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Anatomy Review

Gray’s AnatomyReview

THIRD EDITION

MariosLoukas, MD, PhD

Proessor, Department o Anatomica Sciences

Dean o Basic Sciences; Dean o Researc

St. George’s University Scoo o Medicine Grenada, West Indies

R.Shane Tubbs,MS, PA-C,PhD

Proessor

Departments o Neurosurgery, Neuroogy and Structura and Ceuar Bioogy

Tuane University Scoo o Medicine, New Oreans, Louisiana, United States

Department o Neurosurgery and Ocsner Neuroscience Institute, Ocsner Heat System, New Oreans, Louisiana, United States

Department o Anatomica Sciences

St. George’s University Grenada, West Indies

Peter H.Abrahams, MBBS, FRCS(ED), FRCR, DO(Hon),FHEA, FRSA

Peter Abraams MBBS FRCS(ED) FRCR DO(Hon) FHEA FRSA

Pro. “Emeritus” o Cinica Anatomy, Warwick Medica Scoo, NationaTeacing eow & Lie Feow, Girton Coege, Cambridge

Visiting Pro. LKC Scoo o Medicine NTU Singapore Consutant Brune Médica Scoo

Stephen W.Carmichael, PhD,DSc

Proessor Emeritus o Anatomy and Ortopedic Surgery

Mayo Cinic

Rocester, Minnesota, United States

ThomasGest,PhD

Proessor o Anatomy

University o Houston Coege o Medicine Houston,Texas, United States

Frst edton 2010 Second edton 2016

No part of ths publcaton may be reproduced or transmtted n any form or by any means, electronc or mechancal, ncludng photocopyng, recordng, or any nformaton storage and retreval system, wthout permsson n wrtng from the publsher Detals on how to seek permsson, further nformaton about the Publsher’s permssons polces and our arrangements wth organzatons such as the Copyrght Clearance Center and the Copyrght Lcensng Agency, can be found at our webste: wwwelsever.com/permssons

Ths book and the ndvdual contrbutons contaned n t are protected under copyrght by the Publsher (other than as may be noted heren).

Notices

Practtoners and researchers must always rely on ther own experence and knowledge n evaluatng and usng any nformaton, methods, compounds or experments descrbed heren Because of rapd advances n the medcal scences, n partcular, ndependent vericaton of dagnoses and drug dosages should be made To the fullest extent of the law, no responsblty s assumed by Elsever, authors, edtors or contrbutors for any njury and/or damage to persons or property as a matter of products lablty, neglgence or otherwse, or from any use or operaton of any methods, products, nstructons, or deas contaned n the materal heren

ISBN: 978-0-323-63916-3

Content Strategist: Jeremy Bowes

Content Development Specialist: Km Benson

Project Manager: Andrew Rley

Design: Amy Buxton

Illustration Manager: Deanna Sorenson

Marketing Manager: Kathleen Patton

Prnted n Inda

Last dgt s the prnt number: 9 8 7 6 5 4 3 2 1

To my fater Cristos tat gave me te foundations, love, empaty and care to become a pysician, and more importantly te inspiration and continuous tirst to create knowledge and sare it wit te rest of te world Love you Dad, I am tinking of you every day

To Rut Jones. You are te best.

RST

To “Lucy in te Sky wit Diamonds,” and all te descendants of “Papi and Lulu”

Susan Lee Stoddard, Allen St. P. Carmicael, and Magnolia Quinn Carmicael

SWC

To my family, for all of teir support, and to my students, for all of teir inspiration

Preface

Rote memorization o anatomic acts as been te cardina eature o exaustive, and exausting courses in uman anatomy or many generations o students in medicine, dentistry, and oter aied eat science programs. Oten, itte distinction was made between te weat and te ca, and itte attention was given to te practica, cinica appication o te inormation. Gray’s Anatomy Review was designed or use by students wowistotestteirknowedgeocinicaanatomy hequestions, answers, and expanations in tis book are intended to serve mutipe purposes or students in various programs.

1 his review provides a tougt-provoking source or study by students in preparation or examinations in various programs o gross anatomy around te gobe.

2 To avoid pointess memorization by te student, a te questions are ramed witin cinica vignettes tat guide te student toward practica appications o te textua materia.

3 he mutipe-coice, singe-best-answer ormat o te questions is designed to aciitate student review in preparation or te United States Medica Licensing Examination (USMLE) and simiar quaiying examinations

4. he expanations o te answers empasize te critica importance o understanding norma and dysunctiona uman anatomy

5. Student understanding is urter enanced by critica examination o aternative, incorrect answers tat students migt be tempted to coose

6. Finay, te review provides a succinct distiation o te petora o acts in cinica anatomy, assisting te student’s earning and understanding o important concepts in te practice o medicine, irrespective o te student’s career coice he majority o te questions in tis review book are correated wit te oowing textbooks:

• Gray’s Anatomy for Students, ed 4, by Ricard L Drake, A. Wayne Vog, and Adam W. M. Mitce

• Netter Atlas of Human Anatomy, ed 7, by Frank Netter

• Abraams’ and McMinn’s Clinical Atlas of Human Anatomy, ed 8, by Peter H. Abraams, Jonatan D. Spratt, Marios Loukas, and Abert N. Van Scoor Eac answer is reerenced to pages in Gray’s (GAS), Netter ’ s (N) and Abraams’ and McMinn’s (ABR/McM). For te embryoogy capter we ave correated te cinica vignettes wit Before We Are Born: Essentials of EmbryologyandBirtDefects, ed 9, by Keit L Moore,TVN Persaud, and Mark G. Torcia.

We ave incorporated or adapted many drawings, ucoor iustrations, and radioogica images in an attempt to acceerate te earning process and to enance understanding o bot te anatomy and te cinica appications he primary sources on wic we ave drawn or iustrative materia are rom Abraams’and McMinn’s ed 8, “Clinical Atlas of Human Anatomy ”

Acknowledgments

A cinica review book is te work not ony o te autors but aso o numerous scentc and cnca rends and coeagues wo ave been so generous wt ter knowedge and gven sgncant eedback and ep. hs book woud not ave been possbe were t not or te contrbutons o te coeagues and rends sted beow.

A very speca group o medca students, members o te Student Cnca Researc Socety at te Department o Anatomca Scences at St. George’s Unversty, eped enormousy wt te competon o ts project troug ter comments and crtcsm o eac capter as part o te advsory board o ts book.

Advisory Board (for the First and Second editions)

Nkos Avarez (Neck)

Mea Bargava (Pelvis and Perineum)

Lann Cn Casey (Lower Limb)

Rana Cakrabart (Upper Limb)

Ramya Ctters (Embryology)

Monca Dandapan (Abdomen)

Pyumka De Sva (Upper Limb)

Uta Guo (Embryology)

Rc Hajjar (Abdomen)

Roand Howard (Lower Limb)

Ljo C. Ipparamb (Upper Limb)

heoanns Koas (Upper Limb)

Jun Lee (Back)

Ova Lu (Lower Limb)

Prateek Matur (Head)

Spro Mavromats (Neck)

Lews Musoke (Lower Limb)

Anastasya Neyubna (Pelvis and Perineum)

Georga Pau (Pelvis and Perineum)

Tony Sadek (horax)

Sanojan hyagangam (Back)

Davd hornton (Abdomen)

Randy Tgue (Head)

Ryan Uyan (horax)

Lndsey Van Brunt (Head and Neck)

Danee Van Patten (Head and Neck)

Advisory Board

Yusu Am, MD

Cassandra Ang, MD

for

the Third edition

Tanya Cabrto, MD

Mark Carrasco, MD

Stacey Cares, MD

Vncent Courant, MD

Se Ed, MD

Sasa Lake, MD

Sang Lee, MD

Gaurav Manda, MD

Annesa Noe, MD

Rabjot Ra, MD

Asad Rzv, MD

Messa Roberts, MD

Wasa Roberts, MD., MBA

Sonja Saandy, MD

Twadayo Sam-Odusna, MD

Krsna hakore, MD

Eddong Udoyen, MD

he oowng acuty rom te Department o Anatomca Scences at St George’s Unversty ave aso been very epu wt ter comments and crtcsm as part o te advsory

board:

Crysta Antone-Frank, MD

Emanue Badoo, MD

Kateen Bubb, MD

Danny Burns, MD, PD

James Coey, MBBS

Mara Du Pesss, MSc

Deon Forrester, MD

Iketc Gbenmaco, MD

Racae George, MD

Robert Hage, MD, PD

Geobrna Hargrove, MD

Robert Jordan, PD

heoans Koas, MD

Amed Magoud, MD

Eward Marsa, MD, MSc

Mcae Montabano, MD

Ouem Obadna, MBBS

Vd Persaud, MD, PD

Madonna Petua Pp, MD

Kazzara Raeburn, MD, MSc

Rames Rao, MD

Vs Rao, PD

Deepak Sarma, MD

Fematta Sowa, MD

Kristna hompson, MD

Aena Wade, MD

Dr AntonyD’Antoni,PD,Proessor,atPysicianAssistant Program, Wagner Coege, One Campus Road, Staten Isand, NY,asawaysbeenagreatriendandcoeague.Hiscontinuous support, comments, criticism, and entusiasm ave contributed enormousy to te competion o tis project.

