AbdoPelvis B COPY

Question 1

Question 179 of 328 A 34 year old lady presents with symptoms of faecal incontinence. Ten years previously she gave birth to a child by normal vaginal delivery. Injury to which of the following nerves is most likely to account for this process?

Answer 1

PudendalS2,3,4 keeps the poo up off the floor - POOdendal nerveTheme from April 2012 ExamDamage to the pudendal nerve is classically associated with faecal incontinence and it is for this reason that sacral neuromodulation is a popular treatment for the condition. Injury to the hypogastric autonomic nerves is an aetiological factor in the development of constipation.

Question 2

Question 181 of 328 A 49 year old man undergoes a low anterior resection for cancer. He is assessed in the outpatient clinic post operatively. His wounds are well healed. However, he complains of impotence. Which of the following best explains this p

Answer 2

Damage to the nervi erigentesTheme from 2012 ExamThe penis takes autonomic nerves from the nervi erigentes that lie near the seminal vesicles. These may be compromised by direct surgical trauma (such as use of diathermy in this area) and also by radiotherapy that is used in these patients pre operatively. The result is that up to 50% of patients may develop impotence following rectal cancer surgery.

Question 3

Question 190 of 328 In a patient with an ectopic kidney where is the adrenal gland most likely to be located? A. In the pelvis B. On the contralateral side C. In its usual position D. Superior to the spleen E. It will be absent

Answer 3

In its usual position

Question 4

Question 196 of 328 A 55 year old man is due to undergo a radical prostatectomy for carcinoma of the prostate gland. Which of the following vessels directly supplies the prostate? A. External iliac artery B. Common iliac artery C. Internal

Answer 4

Inferior vesical arteryThe arterial supply to the prostate gland is from the inferior vesical artery, it is a branch of the prostatovesical artery. The prostatovesical artery usually arises from the internal pudendal and inferior gluteal arterial branches of the internal iliac artery.

Question 5

Question 199 of 328 Which of the following structures is not closely related to the piriformis muscle? A. Superior gluteal nerve B. Sciatic nerve C. Inferior gluteal artery D. Inferior gluteal nerve E. Medial femoral circumflex a

Answer 5

Medial femoral circumflex arteryNerve supply of lateral hip rotatorsPiriformis: ventral rami S1, S2Obturator internus: nerve to obturator internusSuperior gemellus: nerve to obturator internusInferior gemellus: nerve to quadratus femorisQuadrator femoris: nerve to quadrator femorisThe piriformis muscle is an important anatomical landmark in the gluteal region. The following structures are closely related: Sciatic nerve Inferior gluteal artery and nerve Superior gluteal artery and nerveThe medial femoral circumflex artery runs deep to quadratus femoris.

Question 6

Question 204 of 328 From which embryological structure is the ureter derived? A. Uranchus B. Cloaca C. Vitello-intestinal duct D. Mesonephric duct E. None of the above

Answer 6

The ureter develops from the mesonephric duct.

Question 7

Question 210 of 328 A 62 year old man is undergoing a left hemicolectomy for carcinoma of the descending colon. The registrar commences mobilisation of the left colon by pulling downwards and medially. Blood soon appears in the left paracolic gutter.

Answer 7

The spleen is commonly torn by traction injuries in colonic surgery. The other structures are associated with bleeding during colonic surgery but would not manifest themselves as blood in the paracolic gutter prior to incision of the paracolonic peritoneal edge.

Question 8

Question 217 of 328 A 53 year old man with a chronically infected right kidney is due to undergo a nephrectomy. Which of the following structures would be encountered first during a posterior approach to the hilum of the right kidney? A. Right r

Answer 8

The ureter is the most posterior structure at the hilum of the right kidney and would therefore be encountered first during a posterior approach.

