GROSS ANATOMY 2nd bimex Flashcards
1
Q
Which one of the following muscles is attached along the ANTERIOR surface of the body of STERNUM?
A. Sternocostalis B. Internal oblique C. Pectoralis major D. Rectus abdominis E. Transversus abdominis
A
Pectoralis major
2
Q
The DERMATOME presents over the NIPPLE is: *
A. T2
B. T4
C. T6
D. T8
A
B. T4
3
Q
The STERNAL ANGLE (ANGLE OF LOIS. char) is an angle formed at the junction between the manubrium and sternum (manubriosternal joint). It lies at the level of the lower border of T4, it is used as landmark to identify the following EXCEPT: *
A. The 2nd costal cartilage B. The bifurcation of the trachea C. The pulmonary trunk D. The anterior and posterior ends of the arch of the aorta E. None of the above
A
The bifurcation of the TRACHEA
4
Q
This LINE of the thorax is formed by the PECTORALIS MAJOR muscle: *
A. Posterior median line
B. Posterior axillary line
C. Anterior axillary line
D. Anterior median line
A
ANTERIOR AXILLARY line
5
Q
This typical rib landmark includes the most COMMON site of RIB FRACTURE: *
A. Tubercle
B. Head
C. Shaft
D. Neck
A
C. Shaft
The shaft of the typical rib has a costal angle, which is described as the weakest point of the rib
6
Q
All the following are characteristics of the STERNUM EXCEPT: *
A. The manubrium articulates with the clavicle and first rib
B. The body of the sternum articulates with the manubrium to form the subcostal angle
C. The xiphoid process can be cartilaginous or ossified
D. Palpation of the sternal angle is a guide for the location of the 2nd rib
A
The BODY of the sternum articulates with the MANUBRIUM to form the SUBCOSTAL angle
7
Q
The POSTERIOR INTERCOSTAL arteries: *
A. Travel anteriorly between the ribs
B. Descend along the anterior wall of the rib cage
C. Travel between ribs and anastomose with anterior intercostal arteries
D. Are provided by blood from the subclavian arteries
A
Travel ANTERIORLY BETWEEN the RIBS
8
Q
The LINGULA of the LEFT LUNG is “similar” to which structure of the right lung? *
A. Superior lobe B. Inferior lobe C. Middle lobe D. Oblique fissure E. Horizontal fissure
A
MIDDLE lobe
9
Q
Which of the following is FALSE of the RIGHT and LEFT LUNG? *
A. Both lungs divide into 10 bronchopulmonary segments
B. Both lungs have a superior and inferior lobe
C. The left lung differs from the right lung in that it has 2 lobes while the right has 3 lobes
D. The bronchopulmonary segment of the right lung includes 5 from the superior lobe, while in the left bronchopulmonary segments includes 2 from the superior lobe
A
The BRONCHOPULMONARY SEGMENT of the RIGHT lung includes 5 from the superior lobe, while in the left bronchopulmonary segments includes 2 from the superior lobe
10
Q
The INFERIOR border of the HEART: *
A. Is primarily the left ventricle
B. Is the right atrium
C. Is primarily the right ventricle
D. Is the junction where the great vessels leave and enter the heart
A
Is primarily the RIGHT VENTRICLE
11
Q
The RIGHT VENTRICLE can be examined along the 3 – 5th intercostal spaces of which SURFACE of the HEART? *
A. Sternocostal / anterior surface
B. Diaphragmatic / inferior surface
C. Pulmonary / left surface
D. Visceral / posterior surface
A
Sternocostal / anterior surface
12
Q
Which of the following is NOT found in the normal adult RIGHT ATRIUM? *
A. SVC opening
B. Tricuspid valve
C. Foramen ovale
D. Fossa ovalis
A
Foramen ovale
13
Q
Regarding the great vessels of the heart, which of the following is TRUE? *
A. The SVC returns blood to the right atrium from areas superior to the diaphragm, including from the heart and lungs
B. The right and left pulmonary veins return deoxygenated blood back to the left atrium
C. The IVC drains blood from the right atrium to areas inferior to the diaphragm
D. The aorta sends blood to the body from the left ventricle
A
The AORTA sends blood to the body from the LEFT VENTRICLE
14
Q
At which intercostal space is one able to AUSCULTATE the AORTIC VALVE? *
A. Left 4th or 5th ICS
B. Left 2nd ICS
C. Right 2nd ICS
D. The aortic valve cannot be auscultated
A
RIGHT 2nd ICS
15
Q
Which of the following correctly describes the conducting pathway of the heart? *
A. SA node –> AV bundle of His –> AV node –> L/R bundle branch –> Purkinje fibers
B. AV node –> SA node –> L/R bundle branch –> AV bundle of His –> Purkinje fibers
C. SA node –> AV node –> AV bundle of His –> Purkinje fibers –> AV bundle of His
D. SA node –> AV node –> AV bundle of His –> L/R bundle branch –> Purkinje fibers
A
SA node --> AV node --> AV bundle of His --> L/R bundle branch --> Purkinje fibers
16
Q
What is the somatic INNERVATION of the PERICARDIUM? *
A. Phrenic nerve
B. Vagus nerve
C. Superficial cardiac plexus
D. Cardia sympathetic plexus
A
Phrenic nerve
17
Q
Which of the following statements does NOT describe the LOCATION of the TRANSVERSE PERICARDIAL
