Final review Flashcards
Problem 1:
A male patient with severe colic in the loin radiating to groin and external genitalia on radiograph shows a stone in the right ureter.
a. Mention two sites for impaction of the stone?
b. Mention where can you locate stone ureter in the X-ray?
c. How does the ureter enter the pelvic cavity?
d. How does the ureter end?
e. How is the ureter related to the broad ligament?
a. Pelvi ureteric and intramural parts.
b. At the tips of transverse processes of the lumbar vertebrae and ischial spine.
c. By crossing the bifurcation of the common iliac artery.
d. Intramural part in the posterior superior angle of the urinary bladder.
e. It passes below the root of the broad ligament.
A 20-years- old girl was admitted to the hospital complaining of severe pain which starts around the umbilicus, then settled in the right iliac fossa and vomiting the patient keeps the right hip flexed. Condition was diagnosed as acute appendicitis.
a. Mention two common positions of the appendix.
b. Give the surface anatomy of it base.
c. How does a surgeon identify the base of appendix during surgery?
d. Name its artery and give its origin.
e. Why does the patient flex his night hip?
Answer:
a. Pelvic and retroceacal,
b. Mc Burney’s point (At Junction of the medial 2/3 and lateral 1/3 of a line extending between umbilicus and right anterior
superior iliac spine.)
c. By following the teniae coli of the caecum as they converge at base of the appendix.
d. Appendicular artery from ileocolic artery.
e. Due to irritation and spasm of psoas major muscle.
Problem 3:
A 65-years-old man, who had a history of chronic duodenal ulcer, was admitted to hospital with signs of severe internal hemorrhage due to perforated duodenal ulcer.
a. What is the commonest site of duodenal ulcer?
b. What is the cause of internal hemorrhage?
c. Where does the duodenum begin?
d. Name two arteries supplying the duodenum.
e. Give the venous drainage of the duodenum.
Answers:
a. Posterior wall of 1st- part of duodenum.
b. Erosion of gastro-duodenal artery.
c. In Transpyloric plane 1/2 inch to the right of middle line.
d. Superior and inferior pancreatico duodenal arteries, supradudenal artery.
e. Portal circulation.
Problem 4:
A 40-years–old fatty female, complained of tenderness in right hypochondrium, which increases after fatty meals and the pain, was referred to right shoulder. A diagnosis of inflammation of the gall bladder was confirmed.
a. Give the surface anatomy of fundus of gall bladder.
b. Why was the pain referred to night shoulder?
c. Give it arterial supply.
d. Give the anterior relation of its fundus.
e. Give the posterior relation of its fundus.
Answers:
a. Tip of right 9 th costal cartilage.
b. Due to irritation of the phrenic nerve (C3.4.5), the same segments supply skin of shoulder by supraclavicular nerves.
c. Cystic artery from right branch of hepatic artery
d. Anterior abdominal wall.
e. Transverse colon.
Problem (5)
A 35 years old farmer came to the clinic complaining of a mass in his left hypochondrium. On examination it was found to be an enlarged spleen which descended downwards and medially.
a. Why does the spleen descend directly downwards?
b. Mention its surface anatomy?
c. Name its ligaments?
d. Name its surfaces?
e. Mention its blood supply?
Answers:
a. Because the left colic flexure and phrenico-colic ligament prevent its direct downward descent.
b. Opposite 9.10.11 ribs with its long axis on the 10th rib and its lateral end at midaxillary line.
c. Lieno-renal and gastro- splenic ligaments.
d. Diaphragmatic and visceral.
e. Splenic artery from celiac trunk and splenic vein into portal vein.
