BRS

16. A 75-year-old patient has been suffering from lung cancer located near the cardiac notch, a deep indentation on the lung. Which of the following lobes is most likely to be excised? (A) Superior lobe of the right lung (B) Middle lobe of the right lung (C) Inferior lobe of the right lung (D) Superior lobe of the left lung (E) Inferior lobe of the left lung

A

2. A 43-year-old female patient has been lying down on the hospital bed for more than 4 months. Her normal, quiet expiration is achieved by contraction of which of the following structures? (A) Elastic tissue in the lungs and thoracic wall (B) Serratus posterior superior muscles (C) Pectoralis minor muscles (D) Serratus anterior muscles (E) Diaphragm

A

34. A patient has a small but solid tumor in the mediastinum, which is confined at the level of the sternal angle. Which of the following structures would most likely be found at this level? A. Bifurcation of the trachea B. Beginning of the ascending aorta C. Middle of the aortic arch D. Articulation of the third rib with the sternum E. Superior border of the superior mediastinum

A

63. A cyclist is thrown over his handle bars and breaks his clavicle as he hits the ground on his shoulder. Which of the following is correct regarding the development of the clavicle? (A) It develops through intramembranous ossification (B) It is the last upper limb bone to begin ossification (C) The clavicle forms from somitic mesoderm (D) It is the first limb bone to complete ossification (E) Associated muscles form from somatic lateral plate mesoderm

A

Questions 56 to 57: A 64-year-old man with a history of liver cirrhosis has been examined for hepatitis A, B, and C viruses. In an attempt to obtain a blood sample from the patient's median cubital vein, a registered nurse inadver- tently procures arterial blood. 56. The blood most likely comes from which of the following arteries? (A) Brachial (B) Radial (C) Ulnar (D) Common interosseous (E) Superior ulnar collateral

A

An 18-year-old boy involved in an automobile accident presents with an arm that cannot abduct. His paralysis is caused by damage to which of the following nerves? A. Suprascapular and axillary B. Thoracodorsal and upper scapular C. Axillary and musculocutaneous D. Radial and lower subscapular E. Suprascapular and dorsal scapular

A 0-15: supraspinatus: suprascapular 15-90: deltoid: axillary 90-180: serratus anterior: long thoracic latissimus dorsi: thoracodorsal nerve. adduction. extension. medial rotation. subscapularis: upper and lower subscapular nerve. adduction and medial rotation Teres major: lower subscapular adduct and medial rotation. rhomboid(elevate the scapular) and levator scapulae (adduct the scapula): dorsal scapular nerve

10. A thoracic surgeon removed the right middle lobar (secondary) bronchus along with lung tissue from a 57-year-old heavy smoker with lung cancer. Which of the following bronchopulmonary segments must contain cancerous tissues? (A) Medial and lateral (B) Anterior and posterior (C) Anterior basal and medial basal (D) Anterior basal and posterior basal (E) Lateral basal and posterior basal

A C: inferior lobe

A patient bleeding from the shoulder to a knife wound is in fair condition because there is vascular anastomosis around the shoulder. Which of the following arteries is most likely a direct branch of the subclavian artery that is involved in the anastomosis? A. Dorsal scapular artery B. Thoracoacromial artery C. Circumflex scapular artery D. Transverse cervical artery E. Suprascapular artery

A anastomosis: circumflex scapular branch of subscapular artery. suprascapular artery dorsal scapular artery Subclavian is coming off of brachiocephalic trunk

73. A lesion of the median nerve causes paralysis of this structure.

A flexor pollicis longus: innervated by median nerve

29. Which structure may herniate through the annulus fibrosus, thereby impinging on the roots of the spinal nerve?

A intervertebral discs are between the bodies of 2 vertebrae. contains annulus fibrosus, nucleus pulposus, fibrocartilage

A patient with a stab wound receives a laceration of the musculocutaneous nerve. Which of the following conditions is likely to have occured? A. Lack of sweating on the lateral side of the forearm B. Inability to extend the forearm C. Paralysis of brachioradialis muscle D. Loss of tactile sensation on the arm E. Constriction of blood vessels on the hand

A musculocutaneous is sympathetic post-ganglionic fibers. blood vessels to the the lateral side of the forearm (lateral antebrachial cutaneous). also includes tactile sensation on the lateral side of the forearm.

A 16-year old boy fell from a motorcycle, and his radial nerve was severely damaged because of a fracture of the midshaft of the humerus. Which of the following conditions would most likely result from this accident? A. Loss of wrist extension leading to wrist drop B. Weakness in pronating the forearm C. Sensory loss over the ventral aspect of the base of the thumb D. Inability to oppose the thumb E. Inability to abduct the fingers

A radial nerve does extension in the wrist. B: median nerve: pronator teres, pronator quadratus, opponens pollis. C: median D: median. opponens pollicis E: dorsal interosseous muscles abDuct the thumb which is innervated by ulnar

A 57-year-old woman comes into her physician's office complaining of fever, nausea, vomiting, and the worst headache of her life. Tests and physical examination suggest hydrocephalus (widening ventricles) resulting from a decrease in the absorption of cerebro- spinal fluid (CSF). A decrease of flow in the CSF through which of the following structures would be responsible for these findings? (A) Choroid plexus (B) Vertebral venous plexus (C) Arachnoid villi (D) Internal jugular vein (E) Subarachnoid trabeculae

C CSF: is absorbed into the venous system through the arachnoid villi (which projects into the cranial dural venous sinus (Superior Sagittal Sinus) A: CSF is produced by the choroid plexuses ventricles of the brain E: the CSF is circulated into the subarachnoid space which goes to the subarachnoid trabeculae. but not absorbed here

A 29-year-old patient comes in; he cannot flex the distal interphalangeal (DIP) joint of the index finger. His physician determines that he has nerve damage from the supracondylar fracture. Which of the following conditions is also a symptom of this nerve damage? A. Inability to flex the DIP joint of the ring finger. B. Atrophy of the hypothenar eminence C. Loss of sensation over the distal part of the second digit. D. Paralysis of all thumb muscles E. Loss of supination

C DIP: flexor digitorum profundus. the index and middle finger innervated by median. sensation over distal part of second digit. A: ulnar B: ulnar C: median D: abductor pollicis longus, extensor pollicis longus and brevis are innervated by radial E: radial: supinator or musculocutaneous which is biceps brachii

A 27-year old patient presents with an inability to draw the scapula forward and downward because of the paralysis of the pectoralis minor. Which of the following would most likely be a cause of his condition? A. Fracture of the clavicle B. Injury to the posterior cord of the brachial plexus C. fracture of the coracoid process D. Axillary nerve injury E. Defects in the posterior wall of the axilla

C Pec minor attaches to coracoid process which comes from the 5th rib. it is D: innervated by the median and lateral pectoral nerves which B: come from lateral cords. pec minor depresses the shoulder A: not attached to clavicle E: anterior wall of axilla

A man is unable to hold typing paper between his index and middle finger. Which of the following nerves was injured? A. Radial nerve B. Median nerve C. Ulnar nerve D. Musculocutaneous nerve E. Axillary nerve

C adduction: palmar interossei: of index finger: ulnar nerve middle finger abduction: dorsal interossei: all ulnar nerve. middle finger only has dorsal interossei

A patient with a deep stab wound in the middle of the forearm has impaired movement of the thumb. Examination indicates a lesion of the anterior interosseous nerve. Which of the following muscles is paralyzed? A. Flexor pollicis longus and brevis B. Flexor pollicis longus and opponens pollicis C. Flexor digitorum profundus and pronator quadratus D. Flexor digitorum profundus and superficialis E. Flexor pollicis brevis and pronator quadratus

