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A bullet entering the body at the fifth right intercostal space in the midclavicular line, and passing horizontally through the thorax from front to rear, would injure:
- the middle lobe of the lung
- the lower lobe of the lung
The external laryngeal nerve:
passes close to the superior thyroid artery
The thoracic duct:
could be torn by a fractured left clavicle
Regarding the vasculature of the thorax and neck:
the vertebral artery is usually the first branch of the left subclavian artery
Which of these statements concerning the superior mediastinum or its contents is true?
It contains two brachiocephalic veins.
The vagus nerve does all of the following except:
carries nerve fibers that contribute to the ansa cervicalis
The spleen is adjacent to which of the following?
- left kidney
- 10th rib
The spleen is located in which abdominal region?
Based on the direction of lymphatic drainage from the stomach, you would expect stomach cancer to spread initially to which of the following organs?
liver and pancreas
All of the following arteries are branches of the superior mesenteric artery, EXCEPT the:
- A. superior pancreaticoduodenal
- B. inferior pancreaticoduodenal
- C. right colic
- D. ileocolic
- E. middle colic
All of the following statements concerning the abdominal aorta are correct, EXCEPT:
- A. The three unpaired visceral branches supply the gastrointestinal tract and associated organs.
- B. Paired gonadal vessels usually arise between the inferior mesenteric artery and the two renal arteries.
- C. The most superior branches of the abdominal aorta are the inferior suprarenal arteries.
- D. The aorta enters the abdomen through the aortic hiatus of the diaphragm formed by the right and left crura.
- E. Aorta lies adjacent to the bodies of the vertebrae as it passes inferiorly.
Select the INCORRECT statement regarding the kidney.
- A. The renal papillae empty directly into the major calyces.
- B. The ureter is the most posterior structure in the hilus of the kidney.
- C. The kidneys lie retroperitoneally.
- D. The right kidney lies slightly lower than the left kidney.
- E. The kidneys lie adjacent to the suprarenal glands.
Identify the INCORRECT statement regarding the femoral nerve.
- A. Arises from the lumbar plexus.
- B. Courses inferiorly and laterally between psoas and iliacus muscles.
- C. Enters the thigh posterior to the inguinal ligament.
- D. Courses lateral to the obturator nerve.
- E. Supplies the quadratus lumborum.
The hepatic portal system communicates with the systemic (caval) system at the:
lower third of the esophagus where the left gastric vein drains into esophageal veins
lie at the level of the celiac trunk
help prevent backflow into atria
Blood is supplied to the right ventricle via the:
- marginal branch of right coronary a.
- right coronary a.
- left coronary a.
- posterior interventricular a.
During forced inspiration:
contraction of the diaphragm develops more negative intrathoracic pressure
In the thorax:
each sternoclavicular joint has two synovial cavities and an articular disk
Which of the following is FALSE?
- A. The linea semilunaris is formed by the lateral border of rectus abdominis m.
- B. The inferior epigastric a. is a branch of external illac a.
- C. The transversalis fascia is part of the endoabdominal fascia.
- D. The superior pathway of internal oblique m. has its muscle fibers directed inferomedially.
- E. The abdominal wall is supplied in part by the lower 6 intercostal nerves.
The following are true of the conducting system of the heart EXCEPT:
- A. the SA node is located near the superior end of the crista tenninal is
- B. the SA node communicates with the AV node via AV bundle
- C. the AV node is located in the interatrial septum just superior of the coronary sinus
- D. the AV bundle coordinates the contraction of both left and right ventricles
- E. the conducting system is organized such that atria contract superior y to inferior1y and ventricles inferiorly to superiorly
Supplies pancreas; gives rise to short gastric arteries and to the left gastro-epiploic artery.
Gives rise to appendicular branch; has ileal branches; supplies cecum.
Is a branch of the common hepatic artery; gives rise to the rightgastroepiploic artery.
