Download Anatomy Board Review 2006

GROSS ANATOMY BOARD REVIEW 2006
1. A 54 year-old contractor has been coming to you for many years with intermittent bouts of low back
pain. Recently, his pain has worsened and following an intense imaging study, you discover that the
body of his L4 vertebra has shifted anteriorly on L5. The defect causing the displacement of L4 is
most likely located in which of the following regions?
A.
B.
C.
D.
E.
Body
Lamina
Pedicle
Spinous process
Transverse process
2. A structural steel worker comes to you to be evaluated for disability. Seven months previous, he fell
and severely sprained his neck. At work he is required to lift heavy objects above his head.
Presently, he is having difficulty abducting his arm - he can only elevate his arm slightly above his
shoulder. Physical exam yielded a well-nourished, muscular individual with normal body habitus.
Strength testing in abduction through the available range of motion is normal. When asked to shrug
his shoulders, the patient’s left side is much stronger than the right. Upper limb pulses were normal
bilaterally. Which of the following would most likely be the cause of his inability to undergo complete
abduction of the affected limb?
A.
B.
C.
D.
E.
Cervical disc injury between C5 and C6
Paralysis of the trapezius
Thoracic outlet syndrome
Torn rotator cuff
Upper brachial plexus injury
3. A laborer who hangs high level billboards comes to your office complaining of back pain localized to
the mid-thoracic region. Through palpatory physical diagnosis you discover T4 - 8 SL, RR. Which of
the following muscles is responsible for this condition?
A.
B.
C.
D.
E.
Iliocostalis
Latissimus dorsi
Longissimus
Rotatores
Semispinalis
4. A 23 year-old gymnast comes to your office with a longstanding complaint of paresthesias affecting
the lateral aspect of his arm and proximal forearm. Recently, he has noticed weakness during
abduction and lateral rotation of the arm. Which of the following would most likely account for this
pattern of motor deficit preceded by sensory loss?
A.
B.
C.
D.
E.
Compression of the median nerve
Compression of the radial nerve
Injury to the upper brachial plexus
Injury to the lower brachial plexus
Herniation of an intervertebral disk
5. A 16 year-old high school quarterback was speared in the ribs with the helmet of the opposing team’s
left tackle. No ribs were broken, but the area was bruised and sore for several weeks. After the injury
healed, the quarterback was evaluated by the team physician for clearance to return to practice.
During the examination, the physician noticed that the inferior angle of the patient’s right scapula
protruded inordinately. Paralysis to which of the following muscles would most likely be the cause of
this condition?
A.
B.
C.
D.
E.
Latissimus dorsi
Pectoralis minor
Rhomboid major and minor
Serratus anterior
Trapezius
6. A tightrope walker fell from his perch atop the high wire, first caught the wire under his axilla and then
hung by the same arm for ten minutes. Luckily he was rescued when he fell 25 feet into a catch net
that had been hurriedly constructed to save him. Following recuperation, the hand that saved him
slowly began to curl and eventually all fingers, except his thumb, took on the appearance of a claw.
Which of the following scenarios would be plausible to explain his resultant condition?
A.
B.
C.
D.
E.
Compromise to the ulnar nerve as it passes posterior to the medial epicondyle
Compression of the median nerve in the hand while he dangled from the high wire
Paralysis of the lumbricals and interossei
Trauma to the radial nerve as the wirewalker caught himself by his axilla
Stretching of the upper brachial plexus
7. Complete fracture of the medial epicondyle of the humerus would most likely lead to which of the
following conditions?
A.
B.
C.
D.
E.
Inability to abduct the thumb
Inability to extend the wrist
Laceration of the radial nerve
Loss of the pincher mechanism between the thumb and index finger
Loss of the power grip
8. A 20 year-old ice skater suffered a fall while doing a competitive program. When you see her, her
wrist is swollen and extremely tender. Palpation on the dorsum of the wrist between the tendons of
the thumb as they cross the carpus yields exquisite pain. When reviewing the x-rays, you will not be
surprised to see which of the following injuries?
