QA AB LECTURES 1-5

FALSE. Achalasia is due to the lower esophageal sphincter not being able to relax, not the pyloric sphincter (which is at distal end of stomach)

T or F. Achalasia is due to the pyloric sphincter not being able to relax and therefore food backs up in the GI. A classic sign on radiograph with barium is "bird beak appearance.

d. ileum

failure of differentiation of the individual organs derived from the embryonic midgut would cause malformation of which of the following organs? a. gallbladder b. spleen c. rectum d. ileum e. descending colon

A

infection from an inflammed appendix is likely to spread via the lymphatics to the: a. superior mesenteric nodes b. celiac nodes c. splenic nodes d. inferior mesenteric nodes e. right internal iliac nodes

D

the vagus nerves pass ________ in the diaphragm? a. through the vena caval hiatus b. through the aortic hiatus c. between the slips of origin of the diaphragm from the ribs d. through the esophageal hiatus e. thorugh the perforation is the crura

e diaphragm

the organ indicated at the tip of the white arrow normally receives a blood supply directly from a branch that also supplies which other structure? a. rectum b. testis c. spleen d. rectus abdominis muscle e. diaphragm

a. the pancreas is not related to the right kidney

the right kidney has the following important relationships except which? a. it is related to the neck of the pancreas b. it is anterior to the right costodiaphragmatic recess c. it is related to the second part of duodenum d. it is related to the right colic flexure e. it is anterior to the right twelfth rib

b. omental appendices

the tagged organ has an association with which of the following? a. omental bursa b. omental appendicies c. lesser omentum d. omental foramen e. right gastroomental a.

b = spleen

fractures of the lef 10th and 11th ribs would most likely effect which of the following structures? a = liver b = spleen c = pancreas d = stomach e = right kidney

g. left ovarian artery

" a structure branches from the abdominal aorta, travels inferiorly in the abdominal cavity, and happens to cross anteriorly over another long thing structure in the area. It continues to descend inferiorly, enters into the pelvic cavity and attaches to an organ." This description is most likely referring to which of the following? a. inferior mesenteric artery b. left ureter c. left renal artery d. left genitofemoral nerve e. left ovarian vein f. vas deferens g. left ovarian artery h. superior rectal artery i. hemiazygous vein

e. spleen (the most frequently injured organ in the abdomen, low BP indicates blood loss within the systemic arterial circulation)

A 13 yo girl is brought to the ER after falling from a horse onto her left side. Her pulse is 120/min, BP is 90/60 mmHg, and her RR are 30/min. PE reveals cold and clammy skin, bruising and fx 9th and 10th ribs on her left side at the posterior axillary line. Which of the following organs is most likely damaged in this pt? a. stomach b. kidney c. lung d. liver e. spleen

c. lower ileum. meckel (ileal diverticulum is a persistent remant of the embryonic vitelline duct is the connection between the apex of the primary intestinal loop of the midgut and the yolk sac. The primary intestinal loop is the highly elongated embyronic midgut. When present an ileal diverticulum is an outpocketing located on the antimesenteric border of the distal ileum, usually 2 ft proximal to the ileocecal junction in children.

A 2 yo boy is brought to the emergerncy room with cramping abdominal pain, fever and vomitting. His parents say these symptoms began 12 hours ago and have progressively worsened. Abdominal radiology indicates a bowel obstruction that appears related to an abnormal intestinal outpocketing connected to the anterior abdominal wall. The consulting surgeon makes a diagnosis of Meckel diverticulitis and recommends surgery to resolve the problem. At which of the following sites does the surgeon expect to find the diverticulum responsible for this condition? a. lower duodenum b. middle jejunum c. lower ileum d. cecum e. transverse colon

d. transversalis fascia

A 32 yo man was shot in the abdomen just below the level of the umbilicus. The bullet was found lodged in his left rectus abdominis muscle, and it stopped short from penetrating the next tissue layer immediately deep to the rectus abdominis. What would that tissue layer be? a. Posterior rectus sheath b. skin c. camper's fascia d. transversalis fascia e. transversus abdominis muscle

b. sigmoidal arteries

A 38 yo man presented to the ED with a 3 day hx of abdominal pain, abdominal distention, nausea and no passage of stools. Abdominal xrays reveal a volvulus that is distal to the descending colon and just proximal to the rectum. Which of the following arteries will be the most likely to be compromised in this condition? a. superior mesenteric a. b. sigmoidal arteries c. marginal artery of Drummond d. splenic a. e. left colic a.

b. hydrocele

A 55 yo man had excessive fluid drained from his right testis. The doctor aspirated the fluid using a needle and syringe. The aspirated liquid was mostly clear and colorless. Based on this information which of the following diagnosis would be the most appropriated for the case? a. cryptorchidism b. hydrocele c. direct inguinal hernia d. hemtatocele e. spermatic cord torsion

d. This patient may have an abdominal aortic aneurysm. Risk factors for the development of this include hypertension, excessive weight and smoking. About 55 of men over 60 years of age have this. 90% of the time abdominal aortic aneurysms develop inferior to the renal arteries.

A 73 yo man presents to his geriatrician for ongoing control of his hypertension (155/90). His physician notes that he has lost about 5 lbs since his last visit. The patient reports that he does not "have as much room for food or has as much of an appetite." He states that he is getting tired of the food at his nursing home. His physician palpates his abdomen and notes that there is a mid-line pulse, which is initially mistaken for a heartbeat, but it is slightly delayed. His physician is concerned about the pulsating abdominal mass and orders an abdominal CT with IV contrast because his physician suspects that her has which one of the following? a. hiatal hernia b. splenomegaly c. cirrhosis of the liver d. an aortic aneurysm e. a horseshoe kidney

a. the ureter crosses the common iliac vessels about halfway on its journey to the urinary bladder. it is slightly stretched and its lumen narrowed as it crosses these vessels, so a calculus can become lodged at this point. This site also is close to the pelvic brim.

