Anatomy Exam 1 – 2018

Included Content

  • Anatomicromedical Terminology & Overview of Bodily Systems 
  • Extrinsic Back Muscles 
  • Vertebral Column 
  • Intrinsic Back Muscles & Suboccipital Region
  • Spinal Canal Contents 
  • Introduction to Ultrasonography 
  • Shoulder Region 
  • Pectoral Region & Superficial Structures of the Upper Limb 
  • Axilla 
  • Brachial Plexus 
  • Arm & Cubital Fossa 
  • Anterior Forearm 

1. Angel S. is an avid cross-fitter who (like most cross-fitters) enjoys exercising with little regard for proper form. No matter what anyone tells her, she is set on using improper form during her dead lift. Angel comes to you for advice after she begins experiencing pain while extending her back. You tell her to consult a physician, as you are only an OMS I, but she can’t afford health insurance since she spends all her money on cross fit. You finally give in and suggest that she has probably injured what muscle(s)?

  1. Trapezius
  2. Latissimus dorsi
  3. Rhomboids
  4. Erector Spinae  

2. Sheila is brought to the ED after being involved in a motor vehicle accident. She was rear-ended by a driver who wasn’t paying attention. Luckily, Sheila was wearing her seat belt. However, she did experience whiplash. The following x-ray was obtained. What structure was affected?

  1. The odontoid process of C2
  2. The spinous process of C2
  3. The body of C2
  4. The lamina of C1

3. Which of the following is true regarding obesity and its effect on the spine?

  1. It can lead to excessive thoracic kyphosis
  2. It can lead to excessive sacral kyphosis
  3. It can lead to excessive lumbar lordosis
  4. None of the above 

4. The following image was obtained from a patient. What answer best describes the problem?

  1. A herniated disc is compressing dorsal funiculus
  2. A herniated disc is compressing the ventral funiculus
  3. An osteophyte is compressing the dorsal funiculus
  4. An osteophyte is compressing the ventral funiculus

5. A slipped disc results when the nucleus pulposus component of an intervertebral disc herniates and compresses the spinal cord. What structure(s) would the nucleus pulposus have to penetrate in order to compress the spinal cord?

  1. Anulus fibrosus
  2. Anterior longitudinal ligament
  3. Posterior longitudinal ligament
  4. A & B
  5. A & C

6. You are performing your rotations in the ED when you are asked by an attending to assist with a spinal tap. The patient is a 32 y/o male who presented with a high fever, headache, and a stiff neck. Upon performing the spinal tap, you note that the CSF is coming out at a rate of 3 drops/sec indicating elevated pressure. The CSF is clear, so the physician orders more testing to determine the cause of increased pressure. The testing shows that CSF glucose levels are low with a high level of polymorphonuclear leukocytes (PMNs). What is the most likely diagnosis?

  1. Viral meningitis
  2. Bacterial meningitis
  3. Subarachnoid hematoma
  4. Influenza A  

7. You are performing rotations at Mercy when you come across the radiologist who asks you to help him make a diagnosis. He shows you the following image and tells you that the patient is exhibiting sensory deficits in the lower limbs. You tell him that:

  1. The patient has a herniated disc that is compressing his dorsal root
  2. The patient has a herniated disc that is compressing his ventral root
  3. The patient has an osteophyte that is compressing his ventral root
  4. The patient has an osteophyte that is compressing his dorsal root

8. Which structures must be punctured in order to perform a spinal tap?

  1. Intervertebral disc
  2. Ligamentum flavum
  3. Dura Mater
  4. B & C only
  5. All of the above

9. You are performing rotations at Mercy when you are asked to check on a 5 y/o pediatric patient. The attending tells you that the patient was born with a heart murmur, which has persisted into childhood. He would like you to perform an ultrasound and confirm the cause of the murmur. He gives you the ultrasound machine and asks you what transducer you should use. You tell him you are going to use:

  1. The curved transducer
  2. The linear transducer
  3. Phased array transducer
  4. The square transducer

10. Which of the following explains the purpose of ultrasound gel?

  1. Decrease the friction between the patient and the transducer
  2. It protects the transducers crystals from being scratched
  3. It reduces the air interface between the patient and the transducer, which would otherwise cause a substantial amount of artifact
  4. It provides an analgesic effect

11. You are performing your first spinal tap. What is a good bony landmark to look for in order to help guide you in finding the correct vertebrae?

