1) A patient has a tumor, located posterior to the root of the lung, that is compressing a

nerve. Which of the following is most likely to be affected in this patient due to the
compression of this nerve?
A) Contraction of the diaphragm
B) Stabilization of the thoracic wall during respiration
C) Slowing down the heart rate

2) A patient presents in the Emergency Department with a stab wound in the left 5th
intercostal space. The knife entered 2cm lateral to the body of the sternum and penetrated
4cm deep. Which of the following structures is most likely to be injured?
A) Left Ventricle
B) Right Ventricle
C) Right Atrium
D) Left Atrium
3) A patient is diagnosed with diminished sympathetic innervation in the T6 dermatome
due to compression of the nerve indicated by the star. Which of the following describes
the location of the postganglionic sympathetic cell bodies that are associated with this
pathway?
A) Dorsal root ganglia
B) Lateral horn of the spinal cord
C) Prevertebral ganglia
D) Paravertebral ganglia

4) A patient arrives in the Emergency Department with a puncture wound through the
manubrium caused by running with a pair of scissors. Which of the following structures
is most likely to be struck first by the blade?
A) Thymus
B) Trachea
C) Esophagus
D) Left brachiocephalic vein
E) Left common carotid artery
5) A patient arrives in the Emergency Department
complaining of difficulty breathing. After viewing
this X-ray of the patient, taken during inspiration, you
suspect there is a nerve injury. Which of following
structures is most likely to be affected as a result of
this injury?
A) Right main bronchus
B) Right parietal pleura
C) Right ventricle

6) A patient presents with complaints of anxiety and an elevated heart rate. Where are the
postganglionic cell bodies located that are responsible for her increased heart rate?
A) Wall of the heart
B) Lateral horn of the thoracic spinal cord
C) Upper thoracic and cervical paravertebral ganglia

7) A patient presents in the Emergency Department with hemorrhaging caused by a knife

wound in the posterior aspect of the 7th intercostal space. From which of the following
vessels does the injured artery originate?
A) Subclavian artery
B) Ascending aorta
C) Thoracic aorta
D) Internal thoracic artery

8) You are observing an autopsy after a suspicious death. The medical examiner suspects
that the cause of death is a poison that is primarily absorbed in the ileum. Which of the
following anatomical features will help the medical examiner identify the ileum for
further examination?
A) Plicae circulares
B) Long vasa recta (straight arteries)
C) Multiple arcades in the mesentery
D) Teniae coli
9) An intercostal nerve is accidentally severed during thoracic surgery. If the injury
occurs at the location indicated by the star in the illustration below, which of the
following fiber types will be affected?

A) Preganglionic parasympathetic
B) Preganglionic sympathetic
C) Postganglionic parasympathetic
D) Postganglionic sympathetic

10) A patient presents in the Emergency Department with severe bronchoconstriction

brought on by an anaphylactic reaction to a bee sting. Where are the postganglionic cell
bodies located that are responsible for bronchoconstriction?
A) Wall of the lung
B) Upper thoracic paravertebral ganglia
C) Ventral horn of the spinal cord
D) Brain

11) A patient is complaining of vocal hoarseness that has been present more than four
months and is unresponsive to over-the counter-medications. You suspect a nerve has
been injured. Which of the following additional structures is most likely to be affected
by this injury?
A) Fibrous pericardium
B) Diaphragm
C) Blood vessels in the skin
D) Heart
12) A patient arrives in the Emergency Department complaining of difficulty breathing
after a car accident. You suspect a rib fracture. Which part of the rib is most susceptible
to fracture?
A) Tubercle
B) Angle
C) Head

13) A patient presents in the Emergency Department with pain along the costal margin.
Which of the following structures is most likely to be causing these symptoms?
A) Superior duodenum
B) Horizontal duodenum
C) Ascending duodenum

14) A surgeon is performing a partial lung resection. During the surgery, she cuts a
segmental bronchus and the vessel that runs parallel to it. Which of the following best
describes the contents of the vessel?
A) Oxygen rich blood from the thoracic aorta
B) Oxygen poor blood to the pulmonary vein
C) Oxygen rich blood from the pulmonary artery
D) Oxygen poor blood from the right ventricle

15) A patient presents with an indirect inguinal hernia. Your attending physician asks you
to review the characteristics of an indirect inguinal hernia and the descent of the gonads.
Which of the following structures passes through the deep inguinal ring?
A) Medial umbilical ligament
B) Round ligament of the uterus
C) Inferior epigastric artery

