Tom Eck, ecktw@umdnj.edu

http://njms.umdnj.edu/calm
I will email you the link again tonight.
Today’s review and a number of other resources should be up by tomorrow afternoon.


Press Ch – 52 – Ch

4)
5)
6)
1)
2)
3)
7)
8)
9)
Nervous System Principles
Lymphatics
Lungs
Heart
Mediastinum
Back
Upper Limb
Surface Anatomy
Embryology






 the second most important content from Chapter 1 most important: anatomical terms, but they are rarely tested directly the structure of peripheral nerves as they exit the spinal cord the anatomical and functional distinctions between the sympathetic and parasympathetic divisions of the autonomic nervous system dermatomes (T4 = nipple; T10 = umbilicus) referred pain

To which segments does heart pain refer?
3.
4.
1.
2.
5.
C1 – C5
C3 – C5
T1 – T4
T3 – T8
T6 – T12
10
Seconds
Remaining
C
1
– C
5
0% 0% 0% 0% 0%
C
3
– C
5
T
1 –
T
4
T
3 –
T
8
T
6 –
T
12


A high-yield topic; especially important in
Unit III, but don’t neglect this
Remember: In referred pain, start by identifying the visceral nerves involved  Sympathetics
From there, identify the spinal segments represented by the nerve(s)  T1 – T4/T5
The pain will refer to the corresponding dermatomes.

Which of the following, if cut, would block sensory perception in the corresponding dermatome?
1.
2.
3.
4.
ventral root dorsal root ventral ramus dorsal ramus
0% 0% 0% 0%
ven tra l r oo t
d or sa l r oo t
ven tra l r amu s
d or sa l r amu s
10
Seconds
Remaining

S – Sensory
A – Afferent
M – Motor
E – Efferent
D – Dorsal
A – Afferent
V – Ventral
E – Efferent


The dorsal root of spinal nerves can be cut to relieve intractable pain
Alternately, the ventral root may be cut to treat spastic paralysis





Don‘t forget to study lymph!
You can expect a few lymph questions on every exam
(~2-3), often relating to the spread of cancer
These tend to be challenging, detail-oriented questions
Major Topics
◦ Lymph Drainage of the Lung
◦ Lymph Drainage of the Axilla and Breast

1.
2.
3.
4.
Into which vessel does lymph from the right arm empty?
Thoracic Duct
IVC
Right Jugular Vein
Right Subclavian Vein
:10
T ho ra cic
D uc t
0% 0% 0% 0%
IV
C
Ri gh t J ug ul ar
V ei n
Ri gh t S ub cla vi an
V ein

Lymph from the right arm drains to the right lymphatic duct, and to the right subclavian vein (at the venous angle) from there.

3.
4.
1.
2.
Which of the following correctly stages the path of pulmonary lymphatic flow?
Pulmonary  Tracheobronchial  Bronchopulmonary
Paratracheal  Tracheobronchial  Deep Cervical
Tracheobronchial  Paratracheal  Deep Cervical
Pulmonary  Paratracheal  Aortic Arch
:10

A patient presents with a severe case of pneumonia. When you ask her to lift her arms, you notice that the veins in her upper limbs remain distended. You suspect radical enlargement of which group of lymph nodes:
3.
4.
5.
1.
2.
Right Pulmonary
Left Pulmonary
Right Bronchopulmonary (Hilar)
Left Bronchopulmonary (Hilar)
Inferior Tracheobronchial (Carinal)
10
0% 0% 0% 0% 0%
Ri gh t P ul mo na ry
Lef
Ri t P ul mo na ry op ul mo na r..
.
on ch gh t Br
Lef t Br on ch op ul mo na ry
(.
In fer io r T ra
..
ch eo br on ch ia
...



