LECOM Post-Bacc Spring Exam 3 MCQ

A occipital triangle (contains CN XI/accessory nerve; only innervation to trapezius impacted --> SCM innervation intact)

A 12 year old is hit with a folding chair while imitating a pro-wresting match with his friend. Afterwards, he has trouble lifting his arm above his head. Rotation and flexion of his neck is normal. Which triangle contains the portion of the nerve that has likely been damaged? A. occipital triangle B. submental triangle C. muscular triangle D. supraclavicular triangle E. carotid triangle F. submandibular/digastric triangle

E internal intercostal muscle (intercostal nerve bundle located between internal and innermost intercostal muscle; place needle just under rib, proximal to desired location)

A 15 year old patient suffers from several broken ribs after being kicked in the chest by a pony. When administering an intercostal nerve block, what is the last layer the needle pierces? A. endothoracic fascia B. external intercostal muscle C. innermost intercostal muscle D. parietal pleura E. internal intercostal muscle F. visceral pleura

C internal laryngeal nerve (located just below the mucosa of the piriform recess; innervates the larynx structures above the vocal folds)

A 16 year old is eating Flamin' Hot Cheetos when one accidentally gets lodged in her throat. At the hospital, the physician sees that the Cheeto has become lodged in her piriform recess. What nerve must the physician be careful not to damage when removing the cheese-flavored puffed cornmeal snack from her throat? A. recurrent laryngeal nerve B. glossopharyngeal nerve C. internal laryngeal nerve D. hypoglossal nerve E. external laryngeal nerve F. facial nerve G. inferior larygeal nerve H. trigeminal nerve

E spleen (left rib fractures risk injury to spleen; right rib fractures risk injury to liver)

A 22 year old is hit by a public bus while crossing the street. While her lawsuit against the city paid off her student debt, she also suffered two broken ribs from the incident. Based on her X-ray, which of the following organs are at risk for further injury? A. liver B. stomach C. heart D. trachea E. spleen F. small intestine

D rupture of visceral pleura and formation of a one-way valve of air into the pleural cavity (tension pneumothorax; air is trapped under positive pressure and displaces the trachea and mediastinum away from affected lung --> compresses vena cava --> diminished atrial filling --> reduced cardiac output --> hypotension)

A 23 year old is stabbed in the chest with a Bic pen during an argument in a bar. Soon afterwards, he experiences sudden chest pain, rapid breathing, tachycardia, and hypotension. He's rushed to the emergency room where they produce the attached X-ray. Which of the following best describes his diagnosis? A. injury to the parietal pleura, permitting air to enter the pleural cavity from outside during inspiration B. injury to thoracic duct allow lymph to enter pleural cavity C. blockage of pulmonary artery branch with a blood clot D. rupture of visceral pleura and formation of a one-way valve of air into the pleural cavity E. inflammation of the pleura F. paralysis of diaphragm

B, D, and H aortic valve, ligamentum arteriosum, and aortic hiatus (points where aorta is fixed most susceptible to injury from deceleration trauma; the majority of non-penetrating aortic injuries occur at the aortic isthmus and result in mediastinal hematoma)

A 26 year old is driving down Peach Street when Jeep suddenly pulls in front of her, resulting in a collision. Which of the following are most susceptible to injury from this deceleration trauma? Choose all that apply. A. sternal angle B. aortic valve C. central tendon of diaphragm D. ligamentum arteriosum E. descending aorta F. ductus arteriosus G. recurrent laryngeal nerve H. aortic hiatus I. phrenic nerve J. pulmonary trunk

D pleural effusion of costodiaphragmatic recess (drain with thoracocentesis at the 8th or 9th intercostal space near the midaxillary line OR chest tube at 4th or 5th intercostal space near the midaxillary line; parietal pleura last layer pierced in thoracocentesis)

A 27 year old patient presents with chest pain, dry cough, and difficulty breathing when lying down. Using the patent's attached x-ray, which of the following is the most likely diagnosis? A. diaphragm paralysis B. Horner's Syndrome C. tension pneumothorax D. pleural effusion of costodiaphragmatic recess E. open pneumothorax F. tumor in right lung G. pleural effusion of costomediastinal recess H. atelectasis

C T4 (T4 --> nipples; T6 --> xiphoid process; T9 --> bottom of costal margine; T10 --> umbilicus)

A 35 year old man experiences pain and tingling on his chest. Several days later, a red, painful rash breaks out over the affected area and he is diagnosed with a herpes zoster infection. Based on the location of his rash, the posterior root of which vertebral level has most likely been infected? A. C7 B. T3 C. T4 D. T6 E. T7 F. T9 G. T10

E anterior scalene, middle scalene, rib 1 (contains the subclavian artery and the brachial plexus --> thoracic outlet syndrome)

