DIRECTIONS
Each of the numbered items or incomplete statements is followed by lettered options. Select the one lettered option that is best in each case.
1. Which of the following structures is the only osteologic connection between the axial skeleton and the upper limb skeleton?
A. Clavicle
B. Humerus
C. Scapula
D. Ulna
2. Damage to which of the following muscles would most likely decrease the stability of the glenohumeral joint?
A. Biceps brachii muscle
B. Infraspinatus muscle
C. Pectoralis major muscle
D. Serratus anterior muscle
E. Triceps brachii muscle
3. Spasm of the scalene muscles may entrap which region of the brachial plexus?
A. Cords
B. Divisions
C. Roots
D. Terminal branches
E. Trunks
4. A 43-year-old man is experiencing spasms of the coracobrachialis muscle, which impinges the nerve that courses through it. Which movement is most likely affected by this muscle spasm?
A. Elbow extension
B. Elbow flexion
C. Shoulder abduction
D. Shoulder adduction
E. Shoulder extension
F. Shoulder flexion
5. The radial and ulnar arteries arise from the bifurcation of which artery?
A. Axillary
B. Brachial
C. Cephalic
D. Deep brachial
E. Subclavian
6. Damage to the posterior cord of the brachial plexus would most likely result in weakness of which of the following muscles?
A. Coracobrachialis
B. Flexor carpi radialis
C. Latissimus dorsi
D. Pectoralis major
E. Supraspinatus
7. Which muscle of the upper limb is innervated by the spinal accessory nerve [cranial nerve (CN) XI]?
A. Levator scapulae
B. Rhomboid major
C. Serratus anterior
D. Splenius capitis
E. Trapezius
8. When a 45-year-old woman performs pushups, the medial border of the right scapula protrudes from her thorax more than it protrudes on the left side. Which nerve is most likely injured, resulting in this observation?
A. Lateral pectoral nerve
B. Long thoracic nerve
C. Medial pectoral nerve
D. Suprascapular nerve
E. Thoracodorsal nerve
9. A 34-year-old woman is diagnosed with quadrangular space syndrome, a rare abnormality localized within the posterior shoulder region. Which of the following structures would most likely be compressed in this patient?
A. Axillary nerve and anterior humeral circumflex artery
B. Axillary nerve and deep brachial artery
C. Axillary nerve and posterior humeral circumflex artery
D. Radial nerve and anterior humeral circumflex artery
E. Radial nerve and deep brachial artery
F. Radial nerve and posterior humeral circumflex artery
10. The suprascapular and dorsal scapular arteries form a collateral circuit on the posterior side of the scapula with which of the following branches of the axillary artery?
A. Anterior humeral circumflex artery
B. Circumflex scapular artery
C. Posterior humeral circumflex artery
D. Thoracoacromial artery
E. Thoracodorsal artery
11. A 77-year-old patient is diagnosed with nerve entrap ment, consistent with a herniated disc on the C5 spinal nerve. Which of the following muscles is most likely affected by this herniation?
A. Deltoid
B. Flexor carpi ulnaris
C. Latissimus dorsi
D. Pectoralis minor
E. Triceps brachii
12. Which of the following anatomic regions will most likely NOT contribute lymph to the thoracic duct?
A. Left large toe
B. Left thigh
C. Left thumb
D. Right large toe
E. Right thigh
F. Right thumb
13. The boundaries of the three parts of the axillary artery are determined by its relationship to which of the following muscles?
A. Pectoralis major
B. Pectoralis minor
C. Teres major
D. Teres minor
14. A 24-year-old woman comes to the physician because of weakness in elbow flexion and numbness on the lateral side of the forearm. A lesion in which of the following nerves would most likely result in these symptoms?
A. Axillary
B. Median
C. Musculocutaneous
D. Radial
E. Ulnar
15. The superior ulnar collateral artery forms a collateral circuit with which of the following arteries?
A. Anterior ulnar recurrent
B. Anterior interosseous
C. Middle collateral
D. Posterior ulnar recurrent
E. Radial collateral
16. A 39-year-old man is diagnosed with a peripheral nerve injury that weakens his ability to extend his elbow, wrist, and fingers. Which area of this patient’s upper limb will cause cutaneous deficit because of this injury?
A. Anterior compartment of the forearm
B. Lateral compartment of the forearm
C. Medial compartment of the forearm
D. Posterior compartment of the forearm
17. A 28-year-old woman is diagnosed with carpal tunnel syndrome. Which of the following tendons course through the carpal tunnel?
A. Flexor carpi radialis
B. Flexor carpi ulnaris
C. Flexor pollicis longus
D. Extensor carpi radialis longus
E. Extensor carpi ulnaris
F. Extensor pollicis longus
18. A 50-year-old woman has difficulty moving her thumb toward the palmar surface of the digiti minimi (fifth digit). She also experiences pain over the palmar surface of the thumb, index, and the middle digits. Pressure and tapping over the lateral portion of the flexor retinaculum causes tingling of the thumb and the 2nd and 3rd digits, indicating nerve damage. The damaged nerve that results in motor and sensory deficits most likely travels via which of the following routes?
A. Between the flexor digitorum superficialis and profundus muscles
B. Between the two heads of the flexor carpi ulnaris muscle
C. Superficial to the flexor retinaculum
D. Through the coracobrachialis muscle
E. Through the supinator muscle
19. The radiocarpal joint includes the distal end of the radius, the triangular fibrocartilage complex, the scaphoid bone, the triquetrum bone, and the
A. capitate
B. hamate
C. lunate
D. trapezium
20. Which of the following fascial layers forms the roof of the carpal tunnel?
A. Extensor retinaculum
B. Fibrous digital sheaths
C. Flexor retinaculum
D. Palmar aponeurosis
E. Transverse palmar ligament
21. A 26-year-old woman is diagnosed with inflammation within Guyon’s canal. She will most likely experience weakness when performing which of the following actions?
A. Abduction of the thumb
B. Adduction of digits 2 to 5
C. Flexion of the wrist
D. Radial deviation of the wrist
22. Compression of the median nerve in the carpal tunnel results in weakness in the thenar muscles and the first and second lumbricals. In which of the following areas would the patient most likely experience cutaneous deficits?
A. Lateral dorsal surface of the hand
B. Lateral palmar surface of the hand
C. Medial dorsal side of the hand
D. Medial palmar side of the hand
23. Which of the following arteries course through the anatomical snuffbox?
A. Deep palmar arch artery
B. Radial artery
C. Superficial palmar arch artery
D. Ulnar artery
24. Which of the following muscles is responsible for flexion of the metacarpophalangeal joints and extension of the interphalangeal joints of digits 2 to 5?
