Royce Lee Montgomery, PhD

Professor

Department of Cell and Developmental Biology

School of Medicine

University of North Carolina

Chapel Hill, North Carolina

Kurt Ogden Gilliland, PhD

Department of Cell and Developmental Biology

School of Medicine

University of North Carolina

Chapel Hill, North Carolina

Appleton & Lange Reviews/McGraw-Hill

Medical Publishing Division

New York Chicago San Francisco Lisbon London

Madrid Mexico City Milan New Delhi San Juan Seoul

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Sixth edition

APPLETON & LANGE REVIEW OF

ANATOMY

0523-00 FM 07/15/02 15:30 Page i

Appleton & Lange Review of Anatomy, Sixth Edition

of America. Except as permitted under the United States Copyright Act of 1976, no part of this publication

may be reproduced or distributed in any form or by any means, or stored in a data base or retrieval system,

without the prior written permission of the publisher.

by Arco Publishing, Inc.

1 2 3 4 5 6 7 8 9 0 VNH VNH 0 9 8 7 6 5 4 3 2

ISBN: 0-07-137727-1

This book was set in Palatino by Circle Graphics.

The editors were Catherine W. Johnson and Lester A. Sheinis.

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Von Hoffmann Graphics, Inc., was printer and binder.

This book was printed on acid-free paper.

Library of Congress Cataloging-in-Publication Data

Montgomery, Royce L.

Appleton & Lange review of anatomy / Royce L. Montgomery, Kurt Ogden

Gilliland.—6th ed.

p. ; cm.

Rev. ed. of: Appleton & Lange review of anatomy for the USMLE Step 1 / Royce L. Montgomery,

Includes bibliographical references.

ISBN 0-07-137727-1 (alk. paper)

1. Human anatomy—Examinations, questions, etc. 2. Physicians—Licenses—United States—Examinations—Study

guides. I. Title: Appleton & Lange review of anatomy. II. Title: Review of anatomy. III. Gilliland, Kurt Ogden. IV.

Montgomery, Royce L. Appleton & Lange review of anatomy for the USMLE Step 1. V. Title.

[DNLM: 1. Anatomy—Examination Questions. QS 18.2 M788a 2003]

QM32 .M65 2002

611′.0076—dc21

2002016672

International Edition ISBN 0-07-121248-5

be reexported from the country to which it is consigned by McGraw-Hill. The International Edition is not available in

North America.

Notice

Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes

in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources

believed to be reliable in their efforts to provide information that is complete and generally in accord with the stan-

dards accepted at the time of publication. However, in view of the possibility of human error or changes in med-

ical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation

or publication of this work warrants that the information contained herein is in every respect accurate or com-

plete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the

information contained in this work. Readers are encouraged to conﬁrm the information contained herein with

other sources. For example and in particular, readers are advised to check the product information sheet included

in the package of each drug they plan to administer to be certain that the information contained in this work is

accurate and that changes have not been made in the recommended dose or in the contraindications for admin-

istration. This recommendation is of particular importance in connection with new or infrequently used drugs.

0523-00 FM 07/15/02 15:30 Page ii

Contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v

1. The Back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Answers and Explanations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

2. The Upper Limb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Answers and Explanations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

3. The Thorax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Answers and Explanations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

4. The Abdomen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

Answers and Explanations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

5. The Pelvis and Perineum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

Answers and Explanations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

6. The Lower Limb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87

Answers and Explanations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100

7. The Head and Neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109

Answers and Explanations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143

iii

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Introduction

If you are planning to prepare for the United States

Medical Licensing Examination (USMLE) Step 1,

then this book is designed for you. Here, in one pack-

age, is a comprehensive review resource with over

600 examination type anatomy multiple-choice ques-

tions with referenced explanations of each answer.

This introduction provides speciﬁc information

on the USMLE Step 1, information on question types,

question-answering strategies, and various ways to

use this review.

THE UNITED STATES MEDICAL LICENSING

EXAMINATION STEP 1

The United States Medical Licensing Examination

Step 1 is a one-day computerized examination con-

sisting of approximately 400 questions to test your

knowledge in the basic sciences. It contains multiple-

choice questions organized within three dimensions.

Each dimension is weighted; however, the projected

percentages for these dimensions are subject to change

from exam to exam. The three dimensions are: (1) Sys-

tem, (2) Process, and (3) Organizational Level. The

application materials illustrate the percentage break-

out and offer you a detailed content outline to aid

you in your review.

Question Formats

The style and presentation of the questions have been

fully revised to conform with the United States Med-

ical Licensing Examinations. This will enable you to

familiarize yourself with the types of questions to be

expected and provide practice in recalling your knowl-

edge in each format. Following the answer to each

question, a reference to a particular and easily avail-

able text is provided for further reference and reading.

Each of the chapters contains single-best answer

multiple choice questions. In some cases, a group of

two or three questions may be related to a situa-

tional theme. In addition, some questions have illus-

trative material (e.g., line illustrations of anatomy)

that require understanding and interpretation on

your part. Moreover, questions may be of three

levels of difficulty: rote memory, memory question

that requires more understanding of the problem,

and a question that requires both understanding and

judgment. In view of the fact that the USMLE Step 1

is moving toward the judgment, critical-thinking

type question, we have attempted to write this

review with this emphasis.

One Best-Answer-Single Item Question. The major-

ity of the questions are posed in the A type, or “one

best answer single item” format. This is the most

popular question format in most exams. It generally

contains a brief statement, followed by ﬁve options

of which only ONE is entirely correct. The options

on the USMLE are lettered A, B, C, D, and E. Although

the format for this question type is straightforward,

the questions can be difﬁcult because some of the

distractors may be partially right. The instructions

you will see for this type of question will generally

appear as below:

DIRECTIONS (Question 1): Each of the numbered

items or incomplete statements in this section is

followed by answers or by completions of the state-

ment. Select the ONE lettered answer or comple-

tion that is BEST in each case.

An example of this question type is:

1. An obese 21-year-old woman complains of in-

creased growth of coarse hair on her lip, chin,

0523-00 FM 07/15/02 15:30 Page v

chest, and abdomen. She also notes menstrual

irregularity with periods of amenorrhea. The

most likely cause is

(A) polycystic ovary disease

(B) an ovarian tumor

(D) Cushing’s disease

(E) familial hirsutism

In the question above, the key word is “most.”

Although ovarian tumors, adrenal tumors, and

Cushing’s disease are causes of hirsutism (described

in the stem of the question), polycystic ovary disease

is a much more common cause. Familial hirsutism

is not associated with the menstrual irregularities

mentioned. Thus, the most likely cause of the mani-

festations described can only be “(A) polycystic ovary

disease.”

Answers, Explanations, and References

In each of the sections of this book, the question sec-

tions are followed by a section containing the answers,

explanations, and references to the questions. This sec-

tion (1) tells you the answer to each question; (2) gives

you an explanation/review of why the answer is

correct and background information on the subject

matter; and (3) tells you where you can ﬁnd more in-

depth information on the subject matter in other books

and/or journals. We encourage you to use this section

as a basis for further study and understanding.

If you choose the correct answer to a question,

you can then read the explanation (1) for reinforce-

ment and (2) to add to your knowledge about the sub-

ject matter (remember that the explanations usually

tell not only why the answer is correct, but also why

the other choices are incorrect). If you choose the

wrong answerto a question, you can read the expla-

nation for a learning/reviewing discussion of the

material in the question. Furthermore, you can note

the reference cited (e.g., “Joklik et al, pp 103–114”),

look up the full source in the bibliography at the end

of the section (e.g., “Joklik WK, Willett HP, Amos DB.

Zinsser’s Microbiology.20th ed. Norwalk, Conn: Apple-

ton & Lange; 1992”), and refer to the pages cited for a

more in-depth discussion.

SPECIFIC INFORMATION ON

THE STEP 1 EXAMINATION

The ofﬁcial source of all information with respect to

the United States Medical Licensing Examination

Step 1 is the National Board of Medical Examiners

(NBME), 3930 Chestnut Street, Philadelphia, PA

19104. Established in 1915, the NBME is a voluntary,

nonproﬁt, independent organization whose sole

function is the design, implementation, distribution,

and processing of a vast bank of question items, cer-

tifying examinations, and evaluative services in the

professional medical ﬁeld.

Please contact the NBME or visit the USMLE

web site (www.usmle.org) for information on exam

registration and scoring.

vi Introduction

STRATEGIES FOR ANSWERING ONE BEST

ANSWER-SINGLE ITEM QUESTIONS

1. Remember that only one choice can be the correct answer.

2. Read the question carefully to be sure that you understand

what is being asked. Pay attention to key words like “most.”

3. Quickly read each choice for familiarity. (This important step

is often not done by test takers.)

4. Go back and consider each choice individually.

5. If a choice is partially correct, tentatively consider it to be

incorrect. (This step will help you eliminate choices and

increase your odds of choosing the correct answer.)

6. Consider the remaining choices and select the one you think

is the answer. At this point, you may want to quickly scan

the stem to be sure you understand the question and your

answer.

7. If you do not know the answer, make an educated guess.

Your score is based on the number of correct answers, not

the number you get incorrect. Do not leave any questions

unanswered.

8. The actual examination is timed for an average of 60 sec-

onds per question. It is important to be thorough to under-

stand the question, but it is equally important for you to

keep moving.

0523-00 FM 07/15/02 15:30 Page vi

DIRECTIONS (Questions 1 through 40): Each of the

numbered items or incomplete statements in this

section is followed by answers or by completions of

the statements. Select the ONE lettered answer or

completion that is BEST in each case.

1. The vertebral column does all of the following

EXCEPT

(A) protect the spinal cord and spinal nerves

(B) support the weight of the body

(D) play an important role in posture and

locomotion

(E) form the main part of the appendicular

skeleton

2. Which of the following is NOT a distinctive

characteristic of a typical cervical vertebra?

(A) The body is small and wider from side to

side than anteroposteriorly.

(B) The vertebral foramen is large and

triangular.

verse foramina.

(D) The articular processes contain superior

facets directed inferoanteriorly.

(E) The spinous processes are short and biﬁd.

3. Which of the following is NOT a distinctive

characteristic of a typical thoracic vertebra?

(A) The body is heart-shaped.

(B) The vertebral foramen is triangular and

larger than in cervical and lumbar

vertebrae.

CHAPTER 1

The Back

Questions

strong and extend posterolaterally.

(D) The articular processes contain superior

facets directed posteriorly and slightly

laterally.

(E) The spinous processes are long and slope

posteroinferiorly.

4. Which of the following is a distinctive charac-

teristic of a typical lumbar vertebra?

(A) The body is massive and kidney-shaped

when viewed superiorly.

(B) The vertebral foramen is circular and

smaller than those of cervical and lumbar

vertebrae.

slender and contain mammillary

processes.

(D) The articular processes contain accessory

processes.

(E) The spinous processes are long and slope

posteroinferiorly.

5. Which of the following is true regarding the

intervertebral disc between the C1 and C2 ver-

tebrae?

(A) Its annulus ﬁbrosus is composed of con-

centric lamellae of ﬁbrocartilage.

(B) It does not contain a nucleus pulposus as

other intervertebral discs do.

(D) It acts like a shock absorber in response to

axial forces.

(E) There is no intervertebral disc between

the C1 and C2 vertebrae.

0523-01 Chap 1 07/15/02 15:31 Page 1

6. All of the following are true regarding the pos-

terior longitudinal ligament EXCEPT

(A) It is narrower and weaker than the ante-

rior longitudinal ligament.

(B) It runs within the vertebral canal and con-

nects the vertebral bodies to each other.

(D) It helps prevent hyperextension of the

vertebral column.

(E) It is attached to the intervertebral discs and

the posterior edges of the vertebral bodies.

7. Spinal arteries supplying the vertebrae are

branches of the

(A) vertebral and ascending cervical arteries

in the neck

(B) posterior intercostal arteries in the lumbar

region

(D) iliolumbar and lateral and medial sacral

arteries in the thorax

(E) aorta

8. Which of the following back muscles is inner-

vated by dorsal rami?

(A) latissimus dorsi

(B) levator scapulae

(D) rhomboid minor

(E) longissimus

9. Which of the following is NOT a deep (or intrin-

sic) muscle of the back?

(A) serratus posterior inferior

(B) levatores costarum

(D) multiﬁdus

(E) splenius capitis

10. The splenius capitis and cervicis

(A) extend the head and neck

(B) ﬂex the head and neck

(D) stabilize the atlas and axis

(E) move the upper limb

11. The erector spinae muscles

(A) ﬂex the vertebral column

(B) ﬂex the head

(D) prevent lateral bending of the vertebral

column

(E) assist with elevation

12. Which of the following is not a member of the

minor deep layer of the back?

(A) levatores costarum

(B) cervical intertransversarii

(D) interspinales

(E) thoracic intertransversarii

13. The transversospinalis muscles do all of the fol-

lowing EXCEPT

(A) extend the head

(B) extend the thoracic and cervical regions of

the vertebral column

(D) stabilize vertebrae

(E) assist with rotation of the vertebral column

14. Which of the following muscles does NOT

attach to transverse processes of vertebrae?

(A) semispinalis

(B) multiﬁdus

(D) intertransversarii

(E) spinalis

15. Which of the following muscles does NOT lat-

erally bend the cervical intervertebral joints?

(A) longus colli

(B) iliocostalis cervicis

(D) splenius capitis

(E) splenius cervicis

16. Which of the following muscles are likely to be

organs of proprioception instead of producers

of motion?

2 1: The Back

0523-01 Chap 1 07/15/02 15:31 Page 2

Questions: 6–23 3

(A) iliocostalis

(B) spinalis

(D) splenius capitis

(E) longissimus

17. Which of the following statements is true regard-

ing the suboccipital and deep neck muscles?

(A) The rectus capitis posterior major arises

from the spinous process of C2 and

inserts into the lateral part of the inferior

nuchal line.

(B) The obliquus capitis inferior arises from

the posterior tubercle of the posterior arch

of C1 and inserts into the medial part of

the inferior nuchal line.

the spinous process of C2 and inserts into

the transverse process of C1.

(D) The rectus capitis posterior minor arises

from the transverse process of C1 and

inserts into the occipital bone between the

nuchal lines.

(E) The suboccipital muscles are innervated

by the ventral rami of C1.

18. ALL of the following extend the atlanto-occipital

joint EXCEPT

(A) rectus capitis posterior major and minor

(B) semispinalis capitis

(D) splenius capitis

(E) longissimus capitis

19. The suboccipital triangle is composed of

(A) a superolateral and superomedial border

(the superior oblique and rectus capitis

posterior major)

(B) an inferolateral border (semispinalis

capitis)

(D) a roof (trapezius)

(E) greater and lesser occipital nerves

20. ALL of the following are innervated by dorsal

rami EXCEPT

(A) muscles of the suboccipital triangle

(B) skin over the neck and occipital bone

(innervated by greater occipital nerve)

(D) skin of the neck and scalp (innervated by

lesser occipital nerve)

(E) skin of the central part of the back

21. Which of the following statements is correct?

(A) The spinal cord is enlarged in the thoracic

region for innervation of the upper limbs.

(B) The spinal cord is enlarged in the lumbo-

sacral region for innervation of the lower

limbs.

the superior two-thirds of the vertebral

canal.

(D) In adults, the spinal cord occupies the full

length of the vertebral canal.

(E) The cauda equina is composed of ventral

but not dorsal roots.

22. Which of the following is NOT true in adults?

(A) The tapering end of the spinal cord may

terminate as high as T12 or as low as L3.

(B) The ﬁrst cervical nerves lack dorsal roots

in 50% of people.

(D) The terminal ﬁlum is the vestigial rem-

nant of the caudal part of the spinal cord

that was in the tail of the embryo.

(E) The spinal cord has a lumbar enlargement

for the lower limb but no equivalent

enlargement for the smaller upper limb.

23. Which of the following is contained in the extra-

dural (epidural) space?

(A) fat (loose connective tissue)

(B) external vertebral venous plexus

(D) denticulate ligaments

(E) radicular, medullary, and spinal arteries

0523-01 Chap 1 07/15/02 15:31 Page 3

24. All of the following are contained in the sub-

arachnoid (leptomeningeal) space EXCEPT

(A) CSF

(B) arachnoid trabeculae

(D) spinal arteries

(E) internal vertebral plexus

25. Which of the following does NOT give rise to

arteries supplying the spinal cord?

(A) ascending cervical artery

(B) deep cervical artery

(D) lumbar arteries

(E) thoracoacromial artery

26. Which of the following is true?

(A) There are paired anterior spinal arteries.

(B) There are paired posterior spinal arteries.

the union of branches of the vertebral

arteries.

(D) Each anterior spinal artery is a branch of

either the posteroinferior cerebellar artery

or the vertebral artery.

(E) There is usually one anterior and one pos-

terior spinal vein

27. Which of the following is true?

(A) There are usually two anterior and two

posterior spinal veins.

(B) Veins of the spinal cord are distributed in

a similar fashion to that of spinal arteries.

not communicate with each other.

(D) Spinal veins are arranged laterally.

(E) Spinal veins are drained by sulcal and

meningeal vein.

28. All of the following are contained in typical

spinal nerves EXCEPT

(A) sensory ﬁbers from tendons and joints

(B) motor ﬁbers to muscles

(D) sensory ﬁbers from blood vessels and

glands

(E) motor ﬁbers to smooth muscle

29. Which of the following is not true regarding the

parasympathetic nervous system?

(A) The cell body of the presynaptic

neuron is located in the gray matter of

the CNS.

(B) The cell body of the postsynaptic neuron

is located in an autonomic ganglion out-

side the CNS.

nephrine.

(D) Its neurons are craniosacral in origin.

(E) It promotes quiet and orderly processes of

the body.

30. Postsynaptic sympathetic ﬁbers that ultimately

innervate the body wall and limbs do which of

the following?

(A) pass from the sympathetic trunks to adja-

cent ventral rami through gray rami com-

municantes

(B) pass from the sympathetic trunks to adja-

cent ventral rami through white rami

communicantes

adjacent dorsal rami through gray rami

communicantes

(D) pass from the sympathetic trunks to

adjacent dorsal rami through white rami

communicantes

(E) pass from the sympathetic trunks to

splanchnic nerves

31. Postsynaptic sympathetic ﬁbers do ALL of the

following EXCEPT

(A) constrict the pupil of the eye

(B) stimulate contraction of blood vessels

muscles

(D) cause sudomotion

(E) cause goose bumps

4 1: The Back

0523-01 Chap 1 07/15/02 15:31 Page 4

32. Which of the following is NOT true?

(A) Variations in vertebrae are affected by

race, sex, genetic factors, and environ-

mental factors.

(B) An increased number of vertebrae occurs

more often in males, and a reduced num-

ber occurs more often in females.

7, or 8.

(D) Some people have more than ﬁve lumbar

vertebrae and therefore fewer thoracic

vertebrae.

(E) The sacrum is typically composed of ﬁve

fused vertebrae.

33. Which of the following statements about

kyphosis is true?

(A) Kyphosis may result from developmental

anomalies as well as from osteoporosis.

(B) The vertebral column curves anteriorly.

eral diameter of the thorax.

(D) Women may develop a temporary kypho-

sis during pregnancy.

(E) It is also known as “swayback” or

“hollow back.”

34. Lordosis is characterized by which of the fol-

lowing?

(A) an abnormal increase in thoracic

curvature

(B) an anterior rotation of the pelvis

(D) rotation of the vertebrae

(E) lateral curvature of the spine

35. Scoliosis may be caused by which of the fol-

lowing?

(A) asymmetrical weakness of intrinsic back

muscles

(B) difference in length of the upper limbs

(D) ipsilateral weakness in gluteal muscles

(E) sciatic nerve lesion

36. Which of the following is NOT true in respect

to caudal epidural anesthesia?

(A) A local anesthetic is injected into the

sacral hiatus or the posterior sacral foram-

ina.

(B) The anesthetic acts on S2-4 and the coc-

cygeal nerves.

is primarily limited by the amount of fat

in the epidural space.

(D) Sensation is lost inferior to the epidural

block.

(E) The sacral hiatus is located between the

sacral cornua and inferior to the 4th sacral

spinous process or median sacral crest.

37. Which of the following is NOT a vertebral

problem?

(A) sacralization of L5

(B) lumbarization of S1

(D) lumbar spinal stenosis

(E) hemisacralization of L5

38. Which of the following statements is true?

(A) In spina biﬁda cystica, the laminae of L5

and possibly S1 do not fuse properly.

(B) In spina biﬁda occulta, one or more verte-

bral arches do not develop, allowing

meninges and even the spinal cord to her-

niate.

bladder/bowel control may be associated

with meningomyelocele.

(D) Some cases of spina biﬁda result from an

improper closure of the neural tube dur-

ing the 8th week of embryonic develop-

ment.

(E) A meningocele is a spina biﬁda associated

with brain herniation.

Questions: 24–38 5

0523-01 Chap 1 07/15/02 15:31 Page 5

39. Which of the following are derivatives of the

epimere?

(A) erector spinae muscles

(B) prevertebral muscles

(D) striated muscles of the anus

(E) sternalis

40. Shortly after week four of development, dorsal

primary rami begin to innervate which of the

following?

(A) ventral axial skeletal musculature

(B) vertebral joints

(D) sweat glands of the lateral back region

(E) erector pili muscles

6 1: The Back

DIRECTIONS (Questions 41 through 46): Identify the anatomical features indicated on the art below.

0523-01 Chap 1 07/15/02 15:31 Page 6

Answers and Explanations

1. (E) The vertebral column forms the main part

of the axial skeleton (Moore, p 432).

2. (D) The articular processes contain superior

facets directed superoposteriorly (Moore, p 439).

3. (B) The vertebral foramen is circular and smaller

than the foramina of cervical and lumbar verte-

brae (Moore, p 441).

4. (A) The body is massive and kidney-shaped

when viewed superiorly. The vertebral foramen

is triangular and larger than the foramina in tho-

racic vertebrae and smaller than those in cervi-

cal vertebrae. The transverse processes are long

and slender and contain accessory processes.

The articular processes contain mammillary pro-

cesses. The spinous processes are short, thick,

and broad (Moore, p 442).

5. (E) There is no intervertebral disc between the

C1 and C2 vertebrae (Moore, p 451).

6. (D) The posterior longitudinal ligament helps

prevent hyperﬂexion of the vertebral column

(Moore, p 451).

7. (A) Spinal arteries supplying the vertebrae are

branches of the vertebral and ascending cervical

arteries in the neck, posterior intercostal arteries

in the thorax, subcostal and lumbar arteries in

the lumbar region, and iliolumbar and lateral

and medial sacral arteries in the pelvis (Moore,

p 467).

8. (E) The longissimus, a deep or intrinsic back

muscle, is innervated by dorsal rami. All super-

ﬁcial or extrinsic back muscles except the trape-

zius, which is innervated by the accessory nerve,

are innervated by ventral rami(Moore, p 467).

9. (A) The serratus posterior inferior is an inter-

mediate extrinsic back muscle (Moore, p 467).

10. (A) The splenius capitis and cervicis, when act-

ing together, extend the head and neck (Moore,

p 468).

11. (C) The erector spinae muscles extend the ver-

tebral column and head when acting bilaterally,

control ﬂexion of the back by gradually length-

ening their ﬁbers, and bend the vertebral column

laterally when acting unilaterally (Moore, p 470).

12. (C) The spinalis is a member of the erector spinae

muscles, which comprise the intermediate mus-

cle layer of the back (Moore, p 470).

13. (C) The transversospinalis muscles do not ele-

vate the ribs to assist inspiration (Moore, p 470).

14. (E) The spinalis inserts on spinous processes—

not transverse processes. The semispinalis, multi-

fidus, rotatores, and intertransversarii all attach to

transverse processes of vertebrae (Moore, p 470).

15. (A) The longus colli ﬂexes the cervical inter-

vertebral joints but does not bend them laterally

(Moore, p 473).

16. (C) Because of their small size and lack of

mechanical advantage, it has been proposed

that the rotatores are likely to be organs of pro-

prioception instead of producers of motion

(Moore, p 474).

0523-01 Chap 1 7/17/02 3:25 PM Page 7

17. (A) The rectus capitis posterior major arises

from the spinous processes of C2 and inserts into

the lateral part of the inferior nuchal line. The

rectus capitis posterior minor arises from the

posterior tubercle of the posterior arch of C1

and inserts into the medial part of the inferior

nuchal line. The obliquus capitis inferior arises

from the spinous processes of C2 and inserts

into the transverse process of C1. The obliquus

capitis superior arises from the transverse pro-

cess of C1 and inserts into the occipital bone

between the nuchal lines. The suboccipital mus-

cles are innervated by the dorsal rami of C1

(Moore, pp 475–476).

18. (C) The longus capitis ﬂexes but does not extend

the atlanto-occipital joint (Moore, p 476).

19. (A) The suboccipital triangle is the deep trian-

gular area between the rectus capitis posterior

major and the superior and inferior oblique

muscles. The boundaries and course of the

suboccipital triangle include the rectus capitis

posterior major, the superior oblique, and the

inferior oblique. The floor is formed by the

atlanto-occipital membrane and posterior arch

of C1. The roof is formed by the semispinalis

capitis. The suboccipital triangle contains the

vertebral artery and suboccipital nerve (Moore,

pp 476–477).

20. (D) The lesser occipital nerve, which is com-

posed of ventral rami of C2 and C3, innervates

the skin of the neck and scalp (Moore, p 477).

21. (B) The spinal cord is enlarged in the lumbo-

sacral region for innervation of the lower limbs

(Moore, p 477).

22. (E) The spinal cord is enlarged in two regions

for innervation of the limbs. The tapering end of

the spinal cord may terminate as high as T12 or

as low as L3. The ﬁrst cervical nerves lack dorsal

roots in 50% of people. The coccygeal nerve may

be absent. The terminal ﬁlum is the vestigial

remnant of the caudal part of the spinal cord that

was in the tail of the embryo (Moore, pp 477–479).

23. Fat (loose connective tissue) is contained in the

extradural (epidural) space (Moore, p 480).

24. (E) CSF, arachnoid trabeculae, segmental med-

ullary arteries, radicular arteries, and spinal

arteries are located in the subarachnoid (lepto-

meningeal) space. The internal vertebral venous

plexus is located in the extradural (epidural)

space (Moore, p 480).

25. (E) The vertebral, ascending cervical, deep cer-

vical, intercostal, lumbar, and lateral sacral arter-

ies give rise to arteries supplying the spinal cord

(Moore, p 486).

26. (B) There are paired posterior spinal arteries

(Moore, p 486).

27. (B) Veins of the spinal cord are distributed in a

similar fashion to that of spinal arteries (Moore,

p 486).

28. (C) Typical spinal nerves do not contain para-

sympathetic ﬁbers (Moore, p 44–45).

29. (C) The postsynaptic neurons of the para-

sympathetic nervous system emit acetylcholine

(Moore, p 45).

30. (A) Postsynaptic sympathetic ﬁbers that ulti-

mately innervate the body wall and limbs pass

from the sympathetic trunks to adjacent ventral

rami through gray rami communicantes

(Moore, p 47).

31. (A) Postsynaptic sympathetic ﬁbers dilate but

do not constrict the pupil of the eye (Moore, p 47).

32. (C) The number of cervical vertebrae is con-

stant at seven (Moore, p 434).

33. (A) Kyphosis (humpback or hunchback) may

result from developmental anomalies as well as

from osteoporosis. It is characterized by an

abnormal increase in the thoracic curvature

with the vertebrae curving posteriorly, result-

ing in an increase in the anteroposterior diame-

ter of the thorax. Women may develop a

temporary lordosis—not kyphosis—during

pregnancy (Moore, p 434).

34. (B) Lordosis is characterized by an abnormal

rotation of the pelvis (Moore, p 434).

8 1: The Back

0523-01 Chap 1 07/15/02 15:31 Page 8

35. (A) Scoliosis may be caused by asymmetrical

weakness of intrinsic back muscles (myopathic

scoliosis), difference in length of the lower

limbs, failure of one half of a vertebra to

develop, or occasionally habitual standing or

sitting in an improper position (habit scoliosis)

(Moore, p 435).

36. (C) The height to which the anesthetic travels

is primarily limited by the amount injected and

by the position of the patient (Moore, p 435).

37. (C) Part or all of L5 may fuse with the sacrum

(hemisacralization or sacralization). In addi-

tion, S1 may separate from the sacrum and fuse

with L5. Lumbar stenosis occurs when an inter-

vertebral disc bulges and narrows the vertebral

canal in the lumbar region, compressing the

spinal nerve roots. T12 is not known to fuse

with L1 (Moore, pp 446–447).

38. (C) Paralysis of the limbs and problems with

bladder/bowel control may be present in severe

cases of meningomyelocele, which is associated

with spina biﬁda cystica, a condition in which

one or more vertebral arches do not develop. In

spina biﬁda occulta, the laminae of L5 and pos-

sibly S1 do not fuse properly. Some cases of spina

biﬁda result from an improper closure of the

neural tube during the 4th week of embryonic

development (Moore, pp 448–449).

39. (A) Myoblasts of the epimeres form the extensor

muscles of the vertebral column (Sadler, p 190).

40. (A) Dorsal primary rami innervate dorsal axial

musculature, vertebral joints, and the skin of

the back (Sadler, p 421).

41. intertransverse ligament

42. internal vertebral venous plexus

43. dura mater

44. arachnoid layer

45. conus medullaris

46. dorsal root ganglion

Answers and Explanations: 17–46 9

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DIRECTIONS (Questions 1 through 83): Each of the

numbered items or incomplete statements in this

section is followed by answers or by completions of

the statement. Select the ONE lettered answer or

completion that is BEST in each case.

1. Which of the following is NOT true regarding

the clavicle?

(A) Its medial end is enlarged where it

attaches to the sternum.

(B) Its lateral end is ﬂat where it articulates

with the humerus.

convex anteriorly.

(D) The clavicle transmits shock from the

upper limb to the axial skeleton.

(E) The clavicle is a “long bone” that has no

medullary cavity.

2. The trapezius attaches to which of the follow-

ing regions of the clavicle?

(A) lateral one-third of the clavicle

(B) conoid tubercle

(D) trapezoid line

(E) quadrangular tubercle

3. Which of the following is true in respect to the

scapula?

(A) The spine of the scapula continues later-

ally as the coracoid process.

(B) The lateral surface of the scapula forms

the glenoid cavity.

CHAPTER 2

The Upper Limb

Questions

cavity and projects anterolaterally.

(D) The scapula is fastened securely to the

thoracic cage at the scapulothoracic joint.

(E) The acromioclavicular joint represents the

true shoulder joint.

4. Which of the following is NOT included in the

condyle of the humerus?

(A) radial, coronoid, and olecranon fossae

(B) epicondyles

(D) capitulum

(E) greater tubercle

5. Which of the following is NOT true in respect

to the ulna and radius?

(A) The brachialis attaches to the tuberosity of

the ulna.

(B) The ulnar styloid process is much larger

than the radial styloid process and

extends farther distally.

the head of the radius articulates with the

humerus.

(D) The ulna is medial to the radius in the

anatomical position.

(E) The bodies of these bones are ﬁrmly bound

together by the interosseous membrane.

0523-02 Chap 2 07/15/02 15:31 Page 11

6. Which of the following is true regarding the

carpus?

(A) The scaphoid articulates proximally with

the ulna and has a tubercle.

(B) The lunate articulates with the ulna and is

broader anteriorly than posteriorly.

with the articular disc of the distal

radioulnar joint.

(D) The pisiform lies on the palmar surface of

the trapezium.

(E) It is composed of seven bones.

7. Which of the following describes the correct

order of the distal row of carpals from lateral to

medial?

(A) triquetrum, trapezoid, capitate, hamate

(B) trapezoid, trapezium, capitate, hamate

(D) trapezium, triquetrum, capitate, hamate

(E) scaphoid, lunate, triquetrum, pisiform

8. Which of the following is actually a lateral cuta-

neous branch of an intercostal nerve, innervat-

ing the skin of the medial surface of the arm?

(A) intercostobrachial nerve

(B) superior lateral cutaneous nerve of the arm

(D) medial cutaneous nerve of the arm

(E) lateral pectoral nerve

9. Which of the following is NOT a branch of the

radial nerve?

(A) posterior cutaneous nerve of the arm

(B) posterior cutaneous nerve of the forearm

(D) superior lateral cutaneous nerve of the

arm

(E) posterior interosseous nerve

10. Which of the following is NOT an anterior tho-

racoappendicular muscle?

(A) pectoralis major

(B) pectoralis minor

(D) subclavius

(E) serratus anterior

11. Which of the following best describes the action

of the pectoralis minor?

(A) stabilizes scapula by drawing it inferiorly

and anteriorly against thoracic wall

(B) anchors and depresses clavicle

(D) rotates scapula

(E) ﬂexes humerus

12. Which of the following muscles attaches to the

coracoid process of the scapula?

(A) pectoralis minor

(B) triceps brachii

(D) pectoralis major

(E) subclavius

13. All of the following are medial rotators of the

arm EXCEPT

(A) latissimus dorsi

(B) teres major

(D) infraspinatus

(E) anterior part of deltoid

14. What muscles are necessary to raise the arm

above the shoulder?

(A) ﬁrst the supraspinatus, next the deltoid,

and then the serratus anterior

(B) ﬁrst the deltoid, next the supraspinatus,

and then the serratus anterior

anterior, and then the deltoid

(D) ﬁrst the serratus anterior, next the deltoid,

and then the supraspinatus

(E) ﬁrst the deltoid, next the serratus anterior,

and then supraspinatus

15. Which of the following is innervated by the

dorsal scapular nerve?

(A) serratus anterior

(B) rhomboid major and minor

12 2: The Upper Limb

0523-02 Chap 2 07/15/02 15:31 Page 12

(D) subscapularis

(E) supraspinatus

16. Which of the following is an extrinsic shoulder

muscle?

(A) deltoid

(B) teres major

(D) teres minor

(E) supraspinatus

17. Which of the following is true in respect to the

trapezius?

(A) It is innervated by the dorsal scapular

nerve.

(B) Its superior ﬁbers retract the scapula.

(D) Its inferior ﬁbers retract the scapula.

(E) Its superior and inferior ﬁbers act together

in rotating the scapula on the thoracic

wall.

18. A patient is asked to place the hands posteriorly

on the hips and to push the elbows posteriorly

against resistance. Which muscle is being tested?

(A) levator scapulae

(B) rhomboid

(D) latissimus dorsi

(E) serratus anterior

19. Which rotator cuff muscle does NOT rotate the

humerus?

(A) supraspinatus

(B) infraspinatus

(D) subscapularis

(E) teres major

20. The axillary nerve innervates which of the fol-

lowing muscles?

(A) coracobrachialis

(B) teres minor

(D) subscapularis

(E) levator scapulae

21. Which of the following is NOT contained in the

axilla?

(A) axillary blood vessels

(B) lymph nodes

plexus

(D) axillary nerve

(E) lymph nodes

22. Which of the following is most correct?

(A) The subscapular artery arises from the

third part of the axillary artery and

contributes to blood supply of muscles

near the scapula and humerus.

(B) The second part of the axillary artery typi-

cally contains two branches—the thora-

coacromial artery and the superior

thoracic artery.

posterior to the pectoralis minor.

(D) The thoracoacromial artery supplies the

pectoral muscles, axillary lymph nodes,

and most importantly the lateral part of

the mammary gland in women.

(E) The lateral thoracic artery divides into

four branches, the acromial, deltoid, pec-

toral, and clavicular.

23. Which of the following is NOT correct?

(A) The brachial plexus is formed by the union

of the ventral rami of C5 through T1.

(B) The roots of the brachial plexus and the

subclavian artery pass through the gap

between the anterior and middle scalene

muscles.

to each root.

(D) Each of the three trunks of the brachial

plexus divide into anterior and posterior

divisions.

(E) The cords of the brachial plexus surround

the brachial artery.

Questions: 6–23 13

0523-02 Chap 2 07/15/02 15:31 Page 13

24. Which of the following is NOT a supraclavicu-

lar branch of the brachial plexus?

(A) dorsal scapular nerve

(B) lateral pectoral nerve

(D) nerve to the subclavius

(E) suprascapular nerve

25. Which of the following is true regarding the

quadrangular space?

(A) It is bounded superiorly by the teres

major.

(B) It is bounded inferiorly by the subscapu-

laris and teres minor.

and laterally by the long head of the

triceps.

(D) It contains the posterior circumﬂex

humeral artery and the axillary nerve.

(E) Brachial plexus herniations occur here.

26. Which of the following is NOT innervated by

the suprascapular nerve?

(A) supraspinatus

(B) infraspinatus

(D) skin over superior part of scapula

(E) shoulder joint

27. Which of the following is NOT a branch of the

posterior cord of the brachial plexus?

(A) upper and lower subscapular nerves

(B) thoracodorsal nerve

(D) radial nerve

(E) long thoracic nerve

28. Which of the following is NOT true in respect

to the brachialis?

