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  • Question 1 - Which structure holds the duodenojejunal flexure in place? ...

    Correct

    • Which structure holds the duodenojejunal flexure in place?

      Your Answer: Suspensory ligament (of Treitz)

      Explanation:

      The duodenum is connected to the diaphragm by the suspensory ligament called the ligament of Treitz. It is a slip of skeletal muscle from the right crus of the diaphragm and a fibromuscular band of smooth muscle from the 3rd and 4th parts of the duodenum. It is an important landmark, used to divide the gastrointestinal tract into the upper and lower parts. Contraction of this ‘ligament’ leads to opening of the duodenojejunal flexure allowing the flow of chyme.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      14.2
      Seconds

  • Question 2 - An abdominal aortogram of a 59 year-old female with an abdominal aortic aneurysm...

    Incorrect

    • An abdominal aortogram of a 59 year-old female with an abdominal aortic aneurysm shows occlusion of the inferior mesenteric artery. The patient, however, does not complain of any symptoms. Occlusion of the inferior mesenteric artery is rarely symptomatic because its territory is supplied by branches of the:

      Your Answer: Splenic artery

      Correct Answer: Middle colic artery

      Explanation:

      The transverse colon is supplied by the middle colic artery which is a branch from the superior mesenteric artery. If the inferior mesenteric artery was occluded, branches from the middle colic may go to the marginal artery which supplies the descending colon, sigmoid colon and rectum.. Ileocolic and right colic arteries also branch from the superior mesenteric artery that supply the colon but the middle colic, which serves the more distal part of the colon is the better answer. The gastroduodenal artery branches off the common hepatic artery, which supplies part of the duodenum, pancreas and stomach. The splenic artery supplies the spleen, pancreas and curvature of the stomach.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      220.7
      Seconds

  • Question 3 - During an operation for a sigmoid colectomy the surgeon ligates the sigmoid arteries....

    Correct

    • During an operation for a sigmoid colectomy the surgeon ligates the sigmoid arteries. From which artery do the sigmoid arteries branch?

      Your Answer: Inferior mesenteric artery

      Explanation:

      Sigmoid arteries are branches of the inferior mesenteric artery (IMA). Sigmoid artery gives off branches that supply the lower descending colon, the iliac colon and the sigmoid colon.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      12.1
      Seconds

  • Question 4 - Point of entry of the vagal trunk into the abdomen: ...

    Correct

    • Point of entry of the vagal trunk into the abdomen:

      Your Answer: Oesophageal hiatus

      Explanation:

      The oesophageal hiatus is located in the muscular part of the diaphragm a T10 and is above, in front and a little to the left of the aortic hiatus. It transmits the oesophagus, the vagus nerves and some small oesophageal arteries.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      23.8
      Seconds

  • Question 5 - A 70-year old man had had a large indirect inguinal hernia for 3...

    Correct

    • A 70-year old man had had a large indirect inguinal hernia for 3 years. He presents at the out patient clinic complaining of pain in the scrotum. There is, however, no evidence of obstruction or inflammation. You conclude that the hernial sac is most probably compressing the:

      Your Answer: Ilioinguinal nerve

      Explanation:

      The ilioinguinal nerve arises together with the iliohypogastric nerve from the first lumbar nerve to emerge from the lateral border of the psoas major muscle just below the iliohypogastric and passing obliquely across the quadratus lumborum and iliacus muscles. It perforates the transversus abdominis, near the anterior part of the iliac crest and communicates with the iliohypogastric nerve between the internal oblique and the transversus. It then pierces the internal oblique to distribute filaments to it and accompanying the spermatic cord through the subcutaneous inguinal ring, is distributed to the skin of the upper and medial parts of the thigh, the skin over the root of the penis and the upper part of the scrotum in man and to the skin covering the mons pubis and labium majus in the woman. As the ilioinguinal nerve runs through the inguinal canal, it could easily be compressed by a hernial sac.

      The femoral branch of genitofemoral nerve provides sensory innervation of the upper medial thigh.

      The femoral nerve innervates the compartment of the thigh and also has some cutaneous sensory branches to the thigh.

      The iliohypogastric nerve innervates the skin of the lower abdominal wall, upper hip and upper thigh. The subcostal nerve innervates the skin of the anterolateral abdominal wall and the anterior scrotal nerve is a terminal branch of the ilioinguinal nerve.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      1218.5
      Seconds

  • Question 6 - The midgut loop, also called the primary intestinal loop in a developing embryo,...

