Anatomy

1. This structure will be incised in doing any type of

episiotomy:
A. anococcygeal body

B. anterior levator ani fibers

C. ischiocavernosus

D. puborectalis
Episiotomy
Structures Cut:
1. Vaginal Mucosa
2. Superficial and
deep transverse
perineal muscles
3. Bulbospongiosus
4. Part of Levator Ani
5. Internal Pudendal
Blood vessels
6. Skin and
Subcutaneous
tissue
Episiotomy
2. The branch of the facial nerve that is closely related to
the parotid duct:
A. temporal

B. zygomatic

C. buccal

D. mandibular
Remedials 2020: Which of the following ligaments provide
the primary support for the cervix of the uterus?
A. Broad - flat sheet of peritoneum, associated with the
uterus, fallopian tubes and ovaries

B. Cardinal - lateral, transverse cervical, or Mackenrodt’s

ligaments. Side of the cervix and the lateral fornix of the
vagina to the lateral pelvic wall

C. Round - originates at the uterine horns (the points at

which the fallopian tubes enter the uterus), and attaches
to the labia majora, passing through the inguinal canal.

D. Suspensory Ligament - extends outwards from the ovary

to the lateral abdominal wall (ovarian artery, ovarian vein,
ovarian nerve plexus and lymphatic vessels)
3. This structure is ligated to prevent excessive bleeding
when surgically removing the ovary:

A. mesovarium

B. mesosalpinx

C. round ligament

D. suspensory ligament
4. After parotidectomy, a patient was noted to have
drooping of the lower lip on the affected side.
The nerve that is most likely injured is:
A. buccal

B. mandibular

C. temporal

D. zygomatic
5. An 85-year-old male consulted due to weak and intermittent urinary stream, straining,
and a feeling of incomplete voiding. An enlarged, non-tender prostate gland was noted on a
digital rectal examination. Prostate specific antigen was 9 ng/ml (NV 4 ng/ml). This lobe of
the prostate gland is likely implicated to cause the patient’s obstructive symptoms:

A. anterior
B. median
C. posterior
D. inferior
 BPH Prostate CA

Median and Lateral LOBES (more Posterior LOBE (Can be felt by DRE)
glandular)

Transition/Periurethral ZONE Peripheral ZONE

*Anterior lobe - fibromuscular *Transition Zone - SURROUND

and has no glands Urethra (periurethral)
*Median lobe - behind prostatic *Central zone - SURROUNDS
urethra, SUPERIOR (Boundary) the ejaculatory duct
to the ejaculatory duct
*Central zone - SURROUNDS
the ejaculatory duct
6. The possible problem in the tongue of a child with
chronic otitis media is:

A. loss of sensation ,anterior 2/3

B. loss of taste, anterior 2/3

C. loss of sensation, posterior 1/3

D. loss of taste, posterior 1/3

7. The structure on the intravenous pyelogram pointed by
the arrow:

A. major calyx

B. minor calyx

C. pelvis of right kidney

D. right ureter
Renal artery (L2) - right is longer
Renal vein - left is longer
Primary bronchus - left is longer
Brachiocephalic vein - left is longer
Testis - left is lower
Kidney - right is lower
8. Patient complained of difficulty breathing with good
voice after total thyroidectomy. Injury to the
following nerves might explain these clinical
manifestations:
A. Bilateral injury to external branch of superior laryngeal.

B. Bilateral injury to recurrent laryngeal.

C. Bilateral injury to internal branch of superior laryngeal.

D. Unilateral injury to recurrent laryngeal.

9, The following correctly depicts the position of the laryngeal
apertures and folds during forced inspiration:
A. Vocal folds adducted, rima vestibuli closed, vestibule closed.

