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Final exam of Regional Anatomy for International Students in English Teaching Class (Sample)

[日期:2014-05-21]   来源:人体解剖学教研室  作者:人体解剖学教研室   阅读:917次  [字体: ]
I.          Type A of multiple choice questions (mcqs)
Directions: There are fifty questions in this section. Below each question are five answers marked A, B, C, D and E; you are required to select the best answer for each question. (Subtotal score: 50, 1 point per question.)
1.         The nerve that can easily be injured during ligation of the inferior  thyroid artery is
A External branch of the superior laryngeal N.     B Recurrent laryngeal N.
C Internal branch of the superior laryngeal N.      D Vagus N.
E Sympathetic trunk
2.         Which structure of following doesn’t lie within the carotid sheath ?
Acommon carotid artery        Binternal jugular vein    Cinternal carotid artery
Dvagus nerve                 Ecervical sympathetic trunk
3.         Which structure does not run on the superficial surface of the sternocleidomastoideus
Aexternal jugular vein        Binternal jugular vein        Cplatysma
Dgreat auricular nerve        Esuperficial lateral cervical lymph nodes
4.         The muscle not attaching the hyoid bone  is
Asternothyroid              Bdigastric               Cthyrohyoid muscle
Domohyoid muscle           Esternohyoid muscle
5.         The correct description about the neck lymph nodes is
AThe angular lymph  nodes are localized in a venous angle     
BThe cancerous cells from both stomach canner and esophagus cancer often spreads to the angular lymph nodes
CVirchow’s lymph nodes are positioned in the intersection between the internal jugular vein and the posterior belly of digastric
DThe cancerous cells from the nasopharyngeal carcinoma  frequently spread to virchow’s lymph nodes        
EAll the above four descriptions are incorrect  
6.         The most reliable statement about the triangles in the neck is supposed to be
AThe submandibular triangles is fenced by mandible, mylohyoid muscle and hyoglossus
BThe carotid triangle is surrounded by internal carotid artery, external carotid artery and mandible
CThe muscular triangle is fenced by the posterior border of sternocleidomastoideus, anterior border of trapezius and clavicle  
DThe Occipital triangle  of neck is bordered by lower belly of omohyoid , posterior-boundary of sternocleidomastoideus and clavicle
EAll the above four statements are wrong
7.         In which triangle of the neck will the surgeon make an incision to gain access to trachea?  
A Carotid         B Muscular  C Subclavian  D Submandibular   E Submental
8.         The cervical plexus innervates all of the following structures EXCEPT:
ADiaphragm                    BOmohyoid muscle           C Platysma 
DSkin over thyroid cartilage       ESkin over clavicle
9.         The structure cut in the thyroid surgery incision should be
Aprevertebral fascia          Bthyrohyoid             Ccarotid sheath
Dsternocleidomastoid         Esternothyroid
10.     During a motorcycle accident, an 18-year-old male landed on the right lateral side of his rib cage with his right upper limb abducted. In the hospital he was found to have "winging" of the right scapula. Which nerve was likely damaged in the accident?
AAccessory    BLateral pectoral    CLong thoracic D Phrenic   E Vagus
11.     Which of posterior mediastinal structures is most closely applied to the posterior surface of the pericardial sac?
Aaorta B azygos vein    C esophagus D thoracic duct   E trachea
12.     The ductus arteriosus unusually keep open after birth, requiring surgical closure. When placing a clamp on the ductus, care must be taken to avoid injury to what important structure immediately dorsal to it?
AAccessory hemiazygos vein           BLeft internal thoracic artery
      CLeft phrenic nerve                   DThoracic duct
      ELeft recurrent laryngeal nerve
13.     An 8-year-old boy is found to have a mid-line tumor of the thymus gland that is impinging posteriorly on a blood vessel. The affected vessel is most likely the:
Aleft brachiocephalic vein             B left pulmonary vein
Cleft bronchial vein                  D right pulmonary artery
     Eright superior intercostal vein
14.     While observing a mastectomy on a 60-year-old female patient, a medical student was asked by the surgeon to help tie off the arteries that supply the medial side of the breast. The artery that gives origin to these small branches is the:
