Chapter 1 Osteo1ogy.............................1 Chapter 2



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C. biceps femoris

D. adductor longus

E. gracilis

27. Which muscle is the flexor and adductor of the wrist joint?

A. brachioradialis

B. pronator teres

C. palmaris longus

D. flexor carpi ulnaris

E. flexor carpi radialis

28. The muscle in the posterior compartment of forearm is the .

A. abductor pollicis longus

B. brachioradialis

C. palmaris longus

D. brachialis

E. pronator teres

29. Which of the following muscles belongs to the hypothenar eminence of the hand?

A. dorsal interossei muscles

B. abductor digiti minimi

C. flexor pollicis brevis

D. adductor pollicis muscles

E. lumbricales

30. What is the action of the muscles located in the posterior compartment of the thigh?

A. adduct the thigh

B. rotate the thigh

C. flex the leg

D. extense the leg

E. flex the thigh

31. Which of the following muscles flexes elbow joint and supinates forearm and also helps to flex the shoulder joint?

A. the triceps brachii

B. the brachioradialis

C. the biceps brachii

D. the coracobrachialis

E. the brachialis

32. What muscle passes through the lesser sciatic foramen?

A. gluteus minimus

B. obturator internus

C. piriformis

D. quadratus femoris

E. superior gemellus

33. Which movement would fail in case of paralysis of the quadriceps femoris muscle?

A. adduction at the hip

B. extension at the hip

C. extension at the knee

D. flexion at the knee

E. medial rotation at the knee

34. All of the following muscles are both the adductor and flexor of the thigh except the .

A. pectineus

B. adductor longus

C. gracilis

D. adductor magnus

E. rectus femoris

35. Which of the following muscles belongs to the anterior group of thigh? .

A. adductor longus

B. biceps femoris

C. semitendinosus

D. quadriceps femoris

E. gluteus maximus

A2

1. A patient presented to his physician with chronic shoulder pain. It was noted that when asked to abduct his arm, he initially leaned laterally, and then straightened up. When iodinated contrast was injected into his shoulder joint it was found to be in the subdeltoid bursa as well as in the joint cavity. Which structure was damaged to produce the shoulder pain?



A. acromioclavicular ligament

B. long head of the biceps brachii

C. subscapularis

D. superior glenohumeral ligament

E. supraspinatus muscle

2. An elderly patient complains of shoulder pain and has difficulty abducting his arm. Arthroscopy is done in which a dye is injected into the shoulder joint and an X-ray taken. The radiologist notes that the dye has leaked from the shoulder joint into the subacromial bursa. What tendon would need to be ruptured for this to occur?

A. deltoid

B. infraspinatus

C. latissimus dorsi

D. supraspinatus

E. teres minor

3. An elderly man complained of pain in his shoulder when he brought his forearm and hand behind his back while dressing. It was determined that stretching of the lateral rotators of his arm during this motion caused the pain. Which muscle was most likely involved?

A. infraspinatus

B. latissimus dorsi

C. subscapularis

D. supraspinatus

E. teres major

4. During a strenuous game of tennis a 55-year-old woman complained of severe shoulder pain that forced her to quit the game. During physical examination it was found that she could not initiate abduction of her arm, but if her arm was elevated to 45 degrees from the vertical (at her side) position, she had no trouble fully abducting it. Which muscle was injury responsible for?

A. deltoid

B. supraspinatus

C. infraspinatus

D. teres major

E. trapezius

5. A six-year-old child, whose medical history includes a rather difficult birth, has a permanently tilted head posture, with the right ear near the right shoulder and the face turned upward and to the left. Which of the following muscles was involved?

A. anterior scalene

B. omohyoid

C. sternocleidomastoid

D. trapezius

E. platysma

6. In the lumbar region, tuberculosis may spread from the vertebrae into an adjacent space to produce an abscess. Pus from the abscess may travel downwards within this space. A patient presents with pus surfacing in the super medial part of the thigh. To which muscle was the tuberculosis most likely involved?

A. internal oblique

B. obturator internus

C. psoas major

D. quadratus lumborum

E. rectus abdominis

7. A patient with painful swelling in the distal calf cannot plantar flex at the ankle with any power. Which tendon was likely to rupture?

A. tibialis anterior

B. extensor digitorum longus

C. extensor hallucis longus

D. plantaris

E. tendon calcaneus

B1

A. the phrenic nerve



B. the inferior vena cava

C. the thoracic duct

D. the superior vena cava

E. the anterior and posterior vagal trunks

1. The esophageal hiatus transmits .

2. The vena caval foramen transmits .

3. The aortic hiatus transmits .

A. the crest of greater tubercle of humerus

B. intertubercular sulcus of humerus

C. the crest of lesser tubercle of humerus

D. the lesser tubercle of humerus

E. the greater tubercle of humerus

4. The insertion of pectoralis major is .

5. The insertion of the infraspinatus is .

6. The insertion of the teres major is .

7. The insertion of the subscapularis is .

A. the rectus femoris

B. the biceps femoris

C. the gastrocnemius

D. the adductor magnus

E. the sartorius

8. Which of the above muscles flexes hip joint and extends knee joint?

9. Which of the above muscles flexes hip joint and knee joint?

10. Which of the above muscles extends hip joint and flexes knee joint?

11. Which of the above muscles flexes knee joint and ankle joint?

True or False Questions

1. Skeletal muscles are named on the basis of sharp, location, attachment, orientation of fibers, relative position, or function. ( )

2. The masseter arises from the inferior border and medial surface of the zygomatic arch and is inserted on the lateral aspect of the ramus and angle of the mandible. ( )

3. The intercostales interni elevate the ribs, and are therefore considered to be muscles of inspiration. ( )

4. The deltoid caps the shoulder joint and forms the rounded contour of the shoulder. ( )

5. The quadriceps femoris can act on both the hip and knee joints to flex and rotate the hip laterally, and also to assist in flexing the knee joint and rotating it medially. ( )

Explanation of Terms

1. linea alba

2. inguinal ligament

3. scalene fissure

4. synergistic muscles

5. endomysium

Answer the Following Questions

1. Which muscles of the neck either originate from or insert on the hyoid bone.

2. List all the muscles that either originate from or insert on the scapula.

3. Which muscles of the lower extremity span two joints, and therefore have two different actions?

4. List the supplementary structures of muscles.

5. Describe the flexor and extensor compartments of the muscles of the forearm.

6. Describe the inguinal canal.

7. Describe the structural arrangement of the muscle fibers and fasciculi within muscle.

8. Describe the openings in the diaphragm.

9. On the basis of function, categorize the muscles that move the humerus at the shoulder joint. ANSWERS

Multiple Choice Questions

A1

1.A 2.D 3.A 4.C 5.C 6.E 7.B 8.C 9.A 10.A 11.B 12.C 13.A 14.E 15.A 16.D 17.C 18.A 19.C 20.D 21.A 22.C 23.D 24.B 25.A 26.C 27.D 28. A 29. B 30. C



31.C 32.B 33.C 34.E 35.D

A2

1. E 2. D 3. A 4. B 5. C 6. C 7. E



B1

1. E 2. B 3. C 4. A 5. E 6. C 7. D 8. A 9. E 10. B 11. C

True or False Questions

1. T 2. T 3. F 4. T 5. F

Explanation of Terms

1. It is placed on the anterior median line of the abdomen, extending from the xiphoid process to the pubic symphysis. It is formed by the blending of the fibers of the sheath of rectus abdominis of two sides.

2. The lower part of the aponeurosis of the obliquus externus abdominis forms the inguinal ligament attached to the anterior superior lilac spine and the pubic tubercle.

3. Above the first rib, there is a triangular space (scalene fissure) between the scalenus anterior and the scalenus medius. The brachial plexus and the subclavian artery emerge from this space.

4. Muscles that contract together in accomplishing a particular movement are said to be synergistic muscles.

5. The individual fibers of skeletal muscle are surrounded by a fine sheath of connective tissue called endomysium. The endomysium binds adjacent fibers together and supports capillaries and nerve endings serving the muscle.

Answer the Following Questions

1. The digastric, mylohyoid, stylohyoid, geniohyoid, sternohyoid, sternothyroid, thyrohyoid, and omohyoid muscles.

2. The trapezius, omohyoid, supraspinous, infraspinous, deltoid, teres minor, major teres, biceps brachii, triceps brachii, coracobrachialis subscapularis, and levator scapulae muscles.