A. Doral interossei muscles
B. Lumbrical muscles
C. Palmar interossei muscles
D. Palmaris brevis muscles
E. Palmaris longus muscles
25. An avulsion fracture results when a bone fragment is pulled from its parent bone by forceful distraction of a tendon or ligament. An avulsion fracture of the ischial tuberosity most likely results from forceful contraction of which of the following muscles?
A. Adductors
B. Gluteals
C. Hamstrings
D. Iliopsoas
E. Quadriceps femoris
26. A 51-year-old man experiences a loss of skin sensation along the medial compartment of the thigh. No other areas of skin are affected. Which of the following best describes the area of deficit?
A. L2 dermatome
B. L3dermatome
C. L4 dermatome
D. Cutaneous field of the femoral nerve
E. Cutaneous field of the obturator nerve
F. Cutaneous field of the saphenous nerve
27. A 55-year-old man has difficulty extending his hip while walking up a flight of stairs. He experiences no cutaneous deficits. Which damaged nerve is most likely responsible for causing this man’s symptoms?
A. Inferior gluteal nerve
B. S1 nerve root
C. S2 nerve root
D. Superior gluteal nerve
28. A 33-year-old man’s pelvis drops on the right side when he steps with his right foot. He has no cutaneous deficits. Which nerve lesion is most likely causing this problem?
A. Common peroneal nerve
B. Femoral nerve
C. Inferior gluteal nerve
D. Obturator nerve
E. Superior gluteal nerve
F. Tibial nerve
29. Which of the following structures serves as a common attachment for the external rotator muscles of the hip?
A. Greater trochanter
B. Inferior pubic ramus
C. Ischial spine
D. Ischial tuberosity
E. Lesser trochanter
F. Superior pubic ramus
30. Which of the following is the most stable position of the hip as a result of the tension generated in the capsular ligaments?
A. Abduction
B. Adduction
C. Flexion
D. Extension
31. Which of the following quadriceps femoris muscles flexes the femur at the hip joint?
A. Rectus femoris
B. Vastus intermedius
C. Vastus medialis
D. Vastus lateralis
32. A 31-year-old woman has a lesion on the femoral nerve. Which of the following actions will the patient most likely have difficulty performing?
A. Knee extension
B. Knee flexion
C. Hip abduction
D. Hip adduction
E. Hip extension
F. Hip flexion
33. The hamstring musculature receives its primary vascular supply from which branch of the deep femoral artery?
A. Medial circumflex femoral branch
B. Lateral circumflex femoral branch
C. Perforating branches
D. Transverse branch
34. Which of the following ligaments primarily resist poste rior translation of the tibia on the femur?
A. Anterior cruciate
B. Lateral collateral
C. Medial collateral
D. Posterior cruciate
35. Which of the following nerves can be found deep to the soleus muscle?
A. Common fibular
B. Deep fibular
C. Femoral
D. Obturator
E. Superficial fibular
F. Tibial
36. A 22-year-old man experiences weakness in ankle dorsiflexion and numbness of the skin between digits 1 and 2 of his foot. Which of the following nerves is most likely damaged, resulting in these observed deficits?
A. Common fibular nerve
B. Deep fibular nerve
C. Femoral nerve
D. Obturator nerve
E. Superficial fibular nerve
F. Tibial nerve
37. Which of the following arteries courses through the prox imal part of the interosseous membrane?
A. Anterior tibial
B. Fibular
C. Popliteal
D. Posterior tibial
38. “Rolling the ankle” is a common injury that causes exces sive inversion and plantar flexion of the foot. Which of the following ligaments would experience the most dam age during such an event?
A. Anterior talofibular
B. Anterior tibiofibular
C. Deltoid
D. Posterior tibiofibular
39. Which of the following fascial structures forms the roof of the tarsal tunnel?
A. Inferior extensor retinaculum
B. Fibular retinaculum
C. Flexor retinaculum
D. Superior extensor retinaculum
E. Talofibular ligament
40. A 51-year-old woman has difficulty abducting and adducting digits 2 to 5 of her foot. In addition, the skin on the plantar surface of digits 4 and 5 is numb. Which of the following nerves is most likely damaged, resulting in these deficits?
A. Deep peroneal
B. Lateral plantar
C. Medial plantar
D. Superficial peroneal
E. Tibial
41. Which of the following arteries most likely gives rise to the deep plantar arch?
A. Arcuate
B. Dorsal pedal
C. First dorsal metatarsal
D. Lateral plantar
E. Medial plantar
42. Which of the following joints is most likely responsible for inversion and eversion of the foot?
A. Calcaneonavicular joint
B. Metatarsophalangeal joint
C. Subtalar joint
D. Talofibular joint
E. Tibiotalar joint
43. A 62-year-old man with portal hypertension caused by alcoholic cirrhosis is taken to the emergency department. He has been vomiting blood as a result of hemorrhage of the gastroesophageal plexus of veins. Which other veins would most likely be enlarged in this patient?
A. Gonadal
B. Iliac
C. Pudendal
D. Rectal
E. Suprarenal
44. In a healthy person, blood from the pulmonary veins flows next into which of the following structures?
A. Aortic arch
B. Left atrium
C. Left ventricle
D. Lungs
E. Pulmonary arteries
F. Pulmonary veins
G. Right atrium
H. Right ventricle
45. A Doppler echocardiogram evaluates blood flow, speed, and the direction of blood within the heart and also screens for any leakage of the four valves. If heart function during systole was being studied, which valves would the Doppler echocardiogram detect to be open?
A. Mitral and aortic
B. Mitral and pulmonary
C. Mitral and tricuspid
D. Pulmonary and aortic
E. Pulmonary and mitral
F. Pulmonary and tricuspid
46. A 52-year-old man visits the office of his family physician. On auscultation, a systolic murmur is heard in the right second intercostal space adjacent to the sternum. What is the most likely cause of this murmur?
A. Prolapsed aortic valve
B. Prolapsed mitral valve
C. Prolapsed tricuspid valve
D. Stenotic aortic valve
E. Stenotic mitral valve
F. Stenotic tricuspid valve
47. An 8-year-old boy is diagnosed with aortic coarctation beyond the left subclavian artery. Aortic coarctation is a congenital abnormality most commonly diagnosed at birth, but it occasionally remains undetected until later in life. Collateral circulation through which of the following vessels is most likely responsible for this coarctation to have remained undetected for so long?
A. Azygos vein
B. Axillary artery
C. Intercostal arteries
D. Internal thoracic vein
48. A 52-year-old woman is diagnosed with gastric cancer. During surgery to remove the cancerous tissue, regional lymph nodes were removed to assist in staging the cancer. Lymph nodes associated with which of the following ves sels were most likely sampled from this patient?
A. Celiac artery
B. External iliac arteries
C. Inferior mesenteric artery
D. Portal vein
E. Right renal vein
F. Superior mesenteric vein
49. A 25-year-old woman involved in a motor vehicle acci dent is brought to the emergency department complain ing of abdominal pain. Radiographic imaging of her abdomen reveals a hematoma in the retroperitoneal space. Trauma to which abdominal structure is most likely responsible for this finding?
