Clinically Oriented Anatomy 7Th Ed By Agur Dalley – Test Bank

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Clinically Oriented Anatomy 7Th Ed By Agur Dalley – Test Bank

 

Chapter 6

1. Which of the following is incorrect pertaining to the clavicle?
A) It is attached via ligaments to the coracoid process.
B) The superior surface is grooved for the subclavian artery.
C) After a fracture, the medial segment is raised by the sternocleidomastoid muscle.
D) Fractures are almost always accompanied by acromioclavicular dislocation.
E) Patients with fractured clavicles typically need to support the ipsilateral upper limb with the contralateral one.
Ans: D

 

 

2. Following an avulsion fracture of the greater tubercle of the humerus, the humerus would primarily be:
A) laterally rotated.
B) medially rotated.
C) abducted.
D) flexed.
E) extended.
Ans: B

 

 

3. In the emergency room you see a 65-year-old woman who fell on her outstretched right hand while walking on ice. Upon examination of the right limb, you feel and see a dorsal protrusion just proximal to the wrist. You suspect a:
A) fractured lunate.
B) fractured distal radius (Colles fracture).
C) mid-radial fracture.
D) dislocated first carpometacarpal joint.
E) dislocated midcarpal joint.
Ans: B

 

 

4. Which of the following is incorrect pertaining to the scaphoid?
A) It articulates with the radius.
B) It is the most frequently fractured carpal bone.
C) Fracture is accompanied by pain along the lateral side of the wrist.
D) A complication associated with fracture is avascular necrosis.
E) It attaches to the flexor retinaculum.
Ans: E

 

 

5. The cephalic vein:
A) becomes the brachial vein.
B) becomes the axillary vein.
C) originates on the medial side of the dorsal venous network at the wrist.
D) pierces the clavipectoral fascia.
E) empties into the subclavian vein.
Ans: D

 

 

6. In the following axial MRI through the distal third of the arm, the brachial artery is labeled number 1 (see thin leader line on image). What is the structure indicated by the arrow?
A) ulnar artery
B) radial nerve
C) cephalic vein
D) short head of biceps tendon
E) basilic vein
Ans: C

 

 

7. You observe a physician perform a muscle test by having the patient abduct her arm 90 degrees and move the arm forward against resistance. What muscle (or part of a muscle) is the physician testing?
A) middle deltoid
B) subscapularis
C) clavicular head of pectoralis major
D) sternocostal head of pectoralis major
E) serratus anterior
Ans: C

 

 

8. Following a left radical mastectomy, a woman is unable to abduct her arm more than 90 degrees. Which of the following structures do you suspect was injured during the surgical procedure?
A) dorsal scapular nerve
B) long thoracic nerve
C) suprascapular nerve
D) serratus posterior superior muscle
E) rotator cuff component of the shoulder joint capsule
Ans: B

 

 

9. The trapezius can perform all of the following functions except:
A) protract the scapula.
B) retract the scapula.
C) elevate the scapula.
D) depress the scapula.
E) rotate the scapula.
Ans: A

 

 

10. In which of the following activities would the latissimus dorsi be least important?
A) using the crawl stroke while swimming
B) using the backstroke while swimming
C) using the breaststroke while swimming
D) performing a chin-up
E) paddling a canoe
Ans: B

 

 

11. Following a knife wound to the neck, you notice that the medial border of a patient’s left scapula is located further from the midline than that of his right scapula. The nerve most likely injured by the wound is the:
A) long thoracic.
B) thoracodorsal.
C) suprascapular.
D) dorsal scapular.
E) spinal accessory.
Ans: D

 

 

12. The arrow in the following radiograph points to the:
A) clavicle.
B) acromion process.
C) coracoid process.
D) superior angle of scapula.
E) superior part of glenoid fossa.
Ans: B

 

 

13. Which of the following is incorrect pertaining to the supraspinatus muscle?
A) It is innervated by a nerve that also supplies cutaneous innervation to the lateral surface of the proximal arm.
B) It initiates the process of abduction of the arm.
C) It is associated with painful abduction when the subacromial bursa is inflamed.
D) It is one of four muscles comprising the rotator cuff.
E) During arm abduction against resistance, the muscle can be palpated.
Ans: A

 

 

14. The cervicoaxillary canal:
A) forms the base of the axilla.
B) is bounded by the first rib, clavicle, and superior edge of the scapula.
C) conducts the subclavian artery.
D) leads to the quadrangular space.
E) is occluded in a shoulder dislocation.
Ans: B

 

 

15. Which of the following is incorrect pertaining to the axillary vein?
A) If lacerated in the axilla, there is a risk of producing an air embolus.
B) It is the vessel that is actually punctured in a typical “subclavian” vein puncture for catheter insertion.
C) It lies deep to the axillary artery as the vessels cross the 1st rib.
D) It is formed by the union of the brachial and basilic veins.
E) It may receive blood from the inguinal region of the body.
Ans: C

 

 

16. Which of the following is incorrect pertaining to lymphatic drainage of the upper limb?
A) The apical axillary lymph nodes receive lymph from all the other axillary groups.
B) The axillary nodes may be enlarged in breast cancer.
C) The left humeral (lateral) axillary nodes receive lymph from both upper limbs.
D) Metastatic spread to the axillary nodes may require excision of part of the axillary vein.
E) Removal of the axillary nodes may result in lymphedema of the upper limb.
Ans: C

