MERU UNIVERSITY OF SCIENCE AND TECHNOLOGY

P.O. Box 972-60200 – Meru-Kenya.

Tel: +254(0) 799 529 958, +254(0) 799 529 959, +254 (0)712 524 293
Website: www.must.ac.ke Email: [email protected]

UNIVERSITY EXAMINATIONS 2022/2023

FIRST YEAR, SECOND SEMESTER EXAMINATION FOR THE DEGREE OF BACHELOR

OF SCIENCE IN CLINICAL MEDICINE AND COMMUNITY HEALTH DEVELOPMENT

CCM 3124: HUMAN ANATOMY I

DATE: APRIL 2023 TIME: 2 HOURS

INSTRUCTIONS: Answer all questions in the booklet provided

Ensure that all your answers are properly numbered
Section A: Short Answer Questions-Answer questions following each other
on the answer booklet
Section B: Long Answer Questions-Answer the questions
Section C: Multiple Choice Questions (MCQs): Write the correct answer on
the space provided in the answer booklet. Each MCQ is one mark.

QUESTION A SHORT ESSAY QUESTIONS (Each Question is 5 Marks)

1. Describe the general organization of the body from superficial to deep.

2. A truck loader at the Meru Wakulima Market is loaded with 48kg of miraa over his head.
Describe how this weight will be transmitted and equally loaded through the different body
regions.
3. A physician tests the patellar tendon reflex as shown. A normal response of the involuntary
contraction of the quadriceps femoris muscle is noted.
 a. This reflex confirms the integrity of what nerve?
b. Describe the distribution of the nerve identified above within the thigh (cutaneous, motor
and articular)
4. Mr. Wanyonyi, a 30yr old male from Bungoma got involved in a road traffic accident and
suffered an open tibial fibula fracture as per images below. When you were asked to
review him, you noted that the limb is bluish in color, cold to touch, swollen and tense
with a distant distal pulse and you suspect compartment syndrome involving the extensor
compartment of the leg.

Based on the location of wound above, populate the table below

Which blood vessels pass through the
compartment?
Which artery would you palpate to check
for vascular compromise?
Which two movements will be lost if the 1.
nerves die off 2.

What surgical procedure needs to be

done to save this limb?
 5. Describe the characteristics of epithelial tissue and one clinical correlate.
6. Describe the general organization of the venous systems of the lower limb and one
clinical correlate.
7. Posterior dislocation of the hip is commonly encountered in passengers involved in road
traffic accidents.
a. Describe the stability factors associated with the hip joint under the following
headings:
i. Bonny factors
ii. Ligaments with their attachment
b. List two complications associated with posterior dislocation of the hip joint.
8. A patient with a skin lesion over the dorsal aspect of the hand needs to undergo an
operation to remove it. Illustrate with a drawing the innervation of the hand before a wrist
block is made.

SECTION B LONG ESSAY QUESTIONS (Each Question is 20 MARKS)

1. A 40yr old female with right breast cancer is to undergo a mastectomy (surgical removal of
the breast) but before this, the surgeon needs to know the status of the lymphnodes. A
sentinel lymphnode biopsy is ordered.
a. Define a sentinel node
b. Describe the lymphatic drainage of breast (a well labelled diagram may be used)
c. After the mastectomy and removal of axillary lymph nodes, it is noted that the patient
is not able to pick objects from the top shelf of her kitchen using her upper limb.
Populate the table below with regards to the injury described.
Injured structure Structure Root value

Muscle affected
Clinical testing

2. Describe the origin, motor, cutaneous and articular distribution of the common peroneal
nerve.
SECTION C MULTIPLE CHOICE QUESTIONS (Each Question is 1 Mark)

1. Which of the following is true of the anatomical position?

(A) The humerus is proximal to the scapula.
(B) The radius is medial to the ulna.
(C) The vertebral arch is ventral to the vertebral body.
(D) The femur is superior to the fibula.
(E) The phalanges of the foot are cranial to the metatarsals.

2. A radiologist wishes to image the body in a plane parallel to both scapulae. Which of the
following choices best describes the desired sectioning?
(A) Horizontal section
(B) Transverse section
(C) Frontal section
(D) Sagittal section
(E) Oblique section

3. A young boy uses his right hand to screw-in a new light bulb. Which of the following terms
best describes the screw-home movement of his forearm?
(A) Flexion
(B) Abduction
(C) Pronation
(D) Adduction
(E) Supination

4. A 16-year-old boy crashes his mountain bike and suffers a fractured tibia. Which of the
following damaged structures would most likely produce the acute pain emanating from the
fractured tibia?
(A) Nerves in compact bone
(B) Nerves in trabecular bone
(C) Surrounding muscle and tendon receptors
(D) Periosteal nerves
(E) Vascular nerves
5. In examining a radiograph of the right shoulder of a 32-year-old male car accident victim, the
radiologist identifies the head of the humerus located below the coracoid process of the scapula
in a subcoracoid position. Which of the following terms best describes the condition of the
humerus?
(A) Avulsed
(B) Comminuted
(C) Dislocated
(D) Reduced
(E) Subluxated

