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Question 1
Correct
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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.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 2
Correct
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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: 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.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 3
Incorrect
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Point of entry of the vagal trunk into the abdomen:
Your Answer: Inferior vena cava hiatus
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.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 4
Incorrect
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When conducting an exploratory laparotomy procedure of a patient diagnosed with a bleeding ulcer of the lesser curvature of the stomach, which artery in this patient are you most likely to ligate to control the bleeding?
Your Answer: Gastroduodenal
Correct Answer: Left gastric
Explanation:The lesser curvature of the stomach is supplied by the left gastric artery along with the right gastric artery. These two arteries are the ones to most likely be ligated if bleeding was to be stopped at the lesser curvature of the stomach. The splenic artery branches from the celiac branch and supplies the spleen. The left gastro-omental, the right and left gastroepiploic arteries supply the greater curvature.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 5
Incorrect
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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: Ilioinguinal nerve
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.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 6
Correct
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During a splenectomy procedure of a 45-year old male patient with a bleeding ruptured spleen, the surgeon decided to clamp the splenic artery near the coeliac trunk to stop the bleeding. Which of the following organ/s parts will be least affected by the clamping?
Your Answer: Duodenum
Explanation:The duodenum is the only organ in the list that would not be affect by the clumping of the splenic artery as it is supplied by common hepatic artery (through the gastroduodenal artery) and the superior mesenteric artery (through the inferior pancreaticoduodenal artery). The splenic artery is the artery that supplies the spleen with oxygenated blood. The splenic artery before reaching the spleen also gives off branches that supply the stomach and the pancreas. The greater curvature and the fundus of the stomach is supplied the short gastric artery which branches off from the splenic artery. The left portion of the greater curvature of the stomach together with the greater omentum is supplied by the left gastro-omental artery of the splenic artery. The body and tail of the pancreas is supplied by branches of the splenic artery through the dorsal and superior pancreatic arteries and the caudal pancreatic arteries respectively.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 7
Incorrect
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During laparoscopic surgery to repair a direct inguinal hernia in a 68-year old man, the surgeon asked the registrar to look at the medial inguinal fossa to identify the direct inguinal hernia. To do so, she would have to look at the area that is between the:
Your Answer:
Correct Answer: Medial umbilical ligament and inferior epigastric artery
Explanation:The medial umbilical fold is made by the medial umbilical ligament-which is the obliterated portion of the umbilical artery, while the lateral umbilical fold is a fold of peritoneum over the inferior epigastric vessels. The median umbilical fold is a midline structure made by the median umbilical ligament i.e. the obliterated urachus. The medial inguinal fossa is the space on the inner abdominal wall between the medial umbilical fold and the lateral umbilical fold. It is place in the abdominal wall where there is an area of weak fascia i.e. the inguinal triangle through which direct inguinal hernias break through. The lateral inguinal fossa on the other hand is a space lateral to the lateral umbilical fold. Indirect inguinal hernias push through this space.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 8
Incorrect
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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.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 9
Incorrect
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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:
Correct 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.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 10
Incorrect
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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.
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This question is part of the following fields:
- Abdomen
- Anatomy
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