Anatomy Exam 2

A 19-year-old man is involved in a motor vehicle accident and suffers a right proximal humeral fracture. The patient is noted to have numbness of the right lateral upper arm and also inability to abduct his arm. Which of following muscles is likely affected by this nerve injury?

Teres minor

The scrotum appears to have a slightly pigmented and wrinkled appearance. What is the explanation for this appearance?

The dartos fascia

Gastric contents exiting a posterior perforation of the stomach wall will accumulate in which of the following?

The omental bursa

A pediatric heart surgeon has just divided the sternum in a child to repair a cardiac malformation. A lobulated gland-like structure is seen immediately obscuring the heart. This is most likely which of the following?

Thymus

A clinician is palpating the anterior neck of a patient who has been involved in a motor vehicle accident and notes the laryngeal prominence. Which of the following describes the anatomical structure that corresponds to this prominence?

Thyroid cartilage

A patient with a hip dislocation is also exhibiting weakness of extension of the thigh at the hip. This would indicate possible damage to which of the following?

Tibial portion of the sciatic nerve

During a procedure to remove a palatine tonsil, the operating field was suddenly filled with bright red blood. Which artery was inadvertently damaged?

Tonsillar branch of facial

A 45-year-old woman is having significant uterine bleeding from uterine fibroids. The radiologist performs an embolization procedure of the uterine arteries. Through which of the following structures do the uterine arteries traverse?

Transverse cervical (cardinal) ligaments

An 18-year-old man is noted to have probable testicular cancer. He undergoes surgery. After incising the scrotum, the surgeon contemplates the approach to the parenchyma of the testes. Through which layer must the surgeon incise to reach the testicular parenchyma?

Tunica albuginea

A 7-year-old male comes in for a routine physical examination. The pediatrician notices that the right testis is enlarged and without tenderness. Transillumination reveals clear fluid which is present around the right testis. This fluid most likely occupies which space?

Tunica vaginalis

A 30-year-old woman is noted to have an absent kidney. Which of the following findings is she also likely to have?

Unicornuate uterus

You point to the colon with your probe, and ask your colleague "What tissue am I touching?"

Visceral peritoneum

A 24-year-old football player receives a blow to the left skull, and the team physician finds weakness of the left SCM. Which of the following associated findings is most likely to be seen in this patient?

Weakness of the trapezius muscle

A patient with a severe tear of the medial collateral ligament of the wrist would likely display which of the following increased wrist movements?

Abduction

A 44-year-old swimmer is seen in the physician's office for right shoulder pain for 1 year. A radiograph of the shoulder indicates that the supraspinatus tendon is calcified. What movement is most likely to cause discomfort in this patient?

Abduction of the humerus

A 50-year-old diabetic man is having difficulty voiding urine. On examination, he has decreased sensation of the perineal region. Which of the following reflexes is the most likely to be affected?

Anal wink

A 56-year-old man had a stroke. Among other symptoms, a marked deficit in bite strength was observed on the affected side, indicating weakness in the muscles of mastication. Which of the following muscles is also innervated by the same nerve?

Anterior belly of digastric

You are in anatomy lab and ask a fellow medical student about the course of the right subclavian artery. Your colleague answers that this structure lies immediately posterior to the

Anterior scalene muscle

A 28-year-old neuroanatomy graduate student noted pain at the bridge of his nose and had been told that he had "sinus" infections. He was speculating about the afferent nerve supply from this area. Which of the following is the most accurate description of the sensory nerve innervation?

Branches of CN V

A thoracic surgeon has entered the right pleural cavity and excised two suspicious lymph nodes at the hilum of the right lung for frozen-section pathological study. These nodes belong to which of the following lymph node groups?

Bronchopulmonary

A 16-year-old girl is brought into the physician's office because her mother suspects an eating disorder. The patient has bilateral swelling of the cheeks that are nontender. There are multiple dental caries. She appears to be of normal weight. Which of the following is the most likely diagnosis?

Bulimia

You ask your dissection colleague "What spinal nerves innervate the peritoneum on the underside of the central region of the diaphragm?"

C3 through C5

A 5-year-old girl complains of severe pain from her right ear due to an acute otitis media. Which of the following nerves is most likely responsible for carrying the sensation of pain from the tympanic membrane?