SINUS? *
A. It lies posterior to the ascending aorta and pulmonary trunk
B. It is anterior to the superior vena cava
C. It is superior to the left atrium
D. It lies posterior to the inferior mediastinum
A
It lies POSTERIOR to the inferior MEDIASTINUM
18
Q
What layer lies between the endocardium and myocardium? *
A. Epicardium
B. Purkinje layer
C. Subendocardial layer
D. Pericardium
A
Subendocardial layer
19
Q
Which of the following is NOT a function of the PERICARDIUM? *
A. It fixes the heart in the mediastinum
B. It allows overfilling of the heart and allows it to expand in size
C. It provides lubrication during contraction
D. It serves as a physical barrier, thus protecting the heart from infection
A
It allows overfilling of the heart and allows it to expand in size
20
Q
A patient suffered from an inferior wall infarct. ECG tracings showed ST segment depression on leads II, III, and AVF. What artery could have been occluded? *
A. Right coronary artery
B. Left anterior descending artery
C. Circumflex artery
D. Proximal left coronary artery
A
A. Right coronary artery
21
Q
A 35-year-old woman was seen in the emergency department after an automobile accident. While driving her car, she had been wearing a lap belt but without the shoulder strap; she hit a utility pole head-on. Examination of the thoracic cage revealed a fracture of the body of the sternum and of the third and the fourth left ribs. In this case, the following structure(s) located behind the body of the sternum and the left ribs could have been injured except which one(s)? *
A. The pericardium B. The right ventricle of the heart C. The right atrium of the heart D. The left ventricle of the heart E. The esophagus
A
The esophagus
22
Q
A 22-year-old man was seen in the emergency department after a street shootout. The patient showed signs of severe hemorrhagic shock. A small entrance wound was found in the third left intercostal space approximately 1 in. (2.5 cm) from the lateral margin of the sternum, but there was no exit wound. The left side of his thorax was dull on percussion, and breath sounds were absent on that side of the chest. It was decided to open the chest (thoracotomy) through the fourth left intercostal space, after which it was found that the left atrium had been perforated by the bullet. When the thoracotomy incision was made to enter the pleural cavity, the following structures were incised except for which one? *
A. The skin and subcutaneous tissue
B. The pectoral muscles and the serratus anterior muscle
C. The latissimus dorsi muscle
D. The external intercostal muscle and the anterior intercostal membrane
E. The internal intercostal and innermost intercostal muscles
A
The latissimus dorsi muscle
23
Q
The following important structures are in the region of the THORACOTOMY incision EXCEPT which one? *
A. The internal thoracic artery B. The intercostal nerve C. The superior epigastric artery D. The intercostal artery E. The intercostal vein
A
The superior epigastric artery
24
Q
A patient was admitted into hospital with acute pericarditis. Because the movements of the heart were compromised by the excess of fluid in the pericardial cavity, and the cause of the infection was unknown, it was decided to perform a pericardiocentesis. A specimen of the fluid was kept for bacteriological examination. PERICARDIOCENTESIS is best performed by passing a NEEDLE through *
A. the fourth intercostal space.
B. the sixth intercostal space at the left paravertebral border.
C. the second intercostal space at the midclavicular line.
D. the subcostal angle.
E. the second intercostal space at the right sternal angle.
A
the subcostal angle.
25
A patient was seen in the Emergency Department in cardiac arrest. During cardiopulmonary resuscitation the POSTERIOR SURFACE of the HEART was compressed by which of the following structures? *
```
A. The body of the sternum
B. The heads of the ribs
C. The tracheal bifurcation
D. The inferior vena cava
E. The bodies of the vertebrae
```
The bodies of the VERTEBRAE
26
A patient is examined in the standing position with a LEFT-SIDED PLEURAL EFFUSION. Where would you expect the pleural fluid to gravitate down to which of the following? *
```
A. The oblique fissure
B. The cardiac notch
C. The costomediastinal recess
D. The costodiaphragmatic recess
E. The horizontal fissure
```
The costodiaphragmatic recess
27
PAIN arising in the HEART is commonly referred to the following SKIN AREAS EXCEPT which? *
```
A. Up into the neck and jaw
B. Down the medial side of the arm
C. The point of the shoulder
D. The epigastric area
E. Over the sternum
```
The point of the shoulder
28
The following anatomic events occur at the level of the STERNAL ANGLE (angle of Louis) EXCEPT which? *