16) A patient receives a diagnosis of ischemic bowel after arriving in the Emergency
Department with acute abdominal pain. Blood flow is found to be obstructed in several
branches of the inferior mesenteric artery. Which of the following structures is most
likely to be affected?
A) Hepatic flexure
B) Ascending colon
C) Descending colon
17) A patient has stage 3 cancer of an organ that is supplied by an artery that branches off
of the aorta at the level of the L1 vertebra. A biopsy of which lymph nodes is most likely
to show metastases?
A) Superior mesenteric lymph nodes
B) Celiac lymph nodes
C) Inferior mesenteric lymph nodes

18) A patient arrives in the Emergency Department experiencing difficulty breathing. A

subsequent X-ray of the thorax indicates a pleural effusion. Which of the following is the
safest location to perform thoracentesis to extract the excess fluid?
A) Posterior aspect of the 5th intercostal space
B) Anterior aspect of the 6th intercostal space
C) Posterior aspect of the 8th intercostal space
D) Lateral aspect of the 10th intercostal space

19) A patient complains of numbness in the C1 dermatome and corresponding weakness

in the C1 myotome. You suspect the C1 spinal nerve may be injured or compressed as it
exits the vertebral canal. Which of the following options best describes the position of the
affected C1 spinal nerve?
A) Inferior to the skull
B) Inferior to the C1 vertebra
C) Inferior to the C2 vertebra

20) Your patient complains of numbness in the area indicated by the dot. Upon
examination, a pinprick test does not elicit any pain. He also notes a lack of sweating in
the same area. Which of the following locations is the most likely site for the lesion?
A) Spinal nerve of T11
B) Ventral root of T12
C) Ventral ramus of T9
D) Dorsal root of T11
21) A patient arrives in the Emergency Department with abdominal pain and testing
reveals the presence of an infection in the gallbladder. Which of the following lymph
nodes will be the first to receive lymph from this structure?
A) Superior mesenteric
B) Lumbar
C) Inferior mesenteric
D) Celiac

22)You are treating a patient with a superficial cut at the location indicated by the line.
The cut has become infected. Lymph from this location will drain directly to which of the
following nodes?
A) Axillary
B) Superficial inguinal
C) Celiac
D) Lumbar

23) Your patient has been diagnosed with an indirect inguinal hernia that has entered the
scrotum. The most superficial fascial layer that covers the herniating intestines and
spermatic cord is derived from which of the following structures?
A) External oblique aponeurosis
B) Transversalis fascia
C) Internal oblique aponeurosis
D) Transversus abdominis aponeurosis

24) A patient arrives in the Emergency Department and is diagnosed with a blockage in
the inferior vena cava. The venous blood in the inferior epigastic veins must now return
to the heart via the:
A) Paraumbilical veins
B) Superior vena cava
C) Superficial epigastric veins
25) A patient arrives in the Emergency Department after fracturing the lower thoracic
vertebrae. You suspect that the thoracic splanchnic nerves have also been injured. Which
of the following types of fibers are located in the thoracic splanchnic nerves?
A) Preganglionic parasympathetic
B) Postganglionic parasympathetic
C) Preganglionic sympathetic
D) Postganglionic sympathetic

26) A cardiothoracic surgeon severs a vessel in the lung that is located intersegmentally
(between bronchopulmonary segments). Which of the following options correctly
identifies the vessel and the level of oxygen in the blood that it carries?
A) Pulmonary vein, oxygen poor
B) Pulmonary artery, oxygen poor
C) Pulmonary vein, oxygen rich
D) Pulmonary artery, oxygen rich

27) A patient arrives in the Emergency Department with a gunshot wound in the posterior
thorax. The bullet entered 2cm to the left of the vertebral column, at the level of the T6
vertebra. Which of the following chambers of the heart is most likely to be struck first?
A) Left atrium
B) Left ventricle
C) Right atrium
D) Right ventricle

28) You are performing a coronary bypass surgery. As you cut through the pericardium,
the scalpel slips and you sever a nerve that travels inferior to the arch of the aorta. Which
of the following types of fibers are most likely to be affected by this injury?
A) Somatic motor
B) Preganglionic parasympathetic
C) Preganglionic sympathetic
D) Postganglionic parasympathetic