CN IX

A patient has a mild chronic cough but has clear lungs and no evidence of bronchitis. Her physician believes that the symptoms are due to postnasal drip brought on by allergy. Which nerve is responsible for the afferent limb of the cough reflex?

CN IX

A 45-year-old diabetic woman has developed shingles involving the right cornea. Through which nerve did the varicella virus most likely travel to the cornea?

CN V

Lacrimal nerve

CN V1

Supraorbital nerve

CN V1

Infraorbital nerve

CN V2

Auriculotemporal nerve

CN V3

A 44-year-old accountant develops a bleeding ulcer around tax time. The gastroenterologist visualizes the ulcer in the proximal duodenum. A radiologist has been called to cannulate and embolize the artery supplying the ulcer. Which of the following arteries does the radiologist need to cannulate?

Celiac artery

After removal of a large portion of the stomach in a patient who has cancer, you are now examining the lymph nodes that receive lymph from the stomach. Which of the following structures receives lymph directly from the stomach?

Celiac nodes

A 3-year-old boy had three episodes of otitis media over the past year. His mother asks the pediatrician why children tend to develop more ear infections than adults. Which of the following is the most likely anatomical explanation?

Changes in the eustachian tube

Which mechanism propels lymph through the lymphatic vessels?

Compression

A 4-year-old boy was noted to have recurrent ear infections. He underwent placement of tubes in the tympanic membranes 3 days previously and currently complains of some difficulty in tasting candy. Which of the following is the most likely explanation?

Disruption of the chorda tympani

You wish to examine the hilum of the right kidney during surgery. Which of the following structures must be elevated and reflected to do so?

Duodenum

You must remove fluid from the pleural cavity of your patient (thoracentesis). You decide to insert the aspiration needle over the top of a rib, into an intercostal space inferior to the lower border of the lung in the MAL at the end of a normal expiration. Which of the following is the lowest (most caudal) level at which this procedure might safely be done without injuring the lung?

Eighth intercostal space

Between the dura mater and the calvaria

Epidural

A 22-year-old college student is being seen for possible sinusitis. The physician sees purulent drainage arising from the superior nasal meatus. Which of the following sinuses is likely to be infected?

Ethmoidal

A 24-year-old man is noted to have a midshaft humeral fracture after falling from a scaffold. Which of the following muscle tests would you perform to test the integrity of the radial nerve?

Extension of the hand at the wrist

As a radiologist examining a contrast study of the pulmonary vessels, you will note how many pulmonary veins entering the left atrium?

Four

A 45-year-old woman is brought to the emergency department (ED) with a 4-h history of vomiting dark brown emesis that has a granular component. Examination shows tenderness of the midabdomen. Upper endoscopy shows a bleeding ulcer of the duodenal bulb on the posterior aspect. Which artery has the ulcer most likely have affected?

Gastroduodenal

Which structure passes through the gap between the superior and middle constrictor muscles?

Glossopharyngeal nerve

A 2-year-old girl is diagnosed with torticollis involving the right SCM. Which of the following describes the most likely anatomical change?

Head rotated to the left

A 65-year-old woman is noted to have cancer of the vulva. Metastasis of the cancer to the lymph nodes in the femoral triangle is noted. Which of the following best describes the location of the lymph nodes?

Immediately medial to the femoral vein

You demonstrate the relationship between the brachial plexus and the superior thoracic aperture during the dissection. What portion of the plexus lies closest to the aperture?

Inferior trunk

A 33-year-old woman underwent partial thyroidectomy for hyperthyroidism in which the thyroid failed to take up radioactive iodine. She is noted to have some hoarseness of voice 1 month later. Which of the following is the most likely explanation?

Injury to the recurrent laryngeal nerve

A 24-year-old male slips on a banana peel and falls onto his outstretched hand. Which of the following structures transmits the force from the radius to the ulna?

Interosseous membrane

In a patient who has a posterior dislocation of the hip, which of the following ligamentous structures would be torn?

Ischiofemoral ligament

As a surgeon about to remove the right adrenal gland, you examine the blood supply of the right adrenal gland and observe which of the following?