Veins of head and upper extremities become distended due to constriction of the SVC by a tumor or grossly enlarged lymph nodes
The bronchopulmonary nodes at the right lung hilus are in close proximity to the SVC
SVC
Hilar Nodes






Differences between Left and Right Lungs
Lobes, Segments
Pleura, Reflections, Recesses
Pneumothorax: in tension pneumothorax, mediastinum
 contralateral side
Aspirated Objects  Right Main Bronchus

3.
4.
1.
2.
5.
6.
Upon examining a patient with left-sided ptosis, miosis, and anhydrosis, a physician suspects a growing superior lobe tumor. Which of the following segments is most likely involved?
Apical
Posterior
Apicoposterior
Anterior
Superior Lingular
Inferior Lingular
10
Seconds
Remaining
0% 0% 0% 0% 0% 0%
A pi ca l
P os ter io r
A pi co po st er io r
A nt er io r per io r L
Su in gu la r
In fer io r L in gu lar

Sympathetic Trunk
-Interruption of Sympathetics to Head causes Ipsilateral
Ptosis (Lid Lag), Miosis
(Pupil Constriction), and
Anhydrosis (Lack of
Sweating)
-often caused by Pancoast
Tumor
-remember to study lung segments; you can expect a few questions testing their locations, both in the written exam and the practical

Which space is entered when a thoracentesis is performed at the MAL in the 9 th ICS?
1.
2.
3.
4.
5.
Transverse sinus
Cardiac notch
Costodiaphragmatic recess
Costomediastinal recess
Pericardial sac
0% 0% 0% 0% 0%
T ra ns ver se sin us
C ar di ac
n ot ch
C os to di ap hr ag ma tic
rec es s ia st in al
rec es s
P er ica rd
C os to med ial
sa c
10
Seconds
Remaining




 pathway of blood – valve pathologies coronary vessels – consequences of blockage auscultation sites – pathological heart sounds
(continuous machine-like murmer = patent ductus arteriosus) radiographs and CTs especially important

Identify the heart chambers marked B and D:
3.
4.
1.
2.
B
Right Ventricle, Left Ventricle
Right Atrium, Left Atrium
Right Ventricle, Left Atrium
Right Atrium, Left Ventricle
D
:10
0% 0% 0% 0%
Ri gh t V en tri cle,
Lef
Ri gh t V en t..
.
t A tri um t A tr iu m
Lef t A tri um,
Ri gh t V en tri cle,
Lef
Ri gh t A tri um,
Lef t V en tri cle



Right Ventricle is associated with the anterior
(sternocostal) surface of the heart
Left Atrium is associated with the posterior surface of the heart, just anterior to the esophagus


CT’s and Radiographs show up in the written exam and the practical
Be able to identify major structures

Which of the following will result a diastolic murmur at the apex of the heart?
3.
4.
1.
2.
5.
Mitral Valve Insufficiency
Mitral Valve Stenosis
Pulmonary Valve Insufficiency
Aortic Valve Stenosis
Aortic Valve Insufficiency
:10
Note: 2 is also correct
0% 0% 0% 0% 0%
Mi tra l V al ve
In su ffi cien cy
Mi tra l V
P al ul ve
St en os mo na ry
V is al ve
In su ffi
...
A or tic
V
A or tic
V is al ve
St en os al ve
In su ffi cien cy






 blood rushes back into the left ventricle as the ventricle relaxes murmur is heard at the apex (not at the right upper sternal border) because the blood flow causing the murmur is reversed (APTM 2245 does not always apply) associated with a collapsing pulse causes left ventricular hypertrophy, as the heart attempts to compensate for decreased pumping efficiency
Insufficiency = Backflow of Blood a.k.a. incompetence, regurgitation

A patient is diagnosed with left atrial hypertrophy. Which of the following valve defects is most likely to have caused this condition?
3.
4.
1.
2.
5.
Tricuspid Valve Insufficiency
Mitral Valve Stenosis
Pulmonary Valve Insufficiency
Aortic Valve Stenosis
Aortic Valve Insufficiency
:10
0% 0% 0% 0% 0%
T ric us pi d
Va lv.
..
Mi tra l V al ve
S.
P ul
..
mo na ry
V al v.
..
A or tic
V al ve
S.
..
A or tic
V al ve
I..
.