C anterior interosseous muscle is a branch of the median nerve. goes to the deep muscles of the forearm. AIM innervates: flexor pollicis longus, half of flexor digitorum profundus and pronator quadratus Median nerve innervates: pronator teres, flexor digitorum superficalis, palmaris longus, flexor carpi radialis, and thenar muscles

Following this accident, the damaged nerve causes difficulty in abduction, extension, and lateral rotation of his arm. Cell bodies of the injured nerve involved in movement of his arm are located in which of the following structures? A. Dorsal root ganglia B. Sympathetic chain ganglion C. Anterior horn of the spinal cord D. Lateral horn of the spinal cord E. Posterior horn of the spinal cord

C axillary: GSE whose cell bodies are located in the anterior horn. deltoid and teres minor. A: intrinsic muscles of the back. cell bodies of GSA and GVA located in the dorsal root ganglia. B. cell bodies of GSE post ganglionic sympathetic fibers. D. cell bodies of sympathetic preganglionic fibers between T1 and L2 E: interneurons

A 12-year-old boy walks in; he fell out of a tree and fractured the upper portion of his humerus. Which of the following nerves are intimately related to the humerus and are most likely to be injured by such a fracture? A. Axillary and musculocutaneous B. Radial and ulnar C. Radial and axillary D. Median and musculocutaneous E. Median and ulnar

C axillary: passes posteriorly around surgical neck of humerus radial nerve: radial groove. middle shaft of humerus ulnar nerve: passes behind medial epicondyle. median nerve: supracondyle Musculocutaneous: not in direct contact with humerus

A 22-year-old female Marcarena dancer fell from the stage and c/o elbow pain and inability to supinate her forearm. Which of the following nerves are most likely injured from this accident? A. median and ulnar nerves B. Axillary and radial nerves C. Radial and musculocutaneous nerves D. Ulnar and axillary nerves E. Musculocutaneous and median nerves

C biceps brachii: supination: musculocutaneous supinator: innervated by radial

A 27-year-old pianist with a known carpal tunnel syndrome experiences difficulty in finger movements. Which of the following intrinsic muscles of her hand is paralyzed? (A) Palmar interossei and adductor pollicis (B) Dorsal interossei and lateral two lumbricals (C) Lateral two lumbricals and opponens pollicis (D) Abductor pollicis brevis and palmar interossei (E) Medial two and lateral two lumbricals

C carpal tunnel is median nerve median nerve: abductor pollicis brevis, opponens pollicis, and 2 lateral lumbricals ulnar nerve: palmar and dorsal interossei, adductor pollicis, and 2 medial lumbricals

A secretary comes in to your office complaining of pain in her wrist from typing all day. You determine that she likely has carpal tunnel syndrome. Which of the following conditions would help you determine the diagnosis? A. In ability to adduct the little finger B. Inability to flex the DIP joint of the ring finger C. Flattened thenar eminence D. Loss of skin sensation of the medial one and one-half fingers E. Atrophied adductor pollicis muscle

C carpal tunnel: median nerve, flexor pollicis longus, flexor digitorum profundus, and flexor digitorum superficalis. Thenar muscles. A: ulnar: medial half of flexor digitorum profundus (ring and little finger), adductor pollicis B: ulnar (ring finger) C: median D: ulnar E: ulnar

27. Dorsal and ventral roots of the lower lumbar and sacral nerves are lacerated. Which structure is most likely damaged?

C cauda equina

A middle-aged coal miner injures his back after an accidental explosion. His magnetic resonance imaging (MRI) scan reveals that his spinal cord has shifted to the right because the lateral extensions of the pia mater were torn. Function of which of the following structures is most likely impaired? (A) Filum terminale internum (B) Coccygeal ligament (C) Denticulate ligament (D) Choroid plexus (E) Tectorial membrane

C denticulate ligament is the lateral extension of the pia mater A: inferior extension of pia mater B: goes from dural sac to coccyx D: produces CSF in ventricles of the brain E: upward extension of posterior longitudinal ligaments from body of axis to occipital bone

A 39-year-old woman with headaches pres- ents to her primary care physician with a pos- sible herniated disk. Her magnetic resonance imaging (MRI) scan reveals that the postero- lateral protrusion of the intervertebral disk between L4 and L5 vertebrae would most likely affect nerve roots of which of the following spinal nerves? (A) Third lumbar nerve (B) Fourth lumbar nerve (C) Fifth lumbar nerve (D) First sacral nerve (E) Second sacral nerve

C herniation at L4/5 affects 5th lumbar nerve root

Destruction of the structure indicated by the letter E most likely causes weakness of which of the following muscles? (A) Flexor carpi radialis (B) Palmaris longus (C) Flexor carpi ulnaris (D) Brachioradialis (E) Flexor digitorum superficialis

C hook of the hamate and pisiform are the insertions site for flexor carpi ulnaris

A 27-year-old stuntman is thrown out of his vehicle prematurely when the car used for a particular scene speeds out of control. His spinal cord is crushed at the level of the fourth lumbar spinal segment. Which of the following structures would most likely be spared from destruction? (A) Dorsal horn (B) Ventral horn (C) Lateral horn (D) Gray matter (E) Pia mater

C lateral horn contains sympathetic preganglionic fibers neuron cell bodies: present between T1-L2 later horn of S2-4 contains parasympathetic preganglionic neuron cell bodies A, B, D, E: entire spinal cord is surrounded by all of these

A 21-year old woman walks in with a shoulder and arm injury after falling during horseback riding. Examination indicates that she cannot adduct her arm because of paralysis of which of the following muscles? A. Teres minor B. Supraspinatus C. Latissimus dorsi D. Infraspinatus E. Serratus anterior

C lats adduct the arm B: abduction of the arm D: lateral rotation A: lateral rotation E: rotates scapular upward, abducts the arm, elevates the arm

A 21-year old patient has a lesion of the upper trunk of the brachial plexus (Erb-Duchenne paralysis). Which of the following is the most likely diagnosis. A. Paralysis of the rhomboid major B. Inability to elevate the arm above the horizontal C. Arm tending to lie in medial rotation D. Loss of sensation on the medial side of the arm E. Inability to abduct the arm

C lesion of upper trunk causes waiters tip (arm lies in medial rot). paralysis of lateral rot. and abduction B: serratus anterior innervated by long thoracic nerve from the roots A: dorsal scapular nerve innervates the rhomboid major A: from medial cord

A young toddler presents to her pediatrician with rather new onset of bowel and bladder dysfunction and loss of the lower limb function. Her mother had not taken enough folic acid (to the point of a deficiency) during her pregnancy. On examination, the child has protrusion of the spinal cord and meninges and is diagnosed with which of the following conditions? (A) Spina bifida occulta (B) Meningocele (C) Meningomyelocele (D) Myeloschisis (E) Syringomyelocele

C meningomyelocele: protrusion of meninges and spinal cord through unfused arch of vertebrae. neural tube defect: take folic acid A: failure of vertebral arch to fuse B: protrusion of meninges through defective vertebral arch E: protrusion of meninges and a tubular cavity in the brain and spinal cord

A patient with Bennett fracture (a fracture of the base of the first metacarpal bone) experiences an impaired thumb movement. Which of the following intrinsic muscles of the thumb is most likely injured? A. Abductor pollicis brevis B. Flexor pollicis brevis C. Opponens pollicis D. adductor pollicis E. Flexor retinaculum

