Exam 1: Anatomy

A 6-year-old girl is brough to the office due to fever and lethargy for the last 5 days. The patient has a recurrent history of upper respiratory infections. One week ago, she was diagnosed with otitis media, where she did not receive medications. During the last week, she became more lethargic. She has been vomiting for the last two days. During examination, the patient had generalized tonic-clonic seizure. Radiological imaging has showed a 3-cm, ring enhancing lesion in the right temporal lobe. This patient's presentation is most likely due to infection spread from which of the following structures ?

A 30-year-old man comes to the office due to left arm pain and weakness. The patient noticed that the pain started after he slept a night while his left arm was underneath his body. After he woke up, the patient felt numbness and tingling in his left arm. Since then, the patient has had difficulty lifting objects using his left arm. The patient has no history of trauma. On examination, the patient has decreased left elbow flexion with diminished biceps reflex. This patient would have sensory loss over which of the following areas?

A 23-year-old man comes to the office due to left-hand clumsiness. several hours ago, he was climbing a mountain but he lost his balance and fell while climbing. He tried to break the fall by grabbing a branch of a tree with his left hand. The patient did not have any head injury. On examination, he has difficulty with fine movements of the left hand. Which of the following structures is injured?

A 66-year-old woman is evaluated in the office due to epigastric abdominal pain, early satiety, and vomiting for the past 3 months. The patient has been drinking alcohol daily for the past 25 years. The patient has lost 15 lb in the past 3 months. On examination, the patient appears cachectic, and she has splenomegaly. An abdominal CT scan reveals an irregular tumor posterior to the stomach, extending from the greater curvature of the stomach compressing the splenic artery. Splenic artery compression would decrease the blood flow in which of the following arteries?

A 67-year-old woman visits the clinic because she has observed diminished vision in her right eye for the last week. The patient claims that her right eye's vision is "narrower" than her left. Her medical history is notable for hypertension, type 2 diabetes, and hyperlipidemia. She also has intermittent lower limb claudication and has experienced two previous instances of transitory vision loss in her right eye. A right nasal hemianopia is shown by visual field testing. A right internal carotid artery aneurysm is discovered during a head and neck MRI/magnetic resonance angiography. Which of the following visual pathway segments is most likely disturbed in this patient?

An 18-year-old girl is brought to the emergency department due to a left lower extremity sports injury. The patient was playing basketball when he jumped and turned to the left suddenly avoiding contact with another player. He landed on his left foot, extending the knee with the foot internally rotated. He complains of instability of the left knee, and he feels sometimes that he will fall. The physical evaluation shows swelling of the left knee. In addition, there is anterior laxity of the tibia over the femur. Which of the following ligaments is most likely injured?

A 73-year-old woman is brought to the emergency department due to right hip pain.  The patient was getting out of the shower when she slipped and fell directly on her right hip.  She now has pain and swelling over the lateral aspect of her hip and cannot walk without assistance.  Vital signs are within normal limits.  Bilateral pedal pulses are normal, and sensation is intact.  X-ray of the right hip is shown below : Examination of this patient will most likely show impaired function of which of the following muscles?

A 65-year-old man presented to the emergency department due to severe chest pain in the morning. The patient is a known case of coronary artery disease and has done percutaneous coronary intervention (PCI) before. On examination, his blood pressure is 130/90 mm Hg, and pulse is 90/min. ECG was done and showed ST elevation in the anterior leads, so he was referred for a PCI. The PCI failed, so a coronary artery bypass graft (CABG) was decided to be done. During the surgery, a part of the great saphenous vein is used as a bypass. How we can access the great saphenous vein?

A 73-year-old man is admitted to the emergency department due to severe chest pain. He has a history of hypertension. On ECG there is ST elevation in leads II, III, and AvF. Cardiac enzymes are elevated. Which of the following structure would be affected?

A 75-year-old man is admitted to the hospital after being diagnosed with stroke. During the evaluation, the patient is found to suffer from oropharyngeal dysphagia. While he was lying down, the patient vomited and developed aspiration pneumonia. Which of the following segments is most likely affected?