 

 

17. In the following radiograph of the wrist, the arrow points to the:
A) scaphoid.
B) lunate.
C) pisiform.
D) articular disc.
E) capitate.
Ans: A

 

 

18. In the emergency room you examine a patient who was thrown from a motorcycle in such a way that, upon landing, his neck and shoulder were widely separated. Which of the following would not be consistent with your suspicion that he is suffering from Erb-Duchenne palsy?
A) medially rotated arm at rest
B) weak shoulder abduction
C) weak elbow flexion
D) sensory loss on lateral aspect of arm
E) weak digital flexion
Ans: E

 

 

19. Which of the following associations pertaining to the brachial plexus is incorrect?
A) pre-fixed brachial plexus—compression of inferior trunk by 1st rib
B) wounds in the posterior triangle of the neck—brachial plexus injuries
C) acute brachial plexus neuritis—severe onset of shoulder pain
D) hyperabduction syndrome—paresthesia
E) inferior brachial plexus injuries—clawhand
Ans: A

 

 

20. Which of the following reasons best explains why it is easier to do a “chin-up” (hands supinated) than a “pull-up” (hands pronated)?
A) Because the brachialis is a less-effective elbow flexor in the pronated position.
B) Because the biceps is a less-effective flexor in the pronated position.
C) Because the brachioradialis is a less-effective flexor in the pronated position.
D) Because the long digital flexors can better assist with elbow flexion in the supinated position.
E) Because the humero-radial-ulnar joint is better aligned in the supinated position.
Ans: B

 

 

21. The ridge indicated by the arrow in the following photograph overlies the tendon of which of the following muscles?
A) palmaris longus
B) palmaris brevis
C) flexor carpi radialis
D) flexor digitorum superficialis
E) abductor pollicis longus
Ans: C

 

 

22. You examine a baseball pitcher who complains of weakened elbow flexion and has a rounded soft protuberance on the anterior surface of the distal part of his arm. Your most likely diagnosis is:
A) a damaged musculocutaneous nerve in association with a “pulling” of the coracobrachialis.
B) a ruptured long head of biceps tendon.
C) a ruptured short head of biceps tendon.
D) a ruptured brachialis tendon.
E) an elbow dislocation.
Ans: B

 

 

23. You examine a patient with a horizontal, posterior, mid-humeral knife wound that reaches the bone. In addition to the muscular lesions, you expect the injury severed the:
A) ulnar nerve and superior ulnar collateral artery.
B) ulnar nerve and deep artery of the arm.
C) radial nerve and humeral nutrient artery.
D) radial nerve and deep artery of the arm.
E) median nerve and brachial artery.
Ans: D

 

 

24. What is the correct order of structures in the cubital fossa from lateral to medial?
A) brachial artery, median nerve, biceps tendon
B) brachial artery, biceps tendon, median nerve
C) median nerve, brachial artery, biceps tendon
D) biceps tendon, brachial artery, median nerve
E) biceps tendon, median nerve, brachial artery
Ans: D

 

 

25. In the following radiograph, what muscle attaches at the location indicated by the arrow?
A) brachialis
B) biceps brachii
C) pronator teres
D) brachioradialis
E) anconeus
Ans: B

 

 

26. The brachioradialis:
A) has a tendon that passes deep to the flexor retinaculum.
B) attaches to the medial epicondyle of the humerus.
C) is innervated by the radial nerve.
D) acts at both the elbow and wrist joints.
E) extends the elbow.
Ans: C

 

 

27. You are assisting in the emergency room when the attending physician examines a patient after an elbow injury. The physician holds the proximal interphalangeal joint of the little finger and asks the patient to flex the distal phalanx. This procedure tests the functionality of what nerve?
A) radial
B) ulnar
C) median
D) posterior interosseous
E) anterior interosseous
Ans: B

 

 

28. Which of the following is incorrect pertaining to the pronator quadratus?
A) It is innervated by the anterior interosseous branch of the median nerve.
B) It is the prime mover for pronation.
C) It initiates the movement of pronation.
D) It helps maintain the integrity of the interosseous membrane between the radius and ulna when upward thrusts are transmitted through the wrist.
E) It can be palpated by deeply pressing an index finger two-thirds of the proximal-distal length of the forearm, at the middle of its ventral surface.
Ans: E

 

 

29. Which of the following statements is incorrect pertaining to the extensors carpi radialis longus and brevis muscles?
A) When only the two muscles act together, wrist extension and abduction is produced.
B) When the two muscles act with the extensor carpi ulnaris, only wrist extension is produced.
C) When the two muscles act with the flexor carpi ulnaris, only wrist abduction is produced.
D) One of the muscles is innervated by the ulnar and the other by the deep branch of the radial nerve.
E) Both attach to the humerus.
Ans: D

 

 

30. The ridge indicated by the arrow in the following photograph overlies the tendon of which of the following muscles?
A) extensor pollicis longus
B) extensor pollicis brevis
C) abductor pollicis longus
D) abductor pollicis brevis
E) first dorsal interossei
Ans: C

 

 

31. Elbow tendonitis (tennis elbow) is associated with:
A) inflammation of the periosteum of the lateral epicondyle of the humerus.
B) inflammation of the medial collateral ligament.
C) inflammation of the annular ligament.
D) rupture of the tendon of the extensor digitorum.
E) transient subluxation of the humero-radial-ulnar joint.
Ans: A

