BRS Anatomy

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52. A 58-year-old woman comes to a hospital and complains of progressive loss of voice, numbness, loss of taste on the back part of her tongue, and difﬁ culty in shrugging her shoulders. Her MRI scan reveals a dural meningioma that compresses the nerves leaving the skull. These nerves leave the skull through which of the following openings? (A) Foramen spinosum (B) Foramen rotundum (C) Internal auditory meatus (D) Jugular foramen (E) Foramen lacerum

53. A 21-year-old woman presents to her physician with a swelling on her neck. On examination, she is diagnosed with an infection within the carotid sheath. Which of the following structures would be damaged? (A) Vagus nerve and middle cervical ganglion (B) Internal carotid artery and recurrent laryngeal nerve (C) Internal jugular vein and vagus nerve (D) Sympathetic trunk and common carotid artery (E) External carotid artery and ansa cervicali

54. An angiogram of a 45-year-old man shows an occlusion of the costocervical trunk. This obstruction could produce a marked decrease in the blood ﬂ ow in which of the following arteries? (A) Superior thoracic artery (B) Transverse cervical artery (C) Ascending cervical artery (D) Deep cervical artery (E) Inferior thyroid artery

55. A 20-year-old guard at the gate of the Royal King's palace blinks his eyes when a strong wind hits the cornea of his eye. The afferent ﬁ bers of the corneal reﬂ ex arc are carried by which of the following nerves? (A) Optic nerve (B) Lacrimal nerve (C) Nasociliary nerve (D) Zygomatic nerve (E) Oculomotor nerve

56. A 57-year-old man comes to a local hospital with fever, headache, nausea, and vomiting. Laboratory tests reveal an infection, and radiologic examination localizes the infection to the cavernous sinus. Which of the following nerves would be unaffected by this condition? (A) Oculomotor nerves (B) Abducens nerves (C) Trochlear nerves (D) Mandibular nerves (E) Ophthalmic nerves

57. A 7-year-old girl has difﬁ culty breathing through her nose and is brought to her pediatrician. On examination, she is diagnosed with adenoids. Which of the following tonsils is enlarged? (A) Palatine tonsil (B) Pharyngeal tonsil (C) Tubal tonsil (D) Lingual tonsil (E) Eustachian tonsil

58. A 59-year-old woman with pain at the side of her skull comes to the emergency department. An emergent head CT scan shows a large lesion in the internal auditory meatus. This condition may progress and damage which of the following pairs of structures? (A) Vagus and glossopharyngeal nerves (B) Internal carotid and vertebral arteries (C) Internal jugular vein and trigeminal nerve (D) Facial and vestibulocochlear nerves (E) Hypoglossal and accessory nerves

59. After ingesting a toxic substance found in her friend's home, a 12-year-old girl is unable to close her lips. Which of the following muscles may be paralyzed? (A) Levator labii superioris (B) Zygomaticus minor(C) Orbicularis oris (D) Lateral pterygoid (E) Depressor labii inferioris

6. A 45-year-old woman is suffering from numbness over the tip of her nose. Which of the following nerves is most likely to be damaged? (A) Ophthalmic division of the trigeminal nerve (B) Maxillary division of the trigeminal nerve (C) Mandibular division of the trigeminal nerve (D) Facial nerve (E) Auriculotemporal nerve

60. A 37-year-old man receives a direct blow to his head and is brought to an emergency department. His radiograph shows a fracture of the ﬂ oor of the middle cranial cavity, causing severance of the greater petrosal nerve. Which of the following conditions could be produced by this injury? (A) Increased lacrimal gland secretion (B) Loss of taste sensation in the epiglottis (C) Dryness in the nose and palate (D) Decreased parotid gland secretion (E) Loss of sensation in the pharynx

61. A 71-year-old man suffers from a known benign tumor in the pterygoid canal. Which of the following nerve ﬁ bers could be injured by this condition? (A) Postganglionic parasympathetic ﬁ bers (B) Taste ﬁ bers from the epiglottis (C) General somatic afferent (GSA) ﬁ bers (D) Preganglionic sympathetic ﬁ bers (E) General visceral afferent ﬁ bers

62. A 65-year-old man with multiple vision problems comes to a local eye clinic. The pupillary light reﬂ ex can be eliminated by cutting which of the following nerves? (A) Short ciliary, ophthalmic, and oculomotor nerves (B) Long ciliary, optic, and short ciliary nerves (C) Oculomotor, short ciliary, and optic nerves (D) Optic and long ciliary nerves and ciliary ganglion (E) Ophthalmic and optic nerves and ciliary ganglion

63. A 22-year-old patient has dryness of the corneal surface of his eye because of a lack of tears. Which of the following nerves may be damaged? (A) Proximal portion of the lacrimal nerve (B) Zygomatic branch of the facial nerve (C) Lesser petrosal nerve (D) Greater petrosal nerve (E) Deep petrosal nerve

64. A 12-year-old boy has difﬁ culty in breathing because he is choking on food. A school nurse performs the Valsalva maneuver to expel air from his lungs and thus dislodge the food. When that fails, she performs a needle cricothyrotomy, which would open into which of the following regions? (A) Rima glottidis (B) Laryngeal vestibule (C) Laryngeal ventricle (D) Infraglottic cavity (E) Piriform recess

65. A 59-year-old stroke patient is unable to swallow because of a nerve injury. Which of the following nerves is unaffected? (A) Hypoglossal nerve (B) Spinal accessory nerve (C) Vagus nerve (D) Facial nerve (E) Trigeminal nerve

66. A 2-year-boy presents with midfacial and mandibular hypoplasia, cleft palate, deformed external ear, and defect in hearing. Which of the following embryonic structures is most likely developed abnormally? (A) First pharyngeal arch (B) Second pharyngeal arch (C) Third pharyngeal arch (D) Fourth pharyngeal arch (E) Sixth pharyngeal arch

67. A 64-year-old woman is unable to open her mouth or jaw because of tetanus resulting from a penetrating wound from a rusty nail. Which of the following muscles would most likely be paralyzed? (A) Masseter muscle (B) Medial pterygoid muscle (C) Lateral pterygoid muscle (D) Buccinator muscle (E) Temporalis muscle

68. A 60-year-old man is unable to open his eye because of a rare neuromuscular disease. Which of the following muscles would most likely be paralyzed? (A) Orbicularis oculi (B) Orbicularis oris (C) Frontalis (D) Levator palpebrae superioris (E) Superior rectus

69. A 31-year-old hockey player is hit in the head by a puck. His radiogram shows a fracture of the foramen rotundum. Which of the following nerves would be damaged by this event? (A) Ophthalmic nerve (B) Mandibular nerve (C) Maxillary nerve (D) Optic nerve (E) Trochlear nerve

7. A 26-year-old singer visits her p hysician—an ear, nose, and throat (ENT) surgeon—and complains of changes in her voice. A laryngoscopic examination demonstrates a lesion of the superior laryngeal nerve, causing weakness of which of the following muscles? (A) Inferior pharyngeal constrictor (B) Middle pharyngeal constrictor (C) Superior pharyngeal constrictor (D) Thyroarytenoid (E) Thyrohyoid

70. A 46-year-old man visits the speech therapist complaining of dryness of the mouth. The therapist performs a swallowing study and, on examination, ﬁ nds that the man has a lack of salivary secretion from the submandibular gland. This indicates a lesion of which of the following nervous structures? (A) Lingual nerve at its origin (B) Chorda tympani in the middle ear cavity (C) Superior cervical ganglion (D) Lesser petrosal nerve (E) Auriculotemporal nerve

71. A 51-year-old woman traveling through British Columbia can see the beautiful blue sky with white clouds but is unable to focus on her face in the mirror. Her lack of accommodation results from paralysis of which of the following muscles? (A) Tarsal muscle (B) Sphincter pupillae (C) Dilator pupillae (D) Ciliary muscles (E) Orbitalis muscles

72. A 3-year-old girl is admitted to the hospital with pain and hearing defect. An MRI examination reveals that she has developmental defects in the auditory tube and middle ear cavity. Which of the following pharyngeal pouches is most likely developed abnormally? (A) First pouch (B) Second pouch (C) Third pouch (D) Fourth pouch (E) Second and fourth pouches

8. A 44-year-old man with "crocodile tears syndrome" has spontaneous lacrimation during eating because of misdirection of regenerating autonomic nerve ﬁ bers. Which of the following nerves has been injured? (A) Facial nerve proximal to the geniculate ganglion (B) Auriculotemporal nerve (C) Chorda tympani in the infratemporal fossa (D) Facial nerve at the stylomastoid foramen (E) Lacrimal nerve

9. A young girl complains of dryness of the nose and the palate. This would indicate a lesion of which of the following ganglia? (A) Nodose ganglion (B) Otic ganglion (C) Pterygopalatine ganglion (D) Submandibular ganglion (E) Ciliary ganglion

A 10-year-old boy falls from a tree house. The resultant heavy compression of the sole of his foot against the ground caused a fracture of the head of the talus. Which of the following structures is unable to function normally? (A) Transverse arch (B) Medial longitudinal arch (C) Lateral longitudinal arch (D) Tendon of the peroneus longus (E) Long plantar ligament

A 10-year-old boy falls off his bike, has difﬁ culty in moving his shoulder, and is brought to an emergency department. His radiogram and angiogram reveal fracture of the surgical neck of his humerus and bleeding from the point of the fracture. Following this accident, the boy has weakness 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

A 10-year-old boy falls off his bike, has difﬁ culty in moving his shoulder, and is brought to an emergency department. His radiogram and angiogram reveal fracture of the surgical neck of his humerus and bleeding from the point of the fracture. Following this accident, the damaged nerve causes difﬁ culty 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 ganglion (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

A 10-year-old boy falls off his bike, has difﬁ culty in moving his shoulder, and is brought to an emergency department. His radiogram and angiogram reveal fracture of the surgical neck of his humerus and bleeding from the point of the fracture. The damaged nerve causes numbness of the lateral side of the arm. Cell bodies of the injured nerve ﬁ bers 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

A 10-year-old boy falls off his bike, has difﬁ culty in moving his shoulder, and is brought to an emergency department. His radiogram and angiogram reveal fracture of the surgical neck of his humerus and bleeding from the point of the fracture. This accident most likely leads to damage of which of the following arteries? (A) Axillary (B) Deep brachial (C) Posterior humeral circumﬂ ex (D) Superior ulnar collateral (E) Scapular circumﬂ ex

A 10-year-old boy falls off his bike, has difﬁ culty in moving his shoulder, and is brought to an emergency department. His radiogram and angiogram 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

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

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

1. A 38-year-old man has had thyroid surgery to remove his papillary carcinoma. The external laryngeal nerve that accompanies the superior thyroid artery is damaged during the surgery. This injury could result in a severe impairment of function of which of the following? (A) Relaxing the vocal cords (B) Rotating the arytenoid cartilages (C) Tensing the vocal cords (D) Widening the rima glottidis (E) Abducting the vocal cords

10. A 33-year-old woman develops Bell's palsy. She must be cautious because this can result in corneal inﬂ ammation and subsequent ulceration. This symptom results from which of the following conditions? (A) Sensory loss of the cornea and conjunctiva (B) Lack of secretion of the parotid gland (C) Absence of the corneal blink reﬂ ex (D) Absence of sweating on the face (E) Inability to constrict the pupil

11. A 39-year-old woman presents to your clinic with complaints of headache and dizziness. She has an infection of a cranial dural sinus. The sinus that lies in the margin of the tentorium cerebelli and runs from the posterior end of the cavernous sinus to the transverse sinus is infected. Which of the following sinuses is affected by inﬂ ammation? (A) Straight sinus (B) Inferior sagittal sinus (C) Sphenoparietal sinus (D) Superior petrosal sinus (E) Cavernous sinus

12. A 34-year-old man in a bar ﬁ ght suffers a knife wound that severs the abducens nerve proximal to its entrance into the orbit. Which of the following conditions results from this injury? (A) Ptosis of the upper eyelid (B) Loss of the ability to dilate the pupil (C) External strabismus (lateral deviation) (D) Loss of visual accommodation (E) Internal strabismus (medial deviation)

13. A 24-year-old man falls from his motorcycle and lands in a creek. Death may result from bilateral severance of which of the following nerves? (A) Trigeminal nerve (B) Facial nerve (C) Vagus nerve (D) Spinal accessory nerve (E) Hypoglossal nerve

14. A 25-year-old man is involved in an automobile accident and slams his head into a concrete wall of a bridge. His computed tomography (CT) scan reveals that the middle meningeal artery has ruptured but the meninges remain intact. Blood leaking from this artery enters which of the following spaces? (A) Subarachnoid space (B) Subdural space (C) Epidural space (D) Subpial space (E) Cranial dural sinuses

15. A 27-year-old paratrooper lands on a pine tree. Consequently, preganglionic parasympathetic nerves leaving the central nervous system are lacerated. Which of the following structures contain cell bodies of the damaged nerve ﬁ bers? (A) Cervical and sacral spinal cord (B) Cervical and thoracic spinal cord (C) Brain stem and cervical spinal cord (D) Thoracic and lumbar spinal cord (E) Brain stem and sacral spinal cord

16. Following radical resection of a primary tongue tumor, a 72-year-old patient has lost general sensation on the anterior two-thirds of the tongue. This is probably due to injury to branches of which of the following nerves? (A) Trigeminal nerve (B) Facial nerve (C) Glossopharyngeal nerve (D) Vagus nerve (E) Hypoglossal nerve

17. A 67-year-old woman comes to her physician complaining of visual loss. Her magnetic resonance imaging (MRI) scan shows an enlarged pituitary gland that lies in the sella turcica, immediately posterior and superior to which of the following structures? (A) Frontal sinus (B) Maxillary sinus (C) Ethmoid air cells (D) Mastoid air cells (E) Sphenoid sinus

18. After having a tonsillectomy, a 57-year-old man with a long history of chewing tobacco use is unable to detect taste on the posterior one-third of his tongue. Which of the following nerves has most likely been injured? (A) Internal laryngeal nerve (B) Lingual nerve (C) Glossopharyngeal nerve (D) Greater palatine nerve (E) Chorda tympani

19. A 14-year-old boy hits his head on the asphalt road after falling off his skateboard. His radiograph reveals damage to the sella turcica. This is probably due to fracture of which of the following bones? (A) Frontal bone (B) Ethmoid bone (C) Temporal bone (D) Basioccipital bone (E) Sphenoid bone

2. A 27-year-old woman with a goiter comes to the hospital for surgical treatment. The surgeon must ligate the superior laryngeal artery before surgically resecting the goiter, so care must be taken to avoid injury to which of the following nerves? (A) External laryngeal nerve (B) Internal laryngeal nerve (C) Superior laryngeal nerve (D) Hypoglossal nerve (E) Vagus nerve

20. The nerve accompanying the superior thyroid artery may be damaged during an operation on the thyroid gland. Which of the following functional defects may result from this injury? (A) Loss of sensation above the vocal cord (B) Loss of lateral rotation of the arytenoid cartilages (C) Paralysis of the vocalis muscle (D) Lack of abduction of the vocal cord (E) Decreased tension of the vocal cord

21. A 37-year-old patient has an infectious inﬂ ammation of the dural venous sinus closest to the pituitary gland and a secondary thrombus formation. Which of the following is the most likely site of infection? (A) Straight sinus (B) Cavernous sinus (C) Superior petrosal sinus (D) Sigmoid sinus (E) Conﬂ uence of sinuses

22. A 53-year-old woman is diagnosed as having a pituitary tumor. If the tumor is large enough, she could exhibit which of the following disorders? (A) Blindness (B) Bitemporal (heteronymous) hemianopia (C) Right nasal hemianopia (D) Left homonymous hemianopia (E) Binasal hemianopia

23. A young singer at the local music theater visits her physician and complains of vocal difﬁ culties. On examination, she is unable to abduct the vocal cords during quiet breathing. Which of the following muscles is most likely paralyzed? (A) Vocalis muscle (B) Cricothyroid muscle (C) Oblique arytenoid muscle (D) Posterior cricoarytenoid muscle (E) Thyroarytenoid muscle

24. A 71-year-old woman often visits an emergency department with swallowing difﬁ culties and subsequent choking while eating food. Which of the following pairs of muscles is most instrumental in preventing food from entering the larynx and trachea during swallowing? (A) Sternohyoid and sternothyroid muscles (B) Oblique arytenoid and aryepiglottic muscles (C) Inferior pharyngeal constrictor and thyrohyoid muscles (D) Levator veli palatini and tensor veli palatini muscles (E) Musculus uvulae and geniohyoid muscles

