NBME Anatomy Review Sylvia Nelsen, Ph.D. March 19, 2015
UPPER & LOWER LIMBS
1. What is the most likely diagnosis in this case? A. Rotator cuff tendinitis: pain w/o weakness B. Adhesive capsulitis: absolute loss of ROM C. Subcapsular bursitis: pain localized to upper back D. Rotator cuff tear: pain & weakness
2. Which of the rotator cuff muscles does NOT rotate the humerus? A. Supraspinatus m. B. Infraspinatus m. C. Teres minor m. D. Subscapularis m. Attachments? Innervation? Theime
1. What is the most likely explanation for the patient s presentation? A. Upper brachial plexus palsy B. Ulnar nerve mononeuropathy C. Lower brachial plexus palsy D. T1 radiculopathy E. Radial nerve mononeuropathy 452N5 If mononeuropathy, which nerve? H9.4.2
2. Which of the following BEST describes the region of sensory deficit? A. Medial arm, forearm, and hand B. Anterior and posterior arm and forearm C. Anterior forearm and palmar surface of hand D. Lateral arm, forearm, and hand E. Posterior forearm and dorsal surface of hand 401N5
1. Which nerve is most likely affected? A. Fibular n. B. Obturator n. C. Genitofemoral n. D. Femoral n. E. Tibial n. 526N5
2. Which of the following BEST describes the region of sensory deficit? A. Anterior and posterior thigh B. Lateral thigh, leg, and foot C. Anteromedial thigh, medial leg and foot D. Posterior leg and plantar surface of foot E. Anterior leg and dorsal surface of foot 526N5
3. The patient s lower limb hematoma is located in the region of the femoral triangle. Which of the following structures would NOT be found in the femoral triangle? A. Inguinal lymph nodes B. Lateral circumflex femoral artery C. Femoral vein D. Femoral branch of the genitofemoral n. E. Pectineus m. 492N5 526N5
THORAX
1. What is the most likely cause of the patient s chest pain? A. Myocardial infarction B. Plueritis C. Pneumothorax D. Costochondritis E. Pericarditis
2. Which type of nerve innervates the intercostal space? A. Dorsal ramus B. Dorsal root C. Spinal nerve D. Ventral ramus E. Ventral root 174N5
3. Which of the following arteries is the LEAST likely to supply blood to the intercostal space? A. Subclavian a. B. Internal thoracic a. C. Inferior epigastric a. D. Musculophrenic a. E. Axillary a. 415N5 184N5
1. Which area of the heart is affected by this obstruction? A. Posterior interventricular septum B. SA node C. Anterior right ventricle D. Left atrium From which vessel does the LAD originate? 211N5
2. Which of the following is NOT typically a branch of the RCA? A. Circumflex branch B. SA nodal branch C. Right marginal branch D. Posterior interventricular branch (PDA)
3. During which part of the contraction cycle do coronary arteries fill? A. Late systole B. Isovolumetric ventricular contraction C. Diastole D. Early systole 218N5
1. Which of the following nerves would be LEAST at risk for injury by a stab wound to the thorax? A. Cardiac and pulmonary plexuses B. Recurrent laryngeal n. C. Phrenic n. D. Vagus n. E. Lesser splanchnic n. 220N5 225N5
2. Which of the following is NOT a major vein of the thorax? A. Azygos v. B. Cephalic v. C. Posterior intercostal vv. D. Internal thoracic v. E. Brachiocephalic v. 186N5
3. Lymph from which of the following regions drains to the thoracic duct? A. Right upper limb B. Right side of the head C. Right lower limb D. Right breast E. Right side of the neck
ABDOMEN
1. The bullet likely damaged retroperitoneal structures. Which of the following structures is NOT retroperitoneal? A. Suprarenal glands B. Ascending colon C. Rectum D. Sigmoid colon E. Aorta/IVC 2665
2. Which of the following organs does NOT supply the splenic vein? A. Stomach B. Cecum C. Rectum D. Pancreas E. Spleen 289N5
