Name  

Date  

SPRING 2020 T1 EXAM REVIEW Score  

1. A 47-year-old woman goes to the doctor for a timely mammogram. On evaluation the doctor
feels a lump in the lower lateral quadrant of the patient’s right breast. Since breast cancer
commonly metastasizes through lymphatic tissue, a mastectomy is performed along with the
removal of the sentinel lymph node. Which lymph node was removed in this case?
A Central node

B Axillary node

C Lateral node

D Parasternal node

E Anterior node

2. A 3-year-old boy presents to his pediatrician for

evaluation of a hand deformity. Physical examination
showed that the patient had only 4 digits on his right
hand, but X-ray shows that the bones of digits 3 and 4
were fused together. Which of the following is the cause
of this deformity?
A Failure of the webs to degenerate

B Disruption of the anteroposterior pattern

C Failure of development of notches between digital rays

D Suppression of limb bud development

E Disruption of limb development in week 5

3. A 40-year-old female comes to her physician for evaluation of right ankle pain. The patient
reports that she was outside when she accidently tripped off the curb and twisted her ankle.
X-ray shows an inversion injury to her right ankle. Which of the following ligaments is the most
likely to be injured?
A Posterior talofibular

B Tibiocalcaneal

C Posterior tibiotalar

D Anterior tibiotalar

E Anterior talofibular

F Tibionavicular
4. A group of medical students are investigating a layer of the epidermis. They notice that the
cells in this layer gradually change their appearance as they move closer to the surface. One
student mentions that she has spotted multiple Langerhans cells in this layer. Another student
says that there are slight thickenings between adjacent cells. What is this student observing?
A Merkel’s cells

B Node of bizzozero

C Keratin filaments

D Hemidesmosomes

E Melanin filaments

5. A 63-year-old man comes to the emergency department with severe

knee pain. The patient has a history of severe arthritis. X-ray shows
that the patient had degeneration of the joints of his lower limbs.
Physical examination shows that the patient’s knees touched. Which
of the following is the correct terminology explaining the patient’s
condition?
A Coxa Varus

B Genu Varus

C Genu Valgus

D Coxa Valgus

E Hallux valgus

6. A 32-year-old woman came to her physician to have her cast removed. She sustained a
fracture to her right leg 8 weeks ago. At the time of the injury, the patient had severe pain, but
normal sensation and strength. After removal of the cast a physical exam was performed. The
exam showed intact muscular function and vascular supply, but sensory deficits in the webbed
space between digits 1 and 2. Which of the following nerves was most likely compressed
causing the patient’s symptoms?
A Common Fibular

B Superficial fibular

C Deep fibular

D Sciatic

E Tibial
7. A 6-year-old boy is brought to the clinic by his mother for the
appearance of blisters on his arms. Upon physical
examination the physician palpates the blisters, but they do
not rupture. The physician orders a histological sample, the
image is attached. Antibodies against what membrane
structure is the cause of this patient’s symptoms?
A Desmosomes

B Connexons

C Zonula adherens

D Tight junctions

E Hemidesmosomes

8. A 62-year-old woman comes to the hospital complaining of a progressing illness for the past 4
weeks and a sharp pain on inspiration that has been felt for the last couple days. The doctor
orders an x-ray and confirms a pleural effusion in the costodiaphragmatic space secondary to
pneumonia. The doctor prescribes an antibiotic for the pneumonia and performs a
paravertebral thoracostomy to relieve the patient’s symptoms. Where is the location that this
procedure is performed?
A Between T6T8 superior border of the thoracic rib

B Between T6T8 inferior border of the thoracic rib

C Between T8T10 superior border of the thoracic rib

D Between T8T10 inferior border of the thoracic rib

E Between T10T12 superior border of the thoracic rib

F Between T10T12 inferior border of the thoracic rib

9. A 56-year-old woman with multiple sclerosis comes to the physician with progressing
symptoms affecting her ability to walk. The doctor prescribes 4-aminopyridine to slow down
the progression of her disease. The drug induced presynaptic voltage-gated calcium channels
to remain open for a longer period of time, which stimulates a greater release of acetylcholine
into the synaptic cleft. Which of the following has a similar mechanism?
A Latrotoxin

B Botulinum Toxin

C Lambert-Eaton Myasthenic Syndrome

D Myasthenia Gravis

E Tubocurarine
10. A 25-year-old girl comes into the emergency room complaining of trouble breathing. Albuterol
is given by the doctor to facilitate the relaxation in smooth muscle, allowing her to breathe
unhindered. A decrease in which of the following substances can account for the increased
sensitivity to calcium in smooth muscles during the asthma attack?
A Actin

B Adenosine Triphosphate

C Calcium-calmodulin complex

D Calmodulin

E Myosin light chain phosphatase MLCP

11. A researcher is studying a specific cell found in the integument. This cell type could migrate to
lymph nodes and present an antigen to T-lymphocytes. It is commonly known for its
immunological function and it expresses both major histocompatibility complexes I & II on its
plasma membrane surface. What is a characteristic feature of the cell type that this researcher
is studying?
A Neurosecretory granules

B Produces vitamin D

C Secretes histamine

D Birbeck granules

E Desmosomal junctions

12. A 30-year-old man visits the physician because he has been having trouble performing simple
tasks. His wife has noticed he has had trouble remembering things and has began to act oddly.
Family history reveals that the patient’s father suffers from a neurodegenerative disorder for
which he was diagnosed at 55. The physical exam demonstrates occasional choreatic
movements of the upper left limb. What genetic phenomenon explains the earlier presentation
in this patient?
A Loss of function

B Haploinsufficiency

C Repeat shrinkage

D Formation of a fragile site

E Anticipation
13. A 46-year-old man comes to a doctor with health concerns relating to his weight. He is 350
pounds with a BMI of 31 30 is obese). The doctor recommends implementing light exercise
into his diet. He goes for a walk around the park the following day. What is the primary energy
source utilized by his muscles to regenerate ATP during his walk?
A Free Fatty Acids

B Glucose

C Phosphorylcreatine

D Lactic Acid

E Amino Acids

14. A 43-year-old woman is brought to the emergency room following a car crash where she
sustained a large penetrating injury to her upper chest 45 minutes ago. She is bleeding
profusely from the wound, skin is cold to the touch, and she appears lethargic. Blood pressure
is 50/35 mmHg, pulse is 140/min. Emergency surgery is performed and the surgeon identifies
a large laceration to the second part of the axillary artery. He clamps the proximal end of the
axillary artery knowing that there is collateral blood supply to supply the arm. Through which
space will the anastomosing artery travel?
A Quadrangular Space

B Triangular Space

C Triangular Interval

D Radial Groove

E 1st intercostal Space

15. A 6-year-old girl was brought to the Emergency department due to

elbow pain after falling in the playground. Physical exam showed
weakness at the wrist. XRays were taken and the results are
demonstrated to the right. Which of the following muscles would
most likely show weakness on examination?
A Flexor carpi ulnaris

B Adductor Pollicis

C Biceps Brachii

D Abductor pollicis brevis

E Abductor pollicis longus

16. A 6-year-old boy is brought to the pediatric clinic by his
parents after complaining of aching in his leg for the past
month. Physical examination shows decreased mobility,
weakness, and bowing of the legs but no other abnormalities.
The patient has no complaints of hair loss. The physician
orders a serum test and the patient has the following lab
reports. What is most likely the underlying cause of this
patient’s symptoms?
A Decreased exposure to sunlight

B Vitamin D resistant rickets

C Hyperparathyroidism

D Hypoparathyroidism

E Hyperphosphatemia

17. A 29-year-old pregnant woman is brought to the emergency room to delivery her baby. The
physician measures the patient’s interspinous diameter and concludes it is too small to deliver
the baby. The woman is rushed to the operating room for a cesarean section. Which of the
following abdominal incisions will be performed by the surgeon during this procedure?
A Median

B McBurney’s Point

C Kocher

D Pfannenstiel

E Linea Semilunaris

18. A 32-year-old man comes to the physician because of weakness in his right arm for the past 2
weeks following participation in a martial arts competition. Vital signs are within normal limits.
Physical examination shows weakness of grasp and wrist drop. There is also a slight radial
deviation when asked to extend his wrist. Sensation over the affected limb is intact. What is
the most likely affected nerve?
A Recurrent branch of the median

B Median

C Ulnar

D Posterior Interosseous

E Anterior Interosseous
19. A 17-year old boy was brought into the emergency department after falling off his bicycle.
When he landed on the right side of his face, putting his neck in extreme extension. Physical
examination revealed that the upper limb was in an adducted, extended and medially rotated
position. Which of the following combination of nerves was most likely injured?
A Axillary, Suprascapular and Median

