GRAY'S ANATOMY FOR STUDENTS
5TH EDITION
• AUTHOR(S)RICHARD L. DRAKE
TEST BANK
Q1
Reference: Ch. 1 — What is anatomy?
Stem: A novice clinician observes two patients with similar
blunt trauma to the lateral thorax: one has normal respiratory
mechanics; the other has paradoxical inward movement of part
of the chest during inspiration. Using anatomical reasoning,
which structural-level change best explains the paradoxical
motion?
A. Rupture of a visceral pleural adhesion to the lung
B. Fracture of multiple adjacent ribs creating a free-floating
segment of chest wall
C. Diaphragmatic tear with abdominal contents entering the
thoracic cavity
D. Partial pneumothorax localized to the apex of the lung
Correct answer: B
,Rationale (correct): A flail chest results from fractures of
multiple adjacent ribs producing a detached chest wall segment
that moves paradoxically during respiration, impairing
ventilatory mechanics (structure → impaired function). Gray
emphasizes how integrity of musculoskeletal elements
maintains normal thoracic excursion.
Rationale (A): Visceral pleural adhesions affect lung expansion
but do not create a free-floating chest wall segment nor cause
paradoxical skeletal movement.
Rationale (C): Diaphragmatic rupture alters abdominal-thoracic
pressure relationships but typically causes herniation, not
localized paradoxical rib motion.
Rationale (D): A localized pneumothorax may collapse lung
tissue but does not produce a flail segment of the chest wall.
Teaching point: Multiple adjacent rib fractures can form a flail
chest and disrupt normal thoracic mechanics.
Citation: Drake, R. L. (2024). Gray’s Anatomy for Students (5th
Ed.). Ch. 1.
Q2
Reference: Ch. 1 — What is anatomy?
Stem: During a teaching session you must explain why
knowledge of anatomical variation is critical when interpreting
clinical signs. Which example best illustrates how normal
anatomical variation could change the clinical finding?
A. A patient with an atypical branching pattern of the aortic
,arch presenting with radial pulse delay
B. A patient with a duplicated ureter showing increased
filtration rate
C. A person with accessory spleen causing a decrease in platelet
count
D. An individual with extra digits causing altered balance
Correct answer: A
Rationale (correct): Variations in aortic arch branching can alter
pulse transmission to the upper limbs and cause asymmetry or
delay in radial pulses; this is a classic example linking anatomical
variation to a clinical sign as emphasized in Gray’s.
Rationale (B): A duplicated ureter affects urine drainage
anatomy but does not increase glomerular filtration rate
systemically.
Rationale (C): An accessory spleen is usually clinically silent and
does not typically cause thrombocytopenia unless pathologic
splenic function exists.
Rationale (D): Polydactyly is an anatomical variation but
typically does not meaningfully alter static balance to the point
of clinical misinterpretation.
Teaching point: Anatomical variants (e.g., aortic arch branching)
can alter expected clinical signs.
Citation: Drake, R. L. (2024). Gray’s Anatomy for Students (5th
Ed.). Ch. 1.
, Q3
Reference: Ch. 1 — Imaging
Stem: A patient has blunt abdominal trauma and suspected
internal bleeding. Which imaging modality provides the fastest,
most sensitive initial assessment for free intraperitoneal fluid in
an unstable patient, and why from an anatomical imaging
standpoint?
A. Contrast-enhanced CT because it best resolves solid-organ
injuries
B. Focused assessment with sonography for trauma (FAST)
because it rapidly detects fluid in dependent peritoneal spaces
C. Plain abdominal radiograph because free air indicates hollow
viscus injury
D. MRI because it offers superior soft tissue contrast without
ionizing radiation
Correct answer: B
Rationale (correct): FAST ultrasound rapidly evaluates
dependent peritoneal spaces (e.g., hepatorenal recess, pelvis)
at the bedside, making it ideal for unstable patients;
anatomically these spaces collect fluid first, so sonography is
sensitive for acute hemoperitoneum. Gray’s imaging section
highlights modality selection based on anatomy and clinical
status.
Rationale (A): CT is highly sensitive and informative but slower
and often unsuitable for unstable patients needing immediate
bedside assessment.
