Anatomy Abdomen BRS - Part 2

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Anatomy Abdomen BRS - Part 2 - Quiz


Questions and Answers
  • 1. 

    A 19-year-old man with ruptured appendix is sent to the emergency department for surgery. To cut off the blood supply to the appendix (if collateral circulation is discounted), a surgeon should ligate which of the following arteries?

    • A.

      Middle colic artery

    • B.

      Right colic artery

    • C.

      Ileocolic colic artery

    • D.

      Inferior mesenteric artery

    • E.

      Common iliac artery

    Correct Answer
    C. Ileocolic colic artery
    Explanation
    The appendicular artery is a branch of the ileocolic artery. The other arteries do not supply the appendix. The middle colic and right colic arteries are branches of the superior
    mesenteric artery. The Inferior mesenteric artery passes to the left behind the peritoneum and distributes to the descending and sigmoid colons and the upper portion of the rectum. The common
    iliac arteries are bifurcations from the aorta.

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  • 2. 

    Because of an inflammatory bowel disease (Crohn's disease) and a small bowel obstruction leading to bowel ischemia, an elderly woman requires bypass of her ileum and jejunum and is scheduled for a gastrocolostomy. The surgeon will ligate all arteries that send branches to the stomach. Which of the following arteries may be spared?

    • A.

      Splenic artery

    • B.

      Gastroduodenal artery

    • C.

      Inferior pancreaticoduodenal artery

    • D.

      Left gastroepiploic artery

    • E.

      Proper hepatic artery

    Correct Answer
    C. Inferior pancreaticoduodenal artery
    Explanation
    The inferior pancreaticoduodenal artery does not supply the stomach. All of the other arteries supply the stomach. Gastrocolostomy is used to establish a communication between the stomach and colon, bypassing the small inte st tne when the patient has Crohn's disease (inflammation disease) and small bowel obstruction.

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  • 3. 

    A 38-year-old woman with peptic ulcer disease of the stomach experiences severe abdominal pain. Which of the following nervous structures would most likely be involved?

    • A.

      Greater splanchnic nerve

    • B.

      Ventral roots of the spinal nerve

    • C.

      Lower intercostal nerve

    • D.

      Vagus nerve

    • E.

      Gray ramus communicans

    Correct Answer
    A. Greater splanchnic nerve
    Explanation
    The greater splanchnic nerve carries pain fibers from the upper gastrointestinal (GI) tract. Neither the ventral roots of the spinal nerves nor the gray rami corn municantes
    contain sensory nerve fibers. The vagus nerve contains sensory fibers associated with reflexes, but it does not contain pain fibers. The lower intercostals nerves carry general somatic afferent (GSA)
    pain fibers from the diaphragm, abdominal wall, and peritoneum but not general visceral afferent (GVA) pain fibers from the GI tract.

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  • 4. 

    . Before beginning a cesarean section (Csection) in a pregnant woman with a genital herpes infection, the obstetrician noted that she had an aponeurosis of the transverse abdominal muscle. This aponeurosis most likely contributes to the formation of which of the following?

    • A.

      Anterior layer of the rectus sheath below the arcuate line

    • B.

      Anterior layer of the rectus sheath above the umbilicus

    • C.

      Posterior layer of the rectus sheath below the arcuate line

    • D.

      Deep inguinal ring

    • E.

      Lacunar ligament

    Correct Answer
    A. Anterior layer of the rectus sheath below the arcuate line
    Explanation
    The anterior layer of the rectus sheath below the arcuate line is formed by aponeuroses of the external and internal oblique and transverse abdominal muscles, but there is no posterior layer of the rectus sheath below the arcuate line. The anterior layer of the rectus sheath above the umbilicus is formed by aponeuroses of the external and internal oblique abdominal muscles. The deep inguinal ring lies in the transversalis fascia. The lacunar ligament is formed by the external oblique abdominal aponeurosis.

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  • 5. 

    Examination of a 54-year-old man reveals an isolated tumor located at the porta hepatis. This tumor most likely compresses which of the following structures?

    • A.

      Cystic duct

    • B.

      Hepatic veins

    • C.

      Common hepatic artery

    • D.

      Left gastric artery

    • E.

      Branches of the portal vein

    Correct Answer
    E. Branches of the portal vein
    Explanation
    The porta hepatis is the transverse fissure (doorway) in the liver and contains the hepatic ducts, hepatic arteries, and branches of the portal vein. "the other structures are not found in the porta hepatis.