C opponens pollicis: first metacarpal. proximal phalanges (intrinsic muscles of the thumb): Abductor pollicis brevis, flexor pollicis brevis, adductor pollicis muscle

After an automobile accident, a back mus- cle that forms the boundaries of the triangle of auscultation and the lumbar triangle receives no blood. Which of the following muscles might be ischemic? (A) Levator scapulae (B) Rhomboid minor (C) Latissimus dorsi (D) Trapezius (E) Splenius capitis

C part of lumbar and auscultation triangle and supplied by thoracodorsal artery lumbar triangle: external oblique, latissimus dorsi, and iliac crest D: involved in auscultation triangle but not the lumbar triangle A, B, D all are supplied by the transverse cervical artery E: supplied by the transverse cervical and occipital arteries

A 17-year-old boy fell from his motorcycle and c/o numbness of the lateral part of the arm. Examination reveals that the axillary nerve is severed. Which of the following types of axons is most likely spared? A. Postganglionic sympathetic axons B. somatic afferent axons C. preganglionic sympathetic axons D. General somatic efferent axons E. General visceral afferent axons

C post ganglionic sympathetic, GSA, GSE, GVA no preganglionic sympathetic general visceral efferent.

A 17-year-old boy with a stab wound received multiple injuries on the upper part of the arm and requires surgery. If the brachial artery were ligated at its origin, which of the following arteries would supply blood to the profunda brachii artery? A. Lateral thoracic B. Subscapular C. Posterior humeral circumflex D. Superior ulnar collateral E. Radial recurrent

C posterior humeral circumflex anastomosis with profunda brachii artery superior ulnar collateral and radial recurrent are inferior to the profunda brachii

A patient has a torn rotator cuff of the shoulder joint as the result of an automobile accident. Which of the following muscle tendons is intact and has normal function? A. Supraspinatus B. Subscapularis C. Teres major D. Teres minor E. Infraspinatus

C rotator cuff: sits: supraspinatus, infraspinatatus, teres minor, subscapularis

In a freak hunting accident, a 17-year-old boy was shot with an arrow that penetrated into his suboccipital triangle, injuring the suboc- cipital nerve between the vertebral artery and the posterior arch of the atlas. Which of the fol- lowing muscles would be unaffected by such a lesion? (A) Rectus capitis posterior major (B) Semispinalis capitis (C) Splenius capitis (D) Obliquus capitis superior (E) Obliquus capitis inferior

C splenius capitis is innervated by dorsal primary rami of middle and lower cervical nerves suboccipital nerve is from dorsal primary rami of C1 and supplies muscles of suboccipital area suboccipital area: rectus capitis posterior major, obliquus capitis superior, obliquus capitis inferior. and semispinalis capitis.

A rock climber falls on his shoulder, resulting in a chipping off of the lesser tubercle of the humerus. Which of the following structures would most likely have structural and functional damage? A. Supraspinatus muscle B. Infraspinatus muscles C. Subscapular muscle D. Teres minor E. Coracohumeral ligament

C subscapularis attaches to the lesser tubercle of the humerus

This accident most likely leads to the damage of which of the following arteries? A. Axillary B. Deep brachial C. Posterior humeral circumflex D. Superior ulnar collateral E. Scapular circumflex

C surgical neck: posterior circumflex humeral artery

64. A patient presents with pain in the neck, numbness and tingling in the fingers, and a week grip. This presentation suggests thoracic outlet syndrome. Which of the following causes has an embryological etiology? (A) Traumatic injury (B) Cardiovascular disease (C) Cervical rib (D) Pancoast tumor (E) Scalene muscle inflammation

C thoracic outlet syndrome: the space between your clavicle and first rib are compressed Space that transmit neurovasculature to the arm is reduced.

24. A 38-year-old woman with a long history of shoulder pain is admitted to a hospital for surgery. Which of the following muscles becomes ischemic soon after ligation of the superficial or ascending branch of the transverse cervical artery? (A) Latissimus dorsi (B) Multifidus (C) Trapezius (D) Rhomboid major (E) Longissimus capitis

C trapezius gets blood from the superficial branch of the cervical artery. A: thoracodorsal artery D: deep or descending branch of transverse cervical B and E: segmental arteries

A 31-year-old roofer walks in tenosynovitis resulting from a deep penetrated wound in the palm by a big nail. Examination indicates that he has an infection in the ulnar bursa. This infection most likely resulted in necrosis of which of the following tendons? A. Tendon of flexor carpi ulnaris B. Tendon of flexor pollicis longus C. Tendon of flexor digitorum profundus D. Tendon of flexor carpi radialis E. Tendon of palmaris longus

C ulnar bursa (common synovial flexor sheath): contains tendons flexor digitorum superficialis and profundus. B: radial bursa: tendon of flexor pollicis longus

A 27-year-old man with cubital tunnel syndrome complains of numbness and tingling in the ring finger and back and sides of his hand because of damage to a nerve in the tunnel at the elbow. Which of the following muscles is most likely to be paralyzed? A. Flexor digitorum superficialis B. Opponens pollicis C. Two medial lumbricals D. Pronator teres E. Supinator

C ulnar nerve goes through the cubital tunnel which innervates the medial 2 lumbricals Median nerve: lateral 2 lumbricals, flexor digitorum superficialis, opponens pollicis, and pronator teres. E: radial

4. A 17-year-old boy was involved in a gang fight, and a stab wound severed the white rami communicantes at the level of his sixth thoracic vertebra. This injury would result in degeneration of nerve cell bodies in which of the following structures? (A) Dorsal root ganglion and anterior horn of the spinal cord (B) Sympathetic chain ganglion and dorsal root ganglion (C) Sympathetic chain ganglion and posterior horn of the spinal cord (D) Dorsal root ganglion and lateral horn of the spinal cord (E) Anterior and lateral horns of the spinal cord

C white rami communicons goes to paravertebral: sympathetic.

26. A neonate appears severely cyanotic and breathing rapidly. Cardiac echocardiogram reveals that the aorta lies to the right of the pulmonary trunk. Which of the following is most likely occurred during development? (A) AP septum failed to develop in a spiral fashion (B) Excessive resorption of septum primum (C) Pulmonary valve atresia (D) Persistent truncus arteriosus (E) Coarctation of the aorta

D

5. A 27-year-old patient with an irregular heartbeat visits her doctor's office for examination. Where should the physician place the stethoscope to listen to the sound of the mitral valve? A. Over the medial end of the second lf intercostal space B. Over the medial end of the second rt intercostal space C. In the lf fourth intercostal space at the mid-clavicular line D. Over the rt half of the lower end of the body sterum E. Over the rt half of the lower end of the body of the sternum

D

7. A 37-year-old patient with palpitation was examined by her physician, and one of the diagnostic records included a posterior-anterior chest radiograph. Which of the following comprises the largest portion of the sternocostal surface of the heart seen on the radiograph? (A) Left atrium (B) Right atrium (C) Left ventricle (D) Right ventricle (E) Base of the heart

D

A 31-year-old patient complains of sensory loss over the anterior and posterior surfaces of the medial third of the hand and the medial one and one half fingers. He is diagnosed by a physician as having "funny bone" symptoms. Which of the following nerves is injured? A. Axillary B. Radial C. Median D. Ulnar E. Musculocutaneous

D

62. After this accident, supination is still possible through contraction of which of the following muscles? (A) Supinator (B) Pronator teres (C) Brachioradialis (D) Biceps brachii (E) Supraspinatus

