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  • Question 1 - In a splenectomy procedure, special care is emphasized on the preservation of the...

    Incorrect

    • In a splenectomy procedure, special care is emphasized on the preservation of the tail of the pancreas that is closely associated with the spleen to avoid post operative pancreatic fistula. As a general surgeon conducting a splenectomy where are you most likely to find the tail of the pancreas in the abdominal cavity?

      Your Answer: Transverse mesocolon

      Correct Answer: Splenorenal ligament

      Explanation:

      The tail of the pancreas is the only intraperitoneal part of the pancreas and is found contained in the splenorenal ligament of the peritoneal cavity. The splenorenal ligament is derived from the peritoneum where the wall of the general peritoneal cavity connects to the omental bursa between the spleen and the left kidney. This ligament contains the splenic vessels and the tail of the pancreas.

      The gastrocolic ligament stretches from the greater curvature of the stomach to the transverse colon, connecting the two.

      The gastrosplenic ligament is derived from the greater omentum and is the structure that connects the stomach to the hilum of the spleen. The gastrosplenic ligament continues from the splenic flexure of the colon to the diaphragm and acts as a support to the spleen.

      The transverse colon is connected to the abdominal wall by the mesocolon ligament.

      The falciform ligament on the other hand, attaches the liver to the ventral wall of the abdomen.

      The hepatoduodenal ligament connects the porta hepatis of the liver to the superior part of the duodenum.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      47.7
      Seconds
  • Question 2 - A 30-year old lady was admitted to the general surgical ward after a...

    Correct

    • A 30-year old lady was admitted to the general surgical ward after a diagnosis of perforation of the first part of the duodenum that resulted from a long standing ulcer. If this perforation led to the expulsion of the gastric content that resulted to the erosion of an artery found in this part of the duodenum (the posterior of the first part of the duodenum). Which of the following arteries is this most likely to be?

      Your Answer: Gastroduodenal

      Explanation:

      The proximal part of the duodenum is supplied by the gastroduodenal artery. This artery is found descending behind the first part of the duodenum after branching from the hepatic artery. If gastric content was to be expelled in the posterior portion of the first part of the duodenum, then this artery would be most likely to be damaged. The common hepatic artery and the left gastric artery are branches of the coeliac trunk that are found superior to the duodenum. The proper hepatic artery is a branch of the common hepatic artery also found superior to the duodenum. The superior mesenteric artery is found behind the pancreas as a branch of the aorta that is at the bottom of the L1 level. The right gastric artery arises above the pylorus from the proper hepatic artery and supplies the lesser curvature of the stomach. The intestinal arteries supply the ileum and the jejunum.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      50.6
      Seconds
  • Question 3 - The following branch of the aorta is unpaired: ...

    Correct

    • The following branch of the aorta is unpaired:

      Your Answer: Coeliac artery

      Explanation:

      Branches that stem from the abdominal aorta can be divided into three: the visceral branches, parietal branches and terminal branches. Of the visceral branches, the suprarenal, renal, testicular and ovarian arteries are paired while the coeliac artery and superior and inferior mesenteric arteries are unpaired. Of the parietal branches the inferior phrenic and lumbar arteries are paired while the middle sacral artery is unpaired. The terminal branches i.e. the common iliac arteries are paired.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      15.8
      Seconds
  • Question 4 - Enlargement of the spleen as seen in Gaucher's disease pushes the spleen downward...

    Correct

    • Enlargement of the spleen as seen in Gaucher's disease pushes the spleen downward and medially. What structure limits the straight-vertical-downward movement?

      Your Answer: Left colic flexure

      Explanation:

      The left colic flexure (also known as the splenic flexure), is the point where the colon takes a sharp turn downwards. It is the point where the transverse colon ends and the descending colon begins. It is located immediately inferior to the spleen so an enlarged spleen must move medially to avoid this colic flexure.

      The left suprarenal gland is retroperitoneal.

      The Ligament of Treitz suspends the fourth part of the duodenum from the posterior abdominal wall.

      The stomach, pancreas and liver lie medial to the spleen and thus would not prevent a vertical downward movement.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      21.1
      Seconds
  • Question 5 - During an operation to repair an indirect inguinal hernia, you are asked to...

    Correct

    • During an operation to repair an indirect inguinal hernia, you are asked to indicate the position of the deep inguinal ring. You indicate this as being:

      Your Answer: Above the midpoint of the inguinal ligament

      Explanation:

      The deep inguinal ring is near the midpoint of the inguinal ligament, below the anterior superior iliac spine. It is lateral to the inferior epigastric artery. The superficial ring, however, is found above the pubic tubercle. The supravesical fossa is the space between the median and medial umbilical folds.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      24.6
      Seconds
  • Question 6 - A specialist registrar was performing the bi-lateral surgical removal of the adrenal glands....

    Incorrect

    • A specialist registrar was performing the bi-lateral surgical removal of the adrenal glands. He first removed the left adrenal gland before moving on to the right one. However, the registrar noticed that the removal of the right adrenal gland would be a challenge because of an overlying structure. What was this structure that overlies the right suprarenal glad?

