Questions Flashcards
The mother of a 3-year-old boy presents to the pediatrician with concerns of an abdominal mass superior to the pubic symphysis just inferior to the umbilicus in the midline of the abdomen. Past medical history is unremarkable and there were no complications during pregnancy. Upon palpation of the abdomen (within the umbilical region) the patient becomes agitated and starts to cry. Ultrasound is preformed over the area of interest showing a cystic structure.
Which of the following conditions is the patient most likely experiencing?
Congenital Hydrocele
Hirschsprung Disease
Meckel diverticulum
Omphalocele
Urachal cyst
Urachal cyst
Urachal cyst – This is the correct answer. A partial obliteration of the uroepithelium duct between the bladder and umbilicus manifesting with a cystic mass which can eventually become infected and present as painful mass below umbilicus leading to the signs and symptoms of the patient.
A 21-year-old motorcycle rider crashes his motorbike as is rushed to the emergency department. The patient is awake and alert, he complains of intense back pain and that when he breaths he gets a sharp pain during respiration. Physical examination shows that his left lower back is bruised and swollen. A radiograph reveals a fracture of the eleventh rib on the left side.
Which of the following organs would be the most likely to sustain injury at this site?
Kidney, Liver, Lung, Pancreas, Spleen
Kidney – This is the correct answer. The kidney lies at the twelfth rib, and problems with pain associated with respiratory processes would result from the ribs being injured.
A 3-week-old male infant is brought to the pediatrician by its mother with concerns of her son’s sudden inability to hold down any milk after 3 weeks of normal breastfeeding. History of present illness reveals that the infant has been experiencing loose, watery stools. Clinical examination reveals a famished appearing infant with signs of failure to thrive. Physical examination reveals mid-epigastric abdominal pain upon palpation eliciting the infant to be agitated with crying. Further palpation of the affected region reveals a small olive-like mass. Once the infant calms down his mother nurses him in the office, and approximately 20 minutes later, the infant projectile vomits. The doctor notes the nonbilious and non-bloody vomitus.
Which of the following conditions is the most likely diagnosis for this infant?
A. Esophageal atresia
B. Intussusception
C. Lower GI bleed
D. Pyloric stenosis
pyloric stenosis
A 69-year-old elderly man is admitted to the hospital with symptoms of treatment resistant gastroesophageal reflux disease (GERD). It is determined (after endoscopy) that the patient must undergo a surgical procedure to treat the patient’s condition. This procedure consists of the fundus of the stomach being sutured around the gastroesophageal junction. During the procedure, the surgeon accidentally damages the right (posterior) vagal trunk while inserting staples into the stomach.
Which of the following organs is most likely affected?
A. Descending colon
B. Esophagus
C. Prostate gland
D. Second part of the duodenum
E. Urinary bladder
Second part of duodenum
A 53-year-old male visits his primary care physician with complaints of abdominal pain after eating. Past medical history is significant for smoking and poor nutritional intake. Upon MRI examination it is found that the patient has developed a hiatal hernia in which the fundus of the stomach protrudes through the esophageal hiatus of the diaphragm into the thorax.
Which of the following structures is/are at greatest risk of injury during surgical repair of this hernia?
Azygos vein
Superior epigastric vessels
Sympathetic chains
Thoracic duct
Vagus nerves
vagus nerves
Which of the following events increases the likelihood of getting infected after ingesting food or water contaminated with a pathogenic microorganism?
Gastrin releasing peptide-mediated stimulation of G cells
Increased carbonic anhydrase activity
Increased K+ conductance across the apical membrane of the parietal cells
Inhibition of the ATP-dependent proton transporter
Parasympathetic stimulation of ECL cells
Inhibition of the ATP-dependent proton transporter
A 73-year-old elderly man is admitted to the hospital with rectal bleeding. Physical examination reveals an abnormal mass of tissue protruding from an area superior to the external anal sphincter, superior to the pectinate line. Biopsy reveals the presence of an adenocarcinoma. Which of the following groups of lymph nodes would first receive lymph from the cancerous area?
Deep inguinal nodes
External iliac nodes
Internal iliac nodes
Middle rectal nodes
Superficial inguinal nodes
Internal iliac nodes – This is the correct answer. The lymphatics of the inferior rectum above the pectinate line drain into the internal iliac nodes.
A 41-year-old obese female presents to the emergency department with complaints of acute abdominal pain that radiates to the back and RUQ of the abdomen. The patient states that she started feeling abdominal pain 3 months ago after eating a large fatty meal. After some time, the pain resolves. Lately, the pain becomes more persistent and throughout the day and becomes severe after eating a meal. She has been experiencing pruritus all over her body. She also claims that her stool is abnormally pale in color and her urine dark tea colored. MRI of the abdomen reveals an inflamed gallbladder and edema surrounding the pancreas.
Which of the following structures is most likely obstructed?
Accessory pancreatic duct
Cystic duct
Hepatopancreatic ampulla
Left hepatic duct
Main pancreatic duct
Hepatopancreatic ampulla - This is the correct answer. The hepatopancreatic ampulla or the ampulla of Vater is formed by the union of the main pancreatic duct with the bile duct. Obstruction of the duct due to a gallstone will prevent the bile from the gallbladder and liver to be secreted into the second part of the duodenum. This will cause obstructive jaundice and will cause an increase of bilirubin levels in the blood, thereby patient will present with jaundice. Pancreatic enzymatic flow becomes blocked causing acute pancreatitis may be observed. She will also feel right upper quadrant pain.
A 36-year-old man is seen in the emergency department with complaints of fever and severe back pain. Two days ago, he sustained a penetrating injury to the back while on a hike. He did not seek medical attention on return. Ultrasound examination reveals fluid collection in a space located behind the peritoneum.
Which of the following structures is likely to be involved in this case?
Appendix
Ascending colon
Jejunum
Stomach
Transverse colon
Ascending colon is the only intraperitoneal organ listed
A 53-year-old male, who is a known case of alcoholic cirrhosis of the liver is posted for segmentectomy. During the operation, the surgeon accidentally incises the artery entering the liver at the portal triad resulting in a pool of blood on the operating table.
A branch of which of the following vessels is responsible for bleeding in the present case?
Celiac trunk
A 27-year-old male is rushed to the emergency department after sustaining a gunshot wound in a street fight. Past medical history is unremarkable. Physical examination reveals bullet wound to the left upper quadrant of the abdomen. Imaging is preformed and reveals profuse intraperitoneal bleeding. An emergency laparotomy is performed, and the source of bleeding appears to be a vessel within the lesser sac.
Which of the following ligaments would most likely be transected to gain adequate entry to the lesser sac?
Gastrocolic ligament
Gastrophrenic ligament
Gastrosplenic ligament
Hepatoduodenal ligament
Splenorenal ligament
Gastrosplenic ligament