(A) Its origin is the distal half of the anterior

surface of the humerus.

(B) Its insertion is the coronoid process and

tuberosity of the ulna.

(D) It is primarily innervated by the musculo-

cutaneous nerve, but some of its lateral

part is innervated by a branch of the

radial nerve.

(E) It crosses two joints.

29. A patient is asked to abduct the arm 90 degrees

and then to extend the ﬂexed forearm against

resistance. Which muscle is being tested?

(A) triceps brachii

(B) brachialis

(D) biceps brachii

(E) supinator

30. The deep artery of the arm accompanies which

of the following before passing around the

body of the humerus?

(A) radial nerve

(B) musculocutaneous nerve

(D) ulnar nerve

(E) axillary nerve

31. Which muscle assists in extension of the fore-

arm, resists abduction of the ulna during prona-

tion of the forearm, and tenses the capsule of

the elbow joint so that it is not pinched when

the joint is extended?

(A) anconeus

(B) triceps brachii

(D) brachialis

(E) biceps brachii

32. Which of the following is a branch of the brachial

artery?

(A) anterior and posterior circumﬂex humeral

arteries

(B) deltoid artery

arteries

(D) thoracoacromial artery

(E) anterior and posterior ulnar recurrent

arteries

14 2: The Upper Limb

0523-02 Chap 2 07/15/02 15:31 Page 14

33. Which of the following nerves supply NO

branches to the arm?

(A) musculocutaneous and median

(B) radial and ulnar

(D) median and radial

(E) musculocutaneous and radial

34. Which of the following nerves is correctly paired

with its cutaneous branch?

(A) median nerve and medial antebrachial

cutaneous nerve

(B) musculocutaneous nerve and lateral ante-

brachial cutaneous nerve

cutaneous nerve

(D) median nerve and medial brachial cuta-

neous nerve

(E) radial nerve and superior lateral brachial

cutaneous nerve

35. The cubital fossa does NOT contain which of the

following?

(A) terminal part of the brachial artery

(B) deep accompanying veins of the arteries

(D) biceps brachii tendon

(E) ulnar nerve

36. A patient is unable to ﬂex the arm and forearm.

Where is the lesion likely to be?

(A) ventral rami of C3–C4

(B) ventral rami of C5–C6–C7

(D) ventral rami of C8–T1

(E) dorsal rami of T1

37. The radial nerve innervates muscles in the exten-

sor compartment of the forearm, but it also in-

nervates the following ﬂexor:

(A) brachioradialis

(B) pronator teres

(D) pronator quadratus

(E) palmaris longus

38. Which muscle does NOT cross the elbow joint?

(A) ﬂexor pollicis longus

(B) pronator teres

(D) ﬂexor carpi ulnaris

(E) ﬂexor digitorum superﬁcialis

39. The ulnar nerve innervates which of the fol-

lowing muscles in the ﬂexor compartment?

(A) the medial part of the ﬂexor digitorum

superﬁcialis

(B) ﬂexor carpi radialis

(D) pronator teres

(E) the medial part of ﬂexor digitorum

profundus

40. The radial artery lies just lateral to the tendon of

which muscle?

(A) pronator teres

(B) ﬂexor carpi radialis

(D) ﬂexor carpi ulnaris

(E) ﬂexor digitorum superﬁcialis

41. The palmaris longus tendon is a useful guide to

which nerve at the wrist?

(A) anterior interosseous nerve

(B) posterior interosseous nerve

(D) ulnar nerve

(E) radial nerve

42. To pronate the forearm, which of the following

must occur?

(A) The pronator quadratus initiates prona-

tion, assisted later by the pronator teres.

(B) The pronator teres initiates pronation,

assisted later by the pronator quadratus.

later by the pronator teres.

(D) The pronator quadratus initiates prona-

tion, assisted later by the anconeus.

(E) The ulnar nerve must be used.

Questions: 24–42 15

0523-02 Chap 2 07/15/02 15:31 Page 15

43. The extensor carpi radialis longus tendon is

crossed by which two muscles?

(A) abductor pollicis longus and extensor pol-

licis longus

(B) extensor indicis and extensor digitorum

brevis

(D) abductor pollicis longus and extensor pol-

licis brevis

(E) extensor indicis and extensor carpi radi-

alis brevis

44. Which of the following is true in respect to the

supinator?

(A) It is innervated by the ulnar nerve.

(B) It supinates the forearm by rotating the

ulna.

with the brachioradialis.

(D) It supinates the forearm when the forearm

is already ﬂexed.

(E) It rotates the radius to turn the palm ante-

riorly.

45. Which of the following does NOT take an ori-

gin from the lateral epicondyle of the humerus?

(A) extensor carpi radialis brevis

(B) extensor carpi ulnaris

(D) supinator

(E) extensor digiti minimi

46. Which of the following is correctly paired with

its nerve?

(A) ﬂexor pollicis longus and anterior

interosseous nerve

(B) ﬂexor digitorum profundus and anterior

interosseous nerve

rior interosseous nerve

(D) brachioradialis and posterior interosseous

nerve

(E) abductor pollicis longus and anterior

interosseous nerve

47. Which of the following is true in respect to the

anatomical snuff box?

(A) It is bounded anteriorly by the tendons of

the extensor pollicis longus.

(B) It is bounded posteriorly by the tendons

of the abductor pollicis longus and exten-

sor pollicis brevis.

snuff box.

(D) The scaphoid and triquetrum can be pal-

pated within the snuff box.

(E) The snuff box is visible when the thumb is

fully ﬂexed.

48. Which of the following does NOT abduct the

hand at the wrist joint?

(A) ﬂexor carpi radialis

(B) extensor carpi radialis longus

(D) abductor pollicis longus

(E) palmaris longus

49. Which of the following is derived from the

radial artery?

(A) dorsal and palmar carpal arteries

(B) common interosseous artery

(D) poster interosseous artery

(E) ulnar recurrent artery

50. The median nerve does which of the following?

(A) innervates the elbow joint with articular

branches

(B) innervates the medial half of the ﬂexor

digitorum profundus

(D) innervates lumbricals 3 and 4

(E) innervates the skin of the dorsum of the

hand

51. The ulnar nerve does NOT do which of the fol-

lowing?

(A) innervate the elbow joint with articular

branches

(B) innervate the ﬂexor carpi ulnaris

16 2: The Upper Limb

0523-02 Chap 2 07/15/02 15:31 Page 16

the palm and dorsum of the hand

(D) innervate the adductor pollicis

(E) innervate the dorsal and palmar interossei

52. The radial nerve does NOT do which of the fol-

lowing?

(A) give a superﬁcial branch that innervates

the dorsum of the hand

(B) innervate the brachioradialis and extensor

carpi radialis longus

extensor carpi radialis brevis and

supinator

(D) give a posterior interosseous branch that

innervates all remaining extensor muscles

in the posterior compartment of the fore-

arm

(E) innervate the glenohumeral joint

53. Which of the following is NOT true in respect

to the ﬂexor pollicis brevis?

(A) It is located medial to the abductor polli-

cis brevis.

(B) It ﬂexes the thumb at the carpometacarpal

joint.

langeal joint.

(D) Its tendon typically contains a sesamoid

bone.

(E) It is innervated by C5–C6.

54. Which of the following is true in respect to the

palmaris brevis?

(A) It aids the palmaris longus in tightening

the palmar aponeurosis.

(B) It is innervated by the median nerve.

(D) It covers and protects the radial artery.

(E) It wrinkles the skin of the hypothenar

eminence and deepens the hollow of the

palm.

55. The recurrent branch of the median nerve does

NOT innervate which of the following?

(A) abductor pollicis brevis

(B) adductor pollicis

(D) opponens pollicis

(E) The recurrent branch of the median nerve

innervates all of the above.

56. Which of the following muscles is correctly

matched with the accompanying description?

(A) lumbricals 1 and 2 . . . bipennate

(B) lumbricals 3 and 4 . . . unipennate

(D) palmar interossei 1–3 . . . bipennate

(E) deltoid . . . bipennate

57. The deep branch of the ulnar does NOT inner-

vate which of the following?

(A) abductor digiti minimi

(B) ﬂexor digiti minimi brevis

(D) dorsal interossei 3 and 4

(E) palmar interossei 1 and 2

58. The carpal tunnel does NOT contain which of

the following?

(A) median nerve

(B) four tendons of the ﬂexor digitorum

superﬁcialis

fundus

(D) the tendon of the ﬂexor pollicis longus

(E) ulnar nerve

59. The sternoclavicular joint . . .

(A) . . . is a saddle-type synovial joint but

functions as a ball-and-socket joint.

(B) . . . is supplied by lateral thoracic and

thoracoacromial arteries.

pectoral nerves.

(D) . . . is the articulation of the clavicle and

gladiolus of the sternum.

(E) . . . dislocates easily.

Questions: 43–59 17

0523-02 Chap 2 07/15/02 15:31 Page 17

60. Which of the following is true in respect to the

acromioclavicular joint?

(A) It is a saddle-type synovial joint.

(B) It is strengthened by the coracohumeral

and transverse humeral ligaments.

arteries.

(D) It is innervated by the nerve to the sub-

clavius.

(E) When dislocated, it is often referred to as

a “separated shoulder.”

61. Which of the following ﬂexes the arm at the

glenohumeral joint?

(A) deltoid (posterior part)

(B) pectoralis major

(D) subscapularis

(E) infraspinatus

62. In respect to movement of the arm at the gleno-

humeral joint, which of the following move-

ments is correctly paired with its prime mover?

(A) extension . . . deltoid (posterior part)

(B) abduction . . . pectoralis major and latis-

simus dorsi

(D) medial rotation . . . infraspinatus

(E) lateral rotation . . . subscapularis

63. Which of the following is true in respect to the

elbow joint?

(A) It is a plane type of synovial joint.

(B) It is strengthened by the radial and ulnar

cruciate ligaments.

arteries.

(D) It is innervated by the median and axil-

lary nerves.

(E) It is surrounded by the intratendinous ole-

cranon bursa, the subtendinous olecranon

bursa, and the subcutaneous olecranon

bursa.

64. Which of the following joints is paired correctly

with its type?

(A) proximal and distal radioulnar joints . . .

condyloid type of synovial joint

(B) radiocarpal joint . . . pivot type of synovial

joint

ovial joints

(D) metacarpophalangeal joints . . . hinge type

of synovial joints

(E) interphalangeal joints . . . condyloid type

of synovial joints

65. All carpometacarpal and intermetacarpal joints

are plane types of synovial joints EXCEPT for

(A) the carpometacarpal joint of the thumb.

(B) the carpometacarpal joint of the ﬁfth

metacarpal.

(D) the intermetacarpal joint of the 4th and

5th metacarpals.

(E) the intermetacarpal joint of the 1st and

2nd metacarpals.

66. Which of the following is NOT true in respect

to the clavicle?

(A) The clavicle varies more in shape than

most other long bones.

(B) The clavicle can be pierced by a branch of

the supraclavicular nerve.

manual workers.

(D) The right clavicle is stronger than the left

and is usually shorter.

(E) The clavicle is a compact bone.

67. Fractures of the scapula typically involve

(A) the acromion.

(B) the coracoid process.

(D) the inferior angle.

(E) the suprascapular notch.

68. Which of the following parts of the humerus is

matched correctly with the nerve with which it

is in direct contact?

18 2: The Upper Limb

0523-02 Chap 2 07/15/02 15:31 Page 18

(A) distal end of humerus . . . radial nerve

(B) surgical neck . . . musculocutaneous nerve

(D) medial epicondyle . . . ulnar nerve

(E) scapular notch . . . suprascapular nerve

69. “Winging” of the scapula is most likely caused

by which of the following?

(A) a lesion to the long thoracic nerve

(B) a lesion to the thoracodorsal nerve

(D) damage to the dorsal scapular nerve

(E) damage to the upper and lower subscapu-

lar nerves

70. Which of the following is correct regarding the

triangle of auscultation?

(A) Its borders are the latissimus dorsi,

scapula, and trapezius.

(B) It is a good location to hear heart murmurs.

costal space are subcutaneous here.

(D) It is a location of back trauma.

(E) It is a location for dorsal rami to pass to

the superﬁcial back.

71. A patient cannot raise the trunk (as in climb-

ing). What is most likely the problem?

(A) damage to the ventral rami of C5–C6–C7

(B) paralysis of the latissimus dorsi

(D) damage to the dorsal rami of C8–T1

(E) injury to the axillary nerve

72. The scapula on one side of a patient is located

farther from the midline than that on the nor-

mal side. What might be the problem?

(A) paralysis of the rhomboids on one side

(B) injury to the long thoracic nerve

(D) dislocated shoulder

(E) separated shoulder

73. The axillary nerve is damaged. What is the

likely result?

(A) The teres major atrophies.

(B) The rounded contour of the shoulder dis-

appears.

lateral forearm.

(D) The patient may lose the ability to adduct

the arm.

(E) The patient may exhibit “wrist-drop.”

74. Which of the following is true regarding rotator

cuff injuries?

(A) Injury or disease may damage the rotator

cuff, causing instability of the acromio-

clavicular joint.

(B) The supraspinatus tendon is the most

commonly torn part of the rotator cuff.

bilitate of the rotator cuff muscles.

(D) The injuries occur when the muscles pull

away from their origin on the acromion.

(E) Acute tears are common in young persons.

75. A patient has been thrown from a motorcycle,

landing on the shoulder such that the neck and

shoulder are widely separated. You suspect an

upper brachial plexus injury. What signs do you

expect?

(A) “clawhand”

(B) paralysis of ﬂexor carpi ulnaris, ﬂexor

digitorum superﬁcialis, and ﬂexor digito-

rum profundus

and extended elbow

(D) loss of sensation in the medial forearm

(E) “wrist-drop”

76. A patient exhibits “clawhand.” What might

have happened?

(A) upper brachial plexus injury

(B) acute brachial plexus neuritis

plexus

(D) lower brachial plexus injury

(E) damage to dorsal rami that send ﬁbers to

the brachial plexus

Questions: 60–76 19

0523-02 Chap 2 07/15/02 15:31 Page 19

77. A patient receives a knife wound to the axilla.

What problems do you expect?

(A) damage to the axillary nerve

(B) paralysis of the coracobrachialis, biceps,

and brachialis

the metacarpophalangeal joints

(D) loss of sensation on the medial surface of

the arm

(E) “clawhand”

78. A patient tries to make a fist, but digits 2 and

3 remain partially extended. What nerve is

injured?

(A) ulnar nerve

(B) radial nerve

(D) musculocutaneous nerve

(E) axillary nerve

79. Which of the following is true in respect to ulnar

nerve injuries?

(A) The injury often occurs where the nerve

passes posterior to the medial epicondyle

of the humerus.

(B) The patient experiences numbness and

tingling on the lateral part of the palm

and the thumb.

hand.”

(D) Patients have difﬁculty because they can-

not ﬂex their ﬁrst, second, and third digits

at the DIP joints.

(E) Power of abduction is impaired, and

when the patient attempts to ﬂex the

wrist, the ﬂexor carpi ulnaris brings the

hand to the medial side.

80. Which limb defect is correctly matched with its

deﬁnition?

(A) meromelia . . . complete absence of one or

more extremities

(B) phocomelia . . . all segments of extremities

are present but abnormally short

more extremities

(D) amelia . . . long bones are absent, and

small hands or feet are attached to the

trunk by short, irregular bones

(E) cleft hand (lobster claw deformity) . . .

absent third metacarpal, fusion of digits

1–2 and 4–5

81. Syndactylyl involves

(A) extra ﬁngers or toes.

(B) absence of a digit or limb.

(D) small hands or feet being attached to trunk

by short bones instead of long bones.

(E) congenital dislocation of glenohumeral

joint.

82. Which of the following is NOT correct?

(A) During development, dorsal cells orga-

nize as the epimere and ventral cells orga-

nize as the hypomere.

(B) Dorsal rami innervate muscles derived

from the epimere.

from the hypomere.

(D) Myoblasts of the hypomere form the

extensor muscles of the vertebral column.

(E) Somites and somitomeres form the mus-

culature of the limbs.

83. A patient in surgery has no pectoralis major.

What do you suspect?

(A) trauma

(B) dominant pectoralis minor

(D) atrophy of the muscle

(E) congenital absence of the muscle

20 2: The Upper Limb

0523-02 Chap 2 07/15/02 15:31 Page 20

DIRECTIONS (Questions 84 through 88): Identify the anatomical features indicated on the art below.

Questions: 77–93 21

DIRECTIONS (Questions 89 through 93): Identify the anatomical features indicated on the art below.

0523-02 Chap 2 07/15/02 15:31 Page 21

22 2: The Upper Limb

DIRECTIONS (Questions 94 through 98): Identify the anatomical features indicated on the art below.

0523-02 Chap 2 07/15/02 15:31 Page 22

Answers and Explanations

1. (B) The lateral end of the clavicle is ﬂat where

it articulates with the acromion at the acromio-

clavicular (AC) joint (Moore, pp 665–666).

2. (A) The trapezius attaches to the lateral third of

the clavicle, acromion, and spine of the scapula.

The deltoid attaches to the deltoid tubercle, the

conoid ligament attaches to the conoid tubercle,

the subclavius attaches to the subclavian groove,

and the trapezoid ligament attaches to the trape-

zoid line (Moore, pp 666, 691).

3. (B) The lateral surface of the scapula forms the

glenoid cavity, superior to which the coracoid

process projects anterolaterally. The glenohum-

eral joint itself represents the true shoulder joint,

whereas the scapulothoracic joint, which is a con-

ceptual joint, is a location where the scapula

moves easily on the thoracic wall. The spine of

the scapula continues laterally as the acromion

(Moore, pp 668–669).

4. (E) The condyle of the humerus (the distal end)

includes the epicondyles, trochlea, capitulum,

and the three fossae (radial, coronoid, and radial)

(Moore, p 670).

5. (B) The radial styloid process is much larger

than the ulnar styloid process and extends far-

ther distally (Moore, p 671–672).

6. (C) The scaphoid articulates proximally with

the radius and has a large tubercle. The lunate

articulates with the radius and is broader anteri-

orly than posteriorly. The triquetrum articulates

proximally with the articular disc of the distal

radioulnar joint. The pisiform lies on the palmar

surface of the triquetrum (Moore, p 674).

7. (C) From lateral to medial, the four bones of the

distal row of carpals are the trapezium, trape-

zoid, capitate, and hamate (Moore, p 674).

8. (A) The intercostobrachial nerve is the lateral

cutaneous branch of the second intercostal nerve

from T2, innervating the skin of the medial sur-

face of the arm (Moore, p 684).

9. (D) The posterior cutaneous nerve of the arm,

posterior cutaneous nerve of the forearm, and

inferior lateral cutaneous nerve of the arm are

branches of the radial nerve. The superior lateral

cutaneous nerve is a branch of the axillary nerve

(Moore, p 684).

10. (C) The pectoralis major, pectoralis minor, sub-

clavius, and serratus anterior are anterior tho-

racoappendicular muscles. The deltoid is a

scapulohumeral (shoulder) muscle (Moore, pp

688, 691).

11. (A) The pectoralis minor stabilizes the scapula

by drawing it inferiorly and anteriorly against

the thoracic wall (Moore, p 688).

12. (A) The pectoralis minor, biceps brachii (short

head), and coracobrachialis attach to the cora-

coid process of the scapula (Moore, p 688).

13. (D) The latissimus dorsi, teres major, and sub-

scapularis medially rotate the arm. The infra-

spinatus and teres minor rotate the arm laterally.

The deltoid is unique in that its anterior part

rotates the arm medially, and its posterior part

rotates the arm laterally (Moore, p 691).

14. (A) The supraspinatus initiates abduction of

the arm. The deltoid becomes fully effective as

0523-02 Chap 2 07/15/02 15:31 Page 23

an abductor following the initial 15 degrees of

abduction. The serratus anterior rotates the

scapula, elevating its glenoid cavity so that the

arm can be raised above the shoulder (Moore,

pp 695, 696, 689).

15. (B) The dorsal scapular nerve innervates the

levator scapulae, rhomboid major, and rhom-

boid minor (Moore, p 691).

16. (C) The trapezius, latissimus dorsi, levator

scapulae, and rhomboids are extrinsic shoulder

muscles. The deltoid, teres major, supraspinatus,

infraspinatus, teres minor, and subscapularis are

intrinsic shoulder muscles (Moore, pp 691–692).

17. (E) The trapezius, innervated by the spinal root

of the accessory nerve (XI), is composed of three

types of ﬁbers. Its superior ﬁbers elevate the

scapula, its middle ﬁbers retract the scapula, and

its inferior ﬁbers depress the scapula. Its superior

and inferior ﬁbers act together in rotating the

scapula on the thoracic wall (Moore, p 694).

18. (B) To test the rhomboids, the patient is asked

to place the hands posteriorly on the hips and to

push the elbows posteriorly against resistance

(Moore, p 695).

19. (A) The supraspinatus is the only rotator cuff

muscle that does not rotate the humerus (Moore,

pp 697–698).

20. (B) The axillary nerve innervates both the del-

toid and the teres minor (Moore, p 691).

21. (C) The axilla contains axillary blood vessels,

lymph nodes, the cords and branches of the

brachial plexus, and the axillary nerve. The

trunks and divisions are found superior to

the axilla in the neck (Moore, p 699).

22. (A) The subscapular artery arises from the third

part of the axillary artery and contributes to

blood supply of muscles near the scapula and

humerus (Moore, p 701).

23. (E) The brachial plexus is formed by the union

of the ventral rami of C5 through T1. The roots

of the brachial plexus and the subclavian artery

pass through the gap between the anterior and

middle scalene muscles. Gray rami contribute

sympathetic ﬁbers to each root. The roots of the

brachial plexus form three trunks, each of which

divides into anterior and posterior divisions.

The cords of the brachial plexus surround the

axillary artery (Moore, p 708).

24. (B) The dorsal scapular nerve, long thoracic

nerve, nerve to the subclavius, and supra-

scapular nerve are supraclavicular branches of

the brachial plexus, whereas the lateral pectoral

nerve is an infraclavicular branch, originating

from the lateral cord (Moore, pp 708–709).

25. (D) The quadrangular space is bounded superi-

orly by the subscapularis and teres minor, infe-

riorly by the teres major, medially by the long

head of triceps, and laterally by the humerus. It

contains the axillary nerve and the posterior cir-

cumﬂex humeral artery (Moore, p 711).

26. (D) The suprascapular nerve innervates the

supraspinatus, infraspinatus, and glenohumeral

(shoulder) joint (Moore, p 710).

27. (E) The posterior cord gives rise to the upper and

lower subscapular nerves, thoracodorsal nerve,

axillary nerve, and radial nerve. The long tho-

racic nerve originates from C5–C6–C7 (Moore,

pp 711).

28. (E) The brachialis originates from the distal half

of the anterior surface of the humerus and inserts

on the coronoid process and tuberosity of the

ulna. It crosses one joint, ﬂexing the forearm in

all positions. While it is primarily innervated by

the musculocutaneous nerve, some of its lateral

part is innervated by a branch of the radial nerve

(Moore, p 722).

29. (A) To test the triceps brachii, the arm is abducted

90 degrees and then the ﬂexed forearm is extended

against resistance (Moore, p 724).

30. (A) The deep artery of the arm accompanies

the radial nerve through the radial groove and

passes around the body of the humerus (Moore,

p 728).

24 2: The Upper Limb

0523-02 Chap 2 07/15/02 15:31 Page 24

31. (A) The anconeus assists in extension of the fore-

arm, resists abduction of the ulna during prona-

tion of the forearm, and tenses the capsule of the

elbow joint so that it is not pinched when the

joint is extended (Moore, p 724).

32. (C) The axillary artery gives rise to the superior

thoracic, thoracoacromial, lateral thoracic, sub-

scapular, and anterior and posterior circumﬂex

humeral arteries. The brachial artery gives rise to

the deep artery of the arm, the nutrient humeral

artery, and the superior and inferior collateral

arteries. The ulnar artery gives rise to the anterior

and posterior ulnar recurrent, common inter-

osseous, anterior and posterior interosseous, and

dorsal and palmar carpal branch arteries (Moore,

pp 699, 727–728, 750).

33. (C) The median and ulnar nerves supply no

branches to the arm (Moore, p 730).

34. (B) The median nerve gives rise to a palmar

cutaneous branch; the ulnar nerve as well has a

palmar cutaneous branch. The radial nerve gives

rise to the posterior brachial cutaneous nerve,

the posterior antebrachial cutaneous nerve, the

inferior lateral brachial cutaneous nerve, and a

superﬁcial branch that innervates the dorsum of

the hand and the digits. The musculocutaneous

nerve continues as the lateral antebrachial cuta-

neous nerve. The axillary nerve gives rise to the

superior lateral brachial cutaneous nerve. The

medial cord of the brachial plexus gives rise to

the medial brachial cutaneous nerve and the

medial antebrachial cutaneous nerve. The supra-

clavicular nerves (from C3–C4) and the inter-

costobrachial nerve (from T2) also contribute

to the cutaneous innervation of the arm (Moore,

pp 684, 758–759).

35. (E) The cubital fossa contains the terminal part

of the brachial artery (and the beginning of the

ulnar and radial arteries), deep accompanying

veins, the median nerve, and the biceps brachii

tendon. In the tissue superficial to the fossa are

the median cubital vein and medial and lateral

antebrachial cutaneous nerve. The deep and

superficial branches of the radial nerve are

within the ﬂoor of the fossa (Moore, pp 731–732).

36. (B) A patient who is unable to ﬂex the arm and

forearm is likely to have a lesion in the ventral

rami of C5, C6, and C7. The biceps brachii and

brachialis receive ﬁbers from C5 and C6, and the

coracobrachialis receives ﬁbers from C5, C6, and

C7. C6 is the main source of ﬁbers for each

(Moore, p 722).

37. (A) The brachioradialis is a ﬂexor of the forearm,

but it is located in the extensor compartment and

is innervated by the radial nerve (Moore, p 734).

38. (A) The superﬁcial muscles (pronator teres,

ﬂexor carpi radialis, palmaris longus, ﬂexor

carpi ulnaris, and ﬂexor digitorum superﬁcialis)

cross the elbow joint. The deep muscles (ﬂexor

digitorum profundus, ﬂexor pollicis longus, and

pronator quadratus) do not (Moore, p 734).

39. (E) All muscles in the anterior compartment

of the forearm are innervated by the median

nerve, except for the ﬂexor carpi ulnaris and the

medial part of the ﬂexor digitorum profundus,

which are innervated by the ulnar nerve (Moore,

pp 736–737).

40. (B) The radial artery lies lateral to the tendon of

the ﬂexor carpi radialis (Moore, p 737).

41. (C) The palmaris longus tendon is a guide for

locating the median nerve at the wrist (Moore,

p 737).

42. (A) To pronate the forearm, the pronator quad-

ratus initiates pronation, assisted later by the

pronator teres (Moore, p 741).

43. (D) The extensor carpi radialis longus tendon

is crossed by the abductor pollicis longus and

extensor pollicis brevis (Moore, p 745).

44. (E) The supinator, which forms the floor of the

cubital fossa along with the brachioradialis, is

innervated by the deep branch of the radial

nerve. It supinates the forearm by rotating the

radius. The biceps brachii also supinates the

forearm when the forearm is already flexed

(Moore, p 746).

Answers and Explanations: 15–44 25

0523-02 Chap 2 07/15/02 15:31 Page 25

45. (C) The abductor pollicis longus originates from

the posterior surfaces of the ulna, radius, and

interosseous membrane. The following muscles

take at least one of their origins from the lateral

epicondyle of the humerus: extensor carpi radi-

alis brevis, extensor digitorum, extensor digiti

minimi, extensor carpi ulnaris, and supinator

(Moore, p 742).

46. (A) The ﬂexor pollicis longus is innervated by

the anterior interosseous nerve from the median

nerve (Moore, pp 736–737, 742–743).

47. (C) The snuff box is bounded anteriorly by the

tendons of the abductor pollicis longus and ex-

tensor pollicis brevis. Posteriorly it is bounded

by the tendon of the extensor pollicis longus. The

radial artery can be felt in the ﬂoor, along with

the radial styloid process, ﬁrst metacarpal,

scaphoid, and trapezium (Moore, p 749).

48. (E) The hand is abducted at the wrist joint by the

flexor carpi radialis, abductor pollicis longus,

extensor carpi radialis longus, and extensor carpi

radialis brevis (Moore, pp 736, 742).

49. (A) The radial artery gives rise to the radial

recurrent artery as well as dorsal and palmar

carpal branches. The ulnar artery gives rise to the

common interosseous artery, anterior and poste-

rior interosseous arteries, anterior and posterior

ulnar recurrent arteries, and dorsal and palmar

carpal branches (Moore, p 750).

50. (A) The median nerve assists in the innervation

of the elbow joint and gives muscular branches

to pronator teres, ﬂexor carpi radialis, palmaris

longus, and ﬂexor digitorum superﬁcialis. The

median nerve also has an anterior interosseous

branch that innervates the lateral part of the

ﬂexor digitorum profundus, ﬂexor pollicis

longus, and pronator quadratus. The recurrent

branch of the median nerve innervates the

thenar muscles, and the palmar cutaneous

branch innervates the skin of the lateral part of

the palm (Moore, pp 757–759).

51. (C) The ulnar nerve gives rise to articular

branches that innervate the elbow joint and mus-

cular branches that innervate the ﬂexor carpi

ulnaris and medial half of the ﬂexor digitorum

profundus. The palmar cutaneous branch inner-

vates the skin of the medial part of the palm, and

the dorsal cutaneous branch innervates the pos-

terior surface of the medial part of the hand and

digits. The deep branch innervates the hypo-

thenar muscles, adductor pollicis, interossei, and

the 3rd and 4th lumbricals (Moore, pp 759–760).

52. (E) The radial nerve gives a superﬁcial branch

that innervates skin on the dorsum of the hand.

The radial nerve itself innervates the brachiora-

dialis and extensor carpi radialis longus. It then

gives a deep branch that innervates the extensor

carpi radialis brevis and the supinator before

continuing as the posterior interosseous nerve,

which innervates the extensor digitorum, ex-

tensor digiti minimi, extensor carpi ulnaris, ab-

ductor pollicis longus, extensor pollicis brevis,

extensor pollicis longus, and extensor indicis

(Moore, pp 742, 761).

53. (E) The ﬂexor pollicis brevis is located medial to

the abductor pollicis brevis. It ﬂexes the thumb

at the carpometacarpal and metacarpophalan-

geal joints and assists in opposition. Its tendon

typically contains a sesamoid bone. It is inner-

vated by the recurrent branch of the median

nerve (C8–T1) (Moore, p 767).

54. (E) The palmaris brevis, innervated by the ulnar

nerve, wrinkles the skin of the hypothenar emi-

nence and deepens the hollow of the palm, assist-

ing the palmar grip. The muscle actually covers

and protects the ulnar artery and the ulnar nerve,

which innervates it. The muscle is not by deﬁ-

nition in the hypothenar compartment. The pal-

maris longus, on the other hand, ﬂexes the hand

at the wrist and tightens the palmar aponeuro-

sis (Moore, p 768).

55. (B) The recurrent branch of the median nerve

innervates the abductor pollicis brevis, flexor

pollicis brevis, and opponens pollicis, but the

deep branch of the ulnar nerve innervates adduc-

tor pollicis (Moore, pp 769–770).

56. (C) Lumbricals 1–2 and palmar interossei 1–3

are unipennate muscles. Lumbricals 3–4 and dor-

sal interossei 1–4 are bipennate muscles. The del-

toid is multipennate (Moore, p 770).

26 2: The Upper Limb

0523-02 Chap 2 07/15/02 15:31 Page 26

57. (C) The deep branch of the ulnar nerve inner-

vates the adductor pollicis, abductor digiti min-

imi, ﬂexor digiti minimi brevis, opponens digiti

minimi, lumbricals 3 and 4, dorsal interossei 1–4,

and palmar interossei 1–3. The median nerve

innervates lumbricals 1 and 2 (Moore, p 770).

58. (E) The carpal tunnel contains the median nerve,

the four tendons of the ﬂexor digitorum superﬁ-

cialis, the four tendons of the ﬂexor digitorum

profundus, and the tendon of the ﬂexor pollicis

longus (Moore, p 774).

59. (A) The sternoclavicular joint, which does not

dislocate easily, is a saddle-type synovial joint

but functions as a ball-and-socket joint. It is the

articulation of the sternal end of the clavicle with

the manubrium of the sternum. The joint is sup-

plied by the internal thoracic and suprascapular

arteries and is innervated by branches of the

medial supraclavicular nerve and the nerve to

the subclavius (Moore, pp 781–782).

60. (E) The acromioclavicular joint is a plane-type

synovial joint and is strengthened by the AC lig-

ament and the coracoclavicular ligament, which

is composed of the conoid and trapezoid liga-

ments. It is supplied by the suprascapular and

thoracoacromial arteries and is innervated by

the supraclavicular, lateral pectoral, and axillary

nerves. When dislocated, it is referred to as a

“separated shoulder” (Moore, pp 784, 787).

61. (B) The pectoralis major (clavicular head) and

deltoid (anterior part) ﬂex the arm at the gleno-

humeral joint. The coracobrachialis and the bi-

ceps brachii assist (Moore, p 792).

62. (A) The posterior portion of the deltoid causes

extension of the arm at the glenohumeral joint.

The deltoid (as a whole, but especially the cen-

tral part) causes abduction, whereas the pec-

toralis major and latissimus dorsi cause adduc-

tion. The subscapularis causes medial rotation,

whereas the infraspinatus causes lateral rota-

tion (Moore, p 792).

63. (E) The elbow is a hinge type of synovial joint,

strengthened by radial and ulnar collateral liga-

ments. It is supplied by arteries derived from the

anastomosis around the elbow and is inner-

vated by the musculocutaneous, radial, and

ulnar nerves. It is surrounded by the intratendi-

nous olecranon bursa, the subtendinous olec-

ranon bursa, and the subcutaneous olecranon

bursa (Moore, pp 795–798).

64. (C) The proximal and distal radioulnar joints

are pivot-type synovial joints. The radiocarpal

(wrist) joint is a condyloid type of synovial joint.

Intercarpal joints are plane-type synovial joints.

Metacarpophalangeal joints are condyloid types

of synovial joints. Interphalangeal joints are

hinge-type synovial joints (Moore, pp 800, 803,

807, 809).

65. (A) All carpometacarpal and intermetacarpal

joints are the plane-type synovial joints except

for the carpometacarpal joint of the thumb,

which is a saddle joint (Moore, p 809).

66. (E) The clavicle varies more in shape than most

other long bones and is thicker and more curved

in manual workers. The right clavicle is stronger

than the left and is usually shorter. The clavicle

can also be pierced by a branch of the supracla-

vicular nerve. The clavicle is a long bone with no

medullary cavity. It consists of spongy (cancel-

lous) bone with a shell of compact bone (Moore,

p 667).

67. (A) Fractures of the scapula typically involve the

protruding subcutaneous acromion. The remain-

der of the scapula is well protected by muscles

and the thoracic wall itself (Moore, p 669).

68. (D) The surgical neck of the humerus is in direct

contact with the axillary nerve, the radial nerve

runs in the radial groove, the distal end of the

humerus is in direct contact with the median

nerve, and the medial epicondyle is in contact

with the ulnar nerve (Moore, p 670).

69. (A) Damage to the long thoracic nerve results

in “winging” of the scapula (Moore, p 689).

70. (A) The triangle of auscultation, a good place to

examine lung sounds, is bounded by the supe-

rior horizontal border of the latissimus dorsi, the

medial border of the scapula, and the inferolat-

Answers and Explanations: 45–70 27

0523-02 Chap 2 07/15/02 15:31 Page 27

eral border of the trapezius. The 6th and 7th ribs

and the 6th intercostal space is subcutaneous

(Moore, p 693).

71. (B) With paralysis of the latissimus dorsi, the

patient is unable to raise the trunk as necessary

for climbing. The cause could be injury to the

thoracodorsal nerve (C6–C7–C8) (Moore, p 693).

72. (A) Injury to the dorsal scapular nerve (C4–C5)

can paralyze the rhomboids, causing the scapula

on one side to be located farther from the midline

than that on the normal side (Moore, p 695).

73. (B) The deltoid atrophies when the axillary

nerve (C5–C6) is damaged. Therefore, the

rounded contour of the shoulder often dis-

appears. A loss of sensation may occur on the

lateral side of the proximal part of the arm

(Moore, pp 696–697).

74. (B) Injury or disease may damage the rotator

cuff, causing instability of the glenohumeral

joint. The supraspinatus tendon is the most

commonly torn part of the rotator cuff. Acute

tears are uncommon in young persons (Moore,

pp 698–699).

75. (C) In an upper brachial plexus injury causing

Erb-Duchenne palsy, one would expect damage

to C5–C6, resulting in “waiter’s tip position”

(adducted shoulder, medially rotated arm, and

extended elbow). This results from paralysis of

the deltoid, biceps, brachialis, and brachioradi-

alis. The lateral aspect of the upper limb also

experiences loss of sensation (Moore, p 716).