A. The right and the left pulmonary arteries enter the lungs.
B. The right recurrent laryngeal nerve arises from the right vagus nerve.
C. The trachea bifurcates.
D. The ascending aorta becomes continuous with the arch of the aorta.
E. The second costal cartilages articulate with the sternum.
The RIGHT RECURRENT laryngeal nerve arises from the RIGHT VAGUS nerve.
29
With aging, the following DETRIMENTAL CHANGES occur in the THORAX EXCEPT which of the following? *
A. The ribs and the costal cartilages become more rigid.
B. The elastic tissue in the lungs tends to degenerate.
C. The manubriosternal joint becomes more mobile.
D. The thoracic and the abdominal muscles tend to atrophy.
E. The xiphoid process becomes ossified.
The MANUBRIOSTERNAL joint becomes more mobile.
30
When passing a NEEDLE through the chest wall and into the PLEURAL CAVITY in the MIDAXILLARY line, the following structures will be pierced EXCEPT which? *
```
A. The external intercostal muscle
B. The skin
C. The parietal pleura
D. The levator costarum
E. The internal intercostal muscle
```
The levator costarum
31
The following statements concerning THORACIC structures are correct EXCEPT which? *
A. The carina is the name given to the site of bifurcation of the trachea.
B. The ligamentum arteriosum is the remains of the ductus arteriosus.
C. The ductus arteriosus is formed from the sixth left pharyngeal arch.
D. The thymus lies in the middle mediastinum.
E. The thymus receives its arterial supply mainly from the internal thoracic arteries.
The THYMUS lies in the middle mediastinum.
32
The following statements concerning an INTERCOSTAL SPACE are correct EXCEPT which? *
A. The anterior intercostal arteries of the lower five intercostal spaces are branches of the musculophrenic artery.
B. The sensory fibers in the lower five intercostal nerves supply the skin of the lateral thoracic and anterior abdominal walls.
C. The posterior intercostal arteries of the lower nine spaces are branches of the thoracic aorta.
D. Throughout an intercostal space, the intercostal nerves and blood vessels lie close to the upper border of the lower rib.
E. The intercostal nerves and blood vessels run between the internal and the innermost intercostal muscles.
Throughout an intercostal space, the intercostal nerves and blood vessels lie close to the UPPER BORDER of the LOWER RIB.
33
The STERNAL ANGLE is formed by the JUNCTION of which two bones? *
```
A. Sternal body and manubrium
B. Manubrium and xiphoid process
C. Sternal body and the clavicles
D. Manubrium and the 2nd rib
E. Manubrium and clavicle
```
Sternal body and manubrium
34
Air inside the pleura describes what condition? *
```
A. Pleural effusion
B. Pneumothorax
C. Pneumonia
D. Ascites
E. Subcutaneous emphysema
```
B. Pneumothorax
35
A patient is undergoing a bronchoscopy for removal of a foreign object. At approximately which vertebral level does the TRACHEA BIFURCATE? *
```
A. C6
B. T2
C. T4
D. T6
E. T7
```
T4
36
The BREAST SPANS vertically between which costal cartilages? *
```
A. 1st and 5th
B. 2nd and 6th
C. 3rd and 7th
D. 4th and 8th
E. 5th and 9th
```
2nd and 6th
37
What vessel provides arterial SUPPLY to the MEDIAL aspect of the BREAST? *
```
A. Mammary artery
B. Thoracoacromial artery
C. Internal thoracic artery
D. Internal thoracic vein
E. External thoracic artery
```
Internal thoracic artery
38
Which of the following nodes receives the majority of breast tissue lymph? *
```
A. Posterior intercostal nodes
B. Parasternal nodes
C. Infraclavicular nodes
D. Axillary nodes
E. Mediastinal nodes
```
Axillary nodes
39
Which one is a characteristic feature of the thoracic vertebrae? *
```
A. Vertebral body kidney shaped
B. Bifid spinous process
C. Long and slanted spinous processes
D. Transverse foramina
E. Has the characteristic vertebra prominens
```
Long and slanted spinous processes
40
Which of these LIGAMENT is unique to the THORACIC SPINE? *
```
A. Anterior longitudinal ligament
B. Costotransverse ligament
C. Nuchal ligament
D. Interspinous ligament
E. Ligamentum nuchae
```
Costotransverse ligament
41
Pain due to a GASTRIC ULCER may be referred to the __________.