4 weeks later, the patient presents to the emergency department with sudden vision loss in her right eye. Blood pressure is 130/80 mm Hg and pulse is 90/min. On examination, the patient lost completely the vision in the right eye. Neurological examination is unremarkable. Fundoscopic examination revealed cherry-red macula. What is the path for the affected artery?

A 70-year-old woman is admitted to the hospital due to severe lobar pneumonia. The patient is receiving the suitable antibiotics, which were determined by susceptibility tests. She has a medical history of hypertension and diabetes mellitus type 2. Her temperature is 38 C (100.4 F) and her pulse is 95/min. Examination shows dullness to percussion and decreased breath sounds over the right lower lung. A chest tube is placed through an incision in the 5th intercostal space in the midaxillary line. Which of the following muscles is most likely to be dissected during the procedure?

A 26-year-old man presented to the office due to ear itchiness and pain. The patient notices a white fluid draining from the canal this morning. The patient is an Olympic swimmer, who has been training intensively in the last two weeks. On examination, minimal manipulation of the ear induces intense pain. During the otoscopic examination, a speculum was introduced in the meatus close to the posterior wall. During the inspection, the patient lost consciousness. Which of the following nerves is affected in the assessment?

A 75-year-old man is evaluated due to new-onset left foot weakness. The patient has a history of osteoarthritis in the right hip and has undergone total hip arthroplasty. The total hip arthroplasty was done in general anesthesia in the left lateral decubitus. The patient has been complaining of weakness in the left foot. Physical examination shows loss of dorsiflexion and eversion of the left foot. He is unable to extend his left foot toes. The sensation is lost over the dorsum of the left foot. The rest of the neurological examination for both limbs is normal. This patient has an injury in which of the following nerves?

A 25-year-old multiparous woman at 39 weeks of gestation undergoes a vaginal delivery for a 4500-g baby. A few minutes after the delivery of the placenta, the patient has massive vaginal bleeding, with a soft uterus felt on abdominal examination. The patient was started on uterotonic medications and uterine massage. The previous measures failed to control the bleeding. The patient is taken for emergency laparotomy. Emergency bilateral ligation of which of the following arteries would stop the bleeding?

A 20-year-old man presented to the emergency department after he was hit in the eye during a street fight. He has received a direct punch to his left eye. The patient is complaining of double vision that worsens with vertical eye movements. Physical examination shows periorbital redness and exophthalmos. The vertical gaze of the left eye is disrupted. Radiological imaging shows orbital floor fracture. Which of the following features would be noticed in this patient?

A 69-year-old woman is evaluated due to left lower limb weakness. Last week, the patient was admitted for total hip arthroplasty due to osteoarthritis. Postoperatively, she started complaining of left lower limb weakness and numbness. Physical examination shows decreased dorsiflexion, plantar flexion, and knee flexion. In addition, diminished sensation in the posterior surface of the calf, and the dorsum of the left foot. There is an absent ankle reflex on the left side. Which of the following would explain the patient's symptoms?

A myocardial perfusion scan has been ordered for a 50-year-old man. The patient presented with recurrent chest pain exacerbated with exercise, relieved with rest. During the scan, there was inducible ischemia at the inferior wall of the heart. Which of the following coronary arteries is most likely affected in this patient?

A 52-year-old man is brought to the emergency department after he had a motor vehicle accident. The patient complains of inability to urinate with a full bladder sensation. During the insertion of the Foley catheter, the procedure failed due to resistance and pain. A full-body CT scan was done. It revealed right side ribs and pelvic fractures. Which part of the urogenital tract is most likely to be affected?

A 25-year-old man is evaluated in the emergency department due to a head trauma sustained in a motor vehicle collision. He lost consciousness for a few minutes, and trauma is found on the left side of his face. He is complaining of headaches and decreased hearing in the left ear. Physical examination shows that the patient is conscious, oriented, and alert. Cervical and head examination does not show abnormalities. Otoscopic examination of the left ear shows hemotympanum. This patient is at risk for injury in which of the following cranial nerves?