 

 

32. Which of the following is incorrect pertaining to the anatomic “snuffbox”?
A) It is bounded anteriorly by the tendons of abductor pollicis longus and extensor pollicis brevis.
B) It is bounded posteriorly by the tendon of extensor pollicis longus.
C) The radial artery traverses its floor.
D) The superficial branch of the radial nerve emerges from it.
E) The radial styloid process can be palpated within it.
Ans: D

 

 

33. In the following radiograph of the wrist of a 2.5-year-old child, the arrow points to the:
A) scaphoid.
B) trapezium.
C) triquetrum.
D) pisiform.
E) epiphysis of the first metacarpal.
Ans: B

 

 

34. What is the clinical significance of a superficial ulnar artery?
A) It often compresses the median nerve in the arm, producing paresthesia and muscle weakness.
B) It is often pinched during elbow flexion, producing mild ischemia in the forearm muscles.
C) Its superficial course in the cubital fossa results in it being mistakenly used for venipuncture.
D) Its caliber is typically smaller than the normal ulnar artery and, under compromising situations, may be unable to provide sufficient blood to the hand.
E) It accompanies the median nerve in the forearm and passes deep to the flexor retinaculum, resulting in hand ischemia in any patient suffering from carpal tunnel syndrome.
Ans: C

 

 

35. Which of the following would not be associated with a complete section of the median nerve at the elbow?
A) inability to flex both the proximal and the distal interphalangeal joints of digits 2 and 3
B) atrophy of thenar eminence muscles
C) greatly weakened pronation
D) loss of sensation on the lateral aspect of the palmar surface of the hand
E) loss of ability to adduct the thumb
Ans: E

 

 

36. Which of the following would not be associated with a complete section of the ulnar nerve at the wrist?
A) inability to abduct the little finger
B) inability to grasp a piece of paper between the extended 4th and 5th digits
C) inability to flex the metacarpophalangeal joint while extending interphalangeal joints of the 2nd digit
D) clawhand
E) loss of all sensation on the palmar aspect of the little finger
Ans: C

 

 

37. “Wrist-drop” is associated with:
A) unopposed action of the lumbricals and interossei.
B) rupture of the extensor digitorum.
C) avulsion of the olecranon.
D) section of the radial nerve at the mid-humeral level.
E) section of the superficial branch of the radial nerve.
Ans: D

 

 

38. In the following coronal MRI of the hand, the arrow points to the:
A) lumbrical.
B) palmaris brevis.
C) interossei.
D) tendon of flexor digitorum profundus.
E) tendon of extensor digitorum.
Ans: C

 

 

39. Dupuytren contracture refers to:
A) an abnormal spasticity in the flexor digitorum profundus tendons.
B) an abnormal spasticity in the flexor pollicis longus tendons.
C) a tightening of the flexor retinaculum that results in carpal tunnel syndrome.
D) a tightening of the anterior skin of the hand, resulting in reduced mobility and an increase depth in the skin creases.
E) a shortening and thickening of the palmar fascia of the hand, resulting in partial flexion of the digits.
Ans: E

 

 

40. Opposition of the thumb:
A) primarily involves rotation at the 1st metacarpophalangeal joint.
B) primarily involves contraction of a muscle that lies deep to the abductor pollicis brevis.
C) primarily involves contraction of a muscle that is innervated by the ulnar nerve.
D) is a movement that requires lateral rotation of the thumb.
E) is a movement that requires flexion of the thumb’s interphalangeal joint.
Ans: B

 

 

41. Which of the following is correct pertaining to the interossei and lumbrical muscles of the hand?
A) The palmar interossei, dorsal interossei, and lumbricals together can produce flexion at the metacarpophalangeal joints and extension at the interphalangeal joints.
B) The palmar interossei, dorsal interossei, and lumbricals together can produce extension at the metacarpophalangeal joints and flexion at the interphalangeal joints.
C) The palmar and dorsal interossei produce abduction of the fingers, whereas the lumbricals can produce adduction.
D) The palmar interossei and lumbricals can produce adduction of the fingers, whereas the dorsal interossei can produce abduction.
E) The dorsal interossei and lumbricals can produce abduction of the fingers, whereas the palmar interossei can produce adduction.
Ans: A

 

 

42. In the following angiogram of the wrist and hand, the arrow points to the:
A) ulnar artery.
B) radial artery.
C) deep branch of the ulnar artery.
D) superficial branch of the radial artery.
E) princeps pollicis artery.
Ans: C

 

 

43. You examine a patient who has a condition in which each time his index finger is flexed and extended, there is an audible “snap.”  Which of the following is the likely cause of this “trigger finger?”
A) infection in the midpalmar space
B) osteoarthritis of the metacarpophalangeal joint
C) carpal tunnel syndrome
D) thickening of the fibrous digital sheath and swelling of the flexor tendons
E) calcification of the origin of the lumbrical muscle
Ans: D

 

 

44. Which of the following is incorrect pertaining to carpal tunnel syndrome?
A) It may involve weakness in the thenar muscles.
B) It may involve anesthesia of the central palm.
C) It may involve paresthesia in the lateral 3½ digits.
D) It may be caused by inflammation of the synovial sheaths of the flexor tendons.
E) Surgical transection of the flexor retinaculum typically relieves its associated symptoms.
Ans: B

