Question 1

A 45-year-old patient has a small, firm, mobile tumor on the dorsum of the right foot just proximal to the base of the big toe and superficial to the bones and the long extensor tendon but deep to the superficial fascia. The patient has a neurofibroma of a digital nerve

-The following information concerning the tumor is correct:

A) It is situated on the lower surface of the foot close to the root of the big toe.
B) It is attached to the first metatarsal bone.
C) On palpation, it moves more freely from medial to lateral than from proximal to distal.
D) It lies deep to the tendon of the extensor hallucis longus muscle.
E) It is attached to the capsule of the metatarsophalangeal joint of the big toe.

On palpation, it moves more freely from medial to lateral than from proximal to distal.

Accepted Answer

The tumor is a neurofibroma of a small digital nerve. This fact explains why the tumor is relatively superficial and moves with the digital nerve more freely from medial to lateral than from proximal to distal. A. The tumor is situated on the dorsum or upper surface of the foot. B. The tumor is mobile and not attached to the first metatarsal bone. D. The tumor lies superficial to the tendon of the extensor hallucis longus muscle. E. The tumor is mobile and is not attached to the capsule of the metatarsophalangeal joint.

Question 2

A 31 -year-old woman has a history of poliomyelitis affecting the anterior horn cells of the lower thoracic and lumbar segments of the spinal cord on the left side. On examination, she has severe right lateral flexion deformity of the vertebral column.

-The following statement is correct about this case:

A) The virus of poliomyelitis attacks and always destroys the motor anterior horn cells of the spinal cord.
B) The disease resulted in the paralysis of the muscles that normally laterally flex the vertebral column on the left side.
C) The muscles on the right side of the vertebral column are hyperactive.
D) The right lateral flexion deformity is caused by the slow degeneration of the sensory nerve fibers originating from the vertebral muscles on the right side.

The disease resulted in the paralysis of the muscles that normally laterally flex the vertebral column on the left side.

Accepted Answer

The disease infected the anterior horn cells, whose axons supply the muscles that normally laterally flex the vertebral column on the left side. A. The virus of poliomyelitis attacks anterior horn cells in the spinal cord. The result may be death of the cells and muscle paralysis or, depending on the severity of the attack, the nerve cells may recover and the muscle paralysis may also recover. C. The muscles on the right side of the vertebral column are contracting normally against the paralyzed left-sided vertebral muscles. D. The sensory nerves of muscles are unaffected by the polio virus.

Question 3

A 20-year-old woman severely sprains her left ankle while playing tennis. When she tries to move the foot so that the sole faces medially, she experiences severe pain.

-What is the correct anatomic term for the movement of the foot that produces the pain?

A) Pronation
B) Inversion
C) Supination
D) Eversion

Inversion

Accepted Answer

The movement of the foot so that the sole comes to face medially is called inversion (see text Fig. 1-3). For a full discussion of the movements of inversion and eversion of the foot at the subtalar and transverse joints of the foot, see text.

Question 4

A 25-year-old man has a deep-seated abscess in the posterior part of the neck.

-The following statement is correct concerning the abscess:

A) The abscess probably lies superficial to the deep fascia.
B) The deep fascia does not determine the direction of spread of the abscess.
C) The abscess would be incised through a vertical skin incision.
D) The lines of cleavage are not important when considering the direction of skin incisions.
E) The abscess would be incised, if possible, through a horizontal skin incision.

Accepted Answer

The abscess would be incised, if possible, through a horizontal skin incision along a line of cleavage (see CD Fig. 1-1). A. A deep-seated abscess in the neck usually lies deep to the superficial fascia and beneath the investing layer of deep cervical fascia. B. The arrangement of the deep fascia in the neck plays an important role in the direction of spread of a deep-seated abscess. C. The abscess would only be incised through a vertical incision if a horizontal incision along a line of cleavage was not possible. A vertical incision in the neck would result in an unsightly scar. D. The lines of cleavage (see CD Fig. 1-1) are very important when considering the direction of skin incisions. However, cosmetic concerns have to take second place in life-threatening situations.

Question 5

A 40-year-old workman received a severe burn on the anterior aspect of his right forearm. The area of the burn exceeded 4 in. $^{2}\left(10 \mathrm{~cm}^{2}\right)$ . The greater part of the burn was superficial and extended only into the superficial part of the dermis.

