Exam 1: Anatomy

A 55-year-old woman comes to the physician with concerns about swelling and pruritus in her right breast. Physical examination shows erythema and prominent pitting of the hair follicles overlying the upper and lower outer quadrants of the right breast. Hard lymph nodes are palpated in the right axilla.  The left breast is normal. There are no nipple changes or discharge. She had right breast mastitis 10 years ago while breastfeeding but has no other history of serious illness. Which of the following is the most likely cause of this patient's skin changes?

A 56-year-old man presented to the clinic due to recurrent rectal bleeding. The patient has been having constipation for the last 6 months. The patient noticed streaks of blood seen covering the stool, but for the last day, the bleeding has been continuous after defecation. Digital rectal examination was unremarkable, but the anoscopy shows swelling with purplish color seen above the dentate line. If this patient undergoes rubber band ligation, which of the following structures would be involved?

A 45-year-old woman presented to the office complaining of a one-month history of hearing abnormality. The patient finds it difficult to tolerate sounds. She complained of ear pain in places with high noises. The patient has a previous medical history of diabetes mellitus. Injury in which of the following nerves would explain the patient's presentation?

During the evaluation of a 26-year-old male patient who was involved in a car accident, a metal part was found stabbed in the chest of the patient. The stab is located laterally, at the level of the 5th intercostal space, along the midclavicular line. Which of the following structures has been injured in this patient?

A 45-year-old man complains of swelling in his left cheek for the past month. No pain, fever, cough, sore throat, or other symptoms are reported by the patient. He has been smoking two packs of cigarettes every day for the past 20 years. On examination, the patient has a mass in the periauricular space of the left side. Radiological imagines show a mass in the left parotid gland sized 3-cm. If this patient is left without treatment, which of the following he would like to develop?

A 28-year-old man arrives at the emergency department complaining of increased chest tightness and occasional acute chest pains for three days. He also experiences slight breathlessness, particularly with exercise. The patient has no past chronic medical issues, however he did have an upper respiratory ailment a week ago that went away on its own. The ECG exhibits sinus tachycardia and low voltage QRS complexes whose amplitude varies from beat to beat. Which of the following chest x-ray findings is more likely in this patient?

A 36-year-old woman presented to the office complaining of left-sided inguinal discomfort. The patient noticed swelling in the left groin while she was dressing yesterday. The patient has no previous medical or surgical history. She does not use illicit drugs. The cardiopulmonary examination is normal. The abdomen is soft and non-tender. On examination, the left popliteal and inguinal lymph nodes are enlarged. This lymphadenopathy is seen in which of the following conditions?

Due to memory loss and frequent falls, a 62-year-old man is brought to the office by his son. The patient has been living alone since his wife died a year ago. His visiting son discovered his father in deplorable living circumstances. The patient was forgetful and didn't recall where certain belongings in his residence, where he had resided for almost 20 years, were located. His walk is extremely shaky, and he has fallen multiple times. According to his son, his father has always been "a drinker" and may have been drinking recently. The patient appears unconcerned about his son's fears and claims to be OK. The vital indicators are within normal ranges. On physical examination, bilateral lateral gaze palsy and nystagmus are present.  Muscle strength and deep tendon reflexes are normal, but the gait is ataxic.  On memory testing, he recalls 0 out of 3 objects after 5 minutes.  A lesion of which of the following labeled structures on a normal brain MRI is most specifically associated with this patient's current condition?

A 16-year-old girl arrives at the clinic complaining of left elbow discomfort that has been bothering her for several months. The pain worsens with activities, limiting her ability to exercise. She has tried over-the-counter ibuprofen and acetaminophen but has only gotten partial relief. Seasonal allergies are mentioned in the medical history, and current treatments include a fluticasone nasal spray. A further examination reveals that the patient's condition is the result of a tendon damage. A long-acting glucocorticoid injection is given to the most tender area, as seen in the figure below.. Which of the following actions is most likely performed by the affected muscle?

A 27-year-old man presented to the office due to scrotal swelling on the left side. The patient noticed the swelling while getting ready for work last week. On examination, the left hemi-scrotum is has a discrete mass, that is localized in the scrotal skin. It is not connected to the testis. It is not mobile, and it does not transilluminate. An ultrasound was done, and it revealed a solid mass in the scrotal skin. If this swelling is malignant, it will pass to which of the following lymph nodes?