    Incorrect

    • The midgut loop, also called the primary intestinal loop in a developing embryo, is formed when the midgut bends around which of the following arteries?

      Your Answer: Coeliac trunk

      Correct Answer: Superior mesenteric

      Explanation:

      In a developing foetus, the midgut develops to form most of the intestines. During this development process, the midgut usually bends around the superior mesenteric artery and forms what is referred to as the midgut loop.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      107.1
      Seconds

  • Question 7 - A 35 year old patient presenting with haematemesis, heart burn and bloody stool...

    Correct

    • A 35 year old patient presenting with haematemesis, heart burn and bloody stool was diagnosed with a duodenal ulcer that had eroded the gastroduodenal artery. The patient was then rushed into theatre for an emergency procedure to control the haemorrhage. If the surgeon decided to ligate the gastroduodenal artery at its origin, which of the following arteries would most likely experience retrograde blood flow from collateral sources as a result of the ligation?

      Your Answer: Right gastroepiploic

      Explanation:

      In the stomach and around the duodenum, there are many arterial anastomoses. Ligation of the gastroduodenal artery would result in the retrograde flow of blood from the left gastroepiploic artery to the right gastroepiploic artery. The blood flows into the right gastroepiploic artery, a branch of the gastroduodenal artery from the left gastroepiploic artery that branches from the splenic artery. This retrograde blood flow is aimed at providing alternate blood flow to the greater curvature of the stomach.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      105.1
      Seconds

  • Question 8 - Which of the following organs of the abdominal cavity is completely covered by...

    Incorrect

    • Which of the following organs of the abdominal cavity is completely covered by the peritoneum?

      Your Answer: Pancreas

      Correct Answer: Spleen

      Explanation:

      Of the organs listed, the spleen is the only organ that is completely intraperitoneal, that is entirely in the peritoneum. Other completely intraperitoneal organs include the stomach, liver, appendix and the small intestines. The kidney, Inferior vena cava, aorta and the suprarenal glands are all retroperitoneal organs. The pancreas and the duodenum are partially retroperitoneal, with the tail of the pancreas in the peritoneum found in the splenorenal ligament while only the first part of the duodenum is intraperitoneal. For the intraperitoneal organs remember SALTD SPRSS
      S = Stomach
      A = Appendix
      L = Liver
      T = Transverse colon
      D = Duodenum (only the 1st part)
      S = Small intestines
      P = Pancreas (only the tail)
      R = Rectum (only the upper 3rd)
      S = Sigmoid colon
      S = Spleen
      For retroperitoneal, just remember SADPUCKER:
      S = suprarenal glands
      A = Aorta and IVC
      D = Duodenum (all but the 1st part)
      P = Pancreas (all but the tail)
      U = Ureter and bladder
      C = Colon (ascending and descending)
      K = Kidneys
      E = Oesophagus
      R = Rectum (Lower two-thirds)
      For secondarily retroperitoneal remember ‘Pussy Cat Dolls“:
      P = Pancreas
      C = Colon (only ascending and descending)
      D = Duodenum (only parts 2-4)

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      26.9
      Seconds

  • Question 9 - The stomach is an organ that is divided into several important anatomical parts....

    Incorrect

    • The stomach is an organ that is divided into several important anatomical parts. These parts of the stomach have varied arterial blood supply that ensure that the whole organ receive oxygenated blood. Which of the following arteries if ligated, will not render any portion of the stomach ischaemic?

      Your Answer: Left gastroepiploic

      Correct Answer: Superior mesenteric

      Explanation:

      The blood supply to the stomach is through the following arteries:

      – The superior mesenteric artery supplies blood to the lower part of the duodenum, pancreas and two-thirds of the transverse colon. Thus ligation of the superior mesenteric artery would not affect the stomach.

      – The right and the left gastroepiploic arteries supply the greater curvature of the stomach – along its edges.

      – The short gastric artery supplies blood to the upper portion of the of the greater curvature and the fundus of the stomach.

      – The gastroduodenal artery supplies blood to the distal part of the stomach (the pyloric sphincter) and the proximal end of the duodenum.

      – The left gastroepiploic and the short gastric are branches of the splenic artery and therefore ligation of the splenic artery would directly affect the stomach.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      98.8
      Seconds

  • Question 10 - The oesophagus is an important part of the alimentary canal. It receives blood...

