Abdomen & Inguinal Region Clinical Questions

ilioinguinal

A 45-year-old man had developed a direct inguinal hernia several months after having an emergency appendectomy. The examining doctor linked the cause of hernia to accidental nerve injury that happened during appendectomy and weakened the falx inguinalis. Which nerve had been injured? Femoral branch of the genitofemoral Genital branch of the genitofemoral Ilioinguinal Subcostal Ventral primary ramus of T10

medial inguinal fossa

A loop of bowel protrudes through the abdominal wall to form a direct inguinal hernia; viewed from the abdominal side, the hernial sac would be found in which region? Deep inguinal ring Lateral inguinal fossa Medial inguinal fossa Superficial inguinal ring Supravesical fossa

an indirect inguinal hernia

A man is moving into a new house and during the process lifts a large chest of drawers. As he lifts he feels a severe pain in the lower right quadrant of his abdomen. He finds that he can no longer lift without pain and the next day goes to see his physician. Surgery is indicated and during the surgery the surgeon opens the inguinal region and finds a hernial sac with a small knuckle of intestine projecting through the abdominal wall just above the inguinal ligament and lateral to the inferior epigastric vessels. The hernia was diagnosed as: A congenital inguinal hernia A direct inguinal hernia A femoral hernia An incisional hernia An indirect inguinal hernia

pubic tubercle

A medical student was asked by her preceptor to palpate the margin of the superficial inguinal ring of a healthy male patient. After passing her finger down the edge of the medial crus of the superficial inguinal ring, she felt a bony protuberance deep to the lateral edge of the spermatic cord, which she correctly identified as the : pecten pubis pubic symphysis pubic tubercle iliopubic eminence iliopectineal line

sigmoid colon

A patient has a large bowel obstruction resulting from a left-sided indirect inguinal hernia. The most likely intestinal segment involved in this obstruction is the: ascending colon cecum descending colon rectum sigmoid colon

the is insufficient evidence to tell

A patient presents with a hernia that is palpable at the superficial inguinal ring. Is this an indirect inguinal hernia? Yes No There is insufficient evidence to tell

ilioinguinal nerve

An elderly patient with a large indirect inguinal hernia came to your clinic complaining of pain in the scrotum. You conclude that the hernial sac is compressing the following nerve: Femoral branch of the genitofemoral Femoral Iliohypogastric Ilioinguinal Subcostal

posterior rectus sheath

An obstetrician decides to do a Caesarean section on a 25-year-old pregnant woman. A transverse suprapubic incision is chosen for that purpose. All of the following abdominal wall layers will be encountered during the incision EXCEPT the: Anterior rectus sheath Posterior rectus sheath Rectus abdominis muscle Skin and subcutaneous tissue Transversalis fascia, extraperitoneal fat, and peritoneum

medical umbilical ligament and inferior epigastric artery

During a laparoscopic examination of the deep surface of the lower anterior abdominal wall (using a lighted scope on a thin tube inserted through the wall), the attending physician noted something of interest and asked the young resident to look at the medial inguinal fossa. To do so, the young doctor would have to look at the area between the: inferior epigastric artery and urachus medial umbilical ligament and urachus inferior epigastric artery and lateral umbilical fold medial umbilical ligament and inferior epigastric artery median umbilical ligament and medial umbilical ligament

direct inguinal hernia

During exploratory surgery of the abdomen, an incidental finding was a herniation of bowel between the lateral edge of the rectus abdominis muscle, the inguinal ligament and the inferior epigastric vessels. These boundaries defined the hernia as a(n): Congenital inguinal hernia Direct inguinal hernia Femoral hernia Indirect inguinal hernia Umbilical hernia

illiohypogastric

Following an emergency appendectomy your patient complained of having paresthesia (numbness) of the skin at the pubic region. The most likely nerve that has been injured during the operation is: Genitofemoral Iliohypogastric Subcostal Spinal nerve T10 Spinal nerve T9ill