A kidney stone (calculus) passing from the kidney to the urinary bladder can become lodged at several sites along its pathway to the bladder, leading to the "loin-to-groin" pain. One common site of obstruction can occur about halfway down the pathway of the ureter where it crossws which of the following structures? a. common iliac vessels b. lumbosacral trunk c. major renal calyx d. renal pelvis e. sacroiliac joint

a. the adrenal medulla is innervated from thoracic levels of the spinal cord mediated by preganglionic sympathetic nerve fibers travelling in the lesser and least splanchnic nerves, with some contribution from the greater splanchnic and lumbar splanchnic nerves

A middleaged woman describes flushing, sever headaches and a feeling that her heart is goining to explose when she geets excited. At the beginning of a PE her BP (130/85) is not significantly above normal. however, on palpation of her upper left quadrant, the examining physician noticies the onset of sympathetic signs. her HP is abnormally high. A CT scan confirms the suspected tumor of the left adrenal gland. The pt is schedueled for surgery. Her symptoms that correlate with the onset of excitement are most likely due to neural stimulation of the adrenal glands. The adrenal medulla received its innervation from which ofthe following? a. preganglionic symp nerves b. postsynaptic symp nerves c. preganglionig parasymp nerves d. postganglionic parasymp nerves e. somatic nerves

e. right lower quadrant

A patient is experiencing pain and discomfort at the area marked with an 'X'. Which of the following answer choices best describes the area of the pain? a. Right hypochondriac region b. subcostal plane c. intertubercular plane d. supravesicle fossa e. Right lower quadrant

c. rugae

A pt is undergoing endoscopy so that a physician can further evaluate a gastric ulcer. Which of the following features is expected to be seen through the camera when viewing the stomach internally? a. plicae circularis b. minor duodenal papilla c. rugae d. hilum of spleen e. duodenaljejunal flexure f. ampulla of vater

a. pyloric sphincter (circular smooth muscle)

A smooth muscle feature, that is normally supposed to maintain constriction of a passage, fails to operate properly due to muscle weakness. It is now allowing chyme to continually flow from the stomach to the duodenum unregulated. Which of the following structures is this is reference to that is not working properly? a. pyloric sphinctor b. sphinctor of Oddi c. lower esophageal sphincter d. duodenaljejunal flexure e. z-line f. omental foramen

e. round ligament of the uterus travels through the inguinal canal in a female

Based on differences between males and females, which of the following statements is true? a. females do not have the same muscles at the lateral abdominal wall as males b. females do not have any structures that travel through the inguinal canal c. ilioinguinal nerve is absent in all males d. the cremaster reflex should always be tested bilaterally in both males and females e. round ligament of the uterus travels through the inguinal canal in a female

B. genital branch of the genitofemoral. the genitofemoral nerve is a branch of the lumbar plexus, arising from the anterior rami of the L1-2 spinal nerves. Its genital branch runs through the inguinal canal within the spermatic cord to innervate the cremaster muscle and lateral aspect of the scrotum (or labium majus in women). The cremaster muscle is a thin layer of skeletal muscle surrounding the spermatic cord, which is derived from the internal abdominal oblique muscle. The cremaster contracts in response to cold temps and cutaneous stimuli to raise the testicle upward, closer to the superficial inguinal ring.

During a physical examination of a 35 yo man with a spinal cord injury the neurologist lightly strokes the right upper medial side of the thigh to test the integrity of the L1-2 spinal cord segments. He notes the cremasteric reflex is absent. Which of the following nerves carries the efferent limb of this reflex arc? a. iliohypogastric b. genital branch of the genitofemoral c. femoral branch of the genitofemoral d. femoral e. ilioinguinal

b. the genitofemoral nerve is almost always found lying on the anterior surface of the psoas major muscle

During abdominal surgery, resection of a portion of the descending colon necessitates the sacrifice of a nerve lying on the surface of the psoas major muscle. Which of the following nerves would most likely be sacrificed? a. femoral b. genitofemoral c. ilioinguinal d. lateral cutaneous nerve of thigh e. subcostal

d. these organs are normally located on either side of the vertebral column (hereditary bilateral polycystic kidneys)

During an autopsy on a 63 yo man, the following structures were identified in the retroperitoneal space. Which of the following statements is the most accurate concerning these organs? a. normally there should only be one of these organs in the body not two b. bilateral renal agenesis accounts for what is seen in the image c. the two spleens look distorted anatomically d. these organs are normally located on either side of the vertebral column e. both organs appear normal in appearance f. diverticulitis is an accurate dx for the appearance of these organs

c. myenteric plexus. the cell bodies of postsynaptic (postganglionic) parasymp neurons populate the myenteric (Auerbach) plexus in the walls of the gut tube. These plexuses are located between the circulr and longitudinal smooth muscle layers and regulate gut motility including peristalsis. the myenteric plexus is a major component of the enteric nervous system

During inspections of a secret govt biological warfare lab, a team of investigators discovers a genetically engineered virus that selectively attacks the cells bodies of postsynaptic parasympathetic neurons. In which of the following locations would this virus be found in the highest density if it were introduced into the body? a. celiac plexus b. paravertebral ganglia c. myenteric plexus d. hypogastric plexuses e. gray matter of sacral spinal cord segments

e. The rectum receives blood from 3 diff arteries, which come from 3 diff major branches: superior rectal artery off the inferior mesenteric a., middle rectal artery off the internal iliac artery, and inferior rectal artery off the internal pudendal artery.

During the PE of a 52 yo man for a life insurance policy, internal hemorrhoids are noted. The man had noticed occasional bright red blood on some of his larger, well-formed stools. Which of the following arteries could be the source of his rectal bleeding? a. superior mesenteric a. b. external iliac a. c. internal pudendal a. d. internal pudendal a. e. inferior gluteal artery f. superior, middle and inferior rectal arteries

b. the gallbladder lies on the inferior surface of the liver between the right and quadrate lobes

Gallbladder pain oftern presents as epigastric pain that subsequently migrates toward the patients right side and can even wrap around to the posterior. The somatic location of the referred pain is not the site of the problem. Anatomically where is the gallbladder located? a. between the left and caudate lobes of the liver b. between the right and quadrate lobes of the liver c. in the falciform ligament d. in the lesser omentum e. in the right anterior leaf of the coronary ligament

e. parietal peritoneum and greater omentum

If access to the left gastroepiploic artery is required, which of the following layers of peritoneum would a surgeon need to enter to reach this vessel? a. greater omentum and lesser omentum b. greater omentum and falciform ligament c. greater omentum and splenorenal ligament d. parietal peritoneum and lesser omentum e. parietal peritoneum and greater omentum f. parietal peritoneum and ligament of Trietz

f. tail of pancreas

In a 39 yo male, a CT scan reveals a 4-cm mass near the hilum of the spleen. Which of the following is the most likely to contain this mass? a. gallbladder b. 1st part of the duodenum c. uncinate process of the pancreas d. 3rd part of the duodenum e. quadrate lobe of liver f. tail of pancreas

a. the common hepatic artery

In a patient with cancer of the stomach who requires a total gastrectomy, the following arteries must be ligated except which? a. the common hepatic a. b. the short gastric arteries c. the left and right gastroepiploic arteries d. the right gastric a. e. the left gastric a.

