NBDE Part I Mock Board

Review
A.F. Doubleday
Oct 8, 2012

A baseball pitcher tears his rotator

cuff. Which of the following muscles
is not likely to be involved?
A. Infraspinatus
B. Subscapularis
C. Supraspinatus
D. Teres major
E. Teres minor

151

Rotator cuff
muscles

ii.
iii. iv.

i. Subscapularis

(not

pictured on posterior
aspect)

ii. Supraspinatus
iii. Infraspinatus
iv. Teres minor
- All are rotators of the
humerus except
supraspinatus
- Supraspinatus assists
deltoid

Which of the following muscles is

innervated by the dorsal rami of
spinal nerves?
A. Splenius cervicis
B. External abdominal oblique
C. Serratus posterior inferior
D. Latissimus dorsi
E. Innermost intercostal

152

Spinal
nerves
Roots:
Anterior (ventral)
root: motor
Posterior (dorsal)
root: sensory
Dorsal root
ganglion: cell
bodies of sensory
neurons located
outside the spinal
cord

Spinal nerve: the union of anterior and posterior

roots, contains both motor and sensory fibers 5

Spinal nerves
Anterior ramus:
limbs & most of
trunk
Posterior ramus:
skin of back &
deep back
muscles only!
Sympathetic chain
ganglion (ANS):
connect to the
anterior ramus of a
spinal nerve by rami
communicantes
6

Segmentation
Paraxial mesoderm
forms somites.
Somites divide
into 3 parts
1. Myotomes:
striated muscles of
body wall & limbs
a. Epimere: dorsal
b. Hypomere:
ventrolateral

Sadler Fig 6.10

Superficial back muscles

C
E

A.Trapezius
B.Latissimus
Dorsi
C.Levator
Scapulae
D.Rhomboid
Major
E.Rhomboid
minor
Moore fig 4.28

Intermediate back
muscles

rratus Posterior Superior

erratus Posterior Inferior

Grants fig 4.32

10

Intrinsic (deep)
muscles
A
B

C2
C1
C3

Most superficial:
A. Splenius Capitis
B. Splenius
Cervicis
Intermediate:
C1. Iliocostalis
C2. Longissimus
C3. Spinalis

Deepest:
D. Transversospinalis
(1. semispinalis capitis,
2.semispinalis, 3.11
multifidus)

Which of the following structures will NOT be

supplied by a branch of the maxillary artery?

A. Tympanic membrane (ear drum)

B. Dura mater
C. Mandibular teeth
D. Buccinator
E. Tongue

153

Maxillary artery & its

branches
- Large branch of
external carotid
artery
- Course:
infratemporal fossa
pterygomaxillary
fissure
pterygopalatine
fossa (passes
between 2 heads
of lateral pterygoid
- Can be divided into

Moore Fig 7.24

13

A. 1st part: retromandibular

1. Deep auricular
artery: supplies
external auditory
meatus & external
part of tympanic
1.
membrane
2. Anterior tympanic
artery: supplies
tympanic
membrane in
middle ear

2.

Moore Fig 7.25

14

A. 1st part:
retromandibular

3. Middle meningeal
artery: supplies dura
mater & calvaria
-runs between a split
in auriculotemporal n.
-goes through
foramen spinosum
4. Accessory meningeal
arteries: supply
cranial cavity

4.
3.

Moore Fig 7.25

15

A. 1st part:
retromandibular
5. Inferior alveolar
artery:
-

Supplies mandible,
gingiva, teeth,
floor of mouth
Goes through
mandibular
foramen
Gives of branch to
mylohyoid

5.

Moore Fig 7.25

16

B. 2nd part (pterygoid part)

1. Deep temporal
arteries: supply
temporalis
2. Pterygoid arteries:
supply pterygoid
muscles
3. Masseteric arteries:
supply masseter
4. Buccal artery:
supplies buccinator

1.
3.

2.

4.

Moore Fig 7.25

17

C. 3 part (pterygopalatine
part)
rd

- Supply orbit and

nasal cavity
1. Posterior superior
alveolar a.
2. Infraorbital a.
3. Descending
palatine a.
4. Artery of pterygoid
canal
5. Pharyngeal a.
6. Sphenopalatine a.

2.

6.

1.
3.

Moore Fig 7.25

18

A patient presents with a

thrombus (blood clot) in the
internal jugular vein at the level of
the jugular foramen. This
thrombus could impinge on what
other structures?
A. External jugular vein
B. CN IX (glossopharyngeal nerve)
C. CN VI (abducens nerve)
D. Sympathetic axons entering the
skull
E. CN XII (hypoglossal nerve)

154

20

Which nerve does NOT provide sensory

innervation to the head or neck?

