PT 601- Exam 2 (Lecture)

A 42-year-old woman undergoes a vaginal hysterectomy. This procedure includes bilateral dissection of the cardinal ligaments and ligation of the uterine arteries. Which of the following structures has the greatest risk of damage during this procedure? A. Urinary bladder B. Ureter C. Rectum D. Ovarian artery E. Jejunum

B. Ureter

A 62-year-old man comes to the physician because of a painless intermittent bulge in his left groin. He is diagnosed with an indirect inguinal hernia. While attempting to isolate the hernial sac surgically, a thin white tube is transected, with minimal bleeding. Which of the following structures was most likely transected? A. Ureter B. Vas deferens C. Testicular artery D. Ilioinguinal nerve E. Epididymis

B. Vas deferens

A 62-year-old woman must undergo a hysterectomy and lymphadenectomy. During this procedure, extensive dissection of the pelvic cavity is necessary. As the surgeon proceeds, it is important to identify the ureter as it crosses the pelvic brim, usually in a position medial to which of the following structures? A. Aorta B. Inferior vena cava C. Infundibulopelvic ligament (suspensory ligament of the ovary) D. Ovary E. Uterine tube

C. Infundibulopelvic ligament (suspensory ligament of the ovary)

A 32-year-old man has vague and poorly localized pain in the umbilical region. Appendicitis is suspected. The pain is most likely transmitted by visceral afferent fibers that travel through which of the following nerves? A. Greater splanchnic B. Least splanchnic C. Lesser splanchnic D. Lumbar splanchnic E. Vagus

C. Lesser splanchnic

A 34-year-old woman has a murmur with its maximal intensity located at the apex of the heart. Which of the following disorders is the most likely cause of this finding? A. Tricuspid valve stenosis B. Pulmonary valve stenosis C. Mitral valve stenosis D. Atrial septal defect E. Aortic valve stenosis

C. Mitral valve stenosis

A 52-year-old man is unable to have an erection after surgical removal of his prostate gland. The most likely cause is injury to which of the following nervous structures? A. Inferior mesenteric ganglion B. Lumbar splanchnic nerves C. Pelvic splanchnic nerves D. Superior hypogastric plexus E. Sympathetic trunk

C. Pelvic splanchnic nerve

A 10-year-old boy has a serious bicycle accident. At the emergency department, it is determined that his urethra has ruptured immediately inferior to the deep perineal pouch, which has allowed urine to spread from the urethra to the superficial perineal pouch and finally into the anterior abdominal wall. Immediately deep to which of the following layers of the anterior abdominal wall would urine be found? A. External oblique muscle B. Internal oblique muscle C. Scarpa's fascia D. Transversalis fascia E. Transversus abdominis muscle

C. Scarpa's fascia

A 58-year-old man is diagnosed with an occlusion of the inferior mesenteric artery near its origin. If significant collateral circulation is not present or fails to develop, he will have an increased risk for ischemia in which of the following parts of the gastrointestinal tract? A. Anal canal B. Ileum C. Sigmoid colon D. Stomach E. Transverse colon

C. Sigmoid colon

An 18-year-old man, in shock and bleeding profusely, is brought to the emergency department after being stabbed in the chest. An examination shows a knife wound to the right first intercostal space, immediately lateral to the manubrium. The knife entered parallel to the ground and penetrated to a depth of 6.5 cm. Which of the following structures is most likely injured? A. Left common carotid artery B. Ascending aorta C. Superior vena cava D. Right ventricle E. Right subclavian artery

C. Superior vena cava

A 72-year-old woman comes to the emergency department complaining of severe abdominal pain. She is diagnosed with cancer involving the abdominal esophagus and fundus of the stomach. Which of the following neural structures is most likely associated with the "pain" fibers involved with this symptom? A. Least splanchnic nerves B. Lumbar splanchnic nerves C. Postganglionic fibers from the celiac ganglion D. Nerves from spinal cord levels T5 to T9 E. Nerves from spinal cord levels L1 to L2

D. Nerves from spinal cord levels T5 to T9

A 23-year-old woman is injured in an automobile collision. She is brought to the emergency department with severe abdominal pain and diagnosed with internal bleeding. Exploratory surgery indicates she has a severely damaged spleen that must be repaired. Which of the following structures is most likely to be encountered during this procedure? A. Inferior mesenteric artery B. Left suprarenal gland C. Left ureter D. Pancreas E. Right kidney

D. Pancreas

An 82-year-old man cannot have an erection after surgical removal of his rectum. An injury to which of the following nervous structures most likely occurred during the procedure, causing this result? A. Inferior mesenteric ganglion B. Least splanchnic nerve C. Lumbar splanchnic nerve D. Pelvic splanchnic nerves E. Sympathetic chain

D. Pelvic splanchnic nerves

A 47-year-old man is diagnosed with bronchogenic carcinoma of the upper lobe of the left lung. X-ray films show paralysis of the diaphragm on the ipsilateral side. Damage to which of the following nervous structures is the most likely cause of this paralysis? A. Sympathetic trunk B. Inferior cervical ganglion C. Recurrent laryngeal nerve D. Phrenic nerve E. Medial cord of the brachial plexus

