abdomen chung

Question 0

What passes through the esophageal hiatus?

Answer 0

Vagus nerve

Question 1

A 63 year old man has back pain, weakness, and SOB. He has aneurysm of abdominal aorta at aortic hiatus of diaphragm. What pairs of structures would most likely be compressed?

Answer 1

Azygous vein and thoracic duct

Question 2

A 36 year old woman with yellow pigmentation of the skin and sclerae presents. Which condition most likely is the cause of her obstructive jaundice?

Answer 2

Cancer in the head of the pancreas (obstructs bile duct)

Question 3

A 2 year old boy presents with pain in his groin that has been increasing in nature over the past few weeks. He has degenerative malformation of transversalis fascia during development. Which structure on anterior abdominal wall is likely defective?

Answer 3

Deep inguinal ring (lies in transversalis fascia just lateral to epigastric vessels)

Question 4

A 29 year old man has duodenal peptic ulcer and complains of cramping epigastric pain. Which structures harbor the cell bodies of abdominal pain fibers?

Answer 4

Dorsal root ganglion

Question 5

A 42 year old obese woman with 7 children has large gallstones that have ulcerated through posterior wall of fundus of gallbladder into intestine. Which of the parts of the intestine is more likely to initially contain gallstones?

Answer 5

Transverse colon (fundus of gallbladder is in contact with this)

Question 6

A 35 year old woman complains of abdominal tenderness and acute pain. Her physician observes that an abdominal infection has spread retroperitoneally. Which structure is most likely affected?

Answer 6

Descending colon

Question 7

A 46 year old woman has hypersecretion of NE from suprarenal medulla. Which types of nerve fibers are most likely overstimulated?

Answer 7

Preganglionic Sympathetic Fibers

Question 8

A 6 year old girl has constipation, abdominal distention, and vomiting and diagnosed with Hirschsprung’s disease (aganglionic megacolon). This condition is caused by absence of which kind of neural cell bodies?

Answer 8

Enteric ganglia (Parasympathetic postganglionic neuron cell bodies) in the lower part of colon

Question 9

A pediatric surgeon is resecting a malignant mass from liver of neonate with cerebral palsy. The surgeon divides the round ligament of the liver during surgery. A fibrous remnant of which fetal vessel is severed?

Answer 9

Left umbilical vein –> Ligamentum Teres (round ligament of liver after birth)

Question 10

A 27 year old woman suffers a gunshot wound to midabdomen. A trauma surgeon locates bleeding from pairs of veins that typically terminate in same vein. Which veins are damaged?

Answer 10

Right and Left Hepatic Veins (drain IVC)

Question 11

A 43 year old man complains of abdominal pain just above umbilicus. A tumor is found anterior to inferior vena cava. Which structure would most likely be compressed by this tumor?

Answer 11

Third part of duodenum

Question 12

A 33 year old man with a perforated gastric ulcer complains of excruciating pain in his stomach. The pain comes from peritoneal irritation by gastric contents in lesser sac. Which nerves contain sensory fibers that convey this sharp pain?

Answer 12

Lower intercostal nerves

Question 13

A boy has pelvic fracture and the doctor tests his reflexes. Which nerves would carry afferent impulses of the cremasteric reflex?

Answer 13

Genitofemoral Nerve

Question 14

A man receives a penetrating knife wound in abdomen and injures both the superior mesenteric artery and vagus nerve. Which portion of the colon would most likely be impaired?

Answer 14

Ascending and transverse colon

Question 15

A man with portal hypertension secondary to cirrhosis of the liver and subsequent massive ascites refuses to have a TIPS procedure. Which of the following surgical connections are involved in the most practical method of shunting portal blood around the liver?

Answer 15

Splenic vein to the left renal vein (divert blood from portal to caval system)

Question 16

A man suffers from ischemia to suprarenal glands. Rapid occlusion of direct branches of which arteries results in this condition?

Answer 16

Aorta, inferior phrenic, and renal arteries

Question 17

A woman has a perforation in posterior wall of the stomach in which the gastric contents have spilled into the lesser sac. The surgeon has opened the gastrosplenic ligament to reach the lesser sac and notes erosion of the ulcer into the artery. Which vessel is involved?

Answer 17

Left gastroepiploic artery

Question 18

A woman with a history of cholecystectomy arrives with intractable hiccups most likely caused by an abdominal abscess secondary to surgical infection. Which nerves carries pain sensation caused by irritation of the peritoneum on the central portion of the inferior surface of the diaphragm?

Answer 18

Phrenic Nerve

Question 19

A boy with a ruptured spleen has a splenectomy. After ligation of the splenic artery the patient heals normally. Normal blood flow would occur in which artery?

Answer 19

Inferior pancreatioduodenal artery

Question 20

A boy complains of nausea, vomiting, fever, and loss of appetite. He has tenderness and pain on the right lower quadrant because he has acute appendicitis. Which structure would be injured at McBurney’s point?

Answer 20

Iliohypogastric nerve

Question 21

A man with ETOH abuse presents with abdominal distention most likely resulting from an alteration in portal systemic blood flow. Which characteristics are associated with portal vein/portal venous system?

Answer 21

Caput medusae and hemorrhoids caused by portal hypertension

Question 22

A physician is trying to distinguish the jejunum from the ileum. He has observed that the jejunum has:

Answer 22

Fewer mesenteric arterial arcades

Question 23

A patient with liver cirrhosis has portal hypertension, which vein is most likely dilated?

Answer 23

Right colic vein (belongs to portal venous system and empties into superior mesenteric vein)

Question 24

A patient is admitted with a retroperitoneal infection. Which artery is most likely to be infected?