```
A. umbilical region.
B. right iliac region.
C. epigastric region.
D. penis or clitoris.
E. none of the above.
```
epigastric region.
42
Pain caused by APPENDICIITIS may first be referred to the __________.
```
A. right iliac region.
B. umbilical region.
C. point of the shoulder.
D. epigastric region.
E. below the right shoulder blade.
```
umbilical region.
43
Intermittent pain (COLIC) in the small intestine may be referred to __________.
```
A. the epigastric region.
B. the left iliac region.
C. just above the symphysis pubis.
D. the umbilical region.
E. none of the above.
```
the umbilical region.
44
The following statements concerning the LYMPHATICS of the ABDOMEN are correct EXCEPT which of the following?
A. The intestinal, right, and left lumbar trunks drain into the cisterna chyli.
B. The lymphatic drainage of the kidney is directly to the superior mesenteric nodes.
C. The thoracic duct begins in the abdomen at the cisterna chyli.
D. The cisterna chyli lies in front of the first two lumbar vertebrae.
E. The lymph vessels from the testes drain into the para-aortic nodes at the level of the first lumbar vertebra
The lymphatic drainage of the KIDNEY is directly to the SUPERIOR MESENTERIC nodes.
45
The SHORT GASTRIC arteries ORIGINATE from the __________.
```
A. superior mesenteric artery.
B. hepatic artery.
C. splenic artery.
D. inferior phrenic artery.
E. left renal artery.
```
SPLENIC artery.
46
The RIGHT GASTRIC artery originates from the __________.
```
A. inferior mesenteric artery.
B. superior mesenteric artery.
C. hepatic artery.
D. gastroduodenal artery.
E. none of the above.
```
HEPATICartery.
47
The LEFT GASTRIC artery originates from the __________.
```
A. superior mesenteric artery.
B. left renal artery.
C. splenic artery.
D. celiac artery.
E. hepatic artery.
```
CELIAC artery
48
The GASTRODUODENAL artery originates from the __________.
```
A. splenic artery.
B. hepatic artery.
C. superior mesenteric artery.
D. right renal artery.
E. celiac artery.
```
HEPATIC artery
49
The LEFT GASTROEPIPLOIC artery originates from the
```
A. inferior mesenteric artery.
B. superior mesenteric artery.
C. splenic artery.
D. celiac artery.
E. left renal artery.
```
SPLENIC artery
50
The DESCENDING COLON receives parasympathetic nerves from the
```
A. pelvic splanchnic nerves.
B. spinal cord segments L1 and 2.
C. greater splanchnic nerve.
D. lesser splanchnic nerve.
E. vagus nerve.
```
PELVIC splanchnic nerves
51
The JEJUNUM receives SYMPHATHETIC nerves from the __________.
```
A. vagus nerves.
B. pelvic splanchnic nerves.
C. spinal cord segments L1 and 2.
D. greater splanchnic nerves and lesser splanchnic nerves.
E. spinal cord segments S2, 3, and 4
```
GREATER splanchnic nerves and LESSER splanchnic nerves.
52
The SIGMOID colon receives sympathetic nerves from the __________.
```
A. lesser splanchnic nerves.
B. vagus nerves.
C. greater splanchnic nerves.
D. spinal cord segments T5 to 9.
E. spinal cord segments L1 and 2.
```
spinal cord segments L1 and L2
53
The ILEUM receives PARASYMPATHETIC nerves from the __________.
```
A. vagus nerves.
B. pelvic splanchnic nerves.
C. lesser splanchnic nerves.
D. spinal cord segments T10 and 11.
E. inferior mesenteric plexus.
```
VAGUS nerves
54
The AZYGOS vein passes __________ in the diaphragm.
```
A. through the aortic hiatus
B. through the esophageal hiatus
C. through the vena caval hiatus
D. through perforations in the crura
E. between the slips of origin of the diaphragm from the ribs
```
through the AORTIC hiatus
55
The THORACIC DUCT passes through __________ in the diaphragm.
```
A. the esophageal hiatus
B. the vena caval hiatus
C. the aortic hiatus
D. perforations in the crura
E. none of the above
```
the AORTIC hiatus
56
The VAGUS nerves pass __________ in the diaphragm?
```
A. through the vena caval hiatus
B. through the aortic hiatus
C. between the slips of origin of the diaphragm from the ribs
D. through the esophageal hiatus
E. through the perforation is the crura
```
through the ESOPHAGEAL hiatus
57
The ILIOHYPOGASTRIC nerve, a branch of the lumbar plexus, emerges from the PSOAS muscle on its __________.
```
A. medial side.
B. anterior surface.
C. lateral side.
D. posterior surface.
E. none of the above
```
LATERAL side
58
The OBTURATOR nerve, a branch of the lumbar plexus, emerges from the psoas muscle on its __________.