Dr Kitt Saer, MD, P D Proessor o Radioogy and Vice Cair o Department o Radioogy at Boston University, or er comments and criticism, and invauabe expertise contributed toward tis project

We are especiay tanku to Ms. Madeene Hyde, at Esevier, or er invauabe insigts, advice, and encouragement

he autors woud aso ike to tank Jeremy Bowes Kim Benson and Andrew Riey, our commissioning and deveopmenta editors, and a te team at Esevier or guiding us troug te preparation o tis book.

he autors tank te following individuals and teir institutions for kindly supplying various clinical, operative, endoscopic, and imaging potograps:

Dr.RayArmstrong,Reumatoogist,SoutamptonGenera Hospita, Soutampton, and Artritis Researc Campaign

Proessor Pau Bouos, Surgeon, Institute o Surgica Studies, University Coege London Medica Scoo, London

Proessor Norman Browse, Emeritus Proessor o Surgery, and Hodder Arnod Pubisers, or permission to use iustrations rom Symptoms and Signs of Surgical Disease, 4t edition, 2005.

Mr Jon Craven, ormery Consutant Surgeon, York District Hospita, York

Proessor Micae Hobsey, ormery Head o te Department o Surgica Studies, he Middesex Hospita Medica Scoo, London

Mr. Rap Hutcings, potograper or Imagingbody.com

Mr Umraz Kan, Pastic Surgeon, Caring Cross Hospita, London

Proessor Jon Lumey, ormery Director, Vascuar Surgery Unit, St. Bartoomew’s and Great Ormond Street Hospitas, University o London

Dr. J. Spratt, Consutant Radioogist and Cinica Director o Radioogy City Hospitas, Sunderand

Dr. Wiiam Torreggiani, Radioogist, he Adeaide and Meat Hospita, Taagt, Dubin

Miss Gii Vads, Optamoogst, ormery at Centra Mddesex Hospta, London

Proessor Jame Wer, Emertus Proessor o Cnca Radoogy, Grampan Unversty Hosptas Trust, Aberdeen, Scotand, and edtor o Wer and Abraams Imaging Atlas of Human Anatomy, ed 5, Esever.

Dedication, v Preface, vi Acknowledgments, vii

 BACK,  Questions, 3 Answers, 20

 THORAX, 43 Questions, 43 Answers, 69

3 ABDOMEN,  Questions, 110 Answers, 143

4 PELVIS AND PERINEUM, 95 Questions, 195 Answers, 209

5 LOWER LIMB, 36 Questions, 236 Answers, 257

6 UPPER LIMB, 84 Questions, 286 Answers, 312

7 HEAD AND NECK, 35 Questions, 352 Answers, 396

8 NEUROANATOMY, 458 Questions, 458 Answers, 466

9 EMBRYOLOGY, 48 Questions, 482 Answers, 489

 QUESTION OBJECTIVES Index, 55

Introduction

First Order Question

1. A 35-year-od man s admtted to te emergency department 30 mnutes ater beng nvoved n a motor vece coson. Pysca examnaton sows a damaged serratus anteror musce Wc o te oowng nerves woud be most key to be njured aong wt njury to te serratus anteror musce?

A. Long toracc

B. Axary

C. Accessory

D. Dorsa scapuar E. horacodorsa

Explanation

A. he ong toracc s te ony nerve tat nnervates te serratus anteror.

B. he axary nerve nnervates te detod and teres mnor.

C. he accessory nerve nnervates te sternocedomastod and trapezus

D. he dorsa scapuar nerve suppes te rombod musces and te ower porton o te evator scapuae.

E. he toracodorsa nerve nnervates te atssmus dors.

First Order Question

2. A 35-year-od man s admtted to te emergency department 30 mnutes ater beng nvoved n a motor vece coson Pysca examnaton sows a damaged serratus anteror musce. Wc o te oowng unctons does te serratus anteror serve?

A. Adducts scapua

B. Depresses rbs

C. Protracton and rotaton o scapua

D. Eevaton o scapua

E. Adducts, extends, and meday rotates arm

Explanation

A. he trapezus and rombod major and mnor retract te scapua.

B. he serratus posteror neror depresses te ower rbs

C. he serratus anteror protracts and rotates te scapua upward.

D. he evator scapuae eevates te superor ange o te scapua, we trapezus eevates ts atera ange or te acromon.

E. he atssmus dors adducts, extends, and meday rotates te arm

Second Order Question

3. A 35-year-od man s admtted to te emergency department 30 mnutes ater beng nvoved n a motor vece coson. Pysca examnaton sows a damaged serratus anteror musce Wc o te oowng unctons w te patent most key be unabe to perorm?

A. Retracton o te scapua

B. Eevaton o te scapua

C. Depresson o te scapua

D. Protracton o te scapua

E. Downward rotaton o te scapua

Explanation

Dferent musces contrbute to te movement o te scapua suc as te serratus anteror, trapezus, evator scapuae, rombods, and pectoras mnor.

A. Retracton o te scapua s carred out by te rombods and trapezus.

B. Eevaton o te scapua s carred out many by te trapezus and evator scapuae musces

C. Depresson o te scapua s perormed prmary by te ower bers o te trapezus.

D. he serratus anteror musce pus te scapua orward (protracton) on te toracc wa.

E. Upward rotaton o te scapua s accompsed by te trapezus and serratus anteror togeter, we downward rotaton o te scapua s perormed by te rombod musces and evator scapuae.

Second Order Question

4. A 35-year-od man s admtted to te emergency department 30 mnutes ater beng nvoved n a motor vece coson. Pysca examnaton sows njury to te cest wa n te axary regon and wnged scapua. Wc o te oowng musces s most key njured?

A. Levator scapuae

B. Serratus anteror

C. Trapezus

D. Rombod major and mnor E. Serratus posteror superor

Explanation

A. he evator scapuae eevates te scapua.

B. he serratus anteror musce pus te scapua orward (protracton) and counterbaances te pu o te trapezus to keep te costa surace o te scapua cosey opposed to te toracc wa, preventng wngng o te scapua.

C. Atropy o te trapezus musce may ead to scapuar wngng, but ts nerve, te accessory, traves troug te posteror trange o te neck.

D. he rombod major and mnor eevate and retract te scapua and ter atropy may ead to sgt scapuar wngng, but ter nerve, te dorsa scapuar, traves troug te neck.

E. he serratus posteror superor eevates te 2nd troug 5t rbs.

Second Order Question

5. A 35-year-od man s admtted to te emergency department 30 mnutes ater beng nvoved n a motor vece coson Pysca examnaton sows njury to te cest wa n te axary regon and wnged scapua. Wc o te oowng nerves s most key njured?

A. Long toracc

B. Axary

C. Accessory

D. Dorsa scapuar

E. horacodorsa

Explanation

A. he ong toracc nerve nnervates te serratus anteror musce, wc protracts and upwardy rotates te scapua Patents wt njury to ts nerve w ave ter scapuae protrude on ter back ke a wng.

B. he axary nerve suppes te detod and teres mnor musces he detod abducts, lexes, and extends te arm we te teres mnor ateray rotates te arm.

C. he accessory nerve s responsbe or suppyng te trapezus and sternocedomastod musces, and t traves troug te posteror cervca trange, not te axa. he trapezus eevates and upwardy rotates te scapua we te sternocedomastod lexes and pus te cn upward to te opposte sde. he baance o pu between trapezus and serratus anteror prevents scapuar wngng.