76. (D) Damage to the inferior trunks of the brachial

plexus (C8–T1) affects the short muscles of the

hand, resulting in “clawhand.” The patient might

have grabbed a tree limb to catch himself while

falling to cause this injury. “Clawhand” may also

be caused by an injury to the ulnar nerve (Moore,

pp 716–717, 761).

77. (B) A knife wound to the axilla would dam-

age the musculocutaneous nerve and result in

paralysis of the coracobrachialis, biceps, and

brachialis. Therefore, ﬂexion of the elbow joint

and supination of the forearm would be weak-

ened. The patient would also lose sensation on

the lateral surface of the forearm (Moore, p 731).

78. (C) When the median nerve is injured, the pa-

tient often exhibits the “hand of benediction.”

When the patient tries to make a ﬁst, digits 2 and

3 remain partially extended because ﬂexion of

the PIP joints is lost in digits 1–3 and weakened

in digits 4–5. Flexion of the DIP joints is lost in

digits 2–3 but maintained in digits 4–5 (since the

ulnar nerve controls the medial part of the ﬂexor

digitorum profundus). Flexion of the MCP joints

of digits 2-3 will also be affected due to a loss of

the lumbricals 1 and 2 (Moore, pp 757, 774, 776).

79. (A) The ulnar nerve is often injured where it

passes posterior to the medial epicondyle of the

humerus. The patient experiences loss of sensa-

tion in the medial part of the palm as well as in

the medial 1

⁄

digits. Most intrinsic hand mus-

cles are paralyzed, and the patient loses the

ability to adduct the hand at the wrist. Patients

cannot make a ﬁst since they are unable to ﬂex the

4th and 5th digits at the DIP joints. The result-

ing deformity is known as “clawhand” (Moore,

pp 761, 776–777).

80. (E) Amelia is the complete absence of one or

more extremities while meromelia is the partial

absence of one or more extremities. All segments

of extremities are present but abnormally short

in micromelia. In phocomelia, long bones are

absent, and small hands or feet are attached to

the trunk by short, irregular bones. In cleft hand

(lobster claw deformity), the third metacarpal is

absent and digits 1–2 and 4–5 are fused (Sadler,

p 179).

81. (C) Syndactyly involves abnormal fusion of ﬁn-

gers and toes. Cleft hand (lobster claw defor-

mity) consists of an abnormal cleft between the

2nd and 4th metacarpal bones, with the 3rd

metacarpal and phalangeal bones being absent

and with digits 1–2 and 4–5 being fused. Poly-

dactyly involves extra ﬁngers or toes, while

ectrodactyly involves the absence of a digit.

Mutations in HOXA13result in hand-foot-geni-

tal syndrome, where carpals and short digits are

fused and the genitalia have altered structures

(Sadler, p 181).

28 2: The Upper Limb

0523-02 Chap 2 07/15/02 15:31 Page 28

82. (D) During development, dorsal cells organize

as the epimere and ventral cells organize as the

hypomere. Dorsal rami innervate muscles de-

rived from the epimere, whereas ventral rami

innervate muscles derived from the hypomere.

Myoblasts of the epimere form the extensor

muscles of the vertebral column, and those of the

hypomere give rise to muscles of the limbs and

body wall. Somites and somitomeres form the

musculature of the limbs (Sadler, pp 189–190).

83. (E) Partial or complete absence of one or more

muscles is rather common. One of the best-

known examples is total or partial absence of the

pectoralis major (Poland anomaly). Similarly,

the palmaris longus, serratus anterior, and quad-

ratus femoris may be partially or entirely absent

(Sadler, p 192).

84. biceps brachii

85. cephalic vein

86. radial nerve

87. brachial artery

88. median nerve

89. lateral cord

90. musculocutaneous nerve

91. medial antebrachial cutaneous nerve

92. ulnar nerve

93. lateral pectoral nerve

94. coracobrachialis

95. brachialis

96. ulna

97. long head of triceps brachii

98. lateral head of triceps brachii

Answers and Explanations: 71–98 29

0523-02 Chap 2 07/15/02 15:31 Page 29

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DIRECTIONS (Questions 1 through 75): Each of the

numbered items or incomplete statements in this

section is followed by answers or by completions of

the statement. Select the ONE lettered answer or

completion that is BEST in each case.

1. The articular part of a rib tubercle articulates

with which of the following structures?

(A) body of the vertebra

(B) costal cartilage

(D) sternum

(E) transverse process

2. Where is the groove for the subclavian artery

located?

(A) posterior to the scalene tubercle

(B) on the clavicle

(D) at the sternal angle

(E) at the angle of the 1st rib

3. The retromammary space is located between

which of the following structures?

(A) skin and the areola

(B) pectoralis major and minor

(D) suspensory ligament and the skin

(E) lactiferous sinus and the nipple

4. The high death rate associated with breast can-

cer is related to which of the following?

(A) nerve supply

(B) blood supply

CHAPTER 3

The Thorax

Questions

(D) poor imaging techniques

(E) complex lymphatic drainage

5. Which of the following statements correctly

apply to the internal thoracic artery?

(A) It runs posterior to the transversus tho-

racis muscle.

(B) It ends in the 6th intercostal space.

epigastric arteries.

(D) It runs posterior to the superior six ribs.

(E) It gives rise to the posterior intercostal

arteries.

6. Which of the following statements concerning

the sternal angle is correct?

(A) It lies at the level of the intervertebral disk

between T4/T5.

(B) It is ﬂanked by the costal cartilage of the

3rd pair of costal cartilages.

artery.

(D) It lies in the epigastric fossa.

(E) It is located 3 mm superior to the jugular

notch.

7. The pleural cavity contains which of the fol-

lowing?

(A) lungs

(B) bronchi

(D) lymph nodes

(E) pulmonary arteries and veins

0523-03 Chap 3 07/15/02 15:32 Page 31

8. The parietal pleura consists of all of the follow-

ing parts EXCEPT

(A) costal

(B) pericardial

(D) diaphragmatic

(E) cervical

9. All of the following statements correctly apply

to the right lung EXCEPT

(A) The superior and oblique ﬁssures divide it

into three lobes.

(B) It is larger and heavier than the left lung.

(D) It contains a thin, tonguelike process

called the lingula.

(E) It has three surfaces.

10. All of the following statements correctly apply

to the left main bronchus EXCEPT

(A) It is wider, shorter, and runs more verti-

cally than the right main bronchus.

(B) It passes anterior to the esophagus.

(D) It contains c-shaped rings of hyaline

cartilage.

(E) It arises at the level of the sternal angle.

11. All of the following statements correctly apply

to a bronchopulmonary segment EXCEPT

(A) It is separated from adjacent segments by

connective tissue septa.

(B) It is the largest subdivision of a lobe.

(D) It is named according to the segmental

bronchus supplying it.

(E) It is a pyramid-shaped segment of the

lung, with its apex facing the lung root

and its base at the pleural surface.

12. Which of the following structures is located in

the middle mediastinum?

(A) thoracic duct

(B) lungs

(D) heart

(E) azygos vein

13. All of the following statements correctly apply

to the right atrium EXCEPT

(A) It receives blood from the superior and

inferior vena cava and coronary sinus.

(B) It forms the right side of the heart.

(D) It contains the limbus fossae ovalis.

(E) It contains trabeculae carneae.

14. The interventricular septum contains which of

the following structures?

(A) anterior papillary muscle

(B) fossa ovalis

(D) sinoatrial node

(E) conus arteriosus

15. All of the following statements correctly apply

to the right coronary artery EXCEPT

(A) Typically supplies the SA node in approx-

imately 60% of people.

(B) Typically supplies the AV node in

approximately 80% of people.

(D) Runs in the coronary sulcus.

(E) Dominance is typical.

16. Which of the following is the basic structural

unit for gas exchange in the lung?

(A) terminal bronchioles

(B) respiratory bronchioles

(D) alveoli

(E) bronchi

17. Which of the following structures carry highly

oxygenated blood from the lungs to the heart?

(A) pulmonary arteries

(B) pulmonary veins

(D) cardiac veins

(E) ascending aorta

32 3: The Thorax

0523-03 Chap 3 07/15/02 15:32 Page 32

18. Which of the following structures is located in

the posterior mediastinum?

(A) lungs

(B) heart

(D) superior vena cava

(E) right coronary artery

19. All of the following statements concerning spinal

nerves are correct EXCEPT

(A) The dorsal and ventral rami are both

motor and sensory.

(B) The cutaneous branches include anterior,

lateral, and posterior branches.

(D) The ventral root is pure motor.

(E) They supply a bandlike skin area known

as a dermatome.

20. Which of the following statements correctly

applies to the tricuspid valve?

(A) It guards the left atrioventricular oriﬁce.

(B) It guards the conus arteriosus.

(D) Chordae tendineae attach to the free

edges of the cusps.

(E) The apex of each cusp attaches to the

ﬁbrous ring around the oriﬁce.

21. All of the following statements concerning the

pericardium are correct EXCEPT

(A) The external layer of the sac is ﬁbrous.

(B) The internal layer is reﬂected onto the

heart as the visceral serous layer (epi-

cardium).

partietal serous layer.

(D) The pericardial cavity is the potential

space between the parietal and visceral

serous layers.

(E) The fibrous pericardium is attached to

the sternum by the pericardiacophrenic

ligament.

22. All of the following veins drain into the coro-

nary sinus EXCEPT

(A) anterior cardiac

(B) small cardiac

(D) great cardiac

(E) oblique vein of the left atrium

23. All of the following statements concerning the

sinoatrial node are correct EXCEPT

(A) It is located near the superior end of the

sulcus terminalis.

(B) It is located at the junction of the superior

vena cava and the right atrium.

(D) It is specialized cardiac muscle ﬁber.

(E) It is avascular.

24. Which of the following structures is located in

the left ventricle?

(A) fossa ovalis

(B) crista terminalis

(D) conus arteriosus

(E) posterior papillary muscle

25. Which of the following structures is located in

the left atrium?

(A) pectinate muscle

(B) pulmonary semilunar valves

(D) septal papillary muscle

(E) atrioventricular node

26. Which of the following is NOT part of the chest?

(A) 12 pairs of ribs

(B) sternum

(D) 12 thoracic vertebrae

(E) clavicle

Questions: 8–26 33

0523-03 Chap 3 07/15/02 15:32 Page 33

27. Which of the following is NOT likely to con-

tribute to chest pain?

(A) cardiac disease

(B) pulmonary disease

(D) gallbladder disorders

(E) intestinal disorders

28. Which of the following is a special feature of a

thoracic vertebra?

(A) foramen for vertebral artery

(B) dens for rotation

(D) costal facets on bodies

(E) costal facets on spinous processes

29. Which of the following is a saddle-type synovial

joint?

(A) sternoclavicular joint

(B) manubriosternal joint

(D) intervertebral joint

(E) costochondral joint

30. The mammary glands are modiﬁed versions of

which type of gland?

(A) sebaceous gland

(B) lymph gland

(D) tonsillar tissue

(E) endocrine gland

31. Which of the following does NOT supply the

breast with blood?

(A) lateral thoracic artery

(B) thoracoacromial artery

(D) internal thoracic artery

(E) costoclavicular artery

32. Which of the following are innervated by dor-

sal rami?

(A) levatores costarum

(B) external intercostals

(D) subcostals

(E) serratus posterior inferior

33. Which of the following do NOT elevate the

ribs?

(A) serratus posterior superior

(B) serratus posterior inferior

(D) levatores costarum

(E) subcostals

34. With which of the following does the intercos-

tobrachial nerve communicate?

(A) medial brachial cutaneous nerve

(B) thoracodorsal nerve

(D) ﬁrst intercostal nerve

(E) sympathetic trunk

35. The musculophrenic arteries give rise to which

of the following?

(A) anterior intercostal arteries for intercostal

spaces 7–9

(B) posterior intercostals arteries for inter-

costal spaces 3–11

(D) inferior phrenic artery

(E) lumbar arteries

36. Anterior and posterior intercostals arteries pass

between which two layers?

(A) skin and external intercostal muscles

(B) external and internal intercostal muscles

muscles

(D) innermost intercostal muscles and trans-

versalis fascia

(E) transversalis fascia and peritoneum

37. Of the bronchopulmonary segments in the supe-

rior lobe of the left lung, which two are com-

bined to form the lingula?

(A) apical and posterior

(B) posterior and anterior

34 3: The Thorax

0523-03 Chap 3 07/15/02 15:32 Page 34

(D) superior and inferior

(E) apical and inferior

38. Which of the following areas do NOT receive

visceral afferent ﬁbers?

(A) bronchial mucosa

(B) bronchial muscles

(D) pulmonary arteries and veins

(E) diaphragm

39. Sympathetic nerves do NOT contribute to which

of the following?

(A) diaphragm

(B) bronchial muscle

(D) alveolar glands of the bronchial tree

(E) sweat glands of the chest

40. Which of the following is correct?

(A) While a person is supine, the arch of the

aorta lies superior to the transverse tho-

racic plane.

(B) While a person is supine, the bifurcation

of the trachea lies at the level of the

xiphisternal junction and T9.

don of the diaphragm is transected by the

transverse thoracic plane.

(D) While a person is standing, the arch of the

aorta lies inferior to the transverse tho-

racic plane.

(E) While a person is standing, the tracheal

bifurcation is transected by the transverse

thoracic plane.

41. The pericardium does NOT receive blood sup-

ply from which of the following?

(A) pericardiacophrenic artery

(B) musculophrenic artery

(D) esophageal arteries

(E) pectoral arteries

42. Which of the following is NOT a branch of the

right coronary artery?

(A) SA nodal

(B) right marginal

(D) AV nodal

(E) circumﬂex

43. Which of the following is NOT contained in the

superior mediastinum?

(A) thymus

(B) great vessels and their branches

(D) trachea

(E) esophagus

44. The thymus is supplied by which of the fol-

lowing?

(A) anterior intercostal branches of the inter-

nal thoracic artery

(B) brachiocephalic artery

(D) left common carotid artery

(E) pericardiacophrenic arteries

45. Which of the following is NOT a branch of the

aorta in the thorax?

(A) posterior intercostal arteries

(B) inferior phrenic artery

(D) esophageal arteries

(E) superior phrenic arteries

46. The posterior mediastinum does NOT include

which of the following?

(A) prevertebral muscles

(B) thoracic aorta

(D) thoracic sympathetic trunks

(E) thoracic splanchnic nerves

Questions: 27–46 35

0523-03 Chap 3 07/15/02 15:32 Page 35

47. Which of the following may compress the

esophagus?

(A) aortic arch

(B) right main bronchus

(D) right brachiocephalic vein

(E) brachiocephalic trunk

48. The azygos vein receives blood from which of

the following?

(A) posterior intercostal veins

(B) anterior intercostal veins

(D) anterior jugular vein

(E) lateral thoracic vein

49. The hemiazygos vein does NOT receive blood

from which of the following?

(A) left subcostal vein

(B) ascending lumbar veins

(D) superior phrenic veins

(E) small mediastinal veins

50. The accessory hemiazygos vein parallels the

vertebral column along which vertebral levels?

(A) T1–4

(B) T2–6

(D) T8–12

(E) L1–4

51. Which of the following is NOT contained in the

anterior mediastinum?

(A) fat

(B) sternopericardial ligaments

(D) lymphatic vessels

(E) heart

52. Which of the following is NOT part of the sym-

pathetic trunks?

(A) prevertebral ganglia

(B) paravertebral ganglia

(D) superior cervical ganglia

(E) inferior cervical ganglia

53. Which of the following does NOT contain syn-

apses for the sympathetic nervous system?

(A) prevertebral ganglia

(B) collateral ganglia

(D) celiac ganglia

(E) cardiac plexus

54. Which of the following does NOT occur in the

sympathetic trunk?

(A) Presynaptic neurons synapse with post-

synaptic neurons immediately.

(B) Fibers ascend and synapse.

(D) Presynaptic ﬁbers innervate immediately

surrounding blood vessels.

(E) Fibers pass, without synapsing, into a

splanchnic nerve.

55. Parasympathetic ﬁbers stimulate secretion by

all glands except which of the following?

(A) sweat glands

(B) lacrimal glands

(D) nasal glands

(E) palatine glands

56. Vasoconstriction is sympathetically stimulated

with the exception of which arteries?

(A) bronchial arteries

(B) coronary arteries

(D) adrenal arteries

(E) renal arteries

57. Which of the following is a result of sympathetic

stimulation in the heart?

(A) decrease in the rate and strength of con-

traction

36 3: The Thorax

0523-03 Chap 3 07/15/02 15:32 Page 36

(B) inhibition of the effect of parasympathetic

system on coronary arteries, allowing

them to dilate

(D) opening and closing of mitral valve

(E) glandular secretion

58. Which of the following is NOT a result of sym-

pathetic stimulation in the lungs?

(A) inhibition of parasympathetic system

(B) bronchodilation

(D) maximum air exchange

(E) surfactant production

59. Sympathetic ﬁbers of the heart are accompanied

by visceral afferent ﬁbers that convey which type

of sensation?

(A) reﬂex

(B) pain

(D) contraction feedback

(E) pressure sensation

60. The pulmonary plexus contains which of the

following?

(A) cell bodies of visceral afferent ﬁbers

(B) cell bodies of postsynaptic sympathetic

ﬁbers

thetic ﬁbers

(D) somatic efferent ﬁbers passing on to

diaphragm

(E) somatic afferent ﬁbers from diaphragm

61. Visceral afferent ﬁbers of the tenth cranial nerve

are NOT distributed to which of the following?

(A) bronchial mucosa

(B) bronchial muscles

(D) pulmonary arteries and veins

(E) diaphragm

62. The greater, lesser, and least splanchnic nerves

are examples of what type of splanchnic nerves?

(A) cervical splanchnic nerves

(B) upper thoracic splanchnic nerves

(D) lumbar splanchnic nerves

(E) pelvic splanchnic nerves

63. The greater splanchnic nerve originates from

which vertebral levels?

(A) T1–4

(B) T5–9

(D) T12

(E) L1–4

64. The ﬁbers of the greater splanchnic nerve syn-

apse in which ganglion?

(A) celiac ganglion

(B) inferior mesenteric ganglion

(D) pulmonary plexus

(E) adrenal cortex

65. The level of the domes of the diaphragm varies

according to various situations. Which of the fol-

lowing does NOT affect the level of the domes of

the diaphragm?

(A) phase of respiration

(B) posture

(D) degree of distention of abdominal viscera

(E) heart contractions

66. Which of the following passes through the

caval opening of the diaphragm?

(A) terminal branches of the right phrenic

nerve

(B) thoracic duct

(D) sympathetic trunk

(E) vagus

Questions: 47–66 37

0523-03 Chap 3 07/15/02 15:32 Page 37

67. Which of the following does NOT pass through

the esophageal hiatus of the diaphragm?

(A) esophagus

(B) branches of the left gastric vessels

(D) vagal trunks

(E) lesser thoracic splanchnic nerve

68. Which of the following passes through the aortic

hiatus of the diaphragm?

(A) least thoracic splanchnic nerve

(B) thoracic duct

(D) sympathetic trunks

(E) terminal branches of the left phrenic nerve

69. Ribs are formed from which of the following?

(A) sclerotome portion of paraxial mesoderm

(B) lateral plate mesoderm

(D) endodermal migration

(E) neural crest cell transitory development

70. The pleuropericardial membranes develop into

what structures of the adult?

(A) ﬁbrous pericardium

(B) diaphragm

(D) visceral pleura

(E) the membranes degenerate completely

71. The diaphragm is NOT derived from which of

the following?

(A) septum transversum

(B) pleuroperitoneal membranes

dorsal body walls

(D) mesentery of esophagus

(E) anterior thoracic fascia

72. The entire cardiovascular system is derived from

which of the following?

(A) neural crest cells

(B) endoderm

(D) ectoderm

(E) notochord invagination

73. Which of the following is NOT derived from

the original aortic arch system?

(A) carotid arteries

(B) arch of the aorta

(D) right subclavian artery

(E) coronary arteries

74. The respiratory system is an outgrowth of what?

(A) middle mediastinum

(B) ventral wall of foregut

(D) aortic arches

(E) pharyngeal arches

75. Which of the following correctly describes the

development of the lungs, in order?

(A) pseudoglandular period, canalicular

period, terminal sac period, alveolar

period

(B) canalicular period, pseudoglandular

period, terminal sac period, alveolar

period

canalicular period, terminal sac period

(D) pseudoglandular period, terminal sac

period, alveolar period, canalicular period

(E) terminal sac period, alveolar period,

pseudoglandular period, canalicular

period

38 3: The Thorax

0523-03 Chap 3 07/15/02 15:32 Page 38

DIRECTIONS (Questions 76 through 85): Identify the anatomical features indicated on the art below.

DIRECTIONS (Questions 86 through 90): Identify the anatomical features indicated on the art below.

0523-03 Chap 3 07/15/02 15:32 Page 39

DIRECTIONS (Questions 91 through 95): Identify the anatomical features indicated on the art below.

40 3: The Thorax

0523-03 Chap 3 07/15/02 15:32 Page 40

Answers and Explanations

1. (E) The tubercle has a smooth articular part for

articulating with the corresponding transverse

process of the vertebra and a rough nonarticu-

lar part for attachment of the costotransverse

ligament (Moore, p 63).

2. (A) The surface of the 1st rib has two trans-

versely directed shallow grooves, anterior and

posterior to the scalene tubercle, for the subcla-

vian vein and the subclavian artery respectively

(Moore, pp 63–64).

3. (C) Between the breast and deep pectoral fas-

cia is a loose connective tissue plane or poten-

tial space known as the retromammary space

(Moore, p 73).

4. (E) Because the axillary lymph nodes are the

most common site of metastases from a breast

cancer, enlargement of the palpable nodes in a

woman suggests the possibility of breast cancer

and may be key to early detection. However, the

absence of enlarged axillary nodes is no guaran-

tee that metastasis from a breast cancer has not

occurred, because the malignant cells may have

passed to other nodes, such as the infraclavicu-

lar and supraclavicular lymph nodes (Moore,

p 78).

5. (B) After descending past the 2nd costal carti-

lage, the internal thoracic artery runs anterior to

the transversus thoracis muscle. It ends in the

6th intercostal space, where it divides into the

superior epigastric and musculophrenic arteries

(Moore, p 91).

6. (A) The sternal angle is located opposite the

2nd pair of costal cartilages at the level of the 4th

intervertebral disc between T4 and T5 vertebrae

(Moore, p 66).

7. (C) The pleural cavity, the potential space be-

tween the layers of pleura, contains a capillary

layer of serous pleural ﬂuid. It provides the lubri-

cation and cohesion that keep the lung surface in

contact with the thoracic wall (Moore, p 95).

8. (B) The parietal pleura includes costal, mediasti-

nal, diaphragmatic, and cervical parts (Moore,

pp 95–96).

9. (D) The right lung has three lobes, the left two.

The right lung is larger and heavier than the left,

but it is shorter and wider, because the right

dome of the diaphragm is higher and the heart

and pericardium bulge more to the left. The ante-

rior margin of the right lung is relatively straight,

whereas the margin of the left lung has a deep

cardiac notch. The cardiac notch primarily in-

dents the anteroinferior aspect of the superior

lobe of the left lung. This often creates a thin,

tongue-like process of the superior lobe, called

the lingula (Moore, p 101).

10. (A) The right main bronchus is wider and

shorter, running more vertically than the left

main bronchus as it passes directly to the hilum

of the lung. The left main bronchus passes infer-

olaterally, inferior to the arch of the aorta and

anterior to the esophagus and thoracic aorta, to

reach the hilum of the lung (Moore, p 104).

11. (C) A bronchopulmonary segment is a pyramid-

shaped segment of the lung with its apex facing

the lung root and its base at the pleural surface.

It is the largest subdivision of a lobe and is sepa-

0523-03 Chap 3 07/15/02 15:32 Page 41

rated from adjacent segments by connective tis-

sue. It is surgically resectable (Moore, p 104).

12. (D) The middle mediastinum contains the heart

(Moore, p 114).

13. (E) The right border of the heart is formed by

the right atrium; it receives venous blood from

the SVC, IVC, and coronary sinus. It contains

both the crista terminalis and the limbus fossae

ovalis. The interior of the ventricles contains

irregular muscular elevations called trabeculae

carneae (Moore, pp 125–127).

14. (E) The interventricular septum is composed

of membranous and muscular parts. The conus

arteriosus leads into the pulmonary trunk. A

thick muscular ridge, the supraventricular crest,

separates the ridged muscular wall of the inﬂow

part of the right ventricle from the smooth wall

of the conus arteriosus or outﬂow part (Moore,

p 127).

15. (C) Typically, the right coronary artery supplies

the right atrium, most of the right ventricle, part

of the left ventricle, part of the AV septum, and

the SA node in approximately 60% of people and

the AV node in approximately 80% of people

(Moore, p 135).

16. (D) The alveolus is the basic unit of gas exchange

in the lung (Moore, p 104).

17. (B) The pulmonary veins, two on each side,

carry well-oxygenated (“arterial”) blood from

the lungs to the left atrium of the heart (Moore,

p 107).

18. (C) The posterior mediastinum contains the tho-

racic aorta, thoracic duct, azygos and hemiazy-

gos veins, esophagus, and thoracic sympathetic

trunks (Moore, pp 150–151).

19. (C) The dorsal and ventral rami are both motor

and sensory. The cutaneous branches include

anterior, lateral, and posterior branches. The dor-

sal root is sensory and the ventral root is motor.

The spinal nerves supply a band-like skin area

known as a dermatome (Moore, p 85).

20. (D) The tricuspid valve guards the right AV

oriﬁce. The bases of the valve cusps are attached

to the ﬁbrous ring around the oriﬁce. Chordae

tendineae attach to the free edges and ventricu-

lar surfaces of the anterior, posterior, and septal

cusps (Moore, p 127).

21. (E) The ﬁbrous pericardium is attached to the

posterior surface of the sternum by the sterno-

pericardial ligaments (Moore, p 116).

22. (A) The coronary sinus receives the great and

small cardiac veins, middle cardiac vein, left pos-

terior ventricular vein, and left marginal vein.

The anterior cardiac veins begin over the ante-

rior surface of the right ventricle and cross over

the coronary groove to end directly in the right

atrium (Moore, pp 136–137).

23. (E) The SA node is located anterolaterally just

deep to the epicardium at the junction of the SVC

and right atrium, near the superior end of the

sulcus terminalis. The SA node, a small collec-

tion of nodal tissue and specialized cardiac mus-

cle ﬁbers, is the pacemaker of the heart. The SA

node is supplied by a branch of the right coro-

nary artery in about 60% of individuals (Moore,

p 137).

24. (E) The interior of the left ventricle includes

anterior and posterior papillary muscles (Moore,

p 131).

25. (A) The interior of the left atrium has a large-

walled part and a smaller muscular auricle con-

taining pectinate muscles (Moore, p 129).

26. (E) The chest consists of 12 pairs of ribs, the ster-

num, costal cartilages, and 12 thoracic vertebrae

(Moore, p 60).

27. (C) Chest pain may result from cardiac disease,

pulmonary disease, intestinal problems, gall-

bladder disorders, and musculoskeletal dis-

orders (Moore, p 61).

28. (D) Thoracic vertebrae have costal facets or

demifacets on their bodies, costal facets on the

transverse processes (for the ﬁrst 9 or 10 thoracic

vertebrae), and long spinous processes (Moore,

p 65).

42 3: The Thorax

0523-03 Chap 3 07/15/02 15:32 Page 42

29. (A) The sternoclavicular joint is a saddle-type

synovial joint (Moore, p 69).

30. (C) The mammary glands are modiﬁed sweat

glands (Moore, p 74).

31. (E) The breast is supplied by the internal tho-

racic, lateral thoracic, thoracoacromial, and pos-

terior intercostal arteries (Moore, p 75).

32. (A) The levatores costarum are innervated by

the dorsal primary rami of C8–T11. (Moore, p 84).

33. (B) The serratus posterior inferior depresses the

ribs (Moore, p 84).

34. (A) The intercostobrachial nerve communicates

with the medial brachial cutaneous nerve (Moore,

p 87).

35. (A) The musculophrenic artery gives rise to

anterior intercostal arteries for intercostal spaces

7–9 (Moore, p 88).

36. (C) Anterior and posterior intercostal arteries

pass between the internal and innermost inter-

costal muscles (Moore, p 88).

37. (D) The superior and inferior bronchopulmo-

nary segments of the superior lobe of the left lung

combine to form the lingula (Moore, p 106).

38. (E) Visceral afferent ﬁbers are distributed to

bronchial mucosa, bronchial muscles, interalve-

olar connective tissue, and pulmonary arteries

and veins (Moore, p 111).

39. (A) The diaphragm receives somatic efferent

and afferent innervation—not sympathetic in-

nervation (Moore, p 113).

40. (A) While a person is supine, the arch of the

aorta lies superior to the transverse thoracic

plane (Moore, p 115).

41. (E) The pericardium receives blood supply from

the pericardiacophrenic artery, musculophrenic

artery, bronchial arteries, esophageal arteries,

superior phrenic arteries, and coronary arteries

(Moore, p 120).

42. (E) The branches of the right coronary artery

include the SA nodal, right marginal, posterior

interventricular, and AV nodal arteries (Moore,

p 134).

43. (C) The superior mediastinum contains the thy-

mus, great vessels and their branches, vagus

nerves, phrenic nerves, cardiac plexus, left recur-

rent laryngeal nerve, trachea, esophagus, thora-

cic duct, and prevertebral muscles (Moore, p 142).

44. (A) The thymus is supplied by the anterior

intercostal and anterior mediastinal branches of

the internal thoracic artery (Moore, p 142).

45. (B) Branches of the aorta in the thorax include

the posterior intercostal, bronchial, esophageal,

and superior phrenic arteries (Moore, p 145).

46. (A) The posterior mediastinum includes the

thoracic aorta, thoracic duct, posterior mediasti-

nal lymph nodes, azygos and hemiazygos veins,

esophagus, esophageal plexus, thoracic sympa-

thetic trunks, and thoracic splanchnic nerves

(Moore, pp 150–151).

47. (A) The esophagus is compressed by the aortic

arch, left main bronchus, and diaphragm (Moore,

p 152).

48. (A) The azygos vein receives blood from the

posterior intercostal veins, vertebral venous

plexuses, mediastinal veins, esophageal veins,

and bronchial veins (Moore, p 155).

49. (D) The hemiazygos vein receives blood from

the left subcostal vein, ascending lumbar veins,

the inferior three posterior intercostal veins, infe-

rior esophageal veins, and small mediastinal

veins (Moore, p 155).

50. (C) The accessory hemiazygos descends on the

left side of the vertebral column from T5 through

T8 (Moore, p 155).

51. (E) The anterior mediastinum contains fat, ster-

nopericardial ligaments, branches of internal

thoracic vessels, and lymphatic vessels (Moore,

p 156).

Answers and Explanations: 12–51 43

0523-03 Chap 3 07/15/02 15:32 Page 43

52. (A) The sympathetic trunk contains the supe-

rior, middle, and inferior cervical ganglia; par-

avertebral ganglia; and the ganglion impar

(Moore, p 46).

53. (E) The cardiac plexus does not contain syn-

apses for sympathetic fibers, as these fibers

have already synapsed in the sympathetic

trunk (Moore, p 150).

54. (D) In the synaptic trunk, presynaptic neurons

synapse with postsynaptic neurons immedi-

ately. Some ﬁbers ascend and synapse, while

other ﬁbers descend and synapse. Some ﬁbers

pass into a splanchnic nerve without synapsing

(Moore, p 46).

55. (A) With the exception of sweat glands, glan-

dular secretion is parasympathetically stimu-

lated (Moore, p 51).

56. (B) With the exception of coronary arteries,

vasoconstriction is sympathetically stimulated

(Moore, p 51).

57. (B) Sympathetic stimulation of the heart in-

creases the rate and strength of contraction and

inhibits the effect of the parasympathetic sys-

tem on coronary arteries, allowing them to

dilate (Moore, p 51).

58. (E) Sympathetic stimulation of the lungs results

in inhibition of the parasympathetic system,

bronchodilation, reduced secretion, and maxi-

mum air exchange (Moore, p 51).

59. (B) Sympathetic ﬁbers of the heart are accom-

panied by visceral afferent ﬁbers, which convey

pain information (Moore, p 52).

60. (C) The pulmonary plexus contains cell bodies

of postsynaptic parasympathetic ﬁbers (Moore,

p 110).

61. (E) Visceral afferent ﬁbers of the tenth cranial

nerve are distributed to bronchial mucosa (for

cough reflex), bronchial muscles (for stretch

reception), interalveolar connective tissue (for

Hering-Breuer reﬂexes, limiting respiratory ex-

cursions), and pulmonary arteries (as pressure

receptors) and veins (as chemoreceptors) (Moore,

p 111).

62. (C) The greater, lesser, and least splanchnic

nerves are lower thoracic splanchnic nerves

(Moore, p 301).

63. (B) The greater thoracic splanchnic nerve orig-

inates from vertebral levels T5–9 (Moore, p 301).

64. (A) The ﬁbers of the greater splanchnic nerve

synapse in the celiac ganglion (Moore, p 302).

65. (E) The level of the domes of the diaphragm

varies according to phase of respiration, posture,

and size and degree of distention of abdominal

viscera (Moore, p 289).

66. (A) The inferior vena cava, terminal branches

of the right phrenic nerve, and lymphatics pass

through the caval opening of the diaphragm

(Moore, p 294).

67. (E) The esophagus, anterior and posterior vagal

trunks, esophageal branches of the left gastric

vessels, and lymphatic vessels pass through the

esophageal hiatus (Moore, p 294).

68. (B) The aorta, thoracic duct, and azygos vein

(sometimes) pass through the aortic hiatus

(Moore, p 295).

69. (A) Ribs form from costal processes of thoracic

vertebrae and thus are derived from the sclero-

tome of paraxial medoderm (Sadler, p 184).

70. (A) The pleuropericardial membranes develop

into the ﬁbrous pericardium (Sadler, p 201).

71. (E) The diaphragm is derived from the septum

transversum and pleuroperitoneal membranes.

Muscular components stem from lateral and

dorsal body walls and mesentery of the esoph-

agus (Sadler, p 206).

72. (C) The entire cardiovascular system is derived

from mesoderm. (Sadler, p 256)

73. (E) The carotid arteries, arch of the aorta, pul-

monary artery, and right subclavian artery are

44 3: The Thorax

0523-03 Chap 3 07/15/02 15:32 Page 44

derived from the original aortic arch system

(Sadler, p 257).

74. (B) The respiratory system is an outgrowth of

the ventral wall of the foregut (Sadler, p 268)

75. (A) The lungs develop in the following periods:

pseudoglandular period, canalicular period, ter-

minal sac period, and alveolar period (Sadler,

p 266).

76. inferior thyroid vein

77. right brachiocephalic vein

78. phrenic nerve and pericardiacophrenic vessels

79. right pulmonary artery

80. left auricle

81. lingula

82. left pulmonary vein

83. ligamentum arteriosum

84. left vagus nerve

85. left internal jugular vein

86. pulmonary arteries

87. aorta

88. superior vena cava

89. left inferior pulmonary vein

90. inferior vena cava

91. manubrium of sternum

92. oblique ﬁssure

93. costal cartilage

94. xiphoid process

95. copula

Answers and Explanations: 52–95 45

0523-03 Chap 3 07/15/02 15:32 Page 45

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DIRECTIONS (Questions 1 through 100): Each of the

numbered items or incomplete statements in this

section is followed by answers or by completions

of the statement. Select the ONE lettered answer or

completion that is BEST in each case.

1. For general clinical descriptions, which of the

following planes is used as one of the planes to

deﬁne four quadrants of the abdominal cavity?

(A) subcostal

(B) transtubercular

(D) transumbilical

(E) midaxillary

2. The midclavicular planes pass through the mid-

point of the clavicles to the midpoint of which

of the following structures?

(A) anterior superior iliac spine

(B) symphysis pubis

(D) inguinal ligament

(E) xiphoid process

3. The fascial layer that covers the deep surface

of the transverse abdominal muscle is known

as which of the following?

(A) parietal peritoneum

(B) deep fascia

(D) Scarpa’s fascia

(E) Camper’s fascia

CHAPTER 4

The Abdomen

Questions

4. Where is extraperitoneal fat located?

(A) between the abdominal oblique muscles

(B) deep to the parietal peritoneum

(D) superﬁcial to the deep fascia

(E) deep to the transversalis fascia

5. The superﬁcial muscle ﬁbers of the external

abdominal oblique arising from the middle to

lower ribs interdigitate with which of the fol-

lowing muscles?

(A) internal abdominal oblique

(B) serratus anterior

(D) pyramidalis

(E) transversus abdominis

6. The anterolateral abdominal wall is bounded

by all of the following structures EXCEPT

(A) cartilages of the 7th through 10th ribs

(B) linea alba

(D) inguinal ligament

(E) pelvic bone

7. The aponeuroses of all three ﬂat muscles of the

anterolateral abdominal wall interlace in which

of the following structures?

