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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
      70
      Seconds

  • Question 2 - Which of the following is a large artery that runs immediately posterior to...

    Incorrect

    • Which of the following is a large artery that runs immediately posterior to the stomach?

      Your Answer: Gastroduodenal

      Correct Answer: Splenic

      Explanation:

      The splenic artery is the large artery that would be found running off the posterior wall of the stomach. It is a branch of the coeliac trunk and sends off branches to the pancreas before reaching the spleen. The gastroduodenal artery on the other hand is found inferior to the stomach, posterior to the first portion of the duodenum. The left gastroepiploic artery runs from the left to the right of the greater curvature of the stomach. The common hepatic artery runs on the superior aspect of the lesser curvature of the stomach, and is a branch of the coeliac trunk. The superior mesenteric artery arises from the abdominal aorta just below the junction of the coeliac trunk.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      32.4
      Seconds

  • Question 3 - The surgical registrar is doing an exploratory laparotomy on a 35 year old...

    Incorrect

    • The surgical registrar is doing an exploratory laparotomy on a 35 year old lady of African descent with tuberculous of the abdomen and suspected perforation. The small bowel is matted due to adhesions and it is difficult to differentiate the ileum from the jejunum. Which of the following features is typical of the jejunum?

      Your Answer: It occupies the right iliac region

      Correct Answer: It has sparse aggregated lymph nodules

      Explanation:

      The jejunum has a wider diameter, is thicker and more vascularized, hence of a deeper colour compared to the ileum. The valvulae conniventes (circular folds) of its mucous membranes are large and thick and its villi are larger than those in the ileum. The jejunum also has sparse aggregates of lymph nodules and most of its part occupies the umbilical and left iliac regions whilst the ileum is mostly in the umbilical, hypogastric, right iliac and pelvic regions.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      32.8
      Seconds

  • Question 4 - Which of the following is a fact worth noting about the development of...

    Incorrect

    • Which of the following is a fact worth noting about the development of the spleen?

      Your Answer: It is always retroperitoneal

      Correct Answer: It develops in the dorsal mesogastrium

      Explanation:

      The spleen in the human embryo arises in week 5 of intrauterine life. It appears as a proliferating mesenchyme above the pancreas. The spleen is one the organs that develops in the dorsal mesogastrium. When the stomach changes its position during development, the spleen is made to move behind the stomach and stays in contact with the left kidney. The spleen is found within the peritoneum of the abdominal cavity thus it is an intraperitoneal organ.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      22.9
      Seconds

  • Question 5 - A surgeon ligates the left middle suprarenal artery while carrying out a left...

    Incorrect

    • A surgeon ligates the left middle suprarenal artery while carrying out a left adrenalectomy. Where does the left middle suprarenal artery originate?

      Your Answer: Coeliac artery

      Correct Answer: Abdominal aorta

      Explanation:

      Middle suprarenal arteries arise from either side of the abdominal aorta, opposite the superior mesenteric artery.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      17.4
      Seconds

  • Question 6 - 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
      34.2
      Seconds

  • Question 7 - The superior pancreaticoduodenal artery, the artery that supplies blood to the pancreas and...

    Incorrect

    • The superior pancreaticoduodenal artery, the artery that supplies blood to the pancreas and the duodenum, is a branch of the:

      Your Answer: Superior mesenteric artery

      Correct Answer: Gastroduodenal artery

      Explanation:

      The superior pancreaticoduodenal artery together with the right gastroepiploic artery form the two branches of the gastroduodenal artery which divides at the lower border of the duodenum.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      15.8
      Seconds

  • Question 8 - A 60-year old patient having a history of cholelithiasis that led to recurrent...

    Incorrect

    • A 60-year old patient having a history of cholelithiasis that led to recurrent pain, bloating, nausea and vomiting, was scheduled for surgery to have the gallbladder removed. During the cholecystectomy, the registrar conducting the procedure accidentally punctured a blood vessel that lies immediately posterior to the omental foramen and blood filled the operating field. Which of the following blood vessels was likely punctured?