D. he dorsa scapuar nerve traves troug te root o te neck to suppy te rombod major and mnor musces wc are responsbe or retracton o te scapua and ep to prevent scapuar wngng

E. he toracodorsa nerve suppes te atssmus dors musce, wc adducts, meday rotates, and extends te arm.

Third Order Question

6. A 35-year-od man s admtted to te emergency department 30 mnutes ater beng nvoved n a motor vece coson

• Fig. .

Pysca examnaton sows te ndngs n Fg 1 1 Wc o te oowng nerves s most key njured?

A. Long toracc

B. Axary

C. Accessory

D. Dorsa scapuar

E. horacodorsa

Explanation

A. he ong toracc nerve nnervates te serratus anteror musce, wc protracts te scapua, ods te scapua cose to te toracc wa preventng t rom “wngng,” and abducts and upwardy rotates te scapua Patents wt njury to ts nerve w ave ter scapua protrudng on ter back ke a wng.

B. he axary nerve suppes te detod and teres mnor musces he detod abducts, lexes, and extends and te teres mnor ateray rotates te arm.

C. he accessory nerve s responsbe or suppyng te trapezus and sternocedomastod musces he trapezus eevates and upwardy rotates te scapua we te sternocedomastod lexes and pus te cn upward to te opposte sde We atropy o te trapezus may resut n scapuar wngng, eson o te ong toracc nerve s more commony te cause o wnged scapua

D. he dorsa scapuar nerve suppes te rombod major and mnor musces and are responsbe or retracton o te scapua Atropy o te rombod musces may resut n sgt scapuar wngng.

E. he toracodorsa nerve suppes te atssmus dors musce, wc adducts, meday rotates, and extends te arm

Fourth Order Question

7. A 35-year-od man s admtted to te emergency department 30 mnutes ater beng nvoved n a motor vece coson. Pysca examnaton sows te ndngs n Fg. 1.1. Wc o te oowng unctons w te patent most key be unabe to perorm durng pysca examnaton?

A. Latera rotaton o te arm

B. Abducton o te arm rom 0 to 15 degrees

C. Fexon o te arm

D. Extenson o te arm

E. Abducton o te arm above 90 degrees

Explanation

A. Perormed by te nraspnatus, teres mnor, and posteror bers o detod musce.

Main Questions

Questions 1–25

1. A 55-year-od man s brougt to te emergency department because o a 5-day story o severe coug, ngt sweats, and emoptyss. A cest x-ray sows tubercuoss o te rgt ung, wt extenson nto te toracc vertebra bodes o T6 and T7, producng a “gbbus deormty.” Wc o te oowng condtons s most key to be conrmed by radoogc examnaton?

A. Hyperordoss

B. Hyperkyposs

C. Scooss

D. Spna bda

E. Osteoartrts

2. A 68-year-od man s brougt to te ospta due to severe back pan. Te patent says te pan began nsdousy 4 monts ago. He as no story o recent trauma or strenuous actvtes Pysca examnaton sows muscuar strengt o 5/5 and sensory ndngs wtn norma mts. An x-ray o te spne sows severe osteopoross o te vertebra coumn, wt compresson ractures to vertebrae L4 and L5. Wc o te oowng parts o te vertebrae are most key ractured n ts patent?

A. Spnous process

B. Vertebra bodes

C. Transverse process

D. Superor artcuar processes

E. Intervertebra dsc

3. A 45-year-od man s brougt to te ospta because o 2-week story o severe pan n te back and ower mb Pysca examnaton sows sgt batera oss o sensaton o te skn over te ower mbs An x-ray o te spne sows spna cana stenoss n te umbar regon Wc o te oowng condtons s most key to be conrmed by a magnetc resonance magng (MRI) examnaton?

B. Perormed by te supraspnatus musce

C. Perormed by te anteror detod bers, pectoras major, bceps brac and coracobracas musces.

D. Perormed by te posteror detod bers, atssmus dors, and teres major musces.

E. In ts mage, te patent as a wnged scapua. hs usuay occurs as a resut o damage to te ong toracc nerve, wc nnervates te serratus anteror musce. he unctons o ts musce are protracton o te scapua and superor rotaton o te genod ossa Eevatng te arm urter tan 90 degrees requres upward rotaton o te scapua (superor rotaton o te genod ossa) tat s normay done by te serratus anteror and trapezus, workng togeter.

A. Hypertropy o supraspnous gament

B. Hypertropy o nterspnous gament

C. Hypertropy o gamentum lavum

D. Hypertropy o anteror ongtudna gament

E. Hypertropy o nuca gament

4. A 35-year-od man s brougt to te emergency department ater beng nvoved n a motor vece coson. Pysca examnaton sows te scapua retracted ateray on te afected sde An x-ray o te neck sows an njury to te dorsa surace o te neck and a racture o te meda border o te rgt scapua Wc o te oowng nerves s most key njured on tat sde?

A. Axary

B. Long toracc

C. Dorsa scapuar

D. Greater occpta

E. Suprascapuar

5. A 64-year-od man s brougt to te emergency department because o a 4-day story o panu ras and skn eruptons tat are ocazed entrey on one sde o s body, cosey oowng te dermatome eve o te spna nerve C7. he patent was dagnosed wt a erpes zoster vra necton known as “snges.” In wc o te oowng structures as te vrus most key proerated to cause te patent’s current condton?

A. he sympatetc trunk

B. he dorsa root gangon o te C7 spna nerve

C. he atera orn o te C7 spna cord segment

D. he posteror cutaneous branc o te dorsa ramus o C7

E. he ventra orn o te C7 spna cord segment

6. A 45-year-od woman comes to te pyscan because se as experenced moderate pan or 2 years over er et ower back he pan radates to er et ower mb and as become a nusance more recenty. Se saystatatertngacaseosotdrnks,tepansuddeny became ntense An MRI o te umbar regon

sows an ntervertebra dsc ernaton between vertebra eves L4 and L5. Wc o te oowng nerves s most key afected by te dsc ernaton?

A. L1

B. L2

C. L3

D. L4

E. L5

7. A 3-year-od boy s brougt by s moter to te emergency department wt severe eadace, g ever, etargy, maase, and conuson. He as a story o mutpe snus nectons. Hs temperature s 40 1°C (104 2°F) A dagnoss o bactera menngts s suspected. Furter evauaton wt a umbar puncture and aboratory anayss o te cerebrospna lud conrms te dagnoss Wc o te oowng vertebra eves s te most approprate ocaton or te umbar puncture?

A. T12–L1

B. L1–L2

C. L2–L3

D. L4–L5

E. L5–S1

8. A 3-year-od boy s brougt by s moter to te emergency department wt severe eadace, g ever, etargy, maase, and conuson. He as a story o mutpe snus nectons. Hs temperature s 40 1°C (104 2°F) A dagnoss o bactera menngts s suspected. Furter evauaton wt a umbar puncture and aboratory anayss o te cerebrospna lud conrms te dagnoss Wc o te oowng externa andmarks s te most reabe to determne te poston o te L4 vertebra spne?

A. he neror anges o te scapuae

B. he gest ponts o te ac crests

C. he owest par o rbs bateray

D. he sacra atus

E. he posteror neror ac spnes

9. A 39-year-od man s brougt to te emergency department wt severe neck pan ater a wpas njury, sustaned wen s car was struck rom bend. He was paced n a cervca coar and anestetc njecton (Ldocane) was admnstered Imagng studes sow trauma to te gament yng on te anteror surace o te cervca vertebra bodes Wc o te oowng gament s most key dsrupted?

A. Anteror ongtudna gament

B. Lgamentum lavum

C. Nuca gament

D. Posteror ongtudna gament

E. Transverse cervca gament

10. A 65-year-od man s brougt to te emergency department because o severe back pan and te weakness n ower mb motons, especay pontng s et toes. Pysca examnaton sows weakness n standng on tptoes on s et eg. Rgt ower mb sows

no motor strengt dects he patent as numbness on te atera sde o te et mb and oot. Sensaton s ntact on te rgt. An MRI o s spne sows compresson o nerve eements at te ntervertebra oramen between vertebrae L5 and S1. Wc o te oowng structures s most key responsbe or ts space-occupyng eson?