3. The long head of biceps femoris, semitendinosus, semimembranosus, rectus femoris, sartorius and gastrocnemius muscles.

4. The fascia, synovial bursa, sesamoid bones and synovial sheath of tendon.

5. The flexors compartment include the brachioradialis, pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris, flexor digitorum superficialis, flexor pollicis longus, pronator quadratus and flexor digitorum profundus. The extensors compartment include the extensor carpi radialis longus and brevis, extensor digitorum, extensor digiti minimi, extensor carpi ulnaris, supinator, abductor pollicis longus, extensor pollicis brevis, extensor indicis and extensor pollicis longus.


6. The inguinal canal is an oblique cleft or passage about 4-5cm long in the adult. It runs obliquely between the muscles, aponeurosis and fasciae of the abdominal wall above the medial part of the inguinal ligament and passes downwards and medially from the deep to superficial inguinal rings. The inguinal canal contains the spermatic cord in male or the round ligament of uterus in female and in both sexes the ilioinguinal nerve.

7. The individual fibers of skeletal muscle are surrounded by a fine sheath of connective tissue called endomysium. The endomysium binds adjacent fibers together and supports capillaries and nerve endings serving the muscle. Another connective tissue, the perimysium, binds groups of muscle fibers together into bundles called fasciculi . The perimysium supports blood vessels and nerve fibers serving the various fasciculi. The entire muscle is covered by the epimysium, which in turn is continuous with a tendon.

8. There are three openings in the diaphragm:

(1) The aortic hiatus lies in front of the 12th thoracic vertebra. It transmits the abdominal aorta and the thoracic duct.

(2) The esophageal hiatus is located in the right crus of the diaphragm at the level of T10. It transmits the esophagus and the anterior and posterior vagal trunks.

(3) The vena caval foramen is located in the central tendon of the diaphragm at the level of T8. The inferior vena cava is adherent to the margin of this foramen.

9. Flexors: The coracobrachialis and biceps brachii;

Extensors: The latissimus dorsi muscle and the long head of triceps brachii;

Adductors: The pectoralis major, latissimus dorsi and teres major;

Abductors. The deltoid and supraspinatus;

Medial rotators: The latissimus dorsi, pectoralis major, deltoid and teres major;

Lateral rotators. The infraspinatus, deltoid, and teres minor.

(Liu Xuezheng, Pan Feng)

Chapter4-5

The General Description of Splanchnology & The Alimentary System

Multiple Choice Questions

A1

1. The palatine tonsil lies .



A. in oral cavity

B. in piriform recess

C. in pharyngeal recess

D. between palatoglossal arch and palatopharyngeal arch

E. in posterior wall of pharynx

2. The major digestive gland is .

A. buccal glands

B. esophageal gland

C. submandibular gland

D. gastric gland

E. intestinal gland

3. The major duodenal papilla lies in .

A. superior part of duodenum

B. descending part of duodenum

C. horizontal part of duodenum

D. ascending part of duodenum

E. duodenojejunal flexure

4. The structure under inferior surface of tongue is .

A. foramen cecum of tongue

B. lingual tonsil

C. terminal sulcus

D. vallate papilla

E. sublingual caruncle

5. Which structure doesn't belong to stomach?

A. angular notch

B. pyloric antrum

C. antrum of stomach

D. pyloric canal

E. fundus of stomach

6. Pharyngeal opening of auditory tube lies in .

A. nasopharynx

B. oropharynx

C. laryngopharynx

D. epiglottic vallecula

E. inferior meatus

7. The beginning of jejunum is .

A. duodenojejunal flexure

B. angular notch

C. transverse part of duodenum

D. pylorus

E. left colic flexure

8. The shortest segment of large intestinal is .

A. ascending colon

B. descending colon

C. sigmoid colon

D. anal canal

E. cecum

9. The piriform recess lies in .

A. nasopharynx

B. oropharynx

C. laryngopharynx

D. isthmus of fauces

E. vestibule of larynx

10. The dentate line is formed by .

A. anal canal

B. transverse fold of rectum

C. anal columns

D. anal valves

E. anal sinus

11. The opening of hepatopancreatic ampulla lied in .

A. superior portion of duodenum

B. major duodenal papilla

C. Calot's triangle

D. pyloric antrum

E. minor duodenal papilla

12. The limitation of pyloric antrum and pyloric canal is .

A. angular notch

B. pyloric valve

C. cardiac incisure

D. intermedia sulcus

E. lesser curvature of stomach

13. Which one is right about the rectum?

A. It continues upwards with the sigmoid colon at the level of pelvic inlet.

B. It continues downwards with the anal canal at the level of dentate line.

C. The upper part is not covered by peritoneum.

D. It has sacral and perineal flexures in the sagittal plane.

E. It is an intraperitoneal viscus.

14. Concerning Hilton's line, the wrong description is .

A. lies at the interval between the sphincter ani internus and externus

B. is about lcm below the dentate line

C. is also called white line

D. is continuous upwards with the anal pectin

E. can not be felt in digital examination of the anal canal

15. Anal canal .

A. continues with the rectum at the level of pelvic diaphragm

B. terminates at the dentate line

C. is about 7-8 cm in length

D. has two flexures in sagittal plane

E. has a dilated upper part called ampulla of rectum

16. Below the dentate line or .

A. the epidermis is skin

B. the epidermis is innervated by somatic nerve

C. the lymph is drained into the superficial inguinal lymph node

D. the blood is drained into the internal iliac vein

E. all of the above are right

17. Which of the following structures is not comprised of forming the isthmus of fauces?

A. uvula

B. free margin of the palatine velum

C. palatopharyngeal arch

D.palatoglossal arch

E. root of tongue

18. All of the deciduous teeth normally erupt by the age of .

A.6 months

B.1 year


C.2.5years

D.3.5years

E.6 years

19. About the teeth, which of the following statements is not true?

A. Teeth are the hardest organs in human body.

B. Normally two sets of teeth develop in a person’s lifetime.

C. The central region of the tooth contains the pulp cavity.

D. The third molars are the last to erupt.

E. Both of the dentine, enamel and cement have no innervation.

20. About the parotid gland, which of the following statements is not true?

A. Parotid gland is the largest salivary gland.

B. It can be divided into two parts in shape: the superficial and the deep.

C. The deep extends and lies between the ramus of the mandible and the sternoclei-domastoid.

D. The parotid duct opens on the oral surface of the cheek opposite the crown of the third upper molar tooth.

E. About 35% of the people have an accessory parotid gland.

21. Which of following is not the structure of nasopharynx?

A. pharyngeal opening of the auditory tube

B. piriform recess

C. tubal torus

D. pharyngeal recess

E. pharyngeal tonsil

22. Which of the following distances is right from the third esophageal constrictions to the upper central incisor teeth?

A. 5cm

B. 15cm


C. 25cm

D. 40cm


E. 45cm

23. About the duodenum, which of the following statements is not right?

A. It has mesentery, and is thus only partially covered with peritoneum.

B. It is the shortest, widest and most fixed part of small intestine.

C. It extends from the pylorus to the jejunum.

D. It receives the openings of the bile and pancreatic ducts.

E. It is divided into four parts.

24. About the vermiform appendix, which of the following statements is right?

A. It has colic bands, haustra of colon and epiploic appendices.

B. It has its own mesentery, the mesoappendix.

C. The appendix is stable in position because of the cecum.

D. Most commonly, its tip lies in front of the ileum.

E. McBurney's point is variable in position

25. Which of the following structures is not contained in the visceral surface of liver?

A. falciform ligament

B. porta hepatis

C. ligamentum venosum

D. ligamentum teres hepatis

E. fossa for gallbladder

A2

1. A 60-year-old male executive who had a history of a chronic duodenal ulcer was admitted to the



ER exhibiting signs of a severe internal hemorrhage- He was quickly diagnosed with perforation of the posterior wall of the first part of the duodenum and erosion of an artery behind it by the gastric expellent. The artery is most likely the .

A. common hepatic

B. gastroduodenal

C. left gastric

D. proper hepatic

E. superior mesenteric

2. An ulcer near the pyloro-duodenal junction perforated and eroded a large artery immediately posterior to the duodenum. The ligation of the eroded vessel at its origin would least affect the arterial supply to the

A. first part of the duodenum

B. second part of the duodenum

C. greater curvature of the stomach

D. head of the pancreas

E. tail of the pancreas

3. You are observing an operation to remove the left suprarenal gland. To expose the gland the surgeon mobilizes the descending colon by cutting along its lateral attachment to the body wall and dissecting medial-ward in the fusion fascia behind it. Suddenly the operative field is filled with blood. The surgeon realizes he has failed to cut a mesenteric attachment between the left colic flexure and another organ, As a result of the traction, the surface of the organ tore- Which organ was injured?