D. Phrenic nerve

A 27-year-old man is brought to the emergency department after a motorcycle accident. His injuries include a severe laceration of the anus. Branches of which of the following nervous structures will need to be anesthetized before surgical repair? A. Inferior hypogastric plexus B. Lumbar splanchnic nerves C. Pelvic splanchnic nerves D. Pudendal nerves E. Sacral splanchnic nerves

D. Pudendal nerves

A 23-year-old woman is stabbed with an ice pick in the right third intercostal space immediately lateral to the sternum. The ice pick passed in an anterior to posterior direction. The most likely structure penetrated by this injury was which of the following? A. Aortic arch B. Inferior vena cava C. Pulmonary trunk D. Right atrium E. Right brachiocephalic vein

D. Right atrium

While repairing a heart defect in a 9-year-old boy, the surgeon must avoid suturing the blood vessel that usually supplies the sinoatrial (SA) node. Which of the following major arteries usually supplies the branch to this part of the conduction system? A. Circumflex B. Marginal C. Anterior interventricular D. Right coronary E. Left coronary

D. Right coronary

A 62-year-old woman comes to her physician complaining of abdominal pain. After numerous tests, a diagnosis of an ulcer in the posterior wall of the descending (second) part of the duodenum is made. A perforation occurring at this site could damage which of the following adjacent structures? A. Abdominal aorta B. Ascending colon C. Gallbladder D. Right renal pelvis E. Superior mesenteric artery

D. Right renal pelvis

A 48-year-old man has a lump in his inguinal region. Although it has been present for 3 to 4 months, it has recently become enlarged and very painful. His physician determines that he has a direct inguinal hernia, and, recently, a segment of gut pushed through the superficial inguinal ring. If the herniating gut is compressing the nerve that lies on the external surface of the spermatic cord at the level of the superficial inguinal ring, which of the following functions will be lost? A. Motor innervation to the bulbocavernosus muscle B. Motor innervation to the cremaster muscle C. Motor innervation to the lower portion of the rectus abdominis muscle D. Sensation from the anterior surface of the scrotum E. Sensation from the dorsal surface of the penis

D. Sensation from the anterior surface of the scrotum

In a 45-year-old man both vagal trunks were severed at the esophageal hiatus of the diaphragm during a surgical procedure. Which of the following organs would still receive preganglionic parasympathetic fibers? A. Cecum B. Duodenum C. Gallbladder D. Sigmoid colon E. Stomach

D. Sigmoid colon

A 52-year-old man has severe portal hypertension. Which portocaval shunt can be created in this patient to help decrease his blood pressure? A. Left gastric vein to the splenic vein B. Right gastric vein to the left gastric vein C. Right renal vein to the right gonadal vein D. Splenic vein to the left renal vein E. Superior mesenteric vein to the inferior mesenteric vein

D. Splenic vein to the left renal vein

A 56-year-old alcoholic has severe portal hypertension. Which of the following veins is most likely enlarged because of this condition? A. Femoral B. Hepatic C. Renal D. Superior rectal E. Testicular

D. Superior rectal

A 56-year-old man is jaundiced and has severe abdominal pain. He is diagnosed with cancer of the head of the pancreas. Pain from this problem would be referred to which of the following dermatomes? A. L1 to L2 B. T12 C. T11 D. T5 to T9 E. T1 to T4

D. T5 to T9

A 2-year-old girl is suspected of aspirating the eye from one of her small stuffed animals and she is seen in the emergency department. Her mother reports consistent coughing but no displays of distress or pain. In which area of the airway would you expect to hear diminished breath sounds? A. Both the left and right lobe B. The carina C. The left inferior lobe D. The right inferior lobe E. The right superior lobe

D. The right inferior lobe

An 86-year-old woman is undergoing surgical reconstruction of the structures supporting the uterus to treat a severe prolapse. During this procedure, which of the following structures is most susceptible to injury? A. Mesosalpinx B. Ovarian artery C. Round ligament of the uterus D. Ureter E. Uterine tube

D. Ureter

A 42-year-old man comes to his physician complaining of a painful, infected abscess on the posterior aspect of his scrotum. Which of the following lymph nodes are most likely to be tender and swollen? A. Deep inguinal B. External iliac C. Internal iliac D. Lumbar E. Superficial inguinal

E. Superficial inguinal

A 72-year-old woman is undergoing surgical reconstruction of a prolapsed uterus. During this procedure, manipulation of which of the following ligaments should be avoided because of the possibility of injuring the uterine vessels? A. Uterosacral B. Suspensory C. Round D. Ovarian E. Transverse cervical (cardinal)

E. Transverse cervical (cardinal)

A 72-year-old woman must undergo a hysterectomy. During the procedure, the surgeon must expose and ligate the uterine artery. Passing inferior to the uterine artery and just lateral to the cervix is which of the following structures that must not be damaged during this procedure? A. Internal iliac artery B. Internal pudendal artery C. Pudendal nerve D. Round ligament of the uterus E. Ureter