-In the superficially burned area, the epidermis cells would regenerate from the following sites except which?

A) The hair follicles
B) The sebaceous glands
C) The margins of the burn
D) The deepest ends of the sweat glands

Accepted Answer

In a superficial burn, the epidermal cells would regenerate from the hair follicles, the sebaceous glands, and the margins of the burn.

Question 6

A 40-year-old workman received a severe burn on the anterior aspect of his right forearm. The area of the burn exceeded 4 in. $^{2}\left(10 \mathrm{~cm}^{2}\right)$ . The greater part of the burn was superficial and extended only into the superficial part of the dermis.

-In the superficially burned area, the epidermis cells would regenerate from the following sites except which?

A) The hair follicles
B) The sebaceous glands
C) The margins of the burn
D) The deepest ends of the sweat glands

Accepted Answer

The sebaceous glands are located superficially (see text Fig. 1-4) and are destroyed in deep burns.

Question 7

In a 63-year-old man, a magnetic resonance imaging scan of the lower thoracic region of the vertebral column reveals the presence of a tumor pressing on the lumbar segments of the spinal cord. He has a loss of sensation in the skin over the anterior surface of the left thigh and is unable to extend his left knee joint. Examination reveals that the muscles of the front of the left thigh have atrophied and have no tone and that the left knee jerk is absent.

-The following statements concerning this patient are correct except which?

A) The tumor is interrupting the normal function of the efferent motor fibers of the spinal cord on the left side.
B) The quadriceps femoris muscles on the front of the left thigh are atrophied.
C) The loss of skin sensation is confined to the dermatomes L1, 2, 3, and 4.
D) The absence of the left knee jerk is because of involvement of the first lumbar spinal segment.

Accepted Answer

The patellar tendon reflex (knee jerk) involves L2, 3, and 4 segments of the spinal cord.

Question 8

A woman recently took up employment in a factory. She is a machinist, and for 6 hours a day she has to move a lever repeatedly, which requires that she extend and flex her right wrist joint. At the end of the second week of her employment, she began to experience pain over the posterior surface of her wrist and noticed a swelling in the area.

-The following statements concerning this patient are correct except which?

A) Extension of the wrist joint is brought about by several muscles that include the extensor digitorum muscle.
B) The wrist joint is diseased.
C) Repeated unaccustomed movements of tendons through their synovial sheaths can produce traumatic inflammation of the sheaths.
D) The diagnosis is traumatic tenosynovitis of the long tendons of the extensor digitorum muscle.

Accepted Answer

The wrist joint is not diseased in this patient. The swelling on the posterior surface of the wrist region was caused by the excessive production of fluid in the synovial sheaths of the extensor tendons secondary to repeated and excessive extensor movements, a condition called traumatic tenosynovitis.

Question 9

A 19-year-old boy was suspected of having leukemia. It was decided to confirm the diagnosis by performing a bone marrow biopsy.

-The following statements concerning this procedure are correct except which?

A) The biopsy was taken from the lower end of the tibia.
B) Red bone marrow specimens can be obtained from the sternum or the iliac crests.
C) At birth, the marrow of all bones of the body is red and hematopoietic.
D) The blood-forming activity of bone marrow in many long bones gradually lessens with age, and the red marrow is gradually replaced by yellow marrow.

Accepted Answer

In a 19-year-old boy, the bone marrow at the lower end of the tibia is yellow. A biopsy specimen of red marrow in an adult, who is suspected of suffering from leukemia, is easily obtained from the iliac crests or the sternum.

Question 10

A 22-year-old woman had a severe infection under the lateral edge of the nail of her right index finger. On examination, a series of red lines were seen to extend up the back of the hand and around to the front of the forearm and arm, up to the armpit.

-The following statements concerning this patient are probably correct except which?

A) Palpation of the right armpit revealed the presence of several tender enlarged lymph nodes (lymphadenitis).
B) The red lines were caused by the superficial lymphatic vessels in the arm, which were red and inflamed (lymphangitis) and could be seen through the skin.
C) Lymph from the right arm entered the bloodstream through the thoracic duct.
D) Infected lymph entered the lymphatic capillaries from the tissue spaces.

Accepted Answer

Lymph from the right upper limb enters the bloodstream through the right lymphatic duct.

Deck 1: Introduction to Clinical Anatomy