A 35 year old patient presents with weakened grip, cold fingers, and pain in her shoulders and neck. Her physician suspects that the patient's lateral neck muscles have become spastic or hypertrophic, impinging the contents of her scalene triangle. What structures comprise the borders of this triangle? A. anterior scalene, middle scalene, posterior scalene B. anterior scalene, posterior scalene, rib 1 C. posterior scalene, middle scalene, manubrium D. middle scalene, clavicle, posterior scalene E. anterior scalene, middle scalene, Rib 1

D diaphragm (retropharyngeal abscess often caused by infections of the oral cavity; "danger space" extends from the base of the skull to the diaphragm)

A 4 year old child who had been diagnosed with tonsillitis the previous week is admitted to the hospital after experiencing severe throat pain, noisy breathing, and odynophagia. Based on this information and the attached X-ray, infection is most likely to spread to which region of the body? A. fibrous pericardium B. esophagus C. carotid sheath D. diaphragm E. thyroids F. visceral pleura

E 5th intercostal space (or place needle in the left xiphi-sternal junction; branches of internal thoracic artery must be avoided)

A 45 year old patient experiences tachycardia, hypotension, and diminished heart sounds. The veins in her neck are also noticeably distended, leading to a diagnosis of cardiac tamponade. When performing a pericardiocentesis to drain the excess fluid in the pericardial space, in which intercostal space should the needle be placed parasternally on the left? A. 1st intercostal space B. 2nd intercostal space C. 3rd intercostal space D. 4th intercostal space E. 5th intercostal space F. 6th intercostal space

D suprascapular nerve (suprascapular VAN, supraclavicular nerves, brachial plexus, and subclavian vein at risk; damage to suprascapular nerve --> weakness in lateral rotation of shoulder and initiation of abduction)

A 5 year old is kicked in the chest by a classmate on a swing set, resulting in a fracture of her left middle 1/3 clavicle. Which of the following nerves is at most risk from this injury? A. vagus nerve B. left recurrent laryngeal nerve C. phrenic nerve D. suprascapular nerve E. anterior intercostal nerve F. dorsal scapular nerve

D disease of oral/nasal cavity (lymphadenopathy in level II --> drains to levels III and IV)

A 50 year old man presents with neck pain and swelling, with visible lymphadenopathy. The affected lymphatic region is most associated with which of the following? A. infections of posterior scalp B. leukemia C. abdominal/thoracic neoplasia D. disease of oral/nasal cavity E. melanoma

B CN VII (platysma plication --> platysma situated in the superficial fascia and diminishes the concavity between the jaw and root of the neck) V = trigeminal VII = facial IX = glossopharyngeal X = vagus XI = accessory XII = hypoglossal

A 55 year old female undergoes a cosmetic face-lift. After the procedure, she finds that she has lost sensation in the front of her neck and is unable to depress her mandible. What nerve was most likely damaged? A. CN V B. CN VII C. CN IX D. CN X E. CN XI F. CN XII

G internal thoracic artery/left internal mammary artery (great saphenous vein and radial artery also commonly harvested for CABG)

A 58 year old patient with a history of smoking presents with shortness of breath while at rest and the feeling of an "elephant" on his chest. Examination shows coronary artery disease of his left anterior descending artery and the patient soon undergoes a CABG procedure. Which of the following is commonly used to bypass the LAD during a CABG? A. occipital artery B. transverse cervical artery C. ascending cervical artery D. right marginal artery E. inferior thyroid artery F. anterior intercostal artery G. internal thoracic artery H. axillary artery I. dorsal scapular artery

C, D, and E glossopharyngeal, vagus, and accessory (emerge from the jugular foramen) V = trigeminal VII = facial IX = glossopharyngeal X = vagus XI = accessory XII = hypoglossal

A 65 year old woman is experiencing dysphagia, loss of salivation, hoarseness, and an impaired gag reflex. Physical examination also reveals difficulty rotating her neck and abducting her arm above her head. Her physician suspects a tumor in her jugular foramen. Which of the following nerves have most likely been impaired? Select all that apply. A. CN V B. CN VII C. CN IX D. CN X E. CN XI F. CN XII

A, E, and F vertebrae, lungs, and brain (via venous channels; lymphatic channels metastasis --> axillary nodes and brachiocephalic veins)

A 67 year old woman is diagnosed with breast cancer. Which of the following are the most likely at risk of metastasis? Select all that apply. A. vertebrae B. heart C. liver D. spleen E. lungs F. brain G. adrenal gland

C bicuspid/mitral valve (Ortner Syndrome: compression of left laryngeal nerve either from enlarged left atrium from mitral valve stenosis or aneurysm of the aortic arch)

A 68 year old patient presents with hoarseness, dysphagia, and difficulty breathing. Her physician suspects that her left recurrent laryngeal nerve is being compressed. His theory is confirmed when an abnormal heart murmur is heard in the patient's fifth intercostal space mid-clavicularly. Which valve is likely experiencing dysfunction? A. aortic valve B. tricuspid valve C. bicuspid valve D. pulmonary valve

