GRAY'S ANATOMY FOR STUDENTS
5TH EDITION
• AUTHOR(S)RICHARD L. DRAKE
TEST BANK
1
Reference
Ch. 1 — The Body — What is anatomy?
Stem
A fourth-year medical student palpates a patient’s right lower
quadrant and reasons about how regional anatomy informs
likely organ involvement. Given that the iliohypogastric nerve
supplies the skin above the inguinal ligament and the appendix
lies in the right lower quadrant, which anatomical reasoning
most accurately links surface findings to deeper visceral referral
patterns?
A. Cutaneous pain over the inguinal region suggests direct
appendiceal irritation because the appendix shares somatic
innervation with the overlying skin.
B. Superficial tenderness above the inguinal ligament more
,likely indicates irritation of parietal peritoneum or somatic
structures rather than visceral appendix pain.
C. Referred pain to the inguinal skin must be mediated by the
vagus nerve because visceral afferents travel centrally.
D. Tenderness in the right lower quadrant cannot be localized
because visceral organs never produce localized pain.
Correct answer: B
Correct Answer Rationale (3–4 sentences)
Parietal peritoneum and somatic structures have somatic
(segmental) innervation that allows precise localization of pain.
Superficial tenderness above the inguinal ligament implicates
structures innervated by lower thoracic/lumbar somatic nerves
rather than deep visceral afferents from the appendix, which
initially produce poorly localized periumbilical pain. This
reasoning aligns with Gray’s emphasis on somatic versus
visceral innervation and clinical surface anatomy.
Incorrect Answer Rationales (1–3 sentences each)
A. The appendix produces visceral pain early and only later
irritates parietal peritoneum to give localized pain; skin supplied
by iliohypogastric nerve is somatic, not directly sharing visceral
innervation.
C. The vagus nerve does not mediate lower abdominal visceral
afferents; lumbar/sacral pathways are involved.
D. Visceral pain can become localized once the parietal
peritoneum is involved; the statement is false.
,Teaching Point
Somatic structures produce precisely localized pain; visceral
pain is diffuse until parietal peritoneum is involved.
Citation
Drake, R. L. (2024). Gray’s Anatomy for Students (5th Ed.). Ch. 1.
2
Reference
Ch. 1 — The Body — What is anatomy?
Stem
During a clinical anatomy oral exam, a student must decide
whether a described statement represents gross anatomy,
microscopic anatomy, or developmental anatomy. A patient’s
congenital diaphragmatic hernia results from failed fusion of
pleuroperitoneal membranes in embryogenesis. Which
classification best fits this description and why does that
classification matter for clinical reasoning?
A. Gross anatomy — because the hernia is visible on imaging
and therefore macroscopic.
B. Microscopic anatomy — because tissue histology determines
membrane strength.
C. Developmental anatomy — because the defect arises from
disrupted embryologic folding and fusion.
D. Functional anatomy — because herniation changes
respiratory mechanics only.
, Correct answer: C
Correct Answer Rationale (3–4 sentences)
A congenital diaphragmatic hernia originates during
embryologic development—specifically failed fusion of
embryonic membranes—so it is a developmental anatomy
problem. Recognizing it as developmental guides clinicians to
search for associated congenital anomalies and to understand
timing and mechanism of the defect, consistent with Gray’s
classification of anatomical subdisciplines. While gross and
functional aspects are relevant clinically, the root cause is
developmental.
Incorrect Answer Rationales (1–3 sentences each)
A. Although gross features are visible, classification by origin
(developmental) is more precise for etiologic reasoning.
B. Microscopic anatomy is important for tissue characterization
but does not explain the embryologic fusion failure.
D. Functional consequences occur but do not classify the origin
of the anomaly.
Teaching Point
Congenital structural defects are best understood through
developmental anatomy.
Citation
Drake, R. L. (2024). Gray’s Anatomy for Students (5th Ed.). Ch. 1.