Its branches supply the splenic flexure of the colon and the sigmoid colon.
inferior mesenteric artery
Courses posterior to the first part of the duodenum; gives rise to branches that supply the head of pancreas.
In the root of the lung the pulmonary artery tends to lie:
cranial to the pulmonary veins
the infraorbital nerve
- -lies deep to the levator labii superioris muscle
- -is superficial to the levator anguli oris muscle
- -supplies the skin of the lower eyelid
The facial artery:
- -takes origin at about the same level as the occipital artery
- -is palpable at the inferior border of the mandible
Structures usually found at vertebral level C5 include:
-common carotid artery
Structures that lie close enough to the inferior thyroid artery to be endangered during its ligation include:
- - vagus nerve
- - recurrent laryngeal nerve
- - sympathetic trunk
communication between portal and caval is the site of venous systems in adults
The ligamentum teres of the liver:
- is connected to a branch of the portal vein
- lies within the falciform ligament
Identify the correct statement(s) regarding the diaphragm.
- It is supplied by the phrenic nerve.
- The foramen for the inferior vena cava is at vertebral level T8.
Which of the following is (are) true of the lesser omentum?
- forms the hepatoduodenal ligament
- contains common bile duct
Heart valves are best heard:
- 2nd interspace, left of sternum - for pulmonic
- 2nd interspace. right of sternum - for aortic
- 5th to 6th interspace, left of sternum - for tricuspid
- 5th interspace, midclavicular line (left) - for mitral
Regarding autonomic supply of the heart:
- 1. controls heart rate via sympathetics synapsing inpart in the superior cervical ganglion
- 2. heart rate is reduced via vagal stimulation
- 3. is distributed over the coronary arteries in the form of plexuses
Inferior to the arcuate line. the rectus abdominis muscle is anterior to the:
The subcostal nerve carries what kind of information?
- somatic sensory
- visceral sensory
- somatic motor
- visceral motor
The paravertebral ganglia at vertebral level TIl:
- contain fibers whose cell bodies are located in the intermediolateral cell column
- have both white and gray rami communicantes
A patient, previously diagnosed as having a gastric ulcer was struck suddenly with severe epigastric pain a half hour after eating. He was nauseous, sweating, vomiting and weakened by the insistent pain. His breathing became rapid and shallow, his upper abdomen became rigid. The pain later moved to and became sharply localized in the upper lumbar region of his back. He was prepared for surgery and upon opening the peritoneal sac fragments of food were seen. The operation was successful and the patient recovered.
- 46. The initial poorly localized pain is carried by:
- 47. The localization of pain to the back initiated stimulation of:
- 48. Upon seeing food in the peritoneal cavity the surgeon incised the gastrocolic ligament to observe the posterior surface of the stomach. The gastrocolic ligament:
- 50. Food exiting the lesser sac will first come into contact with or initially pass by:
- 46. afferents contained within the greater splanchnic nerve
- 47. the posterior wall of the lesser sac
- 48. attaches to the greater curvature of the stomach
- 50. the visceral surface of the liver
In performing a left stellate ganglion block through the root of the neck superior to the clavicle, the~tructure least likely to be damaged:
internal thoracic artery
The blood supply of the ureter includes:
- -renal artery
- -gonadal artery
- -common iliac
All of the following groups of lymph nodes drain into the thoracic duct except:
The right axillary lymph nodes
Arteries involved in establishing collateral circulations from the subclavian to the occipital area of the scalp include:
- deep branch of occipital
- costocervical trunk
Muscles of the posterior abdominal wall supplied by branches of the lumbar plexus include the:
- psoas muscle
- quadratus lumborum
The parotid gland:
has overlying skin innervated by a branch of the cervical plexus
The sympathetic trunk in the neck:
- has fewer than 7 ganglia
- What lies behind the rectus abdominis muscle at a level 2cm above the pubic symphysis?
