Block 7 Anatomy Ta's Abdml Wall Rectus & Viscera
Provided by your anatomy TA's
- 1.
The superior and inferior epigastric arteries lie directly beneath which structure?
- A.
External oblique
- B.
Transversus Abdominis
- C.
Rectus Abdominis
- D.
Internal oblique
Correct Answer
C. Rectus AbdominisExplanation
These two arteries run directly underneath the Rectus Abdominis muscle. In the case of blunt force trauma to the lower abdomen it is common to present with a hematoma from injury to the Inferior Epigastric Artery.Rate this question:
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- 2.
Which of the following is a true statement about the Scarpa's fascia?
- A.
It is discontinuous with the Dartos fascia
- B.
It is continuous with the Colles fascia
- C.
It is continuous with a deep penile fascia.
- D.
It is the most superficial layer of the abdominal wall.
- E.
It is the thickest layer of the abdominal wall
Correct Answer
B. It is continuous with the Colles fasciaExplanation
This fascia is continuous with the Dartos fascia, Colles fascia and superficial penile fascia. It is deeper and thinner than the Camper's fascia.Rate this question:
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- 3.
You are attempting to check for radio-femoral delay in your patient. To find the femoral artery your visualize a line from the ASIS to the pubic tubercle. You palpate for the femoral artery about a centimeter below the midpoint of this line. Which ligament are you trying to approximate by visualizing this line? And from what structure is it formed?
- A.
Median umbilical ligament; urachus
- B.
Medial umbilical ligament; umbilical arteries
- C.
Inguinal ligament; external oblique muscle aponeuroses
- D.
Inguinal ligament; internal oblique muscle aponeuroses
- E.
Round ligament of the uterus; gubernaculum
Correct Answer
C. Inguinal ligament; external oblique muscle aponeurosesExplanation
: The ligament referred to here is the inguinal ligament. It is formed from the folding over of the aponeuroses of the EXTERNAL oblique muscle. The other ligaments are not landmarks for palpating
the femoral nerve.Rate this question:
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- 4.
A 17 year-old, male with a past medical history of hypertension presents to your emergency clinic with severe abdominal pain. Past medical history reveals blunt trauma to the abdomen after engaging in a school fight that afternoon. Physical examination reveals a progressive contusion that you begin to worry about. You quickly call a surgical consult and obtain radiological imaging of the patient's abdomen, which confirms your suspicion. The MOST likely cause of this patient's bleed is damage to the:
- A.
Short gastric artery
- B.
Splenic artery
- C.
Left Gastric artery
- D.
Inferior Epigastric artery
- E.
Gastroduodenal artery
Correct Answer
D. Inferior Epigastric arteryExplanation
The key phrase in this question is "blunt trauma" to the anterior abdominal wall. This is commonly seen in athletes involved in different kinds of sports (i.e., karate) as well as foul play. The inferior epigastric artery and vein are MOST prone to damage in this type of trauma since they lie just on the deep surface of the rectus abdominis muscles. It should be clear to you that veins are more easily damaged than arteries simply due to the differences in the structures that make up their vascular wall. Since the inferior epigastric vein was not an answer choice here, the artery was the next best choice. The other answer choices are vessels related to gastric perfusion, which you will learn in lectures to come.Rate this question:
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- 5.
A patient arrives at your clinical with a protruding mass from his superficial inguinal ring. He is diagnosed with an indirect inguinal hernia. What is the posterior border of the canal that this hernia passes through?
- A.
Fascia transversalis
- B.
Inguinal ligament
- C.
Aponeurosis of the transversus abdominis muscle
- D.
Fibers of the internal oblique muscle
- E.
External oblique aponeurosis
Correct Answer
A. Fascia transversalisExplanation
The posterior border throughout the inguinal canal is formed by the transversalis fascia, which is reinforced medially by the conjoint tendon (transversalis abdominis + internal oblique).Rate this question:
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- 6.
What structures make up the conjoint tendon?
- A.
Rectus abdominis and transversus abdominis
- B.
External oblique and internal oblique
- C.
Internal oblique and transversus abdominis
- D.
Rectus abdominis and internal oblique
Correct Answer
C. Internal oblique and transversus abdominisExplanation
Internal oblique and transversus abdominis aponeurotic fibers make up the conjoint tendon which inserts on the pubic tubercle and strengthens the posterior wall of the medial half of the inguinal canal.Rate this question:
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- 7.
