Gross Anatomy Comprehensive Examination

Front 1

A young man is brought to the emergency room after being mugged. He was stabbed in the shoulder after refusing to give his wallet to his assailant. If the stab wound lacerated the posterior humeral circumflex artery passing through the quadrangular space on the shoulder region, which of the following nerves might be injured?

Back 1

Axillary nerve

Front 2

A victim of an automobile accident is unable to abduct her left arm. This indicates damage to which of the following parts of the brachial plexus?

Back 2

Upper trunk and posterior cord

Front 3

A biomedical engineer would like to reconstruct the arm of a boy who underwent amputation to treat a life-threatening infection. In designing the prosthetic arm, the engineer will need to know that which of the following muscles flexes the elbow and is innervated by the radial nerve?

Back 3

Brachioradialis

Front 4

Young Johnny was playing on the playground at school when he fell and struck his arm against the swing set. He ran to the school nurse, complaining of which of the following conditions as a result of injuring the radial nerve in the spiral groove of the humerus?

Back 4

Inability to extend the hand

Front 5

An indoor soccer player runs into another player while running after the ball. She falls to the ground and fractures the medial epicondyle of the humerus. Which of the following symptoms might she present with when seeing a physician in the emergency room?

Back 5

Inability to sweat on the medial part of the hand

Front 6

After winning a boxing match. a 24-yearold man is unable to abduct his fingers. Which of the following nerves is injured?

Back 6

Ulnar nerve

Front 7

A 42-year-old woman presents to an outpatient clinic with a 6-month history of numbness and tingling on the palmar aspect of her lateral three and one-half fingers, loss of pronation, and flattening of the thenar eminence. Injury to which of the following nerves could cause such a condition?

Back 7

Median nerve

Front 8

A ballet dancer falls to the floor and hurts herself during a practice session before opening night. She sustains an injury to the thoracodorsal nerve that would probably affect the strength of which of the following movements?

Back 8

Extension of the arm

Front 9

A 23-year-old man falls from a ladder and injures his arm. On examination, he feels numbness and has no sweating on the lateral side of his forearm, indicating damage to the lateral antebrachial cutaneous nerve. The cell bodies of injured nerve fibers involved in sweating are located in which of the following structures?

Back 9

Sympathetic chain ganglia

Front 10

There are only 30 minutes left before the concert starts. The pianist, who incidentally has a cut over the palmar surface of her wrist, notices that she is unable to pick up a piece of music between her index and middle fingers. Which of the following nerves is most likely damaged?

Back 10

Ulnar nerve

Front 11

A 29-year-old carpenter receives a crush injury to his metacarpophalangeal joint of the fourth digit ring finger) while remodeling his neighbor's porch. Which of the following pairs of nerves innervates the muscle that moves the injured joint?

Back 11

Ulnar and radial nerves

Front 12

A 21-year-old man celebrating his birthday gets a little carried away with his friends and starts a bar fight. He is stabbed Ivith a knife that severs the roots of C5 and C6 of the brachial plexus. Which of the following muscles is likely to be paralyzed?

Back 12

Infraspinatus

Front 13

The secretary of a rather verbose academic physician in internal medicine complains of numbness and tingling in her hands and fingers. She is constantly typing long patient visit dictations and now has carpal tunnel syndrome, which is due to compression of which of the following structures?

Back 13

Median nerve

Front 14

While playing in a Super Bowl game, a 32-year-old professional football player is tackled, and his anterior cruciate ligament is torn. If not injured, the anterior cruciate ligament of the knee joint:

Back 14

Resists posterior displacement of the femur on the tibia

Front 15

A man interviewing for a new administrative position as hospital chief executive officer (CEO) notices difficulty walking after sitting with his leg crossed for 2 hours. He was nervous during the interview but even more so now that he is attempting to stand to follow two board members for a tour of the hospital. Which of the following actions is most seriously affected by compression and temporary paralysis of the deep peroneal nerve?

Back 15

Dorsiflexion of the foot

Front 16

Deep venous thrombosis is a common complication from sitting in one position for a prolonged period of time, such as during a long car trip or a long plane flight. The first vascular channels likely to be obstructed or occluded by
an embolus from the deep veins of a lower limb are the:

Back 16

Branches of the pulmonary arteries

Front 17

During recruitment by the local representative for the Marines, a young college student presents with the condition known as flat foot. His foot is displaced laterally and everted, and the head of the talus is no longer supported. Which of the following ligaments probably is stretched?

