1.
A middle aged male patient complains of a weak "stream" and nocturia. You believe the most likely cause to be:
Correct Answer
D. Benign prostatic hypertropHy
Explanation
Benign prostatic hypertrophy (BPH) is the most likely cause of the patient's symptoms. BPH is a condition where the prostate gland, which surrounds the urethra, becomes enlarged and obstructs the flow of urine. This can lead to a weak stream and increased frequency of urination, which are the symptoms described by the patient. The other options, such as bladder infection, spinal cord lesion, ureteric calculi, and obstruction of the intramural urethra, are less likely to cause these specific symptoms in a middle-aged male patient.
2.
According to current concepts, the external urethral sphincter:
Correct Answer
B. Has inferior part in males that act as a true spHincter of the intermediate (membranous) urethra.
Explanation
The external urethral sphincter has an inferior part in males that acts as a true sphincter of the intermediate (membranous) urethra. This means that in males, the external urethral sphincter helps control the flow of urine through the intermediate part of the urethra. This is different from females, where the external urethral sphincter is similar and does not have an inferior part that acts as a true sphincter.
3.
Circumcision involves:
Correct Answer
A. Removal of the prepuce of the penis.
Explanation
The correct answer is removal of the prepuce of the penis. Circumcision is a surgical procedure that involves the removal of the foreskin, which is the prepuce, from the penis. This is a common practice in many cultures and religions for various reasons, including religious, cultural, and medical purposes. The removal of the glans, corona, or enlarging the external urethral orifice are not part of the circumcision procedure.
4.
Hemorrhoids are:
Correct Answer
C. Varicosities in rectal/anal veins.
Explanation
Hemorrhoids are varicosities in the rectal/anal veins. Varicosities refer to the condition of being enlarged or swollen, and in the case of hemorrhoids, this occurs in the veins of the rectum and anus. These swollen veins can cause pain, itching, and bleeding. Treatment options for hemorrhoids include lifestyle changes, medications, and in severe cases, surgical procedures.
5.
In male urethral catheterization:
Correct Answer
A. The diameter of the urethra at the external urethral orifice is narrower than at any other point.
Explanation
The diameter of the urethra at the external urethral orifice is narrower than at any other point because the external urethral orifice is the opening of the urethra that leads to the outside of the body. It is the point of exit for urine and semen in males. The urethra gradually widens as it extends further into the body, allowing for the passage of fluids. Therefore, the narrowest point is at the external urethral orifice.
6.
In the emergency room you examine a young boy whose was injured while trying to climb a fence. He says he hit his "bottom" hard while straddling the horizontal bar at the top of the fence. Your examination reveals that his penis and scrotum are edematous as is the lower part of his anterior abdominal wall. Only the most superior aspects of his thighs are also edematous. You suspect the boy:
Correct Answer
E. Ruptured his spongy urethra and the swelling is due to urine
Explanation
The boy's symptoms, including edema in the penis, scrotum, lower abdomen, and superior aspects of the thighs, suggest that there is a rupture in his spongy urethra. This rupture would allow urine to leak into the surrounding tissues, causing the swelling. This explanation is supported by the fact that the swelling is not due to blood, lymph, or an inflammatory reaction from the bulbourethral glands, as these would present differently.
7.
In the following AP pelvic radiograph, the arrow indicates:
Correct Answer
B. The ischial spine.
Explanation
The arrow in the AP pelvic radiograph indicates the ischial spine. The ischial spine is a bony prominence located on the posterior aspect of the ischium, which is one of the three bones that make up the pelvis. It serves as an attachment site for various ligaments and muscles. In the given radiograph, the arrow is pointing to a bony structure that corresponds to the location of the ischial spine.
8.
In the following MRI of a woman with an anteverted and anteflexed uterus, the arrow indicates the:
Correct Answer
C. External os (opening of the cervix)
Explanation
The arrow indicates the external os (opening of the cervix) because an MRI is a medical imaging technique that can provide detailed images of the internal structures of the body. In this case, the MRI is showing the anatomy of a woman's uterus, which is anteverted and anteflexed. The external os is the opening of the cervix, which is the lower part of the uterus that connects to the vagina. The arrow is pointing to this specific structure, indicating that it is the correct answer.