```
A. anterior surface.
B. posterior surface.
C. medial side.
D. upper border.
E. lateral side.
```
medial side
59
The GENITOFEMORAL nerve, a branch of the lumbar plexus, emerges from the psoas muscle on its __________.
```
A. lateral side.
B. posterior surface.
C. medial side.
D. anterior surface.
E. none of the above
```
ANTERIOR surface
60
The FEMORAL nerve, a branch of the lumbar plexus, emerges from the psoas muscle on its __________.
```
A. lateral side.
B. medial side.
C. anterior surface.
D. posterior surface.
E. lower border.
```
LATERAL side
61
The skin in the RIGHT LOWER QUADRANT was tender to touch because which of the following NERVE was (were) stimulated by the inflamed APPENDIX?
```
A. The eighth right intercostal nerve
B. The tenth right intercostal nerve
C. The subcostal and first lumbar nerves
D. The sympathetic autonomic afferent nerves from the appendix
E. The seventh right thoracic nerve
```
The SUBCOSTAL and FIRST LUMBAR nerves
62
Which of the following MUSCLES was (were) contracted in the right lower quadrant (RLQ) to produce the INCREASED TONE and GUARDING?
```
A. The right rectus abdominis muscle
B. The right pyramidalis muscle
C. The right psoas muscle
D. The right external oblique, internal oblique, and transversus abdominis muscles
E. The right quadratus lumborum muscle
```
The right EXTERNAL oblique, INTERNAL oblique, and TRANSVERSUS abdominis muscles
63
Assuming the ulcer had perforated the POSTERIOR WALL of the FIRST part of the DUODENUM, name the ARTERY that is most likely to have been eroded.
```
A. The splenic artery
B. The right gastric artery
C. The gastroduodenal artery
D. The right gastroepiploic artery
E. The right renal artery
```
The GASTRODUODENAL artery
64
If the duodenal ulcer had perforated the ANTERIOR wall of the DUODENUM, where in the peritoneal cavity would the duodenal contents have entered?
```
A. The lesser sac
B. The right anterior subphrenic space
C. The left lateral paracolic gutter
D. The right posterior subphrenic space
E. The pouch of Douglas
```
The right POSTERIOR SUBPHRENIC space
65
A 53-year-old man was admitted to hospital complaining of a chronic gastric ulcer that was not responding to medical treatment. The surgeon decided to perform a vagotomy. The ANTERIOR VAGAL TRUNK was divided between sutures as it lies on the anterior surface of the abdominal part of the esophagus. Which of the following is likely to result from this procedure?
A. A loss of secretomotor nerve supply to the mucosal glands of the stomach.
B. Hoarse voice because of paralysis of the intrinsic muscles of the larynx on the left side.
C. Increased heart rate because of decreased parasympathetic input to the cardiac plexus.
D. Incontinence because of an absence of parasympathetic input to the bladder.
E. Compromised input into the greater splanchnic nerves.
A LOSS of SECRETOMOTOR nerve supply to the mucosal glands of the stomach.
66
A 45-year-old obese woman com plaining of indigestion was admitted to hospital for investigation. She had a past history of gallstones and transient attacks of jaundice. Large gallstones have been known to erode through the POSTERIOR WALL of the GALLBLADDER and enter the intestinal tract. Which part of the INTESTINAL TRACT is likely to INITIALLY contain the stone?
```
A. The sigmoid colon
B. The descending colon
C. The transverse colon
D. The ascending colon
E. The jejunum
```
The TRANSVERSE colon
67
The following statements regarding the CELIAC PLEXUS are correct except which?
A. The celiac plexus is not a purely sympathetic plexus.
B. The celiac plexus does not surround the celiac artery.
C. The celiac ganglia are made of nerve cell bodies and nerve fibers.
D. Parasympathetic preganglionic fibers pass through the plexus, generally synapsing with postganglionic neurons within the walls of the organs they innervate.
E. Sympathetic preganglionic fibers to the celiac plexus originate from thoracic spinal segments and travel in thoracic splanchnic nerves.
The celiac plexus does NOT SURROUND the CELIAC ARTERY
68
The RIGHT KIDNEY has the following important relationships EXCEPT which?
A. It is related to the neck of the pancreas.
B. It is anterior to the right costodiaphragmatic recess.
C. It is related to the second part of the duodenum.
D. It is related to the right colic flexure.
E. It is anterior to the right twelfth rib
It is related to the NECK of the PANCEAS
69
The following structures are present in the PORTA HEPATIS EXCEPT which of the following?
