“)aplan Medicals NBDE Qbank - Test Nozita WOR em of100—_ Mark NDE Gbank-Queetone notte ‘The interobular arteries of the kidney result from subdivision ofthe OA. efferent arterioles OB. arcuate arteries OG. interlobar arteries OD. renal artery omvauron ‘The correct answer is B. The renal artery (choice D) enters the kidney atthe hium and immediately divides into the interior arteries (choice C). These arteries supaly the renal pehis and capsule before passing between the ‘medullary pyramids to the cortcomedullary junction. They then bend almost 90 degrees to frm the shor, arching arcuate arteries (choice B), which run along the coricomedulary junction. ‘The arcuate arteries subdivide into the fine iterlobular arteries, These interobular arteries give off branches that become the afferent arterioles (choice A) ofthe glomerulus. Too ‘Ti aplan medicals NBDE Qbank - Test - Mozilla Joe tem 208100 Cl Mark NODE Qbank -Guestons not time |Luminal narrowing of which ofthe following vessels would compromise blood flow through the renal arteries? ‘Abdominal aorta Celiac trunk ©. Common ifae artery ©. Inferior mesenteric artery ‘OE. Superior mesenteric artery ‘Gonauni Sem ‘The correct answer is A. The renal arteries emerge from the abdominal aorta at about the level of the L1/L2 intervertebral disk and travel at neatly right angles to it (on the ight, passing posterior to the inferior vena cava) to enter the hilum of the kidney, The celia trunk (choice B) gives off the common hepatic, splenic, and left gastric arteries, ‘The common iliac artery (choice C) gives off the internal and extemal liac arteries. In addition, an unascended pebic kidney may be supplied by the common ilac artery. ‘The inferior mesenteric artery (choice D) gives off the superior rectal, sigmoid, and left colic arteries. ‘The superior mesenteric artery (choice E) gives off the inferior pancreaticoduodenal, intestinal (ileal and jejunal), right colic, middle colic, and ileocolic arteries,“Wl kaplan Medical: NBDE Qbank -Test - Mozilla Item 3 of 100 7 Mark NBDE Qbank - Questions not time ‘The two most important hormones controling Calcium metabolism are secreted from the: ©, Parathyroid and thyroid glands © B. Thyroid and thymus glands . Adenohypophysis and parathyroid glands ). Adrenal cortex and thyroid glands © B, Parathyroid and adrenal glands ‘The correct answer is A.PTH, o parathyroid hormone, is considered to be the most important hormone controling calcium metabolism. It increases serum calcium by increasing bone mineral resorption by osteoclasts, increasing digestve absorption of calcium, and decreasing calcium excretion by the kidney. PTH is secreted by Principal cells of the parathyroid, The antagonist hormone, caletonin, is secreted by parafolicular cells of the thyroid (folicular cells secrete thyroxin). It reduces serum calcium by promoting calcium depositon in bones, decreasing digestive absorption of calcium, and promoting calcium excretion. Note that the term adenohypophysis in answer choice C refers to the anterior pituitary. This term and neurohypophysis (posterior pituitary) are often used on NBDE. (JOE not times ‘i eplan Masten: NEDE Qhank - Tere Mostla Rem 4 of 100 Mark ‘A patient is involved in an accident which tears the left lateral pterygoid muscle completely. On attempting to open, the Patients mandible will move: NBDE Qbank - Questions OA. Left OB, Right ©6. Inan elevating direction 9D. Ina direct protruding direction The correct answer is A.There are two ways to answer this question. The formulaic method says that damage to a lateral pterygoid or the innervation to it will make the mandible deviate toward the side of the damage. A ‘deeper understanding of the question would show that the lateral pterygoid isthe primary protruder of the mandible. Contraction of both lateral pterygoids produces straight protrusion. Ifthe left lateral pterygoid is torn, the right muscle will begin to protrude the right side, with the let side remaining stable, and acting as a stationary Pivot point. As a result, the mandible wil pivot out and toward the left (the side of injury). Note that damage to muscles or innervation to one side of a tongue will also produce deviation toward the injured side.Til Kaplan Medicat's NBDE Qbank - Test - Mozilla JO tem 6 of 100 Mark NDE Gbank- Questions ‘An inflammatory process in the temporal bone has resulted in a sweling ofthe facial nerve within the facial canal, Which ‘muscle may be paralyzed as a result ofthis compression? not ti OA, Anterior belly ofthe digastric ©B, Genionyoia OC. Stapedius ©. Stylopharyngeus OE, Masseter ‘The correct answer is C. The stapedius muscle is innervated by the facil nerve (cN Vl). This muscle is located in the ‘middle ear and attaches to the neck of the stapes. Contraction ofthe stapedius reduces the amplitude of oscilation of the stapes and thus reduces the perceived loudness of a sound. Paralysis ofthis muscle may result in hyperacusis. Note thatthe seventh nerve also innervates all muscles of facial expression, ‘The anterior belly ofthe digastric muscle (choice A) is a muscle in the floor ofthe mouth that is innervated by the mandibular dvision of the tigeminal nerve. ‘The geniohyoid muscle (choice B) is one of the suprahyoid muscles in the neck. This muscle is innervated by C1 spinal nerve floes that travel fora short distance with the hypoglossal nerve ‘The stylopharyngeus muscle (choice D) is one ofthe longtudinal muscles of the pharynx that acts to elevate the pharynx ‘The masseter muscle (choice E) is one of the muscles of mastication. All ofthe muscles of mastication are innervated by the mandibular division of the trigeminal nerve, DomeNem 60f100 Mark NBDE Qbank - Questions not ‘A patient with paresthesia of the medial side of the hand and forearm undergoes surgery to correct It If the anterior sealene ‘muscle is cut during tis surgery. what nearby nerve must be avoided?” DA. Phrenic nerve © B. Recurrent laryngeal nerve 5G. Superior laryngeal nerve ©. Supraseapular nerve OE. Vagus nerve em ‘The correct answer is A. The patient is suffering from scalene tiangle syndrome (thoracie outlet syndrome). The lower trunk ofthe brachial plerus and the subclavian artery are being compressed between the anterior scalene muscle and the middle ‘scalene muscle Incision ofthe anterior scalene muscle wil elev this compression. The phrenic nerve ls on the anterior ‘surface ofthe anterarsealene muscle deep to the prevertebral fascia If ths ners is cut, the diaphragm on that side of the ‘body will be paralyzed, Anatomically, the phrenic nerve is one of the nerves ofthe cervical plexus. Ths nerve distrbutes to the saphragm other nerves ofthe cervical plexusm including the ansa cervical, lesser occipital transverse cervical, ‘supraciavical, and greater auricular nerves, as well as the cenvcal nerves, ‘The recurrent laryngeal nerve (choice B) is @ branch ofthe vagus nerve. On the left side it recurs around the aortic arch, and ‘on the right side it recurs around the right subclavian artery It ascends tothe larynx inthe tracheoesophageal groove. The eve inervates several laryngeal muscles and the laryngeal mucosa inferior to the vocal folds. It isnot in contact wit the ‘anterior scalene muscle, ‘The superior laryngeal nerve (choice €) is a branch ofthe vagus nerve that arses just after the vagus nerve passes through the jugular foramen. It imervaies the crcothyroid muscle ofthe larynx and the laryngeal mucosa above the vocal folds. The ‘superior laryngeal nerve is notin contact with the anterior scalene muscle. ‘The supraseapular nerve (choice D) is a branch of the upper trunk of the brachial plus. It arises from the upper trunk after the upper trunk has passed between the anterior and middle scalene muscles. The suprascapular nerve inervates the ‘supraspinatus and infraspinatus muscles. “The vagus nerve (choice E) ies within the carotid sheath within the neck. The carotid sheath is anterior tothe prevertebral fascia. The vagus nerve is notin contact withthe anterior sealene muscle, “aenapian neccets neve Wann eet mostie wees em 7100 Mark NBDE Gbenk - Questions not de During embryological development, hematopoiesis occurs in ferent organs at different times. Which ofthe folowing are the correct ‘organs, in the correct sequence, at which hematopoiesis occurs embryologialy? A. Amnion, yok sac, placenta, bone marrow © B, Placenta, iver and spleen, yok sac, bone marow 6, Placenta, spleen and lymphatic organs, bone marrow ©. Yok sac, bone marrow, ver and spleen DE. Yok sac, iver, spleen and lymphatic organs, bone marrow ‘anata ‘The correct answer is E. By the third week of development, hematopoiesis begins inthe blood islands of the yolk sac. Beginning at 1 month of age and continuing unt 7 months of age, blood elements are also formed in the iver. Hematopoiesis ‘occurs in the spleen and lymphatic organs between 2 and 4 mnths. and inthe bone marrow after 4 months.men ‘NBDE Qbank Guetions ot tne Intramuscular injectons should be given in the upper, outer quadrant of the buttocks to prevent damage to which ofthe folowing nerves? ©. Common peroneal 1B. Lateral femoral cutaneous ©, Obturator ©. Sciatic © E, Superior gluteal “The correct answer is D. Injections are glen inthe upper, outer quadrant ofthe buttocks to prevent damage to the sciatle ‘nerve, which is present in the lower quadrant. The other nerves listed are not particularly ulerabie to inectons Into the buttocks. “The common peroneal new (choice A) is a branch ofthe sciatic nerve that verges from itn the popliteal fossa. It then cvs Into the superficial and deep peroneal nerves, ‘The lateral femoral cutaneous nerve (choice B derives from the lumbar plexus, emerges sightly below the anterior superior lac ‘pine, and suppies the skin ofthe anterior thigh dawn tothe knee. ‘The obturator nerve (choice C) derives from the lumbar plexus, diverges from the fernral neve nthe psoas muscle, and passes ‘medially along the lateral pelvic wal to run i the obturator canal, where it divides Into anterior and posterior dhvisions. The ‘anterior division generally suppies the graciés, adductor brevis. and adductor longus; the posterior Ghision generally supplies the ‘obturator extermus and the adductor pat of the adductor magnus. “The superior gluteal nerve (choice E) isa branch ofthe sacral plexus. It supplies the gluteus minimus and medius and the tensor fascia lata. Small branches of this nerve are likely o be encountered in the upper outer quadrant of the buttock, but injection here is relatively safe m9 0100 Mark NODE Gbank-Guestons not tine 'A person sking for the frst time goes too fast and grabs hold ofa tree wih one arm to stop himself. In doing so, he is most ikely to Inure which ofthe folowing? ©. Lower par of the brachial plexus © B, Median nene 0G. Radial neve ©, Unar nerve ©. Upper part ofthe brachial plus ‘The correct answer is A. Grabbing al sometting to stop oneself, a in the above example, or when a skidding motorcyclist ties {0 catch a lamp pole, or delivering the arms in an extended position during a breech deivery, are the more common mechanisms by which the lower part ofthe brachial ples is damaged. The result of this type of injury isthe loss of motor function ofthe intensic and muscles and numbness along the iner aspect ofthe hand (ulnar side). The brachial plexus inervates the shoulder ‘ire and upper mb and divdes into the median, radial, and ulner nerves and ther branches, There are contrbutions from the Ventral rami and spinal nerves C5-7 ino these structures. Damage to the median nerve (choice B) ean happen in carpal tunnel syndrome or when a person attempts to cut their wrists Damage tothe radial neve (choice C) can occur with humeral fractures or when one (often under the influence of alcoho) falls asleep with his or her arm over the back ofa chai. (Damage tothe unar nerve (choice D) can occur when the elbow is stuck (Yunny bone”) Damage tothe upper part ofthe brachial ples (choice E) can occur when someone falls on the point of the shoulder.Rem 10 0f 1000 Mar NBDE Gbank- Questions not tine During the prosess of meiosis. single homologous chromosome pair fais to separate during the frst meiotic division. This flure would be most likely to produce wich ofthe folowing conditions If fertization occurs and an embryo later develops? A. Balanced translocation OB, Triploidy 2. Trisomy ©. Unbalanced translocation OE: Uniploidy ‘Geman “The correct answer is C. Melos is cel dion that produces gametes with half of the normal somatic chromosome complement. The process described is nondsjncton, which wil cause one daughter cel to have 24 chromosomes, we the ‘other wil have 22 chromosomes. When a gamete with the normal 23 chromosomes combines at frtization witha gamete with £22 0r 24 chromosomes, the embryo will have 47 chromosomes (trisomy) or 45 chromosomes (monosomy). Nondijunetion can ‘occur in either the frst or sezond melate dison. Balanced translocation (choice A) occurs when non-homologous chromosomes exchange genetic material in such @ way that no crtieal genetic materials lost, “ripley (choice B) is the term used when a cell has 69 chromosomes (2N or 3 sets), and can occur in tumors or when an egg is fertized by two sperm, ‘An unbalanced translocation (choice D) occurs when non-homologous chromasomes exchange genetic material with anet loss or {ain of ertical genetic materia Uniplody (choice E) isthe state of having 23 chromosomes, seen normally in sperm andl eggs em 1491100 Wark NDE Gbank- Guertin rote 'A malian gets @ severe bite wound from a pitbull garding a junkyard. The wound is cleansed and he receives a booster inection of tetanus toxoid and an injection of penicin G. Several days later, the wound fs inflamed and pure. The exudate is cultured on blood ‘agar and yields gram-negative rods. Antibiot sensitity tests are pending. The most ikely agent to be isolated is. OR. Bartonella henselae OB, Brucella canis €. Clostricium tetani ©D, Pasteurella muitocida ‘emanate ‘The correct answer is D. Pasteurella multocida isa gram-negalve rod that is normal flora ofthe oral cavity of dogs and cals. It often causes a local abscess following introduction under the skin by an animal bite. Most cases occur inchicren who are ijured Whe playing witha pet Barfonelia henselae (choice A) isa very smal, gram-negative bacterium that is closely related to the rickettsia, although itis abe fo grow on Ifeless media, Is the cause of cat-scratch disease (a local, chronic lymphadenitis most commonly seen in children) and bacilary angiomatosis (seen particulary in patients with AIDS). In this latter patent population, the organism causes proiferato of blood and iymphatc vessels, causing @ characteristic "mulberry’ lesion inthe skin and subcutaneous tissues ofthe afficted inviual ‘Brucella canis(choice B) is a gram-negative rod thats @ zoonotic agent. Its norma hosts the dog, but when it gains access to humans, it causes an undulating febile disease with malaise, lymphadenopathy, and hepatesplenomegaly. The normal route of ‘exposure is by way of ingestion of the organism. Closticium tetani(choice C) i a gram-positve spore-forming anaerobic rod. It causes tetanus (a spaste paralysis caused by ‘etanospasmin), There may be no lesion atthe site of inoculation, and exudation would be extremely rareom 1201100 Wark ‘NODE Qbank - Gusstione Pain sensation from the upper posterior pharynx caried by which cranial nerve? rottime ‘The correct answer is D. The glossopharyngeal nerve (IK) cartes general somatic sensation from the posterior pat ofthe ‘upper pharynx, eustachian tube, and posterior one-third