Questions Flashcards
If one were to make an incision parallel to and 2 inches above the inguinal ligament, one would find the inferior epigastric vessels between which layers of the abdominal wall?
Camper’s and Scarpa’s fascias
External abdominal oblique and internal abdominal oblique muscles
Internal abdominal oblique and transversus abdominis muscles
Skin and deep fascia of the abdominal wall
Tranversus abdominis muscle and peritoneum
Transversus Abdominus & peritoneum
loop of bowel protrudes through the abdominal wall to form a direct inguinal hernia; viewed from the abdominal side, the hernial sac would be found in which region? Deep inguinal ring Lateral inguinal fossa Medial inguinal fossa Superficial inguinal ring Supravesical fossa
Medial Inguinal Fossa
While performing a routine digital examination of the inguinal region in a healthy teen-aged male, the physician felt a walnut-sized lump protruding from the superficial inguinal ring. She correctly concluded that it was :
definitely an indirect inguinal hernia
possibly an unusual femoral hernia
definitely a direct inguinal hernia
possibly an enlarged superficial inguinal lymph node
either a direct or an indirect inguinal hernia
Either a direct or indirect hernia
Where is the deep inguinal ring found?
The deep inguinal ring is found near the midpoint of the inguinal ligament, below the anterior superior iliac spine. This ring is lateral to the inferior epigastric artery. The superficial inguinal ring is found above the pubic tubercle. Remember–the supravesical fossa is the space between the median and medial umbilical folds.
An elderly patient with a large indirect inguinal hernia came to your clinic complaining of pain in the scrotum. You conclude that the hernial sac is compressing the following nerve: Femoral branch of the genitofemoral Femoral Iliohypogastric Ilioinguinal Subcostal
Ilioinguinal
A 45-year-old porter develops a direct inguinal hernia. If the hernia extended through the superficial inguinal ring, it would be surrounded by all of the abdominal wall layers EXCEPT the:
External spermatic fascia
Internal spermatic fascia
Peritoneum and extraperitoneal connective tissue
Weak fascia of the transversus abdominis muscle lateral to the falx
Internal Spermatic Fascia
Which organ becomes retroperitoneal during rotation of the gut tube? Duodenum Kidney Spleen Stomach Transverse Colon
Duodenum
During a cholecystectomy (removal of the gall bladder), the surgical resident accidentally jabbed a sharp instrument into the area immediately posterior to the epiploic foramen (its posterior boundary). He was horrified to see the surgical field immediately fill with blood, the source which he knew was the: aorta inferior vena cava portal vein right renal artery superior mesenteric vein
IVC
Portal Vein is anterior to epiploic foramen
The division between the true right and left lobes (internal lobes) of the liver may be visualized on the outside of the liver as a plane passing through the:
gallbladder fossa and round ligament of liver
falciform ligament and ligamentum venosum
gallbladder fossa and inferior vena cava
falciform ligament and right hepatic vein
gallbladder fossa and right triangular ligament
Gall bladder Fossa & IVC
A 50-year-old female patient with severe jaundice was diagnosed with pancreatic cancer. You suspect that the tumor is located in which portion of the pancreas? Head Neck Body Tail Uncinate process
HEAD
- obstructing the COMMON BILE DUCT
A medical student was asked to identify a small specimen taken for pathological examination from a surgically removed duodenum. The student noted that the specimen revealed a thin wall and no circular folds. The specimen is from which segment? Superior Descending Horizontal Ascending
Superior Part
Upon endoscopic examination of a 65-year-old man who had a history of a chronic duodenal ulcer, it was found that the ulcer had been eroding the posterior wall of the first part of the duodenum. If erosion perforates the wall, the gastric expellant of high acidity would endanger the structures in its vicinity. Which is least likely to be endangered? Common bile duct Gastroduodenal artery Main pancreatic duct Portal vein
Main Pancreatic DUct
A 58-year-old patient was diagnosed with a severe case of portal hypertension due to alcoholic cirrhosis of the liver. It was determined that a bypass between the vessels of the portal and caval systems was necessary. The plan most likely to be successful is:
Coronary vein to right gastro-omental vein
Left colic vein to sigmoidal vein
Inferior mesenteric vein to splenic vein
Splenic vein to left renal vein
Superior rectal vein to inferior rectal vein
Splenic Vein to Left Renal Vein
The splenic vein is a major vein of the portal system, while the left renal vein is a major vein of the caval system.
