III. Tests from “Step-1” database with explanation

1. 
   A 50 -year-old electrician reports pain in his left upper extremity and tingling and numbness in his 4^th and 5^th digits of his left hand. There is mild swelling of the left hand. The man reports most of his pain and numbness occurs when he is doing electrical work with his arms overhead. X-ray reveals the presence of a cervical rib. Which of the following structures is most likely being compressed?
   
   1. 
      Axillary artery
      
   2. 
      Brachial artery
      
   3. 
      Brachiocephalic artery
      
   4. 
      Subclavian artery
      
   5. 
      Subscapular artery
      

The correct answer is D. The subclavian artery passes laterally over the upper surface of the first rib and lies posterior to the scalenus anterior. In the case of thoracic outlet syndrome, this artery is usually compressed between the scalenus anterior and a cervical rib. Thoracic outlet syndrome is a broad term for a group of disorders in which there is compression of certain neurovascular bundles. The presence of a cervical rib adds to the compression, and repetitive motion and poor posture are other predisposing factors. When the neurovascular bundle is entrapped, the patient presents with neurological and/or circulatory changes in the upper extremity on the involved side.

The axillary artery (choice A) is the continuation of the subclavian artery. This artery begins at the outer border of the first rib and continues through the axilla to the lower border of the teres major.

The brachial artery (choice B) is the continuation of the axillary artery in the upper extremity and can not be compressed by a cervical rib.

The brachiocephalic artery (choice C) arises from the arch of the aorta. At the level of the right sternoclavicular joint, it separates into the right common carotid artery and the right subclavian artery.

The subscapular artery (choice E) is the largest branch of the axillary artery. It supplies muscles on the lateral thoracic wall and scapular muscles.

2. 
   A 49-year-old man presents with complaints of pain and cramps in his calf muscles when he walks for long distances. The pain is relieved by resting. The physician suspects arterial insufficiency to the lower limbs and wishes to evaluate the arterial flow by palpation of the dorsalis pedis pulses. In which of the following locations may this pulse be palpated?
   
   1. 
      On the dorsum of the foot, medial to the tibialis anterior tendon
      
   2. 
      On the dorsum of the foot, between the tibialis anterior tendon and the extensor hallucis longus tendon
      
   3. 
      On the dorsum of the foot, between the extensor hallucis longus tendon and the extensor digitorum longus tendon
      
   4. 
      On the dorsum of the foot, lateral to the extensor digitorum longus tendon
      
   5. 
      Posterior to the medial malleolus of the ankle
      

The correct answer is C. The dorsalis pedis artery is the continuation of the anterior tibial artery after the artery crosses the ankle to reach the dorsum of the foot. Its pulse is the most distal palpable pulse in the lower limb and therefore is useful for evaluating the arterial supply to the limb. On the dorsum of the foot, the pulse may be felt as the artery passes over the navicular bone between the extensor hallucis longus tendon and the extensor digitorum longus tendon.

The other locations on the dorsum of the foot (choices A, B, and D) are not sites where this artery may be palpated.

Posterior to the medial malleolus (choice E) is the site where the posterior tibial artery passes into the foot. The pulse of this artery may be felt in this location.

3. 
   During an abdominal surgical procedure, the surgeon wishes to locate the ureter in order to ensure that it is not injured. The ureter may be found immediately anterior to the origin of the
   
   1. 
      common iliac artery
      
   2. 
      external iliac artery
      
   3. 
      internal iliac artery
      
   4. 
      gonadal artery
      
   5. 
      renal artery
      

The correct answer is B. The ureter leaves the renal pelvis and lies on the posterior abdominal wall as it descends to the pelvis. It crosses the pelvic brim at the level of the bifurcation of the common iliac artery. At this point it crosses anterior to the origin of the external iliac artery to enter the pelvis.

The origin of the common iliac artery (choice A) is at the bifurcation of the abdominal aorta, which occurs at the level of the fourth lumbar vertebra in the midline of the abdomen. Both ureters are lateral to the aortic bifurcation.

The origin of the internal iliac artery (choice C) is at the bifurcation of the common iliac artery, which occurs at about the level of the first sacral vertebra. The ureter and the internal iliac artery both enter the pelvis with the ureter on the lateral side of the artery.

