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  • Question 1 - 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: Portal vein

      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
      80.7
      Seconds

  • Question 2 - The oesophagus is an important part of the alimentary canal. It receives blood...

    Correct

    • 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: 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
      361
      Seconds

  • Question 3 - A 42 year old man with an abdominal aortic aneurysm (AAA) underwent an...

    Incorrect

    • A 42 year old man with an abdominal aortic aneurysm (AAA) underwent an abdominal aortic angiography which revealed that his inferior mesenteric artery was occluded. If this patient showed no symptoms, the most likely reason is that the area the inferior mesenteric artery supplies, must be supplied by collateral blood flow from which arteries?

      Your Answer: Right and middle colic

      Correct Answer: Left and middle colic

      Explanation:

      The arterial branches that form an anastomosis between the superior mesenteric artery and the inferior mesenteric artery are the left colic artery and the middle colic artery. The middle colic artery is the most distal branch of the superior mesenteric artery while the left colic forms the most proximal branch of the inferior mesenteric artery. These two arteries will give collateral blood flow in the case that the inferior mesenteric artery gets occluded. The superior mesenteric artery gives off the following branches; ileocolic, appendicular, ileal artery, right colic and middle colic arteries. The left colic, sigmoid and superior rectal arteries are branches of the inferior mesenteric artery. The marginal artery branches off directly from the abdominal aorta.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      63.5
      Seconds

  • Question 4 - During gastrectomy, the operating surgeon ligates the short gastric arteries along the greater...

    Correct

    • 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: 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
      10.9
      Seconds

  • Question 5 - During an anatomy revision session, medical students are told that the posterior wall...

    Correct

    • During an anatomy revision session, medical students are told that the posterior wall of the rectus sheath ends in a thin curved margin whose concavity is directed downwards. What is the name of this inferior border of the rectus sheath?

      Your Answer: Arcuate line

      Explanation:

      The rectus sheath is a tendinous sheath that encloses the rectus abdominis muscle. It covers the entire anterior surface however on the posterior surface of the muscle the sheath is incomplete ending inferiorly at the arcuate line. Below the arcuate line, the rectus abdominis is covered by the transversalis fascia. The linea alba is a band of aponeurosis on the midline of the anterior abdominal wall, which extends from the xiphoid process to the pubic symphysis. It is formed by the combined abdominal muscle aponeuroses. This is a useful site for midline incision during abdominal surgery because it does not carry many blood vessels. All of the other answer choices are related to the inguinal canal.

      The falx inguinalis (sometimes called the inguinal falx or conjoint tendon), is the inferomedial attachment of the transversus abdominis with some fibres of the internal abdominal oblique – it contributes to the posterior wall of the inguinal canal.

      The inguinal ligament is the ligament that connects the anterior superior iliac spine with the pubic tubercle – it makes the floor of the inguinal canal.

      The internal (deep) inguinal ring is the entrance to the inguinal canal, where the transversalis fascia pouches out and creates an opening through which structures can leave the abdominal cavity.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      24.8
      Seconds

  • Question 6 - A 39-year old female patient was diagnosed with a tumour of the left...

    Correct

    • 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 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
      162.5
      Seconds

  • Question 7 - 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
      42.8
      Seconds

  • Question 8 - The vascular structure found on the right side of the fifth lumbar vertebra...

    Correct

    • The vascular structure found on the right side of the fifth lumbar vertebra is?

      Your 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
      15.8
      Seconds

  • Question 9 - During an operation to repair an indirect inguinal hernia, it is noticed that...

    Correct

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

      Your Answer: External abdominal oblique aponeurosis

      Explanation:

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

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

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

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

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

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

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      26.7
      Seconds

  • Question 10 - While conducting a physical examination of a patient, the GP passed a finger...

    Correct

    • While conducting a physical examination of a patient, the GP passed a finger down the edge of the medial crus of the superficial inguinal ring and felt a bony prominence deep to the lateral edge of the spermatic cord. What was this bony prominence?

      Your Answer: Pubic tubercle

      Explanation:

      At the superficial inguinal ring, the pubic tubercle would be felt as a bony prominence lateral to the edge of the spermatic cord. This tubercle is the point of attachment of the inguinal ligament that makes up the floor of the inguinal canal.

      Pecten pubis is the ridge on the superior surface of the superior pubic ramus and the point of attachment of the pectineal ligament.

      The pubic symphysis is the joint between the two pubic bones and the iliopubic eminence is a bony process on the pubis found near the articulation of the pubis and the ilium.

      The iliopectineal line is formed by the arcuate line of the ilium and the pectineal line of the pubis. It is the line that marks the transition between the abdominal and pelvic cavity.

      The sacral promontory is found on the posterior wall of the pelvis and would not be felt through the inguinal ring.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      146.7
      Seconds

  • Question 11 - An abdominal aortogram shows occlusion of the inferior mesenteric artery. Which of the...

    Correct

    • An abdominal aortogram shows occlusion of the inferior mesenteric artery. Which of the following segments of bowel is most likely to have preserved arterial supply?

      Your Answer: Caecum

      Explanation:

      The inferior mesenteric artery supplies blood to the end of the transverse colon and all distal structures in the gastrointestinal tract i.e. splenic flexure, descending colon, sigmoid colon and rectum would all be deprived of blood if it were occluded. The caecum receives blood from the superior mesenteric artery so it would not be affected.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      57.9
      Seconds

  • Question 12 - In the human body, veins often run a course parallel to the artery...

    Incorrect

    • In the human body, veins often run a course parallel to the artery that has the same name. Which of the following listed veins doesn't run parallel to the artery of the same name?

      Your Answer: Superior epigastric

      Correct Answer: Inferior mesenteric

      Explanation:

      The inferior mesenteric artery and inferior mesenteric vein don’t run in tandem because the vein is part of the portal venous system-draining into the splenic vein which drains into the hepatic portal vein. The inferior mesenteric artery is a branch of the descending aorta at the level of L3. The inferior mesenteric vein and artery, however, drain the same region i.e. the descending and sigmoid colon and rectum.

      Superior epigastric vessels course together and are the continuation of the internal thoracic artery and vein.

      Superficial circumflex iliac vessels course together in the superficial fat of the abdominal wall.

      Superior rectal vessels are the terminal ends of the inferior mesenteric vessels, located on the posterior surface of the rectum.

      The ileocolic artery and vein are branches off the superior mesenteric vessels. Both course in the mesentery, supplying/draining the caecum, appendix, terminal portion of the ileum. The inferior epigastric vessels run together.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      15.9
      Seconds

  • Question 13 - Enlargement of the spleen as seen in Gaucher's disease pushes the spleen downward...

    Correct

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

      Your Answer: Left colic flexure

      Explanation:

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

      The left suprarenal gland is retroperitoneal.

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

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

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      127.3
      Seconds

  • Question 14 - A specialist registrar was performing the bi-lateral surgical removal of the adrenal glands....

    Correct

    • 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: 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
      65.8
      Seconds

  • Question 15 - 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
      25.8
      Seconds

  • Question 16 - 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: Transversalis fascia, extraperitoneal fat and peritoneum

      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
      337
      Seconds

  • Question 17 - A construction worker is brought to the A&E after a fall on site....

    Correct

    • 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: 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
      15.7
      Seconds

  • Question 18 - 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
      304.9
      Seconds

  • Question 19 - 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
      24
      Seconds

  • Question 20 - 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
      32
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Abdomen (14/20) 70%
Anatomy (14/20) 70%
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