D innervated by musculocutaneous

32. A cardiologist is on clinical rounds with her medical students. She asks them, "During the cardiac cycle, which of the following events occurs?" A. AV valves close during diastole B. Aortic valve closes during systole C. Pulmonary valve opens during diastole D. Blood flow in coronary arteries is maximal during diastole E. Aortic valve closes at the same time as the AV valve

D A. occurs during systole B. during diastole C. during systole E. aortic valve closes at diastole and AV valve closes and systole

The police bring in a murder suspect who has been in a gunfight with a police officer. The suspect was struck by a bullet in the arm; his median nerve has been dam- aged. Which of the following symptoms is likely produced by this nerve damage? (A) Waiter's tip hand (B) Claw hand (C) Wrist drop (D) Ape hand (E) Flattening of the hypothenar eminence

D A: Erb-duchenne palsy. superior trunk (C5-C6). axillary, musculocutaneous, suprascapular. Upper trunk of brachial plexus B: ulnar C: radial. due to loss of extension E: ulnar nerve

During a snowstorm, a 52-year-old man is brought to the emergency department after a multiple car accident. Which of the following conditions is produced by a force that drives the trunk forward while the head lags behind in a rear-end automobile collision? (A) Scoliosis (B) Hangman fracture (C) Meningomyelocele (D) Whiplash injury (E) Herniated disk

D A: lateral deviation due to uneven growth of spinal column B: fracture of neural arch through fracture of pedicle of the axis C: protrusion of meninges and spinal cord D: compression of spinal nerve roots due to nucleus pulposus protruding through annulus fibrosis

The damaged nerve causes numbness of the lateral side of the arm. Cell bodies of the injured nerve fibers involved in sensory loss are located in which of the following structures? A. Anterior horn of the spinal cord B. Posterior horn of the spinal cord C. Lateral horn of the spinal cord D. Dorsal root ganglia E. Sympathetic chain ganglia

D Axillary GSE, GSA, GVA, and sympathetic post ganglionic A: GSE B: interneuron C: sympathetic pre-ganglionic GVE D: GSA and GVA E: sympathetic post-ganglionic GVE

28. A 31-year-old man was involved in a severe automobile accident and suffered laceration of the left primary bronchus. The damaged primary bronchus: (A) Has a larger diameter than the right primary bronchus (B) Often receives more foreign bodies than the right primary bronchus (C) Gives rise to the eparterial bronchus (D) Is longer than the right primary bronchus (E) Runs under the arch of the azygos vein

D B: rt does C: rt does

An elderly man at a nursing home is known to have degenerative brain disease. When cere- brospinal fluid (CSF) is withdrawn by lumbar puncture for further examination, which of the following structures is most likely penetrated by the needle? (A) Pia mater (B) Filum terminale externum (C) Posterior longitudinal ligament (D) Ligamentum flavum (E) Annulus fibrosus

D CSF: subarachnoid space subarachnoid space: between arachnoid and pia mater Lumbar puncture goes through skin, fascia, ligamentum flavum, epidural space, dura mater, subdural space, and arachnoid mater. C: anterior to spinal cord B: downward from dura mater to dorsum of coccyx E: fibrous tissue and fibrocartilage surrounding nucleus pulposus in intervertebral disc (anterior to spinal cord) A: can't be punctured because it is the anterior surface of the subarachnoid space

A 42-year-old woman with metastatic breast cancer is known to have tumors in the inter- vertebral foramina between the fourth and fifth cervical vertebrae and between the fourth and fifth thoracic vertebrae. Which of the following spinal nerves may be damaged? (A) Fourth cervical and fourth thoracic nerves (B) Fifth cervical and fifth thoracic nerves (C) Fourth cervical and fifth thoracic nerves (D) Fifth cervical and fourth thoracic nerves (E) Third cervical and fourth thoracic nerves

D Cervical spines exit through intervertebral foramina ABOVE the corresponding vertebrae. So if you have a tumor between 4/5 then it will be the 5th. EXCEPTION: at 8th cervical vertebrae which it runs inferior to 7th vertebrae. All other nerves exit BELOW the vertebrae. So spinal nerves exiting the 4/5 thoracic vertebrae would the the 4th thoracic.

A 24-year-old carpenter suffers a crush injury of his entire little finger. Which of the following muscles is most likely to be spared? A. Flexor digitorum profundus B. Extensor digitorum C. Palmar interossei D. Dorsal interossei E: lumbricals

D Dorsal interossei are abductors of the fingers but doesn't attach to the little finger. The abductor digiti minimi abducts the little finger. attached to 1-4th digits C. adducts all fingers. attached to 1st, 4th and 5th digit

12. An 83-year-old man with a typical coronary circulation has been suffering from an embolism of the circumflex branch of the left coronary artery. This condition would result in ischemia of which of the following areas of the heart? (A) Anterior part of the left ventricle (B) Anterior interventricular region (C) Posterior interventricular region D. Posterior part of the lf ventricle E. Anterior part of the rt ventricle

D LAD

A patient comes in complaining that she cannot flex her proximal interphalangeal joints. Which of the following muscles appear to be paralyzed on further examination on her finger? A. Palmar interossei B. Dorsal interossei C. Flexor digitorum profundus D. Flexor digitorum superficialis E. Lumbricals

D PIP: FDS C: DIP: FDP A: flexion and extension B: flexion and extension E: flexion and extension

Which of the following muscles causes upward displacement of the medial fragment? A. pectoralis major B. Deltoid C. Trapezius D. Sternocleidomastiod E. Scalenus anterior

D Pec major and deltoid are involved in pulling the clavicle down laterally. The SCM and trapezius are involved in upward displacement. trapezius is attached to lateral aspect. SCM attached to the medial aspect.

A 14-year old boy falls on his outstretched hand and has a fracture of the scaphoid bone. The fracture is most likely accompanied by a rupture of which of the following arteries? A. Brachial artery B. Ulnar artery C. Deep palmar arterial arch D. Radial artery E. Princeps pollicis artery

D When you fracture scaphoid radial runs by it. Part of anatomical snuffbox radial artery divides into princeps pollicis artery and deep palmar arch

Which of the following muscles is most likely paralyzed as a result of this accident? A. Extensor pollicis brevis B. Abductor pollicis longus C. Abductor pollicis brevis D. Adductor pollicis E. Opponens pollicis

D all innervated by the median except for adductor pollicis which is innervated by the ulnar

66. If the structure indicated by the letter B is fractured, which of the following structures is most likely injured? (A) Musculocutaneous nerve (B) Radial nerve (C) Deep brachial artery (D) Posterior humeral circumflex artery (E) Scapular circumflex artery

D anatomic neck

A 27-year-old mountain climber falls from a steep rock wall and is brought to the emer- gency department. His physical examination and computed tomography (CT) scan reveal dislocation fracture of the upper thoracic ver- tebrae. The fractured body of the T4 vertebra articulates with which of the following parts of the ribs? (A) Head of the third rib (B) Neck of the fourth rib (C) Tubercle of the fourth rib (D) Head of the fifth rib (E) Tubercle of the fifth rib

D body articulates with the head of the rib. specifically body of T4 attaches to ribs 4 and 5 B: neck doesn't articulate with any part of the vertebrae C: transverse process articulates with tubercle (same number)

25. A 25-year-old soldier suffers a gunshot wound on the lower part of his back and is unable to move his legs. A neurologic examination and magnetic resonance imaging (MRI) scan reveal injury of the cauda equina. Which of the following is most likely damaged? (A) Dorsal primary rami (B) Ventral primary rami (C) Dorsal roots of the thoracic spinal nerves (D) Ventral roots of the sacral spinal nerves (E) Lumbar spinal nerves

