BRS Comprehensive Examination
44. A 59-year-old woman has a large pelvic tumor that compresses the inferior hypogastric (pelvic) plexus. Parasympathetic nerve fibers in this plexus come from which of the following nerves? (A) Lumbar splanchnic nerves (B) Pelvic splanchnic nerves (C) Sacral sympathetic chain ganglia (D) Vagus nerve (E) Sacral splanchnic nerves
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(B) Dorsiflexion of the foot (C) Abduction of the toes (D) Adduction of the toes (E) Inversion of the foot 16. 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 flight. The first 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
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(E) Posterior interosseous nerve
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. 1. 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 circumflex 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,...
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10. There are only 30 minutes left before the concert starts. The pianist, who incidentally has a cut over the palmar surface of her wrist, notices that she is unable to pick up a piece of music between her index and middle fingers. Which of the following nerves is most likely damaged? (A) Radial nerve (B) Axillary nerve
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11. A 29-year-old carpenter receives a crush injury to his metacarpophalangeal joint of the fourth digit (ring finger) while remodeling his neighbor's porch. Which of the following pairs of nerves innervates the muscle that moves the injured joint? (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
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12. A 21-year-old man celebrating his birthday gets a little carried away with his friends and starts a bar fight. He is stabbed 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
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13. The secretary of a rather verbose academic physician in internal medicine complains of numbness and tingling in her hands and fingers. She is constantly typing long patient visit dictations and now has carpal tunnel syndrome, which is due to compression of which of the following structures? (A) Ulnar artery (B) Ulnar nerve (C) Mediannerve (D) Flexor carpi radialis tendon (E) Palmaris longus tendon
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14. While playing in a Super Bowl game, a 32-year-old professional football player is tackled, and his anterior cruciate ligament is torn. If not injured, the anterior cruciate ligament of the knee joint: (A) Becomes taut during flexion of the leg (B) Resists posterior displacement of the femur on the tibia (C) Inserts into the medial femoral condyle (D) Helps prevent hyperflexion of the knee joint (E) Is lax when the knee is extended
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15. A man interviewing for a new administrative position as hospital chief executive officer notices difficulty walking after sitting with his leg crossed for 2 hours. He was nervous during the interview but even more so now that he is attempting to stand to follow two board members for a tour of the hospital. Which of the following actions is most seriously affected by compression and temporary paralysis of the deep peroneal nerve? (A) Plantar flexion of the B) Dorsiflexion of the foot (C) Abduction of the toes (D) Adduction of the toes (E) Inversion of the foot
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45. Because of a lesion, the parasympathetic nerve fibers are unable to induce a contraction of the detrusor muscle and relaxation of the internal sphincter. The injured parasym-pathetic fibers 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
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16. 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 flight. The first 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
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17. During recruitment by the local representative for the Marines, a young college student presents with the condition known as flat foot. His foot is displaced laterally and everted, and the head of the talus is no longer supported. Which of the following ligaments probably is stretched? (A) Plantar calcaneonavicular (spring) (B) Calcaneofibular (C) Anterior talofibular (D) Plantar calcaneocuboid (short plantar) (E) Anterior tibiotalar
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18. 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 flexed? (A) Medial meniscus (B) Tibial collateral ligament (C) Fibular collateral ligament (D) Posterior cruciate ligament (E) Anterior cruciate ligament
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19. 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 flattened. Which of the following bones is displaced? (A) Talus (B) Medial three metatarsals (C) Navicular (D) Cuneiform (E) Cuboid
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2. A victim of an automobile accident is unable to abduct her left arm. This indicates damage to which of the following parts of the brachial plexus? (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
