ITEM QUESTION CHOICES ANSWER RATIONALE SOURCE

1 25-year old male is admitted to the A. Varicocele B. Hydrocele In the true hydrocele, there is a collection of Hydrocele
hospital with testicular pain. B. Hydrocele fluid in some part of the processus vaginalis. -Thorek's
Physical examination reveals a C. Cystocele The types may be vaginal, congenital, Anatomy.in
swollen and inflamed right testis. D. Rectocele infantile and hydroceles of the cord. The Surgery p.
CT scan examination reveals vaginal type presents a collection of fluid, not 391
abnormal accumulation of fluid in due to any fault of development, in the tunica
the cavity of the tunica vaginalis. vaginalis. The congenital (intermittent) type is Varicocele-
Which of the following conditions due to a tiny communication between Thorek p.
will MOST accurately describe the processus vaginalis and peritoneal.cavity. In 645
signs observed in the patient? infantile type, the processus vaginalis is
occluded only at the internal abdominal ring.
In hydrocele of the cord, the funicular process
fails to shrink to a fibrous cord so that a
tubular cavity results.

A varicocele is a dilatation and varicose

condition of the spermatic veins and is more
common on the right side usually involving
the anterior group of veins that surround the
testicular artery.

In a cystocele, there is a defect in the fascia

between the bladder and vagina. This allows
a part of the bladder wall to bulge into the
vagina. There are 3 grades of cystocele:
 Grade 1—mildest form, where the bladder
drops only partway into the vagina
Grade 2—moderate form, where the bladder
has sunken far enough to reach the opening
of the vagina
Grade 3—most severe form, where the
bladder sags through the opening of the
vagina

In a rectocele, there is a defect in the fascia

between the rectum and the vagina. This
allows part of the wall of the rectum to bulge
into the vagina.

2 A 42-year old mother of three A. Ischiofemoral B. Ligament of the head In general, the hip joint capsule is tight in NCBI
children visits the outpatient clinic B. Ligament of the of the femur extension and more relaxed in flexion. The Journal:
complaining that her youngest son head of the capsular ligaments include the iliofemoral Anatomy,
cannot walk yet. Radiographic and femur ligament (Y ligament of bigelow), and the Bony Pelvis
physical examinations reveals an C. Pubofemoral pubofemoral and ischiofemoral ligaments. and Lower
unstable hip joint. Which of the D. Iliofemoral Limb, Hip
following ligaments is responsible The iliofemoral ligament is the strongest Joint
for stabilization of the hip joint in ligament in the body and attaches the
childhood? anterior inferior iliac spine (AIIS) to the https://www.
intertrochanteric crest of the femur. ncbi.nlm.nih
.gov/books/
The pubofemoral ligament prevents excess NBK470555
abduction and extension, ischiofemoral /
prevents excess extension, and the
iliofemoral prevents hyperextension.
 The ​ligamentum teres (ligament of the
head of the femur)​ is located intracapsular
and attaches the apex of the cotyloid notch to
the fovea of the femoral head. The
ligamentum teres serves as a carrier for the
foveal artery (posterior division of the
obturator artery) which ​supplies the femoral
head in the infant/pediatric population​.
This relative vascular contribution to the
femoral head blood supply is ​negligible in
adults​. Injuries to the ligamentum teres can
occur in dislocations, which can cause
lesions of the foveal artery, resulting in
osteonecrosis of the femoral head.

3 A 56-year old patient has an A. Atrioventricular D. Sinoatrial (SA) Node The sinoatrial node initiates the impulse of BRS Gross
artificial cardiac pacemaker. Which (AV) Bundle contractions and is known as the pacemaker Anatomy
of the following conductive tissues B. Purkinje fiber of the heart. Impulses from the SA node 7th edition
of the heart had a defective C. AV Node travel through the atrial myocardium to the
function that required the D. Sinoatrial (SA) AV node and then race through the AV
pacemaker? Node bundle which divides into the right and left
bundle branches. The bundle breaks up into
terminal conducting fibers (purkinje fibers) to
spread out into the ventricular walls. The
moderate band carries the right limb of the
AV bundle from the septum to the
sternocostal wall of the ventricle.
4 A patient with a deep stab wound A. Flexor pollicis B. Flexor digitorum The anterior interosseous nerve is a branch BRS Gross
in the middle of the forearm has brevis and profundus and pronator of the median nerve at the radiohumeral joint Anatomy
impaired movement of the thumb. pronator quadratus line and supplies the flexor pollicis longus, 7th edition
Examination indicates a lesion of quadratus half of the flexor digitorum profundus, and the pp. 50, 75
the anterior interosseous nerve. B. Flexor digitorum pronator quadratus. It has sensory fibers to
Which of the following muscles is profundus and volar wrist joint capsule with no cutaneous
paralyzed? pronator innervation.
quadratus
C. Flexor pollicis The median nerve supplies the pronator
longus and teres, flexor digitorum superfi cialis, palmaris
Opponens longus, and flexor carpi radialis muscles. A
pollicis muscular branch (the recurrent branch) of the
D. Flexor digitorum median nerve innervates the thenar muscles.
profundus and
superficialis

5 A teenage girl presents with A. Cilia in alveoli, C. Mast cells, edema Mast cells have long been considered to play Allergy,
paroxysms of dyspnea, cough and enhanced a significant role in the pathophysiology of Asthma and
wheezing. Her parents indicate that mucociliary asthma through their ability to release a host Clinical
she has had these "attacks" during transport of pleiotropic autacoid mediators, proteases, Immunology
cold months, and worsens during B. Eosinophils, and cytokines in response to activation by Journal
the allergy season. Which of the bronchodilation both immunoglobulin E (IgE)-dependent and
following cell types is correctly C. Mast cells, diverse nonimmunologic stimuli. Within the
matched to a function it may edema first few minutes following laboratory allergen
perform in this patient's disease? D. Goblet cell in challenge, secretion of the autacoid
bronchiloes, mediators histamine, prostaglandin D2
hyposecretion (PGD2) and LTC4 induces
bronchoconstriction, mucus secretion, and
mucosal edema​, which account for the acute
symptoms.
 Elevated levels of these products can be
measured in the sputum of asthmatics,in
bronchoalveolar lavage (BAL) fluid, and
around areas of damaged epithelium
post-mortem, suggesting that airway
eosinophils are activated and may be an
important mediator of epithelial damage.
Eosinophils also release
bronchoconstrictor​ mediators such as
leukotriene C4 (LTC4).

Goblet cell hyperplasia (GCH) has been

established as a pathologic characteristic of
mild, moderate, and severe asthma.
Abnormalities in goblet cell number are
accompanied by changes in stored and
secreted mucin (MUC). The functional
consequences of these changes in MUC
stores and secretion can contribute to the
pathophysiologic mechanisms for multiple
clinical abnormalities in patients with asthma,
including ​sputum production​,
hypersecretion​ , airway narrowing,
exacerbations, and accelerated loss in lung
function.

6 A 30-year old female patient A. Appendix C. Suprarenal (Adrenal) Pituitary corticotrope adenomas account for Harrisons
complains that she has been weak B. Gallbladder Gland 70% of patients with endogenous causes Principles of
and easily fatigued over the past 6 of Cushing’s syndrome. However, it should Internal
 months. She has a 3-month acute C. Suprarenal be emphasized that iatrogenic Medicine
history of severe hypertension that (Adrenal) Gland hypercortisolism is the most common cause 19th edition
has required treatment with D. Ovary of cushingoid features. Ectopic tumor p. 2271
antihypertensive medications. She ACTH production, ​cortisol-producing
has recently gained 4.5 kg (10 lbs) adrenal adenomas, adrenal carcinoma,
and currently weighs 75 kg (165 and adrenal hyperplasia​ account for the
lbs). Her blood pressure is 170/100 other causes; rarely, ectopic tumor CRH
mmHg. Purple striae are seen over production is encountered.
the abdomen on physical
examination and possesses a Typical features of chronic cortisol excess
buffalo hump. Fasting serum include thin skin, central ​obesity​,
glucose concentration is hypertension​, plethoric moon facies, ​purple
140mg/dL. A CT scan of the striae​ and easy bruisability, ​glucose
abdomen shows a 6-cm mass intolerance or diabetes mellitus​, gonadal
immediately posterior to the inferior dysfunction, osteoporosis, proximal muscle
vena cava. Which of the following weakness​, signs of hyperandrogenism
organs is the MOST likely origin of (acne, hirsutism), and psychological
the mass? disturbances (depression, mania, and
psychoses). Hematopoietic features of
hypercortisolism include leukocytosis,
lymphopenia, and eosinopenia. Immune
suppression includes delayed hypersensitivity
and infection propensity.

7 A first year resident in the urology A. The duct of the D. The dorsal artery of The dorsal artery of the penis supplies the BRS Gross
department reviews pelvic anatomy bulbourethral the penis supplies the glans penis. Anatomy
before seeing patients. Which of gland opens glans penis. 7th edition
the following statements is correct? into the The seminal vesicles store no spermatozoa. p.292
membranous
urethra.
 B. The duct of the The duct of the bulbourethral gland opens
greater into the bulbous portion of the spongy
vestibular gland urethra, whereas the greater vestibular gland
opens into the opens into the vestibule between the labium
vagina minora and the hymen.
C. The seminal
vesicles store The anterior lobe of the prostate is devoid of
spermatozoa. glandular substance, the middle lobe is prone
D. The dorsal to benign hypertrophy, and the posterior lobe
artery of the is prone to carcinomatous transformation.
penis supplies
the glans penis

8 A thoracentesis is performed to A. 3 and 5 C. 7 and 9 A thoracentesis is performed for aspiration of BRS Gross
aspirate an abnormal accumulation B. 1 and 3 fluid in the pleural cavity at or posterior to the Anatomy
of fluid in a 4- year old patient with C. 7 and 9 midaxillary line one or two intercostal spaces 7th edition
pleural effusion. A needle should D. 5 and 7 below the fluid level but not below the ninth p.180
be inserted at the midaxilliary line intercostal space and, therefore, between ribs
between which of the following two 7 and 9. Other intercostals spaces are not
ribs as to avoid puncturing the preferred.
lung?

9 A 47 year old patient complains of A. Right D. Arch of the azygos vein BRS Gross
chest pain and headache. CT scan brachiocephalic The ​root of the right lung​ lies behind the superior vena cava and part of Anatomy,
reveals a tumor located just vein the right atrium, and​ below the azygos vein​. A and B are also superior 8th edition;
superior to the root of the right B. Right to the root of the right lung, but not as directly close as D. C drains the and
lung. Blood flow in which of the subclavian vein bronchial veins on the left side, not the right. https://www.
following veins is most likely C. Accessory kenhub.com
blocked by this tumor? hemiazygos /en/library/a
vein natomy/hilu
 D. Arch of the m-of-the-lun
azygos vein g

10 Tropocollagen is not assembled in A. Action of lysyl C. Presence of As the 4th step in intracellular collagen BRS Cell
the cell because of which of the oxidase in the nonhelical registration synthesis, ​procollagen​ ​triple-helix Biology and
following? Golgi apparatus peptides at the end of the formation takes place in the RER and is Histology,
B. Cross linking of triple helix precisely regulated by propeptides (extra 7th Edition,
tropocollagen in nonhelical amino acid sequences) at both page 66
the RER ends of each a-chain.​ The three a-chains
C. Presence of align and coil into a triple helix. The
nonhelical oligosaccharide side chains are completed by
registration the addition of carbohydrates in the Golgi
peptides at the apparatus, after which, they are secreted into
end of the triple the extracellular space by exocytosis.
helix Cleavage of this procollagen is catalyzed
D. Presence of by procollagen peptidases, which remove
specific the propeptide sequences at the end of
 collagenases in each a-chain, yielding tropocollagen
the RER and molecules.
Golgi apparatus
Lysyl oxidase catalyses collagen
cross-link formation​, which is essential for
mechanically strong collagen fibrils. It is an
extracellular​ copper-dependent enzyme
(therefore has no direct action on the Golgi
apparatus) . ​Covalent bond formation
(cross-linking) occurs extracellularly​ (not
in the RER) between adjacent tropocollagen
molecules and involves formation of lysine-
and hydrolysine-derived aldehydes. This
cross-linking imparts great tensile strength to
collagen fibrils.