E. Ureter

A 37-year-old woman is diagnosed with a lobular carcinoma of her right breast located in the superomedial aspect, close to the midline. Based on the staging and aggressiveness of her cancer, a lymph node biopsy has been indicated. Which of the following draining lymph nodes is located closest to the cancer and therefore needs to be biopsied? A. Axillary lymph nodes B. Subscapular lymph nodes C. Apical axillary lymph nodes D. Humeral (lateral) lymph nodes E. Parasternal lymph nodes

E. Parasternal lymph nodes

A 62-year-old woman has a neoplasm in the upper lateral portion of the mammary gland. To which of the following group of nodes are cells from this neoplasm most likely to initially metastasize? A. Abdominal lymph nodes B. Clavicular lymph nodes C. Deep nodes between the pectoralis major and minor muscles D. Parasternal lymph nodes E. Pectoral group of axillary lymph nodes

E. Pectoral group of axillary lymph nodes

A 72-year-old woman dies after a stroke. At autopsy, a large embolus is found in the brain. This embolus most likely formed in which of the following blood vessels? A. Right coronary artery B. Right hepatic vein C. Right renal vein D. Superior vena cava E. Right pulmonary vein

E. Right pulmonary vein

A 72-year-old woman is diagnosed with cancer of the right lung. Her right lung must be removed. During this surgical procedure, which of the following structures, passing posterior to the root of the lung, could be injured? A. Aorta B. Hemiazygos vein C. Inferior vena cava D. Right phrenic nerve E. Right vagus nerve

E. Right vagus nerve

A 46-year-old woman complains of significant abdominal pain that her physician thinks is localized to the epigastric region. Which of the following organs is most likely involved in this problem? A. Duodenum B. Ileum C. Kidney D. Sigmoid colon E. Transverse colon

A. Duodenum

A 47-year-old man is undergoing a procedure to repair a duodenal ulcer. As part of the operation, the surgeon reflects the first part of the duodenum to the left, which exposes the area posterior to it. Location of which of the following structures is now possible? A. Gastroduodenal artery B. Hepatic vein C. Left renal vein D. Right renal pelvis E. Superior mesenteric artery

A. Gastroduodenal artery

A 42-year-old slightly overweight woman has pain in the right upper quadrant of her abdomen after eating a fatty meal. The pain is most likely transmitted by visceral afferent fibers that travel through which of the following nerves? A. Greater splanchnic B. Least splanchnic C. Lesser splanchnic D. Lumbar splanchnic E. Vagus

A. Greater splanchnic

A 56-year-old man with breathing difficulties comes to the emergency department. It is determined that he has a large embolus blocking a branch of the right pulmonary artery. In which of the following structures did this embolus most likely originate? A. Left femoral vein B. Left ventricle C. Portal vein D. Right pulmonary vein E. Splenic vein

A. Left femoral vein

A 52-year-old woman is having surgery to remove a large ovarian tumor. During the procedure, the vascular supply to the ovary must be ligated. Clamping and cutting which of the following ligaments will accomplish this task? A. Broad B. Cardinal C. Ovarian D. Round E. Infundibulopelvic (suspensory)

E. Infundibulopelvic (suspensory)

After a 65-year-old man has abdominal surgery, he experiences a tingling of the skin around his umbilicus. Which of the following nerves is most likely causing this symptom? A. 10th intercostal nerve B. Subcostal nerve C. Ilioinguinal nerve D. Iliohypogastric nerve E. 8th intercostal nerve

A. 10th intercostal nerve

A 42-year-old man has trouble swallowing. After numerous tests he is diagnosed with cancer involving the lower end of the thoracic portion of the esophagus and the entire abdominal esophagus. The neoplasm is large and has filled the esophageal hiatus of the diaphragm. In this position it is compressing all of the structures passing through this opening. Which of the following structures is being compressed? A. Anterior vagal trunk B. Azygos vein C. Greater splanchnic nerve D. Right phrenic nerve E. Thoracic duct

A. Anterior vagal trunk

A 74-year-old woman comes to the emergency department after suffering a myocardial infarction. A thrombus in the circumflex branch of the left coronary artery is visible on a coronary angiogram. This event has most likely damaged which area of her heart? A. Apex B. Left atrium and left ventricle C. Right atrium and right ventricle D. Right and left ventricles E. Right ventricle and the interventricular septum

B. Left atrium and left ventricle

Enlarged superficial and deep inguinal lymph nodes are discovered during the examination of an 81-year-old woman. It is assumed that cells from a primary tumor have spread to these lymph nodes. The most likely site of the primary tumor is which of the following organs or structures? A. Bladder B. Labia majora C. Ovary D. Uterine tube E. Uterus