A. Annuus brosus

B. Nuceus puposus

C. Posteror ongtudna gament

D. Anteror ongtudna gament

E. Lgamentum lavum

11. A 27-year-od man s brougt to te emergency department ater beng nvoved n a motor vece coson. Hs vta sgns are wtn norma mts. Pysca examnaton sows weakness durng meda rotaton, extenson, and adducton o te umerus. Hs rada puses are symmetrca and norma. Wc o te oowng nerves s most key njured?

A. horacodorsa

B. Axary

C. Dorsa scapuar

D. Accessory

E. Rada

12. A 39-year-od woman comes to te pyscan because o 2-mont story o nabty to reac te top o er ead to brus er ar wt er rgt and Two monts ago, se ad a mastectomy procedure wt axary ymp node dssecton o er rgt breast. Pysca examnaton sows wngng o er rgt scapua and a norma et scapua Wc o te oowng nerves s most key damaged durng surgery?

A. Axary

B. Accessory

C. Long toracc

D. Dorsa scapuar

E. horacodorsa

13. A 19-year-od man s brougt to te emergency department ater dsocatng s souder wen e was t by te top o a emet durng an ofensve pay by te opposng team we payng ootba. Foowng treatment o te dsocaton, e cannot ntate abducton o s arm. An MRI o te afected souder sows a torn musce. Wc o te oowng musces s most key damaged by te njury?

A. Coracobracas

B. Long ead o te trceps brac

C. Pectoras mnor

D. Supraspnatus

E. Teres major

14. A 1-year-od gr s brougt to te pyscan by er moter or a routne examnaton. he moter says se dd not aways take er prenata vtamns as se was advsed to. Pysca examnaton sows a dmpng o te skn n te mdne o te umbar regon

wt a tut o ar growng over te dmpe Wc o te oowng s te most key dagnoss?

A. Menngomyeocee

B. Menngocee

C. Spna bda occuta

D. Spna bda cystca

E. Racscss

15. A 26-year-od woman comes to te pyscan because o an tc on er back tat appears to be caused by an nsect bte Fve days ago, se returned rom a vacaton n Latn Amerca were se ked n a ranorest.

Wc o te oowng nerve bers carry te sensaton o a mosquto bte on te back, just atera to te spnous process o te T4 vertebra?

A. Somatc aferent

B. Somatc eferent

C. Vscera aferent

D. Vscera eferent

E. Somatc eferent and vscera aferent

16. A 15-year-od gr s brougt to te emergency department because o 3-day story o progressve ever, eadace, and etargy he patent’s parents are aganst vaccnatons and say ter daugter s not up to date on a vaccnatons. Se as no story o major nesses and s not takng any known medcatons. Her temperature s 40.3°C (104.5°F), bood pressure s 101/64 mm Hg, puse s 110/mn, and respratons are 25/mn A dagnoss o menngts s suspected. To obtan a sampe o cerebrospna lud by spna tap n te umbar regon, te tp o te neede must be paced n wc o te oowng ocatons?

A. In te epdura space

B. Between anteror and posteror ongtudna gaments

C. Superca to te gamentum lavum

D. Between aracnod mater and dura mater

E. In te subaracnod space

17. A 59-year-od man comes to te pyscan because o severe back pan ater tng eavy uggage. he patent descrbes te pan n s neck as an eectrcke sootng pan. He as no oss o motor uncton or sensaton. Pysca examnaton sows no neuroogc abnormates or njury to te spna cord An MRI o te cervca spne sows a ernated dsc. Wc o te oowng gaments s n an anatomc poston to protect te spna cord rom drect compresson n ts patent?

A. Supraspnous

B. Posteror ongtudna

C. Anteror ongtudna

D. Lgamentum lavum

E. Nuca gament

18. A 15-year-od gr s brougt to te emergency department because o 3-day story o progressve ever, eadace, and etargy he patent’s parents are aganst vaccnatons and say ter daugter s not up to date on a vaccnatons. Se as no story o

major nesses and s not takng any known medcatons. Her temperature s 40.3°C (104.5°F), bood pressure s 101/64 mm Hg, puse s 110/mn, and respratons are 25/mn A dagnoss o menngts s suspected and a umbar puncture s ordered. In umbar puncture, te neede s oten nserted between te spnous processes o te L4 and L5 vertebrae to ensure tat te spna cord s not njured. hs eve s sae because n te adut te spna cord usuay termnates at te dsc between wc o te oowng vertebra eves?

A. T11 and T12

B. T12 and L1

C. L1 and L2

D. L2 and L3

E. L3 and L4

19. A 45-year-od woman comes to te pyscan because o a 6-year story o dscooraton o er ngers and toes n ow temperatures due to cronc vasospasm

Se was dagnosed wt sceroderma and Raynaud dsease at te age o 39. Ree rom te symptoms n te ands woud requre surgca dvson o wc o te oowng neura eements?

A. Lower cervca and upper toracc sympatetc bers

B. Lower cervca and upper toracc ventra roots

C. Lower cervca and upper toracc dorsa roots

D. Lower cervca and upper toracc spna nerves

E. Batera accessory nerves

20. A 69-year-od woman comes to te pyscan because o neck pan tat as been progressvey gettng worse or te past ew weeks. Her temperature s 37°C (98.6°F), bood pressure s 126/84 mm Hg, puse s 92/mn, and respratons are 21/mn An MRI o te spne sows osteopytes n te ntervertebra oramen betweenvertebraeC2andC3.Wcoteoowng musces w most key be afected by ts condton?

A. Rombod major

B. Serratus anteror

C. Supraspnatus

D. Dapragm

E. Latssmus dors

21. A 42-year-od woman comes to te pyscan wt ower back pan tat as been progressvey gettng worse or te past 2 monts. Her pan s worse wen wakng down  and s aevated wen se bends over. Pysca examnaton sows norma relexes and sensaton bateray n te upper and ower mbs. An MRI sows stenoss o te umbar vertebra cana A amnectomy o two vertebrae s perormed. Wc o te oowng gaments w most key aso be removed?

A. Anteror ongtudna

B. Dentcuate

C. Lgamentum lavum

D. Nuca

E. Crucorm

22. A 28-year-od prmgravda woman at 40 weeks’ gestaton s admtted to te ospta or devery. Her vta sgns are wtn norma mts. A tocometer and eta eart rate montor are paced on er abdomen In te na stages o abor, a cauda anestetc s admnstered va te sacra atus. Into wc o te oowng spaces n te sacra cana s te anestetc most key paced?

A. Vertebra cana

B. Vertebra venous pexus

C. Epdura space

D. Subaracnod space

E. Subdura space

23. A 12-year-od boy was brougt to te emergency department by s parents because o g ever and severe stfness n s back Hs nta temperature s 38.8°C (101.8°F), respratons are 19/mn, puse s 94/mn, and bood pressure s 141/91 mm Hg. A dagnoss o menngts s suspected, and a umbar puncture s ordered. Mcroscopc examnaton o te cerebrospna lud sows ematopoetc ces. Wc o te oowng gaments s most key penetrated by te neede?

A. Supraspnous

B. Dentcuate

C. Anteror ongtudna

D. Posteror ongtudna

E. Nuca

24. A 25-year-od man s admtted to te ospta 30 mnutes ater beng nvoved n a motor vece coson Pysca examnaton sows a suggs response to stmu. Neuroogc examnaton sows no oter abnormates. An MRI sows damage to te tp o te transverse process o te trd cervca vertebra, wt a sgncanty arge pusatng ematoma. Wc o te oowng arteres s most key damaged?

A. Anteror spna

B. Vertebra

C. Ascendng cervca

D. Deep cervca

E. Posteror spna

25. A 79-year-od man comes to te pyscan because o 3-mont story o ncreasngy panu ambuaton Pysca examnaton sows an abnormay ncreased posteror convexty to te toracc curvature resutng rom osteopoross Wc o te oowng s te most key condton o ts patent’s spne?

A. Scooss

B. Hyperkyposs

C. Spna stenoss

D. Lordoss

E. Hernated dsc

Questions 26–50

26. A 42-year-od woman s brougt to te emergency department because o an njury sustaned ater sdng nto second base eadrst durng er company ’ s

sotba game 2 ours ago Se as severe pan and stfness n er neck. Her vta sgns are wtn norma mts. Pysca examnaton sows droopng o er rgt souder and dicuty n eevatng tat souder. An x-ray o te spne sows no ractures and an MRI sows sot tssue damage. Wc o te oowng nerves s most key damaged n ts patent?