11 A 52 year old female with a history A. The right main D. The right main The right lung is larger and heavier than the BRS Gross
of brain tumor and associated bronchus is bronchus is straighter left, but is ​shorter and wider​ (so, A and B is Anatomy,
severe oropharyngeal dysphagia narrower than than the left main wrong) because of the higher right dome of 8th Edition,
develops right lower lobe the left main bronchus the diaphragm and the heart’s inclination to page 60
pneumonia after an episode of bronchus the left. ​The right main bronchus courses
vomiting? Which of the following is B. The right main more vertically than the left​ (D is correct).
the best reason that this type of bronchus is
aspiration pneumonia most longer than the No literature so support/ negate C.
commonly affects the right lower left main
lung lobe? bronchus
C. The right lower
lung lobe has
poorer venous
 drainage than
the other lobes
D. The right main
bronchus is
straighter than
the left main
bronchus

12 A 3 year old boy presents with pain A. Superficial D. Deep inguinal ring The transversalis fascia Is the lining fascia of BRS Gross
in his groin that has been inguinal ring the entire abdominopelvic cavity between the Anatomy,
increasing in nature over the past B. Inguinal parietal peritoneum and the inner surface of 8th Edition,
few weeks. He is found to have a ligament the abdominal muscles. It continues with the pages
degenerative malformation of the C. Sac of a direct diaphragmatic, psoas, iliac, pelvic, and 106-108
transversalis fascia during inguinal hernia quadratus lumborum fasciae. ​It forms the
development. Which of the D. Deep inguinal deep inguinal ring ​and gives rise to the
following structures on the anterior ring femoral sheath and the internal spermatic
abdominal wall is likely defective? fascia. It is directly in contact with the rectus
abdominis below the arcuate line.

The superficial inguinal ring (A) is located in

the aponeurosis of the external oblique
muscles lateral to the punic tubercle. The
inguinal ligament (B) is the folded lower
border of the aponeurosis of the external
oblique muscles, forming the floor (inferior
wall) of the inguinal canal. The most common
site of a direct inguinal hernia is the inguinal
(Hesselbach) triangle, bounded medially by
the linea semilunaris (lateral edge of the
rectus abdominis), laterally by the inferior
 epigastric vessels, and inferiorly by the
inguinal ligament.

13 A neonatal baby was born with A. Mesoderm D. Endoderm Isolated clumps of ​endodermal cells BRS
diabetes mellitus due to B. Proctoderm accumulate within the mesoderm to form Embryology,
inadequate production of insulin. C. Ectoderm islet cells​. The islet cells form: alpha cells (A 6th Edition,
Cells in the endocrine portion of D. Endoderm cells) that secrete the hormone glucagon, page 30 and
the pancreas that secrete insulin, beta cells (B cells) that produce insulin and 122
glucagon, and somatostatin are are the most abundant of the islet cells, delta
derived from which of the cells (D cells) that secrete the hormone
following? somatostatin, which is also produced by a
number of other endocrine cells in the body.

14 Observation of a histologic A. White muscle C. Red muscle fibers Skeletal muscle cells include red (slow Junqueira’s
preparation of muscle reveals fibers contraction but does not fatigue easily) and Basic
striations and peripherally located B. Cardiac muscle white (fast contraction but fatigues easily), Histology,
nuclei. The use of histochemistry C. Red muscle and intermediate. 13th Edition,
shows a strong staining reaction to fibers page 202,
succinic dehydrogenase. The D. Smooth muscle The redness of red muscle fibers was found and
same tissue prepared for electron to be due to myoglobin, and myoglobin was BRS Cell
microscopy shows many found to be correlated with aerobic Biology and
mitochondria in rows between the metabolism due to abundant mitochondrial Histology,
myofibrils and beneath the activity. (​Succinic dehydrogenase is most 7th Edition,
sarcolemma. Which one of the sensitive to use to histologically detecting page 124
following is the best description of mitochondrial proliferation​) The pale or
this tissue? white fibers with low aerobic potential were
found to be well endowed with glycolytic
enzymes that enabled them to obtain energy
rapidly by the incomplete oxidation of
glycogen (hence, fast fibers).
 So,

● Red- distinguished by features

indicative of slow contraction and
strong aerobic metabolism, abundant
mitochondria = strong mitochondrial
SDH activity
● White- distinguished by features
indicative of a fast contraction speed
plus features indicative of weak
aerobic metabolism = low SDH
activity

Smooth muscle cells are non-striated.

Cardiac muscles have centrally located
nuclei.

15 A 37 year old man is suffering from A. Aortic (lumbar) D. Superficial inguinal The skin of the penis is drained into the Snell’s
carcinoma of the skin of the penis. nodes nodes medial group of superficial inguinal Clinical
Cancer cells are likely to B. External iliac nodes​. The deep structures of the penis are Anatomy by
metastasize directly to which of the nodes drained into the internal iliac nodes. Regions,
following lymph nodes? C. Internal iliac page 402
nodes
D. Superficial
inguinal nodes

16 A 23 year old woman visits her A. Body of the B. Uterine cervix The vagina extends between the vestibule Snell’s
obstetrician for an annual checkup. clitoris and the cervix of the uterus, and is located at Clinical
During vaginal examination, which B. Uterine cervix the lower end of the birth canal. The uterine Anatomy by
cervix pierces its anterior wall. Regions,
 of the following structures may be C. Fundus of the page 409,
palpated? uterus The clitoris is situated at the apex of the and BRS
D. Apex of the vestibule anteriorly. The body of the clitoris is Gross
urinary bladder composed of two corpora cavernosa covered Anatomy,
by their ischiocavernosus muscles. Seen 8th Edition,
externally is the glans of the clitoris, partly pages 180
hidden by the prepuce. The fundus of the and 190
uterus is usually non-palpable in a non-gravid
female. The urinary bladder apex is located
at the anterior end and is not palpable. The
fundus or base is located at the
posteroinferior triangular position, and is most
palpable when distended. Regardless, C and
D are not part of the vagina.

17 A 60 year old man was observed in A. Parkinsonian C. Hemiplegic Hemiplegic gait occurs because of poor Evidence-B
the clinic. As he walked, the B. Spastic control of the flexor muscles during swing ased
affected limb is moved forward by C. Hemiplegic phase and spasticity of the extensor muscles Physical
the abduction and circumduction. D. Steppage acting to lengthen the affected leg (compared Diagnosis
Which of the following BEST with the healthy side). The ankle is (Second
describes the gait in this patient? abnormally flexed downward and inward Edition),
(equinovarus deformity), and initial contact 2007
during stance is abnormal, along the lateral
edge of the foot or forefoot. The knee is stiff,
hyperextends during stance, and does not
flex normally during swing. The contralateral
step often advances just to meet the position
of the paralyzed limb, instead of advancing
normally beyond it.
 Because the paralyzed leg is hyperextended,
and therefore longer than the sound leg, the
patient may drag the toe of the affected leg
during swing or adopt abnormal movements
to clear that limb during the swing phase.
These movements include contralateral
trunk lean, which raises the ipsilateral
pelvis to clear the paralyzed leg, and
circumduction, which describes the toe
tracing a semicircle on the floor, first
moving outward and then inward as it
advances, instead of the normal straight
forward movement.

18 A type I diabetic pregnant 28 year A. Binding to B. Cell attachment and Fibronectin​ is a glycoprotein of the
old is taking Humulin three times cadherins adhesion extracellular matrix that binds to
 per day. She complained of B. Cell attachment membrane-spanning receptor proteins. It has
“floaters” and difficulty with and adhesion a high molecular weight of about 440 kDa.
nighttime driving. Dilated indirect C. Binding to actin Fibronectin binds the cell to the extracellular
ophthalmoscopy coupled with filament matrix and organizes it. It can bind collagen,
biomicroscopy and fundus D. Binding to fibrin, and proteoglycans. This protein is also
photography detect the presence selectins involved in cell adhesion, growth, migration,
of proliferative diabetic retinopathy differentiation, and wound healing (Pankov &
with leaky retinal vessels, Yamada, 2002). There are two different types
indicative of increased vascular of fibronectin present in vertebrates which
permeability, growth of new, fragile include soluble plasma fibronectin and
vessels on the retina and posterior insoluble cellular fibronectin (Pankov &
surface to the vitreous, and Yamada, 2002).
macular edema, overexpression of
fibronectin is a histological marker
of diabetic microangiopathy.
Which of the following is the
primary function of fibronectin
in the basement membrane?

19 A 6 year old boy presented for A. Aortic Stenosis D. Coarctation of the Coarctation of the aorta​ occurs when the BRS Gross
routine physical examination. His B. Mitral Valve aorta aorta is ​abnormally constricted ​just inferior Anatomy,
right arm BP is 150/110 mmHg Prolapse to the ductus arteriosus, in which case an 7th Edition,
while his left 80/60 mmHg. A C. Patent ductus adequate collateral circulation develops pp. 163;
systolic murmur is heard over the arteriosus before birth​. Nelson 20th
mid - upper back, his femoral D. Coarctation of Edition, pp.
pulses delayed as compared with the aorta It causes (a) a ​characteristic rib notching 2206
the brachial. ECG showed left axis and a ​high risk of cerebral hemorrhage​; (b)
deviation. What is the MOST likely tortuous and enlarged blood vessels​,
diagnosis? especially the ​thoracic​, ​intercostal​,
epigastric​, and ​scapular arteries​; (c) an
 elevated blood pressure ​in the ​radial artery
and ​decreased pressure ​in the ​femoral
artery​; and (d) the ​femoral pulse to occur
after the radial pulse ​(normally, the femoral
pulse occurs slightly before the radial pulse).

It is important to determine the blood

pressure in each arm; a ​pressure higher in
the right than the left arm suggests
involvement of the left
subclavian artery in the area of
coarctation​.

20 A middle - aged coal miner injures A. Coccygeal C. Denticulate ligament Denticulate Ligaments BRS Gross
his back after an accidental ligament ● Are lateral extensions of the spinal pia Anatomy,
explosion. His MRI scan reveals B. Tectorial mater, consisting of 21 pairs of 7th Edition,
that his spinal cord has shifted to membrane toothpick-like processes. p. 312
the right because the lateral C. Denticulate ● Extend laterally from the pia through
extensions of the pia mater were ligament the arachnoid to the dura mater
torn. Function of which of the D. Choroid plexus between the dorsal and ventral roots
following structures is MOST likely of the spinal nerves.
impaired? ● Help hold the spinal cord in position
within the subarachnoid space.

