Review Questions Flashcards
A 48-year-old male with a history of alcoholism is brought into the ER with severe epigastric pain and hematamesis. Upon physical examination you find him to be jaundiced and tachycardic with low blood pressure. Other physical findings include ascites and splenomegaly; and tortuous dilated veins radiating from the umbilicus (caput medusae). The patient also tells you that he often has bloody stools, and a rectal examination indicates he has hemorrhoids.
- What is your Dx?
- What other abnormalities might be present in this patient?
- Suggest possible treatments for lowering the blood pressure in the portal system.
- Portal hypertension
- Esophageal varices, hemorrhoids, ascites
- Surgical shunting of portal system blood into a caval vein
A 45 year-old male with a long history of alcoholism is admitted to the hospital with jaundice. A radiographic study reveals ascites, portal hypertension and liver cirrhosis. Which of the following veins are likely to be responsible for the production of the ascites?
A.Paraumbilical veins
B.Esophageal anastamoses with azygos tributaries
C.Anastamosing vessels between parietal veins and veins of retroperitoneal intestine
D.Superior rectal and middle rectal veins
C. Anastamosing vessels between parietal veins and veins of retroperitoneal intestine
As seen in the radiograph, bowel loops are positioned centrally due to the presence of _______.
ascites
patient with cirrhosis is scheduled for liver transplant surgery. During the operation rounds, the transplant physician quizzes his students and asks which of the following statements is true of the liver:
A. Receives blood only from the hepatic arteries
B. Drains venous blood into the hepatic veins
C. Manufactures red blood cells in an adult
D. Blood supply to the quadrate lobe comes from the right hepatic artery
E. Functions to concentrate and store bile
B. Drains venous blood into the hepatic veins
Your patient develops a gastric ulcer that erodes away the posterior wall of his stomach. As gastric juices and stomach contents leak out of the stomach, where would they accumulate?
The ulcer then erodes the area posterior to the stomach. Which organ and blood vessel might be damaged by the stomach acid?
If the ulcer were posterior to the first part of the duodenum, which vessel might be damaged?
accumulation in the lesser sac
pancreas and splenic artery would be damaged by the acid
gastroduodenal artery is near the first part of the duodenum
A 55 year old male is admitted to the hospital because of severe weight loss over the preceding 6 months. A CT scan and other tests indicate that a tumor(arrows) is causing portal hypertension. Laboratory studies reveal that the patient has fat in the stool, malnutrition and liver hypoxia. At which of the following locations is the tumor most likely located?
A. Right lobe of liver
B. Left lobe of liver
C. Porta hepatis
D. Falciform ligament
E. Hepatogastric ligament
C. Porta hepatis
A 60 year old man is admitted to the emergency department with severe abdomional pain. An abdominal CT angiogram (below) shows a thrombus in an intestinal artery supplying a loop of intestine. Which of the following layers of peritoneum will the surgeon have to enter to access the affected vessel through an incision through the abdominal wall?
A. Parietal peritoneum and the greater omentum
B. Greater and lesser omentum
C. Lesser omentum and gastrosplenic ligament
D. Parietal peritoneum and the mesentery
E. Greater omentum and the gastrohepatic ligament
D. Parietal peritoneum and the mesentery
You perform a vagotomy (sectioning of the vagal trunks) to improve you patient’s gastric ulcer situation. How could this procedure reduce your patient’s symptoms?
Would the functioning of the descending colon be affected by this procedure?
The vagus nerve supplies parasympathetic innervation to the GI tract up to the proximal 2/3 of the transverse colon – secretion of acid is modulated by the parasympathetic system.
No – the pelvic splanchnic nerves supply parasypathetic innervation to the hindgut
Patients who have perforated gastric ulcers are often propped up in bed. In anatomical terms, explain the reason for a patient being placed in this position.
Suppose you detect a collection of infected material in the peritoneal cavity in the region of the anterior surface of the second part of the duodenum. Indicate the pathways along which the material may spread to reach the:
a) undersurface of the diaphragm
b) the pelvic cavity
Sit the patient up so that the stuff drains downwards.
To get to the udersurface of the diaphgragm, fluid would need to exit at the epiplioc foramen of Carl Winslow and into the hepatorenal recess (of Morrison).
To get to the pelvic cavity, fluid would need to exit the foramen, travel down the paracolic gutters and into the pelvis.
An arteriogram of a 75 year old patient shows that the celiac trunk is occluded by atherosclerotic plaque.
Name the branches of the celiac trunk and the organs that are normally supplied by this artery.
Which structures are supplied by the SMA and IMA?
Branches of celiac trunk are: left gastric artery; splenic artery –> left gastroepiploic; common hepatic, proper hepatic and right gastric artery, gastroduodenal, and right gastroepiploic artery. These supply foregut structures (lower esophagus –> 2nd part of duodenum), spleen, and liver.
SMA supplies the midgut (3rd part of duodenum –> proximal 2/3 of transverse colon)
IMA supplies the hindgut (distal 1/3 of transverse colon –> rectum)
Which structure is retroperitoneal in position and receives blood from the splenic artery?
C – the pancreas is secondarily retroperitoneal and receives branches from the splenic artery
-the spleen is intraperitoneal
A 27-year-old woman has suffered a gunshot wound to her midabdomen. After examining the patient’s angiogram, a trauma surgeon locates the source of bleeding from pairs of veins that typically terminate in the same vein. Which of the following veins are damaged?
A. Left and right suprarenal veins
B. Left and right colic veins
C. Left and right gastroepiploic veins
D. Left and right ovarian veins
E. Left and right hepatic veins
E. Left and right hepatic veins
A patient with diverticulosis of the sigmoid colon presents for follow-up to his primary care physician with ongoing complaints of left lower quadrant pain and occasionally bloody stools. Which of the following is true of the sigmoid colon?
A. Receives its blood from the superior mesenteric artery
B. Is drained by systemic veins
C. Receives parasympathetic fibers from the vagus nerve
D. Has teniae coli and epiploic appendages
E. Is a retroperitoneal organ
D. Has teniae coli and epiploic appendages
A twenty-six year old female arrives in the ER after being hit by a motor vehicle while crossing the street. The patient’s only complaints are abdominal tenderness and left shoulder pain. Her abdomen is tender on palpation of the left upper quadrant, with a faint tire mark over that area; in addition you detect crepitus (indicating fractured ribs) over the 9th,10th, and 11th ribs on the left side. You order a diagnostic CT scan to assess her injury.
- What type of injury do you suspect?
- What other structures lie within this quadrant and are at risk for injury?
- Suppose you had to remove the spleen. What is the major arterial supply of the spleen? What other major branches arise from this artery?
- Ruptured spleen
- Stomach, splenic flexure of the colon, tail of the pancreas, left kidney and adrenal gland
- Splenic artery, left gastro-epiploic artery and short gastric arteries
Name three signs of a splenic rupture.
- Hypotension
- LUQ pain
- Referred pain to left shoulder (phrenic nerve C3, 4, 5)
A 29 year old man who has been diagnosed with acute appendicitis exhibits a “positive psoas sign”.