A.
B.
C.
D.
E.
Fracture of the distal radial epiphysis
Fracture of the hamulus of hamate
Lunate dislocation
Scaphoid fracture
Torn triangular cartilage
9. Which of the following can be attributed to impingement of structures which course through the carpal
tunnel?
A.
B.
C.
D.
E.
Atrophy of the hyopthenar eminence
Diminished adduction of the thumb
Loss of the grasp reflex
Paresthesias of involving the 5th digit
“Tunneling” of the interosseous spaces
10. A 39 year-old female patient comes to your office with multiple complaints. Physical examination
reveals deviation of the tongue, drooping of the faucial pillars with deviation of the palate, diminished
gag and cough reflexes and weakness upon shrugging of the shoulder; all other findings are normal.
Without the aid of further diagnostic procedures, where would you tentatively place the site of the
lesion?
A.
B.
C.
D.
E.
Carotid sheath at the base of the skull
Infratemporal fossa
Lateral to the tonsillar fossa
Pterygopalatine fossa
Submandibular region
11. Two months after thyroidectomy a 32 year-old female patient reports hoarseness. The surgical
wound is well healed and no abnormalities were noted during the surgical procedure. Parathyroid
function is normal, CBC with differential unremarkable, BUN normal, creatinine normal, and upon
laryngoscopy, the muscles of the larynx demonstrate paresis or paralysis. Based on this scenario,
which laryngeal muscle is still intact?
A.
B.
C.
D.
E.
Cricothyroid
Lateral cricoarytenoid
Oblique arytenoid
Posterior cricoarytenoid
Thyroarytenoid
12. You see a 7 year-old male patient in the emergency department. His chief complaint is sore throat
with pain radiating into his ears. His parents report that he has had several sore throats in the past
year, each treated with antibiotics. Physical examination reveals high fever, red throat, swollen
glands along his mandible, and productive sputum of green-white color tinged with blood. A
diagnosis of tonsillitis with spread to the tubal lymphoid tissue is made. Surgical resection is
determined to be the necessary treatment. During surgery, excessive bleeding from the tonsilar bed
may be caused by lesioning direct branches arising from which of the following arteries?
A.
B.
C.
D.
E.
Buccal
External carotid
Facial
Internal carotid
Maxillary
13. Anne, a 47 year-old accountant, reports that she is troubled by repeated sinus headaches. She
states that her current headache has been bothering her intermittently for 4 days. Routine physical
examination reveals sinusitis of both the frontal and maxillary sinuses. The maxillary sinus on the left
is infected to such an extent that its resonance is dulled. Additionally, Anne complains that she is
unable to “feel” her incisor teeth on the left. Impingement of which of the following nerves can cause
this finding?
A.
B.
C.
D.
E.
Anterior superior alveolar
Buccal of CN V3
Greater palatine
Nasopalatine
Posterior superior alveolar
14. After several months of dealing with visual difficulties, James, a 55 year-old construction worker,
makes an appointment with you. You immediately notice a ptosis of the right eyelid with pupillary
constriction in the same eye. Besides a flushed cheek, the skin is very dry over the right face.
Without further testing, your immediate impression is that he has some how injured which of the
following structures?
A.
B.
C.
D.
E.
Ciliary ganglion
Pterygopalatine ganglion
Seventh cranial nerve
Superior cervical ganglion
Sympathetic plexus on the internal carotid artery
15. You see a 16 year-old female patient in the emergency department. She was playing the catcher’s
position in a softball game when she was hit in the pterion with a bat; she immediately lost
consciousness. She regained consciousness while en route to the hospital, but is disoriented and
complains of a severe headache of a pounding nature. You order an MRI suspecting damage to
which of the following?
A.
B.
C.
D.
E.