B Suprascapular, Axillary and Musculocutaneous

C Median, Axillary and Ulnar

D Dorsal Scapular, Suprascapular and Median

E Ulnar and Median

20. A 42-year-old man is brought to the physician by his wife

after a progressive decline of cognitive ability. His wife
explains that he has not been able to work and is losing his
ability to speak. The patient’s father suffered from similar
symptoms and passed away soon after. A computerized
tomography of the patient’s brain B is compared with the
brain of a healthy patient A. Which of the following is most
likely the genetic mechanism explaining the disorder in this
patient?
A CTG trinucleotide repeat expansion

B X-linked inheritance

C Repeat expansion in an intron

D Polyglutamine tract expansion

E Global changes in RNA processing

21. A 2-month-old infant is brought to the doctor by his mother with concerns of an enlarged
scrotum. Transillumination of the affected area is positive. The doctor confirms it is a
communicating hydrocele due to the incomplete obliteration of an abdominal layer during the
formation of the spermatic cord. Which of the abdominal layers is the derivative for the internal
spermatic fascia of the spermatic cord?
A Transversalis Fascia

B Internal Oblique Aponeurosis

C Parietal Peritoneum

D External Oblique Aponeurosis

E Dartos Fascia
22. A 36-year-old woman comes to the physician because she noticed a lump in her left breast on
self-examination two days ago. Vitals are within normal limits. Physical examination shows
dimpling of the skin of the left breast with preservation of the areola. Which of the following is
the most likely underlying cause of this patient’s condition?
A Infection of the lactiferous ducts

B Metaplasia of the breast epithelium

C Deterioration of the pectoral muscle

D Retraction of the suspensory ligaments

E Obstruction of the lymphatic channels

23. A 50-year-old female comes to the emergency department due to upper neck and back pain. A
diagnosis of cervical vertebral canal stenosis is made. The physician wants to perform a
laminectomy of two cervical vertebrae. Which of the following ligaments will most likely be
removed?
A Anterior longitiudinal

B Denticulate

C Ligamentum flavum

D Nuchal ligament

E Arachnoid Mater

24. A 13-year-old boy who has had several broken bones over the years is brought to the
physician by his parents. Physical examination shows a bluish tinge of the patient’s sclera.
Genetic tests show that he has a loss of expression in COL1A1 leading decreased amounts of
procollagen being produced. Which of the following is most likely the genetic mechanism
explaining the pathology in this patient?
A Dominant negative

B Loss of function

C Haploinsufficiency

D Multifactorial

E Anticipation
25. A 39-year-old man is admitted to the hospital with an indirect inguinal hernia. The size of the
herniated intestine is too big for laparoscopic release and an open hernia repair is performed. A
nerve emerging from the superficial ring was damaged during surgery. Which of the following
symptoms most likely resulted from the surgical mistake?
A Loss of sensation to the skin of the suprapubic region

B Loss of sensation to the posterior perium

C Loss of sensation to the skin of anterior and lateral thigh

D Loss of function of the adductor muscles

E Loss of sensation to the skin of the anterior scrotum

26. A 29-year-old woman G2P1 delivered a male infant at 37 weeks

via an uncomplicated vaginal birth. The infant has an APGAR
score of 8 and 9 after 5 and 10 minutes respectively. Physical
examination reveals digital adherence. An X-ray image
representing the abnormality seen in this child is demonstrated.
Which of the following abnormalities is most likely the cause of
the physical exam findings?
A Cutaneous syndactyly

B Congenital Talipes

C Osseous syndactyly

D Polydactyly

E Ectrodactyly

27. A 65-year-old comes to the emergency department with lower back and abdominal pain.
Physical examination also revealed peripheral edema of the lower limbs. A CT scan revealed
that the patient had a complete occlusion of her inferior vena cava at the L2 vertebral level.
Which of the following veins will most likely act as collateral pathways for blood to flow from
the lower to upper parts of the body?
A Left common iliac

B Hemiazygous

C Left gastric

D Ascending lumbar

E Left renal
28. A 3-year-old boy was brought to the pediatrician for a routine exam. Physical exam reveals a
child in the 25th percentile for height and a BMI of 21. It is noted that the child has short limbs
with a relatively normal torso. Genetic testing reveals a mutation in a transmembrane receptor
gene. This results in the premature ossification of the growth plate during embryonic formation
of the long bones. What best describes the mutation in this patient?
A Gain of function

B Heteroplasmy

C Haploinsufficiency

D Anticipation

E Loss of function

29. A 22-year-old woman is in the delivery room of a hospital being evaluated by the doctor.
Measurements are being taken by the physician to determine the fixed size of the birth canal
and the likelihood of a safe vaginal delivery. A distance was measured between the inferior
aspect of the pubic symphysis and the sacral promontory. Which of the following is the name
of this measurement?
A Conjugate diagonal

B Transverse

C Interspinous

D Oblique

E Conjugate AP

30. A 4-year-old boy sustained a small abrasion located on his left upper abdomen, just above the
umbilicus, while he was playing outside. Where will lymph drain from the site of his injury?
A Horizontal superficial inguinal nodes

B Axillary nodes

C Intercostal nodes

D Lumbar nodes

E Internal iliac nodes

31. A 70-year-old female comes to the emergency department after falling down a flight of stairs.
The patient has a history of type II diabetes and chronic renal failure. Radiographic examination
reveals a right hip fracture. Laboratory analysis shows elevated PTH levels, low calcium and
phosphate levels Which of the following could have contributed to her hip fracture?
A Decreased calcium intake

B Decreased 1, 25 dihydroxycholecalciferol

C Decreased exposure to sunlight

D Decreased 25-hydroxycholecalciferol

E Decreased cholecalciferol
32. A 70-year-old woman is brought to the emergency department with severe pain to the left hip
after falling down stairs. Patient history shows she suffered a Colle’s fracture 1 year ago.
Physical examination shows the right lower limb appears shorter than the left and it is
externally rotated. A x-ray of the right hip shows a fracture to the neck of the femur. The
physician suspects this patient suffers from primary osteoporosis. What is a feature of the
overstimulated cells in this patient?
A Communicates and exchanges nutrients via gap junctions

B Well-developed rough endoplasmic reticulum and golgi

C Maintains and nutritionally supports underlying cells

D Multinucleated cells derived from monocyte progenitor

E Connect adjacent Haversian canals to each other

33. A 42-year-old woman of 5 children is admitted to the hospital complaining of fecal

incontinence. The physician notices there is a tear in one of the muscles of the pelvis. A tear in
which of the following muscles would most likely result in the patient’s incontinence?
A Coccygeus

B Obturator internus

C Pubococcygeus

D Iliococcygeus

E Piriformis

34. A 70 year old man comes into the doctor’s office because he is experiencing increasing
shortness of breath and a dry cough for the past 3 months. The doctor hears inspiratory
crackles upon auscultation bilaterally. There is dullness to percussion bilaterally in the lower
lobes. A thoracentesis is performed to sample the fluid. Where would the doctor place the
needle?
A Superior to rib 8 at midaxillary line

B Superior to rib 10 at the midaxillary line

C Superior to rib 10 at the midclavicular line

D Inferior to rib 9 at the midaxillary line

E Superior to rib 9 at the midclavicular line

35. A 35-year-old man comes to the emergency department after falling on a wet sidewalk.
Radiographic examination reveals a fracture of the radius. An MRI further reveals a hematoma
between the fracture radius and the supinator muscle. Physical examination shows weakened
abduction of the thumb and extension of the metacarpophalangeal joints of the fingers with no
loss of sensation anywhere on the limb. Which of the following nerves is affected?
A Anterior Interosseous

B Radial Nerve

C Median Nerve

D Posterior Interosseous

E Ulnar nerve

36. A 3-year-old boy is brought to the physician because of 4-month history of muscle weakness
and changes in his stance. Physical examination shows short stature, bow legs, hypotonia and
muscle weakness. What is most likely reason for this patient’s presenting features?
A Decreased absorption of calcium

B Increased levels vitamin D

C Decreased activity of osteoclasts

D Increased activity of 1α hydroxylase

E Increased absorption of phosphate

37. A 62-year-old man is a part of a study investigating new applications for use of doppler
ultrasound. During the study an occlusion of the left femoral artery at the mid-femur level was
identified. He exhibits no deficits and physical examination is unremarkable. Which artery is
providing collateral blood flow to his left knee?
A Popliteal artery

