Block 6 Anatomy Brs Pretest - Abdomen

20 Questions

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Abdomen Quizzes & Trivia

Questions and Answers
  • 1. 
    You deliver a newborn baby girl that has an umbilical hernia with part of another organ attached to its inner surface. What portion of the gastrointestinal tract is most likely to be attached to the inner surface of the umbilical hernia?
    • A. 

      Anal canal

    • B. 

      Appendix

    • C. 

      Cecum

    • D. 

      Ileum

    • E. 

      Stomach

  • 2. 
    A 46-year-old bakery worker is admitted to a hospital in acute distress. She has experienced severe abdominal pain, nausea, and vomiting 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 scapulas. Subsequently, the pain became localized in the right hypochondrium. The patient, who has a history of similar but milder attacks after hearty meals over the past 5 years, is moderately overweight and the mother of four. Palpation reveals marked tenderness in the right hypochondriac region and some rigidity of the abdominal musculature. An x-ray without contrast medium shows numerous calcified stones in the region of the gallbladder. The patient shows no sign of jaundice (icterus). 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 splanchnics

  • 3. 
    Gallbladder pain often presents as epigastric pain that then migrates towards the patient’s right side and can even wrap around to the posterior. 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

  • 4. 
    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, where is the most probable location of the obstruction?
    • A. 

      The bile duct

    • B. 

      The common hepatic duct

    • C. 

      The cystic duct

    • D. 

      Within the duodenal papilla proximal to the juncture with the pancreatic duct

    • E. 

      Within the duodenal papilla distal to the juncture with the pancreatic duct

  • 5. 
    A full-term 8 lb baby boy was delivered vaginally to a 36-year-old mother. At delivery he had a large scrotum. The delivering OB palpated the enlarged scrotum and determined that both testicles were present. When the OB pressed gently on the newborn’s abdomen the scrotum swelled even more. What congenital condition did the OB note in the chart?
    • A. 

      Abdominal hernia

    • B. 

      Cryptorchid (maldescended) testes

    • C. 

      Varicocele

    • D. 

      Hydrocele

    • E. 

      Femoral hernia

  • 6. 
    Many cesarean sections are performed by making a horizontal skin incision that is slightly curved (about 15 cm) on the anterior abdominal wall just superior to the pubic hairline (bikini or Pfannerenstiel incision). However, this incision is often only made through the skin down to the perimysium of the rectus abdominis muscle. Which of the following cutaneous nerves are at greatest risk with this type of incision?
    • A. 

      Thoracoabdominal (intercostal) nerve (T 10)

    • B. 

      Thoracoabdominal (intercostal) nerve (T 11)

    • C. 

      Iliohypogastric nerve (L1)

    • D. 

      Ilioinguinal nerve (L1)

    • E. 

      Lateral (femoral) cutaneous nerve of the thigh (L2–3)

  • 7. 
    A 13-year-old boy was vacationing with his parents in Mexico on spring break. He developed nausea, vomiting 4 days into the trip despite caution about what he ate and drank. He switched to a clear liquid diet. None of the others on the trip were sick. On his flight back to the United States the next day he developed a fever and increased abdominal pain, especially in the paraumbilical region. His parents took him to their pediatrician the next day as he was feeling worse and could barely move. During the physical exam the pediatrician noted tenderness around the umbilicus and rebound tenderness over McBurney’s point and was sent for an abdominal CT at a local pediatric hospital. Where is McBurney’s point and what is the likely diagnosis?
    • A. 

      At the right costal margin at the mid-clavicular line; ruptured gallbladder

    • B. 

      On a line drawn between the anterior superior iliac spine and umbilicus on the right; appendicitis

    • C. 

      On a line drawn between the anterior superior iliac spine and umbilicus on the left; appendicitis

    • D. 

      On a line drawn between the anterior superior iliac spine and the pubic tubercle on the right; kidney stone

    • E. 