Causes left atrial hypertrophy; the left atrium grows larger to generate the force necessary to push past the obstruction
Stenosis is often associated with hypertrophy of the preceding chamber

1.
2.
3.
4.
5.
Following an acute myocardial infarction, necrosis develops at the apex of the heart. Which vessel was likely occluded?
Left Circumflex
Coronary sinus
Anterior
Interventricular
Posterior
Interventricular
Right coronary
0% 0% 0% 0% 0%
Lef t C irc umf lex
C or on ar
A nt er io y s in us r I nt er ven
P os ter io tr icu la r r I nt er ven tri cu la r
Ri gh t c or on ar y
10
Seconds
Remaining

The Anterior Interventricular Artery (LAD) supplies the anterior twothirds of the interventricular septum, the apex , and the anterior left and right ventricles. It is the most commonly occluded coronary artery.


 be able to trace the course of the major structures that pass through the mediastinum localize structures to each mediastinal compartment

3.
4.
1.
2.
5.
T2/T3
T3/T4
T4/T5
T5/T6
T6/T7
T
2/
T3
0% 0%
T
3/
T4
0%
T
4/
T5
0%
T
5/
T6
0%
T
6/
T7
10





 divides the mediastinum into superior and inferior compartments passes through the T4/T5 intervertebral disk posteriorly and sternal angle anteriorly bifurcation of the trachea boundary between cardiopulmonary and abdominopelvic sympathetics (greater, lesser, and least splanchnic nerves)
Remember: cardiopulmonary = postsynaptic; abdominopelvic = presynaptic

You see a patient with a hoarse voice and a detectable suprasternal pulse. Which of the following diagnoses might explain these symptoms?
1.
2.
3.
4.
Coarctation of the Aorta
Aortic Aneurysm
Tumor Impinging on the Left
Subclavian Artery
Lung Abscess
:10
0% 0% 0% 0%
C oa rc ta tio n of
th e
Ao rta
A or tic
A
T umo neu ry sm in gi ng
o n th r I mp e .
..
Lu ng
A bs ces s




Localized dilation of the aorta
If in the vicinity of the aortic arch, it may impinge on the left recurrent laryngeal nerve, causing hoarseness
If the aneurysm grows large enough, it may lead to a detectable pulse suprasternally

A patient has been diagnosed with an esophageal hernia, a condition in which part of the stomach passes through an enlarged esophageal hiatus. At which spinal segment has the herniation occurred?
3.
4.
1.
2.
5.
T8
T9
T10
T11
T12
10
Seconds
Remaining
T
8
0%
T
9
0% 0%
T
10
0%
T
11
0%
T
12

Structures that pass through the Diaphragm





I Ate Ten Eggs AT Noon
I 8 10 E A 2 T 12
T8: IVC (“Caval Opening”)
T10: Esophagus (Vagus too) (“Esophageal Hiatus”)
T12: Aorta, Azygos Vein, Thoracic Duct (“Aortic
Hiatus”)

In which compartment of the mediastinum is the IVC located?
1.
2.
3.
4.
Superior
Anterior
Middle
Posterior
10
Su per io r
0%
A nt er io r
0% 0%
Mi dd le
0%
P os ter io r

Superior
Anterior
Middle
Thymus, Phrenic Nerve, Vagus Nerve, Esophagus, Trachea,
Thoracic Duct, Azygos Vein, SVC, Aortic Arch,
Brachiocephalic Vein, Left Common Carotid Artery, Left
Subclavian Artery
Thymus
Heart, Phrenic Nerve, Ascending Aorta, SVC, IVC,
Pulmonary Arteries/Veins
Posterior
Descending Aorta, Esophagus (With Vagus Nerve), Thoracic
Duct, Azygos Vein, Splanchnic Nerves
Bolded structures are exclusive to that compartment.





Morphological distinctions between cervical, thoracic, lumbar, sacral, and coccygeal vertebrae
Curvatures
Spinal Cord Structure
Vascular Supply: vertebral arteries, segmental medullary arteries (especially the artery of
Adamkiewicz)

3.
4.
1.
2.
5.
Posterior arch
Anterior arch
Lateral masses
Vertebra prominens
Transverse ligament
0% 0% 0% 0% 0%
P os ter io r a rc h
A nt er io r a rc h
La ter al ma ss es
V er teb ra
p ro s mi
T nen ra ns ver se lig amen t
10