B Descending genicular artery

C Descending branch of the lateral circumflex femoral artery

D Superior lateral genicular artery

E Anterior tibial artery

38. A 40-year-old man is brought to the emergency department after having a seizure that lasted
3 minutes. His wife reports that he had persistent headaches and a stiff neck for the past 1
week. His temperature is 39 C but otherwise within normal limits. Physical examination shows
nuchal rigidity. The physician suspects bacterial meningitis and proceeds with a lumbar
puncture to extract cerebrospinal fluid for further testing. During the lumbar puncture, the
physician inserts his needle between the patient’s spinous processes. As his needle passes
through the layers of the patient’s back, he feels a first pop, and then a second pop. Which of
the following layers has the physician penetrated when he feels the second pop?
A Pia mater

B Ligamentum flavum

C Supraspinous ligament

D Dura mater

E Interspinous ligament

39. A 40-year-old male comes to the emergency department due to a puncture wound on his left
hand. The patient states that he accidentally hammered a nail into his hand while he was doing
yard work. Physical examination shows a deep puncture wound through the palmar aspect of
his left thenar eminence. What of the following nodes would first drain the lymph from this
injury?
A Apical

B Lateral

C Central

D Subclavian

E Anterior

40. A 14-year-old boy comes to the physician for an annual physical.

The physician records his height to be significantly greater than
the previous year. His mother is concerned for her child’s health.
The physician explains that this is normal, and it is due to rapid
mitosis of chondrocytes under the influence of increased levels
of growth hormone. Which letter of the attached image
corresponds with the zone the physician is describing?
A A

B B

C C

D D

E E
41. A 68-year-old woman is brought to the hospital after she had fallen walking down her front
porch. An x-ray confirms an intracapsular fracture of the femur and she is rushed to the
operating room. Which artery can be compromised following this injury that can result in
avascular necrosis of the head of the femur?
A Medial femoral circumflex artery

B Acetabular artery

C Lateral femoral circumflex artery

D Deep femoral artery

E Retinacular artery

42. A 27-year-old man is admitted to the emergency department after a severe crash that
occurred 1 hour ago. Physical examination showed that the patient had weakness in medially
rotating and adducting his right arm. Which of the following nerve roots are most likely injured
and where are their cell bodies found?
A C6, C7, C8; Ventral Horn

B C3 and C4; Ventral Horn

C C7 and C8; Ventral Rami

D C6, C7, C8; Dorsal Horn

E C4 and C5; Dorsal Rami

43. A 23-year-old college football player was tackled by another football player and sustained a
valgus force to his right knee. The patient developed an immediate onset of right knee pain
and could not bear any weight on his leg. MRI of the knee showed a large hematoma. Which of
the following structures is most likely injured in this patient?
A Medial collateral ligament, medial meniscus, and anterior cruciate ligament

B Lateral collateral ligament, medial meniscus, and anterior cruciate ligament

C Lateral collateral ligament, lateral meniscus, and anterior cruciate ligament

D Lateral collateral ligament, lateral meniscus, and posterior cruciate ligament

E Medial collateral ligament, medial meniscus, and posterior cruciate ligament

44. A 25-year-old male comes to the emergency department due to a stab wound in the scapular
region. On examination, he was found to be pale with cool clammy skin. His blood pressure
was 90/70 mmHg and he had a weak pulse of 104/min. The stab wound was located inferior to
the teres major and between the lateral and long heads of the triceps brachii. Which of the
following arteries was most likely injured?
A Suprascapular artery

B Dorsal scapular artery

C Deep Brachial artery

D Thyrocervical trunk

E Subclavian artery

45. A 24-year-old man comes to the physician because of leg pain

for the past 3 weeks. Vital signs are within normal limits. His
diet for the past 4 months has consisted largely of instant
ramen noodles. He spends most of his time in a dark library.
This image shows normal bone histology. Which of the
following correctly describes this type of bone?
A Volkmann canal enters bone at a right angle to the long axis to
communicate with osteocytes

B Osteocytes have cytoplasmic processes with tight junctions

C Haversian systems have concentric lamellae and a central canal

D Compact bones consist of trabeculae separated by marrow

cavities

E Osteoclasts have cytoplasmic processes with gap junctions

46. A 26-year-old man comes into the hospital following a gun-shot wound to his hip. The man is
also observed walking with a waddling gait. The wound is treated, and additional tests are
performed to evaluate possible damage to nervous structures. A positive Trendelenburg sign is
seen when the patient stands on his left leg and his right hip drops to the floor. Which nerve is
affected in this patient?
A Left superior gluteal

B Left inferior gluteal

C Right superior gluteal

D Right inferior gluteal

E Right sciatic
47. A 37-year-old woman comes to the hospital because of increasing lower back pain. MRI shows
intervertebral disc herniation between vertebral levels L5 and S1. If you were to assess the
sensation of her lower limb, which region would you expect to find numbness?
A Little toe

B Third toe

C Anterior thigh

D Lateral thigh

E Great toe

48. A 16-year-old boy is brought to the physician to have his cast removed 6 weeks after a
fracture of the left medial malleolus while playing soccer. He has been using crutches to move
around. He has been experiencing numbness and tingling in his left 5th digit while using
crutches. Compression of Guyon’s canal is the suspected cause. Which of the following
additional symptoms is most likely?
A Atrophy of the thenar muscles

B Paralysis of the interosseous muscles

C Paralysis of flexor carpi ulnaris

D Paralysis of medial half of flexor digitorum profundus

E Ulnar deviation of the wrist

49. A 70-year-old male comes to his physician with right lower back pain and loss of sensation to
the skin in the suprapubic and posterolateral gluteal region. During the physical examination,
the physician also noticed that the patient had paralysis of the right internal oblique and
transversus abdominis muscles. A CT scan revealed a tumor that originated from the right
kidney. Which of the following nerves is being impinged by the tumor?
A Ilioinguinal

B Lumbosacral trunk

C Iliohypogastric

D Obturator

E Lateral Femoral Cutaneous

50. A 7-year-old boy with a high fever is brought to the pediatrician.
During physical examination the patient complains of pain in his
ear. His throat appears red and inflamed, confirming the
diagnosis of pharyngitis. The physician explains that the
infection spread to the tympanic cavity through the eustachian
tube. Which of the following histological images was likely taken
from this structure?
A 1

B 2

C 3

D 4

E 5

51. A 37-year-old man is rushed to the emergency department after a motorcycle 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 circumflex

B Lateral femoral circumflex

C Anterior tibial artery

D Posterior tibial artery

E Fibular artery

52. A 23-year-old man is brought to the emergency department after being struck in the head
during a bar fight 3 hours ago. He is unresponsive, but his friends state he appeared fine after
being struck. A CT of the head shows a biconvex, hyperdense area consistent with an epidural
hematoma. Which of the following primitive tissues is the embryological origin of the meningeal
layer forming the deep border of the hematoma?
A Mesoderm

B Notochord

C Surface ectoderm

D Neural crest

E Neural tube
53. A 29-year-old woman comes to her OB/GYN to deliver her baby. During labor, the obstetrician
notices that the baby’s head is too large to fit through the vaginal opening. The obstetrician
wants to perform an emergency episiotomy to prevent any perineal tears. In order to do so, the
physician must first perform a nerve block that can be palpated at the ischial spine
transvaginally. Which of the following are the ventral rami of the nerve being anesthetized?
A L2, L3, L4

B L5, S1, S2

C S3, S4, S5

D L1, L2, L3

E S2, S3, S4

54. A 28-year old pregnant woman comes to the pregnancy clinic

for a regular check-up. The patient is in the first trimester of
pregnancy and maintains a healthy lifestyle. She asks the
physician if she can continue with her exercise routine to avoid
gaining extra weight during pregnancy. The physician explains
that light exercise is recommended but she should avoid
anything too strenuous. This is because of a hormone released
by that placenta that acts by loosening the ligaments. This
hormone aids with childbirth by relaxing the pubic symphysis.
Which of the following histological images was likely taken from
this structure?
A 1

B 2

C 3

D 4

E 5

55. A 24-year-old man is brought to the hospital following a knee injury

during an indoor soccer game. The patient said he heard a “pop”
during the injury. An MRI was performed, and the ligament
represented in the image below was confirmed to be torn. Which of
the following knee structures was injured?
A Medial meniscus

B Lateral meniscus

C Posterior cruciate ligament

D Anterior cruciate ligament

E Patellar ligament
56. An 8-year-old boy is brought to the emergency department because of pain in his right wrist.
He was tackled during football practice and fell on his wrist. Physical examination shows a red,
swollen wrist with restriction and pain on passive and active movement. An x-ray of the right
wrist shows a fracture that extends into the growth plate of the distal ulna. With regards to the
zones of the growth plate, which of the following areas is indicated by the arrow in this image?
A Zone of Proliferation