of the tongue. It also caries taste sensation from the posterior one-third ‘of the tongue; conveys afferent fibers from the cartid sinus baroreceptors and caratid body chemoreceptors; and conveys efferent fbers to the styopharyngeus muscle ‘The oculomotor nerve I, choice A) supplies the extraocular muscles (superior, inferior, medial re levator palpebrae superiors muscles, and sends parasympathetic fibers tothe cilary muscle andi. nd inferior obique) and ‘The trigeminal neve (V, choice B) receives somatic sensation information fram the face, ps, gums, teth, palate, and anterior ‘two-thirds ofthe tongue. ‘The facial nerve (Vl, choice C) caries taste sensation from the anterior two-thirds ofthe tongue. It supplies motor inervation to the muscles of facial expression and tothe slapedius muscle, and sends parasympathetic fibers tothe lacrimal, submandibular, ‘and subingual glands, ‘The vagus nerve (X, choice E) caries sensation from the lower part ofthe posterior pharynx, laryms, trachea, and esophagus. It ‘supplies parasympathetic nervation to the thoracic and abominal viscera to the left coke eure, nem 1301100 Omak TNEDE Ghani Quettons ret tne Following the healing of atbial fracture, a patient forms a small new piece of able bone near the jon (heterotopie ossifcaton), which is interfering wit ont moblity. Which ofthe folowing isthe source of the osteoblasts that formed this bone? ‘©. Cancelous bone near the fracture ©B. Circulating stem ceis ©. Compact bone near the fracture 6D. Marrow OE, Periosteum ‘The correct answer is E. The source of bone-orming cells folowing a fracture isthe damaged periosteum. Occasionally, some cf these cells become “ost” and can form smal pieces of inappropriately located bone tha impair ont movement. Except in jont caviles, where they are covered by a layer of hyaline catiage, bone surfaces are covered by the periosteum. The periosteum is composed of an outer fibrous and inner cellar layer. The periosteum assists inthe attachment ofa bone to surounding tissues and associated tendons and igaments ‘Surprisingly, nether the cancellous (choice A) nor the compact (choice C) bone near the fracture isthe source ofthe bone-forming ces, Circulating stem cots (choice B) can repopulate damaged bone marrow (choice D), but nether the bone marrow nor the circulating stem cals s the source ofthe Bone-forming celnot tine ‘karyotypic analysis ofa spontaneously aborted fetus demonstrates trisomy of one ofthe chromosomes. Which chromosome is most kel to be affected? AB OB 13 oe. 18 oD. 18 OE 21 Ooms item 14014000 Mark NBDE Gbank- Questions ‘The correct answer is C. Approximately half ofa spontaneous abortions are of fetuses with major chromosomal defects, most ‘commonly trisomy 16, triplody (due to fertizaion of an egg by two sperm), and 45 X.0 (Turner's syndrome). Trisomy 16 and trploidy do nat produce viable offspring, unike 4 X.0, ‘Trisomy 8 (choice A) is one ofthe very rare causes of lve bth somes. Trisomy 13 (cholee B) i one ofthe more common Wve bith tsomy syndromes (Patau syndrome). Trisomy 18 (cholee Ds one ofthe more common Wve bith tsomy syndromes (Edwards syndrome) Tiisomy 21 (choice E) causes Down's syndrome. ‘nem 1501700 0 tae NGDE Gbenk Questions ot tne ‘The superior ophthalmic vein directly communicates with wich ofthe folowing dural venous sinuses? ©, Cavernous sinus OB, Ocriptal sus OC. Sigmoid sinus ©. Superior petrosal sinus OE, Straight sinus ‘Ooms ‘The correct answer is A. The anterior continuation ofthe cavernous sins, the superior ophthalme vein, passes through the superior orbital fissure to enter the ori, Veins of the face communicate withthe superior ophthalme ven. Because of the absence of valves in emissary veins, venous low may occur in ether direction. Cutaneous infections may be carried into the {cavernous sinus and result in @ cavernous sinus infection, which may ead to an infected cavernous sinus thrombosis. The cavernous sinus is lateral tothe ptutary gland and contains portions of cranial nerves Il IV. V1, V2, and VI, and the internal carotid artery, “The occipital snus (choice B) is a the base ofthe fa cerebal in the posterior eranal fossa. It drains into the confuence of ‘The sigmed sinus (choice C) is the anterior continuation ofthe transverse sinus in the middle cranial fossa, The sigmoid sinus passes through the jugular foramen and drains into th internal jugular vel, “The superior petrosal sinus (choice D) is atthe apex of the petrous portion of the temporal bone and is a posterior continuation ofthe cavernous sinus. The superior petrosal sinus connects the cavernous sinus wit the sigmoid sinus, “The straight sinus (choice E)is atthe intersection of the falxcerebr andthe falx cerebel inthe posterareranal fossa, The straight sinus connects the inferior sagittal sinus wit the confuence of sinuses,em 16 of 100 Ci Mer NBDE Qbank - Questions ott 'A patient ie unable to close her right eye. Physical evamination reveals weakness ofthe right orbeularis abut, Which ofthe following ‘adational symptoms would likely also be present? © A, Blurred vision OB. Hyperacusis ©. Inabity to chew © D. Inaba to feel the face OE. Inabity to shrug the shoulder ‘Comune ‘The correct answer B. The facial nerve innervates the muscles of facial expression. The visceral motor portion innervates the lacrimal gland and nasal mucous glands via the sphenopalatne gangion. The submandibular and subingual salivary glands are iervated via the submandiubiar ganglon. This patent has a lesion of the facial nerve (Vil), which leads to an inablly to close the ipsilateral eye because of damaged motor fibers to the arbeularis obul. This patient would also lose her corneal reflex on that ‘Side because ofan inabity to bink and would have ipsilateral paralysis ofthe muscles of facial expression distal tothe lesion. If the lesion affected the facial neve more proximal, addtional ndings woud be hyperacusis (increased sensitivity to sound because of stapedius muscle paralysis), lack of taste sensation inthe anterior two-thirds ofthe tongue, and distubedlacrimation ‘and salvation ‘Blurred vision (choice A) could occur wit lesions of the oculomotor (CN Il), abducens (CN Vi) oF trochlear (CN IV) nerves, hich innervate the extraocular muscles. CN Ill inervates the medal rectus, inferior rectus, superior rectus, and inferor oblique ‘muscles. CN VI inervates the lateral rectus and CN IV inervates the superior obique. {An inability te chew (choice C) would probably be the result ofa lesion ofthe trigeminal nerve (CN V). Motor fibers of CN V Innervate the muscles of mastication (temporal, masseter, and medial and lateral pterygord muscles), and alesion ofthese fibers may cause the jaw to deviate tothe side ofthe weak muscles ‘An inabilty to fee! the face (choice D) would also be the result ofa CN V leslon. This lesion could result in the ipstatera lass of (general sensation of the face and aso ofthe mucous membranes of the oral and nasal caves. ‘lesion of the accessory nerve (CN XI) would cause paralysis ofthe trapezius muscle, which resuts ina sagging ofthe shoulder and a weakness in attempting to shrug the shoulder (choice E). em 17 9 1000 Mark NODE Ghani Guestions nottine Ligation of which ofthe folowing arteries would be most likely to produce the most significant ischemic damage tothe cerebrum? OA. Anterior cerebral artery at its origin from the internal carotid artery 1B, Anterior communicating artery ©, Middle cerebral artery atts origin from the internal carotid artery © D, Posterior cerebral artery a its origin from the basilar artery ©. Posterior communicating artery ‘The correct answer is C. The circle of Wilis isa seres of arterial anastomoses that cle around the pituitary stalk at the ventral surface ofthe brain, Specifically, the circle of Wis encircles the infundibulum ofthe ptutary gland, Hence, the brain can receive blood from either the caroids or the vertebral. If any ofthe vessels ofthe circle of Wiis become blocked, blood can be routed through the remaining vessels. The object of ths queston isto determine which vessel does not belong tothe circle of ‘Wis. Of the options sted, only the middle cerebral artery does not belong to te circle and instead courses laterally to supply the entire lateral convexity ofthe bran, Therefore, ligation of this vessel would produce the most ischemic damage.Rem 18 9 1000 Mark NODE Qbank Guestions nottine Microscopic examination of a section of @ normal young adult ovary reveals large numbers of unusually large cells surrounded by a ‘ingle layer of fat epithetal els. In which phase of the cell cycle are these cels arrested? A, Diplotene stage of the first meiotic dvison © B, Diplotene stage of the second meiotic dvision (OG. Metaphase stage of nvtosis ©. Prophase stage of nvtosis © . Prophase stage ofthe second meiotic division ‘The correct answer is A. The cells described are the primordial eggs, which remain stopped in the dpllene stage ofthe frst Ie'oticdvsion ftom before bith uni fertization, a period which may be 40 or more years. Choices B and E are incorrect because the oovytes are stopped in the fist, not the second, metic dvsion, ‘Choices ¢ and D are incorrect because the cells described are oocytes and are not in mitosis, nem 19 0 100 Mae NBDE Qbank Guetions ot tne \Whhen removing an impacted mandibular thd molar, the oral surgeon must wam the patient of possible lasting numbness ofthe tp of the tongue. Ths loss of general sensation is due to damage tothe OA. aureulotemporal nerve ©. chorda tympani © 6, lingual nerve ©. mental nerve OE. myfohyoid nerve ‘The correct answer is C. The ingual nerve is @ branch ofthe mandibular dislon ofthe trigeminal nerve that conveys general sensaton from the anterior two thirds ofthe tongue. It enters the orl cavty by passing just under the mandibular third molar between the medial pterygoid muscle and the mandibular ramus. “The aurculotemporal nerve (choice A) is branch of V3 that passes from the infatemporal fossa tothe parotid region It ‘contains sensory flbers from the region in font ofthe ear and the temporomandibular joint and also conveys postganglionic parasympathetic fibers tothe parotid salvary gland, “The chorda tympani (choice B) is a branch of CN VI that travels withthe lingual ene in the floor ofthe mouth It caries taste fiers from the anteror two thirds of the tongue and preganglionic parasympathete fibers that synapse in the submandibular ‘ganglion. “The mental nerve (cholee D) isa sensory branch ofthe inferlor alveolar nerve that supplies the skin of the chin and lower lp, “The mylohyoid nerve (choice €) is a motor branch of the inferior alveolar nerve that supples the mylohyoid and anterior bely of the digastric muscles.om 20 of 00 C1 Mark SDE bank - Questions notte ‘A neonate is observed to have a cleft ip. Which of the flowing is the most ikely etiology ofthis matformation? © A. Abnormal development of the third and fourth pharyngeal pouches © B. Bony detects of the malar bone and mandible 156. Failure of the mavilary processes and medial nasal swelings to fuse 5D. Incomplete jing of the palatine sheWves| 1, Insuffeient mgration of neural crest celle ‘Seta ‘The correct answer is. Clef lip is caused by the fare ofthe maxilary processes to fuse with the medial nasal swellings, ‘Abnormal development of the third and fourth pharyngeal pouches (choice A) ean give rise to DiGeorge syndrome, which is characterized by the underdevelopment or absence of several structures, including the thymus and parathyroid Bony defects ofthe malar bone and mandible (cholce B) are associated vith mandibuofacal dysostosis, whichis mainly due to abnormal development of derivatives of te fst arch, Tis conditon is characterized by downward sloping palpebral fissures: hypoplasia ofthe malar and mandibular bones: macrostomia high or cleft palate: abnormally shaped, low-set ears; and unusual hair growth pattems. Insufficient mgraton of neural crest cels (choice E) is an important factor as well |When the palatine shelves falto jon together (choice D), cle palate reste. Cleft ip and cleft palate commonly co-occur. tem 21 of 00 Cs Mark NODE Qbenk - Questions ot tn Which ofthe folowing pharyngeal pouches develops into the palatine tonsi? OR Fist 8, Second 06. Third ©. Fourth OE. Fifth ‘Seana ‘The correct answer is B. The epithelial ining ofthe second pharyngeal pouch buds into the mesenchyme to form the palatine tonsi, Part ofthe pouch remains in the adult asthe tonsilar fossa Itis important to review the other cholees because pharyngeal pouch derivatives are typically tested on the NBDE part 1. ‘Te frst pharyngeal pouch (choice A) develops into the middle ear cavity and eustachian tube. ‘The third pharyngeal pouch (choice C) develops into the thymus and the inferior parathyroid glands. ‘The fourth pharyngeal pouch (choice D) gies rise to the superior parathyroid glands. Recall that abnormal development ofthe third and fourth pouches leads to DiGeorge syndrome and results in hypocalzema, as well as abnormal cellular immunty and consequent susceptiity to viral and fungal nesses. ‘The fth pharyngeal pouch (choice E) gives rse to the C cells of the thyroid gland, These cells secrete calcitonin, a hormone that ‘owers serum caleum,Tem 201 100 CM NBDE Ghani Quertone ot tne ‘Stimulation and pressure on the ear canal can sometimees resutin fainting, This is because the posterior half ofthe external ear canal receives innervation from the ©. auricular branch of the vague nerve OB. aureulotemporal neve 56. greater auncular neve 0D. lesser occipital neve OB, vesibdacatlar neve ‘The correct answer is A. The vagus nerve, through its auricular branch, supples the posterior half of the extemal auditory ‘meatus. Because the vagus also suppies many other organs, reflex symptoms may occur, including fainting (typicaly inthe elderly), coughing, and gagging. The vagus nerve is sensory from the pharynx, pina and external auditory canal, iaphragm, and \sveral organs in the thorasle and abdominopelve caves, It's a mator nerve tothe palatal and pharyngeal museles and visceral ‘organs in thoracic and abdominal cavites. ‘The auriculotemporal nerve (choice B) suppes the anterior haf ofthe external aultory meatus and the fecal surface ofthe upper part ofthe auricle ‘The greater auricular nerve (choice C) suppies both surfaces ofthe lower part ofthe auricle ‘The lesser occipital nerve (choice D) suppes the cranial surface ofthe upper part ofthe auricle. ‘The vestbulococtiear nerve (choice E) supplies hearing and motion sense, inom 2501100) ark NBDE Gbenk = Questions Tot te Which ofthe folowing cranial nerves cares the pain sensation from the tip of tongue? ‘Omar ‘The correct answer is B. This question is essentially asking "which ofthe folowing nerves innervates the tip ofthe tongue?” The innervation ofthe tongue is complex. The mandibular dision ofthe trigeminal nerve (V3) caries general somatic sensation from the anterior two-thirds ofthe tongue. The mandibuar branch is also a Sensory nerve forthe lower gingiva, teeth, and lips, as well 2s the palate. “The maxilary dision (V2, choice A) carries somatic sensation from the palate, upper gingiva, and upper ip, as well asthe lower ‘eyed, cheek, nose, and portion of the pharynx “The facial nerve (Vl, choice C) caries taste from the anterior two-thirds ofthe tongue, as well as innervating the lacrimal gland and the submandbular and subingual salvary glands “The glossopharyngeal nerve (IX, choice D) carries sensation and taste from the posterior one-third of the tongue “The vagus nerve (x, choice E) carries sensation from the lower pharynx.