May 2O24 Sample Mock

A 45-year-old woman presents to the neurology clinic with a two-week history of drooping of the right eyelid and constriction of the right pupil. She also reports a lack of sweating on the right side of her face. She denies any recent trauma or significant medical history. On physical examination, ptosis, miosis, and anhidrosis are observed on the right side, consistent with Horner syndrome. An MRI of the cervical spine is ordered to identify the possible site of the lesion.

Which of the following spinal nerve root levels is most likely involved in this patient's condition?

A 35-year-old male presents to the clinic with complaints of difficulty chewing and pain around his jaw. He reports that these symptoms have progressively worsened over the past few months. On physical examination, there is tenderness over the
temporomandibular joint (TMJ), and the patient has difficulty opening his mouth fully. His medical history is unremarkable, and he has no history of trauma to the jaw or face.
Which structure involved in the patient's symptoms is derived from the first pharyngeal arch?

A 42-year-old construction worker presents to the clinic with complaints of burning pain and tingling sensations radiating into the groin and upper thigh. The symptoms have been progressively worsening over the last few

months, likely exacerbated by his job involving heavy lifting and repetitive movements. On examination, there is tenderness and sensory disturbances in the groin area, particularly over the upper medial thigh and lower abdomen. The physician suspects nerve entrapment and plans further diagnostic testing to identify the specific nerve involved.
Which nerve, known to travel through the inguinal canal, is likely responsible for the patient's symptoms?

A 55-year-old female presents

to the gastroenterology clinic with symptoms of intermittent abdominal pain, bloating, and signs of partial bowel obstruction. She has a history of abdominal surgeries which might have led to adhesions. Imaging studies, including an abdominal CT scan, are planned to better visualize the anatomical structures and potential sites of obstruction. Accurate knowledge of the anatomical landmarks is crucial for the radiologist to assess the images correctly.

At which anatomical location is the duodenojejunal flexure typically found?

A 30-year-old male presents to the clinic with lower abdominal pain and discomfort after an intense workout session. He reports that the pain is localized to his lower abdomen and radiates to his groin. On physical examination, there is tenderness in the lower abdomen and above the inguinal ligament, but no hernia is detected. The physician suspects nerve involvement and needs to determine which nerve is most likely affected based on its anatomical location superior to the psoas major muscle.

Which nerve is located superior to the psoas major muscle and could be responsible for the patient's symptoms?

A 10-year-old boy presents to the pediatric clinic with a complaint of pain at the base of his right thumb, which began a week after he fell on his outstretched hand while playing soccer. Initially, there were no visible signs of injury, and he had full range of motion. However, the pain has progressively worsened, and now it is tender to touch at the anatomical snuffbox. He has difficulty gripping objects and experiences pain with thumb movement.

What is the most likely diagnosis for this child's condition?

A 45-year-old female presents to the neurology clinic with a complaint of difficulty lifting her right foot while walking. She describes frequent tripping and an inability to dorsiflex her foot, leading to a characteristic "steppage gait." On physical examination, she exhibits weakness in dorsiflexion and a lack of sensation over the dorsum of the foot and the first web space.

A nerve conduction study is performed to identify the affected nerve and muscle.

Which muscle is most likely affected in this patient's condition of foot drop?

A 50-year-old male presents to the emergency department with a deep laceration to his upper thigh after a fall. He is experiencing significant bleeding from the wound. The medical team needs to quickly locate and compress the femoral artery to control the hemorrhage before surgical intervention. They palpate the area to find the correct anatomical landmark to apply pressure.

To effectively locate and compress the femoral artery, which anatomical landmark should be used?

A 40-year-old male marathon runner presents to the clinic with difficulty in plantarflexing his foot, which has severely affected his running performance. He reports that he began experiencing pain in his lower leg and ankle after an intense training session a few weeks ago. On examination, there is noticeable weakness in plantarflexion, and he has difficulty standing on his tiptoes. There is also tenderness in the deep posterior compartment of the leg.

Which of the following structures located in the deep posterior compartment of the leg is most likely affected, leading to the loss of plantarflexion?

A 60-year-old male presents to the clinic with a six-month history of persistent pain in his right shoulder, arm, and hand. He also reports weakness in his hand and occasional tingling in his fingers. On physical examination, there is muscle wasting in the right hand and decreased grip strength. Additionally, he has ptosis, miosis, and anhidrosis on the right side of his face. A chest X-ray reveals a mass at the apex of the right lung. A CT scan confirms the presence of a Pancoast tumor.

The tumor is most likely to be located at the level of which vertebra?

A 47-year-old female presents to the emergency department with acute upper right quadrant abdominal pain that radiates to her back. She reports that the pain intensifies after meals, especially after consuming fatty foods. Upon examination, the pain is localized, and there is tenderness in the upper right quadrant of the abdomen. The attending physician suspects gallstones and is considering an ultrasound to confirm the presence of stones and to assess the condition of the liver and gallbladder. Knowledge of the anatomical structures in this area is essential for proper diagnosis and treatment planning.

