REGIONAL ANATOMY - 1

SECTION1. Single selection(3×29Questions = 87)

1. A 45-year-old woman consulted her physician about a painless lump in the right upper outer
quadrant of her breast. During palpation of her axilla, the physician detected enlarged, firm lymph
nodes. A mammogram showed a malignant breast tumor.

(1) In which of the following groups of axillary lymph nodes would most of the cancer cells
initially lodge?
a. Pectoral group of axillary lymph nodes
b. Subscapular group of axillary lymph nodes
c. Central group of axillary lymph nodes
d. Apical group of axillary lymph nodes
Answer: _____

A: the pectoral group of axillary lymph nodes

(2) In a radical mastectomy, the breast, pectoral muscles, fat, and lymph nodes in the axilla were
removed, and then big nerves of the brachial plexus around the axillary artery were exposed, they
are:
a. Superior trunk, middle trunk and inferior trunk
b. Anterior division and posterior division
c. Frontal root, posterior root and middle root
d. Lateral cord, medial cord and posterior cord
Answer: _____

(3) Most of the remaining lymph, particularly from the inner breast quadrants, drains to
a. The axillary lymph nodes
b. The deep cervical lymph nodes
c. The parasternal lymph nodes
d. The infraclavicular lymph nodes
Answer: _____

2. A 57-year-old man fell off the porch and then was confirmed a transverse fracture of the shaft of
his right humerus. Several weeks later, a typical clinical sign called “wrist-drop” was shown, that is
inability to extend the wrist and fingers at the metacarpophalangeal joints.

(1) What nerve was injured to induce the “wrist-drop”?

a. median nerve
b. radial nerve
c. ulnar nerve
d. musculocutaneous nerve
Answer: _____

(2) What muscles was completely paralyzed?

a. the extensor muscles of the forearm
b. the extensor muscles of the upper arm
c. the extensor muscles of the upper arm and forearm
d. the flexor muscles of the forearm
Answer: _____

(3) Where was the fracture located?

a. the surgical neck
b. the radial groove
c. distal humerus
d. medial epicondyle
Answer: _____

3. A 14-year-old girl was taken to the family physician because she had a sharp pain in her chest on
the right side when she coughed. After receiving laboratory and radiology reports, the physician
diagnosed her illness as pleurisy (pleuritis).

(1) Using your knowledge of the nerve supply of the pleura, which of the following statements
about the pain in the child's thorax is most likely correct?
a. The visceral pleura invests the lungs and receives branches from the pulmonary plexuses
b. The parietal pleura, particularly its costal part, is very sensitive to pain
c. Inflammation of the lungs (pneumonitis) caused the pain
Answer: _____

(2) What does the pleural cavity normally contain?

a. A little bit of air with oxygen
b. A capillary layer of serous pleural fluid
c. The bronchi and lungs
Answer: _____

(3) Physical examination in the sitting position revealed percussive dullness inferior to the fifth rib
in the right midaxillary line. The diagnosis was an accumulation of fluid in the right pleural cavity.
Thoracentesis (thoracocentesis) was performed to remove the pleural fluid. Where would the
physician insert the needle into the pleural cavity to avoid injuring the intercostal neurovascular
bundle and lung?
a. Superior to the fifth rib
b. Along the inferior border of the fifth rib
c. Superior to the rib in the eighth or seventh intercostal spaces
Answer: _____

(4) She was given a series of intragluteal injections of antibiotics. After several injections she
complained of numbness and paresthesia on the anterior and lateral sides of her left leg and dorsum
of her foot. The physician also observed that dorsiflexion of her left ankle was weaker. Which of
the following statements best describes the most likely cause of the patient's signs and symptoms?.
a. Injury to the superior gluteal nerve
b. Injury to the inferior gluteal nerve
c. Injury to the tibial division of the sciatic nerve
d. Injury to the left common fibular division of the sciatic nerve
Answer: _____

4. Thyroidectomy was done with regional anesthesia. A transversal skin incision was made in the
lower neck and the left lobe of the thyroid gland was removed.
(1) Which nerve should be blocked with an anesthetic agent for this neck surgery?
a. The vagus nerves,
b. The phrenic nerves,
c. The cervical plexus
d. The sympathetic trunks

Answer: _____

(2) What muscles should be cut in order to explore the left lobe of the thymus?
a. The left sternocleidomastoid and sternothyroid muscles
b. The leftt sternothyroid and omohyoid
c. The left sternocleidomastoid and platysma muscles
d. The left sternothyroid and sternohyoid muscles
Answer: _____