 

 

45. A laceration of the thenar eminence that results in complete section of the recurrent branch of the median nerve would result in:
A) claw hand.
B) ape hand.
C) loss of all ability to abduct the thumb.
D) loss of all ability to adduct the thumb.
E) loss of all ability to flex the metacarpophalangeal joint of the thumb.
Ans: B

 

 

46. You examine a patient who is an avid bicycle rider. He complains of sensory loss on the medial side of his hands and you find some weakness in his intrinsic hand muscles, but not in any other muscle group. You suspect that:
A) the patient used a hand posture that put excessive pressure on the superficial branch of his radial nerve.
B) the patient used a hand posture that put excessive pressure on his ulnar nerve.
C) repetitive wrist flexion and extension that occurred with braking caused swelling of the patient’s long flexor tendons at the wrist.
D) the patient’s flexed trunk but extended neck posture during riding stressed his neck vertebrae so that osteophytes developed reducing the size of his C8/T1 intervertebral foramen.
E) the patient probably has a cervical rib and that extended periods in the riding position resulted in inflammation around the nerves surrounding this structure.
Ans: B

 

 

47. Which of the following relationships at the wrist is incorrect?
A) The median nerve lies deep to the tendon of the palmaris longus.
B) The ulnar artery and nerve lie lateral to the tendon of the flexor carpi ulnaris.
C) The radial artery can be compressed against the radius.
D) The radial artery lies medial to the tendon of the flexor carpi radialis.
E) The scaphoid can be palpated in the floor of the anatomical snuffbox.
Ans: D

 

 

48. Scapulohumeral rhythm refers to:
A) the changing articular configuration of the humeral head in the glenoid cavity with movement.
B) the protective contractions of the rotator cuff muscles with humeral abduction.
C) the protractive and retractive movements of the scapula that occur with humeral flexion and extension.
D) the association between the movements at the glenohumeral and acromioclavicular joints.
E) the relationship between movements at the glenohumeral and scapulothoracic “joints” during humeral abduction.
Ans: E

 

 

49. The sternoclavicular joint:
A) is less likely to dislocate than the clavicle is to fracture in falls on the outstretched hand.
B) is a symphysis.
C) can ankylose (stiffen) without causing significant loss in shoulder mobility.
D) is dependent on muscles for its integrity.
E) involves the clavicle, sternum, and first two costal cartilages.
Ans: A

 

 

50. In the following MRI of the proximal forearm, the arrow points to the:
A) brachioradialis.
B) anconeus.
C) extensor digitorum.
D) flexor digitorum profundus.
E) supinator.
Ans: E

 

 

51. You examine a young male patient whose shoulder was injured during a football game. You immediately notice that his acromion process is abnormally prominent and inferior to the acromial end of the clavicle. You diagnose:
A) an anteriorly dislocated glenohumeral joint.
B) a posteriorly dislocated glenohumeral joint.
C) a dislocated acromioclavicular joint with intact coracoclavicular ligaments.
D) a dislocated acromioclavicular joint with torn coracoclavicular ligaments.
E) a torn rotator cuff.
Ans: D

 

 

52. The surface elevation identified by the arrow in the following photograph is caused by which of the following muscles?
A) subscapularis
B) trapezius
C) long head of triceps
D) serratus anterior
E) teres major
Ans: E

 

 

53. The nerve most likely to be injured in a glenohumeral joint dislocation is the:
A) radial.
B) medial.
C) ulnar.
D) axillary.
E) supraclavicular.
Ans: D

 

 

54. In the emergency room you examine a young girl who is “protecting” her right upper limb by holding it while maintaining the elbow flexed and forearm pronated. The patient’s father related that the patient was misbehaving as the school bus door opened and he inadvertently jerked her up by the hand to lift her onto the bus. You order a series of upper limb radiographs but are fairly certain the injury is:
A) a ruptured biceps tendon.
B) a ruptured pectoralis major tendon.
C) a dislocated (subluxed) radial head.
D) an avulsed lesser tubercle.
E) an avulsed medial humeral condyle.
Ans: C

 

 

55. Which of the following is incorrect pertaining to the wrist joint or wrist bones?
A) Movements at the wrist joint proper (radiocarpal joint) are augmented by movements at the midcarpal and intercarpal joints.
B) The joint involves the radius, articular disk, and all of the carpal bones in the proximal row except the pisiform.
C) Branches of the median, ulnar, and radial nerves supply the joint.
D) Fracture of the lunate is common in children and typically heals well because of multiple sources of blood.
E) Fracture-separation of the distal radial epiphysis is common in children and typically heals well when reduced.
Ans: D

 

 

56. The abnormal condition shown in the following photograph is associated with paralysis of the:
A) serratus anterior.
B) rhomboids.
C) latissimus dorsi.
D) serratus posterior superior.
E) subscapularis.
Ans: A

 

Chapter 7

1. Which of the following is not associated with the frontal bone(s)?
A) malar flush
B) glabella
C) metopic suture
D) supraorbital foramen
E) roof of the orbit
Ans: A

 

 

2. The pterion:
A) is posteroinferior to the external acoustic meatus.
B) is part of the sphenoid bone.
C) is part of the temporal bone.
D) overlies the anterior branch of the middle meningeal artery.
E) is located at the junction of the sagittal and coronal sutures.
Ans: D

