Gross anatomy 205 midterm examination october 10, 1995

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GROSS ANATOMY 205 MIDTERM EXAMINATION......................OCTOBER 10, 1995
There are 50 questions on this examination. You have 90 minutes to complete this examination.

This copy will be returned to you when grading is completed.

MULTIPLE CHOICE QUESTIONS (choose the one correct answer and fill

in the circle on the General Purpose Answer sheet)

1. Pronounced weakness in supination of the forearm is most likely

the result of damage to which of the following nerves?

a. median

b. ulnar

c. musculocutaneous

d. anterior interosseous

e. superficial radial
2. Ulnar nerve injury commonly occurs where the nerve passes behind

the medial epicondyle of the humerus. Injury to the ulnar nerve may result

in all of the following symptoms except
a. loss of sensation on the medial surface of the palm and digits 4 and 5

b. loss of abduction of the wrist

c. loss of flexion at distal interphalangeal joints of digits 4 and 5

d. loss of abduction of digit 5

e. loss of adduction of the thumb
3. All of the following muscles are lateral rotators of the thigh

at the hip joint except

a. sartorius

b. obturator externus

c. obturator internus

d. gracilis

e. quadratus femoris
4. Gait or walking involves the initial contact and controlled lowering

of one foot to the floor. Loss of this component of normal gait is referred

to as "foot-drop." This condition may be characterized by all

of the following statements except

a. the tibialis anterior muscle is paralyzed

b. the common fibular (peroneal) nerve is damaged

c. the patient has a high stepping gait so that the toes do not hit the ground

d. there is loss of sensation from the skin over the anterolateral surface of the leg

e. there is loss of sensation from the skin over the sole of the foot

7-10. A UCLA quarterback was tackled from behind while his right

arm was fully abducted as he was about to throw the football. His right

shoulder joint was dislocated anteriorly so that the head of the humerus

came to lie inferior to the glenoid cavity.
7. The dislocated humeral head came to rest directly against the

tendon of which of the following muscles?

a. supraspinatus

b. infraspinatus

c. subscapularis

d. teres minor

e. teres major
8. The subglenoid dislocation forced the humeral head into the quadrangular

space which may cause damage to which of the following nerves?

a. musculocutaneous

b. suprascapular

c. radial

d. axillary

e. ulnar
9. If the above-mentioned nerve had been damaged in this patient,

all of the following symptoms would occur except

a. some loss of sensation on the lateral aspect of the upper limb

b. some weakness in lateral rotation at the shoulder joint

c. some weakness in medial rotation at the shoulder joint

d. impaired ability to abduct the arm

e. impaired ability to adduct the arm
10. Several weeks after his shoulder dislocation was reduced, the

quarterback complains of persistent pain when he abducts his arm to throw

a football. Because it is commonly damaged in shoulder dislocations, you

suspect a persistent injury and inflammation of the tendons of which of

the following muscles?
a. supraspinatus

b. infraspinatus

c. subscapularis

d. teres minor

e. teres major
11. The saphenous nerve is a sensory branch of which of the following

a. sciatic

b. femoral

c. obturator

d. common fibular (peroneal)

e. tibial

12. All of the following nerves and arteries are in contact with

the humerus, and may be damaged in fractures of the humerus, except

a. posterior humeral circumflex artery

b. profunda brachii artery

c. ulnar artery

d. ulnar nerve

e. radial nerve
13. Which of the following muscles is innervated by posterior

primary rami of spinal nerves?

