Abdominal Clinical Correlation and Surface Anatomy of Abdomen Flashcards by SALI BABY

Three forms of pain

Somatic
Visceral
Referred pain

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arise from skin, fascia, muscles and parietal peritoneum

Somatic abdominal pain

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severe and precisely localized

Somatic abdominal pain

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Pain impulses from the abdomen reach the central nervous system in the following segmental spinal nerves. What nerve innervates the central part of the diaphragm?
A. Phrenic nerve C4-C5
B. Phrenic nerve C2-C4
C. Phrenic nerve C3-C5
D. Phrenic nerve T7-T11

C. Phrenic nerve C3-C5

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What nerve innervates the peripheral part of the diaphragm?
A. Phrenic nerve C4-C5
B. Intercostal nerve T7-T11
C. Phrenic nerve C3-C5
D. Phrenic nerve T7-T11

B. Intercostal nerve T7-T11

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What nerve innervates the anterior abdominal wall?

A. Obturator nerve C4-C5
B. Thoracic nerve T7-T12, including L1
C. Thoracic nerve T6-T11 including L3
D. Phrenic nerve T7-T11

B. Thoracic nerve T7-T12, including L1

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What nerve innervates the pelvic wall?

A. Obturator nerve L2-L4
B. Intercostal nerve T7-T11
C. Phrenic nerve C3-C5
D. Phrenic nerve T7-T11

A. Obturator nerve L2-L4

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Why the inflamed parietal peritoneum is extremely sensitive to pain?

nerves innervate the full thickness of the abdominall wall

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increased tone or rigidity

local reflexes involving the same nerves bring about a protective phenomenon in which abdominal muscles increase in tone

guarding

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this occurs when parietal peritoneum is inflamed in which any movement of that inflamed peritoneum, even when that movement is elicited by removing the examining hand from a site distant from the inflamed peritoneum brings about tenderness

rebound tenderness

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Characterized by cutaneous hyperesthesia, tenderness and muscular spasm or rigidity occur in the lower right quadrant of the anterior abdominal wall

appendicitis

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the parietal peritoneum is chemically irritated, produces the same symptoms and signs but involves the right upper and lower quadrants

perforated peptic ulcer

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arises in abdominal organs, visceral peritoneum and the mesenteries

visceral abdominal pain

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The causes of visceral pain except:
A. stretching of aviscus or mesentery
B. distention of a hollow viscus
C. Chemical damage to a viscus or its covering peritoneum
D. Mechanical damage and constriction of hollow viscus

D. Mechanical damage and constriction of hollow viscus

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Pain arising from this area is dull and poorly localized

abdominal viscus

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pain referred to the midline

visceral pain

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form of visceral pain produced by the violent contraction of smooth muscle

colic

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Common cause of luminal obstruction except:
A. Intestinal obstruction
B. passage of gallstone in the biliary ducts
C. passage of a stone in the ureters
D. Appendicitis

D. Appendicitis

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feeling of pain at a location other than the site of origin of the stimulus but in an area supplied by the same or adjacent segments of the spinal cord

Referred abdominal pain

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the nerve fibers form the diseased structure and the area where the pain is felt ascend in the central nervous system along a common pathway and the cerebral cortex is incapable of distinguishing between the sites

referred somatic pain

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stomach pain can be referred to?

epigastrium

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Why stomach pain can be referred to epigastrium?

A. The afferent pain fibers from the stomach ascend in company with the sympathetic nerves and pass through the celiac plexus and the greater splanchnic nerves

B. The sensory fibers enter the spinal cord at segments T5 and 9 and give rise to referred pain in T5 to 9 on the lower chest and abdominal wall

C. All of the above

D. None of the above

C. All of the above

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Which is correct regarding the referred pain of appendix

A. caused by distention of the lumen of appendix or spasm of its smooth muscle coat

B. Pain travels in nerve fibers that accompany sympathetic nerves through the superior mesenteric plexus and the greater splanchnic nerve to the spinal cord (T12 segment)

C. The vague referred pain is felt in the epigastric area

D. All of the above

B. Pain travels in nerve fibers that accompany sympathetic nerves through the superior mesenteric plexus and the superior splanchnic nerve to the spinal cord (T10 segment)

C. The vague referred pain is felt in the region of the umbilicus (T10 dermatome)

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Which is correct regarding the referred pain of cholecystitis or gallstone colic?