D

Lymphatic spread of carcinoma of the fundus of the stomach is likely to metastasize to the: a. internal iliac nodes b. superior mesenteric nodes c. inferior mesenteric nodes d. celiac nodes e. right gastroepiploic nodes

T10

On physical exam it is noted that a patient has decreased dermatomal sensation around her umbilicus since getting a belly button piercing. The dermatome area corresponds to what spinal nerve root level? a. T10 b. T11 c. L1 d. L3 e. S1

b. testicular artery

Spermatic cord torsion would most likely negatively affect which of the following structures? a. inferior epigastric artery b. testicular artery c. deep circumflex artery d. thoracoepigastric vein e. superficial abdominal wall lymph vessels below the umbillicus

D. Liver

The coronary ligament helps support which of the following structures? a = heart b = stomach c = spleen d = liver e = ascending colon f = small intestines

A

The descending colon receives parasymp vernes from the: a. pelvic splanchnic nerves b. spinal cord segments L1 and L2 c. greater splanchnic nerve d. lesser splanchnic nerve e. vagus nerve

b. T8

The esophageal opening in the diaphragm is at: a. T6 b. T8 c. T10 d.T12 e.L1

a. between the ureter and the renal pelvis

The following is a preop dx on a 5 yo boy: left renal uteropelvic junction obstruction status post pyeloplasty, percutaneous procedure, and pyeloureteroscopy x2 and status pose Pseudomonas pyelonephritix x6. Which of the following describes where the obstruction is? a. between the ureter and the renal pelvis b. point where the ureter attaches to the urinary bladder c. urethra within the pelvic cavity d. between the minor calyx and the renal pelvis e. point where the ureter enters the pelvic cavity f. between the renal cortex and renal medulla

C. the greater omentum is attached above to the greater curvature of the stomach and below to the lower border of the transverse colon

The following structures are connected to the liver except which? a. falciform ligament b. coronary ligament c. the greater omentum d. the ligamentum teres e. ligamentum venosum

D

The genitofemoral nerve, a branch of the lumbar plexus, emerges from the psoas muscle in its, a. lateral side b. posterior surface c. medial side d. anterior surface e. none of the above

f. jejunum; sympathetic

The lesser splanchnic nerve would most likely send fibers that eventually innervate which of the following organs and by what nervous system pathway? a. superior part of duodenum; parasympathetic b. descending part of the duodenum; sympathetic c. gallbladder; parasympathetic d. gallbladder; sympathetic e. jejunum; parasympathetic f. jejunum; sympathetic

c. cremaster muscle and fascia

The muscle indicated by the yellow arrow contributes what layer to the spermatic cord and testis? a. internal spermatic fascia b. external spermatic fascia c. cremaster muscle and fascia d. dartos fascia e. tunica vaginalis

a. renal medulla

The renal pyramids of the kidneys are contained within the: a. renal medulla b. renal cortex c. renal pelvis d. renal sinuses

a. celiac KEY POINT: abdominal viscera lymph drainage is essentially organized by whether organ (based on primitive gut tube derivative) is supplied by the celiac trunk, superior mesenteric artery or inferior mesenteric artery

There is cancer of the organ noted at the tip of the arrow. The cancer will spread through lymphatics that most likely will travel first to which of the following lymph nodes? a. celiac b. inferior mesenteric c. superficial inguinal d. lumbar e. superior mesenteric

e. anterior iliac spine

What is the name of the bony landmark used as a point of reference for locating the site on the surface of the anterior abdominal wall indicated by the number 11? a. spinous process b. umbillicus c. iliac tubercle d. pubic tubercle e. anterior superior iliac spine

e. inguinal ligament

What is the name of the structure that attaches from the anterior superior iliac spine to the pubic tubercle? a. tunica vaginalis b. arcuate line c. semilunar line d. linea alba e. inguinal ligament

f. lateral horns of gray matter

What is the starting point for preganglionic sympathetic motor fibers as it relates to the pathway of innervation for GI organ? a. paravertebral ganglion b. splanchic nerve c. ventral (anterior) root d. white ramus communicas e. dorsal nucleus of vagus f. lateral horns of gray matter g. S2/S3/S4 spinal cord segments

D.

When this structure is obstructed and inflamed, a patient will initially present with periumbilical pain that eventually radiates to the right lower quadrant. Which structure is it on the image? a. b. c. d. e.

b. hilum is the name of the point of attachment between an organ and its supply services

Which is the name for the entry point to the kidneys for nerves, blood vessels, ureters and lymphatics? a. calyx b. hilus c. pelvis d. pyramid

a. jejunal veins - superior mesenteric vein - hepatic portal vein - liver

Which of the following answer choices give the correct route of nutrient rich, dexoygenated blood draining from the jejunum? a. jejunal veins - superior mesenteric vein - hepatic portal vein - liver b. jejunal veins - superior mesenteric vein - splenic vein - heart c. jejunal veins - celiac trunk - abdominal aorta - heart d. jejunal veins - inferior mesenteric vein - splenic vein - hepatic portal vein - liver

c. internal hemorrhoids

Which of the following could most likely be palpated in a digital rectal exam? a. worm-like diverticulum off the cecum b. hard nodule at the splenic flexure c. internal hemorrhoids d. transverse colon volvulus e. aneurysm (bulging) of middle colic artery

a. descending colon

Which of the following organs does not recieve blood supply from the superior mesenteric artery? a. descending colon b. pancreas c. distal 1/3 of transverse colon d. ileum e. jejunum

b. abdominal aorta is located just to the left of the inferior vena cava

Which of the following statements is correct? a. left renal vein drains directly into the left testicular vein b. abdominal aorta is located just to the left of the inferior vena cava c. the inferior vena cava is intraperitoneal within the abdominal cavity d. left testicular vein drains directly into the inferior vena cava e. abdominal aorta and inferior vena cava travel through the same opening of the diaphragm at T10 vertebral level

