Exam 1: Anatomy

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, the short saphenous vein is used as a bypass. How we can access the short vein?

A 36-year-old man is evaluated for double vision. He has an abnormal vision for the whole day yesterday. Today, the patient started having double vision. He does not have prior medical or surgical history. Physical examination shows abnormal pupil reflex. A shining light in the right eye causes right pupil constriction but not the left pupil. Light shining in the left eye causes constriction in the right eye only. Which of the following findings the patient would likely have?

A 25-year-old woman presented to the office due to right-sided groin pain for the last month. One month ago, the patient had surgery for inguinal hernia repair. Since the surgery, the patient has had recurrent right-sided groin pain which is exacerbated by coughing and physical activity. She has no previous medical or surgical history. On physical examination, she has no motor weakness in the anterior abdominal or lower extremity muscles. Stroking the skin of the upper medial thigh or the skin of the mons pubis elicits pain. She is diagnosed with entrapment of a nerve that traverses the superficial inguinal ring with the spermatic cord. Which of the following nerves is affected in this patient?

A 37-year obese man comes to the office for bariatric surgery for his morbid obesity. The patient has tried several non-pharmacological techniques all of which did not work with the patient. The patient is diagnosed with diabetes mellitus type 2 and obstructive sleep apnea. His body mass index is 45 kg/m2. The patient was advised about laparoscopic band ligation around the cardiac part of the stomach. To encircle the band around the stomach, the band will pass through which of the following structures?

A 65-year-old man is sent to the emergency room owing to a sudden change in mental state. The patient was eating supper with his family when he began to struggle with his fork and seemed bewildered. Type 2 diabetes, hyperlipidemia, and hypertension are among the other medical disorders. The patient is a high school mathematics teacher with a smoking history of 40 packs per year. The blood pressure is 180/98 mm Hg, and the pulse rate is 98 beats per minute. Physical examination reveals that the patient is well-oriented, responds correctly to inquiries, and has no motor, sensory, or visual abnormalities. He can't add basic numbers like 17 + 9; he also can't recognize or distinguish his fingers. Which of the following brain areas is most likely affected in this patient?

A 69-year-old man comes to the office complaining of right side earache. On examination, there is middle ear effusion. Neck examination revealed an enlarged anterior cervical lymph node. Needle biopsy of the lymph node reveals the regional spread of squamous cell carcinoma. What is the site of the primary malignancy?

A 67-year-old woman comes to the office complaining of vomiting for the past several months. The vomiting is associated with postprandial crampy abdominal pain. The vomiting has bilious character. During the past 3 months, the patient lost 15 lbs. Physical examination was unremarkable. A CT scan with contrast of the abdomen reveals a mass in the transverse portion of the duodenum that is infiltrating the surrounding tissues. Which of the following structures is at risk for compression by this tumor?

A 16-year-old kid is sent to the emergency room with significant right groin discomfort that has developed during the last 12 hours. The patient has experienced multiple occurrences of minor scrotal soreness while going between classes at school throughout the previous month. He has no serious injury history and is sexually active. Except for an inguinal hernia corrected a year ago, my medical history is ordinary. The temperature is 36.9 C (98.4 F), the blood pressure is 116/78 mm Hg, and the pulse rate is 86 beats per minute. The right hemiscrotum is enlarged and painful on inspection. The picture below depicts a bisected gross specimen from an orchiectomy. Which of the following is the most likely mechanism of this patient's acute testicular pain?

A 16-year-old boy arrives at the emergency department with right knee discomfort following a tumble. His symptoms began following a skiing mishap in which he wrenched his right lower leg outward relative to the thigh. He has no medical issues and is not currently on any drugs. There is edema and pain on the medial area of the right knee on examination. When a mild force is given to the lateral knee while the lower leg remains motionless, the medial joint line widens. Which of the following indicated structures in this patient is most likely injured?

A 65-year-old man arrives at the emergency department with acute slurred speech. He is likewise weak on the right side, although he denies any damage, headache, or loss of consciousness. His medical issues include hypertension and type 2 diabetes. For the past 20 years, the patient has smoked one pack of cigarettes every day. A neurologic examination reveals right-sided lower facial droop, with the forehead muscles spared. Motor strength on the right is 3/5 and on the left is 5/5, with a Babinski response on the right. His right upper and lower limbs are similarly affected by dysmetria and dysdiadochokinesia. As illustrated in the figure below, an MRI of the brain indicates an acute lacunar infarct in the brainstem. Which of the following cranial nerves exits the brainstem closest to the level affected by this patient's stroke?