B. Labia majora

A 64-year-old man undergoes laparoscopic repair of a direct inguinal hernia. After the procedure, he complains to his surgeon that he has tingling sensations in the lateral region of his thigh. The surgeon suspects that a misplaced staple has damaged a nerve. Which of the following nerves is most likely damaged? A. Posterior cutaneous nerve of thigh B. Lateral cutaneous nerve of thigh C. Ilioinguinal D. Femoral branch of genitofemoral nerve E. Femoral

B. Lateral cutaneous nerve of thigh

An 82-year-old woman has a modified radical mastectomy after being diagnosed with ductal carcinoma of the right breast. As a result of the operation, her scapula moves away from the thoracic wall (winging of the scapula) when she presses her flexed arm against a fixed object. Which nerve is most likely injured? A. Axillary B. Long thoracic C. Lower subscapular D. Suprascapular E. Thoracodorsal

B. Long thoracic

A central venous line is being placed in a 32-year-old woman. During the procedure, a significant amount of air enters unnoticed. Which of the following parts of the body is at greatest risk for complications from this event? A. Upper limb B. Lungs C. Heart D. Hand E. Brain

B. Lungs

A 52-year-old woman comes to a clinic to donate bone marrow. During the procedure, the needle is pushed too deeply through the midline of the lower half of the manubrium and blood is obtained. In this situation, the needle has most likely entered which of the following structures? A. Aortic arch B. Left ventricle C. Pulmonary trunk D. Right atrium E. Superior vena cava

A. Aortic arch

An 82-year-old man must have a direct inguinal hernia surgically repaired. During the open procedure, the superficial inguinal ring needs to be reconstructed. Which of the following structures will be involved in completing this part of the surgical procedure? A. Aponeurosis of the external oblique B. Conjoint tendon C. Internal oblique muscle D. Rectus sheath E. Transversalis fascia

A. Aponeurosis of the external oblique

A 67-year-old woman undergoes total gastrectomy for cancer of the stomach. Which of the following groups of lymph nodes should be examined as the most likely sites of initial metastasis? A. Celiac B. Inferior mesenteric C. Internal iliac D. Lumbar E. Superior mesenteric

A. Celiac

A 48-year-old man notices a "bulge in his groin" when he lifts a heavy object or coughs. His physician can reduce the mass by manipulation, but it promptly reappears with his next strain or cough. It is located above and just lateral to the pubic tubercle. The most likely diagnosis of this problem is which of the following? A. Direct inguinal hernia B. Enlarged lymph node C. Femoral hernia D. Indirect inguinal hernia E. Undescended testicle

A. Direct inguinal hernia

A 46-year-old woman, with the following complaints, is brought to her physician by her sister: fatigue, anorexia, abdominal discomfort, and a 9-kg (20-lb) weight loss over the last 4 months. A barium study with contrast shows an ulcer at the angular incisure of the stomach. Endoscopy and biopsy confirm carcinoma of the stomach at the angular notch. As the cancer spreads, which adjacent region or area of the stomach will most likely become involved? A. Lesser curvature B. Greater curvature C. Fundus D. Cardial notch E. Cardia

A. Lesser curvature

A 56-year-old woman has a malignant neoplasm in the upper medial quadrant of her left breast. Which of the following sets of lymph nodes should be checked initially for signs of metastasis? A. Parasternal B. Pectoral C. Subscapular D. Supraclavicular E. Superficial inguinal

A. Parasternal

A 35-year-old man goes to his family doctor due to tingling in the fingers of his left hand and he complains that his left hand seems to frequently feel cooler than his right. He is a sheet-rock worker and he frequently works with his arms overhead for long periods of time. He tells his doctor that his left hand gets much worse after many hours of overhead work. You suspect thoracic outlet syndrome and hypothesize that an artery is being compressed as it exits the thorax. Therefore, the overhead work coupled with reduced vascular supply could cause the tingling in the hand and a reduction in skin temperature of the left hand. Which of the following is most likely compressed and therefore causing the symptoms in this patient? A. Subclavian artery B. Radial artery C. Superior vena cava D. Celiac trunk E. Lateral thoracic artery

A. Subclavian artery

A 62-year-old woman has a venogram that shows a blockage in the left renal vein where it crosses anterior to the aorta. Additional tests indicate that the occlusion is caused by an arterial aneurysm. Which of the following arteries is the most likely location of the aneurysm? A. Superior mesenteric B. Middle colic C. Left colic D. Inferior mesenteric E. Celiac

A. Superior mesenteric

A 12-year-old boy is having an indirect inguinal hernia repaired. During the procedure, the deep (internal) inguinal ring must be enlarged. Which of the following structures must be incised to accomplish this task? A. Transversalis fascia B. Rectus sheath C. Parietal peritoneum D. Conjoined tendon E. Aponeurosis of external oblique

A. Transversalis fascia

A 72-year-old man is brought to the emergency department because of a 4-day history of abdominal pain. He has a history of chronic constipation. Examination shows a distended abdomen with tenderness in the lower left quadrant. Which of the following is the most likely diagnosis? A. Volvulus of the sigmoid colon B. Volvulus of the cecum C. Small-bowel obstruction D. Carcinoma of the colon E. Appendicitis