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20. A 72-year-old woman with Parkinson's disease fell down in the bathtub at her home and suffered a dislocation of the hip joint that may result in vascular necrosis of the femoral head and neck because of injuries to the arteries. Which of the following arteries might remain intact? (A) Lateral femoral circumflex artery
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21. A 78-year-old woman receives knee surgery because her lateral meniscus is torn. Before injury, the normal lateral meniscus of the knee joint: (A) Is C-shaped or forms a semicircle (B) Is attached to the fibular 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
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22. A 17-year-old boy is involved in a group fight, and a stab wound lacerates a ventral root of his thoracic spinal nerve. Cell bodies of the injured nerve fibers are located in which of the following nervous structures? (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
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23. A race car driver is brought to the city trauma center after a high-speed crash in which his car spun out of control and struck the concrete embankment. He has blunt trauma to his chest and undergoes extensive vascular studies to determine which blood vessels are still intact. The interventional radiologist recalls that one of the following veins drains directly into the superior vena cava. Which vein would this be? (A) Internal thoracic vein (B) Azygos vein (C) Hemiazygos vein (D) Right superior intercostal vein (E) Left superior intercostal vein
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24. A 58-year-old stockbroker is brought to the cardiac catheterization laboratory emergently 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 flow in the artery that runs aside the great cardiac vein in the anterior interventricular sulcus of the heart. This is most likely an acute occlusion of the: (A) Circumflex 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
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25. A retired teacher suffers from a massive heart attack while playing golf and dies in the intensive care unit. Autopsy reveals the cause of death as severely diminished blood flow in the coronary arteries. This most likely resulted from embolization of an atherosclerotic plaque at the origin of which of the following vascular structures? (A) Pulmonary trunk (B) Ascending aorta (C) Coronary sinus (D) Descending aorta (E) Aortic arch
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26. A 21-year-old woman comes to the emergency department with acute chest pain and shortness of breath. Her chest radiograph shows opacification of one of her lungs. She undergoes thoracentesis, which reveals that she has a chylothorax resulting from rupture of the thoracic duct. Lymphatic drainage remains normal in which of the following areas? (A) Left thorax (B) Right thorax (C) Left abdomen (D) Right pelvis (E) Left lower limb
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27. An elderly man is choking on his food at a restaurant and attempts by other patrons to dislodge the food bolus using the Heimlich procedure have failed. A retired anesthesiologist rushes to his table and prepares for emergent tracheostomy. She locates the manubrium of the sternum and recalls that it is free from articulation with which of the following structures? (A) Body of the sternum (B) First rib (C) Second rib (D) Third rib (E) Clavicle
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28. 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 fibers would most likely be damaged? (A) General somatic afferent (GSA) fibers (B) Postganglionic parasympathetic fibers (C) Preganglionic sympathetic fibers (D) Postganglionic sympathetic fibers (E) General visceral afferent (GVA) fibers
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43. 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 diagnosed 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 fibrous cord? (A) Stomach (B) Jejunum (C) Ileum (D) Appendix (E) Sigmoid colon
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29. A 31-year-old NHL hockey player complains of numbness in the area of his umbilicus after the national championship game. Which of the following structures that carries GSA fibers was injured during the hockey game? (A) Sympathetic trunk (B) Dorsal root (C) Greater splanchnic nerve (D) Gray rami communicantes (E) White rami communicantes 30. A 75-year-old veteran suffers a heart attack and is found in his home unconscious. He is in ventricular tachycardia and is shocked into normal sinus rhythm. He undergoes emergent catheterization and is found to have a thrombosis in the coronary sinus. Which of the following cardiac veins might remain normal in diameter by catheterization study by the cardiologist? (A) Great cardiac vein (B) Middle cardiac vein (C) Anterior cardiac vein (D) Small cardiac vein (E) Oblique cardiac vein
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3. A biomedical engineer would like to reconstruct the arm of a boy who underwent amputation to treat a life-threatening infection. In designing the prosthetic arm, the engineer will need to know that which of the following muscles flexes the elbow and is innervated by the radial nerve? (A) Flexor digitorum longus (B) Brachioradialis (C) Brachialis (D) Extensor digitorum longus (E) Biceps brachii,...