‘nem 24 of 00 CI Mer TNGDE Gbenk -Quentions ot tt ‘An aneurysm of the axilary artery within the axa is mest ikely to compress which ofthe folowing neural structures? OA, Aillary nerve ©B. Long thoracic newe ‘26. Lower trunk ofthe brachial plexus ©. Medial cord of the brachial plexus ‘OE. Musculocutaneous nerve ‘Geta ‘The correct answer is D. Within the axa, the axilary artery is within the ailary sheath and is surrounded by the three cords of the brachial plex, which are also within the axillary sheath, An aneurysm ofthe ailary artery may compress any ofthe three cords. The brachial plews innervates the shoulder gre and upper mb with contributions from the ventral rami of spinal nerves (C5-Ti, The nerves that form this plenus ongiate from trunks and cords named according to thelr anatomical locaton. ‘The anllary nerve (choice A) isa branch ofthe posterior cord that leaves the axilary sheath, then ets the axila through the ‘quadrangular space to innervate the deltoid muscle ‘The long thoracic nerve (choice B) is not within the axillary sheath. It arses from the anterior rami of theft, sith, and seventh cervieal nerves in the neck and courses along the chest wall o innervate the serratus anterior muscle ‘The lower trunk of the brachial plexus (choice C) Is nat nthe aaa. tis formed n the neck from the anterior rami of the elghth cervical and frst thorace spinal nerves, ‘The musculocutaneous nerve (choice E) isnot within the axlary sheath It arises as a branch of the lateral cord ofthe brachial plexus and enters the arm to innervate the muscles of the anterior compartment of the arm. inom 2601100 CMa NODE Qbank Guestione roti ‘An infantis bom with an abnormally developed faliform bgament. The hepatogastrc and hepatoduodenal ligaments are also ‘malformed. These developmental anomalies are mast bkely due to abnormal development of the . dorsal mesoduodenum 3. dorsal mesogasiiam 5. perearcopertoneal canal . Pleuropercarcial membranes ventral mesentery ‘Comat ‘The correct answer is E. The ventral mesentery forms the faéform fgament, Igamentum teres, and lesser omentum, which can be divided into the hepatogastic and hepateduodenaligament. ‘The dorsal mesoduodenum (choice A) isthe mesentery ofthe developing duodenum, which later disappears so that the duodenum and pancreas lie retroperitoneal. ‘Both omental bursa and the greater omentum are derived fom the dorsal mesogastrum (choice the stomach region hich isthe mesentery of ‘The periardiopertoneal canal (choice €) embryologcaly connects the thoracic and peritoneal canals. ‘The pleuropercardial membranes (choice D) become the pericardium and contrbute to the diaphragm.em 26 f100 C1 Mark TNEDE Qbank Guertone notte ‘A man’s chest is compressed during a car acldent, causing a posterior displacement of the clavicle atthe sternoclavicular ont, Which of the following structures would be most at risk? OA. Aorta OB, Esophagus e. Heart 5D. Superior vena cava OE, Trachea ‘The correct answer is E. The stemoclavicular jin is quite strong and distocates ony wit cfeulty. Dislocations, particulary posterior dislocations, ae occastonaly seen and may be dangerous because of impingement onto the trachea, causing ‘respiratory diffcutes. The trachea is a tough flexible tube witha diameter of approximately 25 cm and a length of approximately ‘em, The trachea begins anterior to the vertebra C6 ina byamentous attachment tothe cicodcartage and ends inthe mediastinum atthe level of vertebra TS. At this point branches to form the right and let primary bronchi ‘Both the aorta (choice A) and the superior vena cava (cholee D) are more posterior than the trachea and are therefore less winerabie ‘The esophagus (choice B) is located behind the trachea and is less vulnerable, ‘The heart (choice C) bes below the clavile and woul not be at particular sk nem 270 00 Mack not tine 'A.CT scan reveals a small tumor atthe cerebellopontne angle ofthe brain, Witch ofthe folowing nerves is most key to be affected by this tumor? NDE Gbank- Questions . Facial nerve 3. Glossopharyngeal nerve 6. Optic nerve SD. Trigeminal neve OE, Vagus nene ‘Sum ‘The correct answer is A. The facial nerve and the vestbulecochlear nerves emerge from the brain stem at the cerebeopontine angle. These are the two nerves that wil be intaly affected by a tumor inthis region. The entre anatomy ofthe facial nerve is as fellows: the facial nerve originates from the taste receptors onthe anterior 2/3 ofthe tongue (sensory) and trom nucle of the pons (motor) It passes through the internal acouste canal ofthe temporal bone to reach the styfomastod foramen. ‘The glossopharyngeal and vagus nerves (choices B and E) emerge from the brain stem atthe postoivary sulcus. This caudal to the cerebellopontine angie. ‘The optic nerve (choice C) exis from the optic chiasm on the ventral surface of the diencephalon. This is rostral tothe cerebelopontine angle. “The trigeminal nene (choice D) emerges from the brain stem at the anterolateral surface of the pons, This i rostral and ventral to the cerebellopontne ange.nem 280100 Chae THEE Qbank Guewions ot tne Ifthe tongue deviates tothe right sde when protruded, the most ikely eause is paralysis of which of he folowing muscles? OA, Lek genioglossus OB, Lett hyogiossus OC. Let palategiossus ©. Right geniogiossus GE. Right nyoglossus ‘Ooms ‘The correct answer is D. The genioglossus muscle is innervated by the hypoglossal nerve. The function ofthe gerioglossus Imusele isto ul the tongue forward (protrude) and toward the opposite side. When the right genioglessus muscle is paralyzed, the let geniogiossus muscle pulls the tongue forward and tothe right, 1 the lft genioglossus muscle were paralyzed (choice A), the tongue Would deviate toward the let on protrusion because ofthe unopposed action ofthe right genioglossus muscle. The lft genoglossus muscle isinervated by the left hypoglossal nerve. “The hyogiossus muscles (choices B and) are innervated by the hypoglossal nerves. The function ofthese muscles isto retract, the tongue, These muscles are nat active during protrusion of the tongue. “The palatogiossus muscle (choice C) are innervated by the vagus nerves rather than the hypoglossal nerves. Their functions to pull the tongue back (retract) and upward toward the palate, ‘nem 299100 Ch Mark NBDE Ghani Guevions rot te ‘A woman sulflers a facture ofthe lft tenth and eleventh ribs. Which of the folowing organs ls most likely to have been injured by these fractured ribs? © A, Descending colon enum ©. Lef adrenal gland »D. Left kidney E. Spleen ‘Gea ‘The correct answer is E. The spleen is a soft rable organ with a tin capsule and is subject oinury upon trauma tothe left Side ofthe abdomen. Itis located in the upper left quadrant ofthe abdomen, deep to the lft nt, tent, and eleventh ibs. Itis the most commonly inured organ in the abdomen, The adult spleen contains the largest number of lymphoid tissues inthe human body. ‘The descending colon (choice A) es in 2 retroperitoneal position on the left side ofthe posterior abdominal wall. The descending colon begins atthe splenic flexure immediately inferior tothe spleen ‘The jelunum (choice B) is a pertoneal stucture suspended by along mesentery. It is located primariy inthe upper left quadrant ‘ofthe abdomen. Its long mesentery alows the jejunum tobe highly moble and thus is not likely to be injured by trauma tothe body wall. ‘The let adrenal gland (choice C) isa retroperitoneal structure that les near the upper pole ofthe left kidney. Itis embedded thn fat and is thus well protected from injury ‘The left kidney (choice D) is a retroperitoneal structure that is wel protected by fat.(tomo of f00 Nar NODE Gbank-Guvations rot tie ‘Which of the folowing embryonic structures gives rise to the adrenal cortex? © A, Ectoderm OB. Endoderm 06. Mesoderm ©. Mesonepivos © E Nera crest ots ‘The correct answer's C. The mesoderm gives rise to the adrenal cortex. In addin, it also ges rise to connective tissue, cartlage, bone, muscle, blood and lymph vessels, kidneys, gonads, serous membranes ining body caviles, and the spleen ‘The ectoderm (choice A) gives rise tothe central nervous system, peripheral nervous system, epidermis and its appendages, ‘manmary glands, pituitary gland, tooth enamel, and the neural rest, ‘The endoderm (choice B) gives rise to the parenchyma ofthe tonsis, thyroid and parathyrold glands, thymus, iver, pancreas, the eptheal ining of the gastrointestinal and respiratory tracts, urnary bladder, urethra, and audtory tube. ‘The mesonepios (choice D) functions as an interim kidney inthe embryo, ‘The neural crest cells (choice E) give rise to ces ofthe spinal and cranial nerves, autonomic ganglia, melanocytes, leplomeninges, connective tissue and bone of branchial arch orgn, and the adrenal medulla, em 34 of 108 SDE Ghani Questions not tine ‘A mutation affecting the development ofthe diencephalon coud interfere with the secretion of which of the folowing hormones? OA. Adrenocorticotrophic hormone (ACTH) OB. Epinephrine ©, Oxytocin ©D. Prolactin. OE, Thyrox-stinuatng hormone (TSH) “The correct answer is C. The neurohypopisis (posterior pituitary) is derived from an evaginaton of the iencephalic ‘neurectoderm, This structure is responsible for releasing oxytocin and vasopressin tothe general circulation, Both hormones are ‘synthesized in cll bodies contained within the hypothalamus. Oxytocin is a hormone produced by the hypothalamic cells and ‘secreted ino capiaries atthe posterior pituitary. It stimulates smooth muscle contractions of the uterus or mammary glands ia the female, but has ne known function inthe male [ACTH (choice A), prolactin choice D), and TSH (choice E) are al synthesized and released by the anterior pituitary, or ‘adenchypophysis, which is derived from an evaginaton of the ectoderm of Rathke's pouch, a diverticulum of the primitive mouth, Remnants ofthis pouch may give rise to a craniopharyagioma in laterite Epinepivine (choice B) is synthesized and released into the circulation by the adrenal medula, @ neural crest derivativenem 3201100 Char WADE Obani -Guestons ‘The primitive streak normally glves rise to which of the folowing structures? © A, Dorsal oot ganglia 3. Lining ofthe gastrointestinal tract ©. Notochord ©. Spinal cord CE, Thyroid gland ‘Gieoumon ‘The correct answer is C. The primitive streak isthe region ofthe epblast though which the cells that give rise to the notochord ‘and the mesoderm of the embryo pass. The only adult derivate ofthe notochord isthe nucious pulposus ofthe intervertebral disk. The mesoderm gives rise to many cifferent tissue types, including muscle, connectve tissue, and blood, ‘The dorsal root ganglia (choice A) are derived from neural crest cels, The neural crest develops atthe time of neurulaton, which |s a process of nflding ofthe neural ectoderm that i induced by the notochord, ‘The lning of the gastrointestinal tract (choice B) is deed from endoderm. The endoderm also gives rise to evaginations of the {gastrointestinal tract, such as the iver and pancreas. The smooth muscle and conectve tissue ofthe gastrointestinal tract are derived from mesaderm, ‘The epnal cord (choice D) is derived from neural ectoderm, which invaginates during neuruation to form the neural tube. The caudal part ofthe neural tube forms the spinal cord, and the rostral part ofthe neural tube forms the brain ‘The thyroid gland (choice E) is derive from endoderm. The endoderm of the floor ofthe pharynx evaginates to form the thyrogiossal duct, which descends to form the thyroid gland. The adut site ofthe evagination ofthe thyroglossal duct is marked by the foramen cecum on the tongue (em 330100 Clare THEE Gbank -Gunstione nottine Which ofthe folowing isthe embryologi precursor ofthe fbrous remnant that runs ina fissure on the visceral surface of the iver? OA, Ductus venosus Hepatic portal vein Lateral splanchnic artery ©. Ligamentum venosum OE, Vieline vein ‘gion ‘The correct answer is A. The structure described is the ligamentum venosum (choice D), which is derived from the ductus ‘The hepatic portal vein (choice B) is derived from the vtline vein (choice E). ‘The lateral splanchnic arteries (choice C) arise from each side ofthe dorsal aorta. They supply intermediate mesoderm and derivatives and gle rise to renal, suprarenal, phrenic, and testicular or ovaian arteriesRem 34 of 100 Mare NODE Qbank - Question ott ‘Overgrowth ofthe frontal bone, hands and feet has occurred, as well as tingling inthe first, second, and third cigs. There is also loss of strength ofthe thumb, Which nerve is most ikely to be invoved? A. Anterior interosseous nerve OB, Median nerve ©. Musculocutaneous nerve ©, Radial nerve OE. Unar nene ‘Geman ‘The correct answer is B. This question is essentialy asking, ‘Which ofthe folowing nerves innervates the anatomical structures Isted?” This patient has acromegaly, which is characterized by overgrowth of the face, jans, hands, and feet, feslargement of intemal organs, hyperglycemia, hypertension, and osteoporosis. It's caused by hypersecretion of growth hormone, often attributed to an adenohypophyseal tumor. Complications include degenerative joint disease, muscular weakness, neuropathies, and diabetes melitus In this question, although the patent's sensory symptoms may be caused by a ‘neuropathy, itis very Ikely that overgrowth inthe wrist area has compressed the carpal tunel, thereby impinging on the ‘median nerve. Note that the median nerve (root CS-T1) provides motor inervation tothe forearm flexors, thenar muscles, and ‘adil lumbrcals. It provides sensory innervation tothe racial 23 of the palm, volar surfaces ofthe thumb, second and third its, and racial 1/2 of the fourth digit, 2s well asthe skin over the lateral surface ofthe hand, ‘Damage tothe anterorinterosseus nerve (choice A), also known as the deep branch of the median nerve, resis in the ‘nabit to form a round "O° with the thum® and forefinger. Ths is due o impaired function ofthe flexor polcis longus. Damage to the anteror iterosseus nerve could explain the patient's thumb dystunetion, but it would nat account fr the patient's paresthesias inthe frst three digts of the hand, ‘The musculocutaneous nerve (choice C) innervates the arm flexors and provides sensory information tothe anterolateral forearm. It's composed of contributions from C5.C7. ‘The radial nerve (choice D) inervates the extensors of the arm and forearm and skin ofthe posterior arm, forearm, and radial half ofthe dorsum ofthe hand (not including the fingertips) Its composed of contributions from C8-C8. “The uinar nerve (choice E) provides motor innervation tothe unar flexors, adductor polis. hypothenar muscles, interosseus ‘muscles, and lmbrcals 4 and 5. It provides sensory innervation to the vinar haf ofthe wrist, palm, and fourth and fith digits. It 's composed of contributions from C8-T1(ema off00 Mark TEDE Ghank - Guestions roti ‘An ucer damages an artery supplying the area ofthe greater curvature ofthe stomach. Which artery is involved? OA, Left gastic OB, Left gastroepipiole OG, Right gastric OD. Right gastroepipoie OE. Short gastre ‘pata ‘The correct answer is D. The right gastroepplole artery, off the gastroduodenal artery, supplies the right half of the greater curvature ofthe stomach and could be directly affected by ulceration of the greater curvature of the stomach at a site ths close (em) tothe pyore sphincter. ‘The left gastric atery (choice A), ofthe celiac trunk, suppies the left half of the lesser curvature ofthe stomach. ‘The left gastroepiplic artery (choice B), off the splenic artery, supplies the lft half ofthe greater curvature