A 62-year-old man comes to the clinic due to feeling food stuck in his throat. The symptoms have started 1 month ago. Additionally, the patient has shortness of breath. The patient is a heavy smoker, has smoked 2 packs of cigarettes per day for the last 20 years. Laryngoscopy reveals a mass in the right piriform recess. Which of the following nerves are located in the piriform recess?

A 75-year-old man presented to the office complaining of severe lower back pain. The pain started 2 weeks ago. The patient did not receive any trauma. The patient describes that in the last 4 months he has had difficulty in initiating urination and a weak urinary stream. The patient has a medical history of chronic hypertension and hyperlipidemia. The patient has been smoking one pack of cigarettes for the last 35 years. On examination, there is tenderness in the lower side of the back. A bone scan revealed an osteoblastic lesion in the lumbar region of the vertebrae. Which of the following structures is involved in the spread of the primary lesion?

A 60-year-old patient was diagnosed with persistent atrial fibrillation associated with rapid ventricular response. The patient was referred for radiofrequency ablation, to ablate the ectopic foci at the pulmonary veins ostia. The patient was accessed through femoral vein to reach the left atrium the catheter will pass through which of the following?

A 29-year-old woman presented to the clinic complaining of recurrent abdominal pain, epigastric fullness, vomiting, and weight loss. On physical examination, the patient has epigastric fullness and visible peristalsis. The upper barium study was done, and showed distended stomach and distended duodenum with a cutoff point at the level of the third part of the duodenum. Conservative measures failed to treat the patient. A laparotomy was done which showed that there is a decreased angle between the aorta and the superior mesenteric artery. Which of the following structures is most likely to be obstructed by the artery?

A 72-year-old man was admitted to the hospital diagnosed with non-ST elevation MI. The patient is scheduled for cardiac catheterization in the following murmur. During the night round, the attending doctor notices a new-onset first-degree atrioventricular block. The patient is known to be left-dominant circulation, what is the affected artery?

A 55-year-old right-handed man arrives at the emergency room with a severe, throbbing right-sided headache and double vision. His medical history includes uncontrolled hypertension and a long history of cigarette usage. A neurologic evaluation reveals that he is awake, attentive, and oriented, as well as capable of following orders. Both the visual fields and the optic fundi are normal. The right eye is down and out with ipsilateral ptosis, and the right pupil is dilated and nonresponsive to light and accommodation. The examination of the left eye is normal. Based on this patient's neurologic impairments, which of the following regions in the picture below is most likely to disclose an aneurysm?

A 38-year-old man is brought to the office for a behavioral modification examination. According to his wife, the patient has experienced frequent outbreaks of rage, a gloomy mood, and sleeplessness. Because of his lack of attention and memory, the patient just lost his work as a machine operator. He has also had involuntary, jerky, nonpurposeful motions of the limbs and face for numerous years, which have increasingly deteriorated. These odd motions occur while he is awake but not while he is sleeping. His 55-year-old mother suffers from dementia and has similar odd bodily motions. Which of the following indicated areas of a normal brain is most likely to be impacted by the illness process in this patient?

A 70-year-old man diagnosed with lung cancer presented to the office for chest pain control. The patient was diagnosed with adenocarcinoma of the left upper lobe. Cancer has spread to reach the pleura and the 2nd and 3rd ribs. He is complaining of severe chest pain that wakes him up each night. Opioid analgesics could not be tolerated due to the side effect of sedation. A nerve block is planned. Which of the following nerves would be the target for the nerve block?

A 70-year-old man is evaluated in the office due to right arm pain after a fall from a height. The patient is known to have hypertension. On examination, there is bruising over the right shoulder. The movement of the right arm is restricted due to the pain. Radiological imaging shows a right humeral fracture at the anatomical neck. The patient is most likely at risk for which of the following injuries?

A 25-year-old man is evaluated in the emergency department after he had a motor vehicle collision. A metallic bar is found embedded in his left arm. His vital signs are normal. According to the physical examination, the proximal forearm has been stabbed with a metallic bar. During the surgical repair, a nerve passing between the flexor digitorum profundus and superficialis is found transected. Which of the following actions would be affected?