During an abdominal surgery, the surgeon describes an area in the transpyloric plane. Which two structures are associated with this anatomical area?
- A.
Origin of the IMA and Pylorus of the stomach
- B.
Fundus of the Gall Bladder and fundus of the stomach
- C.
Pylorus of the stomach and neck of the pancreas
- D.
Origin of the SMA and fundus of the stomach
Correct Answer
C. Pylorus of the stomach and neck of the pancreasExplanation
The transpyloric plane, which is typically at the level of L1, has many structures associated with it. Important structures to be aware of are the fundus of the gall bladder, pylorus of the stomach, origin of the SMA, neck of the pancreas, duodenojejunal junction, and the hilum of the kidney.Rate this question:
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- 8.
A surgeon performs a surgery on the lateral aspect of a patient's abdominal wall. He comes upon a muscle in which the fibers are running "down and in". What is the muscle or fascia that is most likely immediately deep to this muscle?
- A.
Scarpa's fascia
- B.
External Oblique
- C.
Internal Oblique
- D.
Transversalis fascia
- E.
Transverse Abdominis
Correct Answer
C. Internal ObliqueExplanation
The muscle that is being described, as fibers running "down and in" is the external oblique muscle. The layer that is immediately deep to this is the internal oblique muscle. It is important to know the layers in order from superficial to deep: Skin → Camper's Fascia → Scarpa's Fascia → External Oblique → Internal Oblique → Transverse Abdominis → Transversalis fascia → Extraperitoneal fascia → Parietal PeritoneumRate this question:
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- 9.
If a surgeon is performing a left paramedian incision below the arcuate line, what will be the last layer he cuts through before reaching the transversalis fascia?
- A.
Rectus abdominis
- B.
Fascia of the external oblique
- C.
Fascia of the internal oblique
- D.
Fascia of transversus abdominis
- E.
External oblique muscle
- F.
Internal oblique muscle
- G.
Transversus abdominis muscle
Correct Answer
A. Rectus abdominisExplanation
When performing an incision near the midline, you will not encounter any of the lateral wall muscles including the external oblique, internal oblique and transversus abdominis. Therefore, answers E, F and G are incorrect. Now, since the incision was done at a level below the arcuate line, we know that all layers of fascia travel above the rectus abdominis, making that the last muscle that the surgeon will cut through (making answer B, C and D incorrect). Note: no matter where you perform the incision in the abdomen, you will always first encounter skin, Camper's and then Scarpa's fascia (in that order).Rate this question:
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- 10.
Which is true of the blood supply of the anterior abdominal wall?
- A.
Direct branches of the Aorta supply the lateral anterior abdominal wall
- B.
Multiple branches of the Subclavian Artery supply the anterior abdominal wall
- C.
Branches of the Internal Iliac Artery supply the anterior abdominal wall inferior to the arcuate line
- D.
Inferior Epigastric Arteries are found superficial to the rectus abdominus muscle
Correct Answer
A. Direct branches of the Aorta supply the lateral anterior abdominal wallExplanation
Posterior intercostal arteries, supplying the lateral borders of the anterior abdominal wall, originate directly off of the thoracic aorta. (B) The Internal Thoracic Artery is the only branch of the Subclavian Artery supplying the anterior abdominal wall giving off two branches including the Superior Epigastric Arteries. (C) No branches of the Internal Iliac Artery are involved in supplying the anterior abdominal wall. (D) Inferior Epigastric Arteries are found beneath (deep) to the rectus abdominus and superficial to the transversalis fascia both above and below the arcuate line.Rate this question:
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- 11.
You are performing surgery on a 56-year-old man with an ulcer in the first part of the duodenum. In which region of the anterior abdominal wall would you make your initial incision to treat the ulcer?
- A.
Left Lumbar
- B.
Right Lumbar
- C.
Right Hypochondriac
- D.
Epigastric
- E.
Left Hypochondriac
Correct Answer
D. EpigastricExplanation
The duodenum, pancreas, and part of the stomach and liver are all located in the epigastric region of the abdomenRate this question:
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- 12.
Assisting in a surgery, you notice the surgeon's incision draws a large volume of blood immediately from the patient's para-umbilical region. You are startled and ask the surgeon why he isn't more concerned about the bleeding as he calmly clamps the artery and makes his deep incision through the rectus sheath. He explains that:
- A.