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31. A 35-year-old man is suffering from an infected mediastinum (mediastinitis) after neck and chest injuries resulting from a head-on automobile collision. He has been intubated since the accident and on broad-spectrum intravenous antibiotics since admission; however, the infection continues to progress throughout the mediastinum. Which of the following structures is free from infection? (A) Thymus gland (B) Esophagus (C) Trachea (D) Lungs (E) Heart
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32. 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 33. A new biotech company is interested in developing a new mechanical heart with a superficial implantable and rechargeable battery for easy access. During the design phase, the physician hired from the local academic hospital is asked about which structure carries or comes in contact with oxygenated blood. Which of the following answers is correct? (A) Pectinate muscle (B) Crista terminalis (C) Septomarginal trabecula (D) Pulmonary vein (E) Pulmonary artery
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34. A 62-year-old man is diagnosed with a Pancoast's tumor that invades the inferior trunk of the brachial plexus. Which of the following muscle actions most likely resulted from injury to the brachial plexus? (A) Lateral rotation of the arm (B) Extension of the ring finger (C) Abduction of the index finger (D) Flexion of the forearm (E) Pronation of the forearm
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35. A 67-year-old woman complains of increasing urinary frequency and a heaviness in her pelvic area. On examination, her uterine cervix is visible at the vaginal opening. This symptom is caused by which of the following conditions? (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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36. Weight lifters in competition are often concerned about muscle tone and complications with hernias. In particular, the most common hernia in this case is an indirect inguinal hernia, which appears: (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
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37. A 32-year-old man is involved in a car accident and receives a crushed internal injury in his abdomen. Examination reveals a lesion of parasympathetic fibers in the vagus nerve, which interferes with glandular secretory or smooth muscle functions in which of the following organs? (A) Bladder (B) Transverse colon (C) Sigmoid colon (D) Prostate gland (E) Rectum 38. Pancreatic cancer has one of the highest mortality rates of all cancers because of the lack of symptoms until an advanced stage of disease. The one exception is the cancer that is slow growing and located in the head of the pancreas. This may present in an early stage by causing compression of which of the following structures? (A) Duodenojejunal junction (B) Gastroduodenal artery (C) Bile duct (D) Inferior mesenteric artery (E) Common hepatic duct
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39. 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
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4. Young Johnny was playing on the playground at school when he fell and struck his arm against the swing set. He ran to the school nurse, complaining of which of the following conditions as a result of injuring the radial nerve in the spiral groove of the humerus? (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
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40. A young woman with cryptogenic cirrhosis presents to the university hospital for an evaluation as a possible candidate for liver transplant. She has late-stage cirrhosis, and her liver-spleen scan shows a high degree of portal hypertension. The portal venous system includes which of the following veins? (A) Left suprarenal vein (B) Inferior epigastric vein (C) Superior rectal vein (D) Azygos vein (E) Hepatic vein
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41. A 2-month-old boy is admitted to the hospital with diarrhea, vomiting, and difficulty 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
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42. 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 superficial transverse perineal muscles (E) Contains the greater vestibular glands
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46. 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
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47. A young couple is seeing a sex therapist for the first time to determine the cause of some of their recent difficulties. The husband tells the therapist that he no longer has sensation in his scrotum after a race car accident. Which of the following nerves carries undamaged sensory nerve fibers? (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
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48. A patient has a damaged pelvic outlet as the result of an automobile accident. Following this accident, which of the following structures is still intact? (A) Sacrotuberous ligament (B) Inferior pubic ramus (C) Pubic crest (D) Ischial tuberosity (E) Coccyx
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49. A forensic pathologist is examining the pelvic bone of a murder victim to identify the sex of the victim. Which of the following characteristics is that of a female pelvis? (A) Oval-shaped pelvic inlet (B) Smaller pelvic outlet (C) Lesser pubic angle (D) Narrower and longer sacrum (E) Narrower and deeper pelvic cavity
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5. An indoor soccer player runs into another player while running after the ball. She falls to the ground and fractures the medial epicondyle of the humerus. Which of the following symptoms might she present with when seeing a physician in the emergency 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
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50. 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 (filum of the dura) (D) Denticulate ligament (E) Cauda equine
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51. A performer at the traveling circus for the state fair has injured her shoulder during a routine. When she fell off the trapeze, she struck the ground on her back, and most of the blunt force was directed toward her shoulders. A crush injury of the suboccipital nerve would result in paralysis of which of the following muscles? (A) Splenius capitis (B) Trapezius (C) Rectus capitis posterior major (D) Levator scapulae (E) Iliocostalis
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52. A neonate is brought to the pediatrician with headaches, fevers, and change in mental status, mostly manifested as lethargy and lack of appetite. The baby is admitted emergently to rule out meningitis and is to undergo a diagnostic lumbar puncture. When withdrawing cerebrospinal fluid (CSF), the needle may penetrate which of the following pairs of structures? (A) Dura mater and denticulate ligament (B) Arachnoid mater and pia mater (C) Dura mater and arachnoid mater (D) Annulus fibrosus and pia mater (E) Arachnoid mater and nucleus pulposus