A 15-year-old girl is brought to the office due to left knee pain. A few weeks ago, she had knee pain on the anterior side, the pain progressed and is limiting her movement now. The pain is exacerbated by extending the knee while sitting and relieved by rest. Evaluations show avulsion fracture affecting an ossification center due to muscle overuse. Which of the following structures is most likely affected?

A 40-year-old woman presented to the office due to difficulty walking. Three days ago, the patient has received a left-sided intramuscular injection in the buttock. Later, she developed difficulty walking. On examination, there is no erythema or edema at the injections site. The patient has full strength against resistance on the knee and ankles' plantar flexion. When the patient is asked to walk, the right hip drops every time he raises his right foot. The patient has received the injection at which of the following sites?

A 70-year-old woman is brought to the emergency department due to severe lower abdominal wall and nausea. She complains of the inability to urinate for the last two days. Physical examination shows fullness in the suprapubic area. Urethral catheterization has failed multiple times, therefore suprapubic catheterization is planned. The trocar will most likely penetrate which of the following structures during the procedure?

A 13-year-old girl has been taken to the hospital with a fever, cough, and malaise for the previous two days. She has no history of illness, and all of her vaccines are current. Her leukocyte count is 21,000/mm³, and she has 7% band formations. The following are the results of an upright chest x-ray: Which of the following is the most likely location of the pathologic process in this patient?

A 70-year-old man presented to the office complaining of difficulty voiding initiation. The patient does not complain of any other symptoms. Abdominal and external genital examinations are unremarkable. Digital rectal examination reveals hard prostate nodules. Prostate-specific antigen levels are high. Transrectal biopsy confirmed the diagnosis of prostatic adenocarcinoma. During the surgery of radical prostatectomy, the nerves found within the fascia covering the prostate are injured. Which of the following would be the result of this injury?

A 65-year-old man presented to the office complaining of chronic constipation. The patient has bowel movement that occurs every 4 days, the stool is hard. The patient has difficulty defecation, with incomplete evacuation. The patient uses his fingers to induce defecation. Medical history is significant for multiple sclerosis, for which he takes interferon therapy. Vital signs are unremarkable. On examination, the patient has a distended, non-tender abdomen. This patient's presentation is due to inadequate relaxation of which of the following muscles?

A previously healthy 56-year-old man arrives at the clinic with diminished hearing in both ears. He claims to have difficulties comprehending discussions in crowded places. His wife adds that they frequently disagree about the loudness of the television. The patient cannot recall when he initially detected hearing loss, but claims it has been there for at least 6 months and is worsening. He has spent the last 12 years working in a plant where he had to yell to communicate with coworkers and has seldom used hearing protection. As illustrated in the figure below, an audiogram is obtained. Which of the following is most likely abnormal in this patient?

A 36-year-old man is brought to the emergency department after sustaining multiple stab wounds and blunt trauma to his chest during a gang fight. On arrival, he has severe chest pain that worsens on inspiration and coughs intermittently. He is alert and in moderate respiratory distress. His temperature is 37.0°C (98.6°F), pulse is 110/min, respirations are 24/min, and blood pressure is 85/58 mm Hg. Examination shows jugular venous distension.  Breath sounds are decreased on the right and the trachea is deviated to the left.  Which of the following is the most likely cause of this patient's hypotension?

A previously healthy 35-year-old lady arrives at the hospital after several days of productive coughing accompanied by chills and fever. Her sputum is purulent, with slight pink blood streaks. Deep inspiration has also caused acute discomfort throughout the right shoulder and neck area. The patient's medical history is ordinary. Her temperature is 38.3 degrees Celsius (101 degrees Fahrenheit), her blood pressure is 130/70 mm Hg, her pulse is 98 bpm, and her respirations are 22 /minute. The right lower pulmonary lobe exhibits crackles and dullness on examination. The examiner has the patient speak the letter "E" while listening with the stethoscope over the right midback, and the sound is heard by the examiner as a loud letter "A." A chest x-ray is obtained and is shown in the image below. The pain experienced by this patient is most likely carried by which of the following nerves?

A 40-year-old woman presented to the office complaining of a neck mass. The mass was first noticed 5 months ago during showering. The mass grew in size since that time. It is not associated with pain, weight loss, swallowing difficulty, or breathing difficulty. On examination, the patient has the right thyroid lobe mass. There is no lymphadenopathy. Fine-needle aspiration shows follicular tumor. The patient is sent for thyroidectomy. During the procedure, the surgeon is trying to ligate the inferior thyroid artery, which of the following structures is at risk for injury?