of the stomach, Although it anastomoses wit the ight gastroepipoic artery, tis unikely that this artery would be direct damaged by uceration (ofthe stomach near the pyre sphincter, ‘The right gastric artery (choice C), off the proper hepatic artery supplies the right half of the lesser curvature ofthe stomach, ‘The short gastric artery (choice E), actually one of several (4 to 5) short gastric arteries, off the splenic artery (occasional the left gastroepiploic), supplies the fundus ofthe stomach, which is the most distant from the pylorus ‘em 36017000 ae TNEDE Qbank Questions Which ofthe folowing structures is ined with epithelum derived from mesoderm of the ureteric bud? OA, Bowman's capsule 0B, Distal comoluted tubule 5. Loop of Henle 6D. Proximal convoluted tubule OE, Ureter ‘Oona ‘The correct answer is E. The transitional epthesum that ines the ureter, the renal pevs, and the major and minor calyoes fs derived from mesoderm ofthe ureter bud, as isthe cuboidal epthelum ofthe collecting tubules. “The simple squamous epitheSum lning Bowman's capsule (choice A) is derived from mesoderm of the metanephric vesicle. “The simple cuboidal epithelium ining the distal convoluted tubule (choice B) is derived from mesoderm ofthe metanephric vesicle ‘The simple squamous epithelium lning the leap of Henle (choice C) is derived from mesoderm ofthe metanephric vesicle, The proximal convoluted tubule (choice D) is lined with simple columnar epithelum derived from mesoderm of the metanephric veseieem 79100 Mark NODE Gbank- Guestons not tina ‘Atherosclerotic occlusion of which ofthe following arteries would resutin insufficient perfusion of the urinary bladder? OA, External tae OB. Inferior epigastric ©. Internal tae ©. Internal pudendal OE, Lateral sacral ‘The correct answer is C. The badder Is supped by he vesicular branches of the internal ia arteries, The internal aes aise from the common ilae artery, ‘The external iia (choice A) aso arses ftom the common lac artery. It makes no contribution to the blood supply ofthe badder. “The inferior epigastric (choice B) isa branch of th external lac artery. It serves as a landmark nthe inguinal region, ‘The internal pudendal (choice D) is a branch of the anterior division of the intemal lag artery. It supplies the rectal area andthe organs. ‘The lateral sacral (choice E) isa branch ofthe posterior division ofthe Internal lac artery It supples sacral structures. ‘nem 3891100 Char NBDE Qbank Guevions rot tne ‘An angiographic study ofthe distal part of the circle of Wills requves access to the vertebral artery. Access to this artery can be obtained va the © A, anterior tangle ofthe neck ‘muscular tangle ofthe neck C. posterior tangle of he neck D. submental triangle E, suboccitl triangle ‘The correct answer is E. The subeccipital langle lies inthe neck atthe base ofthe skul Is bounded by the inferior oblique, ‘rectus major, and superior obtque muscles. The vertebral artery can be found within the subocciptal tangle, lying on the posterior arch ofthe atias, lateral tothe min, typically at about the level ofthe lower portion ofthe earlobe. Care should be {aken in accessing the vessel because te fst cervical neve les between the vertebral artery andthe posterior arch ofthe atias ‘The circle of Wits contans the folowing arteres: anterior communicating. anteror cerebral, posterior communicating, and posterior cerebral ‘The anterior triangle ofthe neck (cholce A) isin the anterior neck and is bounded by the neck midine, the mandible, and the sternocledomasioid muscle. The anterior triangle ofthe neck is subdivided into the muscular, carotid, submandibular, and ‘submental tangles. ‘The small muscular triangle (choice B) fies between the superior bely ofthe omohyoid and the stemohyoid muscle. ‘The posterior triangle of the neck (choice C) ison the side of the neck and is bounded by the sternocleidomastoid muscle, the trapezius, andthe middle third ofthe clave ‘The submenta angle (choice D), also called the suprahyod triangle, is found below the lower jaw and is bounded by the hyoid bone and anterior belles ofthe digastric muscles.100 Saar TNEDE Ghani Quevtons oy ‘A knife wound to the face eelectively damages the facial neve. Salvation from which of the folowing would be impaled? A. Parotid and subingual glands © B., Parotid and submandibular glands €, Parotid gland only ©. Sublingual gland only OE. Submanabular and subingual glands ‘The correct answer's E. The facial nerve (CN Vil) i intimately related anatomically tothe parotid gland but controls salvation {rom both the submandibular and subingual glands, The subingual salivary glands are located Beneath the mucous membrane on the floor of the mouth. The submandibular salvary glands are found inthe floor ofthe mouth along the inner surface of the ‘mandible within the manila groove, “The parotid gland (choices A, B, and C) is imervated by he glossopharyngeal nerve (CN IX). The parotid glands are located Inferory to the zygomatic arch beneath the skin covering the lateral and posterior surfaces of the mancible. Although the facil ‘nerve most often runs through the parotid gland, it does not supply any innervation there, em a0 100 Mae TNEDE Qbank Guewtions rot tne ‘Most afferents to the cerebral cortex derive fom the A, basal gangia © B. cerebral cortex ©, hippocampus ©. spinal cord OE. thalamus ‘oon ‘The correct answer is B. Most afferents tothe cerebral cortex derive from the cerebral cortex. This type of extensive Interconnection of cortical areas faiitates communication and integration between cortical areas on the same side or on diferent Sides of the bran ‘The basal gangla (choice A) receve thelr most prominent input from the cortex bu output to the globus paldus and the ‘substantia nigra pars reticulata, rather than directly tothe cerebral cortex “The hippocampus (choice C) sends most ofits projections to the mammillary bodies and the thalamus via the fomix, rather than to the cerebral cortex. ‘The ascending tracts ofthe spinal cord (choice D) carry sensory information to brainstem nucle, thalamus, and cerebelum, rather than drecty to the cerebral corter. ‘The thalamus (choice E) projects tothe cerebral cortex, but the cortex recelves quanttately more fibers from other areas of cortex than fom the thalamus.em 4 of 100 ark SDE Qbank Guertone rot time ‘A aife woud tothe neck damages the posterior cord ofthe bret pews. Which ofthe folowing muscles woul be mest key Be pavalyaes? OA. Detoid © B, Fer carpi vars ©, Peco cigiorum swerfeats ©, Fewer pots brevs Paina orgs ‘The correct answer is A. The posterior cord supplies the ailary and racial nerves. Of the muscles listed, only the deltoid is supped by one ofthese two nerves, specifically the axlary nerve. The deltoid originates from the clavicle and scapula, It inserts Into the deltoid tuberosity ofthe humerus. Ths muscle is responsible for abduction ofthe arm, “The flexor carp unaris (choice B) is supplied by the ulnar nerve, ‘The flexor digitorum superfcialls (choice C), the flexor policls brevis (choice D), and the palmaris longus (choice E) are supped by the median nerve. hem 2 of 100 CM TNRDE Qbank Questions ot timed Despite blockage ofthe celiac trunk, the organs receiving their blood supply from the trunk continue to operate normaly. This is dve tO anastomoses between which vesse's? OA. Left gastroepiloe artery and right gastroepipoie artery Let gastroepiploc artery and right gastroepipoc artery . Proper hepatic artery and gastrodvedenal artery Right cole artery and mide cobe artery Superior pancreaticodvodenal artery and inferior pancreaticoduodenal artery ‘The correct answer is E. The superior pancreaticoduodenal artery is @ branch ofthe gastroduodenal artery, which isa branch ‘ofthe comman hepatic artery, ielf a branch of the celiac Lunk. The inferior panereateoduodenal artery isa branch of the ‘superior mesenterle artery, Ocelison of the cele trunk would alow blood from the super mesenteric artery to reach the branches ofthe celiac trunk via the connectons between the superior and inferior panereatcaduedenal arteries. ‘The left gastric and right gastic arteries (choice A) both receive their blood from the cefac trunk. The left gastric artery is @ direct branch ofthe celiac trunk. The right gastre artery is usualy a branch ofthe proper hepatic artery, which is a branch ofthe ‘comman hepatic artery (a branch ofthe celiac trunk). ‘The let and right gastroepiploc arteries (choice B) both receive their blood supply from the celiac trunk. The let gastroepipoic artery is a branch ofthe splenic artery, which i a branch ofthe ealiac trunk. The right gastroepipiolc artery isa branch ofthe ‘gastroduodenal artery, which isa branch of the common hepatic artery (a branch ofthe cefac trunk). ‘The proper hepatic and gastroduodenal arteries (choice C) are branches of the common hepatic artery, which is @ branch ofthe elas tron. ‘The right cole and mide colic arteres (choice D) are both branches ofthe superior mesenteric artery.item 0100 Siar TH@DE Oban -Guestions ‘Which glandular area seeretes hormones which are products of tyrosine metabolism? © A. Alpha cels of pancreas ©, Beta cels of pancreas ©. Adrenal cortex © D. Adrenal medula OE. Testes, ‘Oemusane rot tne ‘The correct answer is D.The prosucts of the adrenal medulla are epinephrine (adrenain) and norepinephrine (noradrenalin). The pathway of production ofthese compunds is @ s folows: tyrosine to DOPA to dopamine to norepinephrine to epinephrine. The hormone secreted by alpha cels ofthe pancreas is glucagon, while beta cels secrete insuin. Both are peptide hormones. The adrenal cortex secretes a variety of hormones including cortisol and aldosterone, both steroid hormones. The testes secrete testosterone aso a steroid hormone, em 8100 Mae THEE Obani Guevtons ot te Wich ofthe following tesues normally has the highest percentage of mucus-seereting cele? A. Esophageal mucosa © B, Oral mucosa, 6. Parotid gland ©, Subingual gland © E, Submandibular gland ‘The correct answer is D. The sublingual salvary glands are located beneath the mucous membrane of the floor of the mouth Numerous sublingual ducts open along either side ofthe ingual frenuurs. Salary glands can contain predominantly serous cells, predominantly mucous cel, or both i their ain. As you proceed from the midine laterally. acini in the subingual gland are ‘almost pure mucous cells, whereas ain in the submancibular gland (choice E) contain a mixture of serous and mucous cells ‘Aci in the parotid gland (choice C) are mostly pute serous ces “The esophageal mucosa (choice A) and the oral mucosa (choice B) are squamous epithelia that donot form acini(em ab of 00 Car NODE Ghani Gunrtione rot tine ‘A mass is noted at the back of a young man's tongue. A biopsy's pathology report comes back with a diagnosis of normal thyroid tissue. This finding is reated tothe embryonic origin ofthe thyroid near whch ofthe folowing structures? A, First pharyngeal pouch Foramen cecum 06. Nasolacrimal duct © D. Second pharyngeal arch OE. Third pharyngeal pouch iene SS ‘The correct answer is B. The thyroid gland originates as a mass of endodermal tissue near the foramen cecum, whichis near the tubereulum impar (which becomes the central part ofthe tongue). Duting development, the thyroid descends infront ofthe ‘haryns, maintaining a connection to the tongue via the thyroglossal duct. Usually, the thyroglossal duct disappears. Uncommon, ‘residual ectopic thyroid tissue can be left anywhere along the path inctding at the back ofthe tongue. In rare cases, al of the thyroid tissue remains at this site, forming a mass that should not be excised. for obvious reasons!) Anatomical, the thyroid land curves across the anterior surface of the trachea ust below the thyroid cartiage that forms the majority of the anterior ‘surface ofthe larynx. The two lbes ofthe thyroid gland are united by a slender connection, the isthmus. “The fist pharygeal pouch (cholce A) develops into the mide ear and eustachian ube ‘The natoacinal duets (choice €) connect the eyes to the oropharynx ‘The second pharyngeal arch (choice D) develops into many muscles of the face and the styl process of the temporal bone ‘The third pharyngeal pouch (choice E) develops into the tyes and inferior parathyroid sands ‘mem aS of 00 Clark TNEDE Qbank Guevtons ot te If cirtosis causes obstructon ofthe portal circulation within the Iver, portal blood could stil be conveyed tothe caval system via Which of the folowing? ‘Azygos and hemiazygos veins Gonadal veins ©. Internal iis veins OD. Splenic vein OE, Vestal venous plews 00 ‘The correct answer is A. The esophageal venous plexus, winch drains into the szygos and hemiazygos veins within the thorax, has anastomoses with branches ofthe lft gastric vein. Thus, following blockage ofthe portal ven, portal blood may enter the ‘superior vena cava via the azygos system. Other important portacaval connections include the superior rectal vein with the mile and inferior rectal veins; paraumbiical veins and epigastric vens (engorgement of these vessels results in caput medusae); and the cole and splenic veins with renal veins and vein ofthe posterior body wall ‘The gonadal veins (choice B) exclusively drain the gonads (although inthe female, the ovarian vein communicates with the Uuterovaginal plexus). These vessels have no anastomoses with portal veins. ‘The intemal ae veins (choice C), which drain most ofthe pelvis and much of the inferior extremities, have no demonstrated portal anastomoses. ‘The splenic vein (choice D) is incorrect because it’ in itself a component ofthe portal venous system, ‘The vesical venous plenus (choice E), whichis stated well within the pelvis and drains the bladder and the prostate (or uterus ‘and vagina) has no association wih portal vessel,nem a7 of 00 Char NBDE Qbank - Questions ot tne In preparation fora procedure to remove the fngernal on an index niger, the physician would most likely anesthetze a branch of the © A. anterior interosseus nerve OB. median nene ©. musculoevtaneous neve 0D. radial nerve OE. ulnar nerve ‘The correct answer is B. The mecian nerve supplies the surface ofthe lateral palm, the palmar surface of the frst three dig, and the stl dorsal surface of the index and middle fngers (including the nall beds). Therefore, prior to performing surgery in this area, itis essential to anesthetize a branch of this nerve (possibly a proper digital branch) to elminate pain sensation around the nal bed of the index finger. The mecian nerve of the branchial plexus distributes tothe Rexor muscles onthe forearm (exor carpi radials and palmars longus), the pronators(p. quadratus and p. teres), dita flexors, and skin over the lateral surtace of the hand. Nether the anterior interesseus (choice A) nor the musculocutaneous (choice C) nerves supplies the hand. The anterior Interosseous nerve supplies the flexor policis longus, te lateral half of flexor digtorum profundus, and pronator uadratus. The ‘musculocutaneous nerve supplies the coracobrachials, biceps, and most ofthe brachialis muscle, then becomes the lateral cutaneous nerve ofthe forearm. ‘The radial newve (choice D) suppes skin on the radial side ofthe dorsal surface ofthe hand, but nat the fingertie, ‘The unar nerve (choice E) supplies the palmar and dorsal surfaces of the medial hand, including the palmar and dorsal surfaces ‘ofthe fourth and fit digit, em 480 100 ae ‘NBDE Ghani Quertone ‘The heart of an embry frst begins beating at which of the folowing ages? OA. 2weeks: OB. B weeks. OC. 4 weeks 6. G weeks GE, B weeks ‘Oona ‘The correct answer is C. While the