A. duodenum

B. kidney

C. liver


D. spleen

E. suprarenal grand

4. A patient was admitted with symptoms of an upper bowel obstruction. Upon CT examination, it was found that the third (transverse) portion of the duodenum was compressed by a large vessel causing the obstruction. The vessel involved is most likely to be the .

A. inferior mesenteric artery

B. superior mesenteric artery

C. inferior mesenteric vein

D. portal vein

E. splenic vein

5. During emergency surgery, it was found that a chronic ulcer had perforated the posterior wall of the stomach and eroded a large artery running immediately posterior to the stomach. The artery is the .

A. gastroduodenal

B. common hepatic

C. left gastroepiploic

D. splenic

E. superior mesenteric

6. In order to approach the area posterior to the stomach, a surgeon decided to go through the lesser omentum Before incising the mesentery she was careful to find and preserve a nerve lying in the upper portion of the hepatogastric ligament, i. e, the .

A. celiac branch of the anterior vagal trunk

B. celiac branch of the posterior vagal trunk

C. greater splanchnic branch to the right suprarenal gland

D. hepatic branch of the anterior vagal trunk

E. hepatic branch of the posterior vagal trunk

7. A 50-year-old female patient with severe jaundice was diagnosed with pancreatic cancer. You suspect that the tumor is located in which portion of the pancreas?

A. head


B. neck

C. body


D. tail

E. uncinate process

8. To stop hemorrhaging from a ruptured spleen, it was necessary to temporarily ligate the splenic artery near the celiac trunk. Which structure of the blood supply is least likely to be affected by the ligation?

A. duodenum

B. greater omentum

C. body of pancreas

D. tail of pancreas

E. stomach

9. A patient was admitted with symptoms of bowel obstruction. Further examination revealed that the obstruction was caused by the nutcracker-like compression of the bowel between the superior mesenteric artery and the aorta. The compressed bowel is most likely the .

A. duodenum

B. jejunum

C. ileum


D. ascending colon

E. transverse colon

B1

A. pharyngeal recess



B. piriform recess

C. anal sinuses

D. major duodenal papilla

E. cardia

1. Where is carcinoma more frequently found?

2. Where can foreign bodies lodge more frequently?

3. Where do the common bile duct and the pancreatic duct open together?

A. duodenal bulb

B. major duodenal papilla

C. minor duodenal papilla

D. suspensory muscle of duodenum

E. longitudinal fold of duodenum

4. Where does most duodenal ulcer occur?

5. opening of hepatopancreatic ampulla

6. opening of accessory pancreatic duct

True or False Questions

1. Duodenum belongs to the inferior digestive tube. ( )

2. Palatoglossal arch descends from both sides of the base of the uvula to the side of the root of the tongue. ( )

3. Deciduous teeth begin to erupt at about 6 months of age. ( )

4. The enamel is the hardest substance in the body and covers the surface of all the teeth. ( )

5. The filiform papillae have a color of white and plenty of taste buds. ( )

6. Parotid duct opens upon a small papilla on the oral surface of the cheek opposite the crown of the second upper molar tooth. ( )

7. The oropharynx and laryngopharynx are the common passages of the alimentary and respiratory canals. ( )

8. On the lateral wall of oropharynx presents the pharyngeal opening of the auditory tube. ( )

9. The esophagus is a collapsible muscular tube and is the narrowest portion of the alimentary canal. ( )

10. The first constriction of esophagus is at its commencement, 15 cm from the upper central incisor teeth. ( )

11. The pyloric orifice is where the esophagus enters the stomach. ( )

12. The fundus of stomach is in direct contact with the diaphragm. ( )

13. The stomach lies in the epigastric, umbilical, and left hypochondriac regions of the abdomen. ( )

14. The duodenum has mesentery, and is partially covered with peritoneum. ( )

15. The duodenum extends from the pylorus to the jejunum, about 20-25cm long. It is the shortest, widest and most fixed part of small intestine. ( )

16. The duodenum is important because it receives the openings of the bile and pancreatic ducts. ( )

17. The common bile duct and the pancreatic duct together perforate the medial side wall of ascending part of the duodenum obliquely. ( )

18. The ligament of Treitz, which is the mark of the commencement of small intestine clinically. ( )

19. The solitary lymphatic follicles are scattered along the length of the jejunum and ileum mucosa. ( )

20. The colic bands are formed by two longitudinal muscular fibers. ( )

21. The tip of the appendix may be in variable position, but its base is relatively constant. ( )

22. The sigmoid colon is closely surrounded by peritoneum, which forms the sigmoid mesocolon. ( )

23. The middle fold of rectum is the largest and most constant, about 7 cm away from anus. ( )

24. White line represents the junction of the endodermal and ectodermal parts of the canal. ( )

25. According to the Glisson distribution of the liver, it can be divided into two half parts and then subdivided into some segments in each half. ( )

26. The gallbladder is completely covered by peritoneum continued from the hepatic surface ( )

27. Two hepatic ducts leave the porta hepatis and join together to form the common bile duct. ( )

28. The pancreas is the biggest alimentary gland of the body. It is both an exocrine and an endocrine gland. ( )

29. The pancreatic duct opens into the major duodenal papilla via the hepatopancreatic ampulla. ( )

Explanation of Terms

1. isthmus of fauces

2. pyloric antrum

3. ligament of Treitz

4. Meckel' s diverticulum

5. ileocecal valve

6. dentate line

7. porta hepatic

8. hepatopancreatic ampulla

Answer the Following Questions

1. Briefly describe the types of papillae of the tongue.

2. Briefly describe the types of major salivary glands.

3. Briefly describe the shape of stomach.

4. Briefly describe the parts of pharynx.

5. Briefly describe the composition of extrahepatic parts of biliary system.

6. Briefly describe the parts of duodenum.

7. Briefly describe the features of colon and cecum.

8. Briefly describe the surface marking of the root of vermiform appendix.

9. Briefly describe the parts of colon.

10. Briefly describe the parts of gallbladder and surface markings of fundus of gallbladder.

11. Briefly describe the location and structures of pancreas.

12. Briefly describe the three constrictions of esophagus.

ANSWERS


Multiple Choice Questions

A1

1. D 2. C 3. B 4. E 5. C 6. A 7. A 8. D 9. C 10. D



11. B 12. D 13. D 14. E 15. A 16. E 17. C 18. C 19. E 20. D 21. B 22. D 23. A 24. B 25. A

A2

1. B 2. E 3. D 4. B 5. D 6. D 7. A 8. A 9. A



B1

1. A 2. B 3. D 4. A 5. B 6. C

True or False Questions

1. F 2. T 3. T 4. F 5. F 6. T 7. T 8. F 9. T 10.T 11. F 12. T 13. T 14. F 15. T 16. T 17. F 18. F 19. F 20. F 21. T 22. T 23. T 24. F 25. T 26. T 27. F 28. F 29. T

Explanation of Terms

1. A little narrow passage from the mouth to the pharynx, named the isthmus of fauces, surrounded by the uvula, the free margin of the palatine velum, the palatoglossal arch and the root of tongue.

2. Pylorus is subdivided by the intermediate groove into a pyloric antrum on the left and a pyloric canal and is the distal end of the stomach. Gastric ulcer and cancer usually occur in pyloric antrum where close to the lesser curvature.

3. The du0denojejunal flexure is held in position by a peritoneal fold, the ligament of Treitz, which is the mark of the commencement of jejunum clinically.

4. In about .2% of individuals, Meckel's diverticulum projects from the antimesenteric border of the distal ileum, its average length about 5cm. It represents the persistent portion of the vitelline stalk (yolk stalk) in early fetal life.

5. Ileocecal orifice consists of two semilunar shaped flaps projecting into the lumen of the large intestine, named the ileocecal valve that not only prevents the reflux from cecum to the ileum but is probably also a sphincter regulating the passage of ileal contents into cecum.

6. The circular line along which the base of the anal valves and the lower part of the anal columns are situated is termed the dentate line, thus representing the junction of the endodermal and ectodermal parts of the canal.

7. The cross-bar of the "H" is the porta hepatis. Through the porta hepatis, the portal vein posteriorly, the left and right branches of the proper hepatic artery on the left side and the hepatic nerve plexus enter the liver.