25. A 31-year-old woman complains of headache and dizziness after hitting a kitchen cabinet door with her head. Her MRI scan and venogram show a large blood clot in the great cerebral vein of Galen. The obstructed vein of the brain is a direct tributary of which of the following venous structures? (A) Emissary veins (B) Pterygoid venous plexus (C) Diploic veins (D) Dural venous sinuses (E) Internal jugular vein

26. A 41-year-old woman overdoses on some prescription medications that have a common side effect of autonomic nerve stimulation. Which of the following conditions or actions results from stimulation of the parasympathetic ﬁ bers to the eyeball? (A) Enhanced vision for distant objects (B) Dilation of the pupil (C) Contraction of capillaries in the iris (D) Contraction of the ciliary muscle (E) Flattening of the lens

27. A 53-year-old woman with a severe middle ear infection comes to a hospital. On examination, a physician ﬁ nds that the infection has injured the tympanic nerve. The damaged nerve: (A) Is a branch of the facial nerve (B) Contains postganglionic parasympathetic ﬁ bers (C) Synapses with ﬁ bers in the lesser petrosal nerve (D) Is a branch of the glossopharyngeal nerve (E) Forms the tympanic plexus in the external auditory meatus

28. A 13-year-old boy competing in a motocross competition falls from his bike and sustains massive head injuries. Which of the following cavities are separated from the middle cranial fossa by a thin layer of bone? (A) Auditory tube and bony orbit (B) Middle ear cavity and sphenoid sinus (C) Sigmoid sinus and frontal sinus (D) Sphenoid sinus and ethmoid sinus (E) Maxillary sinus and middle ear cavity

29. A 32-year-old house painter suffers from a head injury after falling off a ladder and has bleeding in his head. During intraoperative testing, the neurosurgeon notes loss of general sensation in the dura of the middle cranial fossa. Which of the following nerves has been affected? (A) Vagus nerve (B) Facial nerve (C) Hypoglossal nerve (D) Trigeminal nerve (E) Glossopharyngeal nerve

3. A 19-year-old woman complains of numbness of the nasopharynx after surgical removal of the adenoid. A lesion of which of the following nerves would be expected? (A) Maxillary nerve (B) Superior cervical ganglion (C) External laryngeal nerve (D) Glossopharyngeal nerve (E) Vagus nerve

30. During a carotid endarterectomy of a 57-year-old man who suffered a stroke, the carotid sinus is damaged. A third-year medical student in surgical rotation notices that the injured structure: (A) Is located at the origin of the external carotid artery (B) Is innervated by the facial nerve (C) Functions as a chemoreceptor (D) Is stimulated by changes in blood pressure (E) Communicates freely with the cavernous sinus

31. During a game, a 26-year-old baseball player is hit in the head by a baseball, which fractures the optic canal. Which of the following pairs of structures is most likely to be damaged? (A) Optic nerve and ophthalmic vein (B) Ophthalmic vein and ophthalmic nerve (C) Ophthalmic artery and optic nerve (D) Ophthalmic nerve and optic nerve (E) Ophthalmic artery and ophthalmic vein

32. A 43-year-old man has new onset of difﬁ culty with speaking. Examination by the ENT resident reveals problems in elevating the hyoid bone and ﬂ oor of the mouth, secondary to paralysis of the posterior belly of the digastric muscle. Which of the following nerves is most likely involved? (A) Accessory nerve (B) Trigeminal nerve (C) Ansa cervicalis (D) Facial nerve (E) Glossopharyngeal nerve

33. The drummer of a local band presents to your clinic with hearing loss. Otoscopic examination reveals loss of contraction of the tensor tympani and the stapedius, which prevents damage to the eardrum and middle ear ossicles. These muscles are most likely controlled by which of the following nerves? (A) Chorda tympani and tympanic nerve (B) Trigeminal and facial nerves (C) Auditory and vagus nerves (D) Facial and auditory nerves (E) Trigeminal and accessory nerves

34. The pupil in the eye of a 43-year-old patient remains small even when room lighting is dim. Which of the following nerves would be injured? (A) Trochlear nerve (B) Superior cervical ganglion (C) Oculomotor nerve (D) Ophthalmic nerve (E) Abducens nerve

35. A pharyngeal (gag) reﬂ ex is the contraction of the pharyngeal constrictor muscles that is elicited by touching the back of a patient's pharynx (e.g., with a tongue depressor). Afferent nerve ﬁ bers that innervated the pharyngeal mucosa are branches of which of the following nerves? (A) Trigeminal nerve (B) Facial nerve (C) Glossopharyngeal nerve (D) Vagus nerve (E) Hypoglossal nerve

36. A patient can move his eyeballs normally and see distant objects clearly but cannot focus on near objects. This condition may indicate damage to which of the following structures? (A) Ciliary ganglion and oculomotor nerve (B) Oculomotor nerve and long ciliary nerve (C) Short ciliary nerves and ciliary ganglion (D) Superior cervical ganglion and long ciliary nerve (E) Oculomotor, trochlear, and abducens nerves

37. A benign tumor in the orbit of a 49-yearold man compresses a structure that runs through both the superior orbital ﬁ ssure and the common tendinous ring. Which of the following structures is most likely damaged? (A) Frontal nerve (B) Lacrimal nerve (C) Trochlear nerve (D) Abducens nerve (E) Ophthalmic vein

38. A 37-year-old man feels a little discomfort when moving his tongue, pharynx, and larynx. Physical examination indicates that the muscles attached to the styloid process are paralyzed. Which of the following groups of cranial nerves are damaged? (A) Facial, glossopharyngeal, and hypoglossal nerves (B) Hypoglossal, vagus, and facial nerves (C) Glossopharyngeal, trigeminal, and vagus nerves (D) Vagus, spinal accessory, and hypoglossal nerves (E) Facial, glossopharyngeal, and vagus nerves

39. A 32-year-old woman has hoarseness in her voice, and her uvula is deviated to the left on phonation. Which of the following nerves is damaged? (A) Right trigeminal nerve (B) Left trigeminal nerve (C) Right vagus nerve (D) Left vagus nerve (E) Left glossopharyngeal nerve

4. During surgery on a 56-year-old man for a squamous cell carcinoma of the neck, a surgeon notices profuse bleeding from the deep cervical artery. Which of the following arteries must be ligated immediately to stop bleeding? (A) Inferior thyroid artery (B) Transverse cervical artery (C) Thyrocervical trunk (D) Costocervical trunk (E) Ascending cervical artery

40. A high school basketball player experiences a sudden difﬁ culty in breathing and is brought to an emergency department. When a low tracheotomy is performed below the isthmus of the thyroid, which of the following vessels may be encountered? (A) Inferior thyroid artery (B) Inferior thyroid vein (C) Costocervical trunk (D) Superior thyroid artery (E) Right brachiocephalic vein

41. A 59-year-old man complains of numbness in the anterior cervical triangle. Therefore, damage has occurred to which of the following nerves? (A) Phrenic nerve (B) Greater auricular nerve (C) Transverse cervical nerve (D) Supraclavicular nerve (E) Lesser occipital nerve

42. A 53-year-old man has difﬁ culty with breathing through his nose. On examination, his physician ﬁ nds that he has swelling of the mucous membranes of the superior nasal meatus. Which opening of the paranasal sinuses is most likely plugged? (A) Middle ethmoidal sinus (B) Maxillary sinus (C) Posterior ethmoidal sinus (D) Anterior ethmoidal sinus (E) Frontal sinus

43. Following a penetrated injury in the submandibular triangle, the tongue of a 45-year-old patient deviates to the left on protrusion. Which of the following nerves is injured? (A) Right lingual nerve (B) Left lingual nerve (C) Right hypoglossal nerve (D) Left hypoglossal nerve (E) Left glossopharyngeal nerve

44. A 47-year-old man cannot move his eye laterally. Which of the following conditions would cause this type of inability to move the eye? (A) Tumor of the pituitary gland (B) Occlusion of the posterior cerebral artery (C) Infection in the maxillary sinus (D) Infection in the cavernous sinus (E) Tumor in the anterior cranial fossa

45. A young boy with a tooth abscess from a longstanding infection suffers damage of the lingual nerve as it enters the oral cavity. Which of the following structures contain cell bodies of injured nerve ﬁ bers? (A) Geniculate and otic ganglia (B) Trigeminal and submandibular ganglia (C) Trigeminal and dorsal root ganglia (D) Geniculate and trigeminal ganglia (E) Geniculate and pterygopalatine ganglia

46. A 61-year-old woman is found to have ocular lymphoma invading her optic canal. Which of the following structures would most likely be damaged? (A) Ophthalmic vein (B) Ophthalmic nerve (C) Oculomotor nerve (D) Trochlear nerve (E) Ophthalmic artery

47. A 76-year-old man with swallowing difﬁ culties undergoes imaging for a possible mass. The CT scan image at the level of the cricothyroid ligament in his neck should show which of the following structures? (A) Inferior laryngeal nerves (B) External carotid arteries (C) Inferior thyroid veins (D) Thyrocervical trunks (E) Internal laryngeal nerves

48. A knife wound has severed the oculomotor nerve in a 45-year-old man. Which of the following conditions will occur because of this injury? (A) Constricted pupil (B) Abduction of the eyeball (C) Complete ptosis (D) Impaired lacrimal secretion (E) Paralysis of the ciliary muscle

49. The muscles that are of branchiomeric origin are paralyzed in a 26-year-old patient. A lesion of which of the following nerves would cause muscle dysfunction? (A) Oculomotor nerve (B) Trochlear nerve (C) Trigeminal nerve (D) Abducens nerve (E) Hypoglossal nerve

5. A 17-year-old boy receives an injury to the phrenic nerve by a knife wound in the neck. The damaged nerve passes by which of the following structures in the neck? (A) Anterior to the subclavian vein (B) Posterior to the subclavian artery (C) Deep to the brachial plexus (D) Medial to the common carotid artery (E) Superﬁ cial to the anterior scalene muscle

50. During surgery for a malignant parotid tumor in a 69-year-old woman, the main trunk of the facial nerve is lacerated. Which of the following muscles is paralyzed? (A) Masseter muscle (B) Stylopharyngeus muscle(C) Anterior belly of the digastric muscle (D) Buccinator muscle (E) Tensor tympani

51. During a gang ﬁ ght, a 17-year-old boy is punched, and his nasal septum is broken. Which of the following structures would be damaged? (A) Septal cartilage and nasal bone (B) Inferior concha and vomer (C) Vomer and perpendicular plate of ethmoid (D) Septal cartilage and middle concha (E) Cribriform plate and frontal bone

A 12-year-old girl suffers from a type of neural tube defect called tethered cord syndrome, a congenital anomaly that results from defective closure of the neural tube. This syndrome is characterized by an abnormally low conus medullaris, which is tethered by a short, thickened ﬁ lum terminale, leading to progressive neurologic defects in the legs and feet. This girl has strong muscle function of the ﬂ exors of the thigh, but she has weakness of the extensors (hamstrings). A lesion has occurred at which of the following spinal cord levels? (A) T12 (B) L1 (C) L3 (D) L5 (E) S5

A 12-year-old girl suffers from a type of neural tube defect called tethered cord syndrome, a congenital anomaly that results from defective closure of the neural tube. This syndrome is characterized by an abnormally low conus medullaris, which is tethered by a short, thickened ﬁ lum terminale, leading to progressive neurologic defects in the legs and feet. Which of the following defects is commonly associated with the tethered cord syndrome? (A) Spina biﬁ da occulta (B) Kyphosis (C) Meningomyelocele (D) Herniated disk (E) Scoliosis

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

A 14-year-old gymnastic silver medalist falls from the parallel bar and complains of pains from the knee and ankle joints. On physical examination, her physician found that the muscle responsible for ﬂ exing the leg at the knee joint and plantar ﬂ exing the foot is severely weakened. Which of the following muscles involved in both movements was most likely damaged in this accident? (A) Tibialis posterior (B) Gastrocnemius (C) Soleus (D) Peroneus longus (E) Flexor digitorum longus

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 ﬁ ngers

A 16-year-old boy presents to the emergency department with rupture of the penile urethra. Extravasated urine from this injury can spread into which of the following structures? (A) Scrotum (B) Ischiorectal fossa (C) Pelvic cavity (D) Testis (E) Thigh

A 16-year-old boy with a ruptured spleen comes to the emergency department for splenectomy. Soon after ligation of the splenic artery just distal to its origin, a surgical resident observes that the patient is healing normally. Normal blood ﬂ ow would occur in which of the following arteries? (A) Short gastric arteries (B) Dorsal pancreatic artery (C) Inferior pancreaticoduodenal artery (D) Left gastroepiploic artery (E) Artery in the lienorenal ligament

A 16-year-old girl with urinary diseases comes to a local hospital. Her urologist's examination and laboratory test results reveal that she has difﬁ culty in removing wastes from the blood and in producing urine. Which of the following organs may have abnormal functions? (A) Ureter (B) Spleen (C) Urethra (D) Bladder (E) Kidney

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

A 16-year-old patient received a laceration of the posterior intercostal nerves by a penetrated knife blade. A pathologist obtained needle biopsy tissues and observed numerous degenerated cell bodies of the unipolar or pseudounipolar neurons. Which of the following structures would most likely provide the abnormal cell morphology? (A) Ventral horn of the spinal cord (B) Lateral horn of the spinal cord (C) Dorsal horn of the spinal cord (D) Dorsal root ganglion (E) Sympathetic chain ganglion

A 16-year-old patient received a stab wound, and axons of the general somatic efferent (GSE) neurons to the shoulder muscles were severed. The damaged axons: (A) Would carry impulses toward the cell bodies (B) Would carry impulses away from the cell bodies (C) Would carry pain impulses (D) Are several in numbers for multipolar neurons (E) Are found primarily in the gray matter

A 17-year-old boy fell from his motorcycle and complains of 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

A 17-year-old boy is injured in an automobile accident. He has a fracture of the shaft of the humerus. 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

A 17-year-old boy is injured in an automobile accident. He has a fracture of the shaft of the humerus. 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 ﬁ bers 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

A 17-year-old boy is injured in an automobile accident. He has a fracture of the shaft of the humerus. 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 ﬁ ngers

A 17-year-old boy is injured in an automobile accident. He has a fracture of the shaft of the humerus. Which of the following arteries may be damaged? (A) Brachial artery (B) Posterior humeral circumﬂ ex artery (C) Profunda brachii artery (D) Radial artery (E) Radial recurrent artery

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

A 17-year-old boy is involved in a group ﬁ ght, and a stab wound lacerates a ventral root of his thoracic spinal nerve. Cell bodies of the injured nerve ﬁ bers are located in which of the following nervous structures? (A) Dorsal root ganglia and sympathetic trunk (B) Lateral horn of spinal cord and dorsal root ganglia (C) Anterior horn and lateral horn of spinal cord (D) Sympathetic trunk and lateral horn of spinal cord (E) Anterior horn of spinal cord and sympathetic trunk

A 17-year-old boy suffers a traumatic groin injury during a soccer match. The urologist notices tenderness and swelling of the boy's left testicle that may be produced by thrombosis in which of the following veins? (A) Left internal pudendal vein (B) Left renal vein (C) Inferior vena cava (D) Left inferior epigastric vein (E) Left external pudendal vein

A 17-year-old boy was involved in a gang ﬁ ght, 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

A 17-year-old boy was stabbed during a gang ﬁ ght resulting in transection of the obturator nerve. Which of the following muscles is completely paralyzed? (A) Pectineus (B) Adductor magnus (C) Adductor longus (D) Biceps femoris (E) Semimembranosus

A 17-year-old boy with a stab wound received multiple injuries on the upper part of the arm and required 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 circumﬂ ex (D) Superior ulnar collateral (E) Radial recurrent

A 19-year-old college student came to his doctor's ofﬁ ce for a neurologic examination. His physician told him that normally synapses are absent in or on which of the following structures? (A) Anterior horn of the spinal cord (B) Dorsal root ganglia (C) Sympathetic chain ganglia (D) Dendrites (E) Cell bodies

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

A 19-year-old man with a ruptured appendix is sent to the emergency department for surgery. To cut off the blood supply to the appendix (if collateral circulation is discounted), a surgeon should ligate which of the following arteries? (A) Middle colic artery (B) Right colic artery (C) Ileocolic colic artery (D) Inferior mesenteric artery (E) Common iliac artery

A 19-year-old young woman with a long history of irritable bowel syndrome presents for the possibility of surgical resection of the gastrointestinal (GI) tract where the vagal parasympathetic innervation terminates. Which of the following sites is most appropriate for surgical resection? (A) Duodenojejunal junction (B) Ileocecal junction (C) Right colic ﬂ exure (D) Left colic ﬂ exure (E) Anorectal junction