Its central vein drains into the IVC

A 45-year-old woman has a severe asthmatic exacerbation and requires an arterial blood gas specimen for management. If you are planning to draw the sample from the brachial artery, where should you insert the needle?

Just medial to the biceps tendon in the cubital fossa

A 45-year-old man complains of shooting pain down his right leg that worsens with sitting and coughing. He also has some numbness in the area. The physician tests sensation on the lateral thigh region. Which of the following nerve roots is being tested?

L4 and L5

During a surgical procedure, a surgeon has reflected the fat pad containing the thymic remnants and notes a large venous structure crossing the midline from the left and apparently emptying into the SVC. This vessel is most likely which of the following?

Left brachiocephalic vein

A 42-year-old woman is undergoing a total abdominal hysterectomy due to leiomyomata of the uterus that has caused significant abnormal vaginal bleeding. During the surgery, the surgeon locates the left ureter to ensure its safety prior to clamping the uterine artery. The ureter is found at the pelvic brim. In this area, the left ureter is located immediately lateral to the

Left internal iliac artery

A 57-year-old man is diagnosed with colon cancer. He is noted to have a probable metastatic mass in the neck at the thoracic duct. Where is the metastasis likely to be located?

Left supraclavicular region

While examining a patient, you notice ptosis of the patient's left eye. This would indicate to you there is paralysis of which muscle?

Levator palpebrae muscle

A 24-year-old medical student has been diagnosed with sinusitis and asks her physician why there is nasal drainage during the night but not during the day. Which of the following is the best explanation?

Location of the ostia within the sinus

While performing a physical examination, you test the function of the muscles attached to the eyeball and thereby the integrity of their innervation. You would test the function of the superior oblique muscle by having the patient do which of the following?

Look in toward the nose and then down

A 25-year-old woman underwent surgery for a thyroid nodule. Two months later, she complains of dryness of skin and muscle spasms. Which of the following is the most likely explanation?

Low serum calcium

In a patient who has testicular cancer that has metastasized (spread) to the lymph nodes, which of the following would you expect to be involved first?

Lumbar (aortic) nodes

You are examining a radiograph of a patient's wrist and note malalignment (dislocation) of one of the carpal bones. Which of the following is most likely to be the dislocated carpal bone?

Lunate

A 54-year-old man has just dislocated his right hip. The physician is concerned about the integrity of the joint's blood supply. Which artery supplies most of the blood supply to the hip joint?

Medial circumflex femoral

During a surgical procedure, you have elevated the transverse colon and note an artery in the transverse mesocolon. What is this vessel?

Middle colic artery

A dissection of the ureter is accomplished to excavate a large retroperitoneal mass. In isolating the ureter, the surgeon is attempting to ensure that the blood supply to the ureter is not disrupted. Which of the following best describes the arterial supply to the ureter?

No specific artery, but rather small branches from the nearby arteries

A 22-year-old male is involved in a knife fight after a soccer game. He is brought to the emergency department. An 8-cm laceration that involves the right cheek, from his right ear to near the corner of his mouth, is noted. Which of the following structures is most likely injured?

Parotid duct

Which of the following is the male homologue of the female clitoris?

Penis

As you proceed to elevate the duodenum and pancreas, you note two veins posterior to the neck of the pancreas uniting to form a large vein that passes superiorly. Which large vein has been formed?

Portal Vein

Which of the following muscles is most important to allow air movement through the larynx?

Posterior cricoarytenoids

As a surgeon exploring the thorax, you will be able to identify the right pulmonary artery in which of the following locations?

Posterior to the ascending aorta and the SVC

A 39-year-old woman complains of hematuria and significant flank tenderness. She has a history of kidney stones. A CT scan depicts the abdominal portion of the ureter lying anterior to a muscle. Which of the following is most likely to be the name of this muscle?

Psoas

To elevate the kidney within the renal fascia and the perirenal fat, the renal fascia must be reflected or incised from the fascia of which of the following muscles?

Psoas muscle

An 18-year-old patient has been improperly fitted with axillary-type crutches, which have produced pressure on the posterior cord of the brachial plexus. Which of the following terminal nerves would most likely be affected?

Radial nerve

A 20-gauge spinal needle is placed through the vagina to assess whether there is blood in the peritoneal cavity. Which of the following describes the most dependent part of the peritoneum or pelvis?