In a case of suspected meningitis where should a lumbar puncture be performed?
3.
4.
1.
2.
5.
L1/L2
L2/L3
L3/L4
L4/L5
L5/S1
L1
/L
2
0% 0%
L2
/L
3
0%
L3
/L
4
0%
L4
/L
5
0%
L5
/S
1
10

Spinal Cord ends at L1/L2

1.
2.
3.
4.
Anterior superior iliac spines
Posterior superior iliac spines
Iliac crests
Spinalis parts of erector spinae muscles 0% 0% 0% 0%
A nt er io r s up er io r i lia c s p.
..
r s up
P os ter io er io r i lia c s
...
Il ia c c res ts
Sp in al is pa rt s o f er ec to r .
..
10


High points of iliac crest correspond to
L4 spinous process

1.
2.
3.
4.
A patient is suffering from a herniation of the
L4/L5 IV disc. Which nerve root is most likely compressed?
L2
L3
L4
L5
L2
0%
L3
0% 0%
L4
0%
L5
10





In a herniated disc of the lumbar vertebrae the nerve that exits at that level is spared, while the nerve root one segment below is often compressed
For lumbar roots, that means a herniation of IV disc
L2/L3 will compress the L3 root
The rule applies the same for cervical vertebrae: C5/C6
 C6 root
For cervical vertebrae, however, it is the nerve exiting at that level is actually compressed; it is only because there is one “extra” cervical nerve that the rule still applies






 questions almost entirely neuromuscular (nerve deficits are BIG)
BRACHIAL PLEXUS know the spinal segments represented by major nerves
(e.g. long thoracic, suprascapular, dorsal scapular, radial, axillary, median, ulnar, musculocutaneous, phrenic) know major actions of each muscle (groupings and locations help) memorize the innervation of each muscle
◦ Innervation gives clues about action, vice versa attachments

A young man notices that following a stab injury he has difficulty doing push-ups, noting that his right shoulder blade tends to
“stick out.” Which nerve was most likely injured to cause this deficit?
3.
4.
1.
2.
5.
Dorsal Scapular
Long Thoracic
Subscapular
Vagus
Phrenic
0% 0% 0%
D or sa l S ca pu la r
Lo ng
T ho ra cic
Su bs ca pu la r
0% 0%
V ag us
P hr en ic
10

= Long Thoracic Nerve (C5, C6, C7)
“5-6-7, wings to heaven”

A patient presents with a medially rotated, adducted arm and extended, adducted forearm. Which spinal segments are represented in the injury?
3.
4.
1.
2.
5.
C3, C4
C4, C5, C6
C5, C6
C7, C8
C8, T1
0% 0%
C
3,
C
4
C
4,
C
5,
C
6
0%
C
5,
C
6
0%
C
7,
C
8
0%
C
8,
T
1
10


C5, C6 = “waiter’s tip” sign



Medially rotated arm due to loss of Infraspinatus
(Suprascapular Nerve)
Adducted arm due to loss of Deltoid (Axillary Nerve)/
Supraspinatus (Suprascapular Nerve)
Extended forearm due to loss of forearm flexors
(Musculocutaneous)

Klumpke palsy = C8, T1 (symptoms similar to ulnar nerve palsy)

Which of the following does not branch off from or derive from the medial cord?
3.
4.
1.
2.
5.
Median
Lateral Pectoral
Medial Pectoral
Ulnar
Medial Antebrachial
0% 0% 0% 0% 0% ia n
Med
La ter al
Pec to ra l
Med ia l P ec to ra l
U ln ar ia l A nt eb ra ch ia l
Med
10

Which of the following muscles rotates the glenoid cavity superiorly?
3.
4.
1.
2.
5.
Levator Scapulae
Trapezius
Spinalis
Rhomboid major
Rhomboid minor
0% 0% 0% 0% 0%
Lev at or
Sc ap ul ae
T ra pez iu s
Sp in al is
Rh omb oi d ma jo r
Rh omb oi d mi no r
10



Descending fibers elevate the scapula and rotate the glenoid cavity superiorly
CN XI Palsy makes arm abduction more difficult

Which of the following does not insert into the intertubercular groove of the humerus?
3.
4.
1.
2.
Latissimus dorsi
Pectoralis major
Teres major
Teres minor
0% 0% 0% 0%
La tis simu s d or si
P ec to ra lis
ma jo r
T er es
ma jo r
T er es
mi no r
10