 

 

3. Which of the following is not correct for the cribriform plate?
A) It is part of the ethmoid bone.
B) It possesses numerous tiny foramina that transmit olfactory nerves.
C) It is located in the middle cranial fossa.
D) It lies adjacent to the crista galli.
E) It is located posterior to the frontal crest.
Ans: C

 

 

4. The arrow in the following figure indicates the location of which of the following cranial bones?
A) maxilla
B) frontal
C) ethmoid
D) sphenoid
E) zygomatic
Ans: D

 

 

5. Which of the following is not a foramen or fissure in the sphenoid bone?
A) superior orbital
B) rotundum
C) ovale
D) lacerum
E) spinosum
Ans: D

 

 

6. During a difficult delivery an obstetrician uses forceps to extract the infant.  Upon examining the baby you notice forceps impressions posteroinferior to the ear.  You are most concerned that the:
A) forceps may have penetrated a fontanelle.
B) middle ear cavity may have been crushed.
C) facial nerve may have been injured.
D) mastoid process may have been avulsed.
E) styloid process and associated muscles may have been avulsed.
Ans: C

 

 

7. Which of the following is incorrect pertaining to fontanelles?
A) The remains of the anterior fontanelle is often indicated by the metopic suture.
B) A bulging fontanelle indicates excessive intracranial pressure.
C) They facilitate molding.
D) Lambda indicates the site of the posterior fontanelle.
E) Fontanelles are normally not palpable after 18 months of age.
Ans: A

 

 

8. Which of the following is incorrect pertaining to the scalp?
A) Superficial wounds do not gape because the margins of the wound are held together by the epicranial aponeurosis.
B) The scalp muscles (e.g., occipitofrontalis) are attached to the pericranium.
C) Blood vessels and nerves enter the scalp inferiorly.
D) Scalp infections may spread to the brain via emissary veins that pass through parietal foramina.
E) Scalp injuries can result in “black eyes.”
Ans: B

 

 

9. In the following figure, what structure traverses the foramen indicated by the arrow?
A) internal jugular vein
B) internal carotid artery
C) basilar artery
D) vagus nerve
E) mandibular nerve
Ans: B

 

 

10. The cerebellar tentorium:
A) is composed of arachnoid matter.
B) contains CSF.
C) has a tough edge that may lesion the oculomotor nerve during tentorial herniation.
D) may become occluded, resulting in loss of blood supply to the cerebellum.
E) may produce headaches associated with pituitary tumors.
Ans: C

 

 

11. Which of the following associations pertaining to the dural venous sinuses is incorrect?
A) arachnoid granulations—calcifications of arachnoid mater within the sinuses associated with arteriosclerosis
B) confluence of the sinuses—near internal occipital protuberance
C) inferior sagittal sinus—located within the falx cerebri
D) sigmoid sinus—continues inferiorly as internal jugular vein
E) occipital sinus—metastases via internal vertebral venous plexuses
Ans: A

 

 

12. Which of the following is not correct pertaining to the cavernous sinus?
A) traversed by the internal carotid artery
B) located on either side of the sella turcica
C) may become thrombosed via infections in the superior part of the face
D) septic thrombosis can lead to the development of meningitis
E) contains the mandibular division of the trigeminal nerve
Ans: E

 

 

13. Pulsating exophthalmos is associated with:
A) tear of the lacrimal artery.
B) tear of the inferior ophthalmic vein.
C) arteriovenous fistula within the cavernous sinus.
D) rupture of the pterygoid venous plexus.
E) section of the oculomotor nerve.
Ans: C

 

 

14. What structure traverses the groove indicated by the arrow in the following figure?
A) internal carotid artery
B) internal jugular vein
C) middle meningeal artery
D) sigmoid sinus
E) transverse sinus
Ans: D

 

 

15. You examine a comatose patient in the emergency room. His wife relates that her husband was struck accidentally in his “temple” by a baseball. After an initial period of unconsciousness, he seemed to be okay but later became drowsy and comatose. You suspect that the patient is suffering from:
A) an extradural (epidural) hematoma caused by a laceration of a branch of the middle meningeal artery.
B) a subdural hematoma caused by a laceration of a branch of the middle meningeal artery.
C) an extradural (epidural) hematoma caused by a laceration of the transverse venous sinus.
D) a subdural hematoma caused by a laceration of a branch of the transverse venous sinus.
E) a subarachnoid hemorrhage caused by a laceration of the internal carotid artery.
Ans: A

 

 

16. Which of the following is incorrect pertaining to the CSF?
A) It returns to the venous system by passing into the vertebral venous plexuses.
B) It provides some cushioning to the brain when the skull is struck.
C) Samples are typically obtained in infants through needle puncture into the posterior cerebellomedullary cistern.
D) Overproduction results in hydrocephalus.
E) Fractures of the floor of the middle cranial fossa may result in leakage through the external acoustic meatus.
Ans: A

 

 

17. Which of the following associations is incorrect pertaining to the blood supply of the brain?
A) middle cerebral artery—supplies the lateral surface of the brain
B) anterior communication artery—connects anterior cerebral arteries
C) hemorrhagic stroke—severe headache and stiff neck
D) cerebral arterial circle (circle of Willis)—an anastomosis between the two vertebral and two internal carotid arteries
E) cerebral arterial circle (circle of Willis)—in most cases prevents development of neurological symptoms following acute ischemic stroke
Ans: E

