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Gray Morris’s Calculate with Confidence, 2nd Canadian Edition (Killian, 2022)
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Test Bank for Gray Morris's Calculate with Confidence, Canadian Edition, 2nd Edition by Killian, 9780323695718, Covering Chapters 1-23 | Includes Rationales
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Test Bank: Gray Morris's Calculate with Confidence, Canadian Edition 2nd Edition by Killian - Ch. 1-23, 9780323695718, with Rationales
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Test Bank Gray Morris’s Calculate with Confidence 2nd Canadian Edition (Killian, 2022) Chapter 1-23 | All Chapters
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Test Bank For Gray Morris’s Calculate with Confidence,2nd Canadian Edition (Killian, 2022) | 9780323695718 |
All Chapters with Answers and Rationals
1 A 1-year-old girl is admitted to the hospital with a palpable mass in her labia majora. Radiographic
examination reveals that a loop of intestine has herniated into the visibly enlarged labium majus. This
condition is due to failure of the processus vaginalis to close off. From which of the following tissue
layers is the processus derived? A. Parietal peritoneum B. Extraperitoneal tissue C. Transversalis fascia D.
Dartos fascia E. Internal abdominal oblique aponeurosis - ANSWER:1 A. The processus vaginalis
(meaning sheathlike process) is composed of parietal peritoneum that precedes the testis as it
"migrates" from a position in the upper lumbar wall to a position outside the abdomen. This process
usually obliterates, leaving only a distal portion that surrounds most of the testis as the tunica vaginalis.
Whereas these features are typical of development in the male, females also have a processus vaginalis
that extends into the labia majus, although congenital inguinal hernias are more common in males than
females. The other listed structures are not involved in congenital inguinal hernias. GAS 293; N 257;
McM 272, 275
2 A 3-year-old boy is admitted to the hospital with signs of acute renal failure. Radiologic studies reveal
that the boy has bilateral masses involving both kidneys. Examination of biopsy material confirms the
diagnosis of Wilms tumor. Which of the following gene mutations is the most common in Wilms tumor?
A. The gene responsible for WT1 B. The gene responsible for HGF C. The gene responsible for VEGF D.
The gene responsible for GDNF E. The gene responsible for FGF-2 - ANSWER:2 A. Wilms tumor is a
kidney malignancy that usually occurs in children. It has recently been shown that it can be caused by
mutations in the WT1 gene, behaving according to the Knudson two-hit model for tumor suppressor
genes. GAS 373; N 308; McM 255, 258
,3 Fusion of the caudal portions of the kidneys during embryonic development is most likely to result in
which of the following congenital conditions? A. Bicornuate uterus B. Cryptorchidism C. Horseshoe
kidney D. Hypospadias E. Renal agenesis - ANSWER:3 C. During development, the kidneys typically
"ascend" from a position in the pelvis to a position high on the posterior abdominal wall. Although the
kidneys are bilateral structures, occasionally the inferior poles of the two kidneys fuse. When this
happens, the "ascent" of the fused kidneys is arrested by the first midline structure they encounter, the
inferior mesenteric artery. The incidence of horseshoe kidney is about 0.25% of the population. GAS
373; N 309; McM 259, 250
4 Which of the following congenital malformations will most predictably result in oligohydramnios? A.
Anencephaly B. Pyloric stenosis C. Renal agenesis D. Tracheoesophageal fistula E. Urethral atresia -
ANSWER:4 C. In normal kidney development the kidneys function during the fetal period with the
resulting urine contributing to the fluid in the amniotic cavity. When the kidneys fail to develop (renal
agenesis), this contribution to the fluid is missing and decreased amniotic fluid (oligohydramnios)
results. GAS 373; N 309; McM 255, 256
5 Failure to urinate during embryonic or fetal life usually causes respiratory difficulties postnatally.
Which of the following relationships best describes this situation? A. Oligohydramnios linked with
hypoplastic lungs B. Polycystic kidneys linked to tracheoesophageal fistula C. Polyhydramnios D. Renal
agenesis linked to insufficient surfactant E. Urethral obstruction linked to ectopic viscera - ANSWER:5 A.
There is some evidence that oligohydramnios is linked to hypoplastic lungs. This is apparently not a
genetic link but rather related to the importance of adequate amniotic fluid in normal lung
development. GAS 167, 373; N 208; McM 199
6 A 4-year-old male child is admitted to the hospital with severe vomiting. Radiologic examination and
history taking reveals that the boy suffers from an annular pancreas. Which of the following structures is
most typically obstructed by this condition? A. Pylorus of the stomach B. First part of the duodenum C.
Second part of the duodenum D. Third part of the duodenum E. Jejunum - ANSWER:6 C. In normal
pancreatic development a bifid ventral pancreatic bud rotates around the dorsal side of the gut tube
and fuses with the dorsal pancreatic bud. Rarely, a portion of the ventral bud rotates around the ventral
side of the gut tube, resulting in an annular pancreas. The portion of the gut tube is the same where the
main pancreatic duct enters the second part of the duodenum (along with the common bile duct). The
incidence of annular pancreas is about 1 in 7000. GAS 336; N 281; McM 235
7 A 3-year-old male child is admitted to the pediatric clinic. Diagnosis reveals that the intermediate
portion of the processus vaginalis is not obliterated. Which of the following conditions will most likely
,result from this? A. Hypospadias B. Sterility C. Congenital hydrocele D. Ectopic testis E. Epispadias -
ANSWER:7 C. The distal portion of the processus vaginalis contributes to the tunica vaginalis that is
related to the testis. If an intermediate portion of the processus vaginalis persists, it often fills with fluid,
creating a hydrocele. If the entire processus vaginalis persists, the patient is likely to develop a
congenital inguinal hernia. GAS 269; N 365; McM 265, 266
8 Testicles are absent from the scrotum of a 1-yearold male admitted to the pediatric clinic. The
pediatrician examined the infant and palpated the testes in the inguinal canal. Which of the following
terms is used to describe this condition? A. Pseudohermaphroditism B. True hermaphroditism C.