A. celiac plexus and greater splanchnic nerves travel together to segment T5 and T9 of spinal cord

B. Vague referred pain is felt in the dermatomes on the lower chest and upper abdominal wall

C. All of the above

D. None of the above

C. All of the above

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Which statement is incorrect? A. inflammatory process spreads to and involve the parietal peritoneum of the anterior abdominal wall or peripheral diaphragm B. the severe somatic pain is felt in the right upper quadrant and through to the back below the inferior angle of the scapula C. Involvement of the central diaphragmatic parietal peritoneum which is innervated by the thoracic nerve (T7-T12 including L1) D. Referred pain over the shoulder because the supraclavicular nerves (C3 and C4) innervate the skin in this area

C. Involvement of the central diaphragmatic parietal peritoneum which is innervated by the phrenic nerve (C3-C5)

A thin cartilaginous lower part of the sternum

Xiphoid Process

Lies opposite the body of T9

Xiphisternal Junction

Indicated in cardiac tamponade

Pericardiocentesis

Curved lower margin of the thoracic wall

Costal margin

Costal Margin is formed in front by cartilages of what ribs?

7th, 8th, 9th and 10th ribs

``` Which is true of costal cartilage? A. Reaches its lowest level at the 10th costal cartilage B. Behind by 11 and 12 ribs C. Lies opposite the body of L3 D. All of the above ```

D. All of the above

palpable along its entire length and ends in front at the anterior superior iliac spine and behind at the posterior superior iliac spine

iliac crest

highest point of iliac crest lies opposite the?

body of L4

About 2 inches posterior to ASIS, the outer margin project to form what structure?

tubercle of the crest

The tubercle lies at the level of which vertebrae

body of L5

It is an important surface landmark and may be identified as a small protuberance along the superior surface of the pubis

Pubic tubercle

cartilaginous joint that lies in the midline between the bodies of the pubic bones

symphysis pubis

can be felt as solid structure pubic bones medial to the pubic tubercle

symphysis pubis

Which is true? A. Symphysis pubis is located beneath the skin in the midline at the lower extremity of the anterior abdominal wall B. The ridge on the superior surface of the pubic bones medial to the pubic tubercle C. All of the above D. None of the above

C. All of the above

lies beneath a skin crease in the groin

inguinal ligament

rolled under inferior margin of the aponeurosis of the external oblique muscle

inguinal ligament

``` Which is incorrect of inguinal ligament A. attached laterally to the ASIS B. curves downward and medially to the symphysis pubis C. All of the above D. None of the above ```

B. curves downward and medially to the pubic tubercle

In female, what structure is being transmitted in the superficial inguinal ring

round ligament of the uterus

triangular aperture in the aponeurosis of the external oblique muscle

superficial inguinal ring

True of superficial inguinal ring: A. In adult males, the margins of the ring can be felt by invaginating the skin of the upper part of the scrotum with the tip of the finger B. situated above and medial to the pubic tubercle C. The soft tubular spermatic cord can be felt emerging from the ring and descending over or medial to the pubic tubercle into the scrotum D. All of the above