A 2-day-old baby is admitted to the hospital with vomiting, fever, and rectal bleeding. Physical and CT scan examinations reveal small bowel obstruction and are d iagnosed as having Meckel's diverticulum. Which portion of the gastrointestinal tract is most likely involved in the development of the diverticulum that may be connected to the inner surface of the umbilicus by a ﬁ brous cord? (A) Stomach (B) Jejunum (C) Ileum (D) Appendix (E) Sigmoid colon

A 23-year-old man falls from a ladder and injures his arm. On examination, he feels numbness and has no sweating on the lateral side of his forearm, indicating damage to the lateral antebrachial cutaneous nerve. The cell bodies of injured nerve ﬁ bers involved in sweating are located in which of the following structures? (A) Collateral ganglia (B) Dorsal root ganglia (C) Sympathetic chain ganglia (D) Lateral horn of spinal cord (E) Anterior horn of spinal cord

A 21-year-old man was involved in a motorcycle accident, resulting in destruction of the groove in the lower surface of the cuboid bone. Which of the following muscle tendons is most likely damaged? (A) Flexor hallucis longus (B) Peroneus brevis (C) Peroneus longus (D) Tibialis anterior (E) Tibialis posterior

A 21-year-old marine biologist asks about her ﬁ rst bimanual examination, and it is explained to her that the normal position of the uterus is: (A) Anteﬂ exed and anteverted (B) Retroﬂ exed and anteverted (C) Anteﬂ exed and retroverted (D) Retroverted and retroﬂ exed (E) Anteverted and retroverted

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 adduct the thumb

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

A 21-year-old soccer player is tackled via a high-impact sweeping injury about the right knee, causing a posterior knee dislocation. Soon after, he is unable to plantar ﬂ ex his right ankle or ﬂ ex his toes. He also experiences loss of sensation on the sole of his right foot. Which of the following nerves is most likely injured? (A) Saphenous nerve (B) Tibial nerve (C) Deep peroneal nerve (D) Superﬁ cial peroneal nerve (E) Common peroneal nerve

A 21-year-old tennis player comes to an emergency room and complains of pain in the knee joint. On examination, he has an infection inside the knee joint capsule but outside the synovial cavity. Which of the following structures is preserved from this infection? (A) Anterior cruciate ligament (B) Posterior cruciate ligament (C) Lateral meniscus (D) Lateral collateral ligament (E) Medial meniscus

A 21-year-old woman comes to the emergency department with acute chest pain and shortness of breath. Her chest radiograph shows opaciﬁ cation of one of her lungs. She undergoes thoracentesis, which reveals that she has a chylothorax resulting from rupture of the thoracic duct. Lymphatic drainage remains normal in which of the following areas? (A) Left thorax (B) Right thorax (C) Left abdomen (D) Right pelvis (E) Left lower limb

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

A 22-year-old female Macarena dancer fell from the stage and complains of 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

A 22-year-old man has a gonorrheal infection that has inﬁ ltrated the space between the inferior fascia of the urogenital diaphragm and the superﬁ cial perineal fascia. Which of the following structures might be inﬂ amed? (A) Bulb of the penis (B) Bulbourethral gland (C) Membranous part of the male urethra (D) Deep transverse perineal muscle (E) Sphincter urethrae

A 22-year-old man presented to his family physician with a laceration of the ﬁ brous sheets or bands that cover his body under the skin and invest the muscles. Which of the following structures would most likely be injured? (A) Tendon (B) Fascia (C) Synovial tendon sheath (D) Aponeurosis (E) Ligament

A 22-year-old patient is unable to "unlock" the knee joint to permit ﬂ exion of the leg. Which of the following muscles is most likely damaged? (A) Rectus femoris (B) Semimembranosus (C) Popliteus (D) Gastrocnemius (E) Biceps femoris

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 ﬁ bers from the second intercostal nerve (E) Damage to the sympathetic preganglionic ﬁ bers

A 22-year-old victim of an automobile accident has received destructive damage to structures that form the boundary of the perineum. Which of the following structures is spared? (A) Pubic arcuate ligament (B) Tip of the coccyx (C) Ischial tuberosities (D) Sacrospinous ligament (E) Sacrotuberous ligament

A 22-year-old woman receives a deep cut in the inguinal canal 1 in. lateral to the pubic tubercle. Which of the following ligaments is lacerated within the inguinal canal? (A) Suspensory ligament of the ovary (B) Ovarian ligament (C) Mesosalpinx (D) Round ligament of the uterus (E) Rectouterine ligament

A 23-year-old jockey falls from her horse and complains of headache, backache, and weakness. Radiologic examination would reveal blood in which of the following spaces if the internal vertebral venous plexus was ruptured? (A) Space deep to the pia mater (B) Space between the arachnoid and dura maters (C) Subdural space (D) Epidural space (E) Subarachnoid space

A 23-year-old man complains of numbness on the medial side of the arm following a stab wound in the axilla. On examination, he is diagnosed with an injury of his medial brachial 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 ganglion (C) Anterior horn of the spinal cord (D) Lateral horn of the spinal cord (E) Posterior horn of the spinal cord

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

A 23-year-old massage therapist who specializes in women's health attends a lecture at an annual conference on techniques of massage. She asks, "What structure is drained by the lumbar (aortic) lymph nodes?" Which of the following structures is the correct answer to this question? (A) Perineum (B) Lower part of the vagina (C) External genitalia (D) Ovary (E) Lower part of the anterior abdominal wall

A 23-year-old woman visits her obstetrician for an annual checkup. During vaginal examination, which of the following structures may be palpated? (A) Apex of the urinary bladder (B) Fundus of the uterus (C) Terminal part of the round ligament of the uterus (D) Body of the clitoris (E) Uterine cervix

A 23-year-old woman who receives a deep cut to her ring ﬁ nger by a kitchen knife is unable to move the metacarpophalangeal 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

A 24-year-old carpenter suffers a crush injury of his entire little ﬁ nger. 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

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

A 24-year-old woman complains of weakness when she extends her thigh and rotates it laterally. Which of the following muscles is paralyzed? (A) Obturator externus (B) Sartorius (C) Tensor fasciae latae (D) Gluteus maximus (E) Semitendinosus

A 24-year-old woman presents to her physician with weakness in ﬂ exing the hip joint and extending the knee joint. Which muscle is most likely involved in this scenario? (A) Sartorius (B) Gracilis (C) Rectus femoris (D) Vastus medialis (E) Semimembranosus

A 25-year-old gladiator sustains a penetrating injury that severs the superﬁ cial peroneal nerve. This will most likely cause paralysis of which of the following muscles? (A) Peroneus tertius (B) Peroneus brevis (C) Flexor hallucis longus (D) Tibialis anterior (E) Tibialis posterior

A 25-year-old man with congenital abnormalities 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) Multiﬁ dus (D) Rotator longus (E) Iliocostalis

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

A 25-year-old woman is suffering from facial paralysis and exhibits ptosis (drooping of the upper eyelid). Injury to which of the following nerves would result in ptosis? (A) Trochlear nerve (B) Abducens nerve (C) Oculomotor nerve (D) Ophthalmic nerve (E) Facial nerve

A 26-year-old heavyweight boxer was punched on his mandible, resulting in a slight subluxation (dislocation) of the a tlantoaxial 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

A 26-year-old man comes to a hospital with fever, nausea, pain, and itching in the perineal region. On examination by a urologist, he is diagnosed as having infected bulbourethral (Cowper's) glands. Which of the following structures is/are affected by this infection? (A) Superﬁ cial perineal space (B) Sphincter urethrae (C) Production of sperm (D) Testis (E) Seminal vesicles

A 26-year-old patient is admitted to a local hospital with a retroperitoneal infection. Which of the following arteries is most likely to be infected? (A) Left gastric artery (B) Proper hepatic artery (C) Middle colic artery (D) Sigmoid arteries (E) Dorsal pancreatic artery

A 26-year-old woman experiences severe back pain from an automobile accident. A CT scan reveals that the L5 vertebral foramen is completely obliterated by a collapsed L5 laminae and pedicles. In this injury, which of the following structures is crushed? (A) Vertebral artery (B) Spinal cord (C) Filum terminale externus (ﬁ lum of the dura) (D) Denticulate ligament (E) Cauda equina

A 26-year-old woman has an amenorrhea, followed by uterine bleeding, pelvic pain, and pelvic mass. Her obstetrician performed a thorough examination, and the patient was diagnosed as having an ectopic pregnancy. Which of the following organs is most likely to provide a normal site of fertilization? (A) Fundus of the uterus (B) Ampulla of the uterine tube (C) Fimbriae (D) Infundibulum of the uterine tube (E) Body of the uterus

A 26-year-old woman with the ﬂ u comes to an outpatient clinic. On examination, a physician diagnoses her with sinus and palate infection, and her uvula deviates to the left side on phonation. Which of the following nerves is injured? (A) Left hypoglossal nerve (B) Right hypoglossal nerve (C) Left vagus nerve (D) Right vagus nerve (E) Left trigeminal nerve

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 ﬂ oor of the cubital fossa appear to be torn. Which of the following groups of muscles have lost their functions? (A) Brachioradialis and supinator (B) Brachialis and supinator (C) Pronator teres and supinator (D) Supinator and pronator quadratus (E) Brachialis and pronator teres

A 27-year-old cardiac patient with an irregular heartbeat visits her doctor's ofﬁ ce 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 left intercostal space (B) Over the medial end of the second right intercostal space (C) In the left fourth intercostal space at the midclavicular line (D) In the left ﬁ fth intercostal space at the midclavicular line (E) Over the right half of the lower end of the body of the sternum

A 27-year-old man with cubital tunnel syndrome complains of numbness and tingling in the ring and little ﬁ nger 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 superﬁ cialis (B) Opponens pollicis (C) Two medial lumbricals (D) Pronator teres (E) Supinator

A 27-year-old mountain climber falls from a steep rock wall and is brought to the emergency department. His physical examination and computed tomography (CT) scan reveal dislocation fracture of the upper thoracic vertebrae. 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 ﬁ fth rib (E) Tubercle of the ﬁ fth rib

A 27-year-old patient exhibits a loss of skin sensation and paralysis of muscles on the plantar aspect of the medial side of the foot. Which of the following nerves is most likely damaged? (A) Common peroneal (B) Tibial (C) Superﬁ cial peroneal (D) Deep peroneal (E) Sural

A 27-year-old patient presents with an inability to draw the scapula forward and downward because of 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

A 27-year-old patient with Marfan's syndrome has an aneurysm of the aortic arch. This may compress which of the following structures? (A) Right vagus nerve (B) Left phrenic nerve (C) Right sympathetic trunk (D) Left recurrent laryngeal nerve (E) Left greater splanchnic nerve

A 27-year-old pianist with a known carpal tunnel syndrome experiences difﬁ culty in ﬁ nger 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

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

A 27-year-old woman has suffered a gunshot wound to her midabdomen. After examining the patient's angiogram, a trauma surgeon locates the source of bleeding from pairs of veins that typically terminate in the same vein. Which of the following veins are damaged? (A) Left and right ovarian veins (B) Left and right gastroepiploic veins (C) Left and right colic veins (D) Left and right suprarenal veins (E) Left and right hepatic veins

A 27-year-old woman involved in a car accident is brought into the emergency department. Her magnetic resonance imaging reveals that she has a laceration of the spinal cord at the L4 spinal cord level. Which of the following structures would you expect to be intact? (A) Dorsal horn (B) Lateral horn (C) Ventral horn (D) Gray matter (E) White mattER

A 28-year-old basketball player falls while rebounding and is unable to run and jump. On physical examination, he has pain and weakness when extending his thigh and ﬂ exing his leg. Which muscle involved in both movements is most likely injured? (A) Short head of biceps femoris (B) Adductor magnus (C) Semitendinosus (D) Sartorius (E) Gracilis

A 29-year-old baseball player whose head is hit by a high-speed baseball is brought to an emergency department. Physical examination and radiogram reveal fracture of the temporal bone and damage to the lesser petrosal nerve. Which of the following conditions could occur as a result of injury to the lesser petrosal nerve? (A) Lack of lacrimal secretion (B) Lack of submandibular gland secretion (C) Lack of parotid gland secretion (D) Constriction of the pupil (E) Ptosis of the upper eyelid

A 29-year-old carpenter receives a crush injury to his metacarpophalangeal joint of the fourth digit (ring ﬁ nger) while remodeling his neighbor's porch. Which of the following pairs of nerves innervates the muscle that moves the injured joint? (A) Median and ulnar nerves (B) Radial and median nerves (C) Musculocutaneous and ulnar nerves (D) Ulnar and radial nerves (E) Radial and axillary nerves

A 29-year-old carpenter sustains severe injuries of the pelvic splanchnic nerve by a deep puncture wound, which has become contaminated. The injured parasympathetic preganglionic ﬁ bers in the splanchnic nerve are most likely to synapse in which of the following ganglia? (A) Ganglia in or near the viscera or pelvic plexus (B) Sympathetic chain ganglia (C) Collateral ganglia (D) Dorsal root ganglia (E) Ganglion impar

A 29-year-old farmer falls on tractor blades and injures his groin. Several days later, he comes to the emergency department, and examination by a physician reveals that the urogenital diaphragm and bulbourethral glands are infected. The infected deep perineal space: (A) Is formed superiorly by the perineal membrane (B) Is formed inferiorly by Colles's fascia (C) Contains a segment of the dorsal nerve of the penis (D) Contains superﬁ cial transverse perineal muscles (E) Contains the greater vestibular glands

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

A 29-year-old man comes to a local hospital with duodenal peptic ulcer and complains of cramping epigastric pain. Which of the following structures harbors the cell bodies of abdominal pain ﬁ bers?(A) Lateral horn of the spinal cord (B) Anterior horn of the spinal cord (C) Dorsal root ganglion (D) Sympathetic chain ganglion (E) Celiac ganglion

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

A 29-year-old woman is admitted to a hospital because the birth of her child is several days overdue. Tearing of the pelvic diaphragm during childbirth leads to paralysis of which of the following muscles? (A) Piriformis (B) Sphincter urethrae (C) Obturator internus (D) Levator ani (E) Sphincter ani externus

A 29-year-old woman with a ruptured ectopic pregnancy is admitted to a hospital for culdocentesis. A long needle on the syringe is most efﬁ ciently inserted through which of the following structures? (A) Anterior fornix of the vagina (B) Posterior fornix of the vagina (C) Anterior wall of the rectum (D) Posterior wall of the uterine body (E) Posterior wall of the bladder

A 29-year-old woman with abdominal pain was admitted to a local hospital, and examination shows that a retroperitoneal infection is affecting a purely endocrine gland. Which of the following structures is infected? (A) Ovary (B) Suprarenal gland (C) Pancreas (D) Liver (E) Stomach

A 3-year-old boy is admitted to the children's hospital with complaints of restlessness, abdominal pain, and fever. An MRI examination reveals that he has a double ureter. Which of the following embryonic structures is most likely failed to develop normally? (A) Mesonephric (Wolfﬁ an) duct (B) Paramesonephric (Müllerian) duct (C) Ureteric bud (D) Metanephros (E) Pronephros

A 3-year-old boy is diagnosed as having a persistent processus vaginalis in its middle portion. Which of the following conditions is most likely to be associated with this developmental anomaly? (A) Direct inguinal hernia (B) Gubernaculum testis (C) Hematocele (D) Hydrocele (E) Cryptorchidism

A 31-year-old NHL hockey player complains of numbness in the area of his umbilicus after the national championship game. Which of the following structures that carries GSA ﬁ bers was injured during the hockey game? (A) Sympathetic trunk (B) Dorsal root (C) Greater splanchnic nerve (D) Gray rami communicantes (E) White rami communicantes

A 31-year-old carpenter was wounded in his left arm by a utility knife and is brought to a local emergency department. He complains of numbness on the medial side of his arm. Which of the following nerves is most likely injured? (A) Axillary nerve (B) Musculocutaneous nerve (C) Medial brachial cutaneous nerve (D) Medial antebrachial cutaneous nerve (E) Radial nerve

A 31-year-old football player with a head injury is brought to a local emergency department. Physical examination, radiogram, and a magnetic resonance imaging scan indicate a lesion of the trigeminal nerve. Which of the following muscles is most likely paralyzed? (A) Geniohyoid (B) Palatoglossus (C) Cricothyroid (D) Tensor veli palatini (E) Levator veli palatini

A 31-year-old man was involved in a severe automobile accident and suffered l aceration 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

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 ﬁ ngers. 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

A 31-year-old roofer walks in with 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 the ﬂ exor carpi ulnaris (B) Tendon of the ﬂ exor pollicis longus (C) Tendon of the ﬂ exor digitorum profundus (D) Tendon of the ﬂ exor carpi radialis (E) Tendon of the palmaris longus

A 32-year-old carpenter fell from the roof. The lateral longitudinal arch of his foot was ﬂ attened from fracture and displacement of the keystone for the arch. Which of the following bones is damaged? (A) Calcaneus (B) Cuboid bone (C) Head of the talus (D) Medial cuneiform (E) Navicular bone

A 32-year-old man is involved in a car accident and receives a crushed internal injury in his abdomen. Examination reveals a lesion of parasympathetic ﬁ bers in the vagus nerve, which interferes with glandular secretory or smooth muscle functions in which of the following organs? (A) Bladder (B) Transverse colon (C) Sigmoid colon (D) Prostate gland (E) Rectum

A 32-year-old man undergoes vasectomy as a means of permanent birth control. A physician performing the vasectomy by making an incision on each side of the scrotum should remember which of the following statements most applicable to the scrotum? (A) It is innervated by the ilioinguinal and genitofemoral nerves. (B) It receives blood primarily from the testicular artery. (C) Its venous blood drains primarily into the renal vein on the left. (D) Its lymphatic drainage is primarily into upper lumbar nodes. (E) Its dartos tunic is continuous with the perineal membrane.