The origin of the gonadal artery (choice D) (either the testicular artery or the ovarian artery) is from the abdominal aorta at a variable level, usually between the renal artery and the inferior mesenteric artery. The ureters are lateral to the origin of this artery.

The origin of the renal artery (choice E) is from the abdominal aorta at about the level of the second lumbar vertebra. The renal arteries pass laterally to enter the renal pelvis. At this site, the ureter is posterior to the artery.

4. 
   A 54-year-old male has developed cirrhosis, with obstruction of the portal circulation within the liver. Portal blood could still be conveyed to the caval system via which of the following?
   
   1. 
      Azygos and hemiazygos veins
      
   2. 
      Gonadal veins
      
   3. 
      Internal iliac veins
      
   4. 
      Splenic vein
      
   5. 
      Vesical venous plexus
      

The correct answer is A. The esophageal venous plexus, which drains into the azygos and hemiazygos veins within the thorax, has anastomoses with branches of the left gastric vein. Thus, following blockage of the portal vein, portal blood may enter the superior vena cava via the azygos system. Other important portacaval connections include: the superior rectal vein with the middle and inferior rectal veins; paraumbilical veins with epigastric veins (engorgement of these vessels results in caput medusae); and the colic and splenic veins with renal veins and veins of the posterior body wall.

The gonadal veins (choice B) exclusively drain the gonads (although, in the female, the ovarian vein communicates with the uterovaginal plexus). These vessels have no anastomoses with portal vessels.

The internal iliac veins (choice C), which drain most of the pelvis and much of the inferior extremities, have no demonstrated portal anastomoses.

The splenic vein (choice D) is incorrect because it is itself a component of the portal venous system.

The vesical venous plexus (choice E), which is situated well within the pelvis and drains the bladder and the prostate (or uterus and vagina), has no association with portal vessels.

1. 
   During the fetal period of the development in the vascular system of the fetus large arterial (Botallo's) duct is functioning which converts into lig. arteriosum after birth. What anatomical formations does this duct connect between each other?
   
   1. 
      Right and left auricle
      
   2. 
      *Pulmonary trunk and aorta
      
   3. 
      Aorta and inferior vena cava
      
   4. 
      Pulmonary trunk and superior vena cava
      
   5. 
      Aorta and superior vena cava
      
2. 
   Usually the intravenous injection is done into median cubital vein because it is slightly movable due to fixation by the soft tissues. What is it fixed in the cubital fossa by?
   
   1. 
      Anconeus muscle
      
   2. 
      Brachioradial muscle
      
   3. 
      *Aponeurosis of biceps muscle
      
   4. 
      Brachial muscle
      
   5. 
      Tendon of the triceps muscle
      
3. 
   A 54-year-old man was admitted to the hospital with complaints of pain in the right subcostal region, vomiting with blood. Objectively: enlarged liver, varicose veins in the stomach and esophagus. Disfunction of what vessel is likely to have taken place?
   
   1. 
      Aorta abdominalis
      
   2. 
      Vena hepatica
      
   3. 
      Vena cava inferior
      
   4. 
      *Vena porta
      
   5. 
      Vena cava superior
      
4. 
   A patient has tissue ischemia lower the knee joint, accompanied with "intermittent claudication". Which artery is occluded in this case?
   
   1. 
      * Posterior tibial
      
   2. 
      Proximal part of the femoral
      
   3. 
      Anterior tibial
      
   4. 
      Popliteal
      
   5. 
      Fibial
      
5. 
   The patient with thymoma (thymus gland tumour) has cyanosis, extention of subcutaneous venous net and edema of the soft tissues of face, neck, upper part of the trunk and upper extremities. What venous trunk is pressed with tumour?
   
   1. 
      *A. Superior vena cava
      
   2. 
      Frontal jugular vein
      
   3. 
      Clavicular vein
      
   4. 
      Internal jugular vein
      
   5. 
      External jugular vein
      
6. 
   Contraction of a great vessel reduced blood derivation from the left ventricle. Which vessel has undergone pathological changes?
   