AMusculophrenic           BInternal thoracic            C Posterior intercostal
 DSuperior epigastric         EThoracoacromial
15.     What structure is situated in the front of the right pulmonary root ?
Aright vagus nerve trunk        Bright recurrent laryngeal nerve
Cazygos vein arch             Dright phrenic nerve      
Eright thoracic sympathetic trunk
16.     The lateral boundary of the cubital fossa is formed by the
AFlexor carpi radialis muscle         BTendon of the biceps muscle
CBrachialis muscle                 DBrachioradialis muscle
EPronator teres muscle
17.     In withdrawing a blood sample from the median cubital vein the needle passes slightly lateral, which nerve might possibly be injured?
ADorsal ulnar cutaneous            B Lateral antebrachial cutaneous
     CMedial antebrachial cutaneous      D Posterior antebrachial cutaneous
     ESuperficial radial
18.     The artery which passes through the quadrangular space of the posterior shoulder supplies which muscle?
A Deltoid               Blevator scapulae         Clatissimus dorsi 
Dtrapezius             Esubscapularis
19.     The pulse of the radial artery at the wrist is felt immediately lateral to which tendon?
AAbductor pollicis longus            BExtensor pollicis longus
CFlexor carpi radialis                DFlexor digitorum profundus
EPalmaris longus
20.     The axillary nerve arises directly from which part of the brachial plexus?
Ainferior trunk                 B lateral cord                 C medial cord
     Dmiddle trunk                  Eposterior cord
21.     While riding a bike, a patient fell against a tree and fractured the shaft of the humerus at midlength. What nerve may be injured because of its close proximity to the injury?
AUlnar                              B Radial              C Axillary
     DMedial antebrachial cutaneous          E Median
22.     Following a car accident in which the patient received a deep laceration on the medial side of his right knee, the patient notices numbness along the medial side of his right leg and foot. He has no motor deficit. The nerve which appears to have been injured is the:
Afemoral nerve                 B saphenous nerve              Csural nerve
     Dsuperficial fibular nerve         E deep fibular nerve
23.     The femoral canal contains the:
ADeep inguinal lymph node(s)     B Femoral artery          C Femoral nerve
     DFemoral vein                   E Ilioinguinal nerve
24.     Which structure does NOT enter or leave the inguinal region by passing deep to the inguinal ligament?
AFemoral artery            B Femoral nerve                  C Femoral vein
     DPsoas major muscle        E Round ligament of the uterus
25.     The pulse of the femoral artery is best felt at which superficial reference point?
AAnterior to the ankle joint           B Femoral triangle         C Mid-thigh
     DPopliteal fossa            E Right lateral portion of the hypogastrium
 
26.     What anterior thigh muscle must be retracted to expose the adductor canal and its contents?
AAdductor magnus            B Gracilis                     CRectus femoris
     DSartorius                  E Vastus intermedius
27.     Which of the following is NOT located within the adductor canal? 
ASaphenous nerve          B Femoral artery          C Nerve to vastus medialis
     DFemoral vein              E Deep femoral artery
28.     After suffering a deep stab wound in the medial upper quadrant of the right buttock, an emergency room patient found walking to be very difficult. The basic problem was that, during stepping, her left hip sagged down as soon as the left foot was lifted off the ground to swing forward. What nerve was damaged?
A Femoral                    B Inferior gluteal                 C Obturator
     DPudendal                    E Superior gluteal
29.     the structure that lies closest to the femur in the popliteal fossa is
ADescending genicular artery                   BGreater saphenous vein
    CPopliteal artery               D Popliteal vein                  E Sciatic nerve
30.     A patient complains of localized pain in a swollen lower calf and cannot strongly plantar flex his foot. What tendon may have been ruptured?
ACalcaneal                  Bperoneus longus        C flexor digitorum longus
     Dflexor hallucis longus        E tibialis anterior
31.     The most usual site for feeling the pulsations of the dorsalis pedis artery in the foot is:
AJust behind the medial malleolus
BJust lateral to the tendon of extensor hallucis longus
CBehind the tendon of peroneus longus
DIn the second dorsal metatarsal space
EJust behind the lateral malleolus.