a. trapezius

b. latissimus dorsi

c. serratus posterior

d. erector spinae

e. rhomboideus major
14-15. A young man is brought into the UCLA emergency room with a

deep and jagged laceration extending from just behind his medial malleolus

down on to the medial aspect of the sole of his foot.
14. You are concerned that his injury may have damaged all of the

following muscles except

a. abductor hallucis

b. flexor hallucis brevis

c. flexor hallucis longus

d. flexor digitorum longus

e. tibialis posterior
15. Your examination reveals minimal muscle damage but the laceration

has severed the medial plantar nerve. You would expect that all of the following

muscles would be paralyzed except
a. abductor hallucis

b. adductor hallucis

e. flexor hallucis brevis

d. flexor digitorum brevis

e. first lumbrical
16. All of the following statements about the knee joint are correct except
a. the principal movements of the knee joint are flexion and extension

b. when the knee is fully extended, the anterior cruciate ligament prevents posterior

displacement of the femur on the tibia and hyperextension of the knee

c. when the knee is fully flexed, the posterior cruciate ligament

prevents anterior displacement of the femur on the tibia and stabilizes the knee when

walking downstairs

d. when the knee is fully extended, it "locks" because of lateral rotation of the

femur on the tibia

e. the popliteus muscle contracts to "unlock" the knee so that flexion of the knee can occur
25. Two muscles form the floor of the femoral triangle on the front

of the thigh. Which of the following muscles forms the medial part

of the floor?
a. pectineus

b. vastus medialis

c. adductor longus

d. rectus femoris

e. iliopsoas
27. In the sole of the foot, layer 2 consists of intrinsic muscles

and tendons of extrinsic muscles. Therefore, all of the following muscles

are considered part of layer 2 except
a. flexor digitorum longus

b. flexor digitorum brevis

c. flexor hallucis longus

d. quadratus plantae

Multiple Choice (select the one best answer).
1. All of the following muscles help to elevate the larynx during the act of swallowing. Which muscle also depresses (lowers) the hyoid bone?
a. thyrohyoid

b. geniohyoid

c. mylohyoid

d. anterior digastric

e. stylopharyngeus
2. Which of the following lymph nodes drains the oropharynx and often are referred to as the "tonsillar nodes" because they

become inflammed in cases of tonsillitis?

a. submandibular

b. subclavian

c. subdigastric or jugulo-digastric

d. bifurcation or jugulo-carotid

e. jugulo-omohyoid
3. Damage to the facial (VII) nerve near the geniculate ganglion results in all of the following symptoms except
a. absence of blinking reflex on affected side

b. absence of lacrimal secretion on affected side

c. corner of mouth pulled to affected side

d. hyperacusia or sensitivity to loud sounds

e. reduced secretion of saliva into oral cavity
4. When the middle meningeal artery is ruptured but the meninges remain intact, blood enters the
a. subdural space

b. epidural space

c. subarachnoid space

d. cavernous sinus

e. sigmoid sinus
5. Which of the following muscles causes abduction of the vocal cords during quiet breathing?
a. cricothyroids

b. thyroarytenoids

c. posterior cricoarytenoids

d. lateral cricoarytenoids

e. oblique interarytenoids
6. All of the following structures are located within the carotid sheath except
a. internal jugular vein

b. internal carotid artery

c. common carotid artery

d. vagus (X) nerve

e. sympathetic chain
7. All of the following conditions or actions result from stimulation of the short ciliary nerves except
a. contraction of the ciliary muscle

b. enhanced vision for distant objects

c. decreased size of the pupil

d. increased thickness of the lens

e. altered blood flow to capillaries in the iris
8. All of the following structures enter the orbit by passing through the anulus tendineus (common tendinous ring) except
a. optic (II) nerve

b. trochlear (IV) nerve

c. abducens (VI) nerve

d. nasociliary nerve

e. ophthalmic artery
9. The accessory meningeal artery passes through which foramen to supply the trigeminal ganglion?
a. foramen ovale

b. foramen spinosum

c. foramen rotundum

d. foramen lacerum

e. foramen cecum
17. All of the following muscles attach to the thyroid cartilage except
a. cricopharyngeus

b. stylopharyngeus

c. inferior pharyngeal constrictor

d. cricothyroid

e. sternothyroid
18. If food enters the larynx, the laryngeal muscles go into spasm and the rima glottidis closes. If the food can not be dislodged,

the person is in danger of asphyxiation and an emergency midline incision is made into which structure to open the airway?