D cauda equina is a collection of dorsal and ventral roots of the lower lumbar and sacral spinal nerves. A and B: roots are in the thoracic and lumbar and are not involved in the formation of the cauda equina

A 34-year-old woman crashes into a tree during a skiing lesson and is brought to a hos- pital with multiple injuries that impinge the dorsal primary rami of several spinal nerves. Such lesions could affect which of the following muscles? (A) Rhomboid major (B) Levator scapulae (C) Serratus posterior superior (D) Iliocostalis (E) Latissimus dorsi

D dorsal primary rami only does intrinsic (deep) muscles of the back. The only intrinsic muscle is Iliocostalis All other muscles are superficial muscles which are innervated by the ventral primary rami

During a breast examination of a 56-year-old woman, the physician found a palpable mass in her breast. Which of the following characteristics of breast cancer and its diagnosis is correct? A. Elevated nipple B. Polymastia C. Shortening of the clavipectoral fascia D. Dimpling of the overlying skin E. Enlargement of the breast

D due to shortening of the suspensory ligaments. Also could be retraction of the nipple due to pulling of the lactiferous ducts.

A 7-year-old boy falls from a tree house and is brought to the emergency department of a local hospital. On examination, he has weakness in rotating his arm laterally because of an injury of a nerve. Which of the following conditions is most likely to cause a loss of this nerve function? A. Injury to the lateral cord of the brachial plexus B. Fracture of the anatomic neck of the humerus C. Knife wound on the teres major muscles D. Inferior dislocation of the head of the humerus E. A tumor in the triangular space in the shoulder region

D falling from a tree is inferior dislocation of the humerus causes damage to the axillary nerve (comes from posterior cord of the brachial plexus (interneuron). axillary is in the quadrangular space with the posterior humeral circumflex artery. A. posterior cord B. inferior dislocation C. teres major: adduction and medial rotation (lower subscapular: posterior cord) E. circumflex scapular

30. Cerebrospinal fluid (CSF) is produced by vascular choroid plexuses in the ventricles of the brain and accumulated in which space?

D in lumbar cistern which is in the subarachnoid space in lumbar area.

A 22-year old patient received a stab wound in the chest that injured the intercostobrachial nerve. Which of the following conditions results from the described lesion of the nerve? A. Inability to move the ribs B. Loss of tactile sensation on the lateral aspect of the arm C. Absence of sweating on the posterior aspect of the arm D. Loss of sensory fibers from the second intercostal nerve E. Damage to the sympathetic preganglionic fibers

D intercostobrachial nerve comes from lateral cutaneous branch of the second intercostal nerve. A: innervates the intercostals and serratus anterior B: medial aspect of the arm C: sweat glands on medial side. E: contains sympathetic postganglionic fibers.

A 44-year-old woman comes to her physi- cian and complains of headache and backache. On examination, she is found to have fluid accumulated in the spinal epidural space be- cause of damage to blood vessels or meninges. Which of the following structures is most likely ruptured? (A) Vertebral artery (B) Vertebral vein (C) External vertebral venous plexus (D) Internal vertebral venous plexus (E) Lumbar cistern

D internal venous plexus is the only once located in the epidural space A and B: are in the transverse foramen C: is the anterior part which is in front of the vertebral column and vertebral arch E: enlargement of subarachnoid space

A 23-year-old woman receives a deep cut to her ring finger by a kitchen knife is unable to move the metacarpophalageal joint. Which of the following pairs of nerves was damaged? A. median and ulnar B. Radial and median C. Musculocutaneous and ulnar D. Ulnar and Radial E. Radial and axillary

D metacarpophalangeal joint of the ring finger is flexed by the lumbrical, palmar, and dorsal interosseous muscles: innervated by the ulnar nerve extensor digitorum: extends the ring finger. innervated by the radial nerve median nerve: lateral 2 lumbricals (flexion of the metacarpophalangeal joints of index and middle finger)

69. A lesion of the radial nerve would most likely cause paralysis of muscles that are attached to this area.

D olecranon is site for attachment of tricep brachii. innervated by radial nerve

The victim of an automobile accident has a destructive injury of the proximal row of carpal bones. Which of the following bones is most likely damaged? A. Capitate B. Hamate C. trapezium D. Triquetrum E. Trapezoid

D proximal row: schaphoid, lunate, triquetrum and pisiform

A patient complains of having pain with repeated movements of his thumb (claudication). His physician performs the Allen test and finds insufficiency of the radial artery. Which of the following conditions would be a result of the radial artery stenosis. A. marked decrease in the blood flow in the superficial palmar arch B. Decreased pulsation in the artery passing superficial to the flexor retinaculum C. Ischemia of the entire extensor muscles of the forearm D. A marked decrease in the blood flow in the princeps pollicis artery E. A low blood pressure in the anterior interosseous artery

D radial artery divides into princeps pollicis and deep palmar artery. A. that would be the deep palmar arch. superficial is ulnar B. that is the superficial palmar arch which is a branch of the ulnar artery C. posterior interosseous artery which is a branch of the ulnar artery E. medial

59. As a result of this fracture, the patient shows lack of sweating on the back of the arm and forearm. Cell bodies of the damaged nerve fibers involved in sweating are located in which of the following structures? (A) Anterior horn of the spinal cord (B) Posterior horn of the spinal cord (C) Lateral horn of the spinal cord (D) Sympathetic chain ganglion (E) Dorsal root ganglion

D radial nerve is the one that is damaged. sympathetic post ganglionic fibers whose cell bodies are located in the sympathetic chain. supply sweat glands, blood vessels and hair follicles. A: GSE B: interneurons C: pre-ganglionic sympathetic. T1-L2. E: GSA and GVA

Following this accident, the patient has no cutaneous sensation in which of the following areas? (A) Medial aspect of the arm (B) Lateral aspect of the forearm (C) Palmar aspect of the second and third digits (D) Area of the anatomic snuffbox (E) Medial one and one-half fingers

D radial nerve runs through the anatomical sniff box. A: medial brachial cutaneous (musculocutaneous) B: musculocutaneous C: median E: ulnar

A 37-year-old man is brought to the emer- gency department with a crushed second cervical vertebra (axis) that he suffered after a stack of pallets fell on him at work. Which of the following structures would be intact after the accident? (A) Alar ligament (B) Apical ligament (C) Semispinalis cervicis muscle (D) Rectus capitis posterior minor (E) Obliquus capitis inferior

D rectus capitis posterior minor comes from the posterior tubercle and inserts on the occipital bone. the only one that doesn't arise or insert from axis or atlas A: goes from apex of dens on the axis to the medial side of the occipital bone B: goes from apex of dens to anterior aspect of foramen magnum of the occipital bone C: arises from the transverse process and inserts on the spinous process E: arises from the spine of the axis and inserts on the transverse process of atlas

25. A 21-year-old patient with a stab wound reveals a laceration of the right vagus nerve proximal to the origin of the recurrent laryngeal nerve. Which of the following conditions would most likely result from this lesion? (A) Contraction of bronchial muscle (B) Stimulation of bronchial gland secretion (C) Dilation of the bronchial lumen (D) Decrease in cardiac rate (E) Constriction of coronary artery

D recurrent laryngeal nerve goes to the heart and loops up

65. If the structure indicated by the letter A (scapula) is calcified, which of the following muscles is most likely paralyzed? (A) Deltoid (B) Teres major (C) Teres minor (D) Infraspinatus (E) Subscapularis

D scapular notch. suprascapular nerve subscapularis A: axillary B: subscapularis C: axillary E: subscapularis

72. The patient is unable to abduct her middle finger because of paralysis of this structure.

D second dorsal interossei is what abducts the middle finger

A man injures his wrist on broken glass. Which of the following structures entering the palm superficial to the flexor retinaculum may be damaged? A. Ulnar nerve and median nerve B. Median nerve and flexor digitorum profundus C. Median nerve and flexor pollicis longus D. ulnar artery and ulnar nerve E. ulnar nerve and flexor digitorum superficialis

D superfical to flexor retinaculum: ulnar nerve, ulnar artery, palmaris longus tendon, and palmar cutaneous branch of median nerve Deep to flexor retinaculum: median nerve, flexor pollicis longus, and flexor digitorum superficialis and profundus.