A 32-year-old patient has a tension pneumothorax that can be treated with needle aspiration. To avoid an injury of the intercostal neurovascular bundle, the needle may be inserted in which of the following locations? (A) Above the upper border of the ribs (B) Deep to the upper border of the ribs (C) Beneath the lower border of the ribs (D) Between the external and internal intercostals (E) Through the transversus thoracis muscle

A 32-year-old patient who weighs 275 lb comes to the doctor's ofﬁ ce. 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 left ﬁ fth intercostal space (D) In the right ﬁ fth intercostal space (E) At the level of the xiphoid process of the sternum

A 32-year-old patient with multiple fractures of the pelvis has no cutaneous sensation in the urogenital triangle. The function of which of the following nerves is most likely to be spared? (A) Ilioinguinal nerve (B) Iliohypogastric nerve (C) Posterior cutaneous nerve of the thigh (D) Pudendal nerve (E) Genitofemoral nerve

A 33-year-old male patient complains of feeling severe pain when he tries to turn his neck. A physician realizes that the problem is in his pivot (trochoid) joint. Which of the following joints would most likely be examined? (A) Atlantooccipital joint (B) Atlantoaxial joint (C) Carpometacarpal joint (D) Proximal tibioﬁ bular joint (E) Intervertebral disks

A 33-year-old man with a perforated gastric ulcer complains of excruciating pain in his stomach. It is observed that the pain comes from peritoneal irritation by gastric contents in the lesser sac. Which of the following nerves contain sensory nerve ﬁ bers that convey this sharp, stabbing pain? (A) Vagus nerves (B) Greater splanchnic nerves (C) Lower intercostal nerves (D) White rami communicantes (E) Gray rami communicantes

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 ﬂ ow 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

A 34-year-old singer has been diagnosed with thyroid cancer and consequently has a thyroidectomy. He has been hoarse ever since the surgery 8 weeks ago. It has been suspected that a nerve was injured during the operation. Which of the following nerves is most likely damaged? (A) External laryngeal nerve (B) Internal laryngeal nerve (C) Recurrent laryngeal nerve (D) Hypoglossal nerve (E) Glossopharyngeal nerve

A 34-year-old woman crashes into a tree during a skiing lesson and is brought to a hospital 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

A 34-year-old woman sustains a deep cut on the dorsum of the foot just distal to her ankle joint by a falling kitchen knife. A physician in the emergency department has ligated the dorsalis pedis artery proximal to the injured area. Which of the following conditions most likely occurs as a result of the injury? (A) Ischemia in the peroneus longus muscle (B) Aneurysm in the plantar arterial arch (C) Reduction of blood ﬂ ow in the medial tarsal artery (D) Low blood pressure in the anterior tibial artery (E) High blood pressure in the arcuate artery

A 35-year-old man has difﬁ culty in dorsiﬂ exing the foot. Which of the following muscles is most likely damaged? (A) Tibialis posterior (B) Flexor digitorum longus(C) Tibialis anterior (D) Peroneus longus (E) Peroneus brevis

A 35-year-old man is suffering from an infected mediastinum (mediastinitis) after neck and chest injuries resulting from a head-on automobile collision. He has been intubated since the accident and on broadspectrum intravenous antibiotics since admission; however, the infection continues to progress throughout the mediastinum. Which of the following structures is free from infection? (A) Thymus gland (B) Esophagus (C) Trachea (D) Lungs (E) Heart

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 artery (D) Radial recurrent artery (E) Median nerve

A 35-year-old woman comes to a local hospital with abdominal tenderness and acute pain. On examination, her physician observes that an abdominal infection has spread retroperitoneally. Which of the following structures is most likely affected? (A) Stomach (B) Transverse colon (C) Jejunum (D) Descending colon (E) Spleen

A 35-year-old woman with a history of cholecystectomy arrives in the emergency department with intractable hiccups most likely caused by an abdominal abscess secondary to surgical infection. Which of the following nerves carries pain sensation caused by irritation of the peritoneum on the central portion of the inferior surface of the diaphragm? (A) Vagus nerve (B) Lower intercostal nerve (C) Phrenic nerve (D) Greater splanchnic nerve (E) Subcostal nerve

A 36-year-old plumber slips and breaks a porcelain sink, cutting an anterior aspect of his wrist deeply on a sharp edge. On arrival to the emergency department, he can adduct his thumb but not oppose it. Which of the following structures has been severed? (A) Radial nerve (B) Median nerve (C) Ulnar nerve (D) Anterior interosseous nerve (E) Posterior interosseous nerve

A 36-year-old woman received a ﬁ rstdegree burn on her neck, arm, and forearm from a house ﬁ re. Which of the following skin structures or functions is most likely damaged or impaired? (A) GSE nerves (B) Parasympathetic general visceral efferent nerves (C) Trophic hormone production (D) Exocrine gland secretion (E) Vitamin A production

A 36-year-old woman with yellow pigmentation of the skin and sclerae presents at the outpatient clinic. Which of the following conditions most likely is the cause of her obstructive jaundice? (A) Aneurysm of the splenic artery (B) Perforated ulcer of the stomach (C) Obstruction of the main pancreatic duct (D) Cancer in the head of the pancreas (E) Cancer in the body of the pancreas

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 medial and lateral fragments. The arm is rotated medially, but it 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 muscles (C) Pectoralis minor muscle and gravity (D) Trapezius and pectoralis minor muscles (E) Deltoid muscle and gravity

A 41-year-old woman is brought to the emergency department by her family because of acute onset of right upper quadrant pain, nausea, and vomiting. For this case, it is important to remember that the bile duct: (A) Drains bile into the second part of the duodenum (B) Can be blocked by cancer in the body of the pancreas (C) Joins the main pancreatic duct, which carries hormones (D) Is formed by union of the right and left hepatic duct (E) Lies posterior to the portal vein in the right free edge of the lesser omentum

A 42-year-old man suffers from a rare tongue disease and comes to the emergency department. On examination, he is unable to protrude his tongue. Which of the following muscles is paralyzed? (A) Hyoglossus (B) Genioglossus (C) Styloglossus (D) Palatoglossus (E) Geniohyoid

A 42-year-old man with portal hypertension secondary to cirrhosis of the liver and subsequent massive ascites presents to the emergency department. He refuses to have a transjugular intrahepatic portosystemic shunt (TIPS) procedure and prefers surgery. Which of the following surgical connections is involved in the most practical method of shunting portal blood around the liver? (A) Superior mesenteric vein to the inferior mesenteric vein (B) Portal vein to the superior vena cava (C) Portal vein to the left renal vein (D) Splenic vein to the left renal vein (E) Superior rectal vein to the left colic vein

A 42-year-old obese woman with seven children is brought to a local hospital by her daughter. Physical examination and her radiograph reveal that large gallstones have ulcerated through the posterior wall of the fundus of the gallbladder into the intestine. Which of the following parts of the intestine is most likely to initially contain gallstones? (A) Cecum (B) Ascending colon (C) Transverse colon (D) Descending colon (E) Sigmoid colon

A 42-year-old woman presents to an outpatient clinic with a 6-month history of numbness and tingling on the palmar aspect of her lateral three and one-half ﬁ ngers, loss of pronation, and ﬂ attening of the thenar eminence. Injury to which of the following nerves could cause such a condition? (A) Axillary nerve (B) Musculocutaneous nerve (C) Median nerve (D) Radial nerve (E) Ulnar nerve

A 42-year-old woman who has had six children develops a weakness of the urogenital diaphragm. Paralysis of which of the following muscles would cause such a symptom? (A) Sphincter urethrae (B) Coccygeus (C) Superﬁ cial transversus perinei (D) Levator ani (E) Obturator internus

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

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 43-year-old man complains of abdominal pain just above his umbilicus. On examination, a tumor is found anterior to the IVC. Which of the following structures would most likely be compressed by this tumor? (A) Right sympathetic trunk (B) Left third lumbar artery (C) Third part of the duodenum (D) Left renal artery (E) Cisterna chyli

A 43-year-old man has a benign tumor located near a gap between the arcuate pubic ligament and the transverse perineal ligament. Which of the following structures is most likely compressed by this tumor? (A) Perineal nerve (B) Deep dorsal vein of the penis (C) Superﬁ cial dorsal vein (D) Posterior scrotal nerve (E) Deep artery of the penis

A 43-year-old woman is admitted to a hospital because of deep abdominal pain in her epigastric region. On examination, it is observed that a retroperitoneal infection erodes an artery that runs along the superior border of the pancreas. Which of the following arteries is likely injured? (A) Right gastric artery (B) Left gastroepiploic artery (C) Splenic artery (D) Gastroduodenal artery (E) Dorsal pancreatic artery

A 43-year-old woman presents with a prolapsed uterus. Repair of a prolapsed uterus requires knowledge of the supporting structures of the uterus. Which of the following structures plays the most important role in the support of the uterus? (A) Levator ani (B) Sphincter urethrae (C) Uterosacral ligament (D) Ovarian ligament (E) Arcuate pubic ligament

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 ﬁ bers (B) Difﬁ culty in expiration (C) Loss of sensation in the ﬁ brous pericardium and mediastinal pleura (D) Normal function of the diaphragm (E) Loss of sensation in the costal part of the diaphragm

A 44-year-old woman comes to her physician and complains of headache and backache. On examination, she is found to have ﬂ uid accumulated in the spinal epidural space because 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

A 45-year-old woman presents with a tumor conﬁ ned to the posterior mediastinum. This could result in compression of which of the following structures? (A) Trachea (B) Descending aorta (C) Arch of the aorta (D) Arch of the azygos vein (E) Phrenic nerve

A 46-year-old male patient with high blood pressure was examined in the emergency department, and his physician found a leakage of blood from the blood vessel that normally carries richly oxygenated blood. Which of the following vessels would most likely be damaged? (A) Superior vena cava (B) Pulmonary arteries (C) Pulmonary veins (D) Portal vein (E) Coronary sinus

A 46-year-old patient comes to his doctor's ofﬁ ce 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 ﬂ ow 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

A 46-year-old woman has a history of infection in her perineal region. A comprehensive examination reveals a tear of the superior boundary of the superﬁ cial perineal space. Which of the following structures would most likely be injured? (A) Pelvic diaphragm (B) Colles's fascia (C) Superﬁ cial perineal fascia (D) Deep perineal fascia (E) Perineal membrane

A 47-year-old man with a known atrial ﬁ brillation returns to see his cardiologist for follow-up of his cardiac health. The right atrium is important in this case because it:(A) Receives blood from the oblique cardiac vein (B) Is associated with the apex of the heart (C) Contains the SA node (D) Receives the right pulmonary vein (E) Is hypertrophied by pulmonary stenosis

A 47-year-old woman has had a lumpectomy and axillary dissection to check for metastasis. She has come in for her followup appointment, and her physician notices on her physical examination that the medial part of her scapula protrudes from her back and that she is not able to raise her arm above the horizontal level. Which of the following nerves has been damaged during her surgery? (A) Median nerve (B) Ulnar nerve (C) Thoracodorsal nerve (D) Long thoracic nerve (E) Radial nerve

A 47-year-old woman is unable to invert her foot after she stumbled on her driveway. Which of the following nerves are most likely injured? (A) Superﬁ cial and deep peroneal (B) Deep peroneal and tibial (C) Superﬁ cial peroneal and tibial (D) Medial and lateral plantar (E) Obturator and tibial

A 48-year-old college football coach undergoes a radical prostatectomy for a malignant tumor in his prostate. Following surgery, he is incapable of achieving an erection. Which of the following nerves is most likely damaged during the surgery? (A) Sacral splanchnic nerve (B) Pelvic splanchnic nerve (C) Pudendal nerve (D) Dorsal nerve of the penis (E) Posterior scrotal nerve

A 49-year-old woman has a large mass on the pelvic brim. Which of the following structures is most likely compressed by this mass when crossing the pelvic brim? (A) Deep dorsal vein of the penis (B) Uterine tube (C) Ovarian ligament (D) Uterine artery (E) Lumbosacral trunk

A 49-year-old woman is diagnosed as having a large lump in her right 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

A 5-month-old boy is admitted to the children's hospital because of urine being expelled from the dorsal aspect of the penis. Which of the following embryologic structures failed to fuse in this patient? (A) Labioscrotal swellings or folds (B) Urogenital sinus (C) Spongy urethra (D) Phallus (E) Urethral folds

A 5-year-old boy with breathing difﬁ culty, chest pain, and cough was admitted to a local hospital. The pediatrician who examined the boy, along with laboratory results, diagnosed the child as having cystic ﬁ brosis. Which of the following structures is most likely blocked? (A) Trachea (B) Primary bronchus (C) Secondary or lobar bronchi (D) Terminal bronchioles (E) Alveolar duct

A 5-year-old girl is brought to the emergency department because of difﬁ culty 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

A 52-year-old woman comes to an orthopedic surgeon complaining of an uncomfortable feeling in her knee and ankle joints. After a thorough examination, she is diagnosed as having arthritis with mild discomfort with passive movements. The muscles acting at the ankle joint appear normal with good strength. Which muscle can both dorsiﬂ ex and invert her foot? (A) Peroneus longus (B) Peroneus brevis (C) Peroneus tertius (D) Extensor hallucis longus (E) Extensor digitorum longus

A 52-year-old woman slipped and fell and now complains of being unable to extend her leg at the knee joint. Which of the following muscles was paralyzed as a result of this accident? (A) Semitendinosus (B) Sartorius (C) Gracilis (D) Quadriceps femoris (E) Biceps femoris

A 53-year-old bank teller is admitted to a local hospital for surgical removal of a benign pelvic tumor conﬁ ned within the broad ligament. There is a risk of injuring which of the following structures that lies in this ligament? (A) Ovary (B) Proximal part of the pelvic ureter (C) Terminal part of the round ligament of the uterus (D) Uterine tube (E) Suspensory ligament of the ovary

A 53-year-old man with a known history of emphysema is examined in the emergency department. Laboratory ﬁ ndings along with examination indicate that the patient is unable to exchange oxygen in the air and carbon dioxide in the blood. This exchange occurs in which portion of the respiratory system? (A) Bronchi (B) Alveolar (air) sac (C) Nasal cavity (D) Larynx (E) Trachea

A 53-year-old woman with known kidney disease presents to a hospital because her pain has become increasingly more severe. A physician performing kidney surgery must remember that: (A) The left kidney lies a bit lower than the right one (B) The perirenal fat lies external to the renal fascia (C) The renal fascia does not surround the suprarenal gland (D) The left renal vein runs anterior to both the aorta and the left renal artery (E) The right renal artery is shorter than the left renal artery

A 54-year-old high school teacher has been diagnosed with coronary artery disease and is going to undergo coronary bypass surgery. During the surgery, the thoracic surgeon decides to use the internal thoracic artery for one of the bypasses. Which of the following arteries gives rise to the internal thoracic artery? (A) Axillary artery (B) Superior epigastric artery (C) Costocervical trunk (D) Subclavian artery (E) Ascending aorta

A 54-year-old man comes to a hospital with abdominal pain, jaundice, loss of appetite, and weight loss. On examination of his radiograms and CT scans, a physician ﬁ nds a slowly growing tumor in the uncinate process of the pancreas. Which of the following structures is most likely compressed by this tumor? (A) Main pancreatic duct (B) Splenic artery (C) Portal vein (D) Superior mesenteric artery (E) Superior pancreaticoduodenal artery