A. Jejunum
B. Liver
C. Pancreas
D. Esophagus
E. Transverse colon
50. A 55-year-old man undergoes a colonoscopy, which reveals multiple polyps in the descending and sigmoid colons. Because polyps may develop into cancer, the polyps or the regions of the bowel with multiple polyps are often surgically removed. The surgeon will most likely ligate which of the following arteries when removing the affected portion of bowel?
A. Celiac trunk
B. External iliac artery
C. Inferior mesenteric artery
D. Internal iliac artery
E. Superior mesenteric artery
51. The primary vascular supply to the uterus is most likely from branches of which of the following arteries?
A. External iliac
B. Femoral
C. Gonadal
D. Internal iliac
E. Pudendal
52. During sexual intercourse, male ejaculation is associated with innervation provided by which of the following nerves?
A. Genitofemoral
B. Ilioinguinal
C. Lesser splanchnic
D. Pelvic splanchnic
E. Sacral splanchnic
53. A 49-year-old woman visits her physician with a com plaint of loss of the ability to sense temperature and touch on the right side of the anterior tongue. She says that she has all sensations of taste. Which additional finding might you also observe in this patient?
A. Adducted eye
B. Loss of corneal reflex
C. Reduced gag reflex
D. Tongue deviation during protrusion
E. Weakness in the masseter muscle
54. A radiographic image of the brain of an 84-year-old woman reveals a berry aneurysm in the anterior commu nicating cerebral artery. The aneurysm is most likely adja cent to which of the following arteries?
A. Anterior cerebral
B. Basilar
C. Middle cerebral
D. Posterior communicating
E. Vertebral
55. A 26-year-old woman goes to a clinic because she has noticed a loss of cutaneous sensation on one side of her face. Which cranial nerve is most likely affected that results in this patient’s condition?
A. Abducens
B. Trigeminal
C. Facial
D. Glossopharyngeal
E. Vagus
56. A 51-year-old woman is experiencing ptosis and mydriasis of the left eye. Which additional finding would most likely be present in this patient (assume the left side of the head for each of the following)?
A. Inability to look laterally
B. Inability to accommodate the lens
C. Loss of salivary glands
D. Loss of sweat glands to the face
E. Reduced gag reflex
F. Reduced production of tears
57. When the physician is testing cranial nerves, the patient is often asked to stick the tongue straight out of the mouth. Which of the following muscles is most likely responsible for this action?
A. Anterior digastricus
B. Genioglossus
C. Mylohyoid
D. Palatoglossus
E. Posterior digastricus
58. The maxillary artery gains entrance to the pterygopalatine fossa and eventually the nasal cavity and infraorbital canal via which of the following structures?
A. Foramen rotundum
B. Foramen spinosum
C. Mandibular foramen
D. Pterygomaxillary fissure
E. Superior orbital fissure
59. The pterygopalatine ganglion most likely houses postganglionic neuronal cell bodies for visceral motor parasympathetic components of which of the following cranial nerves?
A. CN III
B. CN V
C. CN VII
D. CN IX
E. CN X
60. During general surgical procedures, anesthetics and mus cle relaxants are used routinely. However, these drugs may decrease nerve stimulation to skeletal muscles, including the intrinsic muscles of the larynx, which results in clo sure of the vocal folds. In such cases, laryngeal intubation is necessary. Because of the effect of the anesthetics, which of the following intrinsic muscles of the larynx will most likely NOT maintain an open glottis?
A. Cricothyroid
B. Lateral cricoarytenoid
C. Posterior cricoarytenoid
D. Thyroarytenoid
E. Transverse arytenoid
61. During an inferior alveolar nerve block, the dentist must avoid damaging the inferior alveolar artery, which enters the mandibular foramen posterior to its associated nerve. The inferior alveolar artery originates in which of the following arteries?
A. Facial
B. Infraorbital
C. Lingual
D. Maxillary
E. Supraorbital
62. A 37-year-old woman complains of hoarseness of several weeks’ duration. Upon further examination, the physician determines that the patient has partial paralysis of her vocal cords. Radiographic studies confirm an aortic arch aneurysm. Which of the following most accurately describes the relationship between the patient’s symp toms and hoarseness and this further finding?
A. Direct contact of the aneurysm with the trachea in the superior mediastinum
B. Injury to that part of the sympathetic chain that pro vides sensory innervation to the larynx
C. Irritation of the left phrenic nerve as it crosses the arch of the aorta on its way to the diaphragm
D. Pressure of the aneurysm on the esophagus in the pos terior mediastinum
E. Pressure on the left recurrent laryngeal nerve, which wraps around the aortic arch
63. A 55-year-old man visits his physician because he is expe riencing paralysis of all of the extraocular eye muscles and a loss of sensation of the root of the nose, upper eyelid, and forehead. Examination shows an abolition of the corneal reflex, but the patient’s vision is not impaired. The most likely cause of this condition would be a fracture of which of the following structures?
A. Foramen rotundum
B. Internal acoustic meatus
C. Superior orbital fissure
D. Pterygopalatine fossa
E. Maxillary sinus
64. A 26-year-old woman involved in an automobile accident was thrown into the windshield and sustained a deep gash to her face, just lateral to her upper lip. The facial artery was severed, resulting in substantial arterial bleeding. At which location, apart from the wound itself, would pressure most likely be placed to inhibit the bleeding in this patient?
A. Internal carotid artery just inferior to the mandible
B. Medial canthus of the eye
C. Midpoint of the neck just posterior to the sternocleidomastoid muscle
D. Skin overlying the mandible just anterior to the masseter muscle attachment
E. Temporal region anterior to the ear
65. When looking through an otoscope, the physician is able to view the tympanic membrane. Which structure is most likely attached to the center of the tympanic membrane on its internal surface?
A. Cochlea
B. Incus
C. Malleus
D. Stapes
E. Tensor tympani muscle
66. An 84-year-old woman is brought to the emergency department because her son thinks she has had a stroke because of the paralysis on the right side of the woman’s body. Neurologic studies show that an intracerebral hem orrhage has interrupted the blood supply to the posterior part of the frontal lobe, the parietal lobe, and medial por tion of the temporal lobe of the left cerebral hemisphere. Which vessel most likely caused the stroke in this patient?
A. Anterior cerebral artery
B. Middle cerebral artery
C. Posterior cerebral artery
D. Middle meningeal artery
E. Vertebral artery
67. In the cervical region, the phrenic nerve courses along the anterior surface of which of the following muscles?
A. Anterior scalene
B. Middle scalene
C. Posterior scalene
D. Sternocleidomastoid
E. Trapezius
68. A 30-year-old woman has become anemic because she has been having severe anterior epistaxis on the nasal septum. An ear, nose, and throat specialist has been called to consult about the woman’s bleeding. It is necessary to surgically ligate the nasal arteries in this patient. The specialist must consider arterial branches from the maxillary and ophthalmic arteries as well as which other artery?