thrd-veek embryo isa primitive trlaminar plate, inthe fourth week, the heart begins to form and begins beating almost immediately. Hematopoiess occurs inthe yok sac, and a primitive circulatory system connects the capilary pleruses ofthe yok sac and chorion tothe embryo, Partitioning ofthe atrium also begins in the fourth week. During the fifth week, cardiac septa form and the atrioventricular (AV) cushions fuse. By the sith week, the hearts close to full formed. This early sequence for the heart explains why itis so ditfcut to try to prevent congenital malformations ofthe cardiovascular system from occuring because the mother ofa 6veek-od fetus is only about 8 weeks from her last menstrual period and may have assumed that she just ‘missed a period” (avery common phenomenon for reasons other than pregnancy.em 49 0100 ark TNEDE Ghani Guertone ot tne ‘When a large bolus of food is swallowed, the hyoid bone moves anteriorly to open the pharynx, The muscle responsibie fortis action 's innervated by wich ofthe folowing nerves? OA. Ct (ansa cereals) 08. CNIK OG. Pharyngeal plows 00, CNV3 OE. CNV ‘The correct answer Is A. The muscle that moves the hyoid anteriorly to open the pharyax isthe geniohyoid. Tis muscle is innervated by the ansa cercais branch of C1. The ansa cenvcals also imervates the thyrohyoid andthe intra hyoids. Cranial nerve IX (choice B) imervates the styopharyngeus. “The pharyngeal plows (choice C) imervates the palatoglossus,palatopharyngeus, and crcopharyngeus. Cranial nerve V3 (choice D)innervates most of the muscles of mastication, Cranial nerve Vil (choice E) imervates the buccinator and other muscles of facial expression em 60 f 1000 Mark ‘NODE Qbank = Guestione rotine Contraction of which ofthe folowing muscles contributes most tothe backward movement ofthe lower jaw during the process of mastication? A. Digastle OB. Lateral pterygoid DC. Medial pterygoid ©. Mylohyort OE, Temporal ‘The correct answer is E. Mastcaton is a complex process invalng aternating eevaton, depression, forward mavement, and ‘backward movement ofthe lower jaw. The backward-moverent step is accomplished by the posterior fibers of the temporals ‘muscle. The temporals orginates along the temporal ines ofthe temporal bone and inserts into the coronaid process ofthe ‘mandible. Its innervated by the manibular branch of the trigeminal nerve, “The digastric (choice A) helps to depress (open) the lower jaw during chewing “The lateral pterygoid (choice B) helps to move the lower jaw forward, laterally, or dovmward during chewing “The medial pterygoid (choice C) helps to elevate (close) the lower jaw during chewing, “The mylohyoid (choice D) helps to depress (open) the lower jaw during chewing.nem 610100 Mar THEDE Ghani Guertione rete Ifa patients unable to touch the tp of his tongue tothe roof of his mouth, dysfunction of which of the folowing muscles is most kely the cause? © A, Buccinator OB, Genihyoid ©. Palatoglossus ©. Palatopharyngeus OE, Tensor pala ‘geo ‘The correct answer is C. Elevation ofthe tongue is carried out by the styloglossus (nnervated by the hypoglossal nerve, CN Xil) andthe palatoglossus (innervated by the pharyngeal plerus). The palatoglossus orgnates on the anterior surface of the soft palate and insets inthe side of the tongue. “The buccinator (choice A) function i storing, fling, and emptying the vestibule. “The geriohyoid (choice B) moves the hyoid anteriorly to open the pharynx “The palatopharyngeus (choice D) produces a "stripping wave" onthe posterior pharyngeal wal, “The tensor palat (choice E) tenses the soft palate inom 6201100 CMa NODE Qbank Guestione ret time Zygomycosis, a destructive fungal infection ofthe sinuses, i ely to reach the brain by which ofthe folowing routes? © A, Cavernous sinus © B, External carotid artery ©. Internal carotid artery © D. Superar sagital sinus OE, Superior vena cava ‘Geena ‘The correct answer Is A. This question requires knowledge of pathophysiology witha basic understanding f anatomy. The cavernous sinuses are located on either side ofthe body ofthe sphenoid bone and become a potential route of infection because they receive blood both from the face (va the ophthalme veins and sphenoparetal sis) and from some ofthe cerebral ven. ‘The spread of infection ino the cavernous sinus can produce ether central nervous system (CNS) infection or cavernous sinus tombosis, bth of which are potential fata. ‘The route from the face to the brains not arterial (choices B andi C). ‘The superior sagittal sins (choice D) i located in the fax cerebri and drains venous blood from the bran to other dural sinuses, ‘rom wiich ft eventually drains into the jugular vein. Zygomnyeosis does not reach the brain by way of the superior sagittal sinus, ‘The superier vena cava (choice E) drains blood trom the upper part ofthe body inte the heart.tom 63 9 100 ark NODE Qbank - Questions nottines ‘Alter faling on his laterally outstretched arm, a patient suffered a dsiocation ofthe glenchumeral oat. Which of the folowing nerves is ‘most likely to have been injured from this distocaton?” OA. Asilary nerve ©B, Dorsal scapular nerve ©€. Lateral pectoral nerve 2D, Medial pectoral nerve E. Suprascapularnewe ° ‘Seman ‘The correct answer Is A. When the head of the humerus dsiocates from the glenohumeral jot, texts inferior, where the joint capsule isthe weakest. Inmediatly inferior tothe glenchumeral joint, the ailary nerve ests from the axilla by passing through the quadrangular space. At his locaton, the downward movement ofthe head of the humerus can stretch the adlary nerve. The aillary nerve inervates the dettord muscle after leaving the aula “The dorsal scapular nerve (choice B) passes along the medial border of the scapula to inervate the rhombotd muscles. The nerve does not passin the region of the glenchumeral int. “The lateral and medial pectoral nerves (choices C and D) branch from the lateral and medial cord ofthe brachial lens, respectively, and ext through the anterior wall ofthe alla to inervate the pectorals major and minor. These nerves do not pass in the region of the glenohumeral int. “The suprascapular nerve (choice E) isa branch ofthe upper trunk ofthe brachial plexus and passes over the superior border of the scapula to inervate the supraspnalus and infragpinatus muscles. This nerve does not passin the region ofthe glenohumeral joint em 640100 are NODE Qbank Guestions not tine ‘A person fits one foot prior to taking a step. Which ofthe folowing nerves innervates the muscle group that allows the person to ‘maintain balance by holding the weight of his body over the foot remaining onthe ground? © A. Femoral nerve 1B. Fist and second sacral neves (0G. Obturator nerve ©. Superior gliteal nerve OE. Thal newe ‘Ganesan ‘The correct answer is D. The muscles in question are the gluteus medius and gluteus minimus, which are the innervated by the superior gluteal nerve, Testbooks often describe these muscles as abductors ofthe hip, butin real fe, they usualy function as. escnibed in the question “The femoral nerve (choice A) innervates muscles ofthe anterior thigh, allowing extension ofthe leg atthe knee. “The first and second sacral nerves (choice B) imervate the informis muscle, which sa lateral rotator ofthe thigh atthe hip, ‘The obturator nerve (choice C) innervates muscles ofthe medial thigh ‘The tibial nerve (choice E) inervates muscles of the posterior lower le.em 650f100 CMe NBDE Qbank Guestons om ‘Damage to the parasagittal ragion and fax cerebr ill most Ikely result n which ofthe fllowing neurolagle dete? A ‘Altered taste Leg paralysis ©. Loss of facial sensation D. Piosis E Uniateral deafness ‘The correct answer is B. A meningioma ofthe parasagital region and the fal cerebri would be located a the top of the brain, ‘near the midine. In this postion, i could compress the sensory or motor cortex suppiyng the lower extremities. The fax cerebri 's a fold of dura mater that projects between the cerebral hemispheres inthe longticinal issues. Its interior portions attach nteroly tothe crita gall and posteroly tothe internal occipital crest. Taste (choice A) is supplied by cranial nerves VI, IX, and X. These nerves arise from the brainstem, Favial sensation (choice C) i supplies by eanial nerve V, the nuclei of which are in the brainstem. Furthermore, the area ofthe sensory cortex that subsenves the face ison the lateral aspect ofthe cortex and would not be affected by a tumor inthe parasagittal region tosis (choice D) can be caused by a defect in cranial nerve Il, wich arises from the brainstem, Uniateral deafness (choice E) suggests damage to cranial nerve whieh arises trom the brainstem, em 68 of 100 Char SDE Gbenk- Guertions ory ‘On microscopic examination of bone, smal thread-ike canals are seen radiating out from the area of each osteocyte. These structures are the OA. Volkman canals B. Canalcut . Osteons (©, Haversian canals 0, lacunae ‘The correct answer is B. In compact bone, the bone i in concentric layers, and small spaces between layers house the ‘osteocytes, oF mature bone cels. These small spaces are caled lacunae. Rackating out from the lacunae are smal conducting ‘vessels known as canalcul. They help bring nutrients to and waste from the osteorytes. Remember that bone matrix does not alow difusion ready. The original source of rutints to compact bone is Haversian canals, which contain arteries, velns, and nerves, Smaller perpendicular branches of these canals are sometimes called Volkman canals, Osteons are also called Haversian systems, and consist of the Haversian canal, the concentric bone layers around them, the osteocytes inthe concentric ‘gs, the lacunae and canabcul. Osteons are found in compact (lamellar) boneem 67 of 1000 Wark NBDE Qbank Guertone ‘Which ofthe folowing veins may be anastomosed to accompish a porto-caval shunt? A. Left renal ven and let tester veln 1B, Right renal vein and right suprarenal vein CC. Splenic vein and left renal vein © D, Superior mesenteric vein and inferior mesenteric vein ‘©: Superior mesenteric vein and splenic vein ‘Gamat rot ine ‘The correct answer is C. The splenic vein drains direct into the portal veln. The left renal vein drains directly into the inferior vena cava. Anastomosis ofthese veins would allow blood from the portal vein to drain retrograde though the spienic vein into the renal ven and then ito the inferior vena cava ‘The let renal vein (choice A) drains directly into the inferior vena cava. The left testicular vein drains directly into the lft renal vein. Thus, these veins are already in communication, and nether veins part of the portal venous system. “The righ renal vein (choice B) drains directly into the inferior vena cava, The right suprarenal vein also drains dtecty into the Inferior vena cava, Thus, neither vein fs part ofthe portal venous system. “The superior mesenteric vein (choice D) drains directy into the portal vein. The inferior mesenteric ven drains ito the splenic vein, which then drains into the portal ven, Thus, nether ven is part ofthe caval venous system, ‘The superior mesenteric vein (choice E) drains directly into the portal vein. The splenic ven also drains direct into the portal vein. Thus, neither ven is part ofthe caval venous system. inom 680100 Chae ‘NODE Qbank -Guewions ot tne While ying supine in bed eating, a chid aspirates a peanut. Which ofthe folowing bronchopulmonary segments would this foreign ‘object most key enter? A. Apieal segment ofthe left upper lobe © B. Apical segment ofthe roht upper lobe ©. Medial segment ofthe right middle lobe 0D, Posterior basal segment of the let lower lobe OE. Superior segment of the right lower lobe ‘eta ‘The correct answer is E, Because the right main bronchus is wider and more vertical than the lef, foreign objects are more kel to be aspirated into the right main bronchus. The superior segmental bronchus ofthe lower lobar bronchus isthe ony ‘segmental bronchus that exs from the posterior wall ofthe lobar bronchi. Therefore, ia patient is supine at the tie of aspiration, the object is most kely to enter the superior segmental bronchus of the lower lobe, None ofthe segmental bronchi ofthe left ng (choices A and D) are ikely to receive the object because the object is less ikely to enter the left main bronchus, “The apical segment ofthe right upper lobe (choice B) isnot Ikely o receive the foreign object because ofthe sharp angle that the upper lobar bronchus makes withthe right main bronchus and the sharp angle thatthe apical segmental bronchus makes with the lobar bronchus, “The mesial segmental bronchus of the right mide Jobe (choice C) arses from the anterior wall ofthe right mide lobar bronchus, Therefore, when the patient is supine, the effect of gravty wil tend to prevent the object from entering this Segmental bronchusem 9 of 1000 Nar SDE Ghani Questions nottine ‘Which membrane isin the way is you try to reach the lesser peritoneal sac and head the pancreas after penetrating the greater peritoneal sac? © A. Faleform figament OB, Gastronepatie igament 2, Gastrospienicigament ©. Hepatoduedenal igament ©. Splenorenaligament ‘Geman ‘The correct answer is B. The gastrohepatic Igamentis the pat ofthe lesser omentum that separates the greater peritoneal ‘sac from the right porton ofthe lesser peritoneal sac. This porton ofthe lesser omentum has no significant blood vessels within t ‘and may be incised for surgical access, “The faleiform igament (choice A) Is a mesenteric membrane between the Iver and the anterior abdominal wal, This Sgament is within the greater peritoneal sac and does not separate it rom the lesser pertoneal sac. ‘The gastrosplenc igament (choice C) passes from the greater curvature ofthe stomach to the spleen, It separates the greater peritoneal sac from the left portion of the lesser pertoneal sac. Incision ofthis structure would be the appropriate surgical ‘approach to gain access tothe let sie ofthe lesser peritoneal sac “The hepatoduedenal igament (cholee D) is part of the lesser omentum and separates the greater peritoneal sac from the right ‘portion ofthe lesser peritoneal sac. It forms the anterior border ofthe epploic foramen. However, the hepatoduodenaligament Contains the common bile dct, the proper hepatic artery, andthe portal vein, and therefore may not be incised for surgical “The splenorenaligament (choice E) passes from the spleen to the parietal peritoneum on the anterior surface ofthe left kidney. It separates the greater peritoneal sa from the lft portion ofthe lesser peritoneal sac. Tis igament contains the splenic artery, ‘splenic ven, and the tal ofthe pancreas, and therefore may not be incised to gan access tothe lesser pertoneal sac. em 60 9109 Mae TNEDE Gbank Quentin Tot tne In which ofthe following regions of the lveris the oxdase PASO system located? DA. Bile ducts 1B, Intermediate zone 6. "to cals © D, Pericentral vin zone OE Petiportal one ‘The correct answer is D. The lver can be divided into three zones. Zone 1 Is periportal, zone 2s intermediate (between 1 and 3), and zone 3 is associated wih the central vin, Zone 3 contains the P50 oxidase enzyme system and is mast sensitve to inury. The CP450 system is very important tobe familar with because its the major ste of drug interaction, For example, the macrolides, which are commonly used In dentisty in peneain-allerge patents are potent hepate enzyme inhibitors, as are antifungals ike ketoconazole and fuconazoe “The P460 system isnot located inthe bile ducts (choice A) “The intermediate zone (choles or zone 2's the second area most sensitive to lscherse injury. “ita” ces (choice C) are the