      Your Answer: Right renal artery

      Correct Answer: Inferior vena cava

      Explanation:

      The omental foramen is the pathway that connects the greater peritoneal sac and the lesser peritoneal sac. The omental foramen is bordered posteriorly by the inferior vena cava. This is the blood vessel that would most likely be punctured.

      The aorta and its branch, the renal artery, lie postero-lateral to the omental foramen and are deeper than the inferior vena cava hence making them less likely to be injured.

      The hepatic portal vein, the hepatic artery and the superior mesenteric vein borders the omental foramen anteriorly and would not be injured by a jab on the posterior border of the omental foramen.

      Finally, the splenic artery is found in the splenorenal ligament that borders the omental foramen laterally to the left.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      47.6
      Seconds

  • Question 9 - During a case presentation, a 26 year old is said to have fractured...

    Incorrect

    • During a case presentation, a 26 year old is said to have fractured his pelvis and shattered his coccyx following a motorbike accident. It is mentioned that he is likely to have lacerated his middle sacral artery from this kind of injury. Where does the middle sacral artery branch from?

      Your Answer: External iliac artery

      Correct Answer: Abdominal aorta

      Explanation:

      The middle sacral artery arises from behind the aorta a little above the point of its bifurcation to descend down in front of L4,5, the sacrum and coccyx.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      22.5
      Seconds

  • Question 10 - The following organs would be expected to lie within the right lower quadrant...

    Incorrect

    • The following organs would be expected to lie within the right lower quadrant of the abdomen, assuming that the gastrointestinal tract is rotated normally:

      Your Answer:

      Correct Answer: Distal jejunum, caecum, vermiform appendix

      Explanation:

      The abdomen is divided by theoretical anatomic lines into four quadrants. The median plane follows the linea alba and extends from the xiphoid process to the pubic symphysis and splits the abdomen in half. The transumbilical plane is a horizontal line that runs at the level of the umbilicus. This forms the upper right and left quadrants and the lower right and left quadrants. Structures in the right lower quadrant include: caecum, appendix, part of the small intestine, ascending colon, the right half of the female reproductive system, right ureter. Pain in this region is most commonly associated with appendicitis.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds

  • Question 11 - During an operation to repair an indirect inguinal hernia, it is noticed that...

    Incorrect

    • 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:

      Correct 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
      0
      Seconds

  • Question 12 - A 30 year old gym coach presented to the surgical out patient clinic...

    Incorrect

    • A 30 year old gym coach presented to the surgical out patient clinic with a lump in the inguinal region. He was booked for surgery, during which, the surgeon opened the inguinal region and found a hernial sac with a small segment of intestine projecting through the abdominal wall. It was located just above the inguinal ligament and lateral to the inferior epigastric vessels. What type of hernia was this?

      Your Answer:

      Correct Answer: An indirect inguinal hernia

      Explanation:

      An indirect inguinal hernia exits the abdominal cavity lateral to the inferior epigastric vessels and enters the inguinal canal through the deep inguinal ring. These are the most common types of hernias often caused by heavy weigh lifting. Direct inguinal hernias exit the abdominal cavity medial to the inferior epigastric vessels through weak fascia.

      Congenital inguinal hernias are indirect hernias that occur due to persistence of the processus vaginalis.

      Femoral hernias occur when abdominal viscera push through the femoral ring in the femoral canal.

      Incisional hernia occurs after surgery when the omentum or organ protrudes through a previous site of incision.

      Obturator hernia are a very rare type of hernia where the pelvic or abdominal contents protrude through the obturator foramen.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds

  • Question 13 - A medical officer was shown an X ray with barium contrast and was...

    Incorrect

    • 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:

      Correct 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
      0
      Seconds

  • Question 14 - A construction worker is brought to the A&E after a fall on site....

    Incorrect

    • A construction worker is brought to the A&E after a fall on site. The patient is conscious but complains of inability to feel his legs. A neurological examination reveals that he has no cutaneous sensation from his umbilicus to his toes. What is the likely level of the spinal cord that is injured?