Anterior cerebral artery
Deep auricular artery
Middle cerebral artery
Middle meningeal artery
Superficial temporal artery
16. A 17 year-old football player who has been chewing tobacco almost constantly since he was thirteen
is seen by an oncologist for removal of an unhealed lesion inferiorly near the tip of the tongue. The
oncologist plans to remove the lesion and the first set of lymph nodes to which the lesion will drain.
Which lymph node(s) will be removed?
A.
B.
C.
D.
E.
All superior deep cervical nodes
Inferior deep cervical nodes
Jugulodigastric
Submental
Submandibular
17. During a routine physical, a 35 year-old female complains of pain in the temporal region. The pain is
well localized to the temporomandibular joint and is exacerbated by chewing. She reports no prior
history of joint disease in this region, however, she recalls biting down hard on a fireball about a day
before the pain started. Palpation reveals that the articular disc is moved anteriorly as compared to
the rest of the joint. Which muscle could be the cause of this abnormal joint positioning and therefore
the pain?
A.
B.
C.
D.
E.
Buccinator
Lateral pterygoid
Masseter
Medial pterygoid
Temporalis
18. An adventurous 4 year-old boy has fallen through a glass door at home and was brought to the
emergency department by his father. The only injury is a deep laceration to the scalp (easily hidden
by the hair), running from about the superior temporal line to the sagittal suture; the bleeding is
copious. Which of the following contributes to the excessive bleeding?
A.
B.
C.
D.
E.
Emissary veins communicating with the subaponeurotic layer
Sharpey fibers of the pericranium holding the wound open
The abundant arterial supply to the loose areolar tissue
The abundant arterial supply within the dense connective tissue layer
The muscles of the galea aponeurotica pulling the wound open
19. You have been providing care to a patient with vascular disease for approximately 15 years. During
the past few years you have specifically followed a berry aneurysm, which developed, on the internal
carotid artery within the cavernous sinus. Today the patient presents with a complaint of a
neurological origin. Which of the following symptoms could be caused by the aneurysm you have
been following?
A.
B.
C.
D.
E.
Anesthesia of the skin overlying the mandible on the same side as the aneurysm
Blindness on the affected side due to blockage of the ophthalmic artery
Disturbances to the bilateral temporal visual fields
Paresis of lateral eye movements ipsilateral to the aneurysm
Paresis of superior, inferior and medial eye movements contraleral to the aneurysm
20. You see a patient in the emergency department who has attempted suicide by placing a rifle in his
mouth. When he reached for the trigger he turned his head slightly. The bullet entered his head
lateral to the midline near the posterior extent of the hard palate, traveled superiorly through the skull
(without deflection) and exited inferior to the lateral canthus of the eye (without damaging the
eyeball). The bullet traveling this path could have injured which of the following?
A.
B.
C.
D.
E.
Chorda tympani
Hypoglossal nerve
Infraorbital nerve
Lingual nerve
Sigmoid sinus
21. You suspect that an infant is suffering from a large patent ductus arteriosus. Which of the following
conditions would support your hypothesis?
A.
B.
C.
D.
E.
Decreased flow through the pulmonary valve
Increased flow through the aortic valve
Increased left ventricular filling
Hypertrophy of the left atrium
Right ventricular hypertrophy
22. A 49-year old male smoker presents with the main complaint of coughing and difficulty breathing.
Imaging studies reveal enlarged paratracheal (tracheal) nodes are discovered on the left side. This
finding indicates metastasis arising from which of the following structures?
A.
B.
C.
D.
E.
Inferior lobe of left lung
Inferior lobe of right lung
Middle lobe of right lung
Superior lobe of left lung
Superior lobe of right lung
23. A 14-year-old girl experiences dyspnea due to environmentally induced asthma. After being chased
by a rabid, 6-year-old pit bull terrier, her mother notices that her breathing, although rapid, is not as
labored. This less labored response by the lungs was mediated by neurons with their soma in which
of the following locations?
A.
B.
C.
D.
E.