What is a “psoas sign” and why would some types of appendicitis produce it?
What other type of pathology might produce a psoas sign? Where might one feel a mass with this type of pathology?
Psoas sign is pain upon extending the thigh due to inflamed psoas major muscle or appendicitis (appendix is just anterior to the psoas major).
Tuberculosis which invades the lumbar spine; inflamed appendix, pancreas, sigmoid colon can produce a positive psoas sign.
A 45-year-old man complains of heartburn, substernal pain and the feeling of regurgitation after he eats. What might be the cause of his symptoms?
GERD
A 32 year old woman is admitted to the hospital for the delivery of her baby. Her obstetrician decides to perform an emergency Cesaerian section. A Pfannensteil incision is used to reach the uterus by making a transverse section through the external rectus sheath about 2 cm above the pubic symphyses. Which of the following nerves is most at risk when this incision is made?
A. T10
B. T11
C. Iliohypogastric
D. Ilioingiuinal
E. Lateral femoral cutaneous
C. Iliohypogastric
A 53 year old male is admitted to the ER with severe upper abdominal pain. Gastroscopy reveals a tumor in the antrum of the stomach. A CT is ordered to evaluate lymphatic enlargement of the stomach and other nodes. Which of the following lymph nodes is most likely to be involved in a malignancy of the stomach?
A. Superficial inguinal
B. Lumbar
C. Celiac
D. Superior mesenteric
E. Inferior mesenteric
C. Celiac
A mother brings her 2-week old baby to the pediatrician because he exhibits “projectile vomiting” of curdled milk (milk mixed with gastric acid) stained with bile. You suspect an obstruction somewhere along the baby’s GI tract. An X-ray shows a “double-bubble” sign in which both the stomach and part of the duodenum is extended.
- What do you suspect could be the problem with this child?
- Which other abnormal conditions might explain his problems?
Obstruction of the duodenum beyond the hepatopancreatic ampulla: annular pancreas or SMA syndrome or duodenal atresia.
check the double-bubble sign in the photo…
A 4 day old infant vomits the contents of his stomach but the vomitus does not contain bile. There is no evidence that he is choking. Which of the following conditions will best explain his symptoms?
A. Duodenal stenosis
B. Duodenal atresia
C. Hypertrophied pyloric sphincter
D. Tracheoesophageal fistula
E. Esophageal atresia
What if the infant exhibited signs of choking or aspiration pneumonia?
C. Hypertrophied pyloric sphincter
Choking or aspiration pneumonia could be due to:
●Esophageal Atresia (EA) – congenital malformation that represents the failure of the esophagus to develop a continuous passage into the stomach
●Tracheo-esophageal Fistula (TEF) – malformation where the trachea and esophagus fails to separate into distinct structures and a passage is created between them
A 47 year old obese man experiences nausea, vomiting, abdominal distension and stabbing pain after eating. It appears to be relieved when he leans forward or puts his knees to his chest.
A CT scan reveals a dilated superior mesenteric artery and you diagnose the patient with Superior Mesenteric Artery Syndrome.
Why would the SMA cause these symptoms? Which other problems might result from a dilated SMA?
SMA syndrome compresses the third part of the duodenum –> distension of the 1st and 2nd parts of the duodenum, nausea, comiting, etc.
Other symptoms like hematuria can result from compression of the left renal vein, which the left gonadal vein drains into –> edema of the left testicle or artery.
While on the pediatric surgery service, you are called to the neonatal intensive care unit to evaluate a thirty-six hour old infant. Auscultation reveals an absence of breath sounds on the left side of his chest, but you note apparent bowel sounds on the left side of the chest. The patient has no bowel sounds within his abdomen. The resident orders a chest x-ray, which demonstrates bowel within the thorax.
- What is your diagnosis?
- Where in the diaphragm does this type of pathology most often occur?
- What normal apertures are found in the diaphragm , and what structures pass through each aperture?
- Congenital diaphragmatic hernia
- Posteriolateral part of the diaphragm, usually on the left side
- IVC - T8
Esophagus, vagal trunks, branch of the left gastric artery - T10
Aorta, thoracic duct, azygos vein - T12
A 59-year-old man suddenly experiences an excruciating colicky pain across the upper part of her abdomen. Two days later the patient became jaundiced and it was noticed that the degree of jaundice varied from day to day. Radiographic studies reveal a tumor in the head of the pancreas. Which of the following structures is most likely being obstructed?
A. Proper hepatic artery
B. Accessory pancreatic duct
C. Common hepatic duct
D. Common bile duct
E. Cystic duct
What other symptoms might the patient exhibit eventually?
D. Common bile duct
Other symptoms: pancreatitis, steatorrhea
A forty year old slightly obese female presents to the ER with spasmodic, colicky pain in her right upper quadrant, with some right shoulder discomfort and accompanying nausea and vomiting. She is noticeably uncomfortable on deep inspiration, and palpation reveals an increase in pain while palpating the RUQ.
- What do you think is this patient’s problem?
- Which clinical diagnostic test would you use to confirm your diagnosis?
- Why might the patient experience right shoulder discomfort?
- During a laparoscopic procedure to remove the offending organ, the surgeon is responsible for dissecting out the cystohepatic triangle (of Calot) ; what are the borders of the triangle?
- Cholecystitis
- Ultrasound
- Inflamed gallbladder irritating the right hemidiaphragm
- Cyctic duct, hepatic duct, liver
During a laparoscopic cholecystectomy on a 67 year old female, which of the following arteries must be clamped to remove the gallbladder safely?
A. Common hepatic
B. Proper hepatic
C. Right hepatic
D. Left hepatic
E. Cystic
Which artery is this usually a direct branch from?
What is the landmark that surgeons use to locate this artery?
E. Cystic, a branch from right hepatic a.
The Triangle of Calot is the landmark
Your patient has a retroperitoneal infection. Which of the following organs would most likely be susceptible to the infection:
A. spleen
B. jejunum
C. duodenum
D. sigmoid colon
E. Transverse colon
C. Duodenum
A 43 year old female is diagnosed with midgut volvulus and intestinal ischemia. A laparotomy is performed to release the obstruction. Which of the following structures is used as a landmark to determine the position of the duodenojejeunal junction?
A. Vasa recta
B. Superior mesenteric artery
C. Inferior mesenteric artery
D. Ligament of Treitz
E. The proximal attachment of tenia coli
D. Ligament of Treitz
A patient arrives in your office complaining of sharp pain which began in the right postero-lateral abdominal wall and which now moves down into his groin. He also reports seeing a little blood in his urine this morning.
What might you suspect is going on with this patient?
What might you do to confirm your suspicion? What would the treatment be?
An intravenous pyelogram revealed that the calyces and pelvis of the right kidney were grossly dilated. Why?
Suspect a kidney stone
Take a KUB X-ray or ultrasound. Tx is hydration, pain meds
Dilated kidney from obstruction of the ureter
The white arrow in the image below points to a kidney stone. Based on the anatomy shown in the radiograph, where is this stone located?