  1. Inferior angle of the scapula
  2. Spine of the scapula
  3. Vertebral prominence  
  4. Most superior border of iliac crest

12. Syringomyelia is a disorder in which a fluid-filled cyst (called a syrinx) forms within the spinal cord central canal.  This syrinx can get bigger and elongate over time, damaging the spinal cord and compressing and injuring the nerve fibers that carry information to the brain and from the brain to the rest of the body. What gray matter is most likely to be compressed first if a patient has this condition?

  1. Laminae XII
  2. Laminae XI
  3. Laminae XI
  4. Laminae X

13. You are performing rotations in the OB-GYN department. An attending asks you to assist with an ultrasound of a patient in her 3rd trimester. You get the ultrasound machine set up, and apply the ultrasound gel to the patient’s abdomen. As the attending performs the ultrasound, she tells you that the picture is too dark. You should help her out by:

  1. Increasing the gain
  2. Decreasing the gain
  3. Decreasing depth
  4. Increasing depth

14. Which of the following is true?

  1. Extrinsic muscles arise from the hypomere and are innervated by the posterior rami
  2. Extrinsic muscles arise from the hypomere and are innervated by the anterior rami
  3. Intrinsic muscles arise from the hypomere and are innervated by the posterior rami
  4. Intrinsic muscles arise from the epimere and are innervated by the anterior rami

15. You finally decide to take a break from studying and decide to go for a jog. Upon doing so, you accidentally misstep into a pothole and notice immediate pain on the posterior side of your ankle. You also notice that you have lost all ability to perform plantar flexion. You consult a physician, and she tells you that you have torn your Achilles tendon. Which of the following is true regarding your injury?

  1. You are exhibiting a grade 1 strain
  2. You are exhibiting a grade 2 strain
  3. You are exhibiting a grade 3 strain
  4. You are exhibiting a sprain
  5. You are exhibiting a spasm

16. Upon examining a recently mounted slide, you realize that something is wrong. The picture below shows what you are viewing. What type of artifact caused this to occur?

  1. Precipitates
  2. Knife marks
  3. Folding
  4. Poor dehydration

17. Vertebrobasilar insufficiency is a condition characterized by poor blood flow to the posterior (back) portion of the brain. Vertigo, the sensation of spinning even while a person is still, is the most recognizable and quite often the sole symptom of decreased blood flow in the vertebrobasilar distribution. The vertigo due to this condition can be brought on by head turning, which could occlude what artery resulting in decreased blood flow to the brain?

  1. Occipital artery
  2. Vertebral artery
  3. Transverse cervical artery
  4. Common carotid artery

18. This is an example of a(n):

  1. T2 weighted MRI
  2. CT Scan
  3. X-ray
  4. T1 weighted MRI

19. You have a patient whom you suspect may have pancreatic cancer based on her clinical presentation. What imaging technique should you order to confirm this assumption?

  1. X-ray
  2. MRI
  3. CT
  4. PET

20. Which of the following would result in the least amount of radiation for your patient?

  1. X-ray
  2. CT
  3. MRI
  4. PET

21. What imaging technique(s) is safe for pregnant patients?

  1. MRI
  2. X-ray
  3. Ultrasonography
  4. B & C
  5. A & C

22. Which material is the most radiopaque?

  1. Bone
  2. Teeth
  3. Gas
  4. Water
  5. Fat

23. Scleroderma is a chronic connective tissue disease that affects the skin and may also affect internal organs in some people. It causes the body to produce too much collagen. Which staining technique would be most useful in diagnosing an individual with this disease?