“lady between two majors” teres major, latissimus dorsi, and pectoralis major insert in the intertubercular groove


 attachments are likely to appear in 3 or 4 questions learn the “hotspots”: intertubercular groove, greater and lesser tubercles of humerus, supra- and infra-glenoid tubercles, coracoid process, coronoid process, olecranon, medial epicondyle of humerus, lateral epicondyle of the humerus, extensor expansion for most other attachment sites, a more general idea will suffice (i.e. what bone(s))

After fracture of the clavicle, which muscle is responsible for the palpable fragment?
1.
2.
3.
4.
Trapezius
Sternocleidomastoid
Pec Major
Pec Minor
0% 0% 0% 0%
T ra pez iu s
St er no cleid oma st oi d
P ec
Ma jo r
P ec
Mi no r
10

Sternocleidomastoid

What nerve may be injured following fracture of the surgical neck of the humerus?
3.
4.
1.
2.
Axillary
Radial
Median
Ulnar
A xi lla ry
0%
Ra di al
0% 0%
Med ia n
0%
U ln ar
10

What nerve may be injured following fracture of the medial epicondyle of the humerus?
3.
4.
1.
2.
Axillary
Radial
Median
Ulnar
A xi lla ry
0%
Ra di al
0% 0%
Med ia n
0%
U ln ar
10

What nerve may be injured following fracture of the radial groove of the humerus?
3.
4.
1.
2.
Axillary
Radial
Median
Ulnar
A xi lla ry
0%
Ra di al
0% 0%
Med ia n
0%
U ln ar
10





Surgical neck – axillary
Radial groove – radial
Distal end of humerus – median
Medial epicondyle - ulnar

A man fractures his humerus at the spiral groove. What neurological problem is likely to be observed?
3.
4.
1.
2.
Claw hand
Simian hand
Hand of benediction
Wrist drop
0% 0% 0% 0%
C la w
h an d
Si mi an
h an d
H an d of
b en ed ict io n
W ris t d ro p
10



This would damage the radial nerve leading to loss of extension at the wrist
(wrist drop) the radial nerve innervates extensors of the forearm, wrist, and most extensors of the phalanges

3.
4.
1.
2.
Following a laceration to the palm just medial to the thenar eminence, which of the following intrinsic movements of the thumb is likely to be fully intact?
Opposition
Abduction
Flexion
Adduction
0%
O pp os iti on
A bd uc tio n
0% 0% 0%
Fl ex io n
A dd uc tio n
10


 opponens policis, abductor policis brevis, and flexor policis brevis are all innervated by the recurrent branch of the median nerve (which is likely to have been lacerated here)
Adductor policis is innervated by the ulnar nerve

A complete avulsion of the lateral epicondyle would be least likely to disrupt the functioning of which muscle?
1.
2.
3.
4.
5.
Extensor digitorum
Supinator
Extensor carpi ulnaris
Extensor pollicis longus
Extensor digiti minimi
0% 0% 0% 0% 0%
Ex ten so r d igi to ru m
Su pi na to r
Ex ten so r c ar pi
Ex
u ln ar is ten so r p ol lic is lo ng
Ex ten us so r d igi ti mi ni mi
10


Extensor pollicis longus does not have its origination at the lateral epicondyle; all others listed do

Which of the following resists inferior displacement of the humeral head in the glenoid cavity?
1.
2.
3.
Long head of the triceps brachii
Medial head of triceps brachii
Lateral head of triceps brachii
0% 0% 0%
Lo ng
h ea d of
th e tri ce ps
...
Med s b
...
ia l h ea d of
tr icep
La ter al hea d of
tr icep s b
...
10


 stabilizes the head of the abducted humerus in the glenohumeral joint, resisting inferior displacement attaches to the infraglenoid tubercle

The nerve that provides sensory innervation to the posterolateral forearm branches from the…
1.
2.
3.
4.
5.
Posterior cord
Medial Cord
Radial nerve
Ulnar nerve
Musculocutaneous nerve
0% 0% 0% 0% 0%
P os ter io r c or d
Med ia l C or d
Ra di al
n er ve
U ln ar
n er ve sc ul oc ut an eo
...
Mu
10