A. C1
B. C2
C. C3
D. C4
E. C5

155

Cutaneous
Innervation of
Posterior Neck
Via posterior rami of
C2-C4 (or C2-C5)

Alison F. Doubleday Fall

2011

22

23

The carotid sheath encapsulates

which of the following structures?
A. Superficial cervical lymph nodes
B. External carotid artery
C. Vagus nerve (CN X)
D. Anterior jugular vein
E. Two of the above

160

Contents of Carotid Triangle

Common/internal carotid
artery, internal jugular
vein, CN X (vagus), and
deep cervical lymph
nodes surrounded by
carotid sheath
Bifurcation of common
carotid into internal and
external carotid arteries
Recall: pulse of common
carotid may be taken b/t
trachea and medial
border of superior of
SCM
25

Which of the following statements

about the suboccipital triangle is
FALSE?
A. The greater occipital nerve supplies the
skin of the scalp
B. The occipital artery runs lateral to the
triangle
C. The suboccipital nerve is the posterior
ramus of C2
D. The posterior atlantooccipital membrane
forms the floor of the triangle
E. The rectus capitis posterior minor muscle
does not form the a border of the triangle

164

Suboccipital Triangle
Location and coverings:
Floor: posterior atlanto-occipital
membrane
Roof: semispinalis capitis
Boundaries: 3 muscles
Obliquus capitus superior (superior
oblique)
Obliquus capitus inferior (inferior
oblique)
Rectus capitus posterior major
27

Occipital
artery

C2

Semispinalis Capitis

4.

Grants fig 4.38

3.

Suboccipital
Triangle

1.

Suboccipital nerve (C1)

Greater occipital nerve
(C2)

2.

Semispinalis capitis

1.
2.
3.
4.

Superior oblique
Inferior oblique
Rectus capitis posterior major
Rectus capitis posterior minor
28

Suboccipital Triangle
A

Nerve supply:
A. Suboccipital nerve
(posterior ramus of
C1) - motor only.
Supplies muscles
of the suboccipital
triangle.
B. Greater occipital
nerve (posterior
ramus of C2)
cutaneous only.
Supplies the scalp.
29
Grants Fig 4.39

 Blood supply:
Occipital artery (lateral to suboccipital
triangle) - supplies scalp
Vertebral artery (deep in suboccipital
triangle) - supplies brain and part30of the

Suboccipital triangle

Moore
Fig 4.37
31

Which of the following is innervated

by the somatic nervous system?
A. Abdominal organs
B. Visceral peritoneum
C. Parietal peritoneum
D. Two of the above are innervated by
the somatic nervous system
E. None of the above are innervated by
the somatic nervous system

163

Introduction

Moore Fig 2.9

Peritoneum: a thin serous membrane that lines

both the abdominal wall and the abdominal viscera
Parietal peritoneum: lines the abdominal wall
Visceral peritoneum: lines the abdominal viscera
Peritoneal cavity: space between these two layers

Peritoneum
Parietal peritoneum
Innervated by
somatic nerves
(abdominal region:
T7-L1)
Rebound tenderness

Visceral peritoneum
innervated by ANS
Referred pain

Peritoneal cavity:
potential space
between the two

Moore Fig 2.9

Which of the following statements

about gastrulation and the primary
germ layers is TRUE?
A. All 3 primary germ layers are
formed from epiblast cells
B. The primary germ layers contain
cells that are pluripotent
C. Lateral plate mesoderm and
endoderm combine to form the body
wall
D. The notochord is formed from
ectoderm

177

Epiblast cell migration & gastrulation

1. Some cells migrate to primitive streak

2. These cells detach and invaginate and replace
the hypoblast: form endoderm
3. Further migrating cells differentiate and form

4. The remaining epiblast cells form ectoderm

5. Once the 3 germ layers are established, these
cells are no longer pluripotent

Mesoderm also contributes to

formation of the notochord
1. defines primordial
axis of embryo,
induces
development of
neural plate, axial
skeleton
2. Vertebral column
forms around it
3. Regresses and,
mostly, disappears

4th week: folding

of embryonic disc

- Intraembryonic
coelom forms
future body
cavities
- Body wall formed
from somatic
mesoderm and
ectoderm
- Gut tube formed
from splanchnic
http://www.indiana.edu/~anat550/genanim/latfold/index.html
mesoderm and

Which of the following elements is not

derived from the 2nd pharyngeal arch?
A. The greater horn of the hyoid
B. The stylohyoid ligament
C. The styloid process
D. The stapes
E. All of the above are derived from the
2nd pharyngeal arch

178

Derivatives of the Pharyngeal Arches

Pharyngeal
Arch

Arch Artery

Cranial Nerve

Muscles
(derived from paraxial
mesoderm)

Skeletal Structures &

Ligaments
(derived from arch
cartilage)

terminal branch of
maxillary artery

Trigeminal (CN V)
[maxillary prominence:
V2
mandibular prominence:
V3 ]

Muscles of Mastication
Mylohyoid
Digastric: Anterior Belly
Tensor Tympani
Tensor Veli Palatini