A. Lymph nodes
B. The right and left branches of the portal vein
C. The right and left hepatic ducts
D. The right and left hepatic veins
E. The right and left branches of the hepatic artery
The right and left HEPATIC VEINS
70
When tapping a HYDROCELE (collection of fluid in the tunica vaginalis), the cannula must pierce the following structures EXCEPT which?
```
A. The skin
B. The fatty subcutaneous tissue
C. Dartos muscle
D. The cremasteric fascia
E. The external and internal spermatic fasciae
```
The fatty SUBCUTANEOUS tissue
71
The following veins DRAIN directly into the INFERIOR VENA CAVA EXCEPT which of the following?
```
A. The hepatic veins
B. The renal veins
C. The lumbar veins
D. The inferior mesenteric vein
E. The right testicular (ovarian) vein
```
INFERIOR MESENTERIC vein
72
The following general statements are correct EXCEPT which of the following? *
A. The superior and inferior epigastric vessels anastomose on the posterior surface of the rectus abdominis muscle.
B. The inguinal ligament is attached laterally to the anterior inferior iliac spine.
C. The abdominal aorta bifurcates below into the two common iliac arteries.
D. The foregut ends in the second segment of the duodenum.
E. The umbilicus is inconstant in position but is usually located at the level of L4.
The INGUINAL LIGAMENT is attached laterally to the ANTERIOR INFERIOR ILIAC SPINE
73
If the COMMON HEPATIC ARTERY is unavoidably LIGATED during surgery, the ARTERIAL SUPPLY to the liver is MAINTAINED by the following anastomotic connections EXCEPT which of the following?
A. The superior pancreaticoduodenal artery anastomosing with the inferior pancreaticoduodenal artery
B. The right gastric artery anastomosing with the left gastric artery
C. The gastroduodenal artery anastomosing with the splenic artery
D. The esophageal arteries anastomosing with the inferior phrenic arteries
E. The right gastroepiploic artery anastomosing with the left gastroepiploic artery
The GASTRODUODENAL artery anastomosing with the SPLENIC artery
74
The following statements regarding the PORTAL VEIN are correct EXCEPT which of the following?
A. It courses through a portion of the lesser omentum.
B. It enters the liver at the porta hepatis.
C. It receives venous blood from both the large and the small intestines.
D. It originates at the junction of the superior mesenteric and the splenic veins.
E. It passes in front of the neck of the neck of the pancreas.
It passes in FRONT of the neck of the NECK of the PANCREAS.
75
The following statements are correct regarding an INGUINAL HERNIA EXCEPT which of the following?
A. The inferior epigastric artery lies medial to the neck of an indirect inguinal hernia.
B. An inguinal hernia is more common than a femoral hernia in females.
C. A direct inguinal hernia is more common in elderly men than in boys.
D. The opening of the sac of a direct inguinal hernia is wide.
E. The contents of an indirect inguinal hernia may be strangulated against the lacunar ligament.
The contents of an indirect inguinal hernia may be strangulated against the lacunar ligament.
76
When performing a midline abdominal PARACENTESIS (tapping the abdominal cavity) BELOW the UMBILICUS, the cannula will pass through the following anatomic structures EXCEPT which?
```
A. The skin and the fascia
B. The linea alba
C. The transversalis fascia and extraperitoneal fat
D. The rectus abdominis muscle
E. The parietal peritoneum
```
The RECTUS ABDOMINIS muscle
77
In a patient with cancer of the stomach who requires a TOTAL GASTRECTOMY, the following arteries must be LIGATED EXCEPT which?
```
A. The common hepatic artery
B. The short gastric arteries
C. The left and the right gastroepiploic arteries
D. The right gastric artery
E. The left gastric artery
```
COMMON HEPATIC artery
78
If the PORTAL VEIN becomes BLOCKED, the following venous anastomoses are important in uniting the portal with the systemic venous systems EXCEPT which of the following?
A. Esophageal branches of the left gastric and azygos veins
B. Veins of the ligamentum teres and paraumbilical veins
C. The superior and inferior rectal veins
D. The right colic veins and lumbar veins
E. The middle and inferior rectal veins
The MIDDLE and INFERIOR RECTAL veins
79
The following structures pass through the ESOPHAGEAL HIATUS in the diaphragm EXCEPT which of the following?
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A. The left vagus nerve
B. Branches of the left gastric artery
C. The left phrenic nerve
D. The right vagus nerve
E. A tributary of the portal vein
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left PHRENIC nerve
80
The SPERMATIC CORD contains the following structures EXCEPT which of the following?
