) fist—lung; space between inner and outer balloon layers—pleural cavity; outer layer of balloon—parietal pleura D) fist—lung; space between inner and outer balloon layers—pleural cavity; outer layer of balloon—visceral pleura E) fist—pleural cavity; inner layer of balloon—visceral pleural; space between inner and outer balloon layers—endothoracic surgical plane

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16. Pertaining to the pleura, the: A) diaphragmatic pleura is part of the visceral pleura.

B) suprapleural membrane is part of the parietal pleura.

C) costodiaphragmatic recess is larger during inspiration than during expiration.

D) costal pleural reflection passes obliquely across the 6th rib in the midclavicular line, the 8th rib in the midaxillary line, and the 10th rib at its neck.

E) parietal and visceral layers of pleura are continuous at the pulmonary ligament.

17. A plain radiograph of a patient following a knife wound to the left side of his neck showed elevation of the left hemidiaphragm, narrowing of the left intercostals spaces, and displacement of the trachea to the left. You suspect: A) hemothorax due to blood from the wound.

B) pneumothorax due to knife penetration of the cervical pleura.

C) transection of the phrenic nerve.

D) transection of the sympathetic trunk.

E) pleurisy.

18. Which of the following would be the safest locations to insert a needle for thoracocentesis of the pleural cavity during expiration?

A) immediately superior to the 10th rib at the midaxillary line B) immediately inferior to the 9th rib at the midaxillary line C) immediately superior to the 5th rib at the midclavicular line D) between the costal cartilages of the left 4th and 5th ribs E) between the costal cartilages of the right 4th and 5th ribs 19. During auscultation of the lungs: A) it is normal to hear the sliding of the parietal and visceral layers of pleura.

B) it is normal to hear the movement of the pleural fluid.

C) pleural rub sounds indicate pleuritis or pleurisy.

D) pleural rub sounds indicate a loss of negative pressure in the pleural cavity.

E) pleural rub sounds indicate pneumonia.

20. Which of the following is incorrect pertaining to the surface anatomy of the lungs?

A) Typically, the right lung has three lobes, and the left lung has two.

B) The lingula extends into and out of the costodiaphragmatic recess during respiration.

C) Vascular and nervous structures enter each lung at its hilum.

D) The apex of each lung is in contact with the diaphragm.

E) The mediastinal surface of each lung is related to the heart and pericardium.

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21. Which of the following is incorrect pertaining to bronchopulmonary segments?

A) Each is separated from adjacent segments by visceral pleura.

B) Each is supplied independently by a tertiary bronchus and tertiary branch of the pulmonary artery.

C) Each is surgically resectable.

D) Each is drained by intersegmental parts of the pulmonary veins that lie in the tissue between segments.

E) There are approximately eight to ten in each lung.

22. Spread of bronchiogenic carcinoma to the bronchiomediastinal lymph nodes might be indicated by: A) loss of cough reflex.

B) pleurisy.

C) distorted and displaced carina.

D) fluid sounds upon lung percussion.

E) segmental atelectasis.

23. Which of the following is incorrect pertaining to any bronchial artery or vein?

A) drains to the azygos vein B) supplies lung tissue C) arises from the pulmonary trunk D) supplies the esophagus E) supplies visceral pleura 24. Almost immediately following a compound fracture of the femur in an automobile accident, an otherwise healthy patient suffered severe respiratory distress and died.

The most likely cause of death was: A) loss of blood.

B) infection.

C) pulmonary fat embolism.

D) sympathetic overactivity.

E) myocardial infarction.

25. Which of the following pertaining to lung (bronchiogenic) carcinoma is least likely?

A) a persistent cough B) spitting of blood (hemoptysis) C) metastasis to bronchopulmonary nodes D) enlarged supraclavicular nodes E) enlarged axillary nodes

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26. Which of the following is incorrect pertaining to the innervation of the lung or any part of the pleura?

A) It receives both sympathetic and parasympathetic fibers.

B) Cough reflex fibers (visceral afferents) accompany the vagus nerve.

C) Pain fibers supplied by intercostal nerves.

D) Pain can be referred to the shoulder.

E) Intrinsic smooth muscle is supplied by phrenic nerve.

27. Which of the following is incorrect pertaining to the anatomy of the lung and/or pleura?

A) The parietal pleural generally extends three ribs inferior to the lung.

B) The bifurcation of the trachea occurs approximately at the level of the sternal angle.

C) The right main bronchus is wider and more vertical than the left.

D) Each main bronchus supplies a lung.

E) The right lung has a horizontal fissure.

28. In the following PA radiograph of the thorax, the arrow points to:

A) B) C) D) E)

the stomach. the dome of the right hemidiaphragm. the 12th rib. the lower margin of the left lung. the lower margin of the right lung.

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29. In the following illustration, the arrows points to a line that represents the:

A) B) C) D) E)

separation between the superior thoracic aperture and the mediastinum. separation between the superior mediastinum and the inferior mediastinum. separation between the superior and inferior thoracic lymph drainage areas. separation between the axillary and abdominal lymph drainage of the breast. level of the jugular notch.

30. All of the following are true of the mediastinum except: A) it consists primarily of hollow (air or liquid filled) visceral structures.

B) it contains the lungs.

C) it has relationships that change depending on whether the patient is in the upright or supine position.

D) when widened inferiorly, it may indicate heart failure.

E) it contains lymph nodes.

31. Which of the following is incorrect pertaining to the pericardium?

A) It consists of visceral and parietal layers of serous pericardium, and the fibrous pericardium.

B) The visceral and parietal layers of the serous pericardium are continuous around the aorta and pulmonary trunk where they exit the heart.

C) It is mainly supplied with blood from the pericardiophrenic artery.

D) It has pain fibers that are conveyed by the intercostal nerves.

E) It encloses the terminal part of the inferior vena cava.

32. Cardiac tamponade refers to: A) the effect of a pneumothorax on the heart.

B) the buildup of fluid in the pericardial cavity that impedes the pumping of the heart.

C) the rustle-of-silk sound heard in a stethoscope when there is pericarditis.

D) pericardial calcification.

E) pain from a heart attack.

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33. Which of the following is incorrect pertaining to the apex of the heart?

A) It is formed by the inferolateral part of the left ventricle.

B) Typically it lies posterior to the left 5th intercostal space in adults.

C) It underlies the site where the “heartbeat” may be auscultated on the thoracic wall.

D) It is where the sounds of the mitral valve closure are maximal (apex beat).

E) It is bisected by the coronary groove.

34. In the following illustration, the arrow traverses the:

A) B) C) D) E)

transverse pericardial sinus. oblique pericardial sinus. costopericardial recess. pericardial venous sinus. sinus venosus.

35. Which of the following associations is incorrect?

A) right border of the heart—right atrium B) diaphragmatic surface of the heart—mainly left ventricle C) left border of the heart—mainly left atrium D) anterior surface of the heart—mainly right ventricle E) superior border—right and left atria and auricles 36. Which of the following structures is not associated with the right atrium?

A) crista terminalis B) pectinate muscles C) oval fossa (fossa ovalis) D) opening of coronary sinus E) tendinous chords (chordae tendinea)

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37. The septomarginal trabeculae (moderator band) is important because it: A) conducts subendocardial branches (Purkinje fibers) from the AV node to the anterior papillary muscle.

B) funnels the blood of the right ventricle into the infundibulum.

C) is the thickest part of the myocardium of the left ventricle.

D) prevents blood during systole from reentering the left atrium.

E) provides the fibrous skeleton to which the heart valves are attached.

38. The mitral valve: A) is located between the right atrium and ventricle.

B) has cusps attached to pectinate muscles.

C) has three cusps.

D) is associated with a condition (mitral valve prolapse) in which blood regurgitates into the left atrium when the left ventricle contracts.

E) is located posterior to the sternum at the level of the 2nd costal cartilage.

39. Stenosis of the aortic valve is associated with all of the following except: A) turbulence as the blood exits the heart.

B) murmurs heard with a stethoscope.

C) thrills felt on the surface of the chest.

D) acute occurrence.

E) left ventricular hypertrophy.

40. “Dominance” of the coronary arterial system is determined by the coronary artery that: A) is larger.

B) supplies the AV node.

C) supplies the SA node.

D) supplies the posterior interventricular artery (posterior descending artery).

E) branches first from the aorta.

41. The right coronary artery typically: A) supplies both the AV and SA nodes.

B) supplies most of the interventricular septum.

C) has a circumflex branch.

D) passes to the left side of the pulmonary trunk after arising from the right aortic sinus.

E) supplies the fibrous pericardium.

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42. Following a heart attack you tell a patient that he now has a myocardial infarction.

You explain this as: A) a blockage of his smallest cardiac veins (venae cordae minimae).

B) an area of his myocardium that is necrotic.

C) an area of his myocardium that is fibrillating.

D) an area of his myocardium that is paradoxically contracting.

E) an area of his myocardium that is edematous.

43. In the emergency room you examine a patient experiencing angina pectoris. Which of the following is least likely to be associated with your patient?

A) severe, crushing pain deep to the sternum B) ischemia to a part of his myocardium C) a partial or complete blockage of a coronary artery D) decreased oxygen exchange in the lungs E) pain relief with rest 44. In the following illustration, the arrow points to the:

A) B) C) D) E)

left vagus nerve. left sympathetic trunk. left phrenic nerve. left internal thoracic artery. hemiazygos vein.

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45. In the following CT of the chest, the arrow points to the:

A) B) C) D) E)

arch of the azygos vein. arch of the aorta. left atrium. left ventricle. pulmonary trunk.

46. In the following left lateral view of an aortic angiogram, the arrow points to the:

A) B) C) D) E)

right coronary artery. circumflex artery. posterior interventricular artery. artery to the SA node. coronary sinus.

47. All of the following are true pertaining to coronary bypass surgery except: A) it can only be done after a coronary angioplasty procedure.

B) a segment of the saphenous vein is often used to bypass the obstructed segment of the affected coronary artery.

C) the internal thoracic artery may be used to directly supply the distal segment of a coronary artery.

D) it is done in cases of coronary artery stenosis.

E) when a vein is used to shunt the blood around the obstructed segment, it has to be reversed so that the valves do not impede the flow of blood.

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48. Which of the following associations is incorrect?

A) great cardiac vein—ascends parallel to the anterior interventricular artery B) middle cardiac vein—ascends parallel to the posterior interventricular artery C) anterior cardiac veins—terminate in the coronary sinus D) oblique vein of left atrium—terminates by forming coronary sinus with great cardiac vein E) coronary sinus—traverses the posterior aspect of the coronary groove 49. Which of the following is not true of the SA node?

A) It is located at the junction of the superior vena cava and right atrium near the superior end of the sulcus terminalis.

B) It is the pacemaker of the heart.

C) It sends impulses directly to the interventricular bundle of subendocardial branches (fibers).

D) It receives sympathetic impulses from the first five to six thoracic segments that accelerate its basal rate.

E) It receives parasympathetic impulses from the vagus nerve that decrease its basal rate.

50. A moderately obese 55-year-old woman wishes to start an exercise program. She seeks your advice prior to beginning this program, and you recommend that she have a treadmill stress test. Which of the following is incorrect pertaining to this test?

A) The impulses generated by her SA node will be monitored.

B) Blood pressure will be monitored.

C) Pulse rate will be monitored.

D) Treadmill speed will be increased during the progression of the test.

E) The results of the test show the minimal heart rate the patient should strive for while exercising.

51. All of the following may be associated with a “heart block” except: A) section of the superior part of the thoracic sympathetic trunk.

B) coronary artery disease.

C) loss of synchrony between atrial and ventricular contractions.

D) use of an artificial pacemaker.

E) ventricular fibrillation.

52. Which of the following is incorrect pertaining to the pattern of referred pain typically associated with angina pectoris?

A) may be felt in left shoulder B) may be felt in area of left upper limb supplied by medial brachial cutaneous nerve C) may be felt in the right shoulder D) may be felt in left fingers E) may be felt in back

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53. Which of the following is incorrect pertaining to the arch of the aorta?

A) It begins and ends at the same transverse level.

B) It passes over the root of the left lung.

C) The ligamentum arteriosum connects to the superior aspect of the arch at its most superior point.

D) It gives rise to the left common carotid artery posterior to the manubrium.

E) It may give rise to an artery that directly supplies the thyroid gland.

54. Which of the following is incorrect pertaining to coarctation of the aorta?

A) It is typically associated with reduced blood flow to the brain.

B) It refers to a narrowing of the aorta.

C) It typically occurs near the site of the attachment of the ligamentum arteriosum.

D) It may be associated with enlarged internal thoracic and intercostal arteries.

E) It may be associated with osteological changes in the ribs that are visible radiologically.

55. Which of the following is not true of the right vagus nerve?

A) It passes anterior to the right subclavian artery.

B) It gives rise to the right recurrent laryngeal nerve.

C) It passes posterior to the root of the right lung.

D) It gives a branch to the right pulmonary plexus.

E) It gives rise to a branch that supplies sensory innervation to the diaphragm.

56. Which of the following is not true of the left phrenic nerve?

A) It traverses the superior mediastinum between left subclavian and common carotid arteries.

B) It crosses anterior to the arch of the aorta.

C) It passes posterior to the root of the left lung.

D) It supplies motor fibers to the diaphragm.

E) It pierces the diaphragm.

57. The esophagus: A) contains cartilaginous rings.

B) enters the superior mediastinum anterior to the trachea.

C) in the superior mediastinum is in contact with the thoracic duct on its left.

D) inclines to the right as it nears the diaphragm.

E) traverses the diaphragm at the T8 level.

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58. Which of the following group of three structures may cause apparent “constrictions” of the esophagus on an oblique chest radiograph after the patient has swallowed barium?

A) arch of the aorta, left main bronchus, diaphragm B) arch of the azygos vein, left main bronchus, diaphragm C) left brachiocephalic vein, arch of the azygos vein, diaphragm D) arch of the aorta, left main bronchus, left main pulmonary vein E) left brachiocephalic vein, arch of the aorta, left main pulmonary vein 59. During surgery to remove a metastasis from the posterior aspect of the left lung, the surgical field began to fill with a clear to milky fluid. Which of the following had most likely occurred?

A) The surgeon had penetrated the pleural cavity allowing its fluid to flow into the surgical field.

B) The surgeon had penetrated the pericardial cavity allowing its fluid to flow into the surgical field.

C) The surgeon had lacerated the thoracic duct.

D) The surgeon had lacerated the right auricle of the heart.

E) The surgeon had lacerated the left main bronchus.

60. Which of the following is not correct pertaining to the azygos venous system?

A) It drains blood from the posterior walls of the thorax and abdomen.

B) The azygos vein arches superior to the root of the right lung.

C) The hemiazygos vein receives tributaries from the left posterior intercostal veins.

D) It forms an alternate route for venous blood to return to the heart when the inferior vena cava is blocked.

E) The hemiazygos vein arches superior to the root of the left lung.

61. Which of the following is not typically visible in a PA chest radiograph?

A) the interventricular septum B) the right border of the heart C) the left border of the heart D) the terminal part of the arch of the aorta (aortic knob) E) both clavicles 62. Which of the following associations is incorrect?

A) coronary angiography—shows stenosis in coronary arteries B) echocardiogram—shows valvular stenosis and regurgitation C) iodine contrast enhanced CT—shows breast cancer D) Doppler echocardiogram—shows efficiency of oxygen exchange E) fluoroscopy—shows paradoxical movements of diaphragm

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63. The “bare area” within the thorax refers to: A) a deviation in the left sternal reflection of the pleural that facilitates needle puncture of the pericardial cavity without penetration of the left lung or pleural cavity.

B) a deviation in the right sternal reflection of the pleural that facilitates needle puncture of the pericardial cavity without penetration of the right lung or pleural cavity.

C) a deviation in the right costal reflection of the pleural that facilitates needle puncture of the liver without penetration of the right lung or pleural cavity.

D) the area of the heart that is in direct contact with the sternum.

E) an area of continuity between both pleural cavities and the heart.

64. Which of the following is incorrect pertaining to the thoracic sympathetic trunk?

A) It is in continuity with the cervical and lumbar sympathetic trunks.

B) It lies against the heads of the ribs in the superior part of the thorax.

C) It only supplies postganglionic sympathetic fibers to thoracic viscera.

D) It gives rise to the greater, lesser, and least splanchnic nerves.

E) It has white and gray rami at each level.

65. A former construction worker who remodeled old buildings that contained asbestos insulation is found to have a malignancy growing from the visceral pleura of the lingula. In which of the following lung lobes is the tumor located?

A) right middle B) left upper C) right lower D) right upper E) left lower

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Answer Key 1. C 2. D 3. A 4. C 5. E 6. C 7. C 8. B 9. B 10. B 11. A 12. D 13. D 14. C 15. C 16. E 17. B 18. A 19. C 20. D 21. A 22. C 23. C 24. C 25. E 26. E 27. A 28. B 29. B 30. B 31. D 32. B 33. E 34. A 35. C 36. E 37. A 38. D 39. D 40. D 41. A 42. B 43. D 44. A 45. B 46. B 47. A 48. C

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49. C 50. E 51. A 52. D 53. C 54. A 55. E 56. C 57. C 58. A 59. C 60. E 61. A 62. D 63. A 64. C 65. B

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Name: __________________________ Date: _____________ 1. Which vertebral level does the transumbilical plane pass through?