 

 

18. You examine a patient in the emergency department following a bee sting to the bridge of her nose. Both of the patient’s eyes are swollen shut because:
A) the sting interfered with the nerve that raises the eyelid.
B) the sting blocked lymph drainage from the region.
C) the face is characterized by very cutaneous veins that ruptured from the sting.
D) the face is characterized by very cutaneous arteries that ruptured from the sting.
E) the face is characterized by very loose subcutaneous connective tissue that allows accumulation of excessive fluid with inflammation.
Ans: E

 

 

19. Which of the following signs would be consistent with Bell palsy?
A) inability to raise the upper eyelid
B) loss of the tympanic reflex
C) food dribbling from the corners of the mouth
D) loss of ability to protrude the tongue
E) loss of ability to focus on near objects
Ans: C

 

 

20. A late nineteenth century technique to treat trigeminal neuralgia was to inject alcohol into the trigeminal ganglion, which destroys all of the sensory fibers in the ganglion.  The most likely (direct) method by which the surgeon performed this procedure was to insert a needle:
A) through the infraorbital foramen.
B) through the foramen ovale.
C) under the eyeball through the inferior orbital fissure.
D) through the pterygomaxillary fissure.
E) through the nasal cavity.
Ans: B

 

 

21. A late nineteenth century technique to treat trigeminal neuralgia was to inject alcohol into the trigeminal ganglion, which destroys all of the sensory fibers in the ganglion. Once the procedure was successfully implemented, the patient would:
A) be unable to chew.
B) lose sensation from all areas of his face except the area overlying the parotid gland and some of the auricle
C) lose sensation from just the area overlying the body and ramus of the mandible.
D) lose sensation from just the midface area.
E) lose all sensation from his tongue.
Ans: B

 

 

22. In the carotid arteriogram below, the location of the internal carotid artery at the site indicated by the arrow is in the:
A) substance of the brain.
B) cavernosus sinus.
C) petrous part of the temporal bone.
D) foramen lacerum.
E) maxillary sinus.
Ans: B

 

 

23. Injection of an anesthetic agent into the infraorbital foramen would eliminate sensation from all of the following regions/structures except the:
A) hard palate.
B) anterior maxillary teeth.
C) upper lip.
D) upper gum.
E) philtrum.
Ans: A

 

 

24. Ophthalmic herpes zoster is characterized by:
A) inability to raise the upper eyelid.
B) inability to abduct the eye.
C) inability to focus on near objects.
D) corneal ulceration.
E) loss of sensation from the forehead.
Ans: D

 

 

25. The muscle primarily responsible for producing the mouth posture shown in the following figure is:
A) orbicularis oris.
B) risorius.
C) zygomaticus major.
D) buccinator.
E) levator labii superioris.
Ans: A

 

 

26. While jogging on a trail you come upon a child who fell off her bike and has severe facial lacerations that are bleeding profusely.  In order to most effectively curtail the bleeding, you would put pressure on the:
A) horizontal ramus of the mandible just anterior to the attachment of the masseter.
B) horizontal ramus of the mandible directly inferior to the angle of the mouth.
C) infraorbital foramen.
D) lateral aspect of mastoid process.
E) coronoid process of the mandible.
Ans: A

 

 

27. All lymphatic vessels from the head and neck drain directly or indirectly into lymph nodes located:
A) at the junction of the internal jugular and subclavian veins.
B) along the subclavian vein.
C) along the internal jugular vein.
D) along the external jugular vein.
E) along the anterior jugular vein.
Ans: C

 

 

28. Which one of the following nerves does not have a relationship with the parotid gland or its sheath?
A) auriculotemporal nerve
B) facial nerve
C) glossopharyngeal nerve
D) great auricular nerve
E) chorda tympani
Ans: C

 

 

29. Which of the following associations pertaining to the parotid gland is incorrect?
A) parotid duct—opens opposite upper 2nd molar
B) mumps—swelling of the parotid gland
C) parotid sialogram—metastasis from a parotid tumor
D) blockage of the parotid duct—pain upon sucking a lemon
E) accessory parotid gland—drains into the parotid duct
Ans: C

 

 

30. Which one of the following conditions would be most consistent with the definition of a “blowout” fracture of the orbit?
A) orbital fat becoming displaced into frontal sinus
B) the inferior oblique muscle becoming displaced into the maxillary sinus
C) all of the recti muscles becoming detached from their bony attachments
D) the superior oblique muscle losing its attachment to the trochlea
E) exophthalmos
Ans: B

 

 

31. Which of the following associations pertaining to the eyes is incorrect?
A) ptosis—damage to the oculomotor nerve
B) “pinkeye”—inflammation of the conjunctiva
C) superior conjunctival fornix—receives lacrimal fluid (tears)
D) tear drainage—via nasolacrimal duct to middle meatus of nose
E) stimulation of tear production—greater petrosal nerve
Ans: D

 

 

32. Upon neurological examination, you notice a slow pupillary light reflex in a patient’s right eye. Which of the following is consistent with this sign?
A) lesion of the right nasociliary nerve
B) compression of the right oculomotor nerve
C) compression of the right facial nerve proximal to the geniculate ganglion
D) compression of the right facial nerve distal to the geniculate ganglion
E) lesion of the left long ciliary nerves
Ans: B