8. The common bile duct reaches the pancreatic duct together they enter the duodenal wall where they usually unite to form the hepatopancreatic ampulla.

Answer the Following Questions

1. Filiform papillae, fungiform papillae, foliate papillae and vallate papillae.

2. The parotid, submandibular and sublingual glands.

3. The stomach has two surfaces, an anterior and posterior surface; two curvatures, greater and lesser curvature; and two orifices, cardiac and pyloric orifice.

4. By the levels of the soft palate and the superior border of the epiglottis, the pharynx may be divided into three parts: nasal, oral and laryngeal.

5. Common hepatic duct, cystic duct, common bile duct.

6. It is divided into four parts: superior, descending, horizontal and ascending part.

7. The typical characteristics of the colon and cecum are colic bands, haustra of colon and epiploic appendices.

8. McBurney's point, the usual surface marking for appendicular base is the junction of the middle and lateral thirds of a line that joins the right anterior superior iliac spine to the umbilicus.

9. The colon is divided into four parts: the ascending, transverse, descending and sigmoid.

10. It consists of the fundus, body, neck and cystic duct, the usual surface marking for fundus of gallbladder is the junction of costal arch and the lateral border of the right rectus abdominis.

11. The pancreas is an elongated structure that lies in the posterior abdominal wall, and transversely situated in the epigastric and left hypochondriac regions. The pancreas can be divided into head, neck, body and tail.

12. The first constriction is at its commencement, 15 cm away from the upper central incisor teeth The second is where the left bronchus crossed its anterior surface, 25 cm away from the upper central incisor teeth. The third occurs where the esophagus passes through the diaphragm into the stomach, 40 cm away from the upper central incisor teeth. Foreign bodies can lodge and carcinoma of esophagus is more frequently found in these constrictions.

(Zhang Yafang) Multiple Choice Questions

A1

1. Which muscle group combination permits inspiration?



A. diaphragm muscle, abdominal complex

B. intercostales interni muscle, diaphragm muscle

C. intercostales externi muscle, intercostales interni muscle

D. intercostales externi muscle, diaphragm muscle

E. transversus thoracis muscle, diaphragm muscle

2. Several surface landmarks on the thoracic wall correspond to the pleural borders. Relationships between these landmarks and the pleura on the left side include .

A. posteroinferior extension of the left costodiaphragmatic recess above the twelfth rib

B. lateral divergence of the left costomediastinal recess at the level of the fourth to the sixth rib to form the cardiac notch

C. superior extension of the apex of the pleura below the level of the left clavicle

D. anteroinferior extension of the left pleural cavity below the costal margin in the region of the xiphoid process

E. later inferior extension of the left costodiaphragmatic recess in the seventh rib

3. Paired air spaces in certain bones of the skull are called paranasal sinuses. Which of following answer is not belong to paranasal sinuse?

A. maxillary sinus

B. ethmoidal sinus

C. frontal sinus

D. cavernous sinus

E. sphenoidal sinus

4. Which of following cartilage compose of the framework of the larynx?

A. thyroid cartilage

B. cricoid cartilage

C. epiglottic cartilage

D. arytenoid cartilage

E. all of above

5. Which of the paranasal sinuses listed below does not drain by gravity with the body in the erect position?

A. frontal sinus

B. sphenoidal sinus

C. ethmoidal sinus

D. maxillary sinus

E. B and C

6. The right lung is different from the left lung in being .

A. subdivided into ten bronchopulmonary segments

B. generally longer and narrower

C. divided by the oblique fissure

D. composed of three lobes

E. none of above

7. Structures located in the posterior mediastinum do not include the .

A. thoracic duct

B. esophagus

C. hemiazygous vein

D. phrenic nerves

E. thoracic aorta

8. Which of the description about the lung listed follow is not correct?

A. Each lung extends from the diaphragm to a point just above the clavicle.

B. Each lung's surfaces are bordered by the ribs to the front and back.

C. Each lung has four surfaces that match the contour of the thoracic cavity.

D. The left lung is somewhat smaller than the right and has a cardiac impression on its medial surface to accommodate the heart.

E. The right lung is subdivided into a superior lobe and an inferior lobe by a single fissure

9. Which of the following is a false statement?

A. The term respiration can be used in reference to ventilation (breathing) or oxygen utilization by body cells.

B. The incoming (inhaled) air that contacts the pulmonary alveoli is unchanged from that which surrounds the body.

C. As a resonating chamber, the nasal cavity is important in sound production.

D. It is only through the wails of the pulmonary alveoli that gaseous exchange occurs.

E. none of above

10. Which is not a component of the nasal septum?

A. the palatine bone

B. nasal septal cartilage

C. the ethmoid bone

D. the vomer

E. mucous membrane

11. Which of the following is not characteristic of the left lung?

A. a superior lobe

B. an inferior lobe

C. a cardiac impression

D. a single fissure

E. a middle lobe

12. The epithelial lining of the wall of the thoracic cavity is called the .

A. costal pleura

B. mediastinal pleura

C. pleural peritoneum

D. parietal pleura

E. visceral pleura

13. The vocal folds (cords) are attached to the .

A. cricoid and thyroid cartilages

B. cuneiform and cricoid cartilages

C. arytenoid and thyroid cartilages

D. corniculate and thyroid cartilages

E. cricoid and the corniculate

14. Which of the description about the pharynx is not correct?

A. The pharynx is a funnel-shaped organ. It contains a passageway that connects the oral and nasal cavities with the esophagus and larynx.

B. The pharynx is divided on the basis of location and function into three regions.

C. The oropharynx is the middle portion, extending from the soft palate to the level of the hyoid bone, contains the palatine and lingual tonsil.

D. The nasopharynx, connected by the auditory tubes to the tympanic cavities, contains the lingual tonsils.

E. The laryngopharynx extends from the hyoid bone to the larynx and esophagus.

15. The trachea, right principal bronchus, left principal bronchus, lobar bronchi, segmental bronchi and associated structures compose of the

A. bronchial tree

B. respiratory division

C. upper respiratory system

D. lower respiratory system

E. none of above

16. What structures support the very tip of the nose?

A. inferior nasal concha

B. lateral cartilages

C. lesser alar cartilages

D. greater alar cartilages

E. supreme nasal concha

17. The lower end of the larynx is formed by the .

A. cricoid cartilage

B. thyroid cartilage

C. cuneiform cartilage

D. arytenoids cartilage

E. the first tracheal cartilage

18. Cartilage gives way to smooth muscle fiber at .

A. respiratory bronchioles

B. segmental bronchi

C. lobar bronchi

D. alveolar ducts

E. principal bronchus

19. What is the force that causes air to flow into the lungs during inspiration and out if the lungs during expiration?

A. intercostales externi muscle contraction

B. intercostales interni muscle contraction

C. surface tension

D. diaphragm movements

E. atmospheric pressure

20. The groove inferior to a nasal concha is known as a .

A. papilla

B. meatus

C. canal

D. suture

E. Eustachian groove

21. Which of the following is true?

A. The laryngeal prominence is part of the cricoid cartilage.

B. The laryngeal prominence is larger in females than in males.

C. The cricoid cartilage is inferior to the thyroid cartilage.

D. The thyroid cartilage is the smallest of the laryngeal cartilages.

E. There are pairs of the epiglottic cartilage.

22. The nose serves all the following functions except:

A. providing resonance for voice production

B. passageway for air movement

C. warming and humidifying inspired air

D. cleansing inhaled air

E. absorbing oxygen

23. The description about the paranasal sinuses below which is wrong?

A. There are 4 pairs of paranasal sinuses.

B. Maxillary sinus communicates via drainage ducts within the oral cavity.

C. Paranasal sinuses may help warm and moisture the inspired air.

D. Paranasal sinuses are responsible for some sound resonance.

E. Paranasal sinuses function to decrease the weight of the skull while providing structural strength.

24. Which structure listed below close the glottis during swallowing to prevent the foreign bodies coming in the trachea?