A) T10 B) T12 C) L3/L4 disc D) L5/S1 disc E) at the level of the sacral promontory 2. Camper's and Scarpa's fascia refer to the: A) fascial layers of the abdominal wall that are deep to the peritoneum.

B) superficial and deep (respectively) fascial layers of the posterior abdominal wall.

C) superficial and deep layers (respectively) of the rectus sheath.

D) fatty and membranous layers (respectively) of the superficial fascia of the inferior anterior abdominal wall.

E) fatty and membranous fascial layers (respectively) of the perineum.

3. Most muscle fibers of the external oblique muscle: A) run transversely.

B) run inferomedially from their superior attachment.

C) run inferolaterally from their superior attachment.

D) pass deep to the linea alba.

E) pass deep to the inguinal ligament.

4. The nerve supply to the muscles of the anterior abdominal wall: A) pierces the peritoneum immediately prior to entering the deep surface of the muscle.

B) is derived from the sympathetic trunk.

C) travels between the internal oblique and transverses abdominis muscles.

D) also innervates the diaphragm.

E) is derived from sacral ventral rami.

5. Which of the following is incorrect pertaining to the rectus abdominis muscle or rectus sheath?

A) The linea alba separates (lies in the midline between) the two rectus muscles.

B) The attachments (tendinous insertions) between the muscle and the anterior layer of sheath account for the abdominal definition (ripples) evident when muscular individuals tense this muscle.

C) The posterior layer of the sheath is composed of the aponeuroses of the internal oblique and the transversalis fascia throughout the extent of the sheath.

D) The external oblique aponeurosis contributes to the anterior wall of the sheath throughout the craniocaudal extent of the sheath.

E) Transverse surgical incisions can be made in this muscle without resulting in muscle fiber necrosis.

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6. The muscles of the anterior abdominal wall assist in all of the following activities except: A) inspiration.

B) defecation.

C) sneezing.

D) vomiting.

E) parturition.

7. Ascites refers to: A) uncontrollable diarrhea.

B) uncontrollable flatulence.

C) abnormal accumulation of fluid in the peritoneal cavity.

D) abdominal organ enlargement.

E) leakage of fluid through the umbilicus.

8. Which of the following is incorrect pertaining to the umbilicus?

A) Umbilical hernias are more common in women.

B) Umbilical eversion is associated with increased intraabdominal pressure.

C) Underlying the umbilicus is the umbilical ring.

D) All layers of the anterolateral abdominal wall fuse at the umbilicus.

E) The umbilicus is in the L1 dermatome.

9. Upon palpating the anterior abdominal wall of a patient, you notice an intense reflexive muscular contraction in the abdominal muscles. Which of the following is not correct pertaining to this sign?

A) It is called “guarding.”

B) It may indicate an inflamed appendix.

C) Functionally, these spasmodic muscular contractions are an attempt to protect the underlying viscera.

D) It is best observed when the patient is perfectly supine.

E) The impulses for muscular contractions are carried through the ventral rami of the inferior thoracic and first lumbar nerves.

10. Which of the following is not correct pertaining to a typical surgical incision used for an appendectomy?

A) The McBurney point is identified.

B) An almost transverse or an oblique (McBurney) incision may be used.

C) The subcostal nerve is identified and preserved.

D) The iliohypogastric nerve is identified and preserved.

E) If gridiron incisions are used, there is no loss of strength in the ability of the anterolateral abdominal muscles to resist intraabdominal pressure.

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11. Endoscopic abdominal surgery: A) requires a larger incision than traditional surgery and is only used for obese patients.

B) is more likely to result in incisional hernias.

C) requires less time for healing than conventional surgery.

D) refers to a procedure whereby the lower six thoracic nerves are anesthetized allowing the patient to be awake during abdominal surgery.

E) refers to a procedure whereby abdominal surgery is performed via instruments passed through the alimentary tract.

12. A transverse incision through the rectus abdominis muscle and both layers of the rectus sheath at the arcuate line would transect the: A) inferior epigastric artery.

B) thoracoepigastric vein.

C) first lumbar artery.

D) ilioinguinal nerve.

E) T12 intercostal nerve.

13. Which of the following associations is incorrect?

A) median umbilical fold—urachus B) medial umbilical folds—obliterated parts of umbilical arteries C) lateral umbilical folds—inferior epigastric arteries D) falciform ligament—connects internal aspect of superior abdominal wall to lesser omentum E) falciform ligament—paraumbilical veins 14. Which of the following is incorrect pertaining to the inguinal ligament?

A) It is composed of the aponeurotic fibers of the external oblique muscle.

B) It extends primarily between the anterior superior iliac spine and the pubic tubercle.

C) It is often perforated by a direct inguinal hernia.

D) It has fibers that cross the midline to help form the reflected inguinal ligament.

E) It is paralleled deeply by the iliopubic tract, which is composed of transversalis fascia.

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15. The following image depicts a physician palpating the:

A) B) C) D) E)

fundus of the stomach. pancreas. inferior margin of the liver. costodiaphragmatic recess. transverse colon.

16. Which of the following is incorrect pertaining to the deep (internal) inguinal ring?

A) It is an opening in the peritoneum.

B) It is located lateral to the inferior epigastric artery.

C) It transmits the spermatic cord in males.

D) It transmits the round ligament of the uterus in females.

E) It forms the deep entrance to the inguinal canal.

17. Which of the following is incorrect pertaining to the inguinal canal?

A) It transmits an indirect inguinal hernia.

B) It is traversed prenatally by the processes vaginalis, which later occludes.

C) It is traversed prenatally by the primordial testis.

D) Its roof is formed by the inguinal ligament.

E) Its superficial opening is the superficial (external) inguinal ring.

18. Cryptorchidism refers to: A) inflammation of the inguinal triangle.

B) an undescended testis.

C) an enlargement of the round ligament of the uterus.

D) fluid in the inguinal canal.

E) the abnormal descent of an ovary into the inguinal canal.

19. One of the standard tests of a newborn infant is to stroke the inside of its thigh to elicit the cremaster reflex. What would be the response you would expect to see?

A) twitching of the skin in the hypogastric region B) closing of the labia C) contraction of the dartos muscle D) penile rigidity E) testicular retraction

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20. In examining a male patient you place your finger in his superficial inguinal ring and ask him to cough. You then feel a sudden impulse medial to your finger. You conclude that your patient most likely has: A) a femoral hernia.

B) a direct inguinal hernia.

C) an undescended testis.

D) a supravesical hernia.

E) testicular cancer.

21. Which of the following is not true of a hydrocele?

A) It can be distinguished from a hematocele by transillumination.

B) It is typically associated with a direct inguinal hernia.

C) It refers to excess fluid in a persistent processus vaginalis.

D) It may be confined to the spermatic cord.

E) It may be associated with inflammation of the epididymis.

22. Which of the following associations is incorrect?

A) rete testis—opening of the ductus deferens B) testicular arteries—arise from abdominal aorta C) varicocele—dilation of the pampiniform plexus D) epididymis—sperm maturation E) anterior scrotum—innervated by branches from the ilioinguinal and genitofemoral nerves 23. While removing a cancerous testis, the surgeon inadvertently allowed fluid from the testis to flow over the incised skin of the scrotum. The surgeon should: A) not be concerned about this accident.

B) be concerned about a potential spread of the cancer to the superficial inguinal lymph nodes.

C) be concerned about the potential spread of the cancer to lumbar lymph nodes.

D) be concerned about the potential spread of the cancer to perineal lymph nodes.

E) be concerned about the potential spread of the cancer to penile lymph nodes.

24. Technically, the peritoneal cavity: A) contains all the intraperitoneal organs.

B) is a closed cavity in both sexes.

C) is the potential space between the parietal and visceral peritoneum.

D) is typically open to the testis in the male.

E) contains lymph nodes.

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25. Which of the following associations is incorrect?

A) ruptured appendix—peritonitis B) peritoneal adhesions—volvulus C) withdrawal of urine from bladder—paracentesis D) intraperitoneal injection—rapid rate of absorption E) peritoneal dialysis—removal of wastes from abdominal cavity 26. Which of the following is incorrect pertaining to a mesentery?

A) It is sensitive to laceration near its attachment to organs.

B) It is a double-layer of peritoneum.

C) It transmits nerves and blood vessels to organs from the body wall.

D) It constitutes a region of continuity between visceral and parietal peritoneum.

E) It contains lymph nodes and vessels.

27. To minimize the spread of peritoneal fluid via the paracolic gutters from a lower abdominal infection, the patient is placed: A) on his right side.

B) on his left side.

C) supine.

D) prone.

E) in an inclined position (head and trunk elevated at least 45 degrees).

28. The omental bursa: A) is a completely sealed-off recess of the peritoneal cavity.

B) is located anterior to the stomach.

C) can contain pancreatic fluid following rupture of the pancreas.

D) has medial and lateral recesses.

E) contains the portal vein.

29. Which of the following is incorrect pertaining to the esophagus?

A) Typically it joins with the stomach at the T11 level.

B) GERD (gastroesophageal reflex disorder) is associated with pyrosis (heartburn).

C) Esophageal varices are associated with blockage of the inferior vena cava.

D) The esophagus is innervated by the vagal trunks and thoracic sympathetic splanchnic nerves.

E) Its abdominal part is typically supplied by the left gastric artery.

30. The superior mesenteric artery: A) arises from the aorta at the T10 level.

B) is accompanied by the superior mesenteric vein on its right.

C) gives rise to a series of arterial arcades called vasa recta.

D) passes posterior to the horizontal part of the duodenum.

E) is accompanied by sympathetic fibers derived from lumbar splanchnic nerves.

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31. Following an automobile accident, a female patient complains of colicky abdominal pain. She also has been vomiting and her abdomen is distended. Which of the following is the most likely cause of her pain and signs?

A) Her small bowel has been torn.

B) The accident freed a small clot from her aorta that subsequently entered and occluded the vasa recta supplying her ileum.

C) The sympathetic nerve supply to her small bowel has been injured.

D) Her parietal peritoneum has been lacerated.

E) The accident triggered appendicitis.

32. Which of the following is least likely pertaining to an ileal diverticulum (of Merkel)?

A) It occurs near the junction between the jejunum and the ileum.

B) It occurs on the antimesenteric border of the ileum.

C) It may have a cordlike attachment to the umbilicus.

D) If inflamed, it may produce symptoms that mimic those of appendicitis.

E) It may be present in both infants and adults.

33. Initially appendicitis manifests as diffuse pain in the periumbilical region and later as circumscribed pain in the right lower quadrant. Why? A) Because the appendix swells with appendicitis so that it contacts both the anterior and posterior abdominal walls.

B) Because the pain is first conveyed via vagal parasympathetic fibers and then by somatic fibers in the parietal peritoneum of the abdominal wall.

C) Because the pain is first conveyed via sympathetic fibers that enter the spinal cord at the T10 level and then by somatic fibers in the parietal peritoneum of the abdominal wall.

D) Because the appendix first irritates the subcostal nerve and then the ilioinguinal nerve.

E) Because the most sensitive afferents of the appendix are those that are associated with the sympathetic fibers that enter the T10 level of the spinal cord, but later less sensitive afferents associated with the lower quadrant become activated.

34. The teniae coli: A) are located along the jejunum.

B) compose the muscular wall of the appendix.

C) are found along the walls of the rectum.

D) are the most superficial part of the sphincter ani.

E) may be used during an appendectomy to locate the appendix.

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35. The image following is an arteriogram of the superior mesenteric artery and its branches. The artery indicated by the arrow is the:

A) B) C) D) E)

superior mesenteric. middle colic. inferior pancreaticoduodenal. first jejunal branch. ileocolic.

36. Which of the following is not correct for the sigmoid arteries?

A) They traverse the sigmoid mesocolon.

B) They help to form the marginal artery.

C) They arise from the inferior mesenteric artery.

D) They typically divide into ascending and descending branches.

E) They are the main source of blood to the left ureter.

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37. In the following barium-enhanced radiograph, the arrow points to the:

A) B) C) D) E)

sigmoid colon. ascending colon. descending colon. duodenum. cecum.

38. Which of the following associations is incorrect?

A) Crohn disease—chronic inflammation of the colon and rectum B) colonoscopy—visualization of the interior of the colon C) diverticulosis—primarily affects infants D) diverticulitis—hemorrhage E) tumors of the colon—mainly occur in the rectum 39. Your friend was in an automobile accident in which his spleen was ruptured. Which of the following is least likely based on this knowledge?

A) The accident caused trauma to the left upper abdominal quadrant.

B) The spleen must be repaired or your friend will die.

C) The rupture resulted in the escape of red blood cells into the peritoneal cavity.

D) The inferior lobe of the left lung may also have been injured.

E) Ribs 9–11 on the left side were fractured.

40. Which of the following is incorrect pertaining to the pancreas?

A) The superior mesenteric artery lies anterior to its neck.

B) Its head is embraced mainly by the descending part of the duodenum.

C) It is retroperitoneal.

D) Its main duct joins with the common bile duct before entering the duodenum.

E) It is partially supplied by branches from the splenic artery.

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41. Which of the following associations is incorrect?

A) gallstone in hepatopancreatic ampulla—pancreatitis B) sudden, severe, forceful compression of the abdomen—rupture of the pancreas C) pancreatectomy—removal of most of the pancreas D) cancer of the head of the pancreas—jaundice E) pancreatic cancer—rarely metastasizes 42. In the following enhanced radiograph of the biliary system, the arrow points to the:

A) B) C) D) E)

cystic duct. left hepatic duct. common hepatic duct. (common) bile duct. pancreatic duct.

43. In the following enhanced CT scan of the abdomen, the arrow points to the:

A) B) C) D) E)

spleen. liver. stomach. left kidney. inferior lobe of the left lung.

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44. The hepatorenal recess (Morison pouch): A) is part of the omental bursa.

B) is in the subphrenic recess.

C) receives infected fluids draining from the omental bursa in the supine position.

D) is a potential space in the hepatorenal ligament.

E) is extraperitoneal.

45. The hepatoduodenal ligament: A) is part of the greater omentum.

B) contains the portal vein, common bile duct, and hepatic artery.

C) contains the round ligament of the liver.

D) attaches to the bare area of the liver.

E) attaches to the neck of the gallbladder.

46. In the following MRI of the abdomen, the arrow points to the:

A) B) C) D) E)

aorta. splenic vein. celiac artery. right gastric artery. inferior vena cava.

47. Which of the following is incorrect pertaining to the portal vein?

A) It is typically formed by the superior mesenteric and splenic veins posterior to the neck of the pancreas.

B) It carries more of the total blood volume reaching the liver than any other vessel.

C) It is typically the most anterior of the structures within the hepatoduodenal ligament.

D) It divides into right and left branches at the porta hepatis.

E) It may spread cancer to the liver.

48. Which of the following is incorrect pertaining to lymph drainage of the liver?

A) There are both superficial and deep lymphatic vessels.

B) Some drainage is via vessels passing directly to phrenic nodes.

C) Some drainage is to vessels within the falciform ligament.

D) Hepatic nodes are located in the greater omentum.

E) Metastases spread via the lymph system will eventually reach the celiac nodes.

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49. What structure traverses the opening indicated by the arrow in the following figure?

A) B) C) D) E)

esophagus inferior vena cava aorta psoas major quadratus lumborum

50. Cirrhosis of the liver is associated with all of the following except: A) softening of the liver.

B) destruction of hepatocytes.

C) portal hypertension.

D) alcoholism.

E) enlargement of the liver.

51. When the sphincter of the bile duct contracts: A) bile is propelled into the duodenum.

B) bile is forced into the gallbladder for concentration and storage.

C) pancreatic juices are prevented from entering the duodenum.

D) bile flow in the common hepatic duct is occluded.

E) bile flow in the cystic duct is occluded.

52. Which of the following is incorrect pertaining to the gall bladder?

A) Some venous drainage is directly into the visceral surface of the liver.

B) Cholecystitis can result from an impacted gallstone.

C) A gallstone lodged in the cystic duct causes intense spasmodic pain.

D) During cholecystectomy surgeons typically ligate the left hepatic artery.

E) The infundibulum of the gall bladder is a pouch that appears between the neck and the cystic duct in diseased states.

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53. In the following enhanced CT of the abdomen, the arrow points to the:

A) B) C) D) E)

lumbar artery. right crus of the diaphragm. psoas major. quadratus lumborum. inferior pole of the right kidney.

54. Which of the following is not associated with portal hypertension?

A) esophageal varices B) caput medusae C) increased blood flow in the inferior vena cava D) surgically making a splenorenal anastomosis E) surgically connecting the portal vein to the inferior vena cava 55. In the following renal arteriogram, the arrow points to:

A) B) C) D) E)

the inferior phrenic artery. rib 10. rib 11. rib 12. an abnormal lumbar rib.

56. The renal fascia: A) separates the kidney from the ureter.

B) usually prevents pus from a perinephric abscess from spreading to the contralateral kidney.

C) prevents the kidney from moving during respiration.

D) holds the renal artery and vein together.

E) is composed of peritoneum.

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57. In renal transplantation the: A) suprarenal gland is transplanted with the kidney.

B) renal artery and vein are sutured to the aorta and inferior vena cava, respectively.

C) kidney is sutured to the diaphragm to maintain its position.