      Your Answer:

      Correct Answer: T10

      Explanation:

      The umbilicus has a relatively consistent position in humans and thus serves as an important land mark. The skin around the waist at the level of the umbilicus is supplied by the tenth thoracic spinal nerve (T10 dermatome).

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds

  • Question 15 - Which muscle extends to form the cremasteric muscle? ...

    Incorrect

    • Which muscle extends to form the cremasteric muscle?

      Your Answer:

      Correct Answer: Internal abdominal oblique muscle

      Explanation:

      The cremasteric muscle is a thin layer of muscle composed of several fasciculi that originate from the middle of the inguinal ligament. At its point of origin the fibres are continuous with the fibres of internal oblique and sometimes with the transversus abdominis. It then passes along the lateral side of the spermatic cord and descends with it through the superficial inguinal ring on the front and sides of the cord.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds

  • Question 16 - The transverse colon has two curvatures known as the colic flexures on each...

    Incorrect

    • The transverse colon has two curvatures known as the colic flexures on each side of its lateral ends, the right and left. The left colic flexure found on the side of the descending colon is attached to an organ superiorly by a mesenteric ligament. Which organ is this?

      Your Answer:

      Correct Answer: Spleen

      Explanation:

      The left colic flexure is the bend of the transverse colon as it continues to form the descending colon on the left upper quadrant. The spleen is located on the superior aspect of the left colic flexure. It is commonly referred to as the splenic flexure because of its relation o the spleen superiorly.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds

  • Question 17 - During an exploratory laparotomy a herniation of bowel is identified between the lateral...

    Incorrect

    • During an exploratory laparotomy a herniation of bowel is identified between the lateral edge of the rectus abdominis, the inguinal ligament and the inferior epigastric vessels. These boundaries define the hernia as being a:

      Your Answer:

      Correct Answer: Direct inguinal hernia

      Explanation:

      The boundaries given define the inguinal triangle which is the site for direct inguinal hernias. Indirect inguinal hernias occur lateral to the inferior epigastric vessels.

      Femoral hernias protrude through the femoral ring, into the femoral canal.

      Umbilical hernias protrude through a defect in the umbilical area.

      Obturator hernias, occur through the obturator foramen. These are very rare.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds

  • Question 18 - A 30-year old lady was admitted to the general surgical ward after a...

    Incorrect

    • 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:

      Correct 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
      0
      Seconds

  • Question 19 - A 70-year old man who is suspected to have a perforated colonic diverticulum...

    Incorrect

    • A 70-year old man who is suspected to have a perforated colonic diverticulum is explored in theatre through a midline incision. This incision will be through the:

      Your Answer:

      Correct Answer: Linea alba

      Explanation:

      The linea alba is the point where this incision was made. It is a tendinous raphe in the midline of the abdomen extending between the xiphoid process and the symphysis pubis. It is placed between the medial borders of the recti and is formed by the blending of the aponeuroses of the external and internal obliques and transversi.

      The linea aspera is a vertical ridge on the posterior surface of the femur.

      The arcuate line is the inferior border of the posterior rectus sheath behind the rectus abdominis muscle.

      The semilunar line is the lateral margin of the rectus abdominis.

      The iliopectineal line is a line on the pelvic bones formed by the arcuate line of the ilium and the pectineal line of the pubis.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds

  • Question 20 - The Brunner glands secrete an alkaline product that helps maintain an optimal pH...

    Incorrect

    • The Brunner glands secrete an alkaline product that helps maintain an optimal pH for pancreatic enzyme activity. Where are these glands located?

      Your Answer:

      Correct Answer: Submucosa of the duodeneum

      Explanation:

      The Brunner glands are located in the submucosa of the duodenum. These glands are connected to the interstitial lumen by ducts that open into certain crypts. They secrete an alkaline product that protects the duodenal mucosa from the acidic chyme and helps achieve an optimal pH for the enzymes.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds

  • Question 21 - A nerve is injured during a surgical operation to repair an inguinal hernia....