D. All of the above

a pouch of skin and fascia

scrotum

``` Scrotum consists of the following except: A. Testes B. Epididymides C. lower end of the spermatic cords D. None of the above ```

D. None of the above

dark line in the midline that indicates the bilateral origin of the scrotum along the line of fusion

scrotal raphe

Which is incorrect? A. On each side of scrotum is a soft ovoid body surrounded on its lateral, anterior and medial surfaces by the two layers of the tunica vaginalis B. The testes should lie free and not tethered to the skin or subcutaneous tissue C. Posterior to the testis is an elongated structure, epididymis D. It has enlarged upper end that composed of head, body and tail

A. On each side of scrotum is a firm ovoid body surrounded on its lateral, anterior and medial surfaces by the two layers of the tunica vaginalis

emerges from the tail and ascends medial to the epididymis to enter the spermatic cord at the upper end of the scrotum

vas deferens

vertically running fibrous band that extends from the symphysis pubis to the xiphoid process and lies in the midline

linea alba

true of linea alba: A. formed by the fusion of the aponeuroses of the muscles of the anterior abdominal wall B. represented on the surface by a slight median groove C. All of the above D. None of the above

C. All of the above

Which statement is false? A. Umbilicus lies in the linea alba and is inconstant in position B. It is a puckered scar and is the site of attachment of the umbilicus in the fetus C All of the above D. None of the above

D. None of the above

Lie on either side of the linea alba and run vertically in the abdominal wall

Rectus abdominis

True of rectus abdominis except: A. Four tendinous intersections run across each rectus abdomins muscle B. made prominent by asking the patient to raise the shoulders while in the supine position without using the arms C. In muscular individual, it can be palpated as transverse depressions at the level of the tip of the xiphoid process, at the umbilicus, halfway between the two D. None of the above

A Three tendinous ....

lcoated at the lateral edge of the rectus abdominis muscle and crosses the costal margin at the tip of 9th costal cartilage

Linea Semilunaris

how to accentuate the semilunar lines?

ask the patient to lie on the back and raise the shoulders off the couch without using the arms to accomplish this, the patient contracts the rectus abdominis muscles so that their lateral edges stand out

This line passes through the midpoint between the ASIS and symphysis pubis

vertical lines

plane that passes through the tips of ninth costal cartilages on the two sides--that is, the point where the lateral margin of the rectus abdominis (linea semilunaris) crosses the costal margin

transpyloric plane

``` Transpyloric plane passes through all of the following except: A. pylorus of the stomach B. head of the pancreas C. neck of the pancreas D. duodenal junction ```

B. head of the pancreas

this plane lies at the level of the body of first lumbar vertebra

transpyloric plane

joins the lowest point of the costal margin on each side-that is, the 10th costal cartilage

subcostal plane

subcostal plane lies at what level of the vertebra?

passes across the highest points on the iliac crests and lies on the level of the body of L4

intercristal plane

commonly used as a surface landmark when performing a lumbar spinal tap

intercristal plane

in which level of vertebra that intertubercular plane lies?

joins the tubercles on the iliac crests and lies at the level of L5

intertubercular plane

True of abdominal quadrants: A. It is a common practice to divide the abdomen into four quadrants B. vertical median plane (from the transumbilical plane) C. horizontal line that intersects at xiphoid process (from the xiphiod process down to pubic symphysis) D. All of the above

A B. vertical median plane (from the xiphiod process down to pubic symphysis) C. horizontal line that intersect at the umbilicus (transumbilical plane) L4

``` organs in lower right quadrant A. Cecum B. Appendix C. All of the above D. None of the above ```

C. All of the above

organs in upper right quadrant

liver and gallbladder

organs in upper left quadrant

stomach and spleen

organs in lower left quadrant

sigmoid colon

which is true of Nine abdominal regions? A. Uses two horizontal line, the transpyloric and transtubercular plane B. Uses two vertical line,the midclavicular line that passes through midpoint of the clavicle, tip of 9th costal cartilage, deep inguinal ring, mid inguinal point, femoral artery pulse C. Has 3 central regions and 6 lateral regions D. All of the above E. None of the above

D. All of the above

``` Central region are all of the following except: A. Epigastric B. Hypochondrium C. Umbilical D. Pelvic/suprapubic ```