Brainstem
Dorsal root ganglia
Pulmonary plexus
Superior ganglion of the vagus
Sympathetic chain ganglia (T2-T5)
24. A forty-two-year-old male presents with intermittent numbness of the left arm and edema of the
ankles. His overall health appears to be good, he is normotensive, all pulses symmetrical with the
exception of a diminished left radial pulse, and he is on no medications. Displacement of which of the
following osseous structures may be responsible for his condition?
A.
B.
C.
D.
E.
Clavicle
First rib
Manubrium
Scapula
Second thoracic vertebra
25. Traumatic injury damages nerves as they pass inferiorly from a plexus associated with the hilum of
the lung. This would most likely result in which of the following?
A.
B.
C.
D.
E.
Bronchodilation
Decreased heart rate
Decreased upper GI motility
Increased heart rate
Loss of contractility in the aorta
26. A hepatic tumor within the liver parenchyma obstructs outflow to the inferior vena cava. Which of the
following veins would carry a resultant increase in blood flow?
A.
B.
C.
D.
E.
Ascending lumbar
Common iliac
Left renal
Portal
Right renal
27. A 63 year-old chronic alcoholic is rushed to the ER with severe abdominal pain. Ultrasound reveals a
large cyst in the caudate lobe of the liver that subsequently ruptures. A significant quantity of fluid
becomes localized in the hepatorenal recess. It has most likely gained access to this area by passing
through which of the following?
A.
B.
C.
D.
E.
Epiploic foramen
Left infracolic gutter
Left paracolic gutter
Retroperitoneal space
Right infracolic gutter
28. A man presents with an aneurysm of the superior mesenteric artery close to its origin. Which of the
following organs may become enlarged due to impaired venous return?
A.
B.
C.
D.
E.
Bladder
Gallbladder
Left Kidney
Right Kidney
Spleen
29. During a rugby match, a 42 year-old male player was gang tackled and kneed in the groin. He felt a
dull, constant, achy pain in his lower abdomen accompanied by nausea. The latter is the result of
nerve cell bodies located where?
A.
B.
C.
D.
E.
Brainstem
Dorsal root ganglia T5 -T9
Inferior ganglion of the vagus
Pelvic plexus
Sympathetic chain ganglia L1 - L2
30. A one hundred and four pound 96-year old male, presents in your office for a routine checkup. While
you are conducting your examination, he aspirates a piece of hard candy he is sucking on and begins
to turn blue. You prepare to administer the Heimlich maneuver because you surmise that the candy
has most likely become lodged in the:
A.
B.
C.
D.
E.
Choanae
Epiglottic vallecula
Left main stem bronchus
Piriform recess
Right primary bronchus
31. Ann, a 56-year-old retired medical secretary, has continually gained weight over the past year
despite dieting. During her annual checkup her family doctor observed an obvious size increase in
the patient’s abdomen and palpated the presence of a large abdominal mass. Without any further
testing, the physician ordered a laporotomy for this patient. After the abdominopelvic cavity was
opened, the surgeon saw a mass about the size of a large softball. The mass was biopsied and the
pathologist determined that the patient had a mucinous cystadenocarcinoma, a malignant type of
ovarian tumor. Which of the following groups of lymph nodes would have been infected first by this
tumor?
A.
B.
C.
D.
E.
Common iliac
Deep inguinal
Internal iliac
Lumbar
Sacral
32. Your 51-year-old patient has a history of recurring kidney stones that he generally passes without too
much difficulty or pain. Recently, one of the stones became lodged in the ureter where it courses
through the urinary bladder and he has been experiencing excruciating pain. While some of the pain
is dull, most of the time it is acute. Which of the following represent level(s) of nerve fibers that
conduct the pain from the area of the lodged stone to the spinal cord?
A.
B.
C.
D.
E.
T9
T10
T12
L4
S1
33. Where are the cell bodies of the pain fibers that are registering pain in the above patient located?
A.
B.
C.
D.
E.
Brainstem
Dorsal root ganglia
Hypogastric plexus
Pelvic plexus
Sympathetic chain, sacral ganglia
34. A thrombus becomes lodged at the origin of the internal iliac artery and completely blocks arterial
flow through its branches. Which of the following pairs of arterial anastomoses would effectively help
restore blood to deprived pelvic structures?