A. At the junction of the ureter and pelvis
B. In the middle of the abdominal ureter
C. In the ureter as it passes anterior to the common iliac artery
D. In the kidney
E. In the adrenal gland
D. In the kidney
A 30-year old man comes to your office with significantly elevated blood pressure, rapid heart rate, sweating and elevated metabolism. A CT scan shows a large mass just above his left kidney.
What is your diagnosis?
Phaeochromocytoma
Which of the following is incorrect pertaining to the structure indicated by the red arrow in the coronal CT shown below?
A. The right gland is exclusively supplied with blood via an artery that branches from the right renal artery
B. The diaphragm is posterior to both the right and left glands
C. The left gland is typically drained exclusively via a vein that empties into the left renal vein
D. Both left and right glands are retroperitoneal
E. Preganglionic sympathetic fibers reach the chromaffin cells in the medulla
A. The right gland is exclusively supplied with blood via an artery that branches from the right renal artery
A twenty-five year-old female presents to the emergency room with a complaint of “colicky” periumbilical pain which has intensified over the last 6-8 hours and now has started to migrate to the right lower quadrant.. On palpation the patient demonstrates abdominal guarding and rebound tenderness, and the muscles of the anterior wall in the right lower quadrant are rigid.
- Can you explain why the pain of appendicitis is felt first in the periumbilical area and then shifts to the right lower quadrant?
- Why were the muscles of the anterior abdominal wall rigid?
The appendix is part of the midgut and supplied by a branch of the SMA. The lesser splanchnic nerve (T10,T11) supplies the midgut and visceral sensory fibers travel back to these spinal cord levels to give referred pain around the umbilicus. When the appendix ruptures it may cause peritonitis in the right lower quadrant, but sensation from the peritoneum is from somatic nerves T10-T12
Your 31-year-old patient has lower right quadrant pain that is originally thought to be appendicitis but CT showed to be pyelonephiritis (kidney infection). Which of the following nerves would convey visceral sensory fibers from the kidney and cause referred pain to the skin of the suprapubic region of her abdomen?
A. Greater splanchnic
B. Lesser splanchnic
C. Least splanchnic
D. Pelvic splanchnic
E. vagus
C. Least splanchnic
A 45 year old woman is admitted to the ER with a complaint of severe abdominal pain. A CT scan indicates advanced cancer in the head of the pancreas. A celiac plexus block is performed to relieve her pain. Which of the following nerves structures are likely to be present on the celiac plexus?
A. Preganglionic parasympathetic and somatic motor fibers
B. Postganglionic parasympathetic and visceral afferent fibers
C. Postganglionic sympathetic and visceral afferent fibers
D. Pre- and post ganglionic sympathetic, preganglionic parasympathetic and visceral afferent fibers
E. Preganglionic sympathetic, preganglionic parasympathetic and visceral afferent fibers
D. Pre- and post ganglionic sympathetic, preganglionic parasympathetic and visceral afferent fibers
A 26 year old male is admitted to the ER with periumbilical pain. A CT scan reveals internal bleeding about 2 feet proximal to the iliocecal junction. A biopsy also reveals that the lesion contains gastric mucosa. Which of the following is the most likely diagnosis?
A. Ruptured appendix
B. Volvulus
C. Diverticulosis
D. Meckel’s diverticulum
E. Duodenal ulcer
D. Meckel’s diverticulum
A 46 year old man comes to the ER complaining of non-specific abdominal pain and distention. Which imaging modality would you use first to diagnose his problems?
A. Abdominal plain film
B. CT scan
C. MRI
D. Ultrasound
E. Nuclear Medicine
What if your patient had been in a motor vehicle accident?
What if your patient were a 57 year old woman with RUQ pain that develops after eating?
What if your patient were 25-year old woman with pelvic pain?
A. Abdominal plain film
If in a MVA: CT
RUQ pain: Ultrasound
Pelvic pain: Ultrasound
You are on your Ob/Gyn rotation and are assisting in a delivery. The baby’s head has descending into the pelvic cavity (true pelvis). The head has already passed through the superior pelvic aperture (pelvic inlet); your job is to guide it through the inferior pelvic aperture (pelvic outlet).
- What are the boundaries of these two apertures? It looks like the baby’s head is quite large and might tear the vaginal opening.
- What ligaments support the bony pelvis and which structures form the floor of the pelvis?
Pelvic inlet boundaries: a plane from the sacral promontory to the superior pubis symphysis.
Pelvic outlet boundaries: tip of coccyx to lower pubic symphysis.
See pic for ligaments
A 27 year old man arrives in the ER after a motor vehicle accident. He is hypotensive and in extreme pain. His pelvic CT scan is shown below. What major complication are you concerned about?
Massive bleeding from rupture of internal iliac branches
During dissection of deep pelvic lymph nodes in a 60-year-old man, the surgeon accidentally severs the internal iliac artery at its origin. Which of the following structures will maintain its normal blood supply immediately following this lesion?
A. Bladder
B. Scrotum
C. Penis
D. Testes
E. Perineum
D. Testes
The testes (and ovaries) are supplied by the testicular (ovarian) arteries which are branches from the abdominal aorta
A 43-year-old man is brought to the ER after being struck by a car. Radiographic imaging reveals a rotationally unstable pubic ramus fracture, which is depicted below. Which of the following structures is most likely damaged specifically by the fracture of the superior pubic ramus?
A. Sympathetic chain
B. Superior gluteal artery
C. Vas deferens
D. Piriformis muscle
E. Sciatic nerve
Which parts of the pelvis have been fractured?
C. Vas defrens
Superior and inferior pubic rami were fractured
Your patient is in the first stage of labor and has requested a pudendal nerve block to reduce the pain of delivery.
What area would be anesthetized by this block?
What bony landmarks would you palpate for?
What other methods of anesthesia might be used to provide pain relief during childbirth?
Perineum would be anesthetized.
Palpate for the ischial tuberosity or ischial spine.
Other methods are caudal epidural or spinal block.
You decided to perform a mediolateral episiotomy. What is an episiotomy?
Explain the difference between a mediolateral episiotomy and a median episiotomy.
Name the muscles that would be cut in each type.
An episiotomy is a surgical incision of the perineum and the posterior vaginal wall during second stage of labor to quickly enlarge the opening for the baby to pass through and decrease the degree of tearing of the muscles around the vaginal opening.
Mediolateral episiotomy avoids the perineal body and cuts through the bulbospongiosus muscle. A median episiotomy cuts the bulbospongiosus and the perineal body, where the superficial transverse perineal muscle attaches.
A 37 year-old woman is hospitalized because of an enlarged painful abdomen. An ultrasound exam is performed and the presence of fluid in the peritoneal cavity is found. A needle is placed through the posterior vaginal fornix to drain the fluid. Which space must the needle enter to drain the fluid?
A. Superficial perineal pouch
B. Deep perineal pouch
C. Ischioanal fossa
D. Rectouterine pouch
E. Hepatorenal recess
D. Rectouterine pouch
A 2-year-old boy is being potty-trained. Which of the following events occurs when he attempts to pass his stool?