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A. The scrotal arteries and veins
B. The vas deferens
C. The pampiniform plexus
D. The testicular artery
E. Autonomic nerves
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SCROTAL arteries and veins
81
The JEJUNUM and ILEUM can be differentiated on the basis of the following anatomic features EXCEPT which of the following? *
A. Numerous (four to five) arterial arcades are associated with the jejunum.
B. The plicae circulares are much more prominent in the jejunum than in the ileum.
C. Fat depositions are generally present throughout the mesentery associated with the ileum.
D. The jejunum is generally located in the upper left region of the abdominal cavity.
E. Peyer’s patches are characteristic of the lower ileum and may be visible on the surface.
NUMEROUS (four to five) arterial ARCADES are associated with the JEJUNUM.
82
The RECTUS SHEATH contains the following structures EXCEPT which of the following?
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A. The pyramidalis muscle (when present)
B. The ligamentum teres
C. The inferior epigastric artery
D. The T7 to 12 anterior nerve rami
E. The rectus abdominis muscle
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ligamentum teres
83
The following statements concerning the SUPERFICIAL FASCIA of the ANTERIOR ABDOMINAL wall are correct EXCEPT which of the following? *
1A. It has a superficial fatty layer and a deep membranous layer.
B. Scarpa’s fascia fuses with the fascia lata just below the inguinal ligament.
C. Camper’s fascia is continuous with the Colles’ fascia in the perineum.
D. It is continuous with the dartos muscle in the wall of the scrotum.
E. It does not contribute to the femoral sheath.
CAMPER’s fascia is continuous with the COLLES’ fascia in the perineum
84
The following statements concerning the superficial INGUINAL RING are correct EXCEPT which of the following?
A. It is a perforation in the aponeurosis of the external oblique muscle.
B. Its greatest width lies above and medial to the pubic tubercle.
C. It is strengthened posteriorly by the conjoint tendon.
D. The internal spermatic fascia is attached to its margins.
E. In males, it allows passage of the spermatic cord and ilioinguinal nerv
The INTERNAL SPERMATIC FASCIA is attached to its margins
85
The following structures are connected to the LIVER EXCEPT which of the following?
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A. The falciform ligament
B. The coronary ligament
C. The greater omentum
D. The ligamentum teres
E. The ligamentum venosum
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GREATER omentum
86
In patients with an OBSTRUCTION of the SUPERIOR VENA CAVA, blood may return to the RIGHT ATRIUM through the following anastomotic channels EXCEPT which of the following?
A. The lateral thoracic, lumbar, and superficial epigastric veins
B. The superior and inferior epigastric veins
C. The lateral thoracic, paraumbilical, and portal veins
D. The posterior intercostal and lumbar veins
E. The lateral thoracic veins
E. The LATERAL THORACIC veins
87
The following statements concerning the GALLBLADDER are correct EXCEPT which? *
A. The arterial supply is from the cystic artery, which is a branch of the right hepatic artery.
B. The fundus of the gallbladder is located just beneath the tip of the right ninth costal cartilage.
C. The peritoneum completely surrounds the fundus, the body, and the neck.
D. The nerves of the gallbladder are derived from the celiac plexus.
E. Pain sensation from gallbladder disease may be referred along the phrenic and the supraclavicular nerves to the skin over the shoulder.
The PERITONEUM completely surrounds the fundus, the body, and the neck
88
After complete OCCULSION of the origin of the INFERIOR MESENTERIC artery with a blood clot, the blood supply of the LEFT portion of the COLON is maintained by the following arteries EXCEPT which of the following?
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A. The marginal artery
B. The middle colic artery
C. The left lumbar arteries
D. Anastomoses between the superior, middle, and inferior hemorrhoidal arteries
E. The sigmoid arteries
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LEFT LUMBAR arteries
89
The following structures form the BOUNDARIES of the entrance into the lesser sac (EPIPLOIC FORAMEN) EXCEPT which of the following? *
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A. The inferior vena cava
B. The bile duct
C. The portal vein
D. The quadrate lobe of liver
E. The first part of the duodenum
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QUADRATE lobe of liver
90
The following statements concerning the PYLORIC SPHINCTER are correct EXCEPT which of the following?
A. It receives its motor innervation from the sympathetic autonomic nerves.
B. It lies on the level of the third lumbar vertebra.
C. It is inhibited by the impulses passing down the vagus nerves.
D. It is formed by a thickening of the circular layer of smooth muscle in the stomach wall.
E. The cavity of the pylorus is called the pyloric canal.
It lies on the level of the THIRD LUMBAR vertebra
91
The LESSER OMENTUM contains the following important structures EXCEPT which of the following?
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A. The left gastric artery
B. The portal vein
C. The inferior vena cava
D. The bile duct
E. The common hepatic artery
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INFERIOR VENA CAVA
92
The following statements concerning the APPENDIX are correct EXCEPT which of the following?
A. The appendix is situated in the right iliac region.
B. At the base of the appendix, the teniae coli of the cecum fuse to from a complete longitudinal muscle layer in the wall of the appendix.