internal spermatic fascia

If a direct inguinal hernia extended through the superficial inguinal ring, it would be surrounded by all of the abdominal wall layers EXCEPT the: External spermatic fascia Internal spermatic fascia Peritoneum and extraperitoneal connective tissue Weak fascia of the transversus abdominis muscle lateral to the falx

indirect inguinal hernia

If a hernia enters into the scrotum, it is most likely a(n): Direct inguinal hernia Indirect inguinal hernia Femoral hernia Obturator hernia

transversus abdominis and peritoneum

If one were to make an incision parallel to and 2 inches above the inguinal ligament, one would find the inferior epigastric vessels between which layers of the abdominal wall? Camper's and Scarpa's fascias External abdominal oblique and internal abdominal oblique muscles Internal abdominal oblique and transversus abdominis muscles Skin and deep fascia of the abdominal wall Tranversus abdominis muscle and peritoneum

round ligament of the uterus

In a female with an indirect inguinal hernia, the herniated mass lies along side of which structure as it traverses the inguinal canal? Iliohypogastric nerve Inferior epigastric artery Ovarian artery and vein Pectineal ligament Round ligament of the uterus

inferior epigastric

In order to reduce a hernia (return it to the abdominal cavity), a surgeon finds it necessary to ligate an artery in the extraperitoneal connective tissue (preperitoneal fat) running vertically just medial to the bowel as the bowel passes through the abdominal wall. This artery is the: Deep circumflex iliac Inferior epigastric Superficial circumflex iliac Superficial epigastric Superficial external pudendal

E. inferior epigastric artery

In performing surgery to reduce an aneurysm in the external iliac artery, the surgeon must be careful to avoid damage to the branches of this artery. One such branch is the: A. External pudendal artery B. Obturator artery C. Superior gluteal artery D. Inferior gluteal artery E. Inferior epigastric artery

perineum

In right-sided cryptorchidism (undescended testis), the testis may have been trapped in any site EXCEPT: At the deep inguinal ring Just outside the superficial inguinal ring Pelvic brim Perineum Somewhere in the inguinal canal

D. a splenectomy will be performed

In the emergency department, an adult patient is shown to have a ruptured spleen after an automobile crash. Which of the following is most likely in this situation? A. The spleen will be repaired. B. The splenic artery will be ligated. C. The celiac trunk will be ligated. D. A splenectomy will be performed. E. The spleen will be transplanted.

A. the left renal vein is longer than the right renal vein

Kidney transplant surgeons prefer to transplant the left kidney compared to the right kidney. Which of the following is true and most likely explains this preference? A. The left renal vein is longer than the right renal vein. B. The left renal artery is longer than the right renal artery. C. The right renal vein receives the right gonadal vein. D. The right renal artery is the only source of blood to the right suprarenal gland. E. The right kidney is firmly attached to the liver.

sigmoid

The _________ colon is the most likely intestinal segment to be involved in a life-sided indirect hernia

arcuate line

The boundaries of the inguinal triangle include all except: Arcuate line Inferior epigastric vessels Inguinal ligament Lateral border of rectus abdominus muscle

arcurate line

The inferior border of the rectus sheath posteriorly is called the: Falx inguinalis Inguinal ligament Internal inguinal ring Arcuate line Linea alba

inferior epigastric

The internal thoracic artery is sometimes surgically cut near the caudal end of the sternum and used to supply blood to a region of the heart. In these cases, maintenance of adequate blood flow to the rectus abdominis may be dependent on increased flow through which artery? Superficial epigastric Inferior epigastric Umbilical Superficial circumflex iliac Deep circumflex iliac

level of umbilicus

The normal pattern of venous and lymphatic drainage of the superficial tissues of the anterior abdominal wall is arranged around a horizontal plane. Above that plane, drainage is in a cranial direction; below the plane drainage is in a caudal direction. This reference plane corresponds to: Transpyloric plane Level of anterior superior iliac spines Transtubercular line Level of arcuate line Level of umbilicus

arcurate line

The posterior layer of the rectus sheath ends inferiorly at the Arcuate line Intercrestal line Linea alba Pectineal line Semilunar line

anterior labial

The skin of the mons pubis is supplied by which nerve? Anterior scrotal Anterior labial Femoral branch of the genitofemoral Iliohypogastric nerve Subcostal nerve

external abdominal oblique aponeurosis

The superficial inguinal ring is an opening in which structure? External abdominal oblique aponeurosis Falx inguinalis Internal abdominal oblique muscle Scarpa's fascia Transversalis fascia