Rectouterine pouch (of Douglas)

During the removal of a patient's kidney, you would observe which of the following as being most anterior within the renal sinus?

Renal vein

A 34-year-old man is involved in a motor vehicle accident. He is brought into the emergency room and is noted to have a hematoma involving the pancreas. What is the most likely location of this hematoma?

Retroperitoneal midline

A 31-year-old woman is in her physician's office for a fitting for an intrauterine contraceptive device. The physician performs a pelvic examination to ensure that the device is placed in the correct direction. The physical examination shows that the uterine body is tipped toward the rectum and that the uterine fundus is tipped anteriorly. Which of the following describes the position of the uterus?

Retroverted, anteflexed

Which of the following structures defines the lateral boundary of the superior thoracic aperture?

Rib 1

During surgery you note a retroperitoneal artery crossing the right side of the posterior abdominal wall and supplying the ascending colon. Which vessel is this?

Right colic artery

Ligation of the common hepatic artery will eliminate the gastric blood supply through which of the following arteries?

Right gastroomental and right gastric arteries

You are explaining the anatomy of the shoulder to a young athlete who has sustained an injury to one of his shoulders. You tell him that the chief stability to this joint is from which of the following?

Rotator cuff muscles

You are at surgery and are about to mobilize the second portion of the duodenum and the head of the pancreas. You note an artery and vein passing anteriorly to the uncinate process of the pancreas and the third portion of the duodenum. Which vessels are these?

SMA and SMV

A 44-year-old woman who has a DVT of the lower extremity suddenly gasps and collapses. She is found to be hypotensive. Resuscitative measures are attempted without success. Which of the following is the most likely diagnosis?

Saddle Embolus

A 23-year-old accountant trips over a briefcase and falls onto his outstretched hand. A carpal bone fracture is suspected. Which of the following bones is most likely fractured?

Scaphoid

A surgical incision through the fundus of the stomach would require you to clamp which of the following?

Short gastric arteries

During a dissection, you inform your colleague that the surface of the peritoneum covering the stomach is composed of

Simple squamous epithelium

During this procedure, the lower border of the lung will lie at the level of which rib in the MCL?

Sixth

A 34-year-old woman is undergoing cystoscopic examination under spinal anesthesia. As the anesthesiologist places the needle into the subarachnoid space to inject the anesthetic agent, the needle traverses various layers. Which of the following describes the accurate sequence of layers from skin to subarachnoid space?

Skin, supraspinous ligament, interspinous ligament, dura mater, subarachnoid space

As you continue, you also note a large, tortuous artery passing to the left along the superior border of the pancreas. This is likely to be which of the following?

Splenic Artery

An important function of the rotator cuff is

Stabilization of the humeral head

You are evaluating a radiograph of the only bony articulation between the upper limb and the trunk. Which of the following joints are you evaluating?

Sternoclavicular

A 2-month-old baby is noted to have macrocephaly (large head) and developmental delay. On ultrasound, the baby has significant hydrocephalus. The pediatrician is suspicious of congenital stenosis of the aqueduct of Sylvius. Which of the following are the most likely findings in this infant?

Subarachnoid

Between the arachnoid and pia maters...

Subarachnoid

Between the dura and arachnoid maters

Subdural

A 45-year-old woman is undergoing surgical resection of the salivary gland for probable cancer. After surgery, she notes that she cannot move her tongue well. Which of the following salivary glands is most likely involved in the surgery?

Submandibular

A 15-year-old boy is eating a fish dinner and inadvertently has a bone "caught in his throat." He complains of significant pain above the vocal cords. Which of the following nerves is responsible for carrying the sensation for this pain?

Superior laryngeal nerve

During this same physical exam, you ask the patient to look laterally with her right eye, and then upward. You have just tested the function of which muscle?

Superior rectus muscle

A college baseball pitcher has shoulder discomfort, and you suspect a rotator cuff tear. You will most likely see damage to the tendon of which of the following muscles?

Supraspinatus

Continuing your discussion with your dissection colleague, you ask "Which spinal nerve innervates the umbilical region?"

T10

During this thoracentesis procedure, the lowest level of the pleural cavity will lie at the level of which rib at the end of expiration in the MAL?

Tenth