21 At the ER, you find an anxious, A. Gastric ulcer D. Acute myocardial Pain originating in the heart as the result of Snell
pale man who is uncomfortable on B. Appendicitis infarction acute myocardial ischemia is assumed to be Clinical
an examination table. The 56 year C. Pneumonia caused by ​oxygen deficiency ​and the Anatomy,
old complains of chest, jaw and left D. Acute accumulation of metabolites​, which pp. 90
arm pain. He is perspiring heavily myocardial stimulate the sensory nerve endings in
infarction the myocardium​.
 while his extremities are cool. What
is the LIKELY diagnosis? The pain is not felt in the heart, but is
referred to the skin ​areas supplied by the
corresponding spinal nerves. The skin areas
supplied by the ​upper four intercostal
nerves ​and by the ​intercostobrachial nerve
(T2) ​are therefore affected. The
intercostobrachial nerve communicates with
the medial cutaneous
nerve of the arm and is distributed to skin on
the ​medial side of the upper part of the
arm​. A certain amount of spread of nervous
information must occur within the central
nervous system, for
the pain is sometimes felt in the ​neck and
the jaw​.

22 A newborn baby was diagnosed A. Failure of C. Absence of Eventration of diaphragm is a congenital https://www.
with eventration of the diaphragm. migration of musculature in one half anomaly consisting of​ failure of muscular ncbi.nlm.nih
In this condition, half of the diaphragm of the diaphragm development of part or all of one or both .gov/pmc/art
diaphragm ascends into the thorax B. Absence of hemidiaphragms. icles/PMC2
during inspiration, while the other pleuropericardia Clinically, eventration of diaphragm refers to 860415/
half contracts normally. What is the l fold an abnormal elevation of one leaf of an intact
cause of this condition? C. Absence of diaphragm as a result of paralysis, aplasia, or
musculature in atrophy of varying degrees of muscle fibers.
one half of the In some cases, it may be difficult or
diaphragm impossible to distinguish from diaphragmatic
D. Failure of the paralysis.
septum
 transversum to
develop

23 A 34 year old mother delivers her A. Chron’s C. Hirschprung Disease Megacolon (Hirschsprung’s disease) is BRS, Gross
second child, an 8 lb 1 oz baby Disease caused by the ​absence of enteric ganglia Anatomy,
boy. After 36 hours and several B. Ulcerative (cell bodies 7th Edition,
breastfeeding sessions, the baby Colitis of parasympathetic postganglionic fibers) in page 200
boy still has not passed meconium. C. Hirschsprung the lower part of the colon, which leads to
The next 12 hours, the boy’s Disease dilation of
abdomen grows noticeably larger, D. Imperforate the colon proximal to the inactive
he gains weight, and wets his Anus segment​. It is of congenital origin, results
diaper. The boy has active bowel from failure of neural crest cells to form the
sounds in the upper half his myenteric plexus, and is usually ​diagnosed
abdomen, but markedly fewer during infancy and childhood​; symptoms
after. Which one of the following is are ​constipation or diarrhea, abdominal
the MOST likely diagnosis of the distention, vomiting, and a lack of
congenital condition seen in this appetite​. However, the ​primary symptom ​is
newborn? not passing meconium​, the first bowel
movement of the newborn infant.

24 A 67 year old man with pancreatic A. Around each D. Around the celiac Sensory information from the pancreas is https://www.
adenocarcinoma in the head of the lateral trunk transmitted to the central nervous system pancreapedi
pancreas was taken to surgery. A epigastric fold (CNS) via both vagal and spinal pathways. a.org/review
PET-CT suggested metastases to B. At each Cell bodies of the spinal afferent pancreatic s/neural-con
both liver and multiple posterior intercostal neurons are located in the T6-L2 dorsal root trol-of-pancr
lymph nodes. The patient was nerve under ribs ganglia (DRG) and their axons traverse the eas
advised palliative surgery since the 6-8 splanchnic nerves and celiac plexus, before
cancer was already too far C. Around the they enter the pancreas. https://www.
advanced for removal. Ablation of coronary kenhub.com
the autonomic innervation, which ligament /en/library/a
 carries pain in this region, is D. Around the The innervation of the liver is governed by the natomy/bloo
performed to provide pain relief. celiac trunk hepatic nervous plexus which runs along the d-supply-an
The surgeon will inject 50% hepatic artery and portal vein. It receives d-innervatio
ethanol to kill nerve cells at which sympathetic fibers from the celiac plexus and n-of-the-live
one of the following location? parasympathetic fibers from the anterior and r
posterior vagal trunks.

25 A 65-year old presents with A. Blocked cystic A. Blocked cystic ​ iliary obstruction refers to blockage of the
B
jaundice of 2 to 3 weeks duration, duct duc​t bile duct system preventing bile from flowing https://www.
fatigue and increasing epigastric B. Viral hepatitis from the liver into the intestinal tract. Bile is ncbi.nlm.nih
pain. The pain does not relate to C. Portal synthesized in the liver and transported via .gov/books/
eating. He has pale stools, dark hypertension the bile ducts into the duodenum to assist NBK539698
urine, and elevated urinary and D. Blocked with the metabolism of fats. Bile is a /
serum conjugated bilirubin. CT duodenal substance produced continuously by the
scan reveals a suspicious mass in papilla hepatocytes consisting of bile salts, bilirubin,
the head of the pancreas adjacent fats, water, and inorganic salts. Bile formed in
to the descending duodenum. The the liver flows through the right and left
gallbladder is significantly hepatic ducts into the common hepatic duct.
enlarged. Nearly 50% of the bile flows into the cystic
Which of the following is the duct and is then stored in the gallbladder with
LIKELY cause of the elevated the rest of the bile flowing through the
bilirubin? common bile duct and converging and
flowing through the main pancreatic duct in
the head of the pancreas to empty into the
duodenum through the sphincter of Oddi.
Biliary obstruction can occur anywhere along
this path and lead to serious complications.
26 A 48-year old woman consulted a A. Ataxic ​B. Parkinson ​Patients with Parkinson’s disease have a Clinical
doctor with the upper torso slightly B. Parkinson characteristic flexed posture. A slow shuffling Neuroscienc
stooped forward, feet shuffle with C. Steppage gait is combined with reduced or absent arm e
loss of arm swing. Which of the D. Spastic swing and the hands are held in front of the 2014,
following is the LIKELY gait in this body.
Pages
patient?
163-179

27 Which of the following motor A. Knee D. Great toe extension- Patellar tendon reflex: a tap on the patellar BRS Gross
functions is correctly paired with extension-L1 L5 tendon elicits ​extension of the knee joint​. anatomy
the appropriate nerve root B. Hip adduction- Both afferent and efferent limbs of the reflex 7E. P91
innervation? L5 arc are in the ​femoral nerve (L2–L4)​. Clinical
C. Great toe The muscles in the medial compartment of anatomy by
flexion-L4 the thigh are collectively known as the ​hip Regions 9E.
D. Great toe adductors​. There are five muscles in this P464 (Table
extension- L5 group; gracilis, obturator externus, adductor 10.3)
brevis, adductor longus and adductor Clinical
magnus. All the medial thigh muscles are anatomy by
innervated by the ​obturator nerve (L2-L4)​, Regions 9E.
which arises from the lumbar plexus. Arterial P489
supply is via the obturator artery. Clinical
Flexor hallucis longus (Great Toe Flexion) anatomy by
Tibial nerve S2 and 3, ​flexes distal phalanx Regions 9E.
of big toe; plantar flexes foot at ankle joint; p484
supports medial longitudinal arch of foot
Extensor Hallucis longus (Great Toe
Extension)
 Deep peroneal nerve L5-S1 ​Extends big
toe; extends foot at ankle joint; inverts foot at
subtalar and transverse tarsal joints

28 A medical student was to A. Fingertips D. Medial edge Palmar surface of the finger and finger pads Seidel's
demonstrate palpation of the chest. B. Pads of the is more sensitive than the fingertips. The Guide to
Which is the MOST sensitive part finger ulnar surface of the hand and finger ​is the Physical
of the hand the student should use C. Wrist most sensitive area for distinguishing Examination
to vibration? D. Medial edge vibration. - E-Book:
An
Interprofessi
onal
Approach
p35

29 A bifid ureter or paired unilateral A. Metanephric B. Ureteric bud/ Bifid Ureter Clinical
ureters result from partial or mesoderm metanephric diverticulum In bifid ureter, the ureters may join in the anatomy by
complete division of which of the B. Ureteric bud/ lower third of their course, may open through Regions 9E.
following embryonic structures? metanephric a common orifice into the bladder, or may p213
diverticulum open independently into the bladder. In the
C. Mesonephric latter case, one ureter crosses its fellow and
duct may produce urinary obstruction. The cause
D. Paramesonephr of bifid ureter is a ​premature division of the
ic duct ureteric bud​. Cases of double pelvis and
double ureters may be found by chance on
radiologic investigation of the urinary tract.
They are more liable to become infected or to
be the seat of calculus formation than a
normal ureter.
30 A 7 year old girl has difficulty A. Lingual tonsil B. Pharyngeal tonsil ​Adenoids Clinical
breathing through her nose and is B. Pharyngeal Excessive hypertrophy of the lymphoid anatomy by
brought to her pediatrician. On tonsil tissue, usually associated with infection, Regions 9E.
examination, she is diagnosed with C. Tubal tonsil causes the ​pharyngeal tonsils ​to become p637
adenoids. Which of the following D. Palatine tonsil enlarged; they are then commonly referred to
tonsils is enlarged? as adenoids. Marked hypertrophy blocks the
posterior nasal openings and causes the
patient to snore loudly at night and to breathe
through the open mouth. The close
relationship of the infected lymphoid tissue to
the auditory tube may be the cause of
deafness and recurrent otitis media.
Adenoidectomy is the treatment of choice for
hypertrophied adenoids with infection. The
nasal part of the pharynx may be viewed
clinically by a mirror passed through the
mouth.

31 A 46 year old college football A. Pudendal nerve B. Pelvic splanchnic Parasympathetic preganglionic fibers in the BRS Gross
coach undergoes a radical B. Pelvic nerve pelvic splanchnic nerve​ are responsible for anatomy
prostatectomy for a malignant splanchnic erection of the penis. Sympathetic 7E. P293
tumor in his prostate. Following nerve preganglionic fibers in the sacral splanchnic
surgery, he is incapable of C. Sacral nerves are responsible for ejaculation. The
achieving an erection. Which of the splanchnic pudendal nerve supplies the external anal
following nerves MOST likely nerve sphincter and perineal muscles and supplies
damaged during surgery? D. Dorsal nerve of GSA fibers to the perineal region. The dorsal
the penis nerve of the penis is a terminal branch of the
pudendal nerve and supplies sensation of the
penis. The posterior scrotal nerves are
 superficial branches of the perineal nerve and
supply sensory fibers to the scrotum.

32 A 70-year old woman often A. Sternohyoid C. Oblique arytenoid and Oblique arytenoid is a paired intrinsic
consults for swallowing difficulties and aryepiglotic muscles laryngeal muscle. It is found on the anterior
and subsequent choking while Sternothyroid aspect of the larynx, cranial to the superior
eating food. Which of the following Muscles border of the cricoid cartilage. It is the more
pairs of muscles is MOST B. Levator veli superficial of the arytenoid muscles, with the
instrumental in preventing food palatini and transverse arytenoid muscle lying underneath
from entering the larynx and Tensor veli it.
trachea during swallowing? palatine
muscles The intrinsic laryngeal muscles are grouped
C. Oblique according to their main function. In that
arytenoid and manner, the oblique arytenoid muscle, along
aryepiglottic with the transverse arytenoid and posterior
muscles and lateral cricoarytenoid muscles, are
D. Inferior grouped together as muscles that alter the
pharyngeal position of the vocal cords (adduction and
constrictor and abduction), thus adjusting the dimensions of
thyrohyoid the rima glottidis. Oblique arytenoid also acts
muscles in combination with transverse arytenoid and
aryepiglottic to form the sphincter of the
laryngeal inlet, preventing food and liquid
from passing into the respiratory tract

33 A 7-day old baby is diagnosed as A. Endoderm C. Mesoderm The endoderm of the primitive foregut forms
having congenital neonatal B. Proctoderm the respiratory epithelium.
emphysema which is caused by C. Mesoderm
collapsed bronchi because of D. Ectoderm Splanchnopleuric layer of lateral plate
failure of bronchial cartilage mesoderm forms the connective tissue,
 development. Bronchial cartilages muscle, vasculature, and bronchial cartilage
are derived from which of the of the respiratory tract.
following derivations?
Neural crest cells of the ectoderm form the
laryngeal cartilage.