    Incorrect

    • A nerve is injured during a surgical operation to repair an inguinal hernia. It passes through the superficial inguinal ring. Which nerve is it most likely to be?

      Your Answer:

      Correct Answer: Ilioinguinal

      Explanation:

      The ilioinguinal nerve doesn’t pass through the deep inguinal ring but enters the inguinal canal from the side and leaves by passing through the superficial ring thus it is at risk of injury during inguinal hernia repair.

      The femoral branch of genitofemoral nerve travels lateral to the superficial inguinal ring.

      The iliohypogastric nerve and the subcostal nerve travel superior to the inguinal canal and superficial inguinal ring.

      The obturator nerve is a branch of the lumbar plexus that innervates the muscles of the thigh.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds

  • Question 22 - An explorative laparotomy is done on a 23 year old following a gunshot...

    Incorrect

    • An explorative laparotomy is done on a 23 year old following a gunshot abdominal injury through the right iliac fossa. It is found that the ileocolic artery is severed and the bullet had perforated the caecum. From which branch does the ileocolic artery originate?

      Your Answer:

      Correct Answer: Superior mesenteric artery

      Explanation:

      Ileocolic artery branches off from the superior mesenteric artery. It then divides to give a superior and inferior branch.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds

  • Question 23 - A 51-year old woman after undergoing a barium swallowing was discovered to be...

    Incorrect

    • A 51-year old woman after undergoing a barium swallowing was discovered to be suffering from an oesophageal hiatal hernia. Which muscle fibres of the diaphragm border this hernia directly if the stomach herniates through an enlarged oesophageal hiatus?

      Your Answer:

      Correct Answer: Right crus

      Explanation:

      The oesophageal hiatus is a natural fissure on the thoracic diaphragm that allows passage of the oesophagus and the vagal nerve. The oesophageal hiatus is located in one of the tendinous structures of the diaphragm that connect it to the spine which is known as the right crus. In case of an hiatal hernia, this diaphragmatic structure would be the one bordering the hernia as it is the structure that encircles the oesophageal hiatus.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds

  • Question 24 - Point of entry of the vagal trunk into the abdomen: ...

    Incorrect

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

      Your Answer:

      Correct 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
      0
      Seconds

  • Question 25 - During gastrectomy, the operating surgeon ligates the short gastric arteries along the greater...

    Incorrect

    • During gastrectomy, the operating surgeon ligates the short gastric arteries along the greater curvature of the stomach. Where do the short gastric arteries branch from?

      Your Answer:

      Correct Answer: Splenic artery

      Explanation:

      Short gastric arteries arise from the splenic artery at the end or from its terminal divisions. They are about 5 or 7 in number, passing from the left to the right in between the layers of the gastrosplenic ligament to be distributed along the greater curvature of the stomach.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds

  • Question 26 - 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:

      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
      0
      Seconds

  • Question 27 - The fundus of the stomach receives blood supply from the same artery as...

    Incorrect

    • The fundus of the stomach receives blood supply from the same artery as the greater curvature of the stomach. Which of the following arteries when ligated will disrupt blood supply to the fundus of the stomach through this artery?

      Your Answer:

      Correct Answer: Splenic

      Explanation:

      The fundus of the stomach along with the greater curvature of the stomach receive blood supply from the short gastric artery. The short gastric artery arises from the end of the splenic artery. The ligation of the splenic artery therefore would cause a disruption of blood supply to the fundus of the stomach.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds

  • Question 28 - An ultrasound report of a 35-year old female patient revealed that she had...

    Incorrect

    • An ultrasound report of a 35-year old female patient revealed that she had cancer of the pancreas and presented with subsequent severe obstructive jaundice. In which part of this was woman's pancreas was the tumour most likely located?

