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  • Question 1 - 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: Superior mesenteric vein

      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
      35.6
      Seconds
  • Question 2 - A patient who underwent emergency appendicectomy complains of having numbness (paraesthesia) of the...

    Correct

    • A patient who underwent emergency appendicectomy complains of having numbness (paraesthesia) of the skin at the pubic region. Which nerve was most likely injured in the operation?

      Your Answer: Iliohypogastric

      Explanation:

      The iliohypogastric nerve comes from L1 and emerges from the upper part of the lateral border of the psoas major. It then crosses obliquely in front of the quadratus lumborum to the iliac crest where it perforates the posterior part of transversus abdominis and divides between that muscle and the internal oblique into a lateral and an anterior cutaneous branch. This provides sensory innervation to the skin of the lower abdominal wall, upper hip and upper thigh.

      The genitofemoral nerve also comes from the lumbar plexus that innervates the skin of the anterior scrotum or labia majora and upper medial thigh.

      The subcostal nerve is the ventral primary ramus of T12 providing sensory innervation to the anterolateral abdominal wall in an area superior to the pubic region.

      A spinal nerve owing to their deep location would not have been injured in the procedure.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      17.1
      Seconds
  • Question 3 - A medical officer was shown an X ray with barium contrast and was...

    Correct

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

      Your Answer: Circular folds of the mucosa

      Explanation:

      Distinguishing features include:

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

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

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

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      83.3
      Seconds
  • Question 4 - 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: Epithelium of the Ampulla of Vater

      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
      28.8
      Seconds
  • Question 5 - You observe a procedure to harvest the left internal thoracic (mammary) artery to...

    Correct

    • 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: 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
      52.8
      Seconds
  • Question 6 - 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: Left testicular vein

      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
      34.3
      Seconds
  • Question 7 - 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
      19.5
      Seconds
  • Question 8 - A 70-year old man presents to the surgical out patient clinic with a...

    Incorrect

    • A 70-year old man presents to the surgical out patient clinic with a direct inguinal hernia on the right side. He had undergone and appendicectomy 6 months prior. The examining doctor correlated the development of the hernia to iatrogenic nerve injury that happened during the operation. Which nerve had been injured?

      Your Answer: Femoral branch of the genitofemoral

      Correct Answer: Ilioinguinal

      Explanation:

      Direct inguinal hernias occur because of weakness in the abdominal muscles. The ilioinguinal nerve is important for innervating the muscles of the lower abdominal wall and damage during appendicectomy therefore prevents the man from being able to contract abdominal muscles to pull the falx inguinalis over the weak fascia.

      The genitofemoral nerve innervates the cremaster muscle and injury to it would cause inability to elevate the testes.

      The subcostal nerve and the ventral primary ramus of T10 innervate the muscles, skin and fascia of the upper abdominal wall.

      The iliohypogastric nerve supplies the skin over the upper part of the buttock behind the area supplied by the subcostal nerve.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      42.9
      Seconds
  • Question 9 - During a procedure to treat an ulcer in the first part of the...

    Correct

    • 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: 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
      41.7
      Seconds
  • Question 10 - 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
      31.9
      Seconds
  • Question 11 - 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
      13.5
      Seconds
  • Question 12 - An abdominal aortogram of a 59 year-old female with an abdominal aortic aneurysm...

    Correct

    • 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: 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
      31.9
      Seconds
  • Question 13 - 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: Abdominal aorta

      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
      27.3
      Seconds
  • Question 14 - Point of entry of the vagal trunk into the abdomen: ...

    Correct

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

      Your Answer: Oesophageal hiatus

      Explanation:

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

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      16.2
      Seconds
  • Question 15 - During an exploratory laparotomy in a 22 year-old man shot in the abdomen,...

    Correct

    • During an exploratory laparotomy in a 22 year-old man shot in the abdomen, the operating doctor discovers the large bowel is perforated. Which of the following characteristics of the bowel enabled the surgeon to identify it as the large bowel?

      Your Answer: Epiploic appendages

      Explanation:

      The large intestine doesn’t have a continuous layer of longitudinal muscle. Instead, it has three strips of longitudinal muscle called taenia coli. The large intestine is covered with omental appendages that are fat filled. It is also folded into sacculations called haustrations. Serosa is a general term for the outermost coat or serous layer of a visceral structure that lies in the body cavities of the abdomen or thorax.

      Complete circular folds are only found in the small intestine.

      Valvulae conniventes or valves of Kerckring are the circular folds which are large valvular flaps projecting into the lumen of the small bowel.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      30
      Seconds
  • Question 16 - The gastrosplenic ligament also known as the gastrolienal ligament is the structure that...

    Correct

    • 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: 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
      44.8
      Seconds
  • Question 17 - Which statement is true regarding the diaphragmatic openings: ...

    Incorrect

    • Which statement is true regarding the diaphragmatic openings:

      Your Answer: The left phrenic nerve passes through the opening at T8

      Correct Answer: The thoracic duct passes through the opening at T12

      Explanation:

      The diaphragmatic openings are:

      T8 – opening for the inferior vena cavaand the right phrenic nerve

      T10 – opening for the oesophagusand the left gastric artery and vein

      T12 – opening for the aorta, the thoracic duct and azygos vein.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      54.3
      Seconds
  • Question 18 - A patient who has used NSAIDS for many years presents to the A&E...

    Correct

    • A patient who has used NSAIDS for many years presents to the A&E with symptoms of acute haemorrhagic shock. An emergency endoscopy is done that shows that a duodenal ulcer has perforated the posterior wall of the first part of the duodenum. Which artery is most likely to be the cause of the haemorrhage?