fa-contaning mesenchymal ces located in the space of Disse. This ithe site of wtamin A storage “The periportal zone (choice E), or zone 1, is the area most senstve to toxc injury. This i the area that shows infitration with hepatitis‘nem 619700 Mack NBDE Qbank Questions ‘Which part ofthe hypothalamus controls satiety, and would lead to obesty if destroyed? OA, Lateral nucleus OB, Septal ncieus ©€. Suprachiasmatc nucleus ©. Supracpte nucleus OE. Ventromedal nucleus ‘Stas ‘The correct answer is E. The ventromedial nucleus is thought to be the satiety center of the brain. Bilateral destruction leads to hyperphagia, obesity, and savage behavior. Stimulation inhibits the urge to eat. Destruction ofthe lateral naclus (choice A) resuts in starvation, vitereas stimulation ofthis nucleus induces eating, Destruction ofthe septal nucleus (choice B) produces aggressive behavior “The suprachiasmatic nucleus (choice C) receives direct input fom the retina and plays a olen controling circadian rhythms “The supraoptc nucleus (choice D) hormone (ADH) and oxytocin ong withthe periventricular nucleus, regulates water balance and produces antidiuretic Asahi ogs inf na cad tro ena ay ya pos oa woe flexibility to stretch and return to its original shape. These fibers are also found in substantial numbers in the A ge mde oa 8 ie ob mer “Ele ‘The correct answer i E. The fbers are east fibers. You should remember three specif sites where these ae found: large arteries (particularly the aorta), vocal cords (or cords), and ligamenta fava (which connect the vertebrae). Small amounts of clastic issue are also found in skin and to a much lesser degree in other tissues. The vocal folds (or cords) protect the entrance to the gots. They are located inferior to the ventricular folds. The vocal olds are highly elastic because they contain bands of clastic tissue called the vocal ligaments, The vocal folds are noted inthe production of sounds. Elastic tssue is nt found in muscle (choice A) or mesentery (choice C) Elastic Uesue is not found in substantial amounts in the Wer (choice B) oF spleen (choice D)nem 63 of 100 Ci Merk TNGDE Gbenk - Questions ott ‘The xray ofa chic's arm after a fall appears to show a fracture near, but not at, the distal end of the ula. Before diagnosing a ‘racture, you shoud also consider the possibilty that ths is actually which ofthe following? ‘OA, Aiea cartiage OB. Epiphyseal pate 06. Perichondrium SD. Primary ossifcaton center OE. Secondary ossifeaton center ‘Seman ‘The correct answer is B. The epipyseal plate ofthe bone contains cartilage that is racholucent, The plate in a bone that is not yet fuly ossfed can produce a "ine" crossing the bone near the end. This may be easly mistaken fora fracture by the ‘nexperienced. Anatomically, the epiphyseal plate separates the epiphysis from the dlaphysis, Aricular cartilage (choice A) is ratiolucent, but occurs atthe very tip of the long bones, PPerichondrium (choice C) is usualy ciffeult to see on xray. Primary (choice D) and secondary (choice E) ossification centers are radiopaque. em 649100 CMa TNEDE Qbank Guestone rae The ureter is found immediately anterior tothe origin of the 2A. common ae artery 5B, extemal ae artery 16. intemal ila artery ©. gonadal artery OE. renal artery ‘The correct answer is B. The ureter leaves the renal pes and lies on the posterior abdominal wal as it descends tothe peli. Iterosses the pehic br atthe level of the bifurcation ofthe common iliac artery. At this point, it erosses anteror tothe origin of the external lac artery to enter the pehis. In summary, the ureters are a par of muscular tubes that extend inferiorly trom the kidneys for approximately 30 om before reaching the urinary badder. Each ureter begins at the funnel-shaped renal pelvis. As the ureters descend from the kidneys, they pass inferiorly and medialy over the psoas muscles. The ureters penetrate the posterior Wal ofthe bladder without entering the peritoneal cay “The origin ofthe common ilac artery (choice A) is atthe bifurcation of the abdominal aorta, which occurs atthe level ofthe fourth lumbar veribra in the midine of the abdomen. Both ureters ae lateral to the aort bifuration “The origin ofthe intemal ila artery (choice C) is atthe bifurcation of the common lac artery, which occurs at about the level of the frst sacral vertebra. The ureter andthe intemal ac artery both enter the pelvis withthe ureter on the lateral sie ofthe artery ‘The origin ofthe gonadal artery (choice D) (ether the testicular artery or the ovarian artery is from the abdominal aorta at a variable level, usualy between the renal artery andthe inferior mesenteric artery. The ureters are lateral to the origin ofthis artery “The origin ofthe renal artery (choice E) is from the abdominal aorta at about the level ofthe second lumbar vertebra, The renal arteries pass laterally to enter the renal pebis, At this site, the ureter is posterior tothe artery.em botf00 Mark TNSDE Ghani Guarione not tne ‘Damage to the upper fbers ofthe trapezius moscle would most ikely mpair whieh ofthe folowing movements? © A, Depression of the medial end ofthe scapula © B. Elevation ofthe aeromion 06. Flexion ofthe neck ©.B. Raising ofthe medial border ofthe scapula OE. Turning ofthe face sideways ‘dba ‘The correct answer is B. The trapezius is a large muscle arising inthe posterior midine from the superior nuchal ie ofthe ‘kal, igamentum nuchae, and spinous processes of al ofthe thoracie vertebrae. The upper fbes, which are potentially damaged by wounds to the posteror and lateral neck, insert onthe crest ofthe spine ofthe scapula, the medial border ofthe ‘acromion, and the lateral third ofthe clavicle. The upper bers serve to elevate the acromion. ‘The lower fibers ofthe trapezius depress the medal end of the scapula (choice A) ‘The stemocleidomastods are important in extension of the head atthe atlanto-occipital ont and flexion of the cervcal vertebral columa (choice C) ‘The thomboids and levator scapula are important in raising the medal border ofthe scapula (choice D), Contraction of a single stemocleidomastoid muscle is important in turing of the face sideways (choice E) inthe contralateral dreston, [femeeorioo Oe TBDE Obani Guenione rotted ’An esophageal biopsy shows normal smooth muscle and striated muscle inthe same section, Which portion ofthe esophagus was the source ofthis biopsy? OA. Lower esophageal sphincter ©. Lower third of the esophagus OG. Midale tir ofthe esophagus ©. Upper esophageal sphincter OE. Upper third ofthe esophagus ‘The correct answer is C. The middle tic ofthe esophagus contains both striated and smooth muscle. ‘The lower thie (cholee B) of the esophagus, including the lover esophageal sphincter (choice A) contains only smooth muscle ‘Some authors ientty the cricopharyngeus muscle as an upper esophageal sphincter (choice D), despite the fact that unke a true sphincter, this muscle does not completely encircle the esophagus. The ercopharyngeus is composed exclusively of skeletal muscle; therefore, the biopsy could not have been from ths area ofthe esophagus. ‘The muscularis ofthe upper thir ofthe esophagus (choice E) Is composed entirely of stated muscle,emer of100 Chen NBDE Qbank -Guewions or ‘A wound to the posterior lft anilary Ine, between the ninth and tenth rib, and extending approsimately 5 cm deep, wil most likely damage wich organ? OA. Ascending colon B. Duodenum 5. Left kidney 5D. Leftlobe of the iver OE. Spleen ‘The correct answer is E. The spleen folows the long axes of ribs 9 10 11 and bes mostly posterior to the stomach, above the colon, and partly anterior to the Keney. tis attached tothe stomach by a broad mesenterial band, the gastrosplemsc ligament. Therefore, its the most likely organ ofthe group to be pierced by a sharp object penetrating just above rip 10 atthe posterior axillary ine. Note that te pleural cavity, and possibly the lower part ofthe inferior lobe ofthe lung, would be pierced Before the spleen. ‘The ascending colon (choice A) ison the wrong side (the right) to be penetrated by a sharp instrument piercing the left side. Most ofthe duodenum (choice B) is postioned too far to the right to be affected by this injury. Even the tied part ofthe duodenum, which runs from right to lef, would stil be out of harm's way. In adéltion, the duodenum les at about levels Lt to L3, placing it oo low to be injured inthis case ‘The superior poe ofthe lft Kiéney (choice C) is bordered by the lower part of the spleen. However itis crossed by rb 12 and usualy does not extend above rib 11. It would probably be too low and medial tobe injured in this case because this penetration is at the posterior allary ine ‘The lft lobe ofthe lver (choice D) is positioned lust beneath the diaphragm, ust over and anterior tothe stomach. The anterior posttoning of this structure makes it an unkely candidate for injury in this ease. Even with deep penetration atthe correct angle, it would not be penetrated before te spleen, im 68 100 ae TNGDE Ghani Quentin ot tne ‘A newbom baby is noted to have a left unilateral cleft ip. There are no abnormalities ofthe baby's palate. Which ofthe folowing developmental defects accounts for this occurence? (A. Fallure of the let lateral palatine process to fuse withthe median palatine process © B. Failure of the left mallary prominence to unite with the lft medial nasal prominence €. Failure of the primary palate to fuse with the secondary palate 5D. Failure of the right and left medial nasal prominences to merge ©: Failure of the right palatine process to fuse with the lft palatine process ‘The correct answer is B. Inthe formation ofthe upper lip, the ight an left medial nasal prominences merge to form the Phitram ofthe upper ip. The lateral masalary prominence then merges with the merged medial nasal prominences, Falure ofthis merger to oocur resus in a uniataral cet Ip. Faure of a lateral palatine process to fuse with the median palatine process (choice A), wich s synonymous with a fadure of ‘the primary palate to fese withthe secondary palate (choice C),resuits in a prmary cleft palate. Primary clefts of the palate are found anterior to the incisive foramen of the palate. Primary cleft palates may occur along with lft lps but are the result of a separate developmental defect. Falure of the ght and left medial nasal prominences to merge (choice D) results in a median cleft lp. Ths is a rare anomaly. Normal, the right and let medial nasal prominences merge ito a single prominence that forms the phitrum of the lp. Falure ofthe right and left palatine processes to fuse (choice E) results ina secondary clet palate. Secondary cleft palates are ‘ound posterior to the incisive foramen, Normally, the right and left palatine processes fuse together and fuse to the prmary palate.Tem of 100 Ware THEDE Ghani Guerin retinas It the tendon ofthe biceps brachiis severed atthe ebow, and the cut causing ths injury extends 2 cm mecaly, which ofthe folowing ‘structures willbe injured? OA. Brachial artery ©B, Musculocutaneous nene OC, Profunda brachi artery ©. Radial nerve OE. Unar nerve ‘The correct answer is A. The brachial artery is immediately metial to the tendon ofthe biceps brachi atthe elbow. As the artery enters the forearm, it's covered by the bictal aponeurosis, a broadening of the biceps tendon, ‘The museulocutaneous nerve (choice B) does nat cross the elbow. The musculocutaneous nerve gives offal of ts muscular branches to muscles inthe arm, The remainder ofthe nerve is then renamed the lateral cutaneous new ofthe forearm, wich passes the elbow lateral to the tendon ofthe biceps. ‘Te profunda bracil artery (choice C) arses from the brachial artery nthe proximal part of the arm. It accompanies the radial artery inthe musculospral groove and then divides ito the radial colateal artery and mile calateral artery, which eross the elbow lateral o the tendon ofthe biceps, “The radial nerve (choice D) es within the musculospral groove along the back ofthe humerus, then passes between the brachioradals muscle and te brachials muscle a the elbow, lateral to the tendon ofthe biceps. “The unar nerve (choice E) crosses the ebow posterior to the medial epicondyle ofthe humerss It then passes between the two heads ofthe fexor carp unais and courses through the forearm deep to this muscle item 700f 100 are WADE Obank-Guesions ot tne ‘A.man suffers a direct blow tothe right eye, producing eye pain and severe bleeding from the nose. X-rays reveal a blowout fracture ofthe floor ofthe ort. Involvement of which of the folowing structures fs suggested by the patient's symptoms? OA. Ethmoid air cots OB, Masilary sinus 6, Oraleavty ©. Prerygopalatine fossa OE, Sphenol sus ‘The correct answer is B. The foor ofthe orbits also the roof ofthe maxilay sins, The bone separating the orbit from the smarilary sinus is frequently gute thn and may fracture from increased intraoral pressure caused by a direct ow to the eye. ‘The subsequent bleeding into the mavilary sinus wil result in blood draining from the sins into the nasal cavity. The maallary sinuses are the largest siuses inthe sku. These sinuses ighten the portion of the maxllae above the teeth and produce mucous ‘secretions that help to “fush' the interior surfaces of the nasal cavities. ‘The ethmoid air cells (choice A) are medial to the orbit. This bone is also frequently gute thin ‘The ora caity (choice C) is separated from the orbit bythe maxdlary sins. ‘The pterygopalatine fossa (choice D) s posteromesial to the orbit. The medial portion of the inferior orbital fissure communicates between the orbit andthe pterygopalatine fossa, ‘The ephencid sinus (choice E) is posteromedial tothe orbit. There is no communication between the sphenald sinus and the orbitJem 7tort09 cman NDE Qbank - Questions ‘Damage to the cervical sympathetic trunk in a patient is most likely to be seen in which of the folowing findings? © A. Constiton ofthe right pup © B, Dilation ofthe right pupl ©. Inabity to abduct the night eye ©. Inabity to close the right eye OE. Paraly ofthe platyma muscle on he ght side ‘The correct answer is A. The sympathetic trunk les posterior to the internal jugular vein. Preganglonc sympathetic nerve fbers cen be damaged in @ cervical trunk injury. These nerve bers synapse inthe superior cenical gangion on postgengbonic ‘sympathetic neurons that innervate structures inthe head. The diator pupllae muscle (smooth muscle of theirs that dates the pupil is sympatheticaly innervated: paralysis ofthis muscle due to interruption of is imervation results in constriction ofthe pupil {miosis ation of the pupl (choice B) would resut from paralysis ofthe sphincter pupltae muscle (smooth muscle of theirs that, Ceonsticts the pup). Ths muscle is parasympatheticaly nervated and would not be affected by ths inry ‘An inability to abduct the eye (choice C) woud result rom paralysis ofthe lateral rectus muscle, an extraccular muscle that is Imervated by the abducens nerve, It would not be affected by this inury ‘An inability to close the eye (choice D) would result from paralysis ofthe orbcularis ooull muscle, a skeletal muscle ofthe face. ‘This muscle is innervated by the facial nerve and would not be affected by this injury ‘The platysma muscle (choice E) isa skeletal muscle in the superficial fascia ofthe neck. It's imervated by the facial nerve and Would not be affected by tis inary. [rem ors00 oan SDE Goank Gunnons matt ‘What type of mucosa is normal forthe distal esophagus? © A. Cllated, columnar epithelium OB. Keratnzed, stratifed, squamous eptheiom © G. Noneated, columnar epithelium 