The artery is a branch off the internal iliac and the bleeding will stop on it's own
- B.
The artery is a superficial branch of the Superior epigastic and is not important.
- C.
The artery is an anastomosis off the femoral and is not likely to cause muscle ischemia
- D.
The artery is a branch off the Internal Thoracic, which is dual supplied by the portal system
Correct Answer
C. The artery is an anastomosis off the femoral and is not likely to cause muscle ischemiaExplanation
the artery is the superficial epigastric and is above the rectus abdominis muscles. (A) is false, these branches don't supply the skin. (B) is false because the Superior epigastric is underneath the rectus abdominis muscle, which the surgeon dissected after clamping the superficial epigastric. (D) is wrong for so many reasons, mostly because the portal system is venous, and doesn't perfuse tissue, it drains them.Rate this question:
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- 13.
A patient with an inguinal hernia is undergoing surgery. The surgeon must cut through the rectus abdominis in the hypogastric region. The fascia that is posteriorly in contact with the abdominis rectus is made up of which aponeurosis?
- A.
Transversalis fascia
- B.
Transversalis fascia and oblique fascia
- C.
Internal oblique fascia and transversalis fascia
- D.
Internal oblique fascia
Correct Answer
A. Transversalis fasciaExplanation
Past the arcuate line the posterior rectus sheath is absent and the rectus abdominis is in direct contact with transversalis fasciaRate this question:
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- 14.
A 15-year-old male was taken to the Emergency Department complaining of tenderness and pain in the lower right quadrant of his abdomen. Upon palpation of the patient's abdomen, the patient vocalizes pain and elicits a "guarding reflex." The physician then correctly identifies that the patient is complaining from an inflamed appendix. Which of the following locations did the Physician palpate to elicit the pain in this patient?
- A.
Approximately 2/3 from the umbilicus to the Anterior Superior Iliac Spine (ASIS)
- B.
Approximately 2/3 from the umbilicus to the Iliac Spine
- C.
Approximately 1/3 from the umbilicus to the Anterior Superior Iliac Spine (ASIS)
- D.
Approximately 1/3 from the umbilicus to the Iliac Spine
Correct Answer
A. Approximately 2/3 from the umbilicus to the Anterior Superior Iliac Spine (ASIS)Explanation
This location describes McBurney's point, which is the approximate superficial anatomical appendix landmarkRate this question:
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- 15.
After a motor vehicle accident, a patient is brought to the emergency department. X-ray reveals fractured left ninth and tenth ribs. She has a rapid heart rate and low blood pressure. Peritoneal lavage reveals free blood in the peritoneal cavity. A surgeon is able to stop the bleeding by placing a clamp across which of the following structures?
- A.
Falciform ligament
- B.
Hepatoduodenal ligament
- C.
Hepatogastric ligament
- D.
Splenorenal ligament
- E.
Gastrosplenic ligament
Correct Answer
D. Splenorenal ligamentExplanation
The spleen spans from about rib nine to rib ten. Therefore the fractured ribs should clue you in to a splenic rupture. The low blood volume, high heart rate, and peritoneal lavage are all indicators of intraperitoneal hemorrhage. The key to stopping the hemorrhage would be to clamp the arteries supplying blood to the spleen. The splenic vessels can be found in the splenorenal ligament, which also houses the tail of the pancreas.Rate this question:
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- 16.
A 45-year-old man develops an abdominal abscess following a complicated appendectomy. Which of the following structures functions to localize the resulting inflammatory process?
- A.
Lesser omentum
- B.
Greater omentum
- C.
Visceral peritoneum
- D.
Parietal peritoneum
Correct Answer
B. Greater omentumExplanation
The lesser omentum runs from the lesser curvature of the stomach superiorly; also, since the appendectomy was performed on the inferior aspect of the abdomen, the abscess was more likely to develop in the region of the greater omentum, which runs from the greater curvature of the stomach inferiorly. It is referred to as the "abdominal policeman" because of the function asked in this question. None of the remaining answer choices have a function in localizing infection.Rate this question:
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- 17.
The round ligament of the liver is also known as the ligamentum teres hepatis. This structure found in adults is the remnant of what embryological structure?
- A.
Ligamentum venosum
- B.