A. Ascending pharyngeal
B. External carotid
C. Facial
D. Internal carotid
E. Lingual
69. A 2-year-old boy is diagnosed with torticollis involving the right sternocleidomastoid muscle. Which of the following anatomic changes is most likely to occur in this patient?
A. Head extended backward in the midline
B. Head flexed forward in the midline
C. Head rotated to the left
D. Head rotated to the right
70. A 46-year-old woman is diagnosed with a tumor of the parotid gland. Which of the following functions is most likely to be disrupted by this lesion (assume the left side for each choice)?
A. Corneal sensation
B. Elevation of the shoulder
C. Facial sensation
D. Protrusion of the tongue
E. Taste to the anterior tongue
F. Wrinkling of the forehead
71. To clinically test the superior oblique muscle of the eye, the physician would most likely have the patient look
A. laterally
B. laterally and then downward
C. laterally and then upward
D. medially
E. medially and then upward
F. medially and then downward
72. During a physical examination, the patient is instructed to look laterally and then upward. Which extraocular muscle is being tested in this patient?
A. Inferior oblique
B. Inferior rectus
C. Lateral rectus
D. Medial rectus
E. Superior oblique
F. Superior rectus
73. A 63-year-old woman visits her physician for a routine physical examination. During the examination, the physi cian touches the patient’s scalp with a pin near the hairline to test for cutaneous sensation. Which of the following nerves is the physician most likely testing?
A. CN IV
B. CN V
C. CN VI
D. CN VII
E. CN VIII
F. CN IX
G. CN X
74. A 23-year-old man is brought to the emergency depart ment after being involved in an automobile accident. Examination shows that the patient has an intracranial hemorrhage resulting from lateral trauma to the skull in the region of the pterion. Which of the following is the most likely location for the hemorrhage?
A. Immediately superficial to the dura mater
B. Immediately deep to the dura mater
C. Within the subarachnoid space
D. Within the brain parenchyma
75. A 32-year-old man with carcinoma of the testis under goes exploratory surgery to biopsy lymph nodes. Which of the following lymph nodes is being sampled to deter mine if the cancer has metastasized via the lymphatic sys tem?
A. External iliac
B. Femoral
C. Internal iliac
D. Paraaortic
E. Superficial inguinal
76. A 20-year-old woman is brought to the emergency department after being involved in an automobile acci dent. Physical examination reveals hypotension and tenderness along the left midaxillary line. Radiographic imaging reveals a large swelling below the left costal margin, and ribs 9 and 10 are fractured near their angles. Which of the following abdominal organs was most likely injured as a result of this accident?
A. Descending colon
B. Left kidney
C. Pancreas
D. Spleen
E. Stomach
77. During sexual arousal, an erection is caused by a dilation of arteries filling the erectile tissue of the penis. These arteries are innervated by which of the following nerves?
A. Genitofemoral
B. Iliohypogastric
C. Parasympathetic
D. Pudendal
E. Sympathetic
78. The functional significance of the marginal artery of Drummond is anastomosis among which of the following vessels?
A. Arteries supplying the colon
B. Arteries supplying the liver
C. Lymphatics draining the kidneys
D. Lymphatics draining the pancreas
E. Veins draining the bladder
F. Veins draining the posterior abdominal wall
79. A 40-year-old man undergoes a vasectomy. After the procedure, when the patient has an orgasm during sexual intercourse, he will most likely
A. no longer have an ejaculate
B. still have an ejaculate, and the ejaculate will contain sperm
C. still have an ejaculate, but the ejaculate will not con tain sperm
80. A 70-year-old-man has a 90% blockage at the origin of the inferior mesenteric artery. This blockage rarely results in intestinal angina because of collateral arterial supply. Which of the following arteries is the most likely additional source of blood to the descending colon?
A. Left gastroepiploic
B. Middle colic
C. Sigmoid
D. Splenic
E. Superior rectal
81. The mesoappendix is a fold of mesentery that contains an artery that is most likely a direct branch of which of the following?
A. Celiac trunk
B. Ileocolic artery
C. Middle colic artery
D. Right colic artery
E. Superior mesenteric artery
82. A 50-year-old woman is diagnosed with severe obstruc tive jaundice. Blockage of which of the following struc tures would most likely result in her condition?
A. Common hepatic duct
B. Pancreatic duct
C. Parotid duct
D. Submandibular duct
E. Thoracic duct
83. A 22-year-old man is admitted to the emergency depart ment after being stabbed with a knife. The laceration is 8-cm long and involves the right cheek, from the right ear to near the corner of the mouth. Which of the following structures is most likely injured?
A. Lingual artery
B. Mandibular branch of facial nerve
C. Parotid duct
D. Submandibular duct
E. Superficial temporal artery
84. A 61-year-old man is diagnosed with an acute stroke. His primary deficit is a partial loss of the visual field as a result of a lesion in the occipital lobe. Which of the following arteries is most likely to be involved?
A. Anterior cerebral
B. Internal carotid
C. External carotid
D. Middle cerebral
E. Posterior cerebral
85. A 4-year-old boy is taken to the pediatrician because of recurrent ear infections. Tubes were placed in the tym panic membranes in the boy’s ears 3 days ago, and he is now complaining of difficulty in tasting sweet foods. Which nerve was most likely disrupted during the inser tion of the tubes that resulted in these findings?
A. Chorda tympani
B. Greater petrosal
C. Lesser petrosal
D. Vagus
E. Vestibulocochlear
86. A 4-year-old girl is brought to the pediatrician because she has pain in the left ear. Examination reveals acute otitis media. Which nerve is responsible for conducting the painful sensation from the internal surface of the tympanic membrane to the brain?
A. CN VII
B. CN VIII
C. CN IX
D. CN X
E. CN XI
87. An emergency cricothyroidotomy is warranted when an airway collapses or when severe laryngoedema occurs. Which of the following is the most accurate description of the location of the cricothyroid membrane?
A. Immediately inferior the cricoid cartilage
B. Immediately inferior to the hyoid bone
C. Immediately inferior to the thyroid cartilage
D. Immediately superior to the hyoid bone
E. Immediately superior to the thyroid cartilage
88. A 49-year-old woman visits her physician because of severe nose bleeds. Which major blood supply to the nasal cavity would need to be occluded to correct this patient’s condition?
A. Ethmoidal artery
B. Facial artery
C. Greater palatine artery
D. Sphenopalatine artery
E. Superior labial artery
89. A 52-year-old man is brought to the emergency depart ment because he is experiencing severe chest pain in the mediastinum. He says that 3 weeks ago he was treated for an abscess in the left mandibular molar. Studies deter mine that the chest pain is the result of an infection in the mediastinum. Which of the following is the most likely space that infection spread through to course from the mandibular region to the mediastinum?
