Block 6 Anatomy Brs Pretest - Abdomen Pt2

25 Questions

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Abdomen Quizzes & Trivia

Questions and Answers
  • 1. 
    A man, the victim of a superficial knife wound to the lower abdomen during a barroom brawl, subsequently develops a direct inguinal hernia. Damage to which of the following nerves is most likely responsible for the predisposing weakness of the abdominal wall?
    • A. 

      Genitofemoral nerve

    • B. 

      Ilioinguinal nerve

    • C. 

      The subcostal nerve

    • D. 

      Pelvic splanchnic nerves

    • E. 

      The nerve of the tenth intercostal space (T10)

  • 2. 
    A multiparous mother brings in her second son, an 18-month-old active toddler, because she has noticed blood (sometimes red, one time “currant jelly”) in his stools. Although the toddler is trying new foods, she doesn’t think the blood is associated with anything in his diet. Your physical exam, including a digital rectal exam, is normal. You order an upper GI barium swallow with small bowel follow through and radiological report describes a 2-inchlong diverticulum, pointing toward the umbilicus, in the ileum, about 2 ft from the ileocecal valve. You explain to the mother that the blood is most likely from which of the following sources?
    • A. 

      An appendix that must be removed

    • B. 

      A Meckel’s (ileal) diverticulum

    • C. 

      Active diverticulitis

    • D. 

      Internal hemorrhoids

    • E. 

      A duodenal ulcer

  • 3. 
    Which of the following gives rise to all structures of the kidney?
    • A. 

      Somitic mesoderm

    • B. 

      Intermediate mesoderm

    • C. 

      Splanchnic lateral plate mesoderm

    • D. 

      Somatic lateral plate mesoderm

    • E. 

      Neural crest

  • 4. 
    A middle-aged woman describes flushing, severe headaches, and a feeling that her heart is “going to explode” when she gets excited. At the beginning of a physical examination her blood pressure (130/85) is not significantly above normal. However, on palpation of her upper left quadrant, the examining physician notices the onset of sympathetic signs. Her blood pressure (200/135) is abnormally high. A subsequent CT scan confirms the suspected tumor of the left adrenal gland. The patient is scheduled for surgery. The symptoms that the patient correlates with the onset of excitement were most likely due to neural stimulation of the adrenal glands. The adrenal medulla receives its innervation from which of the following?
    • A. 

      Preganglionic sympathetic nerves

    • B. 

      Postsynaptic sympathetic nerves

    • C. 

      Preganglionic parasympathetic nerves

    • D. 

      Postganglionic parasympathetic nerves

    • E. 

      Somatic nerves

  • 5. 
    A 42-year-oldman presents with an enlarged left adrenal gland on CT scan. He is scheduled for adrenalectomy. The left adrenal gland is located, and the venous drainage is ligated to prevent life-threatening quantities of adrenalin from entering the bloodstream on manipulation of the gland. Normally, the left adrenal venous drainage is into which of the following?
    • A. 

      Inferior vena cava

    • B. 

      Left azygos vein

    • C. 

      Left inferior phrenic vein

    • D. 

      Left renal vein

    • E. 

      Superior mesenteric vein

  • 6. 
    Which of the following statements concerning a direct inguinal hernia is correct?
    • A. 

      It protrudes through the inguinal (Hesselbach’s) triangle

    • B. 

      It is the most common type of abdominal hernia in newborn boys

    • C. 

      It traverses the entire length of the inguinal canal

    • D. 

      It contains all three fascial layers of the spermatic cord

    • E. 

      It exits the inguinal canal via the superficial inguinal ring

  • 7. 
    While moving furniture, an 18-year-old teenager experiences excruciating pain in his right groin. A few hours later he also develops pain in the umbilical region with accompanying nausea. At this point he seeks medical attention. Examination reveals a bulge midway between the midline and the anterior superior iliac spine, but superior to the inguinal ligament. On coughing or straining, the bulge increases and the inguinal pain intensifies. The bulge courses medially and inferiorly into the upper portion of the scrotum and cannot be reduced with the finger pressure of the examiner. It is decided that a medical emergency exists, and the patient is scheduled for immediate surgery. Nausea and diffuse pain referred to the umbilical region in this patient most probably are due to which of the following?
    • A. 

      Compression of the genitofemoral nerve

    • B. 

      Compression of the ilioinguinal nerve

    • C. 

      Dilation of the inguinal canal

    • D. 

      Ischemic necrosis of a loop of small bowel

    • E. 

      Ischemic necrosis of the cremaster muscle

  • 8. 
    A 77-year-old woman complains to her doctor about left sided chest pain, difficulty swallowing and the sensation that food is stuck in her esophagus. Antacids don’t seem to help much. The symptoms seems to get worse if she lies down shortly after meal and she often has some small reflux of acidic stomach contents. A barium swallow study is performed and one of the late images taken is illustrated below. Based on the history and radiological image which of the following is the most likely diagnosis?
    • A. 