    Incorrect

    • The oesophagus is an important part of the alimentary canal. It receives blood from various arteries in the body. Which one of the following is an artery that will lead to some level of ischaemia to the oesophagus when ligated?

      Your Answer: Right gastric

      Correct Answer: Left inferior phrenic

      Explanation:

      The oesophagus receives its blood supply from the following arteries: the inferior thyroid branch of the thyrocervical trunk, the descending thoracic aorta, the left gastric branch of the coeliac artery and the from the left inferior phrenic artery of the abdominal aorta. Hence ligation of the left inferior phrenic will lead to ischemia to some portions of the oesophagus.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      42.9
      Seconds

  • Question 11 - A surgeon ligates the left superior suprarenal artery whilst preforming a left adrenalectomy....

    Incorrect

    • A surgeon ligates the left superior suprarenal artery whilst preforming a left adrenalectomy. Where does the left superior suprarenal artery originate?

      Your Answer: Renal artery

      Correct Answer: Left inferior phrenic artery

      Explanation:

      The superior suprarenal arteries arises from the inferior phrenic artery on either side.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      32.4
      Seconds

  • Question 12 - A 39-year old female patient was diagnosed with a tumour of the left...

    Correct

    • A 39-year old female patient was diagnosed with a tumour of the left adrenal gland. The tumour, which is metastasizing to the adjacent tissues, has already extended to the left suprarenal vein. If the tumour is still spreading, which of the following veins will most likely be affected after the involvement of the left suprarenal vein?

      Your Answer: Left renal vein

      Explanation:

      The suprarenal veins or also known as the veins of Warshaw, are the veins that receive blood from the suprarenal glands. These veins receive blood from the medullary venous plexus and the cortex of the adrenal glands (suprarenal glands). They are two in number – the left and the right suprarenal veins. The right suprarenal vein drains into the inferior vena cava while the left suprarenal vein drains into the left renal vein. This therefore means that in the case of a metastasizing tumour involving the left suprarenal vein, the tumour will most likely extend from the left suprarenal vein to the left renal vein into which it drains.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      11.5
      Seconds

  • Question 13 - A patient sustained an iatrogenic injury to one of the structures passing through...

    Correct

    • A patient sustained an iatrogenic injury to one of the structures passing through the deep inguinal ring. This was during an operation to repair an inguinal hernia. Which structure is most likely to be injured?

      Your Answer: Round ligament of the uterus

      Explanation:

      The deep inguinal ring transmits the spermatic cord in the man and the round ligament of the uterus in the female. It is bound below and medially by the inferior epigastric vessels (so these don’t go through it).

      The ilioinguinal nerve, although it courses through the inguinal canal, does not pass through it.

      The iliohypogastric nerves run between the internal oblique and transversus abdominis in the abdominal wall, piercing the internal oblique at the anterior superior iliac spine to travel just deep to the external oblique.

      The inferior epigastric artery runs between the transversus abdominis and the peritoneum forming the lateral umbilical fold.

      The medial umbilical ligament is the obliterated umbilical artery that it lies within the medial umbilical fold of peritoneum.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      328
      Seconds

  • Question 14 - Which nerve lies immediately medial to the psoas major muscle? ...

    Correct

    • Which nerve lies immediately medial to the psoas major muscle?

      Your Answer: Obturator

      Explanation:

      The obturator nerve is formed from the ventral divisions of the 2nd, 3rd and 4th lumbar nerves. It courses through the fibres of the psoas major and emerges from the medial border near the pelvic brim.

      The iliohypogastric nerve comes from the first lumbar nerve and emerges from the upper part of the lateral border of psoas major.

      The ilioinguinal nerve arises with the iliohypogastric nerve from the first lumbar nerve and also emerges from the lateral border of the psoas major muscle.

      The lateral femoral cutaneous nerve comes from the posterior division of the 2nd and 3rd lumbar nerves to emerge from the lateral border of the psoas major muscle near its middle.

      The femoral nerve also arises from the dorsal divisions, but of the 2nd, 3rd and 4th lumbar nerves and courses through the muscle fibres to emerge at the lower part of the lateral border.

      The coccygeal nerve doesn’t arise from the lumbar plexus but from the sacral plexus.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      14.9
      Seconds

  • Question 15 - The vascular structure found on the right side of the fifth lumbar vertebra...