A 54-year-old man with a long history of alcohol abuse presents to the emergency department with rapidly increasing abdominal distention most likely resulting from an alteration in portal systemic blood ﬂ ow. Which of the following characteristics is associated with the portal vein or the portal venous system? (A) Lower blood pressure than in the IVC (B) Least risk of venous varices because of portal hypertension (C) Distention of the portal vein resulting from its numerous valves (D) Caput medusae and hemorrhoids caused by portal hypertension (E) Less blood ﬂ ow than in the hepatic artery

A 54-year-old patient is implanted with an artiﬁ cial 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 ﬁ ber (E) Moderator band

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

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) Circumﬂ ex branch of the left coronary artery

A 57-year-old patient has a heart murmur resulting from the inability to maintain constant tension on the cusps of the AV valve. Which of the following structures is most likely damaged? (A) Crista terminalis (B) Septomarginal trabecula (C) Chordae tendineae (D) Pectinate muscle (E) Anulus ﬁ brosus

A 57-year-old patient has a tumor in the body of the pancreas that obstructs the inferior mesenteric vein just before joining the splenic vein. Which of the following veins is most likely to be enlarged? (A) Middle colic vein (B) Left gastroepiploic vein (C) Inferior pancreaticoduodenal vein (D) Ileocolic vein (E) Left colic vein

A 57-year-old woman comes into her physician's ofﬁ ce 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 cerebrospinal ﬂ uid (CSF). A decrease of ﬂ ow in the CSF through which of the following structures would be responsible for these ﬁ ndings? (A) Choroid plexus (B) Vertebral venous plexus (C) Arachnoid villi (D) Internal jugular vein (E) Subarachnoid trabeculae

A 57-year-old woman presents with increasing numbness of the fourth and ﬁ fth digits on her right hand. On examination, it is noticed that she has a wasted hypothenar eminence, inability to abduct the thumb, and a characteristic claw hand. Which of the following nerves has most likely been injured? (A) Axillary nerve (B) Anterior interosseous nerve (C) Radial nerve (D) Ulnar nerve (E) Median nerve

A 58-year-old man is admitted to a hospital with severe abdominal pain, nausea, and vomiting resulting in dehydration. Emergency CT scan reveals a tumor located between the celiac trunk and the superior mesenteric artery. Which of the following structures is likely compressed by this tumor? (A) Fundus of the stomach (B) Neck of the pancreas (C) Transverse colon (D) Hepatopancreatic ampulla (E) Duodenojejunal junction

A 58-year-old man is diagnosed as having a slowly growing tumor in the deep perineal space. Which of the following structures would most likely be injured? (A) Bulbourethral glands (B) Crus of penis (C) Bulb of vestibule (D) Spongy urethra (E) Great vestibular gland

A 58-year-old man is presented with edema of the lower limb and enlarged superﬁ cial veins of the abdominal wall. Examination of radiographs and angiograms reveals obstruction of the IVC just proximal to the entrance of the renal vein. This venous blockage may result in dilation of which of the following veins? (A) Left suprarenal vein (B) Right inferior phrenic vein (C) Right hepatic vein (D) Left gastric vein (E) Portal vein

A 58-year-old stockbroker is brought to the cardiac catheterization laboratory e mergently after evaluation in the emergency department has determined that he is suffering from an acute myocardial infarction. During the catheterization, he is found to have inadequate blood ﬂ ow in the artery that runs aside the great cardiac vein in the anterior interventricular sulcus of the heart. This is most likely an acute occlusion of the: (A) Circumﬂ ex branch of the left coronary artery (B) Marginal branch of the right coronary artery (C) Left coronary artery (D) Right coronary artery (E) Posterior interventricular artery

A 59-year-old man has pus in the loose connective tissue layer of the scalp, and consequently, his superior sagittal sinus is infected. The arachnoid granulations in the infected sinus: (A) Absorb CSF into the dural venous sinuses (B) Are storage areas for CSF (C) Produce CSF (D) Allow CSF to return to the ventricles of the brain (E) Filter venous blood into CSF

A 59-year-old man is diagnosed with prostate cancer following a digital rectal examination. For the resection of prostate cancer, it is important to know that the prostatic ducts open into or on which of the following structures? (A) Membranous part of the urethra (B) Seminal colliculus (C) Spongy urethra (D) Prostatic sinus (E) Prostatic utricle

A 59-year-old woman comes to a local hospital for uterine cancer surgery. As the uterine artery passes from the internal iliac artery to the uterus, it crosses superior to which of the following structures that is sometimes mistakenly ligated during such surgery? (A) Ovarian artery (B) Ovarian ligament (C) Uterine tube (D) Ureter (E) Round ligament of the uterus

A 59-year-old woman has a large pelvic tumor that compresses the inferior hypogastric (pelvic) plexus. Parasympathetic nerve ﬁ bers in this plexus come from which of the following nerves? (A) Lumbar splanchnic nerves (B) Pelvic splanchnic nerves (C) Sacral sympathetic chain ganglia (D) Vagus nerve (E) Sacral splanchnic nerves

A 6 month-old male infant is admitted to the children's hospital because he has no testis in his scrotum. During physical examination, the pediatrician palpated the testis in the inguinal canal. What is the diagnosis of this condition? (A) Male pseudohermaphroditism (B) Hypospadias (C) Epispadias (D) Cryptorchid testis (E) Chordee

A 6-year-old boy comes to his pediatrician with a lump in the groin near the thigh and pain in the groin. On examination, the physician makes a diagnosis of a direct inguinal hernia because the herniated tissue: (A) Enters the deep inguinal ring (B) Lies lateral to the inferior epigastric artery (C) Is covered by spermatic fasciae (D) Descends into the scrotum (E) Develops after birth

A 67-year-old woman with a long history of liver cirrhosis was seen in the emergency department. In this patient with portal hypertension, which of the following veins is most likely to be dilated? (A) Right colic vein (B) Inferior epigastric vein (C) Inferior phrenic vein (D) Suprarenal vein (E) Ovarian vein

A 68-year-old woman with uterine carcinoma undergoes surgical resection. This cancer can spread directly to the labia majora in lymphatics that follow which of the following structures? (A) Pubic arcuate ligament (B) Suspensory ligament of the ovary (C) Cardinal (transverse cervical) ligament (D) Suspensory ligament of the clitoris (E) Round ligament of the uterus

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 biﬁ da occulta (C) Meningocele (D) Meningomyelocele (E) Kyphosis

A 7-day-old baby is diagnosed as having congenital neonatal emphysema, which is caused by collapsed bronchi because of failure of bronchial cartilage development. Bronchial cartilages are derived from which of the following derivations? (A) Ectoderm (B) Mesoderm (C) Endoderm (D) Proctodeum (E) Neuroectoderm

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 muscle (D) Inferior dislocation of the head of the humerus (E) A tumor in the triangular space in the shoulder region

A 7-year-old girl comes to the emergency department with severe diarrhea. Tests show that the diarrhea is due to decreased capacity of normal absorption in one of her organs. Which of the following organs is involved? (A) Stomach (B) Gallbladder (C) Large intestine (D) Liver (E) Pancreas

A 72-year-old man comes to his physician for an annual checkup. Which of the following structures is most readily palpated during rectal examination? (A) Prostate gland (B) Epididymis (C) Ejaculatory duct (D) Ureter (E) Testis

A 72-year-old woman complains of a cramp-like pain in her thigh and leg. She was diagnosed as having a severe intermittent claudication. Following surgery, an infection was found in the adductor canal, damaging the enclosed structures. Which of the following structures remains intact? (A) Femoral artery (B) Femoral vein (C) Saphenous nerve (D) Great saphenous vein (E) Nerve to the vastus medialis

A 72-year-old woman with Parkinson's disease fell down in the bathtub at her home and suffered a dislocation of the hip joint that may result in vascular necrosis of the femoral head and neck because of injuries to the arteries. Which of the following arteries might remain intact? (A) Lateral femoral circumﬂ ex artery (B) Medial femoral circumﬂ ex artery (C) Obturator artery (D) Inferior gluteal artery (E) Deep iliac circumﬂ ex artery

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 75-year-old veteran suffers a heart attack and is found in his home unconscious. He is in ventricular tachycardia and is shocked into normal sinus rhythm. He undergoes emergent catheterization and is found to have a thrombosis in the coronary sinus. Which of the following cardiac veins might remain normal in diameter by catheterization study by the cardiologist? (A) Great cardiac vein (B) Middle cardiac vein (C) Anterior cardiac vein (D) Small cardiac vein (E) Oblique cardiac vein

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 c ontain? (A) Horizontal ﬁ ssure (B) Groove for superior vena cava (SVC) (C) Middle lobe (D) Lingula (E) Larger capacity than the righ

A 78-year-old man has carcinoma of the rectum. The cancer is likely to metastasize via the veins into which of the following structures? (A) Spleen (B) Kidney (C) Liver (D) Duodenum (E) Suprarenal gland

A 78-year-old man is suffering from ischemia of the suprarenal glands. This condition results from rapid occlusion of direct branches of which of the following arteries? (A) Aorta, splenic, and inferior phrenic arteries (B) Renal, splenic, and inferior mesenteric arteries (C) Aorta, inferior phrenic, and renal arteries (D) Superior mesenteric, inferior mesenteric, and renal arteries (E) Aorta and hepatic and renal arteries

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

A 78-year-old woman receives knee surgery because her lateral meniscus is torn. Before injury, the normal lateral meniscus of the knee joint: (A) Is C-shaped or forms a semicircle (B) Is attached to the ﬁ bular collateral ligament (C) Is larger than the medial meniscus (D) Lies outside the synovial cavity (E) Is more frequently torn in injuries than the medial meniscus

A 9-month-old girl was admitted to the children's hospital with tachypnea (fast breathing) and shortness of breath. Physical examination further exhibits tachycardia (fast heart rate), a bounding peripheral pulse, and her angiographs reveal a patent ductus arteriosus. Which of the following embryonic arterial structures is most likely responsible for the origin of the patent ductus arteriosus? (A) Right fourth arch (B) Left ﬁ fth arch (C) Right ﬁ fth arch (D) Left sixth arch (E) Right sixth arch

A 9-year-old boy was admitted to the emergency department complaining of nausea, vomiting, fever, and loss of appetite. On examination, he was found to have tenderness and pain on the right lower quadrant. Based on signs and symptoms, the diagnosis of acute appendicitis was made. During an appendectomy performed at McBurney's point, which of the following structures is most likely to be injured? (A) Deep circumﬂ ex femoral artery (B) Inferior epigastric artery (C) Iliohypogastric nerve (D) Genitofemoral nerve (E) Spermatic cor

A 9-year-old girl has crashed into her neighbor's brick fence while riding her bike and is brought to the emergency department with a great deal of abdominal pain. Her radiogram and angiogram show laceration of the superior mesenteric artery immediately distal to the origin of the middle colic artery. If collateral circulation is discounted, which of the following organs may become ischemic? (A) Descending colon (B) Duodenum (C) Pancreas (D) Ascending colon (E) Transverse colon

A ballet dancer falls to the ﬂ oor and hurts herself during a practice session before opening night. She sustains an injury to the thoracodorsal nerve that would probably affect the strength of which of the following movements? (A) Adduction of the scapula (B) Elevation of the scapula (C) Abduction of the arm (D) Extension of the arm (E) Lateral rotation of the arm

A basketball player was hit in the thigh by an opponent's knee. Which of the following arteries is likely to compress and cause ischemia because of the bruise and damage to the extensor muscles of the leg? (A) Popliteal (B) Deep femoral (C) Anterior tibial (D) Posterior tibial (E) Peroneal

A biomedical engineer would like to reconstruct the arm of a boy who underwent amputation to treat a life-threatening infection. In designing the prosthetic arm, the engineer will need to know that which of the following muscles ﬂ exes the elbow and is innervated by the radial nerve? (A) Flexor digitorum longus (B) Brachioradialis (C) Brachialis (D) Extensor digitorum longus (E) Biceps brachii

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 ﬂ ow in coronary arteries is maximal during diastole (E) Aortic valve closes at the same time as AV valve

A construction worker falls feet ﬁ rst from a roof. He sustains a fracture of the groove on the undersurface of the sustentaculum tali of the calcaneus bone. Which of the following muscle tendons is most likely torn? (A) Flexor digitorum brevis (B) Flexor digitorum longus (C) Flexor hallucis brevis (D) Flexor hallucis longus (E) Tibialis posterior

A construction worker is hit on the leg with a concrete block and is subsequently unable to plantar ﬂ ex and invert his foot. Which of the following muscles is most likely damaged? (A) Extensor digitorum longus (B) Tibialis anterior (C) Tibialis posterior (D) Peroneus longus (E) Peroneus brevis

A construction worker 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 indicis tendon (D) Abductor pollicis brevis tendon (E) Radial artery

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

A forensic pathologist is examining the pelvic bone of a murder victim to identify the sex of the victim. Which of the following characteristics is that of a female pelvis? (A) Oval-shaped pelvic inlet (B) Smaller pelvic outlet (C) Lesser pubic angle (D) Narrower and longer sacrum (E) Narrower and deeper pelvic cavity

A general surgeon is giving a lecture to a team of surgery residents. She describes characteristics of structures above the pectinate line of the anal canal, which include: (A) Stratiﬁ ed squamous epithelium (B) Venous drainage into the caval system (C) Lymphatic drainage into the superﬁ cial inguinal nodes (D) Visceral sensory innervation (E) External hemorrhoids

A kick ﬁ ghter is brought into the locker room after being knocked out by his opponent. He has suffered severe trauma to the articular disk and capsule of the temporomandibular joint. This could result in paralysis of which of the following muscles? (A) Masseter (B) Temporalis (C) Medial pterygoid (D) Lateral pterygoid (E) Buccinator

A knife wound penetrates the superﬁ cial vein that terminates in the popliteal vein. Bleeding occurs from which of the following vessels? (A) Posterior tibial vein (B) Anterior tibial vein (C) Peroneal vein (D) Great saphenous vein (E) Lesser saphenous vein

A man injures his wrist on broken glass. Which of the following structures entering the palm superﬁ cial to the ﬂ exor retinaculum may be damaged? (A) Ulnar nerve and median nerve (B) Median nerve and ﬂ exor digitorum profundus (C) Median nerve and ﬂ exor pollicis longus (D) Ulnar artery and ulnar nerve (E) Ulnar nerve and ﬂ exor digitorum superﬁ cialis

A man interviewing for a new administrative position as hospital chief executive ofﬁ cer notices difﬁ culty walking after sitting with his leg crossed for 2 hours. He was nervous during the interview but even more so now that he is attempting to stand to follow two board members for a tour of the hospital. Which of the following actions is most seriously affected by compression and temporary paralysis of the deep peroneal nerve? (A) Plantar ﬂ exion of the foot (B) Dorsiﬂ exion of the foot (C) Abduction of the toes (D) Adduction of the toes (E) Inversion of the foot

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

A man with a neuromuscular autoimmune disease has another attack at home. His wife calls the doctor's ofﬁ ce because he is unable to speak. Once at the ofﬁ ce, he is unable to open his jaw because of paralysis of which of the following muscles? (A) Medial pterygoid (B) Masseter (C) Temporalis (D) Lateral pterygoid (E) Buccinator

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

A middle-aged woman is receiving a shiatsu massage when her therapist notices that the client has numbness of her back. A lack of sensation overlying the skin over the anterior triangle of the neck may be due to injury to which of the following nerves? (A) Great auricular nerve (B) Transverse cervical nerve (C) Superior ramus of the ansa cervicalis (D) Inferior ramus of the ansa cervicalis (E) Superior laryngeal nerve

A mother with diabetes gives birth to a baby who is diagnosed as having dextroposition of the aorta and the pulmonary trunk with cyanosis and shortness of breath. Which of the following structures is required to remain patent until surgical correction of the deformity? (A) Umbilical arteries (B) Umbilical vein (C) Ductus arteriosus (D) Ductus venosus (E) Sinus venosus

A motorcyclist falls from his bike in an accident and gets a deep gash that severs the superﬁ cial peroneal nerve near its origin. Which of the following muscles is paralyzed? (A) Peroneus longus (B) Extensor hallucis longus (C) Extensor digitorum longus (D) Peroneus tertius (E) Extensor digitorum brevis

A neonatal baby was born with diabetes mellitus due to an inadequate production of insulin. Cells in the endocrine portion of the pancreas that secrete insulin, glucagon, and somatostatin are derived from which of the following?(A) Ectoderm (B) Mesoderm (C) Endoderm (D) Proctodeum (E) Neural crest cells