      Sliding hiatal hernia

    • B. 

      Para esophageal hiatal hernia

    • C. 

      Congenital Bochdalek hernia

    • D. 

      Pylorospasm

    • E. 

      Congenital hypertrophic pyloric stenosis

  • 9. 
    A 24-year old man was a passenger in an automobile broadsided by another vehicle. Although he was wearing a seat belt he felt “terrible,” and had left sided abdominal, flank, and shoulder pain. During the ambulance ride into the emergency room his blood pressure kept dropping, he appeared pale, had a rapid heartbeat, with otherwise normal lung and heart sounds. Intravenous saline was started en route. Which of the following abdominal organs is most likely damaged?
    • A. 

      Stomach

    • B. 

      Duodenum

    • C. 

      Pancreas

    • D. 

      Left kidney

    • E. 

      Spleen

  • 10. 
    Volvulus is most likely to occur within segments of the GI tract that are intraperitoneal, not retroperitoneal. Which segments of the GI tract are susceptible to volvulus, and to where does the referred pain of volvulus tend to occur for that segment?
    • A. 

      Duodenum; epigastric region

    • B. 

      Jejunum; epigastric region

    • C. 

      Ascending colon; umbilical region

    • D. 

      Descending colon; umbilical region

    • E. 

      Sigmoid colon; suprapubic region

  • 11. 
    You have a patient who has renal failure as a result of Alport’s syndrome. While he is currently on dialysis, he is hoping to receive a transplanted kidney. He asks you if they are going to remove one of his bad kidneys and put the new transplanted kidney back in the same place. You tell him which of the following?
    • A. 

      The right kidney is always removed since it is more inferior and easier to remove and the new kidney will go in its place

    • B. 

      The left kidney will be removed because it is easier to move the descending colon out of the way and the newly transplanted kidney will go in its place

    • C. 

      He will keep both of his kidneys, and the newly transplanted kidney will be placed on the left posterior wall just inferior to his left kidney since there is more room because the left kidney is higher

    • D. 

      The newly transplanted kidney will be placed in the iliac fossa in the greater pelvis, attached to branched iliac vessels and the ureter connected directly to the bladder

  • 12. 
    Allen is a 30-year-old bachelor who frequents “singles” bars. He is cautious and always uses a condom in his sexual encounters. Recently, he has felt “off,” experiencing a sore throat, malaise, and a slight fever. When you see him in your office, he has a few swollen lymph nodes and has a large palpable structure in the left upper abdomen indicated by the asterisk in the accompanying radiograph. He had a positive monospot test and an elevated sedimentary rate. The structure you palpated was which of the following?
    • A. 

      Hepatomegaly

    • B. 

      Splenomegaly

    • C. 

      The stomach

    • D. 

      A tumor of the liver

    • E. 

      Liver cirrhosis

  • 13. 
    A patient complained of severe abdominal pain on several occasions, but no cause could be identified. She was recently diagnosed with vasculitis of small and medium muscular blood vessels (polyarteritis nodosa) so you ordered an abdominal arteriogram to determine whether there were abdominal vascular changes that would explain her abdominal pain. On her arteriogram there is a tortuous vessel indicated by the arrow. What is this vessel?
    • A. 

      Left gastric artery

    • B. 

      Superior mesenteric artery

    • C. 

      Splenic artery

    • D. 

      Right gastric artery

    • E. 

      Right gastro-omental artery

  • 14. 
    Which of the following is structure 20 in the axial CT of the abdomen with intravenous contrast below?
    • A. 

      Celiac trunk (artery)

    • B. 

      Common hepatic artery

    • C. 

      Left crus of diaphragm

    • D. 

      Splenic artery

    • E. 

      Superior mesenteric artery

  • 15. 
    Pathology within some abdominal organs can occasionally cause referred pain in the shoulder and neck regions, C3–C5, because the diaphragm receives its motor and afferent innervation from this level as a result of its cranial embryonic development. Which of the following abdominal organs sometimes causes unilateral shoulder/neck pain?
    • A. 

      Liver; left side

    • B. 

      Gallbladder; right side

    • C. 

      Pancreas; right side

    • D. 

      Spleen; right side

    • E. 

      Appendix; left side

  • 16. 
    Sensation of fullness in the rectum involves stretch receptors, which of the following provides innervation for those receptors?
    • A. 

      Lumbar sympathetic chain

    • B. 

      Pelvic splanchnic nerves (nervi erigentes)

    • C. 

      Pudendal nerve

    • D. 

      Sacral sympathetic chain

    • E. 

      Vagus nerve

  • 17. 
    A 50-year-old man comes in for a physical so he can attend a boy scout camp with one of his sons. You suggest a colonoscopy after he returns from camp. He agrees, but wants you to describe the procedure and potential risks and complications. You explain that the goal of a colonoscopy is to look at the entire length of the large intestine from the anus to the small intestine (ileocecal junction), observing polyps or diverticuli with a flexible fiber optic colonoscope inserted through the anus. There is a small risk of perforating the bowel especially when the colon takes a sudden turn or twists on itself at regions where it is intraperitoneal rather than attached to the posterior abdominal wall (retroperitoneal). Which of the following regions of the colon generally poses the greatest risk for perforation because the bowel takes either a sudden change in direction or is suspended by a mesentery?
    • A. 