A. Volvulus of the sigmoid colon

After 3 weeks, an 81-year-old woman with progressive swelling of the right side of her face and neck and her right upper limb shows up at her physician's office. A physical examination also shows she has an engorged right jugular vein and her right radial pulse is weak. An x-ray film of the chest is most likely going to confirm which of the following diagnoses? A. An aortic arch aneurysm B. A mass in the upper lobe of the right lung C. A right cervical rib D. A right pneumothorax E. Thoracic duct blockage in the posterior mediastinum

B. A mass in the upper lobe of the right lung

A 43-year-old woman has pain in her epigastric region. This pain is most likely referred from which of the following? A. An obstruction of the transverse colon B. An upper duodenal ulcer C. Rectal polyps D. A renal calculus E. A testicular tumor

B. An upper duodenal ulcer

A 17-year-old girl comes to the emergency department with an abdominal gun shot wound. The entrance point is in the upper abdomen, and surgical exploration of the site shows severe damage to the pancreas. To assess damage to the first part of the superior mesenteric artery, where should the surgeon look? A. Anterior to the body of the pancreas B. Anterior to the left renal vein C. Anterior to the transverse colon D. Posterior to the inferior vena cava E. Posterior to the third part of the duodenum

B. Anterior to the left renal vein

A 21-year-old woman is admitted to the hospital because of a 12-hour history of pain in the right iliac fossa. Appendicitis is suspected. Which of the following descriptions of the location of the pain is most consistent with the diagnosis? A. Beginning in the right flank and moving to the right iliac fossa B. Beginning in the umbilical region and moving to the right iliac fossa C. Beginning in the rectal region and moving to the right iliac fossa D. Beginning in the back and moving to the right iliac fossa E. Beginning and remaining in the right iliac fossa

B. Beginning in the umbilical region and moving to the right iliac fossa

A 63-year-old woman complaining of abdominal pain visits her physician. After numerous tests, it is determined that she has an occlusion of the superior mesenteric artery near its origin. Which of the following parts of the gastrointestinal tract will become ischemic if significant collateral circulation does not develop? A. Duodenum B. Ileum C. Rectum D. Sigmoid colon E. Stomach

B. Ileum

A 63-year-old woman being treated for atrial fibrillation develops acute abdominal pain and is taken for an exploratory operation. At surgery, the descending colon is found to be ischemic. A thromboembolism in which of the following vessels is most likely responsible for this condition? A. Right colic B. Inferior mesenteric C. Iliocolic D. Gastroduodenal E. Celiac

B. Inferior mesenteric

A 27-year-old woman has elected to use a pudendal block during the delivery of her child. The anesthesia will be administered transvaginally. Which of the following structures will provide a landmark for locating the pudendal nerve prior to injecting the anesthesia? A. Arcuate line B. Ischial spine C. Posterior superior iliac spine D. Pubic symphysis E. Sacral promontory

B. Ischial spine

A 56-year-old man with congestive heart failure presents to the emergency department because of a rusty red-colored hemoptysis, or blood in the sputum. The color is caused by the phagocytosis of leaked erythrocytes by alveolar macrophages, and the hemoptysis associated with congestive heart failure is often attributed to increased intravascular pressure. Which of the following vessels are most likely responsible for the leakage of erythrocytes, causing blood in the sputum of this patient? A. Pulmonary veins B. Pulmonary capillaries C. Pulmonary trunk D. Pulmonary arteries E. Pulmonary lymphatics

B. Pulmonary capillaries

A 19-year-old woman with respiratory distress is admitted to the emergency department after being injured in an automobile collision. Among other findings, x-ray films of her chest show abdominal viscera in the left hemithorax. Which of the following is the most likely diagnosis? A. Gastroschisis B. Rupture of the diaphragm C. Rupture of the esophagus D. A short esophagus with an intrathoracic stomach E. A sliding esophageal hernia

B. Rupture of the diaphragm

A 36-year-old man presents to the emergency department with a staple gun wound to the chest that occurred while remodeling his house. A staple was found to have pierced the external (deep) investing fascia anteriorly near his left 10th rib. Which of the following superficial structures has the staple most likely to have passed through before the external investing fascia? A. Internal investing fascia B. Subcutaneous layer C. Scarpa's fascia D. Pericardium E. Intercostal muscles

B. Subcutaneous layer

For the past 6 months, an 84-year-old woman experiences pain in her left shoulder and arm that radiates to the sternum after any physical exertion. Rest and nitroglycerine relieve the pain. On the basis of this history, a diagnosis of angina pectoris is made. Which of the following spinal cord segments serve as the point of origin of the pain afferents involved in this problem? A. C8 to T8 B. T1 to T4 C. T1 to T8 D. T5 to T9 E. T8 to L1

B. T1 to T4

An 87-year-old woman complains of not feeling anything on a portion of her chest wall. An examination determines that she has complete loss of sensory and motor function in a small portion of her anterior thoracic wall. Which of the following nervous structures is most likely responsible for this patient's deficit? A. White rami communicantes B. Anterior roots of a spinal nerve C. Anterior ramus of a spinal nerve D. Sympathetic trunk E. Spinal ganglion