29) A man presents in the Emergency Department with a myocardial infarction in the
posterior aspect of the interventricular septum. Which of the following arteries is most
likely to be occluded?
A) Circumflex
B) Left anterior descending
C) Right coronary
D) Right marginal
30) A patient presents with chest pain. During auscultation, you hear a pericardial friction
rub. The patient is most likely to be suffering from which of the following conditions?
A) Cardiac tamponade
B) Myocardial infarction
C) Pericarditis

31) A man presents with sharp pain in his chest during elevated activity and deep
inspiration. The nerves that transmit this type of sensation have cell bodies that are
located in which of the following locations?
A) Dorsal root ganglia
B) Paravertebral ganglia
C) Ventral horn of the spinal cord
D) Lateral horn of the spinal cord

32. A patient arrives in the Emergency Department with a stab wound through the
xiphisternal joint. Which of the following structures is most likely to be injured?
A) Right ventricle
B) Left ventricle
C) Right atrium
D) Left atrium

33) A patient presents with a lack of sweat in the skin along the spine. Which of the
following best describes the pathway that innervates the sweat glands in this region?
A) Lateral horn → ventral ramus → spinal nerve → ventral root → white
ramus communicans → paravertebral ganglion → gray ramus
communicans → dorsal ramus → body wall
B) Lateral horn → ventral root → spinal nerve → ventral ramus → white
ramus communicans → paravertebral ganglion → gray ramus
communicans → dorsal ramus → body wall
C) Lateral horn → ventral root → spinal nerve → ventral ramus → white
ramus communicans → paravertebral ganglion → gray ramus
communicans → ventral ramus → body wall

34) During fetal circulation, oxygen rich blood bypasses the liver via which of the
following structures?
A) Ligamentum venosum
B) Ductus venosus
C) Ligamentum arteriosum
D) Umbilical artery
E) Ligamentum teres
35) A 5-month-old girl presents with a heart murmur that is caused by the failure of a
fetal shunt to close between the pulmonary trunk and the arch of the aorta. Which of the
following structures has failed to close in this patient?
A) Ductus arteriosus
B) Ligamentum arteriosum
C) Foramen ovale
D) Fossa ovalis

36) A patient requires a nerve block to be administered in the 3rd intercostal space. Which
of the following locations is the best target or targets for the injection of anesthetic in this
patient?
A) The center of the 3rd intercostal space, avoiding the superior and
inferior margins of the adjacent ribs
B) The superior and inferior margins of the 3rd rib
C) The inferior margin of the 2nd rib and the superior margin of the 3rd rib
D) The inferior margin of the 3rd rib and the superior margin of the 4th rib

37) A patient is diagnosed with a tumor that is compressing the greater thoracic
splanchnic nerve. Which of the following structures is most likely to be affected?
A) Jejunum
B) Diaphragm
C) Sigmoid colon
D) Bronchi

38) You are treating a patient with a stomach ulcer. Which of the following best describes
the pathway for lymphatic drainage from the stomach?
A) Superior mesenteric lymph nodes → thoracic duct → left venous angle
B) Superior mesenteric lymph nodes → chyle cistern → thoracic duct →
right venous angle
C) Celiac lymph nodes → thoracic duct → chyle cistern → left venous
angle
D) Celiac lymph nodes → chyle cistern → thoracic duct → left venous
angle

39) A surgeon is making an incision 5cm inferior to the umbilicus. Which of the
following correctly describes the fascial layers at this location from superficial to deep?
A) Skin, Scarpa fascia, Camper fascia, transversalis fascia, deep investing
fascia
B) Skin, Camper fascia, Scarpa fascia, deep investing fascia, transversalis
fascia
C) Skin, Scarpa fascia, Camper fascia, deep investing fascia, transversalis
fascia
D) Skin, Camper fascia, Scarpa fascia, transversalis fascia, deep investing
fascia
40) A patient arrives in the Emergency Department with a stab wound. The knife entered
the posterior abdominal wall and struck a primarily retroperitoneal organ. Which of the
following structures is most likely to be injured?
A) Liver
B) Adrenal gland
C) 1st part of the duodenum
D) Head of the pancreas

41) During a spinal tap procedure, the dorsal root of the T3 spinal nerve was accidentally
injured. Which of the following deficits is most likely to be observed in this patient?
A) Sensory deficits in the T3 dermatome
B) Motor deficits in the T3 myotome
C) Motor deficits in the T3 myotome and sensory deficits in the T3 dermatome