a. median thyrohyoid ligament

b. median cricothyroid ligament

c. cricotracheal ligament

d. vocal ligament

e. thyroid cartilage
19. Which part of the larynx is most directly concerned with voice production?
a. aditus

b. vestibule

c. glottis

d. ventricle

e. infraglottic cavity
20. Damage to the sympathetic trunk in the neck interrupts the sympathetic nerve supply to the head and neck on that side. This

condition is known as the Horner syndrome which consists of all of the following symptoms except

a. pupillary constriction

b. ptosis or drooping of upper eyelid

c. vasoconstriction

d. absence of sweating

e. apparent retraction of the eye into the orbit (enophthalmus)
21. Which of the following branches of the vagus (X) nerve supplies motor innervation to muscles of both the pharynx and

a. pharyngeal nerve

b. superior laryngeal nerve

c. external laryngeal nerve

d. internal laryngeal nerve or

e. recurrent laryngeal nerve

22. Which of the following paranasal sinuses drains into the nasal cavities above the middle nasal conchae?
a. sphenoid

b. maxillary

c. anterior ethmoidal

d. middle ethmoidal

e. posterior ethmoidal
23-26. A 19 year old male victim of a drive-by shooting presents in the emergency room with a .22 caliber bullet wound in the

left infratemporal fossa, just below the zygomatic arch and about one inch anterior to the external auditory meatus. The bullet

passed through the mandibular notch and imbedded at the base of the pterygoid process of the sphenoid bone. Following a

relatively uncomplicated surgical extraction, the patient had paresis (weakness) and paralysis of his left masticatory muscles.

23. What structure was most likely severed by the bullet?
a. facial (VII) nerve

b. maxillary (V2) nerve

c. maxillary artery

d. mandibular (V3) nerve

e. retromandibular vein
24. With damage to the above structure, what other symptoms might you expect to see in this patient?
a. numbness of the left side of the eyelid and forehead

b. numbness of the left ear or

c. numbness of the left side of the tongue and sublingual region

d. numbness of the left side of the oropharynx

e. numbness of the left cheek and side of the nose
25. If the sense of taste from the anterior two-thirds of the tongue is normal, you might conclude that which of the following

nerves was not damaged by the bullet?

a. hypoglossal (XII)

b. lingugl branch of V3

c. lesser petrosal branch of IX

d. chorda tympani branch of VII

e. greater petrosal branch of VII
26. Since secretions from the left parotid gland are reduced greatly, but sublingual and submandibular secretions are normal,

which of the following ganglia was damaged?

a. geniculate

b. submandibular

c. otic

d. trigeminal

e. pterygopalatine
27-29. You and a classmate decide to play racketball after class but neither of you are wearing safety glasses. During the

game, your classmate is struck in the right eye by the ball and complains that her cheek and upper lip are numb and that she can

not look upward with her right eye. Suspecting that she has sustained a blowout fracture of the orbit, you take her to the

emergency room.

27. When you reach the emergency room, your suspicions about the fracture are confirmed and you are told by the attending

physician that the following has occurred?

a. the medial rectus muscle is entrapped by a fracture of the medial wall of

the orbit

b. the superior rectus muscle is entrapped by a fracture of the roof of the


c. the lateral rectus muscle is entrapped by a fracture of the zygomatic


d. the inferior rectus muscle is entrapped by a fracture of the maxillary


e. the superior rectus muscle has detached from the eyeball
28. Since she is complaining of persistent numbness of her cheek and upper lip, which nerve has most likely been damaged by

this fracture?

a. supraorbital

b. infraorbital

c. supratrochlear

d. infratrochlear

e. buccal
29. There is no damage to the left orbit and, when your classmate is asked to look upward her left eye moves normally. The

ability to look upward requires the simultaneous contractions of which two extraocular muscles?