Cryptorchism D. Congenital adrenal hyperplasia E. Chordee - ANSWER:8 C. Cryptorchism, often called an
undescended testis, is the result of incomplete migration of the gonad from the abdomen to a location
in the scrotum where it is exposed to temperatures slightly lower than core body temperature. This is
important for spermatogenesis and testicular function. A testis that cannot be surgically relocated into
the scrotum is usually removed because it would otherwise be prone to develop testicular cancer. GAS
293; N 364; McM 265, 266
9 A 28-year-old woman who is 8 months pregnant goes to the outpatient clinic for her prenatal checkup.
Ultrasound examination of the fetus reveals gastroschisis, with herniation of the small bowel into the
amniotic cavity. Failure of proper formation of which of the following structure(s) has resulted in this
condition? A. Head fold B. Tail fold C. Neural folds D. Lateral folds E. Amnion - ANSWER:9 D. The lateral
folds are key structures in forming the muscular portion of the anterior abdominal wall. Failure of the
lateral folds can cause a minor defect, such as an umbilical hernia, or a major defect, such as
gastroschisis. GAS 265, 311; N 247; McM 222
10 Rotation of the stomach during development results in movement of the left vagus nerve from its
original position. Through approximately how many degrees of rotation does the nerve move, and what
is its final position? A. 90 degrees to become the anterior vagal trunk B. 90 degrees to become the
posterior vagal trunk C. 270 degrees to become the anterior vagal trunk D. 270 degrees to become the
posterior vagal trunk E. 180 degrees to become the right vagal trunk - ANSWER:10 A. Rotation of the gut
tube is a major event in the development of the gastrointestinal system. Parts of the tube rotate 270
degrees, but the proximal foregut, specifically that portion that forms the esophagus, rotates only 90
degrees. Looking from below (the standard CT or MRI view), this rotation is counterclockwise. This
brings the left vagus nerve onto the anterior surface of the esophagus as it passes through the thorax.
GAS 265, 363-364; N 263; McM 241, 257
, 11 A newborn baby was diagnosed with eventration of the diaphragm, wherein one half of the
diaphragm ascends into the thorax during inspiration, but the other half contracts normally. What is the
most likely cause of this condition? A. Absence of a pleuropericardial fold B. Absence of musculature in
one half of the diaphragm C. Failure of migration of the diaphragm D. Failure of development of the
septum transversum E. Absence of a pleuroperitoneal fold - ANSWER:11 B. The diaphragm develops
from several components. Initially, the septum transversum (which will become the central tendon)
forms in the cervical region, gaining innervation from C3, C4, and C5. Later, myoblasts migrate in from
the body wall to form the muscular part of the diaphragm, often considered to be two bilateral
hemidiaphragms. These muscles are innervated by the phrenic nerves that are derived from C3, C4, and
C5. Eventration of the diaphragm occurs when one muscular hemidiaphragm fails to develop. With
positive pressure in the abdominal cavity, and low or negative pressure in the thoracic cavity, abdominal
organs are pushed into the thorax. The pleuroperitoneal folds contribute to a portion of the diaphragm
posteriorly. GAS 371; N 191, 192; McM 213, 260
12 A 2-day-old newborn male is cyanotic after attempts to swallow milk result in collection of the milk in
his mouth. After 2 days he develops aspiration pneumonia. A tracheoesophageal fistula is suspected.
Which of the following structures has most likely failed to develop properly? A. Esophagus B. Trachea C.
Tongue D. Tracheoesophageal septum E. Pharynx - ANSWER:12 D. The tracheoesophageal septum is the
downgrowth that separates the ventral wall of the foregut (esophagus) from the laryngotracheal tube.
The presence of a fistula would result in passage of fluid from the esophagus into the trachea and could
cause aspiration pneumonia. If the esophagus did not develop correctly, as in esophageal atresia, it
would end as a blind tube. This kind of defect, although associated with tracheoesophageal fistula, is not
the result of an opening into the trachea, and pneumonia would not result. Abnormal tracheal
development can be associated with tracheoesophageal fistula, therefore, but it is not the direct cause
of it. Abnormal tongue development does not result in a tracheoesophageal fistula. Abnormal
development of the pharynx is not associated with a tracheoesophageal fistula. GAS 172; N 230; McM
196
13 A 3-day-old newborn male has difficulties in breathing. A computed tomography (CT) scan of his
chest and abdomen reveals the absence of the central tendon of the diaphragm. Which of the following
structures most likely failed to develop properly? A. Pleuroperitoneal folds B. Pleuropericardial folds C.
Septum transversum D. Cervical myotomes E. Dorsal mesentery of the esophagus - ANSWER:13 C. The
septum transversum forms the central tendon of the diaphragm. The pleuroperitoneal folds form the
posterolateral part of the diaphragm. The pleuropericardial folds separate the pericardial cavity from
the pleural cavity and form the fibrous pericardium. The cervical myotomes form the musculature of the
diaphragm. The dorsal part of the dorsal mesentery of the esophagus forms the crura of the diaphragm.
GAS 161; N 191, 192; McM 213, 260
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