The posterior antebrachial cutaneous nerve arises from the radial nerve major nerves of the upper limb often terminate as cutaneous nerves knowing the distribution of these sensory nerves helps to identify the major nerve involved in the deficit

1.
2.
3.
4.
Describe the anatomical location of the long head of the triceps.
Anterior to both teres major and teres minor
Posterior to both teres major and teres minor
Anterior to teres major and posterior to teres minor
Anterior to teres minor and posterior to teres major
0% 0% 0% 0%
A nt er io r t o bo th
ter es
P os ter io
m.
..
r t o bo th
ter es
A nt er io
..
.
r t o te jo r .
..
ma res
A nt er io r t o te res
mi no r a
..
10

Teres minor
Teres major
Long head
Humerus





Teres minor wraps around the back to the greater tubercle
Teres major passes anteriorly to the intertubercular groove
The long head of the triceps passes in between
Know the quadrangular space
The medial humeral circumflex artery and axillary nerve pass through this window

Which part of the hand would experience paresthesia in carpal tunnel syndrome?
3.
4.
1.
2.
5.
Thenar eminence
Dorsal surface
Hypothenar region
Nail bed of middle finger
Tip of little finger
0% 0% 0% 0% 0%
T hen ar
emin en ce ur fa ce
D or sa l s
H yp ot hen ar
r
N ai l b ed eg io n
o f mi dd le fin ger
T ip
o f l itt le fin ger
10

1.
2.
3.
4.
The following patient presents with no loss of consciousness, no visible trauma, and no sensory deficits.
What is the likely problem?
Ulnar n. damage
Median n. damage
Volkmann’s contracture
Dupuytren’s contracture
0% 0% 0% 0%
U ln ar
n
. d ama ge
Med ia n n.
d ama
V ol kma ge nn
’s co nt ra ct ur e tren
D up uy
’s co nt ra ct ur e
10




Not due to nerve damage because no associated sensory loss
In Volkmann’s you would expect to see wrist involvement as well and would expect a preceding ischemic event, such as the improper wrapping of a tourniquet
In Dupuytren’s, also look for the presence of subcutaneous nodules



 don’t neglect; a significant portion of the test questions are generally straightforward, focusing on the precursors of adult structures as well as abnormalities heart embryology is especially important for this exam

In which of the following conditions does the body compensate by opening up a collateral pathway for blood flow?
3.
4.
5.
1.
2.
Tetralogy of Fallot
Patent Ductus Arteriosus
Patent Foramen Ovale
Coarctation of the Aorta
Aortic Stenosis
10
0% 0% 0% 0% 0%
T
...
et ra lo gy
o f F
P at s .
..
en t D uc tu
P at
...
en t F or amen
C oa rc ta tio n of
...
A or tic
St en os i..
.

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


Diminished femoral pulses and rib notching due to increased blood flow = classic signs of coarctation
Collateral Circulation: Aorta
 Subclavian  Internal
Thoracic  Anterior
Intercostal  Posterior
Intercostal
Note: the Supreme Intercostal
Arteries represent an additional pathway
Collateral circulations are
HUGE; know these

The chest radiograph of a cyanotic newborn is shown below. Immediately suspecting a congenital abnormality, you anticipate four pathological conditions. Which of the following would you NOT expect to find:
2.
3.
4.
5.
1.
Right Ventricular
Hypertrophy
Overriding of the Aorta
Pulmonary Stenosis
Mitral Stenosis
Ventricular Septal
Defect
0% 0% 0% 0% 0%
Ri gh t V en tri cu la r H yp er
...
O ver rid in g
Ao rta of
th e
P ul mo na ry
St en os is
Mi tra l S ten os is tri cu la r S
V en ep ta l D ef ec t
10

Boot-Shaped
Heart
Indicates right ventricular hypertrophy seen in Tetralogy of Fallot .
(A similar radiograph is in the lab. Remember to review all of these.)
P ulmonary Artery Stenosis
R ight Ventricular Hypertrophy
O verriding of the Aorta
VE ntricular Septal Defect