34 A 55-year old complains of fecal A. Coccygeus D. Pubococcygeus The levator ani muscle consists of the BRS Gross
incontinence. The most likely muscle muscle puborectalis, pubococcygeus, and Anatomy,
contributing factor to such a B. Iliococcygeus iliococcygeus. It supports and raises the 8th Edition;
problem is atrophy, paralysis, or muscle pelvic floor. The coccygeus also supports and Research
dysfunction of which of the C. Urogenital raises the pelvic floor. Articles
following structures? diaphragm
D. Pubococcygeus Defecation is initiated by distention of the
muscle rectum which has filled from the sigmoid
colon, and afferent impulses transmitted to
the spinal cord by the pelvic splanchnic
nerve.

Pubococcygeus and iliococcygeus contribute

to lateral pressure to narrow the levator
hiatus, and puborectalis muscle has a role in
maintaining continence. Impaired levator ani
contraction is strongly correlated with
severity of fecal incontinence.

Fecal continence relies on two systems: A

resistive and a capacitive system. The rectum
that is a reservoir for stool represents the
capacitive system. The resistive system is
made up of the anal sphincters and the
 pubococcygeus muscle that closes the anal
canal and maintains optimal intra abdominal
pressure.

35 A radiograph of a 34-year-old A. Left gastric C. Left Gastrepiploic The gastrolienal (gastrosplenic) ligament BRS Gross
woman reveals a perforation of the artery Artery extends from the left portion of the greater Anatomy,
stomach in which the gastric B. Gastroduodenal curvature of the stomach to the hilus of the 8th Edition
contents have spilled into the artery spleen and contains the short gastric and left
lesser sac. The general surgeon C. Left gastroepiploic vessels.
has opened the gastrosplenic gastroepiploic
artery. Which of the following artery
vessels is most likely involved? D. Right gastric
artery

36 A 17-year-old boy with a stab A. Superior ulnar C. Posterior humeral The posterior humeral circumflex artery BRS Gross
wound received multiple injuries on collateral circumflex anastomoses with the anterior circumflex Anatomy,
the upper part of the arm and B. Subscapular artery and an ascending branch of the 8th Edition
required surgery. If the brachial C. Posterior profunda brachii artery and also sends a
artery were ligated at its origin, humeral branch to the acromial rete.
which of the following arteries circumflex
would supply blood to the profunda D. Lateral thoracic The profunda brachii descends posteriorly
brachii artery? with the radial nerve and gives off an
ascending branch, which anastomoses with
the descending branch of the posterior
humeral circumflex artery.

37 During a domestic dispute, a A. Rhomboid C. Rhomboid major and The trapezius is solely innervated by the
17-year-old boy receives a deep minor and trapezius spinal accessory nerve, or cranial nerve XI,
stab wound around the superior latissimus dorsi which crosses the posterior cervical triangle
angle of the scapula near the
 medial border, which injures both B. Trapezius and superficially before diving vertically along the
the dorsal scapular and spinal serratus deep surface of the trapezius.
accessory nerves. Such an injury posterior
could result in paralysis or superior Both rhomboid muscles are innervated by the
weakness of which of the following C. Rhomboid dorsal scapular nerve, with its fibers
muscles? major and predominantly derived from the C5 nerve root
trapezius with minor contributions from C4 or C6.
D. Splenius
cervicis and Paralysis to the trapezius muscle, like
sternocleidoma serratus anterior paralysis, is primarily
stoid neurogenic, but from injuries to the spinal
accessory nerve. Similarly, rhomboid
paralysis tends to be primarily neurogenic in
nature, involving the dorsal scapular nerve.

38 A 39-year-old small business A. Postganglionic C. Preganglionic Sacral Splanchnic Nerves consist primarily of BRS Gross
manager sustained a gunshot sympathetic sympathetic fibers preganglionic sympathetic fibers that come Anatomy,
wound in the pelvic cavity, resulting fibers off the chain and synapse in the inferior 8th Edition
in a lesion of the sacral splanchnic B. Preganglionic hypogastric (pelvic) plexus.
nerves. Which of the following parasympatheti
nerve fibers would primarily be c fibers The only splanchnic nerves that carry
damaged? C. Preganglionic parasympathetic fibers are the pelvic
sympathetic splanchnic nerrves. All other splanchnic
fibers nerves are sympathetic.
D. Postganglionic
parasympatheti
c fibers

39 A 39 yo small business manager A. Postganglionic C. Preganglionic The sacral splanchnic nerves consist
sustained a gunshot wound in the sympathetic fibers sympathetic fibers primarily of preganglionic sympathetic
 pelvic cavity, resulting in a lesion of B. Preganglionic neurons and also contain GVA fibers. None
the sacral splanchnic nerves. parasympathetic fibers of the other fibers listed are contained in
Which of the ff nerve fibers would these nerves.
primarily be damaged? C. Preganglionic
sympathetic fibers

D. Postganglionic
parasympathetic fibers

40 A 17 yo girl is admitted to the A. Phrenic D. Vagus

hospital with severe dyspnea. PE
reveals that the patient is suffering B. Greater thoracic
from an asthma attack, with splanchic
associated bronchospasm. Which
C. Intercostal
of the ff nerves is responsible for
the innervation of the bronchial
D. Vagus
smooth muscle cells?

41 A 42 yo female patient has been A. Pectoralis minor B. Elastic tissue in the ​ ormal, quiet expiration is achieved by
N ​ RS
B
lying down on the hospital bed for muscle lungs and thoracic wall contraction of extensible tissue in the lungs Anatomy-Th
more than 4 months. Her normal and the thoracic wall. The serratus posterior orax
quiet expiration is achieved by B. Elastic tissue in the superior muscles, diaphragm, pec- toralis
contraction of which of the ff lungs and thoracic wall major, and serratus anterior are muscles of
structures? inspiration.
C. Serratus posterior
superior muscles
 D. Serratus anterior
muscle

42 A 53 yo man presented with A. Primary lateral C. Progressive spinal

symmetrical wasting of the intrinsic sclerosis muscular atrophy
hand muscle, slowly progressing to
more proximal muscle of the arms; B. Progressive bulbar Not sure
diminished or absent tendon palsy
reflexes. Given the signs and
C. Progressive spinal
symptoms, which is the LIKELY
muscular atrophy
disorder?
D. Amyotrophic lateral
sclerosis

43 A 26 yo cardiac patient with an A. over the medial end B. in the left fifth ICS at Aortic valve - 2nd ICS, right sternal edge
irregular heartbeat consulted a of the second left ICS the midclavicular line Pulmonic valve - 2nd ICS, left sternal edge
doctor. To listen to the sound of Tricuspid valve- 4th-5th ICS, left sternal edge
the mitral valve, the doctor should B. in the left fifth ICS at Mitral valve - 5th ICS, MCL
place the stethoscope ___ the midclavicular line

C. in the left 4​th​ ICS at

the midclavicular line

D. over the medial end

of the second right ICS
44 A pituitary adenoma is likely to A. Diabetes insipidus C. Cushing syndrome Pituitary adenomas are anterior pituitary
result in which one of the ff? specific. a corticotroph-adenoma would
B. Deficiency in T3 and cause increased levels of acth and stimulate
T4 excessive production of corticosteroids from
the adrenal cortex (cushing's syndrome). LH
C. Cushing syndrome
and FSH-producing gonadotrophs occur but
tend to result in hypogonadism. somatotropic
D. Stunted growth or
tumors produce GH and cause giantism.
dwarfism
prolactinomas are the most common form of
pituitary adenoma resulting in infertility,
galactorrhea, and amenorrhea. diabetes
insipidus is caused by absence of
vasopressin, leading to excretion of a large
quantity of dilute fluid (hypotonic polyuria).
overproduction of PTH leads to osteoporotic
changes, but PTH is not regulated by the
anterior pituitary.

45 A 33yo man with a perforated A. White rami B. Lower intercostal P​ain sensation originating from peritoneal
gastric ulcer complains of communicantes nerves irritation by gastric contents in the lesser sac
excruciating pain in his stomach. It is carried by lower intercostals nerves. The
is observed that the pain comes B. Lower intercostal vagus nerves carry sensory fibers associated
from peritoneal irritation by gastric nerves with reflexes in the GI tract. The greater
contents in the lesser sac. Which splanchnic nerves and white rami
C. Greater splanchnic
of the ff nerves contain sensory cornmunicantes carry pain (general visceral
nerves
nerve fibers that convey this sharp, afferent) fibers from the wall of the stomach
stabbing pain? and other areas of the gi tract. the gray rami
D. Gray rami
communicantes contains no sensory fibers
communicantes
but contain sympathetic postganglionic fibers.
46 Bong is a 6-year-old complaining a. Sarcoidosis C. Acute lymphadenitis Painful and acute enlarged nodes suggest a Robbins
of worsening pain in the right side b. Follicular reactive condition and not a neoplastic and Cotran
of his groin for the past week. lymphoma process such as a lymphoma or a leukemia. Review of
Physical examination shows c. Acute In children, enlarged tender nodes and acute Pathology
painful, swollen lymph nodes in the lymphadenitis lymphadenitis are common. Many infectious 4th ed
right inguinal region. An inguinal d. Cat-scratch processes can Chapter 13
lymph node biopsy is performed, disease give rise to these findings, particularly
and on microscopy the node has bacterial infections. Children are “antigen
large, variably sized, germinal sponges” when exposed to the usual minor
centers containing numerous infections; they are quite active and acquire
mitotic figures. There are plenty of cuts and scrapes on extremities,
numerous parafollicular and which can become infected, with reactive
sinusoidal neutrophils. What is the hyperplasia of regional nodes. Cat-scratch
MOST likely cause of these disease can produce sarcoidlike granulomas
histologic changes? with stellate abscesses.
Follicular lymphomas are B-cell neoplasms
that efface the normal architecture of the
lymph nodes; these tumors do not occur in
children. Sarcoidosis is a chronic
granulomatous process typically seen in
adults and characterized by the formation of
noncaseating granulomas.

