Anterolateral Abdominal Wall & Inguinal Canal

1. A 29-year-old man is admitted to the local clinic for a vasectomy. During the procedure, the
surgeon separates the layers of the spermatic cord to expose the ductus deferens so that it can
be ligated and cut. From what structure is the external spermatic fascia derived?

a. External Oblique Aponeurosis —> External spermatic fascia

b. Transversus Abdominis Muscle

c. Cremaster Muscle

d. Internal Oblique Muscle

e. Transversalis Fascia —> Internal spermatic fascia

2. A 42-year-old man is admitted to the hospital with groin pain. Physical examination reveals that
the man has an indirect inguinal hernia. Which of the following nerves is compressed by the
herniating structure in the inguinal canal to give the patient pain?

a. Ilioinguinal —> in inguinal canal; compressed in an indirect hernia

b. Pudendal

c. Subcostal

d. Lateral Femoral Cutaneous

e. Iliohypogastric

3. A 45 year old woman is Brough to the emergency department with herpes zoster (shingles).
Examination reveals severe sharp burning pain and vesicular eruption on the skin around the
umbilicus. Which spinal nerve contributes to this dermatome?

a. T11

b. T12 —> dermatome of esophagus

c. T8

d. T10 —> dermatome of umbilicus

e. T9

4. A 55-year-old woman is brought to the local hospital following a mastectomy. Her surgeon now
performs a procedure to restore the thoracic contour using a musculocutaneous ap. The
ipsilateral rectus abdominis muscle was detached from the surrounding structures and
transposed to the thoracic wall. Which of the following landmarks is most often used to locate the
inferior end of the posterior, tendinous layer of the rectus sheath?

a. Intercristal Line

b. Arcuate Line
c. Linea Alba

d. Pectineal Line

5. A 55-year-old man is admitted to the emergency department with acute onset of lower back
pain on the right with concomitant loss of sensation of the skin in the posterolateral gluteal and
anterior pubic regions on the right side. A physical examination reveals severe pain inferior to the
twelfth rib at the right costovertebral angle with palpation. Further evaluation con rms paralysis of
the right internal oblique and transversus abdominis muscles. An abdominal CT scan revealed a
tumor that originated in the right kidney, entered the posterior renal capsule, and pressed on the
ipsilateral quadratus lumborum muscle. Which of the following nerves was most likely
compressed by the tumor?

a. Subcostal

b. Femoral

c. Lateral cutaneous nerve of thigh

d. Ilioinguinal

e. Iliohypogastric
6. A 35-year-old man is brought to the emergency department with a massive hernia that passes
through the inguinal triangle (of Hesselbach). Which of the following structures is used as a
landmark to distinguish a direct inguinal hernia from an indirect inguinal hernia?

a. Femoral canal

b. Inferior epigastric vessels —> makes up part of triangle of hesselbach

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d. Pectineal ligament

e. Inguinal ligament

7. A 33-year-old man is is brought to the emergency department with a bulge in his scrotum.
Examination reveals an indirect inguinal hernia. During the open hernia repair the internal
spermatic fascia is identi ed and re ected to expose the ductus deferens and testicular vessels.
From which of the following does the internal spermatic fascial layer of the spermatic cord
develop?

a. External oblique aponeurosis

b. Transversus abdominis aponeurosis

c. Internal oblique aponeurosis

d. Transversalis fascia —> ICE TIE

e. Processus vaginalis

8. A 35-year old woman is admitted to hospital. A “tummy-tuck” (abdominoplasty) procedure is

performed. Which of the following layers of the abdominal wall will hold the sutures?

a. Extraperitoneal tissue

b. External oblique aponeurosis

c. Camper’s fascia

d. Transversalis fascia

e. Scarpa’s fascia —> holds sutures after abdominoplasty

9. A 44-year-old woman is brought to the emergency department with pain radiating to her
inguinal region. Radiologic and physical examination reveal a herniation. Which of the following is
the most common type of hernia in a female patient?

a. Indirect inguinal hernia —> most common in females & young males
b. Direct inguinal hernia —> older males

c. Umbilical hernia

d. Epigastric hernia

e. Femoral hernia

10. A 65-year-old man was brought to the emergency department with groin pain and a palpable
mass just superior to the inguinal ligament. Examination con rmed an inguinal hernia and a
surgical repair was performed. During the procedure the surgeon identi ed a loop of intestine
extending through the deep inguinal ring. Which of the following types of hernia was this?

a. Umbilical

b. Indirect inguinal —> though deep inguinal ring

c. Direct inguinal —> does NOT enter dee inguinal ring

d. Femoral

e. Lumbar

Peritoneum & Peritoneal Cavity (Foregut)

1. A 24-year-old man is brought to the emergency department following a car crash. Examination
reveals a lacerated spleen which requires an urgent splenectomy. During the procedure, the
surgeon ligates the blood supply of the spleen at its hilum. Improper placement of the ligature
may occlude the artery that supplies which of the following structures?

a. Fundus of the stomach —> short gastric a branch of splenic a

b. Kidney

c. Splenic exure of the colon

d. Head of the pancreas

e. Pyloric sphincter

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2. A 42-year-old man is admitted to hospital with severe weight loss and vomiting. The physician
reveals that the umbilical and epigastric regions are tender and painful. A CT scan shows a
massive tumor originating from the third part of the duodenum. Which of the following structures
is most likely to be compressed by the tumor?

a. Common bile duct

b. Superior mesenteric artery —> third part of duodenum

c. Portal vein

d. Gastroduodenal artery

e. Posterior superior pancreaticoduodenal artery

3. A 62-year-old woman undergoes a Nissen fundoplication, in which the fundus of the stomach is
completely sutured around the gastroesophageal junction, to treat a severe case of
gastroesophageal re ux disease (GERD). During the procedure, the surgeon accidentally
damages the right (posterior) vagal trunk while inserting staples into the stomach. Which of the
following organs is most likely a ected?

a. Urinary bladder

b. Prostate gland

c. Descending colon

d. 2nd part of duodenum

e. Esophagus

4. A 22-year-old woman is brought to the emergency department with complaints of pain over her
umbilicus. Examination revealed acute appendicitis and the appendix was removed in an
emergency appendectomy. One week postoperatively she complained of paresthesia of the skin
over the pubic region and the anterior portion of her perineum. Which of the following nerves was
most likely injured during the appendectomy?

a. Genitofemoral

b. Spinal nerve T9

c. Ilioguinal —> increased risk of damage during appendectomy

d. Subcostal

e. Iliohypogastric —> doesn’t produce paraesthesia post op

5. A 34-year-old woman is scheduled for a laparoscopic cholecystectomy. The surgeon

accidentally clamped the hepatoduodenal ligament instead of the cystic artery. Which of the
following vessels would most likely be occluded in this iatrogenic injury?

a. Inferior vena cava

b. Splenic artery

c. Proper hepatic artery —> Pringle manuver

d. Superior mesenteric artery

e. Common hepatic artery

6. A 45-year-old man is brought to the emergency department with sever abdominal pain.
Examination reveals cholelithiasis (gallstones in the gallbladder) and an emergency
cholecystectomy is performed. During the procedure the scissors of the surgical resident
accidentally entered the tissues immediately posterior to the foramen of winslow (its posterior
boundary). The surgical eld was lled immediately by profuse bleeding. Which of the following
vessels was the most likely source of bleeding?

a. Portal vein

b. Superior mesenteric vein

c. Right renal artery

d. Aorta

e. Inferior vena cava —> posterior to foramen of Winslow

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 7. A 34-year-old man with a history of alcoholic cirrhosis is brought to the emergency department
complaining of severe dysphagia and retrosternal “burning” pain. During the esophagoscopy, the
endoscopist advanced the endoscope until its tip reached the esophageal hiatus of the
diaphragm. At which of the following vertebral levels did the tip of the endoscope most likely end?