32.     A patient with a fracture to the left upper tibia was treated with a plaster cast. A few days later he started to develop progressive numbness over the dorsum of the foot and weakness in dorsiflexion. The cast was quickly changed and the signs were attributed to nerve compression. The compressed nerve was most likely the:
ATibial       B Obturator       C Sciatic    D Femoral  E Common fibular
33.     The tendon of which muscle forms the patellar ligament?
A Tibialis posterior            B Triceps surae            C Triceps brachii
D Biceps brachii              E Quadriceps femoris
34.     What place is the lowest position in the female peritoneal cavity when the woman is sitting position
Ahepatorenal recess                           Brectovesical pouch
Cvesicouterine pouch                          DDouglas’fossa
EAll the above four places are not right positions
35.     Which structure passes through the deep inguinal ring?
AIliohypogastric nerve                     B Ilioinguinal nerve
CInferior epigastric artery                  DMedial umbilical ligament
ERound ligament of the uterus
36.     A 15-year-old boy was admitted to the emergency room for having large bowel obstruction resulting from a left-sided indirect inguinal hernia. The most likely intestinal segment involved in this obstruction is the:
Aascending colon                Bcecum              C descending colon
     Drectum                       Esigmoid colon
37.     A 45-year-old man had developed a direct inguinal hernia several months after having an emergency appendectomy. The examining doctor linked the cause of hernia to accidental nerve injury that happened during appendectomy and weakened the falx inguinalis. Which nerve had been injured?
Agenitofemoral              Bfemoral nerve             C Ilioinguinal
     DSubcostal                  E T10
38.     Visceral pain is often referred to a site on the body wall (where the patient "feels" it) that is innervated by the same spinal cord segment that innervates the visceral organ involved. Pain of appendicitis is often first felt around the umbilicus, indicating that the appendix receives its sympathetic (and thus visceral afferents) from which spinal cord segment?
AT 9       B T 10       C T 11      D T 12        E L 1
39.     Which of the following doesn’t supply the stomach,
A Left gastric               BRight gastric           CShort gastric
DSuperior mesenteric         ELeft gastroepiploic
40.     Which of the following structures does not lie at least partially in the retroperitoneum?
Aadrenal glandsuprarenal gland     B duodenum            C kidney
     Dpancreas                          E spleen
41.     The fundus of the stomach receives its arterial supply from the:
ASplenic             B Inferior phrenic        C Left gastroepiploic
     DRight gastric                            E Common hepatic
42.     A 50-year-old female patient with severe jaundice was diagnosed with pancreatic cancer. You suspect that the tumor is located in which portion of the pancreas?
AHead      B Neck        C Body       D Tail       E Uncinate process
43.     A patient was admitted with symptoms of bowel obstruction. Further examination revealed that the obstruction was caused by the nutcracker-like compression of the bowel between the superior mesenteric artery and the aorta. The compressed bowel is most likely the:
ADuodenum                 B Jejunum               C Ileum    
D Ascending colon           ETransverse colon
 
44.     A 58-year-old patient was diagnosed with a severe case of portal hypertension due to alcoholic cirrhosis of the liver. It was determined that a bypass between the vessels of the portal and caval systems was necessary. The plan most likely to be successful is:
ACoronary vein left grastric veinto right gastro-omental vein
     BLeft colic vein to sigmoidal vein       C Inferior mesenteric vein to splenic vein
     DSplenic vein to left renal vein         E Superior rectal vein to inferior rectal vein
