Abdomen & Pelvis Flashcards

MRCS

1
Q

List the contents of the spermatic cord (3 arteries, 3 nerves, 3 other structures)

A

Arteries - testicular, cremasteric, artery to vas

Nerves - genital branch of genitofemoral, sympathetic nerves, ilioinguinal nerve (on it)

Other - vas deferens, pampiform plexus, lymphatics

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2
Q

Where is the deep inguinal ring?

A

1cm above the midpoint of the inguinal ligament, lateral to inferior epigastric vessels

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3
Q

Where is the superficial ring?

A

Above and medial to the pubic tubercle

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4
Q

Where do the inferior epigastric vessels enter the abdominal wall?

A

Arcuate line - halfway between the umbilicus and pubic symphysis

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5
Q

Where does the root of the penis attach proximally?

A

Perineal membrane, pubic rami via the crura, pubic symphysis via the suspensory ligament

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6
Q

Which testicle lies lower in the scrotum?

A

Left

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7
Q

Name the tissue layer that encapsulates the testicles

A

Tunica albuginea

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8
Q

Name the tissue layer that forms a sac around the testicles

A

Tunica vaginalis (parietal)

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9
Q

Where do the testicular veins drain?

A

Right - IVC
Left - left renal vein

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10
Q

Name the muscle that encapsulates the testicles

A

Cremaster muscle

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11
Q

What is the gubernaculum?

A

A fibrous cord that connects the fetal testis with the bottom of the scrotum

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12
Q

Where are the ejaculatory ducts found?

A

Lateral aspect of prostate gland

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13
Q

Where do the common ejaculatory ducts open?

A

Verumontanum either side of the urticle

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14
Q

Name the fascia that surround the corpora in the penis and what is it a continuation of?

A

Buck’s fascia
Scarpa’s fascia

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15
Q

Name the superficial fasica surrounding the penis

A

Colles fascia

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16
Q

Which kidney lies lower in the abdomen and why?

A

Right - displaced by the liver

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17
Q

Name the fascia that surrounds the kidney and adrenal gland

A

Gerota’s fascia

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18
Q

How long is the ureter?

A

25-30cm

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19
Q

What spinal level do parasympathetic fibres to the bladder originate?

A

S2-4

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20
Q

Which nerve supplies the external urethral sphincter?

A

Pudendal nerve

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21
Q

Describe the mechanism of a direct inguinal hernia

A

Bowel enters the inguinal canal directly through a weakness in the posterior wall of the canal

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22
Q

Describe the mechanism of an indirect inguinal hernia

A

Bowel enters the inguinal canal via the deep inguinal ring
Occur due to a patent processus vaginalis

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23
Q

What are the borders of Hesselbach’s triangle?

A

Medial - lateral border of rectus abdominis
Superior - inferior epigastric vessels
Inferior - inguinal ligament

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24
Q

Where is the femoral artery palpated?

A

Mid-inguinal point - midpoint between pubic symphysis and ASIS

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25
Q

What type of cancer is associated with Barrett’s oesophagus?

A

Oesophageal adenocarcinoma

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26
Q

What level is the oesophageal hiatus?

A

T10

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27
Q

What level is the inferior oesophageal sphincter?

A

T11

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28
Q

Which arteries anastomose to supply the stomach?

A

Gastric and gastro-omental

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29
Q

What is a sliding hiatus hernia?

A

The lower oesophageal sphincter slides superiorly

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30
Q

What is a rolling hiatus hernia?

A

Part of the stomach herniates into the thorax next to the lower oesophageal sphincter

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31
Q

What is the most common site of duodenal ulceration?

A

Hepatoduodenal ligament

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32
Q

What is the major duodenal papilla?

A

The site in the descending duodenum (D2) where the ampulla of Vater opens to secrete bile and pancreatic fluids

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33
Q

Which part of the duodenum transverses the IVC and aorta?

A

Inferior (D3)

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34
Q

Which artery is at risk of erosion from a duodenal ulcer?

A

Gastroduodenal

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35
Q

What is the arterial supply to the duodenum?

A

Gastroduodenal artery - before major duodenal papilla
Pancreaticoduodenal artery - after major duodenal papilla

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36
Q

What artery supplies the caecum?

A

Ileocolic artery from SMA

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37
Q

What is the name of the ligament which attaches the colon to the diaphragm?