A. Carotid
B. Masticator
C. Pretracheal
D. Retropharyngeal
E. Suprasternal
90. A 14-year-old girl arrives at the dentist’s office to have a cavity in her lower right incisor filled. Which nerve will the dentist most likely block before beginning the proce dure?
A. CN V-1
B. CN V-2
C. CN V-3
91. A radiologist is conducting a contrast study of the pulmonary circulation on a 41-year-old man. What is the most likely number of veins observed entering the left atrium?
A. Two
B. Three
C. Four
D. Five
E. Six
92. A 55-year-old woman undergoes surgery of the lateral abdominal wall. The surgeon entering the cavity will be careful to avoid injury to vessels and nerves within the abdominal wall. The vessels and nerves will most likely be located deep to which of the following structures?
A. External oblique muscle
B. Internal oblique muscle
C. Superficial fascia
D. Transverse abdominis muscle
E. Transversalis fascia
93. During surgery of a 60-year-old man, the anterior rectus muscle sheath between the xiphoid process and the umbilicus is incised. In this region, the rectus sheath is derived from which of the following muscles?
A. External oblique muscle
B. External and internal oblique muscles
C. Internal oblique muscle
D. Internal oblique and transverse abdominis muscles
E. Transverse abdominis muscle
94. In a healthy person, blood from the left ventricle would most likely flow next into which of the following struc tures?
A. Aortic arch
B. Left atrium
C. Left ventricle
D. Right atrium
E. Right ventricle
F. Pulmonary arteries
G. Pulmonary veins
95. One aspect of the physical examination is measuring the jugular venous pressure (JVP). The JVP appears as a pulse in the neck by the external jugular vein. Therefore, the JVP is produced by the venous system, not the arterial sys tem, because of the right atrial contraction. There are no valves in the superior vena cava. Therefore, during dias tole, some blood is pushed, in a pulsating fashion, back out of the right atrium and up the superior vena cava, all the way to the external jugular vein. The JVP is only pathologic if the pulse is observed too high up the neck, indicating an overload or backup of blood entering the heart. An abnormally high JVP can be caused by several conditions. Which of the following conditions is most likely to cause an abnormally high JVP?
A. Left-sided heart failure
B. Mitral valve prolapse (regurgitation or backflow of blood)
C. Right atrial fibrillation (uncoordinated contraction)
D. Tricuspid valve stenosis (narrowing)
96. A 22-year-old man visits his physician and is diagnosed with a herniated disc impinging the spinal nerve that exits inferior to the C6 vertebra. Pain from the impinged nerve would most likely radiate to which cutaneous region?
A. Lateral shoulder
B. Lateral surface of digit 5
C. Medial surface of the elbow
D. Medial surface of the manubrium
E. Palmar surface of digit 3
F. Palmar surface of the thumb
97. A 51-year-old man visits his physician with a complaint of back pain that the man says resulted from bending over and picking up a heavy box without bending his knees. Which of the following muscles was most likely injured in this patient?
A. Iliocostalis
B. Latissimus dorsi
C. Rhomboid major
D. Serratus posterior inferior
E. Trapezius
98. A 61-year-old woman visits her physician with a com plaint of shortness of breath. Physical examination reveals cyanosis and an enlarged right ventricle. Which of the following structures is most likely obstructed in this patient?
A. Bronchial arteries
B. Bronchioles
C. Coronary arteries
D. Coronary sinus
E. Pulmonary arteries
F. Pulmonary veins
99. Heart murmurs are abnormal heart sounds caused by turbulent blood flow. They are often associated with pathologic heart valves. The murmurs are generally organized into the following categories:
Systolic murmurs occur during ventricular contraction.
Diastolic murmurs occur during atrial contraction (ventricular relaxation and filling).
The two common causes of murmurs are valve stenosis and valve regurgitation (prolapse):
Valve stenosis occurs when the valve becomes narrower. During contraction, the blood is forced through a smaller opening and the flow becomes turbulent, causing the extra heart sound.
Valve regurgitation occurs when the valve is unable to close completely and thus becomes incompetent, allowing blood to flow in reverse, back through the valve. This murmur occurs when the affected valve is supposed to be closed.
Which of the following would most likely present as a diastolic murmur?
A. Aortic valve stenosis
B. Mitral valve regurgitation
C. Pulmonary valve stenosis
D. Tricuspid valve stenosis
100. Neisseria meningitidis and Streptococcus pneumoniae are the leading causes of bacterial meningitis. To confirm diagnosis of bacterial meningitis, cerebrospinal fluid (CSF) is most likely obtained from which of the following regions?
A. Epidural space
B. Intervertebral foramen
C. Subarachnoid space
D. Subdural space
E. Subpial space
ANSWERS
1–A: The clavicle connects the manubrium of the sternum to the acromion of the scapula.
2–B: The infraspinatus is a rotator cuff muscle that stabilizes the glenohumeral joint. The tendons of the rotator cuff reinforce the ligaments of glenohumeral joint capsule.
3–C: The roots of the brachial plexus pass between the anterior and middle scalene muscles. Spasm of these muscles may entrap the brachial plexus roots.
4–B: The musculocutaneous nerve courses through the coraco-brachialis muscle and innervates the anterior compartment of the arm. Muscles of the anterior arm include the biceps brachii and brachialis; both of these muscles flex the elbow. The triceps muscle extends the elbow and is innervated by the radial nerve. Shoulder abduction is produced by the deltoid muscle, which is innervated by the axillary nerve. Shoulder adduction, extension, and flexion are produced by the latissimus dorsi muscle and the pectoralis major muscle with innervation from the thoracodor-sal nerve and pectoral nerves, respectively.
5–B: The brachial artery bifurcates just distal to the elbow to form the radial and ulnar arteries.
6–C: The upper subscapular, lower subscapular, and thora-codorsal nerves branch off the posterior cord in the axilla, just anterior to the subscapularis muscle. The thoracodorsal nerve innervates the latissimus dorsi muscle. All other muscles are innervated by anterior divisions of the brachial plexus.
7–E: The trapezius muscle is innervated by the spinal accessory nerve (CN XI). The levator scapulae and rhomboid major muscles are innervated by the dorsal scapular nerve (C5), and the splenius capitis is innervated by cervical dorsal rami.
8–B: The serratus anterior muscle stabilizes the medial border of the scapula against the thorax. A pushup position pushes the medial border of the scapula away from the thorax, causing the weakness to become more apparent. The long thoracic nerve (C5–C7) innervates the serratus anterior muscle.
9–C: Quadrangular space syndrome results when the muscles surrounding the quadrangular space, mainly the teres major and minor and the long head of the triceps brachii, compress the posterior humeral circumflex artery and axillary nerve.