D left ventricle (in cardiovascular patients, dyspnea is typically caused by left ventricular dysfunction, either systolic or diastolic; increased intracardiac pressures lead to pulmonary vascular congestion --> fluid leakage into alveolar space)

A 68 year old patient with a history of coronary artery disease has recently been experiencing dyspnea when walking up stairs and during mild exertion. Which chamber of the heart is most likely experiencing dysfunction? A. right atrium B. right ventricle C. left atrium D. left ventricle

D phrenic nerve (dermatome for C3, C4, and C5 also located in the shoulder --> GSA)

A 70 year old man experiences sudden chest pains, shortness of breath, and pain in his shoulder. After performing a physical examination, his physician diagnoses him with pericarditis. Which nerve is most responsible for the patient's shoulder pain? A. vagus nerve B. accessory nerve C. ansa cervicalis D. phrenic nerve E. hypoglossal nerve F. sympathetic trunks

E external carotid artery (carotid endartectomy usually performed on internal carotid artery to clear it of plaques which can traverse to the brain)

A 70 year old patient undergoes a carotid endartectomy to prevent a brain embolism. Which artery is most likely clamped off during this procedure? A. ventral artery B. right subclavian artery C. internal carotid artery D. occipital artery E. external carotid artery F. thyrocervical trunk

B supraclavicular triangle (contains the third part of the subclavian artery and the external jugular vein, which is distended in the patient; internal jugular vein within the carotid triangle)

A 74 year old patient is diagnosed with Superior Vena Cava Syndrome. Which triangle contains the distended vein depicted in the image? A. digastric triangle B. supraclavicular triangle C. carotid triangle D. occipital triangle E. digastric triangle F. muscular triangle

D hemidiaphragm paralysis (most commonly caused by trauma, tumor, and iatrogenic injury)

A chest x-ray is taken of a patient presenting dyspnea, particularly when lying in a prone position. Which of the following is the most likely diagnosis? A. tension pneumothorax B. Klumpke palsy C. pancoast tumor D. hemidiaphragm paralysis E. open pneomothorax F. pleural effusion of costodiaphragmatic recess G. atelectasis

D lateral cricoarytenoid (pulls muscles forward to close the rima glottis; individuals with damaged lateral cricoarytenoid muscle may present with disrupted bowl movements)

A physician asks her patient to perform the Valsalva maneuver, which allows her to examine the condition of the patient's Eustachian tube. During this maneuver, which laryngeal muscle is stimulated to contract? A. transverse arytenoid B. posterior cricoarytenoid C. oblique arytenoid D. lateral cricoarytenoid E. cricothyroid F. aryepiglotticus G. thyroarytenoid

C cricopharyngeus muscle (esophagus constricted at aortic arch, left main bronchi, diaphragm, and junction with the pharynx --> esophageal inlet --> cricopharyngeus muscle)

A physician is performing an endoscopy on a patient to check for gastric ulcers. However, the endoscope accidentally gets stuck on its way to the stomach, much to the patient's discomfort. Which of the following has most likely restricted the endoscope's path? A. right secondary bronchi B. vertebral bodies C. cricopharyngeus muscle D. trachea E. thoracic duct F. ligamentum arteriosum G. none of the above

B external laryngeal nerve (innervates cricothyroid muscle, which stretches and increases tension on vocal cord --> higher pitch)

After recovering from a bout of laryngitis, a 26 year old singer finds herself unable to reach high pitch notes. Her ability to speak and sing deeper notes is normal. Which of the following nerves have likely been damaged? A. recurrent laryngeal nerve B. external laryngeal nerve C. inferior laryngeal nerve D. internal laryngeal nerve

E CN XI (accessory nerve --> left sternocleidomastoid --> torticollis) V = trigeminal VII = facial IX = glossopharyngeal X = vagus XI = accessory XII = hypoglossal

An infant is diagnosed with a condition in which a major muscle in his neck has become fibrotic and subsequently shortens. This condition is often caused by trauma before or shortly after birth. What nerve provides motor innervation to the affected muscle? A. CN V B. CN VII C. CN IX D. CN X E. CN XI F. CN XII

D thyroid and cricoid (cricothyroid articulation allows for rotational/gliding movement that's important in changes in vocal tension --> changes in human pitch)

Articulation between which two laryngeal cartilages plays a key role in adjusting human pitch? A. thyroid and epiglottis B. arytenoid and cricoid C. epiglottis and arytenoid D. thyroid and cricoid E. epiglottis and cricoid

C T4-T5 (Sternal Angle)

At approximately what vertebral level does the azygos vein drain into the superior vena cava? A. T1-T2 B. T2-T3 C. T4-T5 D. T6-T7 E. T8-T9 F. T9-T10 G. T12-L1

C rib 4 (horizontal/transverse fissure only in right lung; oblique fissure located at rib 4 in mid-scapular plane)