Question 9

Question 221 of 328 Which of the following regions of the male urethra is entirely surrounded by Bucks fascia? A. Preprostatic part B. Prostatic part C. Membranous part D. Spongiose part E. None of the above

Answer 9

Spongiose partTheme from 2010 ExamBucks fascia is a layer of deep fascia that covers the penis it is continuous with the external spermatic fascia and the penile suspensory ligament. The membranous part of the urethra may partially pass through Bucks fascia as it passes into the penis. However, the spongiose part of the urethra is contained wholly within Bucks fascia.

Question 10

Question 223 of 328 A 48 year old lady is undergoing a left sided adrenalectomy for an adrenal adenoma. The superior adrenal artery is injured and starts to bleed, from which of the following does this vessel arise? A. Left renal artery B. In

Answer 10

The superior adrenal artery is a branch of the inferior phrenic artery.

Question 11

Question 226 of 328 An 80 year old lady with a caecal carcinoma is undergoing a right hemicolectomy performed through a transverse incision. The procedure is difficult and the incision is extended medially by dividing the rectus sheath. Brisk art

Answer 11

The vessel damaged is the epigastric artery. This originates from the external iliac artery (see below).

Question 12

Question 227 of 328 A 73 year old man has a large abdominal aortic aneurysm. During a laparotomy for planned surgical repair the surgeons find the aneurysm is far more proximally located and lies near the origin of the SMA. During the dissection a ve

Answer 12

Left renal veinTheme from April 2012 ExamThe left renal vein runs across the surface of the aorta and may require deliberate ligation during juxtarenal aneurysm repair.

Question 13

Question 229 of 328 A 18 year old man presents with an indirect inguinal hernia and undergoes surgery. The deep inguinal ring is exposed and held with a retractor at its medial aspect. Which structure is most likely to lie under the retractor? A

Answer 13

Inferior epigastric arteryBoundaries of the deep inguinal ring: Superolaterally - transversalis fascia Inferomedially - inferior epigastric arteryThe deep inguinal ring is closely related to the inferior epigastric artery. The inferior epigastric artery forms part of the structure referred to as Hesselbach’s triangle.

Question 14

Question 239 of 328 In a patient with a carcinoma of the distal sigmoid colon, what is the most likely source of its blood supply? A. Ileocolic artery B. External iliac artery C. Internal iliac artery D. Superior mesenteric artery E.

Answer 14

Inferior mesenteric arteryTheme from September 2013 ExamDuring a high anterior resection of such tumours, the inferior mesenteric artery is ligated. Note that the branches (mainly middle rectal branch) of the internal iliac artery are important in maintaining vascularity of the rectal stump and hence the integrity of the anastomoses.

Question 15

Question 242 of 328 A patient is due to undergo a right hemicolectomy for a carcinoma of the caecum. Which of the following vessels will require high ligation to provide optimal oncological control? A. Middle colic artery B. Inferior mese

Answer 15

Ileo-colic arteryThe ileo - colic artery supplies the caecum and would require high ligation during a right hemicolectomy. The middle colic artery should generally be preserved when resecting a caecal lesion.This question is essentially asking you to name the vessel supplying the caecum. The SMA does not directly supply the caecum, it is the ileocolic artery which does this

Question 16

Question 246 of 328 A 63 year old man undergoes a radical cystectomy for carcinoma of the bladder. During the procedure there is considerable venous bleeding. What is the primary site of venous drainage of the urinary bladder? A. Vesicoprostatic

Answer 16

Vesicoprostatic venous plexusThe urinary bladder has a rich venous plexus surrounding it, this drains subsequently into the internal iliac vein. The vesicoprostatic plexus may be a site of considerable venous bleeding during cystectomy.

Question 17

Question 247 of 328 A 60 year old female is undergoing a Whipples procedure for adenocarcinoma of the pancreas. As the surgeons begin to mobilise the pancreatic head they identify a large vessel passing inferiorly over the anterior aspect of the unci

Answer 17

Theme from January 2012 ExamThe superior mesenteric artery arises from the aorta and passes anterior to the lower part of the pancreas. Invasion of this structure is a relative contra indication to resectional surgery.