      On a line drawn between the anterior superior iliac spine and the pubic tubercle on the left; kidney stone

  • 8. 
    A 65-year-old male presents with jaundice for 2–3 weeks, fatigue and increasing epigastric pain. He has no history of peptic ulcers and says the pain does not relate to eating in anyway. His epigastric pain is midline and he has had some recent back pain. His urinary bilirubinogen and serum bilirubin are elevated (serum bilirubin 5.8 mg/dl). Helical CT reveals a suspicious mass in the head of the pancreas adjacent to the descending duodenum. The gallbladder is significantly enlarged. Which of the following is the likely cause of the elevated bilirubin?
    • A. 

      Viral hepatitis

    • B. 

      Blocked cystic duct

    • C. 

      Open hepatic duct

    • D. 

      Blocked duodenal papilla

    • E. 

      Gilbert syndrome

  • 9. 
    A full-term male infant displays projectile vomiting 1 h after suckling. There is failure to gain weight during the first 48 hours. The vomitus is not bile-stained and no respiratory difficulty is evident. Examination reveals an abdomen neither tense nor bloated. Which of the following is the most probable explanation?
    • A. 

      Congenital hypertrophic pyloric stenosis

    • B. 

      Congenital absence of a kidney

    • C. 

      Patent ileal diverticulum

    • D. 

      Imperforate anus

    • E. 

      Tracheoesophageal fistula

  • 10. 
    In Hirschsprung’s disease, there is a loss of peristalsis in the lower colon and often fatal obstruction. Preganglionic neurons, which would innervate the aganglionic segment of bowel, originate in which of the following?
    • A. 

      The nucleus ambiguus

    • B. 

      Cervical intermediolateral cell column

    • C. 

      Sacral levels two to four of the spinal cord

    • D. 

      The motor nucleus of the vagus nerve (CN X)

    • E. 

      The ventral horn at spinal levels L1–L2

  • 11. 
    The 65-year-old with pancreatic adenocarcinoma in the head of pancreas was taken to surgery. A PET CT suggested some metastasis to both liver and multiple posterior lymph nodes. It was explained to the patient and his family that the surgery would likely not be curative, but rather palliative in that the cancer was already too far advanced for removal. During the surgery ablation of the autonomic innervation that carries pain in this region is also performed to provide pain relief. The surgeon will inject 50% ethanol to kill nerve cells at which of the following locations?
    • A. 

      At each subcostal nerve under ribs 6–8

    • B. 

      Around the celiac trunk

    • C. 

      Around each lateral epigastric fold

    • D. 

      Around the coronary ligament

    • E. 

      Around the lateral arcuate ligament

  • 12. 
    An 11-year-old girl is brought into your pediatric office by her mother. She recently learned to do back flips on the balance beam, when her foot slipped off and she landed with her perineum striking the beam. She developed a massive subcutaneous hematoma filling her perineum that posteriorly formed a straight horizontal line just anterior to her anus, and anteriorly extended onto the anterior abdominal wall about half way up to her umbilicus and above the inguinal ligament. No blood entered her thighs. She could still urinate and there was no blood in her urine. The hematoma was contained by what space?
    • A. 

      Ischioanal fossa

    • B. 

      Superficial perineal space

    • C. 

      Deep perineal space

    • D. 

      Femoral sheath

    • E. 

      Inguinal canal

  • 13. 
    A slender 53-year-old woman who smokes a pack of cigarettes each day comes to your office complaining of a pulsating sensation in her abdomen with generalized abdominal and back pain. You palpate her abdomen and feel a mid-line pulse with every heart beat. You order an abdominal Doppler ultrasound, which shows a large, high abdominal aortic aneurysm above renal arteries of about 8 cm in diameter. She is admitted to the hospital immediately for repair of her aortic aneurysm because it is life threatening, but you warn her that one of the complications of such surgical repair includes paraplegia. During the procedure the vascular surgeon must completely clamp off the abdominal aorta for about an hour while repairing the aneurysm. Which of the following would explain to the patient why there is a risk of paraplegia?
    • A. 

      Stopping the blood within the abdominal aorta causes the muscle of the lower limbs to die

    • B. 

      Stopping the blood within the abdominal aorta causes the peripheral nerves of the lower limb to die

    • C. 

      Stopping the blood within the abdominal aorta causes loss of blood flow to the major radicular artery (of Adamkiewicz), which causes the motor components in the spinal cord for the lower limb to die

    • D. 