A 38-year-old homebuilder was involved in an accident and is unable to supinate his forearm. Which of the following nerves are most likely damaged? A. Suprascapular and axillary B. Musculocutaneous and median C. Axillary and radial D. Radial and musculocutaneous E. Median and ulnar

D supination of the forearm: biceps brachii and supinator so musculocutaneous and radial

A 29-year old man comes in with a stab wound, cannot raise his arm above horizontal, and exhibits a condition known as "winged scapula". Which of the following structures of the brachial plexus would most likely be damaged? A. Medial Cord B. Posterior Cord C. Lower Trunk D. Roots E: Upper Trunk

D that is the serratus anterior which is the lateral thoracic which comes from the roots

18. A newborn baby is readmitted to the hospital with hypoxia and upon testing is found to have pulmonary stenosis, transposition of the aorta, interventricular septal defect, and hypertrophy of the right ventricle. Which of the following is best described by these symptoms? (A) ASD (B) Patent ductus anreriosus (C) Tetralogy of Fallot (D) Aortic stenosis (E) Coarctation of the aorta

d

15. A 37-year-old patient with severe chest pain, shortness of breath, and congestive heart failure was admitted to a local hospital. His coronary angiograms reveal a thrombosis in the circumflex branch of the left coronary artery. Which of the following conditions could result from the blockage of blood flow in the circumflex branch? (A) Tricuspid valve insufficiency (B) Mitral valve insufficiency (C) Ischemia of AV node (D) Paralysis of pectinate muscle (E) Necrosis of septomarginal trabecula

B

29. A 62-year-old woman who is a heavy smoker has an advanced lung cancer that spread into her right third posterior intercostal space posterior to the midaxillary line. If cancer cells are carried in the venous drainage, they would travel first to which of the following veins? (A) SVC (B) Right superior intercostal vein (C) Right brachiocephalic vein (D) Azygos vein (E) Hemiazygos vein

B

6. A 19-year-old man came to the emergency department, and his angiogram exhibited that he was bleeding from the vein that is accompanied by the posterior interventricular artery. Which of the following veins is most likely to be ruptured? (A) Great cardiac vein (B) Middle cardiac vein (C) Anterior cardiac vein (D) Small cardiac vein (E) Oblique veins of the left atrium

B

A 49 year old women is diagnosed with having a large lump in her rt breast. Lymph from the cancerous breast drains primarily into which of the following nodes? A. Apical nodes B. Anterior (pectoral) nodes C. parasternal (internal thoracic) nodes D. supraclavicular nodes E. Nodes of the anterior abdominal wall

B

During the procedure, the needle hits a nerve medial to the artery. Which of the following nerves is most likely damaged? (A) Radial (B) Median (C) Ulnar (D) Lateral antebrachial (E) Medial antebrachial

B

Questions 58 to 62: A 17-year-old boy is injured in an automobile accident. He has a fracture of the shaft of the humerus. 58. Which of the following nerves is most likely damaged? (A) Axillary nerve (B) Radial nerve (C) Musculocutaneous nerve (D) Median nerve (E) Ulnar nerve

B

Which of the following conditions is most likely to occur secondary to the fractured clavicle? A. A fatal hemorrhage from the brachiocephalic vein B. Thrombosis of the subclavian vein, causing a pulmonary embolism C. Thrombosis of the subclavian artery, causing an embolism in the ascending aorta D. Damage to the upper trunk of the brachial plexus E. Damage to the long thoracic nerve, causing the winged scapula

B A. would be subclavian instead of brachiocephalic B. subclavian vein goes to brachiocephalic to SVC to rt atrium to rt ventricle to pulmonary trunk to lungs. D. not artery. E. that is protected by the axilla

21. A 75-year-old woman was admitted to a local hospital, and bronchograms and radiographs revealed a lung carcinoma in her left lung. Which of the following structures or characteristics does the cancerous lung contain? (A) Horizontal fissure (B) Groove for superior vena cava (SVC) (C) Middle lobe (D) Lingula (E) Larger capacity than the right

B A: only in rt B: only in rt C: only in rt E: rt is larger so no

A 27-year-old baseball player is hit on his forearm by a high-speed ball during the World Series, and the muscles that form the floor of the cubital fossa appear to be torn. Which of the following groups of muscles have lost their function? A. Brachioradialis and supinator B. Brachialis and supinator C. Pronator teres and supinator D. Supinator and pronator quadratus E. Brachialis and pronator teres

B Cubital fossa: Brachialis and supinator muscles form the floor brachioradialis and pronator teres form the lateral and medial boundaries

After a 26-year-old man's car was broadsided by a large truck, he is brought to the emergency department with multiple fractures of the transverse processes of the cervical and upper thoracic vertebrae. Which of the following muscles might be affected? (A) Trapezius (B) Levator scapulae (C) Rhomboid major (D) Serratus posterior superior (E) Rectus capitis posterior major

B It arises from transverse process of upper cervical vertebrae Inserts on the medial border of the scapula All of the other muscles attach to the spinous process

A 24-year-old woman comes to a hospital to deliver her baby. Her obstetrician uses a caudal anesthesia during labor and childbirth to block the spinal nerves in the epidural space. Local anesthetic agents are most likely injected via which of the following openings? (A) Intervertebral foramen (B) Sacral hiatus (C) Vertebral canal (D) Dorsal sacral foramen (E) Ventral sacral foramen

B caudal (epidural) block spinal nerves via sacral hiatus A: intervertebral foreamen transmits dorsal and ventral rami of spinal nerves C: spinal cord D: dorsal primary rami of sacral nerves E: ventral primary rami of sacral nerves

28. The spinal cord is crushed at the level of the upper part of the first lumbar vertebra. Which structure is most likely damaged?

B conus medullaris is the end of the spinal cord that ends at L2. or between L1 and L2.