(A) inguinal ligament

(B) transversalis fascia

(D) anterior superior iliac spine

(E) rectus abdominis

0523-04 Chap 4 07/15/02 15:32 Page 47

8. All of the following structures are located

within the rectus sheath EXCEPT

(A) pyramidalis

(B) rectus abdominis

(D) deep inguinal ring

(E) ventral primary rami of T7–T12 nerves

9. Inferiorly, the inferior margin of the external

oblique aponeurosis thickens and folds back on

itself to form which of the following structures?

(A) rectus sheath

(B) inguinal ligament

(D) deep inguinal ring

(E) fundiform ligament

10. The reﬂected inguinal ligament receives ﬁbers

from the contralateral aponeurosis of which of

the following structures?

(A) external abdominal oblique

(B) internal abdominal oblique

(D) rectus abdominis

(E) pyramidalis

11. Between the internal oblique and transverse

abdominal muscles is a neurovascular plane

that contains all of the following EXCEPT

(A) iliohypogastric nerve

(B) deep circumﬂex iliac artery

(D) subcostal nerve

(E) ilioinguinal nerve

12. The rectus abdominis muscle is anchored trans-

versely by attachment to the anterior layer of

the rectus sheath by which of the following

structures?

(A) pubic tubercle

(B) xiphoid process

(D) tendinous intersections

(E) umbilicus

13. Which of the following structures deﬁnes the

point at which the posterior lamina of the inter-

nal oblique and the aponeurosis of the trans-

verse abdominal become part of the anterior

rectus sheath?

(A) arcuate line

(B) inguinal ligament

(D) deep inguinal ring

(E) medial crus

14. The two medial umbilical folds represent rem-

nants of which of the following structures?

(A) urachus

(B) umbilical arteries

(D) ductus venosus

(E) ductus arteriosus

15. Which of the following fossae are potential sites

for direct inguinal hernias?

(A) supravesical

(B) medial inguinal

(D) ischiorectal

(E) iliac

16. The inguinal canal contains which of the fol-

lowing nerves?

(A) iliohypogastric

(B) ilioinguinal

(D) obturator

(E) lateral femoral cutaneous

17. Which of the following structures give rise to

the deep inguinal ring?

(A) gubernaculum

(B) conjoined tendon

(D) external abdominal oblique aponeurosis

(E) transversalis fascia

48 4: The Abdomen

0523-04 Chap 4 07/15/02 15:32 Page 48

18. The lacunar ligament is a reﬂection or exten-

sion from the deep aspect of which of the fol-

lowing structures?

(A) falciform ligament

(B) round ligament

(D) inguinal ligament

(E) transversalis fascia

19. The iliopubic tract is the thickened inferior

margin of which of the following structures?

(A) inguinal ligament

(B) transversalis fascia

(D) falciform ligament

(E) round ligament

20. The testes develop in which of the following

areas?

(A) scrotum

(B) abdominal cavity

(D) rectus sheath

(E) superﬁcial fascia

21. The gubernaculum is represented postnatally

by which of the following structures?

(A) tunica vaginalis testes

(B) processus vaginalis

(D) scrotal ligament

(E) internal spermatic fascia

22. The cremaster muscle and fascia are derived

from which of the following structures?

(A) external abdominal oblique muscle

(B) transverse abdominal muscle and fascia

(D) transversalis fascia

(E) external abdominal aponeurosis

23. The cremaster muscle is innervated by which

of the following nerves?

(A) genital branch of the genitofemoral

(B) ilioinguinal

(D) femoral

(E) obturator

24. The artery of the ductus deferens arises from

which of the following structures?

(A) aorta

(B) inferior epigastric

(D) pudendal

(E) common iliac

25. All of the following nerves contribute branches

to the scrotum EXCEPT

(A) lateral femoral cutaneous

(B) pudendal

(D) genitofemoral

(E) posterior femoral cutaneous

26. The epididymis is located on the posterior as-

pect of which of the following structures?

(A) urinary bladder

(B) prostate

(D) ovary

(E) uterine tube

27. The testes are covered by a tough ﬁbrous coat

known as the

(A) cremaster fascia

(B) tunica albuginea

(D) tunica dartos

(E) Scarpa’s fascia

28. Which of the following structures represents

the closed-off distal part of the embryonic pro-

cessus vaginalis?

(A) gubernaculum

(B) tunica albuginea

(D) tunica vaginalis

(E) urogenital diaphragm

Questions: 8–28 49

0523-04 Chap 4 07/15/02 15:32 Page 49

29. The pampiniform plexus provides which of

the following testicular functions?

(A) lymphatic drainage

(B) blood supply

(D) thermoregulatory system

(E) hormonal production

30. The parasympathetic innervation of the testis

includes which of the following nerves?

(A) pelvic splanchnic

(B) vagus

(D) ilioinguinal

(E) pudendal

31. The peritoneal cavity contains which of the

following?

(A) liver

(B) pancreas

(D) kidney

(E) peritoneal ﬂuid

32. Which of the following structures connects the

lesser curvature of the stomach and the proxi-

mal part of the duodenum to the liver?

(A) lesser omentum

(B) peritoneal ligament

(D) lesser omentum

(E) peritoneal fold

33. Which of the following structures is often

referred to as the “abdominal policeman”?

(A) hepatoduodenal ligament

(B) gastrohepatic ligament

(D) gastrocolic ligament

(E) falciform ligament

34. Which of the following ligaments conducts

the portal triad (portal vein, hepatic artery,

and bile duct)?

(A) greater omentum

(B) falciform ligament

(D) hepatoduodenal ligament

(E) gastrocolic ligament

35. Which of the following structures forms the

superior boundary of the omental foramen?

(A) inferior vena cava

(B) duodenum

(D) head of the pancreas

(E) hepatoduodenal ligament

36. Which of the following structures contains both

smooth and skeletal muscles?

(A) stomach

(B) jejunum

(D) esophagus

(E) rectum

37. Which of the following arteries provides the

abdominal parts of the esophagus with its arte-

rial supply?

(A) cystic

(B) gastroduodenal

(D) hepatic

(E) left gastroepiploic

38. Rugae are located in which of the following

structures?

(A) duodenum

(B) stomach

(D) ileum

(E) transverse colon

39. The left gastro-omental artery arises from which

of the following arteries?

(A) splenic

(B) hepatic

50 4: The Abdomen

0523-04 Chap 4 07/15/02 15:32 Page 50

(D) left gastric

(E) right gastric

40. The sympathetic nerve supply of the stomach

arises from which of the following cord seg-

ments?

(A) T1–T5

(B) T6–T9

(D) L1–L3

(E) T10–L2

41. The ﬁrst part of the duodenum is located at

which of the following vertebral levels?

(A) T10

(B) L2

(D) L5

(E) L3

42. The bile and pancreatic ducts enter which of

the following structures?

(A) stomach

(B) 2nd portion of the duodenum

(D) ileum

(E) liver

43. Which of the following structures crosses over

the inferior or horizontal (third) portion of the

duodenum?

(A) pancreas

(B) hepatic artery

(D) superior mesenteric artery

44. The duodenojejunal junction is supported by

the attachment of which of the following

structures?

(A) suspensory muscle of the duodenum

(ligament of Treitz)

(B) falciform ligament

(D) greater omentum

(E) transverse mesocolon

45. The superior anterior and posterior pancreati-

coduodenal arteries arise from which of the fol-

lowing arteries?

(A) right colic

(B) ileocolic

(D) hepatic

(E) splenic

46. The root of the mesentery crosses all of the fol-

lowing structures EXCEPT

(A) ascending and horizontal parts of the

duodenum

(B) abdominal aorta

(D) right ureter

(E) splenic artery

47. The superior mesenteric and splenic veins

unite to form the portal vein posterior to which

of the following structures?

(A) right kidney

(B) neck of the pancreas

(D) 2nd portion of the duodenum

(E) spleen

48. The sympathetic ﬁbers in the nerves to the

jejunum and ileum originate in which of the

following spinal cord segments?

(A) C5–T1

(B) T1–T5

(D) T9–T12

(E) L1–L2

49. Circular folds (plicae circulares) are character-

istic of which of the following structures?

(A) transverse colon

(B) stomach

(D) cecum

(E) sigmoid colon

Questions: 29–49 51

0523-04 Chap 4 07/15/02 15:32 Page 51

50. Omental appendices are located on which of

the following structures?

(A) stomach

(B) duodenum

(D) ascending colon

(E) liver

51. The are no teniae coli in which of the follow-

ing structures?

(A) ascending colon

(B) transverse colon

(D) sigmoid colon

(E) appendix

52. The appendicular artery is a branch of which

of the following arteries?

(A) inferior mesenteric

(B) inferior epigastric

(D) testicular

(E) renal

53. Which of the following structures can be

located deep to a point that is one-third of the

way along the oblique line, joining the right

anterior superior iliac spine to the umbilicus?

(A) gallbladder

(B) spleen

(D) appendix

(E) urinary bladder

54. Which of the following structures receives

parasympathetic innervation from the pelvic

splanchnic nerves?

(A) appendix

(B) sigmoid colon

(D) ascending colon

(E) duodenum

55. The rectum is continuous with the sigmoid

colon at the level of which of the following ver-

tebrae?

(A) L3

(B) L5

(D) S5

(E) coccygeal 1

56. All of the following statements concerning the

spleen are correct EXCEPT

(A) largest of the lymphatic organs

(B) associated posteriorly with the left 9th

through 11th ribs

(D) normally, does not descend inferior to

the costal region

(E) varies considerably in size, weight, and

shape

57. The splenic artery usually follows a tortuous

course along which of the following structures?

(A) left kidney

(B) greater curvature of the stomach

(D) transverse colon

(E) cecum

58. The head of the pancreas is embraced by which

of the following structures?

(A) stomach

(B) spleen

(D) C-shaped curve of the duodenum

(E) transverse mesocolon

59. The head of the pancreas rests posteriorly on

which of the following structures?

(A) left renal vein

(B) superior vena cava

(D) duodenum

(E) superior mesenteric artery

60. The main pancreatic duct and the bile duct unite

to form which of the following structures?

(A) common bile duct

(B) hepatic duct

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(D) cystic duct

(E) hepatopancreatic ampulla

61. The round ligament of the liver is the ﬁbrous

remnant of which of the following structures?

(A) umbilical vein

(B) ductus venosus

(D) umbilical artery

(E) urachus

62. The porta hepatis gives passage to all of the

following structures EXCEPT

(A) portal vein

(B) hepatic artery

(D) lymphatic vessels

(E) cystic artery

63. Which of the following ligaments encloses the

portal triad?

(A) hepatoduodenal

(B) hepatogastric

(D) hepatorenal

(E) gastrosplenic

64. The portion of the hepatic artery extending

between the celiac trunk and the gastroduo-

denal artery is known as the

(A) proper hepatic

(B) common hepatic

(D) left hepatic

(E) middle hepatic

65. The hepatic veins drain into which of the fol-

lowing structures?

(A) liver

(B) inferior vena cava

(D) portal vein

(E) superior vena cava

66. The spiral valve is located in which of the fol-

lowing structures?

(A) head of pancreas

(B) pylorus

(D) cecum

(E) rectum

67. The cystic artery commonly arises from the

right hepatic artery in the angle between the

common hepatic duct and which of the follow-

ing structures?

(A) cystic duct

(B) celiac trunk

(D) proper hepatic artery

(E) gastroduodenal artery

68. Which of the following veins, when dilated,

produces caput medusae?

(A) proper hepatic

(B) splenic

(D) paraumbilical

(E) rectal

69. Inferiorly, the posterior surfaces of the kidney

are related to all of the following structures

EXCEPT

(A) subcostal nerve

(B) iliohypogastric nerve

(D) 2nd portion of the duodenum

(E) quadratus lumborum

70. The renal papillae empty into which of the fol-

lowing structures?

(A) renal vein

(B) ureter

(D) renal pyramid

(E) renal column

Questions: 50–70 53

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71. All of the following statements concerning the

renal hilum are correct EXCEPT

(A) the renal vein is anterior to the renal

artery

(B) the renal artery is anterior to the renal

pelvis

(D) it is located on the concave medial mar-

gin of the kidney

(E) it contains the renal pyramids

72. The suprarenal glands are located between the

superomedial aspects of the kidneys and which

of the following structures?

(A) neck of the pancreas

(B) diaphragm

(D) mesentery

(E) 1st part of the duodenum

73. Which of the following structures is related to

the spleen, stomach, pancreas, and the left crus

of the diaphragm?

(A) left suprarenal gland

(B) left kidney

(D) transverse mesocolon

(E) abdominal aorta

74. All of the following statements concerning the

suprarenal cortex are correct EXCEPT

(A) derives from mesoderm

(B) secretes corticosteroids

(D) associated with the sympathetic nervous

system

(E) causes the kidney to retain sodium

75. The superior suprarenal arteries are branches

of which of the following arteries?

(A) abdominal aorta

(B) renal

(D) celiac trunk

(E) superior mesenteric

76. Which of the following muscles is considered

to be the chief muscle of inspiration?

(A) internal intercostal

(B) external intercostal

(D) scalene

(E) sternocleidomastoid

77. All of the following statements concerning the

central tendon of the diaphragm are correct

EXCEPT

(A) It has no bony attachments.

(B) It is incompletely divided into three

leaves.

(D) It lies near the center of the diaphragm.

(E) It is perforated by the inferior vena cava.

78. The crura of the diaphragm are musculotendi-

nous bundles that arise from which of the fol-

lowing structures?

(A) posterior longitudinal ligament

(B) sternum

(D) renal fascia

(E) psoas major muscle

79. The nerves of the kidneys and suprarenal

glands are derived from which of the following

plexuses?

(A) celiac

(B) lumbar

(D) sacral

(E) inferior hypogastric

80. The lateral arcuate ligaments are formed from

thickenings from which of the following mus-

cular fasciae?

(A) psoas major

(B) quadratus lumborum

(D) rectus abdominis

(E) sternalis

54 4: The Abdomen

0523-04 Chap 4 07/15/02 15:32 Page 54

81. All of the following structures may herniate

into the thoracic cavity when there is a trauma-

tic diaphragmatic hernia EXCEPT

(A) stomach

(B) kidney

(D) mesentery

(E) spleen

82. All of the following structures pass through

the esophageal hiatus EXCEPT

(A) posterior vagal trunk

(B) esophageal branches of the left gastric

vessels

(D) thoracic duct

(E) esophagus

83. The greater and lesser splanchnic nerves pass

through the diaphragm via which of the fol-

lowing structures?

(A) sternocostal foramen

(B) aortic hiatus

(D) vena caval foramen

(E) medial arcuate ligament

84. The parasympathetic root of the celiac plexus

is a branch of which of the following?

(A) greater splanchnic

(B) pelvic splanchnic

(D) posterior vagal trunk

(E) lesser splanchnic

85. The bifurcation of the abdominal aorta occurs at

the level of which of the following structures?

(A) crest of the ilium

(B) inguinal ligament

(D) symphysis pubis

(E) obturator foramen

86. The inferior vena cava begins anterior to which

of the following structures?

(A) right crus of the diaphragm

(B) right kidney

(D) crest of the ilium

(E) bifurcation of the aorta

87. The cisterna chyli is the inferior end of which

of the following structures?

(A) inferior vena cava

(B) abdominal aorta

(D) testicular artery

(E) thoracic duct

88. How are the pelvic splanchnic nerves distinct

from other splanchnic nerves?

(A) derived from ventral primary rami of L2,

L3, and L4

(B) derived from the sympathetic trunks

ﬁbers to the inferior hypogastric plexus

(D) provide postganglionic sympathetic

innervation to the cecum

(E) convey postganglionic parasympathetic

innervation to the ascending colon

89. All of the following statements concerning the

psoas major muscle are correct EXCEPT

(A) It passes inferolaterally, deep to the

inguinal ligament.

(B) It inserts on the lesser trochanter of the

femur.

ded in the posterior part of the psoas.

(D) It is a long, thick and fusiform muscle.

(E) Its name stems from a Greek word

meaning “muscle of the loin.”

90. Which of the following statements correctly

applies to the suprarenal medulla?

(A) derived from mesoderm

(B) secretes corticosteroids and androgens

(D) secretes acetylcholine

(E) produces hormones that cause the kidney

to retain sodium and water in response to

stress

Questions: 71–90 55

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91. The anatomical left and right lobes of the liver

are separated on the diaphragmatic surface of

the liver by which of the following structures?

(A) ﬁssure for the round ligament of the

liver

(B) ﬁssure for the ligamentum venosum

(D) porta hepatis

(E) lesser omentum

92. All of the following statements concerning the

spleen are correct EXCEPT

(A) It is the largest branch of the celiac trunk.

(B) It follows a tortuous course along the

inferior border of the pancreas.

enter the hilum of the spleen.

(D) It runs anterior to the left kidney.

(E) It follows posterior to the omental bursa.

93. In the developing embryo, the midgut rotates

270 degrees around which of the following

structures?

(A) superior mesenteric artery

(B) celiac trunk

(D) left renal artery

(E) inferior vena cava

94. Which of the following structures is avascular?

(A) superior ileocecal fold

(B) inferior ileocecal fold

(D) appendix

(E) cecum

95. Which of the following statements correctly

relates to the 3rd part of the duodenum?

(A) It is supported by the suspensory liga-

ment of the duodenum.

(B) The bile and pancreatic ducts enter its

posteromedial wall.

artery and vein.

(D) It attaches to the hepatoduodenal

ligament.

(E) It lies to the right and runs parallel to the

inferior vena cava.

96. The left gastro-omental artery arises from

which of the following arteries?

(A) celiac trunk

(B) right gastric

(D) splenic

(E) hepatic

97. Rugae are located in which of the following

structures?

(A) duodenum

(B) jejunum

(D) cecum

(E) stomach

98. All of the following statements concerning the

esophagus are correct EXCEPT

(A) It extends from the pharynx to the

stomach.

(B) It is crossed by the arch of the aorta.

(D) It passes through the esophageal hiatus.

(E) It normally has four constrictions.

99. Digestion occurs mainly in which of the fol-

lowing structures?

(A) cecum and ascending colon

(B) transverse colon

(D) jejunum and ileum

(E) transverse and sigmoid colon

100. Most reabsorption of water occurs in which of

the following structures?

(A) stomach

(B) jejunum

(D) ascending colon

(E) rectum

56 4: The Abdomen

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DIRECTIONS (Questions 101 through 110): Identify the anatomical features indicated on the art below.

Questions: 91–110 57

0523-04 Chap 4 07/15/02 15:32 Page 57

DIRECTIONS (Questions 116 through 120): Identify the anatomical features indicated on the art below.

58 4: The Abdomen

DIRECTIONS (Questions 111 through 115): Identify the anatomical features indicated on the art below.

0523-04 Chap 4 07/15/02 15:32 Page 58

DIRECTIONS (Questions 126 through 130): Identify the anatomical features indicated on the art below.

Questions: 111–130 59

DIRECTIONS (Questions 121 through 125): Identify the anatomical features indicated on the art below.

0523-04 Chap 4 07/15/02 15:32 Page 59

Answers and Explanations

1. (D) The transumbilical and median planes

divide the abdomen into four quadrants

(Moore, p 176).

2. (D) The midclavicular planes pass through

the midpoint of the clavicles to the midin-

guinal points (Moore, p 176).

3. (C) Transversalis fascia lines most of the ab-

dominal wall and covers the deep surface of the

transverse abdominal muscle. The deep fascia

invests the external abdominal oblique muscle.

Both Camper’s and Scarpa’s fascia are located

in the inferior part of the abdominal subcuta-

neous tissue (Moore, pp 178–179).

4. (E) The parietal peritoneum is internal to the

transversalis fascia and is separated from it by

a variable amount of endoabdominal (extra-

peritoneal) fat. Camper’s fascia and the deep

fasciae are all superﬁcial to the extraperitoneal

fat (Moore, p 179).

5. (B) The superﬁcial ﬁbers of the external ab-

dominal oblique arising from the middle and

lower ribs interdigitate with only those of the

serratus anterior (Moore, p 180).

6. (B) The anterolateral abdominal wall includes

the cartilages of the 7th–10th ribs and xiphoid

process superiorly. Inferiorly it is bounded by

the inguinal ligament and the pelvic bone

(Moore, p 178).

7. (C) The aponeuroses of these muscles inter-

lace at the linea alba with their fellows of the

opposite side to form the tough, aponeurotic

tendinous sheath of the rectus muscle, and

the rectus sheath (Moore, p 180).

8. (D) The contents of the rectus sheath include

the pyramidalis and rectus abdominis mus-

cles, the superior and inferior epigastric arter-

ies and veins, the lymphatics, and ventral

primary rami of T7–T12 nerves (Moore, p 180).

9. (B) Inferiorly, the inferior margin of the exter-

nal oblique aponeurosis thickens and folds back

on itself to form the inguinal ligament, a ﬁbrous

band extending between the anterior superior

iliac spine and the pubic tubercle (Moore, p 180).

10. (A) Some ﬁbers of the inguinal ligament pass

upward to cross the linea alba and blend with

the lower ﬁbers of the contralateral aponeuro-

sis. These ﬁbers form the reﬂected inguinal lig-

ament (Moore, p 180).

11. (C) The neurovascular plane of the antero-

lateral abdominal wall contains the thoraco-

abdominal nerves, cutaneous branches T7–T11,

ventral ramus of T12, iliohypogastric and ilioin-

guinal nerves, lumbar arteries, and the deep cir-

cumﬂex iliac artery (Moore, p 182).

12. (D) The rectus muscle is anchored trans-

versely by attachments to the anterior layer of

the rectus sheath and three or more tendinous

intersections (Moore, p 183).

13. (A) The inferior limit of the posterior lamina of

the rectus sheath is marked by the arcuate line,

which deﬁnes the point at which the posterior

lamina of the internal oblique and the aponeu-

rosis of the transverse abdominal become part

of the anterior rectus sheath (Moore, p 184).

14. (B) The median umbilical fold represents the

remnant of the urachus; the medial umbilical

0523-04 Chap 4 07/15/02 15:32 Page 60

folds are remnants of the occluded fetal umbil-

ical arteries; and the lateral umbilical folds

cover the inferior epigastric vessels (Moore,

p 191).

15. (B) The medial inguinal fossae between the

medial and lateral umbilical folds, the inguinal

triangles, are potential sites for the less common

direct inguinal hernias. The lateral inguinal fos-

sae, lateral to the lateral umbilical folds, are po-

tential sites for the most common type of hernia

in the lower abdominal wall—indirect inguinal

hernia (Moore, p 191).

16. (B) The inguinal canal contains the spermatic

cord in the male and the round ligament in the

female. The inguinal canal also contains blood

and lymphatic vessels and the ilioinguinal

nerve in both sexes (Moore, p 193).

17. (E) The deep inguinal ring (entrance to the

inguinal canal) is the site of an outpouching of

the transversalis fascia approximately 1.2 cm

superior to the middle of the inguinal liga-

ment (Moore, p 193).

18. (D) The inguinal ligament is reinforced in its

most medial part by the lacunar ligament, a re-

ﬂected part or extension from the deep aspect

of the inguinal ligament to the pectineal line of

the pecten pubis (Moore, p 193).

19. (B) The iliopubic tract is the thickened inferior

margin of the transversalis fascia that appears

as a fibrous band running parallel and deep

to the inguinal ligament. The iliopubic tract

demarcates the inferior edge of the deep ingui-

nal ring (Moore, p 193).

20. (C) The testes develop in the extraperitoneal

connective tissue in the superior lumbar region

of the posterior abdominal wall (Moore, p 193).

21. (D) The gubernaculum is a ﬁbrous cord con-

necting the primordial testis to the anterolateral

wall at the site of the future deep inguinal ring.

The gubernaculum is represented postnatally

by the scrotal ligament, which extends from the

testis to the skin of the scrotum (Moore, p 194).

22. (C) The cremasteric fascia contains loops of cre-

master muscle, which is formed by the lower-

most fascicles of the internal oblique muscle

arising from the inguinal ligament. The cremas-

teric fascia is derived from the deep and super-

ﬁcial fascia of the internal oblique (Moore, p 198).

23. (A) The cremaster muscle is innervated by the

genital branch of the genitofemoral nerve

(Moore, p 198).

24. (C) The artery of the ductus deferens arises

from the inferior vesicle (Moore, p 198).

25. (A) Genital branch of the genitofemoral,

anterior scrotal branches of the ilioinguinal,

posterior scrotal branches of the pudendal, and

perineal branches of the posterior femoral cuta-

neous provide the innervation to the scrotum

(Moore, p 201).

26. (C) The epididymis lies on the posterior sur-

face of the testis, which is covered by the tunica

vaginalis except at its posterior margin (Moore,

p 201).

27. (B) The testes are covered with a tough fi-

brous coat know as the tunica albuginea

(Moore, p 201).

28. (D) The tunica vaginalis is a closed peritoneal

sac partially surrounding the testis, which rep-

resents the closed-off distal part of the embry-

onic processus vaginalis (Moore, p 202).

29. (D) The pampiniform plexus is part of the

thermoregulatory system of the testis, helping

to keep this gland at a constant temperature

(Moore, p 202).

30. (B) The autonomic nerves of the testis arise as

the testicular plexus of nerves on the testicular

artery, which contains vagal parasympathetic

ﬁbers and sympathetic ﬁbers from the T7 seg-

ment of the spinal cord (Moore, p 202).

31. (E) The peritoneal cavity is a potential space of

capillary thinness between the parietal and vis-

ceral layers of peritoneum. It contains no organs

but rather a thin film of peritoneal fluid that

lubricates the peritoneal surfaces (Moore, p 210).

Answers and Explanations: 1–31 61

0523-04 Chap 4 07/15/02 15:32 Page 61

32. (D) The lesser omentum connects the lesser

curvature of the stomach and the proximal part

of the duodenum to the liver (Moore, p 213).

33. (C) The greater omentum has considerable

mobility and moves around the peritoneal

cavity with peristaltic movements of the vis-

cera. It wraps itself around an inﬂamed organ

such as the appendix, walling it off and

thereby protecting other viscera from it. For

this reason, the great omentum is referred to

as the “policeman of the peritoneal cavity.”

34. (D) The liver is connected to the duodenum

by the hepatoduodenal ligament (the thick-

ened free edge of the lesser omentum that con-

ducts the portal triad: portal vein, hepatic

artery, and bile duct) (Moore, p 213).

35. (C) The caudate lobe of the liver, covered with

visceral peritoneum, forms the superior bound-

ary of the omental foramen (epiploic foramen,

or foramen of Winslow), an opening situated

posterior to the free edge of the lesser omentum

(hepatoduodenal ligament).

36. (D) The esophagus has internal circular and

external longitudinal layers of muscle. In its

superior third, the external layer consists of

skeletal muscle, the inferior third is composed

of smooth muscle, and the middle third is made

up of both types of muscle (Moore, p 224).

37. (C) The arterial supply of the abdominal part

of the esophagus is from the left gastric artery,

a branch of the celiac trunk, and the left infe-

rior phrenic artery (Moore, p 225).

38. (B) When the gastric mucosa is contracted, it

is thrown into longitudinal ridges known as

gastric folds or rugae (Moore, p 227).

39. (A) The left gastro-omental artery arises from

the splenic artery and courses along the greater

curvature to anastomose with the right gastro-

omental artery (Moore, p 229).

40. (B) The sympathetic nerve supply of the stom-

ach from T6 through T9 segments of the spinal

cord passes to the celiac plexus through the

greater splanchnic nerve (Moore, p 231).

41. (C) The superior (1st) part of the duodenum

lies anterolateral to the body of L1 vertebra

(Moore, p 237).

42. (B) The bile and pancreatic ducts enter the pos-

teromedial wall of the 2nd portion of the duo-

denum (Moore, p 237).

43. (D) The inferior or horizontal (third) portion

of the duodenum is crossed by the superior

mesenteric artery and vein and the root of the

mesentery of the jejunum and ileum (Moore,

p 237).

44. (A) The duodenojejunal junction is supported

by the suspensory muscle of the duodenum (lig-

ament of Treitz) (Moore, p 237).

45. (C) The gastroduodenal artery and its

branches, the superior anterior and posterior

pancreaticoduodenal arteries, supply the duo-

denum proximal to the entry of the bile duct

into the descending (second) portion of the

duodenum (Moore, p 241).

46. (E) The root of the mesentery crosses (succes-

sively) the ascending and horizontal parts of

the duodenum, abdominal aorta, inferior vena

cava, right ureter, right psoas major, and right

testicular or ovarian vessels (Moore, p 244).

47. (B) The superior mesenteric and splenic veins

unite to form the portal vein posterior to the

neck of the pancreas (Moore, p 244).

48. (C) The sympathetic ﬁbers in the nerves to the

jejunum and ileum originate in the T5 through

T9 segments of the spinal cord (Moore, p 244).

49. (C) The jejunum contains circular folds along

with the duodenum. The circular folds are

absent in the ileum and large intestine (Moore,

p 244).

50. (D) The large intestine can be distinguished

from the small intestine by teniae coli, haustra,

and omental appendices (Moore, p 249).

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51. (E) There are no teniae in the appendix or rec-

tum (Moore, p 249).

52. (C) The appendix is supplied by the appendic-

ular artery, a branch of the ileocolic artery

(Moore, p 251).

53. (D) The base of the appendix lies deep to a

point that is one-third of the way along the

oblique line, joining the right anterior superior

iliac spine to the umbilicus (spinoumbilical or

McBurney’s point) (Moore, p 251).

54. (B) The pelvic splanchnic nerves provide the

parasympathetic innervation for the distal

one-third of the transverse colon, descending

colon, and rectum (Moore, p 255).

55. (C) The rectum, the ﬁxed terminal part of the

large intestine, is continuous with the sigmoid

colon at the level of S3 vertebra (Moore, p 255).

56. (C) The spleen is the largest of the lymphatic

organs and is a mobile structure entirely sur-

rounded by peritoneum except at the hilum.

It lies beneath the 9th, 10th, and 11th ribs and

does not normally descend inferior to the

costal margin. The spleen varies considerably

in size, weight, and shape (Moore, p 256).

57. (C) The splenic artery, the largest branch of

the celiac trunk, follows a tortuous course pos-

terior to the omental bursa, anterior to the left

kidney, and along the superior border of the

pancreas (Moore, p 257).

58. (D) The head of the pancreas is embraced by

the C-shaped curve of the duodenum to the

right of the superior mesenteric vessels (Moore,

p 257).

59. (A) The head of the pancreas rests posteriorly

on the inferior vena cava, right renal artery and

vein and left renal vein (Moore, p 259).

60. (D) The main pancreatic duct and the bile duct

unite to form a short, dilated hepatopancreatic

ampulla, which opens into the descending part

of the duodenum at the summit of the major

duodenal papilla (Moore, p 261).

61. (A) The round ligament of the liver is the

fibrous remnant of the umbilical vein that car-

ried well-oxygenated and nutrient-rich blood

from the placenta to the fetus (Moore, p 265).

62. (E) The porta hepatis gives passage to the por-

tal vein, hepatic artery, hepatic nerve plexus,

hepatic ducts, and lymphatic vessels (Moore,

p 265).

63. (A) The portion of the lesser omentum extend-

ing between the porta hepatis of the liver and

the duodenum (the hepatoduodenal ligament)

encloses the portal triad (Moore, p 265).

64. (B) The common hepatic artery extends from

the celiac trunk to the origin of the gastroduo-

denal artery. The proper hepatic artery extends

from the origin of the gastroduodenal artery

to its bifurcation into right and left hepatic

branches (Moore, p 265).

65. (B) The hepatic veins, formed by the union of

the central veins of the liver, open into the infe-

rior vena cava just inferior to the diaphragm

(Moore, p 266).

66. (C) The mucosa of the neck of the gallbladder

spirals into a fold known as the spiral valve,

which keeps the cystic duct open so that bile

can easily divert into the gallbladder when

the distal end of the bile duct is closed, or so bile

can pass to the duodenum as the gallbladder

contracts (Moore, p 274).

67. (A) The cystic artery commonly arises from

the right hepatic artery in the angle between

the common hepatic duct and the cystic duct

(Moore, p 275).

68. (D) The paraumbilical veins of the anterior

abdominal wall (portal system) anastomosing

with superﬁcial epigastric veins (systemic sys-

tem), when dilated, produce caput medusae

(Moore, p 277).

69. (D) Inferiorly, the posterior surfaces of the

kidney are related to the quadratus lumborum

muscle and the subcostal, iliohypogastric, and

ilioinguinal nerves and vessels (Moore, p 280).

Answers and Explanations: 32–69 63

0523-04 Chap 4 07/15/02 15:32 Page 63

70. (C) The renal papillae empty into the minor cal-

ices, which empty into major calices which in

turn empty into the pelvis of the ureter (Moore,

p 280).

71. (E) At the concave medial margin of each kid-

ney is a vertical cleft, the renal hilum, where the

renal artery enters and the renal vein and renal

pelvis leave the renal sinus. At the hilum, the

renal vein is anterior to the renal artery, which

is anterior to the renal pelvis (Moore, p 280).

72. (B) The suprarenal glands are located between

the superomedial aspects of the kidneys and

the diaphragm (Moore, p 285).

73. (A) The semilunar left suprarenal gland is rela-

ted to the spleen, stomach, pancreas, and left

crus of the diaphragm (Moore, p 285).

74. (D) The suprarenal cortex derives from meso-

derm and secretes corticosteroids and andro-

gens. These hormones cause the kidneys to

retain sodium and water in response to stress

(Moore, p 285).

75. (C) The superior suprarenal arteries are pro-

vided by the inferior phrenic. The middle supra-

renal arteries are provided by the abdominal

aorta and the inferior suprarenal arteries are

provided by the renal artery (Moore, p 287).

76. (C) The diaphragm, the chief muscle of inspira-

tion, descends during inspiration. Only its cen-

tral part moves because its periphery, as the

ﬁxed origin of the muscle, attaches to the inferior

margin of the thoracic cage and the superior

lumbar vertebrae (Moore, p 289).

77. (C) The central tendon of the diaphragm has

no bony attachments and is incompletely di-

vided into three leaves, resembling a wide

cloverleaf. Although it lies near the center of the

diaphragm, the central tendon is closer to the

anterior part of the thorax. The inferior vena

cava perforates the central tendon. The aortic

hiatus is formed by the right and left muscular

crura (Moore, p 292).

78. (C) The crura of the diaphragm are musculo-

tendinous bundles that arise from the ante-

rior surfaces of the bodies of the superior three

lumbar vertebrae, the anterior longitudinal

ligament, and the intervertebral discs (Moore,

p 291).

79. (A) The nerves of the kidneys and suprarenal

glands are derived from the celiac plexus, the

lesser and least thoracic splanchnic nerves, and

the aorticorenal ganglion (Moore, p 290).

80. (B) The diaphragm is attached on each side to

the medial and lateral arcuate ligaments, which

are thickenings of the fascia covering the psoas

major and quadratus lumborum muscles,

respectively (Moore, p 292).

81. (B) The stomach, spleen, mesentery, and intes-

tine may herniate into the thorax when there is

a traumatic diaphragmatic hernia (Moore, p 295).

82. (D) The esophageal hiatus is an oval aperture

for the esophagus in the muscle of the right crus

of the diaphragm at the level of the T10 verte-

bra. The esophageal hiatus also transmits the

anterior and posterior vagal trunks, esophageal

branches of the left gastric vessels, and a few

lymphatics (Moore, p 294).

83. (C) The sympathetic trunks pass deep to the

medial arcuate ligament. There are two small

apertures in each crus of the diaphragm; one

transmits the greater and the other the lesser

splanchnic nerve (Moore, p 295).

84. (D) The parasympathetic root of the celiac

plexus is a branch of the posterior vagal trunk

that contains ﬁbers from the right and left vagal

nerves. The sympathetic roots of the plexus are

the greater and lesser splanchnic nerves (Moore,

p 3020).

85. (A) The bifurcation of the aorta can be located

on the surface anatomy approximately 2.5 cm

superior to the transpyloric plane to a point

slightly inferior to and to the left of the umbili-

cus. Bifurcation is also indicated just to the left

of the midpoint of a line joining the highest

points of the iliac crests (Moore, p 305).

64 4: The Abdomen

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86. (C) The inferior vena cava begins anterior to

the L5 vertebra by the union of the common

iliac veins. The union occurs approximately

2.5 cm to the right of the median plane, inferior

to the bifurcation of the aorta and posterior to

the proximal part of the right common iliac

artery (Moore, p 307).

87. (E) In a small proportion of individuals, the

inferior end of the thoracic duct—which begins

with the convergence of the main lymphatic

ducts of the abdomen—takes the form of the

commonly depicted, thin-walled sac or dilation

known as the cisterna chyli (Moore, p 308).