A. Relaxation of the pubococcygeus muscle
B. Relaxation of the puborectalis muscle
C. Relaxation of the coccygeus muscle
D. Contraction of the external anal sphincter
E. Contraction of the external anal sphincter
B. Relaxation of the puborectalis muscle
Upon performing a rectal exam, you discover that your patient has an enlarged prostate gland.
How were you able to make this observation while performing a rectal exam?
What other structures can be palpated during this type of exam in a male?
The prostate lies anterior to the rectum.
Other structures that can be palpated are the seminal vesicles and vas defrens.
A 63-year old male who has hypertension complains of a 6-month difficulty invoiding and the sensation he cannot empty his bladder completely. He has had two episodes of urinary tract infections but denies dysuria (burning with urination) or urethral discharge.
What is the most likely diagnosis?
What is the anatomical explanation for the patient’s symptoms?
BPH - compression of the bladder neck of the prostatic urethra
A 15 year-old boy is admitted to the ER after trying to jump over a fence and hitting his groin. MRI examination reveals severe edema of the boy’s scrotum and abdominal wall and extravasated urine. Which of the following structures is most-likely ruptured?
A. Spongy urethra
B. Pre-prostatic urethra
C. Prostatic urethra
D. Urinary bladder
E. Ureter
A. Spongy urethra
A 27 year old female notes a tender lump in her groin area that appeared approximately 3 weeks ago. She relates that she had a similar mass about 1 year ago that required minor surgery. On physical examination, she is afebrile and inspection of the perineum shows a 3 x 2 cm fluctuant mass at the 5-o’clock position of the vestibule. It is mildly tender, red and slightly warm to the touch.
What is the most likely diagnosis?
What structures in the groin would also become enlarged?
Greater vestibular (Bartholin’s) gland abscess
Other structures enlarged: superficial inguinal lymph nodes.
Which of the following structures would be most likely affected by an abscess confined within the deep perineal pouch of a 46-year-old man?
A. Bulbourethral glands
B. Bartholin’s glands
C. Ischiocavernosus muscles
D. Bulbospongiosus muscles
E. Perineal body
A. Bulbourethral glands
A 65 year old male with benign prostatic hypertrophy (BPH) has frequent episodes of urinary incontinence, particularly at night.
- Which sphincter controls voluntary flow of urine and where is it located?
- What other structures are located in this space?
- Which nerve supplies innervation to this sphincter?
- External urethral sphincter – deep pouch
- Bulbourethral glands, deep transverse perineal muscles
- Pudendal nerve
A 62-year-old man is incapable of penile erection after rectal surgery with prostatectomy. The patient most likely has a lesion of which of the following nerves?
A. Pudendal nerve
B. Sympathetic trunks
C. Pelvic splanchnic nerves
D. Dorsal nerve of the penis
E. Genitofemoral nerve
C. Pelvic splanchnic nerves
Your patient has a malignant tumor on his left testicle (or her left ovary). The cancer spreads via the lymphatic system and begins to invade the patient’s lymph nodes. Which group of lymph nodes would the cancer invade first? Would your answer be the same if the cancer was in the scrotum?
Lymphatic drainage from the testes or ovaries follows the blood vessels (IVC, aorta) and would involve paraaortic (lumbar) lymph nodes. Lymphatic drainage from the scrotum or labia majora would involve superficial inguinal lymph nodes.
A 21-year-old woman asks about her first bimanual examination, and it is explained to her that the normal position of the uterus is:
A. Anteverted and retroverted
B. Retroverted and retroflexed
C. Anteflexed and retroverted
D. Anteverted and anteflexed
E. Retroflexed and anteverted
D. Anteverted and anteflexed
A 45 year-old woman arrives in the ER because of pelvic discomfort. During a physical exam, the gynecologist discovers that the patient’s uterus has completely prolapsed. All of the following structures provide support to the uterus and help to prevent uterine prolapse EXCEPT:
A. Uterosacral ligaments
B. Lateral (cardinal ligaments)
C. Mesosalpinx and mesovarium
D. Round ligament of the uterus
E. Pelvic diaphragm
C. Mesosalpinx and mesovarium
A male infant is born with undescended testes that remain intra-abdominal 5 months later (cryptorchidism). Each testis possesses an elongate, distinctive gubernaculum testis running into the scrotum. Which of the following structures in female anatomy is homologous to the gubernaculum testis?
A. Round ligament of the uterus
B. Uterine tube
C. Vestibular bulb
D. Labia minora
E. Ureter
A. Round ligament of the uterus
During an oophorectomy (ovariectomy – removal or ovaries), the surgeon plans to ligate the ovarian vessels within the peritoneal fold that contains them. What is this fold?
A. Broad ligament
B. Ovarian ligament
C. Suspensory ligament of the ovary
D. Mesosalpinx
E. Mesovarium
C. Suspensory ligament of the ovary
A 53-year-old woman is admitted to a local hospital for surgical removal of a benign pelvic tumor confined within the broad ligament. There is a risk of injuring which of the following structures that lies in this ligament?
A. Ovary
B. Proximal part of pelvic ureter
C. Terminal part of the round ligament of the uterus
D. Uterine tube
E. Ovarian vessels
D. Uterine tube
A 45 year old underwent a complete hysterectomy, and the uterine artery was ligated near the junction of the uterus and vagina during the procedure. What structure would most likely be at risk during the ligation of the uterine artery?
A. Ovarian artery
B. Ureter
C. Round ligament of the uterus
D. Pudendal nerve
E. Obturator artery
B. Ureter
An ultrasound examination of a 3-year-old boy shows a collection of fluid in his scrotum that is diagnosed as being the result of persistent processus vaginalis in its middle portion. Which of the following conditions is most likely to be associated with this developmental anomaly?
A. Direct inguinal hernia
B. Undescended testis
C. Hydrocele
D. Varicocele
E. Indirect inguinal hernia
C. Hydrocele, or E. Indirect inguinal hernia
- Crus of penis
- Corpora cavernosa
- Corpus spongiosus
- Piriformis
- Levator ani: pubococcygeus
- Sphincter urethrae
- Deep transverse perineal muscle
- External anal sphincter
- Iliococcygeus muscle
- Bulbospongiosus
- Ischiocavernosus
- Pudendal nerve
- Superficial transverse perineal muscle
- Piriformis
- Coccygeus
- Levator ani
- Membranous urethra
- Obturator internus fascia
- Seminal vesicles
- Prostate
- Seminal vesicles
- Corpus spongiosum
- Corpus cavernosum
- Corpus cavernosum
- Corpus spongiosum
- Spongy urethra
- Membranous urethra
- Prostatic urethra
- Bulb of vestibule
- Ischiocavernosus
- Levator ani: pubococcygeus
- Bulb of vestibule
- Iliococcygeus
- External anal sphincter
- Deep transverse perineal muscle
- Bulbospongiosus
- Fascia of pelvic diaphragm
- Superficial transverse perineal muscle
Ischioanal fossa filled with fat
What is the male equivalent of Bartholin’s gland?