 

 

33. The “blind spot” of the eye refers to the:
A) macula lutea.
B) uvea.
C) fovea centralis.
D) choroid.
E) optic disc.
Ans: E

 

 

34. In the following sagittal MRI, the arrow points to the:
A) levator palpebrae superioris.
B) superior rectus.
C) superior oblique.
D) superior ophthalmic artery.
E) facial artery.
Ans: B

 

 

35. While waiting to assist a neurologist who is about to perform a lumbar puncture, she asks you to conduct an eye exam on the patient. Why?
A) Because a CSF infection would be revealed by a discoloration in the anterior chamber of the eye.
B) Because slowness in pupillary dilation would indicate reduced CSF pressure.
C) Because papilledema would indicate increased CSF pressure.
D) Because retinal arterial sprouting would indicate arterial leakage into the CSF.
E) Because swelling of the ophthalmic veins would indicate increased CSF pressure.
Ans: C

 

 

36. Presbyopia refers to the loss of:
A) transparency of the lens.
B) focusing power of the lens.
C) the pupillary light reflex.
D) coordination between the two eyes.
E) coordination between the extraocular muscles.
Ans: B

 

 

37. In complete oculomotor nerve palsy, the pupil is:
A) depressed and abducted.
B) elevated and abducted.
C) depressed and adducted.
D) elevated and adducted.
E) fixed in a neutral position.
Ans: A

 

 

38. Following partial thyroidectomy a patient presents with signs and symptoms that you believe indicate his cervical sympathetic trunk was inadvertently transected during the procedure. Which of the following would not be consistent with your suspicion?
A) pupillary constriction
B) ptosis
C) inability to firmly close the eyelids
D) absence of sweating on the forehead
E) redness and increased temperature on the forehead
Ans: C

 

 

39. In the following illustration of a dissection of the infratemporal region, the arrow points to the:
A) lingual nerve.
B) inferior alveolar nerve.
C) chorda tympani.
D) buccal nerve.
E) masseteric nerve.
Ans: B

 

 

40. Blockage of the central artery of the retina due to an embolus is associated with:
A) total and immediate blindness.
B) partial blindness (loss of central vision).
C) glaucoma.
D) papilledema.
E) initial blindness followed by slow recovery, assuming that collateral circulation is provided by the ciliary arteries.
Ans: A

 

 

41. To anesthetize all of the mandibular teeth but not the tongue, you would place the needle of the syringe:
A) at the inferior opening of the foramen ovale.
B) at the opening of the mandibular canal.
C) at the opening of the mental foramen.
D) at the otic ganglion.
E) on the posterior aspect of the maxilla in the infratemporal fossa.
Ans: B

 

 

42. Excessive contraction of both lateral pterygoid muscles may result in:
A) fracture of the angle of the mandible.
B) fracture of the coronoid process of the mandible.
C) lateral dislocation of one mandibular condyle and medial dislocation of the other.
D) anterior dislocation of condyles of the mandible.
E) posterior dislocation of the condyles of the mandible.
Ans: D

 

 

43. Which of the following is incorrect pertaining to the muscles of mastication?
A) They are all innervated by the motor division of the trigeminal nerve.
B) The temporal, masseter, and medial pterygoid all can close the mouth.
C) Alternating contraction of the temporalis muscle can produce rotary movements.
D) Two of them attach to the lateral pterygoid plate.
E) The masseter can protrude the mandible.
Ans: C

 

 

44. Which of the following is incorrect pertaining to the lips?
A) They are attached by frenula to the vestibular gingiva.
B) The upper and lower lips receive sensory innervation via the infraorbital nerve.
C) Both lips receive blood via branches from the facial artery.
D) Lymph from the lips drain to the submandibular and submental lymph nodes.
E) They contain the orbicularis oris muscle.
Ans: B

 

 

45. In the emergency department you examine a patient complaining of severe maxillary sinus pain. Upon looking in his mouth, you observe severely degenerated maxillary molars. The patient admits that he has not been treated by a dentist for many years and recently had an upper posterior toothache. Which of the following is the most likely cause of the patient’s pain?
A) An infection from an upper molar has spread along the inferior alveolar nerve to the maxillary sinus.
B) An infection has spread via the root of an upper maxillary molar into the maxillary sinus.
C) Poor dental hygiene has resulted in alveolar bone retraction with accompanying fracture of a tooth and invasion of the maxillary sinus by oral bacteria.
D) Poor dental hygiene has caused the root of a maxillary molar to break and invade the maxillary sinus.
E) Poor dental hygiene has weakened the maxillary facial buttress causing both the toothache and sinus pain.
Ans: B

 

 

46. In the following coronal CT, the arrow points to the:
A) superior concha.
B) sphenoid sinus.
C) ethmoid sinus.
D) nasopharynx.
E) infundibulum.
Ans: C

 

 

47. Which of the following is incorrect pertaining to the soft palate?
A) It extends inferiorly as the palatine tonsil.
B) It is composed of both aponeurotic and muscular parts.
C) It is tensed against the posterior wall of the pharynx during swallowing.
D) It is tensed by a muscle that uses the pterygoid hamulus as a pulley.
E) It is provided with sensory innervation via the lesser palatine nerve.
Ans: A