During a domestic dispute, a 16-year-old boy receives a deep stab wound around the su- perior angle of the scapula near the medial bor- der, which injures both the dorsal scapular and spinal accessory nerves. Such an injury could result in paralysis or weakness of which of the following muscles? (A) Trapezius and serratus posterior superior (B) Rhomboid major and trapezius (C) Rhomboid minor and latissimus dorsi (D) Splenius cervicis and sternocleidomastoid (E) Levator scapulae and erector spinae

B dorsal scapular: rhomboids and levator scapulae accessory nerve: trapezius and SCM serratus posterior superior is innervated by the ventral primary rami splenius cervicis and erector spinae are innervated by the dorsal primary rami

22. An 18-year-old girl is thrust into the steering wheel while driving and experiences difficulty in expiration. Which of the following muscles is most likely damaged? (A) Levator costarum (B) Innermost intercostal muscle (C) External intercostal muscle (D) Diaphragm (E) Muscles of the abdominal wall

B forced expiration: innermost intercostals

Following this accident, the boy has weak- ness in rotating his arm laterally. Which of the following muscles are paralyzed? (A) Teres major and teres minor (B) Teres minor and deltoid (C) Infraspinatus and deltoid (D) Supraspinatus and subscapularis (E) Teres minor and infraspinatus

B lateral rotation: teres minor, deltoid, and infraspinatus (suprascapular) axillary: deltoid teres major: medial rotation, adduction of the arm, lower subscapular nerve infraspinatus: lateral rotation. suprascapular n. subscapularis: medial rotation. lower and upper subscapular nerve supraspinatus: abduction of the arm 0-15. suprascapular

A 23-year-old man complains of numbness on the medial side of the of the arm following a stab wound in the axilla. On examination, he is diagnosed with an injury of his medial branchial cutaneous nerve. In which of the following structures are the cell bodies of the damaged nerve involved in numbness located? A. Sympathetic chain ganglion B. Dorsal Root Ganglia C. Anterior Horn of the Spinal cord D. Lateral horn of the spinal cord E. Posterior horn of the spinal cord

B median brachial cutaneous: sensory (general somatic afferent). cell bodies in DRG. causes numbness on medial side of arm A. sympathetic post ganglionic fibers (sympathetic ganglia) C. skeletal motor: general somatic efferent D. sympathetic preganglionic E. interneurons

A 25-year-old man with congenital ab- normalities at birth has a lesion of the dorsal scapular nerve, making him unable to adduct his scapula. Which of the following muscles is most likely paralyzed? (A) Semispinalis capitis (B) Rhomboid major (C) Multifidus (D) Rotator longus (E) Iliocostalis

B only superficial muscle and is innervated by the dorsal scapular nerve. innervated by ventral primary rami. adducts the scapula A, C, D, and E: are all deep muscles innervated by the dorsal primary rami. not connected to the scapula

67. Destruction of this area would most likely cause weakness of supination and flexion of the forearm.

B radial tuberosity. where biceps brachii attaches

24. A 46-year-old patient comes to his doctor's office and complains of chest pain and headache. His computed tomography (CT) scan reveals a tumor located just superior to the root of the right lung. Blood flow in which of the following veins is most likely blocked by this tumor? (A) Hemiazygos vein (B) Arch of the azygos vein (C) Right subclavian vein (D) Right brachiocephalic vein (E) Accessory hemiazygos vein

B root is at T4: arch of azygous is at T4

71. If the floor of the anatomic snuffbox and origin of the abductor pollicis brevis are damaged, which of the following bones is most likely to be involved? (A) A (B) B (C) C (D) D (E) E

B scaphoid is the floor of the anatomical sniff box. site for the origin of the abductor pollicis brevis

3. A 23-year-old man received a gunshot wound, and his greater splanchnic nerve was destroyed. Which of the following nerve fibers would be injured? (A) General somatic afferent (GSA) and preganglionic sympathetic fibers (B) General visceral afferent (GVA) and postganglionic sympathetic fibers (C) GVA and preganglionic sympathetic fibers (D) General somatic efferent (GSE) and postganglionic sympathetic fibers (E) GVA and GSE fibers

B splanchnic nerves go to the gut. GVA

Questions 51 to 55: A 10-year-old boy falls off his bike, has difficulty in moving his shoulder, and is brought to the emergency department. His radiograph and angiograph reveal fracture of the surgical neck of his humerus and bleeding from the point of the fracture: Which of the following nerves is most likely injured as a result of this accident? A. Musculocutaneous B. Axillary C. Radial D. Median E. Ulnar

B surgical neck fracture: axillary.

75. Atrophy of this structure impairs extension of both the metacarpophalangeal and interpha- langeal joints.

E extensor digitorum: extends the metacarpophalangeal and interphalangeal joints

A 69-year-old man has an abnormally increased curvature of the thoracic vertebral column. Which of the following conditions is the most likely diagnosis? (A) Lordosis (B) Spina bifida occulta (C) Meningocele (D) Meningomyelocele (E) Kyphosis

E kyphosis or hunchback: increased thoracic curvature A: abnormal lumbar curvature B: when the vertebral arch doesn't fuse C: meninges protrude. vertebral arch doesn't fuse D: protrusion of meninges and spinal cord

A 20 year old man fell from the parallel bar during the Olympic trial. A neurologic examination reveals that he has a lesion of the lateral cord of the brachial plexus. Which of the following muscles is most likely weakened by the injury? A. Subscapularis B. Teres major C. Latissimus dorsi D. Teres minor E. Pectoralis major

E lateral cord: lateral pectoral: pectoralis major A: lower and upper subscapular: posterior cord B: lower subscapular: posterior cord C. thoracodorsal: posterior cord D: axillary branch

68. Destruction of this area would most likely cause weakness of pronation of the forearm and flexion of the wrist joints.

E medial epicondyle is the attachment side for common flexor tendon and pronator teres.

Questions 48 to 50: A 21-year-old man injures his right arm in an automobile accident. Radio- graphic examination reveals a fracture of the medial epicondyle of the humerus. Which of the following nerves is most likely injured as a result of this accident? A. Axillary B. Musculocutaneous C. Radial D. Median E. Ulnar

E medial epicondyle: ulnar

Use this for the next 3 questions A 37-year-old female patient has a fracture of the clavicle. The junction of the middle and lateral thirds of the bone exhibits overriding of the middle and lateral fragments. The arm is rotated medially, but is not rotated laterally. The lateral portion of the fractured clavicle is displaced downward by which of the following? A. deltoid and trapezius muscles B. Pectoralis major and deltoid C. Pectoralis minor and gravity D. Trapezius and pectoralis minor E. Deltoid and gravity

E pec major and deltoid pull it down breaks at 2/3 and lateral goes down and medial goes up SCM and trapezius pulls up the clavicle medially. pec major attaches to the middle of the clavicle and middle tubercle of the humerus. Pec major also does median rotation. Deltoid attaches to the lateral side of the clavicle

13. A 44-year-old man with a stab wound was brought to the emergency department, and a physician found that the patient was suffering from a laceration of his right phrenic nerve. Which of the following conditions has likely occurred? (A) Injury to only GSE fibers (B) Difficulty in expiration (C) Loss of sensation in the fibrous pericardium and mediastinal pleura (D) Normal function of the diaphragm (E) Loss of sensation in the costal part of the diaphragm

E phrenic nerve: innervates parietal pleura, pericardium, and diaphragm

17. A thoracentesis is performed to aspirate an abnormal accumulation of fluid in a 37-year-old patient with pleural effusion. A needle should be inserted at the midaxillary line between which of the following two ribs so as to avoid puncturing the lung? (A) Ribs 1 and 3 (B) Ribs 3 and 5 (C) Ribs 5 and 7 (D) Ribs 7 and 9 (E) Ribs 9 and 11

E there is no heart or ribs here or 9-10th rib you can also listen to the heart here

11. The bronchogram of a 45-year-old female smoker shows the presence of a tumor in the eparterial bronchus. Which airway is most likely blocked? (A) Left superior bronchus (B) Left inferior bronchus (C) Right superior bronchus (D) Right middle bronchus (E) Right inferior bronchus

C

20. A 56-year-old patient recently suffered a myocardial infarction in the area of the apex of the heart. The occlusion by atherosclerosis is in which of the following arteries? (A) Marginal artery (B) Right coronary artery at its origin (C) Anterior interventricular artery (D) Posterior interventricular artery (E) Circumflex branch of the left coronary artery