d vagus nerve operates as part of the parasympathetic nervous system

Which of the following statements is correct? a. prevertebral ganglia are located along the sympathetic trunk b. cranial nerves function as part of the sympathetic nervous system c. preganglionic sympathetic motor axons always synapse in the sympathetic chain ganglion d. vagus nerve operates as part of the parasympathetic nervous system e. postganglionc autonomic nerve fibers tend to travel with the veins to reach their target organ

a. enters the deep inguinal ring

Which of the following statements regarding an indirect inguinal hernia is clinically true? a. enters the deep inguinal ring b. can also protrude through the umbilicus c. herniates medial to the inferior epigastric vessels d. passes through the inguinal triangle e. it is not covered by spermatic fascia

a right kidney

Which of the following structures is indicated with the X in this coronal CT? a. right kidney b. liver c. stomach d. spleen e. psoas major

C. gallbladder releasing stored bile into the cystic duct

Which of the following would be considered a parasympathetic effect of stimulation on a GI organ? a. inhibition of secretion of pancreatic enzymes b. decreased gastric secretion c. gallbladder releasing stored bile into the cystic duct d. decreased absorption by the jejunum e. relaxation of smooth muscle bands of the ascending colon

c. permanent relaxation of the pyloric sphincter the celiac ganglion (plexus) is the synapse point between presynaptic and postsynaptic sympathetic neurons that supply the celiac arterial axis. Sympathetic stimulation inhibits gut motility and glandular secretions and causes contraction of gut sphincters

Which of the followng funcitonal outcomes could result from failure of synaptic transmission in the celiac ganglion? a. decreased secretions from the gastric glands on the anterior wall of the stomach b. reduced rsecretion of epinephrine from the adrenal (suprarenal) medulla c. permanent relaxation fo the pyloric sphincter d. increased motility in the wall of the descending colon e. paralysis of the quadratus lumborum muscle

C. superior mesenteric artery The superior mesenteric arises from the abdominal aorta at L1 and it supplies the midgut from the second part of the duodenum to the distal potion of the transverse colon. the appendix is an outpocketing of the embryonic midgut connected to the cecum, located in the lower right quadrant of the abdomen in proximity to the ileocecal jx. Bc the vermiform appendix is derived from the midgut, its blood supply arises from a branch of the superior mesenteric artery specifically arising off of the ileocolic artery. The appendicular artery would need to be ligated to alleviate excessive bleeding.

a 12 yo boy is brought tothe emergency room with a fever, nausea and pain in his abdomen. Acute appendicitis is the preliminary dx due to his symptoms and an elevated WBC count (leukocytosis). the given axial CT reveals an inflamed radiodense appendix in the retrocecal position, exhibiting a thickened wall and surrounding the edema. The boy is taken to the operating room for a laparoscopic appendectomy. Branches of what artery will need to be ligated during the procedure to alleviate excessive bleeding? a. celiac b. superior epigastric c. superior mesenteric d. inferior epigastric e. inferior mesenteric

D. the ileum (a is gastric rugae of the stomach, b is the jejunum, c is the pancreas)

a 23 yo woman suffers from Crohn's disease. Which of the following types of mucosa represent the organ for the most common area of involvement for this patient's disease?

d. liver (the liver resides on the R side of the body and its entire surface is afforded the protection of the thoracic cage in healthy individuals. The liver is the most likely damaged organ due to the location of the knife wound. The liver can extend superior to approximately the level of the nipple from the 9th intercostal space described, depending on the inflation state of the R lung.

a 24 yo man is brought to the ER with a knife wound located in the 9th intercostal space at the right midaxillary line. Given the location of the penetration wound, what structure is most likely damaged? a. stomach b. kidney c. lung d. liver e. spleen

E. the left renal vein. The left testicular vein drains blood into the left renal vein, while the right testicular vein drains blood into the IVC.

a 27 yo man presents to his family practice physician with a mass within his left testicle. Upon PE it is confirmed that his left testicle. Upon physical examination it is confirmed that his left testicle is about twice the size of his right testicle. A CT scan of his abdomen and pelvis is ordered. Which structure on the CT below receives blood from the left testicle A. B. C. D. E. F. G. H.

C gastroduodenal ( one of the terminal branches of the heptatic artery, it descends immediately posterior to the 1st part of the duodenum and terminates by splitting into 2 branches: right gastroomental (gastroepiploic) and superior pancreaticoduodenal. Its close relation to the second part of the duodenum makes this vessel susceptible to lesions such as the perforated ulcer)

a 35 yo man suffers sharp abdominal pain accompanied by hematemesis for 2 days. he dies without seeking medical help. Autopsy findings reveal a perforated ulcer in the posterior wall of the first part of the duodenum, which damaged artery in close proximity. Which of the following arteries was most likely ruptured? a. short gastric b. left gastroomental c. gastroduodenal d. splenic e. left gastric

e. greater splanchnic

a 42 yo obese woman comes to the clinic with episodes of severe right upper quadrant pain, usually associated with eating a fatty meal. She has a past medical hx of cholecystistis. No prior surgeries. Which of the following nerves carries the visceral pain associated with this condition? a. vagus b. pelvic splanchnic c. intercostal d. iliohypogastic e. greater splanchnic

c. the transverse colon is in close posterior relation to the gallbladder

a 45 yo obese woman complaining of indigestion was admitted to hospital for investigation. She had a past history of gallstones have been known to erode through the posterior wall of the gallbladder and enter the intestinal tract. which part of the intestinal tract is likely to initially contain the stone? a. the sigmoid colon b. the descending colon c. the transverse colon d. the ascending colon e. the jejunum

e. diverticulosis

a 45 yo woman is undergoing a colonoscopy during an annual physical exam. the patient denies any current pain and has no cheif complaints. Her vital signs are within normal limits. An incidental finding is noted during the colonoscopy. What is it? a. appenidicitis b. Meckel's Diverticulitis c. ulcerative colitis d. intussusception e. diverticulosis

A. visceral afferent pain fibers from the GB travel thru the celiac - along the greater splanchnic nerves to levels T5 to T9 of the spinal cord. Therefore, pain originating in the GB will ber referred to dermatomes served by T5-T9 which include a band from the infrascapular region to the epigastrum. If the GB enlarges sufficiently, then pain could be carried by the phrenic nerve.