 

 

48. Vallate papillae are taste receptors located:
A) on the hard palate.
B) on the soft palate.
C) on the tip of the tongue.
D) directly anterior to the terminal sulcus on the tongue.
E) on the epiglottis.
Ans: D

 

 

49. The chorda tympani nerve supplies:
A) motor innervation to the intrinsic muscles of the tongue.
B) motor innervation to the extrinsic muscles of the tongue.
C) sensory innervation to the fungiform papillae located at the apex of the tongue.
D) sensory innervation to the posterior third of the tongue.
E) sensory innervation to the epiglottis.
Ans: C

 

 

50. The gag reflex can be initiated by touching the posterior aspect of the tongue.  The nerve responsible for conducting the afferent part of this reflex is the:
A) lingual.
B) vagus.
C) glossopharyngeal.
D) hypoglossal.
E) pinnal accessory.
Ans: C

 

 

51. You are assisting an oral surgeon who is about to remove a calculus (stoma) from a patient’s submandibular duct. The surgeon asks you to remind him what nerve he has to be careful not to injure while incising the duct directly under the floor of the mouth. You reply:
A) spinal accessory.
B) lingual.
C) chorda tympani.
D) internal laryngeal.
E) glossopharyngeal.
Ans: B

 

 

52. Which of the following regions does not communicate with the pterygopalatine fossa via the indicated route?
A) infratemporal fossa via pterygomaxillary fissure
B) nasal cavity via the sphenopalatine foramen
C) orbit via the inferior orbital fissure
D) middle cranial fossa via foramen rotundum
E) sphenoid sinus via the pterygoid canal
Ans: E

 

 

53. Which of the following is not true of the nasal septum?
A) It forms the medial wall of the nasal cavity.
B) It is attached to the inferior nasal concha.
C) It has bony and cartilaginous parts.
D) It attaches to the cribriform plate superiorly.
E) It is partly innervated by the nasopalatine nerve
Ans: B

 

 

54. In the following lateral radiograph, the arrow points to:
A) a coronal suture.
B) a skull fracture.
C) a vessel in the temporalis muscle.
D) the groove for the middle meningeal artery.
E) the edge of the greater wing of sphenoid bone.
Ans: D

 

 

55. In which of the following areas of the nasal cavity would you look to determine whether the ostium of the maxillary sinus is obstructed?
A) vestibule
B) atrium
C) inferior meatus
D) middle meatus
E) superior to the opening of the auditory tube
Ans: D

 

 

56. The choanae:
A) are attached to the maxilla.
B) are attached to the ethmoid.
C) provide a passageway from the nasopharynx to the nasal cavity.
D) provide a passageway between the nasopharynx and the oropharynx.
E) provide an attachment for the tensor veli palatini.
Ans: C

 

 

57. Which of the following is correct pertaining to using an otoscope?
A) In infants and adults, the helix is pulled posterosuperiorly to reduce the curvature of the external acoustic meatus.
B) The tympanic membrane is typically transparent.
C) The handle of malleus is usually visible near the umbo.
D) Any light reflex from the otoscope’s bulb indicates an abnormality.
E) It is normal to observe an amber (bloody) colored fluid in the tympanic cavity.
Ans: C

 

 

58. You examine a patient with localized meningitis in the middle cranial fossa. The meningitis is believed to be secondary to otitis media. The most likely route by which the infection spread is through the:
A) floor of the tympanic cavity.
B) tegmen tympani.
C) labyrinthine (medial) wall of the tympanic cavity.
D) tympanic membrane.
E) pharyngotympanic tube.
Ans: B

 

 

59. In the following photograph of a view through an ophthalmoscope, the arrow points to the:
A) macula.
B) optic disc.
C) fovea centralis.
D) light reflex.
E) lens.
Ans: B

 

 

60. Hyperacusia would be associated with:
A) lesion of the chorda tympani.
B) lesion of the facial nerve at the internal acoustic meatus.
C) otitis media.
D) blockage of the pharyngotympanic tube.
E) increased endolymphatic pressure.
Ans: B

 

 

61. Which of the following is incorrect pertaining to the vestibular labyrinth?
A) It is composed of the saccule, the utricle, and the semicircular canals.
B) Its macula contains otoliths.
C) Its macula is innervated by the vestibulocochlear nerve.
D) Diseases result in Ménière syndrome.
E) It contains endolymph.
Ans: D

 

 

62. Which of the following is incorrect pertaining to the pterygopalatine ganglion?
A) It receives preganglionic parasympathetic fibers via the greater petrosal nerve.
B) Sympathetic fibers reach it via the deep petrosal nerve.
C) If stimulated, tearing of the eyes and nasal secretions occur.
D) Both sympathetic and parasympathetic fibers travel through the pterygoid canal to reach it.
E) The ganglion contains the cell bodies of the postganglionic sympathetic neurons.
Ans: E

 

 

63. The abnormality shown in the following illustration is called:
A) cleft lip.
B) split lip.
C) separated lip.
D) canine separation.
E) incisor hiatus.
Ans: A

 

 

64. The arrow in the following photograph points to the:
A) limbus.
B) conjunctival fornix.
C) lacrimal punctum.
D) lacrimal lake.
E) orbital recess.
Ans: B