      Stopping the blood within the abdominal aorta causes microemboli within the lower limb to form during the surgery and those microemboli then pass through the lung and left side of the heart into the brain where they selectively lodge in the motor cortex that controls the lower limbs

    • E. 

      Stopping the blood within the abdominal aorta causes excessive perfusion of the brain during the surgery, which selectively causes bleeding stroke within the motor cortex that controls the lower limbs

  • 14. 
    The lateral umbilical fold serves as the demarcation for whether an inguinal hernia is direct or indirect. The lateral umbilical fold on each side  of the inner surface of the anterior abdominal wall is created by which of the following underlying structures?
    • A. 

      Falx inguinalis

    • B. 

      Inferior epigastric artery

    • C. 

      Lateral border of the rectus sheath

    • D. 

      Obliterated umbilical artery

    • E. 

      Urachus

  • 15. 
    A 19-year-old teenager is brought to the emergency room after a single-car accident just 20 minutes earlier in which she lost control of her car on black ice and hit a retaining column of an overpass at about 45 miles per hour. She was wearing a seat belt but looks pale, has tachycardia and positional ypotension, is extremely nauseated, and is lying in the fetal position due to increasingly severe abdominal pain. She has no fractures and a cranial nerve test is normal. You order an abdominal CT because you suspect which of the following?
    • A. 

      Lacerated kidney

    • B. 

      Ruptured spleen

    • C. 

      Ruptured gallbladder

    • D. 

      Diverticulitis

    • E. 

      Hemorrhoids

  • 16. 
    A posteriorly perforating ulcer in the pyloric antrum of the stomach is most likely to produce an initial localized peritonitis or abscess formation in which of the following?
    • A. 

      Greater sac

    • B. 

      Left subhepatic and hepatorenal spaces (pouch of Morison)

    • C. 

      Omental bursa

    • D. 

      Right subphrenic space

    • E. 

      Right subhepatic space

  • 17. 
    A 55-year-old woman arrives at the emergency room the day after St. Patrick’s Day coughing up bright red blood. She has frequented your emergency room before. History includes excessive alcohol consumption. Using abdominal percussion you determine that her liver extends 5 cm below the right costal margin at the midclavicular line. You call in a gastroenterologist because you suspect that the bright red blood is most likely the result of which of the following?
    • A. 

      Hemorrhoids

    • B. 

      Colon cancer

    • C. 

      Duodenal ulcer

    • D. 

      Gastric ulcer

    • E. 

      Esophageal varices

  • 18. 
    The lesser sac (omental bursa) is directly continuous with which of the following recesses or spaces?
    • A. 

      Infracolic compartment

    • B. 

      Left colic gutter

    • C. 

      Left subphrenic recess

    • D. 

      Right subphrenic space

    • E. 

      Hepatorenal recess

  • 19. 
    Mucosal necrosis of the rectum usually will not result from occlusion of the inferior mesenteric artery for which of the following reasons?
    • A. 

      Arterial supply to the rectum is from anastomotic connections from the superior mesenteric artery

    • B. 

      Arterial supply to the rectum is from the left colic artery with anastomoses to branches of the internal iliac artery

    • C. 

      The inferior mesenteric artery does not supply the rectum

    • D. 

      A principal branch of the external iliac artery is a major supplier to the rectum

    • E. 

      The middle rectal artery, a branch of the internal iliac artery, supplies the rectum

  • 20. 
    Sympathectomy may occasionally relieve intractable pain of visceral origin, in as much as visceral afferent pain fibers run along the sympathetic pathways in the abdomen. The autonomic control of peristalsis in the descending colon should not be affected by bilateral lumbar sympathectomy for which of the following reasons?
    • A. 

      The descending colon is controlled chiefly by parasympathetic innervation from the pelvic splanchnic nerves

    • B. 

      The descending colon receives its parasympathetic innervation from the vagus nerve

    • C. 

      The descending colon receives its sympathetic innervation from thoracic splanchnic nerves

    • D. 

      Lumbar splanchnics from L1, L2, and L3 only innervate the pelvic viscera via the hypogastric nerve

    • E. 

      Only presynaptic sympathetic fibers have been severed