D) transplanted ureter is sutured to the patient's ureter.

E) kidney is placed in the iliac fossa of the greater pelvis.

58. Which of the following is incorrect pertaining to the kidneys?

A) The right kidney is related anteriorly to the liver, duodenum, and ascending colon.

B) The left kidney is related anteriorly to stomach, spleen, pancreas, jejunum, and descending colon.

C) The renal pelvis is the junction between the renal artery and the renal hilum.

D) Extension of the hip joint may increase pain associated with kidney disease.

E) Both kidneys are retroperitoneal.

59. You see a female patient in the emergency room with severe, intermittent “loin” (lumbar region) pain who is also having great difficulty urinating. Your most likely first diagnosis is: A) kidney disease.

B) ureteric ischemia.

C) ruptured renal artery.

D) ectopic pregnancy.

E) ureteric calculus.

60. The suprarenal glands: A) are typically each drained by one vein.

B) are each supplied by one artery that arises from the abdominal aorta.

C) are each supplied by one artery that arises from a renal artery.

D) each receive blood from and drain directly into the kidney.

E) receive sympathetic innervation via the lumbar splanchnic nerves.

61. Which of the following is incorrect pertaining to the celiac plexus?

A) It surrounds the root of the celiac arterial trunk.

B) It contains both sympathetic and parasympathetic fibers.

C) It supplies the stomach.

D) It supplies the descending colon.

E) It supplies the gallbladder.

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62. In the following MRI of the abdomen, the arrow points to the:

A) B) C) D) E)

spleen. right kidney. stomach. transverse colon. duodenum.

63. Which of the following is incorrect pertaining to the diaphragm?

A) Its central tendon is in contact with the fibrous pericardium.

B) Its crura attach to the inferior six costal cartilages.

C) It is partially supplied with blood via branches of the internal thoracic artery.

D) It is at its most superior level when a person is supine.

E) Irritation of the diaphragmatic pleura can result in pain that is referred to the shoulder.

64. A positive psoas sign: A) could indicate liver cancer.

B) means that the thigh can be extended more than 30 degrees.

C) means that the psoas muscle is normal in strength.

D) could indicate pancreatitis.

E) indicates a normal psoas reflex.

65. The ilioinguinal and iliohypogastric nerves: A) innervate the psoas muscle.

B) pass posterior to the quadratus lumborum.

C) are both L1 ventral rami.

D) together form the lumbosacral trunk.

E) supply the adductor muscles of the thigh.

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66. Which of the following is not an anterior relation of the abdominal aorta?

A) pancreas B) horizontal part of duodenum C) left kidney D) coils of jejunum and ileum E) root of the mesentery 67. The inferior vena cava: A) begins anterior to the L5 vertebrae.

B) receives the right testicular vein.

C) is shorter than the abdominal aorta.

D) passes into the thorax at the T10 level.

E) is the only route by which blood from the inferior part of the body can return to the heart.

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Answer Key 1. C 2. D 3. B 4. C 5. C 6. A 7. C 8. E 9. D 10. C 11. C 12. A 13. D 14. C 15. C 16. A 17. D 18. B 19. E 20. B 21. B 22. A 23. B 24. C 25. C 26. A 27. E 28. C 29. C 30. B 31. B 32. A 33. C 34. E 35. E 36. E 37. A 38. C 39. B 40. A 41. E 42. B 43. A 44. C 45. B 46. E 47. C 48. D

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49. C 50. A 51. B 52. D 53. B 54. C 55. D 56. B 57. E 58. C 59. E 60. A 61. D 62. B 63. B 64. D 65. C 66. B 67. B

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Name: __________________________ Date: _____________ 1. Which of the following is most likely pertaining to the two pelves depicted above?

A) B) C) D) E)

The one on the left is male and the one on the right is female.

The one on the right is male and the one on the left is female.

The one on the left is from a younger person than the one on the right.

The one on the right is from a younger person than the one on the left.

The one on the right shows arthritic degeneration at the sacroiliac joint.

2. Which of the following is incorrect pertaining to the bony pelvis?

A) The pelvic girdle is composed of the right and left hip bones and the sacrum.

B) In infants and children the hip bone is composed of three separate bones—the ilium, ischium, and pubis.

C) The ala of the ilium helps to form the acetabulum.

D) The ischial spine separates the greater and lesser sciatic foramina.

E) The pelvic brim separates the greater (false) and lesser (true) pelves.

3. The sacrotuberous ligament: A) passes through the greater sciatic notch.

B) attaches to the ala of the sacrum.

C) resists posterosuperior rotation of the sacrum (inferior aspect moving posteriorly and superiorly).

D) passes through the obturator foramen.

E) prevents posterior dislocation of the femoral head.

4. In examining a newly pregnant woman, you notice that the spinous process of the L5 vertebra is abnormally prominent compared to the spinous processes of the superior lumbar vertebrae. You suspect: A) a fracture of the body of L5.

B) spondylolisthesis.

C) a vertebral canal tumor.

D) spina bifida.

E) kyphosis.

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5. Which of the following is incorrect pertaining to the pelvis during pregnancy?

A) The true (conjugate) distance between the sacral promontory and the posterosuperior aspect of the pubic symphysis increases.

B) The hormone, relaxin, relaxes the pelvic ligaments.

C) The transverse diameter of the pelvis is increased.

D) The amount of pelvic rotation permitted around the sacrum is increased.

E) The coccyx is permitted to move more posteriorly.

6. Which of the following is incorrect pertaining to the pelvic diaphragm?

A) It separates the pelvic cavity from the perineum.

B) It is pierced by the vagina in females.

C) It helps maintain urinary continence.

D) It helps maintain fecal continence.

E) It is synonymous with the levator ani.

7. In the following AP pelvic radiograph, the arrow indicates:

A) B) C) D) E)

the sacrotuberous ligament. the ischial spine. the ischial tuberosity. the iliac tubercle. a posteriorly dislocated femoral head.

8. The levator ani: A) is innervated by pelvic splanchnic nerves.

B) actively contracts during coughing.

C) causes increased urination when spastic.

D) is part of the urogenital diaphragm.

E) actively contracts during inspiration.

9. The rectouterine pouch: A) may be entered from the anterior vaginal fornix.

B) is a peritoneal recess.

C) is within the broad ligament.

D) contains the ovaries.

E) provides support to the bladder.

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10. Which of the following is incorrect pertaining to the transverse cervical (cardinal) ligament?

A) It is composed of subperitoneal endopelvic fascia.

B) It provides support to the uterus.

C) It attaches to the lateral wall of the pelvic cavity.

D) It provides an attachment for the levator ani.

E) It may be used to hold sutures during pelvic surgery.

11. Which of the following is incorrect pertaining to the sacral plexus?

A) It is located on the posterolateral wall of the lesser pelvis.

B) It is related to the anterior surface of the piriformis muscle.

C) It is joined by the lumbosacral trunk.

D) It may be compressed during parturition, resulting in lower limb pain.

E) Most of its branches exit the pelvis through the lesser sciatic foramen.

12. The hypogastric plexuses: A) convey vagal fibers to the pelvic viscera.

B) convey pelvic splanchnic fibers to pelvic viscera.

C) convey sympathetic fibers to pelvic viscera.

D) receive white communicating rami from the sacral spinal nerves.

E) comprise the pelvic part of the sympathetic trunk.

13. Which of the following is incorrect pertaining to pelvic parasympathetic innervation?

A) It derives from spinal segments S2-4.

B) It stimulates rectal contraction for defecation.

C) It stimulates bladder contraction for urination.

D) It stimulates ejaculation.

E) The fibers are accompanied by visceral afferent fibers from pelvic viscera.

14. The pelvic pain line: A) characterizes pelvic pain referral areas based on the inferior limit of peritoneum.

B) is at the level of the first sacral segment.

C) refers to the vertebral level at which the pain associated with parturition is most severe.

D) is only relevant during childbirth.

E) relates to the referred pain felt in the midsagittal plane after hysterectomy.

15. Which of the following is incorrect pertaining to the umbilical artery?

A) It gives rise to the obturator artery.

B) It is a branch of the internal iliac artery.

C) It gives rise to superior vesical arteries.

D) It forms the medial umbilical ligament.

E) Postnatally, has both patent and occluded parts.

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16. The uterine artery: A) passes superior to the ureter at the lateral fornix of the vagina.

B) is a branch of the external iliac artery.

C) is intraperitoneal.

D) supplies the bladder.

E) connects to the uterus at its junction with the uterine tubes.

17. You examine a young boy in the emergency room who is bleeding from his penis after an accident. This blood is derived primarily from a branch of which of the following arteries?

A) superior gluteal B) internal pudendal C) external pudendal D) femoral E) inferior epigastric 18. Which of the following is incorrect pertaining to the ovarian artery?

A) It traverses the suspensory ligament of the ovary.

B) It crosses anterior to the ureter.

C) It has reduced blood flow following ligature of the internal iliac artery.

D) It helps supply the uterine tube.

E) It is accompanied by lymph vessels draining the ovary.

19. Which of the following is not typically a tributary of the internal iliac vein?

A) superior rectal vein B) veins from the vesical pelvic plexus C) internal pudendal vein D) uterine vein E) superior gluteal vein 20. Pelvic lymph drainage: A) is associated with six primary groups of well-defined lymph nodes.

B) is defined by well-developed flow patterns that permit prediction of the spread of metastatic cancer from one organ to another.

C) includes vessels that drain the testis.

D) is characterized by terminal efferent vessels that pass the lymph to lumbar (caval/aortic) nodes.

E) rigidly follows venous drainage patterns.

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21. The ureters: A) pass straight through the bladder wall (in a horizontal plane).

B) are accompanied throughout their length by arteries and veins derived from the renal vessels.

C) have afferent fibers that typically refer pain to the lower abdomen, especially the inguinal region.

D) cross anterior to the ductus deferens.

E) are intraperitoneal.

22. Detrusor muscle contraction is stimulated by: A) the superior hypogastric nerve.

B) lumbar splanchnic nerves.

C) pelvic splanchnic nerves.

D) internal pudendal nerve.

E) contractions of the levator ani.

23. Which of the following is incorrect pertaining to the bladder?

A) A cystocele may result from injuries associated with parturition.

B) Withdrawal of urine from the bladder requires the needle to enter the peritoneal cavity.

C) Rupture of the superior part of the bladder is usually associated with extravasation (passage) of urine into the peritoneal cavity.

D) The interior of the bladder may be viewed with a cystoscope.

E) A complete spinal cord transaction superior to the second sacral segment would eliminate voluntary control of micturition.

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24. In the following MRI of a woman with an anteverted and anteflexed uterus, the arrow indicates the:

A) B) C) D) E)

body of the uterus. opening of the vagina. external os (opening of the cervix). bladder. rectum.

25. The female urethra: A) is more difficult to catheterize than the male urethra.

B) opens into the vestibule of the vagina.

C) has cilia that very effectively prevent bacteria from entering the bladder.

D) begins with a distinct sphincter in the bladder, the internal urethral sphincter.

E) has a distinct posterior ridge termed the urethral crest.

26. The trigone of the bladder: A) forms the boundaries of the internal urethral orifice.

B) is a slight elevation of the internal posterior wall produced by the prostate.

C) is the internal area demarcated by the internal urethral and ureteric orifices.

D) is the extraperitoneal part of the external surface.

E) is synonymous with the apex.

27. The ductus deferens: A) is typically ligated during a vasectomy as it exits the superficial inguinal ring.

B) terminates by uniting with the duct of the seminal glands to form the ejaculatory duct.

C) begins at the head of the testis.

D) is intraperitoneal.

E) is drained by lymph vessels destined for the deep inguinal nodes.

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28. A middle-aged male patient complains of a weak “stream” and nocturia. You believe the most likely cause to be: A) a bladder infection.

B) a spinal cord lesion affecting his pelvic splanchnic nerves.

C) benign prostatic hypertrophy.

D) a ureteric calculi.

E) an obstruction of his intramural (preprostatic) urethra.

29. Prostate cancer: A) is characterized by a softening of the prostate that can be felt during a digital rectal exam.

B) is best identified rectally when the patient has a full bladder.

C) often metastasizes to the testes.

D) is conclusively identified by a positive test of the external iliac lymph nodes.

E) is associated with bladder cancer.

30. Which of the following associations is incorrect?

A) digital examination of the vagina—ovarian cysts B) digital examination of the vagina—pulsations of uterine artery C) urethrovaginal fistula—continuous dribbling of urine from the vagina D) culdocentesis—drainage of a pelvic abscess via posterior vaginal fornix E) rectovaginal fistula—discharge of fecal matter from the vagina 31. The vaginal fornix: A) surrounds the vaginal part of the cervix.

B) contains the ovaries.

C) is part of the broad ligament.

D) is the inferior part of the rectouterine pouch.

E) is the recess between the external urethral and vagina orifices.

32. Which of the following structures is least important for supporting the uterus and/or maintaining its position?

A) broad ligament B) transverse cervical (cardinal) ligaments C) uterosacral ligament D) pelvic diaphragm E) round ligament of the uterus 33. Softening of the isthmus of the uterus (Hegar sign) is associated with: A) pregnancy.

B) uterine cancer.

C) a prolapsed uterus.

D) menopause.

E) menstruation.

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34. A pregnant patient seeks your counsel pertaining to anesthesia during delivery. She is particularly interested in a caudal epidural block. You explain that this procedure: A) eliminates all pain associated with labor and delivery.

B) just minimizes the pain sensations that arise from the lower part of the birth canal (cervix and vagina) and the perineum.

C) just minimizes the pain sensations that arise from the body and fundus of the uterus.

D) just minimizes the pain associated with fibers traveling in the pudendal nerve.

E) is typically not used for delivery, but rather for an episiotomy.

35. Which of the following is incorrect pertaining to the uterine tubes?

A) They lie in the mesosalpinx part of the broad ligament.

B) They allow the development of peritonitis from genitourinary tract infections.

C) They may be ligated to prevent pregnancy.

D) They may become the site of an ectopic pregnancy.

E) Their distal part, the ampulla, surrounds the ovary.

36. In the following hysterosalpingogram, the arrows indicate the:

A) B) C) D) E)

uterine arteries. uterine tubes. mesovarium. round ligaments. ureters.

37. The anorectal flexure of the anal canal: A) occurs at the level of S3.

B) is maintained by the transverse rectal folds.

C) is where the alimentary tract penetrates the pelvic diaphragm.

D) is within the rectovesical pouch.

E) is where the omental appendices cease.

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38. Which of the following is incorrect pertaining to the perineal body?

A) Stretching or tearing during parturition is associated with prolapse of pelvic viscera.

B) It is an attachment site for the external anal sphincter.

C) It is an attachment site for both the superficial and deep transverse perineal muscles.

D) It lies anterior to the vestibule in females.

E) It blends anteriorly with the perineal membrane.

39. In the emergency room you examine a young boy whose was injured while trying to climb a fence. He says he hit his “bottom” hard while straddling the horizontal bar at the top of the fence. Your examination reveals that his penis and scrotum are edematous as is the lower part of his anterior abdominal wall. Only the most superior aspects of his thighs are also edematous. You suspect the boy: A) ruptured his corpus cavernosa and the swelling is due to blood.

B) bruised his penis and scrotum and the swelling is due to lymph.

C) ruptured his spongy urethra and the swelling is due to urine.

D) ruptured his internal pudendal vein and the swelling is due to blood.

E) ruptured his deep perineal pouch and the swelling is due to an inflammatory reaction resulting from the release of fluid from the bulbourethral glands.

40. In the following image of a coronal section through the rectum and anal canal, the arrow indicates:

A) B) C) D) E)

the pudendal canal. the superficial perineal space. the deep perineal space. the ischioanal fossa. an ischioanal fistula.

41. The superficial and deep perineal pouches are separated superiorly by the: A) deep transverse perineal muscles.

B) superficial transverse perineal muscles.

C) perineal membrane.

D) deep perineal fascia (investing or Gallaudet fascia).

E) membranous layer of the subcutaneous tissue of the perineum.

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42. According to current concepts, the external urethral sphincter: A) is similar in males and females.

B) only exists in females.

C) only exists in males.

D) is innervated by pelvic splanchnic nerves.

E) has an inferior part in males that acts as a true sphincter of the intermediate (membranous) urethra.

43. Which of the following is incorrect pertaining to the ischioanal fossa?

A) The anococcygeal ligament prevents the spread of infection from one fossa to the other.

B) Each fossa is bounded medially by the external anal sphincter.

C) Each fossa is traversed by the inferior anal vessels and nerves.

D) Tenderness between the anus and ischial tuberosity is a diagnostic sign associated with an ischioanal abscess.

E) Loss of the fat within each fossa (occurs with extreme starvation) is associated with rectal prolapse.

44. The pectinate line of the anal canal: A) denotes the separation of the external and internal sphincter ani muscles.

B) denotes the separation between the rectal and anal mucosa.

C) separates the part of the anal canal that is sensitive to laceration from the part that is not.

D) separates the part of the anal canal that is innervated by sympathetic fibers from that innervated by parasympathetic fibers.

E) indicates the anorectal junction.

45. Hemorrhoids are: A) enlarged anal lymph nodes.

B) infected anal sinuses.

C) varicosities in rectal/anal veins.

D) infected and enlarged anal mucus glands.