3
5TH EDITION
• AUTHOR(S)RICHARD L. DRAKE
TEST BANK
1
Reference
Ch. 1 — The Body — What is anatomy?
Stem
A fourth-year medical student palpates a patient’s right lower
quadrant and reasons about how regional anatomy informs
likely organ involvement. Given that the iliohypogastric nerve
supplies the skin above the inguinal ligament and the appendix
lies in the right lower quadrant, which anatomical reasoning
most accurately links surface findings to deeper visceral referral
patterns?
A. Cutaneous pain over the inguinal region suggests direct
appendiceal irritation because the appendix shares somatic
innervation with the overlying skin.
B. Superficial tenderness above the inguinal ligament more
,likely indicates irritation of parietal peritoneum or somatic
structures rather than visceral appendix pain.
C. Referred pain to the inguinal skin must be mediated by the
vagus nerve because visceral afferents travel centrally.
D. Tenderness in the right lower quadrant cannot be localized
because visceral organs never produce localized pain.
Correct answer: B
Correct Answer Rationale (3–4 sentences)
Parietal peritoneum and somatic structures have somatic
(segmental) innervation that allows precise localization of pain.
Superficial tenderness above the inguinal ligament implicates
structures innervated by lower thoracic/lumbar somatic nerves
rather than deep visceral afferents from the appendix, which
initially produce poorly localized periumbilical pain. This
reasoning aligns with Gray’s emphasis on somatic versus
visceral innervation and clinical surface anatomy.
Incorrect Answer Rationales (1–3 sentences each)
A. The appendix produces visceral pain early and only later
irritates parietal peritoneum to give localized pain; skin supplied
by iliohypogastric nerve is somatic, not directly sharing visceral
innervation.
C. The vagus nerve does not mediate lower abdominal visceral
afferents; lumbar/sacral pathways are involved.
D. Visceral pain can become localized once the parietal
peritoneum is involved; the statement is false.
,Teaching Point
Somatic structures produce precisely localized pain; visceral
pain is diffuse until parietal peritoneum is involved.
Citation
Drake, R. L. (2024). Gray’s Anatomy for Students (5th Ed.). Ch. 1.
2
Reference
Ch. 1 — The Body — What is anatomy?
Stem
During a clinical anatomy oral exam, a student must decide
whether a described statement represents gross anatomy,
microscopic anatomy, or developmental anatomy. A patient’s
congenital diaphragmatic hernia results from failed fusion of
pleuroperitoneal membranes in embryogenesis. Which
classification best fits this description and why does that
classification matter for clinical reasoning?
A. Gross anatomy — because the hernia is visible on imaging
and therefore macroscopic.
B. Microscopic anatomy — because tissue histology determines
membrane strength.
C. Developmental anatomy — because the defect arises from
disrupted embryologic folding and fusion.
D. Functional anatomy — because herniation changes
respiratory mechanics only.
, Correct answer: C
Correct Answer Rationale (3–4 sentences)
A congenital diaphragmatic hernia originates during
embryologic development—specifically failed fusion of
embryonic membranes—so it is a developmental anatomy
problem. Recognizing it as developmental guides clinicians to
search for associated congenital anomalies and to understand
timing and mechanism of the defect, consistent with Gray’s
classification of anatomical subdisciplines. While gross and
functional aspects are relevant clinically, the root cause is
developmental.
Incorrect Answer Rationales (1–3 sentences each)
A. Although gross features are visible, classification by origin
(developmental) is more precise for etiologic reasoning.
B. Microscopic anatomy is important for tissue characterization
but does not explain the embryologic fusion failure.
D. Functional consequences occur but do not classify the origin
of the anomaly.
Teaching Point
Congenital structural defects are best understood through
developmental anatomy.
Citation
Drake, R. L. (2024). Gray’s Anatomy for Students (5th Ed.). Ch. 1.
3