A. hyoid bone

B. epiglottis

C. thyroid cartilage

D. cricoid cartilage

E. arytenoid cartilage

25. Which is not correct in the following description?

A. Pleurae are serous membranes surrounding the lungs and lining the thoracic cavity.

B. The visceral pleura adhere to the outer surface of the lung and extend into each of the interlobar fissures.

C. The parietal pleura line the thoracic walls and the thoracic surface of the diaphragm.

D. Between the visceral and parietal pleurae is the slitlike pleural cavity.

E. The pleural cavity between the two moistened membranes contains large amount of fluid to lubricate each other.

26. Normal rate of respiration in an adult human being is times per minute.

A. 10-12

B. 12-14


C. 16-18

D. 22-24


E. 26-28

27. Which structure listed below doesn't appear in the laryngeal cavity?

A. aperture of larynx

B. vestibular fold

C. cricothyroid muscle

D. ventricle of larynx

E. vocal cord

28. Which structure is included in the hilum (root of lung)?

A. pulmonary artery

B. pulmonary vein

C. principal bronchus

D. associated nerve

E. all of above

29. Which is not correctly described below?

A. The alveolar ducts open into pulmonary alveoli as outpouching along their length.

B. Alveolar sacs are clusters of pulmonary alveoli.

C. The alveolar ducts, pulmonary alveoli, and alveolar sacs make up the respiratory

division of the lungs.

D. Gas exchange occurs across the walls of the alveolar ducts and the tiny pulmonary

alveoli.


E. Pulmonary alveoli are polyhedral in shape and are usually clustered together.

30. Which is not correct about the mediastinum described below?

A. The mediastinum lies between the right and left pleura in and near the median sagittal plane of the chest.

B. It extends from the sternum in front to the vertebral column behind, and contains all the thoracic viscera excepting the lungs.

C. May be divided for purpose of description into four parts.

D. The superior mediastinum is that portion of the interpleural space which lies between the manubrium sternum in front, and thel-4 thoracic vertebrae behind.

E. The heart located in the anterior mediastinum.

A2

1. In case of chest trauma, an examining physician checks for increasing venous pressure, falling arterial pressure, and increasing heart rate with diminishing heart sounds. These signs are indicative of heart failure due to tamponade and necessitate immediate pericardiocentesis. At which of the following sites may a needle effectively be inserted into the pericardial cavity without risking a pneumothorax?



A. adjacent to the xiphoid process angling upward and to the left

B. adjacent to the sternum in the right fourth intercostal space

C. adjacent to the sternum in the left second intercostal space

D. in the right fourth intercostal space immediately below the nipple

E. in the left fourth intercostal space immediately below the nipple

2. Foreign bodies that are aspirated tend to be located in the right inferior lobar bronchus because the .

A. right main stem or principal bronchus is of greater diameter than the left

B. left principal bronchus is more horizontal than the right

C. right inferior lobar bronchus nearly continues the direction of the trachea

D. right lung has no middle lobe

E. all of above except D

3. Pulmonary disease can sometimes be localized to a bronchopulmonary segment, in which event surgical resection may be feasible. Which of the following is not characteristic of a bronchopulmonary segment that assists in its surgical definition?

A. an apex directed toward the hilum of the lung

B. a central segment artery

C. a central tertiary or segmental bronchus

D. a central vein

E. separated from each other by connective tissue septa

4. Which of the structure listed below is the marker of bifurcation of trachea during tracheoscope examination?

A. tracheal cartilages

B. vestibular fold

C. carina of trachea

D. vocal fold

E. hilum of lung

5. When a patient has pleural effusion, usually the fluid aggregate in which part of the pleural cavity in the erect position?

A. phrenicomediastinal recess

B. costomediastinal recess

C. costodiaphragmatic recess

D. retrocecal recess

E. intersigmoid recess

6. In clinical patient with lobar pneumonia, the inflammation usually localizes in .

A. all the left or right lung

B. pulmonary lobes

C. bronchopulmonary segment

D. pulmonary lobule

E. pulmonary alveoli

BI

Movements of the chest wall and diaphragm produce changes in thoracic volume and pulmonary ventilation. For each respiratory muscle action described below, select the factor to which it is most nearly related.



A. a factor in quiet expiration

B. a factor in quiet inspiration-

C. a factor in exertional expiration

D. an accessory factor in exertional inspiration

E. not a factor in respiration

1. contraction of the intercostales externi muscles

2. contraction of the rectus abdominis muscle

3. contraction of the diaphragmatic muscle

4. contraction of the sternocleidomastoid muscle

5. contraction of the obliquus internus abdominis muscle

True or False Questions

1. The upper respiratory tract consists of the nose, pharynx and larynx and trachea. ( )

2. The nose mucosa can be divided into two parts: the olfactory region and the respiratory region. ( )

3. The sphenoidal sinus opens their mouth at semilunar hiatus of middle nasal meatus. ( )

4. Thyroid cartilage is the largest cartilage in the larynx, the superior extremity of the anterior horn is called laryngeal prominence and that is obvious in adult males. ( )

5. The laryngeal cavity can be divided into laryngeal vestibule, infraglottic cavity and intermediate cavity. ( )

6. The left principal bronchus is short, straight and thick, and the subcarinal angle is small, so the foreign particles are more likely to lodge here. ( )

7. The apex of lung usually is 2. 5 cm below the level of the medial 1/3 of the clavicle. ( )

8. Pleura are serous membrane surrounding the lungs and lining the thoracic cavity. The visceral pleura adhere to outer surface of the lung and extend into each of the interlobar fissures. ( )

9. On the anterior aspect of pericardium of this region, there are no pleura, so the left xiphocostal angle is the safe region for pericardiopuncture in clinic. ( )

10. The anterior mediastinum is very narrow, which contains thymus or its remnant, principal bronchi, anterior mediastinal lymph nodes, mediastinal branches of internal thoracic artery, loose connective tissue, and stern pericardial ligament, etc. ( )

Explanation of Terms

1. paranasal sinuses

2. conus elasticus

3. vocal fold

4. carina of trachea

5. bronchial tree

6. pleural cavity

7. root of lung

Answer the Following Questions

1. What is the composition of the nasal septum?

2. Explain the difference between the lung of fetus and adult?

3. Describe the Blood supply of lungs?

4. Describe the composition of the costodiaphragmatic recess?

5. Describe the projection of the lung?

ANSWERS


Multiple Choice Questions

A1

1. D 2. B 3. D 4. E 5. E 6. D 7. D 8. E 9. B 10. A



11. E 12. A 13. C 14. D 15. A 16. D 17. E 18. A 19. E 20. B 21. C 22. E 23. B 24. B 25. E 26. C 27. C 28. E 29. D 30. E

A2

1. A 2. E 3. D 4. C 5. C 6. B



B1

1. B 2. C 3. B 4. D 5. C

True or False Questions

1. F 2. T 3. F 4. T 5. T 6. F 7. F 8. T 9. T 10. F

Explanation of Terms

1. The paranasal sinuses are the gas cavities in cranium around the nasal cavity, and debouch at nasal cavity. There are four pairs of paranasal sinuses including frontal sinus, ethmoidal sinus, sphenoidal sinus and maxillary sinus. The paranasal sinuses have the effects of warming and moistening the inspired air, generating resonance of pronunciation as well as decreasing the weight of skull.

2. The conus elasticus is an elastic fibrous membrane, which arises from the posterior aspect of thyroid cartilage's anterior horn and shows fan-shape, then stops at the vocal process of the arytenoids cartilage and the superior border of the cricoid cartilage outwards and posteriorly.

3. The vocal fold is constructed by vocal ligament, voealis and laryngeal mucous membrane.

4. There is a carina of trachea of half-moon on the inner aspect of bifurcation of trachea, and it is of anteroposterior axes and upward, and deviates to the left side, so it is an important sign of judging the bifurcation of trachea by bronchoscope test.

5. The bronchial tree is so named because it is composed of a series of respiratory tubes that branch into progressively narrower tubes as they are extending into the lung.

6. Between the visceral and parietal pleurae is the slitlike pleural cavity. It contains a lubricating fluid that allows the membranes to slide each other easily during respiration.

7. All the pulmonary vessels, bronchi, nerves and lymphatic vessels are wrapped by connective tissues, called root of lung.

Answer the Following Questions

1. The nasal septum is constructed by the perpendicular plate of the ethmoid bone, vomer and septal cartilage, with mucous membrane covering, and usually deviates on one side.

2. The lungs of fetus and newborn which have never respired have no air and with a bigger specific gravity and can sink into the water. On the contrary, the lungs of respirators have a smaller specific gravity, and can float on the water. The weight of fetus's lung is 1/70 of their body weight, and the volume of which is about a half of that of thoracic cavity. In the development process of lung, the fetus’s lung of 3 months before birth grows fastest, and the volume of lung after birth occupies about 2/3 of thoracic cavity's volume. The lungs of a fetus are pink but may become discolored in an adult as a result of smoking or air pollution. In the normal condition, the fetus's lung will mature in the 36th week of duration of pregnancy. Before that, the lung's type II alveolar cells in premature infant before the 36th week duration of pregnancy isn't mature and can't secret enough pulmonary surfactant, so respiratory distress syndrome of newborn (RDS) easily takes place and the treatment of promoting the mature of fetuses lung is needed.