A

Phrenicocolic ligament

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38
Q

Why the sigmoid colon prone to volvulus?

A

The sigmoid mesocolon that is attached to the posterior pelvic wall making it a long mesentery

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39
Q

Name 4 features of the colon that distinguishes it from the small intestine

A

Omental appendices
Teniae coli
Haustra
Wider diameter

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40
Q

Name the 3 teniae coli

A

Mesocolic
Free
Omental

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41
Q

What is the arterial supply to the ascending colon?

A

Ileocolic (colic, anterior caecal, posterior caecal branches) and right colic arteries from the SMA

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42
Q

What is the arterial supply to the transverse colon?

A

Right colic artery (SMA)
Middle colic artery (SMA)
Left colic artery (IMA)

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43
Q

What is the arterial supply to the descending colon?

A

Left colic artery from the IMA

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44
Q

Name the artery that provides collateral blood supply to the colon

A

Marginal artery of Drummond

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45
Q

What spinal level does the rectum begin?

A

S3

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46
Q

How can the rectum be distinguished from the colon?

A

Absence of taenia colic, haustra and omental appendices

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47
Q

Which main arteries suppy the rectum?

A

IMA
Internal iliac
Internal pudendal

48
Q

What does the pectinate/denate line delineate?

A

Above - hindgut, columnar epithelium
Below - ectoderm, squamous epithelium

49
Q

What is the blood supply to the anus?

A

Above pectinate line - IMA
Below pectinate line - internal pudendal

50
Q

What positions are haemorrhoids found within the rectum?

A

3, 7, 11 o’clock

51
Q

What spinal level is the oesophageal hiatus?

A

T10

52
Q

Where are the three narrowings in the oesophagus where things get stuck?

A

At the start
Crossing the left main bronchus
Termination

53
Q

Which veins anastomose giving rise to oesophageal varices?

A

Azygos vein
Oesophageal tributary of the left gastric vein

54
Q

What level does the aorta originate and terminate?

A

T12
L4

55
Q

Where is the femoral canal found?

A

Medial compartment of femoral sheath

56
Q

What are the boundaries of the femoral ring?

A

Anterior - inguinal ligament
Posteriorly - pectineal ligament
Laterally - femoral vein
Medially - lacunar ligament +/- obturator artery

57
Q

List the contents of the femoral canal

A

Fat
Lymphatics
Lymph node (Cloquet’s node)

58
Q

Name the anterior branches of the aorta

A

Coeliac axis
SMA
IMA

59
Q

Name the lateral paired branches of the aorta

A

Suprarenal artery
Renal artery
Gonadal artery

60
Q

Name the paired branches of the aorta to the abdominal cavity

A

Lumbar arteries (4)
Inferior phrenic arteries

61
Q

Which artery is the femoral artery a continuation of?

A

External iliac artery

62
Q

What level does the IVC form?

A

L5

63
Q

Name the connection between the greater and lesser sac

A

Epiploic foramen (of Winslow)

64
Q

What the another name for the free edge of the lesser omentum?

A

Hepatoduodenal ligament

65
Q

Name the borders of calot’s triangle

A

Medial - common hepatic duct
Inferior - cystic duct
Superior - inferior surface of the liver

66
Q

Name the lymph node in Calot’s triangle

A

Lund’s node

67
Q

What type of epithelium is the peritoneum comprised of?

A

Simpe squamous - mesothelium

68
Q

What spinal level do the kidneys lie?

A

T12-L3

69
Q

Name the structure that is the remnant of the umbilical vein

A

Ligamentum teres - free edge of falciform ligament

70
Q

Name the ligament that divides the anterior surface of the liver

A

Falciform ligament

71
Q

Name the ligaments that attaches the superior surface of the liver to the diaphragm

A

Coronary ligament
Left and right triangular ligaments

72
Q

Name the two ligaments within the lesser omentum

A

Hepatoduodenal ligament
Hepatogastric ligament

73
Q

What is Morrison’s pouch?

A

Potential space behind the liver where fluid can accumulate when lyine supine

74
Q

Name the 4 lobes of the liver

A

Left
Right
Caudate
Quadrate

75
Q

Name the structures within a portal triad

A

Arteriole from hepatic artery
Venule from hepatic portal vein
Bile duct

76
Q

What structure is found in the centre of a liver lobule?