E) arteriovenous malformations in the anal mucosa.

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46. In the following coronal MRI of the penis and scrotum from a normal male, the arrow indicates the:

A) B) C) D) E)

corpus spongiosum. corpus cavernosum. pampiniform venous plexus. vas deferens. testis.

47. In male urethral catheterization: A) the diameter of the urethra at the external urethral orifice is narrower than at any other point.

B) the urethra is least protected (most likely to rupture) at the bulb.

C) the intermediate (membranous) segment is the most distensible part of the urethra.

D) the location of the ducts of the bulbourethral glands must be identified in order to avoid injuring the glands.

E) the patient is likely to feel the most discomfort (sharpest pain) when the catheter penetrates the prostatic urethra.

48. The blood that results in penile erection is primarily derived from the: A) posterior scrotal arteries.

B) deep arteries of the penis.

C) deep branches of the external pudendal arteries.

D) deep dorsal vein.

E) superficial dorsal veins.

49. Circumcision involves: A) removal of the glans of the penis.

B) removal of the prepuce of the penis.

C) removal of the corona of the glans of the penis.

D) enlarging the external urethral orifice.

E) surgically constructing a new external urethral orifice.

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50. Which of the following is not associated with male erection or ejaculation?

A) closure of the vesical (internal urethral) sphincter.

B) contraction of urethral smooth musculature.

C) contraction of bulbospongiosus.

D) parasympathetic impulses reaching the penis from the prostatic nervous plexus.

E) contraction of the smooth muscle of the helical arteries.

51. Which of the following is incorrect pertaining to the female perineum?

A) The greater vestibular glands are typically palpable.

B) The bulbs of the vestibule are composed of erectile tissue.

C) Located immediately within the vaginal orifice, the hymen is a thin fold of mucous membrane that ruptures in young women with physical activity or sexual intercourse.

D) The vestibule is the space enclosed by the labia minora.

E) The mons pubis is composed of skin covering fatty tissue.

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Answer Key 1. A 2. C 3. C 4. B 5. A 6. E 7. B 8. B 9. B 10. D 11. E 12. C 13. D 14. A 15. A 16. A 17. B 18. C 19. A 20. D 21. C 22. C 23. B 24. C 25. B 26. C 27. B 28. C 29. B 30. C 31. A 32. E 33. A 34. B 35. E 36. B 37. C 38. D 39. C 40. D 41. C 42. E 43. A 44. C 45. C 46. B 47. A 48. B

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49. B 50. E 51. A

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Name: __________________________ Date: _____________ 1. In the following lateral radiograph of the thoracic part of the vertebral column, the arrow points to the:

A) B) C) D) E)

head of a rib. pedicle of vertebra. superior articular facet. lamina of vertebrae. spinal nerve.

2. In the following AP radiograph of the inferior thoracic and lumbosacral parts of the vertebral column, the arrow points to the:

A) B) C) D) E)

spinous process of L3. spinous process of L4. spinous process of L5. median sacral crest. lamina of L5.

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3. Which of the following is incorrect pertaining to typical cervical vertebrae?

A) nearly horizontal articular facets B) most mobile region of the vertebral column C) presence of transverse foramina D) presence of uncinate processes E) dislocations that are always associated with spinal cord damage 4. In the following image of a lateral radiograph of the cervical part of the vertebral column, the arrow points to a fracture of the:

A) B) C) D) E)

pars interarticularis of the axis (hangman's fracture). posterior arch of the atlas. lamina of the atlas. spinous process of C3. occipital condyles.

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5. In the following AP radiograph of the mouth and upper cervical part of the vertebral column, the arrow points to the:

A) B) C) D) E)

uvula. spinous process of C3. dens (odontoid) process of C2 (axis). anterior tubercle of C1 (atlas). canine tooth.

6. Which of the following is incorrect pertaining to the thoracic part of the vertebral column?

A) includes the most frequently fractured vertebra B) presence of costal facets C) Most vertebrae have horizontal spinous processes.

D) articular facets that are most effective at limiting flexion E) Inferior vertebrae have mammillary processes.

7. Lumbar spinal stenosis refers to: A) a narrowing of the lumbar intervertebral foramina.

B) a narrowing of the vertebral (spinal) canal in one or more of the lumbar vertebrae.

C) a congenitally restricted dural sheath in the lumbar region.

D) osteoporotic changes in the lumbar bodies that reduce lumbar movements.

E) progressive abnormal shortening of the lumbar spinous processes resulting in extreme lordosis.

8. Which of the following is incorrect pertaining to the sacrum?

A) It articulates with the L5 vertebra at the lumbosacral angle.

B) It articulates with the coccyx at its apex.

C) Its sacral hiatus leads to the sacral canal.

D) Its cornua articulate with the inferior articular facets of the L5 vertebra.

E) It articulates with the ilium at the auricular surface.

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9. During vertebral ossification, the costal elements in the cervical region: A) become part of the spinous processes.

B) become part of the transverse processes.

C) become part of the vertebral arch.

D) never develop.

E) degenerate.

10. The following lateral view MRI of the lumbosacral part of the vertebral column shows:

A) B) C) D) E)

L4/L5 IV disc hypertrophy.

L4/L5 IV disc herniation.

L5/S1 IV disc hypertrophy.

L5/S1 IV disc herniation. spondylosis of the vertebral lamina at L5.

11. The following lateral view MRI of the lumbosacral part of the vertebral column shows:

A) B) C) D) E)

a fracture of the vertebral body at L5. a fracture of the sacrum. spondylolisthesis. sacral movement associated with parturition. separation of the sacroiliac ligament.

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12. Spina bifida cystica refers to a congenital anomaly characterized by: A) an asymptomatic bifurcation of the cauda equina.

B) a division of the L5 vertebral body that is often associated with sciatica.

C) a developmental defect of one more lumbar vertebral arches that may be associated with limb paralysis and deficiencies in bowel/bladder control.

D) an abnormal division of spinal nerves so that lower limb movement control is disturbed.

E) the spinous processes of all of the presacral vertebral column being bifid.

13. Which of the following is incorrect pertaining to IV discs?

A) They are traversed by blood vessels that are branches of the anterior and posterior spinal arteries.

B) They differ in thickness in different parts of the vertebral column.

C) Cervical and lumbar discs are thicker anteriorly than posteriorly.

D) The nucleus pulposus is primarily composed of water.

E) The annulus fibrosus is composed of concentric lamellae of fibrocartilage.

14. Which of the following is correct pertaining to the longitudinal ligaments of the vertebral column?

A) Both tend to limit hyperflexion.

B) Both tend to limit hyperextension.

C) The anterior limits hyperextension whereas the posterior limits hyperflexion.

D) The anterior limits hyperflexion whereas the posterior limits hyperextension.

E) Both limit lateral flexion.

15. Which of the following is incorrect pertaining to herniation of the nucleus pulposus?

A) usually occurs posterolaterally B) may produce lumbago C) may produce sciatica D) tends to occur acutely in an elderly person E) typically occurs at or near the lumbosacral junction 16. Typically, cervical disc herniation: A) results from forcible hyperextension.

B) affects the spinal nerve exiting at the level of the affected disc (C5 nerve affected with C4/C5 disc herniation).

C) is associated with vertebral body fracture.

D) is associated with osteoarthritis of the facet joints.

E) is associated with rupture of the ligamentum flavum.

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17. Which one of the following associations is incorrect?

A) tectorial membrane—superior continuation of the posterior longitudinal ligament B) cruciate (cruciform) ligament—composed of the transverse ligament of the atlas and the longitudinal bands C) rupture of the transverse ligament of the atlas—atlantoaxial subluxation D) rupture of the alar ligaments—increased range in head movements E) fracture of the dens—anterior dislocation of C3–C5 vertebrae 18. While driving under the influence of alcohol, one of your patients hit a streetlight head-on at 50 mph. There is some concern that she injured her vertebral column. As a result of this accident, which of the following injuries would be most likely?

A) fracture of the facet joints at C3/C4 B) fracture of the facet joints at T12/L1 C) fracture of the facet joints at L5/S1 D) fracture of the body of T12 E) dislocation of C3 on C4 19. Excessive lumbar lordosis is associated with all of the following except: A) pregnancy.

B) obesity.

C) unequal limb length.

D) “hollow back.”

E) anterior rotation of the pelvis.

20. Which of the following is incorrect pertaining to the neurovascular supply of the vertebral column?

A) The vertebral bodies are supplied exclusively by the anterior and posterior spinal arteries.

B) Venous drainage is to both internal (within the vertebral canal) and external venous plexuses.

C) Zygapophyseal joints are supplied by medial branches of posterior rami of spinal nerves.

D) Pain fibers from the ligamentum flavum are conveyed by (recurrent) meningeal branches of spinal nerves.

E) Proprioceptive fibers from the anterior longitudinal ligament are conveyed by (recurrent) meningeal branches of spinal nerves.

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21. The following lateral radiograph of the thoracic part of the vertebral column is from a patient with severe osteoporosis. Which of the following conditions does it demonstrate?

A) B) C) D) E)

kyphosis scoliosis lordosis IV disc herniation vertebral body hypertrophy

22. Which of the following is incorrect pertaining to the lumbar cistern?

A) It contains CSF. B) It contains the cauda equina.

C) It contains the internal filum terminale.

D) It typically begins in adults at L2.

E) It contains epidural fat.

23. The denticulate ligaments: A) anchor the dural sac to the walls of the vertebral canal.

B) anchor the spinal cord to the dural sac.

C) are composed of arachnoid matter.

D) are composed of dura matter.

E) attach to the filum terminale.

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24. One of your patients is about to undergo emergency surgery to repair an upper abdominal aortic aneurysm. You explain to your patient that there is a distinct risk that when he awakes from surgery, the lower half of his body will be paralyzed. The most likely reason for this is that: A) the anesthesiologist will incorrectly inject the anesthetic fluid into the spinal cord instead of into the lumbar cistern.

B) the surgeon will accidentally cut into the spinal cord.

C) ligation of the aorta will interrupt blood flow to the great anterior medullary artery (of Adamkiewicz).

D) access to the aorta requires partial transaction of the lumbosacral trunk.

E) during surgery venous thrombosis may result in a stroke.

25. In the following myelogram, the drawn “loop” encircles the:

A) B) C) D) E)

filum terminale. conus medullaris. body of L3. cauda equina. sympathetic trunk.

26. The semispinalis capitis: A) is part of the erector spinae group of muscles.

B) when acting unilaterally, rotates the head so that the face points to the ipsilateral side.

C) when acting bilaterally, flexes the neck.

D) is innervated by cervical and upper thoracic posterior rami.

E) is superficial to the splenius capitis.

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27. The rotatores: A) have a relatively large mechanical advantage for producing trunk rotation.

B) possibly function primarily as “kinesiological monitors” or organs of proprioception.

C) are part of the erector spinae group of muscles.

D) are attached to the transverse processes of a pair of consecutive vertebrae.

E) when acting bilaterally, can produce trunk flexion.

28. Which of the following is incorrect pertaining to the vertebral artery?

A) It traverses the transverse foramina of the cervical vertebrae.

B) If partially occluded, it can cause dizziness upon turning the head.

C) It traverses the suboccipital triangle.

D) It traverses a groove on the posterior arch of the atlas.

E) It only has branches that supply the brain.

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Answer Key 1. B 2. B 3. E 4. A 5. C 6. C 7. B 8. D 9. B 10. D 11. C 12. C 13. A 14. C 15. D 16. B 17. E 18. D 19. C 20. A 21. A 22. E 23. B 24. C 25. D 26. D 27. B 28. E

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Name: __________________________ Date: _____________ 1. Coxa vara refers to: A) an abnormal decrease in the angle between the shaft of the femur and the tibia.

B) an abnormal decrease in the angle between the head and neck of the femur and its shaft (angle of inclination).

C) an abnormally short distance between the anterior superior iliac spine and the center of the acetabulum.

D) an abnormally short distance between the iliac crest and the greater trochanter.

E) an abnormally short femur.

2. The part of the femur that is most susceptible to fracture in conjunction with osteoporosis is: A) mid-shaft.

B) medial condyle.

C) along the intertrochanteric line.

D) neck.

E) intercondylar area.

3. In the following radiograph of the hip, the arrow points to the:

A) B) C) D) E)

greater trochanter. lesser trochanter. ischial spine. quadrate tubercle. femoral neck.

4. You examine a young patient in the emergency room who is complaining of ankle pain following a soccer game. The patient demonstrates to you that an accident resulted in his foot being forced into an excessively inverted position. Based on this scenario, which of the following is the most likely injury?

A) fractured talus B) fractured calcaneus C) fractured lateral malleolus D) tibial dislocation E) medial malleolar dislocation

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5. The talus articulates with all of the following bones except: A) cuboid.

B) navicular.

C) calcaneus.

D) tibia.

E) fibula.

6. The iliotibial tract is the conjoint distal aponeurotic attachment of which of the following pairs of muscles?

A) gluteus medius and minimus B) gluteus medius and maximus C) gluteus maximus and the tensor of the fascia lata D) the tensor of the fascia lata and rectus femoris E) rectus and biceps femoris 7. Which of the following is incorrect pertaining to the great saphenous vein?

A) It passes posterior to the medial malleolus.

B) It passes posterior to the medial condyle of the femur.

C) It drains into the femoral vein.

D) It has a nearly uniform diameter because blood is shunted to deeper veins.

E) It traverses the saphenous opening in the fascia lata.

8. A saphenous cutdown refers to a skin incision associated with: A) removal of the saphenous vein for use in a coronary bypass procedure.

B) insertion of a cannula into the vein at the ankle for prolonged administration of blood, drugs, etc.

C) repair of a femoral hernia that traverses the saphenous opening in the fascia lata.

D) removal of a piece of saphenous nerve for use as a nerve graft.

E) removal of the saphenous nerve because of severe pain along the medial side of the foot.

9. You examine a female patient with enlarged superficial inguinal lymph nodes. Upon further examination you cannot find any cutaneous or subcutaneous signs that would suggest an infection. Perplexed, you ask your colleague what else might cause this condition. She reminds you that these nodes also receive some lymph from the: A) liver via the falciform ligament.

B) ovary via the suspensory ligament of the ovary.

C) uterus via the round ligament of the uterus.

D) bladder via vessels that accompany the urethra.

E) vertebral column via posterior cluneal vessels.

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10. Which of the following is incorrect pertaining to human locomotion?

A) The stance phase of walking begins with “foot-flat” as the entire plantar surface of the foot contacts the ground.

B) The stance phase of walking is longer than the swing phase.

C) During walking there is a period when both feet are in contact with the ground.

D) The push-off phase of walking is associated with contraction of the plantar flexors.

E) The knee extensors contract during the first part of the stance phase.

11. While on a neurology rotation, the attending physician asks you to test a patient's femoral nerve function. Which of the following would you do?

A) Have the patient do a sit-up while you hold and resist his thigh.

B) Have the patient rotate his thigh medially while you resist this movement.

C) Have the patient extend his thigh against your resistance.

D) Have the patient extend his knee against your resistance.

E) Have the patient flex his knee against your resistance.

12. Which of the following is incorrect pertaining to the patella?

A) It increases the mechanical advantage of the quadriceps femoris for extending the knee.

B) Its apex indicates the level of the knee joint when the leg is extended.

C) Pain felt deep to it may be associated with a condition known as chondromalacia patella.

D) Because of the way it ossifies, the patella always fractures in at least four pieces.

E) Testing of its associated tendon reflex is done with the patient sitting and legs “dangling.”

13. Which of the following is incorrect pertaining to the femoral triangle?

A) The femoral sheath and its contents enter the triangle by passing posterior to the inguinal ligament.

B) The femoral nerve enters the triangle by passing deep to the inguinal ligament.

C) The iliopectineal arch forms the lateral boundary of the triangle.

D) It contains lymph nodes.

E) It can be viewed on the surface of the skin when the thigh is flexed, abducted, and laterally rotated.

14. Which of the following is incorrect pertaining to the femoral canal?

A) It is the passageway by which the external iliac vessels enter the thigh.

B) its abdominal opening is termed the femoral ring C) It contains lymph vessels.

D) It is bounded anteriorly by the inguinal ligament.

E) It usually transmits a femoral hernia.

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15. You examine a patient with swelling in her femoral triangle. She also has varicose veins. Of the following choices, which is the most likely cause of the swelling?

A) aneurysm of the femoral artery B) saphenous varix C) femoral nerve neuroma D) indirect inguinal hernia E) bursitis 16. The adductor canal is: A) an opening in the adductor magnus muscle.

B) a mid-thigh intermuscular passageway that conducts the femoral vessels.

C) the space between the adductor longus and brevis that transmits the anterior divisions of the obturator vessels.

D) the passageway used by the obturator internus muscle to exit the pelvis.

E) the passageway used by the obturator externus muscle to reach the greater trochanter.

17. Your friend is diagnosed with trochanteric bursitis. You explain to him that this bursa is between the: A) iliopsoas tendon and the lesser trochanter, allowing the muscle to move freely across the neck of the femur.

B) obturator externus and the lesser trochanter, allowing the muscle to move freely across the trochanter.

C) gluteus maximus and medius at the site of the greater trochanter, allowing the muscles to move freely across one another.

D) skin and the gluteus maximus at the site of the greater trochanter, allowing comfortable sitting by distributing forces across the trochanter.

