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PART 2 (B) General visceral afferent (GVA) and

postganglionic sympathetic fibers
1. A 32-year-old patient who weighs 275 lb
(C) GVA and preganglionic sympathetic fibers
comes to the doctor’s office. On the surface
(D) General somatic efferent (GSE) and
of the chest, the physician is able to locate
postganglionic sympathetic fibers
the apex of the heart:
(E) GVA and GSE fibers
(A) At the level of the sternal angle
(B) In the left fourth intercostal space
4. A 17-year-old boy was involved in a gang
(C) In the left fifth intercostal space
fight, and a stab wound severed the white
(D) In the right fifth intercostal space
rami communicantes at the level of his sixth
(E) At the level of the xiphoid process of the
thoracic vertebra. This injury would result in
sternum
degeneration of nerve cell bodies in which
of the following structures?
2. A 43-year-old female patient has been
lying down on the hospital bed for more
(A) Dorsal root ganglion and anterior horn
than 4 months. Her normal, quiet expiration
of the spinal cord
is achieved by contraction of which of the
(B) Sympathetic chain ganglion and dorsal
following structures?
root ganglion
(A) Elastic tissue in the lungs and thoracic wall
(C) Sympathetic chain ganglion and posterior
(B) Serratus posterior superior muscles
horn of the spinal cord
(C) Pectoralis minor muscles
(D) Dorsal root ganglion and lateral horn of
(D) Serratus anterior muscles
the spinal cord
(E) Diaphragm
(E) Anterior and lateral horns of the spinal cord

3. A 23-year-old man received a gunshot

wound, and his greater splanchnic nerve
was destroyed. Which of the following nerve
fibers would be injured?
(A) General somatic afferent (GSA) and
preganglionic
sympathetic fibers
5. A 27-year-old cardiac patient with an
irregular heartbeat visits her doctor’s office
for examination. Where should the physician
place the stethoscope to listen to the sound
of the mitral valve?
(A) Over the medial end of the second left
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intercostal space (C) Left ventricle

(B) Over the medial end of the second right (D) Right ventricle
intercostal space (E) Base of the heart
(C) In the left fourth intercostal space at the
midclavicular line 8. A 5-year-old girl is brought to the
emergency department because of diffi culty
(D) In the left fi fth intercostal space at the
breathing (dyspnea), palpitations, and
midclavicular line
shortness of breath. Doppler study of the heart
reveals an atrial septal defect (ASD). This
(E) Over the right half of the lower end of
malformation usually results from incomplete
the body of the sternum
closure of which of the following
6. A 19-year-old man came to the emergency
embryonic structures?
department, and his angiogram
(A) Ductus arteriosus
exhibited that he was bleeding from the vein
(B) Ductus venosus
that is accompanied by the posterior
(C) Sinus venarum
interventricular artery. Which of the following
(D) Foramen ovale
veins is most likely to be ruptured?
(E) Truncus arteriosus
(A) Great cardiac vein
(B) Middle cardiac vein
9. A 54-year-old patient is implanted with
(C) Anterior cardiac vein
an artificial cardiac pacemaker. Which of the
(D) Small cardiac vein
following conductive tissues of the heart had
(E) Oblique veins of the left atrium
a defective function that required the
pacemaker?
7. A 37-year-old patient with palpitation was
(A) Atrioventricular (AV) bundle
examined by her physician, and one of the
(B) AV node
diagnostic records included a posterior–
(C) Sinoatrial (SA) node
anterior chest radiograph. Which of the
(D) Purkinje fi ber
following comprises the largest portion of the
(E) Moderator band
sternocostal surface of the heart seen on the
radiograph?
10. A thoracic surgeon removed the right
(A) Left atrium
middle lobar (secondary) bronchus along
(B) Right atrium
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with lung tissue from a 57-year-old heavy

