Exam 1: Anatomy

A 45-year-old man presented to the clinic due to hoarseness that started in the past month. Additionally, he has had solid food dysphagia for the past several months. The patient was diagnosed with rheumatic heart disease during childhood. The patient was referred to a gastroenterologist for investigations regarding her dysphagia. During barium swallow, the esophagus has compression at the level of mid-thorax. The patient has enlargement in which of the following chambers?

Following a ground-level fall at home, a 46-year-old woman is transported to the emergency room by ambulance. She slid out of the shower and landed on her left knee on the tile floor. The patient is unable to walk due to acute left knee pain and edema. The examination reveals a knee contusion and soft tissue edema, as well as a substantial knee effusion. The picture below shows an X-ray of the knee: Which of the following examination findings would most likely be seen in this patient?

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?

A 65-year-old woman is admitted to the hospital for a total abdominal hysterectomy with bilateral salpingo-oophorectomy for endometrial cancer. The patient has no other medical conditions and no prior surgeries. After the surgery, she develops left-sided back pain. The patient urinated normally after the surgery. The presentation is explained by injury to which of the following structures?

A 68-year-old man is tested for left-eye vision loss that improved spontaneously after several hours. The patient has a history of high blood pressure, type 2 diabetes, coronary artery disease, and ischemic cardiomyopathy. For the past 40 years, he has smoked a pack of cigarettes every day. A left carotid bruit is seen on physical examination, but no neurologic abnormalities are found. A carotid duplex ultrasound reveals an 85 percent blockage of the left internal carotid artery, prompting carotid angiography with stenting. Atherosclerotic material embolizes to the artery depicted (red arrow) on the cerebral magnetic resonance angiograph below during the treatment. Which of the following actions is most likely to be impaired in this patient?

A 48-year-old woman is evaluated in the office due to left shoulder pain. This pain affected her function in the house chores. The pain progressed over the previous months, and she is unable now to do minimal activities like dressing. Radiological imaging shows calcification in the supraspinatus muscle tendon. Which of the following actions would exacerbate the pain?

A 63-year-old man presented to the clinic due to a chronic cough of two months duration. The patient notices blood in the cough in the morning. He has smoked 3 packs of cigarettes daily for the past 20 years. On examination, the right side of the face is engorged, red, and swollen. The right arm and the right side of the neck are swollen, with engorged subcutaneous veins. Which of the following structures is obstructed in this patient?

A 3-year-old girl is admitted to the emergency department due to persistent epistaxis. The girl uses to have nasal bleeding due to nose-picking. The parents used to use nasal pinching to stop the bleeding. The patient has been bleeding for the last 30 minutes, and it did not stop with pinching. There is a negative history of bleeding disorders. She does not have allergies. Cauterization was done, which stopped the bleeding. What is the proper site for applying the cautery?

A 65-year-old man comes to the office due to abdominal distension. The abdominal distention started two months ago. The patient was diagnosed previously with hepatitis C. On examination, his temperature is 36.7 C (98 F), blood pressure is 120/78 mm Hg, the pulse is 82/min and respirations are 20/min. The abdomen is distended, with yellowish discoloration of skin and icterus. The paraumbilical veins are engorged. There are multiple spider nevi over the chest and the arms. Which of the following structures has increased pressure?

A 54-year-old man arrives at the clinic complaining of excruciating discomfort in his left neck and shoulder area for several months. He has also experienced numbness and weakness in his left hand. The patient has no recollection of any big trauma and no prior medical concerns. He attempted chiropractic and massage treatments, but the problems remained. The left upper extremity examination reveals diminished feeling in the palm, index, and middle fingers, as well as weakness in the left wrist extension. The deep tendon reflexes of the left biceps and brachioradialis are normal, while the triceps reflex is weak. The evaluation of the right upper extremity is normal. The most likely cause of this patient's neurologic symptoms is a lesion affecting which of the following identified parts of the brachial plexus?

A 65-year-old woman comes to the office complaining of left limb weakness and fatigue. The pain is exacerbated by raising her hand over her head. The patient's symptoms started after the last hospitalization. Physical examination shows no sensory loss, but the patient lost the ability to abduct the arm above the horizontal line. When the patient is instructed to press against the wall, the left scapula lifts off the thoracic wall. Which of the following conditions is the cause of the patient's presentation?

A 23-year-old woman is suffering from severe visual neuritis. She has had relapsing-remitting multiple sclerosis in the past. Her brain MRI indicates a demyelination region affecting the right optic nerve. Which of the following is most likely to be discovered after a thorough examination of both eyes?

If the transesophageal echocardiogram probe is rotated to face posteriorly at the mid esophagus, what is the closest structure to the probe?

A 23-year-old man is evaluated due to acute left shoulder pain. In a street fight, the patient has received a blow to the arm. Physical examinations show flattening of the left deltoid muscle and loss of sensation in the overlying skin. The bilateral radial pulse is intact. Which of the following injuries explain the patient's presentation?

A 35-year-old man presented to the emergency department due to bloody vomiting. The patient has been drinking alcohol for the last 3 hours, after a heavy meal in the company. He vomited 3 times, in the last time a very large amount of red vomit was seen. Blood pressure is 140/88 mm Hg and pulse is 99/min. Physical examination is unremarkable. An urgent upper endoscopy shows a linear bleeding laceration in the esophagus. The bleeding did not respond to initial endoscopic treatment. Embolization of distal branch of which of the following arteries would control the bleeding?

During an abdominal surgery for intrabdominal cancer, rectus abdominis muscle transection is decided. If it is transected laterally, which of the following structures is at risk for injury?

A 40-year-old woman had delivered a 4.5 kg baby in the last week. The patient is a known case of gestational diabetes mellitus and inherited bleeding disorder. Her BMI is 40 kg/m2. The patient presented to the emergency department with a left calf swelling. Temperature is 36.7 C (98 F), blood pressure is 120/80mm Hg, the pulse is 100/min, and respirations are 15/min. Doppler ultrasonography revealed a left deep venous thrombosis. A filter placement is planned to prevent embolization. A section of the patient's abdominal CT at the level of L2 is shown in the image below. The filter will most likely be placed in which of the following structures?

A 25-year-old man presented to the office due to a severe headache that has been present for the last month. The headache intensifies in the morning and is associated with nausea and vomiting. Brain imaging shows a tumor, with enlarged lateral and third ventricles. The fourth ventricle has a normal size. The patient has an obstruction in which of the following structures?

A 56-year-old-man is admitted to the surgical ward for hepatic tumor resection. The patient was sent to the operating room. During the surgery profuse non-pulsatile bleeding is seen around the liver. The surgeon closes the hepatoduodenal ligament, but the bleeding persists. Which of the following is the source of the persistent bleeding?

A 75-year-old man was admitted to the emergency department after he fell and hit his head against the wall. She does not have any visual or auditory abnormalities. Physical examination shows voice hoarseness, gag reflex loss on the right side, and uvular deviation to the left. The patient has also decreased right shoulder strength. An injury involving which of the following structures would explain this patient's symptom?