A. horacodorsa

B. Accessory

C. Dorsa scapuar

D. Greater occpta

E. Axary

27. A 53-year-od man s admtted to te ospta 50 mnutes ater beng nvoved n a motor vece coson. Pysca examnaton sows suggs response to stmu An x-ray o te ower mb sows a et emora racture and a cervca open-mout x-ray sows compresson o te spna cord by te odontod process An MRI o te pevs sows uretra njury and ematoma. Wc o te oowng gaments s most key torn?

A. Anteror ongtudna gament

B. Transverse gament o te atas

C. Lgamentum lavum

D. Supraspnous gament

E. Nuca gament

28. An 18-year-od woman s brougt to te emergency department ater beng njured n a roover motor vece. Pysca examnaton sows mutpe maxoaca aceratons and consderabe weakness n er abty to lex er neck, assocated wt njury to CN

XI. Wc o te oowng musces s most key afected?

A. Iocostas toracs

B. Sternocedomastod

C. Rombod major

D. Rombod mnor

E. Teres major

29. A 23-year-od man was ked n a g-speed motor vece coson ater racng s rend on a oca gway. Wen te medca examner arrves at te scene, t s determned tat te most key cause o deat was a spna cord njury Upon conrmaton by autopsy, te medca examner oicay reports tat te patent’s cause o deat was a racture o te pedces o te axs (C2) Rupture o wc o te oowng gaments woud be most key mpcated n ts ata njury?

A. Lgamentum lavum

B. Nuca gament

C. Crucorm gament

D. Posteror ongtudna gament

E. Supraspnous gament

30. A 65-year-od man s njured wen a vece traveng at a g rate o speed ts s car rom bend He s brougt to te emergency department were e s stabzed, and an x-ray o te spne sows tat two

o s artcuar processes are now ocked togeter, a condton known as “jumped acets.” Surgca repar s scedued te same day. In wc o te oowng regons o te spne as ts njury most key occurred?

A. Cervca

B. horacc

C. Lumbar

D. Lumbosacra

E. Sacra

31. A 47-year-od woman s brougt to te emergency department ater beng nvoved n a motor vece coson 40 mnutes ago Se as severe eadace and back pan. Her bood pressure s 99/78 mm Hg, puse s 122/mn, and respratons are 32/mn. An MRI o te spne sows a arge ematoma rom beedng rom te nterna vertebra venous pexus (o Batson). In wc o te oowng space s te bood most key accumuatng?

A. Subaracnod space

B. Subdura space

C. Centra cana

D. Epdura space

E. Lumbar cstern

32. A 32-year-od man s brougt to te emergency department because o 3-our story o severe pan radatng to te posteror aspect o s rgt tg and eg He as been an ete atete and e was tng eavy wegts durng an ntense tranng sesson wen te pan appeared. Hs vtas are wtn norma mts.

Pysca exam sows no motor weakness or sensory oss n s ower mbs. Relexes are uy ntact bateray n upper and ower mbs. MRI o te umbar spne sows a ruptured L4–L5 ntervertebra dsc

Wc o te oowng nerves s most key afected?

A. L3

B. L4

C. L2

D. L5

E. S1

33. A 24-year-od s brougt to te emergency department because o a ower back stran ater a severe a we skng he patent was not wearng a emet and ost conscousness or an unknown amount o tme. Pysca examnaton sows pan wen te patent s ateray bendng te trunk An MRI o te ower toracc spne sows njury to te musces responsbe or extendng and ateray bendng te trunk Wc o te oowng arteres provde bood suppy to tese musces?

A. Subscapuar

B. horacodorsa

C. Anteror ntercosta

D. Suprascapuar

E. Posteror ntercosta

34. A 22-year-od man s brougt to te emergency department unconscous oowng a ead-to-ead

coson wt anoter payer we payng ootba An x-ray o te ead and neck sows sgt dsocaton o te atantoaxa jont. Pysca examnaton sows decreased range o moton at tat jont He as no oss o sensaton or motor strengt n s upper or ower mbs. Wc o te oowng movements o te ead woud most key be severey afected?

A. Rotaton

B. Fexon

C. Abducton

D. Extenson

E. Adducton

35. A 42-year-od man s brougt to te emergency department because o 2-our story o avng been struck n te back wt an unknown object durng an aggravated robbery An MRI o te spne sows ruptures o te nterna vertebra venous pexus (o Batson) eadng to a ematoma causng compresson o te spna cord Wen aspraton o te excess bood s perormed, te neede soud stop just beore puncturng wc o te oowng structures?

A. Spna cord

B. Pa mater

C. Aracnod mater

D. Dura mater

E. Lgamentum lavum

36. A 65-year-od man s brougt to te emergency department ater beng t by a car n a busy ntersecton. he patent’s current medcatons ncude wararn, metoproo, metormn, and asprn (325mg mg) Hs puse s 112/mn, respratons are 24/mn and saow, and bood pressure s 112/72 mm Hg. An MRI sows dsocaton o te ourt toracc vertebra Wc o te oowng costa structures s most key to be nvoved n te njury?

A. Head o te ourt rb

B. Neck o te ourt rb

C. Head o te trd rb

D. Tuberce o te trd rb

E. Head o te t rb

37. A 20-year-od ker s brougt to te emergency department 45 mnutes ater e sustaned a deep puncture wound to s back durng a a Pysca examnaton sows a eson between te trapezus and atssmus dors musces on te rgt atera sde o s back Pysca examnaton sows weak adducton and meda rotaton o s arm. Wc o te oowng musces s most key njured?

A. Teres mnor

B. Trceps brac

C. Supraspnatus

D. Inraspnatus

E. Teres major

38. A 22-year-od man s brougt to te emergency department ater e was trown troug a pate gass wa n a gt 2 ours ago. An x-ray o te torax sows tat te atera border o s rgt scapua s

sattered Pysca examnaton sows dicuty rotatng s arm ateray. He as no oss o sensaton n s rgt upper mb. Wc o te oowng musces s most key njured?

A. Teres major

B. Inraspnatus

C. Latssmus dors

D. Trapezus

E. Supraspnatus

39. A20-year-odwomancomestoteemergencydepartment wt a 6-day story o eadace, potopoba, and stfness o er back. Se recenty moved nto a dormtory on campus were se ves wt one oter roommate, wo as not been sck. Se s not up to date on er vaccnatons. Pysca examnaton sows postve sgns or menngts and a umbar puncture s perormed to determne  a patogen s n te cerebrospna lud. Wat s te ast structure te neede w penetrate beore reacng te umbar cstern?

A. Aracnod mater

B. Dura mater

C. Pa mater

D. Lgamentum lavum

E. Posteror ongtudna gament

40. A 19-year-od man s brougt to te emergency department wt g ever, severe eadace, nausea, and stf neck tat ave perssted or 3 days. Pysca examnaton sows tere s a purpurc ras on s trunk and extremtes. A dagnoss o menngts s suspected and a sampe o cerebrospna lud usng a umbar puncture s obtaned From wc o te oowng spaces was te cerebrospna lud coected?

A. Epdura

B. Subdura

C. Subaracnod

D. Pretracea

E. Centra cana o te spna cord

41. A 38-year-od man s admtted to te emergency department ater sustanng njures rom a motor vece coson Pysca examnaton sows severa aceratons and eccymoss over s back. Pan rom aceratons or rrtatons o te skn o te back s conveyed to te centra nervous system (CNS) by wc o te oowng?

A. Dorsa ram

B. Communcatng ram

C. Ventra ram

D. Ventra roots

E. Intercosta nerves

42. A 66-year-od woman comes to te pyscan because se ad been dagnosed recenty wt a tumor on er spne Se as started to retan urne and s experencng recta ncontnence. Utrasound o te badder sows no pysca obstructons n te badder. Bot o er symptoms are sgns o conus meduars syndrome. At wc o te oowng vertebra eves s te tumor most key ocated?

A. L3–L4

B. L3

C. L4

D. T12–L2

E. T11

43. Examnaton o a 3-day-od mae sows protruson o s spna cord and mennges rom a deect n te ower back. Wc o te oowng best descrbes ts congenta anomay?

A. Avuson o mennges

B. Menngts

C. Spna bda occuta

D. Spna bda wt myeomenngocee

E. Spna bda wt menngocee

44. A 32-year-od woman comes to te pyscan because o 2-week story o pan n te coccygea area ater gvng brt. To determne weter te coccyx s nvoved, a oca anestetc s rst njected n te regon o te coccyx and ten dynamc MRI studes are perormed. Pysca examnaton sows pan wt papaton to te regon o te coccyx. he oca anestetc s used to nterrupt wc o te oowng nerve patways?