47 A 10-year-old boy with atrial septal a. Small cardiac C. Anterior cardiac vein Anterior Cardiac Vein BRS Gross
defect presents to a pediatrician. vein ■ Drains the anterior right ventricle, crosses Anatomy
This congenital heart defect shunts b. Middle cardiac the coronary groove, and ends directly in the 7th ed.
blood from the left atrium to the vein right atrium.
right atrium and causes c. Anterior cardiac Middle Cardiac Vein
hypertrophy of the right atrium, vein
right ventricle, and pulmonary
trunk. Which of the following veins d. Oblique cardiac ■ Begins at the apex of the heart and
opens into the hypertrophied vein ascends in the posterior IV groove,
atrium? accompanying
the posterior IV branch of the right coronary
artery.
■ Drains into the right end of the coronary
sinus.
Small Cardiac Vein
■ Runs along the right margin of the heart in
company with the marginal artery and then
posteriorly in the coronary sulcus to end in
the right end of the coronary sinus.
Oblique Vein of the Left Atrium
■ Descends to empty into the coronary sinus,
near its left end.
48 A patient is rushed to the a. Left and right B. Inferior and superficial Important Portal–Caval (Systemic) BRS Gross
operating room for an emergent gastric vein epigastric veins Anastomoses Anatomy
cholecystectomy because of b. Inferior and ■ These structures are located between: 7th ed.
cholecystitis. While locating superficial 1. The left gastric vein and the esophageal
landmarks before surgical epigastric veins vein of the azygos system.
resection of an infected c. Superior and 2. The superior rectal vein and the middle
gallbladder, the surgeon recalls a middle rectal and inferior rectal veins.
porto-caval anastomosis. Which of vein 3. The paraumbilical veins and radicles of the
the following pairs of veins form a d. Suprarenal and epigastric (superficial and inferior) veins.
porto-caval anastomosis? renal veins 4. The retroperitoneal veins draining the
colon and twigs of the renal, suprarenal, and
gonadal veins.

49 A possible malignant mass from a. Ductus C. Left umbilical vein Round ligament - Ligament that contains Netters
the liver of a neonate with cerebral arteriosus obliterated umbilical vein Clinical
palsy was resected. The pediatric b. Ductus venosus Anatomy,
surgeon divides the round ligament c. Left umbilical BRS Gross
of the liver during surgery. A vein Anatomy
fibrous remnant of which of the d. Right umbilical 7th ed.
following fetal vessels is severed? vein

round ligament (ligamentum teres hepatis),

located between the lateral portion of the left
lobe and the quadrate lobe.
 (Embryology) The two umbilical veins convey
oxygenated blood from the placenta to the
fetus. The right vein soon disappears.

50 A 42-year-old woman visits the a. The urethra is D. The urethra is much The short length of the female urethra Snell
outpatient clinic due to painful located within shorter in females predisposes to ascending infection; Clinical
urination. A dipstick test reveals the vagina. consequently, cystitis is more common in Anatomy
leukocytosis, which confirms the b. The seminal females than in males.
diagnosis of urinary tract infection. vesicles The female urethra is about 1.5 in. (3.8 cm)
Which of the following is the BEST produce fluid long. It extends from the neck of the bladder
anatomic explanation for the fact resistant to to the external meatus, where it opens into
that women are more susceptible bacteria. the vestibule about 1 in. (2.5 cm) below the
to UTI than men? c. The prostate clitoris.
gland produces
antibacterial
prostatic fluids.
d. The urethra is
much shorter in
females

51 A 64-year-old man presents with a. Esophagus and C. Azygos vein and BRS Gross
back pain, weakness, and vagus nerve thoracic duct Anatomy
shortness of breath. On b. Thoracic duct 7th ed.
examination, he has an aneurysm and vagus
of the abdominal aorta at the aortic nerve Picture:
hiatus of the diaphragm. Which of c. Azygos vein internet
the following pairs of structures and thoracic
would MOST likely be duct
compressed? d. Vagus nerve
and azygos vein
 Aortic Hiatus - lies behind or between two
crura at the level of T12 and transmits the
aorta, thoracic
duct, azygos vein, and occasionally greater
splanchnic nerve.

52 A 25-year-old man undergoing a. Toxoplasma B. Strongyloides The eosinophilia suggests a parasitic Robbins
chemotherapy for acute gondii stercoralis infestation. and Cotran
lymphoblastic leukemia developed b. Strongyloides Immunocompromised individuals can have Review of
fever and abdominal pain within stercoralis superinfection and dissemination with Pathology
the past week. He now has a c. Cryptococcus strongyloidiasis. Type 1 hypersensitivity with 4th ed
severe cough. Temperature is neoformans allergic reactions may also be accompanied Chapter 13
38.4°C. Crackles are heard over all d. Pseudomonas by
lung fields. Lab studies show aeruginosa eosinophilia. The other organisms listed are
hemoglobin, 12.8 g/dL; hematocrit not known to be associated with eosinophilia.
39; MCV 90 µm​3​, platelet 221,000
mm​3​, and WBC count 16,475 mm​3​,
with 51% segmented neutrophils,
5% bands, 18% lymphocytes, 8%
monocytes, and 18% eosinophils.
Infection with which of the following
organisms is MOST likely to be
complicating the course of this
patient’s disease?

53 A 32-year-old woman has A. Left Trigeminal D. Right Vagus Nerve The vagus nerve innervates the musculus BRS Ana,
hoarseness in her voice, and her Nerve uvulae. A lesion of the vagus nerve causes 6th ed. Pg.
uvula is deviated to the left on B. Right deviation of the uvula toward the opposite 442
phonation. Which of the following Trigeminal side of the injury. Because her uvula deviates
nerves is damaged? Nerve to the left on phonation, the right vagus nerve
 C. Left Vagus is damaged. Hoarseness is caused by a
Nerve paralysis of the laryngeal muscles resulting
D. Right Vagus from damage to skeletal motor fibers in the
Nerve recurrent laryngeal branch of the vagus
nerve.

54 Measuring T3 levels does not A. T3 and T4 are

necessarily accurately depict the regulated by
thyroid’s ability to secrete T3 for two different
which one of the following anterior pituitary
reasons? hormones
B. T4 and T3
immunoassays
cross-react in
immunoassays
C. T3 is bound to
thyroid-hormon
e binding
proteins
D. The liver and
kidneys convert
T3 to T4
peripherally

55 A 47-year old man cannot move A. Tumor of the B. Infection in the Important Structures Associated with the Snell 9th ed,
his eye laterally. Which of the pituitary gland cavernous sinus Cavernous Sinuses: pg 544
following conditions would cause B. Infection in the ● The internal carotid artery and the ​6th
this inability to move eye? cavernous sinus cranial nerve​, which travel through it Snell 9th ed,
● In the lateral wall, the ​3rd and 4th pg 551,
cranial nerves​, and the ophthalmic table 11.2
 C. Occlusion of the and maxillary divisions of the 5th
posterior cranial nerve
cerebral artery ● The pituitary gland, which lies
D. Infection in the medially in the sella turcica
maxillary sinus ● The veins of the face, which are
connected with the cavernous sinus
via the facial vein and inferior
ophthalmic vein, are an important
route for the spread of infection from
the face
● The superior and inferior petrosal
sinuses, which run along the upper
and lower borders of the petrous part
of the temporal bone

56 A 60-year-old heavy smoker has A. Hemizygous C. Azygous vein The bronchi, the connective tissue of the Snell 9th
an advanced lung cancer that vein lung, and the visceral pleura receive their ed, pg. 75
spread into her right third B. Right superior blood supply from the bronchial arteries,
intercostal space posterior to the intercostal vein which are branches of the descending aorta.
midaxillary line. If cancer cells are C. Azygous vein The bronchial veins (which communicate Snell 9th ed,
carried in the venous drainage, D. Right with the pulmonary veins) drain into the pg 42
they would travel first to which of brachiocephalic azygos and hemiazygos veins.​ The alveoli fig. 2.11
the following veins? vein receive deoxygenated blood from the
terminal branches of the pulmonary arteries.
The oxygenated blood leaving the alveolar
capillaries drains into the tributaries of the
pulmonary veins, which follow the
intersegmental connective tissue septa to the
lung root. Two pulmonary veins leave each
lung root to empty into the left atrium of the
heart.
57 A 37-year-old patient has an A. Straight sinus B. Cavernous Sinus The dural venous sinus nearest the pituitary BRS Ana
infectious inflammation of the dural B. Sigmoid sinus gland is the cavernous sinus. Cavernous 8th, pg. 446
venous sinus closest to the C. Superior sinus thrombophlebitis is an infectious
pituitary gland and a secondary petrosal sinus inflammation of the sinus that may produce
thrombus formation. Which of the D. Cavernous meningitis, papilledema, exophthalmos, and
following is the MOST likely site of sinus ophthalmoplegia. The other sinuses listed are
infection?
 not closely associated with the pituitary
gland.

58 A 28-year-old man presents to the A. Flexion of the

ER after a high-speed motor distal
vehicle accident. Neurologic exam interphalangeal
showed the lowest functioning joints is intact;
neurologic level is C5. Which is the finger adduction
LIKELY finding in this patient given and abduction
the neurologic assessment level? is not functional
B. Sensation is
intact over and
just inferior to
the clavicle;
sensation is not
intact over the
lateral aspect of
the shoulder
and deltoid
region
C. Deltoid and
biceps motor
function is
intact; extensor
carpi radialis
longus and
brevis muscles
are not
functional
 D. The anal
sphincter is
flaccid when the
glans penis is
squeezed

59 A 35-year-old woman is admitted A. Renal vein

to the ER with severe left B. Common Iliac
abdominal and back pain. Artery
Radiographic evaluation reveals C. Gonadal artery
that the left ureter is blocked with a D. Inferior
kidney stone. Because the ureter is epigastric artery
completely obstructed, an
emergency surgical procedure
must be performed. The MOST
reliable landmark for the
identification of the ureter is that
the left ureter is anterior to the
left_____.

60 A 56-year old woman was a. Lesion of the C. Lesion of the optic Bitemporal hemianopia ​is a loss of the Clinical
diagnosed with bitemporal calcarine cortex chiasm lateral halves of the fields of vision of both Anatomy by
hemianopia. Where is the lesion of b. Lesion of the tip of eyes (i.e., loss of function of the medial half Regions, 9​th
this visual field defect? an occipital lobe of both retinas). This condition is most Edition,
c. Lesion of the optic commonly produced by a tumor of the Page 77
chiasm pituitary gland exerting pressure on the optic
d. Lesion behind the chiasma.
optic chiasm
61 Sympathectomy may occasionally a. The descending D. Lumbar splanchnic a. The descending colon receives its (https://teac
relieve intractable pain of visceral colon receives its from L1, L2, L3 only sympathetic innervation from ​thoracic hmeanatom
origin, since visceral afferent pain sympathetic innervation innervate the pelvic splanchnic nerves.- ​Lumbar splanchnic y.info/abdo
fibers run along the sympathetic from thoracic viscera via the nerves men/gi-tract/
pathways in the abdomen. The splanchnic nerves. hypogastric nerve colon/)
autonomic control of peristalsis in b. The descending b. The descending colon receives its
the descending colon should not colon receives its parasympathetic innervation from the ​vagus
be affected by bilateral lumbar parasympathetic ​ elvic splanchnic nerves
nerve​. – P
sympathectomy for which of the innervation from the
following reasons? vagus nerve. c. The descending colon is controlled ​chiefly
c. The descending by parasympathetic innervation from the
colon is controlled pelvic splanchnic nerves-
chiefly by The descending colon is controlled both by
parasympathetic parasympathetic and sympathetic
innervation from the innervations
pelvic splanchnic
nerves
d. Lumbar splanchnic
from L1, L2, L3 only
innervate the pelvic
viscera via the
hypogastric nerve

62 A 38-year-old man has fever with a. Splenomegaly A. Splenomegaly The major laboratory abnormalities (Harrison’s
chills and rigors for the last 2 b. Glucocorticoid accompanying splenomegaly are determined Principle of
weeks. Temperature is 39.2 ͦC. therapy by the underlying systemic illness. Internal
CBC shows haemoglobin, 13.9 c. Acute viral hepatitis Erythrocyte counts may be normal, Medicine,
g/dl; haematocrit, 40.5; MCV, 93 d. Lung abscess decreased (thalassemia major syndromes, 20​th​ Edition.
um3; platelet count 210,000/mm3; SLE, cirrhosis with portal hypertension), or Page 416)
and WBC count, 13,750/mm3. A increased (polycythemia vera).Granulocyte
 bone marrow biopsy specimen counts may be normal, decreased (Felty’s
shows hypercellularity. Which of syndrome,congestive splenomegaly,
the following is MOST likely to leukemias), or increased (infections or
cause these findings? inflammatory disease, myeloproliferative
disorders). Similarly, the platelet count may
be normal, decreased when there is
enhanced sequestration or destruction of
platelets in an enlarged spleen (congestive
splenomegaly, Gaucher’s disease, immune
thrombocytopenia),or increased in the
myeloproliferative disorders such as
polycythemia vera.