a. T8

b. T7

c. T12

d. T10 —> esophagus

e. T11

8. A 25-year-old woman is admitted to the emergency department with severe, sharp abdominal
pain. Examination reveals that she has a perforated duodenal ulcer and an emergency repair is
performed. During the procedure the gastroduodenal artery is ligated. A branch of which artery
will continue to supply blood to the duodenum in this patient?

a. Superior mesenteric
b. Splenic

c. Proper hepatic

d. Left gastric

e. Right gastric

9. A 35-year-old woman is admitted to the emergency department with severe nausea and
abdominal pain around her umbilical area. Examination reveals that the patient has an in amed
appendix, which is subsequently surgically removed. Which nerve bers carried the pain from the
in amed appendix?

a. Postganglionic sympathetic

b. Visceral a erent —> referred pain to umbilicus from appendix

c. Preganglionic parasympathetic

d. Preganglionic sympathetic

e. Somatic a erents

10. A 52-year-old man is admitted to hospital with severe abdominal pain. Radiographic
examination reveals advanced carcinoma of the head of the pancreas. A celiac plexus block is
performed to relieve her pain. Which of the following best describes the nerve structures that are
most likely to be present in the celiac ganglion?

a. Preganglionic sympathetic, preganglionic parasympathetic, and visceral a erent bers

b. Postganglionic sympathetic and visceral a erent bers

c. Pre- and postganglionic sympathetic, preganglionic parasympathetic, and visceral

a erent bers
d. Preganglionic parasympathetic and somatic motor bers

e. Postganglionic parasympathetic and visceral a erent bers

Peritoneum & Peritoneal Cavity (Midgut & Hindgut)

1. A 34-year old woman is is brought to the hospital with severe vomiting. Examination of the
vomitus reveals the presence of bile. Imaging reveals part of the bowel being compressed
between the abdominal aorta and superior mesenteric artery. Which part is being
compressed?

a. Third part of duodenum —> between aa & sma

b. Second part of duodenum

c. Proximal part of jejunum

d. Ileum

e. First and second part of duodenum

2. A posteriorly perforating ulcer in the pyloric antrum of the stomach is most likely to produce an
initial localized peritonitis or abscess formation in which of the following?

a. Right subhepatic space

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 b. Greater sac

c. Omental bursa —> abscess here during perforating ulcer in stomach

d. Left subhepatic and hepatorenal spaces

e. Right subphrenic space

3. A 67-year-old woman comes to the ER after experiencing 2 days of red blood in her feces. She
reports no vomiting of blood (hematemesis). The given arteriogram shows a stain of contrast
material, indicated by the white arrow, at a bleeding diverticulum. What artery gives o direct
branches to supply the bleeding portion of the gastrointestinal (GI) tract?

a. Abdominal aorta

b. Inferior mesenteric
c. External iliac

d. Superior mesenteric

e. Celiac trunk

4. A 38-year-old woman is admitted to the local clinic with severe left ank pain. The patient's
blood test reveals hematuria and anemia. A magnetic resonance scan shows that blood ow in
the left renal vein is being occluded by an arterial aneurysm where the vein crosses the aorta. The
aneurysm is most likely located in which of the following arteries?

a. Inferior mesenteric

b. Celiac

c. Superior mesenteric

d. Middle colic

e. Left colic

5. Sensation of fullness in the rectum involves stretch receptors, which of the following provides
innervation for those receptors?

a. Lumbar sympathetic chain

b. Pelvic splanchnic nerves —> parasympathetic for hindgut

c. Sacral sympathetic chan

d. Pudendal nerve

e. Vagus nerve

6. Sympathectomy may occasionally relieve intractable pain of visceral origin, in as much as

visceral a erent pain bers run along the sympathetic pathways in the abdomen. The autonomic
control of peristalsis in the descending colon should not be a ected by bilateral lumbar
sympathectomy for which of the following reasons?

a. The descending colon receives its sympathetic innervation from thoracic splanchnic nerves

b. Only presynaptic sympathetic bers have been severed

c. The descending colon receives its parasympathetic innervation from the vagus nerve

d. The descending colon is controlled chie y by parasympathetic innervation from the

pelvic splanchnic nerves
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 e. Lumbar splanchnics from L1, L2, and L3 only innervate the pelvic viscera via the hypogastric
nerve

7. Volvulus is most likely to occur within segments of the GI tract that are intraperitoneal, not
retroperitoneal. Which segments of the GI tract are susceptible to volvulus, and to where does the
referred pain of volvulus tend to occur for that segment?

a. Descending colon; umbilical region

b. Ascending colon; umbilical region

c. Jejunum; epigastric region

d. Sigmoid colon; suprapubic region —> volvus occurs in intraperitoneal

e. Duodenum; epigastric region

8. A 35-year-old man is brought to the emergency department with nausea, vomiting, loss of
appetite and abdominal swelling. Examination reveals an in amed appendix and an emergency
appendectomy is scheduled. During the procedure it was discovered that the patient had an
atypical embryologic rotation of the intestine, adhesions, and adipose tissue made it somewhat
di cult to nd the appendix. Most commonly, the vermiform appendix is best located by locating
and tracing which of the following?

a. Descending branch of the right colic artery

b. Ileum to the ileocecal junction

c. Posterior cecal artery

d. Anterior cecal artery

e. Taniae coli of the ascending colon —> how to locate the appendix

9. A 35-year-old man su ers sharp abdominal pain accompanied by hematemesis (vomiting of

blood) for 2 days. He dies without seeking medical help. Autopsy ndings reveal a perforated
ulcer in the posterior wall of the rst part of the duodenum, which damaged the artery in close
proximity. Which of the following arteries was most likely ruptured?

a. Splenic

b. Left gastric

c. Gastroduodenal
d. Left gastro-omental

e. Short gastric

10. A 50-year-old man comes in for a physical so he can attend a boy scout camp with one of his
sons. You suggest a colonoscopy after he returns from camp. He agrees, but wants you to
describe the procedure and potential risks and complications. You explain that the goal of a
colonoscopy is to look at the entire length of the large intestine from the anus to the small
intestine (ileocecal junction), observing polyps or diverticuli with a exible ber optic colonoscope
inserted through the anus. There is a small risk of perforating the bowel especially when the colon
takes a sudden turn or twists on itself at regions where it is intraperitoneal rather than attached to
the posterior abdominal wall (retroperitoneal). Which of the following regions of the colon
generally poses the greatest risk for perforation because the bowel takes either a sudden change
in direction or is suspended by a mesentery?

a. Rectum, sigmoid colon and descending colon

b. Descending colon, transverse colon and ascending colon

c. Sigmoid colon, descending colon and splenic xture

d. Sigmoid colon, splenic exure and descending colon

e. Sigmoid colon, splenic exure and hepatic exure

ABDOMINAL VISCERA

1. During surgery to remove the gallbladder (cholecystectomy), a surgery resident damages the
cystic artery before a clamp is properly placed. The attending physician applies pressure to the
free edge of the hepatoduodenal ligament of the lesser omentum to control the bleeding until the
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damaged artery is clamped and ligated. Which of the following arteries was compressed by the
attending physician?

a. Splenic

b. Gastroduodenal

c. Celiac

d. Proper hepatic —> Pringle manuver

e. Common hepatic

2. During a splenectomy, a surgeon carefully dissects the peritoneal ligament containing the
splenic vessels at the hilum of the spleen. Which of the following peritoneal ligaments is being
dissected by the surgeon?

