76) During surgery at the root of the neck, an attending surgeon cautions her resident to locate important structures which need to be protected. One of these is the phrenic nerve, responsible for the innervation of the diaphragm and thus, respiration. The phrenic nerve can be positively identified by which of the following anatomical relationships?

76) Explanation

At the root of the neck, the phrenic nerve (C3, C4, C5) lies on the scalenus anterior muscle, not the scalenus medius (choice C). The transverse cervical and suprascapular arteries course over it. The vagus (tenth cranial) nerve, not the phrenic nerve is located between the common carotid artery and the internal jugular vein (choice A). The recurrent laryngeal branch from the vagus nerve wraps around the right subclavian artery (choice D), and courses cranially between the esophagus and the trachea (choice B).

77) A premature female infant is born about 24 weeks after fertilization and develops rapid, labored breathing shortly after birth. She is immediately transferred to intensive care where she is diagnosed with hyaline membrane disease (HMD). Which of the following is most likely deficient in the infant?

77) Explanation

HMD is also known as respiratory distress syndrome, which is most often caused by the lack of lung surfactant, due to a premature birth. Lung surfactant production begins around 20 weeks after fertilization. But it is present only in small amounts until the last 2 weeks before birth when its amount increases significantly. Alveolar ducts (choice A) branch from the respiratory bronchioles during development. Type I alveolar cells (choice D) or pneumocytes are squamous epithelial cells, which participate in gas exchange. These epithelial cells line the terminal saccules (choice C). Type II alveolar cells (choice E) synthesize surfactant.

78) A 28-year-old male patient suffering from head trauma resulting from a car accident is brought unconscious to the emergency room. In performing the pupillary light reflex, you notice that even though the left pupil constricts when you shine a light directly into the left eye, it does not do so when you shine a light into the right eye. This is best explained by a disconnection between which of the following bilateral structures?

78) Explanation

The central visual pathway for the pupillary light reflex is organized as follows: fibers from the ganglionic layer of the retina project posteriorly to the pretectum, which in turn innervates the Edinger-Westphal nucleus. Preganglionic parasympathetic neurons in the EdingerWestphal nucleus project to the ciliary ganglion, which sends postganglionic parasympathetic innervation back to the constrictor pupillae of the eye. The Edinger-Westphal nuclei from each side of the midbrain are also connected to each other by projections running through the posterior commissure. Disconnection of these fibers will result in loss of the consensual pupillary light reflex on the contralateral side, as happens in this case. The habenula (choice B) is a nucleus of the thalamus, which does not participate in the central visual pathways. The lateral geniculate nucleus (choice D) receives fibers from the ganglionic layer of the retina. However, fibers participating in the pupillary light reflex run through this structure without synapsing and terminate in the pretectum. Thus, the lateral geniculate nucleus does not participate in the pupillary light reflex. The inferior colliculus (choice C) and the medial geniculate nucleus (choice E) are components of the auditory system.

79) A patient presented with acute abdominal pain on clinical suspicion patient underwent cholecystectomy. On histopathological examination the finding is normal. The gallbladder epithelium will be:

79)
c. Simple columnar with brush border
• Gallbladder is lined by the columnar epithelium with brush border (irregularly placed microvilli).

80) Explanation


• Periosteum has dense but no definite orientation (irregular) of collagen fibers. Tendon, aponeurosis and ligaments have collagen fiber bundles which are arranged in a uniform parallel (regular) fashion.

81) Explanation

• Ulnar nerve passes above (superficial) to flexor retinaculum especially the palmar cutaneous branch of ulnar nerve

82) Explanation

• Labia majora is homologous to scrotum in male.
• Round ligament terminates at upper border of labia majora

82) Explanation

• Labia majora is homologous to scrotum in male.
• Round ligament terminates at upper border of labia majora