At approximately which rib is the horizontal fissure located in the mid-axial plane? A. rib 2 B. rib 3 C. rib 4 D. rib 5 E. rib 6 F. rib 8 G. rib 10

B T2-T7 (parasympathetic innervation from vagus nerve --> constricts bronchioles)

At what spinal nerve levels are the sympathetic preganglionic cell bodies that dilate bronchioles located? A. T1-T4 B. T2-T7 C. T1-L2 D. T1-T8 E. T1-L4

C cricothyroid (cricothyroid innervated by external laryngeal nerve, which runs with the superior thyroid artery; all other structures innervated by the recurrent laryngeal nerve)

During a thyroidectomy, ligation of the superior thyroid artery would most likely affect which of the following structures? A. thyroarytenoid B. posterior cricoarytenoid C. cricothyroid D. lateral cricoarytenoid E. transverse arytenoid F. aryepiglotticus

F ten (right = 3 secondary, 10 tertiary; left = 2 secondary; 10 tertiary)

How many tertiary bronchi does the right primary bronchus possess? A. one B. two C. three D. four E. five F. ten

C first decade (oxyphil cells in parathyroid gland; larger cells with dark nuclei and strongly eosinophilic cytoplasm due to numerous mitochondria; thought to be non-secretory)

In what stage of the life does the cell type indicated by the blue arrow appear? A. birth B. 2-5 years C. first decade D. second decade E. third decade

B mid-clavicular plane (~5th intercostal space)

In which plane does the apex of the heart reside? A. parasternal plane B. mid-clavicular plane C. mid-axillary plane D. mid-scapular plane

E parathyroid gland (clear cells: larger cells with dark nuclei and watery, clear cytoplasm)

In which structure are the cells in the image located? A. thymus B. thyroid gland C. bronchioles D. larynx E. parathyroid gland F. trachea G. epiglottis

F diaphragm (phrenic nerve characteristically runs atop the anterior scalene muscle)

Innervation to which structure would likely be impaired by damage from the scalpel? A. larynx B. posterior cricoarytenoid C. sternocleidomastoid D. tongue E. carotid sinus F. diaphragm G. geniohyoid H. platysma

A -- 2; manubriosternal -- secondary cartilaginous B -- 1; xiphisternal -- primary cartilaginous C -- 4; interchondral -- plane joint D -- 3; sternoclavicular -- saddle joint (costochondral = primary cartilaginous)

Match the joint with the joint type. A. manubriosternal B. xiphisternal C. interchondral D. sternoclavicular 1. primary cartilaginous 2. secondary cartilaginous 3. saddle joint 4. plane joint

B GVE (SVA = taste; GVA = visceral afferent; vagus also innervates skeletal muscle in upper 1/3 of esophagus)

Parasympathetic innervation to the brain from the vagus nerve consists of which axon type? A. GVA B. GVE C. GSA D. GSE E. SVA F. SVE G. SSA

C scoliosis (Pectus excavatum --> a depression of the sternum; "funnel chest"; associated with exercise intolerance, dyspnea, chest pain)

Pectarus carinatum is genetic disorder characterized by anterior protrusion of the chest wall. Patients with this condition commonly experience dyspnea, frequent respiratory infections, and what other condition? A. thoracic outlet syndrome B. ortner syndrome C. scoliosis D. "funnel chest" E. tension pneumothorax F. miosis G. pleurisy

E internal jugular vein (central line placement procedure)

Superiorly, the sternocleidomastoid attaches to the mastoid process and the superior nuchal line. Inferiorly, the SCM splits to attach to the sternum medially and to the clavicle laterally. This split creates a triangle through which access to what structure can be attained? A. left subclavian vein B. pulmonary trunk C. external jugular vein D. left common carotid artery E. internal jugular vein F. right subclavian artery G. inferior thyroid vein H. superior vena cava I. left brachiocephalic vein

C and D Inferior Right and Inferior Lobes (Triangle of Auscultation located posteriorly at intercostal space 6)

The Triangle of Auscultation is used to listen to sounds from which lung lobes? Choose all that apply. A. Superior Right Lobe B. Superior Left Lobe C. Inferior Right Lobe D. Inferior Left Lobe E. Middle Right Lobe F. Middle Left Lobe

D thymus (also contains connective tissue and lymph nodes; bounded by sternum, pericardial sac, sternal angle, diaphragm, and mediastinal pleura)

The anterior mediastinum contains the inferior end of which of the following structures? Choose all that apply. A. thyroid B. trachea C. esophagus D. thymus E. heart F. aortic arch G. ligamentum arteriosum

G anterior scalene

The attachment of which muscle is located between the right subclavian vein and right subclavian artery? A. posterior belly of omohyoid B. trapezius C. sternohyoid D. middle scalene E. longus colli F. sternocleidomastoid G. anterior scalene H. longus capitis I. posterior scalene