Umbilical vein
- C.
Umbilical artery
- D.
Umbilical cord
- E.
Viteline duct
Correct Answer
B. Umbilical veinExplanation
The round ligament of the liver (not to be confused with the round ligament of the uterus) is the remnant of the umbilical vein. Note that the umbilical vein carries oxygenated blood from the mother to the fetus.Rate this question:
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- 18.
A 43-year-old male is seen in the emergency room for chronic epigastric pain that is relieved by eating. He states he has had this complication for many years. Upper endoscopy reveals a large ulcer on the lesser curvature of the stomach. Which is the most likely complication, should the patients condition worsen?
- A.
Chronic pancreatitis
- B.
Acute hemorrhage from bleeding gastric arteries
- C.
Acute cholecystitis
- D.
Duodenal obstruction
Correct Answer
B. Acute hemorrhage from bleeding gastric arteriesExplanation
Ulceration of the lesser curvature of the stomach can worsen and result in complete ulceration of the stomach wall and rupture of vessels in close proximity. The left and right gastric arteries are closely associated with the lesser curvature of the stomach and can rupture due to perforation of the stomach lining due to chronic ulceration. (A) Chronic pancreatitis results from enzymatic digestion of pancreatic tissue most commonly from chronic alcohol intake. (C) Acute cholecystitis is not a complication of gastric ulcer and is most likely due to obstruction of either cystic duct, common bile duct or traumatic event. (D) Duodenal obstruction is not a likely complication of gastric ulcer.Rate this question:
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- 19.
A man is in a car accident and breaks the tip of his sternum. At presentation to the ER he is found to be markedly hypotensive and his abdomen is distended. What is the most likely source of blood?
- A.
Gastroduodenal artery
- B.
Right Gastric artery
- C.
Common Hepatic artery
- D.
Splenic artery
Correct Answer
A. Gastroduodenal arteryExplanation
The Gastroduodenal artery is the only artery, which lies centrally in the transpyloric plane.Rate this question:
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- 20.
A 55-year-old man with a history of alcohol abuse presents to the emergency department complaining of a cough, swelling in his abdomen and swelling in his ankles. On examination, the physician notes the man has a protruding abdomen and yellowing of the sclera of his eyes. The physician identifies that the patient is suffering from ascites and wants to drain the liquid accumulated in his abdomen that is causing the protruding abdomen. Which of the following techniques should the physician use?
- A.
Peritoneal lavage
- B.
Paracentesis
- C.
Pericardiocentesis
- D.
Culdocentesis
Correct Answer
B. ParacentesisExplanation
The man has symptoms suggesting portal hypertension, secondary to liver disease. The paracentesis technique should be sued to remove the fluid accumulated in the peritoneal cavity.Rate this question:
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- 21.
The hepatoduodenal ligament is being pinched between my thumb and forefinger. Which branch of the Celiac trunk is found within this ligament?
- A.
Gastroduodenal Artery
- B.
Common Hepatic Artery
- C.
Hepatic Artery
- D.
Proper Hepatic Artery
Correct Answer
D. Proper Hepatic ArteryExplanation
The portal triad lies within the hepatoduodenal ligament and contains, the common bile duct, proper hepatic artery, and hepatic portal vein.Rate this question:
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- 22.
Which of the following is most consistent with the double-layered fold of peritoneum which connects the lesser curvature of the stomach and 1st part of duodenum to the liver?
- A.
Is known as the greater omentum and contains the gastrocolic ligament
- B.
Is known as the greater omentum and contains the hepatoduodenal ligament
- C.
Is known as the lesser omentum and contains the gastrocolic ligament
- D.
Is known as the lesser omentum and contains the hepatoduodenal ligament
- E.
Is known as the greater omentum and contains the hepatogastric ligament
- F.
Is known as the lesser omentum and contains the gastrophrenic ligament
Correct Answer
D. Is known as the lesser omentum and contains the hepatoduodenal ligamentExplanation
The lesser omentum is a fold of peritoneum, which connects the lesser curvature of the stomach and duodenum with the liver and contains the hepatoduodenal and hepatogastric ligaments. The hepatoduodenal ligament is especially important because it contains the structures of the portal triad (portal vein, common bile duct, and the hepatic artery proper).Rate this question:
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Mar 20, 2023Quiz Edited by
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