      Your Answer:

      Correct Answer: Head

      Explanation:

      The pancreas is divided into five parts; the head, body, neck, tail, and the uncinate process. Of the five parts, tumours located at the head of the pancreas in most instances cause obstruction of the common bile duct more often than tumours in the other parts of the pancreas. This is because the common bile duct passes through the head of the pancreas from the gallbladder and the liver (it is formed where the cystic and the hepatic bile duct join) to empty bile into the duodenum. This biliary obstruction leads to accumulation of bile in the liver and a consequent bilirubinaemia (raised levels of blood bilirubin). This results in jaundice. The pancreas is not divided into lobes.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds

  • Question 29 - A urologist makes a transverse suprapubic incision to retrieve a stone from the...

    Incorrect

    • A urologist makes a transverse suprapubic incision to retrieve a stone from the urinary bladder. Which of the following abdominal wall layers will the surgeon NOT traverse?

      Your Answer:

      Correct Answer: Posterior rectus sheath

      Explanation:

      Pfannenstiel incision (a transverse suprapubic incision) is made below the arcuate line. Thus, there is no posterior layer of the rectus sheath here, only the transversalis fascia lines the inner layer of the rectus abdominis. The layers traversed include: skin, superficial fascia (fatty and membranous), deep fascia, anterior rectus sheath, rectus abdominis muscle, transversalis fascia, extraperitoneal connective tissue and peritoneum.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds

  • Question 30 - Which nerve lies immediately medial to the psoas major muscle? ...

    Incorrect

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

      Your Answer:

      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
      0
      Seconds

  • Question 31 - 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:

      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
      0
      Seconds

  • Question 32 - A surgeon performing a Whipple's procedure, that involves mobilizing the head of the...

    Incorrect

    • A surgeon performing a Whipple's procedure, that involves mobilizing the head of the pancreases, accidentally injured a structure immediately posterior to the neck of the pancrease which bled out. Which structure is most likely to have been injured?

      Your Answer:

      Correct Answer: Superior mesenteric artery

      Explanation:

      The structure immediately posterior to the neck of the pancreas is the superior mesenteric vein. The neck of the pancreas lies anterior to the superior mesenteric vein, which joins with the splenic vein to form the portal vein.

      The superior mesenteric artery (SMA) is also located in proximity to the neck of the pancreas. Specifically, the SMA emerges from the abdominal aorta just below the level of the pancreas and passes posterior to the neck of the pancreas before it descends into the mesentery to supply the intestines. Thus, both the superior mesenteric vein and the superior mesenteric artery are key vascular structures related to the posterior aspect of the neck of the pancreas.

      Bleeding out would suggest an arterial injury.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds

  • Question 33 - The gastrosplenic ligament also known as the gastrolienal ligament is the structure that...

    Incorrect

    • The gastrosplenic ligament also known as the gastrolienal ligament is the structure that connects the greater curvature of the stomach to the hilum of the spleen. Which of the following arteries would most likely be injured if a surgeon accidentally tore this ligament?

      Your Answer:

      Correct Answer: Short gastric

      Explanation:

      The short gastric arteries arise from the end of the splenic arteries and form five to seven branches. The short gastric arteries inside the gastrosplenic ligament from the left to the right, supply the greater curvature of the stomach. The hepatic artery proper runs inside the hepatoduodenal ligament. The right gastric artery and the left gastric artery are contained in the hepatogastric ligament. The caudal pancreatic artery branches off from the splenic artery and supplies the tail of the pancreas. The middle colic artery supplies the transverse colon. The splenic artery does not travel in the gastrosplenic ligament and so it would not be damaged by a tear to this ligament.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
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  • Question 34 - Enlargement of the spleen as seen in Gaucher's disease pushes the spleen downward...

    Incorrect

    • 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:

      Correct 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
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  • Question 35 - During a procedure to treat an ulcer in the first part of the...