A. Vscera aferent

B. Somatc eferent

C. Somatc aferent

D. Sympatetc pregangonc

E. Parasympatetc pregangonc

45. A 65-year-od man comes to te pyscan or a routne examnaton. He s 1.8 m (5 t, 11 n) and 78 kg (172 b) He as a story o exercse-nduced astma and uses an abutero naer as needed. Hs vta sgns are wtn norma mts or s age. He s tested or ease and lexbty o te movements o s umbar regon. Wc o te oowng movements s most caracterstc o te ntervertebra jonts n te umbar regon?

A. Crcumducton

B. Latera lexon

C. Abducton

D. Adducton

E. Inverson

46. A 72-year-od man wt a story o cancer o te prostate gand s brougt to te emergency department wt oss o conscousness and sezures. Pysca examnaton sows oss o vbraton and proprocepton on s et sde beow te umbca ne. A computed tomograpy (CT) scan o te bran sows metastatc tumors and a CT scan o te pevs sows a prmary tumor. Wc o te oowng best expans te metastass to te bran?

A. he nterna venous pexus contans te ongest vens n te body.

B. he nterna venous pexus as vaves tat ensure one-way movement o bood

C. he nterna venous pexus s ocated n te subaracnod space.

D. he nterna venous pexus s, n genera, vaveess

E. he nterna venous pexus s ocated n te subdura space.

47. A 26-year-od man s brougt to te emergency department ater e spped and e rom a adder onto te pavement beow we pantng s ouse. Pysca examnaton sows no abnormates An x-ray o te scapua sows tat te porton o s et scapua tat orms te tp, te gest pont o te souder as been ractured Wc o te oowng bony parts s most key ractured?

A. Coracod process

B. Superor ange o te scapua

C. Genod

D. Spne o te scapua

E. Acromon

48. A 43-year-od man wo s a constructon worker s brougt to te emergency department ater a a rom a two-story budng Pysca examnaton sows oss o a sensaton n s ower mbs. An MRI o te cervca spne sows a crused spna cord at C6 vertebra eve Wc o te oowng musces w most key be parayzed?

A. Sternocedomastod

B. Trapezus

C. Dapragm

D. Latssmus dors

E. Detod

49. A 36-year-od woman, at 14 weeks’ gestaton comes to te pyscan or a prenata vst. Se as ad one prevous pregnancy resutng n u term devery. Today, er vta sgns are wtn norma mts. Pysca examnaton sows a uterus consstent n sze wt a 14-week gestaton Se as no beedng or vagna dscarge. A materna serum sampe wt g apa-etoproten s ndcatve o a possbe neura tube deect Feta utrasonograpy sows a etus wt myeomenngocee protrudng rom te back o te cd. Wc o te oowng s te most key dagnoss o ts congenta anomay?

A. Cranum bda

B. Spna bda occuta

C. Spna bda cystca

D. Hemotorax

E. Cauda regresson syndrome

50. A 7-year-od gr s brougt to te pyscan by er parents because o a sot ump above te buttocks. Pysca examnaton sows te ump s ocated just superor to te ac crest unateray on te et sde he protruson s deep to te skn and pabe to te touc. Wc o te oowng s te most key dagnoss?

A. Tumor o te externa abdomna obque musce

B. Hernaton at te umbar trange (o Pett)

C. Indrect nguna erna

D. Drect nguna erna

E. Femora erna

Questions 51–75

51. A 74-year-od woman comes to te pyscan because o a 1-year story o back pan Her temperature s 37.1°C (98.8°F), puse s 74/mn, respratons are 15/ mn, and bood pressure s 138/74 mm Hg. Pysca examnaton sows no neuroogc abnormates An MRI o te spne sows tat te ntervertebra dscs ave been decreased n sze because o age, resutng n md spna stenoss and dsc ernaton At wc ocatons are te spna nerves most key to be compressed?

A. Between te dentcuate gaments

B. As tey pass troug te vertebra oramen

C. Between te superor and neror artcuar acets

D. Between te neror and superor vertebra notces

E. Between te superor and neror ntercostovertebra jonts

52. A 37-year-od pregnant woman, gravda 1, para 0, at 39 weeks’ gestaton, comes to te ospta wt reguar uterne contractons at 12-mnute ntervas tat ave been steady ncreasng n strengt. Pysca examnaton sows a cervx dated to 4 cm and 50% efaced Se s gven a cauda epdura bock to aevate pan durng vagna devery. Wc o te oowng andmarks s most commony used or te cauda epdura bock?

A. Anteror sacra oramna

B. Posteror sacra oramna

C. Cornua o te sacra atus

D. Intervertebra oramna

E. Medan sacra crest

53. A 38-year-od woman comes to te pyscan because o a 3-mont story o persstent back pan and eadaces Se as not ad any ever, cs, or wegt oss Se as no story o major medca ness. Pysca examnaton sows areas o ocazed tenderness n te cervca spne A CT scan sows breast cancer wt metastass to te bran and cervca spne. An MRI o te cervca spne conrms ocazed metastass to te certan parts o te cervca spne Metastass s most key ocated n wc o te oowng ocatons?

A. Odontod process

B. Transverse process

C. Latera mass

D. Pedce

E. Spnous process

54. A 22-year-od man s brougt nto te emergency department oowng a braw n a tavern He as severe pan radatng across s back and down s et upper mb. He supports s et upper mb wt s rgt and, odng t cose to s body Any attempt to move te et upper mb greaty ncreases te pan An x-ray o te scapua sows an unusua sagtta racture troug te spne o te et scapua he racture extends superory toward te superor scapuar

notc Wc o te oowng nerves s most key afected?

A. Suprascapuar

B. horacodorsa

C. Axary

D. Subscapuar

E. Suprascapuar and toracodorsa

55. A 5-year-od boy s brougt to te emergency department because o 2-day story o pan n te upper back and a “stf” neck Hs moter says e as ost some o s earng and s concerned wt tese consteatons o symptoms. Pysca examnaton sows te boy as a ow posteror arne and a sortwebbed neck. An x-ray o te cervca spne sows abnorma uson o te C5 and C6 vertebrae and a g-rdng scapua Wc o te oowng s te most key dagnoss?

A. Lordoss

B. Kyposs

C. Scooss

D. Spna bda

E. Kppe-Fe syndrome

56. A 53-year-od man comes to pyscan because o 3-mont story o progressve back pan. Hs pan s radatng down s egs and e can wak or about 6 mnutes beore te pan becomes unbearabe. Pysca examnaton sows norma patear tendon relexes, peda puses are present, and tere s dicuty n eewakng. An MRI examnaton sows anteror dsocaton o te body o te L5 vertebra upon te sacrum. Wc o te oowng s te most key dagnoss?

A. Spondyoyss

B. Spondyostess

C. Hernaton o ntervertebra dsc

D. Lordoss

E. Scooss

57. A 1-year-od boy s brougt to te pyscan by s moter because o s batera arm weakness, dcuty swaowng mk, and strdor. Pysca exam sows te boy s barey abe to t s arms of te exam tabe. He s dagnosed wt a congenta maormaton. An MRI o te bran and spna cord sows te cerebeum and medua obongata are protrudng nerory troug te oramen magnum nto te vertebra cana. Wc o te oowng s te most key dagnoss?

A. Menngocee

B. Kppe-Fe syndrome

C. Car II maormaton

D. Hydrocepaus

E. Tetered cord syndrome

58. A 62-year-od woman s admtted to te ospta because a 5-mont story o back pan as gotten progressvey worse. Se ees reeved wen se bends orward and worse wen se waks or a ew mnutes. Pysca examnaton sows se as 5/5 motor strengt bateray n te ower extremtes. here s

a sgt sensaton dect on te et meda aspect o te tg. An x-ray o te spne sows te L4 vertebra body as spped anterory, wt racture o te zygapopysa jont (Fg 1.2) Wc o te oowng s te most key dagnoss?

A. Spondyoyss and spondyostess

B. Spondyostess

C. Crus vertebra racture

D. Intervertebra dsc ernaton

E. Kppe-Fe syndrome

59. A 40-year-od woman s brougt to te emergency department ater beng njured n a motor vece coson n wc er neck was yperextended wen er vece was struck rom bend. An x-ray o er cervca spne sows a racture o te odontod process (dens). Wc o te oowng structures s aso most key njured?