10–B: The circumflex scapular artery courses through the triangular space to form a collateral circuit with the suprascapular and dorsal scapular arteries.
11–A: The C5 spinal nerve level is a principal contributor to the axillary nerve, which innervates the deltoid muscle.
12–F: The right side of the head, neck, and thorax and the right upper limb drain lymph into the right lymphatic duct. All other parts of the body drain lymph into the thoracic duct. Therefore, the right thumb is the only structure in the choices listed that does not drain into the thoracic duct.
13–B: The boundaries of the three parts of the axillary artery are determined by its relationship to the pectoralis minor muscle.
14–C: When the musculocutaneous nerve is damaged, the biceps brachii and brachialis muscles are weakened or paralyzed. In addition, the skin on the lateral side of the forearm receives its cutaneous innervation via the lateral cutaneous nerve of the forearm, a branch of the musculocutaneous nerve.
15–D: The superior ulnar collateral artery anastomoses with the posterior ulnar recurrent artery from the ulnar artery, posterior to the medial epicondyle.
16–D: Damage to the radial nerve would cause the weakness in the triceps brachii muscle and extension of the elbow. This damage would cause deficits in the cutaneous field of the radial nerve in the posterior compartment of the forearm.
17–C: The flexor pollicis longus tendon courses through the carpal tunnel along with the flexor digitorum superficialis and flexor digitorum profundus tendons and the median nerve.
18–A: The median nerve courses between the flexor digitorum superficialis and profundus muscles en route to the carpal tunnel. The ulnar nerve courses between the two heads of the flexor carpi ulnaris muscle; the palmar branch of the median nerve courses superficial to the flexor retinaculum; the musculocuta-neous nerve courses through the coracobrachialis muscle; and the radial nerve courses through the supinator muscle.
19–C: The radiocarpal joint is formed by the distal end of the radius, the triangular fibrocartilage complex, and the proximal row of the carpal bones. The lunate bone is included in the proximal carpals.
20–C: The flexor retinaculum anchors to the hamate, pisiform, trapezium, and scaphoid bones to enclose the tendons of the flexor digitorum superficialis, flexor digitorum profundus, and flexor pollicis longus muscles and the median nerve.
21–B: The ulnar nerve courses through Guyon’s canal. Compression of the nerve will cause weakness in the muscles it innervates, including the palmer interosseus muscles, which are responsible for adduction of digits 2 to 5.
22–D: The palmar digital branches of the median nerve send cutaneous branches to the skin of the medial side of the palm after the median nerve passes through the carpal tunnel. The palmar branch of the median nerve that innervates the lateral skin of the palm branches proximal to the carpal tunnel.
23–B: The radial artery courses through the anatomical snuffbox, where a radial pulse can be felt.
24–B: The lumbrical muscles cross anterior to the metacar-pophalangeal joints, then insert on the extensor expansion. It is this orientation that allows the muscles to flex the metacar-pophalangeal joints and extend the interphalangeal joints.
25–C: The ischial tuberosity is the attachment site for the hamstring muscles on the ischial tuberosity. The adductor muscles attach to the pubis; the gluteal muscles attach to the ilium; the quadriceps femoris muscle attaches to the femur; and the iliop-soas muscle attaches to the lumber vertebrae and ilium.
26–E: The cutaneous field of the obturator nerve only covers the skin of the medial compartment of the thigh. The L3–L4 dermatome also covers part of the medial compartment of the thigh, but extends over the distal anterior compartment of the thigh as well.
27–A: The patient is having difficulty extending his hip from a flexed position. This action is largely performed by the gluteus maximus muscle. Damage to the inferior gluteal nerve would weaken the gluteus maximus without causing cutaneous deficit. Damage to either the S1 or S2 nerve roots may weaken the glu-teus maximus, but their dermatomes would also be affected.
28–E: The gluteus medius and minimus muscles abduct the hip and hold the pelvis over the stance limb (limb that is on the ground during gate), preventing drop on the opposite swing side when walking. Damage to the superior gluteal nerve would weaken both muscles without a cutaneous deficit.
29–A: Five of the six external hip rotator muscles attach to some aspect of the greater trochanter of the femur. The quadratus femoris attaches near the greater trochanter on the intertrochanteric crest.
30–D: The capsular ligaments of the hip are pulled taut during extension of the hip, decreasing distraction between articular surfaces and stabilizing the joint.
31–A: The rectus femoris muscle is the only quadricep muscles that crosses the hip joint, originating on the anterior inferior iliac spine. A muscle must cross a joint to produce an action at that joint.
32–A: The femoral nerve innervates the anterior compartment of the thigh (quadricep muscles group). The muscles of the anterior compartment of the thigh are the primary knee extensors.
33–C: The perforating arteries branch off the deep femoral artery and pierce through the adductor magnus muscle as it inserts on the linea aspera. These arteries are the primary arterial supply to hamstring musculature.
34–D: The posterior cruciate ligament ascends from the posterior element of the superior tibia to the femur in the joint capsule of the knee. This orientation makes it very strong so that it is able to resist posterior translation of the tibia on the femur. In contrast, the anterior cruciate ligament resists anterior translation of the tibia on the femur.
35–F: The tibial nerve descends through the posterior part of the leg between the soleus and the deep posterior muscles of the leg.
36–B: The muscles of the anterior compartment of the leg produce dorsiflexion of the ankle. The deep fibular nerve innervates the anterior compartment and supplies the skin between digits 1 and 2 of the foot.
37–A: The anterior tibial artery branches from the popliteal artery, then courses through the proximal part of the interosseous membrane to enter the anterior compartment of the leg.
38–A: The lateral side of the ankle experiences the most damaging strain when the ankle is rolled or over-inverted and plantar flexed. The anterior talofibular ligament is located on the lateral side of the ankle and will experience the most damage.
39–C: The flexor retinaculum forms the roof of the tarsal tunnel between the calcaneus and the medial malleolus.
40–B: The dorsal and plantar interossei are responsible for adduction and abduction of the small toes. The lateral plantar nerve supplies the dorsal and plantar interossei as well as the plantar skin of digits 4 and 5.
41–D: The lateral plantar artery gives rise to the deep plantar arch. The terminal end of the deep plantar arch joins the deep plantar branch of the dorsalis pedis artery.
42–C: The subtalar joint allows for movement primarily in the coronal plane.
43–D: Cirrhosis of the liver may result in portal hypertension because of the backup of venous blood from the gut. Therefore, congested blood results in engorged veins in the portocaval anastomoses, such as the periumbilical veins, rectal veins, and the gastroesophageal veins.
44–B: The right atrium of the heart collects systemic and coronary deoxygenated blood. The right ventricle pumps blood through the pulmonary arteries to the lungs to become oxygenated. Oxygenated blood then returns from the lungs to the left atrium of the heart via the pulmonary veins. Therefore, blood from the pulmonary veins will most likely flow next into the left atrium.