9.
In the following coronal MRI of the penis and scrotum from a normal male, the arrow indicates the:
Correct Answer
B. Corpus cavernosum
Explanation
The correct answer is Corpus cavernosum. The corpus cavernosum is a pair of sponge-like erectile tissues that run along the length of the penis. They are responsible for the majority of penile rigidity during an erection. In the given MRI image, the arrow is indicating the corpus cavernosum, which appears as a dark area due to its low signal intensity on the image.
10.
Prostate cancer:
Correct Answer
D. Is best identified rectally when the patient has a full bladder.
Explanation
Prostate cancer is best identified rectally when the patient has a full bladder because the full bladder helps to push the prostate gland forward, making it easier to palpate during a digital rectal exam. This technique allows the healthcare provider to feel for any abnormalities or changes in the size, shape, or texture of the prostate gland, which can be indicative of prostate cancer. The full bladder also helps to provide better visualization of the prostate gland during imaging tests such as ultrasound.
11.
The softening of the isthmus of the uterus (Hegar sign) is associated with:
Correct Answer
E. Pregnancy
Explanation
The softening of the isthmus of the uterus, known as Hegar sign, is a characteristic sign of pregnancy. During pregnancy, hormonal changes cause the uterus to enlarge and soften, particularly in the lower segment or isthmus. This softening allows the uterus to accommodate the growing fetus and prepare for labor and delivery. Uterine cancer, a prolapsed uterus, menopause, and menstruation do not typically cause this specific softening of the isthmus, making pregnancy the correct answer.
12.
The anorectal flexure of the anal canal:
Correct Answer
C. Is where the alimentary tract penetrates the pelvic diapHragm.
Explanation
The anorectal flexure of the anal canal refers to the point where the alimentary tract, specifically the rectum, passes through the pelvic diaphragm. This flexure allows for a change in direction of the rectum as it transitions from the sigmoid colon to the anal canal. It is not related to the level of S3, the transverse rectal folds, the rectovesical pouch, or the omental appendices.
13.
The blood that results in penile erection is primarily derived from the:
Correct Answer
B. Deep arteries of the penis.
Explanation
The blood that results in penile erection is primarily derived from the deep arteries of the penis. These arteries supply the corpora cavernosa, which are the main erectile tissues in the penis. During sexual arousal, these arteries dilate and allow more blood to flow into the penis, leading to an erection. The other options mentioned, such as the posterior scrotal arteries, deep branches of the external pudendal arteries, deep dorsal vein, and superficial dorsal veins, are not primarily responsible for the blood flow that causes penile erection.
14.
The ductus deferens:
Correct Answer
A. Terminates by uniting with the duct of the seminal glands to form the ejaculatory duct.
Explanation
The ductus deferens terminates by uniting with the duct of the seminal glands to form the ejaculatory duct. This is an important anatomical structure in the male reproductive system as it is responsible for carrying sperm from the epididymis to the urethra during ejaculation. This union of the ductus deferens and the seminal gland duct allows for the mixing of sperm and seminal fluid, which is essential for the transport and nourishment of sperm.
15.
The female urethra:
Correct Answer
E. Opens into the vestibule of the vagina.
Explanation
The female urethra opens into the vestibule of the vagina. This means that the opening of the urethra is located in the area between the labia minora, which is the space just in front of the vaginal opening. This is different from the male urethra, which opens at the tip of the penis.
16.
The hypogastric plexuses:
Correct Answer
C. Convey sympathetic fibers to pelvic viscera.
Explanation
The hypogastric plexuses are a network of nerves located in the pelvis. They are responsible for conveying sympathetic fibers to the pelvic viscera, which includes organs such as the bladder, uterus, and rectum. These sympathetic fibers help regulate various functions in the pelvic region, such as blood flow, muscle contractions, and glandular secretions. The other options mentioned, such as conveying vagal fibers or pelvic splanchnic fibers, are not correct as they do not accurately describe the function of the hypogastric plexuses.
17.