Bulbourethral gland (Cowper’s)
- Ureter
- Uterine artery
- Round ligament of the uterus
An obstetrician decides to do a Caesarean section on a 25-year-old pregnant woman. A transverse suprapubic incision about 2 inches above the pubic symphysis is chosen for that purpose. All of the following abdominal wall layers will be encountered during the incision EXCEPT the:
A.Anterior rectus sheath
B.Posterior rectus sheath
C.Rectus abdominus muscle
D.Transversalis fascia and peritoneum
E.Linea alba
B.Posterior rectus sheath
The incision is below the arcuate line where the posterior rectus sheath ends
What does Camper’s and Scarpa’s fascia refer to?
A.Fascial layers of the abdominal wall, which are deep to the peritoneum
B.Superficial and deep (respectively) fascial layers of the posterior abdominal wall
C.Superficial and deep layers (respectively) of the rectus sheath
D.Fatty and membranous layers (respectively) of the superficial fascia (subcutaneous tissue) of the inferior anterior abdominal wall
E.Fatty and membranous layers (respectively) of the superficial fascia (subcutaneous tissue) of the spermatic cord
D.Fatty and membranous layers (respectively) of the superficial fascia (subcutaneous tissue) of the inferior anterior abdominal wall
Which of the following structures is a fibrous remnant of an embryonic or fetal artery?
A.Ligamentum venosum
B.Ligamentum teres hepatis
C.Median umbilical fold
D.Medial umbilical fold
E.Lateral umbilical fold
D.Medial umbilical fold
The medial umbilical fold is a remnant of the obliterated umbilical artery
A 45 year old man comes to the ER with an abscess that extends just under the diaphragm from the right side to the midline. Which of the following structures would most likely be in a position to retard the spread of the abscess across the midline?
A.Gastroduodenal ligament
B.Hepatoduodenal ligament
C.Coronary ligament
D.Falciform ligament
E.Round ligament
D.Falciform ligament
The falciform ligament separates the subphrenic spaces into left and right recesses and extends between the liver and anterior abdominal wall.
A 9 year old male is admitted to the hospital with an indirect inguinal hernia. During the procedure the spermatic cord and transversalis fascia are identified. Which component of the spermatic cord is derived from the internal oblique muscle?
A.External spermatic fascia
B.Cremaster muscle
C.Tunica vaginalis
D.Internal spermatic fascia
B.Cremaster muscle
A physician is conducting a physical examination of a 43 year old male. In order to palpate a potential inguinal hernia, a digit is inserted into the scrotum towards the superficial inguinal ring. The superficial inguinal ring is an opening in which of the following?
A. Transversalis fascia
B. External oblique aponeurosis
C. Conjoint tendon
D. Peritoneum
E. Transversus abdominus aponeurosis
B. External oblique aponeurosis
The deep inguinal ring is formed by the transversalis fascia
A 10 year old boy comes to the hospital with pain in the lower right quadrant after lifting a heavy object . You examine him and find a hernial sac with a small loop of intestine projecting through the abdominal wall just above the inguinal ligament and lateral to the inferior epigastric vessels and continuing down into the scrotum. The hernia was diagnosed as:
A.A direct inguinal hernia
B.An indirect inguinal hernia
C.A femoral hernia
D.A Spigelian hernia
E.An umbilical hernia
B.An indirect inguinal hernia
Hesselbach’s triangle
- inguinal ligmanet
- inferior epigastric
- lateral border rectus abdominis
Direct inguinal hernias pass through ____________ to inferior epigastric
medial
A 47 year-old female comes to the clinic complaining of nausea, vomiting and abdominal pain. A plain-film X-ray (left) and CT scan (right) are shown below. What is the most likely explanation for this patient’s problem?
A. Direct inguinal hernia
B. Indirect inguinal hernia
C. Midgut volvulus
D. Umbilical hernia
E. Spigelian hernia
D. Umbilical hernia
Spigelian hernia occurs
around the semilunar line
32 year old woman is admitted to the hospital for the delivery of her baby. Her obstetrician decides to perform an emergency Cesaerian section. A Pfannensteil incision is used to reach the uterus by making a transverse section through the external rectus sheath about 2 cm above the pubic symphyses. Which of the following nerves is most at risk when this incision is made?
A.T10
B.T11
C.Iliohypogastric
D.Ilioingiuinal
E.Lateral femoral cutaneous
C.Iliohypogastric
Your patient has a retroperitoneal infection. Which of the following organs would most likely be susceptible to the infection: (i.e., which of these is a retroperitoneal structure?)
A. spleen
B. jejunum
C. duodenum
D. sigmoid colon
E. Transverse colon
C. duodenum
All of the other structures are intraperitoneal (they have a mesentery)
A patient with cirrhosis is scheduled for liver transplant surgery. During the operation rounds, the transplant physician quizzes his students and asks which of the following statements is true of the liver:
A. Receives blood only from the hepatic arteries
B. Drains venous blood into the hepatic veins
C. Manufactures red blood cells in an adult
D. Blood supply to the quadrate lobe comes from the right hepatic artery
E. Functions to concentrate and store bile
B. Drains venous blood into the hepatic veins
The quadrate lobe is supplied by the left hepatic artery. The caudate lobe is supplied by both left and right hepatic arteries
The liver also receives blood form the portal vein
A 45-year old man with a history of alcoholism is admitted to the hospital after vomiting a significant amount of blood (hematamesis). A CT scan of his abdomen (below left) is shown below. Examination of his anterior abdominal wall shows dilated veins radiating from his umbilicus (caput medusae – below right). Which of the following venous structures is most likely obstructed?
A.Portal vein
B.Inferior vena cava
C.Superior vena cava
D.Inferior epigastric vein
E.Azygous vein
A.Portal vein
Your patient develops a gastric ulcer that erodes away the posterior wall of his stomach. As gastric juices and stomach contents leak out of the stomach, where would they accumulate?
The ulcer then erodes the area posterior to the stomach.
Which organ and blood vessel might be damaged by the stomach acid?
The area behind the stomach is known as the lesser sac – it is closed on the left but open on the right through an opening called the epiploic foramen (of Winslow)
The pancreas and the splenic artery are located directly behind the stomach and might be damaged by a gastric ulcer
A 55 year old male is admitted to the hospital because of severe weight loss over the preceding 6 months. A CT scan and other tests indicate that a tumor(arrows) is causing portal hypertension. Laboratory studies reveal that the patient has fat in the stool, malnutrition and liver hypoxia. At which of the following locations is the tumor most likely located?
A.Right lobe of liver
B.Left lobe of liver
C.Porta hepatis
D.Falciform ligament
E.Hepatogastric ligament
C.Porta hepatis
A 59-year-old man suddenly experiences an excruciating colicky pain across the upper part of his abdomen. Two days later the patient became jaundiced and it was noticed that the degree of jaundice varied from day to day. Radiographic studies reveal a tumor in the head of the pancreas. Which of the following structures is most likely being obstructed?
A.Proper hepatic artery
B.Accessory pancreatic duct
C.Common hepatic duct
D.Common bile duct
E.Cystic duct
What other symptoms might the patient exhibit eventually?