Answer 24

Dorsal pancreatic artery

Question 25

A pediatric doctor resected a structure that is a fibrous remnant of embryonic/fetal artery in a 5 year old child. Which structure is most likely divided?

Answer 25

Medial umbilical fold

Question 26

A patient has a tumor in the body of the pancreas that obstructs the inferior mesenteric vein just before joining the splenic vein. Which vein is most likely to be enlarged?

Answer 26

Ileocolic vein

Question 27

A man with prostatic hypertrophy returns to his urologist with epididymitis. An acute infection involving dartos muscle layer of the scrotum most likely leads to an enlargement of which of the following lymph nodes?

Answer 27

Superficial inguinal nodes

Question 28

A patient with cryptogenic cirrhosis is scheduled for a liver transplant. The reason the doctor must play close attention to the anatomic location of the liver is that this organ:

Answer 28

Drains venous blood into the hepatic veins

Question 29

A woman is brought to the ER for right upper quadrant pain, nausea, and vomiting. For this case, it is important to remember that the bile duct:

Answer 29

Drains bile into the second part of the duodenum

Question 30

A patient with diverticulosis of the colon presents with ongoing complaints of left lower quadrant pain and occasionally bloody stools. His physician begins workup with appropriate test by recalling that the sigmoid colon:

Answer 30

Has teniae coli and epiploic appendages

Question 31

A man with a ruptured appendix is sent to the ED for surgery. To cut off blood supply to the appendix (if collateral circulation is discounted), a surgeon should ligate which artery?

Answer 31

Ileocolic colic artery

Question 32

Base of Crohn’s disease and a small bowel obstruction leading to bowel ischemia, an elderly woman requires bypass of her ileum and jejunum and is scheduled for a gastrocolostomy. The surgeon will ligate all arteries that send branches to the stomach. Which arteries are spared?

Answer 32

Inferior pancreaticoduodenal artery

Question 33

A woman with peptic ulcer disease of the stomach experiences severe abdominal pain. Which of the nervous structures would most likely be involved?

Answer 33

Greater splanchnic nerve

Question 34

Before beginning Csection the OBGYN noted the patient had an aponeurosis of the transverse abdominal muscle. This aponeurosis most likely contributes to the formation of what?

Answer 34

Anterior layer of the rectus sheath below the arcuate line

Question 35

A man has an isolated tumor located in the porta hepatis. This tumor most likely compresses which structure?

Answer 35

Branches of the portal vein

Question 36

A patient had an emergent cholecystectomy because of cholecystitis. The surgeon recalls that one pair of veins forms a portal-caval anastomoses. Which pairs of veins form a porta-caval anastomoses?

Answer 36

1. Superior and middle rectal vein
2. Left gastric vein and esophageal vein of the azygous
3. Paraumbilical and superficial epigastric vein
4. Rectocolic vein and twigs of the renal vein

Question 37

What is a Meckel’s diverticulum. Which statement is true about the diverticulum?

Answer 37

It is a persistent remnant of the embryonic yolk sac

Question 38

A patient is jaundice and complains of abdominal pain, loss of appetite and weight loss. The CT shows a tumor in the uncinate process of the pancreas. Which structure is most likely compressed by this tumor?

Answer 38

Superior mesenteric artery

Question 39

A boy has a lump in the groin near the thigh and pain in the groin. On examination, the physician makes a diagnosis of a direct inguinal hernia because the herniated tissue:

Answer 39

Develops after birth

Question 40

A 21 year old man lifting heavy boxes results in a hernia. The urologist recalls that the genitofemoral nerve:

Answer 40

Passes through the deep inguinal ring (gives off the genital branch)

Question 41

A man has hepatocellular carinoma. The surgeon locates the affected quadrate lobe of the liver that:

Answer 41

Drains bile into the left hepatic duct

Question 42

A man with edema of the lower limb and enlarged superficial veins of the abdominal wall. Examination reveals obstruction of the inferior vena cava just proximal to the origin of the renal vein. This venous blockage may result in dilation of which vein?

Answer 42

Left suprarenal vein

Question 43

During surgical treatment of portal hypertension of a man with liver cirrhosis, a surgeon inadvertently lacerates the dilated paraumbilical veins. The veins must be repaired to allow collateral flow. Which ligaments is most likely severed?

Answer 43

Ligamentum teres

Question 44

A woman is admitted for deep abdominal pain in her epigastric region. It is observed that a retroperitoneal infection erodes an artery that runs along the superior border of the pancreas. Which artery is likely injured?

Answer 44

Splenic artery

Question 45

A woman with a history of IBS presents for possibility of surgical resection of the GI tract where vagal parasympathetic innervation terminates. Which of the following sites is most appropriate for surgical resection?

Answer 45

Left colic flexture

Question 46

A man is admitted for severe abdominal pain, nausea, and vomiting resulting in dehydration. CT reveals a tumor located between the celiac trunk and the superior mesenteric artery. Which structure is likely compressed by this tumor?

Answer 46

Neck of the pancreas

Question 47

An emergent hernia repair is scheduled. The internal oblique abdominis muscle contributes to the formation of which structure?

Answer 47

Falx inguinalis (formed by aponeurosis of internal oblique and transverse muscle of abdomen)

Question 48

A 9 year old girl crashed into a brick fence. Her radiogram and angiogram shows a laceration of the superior mesenteric artery immediately distal to the origin of the middle colic artery. If collateral circulation is discounted, which organ may become ischemic?

Answer 48

Ascending colon

Question 49

A woman with kidney disease presents with increasing pain. A doctor performing kidney surgery must remember that:

Answer 49

The left renal vein runs anterior to both the aorta and the left renal artery (also the right renal artery runs behind the IVC and is longer than the left renal artery)