B. Vocal folds abducted, rima vestibuli open, vestibule open.

C. Vestibular folds abducted, rima vestibuli closed, vestibule closed.

D. Vocal folds adducted, rima vestibuli open, vestibule open.

10. This symptom will manifest after an injury to the
external branch of the superior laryngeal
nerve:
External Branch of Superior Recurrent Laryngeal Nerve
Laryngeal Nerve (continuation of vagus nerve)
A. breathy voice
Superior thyroid artery Inferior Thyroid artery
B. inability to reach high pitch
SLN - STA RLN - ITA
C. abnormally high pitched voice
Supplies Cricothyroid Supplies All other laryngeal
D. normal voice muscle: ONLY TENSOR of muscles
the vocal cords to produce Sensory innervation below
high pitch sounds vocal cords

Posterior cricoarytenoid
muscle - ONLY ABDUCTOR
of the vocal cords
11. The portion of the stomach affected when a surgeon
cuts the hepatic branch of the anterior
vagal trunk:
A. fundus

B. body

C. antrum

D. pylorus
Nerve Supply of the Stomach
Sympathetic Fibers
● From celiac plexus
● Carries pain-transmitting fibers
Parasympathetic Fibers
● From R and L vagus Nerves (LA-RP)
○ exits the thorax thru the esophageal hiatus of the diaphragm (TV10)
● Secremotor to gastric glands and motor to stomach wall

Anterior Vagal Trunk Posterior Trunk

● LEFT vagus nerve ● RIGHT vagus nerve

● Large Hepatic Branch - passes to the ● Large branch passes CELIAC and
liver with PYLORIC branch to the MESENTERIC plexus - supplies
pylorus intestine to the splenic flexure and
pancreas
Diaphragm

Caval Opening Esophageal Opening Aortic Opening

8th TV in the central tendon 10th TV 12th TV

Inferior vena Cava Esophagus Aorta

Right Phrenic nerve Vagus Nerve/CN10 (Left Thoracic Duct
(terminal branches) and Right) Azygos Vein
Left gastric vessel branches
*Left Phrenic nerve - no and lymphatics
opening but penetrates the
diaphragm
12. After parotidectomy, patient noted paresthesia of the
skin over the parotid gland and ear lobe.
The following nerves may have been inadvertently injured
during the surgery:

A. infraorbital of the trigeminal

B. zygomatic branch of the facial
C. mandibular branch of facial
D. greater auricular from the cervical plexus
Innervation of the face
CN 7 - Facial Nerve
● Motor to muscles of Facial Expression
● Sensory to taste of the anterior ⅔ of the tongue
CN 5 - Trigeminal Nerve
● Motor to muscles of Mastication
○ Masseter (elevator)
○ Temporalis (elevator)
○ Medial pterygoid (elevator)
○ Lateral pterygoid (depressor)
● Sensory to skin of the face and proprioceptive fibers to underlying Facial
expression muscles
Great Auricular Nerve (cutaneous branch of the cervical plexus C2-C3)
● Sensory to skin of the auricle, over parotid gland and mastoid process
● Supplies deep layer of parotid fascia
13. The lymph node area where cancer from the thyroid
gland metastasizes first is the:

A. upper jugular

B. mid jugular

C. prelaryngeal

D. posterior triangle
14. A 25-year-old laborer complains of gradual weakness
and inability to make a tip to tip pinch
with his right thumb and index finger. Hand sensation is
normal. The structure most likely affected
is the:
A. deep radial - supplies the posterior fascial compartment

B. superficial radial - supplies skin of the lateral ⅔ of the dorsum of the palms and posterior surface of the proximal
phalanges of the lateral 1/3

C. anterior interosseous

D. posterior interosseous - branch of the radial nerve supplying posterior fascial compartment of the forearm
Anterior Fascial Component
Superficial
1. Pronator teres - median nerve
2. Flexor carpi radialis - median nerve
3. Palmaris longus - median nerve
4. Flexor carpi ulnaris - ULNAR nerve
Intermediate
5. Flexor digitorum superficialis -median nerve
Deep
6. Flexor digitorum profundus - ULNAR and median nerve
7. Flexor policis longus - Anterior interosseous nerve
(branch of median nerve)
*Flexes distal phalanx of the thumb
8. Pronator quadratus - Anterior interosseous nerve (branch of
median nerve)
Remedials 2020: Compression of the median nerve in the
carpal tunnel will cause loss of sensation over the skin of
which of the following areas?
A. Palmar surface of the hand
B. Lateral Three and a half fingers
C. Palmar aspect of the medial three and a half fingers
D. Medial part of the dorsum of the hand
Thenar Muscles - MEDIAN NERVE
1. Abductor pollicis brevis
a. Adductor pollicis brevis -
ULNAR
2. Flexor pollicis brevis
3. Opponens pollicis