D.Common bile duct
Pancreatitis, if the pancreatic duct is blocked by the tumor
Patients who have perforated gastric ulcers are often propped up in bed. In anatomical terms, explain the reason for a patient being placed in this position.
Suppose you detect a collection of infected material in the peritoneal cavity in the region of the anterior surface of the second part of the duodenum. Indicate the pathways along which the material may spread to reach the a) undersurface of the diaphragm b) the pelvic cavity
When a patient with a gastric ulcer sits up in bed, fluid will flow out from the lesser sac through the epiploic foramen of Winslow. The fluid then flows to the hepatorenal recess, the lowest region in the abdomen when the person is lying supine. When the person sits upright, the infection will then drain down along the right paracolic gutter to the pelvis.
A 63 year old woman is admitted to the hospital with a painful abdomen. Radiographic examination reveals an ulcer in the left greater curvature of the stomach, resulting in intraabdominal bleeding. The artery which is the source of the bleeding is a direct branch of which of the following arteries?
A.Common hepatic
B.Left gastric
C.Right gastric
D.Splenic
E.Gastroduodenal
D.Splenic
The left curvature of the stomach is supplied by the left gastroepipolic artery, the continuation of the splenic artery
Anastamotic connections between branches of the celiac, superior mesenteric and inferior mesenteric arteries may become important if one of these arteries is occluded. Name the arteries which can provide potential collateral circulation between the:
- Celiac trunk and the SMA
- SMA and IMA
1.Celiac trunk and the SMA
Superior (celiac trunk) and inferior (SMA) pancreatico- duodenal arteries
2.SMA and IMA
Middle colic (SMA) and left colic (IMA) arteries through the marginal artery
A patient is admitted to the emergency room with a bullet wound in her lower right quadrant. Which of the following small bowel segments would be most likely to be injured?
A.1st part of the duodenum
B.2nd part of the duodenum
C.3rd part of the duodenum
D.Jejeunum
E.Ileum
E.Ileum
While examining radiographs and angiograms of a 52-year-old patient, a physician is trying to distinguish the jejunum from the ileum. He has observed that the jejunum has:
A.More fat in its mesentery
B.Shorter vasa recta
C.Fewer mesenteric arterial arcades
D.A different blood supply than the ileum
E.Sympathetic innervation from the least splanchnic nerve
C.Fewer mesenteric arterial arcades
The jejunum has fewer arterial arcades and longer vasa recta. The ileum and jejeunum share the same blood supply (SMA) and are innervated by the lesser splanchnic nerve
A 19-year-old young woman is admitted to the ER after an automobile collision. An MRI reveals the spinal cord has been transected at the L4 level. Which of the following portions of the GI tract will lose parasympathetic innervation from the central nervous system?
A.stomach
B.Ascending colon
C.ileum
D.Descending colon
E.Transverse colon
D.Descending colon
The vagus nerve supplies parasympathetic innervation to the GI system up to the proximal 2/3 of the transverse colon.
The pelvic splanchnic nerves supply parasympathetic innervation from the distal 1/3 of the transverse colon to the rectum as well as the pelvic organs
A patient with diverticulosis of the sigmoid colon presents for follow-up to his primary care physician with ongoing complaints of left lower quadrant pain and occasionally bloody stools. Which of the following is true of the sigmoid colon?
A. Receives its blood from the superior mesenteric artery
B. Is drained by systemic veins
C. Receives parasympathetic fibers from the vagus nerve
D. Has teniae coli and epiploic appendages
E. Is a retroperitoneal organ
D. Has teniae coli and epiploic appendages
A.– It is supplied by sigmoid branch of IMA
B.- it is drained by the portal system
C.- It is supplied by pelvic splanchnic nerves
E. - It is an intraperitoneal organ – it has its own mesentery
Where is diverticulitis more frequently found?
Sigmoid colon
A 55 year old man is admitted to the hospital with a large but painless mass in the right groin During physical examination it is noted that the superficial inguinal lymph nodes are hard, suggesting the presence of malignant cells. Which of the following locations would be the most likely primary source of cancer?
A. prostate
B. bladder
C. testis
D. skin of anal canal
E. sigmoid colon
D. skin of anal canal
Infections on the skin of the anal canal, below the pectinate line, drain to superficial inguinal lymph nodes. Infections above the pectinate line drain to internal iliac nodes to common iliac and lumbar nodes
Your patient has a hiatal hernia in which the fundus of the stomach has herniated through the esophageal hiatus of the diaphragm. Which of the following is therefore incorrect?
A.If the patient has typical anatomy, the herniation occurred through the right crus of the diaphragm
B.The herniation occurred approximately at the T10 vertebral level
C.The herniation may affect the flow of blood in the branches of the left gastric artery
D.The herniation may affect the function of the phrenic nerve
D.The herniation may affect the function of the phrenic nerve
The phrenic nerves do not pierce the diaphragm through the esophageal hiatus
The left gastric artery also supplies the lower part of the esophagus
In the lumbar region, tuberculosis may spread from the vertebrae into an adjacent muscle to produce an abscess. A patient presents with pus in the upper medial part of the thigh. To which muscle did the tuberculosis most likely spread?
A.Quadratus lumborus
B.Rectus abdominus
C.Psoas major
D.Diaphragm
E.Transversus abdominus
C.Psoas major
During a physical examination of a 35-year-old man with a spinal cord injury, the neurologist lightly strokes the right upper medial side of the thigh to test the integrity of the L1/2 spinal cord segments. He notes the cremasteric reflex is absent. Which of the following nerves carries the efferent limb of this reflex arc?
A.Iliohypogastric
B.Genital branch of the genitofemoral nerve
C.Femoral nerve
D.Ilioinguinal
E.Subcostal
B.Genital branch of the genitofemoral nerve
Afferent (sensory) limb supplied by ilioinguinal and genitofrmoral nerves
A 53 year old male is admitted to the ER with severe upper abdominal pain. Gastroscopy reveals a tumor in the fundus of the stomach. A CT is ordered to evaluate lymphatic enlargement of the stomach and other nodes. Which of the following lymph nodes would most likely receive the initial primary metastasis of the stomach?
A.Superficial inguinal
B.Lumbar
C.Celiac
D.Superior mesenteric
E.Inferior mesenteric
C.Celiac
After passing through regional nodes lying near the affected part of the GI system, cancer will metastasize through groups of lymph nodes lying along the origin of the celiac trunk, superior mesenteric artery or inferior mesenteric artery
Which of the following statements is incorrect regarding the adrenal glands?
A.Preganglionic sympathetic fibers reach the chromaffin cells in the medulla
B. Both left and right glands are retroperitoneal
C. The left gland is typically drained exclusively via a vein that empties into the left renal vein
D. The right gland is exclusively supplied with blood via an artery that branches from the right renal artery
E. The diaphragm is posterior to both the right and left glands
D. The right gland is exclusively supplied with blood via an artery that branches from the right renal artery
A 56-year old female comes to the emergency room complaining of nausea and bloating for the past week. An X-ray of her abdomen shows obstruction and dilation of a portion of her GI tract (below). In which region is the patient most-likely to experience visceral pain?
