Block 6 Anatomy Wk 7 And 8 From Ta's W Expl
.JPG "Block 6 Anatomy Wk 7 And 8 From Ta")
From your friendly anatomy TA's
- 1.
A patient comes in with a history of recent blunt trauma to the abdomen. You diagnose him as having a rectus sheath hematoma. What blood vessel is most likely damaged?
- A.
Superior epigastric artery
- B.
Superficial epigastric artery
- C.
Inferior epigastric vein
- D.
External pudendal vein
Correct Answer
C. Inferior epigastric veinExplanation
Inferior Epigastric Artery branches from the External Iliac ArteryRate this question:
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- 2.
While presenting a case to your attending, your colleague says that his patient has a direct inguinal hernia. You know that this hernia must be:
- A.
Lateral to the inferior epigastric v.
- B.
Medial to the inferior epigastric a.
- C.
Protrude through the deep inguinal ring
- D.
Covered by internal spermatic fascia
- E.
Lateral to the pubic tubercle
Correct Answer
B. Medial to the inferior epigastric a.Explanation
direct inguinal hernia means it comes through Hesselbach’s triangle which is bounded by the lateral umbilical fold (inferior epigastric artery), linea semilunaris, and the inguinal ligament.Rate this question:
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- 3.
A patient comes to the emergency department complaining of a sharp pain to his right hypochondriac/epigastric area. The patient states that the sharp pain started earlier that day after he ate lunch at KFC, but that he has been experiencing intermittent pains in the same location for a few weeks. He also states that he is feeling pain over his right shoulder and into his back. The source of the patient's pain is most likely due to:
- A.
An inflamed appendix.
- B.
A ruptured appendix
- C.
An inflamed gallbladder
- D.
Peptic ulcer
Correct Answer
C. An inflamed gallbladderExplanation
Gallbladder can also send pain impulses via the right Phrenic nerve, resulting in pain in the C3-5 dermatome, hence the pain over the right shoulder.Rate this question:
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- 4.
A patient's gastric ulcer perforated the posterior wall and eroded an artery. Which artery was most likely damaged?
- A.
Gstroduodenal
- B.
Splenic
- C.
Hepatic
- D.
Left gastric
- E.
Cystic
Correct Answer
B. SplenicExplanation
a rare and dangerous complication of gastric ulcer.Rate this question:
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- 5.
A patient complaining that swallowing is becoming difficult, would be termed what?
- A.
Esophageal cancer
- B.
Dysphagia
- C.
Aphagia
- D.
Odynophagia
Correct Answer
B. DysphagiaExplanation
dysphagia is difficulty, odynophagia is pain in swallowingRate this question:
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- 6.
A 45 year-old obese male, with a 30 pack-year history of smoking, is referred to the gastroenterologist complaining of chronic heartburn. The esophageal endoscopy image below is the result of what process?
- A.
Neoplasia
- B.
Hyperplasia
- C.
Hypertrophy
- D.
Metaplasia
Correct Answer
D. MetaplasiaExplanation
Pictured is typical of Barrett’s esophagus, in which normal (pink) non-keratinized squamous epithelium is replaced by columnar epithelium of the intestinal type (red). Chronic gastroesophageal reflux disease (GERD) leads to Barrett’s esophagus (metaplasia), which increases the risk of adenocarcinoma (neoplasia which is preceded by dysplasia). Obesity, smoking, and alcohol are risk factors.Rate this question:
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- 7.
Upon abdominal exam you elicit a positive Murphy's Sign for cholecystitis under the right costal margin. Assuming the gallstone is large and full of bile acids that can erode a fistulous tract through the gall bladder wall, which of the following would be the most likely culprit for a gastric outlet obstruction?
- A.
Cholecystocolic fistula
- B.
Cholecystoduodenal fistula
- C.
Cholecystojejunal fistula
- D.
Pyloric stenosis
Correct Answer
B. Cholecystoduodenal fistulaExplanation
A cholecystocolic fistula allows for emptying of the gallstone into the transverse colon and rarely will cause a gallstone ileus. The cholecystojejunal fistula and the cholecystoduodenal fistula both enter the small intestine and may block the passage by the ileocecal valve. However the question asks for a likely culprit for gastric outlet obstruction (as seen in the endoscopy photo - pylorus with gallstone obstruction). This would most likely be a fistulous tract to the 1st part of the duodenum that would occlude the lumen and outflow of pylorus (Bouveret's Syndrome). Pyloric stenosis, although being the most common cause of GOO, is not described in the stem.Rate this question:
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- 8.