88. (C) The pelvic splanchnic nerves are distinct

from other splanchnic nerves in that they have

nothing to do with the sympathetic trunks and

are derived directly from ventral rami of spinal

nerves S2 through S4. They also convey pre-

synaptic parasympathetic ﬁbers to the inferior

hypogastric plexus (Moore, p 302).

89. (C) The psoas muscle is a long, thick, fusi-

form muscle that lies lateral to the lumbar ver-

tebrae. Psoas is a Greek word meaning “muscle

of the loin.” The muscle passes inferolaterally,

deep to the inguinal ligament to reach the lesser

trochanter of the femur. The lumbar plexus of

nerves is embedded in the posterior part of the

psoas (Moore, p 299).

90. (C) The suprarenal medulla is derived from

neural crest cells associated with the sympa-

thetic nervous system. The chromafﬁn cells of

the medulla are related to sympathetic (post-

ganglionic) neurons in both derivation (neural

crest cells) and function. These cells secrete

catecholamines (mostly epinephrine) into

the bloodstream in response to signals from

presynaptic neurons (Moore, p 286).

91. (C) In the current terminology, the left liver

includes the caudate lobe and most of the

quadrate lobe. The anatomical left lobe is sepa-

rated from these lobes on the visceral surface by

the ﬁssure for the round ligament of the liver

and the ﬁssure for the ligamentum venosum;

on the diaphragmatic surface the anatomical

left lobe is separated by the attachment of the

falciform ligament (Moore, p 265).

92. (B) The splenic artery is the largest branch of

the celiac trunk. It follows a tortuous course

posterior to the omental bursa, anterior to the

left kidney, and along the superior border

of the pancreas. It divides into five or more

branches that enter the hilum of the spleen

(Moore, p 257).

93. (A) For several weeks the rapidly growing

midgut, supplied by the superior mesenteric

artery, is physiologically herniated into the

proximal part of the umbilical cord. It is at-

tached to the yolk sac by the yolk stalk. As it

returns to the abdominal cavity, the midgut

rotates 270 degrees around the axis of the

superior mesenteric artery (Moore, p 246).

94. (B) The appendicular artery is located in the

mesoappendix and the anterior cecal artery is

located in the superior ileocecal fold. Both the

appendix and cecum are vascular. The inferior

ileocecal fold is avascular (Moore, p 238).

95. (C) The inferior or horizontal (3rd) part of the

duodenum runs transversally to the left, pass-

ing over the inferior vena cava, aorta, and L3

vertebra. It is crossed by the superior mesenteric

artery and vein and the root of the mesentery

(Moore, p 237).

96. (D) The left gastro-omental artery arises from

the splenic artery and courses along the

greater curvature to anastomose with the right

gastro-omental artery (Moore, p 229).

97. (E) The smooth surface of the gastric mucosa,

mucous layer of the stomach, is thrown into

longitudinal ridges when contracted. These

are the gastric folds or rugae and most obvious

along the greater curvature of the stomach

(Moore, p 227).

98. (C) The esophagus is a muscular tube (approx-

imately 25 cm long) that extends from the phar-

ynx to the stomach. It normally has four con-

strictions and is crossed by the arch of the aorta

and the left main bronchus (Moore, p 221).

Answers and Explanations: 70–98 65

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99. (C) Digestion occurs mainly in the stomach

and duodenum. Peristalsis—ring-like, contrac-

tion waves that begin around the middle of

the stomach and move slowly toward the

pylorus—is responsible for mixing the masti-

cated food mass with gastric juices and for

emptying the contents of the stomach into the

duodenum (Moore, p 218).

100. (D) Most reabsorption occurs in the ascend-

ing colon (Moore, p 218).

101. falciform ligament

102. lesser omentum

103. left gastric artery

104. celiac trunk

105. gastrolienal ligament

106. splenic artery

107. gastrocolic ligament

108. common hepatic artery

109. pylorus

110. proper hepatic artery

111. caval opening

112. esophageal hiatus

113. right crus of diaphragm

114. aortic hiatus

115. quadratus lumborum

116. internal abdominal oblique

117. superior epigastric artery

118. rectus abdominis

119. transversus abdominis

120. inferior epigastric artery

121. transversus abdominis aponeurosis

122. external abdominal oblique aponeurosis

123. transversalis fascia

124. rectus abdominis

125. internal abdominal oblique aponeurosis

126. subcostal nerve

127. iliohypogastric nerve

128. lateral femoral cutaneous nerve

129. femoral nerve

130. genitofemoral nerve

66 4: The Abdomen

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DIRECTIONS (Questions 1 through 100): Each of

the numbered items or incomplete statements in this

section is followed by answers or by completions of

the statement. Select the ONE lettered answer or

completion that is BEST in each case.

1. All of the following statements concerning the

pelvic cavity are correct EXCEPT

(A) It is bounded posteriorly by the coccyx.

(B) It is bounded anteriorly by the pubic

symphysis.

boundary.

(D) The pelvic outlet forms the inferior

boundary.

(E) The musculofascial pelvic diaphragm

closes the pelvic inlet.

2. All of the following bones contribute to the

formation of the pelvic cavity EXCEPT

(A) ischium

(B) pelvis

(D) coccyx

(E) sacrum

3. Which of the following structures is located

between the ischial spine and the ischial

tuberosity?

(A) obturator foramen

(B) lesser sciatic notch

(D) pubic arch

(E) arcuate line

CHAPTER 5

The Pelvis and Perineum

Questions

4. The lateral part of the superior ramus of the

pubis forms which of the following structures?

(A) iliopubic eminence

(B) pubic tubercle

(D) anterior inferior iliac spine

(E) acetabulum

5. All of the following structures provide bound-

aries for the pelvic inlet EXCEPT

(A) inferior ramus of the pubis

(B) sacral promontory

(D) arcuate line of the ilium

(E) pecten pubis

6. When a person is in the anatomical position,

which of the following structures lie in the

same vertical plane?

(A) sacral promontory and pubic tubercles

(B) anterior superior iliac spines and the

anterior aspect of the pubic symphysis

posterior aspect of the ischial tuberosity

(D) ischial spines and the posterior border of

the obturator foramen

(E) superior pubic rami and the greater sci-

atic notch

0523-05 Chap 5 07/15/02 15:33 Page 67

7. Weak areas of the pelvis include all of the fol-

lowing EXCEPT

(A) ischial tuberosities

(B) alae of the ilium

(D) sacroiliac joint

(E) acetabula

8. The pelvic ﬂoor is formed by all of the follow-

ing muscles EXCEPT

(A) pubococcygeus

(B) coccygeus

(D) puborectalis

(E) iliococcygeus

9. Which of the following muscles covers and

pads the lateral pelvic wall?

(A) obturator internus

(B) piriformis

(D) iliococcygeus

(E) ischiococcygeus

10. All of the following statements concerning the

sciatic nerve are correct EXCEPT

(A) It is the largest and broadest nerve in the

body.

(B) It is formed by the dorsal rami of L4 to S3.

foramen.

(D) It exits the pelvis inferior to the piriformis

muscle.

(E) It is one of the two main nerves of the

sacral plexus.

11. All of the following statements concerning the

pudendal nerve are correct EXCEPT

(A) It is derived from the anterior divisions

of the ventral rami of S2 through S4.

(B) It accompanies the internal pudendal

artery.

sciatic foramen.

(D) It leaves the pelvis through the greater

sciatic foramen inferior to the piriformis

and coccygeus muscles.

(E) It is the chief sensory nerve of the exter-

nal genitalia.

12. Which of the following nerves exits the pelvis

through the greater sciatic foramen, superior

to the piriformis?

(A) sciatic

(B) pudendal

(D) lumbosacral trunk

(E) obturator

13. Which of the following statements concerning

the sacral sympathetic trunks is correct?

(A) Usually has four sympathetic ganglia.

(B) Descends on the pelvic surface of the

ischium.

clitoris.

(D) Passes through the obturator canal.

(E) Pierces the sacrotuberous ligament.

14. The inferior hypogastric plexus receives ﬁbers

from which of the following nerves?

(A) pudendal and obturator

(B) sciatic and superior gluteal

(D) pelvic splanchnic and hypogastric

(E) sacral sympathetic and obturator

15. All of the following arteries enter the true pelvis

EXCEPT

(A) internal iliac

(B) median sacral

(D) ovarian

(E) testicular

16. Which of the following arteries is considered

to be the artery of the pelvis?

(A) obturator

(B) pudendal

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(D) internal iliac

(E) sacral

17. Which of the following arteries arises from the

anterior division of the internal iliac?

(A) superior rectal

(B) iliolumbar

(D) gonadal

(E) obturator

18. All of the following statements concerning the

ureters are correct EXCEPT

(A) They are retroperitoneal.

(B) They cross the pelvic brim anterior to the

bifurcation of the common iliac arteries.

kidneys to the urinary bladder.

(D) Their superior halves lie in the abdomen

and the inferior halves lie in the pelvis.

(E) Their oblique passage through the blad-

der wall forms a one-way “ﬂap valve.”

19. The uvula of the bladder is located in which of

the following locations?

(A) retropubic space

(B) trigone of the bladder

(D) fundus of the bladder

(E) pubovesical ligament

20. Parasympathetic ﬁbers to the bladder are de-

rived from which of the following nerves?

(A) pelvic splanchnic

(B) greater splanchnic

(D) superior hypogastric plexus

(E) sacral plexus

21. Which of the following parts of the male ure-

thra is the widest and most dilatable?

(A) preprostatic

(B) prostatic

(D) spongy

(E) external urethral meatus

22. Which of the following structures opens into

the prostatic sinus?

(A) prostatic utricle

(B) ejaculatory ducts

(D) seminal vesicles

(E) bulbourethral glands

23. The paraurethral glands open into which of

the following structures?

(A) near the external urethral oriﬁce

(B) in the neck of the bladder

(D) in the seminal colliculus

(E) in the ejaculatory ducts

24. All of the following statements concerning the

ductus deferens are correct EXCEPT

(A) It begins in the head of the epididymis.

(B) It ascends in the spermatic cord.

(D) It joins the duct of the seminal vesicle to

form the ejaculatory duct.

(E) It descends medial to the ureter and

seminal vesicle.

25. All of the following statements concerning the

seminal vesicles are correct EXCEPT

(A) The peritoneum of the rectovesical

pouch separates the superior ends of the

seminal vesicles from the rectum.

(B) They do not store sperm.

between the fundus of the bladder and

the rectum.

(D) The inferior ends of the seminal vesicles

are separated from the rectum by the

rectovesical septum.

(E) Bulbourethral glands empty into the

seminal vesicles.

Questions: 7–25 69

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26. The posterior fornix is the deepest part of which

of the following structures?

(A) urinary bladder

(B) vagina

(D) urethra

(E) uterus

27. All of the following statements concerning the

uterus are correct EXCEPT

(A) It is anteverted.

(B) It is anteﬂexed.

(D) It is divisible into two main parts.

(E) The body of the uterus lies between the

layers of the broad ligament.

28. Which of the following parts of the uterus pro-

trudes into the uppermost vagina?

(A) round ligament

(B) body

(D) isthmus

(E) cervix

29. The rounded vaginal part of the cervix ex-

tends into the vagina and communicates with

it through which of the following structures?

(A) uterine tubes

(B) external os

(D) urethra

(E) internal os

30. Laterally, the peritoneum of the broad liga-

ment is prolonged superiorly over the ovarian

vessels as which of the following structures?

(A) mesovarium

(B) mesosalpinx

(D) suspensory ligament of the ovary

(E) transverse cervical (cardinal) ligaments

31. The oocytes expelled from the ovaries usually

are fertilized in which of the following areas of

the uterine tubes?

(A) infundibulum

(B) ampulla

(D) uterine

(E) ﬁmbria

32. The distal end of the ovary connects to the lat-

eral wall of the pelvis by which of the follow-

ing structures?

(A) round ligament

(B) ligament of the ovary

(D) transverse cervical ligament

(E) lateral cervical ligament

33. Which of the following nerves provides para-

sympathetic innervation to the ovaries?

(A) pudendal

(B) pelvic splanchnic

(D) obturator

(E) superior hypogastric

34. The rectosigmoid junction lies anterior to

which of the following structures?

(A) S3 vertebra

(B) prostate

(D) bladder

(E) pararectal fossae

35. All of the following osseoﬁbrous structures

mark the boundaries of the perineum EXCEPT

(A) pubic symphysis

(B) inferior pubic rami

(D) ischial tuberosities

(E) ischial rami

36. The perineum is divided into two triangles by

drawing a transverse line between which of

the following structures?

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(A) anterior ends of the ischial tuberosities

(B) coccyx to pubic tubercles

(D) medial ends of inguinal ligament to tip

of coccyx

(E) sacrum to pubic symphysis

37. The perineal body is the site of convergence of

all of the following muscles EXCEPT

(A) ischiocavernous

(B) bulbospongiosus

(D) deep transverse perineal

(E) external anal sphincter

38. In males, the superﬁcial perineal pouch con-

tains which of the following structures?

(A) prostate

(B) seminal vesicles

(D) neck of the bladder

(E) ischiocavernous muscle

39. In females, the deep perineal pouch contains

which of the following structures?

(A) clitoris

(B) greater vestibular glands

(D) bulbs of the vestibule

(E) external urethral sphincter

40. The pudendal canal is a space within which of

the following structures?

(A) the deep perineal space

(B) the superﬁcial perineal space

(D) the broad ligament

(E) the urogenital triangle

41. The pudendal nerve innervates which of the

following structures?

(A) ovaries

(B) testes

(D) levator ani

(E) muscles of the deep and superﬁcial peri-

neal pouch

42. The anal columns contain which of the follow-

ing structures?

(A) internal pudendal vessels

(B) pudendal nerve

(D) obturator nerve

(E) inferior rectal vessels

43. All of the following statements concerning the

pectinate line are correct EXCEPT

(A) It is the junction between the superior

and inferior parts of the anal canal.

(B) The superior rectal artery supplies the

superior part of the anal canal.

part of the anal canal drain into the inter-

nal lymph nodes.

(D) The superior part of the anal canal is

drained by the internal rectal venous

plexus which drains into tributaries of

the caval venous system.

(E) The nerve supply to the anal canal supe-

rior to the pectinate line is somatic inner-

vation.

44. The navicular fossa is located in which of the

following structures?

(A) glans penis

(B) prostate

(D) seminal vesicle

(E) expanded in the clitoris

45. Which of the following nerves do NOT inner-

vate the scrotum?

(A) ilioinguinal

(B) genitofemoral

(D) posterior femoral cutaneous

(E) obturator

Questions: 26–45 71

0523-05 Chap 5 07/15/02 15:33 Page 71

46. The deep arteries of the penis are located in

which of the following areas?

(A) superﬁcial to the tunica albuginea

(B) superﬁcial to the deep fascia

(D) within the corpora cavernosa

(E) prepuce

47. Which of the following muscles surrounds the

crura in the root of the penis?

(A) superﬁcial transverse perineal

(B) deep transverse perineal

(D) ischiocavernosus

(E) cremaster

48. The space between the labia minora, the ves-

tibule, contains all of the following structures

EXCEPT

(A) urethral opening

(B) opening of the vagina

(D) ducts of the lesser vestibular glands

(E) bulbs of the vestibule

49. Each of the following statements relating to

the labia minora is correct EXCEPT

(A) They are folds of fat.

(B) They are hairless.

within the labia majora.

(D) They have a core of spongy connective

tissue containing erectile tissue.

(E) They contain many sebaceous glands

and sensory nerve endings.

50. Parasympathetic stimulation in the female pro-

duces which of the following?

(A) decreased vaginal secretions

(B) engorgement of erectile tissue in the

bulbs of the vestibule

gland

(D) decrease in size of the clitoris

(E) the clitoris becomes ﬂaccid

51. The paramesonephric ducts in the male degen-

erate except for which of the following struc-

tures?

(A) efferent ductules of the testis

(B) appendix testis

(D) seminal vesicles

(E) ductus deferens

52. The only parts remaining from the mesoneph-

ric system in the female include which of the

following structures?

(A) ﬁmbriae

(B) uterine tubes

(D) uterus

(E) cervix

53. The vaginal fornices are derived from which

of the following structures?

(A) paramesonephric duct

(B) mesonephric ducts

(D) sinovaginal bulbs

(E) urogenital sinus

54. Rapid elongation of the genital tubercle in the

male gives rise to which of the following

structures?

(A) testes

(B) scrotum

(D) phallus

(E) epididymis

55. The scrotum arises from which of the following

structures?

(A) mesonephric ducts

(B) paramesonephric ducts

(D) cloacal fold

(E) genital swellings

56. The clitoris is derived from which of the fol-

lowing structures?

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(A) urethral folds

(B) genital swellings

(D) mesonephric ducts

(E) genital tubercle

57. Which of the following structures give rise to

the labia minora?

(A) mesonephric ducts

(B) urogenital groove

(D) urethral folds

(E) genital tubercle

58. Which of the following structures extends into

the labia majora?

(A) suspensory ligament of the ovary

(B) ligament of the ovary proper

(D) round ligament of the uterus

(E) uterine tube

59. Which of the following terms correctly applies

to the pelvis of the normal female?

(A) spondyloid

(B) android

(D) anthropoid

(E) platypelloid

60. Persons with spondylolysis have a defect in

which of the following structures?

(A) vertebral arch

(B) body of L5 vertebra

(D) vertebral canal

(E) vertebral body

61. The neck of the bladder in females is held

ﬁrmly by which of the following structures?

(A) puboprostatic ligaments

(B) puborectalis muscle

(D) coccygeus muscle

(E) pubovesical ligaments

62. The median umbilical ligament contains which

of the following structures?

(A) inferior epigastric vessels

(B) obturator vessels

(D) uterine tubes

(E) ovarian vessels

63. The inferior ends of the seminal vesicles are

closely related to the rectum and are sepa-

rated from it only by which of the following

structures?

(A) pubovesical ligament

(B) puboprostatic ligament

(D) puborectalis muscle

(E) coccygeus muscle

64. Which of the following structures is the larg-

est accessory gland of the male reproductive

system?

(A) testes

(B) seminal vesicles

(D) bulbourethral glands

(E) epididymis

65. All of the following muscles compress the va-

gina and act like sphincters EXCEPT

(A) pubovaginalis

(B) external urethral sphincter

(D) bulbospongiosus

(E) pubococcygeus

66. The mesosalpinx forms the mesentery for which

of the following structures?

(A) uterine tube

(B) ovary

(D) bladder

(E) uterus

Questions: 46–66 73

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67. The ovarian arteries arise from which of the

following arteries?

(A) superior gluteal

(B) inferior gluteal

(D) superior rectal

(E) internal pudendal

68. Which of the following structures provides

support for the ampulla of the rectum?

(A) urogenital diaphragm

(B) puboprostatic ligament

(D) tendinous arch of pelvic fascia

(E) levator ani and anococcygeal ligament

69. In males the rectum is related anteriorly to all

of the following structures EXCEPT

(A) fundus of the urinary bladder

(B) proximal parts of the ureters

(D) seminal vesicles

(E) prostate

70. Some obstetricians apply the term perineum to

a more restricted region that extends between

which of the following structures?

(A) perineal body and the mons pubis

(B) vagina and anus

(D) ischial spines and pubic tubercles

(E) vestibule and sacrum

71. Distally the corpus spongiosum expands to

form which of the following structures?

(A) bulb of the penis

(B) clitoris

(D) glans penis

(E) crura of the penis

72. Helicine arteries are located in which of the

following structures?

(A) superﬁcial perineal space

(B) deep perineal space

(D) spermatic cord

(E) bulbospongiosum

73. The term vulva is synonymous with which of

the following structures?

(A) mons pubis

(B) labia majora

(D) clitoris

(E) pudendum

74. Which of the following structures may be re-

ferred to as the fourchette?

(A) prepuce of the clitoris

(B) frenulum of the labia minora

(D) glans clitoris

(E) mons pubis

75. The lesser vestibular glands open into which

of the following structures?

(A) vestibule between the urethral and vagi-

nal oriﬁces

(B) vestibule on each side of the vaginal

oriﬁce

(D) glans clitoris

(E) bulbourethral ducts

76. Which of the following structures is incised

during median episiotomy for childbirth?

(A) perineal body

(B) greater vestibular glands

(D) clitoris

(E) urethra

77. Which of the following arteries is a direct con-

tinuation of the inferior mesenteric artery?

(A) superior rectal

(B) middle rectal

(D) iliolumbar

(E) lateral sacral

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78. The superior gluteal artery leaves the pelvis

through which of the following openings?

(A) greater sciatic foramen

(B) lesser sciatic foramen

(D) pudendal canal

(E) sacral foramina

79. Which of the following structures separates

the bladder from the pubic bones in females?

(A) rectouterine fold

(B) vesicouterine pouch

(D) median umbilical fold

(E) retropubic space

80. The membranous part of the male urethra is

located in which of the following structures?

(A) bladder

(B) prostate

(D) bulb of penis

(E) glans penis

81. The paraurethral glands are homologues to

which of the following structures?

(A) testes

(B) prostate

(D) bulbourethral glands

(E) epididymis

82. Lithotripsy uses shock waves to break up which

of the following structures?

(A) blood clots

(B) foreign bodies

(D) urinary calculi

(E) abscesses

83. Which of the following areas contributes to the

major part of the prostate?

(A) anterior lobe

(B) isthmus

(D) lateral lobes

(E) middle lobe

84. The relationship (“water passing under the

bridge”) is an especially important one for sur-

geons ligating which of the following arteries?

(A) ovarian

(B) testicular

(D) vaginal

(E) obturator

85. Immediately superior to the perineal membrane

is located which of the following muscles?

(A) obturator internus

(B) levator ani

(D) ischiocavernous

(E) deep transverse perineal

86. The navicular fossa is located in which of the

following structures?

(A) bulb of the penis

(B) prostate

(D) glans penis

(E) neck of bladder

87. All of the following nerves provide innerva-

tion to the scrotum EXCEPT

(A) obturator

(B) ilioinguinal

(D) pudendal

(E) posterior femoral cutaneous

88. All of the following structures surround the

corpora cavernosa and corpus spongiosum

EXCEPT

(A) loose areolar tissue

(B) deep fascia

(D) skin

(E) tunica dartos

Questions: 67–88 75

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89. Which of the following arteries gives rise to

the deferential artery?

(A) internal pudendal

(B) testicular

(D) obturator

(E) umbilical

90. Which of the following structures is located at

the free anterior borders of the levator ani?

(A) coccygeus muscle

(B) piriformis muscle

(D) obturator internus muscle

(E) rectum

91. Which of the following structures form a

U-shaped sling around the anorectal junction?

(A) sacrospinous ligament

(B) anococcygeal ligament

(D) puborectalis muscle

(E) sacrotuberous ligament

92. Which of the following muscles is the larger

part and most important muscle in the pelvic

floor?

(A) coccygeus

(B) obturator internus

(D) deep transverse perineal muscle

(E) levator ani

93. Which of the following muscles passes through

the lesser sciatic foramen?

(A) obturator internus

(B) piriformis

(D) pubococcygeus

(E) iliococcygeus

94. Which of the following muscles leaves the lesser

pelvis through the greater sciatic foramen?

(A) pubococcygeus

(B) iliococcygeus

(D) piriformis

(E) coccygeus

95. The pelvic splanchnic nerves contain which of

the following?

(A) somatic afferents

(B) sympathetic ﬁbers

(D) special visceral efferents

(E) special somatic afferents

96. The internal iliac artery is crossed by which of

the following structures at the level of the 4th

intervertebral disc between L5 and S1?

(A) puborectalis muscle

(B) ureter

(D) umbilical artery

(E) tendinous arch of the levator ani

97. The superior end of the vagina surrounds

which of the following structures?

(A) round ligament

(B) urogenital hiatus

(D) cervix

(E) neck of bladder

98. Which of the following nerves innervates the

lower one fourth of the vagina?

(A) pelvic splanchnics

(B) lumbar splanchnics

(D) superior hypogastric plexus

(E) inferior hypogastric plexus

99. Which of the following structures forms the

mesentery of the uterus?

(A) round ligament of the uterus

(B) mesosalpinx

(D) endopelvic fascia

(E) mesometrium

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100. The posterior part of the tendinous arch of

pelvic fascia forms which of the following

ligaments?

(A) puboprostatic

(B) pubovesicle

(D) sacrogenital

(E) sacrospinous

Questions: 89–115 77

DIRECTIONS (Questions 101 through 105): Identify

the anatomical features indicated on the art below.

DIRECTIONS (Questions 106 through 110): Identify

the anatomical features indicated on the art below.

DIRECTIONS (Questions 111 through 115): Identify the anatomical features indicated on the art below.

0523-05 Chap 5 07/15/02 15:33 Page 77

DIRECTIONS (Questions 121 through 125): Identify the anatomical features indicated on the art below.

DIRECTIONS (Questions 116 through 120): Identify the anatomical features indicated on the art below.

78 5: The Pelvis and Perineum

0523-05 Chap 5 07/15/02 15:33 Page 78

Answers and Explanations

1. (E) The superior boundary of the pelvic cavity

is the pelvic inlet. The pelvis is limited inferi-

orly by the pelvic outlet, which is closed by the

musculofascial pelvic diaphragm and bounded

posteriorly by the coccyx and anteriorly by the

pubic symphysis (Moore, p 333).

2. (D) The pelvic girdle is formed by the hip (is-

chium, pubis, and ilium) bones and the sac-

rum (Moore, p 333).

3. (B) The concavity between the ischial spine

and the ischial tuberosity is the lesser sciatic

notch. The larger concavity, the greater sciatic

notch, is superior to the ischial spine and is

formed in part by the ilium (Moore, p 334).

4. (C) The pubis is an angulated bone with a

superior ramus that helps to form the acetabu-

lum and an inferior ramus that helps to form

the obturator foramen. A thickening on the an-

terior part of the body of the pubis is the pubic

crest, which ends laterally as a prominent

bump, the pubic tubercle. The lateral part of the

superior ramus has an oblique ridge known as

the pecten pubis or pectineal line of the pubis

(Moore, p 335).

5. (A) The pelvic inlet is bounded by the superior

margin of the pubic symphysis anteriorly, pos-

terior border of the pubic crest, pecten pubis,

arcuate line of the ilium, anterior border of the

ala of the sacrum, and the sacral promontory

(Moore, p 336).

6. (B) When a person is in the anatomical posi-

tion, the anterior superior iliac spines and the

anterior aspect of the pubic symphysis lie in the

same vertical plane (Moore, p 337).

7. (A) Weak areas of the pelvis include the pubic

rami, acetabula, sacroiliac joint, and alae of the

ilium (Moore, p 338).

8. (C) The piriformis muscles cover the postero-

lateral wall of the pelvis. The pelvic floor is

formed by the funnel-shaped pelvic diaphragm,

which consists of the levator ani and coccygeus.

The levator ani includes the pubococcygeus,

puborectalis, and iliococcygeus (Moore, p 342).

9. (A) The bony framework of the lateral pelvic

walls is formed by the hip bones and the obtu-

rator foramen, which is closed by the obturator

membrane. The obturator internus muscles

cover and thus pad most of the lateral pelvic

walls (Moore, p 341).

10. (B) The two main nerves of the sacral plexus

include the sciatic and pudendal. The sciatic

nerve is the largest and broadest nerve in the

body. It is formed by the ventral rami of L4-S3,

which converge on the anterior surface of the

piriformis. The sciatic nerve usually passes

through the greater sciatic foramen, inferior

to the piriformis, to enter the gluteal region

(Moore, p 347).

11. (D) The pudendal nerve is derived from the

anterior divisions of the ventral rami of S2

through S4. It accompanies the internal puden-

dal artery and leaves the pelvis through the

greater sciatic foramen between the piriformis

and coccygeus muscles. It is the main nerve of

the perineum and the chief sensory nerve of the

external genitalia (Moore, p 347).

12. (C) The superior gluteal nerve arises from the

posterior divisions of the ventral rami of L4

0523-05 Chap 5 07/15/02 15:33 Page 79

through S1 and leaves the pelvis through the

greater sciatic foramen, superior to the piri-

formis (Moore, p 347).

13. (A) The sacral sympathetic trunks descend

posterior to the rectum in the extraperitoneal

connective tissue and send gray rami commu-

nicantes to each of the ventral rami of the sacral

and coccygeal nerves. Each of the sacral trunks

is smaller than the lumbar trunks and usually

has four sympathetic ganglia (Moore, p 350).

14. (D) The pelvic splanchnic nerves merge with

the hypogastric nerves to form the inferior

hypogastric (and pelvic) plexuses. (Moore,

p 350).

15. (E) Four main arteries enter the lesser or true

pelvis. The internal iliac and ovarian arteries

are paired, and the median sacral and superior

rectal arteries are unpaired. The testicular

artery does not enter the true pelvis, as it fol-

lows the testes through the inguinal canal into

the scrotum (Moore, p 350).

16. (D) The internal iliac artery is the artery of the

pelvis; however, it does supply branches to

the buttocks, thighs, and the perineum (Moore,

p 350).

17. (E) The superior gluteal and iliolumbar arter-

ies arise from the posterior division of the inter-

nal iliac arteries. The gonadal arteries arise

from the abdominal aorta and the superior rec-

tal arteries from the inferior mesenteric artery.

The umbilical, obturator, uterine, vaginal, inter-

nal pudendal, and inferior gluteal arteries arise

from the anterior division of the internal iliac

arteries (Moore, pp 354–355).

18. (C) The ureters are muscular tubes, 25 to 30 cm

long, that connect the kidneys to the urinary

bladder. They are retroperitoneal, with their

superior halves in the abdomen and their infe-

rior halves in the pelvis. The pelvic part of the

ureters begins where it crosses the bifurcation

of the common iliac artery (Moore, p 357).

19. (B) The uvula of the bladder is a slight projec-

tion of the trigone of the bladder. It is usually

more prominent in older men (Moore, p 362).

20. (A) Parasympathetic ﬁbers to the bladder are

derived from the pelvic splanchnic nerves. They

are motor to the detrusor muscle and inhibitory

to the internal sphincter. Sympathetic ﬁbers to

the bladder are derived from T11 through L2

(Moore, p 362).

21. (B) The prostatic urethra is the widest and most

dilatable part of the male urethra (Moore, p 363).

22. (C) The internal surface of the posterior wall of

the prostatic urethra has a median ridge known

as the urethral crest. A groove on each side,

known as the prostatic sinus, receives the pros-

tatic ductules. A rounded eminence located in

the middle of the median ridge is known as the

seminal colliculus. The prostatic utricle is an

embryonic remnant of the uterus and part of the

vagina. The ejaculatory ducts open beside the

prostatic utricle (Moore, p 364).

23. (A) The paraurethral glands are homologues

to the prostate. They have common paraure-

thral ducts, which open, one on each side, near

the external urethral oriﬁce (Moore, p 364).

24. (A) The ductus deferens begins in the tail of the

epididymis and ascends in the spermatic cord.

It passes through the inguinal canal and enters

the pelvis. It ends by joining the duct of the

seminal vesicle to form the ejaculatory duct. It

descends medial to the ureter and seminal vesi-

cle (Moore, p 367).

25. (E) Ducts of the bulbourethral glands empty

into the urethra. The seminal vesicles are elon-

gated structures that lie between the fundus of

the bladder and the rectum, and they do not

store sperm. They secrete a thick, alkaline ﬂuid

that mixes with the sperm as they pass into the

ejaculatory ducts to the urethra. The superior

ends of the seminal vesicles are covered with

peritoneum and lie posterior to the ureters,

where the rectovesical pouch separates them

from the rectum. The inferior ends of the semi-

nal vesicle are separated from the rectum by the

rectovesical septum (Moore, p 368).

26. (B) The posterior fornix is the deepest part of

the vagina and is closely related to the recto-

uterine pouch. The vaginal fornix is the recess

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around the cervix and is described as having

anterior, posterior, and lateral parts (Moore,

pp 372–373).

27. (C) The uterus is a thick-walled, pear-shaped

muscular organ whose body lies between the

layers of the broad ligament. In the adult, the

uterus is usually anteverted and anteﬂexed; its

position changes with the degree of fullness of

the bladder and rectum (Moore, pp 373–374).

28. (E) Only the cylindrical, narrow inferior part of

the uterus known as the cervix protrudes into

the uppermost vagina (Moore, p 376).

29. (B) The rounded vaginal part of the cervix ex-

tends into the vagina and communicates with it

through the external os. The cervical canal is

broadest at its middle part and communicates

with the uterine cavity through the internal

os and with the vagina through the external

os (Moore, pp 376–377).

30. (D) Laterally, the peritoneum of the broad lig-

ament is prolonged superiorly over the vessels

as the suspensory ligament of the ovary. The

part of the broad ligament by which the ovary

is suspended is the mesovarium. The part of the

broad ligament forming the mesentery of the

uterine tube is the mesosalpinx. The major part

of the broad ligament, the mesentery of the ute-

rus, or mesometrium, is below the mesosalpinx

and mesovarium (Moore, p 381).

31. (B) The ampulla is the widest and longest part

of the uterine tubes. It begins at the medial end

of the infundibulum. Oocytes expelled from

the ovaries are usually fertilized in the ampulla

(Moore, p 383).

32. (C) The distal end of the ovary connects to the

lateral wall of the pelvis by the suspensory lig-

ament of the ovary. The ligament conveys the

ovarian vessels, lymphatics, and nerves to and

from the ovary and constitutes the lateral part

of the mesovarium of the broad ligament. The

ovary also attaches to the uterus by the liga-

ment of the ovary (Moore, p 384).

33. (C) The parasympathetic ﬁbers in the ovarian

plexus are derived from the vagus nerve (Moore,

p 384).

34. (A) The rectosigmoid junction lies anterior to

the S3 vertebra (Moore, p 384).

35. (C) The osseoﬁbrous structures marking the

boundaries of the perineum include the pubic

symphysis, inferior pubic rami, ischial rami,

ischial tuberosities, sacrotuberous ligaments,

inferiormost sacrum, and coccyx (Moore, p 389).

36. (A) A transverse line joining the anterior ends

of the ischial tuberosities divides the perineum

into two triangles. The anal triangle, containing

the anus, is posterior to this line. The urogen-

ital triangle, containing the root of the scro-

tum and penis in males and the external geni-

talia in females is anterior to this line (Moore,

pp 389–390).

37. (A) The bulbospongiosus, external anal sphinc-

ter, and superficial and deep transverse per-

ineal muscles converge at the site of the perineal

body (Moore, p 390).

38. (E) The following structures are found in the

superﬁcial perineal space: the root of the penis

and its associated muscles, the ischiocavernous

and bulbospongiosus. The proximal part of

the spongy urethra, superﬁcial transverse per-

ineal muscles, internal pudendal vessels, and

branches of the pudendal nerve are also located

in the superﬁcial perineal space (Moore, p 394).

39. (E) In females, the deep perineal pouch con-

tains the proximal part of the urethra, the

external urethral sphincter muscle, the deep

transverse perineal muscles, and related ves-

sels and nerves (Moore, p 394).

40. (C) The pudendal canal is a space within the

obturator fascia, which covers the medial aspect

of the obturator internus and lines the lateral

wall of the ischioanal fossa (Moore, p 395).

41. (E) The pudendal nerve supplies most of the

innervation to the perineum. Toward the distal

end of the pudendal canal, the pudendal nerve

Answers and Explanations: 13–41 81

0523-05 Chap 5 07/15/02 15:33 Page 81

splits, giving rise to the perineal nerves and

continuing as the dorsal nerve of the penis or

clitoris (Moore, p 395).

42. (C) The superior half of the anal canal con-

tains mucous membrane that is characterized

by a series of longitudinal ridges called anal

columns. These columns contain the terminal

branches of the superior rectal artery and vein

(Moore, p 395).

43. (D) The pectinate line indicates the junction of

the superior part of the anal canal and the infe-

rior part. The anal canal superior to the pecti-

nate line differs from the part inferior to the

pectinate line in its arterial supply, innervation,

and venous and lymphatic drainage. The supe-

rior rectal artery supplies the superior part of

the anal canal and the inferior rectal arteries

supply the inferior part. Superior to the pecti-

nate line, the internal rectal venous plexus

drains chieﬂy into the superior rectal vein—a

tributary of the inferior mesenteric vein and the

portal system. Inferior to the pectinate line the

internal rectal plexus drains into the inferior

rectal veins—tributaries to the caval venous sys-

tem. Superior to the pectinate line, the lymphat-

ics drain into the internal iliac lymph nodes into

the common iliac and lumbar nodes. Inferior to

the pectinate line, the lymphatics drain into the

superﬁcial inguinal lymph nodes. Superior to

the pectinate line, the innervation is visceral;

inferior to the pectinate line, the innervation is

somatic (Moore, pp 398–400).

44. (A) The lumen of the spongy urethra is approx-

imately 5 mm in diameter and expanded in the

bulb of the penis to form the intrabulbar fossa

and in the glans penis to form the fossa navicu-

laris (Moore, p 403).