      Rectum, sigmoid colon and descending colon

    • B. 

      Sigmoid colon, descending colon and splenic flexure

    • C. 

      Sigmoid colon, splenic flexure and descending colon

    • D. 

      Sigmoid colon, splenic flexure and hepatic flexure

    • E. 

      Descending colon, transverse colon and ascending colon

  • 18. 
    Which of the following is the principal supply to the body and tail of the pancreas?
    • A. 

      Common hepatic artery

    • B. 

      Inferior phrenic artery

    • C. 

      Left gastric artery

    • D. 

      Splenic artery

    • E. 

      Superior mesenteric artery

  • 19. 
    A 42-year-old slightly overweight woman comes into your office complaining of recent blood in her stool. She has no fever and feels well otherwise. She generally has 1 or 2 bowel movements daily with no change in frequency or consistency. You ask if she has any painful hemorrhoids and she says she has none and no pain upon defecation. Prior to examining your patient what should be on your list of potential causes of blood in the stool?
    • A. 

      Diverticular disease and colorectal cancer

    • B. 

      Diverticular disease and internal hemorrhoids

    • C. 

      Diverticular disease, external hemorrhoids, and colorectal cancer

    • D. 

      External hemorrhoids and fissures, and diverticular disease

    • E. 

      Diverticular disease, internal hemorrhoids, and colorectal cancer

  • 20. 
    During the physical exam of a 52-year-old man you note internal hemorrhoids. He complains of blood in his stool. Which of the following arteries could be the source of his rectal bleeding?
    • A. 

      Superior rectal artery off the inferior mesenteric artery

    • B. 

      Middle rectal artery off the internal iliac artery

    • C. 

      Inferior rectal artery off the internal pudendal artery

    • D. 

      Both b and c

    • E. 

      A, b, and c

  • 21. 
    409. Several major anatomic structures pass through hiatal openings in the diaphragm. Which of the following lettered openings normally transmits the left vagus nerve?
    • A. 

      A

    • B. 

      B

    • C. 

      C

    • D. 

      D

    • E. 

      E

  • 22. 
    During the visit of a 73-year-old man to your office for ongoing control of his hypertension (155/90) you note that he has lost about 5 lb since his last visit. He reports that he just doesn’t seem to have as much room for food or as much of an appetite. He states that he is getting tired of the food at his nursing home. You palpate his abdomen and note that there is a midline pulse, which you had initially mistaken for a heartbeat, but it is slightly delayed. You grow quite concerned about this pulsating abdominal mass and send him for an abdominal CT with intravenous contrast because you think that he has which of the following?
    • A. 

      A hiatal hernia

    • B. 

      Splenomegaly

    • C. 

      Cirrhosis of the liver

    • D. 

      An aortic aneurysm

    • E. 

      A horseshoe kidney

  • 23. 
    Most direct inguinal hernias occur in older men as the conjoint tendon weakens with increased abdominal pressure, often a complication of excessive abdominal weight gain. In contrast, most indirect inguinal hernias occur in which of the following?
    • A. 

      Teenage females

    • B. 

      Multiparous women

    • C. 

      Newborn boys

    • D. 

      Teenage males

    • E. 

      Skinny middle aged men

  • 24. 
    As a general surgeon specializing in oncological cases you do a fair number of bowel resections. A 55-year-old man is referred to your office by his gasteroentrogist who recently removed two polyps from his splenic flexure of the colon during an endoscopic exam. The pathology report has confirmed that they are both cancerous and recommends surgical resection of a portion of the bowel from where the polyps were removed. Lymph nodes that receive lymph from this region are removed for sampling to stage the cancer growth. The 55-year-old patient comes to your office to learn what is involved in the surgical procedure. You describe that you are probably going to remove about a foot long section of large intestine, which includes part of the transverse and descending colon and then reattach the cut ends to each other and reconnect a major artery and collect numerous lymph nodes. Which of the following  major arteries is going to be reconnected and where are you going to collect lymph nodes from to stage the potential spread of the colon cancer?
    • 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

  • 25. 
    When examining a 48-year-old woman for the first time at a free clinic you note that she is quite slender and tanned. During the physical exam you note that she has prominent veins both on her anterior abdominal wall and also about her nose. During the physical exam you can palpate a fairly large firm organ that extends well below the right costal margin during both inspiration and expiration. There is no abdominal tenderness. Which of the following is the most likely explanation for your physical findings?
    • A. 

      Splenomegaly

    • B. 

      Hepatomegaly

    • C. 

      Appendicitis

    • D. 

      Cholecystitis

    • E. 

      Abdominal aortic aneurysm