      Your Answer: Gastroduodenal

      Explanation:

      The gastroduodenal artery is a branch of the hepatic artery and descends near the pylorus between the first part of the duodenum and the neck of the pancreas to divide at the lower border of the duodenum into the right gastroepiploic and pancreaticoduodenal arteries. Before it divides, it gives off a few branches to the pyloric end of the stomach and to the pancreas. The artery that is most likely involved in this situation is the gastroduodenal artery since it is posterior to the first part of the duodenum.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      20.9
      Seconds
  • Question 19 - 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
      25.1
      Seconds
  • Question 20 - A 20 year old is brought to the A&E after he fell from...

    Correct

    • A 20 year old is brought to the A&E after he fell from a moving cart. The boy has sustained blunt abdominal injury, and the there is a possibility of internal bleeding as the boy is in shock. An urgent exploratory laparotomy is done in the A&E theatre. On opening the peritoneal cavity, the operating surgeon notices a torn gastrosplenic ligament with a large clot around the spleen. Which artery is most likely to have been injured in this case?

      Your Answer: Short gastric

      Explanation:

      The short gastric arteries branch from the splenic artery near the splenic hilum to travel back in the gastrosplenic ligament to supply the fundus of the stomach. Therefore, these may be injured in this case.

      The splenic artery courses deep to the stomach to reach the hilum of the spleen. It doesn’t travel in the gastrosplenic ligament although it does give off branches that do.

      The middle colic artery is a branch of the superior mesenteric artery that supplies the transverse colon.

      Gastroepiploic artery is the largest branch of the splenic artery that courses between the layers of the greater omentum to anastomose with the right gastroepiploic.

      Left gastric artery, a branch of the coeliac trunk. It supplies the left half of the lesser curvature.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      61
      Seconds
  • Question 21 - A 19 year old male patient exhibiting signs of shock was brought to...

    Correct

    • 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: 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
      42.5
      Seconds
  • Question 22 - During laparoscopic surgery to repair a direct inguinal hernia in a 68-year old...

    Incorrect

    • 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: Inferior epigastric artery and lateral umbilical fold

      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.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      60.9
      Seconds
  • Question 23 - The LEAST mobile structure in the peritoneal cavity is the: ...

    Correct

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

      Your 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
      13.7
      Seconds
  • Question 24 - A correct statement about the RECTUM: ...

    Correct

    • A correct statement about the RECTUM:

      Your Answer: It is an important anastomotic site for the portal and caval (systemic) venous systems

      Explanation:

      The rectum is part of the gastrointestinal tract that is continuous above with the sigmoid colon and below with the anal canal. It contains both longitudinal and circular smooth muscles. These are supplied by the enteric nervous system. It is about 12 cm long. It has no sacculations comparable with those of the colon. It has three permanent transverse folds called the valves of Houston. The peritoneum is related to the upper two thirds of the rectum only whereas the lower part is not covered by peritoneum. It is supplied by the superior rectal (hemorrhoidal) branch of the inferior mesenteric artery and the median sacral artery that is a direct branch from the abdominal aorta. It is drained by veins that begin as a plexus that surround the anus. These veins form anastomoses with the portal system (portocaval anastomoses).

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      30.8
      Seconds
  • Question 25 - 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: 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.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      36.1
      Seconds
  • Question 26 - During an exploratory laparotomy a herniation of bowel is identified between the lateral...

    Correct

    • 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: 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
      26.8
      Seconds
  • Question 27 - During a laparoscopic inguinal hernia repair, the surgeon finds an artery in the...

    Incorrect

    • During a laparoscopic inguinal hernia repair, the surgeon finds an artery in the extraperitoneal connective tissue (preperitoneal fat) that courses vertically and just medial to the bowel as the bowel passes through the abdominal wall. Which artery is this?

      Your Answer: Superficial epigastric

      Correct Answer: Inferior epigastric

      Explanation:

      The inferior epigastric artery comes from the external iliac artery just above the inguinal ligament to curve forward in the subperitoneal tissue and then ascend obliquely along the medial margin of the deep inguinal ring. It continues to ascend between the rectus abdominis and the posterior lamella of its sheath after piercing the fascia transversalis and passing anterior to the linea semicircularis. Finally it gives off numerous branches that anastomose above the umbilicus with the superior epigastric branch of the internal mammary artery and with the lower intercostal arteries. As this artery ascends obliquely upwards from its origin it lies along the lower medial margins of the deep inguinal ring and posterior to the start of the spermatic cord. It is found in the preperitoneal fat of the abdomen lying just superficial to the peritoneum and forms the lateral umbilical fold. Hernias that pass lateral to this are indirect and medial to this, direct hernias.

      The deep circumflex artery travels along the iliac crest on the inner surface of the abdominal wall. It is very lateral to the abdominal wall and hernias would pass medial to it.

      The superficial circumflex iliac, superficial epigastric, superficial external pudendal arteries are all superficial arteries found in the superficial fascia.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      90
      Seconds
  • Question 28 - An explorative laparotomy is done on a 23 year old following a gunshot...

    Correct

    • 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: 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
      24.3
      Seconds
  • Question 29 - The normal location of the major duodenal papilla: ...

    Correct

    • The normal location of the major duodenal papilla:

      Your Answer: Descending part of the duodenum

      Explanation:

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

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      17.2
      Seconds
  • Question 30 - 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: Right crus of the diaphragm

      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
      37.5
      Seconds

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