B. Hypochondrium

``` Lateral region are all of the following except: A. Right and left hypochondrium B. right and left lumbar C. right and left iliac D. None of the above ```

D. None of the above

this organ lies under cover of the lower ribs, and most of its bulk lies on the right side

liver

True of liver except: A. In infants, until about the 3rd year, the lower margin of the liver extends one or two fingerbreaths below the costal margin B. In the adult who is obese or has a wel;-developed rectus abdominis muscle, the liver is palpable C. In a thin adult, the lower edge of the liver may be felt a fingerbreadth below the costal margin D. Liver can most easily be felt when the patient inspires deeply and the diaphragm contracts and pushes down the liver

B. In the adult who is obese or has a wel;-developed rectus abdominis muscle, the liver is NOT palpable

Fundus of the gallblasser lies opposite the tip of what costal cartilage?

right ninth costal cartilages

organ that situated in the left upper quadrant and lies undercover of the 9, 10 and 11 ribs

spleen

True of spleen: A. its long axis corresponds to that of the 10th rib B. in adult, the lower pole of the spleen may just be felt C. in infant, it does not normally project forward in front of the midaxillary line

A B. in INFANT , the lower pole of the spleen may just be felt C. in ADULT , it does not normally project forward in front of the midaxillary line

Which is incorrect regarding pancreas A. lies across the transpyloric plane B. The head lies below and to the right of the plane C. The neck lies on the plane D. The body and tail lie above and to the left E. All of the above D. None of the above

D. None of the above

True or false right kidney lies at a slightly at a higher level than the left kidney

false right kidney lies at a slightly at a LOWER level than the left kidney because of the bulk of the right lobe of the liver

True or false the lower pole of the right kidney can be palpated in the right lumbar region at the end of deep inspiration in a person with poorly developed abdominal muscles

True

True of kidneys: A. the hilum of each kidney lies on the transpyloric plane, about 3 fingerbreadths from the midline B. the normal left kidney, which is higher than the right kidney, is not palpable C. On the back, kidneys extends from the 12th thoracic spine to L3 and the hili are opposite the L1 D. All of the above E. None of the above

D. All of the above

lies about 3 fingerbreadths below and to the left of the xiphisternal junction (the esophagus pierces the diaphragm at the level of the 10th thoracic vertebra)

cardioesophageal junction

lies on the transpyloric place just to the right of the midline

pylorus

lies on a curved line joining the cardioesophageal junction and the pylorus

lesser curvature

has an extremely variable position in the umbilical region or below

greater curvature

lies on the transpyloric plane about four fingerbreadths to the right of the midline

duodenum

situated in the right lower quadrant and is often distended with gas and gives a resonant sound when percussed

cecum

can cecum be palpated through the anterior abdominal wall

YES

True of appendix except: A. lies in the right upper quadrant B. the base of the appendix is situated one third the way up the line joining the ASIS to the umbilicus (McBurney's point) C. The position of the free end of the appendix is variable D. None of the above

A. lies in the right lower quadrant

True of ascending colon: A. extends upward from the cecum on the lateral side of the right vertical line and disappears under the right costal margin B. it can be palpated through the anterior abdominal wall C. All of the above D. None of the above

C. All of the above

True of transverse colon except: A. extends across the abdomen, occupying the left and right iliac region B. It arches downward with its concavity directed upward C. Because it has mesentery, its position is variable D. All of the above E. None of the above

A. extends across the abdomen, occupying the UMBILICAL REGION

true of descending colon except: A. extends downward from the left costal margin on the lateral side of the left vertical line B. in the left lower quadrant, it curves medially and downward to become continuous with the sigmoid colon C. has a larger diameter than the ascending colon and can be palpated through the anterior abdominal wall D. All of the above E. None of the above

C. has a SMALLER diameter than the ascending colon and can be palpated through the anterior abdominal wall

lies in the midline of the abdomen and bifurcates below into the right and left common iliac arteries opposite the L4

aorta

true of external iliac artery: A. the pulsations of this artery can be felt as it passes under the inguinal ligament to become continuous with the femoral artery B. can be located at the point halfway between the ASIS and the symphysis pubis C. All of the above D. None of the above

C. All of the above

``` true of aorta: A. The pulsations of the aorta can be easily palpated through the upper part of the anterior abdominal wall just to the left of the midline B. the aorta lies at intercristal plane C. All of the above D. None of the above ```

C. All of the above