a. Splenorenal ligament
b. Hepatoduodenal ligament

c. Transverse mesocolon

d. Gastrosplenic ligament

e. Coronary ligament

3. Gallbladder pain often presents as epigastric pain that then migrates towards the patient’s right
side and can even wrap around to the posterior. The referred pain is not the site of the problem.
Anatomically where is the gallbladder located?

a. In the lesser omentum

b. Between the right and quadrate lobes of the liver

c. Between the left and caudate lobes of the liver

d. In the right anterior leaf of the coronary ligament

e. In the falciform ligament

4. A 46-year-old bakery worker is admitted to a hospital in acute distress. She has experienced
severe abdominal pain, nausea, and vomiting for 2 days. The pain, which is sharp and constant,
began in the epigastric region and radiated bilaterally around the chest to just below the scapulas.
Subsequently, the pain became localized in the right hypochondrium. The patient, who has a
history of similar but milder attacks after hearty meals over the past 5 years, is moderately
overweight and the mother of four. Palpation reveals marked tenderness in the right
hypochondriac region and some rigidity of the abdominal musculature. An x-ray without contrast
medium shows numerous calci ed stones in the region of the gallbladder. The patient shows no
sign of jaundice. Di use pain referred to the epigastric region and radiating circumferentially
around the chest is the result of a erent bers that travel via which of the following nerves?

a. Pelvic splanchnics

b. Greater splanchnic —> sympathetic of foregut

c. Vagus

d. Intercostal

e. Phrenic

5. An 35-year-old obese male complains of nausea, elevated temperature and intermittent acute
pain in the right upper quadrant of his abdomen during the past 2 days. Examination con rms a
24-hour history of jaundice and a history of gallstones. Which of the following structures has most
likely been obstructed by a gallstone?

a. Left hepatic duct

b. Cystic duct

c. Pancreatic duct

d. Right hepatic duct

e. Common bile duct —> jaundice, most impactful in bile system

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 6. A 24-year-old man is brought to the emergency department with severe abdominal pain
following a splenectomy. The patient’s history and physical examination indicate a right
subphrenic abscess (accumulation of infected uid between the diaphragm, liver, and spleen) that
extends to the midline. Which of the following structures would most likely be in a position to
retard the spread of the abscess across the midline?

a. Falciform ligament
b. Round ligament

c. Gastroduodenal ligament

d. Coronary ligament

e. Hepatoduodenal ligament

7. A 55-year-old woman arrives at the emergency room the day after St. Patrick’s Day coughing
up bright red blood. She has frequented your emergency room before. History includes excessive
alcohol consumption. Using abdominal percussion you determine that her liver extends 5 cm
below the right costal margin at the midclavicular line. You call in a gastroenterologist because
you suspect that the bright red blood is most likely the result of which of the following?

a. Hemorrhoids

b. Gastric ulcer

c. Esophageal varices
d. Colon cancer

e. Duodenal ulcer

8. A woman presents with gallstones and no jaundice. She is prepared for exploratory surgery.
The lesser omentum is incised close to its free edge, and the biliary tree is identi ed and freed by
blunt dissection. The liquid contents of the gallbladder are aspirated with a syringe, the fundus
incised, and the stones are removed. The entire duct system is carefully probed for stones, one of
which is found to be obstructing a duct. In view of her symptoms, where is the most probable
location of the obstruction?

a. The bile duct

b. Within the duodenal papilla distal to the juncture with the pancreatic duct

c. The common hepatic duct

d. Within the duodenal papilla proximal to the juncture with the pancreatic duct

e. The cystic duct —> NO jaundice

9. Following involvement in a car crash, a 20-year-old undergoes a splenectomy due to a

lacerated spleen secondary to blunt abdominal trauma. During the procedure, the surgeon ligates
the blood supply of the spleen at its hilum. Improper placement of the ligature may lead to
damage to the arterial supply of which of the following structures?

a. Kidney

b. Fundic portion of the stomach

c. Splenic xture of colon

d. Head of pancreas

e. Pyloric portion of stomach

10. A 52-year-old woman presents with severe upper right quad- rant abdominal pain. She is
jaundiced, obese, and has a history of gallstones. Further examination indicates acute
cholecystitis, and she undergoes an open abdominal cholecystectomy (removal of gall bladder).
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 During the surgery, the doctor inserts her index nger into the omental (epiploic) foramen to
palpate the structures in the hepatoduodenal ligament. Which of the following structures lies
immediately posterior to her nger?

a. Liver

b. Head of the pancreas

c. Abdominal aorta

d. Inferior vena cava

e. Bile duct

POSTERIOR ABDOMINAL WALL

1. A 60-year-old man is diagnosed with a posterior abdominal wall tumor that is causing lesions in
the superior mesenteric ganglia. Which of the following pathways is most likely a ected?

a. Lymph drainage from liver

b. Venous drainage from the transverse colon

c. Parasympathetic supply to the posterior aspect of the stomach

d. Visceral a erents from the proximal duodenum

e. Sympathetic supply to the ascending colon

2. A 42-year-old man presents with an enlarged left adrenal gland on CT scan. He is scheduled for
adrenalectomy. The left adrenal gland is located, and the venous drainage is ligated to prevent
life-threatening quantities of adrenalin from entering the bloodstream on manipulation of the
gland. Normally, the left adrenal venous drainage is into which of the following?

a. Left azygos vein

b. Left inferior phrenic vein

c. Superior mesenteric vein

d. Left renal vein —> where left suprarenal viein drains into
e. Inferior vena cava

3. A 32-year-old woman is brought to the emergency department with pain radiating from her
lower back towards her pubic symphysis. The physician suspects a kidney stone. Examination
reveals a stone partially obstructing the lower part of her right ureter. The stone is probably lodged
where the ureter crosses which structure?

a. Inferior mesenteric artery

b. Inferior vena cava

c. Fourth lumbar artery

d. Common iliac artery —> ureter crosses the common iliac artery
e. Internal iliac artery

4. A middle-aged woman describes ushing, severe headaches, and a feeling that her heart is
“going to explode” when she gets excited. At the beginning of a physical examination her blood
pressure (130/85) is not signi cantly above normal. However, on palpation of her upper left
quadrant, the examining physician notices the onset of sympathetic signs. Her blood pressure
(200/135) is abnormally high. A subsequent CT scan con rms the suspected tumor of the left
adrenal gland. The patient is scheduled for surgery. The symptoms that the patient correlates with
the onset of excitement were most likely due to neural stimulation of the adrenal glands. The
adrenal medulla receives its innervation from which of the following?

a. Preganglionic parasympathetic nerves

b. Somatic nerves

c. Preganglionic sympathetic nerves

d. Postsynaptic sympathetic nerves

e. Postganglionic parasympathetic nerves

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5. A 39-year-old woman presents to the emergency department with pain in her right side that
radiates to the suprapubic region. She also has hematuria and a history of urinary tract infections.
A CT scan reveals polycystic kidney disease with stretched capsule. Which nerve will convey the
pain to the central nervous system (CNS)?

a. Celiac plexus

b. Iliohypogastric nerve
c. Pelvic splanchnic nerve

d. Greater thoracic splanchnic nerve

e. Lesser thoracic splanchnic nerve

6. A 55-year-old woman develops a hiatal hernia in which the fundus of the stomach protrudes
through the esophageal hiatus of the diaphragm into the thorax. Which of the following structures
is/are at greatest risk of injury during surgical repair of this hernia?

a. Thoracic duct

b. Superior epigastric vessels

c. Sympathetic chains

d. Azygos veins

e. Vagus nerves

7. A 26-year-old woman is admitted to the hospital with weakness and fatigability. The patient has
a 3-month history of severe hypertension and is being treated with antihypertensive medications.
Examination reveals a tumor of her right suprarenal gland. She is diagnosed with a
pheochromocytoma (tumor of the adrenal medulla) and is scheduled for a laparoscopic
adrenalectomy. Which of the following nerve bers will need to be cut when the adrenal gland and
tumor are removed?