C. Anterior ramus of a spinal nerve

A 53-year-old man arrives at the emergency department with severe chest pain and difficulty breathing. Physical examination and radiographic imaging reveal that the patient has an emergent case of cardiac tamponade, a fluid buildup outside the heart but within the pericardial sac. As the fluid fills the pericardial sac the heart gets compressed, stroke volume decreases, cardiac output goes down, and heart rate increases. A pericardiocentesis procedure is performed in which a needle is inserted to drain the fluid from within the pericardial sac. The needle is inserted to drain the fluid between which of the following two layers? A. Between the fibrous pericardium and the parietal pericardium B. Between the fibrous pericardium and the visceral pericardium C. Between the parietal pericardium and the visceral pericardium D. Between the fibrous pericardium and the myocardium E. Between the visceral pericardium and the myocardium

C. Between the parietal pericardium and the visceral pericardium

A 54-year-old man presents to the emergency department with dyspnea (difficulty or labored breathing) and some mild hypercapnia (excessive carbon dioxide in the bloodstream, typically caused by inadequate respiration) during exertion. He reports pain in his right shoulder and neck. A CT scan of his chest reveals a diagnosis of unilateral diaphragmatic paralysis due to a right-sided bronchogenic carcinoma. The diaphragm is abnormally superior on this patient's right side and the tumor is located just anterior to the root of the lung. A nerve has likely been damaged to cause the problems with the diaphragm. Which of the following ventral rami contribute to the nerve that has been damaged? A. C5, C6, C7 B. C2, C3, C4 C. C3, C4, C5 D. C7, C8, T1 E. T4, T5, T6

C. C3, C4, C5

A 57-year-old man has trouble urinating. His physician suspects a neurological problem. Tests indicate that the muscles involved in this process innervated by somatic nerves are intact. Therefore, the denervation of which of the following muscles is the most likely cause of this man's difficulty? A. Sphincter urethrae B. Levator ani C. Detrusor D. Deep transverse perineus E. Bulbospongiosus

C. Detrusor

A 52-year-old man has an ulcer in the posterior wall of the first part of the duodenum. Which of the following adjacent structures is most likely to be damaged if a perforation occurs at this site? A. Ascending colon B. Gallbladder C. Gastroduodenal artery D. Pancreas E. Superior mesenteric vein

C. Gastroduodenal artery

A 65-year-old woman complains to her physician of weight loss, vague abdominal pain, and significant low back pain. Examination shows obstructive jaundice. Pancreatic adenocarcinoma is considered the most likely cause of her problems. In which of the following parts of the pancreas is a tumor most likely located? A. Uncinate process B. Tail C. Head D. Body

C. Head

A 12-year-old boy is undergoing liver transplant surgery. During the procedure, the surgeon places the tip of his finger posterior to the free edge of the lesser omentum. Which of the following structures is now positioned posterior to the tip of the surgeon's finger? A. Common bile duct B. First part of the duodenum C. Inferior vena cava D. Proper hepatic artery E. Transverse colon

C. Inferior vena cava

A 42-year-old woman is undergoing liver transplantation. During the procedure, the structure immediately posterior to the omental (epiploic) foramen is damaged, causing significant bleeding. Which of the following vessels is most likely injured? A. Right renal vein B. Portal vein C. Inferior vena cava D. Common hepatic artery E. Abdominal aorta

C. Inferior vena cava

A 53-year-old woman is diagnosed with cervical cancer. Initial metastasis is likely to involve which of the following groups of nodes? A. Deep inguinal B. Inferior mesenteric C. Internal iliac D. Lumbar E. Superficial inguinal

C. Internal Iliac

A 46-year-old man is undergoing surgical repair of a gastric ulcer. An incision is made 2.5 cm left of midline, extending from just below the level of the xiphoid process to the level of the umbilicus. The surgeon retracts the rectus abdominis muscle and incises the posterior rectus sheath. At the level of the incision, aponeuroses from which of the following muscles contribute to this portion of the sheath? A. Internal oblique B. External oblique and internal oblique C. Internal oblique and transversus abdominis D. Transversus abdominis and the transversalis fascia E. External oblique, internal oblique, and transversus abdominis

C. Internal oblique and transversus abdominis

A 49-year-old woman has a neoplasm in the hilus of the left lung, anterior to the primary bronchus. Which of the following structures in the surrounding area is most likely to become compressed if the neoplasm were to continue to grow in an anterior direction? A. Azygos vein B. Esophagus C. Phrenic nerve D. Sympathetic trunk E. Vagus nerve

C. Phrenic nerve

A 56-year-old man comes to his urologist because of difficulty urinating. He says that he has difficulty starting urination, that the stream is decreased, that he has to get up several times a night to urinate, and that urine continues to dribble when he tries to stop. Which of the following is the most likely cause of these problems? A. Urinary tract infection B. Previous head trauma C. Prostatic hyperplasia D. Neuropathy of the pudental nerve E. Neuropathy of sacral splanchnic nerves