- A. transversalis fascia and aponeurosis of transversus abdominis muscle
- B. transversalis fascia
- C.transversalis fascia, aponeurosis of transversus abdominis muscle, part
- of aponeurosis of internal abdominal oblique muscle
- D. Superior epigastric artery
The pleural cavities contain:
- A Lungs
- B. Pulmonary ligaments
- C. Phrenic nerves
- D. A and B above
- E. none of the above
Which abdominal incision would do least damage to the function of rectus abdominis muscle?
- A. Along the costal margin
- B. Accross the transpyloric plane
- C. Along the linea semilunaris
- D. Along the linea alba
- E. Across the transtubercular plane
A swallowed piece of glass lacerates the anterior esophageal wall at vertebral level T7. Which of the structures below might also be lacerated?
The cell bodies of preganglionic parasympathetic neurons that distribute to the descending and sigmoid colon are located in:
sacral cord segments S7 -S4
Which of the following is FALSE regarding nerve fibers transmitting pain from the heart?
- A. they enter lower cervical spinal cord segments
- B. they are visceral afferents
- C. they have cell bodies in dorsal root ganglia
- D. they synapse in the thoracic sympathetic trunk
- E. they enter upper thoracic spinal cord segments
The pulmonic valve is heard most clearly over the:
second left intercostal space
Nerves supplying the rectus abdominis muscle:
include spinal nerves T7 to Ll OR pass between internal abdominal oblique and transversus abdominis mm.
are encased in the renal fascia
The gallbladder lies deep to the junction of the costal arch and the:
right linea semilunaris
In the midaxillary line, the pleural cavity extends inferiorly as far as the rib:
The right kidney:
- Has its hilum turned slightly anteriorly by the psoas muscle.
- Is NOT covered posteriorly by peritoneum
- Is NOT in contact with the head of the pancreas
- Lies slightly inferior to the left kidney
- Has its ureter supplied by multiple arteries
What drains the sigmoid colon?
Lymph from the descending colon can drain toward the cisternal chyli via vessels accompanying:
- A. The inferior mesenteric vein
- B. Gastroepiploic veins
- C. Pancreaticoduodenal veins
- D. Renal veins
- E. All of the above
- acts to depress (pull caudalward) the last rib
- is supplied by ventral primary rami
In what order would a red blood cell in one of the brachiocephalic veins pass through the adult heart?
Superior vena cava, right atrium, left ventricle, pulmonary trunk
- Normally is accomplished by interting a needle into the pleural cavity in the mid-axillary line opposite intercostal spaces 8 and 9.
- May penetrate the diaphragm if done incorrectly.
Which of the following is false?
The left atrium delivers blood directly to the ascending aorta.
Carries parasympathetic fibers toward the stomach
Causes a decrease in peristalsis and glandular secretion in the gut
greater and lesser splanchnic nerves
Supplies suprarenal glands
Greater and lesser splanchnic nerves
Provides parasympathetic innervation to the distal 1/3 of the colon
Damage to vagus nerve at base of skull
- Endangers a branch (or branches) of the superior laryngeal nerve
- And endangers a recurrent laryngeal nerve
Ligation of superior thyroid artery
Endangers a branch (or branches) of the superior laryngeal nerve
Ligation of inferior thyroid vein
Does not endanger a branch of the superior laryngeal nerve, not a recurrent laryngeal nerve
Ligation of patent ductus arteriosus
Endangers a recurrent laryngeal nerve
Laceration of posterolateral part of thyrohyoid membrane
Endangers a branch of the superior laryngeal nerve
- Receives blood from both the celiac and superior mesenteric arteries
- Lies posterior to the stomach
- Has a main and accessory duct
- Lies entirely retroperitoneally
Concerning the infrahyoid muscles:
- The sternothyroid limits the superior migration of an enlarging thyroid gland
- Indluce one pair which is attached to the clavicle by a fascial sling
Branches of the internal thoracic artery include:
- anterior intercostal arteries
- musculophrenic artery
- superior epigastric artery
If the common bile duct were obstructed by a stone just inferior to termination of the cystic duct, the:
- gallbladder might be distended
- biliary system would be blocked