a. Preganglionic sympathetic bers

b. Somatic motor bers

c. Postganglionic sympathetic bers

d. Preganglionic parasympathetic bers

e. Postganglionic parasympathetic bers

8. During the visit of a 73-year-old man to your o ce for ongoing control of his hypertension
(155/90) you note that he has lost about 5 lb since his last visit. He reports that he just doesn’t
seem to have as much room for food or as much of an appetite. He states that he is getting tired
of the food at his nursing home. You palpate his abdomen and note that there is a mid- line pulse,
which you had initially mistaken for a heartbeat, but it is slightly delayed. You grow quite
concerned about this pulsating abdominal mass and send him for an abdominal CT with
intravenous contrast because you think that he has which of the following?

a. A horseshoe kidney

b. An aortic aneurysm
c. A hiatal hernia

d. Cirrhosis of the liver

e. Splenomegaly

9. A 55-year-old man is admitted to the emergency department with symptoms of tachycardia

and edema. Examination reveals complete occlusion of his inferior vena cava at the L3 vertebral
level. As a result of the occlusion, which of the following veins most likely acted as collateral
channels to allow blood to ow from the lower to upper parts of his body?

a. Left common iliac

b. Hemiazygos

c. Ascending lumbar —> L3

d. Azygos

e. Left renal vein

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 10. A slender 53-year-old woman who smokes a pack of cigarettes each day comes to your o ce
complaining of a pulsating sensation in her abdomen with generalized abdominal and back pain.
You palpate her abdomen and feel a mid-line pulse with every heart beat. You order an abdominal
Doppler ultrasound, which shows a large, high abdominal aortic aneurysm above renal arteries of
about 8 cm in diameter. She is admitted to the hospital immediately for repair of her aortic
aneurysm because it is life threatening, but you warn her that one of the complications of such
surgical repair includes paraplegia. During the procedure the vascular surgeon must completely
clamp o the abdominal aorta for about an hour while repairing the aneurysm. Which of the
following would explain to the patient why there is a risk of paraplegia?

Stopping the blood within the abdominal aorta causes loss of blood ow to the major
radicular artery (of Adamkiewicz), which causes the motor components in the spinal cord
for the lower limb to die

EMBRYOLOGY DIGESTIVE SYSTEM

1. A newborn baby has projectile vomiting shortly after each feeding. It is determined that there is
obstruction of the digestive tract as a result of an annular pancreas. Annular pancreas is a result
of an abnormality in which of the following processes?

a. Rotation of the ventral pancreatic bud around the rst part of the duodenum

b. Rotation of the dorsal pancreatic bud around the rst part of the duodenum

c. Rotation of the ventral pancreatic bud around the second part of the duodenum

d. Rotation of the dorsal pancreatic bud around the third part of the duodenum

e. Rotation of the dorsal pancreatic bud around the second part of the duodenum

2. A newborn boy does not pass meconium until 48 hours after his birth. Two weeks later his
mother reports that he has not been passing stool regularly. Anorectal manometry reveals
increased internal anal sphincter pressure on rectal distention with a balloon. Radiographic
studies reveal massive dilation of the colon proximal to the rectum. This indicates a
developmental abnormality in which of the following embryonic tissues?

a. Neural crest
b. Neural ectoderm

c. Ectoderm

d. Endoderm

e. Splanchnic mesoderm

3. The greater omentum is derived from which of the following embryonic structures?

a. Pleuropericardial membranes

b. Dorsal mesoduodenum

c. Ventral Mesentary

d. Pericardioperitoneal canal

e. Dorsal mesogastrium

4. An infant is born with a large defect in the central tendon of the diaphragm. This condition is
most likely the result of malformation of which of the following structures?

a. Dorsal mesentery of the esophagus

b. Cervical somites

c. Pleuroperitoneal folds

d. Septum transversum
e. Ventral mesentery of the gut tube

5. Failure of di erentiation of the individual organs derived from the embryonic foregut would
cause malformation of which of the following organs?

a. Gallbladder
b. Spleen

c. Ileum

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 d. Ascending colon

e. Descending colon

6. A 2-year-old-boy is brought to the pediatrician by his mother because he has had several
episodes of rectal bleeding. Evaluation with a technetium-99m perfusion scan reveals a 3-cm ileal
outpouching located 60 cm from the ileocecal valve. This structure likely contains which of the
following types of ectopic tissue?

a. Esophageal

b. Gastric
c. Hepatic

d. Duodenal

e. Jejunal

7. A low-birth-weight neonate, who passed meconium on the rst day of life, is started on formula
at 2 days of age. The infant develops abdominal distension and tenderness, accompanied by
ndings suggestive of sepis, including hypotension and neutrophilia of the blood. What is most
likely to be seen at emergency surgery?

a. Gangrene of the terminal ileum and ascending colon

b. A massively dilated colon

c. A massive thickening of the pylorus

d. Bowel loops in the chest cavity

e. Normal-appearing GI tract

8. A 5-year-old child is brought to the emergency room with massive, painless bleeding from the
rectum. Colonoscopy fails to demonstrate a lesion in the colon or anus. Upper endoscopy fails to
demonstrate esophagitis, gastric ulcer, or duodenal ulcer. A [99mTc] technetium scan
demonstrates an abnormality in the lower half of the abdomen. Failure of a normal developmental
process involving which of the following structures is the most likely cause of this child's
bleeding?

a. Cecum

b. Ileum
c. Jejunum

d. Duodenum

e. Appendix

9. Which of the following developmental abnormalities might account for unexplained small
intestinal bleeding?

a. CNS heterotopia

b. Parathyroid heterotopia

c. Thyroid heterotopia

d. Pancreatic heterotopia

e. Gastric heterotopia

10. Autopsy of a baby who died minutes after birth demonstrates intestines within the thoracic
cavity. Which of the following most probably accounts for these ndings?

a. Heterotopia

b. Hypertrophic pylorus stenosis

c. Maldevelopment of the lungs

d. Partial absence of the diaphragm

e. Large sliding hernia

PELVIS & PERINEUM I

1. Following vaginal childbirth, a woman experienced urinary incontinence, particularly when

coughing. This was most likely caused by tearing of which of the following?

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 a. Obturator internus muscle

b. Puborectalis muscle

c. Pubococcygeus muscle

d. Super cial transverse perineal muscle

e. Piriformis muscle

2. A 72-year-old man is brought to the local clinic for a scheduled radical prostatectomy. Seven
months postoperatively the patient complains to his physician of impotence. Where are the nerve
cell bodies located that are responsible for erection?

a. Intermediolateral column of L1, L2

b. Sacral parasympathetic nucleus

c. Superior hypogastric plexus

d. Inferior mesenteric ganglion

e. Sacral sympathetic trunk ganglia

3. A 71-year-old man was admitted to hospital for a radical prostatectomy. Seven months
postoperatively the patient complains that he is incapable of obtaining a penile erection without
the use of sildena l (Viagra). Which nerve was most probably damaged during the operation?

a. Perineal

b. Cavernous
c. Dorsal nerve to penis

d. Sacral splanchnic

e. Pudendal

4. A 30-year-old man is admitted to hospital for a routine examination. Physical examination

reveals an indirect hernia and an absent cremasteric re ex. Which of the following nerves carries
the e erent component of the cremasteric re ex?

a. Iliohypogastric nerve

b. Ilioinguinal nerve

c. Obturator nerve

d. Genital branch of genitofemoral

e. Pudendal nerve

5. A 35-year-old man is admitted to the local clinic with discomfort and pain around his anus.
Examination reveals external hemorrhoids. Which of the following nerves carries pain sensation
from the anus?