a. superior rectus and superior oblique

b. superror rectus and inferior oblique

c. superior oblique and inferior oblique

d. inferior rectus and inferior oblique

e. inferior rectus and superior oblique
30. A 10 year old child is admitted to the hospital with a very high fever, rapid pulse and respiration, and complaining of a very

sore throat. Your examination reveals bloody pus in her sputum and an abscess in her tonsillar area. A chest x-ray shows fluid

accumulation in the superior and posterior mediastinum. The fluid (pus) in the thorax indicates that the infection had penetrated

into which of the following spaces?

a. sublingual space

b. pyriform recess

c. pharyngeal recess

d. retrovisceral space

e. carotid sheath
31. Hyperflexion of the head and upper cervical vertebrae is limited primarily by which of the following?
a. posterior longitudinal ligament

b. anterior longitudinal ligament

c. posterior atlanto-occipital membrane

d. mandible encountering the sternum or lower neck

e. alar or check ligaments
32. Paralysis or spasticity of which of the following muscles would prevent full opening of the mouth (depression of the


a. medial pterygoid

b. lateral pterygoid

c. masseter

d. temporalis

e. posterior digastric
33. Damage to the external laryngeal nerve during thyroid surgery will result in the patient's inability to
a. relax the vocal cords

b. tense the vocal cords

c. abduct the vocal cords

d. adduct the vocal cords

e. swallow normally
34. Each of the following sensory nerves is a branch of the cervical plexus except
a. great auricular

b. transverse cervical

c. greater occipital

d. lesser occipital

e. supraclavicular
35. All of the following muscles receive their motor innervation from the pharyngeal branch of the vagus (X) nerve except
a. salpingopharyngeus

b. stylopharyngeus

c. palatopharyngeus

d. superior pharygneal constrictor

e. palatoglossus
36. All of the following statements concerning the pterygopalatine fossa are correct except
a. the maxillary nerve enters the fossa through the foramen


b. the maxillary artery enters the fossa through the pterygomaxillary


c. the zygomatic nerve exits the fossa through the inferior orbital


d. the nasopalatine nerve exits the fossa through the greater palatine


e. the posterior superior alveolar nerves exit the fossa through the

pterygomaxillary fissure

37. All of the following statements concerning the sublingual region of the oral cavity are correct except
a. the duct of the submandibular gland opens lateral to the frenulum of the


b. the submandibular ganglion sends postganglionic parasympathetic fibers

to the sublingual gland via branches of the lingual nerve

c. the lingual artery lies lateral to the hyoglossus muscle

d. the hypoglossal nerve enters the region by passing above the posterior

margin of the mylohyoid muscle

e. the lingual nerve supplies general sensory innervation to the sublingual

38-41. A 50 year old white male developed chronic rhinitis, an inflammation of the nasal mucosa with excessive mucus

secretion and occasional epistaxis or profuse nose bleeding. His symptoms did not respond to medication and surgery was

discussed to relieve his chronic nasal discharge.
38. This condition can be treated surgically by resection of which of the following ganglia?
a superior cervical

b. ciliary

c. submandibular

d. sublingual

e. pterygopalatine
39. Preganglionic fibers which synapse in this ganglion are found in which of the following nerves?
a. greater petrosal

b. lesser petrosal

c. deep petrosal

d. nasopalatine

e. sympathetic chain
40. As a result of this surgery, secretions will be reduced in all of the following tissues except
a. pharyngeal mucosa above the soft palate

b. mucosa lining the soft palate

c. mucosa lining the hard palate

d. sublingual gland

e. lacrimal gland
41. Nose bleeding often originates at Kiesselbach's area where there is anastomosis of the septal branches of all of the

following arteries except

a. sphenopalatine

b. greater palatine

c. superior labial

d. anterior ethmoidal

e. posterior ethmoidal
42. During general anesthesia, care must be taken to prevent the tongue from falling back and blocking the patient's airway

because of total relaxation of which of the following muscles?