6. A physician delivers an intramuscular injection into the lateral aspect of the shoulder. Which
of the following sequences describes the correct order of tissue layers pierced by the needle,
passing from superficial to deep?
(A) Epidermis, dermis, superficial fascia, epimysium, deep fascia
(B) Dermis, epidermis, superficial fascia, deep fascia, epimysium
(C) Dermis, epidermis, superficial fascia, epimysium, deep fascia
(D) Epidermis, dermis, superficial fascia, deep fascia, epimysium
(E) Epidermis, superficial fascia, dermis, deep fascia, epimysium

7. A 20-year-old college student on spring break suffers a first degree sunburn on her back and
upper limbs. Which of the following integumentary structures/functions is most likely affected?
(A) Hair follicles
(B) Subcutaneous fat
(C) Vitamin A production
(D) Parasympathetic nerve endings
(E) General sensory nerve endings

8. A teenage boy breaks a pane of glass with his fist and receives a laceration to the posterior
aspect of his wrist. He notices the tendons that cross his wrist lift out of place (or bowstring)
when he extends his wrist. Which of the following structures was most likely cut by the broken
glass?
(A) Investing deep fascia
(B) Intermuscular septum
(C) Bursa
(D) Retinaculum
(E) Synovial tendon sheath

9. A 32-year-old pregnant woman at 30 weeks of gestation comes to her physician due to excess
weight gain in a 2-week period. Ultrasonography reveals polyhydramnios. Which fetal
abnormality is most likely responsible for the polyhydramnios?
(A) Bilateral kidney agenesis
(B) Urinary tract obstruction
(C) Uteroplacental insufficiency
(D) Hypoplastic lungs
(E) Esophageal atresia

10. The given illustration depicts the passage of a human egg through the female reproductive
tract from ovulation to implantation. These events occur during the 1st week of development.
Fertilization normally occurs at which of the indicated steps?

11. A 20-year-old woman is surprised to discover that she is pregnant. Following a review of her
menstrual history and sexual activity, her physician determines that she is in the 4th week of
pregnancy. Which of the following best describes the condition of the embryo at this time?
(A) Gastrulation is complete, resulting in two germ layers
(B) The embryo is entering a period of relative resistance to teratogenic substances
(C) Neurulation is nearly complete
(D) Somites have not yet formed
(E) The trophoblast is present, but the syncytiotrophoblast has not yet formed
12. A developmental neurobiologist surgically removes the neural crest in the thoracic region of
a chicken embryo immediately after closure of the neural tube. Which of the following cell types
is most likely to be affected?
(A) Cardiac muscle cells
(B) Autonomic ganglia in the thoracic cavity
(C) Epithelial cells lining the lower respiratory tract
(D) Bone cells in the ribs
(E) Skeletal muscle cells in the thoracic wall

13. A Clinical Officer tests the patellar tendon reflex as shown. A normal response of the
involuntary contraction of the quadriceps femoris muscle is noted. This reflex confirms the
integrity of what nerve?

14. A 70-year-old man reports an inability to climb stairs and stand up from a sitting position.
Further examination also shows weakness when laterally rotating the thigh against resistance.
What nerve is most likely compromised in this patient?
(A) Femoral nerve
(B) Obturator nerve
(C) Sciatic nerve
(D) Superior gluteal nerve
(E) Inferior gluteal nerve

15. A physician tests the calcaneal tendon (ankle jerk) reflex as shown. A normal response of
plantar flexion of the ankle joint is noted. This myotatic (deep tendon) reflex confirms the
integrity of what nerve?

(A) Tibial nerve

(B) Deep fibular nerve
(C) Superficial fibular nerve
(D) Medial plantar nerve
(E) Lateral plantar nerve

16. A 75-year-old female patient fell in a hospital and landed on her hip. The given AP X-ray
reveals fragmentation of her proximal femur. Which of the following muscles is most likely
detached in association with the fracture fragment?
(A) Gluteus maximus
(B) Gluteus medius
(C) Iliopsoas
(D) Biceps femoris
(E) Sartorius

17. Physical examination of a 40-year-old man injured in an automobile accident indicates that
he has suffered nerve damage affecting his left upper limb. The patient exhibits significant
weakness when pronating his left forearm and flexing his left wrist. What nerve is most likely
damaged?
(A) Median nerve
(B) Ulnar nerve
(C) Superficial branch of the radial nerve
(D) Deep branch of the radial nerve
(E) Musculocutaneous nerve

18. An 18-year-old boy is cut severely on the lateral wall of his right chest during a knife fight.
Following healing, his scapula moves away from the thoracic wall when he leans on his right
hand, giving the appearance indicated in the given photo. Which of the following nerves is likely
damaged?
(A) Axillary nerve
(B) Thoracodorsal nerve
(C) Long thoracic nerve
(D) Dorsal scapular nerve
(E) Suprascapular nerve

19. The given anteroposterior (AP) X-ray depicts a humeral shaft fracture in a 22-year-old man.
Given the location of the fracture, which of the following structures is most likely damaged?

(A) Posterior circumflex humeral artery

(B) Ulnar nerve
(C) Axillary nerve
(D) Profunda brachii artery
(E) Median nerve
20. The pectoralis minor muscle is an important landmark in identifying and describing
neighboring structures in the chest and axillary regions. Which of the following relationships of
the pectoralis minor is correct?
(A) The lateral cord of the brachial plexus lies lateral to the muscle
(B) The clavipectoral triangle lies lateral to the muscle
(C) The anterior axillary lymph nodes lie along the medial border of the muscle
(D) The lateral wall of the axillary fossa includes the muscle
(E) The second part of the axillary artery lies deep to the muscle