A. Epigastric (T5 – T9)
B. Periumbilical (T10 – T11)
C. Hypogastric (L1-L2)
D. Perineal (S2 – S4)
B. Periumbilical (T10 – T11)
Theese are loops of small intestine which are part of the midgut and supplied with sympathetic fibers from the lesser splanchnic nerve. The visceral sensory nerve fibers travel retrogradely back from the stomach along the greater splanchnic nerve to enter the spinal cord levels T10 – T11
A 28 year-old female comes to the emergency department with nausea and abdominal pain and a fever of 102 F. She states that the pain began around the umbilicus but now is most severe in the right lower quadrant. Her abdomen is tender to the touch and she tenses her abdominal muscles when you press on it. Which of the following conditions is most responsible for the change in the character of her pain?
A. Irritation of nerve endings from the least splanchnic nerve
B. Inflammation of the psoas major muscle
C. Inflammation of the sigmoid colon
D. Inflammation of the parietal peritoneum
E. Retroperitoneal orientation of the appendix
D. Inflammation of the parietal peritoneum
Preganglionic sympathetic cell bodies of neurons that constrict arteries supplying the stomach are located in the _____________ .
A.Celiac ganglion
B.Brainstem
C.Thoracic part of spinal cord
D.Lumbar part of spinal cord
E.Superior mesenteric ganglion
C.Thoracic part of spinal cord
The stomach is part of the foregut and is supplied by the greater splanchnic nerve whose preganglionic cell bodies are located in the intermediolateral cell columns of T5 – T9 spinal cord levels. The postganglionic cell bodies are located in the celiac ganglion.
Your 45-year-old patient is about to donate a kidney to her husband. The surgeon plans to harvest the left kidney. Which of the following is not true about this kidney?
A.Its renal vein is longer than its renal artery
B. It is related anteriorly to the tail of the pancreas
C.It may be subject to effects from compression of its vein by the superior mesenteric artery
D.It is firmly fixed to the posterior abdominal wall by its mesentery
E.Its superior pole lies superior to the 12th rib
D.It is firmly fixed to the posterior abdominal wall by its mesentery
The kidneys developed in the retroperitoneal region of the abdomen – they never had a mesentery
The left gonadal vein terminates in the ____________ .
A.Inferior vena cava
B.Inferior mesenteric vein
C.Left renal vein
D.Splenic vein
E.Left gastric vein
Which other structure drains into this vessel?
C.Left renal vein
The left adrenal gland
A 4 day old infant vomits the contents of his stomach but the vomitus does not contain bile. There is no evidence that he is choking. Which of the following conditions will best explain his symptoms?
A.Duodenal stenosis
B.Duodenal atresia
C.Hypertrophied pyloric sphincter
D.Tracheoesophageal fistula
E.Esophageal atresia
C.Hypertrophied pyloric sphincter
An infant who is brought to the ER is observed to have continuous choking and coughing. There was an excessive amount of saliva in the infant’s mouth and the pediatrician was unable to pass a catheter through the esophagus into the stomach. What is the most likely cause of these symptoms?
A. Annular pancreas
B. Hirchsprung’s disease
C. Midgut volvulus
D. Esophageal atresia
E. Meckel’s diverticulum
D. Esophageal atresia
During the formation of the pancreas, the ventral and dorsal pancreatic buds rotate and fuse. Which of the following is derived the ventral pancreatic bud?
A. Tail
B. Body
C. Accessory pancreatic duct
D. Main pancreatic duct
D. Main pancreatic duct
During a laparoscopic cholecystectomy on a 67 year old female, which of the following arteries must be clamped to remove the gallbladder safely?
A.Common hepatic
B.Proper hepatic
C.Right hepatic
D.Left hepatic
E.Cystic
E.Cystic
A 43 year old female is diagnosed with midgut volvulus and intestinal ischemia. A laparotomy is performed to release the obstruction. Which of the following structures is used as a landmark to determine the position of the duodenojejeunal junction?
A.Vasa recta
B.Superior mesenteric artery
C.Inferior mesenteric artery
D.Ligament of Treitz
E.The proximal attachment of tenia coli
D.Ligament of Treitz
A 26 year old male is admitted to the ER with periumbilical pain. A CT scan reveals internal bleeding about 2 feet proximal to the iliocecal junction. A biopsy also reveals that the lesion contains gastric mucosa. Which of the following is the most likely diagnosis?
A.Ruptured appendix
B.Volvulus
C.Diverticulosis
D.Meckel’s diverticulum
E.Duodenal ulcer
D.Meckel’s diverticulum seen most in the ileium
You are on your Ob/Gyn rotation and are assisting in a delivery. Radiography of the pelvis was done to determine the narrowest part of the pelvic canal in a case in which the fetal head may have been too large for the narrowest fixed diameter of the pelvis during birth. What is this distance?
A. between the ischial tuberosities
B. between the iliac tubercles
C. between the obturator foramina
D. between the pubic symphysis and the sacral promontory
E. between the ischial spines
D. between the pubic symphysis and the sacral promontory
This distance is known as the obstetrical conjugate. The other distances may vary during childbirth because hormones can relax the pelvic ligaments and allow the two sides of the pelvis to move apart and widen the birth canal
Tearing of the pelvic diaphragm during childbirth leads to partial paralysis of which of the following muscles?
A. External anal sphincter
B. Piriformis muscle
C. Sphincter urethrae
D. Levator ani
E. Obturator internus
D. Levator ani
A 43-year-old man is brought to the ER after being struck by a car. Radiographic imaging reveals a rotationally unstable pubic ramus fracture, which is depicted below. Which of the following structures is most likely damaged specifically by the fracture of the superior pubic ramus?
A. Sympathetic chain
B. Superior gluteal artery
C. Vas deferens
D. Piriformis muscle
E. Sciatic nerve
C. Vas deferens
Your 36-year-old patient is in labor and is requesting a spinal epidural nerve block. Which of the following is not true about this form of anesthesia?
A. It eliminates the patient’s awareness of uterine contractions
B. It (sometimes) involves inserting a catheter in the sacral canal
C. It eliminates sensation from the perineum
D. It causes anesthesia of fibers traveling with the pelvic splanchnic nerves
E. The anesthetic does not enter the subarachnoid space
A. It eliminates the patient’s awareness of uterine contractions
An obstetrician performs a median episiotomy to expand the birth canal during a childbirth. Which of the following structures is typically incised during this procedure?
A. Bulbospongiosus muscle
B. Urethra
C. Perineal body
D. Ischiocavernosus muscle
E. Anal canal
C. Perineal body
A 37 year-old woman is hospitalized because of an enlarged painful abdomen. An ultrasound exam is performed and the presence of fluid in the peritoneal cavity is found. A needle is placed through the posterior vaginal fornix to drain the fluid. Which space must the needle enter to drain the fluid?
A.Superficial perineal pouch
B.Deep perineal pouch
C.Ischioanal fossa
D.Rectouterine pouch
E.Hepatorenal recess
D.Rectouterine pouch
A 2-year-old boy is being potty-trained. Which of the following events occurs when he attempts to pass his stool?