    Incorrect

    • During a procedure to treat an ulcer in the first part of the duodenum, the most appropriate site to make the incision on the anterior abdominal wall to approach this ulcer would be the:

      Your Answer:

      Correct Answer: Epigastric region

      Explanation:

      The abdomen is divided into nine regions for descriptive purposes. The epigastric region contains the first part of the duodenum, part of the stomach, part of the liver and pancreas. This would be the region that the surgeon would need to enter to access the ulcer.

      Typically, a midline incision in the epigastric region, extending from just below the xiphoid process down to the umbilicus, provides excellent access to the first part of the duodenum.

      The left inguinal region contains the sigmoid colon.

      The left lumbar region contains the descending colon and kidney.

      The right lumbar region contains the right kidney and descending colon.

      The right hypochondrial region contains part of the liver and gall bladder.

      The hypogastric region contains the urinary bladder and the rectum.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
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  • Question 36 - During an exploratory laparotomy of an acute abdomen, the surgeon identified an inflamed...

    Incorrect

    • During an exploratory laparotomy of an acute abdomen, the surgeon identified an inflamed Meckel's diverticulum. This is:

      Your Answer:

      Correct Answer: Is a site of ectopic pancreatic tissue

      Explanation:

      Meckel’s diverticulum is an outpouching of the small intestine. It usually occurs about 0.6 m (2 feet) before the junction with the caecum. It can be lined with the mucosa of the stomach and may ulcerate. It may also be lined by ectopic pancreatic tissue. It represents the remains of the vitelline duct in early fetal life.

      An abnormal persistence of the urachus is called a urachal fistula.

      Failure of the midgut loop to return to the abdominal cavity is called an omphalocele.

      Polyhydramnios is often caused by anencephaly or oesophageal fistula.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
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  • Question 37 - Where does the ejaculatory duct open into? ...

    Incorrect

    • Where does the ejaculatory duct open into?

      Your Answer:

      Correct Answer: Prostatic urethra

      Explanation:

      There are two ejaculatory ducts, one on either side of the midline. Each ejaculatory duct is formed by the union of the duct from the seminal vesicles with the ductus deferens. They start at the base of the prostate and run forward and downward between the middle and lateral lobes and along the side of the prostatic utricle to end in the prostatic urethra.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
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  • Question 38 - The operating surgeon notices a structure lying alongside a herniated mass whilst repairing...

    Incorrect

    • The operating surgeon notices a structure lying alongside a herniated mass whilst repairing an indirect inguinal hernia in a female patient. Which structure could this be?

      Your Answer:

      Correct Answer: Round ligament of the uterus

      Explanation:

      The main structure traversing the inguinal canal in women is the round ligament. In men, it is the spermatic cord.

      The iliohypogastric nerve innervates the abdominal wall and runs between the transversus abdominis and internal oblique muscles before piercing the internal oblique at the anterior superior iliac spine to run between the internal and external obliques.

      The inferior epigastric artery is between the peritoneum and the transversus abdominis creating the lateral umbilical fold.

      The ovarian artery and the ovarian vein are branches from the descending aorta and inferior vena cava that supply the ovary in the pelvic cavity.

      The pectineal ligament is a thick fascial layer over the pectineal line of the pubis. It doesn’t traverse the canal.

      The broad ligament if found on the lateral sides of the uterus.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
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  • Question 39 - The specialist registrar, while performing the repair of an infrarenal abdominal aortic aneurysm,...

    Incorrect

    • The specialist registrar, while performing the repair of an infrarenal abdominal aortic aneurysm, decides not to re-implant the inferior mesenteric artery into the repaired abdominal aorta. She says that an anastomotic artery running along the border of the large intestine is good enough to supply blood to the territory of the inferior mesenteric artery. Which vessel is she referring to?

      Your Answer:

      Correct Answer: Marginal

      Explanation:

      The marginal artery is a key anastomosis for the large intestine that runs around the border of the large intestine and is formed by the anastomosis of the branches of the ileocolic artery, right colic artery, middle colic artery, left colic artery and sigmoid artery. If a small artery is occluded, these branches allow blood to reach all segments of the colon.