A neonate is brought to the pediatrician with headaches, fevers, and change in mental status, mostly manifested as lethargy and lack of appetite. The baby is admitted emergently to rule out meningitis and is to undergo a diagnostic lumbar puncture. When withdrawing cerebrospinal ﬂ uid (CSF), the needle may penetrate which of the following pairs of structures? (A) Dura mater and denticulate ligament (B) Arachnoid mater and pia mater (C) Dura mater and arachnoid mater (D) Annulus ﬁ brosus and pia mater (E) Arachnoid mater and nucleus pulposus

A neurosurgeon performs surgical resection of a rare meningeal tumor in the sacral region. He tries to avoid an injury of the nerve that arises from the lumbosacral plexus and remains within the abdominal or pelvic cavity. To which of the following nerves should he pay particular attention? (A) Ilioinguinal nerve (B) Genitofemoral nerve (C) Lumbosacral trunk (D) Femoral nerve (E) Lateral femoral cutaneous nerve

A new biotech company is interested in developing a new mechanical heart with a superﬁ cial implantable and rechargeable battery for easy access. During the design phase, the physician hired from the local academic hospital is asked about which structure carries or comes in contact with oxygenated blood. Which of the following answers is correct? (A) Pectinate muscle (B) Crista terminalis (C) Septomarginal trabecula (D) Pulmonary vein (E) Pulmonary artery

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

A patient bleeding from the shoulder secondary 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) Circumﬂ ex scapular artery (D) Transverse cervical artery (E) Suprascapular artery

A patient comes in complaining that she cannot ﬂ ex her proximal interphalangeal joints. Which of the following muscles appear(s) to be paralyzed on further examination of her ﬁ nger? (A) Palmar interossei (B) Dorsal interossei (C) Flexor digitorum profundus (D) Flexor digitorum superﬁ cialis (E) Lumbricals

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 ﬂ ow? (A) Acromial (B) Pectoral (C) Clavicular (D) Deltoid (E) Superior thoracic

A patient complains of having pain with repeated movements of his thumb (claudication). His physician performs the Allen test and ﬁ nds an insufﬁ ciency of the radial artery. Which of the following conditions would be a result of the radial artery stenosis? (A) A marked decrease in the blood ﬂ ow in the superﬁ cial palmar arterial arch (B) Decreased pulsation in the artery passing superﬁ cial to the ﬂ exor retinaculum (C) Ischemia of the entire extensor muscles of the forearm (D) A marked decrease in the blood ﬂ ow in the princeps pollicis artery (E) A low blood pressure in the anterior interosseous artery

A patient experiences paralysis of the muscle that originates from the femur and contributes directly to the stability of the knee joint. Which of the following muscles is involved? (A) Vastus lateralis (B) Semimembranosus (C) Sartorius (D) Biceps femoris (long head) (E) Rectus femoris

A patient experiences weakness in dorsiﬂ exing and inverting the foot. Which of the following muscles is damaged? (A) Peroneus longus (B) Peroneus brevis (C) Tibialis anterior (D) Extensor digitorum longus (E) Peroneus tertius

A patient has a damaged pelvic outlet as the result of an automobile accident. Following this accident, which of the following structures is still intact? (A) Sacrotuberous ligament (B) Inferior pubic ramus (C) Pubic crest (D) Ischial tuberosity (E) Coccyx

A patient has a small but solid tumor in the mediastinum, which is conﬁ ned 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 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

A patient has weakness when ﬂ exing both her thigh and leg. Which of the following muscles is most likely injured? (A) Rectus femoris (B) Semitendinosus (C) Biceps femoris (D) Sartorius (E) Adductor longus

A patient is involved in a motorcycle wreck that results in avulsion of the skin over the anterolateral leg and ankle. Which of the following structures is most likely destroyed with this type of injury? (A) Deep peroneal nerve (B) Extensor digitorum longus muscle tendon (C) Dorsalis pedis artery (D) Great saphenous vein (E) Superﬁ cial peroneal nerve

A patient is rushed to the operating room for an emergent cholecystectomy (resection of a gallbladder) because of cholecystitis. While locating landmarks before surgical resection of an infected gallbladder, the surgeon recalls a portal-caval anastomosis. Which of the following pairs of veins form a portal-caval anastomosis? (A) Hepatic veins and IVC (B) Superior and middle rectal vein (C) Left and right gastric vein (D) Inferior and superﬁ cial epigastric veins (E) Suprarenal and renal veins

A patient is unable to prevent anterior displacement of the femur on the tibia when the knee is ﬂ exed. Which of the following l igaments is most likely damaged? (A) Anterior cruciate (B) Fibular collateral (C) Patellar (D) Posterior cruciate (E) Tibial collateral

A patient presents with a loss of sensation to the skin over the shoulder. Injury to which of the following nerve cells would most likely affect the conduction of sensory information to the central nervous system? (A) Multipolar neurons (B) Bipolar neurons (C) Unipolar or pseudounipolar neurons (D) Neurons in the ventral horn (E) Neurons in sympathetic chain ganglia

A patient presents with a thrombosis in the popliteal vein. This thrombosis most likely causes reduction of blood ﬂ ow in which of the following veins? (A) Greater saphenous (B) Lesser saphenous (C) Femoral (D) Posterior tibial (E) Anterior tibial

A patient presents with sensory loss on adjacent sides of the great and second toes and impaired dorsiﬂ exion of the foot. These signs probably indicate damage to which of the following nerves? (A) Superﬁ cial peroneal (B) Lateral plantar (C) Deep peroneal (D) Sural (E) Tibia

A patient with Bennett's fracture (a fracture of the base of the ﬁ rst 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 (superﬁ cial head) (C) Opponens pollicis (D) Adductor pollicis (E) Flexor pollicis brevis (deep head)

A patient with a deep knife wound in the buttock walks with a waddling gait that is characterized by the pelvis falling toward one side at each step. Which of the following nerves is damaged? (A) Obturator nerve (B) Nerve to obturator internus (C) Superior gluteal nerve (D) Inferior gluteal nerve (E) Femoral nerve

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 superﬁ cialis (E) Flexor pollicis brevis and pronator quadratus

A patient with a stab wound receives a laceration of the musculocutaneous nerve. Which of the following conditions is most likely to have occurred? (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 patient with cirrhosis is scheduled for liver transplant surgery. During the operation rounds, the transplant physician explains to his residents that one of the reasons a surgeon must pay close attention to the anatomic location of the liver is that this organ: (A) Receives blood only from the hepatic arteries (B) Manufactures red blood cells in an adult (C) Drains bile from the quadrate lobe into the right hepatic duct (D) Drains venous blood into the hepatic veins (E) Functions to concentrate and store bile

A patient with diverticulosis of the colon presents for follow-up to his primary care physician with ongoing complaints of left lower quadrant pain and occasionally bloody stools. His physician begins workup with appropriating test by recalling that the sigmoid colon: (A) Is drained by systemic veins (B) Is a retroperitoneal organ (C) Receives parasympathetic ﬁ bers from the vagus nerve (D) Receives its blood from the superior mesenteric artery (E) Has teniae coli and epiploic appendages

A patient with hereditary blood clotting problems presents with pain in the back of her knee. An arteriogram reveals a blood clot in the popliteal artery at its proximal end. Which of the following arteries will allow blood to reach the foot? (A) Anterior tibial (B) Posterior tibial (C) Peroneal (D) Lateral circumﬂ ex femoral (E) Superior medial genicular

A pediatric surgeon has resected a structure that is a ﬁ brous remnant of an embryonic or fetal artery in a 5-year-old child. Which of the following structures is most likely to be divided? (A) Lateral umbilical fold (B) Medial umbilical fold (C) Median umbilical fold (D) Ligamentum teres hepatis (E) Ligamentum venosum

A pediatric surgeon is resecting a possible malignant mass from the liver of a neonate with cerebral palsy. The surgeon divides the round ligament of the liver during surgery. A ﬁ brous remnant of which of the following fetal vessels is severed? (A) Ductus venosus (B) Ductus arteriosus (C) Left umbilical vein (D) Right umbilical vein (E) Umbilical artery

A performer at the traveling circus for the state fair has injured her shoulder during a routine. When she fell off the trapeze, she struck the ground on her back, and most of the blunt force was directed toward her shoulders. A crush injury of the suboccipital nerve would result in paralysis of which of the following muscles? (A) Splenius capitis (B) Trapezius (C) Rectus capitis posterior major (D) Levator scapulae (E) Iliocostalis

A physical ﬁ tness trainer for a young Hollywood movie star explains the reasons for 100 stomach crunches a day. The young star, a medical student before "hitting it big," reafﬁ rms to his trainer that the lateral margin of the rectus abdominis, the muscle responsible for a washboard stomach, deﬁ nes which of the following structures? (A) Linea alba (B) Linea semilunaris (C) Linea semicircularis (D) Transversalis fascia (E) Falx inguinalis

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

A radiograph of a 32-year-old woman reveals a perforation in the posterior wall of the stomach in which the gastric contents have spilled into the lesser sac. The general surgeon has opened the lienogastric (gastrosplenic) ligament to reach the lesser sac and notes erosion of the ulcer into an artery. Which of the following vessels is most likely involved? (A) Splenic artery (B) Gastroduodenal artery (C) Left gastric artery (D) Right gastric artery (E) Left gastroepiploic artery

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

A radiologist interprets a lymphangiogram for a 29-year-old patient with metastatic carcinoma. Upper lumbar nodes most likely receive lymph from which of the following structures? (A) Lower part of the anal canal (B) Labium majus (C) Clitoris (D) Testis (E) Scrotum

A retired teacher suffers from a massive heart attack while playing golf and dies in the intensive care unit. Autopsy reveals the cause of death as severely diminished blood ﬂ ow in the coronary arteries. This most likely resulted from embolization of an atherosclerotic plaque at the origin of which of the following vascular structures? (A) Pulmonary trunk (B) Ascending aorta (C) Coronary sinus (D) Descending aorta (E) Aortic arc

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 muscle (C) Subscapularis muscle (D) Teres minor muscle (E) Coracohumeral ligament

A secretary comes in to your ofﬁ ce complaining of pain in her wrists 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) Inability to adduct the little ﬁ nger (B) Inability to ﬂ ex the DIP joint of the ring ﬁ nger (C) Flattened thenar eminence (D) Loss of skin sensation of the medial one and one-half ﬁ ngers (E) Atrophied adductor pollicis muscle

A sexually active adolescent presents with an infection within the ischiorectal fossa. Which of the following structures is most likely injured? (A) Vestibular bulb (B) Seminal vesicle (C) Greater vestibular gland (D) Inferior rectal nerve (E) Internal pudendal artery

A stab wound penetrates the posterior thoracic wall near vertebra of a 24-year-old man. Examination at the emergency department indicates a lesion of gray rami communicantes. Which of the following nerve ﬁ bers would most likely be damaged? (A) General somatic afferent (GSA) ﬁ bers (B) Postganglionic parasympathetic ﬁ bers (C) Preganglionic sympathetic ﬁ bers (D) Postganglionic sympathetic ﬁ bers (E) General visceral afferent (GVA) ﬁ bers

A thoracentesis is performed to aspirate an abnormal accumulation of ﬂ uid 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

A thoracic surgeon is going to collect a portion of the greater saphenous vein for coronary bypass surgery. He has observed that this vein runs: (A) Posterior to the medial malleolus (B) Into the popliteal vein(C) Anterior to the medial condyles of the tibia and femur (D) Superﬁ cial to the fascia lata of the thigh (E) Along with the femoral artery

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 trauma surgeon in the emergency department at a local center examines a 14-year-old boy with extensive pelvic injuries after a hit and run accident. The surgeon inspects the ischiorectal fossa because it: (A) Accumulates urine leaking from rupture of the bulb of the penis (B) Contains the inferior rectal vessels (C) Has a pudendal canal along its medial wall (D) Is bounded anteriorly by the sacrotuberous ligament (E) Contains a perineal branch of the ﬁ fth lumbar nerve

A victim of an automobile accident is unable to abduct her left arm. This indicates damage to which of the following parts of the brachial plexus? (A) Middle trunk and posterior cord (B) Middle trunk and lateral cord (C) Lower trunk and lateral cord (D) Upper trunk and posterior cord (E) Lower trunk and medial cord

A woman is delivering a breech baby. The obstetrician decides that it is best to perform a mediolateral episiotomy. Which of the following structures should the obstetrician avoid incising? (A) Vaginal wall (B) Superﬁ cial transverse perineal muscle (C) Bulbospongiosus (D) Levator ani (E) Perineal membrane

A young boy is brought to the hospital after a bicycle accident and possible pelvic fracture. While awaiting a computed tomography (CT) scan of his pelvis, a physician proceeds with a focal neurologic examination. In testing the child's reﬂ exes, which of the following nerves would carry afferent impulses of the cremasteric reﬂ ex? (A) Subcostal nerve (B) Lateral femoral cutaneous nerve (C) Genitofemoral nerve (D) Iliohypogastric nerve (E) Femoral nerve

A young child is evaluated by his pediatrician for chronic nosebleeds. He is referred to an allergist when it is determined that his nasal cavity is chronically dry because of a lack of glandular secretions. A possible etiology may be a lesion of which of the following structures? (A) Superior cervical ganglion (B) Lesser petrosal nerve (C) Facial nerve in the facial canal (D) Greater petrosal nerve (E) Deep petrosal nerve

A young couple is having difﬁ culty conceiving a child. Their physician at a reproduction and fertility clinic explains to them that: (A) The ovary lies within the broad ligament (B) The glans clitoris is formed from the corpus spongiosum (C) Erection of the penis is a sympathetic response (D) Ejaculation follows parasympathetic stimulation (E) Fertilization occurs in the infundibulum or ampulla of the uterine tube

A young couple is seeing a sex therapist for the ﬁ rst time to determine the cause of some of their recent difﬁ culties. The husband tells the therapist that he no longer has sensation in his scrotum after a race car accident. Which of the following nerves carries undamaged sensory nerve ﬁ bers? (A) Ilioinguinal nerve (B) Genitofemoral nerve (C) Iliohypogastric nerve (D) Perineal branch of the pudendal nerve (E) Perineal branch of the posterior femoral cutaneous nerve

A young homeless child presents to the emergency department with high fever and low blood pressure. He had strep throat 2 weeks ago when seen in the free clinic; however, his parents could not afford antibiotic medication, and he did not take any. He now has an abscess in the auditory tube that is blocking communication between the nasopharynx and which of the following structures? (A) Vestibule of the inner ear (B) Middle ear (C) Semicircular canals (D) External ear (E) Inner ear

A young man is brought to the emergency department after being mugged. He was stabbed in the shoulder after refusing to give his wallet to his assailant. If the stab wound lacerated the posterior humeral circumﬂ ex artery passing through the quadrangular space on the shoulder region, which of the following nerves might be injured? (A) Radial nerve (B) Axillary nerve (C) Thoracodorsal nerve (D) Suprascapular nerve (E) Accessory nerve

A young man presents to your clinic with a 3-month history of an enlarging mass in his right neck. He undergoes a CT scan that reveals a ﬂ uid-ﬁ lled mass where the common carotid artery bifurcates. Which of the following is another structure that would be located at this level? (A) Thyroid isthmus (B) Cricoid cartilage (C) Sternal angle (D) Superior border of the thyroid cartilage (E) Jugular notch

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 deﬁ ciency) 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 biﬁ da occulta (B) Meningocele (C) Meningomyelocele (D) Myeloschisis (E) Syringomyelocele

A young woman with cryptogenic cirrhosis presents to the university hospital for an evaluation as a possible candidate for liver transplant. She has late-stage cirrhosis, and her liver-spleen scan shows a high degree of portal hypertension. The portal venous system includes which of the following veins? (A) Left suprarenal vein (B) Inferior epigastric vein (C) Superior rectal vein (D) Azygos vein (E) Hepatic vein

A ﬁ rst-year resident in the urology department reviews pelvic anatomy before seeing patients. Which of the following statements is correct? (A) The dorsal artery of the penis supplies the glans penis. (B) The seminal vesicles store spermatozoa. (C) The duct of the bulbourethral gland opens into the membranous urethra. (D) The duct of the greater vestibular gland opens into the vagina. (E) The anterior lobe of the prostate gland is prone to carcinomatous transformation.