A.
B.
C.
D.
E.
Inferior gluteal - superior gluteal
Middle rectal – inferior rectal
Ovarian – uterine
Superior epigastric – inferior epigastric
Superior vesical – inferior vesical
35. Your 49-year-old patient, who has a history of chronic anal fistulae, comes to your office complaining
of a painful swelling in the anal area. Physical examination revealed a hot, red, tender swelling lateral
to the right anal margin, and you correctly diagnose an ischioanal abscess. You elect to drain this
abscess by a surgical incision. Which of the following structures could potentially be injured during
this minor surgery?
A.
B.
C.
D.
E.
Dorsal nerve of the penis
Inferior rectal vessels and nerve
Internal pudendal vessels
Perineal vessels and nerve
Pudendal nerve
36. A 15-year-old male was running across a recently plowed field when he stumbled and over-inverted
his right foot. While examining this patient in the ER you observe that his right ankle is tender and
swollen. Movement of the ankle was restricted, especially when the foot was inverted. Gentle
palpation demonstrated a small tender area inferior and anterior to the lateral malleolus. An X-ray of
the ankle joint was negative. Which of the following structures is most likely injured?
A.
B.
C.
D.
E.
Anterior talofibular ligament
Calcaneofibular ligament
Deltoid ligament
Posterior tibiotalar ligament
Tibionavicular ligament
37. You see a 38-year-old male in the ER who was in a car accident. The man was crossing a busy
street and he stepped in front of an oncoming car. The car bumper hit the lateral side of his left knee
and fractured the neck of the fibula, injuring related structures. Which of the following actions of the
foot would be totally abolished if there were injury to the nerve which courses superficial to the fibula?
A.
B.
C.
D.
E.
Abduction of toes
Adduction of toes
Dorsiflexion
Inversion
Plantar flexion
38. A 72-year-old female suffered a fall while shoveling snow on her sidewalk, which resulted in a
fracture of the neck of the left femur. Several weeks later, avascular necrosis of the head of the femur
occurred. Disruption of which of the following arteries would be responsible for this condition?
A.
B.
C.
D.
E.
Acetabular branch of obturator
First perforating
Medial femoral circumflex
Lateral femoral circumflex
Superior gluteal
39. You see a 37-year-old male in the ER who is walking with the help of crutches. He tells you that he
was playing football with some of his friends and that he was “clipped”(hit from behind and the from
the side simultaneously) as he was running down field on a kickoff. You examine the knee and find it
to be markedly swollen and red. Which of the following structures would most likely be injured?
A.
B.
C.
D.
E.
Anterior cruciate and posterior cruciate
Anterior cruciate, medial collateral, and medial meniscus
Anterior cruciate and lateral collateral
Posterior cruciate, lateral collateral, and lateral meniscus
Posterior cruciate, medial collateral, and medial meniscus
40. As a third-year medical student, your first day at a new clinical rotation is at the local VA hospital. You
observe that an elderly male has an abnormal gait. As the man walks, his pelvis tips abnormally
toward the unsupported side. You identify yourself to this man and inquire how long he has walked in
the described manner. He tells you that he has walked this way for more than 40 years, after he
recovered from poliomyelitis as a young boy. Based on your medical knowledge, which of the
following nerves was affected by the polio?
A.
B.
C.
D.
E.
Femoral
Inferior gluteal
Obturator
Sciatic
Superior gluteal
ANSWER KEY:
1 B
11 A
2 B
12 C
3 E
13 A
4 E
14 D
5 D
15 D
6 C
16 D
7 E
17 B
8 D
18 B
9 C
19 D
10 A
20 C
21 E
22 D
23 E
24 B
25 C
26 D
27 A
28 C
29 C
30 E
31 D
32 D
33 B
34 C
35 B
36 A
37 C
38 C
39 B
40 E