E) gluteus maximus and the greater trochanter, allowing the muscle to smoothly slide over the trochanter.

18. The piriformis muscle: A) is innervated by the superior gluteal nerve.

B) is innervated by the inferior gluteal nerve.

C) attaches to the lesser trochanter.

D) may compress the sciatic nerve, a condition called piriformis syndrome.

E) medially rotates the thigh.

19. Which of the following is incorrect pertaining to the hamstrings?

A) They all attach to the tibia.

B) They all attach to the ischial tuberosity.

C) They all can produce both hip extension and knee flexion.

D) One of them is partially innervated by the common fibular division of the sciatic nerve.

E) One of them is part of the “pes anserinus.”

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20. Following an argument with his wife in which a man backed through a glass storm door resulting in deep laceration of his buttocks, he is having great difficulty walking. To better understand the nature of his disability, you ask him to stand on one foot. By doing so, you are doing all of the following except: A) using a Trendelenburg test.

B) evaluating the function of the abductors of the thigh.

C) evaluating the function of the gluteus medius and minimus.

D) evaluating the function of the gluteus maximus.

E) evaluating the function of the superior gluteal nerve.

21. An intramuscular injection into the buttocks is most safely done: A) into the superolateral quadrant.

B) into the superomedial quadrant.

C) into the inferolateral quadrant.

D) into the inferomedial quadrant.

E) centrally.

22. In the following axial MRI at the level of the hip joint, the red arrow points to the:

A) B) C) D) E)

obturator internus. piriformis. gluteus medius. levator ani. quadratus femoris.

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23. In the following axial MRI, the blue arrow points to the:

A) B) C) D) E)

iliopsoas rectus femoris sartorius gracilis iliotibial tract

24. While assisting in a surgery to repair the middle portion of a torn semitendinosus muscle, the surgeon points to an artery supplying that portion of the muscle and asks you to name it. You reply: A) deep artery of the thigh.

B) superior gluteal artery.

C) perforating artery.

D) obturator artery.

E) femoral artery.

25. Which of the following is not correct pertaining to the popliteal artery?

A) It begins at the adductor hiatus.

B) It is the continuation of the femoral artery.

C) It can be ruptured by a dislocated knee.

D) It is located superficial to the tibial nerve in the popliteal fossa.

E) It is located deep to the popliteal vein in the popliteal fossa.

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26. In the following lateral view photograph of the area surrounding the knee, the arrow indicates the skin contour raised by the:

A) B) C) D) E)

semitendinosus. vastus lateralis. biceps femoris. lateral head of gastrocnemius. adductor magnus.

27. You examine a patient with severe bruising on the anterolateral surface of his leg.

The patient relates that he was severely kicked “in the shin” while playing soccer a few days ago. Besides the pain, the patient is complaining of weakness in ankle dorsiflexion. Your examination reveals a barely perceptible dorsalis pedis pulse.

Which of the following is your most reasonable diagnosis?

A) atrophy of the tibialis anterior B) lacerated deep fibular nerve and anterior tibial artery C) anterior compartment syndrome due to anterior tibial artery hemorrhage D) anterior compartment syndrome due to lymphatic swelling E) aneurysm of the anterior tibial artery with concomitant pressure on the nerve 28. You examine a mildly obese sedentary patient who is complaining of pain in the distal two-thirds of her tibia after participating in a 10-mile walk for cerebral palsy.

When you exert pressure on her tibialis anterior, she winces in pain. Your most likely diagnosis is: A) venous compression of the muscle due to inadequate venous return.

B) shin splints.

C) lymphedema due to sedentary lifestyle.

D) anterior tibial artery hemorrhage.

E) tibialis anterior atrophy.

29. Which of the following is not true of the fibularis longus, brevis, or tertius?

A) innervated by deep fibular nerve B) resists inversion of the foot C) plantarflexes ankle D) attaches to the first metatarsal E) attaches to the calcaneus

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30. In the following popliteal arteriogram, the arrow points to the:

A) B) C) D) E)

popliteal artery. anterior tibial artery. fibular artery. medial genicular artery. fibular recurrent artery.

31. You see a patient in the emergency room with a fibular neck fracture subsequent to an automobile accident. You are fearful that the patient may have severed his common fibular nerve. To determine this, you ask him to walk. Which of the following walking abnormalities would suggest that the nerve has been severed?

A) excessive flexion of the knee at heel-strike B) shortened stance phase C) high-stepping (steppage) gait D) lack of balance (use of a cane) E) lack of effective hallux push-off

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32. In the following axial MRI of the leg at mid-level, the arrow points to the:

A) B) C) D) E)

medial gastrocnemius. tibialis anterior. soleus. flexor digitorum longus. fibularis longus.

33. Which of the following is incorrect pertaining to the calcaneal (Achilles) tendon?

A) It is the common distal attachment of the gastrocnemius, soleus, and plantaris muscles.

B) It continues into the foot as the long plantar ligament.

C) It is used to test S1and S2 nerve function.

D) It is separated from the superior part of the posterior surface of the calcaneus by a bursa.

E) It spirals while passing inferiorly to its attachment on the calcaneus.

34. The tibialis posterior: A) everts the foot.

B) attaches to the femur.

C) supports the medial longitudinal arch of the foot.

D) is an important swing phase muscle.

E) is innervated by the deep fibular nerve.

35. To palpate the pulse in the posterior tibial artery, you should have the patient: A) invert his foot and place your finger between the posterior surface of the medial malleolus and the medial border of the calcaneal tendon.

B) invert his foot and place your finger between the posterior surface of the lateral malleolus and the lateral border of the calcaneal tendon.

C) invert his foot and place your finger along the medial margin of the flexor hallucis longus tendon in the middle of the leg.

D) evert his foot and place your finger between the fibularis longus and brevis.

E) evert his foot and place your finger along the medial margin of the foot.

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36. Which of the following is incorrect pertaining to the plantar aponeurosis?

A) It is part of the superficial fascia of the sole of the foot.

B) It attaches to the calcaneus.

C) It becomes continuous with the fibrous digital sheaths of the toes.

D) When inflamed and painful it produces a condition called plantar fascitis.

E) It functions as a ligament supporting the longitudinal arches of the foot.

37. Which of the following would conclusively demonstrate functionality of the deep fibular nerve?

A) eversion of the foot B) inversion of the foot C) response to pin prick on the anteromedial surface of the middle of the leg D) response to pin prick on the foot at the level of the malleoli E) response to pin prick on the foot between the first and second toes 38. Which of the following is incorrect pertaining to the dorsalis pedis artery?

A) The absence of the dorsalis pedis pulse in an otherwise healthy adult suggests an enlargement of the patient's perforating fibular artery.

B) It enters the foot superficial to the extensor retinaculum.

C) It supplements the arterial supply to the plantar surface of the foot.

D) It gives rise to the arcuate artery.

E) It runs between the extensor hallucis longus and extensor digitorum longus tendons on the dorsum of the foot.

39. In the following coronal MRI of the ankle joint, the arrow points to the:

A) B) C) D) E)

plantar calcaneonavicular (spring) ligament. medial (deltoid) ligament. long plantar ligament. abductor hallucis longus. flexor hallucis longus.

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40. Which of the following is incorrect pertaining to venous or lymphatic drainage of the foot?

A) The small saphenous vein begins from the lateral part of the dorsal venous arch (lateral marginal vein).

B) Deep veins accompany all the arteries of the foot.

C) Most of the blood from the foot drains via the deep veins.

D) Inguinal lymphadenopathy, without popliteal lymphadenopathy, can result from infections along the medial border of the foot.

E) Veins from the plantar surface of the foot drain toward the medial or lateral margins of the foot.

41. The hip joint: A) exhibits complete contact between the head of the femur and acetabulum during normal standing.

B) is strongly supported by the ligament of the head of the femur.

C) is supported anteriorly and superiorly by the iliofemoral ligament, which prevents hyperextension.

D) is supported posteriorly by the pubofemoral ligament, which prevents overabduction.

E) can be rotated more strongly medially than laterally.

42. The most likely reason for avascular necrosis in an 80-year-old woman following hip fracture is that the: A) fracture included the head of the femur.

B) fracture split the neck of the femur longitudinally.

C) fracture included lacerating the transverse acetabular ligament.

D) retinacular branches of the medial femoral circumflex artery were severed by the fracture.

E) deep artery of the thigh was severed by the fracture.

43. You examine a patient after an automobile accident that resulted in a posterior dislocation of the hip joint. Which nerve are you most concerned might have been injured by such an accident?

A) sciatic B) femoral C) obturator D) lumbosacral trunk E) pelvic splanchnic

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44. Genu valgum and genu varum refer to a knee that: A) can be hyper-rotated medially and laterally, respectively.

B) can be hyperflexed and extended, respectively.

C) has a large Q-angle (knock-knees) and a small Q-angle (bow-legged), respectively.

D) can be displaced medially (because of a weak tibial collateral ligament) and laterally (because of a weak fibular collateral ligament), respectively.

E) can be displaced posteriorly and anteriorly, respectively.

45. Following a football injury, a patient complains of knee pain. To test the integrity of his anterior cruciate ligament, you would have him: A) lay supine and press posteriorly on his patella.

B) sit with his leg flexed at the knee and pull anteriorly on his tibia.

C) sit with his leg flexed at the knee and push posteriorly on his tibia.

D) sit with his leg flexed at the knee and laterally rotate his leg.

E) sit with his leg flexed at the knee and medially rotate his leg.

46. The medial meniscus is injured much more frequently than the lateral meniscus because it is: A) more mobile.

B) thinner.

C) attached to the tibial collateral ligament.

D) attached to the popliteus.

E) attached to the patella.

47. You examine a patient who is a carpet installer by profession. He complains of pain in his knee and has a swelling anterior to it. Which of the following is your most likely diagnosis?

A) rupture of his patella tendon B) comminuted fracture of his patella C) prepatellar bursitis D) patellofemoral syndrome E) popliteal cyst 48. Which of the following is incorrect pertaining to the knee joint?

A) The knee joint consists of four articulations, two femoral-tibial articulations, one femoral-patellar articulation, and one tibial-fibular articulation.

B) Flexion of the joint from a fully extended position with the foot on the ground requires an initial lateral femoral rotation that is produced by the popliteus.

C) The joint is supplied with blood via branches of the femoral, popliteal, anterior tibial recurrent, and circumflex fibular arteries.

D) The joint is innervated via branches of the femoral and sciatic nerves.

E) The posterior cruciate ligament attaches to the intercondylar area of the tibia and the medial femoral condyle.

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49. Which of the following is incorrect pertaining to the ankle joint (talocrural articulation)?

A) It is a hinge type of synovial joint.

B) It is more stable in dorsiflexion than in plantarflexion.

C) A sprained ankle is typically an eversion injury.

D) A Pott fracture is associated with ankle injury.

E) Edema between the medial malleolus and calcaneus may cause compression of the tibial nerve and associated heel pain.

50. In the following photograph of a foot, the arrow points to a skin elevation caused by the tendon of the:

A) B) C) D) E)

extensor hallucis brevis. abductor digiti minimi. tibialis anterior. fibularis brevis. tibialis posterior.

51. Which of the following is incorrect pertaining to the foot joints and ligaments?

A) The anatomical subtalar joint is between the posterior articular facet of the calcaneus and the talus.

B) The transverse tarsal joint is the anatomical joint between the talus, navicular, and calcaneus.

C) The plantar calcaneonavicular ligament (spring ligament) supports the head of the talus.

D) The long plantar ligament attaches to the calcaneus and cuboid.

E) The long plantar ligament supports the longitudinal arches of the foot.

52. The arches of the foot: A) are primarily supported by muscle contraction.

B) assist in propulsion.

C) involve the phalanges.

D) are all aligned longitudinally.

E) all involve the talus.

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53. In the following illustration of the plantar surface of a foot, the area of skin referred to by number 1(light green area) is innervated by the:

A) B) C) D) E)

saphenous nerve. medial plantar nerve. sural nerve. superficial fibular nerve. deep fibular nerve.

54. Which of the following associations is incorrect?

A) hallux valgus—lateral deviation of the hallux B) talipes equinovarus—dorsiflexed ankle and toe C) claw toe—hyperextension of the metatarsophalangeal joints and flexion of the interphalangeal joints D) hammertoe—usually affects second digit E) clubfoot—a foot that is twisted out of its normal orientation

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55. In the following radiograph of the foot, the arrow points to the:

A) B) C) D) E)

navicular. cuboid. medial cuneiform. talus. first metatarsal.

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Answer Key 1. B 2. D 3. B 4. C 5. A 6. C 7. A 8. B 9. C 10. A 11. D 12. D 13. C 14. A 15. B 16. B 17. E 18. D 19. A 20. D 21. A 22. A 23. C 24. C 25. D 26. C 27. C 28. B 29. E 30. B 31. C 32. E 33. B 34. C 35. A 36. B 37. E 38. B 39. B 40. C 41. C 42. D 43. A 44. C 45. B 46. C 47. C 48. A

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49. C 50. D 51. B 52. B 53. A 54. B 55. A

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Name: __________________________ Date: _____________ 1. Which of the following is incorrect pertaining to the clavicle?

A) It is attached via ligaments to the coracoid process.

B) The superior surface is grooved for the subclavian artery.

C) After a fracture, the medial segment is raised by the sternocleidomastoid muscle.

D) Fractures are almost always accompanied by acromioclavicular dislocation.

E) Patients with fractured clavicles typically need to support the ipsilateral upper limb with the contralateral one.

2. Following an avulsion fracture of the greater tubercle of the humerus, the humerus would primarily be: A) laterally rotated.

B) medially rotated.

C) abducted.

D) flexed.

E) extended.

3. In the emergency room you see a 65-year-old woman who fell on her outstretched right hand while walking on ice. Upon examination of the right limb, you feel and see a dorsal protrusion just proximal to the wrist. You suspect a: A) fractured lunate.

B) fractured distal radius (Colles fracture).

C) mid-radial fracture.

D) dislocated first carpometacarpal joint.

E) dislocated midcarpal joint.

4. Which of the following is incorrect pertaining to the scaphoid?

A) It articulates with the radius.

B) It is the most frequently fractured carpal bone.

C) Fracture is accompanied by pain along the lateral side of the wrist.

D) A complication associated with fracture is avascular necrosis.

E) It attaches to the flexor retinaculum.

5. The cephalic vein: A) becomes the brachial vein.

B) becomes the axillary vein.

C) originates on the medial side of the dorsal venous network at the wrist.

D) pierces the clavipectoral fascia.

E) empties into the subclavian vein.

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6. In the following axial MRI through the distal third of the arm, the brachial artery is labeled number 1 (see thin leader line on image). What is the structure indicated by the arrow?

A) B) C) D) E)

ulnar artery radial nerve cephalic vein short head of biceps tendon basilic vein

7. You observe a physician perform a muscle test by having the patient abduct her arm 90 degrees and move the arm forward against resistance. What muscle (or part of a muscle) is the physician testing?

A) middle deltoid B) subscapularis C) clavicular head of pectoralis major D) sternocostal head of pectoralis major E) serratus anterior 8. Following a left radical mastectomy, a woman is unable to abduct her arm more than 90 degrees. Which of the following structures do you suspect was injured during the surgical procedure?

A) dorsal scapular nerve B) long thoracic nerve C) suprascapular nerve D) serratus posterior superior muscle E) rotator cuff component of the shoulder joint capsule 9. The trapezius can perform all of the following functions except: A) protract the scapula.

B) retract the scapula.

C) elevate the scapula.

D) depress the scapula.

E) rotate the scapula.

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10. In which of the following activities would the latissimus dorsi be least important?

A) using the crawl stroke while swimming B) using the backstroke while swimming C) using the breaststroke while swimming D) performing a chin-up E) paddling a canoe 11. Following a knife wound to the neck, you notice that the medial border of a patient's left scapula is located further from the midline than that of his right scapula. The nerve most likely injured by the wound is the: A) long thoracic.

B) thoracodorsal.

C) suprascapular.

D) dorsal scapular.

E) spinal accessory.

12. The arrow in the following radiograph points to the:

A) B) C) D) E)

clavicle. acromion process. coracoid process. superior angle of scapula. superior part of glenoid fossa.

13. Which of the following is incorrect pertaining to the supraspinatus muscle?

A) It is innervated by a nerve that also supplies cutaneous innervation to the lateral surface of the proximal arm.

B) It initiates the process of abduction of the arm.

C) It is associated with painful abduction when the subacromial bursa is inflamed.

D) It is one of four muscles comprising the rotator cuff.

E) During arm abduction against resistance, the muscle can be palpated.

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14. The cervicoaxillary canal: A) forms the base of the axilla.

B) is bounded by the first rib, clavicle, and superior edge of the scapula.

C) conducts the subclavian artery.

D) leads to the quadrangular space.

E) is occluded in a shoulder dislocation.

15. Which of the following is incorrect pertaining to the axillary vein?

A) If lacerated in the axilla, there is a risk of producing an air embolus.

B) It is the vessel that is actually punctured in a typical “subclavian” vein puncture for catheter insertion.

C) It lies deep to the axillary artery as the vessels cross the 1st rib.

D) It is formed by the union of the brachial and basilic veins.

E) It may receive blood from the inguinal region of the body.