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

After an automobile accident, a back muscle 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

After his bath but before getting dressed, a 4-year-old boy was playing with his puppy. The boy's penis was bitten by the puppy, and the deep dorsal vein was injured. The damaged vein: (A) Lies superﬁ cial to Buck's fascia (B) Drains into the prostatic venous plexus (C) Lies lateral to the dorsal artery of the penis (D) Is found in the corpus spongiosum (E) Is dilated during erection

After repair of a ruptured diverticulum, a 31-year-old patient begins to spike with fever and complains of abdominal pain. An infection in the deep perineal space would most likely damage which of the following structures?(A) Ischiocavernosus muscles (B) Superﬁ cial transverse perineal muscles (C) Levator ani (D) Sphincter urethrae (E) Bulbospongiosus

After winning a boxing match, a 24-yearold man is unable to abduct his ﬁ ngers. Which of the following nerves is injured? (A) Ulnar nerve (B) Median nerve (C) Radial nerve (D) Musculocutaneous nerve (E) Axillary nerve

An 18-year-old boy involved in an automobile accident presents with arm that c annot abduct. His paralysis is caused by damage to which of the following nerves? (A) Suprascapular and axillary (B) Thoracodorsal and upper subscapular (C) Axillary and musculocutaneous (D) Radial and lower subscapular (E) Suprascapular and dorsal scapular

An 18-year-old girl is thrust into the steering wheel while driving and experiences difﬁ culty 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

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

An 83-year-old man with a typical coronary circulation has been suffering from an embolism of the circumﬂ ex 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 left ventricle (E) Anterior part of the right ventricle

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

An elderly man at a nursing home is known to have degenerative brain disease. When cerebrospinal ﬂ uid (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 ﬂ avum (E) Annulus ﬁ brosus

An elderly man is choking on his food at a restaurant and attempts by other patrons to dislodge the food bolus using the Heimlich procedure have failed. A retired anesthesiologist rushes to his table and prepares for emergent tracheostomy. She locates the manubrium of the sternum and recalls that it is free from articulation with which of the following structures (A) Body of the sternum (B) First rib (C) Second rib (D) Third rib (E) Clavicle

An elderly man with a known large abdominal aortic aneurysm presents to the emergency department with acute severe and diffuse pain in his abdomen. The physician performing the evaluation considers mesenteric ischemia, a life-threatening disease, as a possible etiology. Which of the following organs may be spared from ischemia in the presence of an occlusive lesion in the celiac trunk? (A) Liver (B) Spleen (C) Pancreas (D) Gallbladder (E) Stomach

An elderly man with benign enlargement of his prostate experiences difﬁ culty in urination, urinary frequency, and urgency. Which of the following lobes of the prostate gland is commonly involved in benign hypertrophy that obstructs the prostatic urethra? (A) Anterior lobe (B) Middle lobe (C) Right lateral lobe (D) Left lateral lobe (E) Posterior lobe

An elderly man with prostatic hypertrophy returns to his urologist with another case of epididymitis. An acute infection involving the dartos muscle layer of the scrotum most likely leads to an enlargement of which of the following lymph nodes? (A) Preaortic nodes (B) Lumbar nodes (C) External iliac nodes (D) Superﬁ cial inguinal nodes (E) Common iliac nodes

An elderly man with prostatitis is seen at an internal medicine clinic. The seminal colliculus of his prostate gland is infected, and its ﬁ ne openings are closed. Which of the following structures is/are most likely to be disturbed? (A) Ducts of the prostate gland (B) Prostatic utricle (C) Ducts of the bulbourethral glands (D) Ejaculatory ducts (E) Duct of the seminal vesicles

An elderly woman fell at home and fractured the greater trochanter of her femur. Which of the following muscles would continue to function normally? (A) Piriformis (B) Obturator internus (C) Gluteus medius (D) Gluteus maximus (E) Gluteus minimus

An emergent hernia repair is scheduled. As the attending physician is driving to the hospital, the medical student assisting on the case quickly reviews his anatomy atlas and is trying to commit to memory that the internal oblique abdominis muscle contributes to the formation of which of the following structures? (A) Inguinal ligament (B) Deep inguinal ring (C) Falx inguinalis (conjoint tendon) (D) Internal spermatic fascia (E) Reﬂ ected inguinal ligament

An indoor soccer player runs into another player while running after the ball. She falls to the ground and fractures the medial epicondyle of the humerus. Which of the following symptoms might she present with when seeing a physician in the emergency department? (A) Impaired abduction of the hand (B) Carpal tunnel syndrome (C) Wrist drop (D) Thenar atrophy (E) Inability to sweat on the medial part of the hand

An injury to the leg of a golfer results in loss of the ability to invert the foot. Which of the following muscles is most likely paralyzed? (A) Tibialis posterior (B) Peroneus longus (C) Peroneus brevis (D) Peroneus tertius (E) Extensor digitorum longus

An obstetrician is about to perform a pudendal block so a woman can experience less pain when she delivers her child. He recalls what he learned in medical school about this nerve. Which of the following statements is correct? (A) It passes superﬁ cial to the sacrotuberous ligament. (B) It innervates the testis and epididymis in a male. (C) It provides motor ﬁ bers to the coccygeus. (D) It can be blocked by injecting an anesthetic near the inferior margin of the ischial spine. (E) It arises from the lumbar plexus.

An obstetrician performs a median episiotomy on a woman before parturition to prevent uncontrolled tearing. If the perineal body is damaged, the function of which of the following muscles might be impaired? (A) Ischiocavernosus and sphincter urethrae (B) Deep transverse perineal and obturator internus (C) Bulbospongiosus and superﬁ cial transverse perineal (D) External anal sphincter and sphincter urethrae (E) Bulbospongiosus and ischiocavernosu

An oncologist is reviewing a CT scan of a 74-year-old man with newly diagnosed hepatocellular carcinoma. He locates the affected quadrate lobe of the liver that: (A) Lies between the IVC and ligamentum venosum (B) Receives blood from the right hepatic artery (C) Drains bile into the left hepatic duct (D) Is a medial superior segment (E) Is functionally a part of the right lobe

An orthopedic surgeon ligates the posterior tibial artery at its origin. Which of the following arteries has no blood ﬂ ow immediately after the ligation? (A) Peroneal (B) Dorsalis pedis (C) Superior medial genicular (D) Anterior tibial (E) Descending genicular

At a local hospital tumor board, a gynecologic oncologist discusses the next case for the multidisciplinary team. He explains the rationale for using chemotherapy and radiation after surgical resection because carcinoma of the uterus can spread directly to the labia majus through lymphatics that follow the: (A) Ovarian ligament (B) Suspensory ligament of the ovary (C) Round ligament of the uterus (D) Uterosacral ligaments (E) Pubocervical ligaments

Because of a lesion, the parasympathetic nerve ﬁ bers are unable to induce a contraction of the detrusor muscle and relaxation of the internal sphincter. The injured parasympathetic ﬁ bers that supply the urinary bladder are derived from which of following nerves? (A) Vagus nerve (B) Pelvic splanchnic nerve (C) Sacral splanchnic nerve (D) Lesser splanchnic nerve (E) Greater splanchnic nerve

Because of an inﬂ ammatory bowel d isease (Crohn's disease) and a small bowel obstruction leading to bowel ischemia, an elderly woman requires bypass of her ileum and jejunum and is scheduled for a g astrocolostomy. The surgeon will ligate all arteries that send branches to the stomach. Which of the following arteries may be spared? (A) Splenic artery (B) Gastroduodenal artery (C) Inferior pancreaticoduodenal artery (D) Left gastroepiploic artery (E) Proper hepatic artery

Before knee surgery, a surgeon ligates arteries participating in the anastomosis around the knee joint. Which of the following arteries is most likely spared? (A) Lateral superior genicular (B) Medial inferior genicular (C) Descending branch of the lateral femoral circumﬂ ex (D) Saphenous branch of the descending genicular (E) Anterior tibial recurrent

Coronary angiographs of a 44-year-old male patient reveal an occlusion of the circumﬂ ex 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

Deep venous thrombosis is a common complication from sitting in one position for a prolonged duration, such as during a long car trip or a long plane ﬂ ight. The ﬁ rst vascular channels likely to be obstructed or occluded by an embolus from the deep veins of a lower limb are the: (A) Tributaries of the renal veins (B) Branches of the coronary arteries (C) Sinusoids of the liver (D) Tributaries of the pulmonary veins (E) Branches of the pulmonary arteries

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

During a domestic dispute, a 16-year-old boy receives a deep stab wound around the superior angle of the scapula near the medial border, 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

During a domestic incident, a 28-yearold woman receives a vertical stab wound that lacerates the pterygomandibular raphe. As a result, which of the following muscles would be paralyzed? (A) Superior and middle pharyngeal constrictors (B) Middle and inferior pharyngeal constrictors (C) Superior pharyngeal constrictor and buccinator muscles (D) Medial and lateral pterygoid muscles (E) Tensor veli palatini and levator veli palatini

During a palatine tonsillectomy, a surgeon must ligate arteries to avoid bleeding within the surgical ﬁ eld. Which of the following arteries can be spared? (A) Lesser palatine artery (B) Facial artery (C) Lingual artery (D) Superior thyroid artery (E) Ascending pharyngeal artery

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's fracture (C) Meningomyelocele (D) Whiplash injury (E) Herniated disk

During a sports medicine physical by a local family physician, a young woman is tested for stability of her joints before tryouts for the high school team. Which of the following ligaments is important in preventing forward displacement of the femur on the tibia when the weight-bearing knee is ﬂ exed? (A) Medial meniscus (B) Tibial collateral ligament (C) Fibular collateral ligament (D) Posterior cruciate ligament (E) Anterior cruciate ligament

During an annual health examination of a 46-year-old woman, a physician ﬁ nds hypersecretion of norepinephrine from her suprarenal medulla. Which of the following types of nerve ﬁ bers are most likely overstimulated? (A) Preganglionic sympathetic ﬁ bers (B) Postganglionic sympathetic ﬁ bers (C) Somatic motor ﬁ bers (D) Postganglionic parasympathetic ﬁ bers (E) Preganglionic parasympathetic ﬁ bers

During an outbreak of meningitis at a local college, a 20-year-old student presents to a hospital emergency department complaining of headache, fever, chills, and stiff neck. On examination, it appears that he may have meningitis and needs a lumbar puncture or a spinal tap. Cerebrospinal ﬂ uid (CSF) is normally withdrawn from which of the following spaces? (A) Epidural space (B) Subdural space (C) Space between the spinal cord and the pia mater (D) Subarachnoid space (E) Space between the arachnoid and dura maters

During development, the midgut artery appears to be markedly narrowed at its origin. Which of the following structures is derived from the midgut and may receive inadequate blood supply? (A) Gallbladder (B) Stomach (C) Descending colon (D) Ascending colon (E) Rectum

During early development of the respiratory system, the laryngotracheal tube maintains communication with the primitive foregut. Which of the following embryonic structures is most likely responsible for partitioning these two embryonic structures? (A) Tracheoesophageal folds (B) Tracheoesophageal ﬁ stula (C) Tracheoesophageal septum (D) Laryngotracheal diverticulum (E) Laryngotracheal septum

During pelvic surgery, a surgeon notices severe bleeding from the artery that remains within the true pelvis. Which of the following arteries is most likely to be injured? (A) Iliolumbar artery (B) Obturator artery (C) Uterine artery (D) Internal pudendal artery (E) Inferior gluteal artery

During recruitment by the local representative for the Marines, a young college student presents with the condition known as ﬂ at foot. His foot is displaced laterally and everted, and the head of the talus is no longer supported. Which of the following ligaments probably is stretched? (A) Plantar calcaneonavicular (spring) (B) Calcaneoﬁ bular (C) Anterior taloﬁ bular (D) Plantar calcaneocuboid (short plantar) (E) Anterior tibiotalar

During surgical treatment of portal hypertension in a 59-year-old man with liver cirrhosis, a surgeon inadvertently lacerates the dilated paraumbilical veins. The veins must be repaired to allow collateral ﬂ ow. Which of the following ligaments is most likely severed? (A) Lienorenal ligament (B) Lienogastric ligament (C) Gastrophrenic ligament (D) Ligamentum teres hepatis (E) Ligamentum venosum

Examination of a 54-year-old man reveals an isolated tumor located at the porta hepatis. This tumor most likely compresses which of the following structures? (A) Cystic duct (B) Hepatic veins (C) Common hepatic artery (D) Left gastric artery (E) Branches of the portal vein

In a freak hunting accident, a 17-yearold boy was shot with an arrow that penetrated into his suboccipital triangle, injuring the suboccipital nerve between the vertebral artery and the posterior arch of the atlas. Which of the following 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

Mrs. Jones is undergoing a routine colonoscopy for colon cancer prevention. The gastroenterologist ﬁ nds a Meckel's diverticulum. Which of the following statements is true about the diverticulum? (A) It is found 2 ft distal to the ileocecal junction (B) It is located on the mesenteric side of the ileum (C) It occurs in approximately 20% of the population (D) It is a persistent remnant of the embryonic yolk stalk (E) It may contain renal and suprarenal tissues

Mrs. Jones was riding in the front seat of her son's van when the vehicle abruptly stopped. Unfortunately, she was not wearing her seatbelt and was thrown forward. As a result of the accident, the transverse processes of her cervical vertebrae were crushed against the dashboard of the van. Which of the following muscles might be paralyzed? (A) Trapezius (B) Latissimus dorsi (C) Rhomboid major (D) Levator scapulae (E) Serratus posterior superior

On a busy Saturday night in Chicago, a 16-year-old boy presents to the emergency department with a stab wound from a knife that entered the pelvis above the piriformis muscle. Which of the following structures is most likely to be damaged? (A) Sciatic nerve (B) Internal pudendal artery (C) Superior gluteal nerve (D) Inferior gluteal artery (E) Posterior femoral cutaneous nerve

On the basis of the examination at her doctor's ofﬁ ce, a patient is told that her parasympathetic nerves are damaged. Which of the following muscles would most likely be affected? (A) Muscles in the hair follicles (B) Muscles in blood vessels (C) Muscles that act at the elbow joint (D) Muscles in the gastrointestinal (GI) tract (E) Muscles enclosed by epimysium

Pancreatic cancer has one of the highest mortality rates of all cancers because of the lack of symptoms until an advanced stage of disease. The one exception is the cancer that is slow growing and located in the head of the pancreas. This may present in an early stage by causing compression of which of the following structures? (A) Duodenojejunal junction (B) Gastroduodenal artery (C) Bile duct (D) Inferior mesenteric artery (E) Common hepatic duct

The attending faculty in the coronary intensive care unit demonstrates to his students a normal heart examination. The ﬁ rst heart sound is produced by near-simultaneous closure of which of the following valves? (A) Aortic and tricuspid (B) Aortic and pulmonary (C) Tricuspid and mitral (D) Mitral and pulmonary (E) Tricuspid and pulmonary

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

The muscle that indents the submandibular gland and divides it into superﬁ cial and deep parts is paralyzed because of compression by a large salivary glandular tumor. Which of the following muscles is involved? (A) Hyoglossus (B) Digastric posterior belly (C) Styloglossus (D) Stylohyoid (E) Mylohyoid

The obturator nerve and the sciatic (tibial portion) nerve of a 15-year-old boy are transected as a result of a motorcycle accident. This injury would result in complete paralysis of which of the following muscles? (A) Rectus femoris (B) Biceps femoris, short head (C) Pectineus (D) Adductor magnus (E) Sartorius

The police bring in a murder suspect who has been in a gunﬁ ght with a police ofﬁ cer. The suspect was struck by a bullet in the arm; his median nerve has been damaged. 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

The secretary of a rather verbose academic physician in internal medicine complains of numbness and tingling in her hands and ﬁ ngers. She is constantly typing long patient visit dictations and now has carpal tunnel syndrome, which is due to compression of which of the following structures? (A) Ulnar artery (B) Ulnar nerve (C) Median nerve (D) Flexor carpi radialis tendon (E) Palmaris longus tendon

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

There are only 30 minutes left before the concert starts. The pianist, who incidentally has a cut over the palmar surface of her wrist, notices that she is unable to pick up a piece of music between her index and middle ﬁ ngers. Which of the following nerves is most likely damaged? (A) Radial nerve (B) Axillary nerve (C) Ulnar nerve (D) Median nerve (E) Anterior interosseous nerve

Weight lifters in competition are often concerned about muscle tone and complications with hernias. In particular, the most common hernia in this case is an indirect inguinal hernia, which appears: (A) Lateral to the inferior epigastric artery (B) Between the inferior epigastric and obliterated umbilical arteries (C) Medial to the obliterated umbilical artery (D) Between the median and medial umbilical folds (E) Between the linea alba and linea semilunaris

While examining radiographs and angiograms of a 52-year-old patient, a physician is trying to distinguish the jejunum from the ileum. He has observed that the jejunum has: (A) Fewer plicae circulares (B) Fewer mesenteric arterial arcades (C) Less digestion and absorption of nutrients (D) Shorter vasa recta (E) More fat in its mesentery