      The arcades are anastomotic loops between the arteries that provide alternative pathways for blood flow. They are more prominent in the small intestine than the large intestine.

      Arteriae rectae are small branches that run from the marginal artery to reach the colon.

      The ileocolic artery is the branch of the superior mesenteric artery that supplies the caecum, appendix and terminal part of the ileum.

      The coronary arteries supply blood to the heart.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
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  • Question 40 - During an inguinal hernia repair, an incision is made parallel to and 5cm...

    Incorrect

    • During an inguinal hernia repair, an incision is made parallel to and 5cm above the inguinal ligament. The registrar is warned to look out for the inferior epigastric vessels to avoid damage. Between which layers of the abdominal wall is the registrar likely to find these vessels?

      Your Answer:

      Correct Answer: Transversus abdominis muscle and peritoneum

      Explanation:

      The inferior epigastric vessels lie on the inner surface of the transversus abdominis muscle covered by the parietal peritoneum. This layer of peritoneum lies over the inferior epigastric vessels to make the lateral umbilical fold. Camper’s and Scarpa’s fascia are two layers of the superficial fascia, the fatty layer and the membranous layer respectively.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
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  • Question 41 - 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:

      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
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  • Question 42 - The pattern of drainage of the lymphatic and venous systems of the anterior...

    Incorrect

    • The pattern of drainage of the lymphatic and venous systems of the anterior abdominal wall is arranged around a horizontal plane above which drainage is in a cranial direction and below which drainage is in a caudal direction. Which horizontal plane is being referred to?

      Your Answer:

      Correct Answer: Level of the umbilicus

      Explanation:

      The umbilicus is a key landmark for the lymphatic and venous drainage of the abdominal wall. Above it, lymphatics drain into the axillary lymph nodes and the venous blood drains into the superior epigastric vein, into the internal thoracic vein. Below it, lymphatics drain into the superficial inguinal lymph nodes while venous blood drains into the inferior epigastric vein and the external iliac vein.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
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  • Question 43 - Whipple's procedure involves mobilizing the head of the pancreas. As the surgeon does...

    Incorrect

    • Whipple's procedure involves mobilizing the head of the pancreas. As the surgeon does this, he must be careful to avoid injury to a key structure that is found lying behind the head of the pancreas. Which vital structure is this?

      Your Answer:

      Correct Answer: Common bile duct

      Explanation:

      The posterior relations of the head of the pancreas include: the inferior vena cava, the common bile duct, the renal veins, the right crus of the diaphragm and the aorta.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
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  • Question 44 - 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:

      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
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  • Question 45 - You observe a procedure to harvest the left internal thoracic (mammary) artery to...

    Incorrect

    • You observe a procedure to harvest the left internal thoracic (mammary) artery to be used as a graft for coronary artery bypass surgery. The left internal thoracic artery is mobilised from the inside of the chest wall and divided near the caudal end of the sternum. After dividing the internal thoracic artery at its distal end, the specialist registrar asks you to name the artery that will now have increased blood supply so that adequate blood flow is maintained to the rectus abdominis on the left side. What would your answer be?

      Your Answer:

      Correct Answer: Inferior epigastric artery

      Explanation:

      The rectus abdominis muscle is supplied by the superior epigastric artery which is a branch of the internal thoracic artery. If the internal thoracic artery is thus ligated, blood would no longer flow to it. However, the superior epigastric artery communicates with the inferior epigastric artery (a branch of the external iliac artery). This means that blood could flow from the external iliac, to the inferior epigastric, to the superior epigastric to the rectus abdominis.

      The superficial circumflex iliac artery and the superficial epigastric are two superficial branches of the femoral artery and do not supply the deep branches of the abdomen.

      The deep circumflex iliac artery travels along the iliac crest on the inner surface of the abdominal wall; being too lateral it doesn’t supply blood to the rectus abdominis.

      The distal portions of the umbilical arteries are obliterated in adults to form the medial umbilical folds.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
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  • Question 46 - Which of the following veins empties into the left renal vein? ...