a. Ilioinguinal

b. Pelvic splanchnic

c. Inferior rectal
d. Sacral splanchnic

e. Superior hypogastric

6. A 32-year-old man is brought to the local clinic for a routine physical. The patient informs the
physician that he has a  painless mass located in his right scrotum for several months. An
ultrasonographic examination reveals a homogeneous hypoechoic intratesticular mass. Biopsy
reveals a seminoma. Cancer of the testis metastasizes rst to which of the following lymph
nodes?

a. Internal iliac

b. Super cial inguinal

c. External iliac

d. Deep inguinal

e. Lumbar
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 7. A 25-year-old pregnant woman is admitted to the emergency department with pain to her lower
back, abdominal cramping and severe contractions. The obstetrician schedules an emergency
vaginal delivery and performs a median episiotomy in which the area of the perineal body is cut
deeply. Two weeks after the delivery the woman complains that she has had fecal incontinence
since the delivery. Which of the following structures was also most likely damaged during the
episiotomy?

a. Sphincter urethra

b. Ischiocavernosus muscle

c. External anal sphincter

d. Super cial and deep transverse perineal muscles

e. Sacrospinous ligament

8. A 24-year-old woman seeking assistance for apparent infertility has been unable to conceive
despite repeated attempts in 5 years of marriage. She reveals that her husband fathered a child in
a prior marriage. Although her menstrual periods are fairly regular, they are accompanied by
extreme lower back pain. The lower back pain during menstruation experienced by this woman
probably is referred from the pelvic region. The pathways that convey this pain sensation to the
central nervous system involve which of the following?

a. Pudendal nerve to S2-S4

b. Hypogastric nerve to L1-L2

c. Lumbosacral trunk to L4-L5

d. Pelvic splanchnic nerves to S2-S4

e. Median nerve

9. A 42-year-old woman is admitted to hospital with complains of fecal incontinence. The most
likely contributing factor to such a problem is atrophy, paralysis, or dysfunction of which of the
following structures?

a. Coccygeus muscle

b. Urogenital diaphragm

c. Pubococcygeus muscle
d. Pubovesicocervical fascia

e. Iliococcygeus muscle

10. A rectal cancer that occurs within the anal canal penetrates the mucosa and basement
membrane. Which nodes would you most likely harvest at the same time you removed the
cancerous growth to send to pathology to determine if there has been metastasis?

a. Internal iliac & external iliac nodes

b. Super cial inguinal, internal iliac and pre-aortic inferior mesenteric nodes
c. External iliac, super cial inguinal and pre-aortic nodes

d. Super cial inguinal nodes

e. Inguinal nodes and internal iliac nodes

PELVIS & PERINEUM III

1. A 41-year-old woman is admitted to hospital for a routine examination. A pap smear is

performed on the patient which reveals atypical cervical cells indicating the possibility of
cervical cancer. Which of the following lymph nodes need to be biopsied to con rm the
existence of initial metastasis from the suspected cancerous tumor?

a. Super cial inguinal

b. Sacral

c. Deep inguinal

d. External iliac

e. Internal iliac

2. The body of the uterus tends to wander within the pelvic cavity. However the cervix of the
uterus tends to remain fairly rmly in place most of the time. Which of the following would be
found immediately inferior to the left cardinal (lateral cervical) ligament?

a. Ovarian neurovascular bundle

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 b. Ovarian artery & vein

c. Ureter
d. Uterine tube

e. Round ligament of the uterus

3. A 32-year-old man is admitted to the hospital with severe bladder pain after drinking large
quantities of uids. He is examined by a urologist and is diagnosed with interstitial cystitis. What
is the location of the neural cell bodies responsible for pain sensation from the urinary bladder?

a. Sensory ganglia of spinal nerves T5 to T9

b. The intermediolateral cell column of spinal cord levels S2, S3 & S4

c. The pre-aortic ganglia at the site of origin of the testicular arteries

d. Doral root ganglia of spinal levels T10 to L2

e. Dorsal root ganglia of spinal cord levels S2, S3 & S4

4. A 45-year-old woman is admitted to the emergency department with severe lower abdominal
pain. Examination reveals an ovarian tumor. Which of the following lymph nodes will most likely
become invaded by cancerous cells?

a. Internal iliac

b. Deep inguinal

c. Super cial inguinal

d. Lumbar/lateral/aortic/paraaortic
e. External iliac

5. A 27-year-old pregnant woman is given a caudal epidural block to alleviate pain during vaginal
delivery. Caudal epidural blocks involve injection of local anesthetic into the sacral canal. Which of
the following landmarks is most commonly used for the caudal epidural block?

a. Cornua of the sacral hiatus

b. Median sacral crest

c. Intervertebral foramina

d. Anterior sacral foramina

e. Posterior sacral foramina

6. A 28-year-old pregnant woman is admitted to the emergency department with nausea, severe
lower back pain and contractions. The patient is examined by an obstetrician who administers a
local anesthetic by palpating the ischial spine trans-vaginally. Injection of the anesthetic at this
location blocked a nerve that most likely contained bers from which of the following ventral
rami?

a. S3, S4, S5

b. L5, S1, S2

c. L4, L5, S1

d. S1, S2, S3

e. S2, S3, S4

7. A 55-year-old woman is admitted to the hospital with lower abdominal and pelvic discomfort.
Physical examination reveals that the patient has su ered a complete uterine prolapse. Which of
the following provides support to the uterus?

a. Suspensory ligament of ovary

b. Infundibulopelvic ligament

c. Transverse cervical ligament

d. Pubovesical ligament

e. Coccygeus

8. A 27-year-old woman is admitted to the emergency department with severe pelvic pain.
Radiographic examination reveals a benign tumor on the left ovary. An ovariectomy is performed
and the ovarian vessels are ligated. Which of the following structures is at risk of injury when the
ovarian vessels are ligated?

a. Ureter
b. Uterine artery

c. Vaginal artery

d. Pudendal artery

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 e. Internal pudendal artery

9. A 44-year-old man is admitted to hospital with complaints of generalized fatigue, weight loss,

anorexia, di culty urinating, dysuria, hesitancy, and feelings of incomplete emptying when
urinating. Physical examination reveals that the abdomen was at, soft, and not tender, with no
organomegaly, or inguinal lymphadenopathy. A digital rectal examination con rmed that one of
the lobes of the prostate was enlarged. What structure was most likely a ected in this patient’s
condition?

a. The median zone of the prostate

b. The bromuscular zone of the prostate

c. The lateral capsule of the prostate

d. The transition zone of the prostate

e. The posterolateral lobe of the prostate

10. A 58-year-old woman with multiple sclerosis presents at the local clinic with urinary
incontinence. She is treated with antibiotics. Which of the following nerves is most likely to cause
dysfunction of her external urethral sphincter leading to this incontinence?

a. Sacral splanchnic

b. Pudendal
c. Inferior gluteal

d. Superior gluteal

e. Pelvic splanchnic

PELVIS & PERINEUM III

1. During preparation for a voiding cystourethrogram, a urologist inserting a catheter accidentally

damages the wall of the membranous portion of the urethra in the deep perineal space. If
contrast medium used to ll the bladder for the cystourethrogram were to enter the deep
perineal space, it could come into contact with which of the following structures?

a. Bulbocavernous muscle

b. Ischiocavernous muscle

c. Bulbourethral gland
d. Seminal vesicle

e. Crus of the penis

2. Pap smears are the collection of cells from the uterine cervix to look for cytological evidence of
transformation to cancerous forms, most typically due to a viral infection. While most women do
not report any dis- comfort associated with the collection of cervical cells, a few women do. To
which of the following somatic areas does the uterine cervix refer pain to?