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  • 6. 

    A patient is rushed to the operating room for an emergent cholecystectomy (resection of a gallbladder) because of cholecystitis. While locating landmarks before surgical resection of an infected gallbladder, the surgeon recalls that one pair of veins forms a portal-caval anastomosis. Which of the following pairs of veins form a portal-caval anastomosis?

    • A.

      Hepatic veins and inferior vena cava

    • B.

      Superior and middle rectal vein

    • C.

      Left and right gastric veins

    • D.

      Inferior and superficial epigastric veins

    • E.

      Suprarenal and renal veins

    Correct Answer
    B. Superior and middle rectal vein
    Explanation
    Portal-caval anastomoses occur between the left gastric vein and esophageal vein of the azygos, the superior rectal and middle or inferior rectal veins, paraumbilical and superficial epigastric veins, and retrocolic veins and twigs of the renal vein. The hepatic veins and the inferior vena cava are systemic or caval veins. The left and right gastric veins belong to the portal venous system. The inferior and superficial epigastric veins and the suprarenal and renal veins are systemic veins.

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  • 7. 

    Mrs. Jones is undergoing a routine colonoscopy for colon cancer prevention. The gastroenterologist finds a Meckel's diverticulum. Which of the following statements is true about the diverticulum?

    • A.

      It is found 2 feet distal to the ileocecal junction

    • B.

      It is located on the mesenteric side of the ileum

    • C.

      It occurs in about 20% of the population

    • D.

      It is a persistent remnant of the embryonic yolk sac

    • E.

      It may contain renal and suprarenal Tissues

    Correct Answer
    D. It is a persistent remnant of the embryonic yolk sac
    Explanation
    The Meckel's diverticulum is a persistent remnant of the yolk stalk (vitelline duct) and located 2 feet proximal to the ileocecal junction on the antimesenteric border of the ileum. It is about 2 inches long, occurs in about 2% of the population, and contains two types of mucosal (gastric and pancreatic) tissues in its wall.

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  • 8. 

    A 54-y/o man comes to an ER  with abdominal pain, jaundice, loss of appetite, and weight loss. On examination of his radiograms and computed tomography (CT) scans, a physician finds a slowly growing tumor in the uncinate process of the pancreas. Which of the following structures is most likely compressed by this tumor?

    • A.

      Main pancreatic duct

    • B.

      Splenic artery

    • C.

      Portal vein

    • D.

      Superior mesenteric artery

    • E.

      Superior pancreaticoduodenal artery

    Correct Answer
    D. Superior mesenteric artery
    Explanation
    The uncinate process of the pancreas is a projection of the lower part of the head to the left behind the superior mesenteric vessels. The superior pancreaticoduodenal artery runs between the duodenum and the head of the pancreas. The main pancreatic runs transversely through the entire pancreas superior to the uncinate process. The splenic artery runs along the superior border of the pancreas. The portal vein runs behind the neck of the pancreas.

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  • 9. 

    A 6-year-old boy comes to his pediatrician with a lump in the groin near the thigh and pain in the groin. On examination, the physician makes a diagnosis of a direct inguinal hernia because the herniated tissue:

    • A.

      Enters the deep inguinal ring

    • B.

      Lies lateral to the inferior epigastric artery

    • C.

      Is covered by spermatic fasciae

    • D.

      Descends into the scrotum

    • E.

      Develops after birth

    Correct Answer
    E. Develops after birth
    Explanation
    A direct hernia is acquired (develops after birth), whereas an indirect inguinal hernia is congenital. The direct hernia does not enter the deep inguinal ring but occurs through the posterior wall of the inguinal canal, lies medial to the inferior epigastric artery, is covered only by peritoneum, and does not descend into the scrotum.

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  • 10. 

    A 21-year-old young man was lifting heavy boxes while moving into his new house. During the repair of his resulting hernia, the urologist recalls that the genitofemoral nerve:

    • A.

      Runs in front of the quadratus lumborum

    • B.

      Is a branch of the femoral nerve

    • C.

      Supplies the testis

    • D.

      Passes through the deep inguinal ring

    • E.

      Gives rise to an anterior scrotal branch

    Correct Answer
    D. Passes through the deep inguinal ring
    Explanation
    The genitofemoral nerve descends on the anterior surface of the psoas muscle and gives rise to a genital branch, which enters the inguinal canal through the deep inguinal
    ring to supply the cremaster muscle, and a femoral branch, which supplies the skin of the femoral triangle. The genitofemoral nerve is not a branch of the femoral nerve but arises from the lumbar
    plexus, and does not supply the testis. It is the ilioinguinal nerve that gives rise to an anterior scrotal branch.