A. Relaxation of the pubococcygeus muscle
B. Relaxation of the puborectalis muscle
C. Relaxation of the coccygeus muscle
D. Contraction of the external anal sphincter
E. The vagus nerve relaxes the internal anal sphincter
B. Relaxation of the puborectalis muscle
During an annual physical, a 50-year-old man receives a digital rectal examination. Which of the following structures can be palpated posteriorly through the wall of the rectum during this examination?
A. Vas deferens
B. Bladder
C. Coccygeus
D. Prostate
E. Seminal vesicles
C. Coccygeus
A 47 year-old patient comes to your office for a checkup and he says “Hey Doc, when I pee, I can feel something “down there”– it feels like a “bag o’worms”. What could this be?
Varicocele: an abnormal enlargement of the pampiniform plexus in the scrotum
Cause is unknown, although is thought to result from abnormalities of the veins inside the testicles
A 27-year-old male is brought to the ER because of testicular pain. A CT scan reveals an abnormal accumulation of fluid in the cavity of the tunica vaginalis (below). Which of the following conditions will most accurately describes the signs observed in this patient?
A. varicocele
B. cystocele
C. hydrocele
D. Hypospadias
E. cryptorchidosm
C. hydrocele
A hydrocele is an accumulation of fluid in the tunica vaginalis which gets there through a re-opened porocesses vaginalis from the peritoneal cavity
A 15 year-old boy is admitted to the ER after trying to jump over a fence and hitting his groin. MRI examination reveals severe edema of the boy’s scrotum and abdominal wall and extravasated urine. Which of the following structures is most-likely ruptured?
A.Spongy urethra
B.Pre-prostatic urethra
C.Prostatic urethra
D.Urinary bladder
E.ureter
A.Spongy urethra
Superficial Perineal space has
has external genitalia and Bartholin’s glands
Deep perineal space has
sphincter muscles, pudendal nerve and artery
A 36-year-old man comes to a hospital with fever, nausea, pain, and itching in the perineal region. On examination by a urologist, he is diagnosed as having infected bulbourethral (Cowper’s) glands. Which of the following structures may be affected by this infection?
A. Superficial perineal space
B. Sphincter urethrae
C. Production of sperm
D. Testis
E. Seminal vesicles
B. Sphincter urethrae
The bulbourethral glands are fund in the deep perineal space along with the sphincter urethrae. They lubricate the penis during sexual arousal
Where do the bulbourethral glands open?
A.Ejaculatory duct
B.spongy urethra
C.Prostate
D.Bladder
E.epididymis
B.spongy urethra
If, as in a previous case, the spongy urethra of the male is ruptured, where is the most likely place that extravasated urine will flow (in addition to the scrotum)?
A.Rectouterine pouch
B.Rectovesical pouch
C.Deep perineal pouch
D.Superficial perineal pouch
E.Retropubic space
D.Superficial perineal pouch
The external genitalia are located in the superficial perineal space
An elite cyclist goes to a urologist complaining of numbness and tingling in his perineal region, and intermittent fecal incontinence. The cyclist explains sitting on his bicycle seat during training sessions of more than four hours exacerbate the numbness and abnormal sensations (paresthesia) in his perineal region. Which of the following nerves is most likely impinged in this patient when he sits on his bicycle seat?
A. Lumbar splanchnic nerves
B. Inferior gluteal nerve
C. Pudendal nerve
D. Pelvic splanchnic nerves
E. Obturator nerve
C. Pudendal nerve
A 62-year-old man is incapable of penile erection after rectal surgery with prostatectomy. The patient most likely has a lesion of which of the following nerves?
A. Pudendal nerve
B. Sympathetic trunks
C. Pelvic splanchnic nerves
D. Dorsal nerve of the penis
E. Genitofemoral nerve
C. Pelvic splanchnic nerves
Which nerves control our urinary (and anal) sphincters?
The tone of the internal urethral and anal sphincters is maintained by sympathetic innervation. The sphincters are relaxed by parasympathetic innervation from pelvic splanchnic nerves.
The external sphincters are constricted under voluntary control from branches of the pudendal nerve
Your patient has a malignant tumor on his left testicle (or her left ovary). The cancer spreads via the lymphatic system and begins to invade the patient’s lymph nodes. Which group of lymph nodes would the cancer invade first?
A.Superficial inguinal
B.External iliac
C.Lumbar/para aortic
D.Deep inguinal
E.Internal iliac
C.Lumbar/para aortic
Lymphatic drainage from the testes or ovaries follows the blood vessels (testicular/ovarian artery to aorta) and would involve paraaortic (lumbar) lymph nodes.
Lymphatic drainage from the scrotum or labia majora would involve superficial inguinal lymph nodes
A 21-year-old marine biologist asks about her first bimanual examination, and it is explained to her that the normal position of the uterus is:
A. Anteverted and retroverted
B. Retroverted and retroflexed
C. Anteflexed and retroverted
D. Anteverted and anteflexed
E. Retroflexed and anteverted
D. Anteverted and anteflexed
A 45 year-old woman arrives in the ER because of pelvic discomfort. During a physical exam, the gynecologist discovers that the patient’s uterus has completely prolapsed. Which of the following ligaments provides the most direct support of the uterus?
A.Mesosalpinx and mesometrium
B.Lateral (cardinal ligaments)
C.Broad ligament of the uterus
D.Round ligament of the uterus
E.Suspensory ligament of the ovary
B.Lateral (cardinal ligaments)
A male infant is born with undescended testes that remain intra-abdominal 5 months later (cryptorchidism). Each testis possesses an elongate, distinctive gubernaculum testis running into the scrotum. Which of the following structures in female anatomy is homologous to the gubernaculum testis?
A. Round ligament of the uterus
B. Uterine tube
C. Vestibular bulb
D. Labia minora
E. Ureter
A. Round ligament of the uterus
The round ligament and the ligament of the ovary were part of the gubernaculum
During an oophorectomy (ovariectomy – removal or ovaries), the surgeon plans to ligate the ovarian vessels within the peritoneal fold that contains them. What is this fold?
A. Broad ligament
B. Ovarian ligament
C. Suspensory ligament of the ovary
D. Mesosalpinx
E. Mesovarium
C. Suspensory ligament of the ovary
The suspensory ligament of the ovary is a fold of peritoneum that extends from the ovary to the wall of the pelvis. It is not considered a true ligament in that it does not physically support any anatomical structures; however it is an important landmark and it houses the ovarian vessels.
A 53-year-old woman is admitted to a local hospital for surgical removal of a benign pelvic tumor confined within the broad ligament. There is a risk of injuring which of the following structures that lies in this ligament?
A.Rectum
B.Proximal part of pelvic ureter
C.Terminal part of the round ligament of the uterus
D.Uterine tube
E.Ovarian vessels
D.Uterine tube
A 45 year old underwent a complete hysterectomy, and the uterine artery was ligated near the junction of the uterus and vagina during the procedure. What structure would most likely be at risk during the ligation of the uterine artery?
A. Ovarian artery
B. Ureter
C. Round ligament of the uterus
D. Pudendal nerve
E. Obturator artery
B. Ureter
