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DR. HANKIN
PRACTICE EXAM
12/15/09
1. 52 Y O suffered problems in her right arm several days after strenuous
field exercises. Physical ex revealed wrist drop and weakness of grasp
but normal elbow extension. There is no loss of sensation in affected
limb. Which nerve is affected?
 Ulnar
a. If affected, abduction and adduction of fingers can be affected
(due to interosseous muscles)
b. ONLY muscle innervated by ulnar nerve is ADDUCTOR
pollicis
 Anterior interosseous
a. Deep branch of median nerve
i. Innervates deep muscles (pronator quadratus)
 Posterior interosseous
a. Branch of radial nerve, which goes through the lateral side of
the cubital fossa
b. In the arm is lateral, so affects brachialis and brachioradialis
c. In the forearm has two divisions:
i. Superficial, which goes down to hand (cutaneous)
ii. Deep, which dives down through the supinator muscle
and becomes the posterior interosseous (termination of
deep branch of the radial nerve)
d. Tiny
e. IDENTIFY NERVE IF ON QUESTION!!!!
 Median
a.
 Superficial radial
a. DOES NOT have motor innervation, ONLY SENSORY
b. Is ONLY CUTANEOUS
c. IDENTIFY NERVE
 EXTENSORS ARE MOSTLY RADIAL NERVE
2. A 22 y o woman has radial pulse taken to determine heart rate. Radial
pulse is felt lateral to which tendon?
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 Palmaris longus
o Not always present!!
 Flexor pollicis longus
o Is TOO DEEP
 Flexor digitorum profundus
 Flexor carpi radialis
o Prominent
o Immediately lateral to radial pulse
 Flexor digitorum superficialis
FAIR GAME FOR WRITTEN EXAM
3. Which ligament(s) contribute(s) to the anterior wall of the vertebral
canal?
a. Ligamenta flava
b. Anterior longitudinal
c. Posterior longitudinal
d. All of the above
e. None of the above
SLOW DOWN, AND UNDERLINE KEY WORDS (ANTERIOR,
VERTEBRAL CANAL, etc.) !!!
4. Man with wound to palm cannot touch pads of fingers with thumb, can
grip a sheet of paper between all fingers, and has no loss of sensation
from skin of hand. Which nerve has been injured?
a. Deep branch of ulnar
i. Ulnar nerve is FINE, as fingers can be adducted
b. Anterior interosseous
c. Median (in hand)
i. After it gives off anterior interosseous, continues into
forearm
ii. At forearm, is deep to flexor digitorum superficialis and
above flexor digitorum profundus
iii. In the wrist, is found in the carpal tendon
iv. As it leaves the carpal tunnel, it branches into the recurrent
branch of the median nerve and innervates the thenar
muscles
d. Recurrent branch of median
i. Innervates abductor pollicis brevis and opponens pollicis
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e. Deep branch of radial
i. After radial nerve gives off superficial and deep branches,
the branches are ONLY SENSORY
ii. FLEXOR POLLICIS BREVIS IS INNERVATED BY
MEDIAN NERVE
5. 55 Y O has difficulty elevating right arm above shoulder level. Physical
exam shows winged scapula (medial or inferior border sticks out when
pushing). Right scapula protrudes far more when patient pushes against
resistance. Which neural structure was most likely affected?
a. Posterior cord of the brachial plexus
b. Long thoracic nerve
i. This is WINGED SCAPULA
ii. Supplies SERRATUS ANTERIOR
iii. Serratus anterior ALSO ROTATES the scapula, which
the patient cannot do
1. Trapezius also rotates the shoulder and elevates
the shoulder (attached to scapula)
c. Upper trunk of the brachial plexus
i. Composed of C5 and C6, which is also in long thoracic
nerve
ii. Long thoracic nerve comes off FROM ROOTS
iii. Suprascapular nerve also arises from upper trunk, so
supraspinatus and infraspinatus would also be affected, so
patient would not be able to initiate arm elevation
d. Site of origin of the middle and lower subscapular nerves
e. Spinal nerve roots C7, C8, and T1
6. Quarterback’s arm is forced backward, resulting in shoulder dislocation.
Which structure does NOT CONTRIBUTE to stability of glenohumeral
joint.
a. Inferior glenohumeral ligament
i. Is a part of the fibrous capsule (thickening of anterior
humeral joint)
ii. Contributes to stability
b. Coraco-acromial ligament
i. Part of the coracoacromial arch
ii. Sits like a cap above humerus, preventing superior
dislocation
iii. Contributes to stability
c. Coracohumeral ligament
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i. In general vicinity of biceps brachii (long head originates
from supraglenoid tubercle)
d. Supraspinatus muscle
i. Sits above joint capsule
e. Coracoclavicular ligament
i. Medial to joint capsule, so does NOT contribute
7. After a forceps delivery, baby presents with left upper limb adducted,
internally rotated, and flexed at wrist. Which part of brachial plexus was
affected? Hint: KNOW ERBS’ PALSY
a. Lateral cord
b. Medial cord
c. Roots of lower trunk
d. Roots of middle trunk
e. Roots of upper trunk
i. Roots of C5 and C6 contused, stretched, evulsed, etc.