Hypothenar Muscles - ULNAR

NERVE (deep branch)
1. Abductor digiti minimi
2. Flexor digiti minimi
3. Opponens digiti minimi
15. A 34-year-old female accidentally ingested hydrochloric
acid. The level or segment that will
show the most damage on esophagoscopy:

A. the oropharynx

B. where the right main bronchus crosses the esophagus

C. where the arch of the aorta and left main bronchus cross the esophagus

D. the termination of the esophagus as it enters the cardiac orifice

Constrictions

Constrictions of the esophagus:

site of foreign body obstructions, stricture formation after
caustic injury, carcinomas, difficulty passing scopes
1. Cricopharyngeus (CV6) - commencement
2. Left main bronchus and Arch of the aorta
3. Diaphragm (TV10)
Constrictions of the ureter:
Site of stone obstruction leading to hydronephrosis
1. Ureteropelvic Junction (UPJ)
2. Pelvic brim
3. Ureterovesical junction (UVJ) - narrowest
Sternum
Sternal Angle of Louie
● Level of the 2nd costal cartilage→ 2nd rib
(Manubriosternal joint)
● Level of T4-T5
● Termination of Ascending Aorta
● Commencement and Termination of the
Arch of the Aorta
● Termination of Trachea
● Carina - bifurcation of the trachea
● Divides mediastinum to superior and
inferior
Abdomen
Transpyloric Plane “Addison’s plane
● Tips of the 9th CC
● Fundus of the GB
● Neck of the pancreas
● Pylorus of the stomach
● Duodenojejunal flexure
● Transverse mesocolon
● Hilum of the left kidney
● Origin of the SMA
● Commencement of Portal vein
● L1-L2 (Termination of spinal cord)
Dermatomes
● Xiphoid: T7 (T6?)
● Umbilicus: T10
● Inguinal: L1
Gastric Ulcer perforation: Splenic artery (posterior)
Duodenal Ulcer perforation: gastroduodenal artery
(Posterior)
2020 Remedials:
1. A 56 year old male patient suffered multiple rib fractures and had
ecchymoses along the right hemithorax. Chest xray revealed blunting of the
right costophrenic sulci. At which intercostal space should the surgeon insert
a chest tube to drain the fluid.

A. 2nd Right MCL, Upper border of the rib

B. 7th Right PAL, Upper border of the rib?
C. 5th right AAL, Upper border of the rib
D. 5th left MAL, Lower border of the rib Lungs Pleura

MCL (Ant) 6th rib 8th rib

MAL (Lat) 8th rib 10th rib

Vertebral 10th rib 12th rib

column(Post)
Thoracostomy (Chest tube drainage )
● Evacuate ongoing fluid/air production
● 4th or 5th ICS AAL
Thoracentesis
● 8th or 9th ICS MAL

Needle Insertion Site

● Above Rib
● 1 to 2 ICS below the height of the
effusion, 5 to 10 cm lateral to the spine
● Not below 9th rib to avoid
intra-abdominal injury
Lungs Pleura

MCL (Ant) 6th rib 8th rib

MAL (Lat) 8th rib 10th rib

Vertebral column(Post) 10th rib 12th rib

2020 Remedials: Which is the best space to enter the neck
for an emergency access to the airway outside the
hospital?
A. Hyoid bone and thyroid cartilage
B. Cricoid cartilage and trachea
C. Thyroid cartilage and Cricoid Cartilage - Cricothyroidotomy - Emergency
airway even outside the hospital thru the cricothyroid membrane
D. Tracheal rings
2020 Remedials: What arteries are involved in the
pulsation used in blood pressure monitoring?
A. Brachial and Radial artery
Blood pressure monitoring
B. Ulnar and radial artery
C. Brachial and ulnar artery 1. Palpatory BP
D. Profundaa brachii and brachial a. Inflate BP until radial pulse disappears,
then double check if it reappears upon
artery deflation
2. Auscultatory BP
a. Stethoscope is place at the medial side
of the arm (brachial artery) while
listening for the korotkoff sound (SBP)
and its disappearance (DBP)
2020 Remedials: What structures does functional division
of the liver pass through

A. Lamentum venosum and

ligamentum teres
B. Caudate and Quadrate lobe
C. Fossa of the gallbladder
anteriorly and fossa of the
IVC posteriorly
D. Fossa of the gallbladder
posteriorly and fossa of the
IVC anteriorly
Cantlie’s line
2020 Remedials: What incision is the fastest way to get
inside the greater peritoneal cavity of an adult?

