1.
A 20-year-old male presents to you with a high steppage gait on the right side. You
suspect that he uses this compensatory gain because he suffers from foot drop.
What scenario is the most plausible regarding his condition?
Correct Answer
C. He was slashed with a knife near the lateral knee by a hoodlum on a skateboard
Explanation
Damage to the common fibular nerve results in foot drop. This nerve is most
commonly injured near the fibular head or neck because it is very superficial at this
location, and in close proximity to the bone.
2.
Which tarsal bone articulates with more than one metatarsal bone?
Correct Answer
D. Cuboid
Explanation
Cuboid articulates with the 4th and 5th metatarsals
3.
The superficial fibular nerve is severed near its origin. What motor deficit(s) would
you expect in a patient with this injury?
Correct Answer
C. Weak eversion
Explanation
Superficial fibular nerve innervates the lateral compartment muscles, both of
which are evertors of the foot (as well as very weak plantarflexors). Fibularis tertius is innervated by deep fibular nerve (intact in this patient), and so it can still provide
some ability for eversion.
4.
A patient presents to the emergency department with shortness of breath (dyspnea)
and cold clammy hands. Your team determines that the patient suffers from a
cardiac tamponade (due to blood within the pericardial sac, putting pressure on the
heart). You are asked to perform a pericardiocentesis to save the patient’s life. You
select your needle and insert it in which location in order to minimize risk?
Correct Answer
D. Left infrasternal angle
Explanation
The pericardium can be accessed from the anterior thorax through the Bare Area,
so called because the cardiac notch in the left lung (and its pleural covering) leaves
part of the pericardium exposed at this location. This is an area where the left lung
deflects laterally creating a dull space in the thorax. It is located in the Left
infrasternal angle, which is between the xiphoid process and costal margin, and can
also be accessed through the left 5th and 6th intercostal space immediately to the left
of the sternum.
5.
While performing pericardiocentesis, you unintentionally pierce a vessel running
parasternally within the internal thorax. What vessel has most likely been damaged?
Correct Answer
D. Internal thoracic artery
Explanation
The internal thoracic artery (aka internal mammary artery) is a branch of the
subclavian artery; it runs immediately lateral to the sternum (i.e., parasternally) along
the internal thorax, and thus may be damaged during pericardiocentesis. This artery
has 2 terminal branches: the superior epigastric and musculophrenic arteries.
6.
During open heart surgery, you are instructed by the surgeon to clamp the outflow
vessels of the heart. The anatomical space through which you will place the clamp is
called:
Correct Answer
C. The transverse pericardial sinus
Explanation
is correct because the transverse pericardial sinus is the space behind the
ascending aorta and pulmonary trunk, but anterior to the SVC.
7.
A 2-year-old child presents with a ventricular septal defect, but he does not have
Tetralogy of Fallot. With this congenital anomaly, which valve is most likely to be
insufficient?
Correct Answer
A. Tricuspid valve
Explanation
The tricuspid valve has 3 cusps (anterior, posterior, septal); because it
has a septal cusp, it is most likely affected by a ventricular septal defect. The
majority of VSDs occur in the membranous part, which is near to where the septal
cusp would be attached to the septum via the septal papillary muscles.
8.
A 50 year-old male presents to his family physician for a well checkup. His past
medical history is significant for Rheumatic Fever as a child. During heart
auscultation, you hear a holosystolic murmur loudest in the left 5th intercostal space,
midclavicular line. What do you suspect?
Correct Answer
A. Mitral Regurgitation
Explanation
holosystolic murmur loudest over apex is likely mitral regurgitation, which can be
caused by rheumatic heart disease.
9.
The base of the heart is mostly occupied by which chamber?
Correct Answer
B. Left Atrium
Explanation
The opposite of the apex is the base of the heart, which is mainly comprised of the
left atrium.
10.
One of the recurrent laryngeal nerves is usually shorter than the other. Which one
and why?
Correct Answer
D. Right; starts at right subclavian artery
Explanation
The right recurrent laryngeal nerve loops under the right subclavian artery, while
the left RLN loops under the ligamentum arteriosum (between aortic arch and
pulmonary trunk); this makes the right one significantly shorter than the left one.
11.
The right pulmonic border of the heart consists mainly of what chamber?
Correct Answer
A. Right Atrium
Explanation
Right atrium forms right border of heart; on x-rays, this appears as a mostly
vertical line.
12.
The inferior border of the heart is mainly supplied directly by what artery?
Correct Answer
B. Right Marginal Artery
Explanation
Right marginal artery (aka acute marginal artery) is a branch of the right coronary
artery and runs along the inferior border, supplying most of the cardiac tissues along
this region.
13.
The Middle Cardiac Vein travels with which artery?
Correct Answer
C. Posterior Interventricular Artery
Explanation
Middle cardiac vein runs in the posterior interventricular groove
14.
You see a pharmaceutical commercial advertising a revolutionary drug to treat Mitral
Valve Prolapse that “tugs on the heartstrings.” Its mechanism of action most likely
involves which muscles that act on the chordae tendinae?
Correct Answer
C. Papillary muscles
Explanation
Papillary muscles tense the chordae tendinae during systole, thereby preventing
valve prolapsed (pushback into the atria).
15.
What is the embryological origin(s) of the right atrium?
Correct Answer
B. Primitive atrium and right horn of sinus venosus
Explanation
Remember the right atrium has 2 embryological origins. The atrium proper forms
the rough part and the right horn of sinus venosus forms the smooth part.
16.
What structure carries the Right Bundle Branch to the anterior papillary muscles?
Correct Answer
D. Septomarginal trabecula
Explanation
The septomarginal trabecular (aka moderator band) carries right bundle branch
fibers to the anterior papillary muscle.
17.
How many shunts are typically involved in healthy fetal circulation?
Correct Answer
C. 3
Explanation
Fetal circulation: Placenta-Left umbilical vein-ductus venosus (1st shunt)-Inferior
vena cava-Right atrium-Foramen ovale (2nd shunt)-LA-LV-Aorta-Ductus arteriosus
(3rd shunt to pulmonary trunk)-Common iliac arteries-Umbilical arteries-Placenta
18.
The radiologist reports back to you on a patient who presented to the clinic with
shortness of breath (dyspnea) and chest discomfort: right middle lobe (RML)
pneumonia. You know from your days in the anatomy lab that the RML has two
segments. What are the functionally equivalent lobe and segments on the left?
Correct Answer
C. Lingual - superior and inferior segments
Explanation
Although the left lung has only the superior and inferior lobes, functionally the
lingular portion is equivalent to the right lung's middle lobe. The lingular portion
consists of superior lingular and inferior lingular segments. Remember that even
without a "lingual lobe" the segments are autonomous for blood supply and can be
surgically removed if necessary.
19.
A 50-year-old patient presents with a chief complaint of facial swelling which began
several weeks ago. She also reports shortness of breath (dyspnea) with exertion. On
examination, the patient is tender over the mediastinum. X-rays and fine needle
aspiration reveal a mass consistent with a thymoma. What is the likely mechanism
responsible for the patient’s symptoms?
Correct Answer
D. Compressed left brachiocepHalic vein
Explanation
A thymoma will occupy the most anterior area of the superior mediastinum, that is
just deep to the manubrium of the sternum. And just deep to the thymus gland we
find the left brachiocephalic vein, which would likely be compressed in an
overgrowth of the thymus. This compression may prevent blood from draining from
the left side of the head and neck as well as reduce venous return, producing
various symptoms similar to a superior vena cava syndrome.