smoker with lung cancer. Which of the 13. A 44-year-old man with a stab wound
following bronchopulmonary segments must
was brought to the emergency department,
contain cancerous tissues?
and a physician found that the patient was
(A) Medial and lateral
suffering from a laceration of his right
(B) Anterior and posterior
phrenic nerve. Which of the following
(C) Anterior basal and medial basal conditions has likely occurred?
(D) Anterior basal and posterior basal (A) Injury to only GSE fi bers
(E) Lateral basal and posterior basal (B) Difficulty in expiration
(C) Loss of sensation in the fibrous
pericardium and mediastinal pleura
11. The bronchogram of a 45-year-old
(D) Normal function of the diaphragm
female smoker shows the presence of a
(E) Loss of sensation in the costal part of the
tumor in the eparterial bronchus. Which
diaphragm
airway is most likely blocked?
(A) Left superior bronchus
14. An 8-year-old boy with ASD presents to a
(B) Left inferior bronchus
pediatrician. This congenital heart defect
(C) Right superior bronchus
shunts blood from the left atrium to the
(D) Right middle bronchus
right atrium and causes hypertrophy of the
(E) Right inferior bronchus
right atrium, right ventricle, and pulmonary
trunk. Which of the following veins opens
12. An 83-year-old man with a typical
coronary circulation has been suffering from into the hypertrophied atrium?
an embolism of the circumflex branch of the
(A) Middle cardiac vein
left coronary artery. This condition would
(B) Small cardiac vein
result in ischemia of which of the following
(C) Oblique cardiac vein
areas of the heart?
(D) Anterior cardiac vein
(A) Anterior part of the left ventricle
(E) Right pulmonary vein
(B) Anterior interventricular region
(C) Posterior interventricular region
15. A 37-year-old patient with severe chest
(D) Posterior part of the left ventricle
pain, shortness of breath, and congestive
(E) Anterior part of the right ventricle
heart failure was admitted to a local hospital.
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His coronary angiograms reveal a thrombosis (D) Ribs 7 and 9

in the circumflex branch of the left
coronary artery. Which of the following
conditions could result from the blockage of
blood flow in the circumflex branch?
(A) Tricuspid valve insuffi ciency
(B) Mitral valve insuffi ciency
(C) Ischemia of AV node
(D) Paralysis of pectinate muscle
(E) Ribs 9 and 11
18. A newborn baby is readmitted to the
hospital with hypoxia and upon testing is
found to have pulmonary stenosis,
transposition of the aorta, interventricular
septal defect, and hypertrophy of the right
ventricle. Which of the following is best
described by these symptoms?

(E) Necrosis of septomarginal trabecula (A) ASD

(B) Patent ductus anreriosus

16. A 75-year-old patient has been suffering (C) Tetralogy of Fallot

from lung cancer located near the cardiac (D) Aortic stenosis

notch, a deep indentation on the lung. Which of (E) Coarctation of the aorta
the following lobes is most likely to be
excised?
19. A 33-year-old patient is suffering from a
(B) (A) Superior lobe of the right lung
sudden occlusion at the origin of the
(B) Middle lobe of the right lung
descending (thoracic) aorta. This condition
(C) Inferior lobe of the right lung
would most likely decrease blood fl ow in
(D) Superior lobe of the left lung
which of the following intercostal arteries?
(E) Inferior lobe of the left lung
(A) Upper six anterior
(B) All of the posterior
17. A thoracentesis is performed to aspirate
(C) Upper two posterior
an abnormal accumulation of fluid in a
(D) Lower anterior
37-year-old patient with pleural effusion. A
(E) Lower six posterior
needle should be inserted at the midaxillary
line between which of the following two ribs
20. A 56-year-old patient recently suffered a
so as to avoid puncturing the lung?
myocardial infarction in the area of the apex
(A) Ribs 1 and 3
of the heart. The occlusion by atherosclerosis
(B) Ribs 3 and 5
is in which of the following arteries?
(C) Ribs 5 and 7