B. Anterior labial

The terminal ends of the ilioinguinal nerves in the female are referred to as: A. Anterior cutaneous branches B. Anterior labial C. Cremasterics D. Iliohypogastrics

right lower quadrant

The usual location for an appendectomy incision is the: left lower quadrant left upper quadrant right lower quadrant right upper quadrant

A. IVC

Upon putting his finger through the epiploic foramen, the surgeon knows that directly posterior to his finger is: A. Inferior vena cava (IVC) B. Common hepatic artery C. Cystic duct D. Portal vein E. Gastroduodenal artery

ilioinguinal

Which nerve passes through the superficial inguinal ring and may therefore be endangered during inguinal hernia repair? Femoral branch of the genitofemoral Ilioinguinal Iliohypogastric Obturator Subcostal

A. The sac of the hernia passes lateral to the inferior epigastic artery

Which of the following is correct about indirect inguinal hernias? A. The sac of the hernia passes lateral to the inferior epigastric artery. B. The sac of the hernia passes medial to the inferior epigastric artery. C. The hernial sac is typically embedded in the superficial inguinal lymph nodes. D. The hernia exits the abdomen through the linea alba. E. The hernia exits the abdomen through the fibers of the rectus abdominis.

round ligament of the uterus

Which structure passes through the deep inguinal ring? Iliohypogastric nerve Ilioinguinal nerve Inferior epigastric artery Medial umbilical ligament Round ligament of the uterus

either a direct or an indirect inguinal hernia

While performing a routine digital examination of the inguinal region in a healthy teen-aged male, the physician felt a walnut-sized lump protruding from the superficial inguinal ring. She correctly concluded that it was : definitely an indirect inguinal hernia possibly an unusual femoral hernia definitely a direct inguinal hernia possibly an enlarged superficial inguinal lymph node either a direct or an indirect inguinal hernia

epigastric

You were asked to assist in a surgical operation on a young patient to treat an ulcer in the first part of the duodenum. You would expect that the surgeon will approach the ulcer by doing an anterior abdominal wall incision in the following region: Epigastric Left inguinal Left lumbar Right hypochondrial Hypogastric

E. Psoas major

Your patient has an abscess in the superior part of her thigh that is associated with a muscle that lies lateral to the lumbar vertebrae and attaches to the lesser trochanter of the femur. What muscle is involved in the infection? A. Quadratus lumborum B. Transversus abdominis C. Adductor longus D. Obturator externus E. Psoas major

A. Varicocele

Your patient is complaining about pain on the left side of his scrotum. You examine the patient and notice an enlargement in his left scrotum that disappears when the patient lies down. Upon palpation, the left scrotum feels like "a bag of worms." Your diagnosis is most likely: A. Varicocele B. Testicular torsion C. Testicular cancer D. Epididymitis E. Epididymal cyst

A. varicocele

Your patient is complaining about pain on the left side of his scrotum. You examine the patient and notice an enlargement in his left scrotum that disappears when the patient lies down. Upon palpation, the left scrotum feels like "a bag of worms." Your diagnosis is most likely: A. Varicocele B. Testicular torsion C. Testicular cancer D. Epididymitis E. Epididymal cyst

C. external oblique aponeurosis

the superficial inguinal ring is an aperture in the: A. Internal oblique aponeurosis B. Transverse abdominal muscle aponeurosis C. External oblique aponeurosis D. Transversalis fascia E. Peritoneum

above the midpoint of theinguinal ligament

you would indicate the position of the deep inguinal ring to be: Above the anterior superior iliac spine Above the midpoint of the inguinal ligament Above the pubic tubercle In the supravesical fossa Medial to the inferior epigastric artery