C. Prostatic hyperplasia

An 85-year-old woman is alarmed because she has lost feeling around her anus. Her physician also determines that she has a sensory deficit in the vestibule of her vagina. Which of the following nerves is most likely damaged, causing these sensory losses? A. Pelvic splanchnic B. Posterior femoral cutaneous C. Pudendal D. Sciatic E. Superior gluteal

C. Pudendal

A 42-year-old man comes to his physician complaining of a painful abscess on the posterior aspect of his scrotum. In preparing for the incision and drainage of the abscess, a branch of which of the following nervous structures should be anesthetized? A. Ilioinguinal nerve B. Pelvic splanchnic nerves C. Pudendal nerve D. Components of the sympathetic nervous system E. Vagus nerve

C. Pudendal nerve

An 82-year-old woman has a neoplasm on the posterior portion of her labia minora. During a surgical procedure to remove this growth, anesthetizing a branch of which of the following nervous structures can decrease pain to this area? A. Ilioinguinal nerve B. Pelvic splanchnic nerves C. Pudendal nerve D. Sympathetic nervous system E. Vagus nerve

C. Pudendal nerve

A 17-year-old girl is brought to the emergency department after being stabbed in the chest. Examination shows a shallow stab wound in the left fourth intercostal space, immediately lateral to the sternum. Which of the following structures is most likely injured? A. Thoracic aorta B. Superior vena cava C. Right ventricle D. Right atrium E. Pulmonary trunk

C. Right ventricle

A 57-year-old woman has a 2-week history of bloating, nausea, and vomiting. An upper gastrointestinal radiologic examination using contrast media reveals an obstruction of the third part of the duodenum. The obstruction seems to be due to an arterial aneurysm. Which of the following arteries is the most likely site of the aneurysm? A. Inferior mesenteric artery B. Right renal artery C. Superior mesenteric artery D. Celiac artery E. Gastroduodenal artery

C. Superior mesenteric artery

A 64-year-old woman and a 66-year-old man both have pleurisy. One has left-sided lateral thoracic pain, and the other has left-sided neck and shoulder pain. What combination of nerves, responsible for innervating the parietal pleura, is responsible for the distribution of pain reported by these individuals? A. Phrenic and vagus B. Vagus and intercostal C. Greater splanchnics D. Intercostal and phrenic E. Parasympathetic and sympathetic

D. Intercostal and phrenic

A 35-year-old man is diagnosed with a malignant testicular neoplasm. Which of the following lymph nodes are the most likely sites of initial metastasis? A. Celiac B. Deep inguinal C. Internal iliac D. Lateral aortic lumbar E. Superficial inguinal

D. Lateral aortic lumbar

A 42-year-old man has trouble swallowing. After numerous tests he is diagnosed with cancer involving the lower end of the thoracic portion of the esophagus and the entire abdominal esophagus. The neoplasm is large and has filled the esophageal hiatus of the diaphragm. In this position it is compressing all of the structures passing through this opening. Which of the following functional deficits is most likely the result of this compression? A. A paralyzed right hemidiaphragm B. A weak femoral pulse C. Impaired lymphatic flow D. Loss of parasympathetic nerve supply to the stomach E. Loss of sympathetic nerve supply to the stomach

D. Loss of parasympathetic nerve supply to the stomach

A 52-year-old woman has difficulty breathing and comes to the emergency department. During her examination, rales are heard when the stethoscope is positioned on the right midclavicular line at the level of the fifth intercostal space. The area(s) of the lung involved in this finding is (are) best described by which of the following? A. Both the middle and lower lobes of the right lung B. Both the upper and middle lobes of the right lung C. Lower lobe of the right lung only D. Middle lobe of the right lung only E. Upper lobe of the right lung only

D. Middle lobe of the right lung only

A 56-year-old man is undergoing a cardiac operation. During the procedure, a ligature is passed into the transverse pericardial sinus. Which of the following vascular structures can now be easily secured by tying the ligature, thus stopping the flow of blood? A. Superior vena cava and inferior vena cava B. Superior vena cava and right pulmonary veins C. Aorta and superior vena cava D. Aorta and pulmonary trunk E. Aorta and left pulmonary veins

D. Aorta and pulmonary trunk

A 19-year-old man comes to the physician because of shortness of breath. A murmur is heard over the medial end of the right second intercostal space. An abnormality of which of the following heart valves is the most likely cause of the murmur? A. Tricuspid B. Pulmonary C. Mitral D. Aortic

D. Aortic

A 62-year-old woman complains to her physician that for 6 months she has had repeated episodes of heartburn, belching, regurgitation, and epigastric pain after a large meal. X-ray films show a portion of the stomach is passing upward through the esophageal hiatus of the diaphragm. If other structures passing through the esophageal hiatus are compressed, which of the following functional deficits is most likely? A. Paralysis of the right hemidiaphragm B. Impaired lymphatic flow C. Erectile dysfunction D. Decreased acid production in the stomach E. A weak femoral pulse