3. The pulmonary artery is the functional blood vessels of transferring blood for gas exchange, the branches of which situate at the anterior aspect of bronchus at first, then change direction to posterior aspect. The branches of pulmonary artery in the lung are usually accompanied with the branches of bronchus until they enter into the interalveolar septum and wrap the alveolar wall to form alveolar capillary network. The left and right bronchial arteries are blood vessels of trophism and usually have 1 to 4 branches. The left bronchial artery arises from thoracic aorta and aortic arch, while the right one arises from the 3rd to the 5 th posterior intercostal arteries. In the hilum of lung, the pulmonary arteries coincide with each other and form a network, then enter into the lung and accompany closely with the bronchus, and enter into pulmonary segment via the hilum of bronchopulmonary segment, then form 1 to 3 segmental bronchi arteries. Finally, the segmental bronchial arteries form capillary network in the outer membrane and submucosa of bronchial wall respectively to supply bronchus.

4. The costodiaphragmatic recess is formed by the returning of costal pleura and diaphragmatic pleura, and is the part with lowest position and largest volume of all the pleural recesses. There are two costodiaphragrnatic recesses, and the depth of which can reach the two intercostal spaces. The fluid of pleural cavity often accumulates in the costodiaphragraatic recess at first.

5. The inferior borders of the two lungs have the similar projection on body surface, and the inferior border of lung usually exceeds a distance of 2 ribs over the inferior border of pleura in the related position. The lung intersect with the 6th rib on the mid-clavicular-line, with the 8th rib on the mid-axillary line, with the 10th rib on the scapular line, then migrate with the posterior border on the outside of the 11th spinous process of thoracic vertebra.

(Liu Fang, Fan Jun, Bai Shuling)

Multiple Choice Questions

A1

1. In its normal course, the right ureter passes .



A. anteriorly to the renal artery

B. posteriorly to the ovarian artery

C. superiorly to the vas deferens

D. superiorly to the uterine artery

E. anteriorly to the ovarian artery

2. As a result d anatomic considerations, a nephrolith (stone) usually lodges at .

A. the abdominal part of ureter

B. the pelvic part of ureter

C. the intramural part of the ureter

D. the apex of bladder

E. the trigone of bladder

3. In tracing the abdominal part of ureter, the ureter is observed to intersect the testicular vessel or ovarian vessel and iliac blood vessels. In the following descriptions, which is correct?

A. anterior to the testicular vessel

B. anterior to the ovarian vessel

C. posterior to the ovarian vessel

D. posterior to the left common lilac artery

E. posterior to the right common iliac artery

4. Which isn't belongs to the capsule of kidney in the following?

A. the fibrous capsule

B. the fatty renal capsule

C. the renal fascia

D. the prerenal fascia

E. the muscular tunica

5. Which isn't correct about the description of the renal position?

A. It lies on the two sides of spinal column.

B. It lies at the upper part of posterior wall of abdomen.

C. The liver situates on the top of the right kidney.

D. The right kidney is lower than the left kidney.

E. It belongs to the intraperitoneal organ.

6. Which is incorrect about the positional relationship of kidney and vertebrae?

A. The superior extremity of left kidney lies at the inferior margin of the llth body of thoracic vertebra.

B. The superior extremity of right kidney lies at the superior margin of the 12th thoracic vertebra.

C. The superior extremities of the two kidney approach each other, and their inferior extremities are away from each other.

D. The kidney has the height of about two vertebrae.

E. The inferior extremity of the right kidney lies at the superior margin of the 3rd body of lumbar vertebra.

7. Which is correct about the positional relationship of the 12th rib and kidney?

A. It goes through the upper part of right renal posterior surface.

B. ft goes through the upper part of left renal posterior surface.

C. It goes through the middle part of left renal anterior surface.

D. It goes through the middle part of right renal anterior surface.

E. It goes through the middle part of left renal posterior surface.

8. The structure of renal hilum doesn't include .

A. renal blood vessels

B. nerves

C. renal pelvis

D. lymphatic vessel

E. minor renal calices

9. Which is incorrect about the description of renal shape?

A. It is a parenchymatous organ with the appearance of pea.

B. It can be divided into medial and lateral borders, anterior and posterior surfaces, superior and inferior extremities.

C. Renal hilum is the depression of the middle part in renal medial border.

D. The connective tissue wrapping all the structures of renal hilum is called renal pedicle.

E. The right renal pedicle is longer than left renal pedicle.

10. Which is correct about the arranging relationship of all the structures in renal pedicle?

A. From front to behind, there are renal vein, renal artery and the end of renal pelvis.

B. From front to behind, there are renal artery, renal vein and the end of renal pelvis.

C. From up to down, there are renal vein, renal artery and the end of renal pelvis.

D. From up to down, there are the end of renal pelvis, renal artery and renal vein.

E. All the above aren't correct.

11. Which is incorrect about the description of renal structure?

A. Renal substance can be divided into renal cortex of surface layer and renal medulla of deep layer.

B. The renal cortex can be divided into renal corpuscles and renal tubules.

C. The renal medulla is constituted of 15 to 20 renal pyramids.

D. The minor renal calices converge into major renal pelvis, then the latter converges and forms renal pelvis.

E. The renal cortex has darker color than renal medulla.

12. Which of the following isn't correct about the description of ureter?

A. It arises from the end of renal pelvis, and terminates at urinary bladder.

B. It can be divided into abdominal part, pelvic part and intramural part.

C. There are three strictures in the whole course.

D. The left ureter steps over the anterior aspect of external iliac artery.

E. It descends along the anterior aspect of psoas major muscle.

13. Which is incorrect about the description of bladder?

A. The bladder volume of normal adult is about 350 to 500mi.

B. The bladder presents the shape of vertebral body with three edges.

C. It can be divided into four parts of apex, fundus, body and neck..

D. The fundus of bladder in male is adjoined with prostate gland.

E. The lowest part of bladder was called fundus of bladder.

14. Which is incorrect about the description of trigone of bladder?

A. It lies at the inner surface of fundus of bladder.

B. It is a triangular area formed by two ureteric orifices and an interureteric fold.

C. Its submucous layer and muscular layer are connected compactly with each other.

D. It maintains smooth all the time no matter extending or contraction.

E. It is the predilection site of tumor, concretion and inflammation.

15. Which is incorrect about the description of female urethra?

A. It is about 3 to 5cm long.

B. The character is short, straight and wide.

C. The internal orifice of urethra is surrounded by sphincter muscle of urinary bladder, which is constructed by striated muscle.

D. The external orifice of urethra lies in the front of vaginal orifice.

E. The internal orifice of urethra crosses the accessory diaphragm and debouches at the external orifice of vestibule of vagina.

16. Which is correct about the description of renal sinus?

A. It is the depression of renal hilum extended to renal parenchyma.

B. It is connected with the upper extremity of ureter.

C. It is constituted by renal medulla.

D. It contains renal artery and renal vein.

E. It is connected with the bottom of renal papilla.

17. Which of the following structures don't belong to renal medulla?

A. renal pyramid

B. renal papilla

C. papillary foramina

D. straight tubules

E. minor renal calices

18. From inside to outside, the arranging order of renal envelop is .

A. fibrous capsule, fatty renal capsule and renal fascia

B. fibrous capsule, renal fascia and fatty renal capsule

C. renal fascia, fatty renal capsule and fibrous capsule

D. renal fascia, fibrous capsule and fatty renal capsule

E. fatty renal capsule, fibrous capsule and renal fascia

19. The quantity of renal pyramids in renal medulla is .

A. 8-10

B. 10-12


C. 15-20

D. 20-25


E. 25-30

20. Which of the following belongs to renal cortex?

A. minor renal calices

B. major renal calices

C. renal pelvis

D. renal pyramid

E. renal column

21. Which is correct about the description of renal superior and inferior extremities?

A. The former is wide and thin, the latter is narrow and thick.

B. The former is narrow and thick, the latter is wide and thin.

C. The former is wide and thick, the latter is narrow and thin.

D. The former is narrow and thin, the latter is wide and thick.

E. All the above are false.

22. The renal region refers to .

A. the included angle of the medial border of erector spinae and the 12th rib

B. the included angle of the exterior border of erector spinae and the 12th rib

C. the included angle of the medial border of erector spinae and the llth rib

D. the included angle of the exterior border of erector spinae and the llth rib

E. the included angle of the exterior border of latissimus dorsi muscle and the 12th rib

23. What is renal segment?

A. a renal vein and its supplying renal tissue

B. a renal pelvis and its affiliating renal tissue

C. a minor renal calix and its collecting renal tissue

D. a major renal calix and its collecting renal tissue

E. a renal artery distributes to the renal parenchyma of some region

24. Each kidney can be divided into .

A. 3 renal segments

B. 4 renal segments

C. 5 renal segments

D. 6 renal segments

E. 7 renal segments

25. The renal segments of each kidney include .

A. superior segment, superior anterior segment, inferior anterior segment, inferior segment and posterior segment

B. superior segment, superior anterior segment, superior posterior segment, inferior segment and inferior anterior segment