Back 17

Plantar calcaneonavivular (spring)

Front 18

During a sports medicine physical by a local family physician, a young woman is tested for stability of her joints before try-outs for the high school team. Which of the following ligaments is important in preventing forward displacement of the femur on the tibia when the weight- bearing knee is flexed?

Back 18

Posterior cruciate ligament

Front 19

A 21-year-old man falls from the attic and is brought to the emergency room. Examination and radiogram reveal that the lateral longitudinal arch of his foot is flattened. Which of the following bones is displaced?

Back 19

Cuboid

Front 20

A 72-year-old woman with Parkinson's disease fell down in the bathtub at her home and suffered a dislocation of the hip joint that may result in vascular necrosis of the femoral head and neck because of injuries to the arteries. Which of the following arteries might remain intact?

Back 20

Deep iliac circumflex artery

Front 21

A 78-year-old woman receives knee surgery because her lateral meniscus is torn. Before injury, the normal lateral meniscus of the knee joint:

Back 21

Lies outside the synovial cavity

Front 22

A 17-year-old boy is involved in a group fight, and a stab wound lacerates a ventral root of his thoracic spinal nerve. Cell bodies of the injured nerve fibers are located in which of the following nervous structures?

Back 22

Anterior horn and lateral horn of spinal cord

Front 23

A race car driver is brought to the city trauma center after a high-speed crash in which his car spun out of control and struck the concrete embankment. He has blunt trauma to his chest and undergoes extensive vascular studies to determine which blood vessels are still intact. The interventional radiologist recalls that one of the following veins drains directly into the superior vena cava. Which vein would this be?

Back 23

Azygos vein

Front 24

A 58-year-old stockbroker is brought to the cardiac catheterization laboratory emergently after evaluation in the emergency room has determined that he is suffering from an acute myocardial infarction. During the catheterization, he is found to have inadequate blood flow in the artery that runs aside the great cardiac vein in the anterior interventricular sulcus of the heart. This is most likely an acute occlusion of the:

Back 24

Left coronary artery

Front 25

A retired teacher suffers from a massive heart attack while playing golf and dies in the intensive care unit. Autopsy reveals the cause of death as severely diminished blood flow in the coronary arteries. This most likely resulted from embolization of an atherosclerotic plaque at the origin of which of the following vascular structures?

Back 25

Ascending aorta

Front 26

A 21-year-old woman comes to the emergency department with acute chest pain and shortness of breath. Her chest x-ray film shows opacification of one of her lungs. She undergoes thoracentesis, which reveals that she has a chylothorax resulting from rupture of the thoracic duct. Lymphatic drainage remains normal in which of the following areas?

Back 26

Right thorax

Front 27

An elderly man is choking on his food at a restaurant and attempts by other patrons to dislodge the food bolus using the Heimlich procedure have failed. A retired anesthesiologist rushes to his table and prepares for emergent tracheostomy. She locates the manubrium of the sternum and recalls that it is free from articulation with which of the following structures?

Back 27

Third rib

Front 28

A stab wound penetrates the posterior thoracic wall near vertebra of a 24-year-old man. Examination at the emergency room indicates a lesion of gray rami communicantes. Which of the following nerve fibers would most likely be damaged?

Back 28

Postganglionic sympathetic fibers

Front 29

A 31-year-old NHL hockey player complains of numbness in the area of his umbilicus after the national championship game. Which of the following structures that carries general somatic afferent (GSA) fibers was injured during the hockey game?

Back 29

Dorsal root

Front 30

A 75-year-old veteran suffers a heart attack and is found in his home unconscious. He is in ventricular tachycardia and is shocked into normal sinus rhythm. He undergoes emergent catheterization and is found to have a thrombosis in the coronary sinus. Which of the following cardiac veins might remain normal in diameter by catheterization study by the cardiologist?

Back 30

Anterior cardiac vein

Front 31

A 35-year-old man is suffering from an infected mediastinum (mediastinitis) after neck and chest injuries resulting from a head-on automobile collision. He has been intubated since the accident and on broad-spectrum intravenous antibiotics since admission; however, the infection continues to progress throughout the mediastinum. Which of the following structures is free from infection?

Back 31

Lungs

Front 32

A 42-year-old man suffers from a rare tongue disease and comes to the emergency room. On examination, he is unable to protrude his tongue. Which of the following muscles is paralyzed?

Back 32

Genioglossus

Front 33

A new biotech company is interested in developing a new mechanical heart with a superficial implantable and rechargeable battery for easy access. During the design phase, the physician hired from the local academic hospital is asked about which structure carries or comes in contact with oxygenated blood. Which of the following answers is correct?