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  • 11. 

    An oncologist is reviewing a computed tomography (CT) scan of a 74-year-old man with newly diagnosed hepatocellular carcinoma. He locates the affected quadrate lobe of the liver that:

    • A.

      Lies between the inferior vena cava and ligamentum venosum

    • B.

      Receives blood from the right hepatic artery

    • C.

      Drains bile into the left hepatic duct

    • D.

      Is a medial superior segment

    • E.

      Is functionally a part of the right lobe

    Correct Answer
    C. Drains bile into the left hepatic duct
    Explanation
    The quadrate lobe of the liver drains bile into the left hepatic duct and receives blood from the left hepatic artery. It lies between the gallbladder fossa and the ligamentum teres hepatic, is a medial inferior segment, and is a part of the left lobe.

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  • 12. 

    A 58-year-old man is presented with edema of the lower limb and enlarged superficial veins of the abdominal wall. Examination of radiographs and angiograms reveals obstruction of the inferior vena cava just proximal to the origin of the renal vein. This venous blockage may result in dilation of which of the following veins?

    • A.

      Left suprarenal vein

    • B.

      Right inferior phrenic vein

    • C.

      Right hepatic vein

    • D.

      Left gastric vein

    • E.

      Portal vein

    Correct Answer
    A. Left suprarenal vein
    Explanation
    The veins distal to obstruction are dilated, but the veins proximal to obstruction are not dilated but have low blood pressure. The suprarenal vein drains into the left renal vein and thus is dilated because of high pressure. The right phrenic and right hepatic veins drain into the inferior vena cava above the obstruction. The left gastric vein joins the portal vein, which enters the liver.

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  • 13. 

    A physical fitness trainer for a young Hollywood movie star explains the reasons for 100 stomach crunches a day. The young star, a medical student before "hitting it big" reaffirms to his trainer that the lateral margin of the rectus abdominis, the muscle responsible for a washboard stomach, defines which one of the following structures?

    • A.

      Linea alba

    • B.

      Linea semilunaris

    • C.

      Linea semicircularis

    • D.

      Transversalis fascia

    • E.

      Falx inguinalis

    Correct Answer
    B. Linea semilunaris
    Explanation
    The linea semilunaris is a curved line along the lateral border of the rectus abdominis. The linea alba is a tendinous median raphe between the two rectus abdominis muscles. The linea semicircularis is an arcuate line of the rectus sheath, which is the lower limit of the posterior layer of the rectus sheath. The falx inguinalis (conjoint tendon) is formed by aponeuroses of the internal oblique and transverse abdominal muscles (otherwise known as the transversalis fascia).

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  • 14. 

    During surgical treatment of portal hypertension of a 59-year-old man with liver cirrhosis, a surgeon inadvertently lacerates the dilated paraumbilical veins. The veins must be repaired to allow collateral flow. Which of the following ligaments is most likely severed?

    • A.

      Lienorenal ligament

    • B.

      Lienogastric ligament

    • C.

      Gastrophrenic ligament

    • D.

      Ligamentum teres hepatis

    • E.

      Ligamentum venosum

    Correct Answer
    D. Ligamentum teres hepatis
    Explanation
    The paraumbilical veins and the ligamentum teres hepatis are contained in the free margin of the falciform ligament. The lienorenal ligament contains the splenic vessels
    and a small portion of the tail of the pancreas. The lienogastric ligament contains the left gastroepiploic and short gastric vessels. The gastrophrenic ligament contains no named structures.
    The hepatoduodenal ligament, a part of the lesser omentum, contains the bile duct, proper hepatic artery, and portal vein in its free margin.

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  • 15. 

    A 43-year-old woman is admitted to a hospital because of deep abdominal pain in her epigastric region. On examination, it is observed that a retroperitoneal infection erodes an artery that runs along the superior border of the pancreas. Which of the following arteries is likely injured?

    • A.

      Right gastric artery

    • B.

      Left gastroepiploic artery

    • C.

      Splenic artery

    • D.

      Gastroduodcnal artery

    • E.