B Zone of reserve cartilage

C Zone of hypertrophy

D Zone of resorption

E Zone of calcified cartilage

57. A 48-year-old obese woman comes to her physician because of pain in her thighs. She
complains that she experiences episodes of numbness, tingling and burning pain on the
outside of her thighs. After performing the physical examination, her doctor diagnoses her with
‘meralgia paresthetica.’ This is a condition where the excessive fat tissue compresses the
nerve that passes near the inguinal ligament or medial to the anterior superior iliac spine.
Which of the following nerves is most likely being compressed?
A Ilioinguinal

B Iliohypogastric

C Lateral femoral cutaneous

D Obturator

E Pudendal

58. A 78-year-old man presents to the physician with severe left knee pain
and swelling. History of the patient reveals that he is a retired
construction worker who is still active with regular house and yard
maintenance. He claims that his pain has been apparent for about two
years and it has recently become limiting to his regular activities. The
physician performs a range of motion examination and notices an
increased stiffness of the affected joint. The attached radiological
image was taken from the patient’s affected joint. What is
characteristic of the cartilage found in this region?
A Type I and II collagen fibers

B Type II collagen and elastic fibers

C Found between intervertebral disc

D Does not have perichondrium

E Longitudinal columns of isogenous groups

59. An 18-year-old man is brought to the hospital following a back injury during a football game.
The patient is suffering from a herniated disc of L4/L5. What is the embryological origin of the
nucleus pulposus?
A Paraxial mesoderm

B Neural crest cells

C Notochord

D Splanchnic mesoderm

E Endoderm

60. A 53-year-old man is brought to the emergency department after a head-on vehicle collision.
A CT of the head shows compression of the spinal cord by the dens (odontoid process) of the
axis. Which of the following ligaments was most likely damaged?
A Anterior longitudinal ligament

B Transverse ligament of the atlas

C Ligamentum flavum

D Supraspinous ligament

E Nuchal ligament

61. A 45-year-old comes to the emergency department after having fallen on his outstretched
hand. Physical examination shows swelling in the region and an XRay is performed to
diagnose the injury. Which of the following type of injuries does the patient have?
A Colles’ Fracture

B Smith’s Fracture

C Bennett’s Fracture

D Scaphoid Fracture

E Boxer’s Fracture

62. A 19-year-old woman comes to the emergency department due to severe sunburn. The patient
says she spent the day at the beach and neglected to apply sunblock. Upon physical
examination the physician notices severe red discoloration and fluid filled blisters on the
patient’s back. How would this burn be classified and what is the deepest layer affected?
A Second degree; epidermis

B First degree; epidermis

C Third degree; subcutaneous

D Second degree; dermis

E First degree; dermis

63. A 57-year-old man comes to the hospital with complaints of weakness, lightheadedness and
shortness of breath. An irregular heartbeat was recorded, and an EKG confirms atrial
fibrillation. The physician prescribes digoxin in an attempt to slow down the heart rate and
increase inotropy. Which of the following is the direct target of this drug?
A Na+/Ca2 antiporter

B Na+/K ATPase

C SERCA pump

D L-type Ca2 channel

E B1 receptor

64. A 52-year-old woman comes to the physician because of

generalized bone pain. Her vital signs are within normal limits. A
biopsy of bone is taken and the attached image is obtained.
Which of the following functions of the cell indicated by the
pointer is the most likely cause of her pain?
A Degranulation in response to infection

B Premature calcification of cartilage

C Secretion of Type II collagen

D Secretion of Type I collagen

E Bone resorption and remodeling

65. A 45-year-old man comes to the emergency department after a severe motorbike accident. A
CT was performed and the radiologist noted that the patient had multiple sacral fractures
affecting the S24 levels. A few days later the patient developed fecal incontinence because of
damage to the branches of the pudendal nerve. Which of the following muscles is most likely
responsible for his fecal incontinence?
A Obturator Internus

B Piriformis

C Iliococcygeus

D Puborectalis

E Iliopsoas
66. A group of researchers are investigating sensory receptors of the skin that have a cellular
component composed of flattened Schwann cells. Under histological examination the
researchers describe this receptor as a loosely twisted piece of wool that lies perpendicular to
the skin. Laboratory tests have determined that this receptor is responsive to low frequency
stimuli. Where in the integument is this sensory receptor typically found?
A Stratum granulosum

B Hypodermis

C Dermal papillae

D Deep dermis

E Stratum basale

67. A 2-day-old baby boy is brought to the Neonatal Intensive Care Unit
for hydrocephalus. He exhibits poor feeding, seizures, and
significant torpor. Physical exam shows enlarged cranium and
bulging anterior fontanelle. He undergoes a cerebral shunt
placement, draining the excess cerebrospinal fluid from the
ventricles. The cerebrospinal fluid lies immediately superficial to the
structure labeled ‘PM’ in the histology image (below) of the spinal
cord and coverings. What is the embryonic precursor of this
structure?
A Sclerotome

B Extraembryonic mesoderm

C Marginal layer of neural tube

D Neural plate

E Neural crest cells

68. A 22-year-old woman comes to the emergency department in labor. She is in the 38th week of
pregnancy. Epidural anesthesia is administered for pain. After delivery, she develops back pain
and right lower extremity weakness. A CT of the lumbar spine shows evidence of a hematoma
in the epidural space compressing a nerve that exits below L2. Which of the following vessels
most likely resulted in this hematoma?
A Internal vertebral plexus

B Great radicular artery (of Adamkiewicz)

C Anterior spinal artery

D Posterior spinal artery

E External vertebral plexus

69. A 45-year-old carpenter is brought to the emergency department after a work-related injury of
the right upper limb. Physical examination shows that he is unable to flex the distal phalanx of
digits 2 and 3 but can flex the MCP and PIP joints. The patient also has difficulty flexing the
thumb. There was no sensory loss. Which of the following nerves is damaged?
A Median nerve in the carpal tunnel

B Ulnar nerve in Guyon’s Canal

C Recurrent median nerve at the base of the thumb

D Anterior Interosseous nerve between the heads of pronator teres

E Musculocutaneous nerve

70. A 13-year-old boy comes to the clinic due to excessive sweating from his armpits during
moderate exertion. He is in the 65th percentile for height and has a BMI of 22. The physician
determines that the boy is healthy and recommends he uses antiperspirant deodorant. What is
the mode of secretion of the glands located in this region of the body?
A Endocrine

B Paracrine

C Holocrine

D Apocrine

E Merocrine

71. A group of researchers are investigating the force length curves

for skeletal muscle against different afterloads. Which of the
following graphs has the smallest afterload?
A 1

B 2

C 3

D 4

E 5
72. A 17-year-old boy is examined by a physician after being tackled at a football game. During the
tackle, his neck was bent and his left ear made contact with his left shoulder. He has
numbness in his right arm. Physical examination shows inability to supinate the right elbow,
abduct the right arm to 90 degrees or externally rotate his right arm. He has weakness on right
elbow flexion and abduction of the shoulder above 90 degrees. Which of the following nerves
are most likely affected to produce these symptoms?
A Ulnar, radial, median

B Musculocutaneous, axillary, ulnar

C Axillary, radial, median

D Musculocutaneous, axillary, suprascapular

E Suprascapular, musculocutaneous, ulnar

73. A 48-year-old man comes to the emergency department with severe pain in the right lower
quadrant of the abdomen. His blood pressure is 112/80 mmHg, pulse is 78/min and his
respiration rate is 24/min. Physical examination reveals an absent cremasteric reflex. Which of
the following nerve roots is responsible for the afferent limb of the cremasteric reflex?
A Genitofemoral L1L2

B Pudendal S2S4

C Ilioinguinal L1

D Iliohypogastric T12L1

E Femoral L2L4

74. A 76-year-old man comes to the clinic due to abnormal growths on

the posterior portion of his right hand. History of the patient
reveals that he has been retired for 15 years and frequently travels
to tropical locations. The physician examines the area and notices
multiple nodules and ulcerative lesions. A histological sample is
ordered and is provided. What are characteristic features of the
damaged cells in this patient?
A Desmosomes destroyed by autoimmune attack

B Hyperkeratosis and parakeratosis

C Inflammation and cellular hyperproliferation

D Increased number of melanocytes

E Lack of tyrosinase
75. A 53-year-old man is brought to the emergency department by
his wife after a fall. He has a throbbing pain in his left wrist. X
rays of the left hand show a fracture of the distal radius and
evidence of two other healed fractures. His wife says that he
has been a heavy drinker for the past 35 years and blames the
fractures on his “clumsiness with drinking.” Based on his alcohol
intake, liver cirrhosis is suspected. Laboratory studies show
hypocalcemia, hypophosphatemia, as well as an increase in ALP.
Which of the following changes in enzymatic activity would be
most likely?
A Decreased 1-hydroxylase activity