  1. Masson’s Trichrome
  2. Periodic Acid Schiff
  3. MEthyelene Blue
  4. H&E
  5. Ammoniacal silver

24. Injury to the Dorsal scapular nerve would lead to:

  1. Inability to retract scapula
  2. Inability to elevate the scapula
  3. Inability to shrug
  4. Weakness in retraction of the scapula

25. Phosphorylation is a post translational modification that is responsible for either the deactivation or activation of various proteins. Which cell organelle would be responsible for this modification?

  1. RER
  2. SER
  3. Golgi Apparatus
  4. Cytoskeleton
  5. Ribosome
  6.  

26. Adrenoleukodystrophy is a genetic, x chromosome linked disorder that inhibits the oxidation of fatty acids, leading to an accumulation of lipids in the brain and adrenals. Which of the following cellular structures is this disease most concerned with?

  1. Lysosomes
  2. Golgi Apparatus
  3. Mitochondria
  4. Proteasomes

27. A patient is exhibiting proximal muscle weakness, lactic acidosis, cardiomyopathy, and other various neurological symptoms. In his chart you note that he has been diagnosed with a genetic disorder that was inherited from his mother. What is the general name for this disease?

  1. Lysosomal storage disease
  2. Mitochondrial myopathy
  3. Zellweger Syndrome
  4. Turner’s syndrome

28. Microvillus inclusion disease is a rare genetic disorder of the small intestine that is inherited in an autosomal recessive pattern. It is characterized by chronic, intractable diarrhea in new-born infants, starting in the first few days of life. This results in metabolic acidosis and severe dehydration. Which of the following cellular components is associated with this disease?

  1. Microtubules
  2. Thin filaments
  3. Intermediate filaments
  4. Kinesin

29. Zellweger syndrome, also called cerebrohepatorenal syndrome, is a rare congenital disorder characterized by the reduction or absence of what cellular organelles in the body? 

  1. Lysosomes
  2. Mitochondria
  3. Peroxisomes
  4. Ribosomes

30. Gaucher disease is caused by a deficiency of the enzyme glucocerebrosidase.  Fatty material can collect in the brain, spleen, liver, kidneys, lungs, and bone marrow. This disease is most likely concerned with which of the following cell organelles?

  1. Golgi Apparatus
  2. Smooth ER
  3. Lysosome
  4. Mitochondria
  5. Rough ER

31. Von Gierke disease is the most common of the glycogen storage diseases. This genetic disease results from deficiency of the enzyme glucose-6-phosphatase and impairs the ability of the liver to produce free glucose from glycogen. What cellular organelle is most likely associated with this disease?

  1. Rough ER
  2. Smooth ER
  3. Lysosome
  4. Peroxisome
  5. Cytoskeleton

32. Immotile cilia syndrome (ICS) is an autosomal recessive disease with extensive genetic heterogeneity characterized by abnormal ciliary motion and results in infertility. Ultrastructural and functional defects of sperm result in the lack of effective ciliary motility, causing abnormal mucociliary clearance. Which of the following most likely describes the functional defects associated with the cilia on these sperm?

  1. Absence of dyneins
  2. Absence of kinesins
  3. Absence of actin
  4. Absence of lamins

33. Which of the following consequence(s) are most likely to result from axially node dissection?

  1. Winged scapula
  2. Wrist drop
  3. Claw hand
  4. A & B
  5. All of the above

34. A metastatic tumor was found in the 10 o’clock position on a patient’s left breast. Which of the following would be considered the sentinel lymph nodes for this patient?

  1. Apical
  2. Central
  3. Humeral
  4. Pectoral
  5. Subscapular  

35. Bobby, a college baseball pitcher, comes to your clinic. His ability to flex his arm at his cubital joint has been severely weakened. All other functions are intact. Upon further examination you discover that Bobby has an aneurysm of the axillary artery which is compressing a portion of his brachial plexus. What part of Bobby’s brachial plexus is being affected?

  1. Medial cord
  2. Posterior cord
  3. Inferior trunk
  4. Superior trunk

36. A patient is rushed to the ED after being ejected from his vehicle. Luckily, the patient only acquired one injury, which is shown below in the x-ray. Which of the following muscle tendons may be displaced as a result of this injury?