5TH EDITION
• AUTHOR(S)RICHARD L. DRAKE
TEST BANK
Q1
Reference: Ch. 1 — What is anatomy?
Stem: A novice clinician observes two patients with similar
blunt trauma to the lateral thorax: one has normal respiratory
mechanics; the other has paradoxical inward movement of part
of the chest during inspiration. Using anatomical reasoning,
which structural-level change best explains the paradoxical
motion?
A. Rupture of a visceral pleural adhesion to the lung
B. Fracture of multiple adjacent ribs creating a free-floating
segment of chest wall
C. Diaphragmatic tear with abdominal contents entering the
thoracic cavity
D. Partial pneumothorax localized to the apex of the lung
Correct answer: B
,Rationale (correct): A flail chest results from fractures of
multiple adjacent ribs producing a detached chest wall segment
that moves paradoxically during respiration, impairing
ventilatory mechanics (structure → impaired function). Gray
emphasizes how integrity of musculoskeletal elements
maintains normal thoracic excursion.
Rationale (A): Visceral pleural adhesions affect lung expansion
but do not create a free-floating chest wall segment nor cause
paradoxical skeletal movement.
Rationale (C): Diaphragmatic rupture alters abdominal-thoracic
pressure relationships but typically causes herniation, not
localized paradoxical rib motion.
Rationale (D): A localized pneumothorax may collapse lung
tissue but does not produce a flail segment of the chest wall.
Teaching point: Multiple adjacent rib fractures can form a flail
chest and disrupt normal thoracic mechanics.
Citation: Drake, R. L. (2024). Gray’s Anatomy for Students (5th
Ed.). Ch. 1.
Q2
Reference: Ch. 1 — What is anatomy?
Stem: During a teaching session you must explain why
knowledge of anatomical variation is critical when interpreting
clinical signs. Which example best illustrates how normal
anatomical variation could change the clinical finding?
A. A patient with an atypical branching pattern of the aortic
,arch presenting with radial pulse delay
B. A patient with a duplicated ureter showing increased
filtration rate
C. A person with accessory spleen causing a decrease in platelet
count
D. An individual with extra digits causing altered balance
Correct answer: A
Rationale (correct): Variations in aortic arch branching can alter
pulse transmission to the upper limbs and cause asymmetry or
delay in radial pulses; this is a classic example linking anatomical
variation to a clinical sign as emphasized in Gray’s.
Rationale (B): A duplicated ureter affects urine drainage
anatomy but does not increase glomerular filtration rate
systemically.
Rationale (C): An accessory spleen is usually clinically silent and
does not typically cause thrombocytopenia unless pathologic
splenic function exists.
Rationale (D): Polydactyly is an anatomical variation but
typically does not meaningfully alter static balance to the point
of clinical misinterpretation.
Teaching point: Anatomical variants (e.g., aortic arch branching)
can alter expected clinical signs.
Citation: Drake, R. L. (2024). Gray’s Anatomy for Students (5th
Ed.). Ch. 1.
, Q3
Reference: Ch. 1 — Imaging
Stem: A patient has blunt abdominal trauma and suspected
internal bleeding. Which imaging modality provides the fastest,
most sensitive initial assessment for free intraperitoneal fluid in
an unstable patient, and why from an anatomical imaging
standpoint?
A. Contrast-enhanced CT because it best resolves solid-organ
injuries
B. Focused assessment with sonography for trauma (FAST)
because it rapidly detects fluid in dependent peritoneal spaces
C. Plain abdominal radiograph because free air indicates hollow
viscus injury
D. MRI because it offers superior soft tissue contrast without
ionizing radiation
Correct answer: B
Rationale (correct): FAST ultrasound rapidly evaluates
dependent peritoneal spaces (e.g., hepatorenal recess, pelvis)
at the bedside, making it ideal for unstable patients;
anatomically these spaces collect fluid first, so sonography is
sensitive for acute hemoperitoneum. Gray’s imaging section
highlights modality selection based on anatomy and clinical
status.
Rationale (A): CT is highly sensitive and informative but slower
and often unsuitable for unstable patients needing immediate
bedside assessment.