ii. If abduction is affected, nerve severed before
supraspinatus leaves
iii. Initator abductor muscles (especially supraspinatus,
innervated by suprascapular nerve) is affected, since
ADDUCTOR muscles are working
1. Deltoid affected (innervated by axillary nerve)
2. Wrist FLEXORS (FCU, FDS, FDP, FPL), are
AFFECTED BECAUSE RADIAL NERVE IS
AFFECTED (EXTENSORS ARE KNOCKED
OUT)
8. 56 year old woman’s vascular bundle along medial scapula is damaged.
Which artery will most likely compensate for blood supply lost during
this procedure?
a. Dorsal scapular (IS THE VASCULAR BUNDLE AFFECTED in
the first place)
i. Along with circumflex scapular, anastomosis)
ii. Vein (very superior in scapula, artery, nerve (deep) –
innervates rhomboids and levator scapulae
iii. HAVE TO LOOK DEEP TO RHOMBOIDS, so not
typically seen
iv. RUN ALONG MEDIAL BORDER OF SCAPULAR
v. Contribute to collateral circulation around scapula
b. Suprascapular
i. (ALONG WITH CIRCUMFLEX SCAPULAR ON
LATERAL BORDER OF SCAPULA, ANASTOMOSIS)
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ii. On superior border of scapula
c. Posterior circumflex humeral
d. Lateral thoracic
e. Thoracodorsal
9. 17 Y O male has weak elbow flexion and supination of left forearm after
sustaining knife wound. Nerve had been severed, also. Which condition
will also be seen during exam?
a. Inability to adduct and abduct fingers
b. Inability to flex fingers
c. Inability to flex thumb
d. Sensory loss over lateral forearm
i. Musculocataneous nerve damage
ii. Stab wound in anterior region of arm
iii. Biceps brachii is the more powerful of the supinators
AND is a flexor
iv. Lateral cutaneous nerve is terminator of
musculoctaneous nerve
e. Sensory loss over medial forearm
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DR. BAPTISTA
PRACTICE EXAM
12/14/09
1. 35 year old complains of dyspnea, dysphagia. Which mediastinum is this
tumor located?
a. Superior
i. Base of SVC goes to right brachiocephalic vein 
superior and middle mediastinum
b. Anterior
c. Middle
i. Base of SVC goes to right brachiocephalic vein 
superior and middle mediastinum
d. Posterior
e. 1 and 2
f. 1 and 3
i. Remember CONCEPT of mediastinum and how it
divides within the sternal angle
ii. BASE OF ARTERIES AND VEINS are part of the
middle mediastinum (heart, pericardium, and stem of
great vessels)
g. 2 and 4
h. All
Azygos vein is in posterior mediastinum, BUT arch of azygos vein is in
superior mediastinum
2. 72 Y O male has recurrent unilateral TIA (upper extremity weakness and
numbness) and corresponding side contralateral bruit). The carotid
arteries are formed by:
a. Aortic arch 1
i. Maxillary artery
b. Aortic arch 2
i. Hyoid and stapedial arteries
c. Aortic arch 3
i. Gives rise to common and internal carotid artery
d. Aortic arch 4
i. Arch of aorta
e. Aortic arch 5
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f. Aortic arch 6
i. Ductus arteriosus
ii. Pulmonary arteries
Cardinal
Most important
Forms ALL THE VEINS, IVC (TINY PORTION, IN THORAX),
AND AZYGOS VEIN
Umbilical
Transitory, disappears later
Right side goes away
Left side helps form ductus venosus, which closes when baby is born
to form ligamentum venosum (along with ductus arteriosus and
vitelline vein, close when baby is born)
Vitelline/omphalomesenteric
Gives rise to GUT and IVC (MOSTLY, IN ABDOMEN)
Portal vein
Nutritional veins
3. 32 Y O complains of palpitations, occasional SOB not associated with
activity. Absence of P wave. What is affected?
a. Atria
b. Ventricle
c. AV node
d. HIS bundle
e. Purkinje fibers
f. SA node
g. Right bundle branch
If AV node problem, longer PR segment
Referred pain (sensory T4, 5, 6 innervates heart and will send signals to the
brain, and brain decides where pain comes from; ascending of T, 4, 5, 6
causes arm pain)
Dominance
Atria
Blood supply of SA node
Right/left coronary artery 85%/15%
Dominance is independent of PRESENCE
55% comes from right, 45% comes from left independent of
dominance
AV Node
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Supplied by dominant artery
SA Node
Supplied by BOTH arteries
Septal arteries get supply from LAD and posterior interventricular
branch of LAD
4. 34 Y O suffers penetrating trauma with cardiac injury. Cardiac
tamponade. Which layer of pericardium will be penetrated first by an
incision?