      Your Answer: Left hepatic vein

      Correct Answer: Inferior vena cava

      Explanation:

      The adrenal glands or the suprarenal glands are small glands that are found on top of each of the kidneys. They are retroperitoneal glands. The right adrenal gland is found on top of the right kidney and is closely associated with the inferior vena cava as it directly drains into this large vein. In the case where the right adrenal gland is to be surgically removed, the inferior vena cava might prove a problem to manoeuvre as it overlies the right suprarenal gland. The other blood vessels such as the aorta, right renal, superior mesenteric, splenic artery and the hepatic vein as well as the right crus are not closely associated with either of the suprarenal glands.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      43.2
      Seconds
  • Question 7 - A 55-year old patient with signs and symptoms of internal haemorrhage was brought...

    Correct

    • A 55-year old patient with signs and symptoms of internal haemorrhage was brought in for emergency surgery to control the bleeding. Angiography results revealed an advanced duodenal tumour that had perforated the blood vessel immediately behind the first part of the duodenum. Which of the following is the most likely blood vessel that was ruptured by the cancer?

      Your Answer: Gastroduodenal artery

      Explanation:

      The gastroduodenal artery is the artery that lies just behind the first portion of the duodenum. The gastroduodenal artery would be the most likely artery to be perforated by a cancer in this area. The perforation is as a result of the spillage of the acidic content of the chyme in the duodenum. All the other blood vessels in the list would less likely be affected by the gastric expellant from the duodenum. The coronary vein is located in the lesser curvature of the stomach. The inferior pancreaticoduodenal arcade is located inferiorly to the first part of the duodenum on the head of the pancreas. The hepatic artery proper is a branch of the common hepatic artery that is located superior to the first portion of the duodenum. The splenic vein arises from the spleen; it forms the portal vein by joining the superior mesenteric vein. It is laterally detached from the duodenum. Both the left gastric vein and the splenic vein are located superior to the first portion of the duodenum.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      19.5
      Seconds
  • Question 8 - During an operation to repair an indirect inguinal hernia, it is noticed that...

    Correct

    • During an operation to repair an indirect inguinal hernia, it is noticed that the hernial sac is protruding out of the superficial inguinal ring. The superficial inguinal ring is an opening in which structure?

      Your Answer: External abdominal oblique aponeurosis

      Explanation:

      The superficial inguinal ring is an opening in the aponeurosis of the external oblique just above and lateral to the pubic crest. The opening is oblique and corresponds to the fibres of the aponeurosis. It is bound inferiorly by the pubic crest, on either side by the margins of the opening in the aponeurosis and superiorly by the curved intercrural fibres.

      The inferior crus is formed by the portion of the inguinal ligament that is inserted into the pubic tubercle.

      The falx inguinalis is made of arching fibres of the transversalis fascia and the internal abdominal oblique muscle. It forms the posterior wall of the inguinal canal.

      The internal abdominal oblique forms the root of the inguinal canal.

      Scarpa’s and Camper’s fascia are the membranous and fatty layers, respectively of subcutaneous fascia.

      Transversalis fascia covers the posterior surface of the rectus abdominis muscle inferior to the arcuate line.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      35.5
      Seconds
  • Question 9 - Which of the following structures is derived from the dorsal mesogastrium of the...

    Incorrect

    • Which of the following structures is derived from the dorsal mesogastrium of the stomach during the development of the gut?

      Your Answer: Falciform ligament

      Correct Answer: Greater omentum

      Explanation:

      In a developing foetus, the stomach has two mesogastria from which most of the abdominal ligaments develop. These two mesogastria are the; ventral mesogastrium and the dorsal mesogastrium. During the embryological development of the gut, different organs develop in each mesogastrium; the spleen and pancreas in the dorsal mesogastrium while the liver in the ventral mesogastrium (with their associated ligaments). In the dorsal mesogastrium the following structures develop; the greater omentum (containing the gastrophrenic ligament and the gastrocolic ligament), gastrosplenic ligament, mesentery, splenorenal ligament and phrenicocolic ligament. The structures that develop from the ventral mesogastrium include the; lesser omentum (containing the hepatoduodenal ligament and the hepatogastric ligament) in association with the liver; the coronary ligament (left triangular ligament, right triangular ligament and hepatorenal ligament) and the falciform ligament (round ligament of liver and ligamentum venosum within).

      There are also folds that develop from the dorsal mesogastrium which include; umbilical folds, supravesical fossa, medial inguinal fossa, lateral umbilical fold, lateral inguinal fossa and Ileocecal fold.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      34.7
      Seconds
  • Question 10 - Which nerve lies immediately medial to the psoas major muscle? ...

    Incorrect

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

      Your Answer: Ilioinguinal

      Correct 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
      35.1
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Abdomen (6/10) 60%
Anatomy (6/10) 60%
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