a 46 yo woman is admitted to a hospital in acute distress. She has experienced sever abdominal pain and vomitting for 2 days. The pain, which is sharp and constant, began in the epigastric region and radiated bilaterally around the chest to just below the scapulae. Subsequently, the pain became localized in the right hypochondrium. The pt, who has a hx of similar but milder attacks after hearty meals, is moderately overweight. Palpation reveals marked tenderness in the R hypochondriac region and some rigidity of the abdominal musculature. an xray without contrast medium shows numerous calcified stones in the region of the GB. The pt shows no sign of jaundice. Diffuse pain referred to the epigastric region and radiating circumferentially around the chest is the result of afferent fibers that travel via which of the following nerves? a. greater splanchnic b. intercostal c. phrenic d. vagus e. pelvic splanchnic

c. superficial inguinal l.n.

a 47 yo construction worker has been diagnosed with cancer of the scrotum. Cancer cells from that area would most likely metastasize to which lymph nodes first? a. supraclavicular l.n. b. celiac l.n. c. superficial inguinal l.n. d. lumbar l.n. e. axillary l.n.

b. liver (the tumor within the head of the pancreas is leading to obstruction of the lower biliary tract, specifically draining of the common bile duct. The common bile duct drains bile, produced in the liver, into the second part of the duodenum. This interruption of the biliary system by the pancreatic tumor blocks the flow of bile from the liver)

a 47 yo woman has lost 15 lb over the last 2 mos and presents with upper abdominal pain that radiates to the middle and upper back. During PE, the doctor notes the sclera of her eyes are icteric (yellow). An abdominal CT reveals a tumor within the head of the pancreas. The exocrine secretions of which of the following organs is being blocked leading directly to the icteric sclera of this pt? a. duodenum b. liver c. gallbladder d. pancreas e. stomach

e. incise the peritoneum in right paracolic gutter and elevate the colon

a 52 yo male is undergoing surgery to remove his ascending colon (hemicolectomy) due to cancer tumors. For the surgeon to lift up the ascending colon to remove it, which of them following techniques would most likely be performed? a. incise the mesoappendix and elevate the colon b. incise its mesentery proper and elevate the colon c. cut between the hepatic flexure and sigmoid colon to remove it d. cut between the hepatic flexure and splenic flexure and cut its mesentery e. incise the peritoneum in right paracolic gutter and elevate the colon

A

a 52 yo man was admitted to the hospital complaining of a chronic gastric ulcer that was not responding to the medical treatment. The surgeon decided to perform a vagotomy. The anterior vagal trunk was divided between sutures as it lies on the anterior surface of the abdominal part of the esophagus. Which of the following is likely to result from this procedure? a. a loss of secretomotor nerve supply to the mucosal glands of the stomach b. hoarse voice because of paralysis of the intrinsic muscles of the larynx on the left side c. increased HR bc of decreased parasymp input to the cardiac plexus d. incontinence bc of an absence of parasymp input to the bladder e. compromised input into the greater splanchnic nerves

b. varicose veins radiating from the umbilicus are caput medusae. Caput medusae typically present as a result of portan hypertension, secondary to cirrhosis of the liver caused by excessive alcohol consumption. There are 3 classic locations for portal caval anastmoseis that develop varicose veins; on the anterior abdominal wall (caput medusa); at the anus leading to hemmorhoids; and at the esophagus leading to esophageal varices.

a 58 yo man presents to the ED with fatigue and weakness. Although he has a slight cough, his lungs sound clear, and his heart sounds are normal. His sclerae are icteric. He has a solid mass extending 6 cm inferior to the right inferior costal margin and there are extensive veins radiating from his umbilicus, expecially inferiorly. he admits to consuming alcohol daily for more than 20 years. What is the name of the radiating varicose veins on the anterior abdominal wall and in what other locations might one expect to find varicose veins? a. ascites; esophageal varices and hemorrhoids b. caput medusa; esophageal varices and hemorrhoids c. cirrhosis; esophageal varices and lymphedema d. diverticulosis; esophageal varices and lymphedema e. diverticulosis; lymphedema and hemmorhoids

c. least splanchnic this nerve carries presynaptic sympathetic nerve fibers derived from the T12 spinal level. Visceral afferent fibers traveling along with the least splanchnic nerve refer pain to the T12 dermatome which is located in the suprapubic region of the abdomen and is consistent with the presentation of this pt. The renal nerve plexus is supplied primarily by the least splanchnic, with contributions from the lumbar splanchnic nerves derived from L1 and L2. Tf, visceral sensory fibers conveying pain from the distention of renal capsule would follow sympathetic nerves retrograde to the spinal ganglia at the T12-L2 vertebral levels

a 58 yo woman presents with pain in her side that radiates to the suprapubic (hypogastric) region of her abdomen, hematuria, and a reported hx of uUTIs. The given axial CT scan verifies advanced polycystic kidney disease. Which of the following nerves would convey visceral sensory fibers from the stretched renal capsule and cause referred pain to the skin of the suprapubic region of her abdomen? a. greater splanchnic b. lesser splanchnic c. least splanchnic d. pelvic splanchnic e. vagus

a. celiac artery the primative gut tube extends from the oropharyngeal membrane, cranially, to the cloacal membrane, caudally. It is divided into 3 main parts: foregut, midgut and hindgut. Each of these three segments is supplied by a single (unpaired) major arterial branch of the abdominal aorta. Most of the foregut is supplied by the celiac artery (trunk). thus, occlusion of this vessel will obstruct blood flow to the lower esophagus, stomach, liver, gallbladder, pancreas and proximal duodenum. Also, the celiac artery supplies the spleen, even though the spleen is not a derivative of the foregut. Most of the esophagus is located outside the abdomen and is supplied by local branches in the neck and thorax.

a 58 yo woman with a hx of hypercholesterolemia came to the ER with sever abdominal pain, nausea, and vomitting. She is dx with advanced atherosclerosis after radiologic imaging reveals atherosclerotic plaque narrowing the blood vessel supplying the embryonic foregut and its derivatives. What blood vessel is most likely effected? a. celiac artery b. superior mesenteric artery c. inferior mesenteric artery d. portal vein e. umbilical vein

