Practice Written Exam 2 (2012)
Abdomen
1. A 25-year-old professional weigh lifter presents to your office with pain in his groin after an intense squatting session. You instruct the patient to lay supine on the table. Upon flexing his neck, a bulge appears in the groin area. What type of hernia is this patient most likely to have?
A. Direct Inguinal
B. Femoral
C. Spigelian
D. Umbilical
E. Indirect Inguinal
2. A 32-year-old male presents to the ED with discomfort due to abdominal pain. He has a 3-day history of cramping and diarrhea. He has not eaten in 12 hours. You refer him for a colonoscopy that reveals ulcerated mucosa in a portion of the bowels, which have numerous plicae circularis, less prominent arterial arcades and longer vasa recta. Which portion of bowel is the injured?
A. Duodenum
B. Ileum
C. Jejunum
D. Sigmoid colon
E. Transverse colon
3. A 45-year-old female with a previous history of duodenal ulcers is brought to the ED by an ambulance after fainting at a family picnic and developing sudden signs of shock. By the time she is brought to the ED, your patient is unconscious. Her blood pressure drops, heart rate increases, and demonstrates poor capillary perfusion. A previous diagnosis of a duodenal ulcer indicates that it has eroded directly into one of her arteries causing this sudden hemorrhaging. Which of the following arteries is most likely damaged by an eroded posterior duodenal ulcer?
A. Common hepatic
B. Anterior superior pancreaticoduodenal
C. Left gastric
D. Posterior superior pancreaticoduodenal
E. Short gastric
4. A 72-year-old female presents to your office for follow-up of her chemo treatment for colon cancer. CT results show metastasis to her liver, with nodules appearing on the bare area. To which structure does the bare area of the liver touch?
A. Diaphragm
B. Esophagus
C. Lesser omentum
D. Right kidney
E. Superior portion of the duodenum.
5. A 48-year-old male presents to your ED with sudden onset of RUQ pain. He states that it began 3 days ago, but he thought that it was just a muscle cramp. When it quickly worsened, causing nausea and vomiting, he decided he should be seen. Ultrasound shows a small nodule in his gallbladder. To what region would this pain be referred?
A. Left shoulder
B. Left Arm
C. Right Leg
D. Right Shoulder
E. Umbilicus
6. A 62-year-old female is brought to your ED upon waking up this morning to discover a pulsating mass of an abdominal aortic aneurysm was made and the patient was sent to surgery. At which of the following levels does the aorta bifurcate?
A. L2
B. L3
C. L4
D, L5
E. S1
7. A 16-year-old presents to the ED with a sudden onset of abdominal pain beginning in the periumbilical region radiating down to her RLQ. A diagnosis of appendicitis is made and she is sent to have emergency surgery. Which of the following branches of the superior mesenteric artery provides blood supply to the appendix?
A. Ileocolic
B. Jejunal
C. Middle Colic
D. Inferior pancreaticoduodenal
E. Right Colic
8. A 32-year-old male recovering from a bowel resection is seen post operatively for post operative ileus (lack movement of bowls). What is the level of sympathetic innervation to the proximal ileum?
A. C5-C9
B. T5-T9
C. Lesser splanchnic nerve
D. Least splanchnic nerve
9. A 16 year old male is struck by a car while crossing the street on his left side. Upon arrival to the ED, he is unconscious and unresponsive. His BP is 90-50 and is rapidly losing blood. Upon examination it is noted his spleen is ruptured and he is rushed to the OR for a splenectomy. After being discharged from the hospital, he present to his PCP 3 days later with a very sickly appearance, an elevated temperature, and has now developed borderline diabetes. What has occurred to cause this patients symptoms?
A. A secondary infection of the remaining celiac trunk
B. Damage to the tail of the pancreas while ligating the splenic artery.
C. Damage to the ascending colon while ligating the splenic artery
D. Damage to the ligament of trietz resulting in a upper GI bleed.
E. Damage to the right renal artery during ligation of the celiac trunk
10. A 56-year-old male presents to an oncologist after a referral by his PCP, who noted a large mass in his large intestine on his left side. If metastasis is present, which lymph nodes would be affected first?
A. Celiac Nodes
B. Para Aortic Nodes
C. Inferior Mesenteric Nodes
D. Superior Mesenteric Nodes
E. Deep Inguinal Nodes.
Thorax
11. A 27-year-old female is brought to the ER following a motor vehicle accident in which her airbag deployed. Which portion of her heart is most likely damaged in this type of injury?
A. Apex of the heart
B. Left Atrium
C. Left Ventricle
D. Right Atrium
E. Right Ventricle.
12. A 61-year-old male presents to your office complaining of dysphagia and hoarseness for the past 3 weeks. A chest radiograph reveals a large aneurysm of the ascending aorta. Which of the following nerves are affected?
A. Left recurrent laryngeal nerve
B. Left vagus nerve
C. Right recurrent laryngeal nerve
D. Phrenic nerve
E. Right vagus nerve.
13. A 47-year-old woman returns to your office after a total mastectomy complaining of loss of sensation in the inner aspect of her arm and axilla. Which of the following nerves are most likely injured during this procedure?
A. Axillary nerve
B. Intercostobrachial nerve
C. Long thoracic nerve
D. Phrenic nerve
E. Vagus nerve
14. A 53-year-old male presents to the ER with severe chest pain and shortness of breath. During his exam you ask him to lean forward and his pain resides. What is the most likely diagnosis?