(3) To avoid bleeding, which arteries were ligated during the surgery?
a. The left superior and inferior thyroid arteries
b. The left superior, middle and inferior thyroid arteries
c. The left internal carotid artery
d. The left vertebral artery
Answer: _____

(4) To avoid hoarseness or aphonia, which nerves should be carefully protected during surgery?
a. The left vagus nerve
b. The left recurrent laryngeal nerve
c. The left hypoglossal nerve
d. The left accessory nerve
Answer: _____

(5) A patient showed a severe neurologic syndrome characterized by muscle twitches and cramps
days after he received a thyroidectmy. His serum calcium level decreased. What organs were
damaged during the surgery on him?
a. The sternothyroid and sternohyoid muscles
b. The submandibular glands
c. The parathyroid glands
d. The common carotid artery
Answer: _____

5. Acute inflammation of the appendix is a common abdominal disease. An

emergency surgical removal of the infected appendix (appendectomy) should be
performed.
(1) The incision is made over McBurney's point which represents the position of the base of the
appendix. The McBurney's point is:
a. One third of the way along the oblique line joining the right anterior superior
iliac spine to the umbilicus
b. One third of the way along the right side of transumbilical line
c. One third of the way along the right side of transtubercular line
Answer: _____

(2) The pain of appendicitis usually commences as a diffusive visceral pain in the
periumbilical region because afferent pain fibers enter the spinal cord at the T10
level through:
a. Sympathetic fibers in thoracic spinal nerve
b. Parasympathetic fibers in thoracic spinal nerve
c. Visceral fibers in thoracic spinal nerve
Answer: _____

(3) To fully explore the appendix, t he various layers of the abdominal wall are then opened.
From the superficial to deep, they are:
a. skin, subcutaneous tissue, obliquus externus abdominis, obliquus internus abdominis, transverses
abdominis, transversalis facia and parietal peritoneum.
b. skin, subcutaneous tissue, sheath of rectus abdominis, obliquus internus abdominis, transverses
abdominis, transversalis facia and parietal peritoneum.
c. skin, subcutaneous tissue, aponeurosis of obliquus externus abdominis, obliquus internus
abdominis, transverses abdominis, transversalis facia and parietal peritoneum.
Answer: _____

A
(4) to avoid bleeding, the appendicular artery should be identified and ligated
before the appendix is removed. The appendicular artery is located in:
a. the free edge of the greater omentum
b. the free edge of a fan-shaped fold of peritoneum called the mesentery
c. the free edge of a short triangular mesentery called the mesoappendix
Answer: _____

6. The inguinal canal is formed in relation to the descent of the gonad (testes or
ovary) during fetal development. The inguinal canal in adults is an approximately
4-cm-long, inferomedially directed oblique passage

(1) The main occupant of the inguinal canal is

a. the spermatic cord in males and the ovary ligment in females.
b. the spermatic cord in males and the round ligament of the uterus in females.
c. the small intestine and lymph nodes
Answer: _____

(2) The inguinal canal has an opening at each end, they are:
a. the deep (internal) ring and the superficial (external) inguinal ring
b. the omental foramen and femoral ring
c. the femoral septum and femoral sheath
Answer: _____

A
7. A 68-year-old man with a history of prostatic disease informed the emergency room physician
that he had been unable to urinate for seven hours and had severe and increasing pain.

(1) Where the examiner can palpate the prostate?

a. suprapubic abdomen wall
b. rectum
c. ischioanal fossa
Answer: _____

(2) What caused the buildup of urine in the patient's bladder

a. enlarged prostate is obstructing the man's urethra
b. enlarged seminal gland
c. enlarged ductus deferens
Answer: _____

A
(3) Because several attempts to catheterize him were unsuccessful, the urologist decided to relieve
the bladder pressure by passing a suprapubic catheter (tube) at the midline into his bladder. Through
what structures would the suprapubic tube pass?
a. skin, subcutaneous tissue, linea alba, transversalis fascia, parietal peritoneum and bladder wall
b. skin, subcutaneous tissue, linea alba, transversalis fascia, peritoneal cavity and bladder wall
c. skin, subcutaneous tissue, linea alba, transversalis fascia, and bladder wall
Answer: _____

A
8. A 48-year-old man told his physician that he thought he had "piles." He said that he occasionally
passed bloodstained stools and often observed bright red blood in the toilet or on the toilet paper
after wiping. He also said that he felt protrusions from his anus when he strained during defecation.
He was aware that advertisements for hemorrhoid treatments usually mentioned "itching and
burning"; however, since he was not experiencing any discomfort. Which type of hemorrhoids did
this man have?
a. both internal and external hemorrhoids.
b. internal hemorrhoids only.
c. external hemorrhoids only.
Answer: _____