D manubrium (inferior thoracic aperture bounded by body of T12 vertebrae, inferior costal margin, xiphoid process)

The boundaries of the superior thoracic aperture include the body of T1 vertebrae, rib 1, and what other structure? A. clavicle B. trachea C. costocartilage of T2 D. manubrium E. apex of lung F. xiphoid process G. esophagus

C internal carotid artery (carotid sinus includes sensory nerve endings from CN IX/glossopharyngeal; carotid body is a chemoreceptor found at the "carotid crotch")

The carotid sinus is a baroreceptor that exists as a dilation at the base of which artery? A. ventral artery B. superior thyroid artery C. internal carotid artery D. left common carotid artery E. external carotid artery F. right common carotid artery G. left subclavicular artery H. thyrocervical trunk

D heteroplasmy

The clinical presentation of MERRF can include epilepsy, ataxia, myopathy, and dementia. Which of the following best explains this highly variable presentation? A. mosaicism B. locus heterogeneity C. allelic heterogeneity D. heteroplasmy E. compound heterozygosity

D occipital artery (deep branches of occipital artery anastamose with deep cervical artery of costocervical trunk, ascending cervical artery of the inferior thyroid artery, and with the vertebral artery)

The deep cervical artery of the costocervical trunk anastomosis with branches of which of the following? A. vertebral artery B. ascending cervical artery C. facial artery D. occipital artery E. thyrocervical trunk

A central tendon of diaphragm (sternopericardial ligaments; fibrous pericardium superiorly blends in with adventitia at roots of great vessels)

The fibrous pericardium is anchored to the sternum and what other structure? A. central tendon of diaphragm B. sternal angle C. christa terminalis D. xiphoid process E. trabeculae carneae F. manubrium G. serous pericardium

E and F L2 and L3 (periphery attached to inferior thoracic aperture; muscle fibers converge to central tendon)

The left and right crus of the diaphragm attach to the bodies of which vertebrae? Select all that apply. A. T10 B. T11 C. T12 D. L1 E. L2 F. L3 G. L4 H. L5

E interventricular septum (moderator band only found in the right ventricle; important in conduction)

The moderator band is an extension of cardiac muscle that spans from the anterior papillary muscle to which of the following? A. pectinate muscles B. valve cusps C. chordae tendinae D. aorta E. interventricular septum F. foramen ovale

A, B, D, and G lesser occipital, transverse cervical, supraclavicular, greater auricular (cutaneous nerves; Nerve Point located approximately 1/3 posterior SCM)

The nerve point of the neck is commonly anesthetized during operations involving the neck. Which of the following nerves emerge from this point? Select all that apply. A. lesser occipital nerve B. transverse cervical nerve C. facial nerve D. supraclavicular nerve E. phrenic nerve F. ansa cervicalis G. greater auricular nerve

C chief cells (comprise the majority of cells in the parathyroid and secrete parathyroid hormone; oxyphil cells occur after first decade of life)

The parathyroid is composed of only which cell type in juveniles? A. oxyphil cells B. follicular cells C. chief cells D. clear cells E. parafollicular cells F. adipose cells

D anterior scalene (Part 1 is medial to anterior scalene, Part 2 is behind anterior scalene, and Part 3 is over rib 1)

The parts of the subclavian artery are in relation to which muscle? A. posterior scalene B. sternocleidomastoid C. middle scalene D. anterior scalene E. trapezius F. sternohyoid G. longus colli

C fibrous pericardium (infections in the pre-tracheal space able to spread down to the heart/superior mediastinum, but not above the hyoid)

The pre-tracheal proper fascia attaches to the hyoid bone above and to what structure below? A. clavicle B. visceral pleura C. fibrous pericardium D. manubrium E. serous pericardium F. trapezius G. parietal pleura H. rib 1

C crista terminalis

The sinu-atrial node (SA node) can be found atop which of the following structures? A. sinus venarum B. moderator band C. crista terminalis D. pectinate muscle E. chordae tendinae F. valve cusps

H facial artery (facial artery is intimately related to the submandibular gland; also supplies the face and palatine tonsils)

The submandibular gland is supplied by which branch of the external carotid artery? A. deep cervical artery B. lingual artery C. vertebral artery D. superior thyroid artery E. maxilla artery F. ascending cervical artery G. occipital artery H. facial artery I. inferior thyroid artery J. ascending pharyngeal artery

D descending (dorsal) scapular artery (supplies the rhomboids and pierces the brachial plexus; individuals without the superficial cervical and descending scapular artery possess a transverse cervical artery)

The superficial cervical artery supplies the trapezius and is a branch of the thyrocervical trunk. Which of the following arteries is only present in individuals who possess this superior cervical artery? A. internal thoracic artery B. superior intercostal artery C. transverse cervical artery D. descending (dorsal) scapular artery E. deep cervical artery F. basilar artery G. inferior thyroid artery

G arch of aorta (right recurrent laryngeal nerve loops underneath right subclavian artery; recurrent laryngeal nerve courses with the inferior thyroid artery and is highly susceptible to injury from tumors, aneurism, lymphadenopathy, thyroid surgeries, etc.)