Which aortic arch gives rise to the stapedial artery?
4.
5.
6.
1.
2.
3.
First Arch
Second Arch
Third Arch
Fourth Arch
Fifth Arch
Sixth Arch
10
Seconds
Remaining
0% 0% 0% 0% 0% 0%
Fi rs t A rc h
Sec on d
Ar ch
T hi rd
A rc h
Fo ur th
A rc h
Fi fth
A rc h
Si xt h
Ar ch


Remember MSCARD






Maxillary
Stapedial
Common Carotid (External Too)
Arch of Aorta (and Right Subclavian)
Regresses
Ductus Arteriosus (and Pulmonary Arteries)

Which of the following vessels has the highest oxygen saturation?
1.
2.
3.
4.
Pulmonary Veins
Pulmonary Arteries
Ascending Aorta
Right Coronary Artery
10
0% 0% 0% 0%
P ul mo na ry
V ein s
P ul mo na ry
A rt er ies
A sc en di ng
A or ta
Ri gh t C or on ar y
Ar ter y

An embryo successfully reaches the blastula stage but fails to implant itself in the endometrium. Which of the following events may have failed to occur?
1.
2.
3.
4.
Cleavage
Disappearance of the Zona Pellucida
Fusion of Male and Female Pronuclei
Formation of Germ Layers
10
0% 0% 0% 0%
C lea va ge f t he
Z..
.
D isa pp ea ra nc e o
Fu sio n of
Ma le an d
Fo rma
Fema
..
tio n of
G er m
La yer s


The blastocyst must “hatch” by dissolving the zona pellucida before implantation

A newborn suffers from excessive accumulation of saliva and mucous in nose and mouth, gagging, cyanosis after swallowing milk, abdominal distension after crying, and reflux of gastric contents into lungs. Which congenital abnormality may be to blame?
1.
2.
3.
4.
Pulmonary Hypoplasia
Transposition of the Great Vessels
Congenital Diaphragmatic Hernia
Tracheoesophageal Fistula
10
0% 0% 0% 0%
P ul mo na ry
H yp op la sia ns po sit io
T ra n of
th e
Gr e.
.
C on gen ra gma t..
ita l D ia ph
T ra ch eo es op ha gea l F ist ul a



In most common form (seen at left), esophagus ends in blind pouch
Trouble with feeding a prominent symptom at birth

The patient with the herniated disc asks you about the embryological precursor to the substance coming out of the disc (naturally, of course). What should be your response?
1.
2.
3.
4.
Neuroectoderm
Notochord
Intermediate Mesoderm
Lateral Plate Mesoderm
0% 0% 0% 0%
N eu ro ec to der m rd so der m
N ot oc ho
In ter med ia te
Me
La ter al
Pl at e
Mes od er m
10

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
Nucleus Pulposus is the only remnant of the notochord in the adult human
Remember your germ layers

Which of the following is not derived from neural crest cells?
1.
2.
3.
4.
Dorsal Root Ganglia
Enteric Ganglia
Motor Neurons
Melanocytes
0% 0% 0% 0%
D or sa l Ro ot
G an gli a
En ter ic
Ga ng lia
Mo to r N eu ro ns
Mela no cy tes
10



“the fourth germ layer” know the derivatives and consequences of failed migration




Generally come in the form, “A stab wound to the _______ will lacerate which of the following structures:”
Be able to associate surface structures with the viscera underneath
Don’t forget the posterior thorax

A stab wound through the manubrium damages a vessel coursing almost horizontally. Which of the following was most likely lacerated?
3.
4.
1.
2.
Left Brachiocephalic Vein
Right Brachiocephalic
Vein
SVC
Left Common Carotid
:10
0% 0% 0% 0%
Lef t Br ac hi oc ep ha lic
V ein ac hi oc ep ha lic
V ein
Ri gh t Br
SV
C
Lef t C ommo n
Ca ro tid