a. Medial thigh & buttock

b. Epigastric region

c. Subcostal & umbilical regions

d. Lateral leg & perineum

e. Inguinal & pubic regions, anterior labia majora, medial thigh

3. A resident physician is performing a pelvic examination on a young woman. The ngers of one
of her hands is in the patient's vagina and is palpating the cervix. The other hand is pressing on
the abdomen. With the palm of this hand, the physician feels a bony structure in the lower
midline. This structure is most likely the:

a. Ilium

b. Ischium

c. Pubis
d. Coccyx

e. Sacrum

4. Which of the following is one of the roles of the sympathetic chain in the pelvis?

a. Kidney stone development

b. Bladder contraction

c. Erection in both male & female

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e. Cutaneous function (sudomotor, vasomotor, pilomotor)

5. Both the autonomic and vascular systems need to function properly for successful male sexual
function. Which of the following statements concerning erection, emission, and ejaculation in the
male is correct?

a. Parasympathetic nerves stimulate closure of helical arteries

b. Contraction of the internal urethral sphincter is under control of the parasympathetic nervous
system

c. Contraction of the bulbospongiosus muscles impedes the drainage of blood from the
corpus spongiosum
d. Sympathetic neurons stimulate the helicon arteries to dilate and increase blood ow to the
corpora cavernosum

e. Parasympathetic innervation stimulates emission of seminal uid

6. A 75-year-old man with a 40-pack-year history of smoking and hypercholesterolemia has

severe atherosclerosis. Occlusion of which of the following arteries would result in insu cient
perfusion of the urinary bladder?

a. Internal iliac
b. Lateral sacral

c. External iliac

d. Internal pudendal

e. Inferior epigastric

7. A 15-year-old girl is brought into the emergency room with severe abdominal pain and a fever.
laboratory examination is remarkable for an elevated white blood cell count and a pregnancy test
is positive. Upon questioning, it is determined that she attempted to terminate her pregnancy by
inserting a sharp object into her vagina. The physician determines that the wall of the posterior
fornix of the vagina has been penetrated. Into what region did the sharp object penetrate?

a. Rectovesical space

b. Ischioanal space

c. Rectouterine space
d. Deep perineal pouch

e. Vesicouterine space

8. During an abdominal surgical procedure, the surgeon wishes to locate the ureter in order to
ensure that it is not injured. The ureter may be found immediately anterior to the origin of the

A. Internal iliac artery

B. Gonadal artery

C. Externa iliac artery

D. Common iliac artery

E. Renal artery

9. Which structure is most susceptible to unintentional damage during a hysterectomy?

a. Urethra

b. Urinary bladder

c. Uterine artery

d. Kidney

e. Ureter

10. Which of the following contains the ovarian neurovascular bundle?

a. Suspensory ligament of the ovary

b. Mesosalpinx

c. Broad ligament

d. Transverse cervical ligament

e. Mesovarium

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EMBRYOLOGY: REPRODUCTIVE & URINARY SYSTEMS

1. Which of the following characteristics is similar for spermatogenesis and oogenesis?

a. Amount of cytoplasm retained

b. Length of prophase I

c. DNA replication during meiosis

d. Age at which meiosis begins

e. Transmission to fetus of mitochondrial DNA

2. During development, the formation of the kidney is induced by which of the following
structures?

a. Metanephric duct
b. Mesonephros

c. Urogenital ridge

d. Allantois

e. Mesonephric duct

3. A newborn male child is noted to have hypospadias. A complete evaluation determines that the
child has no other genitourinary anomalies. Nonetheless, hypospadias repair will be performed to
prevent which of the following possible sequelae?

a. Bladder exstrophy

b. Hydrocele

c. Phimosis

d. UTI
e. Urachal cysts

4. A patient, who appears to be female, is found to be 46,XY. The patient's vagina is very shallow,
ending in a blind pouch, and there are palpable masses in the labia. The diagnosis of testicular
feminization syndrome is made. Which of the following was most likely present during the early
fetal life of this individual?

a. MIF (Mullerian inhibitory factor)

b. A uterus

c. Depressed levels of testosterone

d. An oviduct

e. A streak ovary

5. In a genotypic male, the testes fail to develop, and do not secrete testosterone or Müllerian
regression factor. Which of the following best describes the in utero reproductive system
development of this individual?

a. Male-type internal reproductive tract & male-type external genitalia

b. Female-type internal reproductive tract & female-type external genitalia

c. Female-type internal reproductive tract & male-type external genitalia

d. Both Male- and female-type internal reproductive tracts & male-type external genitalia

e. Male-type internal reproductive tract & female-type external genitalia

6. Ultrasonographic examination of a 7-month-old fetus demonstrates limb and facial deformities.

The amount of amniotic uid is estimated to be about 10 mL, considerably lower than normal. A
failure of development of which of the following organs can initiate the deformation sequence
experienced by this fetus?

a. Lungs

b. Kidneys
c. Heart

d. Esophagus

e. Duodenum

7. A researcher employs site-directed mutagenesis to produce mutations in a gene that is

important for development of the ureteric bud in a rat embryo. The embryo develops abnormally,
and is delivered stillborn twenty days later. Examination of the stillborn fetus would likely reveal
absence of which of the following renal structures?

a. Ascending loop of henle

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c. Glomerular tuft

d. Collecting duct
e. Descending loop of henle

8. When examining a histological section of a normal ovary, a technician notices an oocyte

surrounded by several layers of follicular cells. A small antrum is present. Which of the following is
the correct term for the entire structure, composed of the oocyte, follicular cells, and antrum?

a. Graa an follicle

b. Corpus luteum

c. Primary follicle

d. Primordial follicle

e. Secondary follicle

9. A prostate-speci c antigen (PSA) level is drawn from a 54-year-old man as part of a routine
health evaluation. Which of the following embryonic structures gives rise to the organ being
screened for carcinoma?

a. Processus vaginalis

b. Testis cords

c. Genital tubercle

d. Urogenital sinus
e. Tunica albuginea

10. Which of the following embryonic structures gives rise to the adrenal cortex?

a. Neural crest cells

b. Mesoderm
c. Endoderm

d. Mesonephros

e. Ectoderm

LOWER LIMB, ANTERIOR & MEDIAL THIGH

1. In preparing to isolate the proximal portion of the femoral artery, the vascular surgeon gently
separated it from surrounding tissues. Posterior to the femoral sheath, what muscle forms the
lateral portion of the oor of the femoral triangle?

a. Sartorius

b. Iliopsoas
c. Adductor longus

d. Rectus femoris

e. Pectineus

2. A 51-year-old immigrant with tuberculosis is found to have large occulent masses over the
lateral lumbar spine. There is a similar mass located in the ipsilateral groin. Physical examination
reveals increased tenderness just medial to the ipsilateral anterior superior iliac spine on
palpation. This pattern of involvement most likely suggests an abscess tracking along which of
the following muscles?

a. Piriformis

b. Psoas major
c. Gluteus maximus

d. Obturator internus

e. Adductor longus

3. A 49-year-old male construction worker is admit- ted to the emergency department with a
painful lump on the proximal medial aspect of his thigh. Radiologic and physical examinations
reveal that the patient has a herniation of abdominal viscera beneath the inguinal ligament into the
thigh. Through which of the following openings will a hernia of this type initially pass to extend
from the abdomen into the thigh?

a. Obturator canal

b. Fossa ovalis

c. Super cial inguinal ring

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 d. Femoral ring
e. Deep inguinal ring

4. The news reported that the 58-year-old ambassador received a slashing wound to the medial
thigh and died from exsanguination in less than 2 minutes. What was the most likely nature of his
injury?