A

Central lobular vein

77
Q

Describe the dual blood supply to the liver

A

Hepatic artery (25%) from coeliac trunk - supplies the non-parenchymal structures
Hepatic portal vein (75%) from small intestine - supplies the parenchymal structures

78
Q

What is Hartmann’s pouch?

A

Mucosal fold in the neck of the gallbladder where gallstones commonly become lodged

79
Q

What is the ampulla of Vater?

A

Where the common bile duct and pancreatic duct join to empty into the duodenum via the major duodenal papilla

80
Q

Name the valve at the major duodenal papilla

A

Sphincter of Oddi

81
Q

What spinal level is the pancrease?

A

L1

82
Q

Which artery supplies the pancreas?

A

Splenic artery

83
Q

What type of epithelium is in the oesophagus?

A

Stratified squamous non-keratinised epithelium

84
Q

Which blood vessel do duodenal ulcers typically erode into?

A

Gastroduodenal

85
Q

What level do the common iliacs join to form the IVC?

A

L5

86
Q

Which artery does the inferior epigastric artery arise from?

A

External iliac artery

87
Q

What is the parasympathetic supply to the bowel?

A

Foregut and midgut - vagus nerve
Hind gut - pelvic splanchnic nerves (S2-4)

88
Q

What is the order of structures anterior to posterior at the renal hilum?

A

Vein, artery, ureter

89
Q

Which artery does the gastroduodenal artery arise from?

A

Common hepatic artery

90
Q

Which two vessels form the oesophageal porto-systemic shunt?

A

Azygos vein and left gastric vein

91
Q

Which part of the adrenal cortex secretes mineralocorticoids?

A

Zona glomerulosa

92
Q

Which hormones are produced by the zona fasiculata of the adrenal cortex?

A

Corticosteroids

93
Q

Which part of the adrenal cortex secretes androgens?

A

Zona reticularis

94
Q

Which part of the adrenal gland secretes catecholamines?

A

Chromaffin cells in the medulla

95
Q

What is psoas sign?

A

Flexion of the hip causes pain in the lower abdomen indicating irritation of the iliopsoas muscle group
Positive in appendicitis

96
Q

What structures does the ligamentum flavum connect?

A

Laminae of the adjacent lumbar vertebrae

97
Q

Where are the ishioanal fossae located in relation to the anus?

A

Lateral

98
Q

Which muscle in important for maintaining faecal continence?

A

Puborectalis

99
Q

Name the levator ani muscles

A

Puborectalis
Pubococcygeus
Iliococcygeus

100
Q

What is the broad ligament?

A

Double layer of peritoneum that attaches the lateral aspect of the uterus to the pelvis

101
Q

What is the round ligament?

A

Remnant of gubernaculum that extends from the ovaries to the labia majora via the inguinal canal
Maintains the anteverted position of the uterus

102
Q

Which ligament joins the ovaries to the uterus?

A

Ovarian ligament

103
Q

Which blood vessels and transmitted via with cardinal ligament?

A

Uterine artery and vein

104
Q

From which artery do the uterine and vaginal arteries arise?

A

Internal iliac artery

105
Q

Where in the fallopian tube does fertilisation occur?

A

Ampulla

106
Q

Which ligament contains the neurovascular structures to the ovary?

A

Suspensory ligament of the ovary

107
Q

Which artery supplies the prostate and seminal vesicles?

A

Inferior vesical

108
Q

Which artery is the main blood supply to the perineum?

A

Internal pudendal

109
Q

Which blood vessel supplies the posterior abdominal wall?

A

Iliolumbar artery

110
Q

Which two veins drain into the external iliac vein?

A

Inferior epigastric
Deep circumflex iliac

111
Q

Damage to which structure in childbirth is most likely to lead to prolapse of the vagina?

A

Perineal body

112
Q

Which branch of the pudendal nerve supplies the external anal sphincter?

A

Inferior rectal

113
Q

Which structure connects the apex of the bladder to the umbillicus?

A

Medial umbilical ligament which is a remnant of the urachus

114
Q

Fascia from which muscle forms the pudendal canal?

A

Obturator internus

115
Q

Which zone of the prostate does BPH typically occur?

A

Transitional zone

116
Q
A