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53. Mrs. Jones was riding in the front seat of her son's van when the vehicle abruptly stopped. Unfortunately, she was not wearing her seatbelt and was thrown forward. As a result of the accident, the transverse processes of her cervical vertebrae were crushed against the dashboard of the van. Which of the following muscles might be paralyzed? (A) Trapezius (B) Latissimus dorsi (C) Rhomboid major (D) Levator scapulae (E) Serratus posterior superior
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54. A middle-aged woman is receiving a shiatsu massage when her therapist notices that the client has numbness of her back. A lack of sensation overlying the skin over the anterior triangle of the neck may be due to injury to which of the following nerves? (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
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55. 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 fluid-filled 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
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56. A kick fighter is brought into the locker room after being knocked out by his opponent. He has suffered severe trauma to the articular disk and capsule of the temporomandibular joint. This could result in paralysis of which of the following muscles? (A) Masseter (B) Temporalis (C) Medial pterygoid (D) Lateral pterygoid (E) Buccinator
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57. A 25-year-old woman is suffering from facial paralysis and exhibits ptosis (drooping of the upper eyelid). Injury to which of the following nerves would result in ptosis? (A) Trochlear nerve (B) Abducens nerve (C) Oculomotor nerve (D) Ophthalmic nerve (E) Facial nerve
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58. A 67-year-old man is known to have infection in the superior petrosal sinus. The infected sinus lies in the margin of which of the following structures? (A) Tentorium cerebelli (B) Falx cerebri (C) Falx cerebelli (D) Diaphragma sellae (E) Straight sinus
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59. A 59-year-old man has pus in the loose connective tissue layer of the scalp, and consequently, his
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6. After winning a boxing match, a 24-year-old man is unable to abduct his fingers. Which of the following nerves is injured? (A) Ulnar nerve (B) Median nerve (C) Radial nerve (D) Musculocutaneous nerve (E) Axillary nerve
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60. While speaking at a charity program, an elderly woman suddenly collapses to the ground. She is found to have a massive stroke, but it is unclear where the vascular lesion is located. She undergoes a cerebral arteriogram. Normally, the great cerebral vein of Galen drains directly into which of the following sinuses? (A) Superior sagittal sinus (B) Inferior sagittal sinus (C) Cavernous sinus (D) Transverse sinus (E) Straight sinus
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61. While resecting a tumor in the palate, a surgical intern removes the mass but finds that it is deeply invasive into the tendon that loops around the pterygoid hamulus. Which of the following muscles would most likely be paralyzed? (A) Tensor tympani (B) Tensor veli palatini (C) Levator veli palatini (D) Superior pharyngeal constrictor (E) Stylohyoid
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62. During a domestic incident, a 28-year-old woman receives a vertical stab wound that lacerates the pterygomandibular raphe. As a result, which of the following muscles would be paralyzed? (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 palatine
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63. A 31-year-old football player with a head injury is brought to a local emergency department. Physical examination, radiogram, and a magnetic resonance imaging 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 palatine
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64. The muscle that indents the submandibular gland and divides it into superficial and deep parts is paralyzed because of compression by a large salivary glandular tumor. Which of the following musclesis involved? (A) Hyoglossus (B) Digastric posterior belly (C) Styloglossus (D) Stylohyoid (E) Mylohyoid
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65. 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
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66. A man with a neuromuscular autoimmune disease has another attack at home. His wife calls the doctor's office because he is unable to speak. Once at the office, he is unable to open his jaw because of paralysis of which of the following muscles? (A) Medial pterygoid (B) Masseter (C) Temporalis (D) Lateral pterygoid (E) Buccinator
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67. 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
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68. A 26-year-old woman with the flu comes to an outpatient clinic. On examination, a physician diagnoses her with sinus and palate infection, and her uvula deviates to the left side on phonation. Which of the following nerves is injured? (A) Left hypoglossal nerve (B) Right hypoglossal nerve (C) Left vagus nerve (D) Right vagus nerve (E) Left trigeminal nerve
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69. During a palatine tonsillectomy, a surgeon must ligate arteries to avoid bleeding within the surgical field. Which of the following arteries can be spared? (A) Lesser palatine artery (B) Facial artery (C) Lingual artery (D) Superior thyroid artery (E) Ascending pharyngeal artery
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7. A 42-year-old woman presents to an out-patient clinic with a 6-month history of numbness and tingling on the palmar aspect of her lateral three and one-half fingers, loss of pronation, and flattening of the thenar eminence. Injury to which of the following nerves could cause such a condition? (A) Axillary nerve (B) Musculocutaneous nerve (C) Median nerve (D) Radial nerve (E) Ulnar nerve
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70. A young child is evaluated by his pediatrician for chronic nosebleeds. He is referred to an allergist when it is determined that his nasal cavity is chronically dry because of a lack of glandular secretions. A possible 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 Questions 71 and 72: A 12-year-old girl suffers from a type of neural tube defect called tethered cord syndrome, a congenital anomaly that results from defective closure of the neural tube. This syndrome is characterized by an abnormally low conus medullaris, which is tethered by a short, thickened filum terminale, leading to progressive neurologic defects in the legs and feet.