What anatomical structure is located between the Linea semilunaris and the right costal margin?

A 63-year-old male with a history of liver cirrhosis and ascites is admitted to the hospital due to worsening abdominal distention and discomfort. The medical team is concerned about fluid accumulation and its potential complications, such as spontaneous bacterial peritonitis. The patient is placed in a supine position for comfort and to prepare for an ultrasound examination to evaluate the distribution and volume of the ascitic fluid.

Understanding where fluid tends to collect in the abdomen in different body positions is crucial for accurate assessment and treatment.

In a patient lying in the supine position, where does fluid commonly collect in the abdomen?

A 29-year-old female presents to the emergency department with a severe headache, fever, and neck stiffness. Based on these symptoms, the attending physician suspects meningitis and decides to perform a diagnostic lumbar puncture to analyze the cerebrospinal fluid (CSF) for evidence of infection. Understanding the correct anatomical site for lumbar puncture and the layers the needle will traverse is essential for safe and effective procedure execution.

In a lumbar puncture, which space does the needle enter to collect cerebrospinal fluid?

A 60-year-old male visits a urologist due to symptoms of frequent urination, urgency, and discomfort in the lower abdomen. After discussing his symptoms and medical history, which includes a prior diagnosis of benign prostatic hyperplasia, the urologist decides to perform a per-rectal (PV) examination to assess the size and consistency of the prostate gland.

This examination is critical for evaluating potential complications such as prostate enlargement that may be exerting pressure on the bladder and surrounding structures.

During a per-rectal examination, what structure lies anteriorly that the physician must be aware of?

A 55-year-old woman visits her primary care doctor complaining of recent episodes of incontinence, which have become increasingly frequent and are impacting her quality of life.

She describes the incontinence as occurring both during physical activities and unexpectedly while at rest. Her medical history includes a complicated childbirth many years ago, which might have affected her pelvic floor. After a detailed discussion, the physician suspects a neurogenic cause and plans a referral to a specialist for further neurologic and muscular assessment of the pelvic floor.

Which nerve impairment is likely contributing to the patient's symptoms of a lax sphincter?

A 40-year-old marathon runner presents to the sports medicine clinic with severe buttock pain radiating down the back of her leg, exacerbated by long-distance running and prolonged sitting. The pain has been persistent for several weeks, and preliminary physical therapy focusing on lower back and hip flexibility has not improved her symptoms. The sports physician suspects deep gluteal syndrome or sciatica and considers the anatomical relationship of the sciatic nerve to nearby muscles as crucial for diagnosis and treatment planning.

What is the relationship of the sciatic nerve in relation to the piriformis muscle?

A 55-year-old male presents to the gastroenterology clinic with progressive difficulty swallowing and unintentional weight loss over the past few months. An esophagogastroduodenoscopy (EGD) reveals a suspicious lesion located in the mid third of the esophagus. A biopsy confirms esophageal carcinoma. The oncologist discusses the next steps, including detailed imaging to assess lymph node involvement, which is crucial for staging the cancer and planning treatment.

Understanding the lymphatic drainage of the esophagus is essential for accurately predicting the potential spread of malignancy.

Which group of lymph nodes is primarily responsible for the lymphatic drainage of the mid third of the esophagus?

A 28-year-old female rock climber presents to the sports medicine clinic with pain on the radial aspect of her wrist that intensifies when she moves her thumb or wrist. The pain started after a particularly strenuous climb where she used her hands to grip tightly. On examination, the physician notes tenderness and slight swelling in the area known as the anatomical snuffbox. Knowledge of the anatomical boundaries of the snuffbox is important for assessing potential injuries in this region, such as scaphoid fractures or tendonitis.

What forms the posteromedial boundary of the anatomical snuffbox?

A 34-year-old carpenter presents to the emergency department after accidentally hitting his wrist against the edge of a wooden table while working. He complains of pain and swelling around the wrist, and he is unable to extend his thumb at the interphalangeal joint. On physical examination, there is notable tenderness over the dorsal aspect of the wrist, particularly near the styloid process of the radius. The attending physician suspects a tendon injury and plans to perform further diagnostic imaging to confirm the diagnosis and plan appropriate treatment.

If a patient is unable to extend his thumb, which tendon injury is most likely responsible?

A 38-year-old male visits the dermatology clinic with a lesion on the glans penis, which he first noticed several weeks ago. The lesion has not responded to over-the-counter treatments and has become slightly painful. The dermatologist is concerned about the possibility of a sexually transmitted infection or a malignant growth, such as squamous cell carcinoma. A biopsy is planned, and the patient is counseled about potential lymphatic spread, which is critical for staging and treatment planning if the lesion is malignant.

Understanding the lymphatic drainage pattern of the glans penis is essential for accurately predicting potential metastatic pathways.