The CBC may reveal cytopenia of one or

more blood cell types, which should suggest
hypersplenism.​ This condition is
characterized by splenomegaly, cytopenia(s),
normal or hyperplastic bone marrow, and a
response to splenectomy.

63 An 18-year-old girl is thrust into the a. External intercostal B. Muscles of the Quiet expiration is largely a passive ( Clinical
steering wheel while driving and muscle abdominal wall phenomenon and is brought about by the Anatomy by
experiences difficulty in expiration. b. Muscles of the elastic recoil of the lungs, the relaxation Regions, 9​th
Which of the following muscles is abdominal wall of the intercostal muscles and diaphragm, Edition,
MOST likely damaged? c. Levator costarum and an increase in tone of the muscles of the Page 77)
d. Innermost intercostal anterior abdominal wall, which forces the
muscle relaxing diaphragm upward.
64 A 38-year-old man infected with a. Cytomegalovirus D. Epstein-Barr virus This HIV-positive patient has an extranodal (Robins and
HIV for the past 10 years is b. Human T-cell infiltrative mass, composed of B cells Cotran
admitted to the hospital with lymphotropic virus type (CD19+), in the ileum. This is a diffuse Review of
abdominal pain for 3 days duration. 1 large-cell lymphoma of B cells. These tumors Pathology,
PE shows abdominal distention c. Human herpes virus contain the Epstein-Barr virus (EBV) genome, 4​th​ edition,
and absent bowel sounds. An 8 and it is thought that immunosuppression Page 186
abdominal CT scan shows a mass d. Epstein-Barr virus allows unregulated proliferation and and 198)
lesion involving the ileum. He neoplastic transformation of EBV-infected B
undergoes surgery to remove an cells. Cytomegalovirus is not known to cause
area of bowel obstruction in the any tumors. HIV is not seen in normal or
ileum. Gross examination of the neoplastic B cells. Human herpesvirus 8 (also
specimen shows a form, white called ​Kaposi sarcoma herpesvirus)​ is found
mass, 10 cm long and 3 cm at its in the spindle cells of Kaposi sarcoma and in
greatest depth. The mass has body cavity B-cell lymphomas in patients with
infiltrated through the wall of the AIDS. Human T-cell leukemia/lymphoma
ileum. Histologic studies show a virus type 1 is related to HIV-1, and it causes
mitotically active population of adult T-cell leukemia/lymphoma.
CD19+ lymphoid cells with
prominent nuclei and nucleoli.
Molecular analysis is MOST likely
to show which of the following viral
genomes in the lymphoid cells?

65 A 58-year-old man is admitted due a. Left colic B. Superior mesenteric The left renal vein courses between the aorta (​www.medd
to left flank pain. Blood exam b. Superior mesenteric and superior mesenteric artery to join the ean.luc.edu​)
indicates hematuria and anemia. c. Inferior mesenteric inferior vena cava
MRI reveals that blood flow in the d. Celiac
left renal vein is being occluded by
 an arterial aneurysm where the
vein crosses the aorta. The
aneurysm is MOST likely located in
which artery?

66 66. A 60-year-old man is a. Prostatic utricle B. Prostatic sinus Ducts from the prostate gland open into the (BRS Gross
diagnosed with prostate cancer b. Prostatic sinus prostatic sinus, which is a Anatomy 7​th
following a digital rectal c. Seminal colliculus groove on either side of the urethral crest. edition,
examination. For the resection of d. Spongy urethra The prostate gland receives the ejaculatory Page 291)
prostate cancer, it is important to duct, which opens into the prostatic urethra
know that the prostatic ducts open on the seminal colliculus (a prominent
into or on which of the following elevation
structures? of the urethral crest) just lateral to the
prostatic utricle, which is a small blind pouch.
The bulbourethral gland lies on the lateral
side of the membranous urethra within the
deep perineal space, but its duct opens into
the bulbous portion of the spongy (penile)
urethra.

67 A patient bleeding from the A. Circumflex scapular ​B. Dorsal scapular Branches of the subclavian artery involved in BRS Gross
shoulder secondary to a knife artery artery the shoulder anastomosis include: (1) Ana 6th ed
wound is in fair condition because suprascapular artery and (2) dorsal scapular p 51
there is vascular anastomosis B​. Dorsal scapular or descending scapular artery.
around the shoulder. Which of the artery
following arteries is most likely a Suprascapular artery is a branch of the
C. Suprascapular thyrocervical trunk, passes over the superior
direct branch of the subclavian
artery transverse scapular ligament, anastomoses
artery that is involved in the
anastomosis? with the deep branch of the transverse
cervical artery (​dorsal scapular artery​) and
 D. Thoracoacromial the circumflex scapular artery around the
artery scapula, providing collateral circulation.

Dorsal scapular artery or descending

scapular artery ​arises from subclavian
artery​ but may be a deep branch of the
transverse cervical artery (question asked
about which is most likely a ​DIRECT​ branch
of subclavian artery)

68 A 22-year old man has a a. Membranous part of ​c.​ Bulb of the penis The ​superficial perineal space (pouch)​ lies BRS Gross
gonorrheal infection that has the male urethra between the inferior fascia of the urogenital Ana 6th ed
infiltrated the space between the diaphragm and superficial perineal fascia. p 279
 inferior fascia of the urogenital
diaphragm and the superficial b. Bulbourethral glands The superficial perineal space contains (1)
perineal fascia. Which of the perineal muscles, (2) the crus of the penis or
c.​ Bulb of the penis
following structures might be clitoris, (3) ​the bulb of the penis or
inflamed? vestibule​, (4) the central tendon of the
d. Deep transverse
perineum, (5) the greater vestibular glands in
perineal muscle
the female, (6) branches of the internal
pedundal vessels, and (7) the pudendal
nerve

69 A 63-year old man presents with a. Sternum c. ​Iliac crest The most common ​site​ for a ​bone marrow Snell’s
splenomegaly, lymphadenopathy, b. Scapula biopsy​ is the posterior iliac crest. Clinical
persistent fever, night sweats, and c. ​Iliac crest Anatomy
weight loss. Bone marrow d. Humerus The sternum is a common site for bone 9th ed
aspiration and biopsy are marrow biopsy because it possesses
scheduled. The BEST place to take hematopoietic marrow throughout life and
because of its breadth and subcutaneous
 a sample bone marrow is in the position.-BRS Gross Ana… ​BUT​ ​sternal
___? aspiration should not be attempted in patients
suspected with plasma cell myeloma or other
disorders associated with bone resorption.
Also, sternal aspiration is avoided since it
causes more pain and presents the risk for
heart injury.

70 A 47-year old woman is admitted a. Intercostal ​d. ​ Greater Visceral afferent pain fibers from the Snell’s
due to sharp and constant splanchnic gallbladder travel through the ​celiac plexus, Clinical
abdominal pain, beginning in the b. Vagus hence along the greater splanchnic Anatomy
epigastric region and radiated nerves to levels T5 to T9​ of the spinal cord. 9th ed
c. Phrenic
bilaterally around the chest to just Thus, pain originating from the gallbladder
below the scapulae. The pain later will be referred to the dermatomes served by
d. ​ Greater
became localized in the right T5 to T9, which include a band from the
splanchnic
hypochondrium. Similar but milder infrascapular region to the epigastrium​.
attacks were noted after hearty
meals, is moderately overweight.
PE showed marked tenderness in Parietal pain would be localized to the right
the right hypochondriac region and hypochondriac region (below the ribs where
some rigidity of the abdominal the gallbladder is located) by intercostals and
musculature. An x-ray without can also be referred to the right shoulder via
contrast medium shows numerous the phrenic nerve.
calcified stones in the region of the
gallbladder. There was no sign of
jaundice. Diffuse pain referred to
the epigastric region and radiating
circumferentially around the chest
is the result of afferent fibers that
 travel via which of the following
nerves?

71 During a snowstorm, a 53-year old a. Herniated disc ​d. ​ Whiplash injury Whiplash injury of the neck: is produced by a BRS Gross
man sustained multiple car force that drives the trunk forward while the Ana p 297
accident. Which of the following b. Hangmans head lags behind, causing ​the head (with
conditions is produced by a force fracture the upper part of the neck) to hyperextend
that drives the trunk forward while and the lower part of the neck to hyperflex
c.
the head lags behind in a rear-end rapidly​ , as occurs in rear-end automobile
Meningomyelocele
automobile collision? collisions. This injury occurs frequently at the
junction of vertebrae C4 and C5​; thus,
d. ​Whiplash injury
vertebrae C1 to C4 act as the lash, and
vertebrae C5 to C7 act as the handle of the
whip. It results in neck pain, stiff neck, and
headache and can be treated by supporting
the head and neck using a cervical collar that
is higher in the back than in the front; the
collar keeps the cervical vertebral column in a
flexed position.

72 A 43-year old man has new onset a. Ansa cervicalis c. ​ Facial nerve In the suprahyoid muscles, the ​stylohyoid BRS Gross
of difficulty with speaking. and digastric posterior belly​ are innervated Ana 6th ed
Examination by the ENT resident b. Accessory nerve by ​the facial nerve​, whereas the ​mylohyoid p710
reveals problems in elevating the and digastric anterior belly are innervated by
c. ​ Facial nerve
hyoid bone and floor of the mouth, the trigeminal nerve​, and the ​geniohyoid is
secondary to paralysis of the innervated by C1 through the hypoglossal
d. Trigeminal nerve
posterior belly of the digastric nerve​.
 muscle. Which of the following
nerves is MOST likely involved?

73 A 54-year old man is admitted to a. Oculomotor ​c. ​Abducens nerve Abducens nerve is beside the internal carotid Snell’s
the hospital due to severe nerve artery INSIDE THE CAVERNOUS SINUS Clinical
headaches. CT examination and would be affected first by the aneurysm Anatomy
reveals an internal carotid artery b. Ophthalmic 9th ed
aneurysm inside the cavernous nerve
sinus. Which of the following
c. ​Abducens
nerves would typically be affected
nerve
first?
d. Maxillary nerve

74 A 5 year old boy with breathing a. Alveolar duct a. Terminal bronchioles Cystic fibrosis (CF) is an autosomal recessive BRS
difficulty, chest pain, and cough b. Terminal exocrinopathy affecting multiple epithelial
was admitted to a local hospital. bronchioles tissues. The gene product responsible for CF
The pediatrician who examined the c. Secondary or (the
boy, along with laboratory results, lobar bronchi cystic fibrosis transmembrane conductance
diagnosed the child as having d. Primary regulator [CFTR]) serves as an anion channel
cystic fibrosis. Which of the bronchus in the apical (luminal) plasma membranes of
following structures is MOST epithelial cells and regulates volume and
probably blocked? composition of exocrine secretion. It affects
the respiratory system by causing an excess
production of viscous mucus by the bronchial
glands, followed by mucous plugging and
obstruction of the respiratory airway,
particularly a small airway, such as that in a
child. The alveolar duct is a part of respiratory
units. The other structures are not affected
because they are large airways and are not
usually obstructed and thus not help in
making the diagnosis.
75 A 46 year old woman presented a. Spastic D. Steppage gait Foot drop​ - defined as a significant stanfordmed
with the drop foot with the affected b. Parkinsonian weakness of ankle and toe dorsiflexion. The icine25.stan
limb lifted higher than normal. c. Ataxic foot and ankle dorsiflexors include the tibialis ford.edu/the
Which of the following is the likely d. Steppage anterior, the extensor hallucis longus (EHL), 25/gait.html
and the extensor digitorum longus (EDL).
gait in this patient?
These muscles help the body clear the foot
during swing phase and control plantarflexion
of the foot on heel strike. Weakness in this
group of muscles results in an equinovarus
deformity. This is sometimes referred to as
steppage gait, because the patient tends to
walk with an exaggerated flexion of the hip
and knee to prevent the toes from catching
on the ground during swing phase. During
gait, the force of heel strike exceeds body
weight, and the direction of the ground
reaction vector passes behind the ankle and
knee center. Foot drop can be associated
with a variety of conditions, including
dorsiflexor injuries, peripheral nerve injuries,
stroke, neuropathies, drug toxicities, or
diabetes.

