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  • Question 1 - 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
      52.3
      Seconds

  • Question 2 - 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 3 - A 55-year old patient with signs and symptoms of internal haemorrhage was brought...

    Incorrect

    • 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:

      Correct 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
      0
      Seconds

  • Question 4 - During an operation for a sigmoid colectomy the surgeon ligates the sigmoid arteries....

    Incorrect

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

      Your Answer:

      Correct 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
      0
      Seconds

  • Question 5 - During an operation to repair a hiatal hernia, the coeliac branch of the...

    Incorrect

    • During an operation to repair a hiatal hernia, the coeliac branch of the posterior vagal trunk is injured. This damage would affect muscular movements as well as some secretory activities of the gastrointestinal tract. Which gastrointestinal segment is LEAST likely to be affected?

      Your Answer:

      Correct Answer: Sigmoid colon

      Explanation:

      The vagus nerve supplies the parasympathetic fibres to the abdominal structures that are receive arterial supply from the coeliac trunk or superior mesenteric artery i.e. up to the transverse colon. The end of the transverse colon and the gastrointestinal structures distal to this point receive parasympathetic innervation from the pelvic splanchnic nerves and blood from the inferior mesenteric artery(IMA). The ascending colon, caecum, jejunum and ileum would all, thus, be affected by this damage. Sigmoid colon would not be affected.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds

  • Question 6 - The following branch of the aorta is unpaired: ...

    Incorrect

    • The following branch of the aorta is unpaired:

      Your Answer:

      Correct 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
      0
      Seconds

  • Question 7 - A 39-year old female patient was diagnosed with a tumour of the left...

    Incorrect

    • 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:

      Correct 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
      0
      Seconds

  • Question 8 - The nutcracker effect of the alimentary canal is described as a nutcracker-like compression...

    Incorrect

    • The nutcracker effect of the alimentary canal is described as a nutcracker-like compression caused by the aorta and the superior mesenteric arteries on a certain section of the alimentary canal leading to bowel obstruction. Which of the following parts of the alimentary canal is usually obstructed by this nutcracker compression of the two arteries?

      Your Answer:

      Correct Answer: Duodenum

      Explanation:

      The ‘nutcracker effect’ is only seen in one part of the alimentary canal, and that is in the third part of the duodenum. This can happen when the superior mesenteric artery that passes across the duodenum and the aorta, posteriorly to the third part of the duodenum enlarges and starts compressing the duodenum. The result is an obstructed duodenum that inhibits passage of food.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds

  • Question 9 - 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
      0
      Seconds

  • Question 10 - A 60-year old man with a left-sided indirect inguinal hernia underwent emergency surgery...

    Incorrect

    • A 60-year old man with a left-sided indirect inguinal hernia underwent emergency surgery to relieve large bowel obstruction resulting from a segment of the bowel being strangulated in the hernial sac. The most likely intestinal segment involved is:

      Your Answer:

      Correct Answer: Sigmoid colon

      Explanation:

      The sigmoid colon is the most likely segment involved as it is mobile due to the presence of the sigmoid mesocolon. The descending colon, although on the left side, is a bit superior and is also retroperitoneal. The ascending colon and caecum are on the right side of the abdomen. The rectum is too inferior to enter the deep inguinal ring and the transverse colon is too superior to be involved.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds

  • Question 11 - 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 12 - 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 13 - 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
      0
      Seconds

  • Question 14 - A patient sustained an iatrogenic injury to one of the structures passing through...

    Incorrect

    • 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:

      Correct 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
      0
      Seconds

  • Question 15 - 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
      0
      Seconds

  • Question 16 - 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:

      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
      0
      Seconds

  • Question 17 - A surgical registrar performing an adrenalectomy procedure on the left suprarenal gland of...

    Incorrect

    • A surgical registrar performing an adrenalectomy procedure on the left suprarenal gland of a 25 - year old male patient, accidentally jabbed and injured a vital structure that lies anterior to the left suprarenal organ. Which of the following was the structure most likely injured?

      Your Answer:

      Correct Answer: Pancreas

      Explanation:

      The adrenal (suprarenal) glands are organs of the endocrine system located on top of each of the kidneys. The left suprarenal gland, in question, is crescent in shape and slightly larger than the right suprarenal gland. It is posteriorly located to the lateral aspect of the head of the pancreas which is thus the most likely to be injured. The other organs like the duodenum, liver and the inferior vena cava are related to the right suprarenal gland. The spleen and the colon are not in close proximity with the left suprarenal gland and are not likely to be the organs injured.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds

  • Question 18 - The LEAST mobile structure in the peritoneal cavity is the: ...

    Incorrect

    • The LEAST mobile structure in the peritoneal cavity is the:

      Your Answer:

      Correct Answer: Pancreas

      Explanation:

      The presence or absence of the mesentery determines mobility of abdominal contents. Structures like the stomach, transverse colon and appendix have mesenteries and thus are relatively mobile. In contrast, the pancreas is a retroperitoneal (behind the peritoneum) structure and therefore is fixed. The greater omentum is a large mobile fold of omentum that hangs down from the stomach .

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds

  • Question 19 - 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
      0
      Seconds

  • Question 20 - During clinic, a medical student conducts a physical examination on a teenage boy...

    Incorrect

    • During clinic, a medical student conducts a physical examination on a teenage boy with a lump in the inguinal region. The lump is protruding from the superficial inguinal ring. The student correctly concluded that it was:

      Your Answer:

      Correct Answer: Either a direct or an indirect inguinal hernia

      Explanation:

      It is not possible to tell if an inguinal hernia is direct or indirect just by palpating it. Despite the fact that indirect inguinal hernias commonly come out of the superficial inguinal ring to enter the scrotum, direct inguinal hernia might still do this.

      Femoral hernia goes through the femoral ring into the femoral canal (has nothing to do with the superficial inguinal ring).

      Superficial inguinal lymph nodes lie in the superficial fascia parallel to the inguinal ligament; it would therefore feel more superficial and would not be mistaken for a hernia protruding through the inguinal ring.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds

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