45. (E) The anterior aspect of the scrotum is sup-

plied by anterior scrotal nerves derived from

the ilioinguinal nerve and by the genital branch

of the genitofemoral nerve. The posterior as-

pect of the scrotum is supplied by posterior

scrotal nerves, branches of the superﬁcial per-

ineal nerves, and the perineal branch of the pos-

terior femoral cutaneous nerve (Moore, p 405).

46. (D) The arterial supply of the penis is mainly

from the branches of the internal pudendal

arteries. The deep arteries of the penis are the

main vessels supplying the cavernous spaces

in the erectile tissue of the corpora cavernosa

and are therefore involved in the erection of

the penis. The deep arteries pierce the crura

and run within the corpora cavernosa (Moore,

p 410).

47. (D) The ischiocavernous muscles surround the

crura in the root of the penis. Each muscle arises

from the internal surface of the ischial tuberos-

ity and ischial ramus and passes anteriorly on

the crus of the penis, where it is inserted into

the sides and ventral surface of the crus and

the perineal membrane. The ischiocavernous

muscles force blood from the cavernous spaces

in the crura into the distal parts of the corpora

cavernosa, thus increasing the turgidity of the

penis (Moore, p 409).

48. (E) The vestibule is the space between the labia

minora containing the openings of the urethra,

vagina, and ducts of the greater and lesser

vestibular glands. The greater vestibular glands

are round or oval and are partly overlapped

posteriorly by bulbs of the vestibule and, like

the bulbs, are partially surrounded by the bul-

bospongiosus muscles (Moore, p 413).

49. (A) The labia minora are folds of fat-free, hair-

less skin. They are enclosed in the pudendal

cleft within the labia majora, immediately sur-

rounding the vestibule of the vagina. They have

a core of spongy connective tissue containing

erectile tissue and many small blood vessels

(Moore, p 413).

50. (B) Parasympathetic stimulation in the female

produces an increase in vaginal secretions, erec-

tion of the clitoris, and engorgement of erectile

tissue in the bulbs of the vestibule (Moore, p 415).

51. (B) Except for the most cranial portion, the

appendix epididymis, the mesonephric ducts

persist and form the main genital ducts. Imme-

diately below the entrance of the efferent duc-

tules, the mesonephric ducts elongate and

become highly convoluted, forming the ductus

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epididymis. From the tail of the epididymis

to the outbudding of the seminal vesicle, the

mesonephric ducts obtain a thick muscular coat

and form the ductus deferens. The region of

the ducts beyond the seminal vesicles is the

ejaculatory duct. Except for a small portion at

their cranial ends, the appendix testis, the para-

mesonephric ducts in the male degenerate

(Sadler, p 326).

52. (C) The only parts remaining from the meso-

nephric system are the epoöphoron, paro-

öphoron, and Gartner’s cyst (Sadler, p 325).

53. (A) The winglike expansions of the vagina

around the end of the uterus, the vaginal for-

nices, are of paramesonephric origin (Sadler,

p 329).

54. (D) The rapid elongation of the genital tuber-

cle in the male gives rise to the phallus (Sadler,

p 331).

55. (E) The genital swellings, known in the male

as the scrotal swellings, arise in the inguinal

region. With further development, they move

caudally, and each swelling then makes up half

of the scrotum (Sadler, p 332).

56. (E) In females, the genital tubercle elongates

only slightly and forms the clitoris (Sadler,

p 335).

57. (D) The urethral folds do not fuse, as in the

male, but develop into the labia minora (Sadler,

p 336).

58. (D) Descent of the gonads is considerably less

in the female than in the male, and the ovaries

ﬁnally settle just below the rim of the true pel-

vis. The cranial genital ligament forms the sus-

pensory ligament of the ovary, whereas the

caudal genital ligament forms the ligament of

the ovary proper and the round ligament of the

uterus. The latter extends into the labia majora

(Sadler, p 342).

59. (C) Android and anthropoid pelves are com-

mon in males. The platypelloid pelvis is un-

common in both males and females. The gyne-

coid pelvis is the normal female type of pelvis

(Moore, p 337).

60. (A) Persons with spondylolysis have a defect

in the vertebral arch. When this is bilateral, it

results in the L5 vertebra being divided into

two pieces. If the parts separate, the abnor-

mality is spondylolisthesis, which is anterior

displacement of the body of the L5 vertebra on

the sacrum (Moore, p 339).

61. (E) The bladder is relatively free within the

extraperitoneal subcutaneous fatty tissue ex-

cept for its neck, which is held ﬁrmly by the

puboprostatic ligaments in males and the pubo-

vesical ligaments in females (Moore, p 359).

62. (C) The median umbilical ligament is formed

by the remnant of the urachus (Moore, p 361).

63. (C) The inferior ends of the seminal vesicles

are closely related to the rectum and are sepa-

rated from it only by the rectovesical septum,

a membranous partition (Moore, p 368).

64. (C) The prostate is the largest accessory gland

of the male reproductive system (Moore, p 369).

65. (E) The pubovaginalis, external urethral

sphincter, urethrovaginal sphincter, and bul-

bospongiosus compress the vagina and act like

sphincters (Moore, p 372).

66. (A) The part of the broad ligament forming

the mesentery of the uterine tube is the meso-

salpinx (Moore, p 377).

67. (C) The ovarian arteries arise from the abdom-

inal aorta (Moore, p 384).

68. (E) The dilated terminal part of the rectum,

lying directly above and supported by the pel-

vic diaphragm (levator ani) and anococcygeal

ligament is the ampulla of the rectum (Moore,

p 385).

69. (B) In males the rectum is related anteriorly

to the fundus of the urinary bladder, terminal

parts of the ureters, ductus deferens, seminal

vesicles, and prostate (Moore, p 385).

Answers and Explanations: 42–69 83

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70. (B) Some obstetricians apply the term per-

ineumto a more restricted region that includes

the area between the vagina and anus (Moore,

p 389).

71. (D) Distally the corpus spongiosum expands

to form the conical glans penis (Moore, p 407).

72. (C) The deep arteries of the penis are the main

vessels supplying the cavernous spaces in the

erectile tissue of the corpora cavernosa and are

therefore involved in the erection of the penis.

They give off numerous branches that open

directly into the cavernous spaces. When the

penis is ﬂaccid, these arteries are coiled and

therefore are called helicine arteries (Moore,

p 410).

73. (E) The synonymous terms vulva and puden-

duminclude the clitoris, vestibule of the vagina,

bulbs of vestibule, and greater vestibular gland

(Moore, p 413).

74. (B) In young women, especially virgins, the

labia minora are connected by a small fold

known as the frenulum of the labia minora or

the fourchette (Moore, p 413).

75. (A) The slender ducts of the greater vestibular

glands pass deep to the bulbs of the vestibule

and open into the vestibule on each side of the

vaginal oriﬁce. The lesser vestibular glands are

small glands on each side of the vestibule that

open into it between the urethral and vaginal

oriﬁces (Moore, p 414).

76. (A) The perineal body is the major structure

incised during median episiotomy for child-

birth (Moore, p 391).

77. (A) The superior rectal artery is the direct

continuation of the inferior mesenteric artery.

The superior rectal artery anastomoses with

branches of the middle rectal artery (a branch of

the internal iliac artery) and with the inferior

rectal artery (a branch of the internal pudendal

artery) (Moore, p 355).

78. (B) The superior gluteal artery leaves the

pelvis through the superior part of the greater

sciatic foramen, superior to the piriformis mus-

cle, to supply the gluteal muscles in the but-

tocks (Moore, p 355).

79. (E) When empty, the adult male or female uri-

nary bladder is in the lesser pelvis, lying pos-

terior and slightly superior to the pubic bones.

It is separated from these bones by the poten-

tial retropubic space and lies inferior to the

peritoneum, where it rests on the pelvic ﬂoor

(Moore, p 359).

80. (C) The intermediate part of the urethra (mem-

branous part) is the section passing through the

external urethral sphincter and the perineal

membrane. The short intermediate part, extend-

ing from the prostatic urethra to the spongy ure-

thra, is the narrowest and least distensible part

of the urethra (Moore, p 364).

81. (B) Urethral glands are present particularly

in the superior part of the female urethra. The

paraurethral glands are homologues to the

prostate (Moore, p 364).

82. (D) Lithotripsy uses shock waves to break up

a stone into small fragments that can be passed

in the urine (Moore, p 358).

83. (D) The lateral lobes on either side of the ure-

thra form the major part of the prostate (Moore,

p 369).

84. (C) In its uppermost portion, at the base of the

peritoneal broad ligament, the uterine artery

runs transversely toward the cervix while the

ureters pass immediately beneath them as they

pass on each side of the cervix toward the blad-

der. This relationship (“water passing under

the bridge”) is an especially important one for

surgeons ligating the uterine artery, as in a hys-

terectomy (Moore, p 380).

85. (E) Immediately superior to the perineal mem-

brane is the deep transverse perineal muscle

(Moore, p 390).

86. (D) The lumen of the spongy urethra is approx-

imately 5 mm in diameter: however, it is ex-

panded in the bulb of the penis to form the

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intrabulbar fossa and in the glans penis to form

the navicular fossa (Moore, p 403).

87. (A) The anterior aspect of the scrotum is sup-

plied by anterior scrotal nerves derived from

the ilioinguinal and the genital branch of the

genitofemoral nerve. The posterior aspect of

the scrotum is supplied by posterior scrotal

nerves, provided by perineal branches of the

pudendal and perineal branches of the poste-

rior femoral cutaneous nerve (Moore, p 405).

88. (E) The penis is composed of three cylindrical

bodies of erectile cavernous tissue enclosed by

a ﬁbrous capsule, the tunica albuginea. Super-

ﬁcial to the capsule is the deep fascia of the

penis (Buck’s fascia). Superﬁcial to the deep

fascia is the loose areolar tissue, which lies just

beneath the skin of the penis. The tunica dar-

tos is located in the scrotum (Moore, p 406).

89. (C) The tiny deferential artery usually arises

from the inferior vesical artery and terminates

by anastomosing with the testicular artery,

posterior to the testis (Moore, p 367).

90. (C) The free anterior borders of the levator ani

are separated by a gap, the urogenital hiatus,

through which the urethra (and, in the female,

the vagina) passes (Moore, p 357).

91. (D) The puborectalis muscle unites with its

partner to from a U-shaped sling around the

anorectal junction. The puborectalis is respon-

sible for the anorectal angle (perineal ﬂexure),

which is important in maintaining fecal conti-

nence (Moore, p 345).

92. (E) The levator ani, a broad muscular sheet, is

the largest and most important muscle in the

pelvic ﬂoor (Moore, p 341).

93. (A) Each obturator internus passes posteriorly

from the lesser pelvis through the lesser sciatic

foramen and turns sharply laterally to attach

to the greater trochanter of the femur (Moore,

p 341).

94. (D) The piriformis muscle leaves the lesser

pelvis through the greater sciatic foramen to

attach to the upper border of the greater tro-

chanter of the femur (Moore, p 341).

95. (C) The pelvic splanchnic nerves contain para-

sympathetic ﬁbers derived from S2, S3, and S4

spinal cord segments and visceral afferent

ﬁbers from cell bodies in the spinal ganglia of

the corresponding spinal nerves (Moore, p 350).

96. (B) The internal iliac artery begins at the level

of the fourth disc between L5 and S1 vertebrae,

where it is crossed by the ureter. It is separated

from the sacroiliac joint by the internal iliac

vein and the lumbosacral trunk (Moore, p 350).

97. (D) The superior end of the vagina surrounds

the cervix; the lower end passes anteroinfe-

riorly through the pelvic ﬂoor to open in the

vestibule (Moore, p 371).

98. (C) Only the lower one-ﬁfth to one-fourth of

the vagina is somatic in terms of innervation.

The innervation of this part of the vagina is

from the deep perineal branch of the pudendal

nerve (Moore, p 373).

99. (E) The major part of the broad ligament, the

mesentery of the uterus or mesometrium,

is below the mesosalpinx and mesovarium

(Moore, p 377).

100. (D) The anterior part of the tendinous arch of

pelvic fascia forms the puboprostatic ligament

in males or the pubovesical ligament in females.

The posterior part of the tendinous arch of pel-

vic fascia forms the sacrogenital ligaments from

the sacrum around the side of the rectum to

attach to the prostate in the male or the vagina

in the female (Moore, p 380).

101. pubic symphysis

102. inferior pubic ramus

103. ischial tuberosity

104. sacrotuberous ligament

105. coccyx

Answers and Explanations: 70–105 85

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106. bulbocavernosus

107. ischiocavernous

108. superﬁcial transverse perineal muscle

109. anal sphincter

110. levator ani

111. rectouterine pouch

112. uterine tube

113. fundus of uterus

114. apex of bladder

115. pubic symphysis

116. bulb of vestibule

117. prepuce of clitoris

118. perineal branches of pudendal nerve

119. inferior rectal nerve

120. inferior cluneal nerve

121. fundus of bladder

122. prostate gland

123. seminal vesicle

124. rectovesical pouch

125. corpora cavernosa

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DIRECTIONS (Questions 1 through 100): Each of the

numbered items or incomplete statements in this

section is followed by answers or by completions of

the statement. Select the ONE lettered answer or

completion that is BEST in each case.

1. All of the following statements concerning the

femur are correct EXCEPT

(A) It is the longest bone in the body.

(B) It is the heaviest bone in the body.

the person’s height.

(D) The distal end of the femur undergoes

ossiﬁcation just before birth.

(E) Its average adult length is 36 inches.

2. The adductor tubercle is located on which of

the following bones?

(A) femur

(B) tibia

(D) ischium

(E) ilium

3. The margin of the acetabulum is deﬁcient infe-

riorly at which of the following structures?

(A) ischial tuberosity

(B) obturator foramen

(D) acetabular notch

(E) ischial spine

4. A deﬁciency in the smooth articular surface of

the acetabulum is known as which of the fol-

lowing?

CHAPTER 6

The Lower Limb

Questions

(A) pecten pubis

(B) pubic crest

(D) ala

(E) ramus

5. A fracture of which of the following bones is

among the most troublesome and problematic

of all fractures?

(A) tibia

(B) ﬁbula

(D) femoral neck

(E) medial malleolus

6. When it is said that an elderly person has a

“broken hip,” the usual injury is a fracture of

which of the following structures?

(A) acetabulum

(B) neck of the femur

(D) ischial tuberosity

(E) ilium

7. The medial and lateral malleoli articulate with

which of the following bones?

(A) femur

(B) calcaneus

(D) cuboid

(E) ﬁbula

0523-06 Chap 6 07/15/02 15:35 Page 87

8. Which of the following bones is the most com-

mon site for a compound fracture?

(A) femur

(B) tibia

(D) ilium

(E) ischium

9. Which of the following bones is the largest and

strongest bone of the foot?

(A) talus

(B) calcaneus

(D) navicular

(E) lateral cuneiform

10. The sustentaculum tali projects from the supe-

rior surface of which of the following bones?

(A) intermediate cuneiform

(B) talus

(D) navicular

(E) calcaneus

11. Which of the following bones articulates with

the ﬁbula, tibia, calcaneus, and navicular?

(A) talus

(B) lateral cuneiform

(D) medial cuneiform

(E) cuboid

12. Which of the following statements applies to

the 2nd metatarsal bone?

(A) It is the shortest.

(B) It is the strongest.

(D) Its base has a large tuberosity.

(E) Its base articulates with the navicular

bone.

13. The deep fascia of the thigh is known as which

of the following?

(A) Scarpa’s fascia

(B) Colles’ fascia

(D) fascia lata

(E) plantar fascia

14. Which of the following structures covers the

saphenous opening in the fascia lata?

(A) lateral intermuscular septum

(B) medial intermuscular septum

(D) cribriform fascia

(E) iliotibial tract

15. Which of the following structures passes

through the saphenous opening?

(A) femoral artery

(B) femoral vein

(D) obturator nerve

(E) great saphenous vein

16. The small saphenous vein empties into which

of the following veins?

(A) femoral

(B) tibial

(D) popliteal

(E) great saphenous

17. Which of the following statements correctly

applies to the iliopsoas muscle?

(A) It is a ﬂat quadrangular muscle.

(B) It is the chief ﬂexor of the thigh.

fascia lata.

(D) It inserts into the iliotibial tract.

(E) It is located in the posterior compart-

ment of the thigh.

18. All of the following statements concerning the

sartorius muscle are correct EXCEPT

(A) It is known as the “tailor’s muscle.”

(B) It is the longest muscle in the body.

(D) It extends the hip.

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(E) It is located in the anterior compartment

of the thigh.

19. All of the following statements concerning the

quadriceps femoris are correct EXCEPT

(A) Collectively constitutes the largest and

most powerful muscle group in the

body.

(B) It is the great extensor of the thigh.

(D) It forms the main bulk of the anterior

thigh muscles.

(E) The patella provides additional leverage

for the quadriceps.

20. Which of the following statements concerning

the components of the quadriceps femoris is

correct?

(A) The rectus femoris is considered the

“kicking muscle.”

(B) The vastus lateralis is the smallest com-

ponent of the quadriceps.

the vastus lateralis.

(D) The rectus femoris lies deep to the vastus

intermedius.

(E) The vastus intermedius is the chief ﬂexor

of the thigh.

21. Which of the following statements concerning

the gracilis muscle is correct?

(A) It passes through the lesser sciatic

foramen.

(B) It crosses the knee joint.

longus muscles.

(D) It is located in the anterior compartment

of the thigh.

(E) It is a short, fan-shaped muscle.

22. All of the following statements concerning the

adductor magnus are correct EXCEPT

(A) It is the largest muscle in the adductor

group.

(B) It is located in the posterior compart-

ment of the thigh.

(D) It is a composite, triangular muscle with

two parts that differ in nerve supply.

(E) Its main action is to adduct the thigh.

23. Which of the following statements correctly

applies to the adductor hiatus?

(A) It is an opening in the aponeurotic distal

attachment of the adductor longus.

(B) It transmits the femoral nerve, artery and

vein.

adductor tubercle of the femur.

(D) It extends from the adductor canal in the

thigh to the popliteal fossa.

(E) The great saphenous vein passes

through the adductor hiatus.

24. All of the following statements concerning the

femoral triangle are correct EXCEPT

(A) Its superior border is the inguinal

ligament.

(B) Its lateral border is the sartorius.

vein.

(D) The saphenous nerve passes through the

femoral triangle.

(E) Its medial border is the adductor

magnus.

25. All of the following statements concerning the

femoral sheath are correct EXCEPT

(A) It extends 3 to 4 cm inferior the inguinal

ligament.

(B) It is formed by an inferior prolongation

of transversalis and iliopsoas fascia.

(D) Its medial wall is pierced by the great

saphenous vein and lymphatic vessels.

(E) It ends by becoming continuous with the

adventitia of the femoral vessels.

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26. All of the following statements concerning the

femoral canal are correct EXCEPT

(A) It contains the femoral nerve.

(B) It is the medial compartment of the

femoral sheath.

when venous return from the lower limb

is increased.

(D) It extends distally to the level of the

proximal edge of the saphenous

opening.

(E) It contains loose connective tissue, fat, a

few lymphatic vessels, and sometimes a

deep inguinal lymph node (Cloquet’s

node).

27. All of the following statements concerning the

femoral ring are correct EXCEPT

(A) The lacunar ligament forms its medial

boundary.

(B) The anterior boundary is formed by the

inguinal ligament.

boundary.

(D) Its proximal end is closed by extraperi-

toneal fatty tissue that forms the femoral

septum.

(E) It lies anterior to the pectineus muscle.

28. Which of the following statements concerning

the femoral artery is correct?

(A) It enters the femoral canal.

(B) It enters the adductor canal.

(D) It gives rise to the inferior epigastric

artery.

(E) It passes through the obturator canal.

29. Which of the following statements concerning

the deep artery of the thigh is correct?

(A) It is the largest branch of the femoral

artery.

(B) It passes through the adductor canal.

branch.

(D) It exits the adductor canal through the

adductor hiatus.

(E) It passes through the obturator foramen.

30. Which of the following arteries supplies most

of the blood to the head and neck of the femur?

(A) medial circumﬂex femoral

(B) obturator

(D) external pudendal

(E) deep circumﬂex iliac

31. All of the following statements concerning the

adductor canal are correct EXCEPT

(A) It is approximately 15 cm long.

(B) It extends from the apex of the femoral

triangle to the adductor hiatus.

(D) Is is bounded posteriorly by the sartorius

muscle.

(E) It contains the femoral artery and vein.

32. Which of the following statements concerning

the lesser sciatic foramen is correct?

(A) It is the passageway for structures enter-

ing or leaving the pelvis.

(B) It is the passageway for structures enter-

ing or leaving the perineum.

the pelvis through this foramen.

(D) The femoral nerve passes through the

lesser sciatic foramen.

(E) The obturator nerve enters the adduc-

tor compartment via the lesser sciatic

foramen.

33. All of the following structures pass through

the greater sciatic foramen EXCEPT

(A) piriformis muscle

(B) sciatic nerve

(D) inferior gluteal vessels

(E) pudendal nerve

34. All of the following statements concerning the

gluteus maximus are correct EXCEPT

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(A) It is used very little during casual

walking.

(B) It assists in making the knee stable.

(D) It is used in running.

(E) It is used when rising from the sitting

position.

35. The ischial bursa separates the inferior part of

which of the following muscles from the ischial

tuberosity?

(A) gluteus maximus

(B) gluteus minimus

(D) piriformis

(E) obturator internus

36. All of the following statements concerning

the gluteus medius and minimus are correct

EXCEPT

(A) They all have the same nerve supply.

(B) They have the same actions.

vessels.

(D) They abduct the thigh and rotate it

laterally.

(E) They are largely responsible for prevent-

ing sagging of the unsupported side of

the pelvis during walking.

37. The positive Trendelenburg sign is associated

with injuries to which of the following?

(A) quadriceps femoris

(B) adductor muscles

(D) hamstring muscles

(E) piriformis muscle

38. Which of the following muscles is part of the

triceps coxae?

(A) obturator externus

(B) gemelli muscles

(D) gluteus medius

(E) quadratus femoris

39. All of the following muscles are lateral rota-

tors of the thigh EXCEPT

(A) quadratus femoris

(B) obturator internus

(D) gluteus medius

(E) inferior gemellus

40. All of the following statements concerning the

inferior clunial nerves are correct EXCEPT

(A) They are gluteal branches of the poste-

rior cutaneous nerve of the thigh.

(B) These nerves curl around the inferior

border of the gluteus maximus.

S1–S3.

(D) They supply the inferior half of the

buttock.

(E) They are dorsal primary rami.

41. All of the following nerves are ventral primary

rami EXCEPT

(A) posterior cutaneous nerve of the thigh

(B) inferior gluteal

(D) sciatic

(E) superior cluneal

42. All of the following statements concerning the

sciatic nerve are correct EXCEPT

(A) It is the largest nerve in the body.

(B) It is really two nerves.

(D) It receives its blood supply from the

superior gluteal nerve.

(E) It passes inferolaterally under cover of

the gluteus maximus, midway between

the greater trochanter and the ischial

tuberosity.

Questions: 26–42 91

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43. The piriformis syndrome involves which of

the following nerves?

(A) sciatic

(B) obturator

(D) ilioinguinal

(E) inferior gluteal

44. All of the following statements concerning the

internal pudendal artery are correct EXCEPT

(A) It does not supply any structures in the

gluteal region.

(B) It passes to the perineum with the

pudendal nerve.

(D) It crosses the ischial tuberosity.

(E) It re-enters the pelvis through the lesser

sciatic foramen.

45. Which of the following muscles is located in

the posterior aspect of the thigh?

(A) semitendinosus

(B) gluteus maximus

(D) internal obturator

(E) superior gemellus

46. All of the following statements concerning the

hamstring muscles are correct EXCEPT

(A) They are extensors of the thigh.

(B) They are ﬂexors of leg.

tends to fall backwards.

(D) Most take origin from the ischial

tuberosity.

(E) Most are innervated by the tibial divi-

sion of the sciatic nerve.

47. The innervation for the short head of the biceps

is provided by which of the following nerves?

(A) obturator

(B) femoral

(D) ﬁbular division of the sciatic

(E) sartorius

48. A line drawn from the anterior superior iliac

spine to the ischial tuberosity (Nelaton’s line),

passing over the lateral aspect of the hip,

normally passes over which of the following

structures?

(A) sciatic nerve

(B) ischial spine

(D) pudendal nerve

(E) greater trochanter

49. All of the following statements concerning the

popliteal fossa are correct EXCEPT

(A) The biceps femoris forms the superolat-

eral border.

(B) The semimembranosus forms the super-

omedial border.

ﬁbular nerves.

(D) The lateral and medial heads of the gas-

trocnemius form the inferolateral and

inferomedial borders.

(E) It contains the great saphenous vein.

50. The ﬂoor of the popliteal fossa includes which

of the following structures?

(A) oblique popliteal ligament

(B) patella

(D) anterior cruciate ligament

(E) posterior cruciate ligament

51. The lateral sural nerve is a branch of which of

the following nerves?

(A) femoral

(B) common ﬁbular

(D) obturator

(E) posterior cutaneous nerve of the thigh

52. Which of the following muscles dorsiﬂexes the

ankle?

(A) extensor digitorum longus

(B) ﬁbularis longus

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(D) plantaris

(E) gastrocnemius

53. Muscles that evert the foot include which of the

following muscles?

(A) gastrocnemius

(B) soleus

(D) ﬁbularis brevis

(E) ﬂexor digitorum longus

54. All of the following statements correctly apply

to the inferior extensor retinaculum EXCEPT

(A) It passes from the ﬁbula to the tibia prox-

imal to the malleoli.

(B) It is a Y-shaped band of deep fascia.

surface of the calcaneus.

(D) It forms a strong loop around the ten-

dons of the ﬁbularis tertius.

(E) It forms a strong loop around the ten-

dons of the extensor digitorum longus.

55. Which of the following muscles is the strongest

dorsiﬂexor and invertor of the foot?

(A) extensor digitorum longus

(B) tibialis anterior

(D) extensor hallucis longus

(E) ﬂexor hallucis longus

56. All of the following muscles are located in the

deep muscle group of the posterior compart-

ment EXCEPT

(A) ﬂexor digitorum longus

(B) popliteus

(D) ﬂexor hallucis longus

(E) tibialis posterior

57. Which of the following muscles is a ﬂexor of

the knee joint?

(A) popliteus

(B) tibialis anterior

(D) extensor digitorum longus

(E) extensor hallucis longus

58. Which of the following muscles is the power-

ful “push-off” muscle?

(A) gastrocnemius

(B) soleus

(D) ﬂexor hallucis longus

(E) plantaris

59. Which of the following muscles contract to

assist the posterior cruciate ligament in pre-

venting anterior displacement of the femur on

the tibia?

(A) plantaris

(B) popliteus

(D) gastrocnemius

(E) tibialis posterior

60. Which of following muscles is included in the

triceps surae?

(A) gastrocnemius

(B) tibialis anterior

(D) popliteus

(E) ﬁbularis brevis

61. The lateral compartment of the foot contains

which of the following muscles?

(A) abductor digiti minimi brevis

(B) ﬂexor hallucis brevis

(D) ﬂexor hallucis longus

(E) abductor hallucis

62. The central compartment of the foot contains

all of the following muscles EXCEPT

(A) ﬂexor digitorum brevis

(B) ﬂexor digitorum longus

(D) abductor hallucis

(E) lumbricals

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63. The medial plantar nerve is a terminal branch

of which of the following nerves?

(A) femoral

(B) tibial

(D) obturator

(E) sural

64. All of the following statements concerning the

saphenous nerve are correct EXCEPT

(A) It is the largest cutaneous branch of the

femoral nerve.

(B) It passes anterior to the medial malleolus

to the dorsum of the foot.

the foot.

(D) It supplies skin on the anterior and

medial side of the leg.

(E) It innervates the muscles of the foot in

the medial compartment of the foot.

65. Which of the following ligaments prevents

hyperextension of the hip joint during stand-

ing?

(A) iliofemoral

(B) ischiofemoral

(D) ligament of head of femur

(E) transverse acetabular

66. A synovial protrusion beyond the free margin

of the ﬁbrous capsule onto the posterior aspect

of the femoral neck forms a bursa for which of

these muscle tendons?

(A) piriformis

(B) obturator internus

(D) superior gemellus

(E) quadratus femoris

67. All of the following statements concerning the

ligament of the head of the femur are correct

EXCEPT

(A) It is a weak ligament.

(B) It is of little importance in strengthening

the hip.

(D) Usually it contains a small artery.

(E) Its wide end attaches to the margins of

the acetabular notch and the transverse

ligament.

68. Which of the following arteries provides the

main blood supply for the hip joint?

(A) obturator

(B) medial circumﬂex

(D) common iliac

(E) internal iliac

69. Which of the following muscles is the most

important muscle in stabilizing the knee?

(A) biceps femoris

(B) adductor magnus

(D) quadriceps femoris

(E) piriformis

70. Which of the following muscles passes out of

the knee joint to reach the tibia?

(A) plantaris

(B) popliteus

(D) gracilis

(E) tibialis anterior

71. All of the following statements concerning the

ﬁbular collateral ligament are correct EXCEPT

(A) It splits the tendon of the biceps femoris.

(B) It is superﬁcial to the tendon of the

popliteus.

(D) It is rounded and cordlike.

(E) It extends from the lateral epicondyle of

the femur to the head of the ﬁbula.

72. Which of the following statements concerning

the tibial collateral ligament is correct?

(A) It is attached to the lateral meniscus.

(B) It is stronger than the ﬁbular collateral

ligament.

94 6: The Lower Limb

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ﬁbular collateral ligament.

(D) The tibial collateral ligament and medial

meniscus are commonly torn during

contact sports such as football.

(E) It is an expansion of the tendon of the

adductor magnus.

73. The oblique popliteal ligament is an expan-

sion of the tendon of which of the following

muscles?

(A) popliteus

(B) plantaris

(D) semimembranosus

(E) gastrocnemius

74. All of the following ligaments of the knee are

intra-articular EXCEPT

(A) anterior cruciate

(B) lateral meniscus

(D) posterior cruciate

(E) medial meniscus

75. Which of the following statements concerning

the anterior cruciate ligament is correct?

(A) It is the stronger of the two cruciate liga-

ments.

(B) It has a relatively poor blood supply.

femur when one is walking downhill.

(D) It tightens during ﬂexion of the knee

joint, preventing anterior displacement

of the tibia on the femur.

(E) It attaches to the anterior part of the lat-

eral surface of the medial condyle of the

femur.

76. All of the following statements concerning the

menisci of the knee joint are correct EXCEPT

(A) They are thicker at their external

margins.

(B) They taper to thin, unattached edges in

the interior of the joint.

section.

(D) Their external margins attach to the

ﬁbrous capsule of the knee joint.

(E) The transverse ligament of the knee joins

the posterior edges of the menisci.

77. Which of the following statements correctly

applies to the lateral meniscus?

(A) It is larger and less movable than the

medial meniscus.

(B) It is in contact with the ﬁbular collateral

ligament.

ament by the posterior meniscofemoral

ligament.

(D) It adheres to the deep surface of the tib-

ial collateral ligament.

(E) It acts like a shock absorber.

78. Which of the following genicular branches sup-

plies the cruciate ligaments?

(A) femoral

(B) popliteal

rior tibial recurrent

(D) circumﬂex ﬁbular

(E) posterior recurrent branches of the ante-

rior tibial recurrent

79. Which of the following three ligaments are

damaged in the “unhappy triad” of knee in-

juries?

(A) ACL, tibial collateral, and medial

meniscus

(B) PCL, ﬁbular collateral, and lateral

meniscus

(D) PCL, tibial collateral, and lateral

meniscus

(E) ACL, tibial collateral, and lateral

meniscus

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80. Pain on lateral rotation of the tibia on the femur

indicates damage to which of the following

structures?

(A) anterior cruciate ligament

(B) posterior cruciate ligament

(D) medial meniscus

(E) posterior meniscofemoral ligament

81. All of the following ligaments reinforce the

ﬁbrous capsule on the medial side of the ankle

EXCEPT

(A) tibiocalcaneal

(B) posterior tibiotalar

(D) tibionavicular

(E) calcaneoﬁbular

82. Which of the following groups of muscles pro-

duce dorsiﬂexion of the ankle?

(A) anterior compartment of the leg

(B) posterior compartment of the leg

(D) lateral compartment of the leg

(E) lateral compartment of the foot

83. All of the following statements concerning the

plantar calcaneonavicular ligament are correct

EXCEPT

(A) It extends from the sustentaculum tali to

the navicular.

(B) It is also known as the spring ligament.

(D) It plays an important role in maintaining

the longitudinal arch of the foot.

(E) It forms a tunnel for the tendon of the

ﬁbularis longus.

84. All of the following statements concerning the

medial longitudinal arch of the foot are correct

EXCEPT

(A) It is higher and more important than the

lateral longitudinal arch.

(B) It is composed of the calcaneus, talus,

navicular, cuneiforms, and three

metatarsals.

(D) The tibialis anterior helps strengthen this

arch.

(E) The ﬁbularis longus tendon also supports

this arch.

85. Which of the following conditions is associ-

ated with lateral deviation of the great toe?

(A) hallux valgus

(B) hammer toe

(D) pes planus

(E) club foot

86. All of the following statements concerning the

transverse tarsal joint are correct EXCEPT

(A) It occurs where the talus rests on and

articulates with the calcaneus.

(B) It is formed by the combined talonavicu-

lar part of the talocalcaneonavicular and

calcaneocuboid joints.

method for surgical amputation of the

foot.

(D) It is two separate joints aligned trans-

versely.

(E) Dorsiﬂexion and plantarﬂexion of the

foot are the main movements involving

this joint.

87. Which of the of the following areas is involved

in tibial nerve entrapment?

(A) medial malleolus to the calcaneus

(B) lateral malleolus to the navicular bone

(D) lateral malleolus to the ﬁbularis brevis

(E) long plantar ligament to the tendon of

the ﬁbularis longus

88. Which of the following major joints is the most

frequently injured?

(A) shoulder

(B) elbow

(D) knee

(E) ankle

96 6: The Lower Limb

0523-06 Chap 6 07/15/02 15:35 Page 96

89. Which of the following statements correctly

applies in Pott’s fracture-dislocation?

(A) The foot is forcibly dorsiﬂexed.

(B) The foot is forcibly plantar ﬂexed.

(D) The foot is forcibly everted.

(E) The calcaneus is usually fractured.

90. The grip of the malleoli on the trochlea is

strongest during which of the following move-

ments of the ankle?

(A) plantarﬂexion

(B) dorsiﬂexion

(D) inversion

(E) lateral rotation

91. Which of the following statements correctly

applies to genu valgum?

(A) The tibia is diverted medially.

(B) The tibia is diverted laterally.

pressure.

(D) This deformity causes wear and tear of

the medial meniscus.

(E) This deformity does not inﬂuence

weight distribution.

92. Which of the following knee support struc-

tures is considered to be the most important in

the stabilization of the joint?

(A) lateral and medial menisci

(B) anterior and posterior cruciate ligaments

(D) ﬁbrous capsule

(E) quadriceps femoris

93. Which of the following fractures is the most

troublesome and problematic?

(A) medial malleolus of tibia

(B) lateral malleolus of ﬁbula

(D) femoral neck

(E) adductor tubercle

94. Which of the following muscles is the strongest

ﬂexor of the hip joint?

(A) semitendinosus

(B) iliopsoas

(D) gracilis

(E) pectineus

95. All of the following muscles are lateral rota-

tors of the hip joint EXCEPT

(A) obturator externus

(B) superior gemellus

(D) gluteus minimus

(E) quadratus femoris

96. Which of the following arteries is usually eval-

uated during a physical examination of the

peripheral vascular system?

(A) lateral plantar

(B) dorsalis pedis

(D) ﬁbular

(E) posterior tibial

97. The tendon of the biceps femoris and the neck

of the ﬁbula may be used as a guide for locat-

ing which of the following nerves?

(A) saphenous

(B) sural

(D) medial plantar

(E) tibial

98. Which of the following muscle tendons is com-

monly removed for grafting without causing

disability?

(A) extensor hallucis brevis

(B) ﬁbularis tertius

(D) ﬂexor digitorum brevis

(E) tendons of the ﬂexor digitorum longus

Questions: 80–98 97

0523-06 Chap 6 07/15/02 15:35 Page 97

99. Shin splints usually involve muscles in which

of the following compartments?

(A) anterior

(B) lateral

(D) medial plantar

(E) lateral plantar

100. The strongest dorsiﬂexor of the foot is which

of the following muscles?

(A) ﬁbularis tertius

(B) extensor digitorum longus

(D) gastrocnemius

(E) extensor hallucis brevis

98 6: The Lower Limb

DIRECTIONS (Questions 101 through 105): Identify

the anatomical features indicated on the art below.

DIRECTIONS (Questions 106 through 110): Identify

the anatomical features indicated on the art below.

0523-06 Chap 6 07/15/02 15:35 Page 98

DIRECTIONS (Questions 111 through 115): Identify the anatomical features indicated on the art below.