B Decreased 25-hydroxylase activity

C Increased 1-hydroxylase activity

D Increased 25-hydroxylase activity

E Increased tyrosinase activity

76. A 23-year-old female wrestler is brought to the emergency department following an injury
where her opponent powerfully grasped her forearm. Physical examination shows an inability
to flex the distal interphalangeal joint of the index finger on clasping the hands. In addition, she
is unable to flex the terminal phalanx of the thumb and has lost the sensation over the thenar
aspect of the hand. What is the nature of her injury?
A Median nerve within the cubital fossa

B Ulnar nerve along the forearm

C Anterior Interosseous nerve at the pronator teres

D Radial nerve injury

E Median nerve injury at the carpal tunnel

77. A 11-year-old boy comes to the emergency department because of the appearance of blisters
over the last 3 weeks. The physician performs a physical exam and notices the patient’s skin
shears easily when wiped. The physician determines that the boy is suffering from the
separation of his epidermal cells. What membrane proteins are at autoimmune risk in this
disease?
A Cadherins

B Integrins

C Connexins

D Claudins

E Occludins
78. A 46-year-old man comes to the doctor for a routine
check-up. He complains of acid reflux that has been
occurring for the past few months. The doctor
prescribes a new drug that prolongs the duration of
contraction of smooth muscle or latch state. Which of
the following changes in myosin phosphorylation and
lower esophageal sphincter tone would be observed on
administration of this new drug?
A A

B B

C C

D D

E E

79. An 18-year-old female comes to the clinic with nausea and diffuse pain in the periumbilical
region. A few hours later, the pain becomes very sharp and is localized to the right lower
quadrant region of the abdomen. Physical and radiographic examination reveals acute
appendicitis and an emergency appendectomy is performed. Five days postoperatively, the
patient complains of paresthesia of the skin over the pubic region, upper medial thigh and the
anterior portion of her perineum. Which of the following nerves was most likely injured during
her surgery?
A Genitofemoral

B Ilioinguinal

C Femoral

D Iliohypogastric

E Pudendal

80. A 25-year-old man comes into the local clinic after injuring his right elbow and hand slipping on
a wet surface 1 hour ago. He has abrasions over the elbow, and palm of the hand. Physical
examination shows decreased sensation with paresthesia along the ulnar border of the hand
and medial one and a half digits. The physician also noted thumb adduction, and flexion at the
DIP of the ring and little fingers was absent. Which structure was most likely injured?
A Ulnar nerve at Guyon’s Canal

B Median nerve at the cubital fossa

C Median nerve at the carpal tunnel

D Lateral cord of the brachial plexus

E Ulnar nerve at the medial epicondyle

81. A team of researchers is studying a novel treatment for the autoimmune disease Lambert-
Eaton myasthenic syndrome LEMS. Treatment is focused on blocking the autoimmune
inhibition of presynaptic voltage gated calcium channels at the neuromuscular junction.
Successful treatment of LEMS would have which of the following effects?
A Decreased postsynaptic binding of acetylcholine

B Decreased activity of acetylcholinesterase

C Decreased open probability of T-tubule sodium channels

D Increased amplitude of motor neuron action potentials

E Increased rate of presynaptic vesicular fusion

82. A 44-year-old male comes to the emergency department with a bulge to his anterior
abdominal wall located near his inguinal region. Physical examination shows abdominal
contents herniating through his deep inguinal ring, lateral to his epigastric veins. What is the
diagnosis of this patient?
A Direct inguinal hernia

B Indirect Inguinal hernia

C Hydrocele

D Congenital inguinal hernia

E Appendicitis

83. A 47-year-old man is airlifted to the hospital from a remote cabin after he began experiencing
weakness and difficulty breathing for the past two hours. He relates that he was feeling fine
this morning but after lunch, he began experiencing dry mouth, blurry vision, difficulty
swallowing and abdominal pain associated with nausea and vomiting. The physician suspects
that his symptoms are due to food poisoning by a toxin produced by the organism Clostridium
botulinum. He is provided with supportive care including ventilatory support to prevent
suffocation secondary to respiratory paralysis. Which of the following activities of the toxin are
responsible for this life threatening complication?
A Competitive antagonism of nicotinic acetylcholine receptors

B Proteolytic degradation of vesicular fusion proteins

C Disruption of presynaptic voltage gated calcium channels

D Decreased open probability of T-tubule sodium channels

E Excessive stimulation of postsynaptic acetylcholine receptors

84. A researcher is investigating isotonic muscle contraction in a rat
model. Using tissue samples taken from the lower legs of the
model animals, the researchers generate a Velocity-Force
relationship. The points A to D along the curve below reflect
variation of which of the following factors in the examined
tissue samples?
A Frequency of muscle stimulation

B Size of muscle fibers

C Total muscle mass

D Activity of myosin ATPase

E Number of stimulated motor units

85. A 25-year-old woman visits the emergency room because of trouble breathing. Albuterol is
given by the doctor to facilitate the relaxation in smooth muscle, allowing her to breathe
unhindered. A decrease in which substance can attribute to increased sensitivity to calcium in
smooth muscles?
A Actin

B Adenosine Triphosphate

C Calcium-calmodulin complex

D Calmodulin

E Myosin light chain phosphatase MLCP

86. A 46-year-old man came to his family physician because of chest pain for the past 1 hour. He
has a 10-year history of hypertension and type II diabetes. The pain began just after he was
nearly struck by a moose while driving. An EKG reveals ischemic changes and the doctor
explains that his pain is caused by inadequate blood flow to the cardiac muscle with an
increased rate and strength of contraction in response to the stress of the moose encounter.
An increase in which of the following is most likely responsible for the suspected change in the
patient’s cardiac demand?
A Activity of MLCK

B SERCA activity

C Calcium sensitivity of ryanodine receptors

D Concentration of ATP

E Calsequestrin concentration
87. A 43-year-old woman comes to her physician because of fatigue for the past 3 weeks. Blood
pressure is 102/74 mm Hg, pulse is 54/min and respirations are 13/min. The patient states that
she was prescribed Propranolol for hypertension just prior to her symptoms starting. Which of
the following types of neurons are normally found in the white ramus communicans of the
spinal cord that would have led to her symptoms prior to starting medication?
A Motor Neurons

B Afferent Sensory Neurons

C Efferent Sensory Neurons

D Preganglionic Sympathetic Neurons

E Post-ganglionic sympathetic Neurons

88. A 26-year-old woman came to her physician to undergo a

scheduled C-section delivery. The mother has had a history of
folic acid deficiency throughout her pregnancy and was told that
this deficiency could potentially cause complications in her child.
After an uncomplicated delivery, the newly born neonate was
found to have a membranous sac protruding from his lumbar
region. Which of the following is contained within this
membranous sac?
A Dura and arachnoid mater only

B CSF only

C CSF, nerve roots and meninges

D Tissue from all three primary germ layers

E CSF, dura, and arachnoid mater

89. A 51-year-old man comes to the emergency room because of back pain that began this
morning. He was chopping and hauling wood when he experienced an abrupt pain in his lower
back that radiates down the back of his legs. Physical exam shows the straight leg raise test is
positive. An MRI of the affected area is done and shows impingement of nerve roots, causing
his pain symptoms. From which embryonic precursor is the herniating structure derived?
A Lateral mesoderm

B Loosely packed mesenchyme of sclerotome

C Notochord

D Neural Tube

E NCC
90. A 40-year-old woman comes to the emergency department because of a 2-day history of
persistent high fevers, headaches and a stiff neck. Physical examination shows a rash on her
arm and photophobia. The physician suspects meningitis and plans to perform a lumbar
puncture to extract cerebrospinal fluid for further testing. When performing the lumbar
puncture, at which level should the physician insert the needle?
A L3L4

B L4L5

C L1L2

D L2L3

E S1S2

91. A 27-year-old man comes to the physician because of numbness and weakness of his right
foot for the past 3 days. His vital signs are within normal limits. Physical examination shows a
high stepping gait and numbness along the lateral aspect of the foot. An MRI of the right leg
shows compression of the common fibular (peroneal) nerve. Which of the following cutaneous
nerves is responsible for the patient’s numbness in this injury?
A Lateral femoral

B Lateral plantar

C Medial calcaneal

D Saphenous

E Sural

92. A 63-year-old female came to her physician because of a rash on one side of her body about 1
month ago. Vital signs are within normal limits. Physical examination shows a unilateral
distribution of topical red sores that wrap laterally from her left nipple to her back. The
physician diagnoses Herpes-Zoster virus and prescribes Terrasil. Where would the virus
remain dormant in this patient?
A Dorsal root ganglia of T4