Back 33

Pulmonary vein

Front 34

A 62-year-old man is diagnosed with a Pancoast's tumor that invades the inferior trunk of the brachial plexus. Which of the following muscle actions most likely resulted from injury to the brachial plexus?

Back 34

Abduction of the index finger

Front 35

A 67-year-old woman complains of increasing urinary frequency and a heaviness in her pelvic area. On examination, her uterine cervix is visible at the vaginal opening. This symptom is caused by which of the following conditions?

Back 35

Relaxation of the cardinal ligament

Front 36

Weight lifters in competition are often concerned about muscle tone and complications with hernias. In particular, the most common hernia in this case is an indirect inguinal hernia, which appears:

Back 36

Lateral to the inferior epigastric artery

Front 37

A 32-year-old man is involved in a car accident and receives a crushed internal injury in his abdomen. Examination reveals a lesion of parasympathetic fibers in the vagus nerve, which interferes with glandular secretory or smooth muscle functions in which of the following organs?

Back 37

Transverse colon

Front 38

Pancreatic cancer has one of the highest mortality rates of all cancers because of the lack of symptoms until an advanced stage of
disease. The one exception is the cancer that is slow growing and located in the head of the pancreas. This may present in an early stage by causing compression of which of the following structures?

Back 38

Bile duct

Front 39

An elderly man with a known large abdominal aortic aneurysm presents to the - emergency room with acute severe and diffuse pain in his abdomen. The physician performing the evaluation considers mesenteric ischemia, a life-threatening disease, as a possible etiology. Which of the following organs may be spared from ischemia in the presence of an occlusive lesion in the celiac trunk?

Back 39

Pancreas

Front 40

A young woman with cryptogenic cirrhosis presents to the university hospital for an evaluation as a possible candidate for liver transplant. She has late-stage cirrhosis, and her liver-spleen scan shows a high degree of portal hypertension. The portal venous system includes which of the following veins?

Back 40

Superior rectal vein

Front 41

Hirschsprung's disease is diagnosed in the sigmoid colon of a 7-year-old girl. The diseased part of the lower colon:

Back 41

Drains its venous blood into the portal venous system

Front 42

A 29-year-old farmer falls on tractor blades and injures his groin. Several days later, he comes to the emergency room, and examination by a physician reveals that the urogenital diaphragm and bulbourethral glands are infected. The infected deep perineal space:

Back 42

Contains a segment of the dorsal nerve of the penis

Front 43

The weather has been awful in the last few days, and the number of trauma patients in the emergency room has risen dramatically because of the increased number of motor vehicle accidents. During a quick orientation by the attending physician, the rotating residents are told that many of the patients suffer from blunt trauma to the pelvis resulting from crush injuries from the steering column. In males, if the urethra is torn distal to the urogenital diaphragm, urine might accumulate in the:

Back 43

Superficial perineal space

Front 44

A 59-year-old woman has a large pelvic tumor that compresses the inferior hypogastric (pelvic) plexus. Parasympathetic nerve fibers in this plexus come from which of the following nerves?

Back 44

Pelvic splanchnic nerves

Front 45

Because of a lesion, the parasympathetic nerve fibers are unable to induce a contraction of the detrusor muscle and relaxation of the internal sphincter. The injured parasympathetic fibers that supply the urinary bladder are derived from which of following nerves?

Back 45

Pelvic splanchnic nerve

Front 46

At a local hospital tumor board, a gynecologic oncologist discusses the next case for the multidisciplinary team. He explains the ratio-
nale for using chemotherapy and radiation after surgical resection because carcinoma of the uterus can spread directly to the labia majus through lymphatics that follow the:

Back 46

Round ligament of the uterus

Front 47

A young couple is seeing a sex therapist for the first time to determine the cause of some of their recent difficulties. The husband tells the therapist that he no longer has sensation in his scrotum after a race car accident. Which of the following nerves carries undamaged sensory nerve fibers?

Back 47

Iliohypogastric nerve

Front 48

A patient has a damaged pelvic outlet as the result of an automobile accident. Following this accident, which of the following structures is still intact?

Back 48

Pubic crest

Front 49

A forensic pathologist is examining the pelvic bone of a murder victim to identify the sex of the victim. Which of the following characteristics is that of a female pelvis?