MAL MCL PS Median PS MCL MAL
1 st
ICS
Posterior
Segment of
Superior
Anterior Segment of Superior
Axillary Vessels
2 nd
ICS
Posterior
Segment of
Superior
Anterior Segment of Superior
PS of S
3 rd
ICS
Lateral
Segment of Middle
4 th
ICS
LS of
Middle
Anterior
Basal of
Inferior
LS of
Middle
LS of
Middle
*Nipple
MS of
Middle
MS of
Middle
Anterior
Segment of
Superior
SVC
Anterior
Segment of
Superior
SVC
Anterior
Segment of
Superior
RA
Aortic
Arch,
Left
Brachioc ephalic
V.
Ascending
Aorta
RV
Anterior
Segment of Superior
Aortic Knob
Anterior
Segment of Superior
Pulmonary
Trunk
Anterior
Segment of Superior
Conus
Arteriosus
Anterior
Segment of Superior
Axillary
Vessels
AP
Segment of
Superior
1 st
ICS
Anterior
Segment of Superior
AP
Segment of
Superior
2 nd
ICS
Superior
Lingular of
Superior
Superior
Lingular of
Superior
3 rd
ICS
Medial
Segment of Middle
RA
RV RV
Inferior
Lingular of
Superior
LV
*Nipple
Superior
Lingular of
Superior
4 th
ICS
5 th
ICS
Anterior
Basal of
Inferior
LS of
Middle
MS of
Middle
Medial
Segment of Middle
RA/IVC
RV
RV
*No pleura
IL of S
LV (apex)
AMB of
Inferior
Anteromedial
Basal of
Inferior
5 th
ICS
6 th
ICS
Anterior
Basal of
Inferior
DIAPHRAGM
AMB of I
LB of I
6 th
ICS

Which heart chamber is at greatest risk from a thoracic stab wound?
3.
4.
1.
2.
Left Atrium
Left Ventricle
Right Atrium
Right Ventricle
:10
0% 0% 0% 0%
Lef t A tr iu m
Lef t V en tri cle
Ri gh t A tri um
Ri gh t V en tri cle

MAL MCL PS Median PS MCL MAL
1 st
ICS
Posterior
Segment of
Superior
Anterior Segment of Superior
Axillary Vessels
2 nd
ICS
Posterior
Segment of
Superior
Anterior Segment of Superior
PS of S
3 rd
ICS
Lateral
Segment of Middle
4 th
ICS
LS of
Middle
Anterior
Basal of
Inferior
LS of
Middle
LS of
Middle
*Nipple
MS of
Middle
MS of
Middle
Anterior
Segment of
Superior
SVC
Anterior
Segment of
Superior
SVC
Anterior
Segment of
Superior
RA
Aortic
Arch,
Left
Brachioc ephalic
V.
Ascending
Aorta
RV
Anterior
Segment of Superior
Aortic Knob
Anterior
Segment of Superior
Pulmonary
Trunk
Anterior
Segment of Superior
Conus
Arteriosus
Anterior
Segment of Superior
Axillary
Vessels
AP
Segment of
Superior
1 st
ICS
Anterior
Segment of Superior
AP
Segment of
Superior
2 nd
ICS
Superior
Lingular of
Superior
Superior
Lingular of
Superior
3 rd
ICS
Medial
Segment of Middle
RA
RV RV
Inferior
Lingular of
Superior
LV
*Nipple
Superior
Lingular of
Superior
4 th
ICS
5 th
ICS
Anterior
Basal of
Inferior
LS of
Middle
MS of
Middle
Medial
Segment of Middle
RA/IVC
RV
RV
*No pleura
IL of S
LV (apex)
AMB of
Inferior
Anteromedial
Basal of
Inferior
5 th
ICS
6 th
ICS
Anterior
Basal of
Inferior
DIAPHRAGM
AMB of I
LB of I
6 th
ICS

Which rib does the horizontal fissure approximate most closely?
3.
4.
5.
1.
2.
Third
Fourth
Fifth
Sixth
Seventh
10
T hi rd
0% 0%
Fo ur th
0%
Fi fth
0% 0%
Si xt h
Sev en th





Study the TBL’s! Use them to guide your review.
Learn the Blue Boxes, especially the
Chapter 1 ones (summary online)
Don’t forget lymph and embryo!
Review as many bodies as possible






Saturday morning: 10 am – 4 pm
There will be bodies tagged in the lab, as well as radiographs
Complete on your own, giving yourself a minute for the A and B questions
Tags will be left on until Saturday afternoon
Answers will be posted in the lab