42) A patient sustains a neck injury that affects the right phrenic nerve. Which of the
following is most likely to occur in this patient?
A) A thoracic x-ray with a raised (undescended) left hemidiaphragm during
inspiration
B) A thoracic x-ray with a flattened (descended) right hemidiaphragm during
inspiration
C) Diminished sensation from the right parietal pleura
D) Diminished sensation from the visceral layer of the serous pericardium

43) A gastroenterologist is performing a transendoesophogeal ultrasound (where an

ultrasound wand is inserted into the esophagus) on a patient to better visualize the heart.
Which of the following chambers of the heart lies immediately anterior to the esophagus?
A) Left atrium
B) Right atrium
C) Left ventricle
D) Right ventricle
44) During angiography, a blockage is discovered in the artery indicated by the star.
Which of the following veins accompanies this artery?
A) Great cardiac
B) Small cardiac
C) Middle cardiac

45) During a surgical procedure, a secondarily retroperitoneal organ is mobilized to

access its arterial supply. Which of the following structures is secondarily
retroperitoneal?
A) Gall bladder
B) Liver
C) Pancreas
D) Superior duodenum

46) A blockage has developed in an artery that travels anterior to the horizontal part of
the duodenum. Which of the following structures is most likely to be affected by this
blockage?
A) Appendix
B) Spleen
C) Stomach
D) Sigmoid colon
47) An interventional radiologist is performing a procedure. She has just accessed the
celiac trunk via a catheter. What are the three main branches of the celiac trunk?
A) Left gastric, short gastric, common hepatic
B) Left gastric, splenic, proper hepatic
C) Left gastric, splenic, common hepatic
D) Right gastric, splenic, common hepatic

48) A child arrives in the Emergency Department with difficulty breathing. You suspect
the child has inhaled something, which is now blocking his airway. Which of the
following statements correctly describes the most likely site for objects to lodge and the
anatomical features making it so?
A) left main bronchus, because it is wide and more vertically inclined.
B) left main bronchus, because it is narrow and therefore things are more
likely to get stuck there.
C) right main bronchus, because it is wide and more vertically inclined.
D) right main bronchus, because it is narrow and therefore things are more
likely to get stuck there.

49) A patient has a blockage in the artery that supplies the anterior wall of the left
ventricle. The occluded artery is most likely to be which of the following?
A) Posterior interventricular
B) Right marginal
C) Left anterior descending

50) A man is moving into a new house and during the process lifts a large chest of
drawers. As he lifts, he feels a severe pain in the right lower quadrant of his abdomen. He
finds that he can no longer lift without pain and the next day goes to see his physician.
Surgery is indicated, and during the surgery the surgeon opens the inguinal region and
finds a hernial sac with a small knuckle of intestine that initially passed through the
abdominal wall just superior to the inguinal ligament and lateral to the inferior epigastric
vessels. What type of hernia is the patient suffering from?
A) direct inguinal hernia
B) hiatal hernia
C) indirect inguinal hernia
51) A patient presents with reflux and is diagnosed with a hiatal hernia. Which of the
following additional deficits may also be present in this patient as a result of this hernia?
A) Irritation of the parietal pleura
B) Diminished peristalsis
C) Diminished constriction of the GI vessels

52) You are making a suprapubic incision when you realize that you’ve cut too deep
through the anterior abdominal wall and can now see abdominal organs. Which of the
following statements explains why this is more likely to happen in this particular
location?
A) The aponeuroses of the external oblique, internal oblique and
transversus abdominis are thinner inferior to the arcuate line
B) Inferior to the arcuate line, only the transversalis fascia and parietal
peritoneum lie deep to rectus abdominis
C) Inferior to the arcuate line, the aponeurosis of the internal oblique splits
to form part of the anterior and posterior layers of the rectus sheath
53) You are observing a gastric bypass operation when the surgeon asks you to identify
the blood vessel that is indicated by the star. Which of the following statements about this
vessel are true?
A) It supplies the lesser curvature of the stomach
B) It gives rise to the short gastric arteries
C) It anastomoses with the right gastric artery

54) A patient presents in the Emergency Department with severe shortness of breath. It is
determined that he is suffering from a blockage of his LAD and a consequent myocardial
infarction. Where might he experience referred pain?
A) Inferior to the costal margin
B) Along the medial aspect of his left arm
C) Near the umbilicus