B Dorsal root ganglia of T7

C Dorsal horn ganglia of T10

D Ventral root ganglia of T4

E Lateral horn ganglia of T7

93. An 80-year-old woman comes to the emergency department because of back pain after a fall
from a ladder. She landed on her feet and immediately felt a sharp pain in her lower back. An x-
ray of the lumbar spine shows the L3 vertebra is compressed with more narrowing anteriorly
than posteriorly. There is no anterior or posterior translation of the vertebrae and the lateral
cortical line appears to be intact. Which of the following is the most likely diagnosis?
A Jefferson Fracture

B Spondololisthesis

C Spondylolysis

D Wedge fracture

E Hangmans fracture

94. A 2-month-old girl is brought to the physician by her parents because of a mass protruding
from her lower back. History revealed that the mother had a diet that lacked folate during her
pregnancy. Physical examination shows a round sacral mass that is 7cm in diameter. An MRI of
the spine confirms the diagnosis of spina bifida cystica with meningomyelocele. Which of the
following findings is most characteristic of this condition?
A Unfused vertebral arch with a tuft of hair

B Open spinal cord

C Sac consisting of meninges, cord, and nerves

D Sac consisting of only CSF

E Sac containing CSF, meninges, cord, nerves and vertebra

95. A 21-year-old female comes to the emergency department because of right arm pain after
bumping into her refrigerator. An x-ray of her right arm shows a fracture in the proximal radius.
This is her third fracture in the past year. Laboratory studies show hypercalcemia. Which of the
following hormones is responsible for the elevated calcium levels in her blood?
A Calcitonin

B Insulin

C Parathyroid hormone

D Growth Hormone

E Prolactin
96. A 27-year-old man comes to the emergency department because of weakness in his left leg.
He was lifting a heavy box at work and suddenly felt a shooting pain in his back followed by
weakness in the left leg. Physical examination shows 1 strength in flexion of the left knee and
extension of the left hip. An MRI of the lumbar spine shows a herniation of the L3 intervertebral
disc. Which of the following histological findings would be seen on microscopic examination of
a tissue sample from this disc?
A Chondrocytes arranged in linear fashion

B Chondrocytes surrounded by a glassy matrix

C Chondrocytes surrounded by elastic fibers

D Cells that show interstitial and appositional growth

E Cartilage surrounded by a perichondrium

97. A 20-year-old woman is examined in a seated position at the orthopedic clinic. She suffered an
injury a few days earlier during a soccer match. The physician performs specific range of
motion test as a part of his examination. During one of the tests, he presses the tibia backward
and notices that the femur moves anteriorly beyond normal limits. Which test did the physician
perform and which structure was most likely damaged in the right knee?
A Posterior drawer test and anterior cruciate ligament

B Valgus stress test and medial collateral ligament

C Varus stress test and lateral collateral ligament

D Anterior drawer test and posterior cruciate ligament

E Posterior drawer test and posterior cruciate ligament

98. A 55-year-old man comes to the Emergency Department because of lower back pain and
bruising from a motorcycle accident two days ago. Vital signs are within normal limits. MRI of
the patient's lumbar spine shows a herniated disc between the L1 and L2 vertebrae. Damage
to the structure indicated by the arrow is most likely the cause of her back pain. What is the
embryological origin of this structure?
A Neural crest

B Somite

C Notochord

D Sclerotome

E Neural tube
 99. An 82-year-old woman comes to the physician after slipping on a patch of ice and falling onto
her right hand. She feels the most pain on the dorsal side of her hand, especially when
pressure is applied on the base of her thumb. An x-ray of the right hand shows no fractures. A
CT of the right hand shows a carpal bone fracture consistent with the injury. Which of the
following results is likely if treatment of the fractured bone is delayed?
A Avascular necrosis of the bone

B Flattening of the thenar eminence

C Full recovery of the fractured bone

D Inability to flex the wrist

E Inability to flex the wrist

100. A 35-year-old male comes to the emergency department with swelling and pain located in his
scrotum. Vital signs are within normal limits. Physical examination shows a bulge that is lateral
to the inferior epigastric vessels. During surgical repair of the hernia, the internal spermatic
fascia is opened to reveal the contents underneath. What is the origin of the fascia that is
opened during surgery?
A External oblique aponeurosis

B Transversalis fascia

C Internal oblique muscles and aponeurosis

D Parietal peritoneum

E Dartos muscle

101. A 27-year-old man comes to the physician after feeling a sharp pain while working out in the
gym yesterday. Vital signs are within normal limits. CT scan of the affected muscle is indicated
at the blue arrow. Which of the following nerves is most likely damaged in this patient?
A Suprascapular

B Long Thoracic

C Dorsal Scapular

D Thoracodorsal

E Lateral Pectoral
102. A 10-year-old boy came into the physician with his
mother complaining of being easily fatigued while
playing with the other kids. A graph of the force
produced by the muscle at different lengths was
created to look at the evidence. Which of the following
describe the change in muscle length from ‘C to E’?
A A decrease in actin and myosin interaction

B Reduced Ca2 sensitivity of tropomyosin

C Bending and folding of the thick filaments

D Increased release of Ca2 from terminal cisternae

E Reduced entry of Ca2 into the fiber during the action

potential

103. A 43-year-old female came to her physician because of ongoing

knee pain for the past 3 months. An MRI of the knee shows a
weakened ligament indicated by the arrow in the image. Which of
the following is most likely affected?
A Anterior cruciate ligament; Prevents posterior displacement of the
femur

B Anterior cruciate ligament; prevents posterior displacement of the

tibia

C Anterior cruciate ligament; Prevents anterior displacement of the

femur

D Posterior Cruciate ligament; Prevents posterior displacement of the

femur

E Posterior cruciate ligament; prevents anterior displacement of the

tibia

F Posterior cruciate ligament; prevents anterior displacement of the

femur

104. A 4-year-old girl is brought to the physician by her father because of right arm pain. Her father
says that on the way to school, she saw her friends on the other side of the street and began
to run across the street to join them. He instinctively pulled her arm to bring her back onto the
sidewalk. He is afraid he may have pulled too hard and broken her arm. Supination and
pronation of the forearm immediately relieves her pain. Which of the following best describes
the mechanism of this injury?
A Subluxation of the radial head

B Rotator cuff injury

C Posterior dislocation of the elbow joint

D Supracondylar fracture of the humerus

E Shoulder separation
105. A 13-year-old boy is brought to his physician by his parents because of frequent sun burns
that result in sever blister formation. The parents have noticed this occurring for about 3 years.
Physical examination shows an appearance of fair skin, hair, and eyes. Eye examination shows
reduced visual acuity. The patient was diagnosed with albinism; a lack of tyrosinase that
causes reduced production of melanin. What is the embryological origin of the melanin-
producing cells?
A Primitive Streak

B Neural Tube

C Neural Crest Cells

D Mesenchyme

E Neuroepithelium

106. A 16-year-old boy comes to the physician after a fall on his outstretched right arm during a
basketball game. Physical examination shows a step off deformity at the right shoulder. The
right arm is 4 cm longer than the left and ROM is limited by pain at the right shoulder. He is
diagnosed with a dislocation. After reduction, he has weakness on external rotation and
abduction of the right arm. Flexion and extension of the elbow and wrist are unaffected. Which
of the following nerves was most likely compressed upon reduction of the dislocation?
A Axillary nerve

B Median Nerve

C Musculocutaneous nerve

D Radial Nerve

E Ulnar nerve

107. A 74-year-old woman comes to the physician because of neck and radiating arm pain that has
persisted following a minor motor vehicle collision 3 days ago. Vital signs are within normal
limits. Physical examination shows bilateral numbness extending from the medial forearm to
the medial palm and difficulty in elbow, wrist, and finger extension. A disc herniation resulting
in compression the C7 nerve root is suspected. Which of the following vertebral levels is the
most likely location of this herniation?
A C7/C8

B C6/C7

C C5/C6

D C8/T1

E C4/C5
108. A 21-year-old woman is brought to the emergency department because of a sudden shooting
pain in her left leg during a repetition of a dead lift at a weight lifting competition. She has
severe pain radiating to the posterior aspect of her left thigh and leg. A disc herniation is
suspected. An MRI of the spine shows a ruptured L3/L4 intervertebral disc with associated
nerve compression. Which of the following nerves is most likely affected?
A L2

B L3

C L4

D L5

E S1

109. A 60-year-old is admitted to the emergency department due to severe back pain.There is no
history of trauma and physical examination shows tenderness upon palpation in the
lumbosacral region. MRI examination reveals an anterior dislocation of the body of the L5
vertebrae upon S1 and a decapitated ‘scotty dog’ structure. Which of the following is the most
likely diagnosis?
A Spondylolysis