9. In the limbs, some bone fracture might damage the nerve running along the surface of the bone,
such as:
a. the radial nerve
b. the axillary nerve
c. the ulnar nerve
d. the brachial plexus nerve
e. the femoral nerve
f. the common fibular nerve
g. the tibial nerve
h. the sciatic nerve

(1) Which nerve is severely damaged when the surgical neck of the humerus is fractured?
Answer: _____
(2) Which nerve is injured when the medial epicondyle of the humerus is fractured?
Answer: _____
(3) Which nerve is injured when the fibular neck is fractured?
Answer: _____
(4) Which nerve is injured when the proximal tibia is fractured?
Answer: _____

BCFG

REGIONAL ANATOMY - 2

Part I: Multiple Choice Questions (one correct answer only; 38 questions; a total of 76 marks; 2
marks each)

1. Which of the following structures does NOT pass through the parotid gland?
A. the facial nerve
B. the internal carotid artery
C. the external carotid artery
D. the facial vein (or retromandibular vein)
E. the small parotid ducts
Answer: _____
B

2. Which of the following structures is located in the infratemporal fossa?

A. the superficial temporal artery
B. the internal carotid artery
C. the pterygoid venous plexus
D. the facial artery
E. the hyoid bone
Answer: _____

3. Which of the following structures is located in the pterygopalatine fossa?

A. the superficial temporal artery
B. the internal carotid artery
C. the pterygoid venous plexus
D. the mandibular nerve (V3)
E. the maxillary nerve (V2)
Answer: _____

4. In which of the following tissue layers may the bleeding of the scalp extend into the eyelids
causing the “black eye”?
A. the skin
B. the dense connective tissue
C. the aponeurotic layer
D. the loose connective tissue
E. the pericranium
Answer: _____

5. Which of the following nerves innervates the platysma?

A. the facial nerve
B. the cervical plexus
C. the trigeminal nerve
D. the brachial plexus
E. the phrenic nerve
Answer: _____

6. Tracheotomy is a surgical procedure to make an incision in the trachea to keep air pathway open.
Which of the following veins may be damaged during the tracheotomy?
A. the facial vein
B. the subclavian vein
C. the external jugular vein
D. the jugular venous arch
E. the internal jugular vein
Answer: _____
D

7. Which of the following structures is enveloped in the carotid sheath?

A. the subclavian artery
B. the external caroid artery
C. the trigeminal nerve
D. the facial nerve
E. the vagus nerve
Answer: _____
E

8. Which of the following structures passes through the scalenus triangle?

A. the thoracic duct
B. the cervical plexus
C. the subclavian vein
D. the subclavian artery
E. the phrenic nerve
Answer: _____

9. Which of the following structures is located in the posterior cervical triangle?

A. the carotid artery
B. the cervical plexus
C. the internal jugular vein
D. the trachea
E. the phrenic nerve
Answer: _____

10. The thoracic cavity is subdivided into:

A. the thoracic wall, mediastinum, and pleural cavities.
B. the thoracic wall, diaphragm, and pleural cavities.
C. a left and a right pleural cavity, and mediastinum.
D. the diaphragm, mediastinum and pleural cavities.
E. a left and a right pleural cavity, and thoracic wall.
Answer: _____

11. Which of the following statements is true regarding the pleural cavity?
A. The pleural cavities are continuous with each other.
B. The pleural cavities extend above the level of the first ribs.
C. The pleural cavities are lined by multiple layers of flat cells.
D. The pleural cavities contain air.
E. The pleural cavities communicate with the pericardium
Answer: _____

B
12. Which of the following statements is true regarding the posterior intercostal artery?
A. The posterior intercostal artery originates from the internal thoracic artery.
B. The posterior intercostal artery passes in the plane between the external and internal intercostal
muscles.
C. The posterior intercostal artery passes in the plane between the internal and innermost intercostal
muscles.
D. The posterior intercostal artery anastomoses (meets) the corresponding posterior intercostal
artery from the other side.
E. The posterior intercostal artery runs along the lateral margin of the sternum.
Answer: _____

13. Which of the following statements is true regarding the parietal pleura?
A. The parietal pleura covers the mediastinum.
B. The parietal pleura is the external membrane of the lung.
C. The parietal pleura is continuous with the parietal layer of the pericardium.
D. The parietal pleura is not continuous with the visceral pleura.
E. The parietal pleura is fully limited within the thoracic cavity.
Answer: _____