An ulcer near the pyloroduodenal junction perforated and eroded a large artery immediately posterior to the duodenum. The ligation of the eroded vessel at its origin would LEAST affect the arterial supply to the: First part of the duodenum Second part of the duodenum Greater curvature of the stomach Head of the pancreas Tail of the pancreas
Tail of the pancreas
A surgeon needs to construct a bypass between the veins of the portal and caval systems to circumvent insufficient drainage through the natural portacaval anastomoses. Which plan is likely to be successful?
Coronary vein to right gastroepiploic vein
Inferior mesenteric vein to splenic vein
Left colic vein to middle colic vein
Splenic vein to left renal vein
Superior mesenteric vein to splenic vein
SPlenic Vein & Left Renal Vein
A patient with jaundice was diagnosed with cancer of the head of the pancreas. Which structure was compressed by the tumor? Common bile duct Common hepatic duct Cystic duct Left hepatic duct Right hepatic duct
Common Bile Duct
In order to do a vagotomy (section of vagal nerve trunks) to reduce the secretion of acid by cells of the stomach mucosa in patients with peptic ulcers, one needs to cut the gastric branches and retain vagal innervation to other abdominal organs. Where would a surgeon look for these branches in relation to the stomach? along the gastroepiploic vessels along the greater curvature along the lesser curvature in the base of the omental apron in the gastrocolic ligament
Lesser Curvature
Which of the following structures does not lie at least partially in the retroperitoneum? adrenal gland duodenum kidney pancreas spleen
Spleen
Which ligament is a derivative of the dorsal mesogastrium? Coronary Falciform Hepatoduodenal Hepatogastric Gastrocolic
Gastrocolic
A 60-year-old male executive who had a history of a chronic duodenal ulcer was admitted to the ER exhibiting signs of a severe internal hemorrhage. He was quickly diagnosed with perforation of the posterior wall of the first part of the duodenum and erosion of an artery behind it by the gastric expellent. The artery is most likely the: Common hepatic Gastroduodenal Left gastric Proper hepatic Superior mesenteric
Gastoduodenal
During emergency surgery, it was found that a chronic gastric ulcer had perforated the posterior wall of the stomach and eroded a large artery running immediately posterior to the stomach. The artery is the: Gastroduodenal Common hepatic Left gastroepiploic Splenic Superior mesenteric
SPLENIC
The fundus of the stomach receives its arterial supply from the: Common hepatic Inferior phrenic Left gastroepiploic Right gastric Splenic
Splenic
A 57-year-old male complains of intense chest pain, but tests rule out any cardiac pathology. It was determined that the patient suffers from an esophageal (hiatal) hernia in which the stomach herniates through an enlarged esophageal hiatus. Muscle fibers from which of the following parts of the diaphragm would border directly on this hernia? left crus right crus central tendon costal fibers sternal fibers
Right Crus
The boundaries of the perineum include all the following except: Ischiopubic rami Ischial tuberosity Tip of the coccyx Sacrotuberal ligament Sacrospinal ligament
Sacrotuberal Ligament
The part of the male reproductive tract which carries only semen within the prostate gland is the: Prostatic urethra Membranous urethra Seminal vesicle Ductus deferens Ejaculatory duct
Ejaculatory DUct
The perineum is bounded by all of the following skeletal elements except: coccyx ischiopubic ramus spine of ischium symphysis pubis
Ischiopubic Ramus
During a prostatectomy, the surgeon attempts to protect the prostatic plexus of nerves which contains nerve fibers that innervate penile tissue to cause erection. From which nerves do these fibers originate? Deep perineal Dorsal nerve of the penis Genitofemoral Pelvic splanchnics Pudendal
Pelvic Splanchnics
In order to perform an episiotomy prior to childbirth, the perineum must be anesthetized. By inserting a finger in the vagina and pressing laterally, what palpable bony landmark can be used as the posterior limit of the pudendal canal? Coccyx Ischial tuberosity Ischiopubic ramus Obturator groove Ischial spine
Ischial Spine
-The pudendal canal travels from the lesser sciatic foramen to the deep transverse perineus muscle. The ischial spine marks the posterior limit of the pudendal canal, so that’s the correct answer. If you weren’t sure about that, you might also notice that the physician here is trying to perform a transvaginal pudendal nerve block. This means that the physician will be using the ischial spine as a landmark and inserting the needle near this prominence, coating the pudendal nerve with anesthesia before it gives off its branches.