- Has an aponeurourotic layer (galea) that serves as an intermediate muscle tendon
- Receives fibers from anterior and posterior primary rami of spinal nerves
The vagus nerves
- Enter the thorax more medially than do the phrenic nerves
- Pass posterior to the roots of the lungs
- Supply the ascending colon
A tracheotomy at the cricothyroid membrane:
- Is more likely to encounter the pyramidal love than the isthmus of the thyroid gland
- Is performed superior to tracheal rings 2, 3, and 4
- May perforate the anterior jugular vein
The right lung has:
- Three lobes - superior, middle and inferior
- One more fissure than the left lung
- Two fissures and 3 secondary bronchi
- 10 tertiary bronchi
Primary blood supply to ileocecal valve
Superior mesenteric artery
Primary blood supply for duodenal bulb
Supplies junction of esophagus and stomach
Supplies embryonic hindgut derivatives
Inferior Mesenteric Trunk
Critically ill patients have a catheter inserted into the subclavian vein as it passes superior to the first rib. The catheter is to be passed into the heart in order to administer drugs, obtain blood, monitor venous pressure etc.
46. In one patient the catheter was inserted on the left side too far medially; at the junction of the subclavian and internal jugular veins. The patient subsequently developed a large swelling overlying the region which contained milky white fluid. What has occurred?
- A. the internal jugular vein has been damaged
- B. the thoracic duct has been damaged
- C. the internal mammary artery has been damaged
- D. the anterior scalene muscle has been penetrated
- E. none of the above
47. In another patient the needle carrying the catheter penetrated the left cupola. Which of the following might be observed?
- A. mediastinum deviated to the left side
- B. mediastinum deviated to the right side
- C. collapsed the lung on the right
- D. All of the above
- E. none af the above
48. Sometimes, at the same location a cardiac catheter is inserted into the subclavian artery instead of the subclavian vein. Which of the following is (are) true?
- A. the artery is posterior to the vein
- B. the uter.y and vein are separated by the anterior scalene muscle at the first rib
- C. the phrenic nerve is in contact with the vein but not the artery
- D. the catheter will pass directly into the aorta from the subclavian artery on the left but not the right side
- E. all of the above
49. In penetratin structures above the clavicle, the needle will pass through which of the following fascial planes?
- A. Clavicopectoral fascia
- B. investing layer of deep cerical fascia
- C. pretracheal fascia
- D. prevertebral fascia
- E. Scarpa's fascia
50. In the patient, following catheterization, fluoroscopy shows the tip of the catheter ascending the patients neck. Which of the following has occurred?
- A. The catheter has passed into the subclavian artery and then the common carotid artery
- B. The catheter has passed into the brachiocephalic vein
- C. The catheter has entered the superior intercostal vein
- D. The catheter has entered the internal jugular vein
- E. The catheter has entered the thoracic duct.
- 46. B 47.B 48.E 49.B 50.D _________________
All of the following are located approximately at the level of the first lumbar vertebra except the:
- A. upper part of left renal pelvis
- B. transpyloric plane
- C. origin of superior mesenteric artery
- D. origin of the renal artery
- E. pylorus
Obstruction of the inferior vena cava would cause blood to flow:
-through the superficial epigastric veins, toward the umbilicus
-from the superficial epigastric veins into the lateral thoracic veins
Concerning the pericardial sac:
- It is firmly anchored at the central tendon of the diaphragm
- It is continuous with the epicardium at the reflexion sites on the great vessels
- It has a fibrous and a serous layer
- It invests the terminal 3-5cm of the superior vena cava
The following total structures form the following adult structures:
- urachus - median umbilical ligament
- umbilical arteries - medial umbilical ligaments
- septup transversum - central tendon of diaphragm
- umbilical vein - ligamentum teres of liver
Sensory supply to the diaphragm is via the:
- phrenic nerve
- lower intercostal nerves
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