   1. 
      Pulmonary vein.
      
   2. 
      Pulmonary trunk.
      
   3. 
      Aorta.*
      
   4. 
      Superior vena cava.
      
   5. 
      Inferior vena cava.
      
7. 
   Blood pressure rise in aorta increased the load of the cardiac muscle. The muscular wall of which region of the heart reacts to irritation?
   
   1. 
      Left ventricle.*
      
   2. 
      Left atrium.
      
   3. 
      Right ventricle.
      
   4. 
      Right atrium.
      
   5. 
      Venous sinus.
      
8. 
   Blood pressure rise in a great vessel which carries blood to lungs increased the load of the cardiac muscle. The muscular wall of which region of the heart reacts to irritation?
   
   1. 
      *Right ventricle.
      
   2. 
      Left ventricle.
      
   3. 
      Right atrium.
      
   4. 
      Left atrium.
      
   5. 
      Venous sinus
      
9. 
   Examining a teenager a doctor detected a congential heart disease - patent ductus arteriosus. What struc­tures does the duct join in the period of prenatal development?
   
   1. 
      Right and left atriums.
      
   2. 
      Right and left ventricles.
      
   3. 
      Aorta and inferior vena cava.
      
   4. 
      Pulmonary trunk and aorta.*
      
   5. 
      Pulmonary trunk and superior vena cava.
      
10. 
    A patient has the ischemia of tissues below the knee-joint accompanied by intermittent claudication. Which artery occlusion is meant?
    
    1. 
       *Popliteal.
       
    2. 
       Femoral.
       
    3. 
       Posterior tibial.
       
    4. 
       Anterior tibial.
       
    5. 
       Proximal part of femoral artery.
       
11. 
    A surgeon, accessing the organs of the thoracic cavity, made an incision on the anterior chest wall along one of the intercostal spaces. He carefully dissected the tissues of the anterior medial region of the intercostal space in order not to damage the artery situated in parallel to the edge of the breast bone, by 1-1.5 cm more lateral from it. Which artery is meant?
    
    1. 
       Inferior phrenic.
       
    2. 
       Anterior intercostal.
       
    3. 
       Superior phrenic.
       
    4. 
       Costocervical trunk.
       
    5. 
       *Internal thoracic.
       
12. 
    While examining a patient, a surgeon detects artery pulsation behind the medial malleolus. Which artery is meant?
    
    1. 
       *Posterior tibial.
       
    2. 
       Fibular.
       
    3. 
       Anterior tibial.
       
    4. 
       Posterior recurrent tibial.
       
    5. 
       Anterior recurrent tibial.
       
13. 
    Usually, if a patient has essential hypertension, his left cardiac border is shifted to the left. Due to which chambers of heart or vessels does it happen?
    
    1. 
       Left atrium.
       
    2. 
       *Left ventricle.
       
    3. 
       Left ventricle and left atrium.
       
    4. 
       Arch of aorta.
       
    5. 
       Pulmonary trunk.
       
14. 
    Examining patients with cardiovascular system pathology it is often necessary to compare the character of vessels pulsation in symmetrical points of both body parts. Pulsation of which artery is easy to feel on the anterior surface of the inferior third of forearm?
    
    1. 
       A. ulnaris.
       
    2. 
       *A. radialis.
       
    3. 
       A. interossea anterior.
       
    4. 
       Ramus palmaris superficialis.
       
    5. 
       A. interossea posterior.
       
15. 
    A doctor examined a patient who got into a car accident. The patient has a fracture of the left clavicle and disorders of blood circulation in the extremity (radial artery pulsation is absent). What is the cause of blood circulation disorder?
    
    1. 
       Compression of vertebral artery.
       
    2. 
       Compression of axillary artery.
       
    3. 
       Compression of subclavian vein.
       
    4. 
       *Compression of subclavian artery.
       
    5. 
       Compression of axillary vein.
       
16. 
    A patient suffers from liver cirrhosis. The varicose veins of which porta-caval shunt are observed?
    
    1. 
       V. subcostalis.
       
    2. 
       V. femoralis.
       
    3. 
       *V. epigastrica superficialis.
       
    4. 
       D.V. circumflexa ilium profunda.
       
    5. 
       Vv. intercostales posteriores.
       
17. 
    During the ultrasonic examination of the heart a doctor observes semilunar cusps. What happens to them at diastole (relaxation) of ventricles?
    