Malleus
Incus
Anterior Ligament of
Malleus
Sphenomandibular
Ligament

part of stapedial artery

(called the corticotympanic
artery in the adult)

Facial (CN VII)

Muscles of Facial
Expression
Digastric: Posterior Belly
Stylohyoid
Stapedius

Stapes
Styloid Process
Lesser Horns & Upper part
of body of Hyoid Bone
Stylohyoid Ligament

common carotid artery

Glossopharyngeal
(CN IX)

Stylopharyngeus

Greater Horns and Lower

part of body of Hyoid

arch of the aorta,

proximal part of right
subclavian artery

Superior laryngeal
branch of Vagus nerve
(CN X)

Constrictors of the Pharynx Laryngeal Cartilages

Cricothyroid
(e.g., thyroid, cricoid,
Levator Veli Palatini
arytenoid, corniculate &
cuneiform cartilages)

proximal parts of
pulmonary arteries,
ductus arteriosus

Recurrent laryngeal
branch of Vagus nerve
(CN X)

Intrinsic Muscles of Larynx Laryngeal Cartilages

(same as arch 4)

41

A cleft lip can result if the following two

tissues fail to fuse during development:

A. Left and right medial nasal

prominences
B. Left and right palatine shelves
C. Medial nasal prominence and lateral
nasal prominence
D. Intermaxillary segment and the
maxillary prominence
E. Lateral nasal prominence and
palatine shelves
180

 http://www.indiana.edu/~anat550/hna
nim/face/face.html

43

Careless/poor resection of a
parotid gland tumor would cause
the most damage to the nerve
that innervates ___ arch structures
A. 1st
B. 2nd
C. 3rd
D. 4th
E. 6th

157

Which triangle of the neck is bordered

anteriorly by the superior belly of the
omohyoid, posteriorly by the anterior border
of the sternocleidomastoic and superiorly by
the posterior bell of the digastric?

A. Submandibular
B. Carotid
C. Supraclavicular
D. Muscular
E. Submental
159

Anterior Cervical
Region
Borders:
Posterior: anterior
border of SCM
Anterior: midline of
neck
Superior: mandible
Inferior: sternum

Subdivided into 4
smaller triangles
(*carotid, muscular,
submental and
*submandibular)
Alison F. Doubleday Fall
2011

47

Alison F. Doubleday Fall

2011

48

Which nerve does NOT innervate a

muscle that attaches to the hyoid bone?

A. CN VII (facial nerve)

B. CN V3 (mandibular nerve)
C. Anterior ramus of C1
D. CN V2 (maxillary nerve)
E. Anterior ramus of C2

158

Muscles in the anterior cervical

region
strap muscles
Attach to hyoid
and/or thyroid
cartilage; move
these structures
(swallowing,
speaking)
Most innervated by
cervical plexus

Alison F. Doubleday Fall

2011

50

Suprahyoid
Muscles
All will elevate
hyoid bone
Mylohyoid:
Innervated by
branch of CN V3

Digastric:
Also depresses the
mandible
Anterior belly
innervated by CN V3
Posterior belly
innervated by CN VII
Alison F. Doubleday Fall
2011

51

Suprahyoid
muscles
Geniohyoid:
(typically
innervated by C1)
Stylohyoid:
Innervated by CN
VII

Alison F. Doubleday Fall

2011

52

Infrahyoid
muscles

Sternohyoid
Omohyoid
Sternothyroid
Thyrohyoid

Alison F. Doubleday Fall

2011

53

Motor Innervation
Supply most (not all) of
strap muscles
Motor branches
(primarily C1-C3) form
a loop: ansa cervicalis
Subdivided into a
superior root and an
inferior root

Note: C1 nerve (and

part of ansa cervicalis)
travel partway with CN
XII
Alison F. Doubleday Fall
2011

54

Which of the following structures is NOT

typically supplied by a branch of the superior
mesenteric artery?

A. Appendix
B. Cecum
C. Jejunum
D. 3rd part of the duodenum
E. Splenic (left flexure of the
transverse colon)

165

Early formation of gut tube

Sadler Fig. 14.4

Celiac trunk foregut

Superior mesenteric artery midgut
Inferior mesenteric hindgut

Gut derivatives
Foregut derivatives
(abdominal
portion)
1. Esophagus
2. Stomach
3. Proximal half of
duodenum
4. Most of liver
(outgrowth)
5. Pancreas
(outgrowth)
6. Gallbladder/bile
duct system
Moore Fig 2.13
(outgrowth)

Gut derivatives
Midgut derivatives
1. distal half of
duodenum
2. jejunum
3. ileum
4. cecum
5. appendix
6. ascending colon
7. right 2/3
transverse
colon
Moore Fig 2.13

Gut
derivatives
Hindgut derivatives
1. left 1/3
transverse colon
2. descending
colon
3. sigmoid colon
4. rectum
5. superior portion
of anal canal
6. epithelium of
bladder/urethra
Moore Fig 2.13