Which lymph nodes group is responsible for the lymphatic drainage of the glans penis?

A 32-year-old male presents to the urology clinic with complaints of a dull ache and a feeling of heaviness in his left scrotum. During the examination, the urologist notes an enlargement of the veins around the testicle, suspecting a varicocele. Ultrasound confirms the diagnosis, showing dilation of the venous plexus. The urologist explains that impaired drainage of the testicular vein might be contributing to the condition. Understanding the normal drainage pathways of the testicular veins is crucial for diagnosing and managing such cases effectively.

Where does the left testicular vein typically drain?

A 50-year-old male presents to the clinic with complaints of anal discomfort and occasional bleeding, particularly during bowel movements. He has been experiencing these symptoms for several months. A physical examination and further diagnostic procedures, including a sigmoidoscopy, reveal a suspicious lesion located just below the dentate line of the anal canal. The physician discusses the potential need for biopsy and surgical intervention, depending on the pathology results. Understanding the lymphatic drainage pattern of this area is crucial for staging and planning treatment, as it influences potential lymph node involvement and the spread of malignancy.

Which group of lymph nodes is responsible for the lymphatic drainage of the anal canal below the dentate line?

A 65-year-old female undergoes a thoracic surgery for the removal of a mediastinal mass. During the surgery, the thoracic surgeon takes special care to preserve critical structures within the thorax, including the thoracic duct, due to its importance in lymphatic drainage. The team reviews the anatomy of the thoracic duct, particularly its path through the diaphragm, to avoid accidental injury.

Understanding the specific pathway of the thoracic duct through the diaphragm is essential for minimizing surgical complications.

How does the thoracic duct traverse the diaphragm to enter the abdominal cavity?

A 60-year-old male with a history of chronic neck pain undergoes a diagnostic angiogram to investigate the cause of his recurrent vertigo and dizziness, suspected to be related to vascular issues in the neck. The radiologist prepares to examine the vertebral arteries, knowing their origins are crucial for accurately assessing potential stenosis or blockages that could be contributing to the patient's symptoms. Understanding the specific anatomy of the vertebral arteries' origins from the subclavian artery is essential for guiding the angiogram procedure accurately.

Which describes the origin of the vertebral artery?

A 45-year-old male presents to the surgical outpatient clinic for an elective inguinal hernia repair. The surgeon plans to perform the procedure under local anesthesia to reduce recovery time and postoperative complications. To ensure the patient remains comfortable throughout the procedure, understanding the dermatomal level required for effective local anesthetic block is crucial. The surgical team discusses the most appropriate dermatome to target for local anesthesia to provide optimal pain control during the surgery.

For inguinal hernia repair performed under local anesthesia, which dermatome should be effectively blocked to manage pain?

A 35-year-old male arrives at the emergency department following a motor vehicle accident. He was the driver, and upon impact, his chest struck the steering wheel forcefully on the left side, just left of the sternum at the level of the T5 vertebra. He presents with chest pain, difficulty breathing, and signs of shock. The medical team is concerned about potential internal injuries due to the location and force of the impact. Rapid assessment and imaging are initiated to determine the extent of thoracic damage and to guide immediate interventions.

Considering the location of the trauma to the left of the sternum at the T5 vertebral level, which cardiac structure is most at risk of injury?

A 54-year-old male is diagnosed with early-stage gastric cancer located at the fundus of the stomach during a routine endoscopic examination. Given the location of the tumor, the oncologist discusses the potential routes for metastatic spread via the lymphatic system during the tumor board meeting. Understanding the lymphatic drainage pathways from the fundus of the stomach is crucial for planning the surgical approach, including lymph node dissection, to optimize cancer control and staging.

Which lymph node group is primarily responsible for the lymphatic drainage of the fundus of the stomach?

A 33-year-old woman is scheduled for an elective cesarean section. During the pre- operative briefing, the obstetrician explains the surgical approach to the residents, highlighting the importance of understanding each layer of the abdominal wall. The Pfannenstiel incision, a common choice for this procedure, is preferred due to its cosmetic results and lower risk of incisional hernias. The team prepares to perform the incision just above the pubic symphysis and proceed through the abdominal layers to safely reach the uterus.

In a Pfannenstiel incision, after retracting the rectus sheath, which structure is typically required to be opened to access the abdominal cavity?

- A 25-year-old woman presents to the emergency department with severe right lower quadrant abdominal pain, nausea, and vomiting. Her symptoms began about 24 hours ago and have progressively worsened. After a physical examination and imaging studies, she is diagnosed with acute appendicitis. The surgical team prepares her for an urgent appendectomy. As the surgeon discusses the procedure with the surgical residents, he emphasizes the importance of understanding the layers of the abdominal wall that they will encounter and dissect through to reach the appendix.
During an appendectomy, what is the first layer that requires dissection after the skin has been incised?