    1. 
       *Interlock, closing the lumen of vessels.
       
    2. 
       Turn out into the lumen of vessels.
       
    3. 
       Turn out into the lumen of ventricles.
       
    4. 
       Press to the vessels walls.
       
    5. 
       Press to the ventricle walls.
       
18. 
    An inflammatory process in endocardium (endocarditis) is diagnosed. Which structure of heart is damaged in case of this pathology?
    
    1. 
       Myocardium.
       
    2. 
       Conducting system of heart.
       
    3. 
       Coronary artery.
       
    4. 
       Cardiac bursa.
       
    5. 
       *Cardiac valve.
       
19. 
    An injury of skin in the medial region of the sternocleidomastoid muscle caused air embolism. Which cervical vein was damaged?
    
    1. 
       Posterior auricular.
       
    2. 
       Anterior jugular.
       
    3. 
       Internal jugular.
       
    4. 
       *External jugular.
       
    5. 
       Transverse cervical.
       
20. 
    During an operative intervention on a mammary gland profuse bleeding appeared. Which artery was damaged?
    
    1. 
       Internal thoracic.
       
    2. 
       Lateral thoracic.*
       
    3. 
       Superior epigastric.
       
    4. 
       Axillary.
       
    5. 
       Superior thoracic.
       
21. 
    A 45-year-old patient's skin of the right foot and leg is pale, there is no pulsation of the dorsal artery of foot and posterior tibial artery. Pulsation of the femoral artery is preserved. Which artery is damaged?
    
    1. 
       Descending genicular.
       
    2. 
       External iliac.
       
    3. 
       Fibular.
       
    4. 
       Deep artery of thigh.
       
    5. 
       *Popliteal.
       
22. 
    A 60-year-old patient has sharp dilation of subcutaneous veins of the anterior abdominal wall. Circulation of which vein was violated?
    
    1. 
       Vena cava superior.
       
    2. 
       Vena azygos.
       
    3. 
       *Vena portae.
       
    4. 
       D.Vena mesenterica superior.
       
    5. 
       Vena cava inferior.
       
23. 
    A 58-year-old patient is admitted to a cardiological clinic with acute persistent pain in substernal area which does not reduce after the second taking of nitroglycerine. Electrocardiogram shows that he has big necrosis of the posterior su rface of the heart. The diagnosis is transmural myocardial infarction of the posterior wall of the heart. Acute occlusion of which vessel led to his disease?
    
    1. 
       *Right coronary artery.
       
    2. 
       Coronary sinus.
       
    3. 
       Right pulmonary artery.
       
    4. 
       Left coronary artery.
       
    5. 
       Left common carotid artery.
       
24. 
    A patient has varicose veins and thrombophlebitis on the posterolateral surface of the leg. Which vein is damaged?
    
    1. 
       V. saphena magna.
       
    2. 
       *V. saphena parva.
       
    3. 
       V. tibialis posterior.
       
    4. 
       V. peronea.
       
    5. 
       V. tibialis anterior.
       
25. 
    A patient has the affection of the head of the femur of ischemic origin diagnosed. Which artery is damaged?
    
    1. 
       *Ramus acetabularis.
       
    2. 
       A. femoralis.
       
    3. 
       A. illiaca externa.
       
    4. 
       A. profunda femoris.
       
    5. 
       A. umbilicalis.
       
26. 
    A patient has significant enlargement of the left atrium, enlarged liver. Which structure of heart is damaged?
    
    1. 
       *Valva tricuspidalis.
       
    2. 
       Valva aortae.
       
    3. 
       Valva bicuspidalis.
       
    4. 
       Valva trunci pulmonalis.
       
    5. 
       Auricula sinistra.
       
27. 
    A patient complains of pain and spasms along the posteromedial surface of the shin. Which vein is damaged?
    
    1. 
       V. femoralis.
       
    2. 
       *V. saphena magna.
       
    3. 
       V. epigastrica superficialis.
       
    4. 
       V. poplitea.
       
    5. 
       V. saphena parva.
       
28. 
    Examination of a patient has shown an edema on the medial surface of the femur, enlargement of veins, and nodulation. Which vein has pathology?
    