    Incorrect

    • Which of the following veins empties into the left renal vein?

      Your Answer:

      Correct Answer: Left suprarenal

      Explanation:

      The left suprarenal vein empties into the left renal vein which crosses the vertebral column to reach the inferior vena cava. The left renal vein also receives the left gonadal vein.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
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  • Question 47 - A 19 year old male patient exhibiting signs of shock was brought to...

    Incorrect

    • A 19 year old male patient exhibiting signs of shock was brought to the casualty after he had fallen from the 3rd floor of a building. An examination carried out revealed tenderness on the left mid-posterior axillary line and low blood pressure. Further palpation revealed a large swelling that protruded downward and medially below the left costal margin. X-rays showed that the 9th and the 10th ribs were fractured near their angles. Considering these results, which abdominal organ was likely injured by the fractured ribs.

      Your Answer:

      Correct Answer: Spleen

      Explanation:

      The spleen, left kidney, stomach, the splenic flexure of the colon and the suprarenal glands are all in the same quadrant- the left upper quadrant. However, the spleen is the most readily injured organ when there is fracture to the 10th, 11th and the 12th ribs because of its close association with these ribs. This patient exhibits a great indication of a ruptured spleen (tenderness on the left mid and posterior axillary line). The spleen is a thin capsulated organ with a spongy parenchyma, allowing it to bleed profusely in the event of injury. The liver, head of the pancreas and the duodenum are all in the right upper quadrant.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
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  • Question 48 - During an appendicectomy in a 16 year old girl, the registrar initially did...

    Incorrect

    • During an appendicectomy in a 16 year old girl, the registrar initially did not find the appendix on entering the peritoneal cavity. She, however, remained calm as she knew she could find it by:

      Your Answer:

      Correct Answer: Looking at the confluence of the taenia coli

      Explanation:

      The vermiform appendix arises from the apex of the caecum. Although it has a constant base, it can pass in one of several directions such as upward behind the caecum, to the left behind the ileum and mesentery or downward into the lesser pelvis. It is retained in place by a peritoneal fold, the mesoenteriole derived from the left leaf of the mesentery. Taenia coli meet at the appendix which is the terminal portion of the caecum. The appendix is below the ileocecal valve, not above. It is not near the right colic artery (which supplies the ascending colon). It would not be found by removing a layer of the jejuno-ileum and is not in the pelvic brim.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
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  • Question 49 - A CT-scan report of a patient with gastric carcinoma shows that the lymph...

    Incorrect

    • A CT-scan report of a patient with gastric carcinoma shows that the lymph nodes around the coeliac trunk are enlarged. The coeliac trunk:

      Your Answer:

      Correct Answer: Gives rise to the splenic, left gastric and common hepatic arteries

      Explanation:

      The coeliac trunk is a branch of the aorta arising just below the aortic hiatus of the diaphragm to pass nearly horizontally forward to divide into 3 large branches i.e. the left gastric, the hepatic and the splenic arteries. Occasionally it may give off one of the inferior phrenic arteries. It is covered by the lesser omentum and on the right side bordered by the right coeliac ganglion and the cardiac end of the stomach. Inferiorly it is bordered by the upper border of the pancreas and splenic vein. The embryonic midgut is supplied by the superior mesenteric artery.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
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  • Question 50 - Which of the deep fasciae located in the anterolateral abdominal wall form the...

    Incorrect

    • Which of the deep fasciae located in the anterolateral abdominal wall form the inguinal ligament?

      Your Answer:

      Correct Answer: External abdominal oblique aponeurosis

      Explanation:

      The inguinal ligament is the inferior border of the aponeurosis of the external oblique abdominis and extends from the anterior superior iliac spine to the pubic tubercle from whence it is reflected backward and laterally to attach to the pectineal line and form the lacunar ligament.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
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SESSION STATS - PERFORMANCE PER SPECIALTY

Abdomen (1/9) 11%
Anatomy (1/9) 11%
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