B Spondylolisthesis

C Lumbar disc-herniation

D Lordosis

E Scoliosis

110. A 28-year-old man comes to the physician because of a 3-day history of abdominal pain,
fever, and nausea. His pulse is 85/min, temperature is 102 F 38.9 C, and respirations are
16/min. Physical examination shows a positive psoas test and Rovsing’s sign. A diagnosis of
appendicitis is made and an appendectomy is scheduled. Which of the following incisions is
most appropriate for this surgical procedure?
A Pfannenstiel

B Median

C Para-median

D Kocher

E McBurney
111. A 30-year-old woman delivers her child at full term via vaginal delivery. During the delivery she
has a posterior vaginal tear that requires suturing. A nerve block is attempted in order to
anesthetize the area. Which of the following landmarks is most likely used during a
transvaginal approach to locate the target nerve?
A Anterior superior iliac spine

B Coccygeus muscle

C Ischial spine

D Ischial tuberosity

E Sacral promontory

112. A 35-year-old woman comes to the emergency department after the finding of a tender lump
in her left breast. Physical examination shows enlargement of the left breast with a peau
d’orange appearance. No abnormalities are noted in the right breast. An x-ray of the chest
shows a mass lateral to the left breast and no changes on the right breast. Which of the
following sentinel lymph nodes is most likely affected?
A Apical lymph nodes

B Central lymph nodes

C Parasternal lymph nodes

D Pectoral lymph nodes

E Subscapular lymph nodes

113. A 25-year-old man comes to the physician to receive a left gluteal intramuscular injection for
pain. Following the injection, he experiences severe pain in his left leg. Physical examination
shows decreased light touch sensation in the left leg and foot. There is marked weakness in
inversion, eversion, and dorsiflexion of the ankle joint. Which of the following nerves was most
likely injured?
A Fibular nerve

B Inferior gluteal nerve

C Sciatic nerve

D Superior gluteal nerve

E Tibial nerve
114. A 60-year-old man comes the physician for follow up after a hernia repair one week ago. He
has had a burning sensation in his upper thigh for the past 2 days. Physical examination shows
decreased light touch sensation in the upper medial thigh and anterior scrotum. Which of the
following nerves is most likely damaged?
A Femoral nerve

B Genital branch of the genitofemoral nerve

C Illiohypogastric nerve

D Illioinguinal nerve

E Lateral femoral cutaneous nerve

115. A 14-year-old boy comes to the physician for a sports physical. His vital signs are within
normal limits. During the physical examination the physician touches the patient’s femoral
triangle with the base of his reflex hammer, causing the testes to be pulled upward. Which of
the following combinations of nerves is responsible for this reflex?
A T12, L1

B L1, L2

C L2, L3

D L2, L4

E L5, S2

116. A 25-year-old woman in her 24th week of pregnancy comes to the physician for a routine
examination. She was treated for a rubella infection during her 1st trimester. Her vital signs are
within normal values. The physician recommends drawing blood from the umbilical artery to
evaluate fetal health. Which of the following structures develops from this artery?
A Extraperitoneal fascia

B Lateral umbilical fold

C Medial umbilical fold

D Median umbilical fold

E Transversalis fascia
117. A 67-year-old woman is brought to the emergency department by her caretaker who found her
collapsed on the floor. Her vital signs are within normal limits. Physical examination shows
external rotation of the right leg. An x-ray of the right leg shows a subcapital fracture with
avascular necrosis at the femoral head. Which of the following arteries is most likely impacted
by this injury?
A Artery to the head of the femur

B Femoral artery

C Inferior gluteal artery

D Retinacular arteries

E Superior gluteal artery

118. A 23-year-old man is brought to the emergency department because of severe chest pain. The
pain is radiating to the back and has been migrating down to the abdomen for the past 3
hours. His pulse is 55/min, blood pressure is 140/90 mm Hg, respirations are 25/min, and
temperature is 98.6 F 37 C. Physical examination shows a tall man with thin, long limbs. A CT
of the chest shows an aortic dissection. At which of the following vertebral levels does this
artery pass through the diaphragm?
A T8

B T9

C T10

D T11

E T12

119. A 27-year-old G3P3 woman comes to the physician with 3-day history of fecal incontinence.
Her vital signs are within normal limits. Physical examination shows a perineal tear. Trauma to
which of the following muscles is most likely responsible for her symptoms?
A Coccygeus

B Gluteus maximus

C Obturator internus

D Piriformis

E Puborectalis
120. A 35-year-old woman is brought to the emergency department after a car crash. Physical
examination shows the left foot is a blue/gray color and the left knee is swollen. The posterior
tibial pulse is not palpable on the left. An x-ray of the patient’s left leg reveals a fracture
proximal to the femoral condyle. Which of the following arteries is most likely injured due to
this fracture?
A Anterior tibial artery

B Dorsalis pedis

C Iliac artery

D Popliteal artery

E Posterior tibial artery

121. A 27-year-old man is brought to his physician for evaluation of severe lower limb weakness
and loss of sensation. He has a history of peripheral diabetic neuropathy. Physical examination
shows that the patient has no achilles reflex, but all other reflexes are normal. Which of
following nerves is most likely affected?
A S1

B L5

C L3

D L4

E S3

122. A 16-year-old boy comes to the clinic with dyspnea. A week ago, he inhaled rotten milk
through his nose. He says he aspirated a significant amount of fluid. His temperature is 101.3 F,
pulse is 90/min, and blood pressure is 125/80 mmHg. The physician suspects pneumonia and
conducts a physical exam. During the exam, the physician has the boy cross his arms so that
the stethoscope can be placed in the triangle of auscultation. For best auscultation of the right
lung, the stethoscope should be placed to the left of which structure?
A Medial border of scapula

B Medial to trapezius

C Left of latissimus dorsi

D Right of rhomboids

E Lateral to inferior angle of scapula

123. A 15-year-old boy is brought to his physician by his parents because of shortness of breath
and a persistent cough for the past 4 days. The patient says that his symptoms have
progressively worsened over the past few days. Blood pressure is 110/85 mmHg, pulse is 80
bpm, O2 saturation is 97%. Bilateral crackles were heard on auscultation. Laboratory serum
tests show hemoglobin levels of 13.5g/dL and an elevated WBC count. Chest radiographs
shows infiltrates consistent with pneumonia. Which of the following is the medial border of the
triangle of auscultation?
A Superior border of the latissimus dorsi

B Medial border of the scapula

C Lateral border of the latissimus dorsi

D Lateral border of the trapezius

E Medial border of the trapezius

124. A 17-year-old boy comes to the emergency department because of severe ankle pain following
a basketball game an hour ago. His vital signs are within normal limits. Physical examination
shows an inverted right foot with tender swelling extending from the dorsum to the lateral
malleolus. An MRI of the right foot shows a tear of the calcaneofibular ligament. Which of the
following ligaments is most likely also torn in this injury?
A Anterior talofibula

B Anterior tibiotalar

C Plantar calcaneonavicular

D Posterior talofibular

E Posterior tibiotalar

F Tibiocalcaneal

125. A 20-year-old man comes to the emergency department 10 hours after injuring his right leg in
a basketball game. He said he was chasing the basketball when he fell on his knee. Physical
examination shows an abnormal gait. There is marked tenderness and swelling of the right
knee. A test is performed to determine if a ligament is damaged. Results show that the femur is
displaced posterior to the tibia. Which of the following ligaments is most likely injured?
A Anterior cruciate ligament

B Fibular collateral ligament

C Lateral collateral ligament

D Medial Collateral ligament

E Posterior cruciate ligament

126. A 40-year-old woman comes to the physician because of
numerous blisters that appeared 3 weeks ago. Vitals are
within normal limits. Physical exam shows several blisters
on her back and the dorsal aspect of her hands that are
not easily ruptured. Microanalysis shows that the patient
has an autoimmune disease that affects a cell junction
between the dermis and the epithelium. Which of the
following is most likely attacked by the IgG antibodies?
A Occludins

B E-cadherins

C Connexins

D ZO1

E Integrins

127. A 5-year-old girl is brought to the physician for evaluation of musculoskeletal abnormalities.
She has a history of cerebral palsy. Vital signs are within normal limits. Physical examination
shows altered muscle tone, loss of coordination, gait disturbance and scoliosis. Her scoliosis is
due to abnormal development of the deep muscles that are attached to the thoracic spinous
processes. Which of the following nerves innervates this group of muscles?
A Dorsal scapular nerve

B Dorsal rami

C Suprascapular nerve

D Spinal accessory nerve

E Thoracolumbar nerve

128. A 67-year-old man comes to the physician because of 3-day history of chest pain and
shortness of breath. His pulse is 90/min, respirations are 23/min, and blood pressure is
149/100 mm Hg. Physical examination shows tachycardia, dyspnea, and pedal edema. An
echocardiogram shows left ventricular hypertrophy and a diagnosis of heart failure is made.
The physician prescribes him metoprolol. After 1 week, the patient returns with continued
symptoms. Which of the following best describes the effect codeine would have on this
patient?
A Increased salivation

B Respiratory depression

C No effect

D Hyperventilation

E Bronchoconstriction
129. A 5-year-old boy is brought to the physician by his mother for a routine examination. His
mother reports that he is not meeting his developmental milestones. Vital signs are within
normal limits. Physical examination shows a bow-leg deformity, frontal bossing, and a pigeon
chest deformity. Which of the following serum laboratory values can be expected to be seen in
this patient?
A Increased calcium levels

B Increased phosphate levels

C Increased alkaline phosphatase

D Decreased alkaline phosphatase.