B. the superior mesenteric plexus is an autonomic netwreok around the badse of the superior mesenteric artery. Presynaptic sympathetic fibers synapse at this location, and post synaptic sympathetic fibers follow branches of this artery to distribute to the midgut organs, indlucing the ascending colon. Presynaptic parasympathetic fibers from the vagus nerve and visceral afferents also pass through this plexus en route to and from the midgut

a 60 yo man is dx with a posterior abdominal wall tumor that is causing lesions in the superoir mesenteric plexus. Which of the following pathways is most likely affected? a. parasympathetic supply to the posterior aspect of the stomach b. sympathetic supply to the ascending colon c. lymph drainage from the liver d. venous drainage from the transverse colon e. visceral afferents from the proximal duodenum

E. the vagus nerve conveys parasymp. fibers to the gut tube and its derivatives as far distally as the left (splenic) flexure of the transverse colon. the second part of the duodenum is the only listed organ distal to the iatrogenic injury to the stomach but proximal to the left colic flexure. (parasymp loss)

a 62 yo woman undergoes a Nissen fundoplication, in which the fundus of the stomach is completely sutured aroung the gastroesophageal jx, to treat sever case of gastroesophageal reflux disease (GERD). during the procedure, the surgeon accidentally damages the right (posterior) vagal trunk while inserting staples into the stomach. Which of the following organs is most likely affected? a. esophagus b. urinary bladder c. descending colon d. prostate gland e. second part of the duodenum

c. foregut-derived organs; stomach, liver, pancreas and proximal half of duodenum are all innervated by the greater splanchnic nerves (T5-T9) and generally refer pain to the epigastric region.

a 63 yo woman presents with lethargy and unremitting epigastric pain. She is 5'6" and 170 lbs and has smoked for 44 years. She has lost 5 lbs in the last week despite eating normalle. She reports that her skin and eyes have started to yello. She has midline epigastric pain, which also radiates to her back. The pain sometimes gets worse with eating but becomes unbearable and interferes with sleeping. What nerves likely carry her pain and what dx should she fear most? a. greater splanchnic nerves; ascites from cirrhosis b. greater splanchnic nerves; duodenal cancer c. greater splanchnic nerves; pancreatic adenocarcinoma d. lesser splanchnic nerves; gallstones e. lesser splanchnic nerves; gastric carcinoma

D. inferior mesenteric a catheter is passed into the origin of the inferior mesenteric artery (IMA) to produce the given arteriogram. This plain film shows a bleeding diverticulum, stained by contrast material in the descending colon. This finding leads to the lower GI bleed and associated symptoms in this patient. Lower GI bleeds lead to blood in the fecal matter of the patient and do not present with vomiting of blood, which is indicative of an upper GI bleed.

a 67 yo woman comes to the ER after experiencing 2 days of red blood in her feces. She reports no vomiting of blood (hematemesis). the given arteriogram shows a stain of contrast material, indicated by the white arrow, at a bleeding diverticulum. What artery gives off direct branches to supply the bleeding portion of the GI tract? a. abdominal aorta b. celiac trunk c. superior mesenteric d. inferior mesenteric e. external iliac

e. The sigmoidoscope may be used for tx as well as dx. the sigmoidoscope can be used specifically to straighten the sigmoid colon if it has twisted. Volvulus is a twisting of the bowel on itself, cutting off its blood supply and blocking luminal passage. this can occur along the small intestine or at the sigmoid colon

a 78 yo man is brought to the ED by his wife. The man is doubled over with sudden onset of lower abdominal pain after eating dinner at an "all you can eat" buffet. The man's abdomen is distended, with vague lower left abdominal pain and he states that he cannot pass any gas. Bowel sounds are extensive in the upper abdomen, but are lacking in the left lower ab. The GI is asked to bring a sigmoidoscope. What condition does this patient have and how might a sigmoidoscope help? a. colitis; the sigmoidoscope will be able to visualize the lining of the rectum and colon and confirm the dx b. peptic ulcer; the sigmoidoscope will show a normal colon c. diverticulosis; the sigmoidoscope will be able to visualize the multiple diverticulua, thus confirming the dx d. meckel diverticulum; the sigmoidoscope will be able to visualize the typically 2 inch long diverticulum e. sigmoid volvulus; the sigmoidoscope may actually be used to help straighten the sigmoid colon if it has twisted on itself

e. esophageal hiatus

a malignant tumor is located in the posterior mediastinum; near the esophasgus, the heart and superior surface of the diaphragm. This tumor has also extended into the abdominal cavity and is near the cardia and fundus of the stomach. What was the most likely access pt for this tumor to get into the abdominal region? a. medial arcuate ligament b. caval opening c. deep inguinal ring d. omental foramen e. esophageal hiatus f. gastric canal g. ureteric orfices

a. horseshoe kidney

a middle aged man presents to his doc with vague abdominal pain. Based on the review of the following medical image what is the most likely dx? a. horseshoe kidney b. polycystic kidney c. left renal agenesis d. left renal vein entrapment e. renal calculus in right ureter

c. the splenic a. orignates from the celiac trunk and courses tortuously along the posterior aspect of the pancreas.

a patient complained of severe abdominal pain on several occasions, but nos cause could be identified. She was recently diagnosed with polyarteritis nodosa so an abdominal arteriogram is ordered to determine whether there are abdominal vascular changes that would explain her abdominal pain. On her arteriogram there is a tortuous large diameter vessel indicated by the arrow. What is this vessel? a. left gastric a. b. superior mesenteric a. c. splenic a. d. right gastric a e. right gastro-omental artery

a. epiploic foramen (there is a greater and lesser sac and this is the access pt where they communicate

a patient presents with acute abdominal pain and fever. Examination of her abdomen reveals ascites within the lesser sac, which is now draining into the greater peritoneal sac. Which of the following accounts for the seepage of fluid from the lesser sac to the greater sac? a. epiploic foramen b. hepatorenal recess c. gastric canal d. left subphrenic space

f. left quadratus lumborum muscle (this is @ rib 12)

a person has sustained blunt force trauma to the body and several rib fx can be seen in the medical image. Which of the following structures could have its fn affected due to the fx indicated by the yellow circle? a. right subcostal nerve b. left obturator nerve c. right renal vein d. left iliacus muscle e. right superior suprarenal artery f. left quadratus lumborum muscle

b. proper hepatic a.