C

30. A radiologist examines posterior-anterior chest radiographs of a 27-year-old victim of a car accident. Which of the following structures forms the right border of the cardiovascular silhouette? (A) Arch of the aorta (B) Pulmonary trunk (C) SVC (D) Ascending aorta (E) Left ventricle

C

61. Which of the following arteries may be damaged? (A) Brachial artery (B) Posterior humeral circumflex artery (C) Profunda brachii artery (D) Radial artery (E) Radial recurrent artery

C

8. A 5-year-old girl is brought to the emergency department because of difficulty breathing (dyspnea), palpitations, and shortness of breath. Doppler study of the heart reveals an atrial septal defect (ASD). This malformation usually results from incomplete closure of which of the following embryonic structures? (A) Ductus arteriosus (B) Ductus venosus (C) Sinus venarum (D) Foramen ovale (E) Truncus arteriosus

C

9. A 54-year-old patient is implanted with an artificial cardiac pacemaker. Which of the following conductive tissues of the heart had a defective function that required the pacemaker? (A) Atrioventricular (AV) bundle (B) AV node (C) Sinoatrial (SA) node (D) Purkinje fiber (E) Moderator band

C

A 32-year-old patient who weighs 275 lb comes to the doctor's office. On the surface of the chest, the physician is able to locate the apex of the heart A. At the level of the sternal angle B. In the left fourth intercostal space C. In the lf fifth intercostal space D. In the rt 5th intercostal space E. At the level of the xiphoid process of the sternum

C

An automobile body shop worker has hit his middle finger while working on a transmission. Which of the following muscles is most likely to retain function? A. Extensor digitorum B. Flexor digotorum profundus C. Palmar interosseous D. Dorsal interosseous E. Lumbrical

C A: extends all the digit. attach to middle digit B: flexes all the digits. attaches to middle digit C: doesn't attach to middle digit D: attaches to middle digit E: attaches to middle digit

A crush injury of the vertebral column can cause the spinal cord to swell. Which structure would be trapped between the dura and the vertebral body by the swelling spinal cord? (A) Anterior longitudinal ligament (B) Alar ligament (C) Posterior longitudinal ligament (D) Cruciform ligament (E) Ligamentum nuchae

C C: posterior longitudinal ligaments connect the vertebral bodies and intervertebral discs posteriorly. runs anterior to the spinal cord in the vertebral canal E: formed by supraspinous ligaments. form C7 to external occipital protuberance A: runs anterior to vertebral bodies B and D: are anterior to spinal cord

A 35-year old man walks in with a stab wound to the most medial side of the proximal portion of the cubital fossa. Which of the following structures would most likely be damaged? A. Biceps brachii tendon B. Radial nerve C. Brachial nerve D. Radial recurrent artery E. Median nerve

E cubital fossa medial to lateral: median nerve, brachial artery, biceps brachii tendon, and radial nerve

26. When the internal vertebral venous plexus is ruptured, venous blood may spread into which tissue and space?

E epidural fat internal vertebral plexus is in the epidural space

14. An 8-year-old boy with ASD presents to a pediatrician. This congenital heart defect shunts blood from the left atrium to the right atrium and causes hypertrophy of the right atrium, right ventricle, and pulmonary trunk. Which of the following veins opens into the hypertrophied atrium? (A) Middle cardiac vein (B) Small cardiac vein (C) Oblique cardiac vein (D) Anterior cardiac vein (E) Right pulmonary vein

E

19. A 33-year-old patient is suffering from a sudden occlusion at the origin of the descending (thoracic) aorta. This condition would most likely decrease blood flow in which of the following intercostal arteries? (A) Upper six anterior (B) All of the posterior (C) Upper two posterior (D) Lower anterior (E) Lower six posterior

E

27. A 12-year-old boy was admitted to a local hospital with a known history of heart problems. His left ventricular hypertrophy could result from which of the following conditions? (A) A constricted pulmonary trunk (B) An abnormally small left AV opening (C) Improper closing of the pulmonary valves (D) An abnormally large right AV opening (E) Stenosis of the aorta

E

33. Coronary angiographs of a 44-year-old male patient reveal an occlusion of the circumflex branch of the left coronary artery. This patient has been suffering from myocardial infarction in which of the following areas? (A) Right and left ventricles (B) Right and left atria (C) Interventricular septum (D) Apex of the heart (E) Left atrium and ventricle

E

31. A 37-year-old man is brought to the emergency department complaining of severe chest pain. His angiogram reveals thromboses of both brachiocephalic veins just before entering the superior vena cava. This condition would most likely cause a dilation of which of the following veins? (A) Azygos (B) Hemiazygos (C) Right superior intercostal (D) Left superior intercostal (E) Internal thoracic

E A: goes into SVC B: goes into azygous C and D: run into azygous and hemiazygous

23. A 78-year-old patient presents with an advanced cancer in the posterior mediastinum. The surgeons are in a dilemma as to how to manage the condition. Which of the following structures is most likely damaged? (A) Brachiocephalic veins (B) Trachea (C) Arch of the azygos vein (D) Arch of the aorta (E) Hemiazygos vein

E A: superior B: superior C: Middle? D: Superior

A patient comes in with a gunshot wound and requires surgery in which his thoracoacromial trunk needs to be ligated. Which of the following arterial branches would maintain normal blood flow? A. Acromial B. Pectoral C. Clavicular D. Deltoid E. Superior Thoracic

E In the second branch of the axillary artery. First would which is superior thoracic. second branches are pectoral, clavicular, acromial, and deltoid

A construction workers suffers a destructive injury of the structures related to the anatomic snuffbox. Which of the following structures would most likely be damaged? A. Triquetral bone B. Trapezoid bone C. extensor incidis tendon D. abductor pollicis brevis tendon E. Radial artery

E Snuffbox contains: radial artery, schaphoid, abductor pollicis longus, extensor pollicis longus and brevis

After this injury, the patient is unable to do which of the following? A. Flex the proximal interphalangeal joint of his ring finger B. Flex the DIP joint of his index finger C. Feel sensation on his middle finger D. Abduct his thumb E. Adduct his index finger

E adduction is done by the palmar interossei (ulnar) A. flexor digitorum superficalis: median nerve B: flexor digitorum profundus: of the index and middle fingere (median) C. palmar aspect of the middle finger (median) D. abductor pollicis longus (radial) and abductor pollicis brevis (median)

A 16-year old patient has weakness flexing the metacarpophalangeal joint of the ring finger and is unable to adduct the same finger. Which of the following muscles is most likely paralyzed? A. Flexor digitorum profundus B. Extensor digitorum C. Lumbrical D. Dorsal interosseous E. Palmar interosseous

E adduction: palmar interosseous muscles flexion of the metacarpophalangeaal joint: doral and palmar interosseous and lumbricals Extension of interphalangeal joints: dorsal and palmar interosseous abduction of the fingers: dorsal interosseous A: flexes the distal interphalangeal joint

A 26-year-old heavyweight boxer was punched on his mandible, resulting in a slight subluxation (dislocation) of the atlantoaxial joint. The consequence of the injury was decreased range of motion at that joint. What movement would be most affected? (A) Extension (B) Flexion (C) Abduction (D) Adduction (E) Rotation

E atlantoaxial joints do rotation

74. The patient is unable to adduct her little finger because of paralysis of this structure.

G third palmar interossei: adduction of the little finger