The levator ani:
Correct Answer
D. Actively contracts during coughing
Explanation
The levator ani is a group of muscles located in the pelvis that supports the pelvic organs. When a person coughs, the levator ani muscles contract to help stabilize the pelvic floor and prevent any leakage of urine or feces. This contraction is important for maintaining continence during coughing. Therefore, the statement "The levator ani actively contracts during coughing" is correct.
18.
The pectinate line of the anal canal:
Correct Answer
D. Separates the part of the anal canal that is sensitive to laceration from the part that is not.
Explanation
The pectinate line of the anal canal separates the part of the anal canal that is sensitive to laceration from the part that is not. This means that above the pectinate line, the anal canal is lined with columnar epithelium and is not sensitive to pain, while below the pectinate line, the anal canal is lined with stratified squamous epithelium and is sensitive to pain. This distinction is important in understanding the different types of hemorrhoids and their treatment options.
19.
The trigone of the bladder:
Correct Answer
B. Is the internal area demarcated by the internal urethral and ureteric orifices.
Explanation
The trigone of the bladder refers to the internal area demarcated by the internal urethral and ureteric orifices. It is a triangular region on the posterior wall of the bladder that is smooth and devoid of rugae. This region is important in maintaining urinary continence and preventing reflux of urine into the ureters. The trigone serves as a landmark for various clinical procedures such as cystoscopy and catheterization.
20.
The ureters:
Correct Answer
A. Have afferent fibers that typically refer pain to the lower abdomen, especially the inguinal region.
Explanation
The ureters have afferent fibers that typically refer pain to the lower abdomen, especially the inguinal region. This means that when there is a problem or irritation in the ureters, the pain is often felt in the lower abdomen, specifically in the inguinal region. This is important to know because it helps in diagnosing and localizing the source of the pain.
21.
The vaginal fornix:
Correct Answer
E. Surrounds the vaginal part of the cervix.
Explanation
The vaginal fornix refers to the recess or pocket that surrounds the vaginal part of the cervix. It is a circular space formed by the cervix and the vaginal wall. This anatomical structure is important for various gynecological procedures and examinations, such as Pap smears and cervical biopsies. The vaginal fornix provides access to the cervix and allows for the insertion of instruments or collection of samples.
22.
Which of the following is incorrect pertaining to the bony pelvis?
Correct Answer
C. The ala of the ilium helps to form the acetabulum.
Explanation
The ala of the ilium does not help to form the acetabulum. The acetabulum is formed by the fusion of the ilium, ischium, and pubis bones. The ala of the ilium forms the wing-like portion of the ilium bone, but it does not contribute to the formation of the acetabulum.
23.
Which of the following is incorrect pertaining to the uterine tubes?
Correct Answer
B. Their distal part, the ampulla, surrounds the ovary.
Explanation
The correct answer is "Their distal part, the ampulla, surrounds the ovary." This statement is incorrect because the ampulla is not located around the ovary. The ampulla is the widest and longest part of the uterine tube, and it is situated closer to the ovary but does not surround it.
24.
Which of the following is not associated with male erection or ejaculation?
Correct Answer
D. Contraction of the smooth muscle of the helical arteries.
Explanation
The smooth muscle of the helical arteries is actually associated with male erection. When these arteries relax, they allow blood to flow into the penis, leading to an erection. Therefore, the correct answer is that the contraction of the smooth muscle of the helical arteries is not associated with male erection or ejaculation.
25.
Which of the following structures is least important for supporting the uterus and/or maintaining its position?
Correct Answer
B. Round ligament of the uterus
Explanation
The round ligament of the uterus is the least important structure for supporting the uterus and maintaining its position. While the other structures listed, such as the broad ligament, transverse cervical ligaments, uterosacral ligament, and pelvic diaphragm, play important roles in supporting and stabilizing the uterus, the round ligament has a relatively minor role. It primarily helps to anchor the uterus to the anterior pelvic wall and provides some support during pregnancy. However, its absence or dysfunction does not significantly impact the overall support and position of the uterus.
26.
A laceration of the thenar eminence that results in complete section of the recurrent branck of the median nerve would result in:
Correct Answer
D. Ape hand.
Explanation
A laceration of the thenar eminence that results in complete section of the recurrent branch of the median nerve would result in ape hand. The thenar eminence is the fleshy area at the base of the thumb, and the recurrent branch of the median nerve innervates the muscles in this region. A complete section of this nerve would lead to weakness or paralysis of the muscles in the thenar eminence, causing a loss of opposition and flexion of the thumb. This results in a hand posture resembling that of an ape, with the thumb held in a fixed position away from the other fingers.