The vagus nerve provides innervation to the larynx by branching into the superior laryngeal nerve and the recurrent/inferior laryngeal nerve. What structure does the left recurrent laryngeal nerve loop underneath before traveling up the trachea to the larynx? A. subclavian artery B. left primary bronchi C. subclavian vein D. brachiocephalic trunk E. brachiocephalic vein F. left common carotid artery G. arch of aorta H. inferior thyroid artery

C bronchomediastinal trunks (parasternal and upper intercostal nodes --> bronchomediastinal trunks --> brachiocephalic veins)

To where do parasternal lymph nodes drain? A. thoracic duct B. jugulodigastric nodes C. bronchomediastinal trunks D. jugulo-omohyoid nodes E. right subclavian vein

A right paratracheal nodes (inferior tracheobronchial nodes --> right paratracheal nodes)

To where does lymph from the inferior lobe of the left lung drain? A. right paratracheal nodes B. left paratracheal nodes C. right tracheobronchial nodes D. left superior tracheobronchial nodes E. carinal nodes

B level II (jugulodigastric nodes; cancer below the vocal folds spread to level IV/jugulo-omohyoid nodes)

To which lymphatic level would a cancerous mass located above the vocal folds spread? A. level I B. level II C. level III D. level IV E. level V F. level VI

F occipital artery (directed posteriorly and near its origin is crossed by CN XII/hypoglossal nerve) 1 Right common carotid artery 2 Right internal carotid artery 3 Right external carotid artery 4 Superior thyroid artery 5 Lingual artery 6 Facial artery 7 Occipital artery 8 Ascending palatine artery 9 Maxillary artery

What is artery #7? A. maxillary artery B. internal carotid artery C. lingual artery D. ascending pharyngeal artery E. facial artery F. occipital artery G. superior temporal artery H. superior thyroid artery I. posterior auricular artery

D epiglottis (possesses a core of elastic cartilage covered with stratified squamous epithelium tha includes modified salivary glands; "epi"-"glottis' = above the vocal cords)

What is the histological structure? A. larynx B. bronchiole C. parathyroid gland D. epiglottis E. trachea F. thyroid gland

E pretracheal fascia

What is the last fascial layer to be cut when performing a thyroidectomy? A. prevertebral fascia B. carotid sheath C. superficial fascia D. investing fascia E. pretracheal fascia F. infrahyoid fascia

A transversus thoracis muscle (same plane as innermost intercostal muscle; innervated by intercostal nerves)

What muscle is depicted in the image? A. transversus thoracis muscle B. pectoralis minor C. subcostal muscle D. levatores costarum E. serratus anterior

C CN VII (#15 = stylohyoid innervated by facial nerve; also innervates post. digastric)

What nerve innervates #15? A. C1 B. CN V C. CN VII D. Ansa Cervicalis E. CN X

D tubercle (head of rib articulates with body of associated vertebra, and one above it, except for ribs 1, 10, 11, 12, which articulate with their own associated vertebrae)

What part of the rib articulates with the transverse process of its associated vertebral body? A. neck B. head C. costal cartilage D. tubercle E. angle F. external surface G. crest

A ligamentum arteriosum (left recurrent laryngeal nerve directly posterior to ligamentum arteriosum; lymphadenopathy can occur in this space --> damage to left recurrent laryngeal nerve)

What structure connects the pulmonary artery to the arch of the aorta? A. ligamentum arteriosum B. christa terminalis C. sternopericardial ligaments D. sternal angle E. suspensory ligaments F. fossa ovalis

D tongue and oral cavity (lingual artery)

What structure(s) is supplied by the artery indicated by the red arrow? A. thyroid gland B. face and submandibular gland C. middle ear cavity D. tongue and oral cavity E. sternocleidomastoid F. longus capitis and longus colli

D internal jugular vein + subclavicular vein (venous angle --> site of lymph drainage)

What two veins converge to form the brachiocephalic vein? A. superior vena cava + inferior thyroid vein B. internal jugular vein + external jugular vein C. anterior vein + communicating vein D. internal jugular vein + subclavicular vein E. inferior thyroid vein + internal jugular vein F. communicating vein + subclavicular vein

E phrenic nerve (subclavian artery, lung apex, and first rib also at risk)

When performing a subclavian venipuncture, which of the following is most at risk of injury? A. vagus nerve B. inferior thyroid vein C. aortic arch D. right common carotid artery E. phrenic nerve F. suprascapular nerve

B posterior chest wall below rib 5 (use scapular line as landmark; middle lobe of right lung --> anterior chest wall below rib 4)

Where should the stethoscope be placed to listen for breath sounds from the inferior lobes? A. anterior chest wall above rib 3 B. posterior chest wall below rib 5 C. anterior chest wall above rib 5 D. anterior chest wall below rib 4 E. posterior chest wall above rib 3