a resident is assisting the chief surgeon during abdominal surgery and mistakenly clamped the hepatoduodenal ligament. Which of the following structures would most likely be occluded as a result? a. common hepatic a. b. proper hepatic a. c. hepatic vein d. main pancreatic duct e. esophageal vein

c. left renal vein

a very large abdominal aortic aneurysm located in the area close to where the superior mesenteric artery branches from off the aorta, could most likely affect and lead to compression of which of the following? a. superior part of duodenum b. descending part of the duodenum c. left renal vein d. right renal vein e. left common iliac a. f. right common iliac a. g. median sacral a. h. inferior mesenteric a.

c. obstruction of any portion of the biliary tree will produce symptoms of gallbladder obstruction.

a woman presents with gallstones and no jaundice. She is prepared for exploratory surgery. The lesser omentum is incised close to its free edge, and the biliary tree is identified and freed by blunt dissection. The liquid contents of the gallbladder are aspirated with a syringe, the fundus incised, and the stones are removed, The entire duct system is carefully probed for stones, one of which is found to be obstructing a duct. In view of her symptoms, which is the most probable location of the obstruction? a. the bile duct b. common hepatic duct c. cystic duct d. within the duodenal papilla proxiumal to the juncture with the pancreatic duct e. within the duodenal papilla distal to the juncture with the pancreatic duct

c. the middle colic artery from the superior mesenteric artery as well as the anastomoses of all these arteries with the superior, middle and inferior hemorrhoidal arteries will maintain the blood supply to the left portion of the colon.

after complete occlusion of the origin of the inferior mesenteric artery with a blood clot, the blood supply of the left portion of the colon is maintained by the following arteries except which? a. marginal artery b. middle colic artery c. left lumber arteries d. anastomoses between the superior, middle and inferior hemorrhoidal arteries e. sigmoid arteries

d. the part of the duodenum that has the hepatoduodenal ligament attached to it (SAD PUCKER)

all of the following are considered retroperitoneal structures except which one? a. inferior vena cava b. the segment of the ureter that crosses over the testicular artery and vein c. head of pancreas d. the part of the duodenum that has the hepatoduodenal ligament attached to it e. distal esophagus f. the part of the ascending colon just before the right colic flexure

e. relaxation of the teniae coli in descending colon. destriuction of the sacral spinal cord will eliminate parasympathetic outflow to the hindgut, pelvic organs and perineum as well as somatic innervation to much of the pelvis and lower limbs.

an 18 yo boy is brough to the ER after suffering a gunshot wound to his back. Radiographic imaging reveals extensive damage to the neural arches of the L1 and L2 vertebrae, with bone and bullet fragments lodged in the vertebral canal at these levels. Comprehensive neurologic examination indicates destruction of sacral segments of the spinal cord. Which of the following functional outcomes is most likely present? a. reduced swet gland secretion in the abdominal wall b. decreased motility in the duodenum c. increased motility in the ileum d. paralysis of the psoas major muscle e. relaxation of the teniae coli in the descending colon

B. cancer cells from a lesion within the missle aspect of the transverse colon would likely metastasize in the superior mesenteric lymph nodes in advanced cancer staging. The sup. mes. lymph nodes lie in the mesentery along the artery and recieve lymph drainage from the embryonic midgut

an axial CT of a 52 yo man reveals a cancerous lesion in the middle aspect of the transverse colon compressing the lumen of the otherwise radiolucent colon. Based upon the location of the tumor, which of the following lymph nodes groups would first receive metastasizing cells from this cancerous lesion? a. ileocolic b. superior mesenteric c. celiac d. internal iliac e. inferior mesenteric

B because the appendix is on that side B and F are both psoas majors C is quadratus lumborum

an inflamed appendix can be irritated by friction due to contact with which of the following structures as it stretches/moves?

c. common bile duct

an obese 52 yo woman presents in the clinic with right upper quadrant pain that is severe for the past 48 hours, jaundice for the last 24 hours, and nausea. The pain intensifies after she tries to eat a meal. A dx of cholelithiasis is made. Which of the following structures is most likely obstructed by the stone? a. pyloric sphincter b. omental foramen c. common bile duct d. main pancreatic duct e. left hepatic duct

b. liver

an organ is experiencing an ailment, and referring pain to the area outlined in blue? Which of the following organs would it most likely be? a. spleen b. liver c. appendix d. jejunum e. sigmoid colon

D

bacteria from diverticulitis of the proximal two thirds of the transverse colon are likely to spread via lymph vessels to the: a. inferior mesenteric nodes b. celiac nodes c. para-aortic nodes d. superior mesenteric nodes e. left renal nodes

c. prox duodenum

clinically, inflammation in which of the following organs is LEAST likely to present as periumbilical pain? a. cecum b. proximal transverse colon c. proximal duodenum d. ileum e. proximal jejunum

d. the major artery that is going to be reconnected is the marginal artery and the superior and inferior mesenteric lymph nodes will be colected. About a foot long section of the splenix flexure along with the marginal artery and vein, paracolic lymph nodes and adjacent mesentery would all be surgically removed. The splenic flexure receives blood from the marginal artery. Blood forom the splenic flexure portion of the marginal artery comes from both the middle colic artery, which is a branch off the superior mesenteric artery and from the left colic, which is a branch off the inferior mesenteric artery

colorectal carcinoma at the splenic flexure of the colon is dx in a 55 yo man following endoscopy and frozen and paraffin section pathology. About a foot long section of large intestine is removed, which includes part of the transverse and descending colon. The surgeon reattaches the cut ends to each other, reconnects a major artery, and collects numberous lymph nodes. Which one of the following major arteries will be reconnected and which lymph nodes will be connected? a. aorta; splenic and suprarenal lymph nodes b. splenic artery; splenic and suprarenal lymph nodes c. marginal artery; splenic and superior mesenteric lymph nodes d. marginal artery; superior and inferior mesenteric lymph nodes e. sigmoid artery; left colic and sigmoidal nodes

d. lineorenal ligament ( the linreorenal ligament is the portion of the greater omentum that connects the hilum of the spleen with the left kidney. It conveys the splenic vessels and also contains the tail of the pancreas. The mesenteries are double layers of peritoneum that support the abdominopelvic viscera and transmit associated neurovascular structures. The splenic artery is the largest branch of the celiac trunk. It weaves along the superior border of the pancreas, fundus and greater curvature of the stomach and greater omentum)