a. genioglossus

b. styloglossus

c. palatoglossus

d. hyoglossus

e. mylohyoid
43. All of the following statements concerning the ear are correct except
a. the mucosa of the middle ear is innervated by the tympanic plexus which

contains the tympanic branch of IX and the caroticotympanic nerves

b. the sensory innervation to the external ear and outer surface of the

tympanic membrane is supplied by the auriculotemporal nerve

c. the promontory is located on the medial wall of the middle ear and is

produced by the basal coil of the cochlea

d. the tegmen tympani is a thin plate of bone that separates the middle ear

from the middle cranial fossa

e. the spiral organ of Corti rests on the basilar membrane within the scala

tympani of the cochlea

44. Which of the following conditions is least likely to result from the spread of infection from otitis media, an inflammation of

the middle ear?

a. meningitis

b. encephalitis

c. mastoiditis

d. rhinitis

e. laryngitis
45. The labyrinthine artery supplies blood to the inner ear and is a branch of which of the following arteries?
a. internal carotid

b. superior cerebellar

c. posterior cerebral

d. basilar

e. vertebral
46-50. Each of the following glands receives its blood supply from branches of one of the arteries listed on the right. Match

each gland with the most appropriate artery.

46. parotid __A___ a. external carotid
47. prostate __C___ b. internal carotid
48. lacrimal __B___ c. inferior vesical
49. parathyroid __E___ d. internal pudendal
50. greater vestibular __D___ e. thyrocervical

GROSS ANATOMY Final Written Examination 12/10/91

1. A large malignant tumor of bone invades the floor of the middle

cranial fossa. Knowing the anatomy of the middle cranial fossa, you

look for symptoms that would indicate tumor invasion in all of the

following structures, except:

A. foramen spinosum.

B. internal auditory meatus.

C. foramen lace rum.

D. foramen ovale.

E. foramen rotundum.

2. A patient suffers from a dry and painful right cornea, numbness of the right nasal cavity as well as a loss of sensation along the right

side of the palate in the oral cavity. Which of the following could be the cause of these symptoms?
A. a small tumor pressing on the trigeminal ganglion.

B. a growth in the pterygopalatine fossa that compresses the pterygopalatine ganglion.

C. a loss of cell bodies in the pterygopalatine ganglion.

D. compression of the geniculate ganglion.

E. a tumor that compresses the structures in the superior orbital fissure.

3. The following statements about the drainage of the paranasal sinuses are correct, except:

A. The sphenoid sinus drains into the sphenoethmoidal recess.

B. The maxillary sinus drains into the middle meatus.

C. The frontal sinus drains into the inferior meatus.

D. The posterior ethmoidal sinus drains into the superior meatus.

E. The anterior ethmoidal sinus drains into the ethmoidal infundibulum/middle meatus.
4. Each of the following statements regarding veins in the head and neck is true, except:
A. The retromandibular and facial veins unite to form the common facial vein.

B. The external jugular vein lies superficial to the sternocleidomastoid muscle.

C. The internal jugular vein is formed by the union of the inferior petrosal and sigmoid sinuses.

D. The straight sinus is formed by the union of the superior and inferior sagittal sinuses.

E. The facial vein lies superficial to the submandibular gland in the submandibular triangle.

6. Your room mate finally indicates that he has been rather subdued

because he has had a persistent headache for about two weeks.

Having Just started your ophthalmology clerkship, you examine his

eyes and find that he has bilateral papilledema (edema of the

optic disc) and congested retinal veins. You immediately suspect

some intracranial pathology that has increased his cerebrospinal

fluid pressure. The reason for your diagnosis is:

A. Since the retina is an outgrowth of the brain it reflects all neuropathology of the brain by developing papilledema.

B. Since the optic nerve is covered with the meninges, an increase in the pressure of the cerebrospinal fluid will compress the optic nerve and the venous drainage of the retina leading to papilledema.

C. Since the opthalmic artery is so small, increased intracranial pressure compromises blood flow through it as it enters the orbit.

D. Since the vitreous humor communicates with the subarachnoid

space, its pressure rises when cerebrospinal fluid pressure rises.

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