The prostate gland: Contains upper, middle and lower lobes Encircles the urethra Is well imaged radiologically using an intravenous urogram Is extraperitoneal B and D
B & D
Which skeletal feature would you consider to be most characteristic of the female pelvis?
Subpubic angle of 90 degrees or greater
Marked anterior curvature of the sacrum
Tendency to vertical orientation of the iliac bones
Prominent medial projection of the ischial spines
Subpubic angle of 90 degrees or greater
The rectouterine pouch is the lowest extent of the female peritoneal cavity. At its lowest, it provides a coat of peritoneum to a portion of the: urinary bladder urethra uterine cervix vagina
VAGINA
In females, the rectouterine pouch is a peritoneal fold reflecting from the rectum to the posterior fornix of the vagina. At its lowest extent, the rectouterine fold is draped over the posterior fornix of the vagina. This means that surgeons can make an incision in the posterior fornix of the vagina and enter the rectouterine pouch to harvest eggs from the ovaries or remove an ectopic pregnancy. Take a look at Netter Plate 337 for a picture of this relationship
A patient has sustained a fracture to the base of the skull. Thorough examination concluded that the right greater petrosal nerve, among other structures, has been injured. This conclusion was based on which of the patient’s signs:
Partial dryness of the mouth due to lack of salivary secretions from the submandibular and sublingual glands
Partial dryness of the mouth due to lack of salivary secretions from the parotid gland
Dryness of the right cornea due to lack of lacrimal secretion
Loss of taste sensation from the right anterior 2/3rd of the tongue
Loss of general sensation from the right anterior 2/3rd of the tongue
Dryness of the right cornea due to lack of lacrimal secretion
he soft palate is active in all of the following except: Breathing Chewing Coughing Swallowing Yawning
BREATHING
Thoracic duct A 16-year-old male suffered a stab wound in which a knife blade entered immediately superior to the upper edge of the right clavicle near its head. He was in extreme pain, which was interpreted by the ER physician as a likely indicator of a collapsed lung following disruption of the pleura. If that was true, what portion of the pleura was most likely cut or torn? costal pleura cupola hilar reflection mediastinal pleura pulmonary ligament
CUPOLA
During a lung transplant procedure, an observing 4th year attempted to pass his index finger posteriorly inferior to the root of the left lung, but he found passage of the finger blocked. Which structure would most likely be responsible for this? Costodiaphragmatic recess Cupola Inferior vena cava Left pulmonary vein Pulmonary ligament
Pulmonary ligament
What 3 muscles attach to the posterior border of the Thyroid Cartilage?
- Salpingopharyngeus
- Palatopharyngeus
- Stylopharyngeus
What three muscles attach to the Ischial Tuberosity?
- Semitendinosus
- Semimebranosus
- Long head of Biceps Femoris
Which posterior mediastinal structure is most closely applied to the posterior surface of the pericardial sac? aorta azygos vein esophagus thoracic duct trachea
Esophogus
What are the contents of the posterior mediastinum?
This area contains the descending thoracic aorta, the azygos system, the esophagus, the thoracic duct, and lymph nodes
What is the order of the thoracic duct, esophagus, and azygos vein in the posterior mediastinum?
A, T, E (left to right)
Azygos
Thoracid Duct
Esophogus
Most of the drainage of the thoracic body wall reaches the superior vena cava via the azygos vein. A notable exception is the left superior intercostal vein, which normally drains into the: Left brachiocephalic vein Left bronchial vein Left pulmonary vein Left subclavian vein Superior vena cava
Left Brachiocephalic Vein
You were asked to assist in a surgical operation on a young patient to treat an ulcer in the first part of the duodenum. You would expect that the surgeon will approach the ulcer by doing an anterior abdominal wall incision in the following region: Epigastric Left inguinal Left lumbar Right hypochondrial Hypogastric
EPIGASTRIC
Following an emergency appendectomy your patient complained of having paresthesia (numbness) of the skin at the pubic region. The most likely nerve that has been injured during the operation is: Genitofemoral Iliohypogastric Subcostal Spinal nerve T10 Spinal nerve T9
ILIOHYPOGASTRIC
If one were to make an incision parallel to and 2 inches above the inguinal ligament, one would find the inferior epigastric vessels between which layers of the abdominal wall?