Back 49

Oval-shaped pelvic inlet

Front 50

A 26-year-old woman experiences severe back pain from an automobile accident. A computed tomography (,CT) scan reveals that the L5 vertebral foramen is completely obliterated by a collapsed L5 laminae and pedicles. In this injury, which of the following structures is crushed?

Back 50

Cauda equina

Front 51

A performer at the traveling circus for the state fair has injured her shoulder during a routine. When she fell off the trapeze, she struck the ground on her back, and most of the blunt force was directed toward her shoulders. A crush injury of the suboccipital nerve would result in paralysis of which of the following muscles?

Back 51

Rectus capitis posterior major

Front 52

A neonate is brought to the pediatrician with headaches, fevers, and change in mental status, mostly manifested as lethargy and lack of appetite. The baby is admitted emergentiv to rule out meningitis and is to undergo a diagnostic lumbar puncture. When withdrawing cerebrospinal fluid (CSF), the needle may penetrate which of the following pairs of structures?

Back 52

Dura mater and arachnoid mater

Front 53

Mrs. Jones was riding in the front seat of her son's van when the vehicle abruptly stopped. Unfortunately, she was not wearing her seatbelt and was thrown forward. As a result of the accident, the transverse processes of her cervical vertebrae were crushed against the dashboard of the van. Which of the following muscles might be paralyzed?

Back 53

Levator scapulae

Front 54

A middle-aged woman is receiving a shiatsu massage when her therapist notices that the client has numbness of her back. A lack of sensation overlying the skin over the anterior triangle of the neck may be due to injury to which of the following nerves?

Back 54

Transverse cervical nerve

Front 55

A young man presents to your clinic with a 3-month history of an enlarging mass in his right neck. He undergoes a computed tomography (CT) scan that reveals a fluid-filled mass where the common carotid artery bifurcates. Which of the following is another structure that would be located at this level?

Back 55

Superior border of the thyroid cartilage

Front 56

A kick fighter is brought into the locker room after being knocked out by his opponent. He has suffered severe trauma to the articular disk and capsule of the temporomandibular joint. This could result in paralysis of which of the following muscles?

Back 56

Lateral pterygoid

Front 57

A 25-year-old woman is suffering from facial paralysis and exhibits ptosis (drooping of the upper eyelid). Injury to which of the following nerves would result in ptosis?

Back 57

Oculomotor nerve

Front 58

A 67-year-old man is known to have infection in the superior petrosal sinus. The infected sinus lies in the margin of which of the following structures?

Back 58

Tentorium cerebelli

Front 59

A 59-year-old man has pus in the loose connective tissue layer of the scalp, and consequently, his superior sagittal sinus is infected. The arachnoid granulations in the infected sinus:

Back 59

Absorb cerebrospinal fluid (CSF) into the dural venous sinuses

Front 60

While speaking at a charity program, an elderly woman suddenly collapses to the ground. She is found to have a massive stroke, but it is unclear where the vascular lesion is located. She undergoes a cerebral arteriogram. Normally, the great cerebral vein of Galen drains directly into which of the following sinuses?

Back 60

Straight sinus

Front 61

While resecting a tumor in the palate, a surgical intern removes the mass but finds that it is deeply invasive into the tendon that loops around the pterygoid hamulus. Which of the following muscles would most likely be paralyzed?

Back 61

Tensor veli palatini

Front 62

During a domestic incident, a 28-year-old woman receives a vertical stab wound that lacerates the pterygomandibular raphe. As a result, which of the following muscles would be paralyzed?

Back 62

Superior pharyngeal constrictor and buccinator muscles

Front 63

A 31-year-old football player with a head injury is brought to a local emergency department. Physical examination, radiogram. and a magnetic resonance imaging (MRI) scan indicate a lesion of the trigeminal nerve. Which of the following muscles is most likely paralyzed?

Back 63

Tensor veli palatini

Front 64

The muscle that indents the submandibular gland and divides it into superficial and
deep parts is paralyzed because of compression by a large salivary glandular tumor. Which of the following muscles is involved?

Back 64

Mylohyoid

Front 65

A young homeless child presents to the emergency room with high fever and low blood pressure. He had strep throat 2 weeks ago when seen in the free clinic; however, his parents could not afford antibiotic medication. and he did not take any. He now has an abscess in the auditory tube that is blocking communication between the nasopharynx and which of the following structures?

Back 65

Middle ear

Front 66

A man with a neuromuscular autoimmune disease has another attack at home. His wife calls the doctor's office because he is unable to speak. Once at the office, he is unable to open his jaw because of paralysis of which of the following muscles?