You were able to use ursodeoxycholic acid in time to dissolve the stone before it formed a fistula. It seemed to be beneficial over the first year after beginning treatment however one day the patient presented with pain in the epigastric area. On ultrasound you noticed an enlarged pancreas with a smaller stone in the Ampulla of Vater - obstructing the lumen of the pancreatic duct. Due to this obstruction the patient was experiencing acute pancreatitis. If the pancreas was to rupture into the abdominal cavity where would the enzymes be released.
- A.
Greater sac
- B.
Pouch of Douglas
- C.
Lesser sac
- D.
Morrison's Pouch
Correct Answer
C. Lesser sacExplanation
pancreas sits posteriorly to lesser sacRate this question:
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- 9.
The round ligament of the liver (AKA - Ligamentum Teres Hepatis) was embryologically derived from which of the following
- A.
The Left Umbilical Artery
- B.
The Right Umbilical Artery
- C.
The Urachus
- D.
The Left Umbilical Vein
- E.
The Right Umbilical Vein
Correct Answer
D. The Left Umbilical VeinExplanation
The round ligament is derived from the umbilicalvein, and more importantly theleft umbilical vein. Note: the right umbilical vein tends to regress around the second month of development, whereas the left vein persists and becomes this ligament. Also, know these embryological origins well; Median Umbilical Fold - A remnant of the Urachus and the Medial Umbilical Folds - Remnants of the Umbilical ArteriesRate this question:
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- 10.
While studying in the anatomy lab for an upcoming practical exam, a nosey TA approaches you, points to a structure branching off the abdominal aorta at the level of T12, and asks you to name the 3 arteries that directly originate from it. You correctly respond by saying the following:
- A.
SMA, Splenic Artery, and the Superior Pancreaticoduodenal Artery
- B.
Left Gastric Artery, Splenic Artery, and the Proper Hepatic Artery
- C.
SMA, IMA, and Splenic Artery
- D.
Left Gastric Artery, Splenic Artery, and the Common Hepatic Artery
Correct Answer
D. Left Gastric Artery, Splenic Artery, and the Common Hepatic ArteryExplanation
The artery that this TA is pointing to is the Celiac Trunk (the 3 divisions of the trunk are classic and important to remember for examination purposes). The Celiac trunk originates from the abdominal aorta at the level of T12 (the verterbral levels that the Celiac Trunk, the SMA, and the IMA originate are approximately T12, L1, and L3 respectively and are high yield relations). The Celiac trunk branches into the Left Gastric Artery, the Common Hepatic Artery (gives rise to the Gastroduodenal Artery which is at high risk for erosion during duodenal ulcers), and the Splenic Artery. Answer B is wrong because the Proper Hepatic Artery originates from the Common Hepatic Artery and not directly from the celiac trunk.Rate this question:
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- 11.
Your 2-year old patient has had bouts of "tummy pain" and according to the mother, his diapers have had stool that looked like red currant jelly. Upon examination you find the two year old with his legs drawn up to his chest and a palpable sausage-like mass in the lower right abdomen. What is the likely cause of this child's condition?
- A.
Meckel's diverticulitis
- B.
Acute appendicitis
- C.
Ileocecal intususception
- D.
Perianal abscess
- E.
Pyloric stenosis
Correct Answer
C. Ileocecal intususceptionExplanation
This is the classical presentation when the distal ileum telescopes into the cecum. It’s most common in children less than 2 years old (80%) and rare in older children and adults.Rate this question:
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- 12.
Your patient suffered a stab wound to his lower hypogastric region just lateral to the midline, what layers of the abdominal wall did the knife likely cross from first to last?
- A.
Skin, camper's fascia, scarpa's fascia, anterior rectal sheath, rectus abdominis, posterior rectal sheath, transversalis fascia, extraperitoneal fat, peritoneum
- B.
Skin, scarpa's fascia, camper's fascia, anterior rectal sheath, rectus abdominis, posterior rectal sheath, transversalis fascia, extraperitoneal fat, peritoneum
- C.
Skin, camper's fascia, scarpa's fascia,transversalis fascia, anterior rectal sheath, rectus abdominis, posterior rectal sheath, extraperitoneal fat, peritoneum
- D.
Skin, camper's fascia, scarpa's fascia, anterior rectal sheath, rectus abdominis, transversalis fascia, extraperitoneal fat, peritoneum
- E.