Question 18

Question 249 of 328 An 18 year old man is undergoing an orchidectomy via a scrotal approach. The surgeons mobilise the spermatic cord. From which of the following is the outermost layer of this structure derived? A. Internal oblique aponeurosis

Answer 18

External oblique aponeurosisThe outermost covering of the spermatic cord is derived from the external oblique aponeurosis.This layer is added as the cord passes through the superficial inguinal ring.

Question 19

Question 251 of 328 A 53 year old male presents with a carcinoma of the transverse colon. Which of the following structures should be ligated close to their origin to maximise clearance of the tumour? A. Superior mesenteric artery B. Infe

Answer 19

The middle colic artery supplies the transverse colon and requires high ligation during cancer resections. It is a branch of the superior mesenteric artery.

Question 20

Question 253 of 328 Which of the following structures does not lie posterior to the right kidney? A. Psoas major B. 12th rib C. Quadratus lumborum D. Medial artcuate ligament E. 10th rib

Answer 20

10th ribTheme from April 2012 ExamThe 8th and10th ribs lie more superiorly. The 12th rib is a closer relation posteriorly.Quadratus lumborum runs between the posterior part of the iliac crest, iliolumbar ligament and the transverse processes of the lower lumbar vertebrae to the medial part of the lower border of the last rib and transverse process of the upper lumbar vertebrae. In these last two locations it is posterior to the kidney.

Question 21

Question 254 of 328 A 56 year old man is undergoing a radical nephrectomy via a posterior approach. Which of the following structures is most likely to be encountered during the operative approach? A. 8th rib B. 10th rib C. 6th rib D. 1

Answer 21

12th ribThe 11th and 12th ribs lie posterior to the kidneys and may be encountered during a posterior approach. A pneumothorax is a recognised complication of this type of surgery.

Question 22

Question 258 of 328 How many unpaired branches leave the abdominal aorta to supply the abdominal viscera? A. One B. Two C. Three D. Four E. Five

Answer 22

3There are three unpaired branches to the abdominal viscera. These include the coeliac axis, the SMA and IMA. Branches to the adrenals, renal arteries and gonadal vessels are paired. The fourth unpaired branch of the abdominal aorta, the median sacral artery, does not directly supply the abdominal viscera.

Question 23

Question 264 of 328 A 45 year old man presents with bilateral inguinal hernias. The surgical team decide to repair these laparoscopically through an extraperitoneal approach. Through an infraumbilical incision the surgeons displace the inferior aspec

Answer 23

PeritoneumDuring a TEP repair of inguinal hernia the only structure to lie posterior to the mesh is peritoneum. The question is really only asking which structure lies posterior to the rectus abdominis muscle. Since this region is below the arcuate line the transversalis fascia and peritoneum lie posterior to it. Bucks fascia lies in the penis.

Question 24

Question 265 of 328 A 20 year old man undergoes an open appendicectomy performed via a lanz incision. This surgeon places the incision on a level of the anterior superior iliac spine in an attempt to improve cosmesis. During the procedure the app

Answer 24

Ilioinguinal

Question 25

Question 269 of 328 During embryological development, which of the following represent the correct origin of the pancreas? A. Ventral and dorsal endodermal outgrowths of the duodenum B. Ventral and dorsal outgrowths of mesenchymal tissue from

Answer 25

A. Ventral and dorsal endodermal outgrowths of the duodenumThe pancreas develops from a ventral and dorsal endodermal outgrowth of the duodenum. The ventral arises close to, or in common with the hepatic diverticulum, and the larger, dorsal outgrowth arises slightly cranial to the ventral extending into the mesoduodenum and mesogastrium. When the buds eventually fuse the duct of the ventral rudiment becomes the main pancreatic duct.