Back 66

Lateral pterygoid

Front 67

A 29-year-old baseball player whose head is hit by a high-speed baseball is brought to an emergency room. Physical examination and radiogram reveal fracture of the temporal bone and damage to the lesser petrosal nerve. Which of the following conditions could occur as a result of injury to the lesser petrosal nerve?

Back 67

Lack of parotid gland secretion

Front 68

A 26-year-old woman with the flu comes to an outpatient clinic. On examination, a physician diagnoses her with sinus and palate infection, and her uvula deviates to the left side on phonation. Which of the following nerves is injured?

Back 68

Right vagus nerve

Front 69

During a palatine tonsillectomy, a surgeon must ligate arteries to avoid bleeding within the surgical field. Which of the following arteries can be spared?

Back 69

Superior thyroid artery

Front 70

A young child is evaluated by his pediatrician for chronic nosebleeds. He is referred to an allergist when it is determined that his nasal cavity is chronically dry because of a lack of glandular secretions. A possible etiolou may be a lesion of which of the following structures?

Back 70

Greater petrosal nerve

Front 71

+A 12-year-old girl suffers from a type of neural tube defect called tethered cord syndrome, a congenital anomaly that results from defective closure of the neural tube. This syndrome is characterized by an abnormally low conus tnedullaris, which is tethered by a short, thickened filutn terminale, leading to progressive neurologic defects in the legs and feet.+
Which of the following defects is commonly associated with the tethered cord syndrome?

Back 71

Meningomyelocele

Front 72

+A 12-year-old girl suffers from a type of neural tube defect called tethered cord syndrome, a congenital anomaly that results from defective closure of the neural tube. This syndrome is characterized by an abnormally low conus tnedullaris, which is tethered by a short, thickened filutn terminale, leading to progressive neurologic defects in the legs and feet.+
This girl has strong muscle function of the flexors of the thigh, but she has weakness of the extensors (hamstrings). A lesion has occurred at which of the following spinal cord levels?

Back 72

L5

Front 73

A 36-year-old plumber slips and breaks a porcelain sink, cutting an anterior aspect of his wrist deeply on a sharp edge. On arrival to the emergency department, he can adduct his thumb but not oppose it. Which of the following structures has been severed?

Back 73

Median nerve

Front 74

A 21-year-old soccer player is tackled via a high-impact sweeping injury about the right knee, causing a posterior knee dislocation. Soon after, he is unable to plantar flex his right ankle or flex his toes. He also experiences loss of sensation on the sole of his right foot. Which of the following nerves is most likely injured?

Back 74

Tibial nerve

Front 75

A 56-year-old man with a one pack/day history of cigarette smoking is found to have a malignant squamous cell carcinoma located in the superior sulcus of Pancoast (superior apex of the lung). Shortly after the diagnosis is known, the patient develops symptoms that consist of shoulder pain along with ptosis, miosis, enophthalmos, and anhidrosis. Which of the following nerves is most likely compressed by the tumor mass?

Back 75

Cervical sympathetic trunk

Front 76

A 57-year-old woman presents with increasing numbness of the fourth and fifth digits on her right hand. On examination, it is noticed that she has a wasted hypothenar eminence, inability to abduct the thumb, and a characteristic claw hand. Which of the following nerves has most likely been injured?

Back 76

Ulnar nerve

Front 77

A 47-year-old woman has had a lumpectomy and axillary dissection to check for metastasis. She has come in for her follow-up appointment, and her physician notices on her physical examination that the medial part of her scapula protrudes from her back and that she is not able to raise her arm above the horizontal level. Which of the following nerves has been damaged during her surgery?

Back 77

Long thoracic nerve

Front 78

A 31-year-old carpenter was wounded in his left arm by a utility knife and is brought to a local emergency room. He complains of numbness on the medial side of his arm. Which of the following nerves is most likely injured?

Back 78

Medial brachial cutaneous nerve

Front 79

A 54-year-old high school teacher has been diagnosed with coronary artery disease and is going to undergo coronary bypass surgery. During the surgery, the thoracic surgeon decides to use the internal thoracic artery for one of the bypasses. Which of the following arteries gives rise to the internal thoracic artery?

Back 79

Subclavian artery

Front 80

A 34-year-old singer has been diagnosed with thyroid cancer and consequently has a thyroidectomy. He has been hoarse ever since the surgery 8 weeks ago. It has been suspected that a nerve was injured during the operation. Which of the following nerves is most likely damaged?

Back 80

Recurrent laryngeal nerve