27.
Elbow tendonitis (tennis elbow) is associated with:
Correct Answer
A. Inflammation of the periosteum of the lateral epicondyle of the humerus.
Explanation
Elbow tendonitis, also known as tennis elbow, is characterized by inflammation of the periosteum of the lateral epicondyle of the humerus. This inflammation occurs due to repetitive overuse of the extensor tendons in the forearm, leading to microtears and strain on the periosteum. The lateral epicondyle is the bony prominence on the outer side of the elbow, and the periosteum is the thin layer of connective tissue that covers the bone. The inflammation in this area causes pain, tenderness, and difficulty with gripping and lifting objects.
28.
Following a left radical mastectomy, a woman is unable to abduct her arm more than 90 degrees. Which of the following structures do you suspect was injured during the surgical procedure?
Correct Answer
E. Long thoracic nerve
Explanation
Following a left radical mastectomy, the woman's inability to abduct her arm more than 90 degrees suggests that the long thoracic nerve was injured during the surgical procedure. The long thoracic nerve innervates the serratus anterior muscle, which is responsible for the abduction of the arm. Damage to this nerve can lead to weakness or paralysis of the serratus anterior muscle, resulting in limited abduction of the arm.
29.
In the emergency room you examine a patient who was thrown from a motorcycle in such a way that, upon landing, his neck and shoulder were widely separated. Which of the following would not be consistent with your suspicion that he is suffering from Erb-Duchenne palsy?
Correct Answer
C. Weak digital flexion
Explanation
Weak digital flexion would not be consistent with Erb-Duchenne palsy. Erb-Duchenne palsy, also known as Erb's palsy, is a condition caused by damage to the brachial plexus nerves in the upper arm. It typically results in weakness or paralysis of the muscles in the shoulder and upper arm, including weak elbow flexion and weak shoulder abduction. Medial rotation of the arm at rest and sensory loss on the lateral aspect of the arm are also commonly associated with this condition. However, weakness in digital flexion, which refers to the ability to bend the fingers, is not typically seen in Erb-Duchenne palsy.
30.
In the emergency room, you see a 65-year-old woman who fell on her outstretched right hand while walking on ice. Upon examination of the right limb, you feel and see a dorsal protrusion just proximal to the wrist. You suspect a:
Correct Answer
C. Fracture distal radius (Colles fracture).
Explanation
Based on the given information, the patient fell on her outstretched right hand and there is a dorsal protrusion just proximal to the wrist. This is consistent with a Colles fracture, which is a type of fracture of the distal radius. The other options, such as dislocated joints or fractures of other bones, do not fit the clinical presentation described. Therefore, the correct answer is fracture distal radius (Colles fracture).
31.
In the following angiogram of the wrist and hand, the arrow points to the:
Correct Answer
B. Deep branch of the ulnar artery.
Explanation
The correct answer is the deep branch of the ulnar artery. In the angiogram, the arrow is pointing to a branch of an artery that is located deep within the wrist and hand. This branch is specifically identified as a branch of the ulnar artery, which is one of the major arteries in the forearm. The other options, superficial branch of the radial artery, ulnar artery, radial artery, and princeps pollicis artery, are not consistent with the location and identification of the artery indicated by the arrow in the angiogram.
32.
In the following coronal MRI of the hand, the arrow points to the:
Correct Answer
E. Interossei.
Explanation
The arrow in the coronal MRI of the hand is pointing to the interossei. The interossei muscles are located between the metacarpal bones of the hand and are responsible for the movement and control of the fingers. They play an important role in gripping and grasping objects.
33.
In the following radiograph of the wrist, the arrow points to the:
Correct Answer
B. ScapHoid.
Explanation
The arrow in the radiograph is pointing to the scaphoid bone. The scaphoid bone is located in the wrist and is one of the carpal bones. It is situated on the thumb side of the wrist, just below the radius bone. The scaphoid bone is important for wrist stability and is commonly injured in falls or trauma to the wrist. In this radiograph, the arrow is indicating the presence of the scaphoid bone, making it the correct answer choice.