A. Anterior Myocardial Infarction
B. Constrictive Pericarditis
C. S2 Ejection Murmur
D. Pericardial Effusion
E. Posterior Myocardial Infarction
15. A 32-year-old female comes to the clinic with fever, and shortness of breath. X-ray reveals pneumonia in one of the lobes of the right lung. Physician hears crackles and dull sounds during stethoscope exam at the level of the third intercostal space adjacent to the sternum. Which of the following lobes is likely to be affected by the pneumonia?
A. Lower love of right lung
B. Middle lobe of left lung
C. Middle lobe of right lung
D. Upper lobe of left lung
E. Upper lobe of right lung
16. A 69-year-old female is examined by her PCP after a heart attack she suffered 6 months ago. A regurgitation murmur is noted at the 5th intercostal space on the left just lateral to the sternum. Which artery was most likely occluded to cause her MI?
A. Circumflex
B. LAD
C. PDA
D. Right Marginal
E. Left Marginal
17. Radiograph imaging of a 49-year-old males shows severe mitral valve regurgitation. Which of the following prevents regurgitation of the mitral valve cusps into the left atrium?
A. Chordae tendinae
B. Crista supraventricularis
C. Crista terminalis
D. Pectinate muscle
E. Trabeculae carnae.
18. A 32 year old patient comes to doctors office for routine physical. On the surface of the chest, the physician is able to locate the apex of the heart:
A. At the sternal angle
B. In the left fourth intercostals space.
C. In the left fifth intercostals space.
D. In the right fourth intercostals space
E. Below the xiphoid process.
19. Upon retrieval of a swallowed coin from the right main bronchus of a 5 year old boy, the bronchus is penetrated anteriorly. What structure is most likely damaged?
A. Pulmonary vein
B. Pulmonary artery
C. Carina
D. Lymphatic duct
E. Lingula
Pelvis
20. A 7-year-old boy slipped as he was trying to hop a fence and fell on his groin. Upon further inspection it was discovered that his testicle was injured. If the testicle became infected, which lymph nodes would be enlarged?
A. Para-aortic
B. Superficial Inguinal
C. Deep Inguinal
D. Inferior Mesenteric
E. Superior Mesenteric
21. A 78 year old female presents to the ED with a prolapsed uterus. Which of the following structures is responsible for providing the MOST support for the uterus?
A. Broad ligament
B. Levator Ani
C. Round Ligament
D. Transverse cervical (cardinal) ligament
E. Sphincter Urethrae.
22. A 58 year old male presents with a chief complaint of lack of sensation in the glans of his penis. Which of the following nerves is affected and responsible for his symptoms?
A. Dorsal nerve of the penis
B. Hypogastric nerve
C. Pelvic splanchnic nerve
D. Perineal nerve
E. Superior gluteal nerve
23. A 23 year old female is found to have a mass on the lower 1/3 of her vagina. The mass is biopsed and found to be malignant. To which lymph nodes would the cancer metastasize?
A. Superficial inguinal
B. Deep inguinal
C. Inferior mesenteric
D. Superior mesenteric
E. Femoral
24. An 84-year-old male has prostate cancer that has metastasized to his spine. Through which of the following structures did this most likely occur?
A. Azygous veins
B. Hemiazygous veins
C. Accessory Hemiazygous
D. Batson’s plexus
E. External Iliac vein.
25. Before conducting your first bimanual exampination, your preceptor asks you about the position of the uterus. You explain the uterus is:
A. Anteverted and anteflexed.
B. Retroverted and retroflexed.
C. Anteverted and retroflexed.
D. Retroverted and anteflexed.
26. An 8-month-old male infant is brought to his pediatrician because his parents were unable to palpate his testicles in his scrotum. What is this condition called?
A. Chordee
B. Congenital Adrenal Hyperplasia.
C. Cryptorchidism
D. Pseudohermaphroditism
E. True hermaephroditism
27. A 2-year-old male was admitted to the hospital with testicular pain. Physical examination reveals an enlarged scrotum. An otoscope is placed beneath the lateral side of the scrotum and the testis are transilluminated through the scrotal sac. Which of the following best describe the signs observed.
A. Cystocele
B. Hydrocele
C. Chylocele
D. Rectocele
E. Varicocele
28. An elderly man with benign enlargement of his prostate experiences difficulty in urination, urinary frequency, and urgency. Which of the following lobes of the prostate gland is commonly involved in BPH and obstructs the prostatic urethra.
A. Anterior lobe
B. Middle lobe
C. Right lateral lobe
D. Left lateral lobe
E. Posterior lobe
29. A 57-year-old man is incapable of penile erection following a rectal surgery with prostatectomy. The patient most likely has a lesion of which of the following nerves?
A. Dorsal nerve of the penis
B. Perineal nerve
C. Hypogastric nerve
D. Sacral splanchnic nerve
E. Pelvic splanchnic nerve.
30. A 34 year old female receives a midline episiotomy (surgical dissection of the perineal body) during labor. Which of the following muscles would NOT be affected by the episiotomy?
A. External anal sphincter
B. Superficial transverse perineal muscle
C. Coccygeus
D. Deep transverse perineal muscle
E. Bulbospongiosus muscle