  1. Short head of the biceps brachii
  2. Long head of the biceps brachii
  3. Subscapularis
  4. Teres major

37. Billy is an active tennis player but has recently been unable to play due to excess pain near his shoulder. He comes to your clinic and you explain (in layman’s terms) that his pain is associated with the inflammation of the tendon which moves back and forth within the intertubercular groove. You diagnose him with tendonitis of the:

  1. Latissimus dorsi
  2. Medial head of the triceps brachii
  3. Short head of the biceps brachii
  4. Long head of the biceps brachii

38. You are playing softball with your fellow OMS I classmates one evening when you get over zealous and decide to slide into second base. This decision leads to a fracture about the medial epicondyle of your humerus. What deficit are you most likely to have?

  1. Inability to flex wrist
  2. Inability to pronate forearm
  3. Inability to adduct wrist
  4. Inability to abduct wrist

39. Jim was in a car accident where he received a penetrating injury to the lateral portion of his right upper arm. He is unable to abduct his arm above 15º. You tell him that you suspect he may have injured his:

  1. Accessory nerve
  2. Suprascapular nerve
  3. Axillary nerve
  4. Thoracodorsal nerve

40. Which of the following is incorrect?

  1. The subscapularis muscle assists in medial rotation of the arm
  2. The latissimus dorsi is responsible for adduction, medial rotation, and extension of the arm
  3. The teres major assists with adduction and lateral rotation of the arm
  4. The teres minor assists with medial rotation of the arm
  5. None of the above

41. Which of the following correctly describes articulations within your wrist joint?

  1. The ulna articulates with the carpal bones  
  2. The radius articulates with the carpal bones  
  3. The ulna articulates with the radius
  4. B & C
  5. A, B, & C

42. Sarah falls off her bike and fractures her humerus distally, near the supra-epicondylar ridges. Which of the following could potentially occur?

  1. She will be unable to pronate her forearm   
  2. Her ability to flex her wrist will be severely weakened
  3. She will be unable to extend her arm at the elbow
  4. She will be unable to extend her wrist
  5. A, B, and D
  6. All of the above

43. A patient was exhibiting dorsiflexion of the hand following a hard fall on their outstretched arm. The following image was acquired. What best describes this injury?

  1. Wrist drop
  2. Colle’s fractures
  3. Smith’s fracture
  4. Claw hand

44. Carpal tunnel syndrome is a common condition that causes pain, numbness, and tingling in the hand and arm. The condition occurs when one of the major nerves to the hand is squeezed or compressed as it travels through the wrist. What nerve is affected by this condition?

  1. Ulnar nerve
  2. Deep branch of the radial nerve
  3. Superficial branch of the radial nerve
  4. Median nerve

45. Seth B., an OMS I student in need of a break from studying for his first anatomy exam, decided to hit up the Cowboy the Saturday night before his test. Unfortunately, he was mugged in the parking lot before he could have even one Vegas bomb. During the mugging, Seth was brutally stabbed by the assailant in the anterior forearm. He went to the ER where it was discovered that, while many functions of his wrist and hand were impaired, adduction of his wrist was intact. What nerve(s) were most likely damaged in the attack?

  1. Ulnar nerve
  2. Radial nerve
  3. Median nerve
  4. A & B
  5. A & C

46. Kiloh-Nevin syndrome is a medical condition that causes pain in the forearm and, most notably, impaired flexion of the thumb. Which nerve is most likely impaired?

  1. Anterior interosseous nerve
  2. Posterior interosseous nerve
  3. Radial nerve
  4. Ulnar nerve

47. Sally was involved in a motorcycle accident in which she received a penetrating injury on the anterior forearm, at the level of the cubital joint. During your examination, you ask her to make a fist to confirm suspected nerve damage. When Sally attempts to do this, her 2nd and 3rd fingers remain partially extended forming the “hand of benediction.” Which nerve is damaged?