      Dorsal pancreatic artery

    Correct Answer
    C. Splenic artery
    Explanation
    The splenic artery arises from the celiac trunk, runs along the superior border of the pancreas, and enters the spleen through the lienorenal ligament and the hilus of the spleen. The right gastric artery runs along the lesser curvature of the stomach, and the left gastroepiploic artery runs along the greater curvature of the stomach. "I he gastroduodenal artery runs behind the first part of the duodenum. The dorsal pancreatic artery descends behind the neck of the pancreas and divides into right and left branches to supply the pancreas.

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  • 16. 

    A 19-year-old young woman with a long history of irritable bowel syndrome presents for the possibility of surgical resection of the gastrointestinal (GI) tract where the vagal parasympathetic innervation terminates. Which of the following sites is most appropriate for surgical resection?

    • A.

      Duodenojejunal junction

    • B.

      Ileocecal junction

    • C.

      Right colic flexure

    • D.

      Left colic flexure

    • E.

      Anorectal junction

    Correct Answer
    D. Left colic flexure
    Explanation
    The vagus nerve supplies parasympathetic nerve fibers to the gastrointestinal (GI) tract and terminates approximately at the left colic flexure (junction of the transverse
    colon and the descending colon). The duodenojejunal junction, ileocecal junction, and right colic flexure are supplied by the vagus nerve. The descending colon, sigmoid colon, rectum, anal canal, and anorectal junction are supplied by the pelvic splanchnic nerve for parasympathetic innervation.

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  • 17. 

    A 58-year-old man is admitted to a hospital with severe abdominal pain, nausea, and vomiting resulting in dehydration. Emergency computed tomography (CT) scan reveals a tumor located between the celiac trunk and the superior mesenteric artery. Which of the following structures is likely compressed by this tumor?

    • A.

      Fundus of the stomach

    • B.

      Neck of the pancreas

    • C.

      Transverse colon

    • D.

      Hepatopancreatic ampulla

    • E.

      Duodenojejunal junction

    Correct Answer
    D. Hepatopancreatic ampulla
    Explanation
    The pyloric canal and the neck of the pancreas are situated anterior to the abdominal aorta between the origin of the celiac trunk and the superior mesenteric artery. The transverse colon passes anterior to the superior mesenteric artery and the third part of the duodenum. The other structures are not located in front of the aorta.

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  • 18. 

    An emergent hernia repair is scheduled. As the attending physician is driving to the hospital, the medical student assisting on the case quickly reviews his anatomy atlas and is trying to commit to memory that the internal oblique abdominis muscle contributes to the formation of which of the following structures?

    • A.

      Inguinal ligament

    • B.

      Deep inguinal ring

    • C.

      Falx inguinalis

    • D.

      Internal spermatic fascia

    • E.

      Reflected inguinal ligament

    Correct Answer
    C. Falx inguinalis
    Explanation
    The falx inguinalis (conjoint tendon) is formed by the aponeuroses of the internal oblique and transverse muscles of the abdomen. The inguinal ligament is formed by
    aponeurosis of the external oblique abdominal muscle and the reflected inguinal ligament is formed by certain fibers of the inguinal ligament reflected from the pubic tubercle upward toward the linea alba. The deep inguinal ring lies in the transversalis fascia, and the internal spermatic fascia is formed by the transversalis fascia.

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  • 19. 

    A 9-year-old girl has crashed into her neighbor's brick fence while riding her bike and is brought to the emergency department with a great deal of abdominal pain. Her radiogram and angiogram show laceration of the superior mesenteric artery immediately distal to the origin of the middle colic artery. If collateral circulation is discounted, which of the following organs may become ischemic?

    • A.

      Descending colon

    • B.

      Duodenum

    • C.

      Pancreas

    • D.

      Ascending colon

    • E.

      Transverse colon

    Correct Answer
    D. Ascending colon
    Explanation
    The right colic and ileocolic arteries arise from the superior mesenteric artery distal to the origin of the middle colic artery. The right colic artery may arise from the ileocolic artery and supplies the ascending colon. The duodenum and pancreas receive blood from the inferior pancreaticoduodenal artery and superior pancreaticoduodenal. The pancreas is also supplied by the splenic artery of the celiac trunk. The transverse colon receives blood from the middle colic artery. The descending colon is supplied by the left colic artery, which is a branch of the inferior mesenteric artery.

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  • 20. 

    A 53-year-old woman with known kidney disease presents to a hospital because her pain has become increasingly more severe. A physician performing kidney surgery must remember that:

    • A.

      The left kidney lies a bit lower than the right one

    • B.

      The peri-renal fat lies external to the renal fascia

    • C.