45–D: During systole, both ventricles contract. As pressure increases, the atrioventricular valves are forced shut and the semilunar valves (pulmonary and aortic) open to enable blood to flow out of the pulmonary arteries and aorta.
46–D: The aortic valve is auscultated in the right second intercostal space adjacent to the sternum. This patient has a systolic murmur, and therefore, a stenotic or narrowed valve would be heard during systole. In contrast, a murmur of a prolapsed aortic valve would most likely be heard during diastole.
47–C: The coarctation (narrowing) is beyond the left subcla-vian artery, and therefore, blood flowing from the aortic arch to the thoracic aorta is restricted. Blood is shunted through the subclavian arteries to the internal thoracic arteries, where blood next flows into the anterior intercostal arteries, through the posterior intercostal arteries, and retrograde enters the thoracic aorta.
48–A: Lymph flows along the course of arteries within the abdominopelvic cavity. The primary blood supply to the stomach is via branches from the celiac artery; therefore, lymph nodes associated with the celiac artery must be biopsied in this patient.
49–C: Imaging reveals the hematoma to be in the retroperi-toneal space. The only structure from the list of choices (i.e., jejunum, liver, pancreas, esophagus, and transverse colon) that is located in the retroperitoneal space is the pancreas.
50–C: The polyps are located in the hindgut (descending and sigmoid colon). The primary arterial supply to the hindgut is via the inferior mesenteric artery.
51–D: The uterine and vaginal arteries provide the primary arterial supply to the uterus. Both arteries are branches from the internal iliac artery.
52–E: Ejaculation is under sympathetic innervation. Sympathetic neurons responsible for ejaculation begin at the L2 level of the spinal cord, course down the sympathetic trunk, exit via the sacral splanchnic nerves, and course to the ductus deferens and smooth muscle of the urethra. Pelvic splanchnics transport the parasympathetic neurons that are responsible for erection. Remember, Point (Parasympathetic) and Shoot (Sympathetic).
53–E: Temperature and touch to the anterior tongue is provided by CN V-3, and taste is sensed via the chorda tympani nerve (CN VII, the facial nerve). If the lesion results from loss of touch but not taste, the lesion is proximal to the chorda tympani union to the lingual branch of CN V-3. Therefore, muscles of mastication, such as the masseter, would be affected.
54–A: The anterior communicating artery is located between the paired anterior cerebral arteries. A berry aneurysm is a saclike outpouching in the anterior communicating cerebral artery.
55–B: The trigeminal nerve (CN V) is responsible for general sensory innervation of the face.
56–B: The oculomotor nerve (CN III) is affected in this patient, resulting in ptosis (droopy eyelid due to no tone in the levator palpebrae superioris) and mydriasis (dilatation of the pupil due to loss of the papillary constrictor muscle). The oculomotor nerve is also responsible for innervating the ciliary muscles, causing an inability to accommodate the lens. The abducens nerve (CN VI) innervates the lateral rectus (look laterally); the facial nerve (CN VII) innervates the lacrimal and salivary glands; and the glossopharyngeal nerve (CN IX) innervates the parotid salivary gland and is part of the gag reflex.
57–B: The genioglossus muscle attaches to the internal surface of the mental symphysis of the mandible and into the tongue. Therefore, contraction results in protrusion of the tongue. The palatoglossus is the only other tongue muscle listed as a choice, and it elevates the root of the tongue.
58–D: The maxillary artery branches off the external carotid artery in the infratemporal fossa. The maxillary artery courses through the pterygomaxillary fissure, pterygopalatine fossa, and sphenopalatine foramen into the nasal cavity.
59–C: The facial nerve (CN VII) provides parasympathetic innervation to both the pterygopalatine and submandibular ganglia. CN III (oculomotor nerve) provides parasympathetic innervation for the ciliary ganglion. CN IX (glossopharyngeal nerve) provides parasympathetic innervation for the otic ganglion and CN X (vagus nerve) for intramural ganglia. CN V (trigeminal nerve) does not have parasympathetic neurons originating in its nuclei; however, it does provide a pathway for parasympathetics on which to “hitch-hike.”
60–C: The posterior cricoarytenoid muscles abduct the vocal ligaments, whereas the other muscles listed as choices (i.e., cricothyroid, lateral cricoarytenoid, thyroarytenoid, and transverse arytenoid) adduct or tense the vocal ligaments.
61–D: The inferior mandibular artery originates from the maxillary artery in the infratemporal fossa.
62–E: The left recurrent laryngeal nerve courses deep to the aortic arch and can affect its functioning.
63–C: The superior orbital fissure transmits CNN III, IV, V-1, VI, and the superior ophthalmic vein. Therefore, damage to CNN III, IV, and VI accounts for the paralysis of extraocular muscles, and damage to CN V-1 accounts for loss of sensation to the nose, upper eyelid, and forehead.
64–D: The facial artery originates with the external carotid artery, and after emerging from the submandibular triangle, the artery courses along the lateral corner of the mouth and medial canthus of the eye.
65–C: The malleus attaches into the medial surface of the tympanic membrane.
66–B: The cerebral region affected by the stroke (the parietal lobe and the medial portion of the temporal lobe of the left cerebral hemisphere) is supplied by the middle cerebral artery.
67–A: The phrenic nerve is formed by branches of the C3, C4, and C5 ventral rami and immediately courses vertically along the anterior scalene muscle en route to the thoracic cavity.
68–C: The facial artery gives rise to the superior labial artery, which provides arterial branches to the nasal cavity, including the nasal septum.
69–C: Torticollis causes shortening of the sternocleidomastoid muscle, which causes the head to rotate to the contralateral side. In this case, because the right sternocleidomastoid muscle is affected, the patient will look to his left.
70–F: The facial nerve (CN VII) innervates the frontalis muscle, which is responsible for wrinkling of the forehead. The facial nerve is responsible for taste in the anterior part of the tongue; however, the chorda tympani branches from the main trunk before exiting the stylomastoid foramen. Sensation to both the cornea and the face is provided by the trigeminal nerve (CN V). The genioglossus muscle protrudes the tongue from the mouth and is innervated by the hypoglossal nerve (CN XII).
71–F: When the patient is asked to look medially, the axis of vision is parallel to the contraction axis of the superior oblique muscle. When the superior oblique muscle contracts, the eye looks downward. Therefore, to clinically test the superior oblique muscle, the patient is first instructed to look medially and then to look downward. There are two muscles that cause the eye to look downward: the superior oblique and the inferior rectus. When the patient is instructed to look medially, the bio-mechanical advantage to looking downward is isolated to the superior oblique muscle, not the inferior rectus muscle.