16. Which of the following is incorrect pertaining to lymphatic drainage of the upper limb?

A) The apical axillary lymph nodes receive lymph from all the other axillary groups.

B) The axillary nodes may be enlarged in breast cancer.

C) The left humeral (lateral) axillary nodes receive lymph from both upper limbs.

D) Metastatic spread to the axillary nodes may require excision of part of the axillary vein.

E) Removal of the axillary nodes may result in lymphedema of the upper limb.

17. In the following radiograph of the wrist, the arrow points to the:

A) B) C) D) E)

scaphoid. lunate. pisiform. articular disc. capitate.

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18. In the emergency room you examine a patient who was thrown from a motorcycle in such a way that, upon landing, his neck and shoulder were widely separated. Which of the following would not be consistent with your suspicion that he is suffering from Erb-Duchenne palsy?

A) medially rotated arm at rest B) weak shoulder abduction C) weak elbow flexion D) sensory loss on lateral aspect of arm E) weak digital flexion 19. Which of the following associations pertaining to the brachial plexus is incorrect?

A) pre-fixed brachial plexus—compression of inferior trunk by 1st rib B) wounds in the posterior triangle of the neck—brachial plexus injuries C) acute brachial plexus neuritis—severe onset of shoulder pain D) hyperabduction syndrome—paresthesia E) inferior brachial plexus injuries—clawhand 20. Which of the following reasons best explains why it is easier to do a “chin-up” (hands supinated) than a “pull-up” (hands pronated)?

A) Because the brachialis is a less-effective elbow flexor in the pronated position.

B) Because the biceps is a less-effective flexor in the pronated position.

C) Because the brachioradialis is a less-effective flexor in the pronated position.

D) Because the long digital flexors can better assist with elbow flexion in the supinated position.

E) Because the humero-radial-ulnar joint is better aligned in the supinated position.

21. The ridge indicated by the arrow in the following photograph overlies the tendon of which of the following muscles?

A) B) C) D) E)

palmaris longus palmaris brevis flexor carpi radialis flexor digitorum superficialis abductor pollicis longus

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22. You examine a baseball pitcher who complains of weakened elbow flexion and has a rounded soft protuberance on the anterior surface of the distal part of his arm. Your most likely diagnosis is: A) a damaged musculocutaneous nerve in association with a “pulling” of the coracobrachialis.

B) a ruptured long head of biceps tendon.

C) a ruptured short head of biceps tendon.

D) a ruptured brachialis tendon.

E) an elbow dislocation.

23. You examine a patient with a horizontal, posterior, mid-humeral knife wound that reaches the bone. In addition to the muscular lesions, you expect the injury severed the: A) ulnar nerve and superior ulnar collateral artery.

B) ulnar nerve and deep artery of the arm.

C) radial nerve and humeral nutrient artery.

D) radial nerve and deep artery of the arm.

E) median nerve and brachial artery.

24. What is the correct order of structures in the cubital fossa from lateral to medial?

A) brachial artery, median nerve, biceps tendon B) brachial artery, biceps tendon, median nerve C) median nerve, brachial artery, biceps tendon D) biceps tendon, brachial artery, median nerve E) biceps tendon, median nerve, brachial artery

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25. In the following radiograph, what muscle attaches at the location indicated by the arrow?

A) B) C) D) E)

brachialis biceps brachii pronator teres brachioradialis anconeus

26. The brachioradialis: A) has a tendon that passes deep to the flexor retinaculum.

B) attaches to the medial epicondyle of the humerus.

C) is innervated by the radial nerve.

D) acts at both the elbow and wrist joints.

E) extends the elbow.

27. You are assisting in the emergency room when the attending physician examines a patient after an elbow injury. The physician holds the proximal interphalangeal joint of the little finger and asks the patient to flex the distal phalanx. This procedure tests the functionality of what nerve?

A) radial B) ulnar C) median D) posterior interosseous E) anterior interosseous

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28. Which of the following is incorrect pertaining to the pronator quadratus?

A) It is innervated by the anterior interosseous branch of the median nerve.

B) It is the prime mover for pronation.

C) It initiates the movement of pronation.

D) It helps maintain the integrity of the interosseous membrane between the radius and ulna when upward thrusts are transmitted through the wrist.

E) It can be palpated by deeply pressing an index finger two-thirds of the proximaldistal length of the forearm, at the middle of its ventral surface.

29. Which of the following statements is incorrect pertaining to the extensors carpi radialis longus and brevis muscles?

A) When only the two muscles act together, wrist extension and abduction is produced.

B) When the two muscles act with the extensor carpi ulnaris, only wrist extension is produced.

C) When the two muscles act with the flexor carpi ulnaris, only wrist abduction is produced.

D) One of the muscles is innervated by the ulnar and the other by the deep branch of the radial nerve.

E) Both attach to the humerus.

30. The ridge indicated by the arrow in the following photograph overlies the tendon of which of the following muscles?

A) B) C) D) E)

extensor pollicis longus extensor pollicis brevis abductor pollicis longus abductor pollicis brevis first dorsal interossei

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31. Elbow tendonitis (tennis elbow) is associated with: A) inflammation of the periosteum of the lateral epicondyle of the humerus.

B) inflammation of the medial collateral ligament.

C) inflammation of the annular ligament.

D) rupture of the tendon of the extensor digitorum.

E) transient subluxation of the humero-radial-ulnar joint.

32. Which of the following is incorrect pertaining to the anatomic “snuffbox”?

A) It is bounded anteriorly by the tendons of abductor pollicis longus and extensor pollicis brevis.

B) It is bounded posteriorly by the tendon of extensor pollicis longus.

C) The radial artery traverses its floor.

D) The superficial branch of the radial nerve emerges from it.

E) The radial styloid process can be palpated within it.

33. In the following radiograph of the wrist of a 2.5-year-old child, the arrow points to the:

A) B) C) D) E)

scaphoid. trapezium. triquetrum. pisiform. epiphysis of the first metacarpal.

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34. What is the clinical significance of a superficial ulnar artery?

A) It often compresses the median nerve in the arm, producing paresthesia and muscle weakness.

B) It is often pinched during elbow flexion, producing mild ischemia in the forearm muscles.

C) Its superficial course in the cubital fossa results in it being mistakenly used for venipuncture.

D) Its caliber is typically smaller than the normal ulnar artery and, under compromising situations, may be unable to provide sufficient blood to the hand.

E) It accompanies the median nerve in the forearm and passes deep to the flexor retinaculum, resulting in hand ischemia in any patient suffering from carpal tunnel syndrome.

35. Which of the following would not be associated with a complete section of the median nerve at the elbow?

A) inability to flex both the proximal and the distal interphalangeal joints of digits 2 and 3 B) atrophy of thenar eminence muscles C) greatly weakened pronation D) loss of sensation on the lateral aspect of the palmar surface of the hand E) loss of ability to adduct the thumb 36. Which of the following would not be associated with a complete section of the ulnar nerve at the wrist?

A) inability to abduct the little finger B) inability to grasp a piece of paper between the extended 4th and 5th digits C) inability to flex the metacarpophalangeal joint while extending interphalangeal joints of the 2nd digit D) clawhand E) loss of all sensation on the palmar aspect of the little finger 37. “Wrist-drop” is associated with: A) unopposed action of the lumbricals and interossei.

B) rupture of the extensor digitorum.

C) avulsion of the olecranon.

D) section of the radial nerve at the mid-humeral level.

E) section of the superficial branch of the radial nerve.

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38. In the following coronal MRI of the hand, the arrow points to the:

A) B) C) D) E)

lumbrical. palmaris brevis. interossei. tendon of flexor digitorum profundus. tendon of extensor digitorum.

39. Dupuytren contracture refers to: A) an abnormal spasticity in the flexor digitorum profundus tendons.

B) an abnormal spasticity in the flexor pollicis longus tendons.

C) a tightening of the flexor retinaculum that results in carpal tunnel syndrome.

D) a tightening of the anterior skin of the hand, resulting in reduced mobility and an increase depth in the skin creases.

E) a shortening and thickening of the palmar fascia of the hand, resulting in partial flexion of the digits.

40. Opposition of the thumb: A) primarily involves rotation at the 1st metacarpophalangeal joint.

B) primarily involves contraction of a muscle that lies deep to the abductor pollicis brevis.

C) primarily involves contraction of a muscle that is innervated by the ulnar nerve.

D) is a movement that requires lateral rotation of the thumb.

E) is a movement that requires flexion of the thumb's interphalangeal joint.

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41. Which of the following is correct pertaining to the interossei and lumbrical muscles of the hand?

A) The palmar interossei, dorsal interossei, and lumbricals together can produce flexion at the metacarpophalangeal joints and extension at the interphalangeal joints.

B) The palmar interossei, dorsal interossei, and lumbricals together can produce extension at the metacarpophalangeal joints and flexion at the interphalangeal joints.

C) The palmar and dorsal interossei produce abduction of the fingers, whereas the lumbricals can produce adduction.

D) The palmar interossei and lumbricals can produce adduction of the fingers, whereas the dorsal interossei can produce abduction.

E) The dorsal interossei and lumbricals can produce abduction of the fingers, whereas the palmar interossei can produce adduction.

42. In the following angiogram of the wrist and hand, the arrow points to the:

A) B) C) D) E)

ulnar artery. radial artery. deep branch of the ulnar artery. superficial branch of the radial artery. princeps pollicis artery.

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43. You examine a patient who has a condition in which each time his index finger is flexed and extended, there is an audible “snap.” Which of the following is the likely cause of this “trigger finger?”

A) infection in the midpalmar space B) osteoarthritis of the metacarpophalangeal joint C) carpal tunnel syndrome D) thickening of the fibrous digital sheath and swelling of the flexor tendons E) calcification of the origin of the lumbrical muscle 44. Which of the following is incorrect pertaining to carpal tunnel syndrome?

A) It may involve weakness in the thenar muscles.

B) It may involve anesthesia of the central palm.

C) It may involve paresthesia in the lateral 3½ digits.

D) It may be caused by inflammation of the synovial sheaths of the flexor tendons.

E) Surgical transection of the flexor retinaculum typically relieves its associated symptoms.

45. A laceration of the thenar eminence that results in complete section of the recurrent branch of the median nerve would result in: A) claw hand.

B) ape hand.

C) loss of all ability to abduct the thumb.

D) loss of all ability to adduct the thumb.

E) loss of all ability to flex the metacarpophalangeal joint of the thumb.

46. You examine a patient who is an avid bicycle rider. He complains of sensory loss on the medial side of his hands and you find some weakness in his intrinsic hand muscles, but not in any other muscle group. You suspect that: A) the patient used a hand posture that put excessive pressure on the superficial branch of his radial nerve.

B) the patient used a hand posture that put excessive pressure on his ulnar nerve.

C) repetitive wrist flexion and extension that occurred with braking caused swelling of the patient's long flexor tendons at the wrist.

D) the patient's flexed trunk but extended neck posture during riding stressed his neck vertebrae so that osteophytes developed reducing the size of his C8/T1 intervertebral foramen.

E) the patient probably has a cervical rib and that extended periods in the riding position resulted in inflammation around the nerves surrounding this structure.

47. Which of the following relationships at the wrist is incorrect?

A) The median nerve lies deep to the tendon of the palmaris longus.

B) The ulnar artery and nerve lie lateral to the tendon of the flexor carpi ulnaris.

C) The radial artery can be compressed against the radius.

D) The radial artery lies medial to the tendon of the flexor carpi radialis.

E) The scaphoid can be palpated in the floor of the anatomical snuffbox.

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48. Scapulohumeral rhythm refers to: A) the changing articular configuration of the humeral head in the glenoid cavity with movement.

B) the protective contractions of the rotator cuff muscles with humeral abduction.

C) the protractive and retractive movements of the scapula that occur with humeral flexion and extension.

D) the association between the movements at the glenohumeral and acromioclavicular joints.

E) the relationship between movements at the glenohumeral and scapulothoracic “joints” during humeral abduction.

49. The sternoclavicular joint: A) is less likely to dislocate than the clavicle is to fracture in falls on the outstretched hand.

B) is a symphysis.

C) can ankylose (stiffen) without causing significant loss in shoulder mobility.

D) is dependent on muscles for its integrity.

E) involves the clavicle, sternum, and first two costal cartilages.

50. In the following MRI of the proximal forearm, the arrow points to the:

A) B) C) D) E)

brachioradialis. anconeus. extensor digitorum. flexor digitorum profundus. supinator.

51. You examine a young male patient whose shoulder was injured during a football game. You immediately notice that his acromion process is abnormally prominent and inferior to the acromial end of the clavicle. You diagnose: A) an anteriorly dislocated glenohumeral joint.

B) a posteriorly dislocated glenohumeral joint.

C) a dislocated acromioclavicular joint with intact coracoclavicular ligaments.

D) a dislocated acromioclavicular joint with torn coracoclavicular ligaments.

E) a torn rotator cuff.

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52. The surface elevation identified by the arrow in the following photograph is caused by which of the following muscles?

A) B) C) D) E)

subscapularis trapezius long head of triceps serratus anterior teres major

53. The nerve most likely to be injured in a glenohumeral joint dislocation is the: A) radial.

B) medial.

C) ulnar.

D) axillary.

E) supraclavicular.

54. In the emergency room you examine a young girl who is “protecting” her right upper limb by holding it while maintaining the elbow flexed and forearm pronated. The patient's father related that the patient was misbehaving as the school bus door opened and he inadvertently jerked her up by the hand to lift her onto the bus. You order a series of upper limb radiographs but are fairly certain the injury is: A) a ruptured biceps tendon.

B) a ruptured pectoralis major tendon.

C) a dislocated (subluxed) radial head.

D) an avulsed lesser tubercle.

E) an avulsed medial humeral condyle.

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55. Which of the following is incorrect pertaining to the wrist joint or wrist bones?

A) Movements at the wrist joint proper (radiocarpal joint) are augmented by movements at the midcarpal and intercarpal joints.

B) The joint involves the radius, articular disk, and all of the carpal bones in the proximal row except the pisiform.

C) Branches of the median, ulnar, and radial nerves supply the joint.

D) Fracture of the lunate is common in children and typically heals well because of multiple sources of blood.

E) Fracture-separation of the distal radial epiphysis is common in children and typically heals well when reduced.

56. The abnormal condition shown in the following photograph is associated with paralysis of the:

A) B) C) D) E)

serratus anterior. rhomboids. latissimus dorsi. serratus posterior superior. subscapularis.

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Answer Key 1. D 2. B 3. B 4. E 5. D 6. C 7. C 8. B 9. A 10. B 11. D 12. B 13. A 14. B 15. C 16. C 17. A 18. E 19. A 20. B 21. C 22. B 23. D 24. D 25. B 26. C 27. B 28. E 29. D 30. C 31. A 32. D 33. B 34. C 35. E 36. C 37. D 38. C 39. E 40. B 41. A 42. C 43. D 44. B 45. B 46. B 47. D 48. E

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49. A 50. E 51. D 52. E 53. D 54. C 55. D 56. A

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Name: __________________________ Date: _____________ 1. Which of the following is not associated with the frontal bone(s)?

A) malar flush B) glabella C) metopic suture D) supraorbital foramen E) roof of the orbit 2. The pterion: A) is posteroinferior to the external acoustic meatus.

B) is part of the sphenoid bone.

C) is part of the temporal bone.

D) overlies the anterior branch of the middle meningeal artery.

E) is located at the junction of the sagittal and coronal sutures.

3. Which of the following is not correct for the cribriform plate?

A) It is part of the ethmoid bone.

B) It possesses numerous tiny foramina that transmit olfactory nerves.

C) It is located in the middle cranial fossa.

D) It lies adjacent to the crista galli.

E) It is located posterior to the frontal crest.

4. The arrow in the following figure indicates the location of which of the following cranial bones?

A) B) C) D) E)

maxilla frontal ethmoid sphenoid zygomatic

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5. Which of the following is not a foramen or fissure in the sphenoid bone?

A) superior orbital B) rotundum C) ovale D) lacerum E) spinosum 6. During a difficult delivery an obstetrician uses forceps to extract the infant. Upon examining the baby you notice forceps impressions posteroinferior to the ear. You are most concerned that the: A) forceps may have penetrated a fontanelle.

B) middle ear cavity may have been crushed.

C) facial nerve may have been injured.

D) mastoid process may have been avulsed.

E) styloid process and associated muscles may have been avulsed.

7. Which of the following is incorrect pertaining to fontanelles?

A) The remains of the anterior fontanelle is often indicated by the metopic suture.

B) A bulging fontanelle indicates excessive intracranial pressure.

C) They facilitate molding.

D) Lambda indicates the site of the posterior fontanelle.

E) Fontanelles are normally not palpable after 18 months of age.

8. Which of the following is incorrect pertaining to the scalp?

A) Superficial wounds do not gape because the margins of the wound are held together by the epicranial aponeurosis.

B) The scalp muscles (e.g., occipitofrontalis) are attached to the pericranium.

C) Blood vessels and nerves enter the scalp inferiorly.

D) Scalp infections may spread to the brain via emissary veins that pass through parietal foramina.

E) Scalp injuries can result in “black eyes.”

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9. In the following figure, what structure traverses the foramen indicated by the arrow?