  1. Ulnar nerve
  2. Superficial branch of the radial nerve
  3. Median nerve
  4. Deep branch of the radial nerve

48. What is true of Meiosis?

  1. One diploid progenitor cell becomes four haploid daughter cells
  2. It occurs only in somatic cells
  3. Meiosis II creates genetic diversity with synapsis and crossing over
  4. Oogenesis ends in the creation of two oocytes and two polar bodies  

49. Trisomies are often the result of which process?

  1. Synapsis
  2. Crossing over
  3. Oogenesis
  4. Disjunction

50. Which of the following is the correct description of someone with Klinefelter syndrome?

  1. Normal fertility, sometimes learning disabilities, but a majority go undiagnosed
  2. Usually shorter, low set ears, webbed neck, and usually do not being menstruating.
  3. Increase interocular distance and usually learning disabilities
  4. Usually taller, sterile, smaller testicles, decreased hair, & lower libido.

51. Which of the following is the correct description of someone with Triple X syndrome?

  1. Usually taller, normal fertility, sometimes learning disabilities, but a majority go undiagnosed
  2. Usually shorter, low set ears, webbed neck, and usually do not being menstruating.
  3. Increase interocular distance and usually learning disabilities
  4. Usually taller, sterile, smaller testicles, decreased hair, & lower libido.

52. Betty and Dan come into your clinic and tell you that they have been wanting to conceive, but have had no luck. Upon further testing of Dan, you realize that he is lacking the acrosin enzyme which is vital for sperm penetration of the oocyte. This deficiency is inhibiting the oocyte to be fertilized. Which specific layer of the oocyte can the sperm not penetrate?

  1. Corona radiata
  2. Zona pellucida
  3. Plasma membrane
  4. Perivitelline space

53. A 16 y/o female comes into your clinic and discloses that she is scared she might be pregnant. When questioned, she tells you that she had unprotected sex 6 days prior. What would be a good course of action for you to take?

  1. Order a test for early pregnancy hormone
  2. Order a test for HCG hormone
  3. Tell her the come-back in few weeks since her hormones can’t be detected yet
  4. Order a test for estrogen hormone

54. You are doing your clinical rotations in the OB-GYN department at Mercy when you come across a patient who is in her second trimester experiencing excessive vaginal bleeding. After performing an ultrasound, you realize that implantation occurred over the covering of the cervix. What is the diagnosis?

  1. Placenta abrutio
  2. Placenta previa
  3. Ectopic pregnancy
  4. Abdominal pregnancy

55. Which of the following could result in a sacrococcygeal teratoma?

  1. premature regression of the primitive streak during gastrulation.
  2. Abnormal persistence of primitive streak tissue after completion of gastrulation.
  3. abnormal closure of the posterior (caudal) neuropore.
  4. abnormal migration and proliferation of lumbosacral neural crest.

56. Which of the following describes the process by which birth control is used to prevent ovulation?

  1. Birth control pills release a daily dose of estrogen which inhibits ovulation by preventing secretion of FSH and LH from the pituitary
  2. Birth control pills release progestin to interfere with the release of FSH and LH
  3. Birth control pills release progestin to interfere with oocyte transport down the oviduct
  4. A & C
  5. All of the above

57. A 27 y/o male presents to the ED following a motorcycle accident. The patient was ejected from his bike causing him to land on his back, and fracture his T12 vertebrae. A bone fragment from the fracture is putting pressure on his right lateral funiculus. Which of the following would describes this patient’s deficit?

  1. The patient would experience altered sensations of pain and temperature from his lower right limb
  2. The patient would experience altered vibratory sensations from his lower right limb
  3. The patient would experience altered sensations of pain and temperature from his upper left limb
  4. The patient would experience weakness in his lower right limb

58. You are reading a case report of a gymnast that was diagnosed with a fractured coccyx after falling off the uneven bars. Based on what you know about sacrococcygeal dimorphisms, what is likely true regarding this patient?

  1. This patient is most likely male
  2. This patient is most likely female
  3. This patient most likely has Osteosarcoma
  4. This patient most likely suffers from osteoporosis