    1. 
       V. poplitea.
       
    2. 
       V. saphena parva.
       
    3. 
       V. femoralis.
       
    4. 
       *V. saphena magna.
       
    5. 
       V. iliaca externa.
       
29. 
    A patient has vessel dilation on the anteromedial surface of the shin. Which vessel dilation caused this process?
    
    1. 
       V. saphena parva.
       
    2. 
       A. tibialis anterior.
       
    3. 
       *V. saphena magna.
       
    4. 
       A. tibialis posterior.
       
    5. 
       V. poplitea.
       
30. 
    A patient was admitted to a hospital with subcutaneous veins dilation in the area of umbilicus (cirsomphalos). The vascular permeability of which great venous vessel is damaged?
    
    1. 
       V. renalis.
       
    2. 
       V. mesenterica superior.
       
    3. 
       V. mesenterica inferior.
       
    4. 
       V. iliaca interna.
       
    5. 
       *V. portae hepatis.
       
31. 
    Examining a patient with ischemic disease a doctor detected deterioration of venous blood flow in the basin of a cardiac vein, which passes through the anterior interventricular sulcus. Which vein is this?
    
    1. 
       V. cordis parva.
       
    2. 
       V. cordis media.
       
    3. 
       *V. cordis magna.
       
    4. 
       V. posterior ventriculi sinistri.
       
    5. 
       V. obliqua atrii sinistri.
       
32. 
    During the period of prenatal development in the vascular system of a fetus an arterial duct functions, which turns into lig. arteriosum after birth. What vessels does it join?
    
    1. 
       *Pulmonary trunk and aorta.
       
    2. 
       Right and left atrium.
       
    3. 
       Aorta and inferior vena cava.
       
    4. 
       Pulmonary trunk and superior vena cava.
       
    5. 
       Aorta and superior vena cava.
       
33. 
    Examining blood supply a doctor detects pulsation of a large artery, which passes ahead of the talocrural joint between the tendons of the long extensor of the big toe and the long extensor of fingers in a separate fibrous canal. Which artery is this?
    
    1. 
       A. tarsea lateralis.
       
    2. 
       A. tibialis posterior.
       
    3. 
       A. tarsea medialis.
       
    4. 
       *A. dorsalis pedis.
       
    5. 
       A. fibularis.
       
34. 
    Examining blood supply of a foot a doctor detects pulsation of a large artery behind the malleolus medialis in a separate fibrous canal. Which artery is this?
    
    1. 
       A. dorsalis pedis.
       
    2. 
       *A. tibialis posterior.
       
    3. 
       A. tibialis anterior.
       
    4. 
       A. fibularis.
       
    5. 
       A. malleolaris medialis.
       
35. 
    A patient complains of pain and edema of her lower extremities. Examination has shown edema of tissues, noticeable varicose veins, and nodulation on the medial surface of the thigh. Which vein damage might have caused such changes?
    
    1. 
       *V. saphena magna.
       
    2. 
       V. saphena parva.
       
    3. 
       V. femoralis.
       
    4. 
       V. profunda femoris.
       
    5. 
       Vv. tibiales.
       
36. 
    A patient has symptoms of arterial duct nonclosure. Which vessels does it join?
    
    1. 
       *Aorta and pulmonary trunk.
       
    2. 
       Aorta and inferior vena cava.
       
    3. 
       Aorta and superior vena cava.
       
    4. 
       Pulmonary artery and superior vena cava.
       
    5. 
       Pulmonary artery and inferior vena cava.
       
37. 
    A woman appealed to a doctor with complaints of pain and edema of the lower extremity, veins swelling, and varicose nodes formation on the medial surface of the thigh. Which vein is damaged?
    
    1. 
       Popliteal.
       
    2. 
       Small saphenous.
       
    3. 
       Femoral.
       
    4. 
       *Large saphenous.
       
    5. 
       Posterior tibial.
       
38. 
    A patient with a thymus tumor has cyanosis, extension of subcutaneous venous network, edema of soft tissues of the face, neck, upper half of the body, upper limbs. Which venous trunk is blocked?
    
    1. 
       *Superior vena cava.
       
    2. 
       External jugular vein.
       
    3. 
       Subclavian vein.
       
    4. 
       Internal jugular vein.
       
    5. 
       Anterior jugular vein.