A) B) C) D) E)

internal jugular vein internal carotid artery basilar artery vagus nerve mandibular nerve

10. The cerebellar tentorium: A) is composed of arachnoid matter.

B) contains CSF. C) has a tough edge that may lesion the oculomotor nerve during tentorial herniation.

D) may become occluded, resulting in loss of blood supply to the cerebellum.

E) may produce headaches associated with pituitary tumors.

11. Which of the following associations pertaining to the dural venous sinuses is incorrect?

A) arachnoid granulations—calcifications of arachnoid mater within the sinuses associated with arteriosclerosis B) confluence of the sinuses—near internal occipital protuberance C) inferior sagittal sinus—located within the falx cerebri D) sigmoid sinus—continues inferiorly as internal jugular vein E) occipital sinus—metastases via internal vertebral venous plexuses

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12. Which of the following is not correct pertaining to the cavernous sinus?

A) traversed by the internal carotid artery B) located on either side of the sella turcica C) may become thrombosed via infections in the superior part of the face D) septic thrombosis can lead to the development of meningitis E) contains the mandibular division of the trigeminal nerve 13. Pulsating exophthalmos is associated with: A) tear of the lacrimal artery.

B) tear of the inferior ophthalmic vein.

C) arteriovenous fistula within the cavernous sinus.

D) rupture of the pterygoid venous plexus.

E) section of the oculomotor nerve.

14. What structure traverses the groove indicated by the arrow in the following figure?

A) B) C) D) E)

internal carotid artery internal jugular vein middle meningeal artery sigmoid sinus transverse sinus

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15. You examine a comatose patient in the emergency room. His wife relates that her husband was struck accidentally in his “temple” by a baseball. After an initial period of unconsciousness, he seemed to be okay but later became drowsy and comatose.

You suspect that the patient is suffering from: A) an extradural (epidural) hematoma caused by a laceration of a branch of the middle meningeal artery.

B) a subdural hematoma caused by a laceration of a branch of the middle meningeal artery.

C) an extradural (epidural) hematoma caused by a laceration of the transverse venous sinus.

D) a subdural hematoma caused by a laceration of a branch of the transverse venous sinus.

E) a subarachnoid hemorrhage caused by a laceration of the internal carotid artery.

16. Which of the following is incorrect pertaining to the CSF? A) It returns to the venous system by passing into the vertebral venous plexuses.

B) It provides some cushioning to the brain when the skull is struck.

C) Samples are typically obtained in infants through needle puncture into the posterior cerebellomedullary cistern.

D) Overproduction results in hydrocephalus.

E) Fractures of the floor of the middle cranial fossa may result in leakage through the external acoustic meatus.

17. Which of the following associations is incorrect pertaining to the blood supply of the brain?

A) middle cerebral artery—supplies the lateral surface of the brain B) anterior communication artery—connects anterior cerebral arteries C) hemorrhagic stroke—severe headache and stiff neck D) cerebral arterial circle (circle of Willis)—an anastomosis between the two vertebral and two internal carotid arteries E) cerebral arterial circle (circle of Willis)—in most cases prevents development of neurological symptoms following acute ischemic stroke 18. You examine a patient in the emergency department following a bee sting to the bridge of her nose. Both of the patient's eyes are swollen shut because: A) the sting interfered with the nerve that raises the eyelid.

B) the sting blocked lymph drainage from the region.

C) the face is characterized by very cutaneous veins that ruptured from the sting.

D) the face is characterized by very cutaneous arteries that ruptured from the sting.

E) the face is characterized by very loose subcutaneous connective tissue that allows accumulation of excessive fluid with inflammation.

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19. Which of the following signs would be consistent with Bell palsy?

A) inability to raise the upper eyelid B) loss of the tympanic reflex C) food dribbling from the corners of the mouth D) loss of ability to protrude the tongue E) loss of ability to focus on near objects 20. A late nineteenth century technique to treat trigeminal neuralgia was to inject alcohol into the trigeminal ganglion, which destroys all of the sensory fibers in the ganglion.

The most likely (direct) method by which the surgeon performed this procedure was to insert a needle: A) through the infraorbital foramen.

B) through the foramen ovale.

C) under the eyeball through the inferior orbital fissure.

D) through the pterygomaxillary fissure.

E) through the nasal cavity.

21. A late nineteenth century technique to treat trigeminal neuralgia was to inject alcohol into the trigeminal ganglion, which destroys all of the sensory fibers in the ganglion.

Once the procedure was successfully implemented, the patient would: A) be unable to chew.

B) lose sensation from all areas of his face except the area overlying the parotid gland and some of the auricle C) lose sensation from just the area overlying the body and ramus of the mandible.

D) lose sensation from just the midface area.

E) lose all sensation from his tongue.

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22. In the carotid arteriogram below, the location of the internal carotid artery at the site indicated by the arrow is in the:

A) B) C) D) E)

substance of the brain. cavernosus sinus. petrous part of the temporal bone. foramen lacerum. maxillary sinus.

23. Injection of an anesthetic agent into the infraorbital foramen would eliminate sensation from all of the following regions/structures except the: A) hard palate.

B) anterior maxillary teeth.

C) upper lip.

D) upper gum.

E) philtrum.

24. Ophthalmic herpes zoster is characterized by: A) inability to raise the upper eyelid.

B) inability to abduct the eye.

C) inability to focus on near objects.

D) corneal ulceration.

E) loss of sensation from the forehead.

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25. The muscle primarily responsible for producing the mouth posture shown in the following figure is:

A) B) C) D) E)

orbicularis oris. risorius. zygomaticus major. buccinator. levator labii superioris.

26. While jogging on a trail you come upon a child who fell off her bike and has severe facial lacerations that are bleeding profusely. In order to most effectively curtail the bleeding, you would put pressure on the: A) horizontal ramus of the mandible just anterior to the attachment of the masseter.

B) horizontal ramus of the mandible directly inferior to the angle of the mouth.

C) infraorbital foramen.

D) lateral aspect of mastoid process.

E) coronoid process of the mandible.

27. All lymphatic vessels from the head and neck drain directly or indirectly into lymph nodes located: A) at the junction of the internal jugular and subclavian veins.

B) along the subclavian vein.

C) along the internal jugular vein.

D) along the external jugular vein.

E) along the anterior jugular vein.

28. Which one of the following nerves does not have a relationship with the parotid gland or its sheath?

A) auriculotemporal nerve B) facial nerve C) glossopharyngeal nerve D) great auricular nerve E) chorda tympani 29. Which of the following associations pertaining to the parotid gland is incorrect?

A) parotid duct—opens opposite upper 2nd molar B) mumps—swelling of the parotid gland C) parotid sialogram—metastasis from a parotid tumor D) blockage of the parotid duct—pain upon sucking a lemon E) accessory parotid gland—drains into the parotid duct

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30. Which one of the following conditions would be most consistent with the definition of a “blowout” fracture of the orbit?

A) orbital fat becoming displaced into frontal sinus B) the inferior oblique muscle becoming displaced into the maxillary sinus C) all of the recti muscles becoming detached from their bony attachments D) the superior oblique muscle losing its attachment to the trochlea E) exophthalmos 31. Which of the following associations pertaining to the eyes is incorrect?

A) ptosis—damage to the oculomotor nerve B) “pinkeye”—inflammation of the conjunctiva C) superior conjunctival fornix—receives lacrimal fluid (tears) D) tear drainage—via nasolacrimal duct to middle meatus of nose E) stimulation of tear production—greater petrosal nerve 32. Upon neurological examination, you notice a slow pupillary light reflex in a patient's right eye. Which of the following is consistent with this sign?

A) lesion of the right nasociliary nerve B) compression of the right oculomotor nerve C) compression of the right facial nerve proximal to the geniculate ganglion D) compression of the right facial nerve distal to the geniculate ganglion E) lesion of the left long ciliary nerves 33. The “blind spot” of the eye refers to the: A) macula lutea.

B) uvea.

C) fovea centralis.

D) choroid.

E) optic disc.

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34. In the following sagittal MRI, the arrow points to the:

A) B) C) D) E)

levator palpebrae superioris. superior rectus. superior oblique. superior ophthalmic artery. facial artery.

35. While waiting to assist a neurologist who is about to perform a lumbar puncture, she asks you to conduct an eye exam on the patient. Why? A) Because a CSF infection would be revealed by a discoloration in the anterior chamber of the eye.

B) Because slowness in pupillary dilation would indicate reduced CSF pressure.

C) Because papilledema would indicate increased CSF pressure.

D) Because retinal arterial sprouting would indicate arterial leakage into the CSF. E) Because swelling of the ophthalmic veins would indicate increased CSF pressure.

36. Presbyopia refers to the loss of: A) transparency of the lens.

B) focusing power of the lens.

C) the pupillary light reflex.

D) coordination between the two eyes.

E) coordination between the extraocular muscles.

37. In complete oculomotor nerve palsy, the pupil is: A) depressed and abducted.

B) elevated and abducted.

C) depressed and adducted.

D) elevated and adducted.

E) fixed in a neutral position.

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38. Following partial thyroidectomy a patient presents with signs and symptoms that you believe indicate his cervical sympathetic trunk was inadvertently transected during the procedure. Which of the following would not be consistent with your suspicion?

A) pupillary constriction B) ptosis C) inability to firmly close the eyelids D) absence of sweating on the forehead E) redness and increased temperature on the forehead 39. In the following illustration of a dissection of the infratemporal region, the arrow points to the:

A) B) C) D) E)

lingual nerve. inferior alveolar nerve. chorda tympani. buccal nerve. masseteric nerve.

40. Blockage of the central artery of the retina due to an embolus is associated with: A) total and immediate blindness.

B) partial blindness (loss of central vision).

C) glaucoma.

D) papilledema.

E) initial blindness followed by slow recovery, assuming that collateral circulation is provided by the ciliary arteries.

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41. To anesthetize all of the mandibular teeth but not the tongue, you would place the needle of the syringe: A) at the inferior opening of the foramen ovale.

B) at the opening of the mandibular canal.

C) at the opening of the mental foramen.

D) at the otic ganglion.

E) on the posterior aspect of the maxilla in the infratemporal fossa.

42. Excessive contraction of both lateral pterygoid muscles may result in: A) fracture of the angle of the mandible.

B) fracture of the coronoid process of the mandible.

C) lateral dislocation of one mandibular condyle and medial dislocation of the other.

D) anterior dislocation of condyles of the mandible.

E) posterior dislocation of the condyles of the mandible.

43. Which of the following is incorrect pertaining to the muscles of mastication?

A) They are all innervated by the motor division of the trigeminal nerve.

B) The temporal, masseter, and medial pterygoid all can close the mouth.

C) Alternating contraction of the temporalis muscle can produce rotary movements.

D) Two of them attach to the lateral pterygoid plate.

E) The masseter can protrude the mandible.

44. Which of the following is incorrect pertaining to the lips?

A) They are attached by frenula to the vestibular gingiva.

B) The upper and lower lips receive sensory innervation via the infraorbital nerve.

C) Both lips receive blood via branches from the facial artery.

D) Lymph from the lips drain to the submandibular and submental lymph nodes.

E) They contain the orbicularis oris muscle.

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45. In the emergency department you examine a patient complaining of severe maxillary sinus pain. Upon looking in his mouth, you observe severely degenerated maxillary molars. The patient admits that he has not been treated by a dentist for many years and recently had an upper posterior toothache. Which of the following is the most likely cause of the patient's pain?

A) An infection from an upper molar has spread along the inferior alveolar nerve to the maxillary sinus.

B) An infection has spread via the root of an upper maxillary molar into the maxillary sinus.

C) Poor dental hygiene has resulted in alveolar bone retraction with accompanying fracture of a tooth and invasion of the maxillary sinus by oral bacteria.

D) Poor dental hygiene has caused the root of a maxillary molar to break and invade the maxillary sinus.

E) Poor dental hygiene has weakened the maxillary facial buttress causing both the toothache and sinus pain.

46. In the following coronal CT, the arrow points to the:

A) B) C) D) E)

superior concha. sphenoid sinus. ethmoid sinus. nasopharynx. infundibulum.

47. Which of the following is incorrect pertaining to the soft palate?

A) It extends inferiorly as the palatine tonsil.

B) It is composed of both aponeurotic and muscular parts.

C) It is tensed against the posterior wall of the pharynx during swallowing.

D) It is tensed by a muscle that uses the pterygoid hamulus as a pulley.

E) It is provided with sensory innervation via the lesser palatine nerve.

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48. Vallate papillae are taste receptors located: A) on the hard palate.

B) on the soft palate.

C) on the tip of the tongue.

D) directly anterior to the terminal sulcus on the tongue.

E) on the epiglottis.

49. The chorda tympani nerve supplies: A) motor innervation to the intrinsic muscles of the tongue.

B) motor innervation to the extrinsic muscles of the tongue.

C) sensory innervation to the fungiform papillae located at the apex of the tongue.

D) sensory innervation to the posterior third of the tongue.

E) sensory innervation to the epiglottis.

50. The gag reflex can be initiated by touching the posterior aspect of the tongue. The nerve responsible for conducting the afferent part of this reflex is the: A) lingual.

B) vagus.

C) glossopharyngeal.

D) hypoglossal.

E) pinnal accessory.

51. You are assisting an oral surgeon who is about to remove a calculus (stoma) from a patient's submandibular duct. The surgeon asks you to remind him what nerve he has to be careful not to injure while incising the duct directly under the floor of the mouth. You reply: A) spinal accessory.

B) lingual.

C) chorda tympani.

D) internal laryngeal.

E) glossopharyngeal.

52. Which of the following regions does not communicate with the pterygopalatine fossa via the indicated route?

A) infratemporal fossa via pterygomaxillary fissure B) nasal cavity via the sphenopalatine foramen C) orbit via the inferior orbital fissure D) middle cranial fossa via foramen rotundum E) sphenoid sinus via the pterygoid canal

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53. Which of the following is not true of the nasal septum?

A) It forms the medial wall of the nasal cavity.

B) It is attached to the inferior nasal concha.

C) It has bony and cartilaginous parts.

D) It attaches to the cribriform plate superiorly.

E) It is partly innervated by the nasopalatine nerve 54. In the following lateral radiograph, the arrow points to:

A) B) C) D) E)

a coronal suture. a skull fracture. a vessel in the temporalis muscle. the groove for the middle meningeal artery. the edge of the greater wing of sphenoid bone.

55. In which of the following areas of the nasal cavity would you look to determine whether the ostium of the maxillary sinus is obstructed?

A) vestibule B) atrium C) inferior meatus D) middle meatus E) superior to the opening of the auditory tube 56. The choanae: A) are attached to the maxilla.

B) are attached to the ethmoid.

C) provide a passageway from the nasopharynx to the nasal cavity.

D) provide a passageway between the nasopharynx and the oropharynx.

E) provide an attachment for the tensor veli palatini.

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57. Which of the following is correct pertaining to using an otoscope?

A) In infants and adults, the helix is pulled posterosuperiorly to reduce the curvature of the external acoustic meatus.

B) The tympanic membrane is typically transparent.

C) The handle of malleus is usually visible near the umbo.

D) Any light reflex from the otoscope's bulb indicates an abnormality.

E) It is normal to observe an amber (bloody) colored fluid in the tympanic cavity.

58. You examine a patient with localized meningitis in the middle cranial fossa. The meningitis is believed to be secondary to otitis media. The most likely route by which the infection spread is through the: A) floor of the tympanic cavity.

B) tegmen tympani.

C) labyrinthine (medial) wall of the tympanic cavity.

D) tympanic membrane.

E) pharyngotympanic tube.

59. In the following photograph of a view through an ophthalmoscope, the arrow points to the:

A) B) C) D) E)

macula. optic disc. fovea centralis. light reflex. lens.

60. Hyperacusia would be associated with: A) lesion of the chorda tympani.

B) lesion of the facial nerve at the internal acoustic meatus.

C) otitis media.

D) blockage of the pharyngotympanic tube.

E) increased endolymphatic pressure.

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61. Which of the following is incorrect pertaining to the vestibular labyrinth?

A) It is composed of the saccule, the utricle, and the semicircular canals.

B) Its macula contains otoliths.

C) Its macula is innervated by the vestibulocochlear nerve.

D) Diseases result in Ménière syndrome.

E) It contains endolymph.

62. Which of the following is incorrect pertaining to the pterygopalatine ganglion?

A) It receives preganglionic parasympathetic fibers via the greater petrosal nerve.

B) Sympathetic fibers reach it via the deep petrosal nerve.

C) If stimulated, tearing of the eyes and nasal secretions occur.

D) Both sympathetic and parasympathetic fibers travel through the pterygoid canal to reach it.

E) The ganglion contains the cell bodies of the postganglionic sympathetic neurons.

63. The abnormality shown in the following illustration is called:

A) B) C) D) E)

cleft lip. split lip. separated lip. canine separation. incisor hiatus.

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64. The arrow in the following photograph points to the:

A) B) C) D) E)

limbus. conjunctival fornix. lacrimal punctum. lacrimal lake. orbital recess.