C. Afferent pain nerve fibers accompany the sympathetic nerves and enter the spinal cord at the level of the tenth thoracic segment.
D. The appendix receives its blood supply from a branch of the posterior cecal artery.
E. The tip of the appendix cannot reach down into the pelvic cavity
The TIP of the appendix cannot reach down into the PELVIC CAVITY
93
The following statements concerning the DUODENUM are correct EXCEPT which of the following?
A. The lower half of the duodenum receives its arterial supply from the superior mesenteric artery via the inferior pancreaticoduodenal artery.
B. The first part of the duodenum is completely retroperitoneal.
C. The bile duct enters the second (vertical) portion of the duodenum.
D. Lymph from the fourth part of the duodenum drains into the superior mesenteric nodes.
E. The third part of the duodenum passes horizontally to the left in front of the vertebral column and behind the root of the mesentery.
The FIRST part of the DUODENUM is completely RETROPERITONEAL
94
The following differences exist between the ILEUM and the ASCENDING colon EXCEPT which of the following?
A. The ascending colon has appendices epiploicae, whereas the ileum does not.
B. The arterial supply to the wall of the ileum is arranged so that it produces areas of weakness through which mucosal herniations may occur.
C. The ascending colon may have a well-developed marginal artery, whereas the ileum does not.
D. The ileum has longitudinal muscle that forms a continuous layer around the wall, whereas the ascending colon has teniae coli.
E. The ascending colon is retroperitoneal, whereas the ileum is intraperitoneal.
The arterial supply to the wall of the ileum is arranged so that it produces areas of WEAKNESS through which MUCOSAL HERNIATIONS may occur.
95
The following statements concerning the SIGMOID COLON are correct EXCEPT which of the following?
A. It is a continuation of the descending colon.
B. It begins above in front of the left quadratus lumborum muscle.
C. It receives its arterial supply from the inferior mesenteric artery.
D. It becomes continuous with the rectum in front of the third sacral vertebra.
E. It is attached to the posterior pelvic wall by the sigmoid mesocolon.
It begins above in front of the LEFT QUADRATUS LUMBORUM muscle
96
The following statements concerning the SPERMATIC CORD are correct EXCEPT which of the following?
A. It is covered with three layers of fascia derived from the anterior abdominal wall.
B. It contains the vas deferens.
C. The testicular artery and vein lie within it.
D. The inferior epigastric artery passes through it.
E. It contains the genital branch of the genitofemoral nerve.
INFERIOR EPIGASTRIC artery passes through it
97
The following statements concerning the EPIDIDYMIS are correct EXCEPT which of the following?
A. Each has a head, a body, and a tail.
B. Each lies anterior to the testis.
C. Each is made up of a coiled tube.
D. The vas deferens emerges from the tail.
E. They provide storage space for the spermatozoa prior to ejaculation
Each lies ANTERIOR to the TESTIS
98
The following statements concerning the WALL of the SCROTUM are correct EXCEPT which of the following? *
A. It is covered by skin.
B. It possesses superficial fascia that contains smooth muscle called the dartos muscle.
C. It has the external spermatic fascia derived from the external oblique aponeurosis.
D. It has cremasteric fascia derived from the internal oblique muscle.
E. It has the internal spermatic fascia derived from the fatty layer of the superficial fascia.
It has the INTERNAL SPERMATIC fascia derived from the fatty layer of the superficial fascia
99
The following information concerning the sensory innervation of the ABDOMINAL PERITONEUM is correct EXCEPT which of the following?
A. The peritoneum on the central part of the inferior surface of the diaphragm is supplied by the phrenic nerves.
B. The peritoneum forming the mesentery of the small intestine is innervated by autonomic nerves.
C. The peritoneum on the peripheral part of the inferior surface of the diaphragm is supplied by the phrenic nerves.
D. The peritoneum lining the anterior abdominal wall in the right lower quadrant is supplied by T12 and L1 spinal nerves.
E. The peritoneum lining the lateral wall of the pelvis is supplied by the obturator nerve.
The peritoneum on the peripheral part of the INFERIOR surface of the DIAPHRAGM is supplied by the PHRENIC nerves
100
The following statements concerning the abdominal PERITONEAL OMENTA and LIGAMENTS are correct EXCEPT which of the following?
A. The gastrosplenic omentum contains the short gastric arteries and the left gastroepiploic artery.
B. The splenicorenal ligament contains the tail of the pancreas.
C. The lesser omentum is attached superiorly to the porta hepatis of the liver.
D. The greater omentum is attached to the upper border of the transverse colon.
E. The coronary ligament of the liver is the main support for this organ.
The CORONARY LIGAMENT of the liver is the main SUPPORT for this organ