C. superior segment, superior anterior segment and inferior segment

D. superior segment, inferior segment, superior anterior segment and posterior segment

E. superior segment, superior anterior segment, superior posterior segment, inferior segment, inferior anterior segment and posterior segment

26. The narrowest aperture of ureter is about .

A. 0. 1-0. 2cm

B. 0.2-0. 3cm

C. 0. 3-0.4cra

D. 0.4-0. 5cm

E. 0. 5-0.6cm

27. The whole length of ureter is about .

A. 10-15cm

B. 15-20cm

C. 20-30cm

D. 30-35cm

E. 35-40cm

28. The average caliber of ureter is about .

A. 0.3-0.5cra

B. 0. 5-1.0cm

C. 1.0-1.5cm

D. 0.8cm


E. 1.0cm

29. In the ingress of small pelvis, the left ureter steps over .

A. the anterior aspect of the end of left common iliac artery

B. the posterior aspect of the end of left common iliac artery

C. the anterior aspect of the end of left external iliac artery

D. the posterior aspect of the end of left external iliac artery

E. the anterior aspect of the end of left internal iliac artery

30. In the ingress of small pelvis, the right ureter steps over .

A. the anterior aspect of the end of right common iliac artery

B. the posterior aspect of the end of right common iliac artery

C. the anterior aspect of the end of right external iliac artery

D. the posterior aspect of the end of right external iliac artery

E. the anterior aspect of the end of right internal iliac artery

31. The courser of abdominal part of ureter is .

A. descends along the anterior aspect of abdominal aorta

B. descends along the anterior aspect of iliopsoas muscle

C. descends along the anterior aspect of psoas major muscle

D. descends along the anterior aspect of quadratus lumborum muscle

E. descends along the anterior aspect of erector spinae

32. The male pelvic part of ureter steps over which structure of the following?

A. ductus deferens

B. bulb of urethra

C. bulbourethral gland

D. ejaculatory duct

E. contorted seminiferous tubules

33. The female ureter lies at .

A. the anterior aspect of uterine artery

B. the posteroinferior aspect of uterine artery

C. the anterolateral of uterine artery

D. the posterior aspect of uterine artery

E. the superior aspect of uterine artery

34. The first stricture of ureter lies at .

A. the migration part of renal pelvis and ureter

B. the superior pelvic aperture

C. the crossing part of ureter and iliac blood vessels

D. the intramural part of ureter

E. all the above aren't correct

35. The second stricture of ureter lies at .

A. the migration part of renal pelvis and ureter

B. the crossing part of ureter and iliac blood vessels

C. the intramural part of ureter

D. 3cra below renal pelvis

E. the pelvic part of ureter

36. The third stricture of ureter lies at .

A. the migration part of renal pelvis and ureter

B. the intramural part of ureter

C. the crossing part of ureter and lilac blood vessels

D. the superior pelvic aperture

E. the outlet of pelvis

37. Which isn't correct about the description of urinary bladder?

A. The urinary bladder is an organ of capsular.

B. Its shape, size, position and the thickness of wall vary with the engorging extent of urine.

C. The normal volume of adult urinary bladder is 350 to 500ml.

D. The biggest volume of urinary bladder is 800ml.

E. The volume of newborn is about 1/5 of that of adult.

38. Where is the predilection site of bladder tumor?

A. internal orifice of urethra

B. ureteric orifice

C. trigone of bladder

D. interureteric fold

E. vesical uvula

39. The anterior adjacent of urinary bladder is .

A. articulation of pubis

B. ileum


C. perineum

D. womb


E. colon

40. The posterior adjacent of urinary bladder is .

A. articulation of pubis

B. colon


C. womb

D. perineum

E. ileum

41. Which of the following structure doesn't involve in cystoptosis?

A. puboprostatic ligament

B. pubovesical ligament

C. median umbilical fold

D. lateral umbilical fold

E. vesical plica

42. When the urinary bladder is engorged, which of the following statement is right?

A. It lies at the inner pelvic cavity totally.

B. The reflexion curve can migrate upward to the superior aspect of articulation of pubis.

C. The fundus of it can migrate upward to the articulation of pubis.

D. The neck of it migrates downward.

E. The trigone of bladder can migrate upward.

43. Which of the following isn't correct about the position of urinary bladder?

A. The position of urinary bladder in newborn is higher than that in adult.

B. The position of urinary bladder in old people is lower.

C. The position of urinary bladder in newborn is lower than that in adult.

D. The pricking usually processes at the superior aspect of articulation of pubis.

E. The urinary bladder lies at the pelvic cavity totally when it is void.

44. Which are the abnormity of kidney?

A. horseshoe kidney, polycystic kidney, double renal pelvis and ureters

B. polycystic kidney, double renal pelvis and ureters

C. mono-kidney, low-position kidney, double renal pelvis and ureters

D. mono-kidney, low-position kidney, horseshoe kidney

E. All of the above are correct.

45. Which of the following is the anatomic basement for renal transplantation?

A. The kidney has affluent blood circulation.

B. The donor's age is below 30.

C. The transplanted kidney usually is put into the abdominal cavity.

D. The renal veins can be coincided or not.

E. The immunosuppressive drug isn't very important for renal transplantation.

46. Which of the following doesn't belong to the posterior adjacent of kidney?

A. iliacus

B. psoas major

C. quadratus lumborum

D. transversus abdominis

E. diaphragm

A2

1. A male adult fall on a thick branch when he climbed on the tree. As a result, the scrotum swelled, and urine was obstructed. After examination, we found that the abdominal wall was inflated on the superior aspect of pubic symphysis, and there was a dullness region near umbilical part by percussion. The urethral catheterization failed because of the swelling of the private. Question. Where should the puncture be implemented to release urine?



A. on the superior aspect of pubic symphysis

B. on the inferior, aspect of pubic symphysis

C. on the superior aspect of prostate gland

D. on the inferior aspect of prostate gland

E. on the posterior aspect of prostate gland

2. A male patient, 50 years old, go to clinic for paroxysmal gross hematuria. Body examination found that a lump can be palpated on the left abdomen and had light tenderness. The pyelography found that the left kidney is lengthened, narrow and deformed. Question: the most probable disease is .

A. renal carcinoma

B. renal pelvic carcinoma

C. nephrohydrosis

D. renal cyst

E. kidney stone

3. A male patient, 40 years old, occurred gross hemamria without pain, obstructed urination and frequent micturition repeatedly in recent one month. There were also deciduous tumor cells. Besides, his left kidney, ureter and partial urinary bladder wall had been cut for left renal pelvic carcinoma two years ago. Question: the probable diagnosis is .

A. right kidney carcinoma

B. right renal pelvic carcinoma

C. right ureter carcinoma

D. urinary bladder carcinoma

E. urinary bladder tubercle

4. A male patient, 25 years old, undertook KUB one day. The result showed that both the two renal pelvis had a dense shadow, with the size of lxl. 5crn, and the two ureters were obstructed. The stone of two sides were shattered by ESWL. After operation, renal colic, fever and suppression of urine occurred the second day. Question: the most probable diagnosis is .

A. the obstruction of blood clot

B. contusion of kidney

C. the obstruction of gallet in the two ureters

D. acute tubular necrosis

E. acute pyelonephritis

5. A male patient, 36 years old, right solitary kidney, right waist colic pain, and anuresis for 3 days. The examination showed that there was blood urine. Question: the most probable diagnosis is .