      The renal fascia does not surround the suprarenal gland

    • D.

      The left renal vein runs anterior to both the aorta and the left renal artery

    • E.

      The right renal artery is shorter than the left one

    Correct Answer
    D. The left renal vein runs anterior to both the aorta and the left renal artery
    Explanation
    The left renal vein runs anterior to both the aorta and the left renal artery. The renal fascia lies external to the perirenal fat and internal to the pararenal fat, and it also surrounds the suprarenal gland. The right renal artery runs behind the inferior vena cava and is longer than the left renal artery. Because of the large size of the right lobe of the liver, the right kidney lies a little lower than the left.

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  • 21. 

    Which structure is hematopoietic in early life and later destroys worn out red blood cells?

    • A.

      A

    • B.

      B

    • C.

      C

    • D.

      D

    • E.

      E

    Correct Answer
    E. E
    Explanation
    The spleen lies in the left hypochondriac region, is hematopoietic in early life, and later functions in worn-out red blood cell destruction. It filters blood, stores red blood
    cells, and produces lymphocytes and antibodies.

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  • 22. 

    Which structure runs along the superior border of the pancreas and enters the lienorenal ligament?

    • A.

      A

    • B.

      B

    • C.

      C

    • D.

      D

    • E.

      E

    Correct Answer
    D. D
    Explanation
    The splenic artery is a branch of the celiac trunk, follows a tortuous course along the superior border of the pancreas, and divides into several branches that run through the
    lienorenal ligament.

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  • 23. 

    . Which structure is divided into the proper hepatic and gastroduodenal arteries?

    • A.

      A

    • B.

      B

    • C.

      C

    • D.

      D

    • E.

      E

    Correct Answer
    A. A
    Explanation
    The common hepatic artery is divided into the proper hepatic and gastroduodenal arteries.

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  • 24. 

    Which structure provides an attachment of the suspensory muscle of the duodenum (ligament of Treitz)?

    • A.

      A

    • B.

      B

    • C.

      C

    • D.

      D

    • E.

      E

    Correct Answer
    B. B
    Explanation
    The duodenojejunal flexure is supported by a fibromuscular band called the suspensory ligament of the duodenum (ligament of Treitz), which is attached to the right crus of the diaphragm.

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  • 25. 

    Which structure is retroperitoneal in position and receives blood from the splenic artery?

    • A.

      A

    • B.

      B

    • C.

      C

    • D.

      D

    • E.

      E

    Correct Answer
    C. C
    Explanation
    The pancreas is an endocrine and exocrine gland; is retroperitoneal in position; arid receives blood from the splenic, gastroduodenal, and superior mesenteric arteries.

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  • 26. 

    Which structure is a direct branch of the aorta and supplies blood to the ascending and transverse colons?

    • A.

      A

    • B.

      B

    • C.

      C

    • D.

      D

    • E.

      E

    Correct Answer
    D. D
    Explanation
    The superior mesenteric artery, a direct branch of the aorta, supplies blood to the ascending and transverse colons.

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  • 27. 

    Which structure receives blood from the liver and kidney and enters the thorax by piercing the central tendon of the diaphragm?

    • A.

      A

    • B.

      B

    • C.

      C

    • D.

      D

    • E.

      E

    Correct Answer
    B. B
    Explanation
    The inferior vena cava, which receives blood from the liver, kidneys, and other abdominal structures, enters the thorax through the vena caval foramen to empty into the right atrium.

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  • 28. 

    Which structure receives bile, concentrates it by absorbing water and salt, and stores it?

    • A.

      A

    • B.

      B

    • C.

      C

    • D.

      D

    • E.

      E

    Correct Answer
    A. A
    Explanation
    The gallbladder receives bile, concentrates it by absorbing water and salt, and stores it.

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  • 29. 

    Which structure receives blood from the left gonad and suprarenal gland?

    • A.

      A

    • B.

      B

    • C.

      C

    • D.

      D

    • E.

      E

    Correct Answer
    E. E
    Explanation
    The left renal vein runs anterior to the aorta but posterior to the superior mesenteric artery and receives blood from the gonad and suprarenal gland.

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  • 30. 

    Which structure runs behind the inferior vena cava?

    • A.

      A

    • B.

      B

    • C.

      C

    • D.

      D

    • E.

      E

    Correct Answer
    C. C
    Explanation
    The right renal artery arises from the aorta, is longer than the left one, and runs behind the inferior vena cava and the right renal vein.

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