Page 18

Answer Key 1. A 2. D 3. C 4. D 5. D 6. C 7. A 8. B 9. B 10. C 11. A 12. E 13. C 14. D 15. A 16. A 17. E 18. E 19. C 20. B 21. B 22. B 23. A 24. D 25. A 26. A 27. C 28. C 29. C 30. B 31. D 32. B 33. E 34. B 35. C 36. B 37. A 38. C 39. B 40. A 41. B 42. D 43. C 44. B 45. B 46. C 47. A 48. D

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49. C 50. C 51. B 52. E 53. B 54. D 55. D 56. C 57. C 58. B 59. B 60. B 61. D 62. E 63. A 64. B

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Name: __________________________ Date: _____________ 1. Which of the following structures is not connected to the hyoid bone by a muscle?

A) styloid process of the temporal bone B) mastoid process of the temporal bone C) scapula D) manubrium E) body of mandible 2. During radical neck surgery for cancer, the surgeon inadvertently cut the cervical branch of the facial nerve. Which of the following signs would not be observed in the patient?

A) sagging of the skin of the neck on the ipsilateral side B) reduced ability to convey some facial expressions C) reduced force in ability to open mandible against resistance D) reduced sensation on the skin of the neck of the ipsilateral side E) reduced skin tension overlying the superior aspects of the deltoid and pectoralis major muscles 3. In the following transverse CT scan through the neck, the arrow points to the:

A) B) C) D) E)

esophagus. trachea. thyroid gland. body of the 6th cervical vertebrae. spinal cord.

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4. In the following transverse CT scan through the neck, which is at a more inferior level than the scan shown in the previous question, the arrow points to the:

A) B) C) D) E)

lobe of thyroid gland. sternocleidomastoid. sternohyoid. longus colli. internal jugular vein.

5. Which of the following is not correct pertaining to the retropharyngeal space?

A) It is between the prevertebral fascia and the buccopharyngeal fascia.

B) It is closed inferiorly by the pretracheal fascia.

C) It is closed laterally by the carotid sheath.

D) It facilitates movement of the pharynx, larynx, and esophagus relative to the vertebral column during swallowing.

E) It is subdivided by the alar fascia.

6. In a newborn infant, torticollis resulting from a tissue tumor most likely involves which of the following muscles?

A) sternocleidomastoid B) trapezius C) scalenus anterior D) semispinalis cervicis E) levator scapulae 7. Which of the following is not true of either the transverse cervical or suprascapular arteries?

A) typically arises from the thyrocervical trunk B) typically passes anterior to scalenus anterior C) supplies the cords of the brachial plexus D) occasionally arises from the third part of the subclavian artery E) provides blood to the deltoid

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8. Which structure is most likely to be penetrated during a subclavian vein puncture if the needle is inserted too far posteriorly?

A) internal jugular vein B) common carotid artery C) subclavian artery D) lateral cord of brachial plexus E) thoracic duct 9. Which of the following is incorrect pertaining to the external jugular vein?

A) It is the best vein to use for right cardiac catheterization.

B) It typically is a tributary of the subclavian vein.

C) It crosses the sternocleidomastoid muscle superficially.

D) Abnormal prominence may indicate heart failure.

E) If slashed open in the neck, its lumen may be held open by the investing layer of deep cervical fascia resulting in an air embolus.

10. In the following illustration, what is the name of the vessel indicated by the arrow?

A) B) C) D) E)

inferior parathyroid artery inferior thyroid artery thyroid ima artery accessory thyroid artery recurrent thyroid artery

11. Upon examination of a patient with a knife wound to the right side of her neck, you observe that the patient has weakness turning her head to the left against resistance and has a drooping right shoulder. Your diagnosis is injury to the: A) right sternocleidomastoid muscle.

B) left levator scapulae muscle.

C) right spinal accessory nerve.

D) left dorsal scapular nerve.

E) right dorsal scapular nerve.

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12. Which of the following is incorrect pertaining to the cervical plexus?

A) It innervates the omohyoid, sternohyoid and sternothyroid.

B) It innervates a muscle that turns the head.

C) It provides sensory innervation to some of the face.

D) It provides sensory innervation to some of the scalp.

E) It provides sensory innervation to some of the shoulder.

13. The phrenic nerve: A) provides the sole motor innervation to the diaphragm.

B) is derived from the brachial plexus.

C) contains sympathetic fibers derived from the inferior cervical ganglion.

D) enters the chest by passing anterior to the subclavian vein.

E) forms posterior to the anterior scalene muscle.

14. Which of the following is incorrect pertaining to the infrahyoid muscles?

A) They depress the hyoid bone during swallowing and speaking.

B) One of them attaches to the scapula.

C) One of them passes posterior to the thyroid gland.

D) One of them has an attachment to the clavicle.

E) All but one are innervated by the ansa cervicalis.

15. Which one of the following arteries is not a branch of the external carotid?

A) middle meningeal B) occipital C) facial D) lingual E) maxillary 16. Which of the following is not correct pertaining to a male patient scheduled for internal carotid endarterectomy?

A) He has atherosclerotic thickening of the intima of his internal carotid artery.

B) He is at risk for a transient ischemic attack.

C) A Doppler color flow study could have been used to detect his condition.

D) One of the nerves typically at risk during this procedure is the recurrent laryngeal nerve.

E) Nerve damage during the procedure can result in loss of sensory innervation of the larynx superior to the vocal folds.

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17. What is the name of the structure indicated by the arrow in the following illustration?

A) B) C) D) E)

central lobe of thyroid gland pyramidal lobe of thyroid gland isthmus of thyroid gland upper parathyroid gland thyroid fistula

18. In the following median MRI though the lower head and neck, the arrow points to the:

A) B) C) D) E)

vestibule. piriform recess. vallecula. nasal cavity. choanae.

19. In a patient with carotid sinus hypersensitivity, which of the following actions should not be performed by or on a patient?

A) cervical plexus nerve block B) carotid endarterectomy C) taking a carotid pulse D) Valsalva maneuver E) swallowing reflex maneuver

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20. Which of the following is incorrect pertaining to the internal jugular vein?

A) It receives blood from the inferior petrosal sinus.

B) It is in the carotid sheath.

C) It is accompanied in the upper neck by the great auricular nerve.

D) It has pulsations that are observable in some cases of mitral valve disease.

E) Typically, the right vein is used for catheterization.

21. The longus colli and capitis muscles: A) extend the neck.

B) are located posterior to the retropharyngeal space.

C) are innervated by the dorsal rami of the upper cervical nerves.

D) elevate the ribs.

E) are covered anteriorly by the investing layer of deep cervical fascia.

22. “Venous angle” refers to: A) the junction of the two brachiocephalic veins to form the superior vena cava.

B) the junction of the internal jugular and subclavian veins.

C) the angle that the internal jugular vein makes as it crosses the sternocleidomastoid muscle.

D) the angle that the axillary vein makes as it crosses the clavicle.

E) the angle that the anterior jugular vein makes with the midline of the neck.

23. In the following coronal MRI through the lower head and neck, the arrow points to the:

A) B) C) D) E)

vestibule. piriform recess. trachea. vallecula. retropharyngeal space.

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24. The cervical sympathetic trunks: A) are in the carotid sheaths.

B) connect to cervical spinal nerves by gray and white communicating rami.

C) emit cardiopulmonary splanchnic nerves.

D) emit cranial splanchnic nerves.

E) typically have ganglia associated with each spinal level.

25. Which one of the following signs is not consistent with Horner syndrome?

A) drooping of the upper eyelid (ptosis) B) sinking of the eye (enophthalmos) C) contraction of the pupil (miosis) D) profuse sweating while eating E) vasodilation in the skin of the forehead 26. Which of the following is incorrect pertaining to the thyroid gland?

A) Its secretions are controlled by sympathetic fibers derived primarily from the inferior cervical ganglion.

B) Its isthmus usually lies anterior to the 2nd and 3rd tracheal rings.

C) It is typically drained by three pairs of veins.

D) It receives blood via branches of both the subclavian and external carotid arteries.

E) It may become abnormally enlarged, resulting in a goiter.

27. While assisting a surgeon excising a malignant thyroid gland, the surgeon asks you why she is ligating the inferior thyroid artery so far from the gland. You correctly respond by stating that she is doing this to avoid injuring which of the following nerves?

A) sympathetic trunk B) superior cardiac nerve C) phrenic nerve D) external laryngeal nerve E) recurrent laryngeal nerve 28. During a surgical procedure to excise a malignant thyroid gland, the surgeon asks you why she is not removing the posterior part of the patient's thyroid gland. Your correct response is: A) so that the patient does not develop tetany.

B) to avoid damage to the trachea .

C) because it is only the posterior part of the gland that produces calcitonin.

D) to avoid damage to the inferior laryngeal nerve.

E) to avoid excessive bleeding.

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29. Which of the following is incorrect for the cricoid cartilage?

A) It comprises the only complete cartilaginous ring of the airway.

B) It articulates with the arytenoid cartilages.

C) It is an attachment of the vocal ligaments.

D) It is connected via a ligament to the thyroid cartilage.

E) It is connected via a joint to the thyroid cartilage.

30. Which of the following is incorrect pertaining to aspiration of a foreign body?

A) Contact with the mucosa of the vestibule of the larynx will induce laryngeal musculature spasm.

B) Contact with the mucosa of the vestibule of the larynx will cause violent coughing.

C) A Valsalva maneuver may be used to dislodge the foreign body.

D) In extreme cases a needle cricothyrotomy permits rapid entry of air into the trachea.

E) Death will occur in approximately five minutes if the airway is fully obstructed.

31. Which of the following associations pertaining to the muscles of the larynx is incorrect?

A) posterior cricoarytenoid muscles—widen rima glottidis B) cricothyroid muscles—raise pitch of voice C) thyroarytenoid muscles—lower pitch of voice D) lateral cricoarytenoid—adduct vocal folds E) transverse and oblique arytenoid muscles—relax upon swallowing 32. In the last part of the nineteenth century, a German/British laryngologist named Felix Semon formulated a medical law that now bears his name, Semon's Law. The law states that in any injury of a certain nerve, the abductors of the vocal cord become affected sooner than the adductors. The nerve that Semon's Law refers to is the: A) superior laryngeal.

B) recurrent laryngeal.

C) internal laryngeal.

D) external laryngeal.

E) glossopharyngeal.

33. Which of the following is incorrect pertaining to a tracheostomy?

A) It is safer to do in infants than adults because the esophagus is more offset and thereby less likely to be injured.

B) The isthmus of the thyroid gland is typically divided or retracted.

C) Care must be taken to avoid transecting an artery that is sometimes present and runs immediately superficial to the trachea.

D) Care must be taken to avoid transecting the inferior thyroid veins.

E) It is typically performed through a portion of the first four tracheal segments.

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34. As the bolus of food enters the oropharynx during swallowing, all of the following actions occur except: A) the infrahyoid muscles act to depress the larynx.

B) the oropharynx is closed off from the nasopharynx.

C) the oropharynx is shortened.

D) the soft palate is elevated.

E) the constrictor muscles contract.

35. While assisting in the emergency removal of a small toy from a young child's piriform recess, the attending physician asks you to tell him what nerve might be injured if the mucosa lining the recess is penetrated. You reply the: A) vagus nerve.

B) glossopharyngeal nerve.

C) lingual nerve.

D) internal laryngeal nerve.

E) spinal accessory nerve.

36. Which of the following statements pertaining to the pharynx is incorrect?

A) The internal laryngeal nerve passes through the gap between the middle and inferior constrictors.

B) The maxillary and vagus nerves predominantly supply the pharynx with sensory innervation.

C) The inferior constrictor muscle receives some motor innervation from the external laryngeal nerve.

D) The palatine tonsil receives some blood via a branch of the facial artery.

E) The pharyngeal “tonsillar ring” refers to an incomplete ring of lymphoid tissue within the pharynx.

37. Which of the following is incorrect (or least likely) pertaining to adenoiditis?

A) It refers to inflammation of the pharyngeal tonsil.

B) It may involve obstruction of the choanae.

C) It may be associated with impairment in hearing.

D) It may be associated with an orbital infection.

E) It may be associated with otitis media.

38. Which of the following statements pertaining to the cervical esophagus is incorrect?

A) The recurrent laryngeal nerve supplies somatic innervation.

B) It begins at the inferior border of the cricoid cartilage.

C) Its associated veins drain into the inferior thyroid veins.

D) Perforations typically heal completely, without surgery and without serious complications.

E) Dysphagia is the most common symptom associated with cancerous infiltration.

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39. The main group of deep cervical lymph nodes is located: A) adjacent to the trachea.

B) along the external jugular vein.

C) along the internal jugular vein.

D) along the subclavian vein.

E) in the retropharyngeal space.

40. The woman in the following photograph is suffering from:

A) B) C) D) E)

excessive contraction of platysma. goiter. spasmodic torticollis. lesion of the left facial nerve. overactivity in muscles innervated by the right ansa cervicalis.

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Answer Key 1. B 2. D 3. A 4. E 5. B 6. A 7. E 8. C 9. A 10. C 11. C 12. B 13. A 14. C 15. A 16. D 17. B 18. C 19. C 20. C 21. B 22. B 23. B 24. C 25. D 26. A 27. E 28. A 29. C 30. C 31. E 32. B 33. A 34. A 35. D 36. B 37. D 38. D 39. C 40. C

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Name: __________________________ Date: _____________ 1. Which of the following sets of cranial nerves all carry preganglionic parasympathetic (general visceral efferent) fibers?

A) IV, V, VII, X B) III, V, VII, X C) III, VII, IX, X D) VII, VIII, IX, X E) VIII, IX, X, XI 2. In the following superior illustration of the interior of the base of the skull, the arrow points to which of the following cranial nerves?

A) B) C) D) E)

olfactory oculomotor trochlear maxillary abducent

3. Which of the following is not correct pertaining to olfaction?

A) The central processes of the olfactory receptor neurons pass through foramina in the cribriform plate.

B) The central processes of the right and left olfactory receptor neurons each collectively form the right and left olfactory nerve.

C) The olfactory nerves terminate in the olfactory bulb, which is in contact with the orbital surface of the frontal lobe of the brain.

D) The axons of secondary olfactory neurons form the olfactory tract.

E) The olfactory tract terminates in the medulla.

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4. The optic chiasm: A) is in the orbit.

B) refers to the central artery of the retina's crossing of the subarachnoid space.

C) refers to partial splitting of the optic nerve fibers from each side to form the right and left optic tracts.

D) refers to the missing field in visual field deficits.

E) occurs in the lateral geniculate body.

5. Which of the following is not correct for the trochlear nerve?

A) It emerges from the posterior aspect of the brainstem.

B) Nerve injury is characterized by inability to focus on near objects.

C) Nerve injury is characterized by lack of coordination for the two eyes when looking downwards.

D) It traverses the lateral wall of the cavernous sinus.

E) It innervates the superior oblique.

6. Which of the following is not correct for the motor fibers of the trigeminal nerve?

A) They originate in the trigeminal ganglion.

B) They pass through foramen ovale.

C) They are distributed entirely with the mandibular division.

D) They innervate the muscles of mastication.

E) They innervate the tensor tympani muscle.

7. Which of the following associations is not correct?

A) corneal reflex—tests integrity of ophthalmic nerve B) foramen rotundum—maxillary nerve C) pterygopalatine ganglion—maxillary nerve D) trigeminal neuralgia—loss of cutaneous sensation in areas of face supplied by trigeminal nerve E) transection of mandibular nerve—deviation of mandible to lesion side 8. The geniculate ganglion: A) contains the cell bodies of the motor fibers of the facial nerve.

B) contains the cell bodies of the sensory fibers of the facial nerve.

C) contains the synapses of the autonomic fibers of the facial nerve.

D) is located in the brainstem.

E) is located in the middle cranial fossa.

9. Which of the following is not correct pertaining to the VIIIth cranial nerve?

A) A lesion can result in tinnitus.

B) A lesion can result in vertigo.

C) A lesion can result in hearing loss.

D) It enters the internal acoustic meatus.

E) It contains somatic motor fibers.

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10. A lesion of the facial nerve may result in all of the following except: A) loss of taste from the anterior two-thirds of the tongue.

B) inability to open eye.

C) partial sensory denervation of the auricle.

D) increase in loudness of sound E) loss of tear production.

11. A complete lesion of the oculomotor nerve would produce all of the following signs except: A) ptosis.

B) absence of pupillary light reflex.

C) pupillary constriction.

D) abducted and laterally directed eyeball.

E) absence of accommodation reflex.

12. The IXth cranial nerve provides all of the following except: A) sensation from the tongue.

B) sensation from the pharynx.

C) most of the fibers of the greater petrosal nerve.

D) motor innervation to the stylopharyngeus.

E) autonomic innervation to the parotid gland.

13. Jugular foramen syndrome could cause all of the following signs except: A) inability to protrude the tongue.

B) dysphagia.

C) dysphonia.

D) sagging of the soft palate.

E) deviation of the uvula to the unaffected side.

14. Following an automobile accident resulting in a cranial base fracture, a patient's tongue deviates to the right when protruded and he has moderate dysarthria. You suspect damage to the: A) left hypoglossal nerve.

B) right hypoglossal nerve.

C) right glossopharyngeal nerve.

D) left glossopharyngeal nerve.

E) superior root of ansa cervicalis

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15. The following photograph depicts a woman with a lesion in which cranial nerve?

A) B) C) D) E)

III IV V VI VII

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Answer Key 1. C 2. B 3. E 4. C 5. B 6. A 7. D 8. B 9. E 10. B 11. C 12. C 13. A 14. B 15. D

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