34.
In which of the following activities would the latissimus dorsi be least important?
Correct Answer
E. Using the backstroke while swimming
Explanation
The latissimus dorsi is a large muscle in the back that is responsible for various movements of the shoulder joint, such as adduction, extension, and internal rotation. When using the backstroke while swimming, the latissimus dorsi is least important because this stroke primarily involves the muscles of the arms and shoulders, rather than the back. The primary muscles used in the backstroke are the triceps, deltoids, and pectoralis major. Therefore, the latissimus dorsi is least important in using the backstroke while swimming.
35.
Scapulohumeral rhythm refers to:
Correct Answer
C. The relationship between movements at the glenohumeral and scapulothoracic "joints" during humeral abduction.
Explanation
Scapulohumeral rhythm refers to the relationship between movements at the glenohumeral and scapulothoracic joints during humeral abduction. This means that as the arm is raised, both the glenohumeral joint (shoulder joint) and the scapulothoracic joint (shoulder blade and ribcage) work together to achieve the movement. The scapula rotates and moves along the ribcage to allow for the full range of motion of the arm. This coordination between the two joints is important for proper shoulder function and stability during overhead movements.
36.
The arrow in the following radiograph points to the:
Correct Answer
D. Acromion process.
Explanation
The arrow in the radiograph is pointing to the acromion process, which is a bony projection on the scapula that forms the highest point of the shoulder. It can be easily identified on the radiograph as it is a distinct anatomical structure. The other options, such as the superior angle of scapula, superior part of glenoid fossa, coracoid process, and clavicle, are not indicated by the arrow and are not relevant to the given radiograph.
37.
The cephalic vein:
Correct Answer
B. Pierces the clavipectoral fascia.
Explanation
The cephalic vein is a superficial vein that runs along the lateral side of the upper limb. It starts on the medial side of the dorsal venous network at the wrist and ascends along the forearm and arm. It pierces the clavipectoral fascia, a fibrous tissue that covers the muscles and structures in the shoulder region, and then empties into the axillary vein. Therefore, the correct answer is that the cephalic vein pierces the clavipectoral fascia.
38.
The nerve most likely to be injured in a glenohumeral joint dislocation is the:
Correct Answer
B. Axillary.
Explanation
In a glenohumeral joint dislocation, the axillary nerve is most likely to be injured. The axillary nerve runs through the shoulder joint and is vulnerable to injury when the joint is dislocated. This can result in weakness or loss of sensation in the shoulder and upper arm. The other options, supraclavicular, radial, medial, and ulnar nerves, are not commonly injured in glenohumeral joint dislocations.
39.
The ridge indicated by the arrow in the following photograph overlies the tendon of which of the following muscles?
Correct Answer
B. Abductor pollicis longus
Explanation
The ridge indicated by the arrow in the photograph overlies the tendon of the abductor pollicis longus muscle.
40.
The surface elevation identified by the arrow in the following photograph is caused by which of the following muscles?
Correct Answer
D. Teres major
Explanation
The surface elevation identified by the arrow in the photograph is caused by the teres major muscle.
41.
What is the clinical significance of a superficial ulnar artery?
Correct Answer
D. Its superficial course in the cubital fossa returns in it being mistakenly used for venipuncture.
Explanation
The superficial ulnar artery is often mistaken for a vein during venipuncture due to its superficial course in the cubital fossa. This can lead to incorrect placement of the needle and potential complications during blood collection.
42.
Which of the following associations pertaining to the brachial plexus is incorrect?
Correct Answer
C. Pre-fixed brachial plexus--compression of inferior trunk by 1st rib
Explanation
The association between a pre-fixed brachial plexus and compression of the inferior trunk by the 1st rib is incorrect. A pre-fixed brachial plexus refers to a variation in which the brachial plexus roots originate higher up in the neck than usual, whereas compression of the inferior trunk by the 1st rib is typically associated with a condition known as thoracic outlet syndrome. These two conditions are not directly related to each other.
43.
Which of the following is incorrect pertaining to the carpal tunnel syndrome?