Question 26

Question 272 of 328 A 63 year old man is due to undergo a splenectomy. Which splenic structure lies most posteriorly? A. Gastrosplenic ligament B. Splenic vein C. Splenic artery D. Splenic notch E. Lienorenal ligament

Answer 26

Lienorenal ligamentTheme from 2011 ExamThe lienorenal ligament lies most posteriorly. The antero-lateral connection is via the phrenicocolic ligament. Anteriorly the gastro splenic ligament. These structures condense around the vessels at the splenic hilum.

Question 27

Question 274 of 328 Which of the following statements about the spleen is false? A. The hilum contains the splenic vessels. B. The spleen is derived from endodermal tissue. C. The white pulp has immune function. D. The colon lies inferi

Answer 27

The spleen is derived from endodermal tissue.1,3,5,7,9,11 (odd numbers up to 11)The spleen is: 1 inch thick, 3 inches wide, 5 inches long, weighs 7oz (150-200g), lies between the 9th and 11th ribsMost of the gut is derived endodermally except for the spleen which is from mesenchymal tissue.

Question 28

Question 280 of 328 A 45 year old man is undergoing a left hemicolectomy. As the surgeons mobilise the left colon they identify a tubular structure lying at the inferior aspect of psoas major. What is it most likely to be? A. Left ureter B. L

Answer 28

Left ureterThe left ureter lies posterior to the left colon. The sigmoid colon and upper rectum may be more closely related to the iliac vessels. These are not typically found above L4.

Question 29

Question 282 of 328 A 42 year old woman is due to undergo a left nephroureterectomy for a transitional cell carcinoma involving the ureter. Which of the following structures is not related to the left ureter? A. Round ligament of the uterus

Answer 29

Round ligament of the uterusThe ureter is not related to the round ligament of the uterus, it is related to the broad ligament and is within 1.5cm of the supravaginal part of the cervix.

Question 30

Question 284 of 328 A 28 year old man is undergoing an appendicectomy. The external oblique aponeurosis is incised and the underlying muscle split in the line of its fibres. At the medial edge of the wound is a tough fibrous structure. Entry to t

Answer 30

Rectus abdominisThis structure will be the rectus sheath and when entered the rectus abdominis muscle will be encountered.

Question 31

Question 285 of 328 A 35 year old man presents to the surgical clinic with a suspected direct inguinal hernia. These will pass through Hesselbach’s triangle. Which of the following forms the medial edge of this structure? A. External oblique

Answer 31

Rectus abdominis muscleDirect inguinal hernias pass through Hesselbachs triangle (although this is of minimal clinical significance!). Its medial boundary is the rectus muscle.

Question 32

Question 288 of 328 Where are accessory spleens not found? A. Gonads B. Tail of pancreas C. Greater omentum D. Splenorenal ligament E. Ureter

Answer 32

UreterAccessory spleens- 10% population- 1 cm size- locations: hilum of the spleen, tail of the pancreas, along the splenic vessels, in the gastrosplenic ligament, the splenorenal ligament, the walls of the stomach or intestines, the greater omentum, the mesentery, the gonads

Question 33

Question 293 of 328 A 56 year old man is undergoing an anterior resection for a carcinoma of the rectum. Which of the structures below is least likely to be encountered during the mobilisation of the anterior rectum? A. Denonvilliers’ fascia

Answer 33

Middle sacral arteryWith the exception of the middle sacral artery all of the other structures lie anterior to the rectum. They may all be palpated during digital rectal examination.

Question 34

Question 303 of 328 A 25 year old man is being catheterised, prior to a surgical procedure. As the catheter enters the prostatic urethra which of the following changes will occur? A. Resistance will increase significantly B. Resistance wi

Answer 34

Resistance will decrease Theme from September 2011 ExamThe prostatic urethra is much wider than the membranous urethra and therefore resistance will decrease. The prostatic urethra is inclined vertically.

Question 35

Question 307 of 328 A 78 year old man develops a carcinoma of the scrotum. To which of the following lymph node groups may the tumour initially metastasise? A. Para aortic B. Obturator C. Inguinal D. Meso rectal E. None of the above

Answer 35

The scrotum is drained by the inguinal nodes.