E all of the above (inferior root of ansa cervicalis innervates blood vessels and skeletal muscle)

Which axon types are present in the inferior root of the ansa cervicalis? Choose all that apply. A. GVA B. GVE C. GSA D. GSE E. all of the above

D infrahyoid fascia (pretracheal fascia forms sling dividing digastric into anterior and posterior bellies)

Which fascial layer forms a sling that divides the omohyoid into superior and inferior bellies? A. investing fascia B. pretracheal fascia C. prevertebral fascia D. infrahyoid fascia E. carotid sheath F. superficial fascia G. Sibson's fascia

D Sibson's Fascia (specialization of prevertebral fascia and supra-pleural membrane part of endothoracic fascia)

Which fascial layer is attached to the transverse process of C7 down to rib one and supports pleura superiorly? A. Axillary Sheath B. Prevertebral Fascia C. Infrahyoid Fascia D. Sibson's Fascia E. Superficial Fascia F. Investing Fascia G. Alar Fascia H. Pretracheal Fascia I. Carotid Sheath

C arytenoid cartilage (articulates with cricoid cartilage to allow for vocal fold abduction and adduction --> opening and closing of rima glottis)

Which laryngeal cartilage is indicated by the red arrow? A. epiglottis cartilage B. cricoid cartilage C. arytenoid cartilage D. thyroid cartilage

B intercostal nerve (motor to thoracic wall and sensory to skin + parietal pleura; intercostal nerves = anterior rami)

Which nerve innervates the costal and peripheral diaphragmatic parietal pleura? A. vagus nerve B. intercostal nerve C. phrenic nerve D. trigeminal nerve E. thoracodorsal nerve F. accessory nerve G. medial pectoral nerve

A, C, E, G, I superficial cervical, transverse cervical, suprascapular, ascending cervical, inferior thyroid (superficial cervical and transverse cervical common variants among individuals)

Which of the following arteries branches from the thyrocervical trunk? Choose all that apply. A. superficial cervical artery B. deep cervical artery C. transverse cervical artery D. internal thoracic E. suprascapular artery F. descending (dorsal) scapular G. ascending cervical artery H superior intercostal artery I. inferior thyroid artery J. lingual artery

E posterior interventricular artery/posterior descending artery (branching off RCA = right dominant; branching off left circumflex artery = left dominant; branching off both = co-dominant)

Which of the following arteries determines coronary dominance? A. right marginal artery B. circumflex artery C. sinu-atrial nodal branch D. diagonal branch of LAD E. posterior interventricular artery

B primary cartilaginous (costovertebral joints = synovial)

Which of the following best describes the articulation of the ribs with the sternum (sternocostal joints)? A. synovial B. primary cartilaginous C. secondary cartilaginous D. synchondroses E. fibrous

F elastic cartilage; epiglottis (trachea --> hyaline cartilage; primary bronchi --> irregular blocks of hyaline cartilage; larynx --> no cartilage)

Which of the following best describes the cartilage type and location of the histological image? A. elastic cartilage; larynx B. hyaline cartilage; trachea C. fibrous cartilage; larynx D. hyaline cartilage; primary bronchi E. fibrous cartilage; trachea F. elastic cartilage; epiglottis G. hyaline cartilage, bronchioles

B smooth muscle; vagus nerve (upper 5% --> skeletal; middle 35% --> smooth + skeletal; lower 60% --> smooth)

Which of the following best describes the muscular arrangement and innervation of the lower esophagus? A. smooth + skeletal muscle; glossopharyngeal B. smooth muscle; vagus nerve C. skeletal muscle; facial nerve D. smooth + skeletal muscle; phrenic nerve E. smooth muscle; glossopharyngeal nerve F. smooth + skeletal muscle; hypoglossal nerve G. skeletal muscle; vagus nerve

B plays a critical role in speech (larynx --> vocalis skeletal muscle, lack of cartilage, and false vocal fold)

Which of the following best describes the structure indicated in the image? A. bifurcates at sternal angle B. plays a critical role in speech C. flap of cartilage at the root of the tongue D. "clump & cord" type endocrine gland E. endocrine gland in the neck that is divided into lobules

A and C aortic arch and carina (sternal angle = attachment site of rib 2)

Which of the following can be found at the sternal angle? Select all that apply. A. aortic arch B. brachiocephalic trunk C. carina D. apex of lungs E. attachment site of Rib 1 F. thyroid ima artery G. aortic hiatus

E aspirin (antiplatelet therapy)

Which of the following is indefinitely given to all patients after myocardial infarction? A. ACE inhibitors B. beta blockers C. nitrates D. warfarin E. aspirin F. statins

C internal laryngeal nerve (recurrent laryngeal nerve innervates mucosa below the vocal folds; external laryngeal nerve only innervates skeletal muscle --> cricothyroid)