a. Prietal serous
b. Parietal fibrous
c. Fibrous
d. Serous fibrous
e. Serous visceral
f. Epicardium
Two types of pericardium present: FIBROUS and SEROUS
Fibrous is on outside of pericardium
Contains fat
Serous divides into two:
Parietal
Cannot be separated from fibrous pericardium
Shiny
Visceral serous pericardium/”epicardium”
Congenital heart lecture
Transposition of great arteries
Aorta attached to right ventricle and pulmonary trunk
attaches to left; both continue doing what they do normally
Problem: Blood gets from right ventricle to aorta
to circulation into right atrium (HAS NO OXYGEN);
blood from left ventricle to pulmonary trunk into
LUNGS (HAS OXYGEN ALREADY)
Problem from LEFT TO RIGHT ventricles due to
LUNGS not being able to handle the large amount of
blood that is brought in (PULMONARY
HYPERTENSION)
Tetralogy of Fallot
Aorta gets out of place, cushions of valves (mesenchyme
cells that fill in remainder of heart; valve cushions do not form
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because septum membranaceum and septum primum can be
missing) do not form properly
ASD, VSD, PDA (GOOD)
PDA (bad by itself)
Development of heart
Septum primum and septum SECUNDUM
Coarctation of the aorta (with/without PDA and pre/postductal)
ASD
Hypertrophy of right ventricle
Truncus arteriosus
Defect of Neural crest cells not forming septum
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DR. CHIAIA
PRACTICE EXAM
GO OVER THIS************
1. Entire structure in red box, round surrounded by tissue
 Bronchus
 Trachea (my guess)
 Arteriole
 Mulscular artery
 Bronchiole
o No cartilage
o No cartilaginous cap
2. Identify vessel within red box
 Muscular artery
 Capillary
 Arteriole
o Muscular layer
o Less than 5 layers of smooth muscles
 Venule
 Bronchiole
3. Identify bracketed layer. Be specific.
 Thick skin
 Dermis
 Reticular layer
o Papillary layer above
 Papillary layer
 Hypodermis
5. Identify indicated cells (brown). Be specific
a. Melanocytes
b. Keratinocytes
c. Langerhans’ Cells
d. Merkel Cells
e. Clara cells
6. What sensory modality does indicated structure respond to?
a. Light touch (Meissner’s corpuscles)
b. Pain
c. Temperature
d. Moisture
e. Deep touch (Pucinian’s corpuscles)
7. Identify structures indicated by arrows. Be specific.
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a.
b.
c.
d.
Vascular plexus of olfactory epithelium
Olfactory acini
Lamina propria
Bowman’s Glands
i. Folds and duct can be seen
ii. Based on position and shape (rounder)
e. Olfactory epithelium
8. Basic tissue type of indicated cell is. BE CAREFUL!:
a. Simple sqamous epithelium (MORE SPECIFIC)
b. Cardiac muscle
c. Endothelium
i. Lining an internal space, but is epithelium REGARDLESS
d. Smooth Muscle
e. Epithelium (BASIC)
i. Lines surface
9. Features shown in electron micrograph are diagnostic for which cell.
a. Basophil
b. Neutrophil
c. Eosinophil (*****)
i. Dumb-belled
ii. Granulated
d. Reticulocyte
10.Identify the structure indicated by the black arrow. Be Specific.
a. Tinica adventitia
b. Vaso vasorum
c. Tunica media
d. Elastic lamellae
e. Tunica
11.Identify bracketed layer
a. Thin skin
b. Tunica granulosum
c. Stratum epineurium
d. Stratum hallucinum
e. Stratum corneum
i. Outermost layer
ii. Slightly keratinized
12.Identify structure indicated by the arrows.
a. Tracheal cartilage ring
b. Lamina propria
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c. Trachealis muscle
i. Connects cartilage rings
d. Hyaline muscle
e. Elastic lamellae
13.What could account for an increase in the indicated cell type?
a. Low oxygen tension
b. Climing Mount Everest
c. Fall into a crevasse and get injured
i. Neutrophils increase in response to injury
d. All of the above
14.Identify structure enclosed in brackets
a. Alveoli
b. Lymph nodes
c. Respiratory bronchiole
i. Has additional connective tissue associated with it
d. Alveolar sac
i. Blind-ended alveolar duct
e. Alveolar duct
i. Going into alveolar sac
ii. Has exclusively pneumocyte tissue, thinner
15.Cells in the indicated area are killed by the AIDS virus
a. True
a. False
16.What happened here? (tricky) **********
a. Antigen presentation
b. Red blood cell formation
c. Red blood cell destruction
d. Plasma cell differentiation
i. White pulp of seen
ii. Indicates B-cell proliferation
25 micrographs on practical