(A) Marginal artery
(B) Right coronary artery at its origin
(C) Anterior interventricular artery
(D) Posterior interventricular artery
(E) Circumfl ex branch of the left coronary
artery
21. A 75-year-old woman was admitted to a
local hospital, and bronchograms and
radiographs revealed a lung carcinoma in her
left lung. Which of the following structures or
characteristics does the cancerous lung
contain?
(A) Horizontal fissure
(B) Groove for superior vena cava (SVC)
(C) Middle lobe
(D) Lingula
(E) Larger capacity than the right
22. An 18-year-old girl is thrust into the
steering wheel while driving and experiences
Difficulty in expiration. Which of the
following muscles is most likely damaged?
(A) Levator costarum
(B) Innermost intercostal muscle
(C) External intercostal muscle
(D) Diaphragm
(E) Muscles of the abdominal wall
23. A 78-year-old patient presents with an
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advanced cancer in the posterior mediastinum.
The surgeons are in a dilemma as to
how to manage the condition. Which of the
following structures is most likely damaged?
(A) Brachiocephalic veins
(B) Trachea
(C) Arch of the azygos vein
(D) Arch of the aorta
(E) Hemiazygos vein
24. A 46-year-old patient comes to his doctor’s
office and complains of chest pain and
headache. His computed tomography (CT)
scan reveals a tumor located just superior to
the root of the right lung. Blood fl ow in
which of the following veins is most likely
blocked by this tumor?
(A) Hemiazygos vein
(B) Arch of the azygos vein
(C) Right subclavian vein
(D) Right brachiocephalic vein
(E) Accessory hemiazygos vein
25. A 21-year-old patient with a stab wound
reveals a laceration of the right vagus nerve
proximal to the origin of the recurrent
laryngeal nerve. Which of the following
conditions would most likely result from this
lesion?
(A) Contraction of bronchial muscle
(B) Stimulation of bronchial gland secretion
(C) Dilation of the bronchial lumen
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(D) Decrease in cardiac rate (A) Has a larger diameter than the right
primary
(E) Constriction of coronary artery
bronchus
(B) Often receives more foreign bodies than
26. A 5-year-old boy with breathing difficulty,
chest pain, and cough was admitted to a local the right primary bronchus
hospital. The pediatrician who examined
(C) Gives rise to the eparterial bronchus
the boy, along with laboratory results,
(D) Is longer than the right primary bronchus
diagnosed the child as having cystic fibrosis.
(E) Runs under the arch of the azygos vein
Which of the following structures is most
likely blocked?
29. A 62-year-old woman who is a heavy
(A) Trachea
smoker has an advanced lung cancer that
(B) Primary bronchus
spread into her right third intercostal space
(C) Secondary or lobar bronchi
posterior to the midaxillary line. If cancer cells
(D) Terminal bronchioles are carried in the venous drainage, they would
travel first to which of the following veins?
(E) Alveolar duct
(A) SVC
(B) Right superior intercostal vein
27. A 12-year-old boy was admitted to a
(C) Right brachiocephalic vein
local hospital with a known history of heart
(D) Azygos vein
problems. His left ventricular hypertrophy
(E) Hemiazygos vein
could result from which of the following
conditions?
30. A radiologist examines posterior–anterior
(A) A constricted pulmonary trunk
chest radiographs of a 27-year-old victim
(B) An abnormally small left AV opening
of a car accident. Which of the following
(C) Improper closing of the pulmonary valves
structures forms the right border of the
(D) An abnormally large right AV opening
cardiovascular silhouette?
(E) Stenosis of the aorta
(A) Arch of the aorta
(B) Pulmonary trunk
28. A 31-year-old man was involved in a
(C) SVC
severe automobile accident and suffered
(D) Ascending aorta
laceration of the left primary bronchus.
(E) Left ventricle
The damaged primary bronchus:

31. A 37-year-old man is brought to the
emergency department complaining of
severe chest pain. His angiogram reveals
thromboses of both brachiocephalic veins.
This condition would most likely cause a
dilation of which of the following veins?
(A) Azygos
(B) Hemiazygos
(C) Right superior intercostal
(D) Left superior intercostal
(E) Internal thoracic
32. A cardiologist is on clinical rounds with
her medical students. She asks them, “During
the cardiac cycle, which of the following
events occurs?”
(A) AV valves close during diastole
(B) Aortic valve closes during systole
(C) Pulmonary valve opens during diastole
(D) Blood fl ow in coronary arteries is
maximal during diastole
(E) Aortic valve closes at the same time as
AV valve
33. Coronary angiographs of a 44-year-old
male patient reveal an occlusion of the
circumflex branch of the left coronary artery.
This patient has been suffering from
myocardial infarction in which of the
following areas?
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(A) Right and left ventricles
(B) Right and left atria
(C) Interventricular septum
(D) Apex of the heart
(E) Left atrium and ventricle
34. A patient has a small but solid tumor in
the mediastinum, which is confined at the
level of the sternal angle. Which of the
following structures would most likely be
found at this level?
(A) Bifurcation of the trachea
(B) Beginning of the ascending aorta
(C) Middle of the aortic arch
(D) Articulation of the third rib with the
sternum
(E) Superior border of the superior
mediastinum
35. A 37-year-old house painter fell from a
ladder and fractured his left third rib and the
structures with which it articulated. Which of
the following structures would most likely
be damaged?
(A) Manubrium of the sternum
(B) Body of the second thoracic vertebra
(C) Spinous process of the third thoracic
vertebra
(D) Body of the fourth thoracic vertebra
(E) Transverse process of the second
thoracic vertebra
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(E) Tricuspid and pulmonary

36. A 45-year-old woman presents with a
tumor confi ned to the posterior mediastinum.
This could result in compression of
which of the following structures?
39. A 27-year-old patient with Marfan’s
syndrome has an aneurysm of the aortic arch.
This may compress which of the following
structures?