Correct Answer
D. It may involve anesthesia of the central palm.
Explanation
Carpal tunnel syndrome is a condition that occurs when there is compression of the median nerve in the wrist. Symptoms of carpal tunnel syndrome typically include paresthesia (tingling or numbness) in the lateral 3½ digits, weakness in the thenar muscles (the muscles at the base of the thumb), and can be caused by inflammation of the synovial sheaths of the flexor tendons. However, anesthesia (loss of sensation) of the central palm is not a typical symptom of carpal tunnel syndrome. Surgical transection of the flexor retinaculum, which is a ligament in the wrist, is a common treatment for carpal tunnel syndrome and often relieves associated symptoms.
44.
Which of the following is incorrect pertaining to the anatomic "snuffbox"?
Correct Answer
B. The superficial branch of the radial nerve emerges from it.
Explanation
The correct answer is that the superficial branch of the radial nerve emerges from the anatomic "snuffbox". This statement is incorrect because the superficial branch of the radial nerve does not emerge from the snuffbox. The snuffbox is a triangular depression on the back of the hand, and it is bounded anteriorly by the tendons of abductor pollicis longus and extensor pollicis brevis, posteriorly by the tendon of extensor pollicis longus, and the radial styloid process can be palpated within it. The radial artery, not the radial nerve, traverses its floor.
45.
Which of the following is incorrect pertaining to the clavicle?
Correct Answer
A. Fractures are almost always accompanied by acromioclavicular dislocation.
Explanation
The incorrect statement is "Fractures are almost always accompanied by acromioclavicular dislocation." This statement is incorrect because fractures of the clavicle do not necessarily result in acromioclavicular dislocation. While it is possible for both injuries to occur together, they are not always associated with each other.
46.
Which of the following is incorrect pertaining to the scaphoid?
Correct Answer
B. It attaches to the flexor retinaculum.
Explanation
The scaphoid does not attach to the flexor retinaculum. The correct answer is supported by the fact that the scaphoid is not directly connected to the flexor retinaculum, which is a thick band of connective tissue that holds the flexor tendons in place at the wrist. The scaphoid is instead connected to other carpal bones and ligaments in the wrist.
47.
Which of the following is incorrect pertaining to the wrist joint or wrist bones?
Correct Answer
D. Fracture of the lunate is common in children and typically heals well because of multiple sources of blood.
Explanation
Fracture of the lunate is not common in children and does not typically heal well because of multiple sources of blood.
48.
Which of the following relationships at the wrist is incorrect?
Correct Answer
C. The radial artery lies medial to the tendon of the flexor carpi radialis.
Explanation
The correct answer is that the radial artery lies lateral to the tendon of the flexor carpi radialis. This means that the radial artery is positioned on the same side as the tendon of the flexor carpi radialis, rather than being on the opposite side. This relationship is important to understand for medical professionals who may need to locate and access the radial artery for procedures such as taking a pulse or administering medications.
49.
Which of the following would not be associated with a complete section of the median nerve at the elbow?
Correct Answer
B. Loss of ability to adduct the thumb
Explanation
Loss of ability to adduct the thumb would not be associated with a complete section of the median nerve at the elbow. The median nerve primarily innervates the muscles of the forearm and the hand, and controls functions such as flexion of the interphalangeal joints of digits 2 and 3, pronation of the forearm, and sensation on the lateral aspect of the palmar surface of the hand. However, the ability to adduct the thumb is primarily controlled by the ulnar nerve, not the median nerve. Therefore, a complete section of the median nerve at the elbow would not result in the loss of ability to adduct the thumb.
50.
You are assisting in the emergency room when the attending physician examines a patient after an elbow injury. The physician holds the proximal interphalangeal joint of the little finger and asks the patient to flex the distal phalanx. This procedure tests the functionality of what nerve?
Correct Answer
C. Ulnar
Explanation
The physician is testing the functionality of the ulnar nerve. The ulnar nerve is responsible for innervating the muscles that control the flexion of the distal phalanx of the little finger. By holding the proximal interphalangeal joint and asking the patient to flex the distal phalanx, the physician can assess if the ulnar nerve is functioning properly.