a. The femoral artery was cut at the inguinal ligament

b. The medial circum ex femoral was severed at its origin

c. The deep femoral artery was divided at its origin

d. A vessel or vessels were injured at the apex of the femoral triangle

e. The femoral vein was transected at its junction with the saphenous vein

5. A 43-year-old victim of a drunk driving car crash is undergoing reconstructive arm surgery. The
surgeon performs an autograft using a weak adductor of the leg located super cially on the
medial side of the thigh. Which muscle is most likely being harvested to perform this
reconstruction?

a. Sartorius

b. Vastus medialis

c. Gracilis
d. Rectus femoris

e. Vastus lateralis

6. A 30-year-old man who is a bodybuilder presents to the physician’s o ce complaining of pain

and tingling sensation radiating down the inside of his thigh that was exacerbated upon thigh
movement. A hernia through which opening would most likely cause this presentation?

a. Obturator canal

b. Fossa ovalis

c. Deep inguinal ring

d. Super cial inguinal ring

e. Femoral ring

7. A 23-year-old woman was taken to the emergency department after being involved in a head-
on collision with a truck. On physical examination a hematoma was seen in the medial thigh. A CT
scan revealed a fracture of the femur with a ruptured femoral artery. She was taken to the
operating room for repair of the damaged structures. Two days postoperatively during physical
examination the patient has loss of sensation to the anterior medial thigh and medial side of her
leg and foot. Branches of which of the following nerves were most likely injured in the repair of the
fracture?

a. Femoral
b. Saphenous

c. Tibial

d. Obturator

e. Fibular (peroneal)

8. A 35-year-old man was struck by a tour bus while walking in the middle of the street. The man
was admitted to the emergency department and during physical examination was diagnosed with
“adductor gait,” in which an individual crosses one limb in front of the other, due to powerful hip
adduction. Which of the following nerves was most likely involved in this condition?

a. Tibial

b. Superior gluteal

c. Femoral

d. Obturator

e. Inferior gluteal

9. A 20-year-old man visits the family physician complaining of di culty to ex and medially rotate
his thigh while running and climbing. Which of the following muscles is most likely damaged in
this individual?

a. Rectus femoris

b. Semimembranosus

c. Vastus intermedius

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 d. Tensor fasciae latae
e. Sartorius

10. A 34-year-old man is lifting heavy weights while doing squats. Unfortunately, while making a
maximal e ort, he drops the weight and immediately grabs at his upper thigh, writhing in pain.
The man is admitted to the emergency department and during physical examination is diagnosed
with a femoral hernia. What reference structure would be found immediately lateral to the
herniated structures?

a. Femoral artery

b. Adductor longus muscle

c. Femoral vein
d. Femoral nerve

e. Pectineus muscle

GLUTEAL REGION, POSTERIOR THIGH & KNEE

1. A 34-year-old male power lifter visits the outpatient clinic because he has di culty walking.
During physical examination it is observed that the patient has a problem unlocking the knee
joint to permit exion of the leg. Which of the following muscles is most likely damaged?

a. Rectus femoris

b. Popliteus
c. Semimembranosus

d. Gastrocnemius

e. Biceps femoris

2. A 23-year-old man is admitted to the emergency department after injuring his knee while
playing football. During physical examination there is pain and swelling of the knee, in addition to
locking of the knee in full extension. Radiologic examination reveals a bucket handle meniscal tear
(Figure below). Which of the following ligaments is most likely injured?

a. Lateral collateral

b. Coronary

c. Posterior cruciate

d. Medial collateral

e. Anterior cruciate

3. During a 100-meter sprint a 25-year-old male Olympic athlete suddenly pulls up in discomfort
and is seen to be clutching the back of his left thigh in agony. Upon further examination the
athlete describes the pain as a “tearing” sensation and is unable to ex his knee. Based on these
symptoms which of the following actions are a ected due to this injury?

a. Lateral rotation of the hip

b. Hip extension and knee exion

c. Extension of the hip and dorsi exion

d. Flexion of the hip and extension of the knee

e. Medial rotation of the hip

4. After su ering a deep stab wound to her posterior thigh, a 22-year-old woman presents to the
emergency department. The wound is closed but the patient develops a subsequent wound
infection. Which group of lymph nodes rst receives drainage from this deep wound area, and
would most likely be enlarged in this patient?

a. Common iliac

b. Super cial inguinal

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 c. External iliac

d. Internal iliac

e. Deep inguinal

5. A 22-year-old woman is found in a comatose condition, having lain for an unknown length of
time on the tile oor of the courtyard. She is found in possession of cocaine. The patient is
transported to the hospital while EMT personnel receive instructions for treatment of drug
overdose. During the physical examination the patient’s gluteal region shows signs of ischemia.
After regaining consciousness, she exhibits paralysis of knee exion and dorsal and plantar
exion and sensory loss in the limb. What is the most likely diagnosis?

a. Piriformis entrapment syndrome

b. Tibial nerve loss

c. Gluteal crush injury

d. Femoral nerve entrapment

e. S1-2 nerve compression

6. An 80-year-old woman su ered a hip dislocation when she fell down the steps to her garage.
Which of the following is most signi cant in resisting hyperextension of the hip joint?

a. Pubofemoral ligament

b. Negative pressure in the acetabular fossa

c. Ischiofemoral ligament

d. Iliofemoral ligament
e. Gluteus maximus muscle

7. A 24-year-old man is admitted to the emergency department after a car collision. Radiologic
examination reveals a fracture at the junction of the middle and lower thirds of the femur. An MRI
examination provides evidence that the popliteal vessels were injured when the distal fragment of
the fracture was pulled posteriorly. Which of the following muscles is most likely to displace the
distal fracture fragment?

a. Gastrocnemius
b. Semitendinosus

c. Soleus

d. Gracilis

e. Tibialis Anterior

8. After dividing the overlying super cial tissues and gluteal musculature in a 68-year-old female
patient, the orthopedic surgeon carefully identi ed the underly- ing structures while performing a
total hip arthroplasty. The key landmark in the gluteal region, relied upon in surgical explorations
of this area, is provided by which of the following structures?

a. Sciatic nerve

b. Piriformis muscle
c. Spine of ischium

d. Obturator internus tendon

e. Gluteus medius

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 9. A popliteal arterial aneurysm can be very fragile, bursting with
great loss of blood and the potential loss of the leg if it is not dealt
with safely and e ectively. In the 18th century, Dr. John Hunter
(1728-1793) discovered that if a primary artery of the thigh is
temporarily compressed, blood ow in the popliteal artery can be
reduced long enough to treat the aneurysm in the popliteal fossa
surgically, with safety. What structure is indicated in the gure
below that is related to his surgical procedure?

a. Femoral artery

b. Gracilis

c. Adductor brevis

d. Femoral vein

e. Sartorius

10. A 32-year-old patient received a badly placed intramuscular injection to the posterior part of
his gluteal region. The needle injured a motor nerve in the area. Later, he had great di culty rising
to a standing position from a seated position. Which muscle was most likely a ected by the
injury?

a. Gluteus maximus
b. Hamstrings

c. Iliopsoas

d. Gluteus minimus

e. Obturator internus

LEG & FOOT I

1. A 72-year-old woman is admitted to the emergency department after an episode of stroke.

During neurologic examination the patient shows no response to the ankle re ex test. Which
of the following nerve roots is responsible for this re ex?

a. S1
b. L2

c. L5

d. L3

e. L4

2. A 62-year-old man is admitted to the emergency department. Radiologic examination and the
available data indicate the likelihood of a transient ischemic attack. During physical examination
the ankle jerk re ex is absent. Which of the following nerves is most likely responsible for the
re ex arc?