While performing a pelvic exenteration, the surgical oncologist notices a fractured or ruptured boundary of the pelvic inlet. Which of the following structures is most likely damaged? (A) Promontory of the sacrum (B) Anterior-inferior iliac spine (C) Inguinal ligament (D) Iliac crest (E) Arcuate pubic ligament

While playing football, a 19-year-old c ollege student receives a twisting injury to his knee when being tackled from the lateral side. Which of the following conditions most likely has occurred? (A) Tear of the medial meniscus (B) Ruptured ﬁ bular collateral ligament (C) Tenderness on pressure along the ﬁ bular collateral ligament (D) Injury of the posterior cruciate ligament (E) Swelling on the back of the knee joint

While playing in a Super Bowl game, a 32-year-old professional football player is tackled, and his anterior cruciate ligament is torn. If not injured, the anterior cruciate ligament of the knee joint: (A) Becomes taut during ﬂ exion of the leg (B) Resists posterior displacement of the femur on the tibia (C) Inserts into the medial femoral condyle (D) Helps prevent hyperﬂ exion of the knee joint (E) Is lax when the knee is extended

While resecting a tumor in the palate, a surgical intern removes the mass but ﬁ nds that it is deeply invasive into the tendon that loops around the pterygoid hamulus. Which of the following muscles would most likely be paralyzed? (A) Tensor tympani (B) Tensor veli palatini (C) Levator veli palatini (D) Superior pharyngeal constrictor (E) Stylohyoid

While speaking at a charity program, an elderly woman suddenly collapses to the ground. She is found to have a massive stroke, but it is unclear where the vascular lesion is located. She undergoes a cerebral arteriogram. Normally, the great cerebral vein of Galen drains directly into which of the following sinuses? (A) Superior sagittal sinus (B) Inferior sagittal sinus(C) Cavernous sinus (D) Transverse sinus (E) Straight sinus

Young Johnny was playing on the playground at school when he fell and struck his arm against the swing set. He ran to the school nurse, complaining of which of the following conditions as a result of injuring the radial nerve in the spiral groove of the humerus?(A) Numbness over the medial side of the forearm (B) Inability to oppose the thumb (C) Weakness in pronating the forearm (D) Weakness in abducting the arm (E) Inability to extend the hand

A 2-month-old boy is admitted to the hospital with diarrhea, vomiting, and difﬁ culty in bowel movements. A computed tomography (CT) scan of his abdomen reveals a distinctly dilated lower colon and is diagnosed as having Hirschsprung's disease. Which of the following is the most likely embryonic mechanism responsible for development of this congenital megacolon? (A) Malrotation of the hindgut (B) Abnormal formation of the urorectal septum (C) Failure of neural crest cell migration into the hindgut (D) Absence of visceral afferent cells in the myenteric plexus (E) Failure of partitioning of the cloaca

A 2-year-old boy presents with pain in his groin that has been increasing in nature over the past few weeks. He is found to have a degenerative malformation of the transversalis fascia during development. Which of the following structures on the anterior abdominal wall is likely defective? (A) Superﬁ cial inguinal ring (B) Deep inguinal ring (C) Inguinal ligament (D) Sac of a direct inguinal hernia (E) Anterior wall of the inguinal canal

A 20-year-old college student receives a severe blow on the inferolateral side of the left knee joint while playing football. Radiographic examination reveals a fracture of the head and neck of the ﬁ bula. After injury to this nerve, which of the following muscles could be paralyzed? (A) Gastrocnemius (B) Popliteus (C) Extensor hallucis longus (D) Flexor digitorum longus (E) Tibialis posterior

A 20-year-old college student receives a severe blow on the inferolateral side of the left knee joint while playing football. Radiographic examination reveals a fracture of the head and neck of the ﬁ bula. If the lateral (ﬁ bular) collateral ligament is torn by this fracture, which of the following conditions may occur? (A) Abnormal passive abduction of the extended leg (B) Abnormal passive adduction of the extended leg (C) Anterior displacement of the femur on the tibia (D) Posterior displacement of the femur on the tibia (E) Maximal ﬂ exion of the leg

A 20-year-old college student receives a severe blow on the inferolateral side of the left knee joint while playing football. Radiographic examination reveals a fracture of the head and neck of the ﬁ bula. Which of the following arteries could also be damaged by this fracture? (A) Popliteal (B) Posterior tibial (C) Anterior tibial (D) Peroneal (E) Lateral inferior genicular

A 20-year-old college student receives a severe blow on the inferolateral side of the left knee joint while playing football. Radiographic examination reveals a fracture of the head and neck of the ﬁ bula. Which of the following conditions would occur from this fracture? (A) Ischemia in the gastrocnemius (B) Loss of plantar ﬂ exion (C) Trendelenburg's sign (D) Anterior tibial compartment syndrome (E) Flat foot

A 20-year-old college student receives a severe blow on the inferolateral side of the left knee joint while playing football. Radiographic examination reveals a fracture of the head and neck of the ﬁ bula. Which of the following nerves is damaged? (A) Sciatic (B) Tibial (C) Common peroneal (D) Deep peroneal (E) Superﬁ cial peroneal

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 this injury? (A) Subscapularis (B) Teres major (C) Latissimus dorsi (D) Teres minor (E) Pectoralis major

A 20-year-old patient cannot ﬂ ex and medially rotate the thigh while running and climbing. Which of the following muscles is most likely damaged? (A) Semimembranosus (B) Sartorius (C) Rectus femoris (D) Vastus intermedius (E) Tensor fasciae latae

A 21-year-old man celebrating his birthday gets a little carried away with his friends and starts a bar ﬁ ght. He is stabbed with a knife that severs the roots of C5 and C6 of the brachial plexus. Which of the following muscles is likely to be paralyzed? (A) Infraspinatus (B) Flexor carpi ulnaris (C) Palmar interossei (D) Adductor pollicis (E) Palmaris brevis

A 21-year-old man developed a hernia after lifting heavy boxes while moving into his new house. During the repair of his resulting hernia, the urologist recalls that the genitofemoral nerve: (A) Runs in front of the quadratus lumborum (B) Is a branch of the femoral nerve (C) Supplies the testis (D) Passes through the deep inguinal ring (E) Gives rise to an anterior scrotal branch

A 21-year-old man falls from the attic and is brought to the emergency department. Examination and radiogram reveal that the lateral longitudinal arch of his foot is ﬂ attened. Which of the following bones is displaced? (A) Talus (B) Medial three metatarsals (C) Navicular (D) Cuneiform (E) Cuboid

A 21-year-old man injures his right arm in an automobile accident. Radiographic examination reveals a fracture of the medial epicondyle of the humerus. After this injury, the patient is unable to do which of the following? (A) Flex the proximal interphalangeal joint of his ring ﬁ nger (B) Flex the DIP joint of his index ﬁ nger (C) Feel sensation on his middle ﬁ nger (D) Abduct his thumb (E) Adduct his index ﬁ nger

A 21-year-old man injures his right arm in an automobile accident. Radiographic examination reveals a fracture of the medial epicondyle of the humerus. 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

A 21-year-old man injures his right arm in an automobile accident. Radiographic 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

A 21-year-old man is involved in a highspeed motor vehicle accident. As a result, he has extensive damage to his sphincter urethrae. Which of the following best describes the injured sphincter urethrae? (A) Smooth muscle (B) Innervated by the perineal nerve (C) Lying between the perineal membrane and Colles's fascia (D) Enclosed in the pelvic fascia (E) Part of the pelvic diaphragm

A 21-year-old man receives a penetrating knife wound in the abdomen and is injured in both the superior mesenteric artery and the vagus nerve. Which portion of the colon would most likely be impaired by this injury? (A) Ascending and descending colons (B) Transverse and sigmoid colons (C) Descending and sigmoid colons (D) Ascending and transverse colons (E) Transverse and descending colons

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 medial and lateral fragments. The arm is rotated medially, but it is not rotated laterally. 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

A 37-year-old house painter fell from a ladder and fractured his left third rib and the structures with which it articulated. Which of the following structures would most likely be damaged? (A) Manubrium of the sternum (B) Body of the second thoracic vertebra (C) Spinous process of the third thoracic vertebra (D) Body of the fourth thoracic vertebra (E) Transverse process of the second thoracic vertebra

A 37-year-old man is brought to the emergency department complaining of severe chest pain. His angiogram reveals thromboses of both brachiocephalic veins. 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

A 37-year-old man is brought to the emergency 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

A 37-year-old man is suffering from carcinoma of the skin of the penis. Cancer cells are likely to metastasize directly to which of the following lymph nodes? (A) External iliac nodes (B) Internal iliac nodes (C) Superﬁ cial inguinal nodes (D) Aortic (lumbar) nodes (E) Deep inguinal nodes

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

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 circumﬂ ex branch of the left coronary artery. Which of the following conditions could result from the blockage of blood ﬂ ow in the circumﬂ ex branch? (A) Tricuspid valve insufﬁ ciency (B) Mitral valve insufﬁ ciency (C) Ischemia of AV node (D) Paralysis of pectinate muscle (E) Necrosis of septomarginal trabecula

A 37-year-old small business manager receives a gunshot wound in the pelvic cavity, resulting in a lesion of the sacral splanchnic nerves. Which of the following nerve ﬁ bers would primarily be damaged? (A) Postganglionic parasympathetic ﬁ bers (B) Postganglionic sympathetic ﬁ bers (C) Preganglionic sympathetic ﬁ bers (D) Preganglionic parasympathetic ﬁ bers (E) Postganglionic sympathetic and parasympathetic ﬁ bers

A 37-year-old woman complains of a bearing-down sensation in her womb and an increased frequency of and burning sensation on urination. On examination by her gynecologist, she is diagnosed with a uterine prolapse. Which of the following structures provides the primary support for the cervix of the uterus? (A) External anal sphincter (B) Broad ligament of the uterus (C) Cardinal (transverse cervical) ligament (D) Round ligament of the uterus (E) Suspensory ligament of the ovary

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

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 superﬁ cial or ascending branch of the transverse cervical artery? (A) Latissimus dorsi (B) Multiﬁ dus (C) Trapezius (D) Rhomboid major (E) Longissimus capitis

A 38-year-old woman with peptic ulcer disease of the stomach experiences severe abdominal pain. Which of the following nervous structures is most likely involved? (A) Greater splanchnic nerve (B) Ventral roots of the spinal nerve (C) Lower intercostal nerve (D) Vagus nerve (E) Gray ramus communicans

A 39-year-old man is unable to expel the last drops of urine from the urethra at the end of micturition because of paralysis of the external urethral sphincter and bulbospongiosus muscles. This condition may occur as a result of injury to which of the following nervous structures? (A) Pelvic plexus (B) Prostatic plexus (C) Pudendal nerve (D) Pelvic splanchnic nerve (E) Sacral splanchnic nerve

A 39-year-old woman with headaches presents to her primary care physician with a possible herniated disk. Her magnetic resonance imaging (MRI) scan reveals that the posterolateral 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

A 41-year-old man was involved in a ﬁ ght and felt weakness in extending the knee joint. On examination, he was diagnosed with a lesion of the femoral nerve. Which of the following symptoms would be a result of this nerve damage? (A) Paralysis of the psoas major muscle (B) Loss of skin sensation on the lateral side of the foot (C) Loss of skin sensation over the greater trochanter (D) Paralysis of the vastus lateralis muscle (E) Paralysis of the tensor fasciae latae

A 6-year-old girl comes to her pediatrician with constipation, abdominal distention, and vomiting. After thorough examination, she is diagnosed as having Hirschsprung's disease (aganglionic megacolon), which is a congenital disease and leads to dilation of the colon. This condition is caused by an absence of which of the following kinds of neural cell bodies? (A) Sympathetic preganglionic neuron cell bodies (B) Sympathetic postganglionic neuron cell bodies (C) Parasympathetic preganglionic neuron cell bodies (D) Parasympathetic postganglionic neuron cell bodies (E) Sensory neuron cell bodies

A 62-year-old man is diagnosed with a Pancoast's tumor that invades the inferior trunk of the brachial plexus. Which of the following muscle actions most likely resulted from injury to the brachial plexus? (A) Lateral rotation of the arm (B) Extension of the ring ﬁ nger (C) Abduction of the index ﬁ nger (D) Flexion of the forearm (E) Pronation of the forearm

A 62-year-old man is incapable of penile erection after rectal surgery with prostatectomy. The patient most likely has a lesion of which of the following nerves? (A) Dorsal nerve of the penis (B) Perineal nerve (C) Hypogastric nerve (D) Sacral splanchnic nerve (E) Pelvic splanchnic nerve

A 62-year-old patient with pericardial effusion comes to a local hospital for aspiration of pericardial ﬂ uid by pericardiocentesis. The needle is inserted into the pericardial cavity through which of the following intercostal spaces adjacent to the sternum? (A) Right fourth intercostal space (B) Left fourth intercostal space (C) Right ﬁ fth intercostal space (D) Left ﬁ fth intercostal space (E) Right sixth intercostal space

A 62-year-old woman slips and falls on the bathroom ﬂ oor. As a result, she has a posterior dislocation of the hip joint and a fracture of the neck of the femur. Fracture of the neck of the femur results in avascular necrosis of the femoral head, probably resulting from lack of blood supply from which of the following arteries? (A) Obturator (B) Superior gluteal (C) Inferior gluteal (D) Medial femoral circumﬂ ex (E) Lateral femoral circumﬂ ex

A 62-year-old woman slips and falls on the bathroom ﬂ oor. As a result, she has a posterior dislocation of the hip joint and a fracture of the neck of the femur. If the acetabulum is fractured at its posterosuperior margin by dislocation of the hip joint, which of the following bones could be involved? (A) Pubis (B) Ischium (C) Ilium (D) Sacrum (E) Head of the femur

A 62-year-old woman slips and falls on the bathroom ﬂ oor. As a result, she has a posterior dislocation of the hip joint and a fracture of the neck of the femur. Rupture of the ligamentum teres capitis femoris may lead to damage to a branch of which of the following arteries? (A) Medial circumﬂ ex femoral (B) Lateral circumﬂ ex femoral (C) Obturator (D) Superior gluteal (E) Inferior gluteal

A 62-year-old woman slips and falls on the bathroom ﬂ oor. As a result, she has a posterior dislocation of the hip joint and a fracture of the neck of the femur. The woman experiences weakness when abducting and medially rotating the thigh after this accident. Which of the following muscles is most likely damaged? (A) Piriformis (B) Obturator internus (C) Quadratus femoris (D) Gluteus maximus (E) Gluteus minimus

A 62-year-old woman slips and falls on the bathroom ﬂ oor. As a result, she has a posterior dislocation of the hip joint and a fracture of the neck of the femur. The woman undergoes hip surgery. If all of the arteries that are part of the cruciate anastomosis of the upper thigh are ligated, which of the following arteries maintains blood ﬂ ow? (A) Medial femoral circumﬂ ex (B) Lateral femoral circumﬂ ex (C) Superior gluteal (D) Inferior gluteal (E) First perforating

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

A 63-year-old man comes to the emergency department with back pain, weakness, and shortness of breath. On examination, he has an aneurysm of the abdominal aorta at the aortic hiatus of the diaphragm. Which of the following pairs of structures would most likely be compressed? (A) Vagus nerve and azygos vein (B) Esophagus and vagus nerve (C) Azygos vein and thoracic duct (D) Thoracic duct and vagus nerve (E) Inferior vena cava (IVC) and phrenic nerve

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 inadvertently procures arterial blood. 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

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 inadvertently procures arterial blood. 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 67-year-old man is known to have infection in the superior petrosal sinus. The infected sinus lies in the margin of which of the following structures? (A) Tentorium cerebelli (B) Falx cerebri (C) Falx cerebelli (D) Diaphragma sellae (E) Straight sinus

A 67-year-old patient has been given a course of antibiotics by gluteal intramuscular injections after a major abdominal surgery. To avoid damaging the sciatic nerve during an injection, the needle should be inserted into which of the following areas? (A) Over the sacrospinous ligament (B) Midway between the ischial tuberosity and the lesser trochanter (C) Midpoint of the gemelli muscles (D) Upper lateral quadrant of the gluteal region (E) Lower medial quadrant of the gluteal region

A 67-year-old woman complains of increasing urinary frequency and a heaviness in her pelvic area. On examination, her uterine cervix is visible at the vaginal opening. This symptom is caused by which of the following conditions? (A) Tear of the transversalis fascia (B) Weakness of the ovarian ligament (C) Relaxation of the cardinal ligament (D) Weakness of the arcuate pubic ligament (E) Paralysis of the piriformis muscle

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