A. urinary calculus

B. urinary fistula

C. urethral stricture

D. contusion of kidney

E. acute pyelonephritis

6. A female patient, 40 years old, had right waist pain for I year. The examination found that her right kidney occurred space occupying, and there was no blood urine or irritation sign of bladder. The inferior extremity of right kidney could be palpated, and the right kidney region had percussion pain. Besides, the urine routine and IVP were normal. CT indicated that the inferior extremity of right kidney had space occupying, the size of which was about 3 X 3cra, and the CT value was negative value. Question: the most probable diagnosis is .

A. renal carcinoma

B. renal cyst

C. renal pelvic carcinoma

D. embryoma of kidney

E. angiomyolipoma of kidney

7. A male patient, 58 years old, occurred gross hematuria without pain many times in the recent 3 months. The urine routine showed that RBC+ + + +/HP. The ultrasonic B showed that there seemed a lump in the right renal pelvis. Question: the most probable diagnosis is .

A. the stone of renal pelvis

B. renal tuberculosis

C. renal pelvic carcinoma

D. renal carcinoma

E. embryoma of kidney

BI

A. adrenal gland



B. liver

C. diaphragm

D. the descending part of duodenum

E. the posterior aspect of the {undus of stomach

1. The upper 1/3 of the posterior kidney adjoins with .

2. The superior extremity of kidney adjoins with .

3. The anterosuperior part of right kidney adjoins with .

A. the inferior border of the llth body of thoracic vertebra

B. the superior border of the 12th body of thoracic vertebra

C. the plane of the 1st body of lumber vertebra

D. the 7.nd to 3rd intervertebral disc

E. the superior border of the 3rd lumber vertebra

4. The superior extremity of right kidney is on the level with .

5. The superior extremity of left kidney is on the level with .

6. The inferior extremity of right kidney is on the level with .

7. The inferior extremity of left kidney is on the level with .

8. The renal hilum lies at .

A. 1


B. 2 to 3

C. 5


D. 7 to 8

E. 15 to 20

9. Every kidney has renal segments.

10. Every kidney has minor renal calices.

11. Every kidney has major renal calices.

12. Every kidney has renal pelvis.

13. Every kidney has renal pyramids.

True or False Questions

1. The left renal artery is shorter than the right. ( )

2. The renal arteries are enclosed in renal fascia and surrounded with fatty renal capsule. ( )

3. The autonomic nerve fiber isn't concluded in renal sinus. ( )

4. The urinary bladder is covered by peritoneum on all surfaces. ( )

5. The superior extremity of each kidney is capped by the suprarenal gland. ( )

6. The perirenal space lies between the prerenal fascia and postrenal fascia. ( )

7. The normal volume of adult's urinary bladder is 500 to 800ml. ( )

8. The space between the bladder and symphysis pubis is called prevesical space or retropubic space. ( )

9. The female urethra has the length of 6 to 8cm. ( )

10. The position of infant's bladder is higher than that of adult's, while that of old man's bladder is lower. ( )

Explanation of Terms

1. renal sinus

2. trigone of bladder

3. renal hilum

4. renal pedicle

5. fibrous capsule

6. segmental arteries

7. zone devoid of vessel

8. horseshoe kidney

Answer the Following Questions

1. What are the differences on position between the left and right kidney?

2. Try to state the position and adjacent of urinary bladder.

3. The quantity and names of renal segments.

4. The frequent malformation and abnormality of kidney.

5. The division of ureters.

6. Try to state the positions of strictures in the whole length of ureters.

7. The division of an empty bladder.

8. The position and meaning of interureteric fold.

ANSWERS

Multiple Choice Questions



A1

1. B 2. C 3. C 4. E 5. E 6. D 7. A 8. E 9. E 10. A

11. E 12. D 13. E 14. C 15. C 16. A 17. E 18. A 19. C 20. E 21. A 22. B 23. D 24. C 25. A 26. B 27. C 28. B 29. A 30. C 31. C 32. A 33. B 34. A 35. B 36. B 37. E 38. C 39. A 40. C 41. E 42. B 43. C 44. E 45. A 46. A

A2


1. A 2. A 3. D 4. C 5. A 6. E 7. C

B1

1. C 2. A 3. B 4. B 5. A 6. E 7. D 8. C 9. C 10. D 11. B 12. A 13. E



True or False Questions

1. T 2. T 3. F 4. F 5. T 6. T 7. F 8. T 9. F 10.:T

Explanation of Terms

1. A lacouna of blind sac, which enters into renal cortex from renal hilum. There are major renal calices, minor renal calices, renal pelvis, branch of renal artery and renal veins, nerves, lymphatic vessel and adipose tissue.

2. A triangular area known as the trigone of bladder is formed on the mucosa between the two ureteric orifices and the single internal urethral orifice. The internal trigone lacks folds; it is therefore smooth in-appearance and remains relatively fixed in position as the urinary bladder changes shape during distension and contraction. The trigone of bladder is the predilection site of tumor, tubercle and inflammation, and special attention should be paid when cystoscopy.

3. The hilum of the kidney is the depression along the medial border through which the renal blood vessels, nerves, lymphatic vessels and renal pelvis enter or exit.

4. The structures which pass through the renal hilum are enclosed together by the connective tissue, to form the renal pedicle.

5. The fibrous capsule, the innermost layer, is a strong, transparent fibrous attachment to the surface of the kidney, and consists of dense connective tissue and elastic fiber.

6. The 5 secondary branches of renal artery often present segmental distribution, which are called segmental arteries.

7. Each renal segment is supplied by its homonymous artery, and each renal segment is separated by some connective tissue that is lack of blood vessel, which is called zone devoid of vessel.

8. The horseshoe kidney refers to the lower extremity of amphi-kidney connect to each other and shows up a horseshoe form, and this malformation can cause hydronephrosis, infection or calculus.

Answer the Following Questions

1. The upper extremity of the left kidney is on the level with the lower border of the body of the eleventh thoracic vertebra, the lower extremity of the left kidney is between the second intervertebral disc of lumbar vertebra and the third one. The upper extremity of the right kidney is on the level with the upper border of the body of the twelfth thoracic vertebra, and the lower extremity is on the upper border of the body of the third lumbar vertebra.

2. The symphysis pubis is in front of urinary bladder, and the space between the bladder and symphysis pubis is called prevesical space or retropubic space. In male, there are medial and lateral puboprostatic ligaments in this space. In female, the similar bands are termed pubovesical ligament instead. The two connective tissue bands are behind pubic bone as well as the tendinous arch of the pelvic fascia and link with the neck of bladder. In male, the posterior part of bladder is adjoined with ampullae ductus deferentis, seminal vesicles and rectum. In female, the posterior part of bladder is adjoined with uterus and vagina. The intermediate zone of ampulla ductus deferentis of male is called triangle of ampulla ductus deferentis, which link with ampulla of rectum via connective tissue, which is called rectovesical fascia. When the bladder is empty it is placed entirely within the pelvis, while the bladder and line of peritoneal reflection can move upward above symphysis pubis. The position of infant's bladder is higher than that of adult's, and the internal orifice of urethra is at the level of superior border of pubis. On the contrary, the position of old man's bladder is lower.

3. There are 5 renal segments, which are superior segment, anterior superior segment, anterior inferior segment, inferior segment and posterior segment.

4. In the development process, the kidneys may appear malformation or the abnormality of position and quantity, such as horseshoe kidney, polycystic kidney, double renal pelvis and ureters, mono-kidney as well as low-position of kidney.

5. The subdivision of ureter includes three parts: the abdominal part of ureter, the pelvic part of ureter and the intramural part of ureter.

6. There are three strictures in the whole length of ureters: the superior stricture, the middle stricture and the inferior stricture. The superior stricture lies in the migration part of renal pelvis and ureter, while the middle stricture locates in superior pelvic aperture where ureters cross over iliac vessels, and the inferior stricture is situated at the ureteric orifice of intramural part of ureter.

7. An empty urinary bladder is pyramidal; and can be divided into four parts, apex, fundus, body and neck.

8. The fold between the'two ureteric orifices is' called interureterie fold, which is a pale band observed by cystoscope, and it is a sign for finding ureteric orifice in clinic.

(Tian Xiaohong, Bai Shuling)

Multiple Choice Questions

A1

1. Which description is false about the male reproductive organs?



A. The testes are two glandular organs.

B. The epididymis consists of the head, body and tail.

C. The ductus deferens traverses the inguinal canal.

D. The ejaculatory duct opens into the urinary bladder.

E. The prostate is around the commencement of the urethra.

2. The internal genital organs of male do not include .

A. testis

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