0D. Nonkeratinzed, simple, squamous epithelum C, Nonkeratinzed, stratfied, squamous epithelium ‘The correct answer is E. The esophagus is a hotow muscular tube with a length that Is approximately 26 em long witha clameter of 2 em and is covered by nonkeratinzed, stratified, squamous epithelum for its entre length. The esophagus begins posterior tothe crcod cartage, atthe level of vertebra C6. At this level it descends toward the tharacie cay posterior tothe {rachea, passes inerory along the dorsal wall ofthe mediastinum, and finaly enters the abdominopelvic cavity through an ‘pening inthe diaphragm.tem 73.9100 tar NODE Qbank - Questions ott Which ofthe folowing structures does the fetal allantoic duct become in the adult? OA. Cloaca: ©B. Medial umbiial igament 5, Urachus| ©, Ureter OE. Uretira ‘The correct answer is C. The urachus isa fbrous remnant that extends from the umbilcus tothe urinary bladder. I's also known as the median unbical bgament ofthe anterior abdominal wall, The cloaca (choice A) isthe primitve, endodenrvlined region that receives the terminal potion ofthe hindgut Iti ater subdhided into urogental and anal areas, ‘The medial umbilical igament (choice B) isa paired structure located deep to the peritoneum of the anterior abdominal wal. It is ferred by the obliterated umbilical artery “The ureter (choice D) isthe muscular tube that conveys urine from the kidney to the urinary blader. “The urethra (choice E) isthe passageway that caries urine from the bladder to the perineum. em 740100 are ‘The patent closes both of his eyelds in response fo the left eye being touched with a thin wisp of cation as he looks tothe right. Which of the folowing erenal neves is responsible forthe motor im ofthis reflex? A. Abdueens 8, Facial ©. Optic ©. Trigeminal OE. Trochlear ‘Cemunarin ‘The correct answer i “The comeal refex i tested by touching the comea of one eye witha cotton wisp; ths causes both eyes to close, The afferent, or sensory, component ofthe corneal reflex is mediated by the ophthalme division of the ipsilateral {ngeminal nene (V-1). The efferent, or motor, component is mediated by the facial nerve (CN Vil), blateraly. ‘The abducens nerve (CN Vi; choice A) innervate the lateral rectus muscles, which abduet the eyes. “The opti nerve (CN Il; choice C) is responsible for vision, providing the afferent imb ofthe puplary light reflex. The Edinger Westphal nucleus mediates part ofthis reflex. ‘The trigeminal nerve (CN V: choice D) is responsible forthe afferent mb of the coreal rele. It also innervates the muscles of mastication and provides sensory imervation tothe face. “The trochlear nerve (CN IV; choice E)innervates the superior oblique muscles, which depress, intort, and abduct the eyes.fem 75 0f100 CMe NBDE Qbank Guewtons rota ‘Compression ofthe obturator nerve wil result in weakness of which of the following muscles? OA, Adductor magnus OB. Biceps femoris, 06. Rectus femeris ©. Sartorius OE. Vastus mesials ‘cima ‘The correct answer's A. The obturator nerve innervates the muscles ofthe medial compartment ofthe thigh, The adductors are located inferior tothe acetabular surface. These include the adductor longus, adductor brevis, adductor magnus, and gracils. ‘muscles. The adductor magnus is also innervated by the tial nerve ‘The biceps femoris (choice B) isn the posterior compartment ofthe thigh. The long head ofthe biceps femoris is inervated by the tibial portion ofthe sciatic nerve, andthe short head of the biceps femoris is innervated by the common peroneal portion of the soiat nen. ‘The reotus femoris (choice C) and vastus medals (choice E) are two of the four heads ofthe quadriceps femoris muscle. Al four heads ofthe quadriceps femoris muscle ae in the anterior compartment ofthe thigh and are innervated by the femoral ‘The sartrius muscle (choice D) sin the anterior compartment ofthe thigh and s imervated by the femoral nerve oo aman THEE Qbank -Guewtone rot tnt During a cranial nerve test, the patient cannot elevate her right eye from the abducted postion. Which ofthe folowing muscies is paralyzed? (OA. Right inferior obsque © B. Right inferior rectus ©, Right lateral rectus © D. Right superior oblique © Right superior rectus ‘The correct answer is E, The superior rectus muscle can elevate and adduct the eye from the neutral postion, From the ‘abducted poston, its the only muscle that can elevate the eye “The inferior obique muscle (choice A) can elevate and abduct the eye from the neutral positon, From the adducted poston itis the only muscle that can elevate the eye “The inferior rectus muscle (choice B) can depress and adduct the eye from the neural poston. From the abducted positon, its the only muscle that can depress the eye. “The lateral rectus muscle (choice C) can abduct the eye. “The superior obique muscle (choice D) can depress and abduct the eye from the neutral position, From the adducted positon, i is the only muscle that can depress the eye100 amare THEE Qbank -Guewione ot tne ‘A &-year-aldchid who has not had routine pedlatre care develops afebrie disease with cough and a blotchy rash, and is brought to the emergency department. On physical examination, there is cervical and allay lymphadenopathy, Also noted is an erythematous, macropapular rash behing the ears and along the hairine,ivoling the neck and, to @ lesser extent, the trunk. Examination of this patents oropharynx would likely reveal wich ofthe folowing lesions? © A. Adherent thin, whitish patch on gingiva © B. Cold sores on the lips ©, Curdy white materia overlying an erythematous base onthe oral mucosa (©. Lage stalow ulcers on the oral mucosa © E. Mulile smal white spots on the buccal mucosa “The correct answer is E. The cisease described is measles (rubeola), wich has the typical presentation described inthe {question stem, Measles is caused by a Morbivrus, an RNA virus belonging tothe Paramyxouirus famiy, Kopik spots, which are pathognomonic for measles, are smal, bhish-white spots on the buccal mucosa inthe early stages of measles. These lesions ‘appear ust before the onset ofthe characterise rash (which can also vole extremities) and fade as the rash develops. Leukoplakia is a premalignant condition characterized by adherent whitish patches on the gingiva (choice A) and other sites inthe coral cavity. Cold sores onthe ips (choice B) are caused by infection with Herpes virus, ‘Candia infection (thrush) produces curdy white material loosely attached to an erythematous base (choice C), Aphthous ulcers are large shatiow ulcers of the oral mucosa (choice D), commonly known as canker sores.em 78 0 100 Mark THEE Qbank Questions pot tnt Injury to which nerve would resut in wrist drop, and inability to make a tight fit, even though al ders can be flexed? A. Aatlary nerve © B, Long thoracic nerve 0. Median nene ©, Museuoeutaneous nerve OE. Radal nerve ‘The correct answer is E. Physiologically the cstrution ofthe radial nerve is as folows: extensor muscles on the arm and ‘forearm (triceps brat, brachioradialls, extensor carp racials, and extersor carpi uinars), ditigal extensors and abductor polis, ‘and eka over the posterolateral surface ofthe arm. The racial nerve es inthe musculospral groove ofthe humerus and is subject to injury in association with a fracture of the midshatt of the humerus, The radal nerve imervates the extensor muscles of ‘the forearm, incucing the muscles that extend the wrist; paralysis ofthese muscles resus na wrist crop. Although the muscles responsible for flexing the igs are not inervated by the radial nerve, the making of a tight st requires thatthe wrist be stabilized withthe west extensors “The axillary nerve (choice A) leaves the axila through its posterior wall and is nt located inthe region ofthe midshaf of the humerus. The axllary nerve imervates the deltoid and the tees minor muscles, neither of wiich have any function inthe hand “The long thoracie nerve (choice B) les against the chest wall and isnot subect to Ijury as a result of a humeral fracture. The long thoraci nerve innervates the serratus anterior muscle. “The median nerve (choice C) passes though the arm, buts not in close contact with the humerus inthe midshaft region. The nerve is separated from the bone by the brachiais muscle. The median nerve innervates many muscles ofthe anteror ‘compartment ofthe forearm responsible for flexion ofthe wrist and iis, “The musculocutaneous nerve (choice D) isnot in contact withthe humerus. It innervates the muscies in the anterior compartment ‘of te arm. These muscles have no function in the hand. mem 7901100 Omar THEDE Qbank Quattor ott 'An abrasion results in the total oss of epidermis over a large area of an arm, but one month later the abrasion has healed, with regrowth ofthe epidermis, Which ofthe following mechanisms accounts forthe restoration ofthe epidermis over the abraded area? Growth of epidermis from har flicles and sweat glands inthe dermis ‘Migration of endothesalcels from newly grown capilaries ©. Transformation of dermal fibroblast into epidermal ces. ©. Transformation of macrophages into epidermal cels| ©, Transtormation of melanocytes into epderma cals, ‘The correct answer is A. The dermis contains skin appendages (e.g. hai folcles), which contain epithelial stem cells. In the process of healing a large area where the epidermis has been lost but the dermis is intact, re-epitelaliztion occurs by growth of {epdermal cels from the underying skin appendages, as well as from the intact epidermis along the wound edges. Physiologically the dermis les beneath the epider. I has two major components, a superfeial papilay layer and a deeper reticular layer. The papilary layer contains the capllaries and the sensory neurons, which supply the surface ofthe skin. The Fetielar layer consists of an interwoven meshwork of dense iregular connective Ussve. None ofthe one cell ypes are known to directly contribute to the regeneration of epidermis over abraded skin,tam 90 0f 100 Mack NODE absnk - Questions ‘An injection to anesthetize pain from a fracture ofthe seventh rib should be gien in what area?” OA. Seventh intercostal space immediately below the seventh rib inthe midclaviear ne (© B. Seventh intercostal space immediately below the seventh rib just lateral othe angle of the lb (©. Seventh intercostal space immediately below the seventh rib just medial tothe angle ofthe rb 1D. Sikh intercostal space immediately above the seventh rib inthe midctavielar ne ©: Sis intercostal space immediately above the seventh rib just lateral tothe angle of the rib ‘Oenaaton ‘The correct answer is B. The seventh intercostal nerve (the anterior ramus ofthe seventh thoracic spinal nerve) innervates the ‘seventh rib, After passing through the intervertebral foramen between the seventh and eighth thoracie vertebrae, the nerve Bes in the seventh intercostal space. After passing the ange ofthe rib, i occupies a postion along the lower border ofthe rib, nthe costal groove, Use ofa local anesthete at this pont wil anesthetize the rb {By the time the intercostal nerve has reached the midlaviclar line (choice A), It has already innervated most ofthe rib. Use of ‘an anesthetic at this point would not be effective. Wie the intercostal neve is inthe intercostal space media tothe angle of the rib (choice C), iis not along the lower border of the rb ‘The intercostal nerve does not le along the upper border of he rib (choices D and E). Thus, injection at these stes would not be effective. nem 6107700 Char ‘WAGE Gbaak -Guestions ‘The parotid duct pierces the buccinator muscle nearest tothe maxilary OA, First molar . Second molar ©. Third molar 2D. First premolar GE, Second premolar ‘Ges ‘The correct answer is B. The parotid gland les lateral tothe buccinator muscle. The facial nerve and its branches pass though ‘tt produses a serous-only salvar seoretion, which is s2cond in volume to that produced by the submandibular. The parots is the largest salivary gland in se. Its duct, known as Stensen's duct, plerees the buceinator inthe icity ofthe mallary second molar,nem 6201100 Mark THESE Ghani Guetions Which ofthe folowing gastrointestinal hormones is structurally related to secretin? OA, Cholecystokinin OB. Gastrn ©. Glucagon ©. Somatostatin OE, Substance P ‘Oimomsne ‘The correct answer is C, Glucagon, secretin, nd vasoacive intestinal polypeptide (VIP) are all structuraly related Cholecystokinin (choice A) and gastrin (choice B) form another family of related hormones. Neither somatostatin (choice D) nor substance P (choice E) are structurally related to secretin. In ation to ther role inthe gastrointestinal system, both hormones are also present in the brain, ‘nem 630100 Char TNGDE Ghent Guortone ‘The nucleus tha les immediately medial (and deep) tothe uncus isthe OA, amygdala ©. caudate nucleus 6. elaustram ©. hippocampus ‘The correct answer is A. The uncus, which isthe mesial protrusion ofthe parahippocampal gyrus, is an extemal structure seen ‘on the ventral surface ofthe temporal lobe. The amygdala is a collection of nucle! that les directly beneath the uncus, “The caudate nucieus (choice B) is a deep nuclear structure that les lateral othe lateral ventricles. ‘The claustrum (choice C) is a thin and elongated nucleus that les just medial tothe insular cortex ‘The hippocampus (cholce D) is @ nuclear structure that es in the interior ofthe parahippecampal gyrus, ‘The putamen (choice E) is a nuclear structure that resides lateral tothe caudate and medial tothe claustrum.im 0100 ae THEE Qbank -Guestions rot tt In whic ofthe folowing structures are the opacifications located with cataract formation? A. Aqueous humor 1B. Comea 2G. Lens 5D, Optic nerve OE. Retina ‘Cramt ‘The correct answer is C. Cataracts are lens opacifcations. I is not known whether senie cataracis represent disease or normal opacifeaton wih age. Cataracts may occur as @ consequence of diabetes melits, long-term steroids, or congenital infections. Thay are svecesstuly treated at present with lens extraction and implantation of prosthetic lenses. The diagnostic charactersties for cataracts are as folows: 1) blurted vision that is progressive over months to years, 2) no pain or redness is. seen, and 3) ens opacities may be ivisible or grossly vile ‘Aqueous humor (choice A) Is continually replaced due to active secretion by the cllary body. As such It does not undergo ‘pacification li in constant ux. Coreal opacification (choice B) is generally a consequence of squamous metaplasia, in which the transparent, nonkeratinized, squamous cels are replaced by opaque, keratnized, squamous cells. Squamaus metaplasia is a reparative process, usvally due to ction injury fo the comea or a vitamin A deficiency. “The optic newe (choice D) is nt transparent, and it does not undergo opacification injury. It may, however, atrophy due to Ischemic, traumatic, infective, of metabotc insults. “The retin (choice E) consists of multiple layers of neural cels. The retina transparent but isnot the site of cataract formation nem 050100 Char THEDE Qbank -Guewtons rot ne Parathormone will have its greatest effect on which cell type? OA, Osteoclasts OB, Osteoblasts OC. Osteoeytes: 2. Osteosarcomas ‘The correct answer is A. Parathormone (PTH) is secreted by principal cells ofthe parathyroid glands, small gland pairs embeded in thyroid tissue, Parathyrodd hormone wil increase the level of serum caleium by increasing bone calcium resorpton, increasing digestive absorption of calcu, and decreasing kidney excretion of calcium. The bone resorbing cells are osteccasts, “which are large, multinucleated eels, Ostecblasts are bone-formers and secrete bone mati, primarly of eolagen. Osteacytes are mature bone celsivng in lacunae in compact bone. Osteosarcomas are malignant tumors of bone.inom os 0100 Char TWEDE Obani -Guevtons Tot te In the adult, neurons are an example of which ofthe following? OA. Continuously dividing calls 1B, Lable cel 5. Permanent cells 1D, Quiescent cats DE. Stable cel. ‘Conon ‘The correct answer is C. Permanent (non-dvicing) cells have left the cel eycle and can no longer undergo mitotic division Examples that are usually cited include neurons and carciae myocytes. One ofthe major disadvantages ofthese ces is that once they are damaged or destroyed, they do not regenerate Examples of labile (continuously dividing) ces (choices A and B) include the eptheia ofthe body surface, gastrointestinal tract, and urinary tract Examples of stable (quiescent) cels (choices D and E) include the cells ofthe iver andthe glandular organs ofthe body. Tem @7 of 1000 are TWODE Ghani Gusstons not tne In a posterolateral herniation of the nucleus pulposus ofthe intervertebral disk between vertebrae C4 and C5, what neural structure is ‘most likely to be inured? A. Anterior ramus C5 ©, Posterior ramus ©. Spinal cord ©. Spinal nerve C4 ‘The correct answer is E. A posterolateral heriation ofthe nucleus pulposus is the most common type of hemiation, This hemiaton resus inthe nucleus pulposus occupying space within the intervertebral foramen. The spinal nerve in the intervertebral foramen between vertebrae C4 and CS isthe C5 spinal nene. “The anterior and posterior rami (cl herniated nucleus pulposus. ss A and B) are found lateral othe intervertebral foramina and are not compressed by @ “The spina cord (choice C) is within the vertebral canal. A posterior heration of a nucleus pulposus (lass common) may compress the spinal cor Spinal nerve C4 (choice D) is found inthe intervertebral foramen between vertebrae C3 and C4 and would not be compressed by this herniation.