Which of the following is responsible for innervating laryngeal mucosa above the vocal folds? A. external laryngeal nerve B. phrenic nerve C. internal laryngeal nerve D. glossopharyngeal nerve E. recurrent laryngeal nerve

C calcitonin (parafollicular cell of thyroid)

Which of the following is secreted by the cell type circled in the image? A. surfactant B. substance P C. calcitonin D. CC16 E. secretin F. parathyroid hormone

B and D level II (jugulodigastric nodes) and level IV (jugulo-omohyoid nodes) (situated around the internal jugular vein)

Which of the following lymph levels contain the deep cervical nodes where all lymph from the head and neck ultimately drain to? Select all that apply. A. Level I B. Level II C. Level III D. Level IV E. Level V F. Level VI

E azygos vein (hemiazygos and accessory hemiazygos veins drain into azygos at around T8-T9)

Which of the following provides important collateral circulation between the superior vena cava and the inferior vena cava? A. external jugular vein B. left brachiocephalic vein C. hemiazygos vein D. internal jugular vein E. azygos vein F. great cardiac vein G. accessory hemiazygos vein H. right subclavian vein

C transverse pericardial sinus (insertion of a finger through this sinus puts the aorta and pulmonary artery anterior to finger; used in CABG surgery)

Which of the following separates the great arteries from the superior vena cava? A. serous pericardium B. sinus venarum C. transverse pericardial sinus D. oblique pericardial sinus E. sternal angle F. coronary sulcus

C cricothyroid ligament (quadrangular membrane ends inferiorly as the vestibular ligament)

Which of the following structures ends superiorly as vocal ligament? A. thyrohyoid membrane B. mucous membrane C. cricothyroid ligament D. quadrangular membrane E. posterior cricoarytenoid ligament F. laryngeal ventricle

D great cardiac vein (drains the left side of heart and follows the LAD; small and middle cardiac veins drain the right side of the heart --> all coronary veins drain into the coronary sinus in the right atrium)

Which of the following veins is responsible for draining the left side of the heart? Choose all that apply. A. small cardiac vein B. middle cardiac vein C. intermediate cardiac vein D. great cardiac vein E. anterior cardiac vein

D T4/T5 (Sternal Angle/Angle of Louie)

Which of the following vertebral levels separates the superior mediastinum from the inferior mediastinum? A. C7/C8 B. T1/T2 C. T2/T3 D. T4/T5 E. T9/T10

D thoracic duct (esophagus continues posterior to trachea in superior mediastinum into posterior mediastinum in the abdomen)

Which structure in the superior mediastinum ascends posteriorly to the esophagus? A. right brachiocephalic vein B. ascending aorta C. phrenic nerve D. thoracic duct E. internal jugular vein F. trachea G. vertebral bodies

A adventitia (the cartilaginous layer includes C-shaped cartilaginous hyaline bodies and is deficient along the posterior aspect of the trachea)

Which tracheal layer is responsible for binding the trachea to adjacent structures? A. adventitia B. mucosa C. cartilagnous D. submucosa E. tunica media

E submental triangle (contains the submental lymph nodes; posterior triangle --> occipital + subclavicular; anterior triangle --> muscular + carotid + submental + submandibular/digastric)

Which triangle is indicated by the yellow arrow? A. subclavicular triangle B. muscular triangle C. submandibular/digastric triangle D. occipital triangle E. submental triangle F. carotid triangle

D circumflex artery (LAD anastomose with posterior descending artery and within interventricular septum --> provides some collateral circulation to the heart)

While the coronary arteries are largely considered end arteries, there are several anastamoses. With which artery does the RCA anastomose? A. left marginal artery B. left anterior descending artery C. right marginal artery D. circumflex artery E. diagonal branch of LAD F. sinu-atrial nodal branch

D descending aorta (exsanguination; fractures between the head and tubercle or dislocation of ribs 6-9 can impinge or lacerate the descending aorta)

While traveling to Warped Tour, an 18 year old is involved in a motor vehicle accident on the highway. At the hospital, the doctors find that her 7th and 8th ribs have been dislocated on her left side. Which of the following structures is at risk of impingement or laceration? A. left subclavian artery B. spleen C. inferior vena cava D. descending aorta E. superior vena cava F. brachiocephalic trunk G. liver

A and D medial and lateral pectoral nerve (pectoralis major --> medial + lateral pectoral nerve; pectorals minor --> medial pectoral nerve)

While trying to ride a mechanical bull, a 21 year old is flung from its seat after three seconds. Afterwards, he has difficulty rotating and adducting his arm and his physician suspects that one of his chest muscles has been injured. Which of the following nerves have most likely been damaged? Choose all that apply. A. medial pectoral nerve B. anterior pectoral nerve C. thoracodorsal nerve D. lateral pectoral nerve E. dorsal scapular nerve F. transverse cervial nerve G. spinal accessory nerve