    Incorrect

    • The vascular structure found on the right side of the fifth lumbar vertebra is?

      Your Answer: Right external iliac vein

      Correct Answer: Inferior vena cava

      Explanation:

      The most likely vascular structure is the inferior vena cava. The inferior vena cava is formed by the joining of the two common iliac arteries, the right and the left iliac artery, at the level of the fifth lumbar vertebra( L5). The inferior vena cava passes along the right side of the vertebral column. It enters the thoracic cavity into the underside of the heart through the caval opening of the diaphragm at the level of the eight thoracic vertebra (T8).

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      32.4
      Seconds

  • Question 16 - A lady presents to the out patient clinic with a painful boil on...

    Incorrect

    • A lady presents to the out patient clinic with a painful boil on the skin of her mons pubis. Which nerve supplies the skin of the mons pubis?

      Your Answer: Ilioinguinal

      Correct Answer: Anterior labial

      Explanation:

      Anterior labial branch is the terminal branch of the ilioinguinal nerve that innervates the skin of the mons pubis in women and the skin of the anterior scrotum in men.

      The femoral branch of genitofemoral nerve innervates the upper medial thigh.

      The iliohypogastric innervates muscles of the abdominal wall.

      The subcostal nerve innervates muscles of the abdominal wall and the skin of the lower abdominal wall.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      54.4
      Seconds

  • Question 17 - The normal location of the major duodenal papilla: ...

    Correct

    • The normal location of the major duodenal papilla:

      Your Answer: Descending part of the duodenum

      Explanation:

      The major duodenal papilla is on the descending portion of the duodenum on the medial side, about 7-10cm from the pylorus. The pancreatic ducts and the common bile ducts unite and open by a common orifice on the summit of the duodenal papilla.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      29.7
      Seconds

  • Question 18 - A medical officer was shown an X ray with barium contrast and was...

    Correct

    • A medical officer was shown an X ray with barium contrast and was asked to distinguish the small from the large bowel. Which of the following features listed is CORRECT?

      Your Answer: Circular folds of the mucosa

      Explanation:

      Distinguishing features include:

      1. Three strips of longitudinal muscle-taenia coli- on the wall instead of a continuous surrounding longitudinal muscle that is seen in the small intestine

      2. The colon has bulges called haustra that are not on the small bowel.

      3. The surface of the colon is covered with fatty omental appendages. Both the colon and the small intestine have similar circular smooth muscle layer, serosa. Peyer’s patches are lymphoid tissues that are not visible on X ray with barium contrast.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      28.6
      Seconds

  • Question 19 - A 42 year old man with an abdominal aortic aneurysm (AAA) underwent an...

    Incorrect

    • A 42 year old man with an abdominal aortic aneurysm (AAA) underwent an abdominal aortic angiography which revealed that his inferior mesenteric artery was occluded. If this patient showed no symptoms, the most likely reason is that the area the inferior mesenteric artery supplies, must be supplied by collateral blood flow from which arteries?

      Your Answer: Right and middle colic

      Correct Answer: Left and middle colic

      Explanation:

      The arterial branches that form an anastomosis between the superior mesenteric artery and the inferior mesenteric artery are the left colic artery and the middle colic artery. The middle colic artery is the most distal branch of the superior mesenteric artery while the left colic forms the most proximal branch of the inferior mesenteric artery. These two arteries will give collateral blood flow in the case that the inferior mesenteric artery gets occluded. The superior mesenteric artery gives off the following branches; ileocolic, appendicular, ileal artery, right colic and middle colic arteries. The left colic, sigmoid and superior rectal arteries are branches of the inferior mesenteric artery. The marginal artery branches off directly from the abdominal aorta.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      40.5
      Seconds

  • Question 20 - A patient gives a history of dull discomfort in her abdomen associated with...

    Correct

    • A patient gives a history of dull discomfort in her abdomen associated with pain that she points to be on her right shoulder and right scapula. The following organs are most likely to be source of her pain:

      Your Answer: Liver, duodenum and gallbladder

      Explanation:

      Referred pain is felt at a point away from the source of the pain or the unpleasant sensation. It arises when a nerve is damaged or compressed at a point but the pain is felt at another site that is the territory of that nerve. Common abdominal causes of referred pain to the shoulder and the shoulder blade are the liver, duodenum and gall bladder.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      27.2
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Abdomen (11/20) 55%
Anatomy (11/20) 55%
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