a. Super cial bular (peroneal)

b. Common bular (peroneal)

c. Super cial & deep bular (peroneal)

d. Deep bular (peroneal)

e. Tibial

3. A 55-year-old man is admitted to the hospital for an iliofemoral bypass. The operation is
performed successfully and the blood ow between the iliac and femoral arteries is restored.
During rehabilitation which of the following arteries should be palpated to monitor good circulation
of the lower limb?

a. Deep plantar

b. Dorsal metatarsal

c. Dorsalis pedis
d. Deep bular (peroneal)

e. Anterior tibial

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 4. An 18-year-old professional tennis player fell when she leaped for an overhead shot and landed
with her foot inverted. Radiologic examination in the hospital revealed an avulsion fracture of the
tuberosity of the fth metatarsal. Part of the tuberosity is pulled o , producing pain and edema.
Which of the following muscles is pulling on the fractured fragment?

a. Adductor hallucis

b. Tibialis posterior

c. Fibularis brevis
d. Fibularis longus

e. Extensor digitorum brevis

5. A 29-year-old man is brought to the physician for removal of a cast from his left leg. He had
sustained a fracture of the left lower extremity 6 weeks prior which was immobilized in a cast that
extended from just below the knee to the foot. At the time of injury, there was severe pain but
normal strength in the extremity. When the cast was removed, physical examination showed a
pronounced left foot drop with paresthesia and sensory loss over the dorsum of the left foot and
lateral leg. Injury to which nerve is the most likely cause?

a. Tibial

b. Sciatic

c. Deep bular

d. Super cial bular

e. Common bular

6. During a battle, a 19-year-old soldier is shot in the lateral aspect of the right foot by a bullet that
rico- cheted o a building. The soldier is taken to a eld hospital. A radiograph of the foot reveals
that the base of the fth metatarsal was completely obliterated. Which of the following muscles is
most likely a ected by this injury?

a. Fibularis brevis
b. Extensor hallucis longus

c. Tibialis anterior

d. Fibularis longus

e. Gastrocnemius

7. A 58-year-old woman presents to the outpatient surgery clinic for removal of varicose veins on
the medial aspect of her foot. The operation was successful however, one month later she reports
loss of sensation over the medial aspect of her leg and foot. Which of the following nerves was
most likely injured during the procedure?

a. Tibial

b. Lateral femora cutaneous

c. Saphenous
d. Obturator

e. Femoral

8. A 37-year-old unconscious man is rushed to the emergency department after being retrieved
from a motor vehicle crash. On physical examination bruising and obvious deformity is seen over
his left knee joint. Radiological studies showed a posteriorly dislocated supracondylar fracture
with severe compression of the popliteal artery. Which of the following arteries would ensure
adequate blood supply to the leg and foot in this patient?

a. Medial femoral circum ex

b. Posterior tibial artery

c. Lateral femoral circum ex

d. Anterior tibial artery

e. Fibular artery

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 9. A 58-year-old diabetic patient is admitted to the hospital with a painful foot. Physical
examination reveals that the patient su ers from peripheral vascular disease. There is no
detectable dorsalis pedis arterial pulse, but the posterior tibial pulse is strong. Which of the
following arteries will most likely provide adequate collateral supply from the plantar surface to the
toes and dorsum of the foot?

a. Fibular

b. Medial plantar

c. Arcuate

d. Anterior tibial

e. Lateral plantar

10. A 56-year-old diabetic man complains of repeated injury and ulcers to his right big toe. He
also complains that he nds it di cult maintaining his shoes because the tips of the shoes around
the toe area easily wear down. He also complains that for a while now, his rst two toes “feel
funny.” He used to enjoy playing soccer on weekends but has found it di cult to be involved.
Which of the following nerves is most likely a ected?

a. Common bular nerve injury

b. Superior gluteal nerve injury

c. Inferior gluteal nerve injury

d. Deep bular nerve injury

e. Super cial bular nerve injury

LEG & FOOT II

1. A 45-year-old man is admitted to the emergency department after a fall and subsequent leg
injury. On physical examination the patient has a foot drop but eversion is una ected. Which
nerve is most likely injured?

a. Saphenous

b. Common bular

c. Deep bular
d. Super cial bular

e. Tibial

2. A 16-year-old teenage girl su ered an inversion sprain of her ankle during dance class. Physical
examination in the clinic most likely reveals severe tender- ness over which ligament?

a. Calcaneonavicular (spring)

b. Short plantar

c. Deltoid

d. Long plantar

e. Calcaneo bular

3. A 69-year-old woman, who fell down the stairs, presents to the emergency department.
Radiologic imaging reveals a fracture of the talocrural (tibiotalar) joint. Which movements take
place at this joint?

a. Plantar exion & dorsi exion

b. Plantar exion, dorsi exion, inversion & eversion

c. Plantar exion & inversion

d. Dorsi exion & eversion

e. Inversion & eversion

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 4. A 45-year-old is admitted to the hospital after his left leg impacted a fence post when he was
thrown from a powerful four-wheel all-terrain vehicle. Radiologic examination reveals posterior
displacement of the tibia upon the femur. Which of the following structures was most likely
injured?

a. Lateral meniscus ligament

b. Anterior cruciate ligament

c. Patellar ligament

d. Lateral collateral ligament

e. Posterior cruciate ligament

5. Following the insertion of a prosthetic hip joint in a 72-year-old man, it was observed that the
patient had greatly diminished sensation in the region of distribution of the posterior femoral
cutaneous nerve. Which of the following is characteristic of this nerve?

a. Motor innervation of the obturator internus & gemelli muscles

b. Injury results in meralgia parenthetic

c. Arises from sacral spinal nerve levels S1, S2, S3

d. Cutaneous supply of the superior aspect of the gluteal region

e. Provides origin of the sural nerve

6. After being struck from behind by a motor vehicle, a 55-year-old man presents to the hospital
with a swelling of his right knee. Imaging reveals a large hematoma of the popliteal artery
compressing his tibial nerve. Upon neurologic examination which movement would likely be
diminished in strength?

a. Extension of the digits

b. Plantar exion of the foot

c. Dorsi exion of the foot

d. Flexion of the thigh

e. Extension of the leg

7. A 27-year-old man has had increasing di culty walking and complained of an area of
numbness on the dorsum of his right foot. Examination reveals a hard mass at the anterolateral
aspect of his right leg just below the knee. Imaging studies reveal a large bone tumor between the
bula and tibia that is compressing a nerve, accounting for his neurological symptoms. Which of
the following is the most likely description of abnormalities on neurological examination?

a. Weakness of exion at the knee and decreased sensation of the plantar aspect of the foot

b. Decreased/absent knee jerk re ex and decreased sensation on the medial aspect of the leg

c. Weakness of eversion at the ankle and decreased sensation between the rst and second toes

d. Weakness of inversion, dorsi exion at the ankle, and decreased sensation between the
rst and second toes

e. Weakness of plantar exion at the ankle, weakness of toe exion, decreased sensation of the
plantar aspect of the foot

8. A 16-year-old boy presents to the emergency department with a fracture of the rst and second
toes of his right foot. He received an anesthetic injection in the rst web space of his foot, to
permit easy manipulation and correction. Which nerve was blocked by the anesthesia?

a. Sural

b. Cutaneous branch of deep bular

c. Cutaneous branch of super cial bular

d. Saphenous

e. Common bular

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9. A 48-year-old man comes to the physician because of severe back pain for 2 days. The pain
radiates down to the buttock, posterior thigh, and posterolateral leg. He also has numbness on
the lateral side of his left foot. On physical examination sensation to pain is decreased over the
lateral side of the left foot. Deep tendon re exes are absent at the left ankle, and there is a
weakness of dorsi exion of the left foot. Compression of which of the following nerve roots is the
most likely cause of these ndings?

a. T2

b. S3

c. L2

d. L4

e. S1
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