14. The mediastinum is divided into a superior and an inferior mediastinum by a transverse plane:
A. extending from the upper margin of the sternum to the intervertebral disc between the 3rd and
4th thoracic vertebrae.
B. extending from the upper margin of the sternum to the intervertebral disc between the 4th and
5th thoracic vertebrae.
C. extending from the sternal angle to the intervertebral disc between the 5th and 6th thoracic
vertebrae.
D. extending from the sternal angle to the intervertebral disc between the 3rd and 4th thoracic
vertebrae.
E. extending from the sternal angle to the intervertebral disc between the 4th and 5th thoracic
vertebrae.
Answer: _____

15. Which organ does the middle mediastinum contain?

A. the trachea
B. the heart
C. the lung
D. the sympathetic trunk.
E. the descending aorta
Answer: _____

16. During the laboratory sessions, after you removed the heart and pericardium, which organ did
you observe in front of the vertebral column?
A. the trachea
B. the pulmonary artery
C. the sympathetic trunk.
D. the esophagus
E. the descending aorta
Answer: _____

17. During the laboratory sessions, after you removed the infrahyoid muscles, which organ did you
observe?
A. the trachea.
B. the pulmonary artery.
C. the sympathetic trunk.
D. the heart.
E. the descending aorta.
A

Answer: _____

18. Which of the following statements is true regarding the thoracic aorta?
A. The thoracic aorta is continuous with the ascending aorta.
B. The thoracic aorta begins at the lower edge of the 4th thoracic vertebra.
C. The thoracic aorta gives off the internal thoracic artery.
D. The thoracic aorta is the inferior segment of the descending aorta.
E. The thoracic aorta passes through the superior mediastinum.
Answer: _____

E
19. Which of the following structures demarcates the trunk and lower limb?
A. the interior margin of the gluteus maximus
B. the superior margin of the gluteus maximus
C. the upper border of the sacrum
D. a horizontal line at the level of the anterior superior iliac spine
E. the inguinal ligament
Answer: _____

20. Which of the following structures is NOT located within the femoral sheath?
A. the femoral canal
B. the femoral vein
C. the femoral artery
D. the femoral nerve
E. the deep inguinal lymph nodes
Answer: _____

21. Which of the following structures passes through both greater and lesser sciatic foramens?
A. the superior gluteal nerve
B. the inferior gluteal nerve
C. the pudendal nerve
D. the sciatic nerve
E. the obturator nerve
Answer: _____

22. Which of the following nerves is most likely damaged when the neck of the fibula is fractured?
A. the femoral nerve
B. the common fibular nerve
C. the tibial nerve
D. the pudendal nerve
E. the sciatic nerve
Answer: _____

23. Which of the following spinal nerves is TYPICALLY affected by the intervertebral disc
prolapse at the L4/5 level?
A. the L2 spinal nerve
B. the L3 spinal nerve
C. the L4 spinal nerve
D. the L5 spinal nerve
E. the S1 spinal nerve
Answer: _____

24. At which of the following levels does the adult spinal cord usually end?
A. the T12 level
B. the L1/L2 level
C. the L5 level
D. the S2 level
E. the S5 level
Answer: _____
B

25. Which of the following orders of the tissue layers is correct when the lumbar puncture is
performed from the skin to the extra- or epi-dural space?
A. the superficial fascia > supraspinous ligament > interspinous ligament > ligamentum flava
B. the supraspinous ligament > interspinous ligament > superficial fascia > ligamentum flava
C. the superficial fascia > interspinous ligament > supraspinous ligament > ligamentum flava
D. the superficial fascia > supraspinous ligament > ligamentum flava > interspinous ligament
E. the superficial fascia > ligamentum flava > supraspinous ligament > interspinous ligament
Answer: _____

Case 1
A 57-year-old man fell off the porch and then was confirmed a fracture of his right humerus.
Several weeks later, a typical clinical sign called “wrist-drop” was shown, that is inability to extend
the wrist and fingers at the metacarpophalangeal joints.
26. What nerve was injured to induce the “wrist-drop”?
A. the median nerve
B. the radial nerve
C. the ulnar nerve
D. the musculocutaneous nerve
Answer: _____

27. What muscles were completely paralyzed?

A. the extensor muscles of the forearm
B. the extensor muscles of the upper arm
C. the extensor muscles of the upper arm and forearm
D. the flexor muscles of the forearm
Answer: _____
A

28. Where was the fracture located?

A. the surgical neck of the humerus
B. the radial groove of the humerus
C. the distal part of the humerus
D. the medial epicondyle of the humerus
Answer: _____

Case 2
A 42-year-old male executively complains of abdominal pain that began about 6 months previously,
is constant in nature especially after meals, and located in the upper midabdomen superior to the
umbilicus. He also reports some “heartburn” that has been occurring during the previous year. He
has been under a lot of job-related stress and has been self-medicating himself with over-the-
counter antacids, which some relief. He states his stools have changed in color over the previous 2
months and now are intermittently dark and tarry in consistency. The physician tests the patient’s
stool and finds occult blood. Based on mentioned –above, the patient‘s diagnosis is peptic ulcer
disease.