45.     The left ovarian  vein  usually joins which vein?
AInferior vena cava               B Left renal             C Portal
 DSplenic                       E Superior mesenteric
46.     Which of following lie in pelvic cavity?
A Spermatic cord            B Treitz ligament          C Triangle of Calot
D Ischioanal fossa           E Dougulas’s cavity
47.     The surface projection of the fundus of gallbladder is
A The intersection of the lateral border of rectus abdominis and left costal arch
B The intersection of the lateral border of rectus abdominis and right costal arch
C McBurney point               D Lanz point             E none of all above
48.     The nerves controlling the segmental of the lowest plane of the costal arch should be     
A 10th intercostal nerve              B 8th intercostal nerve
C 6th intercostal nerve               D 4th intercostal nerve        
E 9th intercostal nerve
49.     The adjacent organs of the posterior surface of the left kidney is 
A pancrea                B jejunum                   C fundus of stomach
D 11th rib                E left colic flexure
50.     The posterior boundary of the omental foramen is       
Asuperior part of the duodenum       Binferior vena cava
Ccommon bile duct                Dhepatic portal vein           Ehead of pancreas
II.      Comprehensive Questions(CQ)
Directions: In this section, there are 5 questions for you. Based on the requirements of questions, you need to analyze the questions one by one, and then clearly, neatly and concisely put down the corresponding answers on the exam paperssubtotal score:25.
          i.what artery is likely found in the following region structure? 5scores
i)            triangle of Calot  
ii)          lesser sciatic foramen     
iii)         clavipectoral fascia  
iv)        riangle of the vertebral artery   
v)          anatomical snuff  box
         ii.              Describe the lymphatic drainage of the breast(6scores)
         iii.             Briefly described the normal position of appendix5scores.
        iv.             The rotator cuff is composed of what musclesdescribe the innervation of these muscle respectively(6scores).
         v.              What are the boundaries of Hesselbach's (inguinal) triangle ?3scores
III.     Case study(CS)
Directions: In this section, there are 2 cases for you. Based on the requirements of questions, you need to analyze the questions one by one, and then clearly, neatly and concisely put down the corresponding answers on the exam papers(subtotal score:25)
A 28-year-old woman in her 36th week of pregnancy arrived in the emergency room following an automobile accident. Immediately following the accident she went into labor. The accident had broken her pelvis such that the emergency room physician deemed a vaginal delivery would be hazardous. An obstetrician was called, and she agreed with the ER physician's initial assessment. A Cesarian section was performed, resulting in the delivery of a healthy baby girl. During the operation, the obstetrician used a Pfannenstiel incision to open the abdomen. This incision involves making a transverse, slightly convex cut large enough to deliver a child at approximately the pubic hairlinE
Questions to consider:
i)             What abdominal wall layers must be incised at the pubic hairline (near the midline) in order  to access the abdominal cavity? 8score
ii)          What vascular structures might be cut during a Pfannenstiel incision? (2score)  
iii) Why is the incision made in a convex manner instead of straight across? (2score)
During one of your third-year rotations you observe a resident on your service perform a thoracocentesis to obtain a sample of pleural fluid. The resident inserts the needle near the lower border of the eighth rib at the right anterior axillary line and withdraws a few milliliters of fluid. The next day, during your rounds, the patient complains of tingling and numbness of the skin of his chest from the level of the eighth rib down toward the umbilicus on the right side.
Questions to consider:
i)            Why is the needle inserted in the eighth interspace? (1score)
ii)          What layers did the needle pass through to enter the pleural cavity? (6score)
iii)         What specific structure was likely damaged by the needle, and how does this explain the distribution of the parasthesia? (2score)
iv)        What other structures are associated with the damaged structure and how are they arranged? Between what two muscle layers are these structures found? (3score)
v)          Where should the resident have inserted the needle to avoid damaging these structures? (1score)
IV.    Extra questionEQ
Directions: the section is not required in this semester . A student has right to decide whether answer it or not. If there is a correct answer, the points are included in the total score, but we will only give 100 points if your total score is more than 100 points. If there is no answer or the answer is not correct, we will not give any point(subtotal score:10).
A 50-year-old man underwent surgery to remove cancer from his lower rectum. The surgery successfully removed the tumor; however, following the surgery, he began to experience urinary retention, erectile impotence, and ejaculatory difficulty. Prior to the surgery, the patient's sexual function was "normal."
Questions to consider:
i)            What structure was likely damaged by the surgery? (1score)
ii)          Describe the adjation organges of the anterior surface of rectum(4score)
iii)         Where might metastases from a rectal cancer be found? (2score)
iv)        What other functions might be disturbed in this sort of injury in a male patient? (1score)
v)          What functions might be disturbed in a female patient with a similar injury? (2score)