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35862748 Anatomy Questions for USMLE 2 of 2

35862748 Anatomy Questions for USMLE 2 of 2

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anatomy
anatomy

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Published by: hap hazard on Dec 13, 2011
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09/10/2013

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124.Question 2 of 2A 36-year-old male office worker comes to the clinic complaining of general weaknessand shortness of breath. He also relates a rapid, throbbing pulse after climbing a flight of stairs.Which of the following correctly pertains to normal mitral valve function?
A.
The papillary muscles are rudimentary and have no major function
B.
It prevents regurgitation of blood during ventricular relaxation
C.
The chordae tendineae and papillary muscles prevent eversion of the valve cusps
D.
The papillary muscles contract to close the valve
The answer is: C
During the cardiac cycle, differential pressures between the atria and ventricles open andclose the atrioventricular valves. The papillary muscles attach the chordae tendineae tothe heart wall and provide an important dynamic mechanism to ensure the competence of the valves. During the ejection phase of ventricular systole, shortening of the papillarymuscle compensates for the decrease in the ventricular chamber size and thereby, prevents eversion of the atrioventricular valve leaflets, thereby preventing regurgitationduring ventricular systole.125.Question 1 of 5A 64-year-old man is brought into the emergency room after experiencing more than 3 hof increasing chest pain that was unrelieved by rest, antacids, or nitroglycerin. Hecomplains of nausea without vomiting. Further questioning reveals a two-year history of exertional angina pectoris (pressing chest pain that often radiated along the inner aspectof the left arm when the patient climbed one flight of stairs). Propranolol, which reducesthe response of the heart to stress, and nitroglycerin, which dilates systemic veins as wellas coronary arteries, had been prescribed previously. On physical examination he is foundto be acyanotic (normal blood oxygenation), tachypneic (rapid breathing), tachycardiac(rapid pulse rate) with a regular rhythm, and diaphoretic (sweating).This patient's tachycardia probably is mediated by reflex arcs associated with decreasedcardiac output and possibly reduced blood pressure. The visceral efferent (motor) pathway of this cardiac response is mediated by which of the following?
A.
Carotid branches of the glossopharyngeal nerves
B.
Greater splanchnic nerves
C.
Phrenic nerves
D.
Sympathetic cervical and thoracic cardiac fibers
 
E.
Vagus and recurrent laryngeal nerves
The answer is: D
The afferent limb of the cardiac reflex is mediated by the carotid branch of theglossopharyngeal nerve (CN IX) from the aortic body and sinus as well as by the vagusnerve (CN X) from the aortic body. The efferent limb, which is carried by thesympathetic division of the autonomic nervous system, mediates increases in heart rateand strength of heart beat through release of norepinephrine at the postganglionic effector site. The sympathetic cardiac accelerator fibers, affecting primarily the ventricles, arederived from the superior, middle, and inferior cervical ganglia (cervical cardiac nerves)as well as from the upper four thoracic ganglia (thoracic cardiac nerves), whence theyconverge on the cardiac plexus before reaching the heart. Parasympathetic fibers derivedfrom CN X and its recurrent laryngeal branch decrease heart rate and stroke volumethrough release of acetylcholine, principally in the vicinity of the sinuatrial node.126.Question 2 of 5A 64-year-old man is brought into the emergency room after experiencing more than 3 hof increasing chest pain that was unrelieved by rest, antacids, or nitroglycerin. Hecomplains of nausea without vomiting. Further questioning reveals a two-year history of exertional angina pectoris (pressing chest pain that often radiated along the inner aspectof the left arm when the patient climbed one flight of stairs). Propranolol, which reducesthe response of the heart to stress, and nitroglycerin, which dilates systemic veins as wellas coronary arteries, had been prescribed previously. On physical examination he is foundto be acyanotic (normal blood oxygenation), tachypneic (rapid breathing), tachycardiac(rapid pulse rate) with a regular rhythm, and diaphoretic (sweating).In angina pectoris, the pain radiating down the left arm is mediated by increased activityin afferent (sensory) fibers contained in which of the following?
A.
Carotid branch of the glossopharyngeal nerves
B.
Greater splanchnic nerves
C.
Phrenic nerves
D.
Thoracic splanchnic nerves
E.
Vagus nerve and recurrent laryngeal nerves
The answer is: D
Afferent innervation from the heart and coronary arteries travels to the cardiac plexusalong the sympathetic pathways. Once the afferent fibers pass through the cardiac plexus,they run along the cervical and thoracic cardiac nerves to the cervical and upper four thoracic sympathetic ganglia. Having traversed these ganglia, the fibers gain access (via
 
the white rami communicantes) to the upper four thoracic spinal nerves and thecorresponding levels of the spinal cord. The visceral afferent fibers associated with thevagus nerve are associated with reflexes and do not carry nociceptive information. Thegreater, lesser, and least splanchnic nerves convey visceral afferents from the abdominalregion.127.Question 3 of 5A 64-year-old man is brought into the emergency room after experiencing more than 3 hof increasing chest pain that was unrelieved by rest, antacids, or nitroglycerin. Hecomplains of nausea without vomiting. Further questioning reveals a two-year history of exertional angina pectoris (pressing chest pain that often radiated along the inner aspectof the left arm when the patient climbed one flight of stairs). Propranolol, which reducesthe response of the heart to stress, and nitroglycerin, which dilates systemic veins as wellas coronary arteries, had been prescribed previously. On physical examination he is foundto be acyanotic (normal blood oxygenation), tachypneic (rapid breathing), tachycardiac(rapid pulse rate) with a regular rhythm, and diaphoretic (sweating).The patient is admitted to a coronary care unit for tests and observation. Anelectrocardiogram reveals a pattern consistent with a small ventricular posteroseptalinfarct from ischemic necrosis that resulted from inadequate blood supply. In the diagramof a normal heart shown below, the coronary artery most likely to be involved in a posteroseptal infarct (as in this patient) is indicated by which letter?
A.
A
B.
B
C.
C
D.
D
E.
E
The answer is: D
The artery labeled D in the diagram accompanying the question represents the posterior 

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