[femos oreo oa SDE Gosni Goren % Wich ofthe flowing muscles alow a patient ocontnue to ex the ebow after rupture ofthe biceps tendon? [A Brachial and bashers 5. Flexorcarp nar and Texor carpi adals © 6. Flere digtorm stpereiais and fexordigtoram profindus © D, Pronatorteres and supmator © E. Troops and coraobraciass ‘Somos “The correct answers A. The long head ofthe biceps tendons vnrabe to abrasion as t moves within the Bical grove etven the greater and lesertuerosties of ie humervs, The tendon occasionaly snaps, partly the ede Fortunate, the Dacia and bractioradals are sufeeny strong hevorso the evo n whch fino rete even 0 ‘pede repair of the tendon fs undertaken The texor api ras andthe flexor arial (choceB) are flexors atthe rs ot ebw. ‘The for dotonim spercias and the fexordigtorum profundus (choice C) are flexors ofthe wis and agers ‘The pronatr teres and he suiator (hole D)pronate and supa the forearm, respecte “The tceps andthe coracobrachiis (choice E) extend he elbow an fx he shoulder, respect enw atioe Omer TRE Ghank onions wait ‘iss! bodies correspond to which of the folowing cytoplasmic organeles? © A, Golgi apparatus OB, Mitochondria 06. Nocleol 6D. Rough endoplasmic reticulum C.B, Smooth endoplasmic reticulum ‘The correct answer is D. Rough endoplasmic reticulum present in neurons is called Nissl substance, or Nissi bodies. Nis bothes sian intensely with basic dyes and are found inthe cell bady and proximal dendrites, but notin the axon hilock or axontam 90 100 tae NODE Qbank - Questions ot tne Which salvary gland ces have folded cell membranes at ther base thal are filed with large numbers of mitochondria? A. intercalated duct calls 1B, Strated duct cels 6. Serous secretory cels ©, Mucus secretory els OE, Myoeptetal (basket cats ‘The correct answer is B. Striated duct cels Ine sections of salivary ducts, which mosty the composition of salva. In particular, ‘they may add potassium, remove sodium, or add bicarbonate, This ionic movement, mostly against a concentration gradient, requires energy inthe form of ATP. This ATP is made in mitochondria. Rows of mitochondria in these cel, located near th base, appear in ight microscopy to be stipes or stations. Mucous and serous secretory cells, because of ther protein secreting ‘uneton, may have highly developed ribosomes, rough endoplasmic reticulum, and golgi complexes. Inercalated duct cells have no unique specialzatons of note. Mycepitelal cell have contractile ablty, somewhat like muscle cel, em 91 0109 Mark THEE Obani Guevtons Which muscle has fibers that enter the area dise and capsule? A, Medial pterygoid © B. Bucoinator 06, Temporalis ©. Lateral pterygoid 0, Masset ‘The correct answer is D. Only the lateral pterygoid enters the temperomancibular oint (TMU). Its fibers join the articular cise and capsule. These fers are from the superior head of the muscle. Fibers from the inferior head enter the bony head of the ‘mandibular condyle. The lateral ptenygod protrudes the mancible, depresses (opens) and moves it et and night. None of the ther muscies sted enter the TM. Medial plenygod and masseter priarly elevate (close) the mandible, whereas temporals eevates (anterior fiver) and rerudes (posteror fibers). Buccinator forms the substance ofthe cheek ands also a muscle of facial expression, Itis not a muscle of mastication[em s2 0100 omar NDE Obank-Quertons rt ime \Which ofthe folowing structures constitites part ofthe ventricles ofthe heart? OA, Autcle OB, Crista terminalis 6. Fossa ovals ©. Sis venarum ‘OE, Trabecuige cameae ‘Ooms ‘The correct answer is E. The trabeculae carneae are ridges of myocardium inthe ventricular wall. Remember that the Latin root "carne." means “flesh” and that the ventricles are "fesher’ than the ara ‘The auricle (choice A) is derve from the fetal atrium; thas rough myocardium known as muscull pectna or peetnate muscle, ‘The crista terminals (choice B) isthe vertical rkge that separates the smooth portion of the right arm from the rough porton; extends longiudinaly from the superior vena cava tothe inferior vena cava, ‘The fossa ovalis (choice €) isthe remnant of the fetal foramen ovale, an opening inthe interatral septum that alows blood ‘enterng the right atu from the inferior vena cava to pass directly tothe left side of the heat. ‘The sinus venarum (choice D) isthe smooth-walled portion of the atrium that receives blood from the superior and inferior vvena-cava, It's derived from the fetal sinus venosus, [femovereo oman WDE Ghent Gunrlone or Following thyroid surgery, hoarseness and ciffeulty speaking can be atrbuted to damage to a branch of which eranial nerve? A, Facial © B. Glossopharyngeal SC. Hypogiossal ©. Trigeminal OE. Vagus ‘The correct answer is E. The recurrent laryngeal nerves are branches ofthe vagus (CN X) and supply al intrinsic muscles of the larynx, except the cricothyroid. The right recurrent laryngeal nerve recurs around the right subclavian artery. The left recurrent laryngeal nerve recurs in the thorax around the arch of the aorta and igamentum arteriosum. Both nerves ascend tothe larynx by ‘passing between the trachea and esophagus, n close proximity tothe thyroid gland. The recurrent laryngeal nerves are therefore particulary vulnerable during thyroid surgery. and damage may cause extreme hoarseness. ‘The facial nerve (choice A) innervates the muscles of facial expression, the stapedius muscle, and the lacrimal, submandibular, ‘and sublingual glands. It also mediates taste sensation from the anterior two-thirds ofthe tongue ‘The glossopharyngeal nerve (choice B) inervates the stylopharyngeus muscle and the parotid gland. Visceral afferents supely the carotid sinus baroreceptors and carotid body chemoreceptors and mediate taste from the posterior one-third ofthe tongue. ‘Somatosensory flbers Supply pan, temperature, and touch information from the posterior one-thrd ofthe tongue, Uoper Bharyns, imide ear, and eustachian tube ‘The hypoglossal nerve (choice C) inervates the intnsic muscles ofthe tongue, the genioglossus, hypoglossus, and styloglossus muscles, ‘The trigeminal neve (choice D) receives sensory information from the face and also inervates the muscles of mastication[fem 940100 lee NBDE Obsnk- Guerone [At which ofthe folowing ages does fetal movement rst occur? 6A. 1 menth ©B. 2 months 6. 4 months. ©. 6 months. OE. Tmonths. ‘Sea ‘The correct answer is B. Neuromuscular development is sufcient to alow fetal movement inthe eighth week of ife. Other features of Week 8 incide the first appearance of a thin skin, @ head as large asthe rest of the body, foward-ooking eyes, appearance of cigits onthe hands and feet, appearance of testes and ovarles (but not distinguishable extemal genitalia), and crown-rump length of approximately 30 me, By the end of the eighth week, nearly all adut structures have atleast begun to develop, and the fetus Tooks Ike @ baby.” [femssori0o oar TSE Goan vation 4 ‘During a mastectomy, the surgeon notes that he breast umar has spread i valve the muscle layer immediately deep othe breast. Whick mascl is imvaied? A. Extemal oblique OB. Pectorals major oe. Playsma ©. Rectis abdominis ‘OE, Stemodledomastod ‘Seeoma ‘The correct answer is B. The muscle deep to the breast isthe pectoras major. Breast cancer can invade this muscle but usually does not because the relatively thick, deep fascial layer serves as a barrier Formerly, the pectorais major was removed during radical mastectomy, leaving the patient witha major loss of function ofthe agjacent arm, The now more frequently used ‘madiied radical mastectomy spares the pectorais major. ‘The extemal obiques (choice A) and rectus abdominis (choice D) muscles are inthe abdomen, The platysma (choice C) and stermocleldomastoid (choice E) muscles are inthe neck,[rem 96 0100 lar NBDE Gbank-Guenions notte ‘Salvary secretions pass trough the cel membrane at he apex ofthe gland cel and enter the duct. Tis type of seereton is krown OA. endosine OB. apocrine 6. halerne ‘Boole ‘The correct answer is D. This i a basic histology question. Fist, endocrine secretions are hormonal secretions (peptide or steroid) which enter the circulation direct into capillaries, Exocrine secretions are usualy enzymes, and pass trough epithelabined ducts, such as secretory ducts of salvary glands or pancreatic exocrine glands. The other choices refer to how secretions are made and secreted, In holoerne secretions, the entire secretory cell becomes the secretion. Two examples of holoerne secretion are sebaceous secretion and sperm cals (which can be considered whole cel secretion) In apocrine secretion, the apex (apo) becomes the secretion, breaking of from the main body ofthe cel. Mik, secretion of the mammary Glands, isan example of apocrine secretion. Most secretions are merocrine. In ths case, the secretion is produced inthe tyloplasm and ests by passing through the cell membrane. There s no major change inthe cel tel emer ori00 ware TNEDE Ghani Quertone rote ‘Anerve is located close tothe wrist porton of the tendons ofthe flexor earl radials and palmaris longus. This nerve alees from ‘which part(s) of the brachial plexus? OA, Lateral and medial cords OB. Lateral cord ©. Midale and lower trunks 9D. Posterior cord OE, Upper and middle trunks ‘Sum ‘The correct answer is A. The nerve in questions the median nerve, which ies between the palmaris longus and flexor carpi radia tendons onthe anterior aspect ofthe forearm. The median nerve i formed from both the lateral and mecial cords ofthe brachial ponus. The brachial ples inervates the shoulder grsle and upper imb with eontabutons from the ventral rami of spinal nerves CS through Ty, The nerves that form tis plexus originate from trunks and cords named accordingly.nem 980100 Char THEE Qbank -Guewions ot ne From which ofthe folowing arteries does the sphenopalatine artery aise? © A, External carotis OB, Facial 6. Masiary 6D. Ophthalmic O, Transverse ail ‘The correct answer is C. The sphenopalatine artery isthe terminal branch ofthe maullary artery. The maxitary artery arises {rom the extemal carotid artery and then passes through the ifratemparal fossa, glng off branches to structures in ths region. “The artery then passes through the ptenygomaxilary fissure to enter the pterygopalaine fossa, The terminal branch then passes through the sphenopalatine foramen to enter the nasal cavity and supply much of the nasal mucosa, particularly in the posterior region of the nasal cavity. “The external carotid artery (choice A) arises ‘Tom the common carotid artery atthe carotid bifurcation, The extemal carotid artery has eight branches that supply the head and neck region: the superior thyroid, ascending pharyngeal, occipital, ingual, facial, posteror aurieular, masilary, and superfcial temporal arteries, ‘The facial artery (cholce B) arses from the extemal carotid artery. It provides blood supply to much of he facial region. The nasal cavity (particulary the anterior portion) recewves some ofits blood supply ftom branches ofthe facial artery “The ophthalmic arteny (choice D) arses from the internal carotid artery immeciately ater the internal carotid artery emerges {rom the cavernous sinus. The ophtalmi artery passes trough the optic canal to supply structures inthe orbit “The transverse facial artery (choice E) is a branch of the superfcial temporal artery. It suppbes blood to structures inthe upper portion ofthe lateral face. F100 CMe TNGDE Ghani Guertin rot te Pain experienced in the anterior half ofthe external ear canals vanemitted by which ofthe folowing nerves? © A. Aurcular branch of the vagus © B, Aurculotemporal neve ©. Greater auricular nerve 1D. Lesser eecipital nerve DE, Vestbulocochlear nerve ‘wana ‘The correct answer is B. The ear has a complex sensory nerve supply, which includes al ofthe nerves listed, A consequence of this complet is that pain actualy originating nother sites (teeth and shuses are notorious) may be misinterpreted as ear pain, ‘or, less commonly, pain originating in the ear may be misinterpreted as arising from other sites, The anterior half ofthe external ‘ear canal is supplied by the aurculotemporal nerve, whic also supplies the facial surface of the upper part ofthe auricle, ‘The auricular branch ofthe vagus (che A) supplies the posteror halo he extemal ear canal “The greater auricular nerve (choice €) supplies both surfaces ofthe lower par ofthe aul “The lesser cial nerve (choice D)suppies the crarial surface of he upper par ofthe eule “The vestbulocoshear nerve (choice E) supp hearing and moton senseem 100 of 100 mar SDE Ghent Guestona ote Blopsy demonstrates epthelial metaplasia, Which ofthe folowing ell types was most ikely observed inthe voNed areas? ©. Cilated columnar epithelium © B, Coboidal epitelm 6. Keratning squamous epithelum 1D, Nonellated columnar epithelium OE. Nonkeratnizng squamous epithelium “The correct answer is D. The medical conto is Baret's esophagus, in which the normaly nonkeratinzing squamous pithelum (choice E) of the esophagus undergoes metaplasia to gastric or intestnab-ke epithelum composed of nonciiated columnar epithetal cel. Barrett's esophagus typically develops in the setting of chron gastroesophageal refx and significantly Increases the risk of later development of adenocarcinoma ofthe distal esophagus CClated colurnar epithesum (choice A) is found in the respiratory tract. ‘Cuboidal epthelum (choice B) is found inthe Kidney, peritoneal ning, and pleural ining, Keratining squamous epithelium (cholee €) is found in skin. ‘Nonkeratinzing squamous epithelum (choice E), In addon o being the normal epithelium of the esophagus, Ie found in mouth, nose, and vagina,