A. Anteror arc o te atas

B. Posteror tuberce o te atas

C. Atantooccpta jont

D. Ineror artcuar process o te axs

E. Anteror tuberce o te atas

60. A 34-year-od woman s admtted to te emergency department ater a motor vece coson Se rearended a stopped vece at a ow rate o speed. Pysca examnaton sows se as paraspna tenderness n te cervca and toracc regon Se as sgncanty mted range o moton n a axes and se s unabe to perorm a task wen se s asked to turn er ead to te et Neuroogc examnaton s wtn norma mts n te upper and ower extremtes. An MRI o te spne sows a wpas njury n addton to L

yperextenson o er cervca spne Wc o te

oowng gaments s most key njured?

A. Lgamentum lavum

B. Anteror ongtudna gament

C. Posteror ongtudna gament

D. Annuus brosus

E. Interspnous gament

61. A 23-year-od woman s admtted to te emergency department 50 mnutes ater jumpng rom a 50-oot g watera Pysca examnaton sows a number o aceratons and eccymoss over er back and upper extremtes wt 3/5 motor strengt n er ower extremtes and 5/5 motor strengt n er upper extremtes. Sensory and relex examnatons are wtn norma mts n te upper and ower extremtes MRI o te spne sows a atera st o te spna cord to te et. Wc o te oowng structures as most key been torn to cause te devaton?

A. Posteror ongtudna gament

B. Tentorum cerebe

C. Dentcuate gaments

D. Lgamentum lavum

E. Nuca gament

62. A 6-year-od boy s brougt to te ospta by s parents because o a 2-day story o cougng and dyspnea. he patent says e ees ke tere s gass n s ungs Pysca examnaton sows abnorma ung sounds on auscutaton eard most ceary durng naaton wt te scapuae protracted. Wc o te oowng orm te borders o a tranguar space were one soud pace te stetoscope to best ear te ung sounds?

A. Latssmus dors, trapezus, meda border o scapua

B. Detod, evator scapuae, trapezus

C. Latssmus dors, externa abdomna obque, ac crest

D. Quadratus umborum, nterna abdomna obque, neror border o te twet rb

E. Rectus abdomns, nguna gament, neror epgastrc vesses

63. A 45-year-od man comes to te pyscan because o a 2-week severe souder pan and atera arm parestesa. he pan as been boterng m or years and s exacerbated wen e pays basketba He payed basketba or many years n s coege years. Pysca examnaton sows weakened souder movements wt norma sensaton n te upper extremtes Axa T1-wegted MRI sows sgns o quadranguar space syndrome, causng weakened souder movements. Wc o te oowng nerves s most key afected?

A. Suprascapuar

B. Subscapuar

C. Axary

D. Rada

E. Unar

• Fig. .

64. A 29-year-od woman wo s an ete atete was tng eavy wegts durng an ntense tranng sesson wen se et severe pan radate suddeny to te atera aspect o er rgt tg and eg. Se was brougt to te ospta were an MRI o er spne was perormed (Fg 1.3) Wc o te oowng nerves was most probaby afected?

A. L3

B. L4

C. L2

D. L5

E. S1

65. A 58-year-od man n te ntensve care unt exbts tte vountary contro o urnary or eca actvty oowng repar o an abdomna aortc aneurysm n te days pror. Pysca examnaton sows wdespread parayss o s ower mbs. hese unctons were essentay norma pror to admsson to te ospta he most key cause o ts patent’s current condton s wc o te oowng?

A. Injury to te et vertebra artery

B. Injury o te great radcuar artery (o Adamkewcz)

C. Lgaton o te posteror spna artery

D. Transecton o te conus meduars o te spna cord

E. Dvson o te toracc sympatetc trunk

66. A 23-year-od woman s brougt to te emergency department because o a 2-day story o severe back pan Se ad poo wen se was 8 years o age and was dagnosed wt a muscuar dystropy. Pysca examnaton sows no neuroogca dects. CT o er spne sows a cnca condton afectng er vertebra

coumn Wc o te oowng s most key present n ts patent?

A. Hyperordoss

B. Hyperkyposs

C. Scooss

D. Spna bda

E. Osteoartrts

67. A 26-year-od man comes to te pyscan because o pan, weakness, numbness, and tngng n s upper mb or te past 2 monts Pysca examnaton sows no abnormates. MRI o te spne sows a cervca dsc ernaton compressng te nerve roots and a porton o te spna cord An anteror cervca dscectomy and uson (ACDF) surgery s perormed. he ntervertebra dsc s examned upon remova and te annuus brosus and nuceus puposus are severey damaged posteroateray. Wat type o cartage most key gves te tense strengt o te ntervertebra dsc?

A. Hyane

B. Eastc

C. Fbrous

D. Eppysa

E. Eastc and brous

68. A 23-year-od man comes to te pyscan because o a 3-mont story o pan, weakness, numbness, and tngng n s upper mb. MRI o te spne sows a cervca dsc ernaton compressng te nerve roots and a porton o te spna cord. An ACDF surgery s perormed. he ntervertebra dsc s examned upon remova and te nuceus and annuus and nuceus puposus are severey damaged posteroateray. Wat s te embryoogc orgn o te annuus brosus and nuceus puposus, respectvey?

A. Notocord and neura crest ces

B. Neura crest ces and ectoderm

C. Scerotome and myotome

D. Mesencyma ces rom scerotome and neura crest ces

E. Mesencymacesromscerotomeandnotocord

69. A 55-year-od woman comes to te pyscan because o a 1-week story o notceabe canges n er ace. Se ad a mdde ear necton or te past mont tat as been producng dranage. Se recenty deveoped rgt-sded moss, parta ptoss, anydross, and redness o te conjunctva Pysca examnaton sows a bugng and nlamed tympanc membrane. Bopsy examnaton o wc o te oowng structures woud sow te ce bodes o neurons afected by ts dsease?

A. Anteror gray orn o te spna cord

B. Latera gray orn o te spna cord

C. Posteror gray orn o te spna cord

D. Spna ganga

E. Latera coumn o spna cord wte matter

70. A 62-year-od man s brougt to te emergency department ater a severe motor vece coson

resutng n a wpas njury Pysca examnaton sows no neuroogca dects. An MRI o te ead and neck sows severa arne vertebra ractures n te cervca regon mpngng upon te dorsa ram o te same eves. Two monts ater te njury te patent recovers we, but tere s st some weakness n te uncton o a musce Wc o te oowng musces s most key afected?

A. Rombod major

B. Levator scapuae

C. Rombod mnor

D. Semspnas capts

E. Latssmus dors

71. A 22-year-od man s brougt to te emergency department because o a 1-mont story o progressve weakness wt extendng and rotatng s ead

He as eadaces and some musce weakness to te upper musces o s back or te ast 6 monts.

Pysca examnaton sows decreased motor strengt n et and rgt rotaton o te ead wt no neuroogca dects. An MRI o te ead and neck sows a arge tumor compressng te suboccpta and greater occpta nerves. Wc o te oowng musces w most key st be unctonng normay?

A. Rectus capts posteror major and mnor

B. Semspnas capts

C. Spenus capts

D. Obquus capts superor

E. Obquus capts neror

72. A 36-year-od woman s brougt to te emergency department because o a severe epsode o major depressve dsorder. Se as been osptazed severa tmes n te past 8 years. Despte terapy, er condton worsens, and se angs erse Autopsy sows a cervca vertebra racture as a resut o angng. he mecansm o njury resutng n deat s orcbe yperextenson resutng n a racture o wc o te oowng structures?

A. Odontod process

B. Transverse process

C. Latera mass

D. Pedce (pars artcuars)

E. Spnous process

73. A 72-year-od woman comes to te pyscan ater ang n er batroom 2 days ago. Her vta sgns are wtn norma mts An x-ray seres o er vertebra coumn sows a wedge racture at te ourt toracc vertebra and tn cortca bone sowng sgns o osteoporotc canges Wat w be te most key type o abnorma spna curvature n suc a patent?