Ataxic gait​ - cerebellar disease, clumsy,

staggering movements with a wide-based
gait. While standing still, the patient's body
may swagger back and forth and from side to
side, known as titubation, not be able to walk
from heel to toe or in a straight line.
Parkinsonian Gait​ - the patient will have
rigidity and bradykinesia, will be stooped with
the head and neck forward, with flexion at the
knees. The whole upper extremity is also in
 flexion with the fingers usually extended,
walks with slow little steps known at ​marche
a petits​ ​pas​ (walk of little steps), may have
difficulty initiating steps, involuntary
inclination to take accelerating steps, known
as festination.
Spastic Gait ​- common to patients with
cerebral palsy or multiple sclerosis, is a way
of walking in which one leg is stiff and drags
in a semicircular motion on the side most
affected by long-term muscle contraction.

76 During the physical examination of a. Andorgen B. Defect in cortisol Androgen insensitivity - Loss-of-function Uptodate
newborn child, it is observed that insensitivity pathway mutations of the gene that encodes the medscape
the genitalia are female, but b. Defect in androgen receptor (AR) result in androgen
musculinized. The genotype is cortisol pathway insensitivity syndrome (AIS) in 46,XY
determined to be 46,xx. Which one c. Atrophy of the individuals with functional testes and
of the following is the MOST likely zona reticularis unhindered testosterone formation.
cause of this condition? d. Decreased Defect in cortisol pathway - ​Congenital
blood ACTH adrenal hyperplasia (CAH) is a general term
levels used to describe a group of inherited
disorders in which a defect in cortisol
biosynthesis is present with consequent
overproduction of adrenocorticotropic
hormone (ACTH) and secondary adrenal
hyperplasia as a consequence. An enzymatic
defect in 11-beta-hydroxylase is the second
most common variant of CAH. Patients with
11-beta-hydroxylase deficiency present with
 features of androgen excess, including
masculinization of female newborns and
precocious puberty in male children.
Approximately two thirds of patients also
have hypertension, which may or may not be
associated with mineralocorticoid excess,
hypokalemia, and metabolic alkalosis. It is
also associated with compromised adult
height.

77 A 16 years old boy suffers a a. Left internal C. Left renal vein A tender swollen left testis may be produced BRS
traumatic groin injury during a pudendal vein by thrombosis in the left renal vein because
soccer match. The urologist b. Inferior vena the left testicular vein drains into the left renal
notices tenderness and swelling of cava vein. The right testicular vein drains into the
the boy’s left testicle that may c. Left renal vein inferior vena cava. The left internal pudendal
produce by thrombosis in which of d. Left inferior vein empties into the left internal iliac vein.
the following veins? epigastric vein The left inferior epigastric vein drains into the
left external iliac vein, and the left external
pudendal vein empties into the femoral vein.

78 A 25 year old man falls from his a. Facial nerve C. vagus nerve Bilateral severance of the vagus nerve (CN BRS
motorcycle and lands in a creek. b. Trigeminal X) causes a loss of reflex control of
Death may result from bilateral nerve circulation because of an increase in heart
severance of which of the following c. Vagus nerve rate and blood pressure; poor digestion
nerves? d. Spinal results because of decreased gastrointestinal
accessory motility and secretion; and difficulty in
nerve swallowing, speaking, and breathing occurs
 because of paralysis of laryngeal and
pharyngeal
muscles. All of these effects may result in
death. Bilateral severance of other nerves
does
not cause death.

79 A 45 year old woman presented a. Amyotrophic B. Progressive spinal Harrisons

with symmetrical weakness and lateral sclerosis muscular atrophy
atrophy of the pelvic girdle and b. Progressive
proximal leg muscle; later spinal muscular
involvement of the shoulder girdle atrophy
and upper arm muscle; finally, c. Chronic
involvement of the distal limbs and proximal
absence of tendon reflex. Given progressive
the signs and symptoms, which is spinal muscular
the likely disorder? atrophy
d. Primary lateral
sclerosis

80 A 58 year old female employee of a. Patellar D. Prepatellar bursa Excessive compression of the prepatellar Gray’s
a housecleaning business visits the retinacula bursa, as in working on bended knees, can anatomy
outpatient clinic with complaint of b. Infrapatellar result in pain and swelling of the prepatellar
constant, burning pain in her bursa bursa, the so-called housemaid’s knee.
knees. Clinical examinations reveal c. Lateral Prepatellar bursitis affects plumbers, carpet
a “housemaid’s knee” condition. meniscus layers, and other people who spend a lot of
time on their knees. The bursa normally
 Which of the following structures is d. Prepatellar enables the patella to move smoothly under
Most likely affected bursa the skin. The constant friction of these
occupations irritates this small lubricating sac
(bursa) located just in front of the patella,
resulting in a deformable tense cushion of
fluid. Treatment usually requires simple
drainage, but this may need to be repeated
and occasionally steroids introduced.

Excessive irritation of the infrapatellar bursa

in kneeling for frequent and long periods of
time (as in prayer) can result in “parson’s
knee.” The posterior cruciate ligament of the
knee can be injured in sudden, strong flexion
of the knee, with posterior displacement of
the tibia upon the femur.
The patellar retinacula are strong, tendinous
bands of tissue that join the quadriceps
tendon to the vastus lateralis and medialis
muscles.

The lateral meniscus is a cartilaginous

structure between the lateral condyles of the
femur and tibia

81 Coronary angiographs of a A. Right and Left D. Left Atrium and The Circumflex Artery winds around the left Snell 10th
43-year old male patient reveal an Ventricles Ventricles margin of the heart in the atrioventricular ed
occlusion of the circumflex branch B. Right Atria and Left groove.
of the left coronary. This patient Atria
has been suffering from myocardial
infarction in which of the following C. Interventricular
areas? Septum A. Right and Left Ventricles – Left anterior
D. Left Atrium and Descending Artery, Posterior interventricular
Ventricles Artery

B. Right Atria – RCA

Left Atria – Left Circumflex Artery

C. Interventricular Septum - Left anterior

Descending Artery, Posterior interventricular
Artery

D. Left Atrium and Ventricles - Left

Circumflex Artery
82 A 16-year old female was A. Male D. androgen Insensitivity . A. Male hermaphrotidism ​is the condition of
admittedwith bilateral inguinal hermaphrotidism Syndrome incomplete male differentiation of the external Comprehen
masses. She had not begun to B. Turner Syndrome genitalia in an individual with a Y sive gyne
menstruate but showed normal C. Female chromosome. The gonads of the male
breast development for her age. Pseudohermaphroditis pseudohermaphrodite, when present, are
Her external genitalia were m either streak gonads or testes.
feminine, the vagina was shallow, D. androgen
but no uterus could be palpated. Insensitivity Syndrome B. Turner Syndrome – Primary amenorrhea
Laboratory examination revealed and absent breast development. These
that her sex chromatin pattern was individuals have other somatic abnormalities,
negative. Which of the following is the most prevalent being short stature,
the MOST likely diagnosis? webbing of the neck, a short fourth
metacarpal, and cubitus valgus. Cardiac
abnormality, renal abnormalities, and
hypothyroidism.

C. Female Pseudohermaphroditism - t​he

ovaries and müllerian derivatives are normal
 and the sexual ambiguity is limited to
masculinization of the external genitalia. A
female fetus is masculinized only if exposed
to androgens, and the degree of
masculinization is determined by the stage of
differentiation at the time of exposure.
Masculinization can occur secondary to
exogenous maternal steroids as well.

D. androgen Insensitivity Syndrome – or

Androgen Resistance Syndrome “Testicular
Feminization” is a genetically transmitted
disorder in which androgen receptor
synthesis or action does not occur. The
syndrome is caused by the absence of an
X-chromosome gene responsible for
cytoplasmic or nuclear testosterone receptor
function. Women with this disorder have no
female or male internal genitalia, normal
female external genitalia, and a short or
absent vagina. Breast development is normal
or enhanced. Testes that are intraabdominal
or that occur in the inguinal canal have
increased risk of developing a malignancy.

83 A 16-year old presented with BP A. Compression of C. An arteriovenous C. On palpation, a thrill is noted which is a uptodate
140/55mmHg at rest. A large, the femoral fistula palpable vibration over the fistula that is
healed scar is noted on the medial Artery related to flow. On auscultation, a bruit is also
aspect of the left thigh which he
 acquired when he hit a large nail B. Congenital noted which is the auditory manifestation of a
during a fall. Bruit and palpable duplication of thrill, often referred to as a “buzz”.
thrill were noted on the scar. What the femoral
is the patient LIKELY to have? artery
C. An
arteriovenous
fistula
D. Premature
atherosclerosis

84 A 6-year old boy is admitted to the A. Lingual Auricotemporal A. Lingual – It is sensory to the anterior two moore
hospital with high fever and pain B. Auricotemporal thirds of the tongue, the floor of the mouth,
over the parotid gland. A diagnosis C. Chorda and the lingual gingivae.
of parotiditis (mumps) is Tympani
established, and the boy is sent D. Lesser Petrosal B. Auricotemporal – a branch of CN V3 is
back home. Which of the following closely related to the parotid gland. It
nerves is responsible for painful supplies sensory fibers to the auricle and
sensations from the region of the temporal region. It also sends articular fibers
parotid gland? to the TMJ

C. Chorda Tympani – a branch of cranial N

VII carrying taste fibers from the anterior two
thirds of the tongue. It also carries
secremotor fibers for the submandibular and
sublingual salivary glands

D. Lesser petrosal – It carries

parasympathetic fibers from both the
tympanic plexus and nervus intermedius, to
the parotid gland
85 A 38-year old woman with a long A. Rhomboid Major D. Trapezius A. Rhomboid Major- dorsal scapular artery
history of shoulder pain is admitted B. latissimus dorsi
to a hospital for surgery. Which of C. Multifidus B. latissimus dorsi – thoracodorsal artery and
the followingmuscles becomes D. Trapezius brach of the subscapular artery
ichemic soon after ligation of the
C. Multifidus - ​Multifidus receives arterial
superficial or ascending branch of
the transverse cervical artery? blood supply from a number of arteries along

the length of the vertebral column. These are

as follows:

· Cervical region: vertebral, deep cervical

and occipital arteries
 · Thoracic region: dorsal branches of
posterior intercostal and subcostal
arteries