(A) Trachea (A) Right vagus nerve

(B) Descending aorta (B) Left phrenic nerve

(C) Arch of the aorta (C) Right sympathetic trunk

(D) Arch of the azygos vein (D) Left recurrent laryngeal nerve

(E) Phrenic nerve (E) Left greater splanchnic nerve

37. A 62-year-old patient with pericardial 40. A 47-year-old man with a known atrial

effusion comes to a local hospital for aspiration fibrillation returns to see his cardiologist for
of pericardial fluid by pericardiocentesis.
follow-up of his cardiac health. The right
The needle is inserted into the pericardial
atrium is important in this case because it:
cavity through which of the following
(A) Receives blood from the oblique cardiac
intercostal spaces adjacent to the sternum?
vein
(A) Right fourth intercostal space
(B) Is associated with the apex of the heart
(B) Left fourth intercostal space
(C) Contains the SA node
(C) Right fifth intercostal space
(D) Receives the right pulmonary vein
(D) Left fifth intercostal space
(E) Is hypertrophied by pulmonary stenosis
(E) Right sixth intercostal space
38. The attending faculty in the coronary
41. A 57-year-old patient has a heart murmur
intensive care unit demonstrates to his students
resulting from the inability to maintain
a normal heart examination. The first
constant tension on the cusps of the AV
heart sound is produced by near-simultaneous
valve. Which of the following structures is
closure of which of the following valves?
most likely damaged?
(A) Aortic and tricuspid
(A) Crista terminalis
(B) Aortic and pulmonary
(B) Septomarginal trabecula
(C) Tricuspid and mitral
(C) Chordae tendineae
(D) Mitral and pulmonary
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(D) Pectinate muscle (C) Beneath the lower border of the ribs
(E) Anulus fi brosus (D) Between the external and internal
intercostals
42. A mother with diabetes gives birth to a
(E) Through the transversus thoracis muscle
baby who is diagnosed as having
dextroposition of the aorta and the pulmonary
trunk with cyanosis and shortness of breath.
45. A 9-month-old girl was admitted to
Which of the following structures is required
to remain patent until surgical correction of the the children’s hospital with tachypnea (fast
deformity? breathing) and shortness of breath.
(A) Umbilical arteries Physical examination further exhibits
tachycardia (fast heart rate), a bounding
(B) Umbilical vein
peripheral pulse, and her angiographs reveal a
(C) Ductus arteriosus patent ductus arteriosus. Which of the
following embryonic arterial structures is most
(D) Ductus venosus
likely responsible for the origin of the patent
(E) Sinus venosus ductus arteriosus?
(A) Right fourth arch

43. During early development of the (B) Left fifth arch

respiratory system, the laryngotracheal tube
(C) Right fifth arch
maintains communication with the primitive
(D) Left sixth arch
foregut. Which of the following embryonic
(E) Right sixth arch
structures is most likely responsible for
partitioning these two embryonic structures?
(A) Tracheoesophageal folds 46. A 7-day-old baby is diagnosed as having
(B) Tracheoesophageal fistula congenital neonatal emphysema, which is
(C) Tracheoesophageal septum caused by collapsed bronchi because of failure
(D) Laryngotracheal diverticulum of bronchial cartilage development.
(E) Laryngotracheal septum Bronchial cartilages are derived from which
of the following derivations?
44. A 32-year-old patient has a tension (A) Ectoderm
pneumothorax that can be treated with needle
(B) Mesoderm
aspiration. To avoid an injury of the intercostal
(C) Endoderm
neurovascular bundle, the needle may be
inserted in which of the following locations? (D) Proctodeum
(A) Above the upper border of the ribs (E) Neuroectoderm
(B) Deep to the upper border of the ribs
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ANSWERS
1. C
2. A
3. C
4. D
5. D
6. B
7. D
8. D
9. C
10. A
11. C
12. D
13. C
14. D
15. B
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16. D 46. B
17. D
18. C
19. E
20. C
21. D
22. E
23. E
24. B
25. C
26. D
27. E
28. D
29. B
30. C
31. D
32. D
33. E
34. A
35. B
36. B
37. D
38. C
39. D
40. C
41. C
42. C
43. C
44. A
45. D