Skin, camper's fascia, scarpa's fascia, rectus abdominis, posterior rectal sheath, transversalis fascia, extraperitoneal fat, peritoneum
Correct Answer
D. Skin, camper's fascia, scarpa's fascia, anterior rectal sheath, rectus abdominis, transversalis fascia, extraperitoneal fat, peritoneumExplanation
it’s below the arcuate line so no posterior rectus sheath.Rate this question:
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- 13.
After denying that Justin Beiber is the greatest recording artist of all time, Ned hits me with a baseball bat and ruptures my spleen. Where was I likely hit?
- A.
Right posterior-axillary line, ribs 9-11
- B.
Left posterior-axillary line, ribs 9-11
- C.
Left flank
- D.
Right flank
Correct Answer
B. Left posterior-axillary line, ribs 9-11Explanation
fractured ribs can rupture the spleenRate this question:
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- 14.
Mac, the surgeon, and PC, the anatomist, are fighting about which 1/2 of the liver the caudate and quadrate lobes belong to. What would Mac argue?
- A.
Right because they’re right of the falciform ligament
- B.
Right because they’re right of the IVC
- C.
Left because they’re left of the falciform ligament
- D.
Left because they’re left of the IVC
Correct Answer
D. Left because they’re left of the IVCExplanation
http://upload.wikimedia.org/wikipedia/commons/a/a3/Gray1087-liver.pngSurgeons follow the branchings of the portal triad or hepatic veins to divide the liver into 8 segments. Instead of using the falciform ligament, surgeons draw an imaginary line between the IVC and gallbladder as the division between right and left halves.Rate this question:
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- 15.
The splenic artery is an end artery. Ligation leads to ischemia of what structures?
- A.
Spleen and pancreatic tail
- B.
Spleen and gastric antrum
- C.
Pancreatic tail and gastric antrum
- D.
Spleen and gastric fundus
- E.
Gastric body and pancreatic tail
Correct Answer
D. Spleen and gastric fundusExplanation
http://upload.wikimedia.org/wikipedia/commons/3/3b/Gray533.pngshort gastric arteries (off distal portion of splenic artery) supply the gastric fundus. The tail of the pancreas is also found in in the splenorenal ligament in the hilum of the spleen. Its blood supply is from the splenic arteryRate this question:
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- 16.
Years after Ned and Matt Hasselbeck’s altercation, Matt goes to see Ned about a direct inguinal hernia. What is the lateral border of Hesselbach’s triangle?
- A.
Median umbilical fold
- B.
Medial umbilical fold
- C.
Lateral umbilical fold
- D.
Lateral border of rectus abdominis
Correct Answer
C. Lateral umbilical foldExplanation
http://upload.wikimedia.org/wikipedia/commons/a/a8/Inguinal_triangle.pngthe INGUINAL TRIANGLE is a region of the abdominal wall. It is also known by the eponym Hesselbach's triangle It is defined by the following structures • Medial border: Lateral margin of the rectus sheath, also called linea semilunaris • Superolateral border: Inferior epigastric vessels • Inferior border: Inguinal ligament, sometimes referred to as Poupart's ligament The inguinal triangle contains a depression referred to as the MEDIAL INGUINAL FOSSA, through which direct inguinal hernias protrude through the abdominal wall. The MEDIAL INGUINAL FOSSA is a depression located within the inguinal triangle on the peritoneal surface of the anterior abdominal wall between the ridges formed by the LATERAL UMBILICAL FOLD and the medial umbilical ligament, corresponding to the superficial inguinal ring.Rate this question:
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- 17.
Where does the transversus abdominis aponeurosis contribute to the posterior rectus sheath?
- A.
Superior to semilunar line
- B.
Inferior to semilunar line
- C.
Superior to arcuate line
- D.
Inferior to arcuate line
Correct Answer
C. Superior to arcuate lineExplanation
and inferior to the arcuate line, all aponeuroses form the anterior rectus sheath, so the posterior sheath is absent.Rate this question:
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- 18.
What structure develops within the ventral mesogastrium?
- A.
Spleen
- B.
Liver
- C.
Kidney
- D.
Adrenal
- E.
Stomach
- F.
Pancreas
- G.
Duodenum
Correct Answer
B. LiverExplanation
Spleen is derived from DORSAL mesogastriumRate this question:
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.JPG "Upon abdominal exam you elicit a positive Murphy's Sign for cholecystitis under the right costal margin. Assuming the gallstone is large and full of bile acids that can erode a fistulous tract through the gall bladder wall, which of the following would be the most likely culprit for a gastric outlet obstruction?")
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