E Decreased vitamin A levels

130. A 35-year-old male carpenter comes to the emergency department after he suffered a deep
cut to the tip of his thumb. Initially the redness, swelling, and pain were limited to the injured
part of the thumb, but later the entire thumb and thenar eminence became inflamed. What is
the correct path the lymph drainage will take before draining into the thoracic duct?
A Lateral nodes to pectoral lymph nodes

B Direct drainage to apical nodes with some drainage to central nodes

C Lateral nodes to central nodes to apical nodes

D Lateral to posterior nodes

E Lateral nodes to thoracic duct to the cisterna chyli

131. A 24-year-old woman comes to the physician because

of progressive back pain for the past month. She has a
history of chronic renal failure and undergoes
hemodialysis three times a week. She does not smoke
or drink and has no significant family history. An x-ray of
the spine shows demineralization and thinning of
vertebrae. A blood sample is collected for further
testing. Which of the following combination of results is
most likely to be found?
A A

B B

C C

D D

E E

F F

G G

H H
132. A 37-year-old woman comes to the emergency department with spasms, stiffness in the neck,
and sweating. Her symptoms began 2 days after she fell while cleaning her attic and punctured
the medial aspect of her hand on a rusty nail. Her temperature is 102 F 38.9 C, pulse is
100/min, blood pressure is 98/70 mm Hg, and respirations are 10/min. She is diagnosed with a
Clostridium tetani infection. Which of the following is the order of lymphatic drainage from the
site of injury?
A Central, apical, lateral

B Lateral, central, apical

C Central, lateral, apical

D Lateral, apical, central

E Apical, central, lateral

F Apical, lateral, central

133. A 38-year old man is brought to the emergency department after being stabbed in the neck
during a bar fight. His bleeding is stabilized and he is sent to surgery. The surgeon identifies
the laceration on the subclavian artery proximal to its transition to the axillary artery. She is
able to clamp and repair the artery because of the presence of an anastomosis between a
branch of the subclavian artery and a branch of the axillary artery. Which of the following
arteries is the anastomosing branch originating from the axillary artery?
A Thoracodorsal artery

B Circumflex scapular artery

C Lateral Thoracic Artery

D Superior thoracic

E Subscapular artery

134. A 3-year-old boy presents to his pediatrician for

evaluation of a hand deformity. Physical examination
showed that the patient had only 4 digits on his right
hand, but X-ray shows that the bones of digits 3 and 4
were fused together. Which of the following is the cause
of this deformity?
A Failure of the webs to degenerate

B Disruption of the anteroposterior pattern

C Failure of development of notches between digital rays

D Suppression of limb bud development

E Disruption of limb development in week 5

135. A 37-year-old woman comes to the physician because of a small painful mass in her left
breast. Physical examination shows a small, nodular mass in the upper outer quadrant of the
left breast. A mammogram shows nonspecific changes. A biopsy of the mass shows malignant
changes. Which of the following lymph nodes would be first affected in metastasis of this
malignancy?
A Anterior nodes

B Apical nodes

C Central nodes

D Lateral nodes

E Posterior nodes

136. A 19-year-old man comes to the physician because of a 3-month history of right shoulder pain.
He is a division 1 college baseball pitcher. The pain has increased since onset and initiating
overhead movements is painful and difficult. Physical examination shows that he has trouble
initiating arm abduction up to 15 degrees and external rotation manual muscle testing MMT
shows a grade of 3/5. He has no difficulty with lateral rotation. Which of the following nerve
roots is the origin of the nerve innervating the affected muscle?
A C5 only

B C5C6

C C5C7

D C5T1

E C8T1

137. A 44-year-old woman comes to the clinic for evaluation of back pain. She first noticed the pain
a month ago while gardening and has gotten progressively worse over the last week. Physical
examination shows tenderness to palpation over the lumbar spine with limited lumbar flexion
but full lumbar extension. An oblique lumbar spine x-ray is done (below). Which of the following
vertebral structures is encircled?
A Pedicle

B Transverse process

C Pars interarticularis

D Facet joint

E Spinous process
138. A 62-year-old man passes away unexpectedly in his sleep. When his wife finds him the next
morning, his body appears relaxed, almost as if he is still asleep. An autopsy is performed 4
hours later and showed increased stiffness of his muscles and joints. Which of the following
best describes the etiology of this stiffness?
A Actin binding

B Inability of myosin to detach

C Increased tropomyosin binding

D Low calcium

E Repriming

139. An 8-year-old girl is brought to the emergency department by her mother after falling off her
bike. As her bike began to tilt, she stretched her right arm out and landed on top of it. An x-ray
of the right arm shows a right supracondylar fracture. The girl is complaining her “hand feels
funny.” In which of the following distributions is loss of sensation most likely observed?
A Entire dorsal aspect of the hand

B Entire palmar aspect of the hand

C Palmar and dorsal aspect of the 5th digit

D Palmar aspects of the 1st and 2nd digits

E Palmar aspects of the 1st and 2nd digits Palmar aspects of the 3rd 4th and 5th digits

140. A 1-month-old girl is brought to the emergency department by her

parents who are recent immigrants from South-East Asia. They say that
she was born with a mass protruding from her buttocks that has
continued to grow in size since her birth. The mass is similar to the one
shown in the attached image. Which of the following best describes the
origin of this mass?
A Notochord

B Neural tube

C Chorionic villus

D Bilaminar disk

E Primitive streak
141. A group of researchers are comparing the different
classifications of connective tissue. They are specifically
studying a specimen characterized by a calcified matrix
arranged in concentric layers of lamellae surrounding a canal
that transmits blood vessels, nerves and loose connective
tissue. Which image is most likely an example from their study?
A 1

B 2

C 3

D 4

E 5

142. A 32-year-old woman comes to the hospital with a

deep laceration to her right wrist that resulted in a
severed tendon. The two ends of the tendon were
surgically repaired with a 7 cm overlap between the
two ends. Which of the following would be expected of
the repaired muscle compared to the pre-injured
muscle?
A A

B B

C C

D D

E E

143. The following diagram illustrates the force-velocity relationships

of 3 different skeletal muscle fibers. All data is taken from the
ascending limb of the length tension curve. Which of the
following most likely accounts for the differences in the curves?
A Changes in preload

B Changes in afterload

C Temporal summation

D Mass of the muscle fiber

E Myosin ATPase activity

144. A 20-year-old man comes to the physician with weakness in his right hand. His symptoms
began 3 months ago following a suicide attempt by cutting his wrist. Physical examination
shows scarring over his right wrist and clawing of the hand. Which of the following additional
motor deficits would most likely be observed?
A Loss of ulnar deviation at the wrist

B Weakness of wrist extension

C Numbness of dorsal medial 1 1/2 digits

D Loss of flexion of 2nd digit

E Loss of adduction of 1st digit

145. A 40-year-old female comes to her physician for evaluation of right ankle pain. The patient
reports that she was outside when she accidently tripped off the curb and twisted her ankle.
X-ray shows an inversion injury to her right ankle. Which of the following ligaments is the most
likely to be injured?
A Posterior talofibular

B Tibiocalcaneal

C Posterior tibiotalar

D Anterior tibiotalar

E Anterior talofibular

F Tibionavicular

146. A 43-year-old man comes to the hospital for the appearance of worms in his abdomen.
Findings of ascites and edema of the lower extremities were additionally found during physical
exam. Inferior vena cava syndrome is diagnosed due to a blockage of the IVC and the varicose
veins are of the collateral blood flow. Which of the following anastomoses is a pathway for
blood from the lower extremities to be returned to the heart?
A Superficial epigastric veins with thoraco-epigastric veins

B Internal thoracic veins with hemiazygos vein

C Superficial epigastric veins with internal thoracic veins

D Inferior epigastric veins with the azygous vein

E Superior epigastric vein with the ascending lumbar veins