A. Midline
B. Pararectus
C. Paramedian
D. Low transverse infraumbilical

Midline incision
● Through the linea alba
● Almost bloodless, no muscle or nerves are
injured
● Good access and very quick to make
2020 remedials: Which of the following nerves is
responsible for having erection?
A. Sacral splanchnic ● Pelvic Splanchnic plexus or nervi erigentes
B. Pelvic Splanchnic (S2-S4) - parasympathetic innervation to the
hindgut
C. Pudendal ○ Parasympathetic - ERECTION (cavernous
D. Dorsal nerves)
○ Supplies the internal urethral meatus
● Pudendal Nerve - Sympathetic -
EJACULATION -
○ Supplies the external urethral meatus
The union of the following forms the common bile duct
A. Common hepatic and right hepatic duct
B. Cystic duct and common hepatic duct
C. Right and left hepatic duct
D. Duct of Lushka and cystic duct
In females, which WBC can show the X- chromosome on
light microscopy
Barr Bodies - inactivated X chromosome - small
A. Basophil
drumstick-like projection on one of the lobes of
B. Neutrophil
some neutrophils in females
C. Lymphocyte
D. Eosinophil
A hospital healthcare worker sustains a needlestick accident from a patient being
evaluated for jaundice. Hepatitis panel showed: HBsAg (-); Anti-HBsAg (+);
Anti-HBcAg IgM (-); Anti-HBcAg Total (-); Anti-HAV IgG (+); Anti-HCV (-). Give the
correct interpretation of the hepatitis panel:

A. acute infection with HAV

B. acute infection with HBV
C. chronic infection with HBV
D. vaccinated against HBV and HAV
HBsAg (-); Anti-HBsAg (+); Anti-HBcAg IgM (-); Anti-HBcAg Total (-); Anti-HAV IgG (+);
Anti-HCV (-). Give the correct interpretation of the hepatitis panel:

SEC CES
● HBV DNA or HBsAg (australian Ag)- ● Anti HBc IgM - first antibody to appear start of
sign of acute infection convalescent phase, acute infection
● HBeAg - sign of replication (high ● Anti HBc Total (IgM/IgG) - sign of exposure; maybe
infectivity) acute infection or chronic infection; mau be seen
during convalescent phase
● Anti HBs - sign of immunity
63. A beta-hemolytic, catalase positive, Gram-positive
coccus is coagulase-negative by the slide
coagulase test. The most appropriate action in the
identification of this organism is:
A. Identify as coagulase-negative Staphyloccus aureus.
B. Identify as Streptococcus pyogenes.
C. Repeat overnight incubation.
D. Do a tube coagulase test to confirm the slide test. - CONFIRMATORY
Reagent: Rabbit or Human plasma
64. The identification of Entamoeba histolytica in watery,
mucoid stool is almost diagnostic if this
cellular element is present in the cytoplasm of the
trophozoite:
A. glycogen vacuole

B. red blood cells

C. bacteria

D. cellular debris
65. A 54-year-old male butcher died from a motor vehicular accident. During autopsy,
there were noted multiple, small cystic lesions in the brain filled with clear fluid, some
containing small, ovoid milky white objects. These were sent to the laboratory and
were identified as Taenia solium. In this case, humans are:

A. intermediate host - Host wherein larval or intermediate forms of the parasite

are seen

B. definitive host - host wherein in the parasite grows to full potential to adult

C. natural reservoir - harbors infection and serves as a source in the environment

D. animal vector - transmits the parasite to other hosts

67. The CBC parameter that measures the degree of red
cell anisocytosis:
A. red cell distribution width - degree of anisocytosis (RBC size)

B. mean corpuscular hemoglobin - Amount of hemoglobin in an RBC

C. reticulocyte production index

D. mean platelet volume