D. Decreased acid production in the stomach

A 47-year-old woman presents to the emergency department complaining of sudden and severe tearing chest pain. CT imaging of her chest reveals an aortic dissection (DeBakey type III) from approximately the T9-T11 vertebral levels. Based on the vertebral levels identified in the CT scan, which of the following segments of the aorta does this dissection occur in? A. Ascending thoracic aorta B. Ascending abdominal aorta C. Aortic arch D. Descending thoracic aorta E. Descending abdominal aorta

D. Descending thoracic aorta

A 23-year-old man was struck by an automobile while cycling. At the emergency department he is found to have a ruptured urethra. Urine has moved into the region of the lower anterior abdominal wall and the scrotum. Fusion of the membranous layer of superficial fascia (Scarpa's fascia) with which of the following structures inferiorly has prevented urine from moving into the thigh? A. Transversalis fascia B. Inguinal ligament C. Femoral sheath D. Fascia lata E. Cribriform fascia

D. Fascia lata

A 56-year-old man is undergoing a partial kidney resection to remove a renal tumor. As the surgeon exposes the kidney through a posterolateral approach, which of the following nerves must be avoided? A. Least splanchnic and subcostal B. Lateral femoral cutaneous and femoral C. Obturator and genitofemoral D. Iliohypogastric and ilioinguinal E. Greater and lesser splanchnic

D. Iliohypogastric and ilioinguinal

After surgical repair of a direct inguinal hernia, a 64-year-old man complains to his surgeon of numbness in the anterior scrotal area and the medial area of the adjacent thigh. Which of the following nerves is most likely injured? A. Subcostal B. Pudendal C. Medial femoral cutaneous D. Ilioinguinal E. Iliohypogastric

D. Ilioinguinal

A 25-year-old woman is admitted to the hospital because of breathing difficulties. She has had cardiac symptoms due to rheumatic fever since age 12 years. Examination shows a diastolic murmur. Which of the following findings is most likely, after further evaluation, based on this history and the presence of the murmur? A. Angina pectoris B. Bounding, full pulse C. Enlarged left ventricle D. Indentation of the esophagus E. Notching of the ribs

D. Indentation of the esophagus

A 63-year-old man has had pain in the lateral side of his left chest for the past 60 days. On auscultation of the left posterior thorax, a loud sound similar to leather surfaces creaking over one another is heard during inspiration and expiration. Which of the following nerves most likely carries the pain sensation from the affected side? A. Vagus B. Postganglionic sympathetic C. Phrenic D. Greater splanchnic E. An intercostal

E. An intercostal

During a routine physical examination of a 4-year-old boy, a pediatrician discovers a mass in the child's right inguinal region. The mass extends from just above the midpoint of the inguinal ligament to a point above and medial to the pubic tubercle. Which of the following best describes what the physician has identified? A. Enlarged lymph node B. Undescended testicle C. Direct inguinal hernia D. Femoral hernia E. Indirect inguinal hernia

E. Indirect inguinal hernia

A 34-year-old woman who is at 28 weeks gestation has painful hemorrhoids. Enlargement of the normal anastomotic connections between branches of the inferior mesenteric vein and branches of which of the following veins most likely contributed to the development of this problem? A. Uterine B. Paraumbilical C. Ovarian D. Obturator E. Internal pudendal

E. Internal pudendal

A 53-year-old woman has had difficulty swallowing solids for the past several months. She has a 7-year history of cardiovascular disease. X-ray films of the esophagus with barium contrast show indentation and posterior displacement of the esophagus. Enlargement of which of the following structures is the most likely cause of her problem? A. Superior vena cava B. Right lung C. Right atrium D. Left lung E. Left atrium

E. Left atrium

A 56-year-old woman is diagnosed with a perforated duodenal ulcer. During the surgical repair of this problem, the gastroduodenal artery is ligated. After the completion of this operative procedure, which of the following arteries will continue to supply blood to the pancreas? A. Inferior mesenteric B. Left gastric C. Left gastroepiploic D. Proper hepatic E. Splenic

E. Splenic

A 64-year-old man is diagnosed with carcinoma of the anal canal. At this stage of the disease, the neoplasm is located entirely below the pectinate line. To which of the following groups of lymph nodes would cells from this neoplasm initially metastasize? A. Common iliac B. External iliac C. Inferior mesenteric D. Internal iliac E. Superficial inguinal

E. Superficial inguinal

During physical exertion, a 72-year-old man has severe angina pectoris with pain that radiates down the medial side of his left arm. Coronary artery angiography shows a 90% occlusion of the left coronary artery just proximal to its bifurcation. This pain is mediated by increased activity in afferent fibers that travel in which of the following structures? A. Vagus nerves B. Terminal portions of the intercostal nerves C. Somatic nerves to the upper limb D. Phrenic nerves E. Sympathetic trunk

E. Sympathetic trunk