29. If the patient’s peptic ulcer has not been controlled, the perforation of stomach wall would be
happened. So if the posterior wall of the stomach is perforated, gastric contents will accumulate in
which of the following areas?
A. The left paracolic gutter
B. The left paravertebral gutter
C. The right paravertebral gutter
D. The omental bursa
E. The hepatorenal recess
Answer: _____

30. Ligation of the common hepatic artery will eliminate the gastric blood supply through which of
the following arteries?
A. the left gastric and short gastric arteries
B. the short gastric and right gastro-omental arteries
C. the right gastro-omental and right gastric arteries
D. the right gastric and left gastric arteries
E. the left gastric and left gastro-omental arteries
Answer: _____

31. A surgical incision through the fundus of the stomach would require you to clamp which of the
following arteries?
A. the right gastric artery
B. the left gastric artery
C. the right gastro-omental artery
D. the left gastric-omental artery
E. the short gastric arteries
Answer: _____

Case 3
A 31-year-old woman is in her physician’s office for a fitting for an intrauterine contraceptive
device. The physician performs a pelvic examination to ensure that the device is placed in the
correct direction. The physical examination shows that the uterine body is tipped anteriorly.

32. Which of the following describes the position of the uterus?

A. Anteverted, anteflexed
B. anteverted, retroflexed
C. retroverted, anteflexed
D. retroverted, retroflexed
E. In the center of perineal cavity
Answer: _____

Case 3 follow-up
2 years later, this woman and her husband want a baby. So she goes to her physician’s office for
taking the contraceptive device out from her uterus. After several months, she feels faint sometimes.
On one day, she feels painful in the left iliac region and is transferred to the ER. After the basic
examination in ER, the doctor places a 20-gauge spinal needle through the vagina to assess whether
there is blood in the peritoneal cavity.

33. Which of the following describes the most dependent part of the peritoneum or pelvis?
A the vesicouterine fold
B the pararectal space
C the paravesical space
D the rectouterine pouch ( of Douglas)
E the vesicouterine pouch
Answer: _____

15 years later, this woman is having significant uterine bleeding from uterine fibroids. The
radiologist performs an embolization procedure of the uterine arteries.

34. Through which of the following structures do the uterine arteries traverse?
A the transverse cervical (cardinal) ligaments
B the uterosacral ligaments
C the vesicouterine fold
D the anterior vaginal fornix
E the posterior vaginal fornix
Answer: _____

Case 4
A 44-year-old man complains of discomfort in his right upper thigh over the past 6 months. He
works in the garden department of a home improvement center. On examination, there is tenderness
at the right inguinal area. When the patient performs a Valsalva maneuver (bearing down to
increase intra-abdominal pressure), a bulge appears superior to the inguinal crease near the pubic
bone.

35. What is the most likely diagnosis?

A the carcinoma of cecum
B the inguinal Hernia
C the abscess
D the enlarged lymph nodes
E the appendicitis
Answer: _____

36. As a physician examining the inguinal region of this patient, the inguinal ligament will be a key
landmark. This structure is a feature derived from which of the following structures?
A the superficial fascia
B the fascia lata of the thigh
C the aponeurosis of the external abdominal oblique
D the aponeurosis of the internal abdominal oblique
E the aponeurosis of the transversus abdominis
Answer: _____

37. As you continue your examination to check for the presence of an inguinal hernia, you insert the
tip of your finger into the superficial inguinal ring. This is an opening in the :
A the superficial fascia
B the fascia lata of the thigh
C the aponeurosis of the external abdominal oblique
D the aponeurosis of the internal abdominal oblique
E the aponeurosis of the transversus abdominis
Answer: _____

C
38. You are in the process of repairing a direct inguinal hernia. Which of the following anatomical
relations will you find during surgery?
A The hernia will enter the deep inguinal ring
B The hernia will enter the femoral ring
C The hernia will lie lateral to the inferior epigastric vessels
D The hernia will lie medial to the inferior epigastric vessels
E The hernia will lie inferior to the inguinal ligament
Answer: _____

D
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