Camper’s and Scarpa’s fascias
External abdominal oblique and internal abdominal oblique muscles
Internal abdominal oblique and transversus abdominis muscles
Skin and deep fascia of the abdominal wall
Tranversus abdominis muscle and peritoneum
Transversus Abdominus & Peritoneum
The spleen:
Develops in the dorsal mesogastrium
Develops in the ventral mesogastrium
Develops in both the dorsal and ventral mesogastria
Is always retroperitoneal
Becomes retroperitoneal during its development
Develops in the dorsal mesogastrium
Which of the following structures does not lie at least partially in the retroperitoneum? adrenal gland duodenum kidney pancreas spleen
SPLEEN
- covered entirely by VISCERAL peritoneum
In order to approach the area posterior to the stomach, a surgeon decided to go through the lesser omentum. Before incising the mesentery she was careful to find and preserve a nerve lying in the upper portion of the hepatogastric ligament, i.e., the
Celiac branch of the anterior vagal trunk
Celiac branch of the posterior vagal trunk
Greater splanchnic branch to the right suprarenal gland
Hepatic branch of the anterior vagal trunk
Hepatic branch of the posterior vagal trunk
Hepatic Branch of Anterior Vagal Trunk
The fundus of the stomach receives its arterial supply from the: Common hepatic Inferior phrenic Left gastroepiploic Right gastric Splenic
SPLENIC
During an emergency splenectomy, the surgeon accidentally tore the gastrosplenic ligament and its contents. The artery (ies) likely to be damaged in this event is (are) the: Left gastric Splenic Short gastric Middle colic Caudal pancreatic
Short Gastric
While performing emergency surgery to control hemorrhage brought on by arterial erosion caused by a duodenal ulcer, surgeons ligated the badly damaged gastroduodenal artery near its origin, which affected all of its branches as well. Assuming "average anatomy", in which of the following arteries would blood now flow in retrograde fashion (backwards) from collateral sources? Left hepatic Right gastroepiploic Short gastric Left gastric Omental branches
Right Gastropepiploic
Meckel’s diverticulum:
is an abnormal persistance of the urachus
is a site of ectopic pancreatic tissue
is caused by a failure of the midgut loop to return to the abdominal cavity
is an abnormal connection of the midgut to the duodenum
is associated with polyhydramnios
Site of ectopic pancreatic tissue
A patient was admitted with symptoms of bowel obstruction. Further examination revealed that the obstruction was caused by the nutcracker-like compression of the bowel between the superior mesenteric artery and the aorta. The compressed bowel is most likely the: Duodenum Jejunum Ileum Ascending colon Transverse colon
Duodenum
suprarenal gland The celiac plexus of nerves may contain fibers derived from all of the following sources except: posterior vagal trunk greater thoracic splanchnic nerve lesser thoracic splanchnic nerve lumbar splanchnic nerves
Lesser Thoracic
The nerves that end on the secretory cells of the medulla of the suprarenal glands are principally:
Preganglionic fibers from the greater thoracic splanchnic nerve
Postganglionic fibers from the celiac plexus
Postganglionic fibers from the aorticorenal ganglia
Preganglionic fibers from the lesser thoracic splanchnic nerve
Postganglionic fibers from the renal plexus
Pre-ganglionic fibers from the greater thoracic splanchnic nerves
The cisterna chyli accompanies which structure as it passes through the diaphragm? Inferior vena cava Esophagus Greater thoracic splanchnic nerve Aorta
AORTA
During a prostatectomy, the surgeon attempts to protect the prostatic plexus of nerves which contains nerve fibers that innervate penile tissue to cause erection. From which nerves do these fibers originate? Deep perineal Dorsal nerve of the penis Genitofemoral Pelvic splanchnics Pudendal
Pelvic Splanchnics