· Lumbar region: lumbar and lateral

sacral arteries

D. Trapezius – transverse cervical artery,

dorsal scapular artery and posterior
intercostal arterial branches

86 A 56-year old man, 41-pack year A. Vascular C. Endostatin A. Vascular Endothelial Growth factor Robbins
smoker had a “typical smoker’s Endothelial (VEGF) - creates an angiogenic patho
cough” for years which had turned Growth factor gradient that stimulates the
into a chronic productive cough (VEGF) proliferation of endothelial cells and
with hemoptysis. He had dyspnea, B. Platelet-derived guides the growth of new vessels
chest pain, cachexia, and growth factor toward the tumor. It also increases the
increasing dysphonia. He has been (PDGF) expression of ligands that activate the
treated for 4 respiratory infections C. Endostatin Notch signaling pathway, which
in the past 18 months. Imaging D. Extracellular regulates the branching and density of
reveals a tumor that is 3 cm in matrix synthesis the new vessels
greatest dimension, surrounded by B. Platelet-derived growth factor (PDGF)
lung parenchyma. Bronchoscopic - Neovascularization has a dual effect
evaluation reveals a cavitary lesion on tumor growth: perfusion supplies
of a proximal bronchus. needed nutrients and oxygen, and
Immunochemistry indicates a newly formed endothelial cells
 highly vascular tumor with many stimulate the growth of adjacent tumor
microvessels. Vascularity of the cells by secreting growth factors, such
tumor is inhibited by up-regulation as IGF and PDGF
of which of the following? C. Endostatin - angiogenesis inhibitor;
produced by proteolytic cleavage of
collagen
D. Extracellular matrix synthesis - is the
non-cellular component present within
all tissues and organs, and provides
not only essential physical scaffolding
for the cellular constituents but also
initiates crucial biochemical and
biomechanical cues that are required
for tissue morphogenesis,
differentiation and homeostasis.

87 A pediatric surgeon has resected A. Ligamentum Ligamentum Teres A. Ligamentum Teres Hepatis - “round moore
a structure that is a fibrous Teres Hepatis Hepatis ligament of the liver” is the fibrous
remnant of an embryonic or fetal B. Lateral remnant of the umbilical vein, which
artery in a 5-year old child. Which Umbilical fold carried well-oxygenated and
of the following structures is MOST C. Medial umbilical nutrient-rich blood from the placenta
likely to be divided? fold to the fetus
D. Ligamentum E. Lateral Umbilical fold - lateral to the
venosum medial umbilical folds, cover the
inferior epigastric vessels
F. Medial umbilical fold - lateral to the
median umbilical fold, cover the
medial umbilical ligaments, formed by
occluded parts of the umbilical
arteries
 G. Ligamentum venosum - is the fibrous
remnant of the fetal ductus venosus,
which shunted blood from the
umbilical vein to the IVC,
short-circuiting the liver

88 A 20 year old woman complains of A.Superior cervical c. Glossopharyngeal The glossopharyngeal nerve supplies
numbness of the nasopharynx after ganglion nerve sensory innervation to the mucosa of the BRS Gross
surgical removal of the adenoid. A B.External laryngeal upper pharynx, whereas maxillary nerve Anatomy
lesion of which of the following nerve supplies sensory innervation to the face
nerves would be expected? C.Glossopharyngeal below the level of the eye and above the level
nerve of the upper lip and the palate and nasal
D.Maxillary nerve mucosa. The superior cervical ganglion
contributes to a formation of the pharyngeal
plexus but contains no afferent fibers. The
external laryngeal nerve innervates the
cricothyroid and inferior pharyngeal
constrictor muscles.

89 A 37 year old man receives a A.Decreased parotid c. Dryness in the nose The greater petrosal nerve carries BRS Gross
direct blow to his head and is gland secretion and palate parasympathetic (preganglionic) fi bers, Anatomy
brought to an emergency B.Loss of taste which are secretomotor fi bers, to the lacrimal
department. His radiograph shows sensation in the glands and mucous glands in the nasal cavity
a fracture of the floor of the middle epiglottis and palate; carries taste fi bers from the
cranial cavity, causing severance C.Dryness in the nose palate; and carries general visceral afferent
of the greater petrosal nerve. and palate (GVA) fibers from the nasal cavity, palate,
Which of the following conditions D.Increased lacrimal and roof of the oral cavity but not from the
could be produced by this injury? gland secretion pharynx and larynx. Therefore, a lesion of
the greater petrosal nerve causes dryness in
 the nose and palate and decreased lacrimal
secretion.

90 A 20 year old marine biologist A.Anteflexed and c. Anteflexed and Uterus Is the organ of gestation in which the BRS
asks about her first bimanual retroverted anteverted fertilized oocyte normally becomes Anatomy
examination, and it is explained to B.Rretroflexed and embedded and the developing organism
her that the normal position of the anteverted grows until its birth it isnormally anteverted
uterus is C.Anteflexed and (i.e., angle of 90 degrees at the junction of
anteverted the vagina and cervical canal) and
D.Retroverted and anteflexed (i.e., angle of 160 to 170 degrees
retroflexed at the junction of the cervix and body).

91 A 42 year old man presented with A.Primary lateral a. primary lateral

stiffness of the fingers associated sclerosis sclerosis
with weakness of the hand, B.Progressive spinal
followed by atrophic weakness of muscular atrophy
the hands and forearms, slight C.Progressive bulbar
spasticity of the legs, and palsy
generalized hyperreflexia. Given D.Amyotrophic lateral
the signs and symptoms, which is sclerosis
the LIKELY disorder?

92 A 15 year old female was admitted A. Turner b. Androgen insensitivity Androgen insensitivity syndrome involves the gray’s
to the hospital with bilateral syndrome syndrome development of testes and female external anatomy
inguinal masses. Physical B.Androgen genitalia, with a blind-ending vagina and
examination revealed that she had insensitivity syndrome absence of the uterus and uterine tubes. This
not begun to menstruate but C.Inguinal hernias is consistent with the presenting
showed normal breast D.Male symptoms—and is not consistent with the
development for her age. Her pseudohermaphroditis symptoms described.
external genitalia were feminine, m
 the vagina was shallow, but no
uterus could be palpated. Lab
exam revealed that her sex
chromatin pattern was negative.
Which of the following is the MOST
likely diagnosis?

93 A woman is delivering a breech A.Bulbospongiosus d. levator ani An obstetrician should avoid incising the BRS
baby. The obstetrician decides that B.Perineal membrane levator ani and the external anal sphincter. Anatomy
it is the best to perform a C.Vaginal wall The levator ani is the major part of the pelvic
mediolateral episiotomy. Which of D.Levator ani diaphragm, which forms the pelvic floor and
the following structures should the supports all of the pelvic organs
obstetrician avoid incising?

94 A 73 year old man comes to his A.Ejaculatory duct b. Prostate gland The prostate gland may be palpated on BRS
physician for an annual check up. B.Prostate gland rectal examination. The ejaculatory duct runs Anatomy
Which of the following structures is C.Epididymis within the prostate gland and cannot be felt.
MOST likely palpated during rectal D.Ureter In the male, the pelvic part of the ureter lies
examination? lateral to the ductus deferens and enters the
posterosuperior angle of the bladder, where it
is situated anterior to the upper end of the
seminal vesicle, and thus, it cannot be
palpated during rectal examination.

A. Anterior
95 A 68 yo male is admitted to the B. Lateral C. Median The middle lobe of the prostate gland is BRS
hospital with painful urination and C. Median commonly involved in benign
nocturia. MRI examination reveals D. Posterior
enlargement and irregularity of the prostatic hypertrophy, resulting in obstruction
uvula of the urethra. This of the prostatic urethra, whereas the posterior
enlargement resulted in difficulty
 with urinary voiding and
inadequate emptying of the lobe is commonly involved in carcinomatous
bladder. Which of the following transformation. The anterior lobe contains
lobes of the prostate gland will
little glandular tissue, and the two lateral
most likely be hypertrophied:
lobes on either side of the urethra form the

major part of the gland.

A. Superior
96 A 28 yo woman with a goiter is laryngeal nerve B. Internal laryngeal The internal laryngeal nerve accompanies the BRS
scheduled for surgical treatment. B. Internal nerve superior laryngeal artery,
The surgeon must ligate the laryngeal nerve
superior laryngeal artery before whereas the external laryngeal nerve
C. External
surgically resecting the goiter, so accompanies the superior thyroid artery. The
laryngeal nerve
care must be taken to avoid injury superior
D. Hypoglossal
to which of the following nerves? nerve
laryngeal, hypoglossal, and vagus nerves are
not closely associated with the superior

laryngeal artery.

97 A 22 yo woman receives a deep A. Rectouterine D. Round ligament of the The round ligament of the uterus is found in BRS
cut in the inguinal canal 1 in lateral ligament uterus the inguinal canal along its
to the pubic tubercle. Which of the
following ligament is lacerated B. Ovarian Ligament course. The other ligaments do not pass
within the inguinal canal? through the inguinal canal.
Suspensory ligament of
the ovary

D. Round ligament of
the uterus
 A. The apex of
98 A 54 yo female is admitted to the the right lung D. The horizontal fissure It extends from anterior margin at the level of
hospital with a stab wound of the B. The root of of the right lung 4​th​ costal cartilage. Runs horizontally
thoracic wall in the area of the right the left lung backwards to meet the oblique fissure in the
fourth costal cartilage. Which of the C. The mid-axillary line.
following pulmonary structure is horizontal
present at this site? Pulmonary pleura extends into the fissures of
fissure of the
the lungs so that the lobes can move on each
left lung
other during respiration.
D. The
horizontal
fissure of the
right lung

99 A 34yo man in a bar fight suffers a A. Ptosis of the upper B. Internal The abducens nerve (CN VI) innervates the BRS
knife wound that severs the eyelid Strabismus(medial lateral rectus muscle, which
abducens nerve proximal to its deviation)
entrance into the orbit. Which of B. Internal strabismus abducts the eyeball. A lesion of the abducens
the following conditions results (medial deviation) nerve results in internal strabismus (medial
from this injury?
C. Loss of the ability to deviation) and diplopia (double vision). Ptosis
dilate the pupil of the upper eyelid is caused by lesions of

D. External strabismus the oculomotor nerve or sympathetic nerve to

(Lateral deviation) the levator palpebrae superioris. Inability to

dilate the pupil is caused by a lesion of the

sympathetic nerve to the dilator pupillae.
 External strabismus (lateral deviation) is
caused by paralysis of the medial rectus
muscle,

which is innervated by the oculomotor nerve.

Loss of visual accommodation is due to a

lesion of parasympathetic nerve fi bers to the

ciliary muscle.

A. Umbilical
100 A known diabetic mother gives arteries D. Ductus arteriosus A patent ductus arteriosus shunts blood from BRS
birth to a baby who is diagnosed as B. Ductus the pulmonary trunk to the
having dextroposition of the aorta venosus
and the pulmonary trunk with aorta, partially bypassing the lungs, and thus
C. Umbilical vein
cyanosis and shortness of breath. allowing mixed blood to reach the body
D. Ductus
Which of the following structures is tissues
arteriosus
required to remain patent until
and causing cyanosis. Dextroposition or
surgical correction of the
transposition of the great arteries must be
deformity?
accompanied by a VSD or a patent ductus
arteriosus for the infant to survive. The
transposition causes oxygenated blood to
pass from the left ventricle into the pulmonary
trunk and then into the lungs, but
deoxygenated blood travels from the right
ventricle into the aorta and then into the
systemic circulation.