during a splenectomy, a surgeon carefully dissects the peritoneal ligament containing the splenic vessels at the hilum of the spleen. Which of the following peritoneal ligaments is being dissected by the surgeon? a. hepatoduodenal ligament b. coronary ligament c. transverse ligament d. lienorenal ligament e. gastrolienal ligament

e proper hepatic ( the proper hepatic artery travels within the free edge of the hepatoduodenal ligament of the lesser omentum. Compression of this artery would reduce blood loss from the cut surface of the cystic artery. The proper hepatic artery supplies the gallbladder, liver and upper biliary tract. Within the hepatoduodenal ligament, it parallels the bile duct and the portal vein. These 3 structures (portal triad) are enveloped within the free edge of the lesser omentum, specifically at its hepatoduodenal component.

during surgery to remove the gallbladder (cholecystectomy), a surgery resident damages the cystic artery before a clamp is properly placed. the attending physician applies pressure to the free edge of the hepatoduodenal ligament of the lesser omentum to control the bleeding until the damaged artery is clamped and ligated. Which of the following arteries was compressed by the attending? a. celiac b. splenic d. gastroduodenal d. common hepatic e. proper hepatic

D. the two phrenic nerves innervate the diaphragm and they arise from spinal nerves that leave the spinal cord between vertebrae C3-C5

how is the diaphragm innervated? a. by the parasympathetic division arising from the sacral region b. by the spinal nerves arising from T5-T10 c. by the phrenic nerves arising from C5-C7 d. by the phrenic nerves arising from C3-C5

B

lymphatic spread of carcinoma of the sigmoid colon is likely to metastasize to the: a. left common iliac nodes b. inferior mesenteric nodes c. superoir mesenteric nodes d. celiac nodes e. para-aortic nodes

d. esophageal vein

obstruction to portal blood flow through the liver would lead to dilation of which of the following structures? a. superior rectal artery b. common bile duct c. left colic a. d. esophageal vein e. main pancreatic duct f. inferior vena cava

b. enlargement of the GB is common complication of gallstone development. If the GB enlarges sufficiently and becomes inflamed then it can contact the inferior surface of the diaphragm, leading to right-sided shoulder/neck pain. The liver if inflamed would also produce right sided shoulder neck pain.

pathology within some abdominal organs can occasionally cause referred pain in the shoulder and neck regions, C3 to C5, because the diaphragm receives its motor and afferent innervation from this level as a result of its cranial embryonic development. Which one of the following abdominal organs causes unilateral shoulder/neck pain and which side of body is affected? a. liver; left side b. GB; right side c. pancreas; right side d. spleen; right side e. appendix; left side

A. the descengin colon is conrolled by the parasymp innervation from the pelvic splanchnic nerves. Control of peristalsis is principally a fn of the parasymp division of the autonomic nervous system

sympathectomy may occasionally relieve intractable pain of visceral origin, since visceral afferent pain fibers run along the symp pathways in the abdomen. The autonomic control of peristalsis in the descending colon should not be affected by bilateral lumbar sympathectomy for which one of the following reasons? a. the descending colon is controlled cheifly by parasymp innervation from the pelvic splanchnic nerves b. the descending colon receives its parasympathetic innervation from the vagus nerve c. the descending colon receives from L1, L2, and L3 only innervated the pelvic viscera via the hypogastric nerve only presynaptic sympathetic fibers have been severed

c. the aorta bifurcates into the two common iliac arteries at the level of the fourth lumbar vertebra

the following statements concerning the abdominal aorta are correct except which? a. the aorta lies in the midline of the abdomen b. the aorta bifurcates into the right and left common iliac arteries c. the level of bifurcation of the aorta is the fifth lumbar vertebra d. the aorta lies on the left side of the inferior vena cava e. the aorta is related to the anterior surface of the bodies of the lumbar vertebrae

a. the renal papillae open directly into the minor calyces of the kidney

the following statements concerning the right kidney are correct except which? a. the renal papillae open directly into the major calyces b. the kidney lies slightly lower than the left kidney c. the right suprarenal gland covers its upper pole d. the medulla is composed of approx twelve renal pyramids e. at the junction of the renal pelvis with the ureter, the lumen of the ureter is narrowed

d. the inferior mesenteric vein is a tributary of the splenic vein

the following veins drain directly into the inferior vena cava except which? a. hepatic veins b. renal veins c. lumbar veins d. inferior mesenteric vein e. right testicular (ovarian vein

c. superior mesenteric this artery supplies the embryological midgut from the second part of the duodenum to the distal one third of the transverse coln. Branches of this artery, specifically ileal branches need to be ligated before surgical repair of this diverticulum occurs. the ileal (Meckel) diverticulum depicted in this contrast radiograph is a true congenital diverticulum that is a vestigial remnant of the vitelline duct located in the distal ileum

the given contrast radiograph of the small intestine shows a barium-filled diverticulum of the ileum identified by the white arrow. Branches of what artery will need to be ligated during surgical removal of this diverticulum? a. celiac b. renal c. superior mesenteric d. inferior mesenteric e. umbilical

a. the jejunum usually has only one or two arterial arcades with long branches passing to the intestinal wall

the jejunum and ileum can be differentiated on the basis of the following anatomic features except which? a. numerous (four to five) arterial arcades are associated with the jejunum b. the plicae circulares are much more prominent in the jejunum than in the ileum c. fat depositions are generally present throughout the mesentery associated with the ileum d. the jejunum is generally located in the upper left region of the abdominal cavity e. Peyer's patches are characteristic of the lower ileum and may be visible on the surface

c. splenic artery

the left gastroepiploic artery originates from the... a. inferior mesenteric a. b. superior mesenteric a. c. splenic a. d. celiac a. e. left renal a.

c. collecting ducts empty into the papilla, so the papilla must be first

which list of structures is presented in the correct order in which urine passes through them on the way to the bladder? a. ureter, minor calyx, major calyx, renal pelvis, papilla b. renal pelvis, major calyx, minor calyx, papilla, ureter c. papilla, minor calyx, major calyx, renal pelvis, ureter d. minor calyx, major calyx, papilla, renal pelvis, ureter