Questions: 99–115 99

0523-06 Chap 6 07/15/02 15:35 Page 99

Answers and Explanations

1. (E) The femur is the longest and heaviest bone

in the body. In the average adult, its length

is approximately one-quarter of the person’s

height (108 cm or 18 in.). The distal end of the

femur undergoes ossiﬁcation just before birth

(Moore, p 509).

2. (A) The medial surface of the medial condyle

has a large and prominent medial epicondyle,

superior to which is another elevation, the

adductor tubercle (Moore, p 509).

3. (D) The margin of the acetabulum is deﬁcient

inferiorly at the acetabular notch, which makes

the fossa resemble a cup with a piece of its lip

missing (Moore, p 508).

4. (C) The acetabular notch and fossa comprise

a deﬁciency in the smooth articular lunate sur-

face of the acetabulum, which actually articu-

lates with the head of the femur (Moore, p 508).

5. (D) A fracture of the femoral neck is among the

most troublesome and problematic of all frac-

tures because of the instability of the fracture

site. Furthermore, the periosteum covering the

femoral neck is exceedingly thin and has ex-

tremely limited powers of osteogenesis (bone

formation). Because the retinacular arteries

arise from the medial circumﬂex femoral arter-

ies and run parallel to the femoral neck on their

way to supply the femoral head, they are vul-

nerable to injury when the neck of the femur

fractures. Rupture of these vessels cause de-

generation (necrosis) of the femoral head and

bleeding into the hip joint (Moore, p 511).

6. (B) Elderly people fracture the neck of the

femur and refer to the injury as a “broken hip”

(Moore, p 511).

7. (C) The lateral surface of the medial malleolus

articulates with the talus, and the lateral malle-

olus helps hold the talus in its socket (Moore,

p 513).

8. (B) The body of the tibia is the most common

site for a compound fracture—one in which the

skin is perforated and blood vessels are torn

(Moore, p 513).

9. (B) The calcaneus is the largest and strongest

bone in the foot. The calcaneus transmits most

of the body weight from the talus to the ground

(Moore, p 515).

10. (E) The shelf-like sustentaculum tali projects

from the superior border of the medial surface

of the calcaneus and supports the talar head

(Moore, p 515).

11. (A) The talus articulates with the ﬁbula, cal-

caneus, navicular, and tibia (Moore, p 515).

12. (C) The 1st metatarsal is shorter and stouter

than the others. The 2nd metatarsal is the

longest. The bases of the metatarsals articulate

with the cuneiform and cuboid bones. The base

of the 5th metatarsal has a large tuberosity

(Moore, p 515).

13. (D) The deep fascia of the thigh is called fas-

cia lata and the deep fascia of the leg is called

100

0523-06 Chap 6 07/15/02 15:35 Page 100

crural fascia. Scarpa’s fascia is the membra-

nous fascia of the lower abdominal wall and

Colles’ fascia is located in the perineum (Moore,

p 522).

14. (C) The saphenous opening in the fascia lata

is a deficiency in the deep fascia lata inferior

to the medial part of the inguinal ligament,

approximately 4 cm inferolateral to the pubic

tubercle. The medial margin of the saphenous

opening is smooth, but its superior, lateral,

and inferior margins form a sharp crescentic

edge, the falciform margin. The sickle-shaped

margin of the saphenous opening is joined at

its medial margin by ﬁbrofatty tissue—the

cribriform fascia (Moore, p 524).

15. (E) The great saphenous vein passes through

the saphenous opening and cribriform fascia

to enter the femoral vein. Some efferent lym-

phatic vessels from the superﬁcial inguinal

lymph nodes also pass through the saphenous

opening and cribriform fascia to enter the deep

inguinal lymph nodes (Moore, p 524).

16. (D) The small saphenous vein ascends poste-

rior to the lateral malleolus and passes along

the lateral border of the calcaneal tendon. It

then ascends between the heads of the gastroc-

nemius muscle and empties into the popliteal

vein in the popliteal fossa (Moore, p 526).

17. (B) The iliopsoas is the chief ﬂexor of the thigh,

and when the thigh is ﬁxed, it ﬂexes the trunk

on the hip. Its broad lateral part, the iliacus, and

its long medial part, the psoas major, arise from

the iliac fossa and lumbar vertebrae, respec-

tively. It is an anterior thigh muscle (Moore,

p 531).

18. (D) The sartorius is known as the “tailor’s

muscle.” It is the longest muscle in the body

and acts across two joints. It flexes the hip

joint and participates in ﬂexion of the knee. It

is located in the anterior compartment of the

thigh (Moore, p 531).

19. (B) The quadriceps femoris forms the main

bulk of the anterior thigh muscles and collec-

tively constitutes the largest and one of the

most powerful muscles in the body. The qua-

driceps is the great extensor of the leg, and all

four of its parts combine to from a tendinous

attachment to the tibia. The patella also pro-

vides additional leverage for the quadriceps

(Moore, pp 532–534).

20. (A) The rectus femoris is considered to be the

“kicking muscle.” The vastus lateralis is the

largest component of the quadriceps. The vas-

tus intermedius lies deep to the rectus femoris,

and the articular muscle is considered to be a

derivative of the vastus intermedius (Moore,

p 534).

21. (B) The long, strap-like muscle lies along the

medial side of the thigh and knee. It is the only

muscle of the adductor group that crosses the

knee. It is the most superficial of the adduc-

tor group and is the weakest member (Moore,

p 538).

22. (B) The adductor magnus is the largest mus-

cle in the adductor group. It is located in the

medial compartment of the thigh. This large

adductor is a composite, triangular muscle that

has adductor and hamstring parts. The two

parts differ in their attachments, nerve supply,

and main actions (Moore, p 538).

23. (D) The adductor hiatus is an opening in the

aponeurotic distal attachment of the adductor

magnus. It transmits the femoral artery and

vein from the adductor canal in the thigh to the

popliteal fossa posterior to the knee. The open-

ing is just superior to the adductor tubercle of

the femur (Moore, p 541).

24. (E) The femoral triangle is bounded superi-

orly by the inguinal ligament, medially by the

adductor longus, and laterally by the sarto-

rius. The femoral triangle is bisected by the

femoral artery and vein, which leave and enter

the adductor canal at its apex. The saphenous

nerve descends through the femoral triangle

(Moore, p 541).

25. (C) The femoral sheath extends 3 to 4 cm in-

ferior to the inguinal ligament and encloses

proximal parts of the femoral vessel and the

Answers and Explanations: 1–25 101

0523-06 Chap 6 07/15/02 15:35 Page 101

femoral canal. The sheath is formed by an infe-

rior prolongation of transversalis and iliopsoas

fascia. The femoral sheath does not enclose the

femoral nerve. The sheath ends by becoming

continuous with the adventitia of the femoral

vessels (Moore, p 542).

26. (A) The medial compartment of the femoral

sheath is the femoral canal. It extends distally to

the level of the proximal edge of the saphenous

opening. It allows the femoral vein to expand

when venous return from the lower limb is in-

creased. It contains loose connective tissue, fat,

a few lymphatic vessels, and sometimes a deep

inguinal lymph node (Cloquet’s node) (Moore,

pp 542–543).

27. (C) The femoral ring is closed at the proxi-

mal end by extraperitoneal fatty tissue, which

forms the femoral septum. The boundaries of

the femoral ring include the partition between

the femoral canal and the femoral vein laterally.

Posteriorly, the superior ramus of the pubis is

covered by the pectineus muscle. Its medial

boundary is the lacunar ligament; anteriorly,

the boundary is the medial part of the inguinal

ligament (Moore, pp 543–545).

28. (B) The femoral artery is the chief artery of the

lower limb and is the continuation of the exter-

nal iliac artery. It bisects the femoral triangle at

its apex and enters the adductor canal deep to

the sartorius muscle (Moore, p 545).

29. (A) The deep artery of the thigh is the largest

branch of the femoral artery and the chief artery

of the thigh. It arises in the femoral triangle from

the lateral side of the femoral artery (Moore,

p 545).

30. (A) The medial circumﬂex femoral artery is

especially important because it supplies most

of the blood to the head and neck of the femur

(Moore, p 545).

31. (D) The adductor canal (Hunter’s canal) is

approximately 15 cm long and is a narrow fas-

cial tunnel in the thigh running from the apex

of the femoral triangle to the adductor hiatus in

the tendon of the adductor magnus. Located

deep or posterior to the middle third of the sar-

torius, the adductor canal provides an inter-

muscular passage through which the femoral

vessels pass to reach the popliteal fossa. The

contents of the adductor canal include the

femoral vessels, saphenous nerve, and nerve to

the vastus medialis (Moore, p 549).

32. (B) The greater sciatic foramen is the passage-

way for structures entering or leaving the pel-

vis, whereas the lesser sciatic foramen is the

passageway for structures entering or leaving

the perineum. The greater sciatic foramen is the

opening for all lower limb arteries and nerves

leaving the pelvis and entering the gluteal

region (Moore, p 550).

33. (E) The greater sciatic foramen is the passage-

way for the sciatic nerve, piriformis muscle,

and gluteal vessels. The pudendal nerve

enters the perineum through the lesser sciatic

foramen (Moore, p 553).

34. (C) The gluteus maximus is used when rising

from the sitting position or straightening from

the bending position. It is used in climbing

steps and running. It also assists in making the

knee stable. It is used very little during casual

walking and when one is standing motionless

(Moore, p 552).

35. (A) The ischial bursa separates the inferior

part of the gluteus maximus from the ischial

tuberosity, which is often absent (Moore, p 552).

36. (D) The gluteus medius and minimus have the

same actions and nerve supply and are sup-

plied by the superior gluteal arteries. Both mus-

cles abduct the thigh and rotate it medially.

They play an essential role during locomotion

and are largely responsible for preventing sag-

ging of the unsupported side of the pelvis dur-

ing walking (Moore, p 554).

37. (C) When the weight is on both feet, the pelvis

is evenly supported and does not sag. When the

weight is borne by one foot, the muscles on the

same side hold the pelvis so the pelvis will not

sag on the side of the raised foot. When the glu-

teus medius and minimus (abductors of the

102 6: The Lower Limb

0523-06 Chap 6 07/15/02 15:35 Page 102

thigh) are inactive owing to injury of the supe-

rior gluteal nerve, the supporting and steady-

ing action of these muscles is lost and the pel-

vis falls on the side of the raised limb. This is

referred to as a positive Trendelenburg sign

(Moore, p 555).

38. (B) The obturator internus and the superior

and inferior gemelli form a tricipital (three-

headed) muscle that is sometimes called the

triceps coxae (Moore, p 550).

39. (D) The gluteus maximus, piriformis, obtu-

rator internus and externus, and superior and

inferior gemelli are all lateral rotators of the

thigh. Both the gluteus medius and the glu-

teus minimus are medial rotators of the thigh

(Moore, p 551).

40. (E) The inferior clunial nerves are gluteal

branches of the posterior cutaneous nerve of

the thigh, a derivative of the sacral plexus (ven-

tral rami S1 through S3). These nerves curl

around the inferior border of the gluteus max-

imus and supply the inferior half of the buttock

(Moore, p 556).

41. (E) The superior cluneal nerves are dorsal

rami of L1–L3 and the middle cluneal nerves

are dorsal rami of S1–S3. The sciatic, puden-

dal, posterior cutaneous nerve of the thigh,

and the gluteal nerves are all ventral primary

rami (Moore, p 557).

42. (D) The sciatic nerve is the largest nerve in the

body. It is so large that it receives its own blood

supply from the inferior gluteal artery. It runs

inferolaterally under cover of the gluteus max-

imus, midway between the greater trochanter

and the ischial tuberosity. The sciatic nerve is

really two nerves, the tibial and common ﬁbu-

lar (Moore, p 558).

43. (A) A pain in the buttock may result from com-

pression of the sciatic nerve by the piriformis

muscle (piriformis syndrome) (Moore, p 559).

44. (D) The internal pudendal artery leaves the

gluteal region immediately by crossing the is-

chial spine and re-entering the pelvis through

the lesser sciatic foramen. The artery passes to

the perineum with the pudendal nerve and

supplies the external genitalia and muscles in

the pelvic region. It does not supply any struc-

tures in the gluteal region (Moore, p 562).

45. (A) The three muscles in the posterior aspect

of the thigh are the hamstrings, which include

the semitendinosus, semimembranosus, and

biceps femoris (Moore, p 563).

46. (C) The hamstring muscles arise from the is-

chial tuberosity and are innervated by the tib-

ial division of the sciatic nerve. The short

head of the biceps does not meet these crite-

ria. The hamstrings are extensors of the thigh

and ﬂexors of the leg. A person with paralyzed

hamstrings tends to fall forward because the

gluteus maximus muscles cannot maintain the

necessary muscle tone to stand straight (Moore,

p 563).

47. (D) The long head of the biceps femoris is

innervated by the tibial division of the sciatic

nerve and the short head of the biceps is inner-

vated by the ﬁbular division of the sciatic nerve

(Moore, p 563).

48. (E) A line drawn from the anterior superior

iliac spine to the ischial tuberosity (Nélaton’s

line), passing over the lateral aspect of the hip

region, normally passes over or near the top of

the greater trochanter (Moore, p 567).

49. (E) The biceps femoris forms the superolat-

eral border and the semimembranosus muscle

forms the superomedial border. The medial and

lateral heads of the gastrocnemius form the

inferolateral and inferomedial borders. The

contents of the fossa include the small saphe-

nous vein, popliteal arteries and veins, and tib-

ial and common ﬁbular nerves (Moore, p 571).

50. (A) The ﬂoor of the popliteal fossa is formed by

the popliteal surface of the femur, the oblique

popliteal ligament, and the popliteal fascia over

the popliteus (Moore, p 571).

51. (B) The medial sural nerve is derived from the

tibial nerve and the lateral sural nerve is

Answers and Explanations: 26–51 103

0523-06 Chap 6 07/15/02 15:35 Page 103

derived from the common ﬁbular. The medial

and lateral sural nerves unite to form the sural

nerve (Moore, p 590).

52. (A) Dorsiﬂexors of the ankle include the tibialis

anterior, extensors digitorum longus, hallucis

longus, and ﬁbularis tertius (Moore, p 577).

53. (D) Both the ﬁbularis longus and brevis evert

the foot. The ﬁbularis tertius also aids in ever-

sion of the foot (Moore, p 577).

54. (A) The superior extensor retinaculum is a

strong, broad band of deep fascia passing from

the ﬁbula to the tibia, proximal to the malleoli.

The inferior extensor retinaculum is a Y-shaped

band of deep fascia that attaches laterally to

the anterosuperior surface of the calcaneus. It

forms a strong loop around the tendons of the

ﬁbularis tertius and the extensor digitorum

longus muscle (Moore, p 579).

55. (B) The tibialis anterior is the strongest dorsi-

ﬂexor and inverter of the foot (Moore, p 579).

56. (C) The plantaris is located in the superﬁcial

group of muscles in the posterior compartment

(Moore, p 586).

57. (A) The popliteus is a ﬂexor of the knee joint

(Moore, p 588).

58. (D) The ﬂexor hallucis longus is the powerful

“push-off” muscle during walking, running,

and jumping (Moore, p 589).

59. (B) When a person is standing with the knee

partly ﬂexed, the popliteus contracts to assist

the posterior cruciate ligament in preventing

anterior displacement of the femur on the tibia

(Moore, p 588).

60. (A) Together, the two-headed gastrocnemius

and soleus form the three-headed triceps surae

(Moore, p 586).

61. (A) The lateral compartment of the foot con-

tains the abductor and ﬂexor digiti minimi bre-

vis (Moore, p 596).

62. (D) The central compartment of the foot con-

tains the ﬂexor digitorum brevis, ﬂexor digi-

torum longus, quadratus plantae, lumbricals,

proximal part of the tendon ﬂexor hallucis

longus, and the lateral plantar nerve and ves-

sel (Moore, p 596).

63. (B) The medial plantar nerve, the larger of

the two terminal branches of the tibial nerve,

passes deep to the abductor hallucis and runs

anteriorly between the muscles and the ﬂexor

digitorum brevis on the lateral side of the

medial plantar artery (Moore, p 601).

64. (E) The saphenous nerve is the largest cuta-

neous branch of the femoral nerve. In addition

to supplying the skin and fascia on the ante-

rior and medial sides of the leg, the saphenous

nerve passes anterior to the medial malleolus to

the dorsum of the foot, where it supplies skin

along the medial side of the foot as far as the

head of the 1st metatarsal (Moore, p 601).

65. (A) The ﬁbrous capsule is reinforced anteriorly

by the strong, Y-shaped iliofemoral ligament

(of Bigelow) which attaches to the anterior infe-

rior iliac spine and the acetabular rim proxi-

mally and the intertrochanteric line distally.

The iliofemoral ligament prevents hyperexten-

sion of the hip during standing by screwing the

femoral head into the acetabulum (Moore, p 611).

66. (C) A synovial protrusion beyond the free

margin of the ﬁbrous capsule onto the posterior

aspect of the femoral neck forms a bursa for the

obturator externus tendon (Moore, p 611).

67. (C) The ligament of the head of the femur is

weak and of little importance in strengthening

the hip joint. Its wide end attaches to the mar-

gins of the acetabular notch and the transverse

acetabular ligament. Its narrow end attaches

to the pit in the head of the femur. Usually the

ligament contains a small artery to the head of

the femur (Moore, p 611).

68. (B) The main blood supply of the hip joint is

from branches of the circumﬂex femoral arter-

ies (especially the medial circumﬂex femoral

artery) that travel in the retinacula (reﬂections

104 6: The Lower Limb

0523-06 Chap 6 07/15/02 15:35 Page 104

of the capsule along the neck of the femur to-

ward the head). These retinacular vessels may

be damaged in femoral neck fractures and re-

sult in avascular necrosis of the femoral head

(Moore, p 613).

69. (D) The most important muscle in stabilizing

the knee joint is the large quadriceps femoris,

particularly inferior ﬁbers of the vastus medi-

alis and lateralis. The knee joint will function

surprisingly well following a ligament strain

if the quadriceps is well conditioned (Moore,

pp 617–618).

70. (B) The ﬁbrous capsule of the knee is deﬁcient

on the lateral condyle to allow the tendon of the

popliteus to pass out of the joint to attach to the

tibia (Moore, p 618).

71. (C) The fibular collateral ligament (lateral

collateral ligament), rounded and cordlike, is

strong. It extends inferiorly from the lateral epi-

condyle of the femur to the lateral surface of

the head of ﬁbula. The tendon of the popliteus

passes deep to the ﬁbular collateral ligament,

separating it from the lateral meniscus. The ten-

don of the biceps femoris is also split into two

parts by this ligament (Moore, p 619).

72. (D) The tibial collateral ligament (medial col-

lateral ligament) is a strong, ﬂat band that ex-

tends from the medial epicondyle of the femur

to the medial surface of the tibia. At its mid-

point, the deep ﬁbers of the tibial collateral lig-

ament are ﬁrmly attached to the medial me-

niscus. The tibial collateral ligament, weaker

than the ﬁbular collateral ligament, is more

often damaged. As a result, the tibial collateral

ligament and medial meniscus are commonly

torn during contact sports such as football

(Moore, p 619).

73. (D) The oblique popliteal ligament is an expan-

sion of the tendon of the semimembranosus,

which strengthens the ﬁbrous capsule posteri-

orly (Moore, p 619).

74. (C) The patellar ligament is extracapsular. The

cruciate ligaments and menisci are classiﬁed as

intra-articular and are found within the knee

joint. The popliteal tendon is also intra-articular

during part of its course (Moore, p 620).

75. (B) The anterior cruciate ligament (ACL), the

weaker of the two cruciate ligaments, arises

from the anterior intercondylar area of the tibia,

just posterior to the attachment of the medial

meniscus. It extends superiorly, posteriorly, and

laterally to attach to the posterior part of the

medial side of the lateral condyle of the femur.

The ACL has a relatively poor blood supply. It

is slack when the knee is ﬂexed and taut when

it is fully extended, preventing posterior dis-

placement. (Moore, p 620).

76. (E) The menisci are thicker at their external

margins and taper to thin, unattached edges in

the interior of the joint. Wedge-shaped in trans-

verse section, the menisci are ﬁrmly attached at

their ends to the intercondylar area of the tibia.

Their external margins attach to the ﬁbrous cap-

sule of the knee joint. The transverse ligament

of the knee, a slender, ﬁbrous band, joins the

anterior edges of the menisci, allowing them to

move together during knee movements (Moore,

p 621).

77. (D) The lateral meniscus is nearly circular

and is smaller and more movable than the

medial meniscus. The tendon of the popliteus

separates the lateral meniscus from the ﬁbular

collateral ligament. A strong tendinous slip,

the posterior meniscofemoral ligament, joins

the lateral meniscus to the posterior cruciate

ligament and the medial femoral condyle.

The lateral meniscus acts like a shock

absorber (Moore, p 621).

78. (B) The middle genicular branches of the pop-

liteal artery penetrate the ﬁbrous capsule of the

knee joint and supply the cruciate ligaments,

synovial membrane, and peripheral margins of

the menisci (Moore, p 626).

79. (A) The ACL may tear when the tibial collateral

ligament ruptures. First, the tibial collateral lig-

ament ruptures, opening the joint on the medial

side and possibly tearing the medial meniscus

and ACL. This “unhappy triad of injuries” can

result from clipping in football (Moore, p 626).

Answers and Explanations: 52–79 105

0523-06 Chap 6 07/15/02 15:35 Page 105

80. (C) Pain on lateral rotation of the tibia on the

femur indicates injury of the lateral meniscus,

whereas pain on medial rotation of the tibia on

the femur indicates injury of the medial menis-

cus (Moore, p 628).

81. (E) The lateral ligament consists of the anterior

and posterior taloﬁbular ligaments and the cal-

caneoﬁbular ligament. The three discrete liga-

ments are collectively referred to as the lateral

ligament. The fibrous capsule is reinforced

medially by the large, strong medial ligament

(deltoid ligament), which attaches proximally

to the medial malleolus. This ligament consists

of the tibionavicular, tibiocalcaneal, and ante-

rior and posterior tibiotalar ligaments (Moore,

pp 633–635).

82. (A) Dorsiﬂexion of the ankle is produced by

the muscles in the anterior compartment of the

leg (Moore, p 635).

83. (E) The plantar calcaneonavicular ligamentum

(spring ligament) extends from the sustentacu-

lum tali to the posteroinferior surface of the

navicular. It plays an important role in main-

taining the longitudinal arch of the foot (Moore,

p 637).

84. (C) The talar head is the keystone of the medial

longitudinal arch (Moore, p 640).

85. (A) Hallux valgus is a foot deformity char-

acterized by lateral deviation of the great toe.

Hammertoe is a deformity in which the prox-

imal phalanx is permanently flexed at the

metatarsophalangeal joint and the middle pha-

lanx is plantarﬂexed at the interphalangeal joint.

The distal phalanx is also ﬂexed. Claw toes are

characterized by hyperextension of the metatar-

sophalangeal joints and flexion of the distal

interphalangeal joints. Pes planus is flat feet,

and clubfoot refers to a foot that is twisted. The

foot is inverted, the ankle is plantarﬂexed, and

the forefoot is adducted (Moore, pp 641–642).

86. (E) The transverse tarsal joint is formed by the

combined talonavicular part of the talocalca-

neonavicular and calcaneocuboid joints, two

separate joints aligned transversely. Transec-

tion across the transverse tarsal joint is a stan-

dard method for surgical amputation of the

foot. Inversion and eversion of the foot are the

main movements involving these joints (Moore,

p 637).

87. (A) The tibial nerve leaves the posterior com-

partment of the leg by passing deep to the

flexor retinaculum in the interval between

the medial malleolus and calcaneus. The area

involved is from the medial malleolus to the

calcaneus, and the heel pain results from com-

pression of the tibial nerve by the ﬂexor reti-

naculum (Moore, p 636).

88. (E) The ankle is the most frequently injured

major joint in the body. Ankle sprains are most

common. A sprained ankle is nearly always an

inversion injury (Moore, p 636).

89. (D) A Pott’s fracture-dislocation of the ankle

occurs when the foot is forcibly everted. This

action pulls on the extremely strong medial lig-

ament, often tearing off the medial malleolus.

The talus then moves laterally, shearing off the

lateral malleolus or, more commonly, breaking

the ﬁbula superior to the inferior tibioﬁbular

joint (Moore, p 636).

90. (B) The grip of the malleoli on the trochlea is

strongest during dorsiﬂexion of the foot, be-

cause this movement forces the wider, anterior

part of the trochlea posteriorly, spreading the

tibia and ﬁbula slightly apart (Moore, p 632).

91. (B) Genu varum and genu valgum result in

deviation of the tibia from the midline. In genu

varum, the tibia is diverted medially, and in

genu valgum, the tibia is diverted laterally;

these deformities cause unequal weight distri-

bution. In the varum deformity, the medial side

of the knee takes all the pressure, leading to

wear and tear of the medial meniscus (Moore,

p 630).

92. (E) The stability of the knee joint depends on

the strength and actions of the surrounding

muscles and their tendons. The ligaments that

connect the femur and tibia are also important.

Of these supports, the muscles are most impor-

106 6: The Lower Limb

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tant; therefore, many sport injuries are pre-

ventable through appropriate conditioning

and training. The most important muscle in

stabilizing the knee joint is the large quadri-

ceps femoris, particularly inferior ﬁbers of the

vastus medialis and lateralis. The knee joint

will function surprisingly well following a lig-

ament strain if the quadriceps is well condi-

tioned (Moore, pp 617–618).

93. (D) Fractures of the femoral neck are intracap-

sular, and realignment of the neck fragments

requires internal skeletal ﬁxation. Femoral neck

fractures are among the most troublesome and

problematic of all fractures (Moore, p 614).

94. (B) The iliopsoas is the strongest ﬂexor of the

hip joint (Moore, p 613).

95. (D) Medial rotators of the hip joint include

anterior ﬁbers of the gluteus medius, gluteus

minimus, and tensor fascia lata; lateral rotators

include the obturator externus, obturator inter-

nus, superior gemellus, piriformis, quadratus

femoris, and gluteus maximus (Moore, p 613).

96. (B) The pulse of the dorsalis pedis artery, or

dorsal artery of the foot, is evaluated during a

physical examination of the peripheral vascu-

lar system. Dorsalis pedis pulses may be pal-

pated with the feet slightly dorsiﬂexed (Moore,

pp 603–604).

97. (C) The tendon of the biceps femoris may be

traced by palpating its distal attachment to the

lateral side of the head of the ﬁbula. This tendon

and the neck of the fibula guide the examin-

ing ﬁnger to the common ﬁbular nerve (Moore,

p 592).

98. (C) Because of its minor role, the plantaris

tendon can be removed for grafting without

causing any disability (Moore, p 586).

99. (A) Shin splints commonly result from trau-

matic injury or athletic overexertion of muscles

in the anterior compartment—especially the

tibialis anterior (Moore, p 580).

100. (C) The tibialis anterior is the strongest dorsi-

ﬂexor and invertor of the foot (Moore, p 579).

101. deep peroneal nerve

102. tibialis anterior

103. extensor digitorum longus

104. extensor digitorum brevis

105. dorsalis pedis artery

106. abductor digiti minimi

107. ﬂexor digitorum brevis

108. lateral plantar nerve

109. medial plantar nerve

110. lumbrical

111. gluteus minimus

112. sciatic nerve

113. semitendinosus

114. long head of biceps femoris

115. soleus

Answers and Explanations: 80–115 107

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109

DIRECTIONS (Questions 1 through 146): Each of the

numbered items or incomplete statements in this

section is followed by answers or by completions

of the statement. Select the ONE lettered answer or

completion that is BEST in each case.

1. Which of the following is NOT a bone of the

neurocranium?

(A) palatine bones

(B) parietal bones

(D) temporal bones

(E) ethmoid bone

2. Which of the following is NOT a bone of the

facial skeleton?

(A) maxilla

(B) zygomatic bone

(D) inferior nasal concha

(E) nasal bone

3. The metopic suture is a persistence of which of

the following?

(A) frontal suture

(B) coronal suture

(D) lambdoid suture

(E) hypophyseal suture

4. The external occipital protuberance is also

known as which of the following?

(A) nasion

(B) inion

CHAPTER 7

The Head and Neck

Questions

(D) pterion

(E) vertebra prominens

5. Which of the following best describes the land-

mark known as lambda?

(A) point on calvaria at junction of sagittal

and lambdoid sutures

(B) point on calvaria at junction of sagittal

and coronal sutures

noid, squamous temporal, frontal, and

parietal bones

(D) star-shaped landmark at junction of pari-

etomastoid, occipitomastoid, and lamb-

doid sutures

(E) smooth prominence on frontal bone

superior to root of nose

6. The superior point of the neurocranium in the

midline is known as which of the following?

(A) pterion

(B) bregma

(D) asterion

(E) nasion

7. Which of the following foramina is NOT in the

middle cranial fossa?

(A) foramen rotundum

(B) foramen spinosum

(D) groove of greater petrosal nerve

(E) foramen magnum

109

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8. Which of the following foramina is located in

the anterior cranial fossa?

(A) foramen cecum

(B) optic canals

(D) foramen ovale

(E) condylar canal

9. Which of the following foramina does NOT

transmit emissary veins?

(A) foramen cecum

(B) condylar canal

(D) parietal foramen

(E) anterior ethmoidal foramina

10. The superior orbital ﬁssure transmits all of the

following EXCEPT

(A) ophthalmic division of the trigeminal

nerve

(B) maxillary division of the trigeminal nerve

(D) trochlear nerve

(E) abducens nerve

11. All of the following transmit an arterial branch

to the meninges EXCEPT

(A) foramen ovale

(B) foramen rotundum

(D) jugular foramen

(E) mastoid foramen

12. The foramina in the cribriform plate transmit

which of the following?

(A) axons of olfactory cells

(B) posterior ethmoidal arteries

(D) dural veins

(E) sympathetic plexus

13. In addition to the optic nerves, the optic canals

transmit which of the following?

(A) ophthalmic veins

(B) oculomotor nerve

(D) ophthalmic arteries

(E) nerve branches to the meninges

14. The maxillary division of the trigeminal nerve

is transmitted through which of the following?

(A) foramen rotundum

(B) foramen ovale

(D) foramen spinosum

(E) foramen lacerum

15. Which of the following transmits a nerve branch

to the meninges?

(A) foramen spinosum

(B) mastoid foramen

(D) foramen magnum

(E) foramen oval

16. The foramen magnum transmits all of the fol-

lowing EXCEPT

(A) medulla and meninges

(B) vertebral arteries

(D) dural veins

(E) internal carotid artery

17. The jugular foramen transmits all of the fol-

lowing EXCEPT

(A) glossopharyngeal nerve

(B) vagus nerve

(D) inferior petrosal and sigmoid sinuses

(E) sympathetic plexus

18. Which of the following is NOT true regarding

the buccinator?

(A) It is a muscle of mastication.

(B) It is innervated by the facial nerve.

teeth to assist in chewing.

(D) It expels air from the oral cavity.

(E) It draws the mouth to one side when act-

ing unilaterally.

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19. Which of the following is NOT a muscle of fa-

cial expression?

(A) platysma

(B) nasalis

(D) orbicularis oculi

(E) temporalis

20. The mentalis does which of the following?

(A) elevates eyebrows and skin of forehead

(B) functions as a sphincter of oral opening

nostril

(D) elevates and protrudes lower lip

(E) draws ala of nose toward nasal septum

21. The orbicularis oculi is innervated by

(A) optic nerve

(B) oculomotor nerve

(D) trigeminal nerve

(E) facial nerve

22. The facial nerve innervates all of the following

EXCEPT

(A) procerus

(B) corrugator supercilii

(D) depressor anguli oris

(E) zygomaticus major

23. All muscles of facial expression develop from

which pharyngeal arch?

(A) ﬁrst arch

(B) second arch

(D) fourth arch

(E) sixth arch

24. Which of the following does NOT insert on the

angle of the mouth?

(A) platysma

(B) buccinator

(D) zygomaticus major

(E) depressor septi

25. In respect to the orbicularis oculi, which of the

following is true?

(A) Its orbital part delicately closes the eye-

lids in blinking.

(B) Its palpebral part draws the eyelids

medially so that tears may be drained.

in squinting.

(D) It is innervated by a zygomatic branch of

the facial nerve.

(E) It takes origin from the skin of the margin

of the orbit and the tarsal plate, and it

inserts on the lacrimal bone, medial palpe-

bral ligament, and medial orbital margin.

26. Which of the following cutaneous nerves is

derived from the ophthalmic nerve?

(A) external nasal nerve

(B) infraorbital nerve

(D) zygomaticofacial nerve

(E) auriculotemporal nerve

27. Which of the following nerves arises by two

roots that surround the middle meningeal

artery?

(A) auriculotemporal nerve

(B) buccal nerve

(D) zygomaticotemporal nerve

(E) zygomaticofacial nerve

28. Which of the following nerves is NOT cor-

rectly matched with its distribution?

(A) frontal nerve . . . skin of forehead, scalp,

eyelid, and nose

(B) supraorbital nerve . . . skin of forehead

as far as vertex

head

(D) infratrochlear . . . skin and conjunctiva of

upper eyelid

(E) lacrimal . . . skin on dorsum of nose

Questions: 8–28 111

0523-07 Chap 7 07/15/02 15:35 Page 111

29. Which of the following sequences of nerve

branches is NOT correct?

(A) ophthalmic nerve . . . frontal nerve . . .

supraorbital nerve

(B) ophthalmic nerve . . . frontal nerve . . .

infratrochlear nerve

(D) mandibular nerve . . . auriculotemporal

nerve

(E) mandibular nerve . . . inferior alveolar

nerve . . . mental nerve

30. Which of the following nerves is correctly

described with respect to its course?

(A) The auriculotemporal travels from the

anterior division of the mandibular

nerve in the infratemporal fossa to reach

the cheek.

(B) The buccal nerve travels from the poste-

rior division of the mandibular nerve

between the neck of the mandible and

the external acoustic meatus.

palpebral fascia of the upper eyelid near

the lateral canthus of the eye.

(D) The infratrochlear nerve passes superi-

orly on the medial surface of the supra-

orbital nerve.

(E) The supratrochlear nerve emerges

through the supraorbital notch and

divides into branches.

31. The lacrimal nerve innervates the lacrimal

gland with ﬁbers

(A) from the ophthalmic nerve

(B) borrowed via a communicating branch

from the maxillary nerve

(D) from the optic nerve

(E) from the sympathetic plexus

32. The maxillary nerve gives off branches to

which of the following ganglia?

(A) otic ganglion

(B) ciliary ganglion

(D) pterygopalatine ganglion

(E) geniculate ganglion

33. Which of the following is NOT a branch of the

facial nerve?

(A) temporal

(B) zygomatic

(D) mental

(E) cervical

34. The temporal branch of CN VII does NOT

innervate which of the following?

(A) auricularis superior

(B) auricularis anterior

(D) orbicularis oculi (superior part)

(E) orbicularis oculi (inferior part)

35. Which of the following is true regarding the

stylomastoid foramen?

(A) It is located between the styloid and

mastoid processes of the sphenoid bone.

(B) CN V is transmitted through it.

through it.

(D) The stylomastoid branch of the posterior

auricular artery travels though it.

(E) It is a common site of lesion for the glos-

sopharyngeal nerve.

36. Which of the following is NOT a branch of the

facial artery?

(A) inferior labial artery

(B) superior labial artery

(D) angular artery

(E) retromandibular artery

37. Which of the following is a branch of internal

carotid artery?

(A) supratrochlear artery

(B) facial artery

112 7: The Head and Neck

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(D) superﬁcial temporal artery

(E) mental artery

38. Which of the following is NOT true?

(A) The angular artery is distributed to the

superior part of the cheek and lower

eyelid.

(B) The occipital artery is distributed to the

scalp in the back of the head.

uted to the parotid gland and duct.

(D) The mental artery is distributed to facial

muscles and skin of the chin.

(E) The supratrochlear artery is distributed

to the muscles and skin of the scalp.

39. Which of the following is NOT contained

within the parotid gland?

(A) facial nerve

(B) facial artery

(D) parotid lymph nodes

(E) branches of the facial nerve

40. Parasympathetic fibers from CN IX travel to

the parotid gland via which of the following

nerves?

(A) auriculotemporal nerve

(B) great auricular nerve

nerve

(D) external carotid nerve plexus

(E) retromandibular nerve

41. Parasympathetic ﬁbers from CN IX synapse in

which ganglion before traveling to the parotid

gland?

(A) otic ganglion

(B) ciliary ganglion

(D) pterygopalatine ganglion

(E) trigeminal ganglion

42. Which of the following lists the layers of the

scalp in the correct order?