A. Hyperkyposs

B. Scooss

C. Hyperordoss

D. Norma

E. Prmary

74. A 65-year-od woman comes to te pyscan because o a 3-day story o a group o panu bsters over

er back n te dstrbuton o te T9 dermatome

Se notced tat a ew days pror to te erupton o te bsters se experenced an ntense burnng sensaton over er skn Pysca examnaton sows a macuopapuar ras n a dermatoma dstrbuton. A dagnoss o erpes zoster (snges) s made. Were are te neura ce bodes ocated tat are responsbe or te pan sensaton?

A. Dorsa orn

B. Latera orn

C. Dorsa root ganga

D. Sympatetc trunk ganga

E. Wte ram communcantes

75. A 53-year-od man was s admtted to te ospta 30 mnutes ater beng nvoved n a motor vece coson resutng n te dens crusng te spna cord

An x-ray o te ead and neck sows an atantodenta nterva o 7.3 mm and on open-mout odontod x-ray sows atera mass dspacement o 8 mm

Wc o te oowng s most key torn or te dens to compress te spna cord?

A. Anteror and posteror ongtudna gaments

B. Transverse gament o te atas

C. Interspnous gament

D. Supraspnous gament

E. Nuca gament

Questions 76–100

76. A 16-year-od gr s brougt te pyscan or a routne pysca examnaton pror to te begnnng o er scoo year Se as no story o major medca nesses and receves no medcaton. Her vta sgns are wtn norma mts. Pysca examnaton sows one souder s ger tan te oter Wen se asked to bend orward at te wast to touc er toes a posteror bugng o te rbs on te rgt sde s sown.

Wc o te oowng s te most key dagnoss?

A. Kyposs

B. Spondyoss

C. Lordoss

D. Spondyostess

E. Scooss

77. A 30-year-od woman s admtted to te ospta because o a 3-mont story o toracc back pan and persstent coug. Se says tat te coug s gettng progressvey worse Laboratory studes sow a postve Mantoux (PPD: pured proten dervatve) skn test ater 48 ours. An x-ray o te cest sows sgns o tubercuoss n te ungs and dssemnaton n te toracc vertebrae. Wc o te oowng w most key be a ong-term efect n te toracc spne

 ts condton et untreated?

A. Spondyoyss

B. Spondyostess

C. Hernaton o ntervertebra dsc

D. Vertebra coapse

E. Wedge racture

78. A 70-year-od man wt prostate cancer s brougt to te emergency department because o a 4-our story o sarp sootng pans radatng rom s neck nto te upper mb Hs vta sgns are wtn norma mts. Pysca examnaton sows no neuroogca abnormates. An MRI o s spne sows a sma metastatc mass n te cervca regon extendng nto te et ntervertebra oramen between C6 and C7. he ntervertebra dscs appear norma. Wc neura structure s most key beng compressed by te metastatc mass to account or te pan?

A. C8 spna nerve

B. Dorsa orn o C6 spna cord segment

C. C6 spna nerve

D. Dorsa orn o C7 spna nerve

E. C7 spna nerve

79. A 3-day-od gr s brougt to te pyscan by er moter because o a 2-day story o poor eedng, rrtabty, and etargy Her moter says se deveoped a ever tat s unresponsve to over-te-counter medcaton. Her temperature s 40.0°C (104.0°F), bood pressure s 100/60 mm Hg, puse s 94, and respratons are 38/mn. Menngts s suspected and a umbar puncture s perormed. he puncture must be perormed beow te termnaton o te spna cord wc usuay ends at wc vertebra eve n a patent o ts age?

A. L1

B. S1

C. L3

D. S3

E. L5

80. A 26-year-od man comes to te oice because o a 3-day story o an tcy, red ras on s back hree days ago, e returned rom an expedton saar n Okavango Deta n Botswana., durng wc e was bt by many nsects we outsde Sorty ater arrvng back to te Unted States, e notced te area were e was btten as become nected and puruent matera was dranng A surgca procedure to debrde te abscess nvovng te erector spnae musce at vertebra eve T8 s perormed. he nerve branc suppyng te skn and te underyng musce are severed rom te abscess. In wc o te oowng structures are te ce bodes o ts nerve branc ocated?

A. Ventra orn and dorsa orn

B. Ventra orn, dorsa orn, and atera orn

C. Ventra orn, dorsa root gangon, and atera orn

D. Ventra orn, dorsa root gangon, and sympatetc paravertebra gangon

E. Ventraorn,dorsaorn,anddorsarootgangon 81. A 28-year-od man s brougt to te emergency department ater beng nvoved n a motor vece coson resutng n yperextenson o s neck

Pysca examnaton sows mdne tenderness over te cervca vertebrae. He was paced n a cervca

coar he next day s neck was stf and panu Wc o te oowng structures s most key damaged resutng n pan?

A. Anteror ongtudna gament

B. Posteror ongtudna gament

C. Lgamentum lavum

D. Intervertebra dsc

E. Supraspnous gament

82. A 38-year-od man comes to te pyscan because o cronc ower back pan wt radatng pan to te ee. he pan s so debtatng tat e now as troube ambuatng. An MRI o te ower back sows severe narrowng o an ntervertebra oramen, wc causes compresson o te extng nerve root. A surgca procedure s perormed, and durng te procedure te ntervertebra oramen s accessed usng a atera approac. he superor margn (roo) o te ntervertebra oramen s decompressed rom te extng nerve root Wc o te oowng vertebra bony eatures s most key removed?

A. Superor artcuar process

B. Lamna

C. Ineror artcuar process

D. Pedce

E. Spnous process

83. A 35-year-od man s brougt to te emergency department because o a 45-mnute story o njury o s neck wen e was payng ootba An MRI sows an acute posteroatera ernaton o te most superory ocated ntervertebra dsc wc s ocated wtn te correspondng ntervertebra oramen and compressng te extng nerve. Wc o te oowng nerves n most key njured?

A. C1

B. C2

C. C3

D. C4

E. C5

84. A 14-year-od gr s brougt to te emergency room ater se lpped er bcyce of a curb, e, and anded on er ace 45 mnutes ago. Atoug se was wearng a emet, se anded n suc a way tat er neck was orced nto yperextenson Pysca examnaton sows no neuroogca dects but tere s neck rgdty. Wc o te oowng gaments o te cervca spne s most key stretced to te greatest degree durng er njury?

A. Posteror ongtudna

B. Nuca

C. Lgamentum lavum

D. Supraspnous

E. Anteror ongtudna

85. In preparaton or a umbar puncture, te ac crests are papated, and a ne s drawn across te patent’s back wt a skn marker to connect te gest ponts o te et and rgt crests. he neede s nserted above te pont at wc te subaracnod space termnates

nerory Wc o te oowng most key represents te eve at wc te subaracnod space ends nerory?

A. hree spnous processes superor to te orzonta ne

B. Two spnous processes neror to te orzonta ne

C. hree spnous processes neror to te orzonta ne

D. Two spnous processes superor to te orzonta ne

E. he spnous process bsected by te orzonta ne

86. A 68-year-od man s brougt to te emergency department wt acute md-back pan tat began a ew ours ago. Pysca examnaton sows decreased sensaton o te skn bateray over te ower mbs

Motor strengt s assessed at 5/5 n a our mbs.

MRI o te toracc spne sows a arge tumor arsng rom te anteror medan ssure o te spna cord at te eve o te T3 vertebra. he artery compressed by te tumor s most key ormed superory by drect brances rom wc o te oowng arteres?

A. Ascendng cervca

B. Segmenta meduary

C. Vertebra

D. Segmenta spna

E. Posteror spna

87. A 12-year-od gr s brougt to te emergency department by er parents or md-back pan tat as been ongong or weeks and s progressvey gettng worse. Her vta sgns are wtn norma mts Pysca examnaton sows no neuroogca abnormates. An x-ray o te spne sows a emvertebra o te ower toracc spne Wc addtona ndng woud most key be present on te x-ray?

A. Osteopoross

B. Scooss

C. Hyperordoss

D. Spondyostess

E. Sacrazaton

88. A 35-year-od man s brougt to te emergency department because o a 45-mnute story o njury at s neck wen e was payng ootba MRI sows severe narrowng o te C7–T1 ntervertebra oramen on te et. Wc o te oowng nerves s most key compressed?

A. C6

B. C7

C. C8

D. T1

E. T2

89. A 15-mont-od gr s brougt to te pyscan by er moter because o a curvature n er ow back. he moter says tat ts curvature was not present prevousy and tat se notced t wen te gr started standng and wakng. Se as receved a scedued cdood mmunzatons. Se attends