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71. Which of the following defects is commonly associated with the tethered cord syndrome? (A) Spina bifida occulta (B) Kyphosis (C) Meningomyelocele (D) Herniated disk (E) Scoliosis
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72. This girl has strong muscle function of the flexors of the thigh, but she has weakness of the extensors (hamstrings). A lesion has occurred at which of the following spinal cord levels? (A) T12 (B) L1 (C) L3 (D) L5 (E) S5
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73. A 36-year-old plumber slips and breaks a porcelain sink, cutting an anterior aspect of his wrist deeply on a sharp edge. On arrival to the emergency department, he can adduct his thumb but not oppose it. Which of the following structures has been severed? (A) Radial nerve (B) Median nerve (C) Ulnar nerve (D) Anterior interosseous nerve
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74. A 21-year-old soccer player is tackled via a high-impact sweeping injury about the right knee, causing a posterior knee dislocation. Soon after, he is unable to plantar flex his right ankle or flex his toes. He also experiences loss of sensation on the sole of his right foot. Which of the following nerves is most likely injured? (A) Saphenous nerve (B) Tibial nerve (C) Deep peroneal nerve (D) Superficial peroneal nerve (E) Common peroneal nerve
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75. A 56-year-old man with a one pack/day history of cigarette smoking is found to have a malignant squamous cell carcinoma located in the superior sulcus of Pancoast (superior apex of the lung). Shortly after the diagnosis is known, the patient develops symptoms that consist of shoulder pain along with ptosis, miosis, enophthalmos, and anhidrosis. Which of the following nerves is most likely compressed by the tumor mass? (A) Phrenic nerve (B) Vagus nerve (C) Cervical sympathetic trunk (D) Ansa cervicalis (E) Recurrent laryngeal nerve
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76. A 57-year-old woman presents with increasing numbness of the fourth and fifth digits on her right hand. On examination, it is noticed that she has a wasted hypothenar eminence, inability to abduct the thumb, and a characteristic claw hand. Which of the following nerves has most likely been injured? (A) Axillary nerve (B) Anterior interosseous nerve (C) Radial nerve (D) Ulnar nerve (E) Median nerve
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77. A 47-year-old woman has had a lumpectomy and axillary dissection to check for metastasis. She has come in for her follow-up appointment, and her physician notices on her physical examination that the medial part of her scapula protrudes from her back and that she is not able to raise her arm above the horizontal level. Which of the following nerves has been damaged during her surgery? (A) Median nerve (B) Ulnar nerve (C) Thoracodorsal nerve (D) Long thoracic nerve (E) Radial nerve
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78. 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
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79. A 54-year-old high school teacher has been diagnosed with coronary artery disease and is going to undergo coronary bypass surgery. During the surgery, the thoracic surgeon decides to use the internal thoracic artery for one of the bypasses. Which of the following arteries gives rise to the internal thoracic artery? (A) Axillary artery (B) Superior epigastric artery (C) Costocervical trunk (D) Subclavian artery (E) Ascending aorta
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8. A ballet dancer falls to the floor and hurts herself during a practice session before opening night. She sustains an injury to the thoracodorsal nerve that would probably affect the strength of which of the following movements? (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
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80. A 34-year-old singer has been diagnosed with thyroid cancer and consequently has a thyroidectomy. He has been hoarse ever since the surgery 8 weeks ago. It has been suspected that a nerve was injured during the operation. Which of the following nerves is most likely damaged? (A) External laryngeal nerve (B) Internal laryngeal nerve (C) Recurrent laryngeal nerve (D) Hypoglossal nerve (E) Glossopharyngeal nerve
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9. A 23-year-old man falls from a ladder and injures his arm. On examination, he feels numbness and has no sweating on the lateral side of his forearm, indicating damage to the lateral antebrachial cutaneous nerve. The cell bodies of injured nerve fibers involved in sweating are located in which of the following structures? (A) Collateral ganglia (B) Dorsal root ganglia (C) Sympathetic chain ganglia (D) Lateral horn of spinal cord (E) Anterior horn of spinal cord(C) Ulnar nerve (D) Median nerve (E) Anterior interosseous nerve
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care unit. Autopsy reveals the cause of death as severely diminished blood flow in the coronary arteries. This most likely resulted from embolization of an atherosclerotic plaque at the origin of which of the following vascular structures? (A) Pulmonary trunk (B) Ascending aorta (C) Coronary sinus (D) Descending aorta (E) Aortic arch (B) Medial femoral circumflex artery (C) Obturator artery (D) Inferior gluteal artery (E) Deep iliac circumflex artery
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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
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