(A) skin, connective tissue, auricular layer,

loose connective tissue, pericranium

(B) skin, aponeurosis, connective tissue,

loose connective tissue, pericranium

loose connective tissue, paradural layer

(D) skin, connective tissue, aponeurosis,

loose connective tissue, pericranium

(E) skin, cartilaginous layer, aponeurosis,

loose connective tissue, pericranium

43. Which of the following descriptions is correct?

(A) The superior sagittal sinus runs superior

to the brain in the inferior free border of

the cerebral falx and ends in the straight

sinus.

(B) The inferior sagittal sinus is formed by

the union of the superior sagittal sinus

and the great cerebral vein and ultimately

joins the conﬂuence of the sinuses.

courses in the posterior cranial fossa and

ultimately become the internal jugular

veins.

(D) The occipital sinus lies in the convex

attached border of the cerebral falx, run-

ning from the crista galli to the internal

occiptal protuberance.

(E) The cavernous sinus is situated on each

side of the sella turcica.

44. The cavernous sinus receives blood from all of

the following EXCEPT

(A) superior and inferior petrosal sinuses

(B) superior ophthalmic veins

(D) superﬁcial middle cerebral vein

(E) sphenoparietal sinus

45. Which of the following nerves is NOT con-

tained within the cavernous sinus?

(A) optic nerve

(B) oculomotor nerve

(D) trigeminal nerve (speciﬁcally the

ophthalmic division)

(E) abducent nerve

Questions: 29–45 113

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46. Which of the following does NOT contribute

to innervation of the dura mater?

(A) ophthalmic division of the trigeminal

nerve

(B) maxillary division of the trigeminal

nerve

(D) facial nerve

(E) C1, C2, and C3

47. Which of the following is correct in respect to

the brain?

(A) The midbrain is composed of the epithal-

amus, dorsal thalamus, and hypothala-

mus and surrounds the third ventricle.

(B) The pons is the rostral part of the brain-

stem and lies at the junction of the mid-

dle and posterior cranial fossae.

and medulla and ventral to the posterior

part of the cerebrum, beneath the tento-

rium.

(D) The cavity of the medulla oblongata

forms the inferior part of the fourth

ventricle.

(E) The cerebrum occupies the middle and

posterior cranial fossae and houses the

third and fourth ventricles.

48. Which of the following correctly describes the

ﬂow of cerebrospinal ﬂuid?

(A) lateral ventricles . . . cerebral aqueduct . . .

3rd ventricle . . . interventricular fora-

men . . . 4th ventricle . . . median and

lateral apertures . . . subarachnoid space

(B) lateral ventricles . . . interventricular fora-

men . . . 3rd ventricle . . . cerebral aque-

duct . . . 4th ventricle . . . median and

lateral apertures . . . subarachnoid space

foramen . . . 3rd ventricle . . . median and

lateral apertures . . . 4th ventricle . . .

cerebral aqueduct . . . subarachnoid

space

(D) lateral ventricles . . . median and lateral

apertures . . . 3rd ventricle . . . cerebral

aqueduct . . . 4th ventricle . . . interven-

tricular foramen . . . subarachnoid space

(E) lateral ventricles . . . straight sinus . . . 3rd

ventricle . . . conﬂuence of the sinuses . . .

4th ventricle . . . median and lateral aper-

tures . . . subarachnoid space

49. Which of the following is true regarding the

carotid canal?

(A) The carotid canal is located in the infe-

rior surface of the sphenoid bone in the

middle cranial fossa.

(B) Structures actually pass across rather

than through the area of the carotid

canal, which is an artifact in dry skulls

and is actually closed by cartilage in life.

carotid artery with associated para-

sympathetic nerves.

(D) The carotid canal contains the internal

carotid venous plexus connecting the cav-

ernous sinus and the internal jugular vein.

(E) The greater petrosal nerve enters behind

and above the carotid canal and leaves

anteriorly as the nerve of the pterygoid

canal.

50. Which of the following foramina is unpaired?

(A) foramen lacerum

(B) greater palatine foramen

(D) lesser palatine foramen

(E) pterygoid canal

51. The oculomotor nerve emerges between which

two arteries of the cerebral arterial circle?

(A) posterior inferior cerebellar artery and

anterior inferior cerebellar artery

(B) anterior inferior cerebellar artery and

labyrinthine artery

lar artery

(D) superior cerebellar artery and posterior

cerebral artery

(E) posterior cerebral artery and middle

cerebral artery

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52. What nerve emerges between the labyrinthine

artery and the anterior inferior cerebellar

artery?

(A) optic

(B) trochlear

(D) abducent

(E) facial

53. Which artery is NOT a branch of the vertebral

artery system?

(A) basilar

(B) posterior cerebral

(D) anterior spinal

(E) ophthalmic

54. Which of the following arteries is correctly

matched with its distribution?

(A) anterior cerebral . . . temporal and occip-

ital lobes of brain

(B) middle cerebral . . . inferior aspect of

cerebral hemispheres and occipital lobe

(D) posterior cerebral . . . brainstem and

cerebellum

(E) basilar . . . optic tract, cerebral pedun-

cle, internal capsule, and

thalamus

55. Which of the following lists best describes the

pathway of tears from the lacrimal glands to

the nasal cavity?

(A) lacrimal ducts . . . lacrimal lake . . .

lacrimal canaliculi . . . lacrimal sac . . .

nasolacrimal duct

(B) lacrimal ducts . . . lacrimal sac . . . lacri-

mal canaliculi . . . lacrimal lake . . .

nasolacrimal duct

lacrimal ducts . . . lacrimal sac . . .

nasolacrimal duct

(D) lacrimal canaliculi . . . lacrimal sac . . .

lacrimal ducts . . . lacrimal lake . . .

nasolacrimal duct

(E) lacrimal punctum . . . lacrimal lake . . .

lacrimal papilla . . . lacrimal sac . . . naso-

lacrimal duct

56. Which of the following best describes the path-

way of parasympathetic ﬁbers to the lacrimal

gland?

(A) CN VII . . . greater petrosal nerve . . .

nerve of the pterygoid canal . . . ptery-

gopalatine ganglion . . . zygomatic

branch of V

. . . lacrimal branch of V

(B) CN IX . . . lesser petrosal nerve . . . nerve

of the pterygoid canal . . . pterygopala-

tine ganglion . . . infraorbital branch of

. . . lacrimal branch of V

ganglion . . . infraorbital branch of V

...

lacrimal branch of V

(D) CN VII . . . deep petrosal nerve . . . nerve

of the pterygoid canal . . . pterygopala-

tine ganglion . . . infratrochlear branch of

. . . lacrimal branch of V

(E) CN V . . . ophthalmic branch of V

...

lacrimal branch of V

57. Which of the following muscles does NOT take

its origin from the common tendinous ring?

(A) superior rectus

(B) inferior rectus

(D) medial rectus

(E) superior oblique

58. Which of the following muscles is NOT inner-

vated by the oculomotor nerve?

(A) levator palpebrae superioris

(B) lateral rectus

(D) inferior oblique

(E) superior rectus

Questions: 46–58 115

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59. Which of the following muscles is NOT prop-

erly matched with it main action?

(A) lateral rectus . . . abducts eyeball

(B) superior rectus . . . elevates, adducts, and

rotates eyeball medially

and rotates eyeball medially

(D) superior oblique . . . adducts, elevates,

and rotates eyeball laterally

(E) inferior oblique . . . abducts, elevates,

and rotates eyeball laterally

60. Which of the following nerves is correctly

matched with its distribution?

(A) long ciliary . . . postsynaptic sympathetic

ﬁbers to the dilator pupillae

(B) short ciliary . . . parasympathetic and

sympathetic ﬁbers to lens and cornea

gland

(D) infratrochlear . . . mucous membrane of

sphenoidal and ethmoid sinuses

(E) ethmoidal . . . conjunctiva and eyelids

61. Which of the following is true in respect to the

ciliary ganglion?

(A) Sympathetic ﬁbers synapse in the ciliary

ganglion.

(B) Afferent ﬁbers from the iris and cornea

pass through the ganglion.

optic nerve and medial rectus.

(D) Parasympathetic ﬁbers in the ganglion

are derived from CN VII.

(E) Parasympathetic ﬁbers in the ganglion

are distributed to the retina and lens.

62. Which of the following arteries is NOT a branch

of the ophthalmic artery?

(A) supraorbital

(B) supratrochlear

(D) anterior ethmoidal

(E) infraorbital

63. Which of the following arteries is correctly

paired with its course and distribution?

(A) central artery of retina . . . runs adjacent

to optic nerve, supplying rods and cones

(B) lacrimal artery . . . runs along medial rec-

tus to supply lacrimal gland and frontal

sinus

to supply choroid, rods, and cones

(D) long posterior cilaries . . . supplies lens

and cornea

(E) posterior ethmoidal . . . supplies dorsal

aspect of nose

64. Which of the following is NOT contained in

the infratemporal fossa?

(A) parts of temporal, lateral pterygoid, and

medial pterygoid muscles

(B) maxillary artery

(D) mandibular, inferior alveolar, buccal,

and lingual nerves

(E) pterygopalatine ganglion

65. Which of the following muscles is NOT a mus-

cle of mastication?

(A) buccinator

(B) temporalis

(D) lateral pterygoid

(E) masseter

66. The muscles of mastication are associated with

which branchial arch?

(A) ﬁrst arch

(B) second arch

(D) fourth arch

(E) ﬁfth arch

67. Which of the following depresses the mandible?

(A) lateral pterygoid

(B) medial pterygoid

(D) masseter

(E) mylohyoid

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68. Which of the following is NOT a branch of the

ﬁrst (mandibular) part of the ﬁrst part of the

maxillary artery?

(A) deep auricular

(B) anterior tympanic

meningeal

(D) inferior alveolar

(E) descending palatine

69. Which of the following is NOT a branch of

the second (pterygoid) part of the maxillary

artery?

(A) deep temporal

(B) labyrinthine

(D) masseteric

(E) buccal

70. Which of the following branches of the third

(pterygopalatine) part of the maxillary artery

is correctly paired with its distribution?

(A) infraorbital . . . maxillary molar and pre-

molar teeth, lining of maxillary sinus,

gingival

(B) posterior superior alveolar . . . inferior

eyelid, lacrimal sac, side of nose, supe-

rior lip

tine glands, mucous membrane of roof

of mouth

(D) artery of pterygoid canal . . . superior

part of pharynx, auditory tube, tympanic

cavity

(E) descending palatine . . . roof of pharynx,

sphenoidal sinus, inferior part of audi-

tory tube

71. Which of the following is NOT true in respect

to the sphenopalatine artery?

(A) It is the termination of the maxillary

artery.

(B) It supplies the lateral nasal wall.

(D) It supplies the paranasal sinuses.

(E) It is transmitted through the incisive

foramen.

72. Which of the following is true in respect to the

otic ganglion?

(A) It is located in the infratemporal fossa

just inferior to the foramen rotundum.

(B) Presynaptic parasympathetic ﬁbers in

the ganglion are derived from the facial

nerve.

the ganglion are destined for the parotid

gland.

(D) Sympathetic ﬁbers synapse in the gan-

glion before continuing on to sweat

glands, erector pili muscles, and blood

vessels.

(E) The ganglion contains cell bodies for

ﬁbers of the trigeminal nerve.

73. Which nerve is NOT correctly matched with

its distribution?

(A) lingual nerve . . . sensation from the

anterior two-thirds of the tongue

(B) lingual nerve . . . sensation from ﬂoor of

mouth and lingual gingivae

from anterior two-thirds of tongue

(D) chorda tympani nerve . . . secretomotor

ﬁbers to submandibular and sublingual

glands

(E) chorda tympani nerve . . . motor ﬁbers to

tensor tympani

74. The temporomandibular joint is what type of

joint?

(A) ﬁbrous joint

(B) cartilaginous joint

(D) pivot-type synovial joint

(E) saddle-type synovial joint

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75. Which of the following is correct in respect to

the hard palate?

(A) The hard palate is composed primarily

of the maxillary bones.

(B) The incisive canal and foramen transmit

the incisive nerves and greater palatine

vessels.

the nasopalatine nerves and greater

palatine nerve.

(D) The lesser palatine foramina transmit the

lesser palatine nerves but not the lesser

palatine vessels.

(E) The descending palatine artery is a

branch of the internal carotid artery.

76. Which of the following palate muscles is NOT

innervated by the cranial part of the accessory

nerve through a pharyngeal branch of the

vagus nerve via the pharyngeal plexus?

(A) tensor veli palatini

(B) levator veli palatini

(D) palatopharyngeus

(E) musculus uvulae

77. Which of the following is correctly matched

with its action?

(A) musculus uvulae . . . pulls uvula

inferiorly

(B) palatopharyngeus . . . pulls walls of phar-

ynx inferiorly, posteriorly, and laterally

during swallowing

part of tongue and draws soft palate

away from tongue

(D) levator veli palatini . . . depresses soft

palate during swallowing and yawning

(E) tensor veli palatini . . . opens auditory

tube during swallowing and yawning

78. Which of the following is NOT a type of lin-

gual papilla?

(A) vallate papillae

(B) foliate papillae

(D) ﬁliform papillae

(E) fungiform papillae

79. Which of the following muscles is NOT inner-

vated by the hypoglossal nerve?

(A) genioglossus

(B) hyoglossus

(D) palatoglossus

(E) intrinsic muscles of the tongue

80. Which of the following tongue muscles is cor-

rectly paired with its action?

(A) superior and inferior longitudinal . . .

curls tip and sides of tongue and short-

ens tongue

(B) transverse . . . ﬂattens and broadens

tongue

(D) genioglossus and hyoglossus . . . elevates

posterior part of tongue

(E) palatoglossus . . . depresses and retracts

tongue

81. Which of the following is true in respect to in-

nervation of the tongue?

(A) The chorda tympani nerve innervates

the mucosa of the anterior two-thirds

of the tongue in respect to general sensa-

tion (touch and temperature).

(B) The chorda tympani nerve innervates

the anterior two-thirds of the tongue in

respect to special sensation (taste).

rior one-third of the tongue in respect

to general sensation (touch and temper-

ature).

(D) The lingual nerve innervates the poste-

rior one-third of the tongue in respect to

special sensation (taste).

(E) The glossopharyngeal nerve innervates

the area of the tongue just anterior to the

epiglottis in respect to both general and

special sensation.

82. How do parasympathetic and taste ﬁbers from

the chorda tympani reach their destination?

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(A) via the lingual nerve, a branch of the

mandibular division of the trigeminal

nerve

(B) via the lingual nerve, a branch of the

glossopharyngeal nerve

vagus nerve

(D) via intermingled ﬁbers in the otic ganglion

(E) via the submandibular nerve, a branch of

the hypoglossal nerve

83. Which of the following taste sensations is cor-

rectly paired with its tongue region?

(A) savoriness . . . posterior part

(B) sourness . . . apex

(D) saltiness . . . lateral margins

(E) sweetness . . . posterior part

84. Which of the following vessels is NOT cor-

rectly paired with its respective area of supply

or drainage?

(A) dorsal lingual arteries . . . supply sub-

mandibular gland

(B) deep lingual artery . . . supplies anterior

tongue

gland and ﬂoor of mouth

(D) dorsal lingual veins . . . accompany the

lingual artery

(E) deep lingual veins . . . drain the apex of

the tongue, joining the sublingual vein

85. Which of the following is NOT correct?

(A) The parotid gland is supplied by

branches of the external carotid and

superﬁcial temporal arteries.

(B) The submandibular gland is supplied by

the submental artery.

by the parasympathetic ﬁbers of the

glossopharyngeal nerve that synapsed in

the submandibular ganglion.

(D) The sublingual glands are supplied by

the sublingual and submental arteries.

(E) The sublingual glands are innervated by

parasympathetic ﬁbers of the facial nerve.

86. Which of the following is NOT an opening to

the pterygopalatine fossa?

(A) pterygomaxillary ﬁssure

(B) sphenopalatine foramen

(D) foramen rotundum

(E) foramen ovale

87. Which of the following is NOT contained in

the pterygopalatine fossa?

(A) third part of maxillary artery

(B) maxillary nerve

(D) pterygopalatine ganglion

(E) optic nerve

88. Which of the following foramina are NOT prop-

erly matched with the structures they transmit?

(A) inferior orbital ﬁssure . . . ophthalmic

nerve, infraorbital vessels, orbital

branches of pterygopalatine ganglion

(B) infraorbital foramen and canal . . . infra-

orbital nerve and vessels

canal . . . pharyngeal nerves from maxil-

lary nerve and pterygopalatine ganglion

and pharyngeal branch of maxillary

artery

(D) zygomaticofacial foramen . . . zygoma-

ticofacial nerve and vessels

(E) zygomaticotemporal foramen . . .

zygomaticotemporal nerve and vessels

89. The nerve of the pterygoid canal is composed

of which of the following?

(A) lesser petrosal nerve and deep petrosal

nerve

(B) greater petrosal nerve and deep petrosal

nerve

(D) maxillary nerve and deep petrosal nerve

(E) maxillary nerve and greater petrosal

nerve

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90. The nerve of the pterygoid canal does NOT

innervate which of the following?

(A) lacrimal gland

(B) palatine glands

(D) mucosal glands of upper pharynx

(E) submandibular gland

91. Which of the following paranasal sinuses com-

municates with the nasal cavity in the superior

meatus?

(A) posterior ethmoidal sinuses

(B) frontal sinus

(D) sphenoidal sinus

(E) maxillary sinus

92. Where does the nasolacrimal duct communi-

cate with the nasal cavity?

(A) superior meatus

(B) middle meatus

(D) nasopharynx

(E) sphenoidal sinus

93. Which of the following is a separate bone?

(A) superior nasal concha

(B) middle nasal concha

(D) crista galli

(E) glabella

94. Which of the following does NOT supply the

medial and lateral walls of the nasal cavity?

(A) sphenopalatine artery

(B) anterior and posterior ethmoidal arteries

(D) infraorbital artery

(E) superior labial artery

95. Which of the following does NOT innervate

the nasal mucosa?

(A) sphenopalatine nerve

(B) nasopalatine nerve

(D) anterior ethmoidal nerve

(E) posterior ethmoidal nerve

96. Which of the following is NOT correct regard-

ing innervation of the ear?

(A) The auricle is innervated by the great

auricular nerve and auriculotemporal

nerve.

(B) The external surface of the tympanic

membrane is innervated by the auricu-

lotemporal nerve and even a small

branch of the vagus.

vated by the tympanic plexus (ﬁbers from

the facial and glossopharyngeal nerves).

(D) The internal surface of the tympanic

membrane is innervated by the

glossopharyngeal nerve.

(E) Sensory cell bodies of the vestibulo-

cochlear nerve are located in the genicu-

late ganglion.

97. Which of the following correctly describes a

wall of the tympanic cavity and its underlying

structure?

(A) tegmental roof . . . cochlea, contained in

the promontory

(B) ﬂoor . . . superior bulb of internal jugular

vein

cranial fossa

(D) anterior wall . . . mastoid cells and facial

nerve

(E) posterior wall . . . carotid canal

98. Which of the following is NOT contained in

the tympanic cavity?

(A) auditory ossicles

(B) tympanic plexus

(D) lesser petrosal nerve

(E) stapedius and tensor tympani muscles

99. Which of the following is NOT true in respect

to the pharyngotympanic tube?

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(A) The salpingopharyngeus closes the tube.

(B) It opens posterior to the inferior meatus

of the nasal cavity.

with atmospheric pressure.

(D) The tensor veli palatini and levator veli

palatini work together to open the tube.

(E) It is supplied by the ascending pharyn-

geal artery, middle meningeal artery,

and artery of the pterygoid canal.

100. What innervates the tensor tympani?

(A) maxillary nerve

(B) mandibular nerve

(D) vestibulocochlear nerve

(E) vagus

101. Which of the following is true?

(A) The malleus articulates with the stapes

and is moved by the tensor tympani.

(B) The round window is an opening in the

medial wall of the tympanic cavity lead-

ing to the vestibule of the inner ear and

is closed by the base of the stapes.

damage to the internal ear when one

hears loud noises.

(D) The stapedius is innervated by the

chorda tympani.

(E) The stapedius pulls the stapes anteriorly

and ﬂattens its base, loosening the annu-

lar ligament and increasing oscillatory

range.

102. Which of the following foramina is NOT cor-

rectly matched with its function?

(A) cochlear aqueduct . . . allows bony

labyrinth to communicate with sub-

arachnoid space; also contains

labyrinthine vein

(B) aqueduct of the vestibule . . . transmits

endolymphatic duct, an artery, and a

vein

vestibulocochlear nerve and vestibular

artery

(D) mastoid canaliculus . . . transmits auricu-

lar branch of the vagus

(E) tympanic canaliculus . . . tympanic

branch of the glossopharyngeal nerve

103. Which of the following is true?

(A) The cochlear labyrinth is composed of

the utricle, the saccule, and three semi-

circular canals.

(B) The membranous labyrinth contains per-

ilymph.

lear duct to the spiral canal of the cochlea.

(D) The spiral membrane forms the ﬂoor of

the cochlear duct.

(E) The saccule is continuous with the coch-

lear duct through the ductus reuniens.

104. Which of the following is NOT true in respect

to typical cervical vertebrae?

(A) They have short, biﬁd spinous processes.

(B) The inferior facets of articular processes

are directed inferoposteriorly, and supe-

rior facets are directed superoposteriorly.

men transversarium, which transmits

the vertebral vein and artery except for

C7, where it transmits only the vertebral

artery.

(D) The vertebral foramen is large and

triangular.

(E) The vertebral body is small, with a con-

cave superior surface and a convex infe-

rior surface.

105. Which fascial layer is NOT correctly matched

with the structures it encloses?

(A) superﬁcial cervical fascia . . . platysma

(B) investing layer of deep cervical fascia . . .

trapezius and sternocleidomastoid

fascia . . . suprahyoid muscles

(D) prevertebral layer of deep cervical

fascia . . . longus colli, longus capitis,

scalenes, deep cervical muscles

(E) carotid sheath . . . carotid arteries, inter-

nal jugular vein, vagus

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106. Which of the following is NOT a superior

attachment of the trapezius?

(A) lateral surface of mastoid process

(B) medial third of superior nuchal line

(D) ligamentum nuchae

(E) spinous processes of C7–T12

107. Which of the following is NOT correct in re-

spect to the posterior triangle of the neck?

(A) Its anterior boundary is formed by the

posterior border of the SCM.

(B) Its posterior boundary is formed by the

anterior border of the trapezius.

middle third of the clavicle.

(D) Its roof is formed by the platysma.

(E) Its ﬂoor is formed by the muscles cov-

ered by the prevertebral layer of deep

cervical fascia.

108. The anterior triangle of the neck does NOT con-

tain which of the following smaller triangles?

(A) supraclavicular triangle

(B) submandibular triangle

(D) carotid triangle

(E) muscular triangle

109. Which of the following muscles is NOT con-

tained in the posterior cervical triangle?

(A) splenius capitis

(B) levator scapulae

(D) posterior scalene

(E) stylohyoid

110. Which of the following is a suprahyoid muscle?

(A) mylohyoid

(B) sternohyoid

(D) sternothyroid

(E) thyrohyoid

111. Which of the following is innervated by the

trigeminal nerve?

(A) mylohyoid

(B) geniohyoid

(D) posterior belly of the digastric

(E) thyrohyoid

112. Which of the following is NOT an anterior ver-

tebral muscle?

(A) longus colli

(B) longus capitis

(D) rectus capitis anterior

(E) rectus capitis lateralis

113. Of the following, which is innervated by the

dorsal rami?

(A) splenius capitis

(B) levator scapulae

(D) middle scalene

(E) anterior scalene

114. Which of the following NEVER exists?

(A) middle thyroid artery

(B) middle thyroid vein

(D) parathyroid veins

(E) anterior jugular vein

115. Which of the following contains PAIRED

laryngeal cartilages?

(A) thyroid, cricoid, epiglottic

(B) arytenoid, corniculate, cuneiform

(D) corniculate, cricoid, cuneiform

(E) cuneiform, corniculate, epiglottic

116. Which of the following intrinsic laryngeal

muscles is NOT innervated by the recurrent

laryngeal nerve?

(A) transverse arytenoids

(B) oblique arytenoids

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(D) posterior cricoarytenoid

(E) lateral cricoarytenoid

117. Which of the following is the primary tensor of

the vocal fold?

(A) cricothyroid

(B) thyroarytenoid

(D) aryepiglottic

(E) posterior cricoarytenoid

118. Which of the following abducts the vocal fold?

(A) vocalis

(B) transverse arytenoids

(D) thyroarytenoid

(E) posterior cricoarytenoid

119. Which of the following is the sensory nerve of

the larynx?

(A) external laryngeal nerve

(B) recurrent laryngeal nerve

(D) paratracheal nerve

(E) inferior thyroid nerve

120. Which of the following are commonly referred

to as the adenoids?

(A) pharyngeal tonsils

(B) submandibular glands

(D) lingual tonsils

(E) sublingual glands

121. Which of the following is NOT innervated by

the cranial root of the accessory nerve?

(A) middle constrictor

(B) inferior constrictor

(D) salpingopharyngeus

(E) stylopharyngeus

122. Which of the following has an insertion on the

pharyngeal tubercle of the occipital bone?

(A) superior constrictor

(B) middle constrictor

(D) salpingopharyngeus

(E) stylopharyngeus

123. Which of the following passes through the gap

between the superior constrictor and the skull?

(A) tensor veli palatini

(B) ascending palatine artery

(D) stylohyoid ligament

(E) stylopharyngeus

124. Which of the following passes through the gap

between the superior and middle constrictors?

(A) glossopharyngeal nerve

(B) levator veli palatini

(D) superior laryngeal artery

(E) superior laryngeal vein

125. Which of the following passes through the

gap between the middle and inferior con-

strictors?

(A) superior laryngeal artery

(B) stylopharyngeus

(D) recurrent laryngeal nerve

(E) inferior laryngeal artery

126. Which of the following passes through the gap

inferior to the inferior constrictor?

(A) vagus nerve

(B) internal laryngeal nerve

(D) inferior laryngeal artery

(E) superior laryngeal vein

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127. Which of the following is correct?

(A) Le Fort I fracture: horizontal fracture of

the maxillae

(B) Le Fort I fracture: fracture through the

maxillary sinuses, infraorbital foramina,

lacrimals, and ethmoids

through superior orbital ﬁssures, eth-

moid and nasal bones, and greater wings

of the sphenoids

(D) Le Fort III fracture: horizontal fracture of

the maxillae

(E) Le Fort III fracture: fracture through the

maxillary sinuses, infraorbital foramina,

lacrimals, and ethmoids

128. Which of the following is NOT present at birth?

(A) styloid process

(B) mastoid process

(D) tympanic membrane

(E) clavicles

129. The inferior alveolar nerve is best blocked at

which location for dental work?

(A) mental foramen

(B) greater palatine foramen

(D) mandibular foramen

(E) lingual foramen

130. A lesion to the zygomatic branch of CN VII

would cause which of the following?

(A) the inability to empty food from the

vestibule of the cheeks

(B) a drooping corner of the mouth

(D) paralysis of the muscles of mastication

(E) a drooping lower eyelid

131. The facial veins make clinically important con-

nections with the cavernous sinus through

which veins?

(A) lingual veins

(B) trigeminal veins

(D) great cerebral vein

(E) meningeal veins

132. An epidural hematoma consists of blood from

which vessel?

(A) middle meningeal artery

(B) cerebral veins

(D) circle of Willis

(E) vertebral artery

133. Cerebral compression is NOT attributed to

which of the following?

(A) intracranial collections of blood

(B) obstruction of CSF ﬂow

(D) edema of brain

(E) viral accumulation at blood-brain barrier

134. Ptosis results from a lesion of which nerve?

(A) optic nerve

(B) oculomotor nerve

(D) trigeminal nerve

(E) abducens nerve

135. Horner syndrome is caused by a lesion of which

of the following?

(A) oculomotor nerve

(B) trigeminal nerve

(D) vagus nerve

(E) cervical sympathetic trunk

136. Which of the following is NOT a symptom of

Horner syndrome?

(A) pupillary constriction

(B) ptosis

(D) absence of sweating on face and neck

(E) lack of lacrimation

137. A lesion of the hypoglossal nerve would result

in which of the following?

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(A) loss of taste on posterior one-third of

tongue

(B) deviation of protruded tongue toward

unaffected side

affected side

(D) inability to retract tongue

(E) loss of salivation

138. What type of injury or condition might cause

a lesion to the olfactory tract?

(A) fracture involving optic canal

(B) fracture of cribriform plate

(D) pituitary tumor

(E) epidural hematoma

139. Sagging of the soft palate, deviation of the

uvula to the normal side, and hoarseness

might be caused by a lesion to which nerve?

(A) facial nerve

(B) glossopharyngeal nerve

(D) accessory nerve

(E) hypoglossal nerve

140. A superﬁcial neck laceration might result in

which abnormal ﬁnding?

(A) paralysis of the scm and superior

ﬁbers of the trapezius, drooping of the

shoulder

(B) paralysis of the mylohyoid, anterior

belly of the digastric, tensor tympani,

and tensor veli palatini

digastric, stylohyoid, and stapedius

(D) anosmia

(E) tinnitus

141. The eye is turned down and out. What type

and site of lesion do you expect?

(A) fracture of cribriform plate

(B) stretching of a nerve as it courses around

the brainstem

region

(D) pressure from herniating uncus on the

nerve or fracture in the cavernous sinus

(E) acoustic neuroma

142. A laceration or contusion in the parotid region

or a fracture of the temporal bone might dam-

age which nerve?

(A) trigeminal nerve

(B) abducens nerve

(D) glossopharyngeal nerve

(E) vagus nerve

143. Which nerve might be damaged by a fracture

involving the cavernous sinus?

(A) olfactory tract

(B) optic nerve

(D) facial nerve

(E) vestibulocochlear nerve

144. The stylopharyngeus is associated with which

branchial arch?

(A) ﬁrst

(B) second

(D) fourth

(E) sixth

145. The arytenoid and cricoid cartilages and laryn-

geal connective tissue are formed by what?

(A) lateral plate mesoderm

(B) paraxial mesoderm

(D) ectodermal placodes

(E) endoderm

146. Which of the following prominences is NOT

correctly paired with the structures formed

from it?

(A) frontonasal: forehead, bridge of nose

(B) maxillary: lateral portion of upper lip

and tip of nose

(D) lateral nasal: alae of nose

(E) mandibular: cheeks

Questions: 127–146 125

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DIRECTIONS (Questions 147 through 151): Identify the anatomical features indicated on the art below.

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Questions: 147–156 127

DIRECTIONS (Questions 152 through 156): Identify the anatomical features indicated on the art below.

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DIRECTIONS (Questions 157 through 161): Identify the anatomical features indicated on the art below.

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DIRECTIONS (Questions 162 through 166): Identify the anatomical features indicated on the art below.

Questions: 157–171 129

DIRECTIONS (Questions 167 through 171): Identify the anatomical features indicated on the art below.

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DIRECTIONS (Questions 172 through 176): Identify the anatomical features indicated on the art below.

DIRECTIONS (Questions 177 through 181): Identify the anatomical features indicated on the art below.

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DIRECTIONS (Questions 182 through 186): Identify the anatomical features indicated on the art below.

Questions: 172–186 131

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Answers and Explanations

1. (A) The bones of the neurocranium include the

frontal bone, paired parietal bones, paired tem-

poral bones, the occipital bone, the sphenoid

bone, and the ethmoid bone (Moore, p 832).

2. (C) The bones of the facial skeleton (viscerocra-

nium or splanchnocranium) include the vomer,

the mandible, inferior nasal conchae, the pala-

tine bones, the zygomatic bones, the maxillae,

the nasal bones, and the lacrimal bones (Moore,

p 832).

3. (A) When the frontal suture persists, it is

known as the metopic suture (Moore, p 834).

4. (B) The external occipital protuberance is also

known as the inion (Moore, p 839).

5. (A) Lambda is the point on the calvaria at the

junction of the sagittal and lambdoid sutures

(Moore, p 842).

6. (C) The vertex is the superior point of the neu-

rocranium in the midline (Moore, p 842).

7. (E) The foramen magnum is in the posterior

cranial fossa (Moore, p 846).

8. (A) The foramen cecum is located in the ante-

rior cranial fossa (Moore, p 846).

9. (E) The anterior and posterior ethmoidal fora-

mina transmit anterior and posterior ethmoidal

arteries and nerves, not emissary veins (Moore,

p 846).

10. (B) The superior orbital ﬁssure transmits the

ophthalmic veins, ophthalmic division of the

trigeminal nerve, oculomotor nerve, trochlear

nerve, abducens nerve, and sympathetic ﬁbers

(Moore, p 846).

11. (B) The foramen ovale transmits the accessory

meningeal artery. The foramen spinosum trans-

mits the middle meningeal artery. The groove

of the greater petrosal nerve transmits the

petrosal branch of the middle meningeal artery.

The jugular foramen transmits the meningeal

branches of the ascending pharyngeal and oc-

cipital arteries. The mastoid foramen transmits

the meningeal branch of the occipital artery

(Moore, p 846).

12. (A) The foramina in the cribriform plate trans-

mit axons of olfactory cells in the olfactory epi-

thelium (Moore, p 846).

13. (D) The optic canals transmit the optic nerves

and the ophthalmic arteries (Moore, p 846).

14. (A) The foramen rotundum transmits the max-

illary division of the trigeminal nerve (Moore,

p 846).

15. (A) The foramen spinosum transmits the men-

ingeal branch of the mandibular division of the

trigeminal nerve (Moore, p 846).

16. (E) The foramen magnum transmits the me-

dulla and meninges, vertebral arteries, spinal

roots of the accessory nerve, dural veins, and the

anterior and posterior spinal arteries (Moore,

p 846).

17. (E) The jugular foramen transmits the glos-

sopharyngeal nerve, vagus nerve, accessory

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nerve, internal jugular vein, inferior petrosal

and sigmoid sinuses, and meningeal branches

of ascending pharyngeal and occipital arteries

(Moore, p 846).

18. (A) The buccinator, a muscle of facial expres-

sion, is innervated by the facial nerve. It presses

the cheek against the molar teeth to assist in

chewing, and it expels air from the oral cavity.

It also draws the mouth to one side when act-

ing unilaterally (Moore, p 851).

19. (E) The temporalis is a muscle of mastication,

not of facial expression (Moore, p 851).

20. (D) The mentalis elevates and protrudes the

lower lip (Moore, p 851).

21. (E) The facial nerve innervates the orbicularis

oculi (Moore, p 851).

22. (C) The trigeminal nerve innervates the mas-

seter (Moore, p 921).

23. (B) The muscles of facial expression develop

from the second pharyngeal arch (Moore, p 852).

24. (E) The depressor septi inserts into part of the

nasal septum and widens the alar part of the

nasalis muscle during deep inspiration (Moore,

p 856).

25. (D) The orbicularis oculi is innervated by a

zygomatic branch of the facial nerve (Moore,

pp 851, 855–856).

26. (A) The external nasal nerve is a cutaneous

nerve derived from the ophthalmic nerve

(Moore, p 857).

27. (A) The auriculotemporal nerve arises by two

roots that surround the middle meningeal

artery (Moore, p 861).

28. (E) The lacrimal nerve is distributed to the

lacrimal gland and a small area of skin as well

as part of the conjunctiva. The external nasal

nerve is distributed to skin on the dorsum of

the nose, including the tip of the nose (Moore,

p 860).

29. (B) The ophthalmic nerve gives rise to the naso-

ciliary nerve, which in turn gives rise to the

infratrochlear nerve (Moore, p 860).

30. (C) The lacrimal nerve passes through the pal-

pebral fascia of the upper eyelid near the lateral

canthus of the eye (Moore, p 860).

31. (B) The lacrimal nerve innervates the lacrimal

gland with ﬁbers borrowed via a communicat-

ing branch from the maxillary nerve (Moore,

p 859).

32. (D) The maxillary nerve gives off branches to

the pterygopalatine ganglion (Moore, p 859).

33. (D) The mental nerve is a branch of the tri-

geminal nerve (Moore, p 863).

34. (E) The zygomatic branch of CN VII inner-

vates the inferior part of the orbicularis oculi

(Moore, p 863).

35. (D) The stylomastoid foramen is located be-

tween the styloid and mastoid processes of the

temporal bone. CN VII and the stylomastoid

branch of the posterior auricular artery travel

through it (Moore, p 862).

36. (E) The facial artery has the following branches:

inferior labial, superior labial, lateral nasal, and

angular (Moore, p 866).

37. (A) The supratrochlear and supraorbital ar-

teries are branches of the internal carotid ar-

tery, while most other arteries of the face are

branches of the external carotid artery (Moore,

p 866).

38. (C) The superﬁcial temporal artery supplies

the facial muscles and skin of the frontal and

temporal regions, while the transverse facial

artery supplies the parotid gland and duct

as well as muscles and skin of the face (Moore,

p 866).

39. (B) Within the parotid gland are found the fa-

cial nerve and its branches, the retromandibu-

lar vein, the external carotid artery, and parotid

lymph nodes (Moore, p 870).

Answers and Explanations: 1–39 133

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