3. The bullet penetrated the anterolateral abdominal wall. Which series of layers is correctly listed, superficial to deep (not necessarily adjacent)? A. Scarpa s fascia, transversalis fascia, internal oblique m., parietal peritoneum B. Transversalis fascia, camper s fascia, transversus abdominis m., parietal peritoneum C. Camper's fascia, external abdominal oblique m., internal abdominal oblique m., transversalis fascia D. Camper s fascia, transversus abdominis m., internal abdominal oblique m., extraperitoneal fat E. Scarpa s fascia, internal abdominal oblique m., extraperitoneal fat, transversalis fascia
4. The bullet penetrated the skin. Which of the following is NOT a histological layer of the epidermis of thin skin? A. Stratum lucidum B. Stratum corneum C. Stratum basale D. Stratum spinosum E. Stratum granulosum http://faculty.cord.edu/todt/336/lab/integument/scalp/scalp6.htm http://upload.wikimedia.org/wikipedia/commons/4/4d/epidermal_layers.svg
1. What is the most likely diagnosis? A. Tumor firm on palpation B. Varicocele dilated veins of the pampiniform plexus (left side) C. Hydrocele transilluminated under light (others are not)
2. Which of the following structures is NOT a boundary of the Hesselbach triangle? A. Rectus abdominis muscle B. Internal abdominal oblique muscle C. Inguinal ligament D. Inferior epigastric vessels
3. What is the primary distinguishing characteristic of the two major types of this condition? A. Indirect hernias are typically reducible, direct are not B. Indirect hernias are found only in children, direct in adults C. Indirect hernias do not involve intestines, direct do D. Indirect hernias pass through the inguinal canal, direct do not
4. Which of the following is NOT found within the normal spermatic cord? A. Artery to ductus deferens B. Pampiniform plexus of veins C. EAO aponeurosis (renamed) D. Genital branch of genitofemoral nerve E. Transversus abdominis muscle (renamed) 4.47GAS
Diagnosis? 1. Which of the following arteries is NOT a major branch of the aorta below the diaphragm? 2 1 A. Superior phrenic arteries B. Middle suprarenal arteries C. Gonadal arteries D. Inferior mesenteric artery 2 2 2 2 8 Renal arteries 1 1 1 2-1-2-1-2, 2-1-2-1, 8 4.148GAS
Diagnosis? 2. In which of the following layers of a muscular artery would you find smooth muscle? A. Tunica intima B. Tunica media C. Tunica adventitia http://bcrc.bio.umass.edu/courses/spring2012/biol/biol523/category/tissue/muscle?page=2
1. Which organ is most likely injured in this case? A. Spleen B. Liver C. Pancreas D. Stomach E. Left kidney 4.166GAS2
2. What surface anatomy landmark corresponds to the location of the spleen? A. Posterior ribs 9-11 B. Inferior to costal margin C. Anterior ribs 10-12 D. Transumbilical plane Spleen 4.168GAS2
3. Where is the most common site of referred pain in this injury? A. C1-C3 dermatomes B. C3-C5 dermatomes C. T2-T4 dermatomes D. T9-T11 dermatomes 159N5
HEAD & NECK
1. Care must be taken during thyroidectomy not to remove all functioning parathyroid gland tissue. How many parathyroid glands are there? A. One B. Two C. Three D. Four E. Five Embryologic origin? 76N5
2. Which one of the following muscles would you be LEAST likely to encounter during a routine thyroidectomy? A. Platysma B. Sternothyroid C. Thyrohyoid D. Sternyhyoid 28N5
3. Which nerve in this region is particularly at risk during thyroidectomy? A. Recurrent laryngeal n. B. Vagus n. C. Sympathetic trunk D. Superior laryngeal n. 76N5
1. Which nerve relays the painful sensation in this patient? A. Mandibular n. B. Ophthalmic n. C. Facial n. D. Maxillary n. What infectious agent? 2N5
2. What is the characteristic distribution pattern of this condition? A. Follows territory of cutaneous nerve B. Follows territory of myotome C. Follows territory of dermatome 76N5
MORE CASES: ANATOMY & EMBRYOLOGY