72–F: When the patient looks laterally, via contraction of the lateral rectus muscle, the axis of vision becomes parallel with contraction axis of the superior rectus muscle. Therefore, when the superior rectus muscle contracts, the eye looks upward. There are two muscles that cause the eye to look upward: the superior rectus and the inferior oblique. When the patient is instructed to look laterally, the biomechanical advantage to looking up is isolated to the superior rectus muscle, not the inferior oblique muscle.
73–B: The physician is testing the trigeminal nerve (CN V). This nerve is responsible for providing general sensory innervation to the anterior scalp and face.
74–A: The patient has an epidural hematoma as a result of rupture of the middle meningeal artery. The middle meningeal artery courses on the internal surface of the skull in the region of the pterion. The lateral trauma most likely caused a skull fracture, which in turn damaged the middle meningeal artery. The middle meningeal artery courses superficial to the dura mater in this location and, as such, bleeds into the epidural space.
75–D: In the abdomen, pelvis, and perineum, lymph flows along the arterial supply of its organ. Therefore, the blood supply for the testis is the testicular artery, which is a branch of the aorta. Paraaortic lymph nodes would be biopsied in a patient who has carcinoma of the testis.
76–D: The spleen is located in the left upper quadrant of the abdomen in midaxillary line. Fractured ribs 9 and 10 would most likely damage the spleen, resulting in significant blood loss and tenderness.
77–C: Pelvic splanchnics transport parasympathetic neurons to the erectile tissue, causing blood vessels to dilate and fill erectile tissue, which causes an erection. Remember, Point (Parasympa-thetic) and Shoot (Sympathetic).
78–A: The marginal artery of Drummond courses in the mesentery adjacent to the large bowel. This artery serves as the vascular arcade connecting the superior mesenteric artery branches (right and middle colic) with the inferior mesenteric artery branches (left colic and sigmoid).
79–C: A vasectomy ligates the ductus deferens in the spermatic cord. Therefore, during ejaculation, sperm cannot reach the urethra. However, secretions from the seminal vesicles, prostate, and bulbourethral glands will continue to produce and secrete their products into the urethra during ejaculations, and therefore, this man will still have an ejaculate.
80–B: The middle colic artery anastomoses with the inferior mesenteric arterial branches, such as the left colic artery, via the marginal artery of Drummond.
81–B: The mesoappendix is a fold of mesentery that transports the appendicular artery to the appendix. The appendicular artery is a branch of the ileocolic artery.
82–A: The liver produces bile and transports it to the gallbladder for storage via the common hepatic duct. Blockage of the common hepatic duct would most likely result in jaundice (interruption of the drainage of bile from the biliary system). The pancreatic duct joins with the common bile duct, but this would not result in jaundice if blocked. The parotid and sub-mandibular ducts transport saliva in the oral cavity. The thoracic duct transports lymph.
83–C: The buccal branch of the facial nerve (CN VII) and the parotid duct travel in the area of the cheek and can be located by a line drawn from the external acoustic meatus to the corner of the mouth.
84–E: The posterior cerebral artery is the artery that primarily provides vascular supply to the occipital lobe.
85–A: The chorda tympani nerve is a branch from the facial nerve (CN VII) and transports special sensory neurons for taste from the anterior portion of the tongue to the brain. The chorda tympani nerve courses along the internal surface of the tympanic membrane and, therefore, is the nerve most likely injured in the procedure of placing tubes in the tympanic membranes.
86–C: The glossopharyngeal nerve (CN IX) originates in the medulla and exits the skull via the jugular foramen. General sensory and visceral motor fibers enter the petrous part of the temporal bone and enter the middle ear as a tympani plexus of nerves. The tympanic plexus conducts general sensory information from the auditory tube and internal surface of the tympanic membrane to the brain.
87–C: The cricothyroid membrane is just inferior to the thyroid cartilage and superior to the cricoid cartilage.
88–D: The major vascular supply to the anterior septum is the sphenopalatine artery; a branch of this artery supplies the nasal septum. The sphenopalatine artery arises from the maxillary artery, which is a terminal branch of the external carotid artery.
89–D: The major pathway between infections of the neck and the chest is through the retropharyngeal space, a potential space between the prevertebral layer of fascia and the buccopharyn-geal fascia surrounding the pharynx.
90–C: The inferior alveolar nerve provides general sensory innervation of the mandibular teeth and branches from CN V-3.
91–C: There are two pairs of pulmonary veins (four veins) that enter the left atrium of the heart.
92–B: The neurovascular plane in the abdominal wall is deep to the internal oblique and superficial to the transverse abdominis muscles.
93–B: The rectus sheath superior to the arcuate line is composed of the aponeuroses from both the external and internal oblique muscles.
94–A: Blood in the left ventricle is oxygenated and is ready to be pumped throughout the systemic circulation via the aorta to provide the body with oxygen.
95–D: The tricuspid valve is the first valve the blood encounters from the venous return to the heart. When this valve is stenotic, blood is pushed back into the venous system, causing an elevated JVP. Left-sided heart failure would more acutely present with pulmonary edema. Mitral valve prolapse will result in blood flowing from the left ventricle into the left atrium, but will not result in an elevated JVP. Right atrial contraction is mostly responsible for the pulsating appearance of the JVP. However, if the atrium has an uncoordinated and random contraction, the JVP would be lower due to weaker atrial contractions and more indistinct due to the uncoordinated rhythm.
96–B: The C7 spinal nerve exits inferior to the C6 vertebra. The C7 dermatome is associated with digit 5, and therefore, pain would radiate to the lateral surface of digit 5.
97–A: The iliocostalis muscle is a part of the erector spinae group, a group of muscles responsible for maintaining an erect vertebral column. When a person bends over, these muscles stretch to accommodate the flexibility. However, this movement weakens the muscle, and thus, when a person attempts to lift a heavy object, the muscle fibers will possibly be injured.
98–E: This patient most likely has pulmonary edema resulting in back flow of blood in the pulmonary arteries. The back flow causes the right ventricle to become enlarged to accommodate for the increased volume of blood. When the patient arrived at the physician’s office, symptoms were shortness of breath and cyanosis (discoloration of skin as a result of lack of oxygenated blood).
99–D: If the tricuspid valve is stenotic, then the turbulent flow will occur during atrial contraction, which occurs toward the end of diastole. Aortic valve stenosis will cause a murmur when the left ventricle is contracting, causing it to be systolic. Mitral valve regurgitation will also cause a murmur when the left ventricle is contracting because blood will be forced back through the valve and will be pushed back into the left atrium, causing a systolic murmur. Pulmonary valve stenosis will be similar to aortic valve stenosis in that it will cause a murmur during right ventricular contraction and, therefore, a systolic murmur.
100–C: CSF resides in the subarachnoid space between the arachnoid and pia mater. CSF is obtained through a spinal tap (lumbar puncture) between the L4 and L5 vertebrae.
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