Question 36

Question 311 of 328 An 22 year old soldier is shot in the abdomen and amongst his various injuries is a major disruption to the abdominal aorta. There is torrential haemorrhage and the surgeons decide to control the aorta by placement of a vascular c

Answer 36

Inferior phrenic arteriesAs the first branches of the abdominal aorta the inferior phrenic arteries are at greatest risk. The superior phrenic arteries lie in the thorax. The potential space at the level of the diaphragmatic hiatus is a potentially useful site for aortic occlusion. However, leaving the clamp applied for more than about 10 -15 minutes usually leads to poor outcomes.

Question 37

Question 312 of 328 Which of the following statements relating to the gallbladder is untrue? A. The fundus is usually intra peritoneal B. Arterial supply is from the cystic artery C. The cystic artery is usually located in Calots triangle

Answer 37

Cholecystokinin causes relaxation of the gallbladderCCK causes gallbladder contraction.

Question 38

Question 313 of 328 Which of the following nerves is the primary source of innervation to the anterior scrotal skin? A. Iliohypogastric nerve B. Pudendal nerve C. Ilioinguinal nerve D. Femoral branch of the genitofemoral nerve E. Obt

Answer 38

Ilioinguinal nerveTheme from April 2012 ExamThe pudendal nerve may innervate the posterior skin of the scrotum. The anterior innervation of the scrotum is primarily provided by the ilioinguinal nerve. The genital branch of the genitofemoral nerve provides a smaller contribution.

Question 39

Question 314 of 328 The transversalis fascia contributes to which of the following? A. Pectineal ligament B. Deep inguinal ring C. Cremaster muscle and fascia D. Inguinal ligament E. External spermatic fascia

Answer 39

Deep inguinal ringThe internal spermatic fascia (derived from transversalis fascia) invests:Ducuts deferensTesticular vesselsThe principal outpouching of the transversalis fascia is the internal spermatic fascia. The mouth of the outpouching is the deep inguinal ring.

Question 40

Question 318 of 328 A 73 year old lady is admitted with right iliac fossa pain. A plain abdominal x-ray is taken and the caecal diameter measured. Which of the following caecal diameters is pathological? A. 4cm B. 5cm C. 6cm D. 7cm E

Answer 40

10cm8 cm is still within normal limits. However, caecal diameters of 9 and 10 are pathological and should prompt further investigation.

Question 41

Question 324 of 328 Which of the following options in relation to the liver is true? A. Ligamentum venosum is an anterior relation of the liver B. The portal triad comprises the hepatic artery, hepatic vein and tributary of the bile duct C

Answer 41

The caudate lobe is superior to the porta hepatisVC goes with VC’The ligamentun Venosum and Caudate is on same side as Vena Cava [posterior].Ligamentum venosum is posterior to the liver. The portal triad contains the portal vein rather than the hepatic vein. There is the ‘bare area of the liver’ created by a void due to the coronary ligament layers being widely separated. There are sympathetic and parasympathetic nerves in the porta hepatis.

Question 42

Question 326 of 328 The following statements regarding the rectus abdominis muscle are true except: A. It runs from the symphysis pubis to the xiphoid process B. Its nerve supply is from the ventral rami of the lower 6 thoracic nerves

Answer 42

It lies in a muscular aponeurosis throughout its lengthThe aponeurosis is deficient below the arcuate line.Rectus abdominis:Arises from 5th, 6th, 7th costal cartilages.Inserts into the pubis.The muscle lies in the rectal sheath, which also contains the superior & inferior epigastric artery and vein.Action: flexion of thoracic and lumbar spine.Nerve supply: anterior primary rami of T7-12

Question 43

Question 328 of 328 During liver mobilisation for a cadaveric liver transplant the hepatic ligaments will require mobilisation. Which of the following statements relating to these structures is untrue? A. Lesser omentum arises from the porta

Answer 43

The right triangular ligament is an early branch of the left triangular ligamentThe right triangular ligament is a continuation of the coronary ligament.